Non-Cochrane · intervention · PM41463780
Antibiotic Prophylaxis and Postoperative Therapy in Tooth Extractions for Patients at Risk of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Scoping Review.
Barone Selene, Antonelli Alessandro, Madonna Antonio, et al. · Antibiotics (Basel, Switzerland) · 2025 · PubMed · doi:10.3390/antibiotics14121279
Findings
Population Patients at risk of MRONJ (receiving bone-modifying and/or antiangiogenic agents) undergoing tooth extraction with antibiotic prophylaxis/therapy
5 findings
| High-dose bone-modifying agent therapy | Low-dose bone-modifying agent therapy | MRONJ incidence (MRONJ/bone exposure cases) Dental extraction in patients on antiresorptive therapy · Common-effect model (Mantel-Haenszel) | OR 3.26 [1.74, 6.10] GRADE not reported 16 studies · 1187 participants |
| High-dose bone-modifying agent therapy | Low-dose bone-modifying agent therapy | MRONJ incidence (MRONJ/bone exposure cases) Dental extraction in patients on antiresorptive therapy · GLMM-adjusted at 0 days of antibiotics (binomial, random intercept by study; final model with duration x dose interaction) | OR 33.5 [6.3, 177.8] GRADE not reported 32 studies |
| High-dose bone-modifying agent therapy | Low-dose bone-modifying agent therapy | MRONJ incidence (MRONJ/bone exposure cases) Dental extraction in patients on antiresorptive therapy · Random-effects model (inverse-variance, REML); primary estimate | OR 2.82 [1.46, 5.43] GRADE not reported 16 studies · 1187 participants |
| Longer antibiotic duration (prophylaxis plus postoperative therapy), per additional day | One day shorter antibiotic duration | MRONJ incidence (MRONJ/bone exposure cases) Dental extraction in patients on antiresorptive therapy · High-dose BMA group (days x high-dose interaction term) | OR 0.86 [0.75, 0.98] GRADE not reported 32 studies |
| Longer antibiotic duration (prophylaxis plus postoperative therapy), per additional day | One day shorter antibiotic duration | MRONJ incidence (MRONJ/bone exposure cases) Dental extraction in patients on antiresorptive therapy · Low-dose BMA group | OR 1.06 [0.93, 1.22] GRADE not reported 32 studies |
Included primary studies 68
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Barry 2021 The incidence of medication-related osteonecrosis of the jaw following tooth extraction in patients prescribed oral bisphosphonates. PMID:34815482 | 2021 | this review only | not stated | not extracted yet |
| Barry et al. 2021 The incidence of medication-related osteonecrosis of the jaw following tooth extraction in patients prescribed oral bisphosphonates DOI:10.1038/s41415-021-3620-9 | 2021 | this review only | not stated | not extracted yet |
| Besi 2024 The role of leukocyte and platelet-rich fibrin in the prevention of medication-related osteonecrosis of the jaw, in patients requiring… PMID:38182917 | 2024 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Besi et al. 2024 The role of leukocyte and platelet-rich fibrin in the prevention of medication-related osteonecrosis of the jaw, in patients requiring… DOI:10.1007/s10006-023-01204-z | 2024 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Bodem 2015 Incidence of bisphosphonate-related osteonecrosis of the jaw in high-risk patients undergoing surgical tooth extraction. PMID:25841311 | 2015 | this review only | not stated | not extracted yet |
| Bodem et al. 2015 Incidence of bisphosphonate-related osteonecrosis of the jaw in high-risk patients undergoing surgical tooth extraction DOI:10.1016/j.jcms.2015.02.018 | 2015 | this review only | not stated | not extracted yet |
| Carini 2012 Surgical protocol in patients at risk for bisphosphonate osteonecrosis of the jaws: clinical use of serum telopetide CTX in preventive… PMID:22783453 | 2012 | this review only | not stated | not extracted yet |
| Carini et al. 2012 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Chang 2025 Prevention of medication-related osteonecrosis of the jaw: institutional insights from a retrospective study. PMID:39670507 | 2025 | this review only | not stated | not extracted yet |
| Chang et al. 2025 Prevention of medication‐related osteonecrosis of the jaw: institutional insights from a retrospective study DOI:10.1111/adj.13050 | 2024 | this review only | not stated | not extracted yet |
| Cuozzo 2022 Incidence and risk factors associated to Medication-Related Osteo Necrosis of the Jaw (MRONJ) in patients with osteoporosis after tooth… PMID:35609780 | 2022 | this review only | not stated | not extracted yet |
