The effect of systemic antibiotics on clinical and patient-reported outcome measures of oral implant therapy with simultaneous guided bone regeneration.

OBJECTIVES: The aim of the present superiority study was to determine the effect of systemic antibiotics primarily on patient-reported outcome measures (PROMs) and post-surgical complications in patients undergoing oral implant therapy with simultaneous guided bone regeneration (GBR). MATERIALS AND METHODS: A total of 236 medically and periodontally healthy patients received oral implants with simultaneous GBR at seven centres. Pre-operative antibiotics of 2 g amoxicillin were prescribed to the test group 1 hr prior to surgery and 500 mg thrice daily on days 1-3 after surgery. The control group was given a placebo. Group allocation was performed randomly. Primary outcome variables were PROMs recorded as visual analogue scale scores assessed on days 1-7 and 14 on pain, swelling, haematoma and bleeding. Post-operative complications as secondary outcome variables were examined at 1, 2, 4 and 12 weeks from surgery. Chi-square tests and repeated measures of analysis of variance (ANOVA) were performed for statistical evaluation. RESULTS: No statistically significant differences (p > .05) between the two groups were detected for the evaluated PROMs. The same was noted with respect to post-surgical complications. Four implants were lost-three in the test group and one in the control group. CONCLUSION: In this trial, systemic antibiotics did not provide additional benefits to PROMs, nor the prevention of post-surgical complications in medically and periodontally healthy patients undergoing oral implant therapy with simultaneous GBR. However, further studies with larger sample sizes are still required to support the clinical outcomes of this study.

Needle fracture as a complication of dental local anesthesia: recommendations for prevention and a comprehensive treatment algorithm based on literature from the past four decades.

OBJECTIVES: The aim of this publication is to provide a concept for prevention and a standardized step-by-step clinical approach to this rare but serious and potentially preventable complication of dental local anesthesia. MATERIALS AND METHODS: We collected data with a PUBMED search using the key words "local anesthesia," "dental anesthesia/anesthesia" OR "mandibular block anesthesia," "complication," "hypodermic needle," "needle breakage" OR "needle fracture," and "foreign body AND removal" OR "retrieval." The existing literature was systematically evaluated from 1980 to date using Microsoft Excel 2007 (Microsoft Corporation). RESULTS: After analysis of the literature, we included 36 reports documenting 59 needle breakage events and defined possible risk factors and preventive measures. All relevant reported parameters were listed in tabular form. The main result of this article is a treatment algorithm for this complication. CONCLUSIONS: Prevention of a needle fracture should be the main goal during local dental anesthesia. Use of longer hypodermic needle can obviate complex retrieval surgery. If immediate removal of the fragment fails, localization, planning, and the necessary surgical procedure should be arranged promptly. CLINICAL RELEVANCE: Following a strict algorithm, successful surgical handling of this complication will depend on minimizing risk and following treatment recommendations closely.

Epulis: a study of 92 cases with special emphasis on histopathological diagnosis and associated clinical data.

OBJECTIVES: Aim of the present study was clinical and histopathological evaluation of a series of epulides to provide clinicians data to frequency distribution and biological behaviour of different underlying entities. MATERIALS AND METHODS: Ninety-two cases of epulides removed by CO2-laser at the Department of Oral Surgery and Radiology, Medical University of Graz from 2000 to 2014 were studied retrospectively for clinical data and histopathological diagnosis. RESULTS: In the presented study, histopathological examination revealed peripheral ossifying fibroma (32.6 %), fibroma/fibrosis (29.3 %), giant cell lesion (13.1 %) and granuloma pyogenicum (8.7 %) as the most frequent underlying entities. For the first time, hyperplastic squamous epithelium (7.6 %), granulation tissue (5.4 %) and peripheral odontogenic fibromas (3.3 %) were detected to clinically appear as epulides. Irrespective of the histological diagnosis, the mean age in our patients was 43.8 years. The majority of the lesions were found in the frontal region of both jaws. In all cases, the patients showed poor oral hygiene, local gingivitis and some of them an occlusal trauma. CONCLUSIONS: To identify different entities with different biological behaviour, to exclude malignant tumours and to identify new entities among epulides, histopathological examination is required. Poor oral hygiene and occlusal trauma seem to play an important role in the pathogenesis and could be risk factors for recurrences. CLINICAL RELEVANCE: Frequency distribution of different entities in epulides is provided to clinicians, and new histopathological entities were detected to clinically appear as epulides.

