## 1 Introduction
Discrepancies among study findings may stem from various influencing factors, such as the type of surgical intervention in the oral cavity and the duration of drug administration [2; 6; 14]. Tooth extraction has emerged as a significant risk factor for MRONJ and has been the focus of increased analysis in recent years. In patients receiving bisphosphonates or denosumab, tooth extraction exerts a destructive impact on the surrounding bone, heightening the risk of MRONJ. Studies indicate that extractions necessitated by underlying conditions, such as periodontal disease [15], clinical symptoms [16], loss of alveolar bone [17], or pulpitis [18] are associated with a greater likelihood of developing MRONJ compared to extractions performed without preceding clinical or radiological findings [19]. Clinicians are continually exploring innovative treatment modalities for medication-related osteonecrosis of the jaw (MRONJ). In addition to surgical interventions, various non-surgical approaches demonstrated efficacy. Methods such as hyperbaric oxygen therapy, ultrasound therapy, and laser biostimulation are increasingly utilized with positive outcomes [20]. Platelet concentrates in solid- and liquid-form A-PRF and I-PRF are also used. They have the ability to regulate inflammation and chemotaxis, secreting pro-inflammatory cytokines (IL-1\(\beta\), IL-6, and TNF\(\alpha\)) and the basic angiogenesis promoter (VEGF) [21; 22]. Vitamin D, known for its pleiotropic effects spanning systems such as the circulatory and skeletal systems, is increasingly recognized as a critical factor in the management of patients with MRONJ [23]. As a fat-soluble secosteroid, vitamin D exists primarily in two bioactive forms: D3 (cholesterol) and D2 (ergocalciferol) [24]. Studies consistently showed that vitamin D deficiency is prevalent within the Polish population, emphasizing the need for year-round supplementation tailored to individual baseline levels [7; 25]. For patients with MRONJ, vitamin D levels below 40 ng/mL may necessitate high-dose supplementation, with doses of up to 10,000 IU per day recommended in certain cases. Beyond its role in MRONJ management, vitamin D exhibits preventive properties against osteoporosis and cancers such as breast cancer in women [26]. Research by [PERSON] et al. demonstrated that low vitamin D levels are a potential risk factor for MRONJ in individuals receiving antiresorptive therapy [27]. This finding underscores the importance of ensuring adequate vitamin D levels, particularly in oncology patients. Studies reveal that a substantial proportion of individuals with breast cancer, prostate cancer, or multiple myeloma--populations at heightened risk for MRONJ--have insufficient vitamin D levels, highlighting the critical role of supplementation in these groups [28]. However, despite growing evidence of vitamin D's importance in bone metabolism and in reducing the risk of various skeletal complications, there remain significant gaps in our understanding of its precise role in MRONJ. While some studies suggest that adequate vitamin D levels may help mitigate the onset or severity of this condition, data on the optimal timing, dosage, and protocol for vitamin D supplementation--especially in patients undergoing invasive procedures such as tooth extraction--are limited. Existing research has often focused on either preclinical models or retrospective analyses, leaving questionsunanswered about the prophylactic versus therapeutic benefits of vitamin D. Furthermore, it remains unclear whether vitamin D can significantly alter the natural course of MRONJ once it has already developed, or primarily exerts its effect by preventing advanced stages of necrosis. In light of these uncertainties, the present study aimed to bridge these knowledge gaps by systematically evaluating vitamin D's impact at multiple points in the MRONJ timeline--encompassing both the prevention of severe disease and the influence on healing outcomes in established cases.