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Abstract
Background: Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse effect associated with antiresorptive and antiangiogenic medications. Its biological mechanisms and optimal therapeutic strategies remain incompletely defined. Objective: To synthesize current evidence regarding etiology, pathogenesis, diagnosis, risk factors, and management of MRONJ. Methods: Following PRISMA guidelines, a search carried out in the following databases: PubMed, PMC, ScienceDirect, and Scopus using the Medical Subject Heading (MeSH). Search terms: Bisphosphonat, complication of antiresorptive therapy, osteonecrosis of the jaw, etiopathogenetic, clinical and diagnostic features. 156 articles full-text articles of high methodological quality were selected written in English. According to the review method used, the PRISMA.A structured literature review identified 80 eligible studies for qualitative synthesis. Peer-reviewed English-language articles addressing clinical and biological aspects of MRONJ were screened and qualitatively analyzed. Current evidence supports stage-adapted management ranging from conservative antimicrobial protocols to surgical resection in advanced disease. Despite progress in mechanistic understanding, uniform evidencebased treatment algorithms remain insufficiently established. Results: MRONJ is multifactorial, involving suppressed bone remodeling, vascular compromise, microbial colonization, and immune dysregulation. Diagnosis remains primarily clinical. Conservative therapy is effective in early stages, while surgical intervention is indicated in advanced disease. Adjunctive regenerative approaches show promising but limited evidence. Conclusions: MRONJ remains a complex clinical entity requiring interdisciplinary management. Further high-quality prospective studies are needed to establish standardized treatment protocols.
