E7
dental epub.
Volume 4ăƒť2016
Cover Story Cambodia Dental Mission 2016
E7
dental epub.
About EViDENT Academia is a group of young dentists that focus on lecturing ideas and innovation to others. In order for a better communication, we use digital works to explain the concepts. Most importantly we not only target the dentists as audience, but also the patients too. We are also proceeding the philosophy of evidence-based dentistry, especially in fields of periodontics, prosthodontics and dental implantology. The team was planned over a year (2014-2015) and collected data of needs from undergraduate dental students and dentists with clinical experience. We share our ideas, our studies, great articles, information of all kinds of dental courses for every dentists and students to get the latest news and discuss for our own protocols. E7 dental e-publishing is one of the online/ paperwork of EViDENT Academia. The publication contains 7 topics per volume in different aspects of dentistry. It is more like a magazine with both dental research and the enjoyment of living. Including topics of lecturing, practical sessions, photos galleries, lifestyle sharing and etc. It is designed for dentists to have a brand new thinking in the academic field. Authors could be from anywhere! E7 epub. is an open sharing work which everyone could subscribe and we are happy to have more and more dentists, professors, students and etc. to join us. We are more than welcome to hear your work experiences, knowledge and ideas, and encourage you to share with no limitation. Lastly, we welcome any kind of suggestions which will help us improve. EViDENT Academia
From Chairman
From Editors
Our team EViDENT Academia is based
We are grateful to have our publishing for
on information sharing. We believe that
more than 1 year! Special thanks to all of
by sharing, we are not giving away, but
our teammates and the supports from
instead, we are gaining knowledge. It is a
dentists around the world. We have been
pleasure to Cinally release our latest
thinking to have a new format in future
volume and many thanks to our readers.
and a better idea for everyone to read and
We are currently planning some activities
to share. Not only the dentists could
for young under-graduated dentists and
understand, but also the patients are
hope to help them in future practice. Now
invited to read some of the oral hygiene
we hope to extend our literature and
care articles. We expect our new path.
connect it with hand-on practical work to expand and allow easier learning and
In this publication, volume 4, we modiCied
comprehension for our readers.
the font for a better resolution and easier to read. Hope you enjoy our latest work!
Chairman
Editor-in-Chief
Calendar
Contents 1
… About
3
… Calendar & Contents (dental events)
4
… The introduction to the PRP and the PRGF
7
… Impression Material Choice in Prosthesis
11
… Oral Rehabilitation with Conventional Complete Denture in A Child with Ectodermal Dysplasia, A Case Report
17 … Cambodia Dental Volunteering Mission 2016 23 … E Vi DE N T Ac a de m i a A n n u a l C o n f ere n ce et MP I EO
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Prosthodontic Implant Course for Undergraduate Students 25 … Dental Presentation & Techniques using Apple Keynote Part 2: Mask Techniques & Background Design 29 … Risk Factors of Osteonecrosis Considered before Implant Placement for Patient Receiving Antiresorptive Therapy Part 2: Prevention, Management & Discussion
EViDENT Academia Contact Email: evident.academia@gmail.com Issuu: https://issuu.com/perio.prostho.cc Facebook: EViDENT Academia Associated Blog: https://perioprosthocc.wordpress.com ,
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E7 Dental E-publishing Volume 4, September, 2016 Publisher/ Editor-in-Chief: Chen-Che Hung Senior Editor: Wei-Hua Chen
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The Introduction to PRP and PRGF Wei-Hua Chen keywords: GBR, GTR, periodontics, plasma, platelet, PRGF, PRP, regeneration Regenerative therapies such as guided
tissue regeneration (GTR) and guided bone regeneration (GBR) are universally accepted as surgical treatments not only for the repair and reconstruction of degraded periodontal tissues but also for quantitative and qualitative enhancement of host bones in localized defects of the alveolar bone.1 Going beyond the conventional GTR or GBR methods, researchers are nowadays investing their efforts in employing tissue engineering principles to achieve better alveolar bone reconstruction or periodontal attachment by inducing the capability for reconstruction in these tissues assisted by such effective biological regulators as enamel matrix derivates (EMD), bone morphogenic proteins (BPs), or other similar growth factors.2
promote tissue repair and affect the behaviour of other cells by modulating the inIlammation and the formation of new blood vessels. Plasma Rich in Growth Factor (or PRGF) is a type of plasma enriched of proteins and circulating growth factors able to aid the bone and soft issue regeneration. PRGF contains many different cells and cell-types highly concentrated in a gelatinous form which can be placed into the site of the injury: these cells stimulate and accelerate the healing process by forming blood clots and releasing growth factors into the wound. PRGF does not need bovine or human thrombin for coagulation; PRGF includes plasma proteins and coagulative factors and is then more advantageous compared to PRP. 3
What is PRP and PRGF? The main goal in the modern surgery to use the regenerative products is to increase the success rate of the connective tissue grafting procedure and the low invasiveness. The Platelet Rich Plasma (PRP), also termed autologous platelet gel (Autologous Platelet Gel), is a gel at high concentration of autologous platelets suspended in a small amount of plasma after centrifugation of the blood of the patient. The PRP is a product derived from blood, its characteristic is due to the fact that the platelets present in the PRP release numerous substances that
Clinical applications of PRP Because PRP enhances osteoprogenitor cells in the host bone and in bone grafts, it has found clinical applications in4 1. Continuity defects. 2. Sinus lift augmentation grafting. 3. Both Horizontal and vertical ridge augmentations. 4. Ridge preservation graftings. 5. Periodontal/peri-implant defects. 6. Cyst enucleations / periapical surgeries. 7. Healing of extraction wounds. , -. 0
8. Endodontic surgeries and retrograde procedures. 9. Ablative surgeries of the maxilla-facial region. 10. Blepharoplasty.
the root surfaces, and the undersurface of the Ilap. 5. Decreases the potential for postoperative infection and/or graft sloughage as the PRP promotes a more rapid uptake and maturation of the graft. Complications 6
Figure. The middle layer of the tube is fibrin buffy coat layer represented by a very large and dense polymerized fibrin block containing the concentrated growth factors (CGF). CGF layer placed in the sterilized metal storage box before compression. This layer is utilized for sinus augmentation as alternative to bone graft. CGF membrane after compressing with
1. Failure of the connective tissue graft to revascularize (graft sloughage). 2. Micromovement of the connective tissue graft, which leads to sloughage. 3. Shrinkage of the connective tissue graft. 4. Excessive bleeding at the donor site. 5. Excessive bleeding at the receptor site. 6. Infection at the graft site. 7. Infection at the donor site. 8. Sloughage of the palatal tissues. 9. Prolonged pain/discomfort at the donor/ receptor site.
metal cover. This membrane is used barrier membrane as alternative to collagen membrane and is used as alternative connective tissue graft for covering exposed root.5
Bene7its 6 1. Decreases the incidence of both intraoperative and postoperative bleeding at the donor and receptor sites because of its inherent hemostatic properties. 2. Decreases the incidence of postoperative pain at the donor and receptor sites by facilitating a more rapid soft tissue healing and maturation rate. 3. Aids in the initial stabilization of the transposed connective tissue at the recipient site as a result of its inherent cohesive and adhesive properties. 4. Promotes a more rapid revascularization of the transposed connective tissue by delivering growth factors speciIic for capillary formation directly to the graft, , -. 0
Conclusion There is wide scientiIic evidence on the positive role of PRP in tissue regeneration and wound healing. Also, a major advantage of autologous PRP in the clinical setting is that it has no adverse effects. Reference 1. Hammerle CH, Karring T. Guided bone regeneration at oral implant sites. Periodontol. 2000;1998(17):151–75. 2. M a r x R E . A p p l i c a t i o n o f t i s s u e engineering principles to clinical practice. In: Lynch SE, Marx RE, Nevins M, Leslie A, editors. Wisne r – Lynch. Tissue engineering applications in maxillofacial surgery and peridontics. 2nd ed. Hanover park: Quintessence publishing; 2008. pp. 47–63.
