摘要
Background@#Although several techniques for the treatment of ulnar impaction syndrome (UIS) have been introduced, there have still been reports on various complications such as delayed union, nonunion, refracture, wrist pain, plate irritation, and chronic regional pain syndrome. This study aimed to compare the differences in radiological and clinical outcomes of patients in which intramedullary bone grafting was performed in addition to plate stabilization with those without additional bone grafting during ulnar shortening osteotomies (USOs). @*Methods@#Between November 2014 and June 2021, 53 wrists of 50 patients with idiopathic UIS were retrospectively reviewed. Patients were divided into 2 groups according to whether intramedullary bone grafting was performed. Among the 53 wrists, USO with an intramedullary bone graft was performed in 21 wrists and USO without an intramedullary bone graft was performed in 32 wrists. Demographic data and factors potentially associated with bone union time were analyzed. @*Results@#There was no significant difference between the 2 groups when comparing postoperative radioulnar distance, postoperative ulnar variance, amount of ulnar shortening, and postoperative Disabilities of the Arm, Shoulder and Hand score. Compared to the without-intramedullary bone graft group, bone union time of the osteotomy site was significantly shortened, from 8.8 ± 3.0 weeks to 6.7 ± 1.3 weeks in the with-intramedullary bone graft group. Moreover, there were no cases of nonunion or plate-induced symptoms. Both in univariable and multivariable analyses, intramedullary bone grafting was associated with shorter bone union time. @*Conclusions@#USO with an intramedullary bone graft for idiopathic UIS has favorable radiological and clinical outcomes. The advantage of this technique is the significant shortening of bone union time.
摘要
Purpose@#To investigate the interaction of corneal endothelial cells (CECs) with corneal stromal cells (CSCs) on the healing of chemically induced corneal endothelial injury. @*Methods@#Twenty-five rabbits were divided into two groups: rabbits exposed to NaOH and controls. Rabbits were clinically evaluated and sacrificed at 1 day, 1 week, 2 weeks, and 4 weeks after endothelial injury. Corneal endothelial cells and corneal stromal cells were cultured and the wound healing rate of the corneal endothelium and cytokines in the culture medium were analyzed with and without co-culture in the Transwell system. @*Results@#Corneal edema and opacity scores were higher in all rabbits exposed to NaOH than in controls. Corneal endothelial apoptosis with little effect on CSCs was observed in rabbits exposed to NaOH at day 1. Two weeks after injury, CECs migrated from the periphery. CSCs were aligned in parallel to Descemet's membrane, which exhibited the presence of CECs. Transforming factor-β1 and interleukin-6 secretion was lower in the co-culture system than in individual cultures of CECs or CSCs. @*Conclusions@#These results revealed intracameral NaOH injection is a model of corneal endothelial injury with minimal impact on the stroma. Communication between CECs and CSCs during wound healing may lead to the modulation of cytokine production, which is necessary for an enhanced healing process of corneal endothelial injury.
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Purpose@#To compare the accuracy of nine intraocular lens (IOL) power calculation formulas. @*Methods@#This study is retrospective consecutive case series. A total of 228 eyes of 228 patients who underwent uncomplicated cataract surgery between October 2015 and March 2021 were included. The accuracy of nine IOL calculation formulas (Kane, Emmetropia verifying optical version, Hill-radial basis function, Olsen, Barrett Universal II [Barrett II], Haigis, Holladay, Hoffer, and SRK/T) was compared and analyzed using differences between the predicted refractive power and actual refractive power at 2 months after cataract surgery. Mean prediction error (ME), mean absolute error (MAE), median absolute error (MedAE), and the percentage of eyes that were within ± 0.50 diopters (D), ± 0.75 D, and ± 1.00 D of the target refraction were calculated for each formula. @*Results@#For all eyes, Haigis formula was the most accurate in MAE, followed by Barrett II formula. Comparing the probability of MAE within 0.50 D, Haigis formula showed the highest accuracy. A total of 20 eyes of 20 patients had more than 25 mm axial length. Regarding MAE, Hoffer Q was the most accurate, followed by the Olsen formula. Comparing the probability of MAE within 0.50 D, the Hoffer Q formula was the most accurate. A total of 24 eyes of 24 patients had more than 46 D keratometry. Regarding MAE and MedAE, Haigis was the most accurate, followed by the Barrett II formula. Comparing the probability of MAE within 0.5 D, Holladay formula was the most accurate. @*Conclusions@#Barrett II and Haigis formulas showed greater accuracy for all patients when we determined IOL power before cataract surgery. Hoffer Q, Olsen, and Barrett II formulas showed higher accuracy for long axial length. And Haigis and Barrett II were the most accurate for steep keratometry.
