Ahmed Ghoneima

• BDS, MSc, MSD, PhD
• Managing Director at Indiana University – Purdue University Indianapolis

Background Desirable molar distalization by bodily movement is challenging and can be difficult to achieve. This study investigated changes in molar angulation (mesiodistal tipping), molar inclination (buccolingual torque) and rotation during distalization using clear aligner therapy (CAT). Materials and methods This retrospective study included 3...

This study aimed to report forces and moments delivered by 3D-printed aligners. Tera Harz TC-85 resin and Zendura FLX (ZF) thermoformed sheets (0.76 mm) were used. Rectangular strip specimens (50 × 10 × 0.6 mm) were produced for a three-point bending test (3PB) at different temperatures. Full anatomical aligners were produced for 3D force measureme...

Objectives To use the finite element method (FEM) to investigate the effect of various attachment configurations and trimming line designs of orthodontic aligners on their biomechanical performance. Method A 3D upper jaw model was imported into 3D design software. The upper right central incisor tooth (Tooth 11) was made mobile, and its periodonta...

Objective The purpose of this retrospective study was to assess the airway volume changes associated with the use of Frankel appliance (FR II) in Class II malocclusion patients using three-dimensional cone beam computed tomography (3D CBCT) imaging. Materials and methods The sample consisted of 31 Class II malocclusion patients (mean age 9.24 ± 1....

In the present study, Thirty-six Class patients II (A condition in which the upper jaw is larger than the lower jaw) were randomly selected and assigned to one of two groups based on their maturation stage: the pre-pubertal group (18 patients, mean age 9.15 ± 1.5 years) and post-pubertal group (18 patients, mean age 16.3 ± 1.0 years). All patients...

Clefts of the lip or palate (CLPs) are the most common craniofacial birth defect, with a worldwide incidence of ~1 in 700 live births. The objective of this study is to assess the characteristics of the nasopharyngeal airway in growing vs. non-growing cleft lip/palate subjects and compare them with normal subjects. This retrospective study analyzed...

Objectives: To design a finite element (FE) model that might facilitate understanding of the complex mechanical behavior of orthodontic aligners. The designed model was validated by comparing the generated forces — during 0.2-mm facio-lingual translation of upper left central incisor (Tooth 21) — with the values reported by experimental studies in...

In the present study, Thirty-six Class patients II (A condition in which the upper jaw is larger than the lower jaw) were randomly selected and assigned to one of two groups based on their maturation stage: the pre-pubertal group (18 patients, mean age 9.15 ± 1.5 years) and post-pubertal group (18 patients, mean age 16.3 ± 1.0 years). All patients...

Objectives: To investigate and quantify forces generated by three-dimensional-printed aligners made of shape memory polymers (four-dimensional [4D] aligner). Methods: Clear X v1.1 material was used in this study. On a custom-made typodont model, correction of maxillary central incisor (tooth 21) malposition by 4D aligners with thicknesses of 0.8 an...

Background The aim of this study was to determine the effects of an elastic mandibular advancement (EMA) appliance on upper airway dimensions, most constricted area (MCA) of the airway, and snoring in a sample of obstructive sleep apnoea (OSA) patients of varying severity. Methods Forty-seven male subjects were classified into two groups comprisin...

Aim : To assess the validity of a Convolutional Neural Network (CNN) digital model to detect and localize orthodontic malocclusions from intraoral clinical images. Materials and methods : The sample of this study consisted of the intraoral images of 700 Subjects. All images were intraoral clinical images, in one of the following views: Left Occlus...

As an innovative approach to overcome the rate-limiting staging of conventional aligners, using shape memory polymers (SMPs) as aligners’ materials was investigated in this in vitro study. The ability of SMPs to shape recover and consequently move tooth, upon appropriate stimuli, was evaluated on a typodont model before clinical application. The st...

Objective To determine if an adjunct proteolytic pre-rinse along with contemporary methods of dental cleaning may more effectively remove visual plaque in subjects with fixed orthodontic appliances. Materials and Methods Forty-three orthodontic subjects, ages 10 to 25, completed this single site, double-blind, crossover clinical trial. Subjects ra...

Aim: To assess the accuracy of DigiBrain4, Inc (DB4) Dental Classifier and DB4 Smart Search Engine* in recognizing, categorizing, and classifying dental visual assets as compared with Google Search Engine, one of the largest publicly available search engines and the largest data repository. Materials and methods: Dental visual assets were collec...

