## 1 Introduction  
Advances in pharmacology introduced highly effective therapies that offer significant benefits in managing severe diseases. Bisphosphonates and RANKL ligand inhibitors, commonly used in treating oncological conditions and skeletal disorders such as osteoporosis and Paget's disease, are associated with adverse effects, including medication-related osteonecrosis of the jaw (MRONJ), a complex and challenging condition to treat [1]. Medication-related osteonecrosis of the jaw (MRONJ) is defined as a pathological condition characterized by the following criteria: a history of current or previous treatment with antiresorptive or antiangiogenic agents; the presence of exposed bone, or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region, persisting for more than 8 weeks; and the absence of a history of radiation therapy to the jaws [2]. The first documented case of bisphosphonate-related jaw necrosis was reported by [PERSON] in 2003 [3]. Seven years later, it was established that denosumab could induce similar complications. The precise etiology of medication-related osteonecrosis of the jaw (MRONJ) remains unclear. Extensive research was conducted on its pathogenesis, with one prominent hypothesis suggesting that the inhibition of osteoclast activity disrupts bone remodeling processes, resulting in bone sclerosis and ischemia [4] Figure 1 illustrates a bone defect resulting from tooth extraction, highlighting the absence of bone trabeculation and the resorption of the cortical plate on both the lingual and labial sides. The risk of developing medication-related osteonecrosis of the jaw during osteoporosis treatment is influenced by several factors, including the route of administration of bisphosphonates. Research indicates that oral administration is significantly safer, with a low incidence of MRONJ. The risk ranges from approximately 0.10% to 0.20% for extended treatment durations, depending on the length of therapy [5]. Many clinicians remain unconvinced of the necessity for special patient preparation prior to procedures such as tooth extractions. However, evidence from a European multicenter study involving 470 patients highlighted that individuals taking oral antiresorptive medications account for 7.8% of all cases of medication-related osteonecrosis of the jaw (MRONJ). These findings underscore the importance of adhering to established protocols to prevent MRONJ, particularly during the surgical management of the oral cavity [6]. Intravenous bisphosphonates are associated with a significantly higher risk of developing MRONJ compared to oral bisphosphonates [7,8]. Oncology patients comprise the primary group receiving intravenous bisphosphonate therapy, with the duration of treatment playing a crucial role in MRONJ risk. According to [PERSON] et al., the incidence of MRONJ in cancer  
Figure 1: MRONJ developed one year after tooth extraction: (**A**) frontal section; (**B**) cross-section. patients varies by cancer type and can reach up to 14%, with the highest risk observed in patients undergoing treatment for multiple myeloma [9; 10]. Moreover, patients receiving intravenous bisphosphonates for three years or longer exhibited a substantially increased risk of MRONJ [10]. This heightened risk is attributed to the pharmacokinetics of these drugs, including their strong affinity for the bone matrix and subsequent accumulation over time [11]. [PERSON] et al. (2020) further demonstrated that the risk of MRONJ varies among specific drugs, with denosumab showing a higher incidence (13.6%) compared to zoledronic acid (4.1%) [12]. Additionally, a systematic review conducted in 2021 highlighted that combination therapy with bisphosphonates and denosumab posed the highest MRONJ risk, reaching approximately 13%, while monotherapy with bisphosphonates or denosumab resulted in risks of 5% and 4%, respectively [13].