Medication-related osteonecrosis of the jaw (MRONJ) is a rare side effect of medications belonging to the antiresorptive (AR) and antiangiogenic (AA) groups. The first cases were described in the literature in 2003, and more than 1300 publications and 15,000 cases have been published since then. The incidence of MRONJ among cancer patients treated with bisphosphonates is 0-6.7%, with denosumab is 0.7-1.7% and with bevacizumab is 0.2%. Patients treated for osteoporosis have a lower risk of developing MRONJ at 0.02 and 0.04% with bisphosphonates and 0.2% with denosumab. In more than 50% of cases, tooth extraction was considered the causative factor responsible for the onset of the MRONJ. Treatment strategies include preventive, medical and surgical interventions.
Guided bone regeneration (GBR) is a common procedure used to rebuild dimensional changes in the alveolar ridge that occur after extraction. In GBR, membranes are used to separate the bone defect from the underlying soft tissue. To overcome the shortcomings of commonly used membranes in GBR, a new resorbable magnesium membrane has been developed. A literature search was performed via MEDLINE, Scopus, Web of Science and PubMed in February 2023 for research on magnesium barrier membranes. Of the 78 records reviewed, 16 studies met the inclusion criteria and were analyzed. In addition, this paper reports two cases where GBR was performed using a magnesium membrane and magnesium fixation system with immediate and delayed implant placement. No adverse reactions to the biomaterials were detected, and the membrane was completely resorbed after healing. The resorbable fixation screws used in both cases held the membranes in place during bone formation and were completely resorbed. Therefore, the pure magnesium membrane and magnesium fixation screws were found to be excellent biomaterials for GBR, which supports the findings of the literature review.
The peri-implant soft tissue (PIS) augmentation procedure has become an integral part of implant-prosthetic rehabilitation. Minimal width of keratinized mucosa (KM) of 2 mm is deemed necessary to facilitate oral hygiene maintenance around the implant and provide hard and soft peri-implant tissue stability. PIS thickness of at least 2 mm is recommended to achieve the esthetic appearance and prevent recessions around implant prosthetic rehabilitation. The autogenous soft tissue grafts can be divided into two groups based on their histological composition—free gingival graft (FGG) and connective tissue graft (CTG). FGG graft is used mainly to increase the width of keratinized mucosa while CTG augment the thickness of PIS. Both grafts are harvested from the same anatomical region—the palate. Alternatively, they can be harvested from the maxillary tuberosity. Soft tissue grafts can be also harvested as pedicle grafts, in case when the soft tissue graft remains attached to the donor site by one side preserving the blood supply from the donor region. Clinically this will result in less shrinkage of the graft postoperatively, improving the outcome of the augmentation procedure. To bypass the drawback connected with FGG or CTG harvesting, substitutional soft tissue grafts have been developed.
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