Search Results (476)

Aim: Pacifiers play a critical role in the early stages of craniofacial and palate development during infancy. While they provide comfort and aid in soothing, their use can also have significant impacts on the growth and function of the oral cavity. This study aimed to simulate and predict the behavior of six different types of pacifiers and their functional interaction with the tongue and palate, with the goal of understanding their potential effects on orofacial growth and development. Materials and Methods: Biomechanical analysis using Finite Element Analysis (FEA) mathematical models was employed to evaluate the behavior of six different commercial pacifiers in contact with the palate and tongue. Three-dimensional solid models of the palate and tongue were based on the mathematical framework from a 2007 publication. This allowed for a detailed investigation into how various pacifier designs interact with soft and hard oral tissues, particularly the implications on dental and skeletal development. Results: The findings of this study demonstrate that pacifiers exhibit different interactions with the oral cavity depending on their geometry. Anatomical–functional pacifiers, for instance, tend to exert lateral compressions near the palatine vault, which can influence the hard palate and contribute to changes in craniofacial growth. In contrast, other pacifiers apply compressive forces primarily in the anterior region of the palate, particularly in the premaxilla area. Furthermore, the deformation of the tongue varied significantly across different pacifier types: while some pacifiers caused the tongue to flatten, others allowed it to adapt more favorably by assuming a concave shape. These variations highlight the importance of selecting a pacifier that aligns with the natural development of both soft and hard oral tissues. Conclusions: The results of this study underscore the crucial role of pacifier geometry in shaping both the palate and the tongue. These findings suggest that pacifiers have a significant influence not only on facial bone growth but also on the stimulation of oral functions such as suction and feeding. The geometry of the pacifier affects the soft tissues (tongue and muscles) and hard tissues (palate and jaw) differently, which emphasizes the need for careful selection of pacifiers during infancy. Choosing the right pacifier is essential to avoid potential negative effects on craniofacial development and to ensure that the benefits of proper oral function are maintained. Therefore, healthcare professionals and parents should consider these biomechanical factors when introducing pacifiers to newborns. Full article

Adjuvant endocrine therapy for early breast cancer significantly reduces recurrence but increases bone fragility. Given limited data on denosumab (60 mg every 6 months) in premenopausal patients receiving endocrine therapy for early breast cancer, we conducted a retrospective real-world study at the Gemelli Hospital (September 2018–January 2025). A descriptive analysis was performed. The primary endpoint was to assess efficacy, evaluated by changes in bone mineral density via dual-energy X-ray absorptiometry and by monitoring bone turnover markers, particularly serum C-terminal telopeptide of type I collagen. Safety was evaluated based on adverse endocrine therapy events (osteoporotic fractures) and adverse denosumab events (osteonecrosis of the jaw). Sixty-nine patients were eligible for the study. Endocrine therapy included ovarian function suppression with exemestane (89.8%) or tamoxifen (10.1%). Baseline spinal osteoporosis decreased from 20.3% to 5.8%, osteopenia from 39.1% to 34.8%, with normal T-scores rising from 17.4% to 34.8%. Femoral improvements were similar. Serum C-terminal telopeptide of type I collagen levels (evaluated in 35.8%) showed stable reduction in 97%. Denosumab adherence was 89.9%. One osteonecrosis of the jaw case occurred (1.4%); no fractures were reported. Denosumab demonstrated efficacy in improving bone density and reducing bone turnover, with excellent adherence and favorable safety. Longer follow-up is needed to assess post-discontinuation effects. Full article

Background and Objectives: We wished to evaluate the effect of antiresorptive agents (ARAs) on peri-implant tissues and to examine the risk factors for peri-implant medication-related osteonecrosis of the jaw (MRONJ). Materials and Methods: The study cohort consisted of patients who underwent implant surgery or maintenance treatment between March 2012 and December 2024. The patients were divided into two groups: those in whom bisphosphonates (BPs) or denosumab (Dmab) was used to treat osteoporosis after implant treatment (the ARA group) and a control group. Peri-implant clinical parameters (implant probing depth (iPPD), implant bleeding on probing (iBoP), marginal bone loss (MBL), and mandibular cortical index (MCI)) measured at the baseline and at the final visit were statistically evaluated and compared in both groups. Risk factors were examined using a multivariate analysis of adjusted odds ratios (aORs). Results: A total of 192 implants in 61 patients (52 female, 9 male) were included in this study. The ARA group consisted of 89 implants (22 patients). A comparison of the clinical parameters showed that the ARA group had significantly higher variations in their maximum iPPD and iBoP values over time than those in the control group. Risk factors for peri-implantitis as objective variables were the use of ARAs (aOR: 3.91; 95% confidence interval [CI]: 1.29–11.9) and the change in the maximum iPPD over time (aOR: 1.86; 95% CI: 0.754–4.58). Conclusions: During long-term implant maintenance treatment, patients’ health and medication status change. Monitoring peri-implantitis, the presumed cause of peri-implant MRONJ, is essential, especially in patients who started ARA treatment after implant placement, and special attention should be paid to changes in implant pocket depth. Full article

