J Korean Assoc Oral Maxillofac Surg.  2021 Apr;47(2):99-111. 10.5125/jkaoms.2021.47.2.99.

A critical assessment of the medication-related osteonecrosis of the jaw classification in stage I patients: a retrospective analysis

• Ristow O
• Hürtgen L
• Moratin J
• Smielowski M
• Freudlsperger C
• Engel M
• Hoffmann J
• Rückschloß T

• KMID: 2515308
• DOI: http://doi.org/10.5125/jkaoms.2021.47.2.99

Abstract

Objectives
It is unclear whether the extent of intraoral mucosa defects in patients with medication-related osteonecrosis of the jaw indicates disease severity. Therefore, this study investigated whether mucosal lesions correlate with the true extent of osseous defects in stage I patients.
Materials and Methods
Retrospectively, all patients with stage I medication-related osteonecrosis of the jaw who underwent surgical treatment between April 2018 and April 2019 were enrolled. Preoperatively, the extent of their mucosal lesions was measured in clinical evaluations, and patients were assigned to either the visible or the probeable bone group. Intraoperatively, the extent of necrosis was measured manually and with fluorescence.
Results
Fifty-five patients (36 female, 19 male) with 86 lesions (46 visible bone, 40 probeable bone) were enrolled. Intraoperatively, the necrotic lesions were significantly larger (P<0.001) than the preoperative mucosal lesions in both groups. A significant (P<0.05) but very weak (R ² <0.2) relationship was noted between the extent of the mucosal lesions and the necrotic bone area.
Conclusion
Preoperative mucosal defects (visible or probeable) in patients with medication-related osteonecrosis of the jaw do not indicate the extent of bone necrosis or disease severity.

Keyword

Medication-related osteonecrosis of the jaw; Bisphosphonate-related osteonecrosis of the jaw; Antiresorptiva-related osteonecrosis of the jaw; Definition; Classification

Figure

• 

  Fig. 1 A 64-year-old female patient; underlying disease: osseous metastasized breast carcinoma; antiresorptive therapy: zoledronate 4 mg every 4 weeks intravenously over 4 years; presentation with unspecific symptoms of the upper jaw (recurrent pain and signs of inflammation) and increased probing depths over 12 months. A, B. Preoperative intraoral findings with probeable bone at first sight (A) and visible bone after carefully pushing back the mucosa (B). C. Intraoperative findings of the necrotic area after subperiosteal preparation: macroscopic marking of the necrosis using a pen after florescence visualization. D. After extracting necrosis-adjacent teeth (#25 and #26), a cone-like necrotic extension in the alveolus up to the maxillary sinus became visible. E. Intraoperative findings after resection of the necrotic bone and smoothing of all bone edges: the maxillary sinus is opened. F. Tension-free wound closure using double-layer closure techniques with a pedicled buccal fat flap. G. The muco-periosteal layer.

• 

  Fig. 2 Fused preoperative (blue) and postoperative (orange) cone-beam computed tomography scans in coronal (A) and axial (B) views: the resection defect in the upper jaw on the left side is highlighted in blue. Note: the swelling of the mucosa in the maxillary sinus. However, no bone reaction (such as bone loss or resorption, osteolysis, or osteosclerosis) could be found. Therefore, this patient was preoperatively classified as stage I. However, postoperatively the lesion should certainly have been classified as stage III because the floor of the maxillary sinus had to be removed. Preoperative clinical information (size of the mucosal defect) offers no conclusion about the severity of the bone disease.

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  Fig. 3 Boxplot comparing the anteroposterior (AP) and transversal (Trans) extent of: the mucosal lesion at presentation (T0), the mucosal lesion on the day of surgery (PreOP), the extent of the necrotic bone intraoperatively (IntraOP), and the extent of the resection defect measured by cone-beam computed tomography (CBCT) in the visible bone group (A) and probeable bone group (B).

Reference

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