International Poster Journal of Dentistry and Oral Medicine, 04/2015

Introduction: Generalized gingival enlargement is a rare condition of varying etiology, resulting in oral hygiene impairment and increased risk of periodontitis. Case report: A 40-year old male was presented with generalized hyperplasia of the gingiva, halitosis, bleeding gums, masticatory difficulties and compromised aesthetic. While the medical history was unremarkable, a positive family history was reported, since his mother was also affected. Clinical examination showed a firm, dense generalized gingival overgrowth, massive plaque, subgingival and supragingival calculus, and tooth migration. Periodontal charting revealed active deep pseudo pockets and periodontal pockets. Generalized bone resorption was radiographically detected. Histological examination revealed connective tissue with dense collagenous fibers, large numbers of fibroblasts, fibrocytes and high quantity of chronic inflammatory cells. A hereditary gingival fibromatosis (HGF) and severe chronic periodontitis were diagnosed. Initial periodontal therapy with adjunctive systemic antibiotics was followed by surgical excision by means of internal gingivectomy and open flap debridement. Significant clinical improvement was achieved and remained stable up to one year. In addition, orthodontic treatment and periodontal maintenance are recommended. Discussion: Gingival fibromatosis can be caused by number of factors, e.g. by inflammation, leukemic infiltration, systemic medication, or genetic origin is considered (hereditary isolated or as part of a syndrome). An association of HGF with periodontitis requires a combined antiinfective and surgical treatment approach. Conclusion: HGF should be managed as early as possible to prevent periodontitis and further functional and esthetical impairment. Regular supportive periodontal therapy is important to maintain the treatment success. Keywords: gingival overgrowth, hereditary gingival fibromatosis, internal gingivectomy

Aim: There is evidence for an association of periodontitis and chronic kidney diseases (CKD), as well as for the positive effect of periodontal therapy on kidney function in CKD.The aim of the study was to determine the oral health status in patients suffering from terminal kidney insufficiency compared to a healthy control group without kidney insufficiency. Methods: 72 dialysis patients of the KfH-Kidney Center Chemnitz, Germany, were examined compared to147 healthy controls. All study subjects received a complete clinical oral examination. A thorough history of systemic diseases, drug use, smoking, oral hygiene habits, and utilization of dental care was obtained by questionnaires and interviews. Parameter of kidney function were obtained from medical charts for dialysis patients. Data analyses included descriptive statistics, comparison of means, correlation analysis as well as multivariate regression. Results: Hemodialysis patients had worse oral hygiene, less and more decayed teeth as well as worse periodontal conditions. Longer time on dialysis (> 3 years) together with a worse efficiency of dialysis was associated with a higher risk for periodontitis. After dentist became known the necessity of dialysis, 57% of the patients did not receive changes in dental treatment, and only 15% of all dialysis patients were offered any prophylaxis. Conclusion: Worse oral health was confirmed in hemodialysis patients compared to healthy controls. In dental practice, the awareness of this association is inadequately and has to be improved to reduce infectious burden as well as to prevent oral complications in these patients. Keywords: oral health status, periodontitis, kidney insufficiency

Aim: To review the literature of adjunctive antimicrobial photodynamic therapy (aPDT) in patients with peri-implantitis. Material and Methods: A systematic review of the literature was conducted according to statement of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and Cochrane Collaboration recommendations. An extensive literature search and a manual search were performed on eight databases and various journals using MeSH terms, keywords, and title words (9th september 2014). Studies were evaluated and summarized in a narrative review. Risk of bias was assessed for each included trial. Cochrane risk bias tool was used to assess each trial on five criteria sequence generation, allocation concealment, blinding, incomplete outcome data and selective outcome reporting. Results: From 123 citations identified and available abstracts screened, 27 full-text reports were assessed and 23 were included in the review. These included 12 over- and review articles and 11 clinical trials (5 prospective trials, 4 RCTs and 2 case studies). Two of the 4 RCTs were identified as continuation of 2 previous RCTs. No meta-analysis could be conducted because of the small number of RCTs with a great heterogeneity. There is insufficient evidence regarding the efficacy of aPDT in peri-implant management due to the small amount of RCT's. No statement can yet be made for additional clinical benefits. Conclusion: According to the present analysis aPDT cannot be recommended for periimplantitis treatment. Further high-quality RCT's are needed to investigate the influence of potential confounders on the efficacy of (adjunctive) aPDT in periimplantitis treatment. Keywords: antimicrobial photodynamic therapy, peri-implantitis, systematic review

