International Poster Journal of Dentistry and Oral Medicine, 03/2018

Introduction: The previous standard material for bone implants is titanium and its composite materials. The high rigidity of titanium causes compressive forces to be transmitted unchanged to the surrounding bone. A possible alternative is the plastic polyetheretherketone (PEEK), which also has a high biocompatibility and a comparable bone strength. The aim of this in vitro pilot study was to analyse the viability, morphology, and adhesion behaviour of human osteoblasts and fibroblasts on PEEK versus titanium surfaces. The focus of this study was on an induced inflammatory condition by incubation with the bacterial toxin lipopolysaccharide (LPS; 10μg / ml, 24 hours). Primary human osteoblasts (NHOst, LONZA) and fibroblasts (NHDF, PromoCell) were cultured on titanium and PEEK samples from MEDICON. The viability testing of the cells on the two materials compared to PLL-coated glass coverslips (reference) was carried out by MTT method. To examine the growth behaviour of the two cell types on the different materials, SEM images were taken. Real-time PCR measurements were used to analyse gene expression of the LBS binding protein (LBP) and the LPS receptor (TLR4). The detection at the protein level and additionally of phalloidin (actin detection) and vinculin (ECM binding protein) was carried out by immunocytochemical (ICC) labelling. Results: The osteoblasts and fibroblasts had the highest viability on the coverslips, followed by the titanium and PEEK samples. In the SEM images, the two cell types on PEEK surfaces showed comparable adhesion properties to titanium. After LPS stimulation, significantly increased LBP gene expression was found in the NHOst. This could also be seen at the protein level after growth on the three materials. While no increased mRNA concentration in the NHOst could be detected under LPS incubation for TLR4, a marked increase in the antibody response on all materials was observed in the ICC markers. For fibroblasts, LPS stimulation had no effect on their LBP and TLR4 gene / protein expression. Under control conditions, the NHOst grew on all materials with parallel actin fibers. After LPS incubation, the osteoblasts contracted. In particular on the coverslips, a punctual intensification of the adhesive contacts was observed. After LPS incubation of the NHDF, the coverslips and titanium samples showed a redistribution of the vinculin detection from perinuclear to the periphery of the cell processes. Discussion: The material PEEK has proven to be highly histologically compatible with the standard material titanium. Like titanium, human osteoblasts and fibroblasts can be colonized on PEEK samples even under pro-inflammatory conditions (LPS). Further studies are needed to clarify whether the material PEEK is suitable as material for dental implants. Keywords: Adhesive behaviour, Osteoblasts, Fibroblasts, PEEK, Lipopolysaccharide

Introduction: Tooth eruption disorders are due to both local and systemic factors. Complex diseases such as Apert syndrome, Down's syndrome, cleidocranial dysostosis, ectodermal dysplasia, or Gardner's syndrome can all be affected by numerous teeth. Patients with local eruption disorders usually have their third mandibular molars and maxillary canines affected. Very rare eruption disorders occur in the first and second molars. In a third variant, non-syndromal primary breakthrough disorder ["Primary Failure of eruption" (PFE)], a primarily non-ankylosed tooth does not break through or breaks through only partially. For the normal population, the prevalence of this abnormality was reported at 0.06% with a gender distribution of 1: 2.25 (male / female). Case Report: A 19-year-old female patient was suspected of having a genetic dental breach after many years of orthodontic treatment had failed. At the age of four, she was diagnosed with hearing loss in terms of central hearing impairment, growth retardation, and hypogonadotropic hypogonadism. Brain MRI, chromosomal analysis, and SHOX deletion analysis revealed no abnormal findings. As part of human genetic counseling, the patient wanted to find out whether her symptoms could be attributed to a superordinate syndromal disease and what diagnostic possibilities exist in suspected cases of PFE that affect molars 17, 27, and 47. A chromosome examination that had already been performed revealed an inconspicuous set of female chromosomes (46, XX). At the patient's request, an array analysis was performed to examine the entire genome for small deletions and duplications that are not visible in normal chromosome analysis. There was no disease-causing deletion or duplication. However, this finding does not exclude the presence of a syndromal disease. The patient was informed that a genetic non-syndrome-related tooth eruption disorder had been reported in some patients / families. Heterozygous mutations in the PTHR1 gene on chromosome 3, which contains the information for the paratreceptor, were identified as the cause of this. At the request of the patient, an examination of this gene was carried out. The mutation c.436C> T, p.Arg146 * in the PTHR1 gene could be detected in a heterozygous state, and the diagnosis of a primary failure of eruption could thus be confirmed. Discussion: The mutation c.436C> T, p.Arg146 * in the heterozygous PTHR1 gene leads to the termination of protein synthesis and has already been described in the literature as a disease-causing factor. Early, genetically-confirmed diagnosis of non-syndromal PFE saves patients, orthodontists, and oral / maxillofacial surgeons from having to undergo frustrating therapy for years. On the part of the practitioner, knowledge of the genetic aetiology of PFE is indispensable for the differential diagnosis of breakthrough disorders. Those affected should be offered a human genetic examination. In severe cases, oral surgical options for extraction or surgical removal with subsequent implant-based rehabilitation or the occlusion adjustment of PFE-affected teeth using segment osteotomy are early decisions. This requires the affected teeth to be surgically available. Keywords: PFE, PTHR-1, tooth eruption disorder

