The PENTO Protocol in Medication-related Osteonecrosis of the Jaw

Inclusion Criteria:

• Age greater than or equal to 18 years
• Current or past treatment with bisphosphonates (oral or IV) and/or targeted therapies (denosumab, bevacizumab)
• Signs and symptoms for more than 8S with confirmation that the signs and symptoms arenot of dental origin
• AAOMS Stage 2 MRONJ
• For patients of childbearing age, effective contraception is required

Exclusion Criteria:

• History of head or neck radiotherapy or maxilla metastases
• Patients who have received treatment in the past (PENTO or PENTOCLO protocol)
• Patients who have undergone surgery for their MRONJ within the last 3 months
• Pregnant or wishing to be pregnant, breastfeeding
• Patient under palliative care
• Patient with hypersensitivity to pentoxifylline or tocopherol or to an excipient
• History of hypersensitivity reaction to penicillins, cephalosporins, or otherbeta-lactams (and clindamycin or lincomycin if applicable) or excipient ofamoxicillin-a. clavulanic or clindamycin
• History of jaundice/hepatic injury related to amoxicillin/clavulanic acid
• Patient taking oral anticoagulants, or with a history of major bleeding or bleedingdisorders
• Patient taking platelet aggregation inhibitor, theophylline or aminophylline
• Patient taking methotrexate, probenecid, mycophenolate mofetil, myorelaxant drugs,macrolide or streptogramin antibiotics
• Patients with hepatic failure or renal failure (Cl < 30 mL/min),
• Patient with hypotension (SBP < 90 mmHg)
• Refusal to participate in the study
• Patient participating in other interventional research that may interfere with theconduct of this research
• Patient unable to understand the protocol
• Patient under curatorship or guardianship