International Poster Journal of Dentistry and Oral Medicine, 04/2003

Introduction: Gustatory sweating is a common complication of parotid gland surgery. Botulinum toxin A (BTX) is considered being effective. This study was designed to evaluate the efficacy on long-term and to value quality of life. Method: Seventeen patients with severe gustatory sweating were treated with injections of one unit/cm2 BTX intracutaneously. The evaluation relied on self-assesment of patients and on clinical examinations four weeks, four, eight, twelve and eigtheen month after treatment. Minor's test was performed and digital photograph aided to calculate affected skin area. Quality of life was evaluated by SF-36 before, six and eighteen month after treatment. Results: The efficiacy of BTX was exellent in the facial skin and less effective in hairy temporal region. Overall there was a median reduction of affected skin area from 30 cm2 to less than 2 cm2. Within eighteen month seven patients (41%) had a symptomatic recurrent gustatory sweating, five patients had an increase in Minor's test without clinical relevance and five patients had no signs of recurrent sweating at all. The overall data have shown an increase in affected skin over eigtheen month, but no significant changes (p=0.117). Quality of life increased over the time. Significant levels could be seen in 'Mental Health' and 'Social Function'. Conclusion: BTX has proven to be a save and highly effective in treatment of gustatory sweating which improves quality of life. 60% of the patients had an asymtomatic period of at least eighteen month. Keywords: botulinum toxin, gustatory sweating, Frey's syndrome

The aim of the present investigation was to evaluate tensile bond strength of three dentin adhesive systems (Excite, Clearfil New Bond, Etch & Prime 3.0) and two cyanoacrylate adhesives (Cyano Veneer, Histoacryl) to animal bone in vitro. Therefore, five mandibles of freshly sacrificed pigs were included. From each mandible ten specimens were prepared using rotating burs under constant water cooling. Bone specimens (diameter 9 mm) with a total thickness of 4 mm (± 0.5 mm) and a cortical layer of 1.5 mm (± 0.2 mm) were obtained under standardized conditions. Each ten specimens were assigned to five experimental groups. Tensile bond strength of the above mentioned adhesive agents was measured 15 minutes after application and light curing of the composite material (Tetric Ceram, colour A2) using an universal testing machine. Following tensile bond strengths were evaluated (mean value and standard deviation, printed in MPa): Excite: 2.96 (± 1.34); Clearfil New Bond: 8.00 (± 1.36); Etch & Prime 3.0: 4.05 (± 1.53); Cyano Veneer: 4.56 (± 0.76); Histoacryl: 5.22 (± 2.01). Statistical analysis showed a significant influence of the used adhesive system on tensile bond strength (p Keywords: bone, dentin bonding agent, cyanoacrylate, bond strength, composite material

The primary chronic aseptic osteomyelitis is a rare form of bone infection but treatment is sometimes very difficult. The aim of this presentation is to demonstrate clinical symptoms, clinical course and different strategies for treatment in a case of severe manifestation in the mandible.The female patient was 13 years old when a chronic recurrent osteomyelitis of the mandible was diagnosed in 1993. After histologic verification multiple treatments followed: decortication combined with administration of antibiotics, rheologics, antiphlogistics, and analgetics, microwave and jodiontophoresis as well as hyperbaric oxygenation. None of this concepts led to improvement, however, a massive increase of volume of the mandible could be assessed on both sides. This esthetic impairment as well as the unchanged clinical symptoms led to psychological changes of the young patient, which made an additional psychotherapy necessary. With a new concept with a combination of azithromycin and calcitonin only little improvement could be achieved. At the moment the patient is in stable somatic and psychologic conditions and presses for a osteoplasty to remodel the whole contour of the mandible to improve the appearence temporaryly. Keywords: diffus sklerosierende Osteomyelitis, Unterkiefer, Therapieoptionen, klinischer Verlauf

