Predictive factors for refractory stage I and II anti-resorptive agent-related osteonecrosis of the jaw

Takahiro Shimizu,Takaya Makiguchi,Masaru Ogawa,Trang Thuy Dam,Mai Kim,Satoshi Yokoo,Jun Kurihara

doi:10.1007/s11282-021-00547-1

Takahiro Shimizu, Takaya Makiguchi + Show 5 more

Open Access

https://doi.org/10.1007/s11282-021-00547-1

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Journal: Oral Radiology	Publication Date: Jul 3, 2021
Citations: 2	License type: open-access

Affiliation: Gunma University

Abstract

ObjectivesWe aimed to predict the possibility of patients with stage I and II anti-resorptive agent-related osteonecrosis of the jaw (ARONJ) developing resistance to our treatment protocol by evaluating their clinical and imaging factors.Materials and methodsWe enrolled 58 patients with ARONJ who underwent imaging modality. As objective variables, we considered the healing, stage-down, and stable stages as successful outcomes, and the stage-up stage as resistant-to-treatment. As explanatory variables, we investigated the clinical and imaging factors. Furthermore, we examined stage-down as an improvement outcome to compare with the stable and stage-up stages, which were considered as no-improvement outcomes. We conducted unpaired between-group comparisons on all explanatory variables using χ2 tests for independence.ResultsAmong 58 patients, the treatment was successful in 53 (91.4%); however, the disease was resistant in five (8.6%). Among the clinical factors, the resistant patients had a longer duration of administration of bone-modifying agents (BMAs) (cut-off: 1251 days, p = 0.032, odds ratio = 11.2, 95% confidence interval 1.115–122.518). In addition, the target disease that was being treated bone metastasis of malignant tumor was the only significant refractory factor (p = 0.024, OR: 3.667 95% CI 1.159–11.603)ConclusionsA combination of metabolic and morphological imaging modalities may be useful for oral surgeons to evaluate the disease activity and predict course of refractory ARONJ.

Highlights

Several imaging modalities and analytical methods have been used to assess the course of anti-resorptive agentrelated osteonecrosis of the jaw (ARONJ) and determine its clinical stages [1]
Studies on the imaging modalities and risk factors of ONJ have focused on assessing its stage and predicting its development, and factors associated with refractory disease or an exacerbation of ONJ have not been investigated in detail
ARONJ developed in the maxilla, mandible, anterior and premolar tooth region, and molar region in 21 (33.9%), 37 (66.1%), four (6.9%), and 57 (93.1%) cases, respectively

Summary

Introduction

Several imaging modalities and analytical methods have been used to assess the course of anti-resorptive agentrelated osteonecrosis of the jaw (ARONJ) and determine its clinical stages [1]. According to the Japanese Society for Oral and Maxillofacial Radiology [2], 64% of oral radiologists believe that dental panoramic radiography (DPR) is the best screening modality for bisphosphonate-related osteonecrosis of the jaw (BRONJ), while 68% of oral radiologists. Oral Radiology treatment, diabetes, malignant tumors, cancer chemotherapy, smoking, and poor oral hygiene were considered as systemic risk factors [5]. Studies on the imaging modalities and risk factors of ONJ have focused on assessing its stage and predicting its development, and factors associated with refractory disease or an exacerbation of ONJ have not been investigated in detail. This study aimed to predict the possibility of treatment resistance among ARONJ patients based on clinical and imaging factors

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