Conservative Approaches to Managing Medication-Related Osteonecrosis of the Jaw (MRONJ): A Narrative Review

Medication-Related Osteonecrosis of the Jaw (MRONJ) is a severe complication associated with the use of bone-modifying agents, such as Zoledronic Acid and Denosumab, in cancer patients. It poses significant challenges in prevention, diagnosis, and treatment, highlighting the urgent need for effective and evidence-based management strategies to optimize patient outcomes. Conservative approaches have gained attention as viable alternatives to surgical intervention, particularly in early-stage MRONJ. These strategies include antimicrobial therapy, pain management, local wound care, and adjunctive therapies such as low-level laser therapy and photodynamic therapy. Hyperbaric oxygen therapy has also been investigated; however, current literature doesn’t provide strong evidence to support its routine use. Additionally, several inflammatory and bone turnover markers, including CTX, P1NP and RANKL in addition to regulatory cytokines like OPG have been studied for their potential to reflect disease progression and treatment response. While non-surgical management has shown promising results in symptom control and healing, the lack of standardized treatment protocols remains a limitation. Further research is needed to refine conservative treatment guidelines to explore reliable biomarkers and innovative therapeutic strategies to improve clinical outcomes and quality of life for affected patients.