1
|
Spille J, Bube N, Wagner J, Spille D, Birkenfeld F, Kübel P, Wiltfang J, Gülses A. Navigational exploration of bony defect mimicking a solid lesion of the mandible compared to conventional surgery by young professionals. J Stomatol Oral Maxillofac Surg 2024; 125:101588. [PMID: 37543209 DOI: 10.1016/j.jormas.2023.101588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/18/2023] [Accepted: 08/02/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION The aim of the current study was to evaluate the accuracy of resection a solid lesion in an acrylic lower jaw by young professionals using a dynamic computer-assisted surgical system comparted to conventional surgery technique. MATERIAL AND METHODS Twenty students performed the removal of the lesion conventionally and twenty students did the operation with a dynamic computer-assisted surgical system. Both groups were compared regarding the defect size, operation time, and surgical complications. RESULTS The defect size in the jaw was significant smaller with the navigated surgery (p < 0.001). Operation time was shorter without navigation system, but no significance was found (p = 0.137). Without navigation system three young professionals perforated the lingual cortex. DISCUSSION Navigated surgery can immediately be used by young professionals and support young surgeons in everyday clinical practice, especially in operations with difficult anatomic situations.
Collapse
Affiliation(s)
- Johannes Spille
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Christian Albrechts University, UKSH- Campus Kiel, Arnold-Heller-Straße 3, Kiel 24105, Germany.
| | - Nele Bube
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Christian Albrechts University, UKSH- Campus Kiel, Arnold-Heller-Straße 3, Kiel 24105, Germany
| | - Juliane Wagner
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Christian Albrechts University, UKSH- Campus Kiel, Arnold-Heller-Straße 3, Kiel 24105, Germany
| | - Dorothee Spille
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Falk Birkenfeld
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Christian Albrechts University, UKSH- Campus Kiel, Arnold-Heller-Straße 3, Kiel 24105, Germany
| | - Paul Kübel
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Christian Albrechts University, UKSH- Campus Kiel, Arnold-Heller-Straße 3, Kiel 24105, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Christian Albrechts University, UKSH- Campus Kiel, Arnold-Heller-Straße 3, Kiel 24105, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Christian Albrechts University, UKSH- Campus Kiel, Arnold-Heller-Straße 3, Kiel 24105, Germany
| |
Collapse
|
2
|
Weitkamp JT, El Hajjami S, Acil Y, Spille J, Sayin S, Okudan ES, Saygili EI, Veziroglu S, Flörke C, Behrendt P, Wiltfang J, Aktas OC, Gülses A. Antibacterial properties of marine algae incorporated polylactide acid membranes as an alternative to clinically applied different collagen membranes. J Mater Sci Mater Med 2024; 35:9. [PMID: 38285196 PMCID: PMC10824850 DOI: 10.1007/s10856-024-06778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/10/2024] [Indexed: 01/30/2024]
Abstract
The reconstruction of bony defects in the alveolar crest poses challenges in dental practice. Guided tissue regeneration (GTR) and guided bone regeneration (GBR) procedures utilize barriers to promote bone regeneration and prevent epithelial growth. This study focuses on evaluating the antibacterial properties of marine algae-polylactic acid (PLA) composite membranes compared to commercially available collagen membranes. Marine algae (Corallina elongata, Galaxaura oblongata, Cystoseira compressa, Saragassum vulgare, and Stypopodium schimperi) were processed into powders and blended with PLA to fabricate composite membranes. Cytocompatibility assays using human periodontal ligament fibroblasts (n = 3) were performed to evaluate biocompatibility. Antibacterial effects were assessed through colony-forming units (CFU) and scanning electron microscopy (SEM) analysis of bacterial colonization on the membranes. The cytocompatibility assays demonstrated suitable biocompatibility of all marine algae-PLA composite membranes with human periodontal ligament fibroblasts. Antibacterial assessment revealed that Sargassum vulgare-PLA membranes exhibited the highest resistance to bacterial colonization, followed by Galaxaura oblongata-PLA and Cystoseira compressa-PLA membranes. SEM analysis confirmed these findings and revealed smooth surface textures for the marine algae-PLA membranes compared to the fibrous and porous structures of collagen membranes. Marine algae-PLA composite membranes show promising antibacterial properties and cytocompatibility for guided bone and tissue regeneration applications. Sargassum vulgare-PLA membranes demonstrated the highest resistance against bacterial colonization. These findings suggest that marine algae-PLA composite membranes could serve as effective biomaterials for infection control and tissue regeneration. Further in vivo validation and investigation of biodegradation properties are necessary to explore their clinical potential.
Collapse
Affiliation(s)
- Jan-Tobias Weitkamp
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - Soumaya El Hajjami
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Yahya Acil
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Johannes Spille
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Selin Sayin
- Marine Science and Technology Faculty, Iskenderun Technical University, 31200, Iskenderun, Hatay, Turkey
| | - Emine Sükran Okudan
- Faculty of Fisheries, Akdeniz University, Dumlupınar Bulvarı, 07058, Antalya, Turkey
| | - Eyüp Ilker Saygili
- Department of Medical Biochemistry, SANKO University, Sehitkamil, 27090, Gaziantep, Turkey
| | - Salih Veziroglu
- Chair for Multicomponent Materials, Institute for Materials Science, Faculty of Engineering, Kiel University, Kaiserstr. 2, 24143, Kiel, Germany
| | - Christian Flörke
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Peter Behrendt
- Department of Anatomy, Christian-Albrechts-Universität zu Kiel, Olshausenstr. 40, 24098, Kiel, Germany
- Department of Orthopedic and Trauma Surgery, Asklepios Skt. Georg, Hamburg, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Oral Cenk Aktas
- Chair for Multicomponent Materials, Institute for Materials Science, Faculty of Engineering, Kiel University, Kaiserstr. 2, 24143, Kiel, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| |
Collapse
|
3
|
Wieker H, Hinrichs C, Retzlaff M, Spille JH, Laudien M, Acil Y, Wiltfang J, Gülses A. A technical feasibility study on adaptation of a microsurgical robotic system to an intraoperative complication management in dental implantology: perforated Schneiderian membrane repair using Symani ® Surgical System. J Robot Surg 2023; 17:2861-2867. [PMID: 37803127 PMCID: PMC10678809 DOI: 10.1007/s11701-023-01721-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/06/2023] [Indexed: 10/08/2023]
Abstract
The aim of the current study was to test the technical and clinical feasibility of a robotic system and investigate its potential in the surgical repair of perforated Schneiderian membranes using an ex-vivo porcine model. Eight pig heads were operated conventionally via a surgical loop and eight pig heads with the surgical robot "Symani® Surgical System" (Medical Microinstruments, Inc., Pisa, Italy). On each specimen, the Schneiderian membrane was incised over a length of 0.7 mm resembling a perforation. Operation time, the maximum sinusoidal pressure, the course of the pressure and the filling volume were measured. Additionally, adaptation of the wound edges has been detected via scanning electron microscopy. There were no significant differences for the pressure maximum (p = 0.528), for the time until the pressure maximum was reached (p = 0.528), or for the maximum filling volume (p = 0.674). The time needed for the suturing of the membrane via robotic surgery was significantly longer (p < 0.001). However, the scanning electron microscope revealed a better adaptation of the wound edges with robotic surgery. The technical feasibility of robot-assisted suturing of Schneiderian membrane laceration using the robotic system has been confirmed for the first time. No differences considering the pressure resistance compared to the conventional repair could be observed, but advantages in wound adaptation could be found with an electron microscope. Regarding the material and training costs and limited indications spectrum, robotic surgery systems still might not present financially feasible options in the daily dental practice yet.
Collapse
Affiliation(s)
- Henning Wieker
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
| | - Cedric Hinrichs
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
| | - Merle Retzlaff
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
| | - Johannes Heinrich Spille
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
| | - Martin Laudien
- Department of ENT Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
| | - Yahya Acil
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany.
| |
Collapse
|
4
|
Spille J, Wagner J, Spille DC, Naujokat H, Gülses A, Wiltfang J, Kübel P. Pronounced mediastinal emphysema after restorative treatment of the lower left molar-a case report and a systematic review of the literature. Oral Maxillofac Surg 2023; 27:533-541. [PMID: 35680758 PMCID: PMC10457226 DOI: 10.1007/s10006-022-01088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
This case report presents an iatrogenic induced mediastinal emphysema after restorative treatment of the lower left second molar, aimed to highlight the potential life-threatening consequences, and providing diagnostics and treatment concepts of complicated dental induced emphysema based on literature review. A 74-year-old female patient was admitted to the emergency department due to a fall on her shoulder. Additional finding was a significant swelling of the face and neck. In the computer tomography of the head, neck, and thorax, a humerus fracture and pronounced soft tissue emphysema from the infraorbital region to the mediastinum was detected. The patient reported that she had been treated by her dentist 4 days earlier. The treatment had to be discontinued after beginning of a pronounced swelling. Other reasons for the emphysema could be excluded out on an interdisciplinary teamwork. The patient was monitored as an inpatient for 5 days and received intravenous antibiotic therapy. This case report shows the rare complication of pronounced mediastinal emphysema after root canal treatment. Emphysema should always be a differential diagnosis of soft tissue swelling and, in case of doubt, a general medical presentation should be made.
Collapse
Affiliation(s)
- Johannes Spille
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH-Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - Juliane Wagner
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH-Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | | | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH-Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH-Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH-Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Paul Kübel
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH-Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| |
Collapse
|
5
|
Wiltfang J, Gülses A. [This is how we carry out dental implantology in patients with inflammatory rheumatic diseases]. Z Rheumatol 2023; 82:599-601. [PMID: 37268788 DOI: 10.1007/s00393-023-01378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Jörg Wiltfang
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| | - Aydin Gülses
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
| |
Collapse
|
6
|
Gülses A, Dohrmann L, Aktas OC, Wagner J, Veziroglu S, Tjardts T, Hartig T, Liedtke KR, Wiltfang J, Acil Y, Flörke C. Decontaminative Properties of Cold Atmospheric Plasma Treatment on Collagen Membranes Used for Guided Bone Regeneration. J Funct Biomater 2023; 14:372. [PMID: 37504867 PMCID: PMC10381767 DOI: 10.3390/jfb14070372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
Background cold atmospheric plasma (CAP) is known to be a surface-friendly yet antimicrobial and activating process for surfaces such as titanium. The aim of the present study was to describe the decontaminating effects of CAP on contaminated collagen membranes and their influence on the properties of this biomaterial in vitro. Material and Methods: A total of n = 18 Bio-Gide® (Geistlich Biomaterials, Baden-Baden, Germany) membranes were examined. The intervention group was divided as follows: n = 6 membranes were treated for one minute, and n = 6 membranes were treated for five minutes with CAP using kINPen® MED (neoplas tools GmbH, Greifswald, Germany) with an output of 5 W, respectively. A non-CAP-treated group (n = 6) served as the control. The topographic alterations were evaluated via X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM). Afterward, the samples were contaminated with E. faecalis for 6 days, and colony-forming unit (CFU) counts and additional SEM analyses were performed. The CFUs increased with CAP treatment time in our analyses, but SEM showed that the surface of the membranes was essentially free from bacteria. However, the deeper layers showed remaining microbial conglomerates. Furthermore, we showed, via XPS analysis, that increasing the CAP time significantly enhances the carbon (carbonyl group) concentration, which also correlates negatively with the decontaminating effects of CAP. Conclusions: Reactive carbonyl groups offer a potential mechanism for inhibiting the growth of E. faecalis on collagen membranes after cold atmospheric plasma treatment.
