Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse drug reaction, consisting of progressive bone destruction in the maxillofacial region of patients. ONJ can be caused by two pharmacological agents: Antiresorptive (including bisphosphonates (BPs) and receptor activator of nuclear factor kappa-B ligand inhibitors) and antiangiogenic. MRONJ pathophysiology is not completely elucidated. There are several suggested hypothesis that could explain its unique localization to the jaws: Inflammation or infection, microtrauma, altered bone remodeling or over suppression of bone resorption, angiogenesis inhibition, soft tissue BPs toxicity, peculiar biofilm of the oral cavity, terminal vascularization of the mandible, suppression of immunity, or Vitamin D deficiency. Dental screening and adequate treatment are fundamental to reduce the risk of osteonecrosis in patients under antiresorptive or antiangiogenic therapy, or before initiating the administration. The treatment of MRONJ is generally difficult and the optimal therapy strategy is still to be established. For this reason, prevention is even more important. It is suggested that a multidisciplinary team approach including a dentist, an oncologist, and a maxillofacial surgeon to evaluate and decide the best therapy for the patient. The choice between a conservative treatment and surgery is not easy, and it should be made on a case by case basis. However, the initial approach should be as conservative as possible. The most important goals of treatment for patients with established MRONJ are primarily the control of infection, bone necrosis progression, and pain. The aim of this paper is to represent the current knowledge about MRONJ, its preventive measures and management strategies.
Aim. Headache is one of the most common diseases associated with Temporomandibular Disorders (TMDs). The aim of this study was to evaluate, retrospectively, if headache influences TMD's symptoms. Material and Methods. A total sample of 1198 consecutive TMD patients was selected. After a neurological examination, a diagnosis of headache, according to the latest edition of the International Classification of Headache Disorders, was performed in 625 subjects. Patients were divided into two groups based on presence/absence of headache: Group with Headache (GwH) and Group without Headache (GwoH). Descriptive statistics and Chi-square index were performed. Results. Sociodemographic (gender, marital status, and occupation) and functional factors, occlusion (occlusal and skeletal classes, dental formula, and occlusal abnormalities), and familiar pain did not show a statistically significant correlation in either group. Intensity and frequency of neck pain, arthralgia of TMJ, and myalgia showed higher correlation values in GwH. Conclusion. This study is consistent with previous literature in showing a close relationship between headache and TMD. All data underlines that headache makes pain parameters more intense and frequent. Therefore, an early and multidisciplinary treatment of TMDs should be performed in order to avoid the overlay of painful events that could result in pain chronicity.
Objectives:The aim of this study was to evaluate and assess knowledge and attitude of dental students about medication-related osteonecrosis of the jaw (MRONJ), to optimize future training programs in this field.Materials and Methods:A cross-sectional study was administrated. Ninety-eight participants agreed to complete an anonymous questionnaire. It was divided into two sections: the first section was about general information such as interviewer's gender and date of birth; the second section included questions about bisphosphonates (BPs), others medication associated to osteonecrosis of the jaw (ONJ), risk factors, and prevention of osteonecrosis. Descriptive statistics were computed and the odds ratio was used to compare the odds for the groups.Results:Ninety-nine percent of participants declared to know BPs, but only 26.9% of 4th year and 34.8% of 6th year students knew the correct definition of MRONJ. Almost all of students identified the importance to report, in anamnesis, the use of BPs, as well as to check-up patients before the beginning of treatment; on the other hand, the knowledge about how invasive dental treatment might be carried out in patients under therapy was not adequate. In addition, half of the students did not recognize any active principle or commercial name of BPs. The situation was even worse regarding alternative drugs involved in ONJ.Conclusions:These findings are alarming and the lack of knowledge about MRONJ suggests that greater educational efforts should be performed about this pathology at undergraduate level.
A tooth preparation technique in fixed prosthodontics for students and neophyte dentists sonal experience with the novel technique. It could helps dental students and neophyte dentists in their learning curve.Key words: tooth preparation, fixed prosthodontics, dental education, prosthodontics. IntroductionTooth preparation for fixed prosthesis is a common procedure in clinical practice, which all general dentists should perform correctly. However, it could be difficult to obtain always a predictable result, especially for dental students or young doctors: they could make mistakes in their learning curve leading to inadequate results. Unlike other human substance, dental tissues don't have regenerative capacity. Therefore, the removal of dental biological material should be planned and executed with maximum attention (1). The purpose of a fixed prosthodontic therapy may vary from the restoration of a single tooth to the rehabilitation of the complete occlusion. A single tooth can be fully restored both functionally and aesthetically. A missing tooth can be replaced by a fixed prosthesis, increasing patient masticatory competence and maintaining or improving dental arches function, often elevating patient's self-image (2). Tooth preparation should have specific geometrical characteristics to provide necessary retention and resistance to the vertical and lateral forces acting on the restoration. The most important element of retention is the presence of two opposing vertical surfaces. The axial walls of the preparation should taper slightly to allow the cementation of the artificial crown. The more parallel are the axial walls the greater is the retention. However, it is impossible to obtain parallel surfaces without producing undercuts. Goodacre et al. (3) suggest an angle of convergence between 10 and 20°. Moreover, the occlusocervical length is another fundamental factor for both retention and resistance. The longer is the preparation the greater is the retention. Teeth with larger diameter need a greater length to prevent dislodgement (4). Proper occlusal and axial reductions are essentials to provide enough space, allowing a good functional morphology and structural durability. Moreover, no more than necessary dental tissues should be removed in order not to jeopardize tooth structure and retention of the restoration (2). Preston (5) and Miller (6) suggest starting the tooth preparation producing depth-orientation groves on the vestibular and incisal surfaces, with a round-end tapered diamond as reference for removing tooth structure. The occlusal reduction is performed by removing the tooth por- SummaryPurpose. The aim of this study was to evaluate a novel technique of tooth preparation in fixed prosthodontics suitable for dental students and neophyte dentists. Materials and methods.Twenty-four dental students of the sixth-year class were recruited to verify the predicibility of this technique. Each student prepared two mandibular second premolars on a typodont for a dental crown with a 90° shoulder finishin...
Objectives:Risk factors in oral implantology are defined as local or systemic conditions that increase failure rates. The purpose of this paper is to evaluate the long-term survival rate of dental implants placed in patients presenting mechanical risk factors.Materials and Methods:This retrospective study was conducted only with patients presenting at least one of the following risk factors were included: Bruxism; crown-to-implant (C/I) ratio <0.8; abutment angulation. The overall implant survival was estimated using Kaplan–Meier analyses. Risk factors for implant failure were identified using the Cox proportional hazard regression models.Results:Eighty-nine eligible patients were enrolled in this study: They were both male (n = 56, 62.92%) and female (n = 33, 37.08%), with an average age of 53.24 (23–76 years), with 227 dental implants inserted. The mean follow-up was 13.6 years (range: 10–16 years). The overall 10-year Kaplan–Meier survival estimate with associated 95% confidence intervals was 86.34% (82.8, 87.1). Bruxism was the only variable that showed a statistically significant association with implant failure (P < 0.05) and a hazard ratio of 2.9, while both Crown to-implant and abutment angulations reported lower values of failure (P > 0.05).Conclusions:Within the limitations of this study, can be concluded that data suggested an evident relationship between bruxism and dental implant failure but further studies, with a larger sample and a different design are required to assess this relationship.
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