Imaging Modalities in Medication-Related Osteonecrosis of the Jaw: A Narrative Review of Diagnostic Findings and Staging

Abstract

Background and Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication of antiresorptive and antiangiogenic therapies. Early and accurate imaging is crucial for diagnosis and management. This review summarizes the current evidence on MRONJ imaging findings across modalities and identifies gaps for future research. Materials and Methods: This narrative review analyzed 32 studies (2010-2024) retrieved from PubMed and EBSCO examining imaging findings and diagnostic patterns of medication-related osteonecrosis of the jaw across different modalities. Two independent reviewers screened all articles, extracted data, and assessed methodological quality. Results: Early-stage MRONJ findings included osteosclerosis, lamina dura thickening, and increased prominence of the inferior alveolar canal, while late-stage findings included periosteal reactions, sequestration, and cortical erosion. CBCT and MRI were most sensitive for early detection and lesion extent. However, substantial variability in imaging protocols limited direct comparisons between studies. Conclusions: This review highlights the variable imaging findings of MRONJ and the need for standardized protocols. Advanced imaging techniques and quantitative indices hold promise for improving early diagnosis, staging, and management.

Keywords: bisphosphonates; cone-beam CT; imaging; osteolysis; osteonecrosis.