Tetracycline fluorescence as a surgical guide for medication-related osteonecrosis of the jaws. Scoping review

Medication-related osteonecrosis of the jaws (MRONJ) is a severe adverse reaction affecting patients treated with antiresorptive and/or antiangiogenic drugs, particularly at high doses and short intervals, as is commonly prescribed in oncologic therapy, rather than at lower doses and less frequent administration associated with osteoporosis. The American Association of Oral and Maxillofacial Surgery has classified MRONJ into four diagnostic stages, which determine treatment strategies ranging from conservative to surgical. Because the removal of necrotic bone is a critical step in management, tetracycline-guided fluorescence has been proposed to reduce recurrence resulting from insufficient or excessive surgical margins, both of which may compromise maxillary bone integrity. A systematic search was conducted using the following terms in different combinations: osteonecrosis, fluorescence, tetracycline, mandible, and surgery, across the PubMed, Scopus, and Web of Science databases. According to the inclusion and exclusion criteria, 4 articles were selected, comprising a sample of 51 patients diagnosed with 57 lesions, all treated with tetracycline-guided fluorescence. Treatment success ranged from 89 % to 100 %, with mucosal integrity as the primary outcome measure. Tetracycline-guided fluorescence shows promising potential as a valuable tool for distinguishing necrotic from vital tissue. However, further prospective clinical studies are needed to validate its potential usefulness as a surgical guide.