Antiresorptive drug-related osteonecrosis of the jaws, literature review and 5 years of experience

PURPOSE

Bisphosphonate drug therapy provides benefits in the case of osteoporosis and carcinomas metastasizing to the bones, but it exposes patients to important side effects. The aim of this study was to investigate the incidence and the appropriate surgical treatment of bone lesions and fractures due to antiresorptive drug-related osteonecrosis of the jaws (ARONJ).

METHODS

Patients presenting with osteonecrosis lesions of the jaw, who were referred to the Maxillo-Facial unit of the University of L'Aquila, were considered for inclusion. Grade of the lesion and treatment choice was recorded for each patient. Descriptive statistics were calculated and the data were analysed with Chi-squared tests. A representative case of a fracture reduction with a supra-periostal approach is reported.

RESULTS

Among the 165 patients with ARONJ lesions, 112 were female and 53 were male. In total, 115 patients received intra-venous bisphosphonate therapy and 50 received oral bisphosphonate therapy. Five stage 2 lesions, three stage 2 lesions and two stage 3 lesions were not a consequence of dental procedures. Eighteen surgical bone excisions were performed and four pathological fractures were reduced. In one case (the reported one), the combined use of platelet-rich plasma and the supra-periostal approach leads to a successful 1-year follow-up.

CONCLUSIONS

ARONJ lesions are a type of pathological bone disease affecting the jawbones. The pathology pathway remains a controversial and frequently discussed topic. A surgically conservative strategy seems to be the best way to assure a comfortable quality of life to those patients negatively affected by this condition.

Scanning electron microscopy and microbiological approaches for the evaluation of salivary microorganisms behaviour on anatase titanium surfaces: In vitro study

Implantology research framed the implant surface as a key element for a good and sustainable osseointegration of an implant fixture. The aim of this study was to analyze the antibacterial properties of anatase-coated titanium healing screws through microbiological and scanning electron microscopy. The comparison of the bacterial colonies growth between the anatase-coated titanium healing screws and non-coated titanium healing screws showed comparable antibacterial properties, without significant statistical differences. The scanning electron microscopy observations confirmed the microbiological study. These data, also considering previous reports on the positive effects on osteoblasts genetic expressions, might suggest a use of the anatase-coated titanium healing screws to preserve the tissues surrounding implants from microbial attacks.

The process of mineralisation in the development of human tooth

Tooth development and mineralisation are processes that derive from different tissues interactions, in particular ectodermal and mesenchymal layers. These interactions are responsible for the formation of unique structures with a particular chemical composition. Despite differences, mineralised tissues are similar and they derive by highly concerted extracellular processes that involve matrix proteins, proteases, and mineral ion fluxes that collectively regulate the nucleation, growth and organisation of forming mineral crystals. This review aims at explaining mineralisation, its stages and when damage occurs and alters the hard tissues structure.

A new computational method for automatic dental measurement: The case of maxillary central incisor

This paper proposes a new automatic approach to determine the accurate measure of human teeth. The aim of the proposed computer based method is to reduce inaccuracy of measurement with respect to traditional approaches. Starting from a 3D model of the teeth which is obtained from 3D scanning, the method algorithmically evaluates the most important dimensional features detectable in central incisors. For this purpose, specific rules are put forward and implemented in original software with a view to identifying repere points, from which to detect dimensional features both unambiguously and accurately. The automatic method which is proposed here is verified by means of the analysis of real teeth and is then compared with the current state-of-the-art methods for teeth measurement.

The ischiatic region: normal and MRI anatomy

AIM

The aim of this study was to describe the anatomy correlated to the normal magnetic resonance imaging (MRI) images of the proximal thigh region and the ischial tuberosity.

METHODS

MRI coronal and axial sequences were obtained from 20 asymptomatic volunteers (10 male and 10 female) aged 20 to 38 years (mean age: 28 years), and then they were compared with 2 anatomical dissections and 7 cryosections of 6 cadaver thighs.

