Search

Osteonecrosis of the jaw is a recognized complication associated with bevacizumab. Here, we present a patient with squamous cell carcinoma of the tonsil who experienced minimal skin fibrosis following intensity-modulated radiation therapy. Subsequently, the patient developed rectal adenocarcinoma and encountered osteonecrosis of the jaw after receiving two cycles of bevacizumab. Close monitoring, accompanied by thorough examination to detect early signs of osteonecrosis of the jaw, should be considered for patients who have undergone radiation therapy in the head and neck region and are receiving bevacizumab or other medications known to be associated with osteonecrosis of the jaw.

Calcifying odontogenic cyst, also known as Gorlin cyst is a rare benign cystic lesion primarily found in the jawbones, accounting less than 1% of odontogenic cysts. It can be associated with odontogenic tumors such as odontomas. We report a rare case of COC associated with complex odontoma in a young patient and discuss its clinical features, diagnosis, and treatment options. An 18-year-old female patient presented with a painless radiopaque lesion of the right mandibular bone at Oral Medicine and Oral Surgery department. Radiographs revealed irregular tooth-like structures in the canine-premolar area. The lesion was surgically removed, and histopathology confirmed COC with a complex odontoma. As of the World Health Organization's 2022 definition, COC is a developmental odontogenic cyst characterized by calcified ghost cells. It typically affects individuals during their second and third decades of life, with no gender preference, almost equally in the maxilla and the mandible. The main treatment is total enucleation, with a generally favorable prognosis. Histopathology is essential for diagnosis due to its mimicry of other jaw conditions. Long-term follow-up is needed to prevent recurrences. [ABSTRACT FROM AUTHOR]

Introduction: This retrospective study highlights the salient aspects of a series of feline patients affected with bisphosphonate related osteonecrosis of the jaw. Though more commonly published in human literature, this presentation is rare in cats. The authors hope that this study will assist in making this a more globally known entity with subsequent improved prognosis. Methods: Data was retrospectively obtained from the medical records between 2015 and 2021 of 20 cats with Medication Related Osteonecrosis of the Jaw. Data included patient information, clinical history, presenting complaint, systemic diseases, details referable to hypercalcemia and treatment thereof, bisphosphonate specifics (dose and duration), clinical presentation of the lesion, diagnostic testing including radiographic and histopathologic descriptions, treatment, and outcome. Results: Pertinent results include that all 20 cats who developed Medication Related Osteonecrosis of the Jaw had been treated for idiopathic hypercalcemia with the bisphosphonate medication alendronate. Eighty-five percent of the cases had prior dental extractions at the site of MRONJ lesion. Ninety-five percent of the affected cats required a surgical procedure to control the disease. Thirty-five percent of cases required at least one revision surgery after the initial procedure was performed. Diagnosis of MRONJ was made by a correlation of diagnostic findings and patient history. No single diagnostic, or combination was pathognomonic for lesion diagnosis. As well, there were no statistically significant associations between patient variables assessed and the overall patient outcome. Discussion: The case series reveals that cats with feline idiopathic hypercalcemia treated with alendronate may be at a risk for development of MRONJ, a serious oral condition with significant morbidity. Prior dental extraction sites in patients concurrently treated with bisphosphonate medications were often associated with MRONJ lesions. Therefore, any needed dental surgery should be performed prior to the use of bisphosphonates where possible. The authors have also included a relevant comparative literature review. [ABSTRACT FROM AUTHOR]

Objective·To explore the effect of all-trans retinoic acid (ATRA) of different concentrations on osteogenic differentiation of jaw bone mesenchymal stem cells (jBMSCs) in rats. Methods·jBMSCs from 4-week-old Sprague-Dawley (SD) rats were isolated and cultured with whole bone marrow adherence method. The surface antigens were identified by using flow cytometry. Alkaline phosphatase (ALP) staining/alizarin red staining, oil red O staining and alcian blue staining were used to prove the multilineage differentiation potential of jBMSCs after osteogenic, adipogenic and chondrogenic induction respectively. jBMSCs were induced in osteogenic medium with ATRA of concentration of 0.01, 0.1, 1, 5, 10, 20 μmol/L in vitro, and dimethyl sulfoxide (DMSO) was used as control group. Cell viability of jBMSCs in different groups were determined by CCK8. ALP staining and alizarin red staining were used to investigate the osteogenic ability of jBMSCs in each group and screened the concentrations for subsequent experiments. Quantitative real-time polymerase chain reaction (qPCR) and immunofluorescence staining were used to analyze the expressions of osteogenesis-related genes and proteins in jBMSCs of different concentrations. Results·The flow cytometry analysis showed that more than 98% of P1 jBMSCs were positive for CD29+CD90+CD31-CD45-, which was congruent with the characteristics of bone mesenchymal stem cells. The results of ALP staining/alizarin red staining, oil red O staining and alcian blue staining indicated that the P1 jBMSCs had the multilineage differentiation potential of osteogenesis, adipogenesis and chondrogenesis. The results of ALP staining/alizarin red staining showed that the osteogenic activity and mineralization ability of jBMSCs in 0.01, 0.1 and 1 μmol/L ATRA groups were increased compared with those in the control group, while the osteogenic activity and mineralization ability were decreased when the concentration of ATRA increased, especially higher than 5 μmol/L (all P <0.05). qPCR analysis showed that the mRNA expression levels of osteogenesis-related genes such as Alp, bone sialoprotein (Bsp), collagen type Ⅰ α1 (Col1a1) and osteocalcin (Ocn) were higher in the 0.1 and 1 μmol/L ATRA groups compared to the control group. However, further increasing the concentration of ATRA led to a decrease in gene expression levels, and when the concentration exceeded 5 μmol/L, it began to be lower than the control group level (all P<0.05). The immunofluorescence staining showed that the expression of osteogenic related proteins SP7, ALP and OCN in the 0.1 and 1 μmol/L ATRA groups were increased compared to the control group, while further increasing the concentration of ATRA led to a decrease in protein expression. When the concentration was higher than 5 μmol/L, it began to be lower than the control group level (all P<0.05). Conclusion·Lower concentrations (0.1, 1 μmol/L) of ATRA can promote the osteogenic differentiation of rat jBMSCs, and the promoting effect reaches its peak at 0.1 μmol/L, while the effect can be weakened by further increasing the concentration. Higher concentrations (5, 10, 20 μmol/L) of ATRA could inhibit the osteogenic differentiation of rat jBMSCs, showing an inhibitory effect. In this study, the dualdirectional effect of retinoic acid on osteogenic differentiation of jBMSCs was demonstrated in vitro, and 0.1 μmol/L ATRA was identified as the optimal concentration for osteogenic differentiation of jBMSCs in rats, which provided a reference basis for the development of in vivo studies and clinical application of ATRA. [ABSTRACT FROM AUTHOR]

Medication-related osteonecrosis of the jaw (MRONJ) is a rare condition, typically seen in patients receiving antiresorptive or antiangiogenic drugs. This study aims to synthesize reports and case series of MRONJ regarding sociodemographic and clinical characteristics and to evaluate the effectiveness of the treatments applied. Following PRISMA guidelines, a search for case reports and case series was carried out in the PubMed-Medline database until March 2024. A total of 88 articles were included in this review, in a total of 151 cases. The key findings reveal that females were the most affected individuals (71% of the cases) with the average age at diagnosis being 66.27 years with a standard deviation of ±13.03. Stage 2 was the most observed stage, in 43% of cases, and zoledronic acid was the most commonly used drug (32% of cases). The oral route was the most common route of administration, in 26% of cases, with an average administration duration of 60.88 months (standard deviation ± 50.92). The mandible was the most commonly affected anatomical location (in 60% of cases). Amoxicillin + clavulanic acid (875 mg + 125 mg) and chlorhexidine (0.12%) were the most used antibiotics and mouthwash, with 16% and 26% of the cases, respectively. Surgical debridement was the most common surgical procedure, in 32% of cases, while the use of an L-PRF membrane was the most prevalent unconventional treatment, in 21% of cases. This study identified a statistically significant relationship between unconventional treatments and the cure of MRONJ (p < 0.001), indicating the need for further research to confirm these results. [ABSTRACT FROM AUTHOR]

