International Poster Journal of Dentistry and Oral Medicine, 03/2014

Introduction: The International Caries Detection and Assessment System (ICDAS) categorize dental caries/restorations and can be applied in Dental Medicine (DM) education, clinical practice, clinical and epidemiology research. Objective: This trial evaluated dental caries experience/severity and restorative interventions by ICDAS, in a population of university DM services. Material and Method: Observational, cross-sectional and descriptive study; random sampling: 284 individuals aged ≥ 18 years, attending the 1st dentistry appointment at the Faculty of Health Sciences, University Fernando Pessoa, over a period extending from September-2008 to July-2010. The intra-oral (visual/tactile) ICDAS record was validated by four examiners trained/calibrated (ICC=0.963) to identify the restorative and dental caries clinical (non-cavitated and cavitated carious lesion) conditions. Descriptive/inferential statistical analysis (alpha=0.05) was conducted. Results: In the sample (64.8% female) the average (±SD) age was 44.3 (±16.4) years, with no significant differences (t-student test, p=0.110) between genders. In average, 118.7 (±81.7) tooth surfaces/individual were observed; Decayed surfaces were: 9.1(±11.8) with primary caries, of which 5.63 (±8.48) were non-cavitated lesions (enamel); of those 0.15 (± 0.97) had fissure sealants and 3.6 (±4.3) were cavitated (dentin). Surfaces restored with definitive material: 9.2 (±13.2). There were secondary caries in 1.7 (±2.9) surfaces; Secondary caries in enamel and dentin occurred at 0.71 (±2.11) and 1.0 (±1.2) surfaces, respectively. The population dental surfaces' condition was: 56.3% healthy, 52.5% with caries (51.8% cavitated lesions (dentin) and 49.3% non-cavitated lesions (enamel)), 53.2% restored, but 42.6% had secondary caries (33.5% cavitated and 31% non-cavitated lesions). Discussion and Conclusions: The ICDAS clinical report revealed high experience/severity of dental caries and restorative interventions, but variable values when analyzing the individual and the population. Trials that include registration of caries activity are needed in order to define individual/population risk. The ICDAS assessment allows the definition of more accurate preventive/restorative decisions in clinical practice and clinical and epidemiological investigations. Keywords: dental caries, caries prevalence, caries severity, restoration, ICDAS, cross-sectional study

The aim of this study is to assess the quality of laser welded joints, by different methods such as: scanning electronic microscopy, metallography, microhardness testing, spectrographic and radiographic analyses. The alloys assessed are a titanium-based alloy used in manufacturing prefabricated pieces for implantology, a standard Au-Pd alloy for the metallo-ceramic technique and a Cr-Co-Mo alloy used for manufacturing the metallic components of partial dentures. The conclusion of the testing is that laser welded joints are generally mechanically satisfactory. Laser is best suitable to weld titanium and its alloys because they have higher rates of laser beam absorption and lower thermal conductivity than other dental casting alloys. Keywords: laser welding, dental alloy

Background: Based on its function in immune response tumor necrosis factor-alpha (TNFa) has been regarded as a candidate gene for inflammatory diseases, including periodontal disease and Crohn's disease (CD). However, the results regarding the impact of genetic characteristics of TNFa on both diseases are inconsistent. The present study was performed in order to evaluate the influence of TNFa polymorphisms as potential risk factors for Crohn's disease after stratification according to periodontal status. Patients and methods: A total of 142 patients with Crohn's disease were included in the study. Genotypes, alleles and haplotypes of TNFa SNPs (rs1800629: c.-308G>A and rs361525: c.-238G>A) were determined by polymerase chain reaction with sequence-specific primers (PCR-SSP). Statistical analyses were performed applying SPSS 19.0. Results: Patients with Crohn's disease suffering from generalized periodontitis were significantly more often carriers of AA-genotype and A-allele of rs1800629 than Crohn's patients without generalized periodontitis (genotype: pexact=0.044, allele: pcorr.=0.048). In binary logistic regression analyses considering age, gender, smoking, approximal plaque index as potential confounders significant allele- but no genotype-dependent associations were proven (OR=2.22). Evaluating the TNFa polymorphism rs361525 no disease related differences in genotype or allele arrangement could be detected. Conclusions: TNFa polymorphism rs1800629 but not rs361525 was proven to be a significant risk indicator for generalized periodontitis in patients with Crohn's disease. Keywords: SNPs, TNFa, Crohn's disease, periodontitis

