Potential associations between Medication-Related Osteonecrosis of the Jaw and endodontic treatment in patients with a History of Antiresorptive Treatment. A preliminary retrospective clinical study

Aim To assess the potential associations between endodontic treatment in patients treated with bone-modifying agents (BMA) and the development of Medication-Related Osteonecrosis of the Jaw (MRONJ) and to assess the pulpal changes in those patients. Methods Seventy patients were enrolled in this retrospective study. Collected data included age, gender, medical history, BMA type and administration route, pulpal and periapical diagnoses, and diagnosis of MRONJ. Patients were divided into four groups based on underlying disease and BMA route: OsP-PO (osteoporosis, oral); OsP-IV (osteoporosis, intravenous); MalOsP-PO (previous malignancy with current osteoporosis, oral); and Mal-IV (malignancy, intravenous). Clinical and radiographic data were compared between groups. Results The study population was predominantly female (80%) with a mean age of 65 years. MRONJ was observed in 11.1% of patients prior to endodontic treatment and in 4.9% following treatment. The highest prevalence was recorded in the Mal-IV group (5/31, 16.1%), followed by OsP-IV (3/23, 13%), MalOsP-PO (1/12, 8.3%), and OsP-PO (0/4, 0%). All post-treatment MRONJ cases involved mandibular molar teeth with preoperative apical radiolucency. Pulp canal obliteration (PCO) was identified in 57.4% teeth, a previously unreported finding. Conclusions PCO was a frequent finding among the study participants. Periapical lesion increases the risk of post-endodontic treatment MRONJ.