Immunhistochemische Untersuchung des Kollagen-Typ-I-Gehalts der Gingiva bei Dysostosis cleidocranialis

Background

Patients with cleidocranial dysplasia (CCD) present a thickend and fibrotic gingiva.

Purpose

To the best of our knowledge it was analysed for the first time, whether this is correlated with an increased rate of collagen I in oral mucosa.

Patients and methods

27 soft tissue biopsies of six CCD-patients and 17 tissue samples of 12 healthy persons were labled with a monoclonal antibody against collagen I and the bound antibodies were detected with alkaline phosphatase-anti-alkaline phophatase-kit. The histological slices were analysed by a digital image recognition software under a fully automated microscope and the rate of collagen I was converted into amounts of grey tones.

Results

The amount of grey tones reached from 11.909 to 15.319 in the CCD-group, and from 2752 to 12.556 in the control group. The U-Test of Mann, Whitney and Wilcoxon for two independent samples generated a rank sum of 91,50 for CCD-patients, and of 79,50 for the control group. The Z-value was 3,246, the p-value 0,005. “Fisher`s exact test” identified a p-value of 0,0003.

Conclusions

The rate of collagen I in the oral mucosa seems to be increased significantly in CCD. This could explain the typical thick and fibrotic consistency of the gingiva and could be one reason for the delayed or missing dentition.     

The original family revisited after 37 years: odontoma–dysphagia syndrome is most likely caused by a microduplication of chromosome 11q13.3, including the FGF3 and FGF4 genes

Objectives

Fibroblast growth factors consist of receptor tyrosine kinase binding proteins involved in growth, differentiation, and regeneration of a variety of tissues of the head and neck. Their role in the development of teeth has been documented, and their presence in human odontogenic cysts and tumors has previously been investigated. Odontoma–dysphagia syndrome (OMIM 164330) is a very rare disorder characterized by clustering of teeth as compound odontoma, dysplasia and aplasia of teeth, slight craniofacial abnormalities, and dysphagia. We have followed the clinical course of the disease in a family over more than 30 years and have identified a genetic abnormality segregating with the disorder.

Materials and methods

We evaluated clinical data from nine different family members and obtained venous blood probes for genetic studies from three family members (two affected and one unaffected).

Results

The present family with five patients in two generations has remained one out of only two known cases with this very rare syndrome. All those affected showed teeth dysplasia, oligodontia, and dysplasia and odontoma of the upper and lower jaw. Additional signs included dysphagia and strictures of the oesophagus. Comorbidity in one patient included aortic stenosis and coronary artery disease, requiring coronary bypasses and aortic valve replacement. Genome-wide SNP array analyses in three family members (two affected and one unaffected) revealed a microduplication of chromosome 11q13.3 spanning 355 kilobases (kb) and including two genes in full length, fibroblast growth factors 3 (FGF3) and 4 (FGF4).

Conclusion

The microduplication identified in this family represents the most likely cause of the odontoma–dysphagia syndrome and implies that the syndrome is caused by a gain of function of the FGF3 and FGF4 genes.

Clinical relevance

Mutations of FGF receptor genes can cause craniofacial syndromes such as odontoma–dysphagia syndrome. Following this train of thought, an evaluation of FGF gene family in sporadic odontoma could be worthwhile.     

Behandlungsangst in der Mund-, Kiefer- und Gesichtschirurgie

Background

Oral and maxillofacial operations are stressful treatment situations for patients. Specific data on this phenomenon were acquired through a multicenter study.

Material and methods

A 10-page questionnaire was answered by 600 oral and maxillofacial patients before individual treatment. Control groups consisted of 800 surgical, dental, internal medicine and general practitioner patients. 26 practices and hospital departments in 11 German cities were involved in the study.

Results

Both subjective anxiety assessment by patients and objective measurement (State Trait Anxiety Inventory; STAI) indicated a high level of treatment anxiety for oral and maxillofacial treatment. STAI scores for OMFS patients were significantly higher than in control groups. Especially female patients, patients treated under local anaesthesia and out-department patients showed high anxiety scores. Treatment experience in oral and maxillofacial surgery does not modify anxiety in case of recurrent treatment.