Background: The aim of this subanalysis of the longitudinal cohort study (ClinicalTrials.gov Identifier: NCT01045070) was to evaluate the prognostic importance of genetic variants of tumor necrosis factor alpha (TNFa) gene for secondary cardiovascular events. Patients and methods: At baseline a total of 942 consecutive patients with angiographically proven coronary heart disease were prospectively included (Martin-Luther-University Halle-Wittenberg, Clinic of Internal Medicine III). All patients were evaluated periodontally regarding plaque index, bleeding on probing, probing depth and clinical attachment level. The one-year cardiovascular outcome of the patients was evaluated considering the predefined, combined, primary endpoint (cardiovascular death, myocardial infarction, and stroke/TIA as the). Single nucleotide polymorphisms (SNPs) c.-308G>A, c.-238G>A of TNFa gene were genotyped by CTS-PCR-SSP Tray kit (Heidelberg, Germany). Results: 941 cardiovascular patients were evaluated in the one year follow-up regarding secondary cardiovascular events (7.2% suffered from cardiovascular events: 2.0% myocardial infarction, 1.7% stroke/TIA, 3.5% cardiovascular death). Using Kaplan-Meier and log-rank Tests neither the genotype, allele and the haplotype constellation of TNFa polymorphisms (c.-308G>A and c.-238G>A) nor the presence of severe periodontal disease could be proven as significant predictors of secondary cardiovascular events. Only the occurrence of diabetes mellitus (Hazard ratio 1.85) and an higher BMI (Hazard ratio 0.943) were significantly associated with secondary cardiovascular events in a complex risk model (cox regression). Conclusions: Genetic variants of TNFa gene, namely c.-308G>A and c.-238G>A, as well as the occurrence of severe periodontal disease could not be proven as significant predictors for secondary cardiovascular events in the one year follow-up. Keywords: TNFa, SNPs, coronary heart disease, periodontitis, prognostic markers

Gorlin-Goltz Syndrome and Situs Inversus Totalis coincidental occurrence is unlikely. But both entities together were found is the rarest bestowal. A search conducted on the PubMed revealed that there is no such unique occurrence in the world literature. Evaluation and treatment of NBCCS requires a multidisciplinary approach involving Dentists, Maxillofacial Surgeons, Dermatologists, Radiologist and Neurologists. This poster will throw light on clinical as well as radiological features of this rarest combination to solve a diagnostic enigma. There is the intriguing possibility that these two clinical phenotypes are histogenetically linked to PTCH/hedgehog signaling. The hedgehog (Hh) signaling pathway plays an important role both in embryonic development and adult stem cell function. Dysregulation of the pathway causes birth defects and cancer. NBCCS is known to be caused by mutations in the PTCH1, the receptor of hedgehog. PTCH1 is localized to primary cilia and mediates key steps in the transduction of the hedgehog signal. It has been suggested that ciliary dysfunction via dysregulation of the hedgehog pathway is the underlying cause of situs-inversus. Introduction: Unique occurrence of Gorlin-Goltz Syndrome with Situs Inversus Totalis is for the first time reported in the world literature by Dr. Monika Gupta in 2011. Gorlin-Goltz syndrome was firstly reported by Jarish and White in 1894. Situs inversus totalis means complete mirror image of thoracic and abdominal organs was firstly described by Matthew Baillie in 18th century. Gorlin-Goltz Syndrome and Situs Inversus Totalis coincidental occurrence is unlikely. But both entities together were found is the rarest bestowal. A search conducted on the PubMed revealed that there is no such unique occurrence in the world literature. Evaluation and treatment of NBCCS requires a multidisciplinary approach involving Dentists, Maxillofacial Surgeons, Dermatologists, Radiologist and Neurologists. This poster will throw light on clinical as well as radiological features of this rarest combination to solve a diagnostic enigma. There is the intriguing possibility that these two clinical phenotypes are histogenetically linked to PTCH/hedgehog signaling. The hedgehog (Hh) signaling pathway plays an important role both in embryonic development and adult stem cell function. Dysregulation of the pathway causes birth defects and cancer. NBCCS is known to be caused by mutations in the PTCH1, the receptor of hedgehog. PTCH1 is localized to primary cilia and mediates key steps in the transduction of the hedgehog signal (1-3). It has been suggested that ciliary dysfunction via dysregulation of the hedgehog pathway is the underlying cause of situs-inversus (4). Case presentation: A 13-year-old girl reported to the department of oral and Maxillafacial surgery. She complained of painless swelling on the lower left side of her face. The swelling was measured 4 × 3 cm, firm and non-tender. Frontal bossing and a wide nasal bridge were also noted. Dermatological examination revealed palmar and plantar pits and keratosis were present. Psychiatric consultation showed intellectual deficit, and ophthalmological examination revealed hypertelorism. Orthopantomography showed multiple cystic lesions in the upper and lower jaws, which were associated with unerupted permanent teeth displaced from their normal positions. Axial computerized tomography showed calcification of the falx cerebri along the venous sinuses and small venous channels. Lateral views of the skull revealed bridging of the sella turcica. A chest radiograph showed bifid fourth and fifth ribs on the left side and dextrocardia, with the heart apex to the right side. Ultrasound examination of the abdomen confirmed complete situs inversus; the liver was on the left, the spleen on the right side, and the stomach was transposed. Discussion and Conclusion: A search conducted on the PubMed revealed that there is no such unique occurrence in the world literature. However, the rarity of these two conditions (NBCCS incidence: 1 in 57,000; situs inversus incidence: 1 in 10,000) suggests that coincidental occurrence is unlikely. Thus, There is the intriguing possibility that these two clinical phenotypes are histogenetically linked to PTCH/hedgehog signaling. The hedgehog (Hh) signaling pathway plays an important role both in embryonic development and adult stem cell function. Dysregulation of the pathway causes birth defects and cancer. NBCCS is known to be caused by mutations in the PTCH1, the receptor of hedgehog. PTCH1 is localized to primary cilia and mediates key steps in the transduction of the hedgehog signal (1-3). It has been suggested that ciliary dysfunction via dysregulation of the hedgehog pathway is the underlying cause of situs-inversus. Keywords: Situs Inversus Totalis, Gorlin-Goltz Syndrome, PTCH1 Mutation, Ciliary Dysfunction

