Quantitative Bone Assessment in Medication-Related Osteonecrosis of the Jaw Using Fractal Analysis: A Systematic Review of the Literature and Clinical Perspectives

Background: Contemporary dentistry increasingly relies on tools and methods derived from the exact sciences, particularly mathematics and physics, to better understand the complexity of biological processes. One such tool is fractal analysis (FA), which enables the characterization and quantification of irregular, complex, self-similar structures commonly observed in nature in the form of the fractal dimension (FD). In oral radiology, it has been found useful for describing structural changes in bone tissue. Objective: The aim of this review is to present the current state of knowledge regarding the application of fractal analysis in the management of patients with, or at risk for, medication-related osteonecrosis of the jaw (MRONJ), with particular emphasis on its diagnostic and prognostic potential. This paper summarizes key research findings, and discusses the principal challenges and limitations associated with the use of this method of analysis in MRONJ cases. Materials and Methods: The inclusion criteria were as follows: original papers, the presence of MRONJ, and fractal analysis. In order to find relevant studies, international databases, including PubMed and Google Scholar, were searched. The last search was performed on 29 November 2025. Six articles were included in the systematic review. Results: The majority of the review studies show lower FD values for MRONJ patients and healthy control groups. The values are the lowest for necrotic lesions and highest for perinecrotic bone tissue. Conclusions: FD values calculated from radiological images of the jaws can be used to differentiate healthy and MRONJ-affected patients and to describe necrotic lesions. Fractal analysis has potential to be used in the diagnosis and monitoring of MRONJ after further studies and standardization of methodology.