Why is CaviTAU® necessary in dentistry and medicine?
In the medical field in general, pulse-echo ultrasonography is widely used for imaging all kinds of soft tissue. In principle, images from structures inside the body are produced by analyzing the reflection of ultrasound waves. This method however is not suitable to yield useful information on the status of the jawbone because of almost complete reflection of ultrasound at the bone/soft tissue interphase. Particularly the cancellous part of the jawbone cannot be examined with commonly used ultrasound equipment. Thus, up to now ultrasound is of very limited use in dental medicine.
The status of the cancellous bone of the jaws can be clinically of great importance. Jerry Bouquot has provided anatomical evidence that the cancellous bone can be largely degenerated, a phenomenon which he calls inter alia “ischemic osteonecrosis leading to cavitational lesions”. He relates osteonecrosis of the jawbone to neuralgic pain and defines a disease called “neuralgia inducing cavitational osteonecrosis (NICO)”
(vgl. JE Bouquot, AM Roberts, P. Person und J.Christian, “Neuralgia-inducing cavitational osteonecrosis (NICO). Osteomyelitis in 224 jawbone samples from patients with facial neuralgia”, Oral Surg Oral Med Oral Pathol. 1992, 73 (3):307–319; J. Bouquot, W. Martin and G. Wrobleski “Computer-based thru-transmission sonography (CTS) imaging of ischemic osteonecrosis of the jaws – a preliminary investigation of 6 cadaver jaws and 15 pain patients”, Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001, 92: 550.)
Johann Lechner investigated in depth the tissue in such lesions which appears as a clump of fat inside of an intact cortical bone. During surgery the material is simply spooned out. This tissue is in an ischemic, fatty degenerative state. Lechner therefore defines the observed changes as “fatty-degenerative osteolysis/osteonecrosis of jawbone (FDOJ)”. He showed that the clumps of fat found in the jawbone are biochemically exceedingly active, producing certain zytokines in high amounts, namely RANTES (CCL-5) and FGF-2, but also PDGF and MCP-1. The level of those zytokines is also elevated in a number of systemic diseases such as cancer, dementia, multiple sclerosis or arthritis. There is strong evidence – coming from startling clinical improvements after the surgical elimination of such tissue – that the development and the persistency of a variety of systemic diseases can be related to the fatty-degenerative osteolysis of jawbone (FDOJ). However, in most of these cases the local effect of neuralgic pain (NICO) is missing.
(Vgl. J. Lechner and V. von Baehr, “RANTES and fibroblast growth factor 2 in jawbone cavitations: triggers for systemic disease?” International Journal of General Medicine 2013, 6: 277-290; J. Lechner and W. Mayer “Immune messengers in neuralgia inducing cavitational osteonecrosis (NICO) in jaw bone and systemic interference”, Eur. J. Integr. Med. 2010, 2 (2): 71-77)
Furthermore, in a recent publication it was made plausible that NICO and FDOJ as well as the so called “aseptic ischemic osteonecrosis in the jawbone” (AIOJ) all describe the same pathological condition of the jawbone which is listed under Code M87.0 in the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10).
(Vgl.. J. Lechner, S. Schuett and V. von Baehr, “Aseptic-avascular osteonecrosis: local `silent inflammation` in the jawbone and RANTES/CCL5 overexpression”, Clinical, Cosmetic and Investigational Dentistry 2017:9 99–109.)
Additionally, the status of the cancellous part of the jawbone is of great importance for dental implants and for the success of implantology, according to earlier publications of Bilal AI-Nawas.
(Vgl . M.O. Klein, K.A. Grotz, B. Manefeld, P.H. Kann and B. Al-Nawas, Ultrasound transmission velocity for non-invasive evaluation of jaw bone quality in vivo prior to dental implantation”, Ultrasound in Medicine & Biology 2008, 34: 1966-1971.)
Hence, serious health risks can be associated with fatty-degenerative osteolysis of the jawbone. A major problem however is that a jawbone with fatty-degenerative osteolysis appears without abnormal findings in X-ray examination. This holds true even if the cancellous bone is in a largely degenerated status, showing only fatty tissue instead of the substantia spongiosa of healthy cancellous bone (FDOJ). Being virtually undetectable by any kind of X-ray examination the occurrence and the phenomena of AIOJ, FDOJ and NICO remain widely unknown and even are disputed or denied
(vgl. . J. Lechner, “Validation of dental X-ray by cytokine RANTES – comparison of X-ray findings with cytokine overexpression in jawbone”, Clinical, Cosmetic and Investigational Dentistry 2014, 6: 71-79.)
To overcome the aforementioned problem, a different approach was needed. Instead of X-ray or other established medical examination methods the use of Through-Transmission Alveolar Ultrasonography (TAU) was evaluated.