International Poster Journal of Dentistry and Oral Medicine, 02/2013

Aims: The squamous cell carcinoma (SCC) is the most common malignant neoplasm of the upper jaw. The manners of metastasing are quite well known. The focus of this study was the other less frequent, and therefore less often described, malignant non-SCC located in the maxilla. The aim of the present study was to analyze the distribution and the manners of metastases for non-SCC in the maxilla. Methods: Since 1994, all inpatients have had digitals files; therefore, all files from 1994-2011 were scanned using different keywords to obtain all patients with an oropharyngeal malignoma. All these files were manually analyzed for the location of the tumor, and only patients with malignomas in the maxilla were included. Tumors arising in the sinus maxillaries were excluded. The histopathological results and the further follow-up were checked for metastasis related to the primary tumor in the maxilla. Results: 168 patients had a malignant tumor arising in the maxilla. 138 had an SCC and 30 patients following other malignant neoplasms were identified (graph 1). These 30 cases divide in 12 male patients with an average age at the first diagnose of 72 years and 18 female patients with an average age at the first diagnose of 57 years. From all cases of non SCC tumors reported here, only 10 per cent (n=3) exhibited cervical nodes metastases (CM). These were found in two adenocarcinoma and one osteosarcoma. Conclusion: Only 18% of malignant tumors arising in the maxilla were non-SCC. Despite the low number of non- SCC located in the maxilla, there is a clear tendency that non-SCC malignomas have a lower tendency to metastasize into cervical lymph nodes as compared to the SCC in the maxilla, which is described to be up to 38%. Since there are only few patients suffering from non-SCC malignomas in the maxilla, no specific treatment protocol can be given according to the site of the tumor. Keywords: Malignant Neoplasms, upper jaw

Background: Periodontitis and coronary heart disease are both triggered by inflammatory response which is influenced by the genetic predisposition. The c.-874T>A polymorphism in interferon-g (IFN-g) has been associated with altered cytokine production. Patients and methods: A total of 960 consecutive patients with angiographic proven coronary heart disease (no or mild periodontitis: n=493, severe periodontitis: n=447) were prospectively included in the study entitled "Periodontitis and Its Microbiological Agents as Prognostic Factors in Patients with Coronary Heart Disease". In this subanalysis, the c.-874T>A polymorphism in IFN-g was analyzed by CTS-PCR-SSP Tray kit (Heidelberg, Germany). Subgingival bacterial colonization (11 bacteria) was assessed using a polymerase chain reaction (PCR)/DNA probe test (micro-Ident®). Results: The genotype (p=0.987) and allele frequencies (p=0.860) of the c.-874T>A polymorphism in IFN-g were not proven to be as risk indicators for the severity of periodontitis in patients with coronary heart disease. However, AA-genotype and A-allele carriers had a decreased risk for subgingival occurrence of P. intermedia (genotype: p=0.006, allele: p=0.01) and E. corrodens (genotype: p=0.034, allele: p=0.013). These associations remained significant after forward stepwise binary logistic regression analyses considering age, gender, smoking, diabetes, plaque index as potential confounders. Conclusions: Despite the genetic background of IFN-g could be shown to be associated with subgingival colonization of P. intermedia and E. corrodens there is no evidence that it is an independent risk indicator for severity of periodontitis in coronary patients. Keywords: interferon-g, SNP, periodontitis heart disease

