International Poster Journal of Dentistry and Oral Medicine, 04/2016

Correlation between labial marginal bone thickness and soft tissue thickness in the anterior maxilla - A Novel CBCT assisted analysis. Keywords: marginal bone thickness, soft tissue thickness, CBCT

Aim: In the European Union, a disease is deemed to be "rare" if fewer than 2000 people are suffering from it. Worldwide 7.000-8.000 rare diseases are know and about four million people are affected in Germany. 15% of the rare diseases can become manifest in the orofacial region. It takes approximately seven years to receive the right diagnosis. Providing and linking different treatment cases on a freely accessible "register for orofacial manifestations in people with rare diseases" can improve patient care and can lead to earlier diagnosis. Material and Methods: Starting in 2011 material from various databases (Orphanet, e-medicine, Gene Clinics, EMA, OMIM) as well as Medline, medical literature and "grayliterature" was collected and evaluated. Since then the gathered information has been incorporated into the web-based, freely accessible register. All rare diseases with orofacial manifestations are registered with current subject-specific literature and categorized properly. Result: So far 405 rare diseases have been identified with orofacial manifestations and 138 out of those diseases or syndromes show dysgnathia. Each of these diseases has been illustrated with a description, a list of orofacial manifestations and related publications. An assignment into categories also enables a search on the basis of clinical symptoms in the register. Conclusion: Rare diseases and their symptoms come with difficult challenges regarding their therapy especially in orthodontics. By setting up a "register for orofacial manifestations in people with rare diseases-ROMSE" a platform is provided for dentists and orthodontists to work interdisciplinary on treatment strategies. Keywords: rare diseases, orofacial manifestations, interdisciplinary dentistry

Aims: Around 30 million people in Europe are affected by a rare disease. Approximately 80% of all known rare diseases are of genetic origin, and around 15% can become manifest in the orofacial region. This may include anomalies of tooth structure, soft tissue, and craniofacial dysplasia such as cleft lip and palate as well as dysgnathia. In medicine and dentistry, there is often little knowledge of clinical manifestations, diagnosis, and treatment of a rare disease. This leads to patients receiving incorrect diagnoses and difficulties in patient-centred care in general. The aim of this working group is to establish a "register for orofacial manifestations in people with rare diseases" in order to allow physicians and dentists as well as patients and their families to inform themselves more about rare diseases with orofacial manifestations. Subject: Starting in 2011, databases (Orphanet, OMIM) as well as PubMed, medical literature and "gray literature" were collected and evaluated. Since 2013 the gathered information has been incorporated into the web-based, freely accessible register at http://romse.org. All rare diseases with orofacial manifestations are registered with current subject-specific literature and categorised properly. Result: So far 471 rare diseases with orofacial manifestations have been listed in the ROMSE register. All rare diseases with orofacial manifestations are properly categorised. The register is also connected to other databases and information platforms for rare diseases such as Orphanet, Research for Rare, se-atlas, and ZIPSE. Additionally, we are collaborating with seven university clinics that serve as a first medical / dental point of contact for those who are affected. Conclusion: Rare diseases and their symptoms come with difficult challenges regarding their therapy. By setting up a "register for orofacial manifestations in people with rare diseases-ROMSE", a platform is provided for dentists and physicians to work in an interdisciplinary manner on treatment strategies. In future, this register should also serve as a source of information for patients and their families. Keywords: rare diseases, interdisciplinary dentistry, register, orofacial manifestations