Conclusion

Managing perioperative anxiety today is still a major challenge in oral and maxillofacial surgery. Irrespective of technical and pharmacological advances further studies on this topic and the development and establishing of stress-reducing and anxiolytic perioperative techniques are of considerable importance.     

Die Bedeutung der zahnbezogenen Focussanierung am Fallbeispiel eines pontinen Abszesses durch Streptokokken der Viridans Gruppe

Background

The treatment of infectious oral lesions is an important prophylactic procedure preceding immunsuppressive therapy. The case reported underlines the importance of this treatment by showing severe complications of an infective dental focus in an immunocompetent patient.

Case report

A 65 year old patient was referred to hospital due to neurological disorders including hypaesthesia, movement deficits, nausea and falls. Because of progressive aggravation with hemiplegia a craniotomy and biopsy of a suspicious area in the pons was performed. A brain stem abscess caused by Streptococcus viridans was diagnosed. Brain stem abscesses are very rare events who contribute to only about 0.6%–6% of all intracranial abscesses. The intraoral inspection revealed a periodontally diseased and carious affected dentition with many missing teeth. Other foci were ruled out. Because of persistency of the symptoms another operation with abscess drainage was performed. Afterwards the clinical symptoms improved but hemiplegia was still present.

Conclusions

Even minor dental procedures as well as existence of a carious or periodontal disease may cause bacteremia with severe septical implications. Patients at risk (e.?g. dieases of the heart valves or diabetes) should always treated with an antibiotic prophylaxis before treatment according to the guidelines of the DGZMK. All oro-pharyngeal infectious foci have to be treated sufficiently to prevent sceptical complications. Even more important is the prophylactic treatment preceding chemo- or radiation therapy.     

Identifikation eines rezidivierenden, oralen Plattenepithelkarzinoms mittels Bürstenzytologie

Background

Large oral lesions comprise the risk that an incisional biopsy does not reveal the most aggressive site in spite of carefully selecting the place of biopsy.

Case report

The first incisional biopsy of a large, clinically suspect, oral lesion could not identify the subepidermal spread of a recurrent oral squamous cell carcinoma. Atypical cells obtained by a simultaneous brush biopsy prompted a renewed, incisional biopsy which finally established the diagnosis of a recurrent, oral squamous cell carcinoma.

Conclusions

The presented case emphasizes the value of brush biopsy in the follow-up of oral squamous cell carcinoma, especially in examination of oral lesions covering a large area.     

Herpes simplex virus reactivation and dental procedures

Objectives

Dental extraction is reported to trigger recurrent herpes labialis (RHL).

Aim

This aims to prospectively study the clinical occurrence of RHL and the oral herpes simplex virus type 1 (HSV-1) viral shedding before and 3 days after different dental procedures.

Materials and methods

Oral HSV-1 DNA was measured by real-time PCR before and 3 days after dental procedures of the inferior dentition in 57 immunocompetent patients (mean age 32.4 years) who were selected and divided into four distinct subgroups (dental inspection without anesthesia, n?=?19; dental filling under local anesthesia, n?=?14; molar extraction under local anesthesia, n?=?15; and molar extraction under general anesthesia, n?=?9) and compared to 32 healthy controls (mean age 33 years).

Results

None of the patients suffered from RHL at day 3. Oral HSV-1 DNA was detected before and after procedure in 1.7 % (1/57) and 5.3 % (3/57), respectively [dental inspection without anesthesia, 5.3 % (1/19); molar extraction under local anesthesia, 6.7 % (1/15); and molar extraction under general anesthesia, 11 % (1/9)]. None of the controls presented RHL or detectable oral HSV-1 DNA. There was no statistically significant difference between the study groups and controls.

Conclusion

Molar extraction increases the risk of oral HSV-1 shedding but not of RHL. Procedure-related nerve damage probably accounts for HSV reactivation.

Clinical relevance

Antiviral prophylaxis for RHL is not routinely recommended for dental procedures, regardless of a prior history of RHL.     

Vergleichende klinische und immunhistochemische Charakterisierung keratozystischer odontogener Tumoren und Ameloblastome im Hinblick auf das Rezidivrisiko

Background

With the new term “keratocystic odontogenic tumour” (KCOT) keratocyts are even in the nomenclature a close differential diagnosis to ameloblastomas (A).

