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MRONJ of the Mandible-From Decortication to a Complex Jaw Reconstruction Using a CAD/CAM-Guided Bilateral Scapula Flap.

Medication-related osteonecrosis of the jaw (MRONJ) has been an integral part of the maxillofacial patient population for some time. The therapeutic concept ranges from conservative approaches over less extended decortications to major jaw resections, which can result in a considerable loss of quality of life. Based on three case reports, this paper presents the long-term history of patients with MRONJ of the mandible, whose disease ultimately resulted in partial or total mandibular resection and subsequent multisegmental reconstruction using a microvascular anastomosed bone flap. Furthermore,

Multiple myeloma and bisphosphonate-related osteonecrosis of the mandible associated with dental implants.

Multiple myeloma (MM) is a malignant plasma cell disorder and more than 30% of patients with this pathology develop osteolytic lesions in the jaw. Either pamidronate or zoledronic acid is recommended in patients with MM who have one or more lytic lesions. However, bisphosphonate-related osteonecrosis of the jaws (BRONJ) has been described as a complication associated with their use. Otherwise, the use of endosseous implants in oral rehabilitation is a well-established procedure, with good long-term success although systemic factors may affect the bone healing around dental implants. We report

Связанный с лекарствами остеонекроз челюсти у нескольких пациентов миэломы: серия случаев.

Остеонекроз челюсти (MRONJ), связанный с лекарственными препаратами, является осложнением антирепрессивной и антиангиогенной терапии, используемой при лечении злокачественных заболеваний, и может вызывать значительную функциональную и эстетичную заболеваемость у пациентов. Множественная миелома (ММ) — гематологическая порча плазмы и клеток, часто связанная с остеолитической болезнью костей. Антирезорптивная терапия (АРТ) уменьшает связанные со скелетом явления в MM и других магнатах с участием скелета, но связана с повышенным риском заболевания MRONJ. В настоящем документе представлены клиниче

MASCC/ISOO Clinical Practice Statement: imaging and clinical laboratory tests in the diagnosis and management of medication-related osteonecrosis of the jaw.

PURPOSE: A MASCC/ISOO Clinical Practice Statement (CPS) is aimed at generating a concise resource for clinicians that concentrates practical information needed for the management of oral complications of cancer patients. This CPS focuses on the use of imaging and clinical laboratory tests for the diagnosis, staging, monitoring, treatment decision, and prediction of medication-related osteonecrosis of the jaw (MRONJ) in cancer patients. METHODS: This CPS was developed based on a critical evaluation of the literature followed by a structured discussion of a group of leading experts, members of

Bone mineral density and muscle mass in adults with developmental skeletal discrepancies.

BACKGROUND: It was aimed to investigate the musculoskeletal status in individuals diagnosed with skeletal discrepancies. METHODS: This case-control study was performed on 35 patients with developmental skeletal discrepancies listed for orthognathic surgery as a case group and 33 patients who were nominated for wisdom tooth removal as a control group. All participants were aged 18-40 years and the research was carried out in the period between May 2018 and May 2019. Dual X-ray absorptiometry (DEXA) was used to assess bone mass density at three bone sites: total hip, femoral neck, and the spina

Metastatic gallbladder cancer presenting as numb chin syndrome: A case report and literature review.

Gallbladder cancer (GBC) is an uncommon malignancy that is highly aggressive in the advanced stages. However, it rarely metastasizes to the mandible. Numb chin syndrome (NCS) is a rare neurological manifestation associated with various underlying causes, including occult primary cancers and distant metastases. It is often considered to be a significant indicator of malignancy, and thorough investigation is essential in the presence of unclear etiology. The current study reported on the case of a 69-year-old Japanese woman who presented with numbness and mild pain in the lower lip and chin area

Oral squamous cell carcinoma vs. medication-related osteonecrosis of the jaw in patients assuming bone-modifying agents: a diagnostic challenge in a multi-hospital case series.

BACKGROUND: Despite advances in the diagnosis of oral squamous cell carcinoma (OSCC), most cases are diagnosed in advanced stages, influencing negatively the patient's prognosis. The absence of specific signs and symptoms contributes to the diagnostic delay of OSCC, often leading to confusion with various oral conditions, including, in patients with a history of bone modifying agents (BMA) and/or anti-angiogenic (AA) molecules, the Medication-Related Osteonecrosis of the Jaw (MRONJ). This study aims to investigate the characteristics of OSCC and MRONJ, focusing on clinical and radiological fea

Consensus Statement on Full-Arch Implant Rehabilitations: Evidence-Based Recommendations from the Italian Consensus Conference.

