Disease Stage and Mode of Therapy Are Important Determinants of Treatment Outcomes for Medication-Related Osteonecrosis of the Jaw.

PURPOSE: The treatment of patients with medication-related osteonecrosis of the jaw (MRONJ) is challenging. The purpose of the present study was to estimate the frequency and identify the factors associated with clinical improvement during treatment. PATIENTS AND METHODS: We designed and implemented a retrospective cohort study and enrolled a sample of subjects diagnosed with MRONJ between 2004 and 2015. The primary predictor variables were a set of heterogeneous variables grouped into the following categories: demographic (age and gender) and clinical (location of necrosis, therapy duration, medication type, disease stage, and treatment type). The primary outcome variable was the treatment outcome, defined as stable or worse and improved or healed. The descriptive, bivariate, and multiple logistic statistics were computed, and statistical significance was defined as P < .05. RESULTS: The sample included 337 subjects with a mean age of 68.9 years. Of the 337 subjects, 256 were women (76%). A total of 143 patients (42.2%) experienced spontaneous necrosis. Twenty-four (7.1%) had had exposure to targeted antiangiogenic agents. Those with stage 1 or 2 disease were more likely to have better outcomes than those with stage 3 disease (stage 1, adjusted odds ratio [OR] 3.4, P = .005; stage 2, adjusted OR 2.2, P = .03). Treatment type was a significant variable. Subjects undergoing surgery were 28 times more likely to have a positive outcome than those receiving nonoperative therapy (adjusted OR 28.7, P < .0001). CONCLUSIONS: Subjects with MRONJ who presented with less severe disease or who underwent operative treatment were most likely to have improvement or complete healing of their MRONJ-related lesions.

A Novel Surgical Approach for Treatment of Class II Furcation Defects Using Marginal Periosteal Membrane.

OBJECTIVES: This study was designed to describe and evaluate the use of a vascularized marginal periosteal barrier membrane (MPM) harvested by a semilunar incision, alone or combined with a bone graft, in treatment of class II furcation defects in mandibular molars, compared to open flap debridement (OFD). METHODS: Thirty class II furcation defects in mandibular molars were randomly assigned into three equal groups: Group I included OFD, Group II included defects treated with MPM, and Group III consisted of defects treated with MPM after applying demineralized freeze-dried bone allograft (DFDBA). At baseline and 6-month follow-up, vertical probing depth (VPD), clinical attachment level (CAL) measurements, along with a radiographic measurement of bone height (BH), were obtained for each defect. Transmission electron microscopy (TEM) was used for further evaluation of the histological changes associated with gingival samples related to each line of treatment. RESULTS: Both Groups II and III reflected significant favorable outcomes in all the assessed parameters compared to OFD. A non-significant difference was found between both groups regarding VPD, while significant improvement in CAL and BH were detected in Group III (p ≤ 0.05). Favorable histological findings were also noticed in the test groups, with more improvement in Group III. CONCLUSION: Placement of a vascularized MPM as a barrier membrane, using a semilunar incision, demonstrated a significant improvement in both clinical and histological outcomes of class II furcation defects in lower molars. When it was combined with DFDBA, a meaningful difference was found with regard to early wound healing and gain in CAL and BH.

A classification system for conditions causing condylar hyperplasia.

A classification system was developed to place patients with condylar hyperplasia (CH) into categories based on histology, clinical and imaging characteristics, effects on the jaws and facial structures, and rate of occurrence. Four major categories were defined. CH type 1 is an accelerated and prolonged growth aberration of the "normal" mandibular condylar growth mechanism, causing a predominantly horizontal growth vector, resulting in prognathism that can occur bilaterally (CH type 1A) or unilaterally (CH type 1B). CH type 2 refers to enlargement of the mandibular condyle caused by an osteochondroma, resulting in predominantly unilateral vertical overgrowth and elongation of the mandible and face. One of the forms has predominantly a vertical growth vector and condylar enlargement, but without exophytic tumor extensions (type 2A), whereas the other primary form grows vertically but develops horizontal exophytic tumor growth off of the condyle (CH type 2B). CH type 3 includes other rare, benign tumors and CH type 4 includes malignant conditions that originate in the mandibular condyle causing enlargement. The order of classification is based on occurrence rates and type of pathology, where CH type 1A is the most commonly occurring form and CH type 4 is the rarest. This classification system for CH pathology should help the clinician understand the nature of the pathology, progression if untreated, recommended ages for surgical intervention to minimize adverse effects on subsequent facial growth and development in younger patients, and the surgical protocols to comprehensively and predictably treat these conditions.

