Osteonecrosis of the Jaw in a Patient Presenting With Post-Transplantation Lymphoproliferative Disorder Treated With Rituximab: A Case Report.

Osteonecrosis of the jaw (ONJ) is a rare but potentially severe condition that can be induced by specific treatments. We report the case of a 69-year-old male kidney transplant recipient who presented with ONJ 5 years after transplantation. The patient presented with ulcerations of the oral mucosa related to post-transplantation lymphoproliferative disorder, which was treated with rituximab. Subsequently, ONJ developed. Although rituximab treatment cannot be firmly established as the cause of this condition, similar cases of ONJ have been reported after treatment with this monoclonal antibody. This case raises a potential link between rituximab treatment and ONJ and prompts further studies to investigate the potential impact of rituximab on bone angiogenesis.

Impact of Orthodontic Gap Closure versus Prosthetic Replacement of Missing Maxillary Lateral Incisor on Dental Arch Relationships and Symmetry in 212 Patients with Cleft Palate: Retrospective Study.

BACKGROUND: Maxillary lateral incisors are frequently missing in patients with cleft lip and/or palate. The aim of this study was to assess how orthodontic gap closure or prosthetic rehabilitation of the missing maxillary lateral incisor affected dental arch relationships and symmetry at the end of treatment. The authors also aimed to determine the effect of the level of oral hygiene on the decision made to manage the missing maxillary lateral incisor gap. METHODS: A descriptive, retrospective cohort study including all patients with cleft lip and/or palate born between 1980 and 1999 and treated at Nantes Cleft Center was performed. Patients presenting unilateral or bilateral missing maxillary lateral incisors were reviewed. Data on management of the missing incisor gap, dental arch relationships, symmetry, and level of oral hygiene were collected. RESULTS: A total of 486 patients with cleft lip and/or palate were reviewed, including 212 patients with unilateral or bilateral missing maxillary lateral incisors. When compared with orthodontic gap closure, prosthetic replacement of the gap was associated with better final dental arch relationships (59.8 percent versus 10.3 percent; p < 0.01) and better dental arch symmetry (88.1 percent versus 44.0 percent; p < 0.01) for patients with unilateral missing incisors but not for patients with bilateral missing incisors. A higher level of oral hygiene was associated with more cases of prosthetic replacement for patients with unilateral missing incisors ( p = 0.03) but had no effect for patients with bilateral missing incisors. CONCLUSION: Prosthetic replacement of the missing maxillary lateral incisor gap provided better functional and aesthetic results for patients with cleft lip and/or palate presenting with unilateral missing maxillary lateral incisor.

A Review of 30 Years of Alveolar Bone Grafting in the Mixed Dentition Using a Standardized Protocol in Western Australia.

BACKGROUND: Outcomes for a continuously applied alveolar bone grafting protocol, established in 1982, are reported and compared to previously published outcomes from the authors' unit and elsewhere. METHODS: A descriptive, retrospective cohort study of alveolar bone grafting outcomes at a tertiary referral cleft center was performed. Records of all alveolar bone grafts between 2002 and 2014 were reviewed (224 grafts). Three-year postoperative periapical radiographs were evaluated using the Bergland, Kindelan, and standardized way to assess graft scores by an external rater. Incomplete records, a syndromic diagnosis, or primary surgery performed elsewhere resulted in 123 grafts being excluded, leaving 101 grafts for assessment. The distribution of scores was compared to the authors' previous studies and international reports. The authors also tested for any impact on the outcome based on cleft type, laterality, timing for incisor or canine eruption, and surgeon experience. RESULTS: A total of 95.6 percent of applicable grafts (66 of 69) were considered "successful" by Bergland scores and 96 percent by Kindelan scores. Eighty-nine percent of grafts were "very good" based on standardized way to assess graft score. No significant differences were detected in outcomes based on timing, cleft type, or laterality. Surgeon experience had a significant impact (p < 0.05) on outcome for Bergland and Kindelan scores. Distribution of Bergland scores did not differ from the authors' earlier studies demonstrating consistent outcomes for over 30 years. CONCLUSIONS: The Western Australian alveolar bone grafting protocol has consistently achieved a very high success rate (96 percent) for over 30 years despite multiple staff changes. These results compared well with best-reported outcomes from worldwide cleft centers. Surgeon training and experience were significant in achieving these outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.