International Poster Journal of Dentistry and Oral Medicine, 04/2024

In the case of vascular malformations of the face and neck, such as venous malformations, a purely mucosa-supported prosthesis can often not be tolerated. Implant-supported restorations are therefore the only way to provide these patients with a functionally and aesthetically satisfactory restoration. The present case describes a patient with an extensive venous low-flow malformation in the area of the right cheek and the right maxilla. It was possible to fix a bar-supported prosthesis on three implants, which hardly stresses the mucosa. Keywords: vascular malformation, implant, prosthetics

Sphaerobacter thermophilus, a Gram-positive, non-motile & non-spore forming bacteria is reportedly present in teeth and produces glycosyltransferase, which is responsible for endodontic infection. The enzyme is found in the human root canal and is involved in peptidoglycan biosynthesis that is significant for bacterial adhesion and biofilm production. In the present study, relevant databases & webservers were accessed for in silico proteomic characterization, virulence and protein disorder prediction to support the metabolic pathway design. Glycosyltransferase-1 family members were phylogenetically investigated, which are exclusively endodontic in origin. Subsequently, the enzyme was subjected to a subcellular localization-based pathogenicity study using computational algorithms & an already established pathway database. Afterwards a putative metabolic pathway was engineered & presented that may further lead towards exploration of glycosyltransferases with wider range of chemical configurations and competent drug designing. Keywords: endodontic, bacteria, Sphaerobacter thermophilus, Glycosyltransferase, metabolic pathway

Temporomandibular joint (TMJ) ankylosis is a serious disabling condition characterized by fusion of the mandibular condyle with the glenoid fossa, disc, and/or eminence, resulting in severely restricted mouth opening and significantly reduced mandibular movements. The condition often has a deteriorating effect on the patient's daily functions such as speech, chewing, breathing, and oral hygiene as well as their wellbeing and quality of life. Furthermore, childhood TMJ ankylosis frequently has a detrimental impact on the facial growth resulting in facial asymmetry, micrognathia, and/or class II malocclusion with posterior or anterior open bite. Trauma is the main cause of TMJ ankylosis, but the condition can also occur as a result of surgery, local or systemic infections, or systemic disease. Surgery is the mainstay of treatment, and several approaches have been applied, including gap arthroplasty (GA), interpositional gap arthroplasty (IGA), reconstruction arthroplasty (RA), or distraction osteogenesis (DO). The aim of this poster is to present a post-traumatic TMJ ankylosis case in a 12-year-old female patient who reported to our department with a chief complaint of difficulty in opening of the mouth. The maximum mouth opening was limited to 1mm. Interposition gap arthroplasty with temporalis myofascial flap was done followed by aggressive physiotherapy. A good functional and aesthetic result was achieved without further surgery. The results conclude that the following suggested best practice protocol is effective in treating unilateral TMJ ankylosis. Keywords: temporomandibular joint, trauma, TMJ ankylosis, gap arthroplasty, childhood trauma

Background: Dental age estimation by radiographic methods for forensic rationale is routinely applied to serve the judicial system. Of these, the Demirjian system is most widely used, but its applicability in the Indian population, specifically the Haryana population, is still lacking. Aim and Objective: This is a pilot study to evaluate the method in a Haryana population using a comprehensive chart for dental age estimation (DAEcc) and establish a correlation between the chronological age (CA) and estimated age. Materials and Methods: The sample comprised 100 subjects (49 males and 51 females) 7–16 years of age. Orthopantomograms of these patients were traced and evaluated for Demirjian dental age computation using DAEcc and compared with CA. Results: A positive correlation was observed between CA and estimated age (R2 = 0.82 in males, R2 = 0.78 in females, and R2 = 0.80 in combined population). The paired t-test between CA and estimated age demonstrated that the Demirjian method underestimates the dental age by 5.1 months, that is, 153 days in males (P = 0.04) and by 7.9 months, that is, 237 days in females (P = 0.01). There was an overall underestimation by 6.3 months (P = 0.001) in the entire study population. Conclusion: This pilot study supports the applicability of the Demirjian method for age estimation in the Haryana population and paves the way for further studies in a larger sample in the same population to accurately establish the association between CA and dental age. Keywords: age estimation, chronological age, Demirjian method, dental age

