RESUMO
Unreasonable medical fees can cause problems such as increased medical costs, greater medical disparities, decreased medical standards, and physician shortages. To prevent such problems, it is important to set appropriate medical fees, ensure their proper use, and improve the efficiency of medical care. The treatment of patients with maxillofacial defects is generally more expensive compared with general prosthodontic treatment because it involves more materials and requires more frequently follow-ups for longer period. However, the actual time required for maxillofacial prosthetic treatment is unclear. Therefore, in this study, we aimed to clarify the amount of time spent treating maxillofacial prosthetic patients. We analyzed clinical data from patients undergoing routine maxillofacial prosthetic treatment, irrespective of difficulty level, at 8 university hospitals and 2 dental clinics. We also collected data from maxillofacial prosthodontists on the treatment time required for various Japanese health insurance items, including the fabrication of maxillofacial prostheses. The results revealed that some aspects of maxillofacial prosthetic treatment may take longer to perform and are more costly to perform than previously thought, suggesting the need for some adjustments to the health insurance reimbursement system. Maintaining an appropriate balance between expenditures and fees will greatly benefit patients and physicians, ensuring positive health outcomes and a healthy society.
RESUMO
Dental implant treatment in patients prescribed medications is associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ) around the implants. However, there is no scientific information on how bisphosphonate and/or steroid therapies affect wound healing around implants after implant placement. The aim of this study was to histopathologically and immunopathologically investigate the effects of bisphosphonate and/or steroid therapy on the early stages of soft and hard tissue wound healing around implants in rat maxillae. Eight-week-old female Wistar rats were used. Alendronate (ALN) monotherapy, dexamethasone (DEX) monotherapy, and ALN/DEX combination therapy were started 4 weeks after tooth extraction of right maxillary first molars. Saline was used as a control (n = 14/group). Implant placement was carried out after grossly and manually confirming no open wounds at 16 weeks post-extraction. Euthanasia was performed at 18 weeks post-extraction. Microcomputed tomography, histological stains and immunostaining to detect blood vessels and macrophages were performed to quantitatively analyze wound healing around implants. ALN/DEX combination therapy significantly increased necrotic bone with more empty lacunae and polymorphonuclear cell infiltration with open wounds when compared with all other therapy groups. Necrotic bone was broadly distributed from the crestal bone to the lower area near the apex of the implants in the ALN/DEX group. Interestingly, both ALN/DEX combination therapy and DEX monotherapy significantly increased the number of CD68+NG2- macrophages, whereas only ALN/DEX combination therapy, not DEX monotherapy, significantly shifted the M1/M2 ratio to M1 by significant increases in M1 macrophages and unchanged M2 macrophages in the connective tissue around implants. Within the limitations of this study, these findings may contribute to understanding the early stages of the histopathology and immunopathology of BRONJ-like lesions around dental implants. Continuous accumulation of M1 macrophages without alteration of M2 macrophages may be associated with developing BRONJ around implants.