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Augmentation procedures in the severely resorbed maxilla are standard techniques in preprosthetic surgery. Aim of the present study was to compare onlay bone grafting and sinus floor elevation with autogenous bone grafts in edentulous patients in terms of bone resorption of the posterior alveolar crest and implant survival in a 5-year longitudinal study. A total of 100 patients (53 female and 47 male patients) requiring augmentation using autogenous bone due to a severely resorbed maxillae were evaluated. The degree of resorption and bone quality were preoperatively estimated in panoramic radiographs according to Lekholm and Zarb. The overall 5-year success rate of implants placed after augmentation procedures in the posterior maxilla was 93.1%. Following onlay augmentations 215 out of 235 implant insertions were successful, i.e. a success rate of 91.5% was achieved. In the sinuslift group, 330 out 349 implants remained successful, i.e. a success rate of 94.6% was found. The difference between both groups was statistically significant at the end of the evaluation period. Bone resorption, measured as loss of total bone height in panoramic radiographs, was initially more pronounced following onlay augmentations (>20% after 12 months of observation). The degree of resorption decreased in the further course of the study. Lower resorption rates and a higher overall success rate were demonstrated for the sinus lift group.

The aim of the present study was to determine the correlation between the primary stability of dental implants placed in edentulous maxillae and mandibles, the bone mineral density and different histomorphometric parameters. After assessing the bone mineral density of the implant sites by computed tomography, 48 stepped cylinder screw implants were installed in four unfixed human maxillae and mandibles of recently deceased people who had bequeathed their bodies to the Anatomic Institute I of the University of Erlangen-Nuremberg for medical-scientific research. Peak insertion torque, Periotest values and resonance frequency analysis were assessed. Subsequently, histologic specimens were prepared, and bone-to-implant contact, the trabecular bone pattern factor (TBPf), the density of trabecular bone (BV/TV) and the height of the cortical passage of the implants were determined. The correlation between the different parameters was calculated statistically. The mean resonance frequency analysis values (maxilla 6130.4+/-363.2 Hz, mandible 6424.5+/-236.2 Hz) did not correlate with the Periotest measurements (maxilla 13.1+/-7.2, mandible -7.9+/-2.1) and peak insertion torque values (maxilla 23.8+/-2.2 N cm, mandible 45.0+/-7.9 N cm) (P=0.280 and 0.193, respectively). Again, no correlations could be found between the resonance frequency analysis, the bone mineral density (maxilla 259.2+/-124.8 mg/cm(3), mandible 349.8+/-113.3 mg/cm3), BV/TV (maxilla 19.7+/-8.8%, mandible 34.3+/-6.0%) and the TBPf (maxilla 2.39+/-1.46 mm-1, mandible -0.84+/-3.27 mm-1) (P=0.140 and 0.602, respectively). However, the resonance frequency analysis values did correlate with bone-to-implant contact of the oral aspect of the specimens (maxilla 12.6+/-6.0%, mandible 35.1+/-5.1%) and with the height of the crestal cortical bone penetrated by the implants in the oral aspect of the implant sites (maxilla 2.1+/-0.7 mm, mandible 5.1+/-3.7 mm) (P=0.024 and 0.002, respectively). The Periotest values showed a correlation with the height of the crestal cortical bone penetrated by the implants in the buccal aspect of the implant sites (maxilla 2.5+/-1.2 mm, mandible 5.4+/-1.2 mm) (P=0.015). The resonance frequency analysis revealed more correlations to the histomorphometric parameters than the Periotest measurements. However, it seems that the noninvasive determination of implant stability has to be improved in order to give a more comprehensive prediction of the bone characteristics of the implant site.

It has been the aim of the present study, to introduce the combination of computed tomography and optical 3D imaging to exophthalmometry and to compare the resulting data to the classic Hertel method. Twenty patients without orbital pathology and 12 patients were included in the study, who were subjected to a preoperative computed tomography. Optical 3D images of the facial surface were assessed and Hertel exophthalmometry was carried out to determine protrusion. In patients with zygomatic fractures the assessment of optical 3D images and Hertel values was repeated 5 days after surgery. Preoperative axial CT slices and postoperative optical contours through the globes were superimposed and the change in protrusion was determined. The protrusion values assessed either by CT, Hertel exophthalmometry or optical 3D imaging for patients without orbital pathology did not show any statistically significant differences between each other. For zygomatic fractures, Hertel exophthalmometry revealed more pronounced protrusion data in four of five cases of a posterolaterally dislocated lateral orbital rim and a higher degree of enophthalmos in cases without dislocation of the lateral orbital rim than it could be proved in the CT slices. The differences between optical measurements and CT data were minimal in patients with zygomatic fractures. The combination of computed tomography as baseline measurement and optical 3D imaging for the follow-up examinations reveal more realistic data in cases of zygomatic fractures than Hertel measurements and should be preferred.