Success of regenerative endodontic treatment depends upon the disinfection of the root canal system. Since almost no instrumentation is carried out, the disinfection protocol relies only on the medications used. Commonly used triple antibiotic paste (TAP) composed of metronidazole, ciprofloxacin, and minocycline has certain drawbacks. Minocycline binds to calcium ions via chelation to form an insoluble complex and results in tooth discolouration. Several antibiotics have been suggested as an alternative to minocycline in the triple antibiotic paste. Recently, antibiotic alternatives to minocycline have been proposed for use in combination with ciprofloxacin and metronidazole, including cefaclor and doxycycline, but discolouration persisted even after the substitution. The aim of this study is to assess the discolouration potential of modified TAP, where minocycline is substituted with amoxyclav and clindamycin. These antibiotics were selected based on two criteria: (1) They don't interfere with the action of ciprofloxacin and metronidazole, and (2) they have a mechanism of action similar to minocycline so that the entire antimicrobial spectrum is covered. Keywords: regenerative, medicament, triple antibiotic paste, disinfection, discolouration, minocycline

Oral squamous cell carcinoma (OSCC), the most common malignant tumour of the oral cavity, can be easily monitored and sampled. Despite the latest advances in chemotherapy and surgery, the recurrence and morbidity rates are still high. OSCC results from multistep accumulation of heterogeneous genetic changes in squamous cells. Attention has now shifted to biomarkers as conventional clinical and histopathological method have failed to predict its biological behaviour accurately. The multimodal tumour treatment therapy usually prescribed leads to reduced quality of life, making the psychosocial consequences of OSCC worse than other malignancies. A quest for identifying prognostic markers that have a significant role to play in maintaining the wellbeing of the patient is the need for today. The purpose of this poster is to enumerate such prognostic markers available and their contribution towards early diagnosis and prognostic relevance. Keywords: Oral squamous cell carcinoma, prognostic markers

Aim: An increasing number of physicians and researchers take advantage of smartphones or other mobile devices during their daily professional routine in order to facilitate the retrieval of medical information and to improve their patients' treatment. Mobile health apps have gained tremendous popularity; however, most of them are devoted to easing medical processes or to simplifying the patients' understanding of their diseases rather than providing a tool to actively screen patients with regard to the prevalence of a certain disease. The aim of the present study was to develop an iPad app intended for the screening of adult outpatients with regard to their oral health status and their dental treatment needs as well as their health-related quality of life and their depressive predisposition. The iPad app is also designed to facilitate data acquisition. It includes a dental examination sheet (WHO oral health questionnaire) and two patient-based questionnaires. The objective of this study was to facilitate a screening of outpatients with regard to dental treatment, oral health-related quality life (OHIP-G14), and Beck Depression Inventory (BDI-II) as well as to test our iPad app with regard to its practicability in a clinical setting. Materials and methods: A total of 196 healthy adult outpatients, reporting to the Department of Operative Dentistry, University Medical Center, Mainz, Germany, for check-up visits, were enrolled in the study. For this investigation, an iPad app was developed with the goal of facilitating dental screenings of outpatients (Fig.1). We also wanted to facilitate the evaluation of the questionnaires by directly digitally implementing the data into an Excel sheet. We used the highly standardised WHO oral health assessment questionnaires for the acquisition of the dental parameters. All the patients were also asked to document their answers for the OHIP-G14 (scale: 0-37) and BDI-II (scale: 0-63) questionnaires directly into the iPad App. Results: This study included 94 male and 102 female patients (mean age 39.8±16.9, 18-83 years). The mean number of teeth was 26.5 (SD± 3.8). A high number of teeth showed restorations or crowns (11.1±5) (Fig.2), and there were also a high number of teeth free of caries (16 ± 7.1). Less than one tooth (0.7±0.9) showed primary or secondary caries. Most of the teeth (mean: 22.6± 7) showed a pocket depth of 4mm, and a marginal number (mean 3±4) showed a pocket depth between 4-5 mm (Fig.5). 17.3% of the subjects were smokers, and 82.7% non-smokers. No enamel fluorosis was detected in 47.3%, 14.5% had mild fluorosis, and 38.2% were classified as questionable (Fig.3 and 6). Enamel or dentinal erosions were observed in 39.1% (Fig.4 and 7). The BDI-II score was 4.4±5 (1-44), and the OHIP-G14 score was 3.9±5.8 (0-24). Mucosal lesions were detected in 10%; 87.3% were lesion-free. Treatment need was urgent in 11.8%, 49.1% required preventive or routine treatment, and no treatment was needed in 39.1% (Fig 8). Conclusions: The investigated outpatients represent a cross-section of the oral health care situation of the German population. The data resemble the results of the DMS V recently published in Germany. The use of the novel app is well-suited for the detection of cohorts; however, some older subjects had difficulties using a tablet computer, which required extra time. Keywords: Oral health, quality-of-life assessment, iPad app

