title: Bisphosphonate-Related Osteonecrosis of the Jaw Bone: Radiological Pattern and the Potential Role of CBCT in Early Diagnosis.
abstract: OBJECTIVE
  To systematize the clinico-radiological symptoms and course of bisphosphonate-related osteonecrosis of jaw bone and toevaluate the diagnostic potential of various radiological techniques to detect mild osteonecrosis in each stage of the disease.
  
  
  METHODS
  The sample consisted of 22 patients previously diagnosed with extraoral malignant disease. Diagnosis was based on a clinical examination in conjunction to digital panoramic radiography and cone beam computed tomography (CBCT). Two dentomaxillofacial radiologists reviewed all images.
  
  
  RESULTS
  Twenty patients showed mandibular involvement clinically, while two others had a maxillary involvement. Four stages of the disease were proposed based on the clinico-radiological findings. Subclinical cortical and lamina dura thickening was detected with only three-dimensional CBCT and periapical images, while ulceration and cortical bone thickening was detected only by three-dimensional CBCT. Mixed sclerotic, lytic bone destruction involving alveolar and basal bone with or without encroachment on the mandibular canal, pathological mandibular fractures were detected by two-dimensional panoramic and three-dimensional CBCT images. Other findings are non healing extraction sockets, periapical radiolucencies, osteolysis, sequestra, oroantral fistula, and periosteal new bone formation.
  
  
  CONCLUSIONS
  The present study showed that bisphosphonate-related osteonecrosis of jaw bone occurs in four distinct clinico-radiological stages. For mild cases, panoramic image diagnosis was much less obvious, whereas cone beam computed tomography was able to fully characterise the bony lesions and describe their extent and involvement of neighbouring structures in all cases. Thus cone beam computed tomography might better contribute to the prevention of bisphosphonate-related osteonecrosis of jaw bone as well to the disease management.
authors.affiliation: Oral Imaging Center, Department of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven Belgium. ; Department of Dentistry, Faculty of Clinical Sciences, University of Maiduguri, Maiduguri Nigeria.
authors.forename: James
authors.initials: J
authors.lastname: Olutayo
authors.affiliation: Department of Paediatric Dentistry and Special Dental Care, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven Belgium.
authors.forename: Jimoh Olubanwo
authors.initials: JO
authors.lastname: Agbaje
authors.affiliation: Oral Imaging Center, Department of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven Belgium.
authors.forename: Reinhilde
authors.initials: R
authors.lastname: Jacobs
authors.affiliation: Department of Paediatric Dentistry and Special Dental Care, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven Belgium.
authors.forename: Vicky
authors.initials: V
authors.lastname: Verhaeghe
authors.affiliation: Private Periodontologist, Antwerp Belgium.
authors.forename: Filip Vande
authors.initials: FV
authors.lastname: Velde
authors.affiliation: Department of Paediatric Dentistry and Special Dental Care, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven Belgium.
authors.forename: Frans
authors.initials: F
authors.lastname: Vinckier
keywords: bisphosphonates; cone-beam CT; early diagnosis.; osteonecrosis jaw