International Poster Journal of Dentistry and Oral Medicine, 03/2003

Objective: To evaluate radiographic measurements for use as prognostic factors for healing of class II furcation defects following regenerative therapy. Material & Methods: In 17 patients (8 female), 33 class II furcation defects [mandibular buccal (n = 12) and lingual (n = 12), and maxillary buccal (n = 11)] were treated using the barrier membrane technique. 26 furcations were treated using a bioabsorbable membrane, while a non-resorbable membrane was used to treat the remaining 7 furcation defects. Clinical parameters and standardized radiographs were obtained before as well as 6 and 24 months after therapy. All radiographs were digitised and evaluated by an examiner blinded to the clinical data. The following distances were measured: cemento-enamel junction line (CEJ-line) to alveolar crest (AC) at the furcation site (AC-CEJ line), CEJ-line to the furcation fornix (Fx-CEJ line), width of the furcation at the level of the AC (FW) as well as the distance from Fx to a straight line between the AC mesial and distal of the tooth (Fx-AC line). Results: Statistically significant (p Conclusion: The analysis of presurgical radiographs may yield information on the success of regenerative therapy of buccal and lingual class II furcation defects. A long root trunk, a wide furcation entrance, and an Fx coronal to the AC have negative influences on the success of therapy. Further, a deep probing depth at the furcation site at baseline increases the likelihood for more favorable horizontal attachment gain in furcations. Keywords: Gesteuerte Geweberegeneration, Grad-II-Furkationsdefekte, Röntgendiagnostik, Messung linearer Distanzen

The aim of this longitudinal study was to assess detailed the status of pits and fissures in permanent molars to get information regarding their need of preventive care. 369 Westphalian children born in 1989 were examined as 8-yr-olds (1997) and as 10-yr-olds (1999). The surface-related caries status according the WHO criteria (1997) was completed by scoring non-cavitated carious lesions. Additionally, sealants in fissures and pits were recorded. A caries free mixed dentition was found in 36 % of the 8-yr-olds and in 39 % of the 10-yr-olds, resp. The caries prevalence was 2.4 dft/ 5.2 dfs/ 0.4 DMFT/ 0.5 DMFS at the age of eight and 1.5 dft/ 2.9 dfs/ 0.6 DMFT/ 0.9 DMFS at the age of ten. 0.3 DS were registered on the occlusal surface of first molars in 8-yr-olds and 0.4 DS in 10-yr-olds. 1.0 fissure sealants were scored in 8-yr-olds and 1.4 10-yr-olds. Sealed pits were rarely scored: 0.1 in 8-yr-olds and 0.2 in 10-yr-olds. The number of non-cavitated occlusal fissures raised from 0.8 in 8-yr-olds to 1.4 in 10-yr-olds. 0.7 initial carious pits were registered in 8-yr-olds and 1.0 lesions were found in 10-yr-olds, resp. We conclude that sealant application financed by insurance companies since 1993 for 6- to 17-yr-olds should be used more frequently by German general dental practitioners. On account of the increasing numbers of non-cavitated lesions sealants are highly effective to prevention caries in fissures and pits. Keywords: epidemiology, caries prevalence, fissure sealants

This study was designed to evaluate the effectiveness of a WHO-supervised school based preventive program for Filipino children. 19 primary schools in deprived communities of rural areas in Northern Mindanao had been selected to take part in the program. By using WHO criteria (1997) one dentist examined 1574 children with an mean age of 7.1 years. The percentage of caries free children was 8.8. Caries prevalence was 1.2 DMFT (± 1.4) and 7.2 dmft (± 5.1). Fillings were not recorded in both dentitions. The mt value was 0.2 (+ 0.7). The preventive program focused on preventive (dietary control, supervised toothbrushing with a fluoridated toothpaste, professional application of fluoride varnish). In order to cope with the high treatment need invasive measures (extractions of deciduous teeth, ART-fillings in permanent teeth) had to be included too. 1162 children with a mean age of 10.2 years were re-examined after three years. The percentage of caries free children was 16.2. Caries prevalence of 1.6 DMFT (± 1.8) was distributed to 0.5 DT, 0.2 MT and 0.9 FT component. The increment of 0.4 DMFT and the distribution of the DMFT components in high caries risk Filipino children reflect the effectiveness of a comprehensive dental care approach. Extractions of carious deciduous teeth and ART-restorations in permanent teeth might be an important impact for reducing the microbial infection in the oral cavity. We conclude that invasive measures seem to be a prerequisite for the caries preventive effect of daily toothbrushing with fluoridated toothpaste in children with high caries experience, particularly in the mixed dentition. Keywords: caries prevalence, Philippine, preventive programme

