Revisiting Medication-related Osteonecrosis of the Jaw: Insights, Management, and Future Directions for Oral Health Professionals

Abstract Medication-related osteonecrosis of the jaw (MRONJ) is an increasingly recognized complication often associated with long-term use of antiresorptive and antiangiogenic medications such as bisphosphonates and denosumab. The condition presents ongoing challenges in identifying and managing affected patients and may significantly affect oral function and quality of life. With the rising number of individuals receiving these therapies, updated and practical guidance for oral healthcare providers has become essential. A comprehensive review of the literature was conducted through PubMed, SCOPUS, and Google Scholar. Relevant journal articles, clinical recommendations, and case reports were selected using terms including MRONJ, bisphosphonates, denosumab, osteonecrosis, and oral health, and were critically examined to summarize current understanding of MRONJ, including its biological mechanisms, diagnosis, treatment options, and emerging approaches. Evidence suggests that MRONJ is influenced by multiple interconnected biological and clinical factors, such as impaired bone turnover, reduced blood supply, immune alterations, and local trauma. Clinical evaluation and imaging, guided by staging systems such as the American Association of Oral and Maxillofacial Surgeons criteria, play key roles in assessment. Management may involve conservative approaches, surgical treatment, and prosthetic rehabilitation, often requiring collaboration across specialties. The COVID-19 pandemic has added further complexity due to delayed dental care and increased steroid use, potentially heightening MRONJ risk. Overall, MRONJ remains a significant concern in modern dental and medical practice. Early recognition, coordinated care, and the integration of developing technologies such as regenerative therapies and AI-assisted diagnostics are essential for improving patient outcomes and supporting comprehensive management.