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BACKGROUND: Patients with dentofacial deformity often present with impaired masticatory function, orofacial pain, and temporomandibular disorders (TMD). This study investigates the relationship between TMD, pain, jaw, and masticatory function at different stages of orthognathic surgical (OS) treatment. METHOD: A total of 120 OS patients were prospectively recruited and grouped as pre-orthodontic (group 1), pre-surgery (group 2), 4-month post-surgery (group 3), 24-month post-surgery (group 4), in addition to 30 controls (group 0). Outcomes were assessed using: Jaw Function Limitation Scale (JFLS), McGill pain questionnaire, DC/TMD instrument, voluntary maximum bite force (MVBF), and masticatory efficiency (ME) using two-colored chewing gum. Data were analyzed using structural equation modeling. RESULTS: The prevalence of non-painful TMD did not differ between groups (P = 0.827). However, the prevalence of painful TMD differed between groups (P = 0.001). Amongst the painful TMDs, the highest prevalence was observed for masseter myalgia in group 2 (P = 0.031), and importantly group 4 did not differ from group 0 (P = 0.948). The MPQ score was significantly higher in group 1 (P = 0.001) compared to group 0, and the JFLS score was significantly higher in group 1, 2 and 3 compared to group 0. Notably MPQ (P = 0.756) and JFLS (P = 0.572) scores in group 4 were not different from group 0. However, MVBF (P = 0.996) and ME (P = 0.991) did not differ between groups 1 and 4. Association of self-reported pain and jaw function with masticatory function was observed in OS patients. CONCLUSION: OS was not associated with a negative impact on TMD. Jaw function and pain levels were similar to controls at the 24-month follow-up. Masticatory function was further affected by the surgery and seems to require a longer recovery time. Moreover, it was confirmed that pain and TMD were associated with limitations in jaw function and impacts on masticatory function.

BACKGROUND: Patients with dentofacial deformity often present with impaired masticatory function, orofacial pain, and temporomandibular disorders (TMD). This study investigates the relationship between TMD, pain, jaw, and masticatory function at different stages of orthognathic surgical (OS) treatment. METHOD: A total of 120 OS patients were prospectively recruited and grouped as pre-orthodontic (group 1), pre-surgery (group 2), 4-month post-surgery (group 3), 24-month post-surgery (group 4), in addition to 30 controls (group 0). Outcomes were assessed using: Jaw Function Limitation Scale (JFLS), McGill pain questionnaire, DC/TMD instrument, voluntary maximum bite force (MVBF), and masticatory efficiency (ME) using two-colored chewing gum. Data were analyzed using structural equation modeling. RESULTS: The prevalence of non-painful TMD did not differ between groups (P = 0.827). However, the prevalence of painful TMD differed between groups (P = 0.001). Amongst the painful TMDs, the highest prevalence was observed for masseter myalgia in group 2 (P = 0.031), and importantly group 4 did not differ from group 0 (P = 0.948). The MPQ score was significantly higher in group 1 (P = 0.001) compared to group 0, and the JFLS score was significantly higher in group 1, 2 and 3 compared to group 0. Notably MPQ (P = 0.756) and JFLS (P = 0.572) scores in group 4 were not different from group 0. However, MVBF (P = 0.996) and ME (P = 0.991) did not differ between groups 1 and 4. Association of self-reported pain and jaw function with masticatory function was observed in OS patients. CONCLUSION: OS was not associated with a negative impact on TMD. Jaw function and pain levels were similar to controls at the 24-month follow-up. Masticatory function was further affected by the surgery and seems to require a longer recovery time. Moreover, it was confirmed that pain and TMD were associated with limitations in jaw function and impacts on masticatory function.

