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Different studies suggest that inflammation as well as hypoxia leads to an increase of p53 protein levels. However, the implication of p53 during oral inflammatory processes is still unknown. The aim of this study was therefore to investigate the effect of hypoxia and inflammation on p53 regulation in human periodontium in vitro and in vivo. Under hypoxic and normoxic conditions, human primary periodontal ligament (PDL) fibroblasts (n = 9) were stimulated with lipopolysaccharides (LPS) from Porphyromonas gingivalis (P.g.), a periodontal pathogenic bacterium. After different time points, cell viability was tested; p53 gene expression, protein synthesis, and activation were measured using quantitative RT-PCR, immunoblotting, and immunofluorescence. Moreover, healthy and inflamed periodontal tissues were obtained from 12 donors to analyze p53 protein in oral inflammatory diseases by immunohistochemistry. LPS-P.g. and hypoxia initially induced a significant upregulation of p53 mRNA expression and p53 protein levels. Nuclear translocation of p53 after inflammatory stimulation supported these findings. Hypoxia first enhanced p53 levels, but after 24 h of incubation, protein levels decreased, which was accompanied by an improvement of PDL cell viability. Immunohistochemistry revealed an elevation of p53 immunoreactivity in accordance to the progression of periodontal inflammation. Our data indicate that p53 plays a pivotal role in PDL cell homeostasis and seems to be upregulated in oral inflammatory diseases. Upregulation of p53 may promote the destruction of periodontal integrity. A possible relationship with carcinogenesis may be discussed.

Summary Aims Stability of orthodontic miniscrew implants is prerequisite to their success and durability in orthodontic treatment. As investigations revealed a positive correlation of miniscrew stability to periimplant bone quality, it has been the aim of this study to analyze the bone structure of resection preparations of human mandibles histologically by investigating the samples according to age, gender and exposure to radiotherapy. Methods Inflammation- and tumor-free alveolar bone sections from human mandibles ( n = 31) with previously diagnosed carcinoma, chronic osteomyelitis or cysts were analyzed histomorphologically and histomorphometrically as to the dimension of trabeculae in cancellous areas. Group A investigated the impact of a history of radiation therapy, group B of gender and group C contrasted biopsies from individuals aging under 60 or over 60 years. Statistics were performed using the Kruskal–Wallis-test. Results Radiation, gender and age did not significantly influence bone density. The mean bone density averaged 40.7 ± 15.0% of spongiosa for the total collective with a median age of 58.4 years ± 14.7 years. Conclusions Our findings provide new information on bone quality, thus contributing to a more precise evaluation of the parameters affecting and those not affecting miniscrew implant stability. On the basis of these results, the formulation of clinical guidelines for risk assessment of therapeutic approaches in patients prior to insertion of orthodontic skeletal anchorage devices seems to be conceivable.

Periodontitis is characterized by deep periodontal pockets favoring the proliferation of anaerobic bacteria likePorphyromonas gingivalis(P. gingivalis), a periodontal pathogen frequently observed in patients suffering from periodontal inflammation. Therefore, the aim of the present study was to investigate the signaling pathways activated by lipopolysaccharide (LPS) ofP. gingivalis(LPS-PG) and hypoxia in periodontal ligament (PDL) cells. The relevant transcription factors nuclear factor-kappa B (NF-κB) and hypoxia inducible factor-1 (HIF-1) were determined. In addition, we analyzed the expression of interleukin- (IL-) 1β, matrix metalloproteinase-1 (MMP-1), and vascular endothelial growth factor (VEGF) in PDL cells on mRNA and protein level. This was accomplished by immunohistochemistry of healthy and inflamed periodontal tissues. We detected time-dependent additive effects of LPS-PG and hypoxia on NF-κB and HIF-1αactivation in PDL cells followed by an upregulation of IL-1β, MMP-1, and VEGF expression. Immunohistochemistry performed on tissue samples of gingivitis and periodontitis displayed an increase of NF-κB, HIF-1, and VEGF immunoreactivity in accordance with disease progression validating the importance of thein vitroresults. To conclude, the present study underlines the significance of NF-κB and HIF-1αand their target genes VEGF, IL-1β, and MMP-1 inP. gingivalisand hypoxia induced periodontal inflammatory processes.

