The effect of radiographic findings on surgical treatment decision and treatment process of patients with medication related osteonecrosis of the jaw

Medication related osteonecrosis of the jaw (MRONJ)'s incidence is increasing since it was first defined in 2003. However, there is still no consensus on the etiology of MRONJ, ideal treatment methods, success rate of these treatment modalities and even MRONJ staging. The AAOMS' staging system is discussed because it is based on only clinical and limited radiographic findings. Stage-dependent treatment strategies according to AAOMS' staging system are also controversial due to the fact that they recommend surgical treatment only for stage 3 patients. The recommended surgical interventions for stage 2 patients were limited to superficial debridement according to the AAOMS treatment recommendations. However, some studies argue that early surgical treatment may yield more successful results in contrast to AAOMS suggestions. In addition, there is a lack of a staging system that evaluates the radiological and clinical findings that affect the success of surgical treatment in the literature. The aim of this study is to evaluate the clinical and radiological findings on surgical treatment decision and also the relationship between these findings and treatment success. In this study, 34 lesions in 28 patients and their follow up records on clinical forms and cone beam computed tomography images were included. Surgical treatment was preferred in 16 of the 28 patients. While the clinical status of the patients was defined, the cases were classified seven classes between K0-K6. These seven classes were divided into 4 subgroups according to the signs of infection and gingival adequacy for primary closure in case of surgery. Radiological evaluation of the patients was performed using a composite radiographic index between 0 to 3. Sclerosis, periosteal reaction, lytic changes, and presence of sequester were evaluated. According to the results of our study, it was seen that the clinical condition was worse in patients with presence of both lytic changes and sequester. In conclusion, based on the data and literature obtained in this study, a staging system is recommended that consist of 7 sub-stages and clinical and radiological findings. Key Words: MRONJ, staging system, lytic changes, sequester.