Monoclonal Antibodies and Osteonecrosis of the Jaw: A Systematic Review of Risk, Incidence, and Clinical Management in Dentistry

Aim: Osteonecrosis of the jaw (ONJ) is a complication associated with antiresorptive therapies, particularly bisphosphonates and monoclonal antibodies such as denosumab. This systematic review explores preventive measures, therapeutic strategies, and the role of a multidisciplinary approach in reducing the risk of ONJ. Materials and Methods: The study was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the protocol was registered on PROSPERO (ID CRD42024593760). A literature search was performed across PubMed, Scopus, and Web of Science using the keywords “osteonecrosis of the jaw” OR “jaw osteonecrosis” OR “ONJ” AND (“monoclonal antibodies” OR “denosumab” OR “antibody therapy”). A total of 2629 articles were identified, of which 19 were included in the qualitative analysis. Results: Denosumab provides significant benefits in treating bone-related conditions but carries a notable risk of ONJ, particularly in cancer patients and individuals undergoing invasive dental procedures. Conclusions: Pretreatment dental assessments and personalized care are crucial for preventing ONJ. Surgical intervention has been shown to be the most effective treatment for resolving the condition.