1
|
Kajihara R, Kondo E, Fukuda H, Sakai H, Koike T, Kurita H. Precursor Radiographic Findings in Patients With Medication-Related Osteonecrosis of the Jaw. J Oral Maxillofac Surg 2024; 82:984-991. [PMID: 38750657 DOI: 10.1016/j.joms.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Oral surgical treatment, such as tooth extraction, has been identified as a risk factor for the onset of medication-related osteonecrosis of the jaw (MRONJ). However, MRONJ may already be latent, and its manifestation may be triggered by extraction. PURPOSE The purpose of this study was to examine the association between pre-extraction imaging and MRONJ. STUDY DESIGN, SETTING, SAMPLE We performed a multicenter case-control analysis of patients receiving antiresorptive agents (ARAs) who underwent extraction between 2012 and 2016. We enrolled patients who had undergone tooth extraction in the setting of ARA exposure. PREDICTOR VARIABLES The predictor variables comprised preoperative radiographic findings associated with MRONJ stage 0. These findings included alveolar bone loss, thickening or obscuring of the periodontal ligament, and osteosclerosis involving the alveolar bone. They were coded as present or absent before tooth extraction. MAIN OUTCOME VARIABLE The primary outcome variable was MRONJ status coded as present or absent. COVARIATES Sex, age, underlying diseases necessitating the administration of ARA, the type of ARA used, corticosteroid use, extraction region, and wound closure were analyzed. ANALYSES Mann-Whitney U test, χ2 test, Fisher's exact test for univariate analysis, and multiple logistic regression analysis were performed. P values < .05 were significant. RESULTS The subjects consisted of 26 patients and 110 controls (male: 8/36, female: 18/74). The mean ages of the MRONJ group and the control group were 77.0 ± 11.9 and 63.0 ± 15.8, respectively (P value = .001). The prevalence of osteosclerosis was significantly higher in the MRONJ group than in the control group (14/72, 53.9%/29.3%, P < .01). Multivariate analysis identified osteosclerosis (odds ratio: 8.4, 95% confidence interval: 2.133.9, P < .01) as a significant independent predictor associated with the development of MRONJ after extraction. CONCLUSION AND RELEVANCE These findings suggest that a precursor to MRONJ is highly likely to be present in patients with osteosclerosis at the time of extraction. The majority of patients who developed MRONJ after extraction had imaging findings that suggested infection in the surrounding alveolar bone.
Collapse
Affiliation(s)
- Ryo Kajihara
- Attending Staff, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan; Attending Staff, Department of Dentistry and Oral Surgery, Ina Central Hospital, Ina, Japan.
| | - Eiji Kondo
- Assistant Professor, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hironobu Fukuda
- Attending Staff, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hironori Sakai
- Assistant Professor, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeshi Koike
- Department Head, Department of Dentistry and Oral Surgery, Ina Central Hospital, Ina, Japan
| | - Hiroshi Kurita
- Professor, Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| |
Collapse
|
2
|
Shin JW, Kim JE, Huh KH, Yi WJ, Heo MS, Lee SS, Choi SC. Radiological manifestations and clinical findings of patients with oncologic and osteoporotic medication-related osteonecrosis of the jaw. Sci Rep 2024; 14:8744. [PMID: 38627515 PMCID: PMC11021436 DOI: 10.1038/s41598-024-59500-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) poses a challenging form of osteomyelitis in patients undergoing antiresorptive therapies in contrast to conventional osteomyelitis. This study aimed to compare the clinical and radiological features of MRONJ between patients receiving low-dose medications for osteoporosis and those receiving high-dose medications for oncologic purposes. The clinical, panoramic radiographic, and computed tomography data of 159 patients with MRONJ (osteoporotic group, n = 120; oncologic group, n = 39) who developed the condition after using antiresorptive medications for the management of osteoporosis or bone malignancy were analyzed. The osteoporotic group was older (75.8 vs. 60.4 years, p < 0.01) and had a longer duration of medication usage than the oncologic group (58.1 vs. 28.0 months, p < 0.01). Pus discharge and swelling were more common in the osteoporotic group (p < 0.05), whereas bone exposure was more frequent in the oncologic group (p < 0.01). The mandibular cortical index (MCI) in panoramic radiographs was higher in the osteoporotic group (p < 0.01). The mean sequestra size was larger in the oncologic group than in the osteoporotic group (15.3 vs. 10.6 mm, p < 0.05). The cured rate was significantly higher in the osteoporotic group (66.3% vs. 33.3%, p < 0.01). Oncologic MRONJ exhibited distinct clinical findings including rapid disease onset, fewer purulent signs, and lower cure rates than osteoporotic MRONJ. Radiological features such as sequestrum size on CT scan, and MCI values on panoramic radiographs, may aid in differentiating MRONJ in osteoporotic and oncologic patients.
Collapse
Affiliation(s)
- Jeong Won Shin
- Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea.
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| |
Collapse
|
3
|
Obermeier KT, Dewenter I, Malenova Y, Fliefel R, Kaeppler G, Otto S. Sclerotic bone: a sign of bone reaction in patients with medication related osteonecrosis of the jaw. Sci Rep 2024; 14:7914. [PMID: 38575664 PMCID: PMC10994931 DOI: 10.1038/s41598-024-57635-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction associated with antiresorptive drugs such as bisphosphonates and denosumab. When dealing with advanced and/or multiple MRONJ lesions undergoing surgical therapy, the extent of surgery is often a topic of discussion. The aim of this study was to identify the differences in bone density in and around the MRONJ lesion before and after surgical treatment to evaluate the needed surgical extend of the modelling osteotomy. In this retrospective study 26 patients with MRONJ lesions that were surgically treated in our department were observed. Length, width and bone density were measured in panoramic radiograph pre and postoperatively with the Imaging processing software Sidexis and ImageJ (Fiji). The necrotic area, the surrounding sclerotic area as well as the healthy contralateral side were observed. Measurements were performed by two independent observers. Pearson correlation was calculated to determine the interobserver variability. Bone density was significantly reduced in the necrotic bone area compared to the healthy unaffected contralateral reference side. The sclerotic bone area surrounding the necrosis showed increased bone density compared to the contralateral unaffected reference side. The density of the sclerotic bone area was increased in the previously affected MRONJ area in the postoperative panoramic radiograph. The pre and postoperative density showed no significant correlation to healing behaviour. The focus of the modelling osteotomy in surgical treatment of mature MRONJ lesions should be predominantly on the parts that appear necrotic and less dense in the panoramic radiograph as sclerotic areas might be an expression of bone reaction.
Collapse
Affiliation(s)
- Katharina Theresa Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University (LMU), Lindwurmstrasse 2a, 80337, Munich, Germany
| | - Ina Dewenter
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University (LMU), Lindwurmstrasse 2a, 80337, Munich, Germany.
| | - Yoana Malenova
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University (LMU), Lindwurmstrasse 2a, 80337, Munich, Germany
| | - Riham Fliefel
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University (LMU), Lindwurmstrasse 2a, 80337, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Ludwig-Maximilians-University (LMU), Fraunhoferstrasse 20, 82152, Planegg/Martinsried, Germany
- Department of Oral and Maxillofacial Surgery, Alexandria University, Alexandria, Egypt
| | - Gabriele Kaeppler
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University (LMU), Lindwurmstrasse 2a, 80337, Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilians-University (LMU), Lindwurmstrasse 2a, 80337, Munich, Germany
| |
Collapse
|
4
|
Muraoka H, Kaneda T, Kondo T, Otsuka K, Tokunaga S. Visualising cervical lymph nodes in jaw osteonecrosis using diffusion-weighted imaging. Oral Dis 2024. [PMID: 38515001 DOI: 10.1111/odi.14938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/06/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES This study aimed to apply diffusion-weighted imaging to the evaluation of cervical lymph nodes affected by medication-related osteonecrosis of the jaw (MRONJ). METHODS This retrospective study analysed the diffusion-weighted imaging data of 70 patients with or without MRONJ (Stages 0-3). The mean apparent diffusion coefficient (ADC) values of the submandibular (level IB) and superior internal jugular (level IIA) nodes in the control and MRONJ groups were calculated, and differences were analysed using the Mann-Whitney test. Moreover, receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of ADC values to predict lymph nodes that were affected by MRONJ. p < 0.05 was considered statistically significant. RESULTS The median [interquartile range] (×10-3 mm2/s) of level IB was 0.74 [0.7-0.81] and 0.93 [0.84-1.09] and that of level IIA was 0.79 [0.76-0.85] and 0.97 [0.84-1.06] in the control and MRONJ groups respectively. ROC analysis revealed that the ADC value had excellent ability to discriminate between the control and MRONJ groups. CONCLUSIONS The study findings indicate that diffusion-weighted imaging can contribute to differentiation of MRONJ from other cervical lymph node diseases and facilitate early detection of MRONJ.
Collapse
Affiliation(s)
- Hirotaka Muraoka
- Department of Radiology, Nihon University School of Dentistry at Matsudo 2-870-1 Sakaecho-Nishi, Matsudo, Japan
| | - Takashi Kaneda
- Department of Radiology, Nihon University School of Dentistry at Matsudo 2-870-1 Sakaecho-Nishi, Matsudo, Japan
| | - Takumi Kondo
- Department of Radiology, Nihon University School of Dentistry at Matsudo 2-870-1 Sakaecho-Nishi, Matsudo, Japan
| | - Kohei Otsuka
- Department of Radiology, Nihon University School of Dentistry at Matsudo 2-870-1 Sakaecho-Nishi, Matsudo, Japan
| | - Satoshi Tokunaga
- Department of Radiology, Nihon University School of Dentistry at Matsudo 2-870-1 Sakaecho-Nishi, Matsudo, Japan
| |
Collapse
|
5
|
Reinert CP, Pfannenberg C, Gückel B, Dittmann H, la Fougère C, Nikolaou K, Reinert S, Schönhof R, Hoefert S. Preoperative Assessment of Medication-Related Osteonecrosis of the Jaw Using [18F]fluoride Positron Emission Tomography (PET)/CT and [18F]fluorodeoxyglucose PET/MRI in Correlation with Histomorphometry and Micro-CT-A Prospective Comparative Study. Diagnostics (Basel) 2024; 14:428. [PMID: 38396467 PMCID: PMC10888075 DOI: 10.3390/diagnostics14040428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the imaging characteristics of medication-related osteonecrosis of the jaw (MRONJ) using [18F]fluoride positron emission tomography/computed tomography (PET/CT) and [18F]fluorodeoxyglucose (FDG) PET/magnetic resonance imaging (MRI) for preoperative assessment and to correlate them with microarchitectural and histomorphometric data with respect to clinical findings. METHODS Twelve patients (five female; mean age 75 ± 7.6 yr) with symptomatic MRONJ underwent both scans on the same day, and imaging findings were used to plan surgical interventions for seven patients. Bone tracer uptake was classified as high, medium, or low, and surgical samples were evaluated using Micro-CT and histomorphometric analysis. RESULTS CT showed medullary sclerosis in all patients, and MRI revealed gadolinium enhancement in four patients. PET imaging revealed remarkably elevated [18F]fluoride uptake and moderately increased [18F]FDG uptake in MRONJ compared to healthy jawbones, with both differences being statistically significant. [18F]fluoride uptake was associated with necrosis, bacteria, and inflammatory tissue. Micro-CT data did not show significant differences, but histomorphometric analysis revealed higher osteocyte and lacunae densities in the high [18F]fluoride uptake group, and more necrotic bone in the medium [18F]fluoride uptake group. Bacteria were observed in all areas. CONCLUSIONS In summary, [18F]fluoride PET accurately identified MRONJ extent, revealing functional changes in jawbone remodeling not visible on CT. [18F]FDG PET showed differences in bone and soft tissue, though less pronounced. This method aids in evaluating disease activity and guiding treatment planning, requiring further research for optimal surgical approaches based on tracer uptake.
