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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]

Three dimensional (3D) kinematic analysis based on motion capture can study synchronized data from the integrated jaw and neck motor system. Jaw function is commonly estimated on linear outcome variables of motion range. By combining jaw border movements in three planes the functional range of motion could be described by movement area and volume measures. Can we ensure the accuracy, test-retest reliability, and intra-individual variability with 3D kinematic analysis for estimating jaw functional range of motion (ROM), including jaw movement area and volume and jaw and head linear measures? Accuracy was estimated by applying the method to a set of beakers with known volume, based on the percentage deviation and Pearson correlation coefficient between target and estimated values. Test-retest reliability was then analysed on maximum jaw movements performed in a pre-determined movement sequence by 17 pain-free participants (25.4 years ± 2.4) to estimate jaw functional ROM. Intraclass correlation coefficients (ICC) were calculated, and Bland-Altman plots were constructed. Coefficient of variation (CV) tested the within session reliability. The accuracy in volume and area measurements were high with a percentage deviation (0.03±0.59) and (1.2±0.45), respectively, with a strong linear relationship (R2=0.99) between target and estimated values. The test-retest reliability showed moderate to excellent reliability, and Bland-Altman plots showed good agreement. Overall, CVs showed high repeatability, but jaw movements in horizontal directions were less reliable and presented higher variability. The study with 3D kinematic analysis of jaw functional ROM, provides a methodological basis for accurate and reliable measurements. The study presents a new way to estimate jaw functional ROM measures, useful for evaluation in clinical intervention, for instance in pain and jaw dysfunction. Moreover, the natural biological movement variability and the complexity of the interplay of jaw-head movement will be emphasised. • A new kinematic method to estimate jaw functional range of motion. • The accuracy in area and volume measurements were high. • Jaw and head linear movement displacements showed high test-retest reliability. • The method has potential to evaluate dysfunctions in jaw-neck motor system. [ABSTRACT FROM AUTHOR]

Background: There is limited knowledge about the impact of painful temporomandibular disorders (TMDs) and pain characteristics on jaw functional limitation and oral health‐related quality of life (OHRQoL) in TMD patients. Objectives: The influence of painful TMDs and pain characteristics on jaw functional limitation and OHRQoL was investigated. Inter‐relationships between limitation in jaw function and various OHRQoL domains, along with facial pain attributes predicting impaired jaw function and diminished OHRQoL were also examined. Methods: TMD patients were recruited from a university‐based hospital. A comprehensive questionnaire comprising demographic variables, the DC/TMD Symptom Questionnaire, Graded Chronic Pain Scale, Jaw Functional Limitation Scale‐8 (JFLS‐8) and Oral Health Impact Profile‐TMD (OHIP‐TMD) was administered. Participants underwent a protocolized physical examination, and TMD diagnoses were determined utilising the DC/TMD algorithms. Participants were subsequently stratified into intra‐articular/pain‐related/combined TMD groups, as well as no TMD pain, acute/chronic pain and low/high‐intensity pain groups. Data were assessed using non‐parametric and hierarchical linear regression analyses (α =.05). Results: The final sample consisted of 280 participants (mean age 31.2 (SD 11.8) years; 79.3% women). Significant differences in pain characteristics, JFLS‐8, and global OHIP scores were observed across the various TMD subtypes, pain chronicity and pain intensity categories. Pain intensity and pain‐related interference exhibited moderate correlations with JFLS‐8 and global OHIP scores (rs = 0.53–0.60). Moderate associations were also noted between JFLS‐8 and global OHIP, as well as most OHIP domains (rs = 0.42–0.64). Both jaw functional limitation and OHRQoL were predicted by sex, pain intensity and pain‐related interference. Conclusions: Sex, pain intensity and pain‐related interference are key determinants for both impaired jaw function and diminished OHRQoL, with pain‐related interference exerting a more pronounced effect. [ABSTRACT FROM AUTHOR]

