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Objective To assess the influence of biphasic calcium phosphate materials with different surface topographies on bone formation and osseointegration of titanium implants in standardized alveolar ridge defects. Materials and methods Standardized alveolar ridge defects (6 × 6 mm) were created in the mandible of 8 minipigs and filled with three biphasic calcium phosphate materials (BCP1–3, 90% tricalcium phosphate/10% hydroxyapatite) with different surface properties (micro- and macroporosities) as well as a bovine-derived natural bone mineral (NBM) as a control. At 12 weeks, implants were placed into the augmented defects. After further 8 weeks of healing, dissected blocks were processed for histological analysis (e.g., mineralized (MT), residual bone graft material (BS), bone-to-implant contact (BIC)). Results All four biomaterials showed well-integrated graft particles and new bone formation within the defect area. MT values were comparable in all groups. BS values were highest in the NBM group (21.25 ± 13.52%) and markedly reduced in the different BCP groups, reaching statistical significance at BCP1-treated sites (9.2 ± 3.28%). All test and control groups investigated revealed comparable and statistically not significant different BIC values, ranging from 73.38 ± 20.5% (BCP2) to 84.11 ± 7.84% (BCP1), respectively. Conclusion All bone graft materials facilitated new bone formation and osseointegration after 12 + 8 weeks of healing.

To assess the impact of various local pathologies on facial alveolar bone dimensions at tooth sites. Cone-beam computed tomography images of 60 patients were analyzed. Healthy teeth and teeth with local pathologies (i.e., endodontically treated, periodontally diseased teeth, and teeth with periapical lesions) were included. The thickness of the facial alveolar bone was measured at five locations: (1) the bone crest (W0), (2) 25% (W25), (3) 50% (W50), (4) 75% (W75) of the distance from the bone crest to the root apex (A), and (5) in the A region (W100). The results were considered statistically significant at p

The aim of this systematic review was to critically evaluate the currently existing clinical evidence on the efficacy of autogenous teeth (AT) for the reconstruction of alveolar ridge deficiencies. A search protocol was developed to answer the focused question: “In patients exhibiting alveolar ridge deficiencies and being in need of an implant retained restoration, what is the efficacy of reconstructive procedures employing AT on changes in ridge dimensions compared with control measures?” Uncontrolled studies were also included to assess the overall efficacy of AT for specific procedures. A total of six studies (one randomized, one non-randomized controlled, two observational, one controlled case series, one retrospective) were identified. Two studies used AT for staged lateral augmentation, whereas four studies used AT as a demineralized dentin matrix (AutoBT) for the simultaneous grafting of dehiscence-type defects, vertical augmentation of post-extraction sockets, and lateral/transcrestal sinus floor elevation. The reported clinical outcomes following the application of either AT or AutoBT were within the range of those data noted in the respective control groups. Adverse events were commonly not observed. The available limited studies involved relatively small patient samples and short follow-up periods but pointed to the potential of AT to serve as an alternative material for the reconstruction of alveolar ridge deficiencies. AT appear to be effective in reconstructing alveolar ridge deficiencies.

Purpose The present study evaluated the platelet distribution pattern and growth factor release (VEGF, TGF-β1 and EGF) within three PRF (platelet-rich-fibrin) matrices (PRF, A-PRF and A-PRF+) that were prepared using different relative centrifugation forces (RCF) and centrifugation times. Materials and methods immunohistochemistry was conducted to assess the platelet distribution pattern within three PRF matrices. The growth factor release was measured over 10 days using ELISA. Results The VEGF protein content showed the highest release on day 7; A-PRF+ showed a significantly higher rate than A-PRF and PRF. The accumulated release on day 10 was significantly higher in A-PRF+ compared with A-PRF and PRF. TGF-β1 release in A-PRF and A-PRF+ showed significantly higher values on days 7 and 10 compared with PRF. EGF release revealed a maximum at 24 h in all groups. Toward the end of the study, A-PRF+ demonstrated significantly higher EGF release than PRF. The accumulated growth factor releases of TGF-β1 and EGF on day 10 were significantly higher in A-PRF+ and A-PRF than in PRF. Moreover, platelets were located homogenously throughout the matrix in the A-PRF and A-PRF+ groups, whereas platelets in PRF were primarily observed within the lower portion. ​Discussion the present results show an increase growthfactor release by decreased RCF. However, further studies must be conducted to examine the extent to which enhancing the amount and the rate of released growth factors influence wound healing and biomaterial-based tissue regeneration. ​Conclusion These outcomes accentuate the fact that with a reduction of RCF according to the previously LSCC (described low speed centrifugation concept), growth factor release can be increased in leukocytes and platelets within the solid PRF matrices. Electronic supplementary material The online version of this article (doi:10.1007/s00068-017-0785-7) contains supplementary material, which is available to authorized users.

