Do various imaging modalities provide potential early detection and diagnosis of medication-related osteonecrosis of the jaw? A review

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.

Diagnostic accuracy comparing OPT and CBCT in the detection of non‐vital bone changes before tooth extractions in patients with antiresorptive intake

“…The role of three‐dimensional (3D) diagnostics in the detection of necrotic changes without exposed or probable bone (corresponding to AAOMS stage 0) has been addressed by working groups for some time (Wongratwanich et al, 2021). These patients present with non‐specific symptoms that cannot be attributed to dental causation.…”

Evaluation of Medication-Related Osteonecrosis of the Jaw (MRONJ) in Terms of Staging and Treatment Strategies by Dental Students at Different Educational Levels

“…These findings are confirmed by a recent review describing panoramic radiographs to be sufficient in depicting osteolysis, osteosclerosis, and thickened lamina dura, but the CBCT and CT can show more features unique to MRONJ, such as periosteal reaction and bone-within-bone appearance. Wongratwanich et al concluded that there is no consensus regarding the use of a specific imaging modality; therefore, dental practitioners should select the imaging modality according to the patient’s conditions to avoid over-investigation and unnecessary interventions [ 38 ].…”

Clinical significance of drug cessation on medication-related osteonecrosis of the jaw in patients with osteoporosis

“…Pathognomonic imaging features for MRONJ have not been established 34 . Before computed tomography (CT) was available, panoramic radiographs were the sole means of diagnosis and prognosis.…”

“…Before computed tomography (CT) was available, panoramic radiographs were the sole means of diagnosis and prognosis. CT is superior to panoramic radiographs because the necrosis level of the cortex bone, trabecular bone density, and sequestration position can be determined accurately 21 , 34 . However, compared to CT, panoramic radiographs offer lower costs, which is beneficial for periodic follow-up.…”