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Ha JY, Eo MY, Sodnom-Ish B, Mustakim KR, Myoung H, Kim SM. Electron microscopic analysis of necrotic bone and failed implant surface in a patient with medication-related osteonecrosis of the jaw. Maxillofac Plast Reconstr Surg 2023; 45:34. [PMID: 37789223 PMCID: PMC10547673 DOI: 10.1186/s40902-023-00402-9] [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: 07/02/2023] [Accepted: 09/17/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Bisphosphonates (BP), a commonly used medication for various bone diseases, have been known to have severe complications such as bisphosphonate-related osteonecrosis of the jaw (BRONJ). Failure of dental implants has also been found in patients with medication-related osteonecrosis of the jaw (MRONJ). In this study, we analyzed the necrotic bone tissues and the surface of the failed implants removed from the jaw in patients treated with BPs and antiresorptive agents. RESULTS Chronic inflammatory cells with collagen and fibrous tissues and bone sequestrum were shown at 5.0 × , 10.0 × , 20.0 × , and 40.0 × magnified histologic sections in the bone and fibrotic scar tissues removed from patients with MRONJ due to osteonecrosis. Hardened bone tissues with microcracked bony resorbed lacunae were observed in SEM. Unlike the previously published comparative data where immune cells, such as dendritic cells, were found in the failed implant surface, these immune cells were not identified in the BRONJ-related peri-implantitis tissues through the TEM investigations. Furthermore, EDS revealed that in addition to the main titanium element, gold, carbon, oxygen, calcium, phosphorus, silicon, and sulfur elements were found. CONCLUSION Hardened bone tissues with microcracked bony resorbed lacunae were observed in the SEM findings, which were considered as the main characteristic of the osteonecrosis of the jaw. Immune cells, such as dendritic cells were not identified in the TEM. EDS showed that in addition to the main titanium element, gold, carbon, oxygen, calcium, phosphorus, and silicon elements were found. Furthermore, it was revealed that sulfur was found, which was considered to be one of the complicated causes of implant failure in patients with BRONJ.
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Affiliation(s)
- Ji Young Ha
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Mi Young Eo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Buyanbileg Sodnom-Ish
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Kezia Rachellea Mustakim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Hoon Myoung
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Soung Min Kim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.
- Oral and Maxillofacial Microvascular Reconstruction Lab, Brong Ahafo Regional Hospital, Ghana Health Service, P.O. Box 27, Sunyani, Brong Ahafo, Ghana.
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Significance of medication discontinuation on bisphosphonate-related jaw osteonecrosis in a rat model. Sci Rep 2022; 12:21449. [PMID: 36509781 PMCID: PMC9744902 DOI: 10.1038/s41598-022-25347-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
Bisphosphonate (BP) discontinuation has been advised as a measure to prevent the incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ), however, its efficacy remains controversial. This study aimed to analyze the efficacy of BP discontinuation in reducing BRONJ severity following tooth extraction in a rat model. Thirty-four male Sprague-Dawley rats were divided into two BRONJ model categories: oral administration (PO) of alendronate (1 mg/kg) for 3 and 8 weeks and intraperitoneal (IP) injection of pamidronate (3 mg/kg) and dexamethasone (1 mg/kg) for 20 days. The PO model was divided into five groups (a control group without BPs and four experimental groups with 1-week discontinuation). The IP model was divided into two groups consisting of group I (without discontinuation) and group II (1-week discontinuation). One molar from both sides of the mandible was extracted. After extraction, the PO models were sacrificed at 3 and 5 weeks, and the IP models were sacrificed either immediately or at 2, 4, 6, and 8 weeks. Micro-CT showed non-significant differences among PO groups but significant differences were observed between IP groups. Most bone remodeling parameters within group I of the IP model differed significantly (p-value < 0.05). Histologically, group I showed a significantly higher percentage of necrotic bone than group II (51.93 ± 12.75%, p < 0.05) and a higher number of detached osteoclasts in TRAP staining. With discontinuation of medication for at least 1 week in rats, the effects of BPs on alveolar bone are suppressed and bone turnover and osteoclast functions are restored.
