OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.
Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
Dentomaxillofac Radiol. 2023 Nov;52(8):20230238. doi: 10.1259/dmfr.20230238. Epub 2023 Oct 24.
To identify clinical and local radiographic predictors for medication-related osteonecrosis of the jaws (MRONJ) by the assessment of pre-operative CBCT images of oncologic patients treated with anti-resorptive drugs (ARDs) undergoing tooth extractions.
This retrospective, longitudinal, case-control study included clinical and imaging data of 97 patients, divided into study and control group. Patients in the study group ( = 47; 87 tooth extractions) had received at least one dose of ARD, undergone tooth extraction(s), and had a pre-operative CBCT. An age-, gender-, and tooth extraction-matched control group ( = 50; 106 tooth extractions) was selected. Three calibrated, blinded, and independent examiners evaluated each tooth extraction site. Statistical analysis used χ/Fisher's exact/Mann-Whitney test to contrast control and study group, ARD type used, and sites with or without MRONJ development. -value ≤ 0.05 was considered significant.
From the study group, 15 patients (32%) and 33 sites (38%) developed MRONJ after tooth extraction. When controls were compared to study sites, the latter showed significantly more thickening of the lamina dura, widened periodontal ligament space, osteosclerosis, osteolysis, and sequestrum formation. In the study group, MRONJ risk significantly increased in patients who had multiple tooth extractions, were smokers, and had shorter drug holidays. Periosteal reaction and sequestrum formation may indicate latent MRONJ lesions. Additionally, patients given bisphosphonates showed considerably more osteosclerosis than those given denosumab.
Periosteal reaction and sequestrum formation are suspected to be pre-clinical MRONJ lesions. Furthermore, ARD induced bony changes and radiographic variations between ARD types were seen.
通过评估接受抗吸收药物（ARD）治疗的肿瘤患者术前 CBCT 图像，确定与药物相关的颌骨坏死（MRONJ）的临床和局部放射影像学预测因素。
本回顾性、纵向、病例对照研究纳入了 97 名患者的临床和影像学数据，分为研究组和对照组。研究组（n=47；87 颗拔牙）至少接受过一次 ARD 治疗、进行过拔牙，并进行了术前 CBCT 检查。选择年龄、性别和拔牙匹配的对照组（n=50；106 颗拔牙）。三名经过校准、盲法和独立的检查者评估了每个拔牙部位。统计分析采用卡方/Fisher 确切检验/Mann-Whitney U 检验对比对照组和研究组、使用的 ARD 类型以及有无 MRONJ 发生的部位。p 值≤0.05 被认为有统计学意义。
研究组中有 15 名患者（32%）和 33 个部位（38%）在拔牙后发生了 MRONJ。与研究部位相比，对照组的牙骨质硬板增厚、牙周膜间隙增宽、骨硬化、骨溶解和死骨形成更为明显。在研究组中，多颗牙齿拔牙、吸烟和药物假期较短的患者，MRONJ 风险显著增加。骨膜反应和死骨形成可能预示着潜在的 MRONJ 病变。此外，接受双磷酸盐治疗的患者比接受地舒单抗治疗的患者表现出更多的骨硬化。
骨膜反应和死骨形成被怀疑是临床前 MRONJ 病变。此外，还观察到 ARD 诱导的骨改变和不同 ARD 类型之间的放射影像学差异。
