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Original Article
- Implant-Related Medication-related Osteonecrosis of the Jaw in Patients Receiving Bone-modifying Agent Therapy: A Retrospective Study on Onset Timing and Causes
- Jangwoo Son, Kang-Min Ahn
- Purpose: Medication-related osteonecrosis of the jaw (MRONJ) is a significant complication associated with bone-modifying agents (BMAs). This study addresses the gap in …
- Purpose: Medication-related osteonecrosis of the jaw (MRONJ) is a significant complication associated with bone-modifying agents (BMAs). This study addresses the gap in understanding how local factors, such as peri-implantitis, extractions, surgical trauma, and timing of implant placement relative to BMA therapy, affect MRONJ development around dental implants.Materials and Methods: We conducted a retrospective analysis of 38 patients who developed peri-implant MRONJ following BMA therapy at Asan Medical Center between 2008 and 2024. Using the 2022 American Association of Oral and Maxillofacial Surgery criteria, we diagnosed and staged MRONJ. We examined the patient profiles, BMA regimens, implant placement timing, and MRONJ onset. Based on this, the subjects were divided into three groups (Group 1: implant placement before BMA administration, Group 2: implant placement after BMA administration, MRONJ occurrence within 1 year after surgery, Group 3: implant placement after BMA administration, MRONJ occurrence more than 1 year after surgery). The causes were classified as chronic inflammation (peri-implantitis) or acute inflammation (trauma caused by surgery or tooth extraction), assessed through radiographic and clinical examinations. We also observed the occurrence of MRONJ at other oral sites.Results: The cohort comprised 37 patients with osteoporosis and one patient with breast cancer. BMA treatment included oral bisphosphonates (15), intravenous bisphosphonates (7), denosumab (3), and combination therapies (13). MRONJ occurred in 21 cases (group 1, 55.2%) when implants were placed before BMA administration and in 17 cases (44.7%) when placed after administration. Among the latter, nine cases (group 2, 23.7%) developed within 1 year of implant placement, and eight cases (group 3, 21.0%) occurred more than 1 year after placement. Chronic inflammation (peri-implantitis) was the primary cause in 26 patients (68.4%), whereas acute inflammation (trauma and other local factors) was the primary cause in 12 patients (31.6%). Nine patients developed MRONJ at additional oral sites. Five cases showed MRONJ-free implants placed simultaneously with the affected implants.Conclusion: The main direct causes of MRONJ differ depending on the timing of BMA administration and implant placement. In cases with osseointegration (Groups 1 and 3), chronic inflammation was the primary cause of MRONJ, whereas acute inflammation was the main cause immediately after surgery (Group 2). Additionally, local infections and inflammation spread from adjacent tooth extractions can cause extensive lesions around MRONJ sites. - COLLAPSE
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Original Article
- Effects of Zoledronic Acid and Teriparatide on Bone Regeneration After Bone Grafting in Ovariectomized Rat
- Kyeong-Mee Park, Eunhye Choi, Wonse Park
- Purpose: Osteoporosis, a condition characterized by decreased bone density, increases susceptibility to fractures. This study aimed to evaluate the early and mid-term …
- Purpose: Osteoporosis, a condition characterized by decreased bone density, increases susceptibility to fractures. This study aimed to evaluate the early and mid-term effects of zoledronic acid and teriparatide on bone regeneration in rats with osteoporosis.Materials and Methods: Osteoporosis was induced in rats through ovariectomy, after which animals were randomly divided into four groups: TPD_2, TPD_4, ZA_2, and ZA_4. Calvarial bone grafting was performed eight weeks after ovariectomy. All animals were sacrificed 2 or 4 weeks after zoledronic acid and teriparatide administration. The tibia and calvaria were harvested for analysis.Results: In the calvaria, the volume fraction of newly formed bone was significantly higher in the ZA_4 group compared to the ZA_2 and TPD_2 groups. The specific bone surface area of residual grafts was significantly lower in the TPD_4 group compared to the ZA_2 and ZA_4 groups. The percentage of newly formed bone in the calvaria was significantly higher in the TPD_2 group compared to the ZA_2 group.Conclusion: Teriparatide plays a role in bone formation during the early stages of bone grafting particularly when bone formation is inhibited. These findings suggest that teriparatide may enhance the success rate of bone transplantation and accelerate the healing process. - COLLAPSE
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Clinical or Case Report
- Reconstruction of Complicated Posterior Maxillary Bone Defects Using Recombinant Human Bone Morphogenetic Protein-2 with Hydroxyapatite and Fibrin Sealant
- Jung Woo Nam
- In cases of common alveolar bone deficiency in the posterior edentulous maxilla, dental implant treatment can proceed following the reconstruction of the …
