Area Of Exposed Bone Research Articles

Evaluation of the Awareness and Knowledge Levels of Dentists Regarding Bisphosphonates and Bisphosphonate-Related Jaw Necrosis

Bisphosphonates are used in the treatment of osteoporosis, bone metastases, and metabolic bone diseases. Long-term use of bisphosphonates increases the risk of osteonecrosis in patients undergoing dental surgery. This study aimed to evaluate dentists’ knowledge about bisphosphonates and bisphosphonate-related osteonecrosis of the jaw (BRONJ) and their treatment approaches in patients using oral and intravenous bisphosphonates. In this study, a 25-question questionnaire was applied to dentists working in different institutions regarding their knowledge and experience about bisphosphonates and BRONJ, and treatment approaches for different surgical procedures in patients using bisphosphonates. The obtained data were statistically analyzed and evaluated. In total, 90.5% of the dentists identified osteoporosis, 79.8% identified bone metastases, 52.4% identified osteitis deformans, and 39.3% identified multiple myeloma as conditions in which bisphosphonates are used, thus answering correctly in a significant proportion. When participants were asked about treatment options according to the stages of BRONJ, participation in the “I’m not sure” option increased as the stages progressed, indicating that dentists were not sufficiently familiar with the treatments for different stages of BRONJ. In total, 88.5% of the participants stated that when they see an exposed bone area in patients they examine, they consider bisphosphonate use as a possible cause. There was a statistically significant difference between dentists with and without prior BRONJ experience regarding their ages (P=0.039) and years of practice (P=0.001). There was a statistically significant difference between dentists with and without BRONJ experience regarding whether they inquired about bisphosphonate use (P=0.001). It was found that dentists have serious deficiencies in knowledge regarding bisphosphonates, their side effects, and treatment approaches for patients using bisphosphonates. Increasing dentists’ knowledge and awareness of this issue would help reduce the risk of developing BRONJ.

Management strategy of a periodontist in treating a patient with bisphosphonate-related jaw osteonecrosis: a clinical case

Relevance. Drug-related osteonecrosis of the jaws is a serious complication of antiresorptive therapy in patients with cancer, systemic osteoporosis, and Paget's disease, significantly impacting the patients' quality of life.Clinical case description. This article analyzes the progressive oral manifestations of a complication of antiresorptive therapy—drug-related osteonecrosis of the jaws—in a patient with breast cancer. The osteonecrosis was characterized by an exposed bone area in the upper jaw, periodontal inflammation, and a malodorous discharge from the mouth. The paper details the appropriate management strategy by the periodontist, tailored to the patient's individual characteristics.Conclusion. Early initiation of a conservative, comprehensive, and gentle treatment regimen can reduce inflammation in periodontal tissues, including the necrotic area, thus avoiding the need for high-risk surgical procedures.

Maxillary Osteomyelitis: A Case Report Highlighting Diagnosis and Treatment Challenges

Osteomyelitis, a condition characterized by inflammatory bone infection involving the medullary cavity, haversian systems, and periosteum, is relatively rare but grave. Historically more prevalent prior to the antibiotic era, it remains a formidable challenge, particularly when comorbid with systemic illnesses such as diabetes mellitus. This case report details the presentation of a 70-year-old male with poorly controlled diabetes mellitus presenting with maxillary osteomyelitis, evidenced by tooth mobility, purulent discharge, and exposed bone areas. Radiographic assessment revealed extensive maxillary bone involvement, corroborated by histopathological examination confirming chronic osteomyelitis. Treatment entailed partial maxillectomy under local anesthesia, necessitated by financial constraints, followed by subsequent monitoring and prosthesis placement. This case underscores the significance of timely diagnosis, interdisciplinary management, and the complexities inherent in treating osteomyelitis complicated by systemic diseases.

Intra-articular delivery of micronized dehydrated human amnion/chorion membrane reduces degenerative changes after onset of post-traumatic osteoarthritis.

