Osteonecrosis development by tooth extraction in zoledronate treated mice is inhibited by active vitamin D analogues, anti-inflammatory agents or antibiotics

Invasive dental treatment such as tooth extraction following treatment with strong anti-bone resorptive agents, including bisphosphonates and denosumab, reportedly promotes osteonecrosis of the jaw (ONJ) at the extraction site, but strategies to prevent ONJ remain unclear. Here we show that in mice, administration of either active vitamin D analogues, antibiotics or anti-inflammatory agents can prevent ONJ development induced by tooth extraction during treatment with the bisphosphonate zoledronate. Specifically, tooth extraction during treatment with zoledronate induced osteonecrosis in mice, but administration of either 1,25(OH)2D3 or ED71, both active vitamin D analogues, significantly antagonized osteonecrosis development, even under continuous zoledronate treatment. 1,25(OH)2D3 or ED71 administration also significantly inhibited osteocyte apoptosis induced by tooth extraction and bisphosphonate treatment. Administration of either active vitamin D analogue significantly inhibited elevation of serum inflammatory cytokine levels in mice in response to injection of lipopolysaccharide, an infection mimetic. Furthermore, administration of either anti-inflammatory or antibiotic reagents significantly blocked ONJ development following tooth extraction and zoledronate treatment. These findings suggest that administration of active vitamin D, anti-inflammatory agents or antibiotics could prevent ONJ development induced by tooth extraction in patients treated with zoledronate.

Prevalence of favourable anatomy for palatal emergence of an immediate implant in the maxillary central incisor post-extraction site.

The purpose of this study was to determine the prevalence of favourable anatomy for palatal emergence of an immediate flapless implant in the maxillary central incisor post-extraction site. Implants were virtually placed into maxillary central incisor sites using 3D implant planning software. Following a strict implant placement criteria to keep a safety distance to the buccal plate and other anatomical structures, sockets where assessed to determine their suitability for a palatally emerging implant. From 321 patients included in this study, 62.3% presented a suitable socket anatomy for an immediate implant to be placed with the angulation for a screw retained crown. In 29% of the cases, the implants had to be labially tilted to keep a minimum distance to the buccal plate. 8.7% were unsuitable for immediate implants due to anatomic limitations. The position and angulation for an implant in the maxillary central incisor socket should be carefully assessed preoperatively with 3D images, as many sites will not be candidates for a palatal emergence and thus, a screw retained restoration.

Standing Intraoral Extraction of the Right Mandibular Third Molar Tooth in a Cow Utilizing Tooth Sectioning

A 2-year-old Holstein heifer presented to a university teaching hospital with an apical tooth infection of the right mandibular third molar. A standing oral extraction technique was attempted for tooth removal; however, the molar could not be delivered intact. A tooth sectioning technique was performed, and the affected molar was successfully delivered. Three months postextraction, the heifer had fully recovered, and the extraction site had healed. To the authors’ knowledge, this is the first description of a tooth extraction in a cow using a tooth sectioning technique. This case describes an alternative technique for tooth removal in cattle with an apical tooth infection. The clinical, diagnostic, and therapeutic features of this case may be helpful to clinicians when they approach similar cases in the future.

Comparison of radiographic changes in the alveolar crest after extraction of fully and partially erupted premolars during orthodontic treatment: A retrospective analytical study

Background. The alveolar process plays an essential role in providing dental support and gradually disappears with tooth loss. Space deficiency can cause one premolar to remain semi-erupted adjacent to a fully-erupted premolar. During orthodontic treatment, each of these premolars can be extracted. This retrospective study aimed to compare radiographic changes of the alveolar crest due to orthodontic movements of fully-erupted and semi-erupted premolars into the extraction sites before and after treatment. Methods. The patients were divided into the fully-erupted premolar extraction (first) group and the semi-erupted premolar extraction (second) group. The distance between the cementoenamel junction (CEJ) and the alveolar crest, from the distal aspect of the canine to the mesial aspect of the first molar, was measured on panoramic radiographs of 78 patients (39 from each group) before and after treatment with a digital caliper. Changes in the alveolar crest were compared between the two groups. Finally, the height differences of the alveolar crest in mesial and distal aspects of the remaining premolars in both groups were calculated at the end of treatment. Descriptive statistical analyses and paired and independent t tests were used in the study. Results. The distance from the CEJ to the alveolar crest at mesial and distal aspects in the first group and the distal aspect of the extraction site in the second group increased significantly. However, changes at the mesial aspect were not significant in the second group. Comparing the alveolar crest height between the two groups and between the mesial and distal aspects of the remaining premolar tooth indicated no significant differences. Conclusion. No significant difference was observed between the extraction of a fully-erupted or semi-erupted premolar to obtain greater alveolar height.

Application of a Temporary Ileostomy via Median Specimen Extraction Site in Laparoscopic Low Anterior Resection

Objective: To evaluate the feasibility and safety of temporary ileostomy via median specimen extraction site in the lower abdomen. Methods: Twenty-two patients who underwent laparoscopic radical resection for rectal cancer and needed temporary ileostomy were prospectively enrolled. Temporary ileostomy was placed on the median specimen extraction site of the lower abdomen. Intraoperative and postoperative conditions, stoma-related complications and ileostomy reversal surgery were observed. d. Results: Among the 22 patients, there were 14 female patients and 8 male patients: the average age was 56 ±14 years; the average body mass index was 22.0 ±3.4 kg/m2; the average tumour size was 4.4 ±2.2 cm; the average distance between the tumour and the dentate line was 5.9 ±2.3 cm; the average time of laparoscopic low anterior resection was 221 ±56 minutes; the average blood loss was 168 ±91 ml; and the average postoperative hospital stay was 9.9 ±3.9 days. The average ileostomy reversal surgery time was 72 ±15 minutes, the average blood loss was 50 ±27 ml, and the average postoperative hospital stay was 5.9 ±1.0 days. Stoma-related complications occurred in 5 patients, of which one was treated by emergency surgery. Conclusion: In laparoscopic low anterior resection, patients with temporary ileostomy via the median specimen extraction site did not have serious complications that required surgical intervention during hospitalization, and there was no mortality during the perioperative period. It is safe and feasible to perform temporary ileostomies via the median specimen extraction site in the lower abdomen, but for permanent ileostomies, the median site in the lower abdomen should be carefully selected as the ileostomy site.

