Dental panoramic radiographic evaluation in bisphosphonate-associated osteonecrosis of the jaws

Objectives:  To determine the extent to which clinical and radiographic features of bisphosphonate-associated osteonecrosis of the jaw (BONJ) are correlated.
Design:  Retrospective case review.
Methods:  The records of 39 patients diagnosed with BONJ and examined by panoramic radiography were retrospectively evaluated. The arches were divided into sextants ( n  = 234) and evaluated for the following signs: sclerosis, surface irregularity, sockets, fragmentation and lysis.
Main outcome measures:  The McNemar, Kruskall–Wallis and equivalency tests were performed to analyze the association between clinical and radiographic signs and BONJ severity.
Results:  Sixty-two out of 234 sextants were abnormal by clinical criteria and 61 out of 234 sextants demonstrated at least one radiographic abnormality. There was agreement between clinical and radiographic detection in 41 sextants. The data showed equivalency between BONJ diagnosis and both sclerosis and surface irregularity. The correlation between number of clinical sites and any radiographic finding was significant in the maxilla ( P  < 0.001) but not in the mandible ( P  = 0.178). The total number of radiographic signs per patient increased with BONJ stage.
Conclusion:  Focal panoramic radiographic findings of sclerosis and surface irregularity correlate with clinical sites of BONJ. This may be a useful and reliable tool to detect early changes of BONJ or to confirm a clinical diagnosis.