Background: Periodontitis and coronary heart disease are both triggered by inflammatory reaction which is influenced by the genetic predisposition. C-reactive protein (CRP) plays an important role in inflammation and its expression is, among others, genetically controlled. Two CRP SNPs (rs1800947, rs1417938) are shown to be associated with different gene expression. One aim of this longitudinal cohort study (ClinicalTrials.govIdentifier: NCT01045070) was the evaluation of the prognostic importance of these CRP variants for further cardiovascular events in in-patients with coronary heart disease (CHD). Patients and methods: At baseline a total of 940 consecutive patients with angio¬graphically proven CHD of the Martin-Luther-University Halle-Wittenberg (Germany), Department of Medicine III, were prospectively included in the study. The one-year cardiovascular outcome of the patients was evaluated considering the 98 predefined, combined, primary endpoint (cardiovascular death, myocardial infarction, and stroke/TIA (transient ischemic attack)). Results: All 940 CHD patients completed the one-year follow up. 7.2% of the patients achieved the primary endpoint (myocardial infarction: 2.0%, stroke/TIA: 1.7%, cardiovascular death: 3.5%). In Kaplan-Meier survival curves and the log-rank tests, the genotype-, allele- and haplotype constellation of the CRP-polymorphisms rs1800947 and rs1417938 could not be proven as significant predictors for adverse cardiovascular events regarding the one-year outcome. Diabetes mellitus (Hazard ratio 1.79) and low body mass index (Hazard ratio 0.94) were confirmed to be prognostic markers for the predefined cardiovascular endpoint in cox regression analyses. Conclusions: Genetic variants of CRP gene, rs1800947, rs1417938, could not be regarded as prognostic markers for further cardiovascular events among in-patients with CHD. Keywords: cardiovascular disease, periodontitis, C-reactive protein, genetic

Background: Immediate implant placement has proven to be a successful and a predictable treatment modality. Nevertheless, immediate implant placement is indicated only in cases where soft and hard tissue conditions are considered ideal at the time of implant placement. Therefore, most implant procedures in the esthetic zone necessitate pre-implant, simultaneous and/or post-implant site enhancement procedures, i.e. augmentation procedures. For this purpose, several techniques and procedures have been proposed. One of the suggested approaches is orthodontic extrusion. While this approach has been originally introduced to save traumatized teeth from extraction, it has been suggested as a method to manipulate soft and hard tissues via gradual extrusion of a "hopeless" tooth and its periodontal apparatus, thereby enhancing the predictability of the implant site. A number of reports available in the literature describe orthodontic extrusion as a reliable method for pre-implant site enhancement. However, no standard protocols have been provided about the application of this technique. An overview about orthodontic extrusion would enhance the knowledge about different techniques as well as provide the clinicians with guidelines that can aid in decision-making and application of this approach. Purpose: The aim of this presentation is to provide an overview about the principles of pre-implant orthodontic extrusion, describe methods and techniques available and provide the clinicians with guidelines about its application. Material and methods: The literature database was searched for studies involving implant site enhancement via orthodontic extrusion of teeth deemed hopeless. Results: The current data is limited to case reports and case series and therefore, no clear guidelines about orthodontic extrusion could be obtained. The available reports, however, showed that orthodontic extrusion could be a reliable option to improve soft and hard tissue conditions prior to implant placement. Conclusion: Orthodontic extrusion can be implemented as a treatment alternative to enhance hard and soft tissue prior to implant placement. While the current literature does not provide clear guidelines, the decision making for a specific approach in orthodontic extrusion seems to be based on the clinician's preferences. Clinical studies are needed to verify the validity of this treatment option Keywords: implant site enhancement, implant site development, soft tissue enhancement, hard tissue enhancement, orthodontic extrusion, orthodontic extraction, forced eruption

Objectives: The objective of this study was to investigate the buffer capacity of typical and experimental restorative materials during a carious and intrinsic erosive attack. Methods: Samples with a small cavity (130 µl) were milled out of composites, a compomer, a giomer, a pulp capping liner, a glass ionomer cement, a PMMA block, extracted teeth and an experimental dual-curing composite containing a bismuth-doped bioactive glass using CEREC MC XL (Sirona) to create a standardized surface. 80 µl of acid (lactic acid with a pH of 4.5 or hydrochloride acid with a pH of 2.6) was added. The change of pH was measured over a period of 12 minutes using a calibrated pH-electrode (In Lab nano, Mettler Toledo). Before and after this test the surface of each sample was electron-microscopically analyzed. Results: After the HCl acid attack the compomer, giomer and the glass ionomer cement showed some buffering effect while composites and PMMA had no relevant buffering effect. The experimental bioactive glass-containing composite buffered most effectively and performed similar to the positive control group (liner). Following the lactic acid attack smaller pH changes were measured as compared to the HCl. However a neutral pH was induced by the majority of the tested materials. The electron microscopy showed transformation in the surface of all materials after an acid attack Significance: The results indicate that bioactive agents can increase the pH in vitro and therefore may be of advantage during an acid challenge. Keywords: buffer capacity, pH, secondary caries