Purpose

Recurrence of KCOT and A were retrospectively compared with regard to treatment and immunohistochemical markers of cell cycle and migration and cell architecture.

Patients und Methods

Biopsies harvested over a period of 22 years of 101 patients (86 KCOT, 15 A) were examined. The histopathological slides were stained with H&E and with the immunohistochemical markers: Cyclin D1, Collagen IV, p16, Cox-2-Laminin-5 and Tenascin-C.

Results

Mean age KCOT 47 years (range 14–80 years), A 41 years (range 16–79 years). Gender KCOT: m:f?=?2:1; A: m:f?=?3:2. Region of origin mandible with predilection of the angle and the ramus: KCOT: 76; A: 12. Maxilla: KCOT: 18; A: 3. Multiple lesions were found in 5 KCOT patients. Treatment primary KCOT: cystectomy (46), cystostomy (6), cystectomy and curettage (17), cystectomy and marginal ostectomy (14), resection (11). A: resection (10), enucleation (5). Recurrence rate KCOT: 11,7% after 5,5 years. Recurrence after: cystostomy (4), cystectomy (6), cystectomy and curettage (3), cystectomy and marginal ostectomy (2). A: no recurrences. Immunohistochemistry Cell cycle associated and extracellular matrix proteins did not differ in quantity in KCOT and A, and did also not differ in recurrent and non-recurrent KCOT.

Conclusions

1. KCOT are in the own cohort more likely recurrent than A.
2. Recurrence rate of KCOT can not be predicted by the used (most common) markers of cell cycle, migration and modulation of architecture.
3. Higher recurrence rate of KCOT in the patients examined is proposed due to less extensive resection.

     

Dental risk factors for osteonecrosis of the jaws: a CONDOR case–control study

Background

Reports of osteonecrosis of the jaw (ONJ) have associated this lesion to treatment with bisphosphonates (BPs) and dental procedures. In this study, we investigated the association of specific dental diagnoses and procedures with ONJ among patients with past BP use.

Methods

Dentists from three practice-based research networks provided ONJ cases and controls (1:3). Data gathered from patients and dental offices with two respective standard questionnaires included demographic, medical, pharmaceutical, and dental information. Diagnoses and procedures up to 3 years prior to ONJ (prior to interview for controls) were analyzed within risk strata, defined by BP use and cancer status, using interaction terms within conditional logistic regression models.

Results

We enrolled 191 ONJ cases and 573 controls from 119 dental offices. Among participants who had used only oral BP, extraction was the only dental risk factor for ONJ (odds ratio (OR)?=?12, p?=?0.01). Suppuration was also more prevalent in cases (18 %) than in controls (9 %), but not statistically significant (OR?=?9, p?=?0.06). Among participants who had not used either oral or IV BP (a majority of whom received radiation therapy to the head and neck), suppuration was the only dental risk factor for ONJ (prevalence?=?34 % for cases and 8 % for controls; OR?=?7, p?=?0.01). The prevalence of extractions in this group was also higher, but not statistically significant (44 vs 10 %; OR?=?3). Limited power precludes definitive findings among participants exposed to IV BP.

Conclusions

Among patients taking oral BP, extraction was the only dental procedure associated with subsequent ONJ development

Clinical relevance

Results of this study suggest that routine dental procedures are not associated with development of ONJ in patients exposed to BPs.     

Evaluation of the long-term storage stability of saliva as a source of human DNA

Objectives

The objectives of this paper are to determine the storage stability of saliva at 37 °C over an 18-month period, and its influence on the DNA yield, purity, PCR protocols and genotyping efficacy.

Materials and methods

Of the 60 participants, blood samples were obtained from 10 and saliva from 50. Samples were subjected to different storage conditions: DNA extracted immediately; DNA extracted following storage at 37 °C for 1, 6, 12 and 18 months. Subsequently, DNA yield, OD_260/280 and OD_260/230 ratios were measured. The isolated DNA was used to amplify exons 0–7 of the RUNX2 gene and subsequently sequenced. Furthermore, 25 SNPs were genotyped.

