Imaging of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with CBCT

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) results in significant clinical problems and sickness of the patient and is associated with exposed jaw bone, limited healing of the mucosa, and osteomyelitis. It was mentioned that cone-beam computed tomography (CBCT) could offer an option for the diagnosis and monitoring of BRONJ. The purpose of this study is to proof of clinical equivalence of CBCT compared to MDCT.

Methods:

We evaluated currently 52 patients in an ongoing trial to compare imaging with three different CBCT devices (Morita Accuitomo, KaVo 3DeXam, Sirona Galileos), MDCT and conventional panoramic X-ray in two centers. Data sets were reconstructed and DICOM data generated and evaluated with OsiriX viewer on a Apple Mac computer. Images of all cross-sections were evaluated descriptively and compared to MDCT. Imaging of sclerosis, sequesters, surface structure and cancellous bone structure were rated with quality points (0=no value of image, 1=image usable for diagnostics). The results were correlated to the clinical status including the classification of BRONJ.

Results:

The results showed no significant difference in clinical monitoring of bone structures amongst MDCT and all CBCT devices in the evaluations. However, maximum of imaging quality and resolution is significantly different between certain devices. Sclerotic bone can be clearly separated from regular cancellous bone structure. Imaging of exposed bone surface changes and sequesters is difficult in some cases.

Conclusions:

CBCT devices are an appropriate advanced imaging technology to support panoramic X-ray in BRONJ patients. MDCT is not essentially necessary in all cases.