Purpose Osteonecrosis of the jaw (ONJ) is a devastating side effect of long-term bisphosphonate (BP) use. We present the largest case series from a single department. Materials and Methods This case ...series included 101 ONJ patients. Data on demographics, medical background, type and duration of BP use, possible triggering events, mode of therapy, and outcome were recorded. Results ONJ was associated with intravenous BPs in 85 patients and with oral BPs in 16 patients. It was diagnosed after 48, 27, and 67 months of pamidronate, zoledronic acid, and alendronate use, respectively. Long-term antibiotics and minimal surgical procedures resulted in complete or partial healing in 18% and 52% of the patients, respectively; 30% had no response. There was no association between ONJ and diabetes, steroid and antiangiogenic treatment, or underlying periodontal disease. Diagnostic biopsies aggravated lesions without being informative about pathogenesis. A conservative regimen is our treatment of choice. Conclusion Solutions for decreasing morbidity and poor outcome of ONJ remain elusive.
Purpose Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-documented devastating side effect of long-term bisphosphonate (BP) use. There is scarce information in the literature on ...BRONJ associated with dental implants (DIs). The purpose of this study was to present a large series of cases of this association. Patients and Methods The files of all patients with BRONJ associated with DIs who were treated in the department of oral and maxillofacial surgery from 2003 to 2009 were reviewed. Data on demographics, medical background, type, and duration of BP treatment before the development of BRONJ, mode of therapy, and therapeutic outcome were retrieved. Results Of the 27 patients enrolled into the study, 11 (41%) developed BRONJ while taking oral BPs and 16 (59%) developed BRONJ associated with intravenous BPs. BRONJ developed after mean periods of 68 months (median, 60), 16.4 months (median, 13), and 50.2 months (median, 35) in patients on alendronate, zoledronic acid, and pamidronate, respectively. Only 6 patients developed BRONJ during the first 6 months after DI placement. When BP treatment had been started before DI placement, there was a mean duration of 16.2 months (median, 11) until the appearance of BRONJ development. Long-term antibiotics and only essential surgical procedures comprised the treatment of choice, and the response rate was considerably better for patients taking the oral type of BPs. There was no significant association between BRONJ and diabetes, steroid intake, or smoking habits. Conclusion Patients undergoing BP treatment and who receive DIs require a prolonged follow-up period to detect any development of BRONJ associated with DIs.
Purpose Osteonecrosis of the jaw is a well-documented side effect of bisphosphonate (BP) use. Attempts have recently been made to predict the development of bisphosphonate-related osteonecrosis of ...the jaw (BRONJ). We prospectively investigated the predictive value of serum levels of C-terminal telopeptide of collagen I (CTX), bone-specific alkaline phosphatase, and parathyroid hormone for the development of BRONJ. Patients and Methods Data on the demographics, comorbidities, and BP treatment were collected from 78 patients scheduled for dentoalveolar surgery. Of the 78 patients, 51 had been treated with oral BPs and 27 had been treated with frequent intravenous infusions of BPs. Blood samples for CTX, bone-specific alkaline phosphatase, and parathyroid hormone measurements were taken preoperatively. Surgery was performed conservatively, and antibiotic medications were prescribed for 7 days. Results Of the 78 patients, 4 patients taking oral BPs (7.8%) and 14 receiving intravenous BPs (51.8%) developed BRONJ. A CTX level less than 150 pg/mL was significantly associated with BRONJ development, with an increased odds ratio of 5.268 ( P = .004). The bone-specific alkaline phosphatase levels were significantly lower in patients taking oral BPs who developed BRONJ. The parathyroid hormone levels were similar in patients who did and did not develop BRONJ. Conclusion The incidence of BRONJ after oral surgery involving bone is greater among patients receiving frequent, intravenous infusions of BPs than among patients taking oral BPs. Although the measurement of serum levels of CTX is not a definitive predictor of the development of BRONJ, it might have an important role in the risk assessment before oral surgery.
Purpose This study evaluated the efficacy of a standardized arthroscopic lysis and lavage in decreasing the intermittent locking and transient pain episodes that characterize patients with early- to ...intermediate-stage internal derangement (Wilkes stage II). Patients and Methods This is a retrospective analysis of the medical records of 27 patients (39 joints) treated by arthroscopic lysis and lavage in the authors' department during a 2.5-year period. Patients were diagnosed preoperatively as having mild internal derangement (Wilkes stage II) that was unresponsive to previous conservative therapy. Three outcome variables were used to assess the efficacy of treatment: 1) frequency of intermittent locking or catching episodes, 2) severity of pain, and 3) maximal interincisal opening. Results Ninety-two percent of patients reported improvement regarding the locking and catching episodes. Most patients (77%) denied experiencing any locking episodes during the follow-up period, and 15% reported experiencing locking episodes but with less frequency or severity. The median duration of symptoms for patients who were freed from locking episodes was 16 months compared with 36 months for patients who still had locking episodes after treatment ( P = .059). Mean pain values (visual analog scale, 0 to 10) decreased from 7.5 preoperatively to 3.2 postoperatively ( P < .0001). For maximal interincisal opening, there was no significant difference after treatment (mean, 39.4 mm preoperatively vs 41.3 mm postoperatively; P = .06). Success was defined as a decrease in locking episodes, a decrease of pain, and maintenance of normal interincisal opening (>36 mm). The overall success rate was 81.4% (22 of 27 patients). Conclusion Arthroscopic lysis and lavage is an efficient treatment modality for treating mild internal derangement of the temporomandibular joint. It decreases the frequency of locking episodes and decreases transient pain periods.
Objective To investigate the prevalence of clinical, radiographic, and histopathologic characteristics of combined central giant cell granuloma (CGCG) and central ossifying fibroma (COF). Study ...design Retrospective clinical and histomorphometric analysis of all cases diagnosed as CGCG or COF between 1994 and 2002. Results A total of 51 cases were included in the study: CGCG (n = 23), COF (n = 25), and combined COF-CGCG (n = 3). All 3 lesions presented expansile, well-defined unilocular radiolucencies, with radiopacities (66%), root resorption (66%) and tooth displacement (33%). Microscopically, areas of classical CGCG and COF were separated by a transition zone of nonvascularized densely packed spindle cells. Surgical procedure resulted in recurrence within 1 year in 1 of 2 patients, calcitonin nasal spray treatment resulted in growth arrest in 1 case. Conclusions Because of the small number of the combined cases, the biologic behavior of the lesions is uncertain. The CGCG component may drive the clinical behavior toward a more aggressive behavior than classical COF; therefore, close follow-up is recommended.
