Search Results (506)

Background/Objectives: Contemporary patient-specific subperiosteal implants have re-emerged as graftless solutions for oral and maxillofacial rehabilitation, driven by advances in digital planning, CAD/CAM workflows, additive manufacturing, and biomaterial engineering. Their indications have progressively expanded from severely atrophic edentulous jaws to segmental defects, single-tooth replacement, congenital craniofacial anomalies, salvage situations, and oncologic reconstruction. This scoping review aimed to map the current evidence on modern patient-specific subperiosteal implants, focusing on indications, workflow, design principles, materials, outcomes, complications, and maintenance. Methods: A scoping review was conducted according to PRISMA-ScR principles to identify clinical studies, case series, case reports, systematic and scoping reviews, technical notes, finite element analyses, in vitro studies, and relevant translational investigations dealing with contemporary custom-made or CAD/CAM subperiosteal implants. The evidence was narratively synthesized according to clinical indication and thematic domains, including full-arch rehabilitation, sectional and single-tooth applications, congenital and post-oncologic defects, rescue indications, biomechanics, material selection, surface response, prosthetic protocols, and complication management. No quantitative meta-analysis was performed because of the scoping design and the substantial heterogeneity of study types, indications, implant systems, outcome definitions, and follow-up durations. Results: The final evidence map included 116 records, of which 56 were unique human clinical records with extractable denominators and 60 were biomechanical, in vitro, surface-biology, review, consensus, historical, or conceptual records. Of the 56 unique clinical records, 49 were mapped within the six indication-level clinical sections, while seven were retained as cross-cutting clinical evidence addressing patient-reported outcomes, design-related complications, bone apposition, anchorage strategy, comparative graftless rehabilitation, or reconstructive/prosthetic principles. The six indication-level sections included 52 clinical-record assignments: 15 for full-arch rehabilitation, 13 for segmental or sectional rehabilitation, one for single-tooth rehabilitation, four for congenital or craniofacial indications, 13 for post-oncologic or post-ablative reconstruction, and six for rescue or salvage indications. Because three records addressed more than one indication, these counts represent indication-level assignments rather than mutually exclusive clinical records. Reported survival in most short- to mid-term clinical series was generally high, commonly ranging from 90% to 100%, although lower values of 70–80% were reported in selected longer-term cohorts and survival clearly overestimated clinical success in some studies. Expanding applications include posterior mandibular and maxillary defects, lateral incisor agenesis, cleft-related or syndromic deformities, maxillectomy reconstruction, obturator support, and hybrid rehabilitation with endosseous implants; however, evidence for the indications at the extremes of this spectrum—single-tooth replacement and primary oncologic reconstruction—remains limited to small, largely single-group case series and reports. Soft-tissue events, including dehiscence, mucositis, recession, and framework exposure, were the dominant complications and showed wide variability, with reported recession/exposure rates ranging from approximately 10% in some sectional and full-arch series to as high as 65% in bilateral maxillary cohorts; their clinical significance varied from asymptomatic stable findings to progressive inflammatory complications requiring revision. Conclusions: Patient-specific subperiosteal implants represent a promising and increasingly versatile reconstructive option; however, the present findings should be interpreted as evidence mapping rather than as definitive comparative evidence. Their clinical use should remain highly selective, prosthetically driven, and supported by meticulous planning, rigid fixation, soft-tissue management, and structured maintenance. Standardized success criteria, longer follow-up, and comparative prospective studies are required. Full article

Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication of antiresorptive and antiangiogenic therapies, and identifying specific risk factors for recurrence remains a significant clinical challenge. This study aimed to evaluate the clinical characteristics and independent risk factors for recurrence in a large-scale cohort of MRONJ patients. Methods: This single-center retrospective study analyzed 812 patients diagnosed with MRONJ according to the 2022 AAOMS criteria at Chosun University Dental Hospital between 2020 and 2024. Demographic, clinical, radiographic, and medication-related variables were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors associated with recurrence. Results: The majority of patients were female (89.9%), with a mean age of 72.9 years, and mandibular involvement was most frequent (70.8%). Tooth extraction was the most common local precipitating factor (47.0%). The overall recurrence rate was 10.1%. Multivariate analysis identified bilateral jaw involvement (OR = 4.555, p = 0.006), mandibular ramus involvement (OR = 8.222, p = 0.008), and systemic liver disease (OR = 3.703, p = 0.037) as significant independent risk factors. Conversely, routes of prior antiresorptive medication administration involving intravenous-only or combined oral/intravenous therapy, as well as hyperlipidemia and a history of dental implant surgery, were associated with lower recurrence rates. Conclusions: Anatomical complexity and systemic health status are critical predictors of MRONJ recurrence. Patients presenting with bilateral or mandibular ramus involvement, or with compromised liver function, require more aggressive surgical debridement and individualized treatment planning to reduce the risk of recurrence. Given the small affected subgroups, the effect sizes for mandibular ramus involvement and liver disease should be interpreted with caution. Full article