PURPOSE: A prospective study was performed to test the accuracy and reproducibility of the DAVID-SLS-2 scanner (SLS-2) [DAVID Vision Systems GmbH], compared to the validated 3dMDtrio scanner (3dMD) [3dMD, LLC, Atlanta, GA, USA].MATERIALS AND METHODS: The accuracy of the SLS-2 was determined through multiple scans of a mannequin face model using both scanners. The reproducibility of a protocol for achieving consistent three-dimensional (3D) face scans in live subjects was carried out using the SLS-2. A precision of ≤1 mm was considered clinically significant.RESULTS: The mannequin face model was reproduced with no significant errors in the SLS-2 compared to the 3dMDtrio, with normally distributed data (mean = 0.002 mm; SD = 0.01 mm). In live subjects, the forehead, midface, chin and general face region showed mean errors and SD <0.24 mm and <1 mm, respectively. In the neck area, the data were not found to be normally distributed (mean = -1.6 mm; SD = 2.1 mm).CONCLUSION: Structured light scanning may be used for acquiring 3D face scans in live subjects in a radiation-free and reproducible manner, provided that the head of the subject is positioned in the same posture for each scan. Special care is recommended in positioning the head in the sagittal plane during scanning.

BACKGROUND: Biomaterials are commonly used to augment the maxillary sinus floor prior to or in conjunction with dental implant installation. Recently, porous titanium granules (PTGs) have been used in oral implant surgery to stabilize implants and function as an osteoconductive matrix.PURPOSE: To evaluate if PTGs can be safely used in a larger population of patients, treated by different surgeons, when sinus floor augmentation was required in conjunction with implant installation. The primary endpoint was 12-month survival rate of the dental implants. Biopsies for histology were taken from the augmented area.MATERIALS AND METHODS: At five centers, 40 subjects with uni or bilateral posterior edentulism and atrophy of the posterior maxilla (3-6 mm) were enrolled. In a single-stage procedure, PTG and one to three dental implants were installed in each quadrant. In total, 70 implants were included in the study.RESULTS: One immobile implant was removed. The mean marginal bone loss was 0.5 mm and 0.8 mm, on the mesial and distal side, respectively. Histologically, all biopsies demonstrated bone ingrowth.CONCLUSIONS: The results suggest that PTG can be safely and effectively used as augmentation material in the sinus floor when used with dental implants in a one-stage procedure.

Today x-ray micro computer tomography (μCT) imaging is used to investigate bone microarchitecture. μCT imaging is obtained by polychromatic x-ray beams, resulting in images with beam hardening artifacts, resolution levels at 10 μm, geometrical blurring, and lack of contrasts. When μCT is coupled to synchrotron sources (SRμCT) a spatial resolution up to one tenth of a μm may be achieved. A review of the literature concerning SRμCT was performed to investigate its usability and its strength in visualizing fine bone structures, vessels, and microarchitecture of bone. Although mainly limited to in vitro examinations, SRμCT is considered as a gold standard to image trabecular bone microarchitecture since it is possible in a 3D manner to visualize fine structural elements within mineralized tissue such as osteon boundaries, rods and plates structures, cement lines, and differences in mineralization

PURPOSE: Tissue engineering is a new way to regenerate bone tissue, where osteogenic capable cells combine with an appropriate scaffolding material. Our aim was in a Medline Search to evaluate osteoblast mineralization in vitro and in vivo including gene expressing combining mesenchymal stem cells (MSCs) and five different carriers, titanium, collagen, calcium carbonate, calcium phosphate and polylactic acid-polyglycolic acid copolymer for purpose of a meta-or a descriptive analysis. MATERIALS AND METHODS: The search included the following MeSH words in different combinations-mesenchymal stem cells, alkaline phosphatase, bone regeneration, tissue engineering, drug carriers, tissue scaffolds, titanium, collagen, calcium carbonate, calcium phosphates and polylactic acid-polyglycolic acid copolymer. RESULTS: Two out of 80 articles included numerical values and as control, carriers and cells, on mineralization and gene expression. ß-tricalcium phosphate (ß-TCP) revealed elevated alkaline phosphatase activity, and calcium-deficient hydroxyapatite a greater gene expression of osteocalcin when seeded with induced MSCs. CONCLUSION: No data are published on titanium used as a carrier in MSC osteoblast mineralization. A meta- as well as a descriptive analysis includes numerical values of test materials and of control reactions from carrier and cells, respectively. Only two articles fulfilled these requirements.

