Abstract
The Medication-Related Osteonecrosis of Jaws (MRONJ) diagnosis process and its prevention play a role of great and rising importance, not only on the Quality of Life (QoL) of patients, but also on the decision-making process by the majority of dentists and oral surgeons involved in MRONJ prevention (primary and secondary). The present paper reports the update of the conclusions from the Consensus Conference—held at the Symposium of the Italian Society of Oral Pathology and Medicine (SIPMO) (20 October 2018, Ancona, Italy)—after the newest recommendations (2020) on MRONJ were published by two scientific societies (Italian Societies of Maxillofacial Surgery and Oral Pathology and Medicine, SICMF and SIPMO), written on the inputs of the experts of the Italian Allied Committee on ONJ (IAC-ONJ). The conference focused on the topic of MRONJ, and in particular on the common practices at risk of inappropriateness in MRONJ diagnosis and therapy, as well as on MRONJ prevention and the dental management of patients at risk of MRONJ. It is a matter of cancer and osteometabolic patients that are at risk since being exposed to several drugs with antiresorptive (i.e., bisphosphonates and denosumab) or, more recently, antiangiogenic activities. At the same time, the Conference traced for dentists and oral surgeons some easy applicable indications and procedures to reduce MRONJ onset risk and to diagnose it early. Continuous updating on these issues, so important for the patient community, is recommended.
Highlights
Medication-Related Osteonecrosis of Jaws (MRONJ) and its prevention play a role of great and rising importance, on the Quality of Life (QoL) of patients, and on the decision-making process of the majority of dentists and oral surgeons, involved every day in MRONJ prevention
Assume that the Consensus Conference embraced the principles and good practices promoted by the new recommendations by SIPMO/SICMF (June 2020) with respect to therapeutic strategies [6,14]; it focuses, here, on the following hot topics: perioperative antibiotic regimen; bone biopsy in patients suffering from clinical–radiological evidence of MRONJ; role of preoperative imaging; anticipated surgery versus planned exfoliation; the shaving and smoothing of bone surfaces during surgical therapy; surgery-related quality of life issues for MRONJ patients; impact of the type of medication on the treatment decision-making of patients with BP-related and non-BP related MRONJ; surgery for asymptomatic MRONJ; and the role of bone turnover markers for surgery
MRONJ is a potentially severe complication of antiresorptive and/or antiangiogenic treatment in patients with skeletal events due to various cancers as well as osteometabolic diseases; MRONJ may lead to a reduced quality of life due to jawbone infections, chronic pain, tooth loss and compromised function
Summary
Medication-Related Osteonecrosis of Jaws (MRONJ) and its prevention play a role of great and rising importance, on the Quality of Life (QoL) of patients, and on the decision-making process of the majority of dentists and oral surgeons, involved every day in MRONJ prevention (primary and secondary). The updated Consensus Conference focused on the common practices still at risk of inappropriateness in MRONJ diagnosis and prevention, and on the dental management of patients exposed to ONJ. It is matter for the cancer (principally) and osteometabolic patients, since they are exposed to an increasing number of drugs with antiresorptive (i.e., bisphosphonates and denosumab) or antiangiogenic activities (e.g., bevacizumab; aflibercept; inhibitors of Tyrosine Kinases, TKIs; and mTOR inhibitors) [6,8,11,15,16,17,18]. The IAC-ONJ planned that a recommended practice equivalent will be advised for any inappropriate practice, within these 6 issues
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