Clinical and Radiological Evaluation of Oral and Maxillofacial Status in Patients Undergoing Antiresorptive Therapy and Its Relationship with MRONJ

<b>Background/Objectives</b>: Patients undergoing antiresorptive therapy were evaluated, focusing on clinical and radiological features and their relationship with medication-related osteonecrosis of the jaw (MRONJ). <b>Methods</b>: Patients were allocated to two groups: MRONJ (<i>n</i> = 27) and non-MRONJ (<i>n</i> = 139). Clinical evaluation included decayed, missing, and filled teeth (DMFT), number of teeth, periodontal status, prosthesis use, and preventive/therapeutic measures. Imaging analysis included panoramic radiography (PAN) and cone beam computerized tomography (CBCT) to assess MRONJ-related signs. <b>Results</b>: The sample showed high levels of DMFT and prosthesis use. There was a tendency of higher prevalence of deeper periodontal pockets in the MRONJ group, with greater need for oral hygiene reinforcement and chlorhexidine prescription. PAN showed higher frequency of osteolysis, persistent alveolar socket, bone sequestration, mandibular canal involvement, periosteal reaction, and sinus involvement in the MRONJ group. Still on PAN, all cases in both groups exhibited a sclerotic trabecular bone pattern. CBCT showed higher frequency of a sclerotic trabecular bone pattern, mandibular canal involvement, and bone sequestration in the MRONJ group. Composite radiographic index modified (CRIm) was higher in the MRONJ group for PAN and CBCT, with low-grade cases in the non-MRONJ and medium-/high-grade cases in the MRONJ group. A positive correlation was found between CRIm and MRONJ staging. <b>Conclusions</b>: This study underscores the role of preventive oral care in patients undergoing antiresorptive therapy, highlighting the need for regular periodontal monitoring. Also emphasized is the importance of integrating clinical and radiographic examinations of these patients. Accordingly, CRIm seems to be a reliable tool for MRONJ staging and monitoring.