Epidemiology, etiopathogenesis, and management of MRONJ: A European multicenter study.

INTRODUCTION: The purpose of this European multicenter study was to describe the general characteristics and risk factors of MRONJ lesions as well as their clinical diagnosis and management at different European Oral and Maxillofacial Surgery centers, in order to minimize selections biases and provide information about the epidemiology, etiopathogenesis, and the current trends in the treatment of MRONJ across Europe. MATERIALS AND METHODS: The following data were registered for each patient: gender; age at MRONJ diagnosis; past medical history; indication for antiresorptive or antiangiogenic therapy; type of antiresorptive medication; local risk factor for MRONJ; MRONJ Stage; anatomic location and symptoms; treatment; surgical complications; recurrence. RESULTS: A total of 537 patients (375 females, 162 males) with MRONJ were included. Statistically significant associations were found between patients with metastatic bone disease and recurrences (P < 0.0005) and between advanced MRONJ stages (stages 2 and 3) and recurrences (P < 0.005). Statistically significant associations were also found between male gender and recurrences (P < 0.05), and between MRONJ maxillary sites and recurrences (P < 0.0000005). CONCLUSIONS: A longer mean duration of antiresorptive medications before MRONJ onset was observed in patients affected by osteoporosis, whereas a shorter mean duration was observed in all metastatic bone cancer patients, and in particular in those affected by prostate cancer with bone metastases or multiple myeloma. Surgery plays an important role for the management of MRONJ lesions.

Risk of dentoalveolar surgery postoperative bleeding in patients taking direct oral anticoagulants and vitamin K antagonists: A prospective observational study.

The aim of this study was to evaluate whether direct oral anticoagulants (DOAC) and vitamin K antagonists (VKA) increase the risk of postoperative bleeding after dentoalveolar surgery. Patients were classified into two groups: one taking DOAC and the other taking VKA with a therapeutic INR range. The control group comprised non-anticoagulated subjects. Participants were matched regarding dentoalveolar procedure. The primary predictor was anticoagulant status. The primary outcome was postoperative bleeding. The DOAC group comprised 77 patients, while the VKA group and control group each consisted of 103 participants. In each group, 103 dentoalveolar surgical procedures were conducted. Postoperative bleeding was recorded in 3/103 (2.9%), 5/103 (4.8%), and 1/103 (0.97%) occasions in the DOAC, VKA, and control groups, respectively, without significant difference (χ2; p = 0.54). The fully adjusted odds ratio for postoperative bleeding was 0.14 (CI 0.01-1.61; p = 0.05) for patients taking DOAC and 0.19 (CI 0.02-1.65; p = 0.285) for those taking VKA compared with non-anticoagulated controls. In conclusion, there was no increase in risk for clinically significant postoperative bleeding after dentoalveolar surgery in patients taking DOAC or VKA compared with non-anticoagulated subjects. Dentoalveolar surgery in patients taking DOAC and VKA can be performed safely without therapy cessation. The study was registered at Clinicaltrials.gov (NCT04505475).

Pathological tumor volume as a simple quantitative predictive factor of survival in oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is the eighth most common type of cancer in the world. Knowledge of prognostic factors of survival in OSCC is key. Several clinical and pathological prognostic factors have been investigated to develop a prognostic model of survival for patients with oral cancer. The present study focused on the association between pathological tumor volume (PTV) and overall survival time in patients with OSCC, regardless of cervical nodal status. The present study was a prospective study and covered 65 consecutive patients who received surgical treatment for oral cancer. The PTV was calculated according to dimensions of the postoperative specimen. Other pathological parameters as perineural and perivascular tumor spreading and extra-nodular propagation were also determined. The data were analyzed using the IBM SPSS 25.0 software. Cox PH regression model was built to analyze association between the PTV and survival time. Survival time was defined as the period from surgery to a target event or last contact. The results of the present study showed that PTV >4.24 cm3 was significantly associated with shorter overall survival time in patients with OSCC. The PTV value was higher in patients with metastasis and in patients with higher pathological tumor and node stage. In conclusion, PTV was an important pathological prognostic factor for survival in patients with OSCC.

Evaluation of Lipid Peroxidation in the Saliva of Diabetes Mellitus Type 2 Patients with Periodontal Disease.

As oxidative stress has been implicated in the pathogenesis of diabetes mellitus and periodontitis, it may serve as a link between these conditions. Therefore, as a part of the present study, salivary lipid peroxidation (LP) in periodontitis patients with and without diabetes mellitus type 2 (DM2) was evaluated, along with the periodontal therapy effectiveness. The study sample comprised of 71 DM2 patients with periodontitis and 31 systemically healthy controls suffering from periodontitis of comparable severity. In all participants, periodontal indices­plaque index (PI), gingival index (GI), papilla bleeding index (PBI), probing pocket depth (PPD), and clinical attachment level (CAL)­were recorded, and salivary LP was measured using a spectrophotometric method prior to treatment initiation and three months post-treatment. At baseline, mean salivary LP in DM2 patients was higher than that measured for the control group, but the difference did not reach statistical significance (p > 0.05), whereas a positive significant correlation was found between PPD and LP in both groups. Three months after nonsurgical periodontal therapy, clinical periodontal parameters and salivary LP levels were significantly reduced in both groups (p < 0.05). These findings indicate that the improvement in clinical periodontal status following nonsurgical periodontal therapy is accompanied by a significant decrease in salivary LP in DM2 patients, suggesting that periodontitis, rather than diabetes, is the primary driver of the elevated salivary LP in this group.

