Radiographic evaluation of maxillofacial region in oncology patients treated with bisphosphonates

Medication-related osteonecrosis of the jaw. Introduction of a new modified experimental model

“…From these initial reports, other authors have also reported new cases of MRONJ without bone exposure, suggesting a review of the classification previously established, since these cases would be erroneously classified as stage "0", but with imaging alterations and symptoms of MRONJ stages "1", "2" and "3" and it is of valuable importance, as some cases of osteonecrosis may be asymptomatic, even absent of clinical bone exposure, being imaging the only diagnostic tool in these cases. As well as other bone diseases, MRONJ must have well defined aspects to get the final diagnosis and, also, in pointing out early alterations and the possibility to establish a prevention plan 41,42 .…”

Osteonecrosis of the jaws in patients assuming oral bisphosphonates for osteoporosis: A retrospective multi-hospital-based study of 87 Italian cases

“…Every patient in the study provided informed consent was methodically examined, and a complete medical history was taken. After clinical examination, all patients underwent radiological examinations of the jaws (panoramic radiograph and CT), focusing particularly on alterations of bone architecture with a loss of medullar bone, trabeculation, or increased bone density [7,45].…”

Radiographic Findings in Patients With Medication-Related Osteonecrosis of the Jaw

“…A wide spectrum of radiographic features has been reported in MRONJ. These findings include bone sclerosis, thickening of lamina dura, erosion of the adjacent cortical bone, periosteal reaction, disruption of spinal trabecular bone, tooth alveolus with delayed remodeling, prominence of the IAN canal, sequestration, and pathological fracture [2][3][4][5]. In the present study, 35 patients with a diagnosis of MRONJ, most of whom were treated with zoledronate, were radiographically evaluated for bone abnormalities.…”

“…For the evaluation, the arches were divided into sextants (1, 2, 3: maxilla and 4, 5, 6: mandible) based on a previously described methodology [5]. Osteolysis (OT), cortical bone erosion (EC), bone sclerosis focal (FS) and diffuse sclerosis (DS), bone sequestration (BS), thickening of the lamina dura (TD), prominence of the inferior alveolar nerve canal (IAN), persisting alveolar sockets (SK), and the presence of pathological fracture (PF) were investigated.…”

“…Clinical signs, such as bone exposure, infection, fistulae, mucosal erythema, and purulent drainage, do not always reflect the true extent of the disease in bone. Some studies have reported the most common radiographic findings of MRONJ using radiographic dental examinations, as follows: thickening of the lamina dura, diffuse osteosclerosis, osteolysis, presence of bone sequestrum, disruption of medullary trabecular bone, and alveoli with delayed remodeling [2][3][4][5][6]. Few MRONJ studies have been conducted with regard to the correlation between radiographic findings and staging of the disease [6].…”