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Journals / Akdeniz Diş Hekimliği Dergisi / 2026 / Cilt: 5 Sayı: 1

Medication-Related Osteonecrosis of the Jaws: Dental Aspects of Pathophysiology, Risk Factors and Preventive Measures

İlaçlara Bağlı Çene Kemiği Osteonekrozu: Patofizyoloji, Risk Faktörleri ve Önleyici Tedbirlere Dental Yaklaşım

Elif Aslan(İZMİR TINAZTEPE ÜNİVERSİTESİ, DİŞ HEKİMLİĞİ FAKÜLTESİ)0000-0001-7609-999X
Pages
77–88
Publication Date
2026-04-29
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

The aim of this review was to evaluate the pathophysiological processes and risk factors involved in the development of MRONJ and to discuss preventive measures from a dental perspective and in the guidance of the current literature.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Medication-related osteonecrosis of the jaw (MRONJ) is defined as a progressive destruction of the jawbones, which occurs as a result of the adverse effects of antiresorptive drugs.
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Key Findings & Data:Although multiple pathophysiological processes and numerous risk factors have been reported to contribute to the development of MRONJ, pathophysiological mechanisms of different factors cause varying rates of MRONJ development in different patients.
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Conclusion & Impact:The aim of this review was to evaluate the pathophysiological processes and risk factors involved in the development of MRONJ and to discuss preventive measures from a dental perspective and in the guidance of the current literature.
🔬Design:Review & Systematic Survey
📍Scope:Comprehensive Sample
⚙️Variables:Patofizyoloji · risk faktörleri · osteonekroz

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is defined as a progressive destruction of the jawbones, which occurs as a result of the adverse effects of antiresorptive drugs. Although multiple pathophysiological processes and numerous risk factors have been reported to contribute to the development of MRONJ, pathophysiological mechanisms of different factors cause varying rates of MRONJ development in different patients. Understanding the relationship between pathophysiological processes and risk factors is crucial for healthcare providers to take necessary precautions before initiating antiresorptive drug therapy. Accordingly, the identification and elimination of focal infections and/or trauma sites by a comprehensive clinical and radiographic examination prior to antiresorptive drug therapy has been accepted as the primary strategy for preventing MRONJ. Therefore, it is particularly imperative for dental professionals to possess adequate and recent knowledge regarding the pathophysiology and risk factors of MRONJ for the adequate identification of the existing risk factors in patients undergoing antiresorptive therapy and the effective prevention of the development of MRONJ. The aim of this review was to evaluate the pathophysiological processes and risk factors involved in the development of MRONJ and to discuss preventive measures from a dental perspective and in the guidance of the current literature.

Özet

İlaçlara bağlı çene kemiği osteonekrozu (MRONJ) antirezorptif ve bazı antianjiyojenik ilaçların yan etkisi sonucu çene kemiklerinin ilerleyen yıkımı ile tanımlanan bir patolojidir. MRONJ gelişiminde birden fazla patofizyolojik sürecin ve çok sayıda risk faktörünün rol oynadığı bilinmekle birlikte, farklı faktörlerin MRONJ gelişimindeki etki mekanizmaları ve MRONJ gelişimine yol açma oranları da değişkenlik göstermektedir. Osteonekroz gelişiminde rol oynayan patofizyolojik süreçler ile risk faktörleri arasındaki ilişkinin hekimler tarafından anlaşılması, antirezorptif ve/veya antianjiyojenik ilaç tedavisi planlanan hastalarda ilaca başlanmadan önce gerekli önlemlerin alınması açısından büyük önem taşımaktadır. MRONJ oluşumunun önlenmesi için kabul gören temel strateji, antirezorptif ve/veya antianjiyojenik ilaç tedavisi öncesinde hem klinik hem de radyografik olarak kapsamlı bir değerlendirme yapılarak fokal enfeksiyon veya travma odaklarının saptanması ve ortadan kaldırılmasıdır. Buna göre, MRONJ gelişiminin önlenebilmesi ve antirezorptif ve/veya antianjiyojenik ilaç kullanan hastalarda mevcut risk faktörlerinin saptanabilmesi diş hekimlerinin MRONJ’un patofizyolojisi ve risk faktörleri konusunda yeterli ve güncel bilgiye sahip olması ile mümkündür. Bu derlemenin amacı, MRONJ gelişiminde rol oynayan patofizyolojik süreçleri ve risk faktörlerini yanı sıra MRONJ’u önlemek amacıyla alınabilecek tedbirleri diş hekimliği açısından güncel literatür rehberliğinde irdelemektir.