The aim of this study was to determine the caries prevalence in 7 (n=349) and 10-year-old (n=359) Filipino children without any access to dental care in deprived rural communities in Northern Mindanao. Caries was recorded using WHO diagnostic criteria (1997) by two calibrated dentists. The percentage of children caries-free at age 7 and 10 was 7.5% and 16.9%, respectively. In 7-year-olds the caries level was 0.7 DMFT (±1.1) and 7.3 dmft (±4.9), which was concentrated in the D/d components. In 10-year-olds the DMFT was 1.9 (±2.8) and 2.4 (±2.7) dmft, exclusively concentrated in the D/d components. While the caries pattern in the younger children revealed that the caries burden was localised to the first molars (0.6 DMFT), more than one third of the caries attack in the 10-year-olds was in the upper and lower incisors and premolars. The caries prevalence and the pattern of the caries distribution suggests that the Filipino children are a high caries population. The high caries attack in the deciduous dentition was associated with severe carious in the permanent dentition. Because of the limited financial and personal resources, restorative treatment using ART was limited to permanent teeth. However, extraction of the carious deciduous teeth was the treatment of first choice. Invasive measures are prerequisites to control existing caries and pain. Only after doing that can primary preventive measures be effectively used. In conclusion, there is an important need to develop evidence based guidelines for basic oral care in deprived communities. Supported by Vivadent, Schaan, Liechtenstein. Keywords: caries prevalence, epidemiology

Oral health improvements in pre-school children have been reported (Marthaler TM. Caries Res 1990; 24:381-396) followed by first indication that the decline in caries levels in preschool children has ceased (Pitts NB, Palmer JD. Community Dent Health 1995;12:52-58).A school based preventive programme whereby dentists or dental auxilarities providing oral health care for children attending kindergarten schools, has been in operation in parts of Germany since 1984. The preventive programme consisted of dental health education, supervised instruction in oral hygiene, diet control and use of low fluoride toothpaste (max. 500 ppm F-). Countrywide representative surveys on oral health in pre-school children are not regularly performed. Information on declining prevalence in dental caries on the basis of smaller local studies are limited. There was a significant decline in caries prevalence in 3- and 5-year-olds in the period 1987 to 1997. While the period between the last two studies from 1997 to 2001 was short, the results could be the first indication that caries decline in these 3- and 5-year old children has ceased. Keywords: caries prevalence, epidemiology

Objectives: To evaluate the fluoride releasing effect of a dentin bonding material over time on nanoleakage. Material and Methods: Standardized class-V cavities were prepared in 60 extracted human molars. 30 cavities were filled with composite (Spectrum) using the Prime&Bond NT bonding system (containing cetylamine hydrofluoride). 30 teeth were filled with the same composite and an experimental Prime&Bond NT without fluoride content. Prior to the examination 15 teeth per group were stored for 24 h in water and the remaining 15 teeth per group were stored for 6 month. After storage the teeth were exposed to a 1% rhodamin B solution for 24 h at 20°C, rinsed in water for 60 s and sectioned parallel to the tooth axis, dividing the restorations into two parts. A confocal laser scanning microscope (CLSM) was used in fluorescence mode to visualize a layer 10 µm below the prepared surface. The lengths of the penetrated pathways were measured. Results: High resolution CLSM images demonstrated a penetration pathway which was located at the junction between hybrid layer and dentin. Storage for 24 h resulted in penetration lengths of 53 ± 59 µm. After 6 month the penetration length was 74 ± 40 µm for the fluoride releasing bonding agent and 75 ± 52 µm for the experimental bond without fluoride content. Storage for 6 month slightly increased dye penetration lengths, but the difference is not statistically significant (p=0.09 with fluoride release and p=0.11 without fluoride release; Mann-Withney U-test). It is concluded that the penetrations observed are a result of nanoleakage and the fluoride release has no effect on nanoleakage. Keywords: dentin bonding agent, nanoleakage, fluoride

Candida albicans, a yeast frequently occurrent in dental plaque and able to secrete both organic acids and collagenolytic enzymes, is supposed to be involved in the caries process. The aim of the investigation was to prove the ability of Candida albicans to produce caries-like lesions in enamel and dentin in vitro. Specimens of enamel and dentin were contaminated with C. albicans strain SC-5314 and incubated in an artificial mouth. Controlled by a microcomputer, an artificial saliva with alternate amounts of carbohydrates was added. The purity and the pH of the culture were observed. After eight weeks of incubation, dentin specimens were embedded either in epoxy resin or in paraffin after decalcification. Five-micrometer-thick step serial histological sections were cut perpendicular to the tooth surface, stained with PAS, Goldner's and von Kossa's stain, and subsequently examined under the light microscope. Enamel slices of 150 micrometer thickness were inspected by polarized light microscopy. A deep demineralization due to organic acids produced by the yeast was found in both the enamel and the dentin specimens. Budding cells and hyphae of C. albicans penetrated the dentin by invading and enlarging the dentinal tubules. Sections of the samples stained with Goldner's stain revealed a loss of collagen close to the yeast, what seemes to be caused by collagenolytic activity of the Candida cells.The present investigation shows the ability of C. albicans strain SC-5314 to invade and destroy inorganic and organic parts of dental hard tissues. Further research is required to determine the role of Candida albicans in the pathology of dentinal caries. Keywords: microbiology, candida albicans, artificial mouth

