Medication-related osteonecrosis of the jaw: clinical and practical guidelines

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. Dental screening and adequate treatment are fundamental to reduce the risk of osteonecrosis in patients under antiresorptive or antiangiogenic therapy, or before initiating the administration. The treatment of MRONJ is generally difficult and the optimal therapy strategy is still to be established. For this reason, prevention is even more important. It is suggested that a multidisciplinary team approach including a dentist, an oncologist, and a maxillofacial surgeon to evaluate and decide the best therapy for the patient. The choice between a conservative treatment and surgery is not easy, and it should be made on a case by case basis. However, the initial approach should be as conservative as possible. The most important goals of treatment for patients with established MRONJ are primarily the control of infection, bone necrosis progression, and pain. The aim of this paper is to represent the current knowledge about MRONJ, its preventive measures and management strategies

Incidental Findings on Cone Beam Computed Tomography Images

Background. Cone beam computed tomography (CBCT) has gained widespread acceptance in dentistry for a variety of applications. Most dentists who are not radiologists/trained in radiology are generally not familiar with interpretation of anatomical structures and/or pathosis outside their area of primary interest, as often this was not within the scope of their training. Objectives. To assess that the number of incidental findings on a CBCT scan is high both within and outside of the primary area of interest, thereby emphasizing the importance of interpretation of all areas visualized on the scan. Materials and Methods. An oral and maxillofacial radiologist reviewed 1000 CBCT scans (382 males and 618 females) for findings both in- and outside the area of interest. Results. Of the 1000 subjects that were reviewed, 943 scans showed findings in the primary regions of interest and/or outside the regions of interest, and 76 different conditions were visualized in these scans both in and outside the areas of interest. Conclusion. From the wide scope of findings noted on these scans, it can be concluded that it is essential that a person trained in advanced interpretation techniques in radiology interprets cone beam computed tomography scans

Combining multiple isotopes and metagenomic to delineate the role of tree canopy nitrification in European forests along nitrogen deposition and climate gradients

Forest canopies influence our climate through carbon, water and energy exchanges with the atmosphere. However, less investigated is whether and how tree canopies change the chemical composition of precipitation, with important implications on forest nutrient cycling. Recently, we provided for the first time isotopic evidence that biological nitrification in tree canopies was responsible for significant changes in the amount of nitrate from rainfall to throughfall across two UK forests at high nitrogen (N) deposition [1]. This finding strongly suggested that bacteria and/or Archaea species of the phyllosphere are responsible for transforming atmospheric N before it reaches the soil. Despite microbial epiphytes representing an important component of tree canopies, attention has been mostly directed to their role as pathogens, while we still do not know whether and how they affect nutrient cycling. Our study aims to 1) characterize microbial communities harboured in tree canopies for two of the most dominant species in Europe (Fagus sylvatica L. and Pinus sylvestris L.) using metagenomic techniques, 2) quantify the functional genes related to nitrification but also to denitrification and N fixation, and 3) estimate the contribution of NO3 derived from biological canopy nitrification vs. atmospheric NO3 input by using \u3b415N, \u3b418O and \u3b417O of NO3in forest water. We considered i) twelve sites included in the EU ICP long term intensive forest monitoring network, chosen along a climate and nitrogen deposition gradient, spanning from Fennoscandia to the Mediterranean and ii) a manipulation experiment where N mist treatments were carried out either to the soil or over tree canopies. We will present preliminary results regarding microbial diversity in the phyllosphere, water (rainfall and throughfall) and soil samples over the gradient. Furthermore, we will report differences between the two investigated tree species for the phyllosphere core microbiome in terms of relative abundance of bacterial and Archaea classes and those species related to N cycling. Finally we will assess whether there are differences among tree species and sites in the number of functional genes related to N cycling and how they are related to the N deposition and/or climate. [1] Guerrieri et al. 2015 Global Change and Biology 21 (12): 4613-4626

Genetic relationships between Candida albicans strains isolated from dental plaque, trachea, and bronchoalveolar lavage fluid from mechanically ventilated intensive care unit patients

Candida albicans often resides in the oral cavity of healthy humans as a harmless commensal organism. This opportunistic fungus can cause significant disease in critically ill patients, such as those undergoing mechanical ventilation in the intensive care unit (ICU) having compromised local airway defense mechanisms. The goal of this study was to determine the intra- and inter-patient genetic relationship between strains of C. albicans recovered from dental plaque, tracheal secretions, and the lower airway by bronchoalveolar lavage of patients undergoing mechanical ventilation. Three pulsed-field gel electrophoresis (PFGE) typing methods were used to determine the genetic relatedness of the C. albicans strains, including electrophoretic karyotyping (EK) and restriction endonuclease analysis of the genome using SfiI (REAG-S) and BssHII (REAG-B). The C. albicans isolates from dental plaque and tracheo-bronchial sites from the same patient were genetically indistinguishable and retained over time, whereas strains from different patients usually separated into different genotypes. Among the three methods, REAG-B proved to be the most discriminatory method to differentiate isolates. The finding of genetically similar strains from the oral and tracheo-bronchial sites from the same patient supports the notion that the oral cavity may serve as an important source for C. albicans spread to the trachea and lung of mechanically ventilated patients

