Weak evidence for the management of medication‐related osteonecrosis of the jaw: An overview of systematic reviews and meta‐analyses

Abstract

Background Although several therapies are proposed for medication‐related osteonecrosis of the jaw (MRONJ), to date there is no consensus or treatment protocol for MRONJ. This overview aims to summarize the available evidence on the management and outcomes of MRONJ. Methods An electronic search without language or date restrictions occurred in five databases and gray literature for articles published until March 2020. This overview was performed according to the PICO format. The eligibility criteria comprised systematic reviews (RS) with or without meta‐analyses that analyzed treatments outcomes for MRONJ. The methodological quality of each SR was evaluated using AMSTAR 2. Results Fifteen studies published between 2014 and 2020 were included in this overview. The summary of the evidence showed that conservative treatment and low level laser therapy can yield favorable results for early stages of MRONJ whereas surgical treatment seems to be better for advanced stages. However, qualitative assessment of the SRs highlighted a global low level of quality. Conclusions There is weak evidence to support treatment protocols for MRONJ. Because of the low quality of the SRs, highlighted by this overview, no insightful therapeutic recommendations can be issued for any intervention for MRONJ.

Clinical considerations for medication-related osteonecrosis of the jaw: a comprehensive literature review

“…Therefore, current treatment strategies for MRONJ have been constructed based on clinical aspects rather than scientific data. In this section, the treatment strategy for MRONJ at each stage is introduced based on several position papers [1,14,30,35], a clinical guideline [10], and other studies including systematic reviews and consensus statements by the International Task Force on ONJ [2,9,26,41,59].…”

“…No treatment is needed for the "At risk" stage, which is characterized by patients who have or had been treated with IV or oral antiresorptive or antiangiogenic therapy. However, patient education regarding MRONJ (prevalence, risks, and symptoms), maintenance of good oral hygiene, and reduction of modifiable risk factors is required to avoid development of MRONJ [1,10,26,35,59].…”

“…However, symptomatic treatment (chronic pain and infection control by appropriate medications) and conservative management are recommended for patients with Stage 0. A close follow-up system should be created for the early detection of progression to a higher stage of MRONJ [1,9,10,26,30,59].…”

Surgical vs conservative treatment of medication-related osteonecrosis of the jaw: A complex systematic review and meta-analysis

“…Various conservative measures such as antibiotics and mouth rinse, alone or in combination with different surgical interventions, have been reported. Low-level laser therapy 3,4 or laser surgery 5,6 have been found to reduce local symptoms and improve healing. A high success rate has also been found after application of autologous platelet concentrates 7,8 and hyperbaric oxygen has been suggested to improve early healing 9 .…”

New Perspective for Soft Tissue Closure in Medication-Related Osteonecrosis of the Jaw (MRONJ) Using Barbed Sutures

“…Regarding MRONJ treatment, there is still no internationally accepted consensus to date [ 8 ]. Conservative approaches comprise of improvement and maintenance of good oral hygiene, elimination of active dentoalveolar pathologies, and application of antibacterial mouth rinses and systemic antibiotic therapy [ 9 ].…”