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Jaw Necrosis

Thomas Mücke, Christian R Krestan, David A Mitchell, Jan S Kirschke, Arno Wutzl
For patients with malignant disease taking bisphosphonates and denosumab, the incidence of medication-related osteonecrosis of the jaw (MRONJ) is up to 15% in contrast to 0.01% in patients with osteoporosis. Clinical presentation of MRONJ extends from asymptomatic exposure of bone in 94% of patients to severe cases of mandibular fractures in a minority of 4.5%. The strongest risk factors for MRONJ are invasive dental procedures and dental infections. Advances in imaging provide more preoperation information compared with panoramic radiograph...
July 2016: Seminars in Musculoskeletal Radiology
M Pedrazzoli, L Autelitano, F Biglioli
Mandibular fracture is usually the clinical end of bisphosphonate-related osteonecrosis of the jaw. This is a painful complication and patients cannot feed as usual, with a worsening of their quality of life. The goal of treatment in bisphosphonate related osteonecrosis of jaw (BRONJ) patients is to slow progression of bone necrosis. We present a novel technique for treatment of severe mandibular BRONJ in stage 3 patients that present with a high risk to develop fracture, since they have a residual unaffected mandibular bone height less than 6 mm...
August 2016: Acta Otorhinolaryngologica Italica
Tao-Cheng Wu, Chiu-Yang Lee, Shing-Jong Lin, Jaw-Wen Chen
BACKGROUND: The renin-angiotensin system (RAS) plays an important role in atherosclerosis. Acting via the angiotensin II receptor, type 1, oxidative stress increases and contributes to endothelial dysfunction and vascular inflammation. Renin exerts effects through a renin receptor causing an increase in the efficiency of angiotensinogen cleavage and facilitates angiotensin II (Ang II) generation and action on cell surfaces. Ang II enhances proliferation and migration of vascular smooth muscle cells, indicating a direct involvement of the RAS in smooth muscle cell proliferation during neointimal formation...
September 2016: Acta Cardiol Sin
Mateja Kaja Jezovnik, Jawed Fareed, Pavel Poredos
INTRODUCTION: Although the role of inflammation in DVT has been investigated in different studies, there is no definite answer as to whether increased systemic inflammation is the cause or the consequence of DVT. AIM: To follow inflammatory parameters in a cohort of patients with idiopathic DVT. METHODS: Out of 49 patients with an acute idiopathic DVT, which were investigated four months after an acute episode (DEVTA 1), 43 patients were included in the follow-up study investigating inflammatory markers and hemostatic markers of endothelial damage five years after an acute DVT (DEVTA 2)...
September 22, 2016: Clinical and Applied Thrombosis/hemostasis
Mohammed Qaisi, Jamie Hargett, Matthew Loeb, Jeffrey Brown, Ronald Caloss
Bisphosphonates have been used for years in the treatment of patients with distant bony metastasis and in the prevention of osteoporosis. One of main side effects of these medications is the development of bisphosphonate related osteonecrosis of the jaw (BRONJ) in a small subset of patients. A new class of medications with a shorter half-life, known as receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors, was introduced with the hopes of avoiding this side effect. However, reports of osteonecrosis of the jaw after the use of RANKL inhibitors have also been documented...
2016: Case Reports in Dentistry
Minju Song, Abdullah Alshaikh, Terresa Kim, Sol Kim, Michelle Dang, Shebli Mehrazarin, Ki-Hyuk Shin, Mo Kang, No-Hee Park, Reuben H Kim
INTRODUCTION: Surgical interventions such as tooth extraction increase the chances of developing osteonecrosis of the jaw in patients receiving bisphosphonates (BPs) for the treatment of bone-related diseases. Tooth extraction is often performed to eliminate preexisting pathological inflammatory conditions that make the tooth unsalvageable; however, the role of such conditions on bisphosphonate-related osteonecrosis of the jaw (BRONJ) development after tooth extraction is not clearly defined...
September 13, 2016: Journal of Endodontics
Amin Rahpeyma, Saeedeh Khajehahmadi
BACKGROUND: Anterior maxilla is a high esthetic region of the mouth. Some flaps are introduced for bone graft coverage, mainly based on secondary epithelization of connective tissue-periosteal tissues. This article evaluates the versatility of a new mucoperiosteal flap for reproducible coverage in anterior maxilla. METHODS: In 5 mongrel dogs a 5 mm width mucosal defect in labial mucosa was created after extraction of upper jaw incisors. Nasopalatine island advancement flap was used for mucosal replacement...
