Osteonecrosis of the jaw and bisphosphonate: prevention, diagnosis and treatment

Introduzione: L'osteonecrosi dei mascellari nei pazienti in terapia con bisfosfonati (ONJ-BF) rappresenta un problema medico multidisciplinare che ha suscitato notevole interesse sia in ambito nazionale che internazionale. Negli ultimi anni sono comparse nel mondo sempre più numerose segnalazioni di osteonecreosi dei mascellari insorte in pazienti trattati con BF. Obiettivi: Nonostante i numerosi studi scientifici ed epidemiologici, i punti oscuri sono moltissimi ed ancora non si è riusciti a fare completa chiarezza nell'approccio clinico da adottare in presenza di pazienti in terapia con questi farmaci. Nel presente lavoro verrà eseguita una disamina dell’eziopatogenesi, degli elementi diagnostici e delle diverse modalità terapeutiche da poter adottare nei confronti di tale fenomeno clinico. Metodi: L'intervento odontoiatrico sembra aumentare la frequenza di una ONJ-BF, tuttavia è possibile che una preesistente ONJ-BF in forma subclinica si manifesti come patologia dentaria o, in alternativa, che l’estrazione o l’intervento odontoiatrico sveli una sottostante osteonecrosi. Risultati: In condizioni normali si assisterebbe ad una guarigione rapida senza sequele infettive, anche se il cavo orale non è un ambiente sterile. Nei soggetti che sviluppano ONJ-BF la guarigione è invece lenta e difficoltosa, con tendenza alla contaminazione della lesione ossea con germi della flora batterica del cavo orale. Conclusioni: Le complesse implicazioni cliniche e medico-legali impongono a tutti gli operatori sanitari, odontoiatri, igienisti dentali, chirurghi orali e maxillo-facciali, una adeguata conoscenza dei processi diagnostici e dei principi generali di prevenzione di tale patologia.Background: Osteonecrosis of the jaws in patients treated with bisphosphonates (ONJ-BF) is a multidisciplinary medical problem that has aroused considerable interest. In recent years several reports of osteonecrosis of the jaws in patients treated with BF have appeared. Objectives: Despite numerous scientific and epidemiological studies, a lot of doubts still persist and it is currently not possible to make significant progress in clarifying the clinical approach to patients using ONJ-BF. Our paper wants to offer a review about the mechanism and the elements of the various diagnostic and therapeutic modalities that can be used against this clinical phenomenon. Methods: Dental procedures seem to increase the frequency of ONJ-BF, but it is possible that a preexisting subclinical ONJ-BF appears as a dental disease or, alternatively, that the extraction or dental procedures reveal a half hidden osteonecrosis. Results: In normal conditions, this could rapidly heal without infectious con

SECONDARIES PROBLEMS OF ORAL MUCOSA DURING ORTHODONTIC TREATMENT

Introduction In the recent years, there was an increase in the number of people, adults and children, who undergo orthodontic therapy, probably since the modern innovations that have characterized the field of orthodontics, which allow us to offer orthodontic devices acceptable from an aesthetic and functional point of view. Objectives In this work, we want to focus on the possible consequences that may occur in the soft tissues during orthodontic treatment, which often are a source of alarm among patients and parents. In addition, it wants to raise awareness about this the orthodontists colleagues to reckon with problematics that may occur during the course of treatment. The orthodontic movements are the result of forces that are applied to the teeth and that are produced by equipment such as brackets, wires, strings, elastic bands and springs. Patients undergoing orthodontic treatment have increased risk of oral problems such as plaque formation, white lesions, gingivitis, oral mucosal lesions (traumatic ulcers, aphthous, hyperkeratosis). Discussions The data obtained from the literature and clinical experience, the most common problems to the oral mucosa that can be encountered in the course of orthodontic treatment include: traumatic injuries of various kinds, pseudocysts lesions of the salivary glands (mucocele, ranula), gingival hypertrohpy, allergic reactions to materials, frictional hyperkeratosis. Conclusions Orthodontic treatment involves a higher risk of oral mucosal lesions and implies a greater awareness of better oral hygiene. Oral hygiene instruction and early treatment of oral lesions are important considerations for better motivation of the patient, treatment planning and the successful outcome. It is important that the doctor follow in a continuous manner the state of health of the teeth and its associated structures, in order to ensure an optimal result for the same treatment, without incurring any unpleasant complications

Cleidocranial Dysplasia: Maxillary Alterations on the Transverse Plane. Presence of Crown-radicular Anomalies and Multidisciplinary Approach of a Clinical Case.

Introduction: Cleidocranial Dysplasia (CCD) is a rare inherited autosomal dominant congenital syndrome that occurs in approximately one out of every one million individuals worldwide; it primarily affects bones that undergo intra-membranous ossification, generally the skull and clavicles. Other bones may be affected such as the long bones, spine, pelvis, bones of hands and feet showing hypoplasia of distal phalanges. Indispensable is the role of the gene Runx2, necessary for the differentiation of odontoblasts and osteoblasts; it regulates the expression of many genes related to the development of dental hard tissues. The aim of this study was to appraise the connection between the Cleidocranial Dysplasia and the appearance of skeletal and dental anomalies not much deepen to this day. With particular emphasis, it wants to describe the multidisciplinary therapeutic approach. Case Report: The patient showed multiple skeletal features of CCD. A distinctive feature was the failed or delayed exfoliation of deciduous dentition and a delayed eruption of permanent teeth. The goal of the treatment is the improvement of both aesthetic and functional aspects. This objective can be achieved through an appropriate multidisciplinary treatment plan that arranges the orthodontic and surgical measures. Results and Discussions: Because of the involvement of facial bones, the altered mode of tooth eruption and the presence of numerous included supernumerary teeth, CCD is a pathology that all dentists should be familiar with. The patients have small faces compared to the skull and the hypoplasia of maxillary, tear, nasal and zygomatic bones. The orthodontic approach in literature seems to be reduced to the guided eruption of bad-positioned and impacted teeth. Knowledge of the clinical features of CCD allows for the early planning of the procedures necessary to resolve the dental pathologies observed in CCD patients

Ruthenium-106 eye plaque brachytherapy in the conservative treatment of uveal melanoma: a mono-institutional experience.

BACKGROUND: Traditional treatment for uveal melanoma is the enucleation of the eye with outcomes cosmetically unacceptable and loss of useful vision. Plaque brachytherapy, compared to enucleation, had the advantage to preserve the eye with outcomes cosmetically acceptable and preservation of vision. PATIENTS AND METHODS: From July 1990 to December 2009 one hundred forty-two (142) patients (51 males and 91 females) with small to medium uveal melanoma were treated with 106Ru plaque brachytherapy. The patients underwent a complete staging before brachytherapy with indirect ophthalmoscopy and ultrasounds. Mean tumour thickness was 3.26 mm (1.6-6 mm). The dose scheduled was 80-100 Gy to the apex with a maximum dose of 800 Gy to the sclera. RESULTS: One hundred forty-two have been treated, nine patients had lost the follow-up and drop out; 133 patients were assessed. Mean follow-up was 7.7 years (6 months-18 years). The overall survival at 5, 10 and 15 years was 92%, 85% and 78% respectively. Cancer fee survival was 95%, 90% and 83%, respectively at 5, 10 and 15 year. Radiation-induced toxicity was represented in 47 patients with a 5 year actuarial survival rate free from complications of 54%. CONCLUSIONS: 106Ru plaque brachytherapy is a valid approach for treatment of uveal melanoma. This technique is efficacy and safe, with a low toxicity profile