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Comparative clinical study of phosphorous necrosis and medical-related osteonecrosis of the jaws

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Abstract

Background

Phosphorous necrosis of the jaw (PNJ) exhibits similar clinical and pathological features as medical-related osteonecrosis of the jaw (MRONJ). This study aims at comparing the similarities and differences between PNJ and MRONJ regarding pathological features and to provide a theoretical basis for the clinical diagnosis and management of PNJ.

Material and methods

A retrospective analysis was conducted to assess clinical differences among 38 PNJ patients and 31 MRONJ patients, who were diagnosed and treated between January 2009 and October 2022. Pathological alterations in bone tissue were evaluated using EDS, H&E, Masson, and TRAP staining on five specimens from both MRONJ and PNJ cases; furthermore, immunohistochemistry was used to determine the expression levels of OPG, RANKL, and Runx2. The mandibular coronoid process was removed from individuals with temporomandibular joint ankylosis to serve as a control.

Results

CBCT imaging demonstrated necrotic bone formation in block, strip, or plaque shapes. EDS analysis showed that the calcium/phosphorus ratio in the bone tissue of PNJ and MRONJ was significantly lower than that of the control group (P < 0.05). Additionally, staining indicated reduced osteoblast counts, disrupted bone trabecular structure, and decreased collagen fiber content in the bone tissues of PNJ and MRONJ. Immunohistochemistry demonstrated that RANKL expression was significantly lower in MRONJ compared to PNJ and control groups (P < 0.05). Conversely, Runx2 expression was significantly higher in PNJ than in MRONJ and control groups (P < 0.05), and there was no significant difference in OPG expression.

Conclusion

PNJ and MRONJ demonstrate comparable clinical manifestations and pathological traits, although disparities may exist in their underlying exhibit comparable clinical manifestations, pathological traits, and molecular mechanisms.

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Funding

This study was financially supported by the National Natural Science Foundation of China (No. 81660187), the Medicine Leading Talent of Yunnan Province Health Care Committee (No.L-2018010), and the Yunnan Provincial Innovation Team Project Team (No. 202105AE160004).

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Gaoxin District, Affiliated Stomatology Hospital of Kunming Medical University, No. 1088 Mid Hai Yuan Road, Yunnan, 650106, China

    Rongju Xie, Weihong Wang, Yemei Qian, Jingyi Li & Hongrong Zhang

  2. Yunnan Key Laboratory of Stomatology, Kunming, 650106, China

    Rongju Xie, Weihong Wang, Yemei Qian, Jingyi Li & Hongrong Zhang

  3. Advanced Analysis and Measurement Center, School of Chemical Science and Engineering, Yunnan University, Kunming, 650091, China

    Longchun Bian

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  1. Rongju Xie
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  2. Weihong Wang
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  3. Longchun Bian
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  4. Yemei Qian
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  5. Jingyi Li
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Contributions

Rongju Xie wrote the first draft of the manuscript. Wang contributed to the design and writing. Longchun Bian participated in EDS experiments, and Yemei Qian, Jingyi Li, and Hongrong Zhang participated in clinical data collection. All authors made major revisions to the manuscript and approved the submitted and revised versions.

Corresponding author

Correspondence to Weihong Wang.

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Ethics approval

The research protocol underwent a thorough review in compliance with the Helsinki Declaration and was approved by the Ethics Committee of the Affiliated Stomatology Hospital of Kunming Medical University (No. KYKQ2020MEC010).

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All patients gave written consent by signing the informed consent form.

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The authors declare no competing interests.

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Xie, R., Wang, W., Bian, L. et al. Comparative clinical study of phosphorous necrosis and medical-related osteonecrosis of the jaws. Clin Oral Invest 28, 147 (2024). https://doi.org/10.1007/s00784-024-05539-z

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