Medication-Related Osteonecrosis of The Jaws, Surgical or Non-Surgical Treatment: The Retrospective Study

Abstract

Objectives: Radiation (ORNJ) and bisphosphonate-related (BRONJ) osteonecrosis of the jaw represent challenging entities to treat, with many patients requiring segmental resection and reconstruction with microvascular free tissue transfer (MFTT) in the setting of failed conservative therapy.

Materials and methods: Every lesion was identified and categorized in accordance with the 2014 AAOMS Position Paper's guidelines. The primary disease diagnosis, antiresorptive or anti-angiogenic regimen and schedule, existence of comorbidities or other risk reasons, time to MRONJ onset, potential relationship with dental practices & manifestation of pain and/or other symptoms were all gathered from each patient's medical history. To ascertain the existence and extent of bone exposure, soft tissue edema, pus discharge, and tooth movement, each patient received a clinical examination. To further identify the extent and boundaries of the lesions, radiological examinations were also carried out, such as orthopantomography (OPG) & improved multiline spiral computed tomography (EMS-CT) with 3D reconstruction.

Results: The current study comprised 20 individuals in total who had 34 MRONJ lesions. Group A com-prised 15 patients with 27 lesions (average age 62.1 years, 9 males, 6 females) who had surgery. Group B includes 5 patients with 7 lesions (average age 61 years, 3 males, 2 females) who had non-surgical therapy. Table 1 reports the clinical characteristics of the lesions in both groups. Both Group A and B patients had recurring follow-up, with a mean follow-up duration of 1.6 years (range: 12–28 months). A retrospective comparative cohort study found that 88.9% of lesions healed with surgery, compared to 0% with non-surgical care. treatment choice was based on AAOMS stage severity, with outcomes assessed by a blinded examiner.

Conclusion: The results reinforce the significance of early detection, customized therapeutic approaches, and continued exploration of innovative strategies to enhance MRONJ management and patient outcomes.