OSTEONECROSIS OF THE JAWS. ANALYSIS OF RISK FACTORS AND DENTAL MANAGEMENT STRATEGIES- PART I

M. Scarpati Cioffari di Castiglione¹, S. Lauri^2*, I. Mastrorilli³, A. Bonomo⁴, F. Ferrantini⁴, L.M. Laudiero⁴, G.M. Granata⁴ and A. Della Corte⁵

¹ Independent researcher, 81021, Caserta, Italy;
² Independent researcher, 00073, Rome, Italy;
³ Independent Researcher, 00135, Rome, Italy;
⁴ Department of System Medicine, University of Rome “Tor Vergata”, Rome, Italy;
⁵ Independent Researcher,72021, Brindisi, Italy.

*Correspondence to:
Simone Lauri,
Independent Researcher,
00073, Rome, Italy.
e-mail: laurisimone1@gmail.com

Received: 04 September, 2025 Accepted: 29 October, 2025

ISSN 2975-044X (online) ISSN 2038-4106 (print) Copyright © by BIOLIFE 2025 This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties. Disclosure: All authors report no conflicts of interest relevant to this article.

ABSTRACT

This comprehensive review examines medication-related osteonecrosis of the jaw (MRONJ), a complex and debilitating pathological condition primarily associated with the use of anti-resorptive agents such as bisphosphonates and denosumab, as well as anti-angiogenic drugs. The article discusses the recent shift from the term BRONJ to MRONJ to reflect the broader range of causative medications. It details the pathophysiological mechanisms—including alterations in bone remodeling, impaired osteoclastic activity, compromised vascularization, and immune dysfunction—that contribute to its development. The review analyzes various risk factors, encompassing pharmacological variables (drug type, dosage, route, and duration), systemic health conditions (such as diabetes, osteoporosis, and cancer metastases), and local factors like invasive dental procedures and chronic inflammatory diseases. Prevention strategies focus on meticulous risk assessment, oral health optimization, timing of treatments, and minimally invasive surgical protocols. The potential utility of biomarkers, particularly serum CTX levels, for early risk prediction is explored, although further validation is needed. The review underscores the importance of further prospective studies to improve understanding of the pathogenetic mechanisms, validate prognostic biomarkers, and evaluate innovative treatment options, ultimately aiming to enhance patient management, reduce incidence, and preserve quality of life in at-risk populations.

KEYWORDS: MRONJ, anti-resorptive, risk factor, prevention, biomarker