International Poster Journal of Dentistry and Oral Medicine, 02/2017

Violence against women (VAW) both inside & outside their home has been a crucial issue in contemporary Indian society. It results in gruesome dentofacial deformities which have an adverse effect on individuals' self-esteem and self-confidence and evoke an undesirable social response. The area of body which maximally determines physical attractiveness is the face; it is also the primary means of identification, expression, & non-verbal communication. Thus, as a dental surgeon it is our priority to relieve the patient's psyche trauma by increasing their mental strength and to make the patient socially acceptable. Long standing burn contractures involving the face and neck often result in restricted mouth opening and narrowed nasal passages, resulting in narrowed airways and poor oral hygiene. Such patients often show malalignment of the teeth with restricted movement of oral structures, resulting in the patient being malnourished, anemic, and hypoproteinemic. Efforts for reconstruction should be directed not only at restoring satisfactory aesthetics, but also the functional needs of the patient. Best results may be obtained by a team approach to the problem. Hence, an attempt has been made here to present the management of these complex patients using a surgical approach. Keywords: burn contracture, skeletal class three, dentofacial deformity, orthognathic surgery, plastic surgery, scar, orthodontic treatment

Aims & Objectives: Midline diastemas in adults are considered unaesthetic, and a variety of options are available for their closure. The treatment modality depends on both the etiology and extent of the diastema. On occasion, orthodontic intervention may become mandatory to provide optimum treatment for the patient in terms of aesthetics, function, and preservation of biological tissue. This is often the case when a midline diastema coexists with 1. Microdontia of lateral incisors. 2. Adequate overjet for retraction of teeth. 3. Anterior deepbite. This paper presents an aesthetic, simple, and rapid method of midline diastema closure by a kind of palatal spring, one which may easily be fabricated by a dental surgeon. Results: The midline diastema closed completely in 4 weeks in a single activation. There was very mild tipping and no rotation of the teeth. Conclusion: Most patients with spacing in the upper anteriors who desire aesthetic treatment are not agreeable to conventional orthodontic appliances. This palatal spring provides a very simple, aesthetic, and an inexpensive method to close or rearrange anterior spaces so as to provide optimum aesthetics and a functionally stable restoration. Keywords: midline diastema, orthodontics, aesthetics, springs

Introduction: Several developmental and regressive changes of teeth shown with advancing age are found to be valuable in age determination. With advancing age there is a reduction in the size of the pulp due to secondary dentin deposition, and measurement of this reduction can be used as a parameter to assess the age of an individual. Kvaal et al. used radiological determination of reduction in pulp cavity size, and this was entered in a regression formula for estimating age. Secondary dentin deposition, however, may be influenced both by environmental conditions and genetic background. Thus, a population-specific formula can improve age estimation; this method requires further validation in non- European populations. Kvaal's method of using IOPA as a diagnostic tool has disadvantages like projection geometry causing distortion and magnification of images. Hence, the present study aims to correlate the age of the tooth by morphological evaluation by using Kvaal's parameters in extracted single rooted teeth under a stereomicroscope. Material and Method: Single rooted extracted tooth were measured for parameters such as tooth length, pulp length and root length as well as the width of root and pulp at 3 levels; level A: At cement-enamel junction (CEJ), level B: at one quarter of the root length from CEJ, level C: mid root level. Stepwise regression analysis was done. Results & Discussion: The present study showed the significance of pulp length, root width, and pulp width in age estimation. We derived a combined and gender-specific regression formula for age estimation. In this study males showed better age prediction, as there is a difference in dentin deposition between the sexes. The pattern of secondary dentin deposition varies among different groups of teeth; hence, tooth specific formulae should be derived. Conclusion: This study suggests that age estimation can be done by using a stereomicroscope to consider pulp length, and root and pulp width parameters. However, further studies with larger sample sizes and an equal distribution of age and gender should be considered in order to validate the accuracy of the present results. Keywords: forensic, Kvaal's method, teeth

