# Resective Surgery versus Debridement in Stage 2 Medication-Related Osteonecrosis of the Jaw
## 4 Discussion
According to [PERSON] et al., major surgery is more effective than mini-invasive surgery [31]. [PERSON] et al. removed the necrotic bone during the surgical treatment and extended the osteotomy reaching the surrounding bone bleeding within a safety margin of 1 cm [50]. Bone resection has to be extended horizontally in order to reach healthy, bleeding bone, although the reliability of this vitality sign remain controversial. [PERSON] et al. developed a technique where bone resection in guided by tetracycline induced fluorescence, administered 7-10 days prior surgery in order to selectively resect the necrotic bone and allowing a more conservative approach [51]. [PERSON] and [PERSON] independently reported a success rate over 80% in MRONJ patients treated with sequestrectomy [52; 53]. Based on [PERSON] and [PERSON] experience, when MRONJ recurrence is diagnosed after a marginal resection, the surgeon should perform a segmentary resection: when a surgical retreatment is needed, is not advisable to repeat the marginal resection [50]. Consistent with [PERSON], many authors underline the radicality obtained through the \"one-shot\" respective surgery [29; 36; 46; 54; 55; 56; 57; 58; 59; 60; 61]. Moreover, the systematic review performed by [PERSON] et al. showed how better results are obtained in patients that underwent major surgery vs. mini-invasive surgery [62]. In our study, in order to verify the outcome differences between surgical resection and debridement, we composed two homogeneous groups of 35 randomized patients each, affected from stage 2 MRONJ. Contrary to what is foresaw by MRONJ stage 2 surgical guidelines, our work highlights a superior functional outcome in Group A treated with respective surgery, when compared to Group B treated with debridement only. [PERSON] et al. reported complete healing in 25.2% of patients subject to non-surgical conservative treatments and in 76.7% of the surgically treated patients [31]. The Japanese Task Force reports a 44.7% of complete healing rate with conservative treatment, while a significantly higher rate is shown for wide surgical interventions (86.8% of patients) [44]. [PERSON] et al. use debridement, with the goal to reduce pain and infection [63]. Therefore, complete closure is achieved in 27.6% of cases vs. 72.3% of cases of non-closure, 34.2% of which presented exposed bone since the first days, while 28.9% of cases showed bone exposure in the first 3 months after an initial mucosal healing. [PERSON] et al. used debridement in 102 patients as first treatment: 69.6% benefitted of a single treatment, 16.7% underwent 2 treatments, 8.8% underwent 3 treatments, 4.9% 4 debridement [46]. Debridement was chosen as single therapy in 83% of cases, 17% of cases were further treated with wider resections. [PERSON] obtained complete healing with surgical therapy in 63.5% and a lack of closure in 36.5% of cases [64]. In our study complete healing was achieved in 82.86% of group A patients vs. 28.57% of group B, a statically significant difference (\(p=0.0136\)). Group A patients showed in 82.86% of cases absence of lesions, 5.71% improvement, 2.86% unchanged, 8.57% worsening; group B showed in 28.57% of cases absence of lesion, 28.57% improvement, 2.86% unchanged, and 40% worsening. Literature reviews regarding complications are scarce: [PERSON] et al. reported a 29.6% rate of complication following surgical treatment without analyzing each complication, while [PERSON] et al. reported a 9.4% of pathological fractures [46; 65]. The complication analyzed in our work were the followings: suture dehiscence (11.43% in group A, 65.71% in group B), dehiscence persistence (2.86% in group A, 42.86% in group B), purulent discharge (5.71% in group A, 54.28 in group B), fistulae (2.86% in group A vs. 17.14 in group B), mouth opening impairment (22.86% in group A vs. 20% in group B).