Background: Micronized dehydrated human amnion/chorion membrane (mdHACM) has reduced short term post-traumatic osteoarthritis (PTOA) progression in rats when delivered 24h after medial meniscal transection (MMT) and is being investigated for clinical use as a disease modifying therapy. Much remains to be assessed, including its potential for longer-term therapeutic benefit and treatment effects after onset of joint degeneration. Objectives: Characterize longer-term effects of acute treatment with mdHACM and determine whether treatment administered to joints with established PTOA could slow or reverse degeneration. Hypotheses: Acute treatment effects will be sustained for 6weeks, and delivery of mdHACM after onset of joint degeneration will attenuate structural osteoarthritic changes. Methods: Rats underwent MMT or sham surgery (left leg). mdHACM was delivered intra-articularly 24h or 3weeks post-surgery (n = 5-7 per group). Six weeks post-surgery, animals were euthanized and left tibiae scanned using equilibrium partitioning of an ionic contrast agent microcomputed tomography (EPIC-µCT) to structurally quantify joint degeneration. Histology was performed to examine tibial plateau cartilage. Results: Quantitative 3D µCT showed that cartilage structural metrics (thickness, X-ray attenuation, surface roughness, exposed bone area) for delayed mdHACM treatment limbs were significantly improved over saline treatment and not significantly different from shams. Subchondral bone mineral density and thickness for the delayed treatment group were significantly improved over acute treated, and subchondral bone thickness was not significantly different from sham. Marginal osteophyte degenerative changes were decreased with delayed mdHACM treatment compared to saline. Acute treatment (24h post-surgery) did not reduce longer-term joint tissue degeneration compared to saline. Histology supported µCT findings and further revealed that while delayed treatment reduced cartilage damage, chondrocytes displayed qualitatively different morphologies and density compared to sham. Conclusion: This study provides insight into effects of intra-articular delivery timing relative to PTOA progression and the duration of therapeutic benefit of mdHACM. Results suggest that mdHACM injection into already osteoarthritic joints can improve joint health, but a single, acute mdHACM injection post-injury does not prevent long term osteoarthritis associated with meniscal instability. Further work is needed to fully characterize the durability of therapeutic benefit in stable osteoarthritic joints and the effects of repeated injections.

Medication-Related Osteonecrosis of the Jaws (MRONJ) in Children and Young Patients—A Systematic Review

Medication-related osteonecrosis of the jaw (MRONJ) is defined by the American Association of Oral and Maxillofacial Surgeons (AAOMS) as the presence of an exposed bone area in the maxillofacial region, present for more than eight weeks in patients treated with the use of antiresorptive or antiangiogenic agents, with no history of radiation or metastatic disease. Bisphosphonates (BF) and denosumab (DS) are widely used in adults for the management of patients with cancer and osteoporosis, and recently there has been an increase in their use in child and young patients for the management of disorders such as osteogenesis imperfecta (OI), glucocorticoid-induced osteoporosis, McCune-Albright syndrome (MAS), malignant hypercalcemia, and others. There are differences between case reports in adults compared to child and young patients related to the use of antiresorptive/antiangiogenic drugs and the development of MRONJ. The aim was to analyze the presence of MRONJ in children and young patients, and the relation with oral surgery. A systematic review, following the PRISMA search matrix based on the PICO question, was conducted in PubMed, Embase, ScienceDirect, Cochrane, Google Scholar, and manual search in high-impact journals between 1960 and 2022, publications in English or Spanish, including randomized and non-randomized clinical trials, prospective and retrospective cohort studies, cases and controls studies, and series and case reports. A total of 2792 articles were identified and 29 were included; all of them published between 2007 and 2022, identifying 1192 patients, 39.68% male and 36.24% female, aged 11.56 years old on average, using these drugs mainly for OI (60.15%); 4.21 years on average was the therapy time and 10.18 drug doses administered on average; oral surgery was observed in 216 subjects, reporting 14 cases of MRONJ. We concluded that there is a low presence of MRONJ in the child and youth population treated with antiresorptive drugs. Data collection is weak, and details of therapy are not clear in some cases. Deficiencies in protocols and pharmacological characterization were observed in most of the included articles.