Aim: The aim of this study was to emphasize the evidence-based dentistry (EBD) concept to dental undergraduate & postgraduate students and also to provide an overview of EBD and its application to incorporate valid scientific evidence into clinical practice. Methodology: A cross sectional multi-centric study was conducted among dental undergraduates and post graduates in the state of Uttar Pradesh. About 30 questions were circulated and a comparison was done to assess factors associated with application of EBD. All participants were informed about the purpose of the study. Results: The undergraduates and postgraduates are awakening to the scientific universe, being essential both for students who want and do not want to pursue a career in this area. We found that students from different dental fields were unaware of the basic concepts of evidence-based health, such as risk of bias assessment of randomized clinical trials. The present study provided us with the knowledge, attitude and practice of EBD as students. Practical classes were done to familiarize students with the EBP process and to maximize their learning with regard to the clinical application of evidence. Data collected during our survey reveals EBD as a supportive tool for educators and decision makers. Further we, found that lack of time was the most common obstacle identified by the participants applying EBD. Conclusions: Teaching EBD is beneficial both for patients and for the qualification of future doctors, especially those who will not pursue an academic career. Application of EBD was associated with knowledge of PICO question formulation and previous EBD training. A lack of time was the most common obstacle identified by the participants applying EBD. Therefore, EBD educational programs should be developed for dental practitioners to enhance their knowledge and skills. Keywords: empiricism, dental curriculum, dental undergraduates, evidence-based dentistry, population, intervention, comparisons, outcomes

Aim: To outline the role of customized solutions in post-COVID mucormycosis by reconstructing one’s lost facial structures and to mark a transformative leap in the field of personalized medicine that ensures optimal functionality and aesthetics. Summary: Post-COVID mucormycosis left individuals with huge maxillofacial defects, a heavy financial burden, and emotional scars for life. Rehabilitation of such patients is our duty as maxillofacial surgeons to give them back their lost aesthetics, function, and self-confidence. The need for customized implants that anchor the adjacent residual zygomatic, pterygoid, nasal, and orbital floors provide better results than conventional implants. Being aware of the challenges in rehabilitating post-COVID rhino-maxillary mucormycosis patients ( lack of maxillary bone (including pterygoid plate and/or zygomatic bone), adhesion of nasal and sinus mucosa with palatal mucosa with fibrosed palatal mucosa, loss of lip support, reduced stress bearing area, lack of vertical guidance, over closure of the mandible, etc), patient-specific zygomatic implants offer efficient stability and function, expediting recovery with minimal morbidity. Conclusion and Inference: PSIs post-COVID offer positive outcomes, ensuring no deep scar on the patient’s dignity and self-confidence. Even after 12 weeks and 4 weeks of follow-up, respectively, no implant-related complications were observed. In the future, custom PSI stands as a precise alternative; CAD/CAM technology drives a step closer in the fabrication of custom implants. Keywords: patient-specific implant , post-COVID mucormycosis , CAD/CAM technology

