Purpose. To systematize current concepts regarding the etiopathogenesis, risk factors, approaches to early diagnosis, and comprehensive management of medication-related osteonecrosis of the jaws (MRONJ) in patients receiving bisphosphonates, denosumab, and/or antiangiogenic agents. Materials and methods. A systematic review of Russian and international publications from 2003 to 2024 was conducted using PubMed, Scopus, and eLIBRARY, selecting studies addressing the clinical presentation, imaging diagnostics, and treatment strategies for MRONJ. In addition, consensus statements and clinical practice guidelines issued by professional maxillofacial surgery societies (including AAOMS 2007–2022) were analyzed with respect to diagnostic criteria and patient care pathways. Results. The pathogenesis of MRONJ is multifactorial and involves suppression of bone remodeling, infection–inflammation with bacterial biofilms (including Actinomyces spp.), microcirculatory/angiogenic disturbances (VEGF-dependent mechanisms), and local immune dysregulation. According to multiple studies, the risk of complications increases with drug type, route of administration, cumulative dose, and treatment duration; in some reports, denosumab is associated with a higher risk than oral bisphosphonates. The most common triggering factors are invasive dental procedures—particularly tooth extraction—performed in the setting of chronic inflammation. The AAOMS staging system, based on the presence of exposed bone, may limit detection of early disease; incorporating CBCT findings into a dynamic classification enables identification of preclinical changes and refinement of treatment planning. Conclusions. Reducing MRONJ incidence requires interdisciplinary prevention, including oral sanitation prior to initiating antiresorptive therapy, control of inflammatory foci, and patient education on individualized oral hygiene. Decisions regarding a “drug holiday” should be individualized based on a risk–benefit balance. Management is stage-dependent: early stages prioritize conservative measures with adjunctive modalities (low-level laser therapy, platelet-rich fibrin), whereas progressive disease necessitates surgical debridement (sequestrectomy/resection) and subsequent rehabilitation.
Lyu et al. (Sun,) studied this question.