Beside functional and aesthetic aspect in orthognathic surgery pain has not a negligible influence on patients' satisfaction after osteotomies in maxillofacial region. The aim of the present study was to evaluate the influence of craniomandibular disorder on patients' satisfaction after osteotomies.Craniomandibular disorder (CMD) were examined by using the Helkimo-Index (D0-DIII) in a group of patients (n=123; f=78, m=43) after osteotomies. The average follow-up time was 47 months (9-141 months). The performed osteotomies were as follows: 67 bilateral sagittal split osteotomies, 11 LeFort-I osteotomies, 11 bimaxillary osteotomies, 13 segment-osteotomies and 4 isolated genioplasties.In 29.3% (n=36) of the patients no symptom of CMD were found. Mild dysfunction (DI) were seen in 56,8% (n=69), whereas 10.6% (n=13) showed moderate (DII) and 3.3% (n=4) severe (DIII) dysfunction. A statistic relation between the kind of osteotomy and severity of dysfunktion after Helkimo were not found. No influence on patients' satisfaction was statistically evaluated.The use of the Helkimo-Index seems to be an effective and reliable method to evaluate also cranio-mandibular disorders (CMD) after orthognathic surgery. Keywords: intraoral bone defect, cyst, SCHULTE-coagulum, reconstruction

Aesthetical aspects have become increasingly important especially for restorations of anterior teeth. Many patients do not like metal abutments shining through the gingiva. With a castable abutment of the Astra Tech Implant System, after casting of a fuseable metal alloy, a ceramic step of individual colour and form was placed in the cervical area. After two years of function and three months of hygienic control the 30 patients were reexamined clinically and radiologically. The evaluation of the periimplant soft tissue was made by the gingival index (GI) according to Loe and Silness (1963) and the papillar bleeding index (PBI) according to Saxer and Mühlemann(1975). Intraoral x-ray images were made as described above. The evaluation of the x-ray images was made by the FRIACOM X-Ray Digitizer. After three months of healing 30 patients had their implants exposed. Incision was made in the middle of the alveolar ridge, the soft tissue was minimally mobilized in vestibulo-oral direction. On the oral side, soft tissue was removed by a 4 mm punching machine. In 16 implants temporary Dentalon-lined Ion-crowns (3M) were installed on temporary abutments with a cross section according to the tooth to be replaced (case 1). In 30 implants prefabricated healing abutments were placed (case 2). Due to a temporary anemia, the soft tissue was supressed by the temporary crown as well as by the healing abutment. After a healing period of 2 weeks an impression was made by an individual spoon. The round emergence profile produced by the healing abutment was first formed with the pattern resin put on to the impression abutment and then individual trimming followed after the impression abutment had been removed. For the final impression the impression abutment was again screwed in the implant. A impression of the individually modelated emergence profile through the temporary crowns was made right after removal of the temporary crown. The modelling was made with a gingival mask. After casting an alloy to which porcelain may be fused ceramic steps were fused in individual colours. The fused ceramic steps were isogingival in 19 patients with 31 restorations, in 11 patients with 15 restorations they were supragingival. All metal-free restorations were fixed by Glasionomer cement (Fuji). After placing the restoration intraoral x-ray images (Kodak Ultraspeed D) were made. The Burn-out-effect showes the different x-ray behavour of the fused aluminiumoxid ceramic step and the the zirkonoxid ceramic of the metal-free restoration. After two years of function and three months of hygienic control the 30 patients were reexamined clinically and radiologically. The evaluation of the periimplant soft tissue was made by the gingival index (GI) according to Loe and Silness (1963) and the papillar bleeding index (PBI) according to Saxer and Mühlemann(1975). Intraoral x-ray images were made as described above. The evaluation of the x-ray images was made by the FRIACOM X-Ray Digitizer. The periimplant soft tissue situation was normal. The x-ray images showed stable bone conditions (max. -0,2 mm bone loss with a mean value of -0,03 mm). All patients were very satisfied with the aesthetic and functional results of the restoration. A subgingival ceramic step shows no disadvantages regarding the periimplantological soft tissue situation. By adapting the emergence profile to the cross section of the tooth to be replaced, a significantly better hygiene is possible compared to a more round cross section, resulting in completely non-irritated soft tissues. Keywords: individual emergence profile, subgingival ceramic bevel, implant prosthodontics