Background/Objectives: Severe jawbone atrophy, particularly in elderly or medically compromised patients, presents a significant challenge for conventional implant placement. In cases where bone augmentation is not feasible, alternative techniques—such as short, narrow, tilted, and zygomatic implants—may be indicated for the rehabilitation of the atrophic jaw. Subperiosteal implants have re-emerged as a further viable alternative, especially with recent advancements in digital planning and custom fabrication. This study aims to evaluate the clinical outcomes and complications associated with subperiosteal implants through a literature review and a supporting case series, and to propose clinical preliminary guidelines for their use. Methods: Fourteen studies—including case reports, case series, retrospective studies, and systematic reviews—were analyzed to assess the effectiveness and risk profile of subperiosteal implants. Additionally, we present a case series of nine patients with advanced vertical and horizontal alveolar bone atrophy treated using custom-made, digitally-designed subperiosteal implants. Surgical techniques, prosthetic workflows, and complications were recorded and assessed. Results: Subperiosteal implants were found to be particularly suitable for patients with narrow alveolar crests and severe atrophy where traditional implants are contraindicated. Literature and case series data indicated favorable outcomes, with early complications such as soft tissue inflammation and prosthetic misfit being manageable. A low complication rate was recorded in our series, with digital workflows contributing to improved implant fit and reduced technical errors. Conclusions: Subperiosteal implants could offer an effective solution for complex atrophic cases, provided that patient selection, surgical precision, and prosthetic design are meticulously managed. Based on our findings, clinical recommendations are proposed to guide their application in contemporary practice. Full article

Study design: The advent of the Matrix Wave^TM System (Depuy-Synthes)—a bone-anchored Mandibulo-Maxillary Fixation (MMF) System—merits closer consideration because of its peculiarities. Objective: This study alludes to two preliminary stages in the evolution of the Matrix Wave^TM MMF System and details its technical and functional features. Results: The Matrix Wave^TM System (MWS) is characterized by a smoothed square-shaped Titanium rod profile with a flexible undulating geometry distinct from the flat plate framework in Erich arch bars. Single MWS segments are Omega-shaped and carry a tie-up cleat for interarch linkage to the opposite jaw. The ends at the throughs of each MWS segment are equipped with threaded screw holes to receive locking screws for attachment to underlying mandibular or maxillary bone. An MWS can be partitioned into segments of various length from single Omega-shaped elements over incremental chains of interconnected units up to a horseshoe-shaped bracing of the dental arches. The sinus wave design of each segment allows for stretch, compression and torque movements. So, the entire MWS device can conform to distinctive spatial anatomic relationships. Displaced fragments can be reduced by in-situ-bending of the screw-fixated MWS/Omega segments to obtain accurate realignment of the jaw fragments for the best possible occlusion. Conclusion: The Matrix Wave^TM MMF System is an easy-to-apply modular MMF system that can be assembled according to individual demands. Its versatility allows to address most facial fracture scenarios in adults. The option of “omnidirectional” in-situ-bending provides a distinctive feature not found in alternate MMF solutions. Full article

Diabetes is a risk factor for periodontitis. Increasing evidence suggests that a central player in this link is the vacuolar H+-ATPase (V-ATPase), which provides a physical and functional core for regulation by the catabolic lysosomal AMP-activated protein kinase complex (L-AMPK) and the anabolic mammalian target of rapamycin complex 1 (mTORC1). These complexes detect levels of various cellular nutrients, including glucose at the lysosome, and promote cellular responses to restore homeostasis. The high-glucose conditions of diabetes foster anabolic mTORC1 signaling that increases inflammation and inflammatory bone resorption in response to periodontal infections. Here, we review the structure and composition of V-ATPase, L-AMPK, mTORC1, and other elements of the energy-sensing platform. Mechanisms by which V-ATPase passes signals to the complexes are examined and recent data are reviewed. Current anti-bone resorptive therapeutics, bisphosphonates and denosumab, enhance the risk of medicine-related osteonecrosis of the jaw (MRONJ) and are not used to treat periodontal bone loss. Accumulating data suggest that it may be possible to target inflammatory bone resorption through agents that stimulate L-AMPK, including metformin and glucagon-like peptide-1 agonists. This approach may reduce inflammatory bone resorption without major effects on overall bone remodeling or increased risk of MRONJ. Full article

