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Kurşun BÜ, Akan E. Evaluation of trabecular bone changes according to the type of prosthesis in patients using bisphosphonates: a retrospective study. Braz Oral Res 2023; 37:e089. [PMID: 37672422 DOI: 10.1590/1807-3107bor-2023.vol37.0089] [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: 11/14/2021] [Accepted: 11/14/2022] [Indexed: 09/08/2023] Open
Abstract
The objective of the study was to retrospectively compare the fractal size values calculated in the trabecular bone according to the type of complete removable denture, removable partial denture, and partial fixed prosthesis between patients using bisphosphonates and healthy patients, retrospectively. Panoramic radiographs of a total of 200 patients, (100 using bisphosphonates,100 control group), were taken from the right and left molar regions before and after treatment with 72 × 72 pixels. The fractal dimension (FD) was computed by using ImageJ Software using the box-counting method on the images obtained. There was an interaction effect between the trabecular bone change-patient group-the type of prosthesis used and the parameters of the area (p < 0.05). In patients using complete removable dentures and removable partial dentures in the maxilla and mandibula in the molar region, a greater decrease in FD values was observed in the control group than in the patient group using bisphosphonates. An increase in FD values over time was observed in the patient group using bisphosphonates with partial fixed maxillary and mandibular prostheses compared to the control group. Partial fixed prostheses should be preferred primarily instead of complete removable or removable partial dentures in patients using bisphosphonates to prevent osteonecrosis due to dental trauma.
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Affiliation(s)
- Begüm Ünlü Kurşun
- Izmir Tinaztepe University, Department of Prosthetic Dentistry, Izmir, Turkey
| | - Ender Akan
- University of Katip Çelebi, Department of Prosthetic Dentistry, Izmir, Turkey
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Lorusso L, Pieruzzi L, Gabriele M, Nisi M, Viola D, Molinaro E, Bottici V, Elisei R, Agate L. Osteonecrosis of the jaw: a rare but possible side effect in thyroid cancer patients treated with tyrosine-kinase inhibitors and bisphosphonates. J Endocrinol Invest 2021; 44:2557-2566. [PMID: 34291429 PMCID: PMC8572199 DOI: 10.1007/s40618-021-01634-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/07/2021] [Indexed: 11/01/2022]
Abstract
Osteonecrosis of the jaw (ONJ) is a rare but very serious disease that can affect both jaws. It is defined as exposed bone in the maxillofacial region that does not heal within 8 weeks after a health care provider identification. ONJ can occur spontaneously or can be due to drugs like bisphosphonates (BPS) and anti-RANK agents, in patients with no history of external radiation therapy in the craniofacial region. Although in phase 3 trials of tyrosine kinase inhibitors (TKIs) used in thyroid cancer (TC) the ONJ was not reported among the most common side effects, several papers reported the association between ONJ and TKIs, both when they are used alone and in combination with a bisphosphonate. The appearance of an ONJ in a patient with metastatic radio-iodine refractory differentiated TC, treated with zoledronic acid and sorafenib, has put us in front of an important clinical challenge: when a ONJ occurred during TKIs treatment, it really worsens the patients' quality of life. We should consider that in the case of ONJ a TKI discontinuation becomes necessary, and this could lead to a progression of neoplastic disease. The most important aim of this review is to aware the endocrinologists/oncologists dealing with TC to pay attention to this possible side effect of BPS and TKIs, especially when they are used in association. To significantly reduced the risk of ONJ, both preventive measures before initiating not only antiresorptive therapy but also antiangiogenic agents, and regular dental examinations during the treatment should always be proposed.