A 45-year-old woman was referred to the Department of Oral Medicine, Diagnosis and Radiology, KLE V.K. Institute of Dental Sciences, Belgaum by a local dentist for evaluation of a swelling in upper right posterior region of jaw. The swelling was present since six months and was small to begin with and gradually increased to attain the present size. There was history of occasional blood discharge from area adjacent to the swelling at intervals of six to eight days since six months. There was no history pain related with the same. Patient also gave history of extraction of maxillary right incisors which was grossly decayed 1 year back and the extraction procedure was uneventful. The medical, social and family histories were unremarkable. The results of review of systems and physical examination revealed no abnormal findings. The clinical examination revealed a diffuse, smooth, solitary dome- shaped swelling with sessile base measuring about 5 X 3cms present palatally adjacent to the midpalatal region extending from permanent right maxillary canine to the permanent right maxillary second molar. The swelling was soft, rubbery, fluctuant, fixed and non-tender on palpation. Mucosa over the swelling was same as adjacent normal keratinized mucosa with no sinus tract or any discharge. The oral hygiene was poor with many missing teeth and poor periodontal status. Patient was subjected for radiographic investigations. The intra-oral periapical radiograph in relation to 13 14 15 region revealed a well defined radiolucency with breach in lower border and measuring approximately 2.5 X 2cms. The superior border of lesion was not covered in radiograph. The internal structure was uniformly radiolucent. The maxillary occlusal topography revealed radiolucency in right maxilla, measuring approximately 2 X 1cms. The lateral border was corticated and well defined whereas the medial border was diffused. The root stump of tooth 14 was seen to overlap with distal aspect of radiolucency. Panoramic radiograph revealed radiolucency in edentulous area anterior to the premolars in right maxilla. The borders were well defined and uniform cortication was visible. The approximate size was 2.5 X 2cms. The internal structure was uniformly radiolucent having a density of soft tissue. There was a breach in lower border of radiolucency with loss of cortication, suggesting the growth of the mass into the underlying soft tissue. The displacement of root pieces of the premolars at the same side was also appreciated. A provisional diagnosis of infected residual cyst with missing canine was given. Depending upon the history and clinical presentation, the other differential diagnosis like postsurgical cysts of the maxillary sinus, primordial cyst, keratocyst and traumatic bone cyst were considered. To reach to a definitive diagnosis the patient was subjected for excisional biopsy of the lesion after carrying out complete heamogram. Excisional biopsy was performed, and the mass was submitted for histopathologic examination. Under scanner view, section shows 3 pieces of tissue with one showing surface epithelium and other showing adipose tissue covered by fibrous capsule under higher magnification tissue shows matured adipocytes in which nucleus is placed at periphery. Tissue is covered by fibrous capsule. In adipose tissue, numerous endptheilly proliferating large and small blood vessels with RBCs and extravasated RBCs are present. Chronic inflammatory infiltrate predominantly lymphocytes and plasma cells are present, collagen fibres with spindle to plump shaped fibroblast can be seen. Features suggestive of LIPOMA. Keywords: Lipoma, intraoral, oral cavity