Hintergrund Kraniomandibulare Dysfunktionen (CMD) betreffen einen erheblichen Teil der Bevolkerung. In den letzten Jahrzehnten haben computerassistierte Methoden fur die Diagnostik und Therapieplanung zunehmend Eingang in die klinische Praxis gefunden.

The present study analyzes the influence of the addition of monocytes to a biphasic bone substitute with two granule sizes (400-700 μm and 500-1000 μm). The majority of the added monocytes was detectable as mononuclear cells, while also low amounts of (chimeric) multinucleated giant cells (MNGCs) were found. No increase in the total number of MNGCs was established, but a significantly increased percent vascularization. Altogether, the results show that the added monocytes become involved in the tissue response to a biomaterial without marked changes in the overall reaction. Monocyte addition enables an increased implant bed vascularization especially via induction of vessel maturation and, thus intervenes positively in the healing reaction to a biomaterial. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2928-2935, 2016.

Sekretansammlungen im Hypopharynx, Aditus laryngis und Trachea bilden eines der Kardinalmerkmale einer oropharyngealen Schluckstorung. Zur Einschatzung des Schweregrades wird international die 4-Punkte-Sekretbeurteilungsskala nach Murray et al. eingesetzt, existierend in einer Lang- und einer Kurzversion. Eine validierte deutsche Ubersetzung der Langversion der sog. Murray-Skala liegt noch nicht vor. Zudem fehlt der wissenschaftliche Nachweis, dass beide Versionen uber eine vergleichbare Aussagekraft verfugen. Ziel der Studie ist sowohl die Validierung der deutschen Ubersetzung der Langversion der Murray-Skala als auch der Vergleich der Reliabilitats- und Validitatswerte der beiden Versionen. Zur Reliabilitats- und Validitatsuberprufung wurden 40 Videosequenzen fiberoptisch endoskopischer Evaluationen des Schluckvorganges (FEES®), 10 pro Schweregrad, jeweils neu randomisiert, von 4 HNO-Arzten unabhangig voneinander beurteilt. Die Beurteilung erfolgte je 2-mal fur die Lang- bzw. Kurzversion. Analysiert wurden Intra- und Interraterreliabilitat sowie die Ubereinstimmungsvaliditat der Ratings anhand eines Referenzstandards. Sowohl die Intrarater- (Spearman-Korrelationen: ρs > 0,840***) als auch die Interraterreliabilitat (Krippendorffs alpha: α > 0,850) zeigten sich als sehr gut, die Ubereinstimmungsvaliditat als hoch signifikant (ρs > 0,981***). Die deutsche Ubersetzung der Murray-Skala in der Lang- wie Kurzversion erwies sich als reliabel und valide, fur beide Versionen mit gleichwertigen Testgutewerten. Damit ist ihre Implementierung fur die Graduierung pharyngolaryngotrachealer Sekrete in die Beurteilung einer FEES®-Diagnostik fur den klinischen und wissenschaftlichen Gebrauch empfehlenswert.

Ameloblastoma is a locally invasive odontogenic tumor with a high recurrence rate. Its local invasiveness is aided by angiogenesis, which can be correctly estimated by CD34. On the other hand, maspin decreases the local invasive and metastatic capability of cancer cells and functions as an angiogenesis inhibitor. We aim to assess the association between maspin expression and microvessel density in ameloblastoma. Twenty-five formalin-fixed paraffin-embedded (FFPE) blocks of ameloblastoma cases were prepared for antibody processing to CD34 and maspin. Positive immunohistochemical staining was marked by brown cytoplasmic/membrane coloration for CD34 and by nuclear/cytoplasmic coloration for maspin. At the ×40 magnification, we counted blood vessels in two areas of dimension; 300 × 400 μm (area A) and 150 × 200 μm (area B) adjacent to the tumor region to assess relative dispersion of the vessels bordering the tumor. The overall approximate microvessel density (MVD) for area A = 11 (minimum 2, maximum 21) and that for area B = 5 (minimum 1, maximum 10). The MVD in the area A of plexiform ameloblastoma was similar to that of the unicystic, while the hemangiomatous variant had the highest MVD for area A. Maspin positivity was present only in the cytoplasm of ameloblast, stellate reticulum, and the fibrous connective tissue in varying proportions. There was no evidence of the anti-angiogenesis effect of maspin in ameloblastoma from this study. The significance of cytoplasmic localization of maspin in the ameloblasts and stellate reticulum cells needs further investigation.