RESULTS

The anatomical specimens were directly correlated with MRI scans. From the comparison it could be seen how the axial MRI sequences well outlined the sciatic nerve, usually observed oval in shape with moderate signal intensity, and thus easily detectable from other surrounding organs. Other structures were also identified by axial images: the ischial tuberosity, the proximal origin of the hamstring muscles arising from the ischium and the related bursae, the gluteus maximus and its bursa, the quadratus femoris and its inconstant bursa, a triangular adipose body and vessels. Coronal scans also showed well the hamstring muscles, both in length and thickness.

CONCLUSIONS

Both MRI images and cadaver dissections showed the ischial tuberosity as an interesting intersection area that could be delimited as follows: on the dorsal border the gluteus maximus and its bursa, on the dorso-medial side the hamstring muscle origin, and on the antero-lateral side the quadratus femoris muscle with its inconstant bursa and the ischial tuberosity. These anatomical and MRI descriptions are very useful to give a contribution to the right explanation of sciatic symptoms caused by those sports specifically overloading the hamstring muscles. Frequently, in fact, in these athletes a sciatic syndrome arise drawing the physician's attention to the lumbosacral joint or to the sciatic nerve course near the piriformis muscle. Another very important site where the sciatic symptoms can rise, indeed, could also be found in the hamstring muscle region, where the nerve run under the gluteus maximus beside the ischiatic bone. Athletes who manifest notorious muscle overload in this anatomical region usually show sciatic pain symptoms that are not to be related with pathologies of the lumbosacral junction nor to relationships of the sciatic nerve with the piriformis muscle but rather to relationships that this nerve acquires with either gluteal muscles as well as with muscles of the underneath ischiatic region.

Smad3-null mice lack interstitial cells of Cajal in the colonic wall

BACKGROUND

Transforming growth factor-beta (TGF-beta)/Smad's signalling pathway plays a pivotal role in organogenesis, oncogenesis, inflammation, repair and fibrosis. The aim of this study was to evaluate the morphology of muscle layers and the density and distribution of interstitial cells of Cajal (ICC) in the colon of Smad3 knockout mice.

MATERIALS AND METHODS

Eighteen Smad3 wild-type mice and 12 null mice were sacrificed at age 4 months and the colons were collected for histology (Haematoxilin-Eosin, Masson thrichrome and Gomori silver staining), morphometry and immunohistochemistry (IHC) analysis. For IHC we used the c-Kit, alpha-smooth muscle actine (alpha-SMA), vimentin, desmin and neuronal cocktail (S-100, NSE, neurofilament 200) antibodies.

RESULTS

When sacrificed, 40% of the null mice showed different degrees of colon dilatation when compared with the wild-type. Histological and morphometric evaluation revealed a significant reduction in muscle layer thickness of the colon in all the null mice when compared with the wild-type. Immunohistochemistry evaluation showed a marked reduction, or even absence, of c-Kit immunoreactivity, which identifies ICC, in the colon of all the null mice, compared with the wild-type.

CONCLUSIONS

Smad3 null mice showed a marked reduction, or even absence, of ICC in the colon together with a concomitant reduction of intestinal smooth muscle layer thickness. This data could account for the colonic dilation observed in approximately 40% of the Smad3 null mice. Alteration of intestinal smooth muscle layers and ICC could also be involved in the resistance of the Smad3 null mice to develop colonic fibrosis.

[In vitro growth of skin fibroblasts of patients with atypical ductal hyperplasia of the breast: effects of 17 beta-estradiol]

In this work we investigated the growth of skin fibroblasts, in vitro cultured, drawn from women suffering Atypical Ductal Hyperplasia (I.D.A.) and from healthy women (controls). Whether in basic conditions or after administration of 17, beta-estradiol, in single of repeated dose, cellular growth was valued. The results obtained show that skin fibroblasts drawn from women suffering I.D.A. treated with 100 microliters/ml of estradiol (effective dose), have an increase of the growth. Moreover the increase of the growth seems to be bequest to "effective dose" but not to the number of administrations.

