Simple bone cyst: description of 60 cases seen at a Brazilian School of Dentistry and review of international literature

BACKGROUND: The aim of this study was to describe the relative frequency and the main demographic and clinic-radiographic features related to patients diagnosed with Simple bone cyst (SBC) in an Oral Diagnosis Service in Southeast Brazil and present a review and discussion of international literature on this topic. MATERIAL AND METHODS: SBC cases from our service encompassing the period between 1978 and 2017 were selected. In addition, a literature search was performed in the Pubmed/MEDLINE online electronic database published between 1951 and 2019. RESULTS: A total of 2,459 cystic lesions were documented in our service, thus 60 patients were diagnosed with the SBC representing 2.4% of all jaw cystic. Most of cases were asymptomatic. Multiple SBC lesions were seen in two patients (3.4%) and association with cemento-osseous dysplasia was seen in one female patient (1.7%). A total of 793 cases were enrolled in this literature review. CONCLUSIONS: The SBC is an asymptomatic lesion often discovered in routine image exams in young patients. The unilocular, well defined margin with scalloped appearance is characteristic and helps the definition of diagnosis. This review suggests a different epidemiologic trend concerning to the sex and it confirms the posterior region of mandible as the more frequent location. The conservative treatment with limited exploration and curettage remains as the gold-standard treatment

No disponible

Medication-related osteonecrosis of the jaws (MRONJ) in cancer patients treated with denosumab VS. zoledronic acid: A systematic review and meta-analysis

BACKGROUND: The aim of the present study was to analyse the incidence, risk ratio (RR) and prognoses of two types of medication-related osteonecrosis of the jaws (MRONJ): denosumab-related osteonecrosis of the jaws (DRONJ) and Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ) in cancer patients under treatment with deno-sumab or zoledronic acid (ZA). MATERIAL AND METHODS: An electronic and manual search was conducted for randomized controlled trials (RCTs) until May 2019. Assessment of the identified studies, risk of bias and data extraction were performed independently by two reviewers. The incidence of DRONJ and BRONJ and the RR to develop MRONJ were calculated at 1 year, 2 years and 3 years of exposure. It was also calculated the odds ratio (OR) of their respective prognoses. They were calculated normalizing the values of the individual studies to 1 year, 2 years or 3 years when necessary through robust regression models using a statistical program. RESULTS: From 1.277 references identified, 8 RCTs were included, which comprised a total of 13.857 patients with a variety of neoplasms. The incidence of DRONJ in cancer patients under treatment with denosumab ranged from 0.5 to 2.1% after 1 year, 1.1 to 3.0% after 2 years, and 1.3 to 3.2% after 3 years of exposure. The incidence of BRONJ in cancer patients under treatment with ZA ranged from 0.4 to 1.6% after 1 year of exposure, 0.8 to 2.1% after 2 years, and 1.0 to 2.3% after 3 years of exposure. Statistically significant differences were found between de-nosumab and ZA in the risk of developing MRONJ after 1, 2 and 3 years of exposure. Nevertheless, there were no significant differences in terms of patient prognosis. CONCLUSIONS: Denosumab is associated with a significantly higher risk of developing MRONJ compared to ZA. Nevertheless, no differences were found in its prognoses

No disponible

Changes in dimension of neurovascular canals in the mandible and maxilla: A radiographic finding in patients diagnosed with MRONJ

BACKGROUND: The aim of this retrospective study was to compare the morphological features of neurovascular canals and foramina of patients with medication-related osteonecrosis of the jaws (MRONJ) and healthy individuals by using cone beam computed tomography (CBCT). MATERIAL AND METHODS: The CBCT images of 58 patients under bisphosphonate therapy diagnosed with MRONJ and age gender- matched controls were retrospectively evaluated. The diameter of mandibular and nasopalatine canal and mandibular, mental and lingual foramina were measured on several sections of CBCT. The value of mental index (MI) and panoramic mandibular index (PMI) were also assessed. RESULTS: The mean value of diametric measurements for all neurovascular canals and foramina in MRONJ patients were narrower than controls. Left mandibular foramen was the most affected area (p < 0.001). There were significantly difference in all measurements of mental foramen, lingual foramen and mandibular incisive canal between two groups (p < 0.05). PMI of MRONJ subjects were also significantly differences in both sides (p < 0.05). CONCLUSIONS: In MRONJ patient, neurovascular canals and foramina are affected due to the alterations in bone remodeling. Therefore, the diametric measurement of neurovascular canals and assessment of MI and PMI on CBCT, is a potentially useful method for detection of early changes associated with bisphosphonate therapy and for predict areas where new necrosis may occur