Since the beginning of 1998, eleven patients have been treated by osteodistraction to correct hypoplasia of the maxilla and midface of various origins. Among them were six patients who were treated by high LeFort I osteotomies and insertion of subcutaneous intraoral distraction devices in the malar region. In the remaining five patients extraoral distraction devices were applied after LeFort I, II and III osteotomies. Distraction osteogenesis was successful in all cases, resulting in a mean sagittal bone gain measured parallel to the skull base of 9.5 mm (range 4.5-12.0) in the group treated with intraoral distractors and a mean of 19.4 mm in the extraoral distraction group (range 15.0-25.0). All patients were kept under orthodontic supervision before, during, and after osteodistraction. In eight patients long-term cephalometric and clinical evaluation after a mean follow-up period of 24 months in the intraoral distraction group (range 22-26) and 12 months in the extraoral distraction group (range 10-14) show stable results concerning the skeletal and dental relations. Long-term follow-up is necessary.

Background and purpose In recent years, various therapeutic concepts have been developed for treating oral cancer, these include preoperative simultaneous ‘neoadjuvant’ radio-chemotherapy and one-stage-surgery with tumour ablation and reconstruction. When considering long-term survival, there is substantial evidence that the neoadjuvant therapy is superior to the primary surgical approach with postoperative radiation. Both treatment concepts, however, have a strong impact on the quality of life. Patients and methods This study prospectively evaluates and compares quality of life in 53 patients with oral cancer treated according to a neoadjuvant concept or primarily surgically, using the questionnaires QLQ C-30 and H and N35 by the EORTC. Results Initially both groups showed a marked reduction in the quality of life. Despite a clear improvement in the first postoperative year baseline values were not reached in most of the scores. Specific long-lasting impairments in the symptom scales concerning oral functions were found in both treatment arms. In the neoadjuvant therapy group, however, especially global health and the emotional status were reduced to a higher degree than in the other group. This was particularly noticeable in the early treatment phase. Conclusions Following an initial deterioration of quality-of-life after 3 months a gradual improvement of physical and psychological function was observed in the course of the first post-treatment year in both groups. Severe side effects can be observed. These side effects vary strongly in their individual expression. Limitations in the quality of life can be justified, if the more aggressive therapy resulted in a better disease free survival.

The aim of the study was to compare the bone mineral apposition rate (BMAR) of immediately loaded implants with an unloaded control during the early healing phase in the partially edentulous mandible. In seven mini pigs, three premolars and the first molar were removed in the left mandible. Three months later, five implants were installed. Four implants received a fixed provisional restoration and were loaded immediately. The most anterior implant was used as unloaded control. Polychromatic fluorescence labelling was performed to assess the BMAR. After 4 months, the implants were retrieved together with the adjacent bone. Histological specimens were prepared and subjected to a fluorescence microscopic and histomorphometric analysis. Two provisional restorations were found partially lost at the end of the observation period. One implant that had lost the splinting fixation showed soft connective tissue healing. The BMAR did not differ statistically significantly between loaded and unloaded implants and within the single groups during the observation period (BMARloaded days 14-42=1.8+/-0.2 microm/d, BMARloaded days 42-70=1.8+/-0.1 microm/d, BMARloaded days 70-98=1.6+/-0.1 microm/d, pBMARloaded days 14-42/42-70/70-98 =0.156, BMARunloaded days 14-42=1.7+/-0.1 microm/d, BMARunloaded days 42-70=1.8+/-0.2 microm/d, BMARunloaded days 70-98=1.6+/-0.4 microm/d, pBMARunloaded days 14-42/42-70/70-98=0.368, pBMARloaded/unloaded days 14-42=0.073, pBMARloaded/unloaded days 42-70=0.098, pBMARloaded/unloaded days 70-98=0.262). Four months after implant placement, the bone-to-implant contact was 77.8+/-17.3% for the loaded and 78.0+/-5.8% for the unloaded implants (P=0.753). Immediate loading does not affect the bone mineral apposition rate when compared with unloaded implants. Rigid splinting seems to be the crucial factor for implant success. Uncontrolled masticatory forces can cause failure after partial loss of the provisional restoration.

Purpose: The aim of this prospective study was to measure the hemoglobin oxygen saturation (HbO2%) and relative Hb concentration of free vascular soft tissue flaps using micro-lightguide spectrophotometry. The objective was to measure the normal range and topographic differences in HbO2% and rel. Hb conc. in tissue transfers before establishing this as a clinical method for monitoring perfusion and vitality. Patients and Methods: In 39 patients who had received free vascular soft tissue flaps (34 radial forearm flaps; 8 latissimus flaps) to cover defects after tumor surgery, the capillary HbO2% in transferred tissue was measured spectrophotometrically preoperatively at the donor site and postoperatively up to the third postoperative day. On average about 500 hemoglobin spectra (200 to 800 spectra) were measured over each 24-hour period. Additionally, the relative Hb concentration was determined for the individual measuring times. The measurements were carried out topographically on the flap base, flap center, and flap periphery. Results: The preoperative HbO2 values at the donor site of free soft tissue flaps were between 20% and 40% in all topographic regions. In the case of clinically successful flaps, a normal distribution of the HbO2 values of 20% to 80% was obtained in the immediate postoperative period, and from the second day on, a normal distribution of 45% to 60%. In the case of 2 flaps with partial necrosis, HbO2 values of less than 10% to 15% were measured from the second postoperative day on. The relative Hb concentration had no influence on the amount of HbO2% measured in the transferred capillaries. In the postoperative phase, here was no topographic difference between the individual flap regions. Conclusions: As a noninvasive method, micro-lightguide spectrophotometry permits quantitative determination of HbO2% and relative Hb concentration over the entire surface of soft tissue flaps. In the case of partially unsuccessful flaps, HbO2 values of less than 10% to 15% were measured beforehand, thus indicating that these HbO2 values are not sufficient to support the vitality of the free tissue transfer. When combined with clinical observation, application can be recommended for the vitality measurement of free soft tissue flaps and permits more information to be obtained on topographic capillary perfusion conditions. © 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:292-297, 2003

