DRUG-INDUCED OSTEONECROSIS OF THE JAWS: A LITERATURE REVIEW ON RISK FACTORS AND THERAPEUTIC APPROACHES

Abstract

Drug-related osteonecrosis of the jaw (DRONJ) is a pathological condition characterized by persistent bone exposure in the maxillofacial region in patients undergoing treatment with antiresorptive or antiangiogenic drugs, in the absence of a history of radiotherapy in the head and neck region. The increased incidence of this condition is directly associated with the growing use of these drugs in the treatment of diseases such as osteoporosis, multiple myeloma, and bone metastases. The etiopathogenesis of DRONJ is multifactorial and involves suppression of bone remodeling, alterations in vascularization, inflammatory response, bacterial colonization, and individual genetic factors. Invasive dental procedures, especially tooth extractions and oral surgeries, are considered important triggering factors for the disease in patients using these medications. Diagnosis is mainly based on clinical evaluation combined with the patient's pharmacological history, and is often complemented by imaging studies to determine the extent of the lesion. Therapeutic management can range from conservative approaches, including infection control and clinical monitoring, to surgical interventions for the removal of necrotic bone tissue. In recent years, new therapeutic strategies have been investigated, including the use of platelet concentrates, such as platelet-rich fibrin (PRF), which demonstrate potential to improve tissue regeneration and clinical outcomes. Therefore, understanding the mechanisms involved in MRONJ is fundamental for the development of effective strategies for prevention, early diagnosis, and appropriate treatment, contributing to better clinical outcomes and quality of life for patients.