Risk comparison of osteonecrosis of the jaw in osteoporotic patients treated with bisphosphonates vs. denosumab: a multi-institutional retrospective cohort study in Taiwan.

In this multi-institutional retrospective cohort study, we compared the long-term risk of osteonecrosis of the jaw following the use of denosumab vs. bisphosphonates in osteoporotic patients. After 2-year use, the likelihood of osteonecrosis of the jaw is lower with denosumab compared to bisphosphonates, and the difference increases with time. PURPOSE: To compare the long-term risk of osteonecrosis of the jaw (ONJ) between osteoporotic patients treated with bisphosphonates (BPs) and denosumab. METHODS: This multi-institutional retrospective cohort study included patients aged > 40 years with osteoporosis between January 2010 and December 2018. Patients who met the eligibility criteria were divided into BPs and denosumab groups by propensity score matching (PSM). The risk of ONJ of denosumab vs. BPs was estimated using a Cox proportional hazards model and was described by the cumulative incidence rate using the Kaplan-Meier method. RESULTS: A total of 84,102 patients with osteoporosis were enrolled, among whom, 8962 were eligible for inclusion based on their first-line drug use (denosumab, n = 3,823; BPs, n = 5,139). Following PCM matching (1:1), the BPs and denosumab groups included 3665 patients each. The incidence density of ONJ in the denosumab and BPs matching groups was 1.47 vs. 2.49 events (per 1000 person-years), respectively. The hazard ratio of ONJ in the denosumab vs. BPs group was estimated as 0.581 (95% confidence interval: 0.33-1.04, p = 0.07). The cumulative incidence rates of ONJ in both groups were similar for the first and second years of drug use (p = 0.062), but significantly different from the third year onwards (p = 0.022). The severity of ONJ was not significantly different between the two groups. CONCLUSION: In osteoporotic patients, after 2 years of use, the likelihood of ONJ being induced by denosumab is lower than that of BPs, and the difference increases with time.

Interference factors regarding the path of insertion of rotational-path removable partial dentures.

BACKGROUND: The aims of this study were to evaluate the effect of the location of the rotational center and the morphology of teeth resulting in interference with the rotational path of insertion and to estimate when an interference test should be performed. METHODS: A total of 400 dental radiograms of maxillary and mandibular first and second molars (100 for each position) were selected. The radiograms were used to hand-sketch the outlines on tracing paper. Then, an interference test was simulated using calipers. Mesial long occlusal rest seats with three different lengths were designed. A curve-simulated rotational path was drawn on the tracing paper showing the outline of a molar. If the curve was intersected by the mesial outline, interference was occurred. A total of 1200 tests were performed. RESULTS: A significant number of interference cases (18.5%, N = 400) occurred when the rotational center was placed at the most distal margin of the occlusal surface. The interference was reduced (2.75%, N = 400) but still present at the distal fourth of the occlusal surface. At the distal one-third of the occlusal surface, interference did not occur (0%, N = 400). There was a significant difference between the results of the three rotational centers (p < 0.0001). CONCLUSIONS: The interference test was not required for a rotational center at the distal third to half of the occlusal surface. However, if the length of the long occlusal rest extends beyond the distal third, an interference test is recommended before final impression.

Modified split-cast technique: a new, timesaving clinical remount technique.

Interocclusal discrepancies can be eliminated by a clinical remount procedure, but most practitioners avoid it because of the time involved. This article introduces a new timesaving method, the modified split-cast technique. It uses a semi-adjustable articulator, tin foil as plaster separator, and an addition-type, silicone bite-registration material. The technician does most of the remounting procedures before the denture delivery appointment, so the dentist spends very little time chairside to complete the clinical remount procedure. Compared with the conventional and two other remounting techniques, the new technique is faster and easier to manipulate.