Barbara Kirnbauer

Dental age estimation of living persons: Comparison of MRI with OPG

The need for forensic age estimations in living adolescents is high mainly due to migration, particularly from countries where birth dates are not reliably documented. To date, the gold standard of dental age estimation is the evaluation of the mineralization and eruption stages of the third molars using an orthopantomogram (OPG). However, the use of ionizing radiation without medical indication is ethically controversial and not permitted in many countries. Thus, the aim of this study was to investigate if dental MRI can be used for the assessment of dental age with equally good results as when using an OPG. 27 healthy volunteers (19 ♀, 8 ♂, age range 13.6-23.1 years, median 18.9 years) underwent an MRI scan of the jaw after a clinically indicated OPG. Mineralization and eruption stages of the molars were independently analyzed on OPGs and MRI by two blinded dentists according to the staging system established by Demirjian and Olze, respectively. The results of OPG and MRI were compared and inter-rater agreement was determined. The developmental stages of the 262 evaluated molars could be clearly differentiated in MRI. For both, mineralization and eruption, there was a good correlation between MRI and OPG. Overall MRI tended to yield slightly lower stages than the OPG. Inter-rater agreement was moderate for mineralization and good regarding eruption. Although a validation of these results using modality-specific reference values is needed, dental MRI seems to be suitable for a use in dental age estimation.

Use of Photodynamic Therapy in Treatment of Bisphosphonate-related Osteonecrosis of the Jaws: Literature Review and Case Series

Introduction: Even though surgical intervention is the preferred option in treatment of Bisphosphonate-related Osteonecrosis of the Jaws (BRONJ) the application of low-level-laser therapy (LLLT) has been described either as part of conservative protocols or as adjuvant measure in surgical regimes. So far there are no reports concerning adjuvant photodynamic laser application in this indication in the literature. Case series: We present the integration of Photodynamic Therapy (PDT) in a stage related treatment concept and report 10/12 cases in which PDT application was beneficial for achieving mucosal healing of BRONJ lesions. Discussion and conclusion: In treatment of bisphosphonate-related osteonecrosis conservative therapeutic measures like the application of low-level-laser therapy and photodynamic therapy help to manage symptoms or may even promote mucosal healing. They are particularly helpful if surgical procedures are not indicated. Photodynamic therapy additionally provides antimicrobial effects and can therefore be used if complications in postoperative healing occur.

Implant Placement Adjacent to Successfully Treated Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ)

Abstract: Bisphosphonate therapy is labelled a limiting or excluding factor for dental implant placement. The decision whether to insert implants is based on the patients individual risk profile. Most authors state that dental implant treatment is contraindicated during or after intravenous bisphosphonate application and especially after BRONJ. A unique case of uneventful implant therapy following the successful surgical treatment of BRONJ in the adjacent region in a patient with osteoporosis and intravenous bisphosphonate therapy is described. Concomitant measures to reduce the risk of BRONJ development are pointed out. It can be concluded that in general non-invasive procedures of prosthetic rehabilitation should be preferred after successful BRONJ treatment. Nevertheless the illustrated case shows that successful implant therapy is possible even in a patient who already suffered from BRONJ in the adjacent region. Clinical studies are needed to confirm this conclusion.

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.

Influence of Extraoral Apicoectomy on Revascularization of an Autotransplanted Tooth: A Case Report

Abstract Autotransplantation is considered a standard procedure with a poorer prognosis for mature than for immature teeth. In this case report, the root tip of an almost fully developed tooth was resected during autotransplantation to fit into a deficient recipient site. As a positive side effect, the apical foramen was enlarged, with potential improvement of the probability of revascularization. Clinical and radiologic follow‐up examinations up to 18 months indicated revascularization and uneventful periodontal regeneration and thus successful autotransplantation. This case supports the hypothesis that intraoperative apicoectomy can improve the prognosis for revascularization of mature autotransplanted teeth. Further prospective controlled clinical studies are needed to confirm this innovative surgical approach.

Assessment of impacted and partially impacted lower third molars with panoramic radiography compared to MRI—a proof of principle study

OBJECTIVES Third molars often require surgical removal. Since three-dimensional radiological assessment is often indicated in difficult cases to avoid surgical complications, the radiation burden has to be considered. Here, MRI may offer a dose-free alternative to conventional X-ray techniques. The aim of this retrospective analysis was to evaluate the assessment quality of MRI compared to panoramic radiography in impacted and partially impacted lower third molars. METHODS Panoramic radiographs and MRI scans of 28 Caucasian patients were assessed twice by four investigators. Wisdom teeth were classified according to Juodzbalys and Daugela 2013. RESULTS When radiological lower third molar assessments with panoramic radiography and MRI were compared, staging concurred in 73% in the first round of assessments and 77% in the second. CONCLUSIONS The presented study demonstrates that MRI not only provides much the same information that panoramic radiography usually does, but also has the advantages of a dose-free three-dimensional view. This may facilitate and shorten third molar surgery. Image interpretation, however, can differ depending on training and experience.

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

ObjectivesThe 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 methodsWe 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).ResultsAfter 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.ConclusionsPrevention 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 relevanceFollowing a strict algorithm, successful surgical handling of this complication will depend on minimizing risk and following treatment recommendations closely.