Italian Position Paper (SIPMO-SICMF) on Medication-Related Osteonecrosis of the Jaw (MRONJ)

Despite being one of the most recently studied oral diseases, MRONJ remains a condition with uncertain and controversial issues. The aim of this updated version of the position paper on MRONJ developed by the Italian Societies of Oral Pathology and Medicine (SIPMO) and of Maxillofacial Surgery (SICMF) is to set forth an original interpretation of the current disputes on MRONJ. The Expert panel was appointed by the SIPMO and SICMF Board of Trustees in 2010 and comprised a multidisciplinary group of clinicians and researchers with recognized expertise in the field, who tracked the available literature and released two consecutive sets of Italian recommendations on MRONJ in 2013 and 2020. The advance of scientific knowledge and the perceived need for refinements to the previous position papers were recognized by the board panel who approved the submission of this updated version. This position paper highlights the current research status and provides a different perspective on several debated aspects of MRONJ including risk estimates, disease definition, diagnostic pathway, individual risk assessment, and the fundamental role of imaging in the diagnosis, classification, and management of MRONJ. The SIPMO-SICMF expert panel believes essential for the information provided to be disseminated to healthcare providers and patients at increased MRONJ risk. The SIPMO-SICMF Expert Panel recognizes that the statements and recommendations here provided warrant further confirmation and updates and highlight the need for a global and interdisciplinary scientific approach to MRONJ to overcome region-specific challenges.