Revista de Odontologia da UNESP
https://revodontolunesp.com.br/article/doi/10.1590/1807-2577.20250026
Revista de Odontologia da UNESP
Original Article

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

Avaliação por TCFC de alterações ósseas dos maxilares em pacientes em uso de terapia antirreabsortiva: uma abordagem clínico-radiográfica para suspeita de OMAM em estágio 0

Mariel Ruivo BIANCARDI; Mariana Quirino Silveira SOARES; Rogerio Jardim CALDAS; Heitor Marques HONÓRIO; Paulo Sérgio Silva SANTOS; Izabel Regina Fischer RUBIRA-BULLEN

http://dx.doi.org/10.1590/1807-2577.20250026 Rev. odontol. UNESP, vol.55, e20250026, 2026
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Abstract

Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse effect associated with antiresorptive and antiangiogenic therapies. Cone beam computed tomography (CBCT) enables the detection of subtle bone alterations and may reveal imaging manifestations before clinically evident disease develops.

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.

Supplementary material accompanies this paper:

Material Suplementar 1.

Material Suplementar 2.

Material Suplementar 3.

Keywords

MRONJ, CBCT, osteosclerosis, antiresorptive therapy, radiologic stage 0

Resumo

Introdução: A osteonecrose dos maxilares associada a medicamentos (OMAM) é uma complicação potencialmente grave relacionada ao uso de fármacos antirreabsortivos e antiangiogênicos. A tomografia computadorizada de feixe cônico (TCFC) permite a detecção de alterações ósseas sutis, podendo identificar manifestações imaginológicas antes do aparecimento de sinais clínicos evidentes.

Objetivo: Avaliar se alterações ósseas detectáveis por tomografia computadorizada de feixe cônico (TCFC) estão presentes em regiões anatômicas clinicamente não afetadas de pacientes diagnosticados com osteonecrose dos maxilares associada à medicamentos (OMAM) e investigar associações entre esses achados de imagem e variáveis relacionadas ao paciente.

Material e método: Este estudo retrospectivo e transversal analisou 94 sítios anatômicos provenientes de exames de TCFC de 27 pacientes com OMAM clinicamente confirmada. Foram avaliadas alterações ósseas, incluindo osteosclerose, aumento da densidade trabecular, espessamento cortical, osteólise, alterações do canal mandibular e alvéolos de extração persistentes, em sítios clinicamente afetados e não afetados. A regressão logística multivariada foi utilizada para investigar associações com idade, doença de base, tipo de medicação, via de administração, duração da terapia e uso de corticosteroides.

Resultado: Todas as alterações observadas por TCFC nas lesões de OMAM também foram identificadas em sítios clinicamente não afetados. Osteosclerose e espessamento cortical mandibular foram associados à terapia antiangiogênica, enquanto alvéolos de extração persistentes foram mais frequentes em pacientes oncológicos. Não foram observadas diferenças estatisticamente significativas entre sítios clinicamente afetados e não afetados quanto à distribuição das alterações radiográficas.

Conclusão: Alterações detectáveis por TCFC comumente associadas à OMAM também podem estar presentes em sítios anatômicos clinicamente não afetados. Esses achados sustentam a hipótese de manifestações imaginológicas precoces da doença e destacam o potencial valor da avaliação abrangente por TCFC em pacientes submetidos à terapia antirreabsortiva ou antiangiogênica. Estudos prospectivos e longitudinais são necessários para validar essas observações e determinar sua relevância clínica.

Material suplementar acompanha este artigo:

Supplementary Material 1.

Supplementary Material 2.

Supplementary Material 3.

Palavras-chave

MRONJ, CBCT, osteosclerose, terapia antirreabsortiva, estágio radiológico 0

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Submitted date:
08/15/2025

Accepted date:
06/08/2026

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