International Poster Journal of Dentistry and Oral Medicine, 01/2002

The diagnosis Langerhans' cell histiocytosis subsumes different granulomatous lesions of unknown origin. Regarding the literature there are controversies about the disease being a reactive process, a neoplasm or a malignancy. The chronic generalised form compasses the trias exophthalmus, insipid diabetes which is due to a compression of the pituitary stalk, and multiple osteolytic defects of the skull. The latter is accepted to be an obligate sign. The case of a 30 year old male is presented in which histological and immunohistological evidence was made of multiple eosinophilic granulomas of the upper and lower jaw. At the time of making the diagnosis there was an insipid diabetes. The treatment was planned according to suggestions of an interdisciplinary conference and consisted of two six weeks cycles of chemotherapy with vinblastin and prednisone. The aim was to preserve teeth and alveolar process. After the chemotherapy biopsies were taken from the former affected regions which were negative. Despite the chemotherapy an apposition of bone was determined in the molar region of the lower jaw that a prosthetic rehabilitation was initiated. In comparison to similar cases the course of the disease is different and not predictable. It's control has to be implemented by regular radiographic examination and possible biopsies because of the lack of specific tracers. Schlagwörter: Langerhans' cell histiocytosis, eosinophilic granuloma of the jaws, immunohistology, chemotherapy, prognosis, Langerhanszell-Histiozytose, eosinophiles Granulom der Kiefer, Immunohistologie, Chemotherapie, Prognose

Active cellular locomotion is a feature of diverse T cell types. Using a 3-D collagen matrix migration model in combination with computer-assisted cell tracking for reconstruction of migration paths and confocal microscopy, we investigated the locomotion behavior of CD4+ lymphocytes governing cell-dental material interactions due to the influence of different dental alloys. We tested the hypothesis of whether changes of lomotory behavior after induction of chemotaxis could be ascribed to changes of the regulatory signal transduction of migration. We did this on the basis of the trading that spontaneous locomotion of T lymphocytes was regulated by PTK activity and was distinct from a second, protein kinase C (PKC)-dependent type of migration inducible by PKC-activating phorbol ester due to different serum eluates of dental alloys. Material and methods: Human peripheral CD4+ cells were isolated from heparinized blood of healthy donors by density-gradient, centrifugation using Ficoll-Hypaque. CD4+ cells were positively selected using immunomagnetic beads coated with mouse anti-human CD4+mAb. Subsequently, cell-bound beads were detached using polyclonal anti-mouse Fab antibodies. Purified CD4+ cells were > 98% Cd3 and 96.99% CD4+, respectively, as detected by flow cytometry. More than 98% of the cells were viable, as assessed by propidium iodide staining and flow cytometry. For collagen lattices preparations 2,5 x 105 cells were mixed with 100µl of buffered collagen solution (pH 7,4) containing 1,67 mg/ml collagen type I in minimal essential Eagle's medium. Locomotion of CD4+ lymphocytes suspended in type I collagen gels was recorded using time-lapse video-microscopy. Paths of 30 randomly selected locomoting cells over a period of two hours were digitized, reconstructed and quantitatively analysed. A dental alloy free assay served as a control. We evaluated two different quantitative parameters using Ti-dental monomaterials in comparison to precious dental alloys: (1) the average percentage of CD4+ cells moving and (2) the velocity of the migrating CD4±cells due to the influence of serum dental material eluates. Results: We could show a reduction of average percentage of CD4+ cells migration in the presence of precious alloys (25,6%5,8 for 'high-precious-alloys', 53,1%5,6 for 'reduced-precious-alloys', 28%5,8 for palladium-based alloys) in comparison to the non-reduction of the average migration in the Ti-group. Concerning the velocity the same deminishing tendency could be seen for precious and palladium-based alloys (range from 1,65µm/min2,0 up to 3,0µm/min2,4) in comparison to the highly biocompatible results of Ti-monomaterials (4,8µm/min2,4). Discussion: We presume that the CD4+ cells are migrating in a 3D collagen matrix migration model in a 'random-walk' fashion influenced by the components of serum dental material eluates. Further the developed test could be used as an indicator for biocompatibility of different dental materials. Conclusion: The results of our newly developed test showed a higher biocompatibility of Ti-monomaterials in comparison to precious dental alloys. Schlagwörter: CD4+ lymphocyte, migration, titanium, dental alloy