September 9, 2016: Journal of Craniofacial Surgery
Saeed Moradi, Ali Talati, Maryam Forghani, Amir Hossein Jafarian, Mandana Naseri, Shiva Shojaeian
OBJECTIVE: Pulp regeneration within the root canal of necrotic teeth is considered an ideal treatment to allow for continued root development and recover teeth vitality. This study aims to evaluate the inductive effect of platelet-rich plasma (PRP) on expression of angiogenesis factors and pulpal revascularization of immature necrotic teeth. MATERIALS AND METHODS: In this experimental animal study, we randomly divided 28 immature premolars from two mixed breed dogs into four groups, two experimental, negative and a positive control...
2016: Cell Journal
Ya-Ping Lee, Chin-Hao Chang, Heng-Hsiu Liu, Chin-Ying Chen, Ching-Yu Chen, Chih-Cheng Hsu, Ching-I Chang, Yen-Ting Lin, Chung-Sheng Lee, Jaw-Shiun Tsai
Frailty is a geriatric syndrome associated with adiposity. Zinc alpha2-glycoprotein (ZAG), a novel adipokine, is a modulator of body fat mass and positively correlates with age. This observational study aims to investigate the relationship between plasma ZAG levels and frailty in the elderly.We enrolled 189 elder participants from a hospital-based comprehensive geriatric assessment program in Taiwan from January 2007 to June 2008. The demographic data, body weight, body mass index, appendicular skeletal muscle mass index (ASMI), body fat mass percentage, metabolic and inflammatory parameters including plasma tumor-necrosis factor alpha, C-reactive protein and ZAG levels, were assessed...
August 2016: Medicine (Baltimore)
Taro Murai, Akihiro Hayashi, Yoshihiko Manabe, Chikao Sugie, Taiki Takaoka, Takeshi Yanagi, Tetsuya Oguri, Masayuki Matsuo, Yoshimasa Mori, Yuta Shibamoto
OBJECTIVE: Dynamic jaws (DJ) are expected to be useful in stereotactic radiotherapy (SRT) for brain metastases (BM). The efficacy and optimal dose fractionation were investigated. METHODS: In a planning study, 63 treatment plans were generated for the following 3 conditions: 1.0-cm fixed jaws (FJ), 2.5-cm FJ and 2.5-cm DJ. In a clinical study, 30 Gy/3 fr, 35 Gy/5 fr or 37.5 Gy/5 fr were prescribed depending on tumour size. Clinical results of groups treated with 2...
October 2016: British Journal of Radiology
Thomas Mücke, Herbert Deppe, Jana Hein, Klaus-Dietrich Wolff, David A Mitchell, Marco R Kesting, Margitta Retz, Jürgen E Gschwend, Mark Thalgott
INTRODUCTION: To explore the preventive effect of a prophylactic oral and maxillofacial treatment to reduce bisphosphonate associated necrosis of the jaws (BRONJ) in metastatic prostate cancer (PC) patients treated with zoledronic acid (4.0 mg i.v./months). MATERIALS AND METHOD: 253 PC patients with bone metastases were prospectively randomized. All patients received baseline assessments including a dental panoramic tomogram. Group A was monitored and treated where deemed necessary by the patient's dentist and were re-evaluated once a year...
August 2, 2016: Journal of Cranio-maxillo-facial Surgery
Douglas Magno Guimaraes, Liliane Silva do Nascimento, Victor Feliz Pedrinha, Glauce Guimarães Pereira, Carlos Renato Figueira Paradela, Flávia Sirotheau Correa Pontes, Hélder Ântonio Rebelo Pontes
Leukemia is a malignant neoplasm of hematologic origin occurring from disorganized proliferation or increased life span of white cells. The initial manifestations of leukemia are generally signs of bone marrow failure, such as pallor, fatigue, fever, bleeding, and infection related to peripheral blood cytopenias. Few reports have described osteonecrosis, especially in the femoral head, as an initial manifestation of acute lymphoblastic leukemia. To the best of our knowledge, osteonecrosis of the jaw has not been reported as a first sign of leukemia...
2016: Quintessence International
Hiromitsu Morita, Yuko Imai, Masahiro Yoneda, Takao Hirofuji
Bisphosphonates and irradiation are useful medical treatments, but can often cause oral complications such as medication-related oral necrosis of the jaw (MRONJ) and osteoradionecrosis (ORN) during oral surgery, including tooth extraction. Therefore, we should take all risks into consideration carefully before choosing dental treatment for patients with a medical history of such therapies. A 55-year-old woman who underwent cord blood transplantation to treat extranodal natural killer T (NK/T) cell lymphoma (nasal type IVB) had a medical history of bisphosphonate and irradiation treatments...
