Actual problems in dentistry Actual problems in dentistry Проблемы стоматологии 2077-7566 2412-9461 113849 10.18481/2077-7566-2026-22-1- ЛЕКЦИИ / ЛИТЕРАТУРНЫЕ ОБЗОРЫ LITERATURE REVIEW ЛЕКЦИИ / ЛИТЕРАТУРНЫЕ ОБЗОРЫ CURRENT STATE OF RESEARCH ON MEDICATION-RELATED OSTEONECROSIS OF THE JAWS (MRONJ) AND PERSPECTIVES СОВРЕМЕННОЕ СОСТОЯНИЕ ИССЛЕДОВАНИЙ ПО МЕДИКАМЕНТОЗНОМУ ОСТЕОНЕКРОЗУ ЧЕЛЮСТЕЙ (МОНЧ) И ПЕРСПЕКТИВЫ РАЗВИТИЯ Лю Минюй Lyu Minyuy qq99077973@gmail.com Жукова Наталья Александровна Zhukova Natal'ya Aleksandrovna dr.natalia.zhukova@gmail.com

кандидат медицинских наук;

candidate of medical sciences;

 Тарасенко Светлана Викторовна Tarasenko Svetlana Viktorovna tarasenko_s_v@staff.sechenov.ru

доктор медицинских наук;

doctor of medical sciences;

 Первый Московский государственный медицинский университет имени И.М. Сеченова I.M. Sechenov First Moscow State Medical University 22 1 10 10 26 01 2026 https://dental-press.ru/en/nauka/article/113849/view

Цель. Систематизировать современные представления об этиопатогенезе, факторах риска, методах ранней диагностики и комплексного лечения медикаментозного остеонекроза челюстей (МОНЧ) у пациентов, получающих бисфосфонаты, деносумаб и/или антиангиогенные препараты. Материалы и методы. Проведен систематический обзор отечественных и зарубежных публикаций 2003–2024 гг. в базах PubMed, Scopus и eLIBRARY с отбором работ, посвященных клиническим проявлениям, лучевой диагностике и стратегиям лечения МОНЧ. Дополнительно проанализированы согласительные документы и клинические рекомендации профессиональных сообществ челюстно-лицевых хирургов (в том числе AAOMS 2007–2022), регламентирующие диагностические критерии и маршрутизацию пациентов. Результаты. Патогенез МОНЧ мультифакториален и включает подавление костного ремоделирования, инфекционно-воспалительные процессы с участием бактериальных биопленок (включая Actinomyces spp.), нарушения микроциркуляции/ангиогенеза (VEGF-зависимые механизмы) и локальную иммунную дисрегуляцию. По данным ряда исследований риск осложнений возрастает в зависимости от вида препарата, пути введения, кумулятивной дозы и длительности терапии; деносумаб в отдельных работах ассоциируется с более высоким риском по сравнению с пероральными бисфосфонатами. Наиболее частым пусковым фактором рассматриваются инвазивные стоматологические вмешательства (особенно удаление зубов) на фоне хронического воспаления. Классификация AAOMS, основанная на обнажении кости, может ограничивать выявление ранних форм; учет МСКТ-признаков в динамической классификации позволяет диагностировать доклинические изменения и уточнять тактику. Выводы. Снижение заболеваемости требует междисциплинарной профилактики: санации полости рта до начала антирезорбтивной терапии, контроля очагов воспаления и обучения индивидуальной гигиене. Вопрос «лекарственных каникул» следует решать индивидуально с учетом баланса рисков. Лечение стадийно-зависимо: на ранних этапах приоритетны консервативные меры с адъювантными методиками (низкоинтенсивная лазерная терапия, PRF), при прогрессировании — хирургическая санация (секвестрэктомия/резекция) и реабилитация.

Purpose. To systematize current concepts regarding the etiopathogenesis, risk factors, approaches to early diagnosis, and comprehensive management of medication-related osteonecrosis of the jaws (MRONJ) in patients receiving bisphosphonates, denosumab, and/or antiangiogenic agents. Materials and methods. A systematic review of Russian and international publications from 2003 to 2024 was conducted using PubMed, Scopus, and eLIBRARY, selecting studies addressing the clinical presentation, imaging diagnostics, and treatment strategies for MRONJ. In addition, consensus statements and clinical practice guidelines issued by professional maxillofacial surgery societies (including AAOMS 2007–2022) were analyzed with respect to diagnostic criteria and patient care pathways. Results. The pathogenesis of MRONJ is multifactorial and involves suppression of bone remodeling, infection–inflammation with bacterial biofilms (including Actinomyces spp.), microcirculatory/angiogenic disturbances (VEGF-dependent mechanisms), and local immune dysregulation. According to multiple studies, the risk of complications increases with drug type, route of administration, cumulative dose, and treatment duration; in some reports, denosumab is associated with a higher risk than oral bisphosphonates. The most common triggering factors are invasive dental procedures—particularly tooth extraction—performed in the setting of chronic inflammation. The AAOMS staging system, based on the presence of exposed bone, may limit detection of early disease; incorporating CBCT findings into a dynamic classification enables identification of preclinical changes and refinement of treatment planning. Conclusions. Reducing MRONJ incidence requires interdisciplinary prevention, including oral sanitation prior to initiating antiresorptive therapy, control of inflammatory foci, and patient education on individualized oral hygiene. Decisions regarding a “drug holiday” should be individualized based on a risk–benefit balance. Management is stage-dependent: early stages prioritize conservative measures with adjunctive modalities (low-level laser therapy, platelet-rich fibrin), whereas progressive disease necessitates surgical debridement (sequestrectomy/resection) and subsequent rehabilitation.

 медикаментозный остеонекроз челюстей (МОНЧ) бисфосфонаты деносумаб остеопороз профилактика лечение Medication-related osteonecrosis of the jaw (MRONJ) bisphosphonates denosumab osteoporosis prevention treatment

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