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Aoki K, Matsunaga S, Ito S, Shibahara T, Nomura T, Matsuzaki H, Abe S, Yamaguchi A. Persistent bone resorption lacunae on necrotic bone distinguish bisphosphonate-related osteonecrosis of jaw from denosumab-related osteonecrosis. J Bone Miner Metab 2021; 39:737-747. [PMID: 33830351 DOI: 10.1007/s00774-021-01223-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Bisphosphonate and denosumab are widely used for the treatment of osteoporosis and bone metastasis of cancer to prevent excessive bone resorption. Osteonecrosis of the jaw is a serious adverse effect of bisphosphonate or denosumab referred to as bisphosphonate-related osteonecrosis of the jaw (BRONJ) or denosumab-related osteonecrosis of the jaw (DRONJ), respectively. Since bisphosphonate and denosumab inhibit bone resorption by different mechanism, we evaluated whether these drug types result in different histopathological characteristics related to bone resorption. MATERIALS AND METHODS We histopathologically investigated 10 cases of BRONJ, DRONJ, and suppurative osteomyelitis. Paraffin sections prepared from decalcified dissected jaw bones were used for histopathological observation, second harmonic generation imaging, and bone histomorphometry. The samples were also observed by a scanning electron microscope. RESULTS Numerous bone resorption lacunae were observed on the necrotic bone surface in almost all cases of BRONJ; however, such resorption lacunae were limited in DRONJ and suppurative osteomyelitis. Prominent bone resorption lacunae were also confirmed by second harmonic generation imaging and scanning electron microscopy in BRONJ, but not in DRONJ or suppurative osteomyelitis. As determined by bone histomorphometry, the number of bone resorption lacunae and the length of the erosion surface of resorption lacunae were significantly higher in BRONJ group than in the DRONJ and suppurative osteomyelitis groups. These parameters were correlated between the necrotic bones and the vital bones in BRONJ. CONCLUSIONS Persistent bone resorption lacunae on the necrotic bone surface are unique to BRONJ, providing a basis for distinguishing BRONJ from DRONJ and OM in histopathological diagnosis.
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Affiliation(s)
- Kazumitsu Aoki
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
- Department of Dentistry and Oral Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 kotobashi, Sumida-ku, Tokyo, 130-8675, Japan
| | - Satoru Matsunaga
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
- Tokyo Dental College Research Branding Project, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Shinichirou Ito
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Takahiko Shibahara
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Takeshi Nomura
- Tokyo Dental College Research Branding Project, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
- Department of Oral Oncology and Maxillofacial Surgery, Ichikawa General Hospital, Tokyo Dental College, 5-11-13 Sugano, Ichikawa city, Chiba, 272-8513, Japan
| | - Hideo Matsuzaki
- Department of Dentistry and Oral Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 kotobashi, Sumida-ku, Tokyo, 130-8675, Japan
| | - Shinichi Abe
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
- Tokyo Dental College Research Branding Project, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan
| | - Akira Yamaguchi
- Tokyo Dental College Research Branding Project, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
- Oral Health Science Center, Tokyo Dental College, 2-9-18 Kanda-Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
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Maciel AP, Quispe RA, Martins LJO, Caldas RJ, Santos PSDS. Clinical profile of individuals with bisphosphonate-related osteonecrosis of the jaw: an integrative review. SAO PAULO MED J 2020; 138:326-335. [PMID: 32725058 PMCID: PMC9673834 DOI: 10.1590/1516-3180.2019.0352.r2.15052020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/15/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is still the most prevalent type of osteonecrosis with clinical relevance. In Brazil, bisphosphonate use is high but there is a lack of epidemiological studies on BRONJ. OBJECTIVE To determine the clinical profile of BRONJ in a Brazilian population through an integrative review. DESIGN AND SETTING Integrative review of BRONJ in a Brazilian population. METHODS Cases and clinical research on Brazilians with BRONJ between 2010 and 2019, indexed in PubMed/MEDLINE, Scopus, Web of Science and LILACS were reviewed. Age, sex, type and time of bisphosphonate intake, administration route, related diseases, region of the BRONJ, diagnostic criteria, staging, triggering factor and type of treatment were analyzed. RESULTS Fifteen articles on 128 subjects were included. Most patients were women (82.03%); the mean age was 63 years. Intravenous zoledronic acid was mostly used (62.50%), for breast cancer treatment (46.87%). The main localization of BRONJ was the mandible (54.68%), associated mainly with tooth extractions (45.98%). The diagnostic criteria were clinical (100%) and radiographic (89.06%), mostly in stage II (68.08%). The surgical treatments were sequestrectomy (37.50%) and platelet-rich plasma (PRP) (36.71%). Microbial control was done using chlorhexidine (93.75%) and infection control using clindamycin (53.90%). CONCLUSIONS BRONJ had higher prevalence in Brazilian women receiving treatment for breast cancer and osteoporosis. The mandible was the region most affected with a moderate stage of BRONJ, particularly when there were histories of tooth extraction and peri-implant surgery. Sequestrectomy with additional drugs and surgical therapy was the treatment most accomplished.
