Radiographic perception of anatomical structures and bony changes in oncologic patients under antiresorptive therapy

Purpose To assess radiographic presentation of anatomical structures, bony changes and soft tissue calcifications on panoramic radiographs of oncologic patients under high dose antiresorptive drug therapy (ART) before exposure to dental extraction. Methods Panoramic radiographs of 57 patients under ART, taken previously to tooth extraction, and 57 control patients were evaluated by two oral radiologists regarding bone pattern, anatomical structures visibility, estimation of cortical width, mandibular cortical index (MCI), and presence of soft tissue calcifications. Parameters were compared between ART and age- and gender-matched healthy control groups. Bone patterns were further assessed by regions with or without tooth extractions and according to uneventful healing or MRONJ development. All comparisons were made using chi-square test with significance level set at 5%. Results Mandible and posterior maxilla presented more sclerotic bone patterns in patients under ART, regardless of tooth extraction and MRONJ development status ( p < 0.05). Heterogeneous bone pattern was identified in two regions that both were subsequently affected by MRONJ. Anatomical structure visibility and presence of soft tissue calcifications was not different among groups ( p > 0.05). ART patients showed significantly more C0 (thickening) and C1 MCI ( p < 0.05). Conclusion Sclerotic bone pattern and thicker mandibular cortices may represent a consequence of ART rather than MRONJ specific findings. Prospective studies on larger patient samples radiographically followed-up during the ART treatment are advised, with specific attention to heterogenous trabecular bone pattern as a possible MRONJ predictor.