Conservative treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ) with topical ozone

OBJECTIVES The aim of this case report is to describe the conservative treat ment of medication-related osteo necrosis of the jaw (MRONJ) using topical ozonated gel. Medication-related osteonecrosis of the jaw is defined as a “drug-re lated adverse reaction character ized by the progressive destruc tion and necrosis of the mandibu lar and/or maxillary bone in pa tients exposed to medications known to increase the risk of the condition, in the absence of previ ous radiation therapy”. Epidemiological data on this con dition are supported by robust studies, highlighting significant variability between patients re ceiving high-dose and low-dose treatments, with a higher inci dence in the former group, and across different drugs (class, ac tive ingredient, route of adminis tration, and dosage). Clinically, the most frequently ob served sign is the persistence of bone exposure for more than 8 weeks. However, there are other Ospedale-Università di Padova, from another region initially for suspicion of osteomyelitis in the right hemimandible. diagnostic criteria, referred to as ‘minor’ signs and symptoms. It is important to note that not all cas es of MRONJ present with bone exposure; therefore, in cases of suspicion, these criteria should be further investigated using radio graphic imaging. Radiological investigations are fundamental in the diagnostic work-up, particularly orthopanto mography (OPT) and intraoral ra diographs (first-line), along with computed tomography (CT) (sec ond-line), although radiological signs tend to be non-specific. Diagnosis of MRONJ is primarily based on clinical and radiological findings. MATERIALS AND METHODS A literature review was conducted by consulting the Pubmed data base. The clinical case of a patient referred to the all’Ambulatorio di Patologia e Medicina Orale e Diagnostica Odontostomatologica dell’Unità Operativa Complessa di Clinica Odontoiatrica dell’Azienda Based on the patient’s clinical his tory and the observed clinical and radiological signs and symptoms, a diagnosis of MRONJ was made, as the patient had been taking alendronate for 5 years. The case was classified (stage 2b according to the SIPMO-SICMF classification, with peri-implantitis affecting an implant in the left mandibular region) and treated with topical applications of ozo nated gel. RESULTS In the clinical case reported thanks to the use of topical ozone, a complete healing of the mucosa and partial bone re-mineralization of the site of MRONJ at stage 2b (according to SIPMO/SIMCF 2023 classification) and a total re gression of perimplantitis were achieved, with the possibility of maintaining the implant in arch was observed. ratterizzata dalla progressiva distruzione e necrosi dell’osso mandibolare e/o ma scellare di soggetti esposti al trattamento con farmaci per cui sia accertato un au MRONJ is associated with the use of certain drug classes, and it is crucial to be aware of drug-relat ed, systemic, and local risk fac tors. Early diagnosis enables a more conservative approach to treatment, minimizing the biologi cal burden on patients. CONCLUSIONS While stabilization is commonly regarded as the primary outcome for MRONJ treatment, in this case, complete healing was achieved with a non-invasive approach. CLINICAL SIGNIFICANCE This report describes a case of effective conservative treatment for MRONJ and peri-implantitis using an easy-to-use medical device.