Osteonecrosis of the jaw: A 5-year analysis of surgical outcomes and risk factors for complications

BACKGROUND: Radiation-induced and drug-induced bone necrosis present significant challenges for maxillofacial surgery departments and dental clinics. While the incidence of osteoradionecrosis (ORN) has decreased, the number of cases of medication-related osteonecrosis of the jaw (MRONJ) has markedly increased. This trend is associated with higher life expectancy and more frequent use of medications linked to MRONJ. To date, no uniform, scientifically validated treatment standards have been established for these conditions. OBJECTIVES: The aim of the study was to evaluate treatment outcomes in patients with ORN and MRONJ, as well as to identify risk factors for complications, with particular emphasis on differences in clinical presentation and management. MATERIAL AND METHODS: A retrospective analysis of medical records over a five-year period was conducted, including the charts of patients diagnosed with MRONJ and ORN who were hospitalized at the Department of Maxillofacial Surgery, Poznan University of Medical Sciences, Poland, and subsequently followed up in the outpatient setting. Selected parameters included C-reactive protein (CRP), smoking status, type of necrosis, sex, and hospitalization time. RESULTS: Differences in patient characteristics, including age, sex, smoking status, and clinical presentation, were observed between the groups. Patients with MRONJ were, on average, 5 years older than those with ORN and exhibited a significantly higher concentration of CRP, indicating a more pronounced inflammatory response. Smoking was identified as a weak but notable predictor of the need for mandibular resection. Additionally, elevated concentrations of CRP were associated with longer hospitalization and a higher incidence of complications, potentially contributing to prolonged hospital stays and an increased risk of adverse outcomes. CONCLUSIONS: The findings highlight distinct clinical courses for MRONJ and ORN, underscoring the need for differentiated treatment strategies. Given the lack of standardized treatment protocols, the observed variations in clinical outcomes suggest the necessity for more targeted therapeutic approaches. Further research is essential to establish effective treatment protocols.