Alveolar Bone Exposure Research Articles

WITHDRAWN: Mandibular osteonecrosis involving tooth germ in children: A rare case report with a 6-year follow-up

IntroductionOsteonecrosis involving permanent tooth germ in deciduous dentition is a rare condition that could affect the dental and maxillofacial development without correct intervention. Case presentationThis case report presents a rare case of mandibular osteonecrosis involving one permanent tooth germ induced by arsenic trioxide in a 4-year-old Chinese girl. Clinical examinations revealed an unhealed wound with alveolar bone exposure, and radiographic evaluations suggested the necrosis of the surrounding alveolar bone. The sequestrectomy without extended curettage, and removal of the affected permanent tooth germ were performed along with systemic antibiotics therapy. No recurrence of the lesion and no complication were noted at six-year follow-up. Clinical discussionWe presented a case of mandibular osteonecrosis in deciduous dentition with ideal prognosis after timely sequestrectomy without extended curettage. Although the disease-free edge is recommended for drug-induced osteonecrosis in adults, this treatment plan was made in reference to the only similar case and recovery potential of pediatric jaws. ConclusionThis is the first drug-induced mandibular osteonecrosis case involving permanent tooth germ in children. Our results suggest that a conservative treatment regimen without extended curettage may be an option for young patients with osteonecrosis in jaws.

Restorative surgery using modified Kazanjian vestibuloplasty and subepithelial connective tissue graft for severe trismus and mandibular denudation after facial contouring surgery: A case report

Oral vestibule is important in oral health. Various vestibuloplasty techniques are used in cases involving vestibule loss. This case report describes the treatment outcomes from performing modified Kazanjian vestibuloplasty with artificial der-mis graft and connective tissue graft for severe trismus and mandibular denudation caused by shallow vestibule and postoperative scarring after facial contouring surgery. Based on an accurate understanding of the anatomical structures within the oral cavity, problems caused by multiple surgery due to inflammatory complications after a facial contouring surgery, including scarring, discomfort during mouth and cheek movements due to loss of oral vestibule, trismus, alveolar bone exposure, and gingival recession, were resolved with a single surgery. When performing intraoral surgery, it is necessary to understand the meaning and importance of vestibule and perform incision and suturing to minimize the shallowing of vestibule. In cases involving vestibule loss, appropriate techniques should be selected to ensure restoration of vestibule.

MULTIFOCAL BONE EXPOSURE IN THE JAW

Reports of rare oral complications as osteonecrosis and spontaneous exfoliation of teeth have been reported after herpes zoster (HZ) infection. A 57-year-old male patient was referred for periodontal evaluation because of gingival bleeding. The patient’s medical history included a diagnosis of chronic lymphocytic leukemia and previous HZ infection. Intraoral examination revealed a redness around the left anterior inferior gingiva and necrosis and alveolar bone exposure around tooth 32. Alveolar bone exposure with spontaneous tooth exfoliation of tooth 21 was noted. Radiographically, the radiolucent area surrounding the tooth 32 and the outline of the socket of the exfoliated tooth 21 were visible. Conservative surgical and antibiotic therapy were performed. The diagnosis of osteonecrosis of the jaw following HZ infection was established. The patient is in follow-up for 1.5 years without signs of recurrence. Clinicians should be aware of unusual complication related to the previous infection of HZ. Reports of rare oral complications as osteonecrosis and spontaneous exfoliation of teeth have been reported after herpes zoster (HZ) infection. A 57-year-old male patient was referred for periodontal evaluation because of gingival bleeding. The patient’s medical history included a diagnosis of chronic lymphocytic leukemia and previous HZ infection. Intraoral examination revealed a redness around the left anterior inferior gingiva and necrosis and alveolar bone exposure around tooth 32. Alveolar bone exposure with spontaneous tooth exfoliation of tooth 21 was noted. Radiographically, the radiolucent area surrounding the tooth 32 and the outline of the socket of the exfoliated tooth 21 were visible. Conservative surgical and antibiotic therapy were performed. The diagnosis of osteonecrosis of the jaw following HZ infection was established. The patient is in follow-up for 1.5 years without signs of recurrence. Clinicians should be aware of unusual complication related to the previous infection of HZ.

Methotrexate‐related lymphoproliferative disorder arising in the gingiva of a patient with rheumatoid arthritis

Methotrexate (MTX) is the primary drug used in the management of rheumatoid arthritis (RA) and other immune-mediated inflammatory diseases. MTX is a strong immunosuppressive agent and has been reported to cause iatrogenic immunodeficiency-associated lymphoproliferative disorders (LPDs). Stomatitis caused by MTX-related cytotoxicity may occur, but gingival MTX-related LPDs are rare. In this article we present a case of gingival MTX-related LPD in a 60-year-old male with RA. The local findings of the gingival ulceration and alveolar bone exposure were similar to those of bisphosphonate-related osteonecrosis of the jaw. However, he had never received bisphosphonate therapy. The biopsy specimen of the gingival lesion was diagnosed as diffuse large B-cell lymphoma with Epstein-Barr virus positivity. Immediate withdrawal of MTX resulted in marked remission of the LPD.

