[Health-related quality of life of children and adolescents with primary nocturnal enuresis who are undergoing therapy]

BACKGROUND

Primary nocturnal enuresis (PNE) affects a relevant proportion of children (10-15% at school entrance). While a significant impact on psychological well-being and self-esteem of children has been reported, the consequences for Health-Related Quality of Life (HRQoL) have been less addressed. The aim of this investigation is the analysis of HRQoL of PNE under therapy with an established questionnaire.

METHODS

The KINDL‑R questionnaire for HRQoL with 24 items in 6 dimensions was sent to all patients of the enuresis outpatient clinic (ages 7-17 years, minimum 3 months of therapy, no achieved dryness). Actual number of wet nights and eventual comorbidities were extracted from the clinical data.

RESULTS

Of 57 questionnaires sent by mail, 47 were returned from patients and parents (82.5%). The patient results did not show a correlation between HRQoL and age, but there was a negative correlation of physical well-being and increasing age (r = -0.259, p < 0.05). A marked negative correlation was seen between bed-wetting frequency and HRQoL (r = -0.372, p < 0.05), especially in the dimensions "self-worthiness" (r = -0.399, p < 0.005) and "chronic-generic" (r = -0.383, p < 0.05).

DISCUSSION

During enuresis treatment without achieved dryness, the patients did not show systematic limitation in HRQoL compared to reference populations. This is in contrast to limitations in HRQoL and self-esteem before therapy, but may possibly be explained by the correlation of this dimension with bed-wetting frequency in this study and the reported improvement through treatment in other studies. Both factors support the need and importance of adequate PNE therapy.

Cellular fluid shear stress on implant surfaces-establishment of a novel experimental set up

Background

Mechanostimuli of different cells can affect a wide array of cellular and inter-cellular biological processes responsible for dental implant healing. The purpose of this in vitro study was to establish a new test model to create a reproducible flow-induced fluid shear stress (FSS) of osteoblast cells on implant surfaces.

Methods

As FSS effects on osteoblasts are detectable at 10 dyn/cm², a custom-made flow chamber was created. Computer-aided verification of circulation processes was performed. In order to verify FSS effects, cells were analysed via light and fluorescence microscopy.

Results

Utilising computer-aided simulations, the underside of the upper plate was considered to have optimal conditions for cell culturing. At this site, a flow-induced orientation of osteoblast cell clusters and an altered cell morphology with cellular elongation and alteration of actin fibres in the fluid flow direction was detected.

Conclusions

FSS simulation using this novel flow chamber might mimic the peri-implant situation in the phase of loaded implant healing. With this FSS flow chamber, osteoblast cells’ sensitivity to FSS was verified in the form of morphological changes and cell re-clustering towards the direction of the flow. Different shear forces can be created simultaneously in a single experiment.

Impact of maxillary sinus augmentation on oral health-related quality of life

BACKGROUND

The aim of this study was to measure the oral health-related quality of life (OHRQoL) after maxillary sinus augmentation to determine the physical and psychological impact of this procedure for the patient.

METHODS

Three hundred sixteen patients treated with an external or internal maxillary sinus augmentation and a total of 863 implants in the Department of Oral and Maxillofacial Surgery, Johannes Gutenberg University, Mainz, Germany, between July 2002 and December 2007 were included in this retrospective study. Total implant survival was assessed. Completion of a modified 26-item version of the Oral Health Impact Profile (OHIP-G) for assessing the oral health-related quality of life before and after the treatment was asked for. Subcategories were (1) functional limitations, (2) physical and psychological disabilities, and (3) complaints due to the surgical procedure. In 53 patients available for clinical follow-up examination, assessment of soft tissue parameters was performed.

RESULTS

After an average time in situ of 41.2 ± 27 months (3.4 years), the in situ rate was 95.4%. One-year survival rate and five-year survival rate according to Kaplan Meier were 95.4 and 94.4%. Concerning functional limitations, significant better values for OHRQoL after sinus augmentation procedure than before the treatment (p < 0.001) were seen. In the subcategory physical and psychological disabilities, all questions had significant better values after the sinus lift (p < 0.001). Concerning complaints due to the surgical procedure, mean total scores were 5.1 ± 5.4 pre-operative, 6.9 ± 6.1 (0-31) post-operative, and 2.4 ± 3.7 recently. This meant a significant difference between "pre-operative" vs. "post-operative" (p = 0.003), "pre-operative" vs. "recently" (p < 0.001), and "post-operative" vs. "recently" (p < 0.001). Concerning the influence of implant indication, edentulous patients showed the most distinct improvement after the procedure. Clinical assessment showed stable soft tissue parameters.

