Conservative treatment of children with chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible.

Chronic diffuse sclerosing osteomyelitis (DSO) of the mandible is a rare disease of unknown aetiology. It has been suggested that overuse of the masticatory muscles, tendoperiostitis (TP), is a contributing factor for DSO. Therefore, we tested this hypothesis by treating consecutive children with conservative therapy. All patients were treated with conservative therapy, comprising occlusal splint therapy, physiotherapy, and/or disease counselling. Pain intensity on a visual analogue scale (VAS) and pain frequency in number of days per 3 months were recorded before the start of treatment, and at 3, 6, and 12 months after treatment initiation. Eleven children (seven girls, four boys, mean age: 11.55 ± 1.97 years) were included in this study. Six patients showed a decrease in pain intensity and pain frequency over time and they continued with conservative therapy. For the remaining five patients, bisphosphonate administration was initiated because of persistent severe pain - one after 3 months of conservative therapy, and the other four after 1 year of conservative therapy. The pain complaints of patients with DSO/TP decreased with conservative therapy, and 55% did not require additional therapy. This suggests that DSO/TP of the mandible is precipitated by muscle overuse.

One versus two titanium screw fixation of autologous onlay bone grafts in the anterior maxilla: a randomised histological pilot study.

PURPOSE: The aim of this study was to compare the histological presentation of local mandibular bone grafts fixed with one screw or two screws in buccal anterior maxillary augmentation procedures. STUDY DESIGN: Local buccal defects of the anterior maxilla were reconstructed in 12 patients (mean age 47 ± 17 years, range 18 to 67 years) using autogenous cortical bone grafts from the mandibular retromolar area. Patients were randomised using envelopes containing study identification numbers. After randomisation, two screws were used to fix the bone graft in six patients, and one screw was used in the other six patients. Four months later during implant placement, a bone biopsy was taken with a trephine. The biopsies were processed for light microscope evaluation. RESULTS: The mean total bone volume varied from 35.8% to 72.4% (mean 51.1% ± 13.4%) in the one-screw group and from 28.7% to 56.6% (mean 40.8% ± 11.5%) in the two-screw group. The mean non-vital bone volume ranged from 0% to 2% (mean 0.9% ± 0.9%) in the one-screw group and from 0% to 8.9% (mean 2.2% ± 3.7%) in the two-screw group. The mean osteoid volume ranged from 2.2% to 7.3% (mean 5.4% ± 1.7%) in the one-screw group and from 2.0% to 16.4% (mean 7.3% ± 5%) in the two-screw group. CONCLUSION: No significant histological differences were found between the use of one or two screws to fix an autologous bone graft in buccal bone grafting procedures prior to implant placement.