Treister Nathaniel S, Friedland Bernard, Woo Sook-Bin
Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 May;109(5):753-64. doi: 10.1016/j.tripleo.2009.12.005. Epub 2010 Mar 29.
Bisphosphonate-associated osteonecrosis of the jaws (BONJ) is characterized by exposed nonvital maxillary or mandibular bone. Cone-beam computerized tomography (CBCT) is an attractive modality for 3-dimensional imaging of the jaws. The purpose of this study was to compare the clinical and radiographic features of a series of 7 subjects with BONJ who were evaluated by both CBCT and digital panoramic radiography.
Seven subjects with BONJ were evaluated by clinical examination, CBCT, and digital panoramic radiography.
Radiographic findings included sclerosis, cortical irregularity, lucency, mottling, fragmentation/sequestra formation, sinus communication, and persistent sockets. There was high correlation between the anatomic location of clinical and radiographic findings. In nearly all cases, CBCT demonstrated a greater extent and quality of changes compared with panoramic radiography.
Cone-beam CT is superior to panoramic radiography in its ability to characterize the nature and extent of radiographic changes in BONJ. Use of CBCT should be strongly considered when radiographic evaluations are included in prospective research investigations of BONJ. However, in the majority of cases of BONJ the clinical significance of improved imaging remains unclear, and therefore specific guidelines for routine clinical care cannot be recommended at this time.
双膦酸盐相关颌骨骨坏死（BONJ）的特征为上颌骨或下颌骨的无活力骨暴露。锥形束计算机断层扫描（CBCT）是一种用于颌骨三维成像的有吸引力的方式。本研究的目的是比较7例经CBCT和数字化全景X线摄影评估的BONJ患者的临床和影像学特征。
对7例BONJ患者进行临床检查、CBCT和数字化全景X线摄影评估。
影像学表现包括骨质硬化、皮质不规则、透亮区、斑点状、碎片/死骨形成、窦腔相通和牙槽窝存留。临床和影像学表现的解剖位置之间存在高度相关性。几乎在所有病例中，与全景X线摄影相比，CBCT显示出更大范围和更高质量的改变。
锥形束CT在表征BONJ影像学改变的性质和范围方面优于全景X线摄影。在BONJ的前瞻性研究调查中纳入影像学评估时，应强烈考虑使用CBCT。然而，在大多数BONJ病例中，影像学改善的临床意义仍不明确，因此目前无法推荐常规临床护理的具体指南。
