nach oben

Erschienen in:

13.02.2020 | Review Article

Laser surgery in management of medication-related osteonecrosis of the jaws: a meta-analysis

verfasst von: Gustavo Antonio Correa Momesso, Cleidiel Aparecido Araújo Lemos, Joel Ferreira Santiago-Júnior, Leonardo Perez Faverani, Eduardo Piza Pellizzer

Erschienen in: Oral and Maxillofacial Surgery | Ausgabe 2/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The aim of this study was to perform a systematic review and meta-analysis to evaluate the efficacy of laser therapy on medication-related osteonecrosis of the jaw (MRONJ) treatment.

Methods

This study followed PRISMA standards, and an electronic search was performed on the PubMed/MEDLINE, Scopus, and Cochrane databases. Eighty-nine articles were found. After reading the manuscripts, 15 articles remained for the review. Three of them were selected for meta-analysis.

Results

Female gender was predominant (72.5%), and mean age was 66.5 years. Follow-up varied between 3 and 80 months, and the most used bisphosphonate was zoledronic acid (71.6%). Stage II of MRONJ was the most prevalent (68.9%), and the mandible was the most affected site (64.5%). Qualitative data showed that treatment with laser surgery (Er:YAG) was most effective regarding complete healing of the lesion (90%) compared with other treatments. Meta-analysis data showed that low-level laser therapy (LLLT) was more effective than medical treatment (P = 0.006), and surgical treatment was more effective than LLLT (P = 0.008).

Conclusion

Laser surgery was significantly superior to LLLT (p < 0.00001). Therefore, laser surgical therapy seems to be a great management strategy for MRONJ treatment from stage II. LLLT was shown to improve conservative management in earlier MRONJ stages.

Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O'Ryan F (2014) American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. J Oral Maxillofac Surg 72(10):1938–1956. https://doi.org/10.1016/j.joms.2014.04.031 CrossRefPubMed

Filleul O, Crompot E, Saussez S (2010) Bisphosphonate-induced osteonecrosis of the jaw: a review of 2,400 patient cases. J Cancer Res Clin Oncol 136(8):1117–1124CrossRef

Ruggiero SL, Drew SJ (2007) Osteonecrosis of the jaws and bisphosphonate therapy. J Dent Res 86(11):1013–1021CrossRef

Ruggiero SL (2007) Guidelines for the diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Clin Cases Miner Bone Metab 4(1):37–42PubMedPubMedCentral

Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B (2009) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws—2009 update. J Oral Maxillofac Surg 67(5):2–12CrossRef

Ruggiero SL (2013) An office-based approach to the diagnosis and management of osteonecrosis. Atlas Oral Maxillofac Surg Clin North Am 21(2):167–173CrossRef

Mester E, Spiry T, Szende B, Tota JG (1971) Effect of laser rays on wound healing. Am J Surg 122(4):532–535CrossRef

Gál P, Vidinský B, Toporcer T, Mokrý M, Mozes S, Longauer F, Sabo J (2006) Histological assessment of the effect of laser irradiation on skin wound healing in rats. Photomed Laser Surg 24(4):480–488. https://doi.org/10.1089/pho.2006.24.480 CrossRefPubMed

Gál P, Mokrý M, Vidinský B, Kilík R, Depta F, Harakalová M, Longauer F, Mozes S, Sabo J (2009) Effect of equal daily doses achieved by different power densities of low-level laser therapy at 635 nm on open skin wound healing in normal and corticosteroid-treated rats. Lasers Med Sci 24(4):539–547. https://doi.org/10.1007/s10103-008-0604-9 CrossRefPubMed

10.

Ozcelik O, Cenk Haytac M, Kunin A, Seydaoglu G (2008) Improved wound healing by low-level laser irradiation after gingivectomy operations: a controlled clinical pilot study. J Clin Periodontol 35(3):250–254. https://doi.org/10.1111/j.1600-051X.2007.01194.x CrossRefPubMed

11.

Amorim JC, de Sousa GR, de Barros SL, Prates RA, Pinotti M, Ribeiro MS (2006) Clinical study of the gingiva healing after gingivectomy and low-level laser therapy. Photomed Laser Surg 24(5):588–594. https://doi.org/10.1089/pho.2006.24.588 CrossRefPubMed

12.

