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The most common precipitating event described in the literature is the extraction of a tooth followed by \u201cspontaneous\u201d occurrence with no clear predisposing event. Current studies are investigating methods of managing dental extractions in patients at risk of <jats:styled-content style=\"fixed-case\">MRONJ<\/jats:styled-content>; however, no studies to date examine the aetiology and management of \u201cspontaneous\u201d <jats:styled-content style=\"fixed-case\">MRONJ<\/jats:styled-content>. This paper describes two cases of \u201cspontaneous\u201d <jats:styled-content style=\"fixed-case\">MRONJ<\/jats:styled-content> seen at the Dental Unit in the Alfred Hospital and systematically reviews the current literature. No significant interactions (<jats:italic>P\u00a0<\/jats:italic>&gt;<jats:italic>\u00a0<\/jats:italic>0.05) were detected between variables: age, sex, bone disease, antiresorptive, antiresorptive duration, jaw, location and stage. \u201cSpontaneous\u201d cases were commonly associated with the mylohyoid ridge, palatal tori and other anatomical sites, and tended to occur in those generally considered at low risk of developing <jats:styled-content style=\"fixed-case\">MRONJ<\/jats:styled-content>. The review suggests that perhaps the term \u201cspontaneous\u201d is a misnomer and thorough history taking is critical in establishing a precipitating event.<\/jats:p>","DOI":"10.1111\/adj.12648","type":"journal-article","created":{"date-parts":[[2018,8,24]],"date-time":"2018-08-24T13:10:15Z","timestamp":1535116215000},"page":"441-454","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["\u201cSpontaneous\u201d medication\u2010related osteonecrosis of the jaw; two case reports and a systematic review"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9942-9856","authenticated-orcid":false,"given":"A","family":"Khominsky","sequence":"first","affiliation":[{"name":"Dental Unit The Alfred Hospital Prahran Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3712-0519","authenticated-orcid":false,"given":"MAWT","family":"Lim","sequence":"additional","affiliation":[{"name":"Dental Unit The Alfred Hospital Prahran Victoria Australia"},{"name":"Melbourne Dental School Royal Dental Hospital of Melbourne Carlton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,9,9]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-2391(03)00720-1"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2014.04.031"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.2405"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdr435"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/odi.12708"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2006.10.061"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2015.01.008"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2007.08.003"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-009-1024-9"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2013.10.002"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2009.03.050"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2005.07.010"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2009.04.051"},{"key":"e_1_2_10_15_1","first-page":"89","article-title":"Medication\u2010related osteonecrosis of the jaws. 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