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Tetradis S, Allen MR, Ruggiero SL. Pathophysiology of Medication-Related Osteonecrosis of the Jaw-A Minireview. JBMR Plus 2023; 7:e10785. [PMID: 37614299 PMCID: PMC10443081 DOI: 10.1002/jbm4.10785] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 08/25/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious adverse effect of antiresorptive medications administered for control of osseous malignancy, osteoporosis, or other bone metabolic diseases. Despite being reported in the literature two decades ago, MRONJ etiology, pathophysiology, and progression remain largely unknown, and current nonoperative or operative treatment strategies are mostly empirical. Several hypotheses that attempt to explain the mechanisms of MRONJ pathogenesis have been proposed. However, none of these hypotheses alone is able to capture the complex mechanistic underpinnings of the disease. In this minireview, we aim to highlight key findings from clinical and translational studies and propose a unifying model for the pathogenesis and progression of MRONJ. We also identify aspects of the disease process that require further investigation and suggest areas for future research efforts toward calibrating methodologic approaches and validating experimental findings. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Sotirios Tetradis
- Division of Diagnostic and Surgical SciencesUCLA School of DentistryLos AngelesCAUSA
| | - Matthew R. Allen
- Department of Anatomy, Cell Biology & PhysiologyIndiana University School of MedicineIndianapolisINUSA
| | - Salvatore L. Ruggiero
- New York Center for Orthognathic and Maxillofacial SurgeryLake SuccessNYUSA
- Department Oral and Maxillofacial SurgeryStony Brook School of Dental MedicineStony BrookNYUSA
- Division of Oral and Maxillofacial SurgeryHofstra‐Northwell School of MedicineHempsteadNYUSA
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Soundia A, Hadaya D, Chau Y, Gkouveris I, Bezouglaia O, Dry S, Pirih F, Aghaloo T, Tetradis S. Local RANKL delivery improves socket healing in bisphosphonate treated rats. Bone 2021; 148:115945. [PMID: 33836308 PMCID: PMC9396533 DOI: 10.1016/j.bone.2021.115945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 01/15/2023]
Abstract
Medication related osteonecrosis of the Jaws (MRONJ) is a severe complication of antiresorptive and anti-angiogenic medications. Osteoclast inhibition is central in MRONJ pathogenesis. Here, we investigated if local application of RANKL (a key molecule in osteoclast activation) could enhance osteoclast generation and improve extraction socket healing in the presence of bisphosphonates. Thirty Wistar-Han rats received one saline or 66 μg/kg zoledronate (ZA) i.p. dose before surgery. A week later, mandibular molars were extracted bilaterally. Collagen tapes infused with water or RANKL were placed in the extraction sockets of 60 hemimandibles of veh (veh/RANKL-, veh/RANKL+) or ZA treated rats (ZA/RANKL-, ZA/RANKL+). Rats were euthanized 3 or 12 days after surgery. Animals euthanized at 12 days received two additional veh or ZA injections. Clinical, radiographic and histologic assessments were performed. Visually, at the 3-day timepoint, no sockets demonstrated complete healing. At the 12-day timepoint, sockets of veh/RANKL- and veh/RANKL+ rats showed intact mucosa, while mucosal defects were noted in ZA/RANKL- rats. Importantly, ZA/RANKL+ sockets showed absence of bone exposure. RANKL delivery increased bone healing in the ZA/RANKL+ sites 12 days after extraction compared to the ZA/RANKL- sites. Histologically, at the 3-day timepoint, ZA/RANKL- sockets demonstrated extensive bone exposure and osteonecrosis. In contrast, ZA/RANKL+ rats showed granulation tissue coverage and significantly reduced osteonecrosis, similar to the veh groups. Importantly, in the ZA/RANKL+ group, osteoclasts attached to the bone surface and osteoclast numbers were higher compared to ZA/RANKL- sites. At the 12-day timepoint, persistent osteonecrosis and bone exposure were detected in the sockets of ZA/RANKL- animals. Contrary, ZA/RANKL+ rats demonstrated socket epithelialization and reduced osteonecrosis. Significantly more total and bony attached osteoclasts persisted in the ZA/RANKL+ vs the ZA/RANKL- group. We present a novel approach towards improving socket healing, in the presence of ZA, by enhancing osteoclastic numbers and attachment through local RANKL application. Our approach is clinically applicable and could improve treatment outcomes of patients on high-dose ZA therapy.
