{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T13:21:53Z","timestamp":1771939313301,"version":"3.50.1"},"reference-count":33,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Stage three osteonecrosis of the jaw (ONJ), whether medication-related (MRONJ) or osteoradionecrosis (ORN), often necessitates aggressive surgical management due to extensive necrosis, infection, and risk of pathologic fracture. While free flap reconstruction remains the gold standard post-segmental mandibulectomy, it may not be feasible for elderly or systemically compromised patients. Objective: The presentation of our own experience with advanced mandibular ONJ on patients managed exclusively with a contemporary titanium reconstruction plate system and to evaluate the clinical outcomes of this approach in the context of the current literature. Methods: From a group of 21 patients treated for ONJ, just four patients with Stage 3 MRONJ or Grade III ORN, unfit for microvascular surgery, underwent segmental mandibulectomy followed by alloplastic reconstruction using standard titanium plating. Outcomes were assessed clinically and radiographically over a follow-up period ranging from 3 to 20 months. A focused literature review was conducted to contextualize results. Results: All patients demonstrated stable reconstruction without plate exposure, fracture, or intraoral bone exposure during follow-up. Esthetic and functional outcomes are reported. No hardware complications were reported. The review of the literature supports plate-only reconstruction as a valid alternative for patients unsuitable for free flap surgery, especially when using rigid, anatomically adaptive systems with robust soft tissue coverage. Conclusions: Titanium plate\u2013only reconstruction following segmental mandibulectomy can provide reliable short- to mid-term outcomes in selected patients with advanced ONJ. Used titanium plating systems appears to be a promising option.<\/jats:p>","DOI":"10.3390\/jcm15051694","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T12:19:23Z","timestamp":1771935563000},"page":"1694","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical Management of Advanced Mandibular Osteonecrosis Utilizing a Contemporary Mandibular Reconstruction Plate in Patients Unsuitable for Free Flap Reconstruction\u2014Preliminary Study and Case Series"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1194-7325","authenticated-orcid":false,"given":"Marios","family":"Fouzas","sequence":"first","affiliation":[{"name":"Oral and Maxillofacial Surgery University Clinic, Dental School, National and Kapodistrian University of Athens, Evangelismos General Hospital, 10676 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3654-1151","authenticated-orcid":false,"given":"Evagelos","family":"Kalfarentzos","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery University Clinic, Dental School, National and Kapodistrian University of Athens, Evangelismos General Hospital, 10676 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4215-0798","authenticated-orcid":false,"given":"Kamil","family":"Nelke","sequence":"additional","affiliation":[{"name":"Maxillo-Facial Surgery Ward, EMC Hospital, Pilczycka 144, 54-144 Wroc\u0142aw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christos","family":"Perisanidis","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery University Clinic, Dental School, National and Kapodistrian University of Athens, Evangelismos General Hospital, 10676 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"ref_1","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 jaw\u20142022 update","volume":"80","author":"Ruggiero","year":"2022","journal-title":"J. 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