Markovic A, Todorovic L (2007) Effectiveness of dexamethasone and low-power laser in minimizing oedema after third molar surgery: a clinical trial. Int J Oral Maxillofac Surg 36(3):226–229. https://doi.org/10.1016/j.ijom.2006.10.006 CrossRefPubMed

13.

Antunes HS, de Azevedo AM, da Silva Bouzas LF, Adão CA, Pinheiro CT, Mayhe R, Pinheiro LH, Azevedo R, D'Aiuto de Matos V, Rodrigues PC, Small IA, Zangaro RA, Ferreira CG (2007) Low-power laser in the prevention of induced oral mucositis in bone marrow transplantation patients: a randomized trial. Blood 109(5):2250–2255. https://doi.org/10.1182/blood-2006-07-035022 CrossRefPubMed

14.

Vescovi P, Merigo E, Manfredi M, Meleti M, Fornaini C, Bonanini M, Rocca JP, Nammour S (2008) Nd:YAG laser biostimulation in the treatment of bisphosphonate-associated osteonecrosis of the jaw: clinical experience in 28 cases. Photomed Laser Surg 26(1):37–46. https://doi.org/10.1089/pho.2007.2181 CrossRefPubMed

15.

Hale GM, Querry MR (1973) Optical constants of water in the 200-nm to 200-microm wavelength region. Appl Opt 12(3):555–563CrossRef

16.

Sasaki KM, Aoki A, Ichinose S, Yoshino T, Yamada S, Ishikawa I (2002) Scanning electron microscopy and Fourier transformed infrared spectroscopy analysis of bone removal using Er:YAG and CO2 lasers. J Periodontol 73(6):643–652. https://doi.org/10.1902/jop.2002.73.6.643 CrossRefPubMed

17.

Sasaki KM, Aoki A, Ichinose S, Ishikawa I (2002) Ultrastructural analysis of bone tissue irradiated by Er:YAG laser. Lasers Surg Med 31(5):322–332. https://doi.org/10.1002/lsm.10110 CrossRefPubMed

18.

Lewandrowski KU, Lorente C, Schomacker KT, Flotte TJ, Wilkes JW, Deutsch TF (1996) Use of the Er:YAG laser for improved plating in maxillofacial surgery: comparison of bone healing in laser and drill osteotomies. Lasers Surg Med 19(1):40–45. https://doi.org/10.1002/(SICI)1096-9101(1996)19:1<40::AID-LSM6>3.0.CO;2-Q CrossRefPubMed

19.

Nelson JS, Orenstein A, Liaw LH, Berns MW (1989) Mid-infrared erbium: YAG laser ablation of bone: the effect of laser osteotomy on bone healing. Lasers Surg Med 9(4):362–374CrossRef

20.

Pourzarandian A, Watanabe H, Aoki A, Ichinose S, Sasaki KM, Nitta H, Ishikawa I (2004) Histological and TEM examination of early stages of bone healing after Er:YAG laser irradiation. Photomed Laser Surg 22(4):342–350. https://doi.org/10.1089/pho.2004.22.342 CrossRefPubMed

21.

Coleman K, Norris S, Weston A, Grimmer-Sommers K, Hillier S, Merlin T (2015) NHMRC additional levels of evidence and grades for recommendations for developers of guidelines

22.

Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. https://doi.org/10.1002/sim.1186 CrossRefPubMed

23.

Atieh MA, Ibrahim HM, Atieh AH (2010) Platform switching for marginal bone preservation around dental implants: a systematic review and meta-analysis. J Periodontol 81(10):1350–1366. https://doi.org/10.1902/jop.2010.100232 CrossRefPubMed

24.

Annibali S, Bignozzi I, Cristalli MP, Graziani F, La Monaca G, Polimeni A (2012) Peri-implant marginal bone level: a systematic review and meta-analysis of studies comparing platform switching versus conventionally restored implants. J Clin Periodontol 39(11):1097–1113. https://doi.org/10.1111/j.1600-051X.2012.01930.x CrossRefPubMed

25.

