Medication-related osteonecrosis of the jaw: A multifaceted diagnostic challenge. Mini review

Medication-related osteonecrosis of the jaw (MRONJ) may present a challenge to the dental clinician due to the many presentations that it can have. This condition can be caused by multiple medications including bisphosphonates, RANKL ligand inhibitors and antiangiogenic drugs. Cases were reported in multiple sites of both the maxilla and mandible, including the hard palate, mylohyoid area, and the buccal plate. The risk factors for this condition include the use of a combination of antiresorptive medications, trauma, periodontal disease, immunosuppression, dental trauma, dental extractions, and bone manipulations. Spontaneous MRONJ have been reported in about half of the cases. Conventional radiographs are not conducive to a diagnosis, underscoring the importance of a three-dimensional modality in the diagnosis of MRONJ. The multifaceted diagnostic challenges of MRONJ are underscored in this mini review.

MRONJ can have diverse presentations and a lengthy multisite involvement. Therefore, long-term follow up for patients with history of use of antiresorptive medications is recommended.