Thirty human zygomatic bone specimens (15 females mean age 81.60 +/- 11.38 years, 15 males, mean age 78.47 +/- 6.58 years) were examined by quantitative computed tomography and histomorphometry. The aim of the study was to assess the bone mineral density, the trabecular bone volume and the trabecular bone pattern factor. Moreover, the anterior-posterior and the medio-lateral dimensions and the estimated implant length within the zygomatic bone were determined. For quantitative computed tomography the specimens were scanned together with a bone mimicking anthropomorphic reference phantom. The bone mineral density was calculated for the specimens in the plane of the intended direction of the implant placement. Subsequently, with the sawing and grinding technique, the specimens were prepared in the same plane for histomorphometry. The trabecular bone mineral density was 369.95 +/- 188.80 mg/cm3 for the female and 398.94 +/- 99.11 mg/cm3 for the male specimens (P = 0.23). The male trabecular bone volume showed a value of 27.32 +/- 9.49%, while the female group reached a value of 19.99 +/- 7.60% (P = 0.23). The trabecular bone pattern factor was 1.2 x 10-2 +/- 1.28 mm-1 for the male and 1.02 +/- 0.96 mm-1 for the female specimens (P = 0.045). The study reveals that the zygomatic bone consists of trabecular bone with parameters that are unfavourable for implant placement. However, the success of implants placed in the zygomatic bone is secured by the employment of at least four cortical portions.

The treatment of oral cancer has a strong impact on the quality of life. In recent years different therapeutic concepts have been developed, these include preoperative simultaneous "neoadjuvant" radiochemotherapy (RCT) and one-stage surgery with tumor ablation and reconstruction. When considering long-term survival, there is substantial evidence that evidenced modality treatment including neoadjuvant RCT is superior to the primary surgical approach with postoperative radiation.This longitudinal study prospectively evaluates quality of life in two groups consisting of 53 neoadjuvant and primarily surgically treated patients with oral cancer, using the quality-of-life core questionnaire (QLQ-C30) and the head and neck cancer module (H and N 35) of the European Organization for Research and Treatment of Cancer (EORTC).Postoperatively both groups showed a marked reduction in quality of life. 1 year later quality of life had equalized between the two groups to such an extent that the quality of life scores had almost reached the preoperative level. Both groups showed specific impairments in the symptom scales. In the neoadjuvant therapy group however, global health and the emotional status were reduced to a greater degree than in the other group.Temporary limitations in quality of life can be expected after tumor treatment of oral cancer as presented here. Neoadjuvant therapy concept is more aggressive and might result in a longer disease-free survival, but the restriction in quality of life is more severe. Primary goal is the eradication of the tumor. Nevertheless preservation or reconstruction of a maximum of function is essential for a high level of quality of life.

The influence of the osteotome technique on the osseointegration of rough-surfaced stepped cylinder implants (Frialit)-2) was compared to conventional preparation of the implant site in an animal model. A total of 104 implants were placed into the distal femoral condyle of 52 New Zealand white rabbits. This region contains sufficient trabecular bone for implant placement. The implant site was prepared either by the osteotome technique or by conventional technique with drills as a control group. During the healing period polychromatic fluorescence labelling was performed with four different fluorescent dyes. After 2, 4 and 8 weeks, the implants were removed with the surrounding bone. The sample preparation was done using the 'sawing and grinding' technique. Ground sections 100 microm thick were used for fluorescence microscopic analysis; 30- microm-thick ground sections were examined histomorphometrically. After 2 weeks the bone-to-implant contact ratio was 55.0 +/- 7.1% for the osteotome technique and 29.2 +/- 4.8% for the control group (P0.0005). After 4 weeks, the bone-to-implant contact ratio was still significantly better for the osteotome technique (bone-to-implant contact ratio osteotome technique 71.1 +/- 7.2%, bone-to-implant contact ratio control 59.0 +/- 6.3%, P = 0.003). Eight weeks after implant placement the bone-to-implant contact ratio was still better for the osteotome technique compared to the conventional implant placement. However it was no longer statistically significant. The qualitative fluorescence microscopic examination showed an earlier and stronger signal for the osteotome technique than the control group. With the latter, the zone of mineralization moved slowly towards the implant surface. Implant sites prepared by the osteotome technique showed a pronounced signal in the whole compressed area already by the second day. In conclusion, the osteotome technique increases new bone formation and leads to an enhanced osseointegration of dental implants in trabecular bone. However, more experimental trials have to be carried out on higher mammals that show a metabolic rate of bone that is more comparable to humans.

