{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T08:06:10Z","timestamp":1773216370312,"version":"3.50.1"},"reference-count":47,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a challenging complication in patients receiving antiresorptive therapy. Management strategies range from conservative pharmacological approaches to extensive surgical resection of necrotic bone. This clinical audit retrospectively evaluated the clinical outcomes of patients undergoing sequestrectomy for MRONJ, comparing those treated with antibiotics alone with those receiving antibiotics in combination with the pentoxifylline\u2013tocopherol (PENTO) protocol. The PENTO protocol was introduced at our institution in 2021 and has since been routinely prescribed for all MRONJ patients. Methods: We analyzed 92 MRONJ sites treated with sequestrectomy. Conservative management consisted of antibiotic therapy, with or without adjunctive PENTO (pentoxifylline 800 mg\/day and tocopherol 800 IU\/day, administered both preoperatively and postoperatively). The primary outcome was healing at three months post-surgery, while the secondary outcome was disease recurrence during longer-term follow-up. Results: Complete healing was achieved in 56 of the 92 sites, with a mean follow-up of 9.98 \u00b1 12.76 months among healed cases. No statistically significant differences in healing rates were observed between the PENTO and antibiotic-only groups. The overall recurrence rate was 12.5%, with no significant difference between the groups. Conclusions: Overall, surgical management of MRONJ resulted in favorable outcomes in a substantial proportion of patients. Within the limitations of this retrospective clinical audit, the addition of PENTO to antibiotic therapy appeared generally well tolerated, but could not result in a significant improvement in healing rates or reduction in recurrences, compared with antibiotic therapy alone, in this patient cohort.<\/jats:p>","DOI":"10.3390\/antibiotics15030280","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T09:55:38Z","timestamp":1773136538000},"page":"280","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pentoxifylline and Tocopherol for the Management of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Retrospective Clinical Audit"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8261-1179","authenticated-orcid":false,"given":"Niccol\u00f2","family":"Lombardi","sequence":"first","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virina","family":"Basta","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Morelli","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Ghidini","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0218-8292","authenticated-orcid":false,"given":"Giovanni","family":"Lodi","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7287-2188","authenticated-orcid":false,"given":"Elena M.","family":"Varoni","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ahdi, H.S., Wichelmann, T.A., Pandravada, S., and Ehrenpreis, E.D. (2023). Medication-induced osteonecrosis of the jaw: A review of cases from the Food and Drug Administration Adverse Event Reporting System (FAERS). BMC Pharmacol. Toxicol., 24.","DOI":"10.1186\/s40360-023-00657-y"},{"key":"ref_2","first-page":"e6944","article-title":"Medication-related Osteonecrosis of the Jaw: A Review","volume":"12","author":"AlDhalaan","year":"2020","journal-title":"Cureus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.oooo.2018.09.008","article-title":"Medication-related osteonecrosis of the jaw: Definition and best practice for prevention, diagnosis, and treatment","volume":"127","author":"Mendes","year":"2019","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Wr\u00f3bel, K., Sikora, M., Ch\u0119ci\u0144ski, M., Jas, M., and Chlubek, D. (2021). Medication-Related Osteonecrosis of the Jaw\u2014A Continuing Issue. Appl. Sci., 11.","DOI":"10.3390\/app11177781"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e10785","DOI":"10.1002\/jbm4.10785","article-title":"Pathophysiology of Medication-Related Osteonecrosis of the Jaw\u2014A Minireview","volume":"7","author":"Tetradis","year":"2023","journal-title":"JBMR Plus"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s40729-021-00323-0","article-title":"Clinical considerations for medication-related osteonecrosis of the jaw: A comprehensive literature review","volume":"7","author":"Kawahara","year":"2021","journal-title":"Int. J. Implant. Dent."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.sdentj.2022.01.003","article-title":"Medication-Related Osteonecrosis of the Jaw (MRONJ): A Review of Pathophysiology, Risk Factors, Preventive Measures and Treatment Strategies","volume":"34","author":"AlRowis","year":"2022","journal-title":"Saudi Dent. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41368-020-00093-2","article-title":"Pathogenesis and multidisciplinary management of medication-related osteonecrosis of the jaw","volume":"12","author":"He","year":"2020","journal-title":"Int. J. Oral Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4103\/njms.NJMS_236_20","article-title":"Medication-related osteonecrosis of the jaw: An update","volume":"13","author":"Bansal","year":"2022","journal-title":"Natl. J. Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1016\/j.joms.2022.02.008","article-title":"American Association of Oral and Maxillofacial Surgeons\u2019 Position Paper on Medication-Related Osteonecrosis of the Jaws\u20142022 Update","volume":"80","author":"Ruggiero","year":"2022","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_11","first-page":"2662","article-title":"Treatment of medication-related osteonecrosis of the jaw (MRONJ). A systematic review","volume":"25","author":"Goker","year":"2021","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.1002\/jbmr.3191","article-title":"Evaluation of the Treatment Strategies for Medication-Related Osteonecrosis of the Jaws (MRONJ) and the Factors Affecting Treatment Outcome: A Multicenter Retrospective Study with Propensity Score Matching Analysis","volume":"32","author":"Hayashida","year":"2017","journal-title":"J. Bone Miner. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1111\/odi.12992","article-title":"Surgical treatment of medication-related osteonecrosis of the upper jaw: Case series","volume":"25","author":"Aljohani","year":"2019","journal-title":"Oral Dis."},{"key":"ref_14","first-page":"1905","article-title":"A multicenter case registry study on medication-related osteonecrosis of the jaw in patients with advanced cancer","volume":"26","author":"Schiodt","year":"2018","journal-title":"Support. Care Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.jcms.2018.12.014","article-title":"Is the conservative non-surgical management of medication-related osteonecrosis of the jaw an appropriate treatment option for early stages? A long-term single-center cohort study","volume":"47","author":"Ristow","year":"2019","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2154","DOI":"10.1016\/j.joms.2017.02.033","article-title":"Intraoral Vacuum-Assisted Closure Therapy\u2014A Pilot Study in Medication-Related Osteonecrosis of the Jaw","volume":"75","author":"Laimer","year":"2017","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.oooo.2016.06.019","article-title":"Pentoxifylline and tocopherol in the management of cancer patients with medication-related osteonecrosis of the jaw: An observational retrospective study of initial case series","volume":"122","author":"Owosho","year":"2016","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.joms.2013.06.188","article-title":"Pentoxifylline and Tocopherol in the Treatment of Yearly Zoledronic Acid\u2013Related Osteonecrosis of the Jaw in a Corticosteroid-Induced Osteoporosis","volume":"72","author":"Magremanne","year":"2014","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1016\/j.oooo.2014.04.014","article-title":"Doxycycline fluorescence-guided Er:YAG laser ablation combined with Nd:YAG\/diode laser biostimulation for treating bisphosphonate-related osteonecrosis of the jaw","volume":"119","author":"Porcaro","year":"2015","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1111\/scd.12143","article-title":"Bisphosphonate-related osteonecrosis of the jaws: Report of a case using conservative protocol","volume":"36","author":"Heggendorn","year":"2016","journal-title":"Sp\u00e9c. Care Dent."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.1007\/s00198-013-2277-x","article-title":"Weekly teriparatide injections successfully treated advanced bisphosphonate-related osteonecrosis of the jaws","volume":"24","author":"Yoshiga","year":"2013","journal-title":"Osteoporos. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1902\/jop.2013.130017","article-title":"Periodontal Disease as a Risk Factor for Bisphosphonate-Related Osteonecrosis of the Jaw","volume":"85","author":"Michalowicz","year":"2014","journal-title":"J. Periodontol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.radonc.2004.08.021","article-title":"The radiation-induced fibroatrophic process: Therapeutic perspective via the antioxidant pathway","volume":"73","author":"Delanian","year":"2004","journal-title":"Radiother. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.bjoms.2016.12.006","article-title":"Pentoxifylline\u2014A review of its use in osteoradionecrosis","volume":"55","author":"Lyons","year":"2017","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Colapinto, G., Goker, F., Nocini, R., Albanese, M., Nocini, P.F., Sembronio, S., Argenta, F., Robiony, M., and Del Fabbro, M. (2023). Outcomes of a Pharmacological Protocol with Pentoxifylline and Tocopherol for the Management of Medication-Related Osteonecrosis of the Jaws (MRONJ): A Randomized Study on 202 Osteoporosis Patients. J. Clin. Med., 12.","DOI":"10.3390\/jcm12144662"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1002\/hed.20121","article-title":"Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and tocopherol: A phase II trial","volume":"27","author":"Delanian","year":"2005","journal-title":"Head Neck"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.oooo.2019.08.004","article-title":"Systematic review of the use of pentoxifylline and tocopherol for the treatment of medication-related osteonecrosis of the jaw","volume":"128","author":"Abdelsamie","year":"2019","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"135","DOI":"10.23736\/S0026-4970.17.04056-0","article-title":"Medication-related osteonecrosis of the jaw: Risk factors in patients under biphosphonate versus patients under antiresorptive-antiangiogenic drugs","volume":"66","author":"Ghidini","year":"2017","journal-title":"Minerva Dent. Oral Sci."