Transition of endochondral bone formation at the normal and botulinum-treated mandibular condyle of growing juvenile rat.

OBJECTIVE: The aim of this study was to understand the temporal and spatial distribution of canonical endochondral ossification (CEO) and non-canonical endochondral ossification (NCEO) of the normal growing rat condyle, and to evaluate their histomorphological changes following the simultaneous hypotrophy of the unilateral masticatory closing muscles with botulinum toxin (BTX). DESIGN: 46 rats at postnatal 4 weeks were used for the experiment and euthanized at postnatal 4, 8, and 16 weeks. The right masticatory muscles of rats in experimental group were injected with BTX, the left being injected with saline as a control. The samples were evaluated using 3D morphometric, histological, and immunohistochemical analysis with three-dimensional regional mapping of endochondral ossifications. RESULTS: The results showed that condylar endochondral ossification changed from CEO to NCEO at the main articulating surface during the experimental period and that the BTX-treated condyle presented a retroclined smaller condyle with an anteriorly-shifted narrower articulating surface. This articulating region showed a thinner layer of the endochondral cells, and a compact distribution of flattened cells. These were related to the load concentration, decreased cellular proliferation with thin cellular layers, reduced extracellular matrix, increased cellular differentiation toward the osteoblastic bone formation, and accelerated transition of the ossification types from CEO to NCEO. CONCLUSION: The results suggest that endochondral ossification under loading tended to show more NCEO, and that masticatory muscular hypofunction by BTX had deleterious effects on endochondral bone formation and changed the condylar growth vector, resulting in a retroclined, smaller, asymmetrical, and deformed condyle with thin cartilage.

Pediatric mandibular chronic nonbacterial osteomyelitis: A case report with 12 years of radiologic follow-up.

Chronic nonbacterial osteomyelitis (CNO) is histologically characterized by nonspecific osteitis. This inflammatory disorder, which lacks an infectious origin, typically presents with chronic pain and swelling at the affected site that can persist for months or even years. However, it is rare for CNO to affect the mandible. A 10-year-old girl presented with a primary complaint of pain in her left mandible. She had no significant medical or dental history. On examination, swelling was visible on the left buccal side, and imaging revealed radiolucent bone deterioration within the left mandible. This case report presents the radiological changes observed over a 12-year follow-up period. Variations in radiopacity, radiolucency, and periosteal reactions were noted periodically. This case highlights the radiological characteristics and findings that are crucial for the diagnosis of CNO, a condition for which no clear diagnostic criteria are currently available.

Beating the rival but losing the game: How the source of alternative offers alters behavior and outcomes in negotiation.

Decades of negotiations research has emphasized the importance of having alternatives. Negotiators with high-value outside offers tend to have greater power and claim higher values in the focal negotiation. We extend this line of work by proposing that the source of alternatives-that is, who negotiators receive an alternative offer from-can significantly shape their negotiation behavior and outcomes. Specifically, we examine how negotiators' behavior changes when they face a counterpart who has an offer from their rival. Four studies demonstrate that this situation enhances negotiators' motivation to outperform their counterpart's alternative by reaching an agreement with the counterpart. This in turn leads the focal negotiator to make less aspirational first offers and eventually claim less value in final agreements. Our findings highlight the importance of considering the existing relationships among actors directly and indirectly involved in a negotiation, reveal a novel motive that can guide negotiators' behavior and outcomes, and uncover a previously unexplored negotiation strategy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Acute Stress Enhances Memory and Preference for Smoking-Related Associations in Smokers.

