Poster Session
Interim and Longitudinal
Experiences
Z. S. Peacock, Y. D. Ji: Harvard School of Dental Medicine
Purpose: The purpose of this study was to assess
interim and longitudinal quality of life of patients af-
ter resection of mandibular benign neoplasms. The
secondary aim of this study was to assess attitudes to-
wards implants, costs, and insurance coverage af-
ter resection.
Methods: This is a cross-sectional survey of patients
who underwent resection of benign mandibular neo-
plasms between 1995 and 2017 at the Massachusetts
General Hospital Department of Oral and Maxillofacial
Surgery. Subjects were included if they had a marginal
or segmental resection and at least 1-year follow-up.
Demographic variables measured include age, gender,
and type of resection. The primary predictor variable
was type and extent of reconstruction. The primary
outcome variable was quality of life patients after resec-
tion within 5 years (interim) or 5 years or more (longi-
tudinal). The secondary outcome variable was type of
dental rehabilitation they received. A modified version
of the University of Washington Quality of Life Survey
(v.4) was utilized to assess quality of life compared to
baseline. Subjects were also asked to choose
three domains
Results: A total of 51 subjects were eligible, with 17
responses (33.3%). The study sample consisted of 17
subjects with a mean age 49.0  20.3 (9 males) and
an average follow-up of 6.3 years  5.2 (range 1,
19). Seven subjects underwent resection within the
past 5 years (interim cohort) and 10 subjects were 5
years or more recovered from the surgery. Subjects
received non-vascularized iliac crest bone grafts
(n=9), tibial graft (n=1), vascularized free fibula flap
(n=3), and no osseous reconstruction (n=4). Func-
tional teeth were lost in 13 subjects and 9 (69.2%)
received implants and dental prostheses. Quality of
life was not significantly different between the interim
and longitudinal cohorts in all domains assessed. No
significant differences in short or long-term quality of
life was found between type of resection or bone
graft. With a trend towards significance, subjects
who received implants had higher quality of life
scores compared to those who did not. Quality of
life in eight subjects (47.1%) returned to baseline,
four subjects (23.5%) had some improvement, and
four subjects (23.5%) had significantly improved qual-
ity of life compared to baseline. Most important do-
mains were appearance of face (n=7), pain in face
(n=5), pain in donor site (n=4), chewing (n=4) and
speech (n=4). Interim quality of life was comparable
to longitudinal in all domains assessed. A total of 10
subjects (58.8%) expected implant rehabilitation after
tumor surgery to be covered by medical insurance.
AAOMS  2017
Conclusion: Patients experience return to a compara-
ble quality of life after resection of benign mandibular tu-
mors regardless of dental rehabilitation and chronicity.
Some patients experience an improved quality of life
compared to prior to their resection. Areas most impor-
tant to patients are the appearance of their face, the
pain of the recipient site, pain of the donor site, chewing,
and speech.
1. M€ucke T, Loeffelbein DJ, Kolk A, Wagenpfeil S, Kanatas A,
Wolff K-D, Mitchell DA, Kesting MR: Comparison of outcome
of microvascular bony head and neck reconstructions using
the fibular free flap and the iliac crest flap. Br J Oral Maxillofac
Surg 51: 514, 2013
2. Vu DD, Schmidt BL: Quality of life evaluation for patients
receiving vascularized versus nonvascularized bone graft
reconstruction of segmental mandibular defects. J Oral Maxil-
lofac Surg Off J Am Assoc Oral Maxillofac Surg 66: 1856, 2008
POSTER 43
Clinical and Radiographic
Presentations in MRONJ after
Bisphosphonates Vs. Denosumab
E. Eshaghzadeh: UCLA School of Dentistry, C. S. Hakim,
K. Walton, S. Tetradis, T. L. Aghaloo
Background: Medication-Related Osteonecrosis of
the Jaw (MRONJ) is a rare but significant side effect of
antiresorptive therapy, and specifically bisphosphonates
or denosumab. Both drugs are prescribed for conditions
exhibiting bone fragility like osteoporosis and primary
or metastatic bone cancer. Current literature contains
few studies comparing the difference between the clin-
ical and radiographic appearance of MRONJ caused by
these medications.
Objective: To examine the existence and extent of
clinical and radiographic differences between pa-
tients treated with only bisphosphonates vs. patients
treated with denosumab with or without bi-
sphosphonates.
Methods: We retrospectively analyzed the records of
70 patients being treated at the UCLA School of
Dentistry for MRONJ caused by bisphosphonate (BP)
therapy or denosumab with or without bisphospho-
nates (Dmab +/- BP). Age, gender, primary disease,
inciting event, stage of disease at presentation and
the presence and extent of radiographic changes asso-
ciated with MRONJ were obtained. FisherOs ~ exact
test was used to compare qualitative variables and
StudentOs~ t-test to compare numeric variables. The
data was analyzed to assess differences between the
disease-causing medications.
Results: In the denosumab +/- bisphosphonates
group, more patients were treated for oncologic dis-
ease while in the bisphosphonates group, the number
of oncologic vs. osteoporotic patients was similar.
Both groups had a higher incidence of females vs.
e-397
Poster Session