Aim of this in-vitro study was to assess the intra- and inter-examiner repeatability of electrical resistance measurements of occlusal surfaces. This study comprised 117 carefully cleaned molars with sound and/or non-cavitated occlusal surfaces. All specimen were investigated independently by four dentists using the ECM device (Lode Diagnostics, The Netherlands) and six dentists using the Cariometer CRM 800. All dentists were familiar with the mode of function of these devices. The measurements were carried out site-specific without using contact gel. After an interval of one week, the same dentists reproduced the readings for assessing the intra-examiner repeatability. Inter- and intra-examiner repeatability were calculated using Lin's intra-class correlation coefficient (ICCLin), scattergrams and residual plots by Bland and Altman (1990). The ICCLin for the ECM device revealed a higher intra-examiner repeatability of 0.69 in comparison to 0.59 for CRM 800. The mean ICCLin for the intra-examiner reproducibility was 0.62 (ECM) and 0.67 (CRM 800), but the variability of inter-examiner readings was greater for CRM 800 (ICCLin 0.37 - 0.83) than for ECM (ICCLin 0.64 - 0.75).The limits of agreement (confidence interval of 95 %) showed for the intra-examiner repeatability (ECM) a deviation of -72.2/+62.2; the values for the inter-examiner repeatability amounted to -65.9/+62.4. The interval of limits of agreement were estimated for the CRM 800 between -4.4/+2.8 (Intra) and -1.9/+4.9 (Inter), respectively. Based on this in-vitro investigation it can be concluded, that the repeatability of both devices showed markedly deviations. The clinical use of these instruments can be only recommended in combination with other diagnostic methods. Keywords: Kariesdiagnostik, Elektrische Widerstandsmessung, Reproduzierbarkeit

The aim of this clinical study was to evaluate the diagnostic outcome of the detection of smooth surface lesions by the Quantitative Light-induced Fluorescence (QLF) method (mirror version) in comparison with visual inspection (VI). 34 fifteen-year-old adolescents were involved in the study. After professional tooth-cleaning 918 buccal and 917 lingual surfaces of the subjects were examined visually with aid of compressed air and magnifying glass (3.5x). Fluorescence images of the smooth surfaces were captured by a CCD camera after excitation with blue light (lmax. 404 nm). A computer programme (Inspektor QLF 2.00) was used to display, store and analyse the images. QLF images were analysed blind by two examiners, presence or absence of a lesion was not marked on the fluorescence images. Average fluorescence loss (DF) of the lesion, the area (A) of the lesion (mm2) and DQ (DF * A) were determined. After exclusion of all surfaces scored as sound, filled or with frank lesions by both methods 17.8% of the buccal/lingual initial enamel lesions (n=489) were detected by VI, 53.8% by VI + QLF and 28.4% by QLF, respectively. There was a significant difference (Mann-Whitney U-test) of the parameters A, DF and DQ between smooth surface lesions recorded by VI + QLF and QLF only. QLF was able to detect smaller enamel lesions with smaller fluorescence loss than VI + QLF. It was concluded that QLF is a sensitive method suitable for quantification of visual undetected incipient caries lesions. Lesion detection by QLF was limited in cases of partially erupted surfaces and of small focal depth on lingual surfaces as well as in patients with poor oral hygiene associated with reduced surface size caused by gingivitis. Keywords: caries detection, optical methods, quantitative light induced fluorescence

