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Sakamoto Y, Sawada S, Kojima Y. Medication-related osteonecrosis of the jaw without osteolysis on computed tomography: a retrospective and observational study. Sci Rep 2023; 13:12890. [PMID: 37558709 PMCID: PMC10412630 DOI: 10.1038/s41598-023-39755-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/30/2023] [Indexed: 08/11/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a refractory osteonecrosis caused by antiresorptive agents such as bisphosphonate and denosumab (DMB). In MRONJ surgery, computed tomography (CT) is generally used to determine the extent of bone resection. However, in some recent MRONJ cases, no abnormal findings were detected on CT. Therefore, we aimed to clarify the characteristics of MRONJ without osteolysis. This retrospective and observational study included 18 patients diagnosed with MRONJ between October 2020 and October 2022 at Department of Dentistry and Oral Surgery, Kansai Medical University Medical Center. In four of 18 patients with MRONJ, no abnormal findings such as osteolysis, separation of sequestrum, and periosteal reaction were observed on CT images at the first visit. All four patients with non-osteolytic MRONJ had malignant tumors and received high-dose DMB, and in the four patients there were no preceding dental infections such as apical lesions or periodontal disease and the trigger of MRONJ was unknown. Surgery was performed in three of the four patients. The extent of bone resection was determined using magnetic resonance imaging and intraoperative gross findings. In the future, it is necessary to establish a method for diagnosing non osteolytic MRONJ and determining the extent of bone resection.
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Affiliation(s)
- Yuki Sakamoto
- Department of Dentistry and Oral Surgery, Kansai Medical University Medical Center, 10-15 Fumizono-Cho, Moriguchi, Osaka, 570-8507, Japan.
| | - Shunsuke Sawada
- Department of Dentistry and Oral Surgery and Oral Care, Kansai Medical University Hospital, Hirakata, Osaka, 573-1191, Japan
| | - Yuka Kojima
- Department of Dentistry and Oral Surgery and Oral Care, Kansai Medical University Hospital, Hirakata, Osaka, 573-1191, Japan
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2
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Ibrahim N, Apandi NIM, Shuhardi SA, Ramli R. Actinomyces sp. Presence in the Bone Specimens of Patients with Osteonecrosis of the Jaw: The Histopathological Analysis and Clinical Implication. Antibiotics (Basel) 2022; 11:antibiotics11081067. [PMID: 36009936 PMCID: PMC9405108 DOI: 10.3390/antibiotics11081067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) and osteoradionecrosis (ORN) are two similar bone pathologies in the jaw with different aetiologies. Actinomycosis is a relatively rare oral infection caused by the Gram-positive anaerobe Actinomyces sp. that normally colonizes the oral cavity. Actinomycosis is associated with the pathogenesis of both the MRONJ and ORN, as evident in our cases, and not just as a superficial contaminant. The clinical and histopathological aspects of the cases treated in our centre were also reported with a review of the literature. Clinical implication on the treatment of the cases was highlighted in view of the presence of this microorganism.
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Affiliation(s)
- Norliwati Ibrahim
- Department of Craniofacial Diagnostics & Biosciences, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
- Correspondence: ; Tel.: +60-179881120
| | - Nurul Inaas Mahamad Apandi
- Department of Craniofacial Diagnostics & Biosciences, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
| | - Syafiqah Aina Shuhardi
- Department of Oral & Maxillofacial Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
| | - Roszalina Ramli
- Department of Oral & Maxillofacial Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
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3
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Wu S, Li F, Tan J, Ye X, Le Y, Liu N, Everts V, Wan Q. Porphyromonas gingivalis Induces Bisphosphonate-Related Osteonecrosis of the Femur in Mice. Front Cell Infect Microbiol 2022; 12:886411. [PMID: 35811676 PMCID: PMC9256925 DOI: 10.3389/fcimb.2022.886411] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/25/2022] [Indexed: 11/15/2022] Open
Abstract
One of the most prominent characteristics of bisphosphonate-related osteonecrosis of the jaw(BRONJ) is its site-specificity. Osteonecrosis tends to occur specifically in maxillofacial bones, in spite of a systemic administration of the medicine. Previous studies suggested rich blood supply and fast bone turnover might be reasons for BRONJ. Yet, a sound scientific basis explaining its occurrence is still lacking. The present study aimed to explore the role of Porphyromonas gingivalis (P. gingivalis), an important oral pathogen, on the site-specificity of bisphosphonate-induced osteonecrosis and to elucidate its underlying mechanism. Mice were intraperitoneally injected with zoledronic acid (ZA) or saline for 3 weeks. In the third week, the right mandibular first molars were extracted and circular bone defects with a diameter of 1 mm were created in right femurs. After the operation, drug administration was continued, and P. gingivalis suspension was applied to the oral cavities and