Evaluation of surgical outcome and influencing risk factors in patients with medication-related osteonecrosis of the jaws

J Craniomaxillofac Surg. 2016 Oct;44(10):1694-1699. doi: 10.1016/j.jcms.2016.08.001. Epub 2016 Aug 9.


Purpose: Surgical treatment of the medication-related osteonecrosis of the jaw (MRONJ) is still challenging. We examined the outcome of the resection of osteonecrotic lesions and the influence of potential risk factors on the operative success.

Methods: Seventy six surgical interventions on 40 patients were evaluated in a prospective design with a mean follow-up of 55 weeks. Primary endpoints were: (i) maintenance of the mucosal closure and (ii) decrease of MRONJ stage. Influential variables included preoperative duration, location and diameter of MRONJ, duration and change of antiresorptive therapy, presence of actinomyces species.

Results: Only in 27.6% of cases long-term maintenance of the mucosal closure was achieved. However, stage II patients decreased to stage I in 81% after surgery (p < 0.01) and stage III patients improved in 83% of cases (OR = 8.08; p = 0.07). Stage I patients profited only in 38% by surgical intervention. MRONJ recurrence after surgery was associated with extended preoperative MRONJ duration (p = 0.015). There was no significance of further influential variables, but MRONJ of the upper jaw seems prognostically more favorable.

Conclusion: Advanced stages of MRONJ benefit from surgical treatment, whereas stage I diseases may also be treated conservatively. An early intervention reduces the risk of recurrence.

Keywords: Bisphosphonates; Denosumab; Osteonecrosis; Recurrence; Surgery.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / etiology
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / surgery*
  • Bone Density Conservation Agents / adverse effects*
  • Denosumab / adverse effects
  • Diphosphonates / adverse effects
  • Female
  • Humans
  • Imidazoles / adverse effects
  • Male
  • Mandibular Reconstruction* / adverse effects
  • Mandibular Reconstruction* / methods
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Treatment Outcome
  • Zoledronic Acid


  • Bone Density Conservation Agents
  • Diphosphonates
  • Imidazoles
  • Denosumab
  • Zoledronic Acid