Positive effects of modified distraction protocols like callusmassage, distraction-compression-technique, dynamisation etc. on bone quality and healing process have been widely published in the field of orthopaedic surgery.Problem: The use of modified protocols for VDO in our field has not been published yet.Report of cases: Two clinical cases will be presented, that underline possible applications in our field and include 1. callusmassage, a cyclic, low frequent stretching of the regenerate beyond the period of distraction and 2. calluscompression, a modifikation which involves a single, 2-3mm recompression after complete distraction.Conclusion: The first clinical applications appeared to be most efficient under depressed healing conditions and lead to the necessity for a controlled experimental evaluation of the numerous possibilities of dynamisation in our field. Keywords: distraction, modified, protocol, bone, quality

Aim:The aim of this study was to investigate clinical experiences with stabilised autologous venous blood coagulum after SCHULTE, over a 10-year period. Material and Method:During the period from 01.01.1990 to 31.12. 2000, 175 in-patients had a cystectomy with the defect filled in with SCHULTE coagulum. The extent of each cyst was measured on the orthopantomogram and calibrated using a test specimen X-ray. Post-operative rates of infection and nerve function disturbances were analysed retrospectively. Results:53.1% of the cysts were follicular and 20.6% were radicular. Residual cysts appeared with a frequency of 19.4%, other osseous lesions at 6.9%. The average diameter of the treated cystic lesion was 25 mm (max. 65mm). There was serious post-operative infection in only 5 cases, and mild post-operative infection in 11 cases. No patients had nerve function disturbances and pathological fractures were not noticed. In 159 cases real reossifications were observed under X-ray at the one year check up. The SCHULTE stabilised autologous venous blood coagulum method for covering bone defects in the mouth is low in risks, easy to implement and, not least, reasonably priced. It could, therefore, also be used for pre-implanting measures. Keywords: intraoral bone defect, defect reconstruction, SCHULTE-Koagulum

In the literature there are few individual reports about fatal conditions after tooth extraction in regions with central hemangiomas. The X-ray examinations are often not pathognomonic and may lead the dentist to misdiagnosis. We report on two children with intraosseous hemangioma of the mandible, which suffered from excessive periodontal bleeding on the occasion of conservative dental treatment. Up to 49 interventions under general anesthesia in one child had been performed to treat the haemangioma with arterial embolisation, surgical procedures and coiling. None of these methods could permanently prevent further bleeding. Using a new method of direct radiographically controlled intraosseous embolisation with histoacrylic agents, both central haemangiomas could be permanently eliminated and secondary bone resection could be performed without additional blood supply. To our knowledge this is the first report on successful permanently direct transosseous embolisation of central haemangiomas in human. By means of this case reports we point out the life threatening danger of undetected central haemangiomas in the dental office and we demonstrate an appropriate treatment using radiograhically controlled intraosseous embolisation and subsequent secondary stage resection of the mandible and its reconstruction. Keywords: Hämangiom, AVM

Topic: Hair transplantation into the cleft lip scar - revisional surgery in male patients Introduction: An upper lip scar often produces psychological discomfort in male cleft patients. They like to wear a mustache to improve profile and appearance and cover up the defect. For the first time Dieffenbach ( Würzburg/Germany) transplanted hair to himself in 1822. Crusius (Berlin/Germany) was the first to use single follicular units for grafting hair as an eyelash replacement in 1914. Today hair transplantation is a routine procedure in aesthetic surgery. Aims: To analyse the long-term outcome of hair replacement using double or single follicular unit hair grafting as the last step in touch-up surgery of cleft lips. Material and Methods: We performed hair transplantation to the upper lip in 10 male patients, 8 of these had an unilateral and 2 a bilateral cleft lip. Each one of these had a mustache with a visible scar.A thin strip of donor hair was taken from the back of the patients scalp and transferred to the lip. This was performed as an out-patient procedure under local anaesthesia. 20 to 70 single and double follicular hair units per patient were used depending on the size of the scar. The recipient area was prepared with a skin punch (diameter: 0.9 mm) and a drill. Results: 9 patients showed successful growth of hair after 6 months with a 'take' of 50 to 80 % . In one case there was only 20% growth. In 5 cases with a unilateral cleft one session was sufficient to achieve the desired result. In 3 unilateral and 2 bilateral cleft patients a second session was necessary to improve the hair density. In 3 scars donor hair shape and colour was obviously different; in 6 of 10 cases the direction of hair growth was different when compared to the mustache. Despite of all this, 8 patients were extremely satisfied. Conclusion: Hair replacement using donor hair from the back of the scalp is a new and successful touch up in cleft lip repair. It is a reliable treatment option to cover completely the upper lip scar. Keywords: Haartransplantation, Oberlippennarbe, Lippen-Kiefer-Gaumen-Spalte, hair transplantation, cleft, cleft lip scar

