Surgical and conservative treatment outcomes of medication-related osteonecrosis of the jaw in relation to tori: A retrospective study

Abstract

Purpose: Tori and exostoses are considered risk factors for the development of medication-related osteonecrosis of the jaw (MRONJ). The aim of this study was to present the prevalence of MRONJ in relation to tori in the Copenhagen ONJ Cohort, evaluate the surgical treatment of MRONJ in relation to tori and explore trauma to tori as an additional risk factor in patients on antiresorptive medication. Methods: Data from a consecutive series of 506 patients with MRONJ (Copenhagen ONJ Cohort) were reviewed for the presence of tori and MRONJ in relation to tori. Demographic and medical data were analyzed, and healing outcomes and pain after the prophylactic removal of tori, surgical treatment of MRONJ in relation to tori and conservative treatment of MRONJ in relation to tori were evaluated and compared using Fisher’s exact test. Results: Thirty-four patients were included, of which 28 were surgically treated and six were conservatively treated. Of the surgically treated patients, 27 (96.4%) healed uneventfully after their first or second revision surgery. Fourteen (41.2%) patients with tori underwent therapeutic removal, eight (23.5%) underwent prophylactic removal, and six (17.6%) underwent both therapeutic and prophylactic removal. Two (33.3%) of the six conservatively treated patients healed spontaneously, while four remained unhealed. Both treatment types resulted in a significant decrease in pain. Conclusion: Prophylactic and therapeutic surgical removal of tori are reliable treatments and should be considered if a patient’s general health allows surgery. The study was approved by The Regional Scientific Ethical Committee (H-6-2013-010) on November 20, 2013, and was retrospectively registered