Introduction: Gorlin-Goltz or nevoid basal cell carcinoma syndrome was already described in the 19th century. The cause for this autosomal dominant inherited disorder is a mutation in the PTCH1 gene (9q22.3) for the patched receptor, a negative regulator of the effects of sonic hedgehog. Gorlin Goltz is characterized by development of basal cell carcinoma in the third decade of life and keratocystic odontogenic tumors in the second and third decade of life. For specialists in the field of dentistry, especially cystic lesions may give a hint to Gorlin Goltz. Histopathologically, keratocystic odontogenic tumors consist of multiple or solitary cavities surrounded by fibrous capsule and lined with keratinized epithelium. Within the fi-brous stroma, typically, single daughter cysts are identified which are infiltrating the sur-rounding bone and causing the high recurrence rate. Case report: A 17-year-old male patient was referred to our Clinic for Oral and Maxillofacial Surgery of the Münster University Hospital by a Dentist with suspected odontogenic cyst on the right side of the upper jaw. About five years earlier, the patient underwent multiple keratocystic odontogenic tumor removal and Gorlin-Goltz syndrome was suspected, however there was no further evaluation. Panoramic tomography image showed well-defined cyst-like translu-cency with sclerotic rim. Teeth numbers 13 - 16 depicted clear signs of tooth displacement. In addition, radiography of the paranasal sinus was done which showed calcification of the falx cerebri. Under general anesthesia, cystectomy with curettage of the bone cavity and peripheral ostectomy was performed. The histopathologic report confirmed the suspicion of keratocystic odontogenic tumor. Summary: With a prevalence of 1-9/100,000, Gorlin-Goltz syndromes rank among the Rare Diseases as defined by the European Union. According to Evans clinical diagnosis is based on the presence of two major or one major and two minor criteria. Since keratocystic odontogenic tumors as typical manifestation of Gorlin-Goltz syndrome are revealed in the specialty of the dental clinician, he/she may be the first to raise the suspicion of the syndrome in as yet undiagnosed cases. Keratocystic odontogenic tumors have high recurrence rates because of infiltrative growing daughter cysts, thorough follow-up is required in case of positive histopathological findings. Keywords: rare diseases, Gorlin syndrome, keratocystic odontogenic tumor

Objectives: The objective of this study was to investigate the efficacy of Philips Sonicare AirFloss Ultra on interdental gingivitis in patients with generally good oral hygiene but deficiencies in the interdental region using the PBI (primary end point) and mAPI. AirFloss Ultra was compared to dental floss during an examination period of four weeks. Methods: 32 adult patients with moderate plaque-induced gingivitis were included in this study and randomized to either the test group (AirFloss Ultra, AF) or the control group (dental floss, DF). All patients were examined on the baseline day and the values were documented. After four weeks of daily use of the interdental cleaning aids, the patients were re-examined and the results were documented. Subsequently a questionnaire to investigate the adherence to the interdental cleaning aids was filled out by the patients. Results: In all patients who could be re-examined (29), an improvement of the gingivitis could be observed after four weeks of daily use of dental floss and AirFloss Ultra. The test-group (AF) performed equally in comparison to the control group (DF). The evaluation of the questionnaire proved that AirFloss Ultra was highly accepted. Significance: The study proves that AirFloss Ultra is of equal value to dental floss in the management of interdental plaque and therefore is eligible for the prevention of gingivitis. In addition, the acceptance resulting from the easy handling is very high and therefore also recommended for manually impaired patients. Keywords: gingivitis, plaque, AirFloss, high-velocity microdroplet device, microburst, power interdental cleaning device, approximal, interdental, adherence

Introduction: As a malignant soft tissue tumour, rhabdomyosarcoma (RMS) develops from the cells of striated muscle. Among under 15-year-olds, the annual incidence is estimated at 1 in 224,000. The median diagnosis age is 5 years. Rhabdomyosarcoma can occur anywhere in the body, even in places where no striated muscle is present. The head and neck regions are affected in 40% of cases, most frequently the orbits and the paranasal sinuses. The currently applicable histological subclassification differentiates RMS between embryonic (variants: botryoid, spindle) and alveolar (variants: solid-alveolar and alveolar) varieties; the cause and origin are still largely unknown. The order and conduct of the individual types of therapy depend on the tumour and the patient's individual risk factors. Case report: In a now 15-year-old patient, rhabdomyosarcoma was diagnosed at the age of 3 years in the right pterygopalatine fossa with tendency to intracranial propagation, successfully treated by excision followed by radiotherapy (total dose: 45 Gy) and chemotherapy. As a result, there was complete anesthesia in the area supplied by the trigeminal nerve and the vision loss in the right eye. The skull growth of the irradiated side has been lower than on the unaffected side. In terms of positional relationship of both jaws, an Angle Class III could be ascertained. The patient also complained of the intraoral situation that had existing for years, because all the teeth had a mobility grade II-III, resulting in severe ingestion. In addition, pain occurred in the area of the temporomandibular joints and the muscles of mastication. In the panoramic radiograph, multiple agenesis of Dentes permanentes and rudimentary developed apices. The Capites of the mandible and processi coronoidei appeared degenerated and flattened. As part of the orthodontic consultation, a lateral cephalogram was made. As a potential therapeutic approach, the extraction of all teeth was introduced followed by implant insertion to allow the functional rehabilitation of the masticatory system. A prerequisite for implant-assisted therapy is a bimaxillary osteotomy, which the patient does not want to decide about at this time. Summary: Since rhabdomyosarcoma are localized in sensitive areas of the body, the treatment is demanding and multidisciplinary. The goal of treatment is to cure the young patients, while accepting possible minor side effects. The intention of this case report is to describe the problems after a combination therapy (surgical intervention, radiotherapy, and chemotherapy) in facial and oral structures at a now 15-year-old patient suffering from an embryonal rhabdomyosarcoma in the head and neck area. Keywords: rhabdomyosarcoma, radiation, long-term effects, oral health