Collapse
Affiliation(s)
- Aydin Gülses
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Lina Dohrmann
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Oral Cenk Aktas
- Chair for Multicomponent Materials, Institute for Materials Science, Faculty of Engineering, Christian-Albrechts-University of Kiel, 24118 Kiel, Germany
| | - Juliane Wagner
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Salih Veziroglu
- Chair for Multicomponent Materials, Institute for Materials Science, Faculty of Engineering, Christian-Albrechts-University of Kiel, 24118 Kiel, Germany
- Kiel Nano, Surface and Interface Science KiNSIS, Kiel University, Christian Albrechts-Platz 4, 24118 Kiel, Germany
| | - Tim Tjardts
- Chair for Multicomponent Materials, Institute for Materials Science, Faculty of Engineering, Christian-Albrechts-University of Kiel, 24118 Kiel, Germany
| | - Torge Hartig
- Chair for Multicomponent Materials, Institute for Materials Science, Faculty of Engineering, Christian-Albrechts-University of Kiel, 24118 Kiel, Germany
| | - Kim Rouven Liedtke
- Department of Orthopedics, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Yahya Acil
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Christian Flörke
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| |
Collapse
|
7
|
Weitkamp JT, Benz K, Rolauffs B, Bayer A, Weuster M, Lucius R, Gülses A, Naujokat H, Wiltfang J, Lippross S, Hoffmann M, Kurz B, Behrendt P. In Vitro Comparison of 2 Clinically Applied Biomaterials for Autologous Chondrocyte Implantation: Injectable Hydrogel Versus Collagen Scaffold. Cartilage 2023; 14:220-234. [PMID: 36859785 PMCID: PMC10416195 DOI: 10.1177/19476035231154507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE In autologous chondrocyte implantation (ACI), there is no consensus about used bioscaffolds. The aim of this study was to perform an in vitro comparative analysis of 2 clinically applied biomaterials for cartilage lesion treatment. DESIGN Monolayer expanded human chondrocytes (n = 6) were embedded in a collagen scaffold (CS) and a hyaluronic acid-based hydrogel (HA). Cells were cultured in chondropermissive medium supplemented with and without interleukin-10 (IL-10) and bone morphogenetic protein-2 (BMP-2). Gene expression of chondrogenic markers (COL1A1, COL2A1, COL10A1, ACAN, SOX9) was detected via quantitative real-time-polymerase chain reaction (RT-qPCR). Biosynthesis of matrix compounds, cell viability, morphology as well as migration from surrounding native bovine cartilage into cell-free scaffolds were analyzed histologically. Adhesion of the material to adjacent cartilage was investigated by a custom-made push-out test. RESULTS The shift of COL1/2 ratio toward COL2A1 was more pronounced in HA, and cells displayed a more spherical morphology compared with CS. BMP-2 and IL-10 significantly increased COL2A1, SOX9, and ACAN expression, which was paralleled by enhanced staining of glycosaminoglycans (GAGs) and type 2 collagen in histological sections of CS and HA. COL10A1 was not significantly expressed in HA and CS. Better interfacial integration and enhanced cell invasion was observed in CS. Push-out tests using CS showed higher bonding strength to native cartilage. CONCLUSION HA-based hydrogel revealed a more chondrocyte-like phenotype but only allowed limited cell invasion, whereas CS were advantageous in terms of cellular invasion and interfacial adhesion. These differences may be clinically relevant when treating cartilaginous or osteochondral defects.
Collapse
Affiliation(s)
- Jan-Tobias Weitkamp
- Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Department of Anatomy, Kiel University, Kiel, Germany
| | - Karin Benz
- TETEC Tissue Engineering Technologies AG, Reutlingen, Germany
| | - Bernd Rolauffs
- G.E.R.N. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Andreas Bayer
- Department of Anatomy, Kiel University, Kiel, Germany
| | - Matthias Weuster
- Clinic for Trauma Surgery, Diako Hospital Flensburg, Flensburg, Germany
| | - Ralph Lucius
- Department of Anatomy, Kiel University, Kiel, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sebastian Lippross
- Department of Trauma and Orthopedic Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Michael Hoffmann
- Department of Trauma Surgery, Orthopedics and Sportsorthopedics, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Bodo Kurz
- Department of Anatomy, Kiel University, Kiel, Germany
| | - Peter Behrendt
- Department of Anatomy, Kiel University, Kiel, Germany
- Department of Trauma Surgery, Orthopedics and Sportsorthopedics, Asklepios Klinik St. Georg, Hamburg, Germany
| |
Collapse
|
8
|
Gülses A, Wagner J, Torst P, Wieker H, Schulte DM, Spille DC, Wiltfang J, Spille J. Changes in hormones of the thyroid axis after tracheostomy and their influence on regeneration in patients with head and neck cancer: A prospective study. J Craniomaxillofac Surg 2022; 50:910-914. [PMID: 36593129 DOI: 10.1016/j.jcms.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/19/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
This prospective study aimed to compare and evaluate changes in hormones of the thyroid axis affected by tracheostomy due to surgical treatment in patients with oral cancer. The patients were evaluated with regard to serum levels of the thyroid axis - free T3/triiodothyronine (fT3) and free T4/thyroxine (fT4), as well as thyroid-stimulating hormone (TSH) - at fixed perioperative time points: during the tumor staging about 1 week before operation, immediately before and within 6 h after operation, 2 days after operation, and about 10 days after operation. Additionally, data on the patients' characteristics (age, gender), relevant secondary diagnoses, duration of ventilation in the intensive care unit, and perioperative complications were obtained and analyzed. In total, 51 patients with an average age of 68.29 years (±11.82) were included. Analyses of thyroid hormones directly before and after tracheostomy showed a significant postoperative decrease in circulating TSH (p = 0.005) and fT3 (p < 0.001), whilst a significant increase in fT4 values (p < 0.001) was found. Nine patients showed perioperative complications, such as infection, emphysema, or requiring a revision operation. Eleven patients were diagnosed with a cardiac problem or suffered from agitation after operation. Within the limitations of the study it seems that hormonal changes following tracheostomy in critically ill patients should be monitored and thyroid hormone adjustment should be taken into account because the latter might lead to lower mortality and morbidity during hospitalization in these patients. CLINICAL TRIAL REGISTRATION NUMBER: DRKS00023942.
Collapse
Affiliation(s)
- Aydin Gülses
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Juliane Wagner
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Pia Torst
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Henning Wieker
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Dominik Maria Schulte
- Christian Albrechts University, Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, Institute of Diabetes and Clinical Metabolic Research, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Jörg Wiltfang
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Johannes Spille
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| |
Collapse
|
9
|
Ayna M, Spille J, Açil Y, Weitkamp JT, Wiltfang J, Esen C, Gülses A. Investigation of Topographical Alterations in Titanium-Zirconium-Alloy Implant Threads following Er:YAG Irradiation. Materials (Basel) 2022; 15:7889. [PMID: 36431373 PMCID: PMC9696102 DOI: 10.3390/ma15227889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
The aim of the current experimental study was to comparatively assess the surface alterations in titanium and titanium-zirconium alloy implants in terms of thread pitch topography after irradiation with an Er:YAG laser, which is recommended in the literature for its sterilizing effect in the treatment of contaminated implant surfaces. Roxolid® and SLA® (Sand-blasted, Large-grit, Acid-etched) implants from Straumann® company with the same macro topography were investigated. The surface treatment was carried out using a wavelength of 2940 nm, 60 s irradiation time, a frequency of 10 Hz, and energies between 120 mJ and 250 mJ. The alterations were quantitatively analyzed by conducting roughness analysis via white light interferometry and qualitatively using SEM images. Roxolid® could particularly maintain its surface topography at a level of 160 mJ. At an energy level of 250 mJ, the surface properties of the pitch could be significantly altered for the first time. Compared to the Standard Plus dental implants studied, no distinct removal of the material from the surface was detected. The alloy properties of Roxolid® confirm the manufacturer's statement in terms of stability and could offer advantages in peri-implantitis management if decontamination has been selected. However, as a part of a respective strategy, smoothening of a Roxolid® implant surface requires a significantly higher energy level compared to SLA-Standard® dental implants.
Collapse
Affiliation(s)
- Mustafa Ayna
- Department of Periodontology, Bonn University, 53111 Bonn, Germany
| | - Johannes Spille
- Department of Oral and Maxillofacial Surgery, Christian Albrecht University, 24105 Kiel, Germany
| | - Yahya Açil
- Department of Oral and Maxillofacial Surgery, Christian Albrecht University, 24105 Kiel, Germany
| | - Jan-Tobias Weitkamp
- Department of Oral and Maxillofacial Surgery, Christian Albrecht University, 24105 Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, Christian Albrecht University, 24105 Kiel, Germany
| | - Cemal Esen
- Laser Technology, Ruhr University, 44801 Bochum, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, Christian Albrecht University, 24105 Kiel, Germany
| |
Collapse
|
10
|
Ayna M, Gülses A. Adapting a simple surgical manual tool to a 3D printed implantology protocol: the use of a universal screwdriver for fixation of custom-made laser sintered titanium subperiosteal implants. 3D Print Med 2022; 8:31. [PMID: 36302914 PMCID: PMC9615198 DOI: 10.1186/s41205-022-00159-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/18/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Current paper aims to describe a simple technique used for the fixation of the screws of a customized implant via a universal screw driver (BoneTrust® Easy Screw according to Dr. Bayer, Medical Instinct®, GmbH, Germany) to simplify the surgical placement of the customized implants. Methods The insertion of the drilling screws for the retention of the implant with angulated handpiece into the palatinal region or zygomatic buttress were performed with universal screw driver. Results The retention screws could be inserted with a proper angulation without interfering with the surrounding tissues. The technique described herein has significantly simplified the surgical intervention. Conclusion The insertion of the drilling screws for the retention of the implant with angulated handpiece into the palatinal region or zygomatic buttress could be challenging, thus the anatomical structures and the insufficient length of the handpiece could interfere with the placement of the screw with a proper angulation. This problem could be easily managed with the use of universal screw driver.
