Medication-Related osteonecrosis of the jaw involving dental implants: A 16-Year observational study in a single cancer center.

Abstract

Objectives: The aim of this study was to evaluate the clinicoradiological features and treatment approaches of MRONJ in cancer patients rehabilitated with osseointegrated implants.

Materials and methods: Medical records of 147 patients who developed MRONJ over a 16-year period were evaluated. Demographic data, type of antiresorptive medication (AR) used, route of administration, frequency, and time of use were collected. Staging, clinical and imaging characteristics, and treatment for MRONJ were also collected.

Results: A total of 25 patients (17%) presented with implants in the region affected by MRONJ, of whom 23 (92%) underwent implant placement prior to the initiation of AR. The total number of affected implants was 42 and most had an external hexagon connection (n = 25, 59.5%). Among these patients, 28 MRONJ areas were identified, most of which were classified as stage 2 (n = 17, 60.7%) and located in the posterior mandible (n = 16, 57.1%). Pain (n = 17, 68%) and the presence of osteolytic areas (n = 21, 84%) were the most commonly observed clinical and imaging characteristics. Surgical treatment was the preferred approach in 84% (n = 21) of cases.

Conclusions: MRONJ involving implants occurred mainly in patients rehabilitated before AR, with frequent involvement of the posterior mandible, pain, and osteolytic areas on radiological imaging. Surgical intervention showed a high rate of clinical success.

Clinical relevance: Implants placed prior to AR may act as local risk factors for MRONJ in cancer patients, underscoring the need for careful evaluation of existing implants before starting treatment.