The effectiveness of different treatment methods in the treatment and prevention of medication-related osteonecrosis of the jaw: A systematic review and Bayesian network meta-analysis

BACKGROUND: The treatment strategies and efficacy of medication-related osteonecrosis of the jaw (MRONJ) are controversial, and there is a lack of unified clinical treatment standards. We used a Bayesian network meta-analysis method to evaluate the clinical efficacy of different intervention methods. METHODS: We searched for clinical controlled trials published from January 2010 to May 2025 in PubMed, the Cochrane Library, Web of Science, and Embase. We assessed the quality of the included studies using the NOS quality assessment and the Cochrane risk of bias tool. We conducted a network meta-analysis (NMA) using R Studio and ranked the treatment modalities for each outcome measure using SUCRA. RESULTS: A total of 19 studies were included, involving 1064 MRONJ patients and 12 different intervention measures. The meta-analysis results showed that the included interventions improved healing rates compared to conventional surgical treatment [RR = 1.44, 95 % CI (1.20, 1.71), P < 0.001]; and reduced the incidence of MRONJ in high-risk populations [RR = 0.10, 95 % CI (0.04, 0.29), P < 0.001]. The network meta-analysis results showed that the top three wound healing rates in the probability-weighted ranking were: BMP-2 + L-PRF (89.3 %) > Hyperbaric oxygen (84.1 %) > YAG laser + LLLT (67.8 %) CONCLUSION: Based on the meta-analysis results, we found that the intervention methods included in the study were effective compared to conventional surgical treatment and prevented the incidence of MRONJ in high-risk populations. The SUCRA value showed that BMP-2 + L-PRF significantly improved the healing rate of MRONJ patients and may have good clinical application prospects.