RANKL was suppressed in ONJ-adjacent soft tissue. (a, b) Spatial distribution of RANKL-expressing cells in the soft tissue areas of BONJ samples (b) was non-homogeneous compared to normal jaw periodontal samples (a). A local high concentration of RANKL-expressing multinucleated cells was detected only at zones of tissue resorption in BONJ samples. (c) The relative cellular expression (labeling index) of RANKL-positive cells was significantly lower in ONJ samples (Controls-ME: 59.38, IQR 21.0 vs. BONJ-ME: 23.25, IQR: 12.0; p < 0.05). (d) A 2.94-fold suppression of RANKL mRNA was detected in ONJ-related bone samples (Controls-ME: 1.00, IQR 0.13 vs. BONJ-ME: 0.34, IQR: 0.44; p < 0.03). Horizontal bars indicate median (ME), and error bars indicate interquartile range (IQR).