Radiographic predictors for MRONJ in oncologic patients undergoing tooth extraction

Area of Science:

• Oral and Maxillofacial Surgery
• Oncology
• Radiology

Background:

• Tooth extraction is a known risk factor for Medication-Related Osteonecrosis of the Jaw (MRONJ) in patients treated with antiresorptive drugs (ARDs).
• However, not all extraction sites progress to MRONJ, suggesting local factors influence development.
• Identifying these local predictors is crucial for risk assessment and patient management.

Purpose of the Study:

• To identify local radiographic predictors of MRONJ in panoramic images of oncologic patients undergoing tooth extraction.
• To correlate specific preoperative and postoperative imaging findings with MRONJ development.

Main Methods:

• Retrospective longitudinal cohort study of 77 oncologic patients undergoing 218 tooth extractions.
• Panoramic radiographs were analyzed pre- and post-operatively for 11 and 5 imaging parameters, respectively.
• Case-control and subgroup analyses were performed to assess MRONJ development.

Main Results:

• MRONJ developed in 29% of extractions (63/218) across 51% of patients (39/77).
• Significant predictors of MRONJ included longer ARD treatment duration, absent/incomplete endodontic fillings with caries, widened periodontal ligament space/periapical lesions, and sclerotic/heterogenous bone patterns.
• Infection and bone sclerosis at extraction sites were significantly associated with higher MRONJ risk (p < 0.05).

Conclusions:

• Pre-extraction radiographic findings of infection and bone sclerosis are significant predictors of MRONJ development.
• Panoramic radiography can aid in identifying high-risk extraction sites in patients on ARDs.
• These findings can inform clinical decision-making regarding tooth extractions in this patient population.