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Purpose <p>Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse drug reaction mostly associated to the use of bone-modifying agents.</p> <p>Preventive dental strategies aim to reduce its risk, but the comparative benefit of structured long-term interventions versus a single pre-treatment dental visit remains unclear. This study assessed the impact of a structured long-term, multidomain dental prevention protocol compared with a single baseline dental assessment in patients receiving an oncological-based, high dose (HD) regime of Zoledronic acid (ZA).</p> Methods <p>Between 2012 and 2015, two Southern Italian university hospitals enrolled adult cancer and myeloma patients initiating ZA. Participants received either the Standard Protocol (SP), a single pre-treatment dental visit, or the Intensive Protocol (IP), which added scheduled follow-ups and periodontal care. MRONJ was diagnosed using SICMF-SIPMO clinical and radiological criteria.</p> Results <p>202 patients (M/F = 83/119; mean age 63.3&#xa0;years), were stratified into a SP group (n = 115) and an IP group (n = 87). Eighteen patients developed MRONJ (8.9%). The MRONJ frequency was significantly higher in the SP group (13.9%) compared to the IP group (2.3%) (p = 0.004).</p> <p>MRONJ cases in the SP group showed poorer oral hygiene, a higher rate and severity of periodontitis alongside, and higher post-extraction onset rate.</p> Conclusion <p>Multidomain dental prevention long-term protocol was found to be effective in reducing the incidence of MRONJ by ZA therapy, compared to a single pre-therapy dental intervention, with a potential change of case characteristics. These findings support integrating routine dental evaluation and periodontal maintenance into cancer and myeloma care pathways to improve patient safety and oral outcomes.</p>

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Medication-related osteonecrosis of the jaw primary prevention: multidomain long-term intervention versus pre-bisphosphonate treatment standalone dental intervention. A retrospective multi-center comparative cohort study

  • 期刊论文

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  • 发表日期：

    2026年1月28日

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  • Rodolfo Mauceri,
  • Gaetano La Mantia,
  • Olga Di Fede,
  • Vittorio Fusco,
  • Antonia Marcianò,
  • Martina Coppini,
  • Giuseppe Seminara,
  • Vera Panzarella,
  • Rita Coniglio,
  • Giuseppe Pizzo,
  • Pietro Tozzo,
  • Domenica Matranga,
  • Laura Maniscalco,
  • Giacomo Oteri,
  • Giuseppina Campisi

摘要

Purpose

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse drug reaction mostly associated to the use of bone-modifying agents.

Preventive dental strategies aim to reduce its risk, but the comparative benefit of structured long-term interventions versus a single pre-treatment dental visit remains unclear. This study assessed the impact of a structured long-term, multidomain dental prevention protocol compared with a single baseline dental assessment in patients receiving an oncological-based, high dose (HD) regime of Zoledronic acid (ZA).

Methods

Between 2012 and 2015, two Southern Italian university hospitals enrolled adult cancer and myeloma patients initiating ZA. Participants received either the Standard Protocol (SP), a single pre-treatment dental visit, or the Intensive Protocol (IP), which added scheduled follow-ups and periodontal care. MRONJ was diagnosed using SICMF-SIPMO clinical and radiological criteria.

Results

202 patients (M/F = 83/119; mean age 63.3 years), were stratified into a SP group (n = 115) and an IP group (n = 87). Eighteen patients developed MRONJ (8.9%). The MRONJ frequency was significantly higher in the SP group (13.9%) compared to the IP group (2.3%) (p = 0.004).

MRONJ cases in the SP group showed poorer oral hygiene, a higher rate and severity of periodontitis alongside, and higher post-extraction onset rate.

Conclusion

Multidomain dental prevention long-term protocol was found to be effective in reducing the incidence of MRONJ by ZA therapy, compared to a single pre-therapy dental intervention, with a potential change of case characteristics. These findings support integrating routine dental evaluation and periodontal maintenance into cancer and myeloma care pathways to improve patient safety and oral outcomes.