Radiographic predictors of bone exposure in patients with stage 0 medication-related osteonecrosis of the jaws

• Main Authors: Aghaloo, T.L (Author), Hadaya, D. (Author), Mallya, S.M (Author), Soundia, A. (Author), Tetradis, S. (Author)
• Format: Article
• Language: English
• Published: Mosby Inc. 2018
• Subjects: adult; Adult; aged; Aged; Aged, 80 and over; Bisphosphonate-Associated Osteonecrosis of the Jaw; cone beam computed tomography; Cone-Beam Computed Tomography; diagnostic imaging; disease exacerbation; Disease Progression; female; Female; human; Humans; jaw osteonecrosis; male; Male; medical photography; middle aged; Middle Aged; panoramic radiography; pathology; Photography, Dental; Radiography, Panoramic; Retrospective Studies; retrospective study; very elderly
• Online Access: View Fulltext in Publisher

 Objective.: The aim of this study was to explore the radiographic appearance of stage 0 medication-related osteonecrosis of the jaws (MRONJ) and examine 5 radiographic parameters (trabecular sclerosis, cortical erosion, periosteal reaction, sequestration, and crater-like defect) as predictors of progression to bone exposure. Study Design.: Twenty-three patients with a history of antiresorptive therapy, no bone exposure, and nonspecific signs and symptoms were included. Intraoral photographs, panoramic and cone beam computed tomography (CBCT) images at initial visit, and follow-up intraoral photographs were reviewed. Three patients had dental disease (DD), 10 patients with stage 0 MRONJ did not progress to bone exposure (NBE), and 10 patients progressed to bone exposure (BE). Radiographic parameters were scored as absent (0), localized (1), or extensive (2), and their sum formed the composite radiographic index (CRI). Results.: DD patients demonstrated minimal radiographic findings, and their CRI was significantly lower than that of NBE and BE patients. Additionally, BE patients demonstrated a higher radiographic index compared with NBE patients. Intriguingly, sequestration was observed in the initial CBCT of 9 (90%) of 10 BE patients, whereas 80% of NBE patients showed absence of sequestration at initial CBCT examination. Conclusions.: CBCT imaging can aid in the differentiation of stage 0 MRONJ from dental disease. Radiographic sequestration at initial presentation can serve as a predictor of future bone exposure in patients with stage 0 MRONJ. © 2018 Elsevier Inc.