Surgical vs conservative treatment of medication-related osteonecrosis of the jaw: A complex systematic review and meta-analysis

Abstract

The objective of this study was to compare the outcome of surgical and conservative treatment approaches for medication-related osteonecrosis of the jaw. Publications in Medline, The Cochrane Library, EMBASE, and PubMed (non-indexed articles) and by Health Technology Assessment organizations were searched. Quality of evidence in primary studies were assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the level of bias in systematic reviews by a measurement tool to assess systematic reviews (AMSTAR). Quality assessment identified 3 primary studies with moderate GRADE score. Moderate risk of bias was found in 7 systematic reviews and low risk of bias in 3. Nine studies were included in the meta-analysis, where 62.1% healing was reported after surgical treatment (144 of 232 included patients) and 28.8% healing was reported after conservative treatment (38 of 132 included patients). Moderate heterogeneity was found among the included studies (P=.02). The overall odds ratio for resolution of osteonecrosis after surgical versus conservative treatment was 1.25 (95% confidence interval, 0.24-2.26) and was not statistically significant. Slightly better outcomes are reported after surgical treatment, in particular for advanced disease stages, but there is a lack of standardized treatment protocols and outcome measures. Overall, the quality of evidence is poor, and the majority of studies have a low evidence certainty rating and high risk of bias.