International Poster Journal of Dentistry and Oral Medicine, 02/2018

Introduction: Complex defect situations with combined vertical and horizontal dimensions continue to be a challenge even for established augmentation procedures. New computer-assisted augmentation methods with their advantages are particularly suitable for this purpose. In the following, an augmentation of a maxillary anterior region with a combined vertical-horizontal defect which has been treated with a patient-specific CAD/CAM titanium mash based on the DAICOM data (DVT) is presented. Patient case: An otherwise healthy 30-year-old patient presented for the treatment of an endentulous space in the upper front (region 21-23) with a severe horizontal-vertical defect after tumour resection. In addition to the bony defect, there was a significant scarring in the vestibule soft tissue as a result of the pre-surgery. Based on the DICOM data, a patient-specific titanium mesh for particulate augmentation was prepared. Despite dehiscence in the healing phase, the augmentation was successful, and implantation in combination with a soft tissue management using artificial collagen matrix was performed. Keywords: CAD/CAM, Titanium mesh, augmentation, dehiscence

Telescopic crowns and casted partial dentures can be used in many clinical cases. This study examined the impact of telescopic partial dentures on single remaining tooth continuation in a period of 10 years. Two partially edentulous patients with single remaining teeth in their jaws -single premolars in a lower jaw, and single molar in the upper jaw on the right side - were selected for the fabrication of telescopic metal-framed partial dentures. Dentures were retained on residual dentition entirely by cylinder telescope crowns. Inner telescopic crowns and metal fundaments of outer telescopic crowns were fabricated using a precious alloy (gold) (DAMCAST CC, Yadent Zhengzhou, China). The fit of the secondary outer crown copings over the primary copings was evaluated on the master casts and in the patient's mouth. Outer crowns were mechanically retained (Palavit G., Heraeus-Kulzer, Germany) in specifically designed boxes in a framework of cobalt-chromium-molybdenum alloy (Co-Cr-Mo-W, (Remanium 2000) UNS R30075, ASTM F75, ISO 5832-4) of partial dentures. Indirect light-cure composite (Sinfony™, 3M) was used for the fabrication of aesthetic axial and occlusal portions of outer telescope crowns. Acrylic-resin anatomic cross-linked artificial teeth (Optognath, Bayer-Galenika, Galenika, Serbia) were used in the set-up procedure in a semi-adjustable articulator (Artex CT, Amann Girrbach). Vital abutment teeth survived considerably long - for 10 years, in the situation of single and few tooth abutments, with at least one recall appointment after the 1st year of the therapy. Telescopic dentures provided aesthetically pleasing and comfortable effects - preventing bone loss and longer life span of the remaining premolar and molar teeth. Keywords: Telescopic partial denture, outer telescope crown, inner coping

Objective: The objective is to remove the local etiological factors responsible for inflammatory gingival enlargement and restore the physiological form of the gingiva. Methodology: A 31-year-old female patient presented with soft, discoloured, tender gingiva with ballooning of the papilla and margins along with generalised plaque and calculus suggestive of generalised chronic inflammatory gingival enlargement on the basis of exclusion of other causes. Meticulous scaling and root planing were performed quadrant-wise weekly. Results: Within a month of non-surgical periodontal therapy, gingival enlargement had reduced markedly, and the patient was put on an oral hygiene maintenance programme. No remission of enlargement was observed after 6 months of follow up. Conclusion: For plaque-induced periodontal disease, non-surgical therapy is still a gold standard among all the therapies available. Keywords: inflammatory, enlargement, non-surgical, plaque, calculus, scaling, root planing

Introduction: The inferior alveolar nerve can be subjected to iatrogenic injury during surgical procedures if its location and course are not carefully identified. Objectives: The objectives of this retrospective study were to determine the bucco-lingual orientation of the inferior alveolar canal (IAC) and to estimate ethnicity-, side-, sex-, and age-related variations in a Malaysian population. Methods: A total of 121 cone beam computed tomography (CBCT) files were selected using a stratified random sampling method. The bucco-lingual position of the IAC was identified on the cross-sectional view of all the premolars and molars on both sides of the mandible. Buccal bone width (B), canal thickness (C), and lingual bone width (L) were measured at the horizontal canal levels. Kruskal Wallis test, Friedman test, one-way analysis of variance (ANOVA) test, and independent and paired samples t-tests were carried out to evaluate side-, ethnicity-, gender- and age-related variations (p0.05). Results: Overall, the IACs were located on the lingual side in second molar regions (left: 71.9%; right: 71.1%); in the centre in first molar regions (left: 57.9%; right: 47.10%); and exits through the mental foramen before second premolar regions. There was a statistically significant difference in the location of the IAC among the age groups in left (p=0.003) and right (p=0.015) second molar regions and between genders in left second premolar regions (p=0.033). On average, B measurement was the thickest at the second molar regions (left, right: 6.13mm) while L was the thickest at the second premolar regions (left: 4.09mm; right: 4.36mm). Statistically significant differences in these measurements were found, associated with ethnicity (p≤0.035), gender (p≤0.013), age (p≤0.038) and side (p≤0.025). Conclusions: From second molar to second premolar, the IAC stretched from lingual to centre and exited through the mental foramen before the second premolars; mean values of B decreased while L increased. These variations should be taken into considerations prior to surgical procedures involving the mandible to prevent iatrogenic injury. Keywords: Implant treatment, nerve injury, CBCT, Malaysian population

