Imaging Science in Dentistry

Korean Academy of Oral and Maxillofacial Radiology (대한영상치의학회)
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Several issues regarding the diagnostic imaging of medication-related osteonecrosis of the jaw

  • Kim, Jo-Eun (Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital) ;
  • Yoo, Sumin (School of Dental Hygiene, Kyungdong University Medical Campus) ;
  • Choi, Soon-Chul (Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University)
  • Received : 2020.06.29
  • Accepted : 2020.09.03
  • Published : 2020.12.31
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Abstract

This review presents an overview of some diagnostic imaging-related issues regarding medication-related osteonecrosis of the jaws(MRONJ), including imaging signs that can predict MRONJ in patients taking antiresorptive drugs, the early imaging features of MRONJ, the relationship between the presence or absence of bone exposure and imaging features, and differences in imaging features by stage, between advanced MRONJ and conventional osteomyelitis, between oncologic and osteoporotic patients with MRONJ, and depending on the type of medication, method of administration, and duration of medication. The early diagnosis of MRONJ can be made by the presence of subtle imaging changes such as thickening of the lamina dura or cortical bone, not by the presence of bone exposure. Most of the imaging features are relatively non-specific, and each patient's clinical findings and history should be referenced. Oral and maxillofacial radiologists and dentists should closely monitor plain radiographs of patients taking antiresorptive/antiangiogenic drugs.