CONCLUSIONS

Evaluation of OHRQoL after sinus augmentation showed a significant improvement indicating a remarkable benefit for the patients through this procedure.

Valosin-containing protein (VCP/p97)-expression correlates with prognosis of HPV- negative oropharyngeal squamous cell carcinoma (OSCC)

Valosin-containing protein (VCP)/p97 has been shown to be associated with antiapoptotic function via activation of the nuclear factor-B (NFB) signaling pathway and with metastasizing of tumors in several studies. VCP is located on chromosome 9p13-p12, a region often deleted in oropharyngeal squamous cell carcinoma (OSCC). The clinical significance of VCP expression in OSCC however remains unclear. In this study, expression of VCP was determined in 106 patients (77 male (71.3%) and 31 female (28.7%); age-range: 34–79 years (mean age 57 years)) by immunohistochemistry and in a subset of 15 patients by quantitative PCR. HPV-DNA was detected by polymerase chain reaction and p16^INK4a immunohistochemistry. The experimental findings were correlated with clinico-pathological data and survival parameters. 47.2% of all OSCC specimens were analyzed as negative or weak staining intensity for VCP. 52.8% of all specimens showed a high staining intensity for VCP. 73.1% of all patients were tested HPV-negative, 26.9% were HPV-positive. The 5-year disease-free and overall survival probabilities of all patients were 71.2% and 55.7%, respectively. No correlation could be found between HPV-status and VCP expression. VCP overexpression in HPV-negative patients was associated with significantly better 5-year disease-free survival (86.4% vs., 45.6%, p = 0.017). The level of VCP-intensity determined by immunohistochemistry could be an additional prognostic marker in HPV-negative OSCC. VCP expression seems not to correlate with the HPV-status.

Long-term bony integration and resorption kinetics of a xenogeneic bone substitute after sinus floor augmentation: histomorphometric analyses of human biopsy specimens

In this case series, a systematic histomorphometric analysis of two human bone biopsy specimens was conducted 1 and 5 years after grafting with a xenogeneic bovine bone substitute material (BSM). While the 1-year specimen still showed extensive signs of an active desmal ossification, the specimen after 5 years mainly showed mature lamellar bone without bone turnover or remodeling. A completed bony integration without extensive resorption of the BSM particles could be detected. Altogether, a good integration in the bone with osteoconduction and a high biocompatibility was seen.

Early root surface colonization by human periodontal ligament fibroblasts following treatment with different biomaterials

OBJECTIVES

The present in-vitro study examined the effects of different biomaterials on early root surface colonization by human periodontal ligament (PDL) fibroblasts using confocal-laser-scanning-microscopy (CLSM).

MATERIALS AND METHODS

Fifteen periodontally-diseased teeth were extracted, treated with scaling/root planing and longitudinally cut to obtain 30 root fragments. Fragments were treated either with 24% EDTA following application of enamel matrix derivative (EMD), 24% EDTA or EMD only, nanocrystalline hydroxyapatite (NHA) paste or oily calcium hydroxide suspension (OCHS) for 1 h each. The analogue untreated root specimens served as controls. Root fragments were incubated with human PDL fibroblasts and cellular proliferation and morphology were evaluated after 1, 3, 5 and 8 days using CLSM-visualization and image recognition software.

RESULTS

The rate of cellular proliferation was different among treatment modalities examined (p = 0.019). Except treatment with NHA paste all treatment modalities improved cellular proliferation on root surfaces at all different points of time compared with the control specimens. A significant difference between treatment modalities was observed between EMD and NHA paste (p = 0.008). No synergistic effect could be demonstrated comparing root surface conditioning with 24% EDTA and EMD application compared to 24% EDTA or EMD application only.

CONCLUSION

The present results suggest that initial root surface colonization by PDL fibroblasts may be enhanced by root surface conditioning with 24% EDTA and application of EMD, application of 24% EDTA or EMD alone and OCHS. The addition of 24% EDTA for root surface conditioning prior to EMD application provided no synergistic effects in terms of early root surface colonization by PDL fibroblasts.