Virtuális tervezés és volumetrikus kiértékelés egy komplex parodontális defektus regeneratív-rekonstruktív sebészi ellátásában

Célkitűzés: Célunk egy parodontális defektus regeneratív-rekonstruktív sebészi ellátásának és a műtétek digitális tervezésének bemutatása hibrid virtuális modell alapján, továbbá a pre- és postoperatív cone-beam computer tomográf (CBCT) felvételek pontos térbeli illesztésével a változások digitális kiértékelése.Vizsgálati anyag és módszer: Félautomatikus szegmentációs módszer alapján a CBCT-ből előállított, keményszövetimodellt és az intraorális szkennerrel vett digitális mintát identikus anatómiai pontok alapján történő illesztését követőenterveztük a sebészi beavatkozásokat. Első lépésben a 26-os fog eltávolításával egybekötött alveolus prezevációt végeztük el az „extraction site development (XSD)” technika alapján. Majd a 24-es és 25-ös fogakat érintő defektusminimálinvazív regeneratív célzatú ellátását végeztük. A preoperatív és postoperatív CBCT felvételek illesztésével és szubtrakciójával volumetrikusan és lineárisan értékeltük ki a beavatkozások eredményét.Eredmények: Az érintett területen összesen 0,44 cm3 keményszöveti többlet keletkezett. Ezzel együtt megfigyelhető kismértékű marginális csontrezorpció, melynek mértéke összesen 0,11 cm3. Lineáris mérések alapján 24-es és 25-ös fogak körül kialakult cirkumdentális, horizonto-vertikális defektus átlagosan 53,88 ± 36,84%-os keményszöveti telődést mutatott, a kresztális csontszél kismértékű lebomlása és 1,22 ± 0,87 ínyrecesszió kialakulása mellett.Konklúzió: Megállapítható, hogy valósághű hibrid modellek segítségével nagy alapossággal tervezhető meg regeneratív-rekonstruktív sebészeti beavatkozások lépései. Valamint pre- és postoperatív CBCT felvételek szubtrakciójával megismerhettük a defektus gyógyulásának mechanizmusait.

A pilot study on immediate loading dental implants

Evolution in the field of dental implantology made the replacement of missing tooth easy and quick. During initial phase of evolution, there was a need of 3 to 6 months of healing period to get teeth on implants but with advancement of technology and research, immediate replacement of missing teeth without waiting period could become a possibility. To access the efficacy of immediate loading in dental implantology using Hexacone® (IHDE DENTAL - Switzerland) dental implant. The objectives were to evaluate pain, infection, recession, loosening of abutment, fracture of implant/crown, de-cementation, peri-implant radiolucency, and marginal bone loss. Five patients (3 male and 2 female) who needed teeth replacement were included in the study. Among 5 patients, 3 patients needed single tooth replacement and the remaining 2 needed segmental replacement. Out of 7 implants 6 implants were placed in the healed bone and 1 was placed in the extraction socket. In case of healed bone, permanent prosthesis were given on 3 day. In case of extraction site, temporary acrylic crown was given on 2 day, which was replaced by permanent prosthesis after 3 month. These patients were evaluated at 7 day, 1 month, 3 months, 6 months and 12 months clinically and radiographically. Infection, prosthetic problems, peri-apical radiolucency, and implant mobility were not observed and marginal bone loss was observed during follow-up periods. On 6 months follow up, 0.5mm and 0.45mm marginal mean bone loss was observed on mesial and distal aspect respectively whereas the same was 1.24mm and 1.14 mm on 12 months follow-up respectively.The immediate loading for dental implants is a successful procedure that decreases the time for the patients to obtain a final restoration satisfying both esthetical and functional problems. Immediately loaded implants survive equally well in extraction socket. No significant difference was seen in survival when implants were placed in healed bone and extraction socket.

Initial Observation of Factors Interfering with the Treatment of Alveolar Osteitis Using Hyaluronic Acid with Octenidine—A Series of Case Reports

Alveolar osteitis (AO) is a common complication following the extraction of the teeth, particularly the lower third molars. It starts within a few days after the extraction and manifests mainly as pain in the extraction site. Several strategies of treatment are available in order to relieve pain and heal the extraction wound. Recently, a novel medical device combining hyaluronic acid (HA) and octenidine (OCT) was introduced for the treatment of AO. This series of case reports aims to summarize the initial clinical experiences with this new device and to highlight factors possibly interfering with this treatment. The medical documentation of five patients with similar initial situations treated for AO with HA + OCT device was analyzed in detail. Smoking and previous treatment with Alveogyl (Septodont, Saint-Maur-des-Fossés, France) were identified as factors interfering with the AO treatment with the HA + OCT device. In three patients without these risk factors, the treatment led to recovery within two or three days. The patient pretreated with Alveogyl and the smoker required six and seven applications of the HA + OCT device, respectively. According to these initial observations, it seems smoking and previous treatment with Alveogyl prolong the treatment of AO using the HA + OCT device that, in turn, shows a rapid effect if these risk factors are not present.