Oladapo Akintola

Background and objectives: Although it is very uncommon, medication-induced osteonecrosis of the jaw (also known as MRONJ) can have serious consequences. Traditionally, this adverse event has been recognised in patients who were treated with bisphosphonate (BP) drugs. Nevertheless, in recent years, it has been established that individuals having treatment with various types of medications, such as a receptor activator of nuclear factor kappa-Β ligand inhibitor (denosumab) and antiangiogenic agents, have had the same issue. The purpose of this research is to determine if the application of human amniotic membrane (hAM) may be used as a therapy for MRONJ. Material and Methods: A multi-source database (MEDLINE, EMBASE, AMED, and CENTRAL) systematic search was performed. The major objective of this study is to obtain an understanding of the efficacy of hAM when it is employed as a treatment modality for MRONJ. The protocol of this review was registered in the INPLASY register under the number NPLASY202330010. Results: The authors were able to include a total of five studies for the quality analysis, whereas for the quantity evaluation, only four studies were eligible. A total of 91 patients were considered for the investigation. After treatment with human amniotic membrane (hAM), a recurrence of osteonecrosis was observed in n = 6 cases (8.8%). The combined efficacy of surgical therapy and the use of hAM resulted in an overall success rate of 91.2%. Intraoperative complications were only documented in one article, and they were mostly caused by the positioning of the hAM, which led to wound breakdown at the surgical site. Conclusions: Based on the small amount of data and low-quality research included in this study, using human amniotic membranes to treat MRONJ might represent a feasible option. Nevertheless, further studies with a wider patient population are required to understand the long-term impacts.

Background: Antiresorptive and antiangiogenic medications can cause a serious adverse effect known as medication-related osteonecrosis of the jaw (MRONJ). In recent years, a new trend of research has emerged emphasizing the potential relation of MRONJ and genetic predisposition. Current evidence-based science of this adverse reaction is associated with poorly performed studies. Additionally, MRONJ research has recently observed a new trend of studies orientated towards the misuse of reviews. This quality meta-review intends to summarize the results of all systematic reviews and meta-analyses that have been published on MRONJ in relation to genetic and pharmacogenomics risk factors. Methods: The research study protocol was registered into the database of the International Network for the Registration of Systematic Reviews and Meta-Analyses (INPLASY) INPLASY202230002. A comprehensive search across several databases (PubMed, EMBASE, MEDLINE, and CINAHL) was conducted to locate multi-language papers published between January 2003 and November 2022. Data were collected from relevant research studies and appraised in accordance with the precise outcomes described in this evaluation. Results: Only five systematic reviews and meta-analyses were analysed in this meta-review. All the reviews included in this research presented qualities mistakes and shortcomings. Two quality assessment tools (Confidence in Evidence from Reviews of Qualitative research (CERQual) and Assessment of Multiple Systematic Reviews 2 (AMSTAR-2)) were used to evaluate each study included in this research. Conclusions: The data evaluated by this meta-review confirmed the poor-quality secondary research underpinning the genetic/pharmacogenomics aspect of MRONJ. Moreover, this study highlighted the many flaws of the current published systematic and meta-analysis studies published so far.

Background: Osteonecrosis of the jaw (ONJ) is a condition affecting patients exposed to medications used to treat benign and malignant conditions of bone tissue. Many studies have highlighted that ONJ is a severe condition, which is very challenging to manage, especially in individuals with oncologic disease. The aim of this umbrella review is to analyze all available interventional and non-interventional systematic reviews published on medication-related osteonecrosis of the jaw (MRONJ) and summarize this evidence. Material and methods: A multi-database search (PubMed, MEDLINE, EMBASE and CINAHL) was performed to identify related multi-language papers published from January 2003 until June 2021. An additional manual search was also performed in systematic review registries (PROSPERO, INPLASY, JBI and OFS) to identify possible missing reviews. Data were extracted from relevant papers and analyzed according to the outcomes selected in this review. Results: The search generated 25 systematic reviews eligible for the analysis. The total number of patients included in the analysis was 80,840. Of the reviews, 64% (n = 16) were non-interventional and 36% (n = 9) were interventional. Study designs included case series 20.50% (n = 140), retrospective cohort studies 12.30% (n = 84) and case reports 12.20% (n = 83). It was unclear what study design was used for 277 studies included in the 25 systematic reviews. Conclusions: The data reviewed confirmed that the knowledge underpinning MRONJ in the last 20 years is still based on weak evidence. This umbrella review highlighted a widespread low-level quality of studies and many poorly designed reviews.