No increased risk of osteonecrosis of the jaw in osteoporotic patients with dental implants: a nationwide cohort study.

OBJECTIVES: The occurrence of implant-associated osteonecrosis of the jaw (ONJ) has been reported in osteoporotic patients, particularly in association with bisphosphonate therapy. This study aimed to investigate the risk of implant surgery and implant presence for ONJ occurrence in osteoporotic patients longitudinally. METHODS: Based on Korean National Health Information Database, subjects over the age of 65 who were diagnosed with osteoporosis between July 2014 and December 2016 were included. The implant group included subjects who had undergone dental implant surgery between January 2017 and December 2017, while the control group included those who had no history of dental implants. The primary outcome was the occurrence of ONJ, and the date of final follow-up was December 2020. RESULTS: A total of 332,728 subjects with osteoporosis were included in the analysis: 83,182 in the implant group and 249,546 in the control group. The risk of ONJ among those who had undergone implant surgery (risk of implant surgery-associated ONJ) was not higher than that among those without implant surgery. The risk of ONJ among those with implants (risk of implant presence-associated ONJ) was lower than that among those without implants. Even in subjects with a history of bisphosphonates, steroids, periodontitis, or tooth extraction, those who had undergone implant surgery or had implants did not have a higher ONJ risk than those who had not undergone surgery or did not have implants; rather, they showed a lower risk. CONCLUSIONS: The results may suggest that dental implants are not associated with an increased risk of ONJ. A further study on whether dental implants are associated with lower ONJ risk is needed. CLINICAL RELEVANCE: Dental implants did not increase the risk of ONJ development in osteoporotic patients, even with a history of bisphosphonates. This may suggest that the risk profiles for ONJ occurrence between selective insertion of dental implants and other dentoalveolar surgery associated with infectious conditions are different.

Cutting-Edge HEK293T Protein-Integrated Lipid Nanostructures: Boosting Biocompatibility and Efficacy.

Recently, artificial exosomes have been developed to overcome the challenges of natural exosomes, such as production scalability and stability. In the production of artificial exosomes, the incorporation of membrane proteins into lipid nanostructures is emerging as a notable approach for enhancing biocompatibility and treatment efficacy. This study focuses on incorporating HEK293T cell-derived membrane proteins into liposomes to create membrane-protein-bound liposomes (MPLCs), with the goal of improving their effectiveness as anticancer therapeutics. MPLCs were generated by combining two key elements: lipid components that are identical to those in conventional liposomes (CLs) and membrane protein components uniquely derived from HEK293T cells. An extensive comparison of CLs and MPLCs was conducted across multiple in vitro and in vivo cancer models, employing advanced techniques such as cryo-TEM (tramsmission electron microscopy) imaging and FT-IR (fourier transform infrared spectroscopy). MPLCs displayed superior membrane fusion capabilities in cancer cell lines, with significantly higher cellular uptake. Additionally, MPLCs maintained their morphology and size better than CLs when exposed to FBS (fetal bovine serum), suggesting enhanced serum stability. In a xenograft mouse model using HeLa and ASPC cancer cells, intravenous administration of MPLCs MPLCs accumulated more in tumor tissues, highlighting their potential for targeted cancer therapy. Overall, these results indicate that MPLCs have superior tumor-targeting properties, possibly attributable to their membrane protein composition, offering promising prospects for enhancing drug delivery efficiency in cancer treatments. This research could offer new clinical application opportunities, as it uses MPLCs with membrane proteins from HEK293T cells, which are known for their efficient production and compatibility with GMP (good manufacturing practice) standards.

Effects of daily versus weekly teriparatide for medication-related osteonecrosis of the jaw: A case-control study.

