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Ali IE, Sumita Y, Wakabayashi N. Advancing maxillofacial prosthodontics by using pre-trained convolutional neural networks: Image-based classification of the maxilla. J Prosthodont 2024. [PMID: 38566564 DOI: 10.1111/jopr.13853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
PURPOSE The study aimed to compare the performance of four pre-trained convolutional neural networks in recognizing seven distinct prosthodontic scenarios involving the maxilla, as a preliminary step in developing an artificial intelligence (AI)-powered prosthesis design system. MATERIALS AND METHODS Seven distinct classes, including cleft palate, dentulous maxillectomy, edentulous maxillectomy, reconstructed maxillectomy, completely dentulous, partially edentulous, and completely edentulous, were considered for recognition. Utilizing transfer learning and fine-tuned hyperparameters, four AI models (VGG16, Inception-ResNet-V2, DenseNet-201, and Xception) were employed. The dataset, consisting of 3541 preprocessed intraoral occlusal images, was divided into training, validation, and test sets. Model performance metrics encompassed accuracy, precision, recall, F1 score, area under the receiver operating characteristic curve (AUC), and confusion matrix. RESULTS VGG16, Inception-ResNet-V2, DenseNet-201, and Xception demonstrated comparable performance, with maximum test accuracies of 0.92, 0.90, 0.94, and 0.95, respectively. Xception and DenseNet-201 slightly outperformed the other models, particularly compared with InceptionResNet-V2. Precision, recall, and F1 scores exceeded 90% for most classes in Xception and DenseNet-201 and the average AUC values for all models ranged between 0.98 and 1.00. CONCLUSIONS While DenseNet-201 and Xception demonstrated superior performance, all models consistently achieved diagnostic accuracy exceeding 90%, highlighting their potential in dental image analysis. This AI application could help work assignments based on difficulty levels and enable the development of an automated diagnosis system at patient admission. It also facilitates prosthesis designing by integrating necessary prosthesis morphology, oral function, and treatment difficulty. Furthermore, it tackles dataset size challenges in model optimization, providing valuable insights for future research.
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Affiliation(s)
- Islam E Ali
- Department of Advanced Prosthodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Prosthodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Yuka Sumita
- Division of General Dentistry 4, The Nippon Dental University Hospital, Tokyo, Japan
- Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noriyuki Wakabayashi
- Department of Advanced Prosthodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Lee ES, Tsai MC, Lee JX, Wong C, Cheng YN, Liu AC, Liang YF, Fang CY, Wu CY, Lee IT. Bisphosphonates and Their Connection to Dental Procedures: Exploring Bisphosphonate-Related Osteonecrosis of the Jaws. Cancers (Basel) 2023; 15:5366. [PMID: 38001626 PMCID: PMC10670230 DOI: 10.3390/cancers15225366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Bisphosphonates are widely used to treat osteoporosis and malignant tumors due to their effectiveness in increasing bone density and inhibiting bone resorption. However, their association with bisphosphonate-related osteonecrosis of the jaws (BRONJ) following invasive dental procedures poses a significant challenge. This review explores the functions, mechanisms, and side effects of bisphosphonates, emphasizing their impact on dental procedures. Dental patients receiving bisphosphonate treatment are at higher risk of BRONJ, necessitating dentists' awareness of these risks. Topical bisphosphonate applications enhance dental implant success, by promoting osseointegration and preventing osteoclast apoptosis, and is effective in periodontal treatment. Yet, systemic administration (intravenous or intraoral) significantly increases the risk of BRONJ following dental procedures, particularly in inflamed conditions. Prevention and management of BRONJ involve maintaining oral health, considering alternative treatments, and careful pre-operative and post-operative follow-ups. Future research could focus on finding bisphosphonate alternatives with fewer side effects or developing combinations that reduce BRONJ risk. This review underscores the need for further exploration of bisphosphonates and their implications in dental procedures.
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Affiliation(s)
- Emily Sunny Lee
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
| | - Meng-Chen Tsai
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
| | - Jing-Xuan Lee
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
| | - Chuki Wong
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
| | - You-Ning Cheng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
| | - An-Chi Liu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
| | - You-Fang Liang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
| | - Chih-Yuan Fang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Chia-Yu Wu
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Taipei Medical University Hospital, Taipei 11031, Taiwan
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - I-Ta Lee
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (E.S.L.); (M.-C.T.); (J.-X.L.); (C.W.); (Y.-N.C.); (A.-C.L.); (Y.-F.L.); (C.-Y.F.)
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Cagna DR, Donovan TE, McKee JR, Eichmiller F, Metz JE, Marzola R, Murphy KG, Troeltzsch M. Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2023; 130:453-532. [PMID: 37453884 DOI: 10.1016/j.prosdent.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2022 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertise in their subject areas that include (in order of the appearance in this report): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence the daily dental treatment decisions of the reader with an emphasis on innovations, new materials and processes, and future trends in dentistry. With the tremendous volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope that readers find this work helpful in managing patients.