To showcase a reported rare case of malignant melanoma in the posterior mandible, lacking a discernible primary source, to delve into its potential origins, and conduct a comparative analysis with documented occurrences of metastatic melanoma affecting the mandible. Methodology: In May 2023, a 29-year-old female sought medical attention for a persistent, painful mass in the right back region of her mandible that had been troubling her for four months. Clinical examination revealed an ulcerated lesion in the retromolar region with pseudomembranous slough, accompanied by swelling in the vestibule on both the buccal and lingual sides. Palpation confirmed the presence of a localized, bony-hard swelling, which was tender on palpation. An OPG and CBCT were conducted, revealing a multilocular radiolucency extending from the right mandibular canine to the second molar, situated 5mm above the lower border of the mandible. An incisional biopsy initially suggested a potential diagnoses of mucoepidermoid carcinoma, sarcomoid lesion, or myoepithelial carcinoma. FNAC results indicated malignancy, with possibilities including poorly differentiated carcinoma, malignant melanoma, or anaplastic lymphoma. Enucleation and curettage were performed, followed by IHC analysis, which indicated focal positivity for CK8/18, suggesting a poorly differentiated malignant tumour. Further investigations revealed a large tumour in the left mandibular ramus. The patient subsequently underwent wide local excision and reconstruction using Recon plate, radicle neck dissection, and reconstruction using a submammary PMMC flap. Pathological analysis revealed nested malignant cells with numerous mitoses, along with positivity for melanocytic markers such as S100, CD56, HMB45, and melan-A. Despite the primary tumour's elusive source, the patient, shows no clinical or radiological evidence of disease more than six months post-initial presentation, highlighting a remarkable and encouraging outcome. Results: The patient is undergoing monthly follow-up sessions and receiving radiotherapy. Although it's early to assess survival rates, there is currently no clinical or radiological evidence of disease since the surgery two months ago. Discussion: Metastatic tumours to the oral cavity are rare (1-3% of all oral malignancies), with the jawbones, particularly the mandible, being more commonly affected. Despite advances in systemic therapy, treating advanced melanomas remains challenging. Spontaneous regression is uncommon, with immunological factors likely playing a key role, though the exact mechanism remains unclear. Clausen and Poulsen (1963) outlined criteria for mandibular metastatic tumours, where positive S-100 immunohistochemical staining and negative HMB-45 are indicative. Typically, melanoma metastasizes to regional lymph nodes before reaching secondary sites. Conclusion: This complex case highlights diagnostic challenges in rare malignancies, but through a comprehensive approach involving clinical, radiological, and pathological assessments, successful treatment and a promising outcome were achieved, underscoring the importance of early intervention and multidisciplinary care. Keywords: malignant melanoma, S100, CD56, HMB45, melan-A

The concerned protein protease HtpX homolog is associated with endodontic infections. This protein is a putative membrane-bound zinc metalloprotease that participates in the proteolytic quality control of membrane proteins. Any structural or functional disturbance may lead to infections. A computational proteomic study was performed that included retrieval of the concerned protein sequence from UniProt, sequence homology search by UniProt BLAST, physicochemical characterization by ProtParam, multiple sequence alignment by CLUSTALW, molecular phylogenetics by MEGA11, virulence and protein disorder prediction by VirulentPred and PONDR respectively, pathway analysis through Pathway Commons, protein-protein interaction analysis through STRING and per-site evolutionary rate estimation by ConSurf. The number of amino acids of the selected proteins ranged from 279 to 336. These proteins were slightly acidic to basic in nature, thermally stable and hydrophobic so that they would reside in and interact with biological membranes. Polynucleobacter necessarius was the ancestor of all the selected organisms, and the related organisms were more or less clustered together. Thus, they might share common pathogenic strategies. The selected proteins were non-virulent. Overall percentage of disordered region ranged from 18.53 to 43.69, which provides functional flexibility as they can assemble linkers and macromolecular complexes to attach with host cell receptors. def, Pnec_1775, fmt, Pnec_1774, Pnec_1773, Pec_1772, ftsH, Pnec_1779, Pnec_1611 and grpE were the functional partners of htpX. Nineteen residues were conserved & exposed. Thirty-eight residues were conserved & buried. This study revealed the mechanism of action of the concerned protein, evolutionary relatedness among organisms, pathways involved and extent of conserved residues. The results from this investigation could be used in the development of effective therapeutic strategies. Keywords: endodontic, metalloprotease, phylogenetics, htpX, pathways

