Promising results of surgical management of advanced medication related osteonecrosis of the jaws using adjunctive leukocyte and platelet rich fibrin.

BACKGROUND: Leukocyte- and platelet-rich fibrin (L-PRF) is an autologous matrix scaffold which regulates inflammation by stimulating cytokines and growth factors that are involved in the immune response. L-PRF is suggested as a viable adjunctive method to surgical interventions due to its advantages on tissue healing. This study aims to retrospectively evaluate the adjunctive role of L-PRF in surgically treated medication-related osteonecrosis of the jaws (MRONJ) patients. METHODS: Between January 2012 and December 2020, patients with AAOMS stage II and III MRONJ lesions, who were treated surgically with adjunctive use of L-PRF in the authors' institution were enrolled. Surgical interventions consisted of either marginal resection or sequestrectomy with peripheral ostectomy (SPO) or curettage and L-PRF application. Medical records of these patients were retrospectively reviewed and healing was assessed according to certain parameters including mucosal closure and presence of infection, exposed bone, fistula or radiologic markers of disease progression for a minimum of 12 months. RESULTS: Thirteen patients (7 women and 6 men) with an average age of 72.4 years (± 10.61, range 54-84) were included in the study, nine of whom had AAOMS stage III and four stage II MRONJ. Three patients had a marginal resection, nine patients had sequestrectomy with peripheral ostectomy (SPO) and one patient underwent a curettage procedure. All marginal resection and six SPO patients showed complete healing while four patients, who had SPO or curettage experienced incomplete healing. Mean follow up was 20.1 ± 18.29 months. CONCLUSION: The use of L-PRF may be a favorable adjunctive option in the treatment of MRONJ owing to its favorable effects on tissue repair, ease of application, minimally invasive and cost-effective character and autogenous nature. Trial registration Retrospectively registered.

Medication-related osteonecrosis of the jaw: An institution's experience.

OBJECTIVES: This study aimed to evaluate and report the outcomes associated with the management of patients who were treated surgically for medication-related osteonecrosis of the jaw (MRONJ).Methods: Demographic and medical profiles of patients with a diagnosis of MRONJ were created. The type of surgical treatment, complications, and treatment outcomes were identified.Results: Twenty-one patients with an average age of 68.42 years (range 40-90 years) were included. Nineteen patients had only mandible involvement, one patient had only maxilla involvement, and one patient had both mandible and maxilla involvement. Thirteen patients underwent marginal resections. Eight patients underwent segmental resection of the mandible with immediate reconstruction. Nineteen patients healed without any complications. Two patients who had undergone segmental resection of the mandible experienced postoperative complications and needed a second surgery to achieve primary closure.Discussion: Advanced MRONJ can effectively be treated with resective surgery in combination with medical treatment.

Recurrent Aphthous Stomatitis as a Result of Zinc Deficiency.

PURPOSE: The purpose of this study is to evaluate the results of patients, with a chief complaint of recurrent aphthous stomatitis (RAS), who were found to have zinc deficiency as the predisposing factor and received appropriate replacement therapy. MATERIALS AND METHODS: A retrospective study was conducted using data from the medical records of patients with a chief complaint of RAS. Patients with potential ulcer-causing conditions were excluded. All patients were intraorally examined to rule out trauma-associated aetiologies. Blood tests were ordered to measure total blood count, serum transferrin, ferritin, zinc, folic acid and vitamin B12 levels. RESULTS: A total of 48 patients, 34 with zinc deficiency and 14 with both zinc and iron deficiencies, were included in this study. Patients received an initial three-monthly replacement treatment and blood tests for the certain deficiencies were repeated at the end of this time interval. Two patients with zinc deficiency reported no relief due to incorrect intake of tablets with milk. Following correct instructions, all patients reached normal serum mineral levels and reported no recurrences. All patients remained asymptomatic and their mineral levels were monitored in every 3 months to detect any abnormalities. Overall mean follow-up for this study was 12.06 months (range: 8-28 months, SD: ± 5.7). CONCLUSION: Zinc deficiency should be considered and investigated as part of the diagnostic process of RAS. A simple blood test may aid in correct diagnosis and complete resolution of this recurring condition rather than constant prescription of certain medicines to suppress the symptoms.

Proton pump inhibitor intake negatively affects the osseointegration of dental implants: a retrospective study.