- In cases of common alveolar bone deficiency in the posterior edentulous maxilla, dental implant treatment can proceed following the reconstruction of the defect through alveolar ridge augmentation and/or maxillary sinus floor augmentation, depending on the specific characteristics of the bone deficiency. However, reconstruction remains challenging in cases of extensive alveolar defects with large bone perforations. The author successfully managed these complicated posterior maxillary bone defects using recombinant human bone morphogenetic protein-2 with hydroxyapatite and fibrin sealant as carriers. This report presents two cases demonstrating the efficacy of this approach. - COLLAPSE
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Clinical or Case Report
- The Surgical Approaches to Treat Peri-implantitis with Intrabony Defect
- Ji-Won Song, Jin-Un Yoon, Hyun-Joo Kim, Ju-Youn Lee, Ji-Young Joo
- Peri-implant diseases are increasingly recognized as complications associated with dental implants. Managing peri-implant diseases remain a challenging issue, with no consistently reliable …
- Peri-implant diseases are increasingly recognized as complications associated with dental implants. Managing peri-implant diseases remain a challenging issue, with no consistently reliable and predictable treatments established to date. Both non-surgical and surgical treatments have been attempted for their management. However, non-surgical treatment through mechanical debridement alone does not provide much benefit in the management of peri-implant diseases. The surgical treatment provides direct access to peri-implantitis lesion for the purpose of thorough debridement of infected tissue and decontamination of implant surfaces. It is effective in reducing inflammation and arresting disease progression. Augmentative surgical techniques using bone graft or biological modulating materials seek to regenerate the bone defects and achieve re-osseointegration. We present an augmentative treatment for peri-implantitis, addressing three different types of bone morphology and bone defect types without removing the prosthesis. However, this study is limited by its short-term observation period. - COLLAPSE
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Clinical or Case Report
- Primary Bone Augmentation Using a Redundant Autogenous Alveolar Bone Block for Restoring Severe Bone Deficiency: A Case Report
- Won-Bae Park, Hyun-Chang Lim
- Autogenous bone is the gold standard for bone regeneration, despite limitations such donor site morbidity and a lack of supply. This study …
- Autogenous bone is the gold standard for bone regeneration, despite limitations such donor site morbidity and a lack of supply. This study reports a case of a 72-year-old male requiring implants in the left posterior mandible with severe bone deficiency due to prior peri-implantitis. For primary bone augmentation of such mandibular area, redundant alveolar bone was harvested in the block-form from the right maxillary area along with simultaneous implant placement in that area. The harvested block was fixed in a press-fit manner. Subsequently, the remaining defect was grafted with a synthetic bone substitute material. The grafted area was covered with a collagen membrane, followed by primary flap closure. Six months later, implant placement was performed, and the bone block was well integrated to the recipient site without mobility or fibrotic union. One year after the final prosthesis delivery, stable marginal bone level and favorable bone block integration were noted. Within the limitation of this case report, the redundant alveolar ridge can be considered as an alternative donor site for primary bone augmentation. - COLLAPSE
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Clinical or Case Report
- Mandibular Rehabilitation with Fibula Free Flap and Dental Implant: A 4-Year Follow–up
- Soobeen Yun, Ahjin Kim, Jin-yong Cho
- A 21-year-old male with a plexiform-type ameloblastoma in the left mandible underwent decompression, partial mandibulectomy, and reconstruction using a fibula free flap. …
- A 21-year-old male with a plexiform-type ameloblastoma in the left mandible underwent decompression, partial mandibulectomy, and reconstruction using a fibula free flap. Virtual surgical planning facilitated precise resection and optimal placement of the fibula graft at the mid-height of the mandible, thereby improving the crown-to-implant ratio. The temporomandibular joint (TMJ) disc was preserved during mandibulectomy to prevent ankylosis and support functional remodeling of the neo-condyle. Postoperatively, malocclusion was managed through intermaxillary fixation, and implant rehabilitation was initiated after a 9-month healing period. At the 55-month follow-up, the patient exhibited stable occlusion, restored mouth opening, and absence of recurrence or complications at the reconstruction or implant sites. The neo-condyle demonstrated rounded contours resembling a natural condyle, and implant osseointegration was achieved without prosthetic complications. This case elucidates the significance of precise fibula flap positioning at the mid-height of the mandible to ensure long-term implant stability. Additionally, it highlights the pivotal role of TMJ disc preservation in facilitating functional recovery. - COLLAPSE
Journal Informaiton
Journal of implantology and applied sciences
Journal of implantology and applied sciences
The Korean Academy of Oral & Maxillofacial Implantology
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Tel: +82-2-558-5966 / Fax: +82-2-558-5965 / E-mail: webmaster@implant.or.kr Copyright© The Korean Academy of Oral & Maxillofacial Implantology. Powered by APUB