Objective: To compare the push-out bond strength of ceramic inlay materials bonded to dentin using two different types of contemporary luting cements. Methods: Standardised occlusal cavities (5 mm in occlusal diameter, 3.5 mm in cervical diameter and 3.5 mm deep) were prepared using a truncated cone-shaped diamond rotary cutting instrument. The prepared cavities were restored in 2 groups with IPS e.max CAD (IPS) (G.1) and zirconia-based (Zr) (G.2) ceramic inlays (n=20 each). Inlays of each group were cemented in 2 subgroups (n=10) using either self-adhesive (SG:A) or conventional etch-and-bond (SG:B) resin cement. Half the specimens in each subgroup (n=5) were subjected to thermocycling, and the crowns of all teeth were then trimmed to a standardised thickness nearly of 3.5mm. The push-out bond strength was tested on a universal testing machine. Assessing the bond failure was also considered. Results: The 1-way ANOVA showed insignificant differences between the push-out bond strength values of all tested subgroups (p= 0.7161). The statistical analysis of the recorded frequencies of different modes of bond failure showed no differences between the tested subgroups (chiᴧ2, p = 8.4283). Conclusion: Neither the type of ceramic nor resin cement has an effect on the bonding values to dentin. Thermocycling of bonded inlays has no adverse effect on their bonding values, although the mode of failure could be affected. Keywords: ceramic, inlays, push-out, bond strength, adhesive resin cement

Background: The purpose of this study was to analyse the elements (Ti, Ni, Si, Al, Mn, Fe, Cr) in orthodontic wires during orthodontic therapy in a clinical cohort. Saliva simultaneous liquids are not accurately comparable with human saliva, so there is a need for this study. (ELIADES, et al. 2002) In addition, the connection between the intraoral period, other intraoral appliances, and the oral hygiene was observed, because these parameters have a secondary influence on the corrosion of wires. (ELIADES, et al. 2005). Purpose: The aim of the following study was to quantify ion leaching from orthodontic wires in relation to time, oral hygiene, and other co-factors. Material/Methods: Data from 50 stainless steel- (SS) and 50 nickel-titanium-wires (NiTi) (Forestadent Bernhardt Förster GmbH) from 100 patients during a normal orthodontic treatment in the Department of Orthodontic at the University of Greifswald were collected and prospectively analysed. Additionally, the type and number of fillings and the plaque index (PI) were registered. With an energy-dispersive X-ray spectroscopy (EDS), the distribution of nickel, chromium, and titanium was compared before and after a special period of intraoral time. The surface of all wires was observed subjectively. Statistically, a t-test and u-test were used (p ≤ 0.05). The influences of a different intraoral time and oral hygiene were analysed using linear regression analysis. Results: On average, all wires were 61.9 days in the oral cavity. The mean age of the patients was 14.6 years, and they had in average of 1.26 fillings. 70% of the kids didn't have any fillings during this study. Every patient had on average 3.2 orthodontic bands on the molars, and 48% were treated with a self-ligating braces system. We had 22 TPA's and 5 LLA's. The EDS analysis showed no significant difference in the distribution of the collected elements irrespective of the plaque index and the intraoral time of these wires. Even with other orthodontic appliances and the number of fillings, there was no significant difference in the number of elements before and after a period of time in a patient's mouth. In addition self-ligating as well as conventional braces showed no differences in the distribution of nickel, chromium, titanium, and other elements. Conclusion: A higher plaque index caused by moderate oral hygiene during an orthodontic treatment and a longer intraoral treatment time of wires do not significantly increase the risk of corrosion of nickel, chromium, titanium, and other elements in orthodontic alloys. The differences between the original and used wires were within a single-digit percent range and showed no significance (p ≤ 0.05). In addition, the type of braces, other intraoral appliances, and the number of fillings did not significantly influence the stainless steel- and nickel-titanium-wires. Nevertheless, visual differences on the surface of all probes could be detected. Keywords: Biomaterials, Ion release, Corrosion, Nickel