INTRODUCTION: Medication-related osteonecrosis of the jaw (MRONJ) is uncommon but can result in severe destruction of the jaw. This case-control study investigated the therapeutic effects of daily or weekly administration of teriparatide in the management of MRONJ using a cohort for osteonecrosis of the jaw. METHODS: Patients who were diagnosed with MRONJ and consented to teriparatide administration were assigned either to a group of daily injection or of weekly injection and completed a 4-week course of injection preoperatively and at least an 8-week course postoperatively. The control group received either the intraoperative rhBMP treatment (CG_BMP) or no additional perioperative treatment (CG_noBMP). The state of MRONJ was evaluated 2 months (T1) and 6 months (T2) postoperatively for all participants. RESULTS: Either group of daily injection (8.35 weeks ± 1.58; n = 17) or weekly injection (9.17 ± 3.79; n = 12) showed significantly faster healing than those of CG_BMP (14.40 ± 6.08; n = 25) or CG_noBMP (15.79 ± 9.79; n = 39). MRONJ was resolved completely in 24 out of 29 participants who completed the course of teriparatide injections, whereas 46.9% of CG showed delayed resolution. Multiple regression analysis indicated 7.50 times (95% CI, 1.77-31.82) more likelihood of complete resolution of MRONJ for participants with teriparatide injections. CONCLUSION: A course of daily or weekly administration of teriparatide injections may improve treatment outcomes for patients with MRONJ.

Effectiveness of individualized 3D titanium-printed Orthognathic osteotomy guides and custom plates.

BACKGROUND: Computer-aided design/manufacturing (CAD/CAM) technology was developed to improve surgical accuracy and minimize errors in surgical planning and orthognathic surgery. However, its accurate implementation during surgery remains a challenge. Hence, we compared the accuracy and stability of conventional orthognathic surgery and the novel modalities, such as virtual simulation and three-dimensional (3D) titanium-printed customized surgical osteotomy guides and plates. METHODS: This prospective study included 12 patients who were willing to undergo orthognathic surgery. The study group consisted of patients who underwent orthognathic two-jaw surgery using 3D-printed patient-specific plates processed by selective laser melting and an osteotomy guide; orthognathic surgery was also performed by the surgeon directly bending the ready-made plate in the control group. Based on the preoperative computed tomography images and intraoral 3D scan data, a 3D virtual surgery plan was implemented in the virtual simulation module, and the surgical guide and bone fixation plate were fabricated. The accuracy and stability were evaluated by comparing the results of the preoperative virtual simulation (T0) to those at 7 days (T1) and 6 months (T2) post-surgery. RESULT: The accuracy (ΔT1‒T0) and stability (ΔT2‒T1) measurements, using 11 anatomical references, both demonstrated more accurate results in the study group. The mean difference of accuracy for the study group (0.485 ± 0.280 mm) was significantly lower than in the control group (1.213 ± 0.716 mm) (P < 0.01). The mean operation time (6.83 ± 0.72 h) in the control group was longer than in the study group (5.76 ± 0.43 h) (P < 0.05). CONCLUSION: This prospective clinical study demonstrated the accuracy, stability, and effectiveness of using virtual preoperative simulation and patient-customized osteotomy guides and plates for orthognathic surgery.

Serum biomarkers for bisphosphonate-related osteonecrosis of the jaw: a prospective clinical study.

In this prospective study, serum levels of 12 possible biomarkers were compared between osteonecrosis of the jaw (ONJ) and control groups, before and after dentoalveolar surgery. The results suggest that patients with abnormal serum levels of specific biomarkers should be monitored closely for the prevention and early diagnosis of ONJ. INTRODUCTION: Bisphosphonate-related osteonecrosis of the jaw (ONJ) is an adverse effect of long-term bisphosphonate therapy. This study aimed to identify bone biomarkers for ONJ risk assessment and diagnosis. METHODS: This prospective study included patients with histories of bisphosphonate therapy without current ONJ who were in need of dentoalveolar surgery of the jaw area. Serum levels of 12 possible bone markers, selected based on their involvement in ONJ pathogenesis, were compared between ONJ and control groups before dentoalveolar surgery (T0), at 8 postoperative weeks (T1), and at 4 months after diagnosis(T2). RESULTS: Seventy-six patients who met the inclusion criteria were included in the study; 33 were assigned to the ONJ group, and 43 patients without ONJ signs or symptoms after dentoalveolar surgery were assigned to the control group. In the ONJ group, at both T0 and T1, the mean tartrate-resistant acid phosphatase isoform 5b (TRACP 5b) levels were significantly lower and the mean Dickkopf-related protein 1 (DKK1) levels were significantly higher than the corresponding values for the control group. Linear mixed model analysis revealed significant group effects over time for serum TRACP 5b and DKK1 after adjusting for demographic, pharmacological, and diagnostic variables. Lower serum levels of TRACP 5b under a specified cut-off value (≤ 2.899 U/L) at T0 indicated a 20.40-fold increased risk of ONJ development. CONCLUSION: Patients with abnormally low serum levels of TRACP 5b and high serum levels of DKK1 should be monitored closely before and after dentoalveolar surgery for the prevention and early diagnosis of ONJ.