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Affiliation(s)
- David R Cagna
- Professor, Associate Dean, Chair, and Residency Director, Department of Prosthodontics, University of Tennessee Health Sciences Center College of Dentistry, Memphis, Tenn.
| | - Terence E Donovan
- Professor, Department of Comprehensive Oral Health, University of North Carolina School of Dentistry, Chapel Hill, NC
| | - James R McKee
- Private practice, Restorative Dentistry, Downers Grove, Ill
| | - Frederick Eichmiller
- Vice President and Science Officer (Emeritus), Delta Dental of Wisconsin, Stevens Point, Wis
| | - James E Metz
- Private practice, Restorative Dentistry, Columbus, Ohio
| | | | - Kevin G Murphy
- Associate Clinical Professor, Department of Periodontics, University of Maryland College of Dentistry, Baltimore, Md
| | - Matthias Troeltzsch
- Private practice, Oral, Maxillofacial, and Facial Plastic Surgery, Ansbach, Germany; Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, Ludwig Maximilian University of Munich (LMU), Munich, Germany
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Zhang W, Liu Y, Luo Y, Shu X, Pu C, Zhang B, Feng P, Xiong A, Kong Q. New insights into the role of long non-coding RNAs in osteoporosis. Eur J Pharmacol 2023; 950:175753. [PMID: 37119958 DOI: 10.1016/j.ejphar.2023.175753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/01/2023]
Abstract
Osteoporosis is a common disease in elderly individuals, and osteoporosis can easily lead to bone and hip fractures that seriously endanger the health of elderly individuals. At present, the treatment of osteoporosis is mainly anti-osteoporosis drugs, but there are side effects associated with anti-osteoporosis drugs. Therefore, it is very important to develop early diagnostic indicators and new therapeutic drugs for the prevention and treatment of osteoporosis. Long noncoding RNAs (lncRNAs), noncoding RNAs longer than 200 nucleotides, can be used as diagnostic markers for osteoporosis, and lncRNAs play an important role in the progression of osteoporosis. Many studies have shown that lncRNAs can be the target of osteoporosis. Therefore, herein, the role of lncRNAs in osteoporosis is summarized, aiming to provide some information for the prevention and treatment of osteoporosis.
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Affiliation(s)
- Weifei Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yuheng Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yuanrui Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiang Shu
- Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital.C.T.), Sichuan University, Chengdu, 610041, China
| | - Congmin Pu
- Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital.C.T.), Sichuan University, Chengdu, 610041, China
| | - Bin Zhang
- Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital.C.T.), Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Pin Feng
- Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital.C.T.), Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ao Xiong
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, China.
| | - Qingquan Kong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital.C.T.), Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Kammerhofer G, Vegh D, Bányai D, Végh Á, Joob-Fancsaly A, Hermann P, Geczi Z, Hegedus T, Somogyi KS, Bencze B, Biczó Z, Juhász DH, Zaborszky P, Ujpál M, Vaszilkó MT, Németh Z. Association between Hyperglycemia and Medication-Related Osteonecrosis of the Jaw (MRONJ). J Clin Med 2023; 12:jcm12082976. [PMID: 37109314 PMCID: PMC10144577 DOI: 10.3390/jcm12082976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is a type of jawbone necrosis caused by the use of drugs for some types of cancer and osteoporosis. The current study aimed to evaluate the associations between hyperglycemia and the development of medication-related osteonecrosis of the jaw. METHODS Our research group investigated data collected between 1 January 2019 and 31 December 2020. A total of 260 patients were selected from the Inpatient Care Unit, Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University. Fasting glucose data were used and included in the study. RESULTS Approximately 40% of the necrosis group and 21% of the control group presented with hyperglycemia. There was a significant association between hyperglycemia and MRONJ (p < 0.05, p = 0.003). Vascular anomaly and immune dysfunction caused by hyperglycemia can lead to necrosis after tooth extraction. Necrosis is more common in the mandible (75.0%) and in the case of parenteral antiresorptive treatment (intravenous Zoledronate and subcutaneous Denosumab). Hyperglycemia is a more relevant risk factor than bad oral habits (26.7%). CONCLUSIONS Ischemia is a complication of abnormal glucose levels, a possible risk factor for necrosis development. Hence, uncontrolled or poorly regulated plasma glucose levels can significantly increase the risk of jawbone necrosis after invasive dental or oral surgical interventions.