Bone aging and decreased autophagic activity are related but poorly explored in the jawbone. This study aimed to characterize the aging jawbones and jawbone-derived stromal cells (JBSCs) and determine the role of autophagy in jawbone mass decline. We observed that the jawbones of older individuals and mice exhibited similar age-related bone loss. Furthermore, leptin receptor (LepR)–lineage cells served as the primary source for in vitro cultured and expanded JBSCs, referred to as LepR-Cre+/JBSCs. RNA-sequencing data from the jawbones and LepR-Cre+/JBSCs showed the upregulated expression of the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway during aging. Through single-cell transcriptomics, we identified a decrease in the proportion of osteogenic lineage cells and the activation of the PI3K/AKT pathway in LepR-lineage cells in aging bone tissues. Reduced basal autophagic activity, diminished autophagic flux, and decreased osteogenesis occurred in the jawbones and LepR-Cre+/JBSCs from older mice (O-mice; O-JBSCs). Pharmacologic and constitutive autophagy activation alleviated the impaired osteogenesis in O-JBSCs. In addition, the suppression of mTOR-induced autophagy improved the aging phenotype of O-JBSCs. The activation of autophagy in LepR-Cre+/JBSCs using chemical autophagic activators reduced the alveolar bone resorption in O-mice. Therefore, our study demonstrated that ATG molecules and pathways are crucial in jawbone aging, providing novel approaches to understanding age-related jawbone loss. [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]

Melibe japonica is a species of gastropod mollusc originally described as a large (up to 70 cm), translucent yellow-white nudibranch with a strong reddish tinge in parts. Subsequent studies reported that it has reddish tubercles all over its translucent pinkish body and cerata. However, it has recently been suggested that M. japonica is a synonym of Melibe viridis without any discussion or explanation. This study aims to show that M. japonica is a valid species. Due to the state of preservation of the type material of M. japonica, neither morphological nor genetic studies were possible, so a neotype for the species was provisionally designated. We provide a detailed description of its external morphology, internal anatomy and phylogenetic relationship, using fresh and preserved specimens collected in Japan. We also extend and update its geographic distribution. [ABSTRACT FROM AUTHOR]

Evidence concerning the osteotoxic effects of chemotherapy (doxorubicin) has been previously described. Periodontitis also progressively increases in patients receiving chemotherapy; however, the beneficial effects of melatonin and metformin on the alleviation of doxorubicin-induced osteotoxicity have never been investigated. Therefore, we investigated the negative impact of doxorubicin on alveolar bone homeostasis and the benefits of melatonin and metformin on the attenuation of doxorubicin-induced alveolar bone toxicity. Male Wistar rats were divided into 4 groups to receive either 1 mL of normal saline solution as a control group, 3 mg/kg of doxorubicin, 3 mg/kg of doxorubicin plus 10 mg/kg of melatonin, or 3 mg/kg of doxorubicin plus 250 mg/kg of metformin. Doxorubicin treatment was given on days 0, 4, 8, 15, 22, and 29, while interventions were given daily on days 0 to 29. Following euthanasia, blood and alveolar bones were collected for evaluation of oxidative stress, bone remodeling, inflammation, microarchitecture, and periodontal condition. We found that doxorubicin increased systemic oxidative stress, decreased antioxidative capacity, increased inflammation, decreased bone formation, increased bone reabsorption, impaired microarchitecture, and impaired periodontal condition of the alveolar bone. Although cotreatment with melatonin or metformin resulted in some improvement in these parameters, cotreatment with melatonin was more effective than cotreatment with metformin in terms of decreasing oxidative stress, reducing bone resorption, and improving microarchitecture and periodontal condition. All of these findings highlight the potential for antioxidants, especially melatonin, to ameliorate doxorubicin-induced alveolar bone toxicity. [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

