Temporomandibular disorders in individuals with Marfan syndrome: an exploratory analysis

BACKGROUND

This study aims to analyze to what extent patients with Marfan syndrome (MFS) are affected by temporomandibular disorders (TMD) and its impact on oral health-related quality of life (OHRQoL). To collect data, an online questionnaire was created to recruit participants from Germany, Austria, and Switzerland through social media and support groups. The questionnaire consists of free-text questions, the German versions of the Oral Health Impact Profile (OHIP-G14), the Depression Anxiety Stress Scale (DASS), and the Graded Chronic Pain Status (GCPS).

RESULTS

A total of 76 participants with diagnosed MFS were included. Of these, 65.8% showed TMD symptoms, the most common being pain or stiffness of the masticatory muscles in the jaw angle (50.0%). Only 14.5% of the participants were already diagnosed with TMD. Of the participants with an increased likelihood of a depression disorder, 76.9% showed TMD symptoms. Of those with a critical score for an anxiety disorder, 90.9% showed TMD symptoms. 73.3% of participants with TMD symptoms reached the critical score for a stress disorder. TMD symptoms were associated with a higher risk for chronic pain. In the median, participants with TMD showed statistically notably higher OHIP-G14 scores than participants without TMD (11.5 [IQR 17] vs. 1 [IQR 3] points, p ≤ 0.001).

CONCLUSION

TMD symptoms had a noticeable impact on OHRQoL in patients with MFS, i.e., chronic pain and psychological impairment. TMD seems underdiagnosed, and more research is needed to prevent the associated chronification of pain and psychological burden to improve the OHRQoL.

Magnetic resonance imaging for jawbone assessment: a systematic review

PURPOSE

To evaluate the accuracy of magnetic resonance imaging (MRI) for jawbone assessment compared to reference-standard measurements in the literature.

MATERIALS AND METHODS

An electronic database search was conducted in PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library in June 2022, and updated in August 2023. Studies evaluating the accuracy of MRI for jawbone assessment compared with reference-standard measurements (histology, physical measurements, or computed tomography) were included. The outcome measures included bone histomorphometry and linear measurements. The risk of bias was assessed by the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). The review was registered in the PROSPERO database (CRD42022342697).

RESULTS

From 63 studies selected for full-text analysis, nine manuscripts were considered eligible for this review. The studies included assessments of 54 participants, 35 cadavers, and one phantom. A linear measurement error ranging from 0.03 to 3.11 mm was shown. The accuracy of bone histomorphometry varies among studies. Limitations of the evidence included heterogeneity of MRI protocols and the methodology of the included studies.

CONCLUSION

Few studies have suggested the feasibility of MRI for jawbone assessment, as MRI provides comparable results to those of standard reference tests. However, further advancements and optimizations are needed to increase the applicability, validate the efficacy, and establish clinical utility of these methods.

Artifacts in magnetic resonance imaging of the head and neck: Unwanted effects caused by implant-supported restorations fabricated with different alloys

STATEMENT OF PROBLEM

Implant-supported restorations may cause artifacts in magnetic resonance imaging (MRI) of the head and neck area. However, the effect of different alloys remains unclear.

PURPOSE

The purpose of this in vitro study was to assess artifacts in head and neck MRI caused by implant-supported restorations with different alloys.

MATERIAL AND METHODS

Three dry mandibles were prepared to receive bilateral dental implants at the second premolar and second molar sites. Different alloy combinations were evaluated: titanium implants+cobalt chromium restorations; titanium-zirconium implants+cobalt chromium restorations; and zirconia implants+ceramic restorations. Specimens were imaged by using a 3-Tesla magnetic resonance scanner system (Achieva 3.0T TX; Philips GmbH) with a turbo-spin-echo sequence. Scan protocols were adjusted to optimize metal artifact reduction and shorten scan time. Artifact volumes were assessed and statistically analyzed by using the Kruskal-Wallis and Spearman tests (α=.05).

RESULTS

A statistically significant difference was found among artifact volume caused by different materials (P=.002). The presence of titanium alloy was correlated with the artifact volume (r=-.87). Artifacts were greater for titanium and fewer for titanium-zirconium alloys, whereas zirconia implants found only minimal artifacts.

CONCLUSIONS

The dimension of artifacts produced by implant-supported restorations varied according to the material.

Evaluation of the clinical safety and performance of a narrow diameter (2.9 mm) bone-level implant: a 1-year prospective single-arm multicenter study

PURPOSE

Narrow-diameter implants facilitate single-tooth restoration when interdental or inter-implant spaces and bone volume are inadequate for using standard diameter implants. This study reports the short-term data on the clinical safety and performance of a bone-level-tapered two-piece implant with a 2.9 mm diameter in the clinical practice setting. This study was retrospectively registered on March 1st, 2016 (NCT02699866).

METHODS

Implants were placed in partially healed extraction sockets of the central and lateral incisors in the mandible and lateral incisors in the maxilla for single-tooth replacement. The primary outcome was to assess implant survival at 12 months after placement. Secondary outcomes included implant success, pink esthetic score, marginal bone-level changes, and safety.

RESULTS

Twenty four males and 17 females with a mean age of 44.5 (± 18.3 standard deviation) received the implant. Three out of 41 implants were lost yielding a survival rate of 92.7% (95%-CI: 79.0%; 97.6%) at 1 year. One patient reported an ongoing foreign body sensation, pain, and/or dysesthesia at month 12. The average pink esthetic score at 6 months was 11.2 (95%-CI: 10.5; 11.9). The bone level was stable with a mean bone-level change of-0.3 mm (± 0.42 mm standard deviation) at 1 year after implantation. No serious adverse events or adverse device events were reported.

CONCLUSIONS

The use of a 2.9 mm diameter bone-level-tapered implant is a safe and reliable treatment option for narrow tooth gaps at the indicated locations. Overall performance and good survival rates support their use in cases, where wider implants are unsuitable.

Klippel-Trenaunay-Weber syndrome: Oro-dental manifestations and management

INTRODUCTION

Klippel-Trenaunay-Weber syndrome (KTWS) is a rare congenital systemic disease characterized by a classic typical triad: cutaneous haemangioma, arterio-venous fistulas or varicosities (or both) and unilateral hypertrophy of hard and soft tissue with different localizations. First described by the French physicians Marcel Klippel and Paul Trenaunay, in 1900, KTWS has a clinically incidence of 2-5/100000. The complete triad (port-wine stains, varicose veins, and soft tissue and/or bony hypertrophy) occurs in almost 2/3 of the patients. Moreover, these features may be present at birth or develops during growing becoming more evident with age. Typical orofacial manifestations include facial asymmetry, jaw enlargement and malocclusion.

CASE PRESENTATION

A previously diagnosed 55-year-old male patient was referred to the Department of Cranio-Maxillofacial Surgery presenting with extended mandibular ramus exostosis on the left side and concomitant malocclusion. Surgical removal of the hypertrophic bone was performed due to progressive mouth opening restriction, limited oral hygiene ability and increased mandible deviation. Bleeding complications and wound healing disorders were not observed. Consistent mouth opening training resulted in an improvement in mouth opening.

CLINICAL DISCUSSION AND CONCLUSION

It is suggested to consider KTWS as one of the differential diagnoses if vascular syndromes in the head and neck region occur. Special attention must be given to dental treatment due to eventual excessive haemorrhage that might occur after oral surgical procedures.