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Affiliation(s)
- L. Lorusso
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - L. Pieruzzi
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - M. Gabriele
- Department of Surgery, Section of Oral Surgery, University of Pisa, Pisa, Italy
| | - M. Nisi
- Department of Surgery, Section of Oral Surgery, University of Pisa, Pisa, Italy
| | - D. Viola
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - E. Molinaro
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - V. Bottici
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - R. Elisei
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - L. Agate
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
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Effect of morphological findings in computed tomography on the quantitative values in single-photon emission computed tomography for patients with antiresorptive agent-related osteonecrosis of the jaw: a cross-sectional study. Ann Nucl Med 2021; 35:853-860. [PMID: 33997910 DOI: 10.1007/s12149-021-01624-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Quantitative analyses of gamma-ray accumulation in single-photon emission computed tomography (SPECT), and the evaluation of antiresorptive agent-related osteonecrosis of the jaw (ARONJ) have been reported recently. However, the relationship between the quantitative parameters calculated from SPECT and the detailed morphological changes observed in computed tomography (CT) remains unclear. This study aimed to investigate patients' characteristics and morphological changes observed on CT, and their effects on the quantitative values in SPECT. METHODS From April 2017 to March 2019, patients diagnosed with ARONJ at our hospital were enrolled. The data obtained before September 2017 were reviewed retrospectively, and other data were collected prospectively. CT scans were evaluated for internal texture, sequestrum formation, periosteal reaction, cortical perforation, bone expansion, and pathological fracture. For quantitative assessment, the ratio of the maximum standardized uptake value (SUV) to the mean SUV in the temporal bone (rSUVmax) was calculated from SPECT images. The factors affecting rSUVmax were investigated by multiple regression analysis. The statistical significance level was set at α = 0.05. RESULTS Overall, 55 lesions of 42 patients (median age and interquartile range, 75 [67-80 years], 27 female) were evaluated. Male sex (p = 0.007) and bilateral location (p < 0.0001) were selected as variables in the multivariate analysis. Adjusted coefficient of determination R2 was 0.59 (p < 0.0001). CONCLUSION Sex and horizontal progression of the disease may affect individually calibrated SUVs in SPECT for patients with ARONJ.
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Wongratwanich P, Shimabukuro K, Konishi M, Nagasaki T, Ohtsuka M, Suei Y, Nakamoto T, Verdonschot RG, Kanesaki T, Sutthiprapaporn P, Kakimoto N. Do various imaging modalities provide potential early detection and diagnosis of medication-related osteonecrosis of the jaw? A review. Dentomaxillofac Radiol 2021; 50:20200417. [PMID: 33411572 DOI: 10.1259/dmfr.20200417] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Patients with medication-related osteonecrosis of the jaw (MRONJ) often visit their dentists at advanced stages and subsequently require treatments that greatly affect quality of life. Currently, no clear diagnostic criteria exist to assess MRONJ, and the definitive diagnosis solely relies on clinical bone exposure. This ambiguity leads to a diagnostic delay, complications, and unnecessary burden. This article aims to identify imaging modalities' usage and findings of MRONJ to provide possible approaches for early detection. METHODS Literature searches were conducted using PubMed, Web of Science, Scopus, and Cochrane Library to review all diagnostic imaging modalities for MRONJ. RESULTS Panoramic radiography offers a fundamental understanding of the lesions. Imaging findings were comparable between non-exposed and exposed MRONJ, showing osteolysis, osteosclerosis, and thickened lamina dura. Mandibular cortex index Class II could be a potential early MRONJ indicator. While three-dimensional modalities, CT and CBCT, were able to show more features unique to MRONJ such as a solid type periosteal reaction, buccal predominance of cortical perforation, and bone-within-bone appearance. MRI signal intensities of vital bones are hypointense on T1WI and hyperintense on T2WI and STIR when necrotic bone shows hypointensity on all T1WI, T2WI, and STIR. Functional imaging is the most sensitive method but is usually performed in metastasis detection rather than being a diagnostic tool for early MRONJ. CONCLUSION Currently, MRONJ-specific imaging features cannot be firmly established. However, the current data are valuable as it may lead to a more efficient diagnostic procedure along with a more suitable selection of imaging modalities.