Recovery from chronic periodontal disease is associated with lower risk for incident diabetes.

AIM: The presence of periodontal disease (PD) at a single time point has been suggested as a predictor of diabetes risk, but whether changes in PD status are associated with altered risk of diabetes is yet to be reported on a population scale. This study investigated whether recovery from or development of PD in a population is associated with an altered risk of diabetes occurrence. MATERIALS AND METHODS: Data of subjects who received health screening from 2002 to 2007 were obtained from the National Health Insurance Service-National Health Screening cohort database of Korea. Patients with a history of diabetes were excluded. Changes in PD status were determined from the first two health screenings. Study subjects were divided into four groups according to the changes in PD status: PD-free, PD-recovered, PD-developed, and PD-chronic. The outcome was the occurrence of diabetes. RESULTS: Overall, 111,611 subjects were included for analysis. During a median follow-up of 9.10 years, diabetes developed in 6102 subjects. The adjusted hazard ratios (HRs) for incident diabetes across various PD change groups (in reference to the PD-free group) were as follows: PD-chronic group = 1.096 (95% confidence interval [CI] 1.026-1.170, p = .006); PD-developed group = 1.073 (95% CI 0.993-1.159, p = .075); and PD-recovered group = 1.019 (95% CI 0.945-1.100, p = .622). The subjects who recovered from PD had a lower diabetes risk than those who had consistent PD (adjusted HR 0.930, 95% CI 0.865-1.000, p = .050), whereas those who developed PD had a higher risk of diabetes than those who remained PD-free. CONCLUSION: The longitudinal change in PD status is associated with incident diabetes risk. Future intervention studies are necessary to determine whether PD treatment can prevent incident diabetes.

Medication-related osteonecrosis of the maxilla: Prognosis of oral surgery combined with endoscopic sinus surgery.

OBJECTIVES: To evaluate the effect of functional endoscopic sinus surgery (FESS) on the resolution of maxillary medication-related osteonecrosis of the jaw (MRONJ). PATIENTS AND METHODS: This study included 62 patients diagnosed with MRONJ in the maxillary posterior area with or without maxillary sinusitis (MS). All patients underwent oral surgery. The concomitant MS was evaluated, and if indicated, FESS was performed on the same operation. Follow-up included clinical and radiological examinations at 4 months postoperation. RESULTS: Of the 62 patients, 24 (38.7%) showed no evidence of MS and 38 (61.3%) showed MS. Advanced MRONJ (stage 3), which has bony destruction of the sinus floor and signs of MS according to its definition, was seen in 27 patients (43.5%). In stage 3 MRONJ, patients with combined treatment of oral surgery and FESS compared to those treated with oral surgery alone showed higher percentage of resolution (84.2%, 37.5%, respectively) at 4 months postoperatively, and the results were statistically significant. CONCLUSION: Simultaneous management of MRONJ and sinusitis with combined treatment of oral surgery and FESS for the treatment of maxillary MRONJ can be an effective method, especially for advanced cases, to address its associated lesions.

Cytocompatibility of 3D printed dental materials for temporary restorations on fibroblasts.

