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Medication-related osteonecrosis of the jaw: evolving research for multimodality medical management

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Abstract

Purpose

Medication-related osteonecrosis of the jaw (MRONJ) is a debilitating side effect of antiresorptive and antiangiogenic agents that can lead to progressive bone destruction in the maxillofacial region. Dental surgery, including tooth extractions, commonly trigger the onset of MRONJ. While guidelines suggest avoiding extraction when possible, complete avoidance is not always feasible, as necrosis can develop from dental and periodontal disease without dental procedures. The goal of this article is to provide an update review of current preventive and therapeutic approaches for MRONJ.

Methods

A comprehensive electronic search was conducted on PubMed/MEDLINE, Embase, and Scopus databases. All English articles encompassing randomized controlled trials, systematic reviews, observational studies, and case studies were reviewed. The current medical treatments and adjuvant therapies for managing MRONJ patients were critically assessed and summarized.

Results

Pentoxifylline and alpha tocopherol (PENT-E), teriparatide, photobiomodulation (PBM), photodynamic therapy (PDT), and the use of growth factors have shown to enhance healing in MRONJ patients. Implementing these methods alone or in conjunction with surgical treatment has been linked to reduced discomfort and improved wound healing and increased new bone formation.

Discussion

While several adjuvant treatment modalities exhibit promising results in facilitating the healing process, current clinical practice guidelines predominantly recommend antibiotic therapy as a non-surgical approach, primarily addressing secondary infections in necrotic areas. However, this mainly addresses the potential infectious complication of MRONJ. Medical approaches including PENT-E, teriparatide, PBM, and PDT can result in successful management and should be considered prior to taking a surgical approach. Combined medical management for both preventing and managing MRONJ holds potential for achieving optimal clinical outcomes and avoiding surgical intervention, requiring further validation through larger studies and controlled trials.

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Data availability

The data of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Oral Medicine & Oral Pathology Clinic, Montreal General Hospital, Montreal, QC, Canada

    Ali Abdolrahmani

  2. Department of Surgery, City of Hope National Cancer Center, Duarte, CA, USA

    Joel B. Epstein

  3. Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA

    Joel B. Epstein

  4. Faculty of Dental Medicine and Oral Health, McGill University, Montreal, QC, Canada

    Firoozeh Samim

Authors
  1. Ali Abdolrahmani
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  2. Joel B. Epstein
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  3. Firoozeh Samim
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Contributions

JE and FS contributed to the study conception and design. AA contributed to literature search. AA and JE contributed to original draft preparation. JE and FS contributed to critical revision of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Firoozeh Samim.

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Abdolrahmani, A., Epstein, J.B. & Samim, F. Medication-related osteonecrosis of the jaw: evolving research for multimodality medical management. Support Care Cancer 32, 212 (2024). https://doi.org/10.1007/s00520-024-08388-4

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