Surgical therapy for medication-related osteonecrosis of the jaw in osteoporotic patients treated with antiresorptive agents

Abstract

Background. Medication -related osteonecrosis of the jaw (MRONJ) is a rare but serious complication of antiresorptive and/or antiangiogenic therapy. It mainly affects oncological patients, however, it can occur in patients with metabolic bone diseases, although this is less frequent. These lesions not only significantly impair the quality of life but can also have impact on the treatment of any underlying disease. In some rare cases MRONJ can be life-threatening. There is still no ideal consensus for treatment, though surgical therapy has been mostly preferred in recent years. Materials and Methods. A monocentric retrospective evaluation of surgical therapy of MRONJ in osteoporotic patients, treated in the time period 3/2014-3/2018 using the uniform department-specific protocol. Results. 26 osteoporotic patients with 32 MRONJ lesions of stage 1 (9%), stage 2 (75%) and stage 3 (16%) were treated surgically. The maxilla: mandibula ratio was 1:2.2, in 19% of patients there was multiple jaw involvement. 69.2% of patients had received bisphosphonates, 15.4% denosumab and 15.4% had a history of both types of antiresorptive treatment. Complete healing was observed in all patients, in 9% of cases by secondary intention in the mean period of 6 weeks. The mean follow-up was 20.5 months. Conclusion. The presented protocol for surgical therapy was effective in the management of all MRONJ stages in the osteoporotic patients described here. The surgery is indicated as an early treatment to prevent complications and the progression of the lesions. It leads to improvement in quality of life and option to resume antiresorptive therapy if interrupted.

Workshop of European task force on medication‐related osteonecrosis of the jaw—Current challenges

“…However, there is an increasing body of evidence suggesting that surgical removal of necrotic bone might be curative in patients with all MRONJ stages (Aljohani et al, 2019;Otto et al, 2018;Ristow et al, 2018), where cure is defined as long-term resolution of symptoms and complete mucosal closure (absence of residual bone exposure). Other studies have documented high success rate of surgical treatment compared to non-surgical treatment (Aljohani et al, 2019;Hauer et al, 2019;Yamada et al, 2018).…”

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

“…A recent review concluded that surgical therapy compared with nonsurgical therapy has been associated with disease resolution [ 29 ]. The reported success rate has ranged from 34.5% to 90% [ 30 , 31 ].…”

“…To improve the treatment results, combined therapies using high-end technologies devices have been applied [ 30 ], and this is the strategic approach that we considered, as well. As an additional component during the surgery, plasma rich fibrin (PRF) has increased the fibroblasts and osteoblasts migration, proliferation and viability, with positive effect in bisphosphonate-related osteonecrosis of the jaws (BRONJ) treatment [ 31 ].…”

Extensive surgery in medication‐related osteonecrosis of the jaw for the prevention of infective endocarditis

“…Second, the treatment strategy for MRONJ that requires a timely outcome should be an extensive surgery. In recent years, surgical therapy has been recommended for MRONJ of Stage 2 or higher, as it is often associated with better outcomes than conservative [30][31][32] Surgical therapy can be divided into two categories: conservative surgery, in which only the necrotic bone is removed/ resected, and extensive surgery, in which the surrounding bone is resected flattened in addition to the necrotic bone. 33,34 Compared with conservative surgery, extensive surgery tends to be more invasive and is often performed under general anesthesia because the surrounding area of the necrotic bone is also resected.…”