Introduction: It is the task of palliative care to care for patients who are terminally ill. At this stage, no excessive interventions should be carried out and the quality of life is paramount. As palliative care is based on an interdisciplinary approach, it should also include oral health care. Case Report: A 71-year-old patient presented with a lack of function of his maxillary full denture. All treatment measures by the family dentist with dental modifications and the use of adhesion aids could not improve the operability. Upon clinical examination, physiological salivation was measured and a flattened vestibule throughout the maxilla could be diagnosed. The patient complained of an extremely stressful life, which had deteriorated due to the intraoral situation and asked for implant-mediated rehabilitation to improve the oral quality of life. After asking about his medical history, the patient reported that the following diagnoses had been made: a multifocal hepatocellular carcinoma in cirrhotic-modified liver, arterial hypertension, an absolute arrhythmia in atrial fibrillation, heart failure NYHA II, and hemifacial spasm on the left side. The hemifacial spasm was initially treated with botulinum toxin injections, and ultimately with micro-euro surgical decompression by Jannetta in 2011. For the treatment of histologically confirmed multifocal hepatocellular carcinoma, intra-arterial chemoembolization of several HCC foci was carried out with doxorubicin in 2014. Because of the cardiac symptoms, warfarin was also given. The last abdomen MRI, natively and with contrast agent, showed no progress in size of the liver foci. In several hours of talks with the patient - at his request without the presence of family - all conventional and surgical intraoral treatment options were discussed in detail. In the foreground of all considerations, expected lifetime played an important role. Based on a preoperative dental digital volume tomographic investigation, adequately sized bone site for insertion of implants was identified in the anterior maxilla. In October 2015, 4 implants were placed without complications in regio 24, 22, 12, and 14, and in December 2015 the existing complete maxillary denture was fixed by locators to ensure function. Discussion: The present case shows the extraordinary stress of patients and therapists. Complex therapeutic strategies should be avoided following the standards of palliative care, but the plan is highly individual and totally dependent on the physical and cognitive limitations and the desires of the patient and possibly his family. After the four basic principles of action autonomy (respect and esteem of the patient), justice (equality), beneficence (weighing of potential benefit to potential harm) and non-maleficence (fundamental obligation to avoid the damage), the required oral surgical treatment was performed. Keywords: palliative care, ethical considerations, dental implants, oral health care

Objectives: To assess the impact of dental caries on oral health-related quality of life among 3 to 5-year-old preschool children in Rohtak City, Haryana. Materials and Methods: A cross-sectional study was carried out among 3 to 5-year-old preschool children in Rohtak City. A total of 12 schools were selected through a simple random sampling method from 4 clusters within Rohtak City. Through a systematic random sampling procedure, every odd numbered child was selected, and the total sample size comprised 469 children, of which 271 (57.56%) were boys and 198 (42.21%) were girls. The Early Childhood Oral Health Impact Scale (ECOHIS) developed by Pahel BT et al. in 2007 was used to assess the oral health-related quality of life (Hindi version). The parents answered the questionnaire, and informed consent was obtained to do the examination. Dental caries was measured by the Caries Assessment Spectrum and Treatment index. The data were analysed using SPSS 21 and descriptive statistics and Kendal's correlation were used, with p value fixed at 0.05. Result: Mean def was found to be 1.085 ± 2.27. Prevalence of caries was found to be 30.3% among males and 34.3% among females. Internal consistency using Cronbach's alpha was 0.873. Mean ECOHIS scores was 1.786 ± 4.01. It was significantly higher in subjects with dental caries (3.046 ± 5.47 vs 1.19 ± 2.01). Mann Whitney U was significant(p0.01). Conclusion: Dental caries significantly affect the oral health-related quality of life among 3 to 5-year-olds in Rohtak City. Keywords: Dental caries, preschool children, oral health-related quality of life

