Use of Cone Beam Computed Tomography for identification and evaluation of medication-related osteonecrosis of the jaws: a dosimetric and multimodal imaging comparison

The aim of this study was to compare Orthopantomograms (OPT) and Computed Tomography (CT) with Cone Beam Computed Tomography (CBCT) in patients with Medication-Related OsteoNecrosis of the Jaws (MRONJ). The study included 25 patients (6 males and 19 females) with MRONJ who had a history of long-term bisphosphonate therapy or one of the recently re-entered MRONJ drugs and underwent OPT, CT and/or CBCT for determination of the extent of disease. We excluded patients with maxillary neoplasia. Considering the presence of early and late signs, OPT was diagnostic in 6 out of 17 cases (35%), while CT and CBCT were diagnostic in 25 out of 25 cases (100%). Analysing the different radiant doses delivered by the selected radiological methods on a phantom, it was found that a more significant effective dose was spread by CT (2.6 mSv) than CBCT (0.164 mSv) or OPT (0.02 mSv). CBCT, from our experience, is a candidate to replace OPT in the first diagnostic step in patients with suspected MRONJ, generating less effective doses and artefacts from metal components than CT.