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Cite This Article

Aslan, E. (2026). Medication-Related Osteonecrosis of the Jaws: Dental Aspects of Pathophysiology, Risk Factors and Preventive Measures. Akdeniz Diş Hekimliği Dergisi, Cilt: 5 Sayı: 1, 77–88. https://doi.org/10.62268/add.1810597

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References (77)

  1. Kim KM, Rhee Y, Kwon YD, et al. Medication related osteonecrosis of the jaw: 2015 position statement of the Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons. J Bone Metab. 2015; 22: 151-65. doi: 10.11005/jbm.2015.22.4.151
  2. Khan AA, Morrison A, Hanley DA, et al. International task force on osteonecrosis of the jaw. diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2015; 30: 3-23. doi: 10.1002/jbmr.2405
  3. Aguirre JI, Castillo EJ, Kimmel DB. Preclinical models of medication-related osteonecrosis of the jaw (MRONJ). Bone. 2021; 153: 116184. doi: 10.1016/j.bone.2021.116184
  4. Aghaloo T, Hazboun R, Tetradis S. Pathophysiology of osteonecrosis of the jaws. Oral Maxillofac Surg Clin North Am. 2015; 27: 489-96. doi: 10.1016/j.coms.2015.06.001
  5. Wat WZM. Current controversies on the pathogenesis of medication-related osteonecrosis of the jaw. Dent J (Basel). 2016; 4: 38. doi: 10.3390/dj4040038
  6. Ruggiero SL, Dodson TB, Aghaloo T, et al. American Association of Oral and Maxillofacial Surgeons' position paper on medication-related osteonecrosis of the jaws-2022 update. J Oral Maxillofac Surg. 2022; 80: 920-43. doi: 10.1016/j.joms.2022.02.008
  7. Khan A, Morrison A, Cheung A, et al. Osteonecrosis of the jaw (ONJ): diagnosis and management in 2015. Osteoporos Int. 2016; 27: 853-9. doi: 10.1007/s00198-015-3335-3
  8. Kawahara M, Kuroshima S, Sawase T. Clinical considerations for medication-related osteonecrosis of the jaw: a comprehensive literature review. Int J Implant Dent. 2021; 7: 47. doi: 10.1186/s40729-021-00323-0
  9. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003; 61: 1115-7. doi: 10.1016/s0278-2391(03)00720-1
  10. Eguia A, Bagán-Debón L, Cardona F. Review and update on drugs related to the development of osteonecrosis of the jaw. Med Oral Patol Oral Cir Bucal. 2020; 25(1): E71-83. doi: 10.4317/medoral.23191
  11. Henry DH, Costa L, Goldwasser F, et al. Randomized, double-blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol. 2011; 29: 1125-32. doi: 10.1200/JCO.2010.31.3304
  12. Drake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc. 2008; 83: 1032-45. doi: 10.4065/83.9.1032
  13. Papapoulos SE, Makras P. Bisphosphonates in the management of patients with postmenopausal osteoporosis; back to the future. Pharmaceuticals (Basel). 2025; 18: 1068. doi: 10.3390/ph18071068
  14. Chiu YG, Ritchlin CT. Denosumab: targeting the RANKL pathway to treat rheumatoid arthritis. Expert Opin Biol Ther. 2017; 17: 119-28. doi: 10.1080/14712598.2017.1263614
  15. Sharma P, Al-Dadah O. Clinical efficacy of bisphosphonates and monoclonal antibodies on bone mineral density following skeletal fractures. J Clin Orthop Trauma. 2022; 34: 102022. doi: 10.1016/j.jcot.2022.102022
  16. Campisi G, Mauceri R, Bertoldo F, et al. Medication-related osteonecrosis of jaws (MRONJ) prevention and diagnosis: Italian consensus update 2020. Int J Environ Res Public Health. 2020; 17: 5998. doi: 10.3390/ijerph17165998