摘要
Background@#This study aimed to evaluate the clinical outcomes of three-column reconstruction of the lower leg using a singlebarrel contralateral vascularized fibular graft (VFG), medial locking plate, and the ipsilateral fibula for the repair of large tibial defects after tumor resection. @*Methods@#In this retrospective study, we reviewed 12 patients who underwent three-column reconstruction using a single-barrel contralateral VFG, medial locking plate, and the ipsilateral fibula between June 1996 and May 2020. These patients had large tibial bone defects following tumor resection. The mean age of the patients was 26.3 years (range, 11–63 years), and 7 of them were women. The mean follow-up period was 104.8 months (range, 26–284 months). The mean size of the tibial bone defect after tumor resection was 17.8 cm (range, 11–26.8 cm). The clinical and radiological outcomes were evaluated at the final follow-up. @*Results@#All patients survived beyond the final follow-up without recurrence of the primary bone tumor. The mean time from reconstruction to bony union at both host-graft junctions was 12.9 months (range, 4–36 months). The mean Musculoskeletal Tumor Society score was 82.3% (range, 60%–97%). All tibial defects were reconstructed with adequate bone healing. There were 4 cases of stress fracture and graft failure; these were resolved by using longer plates and more screws. All patients were ambulatory without assistance and showed no permanent complications. @*Conclusions@#Large tibial defects that occur after tumoral resection can be effectively reconstructed by three-column reconstruction using a medial locking plate, an inlay single-barrel VFG harvested from the contralateral side, and the intact ipsilateral fibula.This technique permits early weight-bearing before fibular hypertrophy and bony union.
摘要
Purpose@#Internal fixation after a femoral neck fracture (FNF) is one of the conventional treatment options for the young and active elderly patients. However, fixation failure of internal fixation is a probable complication. The treatment of fixation failure after a primary internal fixation of the FNF remains a challenge. @*Materials and Methods@#Between July 2002 and March 2017, 83 patients who underwent internal fixation after FNF were retrospectively analyzed. Radiological assessments, including Pauwels’ angle, fracture level, reduction quality, and bone union, were measured, preoperatively and postoperatively.Moreover, intraoperative variables such as time to surgery, surgical time, and estimated blood loss were also evaluated. @*Results@#The patients were divided into the fixation failure and the non-failure groups. Among the 83 patients, 17 cases (20.5%) of fixation failure after the primary internal fixation of the FNF were identi-fied. When comparing the two groups according to the radiographic data, Pauwels’ angle and the reduction quality based on Garden’s angle showed significant differences (p<0.001). Moreover, when comparing the intraoperative variables, unlike the surgical time and estimated blood loss, significant differences were noted in the time interval from injury to surgery and specifically in whether the surgery was performed within 12 hours after injury (p<0.001). @*Conclusion@#Pauwels’ angle, reduction quality, and time to surgery are the major factors that can predict the possibility of internal fixation failure of the FNF. Early and accurate anatomical reduction is needed to decrease complications after the internal fixation of the FNF.
摘要
Objective@#This study compared the epidemiological changes before and after the coronavirus disease 2019 (COVID-19) outbreak in out-of-hospital cardiac arrest patients in a single center. This study analyzed the long-term impact of the COVID-19 pandemic. @*Methods@#Eight hundred and sixty-one out-of-hospital cardiac arrest patients were included in the analysis. Out-of-hospital cardiac arrest patients from January 20, 2018, to January 19, 2020, were used as the control group, and those between January 20, 2020, and January 19, 2022, were used as the study group. The collected data were evaluated using a Student t-test, chi-square test, and logistic regression analysis. @*Results@#During the COVID-19 pandemic, the number of cardiac arrests witnessed at the field level decreased. In the transport stage, mechanical CPR increased and the method for securing the airway had many changes. Transport distances, response times, and on-scene times have increased. Survival discharge from hospital decreased from 9.5% to 5.8% (P=0.045), and good neurological outcomes decreased from 8% to 4% (P=0.017). According to multivariate logistic regression analysis, good neurological outcomes (adjusted odds ratio, 0.299; 95% confidence interval, 0.116-0.772) were significantly lower after the onset of COVID-19. @*Conclusion@#With the outbreak of COVID-19, there have been many changes in the pre-hospital stages of out-of-hospital cardiac arrest patients, and the neurological outcomes have also deteriorated. This continued throughout the pandemic period.