Surface electromyography (sEMG) is a well-established procedure for recording swallowing-related muscle activities. Because the use of a large number of sEMG channels is time consuming and technically sophisticated, the aim of this study was to identify the most significant electrode positions associated with oropharyngeal swallowing activities. Healthy subjects (N = 16) were tested with a total of 42 channels placed in M. masseter, M. orbicularis oris, submental and paralaryngeal regions. Each test subject swallowed 10 ml of water five times. After having identified 16 optimal electrode positions, that is, positions with the strongest signals quantified by the highest integral values, differences to 26 other ones were determined by a Mann-Whitney U test. Kruskal-Wallis H test was utilized for the analysis of differences between single subjects, subject subgroups, and single electrode positions. Factors associated with sEMG signals were examined in a linear regression. Sixteen electrode positions were chosen by a simple ranking of integral values. These positions delivered significantly higher signals than the other 26 positions. Differences between single electrode positions and between test subjects were also significant. Sixteen most significant positions were identified which represent swallowing-related muscle potentials in healthy subjects.

In this study, the in vivo tissue reaction to a new triphasic and injectable paste-like bone-substitute material composed of beta-tricalcium phosphate (β-TCP), methylcellulose and hyaluronic acid was analyzed. Using a subcutaneous implantation model, the interaction of these materials and the peri-implant tissue reaction were tested in Wistar rats for up to 60 days by means of established histological methods, including histomorphometrical analysis. The study focused on tissue integration, classification of the cellular inflammatory response and the degradation of the material. Groups composed of animals injected only with β-TCP granules, sham-operated animals and animals injected with saline were used as controls. After implantation, the triphasic bone-substitute material was present as a bulk-like structure with an inner and outer core. Over a period of 60 days, the material underwent continuous degradation from the periphery towards the core. The implantation bed of the β-TCP granule control group was invaded by phagocytes and formed a poorly vascularized connective tissue soon after implantation. This inflammatory response continued throughout the study period and filled the implantation bed. Significantly, the combination of the three biocompatible materials into one injectable paste-like bone-substitute material enabled modification of the tissue reaction to the implant and resulted in a longer in vivo lifetime than that of β-TCP granules alone. In addition, this combination increased the vascularization of the implantation bed, which is essential for successful tissue regeneration.

Treatment of palato-nasal fistula following primary palatoplasty in patients with nonsyndromic cleft palate is often complicated by recurrence. The authors have tested the feasibility of a surgical technique adding a resorbable collagen membrane at the bony edge of the fistula and report the outcome in the first 14 patients in an open, non-comparative, preliminary investigation. The procedure was well tolerated by all patients, with no relapses during follow up ranging from 4 to 12 months.

In the present study, the structure of two allogeneic and three xenogeneic bone blocks, which are used in dental and orthopedic surgery, were histologically analyzed. The ultimate goal was to assess whether the components postulated by the manufacturer can be identified after applying conventional histological and histochemical staining techniques. Three samples of each material, i.e. allogeneic material-1 and -2 as well as xenogeneic material-1, -2 and -3, were obtained commercially. After decalcification and standardized embedding processes, conventional histological staining was performed in order to detect inorganic matrix, cellular or organic matrix components. Allogeneic material-1 showed trabecular bone-like structures, which were free of cellular components as well as of organic matrix. The allogeneic material-2 showed trabecular bone structures, in which connective tissue and cellular remnants were embedded. Additionally, some connective tissue, which resembled fat-like tissue, was found within this material. The xenogeneic material-1 showed trabecular bone-like structures and contained organic components comparable to that demonstrated for the allogeneic material-2. The xenogeneic material-2 showed trabecular bone structures with single cells located in lacunae. The xenogeneic material-3 also showed trabecular structures. Neither cellular nor organic matrix components were found within this material. According to the data of the present study, the allogeneic material-1 and the xenogeneic material-3 were the only investigated materials for which the obtained histological data were in accordance with the manufactureŕs advertised information. The remaining three materials showed discrepancies-although the manufacturers of all five bone substitute materials stated that their blocks were free of organic/cellular remnants. These data are of great clinical and material science interest. It seems that even patented processing techniques are not always able to deliver reproducible materials. Although the manufacturers of all five bone blocks stated that their blocks were free of organic/cellular remnants, our histological analysis revealed that three out of five bone blocks did contain such remnants. Such specimens might be able to induce an immune response within the recipient.

