J Korean Assoc Oral Maxillofac Surg.  2022 Aug;48(4):219-224. 10.5125/jkaoms.2022.48.4.219.

Radiographic changes of mandibular cortical bone in bisphosphonate drug holiday

• Lee DH
• Seo JI
• Song SI
• Lee JK

• KMID: 2532824
• DOI: http://doi.org/10.5125/jkaoms.2022.48.4.219

Abstract

Objectives
There have been few studies to date on the residual effect of bisphosphonate. This study investigated the radiographic changes of mandibular cortical thickness upon bisphosphonate drug holiday.
Materials and Methods
This retrospective study includes 36 patients diagnosed with MRONJ (medication-related osteonecrosis of the jaw) at Ajou University Dental Hospital in 2010-2021. All patients stopped taking bisphosphonate under consultation with the prescribing physicians. Panoramic radiographs were taken at the start of discontinuation (T₀ ), 12 months after (T₁ ), and 18 months after (T₂ ) discontinuation of bisphosphonate, respectively. Mental index and panoramic mandibular index were calculated using Ledgerton’s method. Paired t-tests were used to analyze differences over time.
Results
The difference in indices (mental index and panoramic mandibular index) between T₀ and T₁ was not statistically significant (paired t-test, P>0.05). However, the difference in these indices between T₁ and T₂ was statistically significant (paired t-test, P<0.05).
Conclusion
The cortical thickness of the mandible decreased in the late stage (after 18 months) as observed by panoramic radiograph.

Keyword

Bisphosphonate-associated osteonecrosis of the jaw; Panoramic radiography; Bisphosphonate holidays

Figure

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  Fig. 1 Defining landmarks by Ledgerton’s method. Panoramic mandibular index (PMI) and mental index (MI), S=the distance from the superior border of mental foramen to mandibular border, I=the distance from the inferior border to mandibular border, C=cortical bone thickness, that is MI.

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  Fig. 2 Groups of patients according to drug holiday length. When comparing T0 and T1, the size of group was 24, patients of which have taken dental panoramic radiograph at starting point of drug discontinuation and 12 months from the start. When comparing T0 and T2, the size of group was 13, patients of which have taken the radiograph at starting point of drug discontinuation and 18-24 months from the start.

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  Fig. 3 Comparison of index values. MI=mental index, PMI(I and S)=panoramic mandibular index. When comparing T0 and T1, the size of the group was 24. When comparing T1 and T2, the size of the group was 13.

Reference

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