RADIOGRAPHIC PREDICTORS OF BONE EXPOSURE IN PATIENTS WITH STAGE 0 ONJ

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): A. SOUNDIA, T. AGHALOO, S. MALLYA, S. TETRADIS

Background

Osteonecrosis of the jaws (ONJ) is a severe adverse effect of antiresorptive medications. Although the diagnosis of ONJ is based on the presence of necrotic bone in the oral cavity, patients at the initial phase of the disease (stage 0 ONJ) can present without bone exposure.¹ Approximately 50% of stage 0 ONJ patients develop bone exposure within 6 to 12 months of initial presentation.² However, diagnostic predictors of stage 0 ONJ progressing to clinical ONJ are absent.

Objectives

The aim of this study was to investigate stage 0 ONJ radiographic features associated with subsequent clinical exposure.

Materials and Methods

Files from 14 patients with stage 0 ONJ (history of antiresorptive medication and nonspecific clinical symptoms) were utilized. Imaging included panoramic radiographs and CBCT scans. Additionally, clinical photos were obtained. Cortical erosion, sclerosis, sequestration, periosteal reaction and crater-like defects were assessed as localized or extensive. Patients were followed up for 6 months to 2 years and absence or presence of clinical exposure was noted.

Results

Two patients reported a history of recent extraction, 3 were edentulous and 9 were dentate. Of the patients, 50% (7 of 14) presented with cortical erosion, 43% (6 of 14) showed bony sequestration or bony spicules, 50% (7 of 14) demonstrated crater-like defect, 50% (7 of 14) had extensive sclerosis, and 36% (5 of 14) presented with periosteal reaction. In follow-up, 50% (7 of 14) of patients with stage 0 ONJ developed clinical exposure during the observation period. Patients with subsequent exposure presented more frequently with abnormal radiographic findings. Interestingly, 6 of these patients presented with sequestration or bony spicules at the initial appointment. All patients with sequestrum advanced to clinical ONJ.

Discussion

Our data show an association of radiographic findings, in particular of sequestration, with development of bone exposure, and emphasize the importance of a thorough radiographic assessment in patients with suspected stage 0 ONJ. Currently, we are expanding our patient population to increase the statistical power of our studies.

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