The cases presented in this article demonstrate an alternative treatment method for restoring anterior teeth using single-tooth implants. In this method, anterior teeth with a negative prognosis are extruded, using a simple orthodontic device consisting of two molar bands, a transpalatal arch, and a titanium arch that optionally may be attached lingually to improve esthetics. When this device is inserted and activated, the sorrounding soft tissues will be remodeled in the direction of extrusion. After a retention period of three month, the teeth can be extracted. The implants can often be inserted during the same treatment session. The method presented creates a sufficiently extensive implant bed, minimizing the risk of gingival recession, papillary loss, and implant surface exposure. Keywords: Weichgewebemanagement, kieferorthopädische Extrusion, Implantation, Ästhetik

Aims: Refinements of the transoral endoscopic assisted open reduction and miniplate fixation of condylar mandible fractures using new instruments is demonstrated. Subject: The transoral endoscopic assisted treatment in 12 consecutive patients with condylar fractures was performed at the University Hospital Freiburg. From February 2000 to January 2002 new instruments (Synthes USA) for the endoscopic reduction and fixation of condylar fractures were used by limited transoral incisions. In eight out of the12 patients no intermaxillary fixation (IMF) was performed after a stable anatomic reduction was demonstrated endoscopically at the posterior border of the ascending ramus. In four patients IMF was performed for five days postoperatively due to bone loss at the fracture side or reduced dentition. Results: The mean operating time without IMF was 1 h 50 min. Anatomic reduction and uneventful healing with early recovery of the patients were noted clinically and by postoperative radiographs. There were no signs of malocclusion in the group of eight patients without IMF. Good postoperative function with mouth opening without deviation and limitation on lateral extrusion was evaluated after 4 weeks. Conclusions: The endoscopic assisted transoral approach proved to be a reliable surgical method for the open treatment of condylar fractures. Special instruments for the fracture reduction and angulated drills and screw driver facilitated the management of the condylar fractures. Keywords: condylar fractures, endoscopic approach, instruments for reduction, minimal invasive surgery

Introduction and Aim: Vascular endothelial growth factor (VEGF) as an angiogenic cytokine is a potent growth factor for endothelial cell proliferation. Its level has been proven to be elevated in systemic scleroderma (SSc) as well as in periodontitis. It was the aim of this study to demonstrate whether VEGF-levels in immunostained gingival biopsies quantified by histomorphometry may be regarded as a specific risk indicator for the progression of SSc with periodontitis in comparison to periodontitis alone. Materials and Methods: Within indicated surgical procedures biopsies were taken from 13 patients with SSc leading to 29 preparations and from 8 patients with chronic periodontitis without SSc leading to 13 preparations. Immunohistochemical testing was performed applying the monoclonal antibody anti-human VEGF Clone G 153-694 (Pharmingen, San Diego, CA92121,USA). Transverse gingival sections from each patient sample were analyzed for VEGF expression evaluation. The area of positive immunostaining in the gingival subepithelial connective tissue was measured using a microscope connected to a computerized video digital system (JAVA video analysis software, Jandel Scientific, Corte Madera, Ca) at a magnification of x100. For each sample five different areas were analyzed and the data were pooled to represent a mean value. The results were expressed in percentage of the positively immunostained area per total connective tissue area measuring 0.3615mm2. The data gained were combined in each group of patients to create a group mean and pooled estimate of standard error. The significance was evaluated applying the Mann-Whitney-U test (pResults: The mean percentage of the positively immunostained area for VEGF in SSc was 7.6%±2.2 while measuring 5.3%±1.2 for chronic periodontitis. The mean rank for SSc was 26.6 and 10.12 for periodontitis. The rank sum for SSc was 771.5 and 131.5 for periodontitis. Thus the difference was highly significant (pConclusion: Using quantitative immunohistomorphometry reveals VEGF expression in gingival biopsies to be elevated more in SSc than in chronic periodontitis. Our results suggest to use VEGF as a molecular marker to distinguish between SSc associated with periodontitis and periodontal diseases. Thus further studies have been initiated with larger groups of patients to corroborate or confute that VEGF is a sufficient parameter for risk assessement in SSc progression in comparison to periodontal diseases. Keywords: Vascular Endothelial Growth Factor (VEGF), Systemic Sclerosis (SSc), periodontitis, immunohistomorphometry