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Affiliation(s)
- Akrivoula Soundia
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Danny Hadaya
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Yee Chau
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Ioannis Gkouveris
- Department of Oral and Maxillofacial Pathology and Medicine, School of Dentistry, National and Kapodistrian University of Athens, Greece
| | - Olga Bezouglaia
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Sarah Dry
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Flavia Pirih
- Division of Constitutive and Regenerative Sciences, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Tara Aghaloo
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA.
| | - Sotirios Tetradis
- Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA, USA.
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Akhoundi MSA, Sheikhzadeh S, Mirhashemi A, Ansari E, Kheirandish Y, Allaedini M, Dehpour A. La diminution de la densité osseuse induite par des antiépileptiques peut accélérer le déplacement orthodontique des dents chez les rats Wistar mâles. Int Orthod 2018; 16:73-81. [PMID: 29459156 DOI: 10.1016/j.ortho.2018.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Mohammad Sadegh Ahmad Akhoundi
- Dental Research Center Dentistry Research Institute, Orthodontics Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Sheikhzadeh
- Orthodontics Department, Dental faculty, Babol University of Medical Sciences, Babol, Iran.
| | - Amirhossein Mirhashemi
- Orthodontics Department, Dental faculty, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Ansari
- Orthodontics Department, Dental faculty, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Kheirandish
- Oral and Maxillofacial Radiology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Allaedini
- Dental Research Center Dentistry Research Institute, Orthodontics Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Dehpour
- Dental Research Center Dentistry Research Institute, Orthodontics Department, Tehran University of Medical Sciences, Tehran, Iran
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Akhoundi MSA, Sheikhzadeh S, Mirhashemi A, Ansari E, Kheirandish Y, Allaedini M, Dehpour A. Decreased bone density induced by antiepileptic drugs can cause accelerated orthodontic tooth movement in male Wistar rats. Int Orthod 2018; 16:73-81. [PMID: 29459155 DOI: 10.1016/j.ortho.2018.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the effect of the carbamazepine and valproic acid on orthodontic tooth movement in male Wistar rats. METHODS Evaluation of tooth movement after 21 days of drugs infusion was carried out by feeler gauge. Bone densitometry on lateral cephalograms was conducted on days 1 and 21. After dissection of the maxillae, histologic parameters were evaluated. RESULTS Orthodontic tooth movement was accelerated in experimental groups rather than controls. Optical density was significantly increased in these groups. In histologic sections, mesioapical portion of the PDL (Periodontal Ligament) was wider in experimental groups. Also, distoapical portion of the PDL was wider only in valproic acid group. CONCLUSION Valproic acid and carbamazepine can decrease the bone density which may induce the accelerated orthodontic tooth movement in rats.
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Affiliation(s)
- Mohammad Sadegh Ahmad Akhoundi
- Dental Research Center Dentistry Research Institute, Orthodontics Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Sheikhzadeh
- Orthodontics Department, Dental faculty, Babol University of Medical Sciences, Babol, Iran.
