American Association Of Oral And Maxillofacial Surgeons Research Articles

Does surgical volume correlate with outcomes in TMJ replacement surgery?

ObjectivesTo survey oral and maxillofacial surgeons (OMS) who perform temporomandibular joint replacement (TMJR) to determine whether length of surgery, specific TMJR protocols, or the incidence of complications are related to experience and case volume. Study DesignAn anonymous electronic survey was emailed to 407 surgeon members of the American Association of Oral and Maxillofacial Surgeons, American Society of Temporomandibular Joint Surgeons, and European Society of Temporomandibular Joint Surgeons known to have TMJR experience via publications or reputation. The descriptive survey contained multiple choice and open-ended questions. Descriptive statistics were computed for each variable for data analysis. Results49 surgeons completed the survey. The average stock TMJR cases included 54.6% unilateral and 50.5% bilateral cases. The average custom TMJR cases included 50.5% unilateral and 49.5% bilateral cases. Average procedure time for stock TMJR was 2.86 hours for unilateral, and 5.30 hours for bilateral cases. The average procedure time for a custom TMJR was 2.75 hours for unilateral, and 4.87 hours for bilateral cases. Average duration of hospital stay for stock and custom TMJR cases was 1.49 and 1.41 days (unilateral), and 1.98 and 1.95 days (bilateral). ConclusionThis study provides some pilot data that demonstrates that the length of surgery, specific TMJR surgical protocols, and the incidence of complications may be related to surgeon TMJR experience and case volume. IntroductionAlloplastic temporomandibular joint replacement (TMJR) is indicated for patients with end-stage temporomandibular joint pathology.1 As with any surgery, complications may occur, however, to date the relationship between the incidence of adverse events and surgeon experience has been unreported for TMJR surgery. The orthopedic literature demonstrates that the risk of complications decreases with more surgeon experience with alloplastic joint replacements.2,3 The aim of this study was to survey OMS who perform TMJR to determine whether length of surgery, specific TMJR protocols, and the incidence of complications could be related to their TMJR experience and case volume. It is hypothesized that with more TMJR surgical experience and case volume there will be fewer complications. Materials and MethodsThe study received Institutional Review Board approval (IRB #2023-0095) by the University of Illinois Chicago Research Office of Protection of Research Subjects. The study complies with the Helsinki Declaration and Health Insurance Portability and Accountability Act of 1996 (HIPAA). An invitation to participate in an anonymous electronic survey, via Survey Monkey (http://www.surveymonkey.com), was emailed to 407 surgeon members of the American Association of Oral and Maxillofacial Surgeons (AAOMS), American Society of Temporomandibular Joint Surgeons (ASTMJS), and European Society of Temporomandibular Joint Surgeons (ESTMJS) list serves. Two weeks after the initial recruitment email was sent, a reminder email was sent to the surgeons. All potential participants were provided with 4 weeks to sign a detailed informed consent form and complete the survey.The descriptive survey contained multiple choice and open-ended questions including: practice type, years in practice, if alloplastic TMJR is preformed, if TMJR Fellowship was completed, years of TMJR practice, average number of annual unilateral and bilateral TMJR cases, number considered an annual “high volume number” of TMJR procedures, average procedure time in hours for unilateral, bilateral, stock, and custom TMJR cases, average duration of hospital stay in days, and any complications and management. Descriptive statistics were computed for each variable for data analysis. ResultsThe survey was successfully sent to 394 emails, with a response rate of 12.9%. 13 emails were returned from the original 407 emails. 49 surgeons completed the survey, and 2 surgeons replied that they did not complete the survey because they are retired. 63.27% of the responding surgeons identified as academic, 53.06% as private practice, 22.45% as both academia and private practice, and 2.04% as military (Figure 1A). 93.88% reported they perform alloplastic TMJR (Figure 1B). 79.17% had not completed a TMJR fellowship (Figure 1C). 27.08% employed TMJR surgery in their practices >26 years (Figure 2).

