Mandibular cortical bone evaluation on cone beam computed tomography images of patients with bisphosphonate related osteonecrosis of the jaws

Objectives The objective of this study was to develop a technique for detecting cortical bone dimensional changes in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). Study Design Subjects with BRONJ who had cone-beam computed tomography imaging were selected, with age- and gender-matched controls. Mandibular cortical bone measurements to detect bisphosphonate-related cortical bone changes were made inferior to mental foramen, in 3 different ways: within a fixed sized rectangle, in a rectangle varying with the cortical height, and a ratio between area and height. Results Twelve BRONJ cases and 66 controls were evaluated. The cortical bone measurements were significantly higher in cases than controls for all 3 techniques. The bone measurements were strongly associated with BRONJ case status (odds ratio 3.36-7.84). The inter-rater reliability coefficients were high for all techniques (0.71-0.90). Conclusions Mandibular cortical bone measurement is a potentially useful tool in the detection of bone dimensional changes caused by bisphosphonates. Long-term administration of bisphosphonates (BPs) affects bone quality and metabolism following accumulation in bone.1 Since the first cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) were published in 2003,2 there has been a search for factors that can predict the onset of the condition. Oral and intravenous BPs reduce bone resorption, increase mineral content of bone, and alter bony architecture.3, 4, 5 and 6 Previous studies have demonstrated these changes both radiographically and following histologic analysis.1, 3, 7, 8, 9 and 10 The BP-related jaw changes may present radiological features, such as thickening of lamina dura and cortical borders, diffuse sclerosis, and narrowing of the mandibular canal3 and 11; however, oral radiographs of patients taking BPs do not consistently show radiographic changes to the jaws.11 and 12 The challenge is to find imaging tools that could improve the detection of changes in the bone associated with BP use. Various skeletal radiographic features associated with BRONJ in conventional periapical and panoramic radiographs, computed tomography, magnetic resonance imaging, and nuclear bone scanning have been described.3, 8, 9, 10 and 11 There has also been a search for BP-related quantitative methods for the evaluation of radiographic images, to avoid observer subjectivity in interpretation. Factors thought to be important include trabecular and cortical structure, and bone mineralization.4 Consequently, measurable bone data have been reported in subjects taking BPs through many techniques, including bone density, architecture, and cortical bone thickness.1, 4, 7 and 13 Trabecular microarchitecture of postmenopausal women has been evaluated with noninvasive techniques, such as high-resolution magnetic resonance images showing less deterioration of the bone 1 year after initiation of oral BP therapy.4 A decrease in bone turnover and a trend for an increase in the bone wall thickness has been detected by histomorphometry in subjects taking BPs.1 Alterations in the cortical structure of the second metacarpal have been detected in digital x-ray radiogrammetry of postmenopausal women treated with BPs.7 Mandibular cortical width may be measured on dental panoramic radiographs, and it has been suggested as a screening tool for referring patients for bone densitometry for osteoporosis investigation.14 and 15 Inhibition of the intracortical bone remodeling in the mandible of mice taking BPs has been reported.16 Thus, imaging evaluation of the mandibular cortical bone could be a biologically plausible way to detect BP bone alterations. Computed tomography can assess both cortical and trabecular bone characteristics. Cone-beam computed tomography (CBCT) can provide 3-dimensional information, while using lower doses and costing less than conventional CT. The CBCT images have been studied as a tool for the measurement of trabecular bone in patients with BRONJ.13 Therefore, cortical bone measurements on CBCT of the jaws might also help to understand bone changes in patients with BRONJ. There is no standard in quantifying dimensional changes of mandibular cortical bone. We explored several different approaches to take into consideration possible changes in length, area, and volume. These led to the 3 techniques developed in this study. This article reports a matched case-control study in which mandibular cortical bone was measured on CBCT images of subjects with BRONJ and controls. The aim of the study was to explore the usefulness of 3 techniques for detecting mandibular cortical bone dimensional changes caused by BP.