Osteonecrosis of the Jaw.

Osteonecrosis of the jaw is a condition in which bone cells die due to various causes. It is classified as drug-induced jaw osteonecrosis, osteoradionecrosis, traumatic, non-traumatic, and spontaneous osteonecrosis. Antiresorptive or antiangiogenic drugs cause drug-induced osteonecrosis. The combination of medications, microbial contamination, and local trauma induces this condition. Osteoradionecrosis is a severe radiation therapy side effect that can affect people with head and neck cancer. It is described as an exposed bone area that does not heal for longer than three months after the end of radiation treatment with the absence of any indications of an original tumor, recurrence, or metastasis. Trauma (tooth extraction), tumor site, radiation dose that the patient receives, the area of the bone which is irradiated, oral hygiene, and other factors are risk factors for the development of osteonecrosis. Less frequently, osteonecrosis can also be induced by non-traumatic and traumatic causes. Non-traumatic osteonecrosis is brought on by infections, acquired and congenital disorders, as well as the impact of chemicals. Traumatic osteonecrosis is brought on by thermal, mechanical, or chemical damage. The treatment of osteonecrosis can be conservative, which aims to be beneficial for the patient's quality of life, and surgical, which involves debridement of the necrotic bone.

Ankle Approach Selection: Defining Eight Ankle Approaches Exposure Segment and Area

Category:Ankle; TraumaIntroduction/Purpose:Ankle and tibial plafond fractures are a frequent problems in everyday practice. To achieve the best possible outcome, proper soft tissue handling and joint surface restoration is mandatory, therefore, approach selection is of vital importance. Currently, there is no consensus nor evidence-based data regarding this critical planning step, and published guidelines are based on expert opinion. The aim of this study was to measure exposure segment and amount of area exposed by 8 different approaches and to provide objective data to be used as a tool in approach selection.Methods:We performed a descriptive cadaveric study. We included the following approaches: anteromedial, anterolateral, direct lateral, posterolateral, posterior paramedian, posterior modified posteromedial, anterior modified posteromedial and direct medial approach. Each approach was performed four times. All incisions where standardized in length and centered 1cm proximal to the tibiotalar joint. After retracting flaps, we took one picture of each approach at a standardized distance, using a 1cm mark as a witness and calculated bone exposure area. On a second stage, all specimens where frozen and used to perform an axial cut 1cm proximal to the tibiotalar joint. A new picture was then obtained of each approach at a standardized distance. The amount of segment exposed by each approach was expressed in degrees, using two reference axes: the mediolateral malleolar axis and an anteroposterior axis at it center. 0° was stablished at the medial malleolus and 90° at the anterior edge.Results:We obtained the following median exposed area for the studied approaches: anteromedial: 18,36cm2, anterolateral: 8,52cm2, direct lateral: 12,72cm2, posterolateral: 9,40cm2, posterior paramedian: 12,18cm2, posterior modified posteromedial: 10,42cm2, anterior modified posteromedial: 12,37cm2 and direct medial: 15,66cm2. The median exposed segment of each approach was: anteromedial: 4°-99°, anterolateral: 50°-170,5°, direct lateral: 137°-200°, posterolateral: 187°-258°, posterior paramedian: 202°-297°, posterior modified posteromedial: 215°-305°, anterior modified posteromedial: 242°-311° and direct medial: 21°- 309,5°. The biggest area of exposure was provided by the anteromedial approach (18,36cm2) and the greatest exposed segment was that of the anterolateral approach (120°). On the other hand, the smallest exposed bone area was that of the anterolateral approach and the smallest segment with the direct lateral approach (63°). A comparative view of the exposed segments is showed in Figure 1.Conclusion:When comparing results focused on posteromedial approaches, the posterior paramedian approach is the one that best combines exposure area and segment. Posterior paramedian approach also allows good access to the posterolateral tibial surface. Based on our results, we propose combining posterior paramedian and posterior modified posteromedial approach, using a single incision and the FHL tendon as a mobile window to manage complex posterior tibial fractures with posteromedial and posterolateral extension. We believe that by defining area and segment exposed by different ankle approaches we provide surgeon with objective data that could help in approach or approaches selection.

