The objective was to evaluate the current evidence regarding the etiology of medication-related osteonecrosis of the jaw (MRONJ). This study systematically reviewed the literature by searching PubMed, Web of Science, and ProQuest databases for genes, proteins, and microRNAs associated with MRONJ from the earliest records through April 2023. Conference abstracts, letters, review articles, non-human studies, and non-English publications were excluded. Twelve studies meeting the inclusion criteria involving exposure of human oral mucosa, blood, serum, saliva, or adjacent bone or periodontium to anti-resorptive or anti-angiogenic agents were analyzed. The Cochrane Collaboration risk assessment tool was used to assess the quality of the studies. A total of 824 differentially expressed genes/proteins (DEGs) and 22 microRNAs were extracted for further bioinformatic analysis using Cytoscape, STRING, BiNGO, cytoHubba, MCODE, and ReactomeFI software packages and web-based platforms: DIANA mirPath, OmicsNet, and miRNet tools. The analysis yielded an interactome consisting of 17 hub genes and hsa-mir-16-1, hsa-mir-21, hsa-mir-23a, hsa-mir-145, hsa-mir-186, hsa-mir-221, and hsa-mir-424. A dominance of cytokine pathways was observed in both the cluster of hub DEGs and the interactome of hub genes with dysregulated miRNAs. In conclusion, a panel of genes, miRNAs, and related pathways were found, which is a step toward understanding the complexity of the disease.

Long-term treatment with bisphosphonates is accompanied by an increased risk of medication-related osteonecrosis of the jaw (MRONJ). Currently, no clinically useful biomarkers for the predictive diagnosis of MRONJ are available. To investigate the potential key proteins involved in the pathogenesis of MRONJ, a proteomic LC-MS/MS analysis of saliva was performed. Differentially expressed proteins (DEPs) were analyzed using BiNGO, ClueGO, cytoHubba, MCODE, KEGG, and ReactomeFI software packages using Cytoscape platforms. In total, 1545 DEPs were identified, including 43 up- and 11 down-regulated with a 1.5-fold cut-off value and adj. p-value < 0.05. The analysis provided a panel of hub genes, including APOA2, APOB, APOC2, APOC3, APOE, APOM, C4B, C4BPA, C9, FGG, GC, HP, HRG, LPA, SAA2-SAA4, and SERPIND1. The most prevalent terms in GO of the biological process were macromolecular complex remodeling, protein–lipid complex remodeling, and plasma lipoprotein particle remodeling. DEPs were mainly involved in signaling pathways associated with lipoproteins, the innate immune system, complement, and coagulation cascades. The current investigation advanced our knowledge of the molecular mechanisms underlying MRONJ. In particular, the research identified the principal salivary proteins that are implicated in the onset and progression of this condition.

The concept of allogenic tooth transplantation has been known since the early stages of modern oral surgery. Despite numerous successful clinical cases, a deeper understanding of the biological and technical aspects of this method is still required to enable its safe and effective implementation in routine clinical practice. In this case report, we describe an allogenic tooth transplantation performed between a mother and her son. In the mother, teeth 14 and 24 had been extracted more than 10 years earlier due to failed endodontic treatment. Only minimal spontaneous space closure between adjacent teeth occurred, and therefore orthodontic space reopening was not required prior to transplantation. The donor teeth were the son’s maxillary first premolars, which were indicated for extraction for orthodontic reasons. The procedure was preceded by a detailed CBCT analysis, establishment of a surgical plan, and definition of the transplantation protocol. Using CAD/CAM-based 3D printing, replicas of the donor teeth were fabricated and used intraoperatively as guides during preparation of the recipient sites within the alveolar bone. The recipient sockets were prepared using instruments from an implant surgical kit. The 3D tooth models enabled precise adaptation of the recipient bed to the morphology of the donor roots, thereby minimizing the extra-alveolar time. Following atraumatic extraction, the donor teeth were immediately transplanted into the recipient. This report presents a case combining 3D printing technology with allogenic tooth transplantation. This approach allows reduction of extra-alveolar time, minimizes unnecessary alveolar bone loss, and improves primary stability of the transplant. The aim of this study is to expand current knowledge regarding the potential use of allogenic tooth transplantation in combination with 3D printing and to support its broader application in clinical dental practice, similarly to other medical fields where transplantation procedures demonstrate high success rates.

Background: Allogenic tooth transplantation has been reported for several decades, but clinical evidence remains limited, particularly regarding contemporary digital workflows, immunological characterization, and long-term outcomes. Cone-beam computed tomography (CBCT), computer-aided design/computer-aided manufacturing (CAD/CAM), and three-dimensional (3D) printing may facilitate preoperative planning and recipient-site preparation while minimizing manipulation of donor teeth. Case Report: A 48-year-old woman underwent allogenic transplantation of two mature maxillary first premolars donated by her 17-year-old son. The corresponding recipient teeth (14 and 24) had been absent for more than 10 years following unsuccessful endodontic treatment. CBCT-based planning and 3D-printed donor-tooth replicas were used to prepare the recipient sites before donor extraction. Owing to anatomical differences in root morphology and recipient-site dimensions, the teeth were transplanted contralaterally (donor 14 to recipient 24 and donor 24 to recipient 14). The extra-alveolar time was approximately 20 s for each tooth. Clinical, periodontal, radiographic, and immunogenetic assessments were performed during postoperative follow-up. Results: At 12 months, both transplanted teeth remained functional without clinically apparent complications. Periodontal probing depths remained unchanged between the 3- and 12-month examinations (tooth 14: 3.5 mm mesially and 4.0 mm distally; tooth 24: 3.0 mm mesially and 3.5 mm distally), with no bleeding on probing and mobility grade 0. No radiographically apparent pathological root resorption or ankylosis was identified. Post-transplant immunogenetic testing demonstrated donor-specific anti-HLA class I and II reactivity. Anti-MICA antibodies were not detected. In the absence of pre-transplant serum, the detected donor-specific antibodies could not be classified as pre-existing or de novo. Conclusions: CBCT-based planning and 3D-printed donor-tooth replicas facilitated the technically feasible transplantation of two mature allogenic premolars, with favorable short-term clinical findings at 12 months. Despite this clinical stability, donor-directed anti-HLA reactivity was detected after transplantation. These findings neither establish immunological tolerance nor demonstrate that the observed alloimmune reactivity was induced by transplantation. Longer follow-up and prospective immunological monitoring are required to evaluate graft survival and the clinical significance of donor-specific antibodies.