Current status of the torus palatinus and torus mandibularis

While there is a hereditary component to tori, this does not explain all cases. Tori tend to appear more frequentlyduring middle age of life; the torus palatinus is more commonly observed in females, but this is not the casewith the torus mandibularis. Certain ethnic groups are more prone to one torus or the other. The torus is mainlyremoved due to prostodontic reasons, as it may also be used as biomaterial, not only in periodontology, but alsoin implantology. The aim of this study was a review of the literature from the past twenty years (AU)

Implant treatment in patients with osteoporosis

Osteoporosis is very common, particularly in post-menopausal women and is characterized by a decrease in bonemass and strength. Osteoporosis also affects the jawbone and it is considered a potential contraindication to placementof dental implants. The present paper reviews the literature regarding the effect of osteoporosis on osseointegrationof implants. Experimental models have shown that osteoporosis affects the process of osseointegration,which can be reversed by treatment. However, studies in subjects with osteoporosis have shown no differencesin survival of the implants compared to healthy individuals. Therefore, osteoporosis cannot be considered a contraindicationfor implant placement. Oral bisphosphonates are the most commonly used pharmacological agents inthe treatment of osteoporosis. Although there have been cases of osteonecrosis of the jaw in patients treated withbisphosphonates, they are very rare and it is more usually associated with intravenous bisphosphonates in patientswith neoplasms or other serious diseases. Nevertheless, patients treated with bisphosphonates must be informed inwriting about the possibility of this complication and must give informed consent. Ceasing to use bisphosphonatesbefore implant placement does not seem to be necessary (AU)

No disponible

Dental implants in patients treated with oral bisphosphonates. A bibliographic review

Bisphosphonates inhibit bone resorption and are used to treat a range of pathologies, including Paget disease, osteoporosis,multiple myeloma and metastases associated with breast or prostate cancer. At present, there is no effectivetreatment for bisphosphonate induced osteonecrosis, so prevention is extremely important. Since quality oflife deteriorates for those suffering osteonecrosis, maximum precautions should be taken with patients at risk, andespecially whenever oral surgery, including dental implant placement, is contemplated. Dentists and oral or maxillofacialsurgeons must keep up to date with the latest approaches to prevention, particularly when treating patientswho are presently taking, or who will be taking bisphosphonates and are also candidates for dental implants (AU)

No disponible

Osteonecrosis of the jaws by intravenous bisphosphonates andosteoradionecrosis: A comparative study

Aims: We analyze the possible clinical differences between bone jaw exposed areas in ONJ (osteonecrosis of thejaws) and ORN (osteoradionecrosis).Patients and method: Group 1 was composed with 53 ONJ cases and group 2 with 20 ORN cases. In both groupswe analyzed, the major size of the exposed bone areas, the number of exposed areas, the location on the jaws andthe presence of others associated and severe complications, such as skin fistulas and jaw fractures. We also investigatedthe possible local aetiology or trigger factor of the lesions.Results: The major size of the bone exposed areas was 2.29±2.02(mean ± std.dev) in group 1 and 2.7±2.9 (mean ±std.dev) in group 2 (p>0.05). The number of exposed areas was 1.8±1.34 (mean ± std.dev) in group 1 and 1.2±0.55(mean ± std.dev) in group 2 (p>0.05). There were more fractures in the second group (20%) (p<0.05), and skinfistulas (35%) (p<0.05). We found more patients in group 1 in which the dental extraction was the local aetiologyof the bone necrosis (35 cases, 66.03%), while in group 2 there were 8 (40%) (p<0.05).Conclusions: In our study with ONJ there were not differences in the major size of the bone exposed areas, butthere were more lesions per patient than in group with ORN. The severity of the complications, such as jaw fracturesand skin fistulas were higher in ORN, and in this group it was more frequent the spontaneous lesions than inthe ONJ where it is more frequent following dental extractions (AU)

No disponible

Florid osseous dysplasia: Report of a case presenting acute cellulitis

In this review, we examined a 45-year-old Asian man who had been diagnosed with florid osseous dysplasia (FOD) ofthe mandible and acute perimandibular cellulitis. This presentation occurred after a history of off-and-on swellingsof the jaw and multiple treatments received at another hospital. An aggressive resection of the jaw was planned;however, the patient denied the treatment and came to our clinic to seek a second opinion. The patient was successfullytreated by conservative surgery and antibiotic treatment with preservation of the jaw integrity and themandibular neurovascular canal. Intraoperatively, a piece of a calcified mass was removed and submitted for histopathologicalexamination. The specimen showed woven bone and densely sclerotic mass of calcified materialsexhibiting reversal lines and inflammatory cell infiltration of the connective tissue. The definitive diagnosis wasFOD with a secondary infection. Treatments for FOD were discussed (AU)