Proposal for a new staging system for osteoradionecrosis of the mandible.

A new staging system for osteoradionecrosis of the mandible has been retrospectively applied to a group of 31 patients. In this system clinicoradiographic signs and symptoms are incorporated in a simplified manner. For imaging purposes the use of plain radiographs such as periapical films and panoramic radiographs is recommended, mainly because of their readily availability. The presented staging system seems well reproducible, facilitating the comparison of study groups dealing with the various issues of osteoradionecrosis of the mandible. It is yet to be evaluated whether the presently proposed staging system is useful for management purposes.

[Surgical treatment of patients with drug abuse and mandible necrosis].

The article describes clinical and radiological classification of osteonecrosis of the mandible in patients with drug dependence, surgical options presented on the basis of classification proposed. Clinical case of simultaneous application of individual plate of nikelid titanium in patient with osteonecrosis of the mandible is presented.

Effects of early bilateral mandibular first molar extraction on condylar and ramal vertical asymmetry.

OBJECTIVES: This study aims to investigate the mandibular vertical asymmetry in a group of adult patients who had early bilateral mandibular first molar extractions. METHODS: Mandibular asymmetry index measurements (condylar, ramal, and condylar plus ramal) were made on the panoramic radiographs of a study group including 30 subjects (mean age, 18.22 ± 1.30 years) and a control group of 25 subjects (mean age, 18.24 ± 1.17 years). Group I comprised the control group patients with no extractions and had excellent class I relationships, no missing teeth, and slight or moderate anterior crowding. Group II included patients with a bilateral mandibular first molar teeth extracted before the age of 12 years. Student's t test was used for the comparison of asymmetry index values between the groups. A paired t test was used to determine possible statistically significant differences between the sides for condylar, ramal, and condylar plus ramal height measurements. RESULTS: No group showed statistically significant side-specific differences for posterior vertical height measurements. Condylar asymmetry index (CAI), ramal asymmetry index, and condylar plus ramal asymmetry index measurements were not statistically different between the groups (p > 0.05). CONCLUSIONS: CAI values were significantly high when compared with the 3 % threshold value in the both groups, but comparisons between the groups were not statistically significant. CLINICAL RELEVANCE: This article investigates the effects of early bilateral mandibular molar teeth extraction that has never been investigated in the literature. The present study showed that the lengths of the condylar, ramal, and condylar plus ramal height were less in the study group than in a well-matched control group of without extraction.

Giant cell lesions of the jaws: does the level of vascularity and angiogenesis correlate with behavior?

PURPOSE: To compare vascularity and angiogenic activity in aggressive and nonaggressive giant cell lesions (GCLs) of the jaws. MATERIALS AND METHODS: This is a retrospective study of 14 GCLs treated at the University of California, San Francisco. Immunohistochemistry was used to determine of the expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), CD34, and CD31. VEGF and bFGF expression in giant cells (GCs) and surrounding mononuclear stroma was classified into 1) high immunoreactivity (>50% staining) and 2) low immunoreactivity (<50% staining). CD31- and CD34-stained vessels were counted at 200× magnification. Clinical and radiographic records were reviewed to classify lesions as aggressive or nonaggressive. RESULTS: Of the lesions, 8 were aggressive and 6 were nonaggressive. High VEGF expression was found within the GCs in 4 of 8 aggressive lesions compared with 1 of 6 nonaggressive lesions. The stroma in both groups had low staining. High staining of the GCs for bFGF was found in 6 of 8 aggressive lesions compared with 3 of 6 nonaggressive lesions. The stroma of all aggressive cases showed high expression of bFGF compared with 3 of 6 nonaggressive cases. The aggressive group had a mean of 20.1 ± 5.4 vessels/high-powered field (hpf) stained for CD31 compared with 11.5 ± 5.6 vessels/hpf in the nonaggressive group. The aggressive group had 24.6 ± 7.0 vessels/hpf stained with CD34 compared with 18.5 ± 4.0 vessels/hpf in the nonaggressive group. CONCLUSIONS: The vascularity and level of angiogenesis within aggressive GCLs are higher than those in nonaggressive lesions.