femur defects. The mice were killed after four or eight weeks postoperatively. The right mandibles and femurs were harvested for micro-CT and histological analyses. A poor healing of bone defects of both jaws and femurs was noted in mice injected with both ZA and P. gingivalis. Micro-CT analysis showed a decreased bone volume, and histological staining showed an increased number of empty osteocyte lacunae, a decreased collagen regeneration, an increased inflammatory infiltration and a decreased number of osteoclasts. In addition, the left femurs were collected for isolation of osteoclast precursors (OCPs). The osteoclastogenesis potential of OCPs was analyzed in vitro. OCPs extracted from mice of ZA-treated groups were shown to have a lower osteoclast differentiation potential and the expression level of related genes and proteins was declined. In conclusion, we established a mouse model of bisphosphonate-related osteonecrosis of both the jaw and femur. P. gingivalis could inhibit the healing of femur defects under the administration of ZA. These findings suggest that P. gingivalis in the oral cavity might be one of the steering compounds for BRONJ to occur.
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Affiliation(s)
- Shuxuan Wu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology [Hubei-Ministry of Science and Technology(MOST)] and Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Feng Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology [Hubei-Ministry of Science and Technology(MOST)] and Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jingjing Tan
- The State Key Laboratory Breeding Base of Basic Science of Stomatology [Hubei-Ministry of Science and Technology(MOST)] and Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xiaoling Ye
- The State Key Laboratory Breeding Base of Basic Science of Stomatology [Hubei-Ministry of Science and Technology(MOST)] and Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Stomatology, Shenzhen Yantian District People’s Hospital, Shenzhen, China
| | - Yushi Le
- The State Key Laboratory Breeding Base of Basic Science of Stomatology [Hubei-Ministry of Science and Technology(MOST)] and Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Nianke Liu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology [Hubei-Ministry of Science and Technology(MOST)] and Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Vincent Everts
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
- Department of Anatomy, Dental Faculty, Chulalongkorn University, Bangkok, Thailand
| | - Qilong Wan
- The State Key Laboratory Breeding Base of Basic Science of Stomatology [Hubei-Ministry of Science and Technology(MOST)] and Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthognathic & Cleft Lip and Palate Plastic Surgery, Hospital of Stomatology, Wuhan University, Wuhan, China
- *Correspondence: Qilong Wan,
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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]
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Mostovoy SO, Kutia SA, Peshkov MV. [Morphological features of jaw osteonecroses in injectable drug abuse]. Arkh Patol 2021; 83:20-26. [PMID: 34859982 DOI: 10.17116/patol20218306120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the characteristic features in the structure of jaw bone sections in patients with jaw osteonecrosis caused by the use of homemade methamphetamine (HM) synthesized by the Nagai method. MATERIAL AND METHODS The investigation material was jaw sequesters and resected sections in 60 patients, which had been taken during sanitizing surgery for chronic odontogenic osteomyelitis (Group 1, n=30, a comparison group) and jaw osteonecrosis (Group 2, n=30). All the patients in Group 2 confirmed that they had been using HM for at least 2 years. The investigation material was selected only from the patients who had not been found to have congenital or acquired immunodeficiencies or multiple organ failure phenomena. The material was fixed according to the standard procedure; the sections obtained were stained with hematoxylin and eosin and Masson-Goldner. Morphometry used the indicators proposed by the American Society of Bone and Mineral Research Histomorphometry Nomenclature Committee, as well as 6 author parameters. The findings of the investigation were statistically processed using the Statistica 10.0 program (StatSoft, USA) by the nonparametric Mann-Whitney test. RESULTS The histoarchitectonics of the mandible bone matrix represented a destructured devitalized tissue complex on the mandibular microspecimens taken from a group of patients with chronic odontogenic osteomyelitis of the jaws. The state of the bone matrix was characterized by the atypical rearrangement with the phenomena of sclerosis, the signs of primary aseptic inflammation with toxic vasculopathy and fibrinoid necrosis, as well as those of secondary pyonecrotic inflammation on the mandibular microspecimens taken in the HM group. CONCLUSION The characteristic morphological pattern of jaw osteonecrotic injuries in persons with HM-induced drug abuse is the simultaneous identification of two types of lesions: a primary lesion as aseptic ossifying osteitis and a secondary lesion as pyonecrotic inflammation. The phenomena of toxic vasculopathy and fibrinoid osteonecrosis can serve as one of the criteria confirming the active regular intake of HM.