Collapse
Affiliation(s)
- Christian Philipp Reinert
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, 72076 Tübingen, Germany; (C.P.); (B.G.); (K.N.)
| | - Christina Pfannenberg
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, 72076 Tübingen, Germany; (C.P.); (B.G.); (K.N.)
| | - Brigitte Gückel
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, 72076 Tübingen, Germany; (C.P.); (B.G.); (K.N.)
| | - Helmut Dittmann
- Department of Radiology, Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tübingen, 72076 Tübingen, Germany; (H.D.); (C.l.F.)
| | - Christian la Fougère
- Department of Radiology, Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tübingen, 72076 Tübingen, Germany; (H.D.); (C.l.F.)
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor, Therapies”, University of Tübingen, 72076 Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, 72076 Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University Hospital Tübingen, 72076 Tübingen, Germany; (C.P.); (B.G.); (K.N.)
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor, Therapies”, University of Tübingen, 72076 Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, 72076 Tübingen, Germany
| | - Siegmar Reinert
- Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, 72076 Tübingen, Germany; (S.R.); (R.S.); (S.H.)
| | - Rouven Schönhof
- Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, 72076 Tübingen, Germany; (S.R.); (R.S.); (S.H.)
| | - Sebastian Hoefert
- Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, 72076 Tübingen, Germany; (S.R.); (R.S.); (S.H.)
| |
Collapse
|
6
|
Coropciuc R, Moreno-Rabié C, De Vos W, Van de Casteele E, Marks L, Lenaerts V, Coppejans E, Lenssen O, Coopman R, Walschap J, Nadjmi N, Jacobs R, Politis C, Van den Wyngaert T. Navigating the complexities and controversies of medication-related osteonecrosis of the jaw (MRONJ): a critical update and consensus statement. Acta Chir Belg 2024; 124:1-11. [PMID: 38059301 DOI: 10.1080/00015458.2023.2291295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES To provide a critical update identifying the knowledge gaps and controversies in medication-related osteonecrosis of the jaw (MRONJ) within the Belgian healthcare context and outline opportunities for improvement and research in these areas. METHODS A literature review was performed to identify guidelines from international clinical societies in oncology or oral and maxillofacial surgery on diagnosing, preventing, and treating MRONJ. The recommendations were critically assessed in light of recent developments in the field and confronted with the clinical experience of experts. RESULTS Despite progress in the diagnostic criteria of MRONJ, the continued need for an 8-week timeout period should be reconsidered. Furthermore, 3D imaging techniques should be introduced to improve diagnosis and staging. The staging system remains ambiguous regarding Stage 0 MRONJ, and ongoing confusion exists regarding the term non-exposed MRONJ. The prevention of MRONJ should be tailored, considering the individual patient's risk of MRONJ, frailty, and life expectancy. More research seems needed into the efficacy and safety of drug holidays, considering the risks of rebound remodeling on fractures. With renewed interest in surgical and adjunct management techniques, adequately designed clinical studies are needed to help translate trial outcomes into universally applicable treatment guidelines taking into account individual patient characteristics. CONCLUSIONS Important knowledge gaps remain and hamper the development of clinical guidelines. Several controversies were identified where consensus is lacking, and further harmonization between stakeholders is necessary. Finally, the need for randomized controlled comparative clinical trials in MRONJ resonates harder than ever to identify the best treatment for individual patients.
Collapse
Affiliation(s)
- Ruxandra Coropciuc
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Catalina Moreno-Rabié
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Wouter De Vos
- Department of Oral and Maxillofacial Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Elke Van de Casteele
- Department of Oral and Maxillofacial Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc Marks
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Special Care Dentistry, Antwerp University Hospital, Antwerp, Belgium
| | - Vincent Lenaerts
- Department of Oral and Maxillofacial Surgery, VITAZ, Sint-Niklaas, Belgium
| | - Evy Coppejans
- Department of Oral and Maxillofacial Surgery, VITAZ, Sint-Niklaas, Belgium
| | - Olivier Lenssen
- Department of Oral and Maxillofacial Surgery, ZNA Middelheim, Antwerpen, Belgium
| | - Renaat Coopman
- Department of Oral and Maxillofacial and Plastic Surgery, University Hospital of Ghent, Ghent, Belgium
| | | | - Nasser Nadjmi
- Department of Oral and Maxillofacial Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Reinhilde Jacobs
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, OMFS-IMPATH Research Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tim Van den Wyngaert
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
| |
Collapse
|
7
|
Ramanauskaite A, Mangold K, Padhye N, Obreja K, Borschert F, Dahmer I, Schwarz F. Influence of antiresorptive/antiangiogenic therapy on changes in periodontal and oral tissue structures: a histomorphometrical analysis in rats. Clin Oral Investig 2023; 27:7695-7704. [PMID: 37910240 PMCID: PMC10713659 DOI: 10.1007/s00784-023-05359-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the influence of various antiresorptive and antiangiogenic medications on morphological changes in periodontal and oral tissue structures. MATERIALS AND METHODS Fifty-five Wistar rats randomly received dual application (i.e., at baseline and after 12-weeks) one of the following medications: (1) amino-bisphosphonate [zoledronate (Zo)], (2) RANKL inhibitor [denosumab (De)], (3) antiangiogenic [bevacizumab (Be)], (4) Zo + Be, (5) De + Be or (6) no medication [Control (Co)]. Periodontal and oral tissue biopsies were obtained at 17 (n = 21 animals, Phase 1, (De = 3, De + Be = 3, Zo = 5, Be = 3, Zo + Be = 2, Co = 5) and 29 (n = 34 animals, (De = 8, De + Be = 6, Zo = 2, Be = 7, Zo + Be = 4, Co = 7, Phase 2) weeks after the second drug application. The following outcomes were histomorphometrically assessed: periodontal space width in the coronal (PLS-C, mm) and apical sections (PLS- A), number of empty alveolar bone lacunae in the coronal, apical sections and at the apex at respective tooth sites (EL - C, EL- A, EL- Ap), mucosal thickness at edentulous alveolar ridge areas (MT, mm), and, when present, associated areas of inflammatory cell infiltrates (ICI, mm2). RESULTS Comparable mean PLS-C, PLS-A, ET-A, ET-C, ET-Ap, and MT values were observed in all experimental groups after Phases 1 and 2. The presence of ICI was identified in 3 animals in the Co group (Phase 1: 1, Phase 2: 2), and 17 animals in the test groups (Phase 1: 4; Phase 2: 14). The estimated ICI surface area was significantly higher in the Zo + Be group, followed by the Zo and Be groups compared to that measured in the Co group. The time (i.e., Phases 1 and 2) was not found to be a predictor for the extent of the ICI area. In all groups, the EL-C, EL-A, and EL-Ap values were significantly higher after Phase 2 compared to those assessed after Phase 1. The MT values were significantly reduced in all groups after Phase 2 compared to those measured after Phase 1. CONCLUSIONS The present evaluation was not able to find any morphological effects of different antiresorptive and antiangiogenic medications on periodontal and oral tissue structures. The presence of inflammatory cell infiltrates was more frequently observed in the animals administered with antiresorptive and antiangiogenic medications as well as combinations thereof. CLINICAL RELEVANCE Administration of antiresorptive and antiangiogenic medications may be capable of inducing inflammatory reactions in periodontal tissues.
Collapse
Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Theodor-Stern-Kai 7; Building 29, 60596, Frankfurt am Main, Germany
| | - Katharina Mangold
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Theodor-Stern-Kai 7; Building 29, 60596, Frankfurt am Main, Germany
| | - Ninad Padhye
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Theodor-Stern-Kai 7; Building 29, 60596, Frankfurt am Main, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Theodor-Stern-Kai 7; Building 29, 60596, Frankfurt am Main, Germany
| | - Fanya Borschert
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Theodor-Stern-Kai 7; Building 29, 60596, Frankfurt am Main, Germany
| | - Iulia Dahmer
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Theodor-Stern-Kai 7; Building 29, 60596, Frankfurt am Main, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Theodor-Stern-Kai 7; Building 29, 60596, Frankfurt am Main, Germany.
| |
Collapse
|
8
|
Diagnosis and Management of Pathological Conditions. J Oral Maxillofac Surg 2023; 81:E221-E262. [PMID: 37833025 DOI: 10.1016/j.joms.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
|
9
|
Evaluation of Medication-Related Osteonecrosis of the Jaw (MRONJ) in Terms of Staging and Treatment Strategies by Dental Students at Different Educational Levels. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020252. [PMID: 36837455 PMCID: PMC9962432 DOI: 10.3390/medicina59020252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/15/2023] [Accepted: 01/23/2023] [Indexed: 02/03/2023]
Abstract
Background: The role of medication-related osteonecrosis of the jaw (MRONJ) as a dento-maxillo-facial pathology is becoming increasingly important due to its growing prevalence. The success of preventive and therapeutic measures relies mainly on the dentist's ability to correctly diagnose the disease. Methods: The aim of this study was to evaluate the skills of dental students of different educational levels in choosing the correct stage, diagnostics, and treatment option for MRONJ based on clinical and radiographic imaging (panoramic radiograph, CBCT). The study was designed as a cross-sectional cohort study. Twenty dental students were asked to complete a questionnaire in their third and fifth year of studies in which they had to correctly stage the disease, choose the radiological diagnostics and recommend the treatment. The control group contained experienced oral and maxillofacial surgeons. Results: With an overall performance of 59% (third year: 145.2/248 points; fifth year: 145.3/248 points), no statistically significant difference between the educational levels could be observed. The classification based on CBCT imaging was significantly more often correct compared to panoramic radiographs (p < 0.001). Conclusions: This study highlights students' lack of knowledge in staging, diagnostics, and treatment of MRONJ, even though the CBCT positively affected decision-making. No significant increase in knowledge could be confirmed through clinical education. This study highlights the need for students to catch up on MRONJ diagnostics and treatment planning. Further expansion of teaching in this disease's context and X-ray diagnostics is needed.
