International Poster Journal of Dentistry and Oral Medicine, 03/2018

Einleitung: Bisheriges Standardmaterial für Knochenimplantate ist der Werkstoff Titan und dessen Verbundmaterialien. Die hohe Steifigkeit von Titan bewirkt, dass Druckkräfte unverändert auf den umgebenden Knochen übertragen werden. Eine mögliche Alternative ist der Kunststoff Polyetheretherketon (PEEK), der ebenfalls eine hohe Bioverträglichkeit und eine dem Knochen vergleichbare Festigkeit besitzt. Zielsetzung der in-vitro Pilotstudie war es, die Viabilität, Morphologie und das Adhäsionsverhalten von humanen Osteoblasten und Fibroblasten auf PEEK- im Vergleich zu Titan-Oberflächen zu analysieren. Der Fokus der Studie lag auf einer induzierten Entzündungsbedingung durch Inkubation mit dem bakteriellen Toxin Lipopolysaccharid (LPS; 10µg/ml, 24 Stunden). Material und Methoden: Primäre humane Osteoblasten (NHOst, LONZA) und Fibroblasten (NHDF, PromoCell) wurden auf Titan- und PEEK-Proben (Æ12mm, Dicke: 2,5 mm) der Firma MEDICON kultiviert. Die Viabilitätstestung der Zellen auf den beiden Materialien im Vergleich zu PLL-beschichteten Glasdeckgläsern (Referenz) erfolgte mittels MTT-Methode. Zur Untersuchung des Anwachsverhaltens der beiden Zelltypen auf den verschiedenen Materialien wurden REM-Aufnahmen angefertigt. Realtime-PCR-Messungen dienten zur Analyse der Genexpression des LBS-Bindeproteins (LBP) und des LPS-Rezeptors (TLR4). Der Nachweis auf Proteinebene und zusätzlich von Phalloidin (Aktin-Nachweis) und Vinculin (EZM-Bindeprotein) erfolgte durch immunzytochemische (ICC-) Markierungen. Ergebnisse: Die Osteoblasten und Fibroblasten wiesen auf den Deckgläsern die höchste Viabilität auf, gefolgt von den Titan und PEEK-Proben. In den REM-Aufnahmen zeigten die beiden Zelltypen auf den PEEK-Oberflächen dem Titan vergleichbare Adhäsionseigenschaften. Nach LPS-Stimulation zeigte sich eine signifikant gesteigerte LBP-Genexpression in den NHOst. Das war auch auf Proteinebene nach Wachstum auf den drei Materialien zu erkennen. Während unter LPS-Inkubation für TLR4 keine erhöhte mRNA-Konzentration in den NHOst nachgewiesen werden konnte, war in den ICC-Markierungen eine deutliche Zunahme der Antikörperreaktion auf allen Werkstoffen festzustellen. Bei den Fibroblasten hatte die LPS-Stimulation keinen Einfluss auf deren LBP- und TLR4-Gen-/Proteinexpression. Unter Kontrollbedingungen wuchsen die NHOst auf allen Materialien mit parallel angeordneten Aktinfasern. Nach LPS-Inkubation hatten sich die Osteoblasten zusammengezogen. Insbesondere auf den Deckgläsern war eine punktuelle Intensivierung der Adhäsionskontakte festzustellen. Nach LPS-Inkubation der NHDF zeigte sich bei den Deckgläsern und den Titan-Proben eine Umverteilung des Vinculin-Nachweises von perinukleär in die Peripherie der Zellfortsätze. Diskussion: Der Werkstoff PEEK erweist sich im Vergleich zum Standardmaterial Titan als histologisch hoch kompatibel. Wie beim Titan wird eine Ansiedelung von humanen Osteoblasten und Fibroblasten auf PEEK-Proben auch unter pro-inflammatorischen Umgebungsbedingungen (LPS) ermöglicht. Weitere Studien sind notwendig, um abzuklären, ob der Werkstoff PEEK als Material für dentale Implantate geeignet ist. Schlagwörter: Adhäsionsverhalten, Osteoblasten, Fibroblasten, PEEK, Lipopolysaccharid