BACKGROUND: Three-dimensional (3D) printing is widely used in the fabrication of dental prostheses; however, the influence of dental materials used for 3D printing on temporary restoration of fibroblasts in tissues is unclear. Thus, the influence of different dental materials on fibroblasts were investigated. METHODS: Digital light processing (DLP) type 3D printing was used. Specimens in the control group were fabricated by mixing liquid and powder self-curing resin restoration materials. The temporary resin materials used were Model, Castable, Clear-SG, Tray, and Temporary, and the self-curing resin materials used were Lang dental, Alike, Milky blue, TOKVSO CUREFAST, and UniFast III. Fibroblast cells were cultured on each specimen and subsequently post-treated for analysis. Morphology of the adhered cells were observed using a confocal laser scanning microscope (CLSM) and a scanning electron microscope (SEM). RESULTS: CLSM and SEM cell imaging revealed that the 3D printed material group presented better cell adhesion with well-distributed filopodia compared to that in the conventional resin material group. Cell proliferation was significantly higher in the 3D printing materials. CONCLUSION: Superior cytocompatibility of the specimens fabricated through 3D printing and polishing process was demonstrated with the proof of better cell adhesion and higher cell proliferation.

Effect of core materials for core fabrication for dental implants on in-vitro cytocompatibility of MC3T3-E1 cells.

BACKGROUND: Despite the wide use of dental materials for CAD/CAM system in prosthetic treatment, the effect of the materials, which are used as dental implants core fabricated, on cells involved in dental implant osseointegration is uncertain. This study aimed to investigate and compare the effect of single core materials used for dental implants fabricated by the dental prostheses fabrication process and the CAD/CAM milling method on MC3T3-E1 cells. METHODS: The materials used for prostheses restoration in this experiment were Porcelain Fused Gold (P.F.G), Lithium disilicate glass ceramic (LiSi2), Zirconia (ZrO2), Nickel-Chromium (Ni-Cr) and Cobalt-Chromium (Co-Cr). MC3T3-E1 cells were cultured and used, the cell adhesion and morphology were observed and analyzed using confocal laser scanning microscopy (CLSM). Methoxyphenyl tetrazolium salt (MTS) and alkaline phosphatase (ALP) assay were used to observe the cell proliferation and differentiation. RESULTS: CLSM revealed irregular cell adhesion and morphology and the filopodia did not spread in the Ni-Cr specimen group. Significantly high cell proliferation was observed in the ZrO2 specimen group. The LiSi2 specimen group presented significantly high cell differentiation. Intergroup comparison of cell proliferation and differentiation between the Ni-Cr specimen group and all other specimen groups showed significant differences (p < .05). CONCLUSION: Cell proliferation and differentiation were observed from the cores, which were fabricated with all specimen groups on cytocompatibility except the Ni-Cr specimen group.

Use of 18F-sodium fluoride bone PET for disability evaluation in ankle trauma: a pilot study.

BACKGROUND: There are no objective and accurate rating tools for permanent impairment of traumatized ankles. The purpose of this study is to assess the role of 18F-Sodium fluoride (18F-NaF) positron emission tomography-computed tomography (PET/CT) bone scans in evaluating patients with limited ankle range of motion (ROM) after trauma. METHODS: 18F-NaF PET/CT was performed in 121 patients (75 men, 46 women; mean age: 45.8) who had ROM < 70% of normal after trauma affecting ankles. Metabolic target volume (MTV), the sum of voxels with standardized uptake value (SUV) > 2.5 was automatically obtained from the 3D volume that included the ankle joint. The maximum & mean SUV (SUVmax & SUVmean), and the total lesion activity (TLA) were measured. RESULTS: The median period from injury to performing 18F-NaF PET/CT was 290 days. The causes of injury were as follows: fracture (N = 95), Achilles tendon rupture (N = 12), and ligament injury (N = 12). Hot uptake in the ankle was seen in 113 of 121 patients. The fracture group had higher SUVmax, SUVmean, and TLA values than the non-fracture group. More limited ROM correlated with higher hot-uptake parameters (SUVmax, SUVmean, TLA). In subgroup analysis, the same correlations were present in the fracture, but not in the non-fracture group. CONCLUSIONS: 18F-NaF PET/CT can provide considerable information in impairment evaluations of limited ankle ROM, particularly in fracture around the ankle. Thus, 18F-NaF bone PET/CT may provide an additional option as an objective imaging tool in disability assessment after ankle injury.

Does the Addition of Bone Morphogenetic Protein 2 to Platelet-Rich Fibrin Improve Healing After Treatment for Medication-Related Osteonecrosis of the Jaw?

