International Poster Journal of Dentistry and Oral Medicine, 04/2017

Aim: Around four million people are affected by a rare disease and 15 per cent can become manifest in the orofacial region, e.g. craniofacial dysplasia such as cleft lip and palate, dysgnathia, and hypodontia. Orthodontics forms a major field in rare diseases. Dentists and orthodontists are often the first to come in contact with young patients who are affected by a rare disease. There are no guidelines in dentistry on how to treat patients with rare diseases or which orofacial manifestation can help to find a diagnosis. The aim is to establish a 'database for orofacial manifestations in people with rare diseases - ROMSE' in order to improve diagnosis and treatment. To allow a standardised documentation of orthodontic cases, it is necessary to unify the classifications of dysgnathia. Materials and method: Since 2011 material from various databases such as Orphanet, OMIM, and PubMed, was evaluated. Starting in 2013 the gathered information was incorporated into a web-based, freely accessible database at http://romse.org. The dysmorphological classification should be the guideline for orthodontists to classify the dysgnathia and to standardise the documentation of people with rare diseases. The classification form is freely available at the ROMSE website. Results: So far 529 rare diseases with orofacial manifestations have been listed in the ROMSE database. About one-third of those diseases or syndromes show dysgnathia. Especially the sub-classification of dysgnathia seems to be difficult since most of the patients were not analysed according to a standardised classification. Wrong or double assignments are the result. Conclusions: Rare diseases and their symptoms come with difficult challenges regarding their therapy. By setting up a ROMSE, a platform is provided for dentists and orthodontists to work on interdisciplinary treatment strategies. A consistent and beyond dentistry classification of dysgnathia can avoid wrong assignments. Keywords: rare diseases, dysgnathia, orthodontics

Background: Nowadays, implant treatment in the aesthetic zone is made according to anatomical and esthetic rules. There are a number of criteria for deciding the design of the future construction and smile. Software options give different approaches for making the measurements for the size, shape, and the correct position of each tooth, taking into account the golden rules of aesthetic and proportion. It has also been proven that the psychology and characteristics of the personality give the smile specific look, which is represented in the concept of Visagism. Aim: To determinate the position of the implant according to the future smile design, based on the face reading and the psychology of the patient. Materials and Methods: 34 implants were placed on 21 patients in the in the aesthetic zone. The vertical position of each implant was placed at a distance between 2 and 3 mm of the CEJ of the future restoration. For the smile design, computer software was used which uses the facial reading as well as the psychological characteristics and wishes of the patient according to the Visagism concept. Based on that project, a wax-up was created in the dental technician lab, and a surgical guide for the implant site preparation was prepared. The first provisional was designed in order to create a volume of soft tissues around the implant, and a second provisional according to the smile design was placed for a final contouring of the gingival margin. After the final soft tissue contouring, an impression was taken, and a final restoration was designed, following the recommendations of the software. Results: All of the 32 implants were positioned in the bone according to the guide, based on the anatomical background and the project of the final restoration. All the implants were perfectly ossteointagrated, and there was no bone loss or soft tissue remodeling after the 3-year recall period. All patients were satisfied with the design of the smile that was proposed by the Visagism software. The two provisionals concept created stabile and well designed soft tissue contour. Conclusion: The concept of planning implant position according to the Visagismile software and soft tissue management with two provisional restorations is a way to achieve predictable aesthetic results. Keywords: Visagism, implant treatment, planning of the implant position, aesthetic result