Analysis of Genes Related to Invadopodia Formation and CTTN in Oral Squamous Cell Carcinoma-A Systematic Gene Expression Analysis

Successful treatment for any type of carcinoma largely depends on understanding the patterns of invasion and migration. For oral squamous cell carcinoma (OSCC), these processes are not entirely understood as of now. Invadopodia and podosomes, called invadosomes, play an important role in cancer cell invasion and migration. Previous research has established that cortactin (CTTN) is a major inducer of invadosome formation. However, less is known about the expression patterns of CTTN and other genes related to it or invadopodia formation in OSCC during tumor progression in particular. In this study, gene expression patterns of CTTN and various genes (n = 36) associated with invadopodia formation were analyzed to reveal relevant expression patterns and give a comprehensive overview of them. The genes were analyzed from a whole genome dataset of 83 OSCC samples relating to tumor size, grading, lymph node status, and UICC (Union for Internatioanl Cancer Control). The data revealed significant overexpression of 18 genes, most notably CTTN, SRC (SRC proto-onocogene, non-receptor tyrosine kinase), EGFR (epidermal growth factor receptor), SYK (spleen associated tyrosine kinase), WASL (WASP like actin nucleation promotion factor), and ARPC2 (arrestin beta 1) due to their significant correlation with further tumor parameters. This study is one of the first to summarize the expression patterns of CTTN and related genes in a complex group of OSCC samples.

Controversial Aspects of Diagnostics and Therapy of Idiopathic Condylar Resorption: An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project

Idiopathic condylar resorption (ICR), though a rare event, is associated with severe detrimental sequelae for the patient. To date, the etiology remains unknown, and treatment strategies are highly controversial. Therefore, the aim of this study is to present an analysis of the consensus- and evidence-based approach to ICR by a German interdisciplinary guideline project of the AWMF (Association of the Scientific Medical Societies in Germany). Following a systematic literature search, including 56 (out of an initial 97) publications, with a predominantly low level of evidence (LoE), two independent working groups (oral and maxillofacial surgery and interdisciplinary, respectively) voted on a draft comprising 25 recommendations in a standardized anonymized and blinded Delphi procedure. While the results of the votes were relatively homogeneous, the interdisciplinary phase required a significantly higher number of rounds (p < 0.001). Most of the controversial recommendations were related to initial imaging (with consensus on CT/CBCT as the current diagnostic standard for imaging), pharmacotherapy (no recommendation due to lack of evidence), discopexy (no recommendation possible due to low LoE) and timing of orthognathic surgery (with consensus on two-staged procedures after invasive TMJ surgery, except for single-stage procedures if combined with total joint reconstruction). Overall, the Delphi procedure resulted in an interdisciplinary guideline offering the best possible evidence- and consensus-based expertise to date in the diagnosis and treatment of ICR.

The Position of the Virtual Hinge Axis in Relation to the Maxilla in Digital Orthognathic Surgery Planning-A k-Means Cluster Analysis

The aim of this study was to investigate a possible relation between skeletal phenotypes and virtual mounting data in orthognathic surgery patients. A retrospective cohort study including 323 female (26.1 ± 8.7 years) and 191 male (27.9 ± 8.3 years) orthognathic surgery patients was conducted. A k-means cluster analysis was performed on the mounting parameters: the angle α between the upper occlusal plane (uOP) and the axis orbital plane (AOP); the perpendicular distance (AxV) from the uOP to the hinge axis; and the horizontal length (AxH) of the uOP from upper incisor edge to AxV, with subsequent statistical analysis of related cepalometric values. Three clusters of mounting data were identified, representing three skeletal phenotypes: (1) balanced face with marginal skeletal class II or III and α=8∘, AxV = 36 mm and AxH = 99 mm; (2) vertical face with skeletal class II and α=11∘, AxV = 27 mm and AxH = 88 mm; (3) horizontal face with class III and α=2∘, AxV = 36 mm and AxH = 86 mm. The obtained data on the position of the hinge axis can be applied to any digital planning in orthognathic surgery using CBCT or a virtual articulator, provided that the case can be clearly assigned to one of the calculated clusters.

Non-Surgical Transversal Dentoalveolar Compensation with Completely Customized Lingual Appliances versus Surgically Assisted Rapid Palatal Expansion in Adults-Tipping or Translation in Posterior Crossbite Correction?

The aim of this study was to investigate buccolingual tooth movements (tipping/translation) in surgical and nonsurgical posterior crossbite correction. A total of 43 patients (f/m 19/24; mean age 27.6 ± 9.5 years) treated with surgically assisted rapid palatal expansion (SARPE) and 38 patients (f/m 25/13; mean age 30.4 ± 12.9 years) treated with dentoalveolar compensation using completely customized lingual appliances (DC-CCLA) were retrospectively included. Inclination was measured on digital models at canines (C), second premolars (P2), first molars (M1), and second molars (M2) before (T₀) and after (T₁) crossbite correction. There was no statistically significant difference (p > 0.05) in absolute buccolingual inclination change between both groups, except for the upper C (p < 0.05), which were more tipped in the surgical group. Translation, i.e., bodily tooth movements that cannot be explained by pure uncontrolled tipping, could be observed with SARPE in the maxilla and with DC-CCLA in both jaws. Dentoalveolar transversal compensation with completely customized lingual appliances does not cause greater buccolingual tipping compared to SARPE.

Efficacy of Multimodality Approach in Patients With Recurrent Head and Neck Squamous Cell Carcinoma

BACKGROUND/AIM

Head and neck squamous cell carcinoma (HNSCC) is characterized by high relapse rates and low survival in comparison to other malignancies.

PATIENTS AND METHODS

Fifty-two patients suffering from recurrent HNSCC were compared, analyzing the impact of different regimes, including surgery, radiotherapy (RT), chemotherapy and immunotherapy on progression-free survival (PFS), overall survival (OS), locoregional control (LRC), and adverse events.

RESULTS

The standard RT technique was intensity-modulated radiotherapy (IMRT) in all patients. In the multivariate analysis, higher cumulative RT dose significantly influenced LRC whereas surgery and age significantly impacted PFS and OS.

CONCLUSION

IMRT dose-escalation, as well as surgery, appear beneficial in the treatment of recurrent HNSCC. Moreover, nivolumab and platin-based therapy might be superior agents for systemic therapy in comparison to cetuximab.

Influence of marginal incision and Le Fort I osteotomy on periodontal tissues: a prospective longitudinal study

The purpose of this prospective study was to evaluate whether the surgical protocol involving marginal incision and Le Fort I osteotomy affects the periodontal outcome. Twenty-nine patients requiring surgical correction of maxillary dysgnathia were selected for this study. Periodontal conditions of maxillary anterior teeth were assessed prior to the surgery (T₀), one month (T₁), and 6 months (T₂) after the surgical procedure. Interdental papillae loss, periodontal parameters and aesthetic outcomes in the anterior zone were assessed. Statistical analysis was performed with Friedman´s test and within ANOVA (p ≤ 0.05) followed by post-hoc tests. Papilla height decreased from T₀ to T₁ (p = 0.003), followed by an increase from T₁ to T₂ (p = 0.040). PPD (T₀ = 1.72 ± 0.46; T₂ = 2.13 ± 0.43) and CAL (T₀ = 1.24 ± 0.55; T₂ = 1.99 ± 0.70) increased after 6 months. There were statistically significant differences in aesthetic score among T₀, T₁ and T₂. Periodontal changes after orthognathic surgery were within acceptable biological levels. Although a change in papillae height was reported after the surgery, initial values were recovered after 6 months. Surgical incision design might improve the outcome of Le-Fort I osteotomy. Anterior aesthetic zone may benefit from a marginal incision design, as it respects vascularization principle and may ensure a wound healing without complications.

Artifacts in magnetic resonance imaging caused by dental materials: a systematic review

OBJECTIVES

The purpose of this systematic review was to search in literature in which severity unintended effects are caused by dental materials in magnetic resonance imaging (MRI), such as to evaluate whether these artifacts hamper the diagnosis in the head and neck region.

