The clinical effectiveness of conservative surgical management in medication-related osteonecrosis of the Jaw

Objectives: Consensus has not yet been reached on the therapy for medication-related osteonecrosis of the jaw (MRONJ). We assessed the effectiveness of conservative surgical management, which involves removing the necrotic bone and performing a gingivectomy, followed by localized cleaning to facilitate the separation of the sequestrum. Additionally, we revalidated the treatment algorithm utilized by our department. Methods: We examined 160 patients diagnosed with MRONJ at three hospitals. The data for this study were collected retrospectively. These patients were followed up for a minimum of 2 years. Results: The outcome 2 years after starting conservative surgical management was: cure: 117 cases; improvement: 22 cases; unchanged: 12 cases; and deterioration: 9 cases. The cure rate was 72.3% and 83.0% at 2 and 5 years after therapy initiation, respectively, and significantly lower at age ≥ 74 years compared to age < 74 years (P < 0.001), with malignant tumour as the primary disease when compared to osteoporosis (P < 0.001), and with ≥ 4 years of administration compared to < 4 years (P = 0.0301). On multivariate analysis, the trigger (P < 0.05), primary disease (P = 0.001), and administration period (P < 0.01) were independent prognostic factors. Conclusions: Conservative surgical management is effective for MRONJ regardless of stage, especially in patients with age < 74 years, osteoporosis, and short drug-administration periods, and could become a first-line therapy for all stages.