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The main aim is to identify, by means of different imaging modalities, the early bone changes in patients “at risk” and in stage 0 MRONJ. A search of the literature was performed on PubMed, Embase, Web of Science, and Cochrane Library databases, until June 9, 2020. No language or year restrictions were applied. Screening of the articles, data collection, and qualitative analysis was done. The Newcastle-Ottawa Scale (NOS) was used for observational studies, and the Systematic Review Centre for Laboratory Animal Experimentation’s (SYRCLE) risk of bias tool for the animal studies. A total of 1188 articles were found, from which 47 were considered eligible, whereas 42 were suitable for the qualitative analysis. They correspond to 39 human studies and 8 animal studies. Radiographic findings such as bone sclerosis, osteolytic areas, thickening of lamina dura, persisting alveolar socket, periapical radiolucency, thicker mandibular cortex, widening of the periodontal ligament space, periodontal bone loss, and enhancement of the mandibular canal were identified as early bone changes due to antiresorptive therapy. All those findings were also reported later in Stage 0 patients. The main limitations of these results are the lack of prospective data and comparisons groups; therefore, careful interpretation should be made. It is a fact that radiographic findings are present in antiresorptive-treated patients, but the precise timepoint of occurrence, their relation to the posology, and potential risk to develop MRONJ are not clear. The importance of a baseline radiographic diagnosis for antiresorptive-treated patients.

Deep carious lesions in immature permanent molars with pulp necrosis pose a serious challenge to contemporary paedodontic practice. A further complex clinical scenario is an immature permanent molar with varying root formation in both roots. This case report demonstrates the successful management of an immature permanent mandibular first molar. An 8-year-old boy was referred for endodontic management of 36 by a general practitioner. After clinical and radiographic evaluation, a diagnosis of recurrent chronic periapical abscess with abrupt root closure in the mesial root and cessation of root closure in the distal root was made. Apexification was undertaken in three appointments. In the first appointment, under local analgesia and isolation, the mesial canals were prepared to size #F3 with rotary Protaper Universal and the distal canal was left unprepared. Both canals were irrigated with 5% sodium hypochlorite and calcium hydroxide intracanal medicament was placed. One week later, the mesial canals were obturated and a 4 mm white MTA apical plug was placed in the distal canal. Partial extrusion of the MTA was seen periapically. After 24 h, the hard-setting of the MTA plug was verified, remainder of the distal canal was obturated and core filling was placed followed by a preformed metal crown as an intermediate restoration. The patient was asymptomatic and showed resolution of the lesion, normal thickness of the PDL space with continuity of the lamina dura after 12 months. Extruded MTA was partially resorbed. Three years follow-up showed complete resorption of the extruded MTA and an intact lamina dura.

Dentin sialophosphoprotein (DSPP) plays an important role in the mineralization of both dentin and bones. The Dspp null mice developed periodontal diseases. Patients with DSPP mutations have dentinogenesis imperfecta (DGI), but very little is known about their bone characteristics. This study aims to characterize alveolar bone cells of a DGI patient with DSPP mutation. Pathogenic variants were identified by whole exome and sanger sequencing. Cells isolated from the alveolar bones of a DSPP patient were investigated for their characteristics including cell morphology, attachment, spreading, proliferation, colony formation, mineralization, and osteogenic differentiation. We identified a Thai family with three members affected with autosomal dominant DGI harboring a heterozygous pathogenic missense mutation, c.50C > T, p.P17L, in exon 2 of the DSPP gene. The patients’ phenotypes presented deteriorated opalescent teeth with periapical lesions, thickening of lamina dura, furcation involvement, alveolar bone loss, and bone exostoses. The alveolar bone cells isolated from DSPP patient exhibited compromised proliferation and colony formation. Scanning electron microscope revealed altered cellular morphology and spreading. The DSPP cells showed deviated mRNA levels of OCN, ALP, and COL1 but maintained in vitro mineralization ability compared to the control. We demonstrate that the DSPP p.P17L mutant alveolar bone cells had compromised cell spreading, proliferation, colony formation, and osteogenic induction, suggesting abnormal bone characteristics in the patient with DGI caused by DSPP mutation. DSPP mutation can induce the behavior alterations of alveolar bone cells.

