Clinical Update quiz
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April Clinical Update
How does the clinical and tomographic appearance of MRONJ influences its treatment prognosis?
Moreno Rabie C , García-Larraín S, Contreras Diez de Medina D , Cabello-Salazar I, Cavalcante Fontenele R, Van den Wyngaert T, Jacobs R. Dentomaxillofac Radiol (2023) 10.1259/dmfr.20230304. Compiled by Dr Sarah Chin.
This article was originally published by The British Institute of Radiology and has been edited for brevity and clarity.
Introduction
Medication related osteonecrosis of the jaws (MRONJ) is defined as exposed bone or a fistula that extends to the bone in the maxillofacial area persisting for more than eight weeks in patients being treated with antiresorptive drugs (ARDs). These medications prevent bone fractures in patients with bone metastases and osteoporosis.
Treatment for MRONJ is to control infection, minimise pain and avoid necrosis progression. Treatment approaches range from conservative to surgical treatment are based on MRONJ- staging, age, primary disease, co-morbidities and type of ARD. Conservative treatment involves the use of a variety of antibiotics and antiseptic mouthwashes. Surgery involves removing necrotic and infected bone, removing the sharp edges of bone and tension free primary closure of the mucoperiosteal flap. Some protocols include the use of laser therapy or local application of autologous platelet concentrates (APC). Mucosal healing indicates treatment success. Success rates vary with 28.8% in conservative treatment and ranging from 27.6% to 91.6% with surgical treatment.
Treatment prognostic factors have been identified such as dosage of ARD, C-reactive protein (CRP) and alkaline phosphate. Some authors have considered the three- dimensional radiographic assessment of the lesion. Radiographic images of exposed necrotic bone are variable and may show osteolysis, cortical bone erosion, sequestrum formation, osteosclerosis as well as periosteal reaction. Osteonecrosis lesions larger than 1/3 of the jaw had a worse surgical prognosis. A periosteal reaction was found to be a poor prognostic outcome indicator.
The aim of this study was to identify clinical and tomographic prognostic factors for conservative and surgical treatment of MRONJ using cone beam CT (CBCT). The secondary aim would be to also investigate imaging features associated with lesion relapse.
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