Comparative evaluation of guided tissue regeneration with use of collagen-based barrier freeze-dried dura mater allograft for mandibular class 2 furcation defects (a comparative controlled clinical study).

AIM: The aim of periodontal surgery is complete regeneration. The present study was designed to evaluate and compare clinically soft tissue changes in form of probing pocket depth, gingival shrinkage, attachment level and hard tissue changes in form of horizontal and vertical bone level using resorbable membranes. MATERIALS AND METHODS: Twelve subjects with bilateral class 2 furcation defects were selected. After initial phase one treatment, open debridement was performed in control site while freezedried dura mater allograft was used in experimental site. Soft and hard tissue parameters were registered intrasurgically. Nine months reentry ensured better understanding and evaluation of the final outcome of the study. RESULTS: Guided tissue regeneration is a predictable treatment modality for class 2 furcation defect. There was statistically significant reduction in pocket depth as compared to control (p < 0.01). There is statistically significant increase in periodontal attachment level within control and experimental sites showed better results (p < 0.01). For hard tissue parameter, significant defect fill resulted in experimental group, while in control group, less significant defect fill was found in horizontal direction and nonsignificant defect fill was found in vertical direction. CONCLUSION: The results showed statistically significant improvement in soft and hard tissue parameters and less gingival shrinkage in experimental sites compared to control site. CLINICAL SIGNIFICANCE: The use of FDDMA in furcation defects helps us to achieve predictable results. This cross-linked collagen membrane has better handling properties and ease of procurement as well as economic viability making it a logical material to be used in regenerative surgeries.

Clinical and radiological evaluation of human osseous defects (mandibular grade ii furcation involvement) treated with bioresorbable membrane: vicryl mesh.

AIM: The purpose of the present study was to evaluate clinical and radiological healing effects after treatment of class II furcation defects using bioresorbable periodontal mesh barriers. MATERIALS AND METHODS: The patients for the following study were selected from Outpatient, Department of Periodontics, College of Dental Sciences, Davanagere, Karnataka. INCLUSION CRITERIA: 1. Patients with age group between 18 and 60 years. 2. Patients who were nonsmokers. 3. Patients who had not undergone any type of periodontal therapy 6 months prior to initial examination. 4. Patients diagnosed as advanced periodontitis having mandibular grade II furcation involvement (Glickman 1953) clinically and radiologically. EXCLUSION CRITERIA: 1. Patients who required antibiotic prophylaxis. 2. Patients allergic to tetracycline and/ or chlorhexidine. 3. Pregnant and lactating mother. 4. Patient showing unacceptable oral hygiene during presurgical (phase 1) therapy. RESULTS: In this study clinical parameters were compared and attempt was made to compare the results radiographically too, with the limitations, the present study showed that the use of resorbable periodontal mesh barriers for GTR therapy at class II furcations resulted in reduction of furcation involvement. CONCLUSION: Therefore it appears that a patient with class II furcations involvement benefits from barrier treatment, because results are superior to conventional treatment without barriers. CLINICAL SIGNIFICANCE: The present study was taken up to evaluate the clinical effects of GTR therapy of class II furcations using bioresorbable periodontal mesh barriers.

Odontogenic keratocyst: a case report and review of an old lesion with new classification.