The purpose of this study was to clarify which panoramic radiographic features can predict the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Participants included 24 patients treated with bisphosphonates (BP) for osteoporosis who developed osteonecrosis of the jaw (ONJ+ group). Controls included 179 patients treated with BP who did not have osteonecrosis (ONJ− group) and 200 patients with no history of BP administration (unmedicated group). The mandibular cortical width, mandibular cortical index (MCI), sclerosis of trabecular bone, and thickening of the lamina dura were evaluated on panoramic radiographs. The mandibular cortical width was significantly smaller in the ONJ– group than in the other groups. Class II MCI (semilunar defects of endosteal margin) was frequently noted on the affected and contralateral sides in the ONJ+ group but not in the ONJ− or unmedicated groups. Sclerosis of the trabecular bone was significantly more frequently observed on the affected side in the ONJ+ group than in the other groups. Thickening of the lamina dura was observed significantly more frequently in the BP-treated groups than in the unmedicated group. Class II MCI may be an indicator to predict the development of BRONJ. Sclerosis of trabecular bone was a characteristic imaging feature of BRONJ. Thickening of the lamina dura may be an imaging feature caused by BP administration.

Background We investigated the clinical and radiographic outcomes of autotransplanted teeth over a follow-up period of 2 to 8 years, and summarize the findings of other relevant studies with regard to the primary factors that influence a good prognosis in such patients. Methods Twenty-three patients (6 men, 17 women) who attended Tanggu Stomatological Hospital, Tianjin, China, from 2008 through 2013, were included in the study. These patients presented with a variety of dental problems, including tooth loss, residual crowns, missing first or second molars, dental trauma, tooth fracture, and unrestored teeth. A total of 26 third molars, including 2 immature molars, were autotransplanted in these patients. The success rate of autotransplantation was assessed on the basis of clinical and radiographic outcomes after follow-up periods ranging from 2 to 8 years. Results Clinical examination revealed stability of all 26 transplanted teeth, with satisfactory masticatory function and no patient discomfort. Radiographic examination revealed normal periapical tissues and an intact lamina dura surrounding the tooth root, indicating adequate healing of periodontal tissues. Conclusions Autotransplantation achieved good results in the Chinese sample population investigated, and was associated with an excellent prognosis. Rigorous case selection, adequate protection of the periodontal ligament, and proper oral hygiene contribute significantly to the long-term success of the procedure.

To investigate the possibility of radiographic examination as a tool for differential diagnosis of bisphosphonate-related osteomyelitis of the jaw (BROMJ). The radiographic findings of the mandibular lesions in 25 BROMJ patients were compared with those in 36 radiation osteomyelitis, 92 suppurative osteomyelitis, and 34 diffuse sclerosing osteomyelitis patients. The diagnostic criterion for BROMJ was osteomyelitis in patients with experience of bisphosphonate therapy. The amount and duration of bisphosphonate administration and presence and term of bone exposure were not considered for diagnosis. BROMJ revealed characteristic radiographic findings. Osteolytic change that started at the superficial layer of bone (cortical bone), followed by extension between the cortical and cancellous bone, large cancellous bone sequestrum formation often accompanied by extensive osteolytic change of the cortical bone or fairly large cortical bone sequestrum formation, and solid-type periosteal reaction formed at a site related to the margin of the remaining cortical bone were found to be pathognomonic, and were observed not only in cases with bone exposure but also in cases without bone exposure. A relationship between lamina dura thickening and the lesion was doubtful. Osteosclerotic change was frequent and remarkable, but not specific. Radiographic examination was considered to be useful for differential diagnosis of BROMJ. Inclusion of the pathognomonic radiographic findings into the definition of BROMJ will make it possible to achieve earlier and more accurate diagnoses. In addition, the active bone remodeling in the lesions confirmed by radiography suggested that osteonecrosis was not the cause, but the result of infection.

To assess the image quality of the mandibular third molar region using different milliamperage (mA) settings of cone-beam computed tomography. Twelve dry mandibles with impacted third molars were scanned with a Kodak 9000 unit (Kodak Dental Systems, Carestream Health, Rochester, NY, USA) using different mA settings (2, 4, 6.3, 8, 10, 12, and 15 mA). Two oral radiologists evaluated the images. They classified the tooth root, periodontal space, lamina dura, trabecular bone, mandibular canal, and overall image quality as excellent, good, poor, or inadequate for diagnosis. Statistical analyses were performed by one-way ANOVA with a post hoc Tukey test to investigate the influence of the mA settings in the image quality of the structures analyzed. The significance level was set at 5 %. The 15 and 12 mA settings provided the highest mean values for all the evaluated criteria, with significant differences from the values for the other mA settings. The 10, 8, and 6.3 mA settings showed no significant differences in relation to tooth root and periodontal space. For the other evaluated criteria, no significant differences were observed for the 10 and 8 mA settings. The 4 and 2 mA settings gave the lowest mean values. The best low-dose protocol with good image quality was the 10 mA setting. Lower dose protocols with 8 and 6.3 mA settings can also be used for these purposes, but caution is necessary because of increased image noise.