Collapse
|
10
|
Baseri Saadi S, Moreno-Rabié C, van den Wyngaert T, Jacobs R. Convolutional neural network for automated classification of osteonecrosis and related mandibular trabecular patterns. Bone Rep 2022; 17:101632. [DOI: 10.1016/j.bonr.2022.101632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
|
11
|
The effect of zoledronic acid and denosumab on the mandible and other bones: a 18F-NaF-PET study. Oral Radiol 2022; 38:594-600. [PMID: 35142984 DOI: 10.1007/s11282-022-00594-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The primary purpose of this study was to determine whether both zoledronic acid (ZA) and denosumab (Dmab) equally suppress bone remodeling of the normal mandible, and the secondary purpose was to determine the influence of ZA and Dmab on other normal bones. METHODS 18F-sodium fluoride-positron-emission-tomography (18F-NaF-PET) was used to perform quantitative analysis of the bone metabolism in various parts. The end points of the study were the mean standardized uptake value (SUV) of each member of the ZA group (n = 9), the Dmab group (n = 16), and the Control group (n = 23). RESULTS The SUV at the thoracic vertebrae in the ZA group were significantly lower than those of the Dmab and Control group (p < 0.05) In addition, the mean SUVs of the cervical vertebrae in the ZA group were significantly lower than those in the Control group (p < 0.05). There was no significant difference among ZA, Dmab and Control group in the other sites. There was no significant difference between the Dmab and Control groups at all sites. CONCLUSIONS The remodeling of mandible was not suppressed due to the treatment with anti-resorptive agents. Differences in the mechanisms of action between the BP and Dmab caused the specificity of the effect on the metabolism of normal bone.
Collapse
|
12
|
Radiographic predictors for MRONJ in oncologic patients undergoing tooth extraction. Sci Rep 2022; 12:11280. [PMID: 35789184 PMCID: PMC9252989 DOI: 10.1038/s41598-022-15254-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/21/2022] [Indexed: 11/09/2022] Open
Abstract
Tooth extraction is a risk factor for the development of osteonecrosis of the jaw following treatment with antiresorptive drugs (ARDs), but not all extraction sites develop this pathology. Therefore, we aimed to identify local radiographic predictors of Medication-Related Osteonecrosis of the Jaw (MRONJ) in panoramic images of oncologic patients undergoing tooth extraction. Based on a retrospective longitudinal cohort study design, patients were included if undergoing one or more tooth extraction, with at least one administration of ARDs, and presence of pre- and post-operative panoramic radiographs. After data collection, blinded and independent observations were performed. Eleven distinct imaging-related parameters were assessed preoperatively and five postoperatively, at each extraction site. A case-control and subgroup analysis assessing MRONJ development was performed. Significance level is set to 0.05 (5%). A total of 77 oncologic patients were selected, undergoing 218 tooth extractions, from which 63 teeth (29%) in 39 patients (51%) developed MRONJ. Results showed that patients developed significantly more MRONJ with longer ARD treatment (p = 0.057), teeth with absent and incomplete endodontic fillings with caries, widened periodontal ligament space and/or periapical lesions (p = 0.005), and sclerotic and heterogenous bone patterns (p = 0.005). In conclusion, tooth extraction sites presenting with infections and bone sclerosis are at higher risk to develop MRONJ.
Collapse
|
13
|
He P, Francois K, Missaghian N, Le AD, Flynn TR, Shanti RM. Are Bacteria Just Bystanders in the Pathogenesis of Inflammatory Jaw Conditions? J Oral Maxillofac Surg 2022; 80:1094-1102. [DOI: 10.1016/j.joms.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
|
14
|
YURTAL Z, SERİNDERE G, AKTUNA BELGİN C, TAKCI L. Investigation of the Effect of Linoleic Acid on Vascularization in Experimentally Induce Zoledronic Acid-Related Osteonecrosis in Rats. MEHMET AKIF ERSOY ÜNIVERSITESI VETERINER FAKÜLTESI DERGISI 2021. [DOI: 10.24880/maeuvfd.970180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
15
|
Effects of Soft Tissue Closure on Medication-Related Osteonecrosis of the Jaw in a Rabbit Model with Tooth Extraction: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4166770. [PMID: 34957304 PMCID: PMC8694973 DOI: 10.1155/2021/4166770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022]
Abstract
Objectives The study investigated the effect of soft tissue closure after tooth extraction on the prevention of medication-related osteonecrosis of the jaw in a rabbit model. Materials and Methods Twenty female New Zealand white rabbits were randomly assigned into the experimental group administrated with zoledronic acid (ZA) and control groups treated with saline. Bilateral lower premolar extraction was performed 4 weeks after ZA/saline administration. Immediately after extraction, the wound on the right mandible was closed by suture while the other side was left open. Animals were sacrificed 4 weeks and 8 weeks after tooth extraction. Fluorochrome labeling solutions were injected subcutaneously to evaluate the bone growth rates. The mandibles were harvested and subjected for microcomputed tomography, confocal microscope, and histomorphological examinations. Results All extraction sites healed well without any signs of infection. Trabecular thickness (Tb.Th) was significantly higher in the ZA-treated group than in the control group at both week 4 and week 8, while no significant difference was detected in the rest of the assessed parameters. The bone growth rate in mandibles showed gradual reduction in the ZA-treated group. Histological analysis showed that at week 8, the animals in the ZA-treated group had significantly higher incidence of osteonecrosis than that in the control group, while no significance was revealed between the sutured and nonsutured side. Conclusions ZA treatment significantly reduces bone growth rates but does not reveal a significant effect on bone mineral density and bone microarchitecture. Soft tissue closure of the extraction socket does not reduce the incidence of ONJ in the ZA-treated rabbit model.
Collapse
|
16
|
The value of diffusion-weighted imaging in the diagnosis of medication-related osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:339-345. [PMID: 34092542 DOI: 10.1016/j.oooo.2021.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/12/2021] [Accepted: 04/17/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to assess apparent diffusion coefficient (ADC) values associated with medication-related osteonecrosis of the jaws (MRONJ) at each stage of the disease compared to controls. STUDY DESIGN The magnetic resonance imaging data of 38 patients in the 4 stages of MRONJ and 10 controls were analyzed. Mean ADC values of bone marrow in the controls and patients in each stage of MRONJ were calculated. The significance of differences was analyzed by using the Kruskal-Wallis test and post-hoc Mann-Whitney tests with Bonferroni adjustment. A receiver operating characteristic (ROC) curve was plotted to distinguish controls from MRONJ stage 0. P < .05 was considered statistically significant. RESULTS The mean ADC values of controls and stages 0 to 3 were significantly different, with the lowest value in the controls (P < .001). ROC analysis revealed a cutoff ADC value of 1.06 × 10-3 mm2/s to distinguish between the control group and MRONJ stage 0 patients, producing values of sensitivity, specificity, accuracy, and area under the ROC curve ranging from 0.89 to 0.94. CONCLUSIONS The ADC values of bone marrow affected by MRONJ are significantly different among controls and stages 0 to 3. ADC values may be useful for distinguishing normal from MRONJ stage 0.
Collapse
|
17
|
Zhou YQ, Son GH, Shi YQ, Yu YJ, Li MY, Zhang Q, Zou DH, Zhang ZY, Yang C, Wang SY. Quantitative Segmentation Analysis of the Radiological Changes by Using ITK-SNAP: Risk Assessment of the Severity and Recurrence of Medication-related Osteonecrosis of the Jaw. Int J Med Sci 2021; 18:2209-2216. [PMID: 33859529 PMCID: PMC8040413 DOI: 10.7150/ijms.56408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/03/2021] [Indexed: 11/05/2022] Open
Abstract
Background and purpose: Medication-related osteonecrosis of the jaw (MRONJ) severely impairs patients' quality of life and is remarkably refractory to treatment. There are lots of studies about identification of the radiographic features of MRONJ, yet reports about quantitative radiographic analysis for the risk assessment of the severity and recurrence of MRONJ are rarely heard. The aim of this study was to investigate the volumes of osteolytic lesions and radiodensity values of osteosclerotic lesions in MRONJ patients by using ITK-SNAP for severity prediction and prognosis evaluation. Materials and methods: Of 78 MRONJ patients (78 lesions) involved in this retrospective study, 53 were presented as osteolytic lesions and 25 were presented as osteosclerotic changes alone. Comprehensive CBCT images, demographics and clinical data of patients were investigated. The volumetric analysis and radiodensity measurement were performed by ITK-SNAP. SPSS 25.0 were used for statistical analysis. Results: The osteolytic lesion volumes in MRONJ patients receiving intravenous bisphosphonates (P=0.004) and patients without osteoporosis (P=0.027) were significantly large. No significant correlation between the volumes and bisphosphonates duration was found (P=0.094). The radiodensity values of osteosclerotic lesions was significantly correlated with bisphosphonates duration (P=0.040). The surrounding area of post-surgical lesions in MRONJ patients with recurrence showed significantly great radiodensity values (P=0.025). No significant correlation between the radiodensity values and the transformation from osteosclerotic lesions to osteolytic lesions was observed (P=0.507). Conclusion: MRONJ patients receiving intravenous bisphosphonates develop into large volumes of osteolytic lesions more easily. Long-term bisphosphonates duration is possibly related with higher bone density of osteosclerotic lesions, while higher density is not associated with the transformation from osteosclerotic lesions to osteolytic lesions. A rise of bone mineral density nearby post-surgical lesions is probably a predictor for MRONJ recurrence.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Zhi-yuan Zhang
- Shanghai Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine (200011); National Clinical Research Center of Oral Disease; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Department of Oral Surgery
| | - Chi Yang
- Shanghai Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine (200011); National Clinical Research Center of Oral Disease; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Department of Oral Surgery
| | - Shao-yi Wang
- Shanghai Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine (200011); National Clinical Research Center of Oral Disease; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Department of Oral Surgery
| |
Collapse
|
18
|
Kün-Darbois JD, Fauvel F. Medication-related osteonecrosis and osteoradionecrosis of the jaws: Update and current management. Morphologie 2020; 105:170-187. [PMID: 33281055 DOI: 10.1016/j.morpho.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 12/19/2022]
Abstract
Medication related osteonecrosis of the jaws (MRONJ) and osteoradionecrosis of the jaws (ORNJ) are two different diseases of quite similar appearance. MRONJ is mainly due to antiresorptive or antiangiogenic drug therapy and ORNJ to radiotherapy. The present work aimed at presenting and comparing the current knowledge on MRONJ and ORNJ. They both present as an exposure of necrotic bone and differ in some clinical or radiological characteristics, clinical course and mostly in treatment. They share similar risk factors. A tooth extraction is more frequently found as a triggering factor in MRONJ. The frequency of a maxillary localisation seems higher for MRONJ. On computed tomographic images, a periosteal reaction seems characteristic of MRONJ. More frequent pathological fractures seem to occur in ORNJ. It is mandatory, for ORNJ diagnosis, to exclude a residual or recurrent tumour using histological examination. Both MRONJ and ORNJ are challenging to treat and cannot be managed similarly. For both, it would still be worth to optimise awareness within the medical community, patients' oral hygiene and dental cares to improve their prevention and make their incidences decrease. Conservative therapy is more frequently achieved for MRONJ than ORNJ and surgical resection is more often performed for ORNJ. For both diseases, the last treatment possible in refractory cases is a surgical extensive resection with free flap reconstruction. A MRONJ classification is widely used today, whereas no consensus exists to date for ORNJ classification. We propose a classification that could play this role.