3. Harris RJ: The connective tissue with partial thickness double pedicle graft: the results of 100 consecutively-treated defects. J Periodontol 65(5):448-461, 1994. 4. Marx R.E., Carlson E.R., Eichstaedt R.M., Schimmele S.R., Strauss J.E. and Geogeff K.R. Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85: 638-46. 5. Dahlin C, Linde A, Gottlow J, Nyman S. Healing of bone defects by guided tissue regeneration. Plast Reconstr Surg. 1988;81(5):672-676 6. Petrungaro PS: Platelet-rich plasma for dental implants and soft-tissue grafting. Dental Implantology Update 11(6): 41-47, 2001.
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Impression Material Choice in Prosthesis Ya-Hui Chuang keywords: biomaterials, impression, material selection, prosthesis, prosthodontics Introduction A dental impression is taken by inserting a dental tray or custom tray with impression material into the patient’s mouth, then the tray is taken out when the impression material has set. This records a negative imprint of the patient’s teeth and oral mucosa, which provides information for the dentist and technician to work on. Thus, impression making is one of the most important steps in prosthesis construction and is compulsory. There are some factors that affect impression quality and accuracy, such as the type of impression material, how well the impression was mixed, ratio of the impression mixture, setting time, skill, periodontal status and oral hygiene. Nevertheless, the choice of impression material also greatly depends on the extent of precision needed and price. Type of Impression Material * The most common materials used in dentistry for impression taking are alginate, polyether, polysul@ide and silicones. Impression materials can by classi@ied according to their setting properties. (Chart 1) Alginate Mixing of alginate is usually by hand and requires vigorous mixing to achieve a good homogenous consistency and minimum air - . 01
,
bubbles. The time required to hand mix well alginate is not very ef@icient and often if not well experienced can lead to setting before properly mixed. However, there are also available mixing devices that can slightly improve the properties of alginate and facilitate handling. When alginate is properly handled, moderate/acceptable surface details can be recorded. In some situations the property of low tear-resistance can offer some advantages. For example in situations of poor periodontally affected teeth and orthodontic appliances. Compared to polyether and silicones, alginate is not dimensionally stable, it should be poured up with plaster within 15-30 minutes to avoid shrinkage. Polysul/ide In comparison to polyethers and silicones, polysul@ides are more rigid, don't have a good elastic recovery. Thus not suitable for situations that have many undercuts. Polysul@ides have a longer setting time, that requires at least 8 minutes in the mouth. Polyether Polyethers have high precision due to their u n i q u e c h e m i c a l s t r u c t u re , n a t u ra l hydrophilicity, which is particularly useful for use in the mouth as humidity will not effect the precision. Thus, polyethers are useful in subgingival preparations. Unlike
Impression Materials Elastic Polyether
Polysulfide
Non-elastic
Silicones
Hydrocolloids
Plaster
Condensation
Agar
Impression compound
Addition
Alginate
Zinc oxide eugenol
Chart 1 Categories of elastic and non-elastic impression materials.
polysul@ide and alginate, polyether is dimensional stabile which allows time for the impression to be sent to the laboratory for casting. Silicones There are two types of silicones, addition curing and condensation curing. Addition cured silicones, Vinyl polysiloxane, are d i m e n s i o n a l l y m o r e s t a b l e t h a n condensation cured silicones which experience a shrinkage as a result of byp r o d u c t e v a p o r a t i o n . D u e t o t h e hydrophobic chemical nature of vinyl polysiloxane impression materials, they cannot mix well with moisture in the mouth, thus it is important to dry the oral cavity
Fig 1 Different silicone types have their own presentation. (Aquasil from Dentsply Sirona Inc.)
first. However, the use of surfactants may improve wetting. These materials have high tensile strength, that they are resistance to tear and have high elastic recovery. Impression Compound Impression compound consist of resins, @illers and waxes. They are thermoplastic, softens when heated. They are usually used for border molding to border seal the special tray to functional depth of the sulcus, which can prevent overextension of @inished denture. Zinc Oxide Eugenol Zinc oxide eugenol impression paste is highly @luid and becomes rigid when set. This high @luidity makes it perfect for special tray impression as a allows close @itting. However, due to rigid set properties, it cannot be used for undercuts. It is a type of mucostatic impression. Mucocompression records the soft tissues under load which m a ke s t h e p a t i e n t m a s t i c a te m o re comfortably. Whereas mucostatic records the soft tissues in resting state. Therefore, it is suitable in situations with @labby ridge, where there is a highly displaceable and mobile anterior maxillary residual ridge due to extensive alveolar bone resorption. In this - . 01
,
situation a combined impression technique i s re q u i re d , m u c o c o m p re s s i o n a n d mucostatic. Since the @labby ridge is highly displaceable, mucostatic impression is required for the anterior region and mucocompression impression for the posterior. As a result the denture can @it properly when in rest and still let the patient masticate comfortably. Mixture Impression materials commonly require the mixture of powder and liquid or two pastes. It is important to follow the instructions from the manufacturers to obtain the correct ratio, working and setting times. Without the correct mixture can affect the setting properties of the impression, and affect the model cast, thereby the accuracy and precision of the prosthesis. It is also important to obtain a uniform consistency of mixture to avoid air bubbles and setting problems. Periodontal Status and Oral Hygiene Oral hygiene status directly in@luences periodontal status, as poor oral hygiene leads to plaque accumulation and thereby in@lammation of the gingiva. In@lammation of the gingiva leads to gingival swelling and increased bleeding, which can in@luence impression accuracy. Thus it is important to have good oral hygiene achieved before processing into prosthetic treatment. Choice Depending on the amount of accuracy needed, one can choose from impression materials that record moderate to excellent surface detail. Such way one can balance between the price of the impression and the amount to accuracy required. For instance - . 01
,
the arch that has the crown preparation would require high reproduction of surface detail to achieve a good @it of the crown leaving no gap at the @inishing line. Whereas alginate can be used on the arch with no crown preparation and used only for occlusion, as acceptable surface detail is suf@icient. For preliminary impressions, the use of alginate is suf@icient, because preliminary impressions are only for pre-treatment study use and making of special trays. In conclusion, the choice of impression materials largely depends on the amount of accuracy needed, price and the type of impression tray used Reference 1. Shillingburg Jr. HT et al., Fundamentals o f F i x e d P r o s t h o d o n t i c s , 4 e d . , Quintessence, 2012 2. S a k a g u c h i R , P o w e r s J , C r a i g ' s Restorative Dental Material, 13th, Mosby Elsevier, 2012 3. Scheller C, Basic Guide to Dental Instruments, Blackwell Munksgaard, 2006
- . 01
,
Good
Moderate
Hydrophilic
Cheap
Need to be poured up quickly
Viscosity
Accuracy
Properties
Advantages
Disadvantages
Edentulous With special trays (non perforated + adhesive) Appropriate for undercut impressions
*Appendix 1 Comparison of different dental impression materials.
