Immediate and flapless implant insertion and provisionalization using autogenous bone grafts in the esthetic zone: 5-year results.

Objectives As the 2-year results for immediately inserted and provisionalized implants have been reported, it remained an open issue, whether the initially high success rates and the esthetic outcome remain stable for longer observation periods. Therefore, this prospective study examines the 5-year hard and soft tissue changes at implants placed in the anterior maxilla. Material and methods Meanwhile, 37 microthreaded implants were placed in 21 patients into extraction sockets with and without facial bone deficiencies by a flapless approach. Facial gaps and bony defects were grafted with autogenous bone chips. The implants were immediately provisionalized. The primary outcome parameters wer…

Acoustic Airway Profiles in Unilateral Cleft Palate Patients

Objective: This study investigates the nasal airway in unilateral cleft palate patients by means of a noninvasive, objective diagnostic method that provides topographic information about the airway profile. Design: A consecutive sample of patients was measured. Setting: Cleft palate rehabilitation center of the University of Mainz, Germany. Patients: Forty-nine subjects were investigated: 34 full-grown patients with complete unilateral cleft lip and palate and 15 controls with subjective normal nasal patency. Intervention: A transnasal series of three acoustic measurements of nasal volume was performed per nostril; measurements were taken both before and after decongestion with 0.3 mg xylom…

Actinomyces in infected osteoradionecrosis--underestimated?

Infected osteoradionecrosis (IORN) is a severe complication of radiation therapy for head and neck cancer. Infected osteoradionecrosis can lead to fracture and often requires subsequent jaw resection. It is known that irradiated bone is highly susceptible to infections, mainly with Candida species and cariogenic bacteria. Only very few data exist on Actinomyces in IORN. The study population consisted of 31 patients (7 female, 24 male; median age, 58.3 years). All patients exhibited clinical and radiological signs of IORN (infection, mucosa or skin fistula, and sequestrated bone). To detect Actinomyces colonies, histological examination was performed using several staining procedures (hemato…

Objective, Noninvasive Evaluation of Velopharyngeal Function in Cleft and Noncleft Patients

Objective The purpose of this study was to investigate a new diagnostic method that provides an approach to noninvasive, objective measurement of velopharyngeal movement by acoustic determination of epipharyngeal volume changes with velopharyngeal muscle function. Design This was a case control study, using consecutive samples. Setting This study took place at the Cleft Palate Rehabilitation Center of the University of Mainz, Germany. Patients Subjects were 29 consecutive cleft lip and palate (CLP) patients and 31 controls (21 patients with dysgnathia and 10 healthy volunteers). Intervention A series of transnasal acoustic measurements (pressure wave: 55 dB for 2 milliseconds) of epipharyng…

Maintenance of marginal bone support and soft tissue esthetics at immediately provisionalized OsseoSpeed implants placed into extraction sites: 2-year results.

Background Placement of implants into extraction sockets targets the maintenance of peri-implant hard and soft tissue structures and the support of a natural and esthetic contour. The main advantages of immediate implant insertion in comparison with delayed implant placement protocols are as follows: a reduced treatment time, less number of sessions, and, thus, the less invasive procedure. This study examines the clinical performance (survival rate, marginal bone levels and Pink Esthetic Score [PES]) of OsseoSpeed™ implants placed into extraction sockets with immediate provisionalization in the anterior maxilla after a follow-up of at least 12 months. Methods Twenty patients received a tota…

Radiation response non-invasively imaged by [18F]FDG-PET predicts local tumor control and survival in advanced oral squamous cell carcinoma

It is a major challenge to preoperatively identify patients who will profit from surgery of advanced oral cancer. In multimodality therapy, response to neoadjuvant radiation correlates to treatment success. Hence, for preoperative decisions, assessment of treatment response is required. Therefore, we analysed the prognostic significance of glucose metabolism after preoperative radiotherapy. [(18)F]FDG-PET investigations were performed for re-staging 35 patients after neoadjuvant radiotherapy (36Gy) immediately prior to tumor resection. Emission and transmission measurements were obtained and SUV's were calculated for the sites of maximum [(18)F]FDG-uptake. Subpopulations of "low" (SUV4) and…

