Introduction
One of the problems in treatment of bisphosphonate-associated osteonecrosis of the jaws (BRONJ) is to understand which radiological imaging technique allows to assess the extent of BRONJ. Cone beam computed tomography (CBCT) is an attractive modality for 3-dimensional imaging of the jaws, for its ability to characterize the nature and the extent of radiographic changes, across different stages. The purpose of this study is to investigate the efficacy of CBCT in the surgical planning of BRONJ. There are a lot of studies in literature about the role of CBCT in diagnosis iter of BRONJ; these studies underline the importance of CBCT to confirm the diagnosis of BRONJ but few studies investigate the role of CBCT for planning the surgical treatment.
Material and methods
We observed 40 cases of BRONJ in patients affected by oncological diseases and osteometabolic desorders, between 2011 and 2014. For 16 patients we required CBCT; for 24 patients we required OPT exam.
The surgical treatments were: debridement, marginal bone resection or segmental bone resection. We based on clinical and radiological findings to choose the most appropriate surgical treatment in every single patient. We observed an high correlation between the anatomic location of BRONJ during surgical treatment and CBCT radiological findings. On the other hand, OPT exam couldn’t produce same results compared to CBCT.
Conclusion
In our experience, we can assert that CBCT is a useful and effective tool in the surgical planning of BRONJ. It gives a lot of informations about the extension of osteonecrosis and about cancellous and cortical bone quality envolved. The CBCT also allows to show complications such as oro-sinusal, oro-nasal or muco-cutanea fistulas and their 3-D tracts, pathological fractures, maxillarisosteolysis, sinusitis, cheekbone and palate osteosceloris. This study about CBCT in BRONJ treatment is in according to SIPMO 2013 recommendations.
References
- Bedogni A, Campisi G, Fusco V, Agrillo A. Edizione CLEUP -VERS. 1.1.2013. Raccomandazioni per la prevenzione e terapia dell’osteonecrosi delle ossa mascellari da bisfosfonati. [Google Scholar]
- Treister NS, Friedland B, Woo SB. Use of cone- beam computerized tomography for evalutatio n of bisphosphonate- associated osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Radiol Endod. 2010 May;109(5):753–64. doi: 10.1016/j.tripleo.2009.12.005. [DOI] [PubMed] [Google Scholar]
- Stockmann P, Hinkmann FM, Lell MM, Fenner M, Vairaktaris E, Neukam FW, Nkenke E. Panoramic radiograph, computed tomography or magnetic resonance imaging technique should be preferred in bisphosphonate associated osteonecrosis og the jaw? A prospective clinical study. Clin Oral Investig. 2010 Jun;14(3):311–7. doi: 10.1007/s00784-009-0293-1. [DOI] [PubMed] [Google Scholar]