International Poster Journal of Dentistry and Oral Medicine, 03/2019

Introduction: It is estimated that only 1% of the malignant tumours that affect the oral cavity occur due to primary neoplasms of another location and of these, about 1% originate in thyroid tumours. Papillary thyroid carcinoma (PTC) is the most common and well-differentiated cancer of the thyroid, accounting for 80-90% of the total malignancies that affect this gland. Metastisation occurs mainly to the regional lymph nodes, with the occurrence of jaw metastases being exceptionally rare. Metastases that occur in the oral cavity seem to exhibit a predilection for mandibular body and angle, which seems to reflect the rich vascularisation of the medullary space of these regions. Case description: We report a case of a 70-year-old female patient with a history of PTC who, after adequate observation and diagnostic orientation, revealed a rare occurrence of mandibular PTC metastasis. A brief review of the literature will be made regarding clinical presentation, radiological aspects, and treatment options. Discussion/ Conclusions: Metastatic PTC to the mandible is a rare event; however, the possibility of its occurrence must be established when the differential diagnosis of maxillofacial tumours is performed. Despite the relatively indolent behaviour of this thyroid neoplasm and its good survival when suitably treated at baseline (~ 95%), the prognosis of patients with distant metastatic disease declines considerably, with only 40% of patients alive 4 years after diagnosis. Thus, timely detection of metastatic disease and its therapeutic orientation has an invaluable impact on the overall survival rate. Palabras clave: papillary thyroid carcinoma, jaw metastasis

The development and expansion of digital media represents one of the greatest advances in our ability to communicate and disseminate knowledge. Among all advanced technologies, the internet is one of the most advanced media by which one can stay connected with rest of the world. This can be used at home and at work as well as during leisure time for personal or professional use. Internet usage provides easy access to the "global village". This facility provides a massive volume of health consciousness along with oral health information to internet users. It allows increased access to medical and dental information and can be used for patient self-education, enabling patients to confirm the information given by their practitioner and to gather additional information. Information technology is beginning to change the exclusive focus of health care from curing disease to preventing disease and enhancing health status. The trend towards preventive medicine also contributes to the patient's desire to gain knowledge. Parents are increasingly using the internet to obtain health-related information for both themselves and their children. The internet has become an important source of dental health information for parents, mostly due to the dramatic increase in internet accessibility. This poster shows parental internet usage patterns and how internet-derived patient information is influencing the practice of paediatric dentistry. Palabras clave: online dental health information, parental internet usage, tech information, internet

The anterior loop length (AnLL) of the inferior alveolar nerve (IAN) is an important clinical landmark in implant dentistry as it may be injured during implant placement. Objective: To measure the prevalence of the anterior loop (AnL) of the IAN and estimate side-, gender-, and age-related variations in AnLL in the Malaysian-Chinese population. Methodology: 244 randomly chosen cone-beam computed tomography Digital Imaging and Communications in Medicine images were divided into three age groups; 18-40, 41-60, and 61-80 years. The route of the IAN was traced using a software until it exited the mental foramen. The AnLL was measured from the point where the IAN exited the mental foramen to the anterior-most margin of the AnL of the IAN by following the diagonal course of the IAN. The measurement was replicated on the opposite side. Data were analysed using one-way analysis of variance and independent and paired sample T-tests with the significance threshold set at P0.05. Results: The prevalence of AnL of the IAN was 89.1% in 488 hemimandibles. Overall, the AnLL ranged between 3.04 and 9.63mm. The mean AnLL was 5.49±1.07mm on the right side and 5.48±1.20mm on the left side. The mean AnLL in the 61-80-year group (5.62±1.00mm) was longer compared to the 41-60 (5.48±1.11mm) and 18-40 (5.46±1.19mm) year groups. There were no statistically significant differences when comparing the mean AnLL between different sides of the mandible (male: P=0.962, female: P=0.983, total: P=0.984), gender (right AnLL: P=0.048, left AnLL: P=0.086) and age (P=0.636) groups. Discussion: By using the mental foramen as a landmark, the actual AnLL and the mesiodistal spread of the AnL of the IAN may help in planning the horizontal and vertical direction of implant placement in the mandibular premolar region. Conclusions: The high prevalence of the AnL of the IAN and its varied AnLL suggests that a 3-dimensional assessment is required if implant placement is planned in the interforaminal region. Palabras clave: implant planning, CBCT, safe zone, surgery complications