Background/Objectives: Osteomyelitis is characterized by an inflammatory process affecting both bone and bone marrow, leading to cell death and the formation of bone sequestrum. Recent literature from the past five years has documented instances of osteomyelitis following infections of SARS-CoV-2. This systematic review explores the link between osteomyelitis of the jaw (OMJ) and COVID-19 infections. Methods: This review adhered to the PRISMA guidelines, systematically analyzing literature from 2020 to 2024 sourced from databases including Medline, Embase, Scopus, and Web of Science. PROSPERO ID: CRD42024526257. Results: The review selected 42 articles, detailing 201 cases of osteomyelitis of the jaw related to COVID-19 (COMJ). The demographic breakdown included 195 male (74.4%) and 67 female patients (25.6%), with a median age of 52.7 years, ranging from 24 to 71 years. A significant portion of COMJ patients (41.5%) were hospitalized due to COVID-19, and 58.5% received corticosteroid therapy. Diabetes mellitus was a common comorbidity among COMJ patients (65.1%). Most cases involved maxilla (182 cases; 90.5%), with nearly half showing sinus involvement (49.4%). The mandible was affected in 19 cases (9.5%). Mucormycosis and aspergillosis emerged as the predominant fungal infections, identified in 103 (51.2%) and 50 (24.9%) cases, respectively. Conclusions: Individuals with pre-existing health conditions such as diabetes mellitus who have been treated for COVID-19 are at an increased risk of developing OMJ, particularly maxillary fungal osteomyelitis. COMJ poses a significant diagnostic and therapeutic challenge for dental and maxillofacial professionals, who are often the first to encounter these cases. [ABSTRACT FROM AUTHOR]

Thanks to the use of new digital technologies and innovations in materials, there has been an increasing interest in subperiosteal implants. These implants are considered to be helpful for the rehabilitation of severe jaw atrophies, as they overcome some disadvantages of endosseous implantology. In the present clinical retrospective study, 18 patients were treated and the clinical outcomes of the treatment were recorded after 12 months of follow-up. [ABSTRACT FROM AUTHOR]

Objective·To explore the effect of all-trans retinoic acid (ATRA) of different concentrations on osteogenic differentiation of jaw bone mesenchymal stem cells (jBMSCs) in rats.Methods·jBMSCs from 4-week-old Sprague-Dawley (SD) rats were isolated and cultured with whole bone marrow adherence method. The surface antigens were identified by using flow cytometry. Alkaline phosphatase (ALP) staining/alizarin red staining, oil red O staining and alcian blue staining were used to prove the multilineage differentiation potential of jBMSCs after osteogenic, adipogenic and chondrogenic induction respectively. jBMSCs were induced in osteogenic medium with ATRA of concentration of 0.01, 0.1, 1, 5, 10, 20 μmol/L in vitro, and dimethyl sulfoxide (DMSO) was used as control group. Cell viability of jBMSCs in different groups were determined by CCK8. ALP staining and alizarin red staining were used to investigate the osteogenic ability of jBMSCs in each group and screened the concentrations for subsequent experiments. Quantitative real-time polymerase chain reaction (qPCR) and immunofluorescence staining were used to analyze the expressions of osteogenesis-related genes and proteins in jBMSCs of different concentrations.Results·The flow cytometry analysis showed that more than 98% of P1 jBMSCs were positive for CD29+CD90+CD31-CD45-, which was congruent with the characteristics of bone mesenchymal stem cells. The results of ALP staining/alizarin red staining, oil red O staining and alcian blue staining indicated that the P1 jBMSCs had the multilineage differentiation potential of osteogenesis, adipogenesis and chondrogenesis. The results of ALP staining/alizarin red staining showed that the osteogenic activity and mineralization ability of jBMSCs in 0.01, 0.1 and 1 μmol/L ATRA groups were increased compared with those in the control group, while the osteogenic activity and mineralization ability were decreased when the concentration of ATRA increased, especially higher than 5 μmol/L (all P

Abstract Background Dentigerous cysts, deemed of developmental origin, are benign odontogenic cysts characterized by a gradual growth rate. Their occurrence is twice as prevalent in men compared to women. These cysts are recognized as the most frequent developmental cysts affecting the jaws, with a typical manifestation in individuals aged 20 to 40, while infrequently identified in young children. Notably, dentigerous cysts have the potential to attain significant dimensions, resulting in painless enlargement of the jaw and subsequent deformation. Objectives To assess the clinicopathological features and management of ten years of experience with dentigerous cysts. Methods A challenging cases were reported from reviewed records of the patients who were treated by the surgical intervention of various dentigerous cysts throughout the period of ten years, 2012–2022 and only histologically confirmed cases were selected, at Ramadi Teaching Hospital in addition to Rashid, Razi, Zuhur Private Hospitals and private clinics in Iraq. Results 76 patients were included in this clinicopathological research. The highest age group affected was ≤ 18 years (68.4%), 54% were male, the mandible was more affected (63.1%) than the maxilla (36.9%). Marsupialization was applied to 30.3% of the cases, while enucleation was carried out in 69.7%. Conclusions The significance of meticulous examination of radiographs and the consequences associated with undetected and untreated ailments is affirmed by this case study. A comprehensive understanding of oral pathology serves as a valuable resource for dentists, facilitating accurate diagnosis, appropriate referrals, and the provision of anticipatory guidance to patients striving to achieve optimal oral health across various age groups.

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a rare, but significant adverse event primarily associated with the intake of antiresorptive and antiangiogenic medications. Although antiresorptive and antiangiogenic the-rapies improve life expectancy, particularly in cancer patients, MRONJ may hamper the patient’s quality of life due to pain, discomfort, anxiety, depression, speech impairment, difficulty in swallowing and eating, frequent medical and dental evaluations and treatments, and the possibility of treatment discontinuation. Leukocyte– and Platelet-rich Fibrin (L-PRF) is an autologous platelet aggregate that promotes wound healing by stimulating re-epithelialization, angiogenesis, and extracellular matrix production. Aim: The present systematic review aimed to compare the results in the published literature on whether L-PRF is an effective and predictable adjuvant to surgical debridement of necrotic bone for improving the healing efficacy in patients with MRONJ. Materials and Methods: The PubMed, Scopus, Cochrane, Science Direct, LILACS, and Web of Science databases were searched using the predetermined MeSH terms and eligibility criteria, and the search yielded a total of five articles. Two studies were retrospective, and three studies were case series. Results: Seventeen participants received a combination of surgical debridement, L-PRF membrane, and antibiotics. Complete wound healing was observed in 70% of the participants, and most of them healed without any complications. Conclusions: L-PRF as an adjuvant to surgical debridement of necrosed bone appears to have a positive association with the healing outcome in patients with MRONJ.

