Is Fluorescence-Guided Surgery Reliable for the Treatment of MRONJ? A Systematic Review and Meta-Analysis

Background: Identification of healthy bone margins is a critical step in the surgical resective treatment of medication-related osteonecrosis of the jaw (MRONJ). Fluorescence-guided surgery (FGS) has been proposed as a method to identify resection margins and improve clinical outcomes. The purpose of this review was to systematically evaluate the success rate of FGS. Materials and Methods: The Cochrane Central Register, PubMed, Scopus and Web of Science databases were searched. Success was defined as the absence of exposed necrotic bone with full mucosal coverage and no signs of MRONJ recurrence, assessed at overall follow-up. The risk of bias was evaluated using the Newcastle-Ottawa Scale, the Moga Index and the GRADE approach. The PRISMA protocol was followed to evaluate and present the results. Results: Nine studies met the inclusion criteria, comprising a total of 285 patients. Of the 314 lesions treated with FGS, 285 achieved complete healing during a mean follow-up of 13.0 months, with an overall success rate of 88.54%. The fluorescence modalities used included autofluorescence, tetracycline-induced fluorescence and near-infrared fluorescence imaging with indocyanine green. Conclusion: Fluorescence-guided surgery appears to be a promising adjunctive tool for the surgical management of MRONJ, contributing to high success rates.