Supervisors info:
Τσιχλάκης Κωνσταντίνος , Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Παπαδάκης Ευάγγελος, Επίκουρος Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Βάρδας Εμμανουήλ, Επίκουρος Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Summary:
Purpose: The main purpose of this research is to evaluate in Cone Beam
Computed Tomography (CBCT) the existence and the extent of imaging
findings in patients with Medication Related Osteonecrosis of the jaw
(MRONJ).. An important aspect of this study to propose the use of a new
modified Composite Radiographic Index (CRIm) with a score resulting from 6
different imaging findings: osteolysis, osteosclerosis, periosteal reaction,
sequestration, non-healing extraction sockets and other findings (sinus
occupation, contact of the lesion with the inferior alveolar nerve, jaw fracture).
Finally we tried to investigate the contribution of these findings to the CRIm
index, as well as possible correlations of the CRIm index with the gender,
location and age.
Materials and Methods:66 CBCT examinations of patients with MRONJ
were retrospectively assessed. All patients were examined in Dental School
of the National and Kapodistrian University of Athens from 2017 until 2019. In
order to quantify the extent and severity of the imaging findings, CRIm was
implemented with a total score resuting from 6 different imaging findings : (A)
osteolysis, (B) osteosclerosis, (C) periosteal bone formation, (D) sequestrum,
(E) non-healing extraction sockets, (F) other findings (Occupied sinus,
Contact of osteolysis with inferior alveolar nerve, Fracture of the jaw).
Findings A, B, C, D, and E have a score of 0 (absence), 1 (presence of
findings up to one centimeter), 2 (presence of findings larger than one
centimeter or presence of multiple findings). Similarly category F has score 0,
1, 2, but 2 only regards presence of multiple findings. CRIm has a continuous
score from 0 to 12. In order to investigate the correlation of characteristics of
the sample with the CRIm index, the statistical control t-test was applied to
compare 2 mean values in independent samples and the Pearson r
parameter correlation coefficient was calculated. In order to investigate the
correlation of the location with the imaging findings, the X2 test was
performed, or alternatively the corresponding Fisher’s exact test. P-values
with a value below 0.05 are considered statistically significant results. SPSS
v.25 software (SPSS Inc., 2003, Chicago, USA) were used to perform the
statistical analysis.
Results: The 65.1% of CBCT examinations belonged to female patients and
34.9% were males. The average age of patients is 68.5 years. In terms of
localization, 38,2% of patients had mandibular posterior location 21,6%
mandibular anterior, 20,6% maxillary posterior and 19,6% maxillary anterior.
Regarding osteolysis and osteosclerosis, the majority of patients (86.3% and
80.3% respectively) had findings larger than one centimeter or multiple
findings in multiple areas of the jaws. Regarding periosteal bone formation,
sequestration, and post-extraction sockets, the majority of patients (74.2%,
42.4%, and 71.2%, respectively) had no findings. Sinus was occupied in
57,2% of patients with maxillary posterior localization, osteolysis was in
contact with the inferior alveolar nerve in 56% of patients with mandibular
posterior localization and 6,1% of the patients exhibited jaw fractures. The
average value of the CRIm index was 5.9 points, the minimum value was 1
point and the maximum value 11 points. The highest value in the index was
the "osteolysis" factor, followed by "osteosclerosis", "sequestration",
"periosteal bone formation" and finally "post-extraction sockets". Females had
an average higher CRIm index than males. Patients with lower anterior or
lower posterior location had an average higher CRIm. The 90% of patients
with MRONJ in the upper anterior jaw, did not show periosteal bone
formation, while 25% present with post-extraction socket over 1 cm or in
multiple locations. The 90.5% of patients with maxillary posterior localization
did not show periosteal bone formation, while 23.8% present with postextraction
socket over 1 cm or in multiple locations. The 95.5% of patients
with mandibullar anterior localization present with osteosclerosis larger than 1
cm or in multiple locations. Finally, the biggest variable of CRIm is explained
by the factor "sequestration".
Conclusions: Osteolysis was the most common finding and accounted for
95% of the cases, while osteosclerosis at 85%. More than half (56%) of
patients with MRONJ in the mandibular posterior area had osteolytic lession
in contact with the inferior alveolar nerve. More than half (57.2%) of patients
with MRONJ in the maxillary posterior jaw area have an occupied sinus. The
CRIm index is a reliable factor in studying the existence and extent of
MRONJ imaging findings. It can be used for further comparisons.
Keywords:
Osteonecrosis jaw, Medication, Cone beam computed tomography, cbct, Index, Imaging, Radiographic, Biphosphonates, Osteoporosis
