Histologic analysis of osteonecrosis of the jaw according to the different aspects on quantitative light-induced fluorescence images.

Abstract

Recurrence of osteonecrosis of the jaw has been reported after surgery. It is therefore necessary to develop a real-time diagnostic method, which can clearly distinguish the surgical margin from unaffected bone. We analyzed a sequestrum from a patient with medication-related osteonecrosis of the jaw (MRONJ). Quantitative light induced fluorescence (QLF) was applied to the sequestrum. In this study, QLF demonstrated three types of fluorescence phenomena (Non-red-fluorescence, hyper-red-fluorescence, and hypo-red-fluorescence) on the sequestrum. Histology revealed geographical, microbiological, and immunological differences based on the fluorescence types on QLF. Non-red-fluorescence showed sclerotic and lamellar bone tissue, hyper-red-fluorescence showed an infectious state due to bacterial invasion and osteolysis, and hypo-red-fluorescence indicated predominantly granular tissue with inflammation, and the absence of bone matrix and bacterial colonies. Based on histologic analysis, we speculated that QLF may be a useful real-time diagnostic tool during surgery for MRONJ. In conclusion, QLF can be useful in distinguishing between lamellar and infected bone, which are visually similar; QLF-guided ONJ surgery, preserving the Non-red-fluorescent areas and removing the hyper- and hypo-red-fluorescent areas of bone may be useful.