Background: Panoramic radiography is one of the most widely used imaging examinations in dental practice, providing a broad view of the jaws and adjacent head and neck structures. Although primarily prescribed for odontogenic assessment, its field of view may reveal non-odontogenic findings with potential clinical significance. Methods: A structured narrative review was conducted according to SANRA criteria. A literature search was performed in PubMed/MEDLINE, Embase, Scopus, and Web of Science for English-language publications from January 2010 to May 2026. Backward and forward citation tracking of relevant articles, key reviews, and reference textbooks was also performed. Eligible studies and authoritative sources addressing non-odontogenic findings detectable on panoramic radiographs were qualitatively synthesized. Results: The review focuses on carotid artery calcifications, maxillary sinus abnormalities, mandibular radiomorphometric signs related to low skeletal bone mineral density, elongation or calcification of the stylohyoid complex, sialoliths, tonsilloliths, calcified lymph nodes, phleboliths, and laryngeal cartilage calcifications. These findings range from benign anatomical variants to radiographic indicators that may require medical or specialist evaluation. Conclusions: Panoramic radiography should be regarded as a tool for recognition and clinical suspicion rather than definitive diagnosis of extraoral or systemic disease. Dentists play a central role in systematically assessing the entire image, documenting relevant abnormalities, correlating them with patient history and risk factors, and initiating appropriate referral when indicated. Full article

Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in osteoporosis patients undergoing tooth extraction. This study aimed to develop and evaluate an interpretable, machine learning–derived triage score for rapid risk stratification at the initial dental visit. Methods: This retrospective study included 850 osteoporosis patients (443 MRONJ, 407 controls) in the derivation cohort and 559 independent multicenter MRONJ cases for external evaluation. A reference random forest model identified a hierarchical feature structure, which was translated into an additive integer-weighted scoring system through systematic hyperparameter optimization. Structural tipping points were identified using isotonic regression and first discrete derivative analysis. Internal performance was further characterized by sensitivity, specificity, PPV, NPV, calibration slope and intercept, the Hosmer–Lemeshow test, decision curve analysis, bootstrap optimism correction, and subgroup analyses. External evaluation assessed three-tier distribution concordance and case capture rates with non-inferiority testing. Results: The reference random forest achieved an AUC of 0.792. The final MRONJ triage score (range 0–17) incorporated six binary predictors with mutually exclusive drug route categories. The triage score preserved discriminative performance (AUC 0.772; ΔAUC = 0.020; p = 0.149). Two tipping points at scores 7 and 14 defined three risk tiers: low (0–6; 20.9%), moderate (7–13; 55.3%), and high (≥14; 83.5%). At the moderate-risk threshold (≥7), the score achieved sensitivity 90.3% (95% CI 87.2–92.7%) and specificity 45.0% (40.2–49.8%); at the high-risk threshold (≥14), specificity rose to 91.4% and PPV to 83.1%. Calibration was adequate (slope 0.994; intercept 0.0006; Hosmer–Lemeshow p = 0.381), and decision curve analysis demonstrated higher net benefit than reference strategies across all clinically relevant threshold probabilities. The bootstrap optimism-corrected AUC was 0.778, and discriminative performance remained stable across age, route, duration, and site subgroups (AUC range 0.70–0.79). In the external cohort, the case capture rate at the ≥7 threshold was non-inferior (83.4% vs. 88.0%; Δ = −4.6%; margin −10%). Conclusions: The MRONJ triage score demonstrated stable discrimination and reproducible case capture in an independent multicenter cohort. By relying on six variables obtainable at the initial dental visit, this framework may have the potential to reduce unnecessary tertiary referrals and support safer clinical decision-making, although this benefit was not directly demonstrated and requires confirmation in prospective implementation studies. Full article