Uses
Heavy, medium and light bodied
Viscosity depending on use of stock trays (higher) or special trays (lower)
Presentation
Strong taste and odour Prone to drying out Need to be poured quickly
Paste / Paste
Polysul.ide
Powder / Liquid
Alginate
Hydrophobic
Excellent dimensional stability
Hydrophilic but water absorption Good dimensional stability
Greater rigidity
Excellent
Dimensional stability degrades (alcohol evaporation)
Impression mixing dispensing gun or putty
Use with impression mixing dispensing gun or putty
Various
Addition Cured Silicones
Condensation Cured Silicones
Good
Paste / Paste
Polyether
Used in stock trays for primary impressions Border trimming material Not for undercut
Poor dimensional stability & shrinkage on cooling
Thermoplastic (softens > 50 degrees)
Poor
Resins, fillers and waxes
Impression Compound
Special tray (close fitting) “wash� material for impression compound support
Strong flavour Adheres to dry mucosa
Dimensionally stable
Good
Highly fluid, but rigid when set
Base paste ZnO / catalyst eugenol paste
Zinc Oxide Eugenol
Oral Rehabilitation with Conventional Complete Denture in A Child with Ectodermal Dysplasia: A Case Report Jaouadi Jamila, BDent, MS, MSD, DDSc, PhD. keywords: case report, denture, ectodermal dysplasia, prosthesis, prosthodontics, rehabilitation Abstract Early prosthetic rehabilitation of edentulous children is very important to restore function, esthetic and psychological development. It is possible to treat these young patients using complete removable prostheses or implant-retained complete dentures. A successful prosthetic treatment needs a rigorous protocol, a regular control and above all, an appropriate psychological care. Keywords complete denture anodontia; oligodontia, child growth, ectodermal dysplasia. Introduction2,7,8,10,12,13 Ectodermal dysplasia (ED) is described as heritable conditions that involve anomalies of structures derived from the ectoderm, including hypodontia. ED can be inherited as sex linked, either autosomal dominant, a u to s o m a l d o m i n a n t , o r a u to s o m a l recessive. It has been Iirst described by Thurnam in 1948 and later in 19th century by Darwin. In 1921, Thadani assigned ectodermal dysplasia to the X chromosome. Orofacial characteristics of this syndrome i n c l u d e a n o d o n t i a o r h y p o d o n t i a , h y p o p l a s t i c c o n i c a l t e e t h , underdevelopment of the alveolar ridges, frontal bossing, a depressed nasal bridge, - . 01
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protuberant lips, and hypotrichosis. It can affect both the primary and permanent dentition. When teeth are missing, the alveolar bone in which they are ordinarily embedded does not develop well, leading to a reduced vertical dimension and a typical aged appearance in the face. Numerous combinations of clinical alteration can be presented in ectodermal dysplasia, observing diverse syndromes and up to 154 different types of ectodermal dysplasia and 11 subgroups, labeled from 1to 4 according to whether they affect the hair, teeth, nails or sweat glands. Recently a new classiIication for ectodermal dysplasia has been proposed, based on the alteration in the protein molecular functions that lie behind it. Conventional prosthodontic rehabilitation in young patients is often difIicult because of the anatomical abnormalities of the existing teeth and alveolar ridges, since the conical shaped teeth and “knife-edge�alveolar ridges, it leads the result of poor retention and stability of dentures. Moreover, denture should allow jaws expansion and a correct growth pattern.
Case Report A 5-year-old female patient visited the department of pediatric and Preventive Dentistry at the faculty of dental medicine of Monastir, Tunisia, in December 2006 for anodontia. She will be starting the school at September 2007. She complaints of inability to masticate and unaesthetic appearance. Her father wishes that, she could be rehabilitated to be able to communicate at school with her friends or teachers and also to correct patterns of chewing and restoring “normal� facial characteristics. Then she was referred to the department of c o m p l e t e d e n t u r e s a t t h e s a m e establishment. The body characteristics conIirmed the diagnosis: (Figure 1, 2) Sparse and Iine hair; The eyebrow,eyelashes and other body hair may also be absent, f r o n t a l b o s s i n g , d e p r e s s e d n a s a l bridge,prominent supra orbital ridges, protuberant and reverse lips and decreased lower facial height, pronounced chin and hyper-pigmented skin around the eyes. Family history has shown no similar case. She was the only one with ED and usually shy. Intraoral examination revealed the absence of all teeth with underdeveloped edentulous alveolar ridge (Figure 3) and xerostomia due to the alteration of sweat glands.
Fig 1, 2
Fig 3
Panoramic radiograph conIirmed the clinical data. (Figure 4) Treatment plan was discussed with patient and her father. The child was rehabilitated with removable maxillary and mandibular conventional complete dentures.The technique is to idealize a complete denture in children fo l l ow i n g t h e s a m e s te p s t h a t a re recommended for adults .The preliminary impressions was made using conventional
Fig 4
metallic edentulous tray with irreversible hydrocolloid impression . The Iinal impression was taken with a custom tray made with autopolymerized a c r yl i c re s i n w i t h b o rd e r - m o u l d e d impression compound, followed by a regular polysulIide impression. (Figure 5, 6) Master casts were mounted on a non adjustable articulator. Occlusal vertical dimension was established using the - . 01
,
physiological rest positions with phonetic and esthetic techniques to verify. (Figure 7) The denture was made in centric occlusion with balanced articulation and anatomically
Fig 8
Fig 5
Fig 9
s h a p e d a c r yl i c te e t h . ( Ac r y Ro c k V, Ruthenium ; Badia Polesine, Italy)(Figure 8) Centric occlusion was established and artiIicial teeth were arranged in wax .A roll of occlusion was made not only to preserve ridges but also to perform the occlusal vertical dimension at the same time to help the girl to be familiar with the conception and make eccentric movement easier. The patient and his father accepted the arrangement of teeth.
Fig 6
To help her to accept the prosthetic rehabilitation, little stickers were integrated i n t o t h e d e n t u r e , m a d e w i t h orthopolymerized resin. (Figure 9) It looks like a surgical stent to ensure that the denture bearing area is well Iitting the denture, make the control less difIicult. Soft
Fig 7 - . 01
,
lining was added on the tow prosthetics to aid comfort when shewing, creating
Fig 10
the most frequently reported treatment modality for the dental management of ED in childhood because these can be easily modiIied during periods of rapid growth. A 1989 consensus conference on implantology concluded that implants are recommended for the anterior mandible in children older than school age. (mostly 7 years or older) number of authors have mentioned possible consequences of oral implants. However, the presented case was treated with conventional complete dentures in both arches, since they have been maintaining a normal daily diet at an early age. N o w a d a y s , M i n i i m p l a n t s a r e recommended for these cases to insure prosthetic stability.