[Different proliferative capacity of human fibroblasts after 17 beta-estradiol administration]

In this study the authors examined the influence of 71, beta-estradiol on cutaneous fibroblasts taken off either from healthy patients with no family history for cancer, or from patients with breast cancer. Fibroblasts were taken from the subcutaneous tissue of the mammary gland by a biopsy carried out in each patients on the same quadrant of the granular surface. Soon after biopsy, the tissue fragments have been washed, dished ed incubated in RPMI at 37 degrees C in a humidified atmosphere of 5% CO2 and 95% air. The action of the hormone was evaluated by the means of cells count for field, in 20 fields in each dish with an inverted microscope (20 x magnification). The results demonstrated that cutaneous fibroblasts from patients with breast cancer show higher values of cell density than those from healthy one. This phenomenon is present both in basal conditions and after hormonal treatment. Two different dosages were used, but only the highest (100 microliters/ml of 17, beta-estradiol) was responsible for an increase of the cell density in all of the treated patients as compared the control groups. These data suggests the presence of a threshold dosage for the estrogens. Below such a dosage there are no effects on cellular growth.

Effects of low power 904 nm radiation on rat fibroblasts explanted and in vitro cultured

In this study, 904 nm radiation was used on rat fibroblasts, explanted and in vitro cultured, to verify the action of various factors on cell growth. Parameters which can modify the behaviour of cultured cells, including the pulse repetition rate and the intensity of the radiation, the distance between the source and the irradiated dishes, the daily duration of exposure and the length of treatment, were studied. The most effective values of the intensity and pulse repetition rate which stimulate cell growth were 3 x 10(-4) W m-2 and 1.6 kHz respectively; the best stimulation was obtained at a sample-source distance of 0.1 m. The duration of daily exposure had no significant effect, whereas the best stimulus of cell growth was obtained by extending the treatment to 12 days.

[Action of infrared laser on in vitro culture of fibroblasts: effects of the exposure time parameter]

We have evaluated the effects of low dose laser radiation on in vitro grown fibroblasts. We have observed no differences between treated plates and no treated plates after modification of exposure time.

[Effects of estradiol on in vitro cultures of human fibroblasts]

This paper assesses the effect of estradiol on the in vitro growth of fibroblast taken from human breast skin. It was observed that estrogens stimulate the proliferation of phenotypically adult fibroblasts; that there is a threshold increase of hormonal concentration which can trigger off this process; and that the size of the single dose is more important than the number of doses of hormone received.

[Application of infrared lasers on in vitro culture of fibroblasts: effects of the duration of treatment parameter]

We have evaluated the effects of low dose laser radiation on in vitro grown fibroblasts. We have seen after twelve days of plates exposure at low doses of laser radiation a remarkable increment of cellular density. We conclude that the stimulating action on cellular mitosis are directly correlated at the length of the sample treatment with I.R. laser.

Effectes of Low-Power I.R. Laser on Cultured Fibroblasts

The Infrared laser effects (λ = 904 nm) on in vitro cultured fibroblasts were tested. It was found that, changing the frequency and the intensity of radiation, it was possible to have opposite results. At low frequency (0,4 KHz) the cellular growth was inhibited; at 1,6 KHz frequency and 3W/cm2/min intensity the proliferation was increased; at higher frequencies the cellular differentiation was stimulated and an increased fibrosynthetic activity was found.

[Effect of calcium ionophore (A23187) on the production of thromboxane B2 in human polymorphonuclear cells in vitro]

Polymorphonuclear leukocytes (PMN) are capable to produce prostaglandins in vivo and in vitro, and thromboxane B2 (TXB2) which is the main metabolite of arachidonic acid in these cells. In the present work we studied, with radioimmunoassay method, the effect of calcium ionophore A23187 on PMN. This substance is capable to stimulate TXB2 release by PMN and its effect is inhibited by indomethacin.