Collapse
Affiliation(s)
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, Universitätsklinikum Schleswig Holstein, Christian Albrechts University, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| |
Collapse
|
11
|
Naujokat H, Loger K, Gülses A, Flörke C, Acil Y, Wiltfang J. Effect of enriched bone-marrow aspirates on the dimensional stability of cortico-cancellous iliac bone grafts in alveolar ridge augmentation. Int J Implant Dent 2022; 8:34. [PMID: 36063250 PMCID: PMC9445114 DOI: 10.1186/s40729-022-00435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background The objective of the current study was to assess the clinical and radiological outcomes following autologous grafting from the iliac crest treated with autologous stem cells in-situ to reduce the postoperative bone graft resorption rate. Materials and methods The study group consisted of patients who underwent vertical augmentation of the jaws via bone grafts harvested from the iliac crest enriched with bone-marrow aspirate concentrates (stem cell group). The first control group (control) included 40 patients underwent a vertical augmentation with autologous bone grafts from the iliac crest. In the second control group, 40 patients received identical surgical procedure, whereas the autologous bone graft was covered with a thin layer of deproteinized bovine bone matrix and a collagen membrane (DBBM group). Clinical complications, implant survival, radiological assessment of the stability of the vertical height and histological evaluation at the recipient site have been followed up for 24 months postoperatively. Results No differences in terms of implant survival were observed in the groups. In the stem cell group, the resorption after 4–6 months was 1.2 ± 1.3 mm and significantly lower than the resorption of the control group with 1.9 ± 1.6 mm (P = 0.029) (DBBM group: 1.4 ± 1.2 mm). After 12 months, the resorption of the stem cell group was 2.1 ± 1.6 mm and significantly lower compared to the control group (4.2 ± 3.0 mm, P = 0.001) and DBBM group (resorption 2.7 ± 0.9 mm, P = 0.012). The resorption rate in the second year was lower compared to the first year and was measured as 2.7 ± 1.7 mm in the stem cell group (1-year bone loss in the time period of 12–24 months of 0.6 mm compared to 2.1 mm in the first 12 months). The resorption was significantly lower compared to the control group (4.7 ± 2.9 mm; P = 0.003, DBBM group: 3.1 ± 0.5 mm, P = 0.075). Conclusions Autologous bone-marrow aspirate concentrate could enhance the dimensional stability of the bone grafts and improve the clinical standard of complex reconstruction of the alveolar ridge. Even though the intraoperative cell enrichment requires an additional equipment and technical specification, it represents an alternative method for in-situ regeneration by osteogenic induction with a contribution of a manageable cost factor.
Collapse
Affiliation(s)
- Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Head: Prof. Dr. Dr. Jörg Wiltfang), Arnold-Heller-Straße 3, Haus B, Kiel, Germany.
| | - Klaas Loger
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Head: Prof. Dr. Dr. Jörg Wiltfang), Arnold-Heller-Straße 3, Haus B, Kiel, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Head: Prof. Dr. Dr. Jörg Wiltfang), Arnold-Heller-Straße 3, Haus B, Kiel, Germany
| | - Christian Flörke
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Head: Prof. Dr. Dr. Jörg Wiltfang), Arnold-Heller-Straße 3, Haus B, Kiel, Germany
| | - Yahya Acil
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Head: Prof. Dr. Dr. Jörg Wiltfang), Arnold-Heller-Straße 3, Haus B, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Head: Prof. Dr. Dr. Jörg Wiltfang), Arnold-Heller-Straße 3, Haus B, Kiel, Germany
| |
Collapse
|
12
|
Naujokat H, Himmel AL, Behrens E, Gülses A, Wiltfang J, Terheyden H. Treatment satisfaction and oral health-related quality of life in patients with cleft lip and palate after secondary alveolar bone grafting. Int J Oral Maxillofac Surg 2022; 51:1454-1461. [DOI: 10.1016/j.ijom.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
|
13
|
Flörke C, Eisenbeiß AK, Metz U, Gülses A, Acil Y, Wiltfang J, Naujokat H. Introducing a Novel Experimental Model for Osseo-Disintegration of Titanium Dental Implants Induced by Monobacterial Contamination: An In-Vivo Feasibility Study. Materials (Basel) 2021; 14:7076. [PMID: 34832476 PMCID: PMC8623268 DOI: 10.3390/ma14227076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 12/19/2022]
Abstract
Background and Objectives: The aim of the current study was to establish an osseo-disintegration model initiated with a single microorganism in mini-pigs. Materials and Methods: A total of 36 titanium dental implants (3.5 mm in diameter, 9.5 mm in length) was inserted into frontal bone (n: 12) and the basis of the corpus mandible (n: 24). Eighteen implants were contaminated via inoculation of Enterococcus faecalis. Six weeks after implant insertion, bone-to-implant contact (BIC) ratio, interthread bone density (ITBD), and peri-implant bone density (PIBD) were examined. In addition to that, new bone formation was assessed via fluorescence microscopy, histomorphometry, and light microscopical examinations. Results: Compared to the sterile implants, the contaminated implants showed significantly reduced BIC (p < 0.001), ITBD (p < 0.001), and PBD (p < 0.001) values. Around the sterile implants, the green and red fluorophores were overlapping and surrounding the implant without gaps, indicating healthy bone growth on the implant surface, whereas contaminated implants were surrounded by connective tissue. Conclusions: The current experimental model could be a feasible option to realize a significant alteration of dental-implant osseointegration and examine novel surface decontamination techniques without impairing local and systemic inflammatory complications.
Collapse
Affiliation(s)
- Christian Flörke
- Department of Oral and Maxillofacial Surgery, UKSH, Christian-Albrechts-University, 24105 Kiel, Germany; (A.-K.E.); (U.M.); (Y.A.); (J.W.); (H.N.)
| | | | | | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, UKSH, Christian-Albrechts-University, 24105 Kiel, Germany; (A.-K.E.); (U.M.); (Y.A.); (J.W.); (H.N.)
| | | | | | | |
Collapse
|
14
|
Gülses A, Flörke C, Wieker H, Wiltfang J. A technical note on establishment of a high hydraulic outflow in arthrocentesis of the temporomandibular joint. Cranio 2021; 39:549-551. [PMID: 34643157 DOI: 10.1080/08869634.2021.1980683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Aydin Gülses
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, Universitätsklinikum Schleswig Holstein, Kiel, Germany
| | - Christian Flörke
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, Universitätsklinikum Schleswig Holstein, Kiel, Germany
| | - Henning Wieker
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, Universitätsklinikum Schleswig Holstein, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, Universitätsklinikum Schleswig Holstein, Kiel, Germany
| |
Collapse
|
15
|
Gülses A, Klingauf L, Emmert M, Karayürek F, Naujokat H, Acil Y, Wiltfang J, Spille J. Injury patterns and outcomes in bicycle-related maxillofacial traumata: A retrospective analysis of 162 cases. J Craniomaxillofac Surg 2021; 50:70-75. [PMID: 34620537 DOI: 10.1016/j.jcms.2021.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/27/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022] Open
Abstract
The objective of the current study is to retrospectively evaluate cycling related dental and maxillofacial injuries and to gain insight into the epidemiology and results of these accidents. Data of patients who were admitted due to the maxillofacial injuries between April 2018 and September 2020 were retrospectively evaluated regarding the patients' characteristics, helmet wearing, type of radiological assessment required for diagnosis and therapy, injury patterns, duration of hospitalization and concomitant injuries. Data of 162 patients were included. 86 (53.08%) patients presented with at least one maxillofacial fracture. A total of 186 maxillofacial bones were fractured. Zygomatico-maxillary complex was the most commonly affected region (n:103, 55,36%). Analysis of the dental traumata revealed that crown fracture without pulp exposure was the most commonly observed entity (n:37, 32.46%) and upper central incisors (n:61, 53.50%) were the most commonly affected teeth. The overall ratio of the number of the fracture line/fracture case was 2.80. However, this ratio was statistically higher in e-bike cases (4.25) compared to non-e-bike riders (2.34) (p:0.014). Bicycle related maxillofacial injuries could correlate with specific morbidity rates and result in severe injuries of the maxillofacial region.
Collapse
Affiliation(s)
- Aydin Gülses
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, UKSH- Campus Kiel, Kiel, Germany.
| | - Livia Klingauf
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, UKSH- Campus Kiel, Kiel, Germany
| | - Marie Emmert
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, UKSH- Campus Kiel, Kiel, Germany
| | - Fatih Karayürek
- Cankiri Karatekin University, Department of Periodontology, Cankiri, Turkey
| | - Hendrik Naujokat
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, UKSH- Campus Kiel, Kiel, Germany
| | - Yahya Acil
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, UKSH- Campus Kiel, Kiel, Germany
| | - Jörg Wiltfang
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, UKSH- Campus Kiel, Kiel, Germany
| | - Johannes Spille
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, UKSH- Campus Kiel, Kiel, Germany
| |
Collapse
|
16
|
Emmert M, Spille J, Behrens E, Ayna M, Karayurek F, Wiltfang J, Acil Y, Gülses A. Comparative assessment of the primary stability of Straumann® BLX implant design using an in-vitro sinus lift-simultaneous implant insertion model. J ORAL IMPLANTOL 2021; 48:269-275. [PMID: 34494117 DOI: 10.1563/aaid-joi-d-20-00411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Straumann ® BLX is a novel implant system, which has been proclaimed to provide an ideal primary stability in all types of bone. In the current study, the primary stability of Straumann ® BLX implant systems with Straumann ® tapered effect (TE) implants have been comparatively assessed in bovine ribs by using a simultaneous sinus elevation and implant insertion model. In the study group, BLX (4.0 x 12 mm), TE (4.1 x 12 mm), BLX (4,5 x 12 mm) and TE (4.8 x 12 mm) were placed in each bony window, which resembles sinus maxillaris. As a control, BLX and TE implants with same sizes were inserted into the proximal diaphysis of the bovine ribs. A total of 40 implant insertions were performed. The stability was measured with resonance frequence analysis. In the study group, TE implants of 4.8 mm showed significantly higher values compared to 4.5 mm BLX implants (p=0.116). However, BLX implants of 4.0 mm in the control group showed higher stability compared to TE with 4.0 mm diameter. (p=0.014). The primary stability of BLX implants in the control group was significantly higher compared to the experimental group in both widths (p=0.018 for BLX 4.0 and p=0.002 for BLX 4.5 respectively). The use of TE design with wide diameter in simultaneous implant placement with sinus lift could present higher ISQ values and might be more appropriate option for implant recipient sites with poor bone volume and quality. However, the advantage of BLX design in standard implant insertion protocols could be precious.
