Stage-related changes of bone density and volume in treatment of medication-related osteonecrosis of the jaw

This retrospective study evaluated changes in lesion bone density and volume in medication-related osteonecrosis of the jaw (MRONJ) using cone-beam computed tomography (CBCT) at different disease stages following conservative and surgical treatment. Additionally, the study analyzed the correlations between these changes and influencing factors. A total of 54 patients (mean [SD] age, 75.43 [7.44] years) diagnosed with stage 0, 1, 2, or 3 MRONJ, according to the American Association of Oral and Maxillofacial Surgeons' guidelines, were included. Pre- and post-treatment CBCT images were superimposed to identify the lesion locations, and lesions were segmented manually using ITK-SNAP software. Lesion mean bone density and volume before and after treatment were calculated. Stage 0-1 lesions showed a 16.8% reduction in bone density and a 17.0% reduction in volume and, while stage 2-3 lesions exhibited a 20.8% increase in bone density and a 46.0% reduction in volume (P < 0.05). In conclusion, stage 2-3 lesions demonstrated better healing outcomes than stage 0-1 lesions. Notably, conservative treatment may potentially benefit from a longer drug holiday, while surgical treatment showed positive effects on both soft and hard tissues in stage 2-3 lesions, regardless of the drug holiday duration.