Reliability of early stage symptoms/clinical findings of osteonecrosis of the jaw: Japanese Osteoporosis Intervention Trial-05 (JOINT-05).

INTRODUCTION: To investigate the differences in the incidence rates of suspected stage 0/1 osteonecrosis of the jaw (ONJ) and incidence risk of relevant clinical findings of suspected stage 0 ONJ between patients treated with sequential therapy comprising weekly teriparatide for 72 weeks followed by alendronate for 48 weeks vs. those who received monotherapy with alendronate for 120 weeks. MATERIALS AND METHODS: Suspected stage 0/1 ONJ was defined by non-specific symptoms. Tooth mobility and periodontal symptoms (gingival bleeding, swelling, and/or pain) were selected as clinical findings of suspected stage 0 ONJ. Poisson regression models were applied to calculate the incidence rate ratios of suspected stage 0/1 between the teriparatide group (TG) and alendronate group (AG). Generalized linear models were used to calculate the risk ratios of clinical findings between groups. RESULTS: Two hundred and sixty-one participants in the TG and 344 in the AG answered a structured questionnaire on oral health and were included in this study. There were no significant differences between the groups in the incidence rate of suspected stage 0/1 ONJ at both 72 and 120 weeks. The risk ratio of the TG to AG for tooth mobility was 0.34 (95% confidence interval [CI] 0.13-0.88, p = 0.02) at 72 weeks and 0.90 (95% CI 0.40-2.03, p = 0.83) at 120 weeks. The incidence rate of tooth mobility related to periodontal symptoms decreased in the TG and increased in the AG during the study. CONCLUSION: Tooth mobility accompanied by clinical periodontal symptoms may be a useful early sign of stage 0 ONJ.

Effect of posterior implant restorations on adjacent teeth and tissues: A case-control study.

INTRODUCTION: Dental implants are an artificial substitute for extracted or missing teeth in the oral cavity and are valuable for improving dental health and quality of life. While many studies on implants can be found, few studies examine their effects on adjacent teeth and tissues. The study aimed to examine complications of teeth adjacent to dental implants in the posterior region. METHODS: In this retrospective case-control study, clinical data of patients treated with implants in the posterior segment were extracted from the medical records in a single community dental clinic between January 9, 2010 and January 9, 2020. The patients were examined clinically and radiographically every 6 months. Data on the adjacent teeth to the dental implants were collected and divided into two groups, complications ("study group") versus no-complications ("control group"). Multivariate logistic regression analysis was performed to find a possible correlation between the complications and the variables checked, followed by checking specific variables in the complication group. RESULTS: A total of 1072 patients were included in the study. There were 179 patients (16.7%) with complications in adjacent teeth, while 893 patients had no documented complications. Predisposing factors for secondary caries were smoking (OR = 2.2, CI = 1.3-3.8) and a higher number of implants (OR = 1.6, CI = 1.1-2.5). Tooth crack and tooth fracture were analyzed together and found to be related to osteoporosis (OR = 8.9, CI = 2.9-27.6), whereas males were more prone to teeth fracture (OR = 2.8, CI = 1.1-7.4). Tooth mobility was related to a higher number of implants (OR = 16.5, CI = 3.7-73.8). Further analyzing the complication group solely, there was a statistical significance for age in primary caries and tooth mobility (p = 0.045). In addition, a higher number of implants was more prevalent with tooth mobility (p = 0.002), wider implant platform was more significant with primary caries (p = 0.012), and periodontal Stage III was more prone to tooth mobility (p < 0.001). The distance between the implant and adjacent tooth was also statistically significant-close proximity with tooth mobility and high distance with dental caries (p = 0.04). CONCLUSIONS: We found a relatively high rate of complications in teeth adjacent to dental implants. Secondary caries was the most common complication. Good understanding and proper position of the implants is essential to avoid adjacent teeth complications.

Effect of nicotine exposure on the rate of orthodontic tooth movement: A meta-analysis based on animal studies.

BACKGROUND: Nicotine exposure has been reported to modify bone cell function and the osseous metabolism with potential effects on the rate of orthodontic tooth movement. OBJECTIVES: To systematically investigate and quantitively synthesize the most recent available evidence from animal studies regarding the effect of nicotine exposure on the rate of orthodontic tooth movement. SEARCH METHODS: Unrestricted searches in 7 databases and hand searching were performed until July 2020 (PubMed, Central, Cochrane Database of Systematic Reviews, SCOPUS, Web of Science, Arab World Research Source, ProQuest Dissertations and Theses Global). SELECTION CRITERIA: We searched for controlled studies on healthy animals investigating the effect of nicotine on the rate of orthodontic tooth movement. DATA COLLECTION AND ANALYSIS: Following study retrieval and selection, relevant data was extracted and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. Exploratory synthesis and meta-regression were carried out using the random effects model. RESULTS: From the initially identified records, 5 articles meeting the inclusion criteria were selected and no specific concerns regarding bias were identified. Quantitative data synthesis showed that the rate of orthodontic tooth movement in the nicotine exposed rats was higher than in the control group animals (2 weeks of force application; 0.317 mm more movement in nicotine exposed rats; 95% Confidence Interval: 0.179-0.454; p = 0.000). No effect of the concentration or the duration force application was demonstrated following exploratory meta-regression. CONCLUSION: Rats administered with nicotine showed accelerated rates of orthodontic tooth movement. Although, information from animal studies cannot be fully translated to human clinical scenarios, safe practice would suggest that the orthodontist should be able to identify patients exposed to nicotine and consider the possible implications for everyday clinical practice.

