International Poster Journal of Dentistry and Oral Medicine, 02/2021

Background: Daily oral hygiene with sufficient biofilm control carried out life-long are the basis for stable oral health and has not yet been satisfactorily solved for people in need of care. The situation is complex due to the various groups involved in daily oral hygiene: people in need of care who, with increasing age and comorbidities, no longer fully contribute to their own oral care; nursing staff who can substitute oral care for a young patient but possibly not completely for an elderly person with an increasing number of risk factors; general practitioners as well as dentists and practice teams in  outreach care. A further complication is the “oral transition phase of aging”, defined by this working group as a risk factor, which in the sense of a continuous general medical decline also represents a deterioration in oral health with increasing age. The evidence shows for each of the groups that measures such as training or oral hygiene interventions such as delegated regular professional tooth brushing can at least stabilize oral health. To date, however, there is no evidence-based, long-term successful care model in which a sustainably acceptable level of oral hygiene could be achieved. Methods: For the project presented here (expected to last 3 years), the existing role profiles, responsibilities, quality management, the corresponding Standard Operating Procedures (SOPs) and the establishment of mandatory interfaces with regard to the respective contribution to oral hygiene will be established for all professional groups involved in oral care redefined for the district of Westphalia-Lippe for elders in need of care. Milestones are semi-annual evaluations of the oral hygiene situation, oral health, general health, and quality of life. In the sense of a self-learning system, interventions are optimised after each interim evaluation. Qualitative occupational group-specific surveys as well as health economic interventions will accompany the project. Expected results: The aim is comprehensive, long-term, needs-based and risk-adapted improvement in oral hygiene and biofilm control for people in need of care with long-term positive benefits for oral health, general health, and quality of life. Outlook: As part of the project, the long-term effort and clinical benefit of the interdisciplinary oral hygiene interventions described will be documented. This should help to develop a socially acceptable model with the participation of all professional groups involved. Ideally, the project will serve as a blueprint for widespread transfer to interdisciplinary oral hygiene care for elders in need of care in Germany. Keywords: Interdisciplinary health care, role profiles of health professions, interfaces, oral transition phase of aging, geriatric health, gerodontology

Actinic cheilitis of the lower lip is more common in sun-exposed regions of skin, with a malignant potential turning the lesion into epithelial cell cancer. Harmful UVB rays are a predominant cause for this potentially malignant disorder. Melanin is considered to protect the basal layer of keratinocytes, and persons with reduced melanin have a higher risk to develop actinic lesions. The patient most often goes misdiagnosed or negligence of the lesion over time will increases the risk. A case report of a patient with histopathologically confirmed actinic cheilitis diagnosed early and managed with a nonsurgical treatment approach and regular follow up of the lesion resulting in a reduction in lesion size, ulcer and burning sensation is presented herewith. Management depends on the duration, lesion size, and severity of the condition. Clinical suspicion must always be maintained in case of ulceration and nodularity. Keywords: Actinic cheilitis, chronic sun exposure, premalignant disorder, melanin, ultraviolet rays

Maxillectomy secondary to trauma/tumour is an unfortunate event occurring to humankind. An obturator has remained as the ultimate solution from the ages of Ambroise Pare in the 16th century. It not only closes the defect, but also assists in functional movements such as swallowing and speaking, indirectly providing the patient mental assurance and social confidence. Although there has been a tremendous change in technology and materials, basic principles of retention remain the same. Thus, similar to complete denture prosthodontics, a dentist must have a thorough knowledge of existing anatomy to attain maximum retention of the obturator. It is necessary to understand that a maxillectomy does not just contain a horizontal component as given by Aramany. We need to know the defect from all 3 dimensions and must keep in mind that all types of defects cannot be rehabilitated with just an intraoral prosthesis. Some might need extraoral retention based on anatomic limitations. Thus, this poster gives a quick glance of the anatomical structures that help in aiding retention of the obturator as well as to predict and deliver successful rehabilitation. Keywords: Obturator, maxillofacial defects

Background: Periodontitis and osteoporosis share some common risk factors, suggesting a possible link between two diseases. Findings of studies in this regard in postmenopausal women lack consistency and are inconclusive owing to variations in methodology and the presence of confounders. The present study assessed the inflammatory status as well as the sequelae of marginal inflammatory periodontal disease. It will be an aid to further elucidate the mechanisms operating in the association of periodontitis with bone mineral density. Methods: Postmenopausal women with osteoporosis (TG) (n=15) and normal bone mineral density (CG) (n=15) were included. Plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded. Results: TG had significantly higher CAL than CG, whereas no difference was found in other parameters between the groups. There was no significant difference in periodontal parameters between groups at sites with PPD ≤4mm. Sites with PPD >4mm had significantly higher PI and GI in TG as compared to similar sites in CG. There was a significantly higher number of sites with CAL ≥5mm in TG as compared to CG. Conclusion: Severity of attachment loss is greater in postmenopausal females with osteoporosis as compared to those with normal bone mineral density, with no support of any difference in periodontal inflammation estimated in terms of BOP. Keywords: Inflammation, osteoporosis, periodontitis

