Search

Purpose: Implant placement in patients with cancer receiving high-dose antiresorptive medication (HDAR) is considered contraindicated. This prospective, feasibility study tested the hypothesis that dental implants can be placed in such patients by applying a staged implant placement protocol with submerged healing. Methods: Three groups of patients on HDAR were included as follows: group 1: patients who underwent tooth extraction, without the development of medication-related osteonecrosis of the jaws (MRONJ); group 2: patients with surgically treated MRONJ who had demonstrated clinical healing for at least 3 months; group 3: patients with established MRONJ who was planned for surgical resection and simultaneous implant placement. Results: A total of 49 implants were placed in 27 patients (group 1: 12, group 2: 7 and group 3: 8). HDAR included bisphosphonates and denosumab. The mean HDAR time was 25 months (SD: ± 18.4, range 3–68 months). An abutment operation was performed 4 months following the implant placement (SD: ± 1.9, range 3–14 months). All patients healed uneventfully. Conclusions: This study demonstrated that it is feasible to insert dental implants and perform an abutment surgery in patients with cancer on HDAR, without the development of MRONJ. Trial registration. ClinicalTrials.gov Identifier: NCT04741906.

Purpose: Tori and exostoses are considered risk factors for the development of medication-related osteonecrosis of the jaw (MRONJ). The aim of this study was to present the prevalence of MRONJ in relation to tori in the Copenhagen ONJ Cohort, evaluate the surgical treatment of MRONJ in relation to tori and explore trauma to tori as an additional risk factor in patients on antiresorptive medication. Methods: Data from a consecutive series of 506 patients with MRONJ (Copenhagen ONJ Cohort) were reviewed for the presence of tori and MRONJ in relation to tori. Demographic and medical data were analyzed, and healing outcomes and pain after the prophylactic removal of tori, surgical treatment of MRONJ in relation to tori and conservative treatment of MRONJ in relation to tori were evaluated and compared using Fisher’s exact test. Results: Thirty-four patients were included, of which 28 were surgically treated and six were conservatively treated. Of the surgically treated patients, 27 (96.4%) healed uneventfully after their first or second revision surgery. Fourteen (41.2%) patients with tori underwent therapeutic removal, eight (23.5%) underwent prophylactic removal, and six (17.6%) underwent both therapeutic and prophylactic removal. Two (33.3%) of the six conservatively treated patients healed spontaneously, while four remained unhealed. Both treatment types resulted in a significant decrease in pain. Conclusion: Prophylactic and therapeutic surgical removal of tori are reliable treatments and should be considered if a patient’s general health allows surgery. The study was approved by The Regional Scientific Ethical Committee (H-6-2013-010) on November 20, 2013, and was retrospectively registered

Background The objective of the present study was to compare the efficacy of different doses of methylprednisolone on postoperative sequelae and quality of life (QoL) following surgical removal of mandibular third molars (SRM3). Material and Methods Fifty-two patients (16 men and 36 women, mean age 25.9 years, range: 18-39) with bilateral impacted mandibular third molars were randomly allocated into intraoperative muscular injection of either 20mg, 30mg, 40mg methylprednisolone or saline injection. Baseline measurements were obtained preoperatively and compared with assessment after one day, three days, seven days and one month. Pain and trismus were estimated by visual analog scale score and interincisal mouth opening, respectively. Subjective assessment of QoL included Oral Health Impact Profile (OHIP-14). Descriptive and generalized estimating equation analyses were made and expressed as mean values with a 95% confidence interval. Results Methylprednisolone revealed no significant differences in pain, trismus and QoL compared with placebo. Higher prevalence of postoperative pain and worsening in QoL were observed with increased age (P=0.00). Smoking and increased time of surgery decreased mouth opening in the early healing phase (P=0.00). Conclusions The present study revealed no significant improvement of methylprednisolone on postoperative sequelae and QoL following SRM3 compared with placebo. Key words:Corticosteroids, dentistry, mandible, methylprednisolone, pain, third molar, trismus.

