Treatment outcomes and time to healing of medication-related osteonecrosis of the jaw based on image findings

Author:

Yasui Takazumi12ORCID,Nagamine Hiroki3,Tanaka Kenta1,Kimura Moemi4,Karube Takeshi2,Kawana Hiromasa25,Onizawa Katsuhiro1

Affiliation:

1. Department of Dentistry and Oral Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan

2. Department of Dentistry and Oral Surgery, School of Medicine, Keio University, Tokyo, Japan

3. Department of Dentistry and Oral Surgery, Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital, Tokyo, Japan

4. Department of Dentistry and Oral Surgery, Kawasaki Municipal Ida Hospital, Kawasaki, Japan

5. Departmant of Oral and Maxillofacial Implantology, Kanagawa Dental University, Yokosuka, Japan

Abstract

Objectives: This study aimed to evaluate the prognostic treatment outcome of non-operative management of medication-related osteonecrosis of the jaw (MRONJ), particularly regarding the relationship between image findings and treatment outcomes. Methods: This single-center, retrospective observational study included patients with MRONJ who were conservatively treated between 2010 and 2020. All patients were evaluated in terms of MRONJ treatment outcomes, time to healing, and prognostic factors, including sex, age, underlying disease, antiresorptive drug type, discontinuation of antiresorptive treatment, chemotherapy, corticosteroid treatment, diabetes mellitus, location of MRONJ, clinical stage of MRONJ, and computed tomography image findings. Results: The complete healing rate among the patients was 68.5%. Cox proportional hazards regression analysis revealed that “Sequestrum formation” on the internal texture (hazard ratio = 3.66; 95% confidence interval, 1.30–10.29; P =.014) and chemotherapy (hazard ratio = 0.41; 95% confidence interval, 0.18–0.95; P =.037) were significantly associated with treatment outcome. The median time to healing in patients with “Sequestrum formation” on the internal texture (4.4 months) was significantly shorter than the median time to healing in those marked with “Sclerosis” or “Normal” (35.5 months; P <.001) and “Lytic changes with sclerosis” (14.5 months; P =.015). Conclusions: The image findings on the internal texture of the lesions at the initial examination and chemotherapy were associated with the treatment outcomes of nonoperative management of MRONJ. The image findings of “Sequestrum formation” were associated with lesions taking a short time to heal and better outcomes, whereas “Sclerosis” and “Normal” were associated with lesions with longer healing times.

Publisher

Oxford University Press (OUP)

Subject

General Dentistry,Radiology, Nuclear Medicine and imaging,General Medicine,Otorhinolaryngology

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