The odontogenic keratocyst (OKC) is distinctive among jaw cysts given its tendency toward recurrence and aggressive clinical behavior. This paper presents a well-documented case of OKC and a review of the diagnostic features, treatment modalities and new evidence supporting the reclassification and renaming of this unique pathologic process.

The unusual cyst: solitary bone cyst of the jaws.

UNLABELLED: Solitary bone cyst of the jaws is an uncommon lesion detected usually as an incidental finding on dental radiographic examination. Historically, this cyst has been known by several different names within the literature. It is usually asymptomatic but can present with buccal swelling, pain, paraesthesia and be associated with non-vital teeth. Radiographically, it has characteristic features that distinguish it from other lesions. The following is an overview of the literature, the experience of two centres over an eight-year period, and a discussion of the dental implications. Clinicians should be aware of this lesion and that unexplained radiolucent lesions of the jaws require referral. CLINICAL RELEVANCE: Clinicians should be aware of both the clinical and radiographic characteristics of solitary bone cyst of the jaws.

Odontogenic cysts: analysis of 2,944 cases in Chile.

INTRODUCTION: Odontogenic cysts constitute a group of frequent intraosseous lesions characteristic in the maxillary bones and one of the main causes of the destruction of these bones. In Chile there are no retrospective studies of these lesions as a whole. OBJECTIVE: The purpose of this study is to determine the frequency of these lesions in so far as they were diagnosed and registered in the Referral Institute for Oral Pathology (IREPO) of the University of Chile in two age groups as well as to analyze and to compare the data obtained with the data published in previous studies. MATERIAL AND METHOD: We studied the records from IREPO of the University of Chile for the period between 1976 and September, 2004; and we determined the frequency according to age, gender and site of each of these lesions. We compare two age groups: younger than or equal to 15 years old and older than 15 years old. Those cases in which the information did not suffice for the purposes of analysis were not considered. All the histological slides were reclassiffed according to the diagnostic criteria included in the Histological Typification of the World Health Organization. RESULTS: We found 2.944 odontogenic cysts (OC), of which 1.935 (65.7%) were inflammatory cysts and 1.009 were developmental cysts. Out of this total, there were 1.554 cysts (52.8%) in men and 1.390 (47.2%) in women. The most frequent cysts were 1.494 radicular cysts (50.7%), 546 dentigerous cysts (18.5%), 421 keratocysts (14.3%) and 328 residual cysts (11.1%). These four varieties represent 94.7% of the OC , that is, 2789 cases. In the population younger than or equal to 15 years of age the developmental cysts (354 cases) are more frequent than the inflammatory cysts (155 cases), the most frequent being dentigerous cysts (240 cases).

Validation of cone-beam computed tomography as a predictor of osteoporosis using the Klemetti classification.

This study aimed at evaluating the validity of cone-beam computed tomography (CBCT) for assessing mandibular bone quality using the Klemetti classification. The morphology of the endosteal mandibular cortex of 30 (60 hemi-mandibles) postmenopausal women between the ages of 45 and 80 years was evaluated based on the Klemetti classification in panoramic radiographs used as reference images. Afterwards, panoramic reconstruction and cross-sectional slices of CBCT examinations of these patients were analyzed and categorized according to the same classification. All the images were assessed by two oral radiologists. The McNemar-Bowker test compared the agreement between the CBCT images and the reference images. No differences were found between the diagnostic results based on panoramic radiography and panoramic reconstruction. However, the mean scores for the cross-sectional evaluation were higher, and the results, statistically different from the others. Based on the disagreement found between the panoramic radiographs and the CBCT cross-sectional slices, the Klemetti classification is not an adequate means of assessing bone quality with CBCT. On the other hand, the higher values found for the cross-sectional slices could be associated with better visibility on the CBCT images.

Periodontal regeneration - furcation defects: a consensus report from the AAP Regeneration Workshop.

