SURGICAL MANAGEMENT STRATEGIES FOR MEDICATION-RELATED OSTEONECROSIS OF THE JAW (MRONJ)
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction characterized by persistent bone exposure in patients undergoing antiresorptive or antiangiogenic therapies. Although conservative management was the historical standard, contemporary evidence suggests limitations in this approach, driving a transition toward resolute surgical protocols. Objective: To analyze scientific evidence regarding surgical management strategies for MRONJ and the impact of adjuvant therapies on clinical resolution. Methodology: This is an integrative literature review structured into six operational stages and guided by the PICO strategy. A systematic search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and BVS/LILACS databases, covering publications up to April 2026. Controlled descriptors (MeSH/DeCS) were used to identify primary studies in English, Portuguese, or Spanish. Selection occurred in two phases via Rayyan software, resulting in a final sample of 8 articles. Results: Early surgical intervention demonstrated success rates exceeding 90%. Strategies such as aggressive debridement and marginal ostectomy, when combined with adjuvant therapies like L-PRF, laser photobiomodulation, and photodynamic therapy, optimized angiogenesis and mucosal re-epithelialization. Final Considerations: The surgical paradigm, coupled with the use of biological adjuvants, currently represents the most effective strategy for the clinical resolution of MRONJ.
Author Biographies
Dentist, Master’s student, Universidade Federal do Piauí (UFPI).
Dentist, PhD candidate in Biotechnology at Universidade Estadual de Feira de Santana.
Dentist, Master’s degree holder and undergraduate medical student.
Graduate in Dentistry from the Faculdade de Odontologia de Bauru, Universidade de São Paulo (FOB-USP), and currently specializing in Endodontics at the Faculdade de Odontologia de Bauru (FOB-USP).
Dentist.
Dentist, Specialist in Public Health – Universidade Paulista (UNIP).
Dentist graduated from the Universidade Federal do Ceará (UFC). Currently specializing in Dental Prosthesis at the Centro Universitário Christus (Unichristus). Holds a postgraduate degree in Pre-Hospital Emergency Care.
Dentist graduated from the Universidade Estadual da Paraíba.
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