INTRODUCTION: Nicotine dependence follows a chronic course that is characterized by repeated relapse, often driven by acute stress and rewarding memories of smoking retrieved from related contexts. These two triggers can also interact, with stress influencing retrieval of contextual memories. However, the roles of these processes in nicotine dependence remain unknown. AIMS AND METHODS: We investigated how acute stress biases memory for smoking-associated contexts among smokers (N = 65) using a novel laboratory paradigm. On day 1, participants formed associations between visual stimuli of items (either neutral or related to smoking) and places (background scenes). On day 2 (24 hours later), participants were exposed to an acute laboratory-based stressor (socially evaluated cold pressor test; N = 32) or a matched control condition (N = 33) prior to being tested on their memory recognition and preferences for each item and place. We distinguished the accuracy of memory into specific (ie, precisely correct) or gist (ie, lure items with similar content) categories. RESULTS: Results demonstrated that the stressor significantly induced physiological and subjective perceived stress responses, and that stressed smokers exhibited a memory bias in favor of smoking-related items. In addition, the stressed group displayed greater preference for both smoking-related items and places that had been paired with the smoking-related items. We also found suggestive evidence that stronger smoking-related memory biases were associated with more severe nicotine dependence (ie, years of smoking). CONCLUSIONS: These results highlight the role of stress in biasing smokers toward remembering contexts associated with smoking, and amplifying their preference for these contexts. IMPLICATIONS: The current study elucidates the role of acute stress in promoting memory biases favoring smoking-related associations among smokers. The results suggest that the retrieval of smoking-biased associative memory could be a crucial factor in stress-related nicotine seeking. This may lead to a potential intervention targeting the extinction of smoking-related context memories as a preventive strategy for stress-induced relapse.

Perceptual Generalization of Alcohol-Related Value Characterizes Risky Drinkers.

Generalizing from past experiences to novel situations is critical for adaptive behavior, whereas overgeneralization can promote maladaptive responses (e.g., context-inappropriate fear in anxiety). Here, we propose that overgeneralizing alcohol-related associations characterizes risky drinking. We conducted two online experiments assessing generalization of alcohol-related gains (Study 1) and losses (Study 2) among individuals who engaged in light or risky patterns of drinking (Study 1: N = 88, 24-44 years old; Study 2: N = 87, 21-44 years old). After learning to associate cards with alcohol and non-alcohol-related outcomes, participants chose whether to play with cards varying in perceptual similarity to those shown during conditioning. Finally, participants completed a surprise recognition memory test for all outcomes. Although both groups showed comparable conditioning, we found that risky drinkers overgeneralized alcohol-related gains and losses. Risky drinkers also showed a bias toward recognizing alcohol-related images. These results indicate a novel role for overgeneralization of alcohol-related gains and losses as a mechanism associated with risky drinking.

Target registration errors in navigation-assisted mandibular surgery according to the tracking methods and the type of markers: experiments using human dry mandibular bone.

OBJECTIVES: This study was conducted to evaluate the accuracy of navigation process according to the type of tracking methods and registration markers. The target registration errors (TREs) were measured at seven anatomical landmarks of the mandible. METHODS: Four different experiments were performed to obtain the TREs using two tracking methods, the optical tracker (Polaris) and the electromagnetic (EM) tracker (Aurora), and two types of registration markers, invasive and noninvasive markers. All comparisons of TREs were statistically analyzed using SPSS and Python-based statistical package. RESULTS: The average TRE values obtained from the four experiments were as follows: (1) 0.85 mm (± 0.07) using invasive marker and Aurora, (2) 1.06 mm (± 0.12) using invasive marker and Polaris, (3) 1.43 mm (± 0.15) using noninvasive marker and Aurora, and (4) 1.57 mm (± 0.23) using noninvasive marker and Polaris. Comparisons between all the experimental results revealed statistically significant differences except for the type of tracking system. Although the comparison between the modality of the tracking system showed no significant differences, the EM-based approach consistently demonstrated better performances than the optical type in all comparisons. CONCLUSIONS: This study demonstrates that irrespective of the tracking modality, using invasive marker is a better choice in terms of accuracy. When using noninvasive marker, it is important to consider the increased TREs. In this study, the noninvasive marker caused a maximum increment of TREs of 0.81 mm compared with the invasive marker. Furthermore, using an EM-based tracker with invasive marker may result in the best accuracy for navigation.

