Panoramic Radiography Features of Medication-Related Osteonecrosis of the Jaws (MRONJ)

Izzetti, Rossana; Gennai, Stefano; Francesco, Pierpaolo De; Carli, Elisabetta; Graziani, Filippo; Nisi, Marco

doi:10.1155/2023/5358849

Cited by 4 publications

(1 citation statement)

References 25 publications

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“…Although, there is a consensus on the significance of imaging in evaluating the extent of MRONJ, the precise role of radiologic findings in MRONJ patients and its contribution to clinical staging remain unclear [4,5]. Radiologic findings of MRONJ may include lytic changes, sclerosis, sequestrations and periosteal bone formation.…”

Section: Introductionmentioning

confidence: 99%

The Application and the Validity of a New Composite Radiographic Index in Patients with Osteonecrosis of the Jaws

Yfanti,

Tetradis,

Nikitakis

et al. 2024

Preprint

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Purpose: The purpose of this study is to apply the Composite Radiographic Index modified (CRIm) in CBCT scans of patients with Medication related osteonecrosis of the jaws (MRONJ) in order to detect its validity, and corelate the radiologic findings with the clinical staging of the disease. Methods: This study included 43 patients with MRONJ diagnosis and CBCT scans performed in the School of Dentistry and approved by the Research Ethics Committee. Clinical staging for every patient (0-3) was provided according to AAOMS 2022 guidelines. In cases of patients with both jaws affected, each jaw was evaluated independently resulting to 52 CBCT scans. The 52 CBCT scans were assessed under standardized viewing conditions by 2 observers who evaluated independently the following 8 radiologic features: lytic changes, sclerosis, periosteal reaction, sequestration, non-healing extraction sockets and other findings (sinus implication, inferior alveolar canal involvement, jaw fracture). The CRIm index was constructed to assess the extent of osseous changes. The radiologic features were scored as absent (0), localized/single (1), extensive/multiple (2), yielding a theoretical range of 0–12. For statistical analysis Fisher’s exact test and Spearman’s correlation coefficient were performed. Results: A statistically significant association of clinical stage with lytic changes, sequestration and inferior alveolar canal involvement was found. Also, a statistically significant correlation of clinical stage with CRIm index classification was obtained. Conclusions: The CRIm index tends to increase as the clinical stages of MRONJ advance, suggesting a correlation between the clinical stage of MRONJ and the CRIm index.

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Section: Introductionmentioning

confidence: 99%

The Application and the Validity of a New Composite Radiographic Index in Patients with Osteonecrosis of the Jaws

Yfanti,

Tetradis,

Nikitakis

et al. 2024

Preprint

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Sclerotic bone: a sign of bone reaction in patients with medication related osteonecrosis of the jaw

Obermeier,

Dewenter,

Malenova

et al. 2024

Sci Rep

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Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction associated with antiresorptive drugs such as bisphosphonates and denosumab. When dealing with advanced and/or multiple MRONJ lesions undergoing surgical therapy, the extent of surgery is often a topic of discussion. The aim of this study was to identify the differences in bone density in and around the MRONJ lesion before and after surgical treatment to evaluate the needed surgical extend of the modelling osteotomy. In this retrospective study 26 patients with MRONJ lesions that were surgically treated in our department were observed. Length, width and bone density were measured in panoramic radiograph pre and postoperatively with the Imaging processing software Sidexis and ImageJ (Fiji). The necrotic area, the surrounding sclerotic area as well as the healthy contralateral side were observed. Measurements were performed by two independent observers. Pearson correlation was calculated to determine the interobserver variability. Bone density was significantly reduced in the necrotic bone area compared to the healthy unaffected contralateral reference side. The sclerotic bone area surrounding the necrosis showed increased bone density compared to the contralateral unaffected reference side. The density of the sclerotic bone area was increased in the previously affected MRONJ area in the postoperative panoramic radiograph. The pre and postoperative density showed no significant correlation to healing behaviour. The focus of the modelling osteotomy in surgical treatment of mature MRONJ lesions should be predominantly on the parts that appear necrotic and less dense in the panoramic radiograph as sclerotic areas might be an expression of bone reaction.

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Clinical and radiologic treatment outcomes of implant presence tirggered‐MRONJ: Systematic review of literature

Nisi,

Gennai,

Graziani

et al. 2024

Oral Diseases

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BackgroundThe present systematic review evaluated clinical and radiographic features and treatment outcomes of peri‐implantitis‐induced medication‐related osteonecrosis of the jaws (Pi‐MRONJ).Materials and MethodsLiterature search was performed in PubMed/MEDLINE, Cochrane CENTRAL, Web of Science, and Scopus databases. Studies reporting Pi‐MRONJ were included. No time restrictions were applied.ResultsIn total, 571 articles were retrieved, and 24 articles were included in the final review. Study population consisted of 111 patients (70% pharmacologically treated for osteoporosis and 30% for oncologic disease). Pi‐MRONJ was characterized by pain, bone exposure and suppuration, and involved a single implant in 55 cases, two implants in 37 cases, three implants in 10 cases, and more than four implants in nine cases. Most of the lesions were assigned Stage II and III. MRONJ developed on average 46.5 ± 33.2 months following implant placement. Sixty‐one lesions were surgically treated with implant removal and debridement of the surrounding necrotic bone. Complete wound healing was observed in 85% of cases.ConclusionsThe presence of dental implants in patients treated with antiresorptive drugs should be considered as a potential risk factor for MRONJ onset. In cases of periimplantitis with delayed wound healing following nonsurgical therapy, the clinician should rule out the presence of Pi‐MRONJ.

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Panoramic Radiography Features of Medication-Related Osteonecrosis of the Jaws (MRONJ)

Cited by 4 publications

References 25 publications

The Application and the Validity of a New Composite Radiographic Index in Patients with Osteonecrosis of the Jaws

The Application and the Validity of a New Composite Radiographic Index in Patients with Osteonecrosis of the Jaws

Sclerotic bone: a sign of bone reaction in patients with medication related osteonecrosis of the jaw

Clinical and radiologic treatment outcomes of implant presence tirggered‐MRONJ: Systematic review of literature

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