| | - Amirhossein Mirhashemi
- Orthodontics Department, Dental faculty, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Ansari
- Orthodontics Department, Dental faculty, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Kheirandish
- Oral and Maxillofacial Radiology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Allaedini
- Dental Research Center Dentistry Research Institute, Orthodontics Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Dehpour
- Dental Research Center Dentistry Research Institute, Orthodontics Department, Tehran University of Medical Sciences, Tehran, Iran
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Cheong S, Sun S, Kang B, Bezouglaia O, Elashoff D, McKenna CE, Aghaloo TL, Tetradis S. Bisphosphonate uptake in areas of tooth extraction or periapical disease. J Oral Maxillofac Surg 2014; 72:2461-8. [PMID: 25262401 DOI: 10.1016/j.joms.2014.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/24/2014] [Accepted: 07/02/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Bisphosphonates (BPs) are widely used for the management of bone diseases such as osteoporosis and bone malignancy. However, osteonecrosis of the jaws (ONJ) is a serious complication of BP treatment. ONJ lesions mainly occur after extraction of teeth deemed unrestorable or around teeth with active periodontal or periapical disease. Because socket healing or dental disease shows higher bone turnover, the authors hypothesized that preferentially high BP accumulation would be observed in these areas. MATERIALS AND METHODS The authors tested the uptake of fluorescein-labeled zoledronic acid (5-FAM-ZOL) in sites of tooth extraction or experimental periapical disease in mice. Maxillary molars were extracted or the crowns of mandibular molars were drilled to induce pulp exposure. Animals were injected with 5-FAM-ZOL 200 μg/kg at various times after intervention and fluorescence was measured at healthy versus intervention sites. Fluorescein injections were used as controls. Data were analyzed by t test and mixed effects linear models were constructed because the animals had repeated measurements over time and at the 2 sites. RESULTS A statistically significant (P≤.001 to .002) time-dependent uptake of 5-FAM-ZOL was detected in the areas of extraction socket and in the alveolar ridge around teeth with periapical disease compared with the healthy contralateral sites of the same animals. For the 2 conditions, the uptake reached a maximum 3 days after experimental intervention and decreased thereafter. CONCLUSIONS These data suggest that sites with increased bone turnover, such as extraction sites or areas of periapical inflammation, are exposed to higher BP doses than the remaining alveolar ridge and could explain, at least in part, the susceptibility of such areas to ONJ.
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Affiliation(s)
- Simon Cheong
- Dental Student, University of Southern California, Herman Ostrow School of Dentistry, Los Angeles, CA
| | - Shuting Sun
- Research Associate, Department of Chemistry, University of Southern California, Los Angeles, CA
| | - Benjamin Kang
- Dental Student, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Olga Bezouglaia
- Research Associate, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA
| | - David Elashoff
- Professor, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Charles E McKenna
- Professor, Department of Chemistry, University of Southern California, Los Angeles, CA
| | - Tara L Aghaloo
- Associate Professor, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA
| | - Sotirios Tetradis
- Professor, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles; Molecular Biology Institute, UCLA, Los Angeles, CA.
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Liu YCG, Lerner UH, Teng YTA. Cytokine responses against periodontal infection: protective and destructive roles. Periodontol 2000 2010; 52:163-206. [PMID: 20017801 DOI: 10.1111/j.1600-0757.2009.00321.x] [Citation(s) in RCA: 197] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Arias JA, Pardo C, Olmos A, Cuadrado ML, Ruibal A. Dental diseases and radionuclide imaging of the jaws. Nucl Med Commun 2004; 25:305-10. [PMID: 15094451 DOI: 10.1097/00006231-200403000-00015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to compare the results of radionuclide bone scans of the jaws with data obtained at the nuclear medicine department from a brief and feasible dental history, taking special account of cases with a positive scan and no recent dental events. Ninety-eight patients undergoing radionuclide bone scan as part of their diagnosis in non-dental, oncological and non-oncological diseases were imaged with 99mTc-labelled oxidronate. Superior and inferior halves of the mandible and maxilla (392 quadrants) were regarded as normal or having an abnormally high uptake. A recent (1 year) dental history was also obtained through a brief questionnaire and data were referred to each quadrant of the jaws. The association between the bone scan and dental disease was assessed by means of the chi-squared test. The overall results of scintigraphy and history coincided in 66 patients (46 with abnormal and 20 with normal findings; P = 0.002). Twenty-five patients had a positive scintigram without any known dental disorder. Results of scintigraphy and history coincided in 254 quadrants (78 with abnormal and 176 with normal findings; P < 0.001). Eighty-three quadrants had hot spots in the scintigram without any known dental lesion. It can be concluded that abnormal jaw scintigrams are frequent in patients without known dental disease, and this may indicate silent osteoblastic activity. These observations should be reported to the dentist for several reasons. First, they may reveal asymptomatic dental lesions. Second, the use of oral prostheses and implants is increasing and they require the support of healthy alveolar bone.
