Prognose und Prognosefaktoren enossaler Implantate im bestrahlten Kiefer

Zusammenfassung Einleitung: Die kaufunktionelle Wiederherstellung nach Kopf-Hals-Bestrahlung ist gegenuber anderen Tumorpatienten durch Strahlenkaries, Radioxerostomie und Osteoradionekroserisiko zusatzlich limitiert. Es wurde der Frage der Implantatprognose und potentieller Prognosefaktoren im bestrahlten Kiefer nachgegangen. Material und Methode: Die retrospektive Studie erfaste von 1988–1997 197 Implantate (47 Patienten). Die Implantatprognose wurde durch Uberlebenszeitanalyse (Kaplan-Meier) bestimmt, wobei implantatunabhangige Verluste zensiert wurden. Auserdem erfolgte eine Gruppenbildung nach potentiell die Prognose beeinflussenden Parametern. Grupppenunterschiede in den Uberlebensrat…

Konfokale Laser-Scanning-Mikroskopie (CLSM): Histotomographie veränderter Zahnhartgewebe bei pathologischer Mundhöhlenökologie

There is no consensus regarding the aetiology of radiation-induced caries. Lesion formation is assumed to originate either from direct radiogenic damage of the hard tissue or from the indirect effects correlated with radioxerostomia. A comparative study is presented of sound teeth (group 1), teeth with documented radiation caries (group 2), teeth after in situ radiation (group 3): 60 Gy, fractionated) and teeth after in vitro radiation (group 4: 500-2500 Gy). Radiations were carried out with a 60Co source. The dentoenamel junction was studied with confocal laser scanning microscopy (CLSM). Axial sections of the teeth were used either fresh or embedded in Technovit (sawing-grinding technique…

Terminal end of the human odontoblast processes

Die Rosai-Dorfman-Lymphadenopathie, eine seltene reaktive lymphoproliferative Erkrankung

Aim The established criteria for benignity or malignancy of lymph nodes when evaluated with B-mode ultrasound can be divided into quantitative measures (size, quantity, contour and density) and qualitative parameters (configuration and structure). The validity of these criteria is controversial. Methods Two cases of sinus histiocytosis with massive lymphadenopathy (SHML) are presented; this is a rare benign reactive disorder in which massive enlargement of cervical lymph nodes often occurs. These enlarged nodes offer a chance to demonstrate and discuss the validity of the sonomorphological criteria. Results The enlarged lymph nodes in SHML fulfill most of the criteria for malignancy. The sa…

Histotomography of the odontoblast processes at the dentine-enamel junction of permanent healthy human teeth in the confocal laser scanning microscope

The translucency of teeth allows the non-destructive subsurface visualisation of their microstructure by confocal laser scanning microscopy (CLSM) at a level of about 150 μm below the surface. The dentine–enamel junction (DEJ) is accessible only directly adjacent to the cervix of the tooth. Therefore teeth have to be sectioned for studying marginal areas of the dental hard tissue. The potential of the technique for (pseudo) three-dimensional visualisation allows the study of an array of individual confocal images, the interpretation of which is similar to that of macroscopic tomographs (CT-scan, MRI). Additionally, the extended focus mode yields the overlay of individual confocal images in …

Incidence of bisphosphonate-associated osteonecrosis of the jaws in breast cancer patients.

BACKGROUND: Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is a relatively new disease. The aim of this study was to evaluate the prevalence of BP-ONJ in breast cancer patients with osseous metastasis and bisphosphonate therapy. METHODS: A retrospective study was conducted in a EUSOMA accredited breast unit in Germany. All patients treated from January of 2000 to March of 2006 with metastatic breast cancer and bisphosphonate therapy were reviewed. All patients were contacted, and missing data were completed through structured interviews with their dentists and physicians (n = 75). Primary outcome was the development of BP-ONJ and the detection of possible additional trigger fa…

Prophylaxis of radiogenic sialadenitis and mucositis by coumarin/troxerutine in patients with head and neck cancer--a prospective,randomized, placebo-controlled, double-blind study.

To study the efficacy of coumarin/troxerutine for the protection of salivary glands and mucosa during irradiation. Design: Prospective, randomized, placebo-controlled, double-blind trial. Setting: University hospital, Germany. Patients: 48 patients who had radiotherapy to the head and neck. Main outcome measures: Salivary gland scintigraphy and acute side-effects of radiotherapy (Radiation Therapy Oncology Group (RTOG) score). Results: 23 patients (11 experimental, 12 placebo) completed the study. The global efficacy measure combining scintigraphy and RTOG score favoured the experimental arm (P= 0.07). The RTOG score showed significantly fewer acute side-effects of radiation in the experime…

Effect of the Parotid Function on the Dental Health after Radiotherapy of the Head and Neck Region

Läßt sich das sonomorphologische Lymphknotenstaging bei Kopf-Hals-Karzinomen automatisieren?

OBJECTIVES B-scan ultrasound imaging is an obligatory examination of great clinical relevance in patients with head and neck cancer. The procedure, however, is dependent on an experienced examiner and thus requires higher personal resources than other examination techniques. In addition, its subjective character leads to possible deficits in reliability and objectivity. Established sonomorphologic criteria (echo-contour, echo-density, echo-structure, boundary) should therefore be matched to the findings of computer aided sonomorphometry. METHOD 200 sonographic images of the cervical region of patients with oral carcinoma were analysed semi- and fully automatically as well as interactively b…

Using ultrasound transmission velocity to analyse the mechanical properties of teeth after in vitro, in situ, and in vivo irradiation.

