Medication Related Osteonecrosis of the Jaw (MRONJ). Review and recent advances

Medication-Related Osteonecrosis of the Jaw (MRONJ) is defined as a complication, which affects the jawbone of patients that meet all of the following criteria: (a) patients were in the past or are now on treatment with bone targeting agents (BTAs) and/or antiangiogenics, (b) they have exposed bone or bone that can be probed through an intraoral or extraoral fistula for more than 8 weeks, and (c) they have no history of radiotherapy or obvious metastatic disease to the jaws. Since the first reports, in 2003, plethora of articles on MRONJ significantly increased our knowledge of this potentially serious complication. However, controversies about the definition and clinical presentation, risk factors, radiological findings, staging and early diagnosis, prevention and treatment may affect the successful management and the quality of life of cancer patients. The purpose of this article is to present the current knowledge about MRONJ and the recent advances to best clinical practice and treatment. Important questions will be discussed, including the following: (1) Should we wait for 8 weeks when a patient on antiresorptive therapy, presents with exposed necrotic jawbone? (2) Can we exclude the diagnosis of osteonecrosis if a patient presents without exposed bone? (3) Is the dental extraction a risk factor for MRONJ? (4) Should we perform the dental extraction, when a patient on antiresorptives, presents with a symptomatic tooth? (5) What is the role of dental or periodontal infection? (6) Shall we re-start the antiresorptives following healing of previous MRONJ?