Emerging antiresorptive medications and their potential implications for dental surgeries.

BACKGROUND: The aim of this review was to discuss the current and newly emerging antiresorptive medications and their potential implications for dental surgeries. TYPES OF STUDIES REVIEWED: The authors searched PubMed (MEDLINE), Cochrane, Embase, and other electronic databases for articles related to osteonecrosis of the jaw and medication-related osteonecrosis of the jaw (MRONJ). In addition, the authors hand searched the bibliographies of all relevant articles, the gray literature, textbooks, and guidelines in association position statements. RESULTS: The following information for MRONJ risk should be evaluated before any invasive dental procedure: metastatic carcinoma has a higher risk than osteoporosis; parenterally administered bisphosphonates and denosumab have a higher risk than orally administered bisphosphonates or antiangiogenic agents; dose and duration of medication received; adjunctive medications or combination of antiresorptive agents also may increase the risk of MRONJ; additive factors and comorbidities such as diabetes, autoimmune disease, immunosuppression, or any condition that might affect healing negatively would result in potentially higher risk of developing MRONJ; angiogenic inhibitors as part of a cancer treatment regimen, with or without antiresorptive medication, are considered high risk. PRACTICAL IMPLICATIONS: Patients who received antiresorptive therapy for malignancy were at higher risk of developing MRONJ than those who received the therapy for osteoporosis, regardless of the route of administration and type of drug. Antiangiogenic agents, bevacizumab, aflibercept, and tyrosine kinase inhibitors such as sunitinib were implicated most commonly in the development of MRONJ. Patients who are taking multiple doses of angiogenic inhibitors should be monitored closely for early diagnosis of possible MRONJ.

Declassifying Mobility Classification.

INTRODUCTION: Tooth mobility is often discussed among dental health care providers according to a numerical scale (ie, 1, 2, or 3) without a clear understanding of the definition of each category. Thus, a comprehensive review to examine and discuss the various classifications is needed. The aim of this comprehensive review was to discuss the main clinical classifications of tooth mobility. METHODS: The authors conducted electronic searches in MEDLINE, Scopus, and PubMed. Additionally, the authors manually searched the textbooks, gray literature, and bibliographies of all relevant articles. RESULTS: The most commonly referenced clinical index for mobility was the Miller index; yet, many other mobility classifications exist as well as modifications of those indexes. The literature has been very inconsistent and at times inaccurate when classifying mobility; using various stages of mobility using grades, classes, and scores interchangeably and not defining the meaning of the actual numerical scores/terminologies are common problems. CONCLUSIONS: In order to avoid ambiguity and provide clarity regarding the impact of degrees of mobility when used clinically, this review comprehensively discusses different classifications and definitions of tooth mobility with attention to the importance of using them consistently and accurately. There is a need to standardize 1 classification for mobility.

Crown lengthening in the maxillary anterior region: a 6-month prospective clinical study.

The purpose of this study was to assess osseous parameters and stability of maxillary anterior teeth following crown lengthening surgery. Thirty-six patients requiring facial crown lengthening of 277 maxillary anterior and first premolar teeth were included. Presurgical and intraoperative clinical measurements were recorded at baseline and 1, 3, and 6 months postsurgery at midfacial, mesiofacial, and distofacial line angles. The data presented here suggest that when crown lengthening anterior maxillary teeth, the distance between the desired gingival margin and alveolar crest is usually insufficient to allow for biologic width. In addition, there is significant tissue rebound that may stabilize by 6 months. Tissue rebound appears related to flap position relative to the alveolar crest at suturing. These findings suggest that clinicians should establish proper anterior crown length with osseous resection.

Case report: Diagnosis and treatment of a botryoid odontogenic cyst found in the maxillary anterior region.

