Giant cell-rich osteosarcoma or giant cell reparative granuloma of the mandible?

Giant cell-rich osteosarcoma (GCRO) is a rare subtype of osteosarcoma, and no literature has reported occurrence in the mandible region up to now. In this article, we report a case of GCRO originating from the mandible in a 67-year-old woman who presented a history of painless mass located in the left side of the mandible after teeth extraction. The curettage biopsy histologic diagnosis is giant cell reparative granuloma before mandibulectomy surgery, but panoramic radiograph revealed an osteolytic lesion. The tumor was completely resected with segmental mandibulectomy and soft tissue with postoperative histologic diagnosis of GCRO. The free fibula osteomyocutaneous flap was performed to reconstruct the defect of the mandible and gingival mucosa. The patient received postoperative radiotherapy and chemotherapy. The 1-year follow-up situation is fine.     

Treatment of pathologic fractures of the mandible in stage III medication-related osteonecrosis of the jaw—an observational study

Purpose

The treatment of pathologic fractures in stage III medication-related osteonecrosis of the jaw (MRONJ) remains challenging. The treatment in the literature is controversial, varying from extensive and aggressive surgery with resections and musculocutaneous free flap reconstruction to conservative treatment with only mouth rinses and/or antimicrobial treatment. The purpose of this study was to analyse the results of the treatment protocol in the Leiden University Medical Center in the Netherlands.

Is there an asymmetry of the condylar and coronoid processes of the mandible in individuals with unilateral crossbite?

Objectives:To evaluate if there is a true skeletal asymmetry of the condylar and coronoid processes of the mandible in growing individuals with unilateral posterior crossbite (UPC) either functional or not.Materials and Methods:This cross-sectional study screened a total of 1120 cone beam computed tomography (CBCT) scans based on inclusion and exclusion criteria. The final sample comprised 20 CBCT images of individuals with UPC and 19 CBCT images of individuals without transverse malocclusion. The lengths of the condylar and coronoid processes were measured to evaluate asymmetry, as well as the magnitude of the mandibular lateral deviation in the UPC group.Results:There was a significant difference between the lengths of the affected and nonaffected sides of the coronoid processes in the UPC group (P < .01). The same was not observed in the condyle in the UPC group (P > .05). There were no significant differences between the groups (P > .05).Conclusions:Although no differences in the condyle were observed, the coronoid process was asymmetric in individuals with UPC. However, this asymmetry was not considered to be clinically significant.     

Postoperative radiographs after open reduction and internal fixation of the mandible: are they useful?

Mandibular fractures are common in oral and maxillofacial departments in the UK. The aim of this study was to find out the national practice in preoperative and postoperative radiographic investigations for fractured mandibles and to audit their diagnostic capacity, including specificity and sensitivity to short-term complications. The audit took place over a 4-month period and involved 100 patients across the Northern region. Ninety percent of patients were reviewed up to discharge and five of these patients developed a short-term postoperative complication. The postoperative radiograph was diagnostic in only one of the five cases. Overall, postoperative radiographs had a sensitivity of 20% and a specificity of 5% in their ability to predict short-term postoperative complications.     

Removal of patient-specific reconstruction plates after mandible reconstruction with a fibula free flap: is the plate the problem?

Computer-aided microvascular mandible reconstruction is an increasingly common procedure in oral and maxillofacial surgery. The aim of this retrospective single-centre study was to evaluate the rate and specifics of hardware removal after fibula free flap (FFF) fixation with a patient-specific reconstruction plate. The study included patients who underwent hardware removal between April 2017 and October 2019. Statistical analyses were performed regarding the different indications for plate removal (dental implantation versus complication) and the surgical approach (intraoral versus extraoral). Plate removal was performed in 29 of 98 patients (29.6%) after FFF fixation with a patient-specific reconstruction plate. Plate removal was done prior to dental implantation in 58.6% of cases and due to complications in 41.4%. Complications seen between reconstructive surgery and plate removal were less frequent in the dental rehabilitation group (8/17 vs 12/12; P = 0.002). Within this group, 35.3% of plates were removed intraorally, and the majority of partial plate removals were performed in the patients with plate removal for dental rehabilitation (72.7% vs 27.3%). Hospitalization was shorter with an intraoral approach (1.7 days vs 4.0 days, P = 0.052). The removal of patient-specific reconstruction plates prior to dental implantation is often partial and can be performed intraorally. The use of patient-specific miniplates for fixation of FFF might facilitate later dental rehabilitation.     