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Affiliation(s)
- Pongsapak Wongratwanich
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Kiichi Shimabukuro
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Masaru Konishi
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Masahiko Ohtsuka
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Yoshikazu Suei
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Takashi Nakamoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Rinus G Verdonschot
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Tomohiko Kanesaki
- Department of Oral and Maxillofacial Surgery, Saiseikai Senri Hospital, 1 Chome-1-6 Tsukumodai, Suita, Osaka 565-0862, Japan
| | - Pipop Sutthiprapaporn
- Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Amphur Muang, Khon Kaen 40002, Thailand
| | - Naoya Kakimoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
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Kim JE, Yoo S, Choi SC. Several issues regarding the diagnostic imaging of medication-related osteonecrosis of the jaw. Imaging Sci Dent 2020; 50:273-279. [PMID: 33409135 PMCID: PMC7758260 DOI: 10.5624/isd.2020.50.4.273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/23/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
Abstract
This review presents an overview of some diagnostic imaging-related issues regarding medication-related osteonecrosis of the jaws (MRONJ), including imaging signs that can predict MRONJ in patients taking antiresorptive drugs, the early imaging features of MRONJ, the relationship between the presence or absence of bone exposure and imaging features, and differences in imaging features by stage, between advanced MRONJ and conventional osteomyelitis, between oncologic and osteoporotic patients with MRONJ, and depending on the type of medication, method of administration, and duration of medication. The early diagnosis of MRONJ can be made by the presence of subtle imaging changes such as thickening of the lamina dura or cortical bone, not by the presence of bone exposure. Most of the imaging features are relatively non-specific, and each patient's clinical findings and history should be referenced. Oral and maxillofacial radiologists and dentists should closely monitor plain radiographs of patients taking antiresorptive/antiangiogenic drugs.
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Affiliation(s)
- Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Sumin Yoo
- School of Dental Hygiene, Kyungdong University Medical Campus, Wonju, Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
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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.
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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
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Fusco V, Santini D, Campisi G, Bertoldo F, Lanzetta G, Ibrahim T, Bertetto O, Numico G, Addeo A, Berruti A, Bettini G, Saia G, Bedogni A. Comment on Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline Summary. JCO Oncol Pract 2020; 16:142-145. [DOI: 10.1200/jop.19.00645] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Vittorio Fusco
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and
| | - Daniele Santini
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and
| | - Giuseppina Campisi
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and
| | - Francesco Bertoldo
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and
| | - Gaetano Lanzetta
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and
| | - Toni Ibrahim
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and
| | - Oscar Bertetto
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and
| | - Gianmauro Numico
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and
| | - Alfredo Addeo
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and
| | - Alfredo Berruti
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and
| | - Giordana Bettini
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and
| | - Giorgia Saia
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and
| | - Alberto Bedogni
- Vittorio Fusco, MD, Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Daniele Santini, MD, Oncology Department, Campus Biomedico University, Rome, Italy; Giuseppina Campisi, DDS, MS, Sector of Oral Medicine, Dip DICHIRONS, Università degli Studi di Palermo, Palermo, Italy; Francesco Bertoldo, MD, Medicine Department, Università di Verona, Verona, Italy; Gaetano Lanzetta, MD, Oncology Unit, INI, Grottaferrata, Italy; Toni Ibrahim, MSc, MD, PhD, Osteoncology and
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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]
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9
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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.
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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
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Shin JW, Kim JE, Huh KH, Yi WJ, Heo MS, Lee SS, Choi SC. Computed tomography imaging features of osteomyelitis of the jaw: comparison between antiresorptive medication-related conditions and medication-unrelated conditions. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:629-634. [PMID: 31983632 DOI: 10.1016/j.oooo.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/07/2019] [Accepted: 11/09/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to analyze and compare the imaging features of osteomyelitis according to the presence or absence of antiresorptive medications by using computed tomography (CT). STUDY DESIGN We retrospectively reviewed the records of 270 patients with osteomyelitis (83 males and 187 females; average age 66.6 years). CT imaging features were analyzed, and imaging and demographic features were compared between the medication-related osteomyelitis (MROM) group and the medication-unrelated osteomyelitis (MUOM) group. RESULTS Trabecular defects, cortical defects, sclerosis, and sequestra were detected in the majority of patients, whereas periosteal new bone formation was less common. The MROM group exhibited sequestra and periosteal new bone formation more frequently on CT images, but the size and appearance of the sequestra and type of periosteal new bone were not significantly different between the 2 groups. CONCLUSIONS Sequestra and periosteal new bone formation were characteristic CT features of osteomyelitis more commonly found in the medication-related condition. These findings may be useful in the evaluation of osteomyelitis and medication-related osteonecrosis of the jaw.