INFANTILE OSTEOPETROSIS ASSOCIATED WITH MANDIBULAR OSTEOMYELITIS: A CASE REPORT

A 7-year-old male patient was referred to an oral medicine service for assessment of mandibular osteomyelitis after deciduous molars extraction. In the anamnesis, infantile osteopetrosis was reported. Intraoral examination revealed an exposed bone area with the presence of suppuration located in the region of previous extraction. Panoramic radiography showed changes in the pattern of eruption and a poorly delimited radiolucent area in left mandibular alveolar region, suggestive of chronic osteomyelitis. A bone debridement was performed which resulted in healing of the alveolar mucosa. However, 9 months later, the patient returned with recurrence of the infectious process and the presence of extraoral fistulas on the left side. As a treatment for mandibular osteomyelitis secondary to osteopetrosis, the patient underwent surgical procedures first for bone debridement in the left mandible and then, for marginal segmental resection of the mandible and placement of a titanium plate. The patient shows no signs of recurrence of the infectious process. Support: FAPEMIG.

Retrospective study of osteoradionecrosis in the jaws of patients with head and neck cancer.

ObjectivesOsteoradionecrosis (ORN) is one of the most severe complications resulting from radiotherapy (RT) in patients with head and neck cancer (HNC). It is characterized by persistent exposed and devitalized bone without proper healing for greater than 6 months after a high dose of radiation in the area. To describe the profile and dental management of ORN in HNC patients undergoing RT in an oncological clinical research center.Materials and MethodsA retrospective descriptive study was performed to analyze dental records from HNC patients with ORN treated at an oncological clinical research center from 2013 to 2017. A total of 158 dental records for HNC patients were selected from a total of 583 records. Afterwards, this number was distributed to three examiners for manual assessments. Each examiner was responsible for selecting dental records that contained an ORN description, resulting in 20 dental records.ResultsMean patient age was 60.3 years with males being the most affected sex (80.0%). The most affected area was the posterior region of the mandible (60.0%) followed by the anterior region of the mandible (20.0%) and the posterior region of the maxilla (10.0%). The factors most associated with ORN were dental conditions (70.0%) followed by isolated systemic factors (10.0%) and tumor resection (5.0%). There was total exposed bone closure in 50.0% of cases. The predominant treatment was curettage associated with chlorhexidine 0.12% irrigation (36.0%).ConclusionPoor dental conditions were related to ORN occurrence. ORN management through less invasive therapies was effective for the closure of exposed bone areas and avoidance of infection.

Treatment of Osteoradionecrosis of the Jaw with Ozone in the Form of Oil-based Gel: 1-year Follow-up

Osteoradionecrosis of the jaws (ORNJs) is aseptic bone necrosis that develops in post-irradiated bone tissue of patients who underwent radiotherapy for head-neck tumors. The present study aims to clinically assess the regenerative ability of the ozone in the form of oil-based gel applied to the exposed bone area in the treatment of ORNJ. Eight patients who underwent radio- therapy for the treatment of cervical or neck cancer were diagnosed with ORN of the jaws at our Department, for a total of 11 sites of necrotic bone exposure (3 patients were diagnosed with more than one site of osteoradionecrosis). In the therapeutic protocol, the exposed bone lesion and osteomucosal margin were cleaned with manual debridement. Then the ORN lesion was treated with topical applications of ozone delivered as oil suspension (Ozosan® - Sanipan, Clivio, Italy) on the exposed bone for 10 minutes. The application was repeated each week until movement of the necrotic fragment was noted Results: In six patients on 8 (75%) lesions resolved with complete mucosal healing with 3 to 19 ozone applications. Total sequestration of the necrotic bone with spontaneous expulsion was observed. One patient improved his conditions shifting from a stage B2S1 to B1S1 according to He et al. classification. A patient only worsened his conditions with treatment. No toxicity was reported or observed. These results showed the efficacy of ozone oil suspensions in the non-invasive treatment of ORN, probably related to its properties of stimulation of local revascularization and antibacterial activity, and the good tolerability of the related protocol used. The use of this kind of medication should be included in ORNJ treatments as effective, noninvasive and self-administered.