Stage-related treatment concept of medication-related osteonecrosis of the jaw-a case series.

OBJECTIVES: There is no general consensus for treatment of medication-related osteonecrosis of the jaw (MRONJ). A stage-related approach that primarily aims to minimize morbidity and preserve function was prospectively evaluated. PATIENTS AND METHODS: Treatment goals are stable mucosal closure and absence of clinical symptoms. Patients were enrolled between March 2010 and October 2011. MRONJ lesions were treated either by conservative means or surgically by debridement or resective surgery. RESULTS: In total, 38 patients were treated. Six patients were healed by undergoing conservative measures; nine were treated palliatively. Four patients dropped out after surgery in the recall phase. In 17 of 19 patients (89.5%) surgical treatment was successful. After a 1-year observation period, the success rate was 92% (23 of 25), including all patients treated as per protocol. CONCLUSION: In stage-related treatment, conservative means or surgical debridement can be successful at early stages. Extensive resection is solely indicated in cases of extended necrosis. CLINICAL RELEVANCE: The number of patients with MRONJ is steadily increasing. Guidelines to deal with this condition are helpful for both clinicians and dental practitioners.

Effects of directly autotransplanted tibial bone marrow aspirates on bone regeneration and osseointegration of dental implants.

OBJECTIVES: Aim of the pilot trial was to evaluate applicability and effects of directly autotransplanted tibial bone marrow (BM) aspirates on the incorporation of porous bovine bone mineral in a sinus lift model and on the osseointegration of dental implants. MATERIAL AND METHODS: Six edentulous patients with bilaterally severely resorbed maxillae requiring sinus augmentation and implant treatment were included. During surgery, tibial BM was harvested and added to bone substitute material (Bio-Oss(®) ) at the randomly selected test site. At control sites, augmentation was performed with Bio-Oss(®) alone. The cellular content of each BM aspirate was checked for multipotency and surface antigen expression as quality control. Histomorphometric analysis of biopsies from the augmented sites after 3 and 6 months (during implantation) was used to evaluate effects on bone regeneration. Osseointegration of implants was evaluated with Periotest(®) and radiographic means. RESULTS: Multipotent cellular content in tibial BM aspirates was comparable to that in punctures from the iliac crest. No significant difference in amount of new bone formation and the integration of bone substitute particles was detected histomorphometrically. Periotest(®) values and radiographs showed successful osseointegration of inserted implants at all sites. CONCLUSION: Directly autotransplanted tibial BM aspirates did not show beneficial regenerative effects in the small study population (N = 6) of the present pilot trial. However, the proximal tibia proved to be a potential donor site for small quantities of BM. Future trials should clarify whether concentration of tibial BM aspirates could effect higher regenerative potency.

Prevalence of bisphosphonate-associated osteonecrosis of the jaw after intravenous zoledronate infusions in patients with early breast cancer.

OBJECTIVES: The definite incidence rate of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is still unknown. The aim of this study was to investigate prevalence of BRONJ in a group of breast cancer patients applying the classification of the Association of Oral and Maxillofacial Surgeons 2009. PATIENTS AND METHODS: Between 2000 and 2008, 63 premenopausal early breast cancer patients who were free of metastases were treated with 4 mg zoledronic acid every 6 months over 3 years as participants of a multicenter, randomized, controlled, adjuvant breast cancer medication trial. Patients were not informed about the risk of jaw necrosis. None reported tooth or jaw complaints during the breast cancer follow-up examinations. In 2010, 48 patients of this cohort were investigated concerning BRONJ by clinical and radiological examinations. RESULTS: No advanced stages (AAOMS 2009)were detected. However, five patients (10.4%) presented purulent (2) and nonpurulent (3) fistulas and radiological signs correlating to BRONJ stage 0. CONCLUSION: Although no case of advanced BRONJ was detected, the study revealed a high prevalence of BRONJ stage 0. This supports the need for tight cooperation between dentists and medical specialists prescribing bisphosphonates including dental pre-therapeutic and follow-up examinations. Adaption of the BRONJ classification taking account to bone exposure via fistulas is recommended. CLINICAL RELEVANCE: BRONJ is said to be a complication linked to high-dosage bisphosphonate therapy. The study demonstrates that even after application of zoledronate in a low-dose protocol, early BRONJ occurred. Radiological signs solely are not sufficient to confirm BRONJ; clinical signs are mandatory.

