International Poster Journal of Dentistry and Oral Medicine, 02/2004

Objectives: Evaluation of tooth loss of molars in relation to their degree of furcation involvement (FI) and treatment modality in patients maintained over a period of at least five years after corrective periodontal therapy. Material and Methods: This study evaluated 70 patients (mean age 46 years; 40 females) to determine the relationship of loss of molars to the degree of FI (degree 0, I, II, III) and periodontal therapy (no further therapy, non-surgical and surgical scaling and root planing, access flap, tunnel preparation, resective or regenerative therapy). The following criteria were required for inclusion: periodontal therapy of at least one molar, at least 5 years of supportive periodontal therapy (SPT), baseline clinical or intrasurgical assessment of the FI. Results: At baseline of periodontal therapy the 70 patients presented a total of 501 molars; 243 were located in the maxilla and 258 in the mandible; 195 exhibited no FI, 119 degree I, 122 degree II, and 65 degree III FI. Only 27 molars did not receive any further periodontal treatment; 126 molars were subjected to non-surgical therapy, and 230 to flap-surgery. Tunnel preparation was performed in 12 molars, root-resection in 18, and regenerative therapy in 56 teeth. 32 molars were extracted during active periodontal therapy (APT): 7% without FI, 3% with degree I, 2% with degree II, and 20% of the molars with degree III FI. The mean follow-up period was 77 months. In this period further 27 molars were lost. Molars with degree III FI had the highest mortality (36%; APT: 22%, SPT: 14%). 16 out of a total of 21 extracted molars with a baseline degree III FI were maxillary teeth. Conclusion: After therapy, the prognosis of molars with baseline degree I and II FI was similar to that of molars without FI. Mandibular molars with degree III FI revealed to have a better prognosis than maxillary molars with degree III FI. Keywords: furcation involvement, molars, periodontal treatment, tooth loss, long-term stability

Treatment of patients suffering from A. actinomycetemcomitans (A. a.)-associated periodontitis aims to eliminate this microorganism. Recolonisation or persistance of A. a. after therapy has been considered as a risk factor for recurrent periodontitis.The purpose of this study was to evaluate the long-term microbiological and clinical effect of a combined mechanical and antibiotic treatment in A. a.-associated periodontitis at least 12 months (mean 36,8 months) after active therapy. This retrospective study included 40 patients (28 female) with a mean age of 37 years, who received mechanical subgingival debridement supplemented with an antibiotic therapy (metronidazole plus amoxicillin/ciprofloxacin). The presence of A. a. after treatment was determined using two commercial nucleic acid probes (IAI PadoTest, DMDx) and culture technique (TSBV). The clinical situation was assessed according to the probing depths.Microbiological reexamination revealed that A. a. was undetectable in 32 patients. The IAI PadoTest showed a positive result for A. a. in 7 and the DMDx in 2 cases. In only one patient A. a. could be detected with both nucleid acid probes and the culture. Clinical improvement was observed in all patients directly after therapy, resulting in a significant reduction of the pocket depths. The clinical outcome was stable over the observation period with no significant difference between patients with or without a postive evidence for A. a. In conclusion, a combined mechanical and antibiotic therapy followed by a regular maintenance is effective to suppress A. a. over a mean period of 37 months, is appropriate for improving the clinical situation, and achieving long-term stability of periodontal health. Keywords: actinobacillus actinomycetemcomitans, microbiological diagnostic

Maintenance of sealant integrity is generally equated to clinical effectiveness. Reported rates of sealant loss in children averaged at nearly 50% in Germany. This raises the question whether partial sealant loss needs replacement, repair or monitoring. Aim of this study was to test the potential of light-induced fluorescence (LF) for judging the quality of fissure sealants compared with clinical assessment. After plaque disclosing (Miraton, Hager) and professional tooth-cleaning 280 occlusal surfaces of 35 fifteen-year-olds were examined visually with aid of compressed air and magnifying glass (3.5x). Sealants were scored clinically as (1) present with marginal integrity and (2) partial loss and detectable margin with or without a discoloured fissure. Fluorescence images of the occlusal surfaces were captured by QLF\\clin (light source: 35 W Xenon microdischarge arc lamp). Images were stored with an Inspektor QLF 2.00 programme. LF images were assessed by two examiners. Additional to the clinical scoring criteria (1, 2) presence or absence of red plaque fluorescence, presumably originates from porphyrins produced by anaerobic bacteria [König K, et al.: SPIE 1993;2080:170-180], was recorded. A total of 89 sealants was scored. 37 sealants were clinically intact and 52 revealed a failure. In 52% of all cases with partial loss discoloured fissures were observed. LF images showed red fluorescence at the margin of 10 sealants clinically scored as intact (1). Partial sealant loss was combined with red plaque fluorescence in the exposed undiscoloured fissure in 17 of 26 cases. The relation of sealant loss with brown discoloured fissures with or without red fluorescence was 10 to 15. It was concluded that LF enables a sensitive assessment of sealants quality. It is debatable whether the presence of bacteria at a sealant margin would automatically justify sealant replacement. Keywords: QLF, fissure sealants, quality assessment, diagnostics

