Background and Objectives: Medication-related osteonecrosis of the jaw (MRONJ) was first recognized as a disease entity and reported in the literature in 2003. Within a few years, the incidence of MRONJ has increased significantly, to the point where now it can be seen in every dental clinic around the world. Its prevention and management still remain major challenges for dentists and oral and maxillofacial surgeons. Materials and Materials and Methods: This prospective clinical study was conducted at the Oral and Maxillofacial Surgery Clinic in Timisoara for a 6-month period and included a total of 85 patients under chronic antiresorptive and antiangiogenic medication. There were two groups of patients: G1 received PRF growth factors, while the other group, G2, was treated with classical surgical methods. Post-operative wound healing was assessed at 2, 4, and 8 weeks by monitoring the absence of local gingival dehiscence, suprainfection, or loco-regional fistulas, both in cases of dental extractions and sequestrectomies in MRONJ cases. Results: The use of PRF in post-extraction sockets in patients predisposed to developing MRONJ aids in local healing in 96% of cases, compared to cases where it was not used, in which normal healing occurred in only 64.29% of patients; there was a significant difference between the two groups (p = 0.016). In MRONJ confirmed cases, application of PRF after excisional debridement of necrotic bone does not appear to have the same therapeutic value as in post-extractional sockets, with a p-value of 0.299 indicating no statistical significance. Conclusions: PRF use can be considered an effective approach in preventing osteonecrotic complications following dental extractions in patients with antiresorptive treatment. Additional studies are needed to establish its role in MRONJ confirmed cases.

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a grave complication in patients with cancer treated with antiresorptive agents, particularly after invasive dental procedures. Identifying reliable clinical factors to assess MRONJ risk remains a clinical challenge. Methods: The retrospective observational study comprised 61 oncologic patients undergoing dental extractions during antiresorptive therapy. Preoperative serum levels of 25-hydroxyvitamin D and β-C-terminal telopeptide cross-link (β-CTx), along with relevant clinical variables, were measured. The analyses included comparative tests, multivariate logistic regression to detect independent predictors of MRONJ, and ROC curve analysis to assess the model’s predictive performance. Results: MRONJ was diagnosed in 18 patients (29.5%). Low preoperative vitamin D levels were significantly associated with MRONJ and remained an independent predictor in the multivariate analysis (OR = 8.74, p = 0.005). The mandibular extraction site was also identified as a significant risk factor (OR = 7.94, p = 0.007). In contrast, β-CTX levels, age, sex, cancer type, and the number of extracted teeth did not show a significant link to MRONJ development in this cohort. The comprehensive multivariate model demonstrated good discrimination capacity (AUC = 0.806). Conclusions: Preoperative vitamin D deficiency is an important independent predictor of MRONJ after dental extractions in patients with cancer receiving antiresorptive agents. Integrating metabolic biomarkers and clinical variables into predictive models may improve risk assessment and support the development of more effective preoperative prevention strategies.

Background and Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with antiresorptive therapy. Although several local and systemic risk factors have been documented, the role of metabolic biomarkers and their relationship with clinical characteristics remains insufficiently investigated. The aim of the present study was to evaluate the relationships between antiresorptive therapy, serum vitamin D levels, demographic characteristics, and lesion location in patients diagnosed with MRONJ. Materials and Methods: This retrospective study included 72 patients diagnosed with MRONJ, divided into three groups according to the antiresorptive therapy administered: zoledronic acid (n = 30), denosumab (n = 22), and oral bisphosphonates (n = 20). Clinical and demographic data, including age, sex, smoking status, serum vitamin D levels, number of extracted teeth, lesion location (mandibular versus maxillary), and associated comorbidities, were obtained from medical records. Statistical analysis was performed using Welch’s ANOVA, Welch’s t-test, chi-square, Fisher’s exact, and Pearson and Spearman correlation analyses. Results: No significant differences in serum vitamin D levels were observed among the three antiresorptive therapy groups. However, patients with mandibular MRONJ had significantly lower serum vitamin D levels than those with maxillary involvement (p = 0.046). Lower serum vitamin D levels were independently associated with mandibular MRONJ after multivariable adjustment. Female sex and thyroid disease were more frequent in the oral bisphosphonate group. Additionally, patient age was moderately positively correlated with the number of extracted teeth (r = 0.440, p < 0.001). Conclusions: This retrospective study identified a possible association between lower serum vitamin D levels and mandibular MRONJ. Given the observational design of the study, these findings should be interpreted with caution and require confirmation in larger prospective studies.

Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) may differ in clinical presentation and severity according to the indication for antiresorptive therapy. This study compared patients with MRONJ treated for an oncologic indication or osteoporosis and evaluated factors associated with advanced disease, defined as American Association of Oral and Maxillofacial Surgeons (AAOMS) stages II and III. Methods: This retrospective observational study included 119 patients with MRONJ, comprising 73 patients with an oncologic indication and 46 treated for osteoporosis. Demographic, clinical, treatment-related, and selected biochemical data were collected from medical records. MRONJ severity was classified according to the AAOMS staging system. Between-group differences were assessed using non-parametric and categorical tests, and multivariable logistic regression was used to examine associations with advanced MRONJ after adjustment for selected covariates. Results: Patients with an oncologic indication were younger and had a shorter duration of antiresorptive therapy than those treated for osteoporosis. The distribution of AAOMS stages differed between groups (p = 0.001). Stage III disease was more frequent in the oncologic group than in the osteoporosis group (32.9% vs. 8.7%), whereas stage II frequencies were similar (43.8% vs. 41.3%). Advanced MRONJ was also more frequent in the oncologic group (76.7% vs. 50.0%; p = 0.003). In the multivariable model, older age (OR, 1.16; 95% CI, 1.06–1.27; p = 0.001) and diabetes mellitus (OR, 8.88; 95% CI, 2.29–34.50; p = 0.002) were associated with higher odds of advanced MRONJ. Compared with oncologic patients, those treated for osteoporosis had lower adjusted odds of advanced disease (OR, 0.14; 95% CI, 0.05–0.44; p < 0.001). No statistically significant association between recorded treatment duration and advanced MRONJ was detected in the sensitivity analysis. Conclusions: MRONJ severity differed between patients treated for an oncologic indication and those treated for osteoporosis, with the difference particularly pronounced for stage III disease. These findings should be interpreted in the context of differences in antiresorptive treatment regimens and do not establish an independent causal effect of treatment indication.

Background/Objectives: Bisphosphonates, a class of drugs that are widely used in the treatment of neoplastic diseases, can lead to the development of medication-related osteonecrosis of the jaw (MRONJ). This condition is challenging to manage due to the high incidence of postoperative complications: superinfections, local wound dehiscence, or fractures in pathological bone. The aim of this study is to evaluate the therapeutic role of bovine-derived xenografts in the management of MRONJ. Methods: This retrospective observational study evaluates the clinical outcomes of patients with confirmed stage II or III MRONJ, after surgical treatment with Bio-Oss application. All patients had received zoledronic acid therapy, which was discontinued for a minimum of four months prior to surgical intervention. The surgical protocol included local debridement, sequestrectomy, and grafting of the residual defect with a bone substitute, followed by periodic clinical evaluations and monitoring of local healing with a follow-up period of up to one year. Results: Of the total number of patients treated according to this surgical protocol, 85.71% achieved favorable healing without complications at 8 weeks. Cases with poor local healing results were more likely to have prolonged zoledronic acid administration. Conclusions: Within the limits of this retrospective observational study, the use of bovine-derived xenografts following sequestrectomy in stage II–III MRONJ was associated with satisfactory local healing in several cases. However, considering the limited sample size and lack of a comparator group, these findings should be interpreted cautiously. To better understand the connection between the length of antiresorptive therapy, surgical management techniques, and postoperative outcomes, more prospective, multicenter trials with bigger patient cohorts are needed.