Modelling growth curves of the normal infant’s mandible: 3D measurements using computed tomography

Clinical Oral Investigations - Data on normal mandibular development in the infant is lacking though essential to understand normal growth patterns and to discriminate abnormal growth. The aim of...     

The anchorage of Brånemark and ITI implants of different lengths. I. An experimental study in the canine mandible

Abstract: The anchorage of machined Brånemark and ITI TPS‐coated implants of various lengths was investigated in an animal model. Brånemark fixtures 7 and 10 mm long and ITI implants 6 and 10 mm long were inserted in the mandible of dogs and were reverse‐torqued after 3 months of healing. The failing mode was different for the two implant systems. For the ITI implants, loosening coincided with the peak reverse‐torque values. For the Brånemark fixtures, two reverse‐torque values were identified and recorded, a ‘start to rotate’ and a peak value. The ‘start to rotate’ values for the 7 and 10 mm Brånemark fixtures were 36.67 and 38.57 Ncm, respectively, the peak values were 61.88 and 69.13 Ncm. The increase in implant length from 7 to 10 mm did not significantly improve the anchorage. The mean reverse‐torque values for the 6‐ and 10‐mm ITI implants were 104.66 and 192.25 Ncm, respectively; the difference was statistically significant. The mean removal torque of the 6‐mm ITI implant was higher than the 7‐ and 10‐mm Brånemark implants. It is suggested that the distinct anchorage magnitude and the distinct loosening patterns registered for both implant systems might be related to the various surface states. The latter might account for the different failure tendencies mentioned in the literature for short Brånemark and ITI implants.     

Periodontal disease as a primary cause of surgical site infection in fractures of the mandible: is smoking a confounding variable?

Fractures of the mandible are common in contemporary oral and maxillofacial practice. Wound infection is the most common complication after open reduction and internal fixation, and the management of these is complex and costly in terms of morbidity to the patient, and in fiscal terms. Whilst numerous epidemiological studies implicate smoking, alcohol, drug use, and adverse behaviour, as well as fracture complexity and diabetes, as important risk factors, the role of periodontal disease is only occasionally mentioned and not formally investigated. The aim of this study therefore was to assess the presence of periodontal disease and its severity according to the 2018 EFP/AAP periodontitis case classification in patients with fractured mandibles who presented to a single level 1 trauma centre, and to look for a possible association with surgical site infection. A total of 305 patients were assessed retrospectively following open reduction and internal fixation via transoral incisions with load-sharing osteosynthesis. The postoperative infection rate was 22.95%. Multivariate and multiple logistic regression revealed that there was a strong association between periodontal staging and postoperative surgical site infection. Crucially, the study predicts that patients with severe periodontal disease (periodontal stage III and IV) are over seven times more likely to develop a wound infection than disease-negative individuals. This has implications for risk adjustment, prognostication, treatment planning, and postoperative care. Surprisingly in this study, cigarette smoking, an established risk factor in the pathogenesis of periodontal disease, did not achieve statistical significance, potentially conflicting with the established literature.     

Growth modification of the rabbit mandible using therapeutic ultrasound: is it possible to enhance functional appliance results?

Previous studies have shown that functional appliances can enhance mandibular growth when applied during the active growth period. However, besides patient compliance problems with bulky appliances and prolonged treatment demands, there is contradictory evidence that functional appliances have a significant long-term effect. Is there a method to enhance the growth response and improve the long-term success of functional appliances? Previous studies have also found that therapeutic ultrasound (US) can stimulate cartilage and bone growth. The objective of this study was to evaluate the effect of therapeutic US on condylar and mandibular growth in the rabbit model. Eight growing New Zealand male rabbits were chosen for this study. They received therapeutic US on one side of the mandible for 20 minutes/day for four weeks. Anthropometrical and histological evaluations revealed that US enhances mandibular growth by condylar endochondreal bone growth and consequently mandibular ramus growth. The significant results of this study support conducting a long-term study to evaluate the ultimate stability of the results obtained. Also, they suggest an extended research with a larger sample size and investigating the molecular basis of this stimulatory effect, together with forward posturing splints for optimal macroscopic and microscopic responses.     