Einleitung: Zahndurchbruchsstörungen sind sowohl durch lokale als auch durch systemische Faktoren bedingt. Bei komplexen Erkrankungen wie z. B. dem Apert-Syndrom, dem Down-Syndrom, der Dysostosis cleidocranialis, der ektodermalen Dysplasie oder dem Gardner-Syndrom können zahlreiche Zähne betroffen sein. Im Unterschied dazu sind bei Patienten mit lokalen Durchbruchsstörungen in der Regel die dritten Unterkiefermolaren und die Eckzähne im Oberkiefer betroffen. Sehr selten treten Durchbruchsstörungen bei den ersten und zweiten Molaren auf. Bei einer dritten Variante, der non-syndromalen primären Durchbruchsstörung ["Primary failure of eruption"(PFE)] bricht ein primär nicht ankylosierter Zahn nicht oder nur partiell durch. Für die Normalbevölkerung wird die Prävalenz dieser Abnormität mit 0,06% bei einer Geschlechtsverteilung von 1:2,25 (m:w) angegeben. Fallvorstellung: Bei einer 19-jährigen Patientin wurde der Verdacht auf eine genetisch bedingte Zahndurchbruchsstörung geäußert, nachdem eine viele Jahre dauernde kieferorthopädische Therapie erfolglos verlaufen war (Abb. 1-3). Im Alter von vier Jahren wurden bei ihr eine Schwerhörigkeit im Sinne einer zentralen Hörstörung, eine Wachstumsverzögerung und ein hypogonadotroper Hypogonadismus diagnostiziert. Ein Hirn-MRT, eine Chromosomenanalyse und eine Untersuchung auf eine SHOX-Deletion ergaben keine auffälligen Befunde. Im Rahmen einer humangenetischen Beratung wollte die Patientin sich informieren, ob die bei ihr vorliegenden Symptome einer übergeordneten syndromalen Erkrankung zugeordnet werden können und welche diagnostischen Möglichkeiten bei Verdacht auf Vorliegen einer PFE bestehen, die die Molaren 17, 27 und 47 betreffen. Eine bereits durchgeführte Chromosomenuntersuchung ergab einen unauffälligen weiblichen Chromosomensatz (46, XX). Auf Patientinnen-Wunsch hin wurde eine Array-Analyse angeschlossen, mit der das gesamte Genom auf kleine Deletionen und Duplikationen untersucht wird, die in der normalen Chromosomenanalyse nicht sichtbar sind. Es zeigte sich hierbei keine krankheitsverursachende Deletion oder Duplikation. Allerdings schließt dieser Befund das Vorliegen einer syndromalen Erkrankung nicht aus. Die Patientin wurde informiert, dass über eine genetisch bedingte, nicht-syndromgebundene Zahndurchbruchsstörung bei einigen Patienten/Familien berichtet wurde. Als ursächlich hierfür wurden heterozygote Mutationen im PTHR1-Gen auf dem Chromosom 3 identifiziert, das die Information für den Paratrezeptor beinhaltet. Auf Wunsch der Patientin wurde eine Untersuchung dieses Gens durchgeführt. Dabei konnte die Mutation c.436C>T, p.Arg146*im PTHR1-Gen in heterozygotem Zustand nachgewiesen und die Diagnose einer Primary failure of eruption somit bestätigt werden. Diskussion: Die Mutation c.436C>T, p.Arg146*im PTHR1-Gen in heterozygotem Zustand führt zum Abbruch der Eiweißsynthese und wurde in der Literatur bereits als krankheitsverursachend beschrieben. Die frühzeitig genetisch bestätigte Diagnose einer non-syndromalen PFE bewahrt Patienten, Kieferorthopäden und Oral-/MKG-Chirurgen vor einer über Jahre verlaufenden frustranen Therapie. Dazu ist auf Behandlerseite die Kenntnis über die genetische Ätiologie der PFE für die Differentialdiagnostik von Durchbruchsstörungen unerlässlich. Den Betroffenen sollte eine humangenetische Untersuchung angeboten werden. Oralchirurgische Optionen in schweren Fällen sind der frühzeitige Entschluss zur Extraktion oder operativen Entfernung mit nachfolgender Implantat-gestützter Rehabilitation oder die Okklusionseinstellung der von einer PFE betroffenen Zähne mit Hilfe einer Segmentosteotomie. Dazu muss eine chirurgisch zugängliche Position der betroffenen Zähne vorliegen. Schlagwörter: PFE, PTHR-1, Zahndurchbruchsstörung

