Evaluation of Various Therapeutic Approaches in Treating Medication-related Osteonecrosis of the Jaw: A Systematic Review

Background and Aims: Medication-related osteonecrosis of the jaws (MRONJ) is a significant and potentially debilitating side effect caused by antiresorptive and antiangiogenic drugs, which can lead to bone exposure in the oral cavity. However, the management of this condition remains controversial, with adjuvant therapies being employed despite limited scientific evidence. This systematic review aimed to identify effective therapeutic procedures for treating MRONJ.

Methodology: A literature search was conducted without any temporal limitations. The PRISMA protocol was followed. To identify relevant studies, we developed electronic search strategies for various bibliographic databases, as Cochrane, Embase, PubMed, Scopus, and Web of Science. It was conducted a comprehensive analysis of 30 studies involving 2,079 patients from 35 countries to evaluate the effectiveness of various treatment approaches for MRONJ.

Results: The systematic review revealed that long-term use of Zoledronic acid for approximately 452.04 months (±27.41; 12-102) exposed many patients (n=772) to the risk of MRONJ. Similarly, Alendronate use for approximately 104.4 months (±60.16; 6-180) also posed a risk, affecting 650 patients, while Pamidronate use for about 20.74 months (±4.94; 6-96) was associated with MRONJ risk in 121 patients. Among the treatment approaches, conservative surgical management was the most frequently employed (27.92%), followed by local debridement (13.57%) and conservative treatment (11.21%). Treatment complications were observed in 13.03% of cases, with the most frequent complications being resistant or worsening clinical stage of osteonecrosis, followed by incomplete mucosal healing or dehiscence and mental nerve injury.

Conclusion: While conservative surgical management, local debridement, and conservative treatment are commonly utilized approaches, the treatment of MRONJ lacks a standardized consensus due to the scarcity of scientific evidence. Further research and comprehensive studies are imperative to establish effective therapeutic strategies for managing this condition.