We introduce a method to apply a preoperative 3D plan for inserting dental implants with an assisting medical robot. The treatment plan is based on the 3D visualization of the CT data of the patient's maxilla and mandible, and supplies the location of the implants in the patient's coordinates. The plan is then transferred to the surgical robot's coordinate system. The robot guides the tool, a drill guide. Position, orientation, and depth of the initial drilling is defined with the tool held by the robot while the surgeon drills. The robot assists the dentist, and the optimal treatment plan will be applied directly to the patient. Schlagwörter: computer assisted implantology, robotics

We are introducing a method that combines a pre-operative 3D plan for inserting dental implants with a dental navigation system. The method is based on the visualization of the CT data of the patient's maxilla and mandible. The position and orientation of each implant is clinically planned using the CT data set as well as the size and type of the implant. The treatment plan supplies the location of the implants in the patient's coordinates and transferred to the patient using a dental navigation system (DenX's, IGI System). The system 'assists' the dentist during the pre-operative planning and also during the intra-operative procedure, while the optimal treatment plan is applied directly to the patient. A PC based software, IGI allows for simulation, visualization, and planning the surgical intervention. The system was tested in Israel at the company site as a prototype and will be installed at the University Hospital of Heidelberg for further evaluation and experience until it will be used for clinical application during the middle of 2002. Schlagwörter: computer assisted implantology

In this case report we introduce a 38-year old HIV-infected (stage B3, CDC) male with distinct oral lesions. The patient was diagnosed HIV positive in 1985 and is currently under treatment with Abacavir, Lamivudin and Zidovudin. During this therapy, the HIV virus has been suppressed below detectibility, and a gain of CD4-cells to 250 cells/µl has been observed. A single course of herpes zoster infection has occurred 5 years ago; genital herpes recurs in irregular intervals. According to the patient's medical history, first gingival overgrowth was noticed about one year ago. It occurred in the region of the lower anterior teeth, including the canines and first cuspids. We found hypertrophic alterations with cleft surfaces on the facial and oral aspects of the gingival tissues. Solitary papules of 6 mm in diameter existed on the edentulous site of the missing first lower left molar, on the mucosa of the lower lip, and on the vestibular gingival papilla between the upper right canine and lateral incisor. Biopsies were taken, and the histological findings confirmed the clinical presumption of an oral papillomatosis. Also, HPV-6 was identified by PCR virus typing. With the patient's informed consent, the oral papillomatosis was treated with Imiquimod 5% cream, which is licensed for the treatment of genito-anal papillomata. It was applied twice a week for a duration of 4 weeks. Since no immediate success was detected, the decision was made to extend the treatment for another 4 weeks, 3 times weekly. After a total of 8 weeks into treatment, a complete remission had occurred. This result seems to be stable, since no recurrence was seen up to eight months after therapy. Also, there were no side-effects during the total period of observation. It remains to be seen whether this treatment result is preserved over a longer period of time. Schlagwörter: Orale Papillomatose, HIV, Imiquimod

Objective: Based on documented excellent radiosensitization effects, a prospective phase II trial was initiated using paclitaxel (P) and carboplatin (C) with concurrent conventional fractionated radiotherapy followed by surgery of the primary tumor and regional neck nodes. Methods: From 6/98 - 8/99 twenty-eight patients (pts) received 5 cycles of weekly P (40mg/m2), C (AUC 1.5) with conventional radiotherapy 40Gy. Surgery was performed within 3-4-weeks after chemoradiation. Results: Pts characteristics: 23 males, 5 females, mean age 54 (range 40-71); stage III 6, stage IV 22. Site: oropharynx 6, oral cavity 22. Twenty-seven pts were evaluable for toxicity and response. One early death was reported due to septic neutropenia. Clinical response was as follows: CR (14/27 52%); PR (13/27 48%). Twenty-three pts were evaluable for pathologic response after surgical resection. Pathological response was as follows: pCR (10/23 44%); pPR(13/23 56%). CTC grade 2 or 3 mucosistis occured in all pts. Hematologic toxicity was as follows: hemoglobin CTC grade 3 (14%), leukocytes CTC grade 1 (24%), grade 3 (33%), grade 4 (10%), thrombocytes CTC grade 2 (10%), grade 3(14%). Conclusions: Concurrent P/C and radiotherapy resulted in excellent clinical and pathological response rates in advanced stage disease. Mucositis was the most common and significant toxicity. Schlagwörter: Paclitaxel, Carboplatin, phase-II-clinical-trial, head and neck cancer, squamous cell carcinoma, chemotherapy, radiotherapy, Dösak

