MRONJ

Question 1

MRONJ

Description of Problem

Answer 1

death of jaw bone related to medication

they all had cancers, and all were on intravenous bisphosphonates

hyperbaric oxygen, which restores vascularity to marginal bone.

Question 2

What types of medications are known to be associated with MRONJ?

Answer 2

Antiresorptives:
Intravenous bisphosphonates
Oral bisphosphonates
RANK ligand inhibitor – a human monoclonal antibody

Antiangiogenic medications

Question 3

What is the theoretical mechanism of MRONJ caused by bisphosphonates and RANK-L inhibitors? Important!

Answer 3

Bisphosphonates and RANK-L inhibitors act by inhibiting osteoclast activity.
Osteoclasts resorb bone, releasing BMP and growth factors that stimulate circulating stem cells to differentiate into osteoblasts and create new bone.
Inhibition of osteoclasts prevents normal bone turnover, remodeling, and healing of bone when wounded.

Question 4

What is the theoretical mechanism for MRONJ caused by antiangiogenic medications? Important!

Answer 4

Antiangiogenic medications interfere with formation of blood vessels and interrupt vascular supply
causing avascular necrosis