Since the beginning of 1998, eight patients have been treated by osteodistraction to correct hypoplasia of the maxilla and midface of various origins. Among them were five patients who were treated by high LeFort I osteotomies and insertion of subcutaneous intraoral distraction devices in the malar region. In the remaining three patients, extraoral distraction devices were applied after LeFort II and III osteotomies. Distraction osteogenesis was successful in all cases, resulting in a mean sagittal bone gain measured parallel to the skull base of 9.0 mm (range 4.5-12.0) in the group treated with intraoral distractors and a mean of 20.3 mm in the extraoral distraction group (range 15.0-25.0). All patients were kept under orthodontic supervision before, during, and after osteodistraction. Long-term cephalometric and clinical evaluation after a mean follow-up period of 24 months in the intraoral distraction group (range 22-26) and 12 months in the extraoral distraction group (range 10-14) show stable results concerning the skeletal and dental relations. Long-term follow-up is necessary.

20 retromolar bone grafts were harvested in outpatients for augmentation of the implant site from January to June 2000 (10 female, 10 male, 40.9 +/- 12.8 years, minimum 17 years, maximum 66 years). The aim of the study was to assess typical complications of this procedure in a prospective manner. For the determination of the superficial sensory function of the inferior alveolar and the lingual nerve, an objective method was used. The bone grafts were harvested for single tooth reconstruction. In 14 cases a ridge augmentation and in 6 cases an endoscopically controlled crestal sinus floor elevation was performed. Preoperatively, the height of bone above the cranial aspect of the inferior alveolar nerve in the retromolar region was assessed radiologically with known markers. The maximum mouth opening was determined. The superficial sensory function of the inferior alveolar and the lingual nerve was assessed with the Pointed-Blunt Test, the Two-Point-Discrimination Test and the objective method of the 'Pain and Thermal Sensitivity' Test (PATH Test). Moreover, the pulp sensitivity of the teeth of the donor site was determined by cold vitality testing. All tests were repeated 1 week postoperatively. Intraoperatively, the width of the retromolar region was measured with a caliper. The patients rated the operative strain on a visual analogue scale. The height of bone above the inferior alveolar nerve in the retromolar region was 11.0 +/- 2.2 mm. The width of the retromolar area was 14.2 +/- 1.9 mm. Postoperatively, the maximal mouth opening changed significantly (40.8 +/- 3.5 mm preoperatively, 38.9 +/- 3.7 mm postoperatively, P = 0.006). However, the reduction was not relevant clinically. A direct injury of the inferior alveolar or lingual nerve did not occur. A sensitivity impairment could not be detected for either of the nerves by the different test methods 1 week postoperatively. The operative strain related to the donor site was significantly less than the strain generated by the implant placement (rating on a visual analogue scale 2.8 +/- 1.0 and 4.1 +/- 2.0, respectively, P = 0.027). Retromolar bone grafts are a viable method for augmentation of the implant site in conjunction with single tooth reconstruction with low strain on the patient and minimal risk of complications.

Callus distraction has become an accepted treatment procedure to lengthen hypoplastic mandibles in humans. For this purpose, extraoral and intraoral devices have been applied successfully. The effects of the distraction vector, distractor stability, and rate and frequency of callus distraction on the regenerating tissues have been examined in various studies. In an experimental animal trial on pigs (n = 12), a newly developed microhydraulic osteodistractor was tested. The animals were evenly assigned to two groups to perform a continuous and noncontinuous osteodistraction of the mandible. Initially, the forces necessary to distract the pig mandibles were recorded from a noncontinuous distraction procedure; the results were then used to perform continuous bone distraction. Besides testing the new distractor, the study proved that in continuous osteodistraction, intramembranous bone regeneration occurred, whereas in noncontinuous osteodistraction the bone regeneration process followed a chondroid ossification. In continuous osteodistraction, the bone regeneration proceeded at a higher speed with the lower distraction forces compared with noncontinuous distraction, thereby reducing the consolidation period. Clinical and microscopical results are presented.

The healing of free vascular grafts in a pre-irradiated graft bed is characterized by an increased risk of wound healing disorders. For that reason, the aim of this study was to examine quantitative vascularization pattern between free vascular grafts and the pre-irradiated graft bed as a function of the preoperative irradiation dose.A total of 217 free microvascular hard and soft tissue grafts were used within 199 patients in the head and neck region to cover defects after ablative tumor surgery. Seventy-six patients (group 1) had no prior radiation (RT), 50 patients (group 2) were treated with preoperative radiochemotherapy using 40 to 50 Gy and 5-FU/cisplatin, and 73 patients (group 3) had prior RT (60-70 Gy) between 1 and 7 years before surgery. After healing of the grafts, samples were taken from 42 patients from the graft, the irradiated graft bed, and the transition area between graft and irradiated graft bed. Samples were analyzed as follows: capillary sprouting, structural changes, and distribution patterns were analyzed by immunohistochemical staining (CD34 labeling of capillary endothelium). Three histological sections (2-4 microm) per sample were examined histomorphometrically (ratio capillary area/total area, capillary lumen, and the number of capillaries) by (National Institute of Health) NIH-image-digitized measurements. A statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney test (two-tailed p.05).The success rate of vascular grafts in group 1 (0 Gy) was 94%, in group 2 (40-50 Gy/5-FU/cisplatin) 90%, in group 3 (60-70 Gy) 84%. In contrast to groups 1 and 2, group 3 showed qualitatively reduced and more irregular capillary distribution with more marked pericapillary fibrosis in the irradiated tissue. Quantitatively, the ratio capillary area/total area, as a marker of improved capillarization, was significantly reduced in group 3 (median 0.01; IQR 0.02) compared with group 1 (median 0.53; IQR 0.32) and group 2 (median 0.44; IQR 1.40) (p.001).After preoperative RT, vascularization of the graft bed decreased continuously as a function of the total dose and time after RT. The results strongly advocate the use of a primary reconstruction after a time interval between 4 and 6 weeks following preoperative RT and suggest the use of a total radiation dose of 40 to 50 Gy.