Beneficial effect of methylprednisolone after mandibular third molar surgery: a randomized, double-blind, placebo-controlled split-mouth trial.

OBJECTIVES: Third molar (M3) removal is the model most frequently used for pain trials in oral surgery. Corticosteroids are frequently administered to reduce trismus and swelling after dentoalveolar surgical procedures. The purpose of this investigation was to evaluate the influence of a single, preoperative oral application of methylprednisolone on postoperative trismus, pain intensity, and the subjective need for analgesic medication after surgical removal of impacted mandibular M3 (LM3). MATERIALS AND METHODS: Sixteen healthy patients requiring similar bilateral surgical LM3 removal were included in a prospective, randomized, placebo-controlled, double-blind study in a split-mouth design. At random, each patient received either weight-dependent methylprednisolone (40-80 mg) or a placebo orally 1 h prior to surgery. In each case, the right and left LM3 were treated in independent visits. Trismus, swelling, pain measured on a 100-mm visual analog scale, and the postoperative demand of analgesics were assessed. RESULTS: Statistical analysis indicates a significant reduction of trismus, swelling, pain intensity, and patient-controlled intake of analgesics during the whole postsurgical period of investigation (first to seventh day). CONCLUSIONS: The results of this study suggest that a single preoperative weight-dependent administration of methylprednisolone is a safe and effective concept for diminishing postoperative discomfort, pain intensity, and the total intake of analgesics after wisdom tooth extractions. CLINICAL RELEVANCE: In case of missing contraindications, the preoperative administration of methylprednisolone is recommended, a routine medication for more extended procedures in oral surgery.

Ectomesenchymal chondromyxoid tumor: a comprehensive updated review of the literature and case report.

Prompted by a unique case of an ectomesenchymal chondromyxoid tumor (ECT) of the palate in a 54-year-old female, we reviewed the English and German literature on this entity until the end of 2016 using PubMed. The search produced 74 lingual cases with a nearly equal sex distribution and a mean age of 39.3 years, and two extra-lingual cases sharing histological and immunohistological features including nodular growth, round, fusiform or spindle-shaped cellular architecture, and chondromyxoid stroma. Immunophenotyping showed the majority of cases to be positive for glial fibrillary acidic protein (GFAP), S-100 protein, glycoprotein CD57, pancytokeratin (AE1/AE3), and smooth muscle actin (SMA); in isolated cases there was molecular-genetic rearrangement or gain of Ewing sarcoma breakpoint region 1 (EWSR1) but no rearrangement of pleomorphic adenoma gene 1 (PLAG1). At present, ectomesenchymal cells that migrate from the neural crest are considered to play a pivotal role in tumor origin. All cases had a benign course, although there were three recurrences. Because of the rarity of this tumor and the need for differential diagnostic differentiation from myoepithelioma and pleomorphic adenoma, both oral surgeons and pathologists should be aware of this entity.

Minimally Invasive Excision of Epulides with a CO2 Laser: A Retrospective Study of 90 Patients.

OBJECTIVE: It is the aim of this study to evaluate if the CO2 laser can beneficially be applied for excising epulides. BACKGROUND DATA: The standard procedure for treating epulides involves the excision of the hyperplastic tissue followed in most cases by the removal of parts of the underlying bone and the final closure of the wound by a flap. The use of the CO2 laser for the treatment of epulides has been documented only in isolated case reports and very few case series. PATIENTS AND METHODS: Ninety patients with different subtypes of epulides were treated with a CO2 laser (Lasram, model OPAL 25, 25 W, 10.600 nm, gas laser); power setting 4 W, continuous wave. The surgery was performed only after a pretreatment could remedy any gingivitis or occlusal trauma. A new surgical way of working using a special applicator that allowed tangential application of the laser beam was applied for all patients. Patients were followed up to 3 years. RESULTS: No perioperative complications or recurrences after 4 weeks could be found. Six patients were lost to further follow-up, whereas 84 patients were followed up to 36 months. In 71 cases there were no recurrences over the entire observation period. Thirteen patients developed a relapse, usually a fibroma/fibrosis according to histopathological evaluation. CONCLUSIONS: Overall CO2 laser seems to be an adequate tool for minimally invasive excision of epulides, although the respective histopathological entity could possibly influence the recurrence rate and so should be considered.

