ASSESSMENT OF OSSEOUS DENSITY CHANGES IN PATIENTS WITH MEDICATION-RELATED OSTEONECROSIS OF THE JAWS USING CONE-BEAM CT: A CASE CONTROL STUDY

Abstract

Objective: In this study, the aim was to analyze density differences in prearranged region of patients with medication-related osteonecrosis of the jaws (MRONJ) and to evaluate potential effected sides in jaws by using cone beam computed tomography (CBCT)

Material and Methods: The records of 29 patients diagnosed with MRONJ and under bisphosphonates therapy and examined by CBCT were retrospectively evaluated with age- and gender-matched controls. The gray values (voxel value (VV)) were detected in the maxillary tuberosity (MTs), anterior supporting bone of nasopalatine canal (NPCs), mental foramen regions (MFs), center of symphysis and the bone surrounding the MRONJ area.

Results: According to the results, the mostly affected area was the bone under the mental foramen. There were significant differences between MRONJ and controls for right and left MFs (p=0.03, p=0.006 respectively). The mean gray value of right MTs were: 165.04 for controls and 212.4 for patients (p=0.13); left MTs were 208.6 for controls and 268.0 for patients (p=0.32); NPCs were 575.1 for controls and 572.6 for patients (p=0.96); and MSs were 679.2 for controls and 828.2 for patients (p=0.1). The gray value in the inferior peripheral bone of exposed region was the highest.

Conclusion: The present study shows that bisphosphonates cause internal morphological changes in jaws. Morphological changes are more frequent in certain parts of the jawbone such as the mental foramen. Gray values obtained by CBCT for quantitative measurements of density differences, can help achieve useful data for prediction of hazardous conditions where MRONJ can occur and how it will progress.

Keywords

• Bisphosphonate,bone density,cone beam computed tomography,osteonecrosis

İlaç Kullanımına Bağlı Osteonekroz Gelişen Hastaların Kemik Dansitelerinin Konik Işınlı BT ile Değerlendirilmesi: Vaka Kontrol Çalışması

Abstract

Amaç: Bu çalışmada, ilaç kullanımına bağlı osteonekroz gelişen hastalarda çenelerin belirli bölgelerindeki kemik yoğunluğunun konik ışınlı bilgisayarlı tomografi (KIBT) ile değerlendilmesi ve potansiyel olarak etkilenen alanların belirlenmesi amaçlanmıştır.

Gereç ve Yöntemler: Çalışmada bifosfonat tedavisi gören ve ilaç kullanımına bağlı osteonekroz gelişen 29 hastanın KIBT'leri yaş ve cinsiyet eşleşmeli kontrol grubuyla beraber retrospektif olarak incelendi. Maksiller tuber (MT), nazopalatin kanalın anteriorundaki kemik (NPK), mental foramen bölgesi (MF), simfizisin anterioru ve osteonekrozlu alanın etrafını saran kemiğin gri voksel değerleri ölçüldü.

Bulgular: Sonuçlara göre en çok etkilenen alan mental foramenin altındaki kemik olarak bulundu. Sağ ve sol MF değerlendirildiğinde osteonekroz hastaları ve kontrol grubu arasında anlamlı farklılıklar bulundu (p=0.03, p=0.006 sırasıyla). Sağ MT için ortalama gri değerleri kontrol grubunda 165.04, hasta grubunda 212.4 (p=0.13); sol MT için ise kontrol grubunda 208.6 hasta grubunda 68.0 olarak ölçüldü (p=0.32). NPK; kontrol grubunda ortalama 575.1 ve hasta grubunda ortalama 572.6 (p=0.96); ve MS kontrol grubunda 679.2 ve hasta grubunda 828.2 olarak ölçüldü (p=0.1). Etkilenen alanın inferiorundaki kemik yoğunluğunun diğer bölgelerden daha yüksek olduğu belirlendi.

Sonuç: Bifosfonat türevi ilaçlar çene kemiklerinin internal yapısında morfolojik değişikliklere neden olmaktadır. Morfolojik değişimler özellikle mental foramen gibi bölgelerde daha fazladır. Dansite farklılıklarının ölçümünde KIBT ile elde edilen gri değerler ile, osteonekrozun oluşacağı bölge ve gelişeceği doğrultudaki tehlikeli koşulların tahmini için yararlı veriler elde edebilir.

Keywords

• Bifosfonat,kemik dansitesi; konik ışınlı bilgisayarli tomografi,osteonekroz

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