Medication-Related Osteonecrosis of the Jaw – 2024 Update

As the global number of patients with osteoporosis and malignant diseases such as breast cancer, multiple myeloma, and prostate cancer increases every year, there is an associated rise in the use of antiangiogenic medications and antiresorptive medications. With increasing frequencies in the use of antiangiogenic and antiresorptive medications, there is an associated increase in the number of medication-related osteonecrosis of the jaw (MRONJ) cases reported from patients. MRONJ has emerged as a significant comorbidity in cancer patients treated with antiangiogenics or high doses of potent antiresorptive agents, such as bisphosphonates (BPs) or denosumab. MRONJ first emerged from BP-treated cancer patients who presented with a spectrum of dental problems, including delayed wound healing following a dental extraction or oral surgery, exposed bone, soft tissue infection and inflammation, anesthesia, paresthesia, odontalgia, sinus pain, and aching bone pain in the mandible, which continues to be a significant source of problems for dentists, physicians, and patients today. A significant number of MRONJ cases secondary to osteoporosis have also been reported in osteoporotic patients receiving antiresorptive medications. The American Association of Oral and Maxillofacial Surgeons (AAOMS) has established diagnostic standards for MRONJ based on pharmacological history, clinical signs, and radiographic findings. However, as the expertise and knowledge base for MRONJ continues to evolve, revisions and refinements for MRONJ pathogenesis and treatment strategies are necessary to reflect the current research status of the disease correctly. This review highlights current scientific information associated with MRONJ to identify and summarize preventative measures, and treatment interventions for reading the impact of this debiliating disorders.

Revisiting best practice guidelines and patient care workflow for managing the risk of medication-related osteonecrosis of the jaw: comparative summary and case studies.

Patients taking antiresorptive medications in dental clinics are at risk of medication-related osteonecrosis of the jaw (MRONJ), which poses daily challenges for their clinicians. Types of practice guideline reviewed: This paper aimed to summarize and revisit three most recognized practice guidelines for the management and prevention of MRONJ, which were proposed by the American Association of Oral and Maxillofacial Surgeons (AAOMS), presented by the Journal of Bone and Mineral Research (JBMR), and the Journal of Clinical Oncology (JCO). Results and Case Studies: The AAOMS position paper focused on risk stratification by different medications, management decision trees, risk factors, pathophysiology, and disease staging. The JBMR international consensus presented eight focused questions, which were addressed by systematic reviews. The JCO Clinical Practice Guideline presented six clinical questions, and each concluded with practical recommendations. Practical information was summarized and converted into an adoptable patient care workflow for clinicians to follow and apply in daily practice. Three case studies presented were treated following these guidelines. Each patient underwent advanced surgeries including alveoloplasty, tooth extraction, implant placement, and particulate bone grafting. Some of the considerations not fully informed were discussed and illustrated in each step of the patient care workflow, which included specifics for risk communication, updates on the use of antibiotics, biomarkers, and drug holidays. Structured risk communication with official informed consent documentation should be considered before initiating invasive treatments. Disease control phase with home care therapy should be provided prior to staged reconstructive therapy. Drug holidays and antibiotics coverage can be customized based on individual conditions and related procedures with interprofessional coordination.

Medication-Related Osteonecrosis of the Jaws: A Comparison of SICMF-SIPMO and AAOMS Guidelines.

(1) Background: Medication-related osteonecrosis of the jaws (MRONJ) is an adverse drug reaction characterized by progressive bone disruption and necrosis in the mandibular and/or maxillary bones. It occurs in individuals who have received antiresorptive drugs without prior radiotherapy. Since its first reported cases in the USA in 2003, extensive literature has emerged worldwide, leading to significant advancements in understanding MRONJ's pathogenesis and management. (2) Results: This article aims to compare the current national recommendations provided by the Italian Society of Maxillofacial Surgery (SICMF)/Italian Society of Oral Pathology and Medicine (SIPMO) and the American Association of Oral and Maxillofacial Surgeons (AAOMS). (3) Conclusions: Historically, the AAOMS advocated for a more conservative approach compared to the Italian guidelines. However, in their 2022 update, the AAOMS adopted a different perspective based on reported evidence, highlighting the advantages of early surgical treatment. Despite resolving some initial controversies, differences still exist between the two sets of recommendations, particularly regarding diagnosis and staging.