Background: There is limited knowledge about the possible long‐term effects on jaw motor function after whiplash trauma. Objectives: The primary aim was to evaluate integrated jaw and head–neck movement amplitudes during jaw function in individuals 2 years after whiplash trauma, compared to controls. The secondary aim was to evaluate changes between the acute stage and a 2‐year follow‐up in terms of jaw and head–neck movement amplitudes during jaw function. Methods: This study included 28 cases exposed to a whiplash trauma 2 years earlier (13 women) and 28 controls (13 women) without previous neck trauma. Head and jaw movement amplitudes were recorded during maximal jaw opening–closing movements using an optoelectronic 3D recording system. For a subpopulation of 12 cases and 15 controls, recordings had also been performed in the acute stage after the whiplash trauma. Jaw and head movement amplitudes were analysed using linear regression with group and sex as independent variables. The subpopulation longitudinal analysis was adjusted for movement amplitudes at baseline. Results: Jaw movement amplitudes were significantly associated with group (coefficient: −0.359: 95% CI: −10.70 to −1.93, p =.006) with smaller amplitudes of jaw movements for whiplash cases. Head movement amplitudes were not associated with group (coefficient: −0.051, 95% CI: −4.81 to 3.20, p =.687). In the longitudinal analysis, both jaw and head movement amplitudes showed significant associations between baseline and the 2‐year follow‐up. Conclusion: The present findings indicate that the effects on jaw function in terms of jaw opening capacity in the acute stage after whiplash trauma do not spontaneously recover. [ABSTRACT FROM AUTHOR]

Maroteaux-Lamy syndrome (mucopolysaccharidoses VI) is a rare genetic disease results in functional deficiency of arylsulfatase B and accumulation of dermatan sulfate within lysosomes in various tissues. Here we present an 8-year-old male who was referred for treatment of limited mouth opening. The patient had been diagnosed with mucopolysaccharidoses VI at age of 6 months. He had received bone marrow transplantation at age of 3.5 years, developed graft-versus-host disease and subsequent vitiligo-like changes. The patient presented with short stature, and some skeletal anomalies. In radiographic images bilateral hyperplasia of the coronoid process, underdeveloped condyles, and dentigerous cyst-like follicles in the jaws were noted. Bilateral coronoidectomy was performed to improve the maximum opening of the mouth. Post-op follow-up examinations in 5 years showed moderate improvement. Abnormal coronoid and condylar processes are unusual in MPS VI. Proper management is needed to improve patients' oral and general health for the remainder of their lives. [ABSTRACT FROM AUTHOR]

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.

The regenerative ability of limb bones after injury decreases during aging, but whether a similar phenomenon occurs in jawbones and whether autophagy plays a role in this process remain unclear. Through retrospective analysis of clinical data and studies on a mouse model of jawbone defects, we confirmed the presence of delayed or impaired bone regeneration in the jawbones of old individuals and mice. Subsequently, osteoblasts (OBs) derived from mouse jawbones were isolated, showing reduced osteogenesis in senescent osteoblasts (S‐OBs). We observed a reduction in autophagy within both aged jawbones and S‐OBs. Additionally, pharmacological inhibition of autophagy in normal OBs (N‐OBs) led to cell aging and decreased osteogenesis, while autophagic activation reversed the aging phenotype of S‐OBs. The activator rapamycin (RAPA) increased the autophagy level and bone regeneration in aged jawbones. Finally, we found that fatty acid‐binding protein 3 (FABP3) was degraded by autolysosomes through its interaction with sequestosome 1 (P62/SQSTM1). Autophagy inhibition within senescent jawbones and S‐OBs led to the excessive accumulation of FABP3, and FABP3 knockdown partially rescued the decreased osteogenesis in S‐OBs and alleviated age‐related compromised jawbone regeneration. In summary, we confirmed that autophagy inhibition plays an important role in delaying bone regeneration in aging jawbones. Autophagic activation or FABP3 knockdown can partially rescue the osteogenesis of S‐OBs and the regeneration of aging jawbones, providing insight into jawbone aging. [ABSTRACT FROM AUTHOR]

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]

Copyright of China Journal of Oral & Maxillofacial Surgery is the property of Shanghai Jiao Tong University, College of Stomatology 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.)