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Affiliation(s)
- Jose A Arias
- Faculty of Health Sciences, Alfonso X el Sabio University, Villanueva de la Canada, Madrid, Spain.
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Tenenbaum HC, Shelemay A, Girard B, Zohar R, Fritz PC. Bisphosphonates and periodontics: potential applications for regulation of bone mass in the periodontium and other therapeutic/diagnostic uses. J Periodontol 2002; 73:813-22. [PMID: 12146541 DOI: 10.1902/jop.2002.73.7.813] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Bisphosphonates are widely utilized in the management of systemic metabolic bone disease due to their ability to inhibit bone resorption. Recently, new uses of this unique class of pharmacological agents have been suggested. Given their known affinity to bone and their ability to increase osteoblastic differentiation and inhibit osteoclast recruitment and activity, there exists a possible use for bisphosphonates in the diagnosis and management of periodontal diseases. These bone-specific properties could also provide an interesting management strategy to stimulate osteogenesis in conjunction with regenerative materials around osseous defects and may also result in the promotion of bone formation around endosseous implants. The objective of this article is to review the scientific evidence regarding the potential applications of bisphosphonate drugs in the therapeutic management of periodontal diseases. Moreover, the mechanism of action and the pharmacology of these drugs will be reviewed. Finally, the potential role of bisphosphonates regarding their potential to accelerate bone formation, in addition to their usual uses for inhibition of bone resorption, is discussed.
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Affiliation(s)
- Howard C Tenenbaum
- Biological & Diagnostic Sciences, University of Toronto, Faculty of Dentistry, ON, Canada.
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Abstract
Comparative investigations of mandibular function among primates have relied upon elementary structural models to estimate states of masticatory stress and strain. In these studies, mandibular corpus morphology is idealized as a homogeneous, isotropic symmetrical body of invariant geometry, and this morphological abstraction is used to infer relative levels of stress and strain in the jaw. In reality, none of the limiting conditions assumed by these models is satisfied; consequently, it is prudent to ask whether this "textbook" engineering approach is valid for the inference of biomechanical behavior. In this study, the predictions of various geometric representations of the mandibular corpus are evaluated against strains recorded in a sample of human jaws loaded in torsion. Symmetrical geometrical models (including various "robusticity" shape indices), although convenient, are probably not consistently reliable for predicting the distribution of strains in the corpus. The experimental data suggest that variations in cortical thickness within sections play a significant role in determining the profile of relative strains. For comparative applications, characterization of the corpus as an asymmetrical hollow ellipse (i.e., with differing thickness of medial and lateral cortical plates) may provide a reasonable portrayal of relative strains.
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Affiliation(s)
- D J Daegling
- Department of Anthropology, Yale University, New Haven, Connecticut 06520-8277, USA.
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Daegling DJ, Hylander WL. Occlusal forces and mandibular bone strain: is the primate jaw "overdesigned"? J Hum Evol 1997; 33:705-17. [PMID: 9467777 DOI: 10.1006/jhev.1997.0164] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Finite element modelling of the function of the periodontium and surrounding alveolar bone suggests these tissues are subjected to unusually large strains in comparison with the bone of the basal mandibular corpus. These studies, in addition to certain experimental investigations, have led to the suggestion that the strains experienced in the basal mandibular corpus are not functionally important. Under this view, size and shape of the basal corpus are not functionally linked to masticatory forces. Since previous comparative investigations have been premised on the assumption that masticatory strains in the basal corpus are functionally important, the assertion that masticatory stresses are concentrated primarily in the alveolar process undermines the credibility of this body of work. The hypothesis that the biomechanical effects of masticatory forces are localized in the alveolar process can be evaluated by reference to a number of bone strain investigations, as well as through consideration of current understanding of bone biology and behavior. Experimental studies indicate that the effects of occlusal forces during mastication are quite apparent in alveolar bone, although relatively large strains are also observed in regions well-removed from a loaded alveolus. It is also apparent that both alveolar and basal mandibular bone are subject to bending and twisting strains associated not only with occlusal forces, but also with muscular and condylar reaction forces. The result is that strain levels in alveolar vs. basal bone may be roughly similar, in contradiction to some published theoretical models. Based on empirical evidence and theoretical considerations, it is premature to conclude that mandibular corpus size and shape are not functionally linked to the biomechanics of chewing and biting.
