Minimizing MRONJ after Tooth Extraction in Cancer Patients Receiving Bone-Modifying Agents

Area of Science:

• Oral and Maxillofacial Surgery
• Oncology
• Pharmacology

Background:

• Medication-related osteonecrosis of the jaws (MRONJ) is a serious complication affecting the maxillofacial region, characterized by exposed necrotic bone.
• The multifactorial nature of MRONJ is recognized, with tooth extraction being a debated risk factor.
• Understanding predisposing factors is crucial for managing MRONJ in patients undergoing oncological treatments with bone modifying agents (BMAs).

Purpose of the Study:

• To investigate the occurrence of MRONJ in patients receiving BMAs for oncology indications who undergo dental extractions.
• To identify and assess potential predisposing factors that may predict the development of MRONJ post-extraction.

Main Methods:

• A retrospective cohort study was conducted at a large tertiary medical center.
• Data were collected from hospital medical records using a structured questionnaire for 93 patients undergoing 103 extractions.

Main Results:

• Local inflammation or infection at the extraction site was significantly associated with MRONJ development (OR = 13.46, p = 0.001).
• Extractions for periodontal disease, vertical root fracture, or periapical pathosis increased MRONJ odds by 4.29 times (p = 0.1).
• A significant association was found between the timing of BMA treatment initiation relative to extraction and MRONJ development (OR = 3.34, p = 0.01).

Conclusions:

• Local inflammation/infection and initiating BMA treatment before extraction significantly increase MRONJ risk by 10.23 times.
• These findings highlight critical factors for developing future protocols to minimize MRONJ incidence.
• The study underscores the importance of considering infection control and treatment timing in BMA patients undergoing dental extractions.