Dental Implants in Patients With Osteoporosis: A Clinical Reality?

Osteoporosis is a systemic disorder characterized by generalized decrease in bone mineral density. Dental implantology is a specialty with high predictability when both quantity and quality of the bone are respected. Therefore, the diagnosis and the implant treatment in patients with osteoporosis are important. In the current study, a literature review about osteoporosis and dental implant therapy was conducted. PubMed, Cochrane, ISI, Dentistry Oral Science, SciELO, and Bireme databases were consulted over the last 20 years. English- and Portuguese-language articles were included in this revision. Some authors stated that the osteoporotic bone is similar to the proposed model of bone type IV. Randomized clinical studies reported implant failure in patients with osteoporosis after menopause. Studies that contraindicate the use of implants in patients with osteoporosis infer that the impaired bone metabolism led to reduction of bone healing around the implants. Nevertheless, other authors believe that the presence of osteoporosis is not a definitive condition to contraindicate the therapy with dental implants. In these cases, the dentist should perform a proper treatment planning, modifying the implant geometry, and use larger implant diameter and with surface treatment. Thus, osteoporosis is not a contraindication for implant surgery because an accurate analysis of bone quality by means tomography is performed.

Clinical Viability of Immediate Loading of Dental Implants: Part I-Factors for Success

Two-stage procedure for dental implants presents corroborated clinical success over 40 years. The evolution of surgical techniques, development of diagnostic methods, knowledge about tissue biology, and quality of implants regarding design and surface supported studies with I surgical stage followed by immediate prosthesis placement. However, several factors influence the treatment success with immediate loading. SO, this Study aimed to evaluate some factors regarding the success and characteristics of implants and patients.

Craniofacial Implants Success in Facial Rehabilitation

The use of craniofacial implants is an effective treatment for patients with deformities, burns, and cancer sequelae. The sites with the most successful implants are the auricular, nasal, and orbital regions. Furthermore, other factors can affect the implant longevity such as irradiated area, surgical technique, bone quality and quantity, macrostructure and microstructure of the implant, maintenance, and systemic factors.

Immediate X delayed loading dental implants: An overview

The aim of this investigation was to accomplish an overview about the principles of the indication and of the success parameters involving immediate and delayed loading dental implants procedures. Studies about the philosophies (immediate and delayed loading dental implants) and their clinical indications will be discussed in order to overview the rules for the clinical success in both techniques. In addition, studies regarding the criteria for immediate loading implants as primary stabilization, surface treatments and bone density and amount will be also analyzed. More important than the philosophy selection, is how and when to use it according to biomechanical rules and principles. Among the vast limitations pointed by the literature regarding procedures of immediate and delayed loading are evidenced the parafunctional habits, primary stabilization, bone quality, surface treatments and the number of dental implants. The anterior region of the jaw seems to be associated with a major percentage of satisfactory results, regardless of rehabilitation procedures. Although several studies have demonstrated high success rates for the immediate loading dental implants, several aspects remain without an explicit definition and further studies are needed to elucidate some reservations.

Efeito do cálcio na qualidade óssea e de ovos de poedeiras

The experiment was carried out, with hens of the Shaver Brown strain in production, during 27 weeks. The objective was to evaluate the mobilization of bone calcium and phosphorus for the formation of the shell eggs, as well as to follow the variations in the bone quality along the production cycle. 64 birds had been used. The experimental desing was entirely randomized with two treatments (calcium percentage in the diet) and four repetitions of eight birds each. The used diets were isoproteic and isoenergetic adequate (3.8%) and low (1.8%) calcium levels. Analysis of bone (tibiae and femurs) mineral density (DMO) were done at 16, 22, 28, 34 and 40 weeks of age were developed. After each radiographic collection, 4 birds/treatment, were abated for the analysis of bone resistance (RO), Seedor index (IS), dry matter (MS), total mineral (MIN) and calcium and phosphorus (Ca and P). The values of egg production, production of egg mass and quality of the egg shell were also evaluated. It was possible to conclude that the birds mobilized bone minerals for the egg production, independently of the treatment and the birds receiving diets with low levels of calcium had the quality of the eggs shell damaged.

