OSTEONECROSIS OF THE JAW ASSOCIATED WITH THE USE OF ANTIRESORPTIVE AND ANTIANGIOGENIC DRUGS: A SYSTEMATIC REVIEW

Abstract

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse event associated with antiresorptive bone therapies and antineoplastic agents, requiring ongoing evaluation of its risk factors and clinical management. Objective: To assess the epidemiological profile, pharmacological, systemic, and local risk factors, anatomical distribution, preventive strategies, and therapeutic efficacy regarding MRONJ resolution. Methods: This study was conducted as a systematic review following PRISMA guidelines, selecting 12 studies evaluated for risk of bias using the Joanna Briggs Institute and Cochrane RoB 2 tools. Results: Denosumab and bisphosphonates were analyzed in 91.7% of articles each; combining CDK4/6 inhibitors (specifically abemaciclib) with denosumab in metastatic breast cancer increased MRONJ incidence from 6.6% to 13.7% and accelerated onset time, while sequential therapy (bisphosphonates followed by denosumab) elevated necrosis risk 2.62-fold. Demographically, a female predominance and an age concentration in middle-aged and elderly patients were observed, with the mandible accounting for 70.5% of lesions; tooth extraction was the primary local trigger (83.3% of studies), followed by periodontal disease (66.7%) and denture trauma (50.0%), while prosthetic cantilever extensions increased peri-implant necrosis. Intensive preventive dental protocols reduced MRONJ incidence from 13.9% to 2.3%, whereas regarding established disease management, extensive surgical resection (83.3% cure rate) and Er:YAG laser-assisted surgery (85.7% mucosal healing) yielded superior outcomes compared to conservative therapy alone. Conclusion: MRONJ is a multifactorial condition amplified by combined oncological regimens, with intensive preventive oral care and surgical resection enhanced by adjuvant technologies representing the most effective clinical strategies, highlighting the essential interdisciplinary collaboration between oncology and dentistry.