Purpose: To test a hypothetical model suggesting that patients pass through a 'psychological cycle' when undergoing a course of dental care: past appointment experiences influence their anticipation of future dental visits, which in turn affect behavioural intentions to attend appointments. Materials and Methods: Self-administered questionnaires were given to 300 students from 5 different colleges in Bangalore city. The questionnaire assessed variables representing the various stages of the hypothesised model and other relevant variables (dental anxiety, general anxiety, and subjective oral health rating) Results: Sequential regression analysis showed that cognitive factors like negative past experiences (p=0.04), and expectations and anticipation of future dental appointments (p0.001) along with psychological factors like dental anxiety (p=0.05) influenced behavioural intentions to attend future appointments. These findings were consistent with the hypothetical model. Conclusion: The model explains dental appointment attendance behaviour based on the contributions of cognitive factors such as expectation and anticipation of future appointments along with past dental experience and can be used to foster better use of dental care. Keywords: Dental appointment attendance, experiences, anticipation, behavioural intentions

Background & Aim: Epidemiological studies regarding associations between psychological stress and periodontitis have reported inconsistent results. The current study aimed to review data on the potential association between psychological stress and periodontitis and a meta-analysis quantified the results of available studies on stress and risk of periodontitis. Methods: In advance, a search protocol was developed. Three databases, PubMed/Medline, Cochrane Library, and Web of Science, were searched for studies published from 1996 until June 2017 according to the PECO search strategy: adults (population P); psychological stress (exposure (E); patients with and without psychological stress (comparison C); periodontitis (outcome O). Study selection was conducted by two independent reviewers (HS and BN). Risk of bias analysis was performed using the modified Newcastle-Ottawa scale. Meta-analysis was performed on the selected studies, and odd ratios (OR) with 95 % confidence intervals (CI) were calculated. Results: The primary search retrieved 218 studies. After applying inclusion and exclusion criteria, 26 observational studies (10 case control and 16 cross sectional studies) were included in the final analysis for data extraction and quality assessment (Fig.1). 14 studies reported an association between psychological stress and periodontitis, whereas 10 studies did not. For the remaining two studies, the association was only significant regarding certain types of stress. The risk of bias was medium to low in most studies. Meta-analysis was performed for the presence /absence of periodontitis (dichotomous) on 8 case-control and cross-sectional studies. A random effects meta-analysis showed that the presence of stress is significantly associated with the risk of periodontitis (pooled OR 2. 84; 95% CI: 1.76; 4.57). However, there was significant heterogeneity across studies (P value for chi2 test was 0.0003; I2 = 74 %) that may be explained by one study. By excluding that study, the pooled OR remained significant (2.13; 95 % CI: 1.77; 2.56), and heterogeneity decreased dramatically (I2 = 0%). Conclusion: The systematic review and meta-analysis showed an increased risk of periodontitis in subjects exposed to psychological stress. However, the different parameters in assessing periodontitis and stress were the main drawback in this analysis. Further well-designed longitudinal studies and standard parameters are necessary to confirm the role of stress as a risk factor for periodontitis. Keywords: psychological stress, mental stress, periodontitis

