Abstract
Introduction: Bone tissue is a specialized connective tissue made up of cells and a mineralized extracellular matrix. To reduce the excessive resorption observed in these pathologies, more rigorous studies have been carried out in pre-clinical and clinical studies to improve antiresorptive medications that allow the treatment or prevention of bone metabolism pathologies. Thus, anti-resorptive agents, such as Bisphosphonates (BFs) and Denosumab (DN), as well as some angiogenesis inhibitors, can induce osteonecrosis of the jaw. Objective: It was to develop a systematic review to specify the main approaches and clinical evidence on the process of osteonecrosis associated with the use of bisphosphonates, as well as the main oral and maxillofacial regenerative treatments. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to April 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 124 articles were found, 36 articles were evaluated in full and 14 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=77.7%>50%. It was concluded that patients undergoing treatment with BFs should be informed about the potential risk of BRONJ. Furthermore, it would be advisable for providers responsible for BF therapy to refer patients for dental check-ups before starting treatment, allowing for patient monitoring by a multidisciplinary team. Although the morbidity rate of this pathology is not high, prevention should be mandatory, thus avoiding mutilating and painful processes. However, if a surgical procedure is necessary, the use of new adjuvant therapies such as hyperbaric camera, teriparatide, pentoxifylline, and alpha-tocopherol can be proposed.