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BACKGROUND: The isolated liner and head exchange procedure has been an established treatment method for polyethylene wear and osteolysis when the acetabular component remains well fixed. In this study, the mid-term results of this procedure were evaluated retrospectively. METHODS: Among the consecutive patients operated on from September 1995, two patients (three hips) were excluded because of inadequate follow-up, and the results of remaining 34 patients (34 hips) were evaluated. There were 20 men and 14 women with a mean age of 49 years. A conventional polyethylene liner was used in 26 cases and a highly cross-linked polyethylene liner was used in eight cases. In three cases, the liner was cemented in a metal shell because a compatible liner could not be used. RESULTS: After a follow-up of 5 to 20.2 years, re-revision surgery was necessary in 10 cases (29.4%): in eight for wear and osteolysis at 55 to 101 months after liner exchange and in two for acetabular loosening at 1 and 1.5 years after liner exchange. Re-revision surgery included all component revision (four cases), cup revision (four cases), and liner exchange (two cases). In all re-revision cases, a conventional polyethylene liner was used initially. There was no failure in the cases in which a highly cross-linked polyethylene liner was used. CONCLUSIONS: The results of this study suggest that isolated acetabular liner exchange is a reasonable option for wear and osteolysis when the metal shell is well fixed. More promising long-term results are expected with the use of highly cross-linked polyethylene liners.
Subject(s)
Female , Humans , Male , Acetabulum , Bone Screws , Follow-Up Studies , Fracture Fixation , Head , Humerus , Methods , Osteolysis , Polyethylene , Retrospective Studies摘要
BACKGROUND: This study examined the osteoinductive activity of demineralized dentin matrix (DDM) from human and polydeoxyribonucleotide (PDRN) for nude mice. METHODS: Twenty healthy nude mice, weighing about 15~20 g, were used for the study. DDM from human and PDRN were prepared and implanted subcutaneously into the dorsal portion of the nude mice. The nude mice were sacrificed at 1, 2, and 4 weeks after grafting and evaluated histologically by hematoxylin-eosin and Masson's trichrome staining. The specimens were also evaluated via a histomorphometric study. RESULTS: The DDM and PDRN induced new bone, osteoblasts, and fibroblasts in soft tissues. The histological findings showed bone-forming cells like osteoblasts and fibroblasts at 1, 2, and 4 weeks. New bone formation was observed in the histomorphometric study. In particular, the ratio of new bone formation was the highest at 2 weeks compared with the first week and fourth week. CONCLUSIONS: In this study, we showed that the PDRN used in this experimental model was able to induce bone regeneration when combined to the DDM.
Subject(s)
Animals , Humans , Mice , Bone Regeneration , Dentin , Fibroblasts , Mice, Nude , Models, Theoretical , Osteoblasts , Osteogenesis , Transplants摘要
BACKGROUND: The aim of this study was to evaluate the effect of autogenous tooth bone as a graft material for regeneration of bone in vertical bony defects of the minipigs. MATERIAL AND METHODS: Six minipigs were used in this study. Four molars were extracted in the right mandibular dentition and sent to the Korea Tooth Bank for fabrication of autogenous tooth bone. Ten days later, each extraction site was implanted with MS Implant Narrow Ridge 3.0 x 10mm fixture (Osstem, Seoul, Korea) after standardized 2mm-sized artificial vertical bony defect formation. Pineappleshaped Root-On type autogenous tooth bones were applied to the vertical defects around the neck area of the posterior three fixtures and the fore-most one was not applied with autogenous bone as a control group. Each minipig was sacrificed at 4, 8, 12 weeks after fixture installation and examined radiologically and histologically. Histological evaluation was done under light microscope with Villanueva osteochrome bone staining with semi-quantitative histomorphometric study. Percentage of new bone over total area (NBF) and bone to implant contact (BIC) ratio were evaluated using digital software for area calculation. RESULT: NBF were 48.15 +/- 18.02%, 45.50 +/- 28.37%, and 77.13 +/- 15.30% in 4, 8, and 12 weeks, respectively for experimental groups. The control group showed 37.00 +/- 11.53%, 32.25 +/- 26.99%, and 1.33 +/- 2.31% in 4,8,12 weeks, respectively. BIC ratio were 53.08 +/- 19.82%, 45.00 +/- 28.37%, and 75.13 +/- 16.55% in 4,8,12 weeks, respectively. Those for the control groups were 38.33 +/- 6.43%, 33.50 +/- 29.51 %, and 1.33 +/- 2.31% in 4, 8, 12 weeks, respectively. CONCLUSION: Autogenous tooth bone showed higher score than control group in NBF and BIC in all the data encompassing 4,8,12 weeks specimens, but statistically significant only 12 weeks data in both NBF and BIC.