MATERIALS AND METHODS

Clinical studies showing the severity of artifacts which dental materials are capable of causing in MRI of head and neck, such as their influence on diagnostic accuracy, were included in this review. The searches were conducted in four electronic databases (PubMed/Medline, Embase, Scopus and Web of Science), and a manual search was made in the reference lists of papers screened for full-text reading. Risk of bias was assessed using "Quality Assessment Tool for Diagnostic Accuracy Studies-2" (QUADAS-2). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence.

RESULTS

From 151 studies selected for full-reading, 19 were considered eligible for this review. Artifacts caused by orthodontic appliances were well-documented, and stainless steel brackets were the materials most likely to cause artifacts in MR imaging of head and neck. The literature was scarce for dental implants and restorations. Diagnoses within the oral cavity, but also those of the brain and craniofacial structures, were affected.

CONCLUSION

Artifacts caused by orthodontic appliances may affect the diagnosis in oral cavity and craniofacial structures. Data regarding dental implants and prosthodontics restorations were inconclusive. The severity of artifacts in MRI and their influence on diagnosis is dependent on dental material features, location in the oral cavity, and magnetic resonance parameters.

Pleiotropic effects on proliferation and mineralization of primary human adipose tissue-derived stromal cells induced by simvastatin

The circulating low-density lipoprotein concentration in blood can be reduced by the administration of statins. Frequently simvastatin (SV) is prescribed. Due to the reported pleiotropic effects of SV the aim of this study was to evaluate mineralization effects on human adipose tissue-derived stromal cells upon administration of SV. After informed consent human adipose tissue-derived stromal cells were obtained from tissue surplus of regular treatments of 14 individuals. According to established protocols after adding various SV concentrations (0.01 µM, 0.1 µM, 1.0 µM, 2.0 µM), alkaline phosphate (osteoblastic marker), mineralization capability and viability were determined at day 18, 21 and 28. The Kruskal-Wallis test was performed for statistical analysis. After adding SV a dose-dependent significant decreased viability and levels of alkaline phosphatase (p < 0.01) and a significantly increased mineralization (p < 0.01) of the primary cultures was recognized during the late mineralization stage. Mineralization of the human adipose tissue-derived stromal cells was induced by SV, possibly originated from alternative pathways than the alkaline phosphatase pathway. Further investigations should be performed regarding switching into the osteoblastic differentiation and as a possible source of cells that can be used as the basis for a potential bone graft substitute, which may allow an extension of the field of application.

In Vivo Accuracy of a New Digital Planning System in Terms of Jaw Relation, Extent of Surgical Movements and the Hierarchy of Stability in Orthognathic Surgery

This retrospective cohort study compares the virtual planned and postoperative jaw positions in patients undergoing orthognathic surgery. Surgery was virtually planned with the Digital Münster Model Surgery system (DMMS). Primary outcome: Spatial difference in the maxillo-mandibulo relation between virtual planning and postoperative result. Secondary outcome: Possible relationship between the measured differences and surgical movements as well as the postoperative stability according to Proffit. Ninety female and sixty-one male patients were included in the study. The average translation errors were 0.54 ± 0.50 mm (anteroposterior), 0.37 ± 0.33 mm (mediolateral), and 0.33 ± 0.28 mm (superoinferior). Orientation errors were 0.86 ± 0.79 degrees (yaw), 0.54 ± 0.48 degrees (roll), and 0.90 ± 0.72 degrees (pitch). The surgical procedures do not differ with respect to their error sizes. Maxilla forward and class II maxilla up with mandible forward are the most precise procedures. Most significant differences were found in the anteroposterior direction, whereby the extent of the surgical movement has no effect on the magnitude of the error. The process of planning with the DMMS followed by surgery is highly accurate and shows error values well below the clinically accepted limit of two millimeters in translation and four degrees in rotation.

Horizontal augmentation techniques in the mandible: a systematic review

Purpose

Placement of dental implants has evolved to be an advantageous treatment option for rehabilitation of the fully or partially edentulous mandible. In case of extensive horizontal bone resorption, the bone volume needs to be augmented prior to or during implant placement in order to obtain dental rehabilitation and maximize implant survival and success.

Methods

Our aim was to systematically review the available data on lateral augmentation techniques in the horizontally compromised mandible considering all grafting protocols using xenogeneic, synthetic, or allogeneic material. A computerized and manual literature search was performed for clinical studies (published January 1995 to March 2021).

Results

Eight studies ultimately met the inclusion criteria comprising a total of 276 procedures of xenogeneic, allogeneic, or autogenous bone graft applications in horizontal ridge defects. Particulate materials as well as bone blocks were used as grafts with a mean follow-up of 26.0 months across all included studies. Outcome measures, approaches and materials varied from study to study. A gain of horizontal bone width of the mandible with a mean of 4.8 mm was observed in seven of eight studies. All but one study, reported low bone graft failure rates of 4.4% in average.

Conclusions

Only limited data are available on the impact of different horizontal augmentation strategies in the mandible. The results show outcomes for xenogeneic as well as autologous bone materials for horizontal ridge augmentation of the lower jaw. The use of allogeneic bone-block grafts in combination with resorbable barrier membranes must be re-evaluated. Randomized controlled clinical trials are largely missing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40729-022-00421-7.

Controversial Aspects of Diagnostics and Therapy of Arthritis of the Temporomandibular Joint in Rheumatoid and Juvenile Idiopathic Arthritis-An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project

Introduction: Due to potentially severe sequelae (impaired growth, condylar resorption, and ankylosis) early diagnosis of chronic rheumatic arthritis of the temporomandibular joint (TMJ) and timely onset of therapy are essential. Aim: Owing to very limited evidence the aim of the study was to identify and discuss controversial topics in the guideline development to promote further focused research. Methods: Through a systematic literature search, 394 out of 3771 publications were included in a German interdisciplinary guideline draft. Two workgroups (1: oral and maxillofacial surgery, 2: interdisciplinary) voted on 77 recommendations/statements, in 2 independent anonymized and blinded consensus phases (Delphi process). Results: The voting results were relatively homogenous, except for a greater proportion of abstentions amongst the interdisciplinary group (p < 0.001). Eighty-four percent of recommendations/statements were approved in the first round, 89% with strong consensus. Fourteen recommendations/statements (18.2%) required a prolonged consensus phase and further discussion. Discussion: Contrast-enhanced MRI was confirmed as the method of choice for the diagnosis of TMJ arthritis. Intraarticular corticosteroid injection is to be limited to therapy-refractory cases and single injection only. In adults, alloplastic joint replacement is preferable to autologous replacement. In children/adolescents, autologous reconstruction may be performed lacking viable alternatives. Alloplastic options are currently still considered experimental.

Effect of Cold Atmospheric Plasma (CAP) on Osteogenic Differentiation Potential of Human Osteoblasts

Bone regeneration after oral and maxillofacial surgery is a long-term process, which involves various mechanisms. Recently, cold atmospheric plasma (CAP) has become known to accelerate wound healing and have an antimicrobial effect. Since the use of CAP in dentistry is not yet established, the aim of the present study was to investigate the effect of CAP on human calvaria osteoblasts (HCO). HCO were treated with CAP for different durations of time and distances to the cells. Cell proliferation was determined by MTT assay and cell toxicity by LDH assay. Additionally, RT-qPCR was used to investigate effects on osteogenic markers, such as alkaline phosphatase (ALP), bone morphogenic protein (BMP)2, collagen (COL)1A1, osteonectin (SPARC), osteoprotegerin (OPG), osterix (OSX), receptor activator of NF-κB (RANK), RANK Ligand (RANKL), and Runt-related transcription factor (RUNX)2. There were small differences in cell proliferation and LDH release regarding treatment duration and distance to the cells. However, an increase in the expression of RANK and RANKL was observed at longer treatment times. Additionally, CAP caused a significant increase in mRNA expression of genes relevant to osteogenesis. In conclusion, CAP has a stimulating effect on osteoblasts and may thus represent a potential therapeutic approach in the regeneration of hard tissue defects.