A new method of extraoral x-ray radiographs for the digital subtraction radiographyDigital subtraction radiography (DSR) is a potential tool for implant research in the early healing process after dental implantation or bone graft.The purpose of this investigation was to evaluate a novel fixation system for dental films in order to make reproducible radiographs possible, because a reproducible projection geometry is a prerequisite for the DSR.A conventional extraoral fixation system for occlusal registrations was modified for individual dental film positionings. In order to quantify the occurring central beam deviations n=400 serial radiographs were taken by 11 instructed dentists.By means of an implemented test piece, the projection deviations could be calculated in the vertical, horizontal and total angulation. The clinical applicability was checked with n=10 patients. n=15 digital subtraction radiographs was performed.The analysis of the projection mistakes showed middle deviations in the upper jaw between 1,12° - 1,22°, in the lower jaw between 1,22° - 1,30°. The 95% confidence interval showed angular deviations in the upper and lower jaw less than 2,2° - 2,7°. On a significance level p >= 0,05, no statistically significant differences found in the examined categories. In the patient group, all x-rays were suitable for a digital subtraction.The accuracy in projection geometry achievable with the new system is sufficient for the DSR. Special advantages are the low apparative expenditure and the possibility of the employment in endentulous patients. Keywords: Implantologie, Knochenabbau, digitale Subtraktionsradiographie, zahnloser Kiefer

Aim of this study was to test recently recommended cut-off limits for the laser fluorescence based device DIAGNOdent (KaVo) for occlusal caries detection. 248 permanent molars of 94 patients (mean age 19.2 yrs) of a general dental practice were included. After professional tooth cleaning the teeth were examined visually and by the DIAGNOdent device. The extent of occlusal lesions (gold standard) was determined after minimal operative intervention. Upon fissure opening 24 teeth had an enamel caries and 224 teeth revealed dentin caries of which 58 and 166 were up to half or beyond half the dentin, respectively. The optimal cut-off limits based on the highest κ-values (0.51 and 0.54) were > 18 for superficial dentinal caries (D3) and > 37 for deep dentinal caries (D4), respectively. The comparison with DIAGNOdent cut-offs given by the manufacturer (n = 4) and those based on clinical trials with in vivo validation (n = 4) and in vitro studies with histological validation (n = 3) revealed considerable variation of the performance. Recommended cut-offs between 17 to 21 for superficial dentin lesions were in the same order of magnitude (0.48 ¡V 0.51). On the D4 level only the manufacturers cut-off of > 34 achieved the best performance (0.51). According to the κ-values and the area under the ROC curves (D3: Az = 0.903; D4: Az = 0.830) the agreement between validated caries extent and laser fluorescence value is still unsatisfactory.Regarding the limited data base cut-off values for the clinical use of DIAGNOdent should be interpreted cautiously until more in vivo studies are available. Keywords: caries, diagnostics, DIAGNOdent, laserfluorescence

The aim of this study was to evaluate the caries prevalence in 8-, 12- and 15-year-old Westphalian children from 1990 to 2001 and to analyse caries experience in children attending schools with different educational level. Caries was diagnosed according to WHO criteria (1987), the DMFT was calculated (SAS database) and comparisons were made (Tukeys student range test; á = 0,05). In 8-year-olds the mean DMFT remained unchanged over the ten-year period with 0.3 DMFT. The proportion of caries free children increased from 80.7% in 1990 to 86% in 2001. In 12-year-olds caries declined from 2.1 DMFT in 1990 to 0.9 DMFT in 2001. The proportion of caries free children increased from 35% in 1990 to 86.6% in 2001. A DMFT of 4.3 was revealed in 15-year-olds in 1990, and 1.6 DMFT in 2001. The proportion of caries free children in 1990 and 2001 increased from 19.8% to 48%. Comparing different educational levels, the caries prevalence of 12-year-olds visiting grammar schools declined from 1.8 to 0.3 DMFT, and from 3.2 to 1.0 in 15-year-olds within ten years. Children visiting secondary modern schools showed a declining prevalence from 2.5 to 1.8 DMFT in 12-year-olds, and from 5.2 to 2.7 DMFT in 15-year-olds. In students of junior high-schools the DMFT decreased from 2.2 to 0.8 in 12-year-olds and from 4.3 to 1.3 DMFT in 15-year-olds.In summary, during the last ten years a substantial caries decline was observed in Westphalian schoolchildren, but this improvement in oral health differed significantly in dependence of the educational level. Keywords: caries, epidemiology