Objective. Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction to high-dose antiresorptive medication (AR) in patients with cancer. A temporary discontinuation of AR (drug holiday) has been suggested to potentially reduce the risk of MRONJ after oral surgery. However, no consensus exists. The aim of the present feasibility trial was to evaluate the impact of a high-dose AR drug holiday in connection with surgical tooth extraction on the development of MRONJ and patient-reported health state. Study Design. Patients with cancer receiving high-dose AR were randomized to a drug holiday from 1 month before to 3 months after surgical tooth extraction or drug continuation. Follow-up was scheduled at 1, 3, and 6 months postoperatively. Patient health state was evaluated using the EQ-5D-5L questionnaire. Results. The study included 23 patients (11 men, 12 women). AR included denosumab (n = 13) and bisphosphonate (n = 10) with median AR durations of 9 and 17.5 months, respectively. Four denosumab patients from the drug holiday group developed MRONJ. Differences in EQ-5D-5L between the treatment groups were found in favor of drug continuation. Conclusions. The results indicate that a high-dose AR drug holiday does not prevent development of MRONJ after surgical tooth extraction and that patient-reported health state declines during a drug holiday compared with drug continuation.

A descriptive retrospective review of two Danish families with Axenfeld-Rieger Syndrome. Documenting clinical findings, treatment of the dental anomalies and dentofacial deformities is described. This article demonstrates the importance of early diagnosis, referral and treatment in highly specialized center to receive the best outcome.

Buccal fat pad (BFP) is used for the closure of large oroantral defects caused by surgical removal of the necrotic bone in patients with medication-related osteonecrosis of the jaw (MRONJ). This study aimed to evaluate the use of BFP for the closure of maxillary sinus defects in stage 3 MRONJ patients.This study recruited 61patients with large oroantral defects caused by MRONJ, including 49 patients with cancer and 12 patients with osteoporosis. Lesions were evaluated clinically and radiographically.Among the 61 patients, 51 (83.6%) healed uneventfully, and 5 patients (8.2%) had local dehiscence and exposed bone; these 56 patients (91.8%) all healed after first or second operation. The Eastern Cooperative Oncology Group Performance Status was associated with being non-cured and might be an indicator for the healing process. All patients experienced a significant increase in body weight postoperatively.This study suggest that block resection with removal of the necrotic bone combined with radical sinusotomy and closure of the defect with BFP is a reliable method to cure MRONJ lesions with a high success rate, and successful operation and prosthetic rehabilitation may improve body weight and the quality of life. The study was approved by the appropriate ethical approval for the Copenhagen ONJ Cohort (protocol no. H-6-2013-010) November 20, 2013.

Virtuel behandlingsplanlægning anvendes på alle kæbekirurgiske afdelinger i Danmark. Mulighederne udnyttes bl.a. inden for korrektiv kirurgisk behandling af vækstbetingede kæbeanomalier og kraniofaciale anomalier, ansigtstraumatologi samt kirurgisk behandling af benigne og maligne tumorer med efterfølgende rekonstruktion. Ingeniørkompetencer benyttes i denne sammenhæng enten in-house eller i samarbejde med kommercielle udbydere.Det forudses, at alle større hospitaler inden for den nærmeste fremtid etablerer enheder til varetagelse af disse funktioner med tæt tværfagligt samarbejde med ingeniører. Ikke bare til virtuel planlægning inden for det kæbekirurgiske speciale, men inden for alle skærende specialer, hvor kirurgisk simulering og brug af patientspecifikke implantater er relevant. Kæbekirurgien må anses for foregangsspeciale i den sammenhæng.

Regional odontodysplasia (RO) is a rare dental anomaly affecting primary and/or permanent dentition, and leads to comprehensive treatment need. The purpose of this study was to present a larger consecutive sample with RO, discuss treatment strategies for patients with RO, and review the literature.A consecutive, retrospective sample of seven children with RO (6 males, 1 female) including all patients diagnosed with RO in the eastern part of Denmark was conducted over a period of 15 years. The evaluation included gender, localisation and treatment outcome. A review of the literature and cases published within the last 15 years was conducted.Referral age was 2-12 years (mean: 7.3 years). The gender ratio was 1:6 (female:male), and the right:left ratio was 3:4. 71% of the patients had RO in the mandible and 29% in the maxilla. 43% had RO in the permanent dentition, while both primary and permanent dentition were affected in 57%. Typically, RO affected incisors and canines. In some patients, RO also affected more distal tooth types. Treatment included early multiple extractions and subsequent combined orthodontics, surgery and prosthetics. A search on RO cases published within the last 15 years was conducted and included 44 cases. The review showed a male and maxillary preponderance. The most common treatment of RO is extraction.Treatment of RO should take place in interdisciplinary, specialised teams, and individual treatment plans should be designed. Fewer but more extensive treatment sessions under general anesthaesia may minimise the burden of care for the patients.