M Abdelsalam, A Ghoneima, A Mageet. Reliability of Three-Dimensional Imaging for Assessment of Airway in Obstructive Sleep Apnoea Patients: A Systematic Review and Meta-Analysis. European Journal of Orthodontics. 2019; 41 (5). Pages e1–e189. Abstract https://doi.org/10.1093/ejo/cjz073

Objective: The bond strength between enamel and the bracket base is influenced by exposure to the oral environment. The aim of the current study was to determine the effect of cigarette smoke on the shear bond strength (SBS) of bonded metallic and ceramic orthodontic brackets. Materials and methods: a sample of 60 sound extracted premolars were...

- Clefts of the lip and/or palate (CLP) is the most common craniofacial birth defect, occurring with a worldwide incidence of ~1 in 700 live births. (Dixon et al,. 2011). - In CLP patients, the associated craniofacial features include midface deficiency, retrognathic mandible, and increased vertical dimensions, resulting in the reduction of the pha...

Objective To assess validity and reliability of palatal superimposition of holograms of 3D digital dental models using a customized software, (Ortho Mechanics Sequential Analyzer OMSA), installed on Microsoft HoloLens device as compared to the OMSA application running on a regular computer screen. Methods The sample consisted of pre‐ and post‐trea...

The aim of this study was to evaluate the validity and reliability of three-dimensional (3D) landmark-based palatal superimposition of digital dental models using the customized software Ortho Mechanics Sequential Analyzer (OMSA) revised by the addition of a computer vision algorithm. The sample consisted of pre- and post-treatment digital maxillar...

Objectives: The purpose of this study was to investigate differences in the thickness of the labial bone overlying the maxillary and mandibular incisors in class I, II, and III skeletal classifications using three-dimensional cone-beam computed tomographs (CBCT) technology. Methods: Pretreatment CBCTs of 54 Caucasian subjects (44 males, 10 femal...

Objectives: To evaluate the precision of the virtual occlusal record using the Carestream CS3600 Intraoral Scanner (Carestream Dental, Atlanta, Ga). Materials and methods: A total of 20 participants were recruited for this prospective study using preestablished inclusion/exclusion criteria. A complete intraoral scan and two bite registrations we...

Objectives: To compare changes in upper airway volume after maxillary expansion with bone- and tooth-borne appliances in adolescents and to evaluate the dentoskeletal effects of each expansion modality. Materials and methods: This retrospective study included 36 adolescents who had bilateral maxillary crossbite and received bone-borne maxillary...

Objective: To evaluate the association between resident selection criteria, including Graduate Record Examination (GRE) scores, and student performance in an orthodontic residency program. Materials and methods: This retrospective study evaluated the academic records of 70 orthodontic residency graduates from the Indiana University School of Den...

Historically, dental residency programs have used numerical assessment criteria to evaluate and identify qualified candidates for admission. Recent elimination of such assessment tools has undermined many programs' holistic evaluation process. The Advanced Dental Admission Test (ADAT) was developed and recently piloted in hopes of addressing this i...

Superimposition of radiographic imaging is used to evaluate patient growth and the effects of surgical and/or orthodontic treatment. The purpose of this study was to compare the outcomes of superimposition between two-dimensional (2D) and three-dimensional (3D) superimpositions. 2D lateral cephalograms were generated from the initial and final cone...

Objective: The aim of this study was to determine whether molar incisor hypomineralization (MIH) is greater in patients with cleft lip and palate (CLP) who underwent primary alveolar grafting (PAG) as compared with CLP waiting for secondary alveolar grafting (SAG) and with controls. Design: A retrospective analysis of intraoral photographs of 13...

Objective The aim of this study was to investigate the risk factors contributing to gingival recession among patients undergoing orthodontic treatment. Methods Records of 100 Caucasian patients who completed orthodontic treatment were evaluated before and after treatment. Intercanine and molar widths, arch perimeter, arch depth, and keratinized gi...

Objectives: The aim of this study was to assess the dimensional accuracy of fused deposition modeling (FDM)-, Polyjet-, and stereolithography (SLA)-produced models by comparing them to traditional plaster casts. Materials and methods: A total of 12 maxillary and mandibular posttreatment orthodontic plaster casts were selected from the archives o...