| Cuozzo et al. 2022 Incidence and risk factors associated to Medication-Related Osteo Necrosis of the Jaw (MRONJ) in patients with osteoporosis after tooth… DOI:10.1016/j.jormas.2022.03.020 | 2022 | this review only | not stated | not extracted yet |
| Di Fede 2024 Reduction of MRONJ risk after exodontia by virtue of ozone infiltration: A randomized clinical trial. PMID:38807567 | 2024 | this review only | not stated | not extracted yet |
| Di Fede et al. 2024 Reduction of <scp>MRONJ</scp> risk after exodontia by virtue of ozone infiltration: A randomized clinical trial DOI:10.1111/odi.15006 | 2024 | this review only | not stated | not extracted yet |
| Ferlito 2010 Dental extractions in patient treated with intravenous bisphosphonates and risk of osteonecrosis of jaws: presentation of a preventive… PMID:21217623 | 2010 | this review only | not stated | not extracted yet |
| Ferlito 2011 Preventive protocol for tooth extractions in patients treated with zoledronate: a case series. PMID:21316136 | 2011 | this review only | not stated | not extracted yet |
| Ferlito et al. 2010 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Ferlito et al. 2011 Preventive Protocol for Tooth Extractions in Patients Treated With Zoledronate: A Case Series DOI:10.1016/j.joms.2010.10.055 | 2011 | this review only | not stated | not extracted yet |
| Hutcheson 2014 A C-terminal crosslinking telopeptide test-based protocol for patients on oral bisphosphonates requiring extraction: a prospective… PMID:24793621 | 2014 | this review only | not stated | not extracted yet |
| Hutcheson et al. 2014 A C-Terminal Crosslinking Telopeptide Test–Based Protocol for Patients on Oral Bisphosphonates Requiring Extraction: A Prospective… DOI:10.1016/j.joms.2014.02.036 | 2014 | this review only | not stated | not extracted yet |
| Karaca et al. 2023 The effect of drug holiday before tooth extraction on the development of medication-related osteonecrosis of the jaw in cancer patients… PMID:37114444 | 2023 | this review only | not stated | not extracted yet |
| Lesclous 2020 Alendronate or Zoledronic acid do not impair wound healing after tooth extraction in postmenopausal women with osteoporosis. PMID:32404281 | 2020 | this review only | not stated | not extracted yet |
| Lesclous et al. 2020 Alendronate or Zoledronic acid do not impair wound healing after tooth extraction in postmenopausal women with osteoporosis DOI:10.1016/j.bone.2020.115412 | 2020 | this review only | not stated | not extracted yet |
| Lodi 2010 Tooth extraction in patients taking intravenous bisphosphonates: a preventive protocol and case series. PMID:20006163 | 2010 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Lodi et al. 2010 Tooth Extraction in Patients Taking Intravenous Bisphosphonates: A Preventive Protocol and Case Series DOI:10.1016/j.joms.2009.07.068 | 2010 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Magalhães 2023 Pentoxifylline and tocopherol as prophylaxis for osteonecrosis of the jaw due to bone-modifying agents in patients with cancer submitted… PMID:37436539 | 2023 | this review only | not stated | not extracted yet |
| Matsumoto 2017 Primary wound closure after tooth extraction for prevention of medication-related osteonecrosis of the jaw in patients under denosumab. PMID:26924135 | 2017 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Matsumoto et al. 2017 Primary wound closure after tooth extraction for prevention of medication-related osteonecrosis of the jaw in patients under denosumab DOI:10.1007/s00784-016-1762-y | 2016 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Mauceri et al. 2020 Platelet-Rich Plasma (PRP) in Dental Extraction of Patients at Risk of Bisphosphonate-Related Osteonecrosis of the Jaws: A Two-Year… DOI:10.3390/app10134487 | 2020 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Megalhaes et al. 2023 Pentoxifylline and tocopherol as prophylaxis for osteonecrosis of the jaw due to bone-modifying agents in patients with cancer submitted… DOI:10.1007/s00520-023-07906-0 | 2023 | this review only | not stated | not extracted yet |
| Miranda 2021 The Role of Platelet-Rich Fibrin (PRF) in the Prevention of Medication-Related Osteonecrosis of the Jaw (MRONJ). PMID:34095295 | 2021 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Miranda et al. 2021 The Role of Platelet‐Rich Fibrin (PRF) in the Prevention of Medication‐Related Osteonecrosis of the Jaw (MRONJ) DOI:10.1155/2021/4948139 | 2021 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Mozzati 2012 Tooth extraction in patients on zoledronic acid therapy. PMID:22483860 | 2012 | this review only | not stated | not extracted yet |