No disponible

Bisphosphonate-associated osteonecrosis of the jaw. A proposal for conservative treatment

The use of bisphosphonates (BPs) has proven effective in the treatment of bone-related diseases, despite the potentialrisk of developing osteonecrosis of the jaw (ONJ). So far, results for the treatment of ONJ have not been satisfactory.In our study, we have treated two patients diagnosed with ONJ. In addition to local treatments a hydrogel wasapplied, with promising results. The fistulae disappeared 2-3 weeks into the treatment. After a six-month follow-upperiod there has been no sign of recurrence. The extent of maxillary bone exposure has diminished notably, althoughnot entirely disappeared. In all cases, the patients exhibit no other symptoms (they suffer from no pain or swelling orfunctional impotence). For this reason we believe this protocol might be useful in the case of patients who suffer frompain and fistulation secondary to BP-associated ONJ to improve the state of their lesions until definitive treatmentcan be undertaken.Although these findings are not conclusive, given that we are reporting data on two patients only, we believe thatthis might be an alternative treatment in refractory cases where other therapies are counter-indicated. A controlledrandomized and prospective study would be required to confirm our findings (AU)

Osteonecrosis de los maxilares asociada a bifosfonatos / No disponible

En los últimos años, en la literatura se han recogido diversas series de osteoquimionecrosis asociadas a bifosfonatos. En algunos pacientes que tomaban bifosfonatos se observó dolor, exposición ósea y osteitis tras una exodoncia u espontáneamente. Presentamos nuestra experiencia desde nuestro servicio de cirugía oral y maxilofacial en el seguimiento de 15 pacientes que han presentado esta patología, incluyendo nuestro protocolo diagnóstico-terapéutico (AU)

Recently in the literature many papers concerning bone osteonecrosis of the jaws (BON) have appeared related with Biphosphonates. Some of the patients taking Biphosphonates developped oral lesions which are similar in appearance to those of radiation-induced osteonecrosis. Clinically, they appear as ragged oral mucosal ulcerations that expose underlying bone and often are extremely painful, many times related with previous manipulation and sometimes spontaneously. The lesions are persistent and do not respond to conventional treatment modalities. We present our experience and recommendations which are based on expert opinion from the literature, the guidelines for the diagnoses and management of care of patients who develop BON; the prevention of this complication based on current knowledge; and recommendations for the routine dental treatment of patients receiving bisphosphonate therapy (AU)

Bisfosfonatos y Patología Oral I. Aspectos generales y preventivos / Bisphosphonates and Oral Pathology I. General and preventive aspects

Los bisfosfonatos constituyen un grupo de fármacos capaces de modular el recambio óseo y disminuir su remodelado cuando existe una reabsorción excesiva. Por ello están indicados en numerosas patologías óseas como la osteoporosis postmenopáusica o la osteolisis asociada al cáncer de mama o al mieloma múltiple. En los últimos años y a raíz de su utilización masiva se han ido publicando numerosos casos de complicaciones asociadas a su uso. Entre los posibles efectos adversos más importantes se encuentran los orales, con la aparición de ulceraciones y sobre todo los casos de osteonecrosis de los maxilares asociados a esta terapéutica. En esta revisión analizamos las características generales de estos medicamentos y su mecanismo de actuación, así como los efectos adversos descritos, especialmente los orales y maxilofaciales, haciendo una referencia especial sobre la prevención de la osteonecrosis de los maxilares, a la luz de los casos descritos en la literatura médica y odontológica. El protocolo preventivo refuerza el papel fundamental del odontólogo en la prevención efectiva de este proceso antes, durante y después del tratamiento

Bisphosphonates constitute a group of drugs capable of modulating bone turnover, and reduce its remodelling when an excessive resorption occurs. This is why they are indicated in a large group of bone diseases like postmenopausal osteoporosisor osteolisis associated with breast cancer or multiple myeloma. Over the last years and due to their extensive use, many cases of complications associated with their use have been published. Among the most important possible adeverse effects are the oral ones, with the appearance of ulcerations and, especially, osteonecrosis of the jaws associated with this therapy. In this paper, we have analyzed the general characteristics of these drugs and their mechanisms of actionas well as the described adverse effects, especially oral and maxillofacial has been made special reference regarding the prevention of osteonecrosis of the jaws, hightened by cases described in medical and odontological literature. The preventive protocol backs up the fundamental role of the odontologist in the effective prevention of this process before, during and after the treatment