Objectives: The purpose of the prospective randomized clinical study in a split-mouth design was to compare the clinical performance of a universal adhesive system (Futurabond U, Voco, Germany) used in both application modes in combination with a nano-hybrid Ormocer© (Admira Fusion, Voco, Germany) after 6 months. Methods: In 50 patients, 19 Class I and 81 Class II cavities were placed with at least two restorations per patient. The adhesive system Futurabond U was used for all the restorations. In one of the two fillings Futurabond U was used as a self-etch adhesive (test group), in the other after conditioning with phosphoric acid (control group). All fillings were placed under rubber dam following the prospective clinical study protocol. The restorations were evaluated at baseline, two weeks following placement, and after six month according to the modified FDI criteria for clinical trials. All data were statistically analysed with the Mann-Whitney U test. Results: After 6 months, 46 patients with 92 restorations were re-examined (92% recall rate). The cumulative survival rate for all restorations was 100%. All teeth remained vital and did not show any signs of postoperative sensitivity. Slight fractures (code Bravo) could be evaluated in three fillings (2 control, 1 test group). None of the teeth showed signs of secondary caries. Statistical analysis showed no significant difference between techniques for any of the evaluation criteria (p>0.05, Mann-Whitney U test). In both groups, this corresponds to cumulative success rates (control group: 100%; test group: 100%) and annual failure rates (AFR) of 0%. Conclusions: After 6 months, the Ormocer© and the different application modes of the universal adhesive used showed no significant impact on the clinical performance of class-I and -II restorations. Furthermore, the universal adhesive Futurabond U might be a promising alternative to other systems. This study was supported by Voco GmbH, Cuxhaven, Germany. Support Funding Agency/Grant Number: Voco, Cuxhaven, Germany. No. 31255331KZEP. Keywords: clinical trial, composite restoration, adhesive dentistry, posterior teeth

Objectives: The aim of this placebo-controlled, double-blinded, randomized clinical investigation was to evaluate the influence of 8% arginine-containing prophylaxis products on pain related parameters (Schiff and VAS scores) compared to a negative control in patients from a German dental clinic suffering from severe dentine hypersensitivity (DH) over 24 weeks. Methods: After ethical approval by the Ethics Committee of the Martin Luther University Halle-Wittenberg (Germany), 101 informed patients having at least two teeth (no molars) with air blast DH scores 2, 3 (Schiff Cold Air Sensitivity Scale) were randomly assigned to either the control or test group. All were treated with a single application of the in-office paste followed by daily toothpaste use (control products without desensitizing ingredients and test products containing 8% arginine, both with the same level of fluoride).The Schiff and VAS scores were evaluated before and after application of the in-office paste and after 4, 8, and 24 weeks for both study teeth. Results: A total of 98 patients completed the study. The distribution of subjects with DH Schiff scores 2 and 3 at screening was similar in both groups. There were no statistically significant differences in the Schiff and VAS scores at baseline between test and control subjects (p>0.05). The pooled data for tooth 1 and tooth 2 yielded significantly greater pain relief as assessed by the Schiff score in the test group than the control group at any appointment, both in the t-test and Wilcoxon signed rank test analyses (p<0.05). The VAS showed no significant differences between both groups. Conclusions: Significant improvements (Schiff score, pain relief) in a German population were demonstrated after application of the in-office paste and over the 24- week period of brushing with the 8.0% arginine-containing toothpaste. This study was supported by Colgate-Palmolive Europe, Therwil, Switzerland. Support Funding Agency/Grant Number: Colgate-Palmolive Europe, Therwil, Switzerland. No. GASAS-1105X, PO No. 7501857177. Keywords: dentin hypersensitivity, arginine, clinical study, oral hygiene, pain relief