Fig 11, 12
extensions where is needed, and also improving the adaptation of the denture. (Figure 10, 11, 12) Discussion1,3,4,5,6,9,11 Dentures in ectodermal dysplasia patients may be constructed even during preschool age, when children usually adapt easier to its use. It is anticipated that as the patient continues to grow and mature,prosthetic replacements and periodic controls will be required. Beside the satisfactory body development, an efIicient masticatory function is related to postnatal brain development and learning. Different authors have proposed different rehabilitation possibilities for these patients. Removable prosthesis (complete dentures, partial dentures, overdentures and etc.) is
Conclusion Early prosthetic treatment led to signiIicant improvements in appearance,speech and masticatory function.Patients should be recalled regularly for the prosthetic modiIication due to the continuous growth.The transitional prosthesis should be replaced by more deIinitive prosthesis while the skeletal growth is completed. References 1. A. S. Bidra, J. W. Martin, and E. Feldman, “Complete denture prosthodontics in children with ectodermal dysplasia: review of principles and techniques,” Compendium of Continuing Education in Dentistry, vol. 31, no. 6, pp. 426–433, 2010. 2. A. A. Weech, “Hereditary ectodermal dysplasia (congenital ectodermal defect),” American Journal of Diseases of Children, vol. 37, pp. 766–790, 1929. - . 01
,
3. A. Bhargava, A. Nagpal, M. Kumar, and R. Bhargav, “Flexible dentures demystiIied,” Dental Technician, vol. 2, pp. 18–21,2010. 4. A. S. Bidra, J. W. Martin, and E. Feldman, “Complete denture prosthodontics in children with ectodermal dysplasia: review of principles and techniques,” Compendium of Continuing Education in Dentistry, vol. 31, no. 6, pp. 426–444, 2010. 5. C. Dellavia, F. Catti, C. Sforza, D. G. Tommasi, and V. F. Ferrario, “Craniofacial growth in ectodermal dysplasia. An 8 year longitudinal evaluation of Italian subjects,” Angle Orthodontist, vol. 80, no. 4, pp. 733– 739, 2010. 6. I. Klineberg, A. Cameron, T. Whittle et al., “Rehabilitation of children with ectodermal dysplasia. Part 1: an international Delphi study,”The International Journal of Oral & Maxillofacial Implants, vol. 28, no. 4, pp. 1090–1100, 2013. 7. J. A. Hobkirk, F. Nohl, B. Bergendal, K. S t o r h a u g , a n d M . K . R i c h t e r, “ T h e management of ectodermal dysplasia and severe hypodontia. International conference statements,” Journal of Oral Rehabilitation, vol. 33, no. 9, pp. 634–637, 2006. 8. K. A. Vieira, M. S. Teixeira, C. G. Guirado, and M. B. D. Gavião, “Prosthodontic treatment of hypohidrotic ectodermal dysplasia with complete anodontia: case report,” Quintessence International, vol. 38, no. 1, pp. 75–80, 2007. 9. L. S. Fishman, “Radiographic evaluation of skeletal maturation. A clinically oriented method based on hand-wirst Iilms,” Angle Orthodontist, vol. 52, no. 2, pp. 88–112, 1982. 10. M. Priolo and C. Lagan`a, “Ectodermal d y s p l a s i a s : a n e w c l i n i c a l - g e n e t i c classiIication,” Journal of Medical Genetics, vol.38, no. 9, pp. 579–585, 2001.
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11. M. S. Chen, W. A. Eichhold, W. A. Welker, and C. C. Chien, “Simplicity in interim toothsupported removable partial denture construction,” The Journal of Prosthetic Dentistry, vol. 54, no. 5, pp. 740–744, 1985. 12. M. A. P. Filius, A. Vissink, G. M. Raghoebar, a n d A . V i s s e r, “ I m p l a n t - r e t a i n e d overdentures for young children with severe oligodontia: a series of four cases,” Journal of Oral andMaxillofacial Surgery, vol. 72, no. 9, pp. 1684–1690, 2014. 13. N. Jain, D. Naitam, A. Wadkar, A. Nemane, S. Katoch, and A. Dewangan, “Prosthodontic rehabilitation of hereditary ectodermal dysplasia in an 11-year-old patient with Ilexible denture: a case report,” Case Reports in Dentistry, vol. 2012, Article ID 489769, 5 pages, 2012.
International Medical College Joint Degree Program of Major European Universities English-taught M.Sc. Program in Dentistry Short-term Practical Training in Europe Long-distance Learning & Online Live Lecture Chinese-taught Supplementary Program Global Collaboration in Hungary, Thailand, Egypt, Turkey, Taiwan, Hong Kong, and Macau
About IMC
➢ • • •
Founded in 2003 Joint Degree Program coordinated with prestigious universities. Accredited in August 2009 in accordance with the Bologna Declaration by Accreditation Agency AQAS, certified by the Accreditation Council in Germany.
Alliance
➢ • • • • • • •
University of Münster, Germany Leipzig University, Germany Dresden University of Technology, Germany University of Duisburg-Essen, Germany Saarland University, Germany University of Szeged, Hungary Mahidol University, Thailand
Cooperation
➢ • • •
University of Bern, Switzerland University of Düsseldorf, Germany Semmelweis University, Hungary
Major (Course Curriculum) •
M.Sc. in Implantology and Dental Surgery
•
M.Sc. in Aesthetic Dentistry
•
M.Sc. in Periodontology
•
M.Sc. in Specialized Orthodontics
Online-Live-Open Day 19th October 2016, 4 pm – 4:30 pm CEST Presenters Univ.-Prof. Dr. Dr. Dr. h.c. mult. Ulrich Joos, Dr. Ute Wegmann For Registration: Send your full name, email address and phone number to
jamiecheng@imc-gec.com Global Education Center International Medical College Joint Degree Master Program Representative Office in Greater China Regions 10 F., No. 107, Sec. 4, Ren-Ai Rd., Da-An District, Taipei City 106, Taiwan
Cambodia Dental Volunteering Mission 2016 Chen-Che Hung, DDS. keywords: cambodia, dental mission, healthcare, oral hygiene, travel, volunteering This Summer, I joined the dental mission, joined a volunteering dental mission in Cambodia organized by GEC (Global Education Center) and Cambodian Health and Smile Organization. The mission was separated into 3 missions, in different sites, and was designed to support the oral hygiene care in the surrounding of Battambang and Siem Reap. The team was led by Dr. Juan , the chairman of
provision, any dental team to provide free health care service should avoid aggressive invasion treatment , such as dental extraction, surgical approach and etc. We should follow this statement to ensure both our rights and respect the rules.
Penghu Dental Association, in Taiwan. With his great leadership and years of experience, he has shown us the standard protocols to do during a dental volunteering work. (Figure 1) Fig 2 Autoclave sterilization at the controlled area.
Fig 1 Dental volunteering work in Cambodia.
