The recent update from the American Association of Oral and Maxillofacial Surgeons exemplified the reconciliation of all the unknowns and the best pragmatic options available on the table for managing patients at risk for and those experiencing medication-related osteonecrosis of the jaw (MRONJ). The case definition and clinical staging criteria were similar to prior updates. It was acknowledged that the precise pathogenesis of MRONJ remained unknown and that no ‘cures’ existed. Prevention of MRONJ primarily relied on regular dental recall visits and obtaining dental clearance before initiating anti-resorptive therapy. In contrast to earlier recommendations, equal emphasis was placed on both operative and non-operative options for patient management, based on operative considerations and patient preferences. Accordingly, treatment recommendations range from surgical excision of lesions across all clinical stages, resulting in significant surgical defects to palliation with antibiotics and pain management.
Identifying the unknowns, challenges, and opportunities in the management of MRONJ will prove pivotal in overcoming roadblocks and moving the field forward. Broadly, such key areas include
1) Unknowns
a. Mechanism(s) of MRONJ- so far this is an empirical understanding that implicates bone resorption, angiogenesis, altered immune response to microbial challenge
b. Genetic susceptibility
c. Predicting personalized risk
2) Challenges
a. Difficulty in establishing effective animal models for MRONJ for translational research
b. Transitioning from promising cures in translational research to clinical trials
c. Validating osteoanabolic therapy in rigorous clinical research
3) Opportunities
a. The potential for large multicenter collaborative, interdisciplinary research to conduct prospective observational and interventional studies
b. Emerging pre-clinical models for MRONJ
We solicit original research, clinical reports, series, commentaries, and perspectives on these three important areas.
Keywords:
osteonecrosis of the Jaw
Important Note:
All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.
The recent update from the American Association of Oral and Maxillofacial Surgeons exemplified the reconciliation of all the unknowns and the best pragmatic options available on the table for managing patients at risk for and those experiencing medication-related osteonecrosis of the jaw (MRONJ). The case definition and clinical staging criteria were similar to prior updates. It was acknowledged that the precise pathogenesis of MRONJ remained unknown and that no ‘cures’ existed. Prevention of MRONJ primarily relied on regular dental recall visits and obtaining dental clearance before initiating anti-resorptive therapy. In contrast to earlier recommendations, equal emphasis was placed on both operative and non-operative options for patient management, based on operative considerations and patient preferences. Accordingly, treatment recommendations range from surgical excision of lesions across all clinical stages, resulting in significant surgical defects to palliation with antibiotics and pain management.
Identifying the unknowns, challenges, and opportunities in the management of MRONJ will prove pivotal in overcoming roadblocks and moving the field forward. Broadly, such key areas include
1) Unknowns
a. Mechanism(s) of MRONJ- so far this is an empirical understanding that implicates bone resorption, angiogenesis, altered immune response to microbial challenge
b. Genetic susceptibility
c. Predicting personalized risk
2) Challenges
a. Difficulty in establishing effective animal models for MRONJ for translational research
b. Transitioning from promising cures in translational research to clinical trials
c. Validating osteoanabolic therapy in rigorous clinical research
3) Opportunities
a. The potential for large multicenter collaborative, interdisciplinary research to conduct prospective observational and interventional studies
b. Emerging pre-clinical models for MRONJ
We solicit original research, clinical reports, series, commentaries, and perspectives on these three important areas.
Keywords:
osteonecrosis of the Jaw
Important Note:
All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.