Collapse
Affiliation(s)
- Marie Emmert
- Christian-Albrechts-Universität zu Kiel: Christian-Albrechts-Universitat zu Kiel Oral and Maxillofacial Surgery Arnold Heller Straße 3 GERMANY Kiel Schleswig Holstein 24105 Christian-Albrechts-Universität zu Kiel: Christian-Albrechts-Universitat zu Kiel
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Emmert M, Gülses A, Behrens E, Karayürek F, Acil Y, Wiltfang J, Spille JH. An experimental study on the effects of the cortical thickness and bone density on initial mechanical anchorage of different Straumann® implant designs. Int J Implant Dent 2021; 7:83. [PMID: 34458954 PMCID: PMC8403613 DOI: 10.1186/s40729-021-00367-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/16/2021] [Indexed: 12/20/2022] Open
Abstract
Background The aim of the current study was to comparatively assess the primary stability of different Straumann® implant designs (BLX, Straumann Tapered Effect, Bone Level Tapered, and Standard Plus) via resonance frequency analysis by using an implant insertion model in freshly slaughtered bovine ribs with and without cortical bone. Tapered Effect (4.1 × 10 mm), Bone Level Tapered (4.1 × 10 mm), Standard Plus (4.1 × 10 mm), and BLX (4.0 × 10 mm) implants were inserted into the distal epiphysis on the longitudinal axis of the freshly slaughtered bovine ribs. As a control, implants with the same sizes were inserted into the proximal diaphysis. The stability of the implants was examined with resonance frequency analysis. Results BLX and Tapered Effect implants showed higher implant stability quotient values in both study and control groups. All implant systems showed a significant decrease of mechanical anchorage in the study group. BLX and Bone Level Tapered designs had a significantly lower loss of mechanical anchorage in the lack of cortical bone. Conclusion Both Tapered Effect and BLX designs could ensure sufficient initial stability; however, BLX implants could be an appropriate option in the lack of cortical bone and poor bone quality at the implant recipient site. Clinical relevance BLX is a novel implant system, which could be especially beneficial in the presence of spongious bone type at posterior maxillae.
Collapse
Affiliation(s)
- Marie Emmert
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Aydin Gülses
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - Eleonore Behrens
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Fatih Karayürek
- Department of Periodontology, Cankiri Karatekin University, Cankiri, Turkey
| | - Yahya Acil
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Jörg Wiltfang
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Johannes Heinrich Spille
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| |
Collapse
|
18
|
Naujokat H, Rohwedder J, Gülses A, Cenk Aktas O, Wiltfang J, Açil Y. CAD/CAM scaffolds for bone tissue engineering: investigation of biocompatibility of selective laser melted lightweight titanium. IET Nanobiotechnol 2021; 14:584-589. [PMID: 33010133 DOI: 10.1049/iet-nbt.2019.0320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The objective of the current in-vitro study was to evaluate the biocompatibility of a new type of CAD/CAM scaffold for bone tissue engineering by using human cells. Porous lightweight titanium scaffolds and Bio-Oss® scaffolds as well as their eluates were used for incubation with human osteoblasts, fibroblasts and osteosarcoma cells. The cell viability was assessed by using fluorescein diazo-acetate propidium iodide staining. Cell proliferation and metabolism was examined by using MTT-, WST-Test and BrdU-ELISA tests. Scanning electron microscope was used for investigation of the cell adhesion behaviour. The number of devitalised cells in all treatment groups did not significantly deviate from the control group. According to MTT and WST results, the number of metabolically active cells was decreased by the eluates of both test groups with a more pronounced impact of the eluate from Bio-Oss®. The proliferation of the cells was inhibited by the addition of the eluates. Both scaffolds showed a partial surface coverage after 1 week and an extensive to complete coverage after 3 weeks. The CAD/CAM titanium scaffolds showed favourable biocompatibility compared to Bio-Oss® scaffolds in vitro. The opportunity of a defect-specific design and rapid prototyping by selective laser melting are relevant advantages in the field of bone tissue engineering and regenerative medicine.
Collapse
Affiliation(s)
- Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Johanna Rohwedder
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Oral Cenk Aktas
- Institute for Materials Science, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Yahya Açil
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| |
Collapse
|
19
|
Es-Souni M, Es-Souni M, Bakhti H, Gülses A, Fischer-Brandies H, Açil Y, Wiltfang J, Flörke C. A Bacteria and Cell Repellent Zwitterionic Polymer Coating on Titanium Base Substrates towards Smart Implant Devices. Polymers (Basel) 2021; 13:2472. [PMID: 34372075 PMCID: PMC8347386 DOI: 10.3390/polym13152472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/17/2021] [Accepted: 07/18/2021] [Indexed: 12/12/2022] Open
Abstract
Biofouling and biofilm formation on implant surfaces are serious issues that more than often lead to inflammatory reactions and the necessity of lengthy post-operation treatments or the removal of the implant, thus entailing a protracted healing process. This issue may be tackled with a biocompatible polymeric coating that at the same time prevents biofouling. In this work, oxygen plasma-activated silanized titanium substrates are coated with poly(sulfobetaine methacrylate), a zwitterionic antibiofouling polymer, using photopolymerization. The characterization of polymer films includes FT-IR, AFM, and adhesion strength measurements, where adhesion strength is analyzed using a cylindrical flat punch indenter and water contact angle (WCA) measurements. Both cytotoxicity analysis with primary human fibroblasts and fluorescence microscopy with fibroblasts and plaque bacteria are also performed is this work, with each procedure including seeding on coated and control surfaces. The film morphology obtained by the AFM shows a fine structure akin to nanoropes. The coatings can resist ultrasonic and sterilization treatments. The adhesion strength properties substantially increase when the films are soaked in 0.51 M of NaCl prior to testing when compared to deionized water. The coatings are superhydrophilic with a WCA of 10° that increases to 15° after dry aging. The viability of fibroblasts in the presence of coated substrates is comparable to that of bare titanium. When in direct contact with fibroblasts or bacteria, marginal adhesion for both species occurs on coating imperfections. Because photopolymerization can easily be adapted to surface patterning, smart devices that promote both osseointegration (in non-coated areas) and prevent cell overgrowth and biofilm formation (in coated areas) demonstrate practical potential.
Collapse
Affiliation(s)
- Mona Es-Souni
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, CAU, 24103 Kiel, Germany; (M.E.-S.); (A.G.); (Y.A.); (J.W.); (C.F.)
| | - Martha Es-Souni
- Department of Orthodontics, Faculty of Dentistry, CAU, 24103 Kiel, Germany;
| | - Hamzah Bakhti
- Department of Mathematics, University of Hamburg, 20146 Hamburg, Germany;
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, CAU, 24103 Kiel, Germany; (M.E.-S.); (A.G.); (Y.A.); (J.W.); (C.F.)
| | | | - Yahya Açil
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, CAU, 24103 Kiel, Germany; (M.E.-S.); (A.G.); (Y.A.); (J.W.); (C.F.)
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, CAU, 24103 Kiel, Germany; (M.E.-S.); (A.G.); (Y.A.); (J.W.); (C.F.)
| | - Christian Flörke
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, CAU, 24103 Kiel, Germany; (M.E.-S.); (A.G.); (Y.A.); (J.W.); (C.F.)
| |
Collapse
|
20
|
Spille J, Jin F, Behrens E, Açil Y, Lichtenstein J, Naujokat H, Gülses A, Flörke C, Wiltfang J. Comparison of implant placement accuracy in two different preoperative digital workflows: navigated vs. pilot-drill-guided surgery. Int J Implant Dent 2021; 7:45. [PMID: 33928447 PMCID: PMC8085150 DOI: 10.1186/s40729-021-00322-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/17/2021] [Indexed: 11/15/2022] Open
Abstract
Background The aim of the study is to evaluate the accuracy of a new implant navigation system on two different digital workflows. Methods A total of 18 phantom jaws consisting of hard and non-warping plastic and resembling edentulous jaws were used to stimulate a clinical circumstance. A conventional pilot-drill guide was conducted by a technician, and a master model was set by using this laboratory-produced guide. After cone beam computed tomography (CBCT) and 3D scanning of the master models, two different digital workflows (marker tray in CBCT and 3D-printed tray) were performed based on the Digital Imaging Communication in Medicine files and standard tessellation language files. Eight Straumann implants (4.1 mm × 10 mm) were placed in each model, six models for each group, resulting in 144 implant placements in total. Postoperative CBCT were taken, and deviations at the entry point and apex as well as angular deviations were measured compared to the master model. Results The mean total deviations at the implant entry point for MTC (marker tray in CBCT), 3dPT (3d-printed tray), and PDG (pilot-drill guide) were 1.024 ± 0.446 mm, 1.027 ± 0.455 mm, and 1.009 ± 0.415 mm, respectively, and the mean total deviations at the implant apex were 1.026 ± 0.383 mm, 1.116 ± 0.530 mm, and 1.068 ± 0.384 mm. The angular deviation for the MTC group was 2.22 ± 1.54°. The 3dPT group revealed an angular deviation of 1.95 ± 1.35°, whereas the PDG group showed a mean angular deviation of 2.67 ± 1.58°. Although there were no significant differences among the three groups (P > 0.05), the navigation groups showed lesser angular deviations compared to the pilot-drill-guide (PDG) group. Implants in the 3D-printed tray navigation group showed higher deviations at both entry point and apex. Conclusions The accuracy of the evaluated navigation system was similar with the accuracy of a pilot-drill guide. Accuracy of both preoperative workflows (marker tray in CBCT or 3D-printed tray) was reliable for clinical use.
Collapse
Affiliation(s)
- Johannes Spille
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - Feilu Jin
- Department of oral and Maxillofacial Surgery, School of Medicine, 2nd Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China
| | - Eleonore Behrens
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Yahya Açil
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Jürgen Lichtenstein
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Hendrik Naujokat
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Aydin Gülses
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Christian Flörke
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Jörg Wiltfang
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| |
Collapse
|
21
|
Ayna M, Karayürek F, Jepsen S, Emmert M, Acil Y, Wiltfang J, Gülses A. Six-year clinical outcomes of implant-supported acrylic vs. ceramic superstructures according to the All-on-4 treatment concept for the rehabilitation of the edentulous maxilla. Odontology 2021; 109:930-940. [PMID: 33837889 PMCID: PMC8387254 DOI: 10.1007/s10266-021-00605-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Abstract
The aim of the current study was to document the long-term clinical results of the use of two prosthetic techniques for the rehabilitation of completely edentulous maxillae according to the “All-on-Four” concept: Fixed, screw-retained prosthesis mounted on a chrome-molybdenum framework with (1) metal-ceramic veneers and (2) Acrylic prosthesis with acrylic resin prosthetic teeth. A total of 34 patients were assigned to subgroups according to their own preference of the superstructure type (ceramics [n: 17] or acrylic resin [n: 17]). Prosthetic complications, marginal bone loss, plaque accumulation, bleeding on probing, bite force and oral-health-related quality of life were assessed over a period of 6 years. Marginal bone loss around implants of the ceramic group remained well within the limits for ‘success’, as defined by the 2007 Pisa consensus over the time (1.43 ± 0.35 mm). However, marginal bone loss was significantly more pronounced around the implants in the acrylic group (2.15 ± 0.30) and the difference between two groups was statistically significant (p: 0.00). Bleeding on probing and plaque accumulation showed also positive correlation with marginal bone loss. Both acrylic and ceramic suprastructures appeared to be equivalent after 6 years; however, ceramic suprastructures revealed superior clinical results in terms of bone loss and plaque accumulation. Current study determines the long-term clinical outcomes of different prosthetic management alternatives in All-on-Four and aids to increase dental professionals’ ability to meet the patients’ expectations.
