Definition and Overview - MRONJ is the progressive death of the jawbone in individuals exposed to certain medications. - It can occur after oral and maxillofacial surgery, periodontal surgery, or endodontic therapy. - Medications that increase the risk of MRONJ include anti-resorptive drugs and anti-angiogenic drugs. - Previously known as bisphosphonate-related osteonecrosis of the jaw (BRONJ). - No known prevention for bisphosphonate-associated osteonecrosis of the jaw.

Signs, Symptoms, and Cause - MRONJ can cause ulcers or areas of necrotic bone for weeks, months, or even years following a tooth extraction. - Mild pain may be experienced due to inflammation of surrounding tissues. - Other signs and symptoms include jaw pain, loose teeth, mucosal swelling, erythema, suppuration, soft tissue ulceration, trismus, non-healing extraction sockets, paraesthesia or numbness in the jaw, bad breath, and exposed necrotic jaw bone. - Symptoms persist for more than 8 weeks. - Patients may be asymptomatic. - MRONJ can be associated with the use of intravenous and oral bisphosphonates. - Scientists believe there is a correlation between jaw necrosis and exposure to bisphosphonates. - Bone injury in patients using bisphosphonates may contribute to the development of MRONJ. - Other medications and factors may also play a role in causing MRONJ. - The exact cause of MRONJ is still unclear.

Risk Factors and Research Findings - MRONJ is more commonly associated with intravenous administration of bisphosphonates. - Dental treatment, duration of bisphosphonate drug therapy, and other concurrent medications increase the risk of MRONJ. - Dental implants and previous treatment with anti-resorptive/anti-angiogenic drugs are also risk factors. - Patients being treated for cancer have a higher risk, while those being treated for osteoporosis/non-malignant bone diseases have a lower risk. - Drug holidays or stopping bisphosphonate use do not necessarily reduce the risk of MRONJ. - The risk of MRONJ after dental extraction is higher in patients treated with antiresorptive drugs for oncological reasons compared to those treated for osteoporosis. - Adjusted extraction protocols can decrease the development of MRONJ. - Concomitant medications and pre-existing osteomyelitis are potential risk indicators for MRONJ. - The risk of MRONJ is influenced by various factors and circumstances. - Further research is needed to better understand and prevent MRONJ.

Medications Associated with MRONJ - Anti-resorptive drugs inhibit osteoclast differentiation and function. - Two main types of anti-resorptive drugs are bisphosphonates and denosumab. - Bisphosphonates are administered orally or intravenously and reduce bone resorption. - Denosumab is a monoclonal antibody administered subcutaneously that inhibits osteoclast differentiation and activation. - Anti-angiogenic drugs interfere with blood vessel formation and are primarily used to treat cancer.

Management and Treatment Options - Treatment involves antimicrobial mouthwashes and oral antibiotics to fight infection. - Local resection of the necrotic bone lesion is often performed. - Severity of osteonecrosis determines the treatment received. - Conservative management includes antiseptic mouthwashes, analgesics, and teriparatide. - Non-surgical management involves antimicrobial mouthwashes, systemic antibiotics, antifungal medication, and analgesics. - Surgical intervention may be necessary for symptomatic exposed bone, fistula formation, and specific conditions. - Other treatment options include hyperbaric oxygen therapy and ultrasonic therapy. - Antibiotics are used to treat cases involving infections, with penicillin being the first-line choice.