Factors associated with the diagnosis, aetiology, and treatment of mandibular fractures occurring during the postoperative period following the removal of a lower third molar are discussed. The following databases were searched using specific key words: PubMed/MEDLINE, LILACS, Embase, and Scopus. The search yielded 124 cases. Sex, age, side, tooth position and angulation, bone impaction, relationship between the tooth and the inferior alveolar nerve, local pathological conditions, aetiology of the fracture, symptomatology, and time between surgery and fracture, as well as any displacement of the fracture and the treatment of the fracture, were evaluated. Data were tabulated and the χ statistical test was applied (P<0.05). Male patients aged >35 years, with teeth in positions II/III and B/C, complete bony impaction, and local bone-like alterations, were found to have a higher frequency of fracture and pericoronitis (P<0.05). Late fractures generally occurred between the second and fourth postoperative weeks (P<0.05). They were generally not displaced and the typical treatment was the non-surgical approach (P<0.05). It is concluded that the risk of mandibular fracture after extraction is associated with excessive ostectomy and/or local alterations. At-risk patients should be thoroughly briefed on the importance of a proper postoperative diet.

IntroductionOsteonecrosis of the jaws associated with the use of bisphosphonates is one of the most serious complications of long-term therapy with bisphosphonates associated to oral surgical procedures, such as dental implants placement.1 Osteonecrosis is defined as bone exposure in the maxillofacial region that does not heal within 8 weeks after its identification. It is associated with the use of an antiresorptive agent (bisphosphonate or denosumab), without history of radiation therapy for the craniofacial region.2 The treatment of this condition is extremely difficult. Currently, antibiotic therapy, minimally invasive surgery, and lower-level laser therapy (LLLT) during the early stages have been considered the gold standard for medication-related osteonecrosis of the jaw (MRONJ). Case PresentationA 65-year-old female patient was referred to the oral and maxillofacial surgery team from Araçatuba Dental School 2 months after a dental implant installation, complaining about its mobility. During anamnesis, hypertension and diabetes were reported, both controlled by daily medication, and use of alendronate (70 mg/d for 5 years) for prevention of osteoporosis. The clinical examination showed an accentuated mobility of the dental implant in the region of tooth 16, bone exposure in the periimplant region with vestibular and palatal extensions, purulent secretion and bad odor, and absence of remission of signs and symptoms ( Figure 1A). After careful evaluation of the medical history and clinical examination, stage 2 MRONJ was diagnosed, characterized by the presence of exposure and necrotic bone associated with symptomatic infection and purulent discharge. The treatment proposed for this case was the implant removal ( Figure 1B), followed by the initiation of 3 sessions per week of LLLT in the area of necrosis over 8 weeks, associated with administration of clindamycin (300 mg every 8 houes) and regular mouthwash with chlorhexidine 0.12% for the same period. An InGaAlP laser was used (Photon lase, DMC; wavelength 810 nm, power 100 mW, frequency 50/60 Hz, and power density 0.3-0.5 W/cm²). The "alveolitis" program was used, corresponding to 50 J/cm² and applied at 3 points of the lesion (distobuccal, mesiobuccal, and palatal), 1-2 mm from the tissue, 3 times in each spot for Case Report This study aimed to report a case of medication related osteonecrosis of the jaw (MRONJ) of a 65-year-old female patient referred to the Oral and Maxillofacial Surgery team from Araçatuba Dental School, complaining about mobility of a previously dental implant placed on the posterior maxillary region. Clinical examination revealed an extensive necrosis area around the implant region. The patient reported bisphosphonate therapy with sodium alendronate for prevention of osteoporosis 5 years ago. A diagnosis of MRONJ was reached and the treatment decided was to remove the dental implant damaged and use the lower-level laser therapy (LLLT) associated with antibiotic therapy with clindamycin 300 mg and mouth rinses with chlorhexidine 0.1...

Based on the results of our review, we concluded that the use of rhBMP-2 for the preservation of the alveolar ridge after tooth extraction or for increasing the local defects is safe and viable. The use of rhBMP-2/Bio-Oss® for the elevation of the maxillary sinus membrane is unnecessary; however, it can improve and accelerate the maturation process in cases of guided bone regeneration in peri-implant defects. Compounds comprising rhBMP-2, allogenic bone, and plasma-rich platelet (PRP) can act as autograft substitutes in mandibular critical defects.

Regarding the superiority of raloxifene observed in the improvement of bone dynamics response, this statement suggests that raloxifene could be a good option for osteoporosis patients in oral rehabilitation procedures.

Guided bone regeneration was studied to establish protocols and develop new biomaterials that revealed satisfactory results. The present study aimed to comparatively evaluate the efficiency of the bacterial cellulose membrane (Nanoskin®) and collagen membrane Bio-Gide® in the bone repair of 8-mm critical size defects in rat calvaria. Seventy-two adult male rats were divided into three experimental groups (n = 24): the CG—membrane-free control group (only blood clot, negative control), BG—porcine collagen membrane group (Bio-Guide®, positive control), and BC—bacterial cellulose membrane group (experimental group). The comparison periods were 7, 15, 30, and 60 days postoperatively. Histological, histometric, and immunohistochemical analyses were performed. The quantitative data were subjected to 2-way ANOVA and Tukey’s post-test, and p < 0.05 was considered significant. At 30 and 60 days postoperatively, the BG group showed more healing of the surgical wound than the other groups, with a high amount of newly formed bone (p < 0.001), while the BC group showed mature connective tissue filling the defect. The inflammatory cell count at postoperative days 7 and 15 was higher in the BC group than in the BG group (Tukey’s test, p = 0.006). At postoperative days 30 and 60, the area of new bone formed was greater in the BG group than in the other groups (p < 0.001). Immunohistochemical analysis showed moderate and intense immunolabeling of osteocalcin and osteopontin at postoperative day 60 in the BG and BC groups. Thus, despite the promising application of the BC membrane in soft-tissue repair, it did not induce bone repair in rat calvaria.