Collapse
Affiliation(s)
- Mustafa Ayna
- Department of Periodontology, University Hospital Bonn, Bonn University, Bonn, Germany
| | - Fatih Karayürek
- Department of Periodontology, Cankiri Karatekin University, Cankiri, Turkey
| | - Søren Jepsen
- Department of Periodontology, University Hospital Bonn, Bonn University, Bonn, Germany
| | - Marie Emmert
- Department of Oral and Maxillofacial Surgery, Universitätsklinikum Schleswig Holstein, Christian Albrechts University, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Yahya Acil
- Department of Oral and Maxillofacial Surgery, Universitätsklinikum Schleswig Holstein, Christian Albrechts University, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, Universitätsklinikum Schleswig Holstein, Christian Albrechts University, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, Universitätsklinikum Schleswig Holstein, Christian Albrechts University, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| |
Collapse
|
22
|
Reichstein W, Sommer L, Veziroglu S, Sayin S, Schröder S, Mishra YK, Saygili Eİ, Karayürek F, Açil Y, Wiltfang J, Gülses A, Faupel F, Aktas OC. Initiated Chemical Vapor Deposition (iCVD) Functionalized Polylactic Acid-Marine Algae Composite Patch for Bone Tissue Engineering. Polymers (Basel) 2021; 13:polym13020186. [PMID: 33430187 PMCID: PMC7825612 DOI: 10.3390/polym13020186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 12/19/2022] Open
Abstract
The current study aimed to describe the fabrication of a composite patch by incorporating marine algae powders (MAPs) into poly-lactic acid (PLA) for bone tissue engineering. The prepared composite patch was functionalized with the co-polymer, poly (2-hydroxyethyl methacrylate-co-ethylene glycol dimethacrylate) (p(HEMA-co-EGDMA)) via initiated chemical vapor deposition (iCVD) to improve its wettability and overall biocompatibility. The iCVD functionalized MAP–PLA composite patch showed superior cell interaction of human osteoblasts. Following the surface functionalization by p(HEMA-co-EGDMA) via the iCVD technique, a highly hydrophilic patch was achieved without tailoring any morphological and structural properties. Moreover, the iCVD modified composite patch exhibited ideal cell adhesion for human osteoblasts, thus making the proposed patch suitable for potential biomedical applications including bone tissue engineering, especially in the fields of dentistry and orthopedy.
Collapse
Affiliation(s)
- Wiebke Reichstein
- Chair for Multicomponent Materials, Institute of Materials Science, Faculty of Engineering, Kiel University, Kaiserstr. 2, 24143 Kiel, Germany; (W.R.); (S.V.); (S.S.); (F.F.)
| | - Levke Sommer
- Department of Oral and Maxillofacial Surgery, Campus Kiel, University Hospital of Schleswig-Holstein, Arnold-Heller-Straße 3, 24105 Kiel, Germany; (L.S.); (Y.A.); (J.W.)
| | - Salih Veziroglu
- Chair for Multicomponent Materials, Institute of Materials Science, Faculty of Engineering, Kiel University, Kaiserstr. 2, 24143 Kiel, Germany; (W.R.); (S.V.); (S.S.); (F.F.)
| | - Selin Sayin
- Marine Science and Technology Faculty, Iskenderun Technical University, 31200 Iskenderun/Hatay, Turkey;
| | - Stefan Schröder
- Chair for Multicomponent Materials, Institute of Materials Science, Faculty of Engineering, Kiel University, Kaiserstr. 2, 24143 Kiel, Germany; (W.R.); (S.V.); (S.S.); (F.F.)
| | - Yogendra Kumar Mishra
- Mads Clausen Institute, NanoSYD, University of Southern Denmark, Alsion 2, 6400 Sønderborg, Denmark;
| | - Eyüp İlker Saygili
- Department of Medical Biochemistry, SANKO University, Şehitkamil, 27090 Gaziantep, Turkey;
| | - Fatih Karayürek
- Department of Periodontology, Cankiri Karatekin University, 18100 Cankiri, Turkey;
| | - Yahya Açil
- Department of Oral and Maxillofacial Surgery, Campus Kiel, University Hospital of Schleswig-Holstein, Arnold-Heller-Straße 3, 24105 Kiel, Germany; (L.S.); (Y.A.); (J.W.)
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, Campus Kiel, University Hospital of Schleswig-Holstein, Arnold-Heller-Straße 3, 24105 Kiel, Germany; (L.S.); (Y.A.); (J.W.)
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, Campus Kiel, University Hospital of Schleswig-Holstein, Arnold-Heller-Straße 3, 24105 Kiel, Germany; (L.S.); (Y.A.); (J.W.)
- Correspondence: (A.G.); (O.C.A.)
| | - Franz Faupel
- Chair for Multicomponent Materials, Institute of Materials Science, Faculty of Engineering, Kiel University, Kaiserstr. 2, 24143 Kiel, Germany; (W.R.); (S.V.); (S.S.); (F.F.)
| | - Oral Cenk Aktas
- Chair for Multicomponent Materials, Institute of Materials Science, Faculty of Engineering, Kiel University, Kaiserstr. 2, 24143 Kiel, Germany; (W.R.); (S.V.); (S.S.); (F.F.)
- Correspondence: (A.G.); (O.C.A.)
| |
Collapse
|
23
|
Wieker H, Fritz Schomaker MC, Flörke C, Karayürek F, Naujokat H, Acil Y, Wiltfang J, Gülses A. A retrospective analysis of the surgical outcomes of different free vascularized flaps used for the reconstruction of the maxillofacial region: Hand-sewn microvascular anastomosis vs anastomotic coupler device. J Craniomaxillofac Surg 2021; 49:191-195. [PMID: 33454184 DOI: 10.1016/j.jcms.2020.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/11/2020] [Accepted: 12/31/2020] [Indexed: 11/24/2022] Open
Abstract
The aim of the study was to assess the surgical outcomes following venous anastomosis with a coupling device and hand-sewn anastomosis in the reconstruction of the maxillofacial region. The study sample was recruited from patients who underwent reconstructive surgeries between January 2011 and November 2016. Tumor type, recipient veins, distribution of flap type, flap survival rates and anastomosis associated complications requiring a flap revision were documented. The follow-up period was four years. In total, 236 patients were included in this study, in which 201 reconstructions were performed via microsurgical venous coupling device (82.04%), whereas hand sewn anastomosis was used in 44 patients (17.96%). Postoperative complications regarding the anastomosis technique revealed that venous coupler devices showed significantly lower complications (4,97%) compared to hand sewn anastomosis (11,36%) (p < 0.05). Within the limitations of the current study, it can be concluded that the coupler system does appear to have advantages over conventional hand-sewn venous anastomosis and should be preferred when possible.
Collapse
Affiliation(s)
- Henning Wieker
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, Kiel, Germany.
| | | | - Christian Flörke
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, Kiel, Germany.
| | - Fatih Karayürek
- Department of Periodontology, Faculty of Dentistry, Çankırı Karatekin University, Çankırı, Turkey.
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, Kiel, Germany.
| | - Yahya Acil
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, Kiel, Germany.
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, Kiel, Germany.
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, Christian Albrechts University, Kiel, Germany.
| |
Collapse
|
24
|
Gülses A, Ayna M, Emmert M, Karataban P, Kübel P, Wiltfang J, Acil Y. Assessment of marginal integrity of five different polymers in retrograde root-end filling following apicoectomy: An in-vitro analysis with scanning electron microscope and micro-radiography. Acta Bioeng Biomech 2021; 23:133-145. [PMID: 34978309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The aim of the study was to evaluate marginal adaptation properties of five different sealers used as root filling material. MATERIALS Apical resection was performed on 100 canals of 50 maxillary premolars in slaughtered pigs. The root end of 24 canals were retrogradely filled with Diaket™, 37 root canals with Super-EBA™ including 18 with Super-EBA™. Regular and 19 with Super-EBA™ fast, 20 canals with ProRoot® MTA and 19 canals with AH-Plus™. For quantitative examination, scanning electron microscope (SEM) analysis and for qualitative examination, microradiography was performed. RESULTS Diaket™ achieved an overall average of 4.872 microns gap value as the best result. The mean values of marginal gap widths of AH-Plus™ and Super-EBA™ were almost with 8.044 microns and 9.951 microns in about the same magnitude, followed by Super-EBA™ Regular with 11,560 microns. Highest marginal gap value was found for ProRoot® MTA with 18.343 microns ( p < 0.001). CONCLUSIONS Both in terms of its marginal integrity and material properties, Diaket™ is the most suitable material for retrograde obturation. A preliminary version of the current paper could be found at www.researchsquare.com/article/rs-6198/v1.
Collapse
Affiliation(s)
- Aydin Gülses
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Mustafa Ayna
- Department of Periodontology, Bonn University Hospital, Bonn, Germany
| | - Marie Emmert
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Pinar Karataban
- Department of Pediatrics and Preventive Dentistry, Bahcesehir University, Istanbul, Turkey
| | - Paul Kübel
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Yahya Acil
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| |
Collapse
|
25
|
Kalantzis S, Veziroglu S, Kohlhaas T, Flörke C, Mishra YK, Wiltfang J, Açil Y, Faupel F, Aktas OC, Gülses A. Early osteoblastic activity on TiO2 thin films decorated with flower-like hierarchical Au structures. RSC Adv 2020; 10:28935-28940. [PMID: 35520083 PMCID: PMC9055844 DOI: 10.1039/d0ra05141a] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022] Open
Abstract
Flower-like hierarchical Au structures, composed of micro- and nanoscale features, lead to higher number of filopodia formation on TiO2 thin films.
