International Poster Journal of Dentistry and Oral Medicine, 02/2002

Aims: To evaluate the effect of Le Fort I osteotomy on nasal form and function. Method: Twenty-five patients undergoing Le Fort I osteotomy for anterior, anterior/superior and anterior/inferior maxillary repositioning were prospectively studied for changes in nasal form and function. Seventeen patients underwent bimaxillary osteotomy. They were evaluated before and 6 months after Le Fort I osteotomy. The nasal form was determined by measurement of standardized raster photographs of the nose and lateral teleradiography. The distances and angles of the nasal base were determined. The nasal profile was assessed by measurement of the nasofacial angle (NF), the nasolabial angle (NL), the angle between upper lip and Frankfort horizontal plane (L/FH), the angle between columella and FH (N/FH) and the nasocolumellar angle (NC). Nasal function was evaluated by anterior rhinomanometry, whereby the overall flow (ccm/s) was determined. Results: The results were classified in groups according to the different repositioning. The distances and the angles of the nasal base were significantly increased in all groups. As for the nasal profile, there was no significant increase of NL, L/FH, N/FH and NC in all groups but significant increase of NF (p Keywords: Le Fort I osteotomy, nasal form, nasal function, rhinomanometry

A prospective follow-up study was performed including 47 patients who underwent monomaxillary or bimaxillary osteotomy. Fixation after sagittal split osteotomy was achieved with a new adjustable bone fixation system. Significant postoperative changes were found in an analysis of axiographic condylar path tracings. A reduction of condylar path length after mandibular advancement was seen after 12 months during mouth opening and protrusion. By contrast, an increase in mobility was noted after mandibular set-back. The analysis of the condylar path angle revealed a significant increase in protrusion after mandibular advancement. A correlation of the postoperative changes with the use of the adjustable bone fixation system was not found. The results support the hypothesis of muscular and condylar derangement after orthognathic surgery which is followed by typical changes in condylar mobility caused by adaptation within the temporomandibular complex. Keywords: adjustable bone fixation system, sagittal split ramus osteotomy

Purpose: Purpose of this work is to give a review about the consequences of a swallowed or aspirated foreign object during dental treatment. Materials and methods: An aspirated foreign object can be life threatening. When the foreign object slides through the glottis it can get stuck in the area of the trachea, which can result in respiratory insufficiency leading to respiratory arrest in case of a total block of the respiratory tract. In 2/3 of the cases the foreign object reaches over the steeper and wider right main bronchus into the area of the right lung. The Dentist and the assistant should in case of an aspirated foreign object be firm with the technique to keep the respiratory ducts free as well as with the technique of artificial respiration. If the patient is conscious and has a stable circulation he should promptly be leaded with an elevated upper part of the body and under permanent oxygen supply to a clinic with the possibility of bronchoscopic extraction of the foreign object after its radiographic identification. Results: To avoid such incidents rubber dam should be used during endodontical treatment. Root canal pins should be secured with dental floss during their try-in. A gauze could avoid the swallowing or aspiration of prostheses during the try-in. Should a unilateral removable denture be delivered it should under all circumstances be supplied with a precision attachment. Conclusions: During dental treatment with small instruments or objects there is always the danger of they being swallowed or aspirated. Safety precautions should be used where ever it is possible, otherwise one may be accused of being negligent. Keywords: Verschlucken, Aspiration, Beatmung, Riegel

Purpose: Purpose of the present study was to evaluate the sulcus-fluid-flow-rate (SFFR) of teeth restored with resin-bonded fixed partial dentures (RBFPD) compared with natural control teeth. The possible differences of the SFFR proximal and distal from the abutment connector on restored teeth was another aim of this study. Materials and methods: The study included 14 patients after treatment with RBFPDs between 1986 and 1997 in our department. They received 16 resin-bonded fixed partial dentures. The sulcus-fluid was collected with filter strips at the mesial and distal side of abutment teeth and natural control teeth. The amount of gingival fluid was then determined by a gingival-crevicular fluid meter (Periotron 6000®). Results: A statistically significant higher sulcus-fluid-flow-rate was observed on teeth restored with RBFPDs in comparison to natural control teeth. On abutment teeth, there was no statistically significant SFFR difference proximal and distal from the abutment connector. Conclusions: Obviously RBFPDs induce an initial periodontal inflammation, as a rule with a subclinical development, therefore a periodical recall must be ensured. Keywords: Sulcus-Fluid, Brücke, Adhäsivbefestigung, Mundhygiene

A case of Langerhans' cell histiocytosis (LCH) with an unusual involvement of the mandibula and the oral soft tissues is reported. Reports of oral manifestation of LCH and treatment methods are reviewed. Keywords: Histiocytosis X, Langerhans' cell histiocytosis, periodontitis

