Medication-Related Osteonecrosis of the Jaws: 2022 Update

Medication-Related Osteonecrosis of the Jaws (MRONJ) is an enigmatic pathologic entity of equivocal etiology and pathophysiology. Once considered a complication directly attributable to bisphosphonate medications, the OMS specialty now recognizes the association of other medication classifications including the RANKL inhibitors, antiangiogenic agents and several traditional chemotherapeutic agents. In addition, the patient's medical comorbidity – including the existence of cancer, metastatic disease, diabetes, obstructive lung disease and social habits such as smoking – are recognized as contributors to the development of this wound-healing dilemma, most often initiated by a traumatic incident such as a tooth extraction. The introduction and timing of conservative therapy of this disease continues to be discussed as well as the role and success of surgical resection of the focus of osteonecrosis. Moreover, strategies to prevent MRONJ in patients exposed to antiresorptive and antiangiogenic therapy must be discussed to reduce the morbidity experienced by patients treated with these medications. In the final analysis, MRONJ is preventable, resectable and reconstructable in a very predictable fashion. This presentation will review these concepts while narrowing the educational gap and reducing the fear experienced by medical and dental professionals in their treatment of patients who require medications associated with this pathologic process.

Learning Objectives

At the conclusion of this program, participants should be able to:

1. List the pathophysiologic mechanisms of MRONJ offered in the international literature. 
2. Discuss the role of conservative therapy vs. surgical resection of MRONJ. 
3. Discuss the medical management of patients planned for surgical resection of MRONJ. 
4. Discuss the follow-up protocol of patients undergoing conservative therapy or resection of MRONJ 
5. Discuss the options associated with reconstruction of segmental defects of the mandible. 

Eric R. Carlson, DMD, MD, EdM, FACS
Professor and Kelly L. Krahwinkel Endowed Chairman
University of Tennessee Graduate School of Medicine
Knoxville, Tennessee
Disclosure: Elsevier (Individual(s) Involved: Self): Book royalties, Speaker/Honoraria; Quintessence Publishing (Individual(s) Involved: Self): Book royalties, Speaker/Honoraria; Wiley Blackwell (Individual(s) Involved: Self): Book royalties, Speaker/Honoraria

An Internet-based CDE/CME Activity
Original Release Date: September 17, 2022
Expiration Date: September 17, 2025
Estimated time to complete this educational activity: 1.0 hours
Method of participation: Self-Study

Continuing Education Provider Approval
The American Association of Oral and Maxillofacial Surgeons is an ADA CERP Recognized Provider.

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education.

ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

The American Association of Oral and Maxillofacial Surgeons designates this activity for 1.0 continuing education credit(s).

AGD - Accepted Program Provider
FAGD/MAGD Credit
11/1/22-12/31/26
Provider ID# 214680

The American Association of Oral and Maxillofacial Surgeons (AAOMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Association of Oral and Maxillofacial Surgeons designates this internet-based enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.