Dental management of patients with bisphosphonate-related osteonecrosis of the jaws: a systematic review of the literature

Abstract

Objective: To analyze the available scientific evidence regarding therapeutic strategies used in the dental management of patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ), assessing their effectiveness and establishing evidence-based clinical recommendations.

Methods: A systematic review of the literature was conducted following the PICO framework and the PRISMA 2020 guidelines. A comprehensive search was performed in PubMed, Scopus, Google Scholar, and Web of Science, including studies published in English and Spanish between 2006 and 2025. MeSH terms and keywords related to osteonecrosis of the jaws, bisphosphonates, and dental management were combined using Boolean operators. After removing duplicate records and applying predefined inclusion and exclusion criteria, seven studies were selected for qualitative analysis. Interventions were classified as conservative, surgical, or adjunctive therapies, and their clinical outcomes were evaluated.

Results: The included studies demonstrated that conservative approaches, including antibiotic therapy and chlorhexidine-based protocols, are effective in the early stages of the disease. In advanced stages, surgical procedures, particularly debridement and sequestrectomy, showed higher rates of clinical resolution. Additionally, adjunctive therapies such as platelet-rich fibrin, low-level laser therapy, hyperbaric oxygen therapy, and teriparatide demonstrated favorable outcomes when used in combination with conventional treatment. Conclusions: The management of bisphosphonate-related osteonecrosis of the jaws should be individualized according to disease stage and patient systemic conditions. Prevention, early diagnosis, and appropriate treatment selection remain essential to improve prognosis and quality of life in affected patients