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Affiliation(s)
- Gabor Kammerhofer
- Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University, 1088 Budapest, Hungary
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
| | - Daniel Vegh
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
- Department of Prosthodontics, Semmelweis University, 1088 Budapest, Hungary
| | - Dorottya Bányai
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
- Department of Paediatric Dentistry and Orthodontics, Semmelweis University, 1088 Budapest, Hungary
| | - Ádám Végh
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
- Department of Oral Diagnostics, Semmelweis University, 1088 Budapest, Hungary
| | - Arpad Joob-Fancsaly
- Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University, 1088 Budapest, Hungary
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
| | - Peter Hermann
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
- Department of Prosthodontics, Semmelweis University, 1088 Budapest, Hungary
| | - Zoltan Geczi
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
- Department of Prosthodontics, Semmelweis University, 1088 Budapest, Hungary
| | - Tamas Hegedus
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
- Department of Prosthodontics, Semmelweis University, 1088 Budapest, Hungary
| | - Kata Sara Somogyi
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
- Department of Prosthodontics, Semmelweis University, 1088 Budapest, Hungary
| | - Bulcsú Bencze
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
- Department of Prosthodontics, Semmelweis University, 1088 Budapest, Hungary
| | - Zita Biczó
- Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University, 1088 Budapest, Hungary
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
| | - Donát Huba Juhász
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
- Faculty of Dentistry, Semmelweis University, 1088 Budapest, Hungary
| | - Péter Zaborszky
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
- Faculty of Dentistry, Semmelweis University, 1088 Budapest, Hungary
| | - Márta Ujpál
- Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University, 1088 Budapest, Hungary
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
| | - Mihály Tamás Vaszilkó
- Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University, 1088 Budapest, Hungary
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
| | - Zsolt Németh
- Department of Oromaxillofacial Surgery and Stomatology, Semmelweis University, 1088 Budapest, Hungary
- Diabetes-Dental Working Group, Semmelweis University, 1088 Budapest, Hungary
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Ali IE, Murase M, Yonehara Y, Sumita YI. Time and cost of maxillofacial prosthetic treatment: The need for assessment. JAPANESE DENTAL SCIENCE REVIEW 2022; 58:67-68. [PMID: 35242248 PMCID: PMC8861383 DOI: 10.1016/j.jdsr.2022.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022] Open
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Winter A, Schulz SM, Schmitter M, Brands RC, Straub A, Kübler A, Borgmann A, Hartmann S. Oral-Health-Related Quality of Life in Patients with Medication-Related Osteonecrosis of the Jaw: A Prospective Clinical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811709. [PMID: 36141982 PMCID: PMC9517310 DOI: 10.3390/ijerph191811709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 05/13/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) represents an adverse side effect of antiresorptive and antiangiogenic medications. It is associated with impaired quality of life, oral health, and oral function and can be classified into various stages. The purpose of this prospective clinical study is to evaluate the impact of stages I and II MRONJ on oral-health-related quality of life (OHRQoL) and related parameters. Patients' OHRQoL, satisfaction with life, oral discomfort, and oral health were assessed using the German version of the Oral Health Impact Profile (OHIP-G49), visual analog scales (VAS), and Satisfaction with Life Scale (SWLS) at baseline (T0), 10 days (T1), and 3 months after treatment (T2) in 36 patients. Data were analyzed using Kolmogorov-Smirnov test, two-way mixed ANOVAs, and follow-up Mann-Whitney U tests. The impact of treatment effects on the original seven OHIP domain structures and the recently introduced four-dimensional OHIP structure were evaluated using linear regression analysis. Thirty-six patients received surgical MRONJ treatment. Before treatment, patients' perceived OHRQoL, oral discomfort, oral health, and satisfaction with life were negatively affected by MRONJ. Surgical treatment significantly improved OHRQoL and related parameters (all p ≤ 0.012). This improvement was greater in patients with higher impairment at T0. OHRQoL and oral restrictions were still impaired after treatment in patients who needed prosthetic treatment. The four-dimensional structure revealed valuable information beyond the standard seven OHIP domains. Increased awareness of MRONJ risks and an interdisciplinary treatment approach for MRONJ patients are needed.
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Affiliation(s)
- Anna Winter
- Department of Prosthodontics, Julius Maximilian University Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
- Correspondence: ; Tel.: +49-(0)-931-201-73100
| | - Stefan M. Schulz
- Department of Behavioural Medicine and Principles of Human Biology for the Health Sciences, Trier University, Universitätsring 15, 54296 Trier, Germany
| | - Marc Schmitter
- Department of Prosthodontics, Julius Maximilian University Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Roman C. Brands
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Anton Straub
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Alexander Kübler
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Anna Borgmann
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Stefan Hartmann
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
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Medication-Related Osteonecrosis of the Mandible Treated with Marginal Resection: A Case Report. SURGERIES 2022. [DOI: 10.3390/surgeries3020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this report is to present a successful combined surgical and pharmaceutical treatment in the highest stage of medicine-related osteonecrosis of the jaw (MRONJ). A 70-year-old man treated for metastatic prostate cancer concomitant with hypertension and diabetes presented due to the exposure of the jawbone. Initial imaging studies suggested MRONJ, and the biopsy did not confirm bone metastasis in the oral cavity. Marginal resection of the mandible was performed after the administration of antibiotics and anticoagulants. There was no recurrence of mandibular necrosis during the 3-year follow-up. MRONJ can develop covertly, with scanty clinical symptoms, and can be easily overlooked. Radical combined treatment may, in some cases, prevent further progression of the disease, which was successful in this case.
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