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Objectives: The purpose of this case-control study was to find a correlation between certain imaging findings in dental panoramic radiographs and the risk for developing a medicationrelated osteonecrosis of the jaw (MRONJ) in patients taking antiresorptive therapy (AT). Methods: Randomized and blinded dental panoramic radiographs of 60 patients undergoing antiresorptive drug treatment (36 patients with MRONJ, 24 patients without MRONJ) and of 60 patients without AT were analyzed by 3 experts for the following signs: sequestrum, osteosclerosis, difference in sclerosing of alveolar process and body of mandible, visible alveolar socket, enhancement and loss of lamina dura, enhancement of the oblique ridge, enhancement of the mandibular canal, proliferative periostitis and osteolytic processes at the cortex. Results: Signs were seen significantly more often in patients undergoing AT than in the control group (CG) (osteosclerosis p-value 5 0.019, visible alveolar socket p-value 5 0.001, enhancement of lamina dura p-value , 0.001, enhancement of the mandibular canal p-value 5 0.025, proliferative periostitis p-value 5 0.05 and osteolytic processes at the cortex p-value , 0.001). While there is no significant difference between the CG and the group of patients with AT without manifest MRONJ for any sign, the significance increases when taking the group of patients under AT with manifest MRONJ into consideration. In addition, if medication was administered for malignant reasons, the signs visible alveolar socket, enhancement of the lamina dura and the enhancement of the mandibular canal were seen significantly more often. Conclusions: The radiographic findings mentioned above are not indicators for the development of MRONJ, as they are seen only in patients with manifest osteonecrosis. However, these findings could be important to assess the dimension and potency of a MRONJ.

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The findings may improve patient-specific therapy according to individual tumor characteristics.