The University Münster model surgery system for orthognathic surgery - The digital update

Aim

The aim of this work is to present a digital methodology of a conventional articulator based planning protocol.

Methods

The digital counterpart consists of intra-oral scans (3Shape) and a free available 3D mesh software (Meshmixer, Autodesk). The maxillary position in relation to the reference plane used and the arbitrary hinge axis were determined mathematically from landmarks on cephalometric x-rays and frontal photographs. Distances and angles were calculated to virtually mount the digital jaws in Meshmixer’s wold frame. Virtual planning is done by cloning and moving the jaws according to the preliminary surgery plan. The spatial movements of the jaws are measured by attached reference points.

Results

This digital approach eliminate the need for articulator hardware and laboratory plaster work. It enables all planning scenarios as they are also possible with conventional plaster-based procedures. The method is time-saving, practical and cost-effective. Standard dimensions of articulators and face-bows have been incorporated in the implementation. This reduction of individual patient values puts the accuracy of the presented method within the range of conventional model surgery.

Conclusion

Arbitrary planning will continue to have its place in orthognathic surgery, especially when digital methods can improve the overall process. The method presented can be seen as a cost-effective alternative for patients who do not require technically complex planning.

Clinical characteristics of oral lichen planus and its causal context with dental restorative materials and oral health-related quality of life

Background

The aim of this study was to investigate the influence of clinical characteristics and dental restorative materials on oral health-related quality of life in patients with oral lichen planus. In particular, the influences of amalgam and metals were investigated.

Methods

A total of 112 patients with clinical and histological features of oral lichen planus from the Department of Cranio-Maxillofacial Surgery at the University Hospital of Münster participated in this prospective study. Clinical parameters of oral lichen planus and the dental restorative materials used were evaluated. Oral health-related quality of life was investigated by using the short form of the German version of the Oral Health Impact Profile (OHIP-14). In addition, physical pain was rated on a visual analogue scale.

Results

The average OHIP-14 score was 13.54. A high correlation was seen between OHIP and pain. Likewise, higher OHIP-values were seen for male patients, and such as for those patients with non-reticular forms of oral lichen planus (OLP). A local form of OLP is more often seen on female patients, such as with the presence of reticular lichen. In regard to the restorations, the presence of composite restorations is correlated with a local lichen, whereas the presence of gold restorations is often seen with a generalized lichen. Furthermore, the grading of strength of association between mucosal lesion and amalgam/metal was tested. No significant differences revealed the analysis of the relationship between gender, clinical form of OLP, age, and presentation form between the 4 gradings of Thornhill.

Conclusions

The oral health-related quality of life is significantly limited in patients with oral lichen planus. But these OHIP scores are not influenced by the restorative materials. Here, pain severity is the most important aspect. We found no statistical differences in the clinical parameters between patients with amalgam or metal restoration and patients without these restorations. It is not necessary to replace amalgam fillings that are not in direct contact with mucosal surfaces.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01622-z.

Implant-Prosthetic Restoration of a Patient with Osteogenesis Imperfecta: A Case Report

Osteogenesis imperfecta describes a group of genetic disorders that result from a defect in collagen type I and range in severity from a subtle increase in fracture frequency to death in the perinatal period. Osteogenesis imperfecta is mostly caused by mutations in the COL1A1 (17q21.33) and COL1A2 (7q21.3) genes. There have only been a few case reports of implant-prosthetic treatment for patients with osteogenesis imperfecta. These reports indicated that implants and augmentation procedures can be implemented in such patients. However, for patients receiving additional antiresorptive therapy, cautious approaches should be chosen and the risk of drug-associated osteonecrosis should be considered. The aim of this article is to report on the implant-prosthetic treatment of a patient with type I osteogenesis imperfecta.

Radiotherapy as Part of Treatment Strategies in Nasal Cavity and Paranasal Sinus Malignancies

BACKGROUND/AIM

Modern intensity-modulated radiotherapy (IMRT) is frequently applied to treat patients with nasal cavity and paranasal sinus (NC/PNS) malignancies.

PATIENTS AND METHODS

One hundred and four patients who underwent radiotherapy (RT) between 1994 and 2020 were recognized. This analysis compared conventional-radiotherapy (CRT) and image-guided IMRT outcomes for NC/PNS malignancies.

RESULTS

The median follow-up was 69 months. Eighty-eight patients (85%) were managed with image-guided IMRT. The median initial radiation dose was 65 Gy, with 68 Gy applied for patients treated with primary RT versus 63 Gy applied for adjuvant therapy (p=0.1). The 5-year locoregional control (LRC) was 85%. The locoregional recurrence rate was 18% following IMRT versus 31% in the 2D/3D-conventional RT group (p=0.09). Moreover, IMRT was associated with a lower inner-ear toxicity rate (8% vs. 20%, respectively; p=0.045).

CONCLUSION

IMRT appears to be linked with higher LRC and lower inner-ear acute toxicities compared to conventional RT.

Assessment of Trabecular Bone During Dental Implant Planning using Cone-beam Computed Tomography with High-resolution Parameters

Background:

Cone-Beam Computed Tomography (CBCT) with high-resolution parameters may provide an acceptable resolution for bone assessment.

Objectives:

The purpose of this study is to assess trabecular bone using two cone-beam computed tomography (CBCT) devices with high-resolution parameters in comparison to micro-computed tomography (µCT).

Methods:

Bone samples (n=8) were acquired from dry mandibles and scanned by two CBCT devices: 1) VV (Veraview R100, Morita; FOV 4x4, 75kV, 9mA, voxel size 0.125µm); and PR (Prexion 3D, Prexion; FOV 5x5, 90kV, 4mA, 37s, voxel size 108µm). Gold-standard images were acquired using µCT (SkyScan 1272; Bruker; 80kV, 125mA, voxel size 16µm). Morphometric parameters (BvTv- Bone Volume Fraction, BsBv- Trabecular specific surface, TbTh- Trabecular thickness and TbSp- Trabecular separation) were measured. Statistical analysis was performed within ANOVA, Spearman Correlation test and Bland-Altmann plots with a statistical significance level at p=0.05.

Results:

CBCT devices showed similar BvTv values in comparison to µCT. No statistical difference was found for BvTv parameters assessed by CBCT devices and µCT. BsBv values were underestimated by CBCT devices (p<0.01), whereas TbTh and TbSp values were overestimated by them (p<0.01). Positive correlations were found between VV and µCT measurements for BvTv (r2= 0.65, p=0.00), such as between PR and µCT measurements for TbSp (r2= 0.50, p=0.04). For BsBv measurements, PR was negatively correlated with µCT (r2= -0.643, p=0.01).

Conclusion:

The evaluated CBCT device was able to assess trabecular bone. However, bone parameters were under or overestimated in comparison to µCT.

Subjective Oral Health-Related Quality of Life and Objective Oral Health in People with Ectodermal Dysplasia

Ectodermal dysplasia (ED) refers to a heterogeneous group of genetic diseases of the skin, skin appendages, and teeth. People with ED experience a poorer oral health-related quality of life (OHRQoL) compared to the general population. The aim of this study was to examine the OHRQoL of people with ED and to measure their objective physical oral health to confirm or disprove evidence of poorer oral health in this population. To determine OHRQoL, the German version of the 14-item Oral Health Impact Profile (OHIP-14G) was used. All the participants in the study were clinically examined, and the measured parameters were recorded using the Physical Oral Health Index (PhOX). In total, 10 male and 11 female participants, with an average age of 22.0 ± 9.0 years, were included in this study. The OHIP-14G summary score was 23.9 (±15.2) points (range: 0–56 points). The PhOX summary score was 61.2 (±5.1) points (range: 22–80 points). The findings indicated that both the OHRQoL and physical oral health of the participants were highly impaired and that their objective and subjective oral health were worse than those of the general population in Germany.