Medication-Related Osteonecrosis of the Jaws (MRONJ) in Children and Young Patients—A Systematic Review

Medication-related osteonecrosis of the jaw (MRONJ) is defined by the American Association of Oral and Maxillofacial Surgeons (AAOMS) as the presence of an exposed bone area in the maxillofacial region, present for more than eight weeks in patients treated with the use of antiresorptive or antiangiogenic agents, with no history of radiation or metastatic disease. Bisphosphonates (BF) and denosumab (DS) are widely used in adults for the management of patients with cancer and osteoporosis, and recently there has been an increase in their use in child and young patients for the management of disorders such as osteogenesis imperfecta (OI), glucocorticoid-induced osteoporosis, McCune-Albright syndrome (MAS), malignant hypercalcemia, and others. There are differences between case reports in adults compared to child and young patients related to the use of antiresorptive/antiangiogenic drugs and the development of MRONJ. The aim was to analyze the presence of MRONJ in children and young patients, and the relation with oral surgery. A systematic review, following the PRISMA search matrix based on the PICO question, was conducted in PubMed, Embase, ScienceDirect, Cochrane, Google Scholar, and manual search in high-impact journals between 1960 and 2022, publications in English or Spanish, including randomized and non-randomized clinical trials, prospective and retrospective cohort studies, cases and controls studies, and series and case reports. A total of 2792 articles were identified and 29 were included; all of them published between 2007 and 2022, identifying 1192 patients, 39.68% male and 36.24% female, aged 11.56 years old on average, using these drugs mainly for OI (60.15%); 4.21 years on average was the therapy time and 10.18 drug doses administered on average; oral surgery was observed in 216 subjects, reporting 14 cases of MRONJ. We concluded that there is a low presence of MRONJ in the child and youth population treated with antiresorptive drugs. Data collection is weak, and details of therapy are not clear in some cases. Deficiencies in protocols and pharmacological characterization were observed in most of the included articles.

Medication-Related Osteonecrosis of the Jaw: A Review

Medication-related osteonecrosis of the jaw (MRONJ), which is uncommon and severely disabling, has no recognized cause. In the lack of radiation exposure to the head and neck area, it is defined by non-healing exposed bone in a patient with a history of antiresorptive or anti-angiogenic drugs. In the early 2000s, there was the initial incidence of MRONJ. The American Association of Oral and Maxillofacial Surgeons (AAOMS) published diagnostic criteria for MRONJ depending on pharmacological record as well as clinical and radiographic characteristics. Patients with osteoclastic bone disease are now thought to benefit most from antiresorptive drugs like bisphosphonate and denosumab. These enhance bone quality by lowering bone turnover and boosting bone density. Because of their powerful ability to reduce osteoclastic activity by slowing the remodelling process and elevating bone density, these medications have also been demonstrated to lower the risk of osteoporotic fractures, enhancing quality of life for the majority of patients. Prior to beginning any form of ONJ-related medicine, oral examination can significantly reduce the likelihood of ONJ as a precautionary step. In addition to managing bone necrosis and resorption, therapeutic objectives can be met via controlling pain and infections. The objective of this analysis is to pinpoint all potential causes and provide a summary of the available MRONJ possible treatments, diagnostic guidelines, and prevention methods

Medication Related Osteonecrosis of the Jaw: A Conservative Approach

Medication-related osteonecrosis of the jaw is a well-known condition to the oral and maxillofacial surgeon despite being considered rare. In recent epidemiologic studies, the incidence of MRONJ was found to be between < 0.05% among patient taking antiresorptive medications for osteoporosis and ∼1.5% for cancer therapy. The pathophysiology is believed to be multifactorial involving bone remodeling inhibition, inflammation/infection, angiogenesis inhibition, dysfunctional immunity and genetics. Most recently, the American Association of Oral and Maxillofacial surgeons (AAOMS) released an updated position paper (2022) for guidelines regarding diagnosis and management of this condition.

