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31.10.2019 | Original Article | Ausgabe 4/2019

Oral and Maxillofacial Surgery 4/2019

Volumetric analysis of MRONJ lesions by semiautomatic segmentation of CBCT images

Oral and Maxillofacial Surgery > Ausgabe 4/2019
Matthias Zirk, Johannes Buller, Joachim E. Zöller, Carola Heneweer, Norbert Kübler, Max-Philipp Lentzen
Wichtige Hinweise
Matthias Zirk and Johannes Buller contributed equally to this work.

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The purpose of this study was to evaluate potential differences in volumes of areas of osteolysis caused by medication-related osteonecrosis of the jaw (MRONJ) between the upper and lower jaw. We aim to analyze the clinical relevance of volumetric measurement of osteolytic lesions for surgical planning of MRONJ patients.


Sixty-seven patients who were clinically and histopathologically diagnosed with MRONJ were retrospectively included in this study. Cone beam computed tomography (CBCT) images were evaluated according to localization, affected anatomical structures, and volumetric measurement of osteolytic lesions caused by MRONJ in appliance of CBCT datasets by using ITK-SNAP.


The most frequently affected localization is the mandible, whereas female patients show significantly more often lesions of the maxilla. The cortical bone was predominantly affected. Furthermore, the affection of teeth, sinus floor, inferior alveolar nerve canal, or even a pathological fracture of the mandible are infrequently existing. The volumetric measurements revealed a statistically significant greater absolute osteolysis volume in males.


Image analysis and volumetric measurements of osteolytic lesions of MRONJ patients is a helpful tool to further understand the clinical appearance and identify compromised anatomic landmarks. Volumetric analysis aids in pre-surgical planning and visualizes the individual extent of the disease for each patient.

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