Objectives: To evaluate the influence of a single intraoperative injection of methylprednisolone on short-term haematological parameters following surgical removal of mandibular third molars.Material and Methods: Fifty-two patients with indications for surgical removal of bilateral impacted mandibular third molars were included in a randomized, split-mouth and double-blinded study design. Each molar were randomly allocated into one of following four groups: 20 mg methylprednisolone, 30 mg methylprednisolone, 40 mg methylprednisolone and placebo. Peripheral blood samples were obtained before and three days after surgery. Haematological parameters involving haemoglobin, white blood cell count and C-reactive protein (CRP) were evaluated and expressed as mean changes. Level of significance was 0.05. Furthermore, outcomes were correlated for age, sex, smoking and time of surgery.Results: There were no significant differences in postoperative haematological parameters with different doses of methylprednisolone compared with placebo. Peripheral blood samples revealed decreased level of haemoglobin and increased level of leucocytes and CRP in each group. Smokers displayed a significant lower level of haemoglobin and CRP compared with non-smokers (P < 0.05) and level of eosinophils decreased significantly with increasing age (P < 0.05).Conclusions: This study indicates that a single intraoperative injection of methylprednisolone seems not to cause suppression of short-term haematological parameters compared with placebo following surgical removal of mandibular third molars.

The objective was to test the hypothesis of no difference in facial swelling, pain, trismus and immediate quality of life after surgical removal of mandibular third molars, with or without post-operative cryotherapy. A MEDLINE (PubMed), EMBASE database and Cochrane library search in combination with a hand search of relevant journals were conducted by including human randomised controlled trials published in English until 17 July 2018. The search identified 37 titles. Six studies with low or unclear risk of bias fulfilled the inclusion criteria. Intermittent cryotherapy for 30 minutes during the first post-operative days significantly diminished facial swelling, pain and trismus compared with no cryotherapy. Patient's satisfaction and perception of recovery were significantly increased with cryotherapy. Therapeutic efficacy of intermittent cryotherapy on post-operative facial swelling, pain and trismus seems to be improved compared with continuous cryotherapy. Considerable variations in study design, diversity of used evaluation methods, outcome measures and various methodological confounding factors posed serious restrictions to review the literature in a quantitative systematic manner. Thus, conclusions drawn from the results of this systematic review should be interpreted with caution. Further well-designed randomised controlled trials including standardised protocol, larger patient sample, blinded outcome assessors, patient-reported outcome measures and three-dimensional volumetric analysis of facial swelling are required before evidence-based recommendations can be provided.

Objective. Nonexposed osteonecrosis of the jaws (NE-ONJ) does not fit into the current definition of osteonecrosis, which requires exposed bone. A modification of the classification of bisphosphonate-induced osteonecrosis of the jaws (ONJ) is proposed. This study aimed to test proposed criteria for NE-ONJ and compare NE-ONJ with exposed ONJ (E-ONJ) in a retrospective analysis. Study Design. In 102 patients with E-ONJ diagnosed according to Ruggiero et al. (2006, 2009), criteria for NE-ONJ were developed. Subgroups of NE-ONJ and E-ONJ were tested against each other using nonparametric and parametric statistics. Results. Among 102 patients with ONJ, 14 had NE-ONJ and 88 had E-ONJ. NE-ONJ and E-ONJ were similar in all important data (P > .05) except bone exposure. Conclusions. NE-ONJ belongs to the same disease condition as E-ONJ. NE-ONJ may be otherwise classified as ONJ stage 1, 2, or 3 and is different from ONJ stage 0. We propose to include the criteria for NE-ONJ into the classification. (Oral Surg Oral

The clinical outcome of closed vs open reduction and rigid fixation was compared based on a systematic review of the literature. Ten non-randomized retrospective studies were found. In six of these ten studies, the complication rate was significantly increased when open reduction and plating was performed. In the remaining studies, a slightly elevated (but not significant) infection rate was found when compared with closed reduction. Altogether, an infection rate of 5.0% was found in the closed reduction group whereas 10.6% and 14.6% were found when open reduction was performed using either plates or wires. Nerve injuries were slightly increased when open reduction was found (although not significant). With regard to occlusal disturbances, no difference was found in the open and closed reduction group. Concerning overall complication problems, six of seven studies showed more problems after open than closed reduction. In conclusion, this literature review using retrospective studies has raised doubts regarding the superiority of open reduction and rigid splinting, compared to closed reduction and intermaxillary splinting. However, a bias concerning the preferential use of open reduction in case of more complicated fractures cannot be excluded, which might explain the differences found between the two procedures. Prospective, randomized clinical trials are needed to illuminate this problem.

