International Poster Journal of Dentistry and Oral Medicine, 01/2007

Objectives: aim of study-to compare effects of two chlorhexidine-gels delivered into periodontal pockets during initial periodontal therapy. Methods: Fifty-one patients(32male,19female) with periodontitis, displaying pockets 5 mm underwent periodontal examination at baseline and after four weeks: assessment of PI, BOP, PD, CAL at six sites/tooth. Maximal-values/quadrant and mean-overall-values of PD+CAL were considered. Patients received initial therapy according to the one-stage-Full-Mouth-Disinfection(Quirynen, 1995). Each quadrant of same-arch randomly received single subgingival application of novel chlorhexidine-xanthan-based-gel(Chlosite®,Ghimas,Italy) or chlorhexidine-gel PlakOut®,(Santa-Balanos,Greece). Patients used 0,2%chlorhexidine mouthwashes(Dentaton®,Ghimas,Italy),for following four weeks, OHI were reinforced. Wilcoxon test was used to compare differences between baseline and four weeks after, and differences between groups. Results: Both therapies resulted in significant improvements in all indices. At four weeks, in the "maximal-values/quadrant" data-group of Chlosite-treatment group, meanPD changed from 8.90±2.26 to 5.25±1.90(pConclusions: Following both approaches, there were significant clinical improvements. Additional single-topical subgingival-application of Chlosite was safe, providing more favorable CALgain and PDreduction than PlakOut. Keywords: periodontal non-surgical therapy, chlorhexidine xanthane based gel, split-mouth study

Introduction:This case report shows an interdisciplinary treatment approach in a 27 years old Patient with upper midline deviation, crowding in lower jaw and need for restoration in regio 2.4-2.5 as chief compliant. Materials and Methods:Midline deflection in upper jaw, aplasia 2.4 & 2.5, severe crowding in mandible and buccal non-occlusion of 3.5. The patient had a removable interim denture. She decided to undergo a comprehensive orthodontics-implantology therapy which consisted of extraction of 3 premolars and a dental implant for 2.4 after an intense consultation. Results:The upper midline deviation was corrected in 21 months using a fixed appliance and space for the dental implant regio 2.4 was created. The crown was fitted 4 months after the insertion of the implant. Vacuum formed retainer with occlusal adjustment in upper jaw and bonded lingual retainer in lower jaw were used to stabilize the result. Discussion:Extensive tooth movement can also be carried out in adult patient. A multidisciplinary treatment requires a good cooperation of several departments. Keywords: orthodontics, agenesis of tooth, dental implants, extraction

The displacement of the tooth into the adjacent soft tissue is a possible complication of a germectomy. This poster describes the management of a maxillary third molar germ that was forced into the retromolar aspect of the pterygomandibular space. Conventional radiographic techniques were inadequate in precisely locating the tooth. So we used a CT scan for its visualization and for the planning of the most careful access performing a virtual surgery. This plan was transferred into the intraoperative situs by the use of a maxillary splint added with CT-markers. Finally the tooth could be removed very simple and the adjacent soft tissue could be saved perfectly by using intraoperative navigation. Keywords: Komplikationen, Weisheitszahn, Computertomographie (CT), Intraoperative Navigation, Germektomie

Aims: In humans, it has been shown that treatment with theimmunosupressant drug cyclosporin A (CsA) leads to increasedlevels of fibrillar extracellular matrix (ECM) type-1 collagen in theconnective tissue of CsA-induced gingival overgrowth (GO). CsAalso up-regulates gene expression of type-III collagen andproteoglycans (PG). In this context it still remains unclearwhether this increase is associated with alter-ations of moleculesinvolved in the turnover of collagens and PG. Material and methods: The present study explores the status ofMMP-1 and -10 and their tissue inhibitor TIMP-1 on the geneexpression as well as on the protein level on frozen sections derivedfrom GO and normal tissue. Results: In situ hybridization (ISH) revealed elevated levels ofMMP-1 gene expression in the epithelial compartment of GOcompared with normal tissue. This elevation also applied to MMP-10, while MMP-10 gene transcription appeared generally stronger,rather than that observed for MMP-1. For TIMP-1, transcriptionlevels were week in normal and strong in GO tissue. Thesedifferences detected in ISH were corroborated by quantitativeRT-PCR. Detection of the protein by indirect immunofluorescenceshowed that normal gingival tissue was devoid of all three proteins,while they were detectable in GO tissue, with emphasis on TIMP-1. Conclusions: Analysis of our data indicates that in addition toMMP-1 and-10, particularly TIMP-1 may contribute to thepathogenesis of CsA-induced GO. Keywords: gingival overgrowth, cyclosporin, matrix-metalloproteinases, gene expression, gingival connective tissue