OBJECTIVES: This study sought to investigate the association between the systemic intake of proton pump inhibitors (PPI) and the early failure of dental implants. MATERIALS AND METHODS: A retrospective cohort study involving 1,918 dental implants in 592 patients (69 implants in 24 PPI users and 1,849 implants in 568 nonusers, respectively) was conducted. The effect of PPI intake on the osseointegration of dental implants was evaluated using patient- and implant-level models. RESULTS: Among 24 PPI users, two patients experienced implant failure, one of whom had three and the other of whom had one failed implant, respectively. Thus, the rate of failure for this population was 8.3%. Separately, 11 nonusers each experienced one implant failure, and the failure rate for these patients was 1.9%. Fisher's exact test revealed statistically significant differences between PPI users and nonusers at the implant level (P=0.002) but failed to show any significance at the patient level (P=0.094). The odds of implant failure were 4.60 times greater among PPI users versus nonusers. Dental implants that were placed in patients using PPIs were found to be 4.30 times more likely to fail prior to loading. CONCLUSION: The findings of this study suggest that PPI intake may be associated with an increased risk of early dental implant failure.

Evaluation of the Short-Term Efficacy of Transdermal Ozone Therapy in Turkish Patients with Internal Derangement of the Temporomandibular Joint

Objective: To investigate the efficacy of transdermal high-frequency ozone therapy in the management of pain and pain-related restricted jaw movements in patients with internal derangement of the temporomandibular joint (TMJ). Material and Methods: This retrospective study included 40 patients who had received transdermal high-frequency ozone therapy for the management of disc displacement with reduction of the TMJ. Subjects were treated 3 times for one week with a bio-oxidative high-frequency ozone generator with an intensity of 80% for ten minutes bilaterally. Pain scores and maximal interincisal opening (MIO) values of the patients were evaluated before and after the treatment. Results: An increase in the mean MIO value was achieved following the ozone therapy, however, the difference was not statistically significant (p=0.350). A statistically significant decrease in the mean pain score (48.13 ± 27.75) was observed following the ozone therapy. Conclusion: Transdermal application of high frequency ozone may be a good alternative for management of pain and pain-related restricted jaw movements in patients with internal derangement of the TMJ.

Esthetic evaluation of implant-supported single crowns: a comparison of objective and patient-reported outcomes.

BACKGROUND: This study investigated objective and patient-reported esthetic outcomes and their correlation for single-tooth implant restorations in the maxillary anterior region. METHODS: Nineteen patients were included. Gingival biotypes and smile lines were evaluated. Esthetic evaluation was performed according to the pink and white esthetic scores (PES and WES). Patients rated their satisfaction regarding the implant treatment using a subjective outcome questionnaire and a 10-cm visual analogue scale (VAS). RESULTS: The mean PES and WES were 10.7 (range 5-13, SD ± 2.24) and 8.6 (range 8-10, SD ± 0.60), respectively. The overall mean VAS was 8.54 ± 0.36 (range 3.8-9.8). No significant correlation was found between VAS and PES or WES (p = 0.475, p = 0.984, respectively). PES and WES scores for gingival biotypes failed to show any statistically significant difference (p = 0.701, p = 0.831). There was a significant negative correlation between the smile line and VAS; indicating that patients with lower smile lines expressed higher patient satisfaction (p = .001). CONCLUSIONS: Professionally reported esthetic outcomes (PES and WES results) may not correlate with patient-reported outcomes. Smile line is a significant factor in patient satisfaction, which should be evaluated thoroughly prior to implant placement in the anterior maxilla.

Does the Intake of Selective Serotonin Reuptake Inhibitors Negatively Affect Dental Implant Osseointegration? A Retrospective Study.

The success of osseointegration is influenced by several factors that affect bone metabolism and by certain systemic medications. Selective serotonin reuptake inhibitors (SSRIs) have been previously suggested to be among these medications. This study aims to investigate the association between systemic intake of SSRIs and failure of osseointegration in patients rehabilitated with dental implants. A retrospective cohort study was conducted, including a total of 2055 osseointegrated dental implants in 631 patients (109 implants in 36 SSRI \users and 1946 in 595 nonusers). Predictor and outcome variables were SSRI intake and osseointegration failure, respectively. The data were analyzed with Mann-Whitney test or Fisher exact test accordingly. Both patient-level and implant-level models were implemented to evaluate the effect of SSRI exposure on the success of osseointegration of dental implants. Median duration of follow-up was 21.5 months (range = 4-56 months) for SSRI users and 23 months (range -60 months) for nonusers ( P = .158). Two of 36 SSRI users had 1 failed implant each; thus, the failure rate was 5.6%. Eleven nonusers also had 1 failed implant each; thus, the failure rate was 1.85%. The difference between the 2 groups failed to reach statistical significance at patient and implant levels ( P = .166, P = .149, respectively). The odds of implant failure were 3.123 times greater for SSRI users compared with nonusers. Patients using SSRIs were found to be 3.005 times more likely to experience early implant failure than nonusers. The results of this study suggest that SSRIs may lead to increase in the rate of osseointegration failure, although not reaching statistical significance.