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Affiliation(s)
- S O Mostovoy
- V.I. Vernadsky Crimean Federal University, Simferopol, Russia
| | - S A Kutia
- V.I. Vernadsky Crimean Federal University, Simferopol, Russia
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Miyamoto I, Tanaka R, Kogi S, Yamaya G, Kawai T, Ohashi Y, Takahashi N, Izumisawa M, Yamada H. Clinical Diagnostic Imaging Study of Osteoradionecrosis of the Jaw: A Retrospective Study. J Clin Med 2021; 10:jcm10204704. [PMID: 34682827 PMCID: PMC8538245 DOI: 10.3390/jcm10204704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/23/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
Radiation therapy (RT) plays a significant role in the management of head and neck malignancies. This study aimed to review the clinical symptoms and various imaging findings of osteoradionecrosis (ORN) and provide a clinical perspective on the development of ORN. The retrospective cohort was composed of 57 sites in 54 patients who had a history of RT and suspected ORN and 48 sites in 45 patients who were confirmed to have ORN. Image analyses included computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, bone scintigraphy, and single-photon emission CT (SPECT). The irradiated tissue was damaged by RT, and the extent of damage was correlated with clinical symptoms. The bone marrow showed sclerotic changes and the devitalized bone showed bone resorption after invasive stimulation. Chronic trismus and pathological fracture are considered severe conditions, typically occurring in the last stage of ORN. Furthermore, neurological symptoms were an important sign of tumor recurrence, since diagnostic imaging was difficult. The possible treatment options vary depending on the stage of ORN. We speculate that bone sclerosis reactions and bone resorption are sequential reactions that seem to be protective measures of the bone to radiation injury.
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Affiliation(s)
- Ikuya Miyamoto
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
- Correspondence: ; Tel.: +81-19-651-5111
| | - Ryoichi Tanaka
- Division of Oral and Maxillofacial Radiology, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (R.T.); (N.T.); (M.I.)
| | - Shintaro Kogi
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
| | - Genki Yamaya
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
| | - Tadashi Kawai
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
| | - Yu Ohashi
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
| | - Noriaki Takahashi
- Division of Oral and Maxillofacial Radiology, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (R.T.); (N.T.); (M.I.)
| | - Mitsuru Izumisawa
- Division of Oral and Maxillofacial Radiology, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (R.T.); (N.T.); (M.I.)
| | - Hiroyuki Yamada
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Dental Medicine, Iwate Medical University, Morioka 020-8505, Japan; (S.K.); (G.Y.); (T.K.); (Y.O.); (H.Y.)
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Necrotising periodontal diseases and alcohol misuse - a cause of osteonecrosis? BDJ TEAM 2021. [PMCID: PMC8517948 DOI: 10.1038/s41407-021-0744-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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8
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Necrotising periodontal diseases and alcohol misuse - a cause of osteonecrosis? Br Dent J 2021; 231:225-231. [PMID: 34446893 PMCID: PMC8390050 DOI: 10.1038/s41415-021-3272-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/18/2020] [Indexed: 11/08/2022]
Abstract
'Necrotising periodontal diseases' is an umbrella term for necrotising gingivitis, necrotising periodontitis, necrotising stomatitis and noma. These rapidly destructive conditions are characterised by pain, interdental ulceration and gingival necrosis which, if left untreated, can result in osteonecrosis. Research indicates that patients with a history of alcohol misuse are at an increased risk of malnutrition, which negatively affects the immune response and predisposition to necrotising periodontal diseases. This article will discuss that osteonecrosis of the alveolar bone does not exclusively occur in association with antiresorptive medications, but can occur as a severe form of necrotising gingivitis. In this article, we will describe two cases to highlight the occurrence, presentation and management of necrotising periodontal diseases secondary to alcohol misuse. Raises clinician awareness on the topic of necrotising periodontal diseases and describes diagnosis and treatment modalities. Explores and explains the link between alcohol misuse, malnutrition and necrotising periodontal diseases. Encourages dentists to liaise with healthcare professionals in the management of patients suffering from underlying comorbidities, highlighting the importance of holistic patient care.
