Osteonecrosis of the jaw (ONJ) is a rare treatment related side effect that was
firstly described in 2002 through a case report in metastatic bone cancer patient treated
with bisphosphonates (BPs) therapy. ONJ is defined as an eight weeks or longer clinical
finding of exposed bone in the oral cavity without response to appropriate therapy. The
diagnosis is mainly clinical but often requires a radiological confirmation with an orthopantomography.
So it must be made by a dental specialist with sufficient experience on
ONJ and requires a detailed anamnestic exploration of comorbidities and treatments history.
In particular, ONJ affects a wide number of oncologic patients treated with BPs for
bone metastatic cancers and, more recently, with anti-angiogenic drugs. The aim of this
this paper is to describe diagnosis and classification of this rare but serious side effect and
its pathophysiology. In particular, we provide a detailed description of clinical evidences
upon the relationship between anti-angiogenic drugs and ONJ. Considering the evolving
of cancer epidemiology with a greater number of cancer surviving patients, this side effect
always deserves more attention. We conclude that ONJ must be always carefully investigated
and prevented with a multidisciplinary approach involving oncologist, radiation oncologist
and skilled dental practitioner when a cancer patient must begin a BP or an antiangiogenic
Keywords: Osteonecrosis of the jaw, bisphosphonates, angiogenesis, anti-angiogenic drug, anti-VEGF, pathogenesis.
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