title: Evaluation of surgical outcome and influencing risk factors in patients with medication-related osteonecrosis of the jaws.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: christoph.klingelhoeffer@ukr.de.
authors: Christoph
authors: C
authors: Klingelhöffer
authors: Department of Clinical Studies, Hospital of the University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: florian.zeman@ukr.de.
authors: Florian
authors: F
authors: Zeman
authors: Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: johannes.meier@ukr.de.
authors: Johannes
authors: J
authors: Meier
authors: Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: torsten.reichert@ukr.de.
authors: Torsten Eugen
authors: TE
authors: Reichert
authors: Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: tobias.ettl@ukr.de.
authors: Tobias
authors: T
authors: Ettl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology / Q000601:surgery*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D000069448:Denosumab / Q000009:adverse effects; D004164:Diphosphonates / Q000009:adverse effects; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects; D008297:Male; D063175:Mandibular Reconstruction / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000069448:Denosumab; D000077211:Zoledronic Acid
keywords: Bisphosphonates; Denosumab; Osteonecrosis; Recurrence; Surgery