We present two cases of apical extrusion of non-setting, calcium hydroxide paste which had been placed as an interappointment root canal dressing during routine endodontic treatment and which resulted in tissue necrosis of a large part of themandible, while. Surgical intervention consisted of resections in both instances. In relation to the cases presented, a systematic review of similar cases in the literature between 1980 and April 2013 was conducted which resulted in eight cases meeting the criteria outlined. As with the two presented cases, half of these eight cases showed serious adverse effects and the use of an injectable system had most often been related to apical extrusion. Consequently, great care should be taken when applying the paste into the canal system. 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

We present two cases of apical extrusion of non-setting, calcium hydroxide paste which had been placed as an interappointment root canal dressing during routine endodontic treatment and which resulted in tissue necrosis of a large part of themandible, while. Surgical intervention consisted of resections in both instances. In relation to the cases presented, a systematic review of similar cases in the literature between 1980 and April 2013 was conducted which resulted in eight cases meeting the criteria outlined. As with the two presented cases, half of these eight cases showed serious adverse effects and the use of an injectable system had most often been related to apical extrusion. Consequently, great care should be taken when applying the paste into the canal system. 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

PURPOSE: Tissue engineering is a new way to regenerate bone tissue, where osteogenic capable cells combine with an appropriate scaffolding material. Our aim was in a Medline Search to evaluate osteoblast mineralization in vitro and in vivo including gene expressing combining mesenchymal stem cells (MSCs) and five different carriers, titanium, collagen, calcium carbonate, calcium phosphate and polylactic acid-polyglycolic acid copolymer for purpose of a meta-or a descriptive analysis. MATERIALS AND METHODS: The search included the following MeSH words in different combinations-mesenchymal stem cells, alkaline phosphatase, bone regeneration, tissue engineering, drug carriers, tissue scaffolds, titanium, collagen, calcium carbonate, calcium phosphates and polylactic acid-polyglycolic acid copolymer. RESULTS: Two out of 80 articles included numerical values and as control, carriers and cells, on mineralization and gene expression. ß-tricalcium phosphate (ß-TCP) revealed elevated alkaline phosphatase activity, and calcium-deficient hydroxyapatite a greater gene expression of osteocalcin when seeded with induced MSCs. CONCLUSION: No data are published on titanium used as a carrier in MSC osteoblast mineralization. A meta- as well as a descriptive analysis includes numerical values of test materials and of control reactions from carrier and cells, respectively. Only two articles fulfilled these requirements.

Background: Short implants (=8 mm) are manufactured for use in atrophic regions of the jaws. As implant length in many studies has been proven to play a major role in implant survival it is indicated to evaluate survival of short implants in the present literature. Purpose: The purpose of this study was systematically to evaluate publications concerning short dental implants defined as an implant with a length of =8 mm installed in the maxilla or in the mandible with special reference to implant type, survival rate, location of implant site, and observation time. Materials and Methods: A Medline and a hand search were conducted to identify studies concerning short dental implants of length =8 mm published between 1992 and October 2009. The articles included in this study report data on implant length =8 mm, implant surface, registered region of installment, observation time, single tooth restorations, supporting overdentures, splinted implants, and implants used for prostheses. Results: The 27 included studies represent zero randomized clinical trial studies, 15 prospective nonrandomized, noncontrolled clinical trials, 11 retrospective nonrandomized, noncontrolled clinical trials, and one review. Data on 6-mm implants were few and most frequent represented was manufactured Straumann implants representing 441 out of 549 implants. Brånemark implants, 7 mm in length, comprised 1607 implants out of 1808. Straumann implants, 8 mm in length, comprised 2040 out of 2352 implants. Failures varied between 0 and 14.5%, 0 and 37.5% and 0 and 22.9% of the 6-, 7-, and 8-mm-long implants, respectively. Conclusion: Short implant length was not related to observation time, installment region, failures, and dropouts were not specified, subsequently a meta-analysis was not possible to perform.

