Conclusions
In addition to well-known medications, MRONJ may be a major adverse
reaction to several new-generation anti-cancer drugs. This drugs may
have unexpected mechanisms, being their pharmacodynamics not
fully-comprehended up until now. Even if this paper reports of a single
event– in addition to the few other cases reported in literature of
ipilimumab MRONJ, the authors recommend caution and strict vigilance in
the dental management of patients treated with novel chemotherapy drugs,
reported to be at risk for MRONJ. Multidisciplinary evaluation is thus
strongly advised; cooperation between the Oncologist and the
Dentist/Oral & Maxillofacial Surgeon may help in taking the best
decision in the patient’s interest, ensuring the best possible result in
the management of relatively recent drugs, which may cause unpredictable
side effects. The administration of the prophylactic antibiotic protocol
(amoxicilline + metronidazole; 3 + 1.5 g per os/die) may be arranged in
accordance between the Surgeon and the Oncologist, with the best
possible evaluation of both oral and systemic condition. Such
cooperation may reduce the occurrence of adverse events which, as we
have shown in our paper, may result in patient’s discomfort and pain.
Further studies are needed on a large number of cases, in order to fully
understand the relation between ipilimumab and MRONJ, and the possible
interference of target-therapy.