MEDICATION-RELATED OSTEONECROSIS OF THE JAWS

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a rare but potentially serious adverse event primarily associated with the use of antiresorptive and antiangiogenic agents. This study aimed to analyze the main drugs associated with MRONJ, its pathophysiology, risk factors, clinical manifestations, diagnosis, prevention, and treatment. An integrative literature review was conducted through searches in PubMed/MEDLINE, SciELO, and open-access indexed sources, prioritizing publications from 2016 to 2026, as well as relevant earlier studies. The findings demonstrated a well-established association between the disease and the use of bisphosphonates, denosumab, and certain antiangiogenic agents, particularly in cancer patients receiving higher-potency treatments and greater cumulative doses. Tooth extractions, odontogenic infections, periodontal disease, local trauma, and treatment duration were identified as important risk factors. Diagnosis is predominantly clinical, supported by imaging examinations and differential diagnosis. Dental preventive care before and during pharmacological treatment is essential, while therapeutic management should consider disease stage and the patient's systemic condition. It is concluded that MRONJ management requires an interdisciplinary approach, early diagnosis, and individualized strategies to reduce maxillofacial morbidity.