Does tooth extraction increase the risk of MRONJ in oncologic Patients? A systematic review and Meta-Analysis

Objective: To evaluate the occurrence of MRONJ after tooth extraction in patients with cancer and to explore factors associated with its development. Materials and methods: A systematic review was conducted following PRISMA guidelines. PubMed/MEDLINE, the Cochrane Library, Scopus, Embase, and Ovid MEDLINE was conducted for studies published between 1970 and 2026. Studies including oncology patients undergoing tooth extraction while receiving antiresorptive and/or antiangiogenic therapy were considered eligible. A random-effects meta-analysis of proportions was conducted to estimate the pooled occurrence of MRONJ after tooth extraction. Exploratory pooled odds ratios were calculated for selected risk factors. In addition, a random-effects meta-analysis of continuous data was performed to compare bone-modifying agent (BMA) therapy duration between MRONJ-positive and MRONJ-negative patients. Results: Seven studies were included, comprising 497 patients with cancer. The pooled proportion of MRONJ after tooth extraction was 27.6% (95%CI16.0%-43.3%). Exploratory pooled analyses showed no significant association between MRONJ and female sex or chemotherapy. By contrast, patients who developed MRONJ had a significantly longer duration of BMA therapy than those who did not, with a pooled mean difference of 8.38 months (95%CI2.44-14.32). Qualitative synthesis suggested that local infection, inflammatory dental disease, and extraction timing may be more consistently associated with MRONJ risk than tooth extraction alone. Conclusions: MRONJ after tooth extraction is not uncommon in oncology patients. However, the available evidence does not support considering tooth extraction as an isolated and uniformly avoidable trigger. Rather, MRONJ risk appears to be influenced by local infectious burden, timing of extraction, and cumulative BMA exposure.