Several studies suggest a biomodulatory influence of low-level laser irradiation in the inflammatory and reparative processes of dental tissues. The aim of this study was to investigate the stimulatory effect of 808-nm laser irradiation on root development of rat molars and also to evaluate the histological reaction of pulp and periapical tissues. Twenty-four 30-day-old Wistar male rats were randomly assigned to three-time and five-time laser therapy groups. After initial x-ray, using mammography equipment, laser energy was applied at a wavelength of 808 nm (2 J/cm(2), 100 mW, 20 s) to the midroot area of the lower molars of one side of mouth at repeated intervals of the 48 h. The animals were killed 1 day after the final treatment, and root length development of the experimental samples was compared to contra-lateral non-irradiated molars using mammography. The histological reaction of the pulp and periapical tissue was evaluated under light microscopy. Root development was more advanced in irradiated groups than in the non-irradiated controls (p 0.001). No significant differences, however, could be found between the root development changes in the three-time and five-time laser therapy groups (p 0.05). Histological findings showed that the occurrence of secondary cement formation was significantly higher in the irradiation groups compared to the controls (p = 0.003). However, there were no statistically significant differences for the frequencies of pulp hyperemia, periodontal ligament fiber organization, or lamina dura remodeling between the groups (p 0.05). Under the conditions used in this study, 808-nm low-level laser accelerates the rat molar root development in the presence of favorable histological reactions.

Background: Exposure of the pulp by caries is often accompanied by chronic inflammation in the immediate area of the carious lesion and localized abscess formation. Direct pulp capping and vital pulpotomy are two accepted clinical modalities to preserve tooth vitality in cases of pulp exposure in carious young permanent teeth but the success rates are often less than 50%. Case report: A 13 year old boy presented with an immature and grossly carious 37. Having already lost 36 a decision was made to maintain 37. Treatment: A cervical pulpotomy was initiated using local analgesia. All the inflamed, contaminated pulp tissue in the pulp chamber to the level of the radicular pulp stumps was removed and a cervical pulpotomy was carried out. Following haemostasis the radicular pulp stumps were coveredwith non-setting calcium hydroxide then setting calcium hydroxide, and the tooth restored temporarily with zinc oxide and eugenol cement. Follow-up: At 26 months following the pulpotomy, the molar had been symptomless and there were no clinical signs of infection or inflammation. Radiographically root development of 37 was complete, the lamina dura was continuous apically and the root canals were partially sclerosed.

The purpose of this study was to report clinical and radiological findings of patients with fibrous dysplasia of the jaws. The subjects of this study were 50 patients with 54 lesions reported to have fibrous dysplasia at the faculty of Dentistry, Chulalongkorn University during 1971–1994. The clinical findings were retrospectively collected and the microscopic features were also confirmed. The ratio of men to women was 26:24 and the ratio of mandible to maxilla was 28:26. In 12 of all, swelling with tenderness or mild pain were noted. The most common age group was from 16 to 25 years. Two lesions (3.7%) were early small lesions with a cyst like appearance. The calcification gradually increased with age: mottled in 14 (25.9%), orange peel in 3 (5.6%), and ground glass in 34 (63%). The characteristics of this disease were painless swelling, a ground glass appearance and thinning or fade down of cortical bone particularly the loss of the lamina dura in 40 lesions (74%) and the inferior border of the mandible in 20 lesions (71.4%). In the maxillary lesions, the maxillary sinus was partially involved in 7 (28.9%), and completly involved in 13 (50%). These maxillary lesions confined to only one site. In the mandibular lesions, there were 9 large lesions (32.1%), all of these crossed the symphysis. Mode of the expansions occurred in all directions in 31 lesions (57.4%), bucco-lingually in 13 (24.1%), and buccally in 7 (13%).

Amongst odontogenic foci of maxillary sinusitis iatrogenic oroantral fistula is the commonest (Dayal et al 1976). In ten cases of post-extraction oroantral fistula seen over the last five years the commonest tooth involved was the second molar. Streptococci and Bacteroides were the commonest aerobic and anaerobic isolates respectively from the antrum. A palatal rotation flap was used for repair in 8 cases while it was combined with a buecal flap in 2 patients. The antral inflammatory process resolved after a simultaneous antral lavage in all cases.

