Evidence map›Paper›PMID 40971002›Full record

ArticleClinical oral investigations2025

Endodontic treatment and management of patients under antiresorptive treatment: a scoping review on MRONJ risk.

Giulio Zavalloni, Andrea Spinelli, Martina Coppini, Rodolfo Mauceri, Giuseppina Campisi, Jacopo Lenzi, Maria Giovanna Gandolfi, Carlo Prati, Fausto Zamparini

Abstract readScoping Review
In one paragraph

Article in Clinical oral investigations, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Giulio ZavalloniUniversity of Bologna, via Zamboni 33, Bologna, 40126, Italy.ORCID http://orcid.org/0000-0002-8774-6096
Andrea SpinelliEndodontic Clinical Section, Department of Biomedical and Neuromotor Sciences, School of Dentistry, University of Bologna, Bologna, 40126, Italy.ORCID http://orcid.org/0000-0002-4674-1766
Martina CoppiniDepartment of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Palermo, PA, Italy.ORCID http://orcid.org/0000-0002-0834-1841
Rodolfo MauceriDepartment of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Palermo, PA, Italy.ORCID http://orcid.org/0000-0002-4008-6502
Giuseppina CampisiUnit of Oral Medicine and Dentistry for frail patients, Department of Rehabilitation, fragility, and continuity of care, Regional Center for Research and Care of MRONJ, University Hospital Palermo, Palermo, PA, Italy.ORCID http://orcid.org/0000-0002-9443-0495
Jacopo LenziDepartment of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, 40126, Italy.ORCID http://orcid.org/0000-0003-2882-4223
Maria Giovanna GandolfiLaboratory of Biomaterials and Oral Pathology, Department of Biomedical and Neuromotor Sciences, School of Dentistry, University of Bologna, Bologna, 40126, Italy.ORCID http://orcid.org/0000-0001-7793-6227
Carlo PratiEndodontic Clinical Section, Department of Biomedical and Neuromotor Sciences, School of Dentistry, University of Bologna, Bologna, 40126, Italy.ORCID http://orcid.org/0000-0001-8163-8628
Fausto ZampariniEndodontic Clinical Section, Department of Biomedical and Neuromotor Sciences, School of Dentistry, University of Bologna, Bologna, 40126, Italy. fausto.zamparini2@unibo.it.ORCID http://orcid.org/0000-0002-0071-4463

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo summarize the current scientific evidence on the implications of root canal treatment (RCT) in patients receiving antiresorptive therapy and to outline best practices for managing such cases to prevent MRONJ. MATERIALS AND

methodsA search strategy across PubMed, Web of Science and Scopus was performed. Clinical studies and reports on RCTs in patients on antiresorptive therapy were screened by two independent reviewers. Data on patient factors (sex, age, disease, treatment, outcome) and tooth-related aspects (procedure, diagnosis, anesthesia, irrigation, obturation, antibiotics) were extracted.

resultsOf the 514 studies identified, 15 articles (133 patients) met inclusion criteria. One prospective study included 65 patients and 96 RCTs; the remaining patients were reported in case reports or series and in two retrospective studies. Endodontic protocols varied largely across studies. The most common indications for RCT were pulpitis (n = 62) and periapical lesions with acute endodontic diseases (n = 119). All patients were undergoing antiresorptive therapy with oral or intravenous bisphosphonates for the management of osteoporosis or oncologic conditions. RCT was performed in all cases using conventional protocols that included local anesthesia (in some cases without vasoconstrictors), mechanical instrumentation, chemical irrigation (most commonly with sodium hypochlorite) and root canal obturation. Five studies reported antibiotic use. The cases of MRONJ (n = 7, 5.3%; mean treatment duration was 49 months) appeared only in oncological patients.

conclusionsRCT appears to be a safe procedure for patients receiving bisphosphonates. Cases in which RCT appeared to act as a trigger for MRONJ are rare and ambiguous and seem primarily associated with procedural errors or high-risk patients. Although some recommendations for endodontic practice to prevent MRONJ have been proposed, there is a clear need for further research in this area. CLINICAL RELEVANCE: Dentists can safely perform RCT in patients undergoing bisphosphonate therapy. Some clinical recommendations based on the available literature are provided.

Indexed as

Bisphosphonate-Associated Osteonecrosis of the JawBone Density Conservation AgentsDiphosphonatesRoot Canal TherapyHumansOsteoporosisRisk FactorsBone Density Conservation AgentsDiphosphonatesBisphosphonate-Associated osteonecrosis of the jawDental educationEndodonticsRoot canal preparation

Identifiers

PMID40971002
PMCPMC12449421

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.