Der Kieferknochen ist nicht vergleichbar mit den anderen Knochen im Körper. Verglichen mit anderen Knochen des Skeletts, verlaufen entzündliche Prozesse hier beschwerlicher. Aufgrund der geringeren Durchblutung des Unterkiefers im Vergleich zum Oberkiefer, die auf die Versorgung durch eine funktionelle Endarterie (Arteria alveolaris inferior) zurückzuführen ist, ebenso der starken kortikalen Knochenschicht, haben Medikamente ein verändertes Anreicherungspotenzial im Knochen. Auch begleitende Grunderkrankungen, beispielsweise ein Diabetis mellitus, wirken sich negativ auf den Knochenstoffwechsel und damit auch auf Vorgänge der Knochenheilung aus [1, 8, 18, 19]. Insbesondere Bisphosphonate hemmen den Metabolismus im Kieferknochen. Dieses führt bei Patienten, welche Bisphosphonate nehmen und bei denen ein kieferchirurgischer Eingriff, wie die Zahnentfernung erfolgt, zu Nekrosen des Kiefers. Bisphosphonate werden oftmals als Chemotherapeutikum bei ossär metastasierenden Tumoren eingesetzt. Dabei weisen sie eine über Jahre dauernde Wirkung im Körper auf. Dennoch haben auch diese Patienten einen Anspruch auf eine Versorgung mit dentalen Implantaten und ggf. auf präimplantologische Eingriffe im Vorfeld, sei es zur oralen Rehabilitation oder zur ästhetischen Rehabilitation. Schlagwörter: Kunstgeschichte, Zähne, Darstellung, Ästhetik

Introduction: The Bundeswehr Patient Evacuation Coordination Centre (PECC) is responsible for organising the evacuation of soldiers to Germany. The aim of this study is to collect and analyse the data of 166 Bundeswehr soldiers who had to be evacuated to Germany by air from the ISAF, KFOR, and EU NAVFOR-ATALANTA missions in recent years. Methods: By the PECC, we selected patients based on diagnoses of diseases and injuries of the mouth, jaws and face. The data on evacuations was analysed using the SAS 9.3 statistics program. Results: Priority levels were indicated when requests for evacuation from the country of deployment were made. They were distributed as follows. Discussion: The rapid evacuation of even complex cases is an important factor in the medical care of soldiers and at the same time ensures high survival rates after attacks and incidents involving severe injuries. The time from the request for evacuation from the country of deployment to the arrival of the means of transport in Germany was the duration of evacuation. Schlagwörter: medical treatment for evacuation, medical reports, repatriation

Purpose: The placement of self-tapping implants is associated with microfractures and the formation of bone chips along the cutting flutes. This study was conducted to investigate the effect of different cutting edge angles on chip formation during the machining of trabecular and cortical bone using instruments with a rough titanium surface. Materials and Methods: Mandibular cortical and trabecular bone specimens were obtained from freshly slaughtered domestic pigs. A predefined thrust force was applied to the specimens. Four specially designed cutting instruments that simulated dental implants and had a rough titanium surface were allowed to complete one full revolution at cutting edge angles of 55, 65, 75, and 85 degrees, respectively. Torque and thrust were measured during the cutting process. Bone chips were measured and weighed under a microscope. Results: Different cutting edge angles did not lead to significant differences in torque. The lowest torque values were measured when the cutting edges were positioned at 65 degrees in trabecular bone and at 85 degrees in cortical bone. Bone chips were significantly larger and heavier at angles of 55 and 65 degrees than at angles of 75 and 85 degrees in trabecular bone. Conclusion: Instruments with a rough titanium surface show considerable angle-dependent differences in chip formation. In addition to bone density, the angle of the cutting edges should be taken into consideration during the placement of dental implants. Good results were obtained when the cutting edges were positioned at an angle of 65 degrees. This angle can have positive effects on osseointegration. Schlagwörter: bone chips, cutting edge angles, dental implants

Introduction: Following the removal of cysts of the jaw, the resultant bone defect is filled or left unfilled depending on its size. There is, however, no universal standard defining the volume above which a bone defect should be filled. The objective of this study was therefore to determine a threshold for bone defect filling and to assess whether this threshold value can be used for preoperative planning. Methods: We analysed cone-beam computed tomography (CBCT) and computed tomography (CT) data from 88 patients who presented with a jaw cyst. First we determined cyst volumes on the basis of CBCT and CT datasets and then we assessed the volume above which defects were filled. Results: We were able to identify a suitable threshold for bone defect filling which correlates well with the cyst diameter described in the German literature by Partsch for deciding whether to perform cyst marsupialisation or enucleation. Conclusion: The preoperative assessment of cyst volume is a simple and effective method of obtaining information about the necessity of filling bone defects and is thus a useful and reasonably accurate tool for surgical planning. Schlagwörter: mandibular cyst, defect reconstruction, cyst enucleation, cyst volume assessment

