SURGICAL MANAGEMENT OF JAW OSTEONECROSIS ASSOCIATED WITH BISPHOSPHONATE USE: THERAPEUTIC APPROACHES AND CHALLENGES

Abstract

Medication-related osteonecrosis of the jaws associated with bisphosphonate use represents a complex clinical condition characterized by impaired bone healing and significant morbidity. Although conservative management has historically been prioritized, surgical approaches have increasingly been incorporated, particularly in refractory cases or advanced stages of the disease. The present study aimed to perform a narrative review of the literature regarding the surgical management of bisphosphonate-associated osteonecrosis of the jaws, emphasizing therapeutic approaches and clinical challenges. A literature search was conducted in PubMed/MEDLINE, SciELO, and internationally indexed scientific databases, including studies published between 2014 and 2024. A total of 20 articles, comprising literature reviews, case series, and case reports, were included. The analysis revealed marked heterogeneity in surgical techniques and a lack of standardized treatment protocols, reflecting the multifactorial nature of the condition. Surgical indication should be individualized, taking into account the extent of necrosis, systemic conditions, and response to conservative therapy. Adequate soft tissue management was identified as a key determinant of successful outcomes, while adjunctive therapies showed promising results despite limited levels of evidence. It is concluded that surgical management represents a relevant therapeutic option for bisphosphonate-associated osteonecrosis of the jaws, requiring careful clinical assessment and a multidisciplinary approach, while further robust clinical studies are needed to establish evidence-based guidelines.