A new modular software concept for individual numerical simulation of the human mandible using the finite element method (FEM) is presented. The main task is an individual analysis of regional stress and stress-compatibility on the basis of computed tomographic data in individual patients. Simulation should, however, also be possible in parallel with biomechanical experiments, or for further research projects. For this purpose, rapid and uncomplicated generation of the FEM model, easy modification of input data, and short computation times are required. Practical use in the clinical setting makes appreciable additional demands on the individual software components.

Anthropometric standard callipers are used in craniofacial conformation assessment of patients with malformations, such as cleft lip and palate, hypoplastic or excessive jaw development, or for aesthetic reasons. Roentgenocephalogram analysis is the mainstay in diagnosing craniofacial osseous and soft-tissue conformation and development. Also called cephalometry, it is based on lateral and posterior–anterior standardized roentgenographs and several insecure landmarks that show considerable intrarater and interrater variation. Moreover, radiation exposure, constant object positioning and the use of costly roentgen equipment is inevitable. Anthropometry, as mostly presented in the literature, is time consuming and cannot reproduce 3D craniofacial conformation. Insecure landmark definitions and soft tissue resilience foster systemic measurement errors. Therefore, a few, easily accessible landmarks, closely related to the underlying bone were selected, measured and reconstructed in their 3D conformation as a wire frame. A soft tissue mask, concentrating on the mid-sagittal profile was added. Facial growth was monitored, growth functions generated and postoperative outcomes evaluated against the preoperative situation. To simplify general anthropometric data acquisition by calliper, a semiautomatic calliper was developed. With its data-input switch connected by optical data cable to a standard personal computer (PC), this calliper permitted completion of standard data sheets, interrater and intrarater validated in test collectives and patients. A major volunteer collective with repeat measurements served for standards and for reliability assessment. Normal growth functions, differentiated by sex, were assessed with 95-percentiles and 5% relative error. Full manual viscerocranial Am was thrice as time-consuming as the semi-automatic calliper-mediated direct data input to the computer. Gauging of the distance of the calliper ends by ruler, taking down the numbers manually, and lastly computer data input were rendered superfluous, and standard relative error decreased. The developed craniofacial Am proved reliable and valid for measurement of craniofacial growth, diagnosis and treatment control. Relative measurement errors are smaller than the ­systematic magnification and distortion in lateral cephalograms. The Am allowed reliable, objective, independent calculation of cranial bone relations and soft tissue projection, sensitive to facial asymmetry. Easy application, versatility and economy were obvious in the assessment of facial proportions, soft tissue ratios, operation planning and follow-up. Semiautomatic anthropometric callipered data acquisition was shown to be faster than the manual technique and equally reliable: measurement errors were effectively diminished and oversight errors avoided. The craniofacial anthropometric routine has been in use over 10 years and proven valuable in growth comparison of different regimens of cleft lip and palate treatment as well as with jaw development in microsomia and jaw deformity treatment, such as dysgnathia. While treating specific craniofacial syndromes, many specialists have needed to assess postnatal growth patterns as a background consideration. Normal development and knowledge of soft-tissues-to-bone relationships and their interaction and the interaction between functional–aesthetic regions have been given high importance in prospective treatment rationales and outcome assessments. Using anthropometric standard callipers, craniofacial features, e.g. of patients with malformations such as cleft lip and palate, dysgnathia (hypoplastic or excessive jaw formation), craniosynostosis are assessed today, as are proportions in the trunk and extremities, with dedicated measurement routines.

The clinical suitability of a bone substitute material is determined by the ability to induce a tissue reaction specific to its composition. The aim of this in vivo study was to analyze the tissue reaction to a silica matrix-embedded, nanocrystalline hydroxyapatite bone substitute. The subcutaneous implantation model in Wistar rats was chosen to assess the effect of silica degradation on the vascularization of the biomaterial and its biodegradation within a time period of 6 months. Already at day 10 after implantation, histomorphometrical analysis showed that the vascularization of the implantation bed reached its peak value compared to all other time points. Both vessel density and vascularization significantly decreased until day 90 after implantation. In this time period, the bone substitute underwent a significant degradation initiated by TRAP-positive and TRAP-negative multinucleated giant cells together with macrophages and lymphocytes. Although no specific tissue reaction could be related to the described silica degradation, the biomaterial was close to being fully degraded without a severe inflammatory response. These characteristics are advantageous for bone regeneration and remodeling processes.