Introduction: Subperiosteal preparation using a periosteal elevator leads to disturbances of local periosteal microcirculation [1]. Soft-tissue damage can usually be considerably reduced using piezoelectric technology. For this reason, we investigated the effects of a novel piezoelectric device on local periosteal microcirculation and compared this approach with the conventional preparation of the periosteum using a periosteal elevator. Material and Methods: A total of 20 Lewis rats were randomly assigned to one of two groups. Subperiosteal preparation on the cranium (picture 1) was performed using either a piezoelectric device or a periosteal elevator. Intravital microscopy (picture 2) was performed immediately after the procedure as well as three and eight days postoperatively [2]. Statistical analysis of microcirculatory parameters was performed offline using analysis of variance (ANOVA) on ranks (p0.05). Results: Periosteal microcirculation was imaged in detail using intravital fluorescence microcopy. The group of rats whose periosteum had been prepared with a piezoelectric device was compared with the group of rats whose periosteum had been prepared with a periosteal elevator. The periosteal elevator group had a significantly lower functional capillary density than the piezoelectric device group at all time points investigated. Postoperatively, both groups showed a considerable increase in functional capillary density, which, however, was always lower in the periosteal elevator group than in the piezoelectric device group (Picture 3). Microvascular red blood cell velocity was significantly lower in the periosteal elevator group than in the piezoelectric device group. During the following 8 days, the red blood cell velocities in the periosteal elevator group became more similar to those measured in the piezoelectric device group. Discussion: Our results show that the use of the piezoelectric device for the preparation of the periosteum was associated with a considerably higher post-procedural periosteal blood flow than the conventional method with a periosteal elevator. Several studies reported that piezosurgery is an atraumatic process that causes only minimal tissue damage. The study presented here confirms this finding for subperiosteal preparation. One possible explanation is that the use of a piezoelectric device leads to the formation of fewer microthrombi during subperiosteal preparation than a periosteal elevator. The results reported here show that the use of a piezoelectric device for the preparation of the periosteum has considerable advantages. Further studies are required to investigate possible positive effects on bone remodeling in patients who have comorbidities and, for example, are treated with bisphophonates, chemotherapeutic agents, or other medications. Schlagwörter: subperiosteal preparation, piezoelectric preparation, intravital microscopy, animal testing

Introduction: Augmentation procedures in preimplant surgery uses a standard method. Different methods for extraction and processing of autologous bone used. The acquisition of bone chips and the the harvesting of bone blocks. Bone blocks and chips are both brought to the place where they are needed for augmentation, wherein the bone block is fixed by means of osteosynthesis in the final position. For a successful osseointegration not only the safe seat of the bone is important, but also a corresponding conturation in which the graft must be securely fixed, which often represents a challenge to the clinician. This are exactly the reasons why the bone-preperation block was developed. Material and Method: With more than 300 patients were anatomically shaped bone graft from different points, taken with different dimensions. In the preperation block, they were worked with rotating and oscillating process outside the mouth. After processing, the bone was to be augmented in the situs and the fixation with osteosynthesis. Results: In all patients the secure fixation of the samples collected and to ensure extra-oral bone graft conturation under water cooling. None of the patients broke the bone or damaged by excessive pressure in texture. Late graft losses were not as well. Discussion: Safe fixation is a must for the extra-oral work, under water cooling, to augmenting of autologous bone blocks. Even the use of bonescrapers clamped on bone is ensured due to the secure fixation. The preperation block is therefore a useful and necessary complement to the existing augmentation sets.

Die Therapie einer infizierten Mund-Antrum-Verbindung stellt für den Behandler eine große Herausforderung dar. Der Leidensweg und die Beeinträchtigung der betroffenen Patienten dürfen nicht unterschätzt werden, vor allem wenn eine Aspergillose der Kieferhöhle vorliegt. Anhand eines Fallbeispiels vermittelt der Beitrag nützliche Informationen zur Pathogenese und zur Therapie dieser nicht ganz einfachen Erkrankung. Schlagwörter: Mund-Antrum-Verbindung, Aspergillose, Kieferhöhlenrevision, Bichat'scher Fettpfropf