Histochemical observation of bony reversal lines in bisphosphonate-related osteonecrosis of the jaw

• Published in: Oral surgery, oral medicine, oral pathology and oral radiology oral medicine, oral pathology and oral radiology, 2017-02, Vol.123 (2), p.220-228
• Main Authors: Kim, Soung Min, BA, DDS, MSD, PhD, Eo, Mi Young, BA, MSD, Kim, Yeon Sook, DDS, MSD, PhD, Lee, Suk Keun, DDS, MSD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Bisphosphonate-Associated Osteonecrosis of the Jaw - pathology; Bone Density Conservation Agents - adverse effects; Chronic Disease; Dentistry; Female; Humans; Male; Middle Aged; Osteomyelitis - pathology; Staining and Labeling; Surgery
• ISSN: 2212-4403; 2212-4411
• DOI: 10.1016/j.oooo.2016.09.225

Abstract Background Prolonged bisphosphonate (BP) uptake can cause infected osteomyelitis with acute osteonecrosis of the jaw. Study Design This study investigates the histochemical characteristics of reversal lines in 50 cases of BP-related osteonecrosis of the jaw (BRONJ) compared to non-BP involved bones in 20 cases of chronic osteomyelitis from the jaws. Necrotic bones were stained with toluidine blue, Safranin O, Giemsa, van Gieson, and Masson’s trichrome staining methods. Results All BP-involved bones in BRONJ were distinguishable from non-BP involved bones in chronic osteomyelitis of the jaws by multiple thick, irregular, reversal lines, which were strongly stained with toluidine blue, Safranin O, and Giemsa solution. The reversal lines of BP-involved bones (average 31.2 ± 10.85 μm) were thicker than those of osteomyelitic bones (average 11.1 ± 3.76 μm), and they were closely associated with immature bony matrices contained collagenous materials positive for van Gieson and Masson’s trichrome staining with statistical significance ( p = 0.0212 in t-test statistics). The immature reversal lines of BP-involved bones continuously remained as thick non-birefringence lines between lamellate structures in the observation under polarizing microscope, while the reversal lines of non-BP-involved bones were gradually thinned as their mineralization advanced. Conclusions Therefore, it was found that the BP-involved bones had immature bony matrices outlined by thick reversal lines, which might be crucial to rapid osteonecrosis of BRONJ and also could be hallmarks for the differential diagnosis of BRONJ from chronic osteomyelitis of the jaws.