Precursor Radiographic Findings in Patients With Medication-Related Osteonecrosis of the Jaw

Abstract

BackgroundOral surgical treatment, such as tooth extraction, has been identified as a risk factor for the onset of medication-related osteonecrosis of the jaw (MRONJ). However, MRONJ may already be latent, and its manifestation triggered by extraction. PurposeThe purpose of this study was to examine the association between pre-extraction imaging and MRONJ. Study design, setting, and populationWe performed a multicenter case-control analysis of patients receiving antiresorptive agents (ARAs) who underwent extraction between 2012 and 2016. We enrolled patients who had undergone tooth extraction in the setting of ARA exposure. Predictor variablesThe predictor variables comprised preoperative radiographic findings associated with MRONJ stage 0. These findings included alveolar bone loss, thickening or obscuring of the periodontal ligament, and osteosclerosis involving the alveolar bone. They were coded as present or absent before tooth extraction. Main outcome variableThe primary outcome variable was MRONJ status coded as present or absent. CovariatesSex, age, underlying diseases necessitating the administration of ARA, the type of ARA used, corticosteroid use, extraction region, and wound closure were analyzed. AnalysesMann-Whitney U test, chi-square test, Fisher’s exact test for univariate analysis, and multiple logistic regression analysis were performed. P-values < 0.05 were significant. ResultsThe subjects consisted of 26 patients and 110 controls (male: 8/36, female: 18/74). The mean ages of the MRONJ group and the control group were 77.0 ± 11.9 and 63.0 ± 15.8, respectively (P-value = 0.001). The prevalence of osteosclerosis was significantly higher in the MRONJ group than in the control group (14/72 53.9%/29.3%, p < 0.01). Multivariate analysis identified osteosclerosis (odds ratio: 8.4, 95%CI: 2.133.9, p < 0.01) as a significant independent predictor associated with the development of MRONJ after extraction. ConclusionsThese findings suggest that a precursor to MRONJ is highly likely to be present in patients with osteosclerosis at the time of extraction. The majority of patients who developed MRONJ after extraction had imaging findings that suggested infection in the surrounding alveolar bone.