Revisiting best practice guidelines and patient care workflow for managing the risk of medication-related osteonecrosis of the jaw: comparative summary and case studies.

This article focuses on summarizing and comparing the three primary clinical guidelines for managing and preventing medication-related osteonecrosis of the jaw (MRONJ) in patients taking antiresorptive medications, as proposed by the American Association of Oral and Maxillofacial Surgeons (AAOMS), the Journal of Bone and Mineral Research (JBMR), and the Journal of Clinical Oncology (JCO). It highlights key aspects such as risk stratification, consultation timing, disease control, the controversial role of drug holidays, antibiotic prophylaxis, and the potential use of the biomarker C-telopeptide (CTX) in clinical decision-making. The article also presents a clinical workflow and three case studies illustrating individualized management approaches, including drug holidays and antibiotic coverage, emphasizing the importance of interprofessional collaboration and informed consent. Despite advances, the article notes ongoing uncertainties regarding drug holiday protocols and CTX utility, calling for further research to optimize MRONJ prevention and treatment in dental practice.