The aim of this case report was to discuss a possible relation between Ulcerative Colitis (CU) and Localized Aggressive Periodontitis. A 39-year-old female patient suffering from CU was referred to the Section of Periodontology of the University Dental Clinic Heidelberg in August 2000. The patient reported that, in the past, CU bursts were always preceded by acute episodes of oral inflammation. Clinical examination revealed pocket depths (PD) between 2 and 11 mm, furcation involvement (FK) up to class III, and increased tooth mobility. Microbiological sampling revealed elevated numbers of subgingival B. forsythus and P. gingivalis. Since November 15th 2000 the patient was hospitalized due to recurring fever and abdominal pain (clinical diagnosis: acute CU burst, histologically confirmed by biopsy). No pathogen bacteria could be traced in the stool. In spite of systemic ciprofloxacin (intercurring urogenital infection) and prednisolon, fever bursts persisted. After other possible causes had been excluded, the patient was referred for dental examination and therapy to the Section of Periodontology. On December 5th and 6th the teeth 2, 15, and 31 (class III FK, PD 7-11 mm) were extracted and all remaining teeth subgingivally instrumented with adjunctive systemic antibiotics (Loracarbef/Metronidazol) according to the concept of 'full-mouth-disinfection' [Quirynen et al. 1995]. The fever disappeared and two days later, the patient was dismissed from hospital. One month later, PD were reduced to 2-5 mm (tooth 13: 7 mm). No bleeding on probing was recorded. Presumably, there is a relation between Aggressive Periodontitis and CU bursts. If there are further hints for associations, case control and longitudinal studies may provide further evidence. Keywords: colitis ulcerosa, Lokalisierte aggressive Parodontitis

Because of causing hyperemia and microbicism and its tonic effect on muscles, iodine iontophoresis has so far been used to soften residual infiltrations, chronic indurations of soft tissue and cervicofacial actinomycosis. In order to evaluate the influence of iodine iontophoresis on therapy of abscesses in the maxillofacial area, we designed a randomized study to investigate the clinical outcome of patients with reflex trismus due to inflammation. Forty-one patients treated by extraoral incision and drainage of the abscess were randomly selected into a group of 21 patients receiving iodine iontophoresis twice a day for 10 minutes beginning at the third postoperative day. Stretching treatment was given to both groups three times a day. Maximal mouth opening was measured daily by the distance of upper and lower incisors. The additional application of iodine iontophoresis accelerated the improvement of mouth opening in the study group in comparison to the control group. Iodine iontophoresis led to an improvement of mouth opening to 100%, compared to 60.6% in the control group at the seventh day of treatment. In-patient treatment time decreased two days in the study group. Therefore, iodine iontophoresis is an effective method of additional treatment in abscesses of the maxillofacial area. Keywords: iodine iontophoresis, abscess

Nowadays, there are two different concepts of the treatment of condylar neck fracture: 1. Conservative treatment 2. Surgical treatment The conservative treatment have traditionally been treated by maxillomandibular fixation (MMF). One technique for conservative treatment of condyle neck fracture of the mandible using Otten's minihooks is described. The minihooks are fixed with AO miniscrews, which are inserted into the nasal spine and the symphyseal region of the mandible. They serve as abutments for intermaxillary elastics or wires. In the case of the displaced condyle fragment, we use an acrylic splint of the upper jaw with a fulcrum (Hypomochlion) in the molar region at the fracture side for distraction of the fragments. Maxillomandibular fixation is applied for 10 days. Sixty patients with condylar neck fracture were treated in the Department of Cranio-Maxillofacial Surgery, University of Muenster, Germany, in 1995-1997. This method is simple and appears to be a time-saving method. It is also easy to maintain proper oral hygiene and can be performed under local anaesthesia. Keywords: condylar neck fracture, Otten's minihook

The management of head and neck cancer patients is a multidisciplinary approach. Especially patients with persisting maxillofacial defects after surgery experience a restriction of their quality of life during and after therapy. The evaluation of quality of life has become an important aspect in the medical treatment of cancer patients. In dentistry, however, only few information is available how head and neck cancer patients feel during and after therapy.The purpose of this study was to investigate how cancer patients with maxillofacial defects (experimental group) evaluate their quality of life compared to a non-tumour control group with multiple teeth extractions. It is known that patients with a long history of medical treatment adapt to their specific situation (coping phenomenon) and that differences in the global quality of life in comparison with a control group are difficult to detect. So additionally, changes in quality of life during the multidisciplinary therapy were assessed retrospectively.A total of 34 patients were included in the study, 17 in each group. All patients completed their therapy including prosthetic rehabilitation between 1995 and 1999. Global quality of life was measured with a standardized questionnaire (EORTC QLQ C-30). In addition, the patients were interviewed in a standardized format to obtain their retrospective views of quality of life during therapy.At the time of investigation, no significant differences in quality of life were found between both groups but the interview revealed differences in the retrospective evaluation of quality of life. Especially diagnosis, but also surgery and radiotherapy were the most incriminating periods of the therapy for the head an neck cancer patients. The results indicate that these patients need psychological support which should start with the diagnosis and should at least proceed throughout the radiation therapy. Keywords: quality of life, patients with maxillofacial defects, interview