Objectives: Comparison of the clinical outcomes after regenerative periodontal surgery using either an enamel matrix derivative (Emdogain®) or a synthetic bone graft (Ostim®) in wide intrabony defects 12 months after treatment. Material and Methods: Thirty-eight patients with chronic periodontitis were recruited (Table 1). All patients showed intrabony defects of at least 4 mm depth and 2 mm width (Figure 4). Using a microsurgical technique a modified papilla preservation flap was prepared. After debridement, patients were randomly assigned to Emdogain group (control) or Ostim group (test) as schown in figures 2, 3. Assessments at baseline, after 6 and 12 months included bone sounding, attachment level, probing pocket depth, bleeding on probing, and recession (Figure 1). Early wound healing, adverse effects and patients perceptions were also recorded (Figure 5, 6). Results: Both treatment modalities led to significant clinical improvements. No significant differences between both groups were recorded. Change in bone fill 12 months after surgery was 1.6 mm (±1.2) in the test group and 1.6 mm (±1.3) in the control group, respectively. A clinical attachment gain of 1.4 mm (±1.8) in the test group and 2.1 mm (±1.6) in the control group was found. A reduction in probing pocket depth of 2.6 mm (±1.8) in the test group and 3.2 mm (±1.8) in the control group was recorded, table 2, 3. Two weeks after surgery primary closure was maintained in 100% of both test and control groups (Figure 5). No differences in patients' perceptions were observed (Figure 6). Conclusion: The results show comparable clinical outcomes following both treatment modalities 12 months after treatment. Further investigation is needed to identify factors influencing individual responses. Keywords: enamel matrix derivative, intrabony defects, periodontal regeneration, randomized clinical trial

Aim: The aim of this retrospective study was to evaluate the influence of age on tooth loss during long-term SPT in advanced aggressive (AgP) and chronic periodontitis (CP). Methods: 213 compliant patients (AgP: 55; CP: 158; n teeth = 4939) were included when following criteria were fulfilled: bone loss >=50% at >=2 teeth, age =35y for AgP (CP: >=40y) and SPT over at least 10 years. Age groups (A: 49y) at baseline were defined. Kaplan-Meier estimate was used to determine survival. Results: During SPT of 15.6±4.8y, 437 (7.33%) teeth were lost in total. In AgP 6.1%, 12.3% and 0% (n.a.) (CP: 7.3%, 10.0%, 9.5%) of all teeth for the age groups A, B and C, respectively, were extracted during SPT. After 15 years the tooth survival probability in A was 94.2%, B 92.0% and C 90.0%, independent from the initial diagnosis (p Keywords: periodontitis, periodontal supportive therapy, risk factor, tooth loss, age

Objective: Impression tray adhesives are delivered in glass bottles with a fixed brush attached inside the cap. If the adhesive is applied on a worn denture or on a tried-in and therefore contaminated impression tray with the brush, microorganism can be transferred into the bottle. Using the adhesive with the same brush at another patient may cause cross-contamination. This study tested tray adhesives for the risk of cross contamination by evaluating their antibacterial properties. Method: Bacterial solutions at 107 cfu/ml made of commercially available in-vitro-test strains and bacterial strains isolated from human saliva were plated on Columbia-agar-plates. Tray adhesive was applied to the centre of the agar-plates and incubated for 48h. The expansion of the biological inhibition assays were measured microscopically. One alginate-adhesive (Fix/Dentsply), a silicone-adhesive (Universal/Heraeus) and a polyether-adhesive (3MESPE) were tested. Results: 21 bacterial strains were selected in the saliva samples of 20 test patients. The overgrowth of the patient strains was 1 % (± 0.3) for the alginate-, 12 % (± 5) for the silicone- and 31 % (± 9) for the polyether-adhesive. The in-vitro-test strains showed an overgrowth of 1 % ± (0.3) for the alginate-, 7 % (± 1) for the silicone- and 7 % (± 2) for the polyether-adhesive. Therefore the adhesives had no antibacterial properties. Conclusion: In-vitro-testing did not show antibacterial properties of tray adhesives. Consequently, there is at least a risk of cross-contamination if a brush is used twice and replaced into the adhesive. It is suggested not to use the brushes, but cast the adhesive into a Dappen-dish and apply the adhesive with a cotton pellet. Keywords: Dental materials, Impression materials, Infection, Microbiology and Oral hygiene