Résumé Le but de cette étude était d’évaluer les modifications de volume des voies aériennes associées à des protocoles d’expansion maxillaire rapide (EMR) utilisant différents rythmes d’activation. Un échantillon de 40 cas traités par EMR a été divisé en deux groupes selon le rythme d’activation de l’EMR (Groupe A : 0,8 mm par jour et Groupe B : 0...

The purpose of this study was to evaluate the airway volume changes associated with rapid maxillary expansion (RME) protocols using different activation rates. A sample of forty RME treated cases was classified into two groups according to the rate of RME activation (Group A: 0.8mm per day and Group B: 0.5mm per day). Three-dimensional images were...

Introduction: Our objectives were to compare, relative to A-point, (1) bone thickness over the most forward maxillary incisor (MFMI) in 2 dimensions vs 3 dimensions, and (2) bone thickness and inclination of each maxillary incisor in 3 dimensions. Methods: Thirty-four cone-beam computed tomography (CBCT) images were coded, and 2-dimensional (2D)...

This study using three‐dimensional cone beam computed tomography (CBCT) images of children determined relationships between nasal skeletal and soft tissue measurements and assessed the association with sex, age, and skeletal maturation stage. Following reliability studies, skeletal and soft tissue parameters were measured on coded CBCTs of 73 child...

Purpose: Recent case reports suggest that amnion-chorion membranes (ACM) and dense polytetrafluoroethylene membranes (dPTFE) can be left exposed during ridge preservation. The aim of this study was to compare the effectiveness of these membranes in ridge preservation, particularly when they are intentionally left exposed. Materials and Methods: A s...

Objectives: To evaluate and compare the accuracy and reliability of 3 different methods of three-dimensional cone-beam computed tomography scans (3D CBCTs) superimpositions: landmark-based, surface-based and voxel-based. Materials and methods: Pre- and post-orthodontic treatment CBCTs (T1 and T2) of 20 subjects with a mean age of 11 years were o...

Objectives: The purpose of this study was to measure changes in buccolingual inclination and in thickness of maxillary and mandibular buccal and lingual bone of maxillary and mandibular molars following orthodontic treatment using edgewise mechanics. Materials and methods: Cone-beam computed tomography scans of 48 patients taken before and after...

Résumé Objectifs L’objectif de cette étude était d’évaluer les changements d’inclinaison vestibulolinguale et de l’épaisseur de l’os vestibulaire et lingual maxillaire et mandibulaire à la suite du traitement orthodontique à l’aide de la mécanique edgewise. Matériels et méthodes Des scanners cone-beam de 48 patients réalisés avant et après un tra...

The purpose of this study was to compare alveolar bone thickness around the teeth adjacent to the cleft using cone beam computed tomography (CBCT) in patients with cleft lip and palate (CLP) who underwent primary alveolar grafting (PAG) as compared with CLP waiting for secondary alveolar grafting (SAG) and to determine the associations with other f...

Objective To evaluate the validity and reliability of three-dimensional (3D) landmark-based palatal superimposition of digital dental models using Ortho Mechanics Sequential Analyzer (OMSA). Methods The sample consisted of pre- and post-treatment digital maxillary dental models of 20 orthodontic cases. For each case, the pre- and post-treatment di...

Introduction: The aim of this multi-center retrospective study was to quantify the changes in alveolar bone height and thickness after using two different rapid palatal expansion (RPE) activation protocols, and to determine whether a more rapid rate of expansion is likely to cause more adverse effects, such as alveolar tipping, dental tipping, fene...

Early in the fourth week intrauterine, five primordial swellings, consisting of neural crest derived mesenchyme, appear around the stomodeum and are mainly responsible for face development (Figure 9.1). The process starts with the appearance of the nasal placodes on the inferior aspect of the frontonasal process. Proliferation of the ectomesenchyme...

Trisomy 21 (Ts21) affects craniofacial precursors in individuals with Down syndrome (DS). The resultant craniofacial features in all individuals with Ts21 may significantly affect breathing, eating and speaking. Using mouse models of DS, we have traced the origin of DS-associated craniofacial abnormalities to deficiencies in neural crest cell (NCC)...

