Estratégias terapêuticas para o tratamento da osteonecrose dos maxilares associada a medicamentos: revisão integrativa da literatura

Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication of antiresorptive and antiangiogenic therapy, and its treatment has not yet been standardized. The aim of this study was to identify and analyze the therapeutic strategies used to treat MRONJ and their clinical outcomes. This is an integrative literature review based on searches of the PubMed/MEDLINE, Web of Science and Scopus databases, supplemented by a manual search, including studies published in English between 2021 and 2026. Of the 133 records identified, 16 studies comprised the final sample. Surgical treatment predominated in clinical practice, being used in 81.9% of patients in a cohort of 934 cases, and segmental resection showed a higher success rate than marginal resection (78.6% vs. 54.3%) in advanced mandibular MRONJ. Platelet concentrates, bone morphogenetic proteins, antimicrobial photodynamic therapy and the combination of pentoxifylline and tocopherol showed favorable results, mainly in case series; however, the Cochrane systematic review found no significant benefit of any intervention added to standard care. Temporary drug discontinuation was not associated with lesion healing, and smoking and compromised systemic conditions negatively influenced outcomes. It is concluded that the treatment of MRONJ should be individualized according to disease stage and the patient's systemic condition, that prevention and early diagnosis by the dentist are essential, and that randomized clinical trials with standardized protocols are needed to establish the efficacy of each therapeutic strategy.