Immediate Nonfunctional Loading of NobelPerfect Implants in the Anterior Dental Arch in Private Practice - 5-Year Data

Background: The concept of scalloped implants to maintain the natural contour of the alveolar ridge has been a source of controversy for many years. Purpose: This study examined the long-term clinical performance of the scalloped NobelPerfect implant in a one-stage procedure (immediate loading in the esthetic zone). Materials and Methods: In 20 patients, immediate prosthetic restorations were placed on 31 NobelPerfect implants in a private practice and followed for up to 78 months. Twenty-one implants were placed immediately after extraction, seven implants were placed after osseous consolidation of the extraction sockets, and three implants were placed secondary to extended alveolar ridge …

Nasal airway in cleft-palate patients: acoustic rhinometric data

The objective of this study was to investigate an instrumental assessment technique for acquiring reproducible, metric data on the nasal airway in cleft-palate associated nasal dysplasia. A consecutive sample of 23 unilateral, 17 bilateral CLP patients and 15 controls with subjective normal nasal patency from a cleft-palate rehabilitation centre were studied. A series of transnasal acoustic measurements (pressure wave: 55 dB for 2 ms) of nasal volume were performed before and after topical decongestion with 2 x 0.3 mg of xylometazoline. A standardized regimen of acoustic parameters of the nasal valve and the adjacent segment of the nasal cavity were calculated. The cleft side yielded a sign…

Diagnostik des oralen Plattenepithelkarzinoms und seiner Präkursorläsionen

Overexpression of p63 is associated with radiation resistance and prognosis in oral squamous cell carcinoma

Summary Background : The tumor suppressor homologue p63 is expressed in basal and parabasal layers of intraoral mucosa. Full length transcripts with transactivational domain (TA forms) present with homology to p53 and implicate functions governing cell proliferation, differentiation and apoptosis control. To date studies show an increase of p63 expression in oral dysplasia and additionally high expression levels correlated with poor prognosis for patients with OSCC, whereas a possible link to radiation resistance of tumors has not been investigated yet. In the present study we tested the hypothesis for p63 being a marker of radioresistance and overall survival in OSCC. Methods : p63 Express…

Overexpression of GLUT-1 is associated with resistance to radiotherapy and adverse prognosis in squamous cell carcinoma of the oral cavity

This study tested the hypothesis that GLUT-1 is a marker of radioresistance in oral squamous cell carcinomas (OSCC). A GLUT-1 labeling index (LI) was determined by immunohistochemistry in 40 pretreatment OSCC biopsies. Radiation responses were categorized by histopathology of the resection specimens. Associations between the LI and radiation response, Kaplan-Meier survival estimates and Cox regression analysis for the variables GLUT-1, T-stage, N-stage and chemotherapy were examined. The median LI was 64.2% (range 14-100%). Tumors with65% of GLUT-1+cells were more resistant to radiation (p=0.023). Overall survival was higher (p=0.044) for subjects with low LI (median value) than those with …

Defects in the Human Leukocyte Antigen Class I Antigen Processing Machinery in Head and Neck Squamous Cell Carcinoma: Association with Clinical Outcome

AbstractPurpose: Human leukocyte antigen (HLA) class I antigen defects, which are frequently present in head and neck squamous cell carcinoma (HNSCC) cells may provide the tumor with an escape mechanism from immune surveillance. Scanty information is available about mechanisms underlying HLA class I antigen defects in both lesions and cell lines from HNSCC. In this study, we investigate the role of antigen processing machinery (APM) component abnormalities in the generation of deficient HLA class I surface expression of HNSCC cells.Experimental Design: Using immunohistochemistry, Western blot, and RT-PCR analyses we correlated the expression of the IFN-γ inducible proteasome subunits and of…

Lymphadenomatous carcinoma of the sublingual gland: report of a first case in an unusual localization.

Background. Lymphadenomatous carcinoma of the salivary gland is a very rare tumor, which hitherto occurred exclusively in the parotid gland. This report describes a case of lymphadenomatous carcinoma of the sublingual gland, which is thought to be the first report of this special entity. Methods and Results. A 36-year-old man was seen with slowly growing mass on his right floor of mouth. Upon surgical removal, the mass was well encapsulated. Microscopic exami- nation revealed a biphasic appearance with islands of neoplas- tic epithelial cells presenting against a dense lymphoid stroma, while the epithelial compartment showed features of malig- nancy. During 30-months of close follow-up, the…

Osteonecrosis of the jaws in patients treated with bisphosphonates - histomorphologic analysis in comparison with infected osteoradionecrosis.

Background:  Patients treated with bisphosphonates because of bone metastases have been shown to develop osteonecrosis of the jaws. In the present study, we examined the histologic findings of these cases. As similarities between this disorder and infected osteoradionecrosis (IORN) are described, both lesions were compared. Methods:  We investigated eight patients with bisphosphonate treatment and osteonecrosis (four female, four male; median age: 65.6 years; cancer: multiple myeloma in five patients, breast cancer in three patients; mandibular involvement in five patients, maxillar involvement in three cases), and 10 patients suffering from IORN (all male; median age: 61.3 years; cancer: s…

Der Oberkiefer – das schlechtere Implantatlager?

In the maxilla, it is sometimes necessary to use implants to achieve a good prosthetic result. However, an increased failure rate of maxillary implants seems to be a common clinical experience. This experience was investigated in a retrospective statistical analysis. In a retrospective study of 665 patients between 1987 and 1997, 2484 implants were examined. The implants in the upper jaw were compared to those in the lower jaw. Implants with and without autogenous bone grafts and fixtures in patients with alveolar ridge atrophy, tumor, or trauma were explored. In particular, the data obtained from the orthopantomograms after completion of the prosthetic superstructures were controlled for p…

Tissue-like self-assembly in cocultures of endothelial cells and osteoblasts and the formation of microcapillary-like structures on three-dimensional porous biomaterials

The survival and functioning of a bone biomaterial requires a rapid and stable vascularization after implantation. However, the mechanisms involved in the context of the complex healing microenvironment are poorly understood. To evaluate the vascularization potential of bone biomaterials, angiogenic stimuli were added to human dermal microvascular endothelial cells (HDMEC) growing on three-dimensional (3-D) bone biomaterials consisting of porous hydroxyapatite, porous calcium phosphate, porous nickel-titanium, successfully being used in humans, and also silk fibroin nets. HDMEC did not migrate to form microcapillary-like structures as they did on cell culture plastic. In cocultures of HDMEC…

Clinical and esthetic outcome with immediate insertion and provisionalization with or without connective tissue grafting in presence of mucogingival recessions: A retrospective analysis with follow-up between 1 and 8 years

Background Recessions following immediate implant insertion are frequently reported in the literature. Data regarding implant installation in presence of mucogingival recessions are rare. Purpose This study observes soft tissue level changes following immediate implant insertion and provisionalization of implants with or without connective tissue grafts in the anterior maxilla in patients with initial mucogingival recession within a follow-up period between one and eight years. Materials and methods Twenty-six patients with marginal gingival recessions, which were designated for extraction and immediate implant insertion in the anterior zone of the maxilla (13-23), were included. Out of a l…

Prospective, blinded comparison of cytology and DNA-image cytometry of brush biopsies for early detection of oral malignancy

summary Objectives: Adjunctive techniques like DNA image cytometry (DNA-ICM) have been attributed to enhance the diagnostic performance of oral brush biopsies. The aim of the study was an evaluation of brush biopsies, analysed according to morphological criteria and by DNA-ICM vs. histological findings in a blinded prospective trial. Materials and methods: Eighty eight brush biopsies of 70 patients were sampled. Only clinical suspicious but not evident malignant oral lesions were included. Clinical diagnosis was leukoplakia (n = 36), lichen planus (n = 18), verruciform erythroplakia (n = 12), erythroleukoplakia (n = 9), erosion (n = 7) and induration (n = 6). Evaluation was conducted via hi…

Primary loading of palatal implants for orthodontic anchorage--a pilot animal study.

