Calabria, Elena (2021) Conservative non-surgical treatment of medication-related osteonecrosis of the jaws: a long-term prognostic evaluation. [Tesi di dottorato]

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BACKGROUND: The conservative non-surgical treatment of medication-related osteonecrosis of the jaws (MRONJ) is generally advisable in patients with poor general health and/or a concomitant malignant disease as the priority is to control signs of infection and symptoms and to prevent a further bone disease progression. AIMS: the aim of this study is to conduct an exploratory analysis on the long-term outcomes of the exclusive conservative non-surgical treatment on a big sample of MRONJ patients, all having a minimum follow-up of at least 12 months. METHODS: A retrospective medical record review of patients diagnosed with MRONJ was carried out in three Oral Medicine /Oral Maxillofacial outpatients' departments. The conservative non-surgical treatment consisted of the use of local antiseptics with or without the use of antibiotics cycles. Regardless of stage, mobile fragments of bone were managed with non-surgical sequestrectomy. MRONJ lesions were staged according to both the American Association of Oral/Maxillofacial Surgeons staging system and the SICMF- SIPMO staging system. The primary outcome was the pain remission. Secondary outcomes were remission of signs of infection and complete clinical remission of MRONJ lesion. RESULTS: One hundred and twenty-six patients were included in the study and observed for a mean time of 39.73 ± 27.38 months. About seventy-one percent of the sample was composed of oncologic patients. 51.1% of the MRONJ lesions had never experienced pain or relapses after the first pain remission, while in 46.8% relapses were successfully treated with medical therapy. Only in the 2.1% pain was persistent. 93% of the patients achieved either complete clinical healing of the lesions (32%), or a clinical stable disease (61%) experiencing pain and signs of infection remission. Only 7% of the patients were refractory to the non-surgical treatment and needed surgical interventions in order to achieve a better pain/infection control. CONCLUSIONS: Although one third of the patients achieve complete clinical remission of MRONJ lesions, the non-surgical treatment had demonstrated to be effective in controlling pain and signs of infection in almost all the patients. Prospective multicenter, controlled trials are necessary to better determine the relative effectiveness of the non-surgical treatment for a more evidence-based approach to management of MRONJ.

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