Background: Aesthetics is a major aspect in growing children and teeth play a vital role in maintaining this. Loss of anterior teeth due to any reason, such as trauma, caries, or congenitally missing teeth, can cause low self-esteem and social setback. Paediatric dentists often face a challenge in rehabilitating missing anterior teeth due to poor patient compliance and the unavailability of options. Here we present a rare case report of missing permanent mandibular anterior teeth and rehabilitation using an innovative customised fixed appliance. Case description/method: A 12-year-old boy presented with a chief complaint of missing lower anterior teeth for 3 years post extraction by the local dentist. Patient demanded a fixed treatment, and thus a novel appliance was designed and customised for the patient. Banding followed by construction of the active lingual arch with acrylic teeth attachment was constructed the shade and size selection of the teeth was done to meet aesthetic and functional demands. Results: The patient received satisfactory treatment and was very happy with the aesthetic rehabilitation using the customised innovative appliance. Discussion: Primary or permanent tooth loss requires a combination of treatments addressing both aesthetics and function. The dentist should try to meet these demands while simultaneously considering the patient’s socioeconomic status. Replacement of lost anterior teeth prevents psychological and social trauma to the growing patient. Conclusion: In the present case, a fixed innovative appliance customised for aesthetic purposes was constructed. This appliance can be an alternate interim treatment to a removable appliance, with higher acceptance and reliability and is easy and quick to fabricate. Keywords: Aesthetics, modified lingual arch, innovative appliance, novel approach

For long term success of implant-supported restorations, the physical/mechanical properties of the relationship in the implant-abutment (I-A) interface is crucial to prevent biological or mechanical complications or both. Accordingly, regardless of I-A connection type (i.e conical, butt joint), material properties and their interaction under function is also important. This refers to machining tolerance of the implant and the abutment at fabrication and their behaviour to the micro-movements. A recent systematic study confirmed material differences at the I-A interface likely to lead to microleakage, and zirconium abutments with titanium implants are not suggested (1). Today, specifically narrow-diameter implants with improved mechanical properties by alloying titanium with zirconium is commonly used specifically at the functional zone. This option even more complicates the mechanical behaviour at the I-A interface due to material differences. Although the I-A interface and the wear characteristics of Ti implants when coupled with Ti or Zr abutments have been presented earlier(2), the joint stability between Ti-Zr implant with Zr- or Ti-abutment is unclear. The aim of this study was to explore the effect of Ti-Zr implant material on the interface between 1-piece zirconia and two different titanium abutments using scanning electron microscopy (SEM). Keywords: Dental implants, Ti-Zr alloyed implants, Titanium abutment, Zirconium abutment, İmplant-abutment connection, Fatigue loading, Biomechanics

Introduction: Since December 2019, we have all faced a bizarre situation due to corona virus disease. COVID-19 belongs to the corona virus family, which is a group of enveloped RNA viruses with spike protein in its membrane envelope. Other members of this family are SARS-COV and MERS-COV, which have spread in the recent years. The interaction between the spike protein and angiotensin converting enzyme 2 (ACE-2) receptor plays an important role for entry of these virus particles into the cells. Aim: To evaluate the composition and mechanism of action of various oral rinses and their efficacy to reduce Covid-19 viral load in published literature. Materials and method: A literature search was performed in PubMed, up to 31st July 2021, focusing on SARS-CoV-2, COVID-19, oral cavity, and oral rinses. The keywords searched were “Covid-19 and mouthwash” or “SARS-COV2 and mouthwash” or “Covid-19 and oral rinses” or “SARS-COV2 and oral rinses”, and 123 articles surfaced in 2020 and 2021. Inclusion criteria were systematic reviews and reviews on this topic, and 34 articles formed a part of this poster. Results and conclusion: Studies have found a very high SARS-COV2 viral load in saliva, which suggests that the virus can be transmitted by salivary interactions, making oral tissues a possible reservoir. Antiseptic mouthwashes are routinely used to reduce the number of microorganisms in the oral cavity. It has been suggested that rinsing the oral cavity with these solutions might aid in reducing the risk of transmission, other systemic complications, and improved oral hygiene in patients with COVID-19, which could accelerate the recovery process. Keywords: Antiseptic mouthwashes, ACE-2 receptors, SARS COV, MERS COV

