Comparison of 4 sinus augmentation techniques for implant placement with residual alveolar bone height ≤3 mm.

This study compared implant outcomes following maxillary sinus floor augmentation (MSFA) in edentulous patients with a residual alveolar bone height ≤3 mm. Four techniques were evaluated: 1-stage bone-added osteotome sinus floor elevation procedure (BAOSFE) with simultaneous implant placement; 2-stage BAOSFE with delayed implant placement; 1-stage lateral window sinus floor elevation with simultaneous implant placement; and 2-stage lateral window sinus floor elevation with delayed implant placement. Patients were followed for 18 to 72 months (mean: 52.5 months) after prosthesis placement. Data were analyzed with cone-beam computed tomography. A total of 96 implants from 71 patients were analyzed; pretreatment, there were no significant differences between patients. Total implant survival was 98.9%. The mean residual bone height was significantly higher in the 1-stage BAOSFE group than the other groups (P < .01); 1 implant in this group failed at 3 months. There was no significant difference in total bone height gain between groups. However, the bone height gain of 1st sinus lifting with 2-stage BAOSFE was significantly lower than the 2-stage lateral window procedure (P < .01). There was no prosthesis failure. The favorable implant outcomes suggest these 1-stage and 2-stage MSFA procedures should be considered as alternative treatment options for patients with extremely atrophic posterior maxilla.

Strontium ranelate treatment in a postmenopausal woman with osteonecrosis of the jaw after long-term oral bisphosphonate administration: a case report.

Bisphosphonates (BPs) suppress bone resorption and increase bone strength, thus reducing the risk of fracture. Oral BPs are widely used for the prevention and treatment of osteoporosis and osteopenia. Here, we describe the case of a postmenopausal woman who took oral alendronate for >3 years for osteoporosis. The patient presented at the clinic with sharp jaw pain and swelling on the left mandible 4 months after extraction of the third molar. Clinical examinations identified an inflamed mucosal opening with pus over an area of necrotic bone. Initial images of cone beam computed tomography revealed a sequestrum at the extracted socket. The condition did not improve after 1 week of antibiotic treatment; therefore, the alendronate treatment was terminated and the patient was prescribed strontium ranelate instead. The patient gradually recovered and, at the 2-year follow-up, the site of BP-related osteonecrosis of the jaw healed completely as determined by both clinical and cone beam computed tomography measures. The bone mineral densities in the femoral neck and lumbar spine improved after 1 year, and were maintained at the 3-year follow-up. The serum C-terminal cross-linking telopeptide values also gradually increased from the initial 130 pg/mL to 320 pg/mL at the 3-year follow-up. Taken together, this case supports the use of strontium ranelate as an alternative treatment for postmenopausal women who receive long-term oral BP treatments and are at risk for serious complications of BP-related osteonecrosis of the jaw.

Evaluation of the Mandibular Lingual Canal and Anterior Loop Length to Minimize Complications Associated With Anterior Mandibular Surgeries: A Cone-Beam Computed Tomography Study.

PURPOSE: This retrospective study evaluated the localization, incidence, and dimensions of the mandibular lingual canal and the anterior loop in the Taiwanese population using the simulation and visual interpretation of cone-beam computed tomography to minimize complications during symphysis block surgical procedures. MATERIALS AND METHODS: The sample population consisted of 215 patients (105 men and 110 women; mean age, 57 yr). The median lingual canal, symphysis bone thickness, and anterior loop length were defined and calculated using cone-beam computed tomography and 3-dimensional reconstructed images. The correlation of all data for men and women was assessed and analyzed statistically using unpaired t tests. RESULTS: All patients exhibited at least 1 median lingual canal in the symphysis, and the diameter of the main branch ranged from 0.21 to 1.48 mm (mean, 0.85 mm), with relevant differences between genders (longer in men than in women). A harvesting depth of 4 mm for the distance from the buccal bone to the terminal end of the median lingual canal resulted in a risk of neurovascular injury (13.0%); this risk was notably higher in women (19.1%) than in men (6.7%). The right and left anterior loop lengths ranged from 0 to 5.46 mm (mean, 2.60 mm) and from 0 to 5.57 mm (mean, 2.61 mm), respectively, with no relevant differences between genders or sides. CONCLUSIONS: The results suggest that routine cone-beam computed tomographic examinations before surgical interventions in the symphysis region are necessary because of the numerous complicated anatomic variations.

Surgical intervention of mucosal fenestration in a maxillary premolar: a case report.

Labial mucosal fenestration of the root apex is an uncommon occurrence. An unusual case involving a maxillary right first premolar is described. When presented, the tooth was nonvital with the buccal root apex readily seen through a soft tissue and bone fenestration. Conventional endodontic treatment with gutta percha failed to resolve the problem. Periodontal surgery with a laterally positioned pedicle flap was thus scheduled. At the 1-month recall, complete healing was evident in the surgical site, and the fenestrated area of the maxillary right first premolar was filled with healthy mucosal tissue. One-year postoperatively, the mucosa remained covered, and there was radiographic evidence of bone infilling in the periapical region.