Joo-Young Ohe

Objectives: This study aimed to evaluate the effects of anti‐resorptive drugs (ARD), including denosumab, on dental implant survival in post‐menopausal women with osteoporosis, compared with those receiving non‐ARD, and to identify risk factors associated with ARD that may influence implant outcomes. Material and Methods: This retrospective cohort study examined 1694 implants placed in 806 women aged 55 years or older with at least of follow‐up of 12 months. Implants were categorized according to exposure to anti‐resorptive drugs (ARD), including bisphosphonates or denosumab, or assignment to a non‐ARD control group. The assessed variables included demographic, ARD‐related, implant/prosthesis‐related factors, and marginal bone loss. Propensity score matching was used to balance group characteristics. Statistical analyses included Firth logistic regression with patient‐level clustering and a linear mixed model for longitudinal bone changes. Kaplan–Meier curves were illustrated to describe implant survival trends among the groups. Results: Implant survival rates were 99.13% (bisphosphonates), 98.08% (denosumab), and 98.24% (control), with no significant differences in implant failure or marginal bone loss between the groups. However, diabetes mellitus, alcohol consumption, and overdenture prosthesis were associated with a significantly increased risk of implant failure. Conclusion: Implant‐based prosthetic rehabilitation is also feasible in post‐menopausal women receiving ARD for osteoporosis. Although the implant survival rate was comparable to non‐ARD users, caution is advised for patients on high doses of ARD or undergoing long‐term therapy due to their pharmacological effects compromising bone metabolism. Additionally, the risk of failure associated with invasive procedures needs to be further evaluated.

Calcium hydroxide is commonly used as a root canal disinfectant due to its high alkalinity and biocompatibility. However, excessive injection pressure may cause extrusion beyond the root apex, leading to complications such as nerve or vascular injury. This report showed a case of a 58-year-old woman who developed cutaneous necro-sis and sensory disturbance in the left midface and nasal alar region following endodontic treatment on the left maxillary second molar. Computed tomographic imaging revealed calcified occlusion of the posterior superior alveolar artery. The patient was treated with debridement, stromal vascular fraction injection, and split-thickness skin graft. This case demonstrates a rare but serious complication, known as Nicolau syndrome, resulting from intra-arterial injection of calcium hydroxide. Clinicians should be aware of this potential risk and exercise cau-tion during delivery of intracanal medicaments, especially in vascular-rich anatomical regions.

This case series analyzes five patients treated at the Department of Oral and Maxillofacial Surgery at Kyung Hee University Dental Hospital for iatrogenic inferior alveolar nerve injuries caused by the extrusion of endodontic materials (calcium hydroxide paste and an MTA-based sealer). The study evaluates the clinical characteristics, symptom onset, anatomical injury distribution, and treatment outcomes for each case. By identifying patterns in radiographic and symptomatic findings, it aims to clarify the degree of nerve involvement and explores how the physicochemical properties of each material affect the perineural space. Through a review of recovery patterns following both surgical and conservative management, the report serves as a practical reference for clinicians. Ultimately, it emphasizes the critical importance of meticulous technique in root canal procedures and the ne-cessity of timely diagnostic imaging when nerve injury is suspected.

The suppressive effect of bisphosphonates (BPs) on bone metabolism is considered to be a major cause of medication-related osteonecrosis of the jaw (MRONJ). Enamel matrix derivative (EMD) stimulates and activates growth factors, leading to the regeneration of periodontal tissues. In this study, we aimed to explore the potential of EMD in reversing the detrimental effects of BPs on human fetal osteoblasts (hFOBs) and osteosarcoma-derived immature osteoblasts (MG63s) by assessing cell viability, apoptosis, migration, gene expression, and protein synthesis. While the suppressive effect of zoledronate (Zol) on cell viability and migration was observed, the addition of EMD significantly mitigated this effect and enhanced cell viability and migration. Furthermore, an increased apoptosis rate induced by Zol was decreased with the addition of EMD. The decreased gene expression of alkaline phosphatase (ALP), osteocalcin (OC), and the receptor activator of nuclear factors kappa-B ligand (RANKL) caused by BP treatment was reversed by the co-addition of EMD to hFOB cells. This trend was also observed for ALP and bone sialoprotein (BSP) levels in MG63 cells. Furthermore, suppressed protein levels of OC, macrophage colony-stimulating factor (M-CSF), BSP, and type 1 collagen (COL1) were recovered following the addition of EMD. This finding suggests that EMD could mitigate the effects of BPs, resulting in the recovery of cell survival, migration, and gene and protein expression. However, the behavior of the osteoblasts was not fully restored, and further studies are necessary to confirm their effects at the cellular level and to assess their clinical usefulness in vivo for the prevention and treatment of MRONJ.

