Clinical and Image Findings in Bisphosphonate-Related Osteonecrosis of the Jaws

Abstract

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is characterized as exposed bone in the jaws for more than 8 weeks in patients with current or previous history of therapy with bisphosphonates (BPs) and no history of radiotherapy in the head and neck. We report a case series of 7 patients with BRONJ and analyze the variations of clinical and imaging signs, correlating them with the presence or absence of bone exposure. Among the patients, 6 were women and 1 was a man, aged 42-79 years. Five of the patients were using zoledronic acid and the other 2 alendronate. The use of BPs varied from 3 to 13 years. In 5 patients, tooth extraction was the triggering event of injuries. Panoramic radiographs and computed tomography (CT) were evaluated by a radiologist blinded to the cases. There were persistent unremodeled extraction socket even several months after tooth extraction in 3 of the cases that were consistent wit CT findings that also showed areas of osteosclerosis and osteolysis. Patients were treated according to the recommendations of the AAOMS, with surgical debridement and antibiotic coverage with amoxicillin in the symptomatic patients. The follow-up of these patients ranged from 8 to 34 months, with a good response to treatment. The image findings in this case series were not specific and showed no difference between each stages of BRONJ (AAOMS, 2009). The image features were similar in presence or absence of exposed bone.

Interrelationship of clinical, radiographic and haematological features in patients under bisphosphonate therapy

“…Bone sequestrum has been associated with BRONJ; 13,48,49 but, in our study, it was the least prevalent radiographic feature. This could be explained by the transversal character of the study, where the images analyzed corresponded to the first radiographic examination to which the patient was subjected, and at this time it could be too early for sequestrum detection.…”

“…Our radiographic data showed a significantly higher prevalence of persisting alveolar socket, osteolysis, bone sclerosis and narrowing of the mandibular canal in the BRONJ group, which corroborates the reported data. 13,46,48,49 On the other hand, there was no significant difference for widening of the periodontal ligament space and thickening of the lamina dura between the groups. This finding disagrees with the literature, according to which these two variables would be early signs of BRONJ.…”

“…[7][8][9]11 According to these authors, BRONJ diagnosis based on bone exposure is a late diagnosis, which is responsible for the refractory behaviour of the disease. In the meantime, studies have analyzed imaging modalities such as radiography, helical CT, CBCT, MR and bone scintigraphy, in search of imaging signs to confirm BRONJ, [12][13][14] where persisting alveolar socket, bone sclerosis, osteolysis, thickening of the lamina dura, narrowing of the mandibular canal, widening of the periodontal ligament space and sequestrum have been reported as the most significant ones. 15,16 Although helpful in determining the extension of the lesion, none of these examinations alone is capable of diagnosing BRONJ, without clinical signs and symptoms.…”

Evaluation of BP-ONJ in osteopenic and healthy sheep: comparing ZTE-MRI with µCT

“…Osteolytic lesions with cortical bone destruction, osteolysis, sequestrum formation and sclerotic regions with periosteal bone proliferation are typical for BP-ONJ. [8][9][10][11][12] Surgical procedures include the resection of necrosis in advanced stages (American Associations of Oral and Maxillofacial Surgeons; AAOMS) and the early surgical approach and safe wound closure. 13 Surgical procedures require precise pre-operative imaging to define necrotic areas and delineate resection margins.…”

Osteonecrose dos maxilares associada a bisfosfonatos: avaliação genética em pacientes oncológicos

“…Os exames de imagem representam auxílio valioso no diagnóstico, na definição da magnitude, como também na avaliação de progressão da OMAB (ARCE et al, 2009;STOCKMANN et al, 2010;HINGST;WEBER, 2018). (BEDOGNI et al, 2008;TREISTER, et al, 2009;ARCE et al, 2009;STOCKMANN et al, 2010;TREISTER;FRIEDLAND;WOO, 2010;FARIAS et al, 2013;BEDOGNI et al, 2012;RUGGIERO et al, 2014; HINGST; WEBER, 2018).…”