Success of regenerative endodontic treatment depends upon the disinfection of the root canal system. Since almost no instrumentation is carried out, the disinfection protocol relies only on the medications used. Commonly used triple antibiotic paste (TAP) composed of metronidazole, ciprofloxacin, and minocycline has certain drawbacks. Minocycline binds to calcium ions via chelation to form an insoluble complex and results in tooth discolouration. Several antibiotics have been suggested as an alternative to minocycline in the triple antibiotic paste. Recently, antibiotic alternatives to minocycline have been proposed for use in combination with ciprofloxacin and metronidazole, including cefaclor and doxycycline, but discolouration persisted even after the substitution. The aim of this study is to assess the discolouration potential of modified TAP, where minocycline is substituted with amoxyclav and clindamycin. These antibiotics were selected based on two criteria: (1) They don't interfere with the action of ciprofloxacin and metronidazole, and (2) they have a mechanism of action similar to minocycline so that the entire antimicrobial spectrum is covered. Schlagwörter: regenerative, medicament, triple antibiotic paste, disinfection, discolouration, minocycline

Oral squamous cell carcinoma (OSCC), the most common malignant tumour of the oral cavity, can be easily monitored and sampled. Despite the latest advances in chemotherapy and surgery, the recurrence and morbidity rates are still high. OSCC results from multistep accumulation of heterogeneous genetic changes in squamous cells. Attention has now shifted to biomarkers as conventional clinical and histopathological method have failed to predict its biological behaviour accurately. The multimodal tumour treatment therapy usually prescribed leads to reduced quality of life, making the psychosocial consequences of OSCC worse than other malignancies. A quest for identifying prognostic markers that have a significant role to play in maintaining the wellbeing of the patient is the need for today. The purpose of this poster is to enumerate such prognostic markers available and their contribution towards early diagnosis and prognostic relevance. Schlagwörter: Oral squamous cell carcinoma, prognostic markers

Aim: An increasing number of physicians and researchers take advantage of smartphones or other mobile devices during 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 adult outpatients with regard to their oral health status and their dental treatment needs as well as 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. The objective of this study was to facilitate a screening of outpatients with regard to dental treatment, oral health-related quality life (OHIP-G14), and Beck Depression Inventory (BDI-II) as well as to test our iPad app with regard to its practicability in a clinical setting. Materials and methods: A total of 196 healthy adult outpatients, reporting to the Department of Operative Dentistry, University Medical Center, Mainz, Germany, for check-up visits, were enrolled in the study. For this investigation, an iPad app was developed with the goal of facilitating dental screenings of outpatients (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. All the patients were also asked to document their answers for the OHIP-G14 (scale: 0-37) and BDI-II (scale: 0-63) questionnaires directly into the iPad App. Results: This study included 94 male and 102 female patients (mean age 39.8±16.9, 18-83 years). The mean number of teeth was 26.5 (SD± 3.8). A high number of teeth showed restorations or crowns (11.1±5) (Fig.2), and there were also a high number of teeth free of caries (16 ± 7.1). Less than one tooth (0.7±0.9) showed primary or secondary caries. Most of the teeth (mean: 22.6± 7) showed a pocket depth of 4mm, and a marginal number (mean 3±4) showed a pocket depth between 4-5 mm (Fig.5). 17.3% of the subjects were smokers, and 82.7% non-smokers. No enamel fluorosis was detected in 47.3%, 14.5% had mild fluorosis, and 38.2% were classified as questionable (Fig.3 and 6). Enamel or dentinal erosions were observed in 39.1% (Fig.4 and 7). The BDI-II score was 4.4±5 (1-44), and the OHIP-G14 score was 3.9±5.8 (0-24). Mucosal lesions were detected in 10%; 87.3% were lesion-free. Treatment need was urgent in 11.8%, 49.1% required preventive or routine treatment, and no treatment was needed in 39.1% (Fig 8). Conclusions: The investigated outpatients represent a cross-section of the oral health care situation of the German population. The data resemble the results of the DMS V recently published in Germany. The use of the novel app is well-suited for the detection of cohorts; however, some older subjects had difficulties using a tablet computer, which required extra time. Schlagwörter: Oral health, quality-of-life assessment, iPad app