Joon-Bum Hong, Joo-young Ohe, Gyu-Jo Shim, Yong-Dae Kwon. JKAOMS 2023;49:365-8. https://doi.org/10.5125/jkaoms.2023.49.6.365

Doogyum Kim, Taeil Lim, Hyun-Woo Lee, Baek-Soo Lee, Byung-Joon Choi, Joo Young Ohe, Junho Jung. JKAOMS 2023;49:347-53. https://doi.org/10.5125/jkaoms.2023.49.6.347

Background: Risk factors for developing medication-related osteonecrosis of the jaw (MRONJ) include the general condition of the patient, smoking habit, poor oral hygiene, and the type, duration, and administration route of the drug, dentoalveolar surgery, such as implant placement. This study aimed to discuss whether implants may induce osteonecrosis in older patients receiving long-term medication and to analyze the radiological pattern of the bone necrosis. Methods: This study included 33 patients diagnosed with dental implant-associated medication-related osteonecrosis of the jaw. Data regarding the medical history, type of medication used, durations of administration, laboratory test results, onset of bone necrosis since implant placement, type of opposing teeth, and radiological pattern of the bone necrosis on cone-beam computed tomography were recorded in patients with and without implants. Results: The most commonly used drug was bisphosphonate, with an average duration of use of 61.37 (± 53.72) months. The laboratory results showed average serum C-terminal cross-linking telopeptide (CTX) level of 0.23 ng/mL, vitamin D, 23.42 ng/mL, and osteocalcin, 4.92 ng/mL. Osteonecrosis occurred after an average of 51.03 (± 39.75) months following implant placement. Radiological evaluation revealed obvious sequestration in the implant-absent group, and the formation of a unit sequestration with an implant fixture (en bloc) was observed in the implant-present group. The patients underwent surgical treatment of sequestrectomy and explantation. Conclusion: Implant placement, especially loading, may be considered a potential risk factor for the development of osteonecrosis in patients undergoing antiresorptive treatment.

I would be happy to provide you with some general reviews on writing a position paper on MRONJ. Firstly, it's important to research the topic thoroughly to ensure you have a comprehensive understanding of MRONJ, including its causes, risk factors, s...

The aim of this study was to evaluate the effects of a partial glossectomy on volumetric changes of pharyngeal airway space (PAS) in patients with mandibular setback surgery. Overall, 25 patients showing clinical features related to macroglossia treated with mandibular setback surgery were included in this retrospective study. Subjects were divided into two groups: the control group (G1, n = 13, with BSSRO) and the study group (G2, n = 12, with both BSSRO and partial glossectomy). The PAS volume of both groups was measured by the OnDemand 3D program on CBCT taken shortly before operation (T0), 3 months post-operative (T1), and 6 months post-operative (T2). A paired t-test and repeated analysis of variance (ANOVA) were used for statistical correlation. Total PAS and hypopharyngeal airway space were increased after operation in Group 2 compared to Group 1 (p < 0.05), while oropharyngeal airway space showed no significant statistical difference with the tendency of increasing. The combination of partial glossectomy and BSSRO surgical techniques had a significant effect on increasing the hypopharyngeal and total airway space in class III malocclusion patients (p < 0.05).