MEDICATION-RELATED OSTEONECROSIS OF THE JAWS, SURGICAL OR NON-SURGICAL TREATMENT: THE RETROSPECTIVE STUDY

Authors

  • Hina Jabeen Department of Oral and Maxillofacial Surgery, Bhitai Medical and Dental College, Mirpurkhas, Sindh, Pakistan.
  • Saeed Ullah Shah Department of Oral Medicine, Altamash Institute of Dental Medicine, Karachi, Pakistan.
  • Mohammad Umar Department of Oral and Maxillofacial Surgery, Rawal Institute of Health Sciences, Rawalpindi, Pakistan.
  • Muhammad Uzair Jamal Department of Oral and Maxillofacial Surgery, Jinnah Medical and Dental College, Karachi, Pakistan.
  • Shumaila Younus Department of Oral Pathology, Jinnah Medical and Dental College, Karachi, Pakistan.
  • Raja Muhammad Daniyal Department of Oral and Maxillofacial Surgery, Fatima Jinnah Dental College, Karachi, Pakistan.

DOI:

https://doi.org/10.33279/jkcd.v15i03.850

Keywords:

Bisphosphonates, American Association of Oral & Maxillofacial Surgery,, MRONJ

Abstract

Objectives: To inform stage-consistent decision-making, we compared surgical versus non-surgical outcomes using AAOMS 2014 criteria with blinded assessment and predefined endpoints. This retrospective research aimed to characterize the course of treatment and results for 20 MRONJ patients.
Materials and Methods: Every lesion was identified and categorized in accordance with the 2014 AAOMS Position Paper's guidelines.5 The primary disease diagnosis, antiresorptive or anti-angiogenic regimen and schedule, existence of comorbidities or other risk reasons, time to MRONJ onset, potential relationship with dental practices & manifestation of pain and/or other symptoms were all gathered from each patient's medical history. To ascertain the existence and extent of bone exposure, soft tissue edema, pus discharge, and tooth movement, each patient received a clinical examination. To further identify the extent and boundaries of the lesions, radiological examinations were also carried out, such as orthopantomography (OPG) & improved multiline spiral computed tomography (EMS-CT) with 3D reconstruction.
Results: The current study comprised 20 individuals in total who had 34 MRONJ lesions. Group A comprised 15 patients with 27 lesions (average age 62.1 years, 9 males, 6 females) who had surgery. Group B includes 5 patients with 7 lesions (average age 61 years, 3 males, 2 females) who had non-surgical therapy. Table 1 reports the clinical characteristics of the lesions in both groups. Both Group A and B patients had recurring follow-up, with a mean follow-up duration of 1.6 years (range: 12–28 months). A retrospective
comparative cohort study found that 88.9% of lesions healed with surgery, compared to 0% with non-surgical care treatment choice was based on AAOMS stage severity, with outcomes assessed by a blinded examiner.
Conclusion: The results reinforce the significance of early detection, customized therapeutic approaches, and continued exploration of innovative strategies to enhance MRONJ management and patient outcomes.

References

Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons’ position paper on medication-related osteonecrosis of the jaws—2022 update. Journal of oral and maxillofacial surgery. 2022 May 1;80(5):920-43.

Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. Journal of oral and maxillofacial surgery. 2003 Sep 1;61(9):1115-7.

Byrne H, O’reilly S, Weadick CS, Brady P, Ríordáin RN. How we manage medication-related osteonecrosis of the jaw. European Journal of Medical Research. 2024 Aug 2;29(1):402.

Tetradis S, Allen MR, Ruggiero SL. Pathophysiology of Medication‐Related Osteonecrosis of the Jaw—A Minireview. Journal of Bone and Mineral Research Plus. 2023 Aug 1;7(8):e10785.

Ruan HJ, Li MY, Zhang ZY, Ma HL, He Y. Medication-related osteonecrosis of the jaw: a retrospective single center study of recurrence-related factors after surgical treatment. Clinical Oral Investigations. 2024 Oct;28(10):1-2.

Kwon YD, Jo H, Kim JE, Ohe JY. A clinical retrospective study of implant as a risk factor for medication-related osteonecrosis of the jaw: surgery vs loading?. Maxillofacial Plastic and Reconstructive Surgery. 2023 Sep 14;45(1):31.

Ruan HJ, Li MY, Zhang ZY, Ma HL, He Y. Medication-related osteonecrosis of the jaw: a retrospective single center study of recurrence-related factors after surgical treatment. Clinical Oral Investigations. 2024 Oct;28(10):1-2.

AlDhalaan NA, BaQais A, Al-Omar A. Medication-related osteonecrosis of the jaw: a review. Cureus. 2020 Feb;12(2).

Lobekk OK, Dijkstra W, Pedersen TØ. Surgical vs conservative treatment of medication-related osteonecrosis of the jaw: A complex systematic review and meta-analysis. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2021 Dec 1;132(6):671-9.

Choi NR, Lee JH, Park JY, Hwang DS. Surgical treatment of medication-related osteonecrosis of the jaw: a retrospective study. International journal of environmental research and public health. 2020 Dec;17(23):8801.

Kün-Darbois JD, Fauvel F. Medication-related osteonecrosis and osteoradionecrosis of the jaws: Update and current management. Morphologie. 2021 Jun 1;105(349):170-87.

Wick A, Bankosegger P, Otto S, Hohlweg-Majert B, Steiner T, Probst F, Ristow O, Pautke C. Risk factors associated with onset of medication-related osteonecrosis of the jaw in patients treated with denosumab. Clinical oral investigations. 2022 Mar 1:1-4.

Bensi C, Giovacchini F, Lomurno G, Eramo S, Barraco G, Tullio A. Quality of life in patients affected by medication-related osteonecrosis of the jaws: A systematic review. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2021 Aug 1;132(2):182-9.

Şahin O, Akan E, Tatar B, Ekmekcioğlu C, Ünal N, Odabaşı O. Combined approach to treatment of advanced stages of medication-related osteonecrosis of the jaw patients. Brazilian Journal of Otorhinolaryngology. 2022 Aug 15;88(4):613-20.

He L, Sun X, Liu Z, Qiu Y, Niu Y. Pathogenesis and multidisciplinary management of medication-related osteonecrosis of the jaw. International journal of oral science. 2020 Dec;12(1):30.

Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O’Ryan F. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. J Oral Maxillofac Surg. 2014;7210:1938–56.

Bedogni A, Fusco V, Agrillo A, Campisi G. Learning from experience. Proposal of a refined definition and staging system for MRONJ. Oral Dis. 2012;186:621–3.

Downloads

Published

2025-09-30

How to Cite

Jabeen, H. ., Shah, S. U. ., Umar , M. ., Muhammad Uzair Jamal, Younus, S. ., & Daniyal , R. M. . . (2025). MEDICATION-RELATED OSTEONECROSIS OF THE JAWS, SURGICAL OR NON-SURGICAL TREATMENT: THE RETROSPECTIVE STUDY. JOURNAL OF KHYBER COLLEGE OF DENTISTRY, 15(03), 31–37. https://doi.org/10.33279/jkcd.v15i03.850