Background: Short implants (=8 mm) are manufactured for use in atrophic regions of the jaws. As implant length in many studies has been proven to play a major role in implant survival it is indicated to evaluate survival of short implants in the present literature. Purpose: The purpose of this study was systematically to evaluate publications concerning short dental implants defined as an implant with a length of =8 mm installed in the maxilla or in the mandible with special reference to implant type, survival rate, location of implant site, and observation time. Materials and Methods: A Medline and a hand search were conducted to identify studies concerning short dental implants of length =8 mm published between 1992 and October 2009. The articles included in this study report data on implant length =8 mm, implant surface, registered region of installment, observation time, single tooth restorations, supporting overdentures, splinted implants, and implants used for prostheses. Results: The 27 included studies represent zero randomized clinical trial studies, 15 prospective nonrandomized, noncontrolled clinical trials, 11 retrospective nonrandomized, noncontrolled clinical trials, and one review. Data on 6-mm implants were few and most frequent represented was manufactured Straumann implants representing 441 out of 549 implants. Brånemark implants, 7 mm in length, comprised 1607 implants out of 1808. Straumann implants, 8 mm in length, comprised 2040 out of 2352 implants. Failures varied between 0 and 14.5%, 0 and 37.5% and 0 and 22.9% of the 6-, 7-, and 8-mm-long implants, respectively. Conclusion: Short implant length was not related to observation time, installment region, failures, and dropouts were not specified, subsequently a meta-analysis was not possible to perform.

PURPOSE: The objective of this study was to address whether among people living in Denmark, those treated with medications to prevent osteoporosis have an increased risk for inflammatory jaw disease compared with those not treated. PATIENTS AND METHODS: A historical cohort study was designed to compare the rate of inflammatory jaw-related events, ie, osteomyelitis, osteitis, periostitis, or sequestrum, between Danish patients who had been prescribed oral bisphosphonates (BP) and other drugs for the treatment of osteoporosis between 1996 and 2006 (the exposed group), and a random sample of the Danish population drawn from a nationwide registry who had not been prescribed oral BPs or other medications to treat osteoporosis (the nonexposed group). The nonexposed subjects were age- and gender-matched to the exposed subjects and randomly drawn from the general population at a ratio of 3 non-BP subjects to 1 BP subject. The primary explanatory variable was oral BP exposure status. Associations between BP treatment and inflammatory jaw events were ascertained using hazard ratios (HR) Cox proportional hazards models. RESULTS: The study sample was composed of 103,562 index subjects and 310,683 control subjects. After adjusting for other factors, including diabetes and chemotherapy, alendronate (HR = 3.15, 95% confidence interval 1.44-6.87) and etidronate (HR = 2.23, 95% confidence interval 1.15-4.31) were associated with an increased risk for inflammatory jaw events. There was no association between oral BP dose and risk for inflammatory jaw events. CONCLUSION: The oral BPs alendronate and etidronate were associated with an increased risk for inflammatory jaw events.

PURPOSE: The objective of this study was to address whether among people living in Denmark, those treated with medications to prevent osteoporosis have an increased risk for inflammatory jaw disease compared with those not treated. PATIENTS AND METHODS: A historical cohort study was designed to compare the rate of inflammatory jaw-related events, ie, osteomyelitis, osteitis, periostitis, or sequestrum, between Danish patients who had been prescribed oral bisphosphonates (BP) and other drugs for the treatment of osteoporosis between 1996 and 2006 (the exposed group), and a random sample of the Danish population drawn from a nationwide registry who had not been prescribed oral BPs or other medications to treat osteoporosis (the nonexposed group). The nonexposed subjects were age- and gender-matched to the exposed subjects and randomly drawn from the general population at a ratio of 3 non-BP subjects to 1 BP subject. The primary explanatory variable was oral BP exposure status. Associations between BP treatment and inflammatory jaw events were ascertained using hazard ratios (HR) Cox proportional hazards models. RESULTS: The study sample was composed of 103,562 index subjects and 310,683 control subjects. After adjusting for other factors, including diabetes and chemotherapy, alendronate (HR = 3.15, 95% confidence interval 1.44-6.87) and etidronate (HR = 2.23, 95% confidence interval 1.15-4.31) were associated with an increased risk for inflammatory jaw events. There was no association between oral BP dose and risk for inflammatory jaw events. CONCLUSION: The oral BPs alendronate and etidronate were associated with an increased risk for inflammatory jaw events.

