Yoshiro Matsui

Adjunct teriparatide therapy with monitoring of bone turnover markers and bone scintigraphy for bisphosphonate-related osteonecrosis of the jaw

The management of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is still difficult in many cases that do not respond to conservative treatments. We report a case of BRONJ treated by adjunctive teriparatide therapy for 6 months with monitoring of bone turnover markers (at baseline, at 1, 3, and 6 months of treatment, and after 9 months off therapy) and bone scintigraphy (at baseline, 3 and 6 months, and after 9 months off therapy). The patient was a 78-year-old woman with osteoporosis and BRONJ. She had not responded to previous conventional treatment. Teriparatide was added for resolution of BRONJ. The pain disappeared after 1 month, and remarkable bone regeneration was obtained after 6 months, with significantly increasing bone formation and resorption markers. Bone scintigraphy showed regression of the uptake area. This case suggests the usefulness of monitoring bone turnover markers and using bone scintigraphy to increase the effectiveness of teriparatide therapy.

Endoscopic Removal of Bilateral Supernumerary Intranasal Teeth

m p n d t o i b Supernumerary teeth occur in 0.1% to 1% of the general population. Dentists and oral-maxillofacial surgeons (OMSs) sometimes encounter a supernumerary tooth, and the most common is the mesiodens; a supernumerary intranasal tooth is very rare. Bilatral supernumerary intranasal teeth are extremely are, and the literature contains only a few reports. Because most intranasal teeth are found by otolaryngologists based on patients presenting with nasal symptoms, dentists and OMSs have less opportunity to treat them. We report a rare case of bilateral supernumerary intranasal teeth removed under endoscopic guidance.

Cervicofacial subcutaneous and mediastinal emphysema caused by air cooling spray of dental laser

Cervicofacial subcutaneous emphysema is a rare complication of dental procedures with an air turbine or syringe, and dentists and oral surgeons sometimes encounter mediastinal emphysema following the presentation of extensive subcutaneous emphysema. Most emphysema occurs incidentally during tooth extraction, restorative treatment, or endodontic treatment, with only a few cases reported of cervicofacial subcutaneous emphysema associated with dental laser treatment. We report a case of cervicofacial subcutaneous and mediastinal emphysema caused by the air cooling spray of dental laser during dental treatment in a 76-year-old woman. After she underwent dental laser treatment, cervicofacial swelling was noted and she was referred to our department. Computed tomography showed both cervicofacial subcutaneous emphysema and mediastinal emphysema. Antibiotics were administered prophylactically and the emphysema disappeared 5 days after the dental laser treatment, without any complications.

Intraoperative lacrimal intubation to prevent epiphora as a result of injury to the nasolacrimal system after fracture of the naso-orbitoethmoid complex.

Treatment of fracture of the naso-orbitoethmoid (NOE) complex is difficult. There are not only aesthetic issues but also functional consequences related to the lacrimal system. Because prophylactic lacrimal intubation for such fractures remains controversial, we have assessed the effectiveness of intraoperative lacrimal intubation to prevent epiphora as a result of such injuries. Thirteen patients diagnosed with craniomaxillofacial fractures including fractures of the NOE complex were included in the study; 10 had unilateral fractures and 3 bilateral. Computed tomography (CT) showed all patients had displaced fragments that had the potential to damage the lacrimal duct. In 7 patients the fractures included the canthal region and in 6 they did not. All patients were treated by open reduction and internal fixation under general anaesthesia, followed by intraoperative lacrimal intubation unilaterally or bilaterally as required. Lacrimal intubation with a silicone tube was successful in all 13 patients (16 sides). The tube was removed 2-9 months (mean 3.8) postoperatively and no subsequent epiphora were seen during follow-up (mean (3-29 months) 11.3 months). Lacrimal intubation for at least 2 months may prevent epiphora caused by injury to the nasolacrimal system after fractures of the NOE complex.

