Osseous changes in patients with medication-related osteonecrosis of the jaws
Abstract
Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive agents. The aim of this study was to investigate the osseous changes in patients with MRONJ.
Methods: Cone beam CT (CBCT) images of 25 patients with MRONJ and controls were retrospectively evaluated. Buccal, lingual, apical cortical bone thicknesses; buccal, lingual, apical intracortical and cancellous bone density; diameter of mental foramen and incisive canal, and width of mental foramen were measured.
Results: Buccal and apical cortical bone thicknesses were increased; however intracortical radiodensity values decreased in the Study Group when compared with the Control Group (p = 0.007, p = 0.001). Narrowing of incisive canal was observed in patients with MRONJ (p = 0.000).
Conclusions: Clinician should have awareness about narrowing of incisive canal, apical and buccal cortical bone thickening, decreasing in cancellous bone radiodensity, and the lingual cortex destruction in patients with MRONJ. hosphonates (Bps) are inorganic pyrophosphates
effective in inhibiting bone resorption and most widely
prescribed for the treatment of patients with osteoporosis, Paget’s Disease, hypercalcemia related to malignancy, multiple myeloma and symptomatic fibrous
dysplasia.1,2 Osteonecrosis of the jaw is a potentially
severe side effect of antiresorptive agents including
bisphosphonates with a mean incidence of 7% (0 to
27.5%) in patients treated intravenously.3
The American Association of Oral and Maxillofacial
Surgeons (AAOMS) has updated their definition in 2014
as medication-related osteonecrosis of the jaw (MRONJ)
to (1) current or previous treatment with antiresorptive
or antiangiogenic agents; (2) exposed bone or bone that
can be probed through an intraoral or extraoral fistula
in the maxillofacial region that has persisted for more
than 8 weeks and (3) no history of radiation therapy to
the jaws or obvious metastatic disease to the jaws.4
Accurate staging is essential to plan the correct treatment for
MRONJ patients. Staging of MRONJ is currently based
on the classification proposed by Ruggiero and colleagues5
and has been adopted by AAOMS6
(Table 1). Although
clinical examination is favoured for diagnosis of MRONJ
primarily, imaging is essential for determining the extent
of lesion, diagnosing early stages and excluding fractures.7
Conventional radiography and CT scans have been
widely used and may show osseous changes such as periosteal reaction, sclerotic lesions, lucency and sequester
formations; however, there is no golden standard.8,9 There are few reports for the quantitative evaluation10,11 of
osseous changes by using cone beam CT (CBCT) and no
distinct clinical-radiological systematization of MRONJ.
Diagnosis of MRONJ in CBCT is usually based on classical subjective image parameters. Therefore, the aim of
this study was to investigate the differences in radiological
variables between the patients with MRONJ and healthy
individuals in CBCT.