Contains fulltext : 52572.pdf (Publisher’s version ) (Closed access) BACKGROUND: Particularly in clinical studies, it has been found that rapid swelling of tissue expanders leads to high-pressure peaks that can cause hypoxia in the tissue and thus also skin damage. For this reason, the present study in animals investigated whether an osmotic expander with silicone shell is capable of expanding in tissue and bringing about useful tissue expansion without complications. It was also examined whether and what quantitative and qualitative differences there are between conventional osmotic expanders and the new expanders with silicone shell. METHODS: The expansion of osmotic expanders with silicone shell was compared with that of osmotic expanders without silicone shell in four mini pigs. The expander type used was an M1 rectangle with an initial volume of 6 ml. Five expanders were implanted in each pig, meaning that 20 expanders were measured. The volume of the expanders was measured directly after explantation. Indirect volume determination was performed by producing plaster casts for subsequent laser optical measurement. RESULTS: Comparison of the two curve profiles showed a much flatter profile for the expanders with silicone shell. The absolute values for the volumes of the expanders with silicone shell were likewise substantially lower. CONCLUSIONS: Controlled skin expansion is a technique of providing localized donor tissue for reconstructive surgery. The new expanders could be in a position to lower the rate of complications in tissue expansion.

Purpose: Chronic hyperactivity of the masticatory muscles is a common functional disorder associated with chronic facial pain and headache. The positive therapeutic effect of botulinum toxin type A on functional disorders and pain symptoms has been known in connection with the treatment of cervical dystonia. The purpose of this report is to assess whether the targeted reduction of masticatory muscular hyperactivity by local injection treatment with botulinum toxin type A can improve facial pain headache symptoms in the event that other treatment methods prove ineffective. Materials and Methods: In an randomized blinded placebo-controlled study, 90 patients (60 verum and 30 placebo) with chronic facial pain were treated with botulinum toxin type A (Botox; Allergan, Ettlingen, Germany) injections into masticatory muscles. Results: Ninety-one percent of patients who received botulinum toxin improved by a significant mean reduction of approximately 3.2 on a visual analog pain scale. By comparison with t test and 2 test, there was a significant difference compared with the placebo group (P .01). Conclusions: The local injection of botulinum toxin type A constitutes an innovative and adequately efficient treatment method for chronic facial pain associated with hyperactivity of the masticatory muscles. An improvement in the painful symptoms can be expected in up to 90% of patients who do not respond to conservative treatment methods. © 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:774-778, 2003

The aim of the present study was to compare three different systems for preparing platelet concentrates: two commercially available bed-side techniques (Curasan system and PCCS) and a procedure used routinely in transfusion medicine. Platelet concentrates were prepared from venous blood of 12 healthy male volunteers using the three different systems. Platelet and leucocyte counts were performed and platelet derived growth factor and transforming growth factor beta were assayed by enzyme linked immunoassay. Handling was also considered. The three systems were able to collect 19.0 ± 16.6% (laboratory system), 41.9 ± 9.7% (Curasan system) and 49.6 ± 21.0% (PCCS) of the absolute number of platelets which were originally in the venous blood volume within the platelet concentrate. Due to the amount of plasma which is left in the platelet concentrate portion, the platelet concentration could be increased between 1.4 ± 1.3 times (laboratory system), 5.0 ± 2.3 times (PCCS) and 11.7 ± 2.4 times (Curasan system) compared to the venous blood. The amount of growth factors correlated with the number of platelets within the platelet concentrates. The two systems for intraoperative use are similar in their effects on the platelets. The absolute gain of platelets seems to be the highest with the PCCS; the highest concentration of platelets per µL is gained with the Curasan system. The laboratory system may offer an alternative if an intraoperative system is not available.

