SYSTEMATIC REVIEW OF CONE BEAM COMPUTED TOMOGRAPHY USE IN DIAGNOSIS OF MEDICATION-RELATED OSTEONECROSIS OF THE JAW

Background Medication-related osteonecrosis of the jaw (MRONJ) is an adverse drug reaction, marked by bone destruction. Most studies have focused on its diagnosis and management. Objective The aim of this review was to explore the role of CBCT in MRONJ diagnosis. Materials and Methods The following databases were searched: PubMed, Scopus, Web of Science, Trip, and Cochrane Library. Search terms were “osteonecrosis,” “medication-related,” “radiography,” “bone resorption,” and “CBCT.” The search for publications from 2003 onward yielded 395 articles (case reports, case series, studies, and systematic reviews). However, only 11 articles met our inclusion criteria. Results The 11 articles with 168 cases were included in a full-text qualitative analysis. Females comprised 66.6% of cases. Mean patient age was 58.5 years. CBCT findings included osteolytic lesions, osteosclerosis, sequestra, and sinus mucosal thickening. The most frequent location was the posterior mandible (62.6%). Stage 1 was most often reported (36.4%). The most frequent precipitating event was extraction (75%). Of the included cases, 52.4% were oncologic cases, and 23.8% were osteoporosis cases. Of the patients, 72.7% had taken antiresorptive medications and 4.5% antiangiogenics. Administration was mostly oral (45%). Several studies included management; 90% of articles reported antibiotic and chlorhexidine use, and 10% reported surgical intervention. Discussion CBCT is a reliable tool in the detection and staging of MRONJ. It is reported to offer advantages over multidetector computed tomography (MDCT) with regard to radiation exposure and is superior to 2-dimensional imaging in the detection of MRONJ features.