RESUMEN
Background: The present study is aimed to compare the osteoblastic activity in periodontally accelerated osteogenic orthodontics (PAOO) with and without the platelet-rich fibrin (PRF) membrane by evaluating the gingival crevicular fluid (GCF), alkaline phosphate (ALP) levels and also to explore the efficiency of PRF membrane in terms of healing. Methods: A split-mouth randomized controlled trial, which comprised 16 sites, was randomly treated with PAOO + PRF membrane and PAOO alone. The primary outcome was to analyze the GCF ALP levels at baseline, 3rd, week, 5th week (2 weeks after surgery, 1 h before and after activation), 7th week (4 weeks after surgery), and 9th week (6 weeks after surgery). The clinical parameters (plaque index [PI], gingival index [GI], bleeding index [BI]) were assessed at baseline, 3rd week, 15th week, and 27th week. Healing index was recorded at 4th week (1 week after surgery), 5th week (2 weeks after surgery), and 7th week (4 weeks after surgery). Results: There was a statistically significant increase in GCF ALP levels (p < 0.05) in the test site (PAOO with PRF membrane) 2 weeks post-surgically compared to the control site. Improvement in the clinical measures (PI, GI, BI) was statistically significant at all time intervals. Adjunctive use of PRF resulted in statistically significant early healing in the first postoperative week compared to the control site (p < 0.05). Conclusions: Within the limitations of this split-mouth study, PRF membrane showed significant osteoblastic activity in the 5th week (2 weeks after PAOO) with the increased GCF ALP levels and accelerated healing in the 1st week after PAOO. They also maintained post-orthodontic stability until 18 months.
RESUMEN
BACKGROUND: An invasive dental procedure is considered one of the risk factors for osteonecrosis of the jaw, especially among patients on bisphosphonates. This study aimed to determine the awareness and perceptions of medical practitioners regarding bisphosphonate-related osteonecrosis of the jaw (BRONJ), and their attitude towards dental referrals of such patients. METHODS: This cross-sectional questionnaire-based study was conducted among medical practitioners in and around Mysore city, Karnataka, India, who commonly prescribe bisphosphonates. The sample included orthopaedic doctors, physicians, endocrinologists, and oncologists, divided based on the duration of practice and speciality. Data on the type of practice, awareness of BRONJ, referral to a dentist before/during therapy, and patient education about adverse effects, were collected and analyzed. A p-value ≤0.05 was considered statistically significant. RESULTS: Among 58 practitioners, 84.5% (49) were aware of the association between bisphosphonates and BRONJ, while 56.9% (33/58) believed dental procedure to be a risk factor, and 55.2% (32/58) did not recommend screening of the oral cavity by a dentist before initiation of bisphosphonate therapy. A majority (65.5%) of them educated their patients about adverse effects. Mean knowledge scores varied with specialization (post-graduation vs. super specialization = 1.43 vs. 2; p = 0.01) but not with the duration of practice (<= 10 years vs. >10 years= 1.57 vs. 1.4; p= 0.24). CONCLUSION: The practitioners in our study were oblivious to dental procedures' role in the osteonecrosis of the jaw, highlighting the need for continuing education programs regarding BRONJ for medical and dental professionals. Clinicians updated regarding evidence-based practices and working cooperatively in teams may reduce the incidence of medication-related osteonecrosis of the jaw.