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Br J Oral Maxillofac Surg. 2014 Sep;52(7):603-8. doi: 10.1016/j.bjoms.2014.04.009. Epub 2014 May 22.

Staging of osteonecrosis of the jaw requires computed tomography for accurate definition of the extent of bony disease.

Author information

1
University and Hospital Trust of Verona, Department of Surgery, Section of Oral and Maxillofacial Surgery, Verona, Italy. Electronic address: alberto.bedogni@univr.it.
2
University College London, UCL Eastman Dental Institute, and NIHR University College London Hospitals Biomedical Research Centre, London, UK. Electronic address: s.fedele@ucl.ac.uk.
3
Liver Research Centre, Clinical Epidemiology Unit, Basovizza, Trieste, Italy. Electronic address: giorgiobedogni@gmail.com.
4
University of Turin, Department of Biomedical Science and Human Oncology, Section of Oral Medicine, UNITO Lingotto Dental Institute, Turin, Italy. Electronic address: matteo.scoletta@libero.it.
5
University of Bari, Department of Odontostomatology and Surgery, Bari, Italy. Electronic address: g.favia@doc.uniba.it.
6
Second University of Naples, Dept. of Medical, Surgical and Dental Specialties, Naples, Italy. Electronic address: giuseppe.colella@unina2.it.
7
University "La Sapienza", Department of Oral and Maxillofacial Sciences, Section of Maxillofacial Surgery, Rome, Italy. Electronic address: alessandro.agrillo@tiscali.it.
8
University Hospital of Padova, Department of Neurosciences, Unit of Oral and Maxillofacial Surgery, Padova, Italy. Electronic address: giordanabettini@libero.it.
9
University of Palermo, Department of Surgical, Oncological and Oral Sciences, Sector of Oral Medicine, Palermo, Italy. Electronic address: odifede@odonto.unipa.it.
10
University of Messina, Department of Odontostomatology, Messina, Italy. Electronic address: oterig@unime.it.
11
Hospital "SS. Antonio, Biagio and C. Arrigo", Department of Oncology and Haematology, Unit of Medical Oncology, Alessandria, Italy. Electronic address: vfusco@ospedale.al.it.
12
University of Pisa, Department of Surgery, Section of Dentistry and Oral Surgery, Pisa, Italy. Electronic address: mario.gabriele@odont.med.unipi.it.
13
University "La Sapienza", Department of Oral and Maxillofacial Sciences, Rome, Italy. Electronic address: livia.ottolenghi@uniroma1.it.
14
Hospital S. Anna, Unit of Maxillofacial Surgery, Como, Italy. Electronic address: stefano.valsecchi@hsacomo.org.
15
University College London, UCL Eastman Dental Institute, London, UK. Electronic address: s.porter@ucl.ac.uk.
16
University of Bari, Department of Odontostomatology and Surgery, Bari, Italy. Electronic address: m.petruzzi@doc.uniba.it.
17
University of Turin, Department of Biomedical Science and Human Oncology, Section of Oral Medicine, UNITO Lingotto Dental Institute, Turin, Italy. Electronic address: paolo.arduino@gmail.com.
18
Second University of Naples, Dept. of Medical, Surgical and Dental Specialties, Naples, Italy. Electronic address: salvatore.damato@unina2.it.
19
University "La Sapienza", Department of Oral and Maxillofacial Sciences, Section of Maxillofacial Surgery, Rome, Italy. Electronic address: claudio.ungari@uniroma1.it.
20
University College London, UCL Eastman Dental Institute, London, UK. Electronic address: pok.fung.10@ucl.ac.uk.
21
University Hospital of Padova, Department of Neurosciences, Unit of Oral and Maxillofacial Surgery, Padova, Italy. Electronic address: giorgia.saia@unipd.it.
22
University of Palermo, Department of Surgical, Oncological and Oral Sciences, Sector of Oral Medicine, Palermo, Italy. Electronic address: campisi@odonto.unipa.it.

Abstract

Management of osteonecrosis of the jaw associated with antiresorptive agents is challenging, and outcomes are unpredictable. The severity of disease is the main guide to management, and can help to predict prognosis. Most available staging systems for osteonecrosis, including the widely-used American Association of Oral and Maxillofacial Surgeons (AAOMS) system, classify severity on the basis of clinical and radiographic findings. However, clinical inspection and radiography are limited in their ability to identify the extent of necrotic bone disease compared with computed tomography (CT). We have organised a large multicentre retrospective study (known as MISSION) to investigate the agreement between the AAOMS staging system and the extent of osteonecrosis of the jaw (focal compared with diffuse involvement of bone) as detected on CT. We studied 799 patients with detailed clinical phenotyping who had CT images taken. Features of diffuse bone disease were identified on CT within all AAOMS stages (20%, 8%, 48%, and 24% of patients in stages 0, 1, 2, and 3, respectively). Of the patients classified as stage 0, 110/192 (57%) had diffuse disease on CT, and about 1 in 3 with CT evidence of diffuse bone disease was misclassified by the AAOMS system as having stages 0 and 1 osteonecrosis. In addition, more than a third of patients with AAOMS stage 2 (142/405, 35%) had focal bone disease on CT. We conclude that the AAOMS staging system does not correctly identify the extent of bony disease in patients with osteonecrosis of the jaw.

KEYWORDS:

AAOMS; Antiresorptive agents; Bisphosphonate; Computed tomography; Osteonecrosis of the jaw; Staging system

PMID:
24856927
DOI:
10.1016/j.bjoms.2014.04.009
[Indexed for MEDLINE]
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