Current Understanding of the Pathophysiology of Osteonecrosis of the Jaw

Area of Science:

• Oral and Maxillofacial Surgery
• Bone Biology
• Pharmacology

Background:

• Osteonecrosis of the jaw (ONJ) is a rare, severe necrotic bone disease affecting the craniofacial region.
• The exact pathophysiology of ONJ remains unclear, though antiresorptive and antiangiogenic medications are implicated.
• Understanding ONJ is crucial due to its significant impact on patient health and treatment.

Purpose of the Study:

• To review and synthesize current theories on the pathophysiology of osteonecrosis of the jaw (ONJ).
• To highlight the proposed mechanisms contributing to ONJ development and localization.
• To summarize experimental studies and identify areas for future research in ONJ.

Main Methods:

• Literature review of current theories and experimental studies on ONJ pathophysiology.
• Synthesis of evidence-based mechanisms including bone remodeling, inflammation, immunity, and angiogenesis.
• Analysis of the role of oral microbiome and systemic conditions in ONJ pathogenesis.

Main Results:

• Key proposed mechanisms for ONJ pathogenesis include disturbed bone remodeling, inflammation/infection, altered immunity, soft tissue toxicity, and angiogenesis inhibition.
• The oral microbiome and dental infections play a central role in ONJ.
• Systemic conditions like rheumatoid arthritis and diabetes mellitus can exacerbate ONJ by affecting immune resilience.

Conclusions:

• The definitive pathophysiology of ONJ is still under investigation.
• Further research is needed in osteoimmunology and the link between angiogenesis and ONJ.
• Investigating the impact of drug holidays on ONJ clinical outcomes is essential.