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Affiliation(s)
- Jeong Won Shin
- Clinical Assistant Professor, Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jo-Eun Kim
- Clinical Assistant Professor, Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital, Seoul, Republic of Korea.
| | - Kyung-Hoe Huh
- Professor, Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Won-Jin Yi
- Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Min-Suk Heo
- Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Sam-Sun Lee
- Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Soon-Chul Choi
- Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Imaging and histomorphometric evaluation of mandible and tibia of rats treated with bisphosphonates. Oral Maxillofac Surg 2019; 23:473-479. [PMID: 31686251 DOI: 10.1007/s10006-019-00807-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/11/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the mandible and tibia of rats treated with bisphosphonates (BPs) by imaging and histomorphometric analysis. STUDY DESIGN Thirty-four rat specimens (Rattus norvegicus, Wistar strain) were distributed into 3 groups: (1) 12 rats treated with zoledronic acid; (2) 12 rats treated with clodronate; and (3) the control group, containing 10 rats that received saline. All bones were exposed to cone beam computed tomography (CBCT). The images were analyzed to determine bone density (BD), using the software OsiriX 7.0. Histological slides were prepared from the specimens and the proportion of bone volume (BV) was quantified using the software Adobe Photoshop CC. RESULTS There was no statistically significant difference in BD either between the drug groups or between mandible and tibia. BV between BPs and control group did not show a significant difference. However, comparing the two bones, the mandibles in the control group displayed higher BV than did the tibiae in the same group. CONCLUSION According to our results, we conclude that (1) BD was not altered by bone type or by type of BP administered, and (2) treatment with zoledronic acid or clodronate did not affect BV in the mandible or tibia of test groups.
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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]
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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.
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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
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Tsuchimochi M, Kurabayashi T. Symposium: Imaging modalities for drug-related osteonecrosis of the jaw (1), role of imaging in drug-related osteonecrosis of the jaw: An up-to-date review (secondary publication). JAPANESE DENTAL SCIENCE REVIEW 2019; 55:1-4. [PMID: 30705708 PMCID: PMC6348294 DOI: 10.1016/j.jdsr.2018.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 11/24/2022] Open
Abstract
MRONJ/ARONJ is a serious adverse effect of medication, although the incidence of the disease is rare, and there are still controversial issues regarding the pathogenesis of MRONJ/ARONJ. Medications that can lead to MRONJ/ARONJ are commonly used to treat osteoporosis and to prevent bone fractures caused by bone metastasis of malignancies. The long-standing disease state of ONJ deteriorates the quality of life of affected patients. Early detection and prevention of the disease are key to alleviating pain and discomfort. To date, several imaging modalities have been introduced to depict the lesions. Imaging modalities, radiography, CT, MRI and nuclear medicine provide important information for managing this challenging disease.
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Affiliation(s)
- Makoto Tsuchimochi
- The Nippon Dental University (Emeritus Professor), Formerly, Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata 951-8580, Japan
| | - Tohru Kurabayashi
- Department of Oral and Maxillofacial Radiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
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Pachêco‐Pereira C, Almeida FT, Chavda S, Major PW, Leite A, Guerra EN. Dental imaging of trabecular bone structure for systemic disorder screening: A systematic review. Oral Dis 2018; 25:1009-1026. [DOI: 10.1111/odi.12950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Camila Pachêco‐Pereira
- School of Dentistry, Faculty of Medicine and DentistryUniversity of Alberta Edmonton Alberta Canada
- Health Sciences Faculty University of Brasília Brasília Brazil
| | - Fabiana T. Almeida
- School of Dentistry, Faculty of Medicine and DentistryUniversity of Alberta Edmonton Alberta Canada
| | - Suraj Chavda
- School of Dentistry, Faculty of Medicine and DentistryUniversity of Alberta Edmonton Alberta Canada
| | - Paul W. Major
- School of Dentistry, Faculty of Medicine and DentistryUniversity of Alberta Edmonton Alberta Canada
| | - Andre Leite
- Health Sciences Faculty University of Brasília Brasília Brazil
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Hingst V, Weber MA. Bildgebende Diagnostik bei medikamenteninduzierten Kiefernekrosen. Radiologe 2018; 58:935-948. [DOI: 10.1007/s00117-018-0443-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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17
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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.