Objectives: This prospective randomized single-blinded clinical study conducted in a split-mouth design examined the impact of an additional application of a flowable composite as a cavity liner in Class I and II composite restorations over 48 months. Methods: According to the study protocol approved by the ethics committee, 100 restorations (Class I and II) were placed in 50 subjects exhibiting two cavities with restorative needs. One cavity was filled solely with a nano-hybrid composite (control group) and the second cavity in combination with an additional layer of a flowable composite (test group). A universal adhesive system was used in both groups in self-etch mode according to the manufacturer's instructions. Clinical evaluation was performed at baseline, 6, 12, 24, 36 and 48 months based on the modified USPHS/Ryge criteria. Results: With a recall rate of 86%, 43 of the initial 50 enrolled patients were evaluated after 48 months. The cumulative survival rate for all restorations was 91.9%. A total of seven restorations (8.1%) were considered failures, three were due to the loss of vitality by endodontic treatment and four due to filling fractures. Five of seven failures were located in the test group (11.6%) and two restorations in the control group (4.7%). In both groups, this corresponds to significantly different cumulative success rates (control group: 95.3%; test group: 88.4 %) and annual failure rates (AFR) (control group: 1.2 %; test group: 2.9 %), respectively (p < 0.05; Mann-Whitney U test). Additionally, compared to the 24 and 36 month results, non-significant differences in parameters such as marginal discoloration and adaption were noted after 48 months. Conclusions: The additional application of a flowable composite did not tend to be superior in this trial and should be further evaluated over a longer period of time. This study was supported by Voco GmbH, Cuxhaven, Germany. Support Funding Agency/Grant Number: VOCO GmbH, Cuxhaven, Germany. No. 31308004KZEP. Keywords: composite restorations, flowable composite, clinical trial, posterior teeth, adhesive dentistry

Objectives: The objective of this study was to evaluate the microtensile bond strength (µTBS) of three universal adhesives applied in etch-and-rinse and self-etch mode on irradiated and sound human dentin. Methods: 180 extracted third molars were specially prepared allowing dentin perfusion and randomly assigned to two superordinate groups. Ninety teeth received either no irradiation or the high-level therapeutic dose of 60 Gy applied fractionally (2 Gy/day, 5 days/week, 6 weeks). Specimens from each group were randomly divided into six subgroups assigned to three established universal adhesives in either etch-and-rinse or self-etch mode (n=15): Futurabond^® U (Fer0, Fer60, Fse0, Fse60), AdheSE^® Universal (Aer0, Aer60, Ase0, Ase60), Xeno® Select (Xer0, Xer60, Xse0, Xse60). Bond strength was measured using an universal testing machine immediately after application and light curing of the adhesive materials. Results: The effect of dentin irradiation and application mode for the adhesive restoration was significant (p<0.01, ANOVA). In all groups, a decrease of µTBS was observed when used on irradiated dentin. No significant influence of high level radiation on the bond strength in both modes of Futurabond® U and AdheSE^® Universal could be evaluated (p>0.05, Tukey’s test). Only Xeno^® Select showed significantly reduced bond strength in self-etch mode after irradiation (Xse60) compared to non-irradiated specimens (Xse0) (p<0.05, Tukey’s test). Evaluated µTBS of all groups (mean values, standard deviations in MPa): Fer0: 23.64 (6.76); Fer60: 17.88 (7.54); Fse0: 23.87 (7.49); Fse60: 19.21 (7.34); Aer0: 29.97 (7.18); Aer60: 29.24 (7.28); Ase0: 35.10 (8.41); Ase60: 26.30 (10.07); Xer0: 26.06 (8.20); Xer60: 22.74 (6.22); Xse0: 24.17 (8.36); Xse60: 11.42 (3.86). Conclusions: Within the limitations of an in vitro study, some effects of high-level tumour irradiation on the bond strength of universal adhesives could be detected. These effects were strongly associated to the used material and application mode. Keywords: bond strength, universal adhesives, irradiation, adhesive dentistry, tumour-therapeutic radiotherapy