Tatiana Miranda Deliberador, Carlos Stutz, Elisa Sartori, Leandro Kluppel, Rubens Moreno de Freitas Department of Implantology, Master’s Program, Latin American Institute of Dental Research and Education – ILAPEO, Curitiba, PR, BrazilCorrespondence: Tatiana Miranda Deliberador, Department of Implantology, Master’s Program, Latin American Institute of Dental Research and Education – ILAPEO, Rua Jacarezinho 656, Curitiba, PR, 80710-150, Brazil, Email tdeliberador@gmail.comAbstract: Medication-related osteonecrosis of the jaw (MRONJ) can be a debilitating complication that can arise in patients who took or are taking antiresorptive (including bisphosphonates) or antiangiogenic agents, leading to visible bone or a fistula that continues for more than eight weeks, without any history of radiotherapy. This clinical case aimed to describe the treatment of MRONJ with topical active oxygen therapy using blue®m oral gel. A 63-year-old female patient that had been taking weekly sodium alendronate (70 mg) for four years by oral via, presented discomfort and implant movement in the &num;46 region, by that underwent surgical extraction of the implant. After three months the patient returned and was diagnosed with MRONJ. Initially, conventional therapies were performed, including surgical debridement and antibiotic therapy, but without success. The patient still had clinical signs of osteonecrosis six months after the implant extraction. The entire socket was then filled with blue®m oral gel by topical application. The patient was instructed to continue applying the gel to the region every 8 hours for 15 days. After this period, the patient returned, and it was observed that the wound was in the healing process, with the presence of epithelialized tissue and without bone exposure. The 2-year clinical follow-up showed the lesion had healed entirely, and a new implant was installed. After the osseointegration period, the final prosthesis was placed. The patient remains under clinical follow-up. Therefore, it can be concluded that the application of blue®m oral gel in this clinical case assisted in the recovery of the osteonecrosis lesion.Keywords: osteonecrosis, bisphosphonate, jaw, reactive oxygen species, wound healing, oxygen

Abstract Background Odontogenic carcinoma with dentinoid (OCD) is a rare and controversial entity, which has not yet been included in the current World Health Organization classification of odontogenic lesions. Owing to the small number of reported cases, the clinicopathological characteristics, biological behavior, prognosis, and appropriate treatment strategies for OCD remain to be defined. Herein, we present an additional case of OCD with a focus on the differential diagnosis and review of the pertinent literature, in order to enable better recognition by oral clinicians and pathologists and further characterization of this entity. Case presentation This paper reports a case of OCD in the posterior mandible of a 22-year-old female. Radiography showed a well-defined unilocular radiolucency with radiopaque materials. The intraoperative frozen section pathology gave a non-committed diagnosis of odontogenic neoplasm with uncertain malignant potential. Then a partial mandibulectomy with free iliac crest bone graft and titanium implants was performed. Microscopically, the tumor consisted of sheets, islands, and cords of round to polygonal epithelial cells associated with an abundant dentinoid matrix. Immunohistochemically, the tumor cells were diffusely positive for CK19, p63, and β-catenin (cytoplasmic and nuclear). No rearrangement of the EWSR1 gene was detected. The final diagnosis was OCD. There has been no evidence of recurrence or metastasis for 58 months after surgery. We also provide a literature review of OCD cases, including one case previously reported as ghost cell odontogenic carcinoma from our hospital. Conclusions OCD is a locally aggressive low grade malignancy without apparent metastatic potential. Wide surgical excision with clear margins and long-term period follow-up to identify any possible recurrence or metastases are recommended. Histopathological examination is essential to conclude the diagnosis. Special care must be taken to distinguish OCD from ghost cell odontogenic carcinoma and clear cell odontogenic carcinoma, as misdiagnosis might lead to unnecessary overtreatment. Study of additional cases is required to further characterize the clinicopathological features and clarify the nosologic status and biological behavior of this tumor.

Abstract Bone-modifying agents (BMA) are extensively used in treating patients with prostate cancer with bone metastases. However, this increases the risk of medication-related osteonecrosis of the jaw (MRONJ). The safety of long-term BMA administration in clinical practice remains unclear. We aimed to determine the cumulative incidence and risk factors of MRONJ. One hundred and seventy-nine patients with prostate cancer with bone metastases treated with BMA at our institution since 2008 were included in this study. Twenty-seven patients (15%) had MRONJ during the follow-up period (median, 19 months; interquartile range, 9–43 months). The 2-year, 5-year, and 10-year cumulative MRONJ incidence rates were 18%, 27%, and 61%, respectively. Multivariate analysis identified denosumab use as a risk factor for MRONJ, compared with zoledronic acid use (HR 4.64, 95% CI 1.93–11.1). Additionally, BMA use at longer than one-month intervals was associated with a lower risk of MRONJ (HR 0.08, 95% CI 0.01–0.64). Furthermore, six or more bone metastases (HR 3.65, 95% CI 1.13–11.7) and diabetes mellitus (HR 5.07, 95% CI 1.68–15.2) were risk factors for stage 2 or more severe MRONJ. MRONJ should be considered during long-term BMA administration in prostate cancer patients with bone metastases.

Background: Dentigerous cysts, deemed of developmental origin, are benign odontogenic cysts characterized by a gradual growth rate. Their occurrence is twice as prevalent in men compared to women. These cysts are recognized as the most frequent developmental cysts affecting the jaws, with a typical manifestation in individuals aged 20 to 40, while infrequently identified in young children. Notably, dentigerous cysts have the potential to attain significant dimensions, resulting in painless enlargement of the jaw and subsequent deformation. Objectives: To assess the clinicopathological features and management of ten years of experience with dentigerous cysts. Methods: A challenging cases were reported from reviewed records of the patients who were treated by the surgical intervention of various dentigerous cysts throughout the period of ten years, 2012–2022 and only histologically confirmed cases were selected, at Ramadi Teaching Hospital in addition to Rashid, Razi, Zuhur Private Hospitals and private clinics in Iraq. Results: 76 patients were included in this clinicopathological research. The highest age group affected was ≤ 18 years (68.4%), 54% were male, the mandible was more affected (63.1%) than the maxilla (36.9%). Marsupialization was applied to 30.3% of the cases, while enucleation was carried out in 69.7%. Conclusions: The significance of meticulous examination of radiographs and the consequences associated with undetected and untreated ailments is affirmed by this case study. A comprehensive understanding of oral pathology serves as a valuable resource for dentists, facilitating accurate diagnosis, appropriate referrals, and the provision of anticipatory guidance to patients striving to achieve optimal oral health across various age groups. [ABSTRACT FROM AUTHOR]

Background and aims. This study aimed at evaluating the etiology and treatment challenges of temporomandibular disorders (TMDs). Methods. 160 subjects with TMDs, 38 males (23.8%) and 122 females (76.3%) were studied. A personalized coefficient was designated, which included the resolution of the main symptom, correction of secondary symptoms, patient collaboration (emotional parameter), treatment duration, and cost. Results. The most frequent cause for consultation was muscle impairment (42.5%), or limitation of mouth opening, followed by joint impairment (23.1%). Muscle pain was noticed, particularly in the masseter (57.5%) and lateral pterygoid muscles (51.9%). Tooth pain or gingival retraction was frequently associated with tooth wear (48.1%) and dental abfraction (31.3%). Remote symptomatology was dominated by otologic symptomatology. Iatrogenic etiology was highest (69.4%), followed by untreated missing teeth (66.9%). Treatment options included muscle relaxation, occlusal balancing (equilibration), kinesitherapy, medication, and swallowing reeducation. Most patients benefited from four to seven different types of therapy, which resulted in a higher cost and a longer and more uncomfortable treatment. The primary symptom was relieved in 82.3% of cases, with recurrence occurring in 15.7%. Conclusion. The treatment of temporomandibular joint dysfunction is time-consuming, demanding, and intricate. Most patients required four to seven different types of therapy, which increased the expense, treatment duration, and suffering. [ABSTRACT FROM AUTHOR]

