Demir A, Pekiner F N
Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkey.
Niger J Clin Pract. 2017 Mar;20(3):346-354. doi: 10.4103/1119-3077.183241.
The aim of this study is to assess radiographic findings of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and to evaluate the efficiency of cone-beam computed tomography (CBCT) and panoramic radiography (PR) by comparing with each other.
The data of 46 patients treated with bisphosphonates for at least 1 to 10 years were retrospectively examined. 27 patients were selected for study group. The first inclusion criteria was an available CBCT or PR. The patients had at least one clinical symptom of exposed bone, intraoral or extraoral swelling and purulent secretion or fistula formation. In accordance with the position papers of the American Association of Oral and Maxillofacial Surgeons, the patients were classified into stages. CBCT and PR images were evaluated by dividing the jaws in 6 segments. Presence of bone sclerosis, cortex irregularity, persistent sockets, periosteal response, sequestration, and osteolysis were recorded.
The radiographic findings of BRONJ were mostly determined at posterior mandible with Stage 2 predominancy. Fifteen patients (55.6%) had previous tooth extraction. 9 of them had exposed bone at the same time. Seven patients had exposed bone without extraction. CBCT findings (P < 0.01) except persistent socket (P = 0.157) were found statistically significant by comparison with PR. Extraction socket finding was detected the same in segments with a percentage of 90.9%.
This study showed that CBCT findings except extraction socket were significantly higher than PR. CBCT combined with clinical examination can be used effectively to determine the borders of effected areas especially at advanced cases.
本研究旨在评估双膦酸盐相关颌骨骨坏死（BRONJ）的影像学表现，并通过相互比较评估锥形束计算机断层扫描（CBCT）和全景放射摄影（PR）的效率。
回顾性检查46例接受双膦酸盐治疗至少1至10年的患者的数据。选择27例患者作为研究组。首要纳入标准是有可用的CBCT或PR。患者至少有一项暴露骨、口腔内或口腔外肿胀、脓性分泌物或瘘管形成的临床症状。根据美国口腔颌面外科医师协会的立场文件，将患者进行分期。通过将颌骨分为6个节段来评估CBCT和PR图像。记录骨硬化、皮质不规则、持续牙槽窝、骨膜反应、死骨形成和骨质溶解的情况。
BRONJ的影像学表现大多在颌骨后部确定，以2期为主。15例患者（55.6%）曾拔牙。其中9例同时有暴露骨。7例患者有暴露骨但未拔牙。与PR相比，CBCT表现（P < 0.01）除持续牙槽窝（P = 0.157）外，差异有统计学意义。在各节段中，拔牙后牙槽窝表现检出率相同，为90.9%。
本研究表明，除拔牙后牙槽窝外，CBCT表现明显高于PR。CBCT结合临床检查可有效用于确定受累区域的边界，尤其是在晚期病例中。