Medication-Related Osteonecrosis of the Jaw: A Reflection of Current Preventative and Therapeutic Guidelines: A Review

Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect of bisphosphonates, denosumab, and antiangiogenic drugs. Although the literature is rich with research work discussing MRONJ, the pathogenesis of this devastating condition has not been adequately understood yet. Roles of infection, immunity and genetic predisposition have been extremely unclear. Moreover, many controversies have been governing risk assessment and management guidelines. In 2003, 36 cases of osteonecrosis of the jaw (ONJ) associated with the use of either pamidronate or zoledronate were reported. Furthermore, in 2014, the American Association of Oral and Maxillofacial Surgeons (AAOMS) suggested the term “medication-related osteonecrosis of the jaw” (MRONJ) to describe jaw osteonecrosis related to the use of medications. This review sheds the light on recent research work discussing the pathogenesis of MRONJ. Moreover, it suggests possible guidelines for risk assessment and management based on information gathered from different research papers found in the literature.

Case series: Osteonecrosis of the jaw related to denosumab preceded by bisphosphonates in cancer and osteoporotic patients

AimsThe purpose of this study was to assess the incidence of medication-related osteonecrosis of the jaw (MRONJ) in cancer and osteoporotic patients taking denosumab (DSB) preceded by bisphosphonates (BP). MethodsThe data collection tool was adapted from the American Society of Bone and Mineral Research (ASBMR) consisting of patient details, comorbidities, clinical history, dose, and duration of DSB and preceding BP, diagnosis and MRONJ stage, management and outcomes. The staging of MRONJ follows recommendations of the American Association of Oral and Maxillofacial Surgeons (AAOMS). This retrospective case series used data from seven patients treated at the Department of Oral Surgery, Edinburgh Dental Institute over a one-year period. ResultsAll patients had a history of bisphosphonate therapy prior to commencement of denosumab therapy. One out of 7 showed no development of osteonecrosis of the jaw yet was categorized as a high-risk case. Of the remaining six cases, osteonecrosis of the jaw was present as stage 2 in four cases and stage 3 in 2 cases. Four cases developed MRONJ 8 weeks after dental extraction. The remaining two cases developed MRONJ at 12 and 20 weeks after extraction. ConclusionsThe main conclusion of this study is the potentially cumulative effect of BP and DSB in the development of MRONJ with dental extraction as a triggering factor. Further research is required before the cumulative effect of these anti-resorptive agents become fully understood.

HISTORICAL SELECTION: Rosenberg MB. Simulation technology in anesthesiology. Anesth Prog. 2000;47(1):8-11.

HISTORICAL SELECTION: Rosenberg MB. Simulation technology in anesthesiology. Anesth Prog. 2000;47(1):8-11.

Are Women Adequately Represented in Leadership Roles in Oral and Maxillofacial Surgery? A 10-year Retrospective Evaluation of Society Leadership and Journal Editorial Boards