Value of nonsurgical therapeutic management of stage I bisphosphonate-related osteonecrosis of the jaw

There is still controversy about the best treatment strategy for patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) stage I. Therefore, the aim of the present study was to analyse the effect of a nonsurgical treatment protocol in patients with BRONJ stage I.During the study period we included 17 patients (11 male; 6 female) who presented with a total of 24 separate areas of BRONJ, stage I. All patients were exclusively treated with a monthly intravenous regime of zoledronic acid due to an underlying malignant disease. All patients were treated using a standardized nonsurgical protocol consisting of antimicrobial mouth rinsing with chlorhexidine (CHX) (0.12%) three times a day, and daily CHX gel application.In 11 patients (45.8%) the surface area of the exposed jawbone was completely healed by nonsurgical treatment. In seven patients (29.2%), nonsurgical treatment reduced the size of the exposed bone area by a mean of 64.7% (range 20.0–96.8%). None of the patients showed an increase in size of the area of exposed jawbone, or a worsening of the BRONJ from stage I to stages II or III. However, the duration of nonsurgical treatment or the duration of intravenous bisphosphonate therapy did not significantly influence the treatment outcome (p = 0.6628, p = 0.6077, respectively).The results of the present study support the beneficial role of nonsurgical treatment in patients presenting with BRONJ stage I. Surgical therapy of BRONJ should be restricted to patients with advanced stages with clinical symptoms and local signs of infection.

Surgical Therapy for Bisphosphonate-Related Osteonecrosis of the Jaw: Six-Year Experience of a Single Institution

Bisphosphonates are drugs commonly used to treat osteoporosis, hypercalcemia of malignancy, and bone metastases. In some cases, its administration has been associated with osteonecrosis of the jaws. The management of medication-related osteonecrosis of the jaw (MRONJ) has not been completely elucidated, and its treatment can vary from no or limited surgery to more extensive surgery. The objective of the present study was to evaluate the efficacy of surgical therapy for patients presenting with MRONJ. A retrospective study was conducted that evaluated all MRONJ cases resulting from bisphosphonate use and treated by surgery from 2006 to 2012. All patients underwent surgery under general anesthesia. A total of 33 patients with 46 MRONJ sites were evaluated. Most of the patients were women, with an age range of 39 to 83 years (mean 65.6 ± 10.6). Complete healing of the MRONJ region was observed in 40 of the 46 sites (87%), with partial improvement (symptom control and reduction of the exposed bone area) observed in 3 sites (6.5%), for a 93.5% clinical benefit rate. Of the remaining regions, 2 showed no significant changes, and 1 presented with a worse aspect compared with the patient's preoperative condition. Such cases were located in the posterior mandible region. The number of applications and type of bisphosphonate did not influence the treatment response. The surgical approach to treating MRONJ showed a high rate of clinical control. Therefore, surgery should be considered as a therapy for some cases of this condition.

Efficacy of a nonsurgical treatment regimen in patients with bisphosphonate-related osteonecrosis of the jaws in Saudi Arabia.

Objectives:The objective of this study was to evaluate the effectiveness of a nonsurgical treatment regimen in the long-term control of necrotic areas of the jaws and pain in such patients.Methods:A total of 96 patients suffering from the disease were included in this study. All patients received nonsurgical treatment regimen for 10 days, and repeated every 3 months for 2 years. The size of the osteonecrotic lesions was measured and the pain level was self-assessed with a visual analog scale.Results:The patients showed a statistically significant (F = 16.1; p < .01; r2 = .95) gradual decrease in the size of exposed bone areas during the nonsurgical therapy (from 12.5 to 8.8 mm). Pain scores ranged from 0 to 3 score scale. Complete resolution of the disease was observed in some patients.Conclusions:This conservative nonsurgical treatment regimen seems to provide successful treatment in reduction of the sizes of exposed bone areas in the majority of patients.