Objective: The purpose of this prospective, randomised, double-blind clinical trial was to compare the anesthetic efficacy of 2% articaine and 4% articaine in inferior alveolar nerve block anesthesia for extraction of mandibular teeth. Study Design: In 95 patients, 105 lower molar and premolar teeth were extracted after intraoral inferior alveolar nerve block. In 53 cases, 2% articaine (group I) and in 52 cases, 4% articaine (group II) was administered. The primary objective was to analyse the differences in anesthetic effects between the two groups (complete/sufficient vs. insufficient/none). Furthermore, differences in pulpal anesthesia (onset and depth, examined with pulp vitality tester (min) as well as length of soft tissue anesthesia (min) were evaluated. Additionally, the need for a second injection, pain while injecting (numeric rating scale (NRS)), pain during treatment (NRS), pain after treatment (NRS), and other possible complications (excessive pain, bleeding events, prolonged deafness) were analysed. Results: Anesthesia was sufficient for dental extractions in both groups without significant differences (p=0.201). The onset of anesthesia did not differ significantly (p=0.297). A significantly shorter duration of soft tissue anesthesia was seen in group I (2.9h vs. 4h; p0.001). There was no significant difference in the need for a second injection (p=0.359), injection pain (p=0.386), and pain during (p=0.287) or after treatment (p=0.412). In both groups, no complications were seen. Conclusion: The local anesthetic effect of the 4% articaine solution is not significantly better when compared to 2% articaine. For mandibular tooth extraction, articaine 2% may be used as an alternative as well. Keywords: Dental local anesthesia, tooth extraction, articaine, nerve bloc

Objectives: The purpose of the present study was to evaluate microtensile bond strength of a microhybrid resin composite restorative materials which is used with an etch-and-rinse adhesive on enamel and dentin after treatment with Er,Cr:YSGG laser with different output power and pulse frequency combinations. Methods: Enamel (E) and dentin (D) samples were prepared from bovine incisors. Following immersion of teeth in the acrylic blocks and flattening surfaces, samples were divided into 8 subgroups as follows (n=5): E-Control (no treatments), E-Bur (mechanical roughening was performed using high-speed diamond bur), E-Laser 6W-20Hz, E-Laser 6W-35Hz, E-Laser 6W-50Hz, E-Laser 3W-20Hz, E-Laser 3W-35Hz, E-Laser 3W-50Hz; D-Control (no treatments), D-Bur (mechanical roughening was performed using high-speed diamond bur), D-Laser 3W-20Hz, D-Laser 3W-35Hz, D-Laser 6W-50Hz, D-Laser 1.5W-20Hz, D-Laser 1.5W-35Hz, D-laser 1.5W-50Hz. Following acid-etching all surfaces, composite build-ups were done. Samples were cut into resin-enamel/dentin sticks with dimensions of 0.8 mm². Four sticks were randomly selected from each tooth (n=20) to be tested in microtensile bond strength tests. Results: E-Laser 3W-50Hz (36.22±6.0 MPa) showed significantly highest bond strength with the exception of E-Control (32.85±9.8 MPa). For dentin, E-Control (27.70 ± 7.0) and E-Bur (24.98 ± 8.8) showed significantly different bond strength from other groups. Conclusions: Laser irradiation could enhance or impair the microtensile bond strength depending on the tooth structure and laser parameters used. Keywords: Er, Cr:YSGG laser, dentin, enamel, bond strength, laser parameters