  17. Baud'huin M, Duplomb L, Ruiz Velasco C, et al. Key roles of the OPG-RANK-RANKL system in bone oncology. Expert Rev Anticancer Ther. 2007; 7: 221-32. doi: 10.1586/14737140.7.2.221
  18. Eriksen EF. Cellular mechanisms of bone remodeling. Rev Endocr Metab Disord. 2010; 11: 219-27. doi: 10.1007/s11154-010-9153-1
  19. Boyce BF, Xing L. Functions of RANKL/RANK/OPG in bone modeling and remodeling. Arch Biochem Biophys. 2008; 473: 139-46. doi: 10.1016/j.abb.2008.03.018
  20. Şahin A. Bone pathophysiology, normal bone physiology, bone turnover and osteoporosis pathophysiology. Turkiye Klinikleri J Rheumatol. 2014; 7: 5-16.
  21. Zhang W, Gao L, Ren W, et al. The role of the immune response in the development of medication-related osteonecrosis of the jaw. Front Immunol. 2021; 12: 606043. doi: 10.3389/fimmu.2021.606043
  22. Nicolatou-Galitis O, Schiødt M, Mendes RA, et al. Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; 127: 117-35. doi: 10.1016/j.oooo.2018.09.008
  23. AlRowis R, Aldawood A, AlOtaibi M, et al. Medication-related osteonecrosis of the jaw (MRONJ): a review of pathophysiology, risk factors, preventive measures and treatment strategies. Saudi Dent J. 2022; 34: 202-10. doi: 10.1016/j.sdentj.2022.01.003
  24. Alsalih A, Dam A, Lindberg P, et al. Medication-related osteonecrosis of the jaws ınitiated by zoledronic acid and potential pathophysiology. Dent J (Basel). 2021; 9: 85. doi: 10.3390/dj9080085
  25. Kalyan S, Wang J, Quabius ES, et al. Systemic immunity shapes the oral microbiome and susceptibility to bisphosphonate-associated osteonecrosis of the jaw. J Transl Med. 2015; 13: 212. doi: 10.1186/s12967-015-0568-z
  26. Mawardi H, Enzinger P, McCleary N, et al. Osteonecrosis of the jaw associated with ziv-aflibercept. J Gastrointest Oncol. 2016; 7: E81-7. doi: 10.21037/jgo.2016.05.07
  27. Suryani IR, Ahmadzai I, Shujaat S, et al. Non-antiresorptive drugs associated with the development of medication-related osteonecrosis of the jaw: a systematic review and meta-analysis. Clin Oral Investig. 2022; 26: 2269-79. doi: 10.1007/s00784-021-04331-7
  28. Tabouret T, Gregory T, Dhooge M, et al. Long term exposure to antiangiogenic therapy, bevacizumab, induces osteonecrosis. Invest New Drugs. 2015; 33: 1144-7. doi: 10.1007/s10637-015-0283-x
  29. Ziebart T, Pabst A, Klein MO, et al. Bisphosphonates: restrictions for vasculogenesis and angiogenesis: inhibition of cell function of endothelial progenitor cells and mature endothelial cells in vitro. Clin Oral Investig. 2011; 15: 105-11. doi: 10.1007/s00784-009-0365-2
  30. Kim S, Williams DW, Lee C, et al. IL-36 Induces bisphosphonate-related osteonecrosis of the jaw-like lesions in mice by inhibiting TGF-β-mediated collagen expression. J Bone Miner Res. 2017; 32: 309-18. doi: 10.1002/jbmr.2985
  31. Yuan A, Munz A, Reinert S, et al. Gingival fibroblasts and medication-related osteonecrosis of the jaw: Results by real-time and wound healing in vitro assays. J Craniomaxillofac Surg. 2019; 47: 1464-74. doi: 10.1016/j.jcms.2019.06.004
  32. Belibasakis GN, Meier A, Guggenheim B, et al. Oral biofilm challenge regulates the RANKL-OPG system in periodontal ligament and dental pulp cells. Microb Pathog. 2011; 50: 6-11. doi: 10.1016/j.micpath.2010.11.002