Implants are innovations that have stood out in dentistry because they are responsible for giving patients back their self- esteem and helping with oral functionality after tooth loss. In some cases, there are more challenging implants, such as in cases where the technique must be performed on the jaw bones, characterizing zygomatic implants. In this work, based on the analysis of publications found in Virtual Databases such as Scielo, Google Scholar and PubMed, articles were selected to compose the present literature review. In this way, the installation of zygomatic implants was investigated, covering their characteristics, as well as advantages, disadvantages and techniques. It was found that zygomatic implants are viable alternatives and that they must be meticulously analyzed by dental professionals, respecting the individuality of the cases when choosing these implants, thus making it possible to change the reality of patients who have suffered complex tooth loss. [ABSTRACT FROM AUTHOR]

Background: The aim of this studywas to investigate the effect of antiresorptive agents on the ossification of reconstructed mandibles by free bone grafts for the first time. Methods: A total of 38 reconstructions of the jaw were retrospectively evaluated for ossification between bone segments by two raters based on postoperative panoramic radiographs. The study group (n = 13) had segmental resection of the mandible and free bone flap reconstruction due to medication-related osteonecrosis of the jaw (MRONJ). The control group (noMRONJ, n = 25) comprised segmental mandibular resections and free bone flap reconstructions due to tumors, chronic osteomyelitis, or traumawithout any radiation. Ossification time and influencing factors were evaluated. Results: Both duration of surgery (346 ± 90 min. vs. 498 ± 124 min.; p < 0.001) and hospitalization (8.7 ± 2.8 days vs. 13.4 ± 5.3 days, p = 0.006) were shorter in theMRONJ group compared to the noMRONJ group. Ossification after mandibular reconstruction was significantly faster in the MRONJ study group [224 days, interquartile range (IQR) 175--287] compared to the control group (288 days, IQR 194-445; p < 0.001). Moreover, good initial contact between the segments resulted in faster ossification (p < 0.001) in the MRONJ group. Ossification rate between original and grafted bone or between grafted bone segments only did not differ in both the study and control groups (MRONJ, p = 0.705 vs. control, p = 0.292). The type of antiresorptive agent did not show any significance for ossification. The rate of wound healing disturbances did also not differ between the study and control groups (p = 0.69). Conclusion: Advanced MRONJ (stage 3) can be resected and reconstructed safely with free microvascular bone flaps. Antiresorptive agents enhance the ossification of the bone segments. Optimal initial contact of the bone segments accelerates bone healing. Surgery and hospitalization are markedly shortened in this vulnerable group of MRONJ patients compared to oncologic patients. [ABSTRACT FROM AUTHOR]

Background: Odontogenic carcinoma with dentinoid (OCD) is a rare and controversial entity, which has not yet been included in the current World Health Organization classification of odontogenic lesions. Owing to the small number of reported cases, the clinicopathological characteristics, biological behavior, prognosis, and appropriate treatment strategies for OCD remain to be defined. Herein, we present an additional case of OCD with a focus on the differential diagnosis and review of the pertinent literature, in order to enable better recognition by oral clinicians and pathologists and further characterization of this entity. Case presentation: This paper reports a case of OCD in the posterior mandible of a 22-year-old female. Radiography showed a well-defined unilocular radiolucency with radiopaque materials. The intraoperative frozen section pathology gave a non-committed diagnosis of odontogenic neoplasm with uncertain malignant potential. Then a partial mandibulectomy with free iliac crest bone graft and titanium implants was performed. Microscopically, the tumor consisted of sheets, islands, and cords of round to polygonal epithelial cells associated with an abundant dentinoid matrix. Immunohistochemically, the tumor cells were diffusely positive for CK19, p63, and β-catenin (cytoplasmic and nuclear). No rearrangement of the EWSR1 gene was detected. The final diagnosis was OCD. There has been no evidence of recurrence or metastasis for 58 months after surgery. We also provide a literature review of OCD cases, including one case previously reported as ghost cell odontogenic carcinoma from our hospital. Conclusions: OCD is a locally aggressive low grade malignancy without apparent metastatic potential. Wide surgical excision with clear margins and long-term period follow-up to identify any possible recurrence or metastases are recommended. Histopathological examination is essential to conclude the diagnosis. Special care must be taken to distinguish OCD from ghost cell odontogenic carcinoma and clear cell odontogenic carcinoma, as misdiagnosis might lead to unnecessary overtreatment. Study of additional cases is required to further characterize the clinicopathological features and clarify the nosologic status and biological behavior of this tumor. [ABSTRACT FROM AUTHOR]

Bone-modifying agents (BMA) are extensively used in treating patients with prostate cancer with bone metastases. However, this increases the risk of medication-related osteonecrosis of the jaw (MRONJ). The safety of long-term BMA administration in clinical practice remains unclear. We aimed to determine the cumulative incidence and risk factors of MRONJ. One hundred and seventy-nine patients with prostate cancer with bone metastases treated with BMA at our institution since 2008 were included in this study. Twenty-seven patients (15%) had MRONJ during the follow-up period (median, 19 months; interquartile range, 9–43 months). The 2-year, 5-year, and 10-year cumulative MRONJ incidence rates were 18%, 27%, and 61%, respectively. Multivariate analysis identified denosumab use as a risk factor for MRONJ, compared with zoledronic acid use (HR 4.64, 95% CI 1.93–11.1). Additionally, BMA use at longer than one-month intervals was associated with a lower risk of MRONJ (HR 0.08, 95% CI 0.01–0.64). Furthermore, six or more bone metastases (HR 3.65, 95% CI 1.13–11.7) and diabetes mellitus (HR 5.07, 95% CI 1.68–15.2) were risk factors for stage 2 or more severe MRONJ. MRONJ should be considered during long-term BMA administration in prostate cancer patients with bone metastases. [ABSTRACT FROM AUTHOR]

There is increasing interest from evolutionary biologists in the evolution of avian bill shape, how the bill is used during feeding and, in particular, the bite forces the bill can deliver. Bite force exhibits isometry with the total mass of the jaw musculature, but there is variation in the functional categories of the jaw muscles in different avian taxa. Qualitative descriptions of the jaw musculature do not allow analysis of the relative contributions that adductor or retractor muscles play in generating a bite force. This study is a meta-analysis of published data for body mass and the mass of the jaw musculature in 66 bird species from 10 orders. The masses of the different muscles contributing to adduction and retraction in closing the jaw, and to depression and protraction in opening the jaw, were summed and allometric relationships explored before investigating the effects of taxonomic order on these relationships. The categories of muscles, and the masses of each category of jaw musculature varied among avian orders. Some species, such as the flightless ratites, had relatively small jaw muscle mass but parrots had an additional adductor muscle. Phylogenetically controlled relationships between body mass and the mass of each muscle category irrespective of taxonomic order were isometric. However, analysis of covariance revealed significant interactions between body mass and taxonomic order. Most orders had low values for body-mass-specific muscle masses in the jaw with the notable exceptions of the Passeriformes (songbirds) and Psittaciformes (parrots). The values of these orders were 3–4 times greater, although the relative amounts of muscles contributing to adduction and retraction were similar in Psittaciformes, but adduction was markedly higher in Passeriformes. The results of these analyses highlight the lack of species-specific data for most birds, which is adversely impacting our understanding of the anatomical features that are determining the functional properties of the bill during feeding. [ABSTRACT FROM AUTHOR]