Objectives: The aim of this study was to determine the skeletal and dental changes in rapid maxillary expansion treatments in two different populations assessed through cone-beam computer tomography (CBCT). Materials and methods: Twenty-one patients from Edmonton, Canada and 16 patients from Cairo, Egypt with maxillary transverse deficiency (11-...

Résumé Objectifs Cette étude a cherché à déterminer les modifications squelettiques et dentaires suite à des traitements par expansion maxillaire rapide chez deux populations différentes évaluées par tomographie volumique à faisceau conique (CBCT). Matériel et méthodes Vingt-et-un patients à Edmonton au Canada et 16 patients au Caire en Egypte (t...

Objective: To determine whether trumpet performance skills are associated with malocclusion. Materials and Methods: Following institutional review board approval, 70 university trumpet students (54 male, 16 female; aged 20-38.9 years) were consented. After completing a survey, the students were evaluated while playing a scripted performance skills...

Objective: To compare maxillary mucosal thickening and sinus volumes of unilateral cleft lip and palate subjects (UCLP) with noncleft (nonCLP) controls. Design: Randomized, retrospective study of cone-beam computed tomographs (CBCT). Setting: University. Patients: Fifteen UCLP subjects and 15 sex- and age-matched non-CLP controls, aged 8 to...

Unilateral cleft lip and palate (UCLP) occurs when the maxillary and nasal facial prominences fail to fuse correctly during development, resulting in a palatal cleft and clefted soft and hard tissues of the dentoalveolus. The UCLP deformity may compromise an individual's ability to eat, chew, and speak. In this retrospective cross-sectional study,...

Background Assessment of the upper airway volume, morphology, and mechanics is of great importance for the orthodontic patient. We hypothesize that upper airway dimensions have significant effects on the dynamics of the airway flow and that both the dimensions and mechanics of the upper airway are greatly affected by orthodontic and orthopedic proc...

Objectives The aim of this retrospective, radiographic study was to determine if there is a significant difference between the most constricted area of the airway (MCA), airway dimensions (length and volume) of the nasal cavity, nasopharynx, oropharynx, maxillary sinuses, and prevertebral soft tissue thickness of trumpeter players vs. controls util...

Airway dimensions are closely linked to the bone and soft-tissue craniofacial anatomy. Reduction of the airway is seen with airway disorders and can impair function. The purpose of this retrospective study was to determine whether changing from open to closed jaw position affects the volume of the nasal cavity, nasopharynx, and oropharynx; the soft...

Objective: To determine whether trumpet performance skills are associated with malocclusion. Materials and methods: Following institutional review board approval, 70 university trumpet students (54 male, 16 female; aged 20-38.9 years) were consented. After completing a survey, the students were evaluated while playing a scripted performance skil...

Bilateral cleft lip and palate (BCLP) is caused by a lack of merging of maxillary and nasal facial prominences during development and morphogenesis. BCLP is associated with congenital defects of the oronasal facial region that can impair ingestion, mastication, speech, and dentofacial development. Using cone beam computed tomography (CBCT) images,...

The aim of this study was to evaluate the reliability of newly developed software in the assessment of orthodontic tooth movement 3 dimensionally. The sample consisted of pretreatment and posttreatment computed tomography scans and plaster dental models of 20 orthodontic patients treated with a hyrax palatal expander as a part of their comprehensiv...

Objectives The aim of this retrospective, radiographic study was to determine if there is a significant difference between the most constricted area of the airway (MCA), airway dimensions (length and volume) of the nasal cavity, nasopharynx, oropharynx, maxillary sinuses, and prevertebral soft tissue thickness of trumpeter players vs. controls util...

Objective: To investigate the relationship between mini-screw implant (MSI) diameter (1.6 vs 2.0 mm) and shape (tapered vs cylindrical) and the amount of microdamage generated during insertion. Materials and methods: Thirty-six cylindrical and 36 tapered MSIs, 6 mm long, were used in this study. Half of each shape was 1.6 mm in diameter, while t...

Cleft lip and palate (CLP) is a craniofacial malformation affecting more than seven million people worldwide that results in defects of the hard palate, teeth, maxilla, nasal spine and floor, and maxillodental asymmetry. CLP facial soft-tissue depth (FSTD) values have never been published. The purpose of this research is to report CLP FSTD values a...

