6533b7defe1ef96bd1276881

RESEARCH PRODUCT

The Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review with a Pooled Analysis of Only Surgery versus Combined Protocols

Rodolfo MauceriRodolfo MauceriRodolfo MauceriFederica CanepaVittorio FuscoCarmine Del GaizoGiuseppe PizzoAntonio GalvanoP TozzoGiuseppina CampisiAlberto BedogniOlga Di FedeVera Panzarella

subject

medicine.medical_specialtyHealth Toxicology and Mutagenesismedicine.medical_treatmentONJReviewsurgerymedicineHumansAdverse effectONJ Osteonecrosis Staging Surgery Therapy TreatmenttherapyONJ; Osteonecrosis; Staging; Surgery; Therapy; Treatment; Bisphosphonate-Associated Osteonecrosis of the Jaw; Diphosphonates; Humans; Bone Density Conservation AgentsDiphosphonatesBone Density Conservation Agentstreatmentbusiness.industryosteonecrosisSignificant differenceBlood componentRPublic Health Environmental and Occupational HealthstagingSurgical proceduresmedicine.diseaseSurgeryPooled analysisImprovement rateMedicineBisphosphonate-Associated Osteonecrosis of the JawOsteonecrosis of the jawbusinessAdjuvant

description

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents, and it is also a potentially painful and debilitating condition. To date, no specific studies have prospectively evaluated the efficacy of its treatment and no robust standard of care has been established. Therefore, a systematic review (2007–2020) with a pooled analysis was performed in order to compare MRONJ surgical techniques (conservative or aggressive) versus combined surgical procedures (surgery plus a non-invasive procedure), where 1137 patients were included in the pooled analysis. A statistically significant difference in the 6-month improvement rate, comparing combined conservative surgery versus only aggressive (91% versus 72%, p = 0.05), was observed. No significant difference regarding any group with respect to the 6-month total resolution rate (82% versus 72%) was demonstrated. Of note, conservative surgery combined with various, adjuvant, non-invasive procedures (ozone, LLLT or blood component + Nd:YAG) was found to achieve partial or full healing in all stages, with improved results and the amelioration of many variables. In conclusion, specific adjuvant treatments associated with minimally conservative surgery can be considered effective and safe in the treatment of MRONJ, although well-controlled studies are a requisite in arriving at definitive statements

yearjournalcountryeditionlanguage
2021-08-10International Journal of Environmental Research and Public Health
https://doi.org/10.3390/ijerph18168432