Abstract: This article focuses on the clinical prevention and management of medication-related osteonecrosis of the jaw (MRONJ) in patients treated with bone-modifying agents (BMAs) [bisphosphonates (BPs) and denosumab]. Integrating domestic 
and international consensus guidelines with clinical practice, it proposes a comprehensive, risk-stratified prevention and 
management strategy. The article systematically analyzes the three major high-risk factors for MRONJ (medication-related, systemic, and local oral factors), emphasizing the difference in MRONJ risk associated with different drug regimens (low-dose vs. high-dose), and constructs a four-tier (R0‒R3) risk stratification system accordingly. For each risk level, the paper elaborates on corresponding key focuses for oral screening, preventive interventions, indications for invasive procedures (such as tooth extraction), and perioperative management protocols. Specific guidance is provided for high-risk (R3) patients regarding drug holidays, radiographic evaluation, minimally invasive surgery, and wound management strategies. The aim of this article is to promote a shift in the clinical approach to MRONJ from a reactive treatment model to a proactive prevention model, providing systematic reference for dentists to effectively reduce the incidence of MRONJ while ensuring the treatment of patients' underlying systemic diseases.

Key words: bone-modifying agents, medication-related osteonecrosis of the jaw, risk assessment, prevention and 
management strategies, invasive procedures

摘要： 本文聚焦于应用骨改良药物（bone-modifying agents，BMAs）[ 双膦酸盐类（bisphosphonates，BPs）药物及地舒单抗 ] 患者发生药物相关性颌骨坏死（medication-related osteonecrosis of the jaw，MRONJ）的临床防控问题，结合国内外共识与临床实践，提出一套基于风险分级的全程化防控策略。文章系统分析了诱发 MRONJ 的三大高危因素（药物因素、全身因素、口腔局部因素），强调不同用药方案（低剂量与高剂量）所致 MRONJ 的风险差异，并据此构建四层级（R0~R3）的风险分级体系。针对每一层级风险等级，本文详细阐述了相应的口腔筛查重点、预防性干预措施、有创操作（如拔牙）的适应证及围手术期的管理规范，并对高风险（R3）患者的药物假期、影像学评估、微创手术与创口处理策略给出了具体指导。本文旨在推动 MRONJ 的临床防控从“被动诊治”向“主动预防”的模式转变，为口腔医生在保障患者全身疾病治疗的前提下，科学、有效地降低 MRONJ 发生率提供系统参考。

关键词: 骨改良药物, 　药物相关性颌骨坏死, 　风险评估, 　防控策略, 　有创操作

CLC Number: 

• R782