Ultrasound transmission velocity (UTV) in isotropic material as a measure for the modulus of elasticity was correlated to mechanical properties. Changes in micromechanical properties of radiated teeth and influence of the oral cavity were to be evaluated nondestructively. UTV was measured in extracted teeth after 36 Gy and 62 Gy of in situ (enorally, with no contact to the oral cavity) and in vitro irradiation. Relative to controls, teeth subjected to 62 Gy in vivo showed higher UTV values for dentine and enamel. Sound teeth irradiated with 60 Gy in situ also showed higher UTV values for enamel, whereas dentine values were not significantly different from those of control. The mechanical pr…

Konfokale Laser Scanning Mikroskopie (CLSM) kortikalen Knochens – Vergleichende Darstellung mit konventioneller Mikroskopie

The effect of amifostine or IMRT to preserve the parotid function after radiotherapy of the head and neck region measured by quantitative salivary gland scintigraphy

Purpose: In this retrospective study, two approaches to preserve the parotid function after radiotherapy (RT) were compared: application of the radioprotective agent amifostine during RT and parotid sparing intensity-modulated radiotherapy (IMRT). Patients and methods: Patients were qualified for this analysis if (1) both parotid glands received a radiation dose of P50 Gy using conventional radiotherapy techniques (cRT) or if they received a parotid sparing IMRT as alternative, if (2) salivary gland scintigraphies before and after RT were performed, and if (3) a normal parotid function was present before RT. Quantitative salivary gland scintigraphy was used to assess the parotid gland funct…

Treatment of injuries to the inferior alveolar nerve after endodontic procedures.

Overextension of filling material into the mandibular canal after root treatment in the lower jaw is a rare but serious complication. Mechanical compression, chemical neurotoxicity and local infection may cause irreversible nerve damage. A report on 11 patients with neurological complaints of the inferior alveolar nerve after endodontic treatment is summarised. The neurological findings are dominated by hypaesthesia and dysaesthesia. Half of the patients reported pain. Hyperaesthesia is found much more rarely. Nearly all the patients had a combination of one or more symptoms. Initial X-rays showed root filling material in the area of the mandibular canal. Nine cases were treated with apicec…

Das basaloide Plattenepithelkarzinom (BSC) der Mundschleimhaut

The basaloid-squamous carcinoma (BSC) that was first described in 1986 by Wain et al. for the head and neck region is a rare distinct variant of squamous cell carcinoma (SCC). The cardinal histopathologic feature is a biphasic cellular pattern of basaloid and squamous components. BSC has been confused with solid adenoid cystic carcinoma (ACC). Although the number of reported cases is small, BSC appears biologically virulent, with a propensity to aggressive local behavior, early regional and distant metastasis, and subsequent poor survival. We report the clinicopathological characteristics of 4 new cases and compare their immunohistochemical features with those of solid ACC and conventional …

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.

Neue Erkenntnisse zur Ätiologie der sogenannten Strahlenkaries

Fragestellung Die Atiologie der Strahlenkaries wird trotz vieler Untersuchungen kontrovers diskutiert: Die These einer direkten radiogenen Lasion des Zahnhartgewebes steht der einer indirekten Pathogenese uber die Radioxerostomie gegenuber.

Mikromorphometrie und Stereographie des Rauhtiefenreliefs beschichteter Implantatoberflächen durch Rasterelektronenmikroskopie und konfokale Laser-Scanning Mikroskopie

Protective effect of amifostine on dental health after radiotherapy of the head and neck.

Abstract Purpose: The cytoprotective agent amifostine has been shown to reduce the radiation-induced acute and chronic xerostomia in head and neck cancer patients. The purpose of this study was to evaluate whether or not amifostine also reduces the incidence of dental caries associated with the radiation-induced xerostomia. Methods and Materials: The dental status before and 1 year after radiotherapy was retrospectively compared in 35 unselected patients treated as part of the prospective randomized and multicenter open-label Phase III study (WR-38) at the University Hospitals of Heidelberg, Freiburg, and Erlangen. The WR-38 study compared radiotherapy in head and neck cancer with and witho…

Prevalence and risk factors of bisphosphonate-associated osteonecrosis of the jaw in prostate cancer patients with advanced disease treated with zoledronate.

Abstract Background In addition to other treatments, patients with prostate cancer (pCA) and bone metastasis receive bisphosphonates. Since 2003, a previously unknown side-effect of bisphosphonates—bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ)—has been described, and frequency has since increased. An exact incidence is still unknown. Objectives The aim of this study was to assess the incidence and additional factors in the development of BP-ONJ. Design, setting, and participants From July 2006 to October 2007, patients with advanced pCA and osseous metastasis receiving bisphosphonate therapy in the Department of Urology or Haematology and Oncology at the Johannes-Gutenberg-Un…

Reply to Athanassios Kyrgidis, Zisis Teleioudis and Konstantinos Vahtsevanos’ Letter to the Editor re: Christian Walter, Bilal Al-Nawas, Knut A. Grötz, et al. Prevalence and Risk Factors of Bisphosphonate-Associated Osteonecrosis of the Jaw in Prostate Cancer Patients with Advanced Disease Treated with Zoledronate. Eur Urol 2008;54:1066–72

Prevalence of bisphosphonate associated osteonecrosis of the jaws in multiple myeloma patients

Abstract Background Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is an adverse effect of bisphosphonate treatment with varying reported incidence rates. Methods In two neighboring German cities, prevalence and additional factors of the development of BP-ONJ in multiple myeloma patients with bisphosphonates therapy were recorded using a retrospective (RS) and cross-sectional study (CSS) design. For the RS, all patients treated from Jan. 2000 - Feb. 2006 were contacted by letter. In the CSS, all patients treated from Oct. 2006 - Mar. 2008 had a physical and dental examination. Additionally, a literature review was conducted to evaluate all articles reporting on BP-ONJ prevalen…