| Mozzati 2013 Tooth extraction in osteoporotic patients taking oral bisphosphonates. PMID:23288026 | 2013 | this review only | not stated | not extracted yet |
| Mozzati et al. 2012 Tooth extraction in patients on zoledronic acid therapy DOI:10.1016/j.oraloncology.2012.03.009 | 2012 | this review only | not stated | not extracted yet |
| Mozzati et al. 2013 Tooth extraction in osteoporotic patients taking oral bisphosphonates DOI:10.1007/s00198-012-2239-8 | 2013 | this review only | not stated | not extracted yet |
| Otto 2015 Tooth extraction in patients receiving oral or intravenous bisphosphonate administration: A trigger for BRONJ development? PMID:25958767 | 2015 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Otto et al. 2015 Tooth extraction in patients receiving oral or intravenous bisphosphonate administration: A trigger for BRONJ development? DOI:10.1016/j.jcms.2015.03.039 | 2015 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Parise 2023 Efficacy of fibrin-rich platelets and leukocytes (L-PRF) in tissue repair in surgical oral procedures in patients using zoledronic… PMID:35739366 | 2023 | this review only | not stated | not extracted yet |
| Parise et al. 2022 Efficacy of fibrin-rich platelets and leukocytes (L-PRF) in tissue repair in surgical oral procedures in patients using zoledronic… DOI:10.1007/s10006-022-01094-7 | 2022 | this review only | not stated | not extracted yet |
| Pippi 2021 What is the Risk of Developing Medication-Related Osteonecrosis in Patients With Extraction Sockets Left to Heal by Secondary Intention? A… PMID:34174218 | 2021 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Pippi et al. 2021 What is the Risk of Developing Medication-Related Osteonecrosis in Patients With Extraction Sockets Left to Heal by Secondary Intention? A… DOI:10.1016/j.joms.2021.05.031 | 2021 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Poli 2019 Adjunctive application of antimicrobial photodynamic therapy in the prevention of medication-related osteonecrosis of the jaw following… PMID:31152878 | 2019 | this review only | not stated | not extracted yet |
| Poli et al. 2019 Adjunctive application of antimicrobial photodynamic therapy in the prevention of medication-related osteonecrosis of the jaw following… DOI:10.1016/j.pdpdt.2019.05.037 | 2019 | this review only | not stated | not extracted yet |
| Poxleitner 2020 Tooth extractions in patients under antiresorptive therapy for osteoporosis: Primary closure of the extraction socket with a… PMID:32122726 | 2020 | this review only | not stated | not extracted yet |
| Poxleitner et al. 2020 Tooth extractions in patients under antiresorptive therapy for osteoporosis: Primary closure of the extraction socket with a… DOI:10.1016/j.jcms.2020.02.006 | 2020 | this review only | not stated | not extracted yet |
| Ristow 2021 Wound closure and alveoplasty after preventive tooth extractions in patients with antiresorptive intake-A randomized pilot trial. PMID:32875698 | 2021 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Ristow 2023 Comparison of Different Antibiotic Regimes for Preventive Tooth Extractions in Patients with Antiresorptive Intake-A Retrospective Cohort… PMID:37370316 | 2023 | this review only | not stated | not extracted yet |
| Ristow et al. 2020 Wound closure and alveoplasty after preventive tooth extractions in patients with antiresorptive intake—A randomized pilot trial DOI:10.1111/odi.13556 | 2020 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Ristow et al. 2023 Comparison of Different Antibiotic Regimes for Preventive Tooth Extractions in Patients with Antiresorptive Intake—A Retrospective Cohort… DOI:10.3390/antibiotics12060997 | 2023 | this review only | not stated | not extracted yet |
| Şahin et al. 2020 Prevention of medication related osteonecrosis of the jaw after dentoalveolar surgery: An institution's experience. PMID:32913575 | 2020 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Saia 2010 Occurrence of bisphosphonate-related osteonecrosis of the jaw after surgical tooth extraction. PMID:20307765 | 2010 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Saia et al. 2010 Occurrence of Bisphosphonate-Related Osteonecrosis of the Jaw After Surgical Tooth Extraction DOI:10.1016/j.joms.2009.10.026 | 2010 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Sandhu 2020 Osteonecrosis of the jaw and dental extractions: A single-center experience. PMID:32723683 | 2020 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Sandhu et al. 2020 Osteonecrosis of the jaw and