Collapse
Affiliation(s)
- J-D Kün-Darbois
- Department of oral and maxillofacial surgery, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex, France; Groupe études remodelage osseux et bioMatériaux, GEROM, SFR 4208, UNIV Angers, IRIS-IBS institut de biologie en Santé, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex, France.
| | - F Fauvel
- Department of oral and maxillofacial surgery, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Department of oral and maxillofacial surgery, CH de Saint-Nazaire, 11, boulevard Georges-Charpak, 44606 Saint-Nazaire cedex, France
| |
Collapse
|
19
|
Differences between bisphosphonate-related and denosumab-related osteonecrosis of the jaws: a systematic review. Support Care Cancer 2020; 29:2811-2820. [PMID: 33140246 DOI: 10.1007/s00520-020-05855-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/23/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Bisphosphonates and denosumab are both antiresorptive medications, each with their own mechanism of action; yet both may result in the same adverse effect: medication-related osteonecrosis of the jaw (ONJ). The present systematic review aims to answer the following question: "Are bisphosphonate-related ONJ and denosumab-related ONJ any different, regarding clinical and imaging aspects?" METHODS This review followed the Joanna Briggs Review's Manual, and the searches were performed on PubMed, Cochrane, Scopus, Web of Science, and Lilacs databases and on the grey literature (ProQuest, Open Grey, and Google Scholar). RESULTS The searches resulted in 7535 articles that were critically assessed. Based on the selection criteria, seven studies were included in the review: five cross-sectional studies and two randomized clinical trials. A total of 7755 patients composed the final population. An increase in bone sequestra, cortical bone lysis, and bone density was observed in bisphosphonate-related ONJ, while larger bone sequestra, more frequent periosteal reactions, and mandibular canal enhancement were noted in denosumab-related ONJ. CONCLUSION This systematic review demonstrated that the imaging characteristics of bisphosphonate-related and denosumab-related ONJ are not similar. Although clinically similar conditions, they were found to be radiographically distinct. More studies are necessary to further elucidate these differences.
Collapse
|
20
|
He L, Sun X, Liu Z, Qiu Y, Niu Y. Pathogenesis and multidisciplinary management of medication-related osteonecrosis of the jaw. Int J Oral Sci 2020; 12:30. [PMID: 33087699 PMCID: PMC7578793 DOI: 10.1038/s41368-020-00093-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect of bone-modifying agents and inhibits angiogenesis agents. Although the pathogenesis of MRONJ is not entirely clear, multiple factors may be involved in specific microenvironments. The TGF-β1 signalling pathway may have a key role in the development of MRONJ. According to the clinical stage, multiple variables should be considered when selecting the most appropriate treatment. Therefore, the prevention and management of treatment of MRONJ should be conducted in patient-centred multidisciplinary team collaborative networks with oncologists, dentists and dental specialists. This would comprise a closed responsibility treatment loop with all benefits directed to the patient. Thus, in the present review, we aimed to summarise the pathogenesis, risk factors, imaging features, clinical staging, therapeutic methods, prevention and treatment strategies associated with MRONJ, which may provide a reference that can inform preventive strategies and improve the quality of life for patients in the future.
Collapse
Affiliation(s)
- Lina He
- The First Affiliated Hospital of Harbin Medical University, Harbin, China.,School of Stomatology, Harbin Medical University, Harbin, China
| | - Xiangyu Sun
- The First Affiliated Hospital of Harbin Medical University, Harbin, China.,School of Stomatology, Harbin Medical University, Harbin, China
| | - Zhijie Liu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China.,School of Stomatology, Harbin Medical University, Harbin, China
| | - Yanfen Qiu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China.,School of Stomatology, Harbin Medical University, Harbin, China
| | - Yumei Niu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China. .,School of Stomatology, Harbin Medical University, Harbin, China.
| |
Collapse
|
21
|
Fractal dimension in CBCT images as predictor for MRONJ: a retrospective cohort study. Clin Oral Investig 2020; 25:2113-2118. [PMID: 32827078 PMCID: PMC7966145 DOI: 10.1007/s00784-020-03523-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Abstract
Objective To estimate boxcounting fractal dimension in a standardized approach in CBCT images of the mandible and maxilla in a group of patients with MRONJ in comparison to a healthy control group. Material and methods From our records, a study group consisting of 80 maxillary and mandibular CBCTs in 77 cases of patients having MRONJ was collected. The control group consisted of 84 mandibular and maxillary CBCTs in a total of 78 patients. Using the boxcounting method, fractal dimension (FD) was estimated in a standardized fashion either cranially to the apex of the canine (maxilla) or beneath the tooth apices of the lower molars in the bone area above the mandibular canal (mandible). Intra-observer reproducibility of the FD-measurements was assessed by 6 repeated measurements in 10 individuals. FD values were correlated to age and sex of the individuals as well as to region of interest (ROI) sizes. Results FD in the study group (1.684 ± 0.051) was roughly 3.5 % lower than in the control group (1.745 ± 0.026, p < 0.0001). Sex and age had a significant (p < 0.001) influence on FD values in the study group, yet not in the control group. FD values increased with age (study group, spearman-rho: 0.2895, p < 0.05) and also ROI size (both groups, p < 0.0001). Reproducibility was good (intra-class correlation coefficient (ICC): 0.87). Conclusions Fractal dimension as assessed by boxcounting seems to be a good descriptor for MRONJ in jaw bones. Influence of age and sex on the outcome values needs to be further investigated in future studies. Clinical relevance CBCTs could be assessed with respect to FD to obtain an overview of the disease status of MRONJ patients.
Collapse
|
22
|
Gaêta-Araujo H, Vanderhaeghen O, Vasconcelos KDF, Coucke W, Coropciuc R, Politis C, Jacobs R. Osteomyelitis, osteoradionecrosis, or medication-related osteonecrosis of the jaws? Can CBCT enhance radiographic diagnosis? Oral Dis 2020; 27:312-319. [PMID: 32623770 DOI: 10.1111/odi.13534] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/25/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To attempt defining differential radiographic diagnostic characteristics for osteonecrotic lesions using 2D as opposed to 3D images. MATERIALS AND METHODS This was a cross-sectional study. Subjects presenting mandibular osteonecrotic lesions (osteomyelitis, osteoradionecrosis, and medication-related osteonecrosis of the jaws) were selected and compared to a group of age- and gender-matched controls, all having both cone-beam computed tomographic images (CBCT) and panoramic radiographs (PANO). Both imaging modalities (predictor variables) were evaluated by two radiologists that scored lesion presence, eight additional radiological features, and a composite severity index (outcome variables). For each pathologic condition, characteristic features were assessed in PANO and CBCT by the Wilcoxon signed-rank test. Regression tree analysis revealed the predictive value of PANO and CBCT (α = 5%). RESULTS Overall, the predictive value of PANO reached 74%, while for CBCT it became 90%. Regarding the composite severity index, CBCT enabled to detect more subtle lesions. Also, CBCT imaging allowed showing more distinct radiographic diagnostic features as compared to PANO imaging, more specifically when distinguishing osteomyelitis from both other lesions. CONCLUSIONS Cone-beam computed tomography enabled showing more differences in radiological features between distinct osteonecrosis disease entities. CBCT imaging might be a better contributor for the detection of early lesions and to monitor further pathological developments in the mandible.
Collapse
Affiliation(s)
- Hugo Gaêta-Araujo
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Olivier Vanderhaeghen
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Karla de Faria Vasconcelos
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Wim Coucke
- Scientific Institute of Public Health Section Quality of Medical Laboratories, Brussels, Belgium
| | - Ruxandra Coropciuc
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
23
|
Moreno-Rabié C, Gaêta-Araujo H, Oliveira-Santos C, Politis C, Jacobs R. Early imaging signs of the use of antiresorptive medication and MRONJ: a systematic review. Clin Oral Investig 2020; 24:2973-2989. [PMID: 32627123 DOI: 10.1007/s00784-020-03423-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/18/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The main aim is to identify, by means of different imaging modalities, the early bone changes in patients "at risk" and in stage 0 MRONJ. MATERIALS AND METHODS A search of the literature was performed on PubMed, Embase, Web of Science, and Cochrane Library databases, until June 9, 2020. No language or year restrictions were applied. Screening of the articles, data collection, and qualitative analysis was done. The Newcastle-Ottawa Scale (NOS) was used for observational studies, and the Systematic Review Centre for Laboratory Animal Experimentation's (SYRCLE) risk of bias tool for the animal studies. RESULTS A total of 1188 articles were found, from which 47 were considered eligible, whereas 42 were suitable for the qualitative analysis. They correspond to 39 human studies and 8 animal studies. Radiographic findings such as bone sclerosis, osteolytic areas, thickening of lamina dura, persisting alveolar socket, periapical radiolucency, thicker mandibular cortex, widening of the periodontal ligament space, periodontal bone loss, and enhancement of the mandibular canal were identified as early bone changes due to antiresorptive therapy. All those findings were also reported later in Stage 0 patients. CONCLUSION The main limitations of these results are the lack of prospective data and comparisons groups; therefore, careful interpretation should be made. It is a fact that radiographic findings are present in antiresorptive-treated patients, but the precise timepoint of occurrence, their relation to the posology, and potential risk to develop MRONJ are not clear. CLINICAL RELEVANCE The importance of a baseline radiographic diagnosis for antiresorptive-treated patients.
