# Resective Surgery versus Debridement in Stage 2 Medication-Related Osteonecrosis of the Jaw
## 4 Discussion
[PERSON] states that the pre-operators duration of the disease represents a negative prognostic factor towards the recurrence of disease, while, according to other studies, therapy duration with bisphosphonate or antiresorptive drugs, MRONJ staging or necrosis localization were not considered relevant recurrence prognostic factors [46]. Recurrence analysis shows a superior percentage in debridement treatments (28.7% of [PERSON] and 9.2% of [PERSON]) compared to resective treatments (8.4% [PERSON] et al. and 11.1% [PERSON] et al.) [46; 50; 54; 63]. Analyzing our clinical records, we recorded the following recurrence rates: 8.57% in group A, 40% in group B, with statistically significant difference (\(p=0.0136\)). [PERSON] et al. used a multiple linear regression to analyze the influencing factors of the recurrence development. The authors fund a statically significant difference base on the treatment performed (conservative vs. surgical, \(p=0.001\)) and among the various surgical treatments, showing better outcome in wide surgical resections (\(p<0.0001\)). Moreover, debridement shows 39.07 odd ratio with \(p<0.0001\), representing a highly unfavorable prognostic factor [46]. Multivariate analysis performed by [PERSON] on 159 patients subject to surgical treatment further showed how the extension of the surgical area is an independent factor related to a better outcome when compared to debridement, further underlining the protective value of the surgical treatment (\(p<0.001\); OR 0.051; IC 95%, from 0.017 to 0.152) [31]. During our statistical analysis, univariate Cox analysis of the surgical treatment demonstrates how debridement represent an unfavorable prognostic factor in recurrence development compared to surgical resection (\(p=0.0032\) Hazard Ration HR 4.9); similarly, complete mucosal healing represents in group B a prognostic factor related to recurrence development (\(p<0.0001\)). The drug used (zoledronic acid vs. denosumab) is not correlated to recurrence (\(p=0.2434\)). Cox multivariate analysis showed how the surgical treatment is an independent prognostic factor correlated to recurrence development (\(p<0.0001\), \(1.3\) Hazard Ratio HR). Quality of life was investigated in few studies: [PERSON] et al. underlined how non-surgical treatments, in addition to occasionally cause disease progression during treatment, often diminish the quality of life [44]. Of the same opinion, [PERSON] et al. underlined how the need of a continuous pharmacological treatment lowers the quality of life [31]. In our study we quantified QoL with EORTC and calculated the considerable increase obtained in patients subject to surgical resection (group A) compared to slight improvements in patients subject to surgical debridement (group B). Despite the fact that underlying oncological condition of the patients has an impact on their overall quality of life, the same starting condition in the preoperative phase (62.68% vs. 62.37%) let us analyze the differences that appeared during the concomitant MRONJ treatment [66]. Since lower scores corresponds to better perceived quality of life by the patients, the difference between the two groups is evident. At one month follow up group A gain a mean improvement (52.42% vs. 60.83%) that becomes more pronounced after three months (42.43% vs. 56.17%) and that at the six months follow-up is 18.31% superior then group B (33.06% vs. 51.37%). This evidence shows how surgical resection, although considered a more aggressive treatment in already debilitated patients for their underlying oncologic condition, improves QoL by almost 20%.