PURPOSE: To investigate the effect of the addition of bone morphogenetic protein 2 (BMP-2) to leukocyte-rich and platelet-rich fibrin (L-PRF) on the treatment of medication-related osteonecrosis of the jaws (MRONJ), this study compared the healing outcome of combined use of BMP-2 and L-PRF with single use of L-PRF. PATIENTS AND METHODS: Of 55 patients who were diagnosed with MRONJ, 25 were treated with L-PRF alone and 30 were treated with L-PRF and recombinant human BMP-2. For each patient, surgical sites were evaluated postoperatively at 4 and 16 weeks. Associations between the treatment method and the resolution of MRONJ were analyzed with the adjustment of patient-specific factors that may influence the treatment outcome. RESULTS: At 4 and 16 weeks postoperatively, patients with MRONJ who were treated with both L-PRF and BMP-2 showed favorable outcomes with complete resolution of the lesions, which was statistically significant compared with that of the therapy using L-PRF alone (P = .028). Therefore, the additional use of BMP-2 considerably improved MRONJ healing. Among patient-specific factors, the existence of a bacterial colony in the biopsy specimen was a significant factor that negatively affected disease resolution (P = .017). CONCLUSIONS: The combined use of BMP-2 and L-PRF leads to the early resolution of MRONJ; thus patients who need to continue antiresorptive therapy may benefit from the combined regimen.

Transport distraction osteogenesis combined with orthodontic treatment in a patient with unilateral temporomandibular joint ankylosis.

Temporomandibular joint ankylosis manifests a range of clinical characteristics dependent upon the age of onset, the affected side, and the severity. When it occurs during development, mandibular growth is affected, resulting in severe retrusion or asymmetry as well as limitation of mandibular movements. Progressive asymmetric mandibular growth in unilateral ankylosis causes canting of the occlusal plane. In this case report, we present a successful temporomandibular joint reconstruction using transport distraction osteogenesis combined with camouflage orthodontic treatment for occlusal canting correction of a patient with unilateral temporomandibular joint ankylosis and severe facial asymmetry.

Midfacial Soft-Tissue Changes after Paranasal Augmentation with Porous Polyethylene.

The aim of this study was to determine the effect of porous polyethylene in paranasal augmentation on the overlying soft tissue. Thirty-three patients underwent paranasal augmentation using 3-mm-thick porous polyethylene and mandibular setback, and 35 patients underwent mandibular setback only. Lateral cephalograms were taken before and 6 months after the surgery to compare the soft-tissue changes in the paranasal area. Complications and patient satisfaction following the surgery were also analyzed. The average soft-tissue change in the paranasal area after the augmentation was 2.42 ± 0.33 mm, while there was no definite soft-tissue change in the paranasal area after mandibular setback alone. The ratio of soft-tissue changes to paranasal implant thickness was 80.7%. All patients in the augmentation group were satisfied with their surgical outcomes, which led to convex lateral profile with increase in midface volume. There were no complications such as postoperative infection or foreign body reaction requiring removal of implants. Paranasal augmentation using porous polyethylene is a predictable method providing minimal morbidity in patients with paranasal deficiency.

AI-based dental caries and tooth number detection in intraoral photos: Model development and performance evaluation.

OBJECTIVES: In this study, we aimed to integrate tooth number recognition and caries detection in full intraoral photographic images using a cascade region-based deep convolutional neural network (R-CNN) model to facilitate the practical application of artificial intelligence (AI)-driven automatic caries detection in clinical practice. METHODS: Our dataset comprised 24,578 images, encompassing 4787 upper occlusal, 4347 lower occlusal, 5230 right lateral, 5010 left lateral, and 5204 frontal views. In each intraoral image, tooth numbers and, when present, dental caries, including their location and stage, were annotated using bounding boxes. A cascade R-CNN model was used for dental caries detection and tooth number recognition within intraoral images. RESULTS: For tooth number recognition, the model achieved an average mean average precision (mAP) score of 0.880. In the task of dental caries detection, the model's average mAP score was 0.769, with individual scores spanning from 0.695 to 0.893. CONCLUSIONS: The primary objective of integrating tooth number recognition and caries detection within full intraoral photographic images has been achieved by our deep learning model. The model's training on comprehensive intraoral datasets has demonstrated its potential for seamless clinical application. CLINICAL SIGNIFICANCE: This research holds clinical significance by achieving AI-driven automatic integration of tooth number recognition and caries detection in full intraoral images where multiple teeth are visible. It has the potential to promote the practical application of AI in real-life and clinical settings.