Copyright of SEMS-Journal is the property of Schwiez Zschr Sportmed Sporttraumatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Non-secretory multiple myeloma (NSMM) is a rare cancer of plasma cells characterized by the absence of detectable monoclonal M protein in the blood or urine. A 57-year-old woman presented with mandibular pain but without intraoral swelling. Imaging studies revealed multiple osteolytic lesions in her mandible and pronounced root resorption of the left mandibular second molar. Biopsy results showed atypical plasmacytoid cells positive for anti-kappa, CD138, MUM1, and CD79a antibodies, but negative for anti-lambda and CD20. These results were indicative of a malignant plasma cell neoplasm. No abnormalities were revealed by free light chain assay or by serum or urine protein electrophoresis, leading to a diagnosis of NSMM. The patient began chemotherapy in conjunction with bisphosphonate therapy and achieved remission following treatment. This case underscores the critical role of dentists in the early detection and prevention of NSMM complications, as the disease can initially present in the oral cavity. [ABSTRACT FROM AUTHOR]

Copyright of Acta Odontologica Latinoamericana: AOL is the property of Acta Odontologica Latinoamericana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To verify medication-related osteonecrosis of the jaw (MRONJ) frequency among patients with plasma cell myeloma (PCM) that had been treated with bisphosphonates, to identify predisposing factors that could influence the development of osteonecrosis. Methods: This observational retrospective study was performed at the Department of Hematology of Hospital Center of Porto (CHUP), Portugal. Results: The study population (n = 112) had a 15.2% (n = 17) prevalence of osteonecrosis. Clinically, bone exposure was the most frequently observed sign, present in 100% (n = 17) of the patients, followed by inflammation in 82.4% (n = 14), orofacial pain in 70.6% (n = 12), suppuration in 47.1% (n = 8), and intra or extra-oral fistula in 17.6% (n = 3) of the cases. The most frequent triggering local factor was dental extraction (82.4%). There was a dependence between the presence of extractions and the development of MRONJ (p < 0.001) but not with the time elapsed from the initiation of infusions with BPs and dental extractions (p = 0.499). In the sample of patients with multiple myeloma (MM), 13.8% were found to be more likely to develop MRONJ after an extraction. Conclusions: The most common local predisposing factor was dental extraction. No dependence was observed between the development of osteonecrosis and the time elapsed from the beginning of treatment with bisphosphonates infusions to surgical procedures. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This clinical case report focuses on a case of surgery performed on a patient with the aim of cutting the dental apices in the patient's upper jaw. Mineral trioxide aggregate (MTA) was used as a filling material, and monitoring the condition showed that the operation was successful. [ABSTRACT FROM AUTHOR]

Copyright of Revista de la Asociación Odontológica Argentina is the property of Asociacion Odontologica Argentina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The evolutionary shift from a single-element ear, multi-element jaw to a multi-element ear, single-element jaw during the transition to crown mammals marks one of the most dramatic structural transformations in vertebrates. Research on this transformation has focused on mammalian middle-ear evolution, but a mandible comprising only the dentary is equally emblematic of this evolutionary radiation. Here, we show that the remarkably diverse jaw shapes of crown mammals are coupled with surprisingly stereotyped jaw stiffness. This strength-based morphofunctional regime has a genetic basis and allowed mammalian jaws to effectively resist deformation as they radiated into highly disparate forms with markedly distinct diets. The main functional consequences for the mandible of decoupling hearing and mastication were a trade-off between higher jaw stiffness versus decreased mechanical efficiency and speed compared with non-mammals. This fundamental and consequential shift in jaw form-function underpins the ecological and taxonomic diversification of crown mammals. This article is part of the theme issue 'The mammalian skull: development, structure and function'.

Background: Surgically assisted rapid maxillary expansion (SARME) with disjunction of the pterygomaxillary suture is a procedure widely used in maxillofacial surgery. However, the pterygomaxillary disjunction (PD) procedure has often been deemed risky. The actual necessity and effectiveness of PD in SARME remain subjects of debate, with some studies suggesting that sufficient expansion can be achieved without it. This systematic review with meta-analysis aimed to evaluate the scientific literature regarding the effects of PD on skeletal and dental changes after SARME. Methods: The systematic review followed the Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify relevant articles published in different databases. The study conducted a comprehensive literature search across seven databases: PubMed/Medline, Web of Science, Science Direct, Scopus, Embase, Cochrane Collaboration Library, and Google Scholar. The selected studies evaluated the effect of the extent of expansion and the stability of SARME with PD, as well as the skeletal and dental changes associated with the treatment. The intervention cohorts within the sampled population chosen for incorporation into our analysis consisted of individuals who underwent SARME accompanied by PD, whereas the control group underwent SARME devoid of PD. Data were combined in a meta-analysis using the Review Manager 5.3.5. (RevMan) program. A systematic search was performed in seven databases (PubMed/Medline, Web of Science, Science Direct, Scopus, Embase, Cochrane Collaboration Library, and Google Scholar). Results: After applying the selection criteria, seven articles were included in the systematic review, totaling 291 patients. Five articles were selected for meta-analysis. A meta-analysis was conducted to assess the effects of anterior and posterior dental expansions. After applying the selection criteria, seven articles were included in the systematic review, totaling 291 patients. Five articles were selected for meta-analysis. A meta-analysis was conducted to assess the effects of anterior and posterior dental expansions. Expansion in the previous region was slightly higher in the SARME with PD group compared to the PD-free group (95 % CI: 1.07 to 1.1 mm; p = 0.98). In the posterior region, expansion exceeding 0.11 mm was observed in the SARME with PD group compared to the PD-free group, but without statistical significance (95 % CI: 1.64 to 1.86 mm; p = 0.903). Conclusion: SARME combined with PD proves to be an effective surgical procedure for correcting transverse maxillary deficiencies. However, no statistically significant differences were observed when SARME with and without PD was compared, indicating that SARME with PD can be used especially in cases that require expansion in the posterior region of the maxilla.

Malocclusions are common craniofacial malformations that cause quality of life and health problems if left untreated. Unfortunately, the current treatment for severe skeletal malocclusion is invasive surgery. Developing improved therapeutic options requires a deeper understanding of the cellular mechanisms responsible for determining jaw bone length. We have recently shown that neural crest mesenchyme (NCM) can alter jaw length by controlling the recruitment and function of mesoderm-derived osteoclasts. Transforming growth factor beta (TGF-β) signaling is critical to craniofacial development by directing bone resorption and formation, and heterozygous mutations in the TGF-β type I receptor (TGFBR1) are associated with micrognathia in humans. To identify the role of TGF-β signaling in NCM in controlling osteoclasts during mandibular development, the mandibles of mouse embryos deficient in the gene encoding Tgfbr1, specifically in NCM, were analyzed. Our laboratory and others have demonstrated that Tgfbr1fl/fl;Wnt1-Cre mice display significantly shorter mandibles with no condylar, coronoid, or angular processes. We hypothesize that TGF-β signaling in NCM can also direct late bone remodeling and further regulate late embryonic jaw bone length. Interestingly, analysis of mandibular bone based on micro-computed tomography and Masson’s trichrome revealed no significant difference in bone quality between the Tgfbr1fl/fl;Wnt1-Cre mice and controls, as measured by the bone perimeter/bone area, trabecular rod-like diameter, number and separation, and gene expression of collagen type 1 alpha 1 (Col1α1) and matrix metalloproteinase 13 (Mmp13). Although there was not a difference in localization of bone resorption within the mandible indicated by tartrate-resistant acid phosphatase (TRAP) staining, Tgfbr1fl/fl;Wnt1-Cre mice had approximately three-fold less osteoclast number and perimeter than controls. Gene expression of receptor activator of nuclear factor kappa-β (Rank) and Mmp9, markers of osteoclasts and their activity, also showed a three-fold decrease in Tgfbr1fl/fl;Wnt1-Cre mandibles. Evaluation of osteoblast-to-osteoclast signaling revealed no significant difference between Tgfbr1fl/fl;Wnt1-Cre mandibles and controls, leaving the specific mechanism unresolved. Finally, pharmacological inhibition of Tgfbr1 signaling during the initiation of bone mineralization and resorption significantly shortened jaw length in embryos. We conclude that TGF-β signaling in NCM decreases mesoderm-derived osteoclast number, that TGF-β signaling in NCM impacts jaw length late in development, and that this osteoblast-to-osteoclast communication may be occurring through an undescribed mechanism.

