Local radiographic risk factors for MRONJ in osteoporotic patients undergoing tooth extraction

• Published in: Oral diseases 2024-04, Vol.30 (3), p.1632-1642
• Main Authors: Moreno‐Rabié, Catalina, Gaêta‐Araujo, Hugo, Ferreira‐Leite, André, Coucke, Wim, Gielen, Evelien, Van den Wyngaert, Tim, Jacobs, Reinhilde
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Alveolar bone; Bisphosphonate-Associated Osteonecrosis of the Jaw - diagnostic imaging; Bisphosphonate-Associated Osteonecrosis of the Jaw - etiology; Bone Density Conservation Agents - adverse effects; Bone Density Conservation Agents - therapeutic use; Bone growth; Case-Control Studies; Chronic infection; denosumab; Dental caries; Dental infection; diphosphonates; Female; Health risks; Humans; Longitudinal Studies; Male; Medicin och hälsovetenskap; Middle Aged; Osteonecrosis; Osteoporosis; Osteoporosis - complications; Osteoporosis - diagnostic imaging; panoramic radiography; Radiography; Radiography, Panoramic; Retrospective Studies; Risk Factors; Sex Factors; Statistical analysis; Teeth; tooth extraction; Tooth Extraction - adverse effects; Tooth extractions
• ISSN: 1354-523X; 1601-0825; 1601-0825
• DOI: 10.1111/odi.14496

Objective To identify local radiographic risk factors for Medication‐Related Osteonecrosis of the Jaws (MRONJ) in osteoporotic patients treated with antiresorptive drugs (ARD) and undergoing tooth extraction. Material and Methods Patients were included in this retrospective, longitudinal, case‐control study, if having at least one administration of ARD, underwent tooth extraction(s), and had pre‐ and post‐operative panoramic radiographs. Additionally, a matched control group was selected. Three calibrated, blinded, and independent observers assessed each tooth extraction site. Statistical analysis compared control against study group, and within the latter, sites MRONJ+ and MRONJ−. Results In total, 120 patients (99 females/21 males) with 354 tooth extractions were included, from which nine patients (7.5%) and eleven tooth extraction sites (3.1%) developed MRONJ. When comparing control with study group, the latter showed significantly more thickened lamina dura, persistence of the alveolar socket, heterogeneous bone patterns, and sequestrum formation. In the study group, MRONJ developed significantly more in males (19%, p = 0.049), smokers (25%, p = 0.008), in the mandible (82%, p = 0.027), when identifying a radiolucent or sclerotic trabecular pattern (p = 0.004) or when extracting teeth with furcation involvement (p