Surgical management of medication-related osteonecrosis of the jaw patients related to dental implants

Objectives: The aim of the present study is to report a case series of patients with peri-implant medication-related osteonecrosis of the jaw (MRONJ), in particular describing the onset of the condition and surgical treatment outcome. Material and Methods: Fifteen consecutive patients with clinical diagnosis of peri-implant MRONJ were retrospectively included in the study. The sample was stratified on the base of oral, pharmacological, and general health variables. The number of affected implants was recorded in all patients, and MRONJ staging applied. Surgical treatment was performed with a standardized operative protocol, involving implant removal, sequestrectomy, debridement of soft tissue, and bone curettage. Follow-up evaluating surgical outcome was performed at twelve months after surgery. Results: in our study sample, patients were almost equally distributed in terms of underlying diseases in osteoporotic and oncologic patients. All MRONJ lesions were symptomatic, and in 6 patients bone exposure was detected. 40 implants in total were evaluated, with MRONJ being present around 29 implants. 12 patients were diagnosed with Stage III MRONJ, and 3 patients with Stage II MRONJ. Surgical treatment leads to complete healing in 86.7% of cases, with 100% success for maxillary MRONJ. Conclusions: Surgical treatment seems to have a positive impact on MRONJ treatment also in cases of peri-implant involvement. However, monitoring and prevention are fundamental in patients under pharmacological treatment with anti-resorptive/ antiangiogenic drugs, as peri-implant MRONJ can develop also in absence of specific traumatic events.