DUYGU GÖLLER BULUT, Gözde ÖZCAN, Fatma AVCI

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

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.

Anahtar Kelimeler:

Bifosfonat, kemik dansitesi; konik ışınlı bilgisayarli tomografi, osteonekroz

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

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,

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1. Arce K, Assael LA, Weissman JL, Markiewicz MR. Imaging findings in bisphosphonate-related osteonecrosis of jaws. J Oral Maxillofac Surg. 2009;67(5 Suppl):75-84. doi: 10.1016/j.joms.2008.12.002.
2. Rosella D, Papi P, Giardino R, Cicalini E, Piccoli L, Pompa G. Medication-related osteonecrosis of the jaw: Clinical and practical guidelines. J Int Soc Prev Community Dent. 2016; 6(2): 97-104. doi: 10.4103/2231-0762.178742.
3. Phal PM, Myall RW, Assael LA, Weissman JL. Imaging findings of bisphosphonate-associated osteonecrosis of the jaws. AJNR Am J Neuroradiol. 2007;28(6):1139-45.
4. Hounsfield GN. Nobel lecture, December 8, 1979. Computed medical imaging. J Radiol. 1980;61(6):459-68.
5. Fullmer JM, Scarfe WC, Kushner GM, Alpert B, Farman AG. Cone beam computed tomographic findings in refractory chronic suppurative osteomyelitis of the mandible. Br J Oral Maxillofac Surg. 2007;45(5):364-71.
6. Schulze D, Blessmann M, Pohlenz P, Wagner KW, Heiland M. Diagnostic criteria for the detection of mandibular osteomyelitis using cone-beam computed tomography. Dentomaxillofac Radiol. 2006; 35(4): 232-5.
7. Fuster-Torres MA, Penarrocha-Diago M, Penarrocha-Oltra D, Penarrocha-Diago M. Relationships between bone density values from cone beam computed tomography, maximum insertion torque, and resonance frequency analysis at implant placement: a pilot study. Int J Oral Maxillofac Implants. 2011;26(5):1051-6.
8. Colella G, Campisi G, Fusco V. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate related osteonecrosis of the jaws-2009 update. J Oral Maxillofac Surg. 2009;67(12):2698-9. doi: 10.1016/j.joms.2009.07.097.
9. Koth VS, Figueiredo MA, Salum FG, Cherubini K. Bisphosphonate-related osteonecrosis of the jaw: from the sine qua non condition of bone exposure to a non-exposed MRONJ entity. Dentomaxillofac Radiol. 2016;45(7):20160049. doi:10.1259/dmfr.20160049.
10. Hansen T, Kunkel M, Weber A, James Kirkpatrick C. Osteonecrosis of the jaws in patients treated with bisphosphonates-histomorphologic analysis in comparison with infected osteoradionecrosis. J Oral Pathol Med. 2006;35(3):155-60.
11. Cankaya AB, Erdem MA, Isler SC, Demircan S, Soluk M, Kasapoglu C et al. Use of Cone-Beam Computerized Tomography for Evaluation of Bisphosphonate-Associated Osteonecrosis of the Jaws in an Experimental Rat Model. Int J Med Sci. 2011;8(8):667-72.
12. Jaffin RA, Berman CL. The excessive loss of Branemark fixtures in type IV bone: a 5-year analysis. J Periodontol. 1991;62(1):2-4.
13. Jemt T, Book K, Linden B, Urde G. Failures and complications in 92 consecutively inserted overdentures supported by Branemark implants in severely resorbed edentulous maxillae: a study from prosthetic treatment to first annual check-up. Int J Oral Maxillofac Implants. 1992;7(2):162-7.
14. Hao Y, Zhao W, Wang Y, Yu J, Zou D. Assessments of jaw bone density at implant sites using 3D cone-beam computed tomography. Eur Rev Med Pharmacol Sci. 2014;18(9):1398-1403.
