Enhancement of bone perfusion through cortical perforations to improve healing of medication-related osteonecrosis of the jaw: a retrospective study.

Medication-related osteonecrosis of the jaw (MRONJ) is generally difficult to treat. So far, no optimal strategy for MRONJ has been established. The aim of this study was to determine whether a new surgical technique, i.e. curettage with cortical perforations of healthy adjacent bone that enhances bone perfusion would be more effective than standard curettage in treating patients with MRONJ. Twenty-eight MRONJ patients who underwent curettage treatment with or without cortical perforation technique at our institution between June 2014 and May 2016 were included in this retrospective study. Ten cases treated using cortical perforation technique were completely cured after primary wound closure with mucoperiosteal flap. During a long-term follow-up, two cases from the cortical perforation group relapsed at the mandibular sites 6 and 40 months post-operation, respectively, while in the control group, 77.8% (14/18) cases relapsed due to infected mucosa fistula or bone exposure 1-3 months after treatment. It was concluded that the new treatment approach might be more effective in treating patients with MRONJ caused by antiresorptive drugs. However, more extensive randomized trials are needed to further evaluate its efficacy in clinic.