Use of the Buccinator Musculomucosal Flap for Bone Coverage in Primary Cleft Palate Repair

Cleft palate is one of the most common congenital malformations in the maxillofacial region. After a cleft palate repair, surgeons must deal with the transverse growth restriction and palatal fistulas caused by scar tissue on the raw bone surface around the hard palate. This report describes the technique of the buccinator musculomucosal flap procedure performed together with repair of the cleft palate. The objective is to cover exposed bone areas of the hard palate to decrease scar contraction and subsequent transverse maxillary growth restriction, as well as tension at the closure. From August 2009 to February 2012, 15 patients underwent the buccinator musculomucosal flap procedure. First, the cleft palate was repaired by mucoperiosteal flaps, resulting in wide and raw bone surfaces around the hard palate. The outline of the flap was marked on the buccal mucosa. Grounding on the exposed bone areas around the hard palate, the authors designed widths of flaps ranging from 1.5 to 2.5 cm. These flaps were elevated from the buccopharyngeal fascia and turned 90° to cover the raw hard palate bone surfaces. The donor sites were closed by direct suture. The follow-up period was 1-26 months (average, 10 months). No complications were found in any patient who underwent the procedure, and no fistulas occurred in the midline of the palate. No patients experienced complications related to the donor sites. No trismus or other dysfunction related to mouth movement was observed. The buccinator musculomucosal flap is a convenient and safe flap procedure with fewer donor-site complications. This procedure also has significant potential for improving maxilla growth and reducing the secondary complications that often can result from cleft palate repair. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The effect of peri-implant bone exposure on soft tissue healing and bone loss in two adjacent implants

PurposeThe purpose of this study was to evaluate the soft tissue and bone change around two adjacent implants in one-stage implant surgery.MethodsEleven subjects (7 males, 4 females) who were needed placement of 2 adjacent implants in the molar area were included. The two implants were placed with the platform at the level of the alveolar crest. The interproximal bone between the 2 implants was not covered with gingiva. After surgery, an alginate impression was taken to record the gingival shape and radiographs were taken to evaluate implant placement. Using a master cast, the gingival height was measured at baseline, 4 weeks, and 12 weeks. In the radiograph, the alveolar bone level was measured at the mesial and distal side of both implants at baseline and 12 weeks.ResultsThe exposed bone was covered with gingiva at both 4 and 12 weeks. Loss of alveolar bone around implants was found in all areas. The alveolar bone level in the exposed bone area did not differ from that in the non-exposed area.ConclusionsThis study showed that the alveolar bone level and gingival height around 2 adjacent implants in the exposed bone area did not differ from that in unexposed bone area.

A prospective clinical trial for assessing the efficacy of a minimally invasive protocol in patients with bisphosphonate-associated osteonecrosis of the jaws

The objective of this study was to assess whether a minimally invasive protocol can be effective in the long-term control of necrotic areas and pain in patients suffering osteonecrosis of the jaw associated with the use of bisphosphonate drugs (BRONJ). Thirty-four consecutive patients (14 male, 20 female) with BRONJ under treatment with zoledronate, pamidronate, or alendronate were enrolled. All of the patients received professional oral hygiene treatment and antiseptic oral rinses, and if in pain they assumed an antibiotic therapy with amoxicillin/clavulanate potassium and metronidazole for ten days. At the baseline visit, as well as at each 3-month recall, the size of the osteonecrotic lesions were measured and the pain level assessed with a visual analog scale. The results from the general linear model showed a statistically significant (F = 16.1; P < .01; r(2) = 0.95) time-related decrease in the size of exposed bone areas during the nonsurgical therapy (from 12.5 ± 12.0 mm to 8.8 ± 10.3 mm). This conservative protocol seems to provide successful treatment in the vast majority of patients.