Congenital epulis in a newborn.

Congenital epulis (CE) is an extremely rare benign tumor of the gingiva that is found on the alveolar ridge of newborns, and the main treatment option is simple excision. Postoperative prognosis is very good, and spontaneous regression may occur despite incomplete excision. This report presented a rare case of CE and its healing process after surgery under local anesthesia. The treatment plan was decided upon through consultation between a medical team and the patient's family, with surgical excision for the main lesion, which benefitted from surgery, and follow-up for a very small-sized lesion, which was thought to be appropriate for a newborn. No recurrence was found after its removal, and favorable healing was observed.

Bibliometric Analysis: The Effects of Triclosan on Human Health.

Triclosan (TCS) is a widely used chemical whose effects on human health remains elusive. TCS may play a role in a variety of health issues, including endocrine dysfunction, irregular embryonic development, and immune suppression. It is possible that TCS's penetrative abilities across all body barriers, including the blood-brain barrier, may make bioaccumulation the primary driver of these issues. In addition, chronic overuse of this chemical in everyday life may further contribute to the already increasing problem of antibiotic resistance. TCS research has steadily increased since its transition from medical to commercial use over the last 50 years. However, there are some clear gaps in the depth of this research as the safety of this agent is not fully agreed upon. The Food and Drug Administration recently issued regulatory rules regarding TCS in some commercial products; however, it is still found in a variety of goods marketed as "antimicrobial" or "antibacterial". The purpose of this bibliometric study is to analyze research trends in this field and determine the amount of global attention TCS has received as to its relevancy in human health. Documenting and determining research concentration trends related to this field may outline where additional research is most necessary, as well as demonstrate the most valuable research produced and its relation to the advancement of our understanding of TCS. We found there to be a shift in research from TCS and its role in medical environments, to research based on the indirect effects of TCS through environmental contaminations, such as the propagation of antibiotic resistance. This shift was coupled with an increase in global research related to this field and identified China as a significant contributor. Although TCS has received notice, the simple fact of its continued use in so many common products, as well as the unclear understanding of its direct health impacts, reinforces the need for additional and more conclusive research before it has possible irreversible effects on our environment and health.

Primary xanthoma inferior to the right mandibular third molar and intraoral vertical ramus osteotomy.

Intraosseous xanthoma of the mandible is a rare benign disorder. A 17-year-old male patient presented with a suspected abscess in the right mandibular third molar, detected on a panoramic radiograph. The patient had no history of systemic or lipid-related metabolic diseases and complained of no specific symptoms or pain. A radiographic examination revealed a heterogeneous radiolucency extending from the apical to the distal aspect of the right mandibular third molar tooth germ. The lesion measured 9×16×24 mm (antero-posterior×mediolateral×supero-inferior) and showed a relatively well-defined, multilocular, foamy appearance with hyperostotic borders spreading to the inferior alveolar nerve canal. After excisional biopsy, a diagnosis of central xanthoma was made. The lesion recurred, and intraoral vertical ramus osteotomy was done near the lesion. For the treatment of xanthoma of the mandible, extensive and delicate surgical treatment under general anesthesia should be considered.

A Randomized, Double-Blind, Sham-Controlled Trial of Transcranial Direct Current Stimulation for the Treatment of Persistent Postural-Perceptual Dizziness (PPPD).