Clinical monitoring with resonance frequency analysis (RFA) of Astra Implants Introduction: A quantitative diagnostic technique capable of assessing implant stability, bone formation and the clinical performance of all implants is supposed to optimise the results and make them more predictable. This study is set up to investigate the healing process of Astra Tech Implants. Materials and methods: 20 patients (at the average age of 50,5 years, 11 women, 9 men) were provided with 47 self-tapping Astra Tech Implants according to the two-stage surgical protocol of Astra Tech Dental Implant System, with lengths of 9 to 15 mm (24 in the mandible and 23 in the maxilla). We used both Astra Tech ST Implants (24) of 4,5 to 5,0 mm in diameter and Astra Tech Uni Implants (23) of 3,5 to 4,0 mm in diameter. The surgical placement was performed under local anesthesia with Ultracain DS following the manufacturer's instructions. Resonance frequency analysis (RFA) according to Meredith et al (1996) was used for implant primary stability measurements. This technique makes use of a small L shaped autoclavable transducer (Type F5, F6 and F7 5mm; Osstell transducer, *Integration Diagnostics Ltd, Sävedalen, Sweden) attached to the Astra Tech Implants. The beam of the transducer extends over a range of frequencies (from 5 to 15 kHz) and the resonance frequency of the beam is measured and presented on the connected instrument* as an ISQ value (Implant Stability Quotient, which is directly related to the resonance frequency). The prosthetic overdentures of the patients were hollow grinded at the implantation area. After a healing period of 90 days the implants were exposed and the secondary stability (ISQ) was determined again with RFA. All fixtures were immediately provided with a fixed prosthetic supply. Results: All 47 Astra Tech Implants showed a high initial primary stability with an average ISQ of 67,35. The fixtures placed in the mandible (24) reached a significantly greater primary stability with an average ISQ of 69,46 than fixtures in the maxilla (23) of 65,25. During the healing period of 90 days all Astra Tech Implants have gained secondary stability. The 24 fixtures inserted in the mandible have gained significantly more stability (ISQ 73,06) than the implants in the maxilla (ISQ 67,08). Until now no implant has failed. Conclusion: Loading Astra Tech Implants after 90 days is a predictable treatment in the mandible as well as in the maxilla. In order to accelerate this procedure we started to expose Astra Tech Implants with a significantly high primary stability (ISQ higher than 65,00) after 56 days. When secondary stability had been increased after 56 days, we started immediately with the prosthetic supply (direct loading). A loss of stability indicated a progressive loading connecting the implant with a healing abutment for additional 56 days. Keywords: clinical monitoring, resonance frequancy analysis (RFA), astra implants

The goal of the present investigation was to evaluate the quality of life and patients satisfaction after maxillectomy and prosthetical rehabilitation over a 30 year period. All obturators were accepted by the patients, aestehtic and functional results were almost good. Based on our investigations we can conclude that the classical prosthetical rehabilitation of maxillary defects is still the therapy of choice due to limited costs and given possibility to control the local recurrence. Keywords: maxillary defects, obturators, patients satisfaction

The influence of micro vessel density and tumor angiogenesis on the aggressiveness of basal cell carcinoma was investigated. Therefore, immunhistochemical staining for CD 31, vascular endothelial growth factor (VEGF) and HIPPEL-LINDAU's protein were performed in 9 cases of facial basal cell carcinoma. In conclusion, there were no direct correlation between micro vessel density and angiogenesis on the growth pattern and aggressiveness in basal cell carcinoma. Keywords: Basal cell carcinoma, angiogenesis, prognosis