Objectives <p>The aim of this study was to evaluate the outcomes of surgical and adjunctive treatments for osteonecrosis of the jaw (ONJ) and to analyze the influence of specific risk factors on postoperative wound healing and recurrence rates.</p> Materials and methods <p>We retrospectively analyzed surgically treated ARONJ and ORN patients from 2012 to 2017. Demographics, comorbidities, etiology, treatments, and healing outcomes were analyzed using descriptive statistics and multivariate regression analyses.</p> Results <p><i>N</i> = 194 patients met inclusion criteria. The overall postoperative healing rate was 78.4%, with wound healing disturbances occurring in 44% of cases. Healing rates were comparable between entities, with 79.4% in ORN and 77.3% in ARONJ patients achieving complete mucosal healing. Neither classical risk factors (smoking, obesity, diabetes) nor treatment regimens predicted wound healing disturbances (WHD). Risk factors for the development of ONJ were not consistently predictive of postoperative complications.</p> Conclusions <p>Thorough resection with tension-free closure is central to ARONJ and ORN treatment. Close postoperative monitoring – especially within the first 100 days – is crucial, given the high early recurrence rate.</p> Clinical relevance <p>The findings underscore the importance of surgical intervention – particularly complete necrotic bone resection with tension-free wound closure – as the cornerstone of effective treatment for osteonecrosis of the jaw, irrespective of its origin (ARONJ or ORN). Traditional risk factors did not predict wound-healing complications. Within the limitations of this retrospective study, common adjunctive measures did not appear to influence healing outcomes. Given the high rate of early recurrence, vigilant postoperative follow-up—especially within the first 100 days—is essential for optimal patient management.</p>