Introduction - Objectives: Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive disorder characterised by palmoplantar hyperkeratosis combined with severe periodontitis. PLS is caused by loss of function mutations in the cathepsin C (CTSC) gene. CTSC is a lysosomal enzyme of polymorphonuclear leukocytes. It plays an essential role in the host's defense against bacteria. The eruption of the deciduous teeth is mostly associated with gingival inflammation and subsequent rapid destruction of the periodontium. Thus, the primary dentition is usually exfoliated prematurely. The same severe aggressive periodontitis occurs in the permanent dentition, leading premature destruction of periodontal tissue. Preventing excessive tooth loss seems to be hardly attainable. Early case reports on periodontal treatment in PLS patients described unsuccessful outcomes. Thus, tooth loss leading to edentulism seemed to be an unavoidable part of this syndrome. However, since the early 1980s, more and more cases have been reported treated by different therapy protocols with controversial success rates. The aim of this systematic review was to evaluate the outcome of the reported therapy regimens of PLS-associated periodontitis and to provide an evidence-based protocol for clinicians for treating periodontitis in these patients. Material and methods: Based on a structured protocol, a literature search was performed using two databases (MEDLINE and the Cochrane Oral Health Group specialist trials register). In addition, reference lists of original and review articles were searched. Articles published from January 1980 until April 2016 in English or German were considered if they reported therapy modalities and therapy outcomes in PLS-associated periodontitis. The search protocol was structured according to the guidelines of the PICO Format: P (patients): PLS patients in all age groups; I (intervention/exposure): therapy of periodontitis as a manifestation of PLS; C (comparison): different therapy regimes; O (outcome): tooth loss or periodontitis progression. Only articles with a minimum of 1 year observation time were included. Two reviewers independently extracted papers of interest. Results: 1140 articles were identified in the primary search, whereas 15 additional articles were found by hand. After applying the inclusion/exclusion criteria and removing duplicates, 43 publications (case reports, case series and one prospective study) were included in the review (Fig. 6). 92 patients (aged from 2 to 34 years) with a follow-up time between 1 year and 33 years were analyzed. Two promising therapeutic protocols were found: 1. Start of therapy in the first dentition: Extraction of all deciduous teeth 6 months before eruption of permanent teeth and/or all erupted permanent teeth (tooth-less phase), followed by the prescription of antibiotics to eliminate all niches 6 months before the breakthrough of the first permanent teeth 2. Start of therapy during mixed dentition/ permanent dentition: Oral hygiene instructions and prophylaxis, extraction of teeth with advanced periodontitis, anti-infectious therapy (mechanically and adjunctive systemic antibiotics, mouth rinses with chlorhexidine) Both modalities are combined with antibiotics, close monitoring, and maintenance therapy. Recommended antibiotics are amoxicillin or amoxicillin + clavulanic acid or amoxicillin + metronidazole. 18 reported cases were treated using the first protocol as well as seven additional cases with a tooth-less period during mixed dentition or of permanent dentition. 22 out of these 25 patients (88%) showed stability in periodontal conditions during follow-up time (1 to 15 years). Other treatment regimes resulted in periodontitis progression in 31 % of cases. In the one prospective cohort study, two out of 13 patients with early treatment initiated before the eruption of the first permanent tooth lost teeth (8 lost teeth) during follow compared to 12 out of 22 patients (99 lost teeth) with treatment starting later following protocol two (Ulbro et al. 2005). Only a few cases (N = 10) were treated by implant therapy. Osseointegration seems to be possible in PLS patients. However, peri-implantitis and implant loss have also been reported. Long-term results are not yet available. Conclusion: Periodontal treatment of PLS patients remains challenging. Therapy concepts that include a tooth-less period seem to have promising results in the long run. The use of adequate adjunctive antibiotics is obligatory. The success rate is strongly affected by patients' compliance; stringent maintenance therapy, including mechanical and antibiotic re-treatment if needed, is a major determinant for preserving permanent teeth in these patients. Long-term results are limited in the literature. Further monitoring of the published patients or new controlled studies with higher patient numbers and long-term observation are necessary for the evaluation of the described therapeutic protocols. Keywords: Periodontitis, periodontal therapy, PLS, Papillon-Lefevre syndrome

Introduction: Traumatic occurrences in the area of the chewing muscles, involving subsequent temporary functional restrictions, may be caused by the impact of external forces, or may have their origin in iatrogenic surgery. This includes, in particular, not only the consequences of dental surgical operations, such as extractions and operations to remove teeth, but also complications arising from the use of local anaesthetics. Rare complications are also well-known, such as inflammatory swellings and a temporary trismus. Any long-term trismus, however, is rather associated with a craniomandibular dysfunction. What is less well-known is an ossification of the chewing muscles as a result of a traumatic or idiopathic incident, such as can occur with myositis ossificans. A distinction must be made between a local, traumatic form (myositis ossificans traumatica) and a progressive form with genetic causes (myositis ossificans progressive). Case study: In April 2016, a 28-year-old male patient came to us because of a long-term trismus which showed no pain symptoms. This had been preceded by dental fillings in the right mandible which had involved a block anaesthesia. Approximately four weeks later, the patient noticed a clear restriction in his ability to open his mouth. After conservative treatment had failed, an operation was carried out under intubation anaesthesia to remove 18 and 48. Immediately after the surgery there was an extensive remission of the functional restrictions. About two weeks after the surgery, the patient's restricted ability to open his mouth returned. The patient was taken into hospital, where a coronoidectomy was carried out on the right side. This too resulted in a temporary improvement in the patient's ability to open his mouth, followed, however, by a relapse. A second operation was carried out at our clinic with the working diagnosis of myositis ossificans traumatica. A genetic cause in the sense of myositis ossificans progressiva was ruled out beforehand. Summary: The etiology of myositis ossificans traumatica has not been conclusively explained so far. The literature mostly contains case studies from the field of orthopaedics. There are only sporadic reports on myositis ossificans traumatica in the chewing muscles. Any clear recommendations on strategies for treatment are either absent or contradictory. The intention of this case study is to add further information to the few cases described and to provide an overview of the existing literature. Keywords: myositis ossificans, myosistis ossificans traumatica, heterotopic ossification

