Morphological Evaluation of Bone Microdamage in Medication-Related Osteonecrosis of the Jaw Using Fluorescence Microscopy

Lilian Bezerra; Ana Carolina Stasiak Carnetti; Riéli Elis Schulz; Heitor Fontes da Silva; Aira Maria Bonfim Santos; Liliane Janete Grando; Rogério Oliveira Gondak; Mariana Comparotto Minamisako; Gustavo Davi Rabelo

doi:10.5327/2525-5711.361

Authors

Lilian Bezerra Federal University of Santa Catarina (Department of Dentistry), Florianópolis, Santa Catarina, Brazil. https://orcid.org/0009-0005-8098-2781
Ana Carolina Stasiak Carnetti Federal University of Santa Catarina (Department of Dentistry), Florianópolis, Santa Catarina, Brazil. https://orcid.org/0009-0001-8686-9182
Riéli Elis Schulz Federal University of Santa Catarina (Department of Dentistry), Florianópolis, Santa Catarina, Brazil. https://orcid.org/0000-0001-6357-0092
Heitor Fontes da Silva Federal University of Santa Catarina (Department of Dentistry), Florianópolis, Santa Catarina, Brazil. https://orcid.org/0000-0002-8738-7011
Aira Maria Bonfim Santos University Hospital Polydoro Ernani de São Thiago, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. https://orcid.org/0000-0001-5653-6777
Liliane Janete Grando University Hospital Polydoro Ernani de São Thiago, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. https://orcid.org/0000-0002-6876-1151
Rogério Oliveira Gondak Federal University of Santa Catarina (Department of Pathology), Florianópolis, Santa Catarina, Brazil. https://orcid.org/0000-0001-7547-660X
Mariana Comparotto Minamisako Oncology Research Center (CEPON), Florianópolis, Santa Catarina, Brazil. https://orcid.org/0000-0002-2492-0755
Gustavo Davi Rabelo Federal University of Santa Catarina (Department of Dentistry), Florianópolis, Santa Catarina, Brazil. https://orcid.org/0000-0001-9511-5078

DOI:

https://doi.org/10.5327/2525-5711.361

Keywords:

Osteonecrosis, Oral medicine, Bone and Bones

Abstract

Objective: The aim was to assess and classify bone microdamage (microcracks, microfractures, and diffuse damage) in MRONJ using fluorescence microscopy, a method that improves artefact discrimination compared to scanning electron microscopy. Methods: Patients diagnosed with MRONJ were selected, and during the surgery, bone fragments, including the sequestrum, were collected and then embedded in methylmethacrylate without decalcification. Bone microdamage was assessed in histological slides and classified as microcracks, microfracture, and diffuse damage, and bone morphology was also evaluated. Results: Ten patients were included in the study (mean age of 66.8 ± 10.4 years, five female and five male). Bone microdamage was identified in 6 patients (60%), the microcracks being the most prevalent type, followed by microfractures (20%) and diffuse damage (20%). Eroded surfaces were present in all samples, both in the cortical and cancellous bone. Other findings included the presence of amorphous non-bone material, intracortical resorption areas, and non-circular Haversian canals. Conclusion: Bone microdamage was present in more than half of MRONJ patients, and the presence of bone microcracks suggests a potential compromise in the mechanical integrity of the bone tissue.

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