These new drugs have proven effective in treating gastrointestinal tumors, renal cell carcinomas, neuroendocrine tumors and other malignancies, but favor the onset of MRONJ. Īntiangiogenic drugs interfere with the formation of new blood vessels by binding to various signaling molecules and interrupting the angiogenesis signaling cascade. Unlike BPS, RANKL inhibitors do not bond with the bone and their effects on bone remodeling are mostly lessened 6 months after treatment discontinuation. It is administered subcutaneously every 6 months to decrease the risk of fractures in patients with osteoporosis and monthly in bone metastases of solid tumors. ![]() In addition to BPS, other anti-resorptive drugs are used to treat these diseases, including denosumab, a RANKL inhibitor that is a monoclonal antibody which inhibits osteoclast function and, therefore, bone reabsorption. They are effective in the treatment of diseases such as osteoporosis, bone metastases, multiple myeloma and Paget’s disease, among others. Īnti-resorptive drugs such as BPS modulate bone metabolism by inhibiting bone reabsorption, and limiting the activity of osteoclasts, although they also have an antiangiogenic effect. In 2014, the American Association of Oral and Maxillofacial Surgeons (AAOMS) recommended replacing the name BRONJ with MRONJ. ![]() However, from 2010 onwards, an increase in the prevalence of osteonecrosis was observed in patients treated with anti-resorptive and antiangiogenic drugs other than bisphosphonates, such as denosumab, and this was named denosumab-related osteonecrosis of the jaw (DRONJ). The first cases of MRONJ were described by Marx during the 2000s in patients receiving bisphosphonates (BPS), and was named bisphosphonate-related osteonecrosis of the jaw (BRONJ). MRONJ is characterized by exposed bone that does not heal in patients with a history or continued use of anti-resorptive or antiangiogenic agents and without a history of exposure to radiation in the head and neck. Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon but serious debilitating disease, whose cause remains unclear, although it may have a multifactorial origin. In cases of refractory osteonecrosis, the application of platelet and leukocyte-rich fibrin (PRF-L) in the surgical approach improves the outcome in soft tissue healing and bone regeneration but further research is needed to confirm its effectiveness. Conservative treatment with antibiotics, chlorhexidine rinses and minimally invasive surgical intervention with necrotic bone resection is effective in treating stage 2 of MRONJ. Radiography showed slow but progressive healing with normal bone structure. Within 12 months of the application of therapeutic protocols, the lesions were completely healed in all cases. This case series evaluated three patients diagnosed with staged 2 MRONJ treated at the University of Murcia dental clinic according to the protocols described by the Spanish Society of Oral and Maxillofacial Surgery and the American Association of Oral and Maxillofacial Surgeons. Although there are different therapeutic protocols, there is still no consensus. ![]() Medication-induced jaw osteonecrosis (MRONJ) is a rare and serious disease with a negative impact on patients’ quality of life, whose exact cause remains unclear and which may have a multifactorial origin.
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