Table 1 males and of MRONJ occurring in the mandible vs. the

Patients’ gender, age, Meds, ONJ Stage, Site maxilla. There was no statistically significant difference
BP Dmab TOTAL p value
regarding the clinical staging of MRONJ between the
two groups. However, radiographically, the bisphospho-
Male 15 (34.9%) 11 (40.7%) 26 (37.1%) 0.80 nate group demonstrated a significantly higher inci-
Female 28 (65.1%) 16 (59.3%) 44 (62.9%)
Mean Age 74.8 67.0 72.0
dence of extensive and localized sclerosis, lytic
Osteoporotic 22 (51.2%) 7 (25.9%) 29 (41.4%) <0.05 changes and sequestration.
Oncologic 21 (48.8%) 20 (74.1%) 41 (58.6%) 100% Stacked Column Graphs Illustrating Radio-
Stage 1 18 (41.8%) 14 (51.9%) 32 (45.7%) 0.34
Stage 2 14 (32.6%) 10 (37.0%) 24 (34.3%)
graphic Feature Comparisons Between Bisphosph-
Stage 3 11 (25.6%) 3 (11.1%) (20.0%) onates Vs. Denosumab +/- Bisphosphonates
MX only 11 (25.5%) 10 (37.0%) 21 (30.0%)
MD only 30 (69.8%) 16 (59.3%) 46 (65.7%) 0.68
Both arches 2 (4.7%) 1 (3.7%) 3 (4.3%)
TOTAL 43 (61.4%) 27 (38.6%) 70 Conclusions: Although there was no difference in the
appearance of clinical bone exposure upon presentation,
a statistically significant difference in the radiographic
presentation of disease was observed. Follow up
outcome studies are needed to assess whether this
diverse radiographic presentation results in differences
in MRONJ progression and healing.

References:
1. Aghaloo, Tara L, Alan L. Felsenfeld, and Sotirios Tetradis. ‘ Osteo-
necrosis of the jaw in a patient on Denosumab.’’ Journal of Oral
and Maxillofacial Surgery 68.5 (2010): 959
2. Ruggiero, Salvatore L, et al. ‘American Association of Oral and
Maxillofacial Surgeons position paper on medication-related os-
teonecrosis of the jaw—2014 update.’’ Journal of Oral and Maxil-
lofacial Surgery 72.10 (2014): 1938-1956

RECONSTRUCTION (INCLUDES
BONE & BIOMATERIALS AND
SOFT TISSUE)

POSTER 44
The Use of Pre-Milled Plates in
Mandibular Reconstruction: A Case
Series of Seven Patients
L. Portnoff: Loma Linda University

Restoration of segmental resection of the posterior

mandible remains a challenge for oral and maxillofacial
surgeons. Patients often require reconstruction with
plates and screw retention to provide continuity and
strength, followed by bone grafting. Several factors are
required for reconstruction of the mandible including
the correct contour, maxillomandibular occlusal relation-
ship, and repositioning of the condyle to restore adequate
function [1]. Mandibular reconstruction with vascular-
ized flaps may be considered the gold standard by some
[2] though in many cases, the use of free flaps is contra-
indicated, such as when the patient is deemed unsuitable
for a prolonged operative procedure or when microvas-
cular expertise is unavailable [3]. For patients who have
not received a vascularized flap, a secondary surgery for
bone grafting was traditionally necessary to bridge the

e-398 AAOMS  2017