Purpose: To test a hypothetical model suggesting that patients pass through a 'psychological cycle' when undergoing a course of dental care: past appointment experiences influence their anticipation of future dental visits, which in turn affect behavioural intentions to attend appointments. Materials and Methods: Self-administered questionnaires were given to 300 students from 5 different colleges in Bangalore city. The questionnaire assessed variables representing the various stages of the hypothesised model and other relevant variables (dental anxiety, general anxiety, and subjective oral health rating) Results: Sequential regression analysis showed that cognitive factors like negative past experiences (p=0.04), and expectations and anticipation of future dental appointments (p0.001) along with psychological factors like dental anxiety (p=0.05) influenced behavioural intentions to attend future appointments. These findings were consistent with the hypothetical model. Conclusion: The model explains dental appointment attendance behaviour based on the contributions of cognitive factors such as expectation and anticipation of future appointments along with past dental experience and can be used to foster better use of dental care. Schlagwörter: Dental appointment attendance, experiences, anticipation, behavioural intentions

Background & Aim: Epidemiological studies regarding associations between psychological stress and periodontitis have reported inconsistent results. The current study aimed to review data on the potential association between psychological stress and periodontitis and a meta-analysis quantified the results of available studies on stress and risk of periodontitis. Methods: In advance, a search protocol was developed. Three databases, PubMed/Medline, Cochrane Library, and Web of Science, were searched for studies published from 1996 until June 2017 according to the PECO search strategy: adults (population P); psychological stress (exposure (E); patients with and without psychological stress (comparison C); periodontitis (outcome O). Study selection was conducted by two independent reviewers (HS and BN). Risk of bias analysis was performed using the modified Newcastle-Ottawa scale. Meta-analysis was performed on the selected studies, and odd ratios (OR) with 95 % confidence intervals (CI) were calculated. Results: The primary search retrieved 218 studies. After applying inclusion and exclusion criteria, 26 observational studies (10 case control and 16 cross sectional studies) were included in the final analysis for data extraction and quality assessment (Fig.1). 14 studies reported an association between psychological stress and periodontitis, whereas 10 studies did not. For the remaining two studies, the association was only significant regarding certain types of stress. The risk of bias was medium to low in most studies. Meta-analysis was performed for the presence /absence of periodontitis (dichotomous) on 8 case-control and cross-sectional studies. A random effects meta-analysis showed that the presence of stress is significantly associated with the risk of periodontitis (pooled OR 2. 84; 95% CI: 1.76; 4.57). However, there was significant heterogeneity across studies (P value for chi2 test was 0.0003; I2 = 74 %) that may be explained by one study. By excluding that study, the pooled OR remained significant (2.13; 95 % CI: 1.77; 2.56), and heterogeneity decreased dramatically (I2 = 0%). Conclusion: The systematic review and meta-analysis showed an increased risk of periodontitis in subjects exposed to psychological stress. However, the different parameters in assessing periodontitis and stress were the main drawback in this analysis. Further well-designed longitudinal studies and standard parameters are necessary to confirm the role of stress as a risk factor for periodontitis. Schlagwörter: psychological stress, mental stress, periodontitis

