Use of bmps as a treatment for medication-related maxillary osteonecrosis (mronj): a systematic review

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is an adverse condition in patients receiving antiresorptive or antiangiogenic therapies. Standard treatments, including surgical debridement, often yield suboptimal outcomes. In this context, bone morphogenetic proteins (BMPs), have been explored for their ability to stimulate osteogenesis and enhance bone repair. Materials and methods: A systematic review of the literature was conducted, focusing on studies that applied rh-BMPs during surgeries to treat MRONJ. Databases were searched for relevant articles from inception to the present, using keywords such as 'MRONJ', 'BMP', and 'bone regeneration'. Inclusion criteria involved studies with human participants who had been treated with rh-BMPs, along with the surgical elimination of bone sequestrum, MRONJ stages 2 and 3 according to the AAOMS staging system and a minimum follow-up period of 6 months. Two independent reviewers (L.H.C. and C.C.V.) systematically selected the articles independently. RESULTS: The review included nine studies with a total of 217 patients treated with rh-BMP. Bone regeneration and osteonecrosis healing was reported in all the studies included using rh-BMP. However, the measurement methods were very different between the studies, using clinical examinations, different radiological tests and biomarkers and own scales. Moreover, there were inconsistencies in treatment protocols and follow-up periods, making it difficult to standardize conclusions. DISCUSSION: While rh-BMPs show promising results for bone regeneration in MRONJ patients, the variability in study methodologies limits definitive conclusions. The biological potential of BMPs could be beneficial, but standardized protocols and longer-term studies are needed to establish their effectiveness. CONCLUSIONS: The application of rh-BMPs may promote bone regeneration in MRONJ patients, but further research with standardized methods is required to confirm these findings.