BACKGROUND: Treatment of furcation defects is a core component of periodontal therapy. The goal of this consensus report is to critically appraise the evidence and to subsequently present interpretive conclusions regarding the effectiveness of regenerative therapy for the treatment of furcation defects and recommendations for future research in this area. METHODS: A systematic review was conducted before the consensus meeting. This review aims to evaluate and present the available evidence regarding the effectiveness of different regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy. During the meeting, the outcomes of the systematic review, as well as other pertinent sources of evidence, were discussed by a committee of nine members. The consensus group members submitted additional material for consideration by the group in advance and at the time of the meeting. The group agreed on a comprehensive summary of the evidence and also formulated recommendations for the treatment of furcation defects via regenerative therapies and the conduction of future studies. RESULTS: Histologic proof of periodontal regeneration after the application of a combined regenerative therapy for the treatment of maxillary facial, mesial, distal, and mandibular facial or lingual Class II furcation defects has been demonstrated in several studies. Evidence of histologic periodontal regeneration in mandibular Class III defects is limited to one case report. Favorable outcomes after regenerative therapy for maxillary Class III furcation defects are limited to clinical case reports. In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although generally Class I furcation defects may be treated predictably with non-regenerative therapies. There is a paucity of data regarding quantifiable patient-reported outcomes after surgical treatment of furcation defects. CONCLUSIONS: Based on the available evidence, it was concluded that regenerative therapy is a viable option to achieve predictable outcomes for the treatment of furcation defects in certain clinical scenarios. Future research should test the efficacy of novel regenerative approaches that have the potential to enhance the effectiveness of therapy in clinical scenarios associated historically with less predictable outcomes. Additionally, future studies should place emphasis on histologic demonstration of periodontal regeneration in humans and also include validated patient-reported outcomes. CLINICAL RECOMMENDATIONS: Based on the prevailing evidence, the following clinical recommendations could be offered. 1) Periodontal regeneration has been established as a viable therapeutic option for the treatment of various furcation defects, among which Class II defects represent a highly predictable scenario. Hence, regenerative periodontal therapy should be considered before resective therapy or extraction; 2) The application of a combined therapeutic approach (i.e., barrier, bone replacement graft with or without biologics) appears to offer an advantage over monotherapeutic algorithms; 3) To achieve predictable regenerative outcomes in the treatment of furcation defects, adverse systemic and local factors should be evaluated and controlled when possible; 4) Stringent postoperative care and subsequent supportive periodontal therapy are essential to achieve sustainable long-term regenerative outcomes.

Retrospective analysis of osteoradionecrosis of the mandible: proposing a novel clinical classification and staging system.

Osteoradionecrosis of the jaw is a common radiation-induced complication that may be observed in oral cancer patients. Several classifications and staging systems have been proposed for osteoradionecrosis of the mandible based on clinical symptoms, radiological findings, and/or the response to diverse treatments. However, none has been universally accepted because of their individual deficiencies. The aim of this study was to introduce a new clinical classification that can be applied to the treatment of osteoradionecrosis in an easier and more acceptable way, through a retrospective analysis of patients with osteoradionecrosis of the mandible. A review was conducted of 99 patients diagnosed with osteoradionecrosis of the mandible in the study institution between 2000 and 2013. A novel classification was established on the basis of bone necrosis and soft tissue defects. A new staging system with four different stages (stage 0, stage I, stage II, and stage III) is proposed. We believe that this new classification and staging system is easier and more acceptable for clinical evaluation than previous ones.

Periodontal regeneration - furcation defects: a systematic review from the AAP Regeneration Workshop.