Objectives: To evaluate the behaviour of peri-implant tissues around implants with different surface treatment. Materials and methods: Eight patients were identified according to these criteria: systemically good health, no history of periodontal disease, no contraindications for the surgical and prosthodontic protocol applied. Each patient received at least 2 implants (1 control, 1 test) into an edentulous quadrant. The control implants had dual acid-etched (DAE) surface in the apical portion and a machined coronal part, test implants had a completely DAE surface. Machined healing abutments were placed on control implants and DAE abutments on test ones. Standardized periapical radiographs were taken at baseline, 3 and 6 months, 1 year after surgery and then annually up to the 6 year follow-up. Histologic and microbiologic analyses of peri-implant tissues were conducted in the first year. Bleedeing on probing (BOP) and Plaque Index (PI) were recorded annually. The research project was approved by the Scientific Ethical Committee of Genoa University and all patients provided informed consent to the study. Statistical analysis: Differences in bone resorption over time were evaluated by Friedman test. For statistically significant differences post-hoc analysis with Wilcoxon signed-rank test was conducted with a Bonferroni correction. Any difference in bone resorption between the two types of implants or the maxilla operated, cortical or midullary bone quality were assessed by a repeated measure ANOVA for ranked data. The same analysis evaluated differences in PI and BOP. A p ≤0.05 was statistically significant. Results: A statistically significant difference in bone level was noted over time, in particular between baseline and the 1-year follow-up appointment (p=0.001), whereas no significant changes were observed after 1-year follow-up. At 1-year follow-up the difference in bone resorption between test and control was significant (p=0.030) with lower bone loss next to test implants. A statistically significant difference (p0.001) was found in bone resorption for the quality of cortical bone, with lower bone resorption in class 1 (dense) bone compared to class 2 (medium) and 3 (soft) during the first 3 years and a greater bone resorption in class 1 bone at subsequent follow-up appointments. In contrast, no statistically significant differences in the bone resorption were found for cancellous bone quality. No statistically significant differences were detected between test and control implants for BOP (p=0.82) and PI (p=0.38). Mean Probing Depth (PD) was 2,92 mm for test implants and 2,74 mm for control implants. No statistically significant difference was found in PD (p=0.235). Conclusions: Moderate bone loss was found 1 year after surgery, then a steady state condition was observed with less bone resorption next to test implants. Implant surface might affect the bone remodelling phase subsequent to the surgical trauma, but once osseointegration was established, implant surfaces did not affect bone maintenance over time. Implant surfaces did not affect soft tissue behavior in the present study. Keywords: implant surface, peri-implant tissue, bone loss

The aim of this study was to evaluate the orthodontic treatment needs in a sample of 12-year-old Yemeni school children using the Dental Aesthetic Index (DAI). Subjects and Methods: The sample comprised 3003, 12-year-old children attending school in six of the governorates of Yemen. For each subject the standard demographic information such as gender and age was collected, after which an intra-oral examination for occlusal status using the DAI was performed. Results: The mean DAI score was 24.86 (SD = 8.44) points (95% CI, 24.07 to 25.65). On the whole, 36.6 % of the sample found to have a dental appearance that requires orthodontic treatment, ranging from 'selective' to 'mandatory'. Of whom 19.0 % prsented with severe and handicapping malocclusion, requiring 'definite' and 'mandatory' treatment. The results of the individual variables showed that about 8 % of the sample with more than one missing permanent teeth. Anterior maxillary and mandibular irregularity occurred in more than 33 % of the sample. More than 30 % of the children examined showed signs of crowding. Spacing in the incisal segments occurred in almost 25 % of the sample. Almost 30 % of the sample had an antero-posterior molar relation discrepancy. Conclusion: According to the findings of this study, almost one of each five of the evaluated Yemeni school children in the sample had a DAI score above or equal to 31 points, suggesting highly desirable or mandatory orthodontic treatment need. The inclusion of occlusal traits as part of the index provided an opportunity to assess several occlusal characteristics in 12-year-old Yemeni children, separately. Keywords: dental aesthetic index, orthodontic treatment need, Yemen

