Medical Treatment For Advanced Medication-Related Osteonecrosis Of The Jaws

The aim of this retrospective study was to evaluate the response of advanced medication related osteonecrosis patients to medical treatment. Records of patients with stage 3 medication-related osteonecrosis (due to American Association Oral and Maxillofacial Surgery Classification) referred to our faculty were reviewed from June 2022 to November 2024. A total of 29 patients (14 female) with avarege age 47,41 (range 34-89) who were treated medically were enrolled in this study. Regarding the reasons for antiresorptive drug use, two patients were treated for osteoporosis, two for multiple myeloma, and 25 patients (with lung, prostate, breast, and renal carcinoma) were treated for bone metastases. The mean follow-up period was 11.62 months. The medical treatment algorithm includes systemic antibiotic therapy until the acute infection is under control, followed by low-dose antibiotic therapy with pentoxifylline and alpha-tocopherol. The treatment responses of the remaining 23 patients were consist of five partial responses and 18 complete recoveries. Gastrointestinal disorders were the most common side effects related to medical treatment, with only one patient unable to tolerate it. Following complete healing of the soft tissue, dental prosthetic treatment is performed, and patients are followed up regularly. Considering our success rate in treatment, although the 2022 AAOMS position paper emphasizes surgical treatment options, we believe that it should be reevaluated to prioritize extensive and complex surgical treatment options as the primary approach for patients with necrosis, particularly in older adults and those undergoing oncologic treatment, without first considering medical treatment