15. Dore F, Filippi L, Biasotto M, Chiandussi S, Cavalli F, Di Lenarda R. Bone scintigraphy and SPECT/CT of bisphosphonate-induced osteonecrosis of the jaw. J Nucl Med. 2009;50(1):30-5. doi:10.2967/jnumed.107.048785.
16. De Vos W, Casselman J, Swennen GR. Cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial region: a systematic review of the literature. Int J Oral Maxillofac Surg. 2009;38(6):609-25. doi:10.1016/j.ijom.2009.02.028.
17. Swennen GR, Schutyser F. Three-dimensional cephalometry: spiral multi-slice vs cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2006;130(3):410-6.
18. Hohlweg-Majert B, Metzger MC, Kummer T, Schulze D. Morphometric analysis-Cone beam computed tomography to predict bone quality and quantity. J Craniomaxillofac Surg. 2011;39(5):330-4. doi:10.1016/j.jcms.2010.10.002. Epub 2010 Oct 27.
19. Durie BG, Katz M, Crowley J. Osteonecrosis of the jaw and bisphosphonates. N Engl J Med. 2005;353(1):99-102.
20. Rugani P, Luschin G, Jakse N, Kirnbauer B, Lang U, Acham S. Prevalence of bisphosphonateassociated osteonecrosis of the jaw after intravenous zoledronate infusions in patients with early breast cancer. Clin Oral Investig. 2014;18(2):401-7. doi:10.1007/s00784-013-1012-5. Epub 2013 Jun 10.
21. Chiandussi S, Biasotto M, Dore F, Cavalli F, Cova MA, Di Lenarda R. Clinical and diagnostic imaging of bisphosphonate- associated osteonecrosis of the jaws. Dentomaxillofac Radiol. 2006;35(4):236-43.
22. Wilde F, Steinhoff K, Frerich B, Schulz T, Winter K, Hemprich A, Sabri O, Kluge R et al. Positron-emission tomography imaging in the diagnosis of bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(3):412-9. doi:10.1016/j.tripleo.2008.09.019. Epub 2009 Jan 4.
23. Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D et al. Bisphosphonateassociated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2007;22(10):1479-91.
24. Guggenberger R, Koral E, Zemann W, Jacobsen C, Andreisek G, Metzler P. Cone beam computed tomography for diagnosis of bisphosphonate-related osteonecrosis of the jaw: evaluation of quantitative and qualitative image parameters. Skeletal Radiol. 2014;43(12):1669-78. doi:10.1007/s00256-014-1951-1. Epub 2014 Jul 5.
25. Torres SR, Chen CS, Leroux BG, Lee PP, Hollender LG, Santos EC et al. Mandibular cortical bone evaluation on cone beam computed tomography images of patients with bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(5):695-703. doi:10.1016/j.oooo.2011.11.011. Epub 2012 Apr 12.
26. Voss P, Ludwig U, Poxleitner P, Bergmaier V, El-Shafi N, von Elverfeldt D et al. Evaluation of BP-ONJ in osteopenic and healthy sheep: comparing ZTE-MRI with µCT. Dentomaxillofac Radiol. 2016;45(4):20150250. doi:10.1259/dmfr.20150250. Epub 2016 Feb 5.
27. Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005;63(11):1567-75.
28. Migliorati CA, Schubert MM, Peterson DE, Seneda LM. Bisphosphonate-associated osteonecrosis of mandibular and maxillary bone: an emerging oral complication of supportive cancer therapy. Cancer. 2005;104(1):83-93.
29. Zahrowski JJ. Bisphosphonate treatment: an orthodontic concern calling for a proactive approach. Am J Orthod Dentofacial Orthop. 2007;131(3):311-20.
30. Olutayo J, Agbaje JO, Jacobs R, Verhaeghe V, Velde FV, Vinckier F. Bisphosphonate-related osteonecrosis of the jaw bone: radiological pattern and the potential role of CBCT in early diagnosis. J Oral Maxillofac Res. 2010;1;1(2):3. doi:10.5037/jomr.2010.1203.