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Díaz-Castellón DF, Llaguno-Rubio JM, Medina-Ocampo PE. [Imaging features of osteomyelitis of the jaws with different diagnostic methods. A review]. REVISTA CIENTÍFICA ODONTOLÓGICA 2021; 9:e077. [PMID: 38464859 PMCID: PMC10919801 DOI: 10.21142/2523-2754-0903-2021-077] [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: 08/21/2021] [Accepted: 09/24/2021] [Indexed: 03/12/2024] Open
Abstract
Osteomyelitis of the jaws (OM) is an infectious pathology involving the bone marrow. It is due to various etiologies, the main one being odontogenic. The diagnosis of OM is a challenge for dentists, who must rely on clinical and imaging examinations. Panoramic radiography is the most frequently used imaging test, but it has some limitations that have improved with the incorporation of new imaging methods such as computed tomography, cone beam computed tomography, magnetic resonance imaging, and bone scintigraphy with radionuclides. The purpose of this review was to describe the imaging characteristics of OM of the jaws according to the radiological diagnostic methods available in the literature in order to provide radiologisst with greater knowledge and improve reporting in daily practice.
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Affiliation(s)
- Dirce Fernanda Díaz-Castellón
- Facultad de Odontología de la Universidad San Francisco Xavier de Chuquisaca. Sucre, Bolivia. Facultad de Odontología Universidad San Francisco Xavier de Chuquisaca Sucre Bolivia
| | - Jhoana Mercedes Llaguno-Rubio
- División de Radiología Bucal y Maxilofacial de la Universidad Científica del Sur. Lima, Perú. , Universidad Científica del Sur División de Radiología Bucal y Maxilofacial Universidad Científica del Sur Lima Peru
| | - Paola Eliana Medina-Ocampo
- División de Radiología Bucal y Maxilofacial de la Universidad Científica del Sur. Lima, Perú. , Universidad Científica del Sur División de Radiología Bucal y Maxilofacial Universidad Científica del Sur Lima Peru
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10
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Yamashita J, Sawa N, Sawa Y, Miyazono S. Effect of bisphosphonates on healing of tooth extraction wounds in infectious osteomyelitis of the jaw. Bone 2021; 143:115611. [PMID: 32829042 DOI: 10.1016/j.bone.2020.115611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Antiresorptive agent-related osteonecrosis of the jaw (ARONJ) and infectious osteomyelitis of the jaw (OMJ) in antiresorptive-naïve patients are different disease entities. Although osteoclast inhibition is at the center of the pathogenesis of ARONJ, the role of osteoclast inhibition in infectious OMJ is unknown. The objective of this study was to determine the effect of bisphosphonate osteoclast inhibition in infectious OMJ. METHODS Osteomyelitis was induced in mice by S. aureus inoculation. The establishment of OMJ was verified by the culture of bone marrow samples obtained from the mandible. Infected animals received either zoledronic acid (ZA) or saline starting at week-2. Treated animals along with non-infected animals underwent tooth extractions at week-4 post-infection. Healing was assessed every week using in vivo micro-computed tomography and intraoral photos. Animals were euthanized at week-8 and cervical lymph nodes were assessed for lymphatic and blood vessels. RESULTS Tooth extraction wounds did not heal in animals with OMJ. These wounds were characterized by incomplete soft tissue coverage, sporadic bone fill in the sockets, and inflammatory cell accumulation in the connective tissue at 4 weeks after tooth extractions. Conversely, the majority of tooth extraction wounds in the infected animals treated with ZA had improved healing with better bone fill than even non-infected control animals. Consistently, atrophic lymphatic vessels were noted in the draining lymph nodes in animals with OMJ. However, infected animals treated with ZA had lymphatic vessels that were unaltered and showed a similar appearance to those in non-infected control animals. CONCLUSION ZA treatment promoted wound healing in the jaw with infectious osteomyelitis. Clearly, antiresorptive therapy is contraindicated in patients with ARONJ. However, our finding suggests that osteoclast inhibition is potentially an effectual remedy for infectious OMJ in antiresorptive-naïve patients.
