International Poster Journal of Dentistry and Oral Medicine, 03/2001

A multitude of procedures exist for treating velopharyngeal incompetence. Because of the morphological variety of problems, several of the currently available procedures can be justified. Each method is associated with its own specific problems and risks, and therapeutic success is often unsatisfactory in a manner which depends on the genesis and extent of the anomaly. The presented case showes a new procedure for treating velopharyngeal incompetence. In a seven year old boy with extensive rhinophonia aperta after an operative cleft palate closure, the dorsal edge of the hard palate and the pterygoid process were osteotomized, and a distraction device was fitted. After a latent period of one week distraction was performed for ten days at 0.75 mm per day. In ten days it was possible to achieve a dorsal displacement of the osteotomized complex amounting to 7.5 mm. Operation, distraction, and the postoperative period proceeded without any problems. The distance between the soft palate and the posterior pharyngeal wall was decreased by approximately 7 mm while the mobility of the soft palate musculature was maintained. Three months after the operation, both rhinophonia aperta and speech comprehensibility were markedly improved. First experiences with the distraction of the palate for treating velopharyngeal incompe-tence were positive. Experiments need to be performed on other patients and over a longer observation period in order to perform a reliable evaluation of this procedure. Schlagwörter: distraction osteogenesis, cleft lip palate, intraoral distraktion device, velopharyngeal incompetence

At the conclusion of this presentation, the participant should be able to identify the benefit of the treatment with Botulinumtoxin A in patients suffering from gustatory sweating. Frey's Syndrome is present in almost all patients after parotid gland surgery. Gustatory sweating decreases quality of life. Botulinumtoxin A has been recently described to be an effective treatment. This prospective clinical study was disigned to evaluate the efficacy of the therapy. 20 patients with severe gustatory sweating following superficial parotidectomy due to adenoma of the parotid gland were treated. Botulimnumtoxin A was injected intracutaneously into the affected area once. Minor's starch iodine test was performed to prove the efficacy of the treatment. Quality of life was evaluated by SF-36. Minor's starch iodine test showed the total absence of gustatory sweating within one week after treatment in all patients. No side effects could be observed. Quality of life was increased significantely.Botulinumtoxin A is highly effective and save in the treatment of gustatory sweating. Intracutaneous injections of Botulinumtoxin A are the treatment of choice in severe cases of Frey's Syndrome. Schlagwörter: Frey's syndrome, gustatory sweating, botulinum toxin

Photodynamic therapy (PDT) is gaining in importance as an alternative treatment procedure for lesions of the oral cavity. The desired goal is an effective and easily controllable therapy with the most possible homogeneous irradiation of the oral cavity lesions. The oral cavity is characterised by complex geometry which must be considered with the selection of the applicators and the appropriate dosimetry. Using MS Excel, functional tables were formulated illustrating standardized geometrical conditions. With the assistance of these tables, the irradiation surface and the appropriate energy or power density can be determined for each application. The applicators used were isotropic of different length (Coherent) - cylindrical and hemizylindrische application systems 2-4cm long and Microlens fibers (Coherent). Power Densities of fewer than 250mW/cm2 were used in order to avoid thermal effects of the oral mucous membrane. Aphthen were treated with a dose of 40-80 J/cm2 and Leukoplakien or Lichen Planus with a dose of 80-130 J/cm2. The use of interactive tables enables a standardisation of the irradiation parameters - even those with different geometrical proportions. In light dosimetry there are differences in the handling of different lesions of the oral mucosa depending upon indication and used applicator. With the appropriate applicator it is possible to implement an even light dose and in the rear areas of the oral cavity. With the help of interactive tables introduced by us, an optimized and standardized treatment protocol can be achieved. Schlagwörter: Lichtdosimetrie, Photodynamische Therapie