Angiero F, Sannino C, Borloni R, Crippa R, Benedicenti S, Romanos GE (2009) Osteonecrosis of the jaws caused by bisphosphonates: evaluation of a new therapeutic approach using the Er:YAG laser. Lasers Med Sci 24(6):849–856. https://doi.org/10.1007/s10103-009-0654-7 CrossRefPubMed

26.

Altay MA, Tasar F, Tosun E, Kan B (2014) Low-level laser therapy supported surgical treatment of bisphosphonate related osteonecrosis of jaws: a retrospective analysis of 11 cases. Photomed Laser Surg 32(8):468–475. https://doi.org/10.1089/pho.2014.3742 CrossRefPubMed

27.

Manfredi M, Merigo E, Guidotti R, Meleti M, Vescovi P (2011) Bisphosphonate-related osteonecrosis of the jaws: a case series of 25 patients affected by osteoporosis. Int J Oral Maxillofac Surg 40(3):277–284. https://doi.org/10.1016/j.ijom.2010.11.002 CrossRefPubMed

28.

Martins MA, Martins MD, Lascala CA, Curi MM, Migliorati CA, Tenis CA, Marques MM (2012) Association of laser phototherapy with PRP improves healing of bisphosphonate-related osteonecrosis of the jaws in cancer patients: a preliminary study. Oral Oncol 48(1):79–84. https://doi.org/10.1016/j.oraloncology.2011.08.010 CrossRefPubMed

29.

Scoletta M, Arduino PG, Reggio L, Dalmasso P, Mozzati M (2010) Effect of low-level laser irradiation on bisphosphonate-induced osteonecrosis of the jaws: preliminary results of a prospective study. Photomed Laser Surg 28(2):179–184. https://doi.org/10.1089/pho.2009.2501 CrossRefPubMed

30.

Stübinger S, Dissmann JP, Pinho NC, Saldamli B, Seitz O, Sader R (2009) A preliminary report about treatment of bisphosphonate related osteonecrosis of the jaw with Er:YAG laser ablation. Lasers Surg Med 41(1):26–30. https://doi.org/10.1002/lsm.20730 CrossRefPubMed

31.

Vescovi P, Merigo E, Meleti M, Manfredi M (2006) Bisphosphonate-associated osteonecrosis (BON) of the jaws: a possible treatment? J Oral Maxillofac Surg 64(9):1460–1462. https://doi.org/10.1016/j.joms.2006.05.042 CrossRefPubMed

32.

Vescovi P, Merigo E, Meleti M, Fornaini C, Nammour S, Manfredi M (2007) Nd:YAG laser biostimulation of bisphosphonate-associated necrosis of the jawbone with and without surgical treatment. Br J Oral Maxillofac Surg 45(8):628–632. https://doi.org/10.1016/j.bjoms.2007.03.016 CrossRefPubMed

33.

Vescovi P, Manfredi M, Merigo E, Meleti M, Fornaini C, Rocca JP, Nammour S (2010) Surgical approach with Er:YAG laser on osteonecrosis of the jaws (ONJ) in patients under bisphosphonate therapy (BPT). Lasers Med Sci 25(1):101–113. https://doi.org/10.1007/s10103-009-0687-y CrossRefPubMed

34.

Vescovi P, Manfredi M, Merigo E, Guidotti R, Meleti M, Pedrazzi G, Fornaini C, Bonanini M, Ferri T, Nammour S (2012) Early surgical laser-assisted management of bisphosphonate-related osteonecrosis of the jaws (BRONJ): a retrospective analysis of 101 treated sites with long-term follow-up. Photomed Laser Surg 30(1):5–13. https://doi.org/10.1089/pho.2010.2955 CrossRefPubMed

35.

Vescovi P, Merigo E, Meleti M, Manfredi M, Guidotti R, Nammour S (2012) Bisphosphonates-related osteonecrosis of the jaws: a concise review of the literature and a report of a single-centre experience with 151 patients. J Oral Pathol Med 41(3):214–221. https://doi.org/10.1111/j.1600-0714.2011.01091.x CrossRefPubMed

36.