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Affiliation(s)
- D J Daegling
- Department of Anthropology, Yale University, New Haven, Connecticut 06520-8277, USA
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Matteson SR, Deahl ST, Alder ME, Nummikoski PV. Advanced imaging methods. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 1996; 7:346-95. [PMID: 8986396 DOI: 10.1177/10454411960070040401] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Recent developments in imaging sciences have enabled dental researchers to visualize structural and biophysical changes effectively. New approaches for intra-oral radiography allow investigators to conduct densitometric assessments of dento-alveolar structures. Longitudinal changes in alveolar bone can be studied by computer-assisted image analysis programs. These techniques have been applied to dimensional analysis of the alveolar crest, detection of gain or loss of alveolar bone density, peri-implant bone healing, and caries detection. Dental applications of computed tomography (CT) include the detailed radiologic anatomy of alveolar processes, orofacial soft tissues and air spaces, and developmental defects. Image analysis software permits bone mass mineralization to be quantified by means of CT data. CT has also been used to study salivary gland disease, injuries of the facial skeleton, and dental implant treatment planning. Magnetic resonance imaging (MRI) has been used extensively in retrospective and prospective studies of internal derangements of the temporomandibular joint. Assessments based on MRI imaging of the salivary glands, paranasal sinuses, and cerebrovascular disease have also been reported. Magnetic resonance spectroscopy (MRS) has been applied to the study of skeletal muscle, tumors, and to monitor the healing of grafts. Nuclear imaging provides a sensitive technique for early detection of physiological changes in soft tissue and bone. It has been used in studies of periodontitis, osteomyelitis, oral and maxillofacial tumors, stress fractures, bone healing, temporomandibular joint, and blood flow. This article includes brief descriptions of the technical principles of each imaging modality, reviews their previous uses in oral biology research, and discusses potential future applications in research protocols.
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Affiliation(s)
- S R Matteson
- Department of Dental Diagnostic Science, University of Texas Health Science Center, San Antonio 78284-7919, USA
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Laga EA, Toth BB, Podoloff DA, Keene HJ. Clinical correlation of oral-dental findings with radiographs and with total body bone scans. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 75:253-63. [PMID: 8426726 DOI: 10.1016/0030-4220(93)90102-a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Bone scans are frequently used to detect osteoblastic areas in bone, including bony metastases in patients with existing tumors. Various dental conditions have been found to cause areas in the jaws to have increased uptake of radiopharmaceuticals. We studied 30 patients with an existing cancer or previous history of cancer with the use of total body bone scans, panoramic radiographs, and dental examinations, and we found no correlation between the intensity of radionuclide uptake in the jaws on the bone scans and the number of teeth in each jaw, the age of the patient, the degree of periodontal disease, or the number of dental pathoses per jaw. The frequency and intensity of positive scan results were related to the presence or absence of intrabony lesions in the jaws. Dental disease therefore does not appear to mask metastatic disease in the jaws; however, when metastasis is suspected, a dental examination with radiographs is recommended.
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Affiliation(s)
- E A Laga
- Department of Dental Oncology, University of Texas M. D. Anderson Cancer Center, Houston
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Jendresen MD, Allen EP, Bayne SC, Hansson TL, Klooster J, Preston JD. Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 1992; 68:137-90. [PMID: 1403904 DOI: 10.1016/0022-3913(92)90302-q] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The committee screened several hundred articles, citing 518 published papers. Some are present quality in research, others provide clinical interest, and some are identified as misleading. New techniques in pulp physiology and pathology are reported. Laser use and techniques in prevention, restorative dentistry, and materials use are reported. Epidemiology of selected diseases and the results of various formulations for treatment are cited. Diagnosis of craniomandibular dysfunction is well represented as well as references to literature reviews and other sophisticated scientific investigation. Research on adhesives is presented in respect to bonding agents for dentin and enamel. Several clinical studies are included, along with customary laboratory reports on several materials.
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