Evaluation of the onset of osteonecrosis of the jaws in patients rehabilitated with removable prostheses.

This study investigates the development of medication-related osteonecrosis of the jaws (MRONJ) in patients treated with anti-resorptive drugs and rehabilitated with removable prostheses. MRONJ is a known complication of therapies such as bisphosphonates and denosumab, often arising after dental procedures including tooth extractions, periodontal or implant surgery, and the use of dentures. The study analyzed 284 patients treated at the Dental School of Turin from January 2008 to February 2020, before they began anti-resorptive therapy. Collected data included demographic information, type of prosthesis, prescribed drug, underlying disease, follow-up duration, vital status, and the onset of MRONJ. After completing all necessary dental treatments, patients received fixed or removable prosthetic rehabilitation. Follow-up visits were scheduled at regular intervals up to yearly assessments to monitor denture condition and oral tissues. The median follow-up duration was 3.8 years, with 133 recorded deaths. Kaplan–Meier survival analysis showed a progressive decline, more pronounced in patients with aggressive diseases such as metastatic lung cancer. Among the 284 cases, two instances of bisphosphonate-related osteonecrosis were identified: a 68-year-old man treated with zoledronic acid for prostate cancer, and a 72-year-old woman taking clodronic acid for breast cancer, whose condition worsened due to delayed follow-up during the COVID-19 pandemic. Both underwent surgical bone reduction to enable gingival closure. The study underscores the need for careful monitoring of patients with removable prostheses to ensure early detection and management of MRONJ.