INTRODUCTION: The botryoid odontogenic cyst (BOC) is a multicompartmentalized variant of the lateral periodontal cyst (LPC) that is typically found in the premolar-canine region of the mandible. METHODS: A 60-year old man was referred for evaluation of a radiolucent lesion discovered on a routine examination. Radiographs revealed a unilocular radiolucency between the roots of teeth #10 and #11. Clinically, the site appeared normal with minimal probing depths, and there were no signs of swelling, bleeding, or mobility of the adjacent teeth. The pulps of both teeth responded to cold without lingering. After patient consent, the lesion was accessed by a mucoperiosteal flap, curetted from its bony cavity, and submitted for biopsy. The site was then treated with a bone allograft and a collagen membrane. RESULTS: The diagnosis of a BOC was made based on location and the histopathological findings of multiple cystic spaces lined by nonkeratinized stratified squamous epithelium. The 22-month follow-up revealed a normal clinical appearance with evidence of radiographic bone fill at the site of the lesion. CONCLUSION: This case shows an unusual presentation of a BOC in both location and radiographic appearance and emphasizes the importance of a microscopic examination of unilocular lesions when associated with teeth having normal responding vital pulps. The relatively high recurrence rate for the BOC warrants periodic follow-up.

Periodontal wound healing with and without platelet-rich plasma: histologic observations and assessment of flap tensile strength.

BACKGROUND: Platelet-rich plasma (PRP) has been promoted as a surgical adjunct to enhance hard and soft tissue wound healing. Although anecdotally reported to be of value, the results of controlled studies examining the added effects of PRP on surgical procedures have been mixed. The purpose of this study was to test the effect of PRP on flap strength at various post-surgical time points in a minipig animal model. METHODS: Twelve Yucatan minipigs provided four sites per animal. PRP was prepared from each animal at the time of surgery. Following reflection of a mucoperiosteal flap in each quadrant, subgingival plaque and calculus were removed. Each surgical site was irrigated with sterile saline; prior to suturing, one randomly selected test quadrant in each arch was treated with PRP. Four animals were euthanized at day 14, and two animals were euthanized at 2, 7, 10, and 28 days. The flap strength in each quadrant was tested by attaching to a loop of 3-0 silk suture through the tissue; the force required to separate the flap from the tooth/bone interface was recorded for each site. A separate portion of each flap site was prepared for descriptive histologic examination, including inflammation, hemorrhage, and new bone growth. RESULTS: Flap strength was significantly less on day 2 compared to later time points, and there were no significant differences between the test and control groups. No histologic differences in healing between test and control sites were seen at any time point. CONCLUSIONS: PRP did not seem to contribute to greater flap strength at any post-surgical time point, nor was it associated with any histologic differences in wound healing in this Yucatan minipig model. The time points chosen for observation post-surgery, as well as the variability in the PRP platelet count, may have contributed to the lack of positive findings in this study.

Implant failure with spontaneous rapid exfoliation: case reports.

BACKGROUND: The predictability and success of endosseous dental implants has secured their place as a standard treatment modality. Nevertheless, a small number of implants will fail regardless of operator experience or clinically recognizable cause. This article presents two cases of early failure of two-stage dental implants manifesting in a spontaneous and rapid exfoliation. METHODS: Two healthy adult male patients received single-tooth, machined titanium implant fixtures during uncomplicated stage-one surgical procedures. RESULTS: After an uneventful early postoperative healing phase, both patients returned during the 4 to 6 week time period with failing implants. Clinical examination in both cases revealed the exfoliation of a fixture from the edentulous area with varying signs of soft tissue reaction in each instance. Radiographs revealed osteotomy sites along with the coronally migrating fixtures, with one of the exfoliated implants accompanied by apparent perifixtural radiolucency. In both cases, the implant fixtures were removed digitally without anesthesia. Subsequent medical follow-up was noncontributory, and ultimate healing was uneventful in both cases. Two separate attempts in the mandibular right second premolar region of one patient ended in similar failures despite the successful osseointegration of an identical fixture on the contralateral side. CONCLUSIONS: Few cases of early exfoliation of dental implants have been reported in the literature. Although the exact etiology of the early fixture loss in these two patients is unclear, the description of these cases can add to the published knowledge of dental implant failures and potentially lead to the uncovering and prevention of their causative mechanisms.