Role of periapical diseases in development of medication-related osteonecrosis of the jaw

Abstract

Objectives: This study aimed to assess the effect of zoledronic acid on the development of medication-related osteonecrosis of the jaw (MRONJ) using an immunocompromised mice model with periapical disease. Materials and Methods: Thirty C57BL/6N mice were randomly divided into three groups (N=10). All animals were subjected to bilateral ovariectomy and then treated with saline (Veh), zoledronic acid (ZA) or concomitant zoledronic acid and dexamethasone (ZA/Dx) for 12 weeks. Eight weeks after starting drug administration, pulpal exposure was conducted on the lower left first molar. Four weeks after pulpal exposure, all mice were sacrificed, and the mandibles were collected for radiological and histological examinations. Results: Micro computed tomography (μ-CT) examination showed significantly reduced periapical bone resorption in ZA/Dx group and decreased periodontal bone resorption in both ZA and ZA/Dx groups. Higher bone mineral density and strengthened microstructure were found in ZA and ZA/Dx groups. More empty lacunae were found in ZA and ZA/Dx groups. Conclusions: Apical periodontitis aggravates MRONJ under immunocompromised circumstances. Concurrent use of ZA and steroids inhibits alveolar bone resorption but increases the risk of developing MRONJ.