MEDICATION RELATED OSTEONECROSIS OF THE JAW—CORRELATING CLINICAL FEATURES WITH RADIOGRAPHIC PRESENTATION (CBCT)

Abstract

<h3>BACKGROUND</h3> The assessment of severity of medication-related osteonecrosis of the jaw (MRONJ) lesions is often complicated because the clinical presentation underrepresents the extent of the radiographically evident lesion. Thus, there is a critical need to identify and develop an objective radiographic staging of the MRONJ lesion to complement the clinical assessment. The composite radiographic index (CRI)¹ is a meaningful index that attempts to convey the nature and extent of the radiographic changes. However, lesions that receive moderate scores using the CRI have a wide range of radiographic severity, undermining its clinical utility. <h3>OBJECTIVE(S)</h3> The proposed research aimed to validate a proposed modification of the CRI (mod-CRI) as a means to increase the clinical utility of the CRI by providing a weighted score for diffuse radiographic changes. <h3>STUDY DESIGN</h3> A systematic review of the literature was performed to identify quantitative indices developed to describe MRONJ lesions. In addition, a retrospective review of institutional electronic health records was conducted to identify patients with cone beam computed tomography (CBCT) imaging of their MRONJ lesions. The resulting CBCT imaging was assessed using both the CRI and mod-CRI. The 2 indices were compared for relative clarity and accuracy in reflecting the actual severity of the MRONJ lesions. <h3>RESULTS</h3> Twenty-two patients (17 female) with MRONJ lesions were identified. The mod-CRI eliminated the intermediate category scores generated using the CRI. It unequivocally categorized all lesions with at least 2 diffuse radiographic changes as severe. There was a statistically significant association between increased clinical stage and higher mod-CRI score (<i>P</i> = .040). <h3>DISCUSSION/CONCLUSIONS</h3> The mod-CRI, developed by modifying the scoring system originally proposed in the CRI, appeared to provide greater clarity in lesion description and assessment. If validated, the modified CRI could enhance communication between the radiologist and the clinician and guide clinical decision making regarding surgical management.