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Osteonecrosis of the jaw (ONJ) is associated with high-dose bisphosphonate therapy in patients with cancer, and has also been linked to bisphosphonate use in patients with osteoporosis. In this Review, the authors examine the epidemiology and pathogenesis of ONJ. Osteonecrosis of the jaw (ONJ) is defined as exposed bone in the oral cavity that persists despite appropriate therapy. Over the past decade, ONJ has been reported in about 5% of patients with cancer receiving high-dose intravenous bisphosphonates, and more recently in similar patients treated with denosumab, another potent inhibitor of osteoclastic bone resorption. The condition has also been described in patients treated with bisphosphonates for benign diseases, such as osteoporosis, but whether bisphosphonates or denosumab increase the incidence above that seen in untreated patients of comparable age and frailty is yet to be established. The pathogenesis of ONJ is uncertain: the toxic effects of bisphosphonates in a wide variety of cells could increase susceptibility to infections in the oral cavity or impair mucosal healing, and denosumab might interfere with monocyte and macrophage function. Local osteolysis is an important defense against infection on bone surfaces that is blocked by both bisphosphonates and denosumab. Preventive dentistry prior to high-dose antiresorptive therapy is a critical measure in cancer patients, but is not usually justified in patients with osteoporosis. The management of established ONJ lesions is problematic: the greatest success seems to come from vigorous antimicrobial therapy with judicious use of surgical debridement. Key Points Osteonecrosis of the jaw (ONJ) is defined as the presence of exposed bone in the mouth that persists despite appropriate therapy ONJ is primarily a problem encountered in patients with cancer receiving high-dose intravenous bisphosphonates for the prevention of skeletal-related events, of whom about 5% develop the condition ONJ has now been reported at a similar frequency in patients with cancer treated with denosumab, a monoclonal antibody against RANKL ONJ has also been reported in patients treated with bisphosphonates for osteoporosis, but it is not yet established whether bisphosphonates increase the incidence above that seen in untreated patients of comparable age and frailty The pathogenesis of ONJ is uncertain, but local toxicity from bisphosphonates or blockade of the normal osteolytic response to infection on a bone surface might be important factors Preventive dentistry prior to initiation of high-dose antiresorptive therapy is important in patients with cancer, but is not usually justified in patients with osteoporosis

Patients with chronic periodontitis underwent periodontal surgery and received daily injections of teriparatide or placebo. The primary outcome was radiographic linear resolution of alveolar bone defects. Teriparatide was associated with improved outcomes. Periodontitis affects more than one in five American adults, is a major cause of tooth loss, and is associated with systemic disorders such as diabetes mellitus, preterm low birth weight, and cardiovascular disease. 1 – 5 Therefore, the development of predictable procedures to regenerate oral bone that is lost owing to developmental defects, trauma, or disease is desirable. A systemic anabolic agent to promote oral bone regeneration would be useful. Teriparatide, which consists of the first 34 amino acids of parathyroid hormone, is an anabolic agent approved by the Food and Drug Administration for the treatment of osteoporosis. Multiple clinical trials have . . .

Fatty degenerative osteonecrosis of the jaw (FDOJ) is a chronic, aseptic inflammatory condition that is characterized by molecular disruptions in bone metabolism and necrotic bone marrow within the jawbone cavities. In contrast to the overt clinical signs typically observed in osteopathies, FDOJ frequently presents with a “silent inflammation” phenotype. The electronic databases PubMed, Scopus, and Embase were searched using appropriate search terms, and the methodology was performed according to PRISMA-ScR guidelines. The elevated expression of inflammatory mediators, particularly C-C motif Chemokine Ligand-5/Regulated on Activation, Normal T Cell Expressed and Secreted (CCL5/RANTES), fibroblast growth factor-2, and interleukin-1 receptor antagonist, distinguishes FDOJ at the molecular level and links it to systemic inflammatory and autoimmune diseases. These immunohistochemical markers play a pivotal role in the pathogenesis of chronic inflammation, immune response regulation, and abnormal bone remodeling. Advanced diagnostic tools, such as conebeam computed tomography and trans-alveolar ultrasonography, facilitate the detection of pathological changes that are not easily discernible with conventional radiography. Surgical intervention remains the primary treatment modality, often complemented by therapies that target these molecular pathways to modulate chronic inflammation. This article underscores the importance of integrating molecular diagnostics, advanced imaging, and clinical data for effective FDOJ detection and management.

Development of quantitative analysis software has enabled application of several standardised uptake values (SUV) for bone analysis in single photon emission computed tomography (SPECT). The present retrospective study aimed to develop a reliable method of monitoring bone inflammatory activity in antiresorptive agent-related osteonecrosis of the jaw (ARONJ) using SPECT quantitative analysis software. Fifteen ARONJ patients underwent SPECT before and after anti-inflammatory therapy. We calculated the mean maximum SUV (SUVmax) of the bilateral cranial bones using quantitative analysis software and used this as the control [C]. We attempted to adjust the SUVmax of the lesion [L] as follows: adjusted SUVmax ( aSUVmax ) = [ L ] − [ C ] . The optimum threshold to calculate the metabolic bone volume (MBV) (cm 3 ) was [C] + 3. The threshold values obtained for each case were input to calculate MBV at each osteomyelitis site. Retrospectively, we compared aSUVmax and MBV of each patient’s ARONJ before and after anti-inflammatory therapy. The patients’ high aSUVmax or large MBV of the ARONJ reduced rapidly, reflecting individual clinical findings after treatment. Application of SPECT quantitative analysis software to monitor bone inflammatory activity in ARONJ could improve the prognosis-deciding abilities of clinicians and enable them to treat ARONJ effectively.

Background Medication-related osteonecrosis of the jaw (MRONJ) is an infrequent, but potentially serious, adverse event that can occur after exposure to bone-modifying agents (BMAs; e.g., bisphosphonates, denosumab, and antiangiogenic therapies). BMAs are typically used at higher doses to prevent skeletal-related events in cancer patients and at lower doses for osteoporosis/bone loss. MRONJ can cause significant pain, reduce quality of life, and can be difficult to treat, requiring a multiprofessional approach to care. Methods We reviewed the literature and guidelines to summarize a practical guide on MRONJ for nurses and other allied healthcare professionals. Results While there is a risk of MRONJ with BMAs, this should be considered in relation to the benefits of treatment. Nurses and other allied healthcare professionals can play a key role alongside physicians and dentists in assessing MRONJ risk, identifying MRONJ, counseling the patient on the benefit–risk of BMA treatment, preventing MRONJ, and managing the care pathway of these patients. Assessing patients for MRONJ risk factors before starting BMA treatment can guide preventative measures to reduce the risk of MRONJ. Nurses can play a pivotal role in facilitating multiprofessional management of MRONJ by communicating with patients to ensure compliance with preventative measures, and with patients’ physicians and dentists to ensure early detection and referral for prompt treatment of MRONJ. Conclusions This review summarizes current evidence on MRONJ and provides practical guidance for nurses, from before BMA treatment is started through to approaches that can be taken to prevent and manage MRONJ in patients receiving BMAs.

Odontogenic cysts and osseous lesions are often seen as challenging diagnostic lesions but the majority of them are easily classified. This article outlines the diagnostic features required for separating the most common of odontogenic cysts and select osseous lesions of the jaws. Clinical and radiographic findings of these jaw lesions often lead to a differential diagnosis that only the histologic findings will clarify. Dentigerous cyst, keratocystic odontogenic tumor, and certain ameloblastomas that have cystic change, may have identical radiographic findings, with only separation by their specific histologic features leading to the significantly different treatments required for each. Conversely, some cystic lesions can appear histologically identical and cannot be diagnosed without the radiographic findings. Certain osseous lesions of the jaws are particularly problematic for diagnosis without the appropriate radiographic findings, and the diagnosis should probably not be attempted on the histologic findings alone. This article will integrate the necessary clinical, radiographic, and histologic findings required to address the most common odontogenic lesions.

This retrospective study evaluated changes in lesion bone density and volume in medication-related osteonecrosis of the jaw (MRONJ) using cone-beam computed tomography (CBCT) at different disease stages following conservative and surgical treatment. Additionally, the study analyzed the correlations between these changes and influencing factors. A total of 54 patients (mean [SD] age, 75.43 [7.44] years) diagnosed with stage 0, 1, 2, or 3 MRONJ, according to the American Association of Oral and Maxillofacial Surgeons’ guidelines, were included. Pre- and post-treatment CBCT images were superimposed to identify the lesion locations, and lesions were segmented manually using ITK-SNAP software. Lesion mean bone density and volume before and after treatment were calculated. Stage 0–1 lesions showed a 16.8% reduction in bone density and a 17.0% reduction in volume and, while stage 2–3 lesions exhibited a 20.8% increase in bone density and a 46.0% reduction in volume ( P  < 0.05). In conclusion, stage 2–3 lesions demonstrated better healing outcomes than stage 0–1 lesions. Notably, conservative treatment may potentially benefit from a longer drug holiday, while surgical treatment showed positive effects on both soft and hard tissues in stage 2–3 lesions, regardless of the drug holiday duration.

Background Periodontitis, which progressively destroys tooth-supporting structures, is one of the most widespread infectious diseases and the leading cause of tooth loss in adults. Evidence from preclinical trials and small-scale pilot clinical studies indicates that stem cells derived from periodontal ligament tissues are a promising therapy for the regeneration of lost/damaged periodontal tissue. This study assessed the safety and feasibility of using autologous periodontal ligament stem cells (PDLSCs) as an adjuvant to grafting materials in guided tissue regeneration (GTR) to treat periodontal intrabony defects. Our data provide primary clinical evidence for the efficacy of cell transplantation in regenerative dentistry. Methods We conducted a single-center, randomized trial that used autologous PDLSCs in combination with bovine-derived bone mineral materials to treat periodontal intrabony defects. Enrolled patients were randomly assigned to either the Cell group (treatment with GTR and PDLSC sheets in combination with Bio-oss ® ) or the Control group (treatment with GTR and Bio-oss ® without stem cells). During a 12-month follow-up study, we evaluated the frequency and extent of adverse events. For the assessment of treatment efficacy, the primary outcome was based on the magnitude of alveolar bone regeneration following the surgical procedure. Results A total of 30 periodontitis patients aged 18 to 65 years (48 testing teeth with periodontal intrabony defects) who satisfied our inclusion and exclusion criteria were enrolled in the study and randomly assigned to the Cell group or the Control group. A total of 21 teeth were treated in the Control group and 20 teeth were treated in the Cell group. All patients received surgery and a clinical evaluation. No clinical safety problems that could be attributed to the investigational PDLSCs were identified. Each group showed a significant increase in the alveolar bone height (decrease in the bone-defect depth) over time ( p  < 0.001). However, no statistically significant differences were detected between the Cell group and the Control group ( p  > 0.05). Conclusions This study demonstrates that using autologous PDLSCs to treat periodontal intrabony defects is safe and does not produce significant adverse effects. The efficacy of cell-based periodontal therapy requires further validation by multicenter, randomized controlled studies with an increased sample size. Trial Registration NCT01357785 Date registered: 18 May 2011.