Peri‐Implant‐Medication‐Related Osteonecrosis of the Jaws: Epidemiological, Clinical and Radiographic Features—A Retrospective Cohort Study

IF 6.8 1区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Clinical Periodontology Pub Date : 2026-03-29 DOI:10.1111/jcpe.70124

Daya Masri, Dror Bar‐Hai, Omar Ghanaiem, Gavriel Chaushu, Liat Chaushu

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引用次数: 0

Abstract

Aim To characterize peri‐implant‐medication‐related osteonecrosis of the jaw (PI‐MRONJ) (epidemiological, clinical, and radiographic features) in order to optimise its diagnosis and management. Materials and Methods This is a retrospective cohort study including patients diagnosed with MRONJ that developed spontaneously around previously osseointegrated and loaded dental implants. Data were extracted from medical records. Outcome parameters included the underlying health condition, onset time, age, distinct radiographic features using 3D imaging, severe complications and systemic comorbidities. Patients were categorised into oncologic or osteoporotic groups. Results Forty patients (86 implants) were diagnosed with PI‐MRONJ between 2015 and 2024. The mean age was 72.1. Radiographic features distinct from peri‐implantitis included—osteolysis (80%), the most prevalent radiographic feature, osteosclerosis (57.1%), sequestration (54.3%), periosteal reaction and inferior alveolar canal involvement (30.8% each) and maxillary sinus involvement (77.8% of maxillary cases). A delay in diagnosis (only two cases [5%] were diagnosed at stage 1) was confirmed. Consequently, severe complication rates were high (38.7% for mandible and 55.6% for maxilla). Patients had an average of 3.1 systemic comorbidities. Oncologic patients showed a shorter onset time from antiresorptive treatment to diagnosis (mean 2.8 vs. 6.2 years, p < 0.001). Conclusions PI‐MRONJ may clinically and radiographically resemble peri‐implantitis. However, it appears to represent a distinct and underrecognised subtype of MRONJ. Consequently, a delay in diagnosis occurs (stage 3). The advanced diagnostic stage aggravates a high rate of severe complications. A diagnostic flowchart is proposed to aid in differential diagnosis. Advanced age (> 70 years) and distinct radiographic features are suggested as hallmark features.

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围种植体-药物相关颌骨骨坏死：流行病学、临床和影像学特征——回顾性队列研究

目的探讨种植体周围药物相关颌骨骨坏死（PI - MRONJ）的流行病学、临床和影像学特征，以优化其诊断和治疗。材料和方法：这是一项回顾性队列研究，包括诊断为MRONJ的患者，这些患者在先前的骨整合和负载牙种植体周围自发发展。数据从医疗记录中提取。结果参数包括潜在的健康状况、发病时间、年龄、使用3D成像的明显放射学特征、严重并发症和全身合并症。患者分为肿瘤组和骨质疏松组。结果2015 - 2024年间，40例患者（86例种植体）被诊断为PI - MRONJ。平均年龄为72.1岁。与种植体周围炎不同的x线表现包括：骨溶解（80%），最常见的x线表现为骨硬化（57.1%）、骨隔离（54.3%）、骨膜反应和下牙槽管受累（各占30.8%）以及上颌窦受累（77.8%）。诊断延误（只有2例[5%]在第一阶段被诊断出来）被证实。严重并发症发生率高（下颌骨38.7%，上颌骨55.6%）。患者平均有3.1个全身合并症。肿瘤患者从抗吸收治疗到诊断的发病时间较短（平均2.8年vs. 6.2年，p < 0.001）。结论PI - MRONJ在临床和影像学上可能类似于种植体周围炎。然而，它似乎代表了MRONJ的一种独特的、未被认识的亚型。因此，诊断出现延误（第3阶段）。晚期诊断阶段加重了严重并发症的高发生率。提出了一种诊断流程图，以帮助鉴别诊断。高龄（70岁）和明显的影像学特征被认为是标志特征。

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来源期刊

Journal of Clinical Periodontology 医学-牙科与口腔外科

CiteScore

13.30

自引率

10.40%

发文量

175

审稿时长

3-8 weeks

期刊介绍： Journal of Clinical Periodontology was founded by the British, Dutch, French, German, Scandinavian, and Swiss Societies of Periodontology. The aim of the Journal of Clinical Periodontology is to provide the platform for exchange of scientific and clinical progress in the field of Periodontology and allied disciplines, and to do so at the highest possible level. The Journal also aims to facilitate the application of new scientific knowledge to the daily practice of the concerned disciplines and addresses both practicing clinicians and academics. The Journal is the official publication of the European Federation of Periodontology but wishes to retain its international scope. The Journal publishes original contributions of high scientific merit in the fields of periodontology and implant dentistry. Its scope encompasses the physiology and pathology of the periodontium, the tissue integration of dental implants, the biology and the modulation of periodontal and alveolar bone healing and regeneration, diagnosis, epidemiology, prevention and therapy of periodontal disease, the clinical aspects of tooth replacement with dental implants, and the comprehensive rehabilitation of the periodontal patient. Review articles by experts on new developments in basic and applied periodontal science and associated dental disciplines, advances in periodontal or implant techniques and procedures, and case reports which illustrate important new information are also welcome.