Following preoperative radiotherapy prior to ablative surgery of squamous epithelial carcinomas of the head and neck region, inflammatory changes and the expression of cytokines involved in wound healing could be observed. These processes lead to a delayed healing of free flaps in the graft bed. The aim of the present experimental study was to analyze the expression profiles of transforming growth factor (activated TGFbeta(1), TGFbeta(2)) and latency-associated peptide (LAP) in the irradiated graft beds and the transition area between grafts and irradiated graft beds.In Wistar rats (male, weight 300-500 g) undergoing preoperative irradiation of the neck region with 30 Gy (30 animals) and non-irradiated rats (42 animals), a free myocutaneous gracilis flap taken from the groin was transplanted to the irradiated region of the neck. The interval between irradiation and transplantation was 4 weeks. In each group on postoperative days 3, 7, 14, and 28, cytoplasmatic expression of activated TGFbeta(1), LAP, and TGFbeta(2) was analyzed by immunohistochemistry to determine labeling indices (positive stained cells/total cells).The success rate in graft beds irradiated with 30 Gy was 76% and in non-irradiated graft beds was 86% (p =.02). In the graft beds irradiated with 30 Gy, there was an increased expression of activated TGFbeta(1) (range, 19.0-33.0), LAP (14.0-21.0), and TGFbeta(2) (3.0-19.5) together with obvious fibrosis. The expression was located in perivascular fibroblasts and endothelial cells. In contrast, a lower expression of activated TGFbeta(1) (11.0-21.0), LAP (1.0-8.0), and TGFbeta(2) (0.0-0.9) (p =.006) was observed in non-irradiated graft beds. In the transition area between graft and irradiated graft bed, high expression of activated TGFbeta(1) (37.0), LAP (19.0), and TGFbeta(2) (16.7-33.4) was observed on the 3rd postoperative day in contrast to the transition area in non-irradiated graft beds (activated TGFbeta(1) 26.0, LAP 7.0, and TGFbeta(2) 0.l).The radiation induced, increased de novo synthesis of LAP, activation of TGFbeta(1), and increased expression of TGFbeta(2) may represent at least one mechanism for the increased fibrosis and wound healing disorders seen in irradiated tissues and in the transition area to graft tissue. The expression of TGFbeta(1,) LAP, and TGFbeta(2) might possess prognostic value with regard to wound healing and fibrosis in previously irradiated graft beds.

Background: Fibular osteocutaneous free tissue transfer represents the work horse procedure in the reconstruction of large oromandibular defects. Before the fibula is harvested the blood supply of the lower leg and foot should be examined, as the perfusion may be based predominantly on the peroneal artery and venae comitantes. To avoid postoperative ischaemia of the lower leg, adequate perfusion must be guaranteed before sacrificing the peroneal vessels. Anatomical variations and peripheral arterial occlusive disease add to the risk of ischaemia. Various methods of evaluating the blood supply have been described. Material and methods: Fifty-two consecutive cases of fibular flaps were evaluated to study the arterial blood supply of the lower extremity. For angiography, the right femoral artery was punctured using the Seldinger technique and a total of 20–25 ml contrast medium (Imeron TM 300) was infused and images required at a rate of 0.5/sec. Results: A patent three-vessel supply to both feet could only be detected in 21 patients. Thirty-one angiograms revealed anatomic and/or arteriosclerotic alterations. Angiography provided accurate information in all patients and allowed successful fibular transfer in those patients who were found preoperatively to have regular conditions. Conclusion: Preoperative assessment of the blood supply of the lower extremity is important before fibular osteocutaneous free tissue transfer. We advocate angiography as interpretation is not examiner dependent.

It was the aim of the study to determine the accuracy of the assessment of volume changes of a non-contact, non-invasive, optical 3D-imaging method in vitro and in vivo for patients, who underwent mid-facial distraction.

