Work

Emerging therapeutic strategies for medication‑related osteonecrosis of the jaw: From microenvironmental modulation to precision medicine (Review)

Year: 2026

Type: review

Abstract: Medication-related osteonecrosis of the jaw (MRONJ) is a challenging complication associated primarily with antiresorptive and antiangiogenic therapies. Its pathogenesis involves a complex interplay of impaired bone remodeling, angiogenesis, inflammation and infection, immune regulation and soft tissue healing. Established management includes conservative care, antimicrobial and symptomatic treatment when indicated and surgical intervention, however clinical outcomes remain variable. The present review aimed to summarize pharmacological, regenerative, biomaterial-based and physical or adjunctive strategies targeting the pathological microenvironment of MRONJ, with emphasis on their mechanisms of action and clinical evidence. The present review also examines the potential role of precision medicine in individualized risk assessment and treatment. Teriparatide, pentoxifylline/tocopherol, autologous platelet concentrates and human amniotic membrane have varying degrees of clinical support, although evidence remains limited or heterogeneous for several approaches. By contrast, geranylgeraniol, hydrogels, most mesenchymal stromal cell-based or cell-derived strategies, natural products and melatonin are supported predominantly by preclinical or limited clinical evidence. Other adjunctive approaches, including hyperbaric oxygen, ozone therapy, photobiomodulation, laser-assisted surgery and antimicrobial photodynamic therapy, require further validation. Overall, these strategies may complement established management, but their clinical readiness varies. Standardized clinical studies and integration of multidimensional patient data may facilitate more robust evaluation and individualized MRONJ management.

Source: Experimental and Therapeutic Medicine

DOI: 10.3892/etm.2026.13325