Vescovi P, Merigo E, Meleti M, Manfredi M, Fornaini C, Nammour S (2012) Surgical approach and laser applications in BRONJ osteoporotic and cancer patients. J Osteoporos 2012:585434. https://doi.org/10.1155/2012/585434 CrossRefPubMedPubMedCentral

37.

Favia G, Tempesta A, Limongelli L, Crincoli V, Maiorano E (2018) Medication-related osteonecrosis of the jaw: surgical or non-surgical treatment? Oral Dis 24(1–2):238–242. https://doi.org/10.1111/odi.12764 CrossRefPubMed

38.

Atalay B, Yalcin S, Emes Y, Aktas I, Aybar B, Issever H, Mandel NM, Cetin O, Oncu B (2011) Bisphosphonate-related osteonecrosis: laser-assisted surgical treatment or conventional surgery? Lasers Med Sci 26(6):815–823. https://doi.org/10.1007/s10103-011-0974-2 CrossRefPubMed

39.

Fedele S, Porter SR, D'Aiuto F, Aljohani S, Vescovi P, Manfredi M, Arduino PG, Broccoletti R, Musciotto A, Di Fede O (2010) Nonexposed variant of bisphosphonate-associated osteonecrosis of the jaw: a case series. Am J Med 123(11):1060–1064CrossRef

40.

Ruggiero SL (2013) Emerging concepts in the management and treatment of osteonecrosis of the jaw. Oral Maxillofac Surg Clin North Am 25(1):11–20CrossRef

41.

Freiberger JJ, Padilla-Burgos R, McGraw T, Suliman HB, Kraft KH, Stolp BW, Moon RE, Piantadosi CA (2012) What is the role of hyperbaric oxygen in the management of bisphosphonate-related osteonecrosis of the jaw: a randomized controlled trial of hyperbaric oxygen as an adjunct to surgery and antibiotics. J Oral Maxillofac Surg 70(7):1573–1583. https://doi.org/10.1016/j.joms.2012.04.001 CrossRefPubMed

42.

Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL (2004) Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 62(5):527–534CrossRef

43.

Madrid C, Bouferrache K, Abarca M, Jaques B, Broome M (2010) Bisphosphonate-related osteonecrosis of the jaws: how to manage cancer patients. Oral Oncol 46(6):468–470. https://doi.org/10.1016/j.oraloncology.2010.03.016 CrossRefPubMed

44.

Ferlito S, Puzzo S, Palermo F, Verzì P (2012) Treatment of bisphosphonate-related osteonecrosis of the jaws: presentation of a protocol and an observational longitudinal study of an Italian series of cases. Br J Oral Maxillofac Surg 50(5):425–429. https://doi.org/10.1016/j.bjoms.2011.08.004 CrossRefPubMed

45.

Saussez S, Javadian R, Hupin C, Magremanne M, Chantrain G, Loeb I, Decaestecker C (2009) Bisphosphonate-related osteonecrosis of the jaw and its associated risk factors: a Belgian case series. Laryngoscope 119(2):323–329. https://doi.org/10.1002/lary.20076 CrossRefPubMed

46.

Hayashida S, Soutome S, Yanamoto S, Fujita S, Hasegawa T, Komori T, Kojima Y, Miyamoto H, Shibuya Y, Ueda N, Kirita T, Nakahara H, Shinohara M, Umeda M (2017) Evaluation of the treatment strategies for medication-related osteonecrosis of the jaws (MRONJ) and the factors affecting treatment outcome: a multicenter retrospective study with propensity score matching analysis. J Bone Miner Res 32(10):2022–2029. https://doi.org/10.1002/jbmr.3191 CrossRefPubMed

47.

Marx RE, Cillo JE, Ulloa JJ (2007) Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg 65(12):2397–2410CrossRef

48.

Boonyapakorn T, Schirmer I, Reichart PA, Sturm I, Massenkeil G (2008) Bisphosphonate-induced osteonecrosis of the jaws: prospective study of 80 patients with multiple myeloma and other malignancies. Oral Oncol 44(9):857–869. https://doi.org/10.1016/j.oraloncology.2007.11.012 CrossRefPubMed

49.