Subject(s)
Dentition , Korea , Molar , Neck , Osteogenesis , Regeneration , Seoul , Swine, Miniature , Tooth , Transplants摘要
OBJECTIVES: The goal of this study was to determine the correlation of clinicopathological factors and the up-regulation of vascular endothelial growth factor (VEGF) expression in oral squamous cell carcinoma. MATERIALS AND METHODS: Immunohistochemical staining of VEGF and quantitative real-time polymerase chain reaction (RT-PCR) of VEGF mRNA were performed in 20 specimens from 20 patients with oral squamous cell carcinoma and another 20 specimens from 20 patients with carcinoma in situ as a controlled group. RESULTS: The results were as follows: 1) In immunohistochemical study of poorly differentiated and invasive oral squamous cell carcinoma, high-level staining of VEGF was observed. Significant correlation was observed between immunohistochemical VEGF expression and histologic differentiation, tumor size of specimens (Pearson correlation analysis, significance r>0.6, P<0.05). 2) In VEGF quantitative RT-PCR analysis, progressive cancer showed more VEGF expression than carcinoma in situ. Paired-samples analysis determined the difference of VEGF mRNA expression level between cancer tissue and carcinoma in situ tissue, between T1 and T2-4 (Student's t-test, P<0.05). CONCLUSION: These findings suggest that up-regulation of VEGF may play a role in the angiogenesis and progression of oral squamous cell carcinoma.
Subject(s)
Humans , Carcinoma in Situ , Carcinoma, Squamous Cell , Immunohistochemistry , Real-Time Polymerase Chain Reaction , RNA, Messenger , Up-Regulation , Vascular Endothelial Growth Factor A摘要
Osteopathia striata with cranial sclerosis (OS-CS) is characterized by linear bone dysplasia at the long bone radiographically and sclerotic change at the cranium. The purpose of this case report is to study the symptoms and treatments of osteomyelitis in a patient with OS-CS. A 41-year-old patient had pus discharge from a fistula at the mental region and increase in radiolucencies with sequestra in panoramic radiograph images. Computed tomography (CT) as well as radiograph images for the whole skeleton were taken. The patient was diagnosed with OS-CS. Sequestrectomy and fistulectomy were performed. The patient recovered and no relapse occurred within six months after surgery. For diagnosis of OS-CS, CT and additional radiograph images for the whole skeleton are required. Because of the increased bone density, this patient is prone to relapse after sequestrectomy. Therefore, the surgeon must minimize trauma with the least incision and exfoliation, and preoperative antibiotics.
Subject(s)
Adult , Humans , Anti-Bacterial Agents , Bone Density , Bone Diseases, Developmental , Diagnosis , Fistula , Osteomyelitis , Osteosclerosis , Recurrence , Sclerosis , Skeleton , Skull , Suppuration摘要
PURPOSE: This study examined the osteoinductive activity of demineralized human dentin matrix for nude mice. METHODS: Twenty healthy nude mice weighing about 15 to 20 g were used for study. Demineralized human dentin matrix was prepared and implanted into the dorsal portion of nude mice (subcutaneous), which were sacrificed at two, four, and eight weeks after demineralized dentin matrix grafting and evaluated histologically by H&E and Masson trichrome staining. The specimens were also evaluated histomorphometrically. RESULTS: The demineralized dentin matrix induced bone and cartilage formation independently in soft tissues. Histological examination showed bone-forming cells such as osteoblasts and fibroblasts at two, four, and eight weeks. CONCLUSION: These results suggest that demineralized human dentin matrix has osteoinductive ability, and is a good alternative to autogenous bone graft materials.