Introduction: Dentistry by its very nature is hands-on. A lack of patient exposure/ interaction in the first two years of the undergraduate course can lead to dissociation between the applied aspects and theoretical aspects of the subject. The major objectives of the study were to develop an ECE module and execute it and to check if it made any difference in the applied part of the topic and in intermediate term retention of the topic. Method: Two topics of equivalent difficulty were chosen for the study. An ECE module consisting of a patient treatment video and handout was prepared for the control topic. A pre-test consisting of equal number of application- and recall-based MCQ's was taken followed by the intervention. This was followed by a post-test and feedback from the students about ECE. The same test was repeated after 90 days to check for intermediate-term retention. Results: A statistically significant difference was observed in the application-based MCQ scores between the study topic and control topic. Though there was no difference in total scores between the study and the control topic in the test taken after 90 days, but the difference in the application-based MCQ's persisted. The students liked the teaching methodology and wanted it to be used for other topics. Conclusion: ECE in the classroom setting has a positive impact on the application-based component of the topic and make the topic more interesting for the students. Keywords: Dental education, dental materials, early clinical exposure

Immediate loading in the edentulous jaw with provisional bridges (pB) can lead to technical complications during the healing phase causing implant loss. In particular, fractures of the provisional in the healing phase can contribute to movement of the implants and thus endanger the osseointegration. The temporaries are often made from an existing denture in the patient's mouth (directly) or after an impression in the laboratory (indirectly). The present study compares the fracture rate of these two different provisional restorations. Material and methods: In a retrospective analysis, the fracture rate of pB was examined on immediately loaded implants in the edentulous jaw during the healing phase. The pB were either created directly from the existing total dentures or prepared indirectly in the laboratory after a postoperative impression and determining the inter-maxillary relation. Results: In 17 women and 7 men (mean age: 63 years ± 10), 11 direct and 15 indirect temporaries were analysed in 21 toothless upper and 5 lower jaws on 4 (n = 12) or 6 (n = 14) implants (n = 132). In 31% of pB (n = 8), a total of 20 fracture complications occurred after an average time of 88 ± 39 days. Both the number of implants (p = 0.597), the localisation in the respective jaw (p = 0.562) and the type of pB (p = 0.597) had no influence on the fracture probability. The distance between the individual implants (p = 0.454) or the entire length of the implant arch (p = 0.967) also had no influence on the fracture rate. Overall, 8% of the implants (n = 10) were not osseointegrated in the healing phase. In cases where fracture of pB was obtained, the implant loss rate was almost twice as high (38% vs 22%, p = 0.418). In all cases with implant loss, post-implantation was performed. Conclusion: The fracture rate of both investigated variants of the temporaries for immediate loading in the edentulous jaw appears to be very high. There are at least indications that a fracture between two implants increases the risk of implant loss during the phase of osseointegration. Keywords: Immediate loading in the edentulous jaw, implantation, provisional bridges, complications

Introduction: Oral-health-related quality of life measures have been developed because objective clinical measures of disease provided little insight into the impact of oral disorders on daily living and quality of life. The EuroQol was developed as a standardised, generic (non-disease-specific) instrument for describing and valuing health-related quality of life. Aim: To assess the quality of life among dental caries and periodontal patients. Materials and methods: The EQ5D questionnaire was used to assess the quality of life among OPD patients in the Department of Oral Medicine and Radiology. An oral examination was done to check for dental caries and the periodontal status of the patient using the Community Periodontal Index and the DMFT index. Convergent and divergent validity were measured for the predetermined hypotheses. Results: Quality of life is affected in both dental caries and periodontal patients. It was found to be poorer with patients who have a high DMFS score. The anxiety and depression dimension of the EQ5D was found to be more significant in females than in males. Conclusion: The EQ5D has both convergent and discriminant validity for the measurement of health status in dental caries and periodontal patients. Dental Public Health significance: Oral diseases like dental caries and periodontal diseases are highly prevalent and can lead to pain, discomfort, anxiety, poor facial appearance, low self-esteem, and impaired function. Quality of life is an important parameter for assessing health outcomes, efficacy, and the economic impact of interventions. So as a public health dentist, we need to take preventive measures for oral diseases. Keywords: EQ5D, oral health, quality of life, validity, dental caries, periodontitis

