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Review
. 2021 May 14;7(1):47.
doi: 10.1186/s40729-021-00323-0.

Clinical considerations for medication-related osteonecrosis of the jaw: a comprehensive literature review

Mampei Kawahara #  1 , Shinichiro Kuroshima #  2   3 , Takashi Sawase  1   4
Affiliations
Review

Clinical considerations for medication-related osteonecrosis of the jaw: a comprehensive literature review

Mampei Kawahara et al. Int J Implant Dent. .

Abstract

Background: Medication-related osteonecrosis of the jaw (MRONJ), which was first reported as bisphosphonate-related osteonecrosis of the jaw (BRONJ) in bisphosphonate users, is a rare but severe soft and hard tissue disease induced by several types of medications. There has been a deluge of information about MRONJ, such as epidemiology, risk factors, clinical recommendations for dental treatment to prevent it, and treatment strategies in medication-prescribed users. The aim of this study was to comprehensively review recent articles and provide the current scientific information about MRONJ, especially clinical considerations or recommendations for dental treatment to prevent its occurrence.

Materials and methods: The current literature review was mainly based on 14 systematic reviews with or without meta-analysis, 4 position papers, 1 consensus statement, 1 clinical guideline, and 2 clinical reviews regarding MRONJ after a PubMed database and manual searches according to inclusion and exclusion criteria. Moreover, 53 articles were selected by manual search in regard to all references from selected articles and other articles identified on the PubMed search, irrespective of publication date, and inclusion and exclusion criteria.

Results: The incidence and prevalence of MRONJ are relatively low, although they are clearly higher in cancer patients receiving high-dose antiresorptive agents or angiogenesis inhibitors rather than osteoporosis patients receiving oral bisphosphonates or denosumab. There are many types of local, systemic, and other risk factors for the development of MRONJ. Clinical recommendations are provided for each clinical situation of patients to prevent MRONJ. There are also treatment strategies for MRONJ in each stage.

Conclusions: General dentists should perform appropriate dental treatment to prevent MRONJ in the patients prior to or when receiving medications that could induce MRONJ. Moreover, there are treatment strategies for MRONJ in each stage that oral surgeons could follow. Adequate and updated clinical information regarding MRONJ based on scientific data is required whenever possible.

Keywords: Angiogenesis inhibitors; Antiresorptive agents; Bisphosphonates; Denosumab; Medication-related osteonecrosis of the jaw.

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Conflict of interest statement

Mampei Kawahara, Shinichiro Kuroshima, and Takashi Sawase declare that they have no competing interests.

References

    1. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O'Ryan F. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw–2014 update. J Oral Maxillofac Surg. 2014;72(10):1938–1956. doi: 10.1016/j.joms.2014.04.031. - DOI - PubMed
    1. Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, et al. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2015;30(1):3–23. doi: 10.1002/jbmr.2405. - DOI - PubMed
    1. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003;61(9):1115–1117. doi: 10.1016/S0278-2391(03)00720-1. - DOI - PubMed
    1. Aghaloo TL, Felsenfeld AL, Tetradis S. Osteonecrosis of the jaw in a patient on Denosumab. J Oral Maxillofac Surg. 2010;68(5):959–963. doi: 10.1016/j.joms.2009.10.010. - DOI - PMC - PubMed
    1. Taylor KH, Middlefell LS, Mizen KD. Osteonecrosis of the jaws induced by anti-RANK ligand therapy. Br J Oral Maxillofac Surg. 2010;48(3):221–223. doi: 10.1016/j.bjoms.2009.08.030. - DOI - PubMed

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