Subject(s)
Animals , Humans , Mice , Cartilage , Dentin , Fibroblasts , Mice, Nude , Muscles , Osteoblasts , Transplants摘要
OBJECTIVES: Bisphosphonates (BP) are widely used in medicine for inhibiting bone resorption; however bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a major side effect of BP. To date, there have been no specific reports on the incidence of BRONJ among Koreans. This study investigated the preliminary results from a nationwide survey of BRONJ in the Departments of Oral and Maxillofacial Surgery (OMFS) at individual training hospitals. MATERIALS AND METHODS: A total of 15 OMFS departments (10 from dental schools, 4 from medical schools, and 1 from a dental hospital) participated in a multi-centric survey. This study assessed every BRONJ case diagnosed between January 2010 and December 2010. The patient age and BP type were evaluated. RESULTS: A total of 254 BRONJ cases were collected. The majority of BRONJ cases were associated with oral BP therapy, while 21.8% of the cases were associated with intravenous administration. Alendronate was the drug most frequently related to BRONJ (59.2% of cases), followed by risedronate (14.3%) and zolendronate (17.0%). The average age of BRONJ patients was 70.0+/-10.1 years, with a range of 38-88 years of age. With the number of BP patients in Korea reported to be around 600,000 in 2008, the estimated incidence of BRONJ is at least 0.04% or 1 per 2,300 BP patients. CONCLUSION: The results suggest that the estimated incidence of BRONJ in Korea is higher than the incidence of other countries. Future prospective studies should be carried out to investigate the exact epidemiological characteristics of BRONJ in Korea.
Subject(s)
Humans , Administration, Intravenous , Alendronate , Bisphosphonate-Associated Osteonecrosis of the Jaw , Data Collection , Diphosphonates , Etidronic Acid , Incidence , Jaw , Korea , Osteonecrosis , Schools, Dental , Schools, Medical , Surgery, Oral , Risedronic Acid摘要
OBJECTIVES: Bisphosphonates (BP) are widely used in medicine for inhibiting bone resorption; however bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a major side effect of BP. To date, there have been no specific reports on the incidence of BRONJ among Koreans. This study investigated the preliminary results from a nationwide survey of BRONJ in the Departments of Oral and Maxillofacial Surgery (OMFS) at individual training hospitals. MATERIALS AND METHODS: A total of 15 OMFS departments (10 from dental schools, 4 from medical schools, and 1 from a dental hospital) participated in a multi-centric survey. This study assessed every BRONJ case diagnosed between January 2010 and December 2010. The patient age and BP type were evaluated. RESULTS: A total of 254 BRONJ cases were collected. The majority of BRONJ cases were associated with oral BP therapy, while 21.8% of the cases were associated with intravenous administration. Alendronate was the drug most frequently related to BRONJ (59.2% of cases), followed by risedronate (14.3%) and zolendronate (17.0%). The average age of BRONJ patients was 70.0+/-10.1 years, with a range of 38-88 years of age. With the number of BP patients in Korea reported to be around 600,000 in 2008, the estimated incidence of BRONJ is at least 0.04% or 1 per 2,300 BP patients. CONCLUSION: The results suggest that the estimated incidence of BRONJ in Korea is higher than the incidence of other countries. Future prospective studies should be carried out to investigate the exact epidemiological characteristics of BRONJ in Korea.
Subject(s)
Humans , Administration, Intravenous , Alendronate , Bisphosphonate-Associated Osteonecrosis of the Jaw , Data Collection , Diphosphonates , Etidronic Acid , Incidence , Jaw , Korea , Osteonecrosis , Schools, Dental , Schools, Medical , Surgery, Oral , Risedronic Acid摘要
Subject(s)
Animals , Humans , Mice , Biopsy , Blotting, Western , Bone Substitutes , Crowns , Dentin , Mice, Nude , Osteogenesis , Sodium , Tissue Donors , Tooth , Transplants摘要
With successful extraction of growth factors and bone morphogenic proteins (BMPs) from mammalian teeth, many researchers have supported development of a bone substitute using tooth-derived substances. Some studies have also expanded the potential use of teeth as a carrier for growth factors and stem cells. A broad overview of the published findings with regard to tooth-derived regenerative tissue engineering technique is outlined. Considering more than 100 published papers, our team has developed the protocols and techniques for processing of bone graft material using extracted teeth. Based on current studies and studies that will be needed in the future, we can anticipate development of scaffolds, homogenous and xenogenous tooth bone grafts, and dental restorative materials using extracted teeth.