No data about the prevalence of clinically undetected occlusal dentine caries are available in young German populations. Therefore the aim of this study was to determine the prevalence of clinically undetected occlusal dentine caries of first and second molars in 78 15-year-old German adolescents by occlusal judgement of bite-wing radiographs. The clinical observa-tions were collected as part of a longitudinal study of caries risk assessment conducted from 1993 to 1999. The same clinical criteria (WHO,1987) were used during the follow ups. Radio-graphic evaluation was only performed in 1999. Bite-wing radiographs were judged by 3 examiners, kappa 0.76. 5.6 D3MFS were clinically scored. 2.6 molars were sealed. After radiographic examination caries prevalence increased to 7.5 D3MFS. 1.8 D3-lesions were registered on the occlusal surfaces of the molars by clinical and radiographic judgements, while 1.3 D3-lesions were only radiographically detected. This difference was statistically significant (Mann-Whitney-Test: p 3S were found in sealed and in filled molars, respectively. 0.2 D3S were detected on clinically judged sound surfaces and 0.3 D3S in brown discoloured fissures. 11.1 % of all molars and 14 % of the sealed molars revealed a clinically undetected occlusal dentine caries. More than 70 % of all occlusal D3-lesions were exclusively detected by bite-wing radiographs. It can be concluded from this study that clinically undetected occlusal lesions are not only a problem in adolescents with low but also with high caries experience. Schlagwörter: epidemiology, caries diagnostics, hidden caries, bitewing radiographs

Epidermolysis bullosa dystrophica hereditaria (Hallopeau-Siemens syndrome) is the most frequent form of recessive inheritable dystrophic epidermolysis. It occurs frequently in geographic areas with high blood relationship (Northsweden, Aargau/Switzerland, Schlüchtern/Germany). Ectodermal dysplasia, esophagal stenosis as well as occurrance of squamous cell carcinomas in the head and neck region are significant symptoms of this disease. We report a case of a 41 year old male patient, child of a consanguine relationship of father and daughter. First signs of the disease with acral epidermiolysis appeared in early childhood. At the age of 24 a genetic examination confirmed the diagnosis when leukokeratosis and a stenosis of the esophagus were detected. 15 years later we performed surgery on a squamous cell carcinoma of the mouth. Surgical reconstruction of the cheek defect was done with a doublesided forearm flap. Ectropions of both lower lids, caused by dermatrophia, were corrected with split-skin grafts during the same operation. Apart from surgical efforts the goal of plastic and reconstructive techniques is to reestablish and maintain tissue function within the head and neck area. The aim of this report is to demonstrate different techniques to restore skin and mucosal defects. Additionally this case demonstration emphasizes the appearance of squamous cell carcinomes within skin and mucous lesions based on a genetic predisposition. In these cases a longtime clinical follow up is recommended. Schlagwörter: Hallopeau-Siemens, recessive dystrophic epidermolysis bullosa, oral and maxillofacial surgery

Occlusal cares diagnosis at non-cavitated, discoloured fissures remains difficult. Modern caries diagnostic devices have been poorly investigated under clinical conditions. The aim of this study was to compare the accuracy of the following methods in occlusal caries detection: (1) visual inspection using magnifying glasses (x2,5), (2) laser fluorescence measurement with KaVo DIAGNOdent device, (3) electric conductive measurement with ECM III, (4) electric conductive measurement with Cariometer CRM 800 (Gente 1999). A total of 381 sites on 192 occlusal surfaces from 40 patients were examined by two dentists using the four diagnostic methods mentioned above. If two or more methods indicated dentinal caries, a minimally invasive preparation was performed. For this reason 47 sites on 34 occlusal surfaces from 22 patients aged 5 to 30 years (mean 19 years) were selected. During stepwise preparation the presence of dentinal caries was determined visually as a gold standard for each of the examined locations within the fissure. ECM showed the best and the only significant predictive values concerning dentinal caries (sensitivity 0.94, specificity 0.62, significance 0.002; area under the ROC curve 0.75). CRM recordings as well as visual inspection and DIAGNOdent scores demonstrated decreasing predictive values (sensitivity/specificity/AUC 0.85/0.47/0.699, 0.69/0.62/0.661 and 0.79/0.38/0.589). Combinations of methods did not improve the results. The low specificity values obtained in this study are partially caused by the preselection of teeth with suspicious fissures, which correlates to the diagnostic needs in the clinical situation. In conclusion, among the four methods used, ECM demonstrated the best suitability for treatment decisions at non-cavitated, discoloured occlusal fissures. Further data should be collected to achieve higher significance. Schlagwörter: occlusal caries diagnostics in vivo, laser fluorescence