Efeito de níveis de fósforo não-fítico e de fitase sobre a tíbia de frangos de corte

It was evaluated the effect of nonphytate phosphorus (NNP) and phytase on broiler tibia. One thousand and two hundred chicks were allocated in a completely randomized design and factorial arrangement 4 x 3 (NPP x phytase levels), with four replicates. NPP levels, at each phase, were 0.45, 0.37, 0.29 and 0.21% - initial, 0.41, 0.33, 0.25 and 0.17% - growth, and 0.37, 0.29, 0.21 and 0.13% - withdrawal. Phytase levels were 0, 500 and 1000 FTU/kg of diet. There was no effect on diameter at 21 days of age. Tibia with lower weight, length and diaphysis, distal epiphysis and average densities e proximal epiphysis density resulted from NPP reduction from 0.37 to 0.29% and from 0.29 to 0.21%, respectively. Inclusion of 500 FTU/kg of phytase improved length and diaphysis density of the tibia, independent of NPP levels. Diets with NPP, at initial, growth and final phases, of 0.37, 0.33 and 0.29%, respectively, supplemented with 1000 FTU/kg of phytase, can be used with no negative effect on bone quality in broilers.

Rehabilitation with zygomatic implants: a treatment option for the atrophic edentulous maxilla--9-year follow-up.

This article reports the 9-year clinical outcome of the two-stage surgical rehabilitation of a severely atrophic edentulous maxilla with a metal-resin fixed denture supported by implants anchored in the zygomatic bone and the maxilla. After clinical and radiographic examination, zygomatic implants were inserted bilaterally and four standard implants were placed in the anterior region of the maxilla. Six months later, the implants were loaded with a provisional acrylic resin denture, and the definitive implant-supported metal-resin fixed denture was provided 1 year after implant placement. After 9 years of follow-up, no painful symptoms, peri-implant inflammation or infection, implant instability, or bone resorption was observed. In the present case, the rehabilitation of severe maxillary atrophy using the zygomatic bone as a site for implant anchorage provided good long-term functional and esthetic results. Therefore, with proper case selection, correct indication, and knowledge of the surgical technique, the use of zygomatic implants associated with standard implants offers advantages in the rehabilitation of severely resorbed maxillae, especially in areas with inadequate bone quality and volume, without needing an additional bone grafting surgery, thereby shortening or avoiding hospital stay and reducing surgical morbidity.

Níveis de cálcio e avaliação óssea e de ovos de avestruzes reprodutoras

Analyses of mineral density in tibias and femurs of breeder ostriches had been carried on six couples 5-7 years old. During 8 weeks, 3 couples had been fed with ration of reproduction (T1) and other 3 couples with ration of maintenance (T2). It was possible to verify that the egg production was not affected by the diets, as well as the quality of egg shells. However the quality of the bones was worse for the birds fed of T2.

Efeitos da ingestão de chás de Camellia sinensis em parâmetros ósseos de ratos machos jovens, tratados ou não com sacarose

Pós-graduação em Ciências Fisiológicas - FOA

Estudo da microarquitetura óssea, do estado nutricional e de fatores farmacológicos na síndrome de Turner

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Perfil metabólico de cálcio e ósseo de pacientes soropositivos para HIV em uso ou não da terapia antirretroviral

Pós-graduação em Alimentos e Nutrição - FCFAR

Influência do sistema nervoso simpático na periodontite induzida e em glândula salivar de ratos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Prótese protocolo com barra pré-fabricada: comportamento ósseo variando o tipo de osso e a configuração horizontal do arco mandibular no MEF-3D

Pós-graduação em Odontologia - FOA

Avaliação do reparo ósseo de cavidades preenchidas por vidro bioativo ou osso liofilizado desmineralizado: análises biomecânica, microscópica e histométrica em cães

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)