PURPOSE: The objective of this study was to address whether among people living in Denmark, those treated with medications to prevent osteoporosis have an increased risk for inflammatory jaw disease compared with those not treated. PATIENTS AND METHODS: A historical cohort study was designed to compare the rate of inflammatory jaw-related events, ie, osteomyelitis, osteitis, periostitis, or sequestrum, between Danish patients who had been prescribed oral bisphosphonates (BP) and other drugs for the treatment of osteoporosis between 1996 and 2006 (the exposed group), and a random sample of the Danish population drawn from a nationwide registry who had not been prescribed oral BPs or other medications to treat osteoporosis (the nonexposed group). The nonexposed subjects were age- and gender-matched to the exposed subjects and randomly drawn from the general population at a ratio of 3 non-BP subjects to 1 BP subject. The primary explanatory variable was oral BP exposure status. Associations between BP treatment and inflammatory jaw events were ascertained using hazard ratios (HR) Cox proportional hazards models. RESULTS: The study sample was composed of 103,562 index subjects and 310,683 control subjects. After adjusting for other factors, including diabetes and chemotherapy, alendronate (HR = 3.15, 95% confidence interval 1.44-6.87) and etidronate (HR = 2.23, 95% confidence interval 1.15-4.31) were associated with an increased risk for inflammatory jaw events. There was no association between oral BP dose and risk for inflammatory jaw events. CONCLUSION: The oral BPs alendronate and etidronate were associated with an increased risk for inflammatory jaw events.

Udgivelsesdato: 2010-May, We studied the association between bisphosphonate use and risk of atrial fibrillation or flutter and the effect of confounders such as heart and lung disease in a nationwide retrospective cohort from Denmark. All users of bisphosphonates and other drugs against osteoporosis between 1996 and 2006 (n = 103,562) were the exposed group and three age- and gender-matched controls from the general population (n = 310,683) were the nonexposed group. The main outcome measure was atrial fibrillation or atrial flutter. Before initiation of treatment against osteoporosis, no excess of atrial fibrillation or flutter was present for any drug except for etidronate (OR = 1.22, 95% CI 1.15-1.29). After initiation of treatment, raloxifene was not associated with any excess risk of atrial fibrillation (OR = 0.98, 95% CI 0.72-1.33). Etidronate (HR = 1.08, 95% CI 1.02-1.14) and alendronate (HR = 1.09, 95% CI 1.00-1.20) were associated with an excess risk of atrial fibrillation after treatment start if statistical adjustments were made for cardiovascular disease. However, this association disappeared upon statistical adjustment for chronic obstructive pulmonary disease (COPD) (etidronate HR = 1.04, 95% CI 0.98-1.10; alendronate HR = 1.05, 95% CI 0.96-1.15). In patients using etidronate (12.5% vs. 3.8%) and alendronate (11.4% vs. 4.6%) major differences were present in prevalence of COPD at start of treatment compared to matched controls. In conclusion, oral bisphosphonates do not seem to be associated with an excess risk of atrial fibrillation. Any excess risk seen in prior studies may be due to confounding from COPD.