Collapse
Affiliation(s)
- Catalina Moreno-Rabié
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Hugo Gaêta-Araujo
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - Christiano Oliveira-Santos
- Department of Stomatology, Public Oral Health, Forensic Dentistry, Division of Oral Radiology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
24
|
Ogura I, Sasaki Y, Sue M, Oda T, Kameta A, Hayama K. Tc-99m hydroxymethylene diphosphonate SPECT/CT for the evaluation of osteonecrosis of the jaw: preliminary study on diagnostic ability of maximum standardised uptake value. Clin Radiol 2020; 75:46-50. [DOI: 10.1016/j.crad.2019.05.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 05/24/2019] [Indexed: 12/13/2022]
|
25
|
Ogura I, Kobayashi E, Nakahara K, Haga-Tsujimura M, Igarashi K, Katsumata A. Computer programme to assess mandibular cortex morphology in cases of medication-related osteonecrosis of the jaw with osteoporosis or bone metastases. Imaging Sci Dent 2019; 49:281-286. [PMID: 31915613 PMCID: PMC6941839 DOI: 10.5624/isd.2019.49.4.281] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/25/2019] [Accepted: 08/11/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the morphology of the mandibular cortex in cases of medication-related osteonecrosis of the jaw (MRONJ) in patients with osteoporosis or bone metastases using a computer programme. Materials and Methods Fifty-four patients with MRONJ (35 with osteoporosis and 19 with bone metastases) were examined using panoramic radiography. The morphology of the mandibular cortex was evaluated using a computer programme that scanned the mandibular inferior cortex and automatically assessed the mandibular cortical index (MCI) according to the thickness and roughness of the mandibular cortex, as follows: normal (class 1), mildly to moderately eroded (class 2), or severely eroded (class 3). The MCI classifications of MRONJ patients with osteoporosis or bone metastases were evaluated with the Pearson chi-square test. In these analyses, a 5% significance level was used. Results The MCI of MRONJ patients with osteoporosis (class 1: 6, class 2: 15, class 3: 14) tended to be higher than that of patients with bone metastases (class 1: 14, class 2: 5, class 3: 0) (P=0.000). Conclusion The use of a computer programme to assess mandibular cortex morphology may be an effective technique for the objective and quantitative evaluation of the MCI in MRONJ patients with osteoporosis or bone metastases.
Collapse
Affiliation(s)
- Ichiro Ogura
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
| | - Eizaburo Kobayashi
- Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
| | - Ken Nakahara
- Advanced Research Center, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
| | - Maiko Haga-Tsujimura
- Department of Histology, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
| | - Kensuke Igarashi
- Department of Life Science Dentistry, The Nippon Dental University, Niigata, Japan
| | - Akitoshi Katsumata
- Department of Oral Radiology, Asahi University School of Dentistry, Mizuho, Japan
| |
Collapse
|
26
|
Baba A, Ojiri H, Goto TK, Ikeda K, Yamauchi H, Ogino N, Mogami T. Symposium: Imaging modalities for drug-related osteonecrosis of the jaw (4), CT and MR imaging findings of antiresorptive agent-related osteonecrosis of the jaws/medication-related osteonecrosis of the jaw (secondary publication). JAPANESE DENTAL SCIENCE REVIEW 2019; 55:58-64. [PMID: 30815046 PMCID: PMC6378898 DOI: 10.1016/j.jdsr.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/25/2018] [Accepted: 11/28/2018] [Indexed: 11/21/2022] Open
Abstract
Generally, CT and MR images of antiresorptive agent-related osteonecrosis of the jaw (ARONJ)/medication-related osteonecrosis of the jaw (MRONJ) show nonspecific findings as seen in active osteomyelitis.However, there are some characteristics as follows; unilateral maxillary sinusitis adjacent to ipsilateral maxillary ARONJ/MRONJ, DRONJ presenting larger sequestrum and periosteal reaction more frequently than BRONJ, BRONJ resulting from intravenous administration of the drug presenting larger and more frequent buccolingual cortical bone perforations than BRONJ from oral administration, and better diagnostic accuracy of extent of perilesional soft tissue inflammation on MR imaging than CT. The CT and MR imaging features of ARONJ/MRONJ are summarized in this report.
Collapse
Affiliation(s)
- Akira Baba
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tazuko K. Goto
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College, Tokyo, Japan
| | - Koshi Ikeda
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hideomi Yamauchi
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuhiro Ogino
- Department of Radiology, Jikei University School of Medicine Daisan Hospital, Tokyo, Japan
| | - Takuji Mogami
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| |
Collapse
|
27
|
Faria KM, Ribeiro ACP, Brandão TB, Silva WG, Lopes MA, Pereira J, Alves MC, Gueiros LA, Shintaku WH, Migliorati CA, Santos-Silva AR. Radiographic patterns of multiple myeloma in the jawbones of patients treated with intravenous bisphosphonates. J Am Dent Assoc 2019; 149:382-391. [PMID: 29703280 DOI: 10.1016/j.adaj.2017.12.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/29/2017] [Accepted: 12/15/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate whether intravenous (IV) bisphosphonate (BP) therapy can change the radiographic patterns of multiple myeloma (MM) in the jawbones. METHODS The authors evaluated panoramic radiographs obtained from 188 patients with MM for the presence of solitary osteolytic lesions, multiple osteolytic lesions, diffuse osteoporosis, diffuse sclerosis, lamina dura abnormalities, nonhealing alveolar sockets, and bone sequestration. The authors compared results obtained from patients treated with IV BPs with those obtained from patients who had never been exposed to BPs. RESULTS Multiple osteolytic lesions (P = .001), diffuse osteoporosis (P = .001), and diffuse sclerosis (P = .0036) occurred more often in the mandible in both groups. Solitary osteolytic lesions occurred less frequently in the BP group (P = .0078). Lamina dura abnormalities (P = .0006) and nonhealing alveolar sockets (P = .0021) were associated with BP treatment. CONCLUSIONS IV BP therapy changes the radiographic patterns of MM in the jawbones. PRACTICAL IMPLICATIONS The effect of BPs in the maxillofacial area is a matter of concern for health practitioners because this type of medication causes several alterations of the jawbones in patients with cancer.
Collapse
|
28
|
Pichardo SEC, Broek FWT, Fiocco M, Appelman-Dijkstra NM, van Merkesteyn JPR. A comparison of the cone beam computed tomography findings in medication-related osteonecrosis of the jaws related to denosumab versus bisphosphonates: an observational pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:411-417. [PMID: 32001241 DOI: 10.1016/j.oooo.2019.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 09/09/2019] [Accepted: 09/21/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to compare the radiographic abnormalities on cone beam computed tomography (CBCT) in patients with medication-related osteonecrosis of the jaws (MRONJ) related to denosumab use versus bisphosphonate use. STUDY DESIGN The study included 34 consecutive patients with MRONJ who had a history of exclusive use of denosumab (n = 17) or bisphosphonates (n = 17) and had undergone CBCT for determination of extent of disease. Demographic data of the patients were collected. Differences in radiologic characteristics between patients with denosumab-related osteonecrosis of the jaws (DRONJ) and those with bisphosphonate-related osteonecrosis of the jaws (BRONJ) were scored and studied on CBCT. RESULTS In patients with DRONJ, sequestra (P = .015) and lysis of the cortical border of the jaw (P = .033) were significantly less common than in patients with BRONJ. Subperiosteal bone formation did not differ between the groups (P = .545). There was no association between stage of disease and duration of drug therapy or duration of symptoms for either medication group. CONCLUSIONS The radiologic features of DRONJ may be different from those of BRONJ with regard to the presence of sequestra and cortical lysis and might, therefore, be improperly diagnosed. Underestimation and undertreatment of DRONJ may potentially lead to progression of disease and, thus, make treatment more difficult.
Collapse
Affiliation(s)
- Sarina E C Pichardo
- Department of Oral & Maxillofacial Surgery, Leiden University Medical Center, Leiden, The Netherlands; Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - Frans W Ten Broek
- Department of Oral & Maxillofacial Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Marta Fiocco
- Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands; Mathematical Institute, Leiden University, Leiden, The Netherlands
| | | | - J P Richard van Merkesteyn
- Department of Oral & Maxillofacial Surgery, Leiden University Medical Center, Leiden, The Netherlands; Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
29
|
Ogura I, Kobayashi E, Nakahara K, Igarashi K, Haga-Tsujimura M, Toshima H. Quantitative SPECT/CT imaging for medication-related osteonecrosis of the jaw: a preliminary study using volume-based parameters, comparison with chronic osteomyelitis. Ann Nucl Med 2019; 33:776-782. [DOI: 10.1007/s12149-019-01390-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/17/2019] [Indexed: 12/14/2022]
|
30
|
Şahin O, Odabaşı O, Demiralp KÖ, Kurşun-Çakmak EŞ, Aliyev T. Comparison of findings of radiographic and fractal dimension analyses on panoramic radiographs of patients with early-stage and advanced-stage medication-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:78-86. [DOI: 10.1016/j.oooo.2019.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 01/09/2023]
|
31
|
Weiss R, Read-Fuller A. Cone Beam Computed Tomography in Oral and Maxillofacial Surgery: An Evidence-Based Review. Dent J (Basel) 2019; 7:dj7020052. [PMID: 31052495 PMCID: PMC6631689 DOI: 10.3390/dj7020052] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 12/24/2022] Open
Abstract
Cone Beam Computed Tomography (CBCT) is a valuable imaging technique in oral and maxillofacial surgery (OMS) that can help direct a surgeon’s approach to a variety of conditions. A 3-dimensional analysis of head and neck anatomy allows practitioners to plan appropriately, operate with confidence, and assess results post-operatively. CBCT imaging has clear indications and limitations. CBCT offers the clinician 3-dimensional and multi-planar views for a more accurate diagnosis and treatment without the financial burden and radiation exposure of conventional computed tomography (CT) scans. Furthermore, CBCT overcomes certain limitations of 2-dimensional imaging, such as distortion, magnification, and superimposition. However, CBCT lacks the detailed depiction of soft tissue conditions for evaluation of pathologic conditions, head and neck infections, and temporomandibular joint (TMJ) disc evaluation. This review evaluates the evidence-based research supporting the application of CBCT in the various fields of oral and maxillofacial surgery, including dentoalveolar surgery, dental implants, TMJ, orthognathic surgery, trauma, and pathology, and will assess the value of CBCT in pre-operative assessment, surgical planning, and post-operative analysis when applicable. Additionally, the significant limitations of CBCT and potential areas for future research will be discussed.
Collapse
Affiliation(s)
- Robert Weiss
- Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry, Dallas, TX 75246, USA.
- Baylor Scott and White Health, Baylor University Medical Center-Dallas, Dallas, TX 75246, USA.
| | - Andrew Read-Fuller
- Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry, Dallas, TX 75246, USA.