Wutzl A, Biedermann E, Wanschitz F, Seemann R, Klug C, Baumann A, Watzinger F, Schicho K, Ewers R, Millesi G (2008) Treatment results of bisphosphonate-related osteonecrosis of the jaws. Head Neck 30(9):1224–1230. https://doi.org/10.1002/hed.20864 CrossRefPubMed

50.

Aoki A, Sasaki KM, Watanabe H, Ishikawa I (2004) Lasers in nonsurgical periodontal therapy. Periodontol 2000 36:59–97. https://doi.org/10.1111/j.1600-0757.2004.03679.x CrossRefPubMed

51.

Schwarz F, Aoki A, Becker J, Sculean A (2008) Laser application in non-surgical periodontal therapy: a systematic review. J Clin Periodontol 35(8 Suppl):29–44. https://doi.org/10.1111/j.1600-051X.2008.01259.x CrossRefPubMed

52.

Schwarz F, Bieling K, Bonsmann M, Latz T, Becker J (2006) Nonsurgical treatment of moderate and advanced periimplantitis lesions: a controlled clinical study. Clin Oral Investig 10(4):279–288. https://doi.org/10.1007/s00784-006-0070-3 CrossRefPubMed

53.

Stübinger S, von Rechenberg V, Zeilhofer HF, Sader R, Landes C (2007) Er:YAG laser osteotomy for removal of impacted teeth: clinical comparison of two techniques. Lasers Surg Med 39(7):583–588. https://doi.org/10.1002/lsm.20528 CrossRefPubMed

54.

Statkievicz C, Toro LF, de Mello-Neto JM, de Sá DP, Casatti CA, Issa JPM, Cintra LTA, de Almeida JM, Nagata MJH, Garcia VG, Theodoro LH, Ervolino E (2018) Photomodulation multiple sessions as a promising preventive therapy for medication-related osteonecrosis of the jaws after tooth extraction in rats. J Photochem Photobiol B 184:7–17. https://doi.org/10.1016/j.jphotobiol.2018.05.004 CrossRefPubMed

55.

Theodoro LH, Assem NZ, Longo M, Alves MLF, Duque C, Stipp RN, Vizoto NL, Garcia VG (2018) Treatment of periodontitis in smokers with multiple sessions of antimicrobial photodynamic therapy or systemic antibiotics: a randomized clinical trial. Photodiagn Photodyn Ther 22:217–222. https://doi.org/10.1016/j.pdpdt.2018.04.003 CrossRef

56.

Garcia VG, Gualberto EC, Ervolino E, Nagata MJH, de Almeida JM, Theodoro LH (2018) aPDT for periodontitis treatment in ovariectomized rats under systemic nicotine. Photodiagn Photodyn Ther 22:70–78. https://doi.org/10.1016/j.pdpdt.2018.02.017 CrossRef

Titel: Laser surgery in management of medication-related osteonecrosis of the jaws: a meta-analysis
verfasst von: Gustavo Antonio Correa Momesso
Cleidiel Aparecido Araújo Lemos
Joel Ferreira Santiago-Júnior
Leonardo Perez Faverani
Eduardo Piza Pellizzer
Publikationsdatum: 13.02.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Oral and Maxillofacial Surgery / Ausgabe 2/2020
Print ISSN: 1865-1550
Elektronische ISSN: 1865-1569
DOI: https://doi.org/10.1007/s10006-020-00831-0

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2020

A decade of reconstructive surgery: outcome and perspectives of free tissue transfer in the head and neck. Experience of a single center institution

Accuracy of orthopantomograms in the assessment of implant position following alloplastic temporomandibular joint replacement

Treatment of calcium pyrophosphate deposition in the temporomandibular joint with resection and simultaneous reconstruction using a custom joint prosthesis

Surgical osteoplasty and soft tissue excision as treatment for facial deformities in patients with renal osteodystrophy: three case reports

Optimising the management of concurrent symphyseal/parasymphyseal and bilateral extracapsular condylar fractures using three-dimensional printing

Full-staged digital and prosthetic guided protocol for the insertion of dental implants in autogenous free bone grafts after reconstruction of segmental mandibular defects

Update Chirurgie