This study focuses on the design and development of the Double Purpose Bench Vise to address safety, efficiency, and adaptability challenges in welding and fabrication environments. The project responds to limitations of conventional vises that restrict precision and increase the risk of strain-related injuries when handling heavy, irregular, or vertically oriented workpieces. Through an engineering-based development approach involving analysis, design, fabrication, and performance evaluation, the study introduces a Double Jaw Vertical Bench Vise equipped with a dual-clamping system and an integrated hydraulic jack mechanism for precise vertical adjustment with minimal physical effort. The device is designed to securely hold various materials, including metal bars, pipes, and wooden components, during cutting, grinding, shaping, welding, and assembly operations. Evaluation results from functional testing and user feedback indicate improved clamping stability, alignment accuracy, and ergonomic performance compared to traditional models, although refinements in structural optimization, weight distribution, and user interface components are recommended. The study suggests further prototype enhancement, extended field testing, and integration of advanced ergonomic and safety features to maximize durability, usability, and overall productivity in professional workshops and technical training laboratories. Full article

Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication of bisphosphonate therapy, whose risk is currently assessed through qualitative staging systems that do not integrate pharmacological determinants of cumulative drug exposure. The aim of this study is to present the Bisphosphonate Accumulation Index (BAI), a pharmacologically derived, dimensionless scalar quantifying cumulative exposure to bone-targeted antiresorptive agents by integrating relative potency, administered dose, dosing frequency, route-specific bioavailability, and treatment duration, for use as a pre-procedural assessment tool in patients receiving bisphosphonates. Methods: The BAI combines five pharmacologically grounded parameters from peer-reviewed literature: (1) relative antiresorptive potency referenced to etidronate; (2) dose per administration (mg); (3) monthly dosing frequency; (4) bioavailability route; and (5) years of treatment within the preceding 10-year window. The model includes nine bisphosphonates registered in Italy. Results: The BAI spans approximately five orders of magnitude (from <1000 for short-term oral therapy to >120,000 for monthly intravenous zoledronic acid). Four analyses support the model: sensitivity analysis identifies relative potency as the main source of variance; ecological calibration against nine MRONJ incidence data points yielded r = 0.911 (p = 0.0006, R² = 0.829), indicating that the BAI accounts for approximately 83% of the population-level variance in published incidence rates across heterogeneous regimens (ecological correlation; this does not establish individual-level predictive validity); Monte Carlo simulation on 10,000 patients generated a plausible exposure-strata distribution (6.1% low, 66.6% moderate, 27.3% high); and concordance analysis with a DDD-based metric showed discordance in 7/8 regimens. Conclusions: The BAI is a transparent, reproducible, pharmacologically grounded metric of cumulative antiresorptive exposure addressing the quantitative gap identified in the AAOMS 2022 Position Paper. The BAI measures pharmacological exposure, which is a necessary but insufficient component of MRONJ risk; clinical modifiers such as corticosteroid co-administration, diabetes, renal function, and procedure type are not integrated and must be evaluated independently. The provisional exposure strata reported here (<1000, 1000–10,000, >10,000) are hypothesis-generating and intended solely to guide the design of validation studies; they should not be used as clinical decision rules until prospective patient-level validation has been completed. Full article

Background/Objectives: The performance of musical wind instruments imposes significant neuromuscular and biomechanical demands on the stomatognathic system. Depending on the mouthpiece type, wind instruments are divided into four classes, which may have distinct impacts on the instrumentalists’ quality of life. This study aimed to evaluate musicians’ self-perception regarding the impact caused by wind instruments practice on oral health-related quality of life (OHRQoL), jaw functional limitations, and chronic pain. Methods: A cross-sectional observational study was conducted among 71 wind instrumentalists (52% female; mean age 24.16 years; mean practice history of 12.8 years) using the Oral Health Impact Profile-14 (OHIP-14), the Jaw Functional Limitation Scale (JFLS), and the Graded Chronic Pain Scale (GCPS). Data were analyzed using the Statistical Package for the Social Sciences (SPSS), with statistical significance set at p < 0.05. Results: Musicians in Class 1 (clarinet/saxophone) and Class 4 (transverse flute) reported the worst OHRQoL and chronic pain scores. Orofacial pain in the jaw, temple, or ear was reported by 66% of the participants. Joint sounds (36%) and closed jaw locking (26%) showed a significant association with female gender; however, this relationship is highly confounded by the strong female clustering in Class 4 (85%) and Class 1 (63%). Behavioral and practice habits significantly influenced outcomes: higher daily study duration (mean 170.31 min), the absence of relaxation exercises, and a willingness to endure physical discomfort for technical progress (73.2%) were significantly associated with lower quality of life and greater functional limitations (mastication and mobility). Performance anxiety, warm-up exercises, and practice intensity peaks showed no significant relationships with OHRQoL. Conclusions: Wind instrument practice severely impacts jaw function and musicians’ well-being. These findings underscore the need for interdisciplinary preventive interventions, including targeted ergonomic training, structured rest protocols, and jaw relaxation exercises, alongside oral public health initiatives that recognize wind musicians as an occupationally vulnerable group. Full article