Objectives: The adhesive bond between casted titanium and porcelain was compromised due to the existence of reactive layers. Furthermore the titanium's coefficient of thermal expansion is significantly lower than that of conventional noble metal alloys, therefore titanium required special low-fusing porcelain with a low coefficient of thermal expansion to be veneered. Modern titanium copings were fabricated using CAD/CAM technology. Earlier versions of CAD software were limited to design non-anatomic metal copings in even thicknesses. The present study reports the clinical results of CAD/CAM titanium-ceramic single crowns with non-anatomic coping design. Fractures of the veneering porcelain were examined after a follow-up of six years. Methods: 41 crowns were fabricated for 21 patients. The titanium copings were CAD/CAM milled (Everest CAD/CAM system, KaVo) with an even thickness of 0.5mm, veneered with low-fusing veneering porcelain (Vita Titanium Porcelain, VITA Zahnfabrik) and cemented using zinc phosphate cement. The patients were recalled yearly to examine for the presence of any complications. The success and survival rates were estimated using the Kaplan-Meier analysis[2]. Results: At the 6-year recall 3 patients (4 crowns) were lost to follow-up. Mechanical complications summed up to 10 cohesive and 2 adhesive porcelain fractures that resulted in the replacement of 2 crowns. The fractured crowns were found in 1 anterior crown and 11 posterior crowns. The 2 crowns that needed to be replaced were both posterior crowns, and the fracture of the porcelain caused loss of either occlusal or proximal contact. One biologic complication was found during the follow-up examinations. The Kaplan-Meier cumulative success rate of CAD/CAM titanium-ceramic crowns with regard to mechanical complications was 67.8%±7.7SE. The Kaplan-Meier cumulative survival rate of CAD/CAM titanium-ceramic crowns with regard to function was 91.3%±4.8SE. Conclusion: The clinical performances of the CAD/CAM titanium-ceramic crowns with nonanatomic coping design for 6 years were poor. To avoid veneering porcelain fracture modern CAD-software with tools to design proper coping should be used. Keywords: coping design, CAD/CAM titanium-ceramic crowns, low-fusing porcelain