In a split-mouth study over six month we analyzed the clinical and microbiological parameters of 47 casted and 9 CAD-CAM manufactured cp-titanium units (22 male and 23 female patients at the age of 19-66 years). The periodontal health of the restored teeth was compared to the contralateral unrestored teeth in periodontally treated patients. The periodontal status was evaluated using a four sites measurement of Plaque-Index (PI), Gingivitis-Index (GI), und Pocket depth (ST) at 'baseline' (T0), two weeks after baseline (T1) and six month after baseline (T2). The quality of the restorations was assessed using the quality assessment criteria of the Califonia Dental Association. The quantitative microbiological analyzes of the subgingival plaque to monitoring the periodontal pathogens A. actinomycetemcomitans (Aa), P. gingivalis (Pg) und P. intermedia (Pi) was provided using a 16S rDNA-probe after 6 months (T2).The split-mouth study did not show a significant difference in periodontal health (PI, GI, AL, PD) between the Ti- and the unrestored control group at T1-T3. All Ti units fulfilled the quality standards of the CDA. Compared to previous studies the analyzed Ti-frameworks showed the same quality as gold-based frameworks. Titanium can be recommended as material for crown and bridge frameworks that does not negatively effect the periodontium and gingiva. Keywords: Titankeramische Suprakonstruktionen, klinisch-kontrollierte Mouth Split-Studie, Parodontaltherapie

Objectives: The term sulfate-reducing bacteria (SRB) describes strictly anaerobic microbes that accomplish the dissimilatory reduction of sulfate to hydrogen sulfide. The 16S rDNA sequence showed a high similarity of 99.7% with the 16S rDNA of the proposed species 'Desulfovibrio fairfieldensis'. The aim of this study was to examine in an in vitro assay the colonization of 2 types of resorbable membranes for guided tissue regeneration by strains of SRB and P.gingivalis. Material and Methods: Pieces of membranes were submerged in batchcultures of Desulfovibrio spp. and P. gingivalis FDC381 in reduced growth medium specific for SRB or PY medium, and incubated for 1-8 days of lagtime. The dry weight of the membranes was determined after 2, 5 hours and 3, 6, 12, and 24 weeks. After incubation, membranes were prepared for SEM analysis. Bacterial density was measured semiquantitatively at 50 x magnification for selecting region of interests (ROI). Five 20x25µm fields were randomly selected for each specimen using the software system Imaging PC for Windows. Results: SEM analysis revealed differences in the accumulation of SRB strains and P. gingivalis on the 2 types of investigated membranes. The deep SRB invasion at the 3d week and frequent presence of internal bacteria at the 6th week on the PLA with copolymer membranes underlined the differences obtained by quantitative evaluation of bacterial density. The difference between the bacterial layers was statistically significant (Kruskal-Wallis-Test, p=0.05). Conclusions: The present investigation examined the relationship between the degrees of PLA membrane degradation and the amount of SRB colonization observed after up to 12 weeks undisturbed growth. The bacterial cells adhering to the membranes surface was depended on the degree of membranes mass loss over the time interval. Interestingly, the results suggest an active role of SRB in the degradation of the resorbable PLA membranes. Keywords: in vitro-colonization, Sulfat-Reducing Bacteria (SRB), resorbable GTR membranes, quantitative SEM-evaluation