Florid cemento-osseous dysplasia (FCOD) is a benign fibro-osseous condition typically presenting as multifocal, sclerotic masses throughout the jaws. While often asymptomatic, the hypovascular nature of the dysplastic bone predisposes it to secondary infection, which can mimic more aggressive pathologies. We present a complex diagnostic challenge involving a 76-year-old female with a history of intravenous ibandronic acid therapy for 18 months. The patient presented with a purulent mandibular fistula and exposed bone, leading to an initial clinical suspicion of Stage 2 Medication-Related Osteonecrosis of the Jaw (MRONJ). Radiographic evaluation, however, revealed generalized “cotton-wool” opacities across all four quadrants, characteristic of FCOD, with multifocal mixed radiolucent–radiopaque changes and a localized demarcated sequestrum in the symptomatic area. Accordingly, the diagnostic reasoning progressed from an initial clinical suspicion of MRONJ, to radiologic consideration of infected FCOD, and finally to exclusion of plasma cell neoplasia by immunohistochemical evaluation. The diagnostic dilemma intensified during histopathological analysis, which revealed an unusually dense, sheet-like infiltration of plasma cells within the fibro-osseous stroma. This striking plasmacytosis initially raised suspicion for a plasma cell neoplasm, such as plasmacytoma or multiple myeloma. To differentiate reactive inflammation from malignancy, immunohistochemical staining for kappa and lambda light chains was performed, demonstrating a polyclonal pattern that confirmed a reactive process. The final diagnosis was determined as FCOD with superimposed secondary osteomyelitis. Following conservative surgical debridement and targeted antibiotic therapy, the patient showed clinical resolution and remained stable at a 6-month follow-up. Recognizing these overlaps is essential for preventing over-treatment and ensuring appropriate management in elderly patients with complex medical backgrounds. Full article

Background: Several studies have investigated the clinical and immunological aspects of medication-related osteonecrosis of the jaw (MRONJ). However, the underlying immunological mechanisms and signaling pathways involved in its pathophysiology remain incompletely understood. This systematic review and meta-analysis, complemented by bioinformatics analyses, aimed to identify proteomic biomarkers associated with MRONJ. Methods: Six databases (PubMed, Embase, Scopus, Web of Science, Cochrane Library, and VHL) were searched, along with gray literature and manual searches. Observational studies in English comparing proteomic profiles of individuals with and without MRONJ were included. Study selection and data management were conducted using EndNote™ X8 and Rayyan.ai, and risk of bias was assessed using the QUADOMICS tool. Functional enrichment analysis was performed using g:Profiler and Reactome, and interaction networks were constructed using GeneMANIA, STRING, and MetaboAnalyst (Cytoscape program; version 3.10.1). Meta-analysis was performed in RStudio (R-4.5, Rstudio extension 2025.05.1+513) (α = 0.05). Results: Three studies were included in the review, and two in the meta-analysis. The meta-analysis showed higher salivary levels of Apolipoprotein B-100 (APOB), Apolipoprotein A-II (APOA2), and Heparin Cofactor 2 (SERPIND1) in MRONJ patients, while the protein Keratin (KRT16) showed reduced levels without statistical significance. Bioinformatics analyses indicated involvement in lipid metabolism, impaired tissue repair, and inflammatory and immune responses. Conclusions: These findings suggest altered salivary proteomic signatures in MRONJ for APOB, APOA2, SERPIND1, and KRT16 proteins. Full article