A study was made of a series of 104 cases with cementoma. This investigation of cementoma revealed the following features: 1. In 73% of periapical cemental dysplasia and benign cementoblastoma, and 80% of cementifying fibroma occurred in female. 2. 40 % of periapical cemental dysplasia occurred in the fifth decades, and 73 % of benign cementoblastoma during the second and third decades, while there was no age predilection in the cementifying fibroma. 3. 63 % of periapical cemental dysplasia occurred in the mandibular anterior region. 91 % of benign cementoblastoma and 80 % of cementifying fibroma occurred in the mandibular premolar and/or molar region. 4. There were no cases complaining of the associated clinical signs and subjective symptoms in the periapical cemental dysplasia, however the patients complained of a pain in 36 % of benign cementoblastoma and 40 % of cementifying fibroma. 5. There were no cases expanding the cortical plates in the periapical cemental dysplasia, however 73 % of benign cementoblastoma and all of the 5 cases of cementifying fibroma showed the expansion of cortical plates. 6. Several radiographic features of the periapical cemental dysplasia were shown as follows: a. 29 % of the cases had multiple lesions. b. 53 % of the cases were in the mature stage. c. During the osteolytic stage, the alveolar lamina dura was lost in 89 % of the cases.

A case of acute lymphocytic leukemia (ALL) in a child is presented. We also reviewed the recent literature of similar cases describing leukemic jaw bones involvement in Japan. Radiographic examinations of the patient disclosed diffuse osteolytic changes of the entire jaws, the corticated border of the crypts of developing teeth, loss of lamina dura, a thickened periodontal space and disappearance of the radiopaque lines that delineate the borders of the mandibular canal. Pronounced regression and restoration of the alveolar bone and the crypts were detectable on the radiographs taken after a course of the treatment for ALL.

Radiographic analysis of 24 cases of hypophosphatasia (H) from 9 Paediatric Centres was performed. 3 cases were of neonatal (lethal), 18 cases of infantile (severe) and 3 cases of late (benign) type. Some of the patients were in reality borderline cases between these groups. In the authors' material all the patients showed radiographic signs of the disease. These were divided into diagnostic, characteristic and suggestive features. All of the patients had in common generalised (usually irregular) osteoporosis, generalised (usually irregular) metaphyseal changes, craniostenosis (13 of 18 infantile cases) or widened cranial sutures and ofter bowing of the long bones. Besides the well know radiographic features of hypophosphatasia some less well known, rare or 'new' ones such as, 1. spurs of the long bones (Bowdler sign), 2. distal femoral central metaphyseal defects and epiphyseal defects, 3. S-like deformities of the tibiae, 4. abnormal shape of the distal phalanges of the fingers, 5. multiple rib fractures and slender bones, 6. wedging of the lower thoracic and upper lumbar vertebrae, 7. partial premature fusion of the epiphyses, 8. nephrocalcinosis, 9. loss of lamina dura around the teeth, 10. variation in radiographic appearances of a pair of siblings with lethal form, and, 11. rapid changes in roentgen appearances. are discussed. In two of our patients (siblings) phosphoethanolamine was undetectable in the urine. The authors doubt if a normal skeletal survey may be present at any stage in any of the three major types of hypophosphatasia.

Dental fluorosis was found in nearly 80% of 520 children aged 12 to 18 years who lived permanently in two Greek villages Kolchikon and Lavrion where the water supply contains 3, 6 and 2, 7 ppm of fluoride. Detailed radiological, ophthalmological and biochemical studies in 52 children with marked dental fluorosis revealed that 29 had bone changes in the mandible consisting of erosion or loss of the lamina dura, cystic rarefaction and sclerosis; opacities of the lens were seen in 57% of the patients. Serum Ca was found to be in the normal range in the majority of patients. Serum P,Mg and creatitine as well as blood urea and urinalysis were normal. Serum alkaline phosphatase was generally high in the presence of bone changes. Serum parathyroid hormone was elevated in 10 children (685, 980, 1200, 1280,2450, 2600, 3000, 3100, 6200, 7200 pg/ml) with increased serum alkaline phosphatase and with skeletal changes resembling hyperparathyroidism and normal in four children (185, 280, 420, 630 pg/ml) who had normal serum alkaline phosphatase and no bone changes. It is suggested that fluorosis can cause secondary hyperparathyroidism.