Preventive Treatments for Osteonecrosis of the Jaw: A Systematic Review and Network Meta-Analysis

ObjectivesA systematic review and network meta-analysis were conducted to address the following research question: "What is the most effective preventive treatment for reducing the risk of jaw osteonecrosis after tooth extraction in patients receiving medications associated with osteonecrosis?"Material and MethodsOnly randomized clinical trials conducted in adults with a history of medication use associated with osteonecrosis of the jaw, who were treated with a preventive method to reduce the risk of osteonecrosis after tooth extraction, were included. Risk of bias and quality of evidence were assessed using the Cochrane Collaboration tool. Bayesian random-effects mixed treatment comparison model was employed to compare all evaluated strategies: regenerative therapy, primary closure, secondary closure, epiperiosteal flap, and ozone infiltration. The network meta-analysis results were presented as point estimates with 95% credible intervals.ResultsFive randomized clinical trials conducted between 2012 and 2024 were included after applying the predetermined criteria. These studies evaluated various interventions, including platelet-rich fibrin, platelet-rich plasma, oxygen-ozone therapy, and different surgical closure techniques. Bayesian network meta-analysis demonstrated no conclusive evidence of superiority for any intervention over primary closure.ConclusionNo preventive strategy demonstrated superiority in reducing the risk of medication-related osteonecrosis of the jaw in patients undergoing tooth extraction.Trial RegistrationInternational Prospective Register of Systematic Reviews: CRD42024619828