The aim of this in vitro study was to investigate changes in occlusion as a consequence of direct and indirect relining for distal extension removable partial dentures RPDs . 20 interim RPDs in the maxilla group 1 , 20 interim RPDs group 2 and 20 definitive RPDs group 3 in the mandible were relined with a light curing relining material. Each group included ten times the indirect technique, 5 times the direct mouth open technique and 5 times the direct mouth closed technique. Occlusal contacts were documented before and after relining 0= no contact, 1= contact .The indirect procedure showed for each denture design an ideal occlusal stability. The results of the direct, mouth open procedure revealed for interim dentures in the maxilla a loss of all occlusal contacts on natural teeth 0.0 and only reduced contact on the artificial teeth 0.6 . Similarities were found for interim and definitive RPDs in the mandible definitive RPD: natural/artificial teeth: 0.1/0.3; interim RPDS: natural/artificial teeth: 0.2/0.5 . The direct, mouth closed relining revealed good occlusal stability for all RPDS and artificial teeth 1.0 .The indirect relining is a reliable procedure for the preservation of occlusion in any of the tested RPDs. The direct relining technique revealed specific limitations not related to the material. Keywords: occlusal accuracy, removable partial denture, relining

The reconstruction of orbital fractures remains a challenge. Using computer assisted surgery (CAS) an intraoperative controll of the reduction allows for an effective and precise 3D reconstruction of the orbital caity in a single operation.The perliminary results of CAS orbital reconstruction based on cone beam CT scans (NewTom Model QR-DVT 9000, NewTom AG, Marburg) is repoted in five children (mean age 9 years). Preoperatively diplopia and enophthalmos was noted. The exported DICOM data were used with a STN workstation (Leibinger, Germany) for evaluation and preoperative planning and intraoperative CAS control of the orbital reconstruction.In 3 children younger than 9 years of age calvarium split grafts and in 2 children 11 and 13 years of age Titan-Mesh were used for orbital reconstruction by transconjunctival approach. The quality of the cone beam scans for CAS was comparable with standard CT scans. Two monaths postoperative none of the pediatric patients showed diplopia or enophthalmos. Keywords: cone beam ct, orbital reconstruction

A polylactide-polyglicolide(PLA-PGL) has been documented clinically to enhance bone regeneration in closed bone defects and to sustain periodontal healing in intrabony defects. So far, there are no controlled clinical studies to compare the effect of the PLA-PGL with the effect of other "biological agents" in treating deep intrabony defects. Aim of the study: to compare treatment of deep intrabony defects with PLA-PGL(Fisiograft®,Ghimas,Italy) to an enamel-matrix-protein-derivative(EMD; Emdogain®,Straumann AG,Waldenburg,Switzerland). Nineteen patients, displaying 26 intrabony defects, were randomly treated with PLA-PGL (test) or with EMD(control). Soft tissue measurements were made at baseline and 6 months after. No differences in the investigated parameters were observed at baseline between groups. Wilcoxon and Mann-Whitney tests were used for statistics. Alpha-error was set 0.05, the power-of-the-study 0.57. No adverse healing response was observed. Six months after, sites treated with PLA-PGL showed reduction in probing pocket depth (PPD) from 7.77±1.48mm to 3.38±0.77mm (p=0.001) and a change in clinical attachment level(CAL) from 9.08±3.57mm to 4.77±1.09mm (n.s.). In the group treated with EMD, PPD was reduced from 7.54±1.20mm to 3.85±1.28mm (p=0.001),CAL changed from 8.15±1.14mm to 5.85±1.28mm (p=0.016). No or little hard tissue fill was observed radiographically in the defects treated with PLA-PGL. Both treatments resulted in improvements of PPD and CAL. A statistically significant difference between the groups in favor of Fisiograft® group was observed with respect to CAL gain(p=0.029),no statistically significant PPD reduction difference between groups in favor of Fisiograft® was observed. At six months, both therapies seemed to lead to significant improvements of the investigated clinical parameters. Keywords: polylactide-polyglycolide, enamel matrix proteins, intrabony periodontal defects