Background/Objectives: Prolonged use of denosumab in patients with metastatic breast cancer has raised concerns about the development of medication-related osteonecrosis of the jaw (MRONJ). However, the threshold at which the risk increases remains unclear. Methods: This retrospective cohort study analyzed patients with breast cancer and bone metastases who received denosumab between May 2012 and August 2024. Associations between cumulative denosumab administration and MRONJ were evaluated using univariate and multivariate logistic regression analyses. A receiver operating characteristic (ROC) analysis was used to determine the optimal cutoff for cumulative doses. Results: MRONJ developed in 101 patients (31.2%). Multivariate analysis identified cumulative denosumab administration (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.03–1.06; p < 0.001) and a history of tooth extraction (OR: 4.40, 95% CI: 2.23–8.71; p < 0.001) as independent risk factors for MRONJ. ROC analysis determined an optimal cutoff of 32 cumulative doses, with an area under the curve of 0.83 (95% CI: 0.78–0.88; p < 0.0001). Conclusions: Cumulative denosumab administration and history of tooth extraction were independent risk factors for MRONJ in patients with breast cancer and bone metastases. The risk of MRONJ increased after 32 cumulative doses, providing a clinically actionable threshold for risk assessment and patient monitoring. Full article

Background: In modern dentistry, alveolar socket preservation after tooth extraction plays a critical role in maintaining the alveolar ridge for future dental implants. This retrospective clinical study evaluated bone-level changes 15 years after immediate implant placement, coupled with alveolar ridge preservation. Methods: Fifty non-smoking patients aged 25 to 75 (30 males and 20 females) who underwent single-implant rehabilitation in both anterior and posterior regions of the upper and lower jaws were included. The study examined bone levels and implant survival over time, using standardized intraoral radiographs at 1, 5, and 15 years post-loading. Implants were placed immediately after atraumatic extraction, and the residual gap was grafted with bovine hydroxyapatite and covered with a collagen membrane. The primary outcome was bone-level stability, while secondary outcomes included implant failure. No temporary crowns or removable dentures were provided during healing. Radiographs were digitized for detailed analysis. Results: The results for 50 patients with immediate implant placement showed that bone-resorption levels were significantly higher in the upper jaw than in the lower jaw. Conclusions: Posterior implants exhibited greater bone loss than anterior implants, particularly at 1 year and 15 years, while no implant failures occurred. Full article

Background and Objectives: Bisphosphonates (BP) like zoledronic acid (ZA) and alendronic acid (AA) are used for osteoporosis (OP) or other bone-related conditions as well as to prevent the spread of metastases and in rheumatoid arthritis treatment. However, they have been associated with an increased risk of osteonecrosis of the jaw (ONJ). This systematic review aimed to assess the incidence and risk of ONJ in osteoporotic patients treated with ZA or AA and evaluate the impact of treatment duration. Material and Methods: The systematic literature review was conducted following PRISMA guidelines. The keywords “Zoledronic acid,” “Alendronic acid,” “Osteoporosis,” and “Osteonecrosis” were searched in PubMed and ScienceDirect databases. Selection criteria included studies on humans written in English, published from 2014. The systematic review protocol was registered in the PROSPERO register under the following number: CRD42024587046. Results: A total of 7 studies with 98,717 osteoporotic patients met the criteria, showing a higher ONJ incidence with ZA than AA. Six studies linked longer BP use to increased ONJ risk, which quadrupled after 5 years of AA use. A positive correlation was found between BP use (≥3 years) and ONJ in OP patients, primarily affecting females over 60. ONJ appeared after 1 year with AA, increasing over time, while ZA-related ONJ emerged as early as 5 months with a higher overall incidence. Conclusions: ZA poses a higher ONJ risk and incidence and earlier onset than AA, occurring within 5 months versus 1 year for AA. These findings emphasize the need for careful monitoring, especially in long-term BP therapy with additional risk factors. Full article