  33. Meghji S. Surface-associated protein from Staphylococcus aureus stimulates osteoclastogenesis: possible role in S. aureus-induced bone pathology. Br J Rheumatol. 1998; 37: 1095-101. doi: 10.1093/rheumatology/37.10.1095
  34. Ruggiero SL, Dodson TB, Fantasia J, et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg. 2014; 72: 1938-56. doi: 10.1016/j.joms.2014.04.031
  35. Gerber HP, Ferrara N. Angiogenesis and bone growth. Trends Cardiovasc Med. 2000; 10: 223-38. doi: 10.1016/s1050-1738(00)00074-8
  36. Nakagawa M, Kaneda T, Arakawa T, et al. Vascular endothelial growth factor (VEGF) directly enhances osteoclastic bone resorption and survival of mature osteoclasts. FEBS Lett. 2000; 473: 161-4. doi: 10.1016/s0014-5793(00)01520-9
  37. Duffy AM, Bouchier-Hayes DJ, Harmey JH. Vascular endothelial growth factor (VEGF) and its role in non-endothelial cells: autocrine signaling by VEGF. VEGF and Cancer, Madame Curie Bioscience Database, 2014, 133-44.
  38. Srivichit B, Thonusin C, Chattipakorn N, et al. Impacts of bisphosphonates on the bone and its surrounding tissues: mechanistic insights into medication-related osteonecrosis of the jaw. Arch Toxicol. 2022; 96: 1227-55. doi: 10.1007/s00204-021-03220-y
  39. Souza EQM, Toro LF, Ganzaroli VF, et al. Peri-implantitis increases the risk of medication-related osteonecrosis of the jaws associated with osseointegrated implants in rats treated with zoledronate. Sci Rep. 2024; 14: 627. doi: 10.1038/s41598-023-49647-4
  40. Bria J, Chiarella E, Sovereto J, et al. The role of amino bisphosphonates zoledronate and alendronate in shaping immunomodulatory profile and angiogenic potential of human periodontal ligament stem cells. PLoS One. 2025; 20: E0335744. doi: 10.1371/journal.pone.0335744
  41. Wang JY, Yu RQ, Huo L, et al. Comparison of vascular morphometry in jawbones and long bones: micro-ct study in a rat model treated with zoledronic acid. Biomed Res Int. 2021; 2021: 6651318. doi: 10.1155/2021/6651318
  42. Otto M, Weigel J, Ziebart T, et al. Significance of bisphosphonates on angiogenesis in vivo and their effect under geranyl-geraniol addition - could it alter the treatment of bisphosphonate-associated necrosis of the jaw?. Oral Maxillofac Surg. 2023; 27: 263-8. doi: 10.1007/s10006-022-01053-2
  43. Kuroshima S, Sasaki M, Sawase T. Medication-related osteonecrosis of the jaw: a literature review. J Oral Biosci. 2019; 61: 99-104. doi: 10.1016/j.job.2019.03.005
  44. Krajewski AC, Biessei J, Kunze M, et al. Influence of lipopolysaccharide and interleukin-6 on RANKL and OPG expression and release in human periodontal ligament cells. APMIS. 2009; 117: 746-54. doi: 10.1111/j.1600-0463.2009.02532.x
  45. Zhang Q, Atsuta I, Liu S, et al. IL-17-mediated M1/M2 macrophage alteration contributes to pathogenesis of bisphosphonate-related osteonecrosis of the jaws. Clin Cancer Res. 2013; 19: 3176-88. doi: 10.1158/1078-0432.CCR-13-0042
  46. Kikuiri T, Kim I, Yamaza T, et al. Cell-based immunotherapy with mesenchymal stem cells cures bisphosphonate-related osteonecrosis of the jaw-like disease in mice. J Bone Miner Res. 2010; 25: 1668-79. doi: 10.1002/jbmr.37
  47. Katz J, Gong Y, Salmasinia D, et al. Genetic polymorphisms and other risk factors associated with bisphosphonate induced osteonecrosis of the jaw. Int J Oral Maxillofac Surg. 2011; 40: 605-11. doi: 10.1016/j.ijom.2011.02.002
