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A systematic review assessing occurrence of medication-related osteonecrosis of the jaw following dental procedures


Bisphosphonate-associated osteonecrosis of the jaw
Bone density conservation agents
Surgery, oral

How to Cite

Lara SM de C, Muniz FWMG, Gerônimo ABC, Santos CS dos, Barbosa Calcia TB. A systematic review assessing occurrence of medication-related osteonecrosis of the jaw following dental procedures. Braz. J. Oral Sci. [Internet]. 2022 Aug. 22 [cited 2023 Dec. 4];21(00):e226585. Available from:


Aim: This study aimed to systematically review existing literature regarding the association between dental procedures—such as tooth extractions and periodontal therapy—and occurrence of medication-related osteonecrosis of the jaw (MRONJ) in individuals using bone-modifying drugs. Methods: Search strategies were performed in PubMed, Scopus, Web of Science and Cochrane Library for a timeframe ending in December 2021. Study selection, data extraction and risk of bias were analyzed independently by two researchers. Three meta-analyses were performed, estimating the crude risk ratio (RR), the adjusted odds ratio (OR) and the adjusted hazard ratio (HR) for the association between tooth extraction and MRONJ. Results: Of the 1,654 studies initially retrieved, 17 were ultimately included. The majority of patients with MRONJ in these studies were female, with a mean age of 64 years. Zoledronic acid was the most commonly used drug among patients with MRONJ, and cancer was the most frequent underlying health condition. Regarding the performed meta-analyses, crude and adjusted analyses demonstrated that tooth extraction increased the risk for MRONJ by 4.28 (95% confidence interval [95%CI]: 1.73–10.58), the OR for MRONJ by 26.94 (95%CI: 4.17–174.17), and the HR for MRONJ by 9.96 (95%CI: 4.04–24.55). Conclusion: It was concluded that performing dental procedures, especially tooth extraction, in patients using bone-modifying drugs increased the risk of MRONJ occurrence and, therefore, should be avoided. Further studies, using adjusted data, are warranted.


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Copyright (c) 2021 Shimelly Monteiro de Castro Lara, Francisco Wilker Mustafa Gomes Muniz, Ana Beatriz Caetano Gerônimo, Cinthia Studzinski dos Santos, Thayanne Brasil Barbosa Calcia


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