Study to Investigate the Knowledge of Rare Diseases among Dentists, Orthodontists, Periodontists, Oral Surgeons and Craniomaxillofacial Surgeons

Fifteen percent of the 5000 to 8000 rare diseases (RDs) can manifest in the oral and maxillofacial region. Little attention has been paid to the care situation of people with RDs in dentistry. Hence, the aim of this study was to assess the level of knowledge about RDs among dentists at a university hospital (DUs) compared to dentists with different professional backgrounds and among general dentists, specialist dentists and DUs in the chamber district of Westfalen-Lippe. Moreover, self-assessment of the level of knowledge was evaluated. A questionnaire was designed, which was made available digitally via a link. A random sample of 1500 dentists, specialist dentists, and oral- and craniomaxillofacial surgeons from the membership of the Dental Association of Westfalen-Lippe, and all dentists, specialist dentists, and oral- and craniomaxillofacial surgeons working at the University Dental Hospitals Münster and Witten/Herdecke, were invited to participate to our study. Differences in the level of knowledge between DUs and non-DUs and differences between DUs, general dentists, and specialist dentists were tested via two-sided Fischer’s exact tests. Differences between the three groups of self-assessment of the level of knowledge and the self-assessment of how sufficient their own knowledge about RDs is were tested via two-sided Kruskal–Wallis tests. The global level of significance was controlled by the Bonferroni method. A total of 267 questionnaires were completed, of which 64.0% were answered by general dentists, 25.5% by specialist dentists and 10.5% by DUs. DUs had a significant higher level of knowledge about RDs (adjusted p = 0.012) compared to non-DUs and achieved higher scores (median = 16.5 points) than general (median = 13 points) and specialist dentists (median = 13 points) (p = 0.001). In the self-assessments, the differences were not significant (p > 0.05). In conclusion, most participants showed no or little knowledge about RDs, and DUs had a significant higher level of knowledge than non-university dentists.

Trabecular Bone Assessment Using Magnetic-Resonance Imaging: A Pilot Study

The aim of this study was to assess trabecular bone morphology via magnetic-resonance imaging (MRI) using microcomputed tomography (µCT) as the control group. Porcine bone samples were scanned with T1-weighted turbo spin echo sequence imaging, using TR 25 ms, TE 3.5 ms, FOV 100 × 100 × 90, voxel size 0.22 × 0.22 × 0.50 mm, and scan time of 11:18. µCT was used as the control group with 80 kV, 125 mA, and a voxel size of 16 µm. The trabecular bone was segmented on the basis of a reference threshold value and morphological parameters. Bone volume (BV), Bone-volume fraction (BvTv), Bone specific surface (BsBv), trabecular thickness (TbTh), and trabecular separation (TbSp) were evaluated. Paired t-test and Pearson correlation test were performed at p = 0.05. MRI overestimated BV, BvTv, TbTh, and TbSp values. BsBv was the only parameter that was underestimated by MRI. High statistical correlation (r = 0.826; p < 0.05) was found for BV measurements. Within the limitations of this study, MRI overestimated trabecular bone parameters, but with a statistically significant fixed linear offset.

Correlation between Oral Health-Related Quality of Life and Objectively Measured Oral Health in People with Ehlers-Danlos Syndromes

It is a well-known fact that people with Ehlers–Danlos syndromes (EDS) report a worse oral health-related quality of life (OHRQoL) than the general population. The aim of this study was to examine whether there is a correlation between the subjective OHRQoL and the objectively measured oral health in people with EDS. To determine the subjective OHRQoL, the German version of the 14-item Oral Health Impact Profile (OHIP-14) questionnaire was used. Furthermore, all participants in the study were clinically examined, and the measured parameters were recorded using the Physical Oral Health Index (PhOX). Altogether, records of 46 participants were collected. The median (interquartile range (IQR)) of the OHIP-14 was 17 (23) points and the median of the PhOX was 73 (16) points. However, a statistically significant correlation could not be demonstrated (r = −0.240, p = 0.108). In the observed cohort, for participants who reported having pain often or very often, the OHIP score (median = 24, IQR = 18, p < 0.01) was higher than the score of the group given by participants who never or intermittently experienced pain (median = 8, IQR = 18). In conclusion, patients with EDS showed a reduced OHRQoL, although it was not possible to observe an association between the subjective OHRQoL and the objective oral health. However, participants who often or very often suffer from pain in their tooth, mouth, and jaw areas showed a reduced OHRQoL.

Simvastatin Induces In Vitro Mineralization Effects of Primary Human Odontoblast-Like Cells

Simvastatin (SV) is an often prescribed statin reducing the LDL-concentration in circulating blood. The aim of this study was to evaluate the pleiotropic effects of SV to primary human odontoblast-like cells. Twenty four wisdom teeth of different subjects were extracted and the pulp tissue was removed and minced under sterile conditions. After mincing, the requested cells were passaged according to established protocols. Osteoblastic marker (ALP conversion), viability and mineralization were determined at days 14, 17 and 21 after simvastatin exposition (0.01 µM, 0.1 µM, 1.0 µM, 2.0 µM). The sample size per group was 24 cultures with three replicates per culture for ALP-conversion and mineralization and 6 replicates for viability. A Kruskal–Wallis test was used for statistical analysis. After adding SV, viability was significantly (p < 0.01) decreased in a time- and dose-dependent manner, whereas after 21 days, mineralization was significant (p < 0.01). ALP-conversion in groups with SV concentrations of 1 and 2 µM SV was significantly (p < 0.01) increased. Pleiotropic effects regarding mineralization in higher SV concentrations were possibly induced via alternative mineralization pathways as almost equal elevations of ALP conversion were not evident in the control and experimental groups.

Does the Clinical Form of Oral Lichen Planus (OLP) Influence the Oral Health-Related Quality of Life (OHRQoL)?

(1) Background: The aim of the study was to investigate the oral health-related quality of life (OHRQoL) of patients with oral lichen planus (OLP) and to evaluate differences between the various clinical forms of OLP. Specifically, the differences in OHRQoL, physical pain levels and eating restriction were assessed; (2) Methods: One hundred and twelve patients with clinical and histological features of OLP from the Department of Cranio-Maxillofacial Surgery of the Münster University Hospital participated in this prospective study. OHRQoL was analysed by using the German short version of the Oral Health Impact Profile (OHIP-14). Physical pain levels and restriction in eating were rated on visual analogue scales (VAS). The statistical analysis was performed using the Mann-Whitney U-Test and the chi-squared test with a significance level at p = 0.05; (3) Results: Group 1 consisted of patients with reticular OLP (n = 50) and group 2 of patients with atrophic, erosive-ulcerative or bullous OLP (n = 62). The average OHIP-14 score was 13.54 points and differed significantly between the two groups. There were significant differences in the domains "physical pain", "psychological discomfort", "physical disability" and "social disability". The VAS "physical pain" score and "restriction in eating" score varied significantly between the clinical forms. Positive correlations were found between the OHIP-14 total scores and the VAS scores; (4) Conclusion: The OHRQoL is significantly limited in patients with OLP; especially, patients with erosive-ulcerative OLP are affected.

Treatment of Mandible Fractures Using a Miniplate System: A Retrospective Analysis

Three-dimensional (3D) mini plate systems are used in the treatment of mandibular fractures. The system is advantageous in comparison to conventional plates due to the stabilization of tension and compression areas, improved initial stability, and biomechanical behavior. The aim of this retrospective study was to evaluate the use of a 3D miniplate system for the treatment of patients with mandibular fractures. Patients with mandibular fractures treated with a 3D plate system at the Department of Oral and Maxillofacial Surgery, University Hospital Münster, during a period of 5 years, were included in this study. Mandibular fracture conditions and minor and major post-operative complications were reported. In total, 336 patients and 391 mandibular fractures were assessed. The most common fracture site was anterior mandible, and 155 cases involved a tooth-bearing area. Minor complications were seen in 8.03% of cases, whereas only 1.49% of patients suffered from major complications. The treatment of mandible fractures using 3D miniplates resulted in fracture reduction with a low complication rate.

