Hillel Ephros

Treatment of a large odontogenic keratocyst using the brosch procedure

The modified Brosch procedure has been described. It represents a reasonable alternative to resection or marsupialization when treating large OKC that occupy the molar, angle, and ramus regions of the mandible. Extraction of teeth affected by the lesion as well as generous removal of partially eroded bone and overlying soft tissues may contribute to lower recurrence rates. Cryosurgical or mechanical treatment of the bony cavity, which is well visualized using this technique, may also lead to improved long-term results. Treatment must be followed by continued, careful observation of the patient.

Review of current literature and implications of RANKL inhibitors for oral health care providers

Bisphosphonates (BPs) were the first class of drugs commonly used to prevent skeletal-related events (SRE) in patients with osteoporosis, multiple myeloma (MM), or solid tumors with metastases to bone. A new alternative class of agents, receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors, are now available for use in these indications and have the potential to replace intravenous BPs. This paper presents a review of the current literature on denosumab and its association with osteonecrosis of the jaw (ONJ). Denosumab is a RANKL inhibitor that has recently been approved for the prevention of SRE for the same indications as BPs except for MM. Although the overall frequency of denosumab-related ONJ may be similar or higher than estimates of the occurrence rate of bisphosphonate-related ONJ, evidence continues to support appropriate planning and preventive care can reduce the likelihood of adverse effects, including osteonecrosis.

The Need for Preoperative Psychological Risk Assessment

Adverse psychological outcomes are more prevalent among patients undergoing elective, appearance-altering surgery than are physical complications. Patients may experience depression, posttraumatic stress disorder, or an exacerbation of preexisting symptoms related to body dysmorphic disorder. Some have directed anger against themselves or against the operating surgeon with suicide, litigation, harassment, and homicide, all well documented. Although there are well-established protocols to conduct medical and anesthetic risk stratification, such protocols do not exist for psychological risk assessment (PRA). The literature related to this is reviewed, the need for PRA is discussed, and an approach to PRA for dentists and surgeons is proposed.