Impact of MRONJ-Associated Medications on Mandibular Cortical Index: A Cross-Sectional Analysis

Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication associated with antiresorptive and antiangiogenic medications, such as bisphosphonates and denosumab, frequently prescribed for osteoporosis and oncologic bone conditions. This study aimed to evaluate the effects of MRONJ-associated medications on mandibular cortical bone morphology using the Mandibular Cortical Index (MCI) on panoramic radiographs, and to compare these findings with those from a healthy control population undergoing routine dental evaluation. Materials and Methods: This cross-sectional study included 62 participants, divided equally into two groups: 31 patients currently receiving medications known to be associated with MRONJ risk, and 31 healthy individuals without a history of such medication use. Panoramic radiographs were obtained for all participants, and the mandibular cortex was evaluated using the MCI classification. Additionally, demographic data, systemic disease presence, and duration of medication use were recorded and analyzed to identify any correlations with cortical bone changes. Results: The comparison of MCI scores between the study and control groups revealed a statistically significant difference (p = 0.003), with the C1 category—representing normal cortical morphology—being more prevalent in the control group. Although no significant differences were identified among the various medication subgroups (e.g., bisphosphonates vs. denosumab), the study group had a significantly higher prevalence of systemic diseases and longer durations of medication use. These findings suggest a possible link between prolonged exposure to MRONJ-associated drugs and early radiographic signs of mandibular bone alteration. Conclusion: Although no specific medication group showed distinct radiographic signs of MRONJ, overall MCI differences between medication users and controls may assist in early diagnosis and clinical decision-making in MRONJ management.