Simvastatin induces adverse effects on proliferation and mineralization of human primary osteoblasts

Background

Frequently statins were administered to reduce the LDL-concentration in circulating blood. Especially simvastatin (SV) is an often prescribed statin. Pleiotropic effects of these drugs were reported. Thus, the aim of this study was to evaluate effects of SV on osteoblastic mineralization.

Methods

After informed consent primary osteoblasts were collected from tissue surplus after treatment of 14 individuals in the Department of Cranio-Maxillofacial Surgery, University Hospital Münster. The cells were passaged according to established protocols. Viability, mineralization capability and osteoblastic marker (alkaline phosphatase) were determined at day 9, 13 and 16 after adding various SV concentrations (0.05 μM, 0.1 μM, 0.5 μM, 1.0 μM). Statistical analysis was performed using the Kruskal-Wallis-test.

Results

The cell cultures showed a time and dose-dependent significantly decreased viability (p < 0.01) and a significantly increased mineralization (p < 0.01) in a late mineralization stage after adding SV. The typical alteration of the alkaline phosphatase (ALP) levels during osteogenic differentiation was not recognizable.

Conclusions

The pleiotropic effects found for different SV concentrations were possibly originated from other mineralization pathways beside the ALP induced one. Additionally, possible alterations of protein expression levels during mineralization and investigation of possible deviating application of SV in other treatment fields can be considered after gaining a deeper insight in the affected mechanisms.

Magnetic resonance imaging artifacts produced by dental implants with different geometries

OBJECTIVES

The purpose of this study was to evaluate the MRI-artifact pattern produced by titanium and zirconia dental implants with different geometries (diameter and height).

METHODS

Three titanium (Titan SLA, Straumann) and three zirconia (Pure Ceramic Implant, Straumann) dental implants differing on their design (diameter x height) were installed in porcine bone samples. Samples were scanned with a MRI (3T, T1W turbo spin echo sequence, TR/TE 25/3.5ms, voxel size 0.22×0.22×0.50 mm, scan time 11:18). Micro-CT was used as control group (80kV, 125mA, voxel size 16µm). Artifacts' distribution was measured at vestibular and lingual sites, mesial and distal sites, and at the apex. Statistical analysis was performed with Within-ANOVA (p=0.05).

RESULTS

Artifacts distribution measured 2.57 ± 1.09 mm for titanium artifacts and 0.37 ± 0.20 mm for zirconia artifacts (p<0.05). Neither the measured sites (p=0.73) nor the implant geometries (p=0.43) influenced the appearance of artifacts.

CONCLUSION

Artifacts were higher for titanium than zirconia implants. The artifacts pattern was similar for different dental implant geometries.

Oral Health-Related Quality of Life in People with Achalasia

Background and Objective: The oral health-related quality of life (OHRQoL) of patients with achalasia has not been evaluated to date. Therefore, the aim of this study was to assess the OHRQoL of patients with achalasia and to get information about the time taken for diagnosis and oral symptoms. Materials and Methods: The study was conceived of as an anonymous epidemiological survey study in people with achalasia in order to assess their OHRQoL in each case. For this, a questionnaire was developed consisting of free-text questions and of the standardized German version of the OHIP-14 questionnaire. Results: In total, forty-four questionnaires were analyzed including 31 female and 13 male participants. Regardless of gender, the mean age was 50.57 years (range: 17–78). Of the surveyed individuals, seventy-nine-point-five-five percent had been diagnosed between 25 and 60 years of age. The period from the first signs of the disease to diagnosis was 6.15 years, irrespective of gender. The overall OHIP-14 score without gender differentiation was 8.72 points (range 0–48); the mean score of female participants was 11.13 (range: 0–48), and the OHIP score of male participants was 3.15 on average. Two participants reported oral symptoms. Conclusions: The already known problem of the delayed diagnosis of rare diseases was also confirmed in the case of achalasia. Females with achalasia seemed to be significantly affected by lower OHRQoL than males with achalasia and women of the general population. Demineralization of the tooth structure was described in two participants.

Influence of Implant Material and Surface on Mode and Strength of Cell/Matrix Attachment of Human Adipose Derived Stromal Cell

A fundamental step for cell growth and differentiation is the cell adhesion. The purpose of this study was to determine the adhesion of different cell lineages, adipose derived stromal cells, osteoblasts, and gingival fibroblast to titanium and zirconia dental implants with different surface treatments. Primary cells were cultured on smooth/polished surfaces (titanium with a smooth surface texture (Ti-PT) and machined zirconia (ZrO₂-M)) and on rough surfaces (titanium with a rough surface texture (Ti-SLA) and zirconia material (ZrO₂-ZLA)). Alterations in cell morphology (f-actin staining and SEM) and in expression of the focal adhesion marker were analysed after 1, 7, and 14 days. Statistical analysis was performed by one-way ANOVA with a statistical significance at p = 0.05. Cell morphology and cytoskeleton were strongly affected by surface texture. Actin beta and vimentin expressions were higher on rough surfaces (p < 0.01). Vinculin and FAK expressions were significant (p < 0.05) and increased over time. Fibronectin and laminin expressions were significant (p < 0.01) and did not alter over time. Strength of cell/material binding is influenced by surface structure and not by material. Meanwhile, the kind of cell/material binding is regulated by cell type and implant material.

Distribution of bone thickness in the human mandibular ramus - a CBCT-based study

Background

The bone thickness of the human mandibular ramus is an important parameter in mandibular surgeries. The aim of this study was to systematically measure the bicortical bone thickness, the ramus dimensions and the position of the lingula. The measurements were tested on significant correlations to the patients’ parameters.

Methods

Based on CBCT scans 150 rami were reconstructed as 3D polygon surfaces. An anatomical grid was adapted to the ramus surface to mark the bone thickness measurement points and to achieve comparability between the measurements on different mandibles. The bone thickness, ramus height, ramus width and the gonion angle were measured. A cluster analysis was performed with these parameters to identify clinically relevant groups with anatomical similarities.

Results

The median distribution of the bone thickness was calculated and visualized in a pseudo-colour map. The mean ramus height was 44.78 mm, the mean width was 31.31 mm and the mean gonion angle was 124.8°. The average distance from the lingula to the dorsal tangent was 53% of the total width and its distance to the caudal tangent was 65% of the total height. Significant correlations between the bone thickness and the ramus proportions could be identified. Age and sex had no significant influence on the mean bone thickness. The measured rami could be divided into two groups by cluster analysis.

Conclusion

The dimensions of the human mandibular ramus can be determined from 3D reconstructed surface models from CBCT scans. Measurements could be made comparable by applying an anatomically oriented grid. A cluster analysis allowed the differentiation of two groups with different bone thickness distributions and geometries, which can be used for the optimization of osteosynthesis systems and their precision of adaptation to different ramus morphologies.

Assessment of Peri-implant Buccal Bone Thickness Using Digital Imaging Techniques: A Systematic Review and Meta-analysis

Objectives:

This systematic review aimed to answer the following focused question: Do the currently available imaging techniques provide accuracy in the assessment of peri-implant buccal bone thickness?

