Use of cone-beam computerized tomography for evaluation of bisphosphonate-associated osteonecrosis of the jaws

• Published in: Oral surgery, oral medicine, oral pathology, oral radiology and endodontics Vol. 109; no. 5; pp. 753 - 764
• Main Authors: Treister, Nathaniel S., Friedland, Bernard, Woo, Sook-Bin
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.2010; Elsevier
• Subjects: Adult; Aged; Alendronate - adverse effects; Biological and medical sciences; Bone Density Conservation Agents - adverse effects; Bones, joints and connective tissue. Antiinflammatory agents; Cone-Beam Computed Tomography - methods; Diphosphonates - adverse effects; Diseases of the osteoarticular system; Dry Socket - chemically induced; Dry Socket - diagnostic imaging; Female; Humans; Imaging, Three-Dimensional - methods; Imidazoles - adverse effects; Male; Mandibular Diseases - chemically induced; Mandibular Diseases - diagnostic imaging; Maxillary Diseases - chemically induced; Maxillary Diseases - diagnostic imaging; Medical sciences; Middle Aged; Oroantral Fistula - chemically induced; Oroantral Fistula - diagnostic imaging; Osteonecrosis - chemically induced; Osteonecrosis - diagnostic imaging; Osteosclerosis - chemically induced; Osteosclerosis - diagnostic imaging; Otorhinolaryngology. Stomatology; Pharmacology. Drug treatments; Radiography, Dental, Digital - methods; Radiography, Panoramic - methods; Surgery; Tooth Socket - diagnostic imaging; Tooth Socket - drug effects; Vascular bone diseases; Evaluation; Jaw; Antiosteoporotic; Radiodiagnosis; Antiosteoclastic agent; Diseases of the osteoarticular system; Medical imagery; Osteonecrosis; Computerized axial tomography; Bisphosphonates; Cone beam
• ISSN: 1079-2104; 1528-395X; 1528-395X
• DOI: 10.1016/j.tripleo.2009.12.005

Bisphosphonate-associated osteonecrosis of the jaws (BONJ) is characterized by exposed nonvital maxillary or mandibular bone. Cone-beam computerized tomography (CBCT) is an attractive modality for 3-dimensional imaging of the jaws. The purpose of this study was to compare the clinical and radiographic features of a series of 7 subjects with BONJ who were evaluated by both CBCT and digital panoramic radiography. Seven subjects with BONJ were evaluated by clinical examination, CBCT, and digital panoramic radiography. Radiographic findings included sclerosis, cortical irregularity, lucency, mottling, fragmentation/sequestra formation, sinus communication, and persistent sockets. There was high correlation between the anatomic location of clinical and radiographic findings. In nearly all cases, CBCT demonstrated a greater extent and quality of changes compared with panoramic radiography. Cone-beam CT is superior to panoramic radiography in its ability to characterize the nature and extent of radiographic changes in BONJ. Use of CBCT should be strongly considered when radiographic evaluations are included in prospective research investigations of BONJ. However, in the majority of cases of BONJ the clinical significance of improved imaging remains unclear, and therefore specific guidelines for routine clinical care cannot be recommended at this time.