For four years, our course of fixed prosthodontics has been taking the concept of evidence-based dentistry into account. Thus last year we introduced a problem-based learning approach in the technical fixed prosthodontics preclinical works. At the end of the course we asked students who had received both traditional and new forms of teachings to evaluate the latter. Every session is divided into two parts. During the first part the students have to study a simple clinical problem and determine an appropriate treatment plan, without any teacher's helping. In the second part, they have to execute the technical work after having choosen the appropriate instrumentation. They can self-evaluate themselves, by mean of evaluation charts including some of basic clinical criteria about each elementary steps (preparation, dowel and core, impression, temporary crown). Formative and summative assessments are used to determine the final validation of the students. An anonymous questionnaire handed out to 101 students made us aware of their opinion on this new form of teaching. The main results were: 1- Does this new learning approach help make your clinical practice easier than the former ? 95% of positive opinion.2- Do you like a problem solving approach better than last year traditional one ? 84% of positive opinion.3- How often do you use the evaluation charts during the sessions? Very often: 13% - Often 63% - Rarely 23%.'We conclude that this new approach by problem based learning in technical works must be developed because it provides a helpful method of learning for all students in their preclinical technical works which paves the way for their clinical practice '. Keywords: prosthodontics, assessment, teaching, decision making

The three stages of quality assurance are: establishment of a procedure, performing an action and its assessment. In our university, in order to assess the quality of education, two evaluative processes have been put in place: a annual process managed by students, and a quadrennial institutional one managed by a commission composed of students and teachers of the dental school and teachers of other faculties of the university: medicine, pharmacy, sciences. These evaluative processes are adapted to the specificities of each faculty.The faculty of dentistry of Bordeaux has carried out 6 quadrennial assessments since April 99 on restorative dentistry, endodontics, prosthodontics, anatomy and child dental health. After the presentation by the teacher in charge of his course and of the internal assessment made by the students, three aspects were debated: needs - objectives, methods: equipment, volume of hours, staff... and knowledge assessment. Each stage of this evaluative process has itself been graded out of 10 by the participants. The first results of these assessments showed that this approach to quality management is judged very positively (8.5/10) and that it improves the perception of the course both by teachers and students. On the basis of these first assessments, curriculum or educational approach changes have been positively evaluated by students of years 2000 and 2001.We conclude that the establishment of a quality assurance in dental education makes it possible not only to assess the teaching procedures but also the expectations of teachers and students. Keywords: assessment, evaluation, quality assurance, educational research

Organic oils, like those used in mouthrinses can, due to their hydrophobe behavior, contribute to the dilution or eluation of substances from periodontal pockets, if they are used for subgingival irrigation.Neutrophil elastase is a proteolytic enzyme known for its destructive potential also of periodontal tissues. Its activity in gingival crevicular fluid (GCF) is a suitable marker to monitor periodontal and gingival inflammation. The aim of the present study was to determine the effect of two different solutions for pocket irrigations on the elastolytic activity (EA) in GCF. In a prospective, randomized double-blind study 20 patients with severe chronic periodontitis were included based on radiographic and clinical parameters. They had at least 3 teeth in the upper jaw with one site probing pocket depth (PD more than 5 mm). After a period of initial plaque control (14 days) an examination phase of 90 days followed. The clinical parameters assessed were a modified plaque index (PLI), 4 sites/tooth, as well as probing pocket depth, bleeding on probing (BOP) and attachment level at 6 sites/tooth. On the days -14, 0, 15, 28, and 90 the patients underwent a complete clinical examination. All clinical measurements performed were using a Florida Probe® and reference acrylic stents. During the experimental phase, prior to clinical examination two samples of GCF were taken at 3 test teeth using Periopaper® on the days 0, 1, 3, 15, 28, and 90. After sample collection and clinical probings all sites PD more than 5 mm were rinsed. The liquids used were 1 ml of oil in the test group respectively 0,9% NaCl in the control group. The sample volumes were analyzed with Periotron 8000® and the elastolytic activity was measured with the Fluostar®. In the test group a decline of the median - EA from 2839 µU/µl (day 0) to 1892 (day 1) and 1137 µU/µl (day 3) could be observed. At the end of the study the median -EA had reached its initial level again. The control group did not show any comparable findings.The results show that a subgingival irrigation with soy bean oil in this frequency decreases EA of inflamed periodontal pockets considerably. Keywords: soy bean oil, pocket irrigation, elastolytic activity, gingival crevicular fluid, periodontal therapy, Florida Probe, Periotron 8000, Periopaper, Fluostar