Early imaging signs of the use of antiresorptive medication and MRONJ: a systematic review

Moreno‐Rabie, Catalina; Gaêta‐Araujo, Hugo; Oliveira‐Santos, Christiano; Politis, Constantinus; Jacobs, Reinhilde

doi:10.1007/s00784-020-03423-0

Cited by 27 publications

(33 citation statements)

References 56 publications

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“…Radiographic bone changes in the maxilla and mandible, after the intake of antiresorptive drugs, have been widely reported in the literature even before clinical exposure of bone in the oral cavity. Although, it is unclear whether most of these findings are solely related to the antiresorptive therapy, indicate a potential progress to osteonecrosis, or represent different stages of the necrotic process 15 . In the present study, we aimed to confirm the associations we previously identified in a smaller and different patient cohort, and validate those pre-operative radiologic local risk factors to the development of MRONJ in patients treated with oncologic-related doses undergoing tooth extraction 11 .…”

Section: Discussionmentioning

confidence: 99%

“…However, for a thorough diagnosis, a three-dimensional method such as computed tomography (CT) and Cone Beam CT is recommended 21 . These tools allow the assessment of the extension of the pathology 22 , 23 and to identify incipient lesions like those seen in patients “at risk” or in “stage 0” 15 , 21 , 23 . Consequently, new diagnostic staging systems have been proposed using a complement of clinical and radiographic signs 24 , 25 .…”

Section: Discussionmentioning

confidence: 99%

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Radiographic predictors for MRONJ in oncologic patients undergoing tooth extraction

Moreno‐Rabie

Lapauw

Gaêta‐Araujo

et al. 2022

Sci Rep

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Tooth extraction is a risk factor for the development of osteonecrosis of the jaw following treatment with antiresorptive drugs (ARDs), but not all extraction sites develop this pathology. Therefore, we aimed to identify local radiographic predictors of Medication-Related Osteonecrosis of the Jaw (MRONJ) in panoramic images of oncologic patients undergoing tooth extraction. Based on a retrospective longitudinal cohort study design, patients were included if undergoing one or more tooth extraction, with at least one administration of ARDs, and presence of pre- and post-operative panoramic radiographs. After data collection, blinded and independent observations were performed. Eleven distinct imaging-related parameters were assessed preoperatively and five postoperatively, at each extraction site. A case–control and subgroup analysis assessing MRONJ development was performed. Significance level is set to 0.05 (5%). A total of 77 oncologic patients were selected, undergoing 218 tooth extractions, from which 63 teeth (29%) in 39 patients (51%) developed MRONJ. Results showed that patients developed significantly more MRONJ with longer ARD treatment (p = 0.057), teeth with absent and incomplete endodontic fillings with caries, widened periodontal ligament space and/or periapical lesions (p = 0.005), and sclerotic and heterogenous bone patterns (p = 0.005). In conclusion, tooth extraction sites presenting with infections and bone sclerosis are at higher risk to develop MRONJ.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radiographic predictors for MRONJ in oncologic patients undergoing tooth extraction

Moreno‐Rabie

Lapauw

Gaêta‐Araujo

et al. 2022

Sci Rep

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“…Nonetheless, further efforts must be made to find radiographic modalities that can clearly differentiate between necrotic and vital bone. Such modalities could enable early diagnosis, significantly affecting the management of the underlying disease and enabling better treatment and the prevention of new potential cases 39,40 . By assessing the real extent of the lesion and detecting asymptomatic necrotic areas, high-resolution imaging could be helpful in individualized treatment planning 41 .…”

Section: Oliver Ristow Et Al: a Critical Assessment Of The Medication-related Osteonecrosis Of The Jaw Classification In Stage I Patientsmentioning

confidence: 99%

A critical assessment of the medication-related osteonecrosis of the jaw classification in stage I patients: a retrospective analysis

