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The Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review with a Pooled Analysis of Only Surgery versus Combined Protocols

Author

Listed:
  • Olga Di Fede

    (Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90127 Palermo, Italy)

  • Federica Canepa

    (Operative Unit of Dentistry and Stomatology, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, 90146 Palermo, Italy)

  • Vera Panzarella

    (Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90127 Palermo, Italy)

  • Rodolfo Mauceri

    (Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90127 Palermo, Italy
    Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy
    Department of Dental Surgery, Faculty of Dental Surgery, University of Malta, MSD 2090 Msida, Malta)

  • Carmine Del Gaizo

    (Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90127 Palermo, Italy)

  • Alberto Bedogni

    (Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padova, 35128 Padova, Italy)

  • Vittorio Fusco

    (Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy)

  • Pietro Tozzo

    (Operative Unit of Dentistry and Stomatology, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, 90146 Palermo, Italy)

  • Giuseppe Pizzo

    (Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90127 Palermo, Italy)

  • Giuseppina Campisi

    (Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90127 Palermo, Italy)

  • Antonio Galvano

    (Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90127 Palermo, Italy)

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents, and it is also a potentially painful and debilitating condition. To date, no specific studies have prospectively evaluated the efficacy of its treatment and no robust standard of care has been established. Therefore, a systematic review (2007–2020) with a pooled analysis was performed in order to compare MRONJ surgical techniques (conservative or aggressive) versus combined surgical procedures (surgery plus a non-invasive procedure), where 1137 patients were included in the pooled analysis. A statistically significant difference in the 6-month improvement rate, comparing combined conservative surgery versus only aggressive (91% versus 72%, p = 0.05), was observed. No significant difference regarding any group with respect to the 6-month total resolution rate (82% versus 72%) was demonstrated. Of note, conservative surgery combined with various, adjuvant, non-invasive procedures (ozone, LLLT or blood component + Nd:YAG) was found to achieve partial or full healing in all stages, with improved results and the amelioration of many variables. In conclusion, specific adjuvant treatments associated with minimally conservative surgery can be considered effective and safe in the treatment of MRONJ, although well-controlled studies are a requisite in arriving at definitive statements

Suggested Citation

  • Olga Di Fede & Federica Canepa & Vera Panzarella & Rodolfo Mauceri & Carmine Del Gaizo & Alberto Bedogni & Vittorio Fusco & Pietro Tozzo & Giuseppe Pizzo & Giuseppina Campisi & Antonio Galvano, 2021. "The Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review with a Pooled Analysis of Only Surgery versus Combined Protocols," IJERPH, MDPI, vol. 18(16), pages 1-23, August.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:16:p:8432-:d:611633
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    References listed on IDEAS

    as
    1. Giuseppina Campisi & Rodolfo Mauceri & Francesco Bertoldo & Giordana Bettini & Matteo Biasotto & Giuseppe Colella & Ugo Consolo & Olga Di Fede & Gianfranco Favia & Vittorio Fusco & Mario Gabriele & An, 2020. "Medication-Related Osteonecrosis of Jaws (MRONJ) Prevention and Diagnosis: Italian Consensus Update 2020," IJERPH, MDPI, vol. 17(16), pages 1-15, August.
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    Cited by:

    1. Anna Winter & Stefan M. Schulz & Marc Schmitter & Roman C. Brands & Anton Straub & Alexander Kübler & Anna Borgmann & Stefan Hartmann, 2022. "Oral-Health-Related Quality of Life in Patients with Medication-Related Osteonecrosis of the Jaw: A Prospective Clinical Study," IJERPH, MDPI, vol. 19(18), pages 1-15, September.

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