MRONJ

Question 1

What are risk factors for delayed healing?

Answer 1

Smoking, immunosuppressed, bone pathology, poor hygiene

Technical: posterior teeth, traumatic xla, inappropriate irrigation

Question 2

What is MRONJ?

Answer 2

Medication related osteonecrosis of the jaw
Exposed bone > 8 week
No hx RT
Medication linked MRONJ
No episode osteonecrosis outside craniofacial skeleton

Question 3

Medications associated MRONJ

Answer 3

Bisphosphonate
Monoclonal ab = denosumab
Tyrosine kinase inhibitors = sunitinib
RANK ligand inhibitors

Question 4

Management of MRONJ

Answer 4

Risk osteonecrosis
Pre-tx: dental assessment, removal teeth hopeless prognosis
During: prevention - OHI, preventative tx
XLA: referral
Tx: trimming bone can cause further necrosis, use chlorhexidine

Question 5

Why MRONJ occur?

Answer 5

Anti-angiogensis - compromised blood supply
Direct toxicity to cells within bone
Toxic to overlying soft tissue