Stephan Acham

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.

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.

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.

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.Tumors: Taking stock of a rare oral growthWith the aim of deepening clinical understanding, researchers have conducted a bilingual literature review of a rare oral tumor. Due to its scarcity, relatively few instances of ectomesenchymal chondromyxoid tumor (ECT) exist in English and German medical literature, yet differentiation from other oral tumors remains important. This, combined with the presentation of a new patient with an especially rare form of the disease, led Astrid Truschnegg and her team of scientists from Austria’s Medical University Graz and IMAH to compile and assess the research conducted on ECT. The team searched papers published up to late-2016 and identified proteins commonly expressed by ECTs, patterns of cellular and tissue structure, genetic similarities, as well as a shared embryonic origin of tumor-associated cells. This review offers clinicians and researchers an accessible brief of current knowledge on a rare, yet significant oral disease.

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.

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.

Nonsurgical treatment of an epulis by photodynamic therapy

• A nonsurgical successful therapy of an epulis (reactive hyperplastic lesion of the gingiva) is presented.