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Purpose To assess the efficacy of different preventive dental visits and treatments in reducing the risk of medication-related osteonecrosis of the jaws (MRONJ). Methods In this retrospective study, patients diagnosed with MRONJ were divided into 5 groups based on available data: no preventive dental visits (group 0); dental visits and compliance with recommended treatments, at the university hospital’s dental clinic (group 1) or maxillofacial surgery unit (group 2), or at a private dentist’s (group 3); dental visits at one of the above and noncompliance with proposed treatments (group 4); patients judged eligible by the oncologist on panoramic radiography (group 5). Patients were classified on severity of MRONJ according to the Italian SIPMO/SICMF 2.0 staging system. A descriptive analysis was performed on the results. Fisher’s exact test was applied (p < 0.05). Results Ninety-three patients diagnosed with MRONJ were considered for the study, but 22 were excluded due to a lack of data, leaving a sample of 71 cases. MRONJ staging was only 0 for some patients (26.92%) in group 0. In all groups, the majority of patients had stage 2 MRONJ. The proportions of cases in stage 3 were 7.69% in group 0, 18.18% in group 3, and 43.48% in group 5. Groups 0 and 3 were somewhat similar as regard MRONJ staging. Most patients in group 5 had MRONJ stage 2 or 3. No statistically significant differences emerged between the groups. Conclusions Preventive dental care can reduce the risk of MRONJ providing patients comply with the specialist’s recommendations.

This study aimed to describe the first case of regenerative surgery in haemophiliac implant. Patients with haemophilia often present dental problems. A multidisciplinary approach is suggested in case of dental surgeries to reduce the high bleeding risk. A 41-year-old male patient with mild haemophilia A (FVIII 8.4%), presenting previous epistaxis, noncomplicated tooth extractions and traumatic haemartroses, all treated with single infusions of coagulation factor concentrates, was referred to the dental clinic of the Padua University Hospital based on the recommendation of his attending dentist. At first dental visit the patient reported intense pain in the right lower second molar, with impaired chewing function. After an endodontic unsuccessful treatment the element was judged as no longer recoverable. In agreement with the patient the dental element was then extracted, after a combined administration of recombinant factor VIII 3000 IU (35 IU/kg), and tranexamic acid 1,000 mg. The extraction was performed under local anaesthesia, paraperiosteal and truncular, moderate sedation, elevation of an envelope flap. After extraction, a preservation of the alveolus was carried out with bovine matrix bone graft covered with a resorbable membrane. Three months after the surgery a flapless implant was placed after a single infusion of factor VIII 2000 IU, tranexamic acid 1,000 mg, and a local para-periostal anaesthesia, without any complication. Oral surgeon and haematologist expert in coagulation diseases must therefore collaborate together to define a shared protocol for managing surgery in those patients.

(1) Background: Multiple myeloma is a rare cancer that primarily affects the bone marrow. Osteoclasts are responsible for increased bone resorption and, therefore, bone destruction. Bisphosphonates are a class of drugs that can slow down bone resorption by reducing the number and action of osteoclasts. Intravenous injections of bisphosphonates (generally Zoledronic Acid) are administered to patients affected by Multiple Myeloma, but BRONJ is described as a serious side effect. This 5-year retrospective study aims to evaluate the efficacy of appropriate dental treatment protocols prior to initiating bisphosphonate therapy to prevent the development of BRONJ. (2) Methods: A total of 99 patients with symptomatic multiple myeloma were involved in this study (41–90 years, mean age 65 years, standard deviation 5 years). The data relating to the visits were tracked using a specific server and consulting the clinical reports. The AAOMS (American Association of Oral and Maxillofacial Surgeons) position was applied for both diagnosis and treatment. A total of 79 patients were examined before the administration of bisphosphonates (group A) and 20 after (group B). (3) Results: The entire sample required dental treatment: 23.2% underwent restorative therapy, 8% endodontic treatments, 44.4% tooth extractions. Periodontal disease was present in 41.4% of the patients. No osteonecrosis was observed in the first group, whereas BRONJ was found in five patients of the second one (25%) and two patients (10%) showed osteosclerotic areas under investigation [OR 0.026 (CI 0.0027 to 0.2454)]. (4) Conclusions: In the literature, there are no precise data about the prevalence of BRONJ. Despite the limitation of the present study, we point out that dental treatment before the treatment with intravenous bisphosphonates can help in reducing the incidence of BRONJ and good dental status is necessary for BRONJ prevention.

Background: The present study aimed to ascertain whether any significant reduction in patients’ postoperative pain and inflammation could be achieved by using sterile physiological solution instead of normal water to irrigate the surgical field and cool the dental bur during third molar extractions. Methods: The study concerned 22 patients (11 females and 11 males) in good general health, who were referred to the Dental Clinic at Padova University hospital for lower third molar extractions. They were randomly assigned to two groups. Only the fluid used to irrigate the surgical field and cool the dental bur differed between the two study groups, being sterile physiological solution for group A, and mains water for group B. Postoperative pain, swelling, trismus and inflammation with high sensitivity CRP where measured and statistically evaluated. The numerosity of our sample was calculated on the grounds of an endpoint based on data in the literature. Results: Eighteen patients needed bilateral extractions, and 4 required only one extraction, so a total of 40 third molars were extracted. A sterile physiological solution was used to irrigate the surgical field in 20 extractions, while water was used in the other 20 cases. Data analysis with Wilcoxon test show no differences between the two groups (p < 0.05). Conclusions: no differences between groups for any of the parameters considered, after third molar extraction procedures undertaken using either sterile physiological solution or water for irrigation and cooling purposes.