Questions: Multi-material compositions, especially for dental applications, are critical due to the oral environment, which can alter the properties of combined materials and affect their bond. Micro-topologies can improve the interface for resin injection molding around metallic inserts by undercuts and surface-enlargements, thus improving the adhesion between the different materials. The aim of the present study was to analyse the structure and biocompatibility of multi-material brackets of different metal-plastic combinations for oral/dental application, characterised by an additively manufactured interface generated by Laser Metal Deposition (LMD). Methods: Simplified bracket bodies (n= 51) formed by injection molding (P.A.N.A.C.E.A.) were delivered to an LMD-process for additively forming pin shaped structures (316L, <200µm) to improve composite-material interface. For injection molding around metallic inserts with PEEK (polyether ether ketone; n=25) and polyamide (n=26), respectively, giving the bracket the final shape, the build-up strategy with the best pull-off force results out of four formerly tested (different geometry and process parameters) was selected. Additionally, brackets out of metallic inserts without additively enhanced surface were also produced and served as control groups (PEEK n=25; polyamide n=25). All test brackets were analysed by stereomicroscopy for insert molding defects and after one year simulated oral thermal (Thermocycler SD, Mechatronik GmbH, Feldkirchen-Westerham, Germany) and mechanical aging (Toothbrush simulator, Willitec GmbH, Munich, Germany); surface roughness of compound brackets was also measured. Statistics were performed by descriptive analysis and paired t-test (significance level: p≤0.05). Results: Regardless of interface, stereomicroscopy analysis of infiltrated brackets revealed numerous filling-defects in PEEK (n=13/36%) compared to polyamide samples, where no filling-defects could be detected. However, PEEK infiltration was much better at additively enhanced surfaces (n=8/32% vs. n=5/45% defects in the test compared to the control group, respectively), whereas n=14 (56%) samples in the control group had to be excluded from the outset and were not taken further into account since no compound could be reached. In none of the samples still under consideration (test groups: PEEK n=17, polyamide n=26; control groups: PEEK n=6, polyamide n=25) a detachment of the compound could be found after simulation of one year thermal and mechanical aging, and an exposure of the interface could only be detected in the test groups with one sample each. Independently of the interface, surface roughness of both plastic materials significantly decreased with aging (0.2-0.3μm vs. 0.5-0.6μm beforehand; p<0.0001). While PEEK initially had somewhat lower Ra values compared to polyamide samples (p=0.01), this reversed for materials after aging (p<0.0001). Conclusions: Additive manufacturing is a favourable technique to modify the interface of complex geometries and enhance composite material properties for oral clinical use. The material compound was not compromised at one year simulated oral thermal and mechanical aging, but surface roughness significantly decreased with aging and substance abrasion was critical with exposure of micro-topologies in some, but clinical negligible cases, so that the weak point was not the interface but laid in the material properties of the resins used for final bracket shaping. Keywords: multi-material compositions, material interface, laser metal deposition (LMD), dentistry, orthodontics

Introduction: Gender determination is pivotal in establishing a biological profile of human remains, where fragments of skull persist with unidentifiable dental arch data. Owing to the resistance and stability against external factors such as trauma and fractures, radiological assessment of the frontal sinus could be a useful indicator for sexual dimorphism. Aim: To analyse the efficiency of morphometric assessment of the frontal sinus for gender determination in an Indian population. Materials and method: A total of 120 (60 males and 60 females) lateral cephalograms above the age of 20 years were retrieved. The frontal sinus index (ratio of maximum height to depth) and area of the same were calculated using Adobe Photoshop software. The results obtained were subjected to statistical analysis using SPSS 19 software. Results and conclusion: The mean average of frontal sinus height, width, index, area, and perimeter were higher in males than females, and except for index, all the parameters were found to be statistically significant (p<.05). This indicates that frontal sinus measurements on lateral cephalograms could prove to be a low-cost, user friendly system for sex determination in the Indian scenario which is more suited to the monetary constraints that often plague the disaster management bodies. Although the gender discrimination was found to be only 65% in our study, which was not very accurate, this is a pilot study and has paved a platform for studies in the future with a larger sample size which might yield more accurate results. Keywords: Frontal sinus index, gender determination, digital evaluation, lateral cephalograms

Background: Age determination of a person involved in judicial or legal proceedings is crucial information that helps to identify the culprit. Oral exfoliative cytology is a non-invasive, inexpensive, pain-free technique for the collection of intact cells from the epithelial strata. In the past, normal exfoliated cells from healthy individuals have been subjected to cytomorphometric analysis. Hence, exfoliative cytology is an upcoming relevant tool for age estimation in forensic science. Aim: To evaluate age estimation by oral exfoliative cytology using cytomorphometry in published literature from 2000-2021. Materials and method: A literature search was performed in PubMed, Scopus, and Google Scholar from 1st January 2000 to 5th September 2021 using the key words “age determination and oral exfoliative cytology/cells” and “forensics and/or healthy individuals.” Results and conslusion: A total of 7 original studies fulfilled the inclusion and exclusion criteria. This poster will be an attempt to systematically review those articles and present the data reemphasizing the role of oral exfoliative cytology in forensics. Keywords: Oral exfoliative cytology, oral exfoliated cells, age determination; cytomorphometry