The Dental Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw: New Paradigm of Primary Prevention

Table 2

Main dental treatments with respect to patients’ categories in the pre-treatment phase with drugs related to ONJ.

Dental procedures on patients in the pre-treatment phase	Cancer patients	Non-cancer patients
Non-Surgical Procedures
Restorative dentistry	Indicated	Indicated
Endodontic treatment	Indicated	Indicated
Orthodontic treatment	Possible	Possible
Periodontal treatments: oral hygiene and non-surgical treatments	Indicated	Indicated
Prosthesis	Possible	Possible
Surgical Procedures
Dentoalveolar surgery		Indicated
Preimplant bone surgery	Contraindicated	Possible^★
Dental implant surgery	Contraindicated	Possible^★
Periodontal/endodontic surgery

to wait for wound healing (4–6 weeks) before initiating antiresorptive or antiangiogenic treatment for cancer therapy. When treatment with ONJ-related drugs cannot be deferred, dentoalveolar surgery is indicated; in this case, the surgical protocol and medical treatment of oncological patients already in-treatment with MRONJ-related drugs will also be performed. Perform only if any infective processes cannot be treated via periodontal/endodontic, non-invasive treatment. ^★Advise the patient that the risk of MRONJ is indefinable in the long term.