Improved Oral Health Is Associated with a Lower Risk of Late Onset Ankylosing Spondylitis: A Nationwide Cohort Study.

Background: The aim of this study was to evaluate the association of oral health status and habits with the occurrence of ankylosing spondylitis (AS) in a nationwide population-based cohort in a longitudinal setting. Methods: A total of 2,415,963 individuals aged 40-79 years who underwent oral health examinations were included from the National Health Insurance Service-National Health Screening (NHIS-HEALS) cohort of Korea between 2003 and 2004. The occurrence of AS was analyzed according to the oral health status and oral hygiene habits. Results: Among 2,271,221 of the participants, AS occurred in 6366 (0.3%) participants over 16.7 years. The likelihood of AS was higher in participants who had periodontitis (hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 1.20-1.46, p < 0.0001) and more missing teeth (HR: 1.68, 95% CI: 1.42-1.99, p < 0.0001). However, better oral hygiene habits such as frequent tooth brushing (HR: 0.77, 95% CI: 0.71-0.83, p < 0.0001) and a history of dental scaling within the last year (HR 0.88, 95% CI 0.82-0.95, p = 0.001) were associated with a lower occurrence of AS. Conclusions: Periodontitis and an increased number of missing teeth could be related to the occurrence of late-onset AS. Improved oral hygiene care may attenuate the likelihood of late-onset AS.

Adjunctive recombinant human parathyroid hormone agents for the treatment of medication-related osteonecrosis of the jaw: a report of three cases.

Teriparatide has been effective in treating people diagnosed with medication-related osteonecrosis of the jaw (MRONJ). However, its efficacy is not well established to be accepted as a standard of care. The objective of this paper was to investigate the efficacy of recombinant human parathyroid hormone for the treatment of MRONJ. We report three cases of MRONJ patients with osteoporosis as the primary disease who were treated with a teriparatide agent along with other adjunctive measures. Each patient was administered a teriparatide injection subcutaneously for 16 weeks, 36 weeks, or 60 weeks. Surgical intervention including partial resection, sequestrectomy, decortication, and saucerization took place during the teriparatide administration. Complete lesion resolution was identified clinically and radiographically in all three patients. In patients diagnosed with MRONJ, teriparatide therapy is an efficacious and safe therapeutic option to improve healing of bone lesions. These findings demonstrate that teriparatide in combination with another therapy, especially bone morphogenetic protein, platelet-rich fibrin, or antibiotic therapy, can be an effective protocol for MRONJ.

Aripiprazole-montmorillonite: a new organic-inorganic nanohybrid material for biomedical applications.

Poor aqueous solubility and the unpleasant taste of aripiprazole (APZ) have been recurring problems, owing to its low bioavailability and low patient tolerance, respectively. Herein, we prepared a nanohybrid system that was based on a bentonite clay material, montmorillonite (MMT), which could both mask the taste and enhance the solubility of APZ (i.e., APZ-MMT). To further improve the efficacy of this taste masking and drug solubility, APZ-MMT was also coated with a cationic polymer, polyvinylacetal diethylamino acetate (AEA). In vitro dissolution tests at neutral pH showed that the amount of drug that was released from the AEA-coated APZ-MMT was greatly suppressed (<1%) for the first 3 min, thus suggesting that AEA-coated APZ-MMT has strong potential for the taste masking of APZ. Notably, in simulated gastric juice at pH 1.2, the total percentage of APZ that was released within the first 2 h increased up to 95% for AEA-coated APZ-MMT. Furthermore, this in vitro release profile was also similar to that of Abilify®, a commercially available medication. In vivo experiments by using Sprague-Dawley rats were also performed to compare the pharmacokinetics of AEA-coated APZ-MMT and Abilify®. AEA-coated APZ-MMT exhibited about 20% higher systemic exposure of APZ and its metabolite, dehydro-APZ, compared with Abilify®. Therefore, a new MMT-based nanovehicle, which is coated with a cationic polymer, can act as a promising delivery system for both taste masking and for enhancing the bioavailability of APZ.

Association of Oral Health with Risk of Rheumatoid Arthritis: A Nationwide Cohort Study.

Periodontitis and rheumatoid arthritis (RA) are inflammatory diseases that share many similarities. We aimed to investigate the associations of periodontitis and oral hygiene status and behaviors with RA in a nationwide general population cohort. Participants from the National Health Screening cohort database of Korea who underwent oral health screening by dentists between 2003 and 2004 were included. The occurrence of RA was analyzed according to the presence of periodontitis, oral health examination findings, and behaviors. Overall, 2,239,586 participants were included. During a median of 16.7 years, RA occurred in 27,029 (1.2%) participants. The risk for incident RA was higher when participants had periodontitis (hazard ratio (HR) 1.2, 95% confidence interval (CI), 1.08-1.24) and an increased number of missing teeth (HR 1.5, 95% CI, 1.38-1.69). In contrast, better oral hygiene behaviors, such as a higher frequency of daily tooth brushing (HR 0.76, 95% CI 0.73-0.79, p for trend <0.001) and a recent history of dental scaling (HR 0.96, 95% CI 0.94-0.99), were associated with a lower occurrence of RA. Periodontitis and increased missing teeth were associated with an increased risk of RA. Maintaining good oral hygiene through frequent tooth brushing and regular dental scaling may reduce the risk of RA occurrence.

Narrow Alveolar Ridge Management with Modified Ridge Splitting Technique: A Report of 3 Cases.

Purpose: In this study, we report the usefulness of implant placement with modified ridge splitting technique from three cases of patients with narrow alveolar ridge. Materials and Methods: Three patients were those who visited the Department of Oral and Maxillofacial Surgery of Ewha Medical Center for consultation regarding implant placement. Through clinical and radiographic evaluation, narrowed alveolar ridge after tooth loss was confirmed in all three patients. For them, it was necessary to use the modified ridge split technique with bone augmentation for the implant to be well placed with enough bone width. Results: In all cases, sufficient bone width was confirmed for implant placement, and bone volume was well maintained after prosthetic restoration without any complications. Initial width of alveolar bone was 4.9 mm on average and was well maintained at an average of 7.6 mm at 1-year follow-up after implant installation. Conclusion: Although the number of subjects in this case report was small and was done by only one surgeon, we suggest that modified ridge splitting technique might be a useful surgical method to enhance narrow edentulous alveolar ridges and enable successful implant placement with shorter healing period compared with single guided bone regeneration.

Association between periodontal disease, tooth extraction, and medication-related osteonecrosis of the jaw in women receiving bisphosphonates: A national cohort-based study.

BACKGROUND: We investigated whether periodontal diseases contribute to the development of medication-related osteonecrosis of the jaw (MRONJ) in addition to tooth extraction, which is a major risk factor for MRONJ occurrence. METHODS: This retrospective, nationwide cohort study was performed using South Korea's National Health Insurance Service database on women aged > 50 years who took bisphosphonates for at least 1 year between 2010 and 2015. MRONJ, periodontal disease, and tooth extraction were defined using the claims data. RESULTS: Among the 27,168 patients analyzed, the incidence of confirmed MRONJ was significantly higher in the periodontal disease group (0.58%) than in the nonperiodontal disease group (0.31%). While extraction alone showed an increased risk of MRONJ development (hazard ratio [HR] = 1.61, 95% confidence interval [CI]: 0.74-3.52), periodontal disease without tooth extraction also indicated a similar risk (HR = 1.68, 95% CI: 0.86-3.28); when a history of both periodontal disease and tooth extraction was present, the HR significantly increased to 2.55 (95% CI: 1.41-4.64). CONCLUSIONS: The risk of MRONJ increased significantly when tooth extraction was performed in patients diagnosed with periodontal disease; therefore, periodontal diseases should be proactively managed in patients taking bisphosphonates.