The purposes of this preliminary study are to assess the risk of developing bisphosphonate-related osteonecrosis of the jaw (BRONJ) in a patient with osteoporosis using zoledronic acid and to report the results of a 1-year prospective clinical study regarding 5 immediately inserted implants in the anterior mandible. For this comparative prospective study, 24 female patients, aged ≥54 years, were chosen, all with partially edentulous mandibles. Group A consisted of 12 patients with osteoporosis taking zoledronic acid receiving a once-yearly intravenous infusion of zoledronic acid (5 mg). Control group B consisted of 12 other patients without osteoporosis and not taking drugs. In both groups, the remaining teeth were extracted before 120 implants, 3.7-mm wide and 16-mm long, were immediately installed in the interforaminal region of the mandibles. The 1-year implant survival rate was 100%. No apparent necrotic bone was observed among patients receiving zoledronic acid (group A) after implant surgery. Immediate implant osseointegration can be successful in a patient with osteoporosis using bisphosphonates, suggesting the safety of implantology as a treatment modality.
The implementation of biodegradable osteosynthetic materials is optimal for the treatment of fractures of the middle third of the facial skeleton, lower part of the upper third of the facial skeleton, mandibular body and parasymphysis (Tab. 3, Fig. 3, Ref. 31).
Background
External root resorption is an irreversible loss of dental hard tissue as a result of odontoclastic action. Multiple external cervical root resorptions in permanent teeth are rare. The exact cause of external cervical root resorption is unclear. It is currently well established that RANK/RANKL signaling is essential for osteoclastogenesis and osteoclast-mediated bone resorption. Denosumab is an anti-RANKL antibody used for the treatment of postmenopausal osteoporosis. RANK/RANKL pathway suppression by denosumab is expected to suppress the activity of clastic cells responsible for hard tissue resorption involving both osteoclasts and odontoclasts.
Case presentation
This case report demonstrates aggressive and generalized idiopathic external cervical root resorption that started and advanced during ongoing antiresorptive therapy with the human monoclonal RANKL-blocking antibody denosumab without discontinuation of therapy in a 74-year-old female patient treated for postmenopausal osteoporosis. The extent of resorptive defects was too large and progressively led to fractures of the teeth. The number of teeth involved and the extend of destruction excluded conservative treatment. The affected teeth had to be extracted for functional prosthetic reconstruction.
Conclusions
This finding suggests that treatment with denosumab may be associated with severe and aggressive odontoclastic resorption of multiple dental roots despite an adequate inhibitory effect on osteoclasts in the treatment of osteoporosis. The RANKL-independent pathways of clastic cell formation are likely to be involved in this pathological process.
OBJECTIVE: Analyse, compare and evaluate the effects of the treatment arthrocentesis with a control group of non-steroid drugs treated patients. MATERIAL AND METHODS: 1752 outpatients (1293 females, 459 males) were examined within the years 2013-2017. We evaluated the following criteria: gender, age, visual analog scale for pain (VAS), inter-incisal distance and reducing intake of orally administered analgesics. RESULTS: The pain level of the group of patients with arthrocentesis had stabilized at mark 2.5 on the pain scale, unlike in the control group after treatment with non-steroidal anti-infl ammatory drugs, pain had stabilized at mark 9 on the pain scale. The inter incisal distance amongst the fi rst group was 37 mm and in the control group only 27 mm, after completed treatment. The amount of applied analgesics in the group with arthrocentesis decreased to 100 mg daily, while in the control group, the dose was adjusted to 700 mg daily. CONCLUSION: In the observed study, arthrocentesis was effective in reducing pain, amount of analgesics per day and improving the mobility of temporomandibular joint (TMJ). The results of this study we use in the ongoing project, that focuses on progressive and innovative methodology of endoscopically assisted arthrocentesis.
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