Medication-Related Osteonecrosis of the Jaw (MRONJ): imaging assessment of risk factors.

Antiresorptive medication is widely used to treat osteoporosis and cancer, among other diseases. The use of these drugs has been linked to the appearance of osteonecrosis in the jaws, which is clinically shown as the persistence of a wound in the oral cavity for more than 8 weeks, causing pain and discomfort and that can also be associated to infection. The key point of the management of these patients relies on the prevention, maintaining good hygiene and frequent dental controls, to avoid extractions and other invasive procedures to prevent the appearance of osteonecrosis of the jaws (ONJ).  The purpose of this doctoral project is to identify the imaging characteristics in patients that are under the treatment of antiresorptive drugs. Up to date, there is little evidence regarding the radiological signs in 2D and 3D imaging of this disease and no classification in images for the progression of it. It would be a big help for the daily practice to identify patterns or changes in the bone structure that could help to predict and assess more efficiently the risk of developing osteonecrosis of the jaws in patients consuming antiresorptive medication. The project would start with a search of the literature, then a retrospective study will be carried out by accessing the database from patients at UZ Leuven St Raphael that consulted for osteonecrosis and that obtained images (panoramic and/or CBCTs) during the appointments, then a randomized clinical trial will be done to evaluate the implementation of three treatment modalities and its corresponding imaging features, and potentially a prospective study will be done of patients that are in risk of developing osteonecrosis (taking antiresorptive medicine) to observe bone changes in the jaws.