Petra Rugani

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.

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.

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.