Kim Soung Min, Eo Mi Young, Kim Yeon Sook, Lee Suk Keun
Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea.
Department of Dental Hygiene, Cheongju University, Cheongju, Korea.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Feb;123(2):220-228. doi: 10.1016/j.oooo.2016.09.225. Epub 2016 Oct 13.
To contrast the pattern of bony reversal linesin bisphosphonate osteonecrosis of the jaw with infected osteomyelitis derived acute osteonecrosis of the jaw.
This study investigated the histochemical characteristics of reversal lines in 50 cases of BP-related osteonecrosis of the jaw (BRONJ) compared with non-BP-involved bones in 20 cases of chronic osteomyelitis of the jaws. Necrotic bones were stained by using the toluidine blue, Safranin O, Giemsa, van Gieson, and Masson's trichrome staining methods.
All BP-involved bones in BRONJ were distinguishable from non-BP-involved bones in chronic osteomyelitis of the jaws by multiple thick, irregular, reversal lines, which were strongly stained with toluidine blue, Safranin O, and Giemsa solution. The reversal lines of BP-involved bones (average 31.2 ± 10.85 μm) were thicker than those of osteomyelitic bones (average 11.1 ± 3.76 μm), and they were closely associated with immature bony matrices containing collagenous materials positive for van Gieson and Masson's trichrome staining with statistical significance (P = .0212 in t test statistics). The immature reversal lines of BP-involved bones continuously appeared as thick non-birefringence lines between lamellate structures as observed under a polarizing microscope, whereas the reversal lines of non-BP-involved bones were gradually thinned as their mineralization advanced.
BP-involved bones had immature bony matrices outlined by thick reversal lines, which might be crucial to rapid osteonecrosis of BRONJ and also could be hallmarks for the differential diagnosis of BRONJ from chronic osteomyelitis of the jaws.
对比双膦酸盐相关性颌骨骨坏死中骨反转线的模式与感染性骨髓炎所致急性颌骨骨坏死的模式。
本研究调查了50例双膦酸盐相关性颌骨骨坏死（BRONJ）中反转线的组织化学特征，并与20例颌骨慢性骨髓炎中未涉及双膦酸盐的骨组织进行比较。坏死骨采用甲苯胺蓝、番红O、吉姆萨、范吉森和马松三色染色法进行染色。
BRONJ中所有涉及双膦酸盐的骨组织可通过多条粗大、不规则的反转线与颌骨慢性骨髓炎中未涉及双膦酸盐的骨组织区分开来，这些反转线在甲苯胺蓝、番红O和吉姆萨染液中染色强烈。涉及双膦酸盐的骨组织的反转线（平均31.2±10.85μm）比骨髓炎骨组织的反转线（平均11.1±3.76μm）更厚，且它们与含有对范吉森和马松三色染色呈阳性的胶原物质的未成熟骨基质密切相关，具有统计学意义（t检验统计中P = 0.0212）。在偏光显微镜下观察，涉及双膦酸盐的骨组织的未成熟反转线在板层结构之间持续呈现为粗大的非双折射线，而未涉及双膦酸盐的骨组织的反转线随着矿化进展逐渐变薄。
涉及双膦酸盐的骨组织具有由粗大反转线勾勒出的未成熟骨基质，这可能对BRONJ的快速骨坏死至关重要，也可能是BRONJ与颌骨慢性骨髓炎鉴别诊断的标志。