Purpose The aim of the present retrospective study was to investigate the morbidity of screws used for intermaxillary fixation (IMF) in the treatment of mandibular fractures. A review of the published data was also performed for a comparison of outcomes. Our hypothesis was that the use of screws for IMF of mandibular fractures would result in minimal morbidity. Materials and Methods Patients treated for mandibular fractures from 2007 to 2013, using screws for IMF, using the international diagnosis code for mandibular fracture, DS026, were anonymously selected (Department of Oral and Maxillofacial Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark). The fracture type, radiographic findings, treatment modality, screw type and number, and root damage were recorded. For the outcome comparison, a review of the published data regarding iatrogenic dental root damage caused by screw fixation was performed in May 2015. Results A total of 156 patients had undergone IMF with screws. The total number of screws was 793. The incidence of root lesions was 0.25% centrally and 0.88% peripherally. The incidence of screw loss was 0.13% and that of screw loosening was 1.89%. In the review, 737 related reports were identified in a search of PubMed and the Cochrane Library. Of these, 25 were considered suitable for inclusion. A lack of valid evidence resulted in a descriptive analysis, because a meta-analysis of the data was not possible. Conclusions The results of the present retrospective study have shown that the use of screws is a valid choice for IMF in mandibular fracture treatment with minimal morbidity. The 793 screws used for IMF resulted in a negligible amount of central and peripheral tooth root trauma. © 2016 American Association of Oral and Maxillofacial Surgeons

An approach was developed to evaluate the load transfer mechanism in the temporomandibular joint (TMJ) area before, during and after mandibular ramus elongation by distraction osteogenesis (DO). In a concerted approach using computer tomography, magnetic resonance imaging (MRI), and finite element analysis, three-dimensional numerical models based on a young male patient, with a dentofacial deformity were generated. The magnitude and direction of the muscle forces acting on the mandible were assessed using both values derived from the muscles volume and cross-section as retrieved from the MRI-scan data-sets and taken from the literature. The resistance of the soft tissue envelope towards elongation during the DO-phase was also included. The finite element analyses showed that before skeletal correction by DO the load transfer was asymmetrical with high peak stresses in the affected joint. Following ramus elongation a more symmetrical loading in TMJs was predicted. The reaction forces in the TMJs during DO were low.

Successful correction of facial asymmetry by mandibular distraction osteogenesis relies on mastering vector control. Lack of necessary vector control continues to compromise the treatment modality. The purpose of this study was to describe a new simplified method for vector transfer and to evaluate this method according to the outcome and the efficacy of distraction osteogenesis in the correction of unilateral mandibular hypoplasia and asymmetry. Twenty-seven patients with unilateral hypoplasia of the mandibular ramus underwent unilateral mandibular distraction osteogenesis with intraoral distraction devices. Posterior-anterior and lateral cephalograms were analyzed by digitalization. Changes in sagittal, vertical, and transversal linear and angular dimensions after the distraction treatment were evaluated by measurements performed on headfilms taken before and after surgery. Means and variances were calculated for selected cephalometric variables for each time point. The differences between the control and the treatment side were calculated, statistically described, and compared with a paired Student t test. Correction of the mandibular asymmetry, chin position, and the canting of the occlusal plane was obtained in all patients clinically, as well as radiographically, by the use of intraoral unidirectional distraction osteogenesis.

Mandibular distraction osteogenesis fails in correcting the skeletal deformities if the vector of distraction is incorrect. Lack of vector control is caused mainly by two factors: first, deficient vector planning and transfer, and, second, resistance of the masticatory muscles and the remaining soft tissue envelope toward elongation. To enhance predictable placement of intraoral distraction devices during surgery and thereby the treatment outcome, a method combining planning, simulation, and transfer was developed. The presurgical planning was based on frontal and lateral head films, and the planned position and orientation of the distraction device was applied on the stereolithographic model. This model was cut according to the planned osteotomy, and the distraction was simulated. The transfer procedure copied the planned and simulated position of the distraction device during surgery by use of an individual guiding splint. The guiding splint was fabricated on plaster models, and transferred to the stereolithographic model to reproduce the planned and simulated distraction treatment during surgery. The reliability of the vector-transfer method was evaluated cephalometrically in a homogenous group of 13 patients and their respective stereolithographic models in comparison with the planned, simulated, and transferred distraction vectors.