The oily Calcium Hydroxide suspension Osteoinductal ® has been documented clinically and histologically to enhance the bone regeneration in closed bone defects and to stimulate the periodontal regeneration in intrabony defects. So far, there is only one controlled clinical study to compare the effect of Osteoinductal® with the effect of the enamel matrix protein derivative Emdogain® in treating deep intrabony defects, at six months after the surgery.Aim of the study was to compare at 12 months after the surgery the treatment of deep intrabony defects with Osteoinductal®, (Osteoinductal GmbH, München, Germany) to the treatment with the enamel matrix protein derivative Emdogain® (Straumann AG, Waldenburg, Switzerland).Seventeen healthy patients, displaying a total of thirty-six intrabony defects, were randomly treated either with Osteoinductal® (test) or with Emdogain®(control). Soft tissue measurements were made at baseline and 6 months following the therapy. No differences in any of the investigated parameters were observed at baseline between the two groups.No adverse healing response was observed in any of the patients. At 12 months after the therapy, the sites treated with Osteoinductal® showed a reduction in probing pocket depth (PPD) from 8.25±1.84 mm to 3.69±0.95 mm and a change in clinical attachment level (CAL) from 9.56±1.82 mm to 5.31±1.78 mm (p=0.001). In the group treated with Emdogain®, the PPD was reduced from 7.85±1.95 mm to 3.65±1.23 mm and the CAL changed from 8.35±2.28 mm to 5.05±1.76 mm (p Keywords: intrabony periodontal defects, oily calcium hydroxide suspension, enamel matrix proteins

Objectives: The purpose of this study was to compare the apical seal in root canals obturated with EndoRez and different gutta-percha techniques using a dye penetration model. Methods: Forty extracted single rooted incisors were endodontically prepared using the Hero 642 system. Root length was determined by insertion of a #10 file into the canal until it appeared at the apex. Working length was recorded 1 mm shorter. The teeth were randomly assigned to four experimental groups of ten each: A: single cone technique, B: lateral condensation, C: warm vertical condensation, D: Thermafil. After root canal filling, the teeth were coated with nail varnish, leaving the apical foramen exposed and stored in 5% methylene blue solution for seven days. Roots were sectioned transversally at each millimetre. The distribution of filling material in each canal was assessed by stereomicroscopic examination of four cross-sections on each tooth. Areas of gutta-percha (G), sealer (S) and voids (V) were measured on the digital images. Results: The total area of gutta-percha was not statistically different among the groups B, C, D (pConclusions: Within the limitations of an in vitro investigation Thermafil and vertical condensation produce a similar apical seal. Keywords: apical sealing, obturation, sealer

Aim: The purpose of the present study was to compare clinically the treatment of deep intrabony defects with an enamel matrix protein derivative (EMD) to access flap (AF) surgery, in an early evaluation at 6 months after the therapy. Methods: Twenty-five patients suffering from chronic periodontitis, and displaying a total of 32 intrabony defects, were randomly treated either with EMD (test) or with access flap surgery (control). Gingival parameters and soft tissue measurements were made at baseline and at 6 months following therapy. Results: No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 6 months after therapy, the test group showed a reduction in mean probing depth (PD) from 7.88±1.67 to 4.00±1.32 mm (pConclusions: Within the limits of the present study, it can be concluded that: (i) at 6 months after surgery both therapies resulted in significant PD reductions and CAL gains, and (ii) early evaluation (at 6 months) of the treatment with EMD resulted in no higher CAL gains and PD reductions than the treatment with access flap surgery. Keywords: enamel matrix proteins, intrabony defects, early evaluation