Udgivelsesdato: 2010-May, We studied the association between bisphosphonate use and risk of atrial fibrillation or flutter and the effect of confounders such as heart and lung disease in a nationwide retrospective cohort from Denmark. All users of bisphosphonates and other drugs against osteoporosis between 1996 and 2006 (n = 103,562) were the exposed group and three age- and gender-matched controls from the general population (n = 310,683) were the nonexposed group. The main outcome measure was atrial fibrillation or atrial flutter. Before initiation of treatment against osteoporosis, no excess of atrial fibrillation or flutter was present for any drug except for etidronate (OR = 1.22, 95% CI 1.15-1.29). After initiation of treatment, raloxifene was not associated with any excess risk of atrial fibrillation (OR = 0.98, 95% CI 0.72-1.33). Etidronate (HR = 1.08, 95% CI 1.02-1.14) and alendronate (HR = 1.09, 95% CI 1.00-1.20) were associated with an excess risk of atrial fibrillation after treatment start if statistical adjustments were made for cardiovascular disease. However, this association disappeared upon statistical adjustment for chronic obstructive pulmonary disease (COPD) (etidronate HR = 1.04, 95% CI 0.98-1.10; alendronate HR = 1.05, 95% CI 0.96-1.15). In patients using etidronate (12.5% vs. 3.8%) and alendronate (11.4% vs. 4.6%) major differences were present in prevalence of COPD at start of treatment compared to matched controls. In conclusion, oral bisphosphonates do not seem to be associated with an excess risk of atrial fibrillation. Any excess risk seen in prior studies may be due to confounding from COPD.

Udgivelsesdato: 2010-Feb, Prior studies have indicated an excess risk of gastroduodenal ulcers and esophagus perforations with the use of bisphosphonates. However, little is known about the contribution of comorbid conditions and concomitant drug use on this risk. We studied the risk of esophagus and gastric events in patients on a wide range of drugs against osteoporosis both before and after initiation of these drugs. We studied a nationwide register-based cohort from Denmark with all users of drugs against osteoporosis between 1996 and 2006 (n = 103,562) as cases and three age- and sex-matched controls from the general population (n = 310,683). In a crude analysis, most drugs were already associated with an increased risk of esophagitis, esophageal ulcerations, or esophageal perforations or gastroduodenal ulcers before initiation of the drugs. Upon adjustment, this excess risk disappeared for most drugs except parathyroid hormone and its analogues, etidronate and clodronate. Only for etidronate, alendronate, and raloxifene were sufficient data present for events after initiation of the drugs, and for these, an increased risk was present for all events except gastroduodenal ulcers with raloxifene. Several drugs against osteoporosis are associated with an increased risk of esophagitis, esophageal ulcers, esophageal perforation, and gastroduodenal ulcers. However, the increase was already present before initiation of the drug for several types of drugs against osteoporosis. This points at an effect of the underlying condition being treated or comorbid conditions and drugs being provided in patients with osteoporosis, such as nonsteroidal anti-inflammatory drugs and corticosteroids.

Udgivelsesdato: 2009-Mar-23

Udgivelsesdato: 2009-Mar-23

Udgivelsesdato: 2010-Feb, Prior studies have indicated an excess risk of gastroduodenal ulcers and esophagus perforations with the use of bisphosphonates. However, little is known about the contribution of comorbid conditions and concomitant drug use on this risk. We studied the risk of esophagus and gastric events in patients on a wide range of drugs against osteoporosis both before and after initiation of these drugs. We studied a nationwide register-based cohort from Denmark with all users of drugs against osteoporosis between 1996 and 2006 (n = 103,562) as cases and three age- and sex-matched controls from the general population (n = 310,683). In a crude analysis, most drugs were already associated with an increased risk of esophagitis, esophageal ulcerations, or esophageal perforations or gastroduodenal ulcers before initiation of the drugs. Upon adjustment, this excess risk disappeared for most drugs except parathyroid hormone and its analogues, etidronate and clodronate. Only for etidronate, alendronate, and raloxifene were sufficient data present for events after initiation of the drugs, and for these, an increased risk was present for all events except gastroduodenal ulcers with raloxifene. Several drugs against osteoporosis are associated with an increased risk of esophagitis, esophageal ulcers, esophageal perforation, and gastroduodenal ulcers. However, the increase was already present before initiation of the drug for several types of drugs against osteoporosis. This points at an effect of the underlying condition being treated or comorbid conditions and drugs being provided in patients with osteoporosis, such as nonsteroidal anti-inflammatory drugs and corticosteroids.