Novel Technique for Reconstruction of the Severely Resorbed Posterior Maxillae: Tuberosity-Flip Approach.

PURPOSE: This report describes a novel technique that allows for 3-dimensional augmentation of localized bone defects of the posterior maxilla and simultaneous implant placement by means of using the maxillary tuberosity as a block graft. MATERIALS AND METHODS: The residual bone in maxillary tuberosity is harvested as a whole. The recipient site and the bone graft are prepared with compatible implant drills. The bone graft is flipped to fit the defect and fixated in place using the dental implant, which anchors both the graft and the subantral bone. RESULTS: The defect of the posterior maxilla is reconstructed with autogenous bone harvested from maxillary tuberosity, and simultaneous implant placement is achieved. CONCLUSION: The proposed technique enables the clinician to reconstruct alveolar defects of the posterior maxilla without the need for an additional donor site and simultaneously place dental implants.

Is History of Periodontitis a Risk Factor for Peri-implant Disease? A Pilot Study.

PURPOSE: The aim of this pilot study was to evaluate clinical outcomes of implant treatment in periodontally compromised patients. MATERIALS AND METHODS: Partially edentulous patients who were diagnosed and treated for chronic periodontitis and later rehabilitated with implant-supported single crowns or fixed partial dentures were enrolled in this study. At the final follow-up, data on probing pocket depth and bleeding on probing were collected, and changes in peri-implant bone levels were assessed on periapical radiographs. Accordingly, patients were categorized into peri-implant disease-free (PID-free), peri-implant mucositis (PIM), or peri-implantitis (PI) groups. Additionally, information on the history of systemic diseases was obtained and correlated with the findings. RESULTS: Seven females and six males with a mean age of 55.2 (standard deviation [SD] ± 8.38) years were included in this study. Fifty-five implants were placed in 13 partially edentulous patients with a history of chronic periodontitis. The mean follow-up in the study was 35.1 (SD ± 2.40) months. No implants were lost in the 13 patients, for a cumulative survival of 100%. PI was confirmed in 3 patients and PIM in 8 patients, while 2 patients were found to be PID-free. Diabetes and hypertension were found to be the predominant systemic factors among patients affected by peri-implant diseases. CONCLUSION: Patients with a history of periodontitis are at considerable risk of being affected by peri-implant mucositis, if not by peri-implantitis.

Comparative assessment of 3D reconstruction technique and Cavalieri's principle in predicting the mandibular bone defect volumes.

PURPOSE: The objective of this study was to compare the accuracy of the Cavalieri's principle and 3D reconstruction in predicting the volume of a bony defect. MATERIALS AND METHODS: Defects of the same approximate size were created on nine artificial mandibles. The actual volume of the defect on each mandible was measured by water displacement, and served as the control. Each mandible was then scanned using a CBCT and volume measurements were made for each defect using two techniques: Cavalieri's principle and 3D reconstruction. For each defect, the volume obtained by each of the two techniques was compared to the control volume using the analysis of variances (ANOVA) with p<0.05. RESULTS: ANOVA between the control, 3D reconstruction and Cavalieri's principle groups showed no statistically significant differences (p=.058). When the control group was further analyzed by Dunnett's post-hoc test, the results from Cavalieri's principle were found to be statistically different than the control group (p=.035), whereas the results of 3D reconstruction technique did not reach the level of significance (p=.523). CONCLUSION: Cavalieri's principle significantly underestimates the actual control volume, and is less accurate than the 3D reconstruction technique. The 3D reconstruction method is a reliable technique in measuring volume of bony defects.

Does Third Molar Surgery Alter Cardiac Parameters? A Retrospective Study

Objective: To investigate perioperative changes in the cardiac parameters of anxiety, which are blood pressure and heart rate, in patients undergoing surgical extraction of third molars. Material and Methods: Patients who reported anxiety before scheduled procedures were monitored for cardiac parameters before, during and after the surgery. The obtained data were analyzed to determine if there is a certain pattern of change within these values in systemically healthy patients. Alterations in selected parameters with regard to duration and difficulty of operation were also studied. IBM SPSS Statistics was used for data analysis. Repeated-measures of analysis of variance (ANOVA), paired samples t-test and Kruskal-Wallis tests were applied and a significance level of 5% was assessed. Results: Difficulty was categorized as minimally, moderately or very difficult in 9, 28 and 3 patients respectively. Mean operation time was 36.18 minutes with a range of 8 to 91 minutes. Operation time showed no variations with different levels of difficulty (p = 0.268). No statistical differences in any of the parameters listed above could be identified. Conclusion: Despite the common belief that dental procedures initiate anxiety, this study reveals that physiological parameters of anxiety show no significant changes over the course of third molar surgery, likewise difficulty and duration of surgery do not cause noteworthy changes in these parameters.