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]

Premaxillary protrusion and the performance advantages it confers are implicated in the success of diverse lineages of teleost fishes, such as Cypriniformes and Acanthomorpha. Although premaxillary protrusion has evolved independently at least five times within bony fishes, much of the functional work investigating this kinesis relates to mechanisms found only in these two clades. Few studies have characterized feeding mechanisms in less‐diverse premaxilla‐protruding lineages and fewer yet have investigated the distinctive anatomy underlying jaw kinesis in these lineages. Here, we integrated dissection, clearing and staining, histology, micro‐CT, and high‐speed videography to investigate an isolated and independent origin of jaw protrusion in the hingemouth, Phractolaemus ansorgii, which employs a complex arrangement of bones, musculature, and connective tissues to feed on benthic detritus via a deployable proboscis. Our goals were to provide an integrative account of the underlying architecture of P. ansorgii's feeding apparatus and to assess the functional consequences of this drastic deviation from the more typical teleost condition. Phractolaemus ansorgii's cranial anatomy is distinct from all other fishes in that its adducted lower jaw is caudally oriented, and it possesses a mouth at the terminal end of an elongated, tube‐like proboscis that is unique in its lack of skeletal support from the oral jaws. Instead, its mouth is supported primarily by hyaline‐cell cartilage and other rigid connective tissues, and features highly flexible lips that are covered in rows of keratinous unculi. Concomitant changes to the adductor musculature likely allow for the flexibility to protrude the mouth dorsally and ventrally as observed during different feeding behaviors, while the intrinsic compliance of the lips allows for more effective scraping of irregular surfaces. From our feeding videos, we find that P. ansorgii is capable of modulating the distance of protrusion, with maximum anterior protrusion exceeding 30% of head length. This represents a previously undescribed example of extreme jaw protrusion on par with many acanthomorph species. Protrusion is much slower in P. ansorgii—reaching an average speed of 2.74 cm/s—compared to acanthomorphs feeding on elusive prey or even benthivorous cypriniforms. However, this reorganization of cranial anatomy may reflect a greater need for dexterity to forage more precisely in multiple directions and on a wide variety of surface textures. Although this highly modified mechanism may have limited versatility over evolutionary timescales, it has persisted in solitude within Gonorynchiformes, representing a novel functional solution for benthic feeding in tropical West African rivers. [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.)

Noonan syndrome (NS) is a phenotypically variable inherited multi-system disorder. Maxillofacial findings can be diagnostic, especially in the evaluation of discrete facial dysmorphia. Diagnostic landmark findings of therapeutic relevance for the jaws such as central giant cell granuloma (CGCG) are rare in NS. However, recent molecular genetic studies indicate that these rare, benign lesions are neoplasms and more common in specific syndromes grouped under the umbrella term RASopathies. A specialist surgical diagnosis can be helpful in identifying the underlying disease. This report outlines diagnosis and treatment of a case of CGCG for which jaw diagnosis became the key to identifying a syndromic disease. [ABSTRACT FROM AUTHOR]

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]

The enduring relationship between humans and domestic sheep has evolved over millennia, showcasing diverse uses such as meat, milk, wool, leather and fur, shaped by geographical, historical, cultural and social factors. The sheep breeds discussed include the Ivesi from Southeastern Anatolia, known for its varied animal products; the resilient Turcana breed of Romania; Kosovo's Bardoka, valued for its triple‐purpose characteristics; and Poland's Polish Mountain Sheep, uniquely utilized for milk production in cheese making. Sheep, with their enduring relationship with humans and significant economic importance, have attracted scientific interest in morphometric studies of their mandibles, yielding valuable data applicable across various fields including basic anatomy, veterinary clinical anatomy, zooarchaeology and veterinary forensic medicine. Traditional morphometric studies rely on statistical methods to compare length, depth and angular ratios between anatomical formations, often highlighting differences between specific points but not fully revealing shape variations between distinct groups. Geometric morphometric analysis has emerged as a preferred method in recent years, enabling shape analyses using coordinate data from various imaging techniques, facilitating a comprehensive examination of mandibular morphometrics among sheep breeds across different countries. This study involved four sheep breeds from different countries, namely İvesi from Turkey, Bardoka from Kosovo, Polish Mountain Sheep from Poland and Turcana from Romania, with a total of 70 mandibles sourced from various veterinary faculties. Mandibular photographs were meticulously captured, focusing on the right side of mandible pairs and placing landmarks and semi‐landmarks along the entire edge, enabling geometric morphometric analysis using tpsUtil, tpsDig2 and MorphoJ software. The analysis included principal component analysis, canonical variate analysis and discriminant function analysis for pairwise comparisons, facilitating a comprehensive examination of mandibular shape variations among the different sheep breeds. Using geometric morphometric methods, this study analysed mandibles from four distinct sheep breeds sourced from different countries, revealing notable variations in regions such as the ramus mandibula, angulus mandibula and incisive areas, attributed to genetic, geographical and dietary influences, highlighting the importance of continued research to better comprehend these shape differences. [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]

