Chris Sproat

• Guy's and St Thomas' NHS Foundation Trust

Background Osteoradionecrosis (ORN) often affects the jaws, but other craniofacial bones are also vulnerable to radiation damage. Studies exploring the role of pentoxifylline, vitamin E and sodium clodronate (PENTO/CLO) for the management of jaw osteoradionecrosis have shown promising results. Extrapolating from these findings, this service evaluat...

Background The purpose of this study was to evaluate the outcomes of alveoplasty and primary closure following dental extractions in patients with an elevated medication-related osteonecrosis of the jaw (MRONJ) risk.Study design A retrospective review of 46 patients with an elevated MRONJ risk was conducted. This included a total of 124 teeth extra...

Patients with existing or a history of medication-related osteonecrosis of the jaw (MRONJ) are considered to be at a higher risk of further developing MRONJ, particularly if dental extractions are necessary. It is assumed that their underlying risk factors predispose them to developing MRONJ and they are allocated into an 'elevated risk group'. The...

As temporomandibular disorders (TMDs) become ever more prevalent in both primary and secondary care settings, successful management is increasingly challenging in both sectors. The authors aim to explore the dilemma of TMD management as the patient journeys through from primary to secondary care and offer educational tools to support practitioners...

Objective Osteoradionecrosis (ORN) is a serious and late complication following radiotherapy for head and neck cancer (HNC). Current medical management involves the use of pentoxifylline, which is advised to be used with caution in certain patients with cardiac‐ or cerebrovascular conditions. This retrospective review aims to assess the clinical ou...

Objective Osteoradionecrosis (ORN) is a well‐recognised complication of radiotherapy in the cured head and neck cancer (HNC) patients. More recently with improved survivorship in the palliative HNC group, there is an increasing population that is also burdened by radiation late effects such as ORN. Currently, there is no proven approach to manage O...

Background: Osteoradionecrosis (ORN) of the jaws remains one of the most debilitating complications of radiotherapy (RT) in patients with head and neck cancer (HNC). Liquid pentoxifylline and vitamin E (PVe) presents an alternative formulation to tablets for patients with dysphagia or enteric feeding. Objective: This study aimed to assess the cl...

Objectives : Osteoradionecrosis (ORN) of the jaw is preceded by dental extractions in up to 10% of cases. We present a case series of post-radiotherapy patients undergoing dental extractions receiving prophylactic antifibrotic agents; pentoxifylline and vitamin E (PVe) to prevent ORN. Study Design A retrospective review was conducted of 219 head a...

Diffuse sclerosing osteomyelitis (DSO) is a rare inflammatory disease of the bone with a poorly understood aetiology. We present a case of a 26-year-old female with DSO, who has been living with this condition for over 12 years. Many different therapies have been used to attempt to manage her symptoms. She is currently taking oral alendronic acid w...

Aim Noonan syndrome is an uncommon disorder which can present with developmental delay, short stature and cardiac anomalies. Oro‐facial presentation includes giant cell lesions with secondary aneurysmal bone cysts (ABC). The current case report presents an extensive mandibular ABC managed solely by oral bisphosphonates. Material & methods This is...

Management of secondary chronic osteomyelitis (SCO) of the mandible is complex and challenging condition. Antibiotics are often first line treatment but have difficulty penetrating the infected bone and surgical intervention can be extensive, disfiguring and may not provide cure. With increasing reports of successful management of primary chronic o...

Objective: Diffuse sclerosing osteomyelitis (DSO) is a poorly understood chronic inflammatory disease, for which many etiologic theories and treatment modalities have been suggested. We retrospectively evaluated bisphosphonate treatment outcomes in patients with DSO and compared them with those of alternative treatment modalities and those reporte...

Aim Coronectomy is an elective surgical technique designed to reduce the risk of morbidity to the inferior dental nerve for those mandibular third molars (M3M) deemed to pose such risk. Successful coronectomy relies on the retention of a vital root with non‐inflamed pulpal tissue and healthy surrounding bone. For this reason coronectomy in teeth wi...

Aims The aim is to introduce a novel transalveolar technique for retrieval of tooth roots from the maxillary antrum using a modified flexible suction catheter. Method The displaced root is confirmed using plain radiographs and the patient is placed on a preoperative antral regime of broad‐spectrum antibiotics, analgesics and nasal decongestants fo...

