CURATIVE RATES OF MEDICATION-RELATED OSTEONECROSIS OF THE JAW FOLLOWING APPLICATION OF THE SICMF-SIPMO SURGICAL TREATMENT ALGORITHM

Background.  Management of Medication related osteonecrosis of the jaw (MRONJ) is challenging and there is little evidence about the effectiveness of treatments.  The present study aims at assessing the value of the SICMF-SIPMO MRONJ staging system as a predictor of treatment success. Patients & Methods. We performed a 10-years longitudinal cohort study at the Unit of Maxillofacial Surgery of Padova University (Italy). The study was approved by the local Ethical Committee of the University Hospital of Padova (CESC 4920/AO/20 - 24 September 2020). Patients were included in the study if they satisfied the SICMF-SIPMO clinico-radiological diagnostic criteria of MRONJ and were staged accordingly. Patients were assigned to each surgical treatment based on the SICMF-SIPMO classification. Patients were followed up at three-month intervals up to 1-year and underwent a CT scan of the jaws at three, six, and twelve months postoperatively. Results. Overall, a total of 70 patients reached the 12-month follow-up and 75 operated jaw sites were available for the analysis.The cumulative curative rate (CR) at 1-year follow-up was 85.3%. MRONJ recurred in 9 jaw sites (12%). The curative rates did not significantly differ between maxilla and mandible (87% vs. 84%). The underlying disease highly influenced the CR of MRONJ, with cancer patients more likely to develop recurrences within 1 year (CR cancer = 76% ; CR osteoporosis =100%). Bone curettage and sequestrectomy showed the highest CR in  MRONJ stage 1, regardless of the underlying disease (88.2%). Marginal resection proved to be successful in MRONJ stage 2 with an overall curative rate of 81%. Nevertheless, MRONJ stage 2 patients with cancer showed high recurrence rates when treated with marginal resection. Segmental resection proved highly successful in MRONJ stage 2 (88.2%) and MRONJ stage 3 (92.9%). Of note, segmental resections in MRONJ stage 2 were mostly performed in cancer patients (12/15). Conclusion. In conclusion, the stage-related surgical algorithm proposed by SICMF-SIPMO can be safely used and it should be implemented to select the appropriate surgical treatment for MRONJ patients. Further studies are warranted before its final validation.