We describe the treatment and prevention methods for medication-related osteonecrosis of the jaw (MRONJ) based on the results of multicenter clinical trials conducted by the authors.
The standard treatment for MRONJ is surgery. It is thought that conservative treatment precedes and surgical treatment is performed only in non-healing cases, but conservative treatment not only has a significantly lower cure rate, but there are also cases where the range of necrotic bone rapidly expands during conservative treatment. Therefore, in the case of operable cases, it is better to use early surgical treatment as the first choice treatment.
Drug holiday of antiresorptive agents prior to MRONJ surgery does not improve the cure rate and therefor is not necessary. In addition, treatment results do not be improved even if antibiotics were given before surgery.
In MRONJ surgery, it is most important to completely remove the osteolytic lesion on CT image. In patients showing periosteal reaction, the healing rate decreases. The periosteal reaction site should be included in the resected area, but if the necrotic bone in the bone is completely removed, healing may be obtained even if the periosteal reaction site is left.
In order to prevent the onset of MRONJ, tooth extraction should be performed early if there is an infection source tooth, instead of avoiding invasive dental treatment, Drug holiday of antiresorptive agent before tooth extraction does not reduce the incidence of MRONJ.