Results

The mean DNA yield, OD_260/280 and OD_260/230 ratios obtained from blood were 67.4 ng/μl, 1.8?±?0.05 and 1.8?±?0.4 respectively. DNA yield obtained from saliva was significantly higher than blood (p?<?0.0001), ranging from 97.4 to 125.8 ng/μl while the OD_260/280 ratio ranged from 1.8?±?0.13 to 1.9?±?0.1. The success rates for the 25 SNPs ranged from 98 to 100 % for blood and 96–99 % for saliva samples with the genotype frequencies in Hardy–Weinberg equilibrium (>0.01).

Conclusions

Saliva can be stored at 37 °C for 18 months without compromising its quality and ability to endure genetic analyses.

Clinical relevance

Saliva is a viable source of human DNA to facilitate the feasibility of large-scale genetic studies.     

The prevalence of root resorption of maxillary incisors caused by impacted maxillary canines

Objectives

The aim of this study was to evaluate the prevalence of root resorption of maxillary incisors caused by impacted maxillary canines using low-dose dental computed tomography and to gain additional knowledge of the underlying aetiology and the progression of root resorption.

Materials and methods

A total of 440 patients (mean age, 24.7 years) with 557 impacted maxillary canines were examined regarding their location and the occurrence of root resorption of maxillary incisors.

Results

The frequency of root resorption was 2 % of central and 7.7 % of lateral maxillary incisors. The location of the 557 impacted canines within the dental arch was palatal in 67.5 %, buccal in 15.4 % and central in 17.1 %. No significant differences could be shown with respect to the width and the shape of the dental follicle of the impacted maxillary canines and the presence of root resorption of incisors. The presence of root resorption of central (p?<?0.0001) and lateral (p?<?0.023) maxillary incisors was significantly correlated with an existing contact relationship of the impacted maxillary canines.

Conclusions

Our investigation confirms the theory of prior reports comprising a much larger patient population, hypothesising that the dental follicle of impacted maxillary canines does not cause resorption of adjacent maxillary incisors per se.

Clinical relevance

Root resorption of maxillary incisors is correlated with effects of contact of the impacted maxillary canines, and these findings should be considered in treatment planning. Our findings are consistent with other reports and may develop new treatment approaches for the treatment of this sequela.     

Veränderung der Nasalanz nach Le Fort-I Osteotomie

Background

Nasalance represents a measure of the relative amount of oral and nasal acoustic energy produced by a speaker. Literature shows changes in nasalance after surgery of the oropharynx. The aim of this prospective study was to evaluate the outcome of speech and nasalance scores after Le-Fort-I-Osteotomy.

Patients and methods

A total of 20 individuals with normal speech development were examined preoperatively and 6 weeks postoperatively with the Nasometer 6200 (Kay-Elemetrics, USA) after bimaxillary surgery. The tone materials used comprised the standardized text passage: ?Ein Kindergeburtstag“, the vowels: /a/, /e/, /i/, /o/, /u/ and a syllable repetition subtest.

Results

All patients showed changes in nasalance scores 6 weeks postoperatively. There were no significant changes reading the standard text. The syllable repetition test showed significant changes for repetition of ?ma ma ma“ and ?na na na“ (p?=?0,003, respectively p?=?0,033). Intonation of the vowel /a/ also revealed significant changes regarding the pre- and postoperative values (p?=?0,006). However, the obtained values had no significant impact on the nasality characteristics of speech.

Conclusion

This study confirms that maxillary osteotomies can result in significant changes of nasalance scores. However these changes do not have any impact on normal speech and voice.     

Die Arthrozentese als hochwirksame Akuttherapie der Kiefergelenkarthralgie

Purpose

This clinical study deals with the efficiency of arthrocentesis in acute arthropathy of the temporomandibular joint (TMJ).

Patients and methods

In total 142?patients (41.5?years average) were included in the examination. Inclusion criteria were a restriction of mouth opening <?40?mm and/or TMJ pain >?3 on a visual analog scale (VAS). The first examination took place the day before surgery; follow-up was performed 1?day and 4?weeks after arthrocentesis. Study parameters were active mouth opening, TMJ pain on preauricular or intra-auricular palpation, myalgia of the temporalis or masseter muscle, and a deviation clicking or crepitation during mouth opening. Arthrocentesis was performed in all patients under general anesthesia by a double puncture, continuous rinsing technique in an inferolateral approach as recommended by Murakami. The upper temporomandibular joint space was rinsed with 250?ml of a physiological sterile saline solution and a pressure of 200?mmHg.