Surgical specialties have traditionally been considered male-dominated fields within medicine. Oral and maxillofacial surgery (OMS) is also a surgical subspecialty whose practitioners largely comprise of men. While many factors contribute to the perpetuation of these trends, past studies have identified the significance of female role models in the decision to pursue a surgical field for female students. The authors thus sought to analyze female representation within key societies and journal editorial boards that play central roles in the academic advancement, organization, and clinical practice of oral and maxillofacial surgery in the United States (US).A retrospective review of 2 major OMS journals, the Journal of Oral and Maxillofacial Surgery (JOMS) and Oral Surgery Oral Medicine Oral Pathology Oral Radiology (OOOO), and six OMS professional and academic societies, including the American Association of Oral and Maxillofacial Surgeons (AAOMS), American College of Oral and Maxillofacial Surgeons (ACOMS), American Board of Oral and Maxillofacial Surgery (ABOMS), American Academy of Craniomaxillofacial Surgeons (AACMFS), OMS Foundation, Osteo Science Foundation, was conducted. The names and genders of the members of the editorial board and board of directors between 2011 and 2020 were acquired from their respective sources. Only verified OMSs were included, while non-OMS clinicians and administrative staff were excluded from the final count. OMSs from countries other than the US were also excluded. A line of best fit was determined using simple linear regression to demonstrate temporal trends in female representation in editorial boards and society leadership. The proportion of female OMS faculty and female OMS residents was obtained from AAOMS. Either the Chi-squared test or Fisher's exact test was used to compare the proportion of female representation in editorial boards and society leadership with the proportion of full-time female OMS faculty.During the study period of the past 10 years, female representation on the editorial boards of OMS journals grew from 4.5% in 2011 to 10.6% in 2020 (Figure 1). A growth from 3.0% in 2011 to 10.3% in 2020 was similarly observed for the proportion of women in society leadership (Figure 2). The proportion of women in editorial boards (8.9%) did not differ from that of full-time female OMS faculty (11.4%) in 2019 (P = .80). Similarly, female representation on society leadership (10.5%) was not different from that of full-time female OMS faculty in 2019 (P = .84).Although there are significantly fewer female surgeons on OMS journal editorial boards and the boards of OMS societies compared to that of male surgeons, the proportion of female representation in these organizations has been growing over the past decade. Currently, the authors found that women seem to be adequately represented in editorial boards and society leadership in the OMS field.

Lifestyle and Career Satisfaction among U.S-based Oral and Maxillofacial Surgeons: Results of a Nationwide Survey

PurposeThe purpose of the study is to identify predictors of lifestyle and career satisfaction among U.S-based oral and maxillofacial surgeons (OMSs). MethodsAll active members of the American Association of Oral and Maxillofacial Surgeons (AAOMS) with a non-generic email were invited to participate in a survey-based assessment. The survey was constructed using the online platform Qualtrics (Provo, UT). A total of 12 close-ended questions were designed and distributed. Two follow-up reminder emails were sent, each after a two-week period. Descriptive statistics were computed. Responses were evaluated through univariate analysis. ResultsIn total, 280 of the 820 invitees completed the survey for an overall response rate of 34%. Majority of respondents were male (89%), more than 45 years old (71%), working in a private-practice setting (55%), and had been in practice for more than 15 years (66%); 61% of the respondents reported taking call more than 3 days a week, with 88% of them stating a negative impact on their practice due to their call schedule. An overwhelming majority of 84.2% OMSs reported being satisfied with their career and 77.5% of respondents were willing to choose a career in oral and maxillofacial surgery again as a fourth-year dental student. On univariate analysis, factors associated with overall career satisfaction included: age, practice location, salary, and personal life balance (P < .01). ConclusionDespite length of training and professional burnout, there is a significant degree of career satisfaction among OMSs practicing in the United States. The majority of queried surgeons would choose the specialty as a profession if given the choice again. Factors associated with negative impact on professional practice need to be further studied at local, regional, and national levels.

Oral Health Benefits in Medicare and Medicaid

It is important the American Association of Oral and Maxillofacial Surgeons (AAOMS) continues to advocate for access to oral healthcare – especially for pediatric, special needs and senior patients. With the recent political changes that have occurred in Washington, DC, and increased calls to have dental benefits added to Medicare, the stakes are high. In a recent poll by the University of Michigan, 93% of adults 65 to 80 years of age favor adding a policy to add dental coverage to Medicare.1 Our specialty has a responsibility to be part of this discussion, communicating ideas that advance sustainable access to safe and effective oral and maxillofacial surgical care.

