Non-Cochrane · intervention · PM41917690
Is Fluorescence-Guided Surgery Reliable for the Treatment of MRONJ? A Systematic Review and Meta-Analysis.
De Angelis Paolo, Tescione Alessandro Donato, Aniceto Ivan Michele, et al. · Oral diseases · 2026 · PubMed · doi:10.1111/odi.70320
Findings
9 findings
| Population | ||||
|---|---|---|---|---|
| Patients with MRONJ undergoing surgical treatment | Fluorescence-guided surgery | No comparator (single-arm proportion) | Success rate (complete mucosal healing, no exposed necrotic bone, no MRONJ recurrence) Overall follow-up (mean 13.0 months) · All 9 included studies, crude aggregate | Proportion (crude aggregate, percent) 88.54 GRADE not reported 9 studies · 314 participants |
| Patients with MRONJ undergoing surgical treatment | Fluorescence-guided surgery | No comparator (single-arm proportion) | Success rate (complete mucosal healing, no exposed necrotic bone, no MRONJ recurrence) 12 months · Follow-up subgroup, crude aggregate | Proportion (crude aggregate, percent) 92.98 GRADE not reported 2 studies · 56 participants |
| Patients with MRONJ undergoing surgical treatment | Fluorescence-guided surgery | No comparator (single-arm proportion) | Success rate (complete mucosal healing, no exposed necrotic bone, no MRONJ recurrence) Overall follow-up (mean 13.0 months) · All fluorescence modalities (TF and AF) | Proportion 0.935 [0.8965, 0.9598] Very low Downgraded: imprecision, indirectness 6 studies · 246 participants |
| Patients with MRONJ undergoing surgical treatment | Fluorescence-guided surgery | No comparator (single-arm proportion) | Success rate (complete mucosal healing, no exposed necrotic bone, no MRONJ recurrence) 6 months · Follow-up subgroup, crude aggregate | Proportion (crude aggregate, percent) 88.77 GRADE not reported 4 studies · 99 participants |
| Patients with MRONJ undergoing surgical treatment | Conventional surgery without fluorescence guidance (control arms) | No comparator (single-arm proportion) | Success rate (complete mucosal healing, no exposed necrotic bone, no MRONJ recurrence) Overall follow-up · Control groups of 3 comparative studies, crude aggregate | Proportion (crude aggregate, percent) 73.53 GRADE not reported 3 studies · 102 participants |
| Patients with medication-related osteonecrosis of the jaw (MRONJ) undergoing surgical treatment | Tetracycline-induced fluorescence-guided surgery (TF) | None (single-arm pooled proportion) | Success rate (complete mucosal healing, no exposed necrotic bone, no recurrence) Overall follow-up · Fluorescence modality: TF | Proportion 0.94 [0.88, 0.97] Very low Downgraded: imprecision, indirectness 3 studies · 107 participants |
| Patients with MRONJ undergoing surgical treatment | Tetracycline-induced fluorescence-guided surgery | No comparator (single-arm proportion) | Success rate (complete mucosal healing, no exposed necrotic bone, no MRONJ recurrence) Overall follow-up · TF, crude aggregate | Proportion (crude aggregate, percent) 90.06 GRADE not reported 5 studies · 161 participants |
| Patients with MRONJ undergoing surgical treatment | Autofluorescence-guided surgery | No comparator (single-arm proportion) | Success rate (complete mucosal healing, no exposed necrotic bone, no MRONJ recurrence) Overall follow-up · AF, crude aggregate | Proportion (crude aggregate, percent) 87.05 GRADE not reported 4 studies · 139 participants |
| Patients with MRONJ undergoing surgical treatment | Autofluorescence-guided surgery | No comparator (single-arm proportion) | Success rate (complete mucosal healing, no exposed necrotic bone, no MRONJ recurrence) Overall follow-up · Subgroup AF (meta-analysis) | Proportion 0.93 [0.87, 0.96] Very low Downgraded: imprecision, indirectness 4 studies · 139 participants |
Included primary studies 9
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Aljohani et al. 2018 Osteonecrosis of the jaw in patients treated with denosumab: A multicenter case series. PMID:29983309 | 2018 | this review only | not stated | not extracted yet |
| Assaf et al. 2014 Intraoperative efficiency of fluorescence imaging by Visually Enhanced Lesion Scope (VELscope) in patients with bisphosphonate related… PMID:24011463 | 2014 | this review only | Success rate (complete mucosal healing, no exposed necrotic bone, no MRONJ recurrence) | not extracted yet |
| Giovannacci et al. 2025 Autofluorescence-Guided Surgery in the Management of Osteonecrosis of the Jaw: Correlation Between Bone Autofluorescence and… PMID:40430114 | 2025 | this review only | Success rate (complete mucosal healing, no exposed necrotic bone, no MRONJ recurrence) | not extracted yet |
| Giudice et al. 2018 Can Autofluorescence Guide Surgeons in the Treatment of Medication-Related Osteonecrosis of the Jaw? A Prospective Feasibility Study. PMID:29175416 | 2018 | this review only | Success rate (complete mucosal healing, no exposed necrotic bone, no MRONJ recurrence) | not extracted yet |
| Hauer et al. 2020 Surgical therapy for medication-related osteonecrosis of the jaw in osteoporotic patients treated with antiresorptive agents. PMID:30647474 | 2020 | this review only | not stated | not extracted yet |
| Otto et al. 2016 Fluorescence-guided surgery for the treatment of medication-related osteonecrosis of the jaw: A prospective cohort study. PMID:27263757 | 2016 | this review only | Success rate (complete mucosal healing, no exposed necrotic bone, no MRONJ recurrence) | not extracted yet |
| Otto et al. 2021 Autofluorescence-guided surgery for the treatment of medication-related osteonecrosis of the jaw (MRONJ): a retrospective single-center… PMID:33309263 | 2021 | this review only | Success rate (complete mucosal healing, no exposed necrotic bone, no MRONJ recurrence) | not extracted yet |
| Ristow et al. 2017 Comparison of auto-fluorescence and tetracycline fluorescence for guided bone surgery of medication-related osteonecrosis of the jaw: a… PMID:27856150 | 2017 | this review only | Success rate (complete mucosal healing, no exposed necrotic bone, no MRONJ recurrence) | not extracted yet |
| Zhi et al. 2025 Intraoperative ICG NIF Imaging Defines Surgical Margin in MRONJ: A Prospective Observational Study. PMID:40364553 | 2025 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with MRONJ undergoing surgical treatment | 285 patients with MRONJ (314 lesions) (n=9 studies) |
| Intervention | Fluorescence-guided surgery for MRONJ | Tetracycline fluorescence (5 studies), autofluorescence (4), ICG near-infrared (1) |
| Comparison | Conventional surgery for MRONJ or absence of a comparator | Conventional surgery in 3 studies (100 control patients, 102 lesions); otherwise no comparator |
| Outcomes | Success rate (complete mucosal healing, no exposed necrotic bone, no pain or suppuration, no recurrence) | Success rate overall 88.54%; pooled proportion 0.93 (6 studies, 246 patients) |
| Study designs | RCTs, prospective or retrospective studies with at least 10 patients | 2 RCTs, 4 prospective and 3 retrospective studies (n=9) |
| Timing | Mean follow-up of at least 6 months | Mean follow-up 13.0 months (range 3 to 36) |
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 | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | 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 | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: No · NRSI: Partial Yes | NRSI: Partial Yes · RCT: No | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: Yes | NRSI: Partial Yes · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |