Non-surgical treatment of adults with chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible

Non-surgical therapy has proved to be effective in chronic diffuse sclerosing osteomyelitis (DSO) of the mandible in children. Therefore we aimed to investigate the effect of non-surgical therapy in adult DSO patients.We included consecutive patients with DSO who received non-surgical therapy in our center. They all received occlusal splint therapy, counselling about the disease, and/or physiotherapy by a specialised team. The use of analgesics, preferably nonsteroidal anti-inflammatory drugs, was advised for symptomatic control during periods of exacerbation.Sixteen patients (11/5 female/male) aged 39.9 ± 15.0 years with DSO of the mandible were included. The mean duration of symptoms was 39.7 ± 26.3 months before referral to our center. Patients were treated with a broad range of treatments before referral. All patients underwent non-surgical treatment. In 12 patients this led to remission. Four patients still had complaints after 12 months of non-surgical therapy and started with intravenous bisphosphonate therapy.In our center, DSO of the mandible was successfully treated with non-surgical therapy, despite a long duration before referral and extensive pre-treatment. Considering this high success rate, we recommend this non-surgical approach as the first treatment option for DSO of the mandible. In case of persistence, alternative treatments such as bisphosphonates should be explored.     

Bisphosphonate therapy in chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible: Retrospective case series

This study aims to evaluate short-term and long-term results of bisphosphonate therapy in patients with diffuse sclerosing osteomyelitis/tendoperiostitis (DSO/TP) of the mandible.Eighteen patients (12 female, 6 male) aged 34.8 ± 22.2 years with DSO/TP of the mandible that were treated with bisphosphonates were included. In 16 patients, the bisphosphonate treatment led to remission with decrease of symptoms (pain, swelling of the cheek, trismus, tenderness of masticatory muscles) with a follow-up period of 4.5 (0.8–11.9) years between start of bisphosphonate treatment and latest follow-up consult. Of these, three patients were still in need of regular bisphosphonate therapy. Two patients were lost to follow-up.Bisphosphonate therapy is a treatment option for DSO/TP of the mandible that is associated with a high chance of remission of symptoms. Within the limitations of the study it seems that this treatment might be an effective second step in DSO/TP refractory to conservative treatment.     

Denosumab as a potential treatment alternative for patients suffering from diffuse sclerosing osteomyelitis of the mandible—A rapid communication

Purpose

Diffuse sclerosing osteomyelitis (DSO) is a rare disease of the jaw bone. Its treatment is challenging. Different medical and surgical treatment protocols have been proposed; however, none of these treatment protocols produce reliable results. Recently, ibandronate administration has been attempted as a treatment alternative in acute cases of DSO. Due to the similar antiresorptive effect, we sought to explore the application of the human monoclonal antibody to the receptor activator of nuclear factor kappaB ligand (RANKL), denosumab, in the treatment of DSO.

Treatment options for mandibular canine transmigration - a case series based on dental literature

The present case series, based on dental literature, aimed to identify factors that influence the final treatment decision for patients affected by mandibular canine transmigration using individual data from case reports in the literature. The protocol used for data synthesis was prepared following the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. An online search was conducted and included studies published up until September of 2019 (MEDLINE, Google Scholar, Scielo, and Conricyt). A chi squared test was used to evaluate associations between the treatment choice and gender, age, Mupparapu classification, and the presence of oral pathologies or dental anomalies (p < 0.05). A multinomial logistic regression was used to evaluate the individual case report data to determine the effect of the explanatory variables for treatment selection. Seventy-six papers fulfilled the inclusion criteria. Surgical removal (46.71%) and radiographic monitoring (38.16%) were the most common treatments reported. Age, Muppararu classification, and the presence of oral pathologies were significantly associated with the treatment option (p < 0.05). In conclusion, surgical removal and radiographic monitoring are the most frequently reported treatments for mandibular canine transmigration. Age, Mupparapu type, presence of oral pathologies, and qualitative aspects such as emotional reasons are relevant for the decision regarding treatment approach.     

The effect of topical fluorides on decalcification in patients with fixed orthodontic appliances: a systematic review.

INTRODUCTION: Decalcification is a significant problem during fixed orthodontic treatment. Topical Fluorides can reduce or eliminate the problem, but the relative effectiveness of different treatments or combinations of topical fluoride preparations is unknown. This systematic review was undertaken to determine the effectiveness of topical fluoride preparations in preventing decalcification during fixed orthodontic treatment. METHODS: A wide search of published and unpublished material in any language was undertaken by using general and specialist databases; key dental journals were searched by hand. Predefined inclusion criteria based on objective outcome measures of decalcification, duration of treatment, presence of a comparison group, and study design were applied to determine study selection. Included studies were double extracted onto pre-designed data extraction sheets. RESULTS AND CONCLUSIONS: By screening titles and abstracts, we identified 143 articles; after the inclusion criteria were applied, 7 reports (of 6 studies) remained. Differences in the methodologies and reporting made statistical analysis impossible. However, the use of topical fluorides in addition to fluoride toothpaste reduced the incidence of decalcification in populations with both fluoridated and non-fluoridated water supplies. Different preparations and formats appear to decrease decalcification, but there was no evidence that any 1 method was superior. There was some evidence that the potency of fluoride preparations might be important.     

Does low birthweight increase the risk of caries? A systematic review.

Low birthweight is a major public health and social problem in the United States. While a long list of mortality and morbidity conditions have been associated with low birthweight, dental conditions have not received much attention. This systematic review addresses this question: Do low-birthweight children (birthweight <2500 grams) subsequently develop more caries than do children with normal-to-high birthweight? The MEDLINE and EMBASE databases were searched for English-language papers published between January 1966 and July 2000 using a search expression developed in conjunction with an experienced librarian. There were 198 papers located in the initial search; a title and abstract review to identify clearly irrelevant papers reduced this number to 37. Two readers each read these papers, and application of predetermined inclusion/exclusion criteria reduced this number to only four papers. Quality criteria were established for scoring each of these papers on evidence tables. The maximum score for each paper was 100; the four papers rated scored between 31 and 61. Results showed that no relationship between low birthweight and subsequent development of caries was reported in any of the four papers. However, conclusions must be cautious because of the scarcity of studies on the subject and the limited scope of the four papers judged. The relationship of low birthweight to subsequent development of caries, especially in the permanent dentition, needs further exploration.     

Disc displacement within the human temporomandibular joint: a systematic review of a ‘noisy annoyance’

To describe the scientific literature about the diagnosis, prevalence, aetiology, natural course and possible treatment modalities of disc displacements within the temporomandibular (TM) joint. PubMed was searched for specific indexing terms. The search yielded 1211 papers. After screening according to title and abstract, 695 papers were excluded, and after full‐text reading, 107 papers remained. Hand‐searching of the reference lists resulted in an extra 47 papers. Thirteen studies, published since the literature search was carried out, were also included, resulting in 167 papers for this review. A disc displacement is a highly prevalent derangement within the TM joint, with reported prevalence ranging from 18% to 35% in the general population. A disc displacement with reduction is mostly a stable, pain‐free and lifelong condition of the joint. In only a small minority of patients, the disc loses its capacity to reduce on opening. Surprisingly, only in rare cases, the loss of disc reduction is accompanied by signs and symptoms of a closed lock (viz. a painful and limited mouth opening). These signs and symptoms have a tendency to reduce and in many cases to resolve within months. The favourable natural course of disc displacements only warrants active treatment for symptomatic disc displacements without reduction. The primary treatment option is a conservative, non‐surgical treatment focusing at speeding up the natural process of alleviation of pain and of improvement in mouth opening. For most patients, a disc displacement is just a pain‐free, lifelong lasting, ‘noisy annoyance’ from their TM joint.     

Prosthetic rehabilitation after osteonecrosis of the jaws due to histiocytosis X and treatment with bisphosphonates apropos of a case

Bisphosphonates are involved in the occurrence of Osteonecrosis of Jaws (ONJ), which is a complication of these treatments. This osteonecrosis concern the alveolar bone and develops generally after an oral surgery. It can however occur spontaneously without preliminary dental extraction. Other risk factors could play potentiates the risk of ONJ. This osteonecrosis results in an osseous exposure in patient treated or having been treated by bisphosphonates, without any cervico-facial irradiation. Actually, no treatment has been the proof of its effectiveness. Preventives measures of ONJ in oral cavity are the best method before, during and after administration of bisphosphonates. In this article, we present the clinical case of a patient with histiocytois treated by bisphosphonates and having developed ONJ. The selection criteria of the prosthetic rehabilitation as well as the techniques used are detailed.     

Effect of instrumentation systems on endotoxin reduction from root canal systems: A systematic review of clinical studies and meta‐analysis

This systematic review assessed the effect of different root canal instrumentation systems on endotoxin reduction from the root canal system. The literature search was conducted in two electronic databases (PubMed and Scopus) using specific key words. The search strategy followed the PRISMA guidelines. Qualitative synthesis and quantitative synthesis of the data were performed and data interpretation was done based on the guidelines in the Cochrane Handbook. The risk of bias was assessed using Cochrane criteria. The initial search yielded 600 citations, of which three papers met the criteria for inclusion in this review. Studies showed a significant reduction in endotoxin following rotary and reciprocating instrumentation, with no significant differences between them. The meta‐analysis showed no statistical significant difference between reciprocation and rotary files (P > 0.05). In conclusion, the instrumentation techniques compared in this review decrease endotoxin content from root canals, with no significant difference between them.     

Recurrence rate of odontogenic myxoma after different treatments: a systematic review

Our aim was to establish the recurrence rate of odontogenic myxoma after different treatments. Our search covered papers from 1972-2017 from different sources. The papers were evaluated and critically appraised by two independent investigators. The recurrence rate and 95% CI were calculated in relation to each specific treatment, and the chi squared test was calculated to find out if there was any significant difference in the recurrence rate between conservative treatment and resection. The overall recurrence rate was 5 of 39 patients (13%) during a mean follow up period of 10 years. With conservative treatment the recurrence rate was 4/22 (19%) (mean follow up 11 years) and after resection it was 1/17 (6%) (mean follow up nine years). Maxillary lesions were more likely to recur than mandibular ones. Quality of life variables such as disfigurement and neural deficit were more common after resection than with conservative treatment. The frequency of recurrence was relatively low over 10 years’ follow up, irrespective of whether resection or a more conservative approach was used, despite being slightly lower (as might be expected) after resection. Conservative treatment should be considered first to avoid resection-associated morbidity and the effect on the quality of life. Maxillary lesions have more room to spread before they are clinically evident, making them difficult to treat optimally and contributing to the recurrence rate.     

Bisphosphonate-associated osteonecrosis of the jaw: what do we currently know? A survey of knowledge given in the recent literature

Increasing application of bisphosphonates for therapy of osteopathies has led to reports of the severe associated adverse effects of osteonecrosis of the jaw (ONJ). We reviewed recent literature to assess several aspects of bisphosphonate-associated ONJ, and to provide healthcare professionals with an overview of treatment and preventive options. Literature databases were searched using keywords. Information of 54 articles were discussed and completed by additional literature. High-risk factors were application of nitrogen-containing bisphosphonates, teeth extractions, and ill-fitting dentures. Treatment included non-surgical options and radical surgery. Success and failure were described for all treatment options; further studies investigating long-term recovery and recurrence are warranted. Paying attention to effective prevention of ONJ before, during, and after treatment is essential.     

The use of acupuncture in dentistry: a review of the scientific validity of published papers

OBJECTIVE: To review the scientific validity of published papers on the efficacy of acupuncture in dentistry based on predefined methodological criteria. MATERIALS: A literature search performed by the Royal Society of Medicine and the University Library, Copenhagen, Denmark was able to identify 74 papers written in English, German, Danish, Swedish, Norwegian, Italian, French and Russian published between 1966 and 1996. The search words were: acupuncture and electro-acupuncture, randomised controlled trials (RCT), dental pain, postoperative dental pain, painrelieving in dentistry, and dental analgesia. Among the 74 listed papers, 48 papers were reviewed in the following languages: English, Danish, Swedish, Norwegian and German. Fifteen papers were excluded because they were written in French, Italian or Russian; 11 papers were excluded because the abstract clearly indicated the paper was not a RCT or the paper was of a general nature without relevance to acupuncture.
METHODS: To assess the methodological quality of the included papers, all papers were scored on the basis of predefined criteria. A total of 92 points could be achieved and on the basis of this scale papers were rated as: Excellent (85–100%), Good (70–84%), Fair (60–69%) and Bad (<60%).
MAIN OUTCOME: Fifteen out of 48 papers met the inclusion criteria.
RESULTS: Only one study met the criteria with more than 85%. Five studies met the criteria with 70–84%. Three studies met the criteria with 60–69%. Six studies did not meet the criteria. Acupuncture in 11 out of 15 studies proved effective in the treatment of tempero-mandibular dysfunction (TMD) and as analgesia. Four studies showed no effect of acupuncture.
CONCLUSION: The value of acupuncture as an analgesic must be questioned. The effect of acupunctutre in treating TMD and facial pain seems real and acupuncture could be a valuable alternative to orthodox treatment.     

Is flapless implant surgery a viable option in posterior maxilla? A review

This article reviews the literature on the outcome of flapless surgery for dental implants in the posterior maxilla. The literature search was carried out in using the keywords: flapless, dental implants and maxilla. A hand search and Medline search were carried out on studies published between 1971 and 2011. The authors included research involving a minimum of 15 dental implants with a follow-up period of 1 year, an outcome measurement of implant survival, but excluded studies involving multiple simultaneous interventions, and studies with missing data. The Cochrane approach for cohort studies and Oxford Centre for Evidence-Based Medicine were applied. Of the 56 published papers selected, 14 papers on the flapless technique showed high overall implant survival rates. The prospective studies yielded 97.01% (95% CI: 90.72-99.0) while retrospective studies or case series illustrated 95.08% (95% CI: 91.0-97.93) survival. The average of intraoperative complications was 6.55% using the flapless procedure. The limited data obtained showed that flapless surgery in posterior maxilla areas could be a viable and predictable treatment method for implant placement. Flapless surgery tends to be more applicable in this area of the mouth. Further long-term clinical controlled studies are needed.     

Short implants (≤8 mm) compared to standard length implants (>8 mm) in conjunction with maxillary sinus floor augmentation: a systematic review and meta-analysis

The objective was to test the hypothesis of no difference in the treatment outcome after the installation of short implants (≤8 mm) in the posterior part of the maxilla compared to standard length implants (>8 mm) in conjunction with maxillary sinus floor augmentation (MSFA) using the lateral window technique, after an observation period of ≥3 years. A search of the MEDLINE, Embase, and Cochrane Library databases, in combination with a hand-search of relevant journals, was conducted. The search yielded 1102 titles. Finally, three studies that fulfilled the inclusion criteria were included. All were considered to have a low risk of bias. Meta-analyses revealed no significant differences in implant survival or peri-implant marginal bone loss between the two treatment modalities. However, the use of standard length implants in conjunction with MSFA was characterized by a tendency towards more peri-implant marginal bone loss. There was no statistically significant difference between the two treatment modalities with regard to overall patient satisfaction. Short implants seem to be a suitable alternative to standard length implants in conjunction with MSFA. However, further randomized controlled trials with larger patient samples and an observation period of more than 3 years are needed before one treatment modality might be considered superior to the other.     

Effectiveness of different treatments for odontogenic keratocyst: a network meta-analysis

Odontogenic keratocysts (OKC) are benign but aggressive lesions. As there is a lack of well randomized clinical studies assessing the effectiveness of the different treatment options for OKC, a network meta-analysis (NMA) was performed to identify the best treatment option with the lowest recurrence rate. An electronic search was performed following the PRISMA guidelines to identify all clinical studies comparing treatment options against enucleation alone. The outcome variable was recurrence. The predictor variables were treatments. The eight included treatments were: enucleation with peripheral ostectomy/curettage (E + PO/curettage); enucleation with cryotherapy (E + CRYO); enucleation with/without PO followed by modified Carnoy’s solution (E ± PO+MCS); enucleation with PO and with topical 5-fluorouracil (E + PO+5FU); enucleation with/without PO followed by original Carnoy’s solution (E ± PO+CS); marsupialization alone (MARS); marsupialization followed by secondary enucleation with/without PO (MARS+2°E ± PO); and resection. The odds ratio was used to estimate the recurrence rate. A frequentist NMA was performed using Stata software. A total of 2989 patients in 40 studies were included. Both direct pairwise meta-analysis and NMA showed that E + 5FU+PO was significantly superior to E ± PO+MCS. However, no statistically significant difference was found between E ± PO+CS vs E + 5FU+PO, E ± PO+MCS, and resection, respectively (all very low quality evidence). The three most effective treatments in reducing the recurrence rate were E + PO+ 5FU (98.1%; very low quality evidence), resection (83.5%; very low quality evidence), and E ± PO+CS (63.8%; moderate quality evidence). The findings from this study suggest that CS remains the most effective fixative agent after enucleation and PO until proven otherwise. Additionally, 5FU appears to be an effective method with promising results that needs further research. Finally, the efficacy of MCS remains controversial; further in vivo and in vitro studies are required to determine new protocols. As this NMA included retrospective studies, the results should be interpreted with great caution (level of evidence: type III).     

Bisphosponates and dental implants: a case report and a brief review of literature

This paper reports a brief review of literature about dental implant in patients taking bisphosphonates (BPs) and a case of a patient taking zoledronate, submitted to postextractive implant surgery. A 54-years-old woman was referred to our observation, at the First Section of Dentistry of Department of Medical-Surgical Specialties, University of Catania. The patient, affected by multiple myeloma, reported being subjected to implant surgery, during the administration of zoledronate. Clinical and radiographic evaluations showed an area of BPs-related osteonecrosis in the only postextraction site where no implant was positioned. From this brief review of literature, we can conclude that the risk of bisphosphonates-related osteonecrosis and of implant failure in patients taking oral bisphosphonates may be low. This is a unique case of implant surgery in patient taking intravenous bisphosphonates. For that, we cannot conclude that implant surgery is safe in patients taking intravenous bisphosphonates or that the immediate implant placement following extraction may prevent the osteonecrosis. According to guidelines of AAOMS, to date any kind of surgical procedure involving alveolar bone in patients treated with itravenous BPs is contraindicated. More studies would be needed to optimize the clinical guidelines for the treatment of patients taking BPs.     

Timing of arthrocentesis in the management of temporomandibular disorders: an integrative review and meta-analysis

The aim of this study was to assess the best timing to perform arthrocentesis in the management of temporomandibular disorders with regard to conservative treatment. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, reference list search, and manual search was performed. Relevant articles were selected after three search rounds for final review based on six predefined inclusion criteria, followed by a round of critical appraisal. Eleven publications, including eight randomized controlled trials and three prospective clinical studies, were included in the review. The studies were divided into three groups based on the timing of arthrocentesis: (1) arthrocentesis as the initial treatment; (2) early arthrocentesis; and (3) late arthrocentesis. Meta-analysis was carried out to compare the efficacy of improvement in mouth opening and pain reduction in the three groups. All three groups showed improvement in mouth opening and pain reduction, with forest plots suggesting that arthrocentesis performed within 3 months of conservative treatment might produce beneficial results. We conclude that there is a knowledge gap in the current literature regarding the preferable timing to perform arthrocentesis in the management of temporomandibular disorders, and more high-quality randomized controlled trials are required to shed light on this subject.     

Patient‐reported outcome measures in burning mouth syndrome – a review of the literature

Oral Diseases (2013) 19 , 230–235 This review aims to investigate the patient‐reported outcomes currently used in the burning mouth syndrome literature and to explore whether any standardisation of such measures has taken place. Electronic databases were searched for all types of burning mouth syndrome studies using patient‐reported outcome measures. Studies were selected by predefined inclusion criteria. Copies of the papers obtained were thoroughly reviewed. A study‐specific data extraction form was used, allowing papers to be reviewed in a standardised manner. The initial literature search yielded a total of 173 citations, 43 of which were deemed suitable for inclusion in this study. Symptom severity and symptomatic relief were reported as a patient‐reported outcome measure in 40 of the studies and quantified most commonly using a visual analogue scale. Quality of life was reported in 13 studies included in this review. Depression and/or anxiety was reported in 14 of the studies. As is evident from the variety of questionnaires and instruments used in the evaluation of the impact of burning mouth syndrome on patients’ lives, no standardisation of patient outcomes has yet been achieved.     

