MRONJ Pathology


An illustration depicting the pathology of Medication Related Osteonecrosis of the Jaw (MRONJ). The project was designed as an editorial piece for a Scientific American style magazine, highlighting the pathogenesis and progress of the condition as well as the impact on affected individuals. The project went through intensive iterative design under the guidance of Dr. Shelley Wall, with anatomical content reviewed by Dr. John Wong. Illustrations were completed in Adobe Photoshop and arranged in Adobe Illustrator.


Educated layperson


Dr. Shelley Wall

Dr. John Wong (content advisor)


Adobe Photoshop

Adobe Illustrator


11 x 17 (print)


December 2018

ProCESS Work

This project was meant to provide an intensive, iterative, and long-term opportunity to create a multi-part illustration that depicted an accurate pathological process over time. The illustration needed to reveal the pathology at multiple scales—including the cellular, tissue, and organismal level—while catering to an educated lay audience as a magazine spread similar to those seen in publications like Scientific American. In order to focus on creating a novel, challenging composition, and to practice rendering dental anatomy, I wanted to choose an oral pathology typically not covered within our pathology course. After contacting a student at the Schulich School of Dentistry at Western University, I began researching medication related osteonecrosis of the jaw (MRONJ). My initial research was compiled as a sequential report, which focused on breaking down the pathology into discrete stages and identified the main “actors”—the structures, characters, and environments that needed to be visualized.


After completing my initial research, the next stage was to practice rendering the tissue landscape related to the pathology in question. My final piece needed to illustrate the progression of MRONJ at multiple scales; however, some of these scales are impossible to depict without artistic visualization. These studies were a vital step in creating a believable and accurate environment, even if some didn't feature in the final piece, as they allowed me to practice this process using reference images of healthy tissue combined with microscopy, radiographic, and written depictions of the pathology.


Completing the initial research regarding the progression of MRONJ and visualizing the presentation of the pathology with practice tissue studies meant that I could begin drafting thumbnails for my final composition. Dr. Shelley Wall, my Professor and supervisor for the project, stressed that the root of pathology—pathos—means to appeal to the emotions of the audience and invoke a sense of sadness, and that this was something our final pieces should accomplish. For this reason, I knew that I wanted a central aspect of my piece to highlight an elderly woman, the main demographic affected by MRONJ, while also showing the discomfort the condition can cause. As another main goal of the piece was to demonstrate the temporal progression of MRONJ, I opted to adapt and reuse my earlier tissue cubes as they presented a clear, discrete method of showing the effect of MRONJ over time. Once I drafted several compositions that accomplished these goals to varying degrees of success, I settled on a near-final composite sketch that guided the viewer diagonally across the page, starting with the human-level effects and moving to the tissue level changes that occur over time. At this point, I also completed the accompanying text for the final piece based on my initial research and sequential report. Once the composite sketch was finished, I did several rough colour studies to help determine what look I wanted to achieve in my final renders.


The final step of this project was to fully render each of the assets needed for the final composition and place them into the final layout using Adobe Illustrator. Each of the assets was rendered in Adobe Photoshop, apart from the flat cross-sections depicting each stage, which were cell-shaded in Illustrator to stylistically differentiate them from the more realistic renders. For the illustration of the face, I opted to complete a full-colour render as I was unsure if I wanted a colour or grey-scale version for the final, and this option afforded me more flexibility. In the end, I decided to use a grey-scale version of the face in order to make the transparent view into the jaw more salient. Once each render was complete, they were placed into Illustrator for the final composition and exported with the intention of existing as an 11x17 inch magazine spread.


Aghaloo, T. L., Kang, B., Sung, E. C., Shoff, M., Ronconi, M., Gotcher, J. E., … Tetradis, S. (2011). Periodontal disease and bisphosphonates induce osteonecrosis of the jaws in the rat. Journal of Bone and Mineral Research, 26(8), 1871–1882.; Allen, M. R., & Burr, D. B. (2008). Mandible Matrix Necrosis in Beagle Dogs After 3 Years of Daily Oral Bisphosphonate Treatment. Journal of Oral and Maxillofacial Surgery, 66(5), 987–994.; Marx, R. (2003). Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. Journal of Oral and Maxillofacial Surgery, 61(9), 1115–1118.; MRONJ. (2018). Retrieved September 15, 2018, from; Ruggiero, S. L., Dodson, T. B., Fantasia, J., Goodday, R., Aghaloo, T., Mehrotra, B., & O’Ryan, F. (2014). American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw - 2014 update. Journal of Oral and Maxillofacial Surgery, 72(10), 1938–1956.

© 2018 by Alexander Young. All Rights Reserved.