IntroductionThis retrospective study highlights the salient aspects of a series of feline patients affected with bisphosphonate related osteonecrosis of the jaw. Though more commonly published in human literature, this presentation is rare in cats. The authors hope that this study will assist in making this a more globally known entity with subsequent improved prognosis.MethodsData was retrospectively obtained from the medical records between 2015 and 2021 of 20 cats with Medication Related Osteonecrosis of the Jaw. Data included patient information, clinical history, presenting complaint, systemic diseases, details referable to hypercalcemia and treatment thereof, bisphosphonate specifics (dose and duration), clinical presentation of the lesion, diagnostic testing including radiographic and histopathologic descriptions, treatment, and outcome.ResultsPertinent results include that all 20 cats who developed Medication Related Osteonecrosis of the Jaw had been treated for idiopathic hypercalcemia with the bisphosphonate medication alendronate. Eighty-five percent of the cases had prior dental extractions at the site of MRONJ lesion. Ninety-five percent of the affected cats required a surgical procedure to control the disease. Thirty-five percent of cases required at least one revision surgery after the initial procedure was performed. Diagnosis of MRONJ was made by a correlation of diagnostic findings and patient history. No single diagnostic, or combination was pathognomonic for lesion diagnosis. As well, there were no statistically significant associations between patient variables assessed and the overall patient outcome.DiscussionThe case series reveals that cats with feline idiopathic hypercalcemia treated with alendronate may be at a risk for development of MRONJ, a serious oral condition with significant morbidity. Prior dental extraction sites in patients concurrently treated with bisphosphonate medications were often associated with MRONJ lesions. Therefore, any needed dental surgery should be performed prior to the use of bisphosphonates where possible. The authors have also included a relevant comparative literature review.

Magnetic fields are safe and used in noninvasive physical therapies. Numerous studies have confirmed that magnetic fields have good osteogenic effects and certain value for clinical application in accelerating orthodontic tooth movement, promoting bone-implant integration, promoting fracture healing and improving the effects of distraction osteogenesis. Magnetic fields are expected to become applied as effective auxiliary methods for treating oral diseases. To support the clinical application of magnetic fields, this article reviews the applications of magnetic fields in the oral cavity, the biological effects on bone cells and the molecular mechanisms through which magnetic fields regulate bone metabolism. The biological effects of magnetic fields on bone cells include promoting osteogenesis by osteoblasts and mesenchymal stem cells and inhibiting bone resorption by osteoclasts. At the molecular level, bone cells sense and respond to magnetic stimulation, and through various mechanisms, such as displacement currents, Lorentz forces, and free radical pair effects, stimuli are transformed into biologically recognizable electrical signals that activate complex downstream signaling pathways, such as the P2 purinergic receptor signaling pathway, adenosine receptor signaling pathway, transforming growth factor-β receptor signaling pathway, mammalian target of rapamycin (mTOR) pathway, and Notch pathway. In addition, magnetic parameters, which are the factors affecting the osteogenic effects of magnetic fields, are discussed. However, the mechanisms of the osteogenic effects of magnetic fields are unclear, and further studies of these mechanisms could provide effective strategies for bone regeneration and periodontal tissue regeneration. In addition, considering the target of magnetic field therapies, combination with other drugs could lead to new strategies for the treatment of oral diseases.

Aim: This study aimed to examine the patterns of partial edentulism and the associated risk factors in Jordan. Methods: A cross-sectional, epidemiological study was carried out across Jordan, and data was collected from adult partially dentate patients in various healthcare facilities. The data collected included sociodemographic data, dental and social history, and clinical examination findings for the jaw and teeth. Multivariate regression models were used to determine the predictors for the number of missing teeth. Results: The sample consisted of 467 partially dentate participants. The leading cause of tooth loss was dental caries (85.4 %), followed by periodontal disease (13.7 %), and trauma (7.5 %). The mean number of missing teeth was significantly higher in the upper jaw (2.5 ± 3.1) compared to the lower jaw (2.2 ± 2.6, p = 0.02). In both jaws, the most prevalent Kennedy classification was Class 3, followed by Class 3/Modification 1 and Class 2/Modification 1. Increased age, smoking, lack of daily tooth brushing, and low education level were significantly associated with high tooth loss. Conclusions: This study contributes to the understanding of partial edentulism in Jordan, reflecting broader oral health concerns and the factors influencing tooth loss. The findings, vital for future research and interventions, offer insights applicable to global oral health challenges, particularly for at-risk groups.

Key Clinical Message: Medication‐related osteonecrosis of the Jaw (MRONJ) is a rare complication of the jaws following the administration of antiresorptive or antiangiogenic drugs. This condition poses a major challenge to its management. Its prevention and management need a multidisciplinary collaboration. We described three patients with MRONJ including their presentation, investigations, management protocols, and outcomes. A brief appraisal of the literature on MRONJ was also done. Medication‐related osteonecrosis of the jaw (MRONJ) is a rare complication of the jaws following the administration of antiresorptive or antiangiogenic drugs. This condition poses a major challenge to its management. We present an appraisal of the literature and three cases of MRONJ. An appraisal of 3 patients who presented to the oral and maxillofacial clinic with MRONJ was done. Relevant physical examination findings, radiological images, clinical photographs and follow‐up was documented. One patient had multiple myeloma while the other two had metastatic cancer. All had received zoledronic acid before developing MRONJ. One patient was surgically treated and successfully recovered while two were managed conservatively. Patients taking antiresorptive medications are at risk of developing MRONJ. Prevention and management of the condition calls for a multidisciplinary collaboration. Patients taking antiresorptive medications need good education on the risks associated with the medications and how to recognize early signs and symptoms. [ABSTRACT FROM AUTHOR]

Background: Neck and jaw pain is common and is associated with jaw functional limitations, postural stability, muscular endurance, and proprioception. This study aimed to investigate the effect of jaw and neck pain on craniocervico-mandibular functions and postural stability in patients with temporomandibular joint disorders (TMJDs). Methods: Fifty-two patients with TMJDs were included and assessed using Fonseca's Questionnaire and the Helkimo Clinical Dysfunction Index. An isometric strength test was performed for the TMJ depressor and cervical muscles. The TMJ position sense (TMJPS) test and cervical joint position error test (CJPET) were employed for proprioception. Total sway degree was obtained for the assessment of postural stability. Deep neck flexor endurance (DNFE) was assessed using the craniocervical flexion test. The mandibular function impairment questionnaire (MFIQ) was employed to assess mandibular function, and the craniovertebral angle (CVA) was measured for forward head posture. Results: Jaw and neck pain negatively affected CVA (R² = 0.130), TMJPS (R² = 0.286), DNFE (R² = 0.355), TMJ depressor (R² = 0.145), cervical flexor (R² = 0.144), and extensor (R² = 0.148) muscle strength. Jaw and neck pain also positively affected CJPET for flexion (R² = 0.116) and extension (R² = 0.146), as well as total sway degree (R² = 0.128) and MFIQ (R² = 0.230). Conclusions: Patients with painful TMJDs, could have impaired muscle strength and proprioception of the TMJ and cervical region. The jaw and neck pain could also affect postural stability, and the endurance of deep neck flexors as well as mandibular functions in TMJDs. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Prevention & Treatment For Stomatological Diseases is the property of Journal of Prevention & Treatment For Stomatological Diseases Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives. This meta-analysis addresses the use of mandibular computed tomography (CT) scans for age and/or sex determination in forensic science. Methods. Six databases were searched until June 2023, using the keyword "mandible" combined with keywords related to "multislice computed tomography" (MCT) or "cone-beam computed tomography" (CBCT) and keywords related to "skeletal age determination" or "sex determination analysis." Main Results. Among the 23 studies included, 11 used MCT and 12 used CBCT to perform forensic assessments. Age determination was the aim of a single study, sex and age determinations were the objective of five studies, and the other studies investigated the determination of sex only. Metaanalysis could be performed only for sex determination. Conclusions. Mandible measurements are useful in sex determination, as the bicondylar and bigonial breadth are larger in males than in females. For the mandible angle, the meta-analysis results confirm sex dimorphism in CBCT scans but not in MCT scans. For age estimation, further studies are needed to prove that the mandible hole is a reliable parameter for age estimation. PROSPERO registration number: CRD42021260967. [ABSTRACT FROM AUTHOR]