Aim: To evaluate changes in volume and structure of bone after autogenous iliac crest bone grafting to the maxilla. To discover the predictive value of computed tomographic (CT) measurements of bone density and study their correlation with the results of his tomorphometric analyses of bone structure. Patients and methods: In 25 patients with atrophic maxillae (mean age 47 years, range 15–71), who had onlay bone grafting and sinus floor augmentation with autogenous iliac crest bone, a CT analysis was carried out immediately before and after grafting, and 5 months (range 4–6) later, at the time of endosseous implantation. On both occasions, bone biopsy specimens were taken. Histology of bone: After preparing and digitizing semithin sections, histomorphometry (NH-Image) was done to establish the ratio of trabeculae to medullary cavity. CT analysis: The available transverse and vertical bone and the bone density of natural and augmented bone were analyzed using the Simplant Program and the CT data. As reference, the bone density of the first cervical vertebra was used. By regression analysis, the correlation of CT bone density and histological bone structure was investigated. Results: After a median healing period of 4.5 months, no significant changes were found in bone volume compared with the measurements made immediately after grafting. The changes in density in the cancellous portion of the grafted bone showed no correlation (correlation coefficient: +0.16) with the results of histomorphometric analysis of bone structure. Conclusions: The predictive value of measurement of bone density to evaluate bone structure on the basis of the D1–D4 classification needs to be reconsidered. The most favourable time for secondary implantation is 4–6 months after iliac crest bone grafting.

Telomerase activity (TA) is associated with most malignant human tumors but is not detected in normal somatic cells with a few exceptions. Three major subunits (hTR, hTP1 and hTERT) of telomerase have been identified. To investigate the clinical implications of the mRNA detection of these components as useful diagnostic and prognostic markers in oral cancer, we examined TA, hTR, hTP1 and hTERT mRNA expressions in 46 oral squamous cell carcinomas (OSCC) and 15 normal oral mucosal tissues from healthy volunteers using a highly sensitive TRAP assay and RT PCR. In all specimens hTR and hTP1 mRNA were detected regardless whether TA was expressed or not. On the contrary, a significant correlation between hTERT expression and TA was shown indicating that the activity of telomerase could be regulated by the extent of hTERT transcription. In addition, hTERT expression showed close association to malignancies. None of the normal mucosal specimens expressed the hTERT subunit, but 76% (35/46) of the tumor specimens did. None of other clinico-pathological and prognostic parameters showed significant relationship with TA or hTERT expression. These results suggest that the detection of hTERT expression may be another useful diagnostic marker, especially for early detection of OSCC, and for distinguishing healthy tissues from neoplastically transformed ones.

Purpose To demonstrate the clinical, radiologic, and histopathologic features of a patient with orbital involvement in cherubism that prompted surgical treatment. Design Single interventional case report. Intervention Findings of the ophthalmic evaluation, computed tomography (CT) scans, intraoperative examination, and light microscopy of the specimens were analyzed. Main outcome measures Globe displacement, orbital bony lesions detected on CT scans, histopathology, and postoperative results were assessed. Results A 27-year-old female was seen with a slowly progressive superonasal globe displacement and a temporal orbital mass bilaterally of 6 years' duration. She had a history of cherubism, but her cheeks and jaws had a normal appearance instead of the bilateral fullness of the lower half of the face typical of the disease. CT scans demonstrated multicystic bony lesions arising from the orbital floors bilaterally. The masses were excised using an anterior transcutaneous transseptal orbitotomy. Histopathology demonstrated numerous giant cells in a fibrovascular stroma, confirming the clinical diagnosis of cherubism. Postoperative recovery was complete. Conclusions Orbital involvement in cherubism may develop beyond puberty, after stabilization or regression of the lesions in the jaws. Patients with cherubism should be routinely evaluated by an ophthalmologist.

In 102 Wistar rats (male, weight 300-500 g), a modified free myocutaneous gracilis flap was obtained from the groin and transplanted to the neck. To create a pre-irradiated transplant bed, a local area of the neck was irradiated preoperatively with 30 Gy (fractionation: 3 x 10 Gy) in 30 animals, and with 50 Gy (fractionation: 5 x 10 Gy) in a further 30 animals. The interval between preoperative irradiation and transplantation was 4 weeks. Forty-two animals received no such preoperative radiation. The evaluation of healing and the success of the transplanted flap was based on a clinical assessment, carried out on postoperative days 1 7. Testing for significant differences was done nonparametrically using the Kruskal-Wallis test. The survival rate in the nonirradiated animals was 86%. In contrast, the healing of the free flaps in the pre-irradiated transplant bed was significantly lower (P=0.003) 76%, after irradiation with 30 Gy and 50% after 50 Gy. The significant difference (P=0.020) in survival rates after irradiation with 30 and 50 Gy was evidence for the dependence of successful healing on the preoperative radiation dose. Transplantation of the free myocutaneous gracilis flap to a previously irradiated transplant bed in the region of the neck is a suitable model for investigating the healing of free transplants to irradiated tissue. The success rate observed in non-irradiated transplant beds is comparable to that seen with other flap models in rats.

Distraction osteogenesis of the mandible is an option in the treatment of mandibular hypoplasia. Today, only intermittent distraction devices are available for clinical application. The aim of this study in minipigs was to evaluate continuous bone distraction using a microhydraulic cylinder. After a seven-day interval, continuous or intermittent distraction of 1.5 mm/day was established for 10 days. Immediately after active distraction, two animals and 20 days later the other four animals were killed and radiographs taken. The mandible was then removed en bloc and the distracted bone examined histologically. Intermittent distraction forces of up to 2500 kPa were necessary to move the cylinders' piston. The pressure needed for continuous distraction was considerably lower (1200-1300 kPa). While the specific histological structure of the varying zones in the distraction gap was similar after continuous and intermittent distraction, bone healing was accelerated after continuous distraction as shown by ultrasonography and scanning electron microscopy.