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Affiliation(s)
- Aloizio Premoli Maciel
- DDS, MSc. Dentist and Doctoral Student, Department of Surgery, Stomatology, Pathology and Radiology, Faculdade de Odontologia da Universidade de São Paulo (FOUSP), Bauru (SP), Brazil.
| | - Reyna Aguilar Quispe
- DDS, MSc. Dentist and Doctoral Student, Department of Surgery, Stomatology, Pathology and Radiology, Faculdade de Odontologia da Universidade de São Paulo (FOUSP), Bauru (SP), Brazil.
| | - Lázara Joyce Oliveira Martins
- DDS, MSc. Dentist and Assistant Professor, Department of Radiology, Clinical School of Dentistry, Universidade de Rio Verde (UniRV), Rio Verde (GO), Brazil.
| | - Rogério Jardim Caldas
- DDS, MSc, PhD. Dentist and Head, Department of Dentistry, Hospital Mário Kroeff - Hospital de Câncer, Rio de Janeiro (RJ), Brazil.
| | - Paulo Sérgio da Silva Santos
- DDS, MSc, PhD. Dentist and Associate Professor, Department of Surgery, Stomatology, Pathology and Radiology, Faculdade de Odontologia da Universidade de São Paulo (FOUSP), Bauru, São Paulo, Brazil.
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Lee SS, Kim SM, Kim YS, Lee SK. Extensive protein expression changes induced by pamidronate in RAW 264.7 cells as determined by IP-HPLC. PeerJ 2020; 8:e9202. [PMID: 32509464 PMCID: PMC7246033 DOI: 10.7717/peerj.9202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/24/2020] [Indexed: 12/19/2022] Open
Abstract
Background Bisphosphonate therapy has become a popular treatment for osteoporosis, Paget’s disease, multiple myeloma, osteogenesis imperfecta, myocardial infarction, and cancer despite its serious side effects. Bisphosphonate-induced molecular signaling changes in cells are still not clearly elucidated. Methods As bisphosphonates are primarily engulfed by macrophages, we treated RAW 264.7 cells (a murine macrophage cell line) with pamidronate and investigated global protein expressional changes in cells by immunoprecipitation high performance liquid chromatography (IP-HPLC) using 218 antisera. Results Pamidronate upregulated proliferation-activating proteins associated with p53/Rb/E2F and Wnt/β-catenin pathways, but downregulated the downstream of RAS signaling, pAKT1/2/3, ERK-1, and p-ERK-1, and subsequently suppressed cMyc/MAX/MAD network. However, in situ proliferation index of pamidronate-treated RAW264.7 cells was slightly increased by 3.2% vs. non-treated controls. Pamidronate-treated cells showed increase in the expressions of histone- and DNA methylation-related proteins but decrease of protein translation-related proteins. NFkB signaling was also suppressed as indicated by the down-regulations of p38 and p-p38 and the up-regulation of mTOR, while the protein expressions related to cellular protection, HSP-70, NRF2, JNK-1, and LC3 were upregulated. Consequently, pamidronate downregulated the protein expressions related to immediate inflammation,cellular differentiation, survival, angiogenesis, and osteoclastogenesis, but upregulated PARP-1 and FAS-mediated apoptosis proteins. These observations suggest pamidronate affects global protein expressions in RAW 264.7 cells by stimulating cellular proliferation, protection, and apoptosis but suppressing immediate inflammation, differentiation, osteoclastogenesis, and angiogenesis. Accordingly, pamidronate appears to affect macrophages in several ways eliciting not only its therapeutic effects but also atypical epigenetic modification, protein translation, RAS and NFkB signalings. Therefore, our observations suggest pamidronate-induced protein expressions are dynamic, and the affected proteins should be monitored by IP-HPLC to achieve the therapeutic goals during treatment.
