Fluorescence-guided bone surgery vs conventional bone resection in medication related osteonecrosis of the jaws: a retrospective study

Fluorescence-guided bone surgery is an innovative technique that uses fluorescence to help define resection margins in medication-related osteonecrosis of the jaws (MRONJ). Despite the reported high cure rate, comparative studies between this technique and conventional bone resection are lacking. This study aims to compare cure and recurrence rates between fluorescence-guided bone surgery and conventional bone resection in MRONJ, while also assessing potential advantages, disadvantages, and limitations of both surgical techniques. A retrospective longitudinal cohort study was conducted including 63 patients with MRONJ treated surgically between January 2018 and December 2024, using either conventional bone resection or fluorescence-guided surgery with VELscope®. Primary outcomes included cure versus absence of cure, and recurrence at 6 months and 1 year, with statistical significance set at p < 0.05. The cohort had a mean age of 71.1 ± 9.5 years, and fluorescence-guided surgery was used in 36.5% (23/63) of cases. Overall cure rates were 90.5% (57/63) at 1 month and 92.1% (58/63) at 3 months, while recurrence occurred in 13.7% (7/51) of patients at 6 months and 24.4% (11/45) at 1 year. No statistically significant differences were found between fluorescence-guided and conventional surgery in terms of cure or recurrence at any follow-up period. Additionally, variables such as sex, age, oncologic status, MRONJ stage, lesion location, number of lesions, associated medication, route of administration, and treatment duration did not significantly affect outcomes. In conclusion, fluorescence-guided bone surgery demonstrated similar cure and recurrence rates compared to conventional surgery in MRONJ patients. This technique may provide marginal benefits over conventional surgery. Further prospective studies are needed to validate these findings.