To me, this was not the Qirst time for me to attend this kind of event. In 2013, we had gone to Nepal for the dental support. the mission in mainly focusing the treatment. This time, in Cambodia, we highlighted the procedures on dental prevention and the education. According to the latest ofQicial - . 01
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We are grateful to have Cambodian from the organisation to help us to assembly the portable dental units and small metal shelves, as the dental chair for our patients. We had prepared the compressor, the electricity and water supplies for doing the treatment. Sterilization units are also ready to secure the chances of infections and contamination. (Figure 2) Depending on the area, experienced doctors had instructed us to have a clear and smooth workQlow to guide the patients from oral hygiene learning, medical history recording, initial visit, treatment procedures, collect medical history sheet, and give gifts to the patients.
Fig 3, 4 Sketch of our workflow. L) The orders and the processes during the dental mission. From the beginning the patient receives oral hygiene education, then continue to the diagnosis, treatments, and finish at the last station. Emergency treatment could be provided by any of our dentists. R) The figure describes the actual management of our dental mission. Each station owns its job. The patients were educated in the same site, the entre, continue to the initial visit place for checkup and diagnosis. Afterwards, he or she will be guided to the dental treatment sites / chairs. Each numbers of the dental station has its specific treatment according to the previous description and the sketch. In our case, Chair 1, 2 were teeth scaling and dental sealants. Chair 3 was teeth fluoridation, with small chairs and kits for the children, and Chair 4, 5, 6 were composite resin restorations and also dental sealants. It was easier to keep the associated materials in the certain area and made our work smoother. At last, after the therapy, the patients came to last section to give us their medical history, written from the dentists, and we thanked their cooperation with the gifts and supplies. The sterilisation area were designed at the back of the space, and we have marked a prohibited area to instruct the patients do not come close to these sites, for both their safety and ours.
The sketch of our workQlow and its space was included. (Figure 3, 4) The treatment we had were teeth Qluoridation, teeth sealants, teeth scaling, operative composite resin restoration and emergency treatment in some cases. (Figure 5)
caries on occlusal site of molars, determined by the severity of the cavities, both dental sealants and composite resin should be considered for the restoration. The philosophy in these kind of dental mission. Since the quality and the quantity
Management of Dental Mission During this dental mission, we focused on the dental sealants procedures mainly on molars of children, and the teenagers. If the Qirst molar (FDI Numbering Sys. 16, 26, 36, 46) or the second molars (17, 27, 37,47) were erupted but without any biomaterials, we will apply the procedures to secure the possibilities of pits and Qissures caries. If the molars were already applied the dental sealants, chances from volunteering works by others before, we will check the stability and treat different issues. If the there are
Fig 5 Therapies we provided. A) Oral hygiene education, B) Initial visit for diagnosis, C) Teeth fluoridation, D) dental sealants and composite resin restoration. - . 01
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Fig 6 The living on the lake Tonlé Sap.
Fig 7 Dental equipments, biomaterials and supplies were moved to the local transporting boat.
Fig 9 St Joseph Church, Prek Toal.
disturbance is obvious, or the patients feel awkward, or else the treatment is complete. It is the appreciation of “the art of balance,” which it is a great challenging to do the perfection like in the clinic, but you should still restore the functions or even esthetics of the teeth. Like most of the volunteering service, sometimes it is better to have all the patients receiving at least one treatment than treat all of the problems from fewer patients. And this kind of decision should be discussed with the team before travelling to the location. The New Experience
Fig 8 Local transporting boat with our supplies on the lake.
are what you are wishing for, the treatment should have treated with the balance between these two statements. For any kinds of restoration, it is a better solution to cover the cavity, and without too much material. We should save the time from checking the occlusion. Only if the - . 01
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In Mission 3, we had sailed to the middle of the lake, Tonlé Sap, to perform dental services at a place called Prek Toal. It was a very interesting experience and a shock when we arrived. This place does not have any lands. These people lives on the water f o r g e n e ra t i o n s . A c c o r d i n g t o o u r Cambodian helpers told us, these “citizens” came from Vietnam, the elderly escaped from Vietnam War and built their houses and ships here. (Figure 6) However, after the war, they did not return back home. They prefer to stay on this lake. Their sons, daughters, or even grandchildren did not own any nations because of the changes of the country. In other words, they do not have
Chart 1 The statistics of each mission and the numbers of the patients from different therapies. Data information was recorded from the medical histories collected by the dental team. 3 missions were located in different regions. Patients composition (amount of elders, adults, teenagers, and children) could be varies. The working time of each mission was individual due to the power supplies we were able to brought.
identiQications, no healthcare and etc. They are “not exist,� and that is why our service is a great deal to them. The equipments and biomaterials we brought were shipped with us in separate boats. (Figure 7, 8) We had planned our service on a Qlat and wide deck from a St. Joseph Church, (Figure 9) the church on the lake, and prepared everything we have to do our best. (Figure 10) It is interesting that you were actually working
on the water. When another boats or ships passed by, we could felt the waves during our treatment. And it was a good idea to help these people. The gifts we brought, new toothbrushes, toothpastes, stationeries and some used clothing really cheers them and both adults and children gave thanks to our work. Because of their religion, they saluted with putting palms together. I am sure we were doing our best and share our feelings with each other. Dental Mission Records
Fig 10 Teeth scaling for local patients. An experience of working on the floating water.
The clinical records from the dental mission were divided into groups as the treatment we provided. To have the best result, each patient could only received a single type of treatment. The treatment is available for 1-2 teeth, especially on the molars. For teeth scaling, and teeth Qluoridation, all the visible teeth should be included. The records are presented in the - . 01
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following on the basis of the medical history sheets we collected back from the patients. (Chart 1) Mission 1 has shown the highest rate in Composite restoration due to a higher amount of adult patients, teachers and staffs
Fig 11 Sunrise at Angkor Wat.
from the school. Sealant applications and Qluoridation were applied to the students in general. Mission 2 has the most accurate balance for the dental mission. Because of its location, inside of Battambang City, what we have provided were familiar to the patients, and they have better oral hygiene too. Unlike Mission 1 and 2 with previous dental care by other organizations, there was no any records of any dental volunteering work in the location of Mission 3. The amount of pits & Qissures sealant treatment was the highest among all the missions. There were no signs of previous dental treatment in children and lack of oral hygiene education. At last
Fig 12 Sightseeing at Angkor Thom.
Special thanks to the Cambodian helpers and tour guides for all the support. Not only helping us to do the translation between the patients but also the packing of the luggages, hotels, restaurants, travelling and etc. (Figure 11, 12) They provide their accompaniment to us, and let us have the opportunities to serve the poor. And thanks t o o u r t e a m , i n c l u d i n g d e n t i s t s , undergraduate students, dental assistants and technicians. (Figure 13) Because of our great communication and hard-working, the success is to everyone. There is a long pathway between different countries. However, in this moment, there is no distance between foreign dentists and local patients.
