Advertisement

Oral Radiology

, Volume 34, Issue 2, pp 151–160 | Cite as

Panoramic radiographic features that predict the development of bisphosphonate-related osteonecrosis of the jaw

  • Ryota Kubo
  • Yoshiko Ariji
  • Tohru Taniguchi
  • Michihito Nozawa
  • Akitoshi Katsumata
  • Eiichiro Ariji
Original Article

Abstract

Objectives

The purpose of this study was to clarify which panoramic radiographic features can predict the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ).

Methods

Participants included 24 patients treated with bisphosphonates (BP) for osteoporosis who developed osteonecrosis of the jaw (ONJ+ group). Controls included 179 patients treated with BP who did not have osteonecrosis (ONJ group) and 200 patients with no history of BP administration (unmedicated group). The mandibular cortical width, mandibular cortical index (MCI), sclerosis of trabecular bone, and thickening of the lamina dura were evaluated on panoramic radiographs.

Results

The mandibular cortical width was significantly smaller in the ONJ group than in the other groups. Class II MCI (semilunar defects of endosteal margin) was frequently noted on the affected and contralateral sides in the ONJ+ group but not in the ONJ or unmedicated groups. Sclerosis of the trabecular bone was significantly more frequently observed on the affected side in the ONJ+ group than in the other groups. Thickening of the lamina dura was observed significantly more frequently in the BP-treated groups than in the unmedicated group.

Conclusions

Class II MCI may be an indicator to predict the development of BRONJ. Sclerosis of trabecular bone was a characteristic imaging feature of BRONJ. Thickening of the lamina dura may be an imaging feature caused by BP administration.

Keywords

Bisphosphonate Osteoporosis Panoramic radiography Computer aided diagnosis Jaw osteonecrosis 

Notes

Compliance with ethical standards

Funding

The authors received no funding for this study.

Conflict of interest

Ryota Kubo, Yoshiko Ariji, Tohru Taniguchi, Michihito Nozawa, Akitoshi Katsuma, and Eiichiro Ariji declare that they have no conflicts of interest.

Human rights statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Animal rights statement

This article does not contain any studies with human or animal subjects performed by any of the authors. Panoramic radiographic features predict the development of bisphosphonate-related osteonecrosis of the jaw.