Background: Persistent postural-perceptual dizziness (PPPD) is a functional vestibular disorder that causes chronic dizziness interfering with daily activities. Transcranial direct current stimulation (tDCS) has reportedly improved dizziness in patients with phobic postural vertigo in an open-label trial. However, no randomized, double-blind, sham-controlled study has been conducted on its therapeutic efficacy in PPPD. Objective: This study was conducted to investigate the efficacy and safety of tDCS as an add-on treatment to pharmacotherapy in patients with PPPD. In addition, functional neuroimaging was used to identify the neural mechanisms underlying the effects of tDCS. Materials and Methods: In a randomized, double-blind, sham-controlled trial, 24 patients diagnosed with PPPD were randomized to receive active (2 mA, 20 min) or sham tDCS to the left dorsolateral prefrontal cortex (DLPFC), administered in 15 sessions over 3 weeks. The clinical measures that assess the severity of dizziness, depression, and anxiety were collected at baseline, immediate follow-up, 1-month follow-up, and 3-month follow-up. Adverse events were also observed. The effect of tDCS on regional cerebral blood flow (rCBF) was evaluated with single photon emission tomography before and after tDCS sessions. Results: For the primary outcome measure of the Dizziness Handicap Inventory (DHI) score, a significant main effect of time was found, but neither the treatment-by-time interaction effect nor the main effect of treatment was significant. For the Hamilton Depression Rating Scale (HDRS) score, there was a statistical significance for the treatment-by-time interaction effect and the main effect of time, but not for the main effect of treatment. However, the treatment-by-time interaction effect and the main effect of time on HDRS score appear to be due to one data point, an increase in depressive symptoms reported by the sham group at the 3-month follow-up. For the Activities-specific Balance Confidence (ABC) Scale and the Hamilton Anxiety Rating Scale scores, there were no significant main effects of time, treatment, and treatment-by-time interaction. In a comparison with the changes in rCBF between the groups, a significant treatment-by-time interaction effect was found in the right superior temporal and left hippocampus, controlling for age and sex. Conclusion: Active tDCS was not found to be significantly more efficacious than sham tDCS on dizziness symptoms in patients with PPPD. It is conceivable that tDCS targeting the DLPFC may not be an optimal treatment option for reducing dizziness symptoms in PPPD. Our findings encourage further investigation on the effects of tDCS in PPPD, which considers different stimulation protocols in terms of stimulation site or the number of sessions. Clinical Trial Registration: cris.nih.go.kr, identifier: KCT0005068.

Changes in facial width according to the ostectomy level of the proximal bone segment in intraoral vertical ramus osteotomy for mandibular prognathism.

BACKGROUND: This study aimed to investigate the changes in facial width according to the ostectomy level of the proximal segment after orthognathic surgery using intraoral vertical ramus osteotomy (IVRO) in patients with mandibular prognathism. METHODS: The participants included 32 individuals who were diagnosed with class III malocclusion prior to surgery. All participants underwent orthognathic surgery using either version of IVRO. The surgery patients were categorized into two groups depending on the type of proximal bone-segment ostectomy technique used: patients whose osteotomy height was at the level of the mandibular tooth occlusal surface (the mandibular tooth surface-level group) and patients whose osteotomy height was at the level of the mandibular inferior border (the mandibular inferior border-level group). The distances between the mandibular width and soft tissue width at the height of the sigmoid notch, mandibular foramen, and alveolar bone and at the anterior-posterior location of the mandibular condyle, mandibular foramen, and coronoid process were compared between the groups. All data were compared to identify differences between preoperative and postoperative measurements. RESULTS: The postoperative change in facial soft tissue width at the intersection of the coronal plane with the coronoid process and the horizontal plane at the height of the mandibular alveolar bone in the group with osteotomy at the level of the mandibular occlusal surface differed significantly from that in the group with osteotomy at the level of the mandibular inferior border, with respective increases (mean ± SD) of 1.3 ± 3.5% and 4.7 ± 5.6%, compared to preoperative measurements (p = 0.050). CONCLUSIONS: Proximal segment ostectomy at the level of the mandibular occlusal surface must be considered with regard to postoperative facial soft tissue width in vertical ramus osteotomy. Additionally, it is necessary to study the visual effect of the width of the mandible appearing small because of the posterior position of the mandible, even when the mandibular facial width is maintained.

Minimum Surgico-Orthopedic Treatment using Computer-Assisted Single-Tooth Osteotomy in an Adolescent Skeletal Class III Patient with Anterior Ankylosed Tooth: A Case Report.