Osteoradionecrosis of the jaw is a morbid complication of radiotherapy in patients with oral and oropharyngeal cancers that may be precipitated by dental extractions. Pentoxifylline and tocopherol (PENTO) has been utilized in the management of osteoradionecrosis and as prophylaxis for post-radiated head and neck oncology patients requiring an invasive dental procedure. This observational study aims to report the outcome of the prophylactic use of PENTO in the prevention of osteoradionecrosis of the jaw after dental extractions in post-radiated oral and oropharyngeal cancer patients and to review the current literature on this topic. Four post-radiated oral and oropharyngeal oncology patients were referred to the dental oncology clinic of the University Dental Practice, University of Tennessee Health Sciences Center for dental extractions. All four patients were prescribed pentoxifylline 400 mg BID (twice a day) and tocopherol 400 IU BID (oral tablets) for 2 weeks before extraction(s) and for 6 weeks after extraction(s). All patients were followed up every week after the second week post-extraction if feasible until the extraction site(s) healed (covered by mucosa). The assessment endpoint was defined as 6 weeks post-extraction with the outcomes assessed as using four categories determined by the area of exposed bone: complete healing (complete mucosal coverage of extraction site); partial healing (reduction in size of extraction site); no change; and progression (increase in size of the extraction site). At the assessment endpoint, all patients had complete healing of all extraction sites. The ORN rate at the patient level (0/4) and individual tooth level (0/8) was 0%. All patients tolerated the PENTO medications and no adverse effects from the use of these medications were reported. This limited study in addition to the other reviewed studies estimates the rate of ORN at the patient level as 3.2% (14/436) for post-radiated head and neck oncology patients after dental extractions/invasive oral procedures. In conclusion, this PENTO regimen can reduce/prevent the incidence of ORN in post-radiated head and neck oncology patients. This safe and cost-effective protocol (PENTO regimen) should be further evaluated as prophylaxis for post-radiated head and neck oncology patients requiring an invasive dental procedure. We recommend large prospective studies to be carried out to further validate these findings. [ABSTRACT FROM AUTHOR]

This study aimed to examine the patterns of partial edentulism and the associated risk factors in Jordan. A cross-sectional, epidemiological study was carried out across Jordan, and data was collected from adult partially dentate patients in various healthcare facilities. The data collected included sociodemographic data, dental and social history, and clinical examination findings for the jaw and teeth. Multivariate regression models were used to determine the predictors for the number of missing teeth. The sample consisted of 467 partially dentate participants. The leading cause of tooth loss was dental caries (85.4 %), followed by periodontal disease (13.7 %), and trauma (7.5 %). The mean number of missing teeth was significantly higher in the upper jaw (2.5 ± 3.1) compared to the lower jaw (2.2 ± 2.6, p = 0.02). In both jaws, the most prevalent Kennedy classification was Class 3, followed by Class 3/Modification 1 and Class 2/Modification 1. Increased age, smoking, lack of daily tooth brushing, and low education level were significantly associated with high tooth loss. This study contributes to the understanding of partial edentulism in Jordan, reflecting broader oral health concerns and the factors influencing tooth loss. The findings, vital for future research and interventions, offer insights applicable to global oral health challenges, particularly for at-risk groups. [ABSTRACT FROM AUTHOR]

Background: The present study analyzes the clinical aspects of the use of small-diameter implants for the fixation of total overdenture-type prostheses on both totally edentulous dental arches. Materials and methods: This is a review of all randomized controlled trials of at least ten patients with a control group in which at least two narrow implants were placed, published between January 2010 and July 2023. Most databases were analyzed, and clinical studies involving the insertion of at least two narrow implants (<3.5 mm in diameter) were analyzed. Results: Studies showed that the survival rate of narrow implants varied from 78% to 100%. Conclusions: The results indicated that narrow-type implants have satisfactory and predictable clinical performance for the long-term stability of overdenture-type prostheses. [ABSTRACT FROM AUTHOR]

Background: Current segmentation approaches for radiation treatment planning in head and neck cancer patients (HNCP) typically consider the entire mandible as an organ at risk, whereas segmentation of the maxilla remains uncommon. Accurate risk assessment for osteoradionecrosis (ORN) or implant-based dental rehabilitation after radiation therapy may require a nuanced analysis of dose distribution in specific mandibular and maxillary segments. Manual segmentation is time-consuming and inconsistent, and there is no definition of jaw subsections. Materials and methods: The mandible and maxilla were divided into 12 substructures. The model was developed from 82 computed tomography (CT) scans of HNCP and adopts an encoder-decoder three-dimensional (3D) U-Net structure. The efficiency and accuracy of the automated method were compared against manual segmentation on an additional set of 20 independent CT scans. The evaluation metrics used were the Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95), and surface DSC (sDSC). Results: Automated segmentations were performed in a median of 86 s, compared to manual segmentations, which took a median of 53.5 min. The median DSC per substructure ranged from 0.81 to 0.91, and the median HD95 ranged from 1.61 to 4.22. The number of artifacts did not affect these scores. The maxillary substructures showed lower metrics than the mandibular substructures. Conclusions: The jaw substructure segmentation demonstrated high accuracy, time efficiency, and promising results in CT scans with and without metal artifacts. This novel model could provide further investigation into dose relationships with ORN or dental implant failure in normal tissue complication prediction models.

BackgroundThe aim of this study was to investigate the effect of antiresorptive agents on the ossification of reconstructed mandibles by free bone grafts for the first time.MethodsA total of 38 reconstructions of the jaw were retrospectively evaluated for ossification between bone segments by two raters based on postoperative panoramic radiographs. The study group (n = 13) had segmental resection of the mandible and free bone flap reconstruction due to medication-related osteonecrosis of the jaw (MRONJ). The control group (noMRONJ, n = 25) comprised segmental mandibular resections and free bone flap reconstructions due to tumors, chronic osteomyelitis, or trauma without any radiation. Ossification time and influencing factors were evaluated.ResultsBoth duration of surgery (346 ± 90 min. vs. 498 ± 124 min.; p < 0.001) and hospitalization (8.7 ± 2.8 days vs. 13.4 ± 5.3 days, p = 0.006) were shorter in the MRONJ group compared to the noMRONJ group. Ossification after mandibular reconstruction was significantly faster in the MRONJ study group [224 days, interquartile range (IQR) 175–287] compared to the control group (288 days, IQR 194–445; p < 0.001). Moreover, good initial contact between the segments resulted in faster ossification (p < 0.001) in the MRONJ group. Ossification rate between original and grafted bone or between grafted bone segments only did not differ in both the study and control groups (MRONJ, p = 0.705 vs. control, p = 0.292). The type of antiresorptive agent did not show any significance for ossification. The rate of wound healing disturbances did also not differ between the study and control groups (p = 0.69).ConclusionAdvanced MRONJ (stage 3) can be resected and reconstructed safely with free microvascular bone flaps. Antiresorptive agents enhance the ossification of the bone segments. Optimal initial contact of the bone segments accelerates bone healing. Surgery and hospitalization are markedly shortened in this vulnerable group of MRONJ patients compared to oncologic patients.