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Affiliation(s)
- Sang Shin Lee
- Department of Oral Pathology, College of Dentistry, Gangneung-Wonju National University, Gangneung, Gangwondo, South Korea
| | - Soung Min Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Seoul National University, Seoul, South Korea
| | - Yeon Sook Kim
- Department of Dental Hygiene, College of Health & Medical Sciences, Cheongju University, Cheongju, South Korea
| | - Suk Keun Lee
- Department of Oral Pathology, College of Dentistry, Gangneung-Wonju National University, Gangneung, Gangwondo, South Korea
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Heim N, Götz W, Kramer FJ, Faron A. Antiresorptive drug-related changes of the mandibular bone densitiy in medication-related osteonecrosis of the jaw patients. Dentomaxillofac Radiol 2019; 48:20190132. [PMID: 31530019 DOI: 10.1259/dmfr.20190132] [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] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Medication-related osteonecrosis of the jaw (MRONJ) is a well known side-effect of anti-resorptive drugs. Changes in bone density might potentially constitute the development of ONJ. This study aimed to investigate, to which degree bisphosphonates (bp) and denosumab (db) induce changes in bone density that can be determined from routine diagnostic CT. METHODS CT scans of 101 patients were investigated. MRONJ was present in 61 patients (n = 26: db-treated; n = 35 bp-treated). 40 patients were included as a reference group. Bone density was measured at two distinct locations in the mandible (M1: anterior of the mental foramen; M2: retromolar), each on the contralateral side to the necrosis. RESULTS The bone density values measured at both locations were found to be significantly higher in the bp-group compared to the db-group (p = 0.027) and to the reference-group (p = 0.016). Almost no difference (p = 0.84) in bone density value was found between the db- and reference-groups.Investigating the effect of duration of treatment, none of the measured values showed significant differences in both locations of db- and bp-group. CONCLUSION The findings from this study suggest that that bisphosphonates change the microarchitecture of the alveolar bone by being embedded in the mandible, which may subsequently lead to a bp-specific corticalization, and a decrease in vascularization of the lower jaw. This process may be distinctive for bp-treatment and seems to induce the congestion of cancellous bone rather rapidly after the first administrations. This effect could not be determined in denosumab-treated patients.
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Affiliation(s)
- Nils Heim
- Department for Oral & Cranio-Maxillo and Facial Plastic Surgery, University Clinic Bonn Germany Sigmund-Freud-Str. 25 Haus 11, 2. Obergeschoss 53127 Bonn, Bonn, Germany
| | - Werner Götz
- University of Bonn, Department of Orthodontics, Dental Hospital of the University of Bonn, Head of the Oral Biology Laboratory, Bonn, Germany
| | - Franz-Josef Kramer
- Department for Oral & Cranio-Maxillo and Facial Plastic Surgery, University Clinic Bonn Germany Sigmund-Freud-Str. 25 Haus 11, 2. Obergeschoss 53127 Bonn, Bonn, Germany
| | - Anton Faron
- University of Bonn, Department for Radiology, Bonn, Germany
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Yuan A, Munz A, Reinert S, Hoefert S. Histologic analysis of medication-related osteonecrosis of the jaw compared with antiresorptive-exposed bone and other infectious, inflammatory, and necrotic jaw diseases. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:133-140. [PMID: 31606424 DOI: 10.1016/j.oooo.2019.08.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/06/2019] [Accepted: 08/25/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study characterized histologic features of medication-related osteonecrosis of the jaw (MRONJ) through analysis of tissues from patients and healthy individuals. STUDY DESIGN Bone biopsies were collected from various infectious, inflammatory, and necrotic jaw diseases. Samples were divided into bone exposed to bisphosphonates or denosumab, as well as bisphosphonate-related osteonecrosis of the jaw (BRONJ), denosumab-related osteonecrosis of the jaw (DRONJ), and mixed necrosis, enabling us to identify features of single agent necrosis without influence from previous therapies. Hematoxylin and eosin (H&E), receptor activator of nuclear factor κ-Β ligand (RANKL), tartrate-resistant acid phosphatase (TRAP), osteoprotegerin, toluidine blue, CD14, and CD68 staining and micro-computed tomography (micro-CT) analysis were performed. Groups were compared by using analysis of variance (ANOVA). RESULTS In total, 156 bone samples were collected from 105 patients. MRONJ variants exhibited more infectious infiltration. Bisphosphonate (P < .001) and mixed necrosis (P = .002) demonstrated more RANKL- and TRAP-positive osteoclasts. Denosumab necrosis (P = .007), and bone exposed to bisphosphonates (P = .028) in combination with denosumab (P = .022) demonstrated significantly lower numbers of osteocytes per area. CD14 and CD68 positivity was increased for BRONJ (P = .008; P < .001, respectively). MRONJ variants exhibited the widest trabecular width and decreased medullary space to bone. No diminished vascular network in MRONJ samples was observed. CONCLUSIONS Histologic features differ among MRONJ variants, with oversuppressed bone turnover, dysfunctional bone resorption, and a disturbed osteocyte network as potential mechanisms of pathogenesis.