Interceptive treatment carried out with removable appliances at the correct time may save the patient from a more complicated treatment at later stage. Early orthodontic treatment will not resolve all potential orthodontic problems or totally inhibit adverse skeletal growth patterns. However, by identifying problems at an early stage it is possible to redirect skeletal growth, improve the occlusal relationship, enhance the patient's esthetics and self-image and, perhaps of even greater importance, achieve results that are unattainable later with the eruption of the teeth and the cessation of growth. Diagnosis and management of three different cases are presented. Case 1: The anterior crossbite associated with a mild skeletal Class III growth pattern was treated with a Fränkel III regulator to achieve a normal anterior overjet and overbite. Case 2: Severe asymmetry in a pre-adolescent boy arose from a unilateral hypoplasia of the condyle. Early orthodontic interceptive treatment with an activator corrected the asymmetry. A plate with posterior bite blocks achieved a normal vertical relationship. Both together leaded to a normal development of the face and jaws. Case 3: A patient with a unilateral posterior crossbite resulting from a maxillary constriction and association with an occlusion guided lateral deviation of the mandible upon closing. A maxillary expansion plate was used to correct the posterior crossbite. This was indicated to establish a stable occlusion and avoid possible deleterious effects on the developing temporomandibular joint. The treatment resulted in the eruption of the permanent molars in normal transverse relationship. Schlagwörter: interceptive therapy, early childhood, mixed dentition

Dental chart systems have been developed mainly to record treatment. It is in addition well suited for rapid and exact reporting of dental findings in identification cases. The proposal to use anatomic/geometric forms including dental roots for adoption by Interpol is demonstrated. Schlagwörter: dental chart systems, disaster-victim-identification, forensic odontology, interpol-form, post-mortem documentation

The aim of this prospective study was to investigate the diagnostic accuracy of DNA-Image-Cytometry in addition to oral exfoliative cytology taken from suspicious oral lesions in our clinic. Cytological diagnoses obtained from 1500 exfoliative smears were compared with histological and/or clinical follow-ups of the respective patients. Additionally nuclear DNA contents were measured after Feulgen restaining using a TV image analysis system. DNA-aneuploidy was assumed if abnormal DNA-stemlines or cells with DNA-content greater 9c were observed. Sensitivity of our cytological diagnosis in addition to DNA-Image-Cytometry on oral smears for the detection of cancer cells was 98,3%, specificity 100%, positive predictive value 100% and negative predictive value 99,6%. The application of DNA-Image-Cytometry with DNA-aneuploidy as a marker for neoplastic transformation in oral smears secures cytologic diagnosis of cancer. Smears from brushings of all visible oral lesions are an easy practicable, cheap, non-invasive, painless and safe screening method for detection of oral precancerous lesions and squamous cell carcinoma in all stages. We conclude that DNA-Image-Cytometry is a very sensitive and highly specific, objective and reproducible adjuvant tool for identification of neoplastic cells in oral smears. Schlagwörter: cancer screening, cytology, oral cancer, dna-cytometry