- Attending Physician, Baylor Scott and White Health, Baylor University Medical Center-Dallas, Dallas, TX 75246, USA.
| |
Collapse
|
32
|
Hwang CS, Lee C, Chae HS, Han C, Yang HW, Lee YS, Park DJ. Characteristics of Chronic Maxillary Sinusitis in Patients With a History of Long-term Bisphosphonate Use. Am J Rhinol Allergy 2019; 33:500-506. [PMID: 31041868 DOI: 10.1177/1945892419847109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Bisphosphonates are widely used as bone stabilizers, which can cause major side effects including bisphosphonate-related osteonecrosis of the jaw (BRONJ) that occurs more frequently in the mandible. Consequently, there is a need for a detailed investigation of BRONJ of the maxilla and, in particular, of involvement of the maxillary sinus. Objective Our aim was to evaluate the characteristic radiologic and clinical manifestations in patients with maxillary sinusitis and a history of long-term bisphosphonate use. Methods Between January 2015 and July 2018, 55 patients with symptoms consistent with chronic rhinosinusitis who underwent a paranasal sinus computed tomography (CT) and had a history of >12 months of bisphosphonate therapy were included in the analysis. Results Radiologically and clinically evident chronic rhinosinusitis was noted in 24 of the 55 patients, of whom more than half (14/24, 58.3%) had BRONJ. The CT studies demonstrated that the maxillary sinus was involved in all 24 patients, characterized by unilateral involvement (70.8%) and bony remodeling in the posterior maxillary region (90.5%). The evidence of osteitis on CT and/or single-photon emission CT was observed in the majority of cases (19/21, 90.5%) and 12 patients (50.0%) had oroantral fistula. However, there were no differences in the clinical appearance of the diseases with respect to the radiologic aspects. Conclusions Besides its well-known effects on the mandible, long-term bisphosphonate use can also affect the maxillary sinus, with typical clinical and radiological manifestations.
Collapse
Affiliation(s)
- Chi Sang Hwang
- 1 Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Chunui Lee
- 2 Department of Oral and Maxillofacial Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Hee Sung Chae
- 1 Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Chun Han
- 1 Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Hyun Woo Yang
- 2 Department of Oral and Maxillofacial Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Young Sub Lee
- 1 Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Dong-Joon Park
- 1 Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| |
Collapse
|
33
|
Ogura I, Sasaki Y, Sue M, Oda T, Kameta A, Hayama K. Tc-99m hydroxymethylene diphosphonate scintigraphy, computed tomography, and magnetic resonance imaging of osteonecrosis in the mandible: Osteoradionecrosis versus medication-related osteonecrosis of the jaw. Imaging Sci Dent 2019; 49:53-58. [PMID: 30941288 PMCID: PMC6444004 DOI: 10.5624/isd.2019.49.1.53] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To present characteristic findings of Tc-99m hydroxymethylene diphosphonate (HMDP) scintigraphy, computed tomography (CT), and magnetic resonance (MR) imaging for osteonecrosis in the mandible, especially osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ). Materials and Methods Thirteen patients with MRONJ and 7 patients with ORN in the mandible underwent Tc-99m HMDP scintigraphy, CT, and MR imaging (T1-weighted images [T1WI], T2-weighted images [T2WI], short inversion time inversion recovery images [STIR]), diffusion-weighted images [DWI], and apparent diffusion coefficient [ADC] mapping). The associations of scintigraphy, CT, and MR imaging findings with MRONJ and ORN were analyzed using the chi-square test with the Pearson exact test. Results Thirteen patients with MRONJ and 7 patients with ORN in the mandible showed low signal intensity on T1WI and ADC mapping, high signal intensity on STIR and DWI, and increased uptake on scintigraphy. Periosteal bone proliferation on CT was observed in 69.2% of patients with MRONJ (9 of 13) versus 14.3% of patients with ORN (1 of 7) (P=0.019). Conclusion This study presented characteristic imaging findings of MRONJ and ORN on scintigraphy, CT, and MR imaging. Our results suggest that CT can be effective for detecting MRONJ and ORN.
Collapse
Affiliation(s)
- Ichiro Ogura
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University, School of Life Dentistry at Niigata, Niigata, Japan
| | - Yoshihiko Sasaki
- Radiology, The Nippon Dental University, Niigata Hospital, Niigata, Japan
| | - Mikiko Sue
- Radiology, The Nippon Dental University, Niigata Hospital, Niigata, Japan
| | - Takaaki Oda
- Radiology, The Nippon Dental University, Niigata Hospital, Niigata, Japan
| | - Ayako Kameta
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University, School of Life Dentistry at Niigata, Niigata, Japan
| | - Kazuhide Hayama
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University, School of Life Dentistry at Niigata, Niigata, Japan
| |
Collapse
|
34
|
Nowicki B, Nehrbass D, Arens D, Stadelmann VA, Zeiter S, Otto S, Kircher P, Stoddart MJ. Medication-related osteonecrosis of the jaw in a minipig model: Parameters for developing a macroscopic, radiological, and microscopic grading scheme. J Craniomaxillofac Surg 2019; 47:1162-1169. [PMID: 30952472 DOI: 10.1016/j.jcms.2019.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/13/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES To devise a macroscopic, radiological, and histological scale for assessing pathological changes associated with medication-related osteonecrosis of the jaw in a minipig model. MATERIALS AND METHODS Medication-related osteonecrosis of the jaw was induced in Göttingen minipigs by weekly intravenous administration of bisphosphonate (zoledronic acid) combined with a tooth extraction procedure. Controls either did not receive zoledronic acid or did not undergo tooth extraction. After 20 weeks, minipigs were euthanized and underwent computed tomography and micro-computed tomography scanning. The mandible underwent additional histological examination. RESULTS The most consistent macroscopic findings in animals that had developed bisphosphonate-related osteonecrosis of the jaw (BRONJ) were necrotic, denuded bone, and formation of fistula and pus. Under radiological examination, impaired extraction socket healing, decrease in attenuation of bone beneath the extraction site, and periosteal reaction were observed. Under histological examination, demineralization of the extracellular bone matrix, denuding of bone, and osteonecrosis were recorded. CONCLUSION These parameters were used to develop a scoring system for grading BRONJ.
Collapse
Affiliation(s)
- B Nowicki
- AO Research Institute Davos, Davos Platz, Switzerland
| | - D Nehrbass
- AO Research Institute Davos, Davos Platz, Switzerland
| | - D Arens
- AO Research Institute Davos, Davos Platz, Switzerland
| | | | - S Zeiter
- AO Research Institute Davos, Davos Platz, Switzerland
| | - S Otto
- Department of Oral and Maxillofacial Surgery, University of Munich, Munich, Germany
| | - P Kircher
- Department of Veterinary Radiology, University of Zurich, Zurich, Switzerland
| | - M J Stoddart
- AO Research Institute Davos, Davos Platz, Switzerland; Medical Faculty, Albert Ludwigs University of Freiburg, Freiburg, Germany.
| |
Collapse
|
35
|
Farolfi A, Ghedini P, Fanti S. Highlights from 2017: impactful topics published in the Annals of Nuclear Medicine. Eur J Nucl Med Mol Imaging 2018; 46:217-223. [PMID: 30267115 DOI: 10.1007/s00259-018-4169-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 01/08/2023]
Abstract
The aim of the review is to highlight articles published in 2017 in the Annals of Nuclear Medicine, an official peer-reviewed journal of the Japanese Society of Nuclear Medicine. Among all published manuscripts during the past year, we conducted a subjective selection of the most relevant topics. Fourteen fascinating articles are included in this review, ranging in topic from preclinical to clinical arenas.
Collapse
Affiliation(s)
- Andrea Farolfi
- Metropolitan Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Pietro Albertoni 15, 40138, Bologna, Italy.
| | - Pietro Ghedini
- Metropolitan Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Pietro Albertoni 15, 40138, Bologna, Italy
| | - Stefano Fanti
- Metropolitan Nuclear Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Pietro Albertoni 15, 40138, Bologna, Italy
| |
Collapse
|
36
|
Soundia A, Hadaya D, Mallya SM, Aghaloo TL, Tetradis S. Radiographic predictors of bone exposure in patients with stage 0 medication-related osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:537-544. [PMID: 30266375 DOI: 10.1016/j.oooo.2018.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/27/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
Abstract
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.
Collapse
Affiliation(s)
- Akrivoula Soundia
- Section of Oral and Maxillofacial Radiology, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Danny Hadaya
- Section of Oral and Maxillofacial Surgery, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Sanjay M Mallya
- Section of Oral and Maxillofacial Radiology, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Tara L Aghaloo
- Section of Oral and Maxillofacial Surgery, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA.
| | - Sotirios Tetradis
- Section of Oral and Maxillofacial Radiology, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA.
| |
Collapse
|
37
|
Koo CH, Lee JH. Evaluation of mandibular cortical bone ratio on computed tomography images in patients taking bisphosphonates. Maxillofac Plast Reconstr Surg 2018; 40:17. [PMID: 30038904 PMCID: PMC6031557 DOI: 10.1186/s40902-018-0153-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/08/2018] [Indexed: 11/23/2022] Open
Abstract
Background Bisphosphonate (BP) has the ability to thicken the cortical bone. In addition, it has been reported that the cortical bone thickened by BP has relation to the medication-related osteonecrosis of the jaw (MRONJ). Therefore, the objective of this article is to analyze the ratio as well as thickness of cortical bone in the mandible using computed tomography (CT) and to evaluate it as the predictive factor of MRONJ. Methods The thickness of the cortical bone was measured on a paraxial view of the CT showing the mental foramen in 95 patients: 33 patients with MRONJ (3 males, 30 females), 30 patients taking BP without MRONJ (2 males, 28 females), and 32 controls (9 males, 28 females). Also, the ratios of the cortical bone to the total bone were obtained using the measured values. Based on these results, we compared the difference of mandibular cortical bone ratio between the three groups. Results The average cortical bone thickness was measured as 3.81 mm in patients with MRONJ, 3.39 mm in patients taking BP without MRONJ, and 3.23 mm in controls. There was only a significant difference between patients with MRONJ and controls (P < 0.05). On the other hand, the average mandibular cortical bone ratio was measured as 37.9% in patients with MRONJ, 27.9% in patients taking BP without MRONJ, and 23.3% in controls. There was a significant difference between all groups (P < 0.05). Conclusion The mandibular cortical bone ratio is large in order of patients with MRONJ, patients taking BP without MRONJ, and controls. This result suggests that the mandibular cortical bone ratio would be very useful to predict the development of MRONJ.