– The possible relation between treatment delay and healing complications in mandibular fracture treatment (excluding condylar fractures) was reviewed systematically. Twenty-two studies were identified. No randomized studies focused on the effect of immediate or delayed treatment. The main focus of most studies was surgical repositioning and internal skeletal fixation. The healing complications analyzed in this study were infection in the fracture line and malocclusion. Statistical analysis of the influence of treatment delay upon healing complications was possible in six studies. Four studies showed no significant difference between immediate and delayed treatment. One study showed a preference for healing for cases treated within 3 days, whereas another study indicated that treatment time between 3 and 5 days were optimal with the lowest rate of complications. Finally, a few studies identified confounding factors such as alcohol, drug abuse and/or non-compliance, factors which have been shown strongly to influence the likelihood of complications. A significant problem in this analysis was that rather few patients were actually treated on an acute basis (i.e. within 12 or 24 hours after injury), a fact which together with the lack of control of confounding factors made this analysis problematic. In conclusion, there is presently no strong evidence for either acute or delayed treatment of mandibular fractures in order to minimize healing complications; new studies including a substantial number of cases treated on an acute basis are very much needed.

Distraction osteogenesis has recently become a mainstay for treatment of mandibular hypoplasia. Thorough knowledge about changes in the temporomandibular joint (TMJ) and the surrounding parts of the mandible and the skull after mandibular distraction is still lacking. The purpose of the current study was to investigate the stress distribution in the mandible and the TMJ before and after skeletal correction by intraoral unilateral vertical mandibular ramus distraction, using a finite element (FE) model. The FE models were based on computed tomography scans and magnetic resonance imaging scans of a patient with unilateral hypoplasia of the right mandibular ramus caused by juvenile idiopathic arthritis. The character of stress distribution in the mandible and TMJ before and after skeletal correction by 15 mm of vertical distraction of the mandibular ramus was analyzed quantitatively and compared during centric occlusion. Before the distraction osteogenesis treatment, the condyles, articular discs, and glenoid fossa regions are loaded with a different stress pattern. The affected right condyle, disc, and fossa are loaded diffusely and externally in comparison with the anterior and with centralized loading on the normal left side. After unilateral mandibular distraction osteogenesis, the load became more centric and symmetrical. The results suggest that correction of the mandibular deformity by distraction osteogenesis tends to normalize the stress patterns in the TMJ.

When teeth are replanted after being avulsed, the repair process sometimes results in ankylosis. In a growing child, the ankylosed tooth fails to move along with the remaining alveolar process during vertical growth, resulting in a tooth that gradually appears more and more impacted and requires several reconstructive procedures to correct. Ankylosed teeth can, however, serve as anchorage for orthodontic correction of a malocclusion and as a point of force application for a dentoalveolar segment during alveolar distraction osteogenesis. This case report describes the treatment of a 13-year-old girl whose maxillary left central incisor had been avulsed and replanted 5 years earlier. The tooth had become ankylosed, and it was used to provide "free anchorage" during distalization of the maxillary dentition. The underdeveloped alveolar process adjacent to the ankylosed tooth was reconstructed by dento-osseous segment distraction osteogenesis, by using the ankylosed tooth as the point of force application.

Distraction osteogenesis has been accepted as an alternative treatment modality for hypoplastic mandibles. Knowledge about the changes occurring in the temporomandibular joint region during mandibular distraction osteogenesis is, however, limited and controversial. Stress distribution in the temporomandibular joint region during unilateral vertical mandibular ramus distraction was studied using a finite element model. The finite element model was based on computed tomography scans and magnetic resonance imaging scans of a patient with unilateral hypoplasia of the right mandibular ramus caused by juvenile idiopathic arthritis. The character of stress distribution in the temporomandibular joint and mandible was analyzed quantitatively at different intervals of the vertical mandibular ramus elongation. During the distraction phase, the condyles, articular disks, and glenoid fossa regions were loaded with a differentiated stress pattern. The affected right condyle, disk, and fossa were submitted to increasing loads with increasing elongation compared with the contralateral temporomandibular joint. Loading on the unaffected left side shifted posteriorly and slightly laterally, because the left condyle was the center of rotation. The loading of the temporomandibular joint regions was low during the active distraction phase, although local areas were subjected to elevated peak stresses.