A clinically relevant number of fractures have impaired or delayed healing. New treatment methods that advance bone healing are, therefore, clinically desirable. In addition, it would be very helpful if these treatment methods could be used in conjunction with established methods. The aim of this study was to evaluate the influence of a single application of rhBMP-2 in the osteotomy line on bone healing in a sheep mandible osteotomy model. An osteotomy cut (width 0.5 mm) was made in the mandible, between the first molar and the mandibular nerve, using a standardised surgical procedure. After osteosynthesis, rhBMP-2 (280 µg in hyaluronic acid) was applied in the osteotomy line. The other sheep mandible site served as control. The animals were sacrificed after 4 and 8 weeks. Bone formation was measured using histomorphometric analysis and 3D-CT scans. Macroscopically, a larger callus formed after 4 and 8 weeks at the untreated mandible study site. 3D-CT scan measurements revealed that rhBMP-2 application led to a significantly lower callus volume after 4 and 8 weeks (p = 0.038). In the morphometric analysis, more than 40% of the untreated osteotomy lines were ossified after 4 weeks. When rhBMP-2 had been applied, 67.9% of the osteotomy line areas were ossified. In comparison to the untreated site, this difference was significant (p = 0.024). After 8 weeks, the ossified area of the test site had increased in comparison to the untreated site, and the difference was still significant (p = 0.021). Application of rhBMP-2 into the osteotomy line had a significant influence on bone healing. Therefore, clinical application of rhBMP-2 might be useful for fractures that are not entirely reducible or for defect fractures. In these cases, rhBMP-2 might correct the defect and lead to an earlier stability. Keywords: rhBMP-2, Knochenheilung, Histomorphometrie

Background: No recent informations exists on periodontitis-associated subgingival microflora of the Romanian population. The occurrence, the interspecies relationships and the relationship with the basic clinical parameters for a group of five periodontal bacteria were determined in a Romanian study population. Methods: Subgingival microbial pool samples were obtained from patients with localized (LagP = 16), generalized (GagP = 24) and chronic periodontitis (CP = 14). A polymerase chain reaction technique was used to detect Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis (formerly Bacillus forsythus), Treponema denticola and Prevotella intermedia. The chi-square and Kruskall-Wallis non-parametric tests were used to assess the differences between the 3 diagnostic groups. Results: In all germs, excepted Aa, the detection frequency did not significantly differ between the CP, LAgP and GAgP groups. The detection frequency of Aa significantly differs, continuously increasing between the CP, LAgP and GAgP groups (p=0.016). The mean proportions of Aa was higher in GAgP than in LAgP and CP respectively (p=0.005). The mean proportion of Td was higher in LAgP than in CP and GAgP respectively (p=0.028). Conclusions: Results demonstrate that the five periodontal pathogens analyzed are strongly associated with Romanian periodontitis. In particular, Aa are more significantly associated with generalized aggressive periodontitis, while Td are more significantly associated with localized aggressive periodontitis. Keywords: periodontal pathogen microflora, Romanian population

A life threatening bleeding of intraosseous arteriovenous malformations of the mandible was successfully managed by embolisation and secondary reconstruction. Mandibular form and function in the pediatric patients were reconstructed using bone grafts in combination with osseointegrated dental implants. Keywords: child arteriovenous intraosseous malformation life threatening

Aim: Oral Health related quality of life (OHQoL) in dentistry is gaining increasing importance. To properly estimate and interpret information about OHQoL characteristics of the Oral Health Impact Profile (OHIP) and their influencing factors have to be examined.Aim of the following study was to characterise dimensions and reveal influencing factors of OHQoL by means of a patient sample of the Dental School Dresden. Material and Method: 112 patients of the Dental School Dresden who had not been to a dentist within the last three months and were 18 years or older had been surveyed as part of a multicenter study. After self completing of the OHIP (49 questions), clinical and sociodemographic data were recorded based on a dental examination. The statistical approach comprised multivariate stepwise logistic regression Analyses. Results: Two thirds of the patients were women; the average age was 52.6 years. 46 % of the patients had 25 or more teeth, 7% were edentulous. 68% of all patients showed general treatment need.In the univariate Analyses the median of the OHIP sum-score (OHIP-ADD) was 12; the 75. Percentile was OHIP-ADD=27. The OHIP-ADD median of patients with 9 - 16 teeth (OHIP-ADD = 42) and with surgical treatment need (OHIP-ADD= 30) were remarkably high. In multivariate statistical analyses prosthetic treatment need (p=0.007) and missing anterior teeth (p=0.03; regardless whether replaced or not) were significant explanatory variables for the model. Conclusion: In this sample, OHQoL can be explained by the clinical variables prosthetic treatment need and location of missing teeth (regardless of replacement) but not or to a letter extent by sociodemographic factors like gender, age and level of education. Keywords: Mundgesundheit, Lebensqualität, OHIP, multivariate Statistik