Subject(s)
Bone Substitutes , Dentin , Intercellular Signaling Peptides and Proteins , Proteins , Stem Cells , Tissue Engineering , Tooth , Transplants摘要
INTRODUCTION: Auto-tooth bone graft material consists of 55% inorganic hydroxyapatite (HA) and 45% organic substances. Inorganic HA possesses properties of bone in terms of the combining and dissociating of calcium and phosphate. The organic substances include bone morphogenetic protein and proteins which have osteoinduction capacity, as well as the type I collagen identical to that found in alveolar bone. Auto-tooth bone graft material is useful as it supports excellent bone regeneration capacity and minimizes the possibility of foreign body reaction,genetic diseases and disease transmission. MATERIALS AND METHODS: Implant placement combined with osteoinductive regeneration,preservation of extraction socket, maxillary sinus augmentation, and ridge augmentation using block type,powder type, and block+powder type autobone graft materialwere performed for 250 patients with alveolar bone defect and who visited the Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University from September 2009 to August 2011. RESULTS: Clinical assessment: Among the 250 patients of auto-tooth bone graft, clinical assessment was performed for 133 cases of implant placement. The average initial stabilization of placed implants was 74 implant stability quotient (ISQ). Radiological assessment: The average loss of crestal bone in the mandible as measured 6 months on the average after the application of prosthesis load was 0.29 mm, ranging from 0 mm to 3.0 mm. Histological assessment: In the histological assessment, formation of new bone, densified lamellated bone, trabecular bones, osteoblast, and planting fixtures were investigated. CONCLUSION: Based on these results, we concluded that auto-tooth bone graft material should be researched further as a good bone graft material with osteoconduction and osteoinduction capacities to replace autogenous bone, which has many limitations.
Subject(s)
Humans , Bone Morphogenetic Proteins , Bone Regeneration , Calcium , Collagen Type I , Dentistry , Durapatite , Foreign Bodies , Mandible , Maxillary Sinus , Osteoblasts , Plants , Prostheses and Implants , Proteins , Surgery, Oral , Transplants摘要
INTRODUCTION: Bisphosphonates is used widely for the treatment of the Paget's disease, multiple myeloma, bone metastases of malignant tumors with the prevention of pain and their pathological fracture. However, it was recently suggested that bisphosphonates related osteonecrosis of the jaw (BRONJ) is a side effect of bisphosphonate use. MATERIALS AND METHODS: Twenty-four individuals, who were referred to the Department of Oral and Maxillofacial surgery, Dankook University Dental Hospital, were selected from those who had exposed bone associated with bisphosphonates from January, 2005 to December, 2009 according to the criteria of American Association of Oral and Maxillofacial Surgeons (AAOMS) for BRONJ. The patients group consisted of 7 males and 17 females between the age of 46 to 78 years (average 61.8 years). Each patient had panoramic imaging, computed tomography (CT), whole body bone scanning performed for a diagnosis and biopsy sampling from the necrotizing tissue. C-terminal cross-linking telopeptide of type I collagen (CTX) level of patients who had undergone surgical intervention was measured 7 days before surgery. RESULTS: The main cause of bone exposure was post-extraction (15), chronic periodontitis (4), persistent irritation of the denture (3). Twenty people had undergone BRONJ treatment for two to eight months except for 4 people who had to maintain the bisphosphonates treatment to prevent a metastasis and bone trabecular pain with medical treatment. When the bisphosphonate treatment was suspended at least for 3 months and followed up according to the AAOMS protocols, the exposed necrotizing bones were found to be covered by soft tissue. CONCLUSION: Prevention therapy, interruption of bisphophonates for at least 3 months and cooperation with the physician for conservative treatment are the essential for treating BRONJ patient with high risk factors. The CTX level of BRONJ patients should be checked before undergoing surgical intervention. Surgical treatments should be delayed in the case of a CTX level <150 pg/mL.