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Affiliation(s)
- Junro Yamashita
- Center for Regenerative Medicine, Fukuoka Dental College, Fukuoka, Japan; Department of Oral Rehabilitation, Fukuoka Dental College, Fukuoka, Japan.
| | - Naruhiko Sawa
- Center for Regenerative Medicine, Fukuoka Dental College, Fukuoka, Japan; Department of Oral Rehabilitation, Fukuoka Dental College, Fukuoka, Japan
| | - Yoshihiko Sawa
- Department of Oral Function and Anatomy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shoji Miyazono
- Department of Oral Rehabilitation, Fukuoka Dental College, Fukuoka, Japan
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Terenzi V, Della Monaca M, Raponi I, Battisti A, Priore P, Barbera G, Romeo U, Polimeni A, Valentini V. MRONJ and ORNJ: When a single letter leads to substantial differences. Oral Oncol 2020; 110:104817. [DOI: 10.1016/j.oraloncology.2020.104817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 12/14/2022]
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12
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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.
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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
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13
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Dekker H, Schulten EAJM, van Ruijven L, van Essen HW, Blom GJ, Bloemena E, Ten Bruggenkate CM, Kullaa AM, Bravenboer N. Bone microarchitecture and turnover in the irradiated human mandible. J Craniomaxillofac Surg 2020; 48:733-740. [PMID: 32591131 DOI: 10.1016/j.jcms.2020.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/13/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the microarchitecture and turnover in irradiated cancellous mandibular bone and the relation with radiation dose, to elucidate the effects of radiotherapy on the mandible. PATIENTS AND METHODS Mandibular cancellous bone biopsies were taken from irradiated patients and controls. Micro-CT scanning was performed to analyze microstructural bone parameters. Bone turnover was assessed by histomorphometry. Local radiation dose at the biopsy site (Dmax) was estimated from radiotherapy plans. RESULTS Twenty-seven irradiated patients and 35 controls were included. Osteoid volume (Osteoid Volume/Bone Volume, OV/BV) [0.066/0.168 (median/interquartile range (IQR), OV/BV; %), P < 0.001], osteoid surface (Osteoid Surface/Bone Surface, OS/BS) [0.772/2.17 (median/IQR, OS/BS; %), P < 0.001] and osteoclasts number (Osteoclasts per millimetre bone surface, Ocl/mmBS; mm2) [0.026/0.123 (median/IQR, Ocl/mmBS; mm2), P < 0.001] were decreased; trabecular number (Tb.N) was lower [1.63/0.63 (median/IQR, Tb.N; 1/mm-1), P = 0.012] and trabecular separation (Tb.Sp) [0.626/0.24 (median/IQR, Tb.Sp; μm), P = 0.038] was higher in irradiated mandibular bone. With higher Dmax, trabecular number increases (Spearman's correlation R = 0.470, P = 0.018) and trabecular separation decreases (Spearman's correlation R = -0.526, P = 0.007). Bone mineral density (BMD, milligrams hydroxyappetite per cubic centimetre, mgHA/cm3) [1016/99 (median/IQR, BMD; mgHA/cm3), P = 0.03] and trabecular separation [0.739/0.21 (median/IQR, Tb.Sp; μm), P = 0.005] are higher whereas connectivity density (Conn Dens) [3.94/6.71 (median/IQR, Conn Dens), P = 0.047] and trabecular number [1.48/0.44 (median/IQR, Tb.N; 1/mm-1), P = 0.002] are lower in Dmax ≤50 Gy compared to controls. CONCLUSIONS Radiotherapy dramatically impairs bone turnover in the mandible. Deterioration in microarchitecture only affects bone irradiated with a Dmax of <50 Gy. The 50 Gy value seems to be a critical threshold to where the effects of the radiation is more detrimental.