Introduction: The term "leukaemia" is used to summarise malignant diseases of the blood-forming or lymphatic system. These are characterised by an abnormally increased production of functionless progenitor cells of leukocytes, which in the further course of haematopoiesis is disturbed. Depending on the course, acute and chronic forms of leukemia are distinguished, with the acute forms untreated leading to death in a few weeks to months if left untreated. Case report: A 25-year-old microsome patient was diagnosed with "chronic myelomonocytic leukaemia" at the age of one and successfully treated with chemotherapy and stem cell transplantation. The patient presented at the age of 22 years in the outpatient department of the University's Dental Clinic with a referral for prosthetic rehabilitation of the upper jaw. The clinical and radiological situation showed a reduced permanent carious dentition. Teeth 012 and 022 were not sustainable. The marginal gingiva was reddened in all four quadrants, and the Periodontal Screening Index (PSI) showed at least a value of 2. Oral hygiene could be improved by a 6-month hygiene phase. Conservative therapy and placement of the fillings were performed using Compomer (Henry Schein^®, New York, USA). Prosthetic restoration of teeth 017-025 with 012 and 022 as pontics was performed using a cemented, vestibular ceramic veneered non precious-based bridge restoration. However, the reddish colour of the marginal gingiva did not decline 3 years after the start of therapy, even though the inflammatory parameters (SBI, PBI, PSI) were constant in a physiological range. The recall interval is 3 months to keep oral hygiene at a high level. Discussion: The type of prosthetic restoration was chosen because the extent of the plastic restorations had exceeded the indication range in almost all lateral or abutment teeth. Thus, a minimally invasive prosthesis by means of adhesive bridges for the anterior tooth region was not indicated, although this represents a suitable alternative today. The treatment of the aesthetically insufficiently supplied anterior region could be carried out in this context. Summary: Patients with underlying diseases should be given intensive prophylactic care and be instructed on individual oral hygiene. Palabras clave: leukemia, marginal gingiva, periodontal findings, prosthetic rehabilitation

Introduction: Since the loss of one's own teeth decreases with age, the various effects of various wear and tear on tooth structure and their therapy have become increasingly important. Erosive and abrasive/attritive processes may overlap. Attritive processes can also progress more rapidly in erosively damaged teeth. If the erosive loss of hard tooth substance particularly affects the palatal and occlusal surfaces of the maxillary teeth, an endogenous aetiology in the sense of chronic gastrointestinal disturbances or regular vomiting with bulimia nervosa can be assumed. However, buccal defects in the lower jaw due to the nocturnal lying position allow reflux diseases to be distinguished from chronic vomiting. Bulimia nervosa has a gender ratio of 1:20 (m:f) and a prevalence of 0.5-5% in western industrial countries. Frequently, affected patients practice intensified mechanical oral hygiene, which leads to increased loss of tooth substance. If erosive and mechanical wear occur simultaneously, a temporally linear correlation can no longer be assumed. Case report: In the case presented, the patient describes a pronounced nocturnal bruxism (abrasion/attrition) and long-term bulimia nervosa. The functional symptoms of the patient (severe head- and earaches) support the dental findings regarding bruxism. Bulimia patients usually show erosions in the area of the oral and occlusal tooth surfaces, especially the incisors. At the time of initial presentation, the patient had already suffered for years from aesthetic, functional, and phonetic limitations. Due to restorations with crowns and bridges in the posterior region, the vertical dimension was largely retained. Teeth 12-22 showed a clinical coronal residual height of approx. 3 mm. Since all 4 anterior teeth still showed vitality, it had to be considered whether they should be devitalised for the forthcoming prosthetic restoration. Since root-canal-treated teeth are more susceptible to fractures than vital teeth, this should be avoided wherever possible. The front of the upper jaw was clearly visible, especially when laughing (gummy smile). Although there was no increased loss of vertical dimension, there was not enough intermaxillary space in the anterior region to reconstruct the anterior teeth. To avoid devitalisation and to harmonise the gingival margin, a crown extension was performed. The required slight bite elevation was achieved by crowning all posterior maxillary teeth that had previously been treated with insufficient restorations. A functional wax-up was created. A Michigan splint with a modelled maxillary front served as a therapeutic denture for 6 months. Then a surgical crown extension was performed with special consideration for the harmonisation of the gingival margin. A mock-up was used as a template and later as a temporary. The patient showed no symptoms after 6 months and was fitted with full zircon crowns in the maxilla. Discussion: Since the loss of hard tooth substance was already at an advanced stage, extensive restoration work had to be carried out. The patient was fitted with a Michigan splint to protect the restorations from attritive secondary damage. In the therapy or prevention of non-carious tooth substance defects, the patient's personal responsibility for success must be made clear. Palabras clave: erosion, bulimia nervosa, prosthetic rehabilitation

