Osteonecrose dos Maxilares Relacionada a Medicamentos: Prevenção e tratamento à luz das evidências atuais: Revisão integrativa: Revisão integrativa

Abstract

Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious adverse effect associated with antiresorptive and antiangiogenic agents, representing a growing challenge for dentistry and oncology. Although several preventive and therapeutic approaches have been proposed, international guidelines remain heterogeneous and controversies persist regarding diagnostic criteria, drug suspension, and surgical timing. Objective: To perform an integrative review of the literature published between 2015 and 2025 on the epidemiology, risk factors, prevention, diagnosis, and management of MRONJ, emphasizing points of consensus, controversies, and research gaps. Methodology: This integrative review was conducted through a bibliographic search in PubMed/MEDLINE, Scopus, Web of Science, Embase, Cochrane Library, and LILACS. The search included publications in English and Portuguese, published between 2015 and 2025. The descriptors used were “medication-related osteonecrosis of the jaw”, “MRONJ”, “osteonecrose relacionada a medicamentos”, “bisphosphonates”, “denosumab”, “antiangiogenic agents”, “prevention”, “diagnosis”, and “treatment”. Inclusion criteria comprised systematic reviews, cohort studies, clinical guidelines, and consensus statements that directly addressed MRONJ. Exclusion criteria involved duplicated records, inaccessible full texts, in vitro or animal studies, and works unrelated to the study objectives. After applying the criteria, 16 articles were included for analysis. Results and Conclusion: The included studies showed a higher incidence of MRONJ in oncologic patients compared with osteoporotic populations, with dentoalveolar surgery, comorbidities, and polypharmacy as major risk factors. Prevention strategies, particularly pre-treatment dental evaluation, remain the cornerstone of management. Conservative measures such as antimicrobial protocols are still relevant, but surgical approaches have shown higher resolution rates, even in advanced stages. Adjuvant therapies, including laser therapy, platelet concentrates, and hyperbaric oxygen, demonstrated promising yet heterogeneous outcomes. International guidelines (AAOMS, MASCC/ISOO/ASCO, Italian Consensus) revealed significant discrepancies regarding diagnostic criteria and treatment recommendations, underscoring the need for global standardization. In conclusion, MRONJ is a multifactorial condition with evolving therapeutic strategies. Preventive measures are fundamental, surgical management offers greater effectiveness in advanced cases, and future multicenter prospective studies are essential to establish standardized protocols and improve clinical predictability.

Keywords: MRONJ, Bisphosphonates, denosumab, antiangiogenic, treatment, prevention.