[Action of some salicylates associated with other non-steroidal anti-inflammatory drugs on the release of prostacyclin from the gastric mucosa of the rat]

In the present work it has been tested if associations of indomethacin or aspirin with diflunisal or sodium salicylate block PGI2 release from gastric mucosa less than the administration of the compounds alone. PGI2 production was determined on aliquots of incubated mucosal strips, tested for ADP-induced aggregation of human platelet rich plasma. The obtained data indicate that PGI2 generation found in rats treated with indomethacin or aspirin associated with diflunisal or sodium salicylate was higher than that found in rats treated with indomethacin or aspirin alone. This effect may be likely explained by competition between salicylates and other non steroidal anti-inflammatory drugs for binding sites on PG-synthetase and plasma proteins.

[Effect of the association of caffeine-indomethacin on the production of prostacyclin in the rat stomach]

Prostaglandin (PG) E1, PGD2 and the unstable PGI2 are inhibitors of human platelet aggregation and increase the concentration on cAMP in human platelets, presumably by stimulation of the adenylate cyclase. Methylxanthines exert their antiaggregatory effect by inhibiting the platelet cAMP phosphodiesterase. We examined whether caffeine-indomethacin is able to block PGI2 release from gastric mucosa less than the administration of indomethacin alone. PGI2 production was determined on aliquots of incubated mucosal strips, tested for ADP-induced aggregation of human platelet rich plasma. The obtained data indicate that the PGI2 production found in rats treated with the association was higher than that observed in rats treated with indomethacin alone. The present preliminary findings suggest that caffeine when given together with indomethacin reduces the indomethacin-induced inhibition of PGI2 release from the gastric mucosa.

[Comparison of the growth of subjects from 6 to 12 years of age in the province of Naples and the province of L'Aquila]

The authors studied weight, height and thoracic circumference of 419 children 6 to 12 years old who were born in Naples county. They transcribed data on special anthropometrical forms and computed arithmetical mean and standard deviation for every series of biometrical values. Then they plotted the graphs of growth-state obtaining so the growth curves. Comparing these graphs with those obtained by the same methods in children from L'Aquila of the same age, the following conclusions can be drawn: 1) Neapolitan children have a slight more increased growth with respect to children born in L'Aquila; 2) the growth of both groups is similar since the shape of their growth curves is overlapping.

[Phospholipid fractions of the hypothalamus and liver morphology and function in the rat]

The Authors studied the effects induced by long administration of hypothalamic phospholipids on the rat liver. They showed that the most important histologic changes can be observed in the liver of animals who received the longest treatment. Such changes consist of significant infiltration of lymphocytes and red blood cells that have overflowed into the pericentrolobular space. This picture of a not-too-serious blood stasis could justify the alterations of the epatocytes contemporarily observed.

["Granuloma pouch" reduction after treatment with indomethacin and diflunisal and collateral effects of these drugs on gastric mucosa]

In the present work it was determined the ability of non-steroidal anti-inflammatory drugs (Diflunisal and Indomethacin) to inhibit formation of "granuloma pouch" exudate induced in rats. This study shows that the combined administration of Diflunisal and Indomethacin exerts similar anti-inflammatory activity as the single drugs. There does not seem to be additive anti-inflammatory effects of the drugs in combination but, if anything, a weak antagonism. The association of the two compounds produces a reduced harmful effect on the gastric mucus.

[Reduced ulcerogenic effect after treatment with indomethacin combined with diflunisal in rats]

In this work, the authors are concerned with the study of the effects of non-steroidal antiinflammatory drugs in the gastric mucosa of the rat after induced chronic inflammation with potassium permanganate.

[Calcium content of KMnO4 induced granuloma after treatment with 2 combined non-steroidal drugs: indomethacin plus diflunisal]

In this work the authors are concerned with the study of different amounts of calcium in granulomas induced by permanganate and treated with Indomethacin only or with Indomethacin plus Diflunisal. Less calcium was found in granulomas of animals treated with Indomethacin plus Diflunisal.

Calcium content of experimental granuloma as determined by X-ray fluorescence. Influence of non-steroid antiinflammatory drugs

The deposit of calcium in experimental granulomas as determined by X-ray fluorescence is notably decreased by orally given indomethacin and diflunisal.