Full-arch implant-supported rehabilitations are widely recognized as an effective treatment option for edentulous patients. Nevertheless, clinical decision-making regarding patient selection, surgical planning, prosthetic material choice, and long-term maintenance protocols remains heterogeneous and requires structured evidence-based guidance. A modified Delphi consensus process was conducted involving 29 experts during the Italian Consensus Conference. A systematic literature review covering the period 2015-2024 was performed, and the certainty of evidence was assessed using the Grading of Re

Assessment of evidence from teeth and the alveolar bone of skulls.

A notable lack of agreement on a standardised criterion for representing changes in alveolar bone persists, which limits its application in forensic dentistry. This study aimed to describe the data on loss of tooth substance and alveolar bone in skulls. Dental and trabecular bone information from 28 skulls from the German Helmer skull collection was collected through dental charting, intraoral photographs taken with a DSLR camera (Nikon D5600, Nikon Corporation, Japan), and small radiographs obtained using a handheld dental X-ray device (Nomad Pro 2, Kavo Kerr, Biberach, Germany). Adobe Photos

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… Facial fractures, particularly in the mandible, are often accompanied by dental injuries, with upper jaw teeth potentially at higher risk during mandibular fractures 76 . … Abbott JR Moore MH David JD Influence of the maxillary canine on mandibular fracture J Craniofac Surg 1992 3 141 144 10.1097/00001665-199211000-00005 1298412 Abbott, J. R., Moore, M. H. & David, J. D. Influence of the maxillary canine on mandibular fracture. …

Risk factors of medication-related osteonecrosis of the jaw: a retrospective study in a Turkish subpopulation.

OBJECTIVES: Medication-related osteonecrosis of the jaw (MRONJ) is a well-known side effect of certain drugs that are used to influence bone metabolism to treat osteometabolic disease or cancers. The purpose of our study was to investigate how high-concentration and low-concentration bisphosphonate (BP) intake affects the disease severity. MATERIALS AND METHODS: Data collected from the medical records of 52 patients treated with BPs, antiresorptive, antiangiogenic drugs and diagnosed with MRONJ were included in this study. Age, sex, type of systemic disease, type of drug, duration of drug tre

Combined Administration of Bisphosphonates, Chemotherapeutic Agents, and/or Targeted Drugs Increases the Risk for Stage 3 Medication-Related Osteonecrosis of the Jaw: A 4-Year Retrospective Study.

OBJECTIVES: Patients with stage 3 medication-related osteonecrosis of the jaw (MRONJ) suffer from severe complications. Chemotherapeutic agents and targeted drugs are considered to be associated with the development of MRONJ. However, little is known regarding the association of those agents with stage 3 MRONJ. The purpose of this study is to analyze the comprehensive medication history of patients with advanced-stage MRONJ (stage 2 and stage 3) and evaluate the possible risk factors for stage 3 MRONJ. Patients and Methods. Sixty patients with advanced-stage MRONJ were involved in this retrosp

Prevention and treatment of oral adverse effects of antiresorptive medications for osteoporosis - A position paper of the Brazilian Society of Endocrinology and Metabolism (SBEM), Brazilian Society of Stomatology and Oral Pathology (Sobep), and Brazilian Association for Bone Evaluation and Osteometabolism (Abrasso).

Antiresorptive therapy is the main form of prevention of osteoporotic or fragility fractures. Medication-related osteonecrosis of the jaw (MRONJ) is a relatively rare but severe adverse reaction to antiresorptive and antiangiogenic drugs. Physicians and dentists caring for patients taking these drugs and requiring invasive procedures face a difficult decision because of the potential risk of MRONJ. The aim of this study was to discuss the risk factors for the development of MRONJ and prevention of this complication in patients with osteoporosis taking antiresorptive drugs and requiring invasiv

Mandibular Radiographic Assessment in Sickle Cell Disease: A Systematic Review of Radiomorphometric Indices and Fractal Dimension.

AIM: This systematic review aimed to investigate the association between sickle cell disease (SCD) and reduced bone mineral density (BMD) using radiomorphometric indices (RMI) and fractal dimension analysis (FDA) on dental radiographic images. METHODS AND RESULTS: Observational studies evaluating BMD in individuals with SCD through RMI or FDA were included. A comprehensive search was conducted across six databases and grey literature in March 2025. Risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Tool for cross-sectional studies, and certainty of the evidence wa

Survival Rates and Clinical Outcomes of Implant Overdentures in Old and Medically Compromised Patients.

