Surgical Protocols Associated with Adjuvant Therapies in the Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Narrative Literature Review

Abstract

Aims: To compare the effectiveness of surgical protocols with or without adjuvant therapies in the treatment of osteonecrosis of the jaws. Study Design:  Narrative literature review with a systematized search strategy. Place and Duration of Study: Studies published from 2020 onward were selected from the PubMed and Google Scholar databases. Methodology: Clinical studies involving patients diagnosed with MRONJ and treated surgically, with or without adjuvant therapies, were included. Case reports, case series and randomized clinical trials published in English were analyzed. Data regarding type of treatment, disease stage and healing outcomes were extracted and descriptively compared. Results: Ten studies comprising 238 treated cases of MRONJ were included. Among 108 cases treated with isolated surgical procedures, 86 (79.63%) achieved complete healing. Among 130 cases treated with surgery combined with adjuvant therapies, including low-level laser therapy, photodynamic therapy, concentrated growth factors, pharmacological preparation with pentoxifylline and tocopherol, and topical ozone therapy, 127 cases (97.69%) achieved complete healing. Conclusion: Surgical treatment combined with adjuvant therapies demonstrates higher effectiveness in achieving complete healing and reducing recurrence rates when compared with isolated surgical approaches, even in advanced stages of MRONJ.