Gingival Coverage of Iatrogenically Denuded Labial Bone Resulting from Thermal Trauma

Damage to periodontal tissue as a result of thermal injury often causes severe gingival recession and denuded alveolar bone. In this case report, two patients undergoing gingival coverage of iatrogenically denuded labial bone associated with the maxillary central incisor and the lateral incisor are presented. The first patient had gingival necrosis and labial alveolar bone exposure on the maxillary left central incisor and was referred from a local dental clinic. The patient had undergone root canal treatment 2 weeks previously. The gingival necrosis was assumed to be caused by a heated plugger. The denuded root surface was immediately covered by a laterally positioned flap over a connective tissue graft obtained from the palate. The gingival margin and overall appearance were symmetrically in harmony with those of the adjacent teeth. Another patient with the same symptoms and dental history was treated using the same procedure. Normal periodontal architecture was successfully reconstructed and maintained. In the cases presented, laterally positioned flap coverage over a subepithelial connective tissue graft was successfully applied to cover thermally injured bone and the root surface.

Perio-esthetic surgery: Using LPF with frenectomy for prevention of scar

An aberrant frenum is postulated to create functional and aesthetic problems. Archer's ‘classical frenectomy’ is an extensive procedure including the excision of fibers, interdental papilla, and exposure of alveolar bone up to the palatine papilla. The resultant delayed healing, loss of interdental papilla, and abnormal scar led towards the conservative approaches like Edward's frenectomy, frenum relocation by Z-plasty and free gingival graft; with their technical and aesthetic limitations. A better approach to make a primary closure in midline and to avoid anesthetic scar by creating a zone of attached gingiva, frenectomy is assisted with lateral pedicle graft. The interdental papilla is left surgically undisturbed and healing takes place by primary intention. Miller, in his study on 27 subjects, suggested that the newly created zone of attached gingiva might have bracing effect inhibiting reopening of diastema. A case series of this technique with its distinct advantages is presented.

Bevacizumab-Related Osteneocrosis of the Jaw

We describe a case of jaw bone necrosis after a lung adenocarcinoma bone metastasis, treated the first time in 2004 by means of pneumonectomy and lymph node ablation. One week after a dental extraction, the patient experienced pain in the mandibular region, in conjunction with alveolar bone exposure. Treatment with amoxicillin and clavulanate every 12 hours for 15 days and 0.2% chlorhexidine rinses was administered and there was a remission of infective complications, but not the closure of the exposed alveolar bone. Only at this time did the patient refer that he was treated with bevacizumab therapy immediately after the extraction. A preventive dental assessment of patients scheduled for bevacizumab therapy should be useful as for the zoledronic acid therapy. Dental surgery procedures for patients during bevacizumab therapy should be carefully evaluated and considered as the last choice, to reduce all possible risks and prevent complications.

Dental extractions after radiation therapy in the head and neck area and hard tissue replacement (HTR) therapy: A preliminary study

Statement of problem. Dental extractions in patients who had radiation therapy for cancer in the head and neck region carry with them the risks of delayed healing, prolonged alveolar bone exposure, infection, and osteoradionecrosis. Among the precautions to minimize these risks are antibiotic coverage, limited extractions at any one time, soft tissue closure, and hyperbaric oxygen treatment. Rapid epithelization and minimal bone exposure are essential after extractions in irradiated patients. Purpose. This study examined the effects of hard tissue replacement on head and neck cancer patients who were treated with radiation therapy. Material and methods. In a series of eight patients who had radiation doses from 4000 cGy to 7440 cGy in the head and neck area and who had 44 teeth extracted, hard tissue replacement material mixed with tetracycline powder was placed in the extraction sites. Results. Of the 44 teeth extracted, 19 mandibular molars and premolars were in the direct field of radiation in seven patients. One patient also had 6 mandibular anterior teeth and 12 maxillary teeth extracted that received minimal radiation exposure. One patient had 6 mandibular anterior teeth extracted that were not in the area of direct exposure. One patient had a mandibular first molar extracted in an area that received minimal radiation exposure. Clinically, complete epithelization occurred in all patients. No infections developed. Radiographically no bone dissolution could be identified in the extraction area(s). The follow-up times ranged from 7 months to 18 months when the patients were seen last. Conclusion. The hard tissue replacement particles appears to provide a matrix for fibrous connective tissue formation. (J Prosthet Dent 1998;79:317-22.)