[EP-26] A case of using predictively designed digital obturator for medication-related osteonecrosis of the jaw
[Abstract]
[Introduction]
It is widely known that medication-related osteonecrosis of the jaw (MRONJ) occurs in cancer patients with bone metastases and osteoporosis. Risk factors associated with the development of MRONJ include invasive dental treatment such as tooth extraction, and periodontal and periapical diseases. Even if a treatment plan is chosen for maxillary MRONJ that waits for spontaneous loss of necrotic bone, the patient may suddenly suffer a maxillary bone loss, resulting in significant impairment of speech and swallowing functions. Written informed consent for this clinical report had been obtained from the patient.
[Case Summary and Treatment Details]
A 72-year-old male patient first visited the Tokyo Medical and Dental University Maxillofacial Clinic in 2022 by referral from the department of oral and maxillofacial surgery. He has a history of rheumatoid arthritis and prostate cancer and has used bone resorption inhibitors. His family dentist treated him with implants in 2015, and he developed the MRONJ in the mandible and maxilla since 2016. In our clinic contact-free morphological scan was performed with an intraoral scanner in the presence of unstable large bone exposure. The obturator was fabricated with the help of CAD-CAM, before massive bone loss occurred. As soon as a major bone defect occurred, a predictively designed digital obturator was placed, allowing immediate functional recovery.
[Progress and Discussion]
Using digital technology, it was possible to fabricate immediate obturator for MRONJ safely in one visit. Digital technology makes it possible to predict massive bone loss and fabricate maxillary dentures before undesirable accidents occur.
[References]
1, Ruggiero SL, Dodson TB, Aghaloo T, et al. American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. J Oral Maxillofac Surg. 2022 ;80.
2, Murase M, Pradhan N, Sumita YI, et al. Use of digital technology in prosthesis fabrication for an elderly patient with a maxillectomy and severe trismus: A clinical report. J Prosthet Dent. Published online June 15, 2023.
3, Towithelertkul C, Murase M, Tamura S, et al. Digital design of open hollow obturator framework using existing dentures: A dental technique. J Prosthet Dent. Published online 13, 2024.
[Introduction]
It is widely known that medication-related osteonecrosis of the jaw (MRONJ) occurs in cancer patients with bone metastases and osteoporosis. Risk factors associated with the development of MRONJ include invasive dental treatment such as tooth extraction, and periodontal and periapical diseases. Even if a treatment plan is chosen for maxillary MRONJ that waits for spontaneous loss of necrotic bone, the patient may suddenly suffer a maxillary bone loss, resulting in significant impairment of speech and swallowing functions. Written informed consent for this clinical report had been obtained from the patient.
[Case Summary and Treatment Details]
A 72-year-old male patient first visited the Tokyo Medical and Dental University Maxillofacial Clinic in 2022 by referral from the department of oral and maxillofacial surgery. He has a history of rheumatoid arthritis and prostate cancer and has used bone resorption inhibitors. His family dentist treated him with implants in 2015, and he developed the MRONJ in the mandible and maxilla since 2016. In our clinic contact-free morphological scan was performed with an intraoral scanner in the presence of unstable large bone exposure. The obturator was fabricated with the help of CAD-CAM, before massive bone loss occurred. As soon as a major bone defect occurred, a predictively designed digital obturator was placed, allowing immediate functional recovery.
[Progress and Discussion]
Using digital technology, it was possible to fabricate immediate obturator for MRONJ safely in one visit. Digital technology makes it possible to predict massive bone loss and fabricate maxillary dentures before undesirable accidents occur.
[References]
1, Ruggiero SL, Dodson TB, Aghaloo T, et al. American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. J Oral Maxillofac Surg. 2022 ;80.
2, Murase M, Pradhan N, Sumita YI, et al. Use of digital technology in prosthesis fabrication for an elderly patient with a maxillectomy and severe trismus: A clinical report. J Prosthet Dent. Published online June 15, 2023.
3, Towithelertkul C, Murase M, Tamura S, et al. Digital design of open hollow obturator framework using existing dentures: A dental technique. J Prosthet Dent. Published online 13, 2024.