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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
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Barngkgei I, Khattab R. Detecting the effect of bisphosphonates during osteoporosis treatment on jawbones using multidetector computed tomography: The
OSTEOSYR
project. ACTA ACUST UNITED AC 2018; 9:e12332. [DOI: 10.1111/jicd.12332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/19/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Imad Barngkgei
- Department of Oral MedicineFaculty of DentistrySyrian Private University Damascus Syria
- Department of Oral MedicineFaculty of DentistryDamascus University Damascus Syria
| | - Razan Khattab
- Department of PeriodontologyFaculty of DentistryDamascus University Damascus Syria
- Department of PeriodontologyFaculty of DentistryAlsham Private University Damascus Syria
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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.
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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
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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.
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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
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Panoramic radiographic features that predict the development of bisphosphonate-related osteonecrosis of the jaw. Oral Radiol 2017; 34:151-160. [DOI: 10.1007/s11282-017-0293-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/20/2017] [Indexed: 11/26/2022]
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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.
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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.
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Taguchi A, Shiraki M, Morrison A, Khan AA. Antiresorptive agent-related osteonecrosis of the jaw in osteoporosis patients from Asian countries. Osteoporos Sarcopenia 2017; 3:64-74. [PMID: 30775507 PMCID: PMC6372774 DOI: 10.1016/j.afos.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 02/27/2017] [Accepted: 03/04/2017] [Indexed: 11/05/2022] Open
Abstract
Bisphosphonate (BP)-associated osteonecrosis of the jaw (ONJ) was first reported in oncology patients in 2003 and subsequently in osteoporosis patients in 2004. Since oral surgical procedures, such as tooth extraction, are also considered one of the major risk factors for ONJ, there is confusion among physicians, dentists, and patients—particularly osteoporosis patients currently taking BPs—regarding the safety of remaining on therapy surrounding these procedures. Many papers about BP-related ONJ (BRONJ) have been published to date. In addition to BRONJ, recent studies have reported an association between ONJ and the antiresorptive therapy denosumab (Dmab; a RANKL-inhibitor). BRONJ and Dmab-related ONJ are together referred to as antiresorptive agent-related ONJ (ARONJ). The pathogenesis of ARONJ still remains unknown. It is forecasted that there will be an increased incidence of patients with osteoporotic fractures and an increased number of prescriptions for antiresorptive agents in Asia in the future. However, prescriptions for antiresorptives for osteoporosis may be restricted in the Asian population as the occurrence of ARONJ may be higher as compared with those in other countries. In this review, we focused on the following topics as it pertains to the Asian osteoporotic population: the oral condition specific for osteoporosis patients; definition, staging, prevalence and incidence of ARONJ; imaging modalities for ARONJ; specific risk factors for ARONJ; prevention strategies for ARONJ, and; cooperation between physicians and dentists in the prevention of ARONJ. Ideally, the Asian Federation of Osteoporosis Societies would cooperate with one another and find more population-specific evidence for the prevention of ARONJ.
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Affiliation(s)
- Akira Taguchi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, Shiojiri, Japan
| | - Masataka Shiraki
- Research Institute and Practice for Involutional Diseases, Nagano, Japan
| | | | - Aliya A Khan
- Divisions of Endocrinology and Metabolism and Geriatrics, Department of Medicine, McMaster University, Hamilton, ON, Canada
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Martelli SJR, Damian MF, Gomes APN, Schinestsck AR, Silva AER, Vasconcelos ACU. Comparison of effects of zoledronic acid and clodronate on the bone structure: imaginological and histomorphometrical study in vivo. J Oral Pathol Med 2017; 46:632-636. [DOI: 10.1111/jop.12546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2017] [Indexed: 01/21/2023]
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Watanabe S, Nakajima K, Mizokami A, Yaegashi H, Noguchi N, Kawashiri S, Inokuchi M, Kinuya S. Bone scan index of the jaw: a new approach for evaluating early-stage anti-resorptive agents-related osteonecrosis. Ann Nucl Med 2016; 31:201-210. [DOI: 10.1007/s12149-016-1145-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/10/2016] [Indexed: 12/13/2022]
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