Summary Objectives This study aimed at evaluating the clinical performance and osseointegration of short orthodontic implants immediately loaded with orthodontic forces. Material and methods The investigation was designed as an experimental animal study. Eight palatal implants of the Ortho-system® were immediately loaded with 100 cN after palatal insertion in 4 female german shepherd dogs. Xylene orange and calcein green were used for polychrome sequential labelling. Histological preparation utilized the cutting and grinding technique. Outcome variables were clinical implant success, histological osseointegration and bone-to-implant contact rates. Results All (8/8) implants were clinically …

Diagnosis of oral squamous cell carcinoma and its precursor lesions

Improvement of survival rate and quality of life after treatment of oral squamous cell carcinoma as well as cost reduction requires reliable early diagnosis of the tumor and its precursor lesions. Four different screening methods are primarily employed: toluidine blue staining (visually detected lesions: sensitivity 70-100%, specificity 25-67%), photodynamic diagnosis (sensitivity 94-99%, specificity 60-89%), autofluorescence (no data published so far) and modern oral cytology (sensitivity 80%,specificity 95-100%). Additional analytic procedures such automated image analysis, DNA image cytometry and immunocytochemistry can be used to enhance the low sensitivity of conventional oral cytology…

Surgically Assisted Rapid Palatal Expansion An Acoustic Rhinometric, Morphometric and Sonographic Investigation

This study aimed to evaluate the effect of surgically assisted rapid palatal expansion on the skeletal structures of the midface. Ten patients (mean age 28.5 years) were investigated by means of acoustic rhinometry, study model analysis and sonography before and after the procedure of surgically assisted rapid palatal expansion. The measurements revealed that surgically assisted rapid palatal expansion not only resulted in transverse expansion of the maxilla, providing dental arch space for lining up the teeth; the procedure also caused a substantial enlargement of the maxillary apical base and of the palatal vault, providing space for the tongue for correct swallowing and thus preventing r…

Acoustic monitoring of the artificial airway — experimental results

Non-invasive acoustic airway-monitoring was evaluated in an experimental study. Recording amplitude and travel time of acoustic pulse response, an acoustic pattern of airway's geometry was then calculated. Measurements on models and excised human cadaver lungs were performed to discover whether displacement or obstruction of the artificial airway could be detected by its acoustic equivalent. Regression analysis revealed a close correlation between displacement of tracheostomy tubes and the shifting of the acoustic area-distance function (corr. coeff.: 0.97-1) and an adequate correlation between acoustic and planimetrical determination of cross-sectional area within the tubes (corr. coeff.: …

Veränderungen des nasalen Atemwegs durch transversale Distraktion des Oberkiefers

Fragestellung: In dieser Untersuchung sollten die Auswirkungen der transversalen Distraktion des Oberkiefers auf den nasalen Atemweg durch ein nichtinvasives Untersuchungsverfahren beschrieben werden. Es wird damit untersucht, ob die chirurgische Gaumennahterweiterung eine Weitung auch der posterioren Oberkieferbasis erreicht und durch Vergroserung des Nasenklappenquerschnitts eine Normalisierung der nasalen Ventilation gelingen kann. Material und Methode: Bei 8 Patienten mit hochgradigem Schmalkiefer wurde eine transversale Distraktion des Oberkiefers vorgenommen. Vor der Osteotomie und nach Abschlus der Distraktion wurde das Querschnittprofil des nasalen Atemwegs unter lokaler Schleimhaut…

Immediately provisionalized OsseoSpeed(™) Profile implants inserted into extraction sockets: 3-year results.

Objectives A sloped shoulder might improve the congruence between extraction socket and dental implant and may add to a better circumferential support of the peri-implant structures. Therefore, this study evaluates the 3-year clinical outcome (survival and success rates, marginal bone levels, and Pink Esthetic Score (PES)) of immediately inserted and provisionalized OsseoSpeed(™) Profile implants in the anterior maxilla. Material and methods Twenty-one implants were inserted in 16 patients. All implants were immediately placed into extraction sites with and without facial bone deficiencies. A flapless procedure was utilized, and the implants were provisionalized immediately. Facial gaps wer…

Influence of soft tissue grafting, orofacial implant position, and angulation on facial hard and soft tissue thickness at immediately inserted and provisionalized implants in the anterior maxilla.

