Background Titanium is a commonly used inert bio-implant material within the medical and dental fields. Although the use of titanium is thought to be safe with a high success rate, in some cases, there are rare reports of problems caused by titanium. In most of these problematic reports, only individual reports are dominant and comprehensive reporting has not been performed. This comprehensive article has been prepared to review the toxicity of titanium materials within the medical and dental fields. Methods We used online searching tools including MEDLINE (PubMed), Embase, Cochrane Library, and Google Scholar by combining keywords such as “titanium implant toxicity,” “titanium implant corrosion,” “titanium implant allergy,” and “yellow nail syndrome.” Recently updated data has been collected and compiled into one of four categories: “the toxicity of titanium,” “the toxicity of titanium alloys,” “the toxicity of titanium implants,” and “diseases related to titanium.” Results Recent studies with regard to titanium toxicity have been increasing and have now expanded to the medical field in addition to the fields of environmental research and basic science. Problems that may arise in titanium-based dental implants include the generation of titanium and titanium alloy particles and ions deposited into surrounding tissues due to the corrosion and wear of implants, resulting in bone loss due to inflammatory reactions, which may lead to osseointegration failure of the dental implant. These titanium ions and particles are systemically deposited and can lead to toxic reactions in other tissues such as yellow nail syndrome. Additionally, implant failure and allergic reactions can occur due to hypersensitivity reactions. Zirconia implants can be considered as an alternative; however, limitations still exist due to a lack of long-term clinical data. Conclusions Clinicians should pay attention to the use of titanium dental implants and need to be aware of the problems that may arise from the use of titanium implants and should be able to diagnose them, in spite of very rare occurrence. Within the limitation of this study, it was suggested that we should be aware the rare problems of titanium toxicity.

Osteoradionecrosis (ORN) of the jaw is a significant complication of radiotherapy for oral cavity cancer. In addition to antibiotic medication, treatment options such as hyperbaric oxygen therapy, surgical approaches, and combined therapy with pentoxifylline and tocopherol have been recently introduced.In this review article, we will discuss the definition and classifications of osteoradionecrosis, its etiology and pathophysiology, previous treatment options, oral and maxillofacial complications of radiotherapy, basic information on pentoxifylline and tocopherol, recent reports of pentoxifylline and tocopherol combined therapy, and, finally, ORN-induced animal models and future approaches.

BackgroundRehabilitating severely atrophic alveolar crests remains challenging for implantologists and maxillofacial surgeons. Recently, a combination of augmentation and dental implantation has been used to treat cases with severe bone atrophy in the maxilla and mandible. Among autogenous bone grafts, iliac bone grafting (IBG) is considered safe for collecting large amounts of bone and obtaining high-density multipotent cells. However, vertical bone resorption may occur during the initial healing stage after IBG. The purpose of the present study is to evaluate bone graft success and implant survival rate, along with bone height in the augmented site and marginal bone level around dental implants placed in iliac onlay bone grafts. We also introduce technique and treatment considerations for successful IBG procedures, as well as optimal implant installation strategy and soft tissue manipulation.MethodsWe examined seven patients who were treated with IBG combined with implant systems over a period of 10 years. The long-term success rate of bone grafts and implant survival rate were recorded. Bone height change and marginal bone loss (MBL) were analyzed by assessing the radiograms acquired after augmentation, at implant installation, prosthetic loading, and after installation 1 year, 2 years, 3 years, and 5 years.ResultsIn a mean observation period of 50 months (range 12–62 months), the success rate of IBG was 100%. A total of 29 implants were installed and the implant success rate was 100%. The mean bone height reductions compared to post-augmentation bone heights were 1.33 ± 0.81 mm after 3 months, 2.00 ± 1.88 mm at implant installation, 2.55 ± 1.68 mm at prosthetic loading, and 3.05 ± 1.63 mm after implant installation 1 year. The cumulative bone height change after implant installation 5 years was 4.05 ± 1.83 mm which corresponds to a mean resorption rate of 42.5%. The mean MBL after installation 3 months, at prosthetic loading, and after installation 1 year, 2 years, 3 years, and 5 years follow-ups were significantly higher than at implant installation. However, MBL at 2 years, 3 years, and 5 years post-installation did not differ significantly (p < 0.05).ConclusionIn patients with atrophic jaws, a combination of the iliac onlay bone graft and dental implants can result in satisfactory reconstruction and reliable long-term prognosis. Despite early stage vertical bone resorption, we observed high success rates and comparable MBL over long-term follow-up. To reduce bone resorption, case evaluation and surgical planning must be meticulous. Further large-scale studies with longer-term follow-up are needed.