The hierarchy of different treatments for arthrogenous temporomandibular disorders: A network meta-analysis of randomized clinical trials

PurposeDifferent treatment options for patients with arthrogenous Temporomandibular Disorders (TMDs) have been reported. However, evidence regarding the most effective intervention using network meta-analysis (NMA) has not been performed. Thus, we conducted a NMA of randomized clinical trials (RCTs) to identify the most effective treatment of arthrogenous TMDs with respect to pain reduction and improved mouth opening, and to generate a ranking according to their effectiveness.Material and methodsAn electronic search on three major databases was undertaken to identify RCTs published before August 2019, comparing up to fourteen different treatments against control/placebo patients for arthrogenous TMDs with respect to pain reduction and improved mouth opening. The treatment variables were controls/placebo, conservative treatment (muscle exercises and occlusal splint therapy), occlusal splint therapy alone, intraarticular injection (IAI) of hyaluronic acid (HA) or corticosteroid (CS), arthrocentesis with or without HA, CS and platelet-rich plasma (PRP), arthroscopy with or without HA and PRP, open joint surgery, and physiotherapy. Frequentist NMA was performed using STATA software. Studies meeting the inclusion criteria were divided according to the length of follow-up (short-term (≤5 months) and intermediate-term (≥6 months to 4 years) and type of TMJ arthrogenous disorders; internal derangement (ID) and TMJ osteoarthritis (OA). The standardized mean differences (SMD) in post-treatment pain reduction and maximum mouth opening (MMO) were analysed.ResultsThirty-six RCTs were identified that performed comparative outcome assessments for pain and 33 RCTs for MMO. At the short term (≤5 months), IAI-HA (SMD = −2.8, CI: −3.7 to −1.8) and IAI-CS (SMD = −2.11, CI: −2.9 to −1.2) (all very low quality evidence) achieved a substantially greater pain reduction than control/placebo.At intermediate term (≥6 months), a statistically significant decrease in posttreatment pain intensity was observed following Arthroscopy-PRP (SMD = −3.5, CI: −6.2 to −0.82), Arthrocentesis-PRP (SMD = −3.08, CI: −5.44 to −0.71), Arthroscopy-HA (SMD = −3.01, CI: −5.8 to −0.12), TMJ surgery (SMD = −3, CI: −5.7 to −0.28), IAI-HA (SMD = −2.9, CI: −4.9 to −1.09) (all very low quality evidence), Arthroscopy-alone (SMD = −2.6, CI: −5.1 to −0.07, low quality evidence) and Arthrocentesis-HA (SMD = −2.3, CI: −4.5 to −018, moderate-quality evidence) when compared to the control/placebo groups.Relative to MMO, the most effective treatments for short- and intermediate-term improvement were the arthroscopy procedures (PRP > HA > alone, all very low-quality evidence) followed by Arthrocentesis-PRP (very low-quality evidence) and Arthrocentesis-HA (moderate-quality evidence).The non-invasive procedures of occlusal splint therapy, physical therapy, conservative therapy, placebo/control provided significantly lower quality outcomes relative to pain and MMO.ConclusionThe results of the present meta-analysis support a paradigm shift in arthrogenous TMJ disorder treatment. There is a new evidence (though on a very low to moderate quality level) that minimally invasive procedures, particularly in combination with IAI of adjuvant pharmacological agents (PRP, HA or CS), are significantly more effective than conservative treatments for both pain reduction and improvement of MMO in both short (≤5 months) and intermediate term (6 months–4 years) periods. In contrast to traditional concepts mandating exhaustion of conservative treatment options, minimally invasive procedures, therefore, deserve to be implemented as efficient first-line treatments (e.g. IAIs and/or arthrocentesis) or should be considered rather early, i.e. as soon as patients do not show a clear benefit from an initial conservative treatment.