Part of the book: Implant Dentistry
Part of the book: A Textbook of Advanced Oral and Maxillofacial Surgery
Osteonecrosis as term represents the death of bone tissue in the body and causes of necrosis can be different. Medication-related osteonecrosis of the jaws (MRONJ) is nowadays known as an inability of the alveolar bone to respond to a local trauma and it can result in severe local and systemic complications. In the etiology of medication-related osteonecrosis there are antiangiogenic and antiresorptive agents which have great effect on alveolar bone, producing an imbalance between resorption (osteoclastic activity) and deposition (osteoblastic activity). The exact mechanisms of development are not todays completely resolved. It is thought that it is a result from combination of medication interactions, microbiological contamination of the area and local tissue trauma. Typical signs and symptoms are painful mucosal lesions, swelling, exposed necrotic bone in the jaws, discomfort and dysesthesias. There is currently no gold standard or clearly defined treatment protocol for the disease itself. Process of treatment is demanding and main goal is to eliminate pain, control infection of soft and hard tissue and minimize progression of osteonecrosis. Besides the conventional surgical treatment, photodynamic therapy can be a viable supportive tool of initial and advanced stages of osteonecrosis and may contribute to improvements of patient′s quality of life.
Part of the book: Photodynamic Therapy
Ameloblastoma is a benign odontogenic tumor of epithelial origin with locally aggressive behavior. It affects a broad age range of patients and it is most commonly found in the mandible, especially posterior area. The majority of ameloblastomas are conventional (multicystic), which are more difficult to eradicate than the unicystic or peripheral types. Although most of ameloblastoma cases can be treated predictably with radical surgical treatment, the management of recurrent and metastasizing ameloblastomas remains a major challenge. Surgical treatment is standard, but the extent of resection is controversial. Radical resection with segmental and marginal mandibulectomy or curettage and enucleation with better quality of life, but with higher recurrence rate. Besides the conventional surgical treatment, novel therapy options like neoadjuvant molecular targeted therapy and decompression in young patients could make a significant improvement in the management of the disease. The aim of this chapter was to determine the present and future concepts of treatment and discuss significant factors responsible for recurrence.
Part of the book: Bone Tumours