Introduction: The 2005 WHO classification distinguishes four types of ameloblastoma: solid/multicystic, extraosseous/peripheral, unicystic, and desmoplastic. Desmoplastic ameloblastoma is classified as a variant of ameloblastoma, with specific clinical, radiological, and histopathological features. Most tumours occur between the ages of 30 and 60, and there is no gender-specific predilection. There are practically no occurrences of desmoplastic ameloblastomas before the age of 20. In most cases, it is the anterior mandibular region that is affected. Immunohistological, tumour-associated markers such as p63 may be increased in the case of a desmoplastic ameloblastoma. The aim should be an excision involving an appropriate safety distance. Case study: In May 2016, a 60-year-old male patient was referred with a swelling in the premolar/molar region of the left mandible This had been preceded by an operation to remove tooth 38, carried out by a registered oral surgeon. As the spongiosa in the vicinity of tooth 38 seemed conspicuously "soft" to the surgeon, he prescribed a histopathological examination. This found fibrotic tissue, giant cells, and reactive new bone formation with signs of active remodelling. Any malignant process was expressly ruled out, as was an ameloblastoma. We for our part prescribed three-dimensional imaging using CT, and the finding was a "tumorous infiltration of ramus and corpus mandibulae". Another biopsy, carried out with intubation anesthesia, was interpreted in the histopathological finding as a "moderately differentiated squamous cell carcinoma". There followed the partial resection of the mandible with a joint replacement and neck dissection on one side. The histopathological finding classified the excised material as a "desmoplastic ameloblastoma". This unusual histopathological finding was sent to the DOESAK registry for a second opinion, and the final diagnosis of "sclerosing odontogenic carcinoma" with perineural infiltration was made. Summary: Sclerosing odontogenic carcinoma might mimic a benign tumor. Thus, an interdisciplinary approach taking into consideration all clinical, radiological, and histopathological features is highly recommended to avoid misdiagnosis and false treatment. The case in question thus underlines the necessity of also taking a critical look at histopathological findings. Wisdom teeth not worth preserving should be removed at an early stage to avoid the consequences mentioned above.

Although implants connections limit the effects of excessive occlusal forces, it seems obvious, according to the laws of elementary biomechanics, that the vertical axis resultant of mandibular implant systems should be aligned to an ideal closing axis perpendicularly to the closing radius. Consequently, three approaches (theoretical, experimental, and clinical) are used to propose a new way of positioning the implants for the mandibular implant-supported fixed dental prosthesis. The objective of this poster is to present a new approach while maintaining the principle of orthogonality at the closing radius. The theoretical part was supported by a cone beam computed tomography (CBCT) study on 211 half mandibles (from Vienna collection - R. Slavicek); the poster presents the experimental part. Keywords: Dental implant, dental biomechanics, occlusal forces, edentulous mandible

Introduction: The concept of food addiction has gained popularity in recent years. This concept purports that certain foods (such as food with high palatability, high caloric value, and foods that are highly processed) have addictive potential. Sugar addiction represents a specific case of food addiction whereby the addictive substance is a specific nutrient, namely sugar, which is usually sucrose. Objectives: To discover evidence for whether sugar has addiction potential in humans or not. Material and Methods: A literature survey was carried out in electronic data bases like PubMed, PubMed Central and Google scholar using the keyword "Sugar addiction". Of 91 search results (from 1/1/2000 till 30/9/2016), after application of the inclusion and exclusion criteria, 10 articles were included in this review. Results: In the literature, addiction has been characterised by four stages: bingeing, withdrawal, craving and sensitisation; sugar has shown all these stages in various studies. Animal studies have shown that sugar and other sweet substances result in the production of neurochemical substances such as dopamine, endogenous opioids, and acetylcholine in the brains of animals. In humans, evidence showed that sugar and other sweet substances can induce craving that is comparable to those induced by cocaine and have also showed that a liking for carbohydrate sugar beverages increases over time [p 0.05]. Conclusions: Strong evidence has been found that foods that have more sugar content and high palatability can induce a reward and craving comparable to addictive drugs. However, more research in humans is clearly needed to confirm this conclusion as most of the studies are on animals. Dental Public Health Significance: Sugar addiction has been found to be related to an increased incidence of obesity, cardiovascular diseases, and diabetes as well as dental caries around the world, which makes it a major public health problem. Keywords: Sugar addiction, plausibility, bingeing, withdrawal, craving