Fig 13 Spectacular dental volunteering team with great passions to help the others. - . 01
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About Author
Chen-Che Hung -
academic manager of EViDENT Academia instructor of odonto.intelligence editor of E7 dental e-publishing author of perio.prostho.cc - passion in dentistry
Dr. Chen-Che Hung, DDS focuses on advanced continuous educational courses for young dentists, and undergraduate dental students. Specialize in Periodontics, Prosthodontics, Dental Implants and the relevances. As one of the founder of EViDENT Academia, he instructs and shares the idea in dental presentation design and the techniques to improve the teamwork. SpeciQic research Qield: periodontics, prosthodontics, dental implants, surgical techniques, keynote lecturing and etc. Contact:
Organizations of Dental Mission Global Education Center
perio.prostho.cc@gmail.com GEC (Global Education Center) was founded in 2006, as the platform for professional education. The center provides studying abroad programs and advanced courses in both dental and medical
Cambodian Health and Smile Organization Qields. for more info: http://www.gec-group.org Cambodian Health and Smile Organization is established to improve the dental health and education of poor Cambodians.
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EViDENT Academia Annual Conference et MPI Prosthodontic Implant Course for Undergraduate Students EViDENT Academia keywords: conference, dental implants, evident academia, keynote lecturing, MPI, prosthodontics In this Summer, EViDENT Academia had held the 2nd annual conference combing with MPI Prosthodontic Course for Undergraduate Students - Academic Lecture. The course was designed for undergraduate students to learn the basis of dental implants and the introduction of surgical techniques. On October 22., the groups will attend to MPI (Mediterranean Prosthodontic Institute) in Castellรณn, Spain and proceed a hands-on workshop with worldwide lecturer Dr. Fernando Rojas-Vizcaya. The academic lecture was presented by Dr. Chen-Che Hung, MPI undergraduate program speaker, and the member of EViDENT Academia. The contents include different aspects of dental implants, such as, oral surgery, periodontics, prosthodontics and etc.
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Step-by-Step protocols were demonstrated during the course, which would be able to guide these young dentists easier during the further workshop practice. Special thanks to our friendly partners, MPI, MPI Taiwan, and BoneModels for the support of this event and the encouragement to the next generations.
For further contacts:
evident.academia@gmail.com https://www.facebook.com/evident.academia
info@prosthodontics.es http://prosthodontics.es
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Dental Presentation & Techniques using Apple Keynote Part 2: Instant Alpha & Opacity Chen-Che Hung, DDS. keywords: figure, keynote, instant alpha, opacity, pictures, presentation design, transparent *the presentation design program is supported by EViDENT Academia. For course info: evident.academia@gmail.com *original work is presented using Apple iWork System.
There are tons of ways to present your idea s through some slides. You could use words, 9igures, photos and even videos. However, to upgrade your lecture, you cannot just simply place these materials without any editing. A key to have a professional presentation, is the precision you did in your work. As the previous article,1 we have explained the concept of correcting the sizes of different elements. The details from now will be another point of view to success your design.
Keynote also owns the feature and allows us to do the same work we are expected. For using Instant Alpha, simply click on the photo, or the 9igure you would like to edit. At the sidebar, select Image > Instant Alpha and
Transparent Background - Instant Alpha A lot 9igures we are using nowadays may in different formats, such as jpg, png, tiff, bmp, and etc. Sometimes, we have the same picture in different format. The chosen may result in different resolution and different presentation. One of the biggest issue is, “How could I remove the background colour?” or “Does this 9igure comes in different format?, in a transparent background?” The answers are various. For all the users of 21th centuries, I am sure we are familiar with Adobe Systems, 2 with packages of Photoshop, Lightroom, Illustrator, InDesign and etc. These softwares contain the simplest way to remove a section colour individually. And thanks to the development of the industries, , -. 0
Fig 1 Technique of using Instant Alpha, Step-by-Step.
a popup text box shows up with the informations, “Click a colour to make it transparent. Drag to make similar colors transparent.” The precision of the editing is removing the area in a small percentage but with multiple times. Once the colour area is selected, it reveals to cyan colours to have the borders. After clicking, the results are shown. (Figure 1) If the unselected part is removed back accident, just click Undo Typing to restore the work. Opacity Opacity is a very great technique to have an overlap 9igure creating by two different 9igures. It is a very useful techniques to use in dental presentation. For clinical cases, the slide could show both intraoral photos and X-ray radiographs together. To perform this technique, a great p r e p a r a t i o n i s i n d i c a t e d . I n t h i s demonstration, we are using a pocket watch from Breguet as the 9igure. An external surface and an internal component. There are now two elements presented in the slide. Select the internal component or the 9igure you want to make it “transparent” on the top of the other 9igure, opacity function could be found at Style > Opacity and the amount of opacity could be managed in percentages. By sliding the sidebar, you could have the image appearance of what it will look like after the setting. When the two 9igures have overlapped with each other, there is the result. (Figure 2) As the dental presentation, by sizing the radiograph to have the same diameter of the crown, then place on the top of the clinical photos, simply using the opacity technique to reveal the transparency of the gingiva.
Fig 2 Technique of using Opacity, Step-by-Step.
(Figure 3) Especially when presenting the surgical cases, such as dental implants, impacted tooth extraction and etc. A relationship of alveolar bones, soft tissues and the teeth could be explained in a very delighted way.
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Fig 3 Technique of using Opacity in a dental presentation slide. The visibility of both clinical photo and its radiograph at the same time.
Series of Dental Presentation & Techniques are presented in different volume of E7 Dental E- p u b l i s h i n g . Fu l l co u r s e o f d e n t a l presentation design are available in the following session.
the article is supported by
For more information, please contact: evident.academia@gmail.com
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Claude Monet, Impression, Soleil Levant, Canvas, 1872 Museum of Modern Art, New York
In the morning, LORD, you hear my voice; in the morning I lay my requests before you and wait expectantly.(Psalm 5:3)
Christian Love Art Project Classic Art with Passages from Bible public domain
Risk Factors of Osteonecrosis Considered before Implant Placement for Patient Receiving Antiresorptive Therapy Part 2: Prevention, Management & Discussion Ming-Hsueh Lee, DDS. keywords: antiresorptive, bisphospohonates, dental implants, onj, osteonecrosis, pharmacology *the article is modified to adjust for the template. *original copy could be found in Dentistry Degree Project of Universidad CEU Cardenal Herrera.
Preventive Measurement and Dental Management As the former part mentioned that the risk factors like oral alveolar operation in conjunction with antiresorptive medication could trigger ONJ. Dentist should be informed not only before the dental invasive treatment but also before antiresorptive therapy. A complete preventive dental care is needed to avoid part of risk factors of ONJ and lower the occurrence of it. To initiate antiresorptive therapy, the oral health should be a optimized condition. A panoramic radiograph and clinical oral examination to check if there is presence of Cistula, dental mobility, caries, or other potential oral disease are essential. At that moment, if prescribing physician agrees, before the antiresorptive therapy, the nonrestorable teeth should be extracted and periodontal treatment, caries removal, or e n d o d o n t i c t r e a t m e n t s h o u l d b e implemented to avoid possible infection or extractions during the therapy. Soft tissue also need to be evaluated, especially for patients wearing dentures. Dentures should be looked over again in the border and the lingual Clange region to adjust it and to eliminate the possibility to cause small trauma in oral mucosal. Implants are also to .
