SYSTEMATIC REVIEW OF CONE BEAM COMPUTED TOMOGRAPHY USE IN DIAGNOSIS OF MEDICATION-RELATED OSTEONECROSIS OF THE JAW

Abstract

<h3>Background</h3> Medication-related osteonecrosis of the jaw (MRONJ) is an adverse drug reaction, marked by bone destruction. Most studies have focused on diagnosis and management. <h3>Objective</h3> The aim of this review was to explore the role of cone beam computed tomography (CBCT) in MRONJ diagnosis. <h3>Materials and Methods</h3> The following databases were searched: PubMed, Scopus, Web of Science, Trip, and Cochrane Library. Search terms were "osteonecrosis," "medication-related," "radiography," "bone resorption," and "CBCT." The search from 1972 onward yielded 395 articles (case reports, case series, studies, and systematic reviews), but only 11 articles met our inclusion criteria. <h3>Results</h3> Eleven articles with 168 cases were included in a full-text qualitative analysis. Females comprised 66.6% of cases (mean age 58.5 years). CBCT findings included osteolytic lesions, osteosclerosis, sequestra, and sinus mucosal thickening. The most frequent location was the posterior mandible (62.6%). Stage 1 was most often reported (36.4%). The most frequent precipitating event was extraction (75%). Of the included cases, 52.4% were oncologic cases, and 23.8% were osteoporosis cases. Of the patients, 72.7% had taken antiresorptive medications, and 4.5% had taken antiangiogenics. Administration was mostly by the oral route (45%). Several articles included information on management, with 90% reporting antibiotic and chlorhexidine use and 10% reporting surgical intervention. <h3>Discussion</h3> CBCT is a reliable tool in the detection and staging of MRONJ. It is reported to offer advantages over multidetector computed tomography (MDCT) with regard to radiation exposure and is superior to 2-dimensional (2-D) imaging in the detection of MRONJ features.