International Poster Journal of Dentistry and Oral Medicine, 01/2003

Aim of this study was to assess the reliability of the measurement of occlusal caries by a laser fluorescent technique. Four dentists using four DIAGNOdent® devices (Dd) according to manufacturers instructions examined 80 carefully cleaned molars with non-cavitated occlusal lesions. Inter- and intra-examiner reproducibility were calculated using Lin's intra-class correlation coefficient (ICCLin), Students t-test and the limits of agreement by Bland and Altman (1990). Excellent intra-examiner reproducibility was found for dentist 2 and dentist 4. Significant differences were calculated for dentist 1 and dentist 3. Inter-examiner reproducibility was significantly different between dentist 3 and each of the other dentists. Significant differences between Dd instruments disappeared after exclusion of all readings of dentist 3. Categorising Dd values in order of treatment related cut-offs a substantial reproducibility was found in the range of 0-14 (ICCLin 0.66) and >30 (ICCLin 0.65). Only 41.6% of all Dd measurements were reproduced in the range 15-30 (ICCLin 0.16). The results suggest that dentists should be trained before using Dds. The low reliability in the interval of 15-30 could limit the use of Dds for a longitudinal caries monitoring on occlusal surfaces. Keywords: DIAGNOdent, Laserfluoreszenz-Messung, Kariesdiagnostik, Reproduzierbarkeit, Variabilität

The neonatal line (NNL) has been interpreted as broadly Retzius line, which can be found in the enamel of all deciduous teeth and of all first lower permanent molars. Since the NNL is discussed as locus minoris resistentiae during the initiation of early child-hood caries (Nursing-Bottle-Syndrome), this study was aimed to investigate the ultra-structure with a scanning electron micro-scope. The study comprised five sound primary front teeth and five sound primary molars. All teeth were hemi-sectioned (MIKRO-TRENN MT 1557, Hofer, Swiss). Afterwards the smear layer was removed by acid etching with 35% phosphoric acid for 30 s. The examination was carried out under a SEM 515 (Philips, Eindhoven, The Netherlands) using a constant cathode voltage of 20 keV and a maximum magnification of 20.000. In seven teeth a NNL was visualized by SEM. At 1.000x magnification only an irregular structure of the enamel prisms was observed. Detailed images showed a typical interruption of the prisms at the NNL between 5.000x to 20.000x magnification; nearly all crystallites of a prism were not mineralised in a length of 0,5 µm. As a result of frequent consumption of erosive and/or cariogenic drinks and foods the predominant demineralisation of the enamel nearby the NNL could be enabled. This gives an explanation for initiation and the rapid progression of the carious process at the NNL. Keywords: Neonatallinie, Ultrastruktur, REM

The liposarcoma of the tongue, an extremely rare tumor is reported in the literature in only 11 cases. None of these cases described a multilocular presentation. Adults between the ages 50 and 70, in the majority men, are primarily afflicted. 20% of all soft tissue tumors are liposarcoma, and 4% occur in the head and neck area. Liposarcoma exhibits a predilection for the trunk and the lower extremities. Most of the liposarcoma tumors in the head and neck region have been located in the cheek and the floor of mouth, however seldom in larynx, lips, maxilla or soft palate.A 40-year-old male reported over 3 years progredient growing tumor in the anterior part of the tongue. Speech was unrestricted and very important for the field worker. Magnet resonance imaging showed 7 tumors with a size to 3x2x1 cm and the biopsy showed a well-differentiated myxoid liposarcoma. Furthermore a local resection of others tumors was done without functional deficits. Radiation therapy may be beneficial, but on account of a low expansion of liposarcoma and the location of tumor we did not apply adjuvant radiotherapy. All 6 to 8 weeks control was made by sonographic or magnet resonance imaging. The patient is without recidivism. Keywords: liposarcoma, tongue, multilocular, myxoid, well-differentiate

