Microbiological investigation of medication-related osteonecrosis of the jaw: preliminary results.

Medication-related osteonecrosis of the jaw (MRONJ) is a well-recognized severe complication of bisphosphonate (BPs) treatment in patients with osteoporosis or metastatic cancer. Microbiological infection has been hypothesized as a contributing factor to bisphosphonate related osteonecrosis of the jaw (BRONJ). Despite infection being present in BRONJ patients, there is no clear data as to whether infection plays a role in the pathophysiology. Moreover, microbial cultures have not been helpful in directing therapy because specific pathogens have not been identified. The objective of this study was to determine the bacterial colonization of jawbone and identify the bacterial phylotypes associated with BRONJ. Twenty oncologic patients, aged 48-87 years (average age 70.65 ± 8.86 years) with BRONJ were enrolled in this study and underwent three different microbiological samplings. Overall, 60 samples were obtained from oral mucosa, necrotic bone fragments and fistula drainage. The same procedure was performed for the laboratory culture of all these specimens. No significant differences regarding either gram+ and gram– species (Chi-squared= 0.1642; p = 0.6854) or aerobes and anaerobes bacteria (Chi-squared= 3.084; p = 0.0791) were found. Compared to other sampling techniques, the oral swab allowed to obtain valuable microbial data in order to recognize pathogens responsible for the infection and to outline a focused antimicrobial therapy.

Which route of antibiotic administration should be used for third molar surgery? A split-mouth study to compare intramuscular and oral intake.

OBJECTIVE: To compare the effectiveness of two different routes of antibiotic administration in preventing septic complications in patients undergoing third molar extraction. MATERIALS AND METHODS: Twenty-four healthy patients requiring bilateral surgical removal of impacted mandibular third molars were successfully enrolled for this study. Depth of impaction, angulation, and relationship of the lower third molars with the mandibular branch had to be overlapping on both sides. A split-mouth design was chosen, so each patient underwent both the first and second surgeries, having for each extraction a different antibiotic route of administration. The second extraction was carried out 1 month later. To compare the effects of the two routes of antibiotic administration, inflammatory parameters, such as edema, trismus, pain, fever, dysphagia and lymphadenopathy were evaluated 2 and 7 days after surgery. Side effects of each therapy were evaluated 48 h after surgery. RESULTS: Oral and intramuscular antibiotic therapies overlap in preventing post-operative complications in dental surgery (p>0.05), even if the oral intake, seems to promote the onset of significant gastrointestinal disorders (p=0.003). CONCLUSIONS: This study could help dentists in their ordinary practice to choose the right route of antibiotic administration in the third molar surgery. At the same effectiveness, the higher cost and the minor compliance of the patient seem not to justify a routine antibiotic intramuscular therapy, reserving it for patients with gastrointestinal disorders.

Use of autologous bone marrow mononuclear cells and cultured bone marrow stromal cells in dogs with orthopaedic lesions.

The aim of the study is to evaluate the clinical application in veterinary orthopedics of bone marrow mononuclear cells (BMMNCs) and cultured bone marrow stromal cells (cBMSCs) for the treatment of some orthopaedic lesions in the dog. The authors carried out a clinical study on 14 dogs of different breed, age and size with the following lesions: 1 bone cyst of the glenoid rime; 2 nonunion of the tibia; 3 nonunion of the femur; 2 lengthening of the radius; 1 large bone defect of the distal radius;1 nonunion with carpus valgus; 4 Legg-Calvé-Perthés disease. In 9 cases the BMMCNs were used in combination with a three dimensional resorbable osteogenic scaffold the chemical composition and size of which facilitates the ingrowth of bone. In these cases the BMMNCs were suspended in an adequate amount of fibrin glue and then distribuited uniformly on a Tricalcium-Phosphate (TCP) scaffold onto which were also added some drops of thrombin. In 1 case of nonunion of the tibia and in 3 cases of Legg-Calvè-Perthés (LCP) disease the cultured BMSCs were used instead because of the small size of the dogs and of the little amount of aspirated bone marrow. X-ray examinations were performed immediately after the surgery. Clinical, ultrasounds and X-ray examinations were performed after 20 days and then every month. Until now the treated dogs have shown very good clinical and X-ray results. One of the objectives of the study was to use the BMMNCs in clinical application in orthopaedic lesions in the dog. The advantages of using the cells immediately after the bone marrow is collected, are that the surgery can be performed the same day, the cells do not need to be expanded in vitro, they preserve their osteogenic potential to form bone and promote the proper integration of the implant with the bone and lastly, the technique is easier and the costs are lower.