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.

Surgical placement of two implants in the anterior edentulous mandible – how much time does it take?

In order for clinicians to effectively manage their practices, they need to know how much time they spent in carrying out procedures. The provision of two-implant overdentures for edentulous patients is becoming more prevalent as increasing evidence demonstrates their great benefit to patients. The aim of this study was to measure the number of visits and the time required during the surgical phase (from pre-op examination to preliminary impressions) of mandibular two-implant overdenture treatment. Thirty edentulous patients were assigned to receive two root-form implants in the mandible between the mental foramen, as part of a randomized controlled clinical trial. All visits and time spent by the oral surgeon, the surgical assistant and the prosthodontist were measured individually. The mean number of scheduled visits with the oral surgeon was four, and the mean time taken was 104 min. The mean time taken by the surgical assistant was 122 min. On average, the prosthodontist was required for two visits, with a total mean time of 36 min. In addition to the scheduled visits, 14 patients solicited additional appointments (unscheduled visits) for various problems (e.g. loose healing cap). The average time taken for unscheduled visits was 32 min. Combining scheduled and unscheduled visits, the mean total time taken by the oral surgeon was 109 min. The surgical assistant was needed for a mean total of 125 min, and the prosthodontist spent, on average, 46 min in this phase of treatment. Results from this study will assist clinicians in establishing the total time and number of visits needed for the surgical phase of two-implant mandibular overdenture treatment.     

Early functional loading of conical Brånemark implants in the edentulous mandible: a 12-month follow-up clinical report

Treatment of patients with implant-supported mandibular fixed prostheses performed according to an early loading concept has shown excellent results in several reports. The outcome of such treatments with 4 implants, in which the posteriors are distally inclined, has not been reported. This clinical report describes a 12-month evaluation of 17 consecutive patients with 68 conical Br?nemark implants placed between the mental foramina according to a 1-stage surgical procedure. Fixed mandibular prostheses were connected to the implants an average of 33 days after implant placement. Clinical and radiographic examinations were performed at the time of placement of the fixed prosthesis and at a 12-month examination. Five implants were lost during the observation period, 3 before loading and 2 after prosthesis connection, rendering an implant survival rate of 93%. One patient lost her prosthesis because of a failing implant. The average marginal bone loss was 0.24 mm.     

Comparative evaluation of soft and hard tissue changes following endosseous implant placement using flap and flapless techniques in the posterior edentulous areas of the mandible—a randomized controlled trial

Background

Dental implant-supported restorations have long been used as a successful modality for replacing missing teeth. There are two well-established methods of implant placement. The traditional approach to implant surgery involves raising a mucoperiosteal flap and the alternative approach does not involve reflecting a flap, each having its own advantages and disadvantages. The purpose of the present study was to compare and evaluate the soft and hard tissue changes around endosseous implants placed using flap and flapless surgery in mandibular posterior edentulous sites over a period of time.

Materials and methods

A total of 20 systemically healthy patients with a single edentulous site in the posterior mandible were enrolled in this study and 20 endosseous implants were placed (10 in the flap group and 10 in the flapless group). The peri-implant probing depth was assessed. Radiographic assessment was done for changes in the marginal bone levels at the mesial and distal side of the implant with measurements made at baseline, 6 months, and 12 months. Patient-centered outcomes were assessed by using the visual analogue scale (VAS). All these parameters were statistically analyzed using the Wilcoxon signed-rank test, paired Student t test, and two-way ANOVA test and were considered to be significant if the p value was ≤?0.05.

Results

Twenty patients were enrolled in the present study and endosseous implants were placed. Eighteen subjects were followed up throughout the study period and two patients were excluded from the study. The mean PD in the flapless group was comparatively less than the flap group at 12 months and was found to be statistically significant. During the observation period of 12 months, reduction of crestal bone height around the implants placed by flapless and flap surgery were statistically significant. The flapless group showed less change in the crestal bone height which was statistically significant compared to the flap group. The mean VAS score on day 0 in the flap and flapless group was statistically significant. The flapless group showed significantly less pain when compared to the flap group.

Conclusion

Although the flapless technique of endosseous implant placement had statistically significant less PD, bone loss, and pain than the flap technique, the difference was found to have uncertain clinical significance.