Analysis of different therapeutic protocols for osteonecrosis of the jaw associated with oral and intravenous bisphosphonates.

INTRODUCTION: Chemotherapy-associated osteonecrosis of the jaw caused by bisphosphonates is an exposure of necrotic bone with more than eight weeks of evolution that is attributable to bisphosphonates and no prior radiation therapy. Its etiopathogenesis remains unknown, although there are two hypotheses that may explain it: the drug's mechanism of action, and the risk factors that can lead to osteonecrosis. There is a wide range of treatment options for managing chemotherapy-associated osteonecrosis of the jaw, from conservative treatments to surgical procedures of varying levels of invasiveness, which are sometimes supplemented with adjuvant therapies. OBJECTIVE: The objective of this article is to group the therapeutic options for osteonecrosis of the jaw (ONJ) into seven different protocols and to evaluate their effectiveness in relation to stage of ONJ. MATERIAL AND METHODS: A literature review was carried out in PubMed following the PRISMA criteria. A total of 47 were collected after compiling a series of variables that define ONJ, applied treatments, and the clinical results obtained. RESULTS AND DISCUSSION: The 47 articles selected have a low to average estimated risk of bias and are of moderate to good quality. According to the data obtained, Protocol 3 (conservative treatment, clinical and radiological follow-up, minimally invasive surgical treatment, and adjuvant therapies) is the most favorable approach for ONJ lesions caused by oral bisphosphonates. For lesions caused by intravenous bisphosphonates, Protocol 2 (conservative treatment, clinical and radiological follow-up, minimally invasive surgical treatment, and no adjuvant therapies) is the best approach. When comparing the different stages of ONJ, Protocol 1 (conservative treatment, clinical and radiological follow-up) promotes better healing of Stage 1 ONJ lesions caused by orally administered bisphosphonates, and Protocol 3 is recommended for Stage II. For ONJ lesions attributable to intravenous bisphosphonates, Protocol 7 (conservative treatment, clinical and radiological follow-up, and adjuvant therapies) provides the best results in Stage 0; in Stages I, II, and III, Protocol 1 gives better results.

Prospective double-blind clinical trial evaluating the effectiveness of Bromelain in the third molar extraction postoperative period.

OBJECTIVES: To evaluate the anti-inflammatory and analgesic effect of Bromelain (pineapple extract) administered orally in the postoperative after extraction of impacted lower molars. STUDY DESIGN: This is a prospective, placebo-controlled, unicentric, double-blind study; the sample size was 34 patients. The pre and postoperative outcomes, evaluated on the third (D3) and eighth day (D8), included inflamtion, pain and oral aperture, as well as the need for analgesics. One group received Bromelain 150mg per day for three days and 100mg on days 4 to 7. The other group received placebo in the same dosage. All outcomes werrecorded quantitatively and analyzed with the Mann-Whitney U test for independent samples. RESULTS: Although there were no statistically significant differences between the treatment groups, a trend towards less inflammation and improved oral aperture was observed in the group that received Bromelain, compared to the group that received placebo. This trend can be attributed completely to random reasons, since there is no statistical difference in the results. CONCLUSIONS: Further studies are necessary to analyze different administration patterns and doses of Bromelain for the use in the postoperative of impacted third molars.

Influencia del diseño del muñón y el método de escaneado en el ajuste marginal de estructuras elaboradas con el sistema Cercon Smart Ceramics® / Influence of tooth preparation design and scanning method on marginal adaptation of Cercon Smart Ceramics® crowns

Introducción: Los métodos de procesamiento asistido por ordenador suponen actualmente una alternativa cada vez más frecuente a los métodos convencionales de laboratorio. La exactitud y precisión de estos sistemas es fundamental para conseguir una correcta adaptación a las preparaciones, requisito indispensable para el éxito a largo plazo de las restauraciones de prótesis fija. El objetivo de este estudio es analizar la influencia del método de escaneado y del diseño del muñón en el ajuste de restauraciones elaboradas con el sistema Cercon Smart Ceramics®. Material y métodos: Se confeccionan 20 probetas de acero inoxidable con distintos ángulos de convergencia oclusal (10º y 15º), sobre las que se realizan 20 cofias con el sistema Cercon Smart Ceramics®. En la mitad de las coronas el láser del sistema efectuará la lectura del encerado de las estructuras, mientras que en la otra mitad se hará la lectura directa del troquel. Tras cementar las restauraciones, se analizará su ajuste marginal mediante microscopía electrónica de barrido. Resultados: Se encuentran diferencias estadísticamente significativas (p≤0.05) entre el ajuste vertical obtenido en las estructuras diseñadas por ordenador (67.65 μm) y las obtenidas a partir del escaneado del modelado (99.34 μm). No son significativas (p≥0.05) las diferencias halladas entre el ajuste de las cofias elaboradas sobre muñones de 10º (77.78 μm) y 15º: (89.21 μm). Conclusiones: En el sistema Cercon, el escaneado directo del muñón proporciona restauraciones con mejor ajuste vertical que el escaneado del encerado. Los distintos valores de convergencia oclusal no influyen significativamente en el ajuste marginal (AU)

Introduction: Today CAD/CAM systems are a common option as contrasted with conventional laboratory methods. Accuracy and precision of these methods are essential to obtain well fitted crowns. This is basic for long-term success in fixed prosthesis. The aim of this study is to evaluate the influence of scanning method and tooth preparation design on marginal adaptation of Cercon Smart Ceramics® restorations. Material and Method: Twenty stainless steel dies were made with different oclusal convergence angles (10º and 15º). Over these dies twenty crowns were fabricated with Cercon Smart Ceramics® system. The system’s laser scanned the wax-up of half of the crowns, and it scanned directly the preparation of the half rest. After cementing the crowns, marginal fitting will be analyzed using an electron microscope. Results: Statistically differences were found (p≤0.05) between marginal fitting of computer designed crowns (67.35 μm) and crowns whose wax-up was scanned (99.34 μm). There aren’t statistically differences between crown’s adaptation over 10º and 15º teeth. Conclusions: In Cercon Smart Ceramics® system, preparation scanning gets better marginal fitted crowns than wax-up scanning. Convergence angle doesn’t influence marginal adaptation (AU)