June 30, 2016: Special Care in Dentistry
P G de Barros Silva, C C de Oliveira, Lac Brizeno, Dvt Wong, Rcp Lima Júnior, R P Gonçalves, F B Sousa, Mrl Mota, R de Albuquerque Ribeiro, Apnn Alves
OBJECTIVES: Characterize the cell profile and immunostaining of proinflammatory markers in an experimental model of bisphosphonate-related osteonecrosis of the jaw (BRONJ). MATERIALS AND METHODS: Male Wistar rats (n = 6-7) were treated chronically with saline solution or zoledronic acid (ZA) at 0.04, 0.20, and 1.00 mg kg(-1) (1.4 × 10(-7) , 6.9 × 10(-6) , and 3.4 × 10(-5)  mol kg(-1) ), and subsequently, the first left inferior molar was extracted...
October 2016: Oral Diseases
Gustavo Maluf, Milena Correia de Pinho, Sandra Ribeiro de Barros da Cunha, Paulo Sérgio da Silva Santos, Eduardo Rodrigues Fregnani
This paper describes two cases in which the use of leucocyte-rich and platelet-rich fibrin (LPRF) combined with bone resection did not result in complete tissue response in the treatment of medication-related osteonecrosis of the jaw (MRONJ). It has been recently described in patients receiving subcutaneous administration of RANK-inhibitors, such as Denosumab, and anti-angiogenic drugs, such as Bevacizumab, as observed in our cases. Due to promising results in recent studies, more patients will receive these medications in order to avoid skeletal complications due to metastatic bone disease and, therefore, this scenario has a potential to become a comparable challenge to the bisphosphonate- induced jaw necrosis in the area of Oral and Maxillofacial Surgery...
May 2016: Brazilian Dental Journal
Atif A Ahmed, Charles Dunlap
BACKGROUND: Giant cell granuloma (GCG) is an intraosseous giant cell fibroblastic lesion that predominantly affects the jaw bones in children and adults. Despite its frequent local progression and destructive effect, it is traditionally considered reparative or reactive in nature. The receptor activator of nuclear factor Kappa B ligand (RANKL), a member of the tumor necrosis factor family and the transcription factor c-fos play a major role in osteoclast proliferation and differentiation...
January 2016: Journal of Oral and Maxillofacial Pathology: JOMFP
Francesco Saverio DE Ponte, Luciano Catalfamo, Gregorio Micali, Michele Runci, Giuseppina Cutroneo, Giovanna Vermiglio, Antonio Centofanti, Giuseppina Rizzo
Osteonecrosis of the jaw (ONJ) is an adverse effect of bisphosphonate treatment that has become the subject of increasing investigations, in particular due to its poorly understood pathogenesis. Several experimental studies on animal models have been conducted; however, the majority of these replicate human ONJ following tooth extraction, and describe alterations in the bone and gingival epithelium when necrosis is manifested. The aim of the present study was to analyze the rat mandibular bone and gingival epithelium during 45 days of zoledronate treatment (which is a bisphosphonate agent), without tooth extraction...
May 2016: Experimental and Therapeutic Medicine
Daniele Rosella, Piero Papi, Rita Giardino, Emauele Cicalini, Luca Piccoli, Giorgio Pompa
Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse drug reaction, consisting of progressive bone destruction in the maxillofacial region of patients. ONJ can be caused by two pharmacological agents: Antiresorptive (including bisphosphonates (BPs) and receptor activator of nuclear factor kappa-B ligand inhibitors) and antiangiogenic. MRONJ pathophysiology is not completely elucidated. There are several suggested hypothesis that could explain its unique localization to the jaws: Inflammation or infection, microtrauma, altered bone remodeling or over suppression of bone resorption, angiogenesis inhibition, soft tissue BPs toxicity, peculiar biofilm of the oral cavity, terminal vascularization of the mandible, suppression of immunity, or Vitamin D deficiency...
March 2016: Journal of International Society of Preventive & Community Dentistry
Christopher R Lattimer, Evi Kalodiki, George Geroulakos, Debra Hoppensteadt, Jawed Fareed
OBJECTIVES: To test for the presence of inflammatory biomarkers in blood taken from varicose veins versus antecubital blood of the same patient and compare this to levels in healthy controls. METHODS: Using a multiplex biochip array method (Randox, United Kingdom), the interleukins (ILs) IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, and IL-10; vascular endothelial growth factor; interferon γ, tumor necrosis factor α ; monocyte chemotactic protein 1 (MCP-1); and epidermal growth factor were measured in citrated plasma samples drawn from the arms and legs of 24 patients with varicose veins and 24 controls...
October 2016: Clinical and Applied Thrombosis/hemostasis
Stefano Andrea Denes, Riccardo Tieghi, Giovanni Elia
The buccal fat pad (BFP) is a well-established tool in oral and maxillofacial surgery and its use has proved of value for the closure of oroantral communications. Oroantral communication may be a common complication after sequestrectomy in "bisphosphonate-related osteonecrosis of the jaws."The authors report a clinical case of a 70-year-old female patient in bisphosphonate therapy presented with right maxillary sinusitis and oroantral communication after implants insertion.The BFP was used to close the defect...
May 2016: Journal of Craniofacial Surgery
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