title: Radiologic bone loss in patients with bisphosphonate-associated osteonecrosis of the jaws: a case-control study.
abstract: OBJECTIVE
  Most patients with bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) report a previous tooth extraction at the necrosis site before the diagnosis was made. At older ages, most teeth are extracted due to periodontal disease, which is per se another BP-ONJ trigger factor. The aim of this study was to evaluate the periodontal status of BP-ONJ patients using panoramic radiographs compared to a control.
  
  
  METHODS
  All patients treated for BP-ONJ up to January 1, 2010 comprised the study. The very first panoramic radiograph was analyzed. The number of remaining teeth and the radiographic bone loss from the cemento-enamel junction to the crestal bone were measured. For each patient, one control was analyzed (matching for gender and age).
  
  
  RESULTS
  One hundred twenty-nine BP-ONJ panoramic radiographs and 129 controls were analyzed (68 women, 61 men; 67.3 ± 9.7 years; osteoporosis [n = 11], breast cancer [n = 33], multiple myeloma [n = 61], prostate cancer [n = 24]). The average number of remaining teeth was 12.9 ± 8.4 for BP-ONJ and 16.4 ± 9.4 for the control (p = 0.02). The average radiographic bone loss was 5.5 ± 2.3 mm for BP-ONJ and 3.1 ± 1.1 mm for the control (p < 0.001); 96.6 % of BP-ONJ and 77.5 % had radiographic bone loss of more than 5 mm. Radiographic bone loss in the molar region was the highest for both groups (BP-ONJ 6.0 ± 2.3 mm; control 3.6 ± 1.4 mm).
  
  
  CONCLUSIONS
  Prevalence and severity of periodontal disease in patients with BP-ONJ is higher compared to healthy controls.
  
  
  CONCLUSIONS
  Patients with periodontal disease might be at a higher risk of developing BP-ONJ; therefore, periodontal disease therapy in patients who are about to receive bisphosphonates should be undertaken.
authors.affiliation: Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany, walter@mkg.klinik.uni-mainz.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Walter
authors.forename: Christian
authors.initials: C
authors.lastname: Laux
authors.forename: Keyvan
authors.initials: K
authors.lastname: Sagheb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography