1,721,055 research outputs found
Bisfosfonati: utilità terapeutiche e reazioni avverse di interesse odontostomatologico
No full textI bifosfonati hanno la capacità di modulare il turnover osseo, controllare e ridurre il rimodellamento in corso di riassorbimento.Il loro meccanismo d’azione si basa sulla capacità di inibire il riassorbimento osseo mediato dagli osteoclasti
Ranula: Modified Micro-Marsupialization: Case Report and Review of Literature
Full text linkIntroduction: Ranula is a limited mucus retention on the floor of mouth. Due to the young age of patients, over the years, attempts were made to find minimally invasive and effective surgical techniques. To date, however, there is still no gold standard. The modified micro-marsupialization is an effective and minimally invasive technique, with minimal risk of relapse, although there are very few reports about it. Case report: A 12-year-old male presented to our ENT Clinic with a rounded swelling with regular and defined margins, measuring 4x3 cm, soft and painless, non-compressible and bluish. Clinical diagnosis of ranula was made and a modified micro-marsupialization was performed: eight interrupted sutures using silk 3-0 were placed perpendicularly to the major axis of the lesion, from one side of the lesion to the other, without reaching the underlying tissue. No sutures were lost during follow-up, no complications occurred. Complete healing was reached after removing sutures on the 30th postoperative day. At 6 months control no relapse was observed. Conclusion: Modified micro-marsupialization is strongly indicated and recommended, especially in pediatric patient, due to its low invasiveness and its very low relapse rate. The poor case history found in the literature is probably an indication of the lack of knowledge of modified micro-marsupialization which, in our opinion, could be considered the gold standard
Simplifying the dental/periodontal management of patients with metabolic bone fragility receiving treatment with denosumab
Full text linkDenosumab (DNB) is a bone-targeted medication used to preserve structural integrity and minimise the risk of fragility fractures in metastatic cancer and metabolic bone disorders. DNB targets and binds RANK Ligand, inhibiting osteoclast maturation, function, and survival. In contrast with nitrogen-containing bisphosphonates (N-BPs), DNB does not bind to hydroxyapatite and incorporate into bone; thus, bone cellular remodelling recovers rapidly after drug suspension.
Denosumab has benn linked to the occurrence of osteonecrosis of the jaw (MRONJ), a uncommon but severe oral side effect with a higher prevalence in metastatic cancer patients than in patients with metabolic bone fragility. Although several oral triggers can initiate MRONJ, invasive oral treatments and tooth extraction still remain the most common precipitating event. In general, tooth extraction and oral surgery should be avoided in patients at increased risk of MRONJ, while extraction of unsalvageable teeth should be performed based on specific risk reduction protocols to eliminate dental/periodontal infections, still protectig from MRONJ onset. Based on the different pharmacological properties of DNB and N-BPs, it is likely that the MRONJ risk profile of patients with metabolic bone fragility receiving receiving different ARs could somewhat vary. We hypothesize the chance to maximize the pharmacokinetic of Prolia® and identify a time interval in which invasive oral treatments can ideally take place without restrictions in patients with metabolic bone fragility, provided that careful case selection, adequate communication among specialists, planning of a delayed dosing window and rigorous postoperative follow-up are granted
Gingival displacement using diode laser or retraction cords: A comparative clinical study
No full textPURPOSE:
To compare two systems used for conditioning the gingival sulcus and exposing the finish line before the final impression for a fixed denture: retraction cords and diode laser. METHODS:
All subjects participating in the study had healthy gingival and periodontal status before intervention for fixed prosthesis. 74 abutments for complete crown restoration were randomly divided into two groups for displacing the gingival sulcus before the final impression: gingival retraction cords (RC) and diode laser (DL). The height of the clinical crowns was measured by a blinded examiner in three points of the buccal surface (mesial, midline and distal) at four different times: after tooth preparation (T0), 15 days after tooth preparation, before exposing the finish line with RC or with DL (T1), 10 minutes after exposing the finish line (T2), and 15 days after the final impression was taken (T3). The amount of gingival retraction produced (ΔT2-T1) and restoration to baseline (ΔT3-T1) were calculated. Ease of technique and patient comfort were evaluated through the Visual Analog Scale. The time required to carry out the technique and bleeding during and after the conditioning procedure were also evaluated.
RESULTS:
There was no difference between the two techniques with regard to the height differences: ΔT2-T1 was 0.65±0.33 for RC and 0.66±0.43 for the DL (P= 0.966), while ΔT3-T1 was 0.03±0.27 for RC and 0.02±0.46 for DL (P= 0.286). DL required less time, was easier for the operator and more comfortable than RC for the patient (all P<0.001).
CLINICAL SIGNIFICANCE:
The amount of gingival retraction and restoration to baseline resulting from use of gingival retraction cords or diode laser technique is similar, but diode laser required less time, was simpler for the operator and was more comfortable to the patient than retraction cords
Neoformazione esofitica mandibolare in una giovane paziente
No full textUna donna caucasica di 18 anni si presentava all’osservazione presso il Settore di Medicina Orale (Università degli Studi di Palermo) data la comparsa di una neoformazione localizzata in zona trigono retromolare destro.
L’anamnesi patologica non evidenziava la presenza di patologie sistemiche attuali o pregresse.
La paziente era in buone condizioni di salute, riferiva di non assumere farmaci e di non avere subito alcun intervento chirurgico; dichiarava di non avere mai fumato. La paziente riferiva un lento e progressivo accrescimento della lesione, in assenza di sintomatologia algica.
L’esame obiettivo extra-orale non evidenziava linfoadenopatie latero-cervicali o altre anomalie. All’esame obiettivo intra-orale si rilevava una neoformazione esofitica a larga base di impianto, distalmente all’elemento 4.7. La lesione aveva circa 1 cm di diametro, la mucosa di rivestimento era di colorito rossastro, con aree di ipercheratosi e di erosione. La lesione risultava mobile rispetto ai piani sottostanti. Alla palpazione si apprezzava una consistenza fibrosa duro-elastica. La paziente esibiva una radiografia endorale in cui si apprezzava la presenza di una radio-opacità con margini netti all’interno della lesione.
In considerazione della crescita della lesione e dell’aspetto clinico-radiografico benigno, si prescriveva alla paziente un’ortopantomografia (OPT)
RE: American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update: Quantitative Risk Assessment and Controversial Issues
No full textAuthor Response to Letter to Editor regarding “Why are osteoporosis patients treated with antiresorptive therapies considered like oncology patients regarding their oral health care?”
No full textDear Editor,
we have read with great interest the Letter to the Editor by Cordova et al. “Why are osteopoporosis patients treated with antiresorptive therapies considered like oncology patients regarding their oral care?”.
We strongly agree with the Authors claiming for “differentiated guidelines for osteoporosis and oncology patients” regarding their risk of Antiresorptive-Related Osteonecrosis of the the Jaw (ARONJ), that is the main form of what is recently known as Medication-Related Osteonecrosis of the Jaw (MRONJ)
Onset of MRONJ in Breast Cancer Patients after Switching from Low to High Dose of Bone Modifying Agents Due to Bone Metastases Development: A Single Center Retrospective Cohort Study
Full text linkBackground: Medication-Related Osteonecrosis of the Jaw (MRONJ) is an adverse drug reaction mainly associated to bone modifying agents (BMAs). Breast cancer (BC) is the most frequent cancer worldwide. Its therapy can cause cancer treatment-induced bone loss (CTIBL), commonly treated with BMAs. The aims of this retrospective study are: to describe characteristics of BC patients under BMAs for CTIBL; to record any switch to high-dose BMAs; to assess MRONJ onset and to identify any factors associated with it. Patients: Authors included patients referred for MRONJ prevention to the Unit of Oral Medicine (University Hospital of Palermo). Results: Fourteen female BC patients under low-dose BMAs for CTIBL were eligible (mean age 66.6 years). Four patients switched to high-dose BMAs for bone metastases. In two of the four, MRONJ developed: one case, in the mandible (risedronate for 48 months then Xgeva® for 60 months); the other case, in the maxilla (Prolia® for 20 months then zoledronate for 16 months). Conclusion: It can be theorized that BC patients under BMAs for CTIBL are likely to have MRONJ risk similar to osteo-metabolic patients. These patients need more careful monitoring of oral health since they may switch, for preventing or treating bone metastases, to heavier BMAs therapy, thus increasing their risk of MRONJ
CD34 and CD105 Microvessels in Resected Bone Specimen May Implicate Wound Healing in MRONJ
Full text linkClinical treatment outcome of MRONJ (medication-related osteonecrosis of the jaw) surgery despite radical osseous removal and primary closure healing still shows differences in terms of outcome and disease recurrence. The study aims to assess the rate of angiogenesis of MRONJ lesions in order to understand the impact of angiogenesis and neoangiogenesis status on MRONJ surgical treatment outcome. This is the first study correlating microvessel density with prognosis in MRONJ surgically-treated patients. The immunohistochemical expression of CD34 and CD105 in MRONJ specimens obtained from surgically-treated patients was evaluated. The most vascularized areas detected by CD34 and CD105 were selected and the microvessel density value of the samples was registered. Samples were retrospectively divided according to the clinical outcome of MRONJ surgical treatment, dividing patients into two groups, “healed” and “not healed”. Statistical analysis was performed to assess if neovessels could influence treatment outcome in patients undergoing radical surgery. In the examined cohort, this value was highly predictive of better treatment outcome after radical surgery of MRONJ. Understanding of angiogenesis-dependent factors deserves further attention as a future target for MRONJ prevention and therapies
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