Medication related osteonecrosis of the jaw: an adjunctive medical regime

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Antiresorptive and antiangiogenic agents, including bisphosphonates, have been revolutionary in the treatment of malignancy and osteoporosis, providing benefit to this group of patients over the past 10 years. Their use has lead to an increasingly well recognised complication of medication-related osteonecrosis of the jaws (mRONJ).


(1) Provide an overview of the pathophysiology and current evidence based management of mRONJ.


(2) Introduce adjunctive medical regime in managing patients with mRONJ.


A series of three patients diagnosed with mRONJ were treated with Pentoxifylline and α-Tocopherol (PENTO), a medical regime revolutionary for the management of osteoradionecrosis. Their clinical and radiographic findings were recorded alongside changes in their neuropathic symptoms.


All three patients were treated with PENTO either in isolation or in conjunction with conventional surgical measures. All showed improvement in their neuropathic symptoms, and had partial/complete reduction in exposed necrotic bone with radiographic evidence of bony healing.


Not all patients are suitable for conventional surgical intervention, and the implementation of a medical regimen as an alternative or adjunctive treatment for mRONJ patients has had promising results both within this case series and across the literature. Further controlled studies in this field are required.

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