Periosteal reaction as a risk factor for poor outcomes after surgical treatment for medication-related osteonecrosis of the jaw: A retrospective analysis of 205 surgeries

Objective: To investigate the relationship between the presence of periosteal reaction and the outcome of surgical treatment for medication-related osteonecrosis of the jaw (MRONJ) and determine the appropriate bone resection method for periosteal reaction. Methods: We retrospectively reviewed the medical records of 163 patients who underwent 205 surgeries for MRONJ in the Department of Dentistry and Oral Surgery, Kansai Medical University Hospital and the Department of Oral and Maxillofacial Surgery, Nagasaki University Hospital. The evaluated parameters were as follows: patient age and sex, site of involvement, stage, trigger, primary disease, type of antiresorptive agent, duration of antiresorptive therapy, presence/absence of preoperative drug holiday, use of corticosteroids, presence/absence of diabetes, leukocyte count, serum albumin and creatinine levels, surgery type, preoperative computed tomography (CT) findings, and treatment outcome. Preoperative CT parameters included separation of the sequestrum, osteosclerosis, and periosteal reaction. The correlation between each variable and the treatment outcome was analyzed using Cox regression analyses. Results: The 1-year cumulative cure rate was 81.5%. Multivariate analysis revealed that malignancy (primary disease), a low average albumin value, and the presence of periosteal reaction were independent risk factors for a poor treatment outcome. Complete healing was achieved in 10 of 12 cases where the bone showing periosteal reaction was surgically resected, whereas complete healing was not observed in 22 of 36 cases with residual periosteal reaction after surgery. Conclusions: Preoperative periosteal reaction is a predictor of a poor outcome after surgical treatment for MRONJ. Clinicians should consider complete resection of the bone showing periosteal reaction.