Medication-related Osteonecrosis of the Jaw: Current Concepts in Prevention and Treatment

Antiresorptive and antiangiogenic medications have been widely advocated at present for the treatment of various conditions, such as malignancies, metastatic bone disease, osteoporosis, etc.One of the adverse effects associated with these medications that can significantly impair a patient's quality of life is osteonecrosis of jaw.Initially termed as bisphosphonate-related osteonecrosis of the jaw (BRONJ), this was observed only with the use of intravenous bisphosphonates.However, subsequent studies have linked this serious condition with oral bisphosphonates and other antiangiogenic drugs, leading to a change in its nomenclature to medication-related osteonecrosis of the jaw (MRONJ).At present, MRONJ has evolved into an established clinical entity with complex etiologic associations and pathophysiology, having significant implications for oral and maxillofacial practice.Despite advancements in understanding the disease process, its effective prevention and management strategies still continue to pose a clinical dilemma, mainly due to its etiologic complexity and diverse clinical spectrum.This review aims to outline current concepts regarding the epidemiology, risk factors, pathophysiology, diagnosis, prevention, and management of MRONJ.A comprehensive evaluation of the available literature was performed, focusing on recent management guidelines and evidencebased strategies.Based on current understanding, the pathophysiology of MRONJ is largely attributed to dysregulated osseous remodeling, inflammation, impaired angiogenesis, infection, and immune-dysregulation. Risk assessment and optimization of oral health before initiating these high-risk medications remain the most effective approaches for prevention of this detrimental complication.Management strategies range from early conservative management that includes antibacterial mouthrinses antibiotic therapy to surgical intervention in advanced cases.Recent advances including adjuvant regenerative therapies and evolving surgical techniques have been promising but further evidence is required to validate their role.