Cleft lip and palate (CLP) affects the dentoalveolar and nasolabial facial regions. Internal and external nasal dysmorphology may persist in individuals born with CLP despite surgical interventions. 7–18 year old individuals born with unilateral and bilateral CLP (n = 50) were retrospectively assessed using cone beam computed tomography. Anterior,...

Objective: The objective of this pilot, retrospective, radiographic study was to determine if children with unilateral cleft lip/palate (CL/P) have more maxillary sinus congestion than age and gender matched controls without CL/P. Methods: With IRB approval, three-dimensional cone beam computerized tomographs (3D CBCT) of children 8-14 yoa with u...

Objective: To assess the position, location, and distribution of maxillary displaced canines in a sample of Japanese population and to develop a classification for the maxillary displaced canine depending on the position in order to facilitate proper diagnosis of this frequently encountered clinical problem. Methods: Cone beam computed tomographic...

Objective: The aim of this retrospective study was to compare the airway and dentoskeletal dimensions among different classes of malocclusion. Methods: Lateral cephalograms of 82 orthodontic subjects, aged 12-25 years, were pulled from the Orthodontic Clinic at Indiana University School of Dentistry, classified based on the molars relationships i...

Objectives: The aim of this study was to determine the skeletal and dental changes in rapid maxillary expansion treatments in two different populations assessed through cone-beam computer tomography (CBCT). Methods: Twenty-one patients from Edmonton, Canada and 16 patients from Indiana, USA with maxillary transverse deficiency (11-17 years old) wer...

Objective: The objective of this retrospective, 3-dimensional cone beam computed tomography study was to determine if there is a significant difference between the most constricted area of the airway, the prevertebral soft tissue thickness and airway dimensions (length and volume) of the nasal cavity, nasopharynx, oropharynx, and maxillary sinuses...

Cleft lip with or without cleft palate (CL/P) is a relatively common craniofacial malformation involving bony and soft-tissue disruptions of the nasolabial and dentoalveolar regions. The combination of CL/P and subsequent craniofacial surgeries to close the cleft and improve appearance of the cutaneous upper lip and nose can cause scarring and musc...

Orthodontists rely heavily on soft-tissue analysis to determine facial esthetics and treatment stability. The aim of this retrospective study was to determine the equivalence of soft-tissue measurements between the 3dMD imaging system (3dMD, Atlanta, Ga) and the segmented skin surface images derived from cone-beam computed tomography. Seventy preex...

Patients with unilateral cleft lip and palate (CLP) deformities commonly develop nasal airway obstruction, necessitating septoplasty at the time of definitive rhinoplasty. We assessed the contribution of the bony septum to airway obstruction using computed tomography (CT) and cone beam CT (CBCT). A 2-year retrospective review of all subjects with u...

Objective: The objectives of this retrospective study using cone beam computed tomography (CBCT) were to determine if there are differences in the volume of various upper airway segments and the most constricted area (MCA) of children with different dental and skeletal patterns. Methods: The initial CBCTs of 83 orthodontic patients (Angle’s Class I...

Objectives: Orthodontists rely heavily on soft tissue analysis to determine esthetics and treatment stability. Although the reliability of three dimensional photography (3dMD) and cone beam computed tomography (CBCT) is established, little data exists comparing the soft tissue measurements between these two imaging modalities. The aim of this retro...

Objective: Music teachers contend that the arrangement of teeth affects trumpet performance. Since there is little quantitative data to support this claim, the purpose of this study was to determine whether trumpet performance skills are associated with various characteristics of arch width and teeth position. Method: Following IRB approval, 70 t...

Objective: The aim of this retrospective cephalometric study was to investigate dentoskeletal and airway dimensional changes in a group of orthodontic patients with deficient mandible using Herbst vs. MARA appliances. Method: Pre-treatment and post-treatment lateral cephalometric radiographs of 34 subjects with deficient mandible (aged 9-22 years...

Objectives: Music teachers contend that the arrangement of anterior teeth affects trumpet performance by influencing the embouchure. Since there is little quantitative data to support this claim, the purpose of this study was to determine whether trumpet performance skills are associated with the malalignment of anterior teeth. Methods: Following...

Trichorhinophalangeal syndrome type I is a rare autosomal dominant disorder characterized by cone-shaped epiphysis, sparse fine hair, pear-shaped nose and variable growth retardation. The typical craniofacial features include thin upper lip, elongated philtrum, large outstanding ears, shortened posterior facial height associated with short mandibul...

