Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a rare, severe debilitating condition from unknown causes. It is characterized by nonhealing exposed bone in a patient with a history of antiresorptive or antiangiogenic agents in the absence of radiation exposure to the head and neck region. The first case of MRONJ was reported in the early 2000s. Diagnostic criteria for MRONJ was developed by the American Association of Oral and Maxillofacial Surgeons (AAOMS) based on pharmacological history as well as clinical and radiographic features. Antiresorptive medications such as bisphosphonate and denosumab are currently considered the treatment of choice in patients with osteoclastic bone disease. These reduce bone turnover and improve bone density, thereby improving bone quality. These agents have also been shown to reduce the risk of osteoporotic fractures due to their potent effect in suppressing osteoclastic activity by slowing the remodeling process and increasing bone density, thereby improving quality of life for most of the patients. Despite the great benefits of bisphosphonates and other antiresorptive medications, osteonecrosis of the jaw (ONJ) due to the effects of these medications in the presence of a local risk factor is a significant drawback. Moreover, antiangiogenic drugs play a major role in developing bone necrosis. They are prescribed in cancer cases to prevent metastasis through the blood and lymph nodes. These drugs interfere with the formation of new blood vessels, resulting in ischemia and eventually ONJ. This risk can be managed by evaluating the route and the duration of administration as such a risk can be considered dose-time dependent. As a preventive measure, dental screening before initiating any type of ONJ-related medications can significantly lower the risk of ONJ. Treatment goals can be achieved through pain and infection control, in addition to the management of bone necrosis and resorption. The aim of this review is to identify all causative agents and summarize the preventive measures, diagnostic criteria, and treatment strategies related to MRONJ.
Highlights
BackgroundMedication-related osteonecrosis of the jaw (MRONJ) is a rare but severe debilitating condition, the exact cause for which has not yet been determined [1,2]
Diagnostic criteria for MRONJ was developed by the American Association of Oral and Maxillofacial Surgeons (AAOMS) based on pharmacological history as well as clinical and radiographic features
The aim of this review is to identify all causative agents and summarize the preventive measures, diagnostic criteria, and treatment strategies related to MRONJ
Summary
Medication-related osteonecrosis of the jaw (MRONJ) is a rare but severe debilitating condition, the exact cause for which has not yet been determined [1,2]. Patients undergoing surgical extraction or any other dentoalveolar surgery with a history or current bisphosphonate use through an oral route of administration for less than four years with no clinical risk factor have a low risk of developing MRONJ and require no alteration in the planned procedure [6]. At-risk patients with a history of antiresorptive or antiangiogenic drugs require no treatment with close clinical and radiographic monitoring They need to be educated about the possibility of bone exposure and further bone necrosis. The surgical approach varies between debridement to complete resection with possible immediate reconstruction with plates or obturators
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