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Affiliation(s)
- Anna Yuan
- Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, Tübingen, Germany.
| | - Adelheid Munz
- Medical Technical Assistant, Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Siegmar Reinert
- Professor and Department Head, Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Sebastian Hoefert
- Senior Surgeon, Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, Tübingen, Germany
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Park MS, Eo MY, Myoung H, Kim SM, Lee JH. Early diagnosis of jaw osteomyelitis by easy digitalized panoramic analysis. Maxillofac Plast Reconstr Surg 2019; 41:6. [PMID: 30800645 PMCID: PMC6358629 DOI: 10.1186/s40902-019-0188-2] [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: 12/16/2018] [Accepted: 01/06/2019] [Indexed: 11/18/2022] Open
Abstract
Background Osteomyelitis is an intraosseous inflammatory disease characterized by progressive inflammatory osteoclasia and ossification. The use of quantitative analysis to assist interpretation of osteomyelitis is increasingly being considered. The objective of this study was to perform early diagnosis of osteomyelitis on digital panoramic radiographs using basic functions provided by picture archiving and communication system (PACS), a program used to show radiographic images. Methods This study targeted a total of 95 patients whose symptoms were confirmed as osteomyelitis under clinical, radiologic, pathological diagnosis over 11 years from 2008 to 2017. Five categorized patients were osteoradionecrosis, bisphosphonate-related osteonecrosis of jaw (BRONJ, suppurative and sclerosing type), and bacterial osteomyelitis (suppurative and sclerosing type), and the control group was 117 randomly sampled. The photographic density in a certain area of the digital panoramic radiograph was determined and compared using the “measure area rectangle,” one of the basic PACS functions in INFINITT PACS® (INFINITT Healthcare, Seoul, South Korea). A conditional inference tree, one type of decision making tree, was generated with the program R for statistical analysis with SPSS®. Results In the conditional inference tree generated from the obtained data, cases where the difference in average value exceeded 54.49 and the difference in minimum value was less than 54.49 and greater than 12.81 and the difference in minimum value exceeded 39 were considered suspicious of osteomyelitis. From these results, the disease could be correctly classified with a probability of 88.1%. There was no difference in photographic density value of BRONJ and bacterial osteomyelitis; therefore, it was not possible to classify BRONJ and bacterial osteomyelitis by quantitative analysis of panoramic radiographs based on existing research. Conclusions This study demonstrates that it is feasible to measure photographic density using a basic function in PACS and apply the data to assist in the diagnosis of osteomyelitis. Electronic supplementary material The online version of this article (10.1186/s40902-019-0188-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moo Soung Park
- 1Department of Dentistry, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Mi Young Eo
- 1Department of Dentistry, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea.,2Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
| | - Hoon Myoung
- 1Department of Dentistry, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea.,2Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
| | - Soung Min Kim
- 1Department of Dentistry, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea.,2Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
| | - Jong Ho Lee
- 1Department of Dentistry, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea.,2Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea
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Zoledronic Acid Induces Site-Specific Structural Changes and Decreases Vascular Area in the Alveolar Bone. J Oral Maxillofac Surg 2018; 76:1893-1901. [DOI: 10.1016/j.joms.2018.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/04/2018] [Accepted: 03/07/2018] [Indexed: 02/07/2023]
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Gülses A, Ayna M, Açil Y. A microorganism not to be overlooked in studies focusing on osteonecrosis of the jaws: Comment on "Kim SM, et al. Histochemical observation of bony reversal lines in bisphosphonate-related osteonecrosis of the jaw". Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:738-739. [PMID: 28478939 DOI: 10.1016/j.oooo.2016.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/29/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Aydin Gülses
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, Kiel, Germany
| | | | - Yahya Açil
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, Kiel, Germany
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