Objectives of Investigation:Nemaline Myopathy (NM) is a rare syndrome with distinctive clinical and pathologic features and is characterized by abundant rod bodies within the muscle fibres. It presents generalized symmetric muscle wasting and weakness, typical facial 'fish mouth' appearance, frequent skeletal deformities and reduced or absent tendon reflexes. This case report describes a male child with NM-Syndrome who was 2 years 11 months at the time of the first examination in our department. He was referred from his speech therapist who had seen initial erosive lesions and caries on his anterior upper teeth. The aim of the case report was to present dental and orofacial status of this child with NM-Syndrome and exemplify dental and orofacial consequences in children with the disease. Materials and methods:2 year 11 month (in June, 2001) male child with NM-Syndrome. Clinical examination:Caries and plaque, extra- and intraoral photographs.Speech therapist examination. Starting prophylaxis by brushing his teeth and apply a fluorid varnish every 2-3 month. Results:We found erosive lesions on 52, 51, 61 and 62 (palatinal and incisal) which were caused by a longlasting reflux nearly one year ago. A poor masseteric and lip muscle function was recorded and was resulting in a permanent flow of saliva out of his mouth. After 7 month we observe a stagnation of the lesions. By undergoing a regular speech therapie, he now is able to control the periorale muscles for a short time und to close his lips. Conclusions:Children with NM-Syndrome should be considered as patients with high risk for caries and dental erosions. Consequently they need special preventive dental care. Additionally, there is also a need for oral motoric training for these patients Keywords: Nemaline Myopathy

Teratomas are rare tumors of childhood with an incidence between 1:20.000 to 1:40.000 births. 5% of those teratomas are located in the head and neck region. Without treatment 80% of the little patients with oropharyngeal teratomas die in the postpartum period because of airway obstruction. The treatment of oropharyngeal teratoma, especially when extended to intracranial cavity, remains very difficult. Establishment of a secure airway is the most important step after delivery. The complete surgical resection has to be performed without creating significant growth impairment. A case of a female patient with an intracranial extended oropharyngeal teratoma is presented. A lateral transmandibular approach to the scull base with temporal exarticulation of the mandible was used for final tumor resection. 6 years after surgery there were no neurological deficits but hemimandibular microsomia treated successfully with distraction ostegenesis. The technical aspects of the surgical technique used are demonstrated and treatment modalities of oropharyngeal teratomas are described. Keywords: Teratom, Kleinkind, Schädelbasis, transmandibulärer Zugang, Distraktionsosteogenese, Unterkiefer

Objectives: The aim of this 5 year follow-up study was to evaluate clinically and radiographically the long-term results after GTR therapy of infrabony defects using non-resorbable and bioabsorbable barriers. Methods: In 12 patients suffering from advanced periodontitis 12 pairs of contralateral infrabony defects were treated. Within each patient one defect received a non-resorbable (ePTFE; control: C) and the other a bioabsorbable (Polyglactin 910; test: T) barrier by random assignment. At baseline, 6 and 60±3 months after surgery clinical parameters and standardized radiographs were obtained. Using digital subtraction analysis gain of bone relative density change (mean grey level change x area) within infrabony defects was assessed. Results: Eight of 12 patients were available for the 60-months re examinations. Six and 60±3 months after GTR therapy statistically significant (p Keywords: infrabony defects/therapy, guided tissue regeneration, membranes, artificial, membranes, barrier, polytetrafluoroethylene/therapeutic use, radiography, dental radiography, dental, subtraction

