International Poster Journal of Dentistry and Oral Medicine, 03/2010

Background: Microbiological identification of Aggregatibacter actinomycetemcomitans and other periodontal pathogens may depend on the test protocol, especially if the concentration is near the lower detection threshold. The goal of the current study was to compare the results of the microbiological testing with different test-kits in patients with severe chronic (CP) and aggressive periodontitis (AgP). Methods: 69 Patients were recruited in the Section of Periodontology, University Hospital of Heidelberg. Inclusion criterium to participate in the study were the clinical diagnoses CP or AgP. Pocket probing depths, vertical attachment level, gingival bleeding index, plaque control record and bleeding on probing were assessed by a periodontologist. Microbiological analysis of pooled samples from subgingival plaque was performed with two different gene probe-tests according to the manufacturer's test protocol (IAI PadoTest 4.5®, Institut für Angewandte Immunologie, Zuchwill, Switzerland (PADO), and the Meridol® Periodiagnostics, GABA, Lörrach, Germany (MERI). Results: CP was diagnosed in 49 patients, AgP in 20 patients. The periodontal pathogens Aggregregatibacter actinomycetemcomitans (A.a.), Tannerella forsythia, Porphyromonas gingialis and Treponema denticola) were identified with both PADO and MERI: Fusobacterium nucleatum and Prevotella intermedia were only assessed by MERI. With the loboratory real-time PCR-test A.a. was identified. in series 1 more patients ware tested positive on A.a. with MERI (25%) than with PADO (20.6%). In series 2 the real-time PCR (23.2%) showed a lower prevalence for A.a. than PADO (36.4%). Only 10.3% of the patients in series 1 and 17.2% of the patients in series 2 were tested positive on A.a. with both tests. The used tests showed an agreement of k=0.72 for series 1 and k=0.41 for series 2. The test-differences for the rest bacteria-species were smaller or barely present. Conclusions: The use of a high sensitive microbiological test is important for the choice of an optimal adjunctive antibiotic treatment. In the underlying study both commercial and laboratory microbiological tests showed an incongruence regarding the identification of A.a. Differences between the tests were also proven for the qualitative microbiological detection. Keywords: periodontitis, microbiological testing, periodontal pathogens, aggregatibacter actinomycetemcomitans

Cystic hygroma is known as lymphangioma which is a benign hamartomatous hyperplasia of lymphatic vessels. This tumour is thought to be developmental malformation of vessels which have poor communication with the normal lymphatic system. Most of the cases of cystic hygroma present before the age of 1-2 year. Only some cases of cystic hygroma present in childhood that enlarged in adulthood. Head and neck is the commonest site of occurrence. Many of this located in the posterior triangle of the neck. They may extend into oral tissues and oro-facial spaces. They may associated with macroglossia, mandibular prognathism, asymmetry of the face. They may cause respiratory embarrassment and dysphagia. We are reporting a case of cystic hygroma in an adult. Keywords: cystic hygroma, cystic lymphatic lesion, macrocystic lymphatic malformation, microcystic lymphangioma, cystic lymphangioma, lymphatic rests

Up to now, evidence based radiographical parameters that allow a reliable prognosis of combined perio-endo lesions before treatment, do not exist. Therapeutical changes of the periradicular tissues can be detected by means of conventional radiographic procedures only several months after performing the endodontical treatment or re-treatment. The present pilot study aims to investigate the visibility of perio-endo lesions in MRI. Materials and Methods: Three patients, in whom one or more combined perio-endo lesions were diagnosed and from whom apical or panoramic x-rays existed, were examined with a 3 tesla MRI Scanner (Magnetom Trio, Siemens, Erlangen, Germany) in the Department of Neuroradiology. The investigations were performed with special head and neck coils with a fat-saturated t2-sequence (t2_STIR_fatsat) at a voxel size of 0.6/0.6/0.6 mm. Results: The periradicular osteolysis discernable on the apical/panoramic x-rays (periodontal space width of 3-5 mm at a magnification of 1.5) could be detected on the MR Images as an opaque periradicular cuff. The width of the periodontal space ranged between 1.8 mm for two patients and 5.6 mm for the third one. Conclusions: Perio-endo lesions can be detected in MR Images. In order to assess therapeutical changes after endodontical treatment or re-treatment in MR Images earlier than in conventional x-rays, further investigations need to be performed. Keywords: Perio-endo lesions, dental MRI, bone loss, periodontitis, periodontal space

Introduction: Essential suggestion of fixed prosthodontics is positioning of casted cores owing to strengthening of devitalized tooth's root. In this manner, fortified roots should be successfully loaded by crowns and bridges. Objective: Objective of this study was to present success of strengthening of infrabony fractured roots of devitalized teeth by particularly designed metal cores. Material and Methods: 3 patients (2 men and1 women, aged 31 to 47 yrs.) having devitalized fractured teeth with infrabony lack of a part of root-dentin substance were selected for fabrication of fixed restoration. ¾ of root filling were removed in root canal preparations. Mock-up of cores was formed directly in the mouths using self-curing resin (Palavit G, Kultzer, Germany) Bounding surface and borders were prepared in resin material as a shoulder surface of core in supragingival i.e. subgingival areas of dentin-root defects, using retraction cord (Ultrapack #1 and #2, U.S.A.), but as the form of chamfer respecting remained coronal surface of devitalized teeth. After casting, 4 cores made of precious alloys (Golden alloy type III, Zlatara Majdanpek; M-Palador cast, Galenika, Serbia) were decidedly polished and cemented, using normal-set zinc-phosphate cement (Cegal-N, Galenika, Serbia). Temporary crowns were not positioned onto cemented cores and these teeth. After finishing of bounding surface (Fine diamond burs NTI-Kahla rotary dental instruments, Germany), dental arches were impressed (Oranwash L, Zhermack). Metal-ceramic fixed restorations (Vita, Europe) were fabricated and positioned. Results: Restored teeth with surrounding tissues showed favorable appearance of gingival margins, and functional stability in static occlusion, dynamic occlusion and mastication. There were not bleeding during probing or dispositions of fixed restorations to horizontal functional loading. There was not pain during 1,2 and 5 year controls. Conclusion: Ultimate providing of shoulder in subgingival metal core surface, decided core polishing and good quality of alveolar bone withstand fractured root and core completing the capability of functional loading and rehabilitation by fixed restoration. Keywords: fixed restoration, core, post and core, devitalized tooth, fracture, dowel