This technical note describes a new surgical technique for a palatal approach to the maxillary sinus for a vertical augmentation prior to dental implant placement. In 12 fully or partially edentulous patients (seven women, five men), 16 palatal sinus elevations were performed. After elevation of palatal full-thickness flap a rectangular access window was cut with a piezosurgical device. The raised sinus cavity was augmented with a synthetic nano-structured hydroxyapatite-based graft material. No harm occurred to the greater palatine artery or the sinus membrane. The vestibular and periimplant gingiva were preserved and there was no disharmonious soft tissue distortion or massive scar formation. Swelling and bleeding were minimal. Primary stability was achieved for all but one implant. This technique may be an alternative to other sinus augmentation approaches in cases where enough transversal width of the posterior alveolar crest is available.

International audience; This retrospective, observational study investigated whether published studies on the use of piezoelectric surgery (PS) in the oral and craniomaxillofacial region fulfilled the requirements of the International Committee of Medical Journal Editors (ICMJE) and the Declaration of Helsinki (DoH) with respect to human subject protections (HSP) and disclosure of financial conflicts (FC). A Medline/PUBMED search was performed in April 2008 to identify all clinical studies on PS, published in English, French and German. Disclosure of HSP (obtaining ethical approval and subjects' informed consent) and FC mentioned in the retrieved articles were analysed. 29 clinical articles were identified in 18 journals, of which 14 journals (78%) required the disclosure of both HSP and FC. Ethical approval was documented in two studies (7%); patient consent was reported in four publications (14%). Four articles disclosed no FC. 21 reports (72%) mentioned neither HSP nor FC. The relationships between funding source and study outcomes could not be identified. Most studies on the use of PS hardly adhered to the regulations recommended by the ICMJE and DoH, and do not mention HSP and FC, indicating the study results with a high degree of suspicion. It is recommended that oral and craniomaxillofacial surgery journals adhere strictly to these regulations because they carry a heavy responsibility regarding the scientific integrity of publications in this specialty.

Severe panfacial trauma require broad reconstructive procedures. As in the case presented, a primary reconstruction with ideal aesthetic outcome cannot be reached in every case. If not, these cases often require further reconstructive procedures. What this can be and how long this could take, this article intends to show. This case report presents the history of a today 30 year old male patient with a severe central midfacial comminuted fracture with preexisting Angle class II and comprehensive reconstruction.

Within a clinical study, 30 pre- and post-operative CT-data sets were acquired directly before and 6 – 11 weeks after surgical maxillary expansion. The pre- operative data were rigidly registered on the post-operative ones. Subsequent 3D-reconstruction showed the skeletal changes due to the surgery. By an approach developed in the group, new bone formation in the osteotomy gap could be visualized. New bone could be clearly differentiated from preexistent bone. New bone formation was non-uniform along the osteotomy lines, but approximately symmetric. The more symmetrical the osteotomy was performed, the more symmetrical bone formation was observed. Actual research is dedicated to the patterns of new bone formation with regard to the applied surgical device and technique.

The biodegradability of root canal sealers in areas other than the root canal system is crucial to the overall success rate of endodontic treatment. The aim of the present study was to investigate, the cell and tissue reaction to GuttaFlow and AHPlus, both in vitro and in vivo. For the in vitro experiments the materials were incubated with Human Periodontal Ligament Fibroblasts and cell proliferation and cytotoxicity analyses were performed. Additional fluorescence-microscope stainings were carried out in order to visualize cell growth and morphology. For assessment of the tissue reaction to the materials a subcutaneous implantation model in Wistar rats was employed and the inflammatory response to the materials was visualized by means of general and specific histology after 6 weeks. Human gingival fibroblasts proliferation seemed to be dependent upon dental material and cultivation time. After an incubation period of 96 hrs AHPlus proved to be significantly (p < 0.002) more cytotoxic than GuttaFlow, as only a small number of fibroblasts survived on AHPlus. In vivo, GuttaFlow was surrounded by a fibrous capsule and no degradation took place, while AHPlus induced a well-vascularized granulation tissue in which the material was phagocyted by macrophages. The results of this study demonstrate that a potential cytotoxic effect of a sealing material may beneficial in order to have antibacterial properties and induce self degradation when accidentally extruded over the apical foramen.