Understanding Jaw Osteonecrosis: Avascular, Bisphosphonate-Related, and Osteoradionecrosis Explained

Objective: This narrative review synthesizes current knowledge on medication-related osteonecrosis of the jaw (MRONJ), osteoradionecrosis (ORN) and the newly emerging avascular osteonecrosis of the jawbone due to corticosteroid use. It explores their aetiopathogenesis and clinical features. Additional comparative analysis of these conditions was made to highlight their distinct and overlapping characteristics, aiding in their better understanding and differentiation. Materials and Methods: A comprehensive literature search was conducted using PubMed and Scopus with a restriction on the publication date, accepting those published between 2010 and 2025. The search included keywords such as “avascular jaw osteonecrosis”, “medication-related osteonecrosis of the jaw” and “osteoradionecrosis”. Articles were selected based on relevance, focusing on clinical studies, systematic reviews, and emerging knowledge on the subject. Results: Despite differences in their pathogenesis, avascular osteonecrosis of the jaw due to corticosteroid use, MRONJ, and ORN exhibit similar clinical manifestations, including bone exposure, pain, and infection. Despite their similarities, attention should be given to fully understand their etiologic origin, as it dictates a different management strategy. Conclusions: The distinct origins of avascular osteonecrosis due to corticosteroid use, medication-related osteonecrosis, and osteoradionecrosis converge on a common pathophysiological pathway: compromised vascular function leading to bone necrosis. This shared feature underscores the critical role of vascular health in maintaining bone integrity and facilitating repair processes. This literature review renders it important that future research should focus on developing targeted diagnostics and prevention protocols to optimize patient care and reduce morbidity.