Medication-Related Osteonecrosis of Jaws (MRONJ) Prevention and Diagnosis: Italian Consensus Update 2020

Abstract

The Medication-Related Osteonecrosis of Jaws (MRONJ) diagnosis process and its prevention play a role of great and rising importance, not only on the Quality of Life (QoL) of patients, but also on the decision-making process by the majority of dentists and oral surgeons involved in MRONJ prevention (primary and secondary). The present paper reports the update of the conclusions from the Consensus Conference—held at the Symposium of the Italian Society of Oral Pathology and Medicine (SIPMO) (20 October 2018, Ancona, Italy)—after the newest recommendations (2020) on MRONJ were published by two scientific societies (Italian Societies of Maxillofacial Surgery and Oral Pathology and Medicine, SICMF and SIPMO), written on the inputs of the experts of the Italian Allied Committee on ONJ (IAC-ONJ). The conference focused on the topic of MRONJ, and in particular on the common practices at risk of inappropriateness in MRONJ diagnosis and therapy, as well as on MRONJ prevention and the dental management of patients at risk of MRONJ. It is a matter of cancer and osteometabolic patients that are at risk since being exposed to several drugs with antiresorptive (i.e., bisphosphonates and denosumab) or, more recently, antiangiogenic activities. At the same time, the Conference traced for dentists and oral surgeons some easy applicable indications and procedures to reduce MRONJ onset risk and to diagnose it early. Continuous updating on these issues, so important for the patient community, is recommended.

Complementarity of Photo-Biomodulation, Surgical Treatment, and Antibiotherapy for Medication-Related Osteonecrosis of the Jaws (MRONJ)

“…Such an approach is confirmed by recent studies, which point out to the better effectiveness of combining different techniques for treating MRONJ [ 73 ], but also to the necessity to diagnose it early and to treat it efficiently [ 74 ]. Other recent aspects of interest refer to telemedicine approaches of such conditions in pandemic situations [ 75 ].…”

A Review of Literature on Updates of Bisphosphonates Administration, Cancer Biomarkers for Bisphosphonate Therapy, and Bisphosphonate-related Osteonecrosis of the Jaw in Breast Cancer

“…MRONJ diagnosis process and its prevention play an important role on the quality of life of patients and the decision-making process by the majority of dentists involved in MRONJ prevention. A recent paper by Campisi et al (33) reports the update of the conclusions from the Consensus conference, focused on the topic of MRONJ, and in particular on the common practices at risk of inappropriateness in MRONJ diagnosis and therapy, as well as on MRONJ prevention and the dental management of patients at risk of MRONJ. It is a matter of cancer and osteometabolic patients that are at risk since being exposed to several drugs with antiresorptive (bisphosphonates) or, more recently, antiangiogenic activities.…”

The Role of the Immune Response in the Development of Medication-Related Osteonecrosis of the Jaw

“…According to the definition by the American Association of Oral and Maxillofacial Surgeons (AAOMS) in 2014, MRONJ is characterized by the following: “(1) exposed bone in the maxillofacial region that does not heal within 8 weeks after identification; (2) exposure to an anti-resorptive agent; and (3) no history of radiation therapy to the craniofacial region” ( 2 ). However, based on newest recommendations (2020) on MRONJ, MRONJ is defined as an “adverse drug reaction described as the progressive destruction and death of bone that affects the mandible and maxilla of patients exposed to the treatment with medications known to increase the risk of disease, in the absence of a previous radiation treatment” ( 3 ). Additionally, the workshop of the European task force on MRONJ in 2019 suggested that it may no longer be necessary to require an 8-week observation of potential MRONJ manifestation to fit the case definition ( 4 ).…”