Introduction: Simvastatin (SV) is a member of the statin family. As an HMG-CoA reductase inhibitor, it is a therapeutic agent for lowering blood cholesterol. Various pleiotropic effects have been reported for SV. Some of them are anti-inflammatory effects and SV stimulates angiogenesis. Proven by animal experiments, SV promotes osteoblast proliferation and differentiation; additionally, a suppression of osteoclastic action has been reported. Methods: This cell culture study analysed the effects of SV on 20 primary mandibular osteoblast cell lines. SV concentrations of 0.01 up to 1 µM were used. Control groups were untreated cells of the specific cell line. The commonly applied clinical dosage ranges from 5-40 mg/d, which matches a systemic SV concentration of 0.05 - 5.0 µM. Effects on cell proliferation (MTT), osteogenic activity (ALP), and the mineralisation rate (alizarin red S quantification) were analysed on day 9, 13, and 16. The sample size per concentration and cell line was 3 for ALP and alizarin red S. The sample size for MTT was 6 per concentration and cell line. Data were not distributed normally, and thus statistical analysis was performed using the Kruskal-Wallis Test at p0.05. Results: The determination of mineralisation relative to the proliferation on day 16 showed a significant increase of 1 µM SV compared to the control (p=0.00001), 0.05 µm SV (p=0.000002), 0.01 µM SV (p=0.000016) and 0.5 µM SV (p=0.06). Additionally, 0.5 µM SV caused a significant increase compared to 0.05 µM SV (p=0.040). On day 16 the SV concentration of 0.5 µM SV showed a significant decrease in the conversion of the alkaline phosphatase relative to the total protein compared to the control (p=0.044), 0.01 µM (p=0.028), and 0.05 (p=0.028). Conclusion: Although observed effects differ in strength between different primary osteoblast cell lines, SV enhanced the conversion of the alkaline phosphatase relative to the total protein, which shows an increased osteogenic activity and mineralisation potential. The stimulation occurred within common clinically applied dosages. The increased mineralisation potential which can be found in higher SV concentrations is limited by the conversion rate of alkaline phosphatase relative to the total protein. Concentrations between 0.05 µM SV and 0.1 µM SV seem to be beneficial for mineralisation. On the other hand, this stimulation may have negative effects elicited by a possible unintentional bone mineralisation. Palabras clave: mineralisation, osteoblasts, osteogenic effect, simvastatin

In addition to the typical, often amber-coloured changes of the enamel and dentin dysplasias and the primary or secondary pigmented hypoplasias, tooth discoloration may also develop which is not directly associated with structural changes. These are medicinal deposits or pigment surpluses that are stored in the tooth structure during tooth development. Sole root discolorations are rare. In the third molars, crown formation is completed between the ages of 12 and 14. The formation of the roots can only be completed between the ages of 19 and 21. Case report: In a 14.5-year-old patient with heterozygous Factor V mutation at the time of surgery, the four third molars were surgically removed. They were inconspicuously shaped and structurally intact with incomplete root growth. All roots showed a homogeneous, brown-yellow discoloration almost throughout. The colour of the four crowns differed from the regular tooth colour. Growth lines (retzius stripes) were macroscopically recognisable e in the enamel. The preoperative panoramic view showed no evidence of structural changes (e.g. hypodense compartments). The postoperative course had no complications. The patient reported that she had received antibiotics several times during infancy for the treatment of otitis media. For about two years she had been taking SKID^® (minocycline, 50 mg/day) for the treatment of acne. In addition, a current long-term medication with Androcur^® (cyproterone acetate antiandrogen) was available. Literature review: Tooth discoloration can occur both as a result of changes in the structural composition of the hard tooth substance and as a result of colour deposits during or after the process of ontogenetic tooth development. Biliverdin can lead to a discoloration of the tooth structure in the case of hyperbilirubinemia or incompatibility of the blood groups between mother and child in the context of haemolyticus neonatorum disease. This also applies to supplementation with iron preparations for the therapy of anaemia in children with chronic kidney failure. In erythropoietic congenital porphyria, discoloration by porphyrin may occur. There are occasional case reports of greyish-brown to yellowish discoloration of teeth with anamnestically confirmed intake of tetracycline or its semi-synthetic derivatives such as minocycline. These publications mainly describe discolorations of the coronal tooth segments. After an extensive literature research, only four publications on discoloration of third molars (12 patients / 28 teeth) have appeared in the last 20 years. Discolorations of the permanent dentition occur in 3 to 6% of cases with long-term administration of minocycline. The intensity of staining seems to depend on the duration of administration and the stage of odontogenesis. In addition to the discoloration of the tooth structure, tetracyclines and their derivatives were found in a few cases in the adjacent bone of third molars. Various mechanisms for the incorporation of minocycline into the tooth structure are discussed. Besides intrinsic and extrinsic hypotheses, an irreversible complex formation within the tooth structure is assumed to be probable. Minocycline differs from other tetracyclines in that it is well absorbed from the gastrointestinal tract, chelated with iron to insoluble complexes and may lead to tooth discoloration. The exact mechanisms are not fully understood. Palabras clave: tooth discolouration, acne therapy, long-term consequences

