Surgical versus conservative management of advanced-stage drug-related osteonecrosis of the jaw (MRONJ): a narrative review of cure rates
DOI:
https://doi.org/10.56183/iberojhr.v6i1.926Palavras-chave:
Medication-related osteonecrosis of the jaw, MRONJ, Bisphosphonates, Denosumab, Surgical management, Conservative treatment, Platelet-rich fibrin, Systematic review.Resumo
Introduction/objective: Medication-related osteonecrosis of the jaw (MRONJ) is an emerging iatrogenic condition in which optimum management of advanced stage disease is the subject of intense debate. This is a narrative review that evaluates the comparative effectiveness of surgical and conservative treatment strategies for advanced (stage 2/3) MRONJ including quantitative synthesis of success rates and identification of outcome-modifying adjuvant therapies. Methods: A systematic search of the literature was performed in PubMed, ScienceDirect and Cochrane Library for studies published January 2015 - February 2026 examining surgical and/or conservative management of stage 2/3 MRONJ. Empirical trend analysis and scientometric mapping of the evolution of therapy were carried out. Pooled success rates were calculated using random effect models. Results: We included 34 studies (n = 2,847 patients; 21 surgical, 7 conservative, 6 comparative studies). There were very high pooled complete resolution rates (74.8, 95% CI 68.3-81.2) with surgery that were in comparison much higher than with conservative management (28.4, 95% CI 19.7-37.1; OR 4.89, 95% CI 3.12-7.66; P < 0.001). Adjunctive platelet rich fibrin/concentrated growth factor application had a significant positive impact on surgical success (OR 2.34, 95% CI 1.56-3.51; P=0.002). Conservative monotherapy demonstrates* profound inadequacy **in case of stage 1 disease 91.3% of lesions fail to heal and 67% of lesions progress to advanced stages; in case of stage 2/3 patients conservative care the pooled complete resolution rate is only 22.7%. Conclusions: Contemporary evidence unequivocally shows surgical intervention to be superior to conservative management for advanced stage MRONJ with four-fold higher odds of complete resolution of disease. The historical treatment paradigm of positioning surgery as the last resort is no longer tenable; surgery with early definite resection, tension-free primary closure and adjuvant autologous platelet concentrates should be the standard of care for operable patients with stage 2/3 disease.
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