MRONJ

Medication-related osteonecrosis of the jaw (MRONJ) is defined as exposed bone or necrotic bone in the maxillofacial region that does not heal within eight weeks, occurring in patients with current or past exposure to antiresorptive or antiangiogenic agents, and with no history of radiation therapy to the jaws.

The condition is multifactorial. Potential mechanisms include suppression of bone remodeling by antiresorptives (such as bisphosphonates and denosumab), inhibition of angiogenesis, local trauma, infection, and impaired soft tissue healing. The interaction of these factors can lead to bone exposure and necrosis in the jaw.

Risk factors include high-dose intravenous bisphosphonates or denosumab used for cancer and multiple myeloma, other antiangiogenic drugs, invasive dental procedures, poor oral health, smoking, diabetes, and glucocorticoid therapy.

Diagnosis is clinical, based on the presence of exposed or nonhealing necrotic bone in the jaw for more than eight weeks, in a patient with antiresorptive or antiangiogenic therapy and no prior radiation to the jaws. Imaging can aid assessment but is not definitive; radiographs may show sequestra or osteolysis in some cases.

Management is staged and individualized. It ranges from conservative measures—improved oral hygiene, chlorhexidine rinses, antibiotics for infection, and pain control—to surgical debridement or resection in advanced cases. Temporary interruption of antiresorptive therapy may be considered in collaboration with the treating physician, depending on cancer risk.

Prevention emphasizes dental evaluation before starting antiresorptive or antiangiogenic therapy, treatment of active dental disease, and avoidance of invasive procedures during therapy when possible. Regular dental follow-up and meticulous oral care reduce risk and support better outcomes.