The data presented in this manuscript describe craniofacial landmark coordinate values, muscle and load moment arm lengths, and mechanical advantage rates for constructing a three-dimensional model of masticatory muscles. Cone-beam computed tomography scans from 30 subjects (aged 12–19 years, 16 females) were used. Thirty-six craniofacial landmarks were identified. Subsequently, the moment arms for 7 muscles and their corresponding load moment arms at incisor and molar positions were determined. Then, the three-dimensional mechanical advantage for each muscle and tooth position was calculated as the ratio of muscle moment arm to load moment arm. This procedure was repeated three times by a main examiner and once by two other examiners. The Friedman test and the square root of the 'method of moments' variance estimator were used to compare data among examiners and calculate random errors, respectively. Although the values for the craniofacial landmark coordinates and biomechanical variables are very close, differences were found between measurements, especially in the interexaminer comparisons. Values served as the basis for reliability (intraclass correlation coefficient) and errors (average mean of absolute differences) analysis in the research paper titled “A three-dimensional method to calculate mechanical advantage in mandibular function: Intra- and interexaminer reliability study,” published in the Journal of Orofacial Orthopedics.

Key Clinical Message This clinical case report focuses on a case of surgery performed on a patient with the aim of cutting the dental apices in the patient's upper jaw. Mineral trioxide aggregate (MTA) was used as a filling material, and monitoring the condition showed that the operation was successful.

Background: The present study analyzes the clinical aspects of the use of small-diameter implants for the fixation of total overdenture-type prostheses on both totally edentulous dental arches. Materials and methods: This is a review of all randomized controlled trials of at least ten patients with a control group in which at least two narrow implants were placed, published between January 2010 and July 2023. Most databases were analyzed, and clinical studies involving the insertion of at least two narrow implants (

Medication-related osteonecrosis of the jaw (MRONJ) is a rare condition, typically seen in patients receiving antiresorptive or antiangiogenic drugs. This study aims to synthesize reports and case series of MRONJ regarding sociodemographic and clinical characteristics and to evaluate the effectiveness of the treatments applied. Following PRISMA guidelines, a search for case reports and case series was carried out in the PubMed-Medline database until March 2024. A total of 88 articles were included in this review, in a total of 151 cases. The key findings reveal that females were the most affected individuals (71% of the cases) with the average age at diagnosis being 66.27 years with a standard deviation of ±13.03. Stage 2 was the most observed stage, in 43% of cases, and zoledronic acid was the most commonly used drug (32% of cases). The oral route was the most common route of administration, in 26% of cases, with an average administration duration of 60.88 months (standard deviation ± 50.92). The mandible was the most commonly affected anatomical location (in 60% of cases). Amoxicillin + clavulanic acid (875 mg + 125 mg) and chlorhexidine (0.12%) were the most used antibiotics and mouthwash, with 16% and 26% of the cases, respectively. Surgical debridement was the most common surgical procedure, in 32% of cases, while the use of an L-PRF membrane was the most prevalent unconventional treatment, in 21% of cases. This study identified a statistically significant relationship between unconventional treatments and the cure of MRONJ (p < 0.001), indicating the need for further research to confirm these results.

Copyright of Salud Uninorte is the property of Fundacion Universidad del Norte and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Juvenile ossifying fibroma is considered a rare benign pathology that affects the maxillofacial region of children and adolescents, exhibiting aggressive behavior and affecting mainly the paranasal sinus region. According to its clinical and histopathological characteristics, it can be classified into two variants: trabecular and psammomatoid. In addition to the paranasal sinuses, other regions of the face may be affected less frequently, such as the jaw. The present work reports a case of psammomatoid juvenile ossifying fibroma, located in the region of the right mandibular body, of a 13-year-old patient, treated at the Oral and Maxillofacial Surgery and Traumatology Outpatient Clinic (CTBMF) of the Municipal Hospital of Tucuruí-PA. [ABSTRACT FROM AUTHOR]

Odontomas are considered hamartomatous lesions and are one of the two most common odontogenic tumors of the jaw. Odontomas are classified as compound or complex. Recently, ameloblastic fibro-odontoma (AFO) and ameloblastic fibro-dentinoma were reclassified as developing odontomas. Though clinically odontomas are usually asymptomatic, they have adverse effects on adjacent teeth such as tooth impaction, delayed eruption, displacement of teeth, over-retention of teeth, and can give rise to odontogenic cysts within the jaw. We sought to evaluate the clinicoradiopathologic presentations of odontomas by collecting and analyzing the clinical, radiographic, and pathologic data of odontomas diagnosed in our institution from 2013 to 2022. Over this 10-year period, there were 242 patients with a histopathological and/or radiographic diagnosis of odontoma. There was no gender predilection and ages ranged from 3 to 101 years (median, 14 years). The second decade of life was the most prevalent (57.4%). There was no jaw predilection; however, the anterior jaw was the most common location. Ninety-four (38.8%) cases presented with clinical findings. The most common finding was tooth impaction (n = 83). Nine (3.7%) cases were histopathologically confirmed to be associated with other lesions such as dentigerous cysts (n = 8) and nasopalatine duct cyst (n = 1). The median age (25 years) of patients diagnosed with odontomas associated with cysts was older than patients with odontomas (14 years) without associated cysts. Compound odontomas were the most common type of odontoma compared to complex and AFOs with 71.4%, 26.6%, and 2%, respectively. The majority of compound odontomas involved the anterior jaw (69.3%) and mandible (54.9%) while the majority of complex odontomas involved the posterior jaw (59.6%) and maxilla (54.7%). The four AFOs were in the posterior jaw and 75% involved the maxilla. The median age (12 years) of patients diagnosed with AFO was the youngest compared to patients diagnosed with compound (13 years) and complex (16 years). In conclusion, we analyzed the clinical, radiographic, and pathologic features of 242 new cases of odontomas. Our study reaffirms that odontomas frequently affect the pediatric population and can disrupt their dentition. Based on the result of this study, our clinical recommendation to prevent problems to adjacent teeth from odontomas is for dentists to be apt in the diagnose of odontomas to ensure that they are surgically removed in a timely manner. [ABSTRACT FROM AUTHOR]

Key Clinical Message Medication‐related osteonecrosis of the Jaw (MRONJ) is a rare complication of the jaws following the administration of antiresorptive or antiangiogenic drugs. This condition poses a major challenge to its management. Its prevention and management need a multidisciplinary collaboration. We described three patients with MRONJ including their presentation, investigations, management protocols, and outcomes. A brief appraisal of the literature on MRONJ was also done. Abstract Medication‐related osteonecrosis of the jaw (MRONJ) is a rare complication of the jaws following the administration of antiresorptive or antiangiogenic drugs. This condition poses a major challenge to its management. We present an appraisal of the literature and three cases of MRONJ. An appraisal of 3 patients who presented to the oral and maxillofacial clinic with MRONJ was done. Relevant physical examination findings, radiological images, clinical photographs and follow‐up was documented. One patient had multiple myeloma while the other two had metastatic cancer. All had received zoledronic acid before developing MRONJ. One patient was surgically treated and successfully recovered while two were managed conservatively. Patients taking antiresorptive medications are at risk of developing MRONJ. Prevention and management of the condition calls for a multidisciplinary collaboration. Patients taking antiresorptive medications need good education on the risks associated with the medications and how to recognize early signs and symptoms.