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References

  1. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003; 61: 1115-7. https://doi.org/10.1016/S0278-2391(03)00720-1
  2. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw - 2014 update. J Oral Maxillofac Surg 2014; 72: 1938-56. https://doi.org/10.1016/j.joms.2014.04.031
  3. Olutayo J, Agbaje JO, Jacobs R, Verhaeghe V, Velde FV, Vinckier F. Bisphosphonate-related osteonecrosis of the jaw bone: radiological pattern and the potential role of CBCT in early diagnosis. J Oral Maxillofac Res 2010; 1: e3.
  4. Kubo R, Ariji Y, Taniguchi T, Nozawa M, Katsumata A, Ariji E. Panoramic radiographic features that predict the development of bisphosphonate-related osteonecrosis of the jaw. Oral Radiol 2018; 34: 151-60. https://doi.org/10.1007/s11282-017-0293-9
  5. Hamada H, Matsuo A, Koizumi T, Satomi T, Chikazu D. A simple evaluation method for early detection of bisphosphonate-related osteonecrosis of the mandible using computed tomography. J Craniomaxillofac Surg 2014; 42: 924-9. https://doi.org/10.1016/j.jcms.2014.01.012
  6. Yajima N, Munakata M, Fuchigami K, Sanda M, Kasugai S. Influence of bisphosphonates on implant failure rates and characteristics of postmenopausal woman mandibular jawbone. J Oral Implantol 2017; 43: 345-9. https://doi.org/10.1563/aaid-joi-D-17-00015
  7. Barngkgei I, Khattab R. Detecting the effect of bisphosphonates during osteoporosis treatment on jawbones using multidetector computed tomography: the OSTEOSYR project. J Investig Clin Dent 2018; 9: e12332. https://doi.org/10.1111/jicd.12332
  8. Barngkgei I, Halboub E, Almashraqi A. Effect of bisphosphonate treatment on the jawbone: an exploratory study using periapical and panoramic radiographic evaluation. Oral Radiol 2019; 35: 159-70. https://doi.org/10.1007/s11282-018-0358-4
  9. Demiralp KO, Kursun-Cakmak ES, Bayrak S, Akbulut N, Atakan C, Orhan K. Trabecular structure designation using fractal analysis technique on panoramic radiographs of patients with bisphosphonate intake: a preliminary study. Oral Radiol 2019; 35: 23-8. https://doi.org/10.1007/s11282-018-0321-4
  10. Torres SR, Chen CS, Leroux BG, Lee PP, Hollender LG, Lloid M, et al. Mandibular inferior cortical bone thickness on panoramic radiographs in patients using bisphosphonates. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119: 584-92. https://doi.org/10.1016/j.oooo.2015.02.005
  11. Taniguchi T, Ariji Y, Nozawa M, Naitoh M, Kuroiwa Y, Kurita K, et al. Computed tomographic assessment of early changes of the mandible in bisphosphonate-treated patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122: 362-72. https://doi.org/10.1016/j.oooo.2016.06.002
  12. Diniz-Freitas M, Fernandez-Montenegro P, Fernandez-Feijoo J, Limeres-Posse J, Gonzalez-Mosquera A, Vazquez-Garcia E, et al. Mandibular cortical indices on cone-beam computed tomography images in osteoporotic women on treatment with oral bisphosphonates. Gerodontology 2016; 33: 155-60. https://doi.org/10.1111/ger.12121
  13. Feitosa EF, Vasconcellos MM, Magalhaes RJ, Domingos-Vieira AC, Visconti MA, Guedes FR, et al. Bisphophonate alterations of the jaw bones in individuals with multiple myeloma. Dentomaxillofac Radiol 2020; 49: 20190155. https://doi.org/10.1259/dmfr.20190155
  14. Iwata E, Akashi M, Kishimoto M, Kusumoto J, Hasegawa T, Furudoi S, et al. Meaning and limitation of cortical bone width measurement with DentaScan in medication-related osteonecrosis of the jaws. Kobe J Med Sci 2016; 62: E114-9.
  15. Torres SR, Chen CS, Leroux BG, Lee PP, Hollender LG, Schubert MM. Fractal dimension evaluation of cone beam computed tomography in patients with bisphosphonate-associated osteonecrosis. Dentomaxillofac Radiol 2011; 40: 501-5. https://doi.org/10.1259/dmfr/14636637
  16. Torres SR, Chen CS, Leroux BG, Lee PP, Hollender LG, Santos EC, et al. Mandibular cortical bone evaluation on cone beam computed tomography images of patients with bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113: 695-703. https://doi.org/10.1016/j.oooo.2011.11.011
  17. Guggenberger R, Koral E, Zemann W, Jacobsen C, Andreisek G, Metzler P. Cone beam computed tomography for diagnosis of bisphosphonate-related osteonecrosis of the jaw: evaluation of quantitative and qualitative image parameters. Skeletal Radiol 2014; 43: 1669-78. https://doi.org/10.1007/s00256-014-1951-1
  18. Bagan JV, Hens-Aumente E, Leopoldo-Rodado M, Poveda-Roda R, Bagan L. Bisphosphonate-related osteonecrosis of the jaws: study of the staging system in a series of clinical cases. Oral Oncol 2012; 48: 753-7. https://doi.org/10.1016/j.oraloncology.2012.02.009
  19. Patel V, McLeod NM, Rogers SN, Brennan PA. Bisphosphonate osteonecrosis of the jaw - a literature review of UK policies versus international policies on bisphosphonates, risk factors and prevention. Br J Oral Maxillofac Surg 2011; 49: 251-7. https://doi.org/10.1016/j.bjoms.2010.05.007