A lot of publications are about the chemical influence of mouthrinses on dental plaque. Most of this investigations are in vitro methods of testing. Ultrastructure analysis of dental plaque are seldom published and mostly done with a scanning electron microscope. The aim of this study is a quantitative comparison between effects of different antimicrobial mouthrinses on dental plaque in vivo. This quantitative investigation was realized with the method of transmission electron microscopy (TEM). 21 adults aged 18 to 62 years participated randomized in a three days study. The subjects wore plastic splints with three pieces of bovine enamel in the molar area of the lower jaw. An amine fluoride / stannous fluoride mouthrinse (ASF) in group 1, 0.12 % chlorhexidine digluconate mouthrinse (CHX) in group 2 and 0.7 % sodium chloride mouthrinse (SCL) in group 3 have been used for rinsing. The rinsing procedure was executed with 10 ml mouthrinse for 30 seconds twice a day. 24 (a), 48 (b) and 72 (c) hours after baseline each a piece of enamel with the plaque layer was removed and prepared for TEM. Ultrathin slices were inspected relating to plaque thickness (PT in µm), quantity of cocci (QC per 10 µm2) and quantity of rods (QR per 10 µm2). Friedman-/Wilcoxon-Test was used for statistical analysis. The results for group 1 are: PT/a 8.42±3.66, PT/b 11.65±5.27 (p=0.018), PT/c 14.02±6.37 (p=0.018); QC/a 15.68±6.16, QC/b 18.08±9.50 (n.s.), QC/c 12.04±5.37 (p=0.018); QR/a 0.23±0.19, QR/b 0.81±1.23, QR/c 0.52±0.44 (n.s.). The results for group 2 are: PT/a 6.91±5.97, PT/b 9.98±6.27 (p=0.018), PT/c 11.91±7.00 (p=0.018); QC/a7.02±4.01, QC/b 7.52±5.27 (n.s.), QC/c 4.29±3.76 (p=0.018); QR/a 0.21±0.47, QR/b 0.25±0.22, QR/c 0.08±0.13 (n.s.). The results for group 3 are: PT/a 4.69±1.88, PT/b 10.60±5.31 (p=0.018), PT/c 19.24±5.70 (p=0.018); QC/a 14.25±3.78, QC/b 16.98±2.82 (p=0.018), QC/c 18.18±2.60 (p=0.018); QR/a 0.52±0.18, QR/b 0.88±0.19 (p=0.018) QR/c 1.29±0.37 (p=0.018). All groups showed significant changes at PT and QC, group 3 showed additionally a significant increase of QR. The results permit the conclusion that the effects of ASF and CHX relating to plaque thickness and quantity of cocci as wel as start of efficacy are very similar. Schlagwörter: mouthrinses, dental plaque, transmission, electron microscopy

A histological evaluation of an amalgam replacement material in comparison to conventional resin systems. The aim of the present study was to evaluate application and adhesive effects of an amalgam replacing material compared to a composite and a compomer system.40 two-sided cavities were prepared in 20 freshly extracted and caries-free molars.20 of these cavities were [ according to the rules of amalgam restaurations.The samples were filled with Ariston pHc© according to the manufacturer's instructions.The remaining 20 cavities were restored with a composite system or a compomere system respectively using the adhesive technique.After Thermocycling (2200 cycles) for light microscopic and SEM investigations, a plastic embedding technique was used to cut the undecalcified teeth in sections of 20 µm thickness.The samples were examined regarding homogenicity, gap formation, bubbles and marginal adaption.Significant differences did not occur in between the different materials. Light microscope and SEM showed a comparable number of bubbles and gaps in all investigated groups. The terraced outline of the of the cavities prepared for the amalgam replacing material was accomponied with an increasing number of gaps and bubbles at the angles between bottom of the cavity and the axial wall and the axial wall and the approximal shoulder. Schlagwörter: Amalgamersatzmaterial, Amalgamersatz, Komposit, Kompomer, Thermocycling, REM, Trenndünnschliff, Spalt, Blase

The goal of the study was to examine the preliminary results of immediateimplant loading in patients with a general medical or psychological conditionrestricting their treatment capacity.Each of 5 patients with increased risk of operation - due to general healthyproblems (3 patients, anticoagulative or antidiabetic treatment) or dentophobiaand treatment only under general anesthesia (2 dentophobic patients)- receivedrestorations in the mandible with 4 one-step, transgingival, bar-supportedimmediately loaded Frialoc implants to minimize the number of implant surgicalinterventions. There was no implant loss over a follow-up period of up to 19 months. Apart froman initial increase in bone resorption at 2 distally implants restored with acantilevered bar (the cantilevers were removed 13 months after delivery of theprosthesis), there were no serious surgical, prosthetic or general medicalproblems during the treatment period. The initial results of the study indicate that single-step Frialoc system allowsfast and comfortable prosthetic mandibular restorations in patients with reducedtreatment capacity with minimal surgical risk because there is only oneprocedure. Further studies on a larger patient collective over a longer period are urgentlyrequired to confirm the initial positive experiences. Schlagwörter: dental implants, Frialoc System, compromised patients