BACKGROUND: The aim of this review is to present the available evidence regarding the effectiveness of different regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy to provide clinical guidelines for the therapeutic management of furcation defects and to identify priorities for future research that may advance the understanding of periodontal regenerative medicine. METHODS: A comprehensive search based on predetermined eligibility criteria was conducted to identify human original studies and systematic reviews on the topic of periodontal regeneration of furcation defects. Two reviewers independently screened the title and abstract of the entries yielded from the initial search. Subsequently, both reviewers read the full-text version of potentially eligible studies, made a final article selection, and extracted the data of the selected studies considering specific clinical scenarios. The clinical scenarios contemplated in this review included the following: 1) facial and interproximal Class I defects in maxillary molars; 2) facial and lingual Class I defects in mandibular molars; 3) facial and interproximal Class II furcation defects in maxillary molars; 4) facial and lingual Class II furcation defects in mandibular molars; 5) Class III furcation defects in maxillary molars; 6) Class III furcation defects in mandibular molars; and 7) Class I, II, or III furcation defects in maxillary premolars. Endpoints of interest included different clinical, radiographic, microbiologic, histologic, and patient-reported outcomes. RESULTS: The initial search yielded a total of 1,500 entries. The final selection consisted of 150 articles, of which six were systematic reviews, 109 were clinical trials, 27 were case series, and eight were case reports. A summary of the main findings of previously published systematic reviews and the available evidence relative to the indication of regenerative approaches for the treatment of furcation defects compared with conventional surgical therapy are presented. Given the marked methodologic heterogeneity and the wide variety of materials and techniques applied in the selected clinical trials, the conduction of a meta-analysis was not viable. CONCLUSIONS: On the basis of the reviewed evidence, the following conclusions can be drawn. 1) Periodontal regeneration has been demonstrated histologically and clinically for the treatment of maxillary facial or interproximal and mandibular facial or lingual Class II furcation defects. 2) Although periodontal regeneration has been demonstrated histologically for the treatment of mandibular Class III defects, the evidence is limited to one case report. 3) Evidence supporting regenerative therapy in maxillary Class III furcation defects in maxillary molars is limited to clinical case reports. 4) In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although most Class I furcation defects may be successfully treated with non-regenerative therapy. 5) Future research efforts should be primarily directed toward the conduction of clinical trials to test novel regenerative approaches that place emphasis primarily on patient-reported outcomes and also on histologic demonstration of periodontal regeneration. Investigators should also focus on understanding the influence that local, systemic, and technical factors may have on the outcomes of regenerative therapy in furcation defects.

Osteoradionecrosis of the mandible: A ten year single-center retrospective study.

BACKGROUND: Numerous factors have been associated with the development of osteoradionecrosis (ORN) of the jaws. The purpose of this study was to investigate the factors that are linked to the severity of mandibular ORN. METHODS: A retrospective study was conducted which included all ORN cases treated in the Department of Oral and Maxillofacial Surgery in Munich (LMU) between 2003 and 2012. The cases were categorized according to the necrosis stage and several variables were evaluated in order to identify possible correlation between them and the severity of the necrosis. RESULTS: A total of 115 patients with 153 osteonecrosis lesions were included in the study. Twenty-three cases were of stage I, 31 were of stage II and 99 were of stage III. The initial tumors were predominantly located in the floor of the mouth, the tongue or the pharynx. Diabetes mellitus (OR: 4.955, 95% Cl: 1.965-12.495), active smoking (OR: 13.542, 95% Cl: 2.085-87.947), excessive alcohol consumption (OR: 5.428, 95% Cl: 1.622-18.171) and dental treatment and/or local pathological conditions (OR: 0.237, 95% Cl: 0.086-0.655) were significant predictors for stage III necrosis. CONCLUSIONS: The aforementioned factors are predictive of ORN severity and can guide its prophylaxis and management.

Is mandibular asymmetry more frequent and severe with unilateral disc displacement?

PURPOSE: To investigate the prevalence of mandibular asymmetry (MA) within the symptomatic unilateral anterior disc displacement (ADD) patients, and analyze the influence TMJ factors of the MA severity. METHODS: Patients aged under 20 years old with symptomatic unilateral ADD and asymptomatic volunteers with normal disc-condyle relationship diagnosed by magnetic resonance imaging (MRI) were included in this study. Posteroanterior cephalometric radiographs were taken to measure MA. Condylar height, disc length and disc displacement were measured by MRI. The prevalence and severity of MA were compared between the ADD and the control groups. The correlation between the severity of MA with the amount of condylar height shortage, disc deformity and distance of disc displacement were also evaluated within the ADD group. RESULTS: There were 165 cases in the unilateral ADD group, and 156 cases in the control group. One hundred and nineteen cases had MA which accounted 72.12% (119/165) in the ADD group; while in the control group, only 25.64% (40/156) exhibited MA. The mean horizontal menton deviation and condylar height shortage in the unilateral ADD group were significantly larger than that in the control group (5.62 mm vs. 4.19 mm; 3.14 mm vs. 1.32 mm, p < 0.01). The severity of MA was significantly correlated with the amount of disc displacement, disc deformity and condylar height shortage (correlation coefficient: 0.80, 0.70, and 0.82). CONCLUSION: MA is much more common and severe in young unilateral ADD patients. The severity of MA is correlated with the height of condyle and the status of the disc.