Introduction: The mandibular infected buccal cyst (Stoneman and Worth 1983) is a rare type of inflammatory odontogenic cyst. It occurs in children aging from about 6 to 11 years (David et al. 1998). It is an uncommon lesion associated with a partial eruption of the permanent mandibular first or second molar. It typically presents on the buccal aspect of the affected tooth (Thikkurissy et al. 2010). The World Health Organization (WHO) has included this lesion in their Histological Typing of Odontogenic Tumours. In the category of "inflammatory cysts", the Classification in the Second Edition in 1992 makes provision for the paradental (inflammatory collateral, mandibular infected buccal) cyst (Kramer et al. 1992). Other authors argue for the term buccal bifurcation cyst, because the lesion is site- and age- specific (Pompura et al. 1997). Case report: A 9-year-old otherwise healthy boy was referred by an orthodontist to our department. He presented with a local suppuration buccal from his lower left first molar (tooth 36) showing no pain or swelling. Probing depths on the surfaces of tooth 36 were 12 mm mid-buccal and disto-buccal. Probing depths on the surfaces of all other teeth were = 3 mm. No clinical caries was noted on this tooth, which also presented vital to thermal testing. It was sealed with flowable restorative material. Radiographs of this area (panoramic and occlusal radiographs) reveled well-defined radiolucencies around the incomplete apices of the erupting tooth. No other tooth or jaw pathology was noted on the radiographs. The pocket was irrigated with hydrogen peroxide repeatedly but the defect did not resolve. Therefore after local anaesthesia, a full-thickness flap was elevated on the buccal aspect of tooth 36. The found small soft tissue which filled the space has been enucleated without extraction of the tooth and histopathologic evaluated. After flap reposition and suturing Amoxicillin was prescribed for a week and postoperative instructions were given to the patient and his parents. The postoperative follow- up visit revealed an uneventful healing period. The histological findings showed parts of an odontogenic (radicular) cyst. No neoplastic characteristics were seen in the lesion. At the 3-month follow-up appointment, the patient was asymptomatic, all probing depths of tooth 36 were =3.5 mm. Discussion: Although the majority of dental abscesses in children results from caries or trauma, a percentage originates from unusual conditions. Knowledge of these conditions would aid the general practitioner in the differential diagnosis and treatment of these entities (Seow 2003). The mandibular infected buccal cyst was first reported in the literature by Stoneman and Worth in 1983. Most of the reported cases of mandibular infected buccal cyst involve the mandibular permanent first or second molars. Although most cases occur unilaterally, bilateral cysts have also been reported. Their key clinical features are abnormal probing depths on the buccal surface and the vitality of the associated molar. Other features such as pain, swelling, and the presence of a localized abscess are all variable but may be initial presenting symptoms. Radiographically, the periodontal ligament space and lamina dura are usually unaffected (Thikkurissy et al. 2010). The pathogenesis of the mandibular infected buccal cyst suggests some relationship to the eruption mechanism. The fact that the mesial buccal cusp of a molar is the first to break through the oral epithelium and be exposed to the oral environment might explain the development of the lesion on the buccal surface at about the time of eruption. The stimulated epithelium could be derived from the cell rests of Serres or of Malassez (Stoneman and Worth 1983). Another suggestion would explain the cyst as arising from a lateral dentigerous cyst that persisted following eruption, the source of epithelium being reduced enamel epithelium (Stoneman and Worth 1983). However, the origin of this cyst epithelium is still unclear (Thikkurissy et al. 2010). The treatment has changed over the years (Santos et al. 2011). While in first descriptions the therapy of choice was extraction of the tooth (Stoneman and Worth 1983; Trask et al. 1985) further on nonsurgical resolution of buccal bifurcation cyst by daily saline and hydrogen peroxide irrigation (David et al. 1998) was reported. Other authors pointed out that some of these lesions were self-limiting (Pompura et al.1997). Infected lesions or those increasing in size have to be treated surgically. In recent articles, the treatment used was enucleation of the cyst without extraction of the tooth involved (Shohat et al.2003; Thikkurissy et al. 2010; Santos et al. 2011). Conclusion: The majority of dental abscesses in children results from caries or trauma. A minority originate from unusual conditions. However, knowledge of these conditions will enable the general practitioner to diagnose and easily treat these entities. One of them, the mandibular infected buccal cyst, can be treated successfully by simple enucleation without extracting the associated tooth. Keywords: odontogenic cyst, inflammatory cyst, mandibular infected buccal cyst

Every attempt should be made to save the natural teeth for the multiple benefit of a patient. Treatment plan should make provision to include the main requirement of the patient. Restoration without complete esthetic satisfaction of the patient is eventually a failure. CAD-CAM milled zirconia provides an opportunity for the dentist to provide a strong and esthetic restoration. This case report presents a patient with a badly broken premolar tooth demanding high esthetic all ceramic restoration. Keywords: Zirconia, CAD-CAM, Estthetic restorations

A 9 year old girl reported with chief complaint of excessively big front teeth Clinical examination showed 11 21 macrodontia, 22 crossbite, 21 rotated 90degrees, anterior crowding. No tooth was missing. Radiographic examination showed that- 11 was in Demirjian's Stage E of root development with blunder buss canals, very thin dentinal walls and nonrestorable endodontically with two pulp horns. Arch analysis was done and 11 was extracted. The tooth examination revealed a macrodont of size 13mm width mesiodistally, fragile and immature thin roots. Orthodontic appliance with Z-spring i.r.t. 21 to correct its rotation and 22 for correction of crossbite was given to the patient. After approx. 6 months, these irregularities were corrected .It followed with fixed orthodontic treatment to close the space of extracted 11 and fine movement. Finally, patient had a more aligned, aesthetically pleasing and no tooth irregularities. Keywords: macrodont, maxillary, crossbite, immature, rotation, crowding, esthetic