The planning of interventions in orthognathic surgery is increasingly no longer carried out on gypsum models in the articulator, but using three-dimensional digital media. In these processes high-resolution 3D images of the teeth from direct intraoral scanning or the digitisation of gypsum models are combined with information on the cranialfacial morphology in order to plan and monitor movements through the osteotomies. The change in the position of the jaws is the basis for the production of splints using rapid prototyping (RP) technologies. In the first described methodology (bimaxillary procedure), the target occlusion is determined by means of virtual models. Now, in a superimposition of the virtual models with the data of a Cone Beam CT, the necessary displacement of the bony structures of the upper and lower jaw can be calculated (iPlan, BrainLab AG, Feldkirchen). This simulation serves as the basis for intraoperative navigation, which optimally positions the maxillo-mandibular block defined by the target splint without an intermediate splint to the skull. The second workflow uses the same basic principles, but also includes motion information on the lower jaw. This is beneficial for patients without a safe centric relation. In this case, a joint-related initial situation is determined by means of the SICAT function (Sirona GmbH, Salzburg), and this is used for a splint produced by means of RP technology (joint fixing is done by means of positioning plate). The target point (unimaxillary interventions) is created in OnyxCeph 3D Lab (ImageInstruments GmbH, Chemnitz) with an occlusogram of the target position and printed three-dimensionally. The advantages and disadvantages as well as limitations of these digital process chains are presented and discussed with the aid of patient examples. This also takes into account technical aspects in the interaction of different software tools and formats. Keywords: orthognathic surgery, rapid prototyping, 3D planning

The intra-operative use of 3D-C-arm devices in the CMF operation theatre is becoming more and more popular. The advantages are particularly described for mid-facial and orbital reconstruction in which intra-operative scanning with 3D-C-arm devices can replace postoperative CBCT or MSCT. The aim of this study was the comparison of different types of 3D-X-ray machines concerning the applied equivalent dosage to the skull. We compared five devices: 64 slice MSCT; Siemens Somatom 3D-C-arm; Ziehm Vario-FD-3D 3D-C-arm; Siemens Iso-C-3D 3D-C-arm; Siemens Arcardis-Orbic-3D CBCT; Sirona Gallileos To determine the equivalent dosage of the devices in different locations, a phantom was loaded with ten dosimeters at the following anatomical regions: eye-lenses, optic-nerves, parotid-glands, submandibular-glands, hypophysis, sublingual-region. For simulation of clinical conditions, the depicted volume of all scans included the mid-face from the maxillary alveolar crest up to the upper frontal sinus. Comparison of MSCT vs. CBCT showed 4-times higher equivalent dosage for the MSCT. Comparison between C-arms of older generation (Vario-FD-3D, Iso-C-3D) and the MSCT showed 3- to 4-times higher equivalent dosage for the MSCT. The measured equivalent dosage of these two C-arm devices were almost similar to the CBCT. The C-arm Arcardis-Orbic showed a 10-times lower equivalent dosage in comparison to the CBCT and up to a 40-times lower equivalent dosage in comparison to the MSCT. The results show that use of intra-operative 3D-C-arm devices can significantly reduce applied radiation dosage compared to a post-operative MSCT. Using a C-arm device of a newer generation could even reduce the applied dosage significantly compared to dental CBCT-scans. Keywords: intraoperative imaging, MSCT, dental-CBCT, 3D-C-arm, computer-assisted surgery, radiation dose