Traumatic tooth avulsion can lead to ankylosis, which may interfere with growth of the alveolar bone in a growing patient. The resulting difference in alveolar bone height and position can lead to esthetic problems such as open bite. A growing 13-year-old female patient presented skeletal Class III malocclusion with bone ankylosis of a maxillary anterior tooth. Even after 2 years of orthopedic and orthodontic treatment, little improvement was achieved regarding the positions of the anterior maxillary teeth, or the vertical position of the maxillary right central incisor. Therefore, surgical treatment by single-tooth osteotomy (STO) and corticotomy for the anterior ankylosed tooth were considered and performed using a CAD/CAM surgical guide, based on presurgical computer-based simulation surgery. Orthodontic and orthopedic treatments were completed at 10 months after surgery. The patient showed a favorable course of healing, with no mobility issues or gingival recession 3 years after single-tooth osteotomy and corticotomy surgeries. A favorable outcome was finally achieved by applying orthopedic treatment combined with STO and corticotomy for the anterior ankylosed tooth. Orthodontic treatment with minimally surgical method is recommended in an adolescent patient with skeletal Class III malocclusion and anterior open bite.

Reduction malarplasty using a simulated surgical guide for asymmetric/prominent zygoma.

BACKGROUND: The present study introduces a reduction malarplasty using a three-dimensional (3D)-printed surgical guide and evaluates the guide's technical applicability. METHODS: Twenty malarplasties were performed for 12 subjects with zygomatic asymmetry/prominency using the current method. 3D reconstruction of the craniomaxillofacial region and fine dental occlusion was made with image data from computed tomograpy and dental scanning. A computer-assisted surgical simulation was performed for reduction malarplasty and a surgical guide was designed for later 3D printing. The manufactured surgical guide was introduced to the operation field to guide the surgery; its surgical accuracy was confirmed by comparing five corresponding points from preoperative simulation and postoperative data. RESULTS: We successfully performed the reduction malarplasty with the surgical guide. The accuracy level of surgery fell to 0.93 mm of total median difference for the corresponding zygoma points of preoperative simulations and postoperative zygoma. The anterior and upper points showed less error level (0.59 and 0.73 mm difference, respectively) than did other points. CONCLUSIONS: We developed a computer-assisted surgical technique using a surgical guide for asymmetrical/prominent zygoma which proved to be simple, practical, and accurate; it is expected to help surgeons perform reduction malarplasty with ease and accuracy.

3D cephalometric landmark detection by multiple stage deep reinforcement learning.

The lengthy time needed for manual landmarking has delayed the widespread adoption of three-dimensional (3D) cephalometry. We here propose an automatic 3D cephalometric annotation system based on multi-stage deep reinforcement learning (DRL) and volume-rendered imaging. This system considers geometrical characteristics of landmarks and simulates the sequential decision process underlying human professional landmarking patterns. It consists mainly of constructing an appropriate two-dimensional cutaway or 3D model view, then implementing single-stage DRL with gradient-based boundary estimation or multi-stage DRL to dictate the 3D coordinates of target landmarks. This system clearly shows sufficient detection accuracy and stability for direct clinical applications, with a low level of detection error and low inter-individual variation (1.96 ± 0.78 mm). Our system, moreover, requires no additional steps of segmentation and 3D mesh-object construction for landmark detection. We believe these system features will enable fast-track cephalometric analysis and planning and expect it to achieve greater accuracy as larger CT datasets become available for training and testing.

Direct transparotid approach via a modified mini-preauricular incision for open reduction and internal fixation of subcondylar fractures.

A transparotid approach, with a retromandibular or preauricular incision, is an alternative surgical approach for treating a subcondylar fracture and reducing the potential for complications such as injury to the facial nerves. However, retromandibular and preauricular incisions are both created far away from the parotid gland-dissection area. Thus, it is necessary to undermine the skin and retract it anteriorly to access the surgical field. Here, we introduce a modified approach wherein the incision allows for direct access to the fracture site. This approach may be adopted to shorten the incision length, reduce the retraction trauma at the surgical site, and help prevent injury to the facial nerve.