Methods:

A search strategy was conducted in eight electronic databases, followed by an additional manual search in grey literature and references of selected articles. Studies evaluating the accuracy of imaging techniques to measure peri-implant buccal bone thickness were included. Individual risk of bias was assessed by the Quality Assessment Tool for Diagnostic Accuracy Studies-2 (QUADAS-2). Meta-analysis was performed to evaluate CBCT accuracy. The overall effect size was determined by means of the Z-test. Q test was used to evaluate the homogeneity of effect sizes among studies and I2 was applied to determine the variance within studies.

Results:

After an initial screening, 83 studies were further selected for full reading and 13 of them were considered eligible for this review. In sum, the accuracy of Cone-beam Computed Tomography (CBCT), of ultrasound, and of computed tomography were assessed. There was no statistically significant difference between CBCT and the gold standard (p=0.81). The mean difference between measurements of bone thickness obtained by CBCT and the goldstandard was -0.0.3mm [95%CI -0.29;0.253mm].

Conclusion:

CBCT showed acceptable accuracy for assessing peri-implant bone. No meaningful conclusion could be drawn about other techniques.

3D-printed Surgical Training Model Based on Real Patient Situations for Dental Education

Background: Most simulation models used at university dental clinics are typodonts. Usually, models show idealized eugnathic situations, which are rarely encountered in everyday practice. The aim of this study was to use 3D printing technology to manufacture individualized surgical training models for root tip resection (apicoectomy) on the basis of real patient data and to compare their suitability for dental education against a commercial typodont model. Methods: The training model was designed using CAD/CAM (computer-aided design/computer-aided manufacturing) technology. The printer used to manufacture the models employed the PolyJet technique. Dental students, about one year before their final examinations, acted as test persons and evaluated the simulation models on a visual analogue scale (VAS) with four questions (Q1-Q4). Results: A training model for root tip resection was constructed and printed employing two different materials (hard and soft) to differentiate anatomical structures within the model. The exercise was rated by 35 participants for the typodont model and 33 students for the 3D-printed model. Wilcoxon rank sum tests were carried out to identify differences in the assessments of the two model types. The alternative hypothesis for each test was: "The rating for the typodont model is higher than that for the 3D-printed model". As the p-values reveal, the alternative hypothesis has to be rejected in all cases. For both models, the gingiva mask was criticized. Conclusions: Individual 3D-printed surgical training models based on real patient data offer a realistic alternative to industrially manufactured typodont models. However, there is still room for improvement with respect to the gingiva mask for learning surgical incision and flap formation.

State of knowledge about information sources and health care centres for rare diseases among affected people in Germany

OBJECTIVES

About four million people are affected by rare diseases in Germany and 30 million in the EU. In 2013, a national action plan for people with rare diseases was adopted in Germany which is also aimed at improving the information situation and better gathering of information for affected patients and their families. Since then, various sources of information and medical care structures have been made available. The aim of this study was to evaluate the state of knowledge about information sources and health care centres for rare diseases among those affected.

METHODS

The study was carried out as anonymous survey among the member associations of the German Alliance for Chronic Rare Diseases (German acronym ACHSE e. V.). For this, a questionnaire was developed which in addition to questions on gender, age and disease comprised free text input referring to knowledge of health care centres or expert centres and source of information on rare diseases in Germany.

RESULTS

A total of 484 individuals suffering from 96 different rare diseases participated in the survey. Of these, 74.47% are aware of medical or dental care centres for treatment of their types of rare disease; 69.31% use self-help groups as a source of information, only a few respondents know government-sponsored "se-atlas" and "Orphanet".

CONCLUSION

The majority of the respondents know medical care centres, most participants use self-help groups as information source, however, government-supported portals are largely unknown so that there is a need for further information in this regard.

[Oral health-related quality of life in rare diseases associated with oral symptoms, diagnostic delay, and sex]

BACKGROUND

In Germany, around four million people are affected by a rare disease, from which 15% show orofacial manifestations.

AIM OF THE STUDY

The aim of this cross-sectional study was to determine the oral health-related quality of life of people with rare diseases and to investigate the relationship between oral symptoms, diagnostic delay, and gender.

MATERIALS AND METHODS

A questionnaire with open-ended questions, including questions from the validated oral health impact profile (OHIP) G14 questionnaire, was developed to survey the subjective oral health-related quality of life. The questionnaire was sent to 125 German member associations of the umbrella organization of self-help groups. The correlation between OHIP values and the three factors was evaluated using a regression model with a significance level of p = 0.01.

RESULTS

In total, 473 participants affected by 96 different rare diseases were included in this analysis. The OHIP value for participants without oral manifestations was 6.54 points lower than for those with oral symptoms (p = 0.001). For oral symptoms, the OHIP increased by 0.080 points (p = 0.014) with each year of diagnostic delay. A connection with sex was not found.

CONCLUSION

Regardless of the presence of oral symptoms, people with rare diseases in Germany show a poorer oral health-related quality of life than is known to the normal population. If oral symptoms are present, they show a negative correlation with oral health-related quality of life. On average, it takes 8.37 years for a disease to be correctly diagnosed. The earlier a rare disease is diagnosed, the better the oral health-related quality of life of those affected.

[Identification of rare diseases in the oral cavity]

In 2013, a national action plan for people with rare diseases (Nationaler Aktionsplan für Menschen mit Seltenen Erkrankungen, NAMSE) was adopted in the Federal Republic of Germany which is currently in the implementation phase. People with rare diseases are often confronted with huge difficulties in the diagnosis and therapy, and being repeatedly misdiagnosed also leads to psychological stress for those affected and their families. Of the up to 8000 rare diseases, about 15% can manifest in the orofacial region and thus give an indication of the underlying disease. A look in the oral cavity or consultative support to determine the cause of symptoms in the oral and maxillofacial region can possibly help the specialists in internal medicine to find the appropriate diagnosis.

[Rare diseases in dentistry and oral medicine : Report on the 2017 first national congress]

On November 25, the first national congress for rare diseases in dentistry and oral medicine under the auspices of ACHSE e. V. and Orphanet was held in Muenster. With speakers from the field of medicine, dentistry, politics, patient advocacy groups, self-help groups and persons concerned, a platform for exchange between physicians and patients on an equal footing was offered to the participants. At the end of each of the 12 lectures, more than 300 national and international guests discussed the various issues and perspectives related to the topic of rare diseases in dentistry and oral medicine. Besides the different presentations focusing on dentistry, neuropediatrics, and human genetics, the existing centers for rare diseases, sources of information, European reference networks, and the national action plan for people with rare diseases were the subjects of intensive discussion. The patient perspective was also considered. From now on the congress shall be held in Muenster biennially.

Using Image-guided Intensity-modulated Radiotherapy on Patients With Head and Neck Soft-tissue Sarcoma

BACKGROUND

Image-guided intensity-modulated radiotherapy (IG-IMRT) is increasingly being used to treat patients with soft-tissue sarcoma (STS) of the head and neck. Although there is no comparison between IMRT and conventional radiation therapy (CRT) concerning their efficacy. In this analysis, we compared CRT and IMRT outcomes for head and neck STS.

PATIENTS AND METHODS

Sixty-seven patients who underwent radiotherapy between 1994 and 2017 were identified.

RESULTS

The median follow-up was 31 months. Of the 67 patients, 34% were treated with CRT technique and 66% with IG-IMRT. The locoregional relapse rate following IMRT was 21% versus 70% with CRT (p<0.001) and the 5-year locoregional control was 69% versus 28%, respectively (p=0.01). IG-IMRT was associated with non-significant, less acute, and chronic adverse events. In the multivariate analysis, a significant influence of radiation technique on locoregional control was confirmed (p=0.04).

CONCLUSION

IG-IMRT seems to be associated both with higher locoregional control as well as lower acute and chronic toxicities.