[Clinical reasoning of impact of contemporary partial dentures constructions on the condition of periodontal tissues of patients with generalized periodontitis of I-II severity].

The aim of the study was the evaluation of the effectiveness of using partial dentures made of thermoplastic materials for patients with generalized periodontitis of I-II degree of severity based on the results of clinical research. The effect of partial dentures made of acrylic, metal and thermoplastic materials with and without splinting elements of fixation on the state of periodontal tissues in patients with generalized periodontitis was studied. The results of clinical studies of patients periodontal tissues condition ,who have had dental defects on the background I-II severity of GP using partial splinting elements of fixation showed a significant improvement in oral hygiene, positive change in activity indicators current of generalized periodontitis. The group of patients for whom were made orthopedic constructions of thermoplastic masses, noticed reducing of the depth of periodontal pockets, tooth mobility, bleeding and inflammation of the interdental papillae and the gingival margin.

Gingival overgrowth in partially edentulous ridges in an elderly female patient with epilepsy: a case report.

BACKGROUND: Drug-influenced gingival overgrowth is an unaesthetic overgrowth of gingiva principally associated with intake of drugs like phenytoin, cyclosporin A and nifedipine. Its occurrence in both dentate and edentulous regions of oral cavity is poorly understood. OBJECTIVES: This report highlights clinical and histological description, aetiology and management of gingival overgrowth in a partially edentulous (non-denture wearer) 60-year-old female patient with epilepsy on phenytoin and phenobarbital drugs from past 7 years. MATERIALS AND METHODS: Patient's intraoral examination revealed lobulated and fibrotic consistency gingival overgrowth around teeth and on partially edentulous ridges of upper and lower arches along with generalised tooth mobility. Under medical consultation, full mouth extraction, surgical excision of overgrowth followed by complete denture rehabilitation and replacement of combination drugs with sodium valproate were accomplished. RESULTS: Histologically, the lesion showed fibro-epithelial hyperplasia. Clinical results after 6 months demonstrated almost complete resolution of gingival overgrowth. CONCLUSION: The findings of present case suggest that gingival overgrowth can occur even in partially edentulous ridges (not exposed to denture wear) that could be due to persistence of gingival overgrowth, which may not resolve completely following tooth extraction or occurs because of incorporation of specific subpopulation of gingival fibroblasts in alveolar ridge mucosa.

[The impact of bisphosphonates on orthodontic treatment]. / De invloed van bisfosfonaten op een orthodontische behandeling.

Bisphosphonates are used in the treatment of various diseases which are associated with a disturbance of the balance between bone apposition and degradation. The most important complication of bisphosphonate use is osteonecrosis of the jaw. Certain components of an orthodontic treatment plan, such as the extraction of 1 or more teeth, are important risk factors in developing this complication. In addition to the desired effects on the bone metabolism, bisphosphonates may delay tooth eruption and inhibit or block orthodontic tooth movement. Nevertheless, case studies suggest that orthodontic treatment is possible despite the use of bisphosphonates. However, it is recommended to avoid orthodontic treatment unless this is strictly indicated.

[Optimizing orthodontic treatment in patients taking bisphosphonates]. / Optimisation des traitements orthodontiques chez les patients sous biphosphonates.

Bisphosphonates have unique pharmacological characteristics unlike those of any other drug group. Millions of adults take oral bisphosphonates for long-term treatment of osteoporosis and osteopenia; some of these people will most likely also seek orthodontic treatment. Adverse dental effects from bisphosphonates have been reported, including decreased tooth movement, impaired bone healing, and osteonecrosis in the mandible and the maxilla. Osteonecrosis has been rarely observed after bisphosphonate use for osteoporosis. However, adverse drug effects might occur more frequently in orthodontic patients, and they would probably be noted before the end-stage pathology of osteonecrosis. Adverse effects during orthodontic treatment, including decreased tooth movement, could last for years after the drug therapy is stopped. Successful orthodontic treatment requires optimal bone healing to prevent excessive tooth mobility. Bisphosphonates appear to have two bone elimination rates - a fast elimination of weeks from the bone surface and a slow elimination of years after incorporation into the bone structure. This article presents methods to clinically and radiographically monitor orthodontic patients who are taking oral bisphosphonates. Efforts to minimize adverse effects and optimize orthodontic procedures with physician-approved drug holidays are discussed. The orthodontic treatment results of three patients who received bisphosphonate therapy are reported.

