The clinical effectiveness of conservative surgical management in medication-related osteonecrosis of the Jaw

• Published in: Journal of oral and maxillofacial surgery, medicine, and pathology Vol. 36; no. 4; pp. 471 - 477
• Main Authors: Kakehashi, Hiroe, Sakamoto, Mizuki, Moriyama, Masafumi, Goto, Yuichi, Kitamura, Ryoji, Ogata, Kenichi, Nakamura, Seiji, Kawano, Shintaro
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.07.2024
• Subjects: Conservative surgical management; Conservative treatment; Medication-related osteonecrosis of the jaw; Surgical treatment; Treatment algorithm; Conservative surgical management; Medication-related osteonecrosis of the jaw; Surgical treatment; Treatment algorithm; Conservative treatment
• ISSN: 2212-5558; 2212-5566
• DOI: 10.1016/j.ajoms.2023.11.001

Consensus has not yet been reached on the therapy for medication-related osteonecrosis of the jaw (MRONJ). We assessed the effectiveness of conservative surgical management, which involves removing the necrotic bone and performing a gingivectomy, followed by localized cleaning to facilitate the separation of the sequestrum. Additionally, we revalidated the treatment algorithm utilized by our department. We examined 160 patients diagnosed with MRONJ at three hospitals. The data for this study were collected retrospectively. These patients were followed up for a minimum of 2 years. The outcome 2 years after starting conservative surgical management was: cure: 117 cases; improvement: 22 cases; unchanged: 12 cases; and deterioration: 9 cases. The cure rate was 72.3% and 83.0% at 2 and 5 years after therapy initiation, respectively, and significantly lower at age ≥ 74 years compared to age < 74 years (P < 0.001), with malignant tumour as the primary disease when compared to osteoporosis (P < 0.001), and with ≥ 4 years of administration compared to < 4 years (P = 0.0301). On multivariate analysis, the trigger (P < 0.05), primary disease (P = 0.001), and administration period (P < 0.01) were independent prognostic factors. Conservative surgical management is effective for MRONJ regardless of stage, especially in patients with age < 74 years, osteoporosis, and short drug-administration periods, and could become a first-line therapy for all stages.