Self-Assessment of Oral Health-Related Quality of Life in People with Ectodermal Dysplasia in Germany

Background: Ectodermal dysplasia describes a heterogeneous group of hereditary, congenital malformations involving developmental dystrophies of ectodermal structures. The aim of this study was to analyse the oral health-related quality of life (OHRQoL) in people with ectodermal dysplasia and to evaluate the influence of different variables. Methods: The study was designed as an anonymous epidemiological survey study among people with ectodermal dysplasia to evaluate oral symptoms, satisfaction with the health system and their respective OHRQoL using the validated German version of the OHIP-14 (Oral Health Impact Profile) questionnaire. Results: When asked about oral symptoms, 110 of the participants provided responses, of which 109 (99.09%) described oral symptoms. The average age of the female participants at the time of diagnosis was 17.02 years (range: 0 to 48 years), the average age of men was 5.19 years (range: 0 to 43 years). The average OHIP-14 overall score for female participants was 12.23 points (SD: 12.39), for male participants an average OHIP score of 11.79 points was recorded (SD: 11.08 points). Difficulty in finding a dentist (p = 0.001), and the dissatisfaction with the health system (p = 0.007) showed a negative impact on the OHRQoL. Conclusion: People with ectodermal dysplasia rate their OHRQoL worse than is usually prevalent in the normal German population (4.09 points); women are diagnosed with “ectodermal dysplasia” later than men. Participants who reported difficulties in finding a dentist for treatment exhibited higher OHIP values. Likewise, dissatisfaction with the health system demonstrated a negative impact on the oral health-related quality of life.

Oral symptoms and oral health-related quality of life of individuals with x-linked hypophosphatemia

Background

The primary purpose of this study was to collect data on the oral health-related quality of life (OHRQoL) of individuals with x-linked hypophosphatemia (XLH). It was also designed to gather information on the period of diagnosis, oral symptoms, orthodontic therapy, and satisfaction with dental care and the healthcare system.

Methods

A questionnaire was developed to evaluate the OHRQoL consisting of open-ended questions and the standardised German version of the Oral Health Impact Profile-14 (OHIP-14).

Results

The questionnaires from 43 participants were analysed, including 32 females (74.41%) and 11 males (25.59%). The mean OHIP-14 total score for the combined genders was 10.30 points (range: 0–37 points). For the combined genders, the mean period of time that elapsed between the first signs of the illness and the diagnosis was 5.52 years (range: 0–49 years). In total, 77.50% of the participants described oral symptoms, such as tooth mineralisation defects (n = 26), abscess or fistula formation (n = 21), dysgnathia (n = 9) and temporomandibular dysfunction (n = 2). The correlation between the participants’ satisfaction with the healthcare system and the OHIP-14 values was weak (− 0.21), and it was not statistically significant (p = 0.199).

Conclusions

The majority of the study participants reported oral involvement in the context of XLH, especially dental hard tissue mineralisation disorders, abscess formation and fistula formation. Those individuals affected by XLH with oral manifestations exhibited a tendency toward a worse OHRQoL than those without oral symptoms. In Germany, the OHIP-14 scores for these XLH patients were worse than those values that were obtained from the general population.

Electronic supplementary material

The online version of this article (10.1186/s13005-019-0192-x) contains supplementary material, which is available to authorized users.

Facial and midfacial symmetry in cleft patients: Comparison to non-cleft children and influence of the primary treatment concept

PURPOSE

Patients with cleft lip, alveolus and palate (CLAP) may suffer from marked asymmetry with an impact on attractiveness and psychosocial aspects. The aim of this study was to assess symmetry in CLAP patients compared to non-cleft controls of similar age with regard to cleft type and treatment concept.

MATERIALS AND METHODS

In CLAP patients with different cleft forms and in healthy non-cleft subjects (control group) a three-dimensional stereophotogrammetric face scan was performed and an objective 3D asymmetry index (AI) was calculated for the whole face, the midface, the upper lip and the nose.

RESULTS

In total, 305 patients were included: 140 CLAP patients (90 male, 50 female, mean age 9.9 ± 3.6 years) and 165 controls (87 male, 78 female, mean age 8.7 ± 2.1 years). In general, CLAP patients showed significantly higher asymmetry than controls, with the most severe asymmetry found in unilateral complete CLAP. Patients treated according to an actual concept considering reconstruction of all affected muscular systems had a significant lower and more favourable AI than patients not treated according to this concept (p < 0.05).

CONCLUSION

An adequate treatment concept is essential to achieve better results concerning symmetry in CLAP, but symmetry values of healthy non-cleft controls are not reached.

Orthodontically Relevant Manifestations in People with Rare Diseases

BACKGROUND

Approximately 15% of all rare diseases occur with orofacial manifestations. Symptoms and manifestations of relevance to orthodontists represent a considerable proportion of these diseases and require appropriate strategies for their treatment. This article provides an overview of the orthodontically relevant manifestations of rare diseases.

MATERIAL AND METHODS

Overall, 3,639 rare diseases listed at the Orphanet, OMIM or Pubmed database were evaluated for orofacial manifestations. All rare diseases which were indicated with at least one orofacial manifestation were recorded in a database for rare diseases with orofacial manifestations called "ROMSE," which was developed by the authors. All the rare diseases were analysed with regard to orthodontically relevant orofacial manifestations, such as dysgnathia, changes in the number of teeth, failures of eruption, pathologies of bone metabolism or orofacial clefts. For all rare diseases with orthodontic relevance, an exact analysis was undertaken.

RESULTS

The orthodontically relevant orofacial manifestation termed dysgnathia is described in 151 of 535 identified rare diseases (28.2%). In these 151 rare diseases, 15 different subforms of dysgnathia, in the sense of skeletal misdevelopments of the jaws but without dental abnormalities, were described. Also changes in the number of teeth (17.9%), orofacial clefts (27.6%), failures of eruption (8.4%) and pathologies of the bone (2.1%) were described.

CONCLUSIONS

Orthodontics play an important role in the diagnosis and treatment of orofacial manifestations in rare diseases. Databases such as ROMSE are a first step toward providing valid information in publicly accessible databases.

Influence of Implant Material and Surface on Differentiation and Proliferation of Human Adipose-Derived Stromal Cells

For the guided regeneration of periimplant hard and soft tissues, human adipose-derived stromal cells (hADSC) seem to be a promising source for mesenchymal stromal cells. For this, the proliferation and differentiation of hADSC were evaluated on titanium and zirconia dental implants with different surface treatments. Results were compared to edaphic cells as human osteoblasts (hOB) and human gingival fibroblasts (HGF). Primary cells were cultured on (1) titanium implants with a polished surface (Ti-PT), (2) sandblasted and acid-etched titanium (Ti-SLA), (3) sandblasted and alkaline etched zirconia (ZrO₂-ZLA) and (4) machined zirconia (ZrO₂-M). The cell proliferation and differentiation on osteogenic lineage were assessed after 1, 7 and 14 days. Statistical analysis was performed by one-way ANOVA and a modified Levene test with a statistical significance at p = 0.05. PostHoc tests were performed by Bonferroni-Holm. Zirconia dental implants with rough surface (ZrO₂-ZLA) showed the highest proliferation rates (p = 0.048). The osteogenic differentiation occurred early for zirconia and later for titanium implants, and it was enhanced for rough surfaces in comparison to polished/machined surfaces. Zirconia was more effective to promote the proliferation and differentiation of hADSCs in comparison to titanium. Rough surfaces were able to improve the biological response for both zirconia and titanium.

[Alternative therapy option for plastic-aesthetic treatment of defects after resection in the upper third of the facial region in the sense of subtotal scalping instead of local flap plastics]

In the presented case, the resulting defect size after resection of a dermatofibrosarcoma protuberans exceeded the treatment capability with local flaps in the region of the exposed facial skin. Through the use of conventional wound healing in combination with a meshed split-thickness skin graft, plastic aesthetic soft tissue treatment with an aesthetically satisfactory result was possible.