  20. Schiodt M, Reibel J, Oturai P, Kofod T. Comparison of nonexposed and exposed bisphosphonate-induced osteonecrosis of the jaws: a retrospective analysis from the Copenhagen cohort and a proposal for an updated classification system. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117: 204-13. https://doi.org/10.1016/j.oooo.2013.10.010
  21. Fedele S, Porter SR, D'Aiuto F, Aljohani S, Vescovi P, Manfredi M, et al. Nonexposed variant of bisphosphonate-associated osteonecrosis of the jaw: a case series. Am J Med 2010; 123: 1060-4. https://doi.org/10.1016/j.amjmed.2010.04.033
  22. Devlin H, Greenwall-Cohen J, Benton J, Goodwin TL, Little-wood A, Horner K. Detecting the earliest radiological signs of bisphosphonate-related osteonecrosis. Br Dent J 2018; 224: 26-31. https://doi.org/10.1038/sj.bdj.2017.1001
  23. Junquera L, Gallego L. Nonexposed bisphosphonate-related osteonecrosis of the jaws: another clinical variant? J Oral Maxillofac Surg 2008; 66: 1516-7. https://doi.org/10.1016/j.joms.2008.02.012
  24. Mawardi H, Treister N, Richardson P, Anderson K, Munshi N, Faiella RA, et al. Sinus tracts - an early sign of bisphosphonate-associated osteonecrosis of the jaws? J Oral Maxillofac Surg 2009; 67: 593-601. https://doi.org/10.1016/j.joms.2008.09.031
  25. Bedogni A, Fusco V, Agrillo A, Campisi G. Learning from experience. Proposal of a refined definition and staging system for bisphosphonate-related osteonecrosis of the jaw (BRONJ). Oral Dis 2012; 18: 621-3. https://doi.org/10.1111/j.1601-0825.2012.01903.x
  26. Bedogni A, Fedele S, Bedogni G, Scoletta M, Favia G, Colella G, et al. Staging of osteonecrosis of the jaw requires computed tomography for accurate definition of the extent of bony disease. Br J Oral Maxillofac Surg 2014; 52: 603-8. https://doi.org/10.1016/j.bjoms.2014.04.009
  27. Soundia A, Hadaya D, Mallya SM, Aghaloo TL, Tetradis S. Radiographic predictors of bone exposure in patients with stage 0 medication-related osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126: 537-44. https://doi.org/10.1016/j.oooo.2018.08.005
  28. Sahin O, Odabasi O, Demiralp KO, Kursun-Cakmak ES, Aliyev T. Comparison of findings of radiographic and fractal dimension analyses on panoramic radiographs of patients with early-stage and advanced-stage medication-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128: 78-86. https://doi.org/10.1016/j.oooo.2019.03.002
  29. Wilde F, Heufelder M, Lorenz K, Liese S, Liese J, Helmrich J, et al. Prevalence of cone beam computed tomography imaging findings according to the clinical stage of bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114: 804-11. https://doi.org/10.1016/j.oooo.2012.08.458
  30. Baba A, Goto TK, Ojiri H, Takagiwa M, Hiraga C, Okamura M, et al. CT imaging features of antiresorptive agent-related osteonecrosis of the jaw/medication-related osteonecrosis of the jaw. Dentomaxillofac Radiol 2018; 47: 20170323.
  31. Bagan JV, Cibrian RM, Lopez J, Leopoldo-Rodado M, Carbonell E, Bagan L, et al. Sclerosis in bisphosphonate-related osteonecrosis of the jaws and its correlation with the clinical stages: study of 43 cases. Br J Oral Maxillofac Surg 2015; 53: 257-62. https://doi.org/10.1016/j.bjoms.2014.12.004
  32. Shin JW, Kim JE, Huh KH, Yi WJ, Heo MS, Lee SS, et al. Computed tomography imaging features of osteomyelitis of the jaw: comparison between antiresorptive medication-related conditions and medication-unrelated conditions. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129: 629-34. https://doi.org/10.1016/j.oooo.2019.11.006
  33. Walton K, Grogan TR, Eshaghzadeh E, Hadaya D, Elashoff DA, Aghaloo TL, et al. Medication related osteonecrosis of the jaw in osteoporotic vs oncologic patients-quantifying radiographic appearance and relationship to clinical findings. Dentomaxillofac Radiol 2019; 48: 20180128. https://doi.org/10.1259/dmfr.20180128
  34. Shin JW. Radiological and clinical features of medication-related osteomyelitis of the jaw (MROMJ): Comparison between osteoporosis and oncology patients [dissertation]. Seoul, Korea: Seoul National University; 2020.
  35. Zhang X, Hamadeh IS, Song S, Katz J, Moreb JS, Langaee TY, et al. Osteonecrosis of the jaw in the United States Food and Drug Administration's Adverse Event Reporting System (FAERS). J Bone Miner Res 2016; 31: 336-40. https://doi.org/10.1002/jbmr.2693
  36. Baba A, Goto TK, Ojiri H, Takagiwa M, Hiraga C, Okamura M, et al. CT imaging features of antiresorptive agent-related osteonecrosis of the jaw/medication-related osteonecrosis of the jaw. Dentomaxillofac Radiol 2018; 47: 20170323.
  37. Heim N, Götz W, Kramer FJ, Faron A. Antiresorptive drug-related changes of the mandibular bone densitiy in medication-related osteonecrosis of the jaw patients. Dentomaxillofac Radiol 2019; 48: 20190132. https://doi.org/10.1259/dmfr.20190132
  38. Pichardo SE, Broek FW, Fiocco M, Appelman-Dijkstra NM, van Merkesteyn JP. A comparison of the cone beam computed tomography findings in medication-related osteonecrosis of the jaws related to denosumab versus bisphosphonates: an observational pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129: 411-7. https://doi.org/10.1016/j.oooo.2019.09.010