Crevicular PMNL's are the predominant cells in the local defense against periodontopathogenic bacteria. Ellis et al. 1996 reported that apoptosis occurs only on sites of periodontitis but not gingivitis. But until now, the proportion of apoptotic or necrotic cells in crevicular fluid is not examined enough. In this context, we investigate apoptotic and necrotic PMNL's in the crevicular fluid of patients with periodontal disease. CF-cells from 29 patients with aggressive periodontitis were obtained by crevicular washings as we described recently. Aggressive periodontitis patients were characterized by various pocket depth categories: 1-3,5 mm, 4-6 mm, 6,5-9 mm and >9 mm. Apoptosis of CF-cells was determined using the Annexin-V-Fluos Staining Kit (Boehringer Mannheim, Germany) and flow cytometry (Facs). To identify apoptotic or dead neutrophils FITC-annexin V.and propidium iodide was used.We found that in periodontitis patients with pocket depth categories: 4-6 mm and 6,5-9 mm, 55% of the PMNL's were apoptotic, compared to the pocket depth categories: 1-3,5 mm and >9 mm(8% and 4%). Furthermore, in category 1-3,5 mm in periodontitis patients we obtained a smaller number of necrotic cells compared to the category >9 mm (p9mm only a small number of apoptotic and furthermore in the last category, a greater number of necrotic CF-cells. Keywords: aggressive Parodontitis, PMNL, Apoptose, Sondierungstiefenkategorien

Mainly, the occlusal fit of prosthodontic restorations is evaluated qualitatively by visual control of color-marked contact points. A large loss of data and information is immanent in conventional methods for the exploration of internal, marginal and occlusal fit of fixed restorations. Aim of this study was to develop a procedure for the three-dimensional analysis of internal and occlusal precision of fit. A test model was developed by reverse engineering. Every single step in the manufacturing of fixed prosthodontic restorations concerning the influence on the achievable precision has to be evaluated. The test model is based on a real and an identical virtual model of upper and lower teeth in static occlusion. The interpenetration of upper and lower tooth surfaces may be evaluated qualitatively analogous to the analysis of occlusal contacts in conventional methods. On top of this, a quantitative evaluation of the size of the contacts is possible. By multi-step optimization, manufacturing a real model in static occlusion, which is identical to a virtual model is considered to be possible within a processing error of Keywords: CAD/CAM, digitizing, restoration, occlusion, method

Spontaneous necrotising soft tissue lesions of the face can be differentiated into necrotising cellulitis, necrotising fasciitis and myonecrosis. Each type can be caused by a single or a variety of different agents. Early recognition and adequate management are mandatory in order to reduce mortality as many of these lesions are rapidly progressive infections causing extensive necrosis of the subcutaneous tissues followed by gangrene of the skin and systemic toxicity. This paper reports about a case of a rarely seen spontaneous necrotic soft tissue lesion of the face caused by the Mucormycosis causing agent Absidia Corymbifera and highlights the management of it. Keywords: Mukormykose, nekrotisierende Läsion, Haut, plastische Chirurgie

Purpose: In this study the literature dealing with clinical and experimental craniofacial distraction osteogenesis (DO) was reviewed from an orthodontic perspective. The purpose of this review was two-fold: (1) to evaluate clinical indications and DO parameters; (2) to evaluate the different DO experimental animal models. Methods: A Pubmed search (NCBI, New Pubmed System) from 1966 through December 2000 was conducted. Key words applied in the search were distraction, orthodontics, lengthening, mandible, maxilla, midface, monobloc, cranial, craniofacial and maxillofacial. The clinical (revised 3 April 2000) and experimental (revised 1 April 2001) search revealed 109 and 120 articles, respectively. Flow sheets were made of each article with the specific parameters relative to DO and orthodontics.Results: A total of 828 patients underwent craniofacial DO: 579 (70.0%) mandibular, 129 (15.6%) maxillary, 24 (2.9%) simultaneous mandibular-maxillary, and 96 (11.6%) midfacial and/or cranial DO. Only 479 patients (57.9%) had data on follow-up and in only 248 patients (30,0%) information on relaps was given. A total of 1207 animals were used in seven different animal models: 54 (45.0%) dog, 25 (20.8%) rabbit, 18 (15.0%) sheep, 11 (9.2%) minipig, 7 (5.8%) monkey, 4 (3.3%) rat and 1 (0.8%) cat model. Only 3 (2.5%) articles investigated on orthodontic tooth movement in the regenerate and only 2 (1.7%) on relaps. Conclusion: On the basis of these results an attempt was done to provide treatment protocols and success criteria for clinical craniofacial DO and guidelines for future experimental DO research. There is still a lack of sufficient data, especially on orthodontic management, dental-skeletal relaps and follow-up, so that treatment strategies have to be validated. Keywords: craniofacial distraction, orthodontics

