The Efficacy of a Combined Medical and Surgical Protocol in the Management of Medication-Related Osteonecrosis of the Jaw: A Retrospective Study

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a serious and debilitating condition characterized by exposed bone in the maxillofacial region in patients with a history of antiresorptive or antiangiogenic therapy. While various management strategies exist, there is no universally accepted standard of care. Methods: A retrospective chart review was conducted for 30 patients diagnosed with MRONJ, who were treated at our institution between 2024 and 2025. All patients received a standardized protocol consisting of a medical regimen (pre- and post-operative antibiotics, chlorhexidine mouthwash, and a drug holiday) followed by surgical intervention (sequestrectomy or debridement with primary wound closure). Results: The primary outcome, complete resolution, was achieved in 83.3% of patients, with a recurrence rate of 16.7%. The mean healing time was approximately 10.4 weeks. Post-operative complications were infrequent but did occur, including wound dehiscence (13.3%), postoperative infection (10%), and pain (26.7%). These results suggest that the combined medical and surgical protocol is a highly effective treatment for MRONJ, yielding a favorable resolution rate with manageable complications. Conclusion: The combined medical and surgical protocol is a highly effective and reliable treatment strategy for MRONJ. The high rate of complete resolution and low rate of complications support this approach as a viable management option.