Impact on dental therapeutic decisions regarding medication related osteonecrosis of the jaw (MRONJ)

Abstract

American Association of Oral and Maxillofacial Surgeons (AAOMS) defines Medication-Associated
Osteonecrosis of the Jaw (MRONJ) in 2022 as “An area of necrotic bone exposed to the oral environment
for more than eight weeks, in the presence of chronic treatment with antiresorptive drugs (AR):
bisphosphonates and/or denosumab and immunomodulatory drugs, in the absence of radiotherapy to the
head and neck”. Previously, AAOMS divided the pathology into 4 stages from 0 to 3 in 2014.
Medical-dental clinical care guidelines have been established in an interdisciplinary preventive manner to
obtain joint clinical recommendations in order to optimize clinical decision-making in our patients, in
accordance with what was agreed in the MRONJ Guide published in 2020.
According to the above, it is essential to consolidate atraumatic therapeutic options in patients who present
the need for AR prescription, understanding the maxillary bone physiology and the pharmacology of the
drugs involved responsible for the development of MRONJ, converging this objective in two lines of study
corresponding to the Doctoral Theses in development: “Retrospective study of patients diagnosed with
MRONJ (Medication related Osteonecrosis of the Jaw) treated surgically”. Od. Sergio Armando Rodriguez
Genta.
“Endodontic observational study in patients treated with antiresorptive, antiangiogenic and/or
immunomodulatory drugs in relation to the pathology of MRONJ (Medication related Osteonecrosis of the
Jaw)”. Od. Jorge Mario Basilaki.
As dentists, we consider extremely important the medical necessity of prescribing AR and the
ineffectiveness of suspending it when making clinical dental decisions. We contraindicate all types of
invasive therapies that involve the manipulation of the maxillary bone, even if they are minimally invasive:
extractions, debridements, implant placement, with endodontics being extremely important in order to
control the inflammatory signs and symptoms of patients diagnosed with MRONJ