Collapse
Affiliation(s)
- Spyridon Kalantzis
- Department of Oral and Maxillofacial Surgery
- University Hospital of Schleswig-Holstein
- 24105 Kiel
- Germany
| | - Salih Veziroglu
- Chair for Multicomponent Materials
- Institute for Materials Science
- Faculty of Engineering
- Kiel University
- 24143 Kiel
| | - Theresa Kohlhaas
- Department of Oral and Maxillofacial Surgery
- University Hospital of Schleswig-Holstein
- 24105 Kiel
- Germany
| | - Christian Flörke
- Department of Oral and Maxillofacial Surgery
- University Hospital of Schleswig-Holstein
- 24105 Kiel
- Germany
| | | | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery
- University Hospital of Schleswig-Holstein
- 24105 Kiel
- Germany
| | - Yahya Açil
- Department of Oral and Maxillofacial Surgery
- University Hospital of Schleswig-Holstein
- 24105 Kiel
- Germany
| | - Franz Faupel
- Chair for Multicomponent Materials
- Institute for Materials Science
- Faculty of Engineering
- Kiel University
- 24143 Kiel
| | - Oral Cenk Aktas
- Chair for Multicomponent Materials
- Institute for Materials Science
- Faculty of Engineering
- Kiel University
- 24143 Kiel
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery
- University Hospital of Schleswig-Holstein
- 24105 Kiel
- Germany
| |
Collapse
|
26
|
Gülses A, Açil Y, Wiltfang J. Oral surgery related fungal endocarditis: The need for a novel concept in endocarditis prophylaxy. Med Hypotheses 2019; 135:109482. [PMID: 31739080 DOI: 10.1016/j.mehy.2019.109482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/08/2019] [Indexed: 11/16/2022]
Abstract
Current paper aims to hypothesize that, oral surgical interventions such as tooth extractions, endosseous implant placement, subgingival curettage, etc. might result in widespread of fungal species via blood stream and can cause fungal contaminations of the cardiac valves. We hereby suggest that, an additional fungal endocarditis risk assessment and prevention protocol should be created for patients with a possible risk of endocarditis development.
Collapse
Affiliation(s)
- Aydin Gülses
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Yahya Açil
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| |
Collapse
|
27
|
Gülses A, Açil Y, Wiltfang J. Danger of highlighting the use of coxibs in daily dental practice. Int J Oral Maxillofac Surg 2019; 48:1608. [PMID: 31230772 DOI: 10.1016/j.ijom.2019.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Affiliation(s)
- A Gülses
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Y Açil
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| |
Collapse
|
28
|
Aktas OC, Metzger W, Haidar A, Açil Y, Gülses A, Wiltfang J, Sacramento CM, Nothdurft FP. Enhancing adhesion and alignment of human gingival fibroblasts on dental implants. J Craniomaxillofac Surg 2019; 47:661-667. [PMID: 30846326 DOI: 10.1016/j.jcms.2019.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/27/2019] [Accepted: 02/04/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Promoting the directional attachment of gingiva to the dental implant leads to the formation of tight connective tissue which acts as a seal against the penetration of oral bacteria. Such a directional growth is mostly governed by the surface texture. MATERIAL AND METHODS In this study, three different methods, mechanical structuring, chemical etching and laser treatment, have been explored for their applicability in promoting cellular attachment and alignment of human primary gingival fibroblasts (HGFIBs). RESULTS The effectiveness of mechanical structuring was shown as a simple and a cost-effective method to create patterns to align HGIFIBs. CONCLUSION Combining mechanical structuring with chemical etching enhanced both cellular attachment and the cellular alignment.
Collapse
Affiliation(s)
- Oral Cenk Aktas
- Institute for Materials Science, Christian-Albrechts-University Kiel, Germany
| | - Wolfgang Metzger
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Saar, Germany
| | - Ayman Haidar
- Department of Prosthetic Dentistry and Dental Materials Sciences, Saarland University, Homburg, Saar, Germany
| | - Yahya Açil
- Department of Oral and Maxillofacial Surgery, Christian-Albrecht-Universität zu Kiel, Kiel, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, Christian-Albrecht-Universität zu Kiel, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, Christian-Albrecht-Universität zu Kiel, Kiel, Germany
| | - Catharina Marques Sacramento
- Department of Prosthesis and Periodontology, Division of Periodontics, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Frank Philipp Nothdurft
- Department of Prosthetic Dentistry and Dental Materials Sciences, Saarland University, Homburg, Saar, Germany.
| |
Collapse
|
29
|
Ayna M, Wessing B, Gutwald R, Neff A, Ziebart T, Açil Y, Wiltfang J, Gülses A. A 5-year prospective clinical trial on short implants (6 mm) for single tooth replacement in the posterior maxilla: immediate versus delayed loading. Odontology 2018; 107:244-253. [DOI: 10.1007/s10266-018-0378-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
|
30
|
Açil Y, Torz K, Gülses A, Wieker H, Gerle M, Purcz N, Will OM, Eduard Meyer J, Wiltfang J. An experimental study on antitumoral effects of KI-21-3, a synthetic fragment of antimicrobial peptide LL-37, on oral squamous cell carcinoma. J Craniomaxillofac Surg 2018; 46:1586-1592. [PMID: 30196859 DOI: 10.1016/j.jcms.2018.05.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/16/2018] [Accepted: 05/25/2018] [Indexed: 01/02/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the oncolytic properties of KI-21-3, a shortened fragment of LL-37, against oral squamous cell carcinoma (OSCC) in an animal model. MATERIALS AND METHODS Twelve athymic nude mice were divided into a therapy and a control group of six animals each. In both groups, SCC-4 cells were administered extraorally into the floor of the mouth in order to create an OSCC model. In the study group, KI-21-3 was applied intravenously during the 8th and 9th weeks. The subjects in the control group were injected with phosphate buffered saline solution in the same manner. During an examination period of 12 weeks, weight control was performed twice a week. Tumor growth was further controlled volumetrically via ultrasonography once a week with regular intervals. Following sacrifice, ablated tumoral tissues were immunohistochemically evaluated in order to determine the proliferation and apoptotic properties. RESULTS The mean tumor weight in the AMP group was 0.0236 ± 0.023 g, which was 30% lower than the control group with the mean value of 0.01651 ± 0.012 g. In the control group, the approximate number of the proliferating cells per visualized field was fourfold higher compared to the therapy group. Moreover, in the control group, the number of apoptotic cells per visualized field was significantly lower compared to the therapy group. CONCLUSION KI-21-3 showed considerable oncolytic properties on SCC-4 carcinoma cells via antiproliferative and caspase-3 apoptotic pathway. Further investigations are necessary to clarify the dose-dependent effects of this agent.
Collapse
Affiliation(s)
- Yahya Açil
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Kaspar Torz
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Henning Wieker
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Mirko Gerle
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Nicolai Purcz
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Olga Marie Will
- University Hospital Schleswig-Holstein, 1 Section Biomedical Imaging, Clinic for Radiology and Neuroradiology, MOIN CC, Germany
| | | | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| |
Collapse
|
31
|
Naujokat H, Açil Y, Gülses A, Birkenfeld F, Wiltfang J. Man as a living bioreactor: Long-term histological aspects of a mandibular replacement engineered in the patient's own body. Int J Oral Maxillofac Surg 2018; 47:1481-1487. [PMID: 29843951 DOI: 10.1016/j.ijom.2018.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/03/2018] [Accepted: 05/08/2018] [Indexed: 11/16/2022]
Abstract
In 2016, we reported the world's first reconstruction of a mandibular discontinuity defect using a custom-made bone transplant that had been prefabricated in the gastrocolic omentum using tissue engineering strategies. However, the tissue of an engineered human neomandible has not been evaluated histologically until now. The current study assessed the long-term histological characteristics of biopsies of the neomandible 9months after transplantation. Histological analysis showed an increased amount of vital mineralized bone tissue after 10months, in comparison to biopsies obtained earlier. The engineered bone covered the surface of the bone substitute material but also grew out typical structures of cancellous bone tissue without a core of BioOss. The amount of induced bone tissue was 32% in the biopsy. In addition, the soft tissue showed an alignment of the connective tissue fibres parallel to the trabecular bone. Increasing time and mechanical forces at the mandible led to an increased amount of mineralized tissue and remodelling of the connective tissue fibres after transplantation. Further research should focus on developing advanced scaffold materials, as the outer titanium mesh cage leads to complications.
Collapse
Affiliation(s)
- H Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Y Açil
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - A Gülses
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - F Birkenfeld
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - J Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| |
Collapse
|
32
|
Açil Y, Arndt ML, Gülses A, Wieker H, Naujokat H, Ayna M, Wiltfang J. Cytotoxic and inflammatory effects of alendronate and zolendronate on human osteoblasts, gingival fibroblasts and osteosarcoma cells. J Craniomaxillofac Surg 2018; 46:538-546. [DOI: 10.1016/j.jcms.2017.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/03/2017] [Accepted: 12/15/2017] [Indexed: 02/02/2023] Open
|
33
|
Naujokat H, Seitz JM, Açil Y, Damm T, Möller I, Gülses A, Wiltfang J. Osteosynthesis of a cranio-osteoplasty with a biodegradable magnesium plate system in miniature pigs. Acta Biomater 2017; 62:434-445. [PMID: 28844965 DOI: 10.1016/j.actbio.2017.08.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/26/2017] [Accepted: 08/23/2017] [Indexed: 10/19/2022]
Abstract
Biodegradable magnesium alloys are a new class of implant material suitable for bone surgery. The aim of this study was to investigate plates and screws made of magnesium for osteosynthesis in comparison to titanium in a cranial fracture model. Implants were used for internal fixation of a cranio-osteoplasty in nine minipigs. Computed tomography was conducted repeatedly after surgery. The implants and the adjacent tissues were harvested 10, 20 and 30weeks after surgery and investigated by micro-computed tomography and histological analysis. The surgical procedure and the inserted osteosynthesis material were well tolerated by the animals, and the bone healing of the osteoplasty was undisturbed at all times. The adjacent bone showed formation of lacunas in the magnesium group, resulting in a lower bone-to-implant contact ratio than that of titanium (72 vs. 94% at week 30), but this did not lead to clinical side effects. Radiological measurements showed no reduction in osteosynthesis material volume, but indicated signs of degradation: distinct volumes within the magnesium osteosynthesis group had lower density in micro-computed tomography, and these volumes increased up to 9% at week 30. The histological preparations showed areas of translucency and porosity inside the magnesium, but the outer shape of the osteosynthesis material remained unchanged. No fracture or loosening of the osteosynthesis devices appeared. Soft tissue probes confirmed sufficient biocompatibility. Given their biodegradable capacity, biocompatibility, mechanical strength and visibility on radiographs, osteosynthesis plates made of magnesium alloys are suitable for internal fixation procedures. STATEMENT OF SIGNIFICANCE To the best of our knowledge this is the first study that used biodegradable magnesium implants for osteosynthesis in a cranial fracture model. The cranio-osteoplasty in miniature pigs allowed in vivo application of plate and screw osteosynthesis of standard-sized implants and the implementation of surgical procedures similar to those conducted on human beings. The osteosynthesis configuration, size, and mechanical properties of the magnesium implants within this study were comparable to those of titanium-based osteosynthesis materials. The results clearly show that bone healing was undisturbed in all cases and that the biocompatibility to hard- and soft tissue was sufficient. Magnesium implants might help to avoid long-term complications and secondary removal procedures due to their biodegradable properties.