Objectives: To compare the cleaning efficacy and the long-term effect on gingivitis of a powered toothbrush with three-dimensional brush head action (Braun Oral-B 3D Plaque Remover D15) and a high-speed 'microtation' brush with an additional 'microbrush®-clip' (Rowenta Dentasonic MH921S). Material and methods: 80 healthy subjects took part in this controlled single blinded parallel study. Subjects were randomised by subject number. The two groups were bal-anced and stratified by gender, gingival index, smoking status and electric toothbrush use. A standard toothpaste was provided and no additional hygiene devices were al-lowed.Clinical assessments of all soft and hard tissues, attachment levels, probing pocket depths, gingivitis and plaque were performed at baseline and repeated 12 weeks later. Results: After 3 months compared to baseline, the median relative gingivitis reduction (upper;lower quartile) in the D15-group over all was 7.7% (-3.4;19.0) and in the Denta-sonic-group -1.2 (-16.2;9.1) the difference between the two groups being highly signifi-cant (p=0.005). The highest differences between both toothbrushes were found at both buccal and lingual surfaces with a gingivitis reduction of 16.6% (-3.7;19.7) for the D15 and -3.4 (-22.1;17.8) for the Dentasonic (p=0.0005). Conclusions: The D15 reduced the gingival index significantly, whereas there was no reduction detected in the Dentasonic group. Any signs of adverse reactions were neither reported nor detected. Keywords: gingivitis, hygiene, powered toothbrushes

In this case report we introduce a 39-year old HIV-infected (stage B3, CDC) male with distinct oral lesions. The patient was diagnosed HIV positive in 1985 and is currently under treatment with Abacavir, Lamivudin and Zidovudin. During this therapy, the HIV virus has been suppressed below detectibility, and a gain of CD4-cells to 250 cells/µl has been observed. According to the patient's medical history, first gingival overgrowth was noticed more than two years ago. It occurred in the region of the lower anterior teeth, including the canines and first cuspids. We found hypertrophic alterations with cleft surfaces on the facial and oral aspects of the gingival tissues. Solitary papules of 6 mm in diameter existed on the edentulous site of the missing first lower left molar, on the mucosa of the lower lip, and on the vestibular gingival papilla between the upper right canine and lateral incisor. Biopsies were taken, and the histological findings confirmed the clinical presumption of an oral papillomatosis. Also, HPV-6 was identified by PCR virus typing. With the patient's informed consent, the oral papillomatosis was treated with Imiquimod 5% cream, which is licensed for the treatment of genito-anal papillomata. It was applied twice a week for a duration of 4 weeks. Since no immediate success was detected, the decision was made to extend the treatment for another 4 weeks, 3 times weekly. After a total of 8 weeks into treatment, a complete remission had occurred. This result seems to be stable, since no recurrence was seen up to 24 months after therapy. Also, there were no side-effects during the total period of observation. It remains to be seen whether this treatment result is observed in other cases. Keywords: oral papillomatosis, HIV, Imiquimod

The aim of this split-mouth-study was to compare the pharmacokinetic profile of two different doxycycline-gels (DOXY and ATRI) for topical subgingival application. Pharmacokinetics of both doxycycline-gels were analyzed in GCF and saliva. In 10 patients suffering from severe periodontitis, 10 pairs of contralateral defects were randomly assigned either to the first application of DOXY or ATRI. 14 days after the topical application of the first antibiotic gel, the application of the second gel in the contralateral defect took place. Clinical examinations at baseline showed no significant differences between sites treated with DOXY and ATRI. Samples of sulcus fluid and saliva were drawn baseline, 2, 5 and 24 hours after application, 2, 3, 4, 7, 9 and 11 days after application. Separation and quantitative measurement of both doxycycline-gels was performed with HPLC and UV-detection at 260 nm. In saliva specimens, time-dependent changes of mean doxycycline concentration were almost identical for both doxycycline-gels and declined from a maximum 2 hours after application (ATRI: 6653.90 ± 3096.14 ng/ml; DOXY: 5386.60 ± 1542.02 ng/ml [arithm. mean ± SEM]) to zero values 9 days after application. In crevicular fluid specimens, sites treated with ATRI exhibited a faster decrease of mean doxycycline concentration (1085.30, 264.00, 273.94, and 258.00 µg/ml measured 2, 5, 24, and 48 hrs. after application) than sites treated with DOXY (1388.38, 1300.40, 803.73, and 235.10 µg/ml). Both doxycycline-gels showed pharmacokinetics of controlled release delivery systems. Keywords: controlled release delivery, doxycycline, pharmacokinetics, topical application