Purpose: The aim of this study was to evaluate profile changes in the hard and soft tissues after onlay grafting in the extremely atrophic maxilla. Patients and Methods: Onlay grafting using autogenous iliac crest bone grafts was performed in 49 patients (42 females and 7 males) with extreme atrophy of the edentulous maxilla (vertical amount of bone

Callus-distraction has become an accepted procedure to lengthen hypoplastic mandibles in humans. Extra- and intraoral devices have been applied successfully. Systematic studies have proven the importance of direction, stability, rate and frequency in callus-distraction. In an experimental animal study a newly developed intraoral microhydraulic osteodistractor was tested. Initially the pressures necessary to distract the mandible in mini-pigs were recorded in discontinuous callus-distraction. These results were used to perform continuous bone distraction. Besides testing the new distractor and evaluating the distraction pressures, the aim of the study was to prove that direct bone growth occurred without preceding cartilage formation. Clinical and microscopic results are presented.

Objective. The purpose of this investigation was to investigate the osseointegration of zirconium oxide (ZrO 2 ) ceramic cones in comparison with that of titanium cones in apicectomy. Study Design. To evaluate the bone/implant interface, 20 ZrO 2 cones and 20 titanium cones were inserted into the mandibles of 4 Gottinger minipigs. During the 6-month healing period, intravital polychrome sequence marking was performed. Qualitative light microscopic, fluorescence microscopic, and quantitative histomorphometric assessment was carried out. Differences between continuous histomorphometric measures were tested through use of a 2-way analysis of variance. Results. Light microscopy revealed zones of direct bone contact with the ZrO 2 and titanium surfaces. Fluorescence microscopy revealed remodeling processes directly adjacent to both material surfaces. There was no significant difference in the distances of the fluorescence bands of each fluorescence marker for either the ZrO 2 surfaces or the titanium surfaces. Quantitatively and histomorphometrically, the mean ratio between the total cone/bone contact and the total cone/fibrous tissue contact was 0.95 (SD 1.10) on the titanium surface (n = 38) and 1.47 (SD 1.12) on the ZrO 2 surface (n = 78; P =.02). Conclusions. The qualitative results show that the biocompatibility of ZrO 2 was similar to that of titanium. The use of ZrO 2 cones for sealing purposes in resected teeth after apicectomy appears to be acceptable. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:91-98)

In a prospective study (January 1999 to December 1997), 34 patients with 26 mandibular and 20 midfacial fractures were investigated. All the fractures were managed by osteosynthesis. To evaluate the incidence and duration of recovery of post-traumatic and postoperative sensory disturbances, the following tests were carried out: sharp/blunt testing, and the two-point discrimination test as conventional clinical examination methods, and electromyographic recording of the masseter reflex to calibrate the clinical findings. To establish the sensory status of the inferior alveolar and the infraorbital nerves in the region of the fracture, and on the intact and control sides, the tests were performed pre-operatively and postoperatively on the seventh day, after 4 weeks and after 3, 6 and 12 months. The incidence of post-traumatic sensory disturbance was 46% for mandibular fractures and 65% for fractures to the midface (sharp/blunt test, two-point discrimination test). The rate of postoperative sensory disturbance in surgical treatment of mandibular fracture involving the region of the intra bony course of the inferior alveolar nerve, including the post-traumatic sensory disturbance, was 76.9%, and 55% following surgical treatment of midfacial fractures. The incidence of persistent sensory disturbances following surgical treatment was 7.7% in the case of mandibular fractures, and 15% in the case of midfacial fractures (sharp/blunt test, two-point discrimination test, masseter reflex). Recovery of neurological function is delayed in the presence of a displaced fracture (> 1 mm) as compared with non-displaced fractures. For the postoperative calibration of sensory disturbances, electromyographic recording of the masseter reflex from the fourth postoperative week onwards has proved useful.

Determination of marker for identification of oral squamous cell carcinoma (OSCC) is important for early diagnosis and individual therapy. Cytokeratins (CKs) like CK 19 and CK 20 are known to be useful diagnostic and prognostic markers for solid tumors. The aim of this study was to evaluate the relevance of further CKs for diagnosis of OSCC. In 10 OSCC and 5 normal mucosal samples, the expression patterns of 31 CK genes were examined by cDNA microarray in order to identify CKs with most pronounced over-expression. The results were verified for CK 17, CK 19, and CK 20 in addition to 46 OSCC samples by relative quantification (RQ) using SYBR green real-time reverse transcriptase polymerase chain reaction (RT qPCR). A correlation of the CK expressions with the tumor classification was carried out. cDNA microarray analyses showed that out of all CKs, CK 17 was up-regulated strongest in OSCC compared to normal samples, and over-expression was most significantly associated with diagnosis (P = 0.002). Expression rates of CK 19 and CK 20 were not significantly different between OSCC samples and normal samples. In 56 samples analyzed by real-time RT qPCR, CK 17 was over-expressed in 53 (94.6%), CK 19 in 18 (32.1%), and CK 20 in 7 (12.5%). The over-expression of CK 17 was significantly associated with metastases of neck lymph nodes (P