Synthesis, chemical characterization, PARP inhibition, DNA binding and cellular uptake of novel ruthenium(II)-arene complexes bearing benzamide derivatives in human breast cancer cells.

Inhibitors of poly(ADP-ribose) polymerase-1 (PARP-1) showed remarkable clinical efficacy in BRCA-mutated tumors. Based on the rational drug design, derivatives of PARP inhibitor 3-aminobenzamide (3-AB), 2-amino-4-methylbenzamide (L1) and 3-amino-N-methylbenzamide (L2), were coordinated to the ruthenium(II) ion, to form potential drugs affecting DNA and inhibiting PARP enzyme. The four conjugated complexes of formula: C1 [(ƞ6-toluene)Ru(L1)Cl]PF6, C2 [(ƞ6-p-cymene)Ru(L1)Cl]PF6, C3 [(ƞ6-toluene)Ru(L2)Cl2] and C4 [(ƞ6-p-cymene)Ru(L2)Cl2], have been synthesized and characterized. Colorimetric 3-(4.5-dimethylthiazol-2-yl)-2.5-diphenyltetrazolium bromide (MTT) assay showed the highest antiproliferative activity of C1 in HCC1937, MDA-MB-231, and MCF-7 breast cancer cells. Efficiency of inhibition of PARP-1 enzymatic activity in vitro decreased in order: C2 > C4 > 3-AB>C1 > C3. ICP-MS study of intracellular accumulation and distribution in BRCA1-mutated HCC1937 revealed that C1-C4 entered cells within 24 h. The complex C1 showed the highest intracellular accumulation, nuclear-targeting properties, and exhibited the highest DNA binding (39.2 ±â€¯0.6 pg of Ru per µg of DNA) that resulted in the cell cycle arrest in the S phase.

Application of modern computer-aided technologies in the production of individual bone graft: A case report.

INTRODUCTION: An autologous bone (bone derived from the patient himself) is considered to be a "golden standard" in the treatment of bone defects and partial atrophic alveolar ridge. However, large defects and bone losses are difficult to restore in this manner, because extraction of large amounts of autologous tissue can cause donor-site problems. Alternatively, data from computed tomographic (CT) scan can be used to shape a precise 3D homologous bone block using a computer-aided design-computer-aided manufacturing (CAD-CAM) system. CASE REPORT: A 63-year old male patient referred to the Clinic of Dentistry of Vojvodina in Novi Sad, because of teeth loss in the right lateral region of the lower jaw. Clinical examination revealed a pronounced resorption of the residual ridge of the lower jaw in the aforementioned region, both horizontal and vertical. After clinical examination, the patient was referred for 3D cone beam (CB)CT scan that enables visualization of bony structures and accurate measurement of dimensions of the residual alveolar ridge. Considering the large extent of bone resorption, the required ridge augmentation was more than 3 mm in height and 2 mm in width along the length of some 2 cm, thus the use of granular material was excluded. After consulting prosthodontists and engineers from the Faculty of Technical Sciences in Novi Sad we decided to fabricate an individual (custom) bovine-derived bone graft designed according to the obtained-3D CBCT scan. CONCLUSION: Application of 3D CBCT images, computer-aided systems and software in manufacturing custom bone grafts represents the most recent method of guided bone regeneration. This method substantially reduces time of recovery and carries minimum risk of postoperative complications, yet the results fully satisfy the requirements of both the patient and the therapist.

Application of fibrin rich blocks with concentrated growth factors in pre-implant augmentation procedures.

INTRODUCTION: Growth factors are mediators regulating the key processes of tissue regeneration, including cell proliferation and differentiation, extracellular matrix synthesis, chemotaxis and angiogenesis. In addition to the role they play in haemostasis and inflammatory processes, thrombocytes are of major importance in the reparation of mineralized and soft tissues. Application of fibrin rich blocks with concentrated growth factors is one of the latest approaches to guided bone regeneration and augmentation of lost bony structures of the alveolar ridge. CASE REPORT: This paper presents a case of a female patient who underwent reconstruction of the defect of residual alveolar ridge of the upper jaw by applying fibrin rich blocks with concentrated growth factors and subsequent placement of two titanium endosteal implants five months after wound healing. CONCLUSION: The loss of a single tooth or several teeth sometimes entails the augmentation of lost bony structures in order to provide optimal conditions for dental implant placement and subsequent prosthetic rehabilitation. A range of contemporary surgical procedures and a variety of dental materials for reconstruction of bony defects of the upper and lower jaws are available nowadays. The method described in this paper, i.e. the application of concentrated growth factors is one of the latest approaches which poses no risk of transmissible and allergic diseases and is at the same time cost effective.