The purpose of this study was to test the viability of human pulp fibroblasts on certain dental materials after their direct application. the materials tested were: Dycal®, Calxyl®, a calcium hydroxide-suspension (0.001137g Calxyl®/ml medium), zinc oxide-eugenol, the glassionomer cement Ketac-Molar® Aplicap® and the dentin adhesive OptiBond SoloTM. At first we used all materials in a 96well assay and then we repeat the study in a 24well assay with the calcium hydroxide-containing materials only. To measure the viability, the viability test EZ4U was carried out in the two assays after 3, 6, 12, 24, 48 hours and 4, 8, 16 and 32 days. The result of both assays suggest, that the direct application of aqueous calcium hydroxide-suspensions will show the lowest decrease in viability of human pulp fibroblasts. Keywords: pulp, fibroblasts, cells, cultured, biocompatibility, dental materials

Aggressive fibromatosis [AF] with bone involvement in the head and neck is a rare neoplasm. The clinical and radiological findings are non-specific, the histological diagnosis is often difficult and an inadequate excision will result in recurrence. A four year-old boy was referred to our department with a fast growing painless mass of the mandible. Excision biopsy revealed AF. Local excision of the tumor was performed but six months after surgery a rapid recurrence was detected. The tumor was unresectable and the boy was treated with a low-dose chemotherapy including methotrexate and vinblastine for one year. Completion of surgical excision is planed afterwards. Although AF are only locally aggressive, their treatment is complex. To avoid disharmonious facial growth alternative modes of therapy should be considered in extended AF. Keywords: aggressive Fibromatose, Unterkiefer, Weichteilsarkom, Rezidiv, radikale Tumoroperation

Aim: The monocyte lipopolysaccharide receptor (LPS) CD14 plays an important role in the in-flammatory response by mediating activation of macrophages, which results in the release of sev-eral inflammatory cytokines, including TNF-a and interleukin 1 and 6. Recently a polymorphism of the CD14 gene, C(-260)→T, was detected to induce a hyperinflammatory response. The aim of this study was to investigate, whether this polymorphism is associated with periodontitis in a South-German population. Methods: 151 consecutive patients with acute ischemic stroke (T) and 149 representative population controls (C) from a case control study were screened for the pres-ence of the C(-260)→T polymorphism by restriction length analysis. Subjects were clinically and radiographically examined for the presence of periodontitis. A questionnaire was used by trained interviewers in a face-to-face interview to investigate all known and/or suspected risk factors for stroke and periodontitis. Periodontitis was defined according to Beck (1996) Results: The TT-genotype was not associated with periodontitis neither in univariate nor in multivariate analysis together with other risk factors for periodontitis. However, in a subset of male subjects under the age of 60, the TT-genotype was statistically significant associated with periodontitis (OR 4.90; 95%-CI 1.06-22.53; p=0.041) in a multivariate analysis together with 'age', 'number of teeth', 'diabetes mellitus', 'smoking' and 'socio-economic status' (all n.s.) Conclusion: The C(-260)→T polymorphysm in the promotor of the CD14 gene seems to be associated with perio-dontitis in males under the age of 60 in a South-German population. However, the results of this study have to be confirmed by a population based cohort study. Keywords: periodontitis, ischemic stroke, cerebrovascular disease

Aim of this study was to compare the efficacy in plaque and gingivitis reduction of an experimental toothbrush (GABA International AG, T) with a standard toothbrush (ADA reference toothbrush, C) in a splitmouth (I) and a 3 months parallel study design (II). Materials and methods: 86 male subjects took part in the study. After 48h of plaque regrowth the teeth of 2 quadrants were brushed for one minute by random with one and the remaining 2 quadrants with the other toothbrush. Immediately before and after tooth brushing (I) as well as after 3 months (II) plaque (Turesky), gingivitis (Löe & Sillness) and the number of gingival lesions = 5mm and > 5mm were evaluated by one blinded exam-iner (E.B.). After that, the individuals were appointed either to the test or the control group by ran-dom (n=43 each). All participants had to follow a standardized oral hygiene regimen for the following 3 months. Results: (I) In total, plaque was reduced from 1.95 ± 0.48 to 1.02 ± 0.41 (p Keywords: manual toothbrush