Antiangiogenic Medications Impede the Oral Mucosal Microcirculation and Interfere with Oral Wound Healing: A Complication Deserving of Attention.

Long-term antiangiogenic therapy may be linked to medication-related osteonecrosis of the jaw (MRONJ), complicating surgical treatment due to impaired postoperative wound healing. However, the mechanisms underlying these healing difficulties remain unclear. This bidirectional cohort study explored the impact of antiangiogenic medications (AGM) in combination with antiresorptive medications (ARM) on oral mucosal microcirculation and its relationship with surgical outcomes in MRONJ patients. A total of 30 patients (15 using ARM and 15 using both ARM and AGM) and 15 healthy volunteers undergoing surgery were included. A handheld vital microscope (HVM) was utilized to assess oral mucosal microcirculation. The results showed that patients taking both AGM and ARM had reduced microvascular density and more stagnant microcirculation than patients taking ARM alone and healthy volunteers. Additionally, impaired microcirculation was also statistically linked to poorer surgical prognosis in MRONJ patients receiving AGM&ARM with lower microcirculation parameters. This study highlights the potential adverse effect of AGM on oral mucosal microcirculation, contributing to impaired wound healing after surgery in MRONJ patients. This study provides new evidence for the vascular mechanisms involved in healing difficulties in MRONJ and supports the hypothesis that AGM plays a detrimental role in oral surgical recovery.