Breaking Barriers in Osteonecrosis of the Jaw: Towards a Cure

The term ‘Osteonecrosis of the jaw (ONJ)’ encompasses rare complications affecting the jawbone, following exposure to radiation therapy (osteoradionecrosis, ORN) or medications such as anti-resorptive, anti-angiogenic medications, etc., collectively termed medication-related ONJ (ONJ). Both entities present a significant diagnostic and therapeutic challenge in oral and maxillofacial surgery.

The recent update from the American Association of Oral and Maxillofacial Surgeons highlights the ongoing uncertainties and the best pragmatic options currently available for managing patients at risk for, or experiencing, ONJ. Despite advances in clinical staging and case definitions, the precise pathogenesis of ONJ remains elusive, and no definitive cures have been established. Preventive measures mainly focus on regular dental visits and ensuring dental clearance before initiating anti-resorptive therapy. Treatment approaches now give equal consideration to both operative and non-operative options based on clinical stage and patient preferences, ranging from surgical excision to palliative care with antibiotics and pain management. This can prove especially challenging to cancer patients, contributing to the morbidity and disease burden.

ORN poses a similar challenge to patients already impacted by cancer and the other side effects of its treatment, from surgery, chemotherapy and radiation.
The primary objective of this Research Topic is to address the unknowns, challenges, and opportunities in the management of ONJ, facilitating progress towards effective treatments and potential cures. Key areas include:

• Unveiling the mechanisms of ONJ and ORN, which currently involve empirical understandings related to bone resorption, angiogenesis, and altered immune responses to microbial challenges.
• Exploration of the complex interplay between ionizing radiation, the microbiome and anti-tumor immunity; similarly, elucidation of the interplay between opportunistic pathogens/host microbiome and osteoimmunology in ONJ
• Identifying genetic susceptibilities and personalized risk factors.
• Overcoming the difficulty in establishing effective animal models for translational research.
• Bridging the gap between promising findings in translational research and clinical trials.
• Validating osteoanabolic therapies through rigorous clinical research.

Recent advances suggest opportunities for large multicenter collaborative, interdisciplinary research to conduct prospective observational and interventional studies. Additionally, the development of emerging pre-clinical models for ONJ offers new avenues for investigation.
This Research Topic invites contributions that explore the multifaceted aspects of ONJ. Specific themes of interest include:

• Mechanisms and empirical understandings related to ONJ.
• Genetic susceptibility and personalized risk prediction.
• Development and validation of animal models for ONJ, expanding the scope for bioinformatic and translational exploration.
• Transition from translational research to clinical application.
• Validation of novel osteoanabolic therapies.
• Collaborative, interdisciplinary research initiatives and emerging pre-clinical models.

We welcome original research articles, clinical reports, case series, commentaries, and perspectives that shed light on these critical areas and help to remove existing roadblocks in the field of ONJ diagnosis and management.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Classification
• Clinical Trial
• Community Case Study
• Curriculum, Instruction, and Pedagogy
• Data Report
• Editorial
• FAIR² Data
• ... View all formats

Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.

Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Classification
• Clinical Trial
• Community Case Study
• Curriculum, Instruction, and Pedagogy
• Data Report
• Editorial
• FAIR² Data
• FAIR² DATA Direct Submission
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Policy and Practice Reviews
• Policy Brief
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: medication-related osteonecrosis of the jaw, MRONJ, anti-resorptive therapy, pain management, osteoanabolic therapy, angiogenesis, bone resorption

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.