Background Resorption of hard and soft tissues following immediate implant insertion is frequently reported. Data regarding the influencing factors on facial tissue thickness are rare. Purpose This retrospective study investigated the impact of connective tissue grafting, the orofacial angulation and position of immediately inserted and provisionalized implants on the facial hard and soft tissue thickness in the anterior maxilla within a 1- to 5-year follow-up. Material and methods Implants with the prerequisite of having preoperative and postoperative cone beam computed tomography (CBCT) and a follow-up of 1 to 5 years were included. Facial bone deficiencies were grafted flaplessly with au…

Severe third molar complications including death-lessons from 100 cases requiring hospitalization.

Purpose In this study we investigated patients that were hospitalized due to third molar (M3) complications. Specifically we analyzed frequency, age distribution, and outcome with respect to the M3 clinical status. Patients and Methods We set up a prospective cohort study and included 100 subjects admitted for management of acute M3-associated complications. The clinical status of the M3 was defined as 1 ) prophylactic M3 removal, 2 ) therapeutic (nonelective) M3 removal, or 3 ) M3 present at the time of admission. Outcome variables were clinical infection markers (C-reactive protein, leukocyte counts) and economic parameters (treatment costs, length of hospital stay, and days of disability…

Therapiemonitoring mittels 2-[18F]-FDG-Positronenemissionstomographie nach neoadjuvanter Strahlenbehandlung des Mundhöhlenkarzinoms

Die Kombination strahlentherapeutischer und chirurgischer Behandlungsschritte beim Mundhohlenkarzinom erfordert eine fruhe, objektive Bewertung des Bestrahlungserfolgs. Schlechtes radiotherapeutisches Ansprechverhalten verlangt die moglichst umgehende chirurgische Sanierung auch bei hohem Operations- und Narkoserisiko. Eine deutliche Remission unter Strahlentherapie kann dagegen die Fortsetzung der Bestrahlungsbehandlung begrunden. Die vorliegende Studie untersucht daher die Bewertung des Bestrahlungserfolgs anhand der durch Positronenemissionstomographie (PET) bestimmten Glukosestoffwechselaktivitat.

Inducible NO synthase confers chemoresistance in head and neck cancer by modulating survivin

The dual role of the inducible NO synthase (iNOS) and NO signaling in head and neck squamous cell carcinoma (HNSCC) is a complex and can both promote or inhibit tumor progression. However, the underlying molecular mechanisms are not yet resolved in detail. We show for the first time that conditions, favoring low NO levels conferred resistance against cisplatin/taxol-induced apoptosis in HNSCC cell lines. Cytoprotection was mediated by survivin, because we observed its upregulation subsequent to low doses of the NO donors S-nitroso-N-acetyl-penicillamine (SNAP) and sodium nitroprusside (SNP) or ectopic expression of physiologic amounts of iNOS. Also, RNAi-mediated depletion of survivin block…

Infected osteoradionecrosis of the mandible: follow-up study suggests deterioration in outcome for patients with Actinomyces-positive bone biopsies.

Abstract Infected osteoradionecrosis (IORN) is one of the major complications of oral cancer radiotherapy. Recent studies showed a high prevalence of Actinomyces in IORN. In this study, the clinical follow up of IORN patients ( n  = 25; 20 male, 5 female) with regard to Actinomyces detection in the mandible was analyzed. Within 1.6–119 months of follow up, disease control was achieved in almost 90% of the patients with Actinomyces -negative bone biopsies, but only in 25% of the Actinomyces -positive group. The presence of Actinomyces was associated with a significantly higher risk of treatment failure ( P  = 0.004; Fisher's exact test). This held true when the data were controlled for ‘exte…

Reflexionsakustische Lagebestimmung von Trachealkanülen

Non-invasive acoustic airway monitoring was evaluated in an experimental study. Recording amplitude and travel time of acoustic pulse response, an area-distance function of the cross sectional dimensions of the endotracheal tube and the adjacent airway was calculated to obtain an acoustic pattern of the airway. Measurements on models and excised human cadaver lungs were performed to discover whether displacement or obstruction of the artificial airway can be detected in the acoustic equivalent. Regression analysis revealed a close correlation between displacement of tracheostomy tubes and the shifting of the acoustic area-distance function (corr. coeff. 0.97-1). Dispersion analysis confirme…