Osteonecrosis of the jaw (ONJ) is most commonly related to medications such as anti-resorptives and anti-angiogenics or head and neck radiotherapy. However, in addition to these, alternative causes of ONJ have also been reported including; infection, chemical toxicity, trauma and vascular ischaemia, but this list is not exhaustive. It is well accep...

Background: Coronectomy has become an increasingly prescribed surgical treatment for mandibular third molars that are deemed to pose a risk to the inferior dental nerve. Retention of the roots poses a risk of need for root retrieval in the future if symptoms are present. Long-term outcomes and the symptoms that lead to root retrieval via coronecto...

Tyrosine kinase inhibitors (TKIs) are oral chemotherapy drugs used primarily to treat leukemias, renal cell carcinomas, gastrointestinal stromal tumors, and neuroendocrine tumors. Within this group, a number of drugs have already been implicated in jaw necrosis. Axitinib (Inlyta) is a novel TKI currently licensed for the treatment of renal cell car...

Objective: This large case series retrospectively reviewed the outcomes of coronectomy in conjunction with dentigerous cyst removal in 68 patients at the oral surgery department of Guy's Hospital. Study design: A retrospective review of 68 patients was undertaken in a single department where 73 teeth with associated dentigerous cysts were treate...

In the past decade there has been a rise of osteonecrosis of the jaws (ONJ) predominately related to bisphosphonate therapy and osteoradionecrosis secondary to radiotherapy. However, osteonecrosis can occur in the absence of these agents. A case of idiopathic osteonecrosis of the maxilla is reported and the literature discussed. Clinical relevance:...

Osteoradionecrosis (ORN) is a complication seen intermittently in patients who have had radiotherapy to the head and neck, and results of treatment with pentoxifylline and tocopherol (PVe) have been encouraging. As a consequence, some argue that this should be used prophylactically to lower the risk of ORN after dental extractions in this group. We...

Osteoradionecrosis (ORN) is a complication of radiotherapy, and is difficult to manage once established. However, its pathogenesis has been reinvestigated, and it is now thought to be potentially amenable to treatment with pentoxifylline and tocopherol (vitamin E). We made a retrospective analysis of 62 patients with established ORN who were treate...

Objectives: To analyze clinical features, dosimetric parameters, and outcomes of osteoradionecrosis (ORN). Study design: Thirty-six patients with ORN who had been previously treated with radiotherapy (RT) were retrospectively identified between January 2009 and April 2014. ORN volumes were contoured on planning computed tomography (CT) scans. Ne...

There is a resurgence of interest in coronectomy for the management of mandibular third molars because it has a low risk of injury to the inferior dental nerve. However, there is concern that the root that is left in place will eventually become a source of infection. We describe the histological evaluation of 26 consecutive symptomatic coronectomy...

Unlabelled: Coronectomy of mandibular third molars is a well established technique that is going through a resurgence as it seems to reduce the risk of inferior dental nerve (IDN) injury. The reservation with the technique arises because of fear that the retained root will become infected and symptomatic over time. General dental practitioners wil...

There is a resurgence of interest in coronectomy, but its appropriate application in the management of third molar teeth has yet to be defined. Dentigerous cysts associated with unerupted teeth are most commonly associated with mandibular third molars. In this case series we evaluate outcome after coronectomy of teeth with associated dentigerous cy...

Coronectomy was developed to reduce the incidence of iatrogenic injury to the inferior dental nerve, which can be a result of routine mandibular third molar surgery, but it is not widely accepted despite early studies that all showed positive results. This two-part paper looks at the technique in more detail to help clinicians gain a better underst...

Coronectomy is a technique that reduces morbidity of the nerve after operation on high-risk mandibular third molars. This two-part paper aims to give an overview of the technique and a description of common problems that can be encountered during and after operation. In this paper we discuss the technique as an overview and then each type of impact...

Removal of mandibular third molars is a common oral surgery procedure which is associated with a significant risk of injury to the inferior dental nerve (IDN). In an era of conservative dentistry the technique of coronectomy, which is conservative in terms of surgery and successful in minimising the incidence of IDN injury, has been met with some r...

Hypertension is reported by the World Health Organisation as one of the most important causes of premature morbidity and mortality, although it is often asymptomatic. Approximately 40% of the UK population are thought to be affected, however, only one third of these are currently detected. Dental practice offers an ideal opportunity to screen for h...