The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding, and failure to adhere to the intention-to-treat principle).
A Cochrane review [Abstract] 1 included 5 studies with a total of 1 218 subjects. Three studies focused on the prophylaxis of medication-related osteonecrosis of the jaw (MRONJ), and 2 studies investigated options for the treatment of established MRONJ. The studies included only participants treated with bisphosphonates and, thus, did not cover the entire spectrum of medications associated with MRONJ.
Prophylaxis of MRONJ:One study compared standard care with regular dental examinations in 3-month intervals and preventive treatments (including antibiotics before dental extractions and the use of techniques for wound closure that avoid exposure and contamination of bone) in men with metastatic prostate cancer treated with zoledronic acid. The intervention seemed to lower the risk of MRONJ (RR 0.10, 95% CI 0.02 to 0.39; 1 study, n=253).One study investigated the effect of plasma rich in growth factors (PRGF) for preventing MRONJ in people with cancer undergoing dental extractions. There was insufficient evidence to support or refute a benefit of PRGF on MRONJ incidence when compared with standard treatment (RR 0.08, 95% CI 0.00 to 1.51; 1 study, n=176). In another study comparing wound closure by primary intention with wound closure by secondary intention after dental extractions in people treated with oral bisphosphonates (n=700), no cases of intraoperative complications or postoperative MRONJ were observed.
Treatment of MRONJ: One study analyzed hyperbaric oxygen (HBO) treatment used in addition to standard care (antiseptic rinses, antibiotics, and surgery) compared with standard care alone. HBO in addition to standard care did not significantly improve healing from MRONJ compared with standard care alone (at last follow-up RR 1.56, 95% CI 0.77 to 3.18; 1 study, n=46). The other study found no significant difference between autofluorescence- and tetracycline fluorescence-guided sequestrectomy for the surgical treatment of MRONJ at any timepoint (at one-year follow-up RR 1.05, 95% CI 0.86 to 1.30; 1 study, n=34).
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