Radiographic predictors of bone exposure in stage 0 MRONJ patients

Publication date: Available online 29 August 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Akrivoula Soundia, Danny Hadaya, Sanjay Mallya, Tara Aghaloo, Sotirios Tetradis

Abstract

Objective

To explore the radiographic appearance of stage 0 MRONJ and examine 5 radiographic parameters (trabecular sclerosis, cortical erosion, periosteal reaction, sequestration, crater-like defect) as predictors of progression to bone exposure.

Study design

23 patients with history of antiresorptive therapy, no bone exposure and non-specific signs and symptoms were included. Intraoral photographs, panoramic and CBCT images at initial visit and follow-up intraoral photographs were reviewed. 3 patients had dental disease (D.D.), 10 stage 0 MRONJ patients did not progress to bone exposure (N.B.E.), and 10 patients progressed to bone exposure (B.E.). Radiographic parameters were scored as absent (0), localized (1) or extensive (2), and their sum formed the composite radiographic index (CRI).

Results

D.D. patients demonstrated minimal radiographic findings and their CRI was significantly lower than that of N.B.E. and B.E. patients. Additionally, B.E. patients demonstrated a higher radiographic index than N.B.E. patients. Intriguingly, sequestration was observed in the initial CBCT of 90% (9/10) of B.E. patients, whereas 80% of N.B.E. patients showed absence of sequestration at initial CBCT examination.

Conclusion

CBCT imaging can aid stage 0 vs dental disease diagnosis. Radiographic sequestration at initial presentation can serve as a predictor of future bone exposure in stage 0 MRONJ patients.

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