Introduction: Root canal filling materials alter the flexural strength of dentine, leading to fracture under compressive loads. Therefore, root-filled teeth commonly undergo further tooth fracture. In this regard, Biodentine may offer an alternative to current conventional materials. Aims: This study aimed to evaluate the fracture resistance (compressive strength) of permanent teeth after filling the root canals with a calcium tri-silicate cement (Biodentine) and gutta-percha. Furthermore, the type of fracture in simulated permanent teeth when loaded to failure was recorded. Methodology: Twenty extracted mandibular first premolar teeth were randomised into two groups: Biodentine and gutta-percha. All teeth were prepared to size 70 K-file at the apex. In one group gutta-percha was placed as far as the cementoenamel junction; in the other, Biodentine was used to fill the canal to the CEJ. Both groups received composite as coronal restoration. To decide on the best method of determining the maximum compressive strength endured by each sample prior to fracture, a static loading test was used. An INSTRON machine was used to apply the force starting from zero Newtons to failure. This was used to measure whether the teeth fractured within the known range of the normal human bite-force. The test was applied to both groups. Results: There was no significant difference in the fracture resistance (compressive loading) between the Biodentine and gutta-percha groups. Crown fracture was the most common type of fracture in both groups. Conclusions: This study suggests that Biodentine should be further investigated in vitro in the treatment of non-vital teeth. Keywords: Flexure strength, cementoenamel junction

Introduction: Dermal fillers are taking the world by a storm where dental esthetics is given prime most importance .Papilla reconstructs being a challenge for a periodontist dermal fillers as hyluronic acid can act as minimally invasive technique or reconstructions. Aim:The purpose of this prospective clinical trial was to examine the clinical and patient outcome following esthetic reconstruction of interdental papilla loss in anterior teeth,using hyaluronic acid gel injection. Material and Methods: 10 systemically healthy adults with at least one anterior site with class I and II interdental papilla loss were recruited. Following local anesthesia 0.2 ml hyaluronic acid gel injection was injected on base of papilla, plumping effect was noted. The patient was then recalled and revaluated after 7 days papilla fill using Papilla presence score, if needed a second injection was administer for complete papillary fill.The stability of papillary fill was then evaluated at 1 week, 4 week and 3 month. Results: Twelve sites amongst 6 males and 4 females were treated in the study. The lost interdental papilla was with preoperative 2.1± 1.2 mm², which reduced to 1.1±0.7 mm² at 4 week interval and had 0.7±0.5 mm² at 3 month interval as evaluated by photograph measurement and use of image software. Differences between baseline and postoperative visits were statistically significant (p 0.0001). Conclusions: Use of hyaluronic acid gel injection to treat interdental papilla loss resulted in significant improvement at 6 months. Patients expressed satisfaction with the obtained improvement. Keywords: hyaluronic acid, papilla reconstruction, dermal fillers, papillary fill, dreaded triangle, interdental papilla

Objective: The human body is made up of a number of elements which are categorised into abundant and trace elements. Trace elements are also known as micronutrients. Although required in much smaller quantities in the body, they still play pivotal role in vital processes of the body. Trace elements include iron (Fe), zinc (Zn), copper (Cu), selenium (Se), chromium (Cr), cobalt (Co), iodine (I), manganese (Mn), and molybdenum (Mo), etc. The present study was conducted to determine whether trace elements, namely iron and copper, play a role in the pathogenesis of recurrent apthous stomatitis. Materials and Method: A total of 30 subjects formed the pilot study, including 15 patients with recurrent apthous stomatitis and 15 persons as healthy controls. Salivary levels of iron and copper were detected biochemically by semi-autoanalyser. Results: All parameters were statistically analysed. Significant correlation was found. The patients were found to have significantly lower levels of trace elements than in the healthy control group. The attempt was made to check the presence of these elements in the saliva and establish a correlation. Conclusion: Saliva, like blood, contains different substances that reflect physiological status. Salivary diagnostics offer an easy, inexpensive, safe, and non-invasive approach for disease detection, and possess a high potential to revolutionize the next generation of diagnostics. More studies with larger sample sizes on salivary trace elements are warranted to establish them as biochemical markers in the pathogenesis of RAS. Keywords: Recurrent apthous stomatitis, iron, copper, serum, saliva, biochemical markers