Osteonecrosis and osteomyelitis of the jaw associated with tumour necrosis factor-alpha (TNF-α) inhibitors: a systematic review

Tumour necrosis factor-α (TNF-α) inhibitors are increasingly being used as immunomodulators to manage inflammatory conditions such as rheumatoid arthritis and Crohn’s disease. Reported serious side effects include an increased incidence of lymphoma and greater susceptibility to infections such as tuberculosis. The aim of this systematic review was to find out whether there is an associated risk of medication-related osteonecrosis of the jaw (MRONJ). Three authors independently searched PubMed, MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials for published reports of oral osteonecrosis (ONJ) or osteomyelitis (OM) in patients who took anti TNF-α drugs and had no history of antiangiogenic agents or antiresorptive treatment. All types of studies on humans treated with TNF-α inhibitors were considered. Only six were eligible for analysis, and all were independently assessed for risk of bias. They included six patients with ONJ or OM that was attributed solely to TNF-α inhibitors. The most common site of ONJ was the posterior mandible (n = 5). The mean (SD) duration of anti-TNF-α treatment before the development of bony lesions was 62.5 (47.4) months. Invasive surgery was reported as a precipitating factor in five cases, and the ONJ/OM resolved with conservative management in five. Although all the studies were judged to be at high risk of bias, the limited data suggest that some patients will potentially develop ONJ/OM as a result of treatment with TNF-α inhibitors. Studies of higher quality are now needed to establish the relative risk of MRONJ in patients who take them.     

Bioactivating a bone substitute accelerates graft incorporation in a murine model of vertical ridge augmentation

ObjectiveCompared to autologous bone grafts, allogeneic bone grafts integrate slowly, which can adversely affect clinical outcomes. Here, our goal was to understand the molecular mechanisms underlying graft incorporation, and then test clinically feasible methods to accelerate this process.MethodsWild-type and transgenic Wnt “reporter” mice were used in a vertical ridge augmentation procedure. The surgery consisted of tunneling procedure to elevate the maxillary edentulous ridge periosteum, followed by the insertion of bone graft. Micro-computed tomographic imaging, and molecular/cellular analyses were used to follow the bone graft over time. Sclerostin null mice, and mice carrying an activated form of β-catenin were evaluated to understand how elevated Wnt signaling impacted edentulous ridge height and based on these data, a biomimetic strategy was employed to combine bone graft particles with a formulation of recombinant WNT protein. Thereafter, the rate of graft incorporation was evaluated.ResultsTunneling activated osteoprogenitor cell proliferation from the periosteum. If graft particles were present, then osteoprogenitor cells attached to the matrix and gave rise to new bone that augmented edentulous ridge height. Graft particles alone did not stimulate osteoprogenitor cell proliferation. Based on the thicker edentulous ridges in mice with amplified Wnt signaling, a strategy was undertaken to load bone graft particles with WNT; this combination was sufficient to accelerate the initial step of graft incorporation.SignificanceLocal delivery of a WNT protein therapeutic has the potential to accelerate graft incorporation, and thus shorten the time to when the graft can support a dental implant.     

穿颧种植技术的研究进展

穿颧种植技术是临床上修复上颌骨大面积缺损、恢复上颌牙列外形及功能的重要手段,不仅可减少植骨量、缩短修复进程,还可提高患者舒适度、改善发音及咀嚼功能。随着临床应用的普及,该技术不断改进完善。本文围绕该技术适用范围的更新、种植体数量和位点的选择理念、术式的改良及评价、常见特异性并发症的规避及应对、专用成功标准的提出以及数字化技术的辅助应用等方面的研究进展进行综述。     

Tooth extractions in patients under antiresorptive therapy for osteoporosis: Primary closure of the extraction socket with a mucoperiosteal flap versus application of platelet-rich fibrin for the prevention of antiresorptive agent-related osteonecrosis of the jaw

PurposeThe aim of this study was to compare primary closure of the extraction socket to application of platelet-rich fibrin (PRF) without subsequent primary closure for the prevention of osteonecrosis of the jaw (ONJ) in patients administered antiresorptive therapy for osteoporosis.Materials and methodsPrimary closure of the extraction socket was performed with a mucoperiosteal flap and two-layer suturing or PRF was inserted into the extraction socket without subsequent primary closure. In all patients, intra- and postoperative complications as well as the overall treatment outcome were recorded.ResultsThe patient sample consisted of 77 patients; primary closure with a mucoperiosteal flap was performed in 39 patients (group A), and application of PRF without subsequent primary closure was performed in 38 patients (group B). There were no statistically significant differences (p > 0.05) between the two groups in terms of age and gender, duration and type of antiresorptive therapy, teeth to be extracted (number, location and type) as well as comorbidities. No intraoperative complications occurred in either of the groups. Postoperative complications were found in 6 patients in group A and in one patient in group B. Analyzing risk factors for these complications, the highest OR (6.72 with p = 0.085 in univariate analysis; 12.81 with p = 0.052 in multivariate analysis) was found for the type of procedure (group A/group B). All patients had complete mucosal coverage without any signs of antiresorptive agent−related osteonecrosis of the jaw at the final control examination 90 days postoperatively.ConclusionBased on the results of this study, the use of PRF can be recommended as a preventive measure in patients requiring tooth extractions while being under antiresorptive therapy for osteoporosis.     

颌骨囊肿刮除术并发症的预防与处理

颌骨囊肿刮除术是牙源性颌骨囊肿的常规治疗手段,但囊肿刮除术中、术后的并发症常影响骨腔的愈合以及患者的生活质量。常见并发症有术后感染、囊肿复发、病理性骨折、感觉异常等。这些并发症的发生与囊肿大小、患病部位、手术方式、是否有植入物等有密切关系。避免或减少这些并发症对提高临床疗效、改善患者生活质量有非常重要的意义。文章结合该领域研究现状和笔者的经验,介绍颌骨囊肿刮除术相关并发症的预防与处理。     

颌骨囊肿术后骨形成的影像学评估

手术是颌骨囊肿的主要治疗方法。囊肿刮除术、开窗减压术（袋形术）在临床上广泛应用。术后采用影像学方法观察骨腔的愈合或囊腔的缩小,是术后疗效评估及开窗减压术后选择二期囊肿刮除术时机的必要措施。由于不同的手术方式,上、下颌骨结构的差别,病变类型、大小以及患者年龄等差异,可能影响囊肿术后骨沉积的速率与结果。文章结合文献和笔者的经验,就颌骨囊肿术后骨形成的影像特点与相关因素做一概述。     

药物相关性颌骨坏死治疗方法的研究进展

药物相关性颌骨坏死是患者使用抗骨吸收或抗血管生成药物导致的并发症,破坏了口腔卫生,影响患者饮食、语音功能,降低生活质量。对MRONJ患者最恰当的治疗策略还未达成共识。本文就近年来药物相关性颌骨坏死的分期及辅助治疗方法的研究进展作一综述。