As we approach the dawn of genomic medicine, the escalating use of salivary diagnostics will help spur a shift from disease diagnosis to real-time health surveillance. With newly evolving technologies like the biosensors its becoming progressively easy to detect minute quantities of salivary components including mRNA , proteins , cortisol , and others. The domain of salivary diagnostics via salivary biosensors has catapulted into one of dentistry's most promising areas of research. Because of non-invasive nature of salivary collection, point-of-care diagnostics is set to become the Holy Grail for healthcare in 21st century. Coupling this with devices being developed in nanotechnology, we are about to realize portable devices that can revolutionalize the diagnosis of a wide variety of disease conditions on site using an oral sample. A salivary biosensor is a small, self-contained device which utilizes biological reactions for detecting and measuring a particular substance [a salivary biomarker] of interest. The biosensor consists of a biological recognition element in intimate contact with a transducer that translates the bio-recognition event into a useful electrical signal. The commonly used transducers include optical, electrochemical or mass-sensitive elements and generate light, current or frequency signals, respectively. The advantages of using biosensor in salivary diagnostics are that it eliminates the need for a trained technician and also eliminates the risk of contracting infectious disease for both technician and patient. Moreover, it offers detection of malignancies at a sufficiently early stage, and also has implications in bioterrorism surveillance. Keywords: Saliva, biosensors, biomarkers, genomics

Cancer is one of the deadliest diseases affecting the mankind causing 6 million deaths every year, worldwide. Oral cancer is the number one among all cancers in male patients and number three among cancers in female patients. It takes only a 90-second visual and tactile examination to achieve early detection in basic oral cancer examination. Oral cancer screening has relied upon the conventional oral examination of patients. Early diagnosis of oral cancer is a major area of concern, since 60% of these cases are diagnosed late in their course of the disease. When found early oral cancer survival rate is 80-85%, so need of the hour is to educate the dentist on the latest available technical/diagnostic aids. Failure to diagnose oral cancer is rising, and can prove difficult to defend. New technologies have provided an exciting new array of clinical diagnostic tools for localizing or emphasizing abnormal mucosa in the dental clinic. Some of these technologies claim to identify atypical cells prior to biopsy, even before there are clinically visible changes. Hence allow a more confident as assessment of risk and localization of the most "suspicious" area to biopsy. A variety of commercial diagnostic aids are available to potentially assist in the screening of healthy patients for evidence of otherwise occult cancerous change or to assess the biologic potential of clinically abnormal mucosal lesions. The prevention of oral cancer and its associated morbidity and mortality hinges upon the early detection of neoplastic lesions, allowing for histologic evaluation and treatment as necessary. This poster deliberates these newer technologies and their importance in early diagnosing of Oral Cancer. Keywords: oral cancer, early detection, diagnostic aids

Cilia are common organelles present on nearly every cell in the mammalian body. Found either in large groups on a single cell or as solitary structures, cilia are classified into three basic categories: motile, primary, or nodal. Primary cilia are solitary organelles projecting from the surface of cells. These cilia lack the central pair of microtubules needed to generate motile force and are thus described as having a 9-0 pattern. Dentigerous cyst is the second most common type of odontogenic cysts. It is the most common developmental cyst of the jaws and is always associated with an impacted tooth. The origin of the cyst is not yet known. Recent studies have shown that loss of Ptch and Shh signalling pathways are involved in the cystogenesis of dentigerous cyst. The Shh signalling pathway is active in the primary cilia. Based on the presentation of a dentigerous cyst in an autosomal dominant polycystic kidney patient and the demonstration of primary cilia like structures on the cyst wall by using a scanning electron microscope, a new hypothesis for the pathogenesis of dentigerous cyst is proposed recently (Anoop U.R. et al, 2011). To test this hypothesis and to check whether this hypothesis can be applied to other odontogenic cysts, a scanning electron microscopic study was conducted including 5 cases each of dentigerous cyst, odontogenic keratocysts and periapical cysts. The results showed the presence of primary cilia like structures in all cases of OKC and DC but not in any of PA cysts. The absence of PC like structures in PA cysts shows that the pathogenesis of inflammatory odontogenic cysts is entirely different from developmental cysts. Keywords: primary cilia, dentigerous cyst, odontogenic keratocyst, periapical cyst, scanning electron microscope