Optimizing orthodontic treatment in patients taking bisphosphonates for osteoporosis.

Bisphosphonates have unique pharmacological characteristics unlike those of any other drug group. Millions of adults take oral bisphosphonates for long-term treatment of osteoporosis and osteopenia; some of these people will most likely also seek orthodontic treatment. Adverse dental effects from bisphosphonates have been reported, including decreased tooth movement, impaired bone healing, and osteonecrosis in the mandible and the maxilla. Osteonecrosis has been rarely observed after bisphosphonate use for osteoporosis. However, adverse drug effects might occur more frequently in orthodontic patients, and they would probably be noted before the end-stage pathology of osteonecrosis. Adverse effects during orthodontic treatment, including decreased tooth movement, could last for years after the drug therapy is stopped. Successful orthodontic treatment requires optimal bone healing to prevent excessive tooth mobility. Bisphosphonates appear to have 2 bone elimination rates--a fast elimination of weeks from the bone surface and a slow elimination of years after incorporation into the bone structure. This article presents methods to clinically and radiographically monitor orthodontic patients who are taking oral bisphosphonates. Efforts to minimize adverse effects and optimize orthodontic procedures with physician-approved drug holidays are discussed. The orthodontic treatment results of 3 patients who received bisphosphonate therapy are reported.

Relationship between the tooth eruption and regional blood flow in angiotensin II-induced hypertensive rats.

OBJECTIVE: The mechanism of action of vasoactive drugs on tooth movement is unknown. The purpose of the present study was to measure simultaneously the axial movement of the mandibular incisor, regional blood flow at the base of the incisor, and systemic arterial blood pressure in angiotensin II-induced hypertensive rats to determine the possible cause of tooth displacement. DESIGN: The measurements were made under artificial respiration with halothane anaesthesia. In the experimental animals, 2.5 microg of angiotensin II in 1 ml of Ringer's solution was infused at 0.83 ml/h for 12 h from the femoral vein. In the control animals, only Ringer's solution was infused. RESULTS: Angiotensin II caused an increase of the mean arterial blood pressure from 86 to 119 mm Hg, and decreases of the eruption rate from 667 to 494 microm/24 h and the regional blood flow from 262 to 214 mV. There was a positive correlation between the eruption rate and regional blood flow, and a negative correlation between the blood pressure and regional blood flow. CONCLUSION: These results suggest that angiotensin II caused constriction of the peripheral vascular smooth muscle resulting in an increase of arterial blood pressure and a decrease of regional blood flow, followed by a decrease of fluid volume and then a reduction of either the pressure within the socket or of the eruptive force. We assume that the regional vascular pressure within the socket plays an important role in determining the position of the rat incisor.

Premature exfoliation of primary molars related to the use of formocresol in a multivisit pulpotomy technique: a case report.

Since its introduction in 1904, formocresol has become one of the most widely studied dental medicaments. In the United Kingdom, it is the preferred primary tooth pulpotomy medicament of the majority of Specialists in Paediatric Dentistry. Reports of adverse effects resulting from its clinical use are rare. This paper presents a case of premature exfoliation of primary molars that may be related to the use of formocresol in a multivisit pulpotomy technique.

Local and chronic application of PTH accelerates tooth movement in rats.

We previously reported that whereas systemic continuous infusion of parathyroid hormone (PTH) accelerated orthodontic tooth movement, systemic but intermittent injection of PTH did not increase the rate of tooth movement. Analysis of these data suggested that continuous administration of PTH could be applicable for orthodontic therapy. In the present study, we investigated whether local and chronic application of PTH(1-34) would accelerate orthodontic tooth movement. To increase the residence time of PTH in the injected area, we used methylcellulose (MC) gel (2% W/V) for a slow-release formulation of PTH. MC gel containing PTH (PTH-MC) continuously released biologically active PTH into the acceptor medium for more than 72 hrs in vitro. When male rats received a local injection of PTH-MC into the subperiosteum in the mesio-palatal region of the maxillary first molar (M1) every other day, M1 movement, which was mesially drawn by an orthodontic coil spring attached to the maxillary incisors, was accelerated in a dose-dependent manner. PTH-MC injection at 1 microg/400 g body weight caused a 1.6-fold increase in the rate of tooth movement. The acceleration of tooth movement by PTH-MC injection was marked on days 6, 9, and 12. Local injection of PTH dissolved in saline without MC did not significantly accelerate tooth movement on day 6 or later. Histological examination revealed active osteoclastic bone resorption and a widened periodontal space on the compression side of the periodontal tissue in the PTH-MC-injected rats. These results suggest that local injection of PTH in a slow-release formulation is applicable to orthodontic therapy.