Non-Surgical Therapy For Denosumab-Associated Jaw Osteonecrosis: Case Report

This case report describes non-surgical management of denosumab-related osteonecrosis of the jaw to inform treatment strategies for medication-related osteonecrosis of the jaw (MRONJ) in patients with systemic comorbidities. A 56-year-old patient with lung adenocarcinoma and bone metastases presented with a 2-month history of oral mucosal swelling and ulceration, initially misdiagnosed as a periodontal abscess. After referral, Stage II MRONJ was confirmed based on denosumab therapy history, gingival swelling with suppuration, radiographic findings (generalized periodontal ligament widening and bilateral posterior maxillary bone density elevation). Due to progressive cancer and poor systemic tolerance to multiple chemotherapies, the oncologist recommended discontinuation of denosumab, and non-surgical sequential therapy was implemented: periodontal debridement, anti-inflammatory medications, regular oral hygiene maintenance, adjunctive hyperbaric oxygen (HBO), pentoxifylline (PEN) and vitamin E (TO) infusions, and neodymium laser therapy. Significant clinical improvement was observed. Amid increasing denosumab utilization, our survey identified persistent gaps in clinician awareness of MRONJ diagnostic workflows and therapeutic algorithms. Institutions must prioritize MRONJ-focused training programs, foster interdisciplinary collaboration with oncology and clinical nutrition departments, and establish evidence-based multidisciplinary protocols to optimize non-surgical or pharmacotherapeutic modalities. Sequential non-surgical therapy demonstrates potential in alleviating symptoms and improving quality of life for chemotherapy-dependent MRONJ patients.