Abstract : Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse effect of antiresorptive and antiangiogenic medications, such as bisphosphonates and denosumab. Conventional management—including conservative therapy and surgical debridement—often provides incomplete or temporary resolution. Mesenchymal stem cells (MSCs), with osteogenic, paracrine, immunomodulatory, and angiogenic properties, have emerged as a promising regenerative option. A systematic search of PubMed, Scopus, and Web of Science was conducted up to December 2023 using the terms “MRONJ,” “mesenchymal stem cells,” “cell therapy,” and “bone regeneration.” Eligible studies included randomized controlled trials, case series, observational studies, and case reports evaluating MSC-based approaches for MRONJ management. Clinical evidence indicates that MSC therapy enhances bone regeneration, reduces lesion size, improves mucosal closure, and alleviates pain. MSCs derived from bone marrow, adipose tissue, and umbilical cord have been applied via local injection, scaffolds, and platelet concentrates, with generally favorable outcomes. However, most studies were limited by small sample sizes, methodological heterogeneity, lack of standardized protocols, and short follow-up periods. Emerging strategies, including MSC sheets and exosome-derived therapies, show additional promise, though current evidence remains preliminary. MSC therapy represents an innovative and potentially effective approach for MRONJ, offering regenerative benefits beyond conventional treatments. While early clinical findings are encouraging, further large-scale controlled trials are required to determine optimal protocols, assess long-term safety, and establish its role in routine clinical practice.