Insufficient Evidence to Compare the Efficacy of Treatments for Medication-Related Osteonecrosis of the Jaws

Abstract

Selection Criteria: Three electronic databases (MEDLINE, Embase, and the Cochrane Library) plus Scopus and Google Scholar were searched for prospective cohort studies, nonrandomized trials, and randomized controlled trials that evaluated the effectiveness of therapies used to manage medication-related osteonecrosis of the jaws (MRONJ), as defined by the American Association of Oral and Maxillofacial Surgeons' 2014 diagnostic criteria.

Key Study Factor: This review did not set any limitations on the type of intervention used to manage MRONJ and instead used the type of study as the key inclusion factor. All prospective cohort studies, nonrandomized trials, and randomized controlled trials whose participants were receiving any type of treatment for their diagnosed MRONJ were eligible for inclusion.

Main Outcome Measure: The primary outcome was a measurable improvement in clinical signs and symptoms of MRONJ, which included complete resolution of the lesion, changes in bony exposure and/or mucosal coverage, changes in radiographic lesion size, quality of life, and the presence of pain and/or neurosensory changes.

Main Results: Of the 3226 records identified in the search, 51 full-text articles were assessed for eligibility and 13 met the specified inclusion criteria. Thirty-eight articles were excluded due to ineligible study designs. Two studies were included in the meta-analysis, which compared odds ratios for the complete resolution of MRONJ in patients who received surgical and nonsurgical treatment.

The 13 included studies reported on 9 different interventions: conservative surgical therapy, aggressive surgical therapy, nonsurgical therapy, supplemental hyperbaric oxygen therapy, antibiotic therapy, flap repair, discontinuation of antiresorptive medications, teriparatide therapy, and plasma rich in growth factors. The review found that surgical therapy may result in higher rates of MRONJ resolution than nonsurgical (medical) therapy. Insufficient data were available to draw conclusions on the other treatment modalities identified in the review.

Conclusions: Limited data suggest that surgical treatment for MRONJ may result in a higher rate of complete resolution than medical therapy. Further well-designed research is required to confidently recommend a particular mode of therapy for this disease.