Collapse
|
34
|
Açil Y, Heitzer MA, Gülses A, Naujokat H, Podschun R, Wiltfang J, Flörke C. The correlation between periodontal health status and suspectibility to infections associated with craniomaxillofacial osteosynthesis plates. J Craniomaxillofac Surg 2017; 45:1868-1874. [PMID: 28927956 DOI: 10.1016/j.jcms.2017.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/17/2017] [Accepted: 08/15/2017] [Indexed: 01/23/2023] Open
Abstract
AIM The aim of the present study was to demonstrate the possible relation between periodontal health status and infections associated with osteosynthesis materials (OMs) used in the oral and maxillofacial reconstruction. MATERIAL AND METHODS The study group consisted of 32 individuals which were subdivided into two groups regarding their PSI scores. After the removal of the osteosynthesis plates, microbial colonization was assessed via microbiological cultivation, fluorescence microscopy and scanning electron microscopy. In addition, samples obtained from gingival crevicular fluids were investigated by fluorescence microscopy. RESULTS A total of 118 osteosynthesis plates were examined. 8.5% (n = 10) of the plates were associated at least one of the clinical signs of infection. There was a positive correlation between periodontal disease and clinical signs of infection (p = 0.022). Patients with infection signs also had a higher number of smoking history (pack years, p = 0.010). Intraorally placed osteosynthesis plates showed wide range of bacterial colonizations compared to extraorally inserted osteosynthesis materials (p = 0.004). CONCLUSION Patients with poor periodontal health might be potential candidates for OM related infections. Early removal of OMs in patients with poor periodontal health status and/or heavy smokers would have clinical benefits. In addition, preferation of extraoral access to the fracture line might decrease the possibility of plate related infections.
Collapse
Affiliation(s)
- Yahya Açil
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Marie-Annett Heitzer
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Rainer Podschun
- Institute for Infection Medicine (Head: Prof. Dr. Helmut Fickenscher), University Hospital Schleswig-Holstein, Campus Kiel, Brunswiker Straße 4, 24105 Kiel, Germany.
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Christian Flörke
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| |
Collapse
|
35
|
Naujokat H, Gülses A, Wiltfang J, Açil Y. Effects of degradable osteosynthesis plates of MgYREZr alloy on cell function of human osteoblasts, fibroblasts and osteosarcoma cells. J Mater Sci Mater Med 2017; 28:126. [PMID: 28711997 DOI: 10.1007/s10856-017-5938-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 06/26/2017] [Indexed: 06/07/2023]
Abstract
The aim was to evaluate the biocompatibility of osteosynthesis plates of the MgYREZr/WE43 alloy by using human cells in vitro. Eluates of degradable magnesium osteosynthesis plates as well as halved plates were used for incubation with human osteoblasts, fibroblasts and osteosarcoma cells. The cell viability was evaluated by using FDA/PI-Staining and LDH analysis. Cell proliferation was assessed by MTT, WST-Test and BrdU-ELISA. Scanning electron microscope was used for investigation of the cell adhesion. The number of devitalized cells in all treatment groups did not significantly deviate from the control group. According to MTT results, the number of metabolically active cells was not significantly affected by the addition of the eluates. The number of metabolically active cells was reduced by 24 to 38% compared to the control on incubation in direct contact with the osteosynthesis plates. The proliferation of the cells was inhibited by the addition of the eluates. While the eluate of the half-hour elution has only a very small effect, the 24 h eluate significantly inhibits proliferation by 23-25% compared to the control. The roughened surface of the magnesium osteosynthesis plate after incubation showed adherent cells. However, some areas of the plates were also free of adherent cells. WE43 based magnesium alloys showed favorable biocompatibility considering the viability of the cells evaluated; however, proliferation rates were reduced in a time dependent manner, especially in fibroblast group. This might be a potential clinical benefit of magnesium osteosynthesis plates and their superiority to titanium, thus the fibroblastic ingrowth might negatively influence the bone-plate contact.
Collapse
Affiliation(s)
- Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
- Public Hospital Association, Ministry of Health of Turkey, Ankara, Turkey.
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Yahya Açil
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| |
Collapse
|
36
|
Gülses A, Ayna M, Açil Y. A microorganism not to be overlooked in studies focusing on osteonecrosis of the jaws: Comment on "Kim SM, et al. Histochemical observation of bony reversal lines in bisphosphonate-related osteonecrosis of the jaw". Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:738-739. [PMID: 28478939 DOI: 10.1016/j.oooo.2016.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/29/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Aydin Gülses
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, Kiel, Germany
| | | | - Yahya Açil
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, Kiel, Germany
| |
Collapse
|
37
|
Ayna M, Gülses A, Acil Y. A comparative study on 7-year results of "All-on-Four™" immediate-function concept for completely edentulous mandibles: metal-ceramic vs. bar-retained superstructures. Odontology 2017; 106:73-82. [PMID: 28321585 DOI: 10.1007/s10266-017-0304-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
Abstract
The study aims to document the clinical outcomes over a 7-year period of two techniques used for the rehabilitation of edentulous mandibles according to the "All-on-Four™" concept: (1) fixed complete-arch prostheses fabricated with metal-ceramic implant-supported fixed prosthesis with a titanium framework and all-ceramic crowns and (2) bar-retained implant-supported removable prosthesis with acrylic resin prosthetic teeth. The study was performed on 32 patients who received immediately loaded "All-on-Four™" fixed mandibular prostheses. (Fixed prostheses with ceramic superstructures, n:16; bar-retained removable acrylic prostheses, n:16). The patients were evaluated for up to 7 years after prosthesis completion. The endpoints included the evaluation of prosthodontic complications, bone resorption, plaque accumulation, bleeding on probing, periodontal probing depth and an oral health impact profile (OHIP). Bone loss remained under 1.2 mm in all of the implants, and no difference was observed between two groups. Plaque accumulation increased gradually in both groups, and the bar-retained acrylic-bearing implants showed significantly higher values during the first 5 years. Immediate improvement was assessed by the OHIP score in both groups. The observed bone loss and the subjective outcomes showed equivalent levels of clinical success for bar-retained and ceramic superstructures over a 7-year period. The higher level of plaque accumulation observed around implants with bar-retained superstructures requires that patients with acrylic superstructures be highly motivated to maintain their personal oral hygiene. Further studies are needed to clarify the occurrence of prosthodontic complications and assess their economic aspects.
Collapse
Affiliation(s)
- Mustafa Ayna
- Center for Dental Implantology, 47051, Duisburg, Germany
| | - Aydin Gülses
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, 24105, Kiel, Germany.
| | - Yahya Acil
- Christian Albrechts University, Department of Oral and Maxillofacial Surgery, 24105, Kiel, Germany
| |
Collapse
|
38
|
Sezgin S, Sencimen M, Gülses A, Erdemci F, Ayna M, Gider İK, Ongoru O, Cayci T. Erratum to: An experimental study on the comparison of the effects of triester glycerol oxide on wound repair. Oral Maxillofac Surg 2016; 21:107. [PMID: 27891558 DOI: 10.1007/s10006-016-0602-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Serhat Sezgin
- Dental Service, Aksaz Military Hospital, Muğla, Turkey
| | - Metin Sencimen
- Department of Oral and Maxillofacial Surgery, Gülhane Military Medical Academy, Ankara, Turkey
| | - Aydin Gülses
- Dental Service, Sarikamis Military Hospital, Sarikamis, Kars, Turkey.
| | - Fevzi Erdemci
- Dental Service, Tatvan Military Hospital, Bitlis, Turkey
| | - Mustafa Ayna
- Center for Implant Dentistry, Duisburg, Germany.,Danube University Krems, Krems, Austria
| | - İsmail K Gider
- Dental Service, Edremit Military Hospital, Balikesir, Turkey
| | - Onder Ongoru
- Department of Pathology, Gülhane Military Medical Academy, Ankara, Turkey
| | - Tuncer Cayci
- Department of Microbiology, Gülhane Military Medical Academy, Ankara, Turkey
| |
Collapse
|
39
|
Açil Y, Ghoniem AA, Gülses A, Kisch T, Stang F, Wiltfang J, Gierloff M. Suppression of osteoblast-related genes during osteogenic differentiation of adipose tissue derived stromal cells. J Craniomaxillofac Surg 2016; 45:33-38. [PMID: 27842921 DOI: 10.1016/j.jcms.2016.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/31/2016] [Accepted: 10/11/2016] [Indexed: 11/25/2022] Open
Abstract
Recent studies indicated a lower osteogenic differentiation potential of adipose tissue-derived stromal cells (ASCs) compared to bone marrow derived mesenchymal stromal cells. The aim of this study was to evaluate the effects of potent combinations of highly osteogenic bone morphogenetic proteins (BMPs) in order to enhance the osteogenic differentiation potential of ASCs. Human ASCs were cultured for 10 days in the presence of osteogenic medium consisting of dexamethasone, ß-glycerophosphate and ascorbat-2-phosphate (OM) supplemented with BMP-2, BMP-6, BMP-9+IGF-2 and BMP-2,-6,-9 (day 1+2: 50 ng/ml, days 3-6: 100 ng/ml, days 7-10: 200 ng/ml). The formation of the osteoblast phenotype was evaluated by quantification of osteoblast-related marker genes using real-time polymerase chain reaction (RT-PCR). Matrix mineralization was assessed by Alizarin Red S staining. Statistical analysis was carried out using the one-way analysis of variance (ANOVA) followed by the Scheffe's post hoc procedure. Osteogenic medium (OM) significantly increased the expression of alkaline phosphatase (ALP) and osteocalcin (p < 0.05) and led to a stable matrix mineralization. Under the influence of BMP-9+IGF-2 and BMP-2,-6,-9 the ALP expression further increased compared to ASCs cultured with OM only (p < 0.01). However, multiple osteogenic markers showed no change or decreased under the influence of OM and BMP combinations (p < 0.05). The current results indicate a restricted osteogenic differentiation potential of ASCs and suggest careful reconsideration of their use in bone tissue engineering applications.