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Affiliation(s)
- H Dekker
- Amsterdam UMC, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam, the Netherlands.
| | - E A J M Schulten
- Amsterdam UMC, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam, the Netherlands.
| | - L van Ruijven
- Department of Functional Anatomy, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.
| | - H W van Essen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Chemistry, the Netherlands.
| | - G J Blom
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiotherapy, Amsterdam, the Netherlands.
| | - E Bloemena
- Amsterdam UMC, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam, the Netherlands.
| | - Chr M Ten Bruggenkate
- Amsterdam UMC, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam, the Netherlands; Alrijne Hospital, Department of Oral and Maxillofacial Surgery, Leiderdorp, the Netherlands.
| | - A M Kullaa
- Institute of Dentistry, University of Eastern Finland, Kuopio Campus, and Educational Dental Clinic, Kuopio University Hospital, Kuopio, Finland.
| | - N Bravenboer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Chemistry, the Netherlands; Leiden University Medical Center, Department of Internal Medicine, Division of Endocrinology and Center for Bone Quality, Leiden, the Netherlands.
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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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15
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Liu SS, Lin TY, Fu E, Hsia YJ, Chiu HC, Tu HP, Chiang CY. Immediate hyperbaric oxygen after tooth extraction ameliorates bisphosphonate-related osteonecrotic lesion in rats. J Periodontol 2019; 90:1449-1456. [PMID: 31257597 DOI: 10.1002/jper.18-0761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/23/2019] [Accepted: 03/15/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study aims to assess whether hyperbaric oxygen (HBO) applied immediately after tooth extraction could ameliorate medication-related osteonecrosis of the jaw in rats. METHODS To evaluate whether osteonecrosis could be successfully induced, healing of extraction maxillary molars was examined in 40 female Sprague Dawley rats received zoledronic acid (7.5 µg/kg) plus dexamethasone (1 mg/kg). Rats were divided into four groups, receiving zero, two, four, or seven injection(s) for 7 days, respectively. Effect of HBO, pressurized to 2.5 atmospheres absolute (ATA) at rate of 0.15 ATA/min with 100% oxygen for 90 minutes, applied immediately after tooth extraction, on the development of osteonecrosis was evaluated. Lesions among groups were compared by size of ulceration, exact area (mm2 ) or relative area (%), and by histology. RESULTS Unhealed ridge was observed in all nine rats in four and seven injection groups, but none of 10 rats in the control (non-injection) group. Immediate HBO significantly reduced the lesions in rats that received four injections, regardless of the distribution and the total/relative areas of lesions (P <0.01). Histological findings showed the lesions were uncovered epithelium and severe tissue inflammation. CONCLUSION This is the first in vivo study demonstrating the HBO applied immediately after tooth extraction effectively decreases the development of medication-related osteonecrosis.
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Affiliation(s)
- Sao-Shen Liu
- Periodontics Division, Department of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tzu-Yi Lin
- Periodontics Division, Department of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Private Practice, New Taipei City, Taiwan, ROC
| | - Earl Fu
- Periodontics Division, Department of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Dentistry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Xindian, New Taipei City, Taiwan, ROC
| | - Yi-Jan Hsia
- Periodontics Division, Department of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Dentistry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Xindian, New Taipei City, Taiwan, ROC
| | - Hsien-Chung Chiu
- Periodontics Division, Department of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsiao-Pei Tu
- Department of Oral hygiene, Hsin-Sheng Junior College of Medical Care and Management, Toayuan City, Taiwan, ROC
| | - Cheng-Yang Chiang
- Periodontics Division, Department of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Biguetti CC, De Oliva AH, Healy K, Mahmoud RH, Custódio IDC, Constantino DH, Ervolino E, Duarte MAH, Fakhouri WD, Matsumoto MA. Medication-related osteonecrosis of the jaws after tooth extraction in senescent female mice treated with zoledronic acid: Microtomographic, histological and immunohistochemical characterization. PLoS One 2019; 14:e0214173. [PMID: 31199812 PMCID: PMC6568384 DOI: 10.1371/journal.pone.0214173] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022] Open
Abstract
Treatment with cumulative dosages of zoledronic acid (ZA) in elderly patients is a risk factor for the development of medication-related osteonecrosis of the jaws (MRONJ), mainly related to surgical triggers such as tooth extraction. However, animal models for the investigation and understanding of MRONJ pathophysiology in senescent and postmenopausal stages remains to be developed and characterized. The aim of this study was to analyze MRONJ development in senescent female mice treated with cumulative dosages of ZA. For this purpose, twenty 129/Sv female mice, 64 weeks old, were treated with 0.9% saline solution as control group (n = 10), and with ZA at 250μg/Kg (n = 10), once a week, starting 4 weeks before the upper right incisor extraction and until the end of the experimental time points (7 days and 21 days). At 7 and 21 days post-surgery, specimens were harvested for microCT, histological, birefringence and immunohistochemical analysis. Clinically, an incomplete epithelialization was observed in ZA group at 7 days and a delayed bone matrix mineralization and collagen maturation at 7 and 21 days compared to the controls. Controls revealed sockets filled with mature bone at 21 days as observed by microCT and birefringence, while ZA group presented delayed bone deposition at 7 and 21 days, as well increased leukocyte infiltration and blood clot at 7 days, and increased bone sequestrum and empty osteocyte lacunae at 21 days (p<0.05). Also, ZA group presented decreased quantity of TGFb+ and Runx-2+ cells at 7 days, and decreased quantity of TRAP+ osteoclasts compared to the control at 21 days (p<0.05). Altogether, these data demonstrate the usefulness of this model to understanding the pathophysiology of MRONJ.
