Prevalence of cone beam computed tomography imaging findings according to the clinical stage of bisphosphonate-related osteonecrosis of the jaw

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.

Section: Discussionmentioning

confidence: 99%

Can dental panoramic radiographic findings serve as indicators for the development of medication-related osteonecrosis of the jaw?

Klingelhöffer¹,

Klingelhöffer²,

Müller³

et al. 2016

“…With progression of the severity of the BRONJ lesion, osteolysis of the bone also seems to be progressive, as expressed by the formation and sequestration of the new periosteal bone especially in the mandible. 20 Some studies in large animals and in humans have proposed that alteration is substantially higher in the jaws, especially within the intracortical 21 component relative to other skeletal sites. 12 Clinical studies have also shown improved cortical bone thickness after bisphosphonate therapy.…”

Section: Discussionmentioning

confidence: 99%

Are there any differences in mandibular morphology of patients with bisphosphonate-related osteonecrosis of jaws?: a case-control study

Özcan¹,

Şekerci²,

Gönen³

2016

Objectives: The aim of this study was to compare the morphological differences in the mandible between patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) and healthy individuals and to detect the correlation between these parameters on panoramic radiography and CBCT. Methods: The CBCT and panoramic images of patients with BRONJ (n 5 32) and control groups (n 5 32) were included in the study. All the comparisons were analyzed between the osteonecrosed and healthy sides of patients with BRONJ and control group. The panoramic radiographs were used to measure the values of the condyle angle, gonial angle, antegonial angle, antegonial depth, condylar height and ramal height. The mandibular cortical index (MCI) and bone quality index (BQI) were also examined on cross-sectional scans of CBCT images. Results: There were significant differences in the MCI (p 5 0.014) and BQI (p 5 0.021) between the left and right side of the BRONJ group and also between the osteonecrosed side of the BRONJ and control group (p , 0.0001). No significant difference was found in other comparisons. Conclusions:The outcomes of the present study indicate that bisphosphonates influenced some internal morphological changes in the mandible. These changes may be a reason of BRONJ. But, these changes are not reflective of the measured values obtained using panoramic radiographs on the external morphology of the mandible.

“…[18][19][20][21] Although radiological interpretation is crucial for the definition of BRONJ lesions, in cases that necrotic bone is present but not yet exposed into the oral cavity, radiographic images may also appear normal. 22 Unfortunately, there is only a limited number of publications about the diagnostic importance of radiological evaluation in these lesions. The Tukey test was used as post hoc to define significantly different groups.…”

Section: Discussionmentioning

confidence: 99%

“…Despite insignificant appearances on radiological images, periosteal new bone formation is frequently seen in BRONJ patients. 22 It was shown that, especially in the mandible, with progression of the severity of the BRONJ lesion, formation of new periostal bone increases. 20,22,23 In a periodontal disease induced BRONJ rat model, Aghaloo et al 24 reported increased periosteal new bone formation and wider alveolar bone on microCT images.…”

Section: Discussionmentioning

confidence: 99%

Teriparatide and the treatment of bisphosphonate-related osteonecrosis of the jaw: a rat model

Ersan¹,

Ruijven²,

Bronckers³

et al. 2014

Objectives: The objectives of this study were to establish a bisphosphonate-related osteonecrosis of the jaw (BRONJ) rat model and to analyse the effects of teriparatide (TP) on this model. Methods: Sprague-Dawley rats were divided into three groups: I-zoledronic acid (ZA, n 5 10); II-ZA and teriparatide (ZA 1 TP, n 5 10); III-control (n 5 10). Osteonecrosis was induced by administering zoledronic acid to groups ZA and ZA 1 TP. A week after the injections, rats underwent extraction of the first left mandibular molar. Following a four week period, TP was administered to the ZA 1 TP group for 28 days. Upon killing, extraction sockets were examined clinically, radiologically and histopathologically. Results: Clinical examination revealed necrotic bone exposure in none of the animals. MicroCT (mCT) examination showed that bone mineral density of the newly formed bone in the extraction socket was lower in the ZA group than in the ZA 1 TP group (p , 0.05). Histopathological examination revealed that only the ZA and ZA 1 TP groups developed osteonecrosis, and the osteonecrotic bone area in the ZA group was larger than that in the ZA 1 TP group (p , 0.05). Tartrate-resistant acid phosphatase (TRAcP) enzyme histochemistry revealed that the number of detached and large osteoclasts were higher in the ZA group than in other groups, whereas the number of apoptotic osteoclasts in both ZA and ZA 1 TP groups were higher than in the control group (p , 0.05). Conclusions: Our data indicate that bisphosphonate-related osteonecrosis of the jaw model used in the present study is an attractive model to investigate treatment modalities and that TP might be an effective treatment in BRONJ.