Comparison of efficacy of local hemostatic modalities in anticoagulated patients undergoing tooth extractions.

BACKGROUND/AIM: Patients receiving long-term oral anticoagulant therapy pose a clinical challenge during invasive dental procedures. The goal of this study was to compare different local hemostatic modalities after tooth extraction in patients receiving chronic Vitamin-K antagonist therapy. METHODS: Totally 90 patients with International Normalized Ratio (INR) ≤ 3.0 requiring simple extraction of one or two teeth were randomized into three groups, 30 patients in each group. The patients with the mean INR value of 2.35 ± 0.37, in whom extraction wound was sutured comprised the group A. In the group B with the mean INR of 2.43 ± 0.4, local hemostasis was achieved by placing absorbable gelatin sponges into the wound without suturing. The group C consisted of the patients with the mean INR of 2.36 ± 0.34 in whom neither gelatin sponge nor suturing were used for providing local hemostasis. Bleeding was registered as an event if other than initial hemostatic measure was needed or additional oral surgeon intervention required. RESULTS: The obtainded results show that 1 (3.3%) patient in the group A, 2 (6.7%) patients in the groups B and C manifested post-extraction bleeding. All cases of hemorrhage were easily solved with local hemostatic measures and all, except one case, were registered in the first two hours after the procedure until the dismissal. A difference between the groups was not statistically significant (χ2 = .42, p > 0.05). CONCLUSION: In therapeutically anticoagulated patients tooth extractions can be safely performed without altering the dose of anticoagulant medication if efficient local hemostasis is provided. In most cases; in patients with INR ≤ 3.0 after extraction of one or two teeth postoperative bleeding can be controlled with local pressure, without any additional local hemostatic measures.

[Stabilisation of lower denture using mini dental implants].

UNLABELLED: INTRODUCTION. The role of the total lower denture is not only to replace the missing teeth but also to provide the substitute for a range of supporting tissues which have diminished due to the process of resorption, to re-establish the original relations in the region ofjaw complex, to support the surrounding soft tissues which have lost their natural support, and, moreover, to be unobtrusive and discrete substitution of lost functions. Application of Mini-dental Implants. If anatomical conditions are unfavorable, there is a wide range of oral-surgical pre-prosthetic procedures which can be performed on both soft tissues and bone structures (vestibuloplasty, alveolar ridge augmentation...) in order to enable proper fabrication of the total lower denture to some extent. Having in mind the old age of the patients, the majority of who suffer from chronic diseases such as diabetes mellitus, cardiovascular problems, systemic diseases etc., these procedures should be avoided because of the extent of the procedure, possible systemic complications and prolonged therapy period. CONCLUSION: Most recently, the application of titanium endosteal mini implants have proved to be one of good solutions in overcoming unfavorable anatomical conditions resulting in stability and retention of total lower dentures.

Comparative analysis of accuracy of diagnosis of chronic periapical lesions made by clinical and histopatological examination.

INTRODUCTION: The preliminary diagnosis of chronic periapical lesions is made on the basis of clinical symptoms and radiographs, which is a reliable diagnostic tool, but it has only a subsidiary role since histopathological verification is essential for the definitive diagnosis. This study was aimed at diagnosing removed chronic periapical lesions and classifying them by size as well as at comparing the clinical diagnoses with histipathological results. MATERIAL AND METHODS: The study included 34 patients diagnosed with chronic periapical process by applying clinical examination and radiography. The removed chronic periapical lesions were processed according to classical histological technique and analyzed by hematoxylin and eosin staining protocol. RESULTS: According to histopathological analysis 53% of chronic periapical lesions were periapical granulomas and 47% were radicular cysts. The size of the lesions ranged from <9 mm (70% of lesions), 9 to 20 mm (18% of lesions) and >20 mm (12% of lesions).The histopathological examination revealed that clinical diagnosis was wrong in 26% of cases. CONCLUSION: A statistically significant difference between clinical and histopathological diagnosis has been found. The histopathological findings strongly suggest the necessity of complete curettage of lesions sizing >20 mm in order to prevent recurrences.

[Orthodontic-surgical therapy of retained upper canine].

INTRODUCTION: Therapy of impacted teeth is undoubtedly one of the most intriguing issues for the experts in the field of dentistry. General dental practitioners, as well as specialists in the field of pediatric dentistry, periodontology, orthodontics and particularly oral and maxillofacial surgery have been facing this challenge throughout past several years. Each of these experts can contribute to solving this problem; however, each of them alone can solve only a limited number of cases. DISCUSSION AND CONCLUSION: Since recently, the fate of impacted tooth has been determined mainly by the competence, experience and skill of the orthodontist to apply light traction in an appropriate direction once the tooth has been made surgically exposed. Oral surgeon and orthodontist should share the responsibility for a patient with impaction as they together have the necessary skill and competence required for an effective therapy. In addition, dental age of the child is to be taken into consideration, as well as his/her overall health status and potential interference with other anomalies of dental arch.