Antibiotic Prophylaxis and Postoperative Therapy in Tooth Extractions for Patients at Risk of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Scoping Review

Background/Objectives: Although several studies have reported antibiotic protocols for the prevention of medication-related osteonecrosis of the jaw (MRONJ) in patients receiving antiresorptive and/or antiangiogenic therapy following tooth extraction, it remains unclear which protocol is the most effective. Accordingly, this scoping review analyzed antibiotic use in dental extractions in these patients, focusing on whether antibiotic duration influences MRONJ occurrence. Methods: Two authors independently searched PubMed, Scopus, and Web of Science (2003-2025). Out of the 770 studies screened, 36 were included. Descriptive statistics, a meta-analysis comparing MRONJ incidence in patients treated with high-dose (HD) and low-dose (LD) antiresorptive treatment according to the therapeutic indication and generalized linear mixed models on antibiotic duration were obtained (α = 0.05). Results: Amoxicillin, alone or with clavulanic acid, was the most used antibiotic, and in 8 studies it was combined with metronidazole. Seven studies reported parenteral antibiotic administration. Median antibiotic duration was 1.5 days pre-extraction, 5.5 days post-extraction, and 7 days overall. MRONJ risk was significantly higher in HD than LD patients (95% CI: 1.46-5.43; p = 0.002), and antibiotic duration was positively associated with reduced MRONJ risk in HD patients (β = -0.15, p = 0.026; OR = 0.86, 95% CI: 0.75-0.98). Conclusions: The literature shows heterogeneous antibiotic protocols for MRONJ prevention. The increased MRONJ risk and greater protective effect of antibiotics in HD patients suggest that patient risk profile may be more relevant than the antibiotic regimen.