Proceedings From the First Cleft, Craniofacial, and Pediatric Oral and Maxillofacial Surgery Summit

The first Cleft, Craniofacial, and Pediatric Oral and Maxillofacial Surgery Summit took place in Oklahoma City on November 23, 2019. The symposium was hosted by Dr. Paul S. Tiwana and was co-sponsored by American Association of Oral and Maxillofacial Surgeons (AAOMS) Committee on Cleft, Craniofacial, and Pediatric OMS (CCCPOMS). The Summit convened directors of fellowship programs, experts, and leaders in the fields of cleft, craniofacial, and pediatric oral and maxillofacial surgery. Representatives from AAOMS and American Board of Oral and Maxillofacial Surgery (ABOMS) also attended (Fig.

Oral-Maxillofacial Surgery Anesthesia Team Model at a Crossroads Safety in Office-Based Anesthesia – Lessons We Can Learn from Aviation

Throughout its history, the American Association of Oral and Maxillofacial Surgeons (AAOMS) has raised the bar for patient safety. This article addresses new initiatives under consideration by the AAOMS House of Delegates that are consistent with a desire to assure patient access to safe and effective care. The anesthesia team model in oral-maxillofacial surgery is under attack on multiple fronts, and persistent criticism has intensified over the last few years. Dental office anesthesia tragedies that have occurred with every type of anesthesia provider and every model of anesthesia delivery have disproportionately triggered high-profile attacks on the safety of the oral-maxillofacial surgery model both from within and outside healthcare. Critics have alleged repeatedly that our model of anesthesia delivery is unsafe, we have inadequate skills to manage an airway during a crisis and we employ poorly prepared team members monitoring our anesthesia.

The Importance of Alliance between Hematologists and Dentists: A Retrospective Study on the Development of Bisphosphonates Osteonecrosis of the Jaws (Bronj) in Multiple Myeloma Patients.

(1) Background: Multiple myeloma is a rare cancer that primarily affects the bone marrow. Osteoclasts are responsible for increased bone resorption and, therefore, bone destruction. Bisphosphonates are a class of drugs that can slow down bone resorption by reducing the number and action of osteoclasts. Intravenous injections of bisphosphonates (generally Zoledronic Acid) are administered to patients affected by Multiple Myeloma, but BRONJ is described as a serious side effect. This 5-year retrospective study aims to evaluate the efficacy of appropriate dental treatment protocols prior to initiating bisphosphonate therapy to prevent the development of BRONJ. (2) Methods: A total of 99 patients with symptomatic multiple myeloma were involved in this study (41–90 years, mean age 65 years, standard deviation 5 years). The data relating to the visits were tracked using a specific server and consulting the clinical reports. The AAOMS (American Association of Oral and Maxillofacial Surgeons) position was applied for both diagnosis and treatment. A total of 79 patients were examined before the administration of bisphosphonates (group A) and 20 after (group B). (3) Results: The entire sample required dental treatment: 23.2% underwent restorative therapy, 8% endodontic treatments, 44.4% tooth extractions. Periodontal disease was present in 41.4% of the patients. No osteonecrosis was observed in the first group, whereas BRONJ was found in five patients of the second one (25%) and two patients (10%) showed osteosclerotic areas under investigation [OR 0.026 (CI 0.0027 to 0.2454)]. (4) Conclusions: In the literature, there are no precise data about the prevalence of BRONJ. Despite the limitation of the present study, we point out that dental treatment before the treatment with intravenous bisphosphonates can help in reducing the incidence of BRONJ and good dental status is necessary for BRONJ prevention.

Peer Comparisons to Increase Responsible Opioid Prescribing Among Oral and Maxillofacial Surgeons

The field of oral and maxillofacial surgery has made a concerted effort to promote responsible opioid prescribing for postoperative pain control. A 2020 white paper from the American Association of Oral and Maxillofacial Surgeons (AAOMS) highlights some of these efforts, which includes supporting the mandatory usage of prescription drug monitoring programs, promoting continuing education courses, and developing evidence-based prescription guidelines.1 However, the job is not finished, as the opioid epidemic remains a public health challenge in the United States.

