Management of medication-related osteonecrosis of the jaw through the association of surgical treatment with local and systemic adjuvant therapies: a case series with follow-ups of up to 3 years.

The objective of this case series was to report the outcomes of patients diagnosed with medication-related osteonecrosis of the jaw (MRONJ) and seek a remission through surgical management associated with local and systemic adjuvant therapies. A total of 14 patients were followed for up to 3 years, of whom one had MRONJ stage 0; three with stage I; seven with stage II; and four with stage III. Twelve patients underwent conservative sequestrectomy. In seven of these cases, the surgery was guided by fluorescence, using doxycycline preoperatively to remove necrotic bone tissue more accurately. In four participants, platelet-rich fibrin membranes were positioned at the surgical site before suturing. All 14 patients were instructed to perform daily mouthwashes with 0.12% chlorhexidine, and all underwent weekly sessions of antimicrobial photodynamic therapy according to the following protocol: Pre-irradiation with methylene blue (100 μg/mL) for 60 seconds, followed by irradiation with a low-level laser (600 nm; 100 mW; 214 J/cm2; 6 J/point; 60 s/point). Other adjuvant therapies were employed, such as the prescription of a combination of pentoxifylline and tocopherol, in addition to metronidazole paste. The proposed therapies led to remission in most patients, and although some of the patients did not achieve complete remission, they showed a significant reduction in pain complaints. These results demonstrate that the protocols used in this study are promising for the management of MRONJ in different stages. As such, they offer potential for the practice of surgeons and should be the object of further clinical investigations. (Quintessence Int 2025;56:654-666; doi: 10.3290/j.qi.b6376673).