Medication-related osteonecrosis of the jaw (MRONJ) is an enigmatic pathologic entity of equivocal etiology and pathophysiology. Once considered a complication directly attributable to bisphosphonate medications, the OMS specialty now recognizes the association of other medication classifications, including the RANKL inhibitors, antiangiogenic agents and several traditional chemotherapeutic agents. In addition, the patient's medical comorbidity – including the existence of cancer, metastatic disease, diabetes, obstructive lung disease and social habits such as smoking – are recognized as contributors to the development of this wound healing dilemma, most often initiated by a traumatic incident such as a tooth extraction. The introduction and timing of conservative therapy of this disease continues to be discussed as well as the role and success of surgical resection of the focus of osteonecrosis. Moreover, strategies to prevent MRONJ in patients exposed to antiresorptive and antiangiogenic therapy must be discussed to reduce the morbidity experienced by patients treated with these medications. In the final analysis, MRONJ is preventable, resectable and reconstructable in a very predictable fashion. This presentation will review these concepts while narrowing the educational gap and reducing the fear experienced by medical and dental professionals in their treatment of patients who require medications associated with this pathologic process.
Learning Objectives:
At the conclusion of this presentation, participants should be able to:
List the pathophysiologic mechanisms of MRONJ offered in the international literature.
Discuss the role of conservative therapy vs. surgical resection of MRONJ.
Discuss the medical management of patients planned for surgical resection of MRONJ.
Discuss the follow-up protocol of patients undergoing conservative therapy or resection of MRONJ.
Discuss the options associated with reconstruction of segmental defects of the mandible.