The incidence of postoperative hemorrhage after tooth extraction in patients with thrombocytopenia.

OBJECTIVES: The risk of bleeding after tooth extraction in thrombocytopenia patients remains unclear. Therefore, the present study aimed to assess the risk of bleeding after tooth extraction in patients with thrombocytopenia. MATERIALS AND METHODS: : The study included 220 patients who had a medical history of thrombocytopenia and underwent tooth extraction (330 teeth). The patients were divided into those who had thrombocytopenia (platelet count <150k) immediately before the tooth extraction, and those who had platelet counts that were between 150k and 250k before the extraction. Bleeding complications were recorded and compared between the patient groups. RESULTS: : Of the 220 patients, 130 underwent tooth extractions while having thrombocytopenia (platelet count <150k), and 90 had platelet counts that were between 150k and 250k before tooth extractions. Bleeding complications occurred in 11 patients (5.0%) of the 220 patients. Among those 11 patients with bleeding complications, 10 patients (7.7%) had thrombocytopenia (platelet count <150k) of the 130 patients, and 1 patient (1.1%) had a normal platelet count of the 90 patients. There was a significant difference between the patient groups regarding bleeding after extractions (P<0.001). No significant difference in the incidence of post-extraction bleeding was found between the subgroups by platelet count within the thrombocytopenia group. CONCLUSION: Thrombocytopenia (platelet count <150k) increases the risk of post-tooth extraction bleeding. Therefore, bleeding control under the proper evaluation of hemostasis and performing delicate tooth extraction procedures using hemostatic plugs is necessary during the tooth extraction of patients with thrombocytopenia.

Fully-customized distraction assembly for maxillofacial distraction osteogenesis: a novel device and its experimental accuracy verification.

BACKGROUND: A new distraction osteogenesis assembly system comprising a fully customized CAD/CAM-based fixation unit and ready-made distraction unit was developed. The aim of this study was to introduce our new distraction system and to evaluate its accuracy level in a sampled mandibular distraction osteogenesis. METHODS: Our system consists of a fully customized CAD/CAM-based fixation plate unit with two plates for each moving and anchoring part, and a ready-made distraction unit with attachment slots for fixation plates. The experimental distractions were performed on 3D-printed mandibles for one control and two experimental groups (N = 10 for each group). All groups had reference bars on the chin region and teeth to measure distraction accuracy. The control group had the classical ready-made distraction system, and experimental groups 1 and 2 were fitted with our new distraction assembly using a different distractor-positioning guide design. All distracted experimental mandibles were scanned by CT imaging, then superimposed on a 3D simulation to get their discrepancy levels. RESULTS: The measured 3D distances between the reference landmarks of the surgical simulations and the experimental surgeries for the three groups were significantly different (p < 0.0001) by statistical analysis. The errors were greater in the control group (with a total average of 19.18 ± 3.73 mm in 3D distance between the simulated and actual reference points) than those in the two experimental groups (with an average of 3.68 ± 1.41 mm for group 1 and 3.07 ± 1.39 mm for group 2). The customized distraction assembly with 3D-printed bone plate units in group 1 and 2, however, did not show any significant differences between simulated and actual distances (p > 0.999). CONCLUSION: Our newly-developed distraction assembly system with CAD/CAM plate for the distraction osteogenesis of the mandible produced a greater level of accuracy than that of a conventional distraction device. The system appears to address existing shortcomings of conventional distraction devices, including inaccuracy in vector-controlled movement of the system. However, it also needs to be further developed to address the requirements and anatomical characteristics of specific regions.

Maxillary sinus haziness and facial swelling following suction drainage in the maxilla after orthognathic surgery.

