{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T02:02:55Z","timestamp":1790128975844,"version":"4.0.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect in antiresorptive treatment. Treatment of MRONJ is considered primarily conservative with oral mouth rinses and antibiotics but may demand surgery, depending on the complaints and general condition of the patient, the extent of the necrosis, and the overall prognosis with respect to the underlying disease. A 77 year old female patient with invasive ductal breast cancer and bone metastases was treated with intravenous bisphosphonate (BP) zoledronic acid. During therapy, she developed MRONJ in the mandible with severe pain. Clinical examination revealed confluent exposed bone of the lower left jaw and a fistula at the right molar region. The panoramic radiograph revealed a mandibular osseous involvement with diffuse radiopaque areas between radiolucent areas. For preoperative planning, <jats:sup>18<\/jats:sup>F-fluoride positron emission tomography\/computed tomography (PET\/CT) of the jaw was performed, showing substantially increased <jats:sup>18<\/jats:sup>F-fluoride uptake in regions 38 to 47 of the mandible with a focal gap in region 36 (area of clinically exposed bone). CT revealed medullary sclerosis and cortical thickening with confluent periosteal reaction and focal cortical erosion in the regions 37 to 42, whereas the regions 43 to 47 were only subtly sclerotic without cortical thickening. After systemic antibiotic therapy with sultamicillin following significant symptom and pain relief, <jats:sup>18<\/jats:sup>F-fluoride PET\/CT imaging was performed again after 5 months. No changes in either CT and PET were observed in regions 38 to 42, whereas the bony sclerosis was slightly increased in regions 43 to 47 with a slight reduction of <jats:sup>18<\/jats:sup>F-fluoride uptake. <jats:sup>18<\/jats:sup>F-fluoride PET\/CT showed no significant changes assessing the extent of MRONJ prior and after systemic antibiotic therapy, providing no evidence that conservative treatment reduced the extent of the MRONJ-affected jawbone. The additional information of <jats:sup>18<\/jats:sup>F-fluoride PET enables to identify the true extent of MRONJ which may be underestimated by CT imaging alone. Patients with MRONJ undergoing conservative treatment could benefit because additional imaging may be avoided as the pre-therapeutic <jats:sup>18<\/jats:sup>F-fluoride PET\/CT delivers all information needed for further treatment. Our findings support the recommendation of a surgical approach as long-term antibiotics cannot downsize the extent of MRONJ.<\/jats:p>","DOI":"10.3389\/fonc.2021.700397","type":"journal-article","created":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T17:51:45Z","timestamp":1625161905000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["18F-Fluoride PET\/CT Imaging of Medication-Related Osteonecrosis of the Jaw in Conservative Treatment\u2014A Case Report"],"prefix":"10.3389","volume":"11","author":[{"given":"Christian Philipp","family":"Reinert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Pfannenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergios","family":"Gatidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"la Foug\u00e8re","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantin","family":"Nikolaou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Hoefert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2020.02.017","article-title":"Medication-Related Osteonecrosis of the Jaw (MRONJ) Stage III: Conservative and Conservative Surgical Approaches Versus an Aggressive Surgical Intervention: A Systematic Review","volume":"48","author":"Vanpoecke","year":"2020","journal-title":"J Cranio Maxillofacial Surg"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-018-2743-0","article-title":"Treatment Outcomes and Prognostic Factors of Medication-Related Osteonecrosis of the Jaw: A Case- and Literature-Based Review","volume":"23","author":"Yamada","year":"2019","journal-title":"Clin Oral Investig"},{"key":"B3","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.jocd.2016.09.005","article-title":"Case-Based Review of Osteonecrosis of the Jaw (ONJ) and Application of the International Recommendations for Management From the International Task Force on ONJ","volume":"20","author":"Khan","year":"2017","journal-title":"J Clin Densitometry"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2008.01.038","article-title":"Mandible Matrix Necrosis in Beagle Dogs After 3 Years of Daily Oral Bisphosphonate Treatment","volume":"66","author":"Allen","year":"2008","journal-title":"J Oral Maxillofacial Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2014.04.031","article-title":"American Association of Oral and Maxillofacial Surgeons Position Paper on Medication-Related Osteonecrosis of the Jaw\u20142014 Update","volume":"72","author":"Ruggiero","year":"2014","journal-title":"J Oral Maxillofacial Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1007\/s00774-016-0810-7","article-title":"Antiresorptive Agent-Related Osteonecrosis of the Jaw: Position Paper\u00a02017 of the Japanese Allied Committee on Osteonecrosis of the Jaw","volume":"35","author":"Yoneda","year":"2017","journal-title":"J Bone Mineral Metab"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70305-X","article-title":"Pharmacovigilance and Reporting Oversight in US FDA Fast-Track Process: Bisphosphonates and Osteonecrosis of the Jaw","volume":"9","author":"Edwards","year":"2008","journal-title":"Lancet Oncol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.tripleo.2011.02.037","article-title":"Osteonecrosis of the Jaw in Oncology Patients Treated With Bisphosphonates: Prospective Experience of a Dental Oncology Referral Center","volume":"112","author":"Nicolatou-Galitis","year":"2011","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.cden.2008.05.002","article-title":"Cone-Beam CT Diagnostic Applications: Caries, Periodontal Bone Assessment, and Endodontic Applications","volume":"52","author":"Tyndall","year":"2008","journal-title":"Dental Clinics North America"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.07.3045","article-title":"MRI of Mandibular Osteonecrosis Secondary to Bisphosphonates","volume":"190","author":"Garc\u00eda-Ferrer","year":"2008","journal-title":"Am J Roentgenol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-009-0293-1","article-title":"Panoramic Radiograph, Computed Tomography or Magnetic Resonance Imaging Which Imaging Technique Should Be Preferred in Bisphosphonate-Associated Osteonecrosis of the Jaw? 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