Treatment of Medication-Related Osteonecrosis of the Jaws without Segmental Resections: A Case Series.

BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious reaction to anti-resorptive drugs (ARDs) in patients treated for osteoporosis and conditions related to cancer. Treatment for MRONJ consists of the use of non-operative therapies according to the evolution of the disease, which consist of the use of antimicrobial mouthwashes, systemic antibiotics, and operative therapies, such as debridement of necrotic bone, marginal or segmental resection, and bone reconstruction of the jaws in more advanced stages of the disease. CASE REPORT This is a case series of 11 female patients treated for MRONJ, with a mean age of 76.5 years. Patients with malignant diseases of the jaws or those undergoing head and neck radiotherapy were excluded. Nine patients were medicated for osteoporosis with oral bisphosphonates and denosumab, and 2 patients used zoledronate to treat metastatic breast cancer. MRONJ prevailed in the mandible, most patients were classified as stage 2, and the most frequent triggers were tooth extraction and prosthetic trauma. All patients initially underwent non-operative therapies and were operated according to MRONJ stage, but none required segmental resection. Adjuvant treatments were used in 5 patients, and mean treatment and follow-up periods were 5 and 18.3 months, respectively. There was complete resolution of disease in all patients, with only 1 relapse. CONCLUSIONS This case series suggests that it is possible to treat MRONJ with conservative therapies in the early stages of the disease and minimally invasive surgeries in more advanced stages of the disease, thus avoiding segmental jaw resections.

A Case Report of Oral Bisphosphonate Treatment for Osteoporosis Leading to Atypical Femoral Fracture and Pathologic Mandibular Fracture.

BACKGROUND Bisphosphonates inhibit bone resorption in patients with postmenopausal osteoporosis and reduce osteoporotic fracture incidence. Medication-related osteonecrosis of the jaws (MRONJ) and atypical femoral fractures (AFF) are both rare but serious adverse effects of anti-resorptive drugs (ARD) such as bisphosphonates. The most advanced form of MRONJ is termed stage 3 and can lead to severe local sequelae like pathologic mandibular fractures (PMF). This study reports a case of MRONJ-related PMF and AFF with osteomyelitis secondary to bisphosphonate treatment for osteoporosis. CASE REPORT A 63-year-old white woman was diagnosed with PMF related to MRONJ stage 3 during treatment of an AFF with osteomyelitis. She had been treated for postmenopausal osteoporosis with 70 mg of alendronate weekly for 2 years. The PMF was treated by stable internal fixation combined with debridement and sequestrectomy, but further debridement was required and 2 mandibular implants were then removed. Postoperative recovery was uneventful and the mandibular infection was controlled after the second surgery. Three weeks later, she was discharged from the hospital, instructed to discontinue the use of alendronate, and referred for 30 sessions of hyperbaric oxygen therapy. At the 3-year follow-up, the PMF was completely healed without signs of mandibular infection or bone exposure. CONCLUSIONS This report raises awareness of both MRONJ and AFF as possible adverse effects of short-term bisphosphonate therapy for postmenopausal osteoporosis, and highlights the importance of dental and orthopedic follow-ups. It is crucial to emphasize the need for early diagnosis and treatment to prevent MRONJ progression to PMF.

Granuloma central de células gigantes: relato de um caso clínico / Giant cells central granuloma: a case report

Este trabalho apresenta um caso clínico de granuloma central de células gigantes em uma paciente do sexo feminino de 25 anos de idade com uma lesäo expansiva na abóbada palatina direita e com mobilidade dentária na hemi-arcada ipsilateral. Após a avaliaçäo radiográfica e biópsia incisional da lesäo foi realizada a curetagem e a remoçäo dos dentes envolvidos sob anestesia geral, resultando em uma ampla comunicaçäo buconasal, a qual foi selada com uma prótese parcial removível com obturador nasal

Disfunção temporomandibular: estudo clínico e radiográfico da relação com as deforminadades maxilomandibulares / Temporomandibular disfunction: clinical and radiographic study of the relationship with maxillomandibular deformities

Este estudo visa investigar a sintomatologia dolorosa temporomandibular em pacientes portadores de maloclusões esqueléticas. Foram avaliados clínica e radiograficamente 15 pacientes, correlacionado os fatores idade, tipo de deformidade e grau de disfunção temporomandibular. Os resultados indicaram uma elevada incidência da disfunção temporomandibular na amostra, independente do tipo de deformidade maxilomandibular, mas com aumento da sintolomandibular nos grupos de faixa etária maior

Disfunção temporomandibular: estudo clínico e radiográfico da relação com as deformidades maxilomandibulares / Tempore mandibular disfunction: Clinical and radigrafic study of the relation with maxilo and mandibular alterations

Este trabalho aborda a relação entre deformidades maxilomandibulares e disfunções temporomandibulares a partir de uma amostra de 15 pacientes, distribuídos em três grupos. Os resultados indicam uma incidência elevada de sintomatologia temporomandibular na amostra. As deformidades temporomandibulares parecem atuar como fatores irritativos crônicos