Background/Objectives: The lateral symmetry of dental disease and treatment patterns reflects underlying biological, behavioral, and systemic factors. Although clinical experience suggests asymmetric treatment frequencies, large-scale quantitative evidence remains limited. This study aimed to analyze the symmetry and asymmetry of dental interventions—encompassing restorations, extractions, endodontic treatments, and prosthetic procedures—in relation to tooth position, jaw, patient sex, and age group. Methods: A retrospective analysis was conducted on 30,063 dental intervention records from 2738 patients treated at a single private practice between 1999 and 2025. Tooth identification was based on FDI two-digit notation. Chi-square goodness-of-fit tests were applied to assess left–right and upper–lower symmetry, stratified by sex, age group, and tooth position. Bonferroni correction was applied to account for multiple comparisons (adjusted α = 0.0033). Results: Overall left–right symmetry was maintained across the full dataset (χ² = 0.17, p = 0.682). After Bonferroni correction, only the right-side excess at the first premolar position remained statistically robust (p = 0.002), driven predominantly by the lower jaw (tooth 44 vs. 34; p = 0.011). The upper jaw received significantly more interventions than the lower jaw (56.3% vs. 43.7%, p < 0.001). Additional asymmetries observed at the uncorrected threshold—in the lower jaw (p = 0.026), in the 18–30 age group (p = 0.009), and a sex × jaw interaction (p = 0.047)—did not survive correction. Conclusions: Dental treatment patterns are predominantly symmetric at the population level. The most robust site-specific finding was a right-side excess of first premolar interventions, particularly in the lower jaw. These results may inform targeted preventive strategies and population-level oral health planning, with caution warranted in generalizing findings beyond the single-practice setting. Full article

Medication-related osteonecrosis of the jaw (MRONJ) is a complex condition associated with the use of antiresorptive drugs, such as bisphosphonates and denosumab. The condition is characterized by the presence of exposed bone in the maxillofacial region that fails to heal. MRONJ remains highly intractable, as its pathogenic mechanisms are not yet fully understood. It is therefore essential to elucidate the molecular mechanisms underlying the disease. MiRNA expression analysis and proteomic studies were performed on a selected cohort of patients with MRONJ on jawbone tissue, using qRT-PCR and 2D electrophoresis followed by mass spectrometry. MiRNAs and proteomics data validation was carried out by Western blot analysis of differentially expressed proteins highlighted by a proteome study and predicted targets of differentially expressed miRNAs. Nineteen miRNAs were overexpressed and two downregulated in jawbone tissue from all MRONJ patients. Notably, five of these dysregulated miRNAs are involved in the regulation of angiogenesis and desmosome functions, suggesting a potential link to the molecular alterations observed at the protein level. Proteomic analysis revealed decreased concentrations of the pigment epithelium-derived factor, and of desmoglein-1, a desmosomal cadherin. Validation analysis confirmed the dysregulation of pathways involved in bone remodeling and necroptosis. The pathophysiology of MRONJ arises from a complex interplay of factors, including impaired bone remodeling, affected angiogenesis, and altered cell adhesion and differentiation mechanisms, ultimately leading to necroptosis. Through proteomic analysis and validation of miRNA expression, our study proposes specific molecular alteration in MRONJ-compromised bone tissue, involving desmosomal component imbalance and angiogenesis inhibition. Full article

Osteonecrosis of the jaw (ONJ) is a multifactorial disorder characterized by impaired bone remodeling, vascular compromise, immune dysregulation, and mucosal barrier disruption. Although these mechanisms have been extensively investigated, they are often discussed separately, limiting an integrated understanding of ONJ pathogenesis. Vitamin D has emerged as a biologically relevant factor across these interconnected pathways, yet its role in ONJ remains incompletely defined. This narrative and hypothesis-generating review synthesizes current mechanistic, preclinical, observational, and clinical evidence regarding vitamin D biology and ONJ and proposes a vitamin D-centered vulnerability model in which vitamin D deficiency acts as a context-dependent modifier rather than a primary causal driver. Mechanistically, vitamin D deficiency may impair osteoblast function and mineralization, disrupt angiogenic responses, promote pro-inflammatory immune signaling, and compromise mucosal integrity, collectively creating a microenvironment susceptible to impaired healing and osteonecrosis. These effects are likely to vary across clinical settings, particularly in patients receiving antiresorptive or antiangiogenic therapies. Clinical and epidemiological studies have reported associations between low vitamin D status and increased ONJ risk or severity, while some observational studies suggest that vitamin D supplementation may be associated with improved outcomes in selected populations. However, current human evidence remains predominantly observational and subject to substantial heterogeneity and residual confounding, and direct randomized evidence is lacking. Overall, this framework provides an integrated perspective linking vitamin D biology to ONJ-related pathogenic processes and may support future mechanistic research, risk stratification, and supportive multidisciplinary management strategies. Nevertheless, the proposed model should be interpreted cautiously as hypothesis-generating and requires further validation in well-designed prospective studies and randomized controlled trials. Full article