To investigate the effects of nicotine and cigarette smoke condensate (CSC) exposure on cytokine expression from human endothelial cells in order to identify one possible mechanism that smoking plays in the pathogenesis of both periodontal disease (PDD) and cardiovascular disease (CVD). Human endothelial cells (HUVECs) were exposed to different con...

The purpose of this retrospective radiographic study was to determine the reliability and reproducibility of skeletal and dental measurements of lateral cephalograms created from a computerised tomography (CT) scan compared with conventional and digital lateral cephalograms. CT and conventional lateral cephalograms of the same patients were obtaine...

In this retrospective study with 3-dimensional computed tomography, we evaluated airway volume, soft-palate area, and soft-tissue thickness changes before and after rapid maxillary expansion in adolescents. Another purpose was to determine whether rapid maxillary expansion caused changes in the palatal and mandibular planes and facial height. The s...

Objective: The purpose of this retrospective radiographic study was to determine the reliability and reproducibility of skeletal and dental measurements of lateral cephalograms created from computed tomography (CT) scan compared to the conventional and digital lateral cephalograms. Method: Following reliability studies, CT records of 30 patients...

Objective: The aim of this retrospective study was to investigate the effects of mandibular positional changes on the airway dimensions in a group of orthodontic patients. Methods: Following reliability studies, lateral cephalometric radiographs of 118 Caucasian subjects, aged 8-15 years, were selected from the postgraduate orthodontic clinic arc...

Objective: The objectives of this retrospective study using cone beam computed tomography (CBCT) were to determine if there are differences in the volume of various airway segments and the most constricted area (MCA) of children with different dentoskeletal patterns. Method: The initial CBCTs of 83 orthodontic patients (30 Angle Class I; 26 Class...

The aim of this study was to assess the reliability and reproducibility of angular and linear measurements of conventional and digital cephalometric methods. A total of 13 landmarks and 16 skeletal and dental parameters were defined and measured on pre-treatment cephalometric radiographs of 30 patients. The conventional and digital tracings and mea...

The aim of this study was to determine whether the orthopedic forces of rapid maxillary expansion cause significant quantitative changes in the cranial and the circummaxillary sutures. Twenty patients (mean age, 12.3 ± 1.9 years) who required rapid maxillary expansion as a part of their comprehensive orthodontic treatment had preexpansion and poste...

The purpose of the present study was to evaluate the accuracy and reliability of airway volume digital measurements of cone-beam computed tomography (CBCT) compared with the manual measurements of an airway model. An acrylic airway model was constructed and attached to a human dry skull in the natural position of the airway passage. The total and i...

Osteonecrosis of the jaw is a serious complication of bisphosphonate treatment for which the pathophysiology is unknown. The purpose of this study was to investigate whether in vivo zoledronic acid (ZA) induces alterations in cell proliferation, apoptosis, and matrix metalloproteinases (MMPs) expression in oral mucosal epithelial cells. One-year-ol...

The nasopharynx plays a fundamental role in dentofacial morphology and nasorespiratory function. Objective: The aim of this retrospective study was to compare the nasopharyngeal and dentoskeletal dimensions between two ethnic groups. Methods: Following reliability studies, lateral cephalometric radiographs of 30 African American and 30 Caucasian su...

Rapid maxillary expansion (RME) is an orthopedic procedure prescribed for treatment of crossbites and transverse maxillary deficiencies. RME reportedly increases nasal width and volume, thereby lessening nasal resistance and improving nasal respiration. Objectives: The purpose of this preliminary report of a retrospective 3-dimensional study, utili...

To investigate the skeletal and dental changes induced by rapid maxillary expansion, using computed tomography (CT) scans and three-dimensional (3-D) reconstructed images. Twenty patients (Mean age: 12.3 +/- 1.9 years) who required rapid maxillary expansion as a part of their comprehensive orthodontic treatment underwent pretreatment (T1) and post-...

To cite this article: Ghoneima AA, Allam ES, Zunt SL, Windsor LJ: Bisphosphonates treatment and orthodontic considerations Orthod Craniofac Res 2010;13:1–10 Authors – Ghoneima AA, Allam ES, Zunt SL, Windsor LJ Currently, the use of oral and systemic forms of bisphosphonates is increasing dramatically in a large group of patients either in the form...