Multiple primary enoral soft tissue manifestations of a Hodgkin lymphoma--case report and literature review

BACKGROUND

Hodgkin lymphoma (HL) are lymphoproliferative neoplasms, histologically comprising of mononuclear and multinucleated Hodgkin and Reed Sternberg cells (HRS). About 4 % of all lymphatic malignancies of the head and neck are HL. The typical disease presents itself as a nodal lesion. Extranodal, enoral soft tissue involvement by HL is very rare.

CASE REPORT

A 73-year-old man with a suspect, ulcerating lesion in the left retromolar region of the mandible was assigned to our hospital. Prior anti-inflammatory therapy has been without success. Subsequently, three biopsies were taken which could only show inflammation. Finally, two biopsies from the left retromolar region and the left inner cheek showed HRS cells with positive expressions of CD15 and CD30 corresponding to a Hodgkin lymphoma. No lymphatic node or bone involvement could be detected. The patient was designated to receive radio-chemotherapy, but died 3 weeks after diagnosis of multiple organ failure. In a literature review, together with this report, nine cases were found concerning primary HL of the oral mucosa. Accordingly, this is the first case of primary multiple extranodal HL in the oral mucosa in absence of lymphatic node involvement.

DISCUSSION

Neither clinical features nor radiological appearances of HL presenting as primary enoral lesions are pathognomonic. Especially when only small biopsy specimens are available, histological diagnosis remains challenging, may lead to a delay in therapy and may result in a significant worse prognosis.

Evaluation of ultrasound transmission velocity and 3-dimensional radiology in different bone types for dental implantology: a comparative ex vivo study

OBJECTIVE

To evaluate ultrasound transmission velocity (UTV) for assessment of mechanical bone quality, an ex vivo comparison of different bone types measured with UTV, 2-dimensional (2D) histomorphometry and with 3-dimensional (3D) radiology (cone-beam computerized tomography [CBCT], computerized microtomography [μCT]) was conducted.

STUDY DESIGN

Clinical cortical, cancellous, and mixed bone (each n = 6) was measured via UTV (m/s), CBCT (white pixel/black pixel ratio [WP/BP]), μCT (bone volume/total volume [μBV/TV]), and histomorphometry (bone volume/total volume [hBV/TV]). UTV values were correlated with 2D-histomorphometry and 3D-radiologic results.

RESULTS

For the cortical, cancellous, and mixed bone samples, respectively, UTV values were 1,945.17, 1,266.9,and 1472.2 m/s, WP/BP quotients were 0.96, 0.15, and 0.33, μBV/TV quotients were 0.94, 0.2, and 0.47, and hBV/TV quotients were 0.96, 0.24 and 0.39. Significant correlations between UTV and the other methods were seen (P < .0001).

CONCLUSIONS

Similar to the other methods, UTV is able to discriminate between different bone types ex vivo.

Immobilisation of linear and cyclic RGD-peptides on titanium surfaces and their impact on endothelial cell adhesion and proliferation

Functional coatings on titanium vascular stents and endosseous dental implants could probably enhance endothelial cell (EC) adhesion and activity with a shortening of the wound healing time and an increase of peri-implant angiogenesis during early bone formation. Therefore, the role of the structure of linear and cyclic cell adhesive peptides Arg-Gly-Asp (l-RGD and c-RGD) on differently pre-treated titanium (Ti) surfaces (untreated, silanised vs. functionalised with l- and c-RGD peptides) on EC cell coverage and proliferation was evaluated. After 24 h and after 3 d, surface coverage of adherent cells was quantified and an alamarBlue® proliferation assay was conducted. After 24 h, l-RGD modified surfaces showed a significantly better coverage of adhered cells than untreated titanium (p=0.01). Differences between l-RGD surfaces and silanised Ti (p=0.066) as well as between l-RGD and c-RGD surfaces (p=0.191) were not significant. After 3 d, c-RGD surfaces showed a significantly higher cell coverage than untreated Ti, silanised and l-RGD titanium surfaces (all p<0.0001). After 24 h, c-RGD modified surfaces showed significant higher cell proliferation compared to untreated Ti (p=0.003). However, there were no differences in proliferation between c-RGD and l-RGD (p=0.126) or c-RGD and silanised titanium (p=0.196). After 3 d, proliferation on c-RGD surfaces outranged significantly untreated titanium (p=0.004), silanised (p=0.001) and l-RGD surfaces (p=0.023), whereas no significant difference could be found between untreated Ti and l-RGD surfaces (p=0.54). According to these results, the biomimetic coating of c-RGD peptides on conventional titanium surfaces showed a positive effect on EC cell coverage and proliferation. We were able to show that modifications of titanium surfaces with c-RGD are a promising approach in promoting endothelial cell growth.

