Weak evidence for the management of medication-related osteonecrosis of the jaw: An overview of systematic reviews and meta-analyses.

BACKGROUND: Although several therapies are proposed for medication-related osteonecrosis of the jaw (MRONJ), to date there is no consensus or treatment protocol for MRONJ. This overview aims to summarize the available evidence on the management and outcomes of MRONJ. METHODS: An electronic search without language or date restrictions occurred in five databases and gray literature for articles published until March 2020. This overview was performed according to the PICO format. The eligibility criteria comprised systematic reviews (RS) with or without meta-analyses that analyzed treatments outcomes for MRONJ. The methodological quality of each SR was evaluated using AMSTAR 2. RESULTS: Fifteen studies published between 2014 and 2020 were included in this overview. The summary of the evidence showed that conservative treatment and low level laser therapy can yield favorable results for early stages of MRONJ whereas surgical treatment seems to be better for advanced stages. However, qualitative assessment of the SRs highlighted a global low level of quality. CONCLUSIONS: There is weak evidence to support treatment protocols for MRONJ. Because of the low quality of the SRs, highlighted by this overview, no insightful therapeutic recommendations can be issued for any intervention for MRONJ.

Resin-dentin Bond Stability of Experimental 4-META-based Etch-and-rinse Adhesives Solvated by Ethanol or Acetone.

PURPOSE: To investigate the influence of 4-META concentration and type of solvent on the degree of conversion (DC%) and resin-dentin bond stability of experimental etch-and-rinse adhesives. MATERIALS AND METHODS: Four different concentrations of 4-META (12 wt%, 20 wt%, 30 wt%, 40 wt%) were added to a model adhesive system consisting of TEG-DMA (25 wt%), UDMA (20 wt%), HEMA (30 wt%), water (4 wt%), camphorquinone (0.5 wt%), and tertiary amine (0.5 wt%) dissolved in 20% acetone (A12, A20, A30 and A40) or 20% ethanol (E12, E20, E30 and E40). DC% was evaluated by FT-IR spectroscopy. Human molars were wet ground until the occlusal dentin was exposed, the adhesive systems were applied after 37% phosphoric acid etching, and resin composite buildups were incrementally constructed. After storage in distilled water at 37°C for 24 h, the teeth were cut into resin-dentin beams (cross-sectional area 1 mm2). Microtensile bond strength (µTBS) was evaluated after 24 h, 6 months, and 1 year of water storage at 37°C. The failure mode was categorized as adhesive, mixed, or cohesive. Data were analyzed using ANOVA and Tukey's HSD test (α = 0.05). RESULTS: A12 presented the lowest DC% (p < 0.05). All the other adhesive systems showed statistically similar DC% (p > 0.05). All adhesive systems maintained resin-dentin bond stability after 6 months of water storage, while only A40 and E40 maintained it after 1 year. CONCLUSION: Irrespective of the type of organic solvent, the incorporation of high concentrations of 4-META (40 wt%) improved the resin-dentin bond stability of the experimental etch-and-rinse adhesive systems over a period of 1 year.

Reconstrução cirúrgica de reabsorção condilar progressiva severa: relato de caso / Surgical reconstruction of severe progressive condylar resorption: case report

A reabsorção condilar progressiva é uma condição de etiologia controversa, caracterizada pela diminuição gradual do volume do côndilo mandibular, podendo o paciente apresentar, ao exame clínico, sinais e sintomas, como instabilidade oclusal e esquelética, oclusão classe II, mordida aberta anterior, dor e retrognatismo mandibular. Dentre os métodos terapêuticos para o seu tratamento, destacam-se a utilização de enxertos e próteses articulares, associados ou não à cirurgia ortognática para a reconstrução do côndilo mandibular. Este trabalho tem como objetivo relatar o caso clínico de uma paciente do sexo feminino, 28 anos de idade, portadora de artrite reumatoide juvenil, com presença de reabsorção condilar progressiva severa, abertura bucal máxima de 20 mm, dispneia noturna, retrusão mandibular e perfil facial convexo. Ela foi tratada no Hospital Federal dos Servidores do Estado por meio de cirurgia ortognática maxilomandibular com rotação anti-horária do plano oclusal e instalação de prótese condilar bilateral customizada TMJ Concepts®. A reconstrução total proporcionou uma perfeita adaptação à estrutura óssea remanescente, com melhora estético-funcional da paciente. Segue em controle pós operatório de dois anos, sem recidiva e com oclusão satisfatória... (AU)

Progressive condylar resorption is a controversial etiology condition characterized by the gradual decrease in the condylar volume, and the patient may present in clinical examination signs and symptoms such as occlusal and skeletal instability, occlusion Class II, anterior open bite, pain and retrognathism mandibular. Among the therapeutic methods for their treatment, it highlights the use of grafts and prosthetic joint, with or without orthognathic surgery for the reconstruction of the mandibular condyle. The purpose this study is to report the case of a female patient, 28 years old, holder of juvenile rheumatoid arthritis, with the presence of severe progressive condylar resorption, maximum mouth opening 20 mm, nocturnal dyspnoea, mandibular retraction and convex facial profile. It was treated at the Hospital Federal dos Servidores do Estado through orthognathic surgery maxilomandibular with counterclockwise rotation of the occlusal plane and installation of customized bilateral condylar prosthesis TMJ Concepts®. The total reconstruction provided a perfect adaptation to the remaining bone structure, aesthetic and functional improvement of the patient. The same goes for postoperative control two years without recurrence and satisfactory occlusion... (AU)