MRONJ is triggered by invasive dental procedures. Dental extraction is the most common predisposing event of the disease.
Literature reports that 52 to 61% of patients who receive dental extractions and are exposed to antiresorptive or antiangiogenic therapy may develop MRONJ .
Numerous risk reduction strategies have been attempted over the years with the aim of reducing the development of the disease in this group of patients. These include pre-operative withdrawal of the anti-resorptive/anti-angiogenic medication, peri-operative antibiotic therapy and modified surgical procedures (Table 1).
However, there is no robust evidence that any of the strategies attempted so far is effective in reducing the risk of MRONJ development.
Tables I: Research overview of adjusted protocols and relative MRONJ rate as per literature
|
Authors |
Type of study |
Type of Adjusted protocol |
Number of Patients |
% MRONJ reported in the group studied |
|
Ferlito et al. 2011 |
CS |
Surgical + alveolectomy |
43 |
0% |
|
Hasegawa et al 2013 |
CS |
Dental extraction + drug holiday |
201 |
0% |
|
Lazarovici et al. 2010 |
CS |
Simple dental extraction |
27 |
51.9% |
|
Lodi et al 2010 |
CS |
Minimally Invasive + PC |
43 |
0% |
|
Migliorati et al. 2013 |
CH |
Minimally Invasive + SI |
13 |
7.7% |
|
Mozzati et al. 2013 |
RCT |
Atraumatic + PI Versus Surgical + SI
|
700 |
0% |
|
Mozzati et al. 2012 |
RCT |
Surgical extraction + PC and PRGF Versus Surgical extraction PC no PRGF |
176 |
2.8% |
|
Scoletta et al. 2013 |
CS |
Surgical + alveolectomy + PRGF |
63 |
1.6% |
|
Vescovi et al. 2013 |
CS |
Simple extraction + Laser |
95 |
5.3% |
References
Saad F, Brown JE, Van Poznak C, et al: Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-controlled phase III trials in cancer patients with bone metastases. Ann Oncol 2012; 23:1341
Fehm T, Beck V, Banys M, et al: Bisphosphonate-induced osteonecrosis of the jaw (ONJ): Incidence and risk factors in patients with breast cancer and gynecological malignancies. Gynecol Oncol. 2009; 112:605
Beth-Tasdogan NH, Mayer B, Hussein H, Zolk O. Interventions for managing medication-related osteonecrosis of the jaw. Cochrane Database System Review 2017 Oct 6; 10:CD012432
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