Assessment to Quantitative Imaging Biomarkers
Speaker: Ling-Ying Wei, DDS, PhD
(National Taiwan University Hospital)
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) poses a major dilemma in dental practice: fear of osteonecrosis often leads to undertreatment of active infections, while uncoordinated drug discontinuation risks rebound fractures. Moreover, conventional risk assessment has largely relied on subjective judgment, lacking objective criteria for early detection.
This presentation introduces an evidence-based clinical pathway based on our series of original studies, and equips clinicians with objective, data-driven algorithms to balance bone health and jaw safety.
- Extraction risk profiling and stratification: Analysis of 1,067 extractions revealed that a 3-month antiresorptive interruption significantly reduces MRONJ risk, while identifying a high-risk synergistic profile (long-term therapy, short interruption, mandibular posterior extraction; AOR = 80.29).
- Clinical risk scoring system: An externally validated 5-to-16-point predictive score. With a cutoff of 12 points, it delivers a negative predictive value (NPV) of 98.9%, serving as a robust rule-out tool for safe routine extractions.
- Quantitative imaging biomarkers: Combining 2D panoramic fractal dimension (FD) and 3D CBCT cortical kinetics uncovers a distinct "trabecular-cortical uncoupling" pattern, enabling objective ROC-based detection prior to clinical bone exposure.