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better to be placed before patients are exposed to bisphosphonate.16, 32 Dentists also have to give instructions and explanations to patients about the importance of oral hygiene, the risks of ONJ, or reporting the symptom immediately; especially for intravenous bisphosphonate and denosumab intakers. They have higher risk of ONJ and need to know what is the pros and cons if they receive the invasive treatment or no. No matter the degree of risk, the patients need to sign the informed consent after they make the decision with fully understanding of the situation. Routine dental checkup is a must to maintain their oral health and to detect any sign or symptom of ONJ in the following therapy. A case reported in 2013,5 that the patient receiving implant therapy after taking bisphosphonate 4 years, she complained about the discomfort and lost the implants after the dental implant placement. During the dental appointments, she presented the signs and symptoms such as acute abscess in the submandibular region, erythema, trismus, severe pain, dysphagia and active intraoral drainage in the inferior alveolar ridge. (Figure 1A, 1B) The CT scan also showed the destruction of symphysis bone. (Figure 1C)
A
B
C
Fig 1 Clinical observation of the patient, A) Extraoral view of abscess : increase in submandibular volume and erythema, B) Intraoral view: active drainage in the alveolar ridge increase in volume and erythema, C) Computed tomography revealing absence of implants and severe destruction of mandibular symphysis bone.5
When the patients are subjected to the antiresorptive therapy, avoiding bacterial infections, traumas, soft tissue irritation should be reinforced to instruct patients during routine dental appointments. In this moment, dentists should choose treatment carefully and conservatively. Endodontic treatment is more suitable than extractions. Coronal amputation with root canal treatment on the residual root may substitute the extraction to lower the risk.24 Besides, to notify the importance of at-home dental care to patients such as antiseptic mouth wash, dental Closs, or Cluoride tooth paste use. Daily supplementation with
calcium and vitamin D was also related to the better bone condition. Possible Indicators of Risk to ONJ and Drug Holiday It is a difCicult decision for dentists to place implant on patients with antiresorptive therapy. The risk needs to be evaluated and informed to the patients. There are some tools or indicators that dentists can use to assess the risk or oral health condition the patients had. C-terminal telopeptide (CTX) is a biomarker which indicate the activity of osteoclast or recovery of bone remodeling.32 .
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If the value increased, it means the ability of bone turn over is recovering. If the value is lower than 100pg/ml, it indicates the patient is in high risk. Moderate risk is when the value is lower than 150pg/ml. In a study, 32 they found that after 6 months of drug holiday, the ability of bone remodeling had recovered a lot based on the value of CTX test; therefore they suggested 4 to 6 months drug holiday was clinically important. The risk would be lower and minimized. If the value of next test after drug holiday was still lower than 150pg/ml, it means the turnover rate of bone was still low. Dental invasive management or surgery should be avoided. In spite of some studies14, 30 have seen this tool as a indicator of risk of ONJ, the other study tested it again in 2012.35 Their result showed that among high risk group, moderate risk group, or minimal risk group (150-229 pg/ml) there was no signiCicant difference (p>0.005) to the risk of ONJ. Thus, serum CTX test for the patients taking antiresorptive medication could only be a reference for evaluating dynamic effect of the bone. It is not so reliable to use it as an indicator to the risk.25 Apart form the CTX test, there was a Cinding about periodontal ligament widening without concurrent change in adjacent trabecular bone which was correlated to the risk to ONJ.28 (Figure 2) They compared
Fig 2
A) Periodontal ligament widening along the
root of the mandibular right second molar, B) with lingual bone exposure. .
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group with BRONJ and non-BRONJ group, the signiCicant difference of PDL change in radiograph existed (p<0.001). Although there was no hundred percent correlation between the PDL widening and the ONJ risk, it offered the dentists a quick clinical way to predict the possible risk to ONJ. PDL widening may combine with loose teeth in clinical Cinding. To identify the possibility of occurrence of ONJ, it is necessary to use these indicators to evaluate the risk and give the suggestions to patients. As it has been said some patients are in higher risk, dentists with these predicting tools can be more convincing and lower more incidence to ONJ. Once patients have risk factors or the possible signs to get the ONJ, some of them need to discontinue their antiresorptive medication to rebuilt the ability of bone remodeling. Drug holiday, in fact, is a reasonable treatment plan even for osteoporotic patients who do not need dental treatment. It has been revealed that over 3 to 5 years of exposure to oral bisphosphonate would be h a rd t o b e n e C i t p a t i e n t s a ny m o re . Discontinuing the medication could revive the capability of bone remodeling.15 Drug holiday for bisphosphonate intakers who were going to have invasive dental treatment has been discussed for long time. Up to the present time, there are still rare evidence to decide the duration of drug holiday or to prove that the drug holiday can really alter the risk of ONJ. It is established upon the theory of pharmacology such as that the majority of the free BP in serum would be secreted within two months.16 CTX test, or statistic result from recent studies.
Patients in different conditions
Duration of drug holiday
For Oral BP users exposed within 4
It is not necessary to discontinue the medication.(16)
years For Oral BP users over 4 years or
At least 2 months prior to invasive process and 3 months after it.
within 4 years but with risk factors such
Reuse of medication needs to wait for osseous healing until the
as history of glucocorticoid therapy,
wound healed.(16,21)
diabetes or smoking
Drug holiday lasts for at least 4 months to avoid poor prognosis. (39)
For antiresorptive medication intakers
BP or denosumab could be used during the invasive process. (6)
within 2 years For IV BP oncology patients
Avoid invasive treatment. (16)
For IV BP osteoporotic patients or
Duration is unknown. It needs further analysis.
patients with denosumab therapy Tab 2 The conclusions of drug holiday for patients in different conditions from different articles.
In 2009 AAOMS offered the duration of drug holiday to help dental treatment for patients with bisphosphonate therapy and thereafter most studies have used it as a t r e a t m e n t p l a n e g u i d e l i n e . 2 1 T h e y recommended that 3 months before and 3 months after invasive dental surgery if systemic condition of patients is permitting. Position paper of AAOMS in 2014 gave conCirmative response to another study which stated that 2 months prior to the invasive treatment should be enough. The serum of bisphosphonate would reach a very low level.
holiday before invasive treatment. IV BP statistic data in earlier data usually were collected from oncology patients. The incidence of intravenous BP related osteonecrosis was high in these studies.30 Hence, among these studies, there was the consensus that invasive treatment for IV BP users is contraindicated. If the group of IV BP users for osteoporosis were separated from the one for malignancies, the incidence of BRONJ is very different.16 Based on this reason, it is assumed that not all the patients with intravenous BP should avoid dental invasive treatment.
Both position papers have no clear answer to the drug holiday of intravenous bisphosphonate users.16 Combining several studies, the suggestions of discontinuation of antiresorptive medication showed in Table 2. There was no data shown IV BP osteoporotic patients or patients with denosumab therapy need to take drug
Survival Rate of Implant Placement Nowadays dental implant is common used in oral rehabilitation. Although bone quality and healing capacity are affected by antiresorptive medication. Given the fact that the incidence of ONJ is low,16 implant placement is not always contraindicated to the patients exposed to these medications. .
