title: Medication-Related Osteonecrosis of the Jaws: Considerations on a New Antiresorptive Therapy (Denosumab) and Treatment Outcome after a 13-Year Experience.
abstract: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients receiving antiresorptive therapies for bone neoplastic localizations and osteoporosis. The aim of this study was to evaluate the clinicopathological features of MRONJ in a cohort of patients treated by new antiresorptive drugs (denosumab) and the corresponding outcome after 13-year maximum follow-up. Overall, 244 patients affected by MRONJ were treated from 2003 to 2015. After clinical and radiological examinations, all lesions were staged according to a dimensional staging system and then surgically treated. All the denosumab-related lesions were classified as stage II or III, thus requiring a more or less invasive surgical approach, despite the results of many recent studies, which suggested a conservative medical approach with early resolution for MRONJ in patients on denosumab. In the current series, 86.9% of treated lesions showed complete clinical and radiological healing, while 13.1% recurred; all recurrences were detected in patients who could not interrupt chemotherapy, steroids, and/or antiresorptive drugs administration due to their general conditions. In conclusion, all oral specialists should be aware of the MRONJ risk among patients taking new antiresorptive drugs; moreover, our protocol based on surgical treatment guided by dimensional staging could be considered effective in view of the low recurrence rate.
authors.affiliation: Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology, "Aldo Moro" University, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Gianfranco
authors.identifier: 0000-0002-6746-7241
authors.initials: G
authors.lastname: Favia
authors.affiliation: Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology, "Aldo Moro" University, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Angela
authors.identifier: 0000-0003-4506-6292
authors.initials: A
authors.lastname: Tempesta
authors.affiliation: Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology, "Aldo Moro" University, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Luisa
authors.identifier: 0000-0001-5246-1253
authors.initials: L
authors.lastname: Limongelli
authors.affiliation: Department of Interdisciplinary Medicine, Complex Operating Unit of Odontostomatology, "Aldo Moro" University, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Vito
authors.identifier: 0000-0003-0236-0205
authors.initials: V
authors.lastname: Crincoli
authors.affiliation: Department of Emergency and Organ Transplantation, Operating Unit of Pathological Anatomy, "Aldo Moro" University, Piazza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Eugenio
authors.identifier: 0000-0002-0472-5338
authors.initials: E
authors.lastname: Maiorano