Aim: To investigate the efficacy of adjunctive antimicrobial photodynamic therapy (aPDT) in patients with chronic periodontitis. Material and Methods: Meta-analyses were conducted according to PRISMA and Cochrane recommendations. Extensive literature and manual search were performed on eight databases. Mean difference (MD), 95% confidence intervals (CI) were calculated for probing depth (PD) reduction and gain in attachment level (AL). I2 test was used for inter-study heterogeneity, publication bias was examined by visual inspection of funnel plots. Results: From 992 identified and available records 811 were screened after removing of duplicates. 143 full-text reports were assessed and 81 studies were included in qualitative and 12 in quantitative synthesis (meta-analysis). The metaanalysis showed a statistical significant superior PD reduction (mm) and AL gain (mm) in test group (SRP + aPDT) over control group (SRP alone) for the follow-up of: 6 weeks (PD reduction) MD 0.15, 95% CI 0.06 to 0.25, p=0.001; 12 weeks (PD reduction) MD 0.17, 95% CI 0.16 to 0.18, p0.00001; 12 weeks (AL gain) MD 0.24, 95% CI 0.10 to 0.38, p=0.007. For the follow-up of 6 months the meta-analysis showed a not statistical significant difference between test and control group: 6 months (PD reduction) MD 0.08, 95% CI -0.25 to 0.42, p=0.63; 6 months (AL gain) MD 0.20, 95% CI -0.08 to 0.48, p= 0.16. Conclusion: While there is strong clinical evidence of short-term benefits for PD reduction (mm) and AL gain (mm) weak evidence is available for long-term benefits of adjunctive antimicrobial photodynamic therapy in chronic periodontitis. Keywords: adjunctive photodynamic therapy, chronic periodontitis, meta-analysis

Aim: To evaluate the efficacy of an experimental amine fluoride/stannous fluoride mouthrinse on plaque during home-use. A secondary outcome is to investigate the efficacy on gingivitis and staining potential. Material and Methods: For this three-month randomized, investigator-blinded and clinically controlled study in parallel groups, 240 adult participants with gingivitis were recruited. The test group (n=80) rinsed with the experimental product for 30s twice daily. The positive control group (n=80) rinsed with meridol® (amine fluoride/stannous fluoride) in the same manner. In both rinsing groups habitual toothbrushing was performed. The negative control (n=80) performed toothbrushing only. Plaque index (Silness & Löe 1964), gingival index (Löe 1967), discoloration index (Brecx et al. 1993) and safety were recorded at screening, baseline, after 3 and 12 weeks. ANOVA and Bonferroni adjusted post-hoc tests at a significance level of α=0.05 were applied. Results: Both mouthrinses led to a statistically significant plaque reduction compared to the negative control after 3 and 12 weeks. However, no differences existed between test and positive control. A statistically significant gingivitis reduction was observed between test and negative control groups after 3 weeks. Tooth discoloration occurred in all groups but was higher in the rinsing groups. No difference existed between test and positive control. Conclusion: Rinsing with amine fluoride/stannous fluoride formulations in addition to toothbrushing inhibits plaque in comparison to brushing alone. With exception of gingivitis reduction up to three weeks, no further advantage of the test rinse compared to the positive control rinse was found. Keywords: plaque, gingivitis, mouthrinse, amine fluoride/stannous fluoride

Aim: SEM analysis of effect of chelating agent and endoactivator on smear layer removal from root canals of primary teeth. Material and Methods: Root canals of extracted human primary teeth were biomechanically prepared using 6% citric acid, endoactivator and normal saline, as control, for removal of smear layer .The specimens were subjected to scanning electron microscopic analysis. Results: In control group photomicrographs, debris and heavy smear layer covered the root canal surface and tubules in comparison to citric acid and endoactivator used study group photomicrographs which showed moderate to no smear layer on root canal surface and tubules. Conclusion: Effective removal of smear layer both by citric acid and endoactivator show promising use for root canals of primary teeth biomechanical preparation. Keywords: endoactivator, smear layer, citric acid, scanning electron microscope

The availability of adequate bone volume for dental implant placement is often diminished by trauma, pathology, periodontal disease, and tooth loss. Achieving esthetically pleasing therapeutic outcomes in the rehabilitation of a deficient anterior maxilla with dental implants can be very challenging. Bone resorption in the anterior maxillary ridge frequently results in a bucco-lingual and corono-apical deformity, which precludes implant placement. Grafting procedures have been documented to be highly effective in reconstructing jaw anatomy and providing biomechanical support for the placement of dental implants. This poster describes a surgical approach to achieve esthetic rehabilitation in a case with a severely deficient anterior maxilla. A technique of bone augmentation with block allograft and titanium mesh is described. Implants were placed and soft tissue was developed to achieve a harmonious bone tissue interface. Prosthetic rehabilitation was carried out with customized Zirconia abutments and All ceramic crowns to achieve a highly esthetic outcome. Keywords: titanium mesh, customized zirconia abutments, ridge-split, guided bone regeneration, connective tissue grafting, papilla regeneration, block allograft, esthetics, deficient ridge management