# Case Report: Surgical treatment of stage 3 medication-related osteonecrosis of the maxilla using the “FTT Split” surgical protocol: a report of 14 cases

## TL;DR

A new surgical protocol called 'FTT Split' was successfully used to treat 14 stage 3 maxillary MRONJ cases with complete healing.

## Contribution

The 'FTT Split' surgical protocol is introduced as a novel treatment for stage 3 maxillary medication-related osteonecrosis.

## Key findings

- All 14 patients achieved primary wound closure without complications.
- Complete healing was observed during postoperative follow-ups lasting up to 3 years.
- The FTT Split protocol showed high success rates in treating stage 3 maxillary MRONJ.

## Abstract

Most severe presentation of medication-related osteonecrosis of the jaw (MRONJ) is classified as stage 3 for which there are still no standard surgical therapy guideline. Our aim was to describe “Five Times Three (FTT) Split” protocol as surgical treatment of stage 3 maxillary MRONJ. The present case series included a total of 14 patients diagnosed with stage 3 MRONJ of the upper jaw who were treated from February 2022 to September 2024 with mucoperiosteal flap and “FTT Split” protocol. The patients were followed up both clinically and radiologically for a period ranging from 9 months to 3 years. Primary wound closure was successfully achieved in all cases without any signs of oroantral or oronasal communication, and complete healing was observed during the postoperative follow-up period. The “FTT Split” surgical protocol demonstrated high success rates during a controlled postoperative period.