Background/Objectives: Osteoporosis is a widespread and chronic systemic bone disease that affects the jaws and teeth and, therefore, also dentistry. Osteoporosis can be diagnosed by different radiological methods. Dental cone beam computed tomography (CBCT) plays an important role in dentistry imaging. The aim of our retrospective pilot study was to find criteria in CBCT that point to the possible existence of osteoporosis. Methods: Pilot study. The hard palate thickness (HPT) of the patients was measured at a defined location in the CBCT. Additionally, the CBCT images were presented to a radiologist for visual assessment. Both results were compared with the DXA measurements—as the “gold standard”—and patient history. Results: We found a consistent correlation between the visual assessments using established radiological criteria, including the new criterion of hard palate thickness (HPT), and the diagnosis of normal or pathological bone density. Secondly, for the HPT measurement all “pathologic” CBCT had an HPT of ≤0.9 mm, and all normal patients had an HPT of ≥0.9 mm. Conclusions: Despite the small sample size, this CBCT pilot study showed a correlation between HPT and systemic bone disease. Therefore, as our main result, we found a new CBCT diagnostic criterion, which quickly and uncomplicatedly points to the possible existence of bone disease, especially osteoporosis. We propose HPT as a new criterion in the evaluation of CBCT images. A threshold of <0.9 mm may be indicative for osteoporosis or osteopenia, indicating a need for further evaluation. Full article

Background: Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) is a severe complication associated with bisphosphonate therapy, commonly used in the treatment of osteoporosis and metastatic bone diseases. Low-Level Laser Therapy (LLLT) has been proposed as a potential treatment modality for BRONJ, with its anti-inflammatory, analgesic, and regenerative effects being of particular interest. This systematic review aims to critically assess the current evidence regarding the efficacy of LLLT in the management of BRONJ. Methods: This review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of electronic databases, including PubMed, Scopus, and Web of Science, was performed to identify relevant studies published up to September 2024. The systematic review protocol has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) with the number 423003. All studies considered are observational. Studies were included if they investigated the application of LLLT in BRONJ treatment, reporting clinical outcomes such as pain reduction, lesion healing, and quality of life. The quality of the studies was assessed using the Cochrane Risk of Bias tool, and the data were synthesized descriptively. Results: A total of four studies met the inclusion criteria. The findings indicate that LLLT, particularly when used in conjunction with surgical debridement and pharmacological therapy, significantly may reduce pain and promote soft tissue healing in patients with BRONJ. However, the heterogeneity of study designs, laser parameters, and outcome measures limits the generalizability of these results. Furthermore, most studies were small-scale, with moderate to high risk of bias. Conclusions: The current evidence suggests that LLLT may be a beneficial adjunctive therapy in the treatment of BRONJ. However, conclusions are limited by the lack of randomized controlled trials and methodological heterogeneity, particularly for pain management and soft tissue regeneration. However, further high-quality randomized controlled trials with standardized laser protocols are necessary to establish its efficacy and optimize clinical application. Therefore, one of the limitations of this literature review with meta-analysis is that only four studies were considered and, moreover, they were observational. The results of the meta-analysis showed that there is not enough evidence to declare a statistical correlation; this result will surely be due to the small number of studies and heterogeneity. Full article

Background and Clinical Significance: Chronic nonbacterial osteomyelitis (CNO) of the jaw is a rare autoinflammatory bone disorder that primarily affects children and adolescents. Diagnosing CNO of the mandible can be challenging due to its rarity, and the clinical and radiographic findings overlap with those of other bone disorders. Case Presentation: This case series retrospectively presents four female pediatric patients (9–12 years old) diagnosed with mandibular CNO. The patients were treated at King Abdulaziz University Dental Hospital, Jeddah, Saudi Arabia, between 2018 and 2024. Clinical features and radiographic and histopathological findings were evaluated. All cases had mandibular swelling and pain. Radiographic features consistently revealed mixed sclerotic and radiolucent lesions with bone expansion and periosteal reactions. Histopathological findings revealed viable bone interspersed with varying degrees of fibrous tissue. No evidence of bacterial colonies or inflammation was observed. This case series highlights the radiographic and histopathological features of CNO in the mandible of pediatric patients. The mixed radiographic features and variability of histopathological findings combined with the refractory nature of the lesions contribute to diagnostic complexity. Diagnostic challenges include differentiating CNO from other inflammatory and fibro-osseous conditions. The presence of recurrent episodes of pain, the formation of subperiosteal bone, periostitis, lysis of the cortical layer, expansion of the mandibular canal, and sterile bone biopsies with nonspecific inflammatory changes were related mainly to CNO. Conclusions: These findings underscore the need for increased awareness and a multidisciplinary approach for accurate diagnosis and management of CNO. Conservative management, particularly in dental cases, avoids prolonged unnecessary use of antibiotics, and the prescription of nonsteroidal anti-inflammatory drugs should be followed. Full article