dental extractions: A single-center experience DOI:10.1016/j.oooo.2020.07.001 | 2020 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Scoletta 2011 Initial experience on the outcome of teeth extractions in intravenous bisphosphonate-treated patients: a cautionary report. PMID:21129835 | 2011 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Scoletta 2013 Tooth extractions in intravenous bisphosphonate-treated patients: a refined protocol. PMID:23434159 | 2013 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Scoletta et al. 2011 Initial Experience on the Outcome of Teeth Extractions in Intravenous Bisphosphonate-Treated Patients: A Cautionary Report DOI:10.1016/j.joms.2010.07.026 | 2011 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Scoletta et al. 2013 Tooth Extractions in Intravenous Bisphosphonate-Treated Patients: A Refined Protocol DOI:10.1016/j.joms.2013.01.006 | 2013 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Seki 2022 Medication-related osteonecrosis of the jaw after tooth extraction in patients receiving pharmaceutical treatment for osteoporosis: A… PMID:36299343 | 2022 | this review only | not stated | not extracted yet |
| Seki et al. 2022 Medication-related osteonecrosis of the jaw after tooth extraction in patients receiving pharmaceutical treatment for osteoporosis: A… DOI:10.1016/j.jds.2022.03.014 | 2022 | this review only | not stated | not extracted yet |
| Shudo 2018 Long-term oral bisphosphonates delay healing after tooth extraction: a single institutional prospective study. PMID:29967931 | 2018 | this review only | not stated | not extracted yet |
| Shudo et al. 2018 Long-term oral bisphosphonates delay healing after tooth extraction: a single institutional prospective study DOI:10.1007/s00198-018-4621-7 | 2018 | this review only | not stated | not extracted yet |
| Spanou 2020 Primary wound closure and perioperative antibiotic therapy for prevention of bisphosphonate-related osteonecrosis of the jaw after tooth… PMID:32020132 | 2020 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Spanou et al. 2020 DOI:10.3290/j.qi.a43949 | NR | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Tartaroti 2020 Antimicrobial photodynamic and photobiomodulation adjuvant therapies for prevention and treatment of medication-related osteonecrosis of… PMID:31923636 | 2020 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Tartaroti et al. 2020 Antimicrobial photodynamic and photobiomodulation adjuvant therapies for prevention and treatment of medication-related osteonecrosis of… DOI:10.1016/j.pdpdt.2020.101651 | 2020 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
| Vescovi et al. 2013 Case series of 589 tooth extractions in patients under bisphosphonates therapy. Proposal of a clinical protocol supported by Nd:YAG… PMID:23524436 | 2013 | this review only | MRONJ incidence (MRONJ/bone exposure cases) | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients undergoing tooth extraction while receiving bone-modifying and/or antiangiogenic agents (at least 10 patients; no history of MRONJ or head and neck radiation) | 5115 patients on bone-modifying and/or antiangiogenic agents undergoing tooth extraction (n=36 studies); oncologic and osteometabolic indications |
| Intervention | Antibiotic regimen (prophylaxis and postoperative therapy) | Antibiotic protocols: amoxicillin with or without clavulanic acid, with or without metronidazole; parenteral regimens (n=7 studies); median duration 7 days overall (1.5 pre-extraction, 5.5 post-extraction) |
| Comparison | Other antibiotics or no antibiotics | High-dose versus low-dose antiresorptive groups (n=16 studies in meta-analysis); antibiotic duration modeled as continuous (n=32 studies) |
| Outcomes | MRONJ incidence | MRONJ or bone exposure (111 cases in 4239 patients; 61 cases in the 16-study meta-analysis) |
| Study designs | Original articles in English: case series, RCTs, randomized pilot trials, retrospective, prospective and observational studies | 15 prospective, 5 case series, 10 retrospective, 1 retrospective case series, 1 retrospective cohort, 1 observational, 1 case-control, 1 randomized pilot trial, 1 RCT |
| Timing | Not specified | Follow-up 14 to 3270 days |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | No | No | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: No · NRSI: No | NRSI: No · RCT: No | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Partial Yes · NRSI: No | NRSI: No · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | No | No | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |