Risk assessment of bisphosphonate-related osteonecrosis of the jaw based on CBCT scans
Ferenc Koppány1, Árpád Joób-Fancsaly1, Zsolt Németh1
1Fogorvostudományi Kar, Arc-, Állcsont-, Szájsebészeti és Fogászati Klinika,Semmelweis Egyetem Budapest.
Introduction:
Bisphosphonate-related osteonecrosis of the jaw is a condition that severely affects the quality of life, therefore an early diagnosis is of utmost importance (both from a general and a surgical point of view), alongside with an accurate assessment of the risk of emergence of the disease.
Aim:
Estimation of the prognosis is not resolved; among several radiological options those used in dentistry seem the most fit for the purpose, with cone-beam computed tomography (CBCT) being superior in this task. Assessment of the risk of BRONJ developed following orally applied bisphosphonate is unemphatic in most case studies - these focus more on the intravenous application carrying a greater risk of BRONJ.
Method:
In contrast with the studies published so far, we performed our measurements on preoperative CBCT scans, thereby directly studying the possibility of risk assessment. Our measurements were conducted through evaluating CBCT scans. We chose the frontal section in the midline of the mental foramen as the representative area. We measured density and thickness of the cortical bone on several given points; the diameter of the mental foramen was also measured. In the first group, we examined patients suffering from osteoporosis who had developed BRONJ following oral bisphosphonate treatment. In the second group, we looked at patients suffering from osteoporosis, who had received oral bisphosphonate therapy for this condition but did not develop BRONJ after oral surgery. As control group, we chose patients suffering from osteoporosis who had not received any of the medications known to cause BRONJ.
Results:
Based on our results, it is clear that there is no significant difference in the bone density of those patients who developed BRONJ and those who did not, examining the preoperative CBCT scans.
Conclusions:
Using CBCT scans (and thereby submitting the patient to radiation exposure) in order to estimate the possibility of BRONJ following oral bisphosphonate treatment for osteoporosis is not recommended. It is important not to expose patients to more radiation than strictly necessary to predict BRONJ following oral bisphosphonate treatment in accordance with the ALARA (as low as reasonably achievable) principle. Orv Hetil. 2020; 161(21): 867-872.