Ristow

Hürtgen

Moratin

et al. 2021

JKAOMS

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Objectives It is unclear whether the extent of intraoral mucosa defects in patients with medication-related osteonecrosis of the jaw indicates disease severity. Therefore, this study investigated whether mucosal lesions correlate with the true extent of osseous defects in stage I patients. Materials and Methods Retrospectively, all patients with stage I medication-related osteonecrosis of the jaw who underwent surgical treatment between April 2018 and April 2019 were enrolled. Preoperatively, the extent of their mucosal lesions was measured in clinical evaluations, and patients were assigned to either the visible or the probeable bone group. Intraoperatively, the extent of necrosis was measured manually and with fluorescence. Results Fifty-five patients (36 female, 19 male) with 86 lesions (46 visible bone, 40 probeable bone) were enrolled. Intraoperatively, the necrotic lesions were significantly larger ( P <0.001) than the preoperative mucosal lesions in both groups. A significant ( P <0.05) but very weak ( R 2<0.2) relationship was noted between the extent of the mucosal lesions and the necrotic bone area. Conclusion Preoperative mucosal defects (visible or probeable) in patients with medication-related osteonecrosis of the jaw do not indicate the extent of bone necrosis or disease severity.

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“…Although the role of the hygienist is fundamental to the development of preventive strategies relating to MRONJ, only a few papers in the international literature have addressed the work of the dental hygienist[ 19 – 22 ]. This position paper is the result of the work of a Board of experts, in the light of the following: new findings, the publication in 2020 of the new Italian recommendations regarding MRONJ and the best practice shared in the 2021 ONJ Update Conference ( www.onjupdate.it ) [ 2 , 3 , 6 , 23 – 31 ].…”

Section: Introductionmentioning

confidence: 99%

The preventive care of medication-related osteonecrosis of the jaw (MRONJ): a position paper by Italian experts for dental hygienists

Mauceri

Coniglio

Abbinante

et al. 2022

Support Care Cancer

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Purpose The prevention and early diagnosis of medication-related osteonecrosis of the jaw (MRONJ) is fundamental to reducing the incidence and progression of MRONJ. Many in the field believe that dental hygienists should play an integral role in primary and secondary MRONJ prevention. However, to date, very few publications in the literature have proposed standardised MRONJ protocols, which are dedicated to dental hygienists. The aim of this study was to provide guidance to the health care providers managing MRONJ. Methods The expert opinion in this study was developed by dental hygienists from the main Italian technical-scientific associations (Italian Dental Hygienists Association, AIDI and National Union of Dental Hygienists, UNID) and authors of the latest Italian recommendations regarding MRONJ from the field of dentistry and maxillofacial surgery. Results The oral care protocol outlined in this position paper is focused on the role of dental hygienist in patients at risk or affected by MRONJ, and it regards 3 main issues: primary prevention, secondary prevention and supporting the treatment of MRONJ. Each issue contains easy-to-apply indications and procedures, as described by the authors, regarding the role of the dental hygienist. Conclusion Referring to the main issues under consideration (primary prevention, secondary prevention and the treatment of MRONJ), a clinical examination of periodontal tissue is critical in preventing MRONJ. It is the opinion of the authors of this study that the application of a periodontal screening score is fundamental in defining personalised strategies for patients at risk of MRONJ. By means of these basic procedures, a protocol for assisting the health care provider and the presentation of a practical approach for patients at risk or affected by MRONJ are described in this study.

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Early imaging signs of the use of antiresorptive medication and MRONJ: a systematic review

Cited by 27 publications

References 56 publications

Radiographic predictors for MRONJ in oncologic patients undergoing tooth extraction

Radiographic predictors for MRONJ in oncologic patients undergoing tooth extraction

A critical assessment of the medication-related osteonecrosis of the jaw classification in stage I patients: a retrospective analysis

The preventive care of medication-related osteonecrosis of the jaw (MRONJ): a position paper by Italian experts for dental hygienists

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