Bisphosphonates and Oral Pathology II. Osteonecrosis of the jaws: review of the literature before 2005

Los bisfosfonatos son fármacos moduladores del recambio óseo que están indicados en numerosas patologías óseas desde la osteoporosis a la osteolisis asociada a patología neoplásica. En los últimos años se han ido publicando numerososcasos de osteonecrosis de los maxilares asociada a la toma de estos medicamentos. En esta revisión se analizan los casos publicados en la literatura indexada desde el inicial del 2003 hasta diciembre del 2005. Durante este periodo se han publicado 246 casos, afectando más a las mujeres y sobre todo en la sexta década de vida. Los bisfosfonatos más frecuentemente asociados han sido los nitrogenados (pamidronato-ácido zoledrónico) y el antecedente oral más común la exodoncia. No obstante, más del 25% correspondieron a casos “espontáneos”. La localización mas frecuente fue la mandíbula y clínicamente la mayoría de los casos mostraban exposición ósea y dolor asociado. La terapéutica ha sido muy diversa con diferentes pautas antibióticas con o sin cirugía, mostrando en general un pronóstico incierto con bajos índices de curación

Bisphosphonates are bone-turnover modulating drugs which are used in the management of a number of bone diseases ranging from osteoporosis to neoplasic pathology-associated osteolysis. In the last years a number of cases of osteonecrosis of the jaws associated with these drugs have been reported. In this review we analyze the cases published in the literature indexed from 2003 to December 2005. During this period 246 cases were reported, being more frequently associated with women in the sixth decade of life. More frequently associated bisphosphonates were the nitrogenated bisphosphonates (pamidronate, zolendronic acid) and the most common oral antecedent was a dental extraction. Nevertheless more than 25% of the cases were spontaneous. The most frequent site was the mandible and most of the cases presented clinical evidence of bone exposure and pain. Different treatments have been proposed with different antibiotic therapies with or without surgery, showing in general terms an uncertain prognosis with low healing rates

Osteonecrosis maxilar y bisfosfonatos. Presentación de tres nuevos casos / Osteonecrosis of the jaws and bisphosphonates. Report of three cases

Los bisfosfonatos están adquiriendo una relevancia terapéutica cada vez mayor, dada su utilidad en el manejo de diversas patologías.Con el incremento de su uso, se están documentando casos de necrosis ósea mandibular, y en menor medida maxilar, de difícil solución y con una importante afectación de la calidad de vida de los pacientes en tratamiento con estos fármacos.El factor que con mayor frecuencia desencadena el proceso es la actuación de los profesionales: odontólogos, estomatólogos y cirujanos orales y maxilofaciales. La previsión, las intervenciones atraumáticas y el tratamiento conservador, parecen ser los medios más adecuados para minimizarla incidencia o resolver las complicaciones.Este artículo presenta tres casos, seguidos por nuestro servicio, de pacientes con necrosis ósea maxilar tras procedimientos dentales, fundamentalmente exodoncias.El conocimiento de este posible efecto secundario de los bisfosfonatos debería ser tenido en cuenta antes de cualquier intervenciónen este tipo de pacientes

Bisphosphonates are recently acquiring increasing relevance in the treatment of several diseases.In line with the increased use of these compounds, cases of mandibular osteonecrosis, and to a lesser extent, maxillary osteonecrosis,are being reported. This necrosis is difficult to treat in patients who usually have a previously limited quality of life.A surgical performance carried out by oral and maxillofacial surgeons, stomatologists and odontologists might lead to bone exposure.A treatment based on conservation and as harmless as possible seems to be the most advisable way of acting with these patients in order to minimize the incidence and treat the complications, once the lesions have been ascertained.We report three cases treated in our service of osteonecrosis of the jaws after exodontics.This side effect should be remembered before starting any surgical treatment in these patients

Férula quirúrgica intermedia en cirugía ortognática bimaxilar: Un método simple de obtención / The intermediate surgical splint in bimaxillary surgery. A simple method for obtaining it

No disponible

Eficacia de la monoterapia con Piperacilina-tazobactam en infecciones del área maxilofacial. Discusión / Efficacy of single drug therapy with piperacillin-tazobactam in infections of the maxillofacial area. Discussion

No disponible

Eficacia de la monoterapia con piperacilina-tazobactam en infecciones del área maxilofacial / Efficacy of single drug therapy with piperacillin-tazobactam in infections of the maxillofacial area