Background/Objectives: Orofacial myofunctional therapy (OMT) is a system of targeted neuromuscular exercises and behavioral retraining intended to optimize tongue, lip, jaw, and airway function during rest, breathing, swallowing, and sleep. Historically associated with tongue thrust and abnormal swallowing, OMT is now applied across an expanding range of clinical contexts, including sleep-disordered breathing (SDB), tongue-tie rehabilitation, orthodontic stability, and perioperative functional recovery. As its use has broadened, persistent questions have followed: what is myofunctional therapy, where did it originate, and how did a set of oral exercises evolve into an intervention increasingly integrated with airway health, sleep medicine, and surgical care? Methods: This article presents a narrative historical review with a perspective component, synthesizing foundational literature, interdisciplinary contributions, and selected contemporary evidence to examine the evolution of OMT from ancient functional practices to modern clinical science. It is written to trace recurring clinical observations, shifts in educational frameworks, and key inflection points that shaped how OMT has been taught and applied over time. Results: OMT did not emerge from randomized controlled trials or standardized protocols. It arose from repeated clinical encounters with patients with atypical craniofacial development, relapse of structural correction, persistent mouth breathing, and/or unresolved swallowing and speech dysfunction despite technically successful treatment. These patterns suggested that anatomy alone could not account for outcome variability. Over time, clinical attention expanded beyond isolated tongue function to include breathing patterns, posture, neuromuscular tone, and airway behavior. In the past two decades, controlled trials, cohort studies, and systematic reviews have supported selected applications of OMT, particularly in SDB and adjunctive airway care, while also revealing ongoing challenges related to training variability, terminology, scope of practice, and standardization. Conclusions: OMT has historically been described as a system of targeted neuromuscular and behavioral interventions aimed at modifying orofacial rest posture and function. Over time, the field has expanded beyond localized muscle retraining toward a broader functional framework that integrates airway physiology, craniofacial growth, sleep, and interdisciplinary rehabilitation. Full article

Prevention of medication-related osteonecrosis of the jaw (MRONJ) associated with low-dose bone-modifying agents (LD-BMAs) remains a clinically relevant challenge, particularly due to the heterogeneity of recommendations and the growing number of patients exposed to these therapies. Unlike high-dose regimens, LD-BMAs are associated with a lower incidence and longer latency of MRONJ, generating uncertainty regarding the optimal timing and scope of dental interventions. This commentary critically compares four major international position papers and consensus documents (AAOMS 2022, SIPMO–SICMF 2020/2024, Chinese Expert Consensus 2024, and SIOT–SIdP 2023) through four pragmatic questions concerning patient stratification, timing of dental assessment, speed of risk reduction, and the role of prescriber-oriented screening tools. The analysis highlights substantial discrepancies among preventive models, particularly regarding whether pre-treatment dental treatments should be mandatory or whether early post-initiation assessment may be acceptable in selected low-risk patients. Full article

Objective: To develop an individual assessment for patients suffering from medication-related osteonecrosis of the jaw (MRONJ), we developed a scoring system that integrates anamnestic, clinical, and radiological parameters to facilitate the process of therapeutic decisions during MRONJ therapy. Methods: In this study, clinical data as well as diagnostic CT scans from 41 MRONJ patients undergoing antiresorptive therapy were analyzed to develop an Osteonecrosis Scoring Clinical Assessment and Radiological Report (OSCAR). Results: Total OSCAR scores ranged from 4 to 30, with lower scores demonstrating less severe disease progression following a de-escalated therapy. OSCAR scores above 15 were associated with higher bone density and an increased need for surgical intervention, with 70% of Denosumab and 71% of bisphosphonate patients requiring surgical intervention. Conclusions: Patients with an OSCAR below 12 were unlikely to require multiple surgical interventions. Since OSCAR parameters are routinely collected during hospitalization, this opens the possibility for future AI-assisted patient assessment and treatment planning. Full article