Studies on the survival rate of implant overdentures in medically compromised patients are limited because most studies exclude patients with systemic diseases affecting implant prognosis. This retrospective study aimed to evaluate the survival rate and clinical outcomes of dental implants used for overdentures in medically compromised patients. A total of 20 patients (9 men, 11 women; mean age: 67.55 ± 6.84 years, range: 53-81 years) were included. Fourteen patients had more than two systemic diseases, and nine patients had more than three systemic diseases. The mean follow-up period was 39.0

Fibular flap mandibular reconstruction for third-stage medication-related osteonecrosis of the jaw: A retrospective single-center study.

BACKGROUND/PURPOSE: The incidence and patient population of medication-related osteonecrosis of the jaw (MRONJ) has dramatically increased due to the use of drugs suppressing bone metastasis. However, its clinical treatment is still very difficult. The aim of this study was to evaluate the effectiveness and outcome of immediate fibular flap reconstruction for MRONJ in the mandible. MATERIALS AND METHODS: Patients who underwent immediate fibular flap reconstruction for MRONJ in the mandible in our institution from 1990 to 2022 were screened and identified. Their demographics, drug history, sym

Marginal resection of solitary plasmacytoma in the anterior region of the mandible and dental implant rehabilitation: Report of an unusual case.

INTRODUCTION: Plasmacytoma describes a neoplastic proliferation of plasma cells affecting different groups of patients according to location, and may demonstrate heterogeneous tumor progression and survival rate. The present article describes a case of solitary plasmacytoma in the mandible. PRESENTATION OF CASE: A 57-year-old male smoker was referred to the oral and maxillofacial service with extensive injury, approximately 4-5 cm in size, involving the anterior inferior region of mandible. After confirming diagnosis of plasmacytoma through incisional biopsy, because it was a recurrent lesion

Fractal Dimension Analysis of Mandibular Trabecular Bone in Patients Receiving Antiresorptive Therapy for Osteoporosis and Oncologic Conditions.

Objectives: This study aimed to assess the effects of antiresorptive drugs on mandibular trabecular bone structure in patients with osteoporosis and those receiving antiresorptive therapy for oncologic conditions using fractal dimension (FD) analysis of panoramic radiographs. Additionally, it investigated the influences of age, gender, drug type, administration route, and treatment duration on mandibular trabecular bone structure. Methods: This retrospective cross-sectional study included 73 patients categorized into the following three groups: 23 osteoporosis patients, 25 oncologic patients,

New dimensional staging of bisphosphonate-related osteonecrosis of the jaw allowing a guided surgical treatment protocol: long-term follow-up of 266 lesions in neoplastic and osteoporotic patients from the university of bari.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is the most serious side effect in patients receiving bisphosphonates (BPs) for neoplastic disease and osteoporosis. The aim of this study is to propose a new dimensional stage classification, guiding the surgical treatment of BRONJ patients, and to evaluate the success rate of this new management. From 2004 to 2013, 203 neoplastic and osteoporotic patients with 266 BRONJ lesions were referred to the Odontostomatology Unit of the University of Bari. All patients underwent surgery after suspension of BPs therapy and antibiotic treatment. T

Bisphosphonate-related osteonecrosis of the jaw mimicking bone metastasis.

Osteonecrosis of the jaw is usually a potential complication of bisphosphonate therapy. In a cancer patient, this disease entity can be misdiagnosed as a metastatic lesion. Our aim is to make clinicians aware of bisphosphonate associated osteonecrosis of the jaw to prevent misdiagnosis and initiate proper treatment at the earliest. We present the case of a breast cancer patient with multiple bony metastases and a jaw lesion presumed to be metastases. After no response to palliative radiation, repeat radiological imaging studies revealed osteonecrosis of the jaw. Correlating a patient's clinica

Asia-Pacific consensus statement on medication-related osteonecrosis of the jaw in patients with osteoporosis.

A unified consensus statement on medication-related osteonecrosis of the jaw (MRONJ) has not yet been established among the Asian member countries or regions of the Asian Federation of Osteoporosis Societies (AFOS). This study aimed to develop a consensus on MRONJ in patients with osteoporosis across these countries and regions. In this study, the term "Asia-Pacific" refers specifically to the Asian member countries and regions of AFOS. A structured survey consisting of nine MRONJ-related questions was distributed across 10 countries and regions to assess the level of agreement and summarize r

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… Advanced-stage MRONJ may involve sequestration, mandibular canal thickening, maxillary sinusitis, or pathological mandibular fractures [ 27 ]. Severe maxillary cases may even exhibit separation of the zygomatic bone. …