Objetivo: Las infecciones del área maxilofacial representan un motivo habitual de consulta para los cirujanos maxilofaciales, siendo las más frecuentes las de origen dental. Estas infecciones son frecuentemente polimicrobianas, por lo que el objetivo del presente estudio ha sido evaluar la eficacia clínica y seguridad de piperacilina-tazobactam en el tratamiento de las infecciones del área maxilofacial. Diseño del estudio: Estudio multicéntrico y prospectivo en donde 79 pacientes con infecciones del área maxilofacial recibieron piperacilina-tazobactam como tratamiento antibiótico. Resultados: La evolución clínica de los pacientes fue favorable en un 97,5 por ciento de los pacientes y la eficacia microbiológica obtenida al final del tratamiento fue del 96,2 por ciento. Se presentaron reacciones adversas en 5 pacientes (6,3 por ciento): 2 casos de mareo, 2 de dispepsia y un caso de flebitis. En ningún caso se precisó la discontinuación del fármaco. Conclusiones: La eficacia clínica y microbiológica junto con la escasez de efectos adversos presentados, hace de piperacilina-tazobactam una alternativa eficaz en el manejo de estas infecciones (AU)

Enfermedad de Eales con infartos cerebrales bilaterales y distonía de cierre mandibular / Eales' disease with bilateral brain strokes and jaw-closing dystonia

La enfermedad de Eales es una vasculopatía oclusiva retiniana que se caracteriza por extensas áreas de isquemia en la periferia, envainamiento vascular y neovascularización. Se asocia a hemorragias en vítreo de repetición. En un 80-90 por ciento de los casos afecta de forma consecutiva ambos ojos. Pese a las múltiples teorías que se han propuesto sigue teniendo un origen incierto y su diagnóstico es de exclusión. En ocasiones estos pacientes desarrollan complicaciones en el sistema nervioso central, sobre todo infartos cerebrales. Presentamos el caso de una mujer de 38 años con enfermedad de Eales que presenta infartos cerebrales bilaterales en territorio de arterias cerebrales medias. En la arteriografía cerebral se comprueban imágenes de arrosariamiento, lo que sugiere la etiología vasculítica de las lesiones. La administración precoz de corticoides podría evitar la afectación de la retina contralateral y las complicaciones neurológicas. La paciente presentó ademas de forma diferida de distonía de cierre mandibular secundaria al infarto en ganglios basales la cual siguió un curso benigno con resolución espontanea en pocos días (AU)

Regeneración del proceso alveolar: injertos óseos

Para poder conseguir un buen resultado en la rehabilitación de los pacientes edéntulos con implantes es necesario reconstruir la atrofia ósea que acompaña a la pérdida dentaria. Para la reconstrucción del proceso alveolar atrófico disponemos de dos alternativas: los injertos óseos y la distracción osteogénica. La distracción de los procesos alveolares, por lo reciente de la misma, es una técnica todavía poco conocida, practicada por pocos cirujanos, con poca casuística y seguimiento a largo plazo, tal y como se desprende de las revisiones bibliográficas. La técnica de distracción está sujeta todavía a numerosas variaciones, y se muestra muy sensible a las manos del cirujano que la realiza. Citamos como muestra de las dificultades técnicas el control del vector, el riesgo de necrosis del fragmento distraído, riesgos periodontales en dientes vecinos, y ser una técnica dependiente del comportamiento y cuidados del paciente. Por todo ello, consideramos que los injertos óseos en sus distintas modalidades, son el tratamiento de elección para la reconstrucción del proceso alveolar. Dicha reparación permitirá colocar los implantes en la posición ideal y, posteriormente, conseguir con la prótesis resultados estéticos y funcionales comparables a la dentición natural perdida (AU)

Reconstrucción mandibular: pasado, presente y futuro / Mandibular reconstruction: past, present and future

La reconstrucción mandibular continua siendo uno de los grandes retos para el cirujano de cabeza.y cuello. Presentamos en este trabajo una revisión de los métodos empleados en nuestro Servicio en los últimos quince años en la reconstrucción mandibular, sus ventajas, inconvenientes y los éxitos de cada técnica. Revisamos el colgajo osteomiocutáneo trapecial como colgajo pediculado regional, las indicaciones actuales de los colgajos microquirúrgicos, peroné, cresta ilíaca y escapular, sin hacer una descripción exhaustiva de los mismos sino haciendo hincapié en las indicaciones, las controversias y nuestros propios resultados en cada colgajo en la última década. Exponemos unas guías clínicas para el estudio de cada defecto que nos ayuden a la selección de uno u otro colgajo. La superioridad de la reconstrucción primaria y de los colgajos microquirúrgicos, sobre los métodos tradicionales, unidos a los implantes osteointegrados nos ha permitido proporcionar una adecuada calidad de vida (estética y función) a los pacientes mandibulectomizados (AU)