Collapse
Affiliation(s)
- Chul-Hong Koo
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, South Korea
| | - Jae-Hoon Lee
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, South Korea
| |
Collapse
|
38
|
Goller-Bulut D, Özcan G, Avci F. Changes in dimension of neurovascular canals in the mandible and maxilla: A radiographic finding in patients diagnosed with MRONJ. Med Oral Patol Oral Cir Bucal 2018; 23:e282-e289. [PMID: 29680848 PMCID: PMC5945243 DOI: 10.4317/medoral.22274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/10/2017] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this retrospective study was to compare the morphological features of neurovascular canals and foramina of patients with medication-related osteonecrosis of the jaws (MRONJ) and healthy individuals by using cone beam computed tomography (CBCT). Material and Methods The CBCT images of 58 patients under bisphosphonate therapy diagnosed with MRONJ and age gender- matched controls were retrospectively evaluated. The diameter of mandibular and nasopalatine canal and mandibular, mental and lingual foramina were measured on several sections of CBCT. The value of mental index (MI) and panoramic mandibular index (PMI) were also assessed. Results The mean value of diametric measurements for all neurovascular canals and foramina in MRONJ patients were narrower than controls. Left mandibular foramen was the most affected area (p<0.001). There were significantly difference in all measurements of mental foramen, lingual foramen and mandibular incisive canal between two groups (p<0.05). PMI of MRONJ subjects were also significantly differences in both sides (p<0.05). Conclusions In MRONJ patient, neurovascular canals and foramina are affected due to the alterations in bone remodeling. Therefore, the diametric measurement of neurovascular canals and assessment of MI and PMI on CBCT, is a potentially useful method for detection of early changes associated with bisphosphonate therapy and for predict areas where new necrosis may occur. Key words:Bisphosphonate, MRONJ, CBCT, neurovascular canals, PMI.
Collapse
Affiliation(s)
- D Goller-Bulut
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry Abant İzzet Baysal University, 14000, Bolu, Turkey,
| | | | | |
Collapse
|
39
|
Demiralp KÖ, Kurşun-Çakmak EŞ, Bayrak S, Akbulut N, Atakan C, Orhan K. Trabecular structure designation using fractal analysis technique on panoramic radiographs of patients with bisphosphonate intake: a preliminary study. Oral Radiol 2018; 35:23-28. [PMID: 30484181 DOI: 10.1007/s11282-018-0321-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/29/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study was performed to evaluate the trabecular pattern of patients with cancer taking bisphosphonates on panoramic images using fractal dimension (FD) analysis by comparison with healthy subjects and to assess whether any difference exists between regions. METHODS FD analysis was conducted using ImageJ 1.3 software (National Institutes of Health, Bethesda, MD, USA) with the box-counting method on panoramic radiographs of 33 patients taking bisphosphonates (13 males and 20 females) and 33 healthy sex- and age-matched individuals. RESULTS FD values were higher (1.39 ± 0.14) in the study group than control group (1.38 ± 0.07) (p ≤ 0.05). No difference was detected in the FD values among the tested regions. The mean FD values in the control and study groups were as follows: region 1, 1.49 and 1.41 (p = 0.54); region 2, 1.36 and 1.37 (p = 0.84); region 3, 1.35 and 1.42 (p = 0.11); and region 4, 1.39 and 1.39 (p = 0.90), respectively. Female patients showed significantly lower values above the mandibular canal on the distal side of the second premolar and anterior to the mental foramen than did male patients (p ≤ 0.05). Age was unrelated to the FD in the study group (p ≥ 0.05). CONCLUSIONS The FD values of the patients with cancer taking bisphosphonates were higher than those of the controls. FD analysis showed the potential for examining bone structure in panoramic radiographs. Studies with a larger sample size are necessary to confirm these results.
Collapse
Affiliation(s)
- Kemal Özgür Demiralp
- Türkiye Public Hospitals Agency, Ministry of Health, Cankaya, 06490, Ankara, Turkey
| | | | - Seval Bayrak
- Dentomaxillofacial Radiology Department, Dentistry Faculty, Abant İzzet Baysal University, Gölköy Yerleşkesi, Gölköy Kampüsü, Gölköy, 14280, Bolu Merkez, Bolu, Turkey.
| | - Nihat Akbulut
- Dentomaxillofacial Surgery Department, Dentistry Faculty, Gaziosmanpasa University, Tasliciftlik yerleskesi, Merkez, 60250, Tokat Merkez, Tokat, Turkey
| | - Cemal Atakan
- Statistics Department, Faculty of Sciences, Ankara University, Dogol Cad., Besevler, 06100, Yenimahalle, Ankara, Turkey
| | - Kaan Orhan
- Dentomaxillofacial Radiology Department, Faculty of Dentistry, Ankara University, Besevler, 06500, Ankara, Turkey
| |
Collapse
|
40
|
Shimamoto H, Grogan TR, Tsujimoto T, Kakimoto N, Murakami S, Elashoff D, Aghaloo TL, Tetradis S. Does CBCT alter the diagnostic thinking efficacy, management and prognosis of patients with suspected Stage 0 medication-related osteonecrosis of the jaws? Dentomaxillofac Radiol 2017; 47:20170290. [PMID: 29168936 DOI: 10.1259/dmfr.20170290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To evaluate the impact of cone beam CT (CBCT) in the diagnostic thinking efficacy, management and prognosis of patients with suspected Stage 0 medication-related osteonecrosis of the jaw (MRONJ). METHODS For 15 patients with suspected Stage 0 MRONJ, clinical photographs, a panoramic radiograph and selected CBCT sections were identified. 13 oral surgeons reviewed the material and answered 10 questions in two different sessions. First session included clinical photographs and panoramic radiographs, while second session also included CBCT images. Questions (Qs) referred to dental disease and bone abnormalities (Qs 1, 2 and 3), differential diagnosis (Qs 4 and 5), patient management (Qs 6 and 7) and prognosis (Qs 8 and 9). Q 10 queried indication (first session) and usefulness (second session) of CBCT images. RESULTS Qs 2, 3, 5, 7 and 9 scores increased between sessions, with statistical differences for Qs 2, 3, 5 and 7 (<0.05). Patients 2, 8 and 11 showed a significant increase in the average score of all Qs between sessions, while scores for patient 10 nearly reached statistical significance (p = 0.055). For Q 10, 57.4% of answers reported that CBCT was needed (first session) and was beneficial (second session). CONCLUSIONS CBCT had a significant impact in differential diagnosis and management of patients with suspected Stage 0 MRONJ.
Collapse
Affiliation(s)
- Hiroaki Shimamoto
- 1 Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry , Suita, Osaka , Japan.,2 Section of Oral and Maxillofacial Radiology, UCLA School of Dentistry , Los Angeles, CA , USA
| | - Tristan R Grogan
- 3 Statistics Core, David Geffen School of Medicine, University of California Los Angeles , Los Angeles, CA , USA
| | - Tomomi Tsujimoto
- 1 Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry , Suita, Osaka , Japan
| | - Naoya Kakimoto
- 4 Department of Oral and Maxillofacial Radiology, Institute of Biomedical & Health Sciences, Hiroshima University , Minami-ku, Hiroshima , Japan
| | - Shumei Murakami
- 1 Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry , Suita, Osaka , Japan
| | - David Elashoff
- 3 Statistics Core, David Geffen School of Medicine, University of California Los Angeles , Los Angeles, CA , USA
| | - Tara L Aghaloo
- 5 Section of Oral and Maxillofacial Surgery, UCLA, School of Dentistry , Los Angeles, CA , USA
| | - Sotirios Tetradis
- 2 Section of Oral and Maxillofacial Radiology, UCLA School of Dentistry , Los Angeles, CA , USA
| |
Collapse
|
41
|
Detecting the earliest radiological signs of bisphosphonate-related osteonecrosis. Br Dent J 2017; 224:26-31. [PMID: 29192692 DOI: 10.1038/sj.bdj.2017.1001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 01/14/2023]
Abstract
Introduction Oral bisphosphonates are the most commonly prescribed anti-resorptive drugs used in the treatment of osteoporosis, but osteonecrosis of the jaw is a serious complication. The early diagnosis of this destructive side effect is crucial in preventing excessive bone loss, pain and infection.Objective To aid dental practitioners in the early identification of bisphosphonate-related osteonecrosis of the jaw.Method A scoping review was carried out.Data sources We searched MEDLINE via OVID, EMBASE via OVID, Dentistry and Oral Sciences Source (DOSS), Proquest Dissertation and Theses Search, to identify references that described clinical and radiological findings in medication-related osteonecrosis of the jaw (MRONJ).Data selection Nineteen references mentioned the earliest radiological changes in MRONJ with a description of the observations and were included in the analysis.Data synthesis The radiographic signs included osteosclerosis/lysis, widening of the periodontal ligament and thickening of the lamina dura and cortex. To assess the quality of original data on which recommendations had been made, these 19 studies were subjected to a quality appraisal.Conclusion Using bone exposure as a criterion for diagnosis of MRONJ, leads to delayed diagnosis and a poor response to treatment. In those patients at risk of bone exposure with MRONJ, insufficient information is present in the literature to allow the general dental practitioner to reliably identify the radiographic features indicating imminent bone exposure. A well-designed prospective study is needed.
Collapse
|
42
|
Gönen ZB, Yillmaz Asan C, Zararsiz G, Kiliç E, Alkan A. Osseous changes in patients with medication-related osteonecrosis of the jaws. Dentomaxillofac Radiol 2017; 47:20170172. [PMID: 28871814 DOI: 10.1259/dmfr.20170172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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.
Collapse
Affiliation(s)
- Zeynep Burcin Gönen
- 1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry and Genome - Stem Cell Center, Erciyes University, Kayseri, Turkey
| | - Canay Yillmaz Asan
- 2 Department of Oral and Maxillofacial Surgery, Ministry of Dental Health Hospital, Kayseri, Turkey
| | - Gökmen Zararsiz
- 3 Department of Biostatistics, Faculty of Medicine, Erciyes University and Turcosa Analytics Solutions Ltd. Co, Erciyes Teknopark, Kayseri, Turkey
| | - Erdem Kiliç
- 4 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bezmialem University, Istanbul, Turkey
| | - Alper Alkan
- 4 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bezmialem University, Istanbul, Turkey
| |
Collapse
|
43
|
Ogura I, Sasaki Y, Kameta A, Sue M, Oda T. Characteristic Multimodal Imaging of Medication-Related Osteonecrosis of the Jaw: Comparison Between Oral and Parenteral Routes of Medication Administration. Pol J Radiol 2017; 82:551-560. [PMID: 29657620 PMCID: PMC5894018 DOI: 10.12659/pjr.902513] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 12/28/2016] [Indexed: 11/16/2022] Open
Abstract
Background To assess multimodal imaging features of medication-related osteonecrosis of the jaw (MRONJ) and to analyze the differences between oral and parenteral routes of medication administration. We retrospectively reviewed panoramic radiographs, CT, MRI, and bone scintigraphy of patients with MRONJ. Material/Methods A retrospective study was conducted in 16 patients with MRONJ who underwent panoramic radiography, CT, MRI, and bone scintigraphy. Statistical analysis for the comparison between routes of medication administration and multimodal imaging features was performed with the Pearson’s χ2 test. Results The percentage of cases with sequestrum separation was 25.0% (4/16 cases) on panoramic radiography and 81.3% (13/16 cases) on CT. The percentage of cases with periosteal bone proliferation on CT was 41.7% (5/12 cases) in the oral route of administration vs. 100% (4/4 cases) in the parenteral route of administration (p=0.042). The percentage of cases with spread of soft tissue inflammation to buccal and other spaces on CT and MRI was 33.3% (4/12 cases) in the oral route of administration vs. 100% (4/4 cases) in the parenteral route of administration (p=0.021). Conclusions The sequestrum separation on panoramic radiography in patients with MRONJ was unclear in comparison to CT. Furthermore, characteristic CT findings of patients with MRONJ in the parenteral administration group were periosteal bone proliferation and spread of soft tissue inflammation to buccal and other spaces.