Introduction: Subperiosteal preparation using a periosteal elevator leads to disturbances of local periosteal microcirculation [1]. Soft-tissue damage can usually be considerably reduced using piezoelectric technology. For this reason, we investigated the effects of a novel piezoelectric device on local periosteal microcirculation and compared this approach with the conventional preparation of the periosteum using a periosteal elevator. Material and Methods: A total of 20 Lewis rats were randomly assigned to one of two groups. Subperiosteal preparation on the cranium (picture 1) was performed using either a piezoelectric device or a periosteal elevator. Intravital microscopy (picture 2) was performed immediately after the procedure as well as three and eight days postoperatively [2]. Statistical analysis of microcirculatory parameters was performed offline using analysis of variance (ANOVA) on ranks (p0.05). Results: Periosteal microcirculation was imaged in detail using intravital fluorescence microcopy. The group of rats whose periosteum had been prepared with a piezoelectric device was compared with the group of rats whose periosteum had been prepared with a periosteal elevator. The periosteal elevator group had a significantly lower functional capillary density than the piezoelectric device group at all time points investigated. Postoperatively, both groups showed a considerable increase in functional capillary density, which, however, was always lower in the periosteal elevator group than in the piezoelectric device group (Picture 3). Microvascular red blood cell velocity was significantly lower in the periosteal elevator group than in the piezoelectric device group. During the following 8 days, the red blood cell velocities in the periosteal elevator group became more similar to those measured in the piezoelectric device group. Discussion: Our results show that the use of the piezoelectric device for the preparation of the periosteum was associated with a considerably higher post-procedural periosteal blood flow than the conventional method with a periosteal elevator. Several studies reported that piezosurgery is an atraumatic process that causes only minimal tissue damage. The study presented here confirms this finding for subperiosteal preparation. One possible explanation is that the use of a piezoelectric device leads to the formation of fewer microthrombi during subperiosteal preparation than a periosteal elevator. The results reported here show that the use of a piezoelectric device for the preparation of the periosteum has considerable advantages. Further studies are required to investigate possible positive effects on bone remodeling in patients who have comorbidities and, for example, are treated with bisphophonates, chemotherapeutic agents, or other medications. Keywords: subperiosteal preparation, piezoelectric preparation, intravital microscopy, animal testing

Aims: To assess preschool children's attitudes towards their dentists. Methods: A questionnaire was developed to evaluate children's attitudes towards their dentists. Informed consent to distribute the questionnaire was obtained from the school principals and parents. The investigators filled the questionnaire out with the children. The questionnaire recorded age, gender, place of residence and contained 17 attitudinal items related to the dentist's gender, attire, age, personal protective equipment and dental clinic interior. The children expressed their attitudes to the above items by choosing from pictograms or photographs. A previous dental experience, if any, was recorded, along with the date of the first dental visit provided by the parents. In a pilot study, 44 children were asked to complete the questionnaire and to identify any questions which were unclear. Subsequently, the questionnaire was modified accordingly and retested for internal consistency (Cronbach's alpha 0.75). The child subjects for the main study were recruited in randomly selected nurseries in the capital city and rural regions. Then all children were included based on signed informed consent. Chi-square test at the significance level of 5% was used to test the relationships between the variables. Results: The questionnaire was completed by 439 children (247 girls, 192 boys; response rate 76.6%) within an age range of 3-7 years, attending public nurseries in the capital city Prague (312 children in 4 nurseries) and in other regions (127 children in 4 nurseries). In total, 376 (85.6%) of the study subjects had already been to the dentist. The girls preferred a dental office decorated with motifs for children more than boys (p=0.05). The children with a previous dental experience (p=0.05) and those who lived out of Prague (p=0.04) were more likely to prefer motifs for children in a dental office. The girls preferred female dentists at the age of their parents (p=0.05). The children currently undergoing dental treatment preferred female dentists, at the age of their parents (p=0.03), wearing colourful medical uniforms. Children from non-Prague regions preferred female dentist in coloured clothes without any protective equipment more than children from Prague (p=0.04). Several reasons for children's dental anxiety were identified. These were related to tooth drilling more in girls than in boys (p=0.03). The children preferred their parents staying in the dental office during their treatment (p=0.02). The children who lived out of Prague were more afraid of tooth drilling and extraction than those from Prague (p=0.03). Conclusions: The study described Czech preschool children's perceptions and preferences towards dental visits and dentists. Dental anxiety of children was related to the age of their first dental visit (2.5 years in non-Prague children, 1.6 years in Prague children), previous dental treatment and place of residence. Identification of children's attitudes towards their dentists could help initiate positive changes to make dental treatment more comfortable for preschool children. Acknowledgements: Supported by program PRVOUK-P 28/LF1/6. Keywords: preschool children, dental care, questionnaire, dentist, dental fear, dental anxiety