},{"key":"ref_29","first-page":"6359","article-title":"Oral bisphosphonate-induced osteonecrosis complications in patients undergoing tooth extraction: A systematic review and literature updates","volume":"27","author":"Dioguardi","year":"2023","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.bjoms.2017.06.014","article-title":"Medication-related osteonecrosis of the jaw in oncological patients with skeletal metastases: Conservative treatment is effective up to stage 2","volume":"55","author":"Coropciuc","year":"2017","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2332","DOI":"10.1016\/j.joms.2018.05.025","article-title":"Nonsurgical Management of Medication-Related Osteonecrosis of the Jaws Using Local Wound Care","volume":"76","author":"Hadaya","year":"2018","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Varoni, E.M., Lombardi, N., Villa, G., Pispero, A., Sardella, A., and Lodi, G. (2021). Conservative Management of Medication-Related Osteonecrosis of the Jaws (MRONJ): A Retrospective Cohort Study. Antibiotics, 10.","DOI":"10.3390\/antibiotics10020195"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1016\/j.jcms.2017.07.014","article-title":"Relevant factors for treatment outcome and time to healing in medication-related osteonecrosis of the jaws\u2014A retrospective cohort study","volume":"45","author":"Martins","year":"2017","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2501","DOI":"10.1016\/j.joms.2012.05.019","article-title":"Resective Surgical Approach Shows a High Performance in the Management of Advanced Cases of Bisphosphonate-Related Osteonecrosis of the Jaws: A Retrospective Survey of 347 Cases","volume":"70","author":"Graziani","year":"2012","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.joms.2009.01.006","article-title":"The Role of Surgical Resection in the Management of Bisphosphonate-Related Osteonecrosis of the Jaws","volume":"67","author":"Carlson","year":"2009","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1016\/j.joms.2019.03.040","article-title":"Surgical Management of Medication-Related Osteonecrosis of the Jaw Is Associated With Improved Disease Resolution: A Retrospective Cohort Study","volume":"77","author":"Lam","year":"2019","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1007\/s00432-010-0953-1","article-title":"Outcome of treatment and parameters influencing recurrence in patients with bisphosphonate-related osteonecrosis of the jaws","volume":"137","author":"Koschinski","year":"2011","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/jbmr.2405","article-title":"Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus","volume":"30","author":"Khan","year":"2015","journal-title":"J. Bone Miner. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1007\/s00784-024-05911-z","article-title":"Medication-related osteonecrosis of the jaw: A retrospective single center study of recurrence-related factors after surgical treatment","volume":"28","author":"Ruan","year":"2024","journal-title":"Clin. Oral Investig."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"302","DOI":"10.5125\/jkaoms.2018.44.6.302","article-title":"Corrigendum: Clinical characteristics and recurrence-related factors of medication-related osteonecrosis of the jaw","volume":"44","author":"Kang","year":"2018","journal-title":"J. Korean Assoc. Oral Maxillofac. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Liang, X., Wang, Y., Zhao, C., and Cao, Y. (2022). Systematic review the efficacy and safety of cilostazol, pentoxifylline, beraprost in the treatment of intermittent claudication: A network meta-analysis. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0275392"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/j.jcms.2020.09.008","article-title":"Pentoxifylline and tocopherol protocol to treat medication-related osteonecrosis of the jaw: A systematic literature review","volume":"48","author":"Cavalcante","year":"2020","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/j.oraloncology.2014.08.016","article-title":"A systematic review of therapeutical approaches in bisphosphonates-related osteonecrosis of the jaw (BRONJ)","volume":"50","author":"Rupel","year":"2014","journal-title":"Oral Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1016\/j.jcms.2015.07.035","article-title":"Surgical treatment of bisphosphonate-associated osteonecrosis: Prognostic score and long-term results","volume":"43","author":"Reich","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"193","DOI":"10.5125\/jkaoms.2016.42.4.193","article-title":"Evaluation of the predisposing factors and involved outcome of surgical treatment in bisphosphonate-related osteonecrosis of the jaw cases including bone biopsies","volume":"42","author":"Kim","year":"2016","journal-title":"J. Korean Assoc. Oral Maxillofac. Surg."},{"key":"ref_46","first-page":"CD003811","article-title":"Antibiotics to prevent complications following tooth extractions","volume":"2","author":"Lodi","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Di Fede, O., Canepa, F., Panzarella, V., Mauceri, R., Del Gaizo, C., Bedogni, A., Fusco, V., Tozzo, P., Pizzo, G., and Campisi, G. (2021). The Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review with a Pooled Analysis of Only Surgery versus Combined Protocols. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18168432"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/3\/280\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T10:15:40Z","timestamp":1773137740000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/3\/280"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,10]]},"references-count":47,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["antibiotics15030280"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15030280","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,10]]}}}