Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect caused by antiangiogenic antiresorptive drugs used to treat various oncological and non oncological diseases. The clinical and radiological characteristics of MRONJ depend on the type of causative drug, the time of administration, and its dosage. Proven systemic risk factors like anemia, uncontrolled diabetes, corticosteroid therapy, and chemotherapy in neoplastic diseases (e.g., high doses of methotrexate up to 30 mg daily) significantly increase the chances of acquiring MRONJ. The risk factors themselves can affect treatment outcomes. Although the main scientific societies have recently disseminated good practice rules on the patient's prevention, diagnosis, and management, there are still no guidelines on shared therapeutic strategies. In general, if conservative treatment fails, surgical treatment is considered, including local debridement, osteoplasty, and marginal or segmental osteotomy. In literature, cohorts of heterogeneous patients with MRONJ have been analyzed for a long time, resulting in a lack of uniformity of information and difficulties interpreting the data. According to the American Association of Oral and Maxillofacial Surgeons criteria, this retrospective study evaluates the surgical treatment outcomes of 64 patients with stage II-III MRONJ, evaluated at the Department of Maxillofacial Surgery of the University of Turin (Italy). The first objective of this retrospective study is to evaluate treatment results for stages II-III in all cases; the second objective is to evaluate the same results by dividing the sample into different cohorts of patients: first, based on the underlying pathology, i.e., oncological and non oncological, and secondly, based on the drug or combination of drugs they took.
Highlights
Medication-related osteonecrosis of the jaw (MRONJ) is an adverse drug reaction described as the progressive destruction and death of bone affecting the jaws of patients exposed to the treatment with medications known to increase the risk of disease in the absence of previous radiotherapy [1, 2].This pathological condition is a side effect of taking various molecules for different pathologies
Among the 32 patients included in the oncological cohort, 19 were treated only with antiresorptive drugs and 13 were treated with antiangiogenetic ones, of which 8 with antiresorptive drugs in association with antiangiogenic agents and 5 with only antiangiogenic agents
Among the 5 oncological patients treated with only antiangiogenic agents, the time of onset of MRONJ was 6.1-11 months, while for those treated with antiresorptive drugs alone or in combination with antiangiogenic agents, the time of onset was 6.516.71 months
Summary
Medication-related osteonecrosis of the jaw (MRONJ) is an adverse drug reaction described as the progressive destruction and death of bone affecting the jaws of patients exposed to the treatment with medications known to increase the risk of disease in the absence of previous radiotherapy [1, 2]. This pathological condition is a side effect of taking various molecules for different pathologies. MRONJ develops in about 7-14% of oncologic patients who take high doses of bisphosphonates and denosumab and in 0.01-0.1%.
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