TY - JOUR
T1 - Staging of osteonecrosis of the jaw requires computed tomography for accurate definition of the extent of bony disease.
AU - Campisi, Giuseppina
AU - Di Fede, Olga
AU - Bettini, Giordana
AU - Oteri, Giacomo
AU - Scoletta, Matteo
AU - Petruzzi, Massimo
AU - Di Fede, Olga
AU - Fung Polly, Pok-Lam
AU - Colella, Giuseppe
AU - Gabriele, Mario
AU - Campisi, Giuseppina
AU - Ungari, Claudio
AU - Saia, Giorgia
AU - Bedogni, Alberto
AU - D'Amato, Salvatore
AU - Ottolenghi, Livia
AU - Agrillo, Alessandro
AU - Valsecchi, Stefano
AU - Fedele, Stefano
AU - Bedogni, Giorgio
AU - Favia, Gianfranco
AU - Fusco, Vittorio
AU - Porter, Stephen
AU - Arduino, Paolo
PY - 2014
Y1 - 2014
N2 - Management of osteonecrosis of the jaw associated with antiresorptive agents is challenging, and outcomes are unpredictable. The severity of disease is the main guide to management, and can help to predict prognosis. Most available staging systems for osteonecrosis, including the widely-used American Association of Oral and Maxillofacial Surgeons (AAOMS) system, classify severity on the basis of clinical and radiographic findings. However, clinical inspection and radiography are limited in their ability to identify the extent of necrotic bone disease compared with computed tomography (CT). We have organised a large multicentre retrospective study (known as MISSION) to investigate the agreement between the AAOMS staging system and the extent of osteonecrosis of the jaw (focal compared with diffuse involvement of bone) as detected on CT. We studied 799 patients with detailed clinical phenotyping who had CT images taken. Features of diffuse bone disease were identified on CT within all AAOMS stages (20%, 8%, 48%, and 24% of patients in stages 0, 1, 2, and 3, respectively). Of the patients classified as stage 0, 110/192 (57%) had diffuse disease on CT, and about 1 in 3 with CT evidence of diffuse bone disease was misclassified by the AAOMS system as having stages 0 and 1 osteonecrosis. In addition, more than a third of patients with AAOMS stage 2 (142/405, 35%) had focal bone disease on CT. We conclude that the AAOMS staging system does not correctly identify the extent of bony disease in patients with osteonecrosis of the jaw.
AB - Management of osteonecrosis of the jaw associated with antiresorptive agents is challenging, and outcomes are unpredictable. The severity of disease is the main guide to management, and can help to predict prognosis. Most available staging systems for osteonecrosis, including the widely-used American Association of Oral and Maxillofacial Surgeons (AAOMS) system, classify severity on the basis of clinical and radiographic findings. However, clinical inspection and radiography are limited in their ability to identify the extent of necrotic bone disease compared with computed tomography (CT). We have organised a large multicentre retrospective study (known as MISSION) to investigate the agreement between the AAOMS staging system and the extent of osteonecrosis of the jaw (focal compared with diffuse involvement of bone) as detected on CT. We studied 799 patients with detailed clinical phenotyping who had CT images taken. Features of diffuse bone disease were identified on CT within all AAOMS stages (20%, 8%, 48%, and 24% of patients in stages 0, 1, 2, and 3, respectively). Of the patients classified as stage 0, 110/192 (57%) had diffuse disease on CT, and about 1 in 3 with CT evidence of diffuse bone disease was misclassified by the AAOMS system as having stages 0 and 1 osteonecrosis. In addition, more than a third of patients with AAOMS stage 2 (142/405, 35%) had focal bone disease on CT. We conclude that the AAOMS staging system does not correctly identify the extent of bony disease in patients with osteonecrosis of the jaw.
UR - http://hdl.handle.net/10447/102457
M3 - Article
VL - 52
SP - 603
EP - 608
JO - BRITISH JOURNAL OF ORAL & MAXILLOFACIAL SURGERY
JF - BRITISH JOURNAL OF ORAL & MAXILLOFACIAL SURGERY
SN - 0266-4356
ER -