Strategies for the Prevention of Medication-Related Osteonecrosis of the Jaw (MRONJ): An Umbrella Review.

Abstract

The objective of this review is to evaluate the effectiveness of different preventive strategies for medication-related osteonecrosis of the jaw (MRONJ) in at-risk patients. This umbrella review was carried out using six electronic databases: PubMed, Cochrane Library, Google Scholar, ScienceDirect, Mendeley, and Scopus. Moreover, it followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The results of the clinical trials were described according to the PICO (Patient/Population/Problem, Intervention, Comparison, and Outcome) criteria. Prevention strategies for MRONJ discussed in the review include local preventive measures before starting antiresorptive treatment, as well as preventive measures during invasive procedures in patients undergoing antiresorptive treatment, such as temporary discontinuation of antiresorptive treatment, prophylactic antibiotic therapy, use of autologous platelet concentrates, laser therapy, surgical measures promoting healing, and, finally, the possibility of combinations of these preventive protocols. Our umbrella review does not allow us to determine the validity of the different preventive protocols for MRONJ in patients undergoing antiresorptive or anti-angiogenic treatment due to the lack of evidence in the systematic reviews included, the diversity of clinical situations, and the absence of direct comparison between the different strategies. Randomized clinical trials are needed to establish evidence-based recommendations.