In vitro proliferation of human osteogenic cells in presence of different commercial bone substitute materials combined with enamel matrix derivatives

BACKGROUND

Cellular reactions to alloplastic bone substitute materials (BSM) are a subject of interest in basic research. In regenerative dentistry, these bone grafting materials are routinely combined with enamel matrix derivatives (EMD) in order to additionally enhance tissue regeneration.

MATERIALS AND METHODS

The aim of this study was to evaluate the proliferative activity of human osteogenic cells after incubation over a period of seven days with commercial BSM of various origin and chemical composition. Special focus was placed on the potential additional benefit of EMD on cellular proliferation.

RESULTS

Except for PerioGlas, osteogenic cell proliferation was significantly promoted by the investigated BSM. The application of EMD alone also resulted in significantly increased cellular proliferation. However, a combination of BSM and EMD resulted in only a moderate additional enhancement of osteogenic cell proliferation.

CONCLUSION

The application of most BSM, as well as the exclusive application of EMD demonstrated a positive impact on the proliferation of human osteogenic cells in vitro. In order to increase the benefit from substrate combination (BSM + EMD), further studies on the interactions between BSM and EMD are needed.

Functional rehabilitation of mandibular continuity defects using autologous bone and dental implants - prognostic value of bone origin, radiation therapy and implant dimensions

AIM

The aim of this retrospective study was to investigate prognostic parameters for the rehabilitation of mandibular continuity defects with free autologous bone and dental implants for patients after intraoral squamous cell carcinoma.

METHODS

Following potential prognostic factors for implant survival were analyzed: bony bed (local bone versus augmented iliac crest bone), radiation dose (no radiation, <50 Gy, >or=50 Gy) and implant dimensions. Kaplan-Meier survival estimates of the inserted implants were performed.

RESULTS

After 5 years, the cumulative survival rate of all investigated implants was 82.6%. Dental implantation into augmented bone resulted in a significantly lower survival rate (78.4%), compared to original local bone (92.8%). Modifications of implant dimensions as well as radiation therapy showed no significant impact on implant survival.

CONCLUSION

For the investigated compromised collective, our results reveal a satisfactory long-term survival rate of dental implants even in augmented bone and underline the value of dental implantation for the functional rehabilitation of cancer patients.

Misleading initial histological diagnosis of a polymorphous low-grade adenocarcinoma in situ ex pleomorphic adenoma-a case report

INTRODUCTION

Polymorphous low-grade adenocarcinoma (PLGA) are frequent tumours of palatinal minor salivary glands. They appear clinically as solid mass located beneath intact surface epithelium, thus quite similar with benign neoplasm. PLGA displays a low tendency of aggressive behaviour. The correct aetiology of this disorder is still unknown.

CASE REPORT

In this contribution, a PLGA is reported which was located in a pleomorphic adenoma (PA). Out of an initially incisional biopsy, only the benign part of the lesion was diagnosed. Definitive histological examination of the whole tumour revealed a small malignant fraction of the specimen besides a major part of benign tissue formations (PA).

CONCLUSION

This case shows the uncertain confidence of incisional biopsy, the variably biologic behaviour of PA, providing hints for consideration of the PLGA aetiology and highlights both the necessity to remove whole PA-like lesions as well as to perform systematically histological examination of whole specimens.

Use of a new cross-linked collagen membrane for the treatment of dehiscence-type defects at titanium implants: a prospective, randomized-controlled double-blinded clinical multicenter study

OBJECTIVES

The aim of the present randomized-controlled double-blinded clinical multicenter study was to assess the use of either a new cross-linked (VN) or a native collagen membrane (BG) for the treatment of dehiscence-type defects at titanium implants.

MATERIAL AND METHODS

A total of n=54 patients were recruited in four German university clinics. According to a parallel-groups design, dehiscence-type defects at titanium implants were filled with a natural bone mineral and randomly assigned to either VN or BG. Submerged sites were allowed to heal for 4 months. Primary (e.g., changes in defect length - DeltaDL, quality of newly formed tissue [0-4] - TQ) and secondary parameters (e.g., membrane exposure, tissue conditions at dehisced sites) were consecutively recorded.