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Thus, it is important to weigh up the risk of and value of implant placement. After preventive measure and a well dental treatment plan, statistic data of survival rate of implant can be a reference to evaluate the risk and recognize the suitable timing for patients to have this treatment. In Table 3, most reviews obtained a very high success rate (95% to 100%) of dental implant when those patients were subjected to oral bisphosphonate. There is nothing different to the normal value of success rate. It is an encouraging number for oral bisphosphonate intakers who may need implant placement as well. There were still the cases of ARONJ reported. A case report of oral BRONJ because of long term use of bisphosphonate over 10 years.36
Year, Author
2007,
Number of Patient
Underlying
and Survival Rate
Disease
61 (100%)
Another case of oral BRONJ occurred because of lacking of proper medical history. The patient considered bisphosphonate was irrelevant so 4 years of BP exposure was not recorded. 37 There were also cases of intravenous bisphosphonate or denosumab related ostenecrosis of jaw but no systemic review was found. Future Resolution A n t i r e s o r p t i v e m e d i c a t i o n l i k e bisphophonate or denosumab are used to treat diseases by inhibiting osteoclast. The main two activities of bone remodeling are coupled. A decrease in bone resorption resulted from bisphospohnates would generate a reduction in bone formation to a similar degree.3 Pronlonged inhibition of osteoclast may unable osteoblast to repair the microdamage of the bone.38 In addition, with steady release of bisphophonate from accumulation of BP on bone, it would lead to
osteoporosis
Fugazzotto
History of Bisphophonates
Result
Oral BP for a mean period
No ONJ; (up to
of 3.3 years.
2 years follow-
PA (40)
up)
2008,
115
Grant BT
(99.5%)
osteoporosis
Oral Bp during implant
No ONJ
treatment. (38 months
(41)
exposure)
2008,
42
Bell B (42)
(95%)
osteoporosis
Oral Bp (6 months to
No ONJ; (3
11years exposure )during
years in
implant treatment.
average followup)
2010,
55
Koka (43)
(99.17%)
Postmenopausal
Oral BP
No ONJ
Tab 3 Survival rate of implant placement related to the patients with oral bisphosphonate therapy. .
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epithelial cells breakdown. Thus, instead of inhibiting osteoclast, selectivly increasing activity of the osteoblast might be another choice to treat osteoporosis to stop this medication-related osteonecrosis. Advanced medication development to increase the turnover rate of the bone to eliminate the residual bisphosphonate may also require to lower the risk of ONJ. Conclusion Based on the current data, for oncology patients with intravenous bisphosphonate, or denosumab exposure, the implant therapy should be avoide because there is a high risk of osteonecrosis. Patients taking oral bisphosphonate use have a really low risk to ONJ and most of implant failures were not because of ONJ occurrence. Even with long-term oral bisphophonate use (over 4 years), implant therapy can be e x e c u t e d a f t e r d i s c o n t i n u i n g t h e antiresorptive medication. Prevention is the essential part to avoid the development of ONJ which is suspicious to be occurred by bacterial infection. Keeping oral hygiene and making a complete treatment plan to decrease the possibility to have dental invasive process during the medication use are important. Reference 1. S a l v a t o r e L . R , J o h n F. , E r i c C . Bisphosphonate-related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2006, 102.4: 433-441. 2. Mariotti A. Bisphosphonates and osteonecrosis of the jaws. Journal of dental education, 2008, 72.8: 919-929.
3. Aspenberg P. Bisphosphonates and i m p l a n t s : a n o v e r v i e w . A c t a orthopaedica, 2009, 80.1: 119-123. 4. Gupta S., Gupta H., Mandhyan D., & Srivastava S. Bisphophonates related osteonecrosis of the jaw. National journal of maxillofacial surgery, 2013. 4(2): 151â&#x20AC;&#x201C; 158. 5. Meira H. C., Rocha M. M, De Souza Noronha V. R., Aguiar D., GuimarĂŁes E., Sousa D, Rodiguez Neto D., Mandibular o s t e o n e c r o s i s a s s o c i a t e d w i t h bisphosphonate use after implant placement: Case report. Dental Press Implantology, 2013;7(2):107-14. 6. Hellstein J. W., Adler R. A., Edwards B., Jacobsen P. L., Kalmar J. R., Koka S., Ristic H. Managing the care of patients receiving antiresorptive therapy for p r e v e n t i o n a n d t r e a t m e n t o f osteoporosis: executive summary of recommendations from the American Dental Association Council on ScientiCic Affairs. The Journal of the American Dental Association, 2011,142(11), 1243-1251. 7. Aghaloo TL, Felsenfeld AL, Tetradis S. Osteonecrosis of the jaw in a patient on Denosumab. J Oral Maxillofac Surg 2010;68(5):959-963. 8. Drake M. T., Clarke B. L., & Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. 2008, In Mayo Clinic Proceedings ;83(9). 9. D a h i y a V. , S h u k l a P. , G u p t a S . Bisphosphonates: An update to the g e n e r a l d e n t i s t . 2 0 1 3 D e n t a l Hypotheses, 4(2), 39. 10. Drake M. T., Clarke B. L., Khosla S. Bisphosphonates: mechanism of action and role in clinical practice.2008, In Mayo Clinic Proceedings ,83(9) 1032-1045. .
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11. Troeltzsch M., Woodlock T., Kriegelstein S., Steiner T., Messlinger K., Troeltzsch, M., Physiology and pharmacology of nonbisphosphonate drugs implicated in osteonecrosis of the jaw.2012, J Can Dent Assoc, 78(c85), 1-7. 12. Gehret C. Denosumab: A New Therapy f o r O s t e o p o r o s i s . 2010 .Pharmacotherapy update, 8(1). 13. Advisory Task Force on BisphosphonateRelated Osteonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial S u r g e o n s P o s i t i o n P a p e r o n Bisphosphonate-Related Osteonecrosis of the Jaws. J Oral Maxillofac Surg. 2007;65(3):369-76 14. Lo J. C., O’Ryan F. S., Gordon N. P., Yang J., Hui R. L., Martin Go, Predicting risk of osteonecrosis of the jaw with oral bisphosphonate exposure (PROBE) i n v e s t i g a t o r s . P r e v a l e n c e o f osteonecrosis of the jaw in patients with oral bisphosphonate exposure.2010, J Oral Maxillofac Surg, 68(2), 243-253. 15. Das S., Crockett J. C., Osteoporosis–a current view of pharmacological prevention and treatment. 2013 Drug design, development and therapy, 7, 435. 16. Ruggiero C, Salvatore L. Thomas B. D, John F, Reginald G, Tara A, Bhoomi M, Felice R . American association of oral and maxillofacial surgeons position p a p e r o n m e d i c a t i o n - r e l a t e d o s t e o n e c ro s i s o f t h e j aw — 2 0 1 4 update. Journal of Oral and Maxillofacial Surgery, 2014, 72.10: 1938-1956. 17. Ayllon J., Launay-Vacher V., Medioni J., Cros C., Spano J. P., Oudard S. , O s te o n e c ro s i s o f t h e j aw u n d e r bisphosphonate and antiangiogenic therapies: cumulative toxicity proCile? .
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