Regenerative and surgical strategies for medication-related osteonecrosis of the jaw (MRONJ): a systematic review

Abstract

Aim: Medication-related osteonecrosis of the jaw (MRONJ) challenges clinicians with its complex pathology and high risk of complications.

Methods: We searched seven databases - PubMed, Scopus, Web of Science, Cochrane Library, Embase, CINAHL, and Google Scholar - and adapted the search strings for each database to optimize retrieval of relevant studies. We then systematically reviewed the included studies to identify the most effective treatments for promoting MRONJ healing.

Results: A total of 329 records were identified through database searches across seven electronic databases. After removal of 45 duplicates, 284 records were screened. Following title and abstract screening and full-text assessment, 13 studies met the eligibility criteria and were included in the qualitative synthesis. The included studies consisted primarily of randomized controlled trials and retrospective cohort studies investigating surgical, pharmacological, and adjunctive therapeutic strategies for MRONJ management. Risk-of-bias assessment using the RoB 2.0 and ROBINS-I (Risk of Bias in Non-randomised Studies - of Interventions) tools showed that most studies presented low to moderate risk of bias, although some methodological concerns were identified. Surgical interventions were commonly associated with improved clinical healing, while adjunctive therapies such as bone morphogenetic protein-2 and teriparatide showed promising outcomes in selected cases. Follow-up periods ranged from 1 month to 2 years, and outcome measures included clinical, radiological, and histological evaluations.

Conclusion: MRONJ treatment is diverse and multifaceted. Such inferences were made to varying degrees in previous investigations, illustrating the limitations for clinical use, revealing the need for further studies to clarify both the efficacy and optimal use of the interventions in diverse clinical settings.

Keywords

Alendronate / bisphosphonates / denosumab / bone regeneration / osteonecrosis / sequestrectomy / teriparatide

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