  48. Nicoletti P, Cartsos VM, Palaska PK, et al. Genomewide pharmacogenetics of bisphosphonate-induced osteonecrosis of the jaw: the role of RBMS3. Oncologist. 2012; 17: 279-87. doi: 10.1634/theoncologist.2011-0202
  49. Sarasquete ME, García-Sanz R, Marín L, et al. Bisphosphonate-related osteonecrosis of the jaw is associated with polymorphisms of the cytochrome P450 CYP2C8 in multiple myeloma: a genome-wide single nucleotide polymorphism analysis. Blood. 2008; 112: 2709-712. doi: 10.1182/blood-2008-04-147884
  50. AlDhalaan NA, BaQais A, Al-Omar A. Medication-related osteonecrosis of the jaw: a review. Cureus. 2020; 12: E6944. doi: 10.7759/cureus.6944
  51. Taylor T, Bryant C, Popat S. A study of 225 patients on bisphosphonates presenting to the bisphosphonate clinic at King's College Hospital. Br Dent J. 2013; 214: E18. doi: 10.1038/sj.bdj.2013.32
  52. Aljohani S, Fliefel R, Ihbe J, et al. What is the effect of anti-resorptive drugs (ARDs) on the development of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients: a systematic review. J Craniomaxillofac Surg. 2017; 45: 1493-502. doi: 10.1016/j.jcms.2017.05.028
  53. Stopeck AT, Fizazi K, Body JJ, et al. Safety of long-term denosumab therapy: results from the open label extension phase of two phase 3 studies in patients with metastatic breast and prostate cancer. Support Care Cancer. 2016; 24: 447-55. doi: 10.1007/s00520-015-2904-5
  54. Jeong HG, Hwang JJ, Lee JH, et al. Risk factors of osteonecrosis of the jaw after tooth extraction in osteoporotic patients on oral bisphosphonates. Imaging Sci Dent. 2017; 47: 45-50. doi: 10.5624/isd.2017.47.1.45
  55. Pazianas M, Miller P, Blumentals WA, et al. A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clin Ther. 2007; 29: 1548-58. doi: 10.1016/j.clinthera.2007.08.008
  56. Soares AL, Simon S, Gebrim LH, et al. Prevalence and risk factors of medication-related osteonecrosis of the jaw in osteoporotic and breast cancer patients: a cross-sectional study. Support Care Cancer. 2020; 28: 2265-71. doi: 10.1007/s00520-019-05044-0
  57. Kang MH, Lee DK, Kim CW, et al. Clinical characteristics and recurrence-related factors of medication-related osteonecrosis of the jaw. J Korean Assoc Oral Maxillofac Surg. 2018; 44: 225-31. doi: 10.5125/jkaoms.2018.44.5.225
  58. Peer A, Khamaisi M. Diabetes as a risk factor for medication-related osteonecrosis of the jaw. J Dent Res. 2015; 94: 252-60. doi: 10.1177/0022034514560768
  59. Wessel JH, Dodson TB, Zavras AI. Zoledronate, smoking, and obesity are strong risk factors for osteonecrosis of the jaw: a case-control study. J Oral Maxillofac Surg. 2008; 66: 625-31. doi: 10.1016/j.joms.2007.11.032
  60. Vahtsevanos K, Kyrgidis A, Verrou E, et al. Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw. J Clin Oncol. 2009; 27: 5356-62. doi: 10.1200/JCO.2009.21.9584
  61. Kos M, Kuebler JF, Luczak K, et al. Bisphosphonate-related osteonecrosis of the jaws: a review of 34 cases and evaluation of risk. J Craniomaxillofac Surg. 2010; 38: 255-9. doi: 10.1016/j.jcms.2009.06.005
  62. Oryan FS, Lo JC. Bisphosphonate-related osteonecrosis of the jaw in patients with oral bisphosphonate exposure: clinical course and outcomes. J Oral Maxillofac Surg. 2012; 70: 1844-53. doi: 10.1016/j.joms.2011.08.033
