"Study of the Month", Feburary 2023: The impact of FDOJ on implant osseointegration and systemic health

How FDOJ affects Bone Healing and Chronic Inflammation

Introduction

This case study highlights the clinical relevance of FDOJ (Fatty Degenerative Osteonecrosis of the Jaw) in implant dentistry. Undetected FDOJ regions can compromise the osseointegration of ceramic implants and contribute to chronic systemic inflammation. Early and accurate diagnosis is particularly critical in patients with low bone density or chronic health conditions.

Objectives

The study aimed to evaluate the effects of FDOJ on:

• Osseointegration of ceramic implants
• Differentiation of bone marrow stromal cells (BMSCs) into osteoblasts or adipocytes
• Systemic inflammatory markers, particularly RANTES/CCL5

Methods

• Diagnostics: CT scans were used to detect FDOJ lesions, supported by transalveolar ultrasound (Kavitau) and histo-/osteoimmunological analyses.
• Bone healing and BMSC differentiation: BMSCs can differentiate into osteoblasts, promoting bone regeneration, or into adipocytes, which reduce bone density and increase fracture risk (Matsushita 2022; Tencerova & Kassem 2016).
• Osteoimmunological characteristics of FDOJ: Acute inflammatory cytokines (TNF-α, IL-1, IL-6) were low, while RANTES/CCL5 was dominant. This chemokine may exacerbate chronic systemic conditions (Lechner et al. 2018).

Clinical Relevance

• Implantology: Complete removal of FDOJ areas is essential to ensure stable osseointegration of ceramic implants.
• Systemic Health: Controlling RANTES/CCL5 can reduce chronic inflammation and improve overall patient well-being.
• Practice Recommendation: Accurate diagnosis and targeted surgical removal of necrotic bone optimize both implant stability and bone regeneration.

Conclusion

FDOJ can significantly affect the osseointegration of ceramic implants and promote systemic inflammatory responses. Careful diagnostics and removal of affected bone are critical for successful implant therapy and overall health. The study emphasizes the importance of “maxillomandibular osteoimmunology” in clinical practice.

References

Die vollständige Studie wurde veröffentlicht unter dem Titel
„Einsatz von Tissue-Level-Zirkonimplantaten bei Risikopatienten“ im Implantologie Journal 7+8/25.

Matsushita Y, Ono W, Ono N. Toward Marrow Adipocytes: Adipogenic Trajectory of the Bone Marrow Stromal Cell Lineage. Front Endocrinol (Lausanne). 2022;13:882297.

Tencerova M, Kassem M. The Bone Marrow-Derived Stromal Cells: Commitment and Regulation of Adipogenesis. Front Endocrinol (Lausanne). 2016;7:127.

Lechner J, Rudi T, von Baehr V. Osteoimmunology of tumor necrosis factor-alpha, IL-6, and RANTES/CCL5: a review of known and poorly understood inflammatory patterns in osteonecrosis. Clin Cosmet Investig Dent. 2018;10:251–262.

Prof. Dr. Etyene Schnurr, DDS, PhD (Scientific Advisor, SDS)

Provides scientific guidance for SWISS DENTAL SOLUTIONS. Research focuses on the oral microbiome, biofilm-related infections, and their systemic impact, from clinical studies and data analysis to drug development.

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