Results

Arthrocentesis resulted in a highly significant increase of mouth opening and a highly significant reduction of TMJ pain on palpation (p<?0.001).

Conclusion

It can be postulated that TMJ arthrocentesis represents a highly efficient therapy of acute TMJ arthropathy. Whether the results have to be judged as a palliative short-time therapy or if even long-term results can be achieved has to be proved by long-term follow-up studies.     

Sekundäre Mittelgesichtsrekonstruktion mittels verschiedener Operationsverfahren unter Nutzung der computergestützten Chirurgie

Aim

Aim of this retrospective study was to assess the outcome after secondary midfacial reconstruction using different operation techniques and computer assisted surgery. Functional and aesthetic aspects as well as experiences are reported.

Patients and methods

18 patients were assessed for enophthalmos, diplopia, and aesthetics during a follow-up period of up to 2.5 years.

Results

In 40% of the patients several techniques for soft and hard tissue reconstruction were used. In 5 of the 9 patients diplopia was improved; in 4 patients there was no change. A significant enophthalmos was corrected in 8 out of 12 patients. After additional surgery 6 patients had a good aesthetic result, 7 a satisfactory and 5 a poor.

Conclusion

For secondary midfacial reconstruction often a combination of different surgical techniques is neccessary. Bony asymmetries and enophthalmos were successfully corrected, however, functional and aesthetic impairment due to bad soft tissue condition are difficult to correct. Computer assisted surgery is helpful for dissection within the orbit, for graft placement, and for positioning of osteotomized segments.     

Analysis of the intraimplant microflora of two-piece dental implants

Objective

Information about the spectrum of microorganisms in the intraimplant cavities of two-piece dental implants is scarce. The purpose of this study was to assess the intraimplant microflora of two-piece dental implants by conventional biochemical testing, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and 16 s rDNA gene sequencing.

Materials and methods

Ten patients (six men and four women; average age?=?66.7 years; age range?=?58–78 years) received 35 two-piece titanium implants carrying ball attachments. Biofilm sampling was performed with sterile microbrushes, and nonadherent microbial samples were obtained by injection and reuptake of predefined volumes of NaCl solution. The samples were cultured and analyzed by conventional biochemical testing, MALDI-TOF MS, and 16 s rDNA gene sequencing.

Results

Of the 103 species detected, 27 and 33 were identified only in the biofilm and nonadherent microbial samples, respectively. Forty-three species were identified in both types of samples.

Conclusions

Two-piece dental implants harbored a broad spectrum of gram-positive and gram-negative aerobes and anaerobes, especially rods and cocci.

Clinical relevance

These findings confirm bacterial translocation from the oral cavity to intraimplant cavities. Microbiological methods as used in this study are necessary to reveal the complete vital microflora of intraimplant cavities.     

Systematische qualitative Histologie von enossalen Implantaten mit anodisch oxidierten Oberflächen

Histological analysis of dental implants is often quantified by calculating the bone-implant contact rate (bone volume/total volume), whereas qualitative aspects like osteoconduction are underrepresented. The aim of this study was to focus on the micro-architectural properties of the bone-implant contact under physiologic loading using a systematic analysis of these characteristics. In 16 Beagle dogs we inserted 6 different types of dental implants in the hard bone of the mandible and the soft bone of the maxilla. After a healing period of two months the implants were loaded for three months and then histologically analysed. For the metric evaluation of qualitative histological aspects 12 examiners answered pivotal questions:

1. Is the implant functional sufficient?
2. Do you see close contact to bone, were bone is present?
3. Is the amount of bone at the implant at least similar to the peripheral bone?
4. Is the bone to implant contact homogenous?
5. Does the bone show a functional architecture?
6. Do you find osseoconductive bone apposition at the crestal and apical border?

A superiority of anodic oxidized surfaces can be seen in questions 1, 2 and 3 mainly for the comparison of identical macrodesigns (MkIII). The potential for osseoconductivity (questions 4 and 5) shows a tendency for significant differences for the ZL Ticer implant. Homogenous bone to implant contact is rarely found, in contrast to rather positive implant function ratings. This suggests the existence of an optimum in the bone to implant contact rate. Bone to implant contact rate as an isolated quantitative parameter should in future be completed by a systematic, standardised and blinded analysis of qualitative properties.     