Immediate loading of four interforaminal implants supporting a locator-retained mandibular overdenture in the elderly. Results of a 3-year randomized, controlled, prospective clinical study.

BACKGROUND: Implant-retained overdentures have become a standard option for the prosthetic treatment of the edentulous mandible in the elderly. PURPOSE: This prospective study aimed to compare immediate and conventional loading of four interforaminal implants supporting a Locator-retained mandibular overdenture in elderly patients regarding implant survival, implant stability, and implant-related complications. MATERIAL AND METHODS: The study population comprised 20 completely edentulous patients (11 males) aged 60 years and older with severe mandible resorption. Each patient received four interforaminal implants (Neoss Ltd., Harrogate, UK). Following randomization, implants were loaded either immediately after dental implant surgery or 3 months after implant placement with the Locator-abutment system. At follow-up visits 3, 6 12, 24, and 36 months after loading, implant stability was evaluated with Periotest and Ostell. RESULTS: Twenty patients received 80 implants. In eight patients, 32 implants were loaded immediately. Two patients had to be switched from the immediate to the conventional loading group due to insufficient primary stability (≤30 Ncm). Implant survival was similar in both groups after 36 months. No implant was lost. Decreasing Periotest, and accordingly, increasing Ostell measurements indicated adequate osseointegration in both groups. The course of treatment was not significantly different in the two groups. There were comparable incidences of postoperative complaints like swelling, hematoma, or wound dehiscence, as well as need for prosthetic treatment due to abutment loosening or occlusal discrepancies. Incidence of pressure marks and number of patient visits were significantly higher in the conventional loading group. CONCLUSION: With sufficient primary stability, immediate loading of four interforaminal implants in the edentulous mandible might be the preferential choice in the elderly, reducing total treatment time, and number of patient visits.

CO2 Laser Excision of a Pyogenic Granuloma Associated with Dental Implants: A Case Report and Review of the Literature.

OBJECTIVE: This article reports the CO2 laser excision of a pyogenic granuloma related to dental implants and reviews the current literature on this pathology in association with dental implants. BACKGROUND DATA: Five publications describe pyogenic granulomas related to dental implants, and a further one describes the removal of such a lesion with an Er:YAG laser; removal with a CO2 laser is not reported. PATIENTS AND METHODS: A 67-year-old male patient presented with a hyperplastic gingival lesion around two implants in the left lower jaw. The hyperplastic tissue was removed with a CO2 laser (Lasram; model OPAL 25, 25 W continuous wave, 10.600 nm, gas laser), and a vestibuloplasty was performed. The excised tissue was examined histopathologically. The patient was followed up after 4 weeks, 6 weeks, 6 months, and 1 year, and a panoramic X-ray was also made. RESULTS: There were no complications during surgery or follow-up. The panoramic X-ray taken 1 year after excision showed neither vertical bone loss nor impaired osseointegration of the implant. Histopathology reported a pyogenic granuloma. After vestibuloplasty, the height of the fixed mucosa was satisfactory. CONCLUSIONS: The CO2 laser seems to be a safe and appropriate tool for removal of a pyogenic granuloma in close proximity to dental implants. The laser parameters must, however, be chosen carefully and any additional irritants should be excluded to prevent a recurrence.

Prevalence of Medication-Related Osteonecrosis of the Jaw in Patients with Breast Cancer, Prostate Cancer, and Multiple Myeloma.

Medication-related osteonecrosis of the jaw is a known side-effect of antiresorptive therapy in patients with malignant diseases. Nevertheless, the exact pathogenesis is still unknown and published prevalences show a significant range. The aim of the presented paper was to assess the prevalence of osteonecrosis (ONJ) in breast cancer, prostate cancer, and multiple myeloma patients receiving parenteral antiresorptive therapy. For this reason a PubMed search was performed and 69 matching articles comprising 29,437 patients were included in the analysis. Nine-hundred fifty-one cases of jaw necrosis were described. The overall ONJ-prevalence was 2.09% in the breast cancer group, 3.8% in the prostate cancer group, and 5.16% for multiple myeloma patients.

