The Use of Imaging Methods in the Diagnosis of Bisphosphonate-related Osteonecrosis of the Jaw

Abstract

Objectives: Osteonecrosis of the jaws is a rare side effect of bisphosphonate therapy, occurring especially in oncological patients but also in patients with metabolic bone diseases. Because it is a relatively recently described disease (year 2003), the etiopathogenesis of these lesions has not yet been fully clarified, there is also no consensus for their treatment. Conservative as well as surgical therapy leads to complete healing in a small percentage of cases only, the emphasis is therefore placed on preventive measures. The diagnosis is based primarily on patient's history and clinical examination, without the need of using imaging methods. Pathological changes in this jawbone necrosis imagined by any of known methods are nonspecific only, distinction of these lesions from other pathological condition is difficult. Imaging of jawbones is important for disease staging and determining the real extent of bone lesion, which does not correlate with the extent of exposed necrotic bone into the oral cavity. These information are useful mainly during the planning of surgical therapy, ie. resections of the jaws. Detection of associated complications such as pathological fractures, deep neck space infections or maxillary sinusitis is another kind of use. Some of the imaging methods seem to be good in early detection of subclinical lesions or even for differentiation of osteonecrosis from neoplastic jawbone disease. The ability to fulfill these criteria is different for each type of imaging examination, so far the most useful imaging methods are hybrid methods which combine functional and morphological imaging. This hybrid imaging gives information not only about structural pathological changes in the jaws and surrounding soft tissues, but also about osteoblast activity and bone metabolism. There is not enough reported cases of such an imaging in the indication of bisphosphonate-related osteonecrosis of the jaw. High price of some of these examinations is also a limiting factor. Aim of study: In this review article the authors summarize the current knowledge of the use of all available imaging methods in the diagnosis of bisphosphonate-related osteonecrosis of the jaw (radiography, computed tomography, cone beam computed tomography, magnetic resonance imaging, bone scintigraphy and single photon emission computed tomography, positron emission tomography and hybrid imaging methods)

Keywords

• imaging methods
• osteonecrosis of the jaw
• bisphosphonates