Computer-assisted preoperative simulation for screw fixation of fractures of the condylar head

w d f ractures of the condylar head are generally treated conseratively because exposure and fixation are difficult without amaging the facial nerve. Conservative treatment is also recmmended for children or for patients whose condylar head s in several fragments.1 The conservative approach requires ong-term treatment, whereas open surgery can provide early ecovery of occlusion and movement of the jaw for adults ho have a condylar fracture with a large segment and loss f the vertical height of the mandibular ramus.1–4 Preoperaive evaluation by three-dimensional computed tomography CT) with computerised simulation can help the surgeon to ecide whether open treatment is possible to fix the fracure. We have used three-dimensional simulation to assist n the planning and treatment of fractures of the condylar ead. Patients with maxillofacial fractures routinely have both hree-dimensional CT and conventional radiography. When he CT shows a fracture of the condylar head, and the ize of the fragment is large enough to fix with a plate, r screws, or both, digital imaging and communication in edicine (DICOM) data from the CT are put into Mimcs 14.01 software (Materialise, Leuven, Belgium) to enable omputer-assisted preoperative simulation. The mandible nd fragments from the condylar fracture are segmented ith the simulation software (Fig. 1), which enables the ragment from the condylar fracture to be virtually reduced n a precise fashion (Fig. 2). After the virtual reduction,

Use of in-house, full-colour printed three-dimensional model for training in endoscopic periradicular surgery for molar radicular cyst

reatment of molar radicular cysts is challenging and many olars may be removed if endodontic treatment is unsucessful. Conventional periradicular surgery of molars is not lways done, because of the technical difficulties and poor isualisation. Endoscopic periradicular surgery (EPS) has een introduced to avoid having to remove molars.1–3 If lling of the root canal is insufficient, we use EPS after ndodontic treatment. However, it is difficult to train oral urgeons to resect roots and fill the root of the molar preisely in a retrograde manner under endoscopic guidance, and training system has yet to be established. We have thereore created in-house, full-colour printed three-dimensional odel for training in EPS for molar radicular cyst. To produce the EPS training model, we used ZPrinter 450 Z Corporation, Burlington, MA, USA), which can print a ull-colour, three-dimensional model using a high perforance plaster-based composite that is cost-effective with ow waste. A full-colour, three-dimensional printer costs 1.9 imes the monochrome4, but the running costs are almost the ame. The vertical build speed is 23 mm/h and the build size 03 mm× 254 mm× 203 mm. In a patient with a molar radicular cyst, DICOM data ere transferred to Mimics 14 software (Materialize, Leuven, elgium) after computed tomography. The jaw, the molar ith the radicular cyst, and the root canal were segmented, nd the data were exported as an STL file to ZPrint softare (Z Corporation). The crown and roots were coloured, he root canals were produced as cavities, and then the three-

Variable oral device for measuring oral lesions.

We describe use of a variable oral device for efficient measurement of oral lesions.

Monitoring of bone turnover markers and bone scintigraphy for teriparatide therapy in bisphosphonate related osteonecrosis of the jaw

Treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) remains an intractable problem in many cases. Recent literatures have shown that the new treatment modality using teriparatide may be beneficial to BRONJ. However, the teriparatide therapy was not effective in all cases. It would be necessary to assess the therapeutic effectiveness of teriparatide with predictable procedures to treat BRONJ. We report here two cases of BRONJ treated by adjunctive teriparatide therapy for 6 months while simultaneously performing the monitoring of changes of bone turnover markers and the quantitative assessment of bone scintigraphy. Six months after the combination of teriparatide and conservative treatment, CT showed evidence of bone regeneration and the intraoral wound was completely healed. Biochemical bone formation markers were monitored at the time points of 0, 1, 3 and 6 months. Almost of all the markers related to the bone formation and resorption revealed an increase during the teriparatide treatment. The uptake area and quantitative value of technetium-99m-methylene diphosphonate showed a reduction after the administration of teriparatide. It was strongly suggested that teriparatide therapy is one of the useful treatments for BRONJ based on monitoring bone turnover results and employing bone scintigraphy.