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 are not 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 other beta-lactams (and clindamycin or lincomycin if applicable) or excipient of amoxicillin-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 bleeding disorders * 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 the conduct of this research * Patient unable to understand the protocol * Patient under curatorship or guardianship