DR. CHANDRASEKARAN KRITHIKA,DR. ASHWINI DESHPANDE,DR. CHITATHOOR SRIDHAR,DR. MANJU. J,DR. PONNULAKSHMI,DR. SELVARAJ JAYARAMAN
DOI: https://doi.org/Background: Medication-Related Osteonecrosis of the Jaw (MRONJ) is a severe condition associated with antiresorptive and antiangiogenic therapies, primarily affecting patients with osteoporosis and metastatic bone disease. Despite extensive research, optimal treatment strategies remain uncertain due to variability in clinical management and outcomes.
Aim: This systematic review evaluates the comparative effectiveness of surgical, non-surgical, and pharmacological treatment modalities for MRONJ in achieving optimal healing, symptom relief, and disease prevention.
Methodology: A systematic search was conducted across PubMed, Embase, Cochrane Library, Scopus, Web of Science, and CINAHL, adhering to PRISMA 2020 guidelines. Studies published between January 2017 and June 2024, including randomized controlled trials, cohort, and case-control studies, were included. Data extraction was performed by two independent reviewers, and study quality was assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool. A narrative synthesis identified treatment trends and clinical outcomes. Fourteen studies met the inclusion criteria, providing insights into MRONJ management strategies.
Results: This review analysed 14 studies involving 1,539 MRONJ patients. Surgical treatments, such as sequestrectomy and resection, showed superior healing, with success rates of 100% in Stage I & II and 86.5% in Stage III. Conservative approaches, including antiseptics, antibiotics, and laser therapy, had limited effectiveness, with 79.8% disease progression. Teriparatide improved bone healing (p=0.013), while early antiresorptive discontinuation accelerated recovery (p=0.01). Zoledronic acid and denosumab posed the highest MRONJ risk, often following extractions (55.8%–73%). Surgical interventions had higher remission rates, while non-surgical methods stabilized disease progression.
Conclusion: Surgical interventions demonstrated superior healing outcomes in MRONJ management, particularly in early-stage cases, while conservative approaches primarily stabilized disease progression. Given the variability in treatment success, individualized management strategies and further research are essential to establish standardized protocols for optimizing patient outcomes and preventing MRONJ-related complications.