The influence of particulated autogenous bone on the early volume stability of maxillary sinus grafts with biphasic calcium phosphate: a randomized clinical trial.

BACKGROUND: It is unknown whether autogenous bone impacts the grafts' stability when added to biphasic calcium phosphate (BCP) within the first six months of maxillary sinus augmentation (MSA). PURPOSE: To investigate the volume stability of BCP alone and in mixtures with autogenous bone for MSA. MATERIALS AND METHODS: Bilateral maxillary sinus augmentation was performed in eight patients in a split-mouth design using BCP at the control site and adding particulated autologous bone at the test site (BCPAB). Based on 16 computed tomography (CT) the volumetric changes were evaluated using the Voxim® software (version 6.3, IVS Technology GmbH, Chemnitz, Germany) by comparing the graft volumes within two weeks of the sinus lift procedure with CT data obtained six months later. Changes of the graft volumes were calculated and statistically significant differences between the two groups were evaluated. RESULTS: Overall, the volumes decreased by 15% for BCP and 18% for BCPAB. The time-dependent decreases were statistically significant in both groups. Differences between the two groups were not statistically significant (p = .065). CONCLUSIONS: An evident decrease of graft volume over the first 6 months of healing has to be expected irrespective of bone graft composite. Autogenous bone seems to have no evident impact on the volume decrease when added to BCP.

Bisphosphonate-related osteonecrosis of the jaws--a review.

The aim was to evaluate the knowledge about bisphosphonate-related osteonecrosis of the jaws (BRONJ). A bibliographic search in Medline, PubMed and the Cochrane Register of controlled clinical trials was performed between 2003 and 2010 by using the terms bisphosphonate and osteonecrosis of the jaw. The amount of publications per year, the type of journal for publication, and the evidence level of the trial were evaluated. Next to this the incidences and the success of treatment strategies for BRONJ were identified. A total of 671 publications were reviewed. Since 2006 more than 100 publications on BRONJ per year (with an upward trend) have been published, mostly in dental journals. The evidence level could be determined for 176 publications and only one grade Ia study was found. The studies showed a wide variety in design, most of them being retrospective. The incidence of BRONJ is strongly dependent on oral or intravenous application and varies between 0.0% and 27.5%. There is no scientific data to sufficiently support any specific treatment protocol for the management of BRONJ. Further clinical studies are needed to evaluate the incidence and treatment strategies at a higher level of evidence. Therefore uniform study protocols would be favourable.

Bisphosphonate-associated osteonecrosis of the jaws: surgical treatment with ErCrYSGG-laser. Case report.

Bisphosphonates (BP) play an important role in concomitant therapy of certain types of cancer and multiple myeloma as well as in treatment of osteoporosis. The administration of BP has great therapeutic benefits, but correlates with a specific kind of osteonecrosis of the alveolar bone. The so-called bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a rare, but often severe adverse side effect of high-dosage and long-term BP therapy. Thus far, no consensus for treatment of BRONJ has been achieved. All strategies have to take into account the insecure prognosis and danger of recurrence of clinically apparent necrosis and progression of disease. At the Department of Oral Surgery and Radiology, Medical University of Graz, an ErCrYSGG laser was successfully applied in surgical treatment of BRONJ. Stable mucosal coverage could be achieved in all of 5 cases. Laser surgery can be considered as a promising technique for the effective treatment of BRONJ.

Evaluation of a muscle relaxant on sequelae of third molar surgery: a pilot study.

OBJECTIVE: The aim of this preliminary study was to evaluate the influence of the muscle relaxant tizanidine following third molar surgery on the main variables trismus and pain as well as on swelling. STUDY DESIGN: Fifty healthy patients participated in this prospective clinical study. The test group received tizanidine (4 mg in the evenings for the first 2 postoperative days) in addition to antibiotic and antiinflammatory medications. Postoperatively, 1 independent investigator performed clinical examinations. Appropriate statistical analysis was used to evaluate data. RESULTS: There was no statistically significant difference in facial pain and swelling between the two groups. Statistically significant improvement was detected when the groups were compared for mouth opening ability at days one and three. CONCLUSION: The results of this trial indicate that the influence of tizanidine on trismus, pain, and swelling does not justify prescription of the additional medication.