Collapse
Affiliation(s)
- Yahya Açil
- Department of Oral & Maxillofacial Surgery (Head of Scientific Laboratories: Prof. Yahya Açil, Head: Prof. Dr. Jörg Wiltfang), Christian-Albrechts University, Kiel, Germany
| | - Amir Alexander Ghoniem
- Department of Oral & Maxillofacial Surgery (Head of Scientific Laboratories: Prof. Yahya Açil, Head: Prof. Dr. Jörg Wiltfang), Christian-Albrechts University, Kiel, Germany
| | - Aydin Gülses
- Center for Oral and Dental Health, Kars, Turkey.
| | - Tobias Kisch
- Department of Plastic Surgery, University of Lübeck, Lübeck, Germany
| | - Felix Stang
- Department of Plastic Surgery, University of Lübeck, Lübeck, Germany
| | - Jörg Wiltfang
- Department of Oral & Maxillofacial Surgery (Head of Scientific Laboratories: Prof. Yahya Açil, Head: Prof. Dr. Jörg Wiltfang), Christian-Albrechts University, Kiel, Germany
| | - Matthias Gierloff
- Department of Plastic Surgery, University of Lübeck, Lübeck, Germany
| |
Collapse
|
40
|
Gülses A, Ayna M, Güçlü H, Sencimen M, Basiry MN, Gierloff M, Açil Y. In Vitro Assessment of Primary Stability of BoneTrust Sinus Implant Design. INT J PERIODONT REST 2016; 36:731-5. [PMID: 27560678 DOI: 10.11607/prd.2562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to analyze the primary stability of BoneTrust Sinus implants (BTSIs), which are intended to enable higher primary stability by their special design with reduced thread section in cases of reduced vertical bone availability, in comparison with standard BoneTrust implants (SBTIs) in vitro. A bone window 3 cm in length, 4 cm in width, and 3 cm in depth, resembling the maxillary bone window of the lateral sinus wall with 4 mm of residual bone height, was prepared at the dorsal side of freshly slaughtered bovine ribs. One single BTSI and a single SBTI with the same diameter (4 or 5 mm) were placed in each window. After implant placement, the implant stability quotient (ISQ) was measured by using resonance frequency analysis with an Osstell device. A total of 88 implants were placed. ISQ values varied between 63 and 84. Among the implants with 4-mm diameter, all BTSIs showed higher ISQ values compared with SBTIs. One-way analysis of variance showed a significant difference between BTSIs/SBTIs (P < .05). BTSIs with 4-mm diameter showed statistically higher values compared to BTSIs with 5-mm diameter (P < .05). Among the implants with 5-mm diameter, all SBTIs showed higher ISQ values compared to BTSIs but there was no significant difference. The use of 4-mm-diameter BTSIs could present higher ISQ values during simultaneous implant placement in conjunction with lateral sinus floor augmentation.
Collapse
|
41
|
Açil Y, Sievers J, Gülses A, Ayna M, Wiltfang J, Terheyden H. Correlation between resonance frequency, insertion torque and bone-implant contact in self-cutting threaded implants. Odontology 2016; 105:347-353. [DOI: 10.1007/s10266-016-0265-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
|
42
|
Ayna M, Gülses A, Mede I. Management of infection after grafting of the sinus bone. Br J Oral Maxillofac Surg 2016; 55:198-199. [PMID: 27435501 DOI: 10.1016/j.bjoms.2016.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Affiliation(s)
- M Ayna
- Center for Implant Dentistry, Duisburg, Germany; Ruhr University Bochum, Germany; Danube University Krems, Austria
| | - A Gülses
- Gülhane Military Medical Academy, Department of Oral and Maxillary Surgery, Ankara, Turkey.
| | - I Mede
- Private Practice, Neukirchen-Vluyn, Germany
| |
Collapse
|
43
|
Sezgin S, Sencimen M, Gülses A, Erdemci F, Ayna M, Gider İK, Ongoru O, Cayci T. An experimental study on the comparison of the effects of triester glycerol oxide on wound repair. Oral Maxillofac Surg 2016; 20:273-9. [PMID: 27324749 DOI: 10.1007/s10006-016-0566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/13/2016] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study is to assess the effects of triester glycerol oxide (TGO) on cutaneous wound epithelization process. MATERIAL AND METHODS Fifty-four male Wistar rats were divided into 2 groups of 27 rats each: control(C) and TGO (PX). The groups have been divided into three subgroups which included nine rats each regarding the wound excision on the 3rd, 7th, and 10th days, respectively. The specimens were evaluated according to histological properties and hydroxyproline levels. RESULTS Seventh day examination showed that PX and control groups present the same score. HP levels in the control group were significantly lower compared to PX groups. CONCLUSION TGO have positive effects on wound epithelization process by increased collagen synthesis.
Collapse
Affiliation(s)
- Serhat Sezgin
- Aksaz Military Hospital, Dental Service, Muğla, Turkey
| | - Metin Sencimen
- Department of Oral and Maxillofacial Surgery, Gülhane Military Medical Academy, Ankara, Turkey
| | - Aydin Gülses
- Sarikamis Military Hospital, Dental Service, Sarikamis, Kars, Turkey.
| | - Fevzi Erdemci
- Tatvan Military Hospital, Dental Service, Bitlis, Turkey
| | - Mustafa Ayna
- Center for Implant Dentistry, Duisburg, Germany.,Danube University Krems, Krems, Austria
| | - İsmail K Gider
- Edremit Military Hospital, Dental Service, Balikesir, Turkey
| | - Onder Ongoru
- Department of Pathology, Gülhane Military Medical Academy, Ankara, Turkey
| | - Tuncer Cayci
- Department of Microbiology, Gülhane Military Medical Academy, Ankara, Turkey
| |
Collapse
|
44
|
Gülses A, Ayna M. Re: Comparison of Azithromycin and Amoxicillin Before Dental Implant Placement: An Exploratory Study of Bioavailability and Resolution of Postoperative Inflammation. J Periodontol 2016; 87:101. [PMID: 26962889 DOI: 10.1902/jop.2016.150508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Aydin Gülses
- Department of Oral and Maxillary Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | | |
Collapse
|
45
|
Gierloff M, Reutemann M, Gülses A, Niehoff P, Wiltfang J, Açil Y. Effects of zoledronate on the radiation-induced collagen breakdown: a prospective randomized clinical trial. Clin Transl Oncol 2014; 17:454-61. [PMID: 25425023 DOI: 10.1007/s12094-014-1257-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 11/10/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND A negative side effect of therapeutic irradiation is the radiation-induced bone loss which can lead, in long term, to pathological fractures. Until today, the detailed mechanism is unknown. If osteoclasts would mainly contribute to the pathological bone loss, bisphosphonates could potentially counteract the osteolytic process and possibly help to prevent long-term complications. The aim of this study was to evaluate the effect of zoledronic acid on the early radiation-induced degradation of bone collagen fibrils by monitoring the urinary excretion of hydroxylysylpyridinoline and lysylpyridinoline under radiotherapy. PATIENTS AND METHODS A total of 40 patients with skeletal metastases were assigned for a local radiotherapy and bisphosphonate treatment. The patients were prospectively randomized into two treatment groups: group A (n = 20) received the first zoledronate administration after and group B (n = 20) prior to the radiotherapy. Urine samples were collected from each patient on the first day, in the middle, and on the last day of the radiation therapy. Measurement of the bone metabolites hydroxylysylpyridinoline and lysylpyridinoline was performed by high-performance liquid chromatography. Statistical analysis was performed using the Mann-Whitney U test. RESULTS The hydroxylysylpyridinoline and lysylpyridinoline excretion decreased significantly in the combined bisphosphonate and radiotherapy group (p = 0.02, p = 0.08). No significant change of the hydroxylysylpyridinoline and lysylpyridinoline excretion was determined in the patients that received solely irradiation. CONCLUSION The results indicate the ability of zoledronate to prevent the early radiation-induced bone collagen degradation suggesting that the radiation-induced bone loss is mainly caused by osteoclastic bone resorption rather than by a direct radiation-induced damage.
Collapse
Affiliation(s)
- M Gierloff
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, Haus 26, 24105, Kiel, Germany
| | | | | | | | | | | |
Collapse
|
46
|
Ayna M, Gülses A, Açil Y. Comprehensive Comparison of the 5-Year Results of All-on-4 Mandibular Implant Systems With Acrylic and Ceramic Suprastructures. J ORAL IMPLANTOL 2014; 41:675-83. [PMID: 24712706 DOI: 10.1563/aaid-joi-d-14-00016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of the present study was to evaluate the comprehensive 5-year results of fixed mandibular dentures fabricated from metal-acrylic or metal-ceramics according to the All-on-4 protocol. Twenty-seven patients who received immediately loaded All-on-4 fixed mandibular dentures in 2006 were included in the study, and they were evaluated up to 5 years after denture integration. Endpoints were chosen in accordance with the 2007 Pisa consensus and included bone resorption, the Oral Health Impact Profile (OHIP), the sulcus fluid flow rate (SFFR), and prosthodontic complications. The initial situation in both groups was largely identical. Bone loss remained under 2 mm after 5 years in all implants and showed no group difference. The SFFR showed a gradual increase in both groups, and acrylic-bearing implants showed a substantially and significantly higher flow rate from the third year onward. The subjective improvement as expressed by the OHIP score was immediate and dramatic, and it showed no group differences. All acrylic restorations showed some extent of abrasion, and veneer fractures occurred in 4 patients (28.6%). Besides a single fracture of a fixation screw, there were no prosthetic complications in patients with ceramic suprastructures. According to bone loss and subjective outcome, acrylic and ceramic suprastructures appeared to be equivalent after 5 years; however, sulcus flow and prosthodontic complications suggest that the economic advantage of acrylic dentures may be specious. The rational choice of implant suprastructures requires comprehensive, long-term observation. Short-term economic benefits might be cancelled out in the long term.
Collapse
Affiliation(s)
- Mustafa Ayna
- 1 Private practice in general dentistry and implantology, Duisburg-Zentrum, Germany
| | - Aydin Gülses
- 2 Center for Dentistry and Oral Health, Mevki Military Hospital, Ankara, Turkey
| | - Yahya Açil
- 3 Department of Oral and Maxillofacial Surgery, Christian-Albrechts-University, Kiel, Germany
| |
Collapse
|
47
|
Sabuncuoglu FA, Sencimen M, Gülses A. Surgical repositioning of a severely impacted mandibular second molar. Quintessence Int 2010; 41:725-729. [PMID: 20806096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 16-year-old girl was referred for surgical-orthodontic treatment with the chief complaint of an unerupted mandibular left second molar. With the exception of this molar, the patient had a fully erupted permanent dentition. A panoramic radiograph showed a horizontally impacted mandibular left second molar beneath a mesially impacted third molar. A surgical approach was used to upright and reposition the impacted second molar. When a molar is severely impacted, surgical uprighting may provide a viable option when other treatment modalities are contraindicated. This case shows an example of successful use of a surgical approach for uprighting and repositioning an impacted molar. The impacted molar was moved into its proper position with surgical exposure, after which it showed good stability.
Collapse
|
48
|
Sencimen M, Varol A, Gülses A, Altug AH. Extraction of a deeply impacted lower third molar by sagittal split osteotomy. ACTA ACUST UNITED AC 2009; 108:e36-8. [DOI: 10.1016/j.tripleo.2009.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 07/01/2009] [Indexed: 11/16/2022]
|