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Affiliation(s)
- Claudia Cristina Biguetti
- Department of Basic Sciences, São Paulo State University (UNESP) - School of Dentistry, Araçatuba, São Paulo, Brazil
- * E-mail:
| | - André Hergesel De Oliva
- Department of Basic Sciences, São Paulo State University (UNESP) - School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Kent Healy
- Department of Diagnostic and Biomedical Sciences, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Ramez Hassan Mahmoud
- Department of Basic Sciences, São Paulo State University (UNESP) - School of Dentistry, Araçatuba, São Paulo, Brazil
| | | | | | - Edilson Ervolino
- Department of Basic Sciences, São Paulo State University (UNESP) - School of Dentistry, Araçatuba, São Paulo, Brazil
| | | | - Walid D. Fakhouri
- Department of Diagnostic and Biomedical Sciences, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Mariza Akemi Matsumoto
- Department of Basic Sciences, São Paulo State University (UNESP) - School of Dentistry, Araçatuba, São Paulo, Brazil
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17
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Constantine S, Clark B, Kiermeier A, Anderson PP. Panoramic radiography is of limited value in the evaluation of maxillary sinus disease. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:237-246. [PMID: 30477956 DOI: 10.1016/j.oooo.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The aim of this study was to determine (1) the diagnostic efficacy of orthopantomography (OPG) in the diagnosis of sinus diseases by using cone beam computed tomography (CBCT) as the imaging gold standard, (2) which diseases can be diagnosed by using panoramic radiography or CBCT, and (3) the interobserver agreement of 2 experienced dental radiologists. STUDY DESIGN The images of 714 individuals who underwent OPG and CBCT on the same day were assessed separately by 2 dental radiologists. The results were compared by using Gwet's AC1 statistical methods. RESULTS In total, 1322 maxillary sinuses were imaged. The sensitivity of OPG for the detection of any maxillary sinus pathology was poor compared with CBCT, but the specificity was high. The sensitivity of OPG for detecting mucosal thickening was 36.7%. The positive predictive value of OPG for diagnosing mucosal thickening was 79.9 %, but the negative predictive value was 51.9%. Interobserver agreement was strong (≥0.912) for all lesions except mucosal thickening. CONCLUSIONS Panoramic imaging has low efficacy in the diagnosis of sinus disease, even when examined by experienced dental radiologists. OPG can be useful in excluding disease, but 3-dimensional scanning is necessary for the definitive investigation of sinus lesions.
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Affiliation(s)
- Sarah Constantine
- Clinical Senior Lecturer, University of Adelaide, Faculty of Health Sciences, Adelaide, SA, Australia; South Australian Dental Service, Adelaide Dental Hospital, University of Adelaide Health and Medical Sciences Building, Adelaide, SA, Australia; Queen Elizabeth Hospital, Department of Radiology, Woodville South, SA, Australia; Women's and Children's Hospital, Department of Medical Imaging, North Adelaide, SA, Australia.
| | - Bruce Clark
- Retired Craniomaxillofacial Radiologist, Women's and Children's Hospital, Department of Medical Imaging, North Adelaide, SA, Australia
| | - Andreas Kiermeier
- Director, Statistical Process Improvement Consulting and Training Pty Ltd., Statistical Process Improvement Consulting and Training Pty Ltd, Gumeracha, SA, Australia
| | - Professor Peter Anderson
- Director of Research, Australian Craniofacial Unit, Women's and Children's Hospital, Australian Craniofacial Unit, Women's and Children's Hospital, North Adelaide, SA, Australia
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