The phosphorous necrosis of the jaws and what can we learn from the past: a comparison of "phossy" and "bisphossy" jaw

INTRODUCTION: The osteopathology of the jaws associated with bone resorption inhibitors is a current topic that engages a variety of clinical specialists. This has increased after the approval of denosumab for treatment of osteoporosis and skeletal-related events in patients with solid malignancy. Early after the first publications, there is a possible connection between phosphorous necrosis of the jaws, a dreadful industrial disease mentioned, and bisphosphonate-induced pathology. The nineteenth century was the prime time for phosphorus necrosis of match factory workers. RESULTS: This occurrence provides an interesting insight into the medical and surgical profession in the nineteenth century. There are striking parallels and repetition of current and old ideas in the approach to this "new disease." There are similar examples in case descriptions when compared with today's patients of bisphosphonate-related osteonecrosis of the jaws (BRONJ). DISCUSSION: Phosphorus necrosis was first described in Austria. Soon after this, surgeons in German-speaking countries including well-known clinicians Wegner (1872) and von Schulthess-Rechberg (1879) pioneered the analysis, preventative measures, and treatment of this disease. The tendency at this time was to approach BRONJ as a "special kind of osteomyelitis" in pretreated and metabolically different bone. Not only the treatment strategy to wait until sequestrum formation with subsequent removal and preventative measures but also the idea of focusing on the periosteum as the triggering anatomical structure may have been adopted from specialists in the nineteenth century. Therefore, phosphorous necrosis of the jaw is an excellent example of "learning from the past.

Is bisphosphonate therapy for benign bone disease associated with impaired dental healing? A case-controlled study

<p>Abstract</p> <p>Background</p> <p>Bisphosphonates are common first line medications used for the management of benign bone disease. One of the most devastating complications associated with bisphosphonate use is osteonecrosis of the jaws which may be related to duration of exposure and hence cumulative dose, dental interventions, medical co-morbidities or in some circumstances with no identifiable aggravating factor. While jaw osteonecrosis is a devastating outcome which is currently difficult to manage, various forms of delayed dental healing may be a less dramatic and, therefore, poorly-recognised complications of bisphosphonate use for the treatment of osteoporosis. It is hypothesised that long-term (more than 1 year's duration) bisphosphonate use for the treatment of post-menopausal osteoporosis or other benign bone disease is associated with impaired dental healing.</p> <p>Methods/Design</p> <p>A case-control study has been chosen to test the hypothesis as the outcome event rate is likely to be very low. A total of 54 cases will be recruited into the study following review of all dental files from oral and maxillofacial surgeons and special needs dentists in Victoria where potential cases of delayed dental healing will be identified. Potential cases will be presented to an independent case adjudication panel to determine if they are definitive delayed dental healing cases. Two hundred and fifteen controls (1:4 cases:controls), matched for age and visit window period, will be selected from those who have attended local community based referring dental practices. The primary outcome will be the incidence of delayed dental healing that occurs either spontaneously or following dental treatment such as extractions, implant placement, or denture use.</p> <p>Discussion</p> <p>This study is the largest case-controlled study assessing the link between bisphosphonate use and delayed dental healing in Australia. It will provide invaluable data on the potential link between bisphosphonate use and osteonecrosis of the jaws.</p

Effect of Longâ Term Oral Bisphosphonates on Implant Wound Healing: Literature Review and a Case Report

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141603/1/jper0584.pd

Medication-related osteonecrosis of the jaw - a current review

Aim This study was aimed to discuss different classes of antiresorptive agents and their modes of action, to review the proposed mechanisms in the pathophysiology of osteonecrosis development and to analyse the prevention and the management of medication-related osteonecrosis of the jaw. Materials and methods Three databases were searched for relevant articles: PubMed, Ovid and Dentistry and Oral Sciences Source. Current literature consists mainly of case series, case reports and expert body opinions. Discussion The repertoire of antiresorptive medication keeps expanding as novel drugs are being introduced. The exact pathway that leads to the development of osteonecrosis remains to be elucidated, but different mechanisms have been put forward. An attempt at staging has been made, and treatment guidelines have been drawn but opinions remain divided. New treatments are being trialled; however, evidence is lacking

A review of non-destructive testing techniques for the in-situ investigation of fretting fatigue cracks

© 2020 The Authors Fretting fatigue can significantly reduce the life of components, leading to unexpected in-service failures. This phenomenon has been studied for over a century, with significant progress being made during the past decade. There are various methods that have been used to study fretting fatigue cracks in order to gain a greater understanding of the effects of fretting fatigue. Destructive methods are traditionally used to observe fretting fatigue cracks. Although useful in determining crack location, crack length, crack propagation modes, crack path and shape, it is not efficient or reliable for time based measurements. Non-destructive testing has developed in recent years and now in-situ monitoring can be used during testing in order to increase the understanding of fretting fatigue. This paper presents a review of non-destructive testing techniques used in-situ during fretting fatigue testing, which are compared in order to conclude the suitability of each technique. Recent developments in non-destructive techniques that could be also applied for fretting fatigue tests are also discussed, as well as recommendations for future research made