Collapse
Affiliation(s)
- Ichiro Ogura
- Department of Radiology, The Nippon Dental University Niigata Hospital, Niigata, Japan
| | - Yoshihiko Sasaki
- Department of Radiology, The Nippon Dental University Niigata Hospital, Niigata, Japan
| | - Ayako Kameta
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan
| | - Mikiko Sue
- Department of Radiology, The Nippon Dental University Niigata Hospital, Niigata, Japan
| | - Takaaki Oda
- Department of Radiology, The Nippon Dental University Niigata Hospital, Niigata, Japan
| |
Collapse
|
44
|
Corsi A, Ungari C, Riminucci M, Agrillo A. Bisphosphonate-Related Osteonecrosis and Metastasis Within the Same Site of the Jaw. J Oral Maxillofac Surg 2017; 75:1679-1684. [DOI: 10.1016/j.joms.2017.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/06/2017] [Accepted: 01/07/2017] [Indexed: 01/31/2023]
|
45
|
McCoy JM, Oreadi D. Diagnosis and Management of Pathological Conditions. J Oral Maxillofac Surg 2017; 75:e224-e263. [DOI: 10.1016/j.joms.2017.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
46
|
Vilarinho JLP, Ferrare N, Moreira AMR, Moura HF, Acevedo AC, Chaves SB, Melo NS, Leite AF, Macedo SB, de Souza MP, Guimarães ATB, Figueiredo PT. Early bony changes associated with bisphosphonate-related osteonecrosis of the jaws in rats: A longitudinal in vivo study. Arch Oral Biol 2017. [PMID: 28622548 DOI: 10.1016/j.archoralbio.2017.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate early bony changes in an animal model of Medication-Related Osteonecrosis of the Jaw (MRONJ) at the side of the local trauma and at the contralateral side, comparing with a control group. Bony changes were evaluated by Microcomputed Tomography (MicroCT) at three times points: at baseline (T0), after drug administration (T1) and after dental extraction (T2). DESIGN Two groups were compared: the experimental group in which zoledronic acid (ZA) was administered (17 rats) and the control group (13 rats). Dental extractions of the lower left first molars were performed in all animals. The left side was considered as the supposed affected area in the ZA group, and the right side was considered as the unaffected area. In these areas, the following structural microtomographic bone parameters were calculated: Bone Mineral Density (BMD), Trabecular Thickness (Tb.Th), and Bone Volume Proportion (BV/TV). The comparison of quantitative bone parameters among the different sides and experimental phases of both studied groups were performed by ANOVA-factorial. RESULTS None of the animals of the control group developed MRONJ. In the ZA group, 76% presented bone exposure. From T0 to T1, Tb.Th and BV/TV increased, and in T2, the mean values were higher in ZA group than in the control group. BMD increased throughout the different phases of both groups. CONCLUSIONS Structural bony changes occurred in the ZA group at both mandibular sides before the dental extraction (T1). Tb.Th and BV/TV should be further investigated as potential early bone markers of MRONJ.
Collapse
Affiliation(s)
- Josy Lorena Peres Vilarinho
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Nathália Ferrare
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Andreia Maria Rocha Moreira
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Helora Freitas Moura
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Ana Carolina Acevedo
- Oral Care Center for Inherited Diseases, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Sacha Braun Chaves
- Biology Institute University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Nilce Santos Melo
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - André Ferreira Leite
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Sérgio Bruzadelli Macedo
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| | - Melissa Paoletti de Souza
- Biological Sciences Department, State University of West Paraná, Rua Universitária 2069, Cascavel, Zip Code: 85819-110, Paraná, Brazil.
| | - Ana Tereza Bittencourt Guimarães
- Biological Sciences Department, State University of West Paraná, Rua Universitária 2069, Cascavel, Zip Code: 85819-110, Paraná, Brazil.
| | - Paulo Tadeu Figueiredo
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Zip Code: 70910-900, Brasília, Brazil.
| |
Collapse
|
47
|
Hoefert S, Yuan A, Munz A, Grimm M, Elayouti A, Reinert S. Clinical course and therapeutic outcomes of operatively and non-operatively managed patients with denosumab-related osteonecrosis of the jaw (DRONJ). J Craniomaxillofac Surg 2017; 45:570-578. [DOI: 10.1016/j.jcms.2017.01.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 11/28/2016] [Accepted: 01/16/2017] [Indexed: 10/20/2022] Open
|
48
|
Obinata K, Shirai S, Ito H, Nakamura M, Carrozzo M, Macleod I, Carr A, Yamazaki Y, Tei K. Image findings of bisphosphonate related osteonecrosis of jaws comparing with osteoradionecrosis. Dentomaxillofac Radiol 2017; 46:20160281. [PMID: 28186845 DOI: 10.1259/dmfr.20160281] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate image characteristics of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and compare these with osteoradionecrosis (ORN). METHODS 34 patients with BRONJ and 16 patients with ORN were included in this study. We investigated the CT and dental panoramic radiograph (DPR) images for osteolysis, osteosclerosis, sequestration, periosteal reaction, pathological fracture and spread of soft tissue inflammation around the jaws. RESULTS Osteolysis, osteosclerosis, sequestration and spread of soft tissue inflammation around the jaws were common radiological features in both BRONJ and ORN. Osteolysis and spreading of soft tissue inflammation around the jaws were predominant in ORN, and by contrast osteosclerosis was predominant in BRONJ. Periosteal reaction was established in 15 of the 34 BRONJ cases, but none in the ORN cases. Pathological fractures were observed in 6 of 16 ORN cases, but none in BRONJ cases. CT was better for detection than DPR for osteolysis, osteosclerosis, sequestration and periosteal reactions. CONCLUSIONS Image findings of BRONJ were characterized as a severe sclerotic change combined with osteolysis, sequestration, periosteal reaction and spread of soft tissue inflammation around the jaws.
Collapse
Affiliation(s)
| | | | - Hitoshi Ito
- 1 Omni Dentix, Dartmouth, Sapporo, Hokkaido, Japan
| | | | - Marco Carrozzo
- 3 Department of Oral Medicine, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Iain Macleod
- 4 Department of Dental Radiology, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Andrew Carr
- 4 Department of Dental Radiology, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Yutaka Yamazaki
- 5 Department of Oral Medicine, Center for Dental Clinics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kanchu Tei
- 6 Department of Oral Surgery, Center for Dental Clinics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| |
Collapse
|
49
|
Radiographic Findings in Patients with Medication-Related Osteonecrosis of the Jaw. Int J Dent 2017; 2017:3190301. [PMID: 28352284 PMCID: PMC5352898 DOI: 10.1155/2017/3190301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/18/2022] Open
Abstract
A retrospective study was conducted of the records and panoramic radiographs of 35 patients treated with bisphosphonates (BP) and diagnosed with MRONJ. Panoramic radiography was used for evaluation, by two examiners, the following findings were subject of search: osteolysis (OT), cortical bone erosion (EC), bone sclerosis focal (FS) and diffuse (DS), bone sequestration (BS), thickening of lamina dura (TD), prominence of the inferior alveolar nerve canal (IAN), persisting alveolar sockets (SK), and the presence of a pathological fracture (PF). Medical information and staging were also recorded in order to correlate with radiographic findings. Bone sclerosis was the most frequent alteration, followed by OT and TD. The mandible was more affected than the maxilla. There was no significant difference between genders or significant correlation between the number of injuries with age and duration of BP usage. Considering the association between the radiographic findings and MRONJ staging, EC was predominant in stage 3 and DS in stage 2. IAN and PF demonstrated greater association with stage 3. In conclusion, the higher the clinical staging, the greater the severity of the bone alteration. Panoramic radiographic examination is a useful screening tool in patients submitted to antiresorptive therapy.
Collapse
|
50
|
Koth VS, Figueiredo MA, Salum FG, Cherubini K. Interrelationship of clinical, radiographic and haematological features in patients under bisphosphonate therapy. Dentomaxillofac Radiol 2017; 46:20160260. [PMID: 28107028 DOI: 10.1259/dmfr.20160260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To analyze the clinical, radiographic and haematological aspects of patients under bisphosphonate therapy. METHODS A retrospective study was conducted where the records of patients taking bisphosphonates were analyzed considering the occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Evaluation included panoramic and periapical radiographies, haematological examinations and clinical features. Radiographies were analyzed determining the presence or absence of bone sclerosis, osteolysis, persisting alveolar socket, narrowing of the mandibular canal, widening of the periodontal ligament space, periradicular radiolucency, sequestrum and thickening of the lamina dura. Laboratory tests consisted of complete blood count, fasting serum glucose, erythrocyte sedimentation rate (ESR) and serum levels of calcium, phosphorus, alkaline phosphatase, parathormone (PTH) and C-terminal telopeptide of collagen I (CTX). RESULTS Alkaline phosphatase and ESR were significantly higher in the BRONJ group, whereas fasting serum glucose, CTX, PTH, calcium and phosphorus did not significantly differ. BRONJ showed association with smoking, tooth extraction, anaemia and leukocytosis. On radiographic analysis, persisting alveolar socket, osteolysis, bone sclerosis and narrowing of the mandibular canal were significantly more prevalent in the BRONJ group. Thickening of the lamina dura, periapical radiolucencies, widening of the periodontal ligament space and sequestrum did not significantly differ between the groups. CONCLUSIONS BRONJ is a multifactorial disease with high morbidity, which requires experimental studies to clarify the role of the reported risk factors and clinical radiographic signs to improve its diagnosis.
Collapse
Affiliation(s)
- Valesca S Koth
- Dental College, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria A Figueiredo
- Dental College, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda G Salum
- Dental College, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Karen Cherubini
- Dental College, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|