More Extensive Surgeries Yield Better Outcomes for MRONJ Patients

Dentistry Today


Osteoporosis patients who suffer drug side effects that result in painful exposed bone in the jaw could benefit if they are treated with one of the more comprehensive surgical options that could reduce the risk of relapse and repeat surgery, according to the Seoul National University School of Dentistry.

Medication-related osteonecrosis of the jaw (MRONJ) is an adverse effect of bisphosphonates, a class of drugs administered orally or intravenously to treat bone loss, as well as other drugs. Symptoms of MRONJ, which is usually identified by painful exposed jawbone in the mouth, include inflamed and non-healing oral tissues and loose teeth. 

Many cancer patients take these drugs, and some develop MRONJ. But this 12-year retrospective cohort study at the Department of Oral and Maxillofacial Surgery at Seoul National Hospital University Dental Hospital focused on patients taking the drugs for osteoporosis, the most common reason Americans take these medications.

From 2004 to 2016, the hospital saw 325 patients who met the criteria. Of those, about 97% were women, with an average age of 75. The researchers analyzed the patient sample to determine which type of surgical procedure produced better treatment outcomes for osteoporosis patients who develop MRONJ.

While acknowledging that treatments should be as conservative as possible, the researchers concluded that patients treated with a less comprehensive surgical procedure suffered higher rates of relapse than those who underwent more extensive surgical options. 

MRONJ treatments range from removal of superficial inflammatory soft tissue and necrotic bone (curettage) to removing infected pieces of the bone (sequestrectomy), removing adjacent bone and its formation of a saucer-like depression (saucerization), or resectioning and reconstructing the jawbone (mandibulectomy).

The researchers further noted that the goal of surgical treatment should be the prevention of relapse after surgery. A more extensive surgical procedure than curettage produced better surgical outcomes based on fewer relapses and repeat surgeries, they reported. Also, they noted, an extensive surgical procedure has a better prognosis than less extensive treatment.

Considering the greater risk of recurrence after surgery, the researchers further recommend that more frequent and careful follow-up with oral and maxillofacial surgeons, especially immediately after the procedure, might be advisable. Though most recurrences develop soon after surgery, some may develop long after the surgery, the researchers advised.

The study, “Extensive Surgical Procedures Result in Better Treatment Outcomes for Bisphosphonate-Related Osteonecrosis of the Jaw in Patients with Osteoporosis,” was published by the Journal of Oral and Maxillofacial Surgery.

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