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Although bacterial infection is usually present, the etiology of MRONJ remains unknown. Here we apply a multimodal and multiscale (micro\u2010to\u2010nano) characterization approach to investigate the interface between necrotic bone and bacteria in MRONJ. A non\u2010necrotic bone sample was used as control. Both necrotic and non\u2010necrotic bone samples were collected from the jaw of a female individual affected by MRONJ after using BPs for 23\u2009years. For the first time, resin cast etching was used to expose bacteria at the necrotic site. The bone\u2013bacteria interface was also resolved at the nanoscale by scanning transmission electron microscopy (STEM). Nanosized particulates, likely corresponding to degraded bone mineral, were often noted in close proximity to or enclosed by the bacteria. STEM also revealed that the bone\u2013bacteria interface is composed of a hypermineralized front fading into a highly disordered region, with decreasing content of calcium and phosphorus, as assessed by electron energy loss spectroscopy (EELS). This, combined with the variation in calcium, phosphorus, and carbon across the necrotic bone\u2013bacteria interface evaluated by scanning electron microscopy (SEM)\u2010energy dispersive X\u2010ray spectroscopy (EDX) and the lower mineral\u2010to\u2010matrix ratio measured by micro\u2010Raman spectroscopy in necrotic bone, indicates the absence of a mineralization front in MRONJ. It appears that the bone\u2013bacteria interface originates not only from uncontrolled mineralization but also from the direct action of bacteria degrading the bone matrix. \u00a9 2022 The Authors.\n                    <jats:italic>JBMR Plus<\/jats:italic>\n                    published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.\n                  <\/jats:p>","DOI":"10.1002\/jbm4.10693","type":"journal-article","created":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T02:54:51Z","timestamp":1666061691000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Multimodal and Multiscale Characterization of the\n                    <scp>Bone\u2010Bacteria<\/scp>\n                    Interface in a Case of\n                    <scp>Medication\u2010Related<\/scp>\n                    Osteonecrosis of the Jaw"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5823-6399","authenticated-orcid":false,"given":"Chiara","family":"Micheletti","sequence":"first","affiliation":[{"name":"Department of Materials Science and Engineering McMaster University  Hamilton Ontario Canada"},{"name":"Department of Biomaterials, Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liza\u2010Anastasia","family":"DiCecco","sequence":"additional","affiliation":[{"name":"Department of Materials Science and Engineering McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Larsson Wexell","sequence":"additional","affiliation":[{"name":"Department of Biomaterials, Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Oral and Maxillofacial Surgery Sk\u00e5ne University Hospital  Lund Sweden"},{"name":"Department of Oral and Maxillofacial Surgery and Oral Medicine Malm\u00f6 University  Malm\u00f6 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dakota M.","family":"Binkley","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Palmquist","sequence":"additional","affiliation":[{"name":"Department of Biomaterials, Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Grandfield","sequence":"additional","affiliation":[{"name":"Department of Materials Science and Engineering McMaster University  Hamilton Ontario Canada"},{"name":"School of Biomedical Engineering McMaster University  Hamilton Ontario 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