BACKGROUND: We investigated the efficacy of a maxillary Jackson-Pratt (J-P) suction drain for preventing maxillary sinus hematoma and facial swelling after maxillary Le Fort I osteotomy (LF1). METHODS: We retrospectively evaluated 66 patients who underwent LF1 at a single institution. Of these, 41 had a J-P suction tube inserted in the mandible and maxilla (maxillary insertion), and 25 had a J-P drain inserted in the mandible only (no maxillary insertion). Facial CT was obtained before and 4 days after surgery. We compared mean midfacial swelling and maxillary sinus haziness by t test and examined correlations between bleeding amount and body mass index (BMI). RESULTS: For the maxillary-insertion group, the ratio of total maxillary sinus volume to haziness (57.5 ± 24.2%) was significantly lower than in the group without maxillary drain insertion (65.5% ± 20.3; P = .043). This latter group, however, did not have a significantly greater midfacial soft tissue volume (7575 mm3) than the maxillary-insertion group (7250 mm3; P = .728). BMI did not correlate significantly with bleeding amount or facial swelling. CONCLUSIONS: Suction drainage in the maxilla reduced maxillary sinus haziness after orthognathic surgery but did not significantly reduce midfacial swelling.

Effect of warfarin discontinuation on the incidence of postoperative bleeding in tooth extraction.

OBJECTIVES: The number of patients undergoing oral anticoagulant therapy for cardiovascular and cerebrovascular disease is increasing. However, the risk of bleeding after tooth extraction in patients receiving warfarin is unclear. Here, we assess the risk of bleeding after tooth extraction in patients on warfarin. MATERIALS AND METHODS: The study included 260 patients taking warfarin who underwent tooth extraction (694 teeth). The patients were divided into those whose teeth were extracted while they were taking warfarin, those who discontinued warfarin before extraction, and those who underwent extraction while receiving heparin bridging therapy. Bleeding complications in the two groups were compared. RESULTS: Of the 260 patients, 156 underwent extraction while taking warfarin, 70 stopped taking warfarin before extractions, and 34 received heparin bridging therapy and stopped taking either medication before extractions. Bleeding complications occurred in 9 patients (3.5%) and 9 tooth sites (1.3%). Among the 9 patients with bleeding complications, 6 underwent extraction while taking warfarin, 2 stopped warfarin before extraction, and 1 underwent extraction after receiving heparin bridging therapy. No significant difference was seen between patient groups regarding bleeding after extractions (P=0.917). CONCLUSION: Warfarin use does not increase the risk of post-extraction bleeding and can therefore be continued during tooth extraction.

The effect of bisphosphonate discontinuation on the incidence of postoperative medication-related osteonecrosis of the jaw after tooth extraction.

OBJECTIVES: The discontinuation of bisphosphonate (BP) treatment before tooth extraction may induce medication-related osteonecrosis of the jaw (MRONJ). Whether the long-term discontinuation of BP treatment before tooth extraction affects the risk of developing MRONJ after tooth extraction or whether extended drug holidays induce systemic side effects remains unclear. The present study assessed the incidence of MRONJ among patients who underwent tooth extraction and did not discontinue BP therapy prior to the procedure. MATERIALS AND METHODS: Patients were classified according to whether or not they discontinued BP therapy before tooth extraction. Differences in the incidence of MRONJ after tooth extraction were compared between the two groups using the chi-squared test. RESULTS: The BP-continuation (BPC) and BP-discontinuation (BPDC) groups included 179 and 286 patients, respectively. One patient in the BPC group and no patients in the BPDC group developed MRONJ (P=0.385). The patients in the BPDC group stopped receiving BP therapy at a mean of 39.0±35.5 months prior to tooth extraction. CONCLUSION: The possibility of pre-existing MRONJ in the extraction area must be considered during the extraction procedure. Routine discontinuation of BP medications for several months before the extraction procedure should be carefully considered, as evidence of its efficacy in reducing the development of post-extraction MRONJ is limited.