  63. Saad F, Brown JE, Van Poznak C, et al. Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-controlled phase III trials in cancer patients with bone metastases. Ann Oncol. 2012; 23: 1341-7. doi: 10.1093/annonc/mdr43
  64. Schiodt M, Otto S, Fedele S, et al. Workshop of European task force on medication-related osteonecrosis of the jaw-Current challenges. Oral Dis. 2019; 25: 1815-21. doi: 10.1111/odi.13160
  65. Jardim Caldas R, Spíndola Antunes H, de Oliveira Rodini Pegoraro C, et al. Oral health condition in cancer patients under bisphosphonate therapy. Support Care Cancer. 2021; 29: 7687-94. doi: 10.1007/s00520-021-06362-y
  66. Kwoen MJ, Park JH, Kim KS, et al. Association between periodontal disease, tooth extraction, and medication-related osteonecrosis of the jaw in women receiving bisphosphonates: a national cohort-based study. J Periodontol. 2023; 94: 98-107. doi: 10.1002/JPER.21-061
  67. Topaloglu G, Koseoglu OT, Karaca C, et al. The effect of chronic dental inflammation on development of Stage 0 medication-related osteonecrosis of the jaw. J Craniomaxillofac Surg. 2017; 45: 1158-64. doi: 10.1016/j.jcms.2017.05.003
  68. Pichardo SEC, van der Hee JG, Fiocco M, et al. Dental implants as risk factors for patients with medication-related osteonecrosis of the jaws (MRONJ). Br J Oral Maxillofac Surg. 2020; 58: 771-6. doi: 10.1016/j.bjoms.2020.03.022
  69. King R, Tanna N, Patel V. Medication-related osteonecrosis of the jaw unrelated to bisphosphonates and denosumab-a review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; 127: 289-99. doi: 10.1016/j.oooo.2018.11.012
  70. Khosla S, Burr D, Cauley J, et al. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2007; 22: 1479-91. doi: 10.1359/jbmr.0707onj
  71. Tsuchimochi M, Kurabayashi T. Symposium: Imaging modalities for drug-related osteonecrosis of the jaw (1), role of imaging in drug-related osteonecrosis of the jaw: an up-to-date review (secondary publication). Jpn Dent Sci Rev. 2019; 55: 1-4. doi: 10.1016/j.jdsr.2018.11.004
  72. Nica DF, Riviș M, Roi CI, et al. Complementarity of photo-biomodulation, surgical treatment, and antibiotherapy for medication-related osteonecrosis of the jaws (MRONJ). Medicina (Kaunas). 2021; 57: 145. doi: 10.3390/medicina57020145
  73. Zirk M, Kreppel M, Buller J, et al. The impact of surgical intervention and antibiotics on MRONJ stage II and III - Retrospective study. J Craniomaxillofac Surg. 2017; 45: 1183-9. doi: 10.1016/j.jcms.2017.05.027
  74. Varoni EM, Lombardi N, Villa G, et al. Conservative management of medication-related osteonecrosis of the jaws (MRONJ): a retrospective cohort study. Antibiotics (Basel). 2021; 10: 195. doi: 10.3390/antibiotics10020195
  75. Rodriguez-Lozano FJ, Oñate-Sánchez RE. Treatment of osteonecrosis of the jaw related to bisphosphonates and other antiresorptive agents. Med Oral Patol Oral Cir Bucal. 2016; 21: E595-600. doi: 10.4317/medoral.20980
  76. Goker F, Grecchi E, Grecchi F, et al. Treatment of medication-related osteonecrosis of the jaw (MRONJ). A systematic review. Eur Rev Med Pharmacol Sci. 2021; 25: 2662-73. doi: 10.26355/eurrev_202103_25430
  77. Jiang C, Zhu G, Liu Q. Current application and future perspectives of antimicrobial degradable bone substitutes for chronic osteomyelitis. Front Bioeng Biotechnol. 2024; 12: 1375266. doi: 10.3389/fbioe.2024.1375266