The Case of Medication-Related Osteonecrosis of the Jaw Addressed from a Pathogenic Point of View. Innovative Therapeutic Strategies: Focus on the Most Recent Discoveries on Oral Mesenchymal Stem Cell-Derived Exosomes

Bisphosphonates-related osteonecrosis of the jaw (BRONJ) was firstly reported by Marx in 2003. Since 2014, the term medication-related osteonecrosis of the jaw (MRONJ) is recommended by the American Association of Oral and Maxillofacial Surgeons (AAOMS). Development of MRONJ has been associated to the assumption of bisphosphonates but many MRONJ-promoting factors have been identified. A strong involvement of immunity components has been suggested. Therapeutic intervention includes surgical and non-surgical treatments, as well as regenerative medicine procedures for the replacement of the lost tissues. The literature confirms that the combination of mesenchymal stem cells (MSCs), biomaterials and local biomolecules can support the regeneration/repair of different structures. In this review, we report the major open topics in the pathogenesis of MRONJ. Then, we introduce the oral tissues recognized as sources of MSCs, summing up in functional terms what is known about the exosomes release in physiological and pathological conditions.

The Virtual Residency Fair: A Legacy of the COVID-19 Era and an Opportunity for the Future

The coronavirus disease 2019 (COVID-19) pandemic has impacted oral and maxillofacial surgery in a myriad of ways. The residency application process has been particularly affected, such as the cancellation of in-person externships and the prospect of virtual interviews. However, the field of oral and maxillofacial surgery has remained resilient in the face of this challenge. On July 29, 2020, the American Association of Oral and Maxillofacial Surgeons (AAOMS) organized a novel virtual residency fair.

Quantitative evaluation of anti-resorptive agent-related osteonecrosis of the jaw using bone single photon emission computed tomography in clinical settings: relationship between clinical stage and imaging

ObjectiveThis study aimed to use quantitative values, calculated from bone single photon emission computed tomography (SPECT) imaging, to estimate the reliability of progression evaluation for anti-resorptive agent-related osteonecrosis of the jaw (ARONJ).MethodsThe study population consisted of 21 patients (23 lesions), clinically diagnosed with mandibular ARONJ, who underwent SPECT/CT scanning. Diagnosis and staging of ARONJ were performed according to the American Association of Oral and Maxillofacial Surgeons (AAOMS) definition and the recommendations of the International Task Force on ONJ. Hybrid SPECT/CT imaging quantitative analyses were performed on a workstation. Each volume of interest (VOI) was semi-automatically placed over a lesion with areas of high tracer accumulation, using the GI-BONE® software default threshold method settings. Additionally, control VOI was manually set over an unaffected area. Measured parameters included standardized uptake values (SUV)—maximum (SUVmax) and mean (SUVmean), metabolic bone volume (MBV)—the total volume above the threshold, and total bone uptake (TBU) as calculated by MBV × SUVmean. We also calculated the SUV ratio (rSUV) between the lesion and control area, factoring for differences in individual bone metabolism; the ratios were termed rSUVmax and rSUVmean, accordingly. The product of multiplying the rSUVmean by MBV of a lesion was defined as the ratio of TBU (rTBU). Quantitative values were compared between clinical stages by the Kruskal–Wallis test and subsequent post hoc analysis.ResultsMBVs (cm3) were: median, [IQR] Stage 1, 8.28 [5.62–9.49]; Stage 2, 15.28 [10.64–24.78]; and Stage 3, 34.61 [29.50–40.78]. MBV tended to increase with stage increase. Furthermore, only MBV showed a significant difference between clinical stages (p < 0.01). Subsequent post hoc analysis showed no significant difference between stages 1 and 2 (p = 0.12) but a significant difference between stages 2 and 3 (p = 0.048). rSUVmax and rTBU tended to increase with stage increase, but the differences between the stages were not significant (p = 0.10 and p = 0.055, respectively).ConclusionMBV, which includes the concept of volume, showed significant differences between clinical stages and tended to increase with the stage increase. As an objective and reliable indicator, MBV might be an adjunct diagnostic method for staging ARONJ.