BackgroundOsteomyelitis is an intraosseous inflammatory disease characterized by progressive inflammatory osteoclasia and ossification. The use of quantitative analysis to assist interpretation of osteomyelitis is increasingly being considered. The objective of this study was to perform early diagnosis of osteomyelitis on digital panoramic radiographs using basic functions provided by picture archiving and communication system (PACS), a program used to show radiographic images.MethodsThis study targeted a total of 95 patients whose symptoms were confirmed as osteomyelitis under clinical, radiologic, pathological diagnosis over 11 years from 2008 to 2017. Five categorized patients were osteoradionecrosis, bisphosphonate-related osteonecrosis of jaw (BRONJ, suppurative and sclerosing type), and bacterial osteomyelitis (suppurative and sclerosing type), and the control group was 117 randomly sampled. The photographic density in a certain area of the digital panoramic radiograph was determined and compared using the “measure area rectangle,” one of the basic PACS functions in INFINITT PACS® (INFINITT Healthcare, Seoul, South Korea). A conditional inference tree, one type of decision making tree, was generated with the program R for statistical analysis with SPSS®.ResultsIn the conditional inference tree generated from the obtained data, cases where the difference in average value exceeded 54.49 and the difference in minimum value was less than 54.49 and greater than 12.81 and the difference in minimum value exceeded 39 were considered suspicious of osteomyelitis. From these results, the disease could be correctly classified with a probability of 88.1%. There was no difference in photographic density value of BRONJ and bacterial osteomyelitis; therefore, it was not possible to classify BRONJ and bacterial osteomyelitis by quantitative analysis of panoramic radiographs based on existing research.ConclusionsThis study demonstrates that it is feasible to measure photographic density using a basic function in PACS and apply the data to assist in the diagnosis of osteomyelitis.Electronic supplementary materialThe online version of this article (10.1186/s40902-019-0188-2) contains supplementary material, which is available to authorized users.

Both maxillary sinusitis (MS) and maxillary retention cyst (MRC) involve the maxillary sinus and show similar clinical features. Clinically, differentiating between MS and MRC is sometimes difficult in asymptomatic patients, despite their quite different pathogenic behaviors. To identify differential protein expressions in the secretory fluids of MS and MRC, 25 cases of asymptomatic MS and 15 cases of asymptomatic MRC were examined pathologically in this study. All patients underwent routine endoscopic sinus surgery or modified Caldwell-Luc procedure and the sinus mucosal specimens obtained during these procedures with the approval of the Institutional Review Board. Their secretory fluids were analyzed via immunoprecipitation-based high-performance liquid chromatography (IP-HPLC) using 25 types of antiserum, including inflammatory cytokines, antimicrobial proteins, and mucosal protective proteins. In the histological examinations, MS and MRC showed similar features in the secretory columnar epithelial lining and thick submucosal connective tissue, both of which contained few inflammatory cells infiltrates. The IP-HPLC analysis revealed that TNFα, IL-1, -8, MMP-3, -10, α1-antitrypsin, cathepsin C, lysozyme, lactoferrin, β-defensin-1, -3, LL-37, mucocidin, and mucin-1 were more intensely expressed in MS than in MRC; whereas IgA, cystatin A, and proline-rich proteins were more strongly expressed in MRC than in MS. These data indicate that the secretory fluid of MS is indicative of a more robust inflammatory reaction to certain bacteria compared to that of MRC, while the secretory fluid of MRC contains more abundant mucosal protective proteins compared to that of MS. Taken together, the IP-HPLC analysis of MS and MRC secretory fluid revealed that MRC showed a weaker inflammatory reaction but a stronger mucosal protective function than MS.

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초록: 셀룰로오스는 탄소와 수소 성분으로 이루어진 탄수화물 복합체로서 β-글루코오스 성분으로 이루어진 식물 세 포벽의 주된 구성성분이다. 미더덕의 피부 각질에서 개발한 동물성 셀룰로오스 유도막에 1-2 MeV 에너지의 전자빔 을 조사하여 C-C 결합보다 C-O 결합이 보다 증가함을 확인하였고, 여러 관련된 결과를 바탕으로 전자빔 조사에 의 해 미세소관을 구성하는 셀룰로오스 미세원섬유들의 탈중합 과정을 일으킬 수 있었다. 셀룰로오스 합성복합체가 이 동함으로써 셀룰로오스 섬유소들을 균일하고 미세하게 변형시킴으로써 골유도재생술을 위한 얇은 μm 단위의 의료 용 유도막으로 활용이 가능할 것으로 사료된다.Abstract: Cellulose is the carbohydrate polymer composed of carbon, hydrogen and β-glucose, and the main composition of plant cell walls. The aim of this study is to evaluate the effect and potential of 1-2 MeV electron beam (E-beam) irradiation to the sea squirt derived cellulose membrane (CM) from Styela clava, called non-native tunicate. C-O bonding was increased than C-C bonding, and several related results showed depolymerization of cellulose microfibrils composed of microtubles. Cross-linking cellulose protein (CCP) was lost after E-beam irradiation, and so thin and delicate cellulose fibrils were detached each other by moving cellulose synthase complex. The potential of this cellulose polymer as a thin μm thickness medical membrane for the guided bone regeneration can be suggested.