Systematic review of medication related osteonecrosis of the jaw (MRONJ) in patients undergoing only antiangiogenic drug therapy: surgery or conservative therapy?

Background Osteonecrosis of the jaw is a severe adverse condition affecting patients exposed to specific types of medications. Previous studies have highlighted that osteonecrosis of the jaw is triggered by invasive dental procedures and can be very challenging to manage, especially in oncologic patients. The primary aim of this review is to analyse all available evidence on the management (surgical and/or conservative) of medication related-osteonecrosis of the jaws (MRONJ) in patients with a history of antiangiogenic drugs therapy and not previously exposed to any antiresorptive drug treatments. Material and methods A multi-database search (PubMed, MEDLINE, EMBASE and CINAHL) was performed to identify related multi-languages papers published from January 2003 until November 2020. Data was extracted from relevant papers and analysed according to the outcomes selected in this review. Results The search generated 28 studies eligible for the analysis. The total number of patients included in the analysis was 36. 16 patients were treated with anti-vascular endothelial growth factor drugs (anti-VEGF) while the remaining patients were administered a combination of antiangiogenic drugs. The most common MRONJ site was the mandible in 29 patients. MRONJ recurrence after treatment was only reported in 6 patients, the majority of which treated conservatively. Conclusions The data reviewed confirmed that an invasive procedure is the most common trigger of MRONJ with relatively high frequency of post-operative recurrence following treatment. However, due to the low quality of available research in literature, it is difficult to draw a definitive conclusion on the validity of the presented treatment to manage patients affected by MRONJ associated with angiogenic therapy.