Radiation therapy for malignant tumors of the head and neck is associated with significant side effects involving the oral cavity. For example, radiation therapy leads to reduced vascularity and oxygen tension of the oral hard and soft tissues and also to salivary gland dysfunction. These changes increase the risk of dental decay and oral infections and lead to reduced healing capacity following oral surgery procedures. A severe complication of radiation therapy is osteoradionecrosis of the jaw bone. The purpose of this paper is to review preradiation oral examination and treatment. Patient management regarding oral disease prior to radiation therapy has to accomplish a number of goals: (1) to identify existing oral disease and potential risk of oral disease, (2) to remove infectious dental/oral foci before the start of radiation therapy, (3) to prepare the patient for the expected side effects with information about them, (4) to establish an adequate standard of oral hygiene to meet the increased challenge, (5) to provide a plan for maintaining oral hygiene and fluoride treatment, for oral rehabilitation, and for follow-up and (6) to inform the patient about the availability of any financial support for dental treatment, and finally (7) to establish the necessary multidiciplinary collaboration within the health care system so that oral symptoms and sequelae before, during and after the radiation therapy can be reduced or alleviated. The methods used to accomplish these goals may vary between cancer centers. Each center should have a multidisciplinary team to handle such problems. After the end of radiation therapy most of the dental treatments in our patients are done by private dentists, except for some oral surgery procedures, which are performed in hospital. In our experience, the major challenge in this process is related to (1) informing of the patient, (2) timing the coordination between all the health care workers involved, (3) establishing an adequate schedule for dental treatment and follow-up, and (4) securing patient compliance to prevent or reduce the oral side effects.

–  The possible relation between treatment delay and healing complications in mandibular fracture treatment (excluding condylar fractures) was reviewed systematically. Twenty‐two studies were identified. No randomized studies focused on the effect of immediate or delayed treatment. The main focus of most studies was surgical repositioning and internal skeletal fixation. The healing complications analyzed in this study were infection in the fracture line and malocclusion. Statistical analysis of the influence of treatment delay upon healing complications was possible in six studies. Four studies showed no significant difference between immediate and delayed treatment. One study showed a preference for healing for cases treated within 3 days, whereas another study indicated that treatment time between 3 and 5 days were optimal with the lowest rate of complications. Finally, a few studies identified confounding factors such as alcohol, drug abuse and/or non‐compliance, factors which have been shown strongly to influence the likelihood of complications. A significant problem in this analysis was that rather few patients were actually treated on an acute basis (i.e. within 12 or 24 hours after injury), a fact which together with the lack of control of confounding factors made this analysis problematic. In conclusion, there is presently no strong evidence for either acute or delayed treatment of mandibular fractures in order to minimize healing complications; new studies including a substantial number of cases treated on an acute basis are very much needed.

In this study, we have characterized bone cell cultures derived from the human maxillary alveolar ridge, which could be a potential cell source for tissue engineering of the severely resorbed maxilla. From 10 individuals, an osseous core was obtained. Without the use of collagenase, 10 explant cultures were established and the morphology of the cells (human maxilla-derived cells (hMDCs)) was studied with light microscopy (LM). Explant cultures were analyzed by flow cytometry with respect to size, granularity and surface marker expression. Fluorochrom-conjugated monoclonal antibodies (CD13, CD31, CD44, CD90 or CD73) were used. hMDCs were cultured in standard medium (SCM) or osteoinductive medium (OIM) for 21 days and analyzed for the presence of alkaline phosphatase (ALP) and calcium deposits (Von Kossa). Furthermore, osteogenic gene expression (osteocalcin [OC], ALP, collagen type 1) were analyzed by reverse transcription polymerase chain reaction (RT-PCR). LM demonstrated that hMDCs had a polygonal morphology containing a central nucleus with two to three nucleoli. Size/granularity analysis revealed differences between individuals. Immunophenotypically, these cells were positive for CD13, CD44, CD90 and CD73 while negative for CD31. Cells cultured in SCM for 21 days showed moderate ALP staining and many calcium deposits. Culturing cells in OIM for 21 days significantly increased both ALP staining and the number of calcium deposits. RT-PCR demonstrated expression of osteogenic marker genes and the ability to upregulate osteocalcin and ALP in response to osteogenic inducers. To our knowledge, it is the first time that surface marker expression has been studied on bone cells originating from this site. Cells were positive for markers characteristic for immature mesenchymal stem cells and had osteogenic differentiation capability. This study indicates that cells derived from maxillary biopsies could be a potential cell source for bone tissue engineering.

Cultivated autogenous bone cell seeded to a DBBM + AB composite did not significantly improve bone formation (density and height) after SFA, compared with what was achieved with DBBM + AB alone. Both approaches resulted into enough bone to support implant placement and osseointegration.

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