We know from experience that many authors with bright ideas and good scientific papers are often frustrated by the delays in the publishing process. This is often not the fault of any one person, as the complex process of checking manuscripts, identifying appropriate referees and awaiting their deliberations can delay acceptance by months. In addition, there may be a backlog of papers and delays at the publishers. These all can add up to long delays and frustrations for the authors. As you know, the Journal is currently going through a lot of changes and has developed as a platform for research and review articles from an international authorship. We have therefore decided to introduce the concept of “Fast Tracking” important review articles. Howwill the “Fast Track” process work? If you have a new and/or important review article, send it to us and indicate your request to “Fast Track” the paper. If the editors share your enthusiasm and desire to fast track the paper, it will be fast tracked to selected referees and published within 2 months. It will be subjected to the normal peer review, and of course, some papers will be rejected for publication by the referees. At this stage, we are going to restrict the fast track to review articles only. We hope you find this innovation helpful.

Summary The aim of the present study was to analyse the results of various reconstruction techniques of the facial skin with regard to general parameters such as the patients' age and health condition and to surgical parameters such as defect size, contamination of surgical fields and the type of reconstruction. 273 cases were evaluated, comprising local flaps (217), island flaps (21), free skin grafts (22) and cutaneous or myocutaneous distant flaps (13). The overall rate of major complications was 13.5%. No correlation was found with the age or impaired health of the patients nor did contamination by oral/nasal bacterial flora or the type of restoration show any significant correlation. The size of the defect turned out to be the only variable significantly related to the occurrence of complications (p = 0.0108). The complication rate observed following the repair of defects smaller than 30 mm in diameter was 7.5% while it rated 19.1% following the repair of defects larger than 30 mm. The overall rate of partial or total flap necrosis was low (2.9%). Secondary corrections and further surgical re-entry were required in 4.7% of all patients.

Zur Verankerung von Epithesen ergeben sich verschiedene Moglichkeiten. Die bisherigen Ergebnisse der Verankerung von Epithesen mit Hilfe osteointegrierter Implantate aus Titan last die Anwendung anderer Verankerungsmittel in den Hintergrund treten.

In light of recently found contribution of factors associated with thrombosis and inflammation to carcinogenesis, we investigated the possible association of coagulation factors XII and XIII with increased risk for oral cancer. In DNA samples of patients with oral squamous cell carcinoma and healthy controls of comparable ethnicity, age and sex, we studied the C46T polymorphism in FXII gene which affects gene transcription and the V34L polymorphism in FXIII gene which affects enzyme activity resulting in alteration of the fibrin network structure. No significant differences were observed in genotype and mutant allele frequencies of the FXII C46T polymorphism between patients and healthy controls. On the contrary, the obtained data for FXIII V34L polymorphism revealed a significant frequency increase of the L allele, which results in thinner fibrin network, in the whole group of patients compared to controls (33.1 versus 22.2% respectively, Fischer value P=0.006). In addition, LL homozygotes had a 3-fold greater risk for developing oral cancer (OR 2.893, 95% CI 1.056-7.890), while in VL heterozygotes a 2-fold greater risk was observed (OR 1.868, 95% CI 1.126-3.101). Significantly increased frequency of L allele was also observed in sub-groups of patients without family history of thrombophilia or cancer, with and without tobacco abuse and with alcohol abuse (P

The present study was performed in order to investigate the possible association of the -418 G/C polymorphism in the tissue inhibitor of metalloproteinase-2 (TIMP-2) gene, which affects its expression, with the risk of developing oral cancer. PCR-based restriction analysis was performed in DNA samples from 158 patients with oral squamous cell carcinoma (OSCC) and 168 healthy controls of equivalent sex, age and ethnicity (Greeks and Germans). Statistical analyses were performed with Fisher's exact test and the calculation of odds ratios with a 95% confidence interval (CI). The frequency of the low C allele expression was ten times greater in the patients than the controls (31% vs 2.7%, respectively; P

In view of the recently found contribution of factors associated with thrombosis and inflammation to carcinogenesis, we investigated the possible association of interleukin-6 (IL-6) with an increased risk of oral cancer. In DNA samples of 162 patients with oral squamous cell carcinoma and 156 healthy controls of comparable ethnicity, age and sex, we studied the -174 G>C polymorphism in the IL-6 gene, which affects its transcription. C allele frequencies were significantly increased in patients compared to controls, 42.6% versus 23.1% (pC polymorphism, by affecting IL-6 gene expression, is strongly associated with oral oncogenesis.

Ectodermal dysplasias are a heterogeneous group of inherited disorders characterized by defective formation of tissues derived from the embryonic ectoderm. Besides tissues of epidermal origin, other maxillofacial structures including hard and soft tissues can be affected. Disturbances in the early development of teeth frequently result in congenital absence or deformities of teeth. The lack of teeth leads to an impaired development of the alveolar crest, with decreased vertical and horizontal dimension. Osseointegrated dental implants in combination with hard and soft tissue augmentation techniques can be used successfully to restore the patients’ masticatory function, phonetics and aesthetics.