Aim & Objective: The aim of this review was to determine the effectiveness of SDF in managing dental diseases. Methodology: A literature search of all the relevant papers on silver diamine fluoride was obtained from online scientific databases and a narrative review was carried out. Based on the selection criteria, 21 articles were selected, and the data were analysed to determine the effectiveness of SDF in the prophylactic and therapeutic management of various diseases affecting the teeth. Results: The available literatures suggest that 38% silver diamine fluoride is effective in arresting caries; a 3.8% solution as effective as a root canal irrigant and desensitiser. There were no significant complications reported with SDF treatment. Conclusion: SDF therapy is painless, simple, and low-cost and it could be widely recommended and promoted as an alternative preventive treatment to conventional invasive caries management, especially among children who are too young for conventional dental care, those with special needs, or those with difficulty accessing and affording basic dental care. Palabras clave: silver diamine fluoride, children, primary dentition, tooth decay, topical fluorides, silver diamine fluoride, randomised controlled trial

Objectives: The aim of this randomised clinical trial was to evaluate the effectiveness of a microdroplet device in combination with a powered toothbrush to prevent proximal gingival inflammation and to determine the long-term adherence to both products in daily proximal hygiene. Methods: 30 participants with gingival inflammation were randomly assigned (n=10) to use: exp. 1: AirFloss Pro filled with water + Sonicare FlexCare+; exp. 2: AirFloss Pro filled with Listerine Zero + Sonicare FlexCare+; and control: dental floss + manual toothbrush for 28 days. Philips provided the Sonic toothbrushes & microdroplet devices and Johnson & Johnson the Listerine Zero. At baseline and 1st recall the papillar bleeding index (PBI) and the Rustogi-modified Navy Plaque Index (RMNPI) were recorded. Patients completed a questionnaire regarding their usual oral hygiene at the first appointment. Additionally, all 30 patients received an AirFloss Ultra device and a Sonicare toothbrush. One year later, oral hygiene parameters were re-evaluated and patients' adherence to their oral hygiene habits was evaluated using a questionnaire. Results: After 28 days, all three groups showed significantly reduced PBI scores. Both test groups showed significantly lower PBI scores than the dental floss control group. After one year, all groups showed lower PBI scores compared to baseline (p0.05). However, PBI scores increased compared to the first recall. 56% of the population still used the microdroplet device; 25% used dental floss. 89% preferred a powered toothbrush compared to 41% at baseline. 11% of the participants practiced proximal care on a daily basis at baseline. After one year, it was at only 15%. Conclusions: Long-term prevention of gingivitis can be achieved using a microdroplet device in combination with a powered toothbrush. The use of the microdroplet device was convenient for patients as after one year more than half of the population preferred the device in their daily oral routine. However, the percentage of patients practicing proximal care only on an irregular basis is still fairly high. Palabras clave: gingivitis, biofilm, AirFloss, high-velocity microdroplet device, microburst, powered interdental cleaning device, approximal, interdental, adherence, long-term

Introduction: "Hypofunctional teeth" refer to the teeth which are not in intercuspation, such as high-positioned canines, open bite incisors, and impacted teeth. Compared with normal teeth, hypofunctional teeth have more periodontal ligament (PDL) atrophy. Previous studies have suggested that application of orthodontic force before extraction increases PDL width, eases the extraction, and may prevent root resorption after replantation. However, the effect of orthodontic tooth movement on the enhancement of human PDL tissue of hypofunctional tooth has never been investigated. Objectives: To examine the amount of PDL tissue on the root surface of extracted third molars following pre-application of orthodontic force Materials and Methods: The subjects were thirteen orthodontic patients who required third molar extraction before or during the treatment and had mesio-angular impacted mandibular third molars on one side and mandibular third molars which can be removed by simple extraction on another side. The experimental mesio-angular impacted third molars (n=13) received orthodontic force using a special appliance, while the contralateral third molars (n=13) received no force application as a control. Alteration in angulation and position of the third molars were assessed by panoramic radiographs. The extracted teeth were stained with toluidine blue to determine the amount of remaining PDL on the root surface under stereomicroscopy. The percentages of stained PDL areas were then compared between the experimental and control groups. Results: The mean angulation of experimental third molars was decreased to 54.4 (± 16.3) % of that before applying force. Mean duration of the orthodontic force application was 14.6 (± 8.1) weeks. Moreover, the mean percentage of PDL tissue on preloaded teeth was significantly higher than that on unloaded teeth (P 0.05). Conclusions: The application of orthodontic force leads to tooth movement, which consequently increases the amounts of PDL tissue in impacted third molars. Thereby, this study may propose the effect of orthodontic tooth movement on the improvement of the PDL quality in the hypofunctional tooth. Palabras clave: hypofunctional teeth, third molars, orthodontic loading, periodontal ligament