La chirurgia orale in pazienti che assumono bisfosfonati per via endovenosa: analisi della letteratura e caso clinico

Objectives The purpose of this case report is to illustrate the consequences of dental surgical extractions in patients who are receiving or have received IV bisphosphonate. Materials and methods A 52-year old man suffering from multiple myeloma was treated with Zometa for one year. At the end of the therapy he underwent some surgical extractions that caused two areas of mandibular osteonecrosis after a few months. The authors obtained the patient's informed consent to report his medical data and pictures. Results The two necrotic areas were treated in different ways and the treatments are still in progress. After 5 months, a slight improvement has been observed in the exposed bone areas. Conclusions In the management of the osteonecrosis of the jaw it is important to assess the cost-benefit ratio, trying to improve health expectations and perspectives in a patient who is already affected by a systemic disease.

A case of lower-extremity deep burn wounds with periosteal necrosis successfully treated by use of allogenic cultured dermal substitute

In patients with burns, bone exposure accompanies serious problems which occasionally lead to amputation. We present a case of an 82-year-old woman who sustained 22% of total body surface area flame burns on her bilateral lower extremities with bone exposure. Despite fascial excision and mesh skin graft, muscles, bones, and tendons were widely exposed on her right leg. The wound was infected by methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. To promote wound healing, we applied an allogeneic cultured dermal substitute (CDS) to the wound surface once weekly, resulting in healthy granulation except for the exposed bone area of the right anterior tibia. We then shaved the cortex of the exposed bone surface until bone marrow bleeding, and grafted mesh skin in combination with CDS. Finally, all wounds healed without osteomyelitis. The use of CDS to treat deep burns exposing bone surface may expand reconstructive options for extremities that otherwise might have been amputated.

Osteonecrosis of the jaws by intravenous bisphosphonates and osteoradionecrosis: A comparative study

We analyze the possible clinical differences between bone jaw exposed areas in ONJ (osteonecrosis of the jaws) and ORN (osteoradionecrosis). Group 1 was composed with 53 ONJ cases and group 2 with 20 ORN cases. In both groups we analyzed, the major size of the exposed bone areas, the number of exposed areas, the location on the jaws and the presence of others associated and severe complications, such as skin fistulas and jaw fractures. We also investigated the possible local aetiology or trigger factor of the lesions. The major size of the bone exposed areas was 2.29+/-2.02(mean +/- std.dev) in group 1 and 2.7+/-2.9 (mean +/- std.dev) in group 2 (p>0.05). The number of exposed areas was 1.8+/-1.34 (mean +/- std.dev) in group 1 and 1.2+/-0.55 (mean +/- std.dev) in group 2 (p>0.05). There were more fractures in the second group (20%) (p<0.05), and skin fistulas (35%) (p<0.05). We found more patients in group 1 in which the dental extraction was the local aetiology of the bone necrosis (35 cases, 66.03%), while in group 2 there were 8 (40%) (p<0.05). In our study with ONJ there were not differences in the major size of the bone exposed areas, but there were more lesions per patient than in group with ORN. The severity of the complications, such as jaw fractures and skin fistulas were higher in ORN, and in this group it was more frequent the spontaneous lesions than in the ONJ where it is more frequent following dental extractions.

Biphosphonate-associated osteonecrosis can be controlled by nonsurgical management

Sixteen patients with jaw biphosphonate-osteonecrosis and with exposed bone areas were subdivided into 2 treatment groups. The first group (7 patients) underwent superficial or radical surgical therapy, while the second (9 patients) underwent antibiotic treatment. A slight reduction of the necrotic areas was observed in 5 of 7 patients in the first group, whereas no change was observed in the remaining 2 patients at 22- and 24-month follow-up. A slight reduction of the necrotic areas was observed in 7 of 9 patients in the second group, whereas no change was observed in the remaining 2 patients at 5- and 24-month follow-up. The statistical analysis showed that the treatment regimen did not significantly influence the dimensional change in the exposed bone. The preliminary results seem to suggest that biphosphonate-associated osteonecrosis can be well controlled by a nonsurgical protocol consisting in long-term administration of antibiotics.