Aim of the study: In several studies periodontal disease has been revealed as an independent risk factor for coronary heart disease (CHD). The present study (ClinicalTrials.gov Identifier: NCT01045070) wanted to answer the question of whether periodontal marker bacteria are associated with the incidence of new cardiovascular events among patients with CHD. Material and Methods: 1002 in-patients with angiographically proven CHD (67.0 ± 10.9 years, 74% men) were included in the study. Four subgingival plaque samples per patient were pooled and analysed by PCR-SSO in a commercial laboratory (Hain Lifescience, Nehren) for the presence of DNA from A. actinomycetemcomitans, P. gingivalis, P. intermedia, T. forsythia, T. denticola, P. intermedia, P. micros, F. nucleatum, C. rectus, E. nodatum, E. corrodens, C. sputigena, C. gingivalis, and C. ochracea. A bacterium was then considered to be present if the number of genome equivalents was at the detection limit. After three years of follow-up, the incidence of the combined endpoint (CEP: myocardial infarction, stroke / TIA, cardiovascular death, death after stroke) was determined. The survival analyses were performed using Kaplan-Meier curves and log-rank tests (univariate) and with Cox regression (multivariate). Results: Follow-up data were received from 953 patients (drop out 4.9%). The incidence of CHD patients with CEP was 16.4%. Patients with CEP were rarely E. corrodens positive compared to patients without endpoint events (57.1% vs. 73, 3%, Log Rank test, p 0.0001). This result remained significant after adjustment for the cofactors age, gender, smoking, hypertension, dyslipidemia, diabetes, a history of CHD, positive CHD family history, severe periodontitis, bleeding index, and missing teeth (adjusted hazard ratio = 0.538, 95% CI 0,386- 0.749, p 0.0001). All other investigated bacteria as well as the number of detected bacterial species per patient were not associated with the cardiovascular outcome. Conclusion: The detection of E. corrodens was associated with a decreased risk for the occurrence of new cardiovascular events among patients with CHD. Keywords: coronary heart disease, periodontal bacteria, cardiovascular outcome

Aim: A number of systemic disorders increase patient susceptibility to periodontal disease by altering the immune, endocrine, and connective tissue status. This case report describes the periodontal manifestation, treatment and long term maintenance of a patient diagnosed with Ehler Danlos Syndrome (EDS) type VIII. EDS VIII is a rare autosomal dominant connective tissue dysplasia characterised by fragile skin, abnormal scarring, joint hypermobility, and early onset of periodontal disease. In addition, loss of the permanent teeth may also be detected. Case Report: A 28-year-old Caucasian female was first introduced in 1999, intra oral examination revealed localized areas of moderate to high attachment and alveolar bone loss (mandibular incisors) associated with mobility grade II; probing depths ranged between 2 and 3.5 mm. The gingival tissues exhibited generalised gingivitis with spontaneous bleeding and massive gingival recession. The treatment consisted of oral health measures followed by regular supra gingival scaling every three months which continued over the following years. Result: Over the subsequent years and the extraction of the hopeless lower incisors, no further tooth loss was recorded in the remaining teeth. Conclusion: Early diagnosis, efficient periodontal therapy, and long-term maintenance applied to patients suffering from EDS VIII are the key elements of preventing further tissue destruction and tooth loss. Keywords: Ehlers Danlos Syndrome, Periodontitis

Titanium and titanium alloys have long been the gold standard for dental implant therapy. This is owing to their excellent mechanical and physical properties and their incomparably well-documented clinical success. However, like all biomaterials, titanium and titanium alloys do have some drawbacks that can compromise the clinical success of implants. In this day and age, when speaking of clinical success, reproducibility of form and function is not all that is required, but also the reproducibility of aesthetics. That is why with the limitations of titanium in the aesthetics department, zirconia certainly makes a timely entrance into implant dentistry. Zirconium dioxide dental implants not only make an aesthetically pleasing alternative, studies have also shed light on their exceptionally superior mechanical properties, even being comparable to those of Titanium. Materials and methods: Forty patients requiring single tooth replacement in the posterior mandible and maxilla were randomly assigned to treatment with zirconium-dioxide (test) or titanium (control) dental implants. Forty-four implants (22 zirconium dioxide ∅ 4.0 length 8mm and 22 titanium with SLA surface ∅ 4.1 length 8mm) were analysed in this study. The implant stability quotient (ISQ) was measured immediately following implant insertion. Results: Forty patients participated in this study. The mean primary implant stability (PIS) values in test and control groups were 65.02 ± 2.85 and 62.62 ± 4.12, respectively. No statistically significant differences were detected, where p0.005, between the analysed groups. However, statistically significant differences were noted between the results of implants in the upper versus lower jaw. Conclusion: The results of this pilot study depict the independence of PIS on the type of implant material. To confirm such a statement, studies of larger sample sizes must be performed. Additionally, a periodic comparison of implant stability changes during the healing phase between zirconium and titanium dental implants should be the focus of upcoming research. Keywords: zirconium dental implants, titanium dental implants, primary implant stability