Bisphosphonates (BP) are nonhormonal medications used in the treatment of various bone malignancies and metabolic conditions. Since 2003, there have appeared a significant and growing number of articles in the worldwide medical and dental literature describing the complication of an osteonecrosis of the jaws associated with the intravenous and, most recently, the oral form of BP medication that has been refractory to any definitive form of treatment. The authors have successfully managed 2 patients taking the oral form of BP with adjunctive treatment using platelet-rich plasma (PRP), and in one case with hyperbaric oxygen (HBO). We were able to obtain complete remission in each case, which is defined as resolution of pain and complete closure of exposed bone in the jaws. The purpose of this report is to describe a treatment protocol and the rationale for using PRP and HBO to obtain complete remission of this new pathologic condition.

Biochemical markers of bone metabolism have been used in medicine to evaluate and provide treatment to patients with metabolic bone diseases, such as osteoporosis. Serum cross-linked C-telopeptide of type I collagen (CTX) is a marker of osteoclast activity and is used to assess the level of bone resorption. Recently, in oral and maxillofacial surgery, it was proposed that the levels of serum CTX may predict the subsequent risk of developing osteonecrosis of the jaws (ONJ) after oral surgery procedures for patients taking oral bisphosphonates (BPs). The goal of this study was to determine whether this specific serum marker of bone resorption could preoperatively predict the risk of developing ONJ from oral BPs.We hypothesized that there is no clinical correlation between the observed preoperative serum CTX values and the risk of developing ONJ. The authors examine the scientific basis (validity) of the morning fasting serum CTX test in 163 consecutive patients who underwent various oral surgery procedures in the office. The authors also review the laboratory test results and the recommended protocol based on the test values. One hundred sixty-three patients (mean age, 75.9 years) were divided into 2 groups. Group I was the control group that consisted of 109 patients taking oral BPs who did not take the CTX test preoperatively. Group 2 consisted of 54 patients taking BPs and who elected to have the CTX test performed to assess their level of risk of developing ONJ, preoperatively. Both groups of patients were observed for a period of 8 weeks for signs and symptoms of BP-associated ONJ after surgery. The clinical data at 8 weeks and beyond revealed that there was no evidence of BP-associated ONJ in all participants. We conclude that the serum CTX is not a valid preoperative test to accurately assess the level of risk of developing ONJ and is not indicated in the oral surgery patient.

To describe a new procedure capable of coupling 2 data sets from cone beam computed tomography (CBCT) and an intraoral laser digital scanner to produce a stereolithographic model and surgical guide. Use of DICOM (digital imaging and communications in medicine) format data obtained from CBCT scan images merged with standard triangulation language (STL) file data obtained from digital impressions using an intraoral laser scanner. The 2 data sets were electronically sent to a 3-dimensional imaging and technology software company over the Internet to fabricate a stereolithographic model of the jaws and surgical guide without the use of stone or plaster models obtained from traditional dental impressions. STL file data are able to accurately fabricate a stereolithographic model and surgical guide for implant surgery.

Osteonecrosis of the jaws (ONJ) is a condition characterized by necrotic exposed bone in the jaws of patients receiving intravenous or oral bisphosphonate therapy. A review of the medical and dental literature reveals that the pathoetiology of ONJ remains unknown and there is no established link that bisphosphonates are the primary cause of this bone pathology. However, there is clinical evidence that Actinomyces may play a critical role in the pathogenesis of bisphosphonate-associated ONJ. Identification and a prolonged course of oral antimicrobial therapy may lead to complete resolution of this actinomycotic osteonecrosis.

Dental implant surgery in the anterior mandible is considered a relatively routine and safe procedure with minimal morbidity. A case of brisk, pulsatile bleeding from the anterior mandibular incisive canal and its management using an active hemostatic matrix is presented. In addition, a review of the literature regarding the anatomy of this region of the mandible and hemostatic strategy to achieve hemostasis will be discussed.

This case report with a review of the literature describes a patient with osteogenesis imperfecta who was treated with dental implants. To our knowledge, only one case report has been published in the English dental literature describing implant treatment in the osteogenesis imperfecta patient. The uncertainty in treatment confronted by all clinicians is the density of bone, which is essential for implant survival.