Objectives The dental treatment in the Tanzanian highlands is challenging. Due to the reduced infrastructure, the caries prevalence and subsequently the prosthetic treatment demand of the local population is heavily increased. The aim of this study was to investigate the general oral health situation of dental patients in a non-urban region of Tanzania. Methods: 1521 patients were included in this study (937 female, 582 male; age 20.4 ± 10.5 years, range 3 to 82 years). Patients were treated in a dental office in Njombe. dmft-Index (0-6 years) and DMFT-Index, edentulousness situation, nutrition habits, and socio-economic factors were collected. Results: The dmft-Index of the treated patients was 4.5; the DMFT-Index was 5.8. Massive sugar containing nutrition was detected anamnestically in 44.9% of the study participants. 59.74% of the patients suffered from general dental plaque, and 31.94% showed isolated dental plaque. In 8.30% of the investigated patients, no dental plaque was detectable. In 97.83% of the patients, oral hygiene products were known. 21.63% of the study participants required treatment for an acute malocclusion. Conclusions The oral health situation of the patients showed a restorative and prosthetic treatment demand. In addition, the education of sufficient oral health and the dissemination of oral health products are imperative. The main goal of further studies must be the development of interdisciplinary infection prophylaxis and oral health prophylaxis systems. Keywords: caries incidence, Tanzania, general oral health, epidemiology

Introduction: Herpes simplex virus type 1 (HSV-1) reactivation can be induced by physical and chemical stress stimuli and/or with immunosuppression. Recurrent intraoral herpes (RIH) induced by a female sex steroid hormonal imbalance as a result of an adverse effect of oral contraceptive pills use is rare. Case report: A 40-year-old female patient presented with an 11-year history of recurrent oral ulceration. Drug history of oral contraceptive pills use for 16 years and of amenorrhea for the past 4 years were confirmed. Intraoral examination revealed multiple coalescing ulcers on the ventral tongue, palate, labial, and buccal mucosa. Serological test showed that anti-HSV-1-IgG was reactive. A female sex steroid hormone test showed low levels of estrogen and progesterone. Diagnosis of RIH induced by a hormonal imbalance due to oral contraceptive pills was made. Oral acyclovir-methylprednisolone combined therapy was given. RIH resolved in a 3-month follow-up. She had her periods back after stopping the pills and switching from oral contraceptive to intrauterine device (IUD). Discussion: RIH can be induced by a low level of female sex steroid hormone in an estrogen receptor-dependent manner. A low level of estrogen may inhibit cytotoxic responses of CD8+ T cell and by a leukocyte-independent effect on infected neurons resulting in susceptibility of oral mucosa to HSV-1 reactivation. The persistence of atypical lesions can be effectively managed by oral acyclovir-methylprednisolone combined therapy. Conclusion: Hormonal imbalance as one risk factor of RIH is important to be considered for preventing its recurrence. Oral acyclovir-methylprednisolone combined therapy and switching oral contraceptive pills to IUD showed a benefit in RIH treatment. Keywords: Hormonal imbalance, oral contraceptive pills, recurrent intraoral herpes

Objective: One of the fundamental principles of orthodontic diagnostics is the measurement of study models. The aim of the study was to assess the suitability of 3D-printed models for metric orthodontic model analysis. Material and method: Ten Alignat impressions were taken from a Frasaco model (upper and lower jaw in habitual occlusion) and ten gypsum models made of plaster. The Frasaco model was also digitised with a 3D model scanner with a resolution of 10 μm (S600 Arti, Zirkonzahn GmbH, Gais, It). The digital model was reconstructed in OnyxCeph 3D Lab (ImageInstruments GmbH, Chemnitz) and exported for 3D printing. Ten model pairs were printed with a DLP (digital light processing) printer (SHERAeco Print D30 with SHERA model fast, Material-Technologie GmbH & Co. KG, Lemförde, Germany) and an FDM (Fused Depostion Molding) printer (Geeetech i3 Prusa, Getech Co. Ltd., ShenZen, PRC) with polylactide. The Frasaco model was measured ten times and all the other models once with a digital caliper (PeWe Tools Ltd, Trochtelfingen); the data were directly imported via USB interface. The key figures such as overbite, overjet, arch width, SI, si, Tonn, and the Bolton relations were determined. Results: For the measurement of the Frasaco model, 0.05% confidence intervals of ± 0.05-0.1mm and a mean standard deviation of 0.12mm were obtained. In the statistical analysis of the measured values by means of ANOVA with paired Mann-Whitney tests, only significant differences were found in the si, with 0.3 mm magnification for FDM models and a deviation of 0.4 mm reduced overbite in gypsum models and FDM models compared to the original. Conclusions: The measurement of study models with a digital caliper has an extraordinarily high degree of accuracy. Both the printed models, independent of the printing process and thus the virtual model, showed only minor deviations from the original in the examination. Virtual models, printed models, and gypsum models can be regarded as equivalent for orthodontic diagnostics. Keywords: 3D printing, orthodontics, CAD/CAM