References

  1. 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.CrossRefPubMedGoogle Scholar
  2. 2.
    Phal PM, Myall RW, Assael LA, Weissman JL. Imaging findings of bisphosphonate-associated osteonecrosis of the jaws. AJNR Am J Neuroradiol. 2007;28:1139–45.CrossRefPubMedGoogle Scholar
  3. 3.
    Guo Y, Wang D, Wang Y, Peng X, Guo C. Imaging features of medicine-related osteonecrosis of the jaws: comparison between panoramic radiography and computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122:e69–76.CrossRefPubMedGoogle Scholar
  4. 4.
    Farias DS, Zen Filho EV, de Oliveira TF, Tinôco-Araújo JE, Sampieri MB, Antunes HS, et al. Clinical and image findings in bisphosphonate-related osteonecrosis of the jaws. J Craniofac Surg. 2013;24:1248–51.CrossRefPubMedGoogle Scholar
  5. 5.
    Krishnan A, Arslanoglu A, Yildirm N, Silbergleit R, Aygun N. Imaging findings of bisphosphonate-related osteonecrosis of the jaw with emphasis on early magnetic resonance imaging findings. J Comput Assist Tomogr. 2009;33:298–304.CrossRefPubMedGoogle Scholar
  6. 6.
    Mücke T, Deppe H, Hein J, Wolff KD, Mitchell DA, Kesting MR, et al. Prevention of bisphosphonate-related osteonecrosis of the jaws in patients with prostate cancer treated with zoledronic acid—a prospective study over 6 years. J Craniomaxillofac Surg. 2016;44:1689–93.CrossRefPubMedGoogle Scholar
  7. 7.
    Paek SJ, Park WJ, Shin HS, Choi MG, Kwon KH, Choi EJ. Diseases having an influence on inhibition of angiogenesis as risk factors of osteonecrosis of the jaw. J Korean Assoc Oral Maxillofac Surg. 2016;42:271–7.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Otto S, Tröltzsch M, Jambrovic V, Panya S, Probst F, Ristow O, et al. Tooth extraction in patients receiving oral or intravenous bisphosphonate administration: a trigger for BRONJ development? J Craniomaxillofac Surg. 2015;43:847–54.CrossRefPubMedGoogle Scholar
  9. 9.
    Huang YF, Chang CT, Muo CH, Tsai CH, Shen YF, Wu CZ. Impact of bisphosphonate-related osteonecrosis of the jaw on osteoporotic patients after dental extraction: a population-based cohort study. PLoS One. 2015;10:e0120756.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Reiss S, Sultan D. Risk factors in the development of oral bisphosphonate-induced osteonecrosis. N Y State Dent J. 2015;81:30–3.PubMedGoogle Scholar
  11. 11.
    Polymeri AA, Kodovazenitis GJ, Polymeris AD, Komboli M. Bisphosphonates: clinical applications and adverse events in dentistry. Oral Health Prev Dent. 2015;13:289–99.PubMedGoogle Scholar
  12. 12.
    Mücke T, Krestan CR, Mitchell DA, Kirschke JS, Wutzl A. Bisphosphonate and medication-related osteonecrosis of the jaw: a review. Semin Musculoskelet Radiol. 2016;20:305–14.CrossRefPubMedGoogle Scholar
  13. 13.
    Kim HY, Kim JW, Kim SJ, Lee SH, Lee HS. Uncertainty of current algorithm for bisphosphonate-related osteonecrosis of the jaw in population-based studies: a systematic review. J Bone Miner Res. 2016 (in press).Google Scholar
  14. 14.
    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.CrossRefPubMedGoogle Scholar
  15. 15.
    Klingelhöffer C, Klingelhöffer M, Müller S, Ettl T, Wahlmann U. Can dental panoramic radiographic findings serve as indicators for the development of medication-related osteonecrosis of the jaw? Dentomaxillofac Radiol. 2016;45:20160065.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al. American Association of Oral and Maxillofacial Surgeons. 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.CrossRefPubMedGoogle Scholar
  18. 18.
    Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws–2009 update. J Oral Maxillofac Surg. 2009;67:2–12.CrossRefPubMedGoogle Scholar
  19. 19.
    Muramatsu C, Matsumoto T, Hayashi T, Hara T, Katsumata A, Zhou X, et al. Automated measurement of mandibular cortical width on dental panoramic radiographs. Int J Comput Assist Radiol Surg. 2013;8:877–85.CrossRefPubMedGoogle Scholar
  20. 20.
    Muramatsu C, Horiba K, Hayashi T, Fukui T, Hara T, Katsumata A, et al. Quantitative assessment of mandibular cortical erosion on dental panoramic radiographs for screening osteoporosis. Int J Comput Assist Radiol Surg. 2016;11:2021–32.CrossRefPubMedGoogle Scholar
  21. 21.
    Katsumata A, Fujita H, Taguchi A, Ariji Y, Ariji E. Computer analysis of mandibular cortex morphology for screening of osteoporosis. J Jpn Stomatol Soc. 2016;65:256–63 (in Japanese).Google Scholar
  22. 22.
    Taguchi A, Suei Y, Sanada M, Ohtsuka M, Nakamoto T, Sumida H, et al. Validation of dental panoramic radiography measures for identifying postmenopausal women with spinal osteoporosis. AJR Am J Roentgenol. 2004;183:1755–60.CrossRefPubMedGoogle Scholar
  23. 23.
    Taguchi A, Suei Y, Ohtsuka M, Otani K, Tanimoto K, Ohtaki M. Usefulness of panoramic radiography in the diagnosis of postmenopausal osteoporosis in women. Width and morphology of inferior cortex of the mandible. Dentomaxillofac Radiol. 1996;25:263–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Taguchi A, Tanimoto K, Suei Y, Wada T. Tooth loss and mandibular osteopenia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79:127–32.CrossRefPubMedGoogle Scholar
  25. 25.
    Taguchi A, Suei Y, Sanada M, Higashi Y, Ohtsuka M, Nakamoto T, et al. Detection of vascular disease risk in women by panoramic radiography. J Dent Res. 2003;82:838–43.CrossRefPubMedGoogle Scholar
  26. 26.
    Klemetti E, Kolmakov S, Kröger H. Pantomography in assessment of the osteoporosis risk group. Scand J Dent Res. 1994;102:68–72.PubMedGoogle Scholar
  27. 27.
    Leite AF, dos Santos Ogata F, de Melo NS, de Souza Figueiredo PT. Imaging findings of bisphosphonate-related osteonecrosis of the jaws: a critical review of the quantitative studies. Int J Dent. 2014;2014:784348.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Ariji Y, Katsumata A, Kubo R, Taguchi A, Fujita H, Ariji E. Factors affecting observer agreement in morphological evaluation of mandibular cortical bone on panoramic radiographs. Oral Radiol. 2017;33:117–23.CrossRefGoogle Scholar

Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Japan KK 2017

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial RadiologyAichi-Gakuin University School of DentistryNagoyaJapan
  2. 2.Department of Oral and Maxillofacial SurgeryAichi-Gakuin University School of DentistryNagoyaJapan
  3. 3.Department of Oral RadiologyAsahi University School of DentistryMizuhoJapan

Personalised recommendations