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.