RESULTS

Four patients were excluded due to an early wound infection (VN:3; BG:1), and one patient was lost during follow-up (VN). The mean DeltaDL was 3.0 +/- 2.5 mm in the VN, and 1.94 +/- 2.13 mm in the BG group. The assessment of TQ revealed comparable mean values in both groups (VN: 3.05 +/- 1.66, BG: 3.46 +/- 1.48). A significant correlation between membrane exposure and inflammation of the adjacent soft tissue was observed in the VN group. In both groups, the mean DL and TQ values were not significantly different at either non-exposed or exposed implant sites.

CONCLUSION

The results of the present study have indicated that VN supported bone regeneration on a level non-inferior to BG. However, in case of a premature membrane exposure, cross-linking might impair soft-tissue healing or may even cause wound infections.

Ultrasound transmission velocity for noninvasive evaluation of jaw bone quality in vivo before dental implantation

For the insertion of dental implants, mechanical bone properties at the implantation site have great impact both for therapeutic regimes as well as for the overall long-term success, making a reliable method for the preoperative assessment of the bone quality desirable. Ultrasound transmission velocity (UTV) has been introduced as a noninvasive method to analyze mechanical properties of bone. The aim of this study was the first intra-oral in vivo assessment of alveolar crest UTV values of edentulous jaws. Partly or fully edentulous patients (n = 108) were enrolled in this study, taking into account possible influence factors that affect bone quality (osteoporosis, radiation therapy). Six intra-oral measurement points were used: left side region, right side region and frontal region, for upper and lower jaw, respectively. Ultrasound transmission velocity values were measured bicortically (in bucco-oral direction) and correlated to sex, age, measurement site and history of osteoporosis or radiation therapy. We found a minimum mouth opening of 30 mm, as well as a residual alveolar ridge height of 8 mm as thresholds for a reliable intra-oral placement of the device. Xerostomia was no contraindication. Assessment of intra-oral UTV showed significantly higher values both for mandibular side regions (female 1713 +/- 153 m/s, male 1734 +/- 221 m/s) and the maxillary frontal region (female 1665 +/- 189 m/s, male 1648 +/- 82 m/s) than for maxillary side regions (female 1538 +/- 177 m/s, male 1583 +/- 90 m/s). These data were even more clarified by intra-individual correlation of upper and lower jaw side region UTV values. We found no correlation between assessed UTV values and the variables sex, age, osteoporosis or radiation therapy. The use of a small UTV device in this study allowed the recording of intra-oral UTV values in a large and heterogeneous patient collective for the first time. Assessment of alveolar-ridge UTV might offer the possibility to identify critical bone quality before implantation or to monitor bone healing (mineralization) after augmentation procedures.

Dental implantation: ultrasound transmission velocity to evaluate critical bone quality--an animal model

PURPOSE

In dental implantology, preoperative evaluation of bone quality is an important aspect for the long-term success of the treatment. The insertion of implants into regions with a great portion of poorly mineralised cancellous bone, in particular, increases the risk of subsequent implant failure. The measurement of Ultrasound Transmission Velocity (UTV) proved to be a non-invasive and valid method for the assessment of mechanical properties of bone. The aim of this study was to correlate conventional histomorphometric bone properties with UTV-values from mandibular and iliac crest bone specimens in an animal model.

MATERIALS AND METHODS

12 native (no sample preparation) porcine specimens from mandibular bone and 14 from iliac crest bone, respectively, were studied both by UTV measurement and by conventional histomorphometry. UTV-values were measured bicortically by three different investigators four times at each site. Bone samples from identical sites were obtained and ground down to a thickness of approx. 50 microm. Transmission light microscopy was used to assess the overall percentage of mineralised bone. Mineral bone density less than 40% was defined as "critical".

RESULTS

The median bone density was 43 % for mandibular bone and 23% for iliac crest bone, respectively. The median UTV values of the mandible (1756 m/sec) were significantly higher than those of the iliac crest specimens (1613 m/sec). Intra-individual correlation testing illustrates a positive, statistically significant correlation between presurgical UTV measurement and the grade of mineralisation (r=0.54). ROC analysis defined a UTV breakpoint of 1767 m/sec to identify critical bone with a sensitivity of 75%.

CONCLUSION

In this ex-vivo model, UTV measurements have proven to be a reliable method for identifying critical bone quality prior to implantation.