Oral Radiology

, Volume 34, Issue 2, pp 151–160 | Cite as

Panoramic radiographic features that predict the development of bisphosphonate-related osteonecrosis of the jaw

  • Ryota Kubo
  • Yoshiko Ariji
  • Tohru Taniguchi
  • Michihito Nozawa
  • Akitoshi Katsumata
  • Eiichiro Ariji
Original Article



The purpose of this study was to clarify which panoramic radiographic features can predict the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ).


Participants included 24 patients treated with bisphosphonates (BP) for osteoporosis who developed osteonecrosis of the jaw (ONJ+ group). Controls included 179 patients treated with BP who did not have osteonecrosis (ONJ group) and 200 patients with no history of BP administration (unmedicated group). The mandibular cortical width, mandibular cortical index (MCI), sclerosis of trabecular bone, and thickening of the lamina dura were evaluated on panoramic radiographs.


The mandibular cortical width was significantly smaller in the ONJ group than in the other groups. Class II MCI (semilunar defects of endosteal margin) was frequently noted on the affected and contralateral sides in the ONJ+ group but not in the ONJ or unmedicated groups. Sclerosis of the trabecular bone was significantly more frequently observed on the affected side in the ONJ+ group than in the other groups. Thickening of the lamina dura was observed significantly more frequently in the BP-treated groups than in the unmedicated group.


Class II MCI may be an indicator to predict the development of BRONJ. Sclerosis of trabecular bone was a characteristic imaging feature of BRONJ. Thickening of the lamina dura may be an imaging feature caused by BP administration.


Bisphosphonate Osteoporosis Panoramic radiography Computer aided diagnosis Jaw osteonecrosis 


Compliance with ethical standards


The authors received no funding for this study.

Conflict of interest

Ryota Kubo, Yoshiko Ariji, Tohru Taniguchi, Michihito Nozawa, Akitoshi Katsuma, and Eiichiro Ariji declare that they have no conflicts of interest.

Human rights statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Animal rights statement

This article does not contain any studies with human or animal subjects performed by any of the authors. Panoramic radiographic features predict the development of bisphosphonate-related osteonecrosis of the jaw.


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Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Japan KK 2017

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial RadiologyAichi-Gakuin University School of DentistryNagoyaJapan
  2. 2.Department of Oral and Maxillofacial SurgeryAichi-Gakuin University School of DentistryNagoyaJapan
  3. 3.Department of Oral RadiologyAsahi University School of DentistryMizuhoJapan

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