Achieving harmonic interface between restoration margins and surrounding periodontal tissues is a prerequisite for long term success of perio-prosthetic treatment. Respecting biological, functional and esthetical considerations are principle elements for such a successful treatment. Obtaining this healthy interface becomes more complicated, when prosthetic surgery is indicated. In the presented case report, we have implemented two different crown-lengthening surgical procedures in treating a 66 year old patient. The results of this treatment have shown a maximal preservation of the biological, functional and esthetical considerations of our patient. Keywords: Biologische Breite, Perio-Prothetik, Ferrulé-Design, Chirurgische Kronenverlängerung, Präparationsgrenze, Fallpräsentation

Introduction: Myxoma is a benign, but locally aggressive neoplasm that rarely appears in the skeleton. It usually occurs in 2nd and 4th decades of life, common in females, in mandibular premolar-molar region, spreading within marrow leading to expansion of cortex. The case in point shows a striking contrast as the myxoma occurred in a male, in the anterior maxilla & perforated the cortex instead of expansion. Objective: To diagnose and surgically excise the maxillary myxoma along with esthetic restoration. Materials and Method: The localized gingival enlargement of the anterior maxilla was diagnosed as myxoma from clinical, radiographical and histopathological examinations. The lesion was surgically excised; defect was curetted and grafted with Hydroxyapatite. The lip pedicle flap was used to cover the defect. The restoration was given after complete healing. Results: The wound healing was excellent. The lip flap was well accepted. The prosthetic restoration reestablished the esthetics of the patient. Discussion: This case presentation exemplifies the importance of clinical suspicion, diagnostic evaluation and management including reconstruction issues in this unique case of maxillary myxoma.Conclusion: Every gingival enlargement should be viewed with a high degree of clinical suspicion for early diagnosis of an aggressive lesion beneath an indolent looking swelling. This may lead to offering the patient a conservative surgery with esthetic restoration rather than disfigurement due to an extensive surgery later. Keywords: rare lesion, maxillary myxoma, gelatinous mass, conservative excision, lip flap, esthetic restoration

Introduction of Cone-Beam Computed Tomography (CBCT) represents a radical change and it is making a breakthrough because of its low effective radiation dose, unique accessibility and low cost with major contributions in the Dentomaxillofacial field. CBCT scanners utilize a cone-shaped ionizing radiation and a two-dimensional detector which allow for a single rotation of the gantry to generate a scan of the entire region of interest. A plethora of applications have been developed that use the 3-dimensional data for a variety of tasks: dentomaxillofacial imaging, implant site assessment, orthodontic planning, impacted tooth evaluation, jaw pathologies, cephalometric analysis, TMJ analysis, periodontal diseases, radiotherapy guidance and more. The virtual modeling and development of a 3D setup that displays individual crowns, roots and craniofacial structures would greatly help the clinician in diagnosis and treatment planning, to determine various treatment options, monitor changes over time, predict and display final treatment results, and measure treatment outcomes accurately. In short, it is ideally suited for high quality and affordable CT scanning of head and neck. CBCT has often been described as the gold standard for imaging oral and maxillofacial area and will definitely become a part of everyday life of most practices in the coming decades. This poster is presented as a review about the development, principle, diagnostic value, benefits and limitations of the emerging diagnostic modality- CBCT. Keywords: cone-beam computed tomography, CBCT, dentomaxillofacial radiology, diagnostic imaging

A multiplicity of therapeutic possibilities is available in modern implantology. For using implants in severe periodontal cases a two step procedure is recommended. Immediate loading of implants after extracion was rejected predominantly. In the past 3D-planning and guided templates were indicated for edentulous or semitoothless jaws. For transdental implant planning and guided surgery a new approach is presented. Transdental Guided Implant Planning and Positioning (TdGIP) permits an immedate implantation post extractionem and immedate funcional loading with crown and/or bridges. The procedure was flanked by antimicrobiotial photodynamic therapy and YSGG laser treatment. Keywords: NobelActive, NobelGuide, Periodontal disease, Transdental Guided-Implant-Planning (TdGIP)Implants, 3D-planning, Navigation, templates, immediate loading, photodynamic therapy, Periobridge, YSGG-Waterlase

Mayor efforts focused during recent years on the improvement of dental education. In continuation of these endeavours we have developed an interactive E-learning-programme (ILKUM) based on the standards required by ADEE (Association for Dental Education in Europe). Presentation of ILKUM to students revealed their overwhelming interest, boosting our concept of "blended learning". The current results encourage further investments in interactive learning, concentrating on the utilization of mobile media such as iPads as well as iPhones. Keywords: ILKUM ( Interactive E-learning-database), ADEE (Association of Dental Education in Europe), Blended Learning, iPad, e-learning