Different Th-cell subsets may have a profound effect on the character of the immune response in periodontal disease. The cytokine IL-4 plays a major role in directing Th2 cell development. In a recent study, we identified two polymorphisms in the human IL-4 gene, which in combination showed a higher correlation to patients of north European heritage (EU) with aggressive periodontitis when compared to controls. The present investigation was undertaken to compare the distribution of this combined IL-4 genotype in two different populations and to determine the role of IL-4 genotypes in the immune response influenced by aggressive periodontitis. The -590 (CVT) promoter- and the 70 bp repeat (intron 2) polymorphisms were detected by specific primers and amplified by polymerase chain reaction (PCR) from dry blood samples taken in Central America (CA) from 16 patients and 14 controls. All of them were examined by a single experienced investigator and included in the study according to clinical parameters and radiographs. Man-Whitney-U-Test and Fisher's Exact Test were used in order to compare genotype frequencies between patients and controls in both populations (CA versus EU). A significant difference between both controls (p Schlagwörter: genetic polymorphisms, Interleukin-4, aggressive periodontitis, molecular biology

The classification of hemangiomas and vascular malformations by Mulliken and Glowacki 1982, based on endothelial characterization, resulted in a systematized and standardized description and assessment of vascular lesions. The next step based on this classification, the development of a causal and differentiated therapy, has not been accomplished, as the various treatment protocols still applied show. The increased knowledge about endothelial changes, angiogenesis, anti-angiogenesis and hematopoiesis allows a more specific insight into the development. Nowadays it has been assumed that embryologic development of both hematopoietic and endothelial cell lines are based on the same progenitor cell, the hemangioblast, and that differentiation starts at that point. The aim of this retrospective study was to analyze the distribution of hematopoietic and endothelial cells and progenitor cells of oral hemangiomas in a collective of children, and to conclude the formation and maturation of the lesions. The specimens of 20 oral hemangiomas (12 cavernous and 8 capillary) were analyzed. The age of the children at the time of excision was one to eight years. The formalin-fixed and paraffin-embedded specimens were stained immunohistochemically for specific surface cell markers. Proliferation activity was demonstrated by using MIB-1. Antibodies used for this study were CD 31, FLK-1/KDR and VE-Cadherin as markers for endothelial cells, and CD 34, CD 45 and TER 119 as markers for hematopoietic cells. The staining activity was determined by semiquantitative analysis of five at random chosen hot spots of each lesion. The results showed MIB-1+ staining in all cases demonstrating proliferation activity and excluding resting embryologic malformations. The analysis of cell specific constellations of markers showed 47% angioblasts (CD 31+, FLK-1/KDR+, VE-Cadherin+), 30% hemangioblasts (CD 31+, FLK-1/KDR+, VE-Cadherin+, CD 34+, CD 45-), 9% hematopoeitic progenitor cells (FLK-1/KDR+, CD 45+, VE-Cadherin-), 1% non-defined cell line; 13% could not be assigned to one of this groups. The capillary group showed more hematopoietic progenitor cells than the cavernous group. Overall, the endothelial cells seem to be dominant over the hematopoietic cells in oral hemangiomas in infancy. Therefore an intralesional local antiangiogenic therapy in cases of growing and unoperable hemangiomas is conceivable. Schlagwörter: hemangioma, cell lines, immunohistochemistry, differentiation

Purpose Loss of implants is a clinic problem especially in alveoli that have been edentulous for long periods. The combination of various augmentation procedures, with primary or secondary implantations, will improve survival rate. This study intended to correlate the survival rate with individual patients' parameters. Methods A total of 194 patients who underwent reconstruction of deficient dental alveolar ridges and insertion of endosseous implants were evaluated retrospectively. In addition, 134 patients, who are in a multi-disciplinary clinical recall system, were examined on a clinical and anamnestic level. The correlations between an individual patient's bone situation, the surgical technique and the implant survival, were evaluated statistically. Results & Discussion We found an overall implant survival rate of 96,8 % in our patients. The best results were obtained in partially edentulous patients by autologous bone grafts in combination with primary implantation. Total alveolar ridge augmentation resulted in the highest implant loss rates, both with primary and secondary implantations. And these were associated with the occurance of a Periimplantitis. Lack of preservation of the soft tissue integrity seems to be the main underlying cause for implant loss. Schlagwörter: implant, augmentation, longevity