Introduction: Root canal filling materials alter the flexural strength of dentine, leading to fracture under compressive loads. Therefore, root-filled teeth commonly undergo further tooth fracture. In this regard, Biodentine may offer an alternative to current conventional materials. Aims: This study aimed to evaluate the fracture resistance (compressive strength) of permanent teeth after filling the root canals with a calcium tri-silicate cement (Biodentine) and gutta-percha. Furthermore, the type of fracture in simulated permanent teeth when loaded to failure was recorded. Methodology: Twenty extracted mandibular first premolar teeth were randomised into two groups: Biodentine and gutta-percha. All teeth were prepared to size 70 K-file at the apex. In one group gutta-percha was placed as far as the cementoenamel junction; in the other, Biodentine was used to fill the canal to the CEJ. Both groups received composite as coronal restoration. To decide on the best method of determining the maximum compressive strength endured by each sample prior to fracture, a static loading test was used. An INSTRON machine was used to apply the force starting from zero Newtons to failure. This was used to measure whether the teeth fractured within the known range of the normal human bite-force. The test was applied to both groups. Results: There was no significant difference in the fracture resistance (compressive loading) between the Biodentine and gutta-percha groups. Crown fracture was the most common type of fracture in both groups. Conclusions: This study suggests that Biodentine should be further investigated in vitro in the treatment of non-vital teeth. Schlagwörter: Flexure strength, cementoenamel junction

Introduction: Dermal fillers are taking the world by a storm where dental esthetics is given prime most importance .Papilla reconstructs being a challenge for a periodontist dermal fillers as hyluronic acid can act as minimally invasive technique or reconstructions. Aim:The purpose of this prospective clinical trial was to examine the clinical and patient outcome following esthetic reconstruction of interdental papilla loss in anterior teeth,using hyaluronic acid gel injection. Material and Methods: 10 systemically healthy adults with at least one anterior site with class I and II interdental papilla loss were recruited. Following local anesthesia 0.2 ml hyaluronic acid gel injection was injected on base of papilla, plumping effect was noted. The patient was then recalled and revaluated after 7 days papilla fill using Papilla presence score, if needed a second injection was administer for complete papillary fill.The stability of papillary fill was then evaluated at 1 week, 4 week and 3 month. Results: Twelve sites amongst 6 males and 4 females were treated in the study. The lost interdental papilla was with preoperative 2.1± 1.2 mm², which reduced to 1.1±0.7 mm² at 4 week interval and had 0.7±0.5 mm² at 3 month interval as evaluated by photograph measurement and use of image software. Differences between baseline and postoperative visits were statistically significant (p 0.0001). Conclusions: Use of hyaluronic acid gel injection to treat interdental papilla loss resulted in significant improvement at 6 months. Patients expressed satisfaction with the obtained improvement. Schlagwörter: hyaluronic acid, papilla reconstruction, dermal fillers, papillary fill, dreaded triangle, interdental papilla

Objective: The human body is made up of a number of elements which are categorised into abundant and trace elements. Trace elements are also known as micronutrients. Although required in much smaller quantities in the body, they still play pivotal role in vital processes of the body. Trace elements include iron (Fe), zinc (Zn), copper (Cu), selenium (Se), chromium (Cr), cobalt (Co), iodine (I), manganese (Mn), and molybdenum (Mo), etc. The present study was conducted to determine whether trace elements, namely iron and copper, play a role in the pathogenesis of recurrent apthous stomatitis. Materials and Method: A total of 30 subjects formed the pilot study, including 15 patients with recurrent apthous stomatitis and 15 persons as healthy controls. Salivary levels of iron and copper were detected biochemically by semi-autoanalyser. Results: All parameters were statistically analysed. Significant correlation was found. The patients were found to have significantly lower levels of trace elements than in the healthy control group. The attempt was made to check the presence of these elements in the saliva and establish a correlation. Conclusion: Saliva, like blood, contains different substances that reflect physiological status. Salivary diagnostics offer an easy, inexpensive, safe, and non-invasive approach for disease detection, and possess a high potential to revolutionize the next generation of diagnostics. More studies with larger sample sizes on salivary trace elements are warranted to establish them as biochemical markers in the pathogenesis of RAS. Schlagwörter: Recurrent apthous stomatitis, iron, copper, serum, saliva, biochemical markers