Background: Information on bucco-lingual orientation of the inferior alveolar nerve (IAN) can reduce the risk of iatrogenic injury to the nerve during implant placement, especially in settings where CBCT is not available. Objectives: To determine the bucco-lingual orientation of the IAN and the buccal and lingual bone width at the canal level in molar regions amongst the 3 ethnicities (Malay, Chinese, Indian) of Malaysians. Methods: 105 CBCT-DICOM files (n=35 per ethnic group) randomly selected from the IMU-dental clinic to determine the bucco-lingual orientation of the IAN in the 1st and 2nd molar regions. The canal size, buccal and lingual bone-width at the canal level were measured. One-way analysis of variance (ANOVA) was separately performed to identify side- and ethnicity-related variations. Results: In the Malay population, 48.6% (36 region) and 51.4% (46 region) of IANs were located at the centre; 62.9% (37 region) and 77.1% (47 region) were placed lingually. In the Malaysian-Chinese population, 48.6% (36 region) and 51.4% (46 region) of IANs were located at the centre; 60% (37 region) and 60% (47 region) were placed lingually. In the Malaysian-Indian population, 48.6% (36 region) and 65.7% (46 region) of IAN were located at the centre; 77.1% (37 region) and 74.3% (47 region) were placed lingually. A statistically significant (P.05) difference was found between the left and right sides of all measurements in the 2nd molar region, and the buccal bone width and canal size of IANs in the 1st molar region. A statistically significant difference was found in buccal bone width and IAN canal size in 37 region between Malaysian-Indian and Malay populations. Conclusion: The IAN was located at the centre in first molar regions and on the lingual side in second molars region, with significant variations in buccal, lingual bone width and canal size on both sides. Ethnicity-associated variations were identified between Malaysian-Indian and Malay populations. Keywords: Implant dentistry, implant surgery, safe zone, mandible anatomy

Introduction: Carcinogenesis is associated with complex changes in metabolism, which include increased consumption of glucose, by breakdown of glycogen and the tumor cells. This may be related to increased blood glucose level in patients with malignant or premalignant diseases. Adverse oral habits like smoking and tobacco chewing are common etiological factors related to oral premalignant diseases. The association of these factors may be related to an increased blood glucose level as an early biomarker for malignancy in suspected patients. Objective: The purpose of this study is to establish a relationship between blood glucose levels and potentially malignant oral disorders in patients with a long-term history of tobacco chewing, smoking, or both. Method: This study was conducted among 30 patients in 1) Persons with clinically developed PMD and a >5-year history of tobacco chewing or smoking or both, 2) Persons with no clinically developed PMD but a >5-year history of tobacco chewing or smoking or both formed the subjects while 3) 30 persons with clinically normal appearing oral mucosa and no tobacco history formed the control group. Results: Results showed that the overall RBS level was increased with habit and with lesions. The male population showed a greater increase. RBS was prominently increased in the male population with OL (139.8 gm/dl) compared to males with no habit history (114.9 gm/dl). Conclusion: The present study suggests a possible association of RBS with OL, while the association with OSCC was not significant. Keywords: Tobacco, carcinogenesis, oral leukoplakia, oral squamous cell carcinoma, random blood sugar

An increasing number of physicians and researchers take advantage of smartphones or other mobile devices in 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 hospitalised patients with regard to their oral health status, their dental treatment needs, and 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 (Fig. 1). The objective of this study was to facilitate a screening of hospitalised patients with regard to dental treatment (Fig. 2 and 3), oral-health-related quality life (OHIP-G14), and Beck Depression Inventory (BDI-II) as well as to test the app with regard to its practicability in a clinical setting. Materials and methods: In this clinical study, a total of 145 hospitalised patients, admitted to the Departments of Orthopedics and Traumatology (UC) and the Department of General Surgery (AC) at the University Medical Center of Mainz, Germany, were enrolled. For this investigation, an iPad app was developed with the goal of facilitating dental screenings of hospitalised patients (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. The patients were asked to document their answers to the OHIP-G14 (scale: 0-37) and BDI-II (Scale 0-63) questionnaires directly into the iPad app. Results: A total of 91 male und 54 female patients with a mean age of 55.6 (SD±17) years were enrolled. The average number of teeth was 23.7 (SD±6) for the UC patients and 21.6 (SD±7) for the AC patients (Fig.4). The patients in the Traumatology Department (UC) generally showed a better oral health status with fewer signs of gingival bleeding (p=0.13; Fig.4), fewer pocket depths over 4mm (UC: 1.2; AC: 2.8) and fewer oral mucosa lesions (UC: 0.5; AC:1) than the General Surgery patients (AC). However, mucosal lesions were only found in 11.4% of all patients. The Beck Depression score (BDI-II) showed significantly better values for the UC patients (2.9; SD±5) than for the AC patients (5.1 SD±6) (p=0.26; Fig.6). Similar observations were found for the OHIP-G14 score (UC patients 3.2±6; AC patients 5.8±8) (Fig. 7). The need for immediate dental treatment was observed in 18%; urgent problems were recorded in 14% of all cases, preventive measures were to be conducted for 31% of all patients, and no dental treatment needs were recorded for 36% of all patients. Conclusions: Using the app is suitable for detecting cohorts in hospitalised patients. However, handling tablets proved to be difficult especially for older patients, so that additional time was necessary. A few patients refused to use the app. Keywords: iPad, oral health, quality of life