Background/Objectives: This retrospective study assessed the accuracy of implant positioning with dynamic computer-aided implant surgery (dCAIS) for Toronto Bridge fabrication, using a conometric prosthetic concept and a new intraoral splinting technique (CLIKSS). It compared discrepancies across various anatomical regions, bone qualities, and implant sites. Methods: This study involved 52 patients undergoing full-arch rehabilitation (17 in the mandible, 30 in the maxilla, and 5 in both), with 366 implants placed (125 in the mandible, 241 in the maxilla; 128 in post-extraction sites, and the remainder in healed sites). All implants were immediately loaded. Precision was assessed by measuring linear and three-dimensional (3D) angular deviations between planned and actual implant positions. Results: Measurement errors for apical linear and 3D deviations at the apex and entry point ranged from 0.24 ± 0.10 to 0.55 ± 0.57 mm, and angular deviations varied from 0.32 ± 0.65° to 0.35 ± 0.71°. Maxillary measurements were significantly higher at the entry, apical, and vertical levels, even when comparing anterior and posterior regions with the corresponding mandibular areas, while no differences were found in the angular deviation. Significant discrepancies were observed among different mandibular bone types. Maxillary post-extraction sites exhibited significantly greater deviations than mandibular sites in all parameters except angular deviation. No significant differences were found between healed and post-extraction sites within the same jaw. Conclusions: dCAIS improved implant placement accuracy, leading to predictable prosthetic outcomes, especially during parallel multi-implant insertions. This report introduced dCAIS for conometric/biconometric implant placement combined with the innovative CLIKSS technique as an effective intraoral split method for this prosthesis connection. Full article

Background: This study aims to evaluate surgical outcomes and compares the prevalence and severity of postoperative complications and reoperations with maxillary osteotomies, focusing on the effectiveness of fixation with demineralized bone matrix (DBM) versus autogenous bone grafts (ABG) in patients with orofacial clefts and craniofacial malformations. Methods: This retrospective cohort study included 138 consecutive patients treated at the Cleft Palate and Craniofacial Center, Helsinki University Hospital, from 2014 to 2022. The cohort consisted of patients with clefts (n = 113), craniosynostosis, and craniofacial syndromes (n = 25). The DBM group (n = 103) received DBX^® (Musculoskeletal Transplant Foundation, Edison, NJ, USA), while the ABG group (n = 35) received autogenous bone grafts. Surgical procedures included Le Fort I and bimaxillary osteotomies. Complications involving the maxilla or both jaws were included in the analysis. Both major and minor complications, as well as reoperations, were analyzed and compared. Results: The DBM group had 13.6% of patients with complications, while the ABG group had 20.0%. Reoperation rates were 6.8% for the DBM group and 5.7% for the ABG group. There were no statistically significant differences in complication or reoperation rates between the DBM and ABG groups. Conclusions: The findings suggest that using DBM or ABG in maxillary osteotomies does not significantly affect complication or reoperation rates, supporting DBM as a viable alternative for maxillary surgeries. Full article

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is one of the side effects of bisphosphonate (BP) administration. Despite some preventive measures having been suggested, a definitive and effective treatment strategy for BRONJ remains to be established. Recent evidence has indicated that BPs dramatically impair the function of orofacial bone marrow stromal cells (BMSCs), which may contribute to the development of osteonecrosis. Thus, we hypothesized that recovery-impaired function of BMSCs at lesion sites could be beneficial in treating BRONJ. N6-methyladenosine (m6A) modification is the most common epigenetic modification and has been demonstrated to play a vital role in the modulation of BMSCs’ function. We detected the role of m6A modification in regulating the function of orofacial BMSCs under BP stimulation, and found that BPs led to a reduction in the global m6A methylation level, SAM level, and METTL3 expression in BMSCs during the osteogenic differentiation period. Meanwhile, betaine, a methyl group donor, effectively reversed the BP-decreased global m6A methylation level and SAM level in BMSCs, as well as rescuing the differentiation ability of impaired BMSCs. In the last part, we built a BRONJ rat model and supplemented rats with betaine via drinking water. The results showed that betaine successfully attenuated bone lesions and promoted wound healing in BP-injected rats, thereby providing new insight into future clinical treatment for BRONJ. Full article