Foudroyanter Verlauf einer therapierefraktären Wegener Granulomatose bei negativen c-ANCA

Background

Wegener's Granulomatosis is a rare systemic disease characterized by the triad of necrotizing granulomas of blood vessels, upper respiratory tract, and kidneys. Diagnosis depends on clinical symptoms (ACR-criteria), detection of serum circulating antineutrophil cytoplasmic antibodies (c-ANCA) and bioptical histopathology.

Case-report

A 34-year-old patient presented with intraoral ulcerating, necrotizing inflammations of the palate and the gingiva. Chest radiograph (nodules, infiltrates), urin analysis (red blood cell casts) being inconspicuous Wegener's granulomatosis was diagnosed by histopathology of an intraoral incisional biopsy. Conventional therapy with corticosteroids and cyclophosphamide relapsed while the disease was taking a progressive course (pulmonary infiltrates, necrotizing vasculitides all over the common integument). The patient died of cardiac decompensation three months after diagnosis. c-ANCAs were not present at any time of disease.

Conclusions

1. Symptoms of the head and neck are manifest in up to 95% of Wegener's granulomatosis. So knowledge of the disease is important for dentists and oral and maxillofacial surgeons in spite of its low prevalence.
2. c-ANCA-titers do not reflect disease activity. Negative c-ANCAs do not exclude Wegener's granulomatosis.
3. Wegener's granulomatosis can take a progressive, therapy resistent course.

     

The influence of ambient lighting on the detection of small contrast elements in digital dental radiographs

Objectives

The aim of this study was to evaluate the effect of ambient light on the detection of contrast elements in digital dental radiographs.

Materials and methods

A high-contrast standardized digital radiograph of an aluminum step wedge containing 32 boreholes of different depth was cut into 40 isometric images. Images were presented at random on a 17-in cathode ray tube (CRT) monitor at different ambient background illuminations of 0, 50, 200, and 500 lx. Twenty observers stated twice their blinded decision whether or not they could perceive a dark spot on a five-point confidence scale. Areas (Az) under receiver operating characteristic curves were calculated and compared between the four different ambient illuminations using the Friedman test. Statistical significance was set at p?<?0.05. Overall agreement was estimated determining the intraclass correlation coefficient.

Results

The Az values (0.735 for 0 lx, 0.728 for 50 lx, 0.735 for 200 lx, and 0.788 for 500 lx) did not significantly differ (p?=?0.796) between the four ambient lighting levels.

Conclusions

The detection of small contrast features in digital dental radiographs on a CRT monitor seems to be comparable over a wide range of ambient background illumination.

Clinical relevance

The ambient light in dental offices of <500 lx may not negatively impact the diagnostic performance of digital dental radiographs.     

Transorale operative Therapie von Kiefergelenkfrakturen mit einer 3D-Platte

Aim

The transoral approach minimizes the risk of damaging the facial nerve. However, stable osteosynthesis with two miniplates at the proximal fragment is often not possible. To achieve a stable fixation also of condylar neck fractures a new delta-shaped plate was developed, which meets the biomechanical demands of this region. This plate was tested in a clinical study.

Patients and methods

In total 11 patients suffering from 13 condyle fractures (Spiessl I: n?=?2, Spiessl II: n?=?10, Spiessl III: n?=?1, 3 bilateral fractures) were treated via a transoral approach and assessed clinically as well as radiologically in the follow-up period. Functional parameters and fracture alignment were assessed.

Results

After 6 months postoperative function had returned to normal with a mouth opening of 42 mm and pro- and laterotrusion of more than 5 mm. Postoperative radiographic controls showed a good fracture alignment in 7 of 8 patients respectively in 6 of 8 cases after 6 months. In 12 of 13 fractures directly postoperative and in 10 of 13 fractures 6 months postoperative, respectively, Towne's view radiographs showed an anatomical correct position. No plate fracture and no bending of plates were observed. Loosening of screws was found in 2 patients during plate removal.

Conclusion

The newly developed three-dimensional plate was easy to handle, and a sufficiently stable osteosynthesis of condyle fractures was possible. This plate can be recommended for surgical fracture treatment via a transoral approach omitting extraoral scars and damage to the facial nerve.