Sclerosis in bisphosphonate-related osteonecrosis of the jaws and its correlation with the clinical stages: study of 43 cases.

We analysed the degree of sclerosis in the different stages of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and studied the relation between the grade of sclerosis, the clinical symptoms, and the depth of lucency. We compared 43 patients with mandibular BRONJ with a control group of 40 cases with no bony lesions. The presence of sclerotic bone, cortical irregularities, radiolucency, fragmentation or sequestration, periostitis, and narrowing of the mandibular canal were studied from computed tomographic (CT) scans using the program ImageJ 1.47v (National Institute of Health, Bethesda, USA) to measure the radiolucency, width of the cortices, and degree of sclerosis. Patients with BRONJ had more severe sclerosis than controls (p<0.01). There was also a significant difference among the different stages of BRONJ, with the highest values found in stage III (p=0.02). The degree of sclerosis differed according to sex, type of bisphosphonate, and the clinical characteristics such as pain, or suppuration, but not significantly so (p>0.05). We conclude that the degree of sclerosis increases with the clinical stage of BRONJ, and is correlated with the depth of lucency.

Guided tissue regeneration associated with bovine-derived anorganic bone in mandibular class II furcation defects. 6-month results at re-entry.

BACKGROUND: The use of graft materials with guided tissue regeneration (GTR) in Class II furcation defects is aimed at improving the outcome of the regenerative technique. In this regard, however, there are a limited number of studies discussing the results obtained when GTR and graft materials are used in the treatment of Class II furcation defects. Furthermore, most studies employ either allogeneic or autogenous materials. The present trial sought to determine whether the use of a bovine-derived anorganic bone (ABB) in conjunction with GTR influenced the outcome of mandibular Class II furcation treatment. METHODS: This study included 14 patients who provided 15 pairs of similar periodontal defects. Each defect was randomly assigned to treatment with either a cellulose membrane in combination with bovine-derived anorganic bone (GTR+ABB) or membrane alone (GTR). Following basic therapy, baseline measurements were recorded including probing depth (PD), clinical attachment level (CAL), and gingival margin position (GMP). Hard tissue measurements were performed during surgery to determine alveolar crestal height (CEJ-AC), and vertical (VDD) and horizontal defect depth (HDD). Membranes remained in position for at least 4 weeks. After 6 months, all sites were re-entered and soft and hard tissue measurements were recorded. RESULTS: Both surgical procedures resulted in statistically significant probing depth reduction and gain in clinical attachment levels, with no significant difference between groups. Gingival recession was more pronounced in the GTR+ABB group (0.87 +/- 0.83 mm), but not statistically different from the GTR group (0.46 +/- 1.19 mm). Vertical defect resolution was significant in both groups (GTR: 1.60 +/- 1.50 mm; GTR+ABB: 1.80 +/- 2.11 mm), without differences between groups. Only horizontal furcation resolution (GTR: 2.47 +/- 0.99 mm; GTR+ABB: 3.27 +/- 1.39 mm) was significantly different between groups (P <0.05). CONCLUSIONS: The use of ABB with GTR techniques improved horizontal defect resolution in mandibular Class II furcation defects, but did not yield superior results regarding soft tissue changes when compared to sites treated with GTR alone. Evaluation of a larger sample could indicate differences and advantages between the evaluated approaches and confirm the real necessity of associating filling materials with GTR.