CBCT evaluation of jawbone changes in patients receiving antiresorptive therapy: a clinical-radiographic approach to suspected stage 0 MRONJ

Resumen

Abstract

Objective: To evaluate whether cone beam computed tomography (CBCT)-detectable bone alterations are present in clinically unaffected jaw regions of patients diagnosed with medication-related osteonecrosis of the jaw (MRONJ) and to investigate associations between these imaging findings and patient-related variables. Material and method: This retrospective cross-sectional study analyzed 94 anatomical sites from CBCT scans of 27 patients with clinically confirmed MRONJ. Bone alterations, including osteosclerosis, increased trabecular density, cortical thickening, osteolysis, mandibular canal changes, and persistent extraction sockets, were assessed in clinically affected and unaffected sites. Multivariate logistic regression was used to investigate associations with age, underlying disease, medication type, route of administration, duration of therapy, and corticosteroid use. Result: All CBCT alterations identified in MRONJ lesions were also observed in clinically unaffected sites. Osteosclerosis and mandibular cortical thickening were associated with antiangiogenic therapy, whereas persistent extraction sockets were more frequent in oncologic patients. No statistically significant differences were observed between clinically affected and unaffected sites regarding the distribution of radiographic alterations. Conclusion: CBCT alterations commonly associated with MRONJ may also be present in clinically unaffected anatomical sites. These findings support the hypothesis of early imaging manifestations of the disease and highlight the potential value of comprehensive CBCT assessment in patients receiving antiresorptive or antiangiogenic therapy. Prospective longitudinal studies are needed to validate these observations and determine their clinical significance.