Mechanical debridement and biofilm removal from periodontally diseased root surfaces form an integral part of initial periodontal therapy. This is usually achieved with traditional hand instruments, sonic-, ultrasonic, or oscillating scalers. Aim of this study was the clinical investigation of a novel ultrasonic device (Vector, Duerr, Bietigheim, Germany) with a new approach of creating ultrasonic vibration, compared to scaling and root planing with hand instruments for non-surgical periodontal therapy. 14 patients were treated using either the Vector device or manual scaling and root planing in this controlled, prospective split-mouth study. 3 months after treatment probing depth and degree of inflammation were reduced in both groups, with relevant differences between the two groups. However, a significant gain of clinical attachment was found in the Vector-group. Keywords: chronische Parodontitis, Scaling und Wurzelglättung, Handinstrument, Vector-System

The goal was to verify the vital potential of filtered bone particles used for bone augmentation. These were harvested during insertion of implants and were then explanted as cell culture. Following stains were used: Alcaline phosphatase, von-Kossa, osteocalzine and vimentine. These showed the cells to be of osteoblast and mesenchymal origin. It was also possible to confirm an osteoblast phenotype. During the past five years 256 patients were treated inserting 566 implants. In 45.3% a Bone collector was used for marginal defects, 6,3% for palatinal defects, 7.4% for periimplant defects, 1.1% for fenestration defects, 2.1% for bone splitting and 5.3% for sinus floor elevation. Histological results will be presented. Keywords: autogeneous transplants, autogeneous augmentation, osteoblast cell culture, collected bone debris, human histology, dental implants, FRIOS-BoneCollector

Immediate loading of dental implants in the partially edentulous patient has not been investigated widely. Immediate loading requires immobilization of the implants by the superstructure (Ledermann, Brunski). An animal study was performed to evaluate the clinical success and the bone metabolism during the course of osseointegration on 12 implant borne bridges. Three month after tooth extraction implant insertion and prosthetic treatment was per-formed. 29 implants out of 62 had an insertion tor-que (IIT) above 35 Ncm. The average insertion tor-que of the implants per bridge (BIT) were determined. If the BIT was higher than 35 Ncm the bridges were successful after 3 month of loading. The histological findings of loaded and unloaded implants will be presented. The procedure with pre-fabricated auxiliary parts allows fabricating a bridge reconstruction during one appointment. Keywords: immediate loading, histological analysis, implant insertion torque, bridge

Modern Education of dental students is mainly performed through dental simulation units. These units make it possible for the students to learn the working sequences close to a realistic clinical situation. A fundamental part of this education is the skill to prepare teeth for prosthodontic treatment. The main priority is the capability to measure and to evaluate the preparation in a standard way. The aforementioned ability is an indispensable requirement of a successful and responsible clinical activity. With the help of a new electronic device - PREPassist - should students be better prepared to meet these requirements. It consists of a computersystem with which it is possible to present the preparation in a three dimensional way and consequently to measure it. It is possible for the students to evaluate the quality of their preparations in an interactive, objective and reproducable way by themselves. So the learning process is thought to be easier and the learning time shorter. It is going to be examined in which way and how much the quality of dental education will be improved using this system. The evaluation of the PREPassist is a cooperate project of the Departments of Prosthodontics of the University of Tuebingen and Freiburg. This study is financed by the Ministry of Science, Research and Art of Baden-Wuerttemberg. Keywords: dental education, preparation, prostethics, digital imaging, quality, technology