Medication-related osteonecrosis of the jaws (MRONJ) is a severe reaction consisting of progressive destruction of maxillofacial bone tissue caused mainly by antiresorptive and antiangiogenic drugs. The aim of this scoping review is to identify biomarkers that can predict the development of MRONJ in patients undergoing dental treatment. A scoping review was performed, using PubMed/MEDLINE, Web of Science and Scopus databases using the search formula with MesH terms: "((((("Bisphosphonate-Associated Osteonecrosis of the Jaw"[Mesh]) OR "Osteonecrosis"[Mesh]) AND "Maxilla"[Mesh]) OR "Mandible"[Mesh]) AND "Oral Surgical Procedures"[Mesh]) OR "Surgery, Oral"[Mesh]". Inclusion and exclusion criteria were applied for article selection. We found 113 articles and screened 80 publications. After, 30 manuscripts remained for full-text evaluation. Twenty were discarded for not being related to the proposed objectives, leaving 9 articles included for qualitative analysis. Several biomarkers considered as possible predictors of MRONJ development were found: bone alkaline phosphatase (BAP), parathyroid hormone (PTH), osteocalcin (OC), procollagen type 1 amino terminal propeptide (P1NP), N-terminal telopeptide of collagen type I (NTX), interleukin 6 (IL-6), deoxypyridinoline (DPD), 25 hydroxyvitamin D (25OHD), creatinine and total calcium, white blood cells (WBC), serum albumin (ALB), hemoglobin (HB), total cholesterol (CHL), C-reactive protein (CRP) and serum alkaline phosphatase (ALP). The most evaluated was C-terminal telopeptide of collagen type I (CTX). The use of predictive biomarkers would represent, for the population consuming drugs associated with osteonecrosis of the jaws, an advance and improvement in the planning of appropriate treatments and in their quality of life. Currently, it has not yet been possible to establish one or more specific biomarkers capable of predicting the development of MRONJ. [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]

Background: During the COVID‐19 pandemic, many individuals sought healthcare virtually. Physiotherapy is integral in managing temporomandibular disorders (TMDs); therefore, establishing how key physical tests can be appropriately adapted to telehealth is paramount. Objectives: To establish the validity and reliability of telehealth (specifically videoconferencing) assessments against in‐person assessments on a battery of TMD physical tests. Method: A repeated‐measures study design was undertaken. Thirty‐six adult participants (19 healthy and 17 TMD) underwent concurrent temporomandibular joint (TMJ) physiological movement measurements via videoconferencing and in‐person as per standard clinical practice. Inclusion criteria included the presence of central incisors and no significant comorbidities precluding a safe telehealth examination. Participants with TMD completed seven additional pain provocation physical tests. Results: Agreement between telehealth and in‐person physiological movement measures was excellent (ICC >0.90, 95% CI: 0.53 to >0.99). Inter‐ and intra‐rater reliability for telehealth measures indicated excellent reliability (ICC >0.97, 95% CI: 0.91 to >0.99). Exact agreement between telehealth and in‐person for provocation tests ranged between 58.8% and 94.1%. Fourteen of the twenty‐six individual measures produced substantial to near perfect agreement (PABAK = 0.65–0.88), seven produced moderate agreement (PABAK = 0.53), while five produced poor to fair agreement (PABAK = 0.18–0.29). Conclusion: There is high level of agreement between telehealth and in‐person measurements of TMJ physiological movement and pain provocation tests. [ABSTRACT FROM AUTHOR]