Purpose: In cases of soft tissue defects with exposed bone surfaces in the head and face region, there is the option of treating the defect with free split-thickness skin grafts following appropriate wound granulation. Secondary granulation on free bone surfaces is often a lengthy process, as granulation primarily occurs from the edges of the wound. Hydrocolloid dressings are gaining increasing attention in this context. The question arises as to whether the positive properties of hydrocolloid dressings can bring about rapid and positive conditioning of the base of the wound in soft tissue defects with exposed bone in the head and face region, with a view to subsequent split-thickness skin graft transplantation. Materials and Methods: In the period from 1997 to 2000, a total of 25 patients with soft tissue defects with exposed bone surfaces in the head and face region were treated with hydrocolloid dressings in the framework of a prospective clinical study. Results: The average time taken for complete granulation of the bone surface was 39.44 days (minimum, 10 days; maximum, 72 days). As a rule, this necessitated 12.8 changes of dressing (minimum, 3; maximum, 26). The granulation tissue was of good quality, generously vascularized, and occasionally exuberant at the edges of the wound Conclusion: On the whole, the combination of hydrocolloid dressing and alginate compress was found to have significant advantages as regards conditioning the exposed bone surface. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:1126-1130, 2002

Objective. Magnetic resonance imaging has become a common diagnostic tool in medical practice. It is a common view that solid-state material lacking a sufficient amount of unpaired nuclear spins, in particular proton spins, is impossible to depict with clinically used magnetic resonance devices. Characteristically rapid dephasing, caused by relatively short spin-spin relaxation (T2 time) also leads to broad resonance lines. A newly introduced technique, constant-time imaging, uses 3 phase-encoding gradients for the acquisition of only one complex data point per phase-encoding step, resulting in detection times of only a few microseconds and extremely sharp resonance lines. Study Design. Using a Bruker spectrometer AMX 300 WB (300 MHz, 7.1 T) with a microimaging attachment, we performed solid-state magnetic resonance imaging of whole teeth. Data processing was carried out by means of 3-dimensional Fourier analysis, and reconstructions were performed by the ParaVision (Bruker) software system. Results. Dental hard tissues (enamel, dentin, and root cementum) and pulpal soft tissue could be depicted in 2-dimensional and 3-dimensional images. The voxel resolution isotropically reached 195 μm. Conclusion. The constant-time imaging technique enabled a naturalistic and nondestructive visualization of the teeth without application of ionizing radiation. This technique bears the potential to help us overcome the limitations of clinically used standard magnetic resonance tomography devices and offers new perspectives for dental imaging. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:256-61)

Objective: This study is an analysis of neonatal outcome in 70 fetuses diagnosed over a 10-year period as having cleft lip with or without cleft palate (CL-P) by ultrasonographic examination. Methods: We describe the natural history of these 70 fetuses with orofacial clefts and select those who may be candidates for fetal surgery. The sonograms of 70 fetuses with orofacial clefts were evaluated for the nature of the CL-P and for the nature of the associated anomalies. Additionally, karyotyping was performed in 63 of 70 patients (90%). Results: The frequency of additional anomalies and the mortality rate varied with the type of cleft. Also, the frequency and type of chromosomal abnormalities varied with the type of cleft. The overall mortality rate was 63% (n = 44). 3 of the surviving 26 fetuses had severe associated anomalies. In 13 of the remaining 23 cases, the fetal age at diagnosis (≧22 weeks) excluded the fetuses from the potential benefits of fetal intervention. Conclusion: Of 70 fetuses with prenatally diagnosed orofacial clefts, only 10 (14%) were candidates for fetal CL-P surgery.

Oxidative stress is characterized by an accumulation of reactive oxygen species (ROS) and plays a key role in the progression of inflammatory diseases. We hypothesize that hypoxic and inflammatory events induce oxidative stress in the periodontal ligament (PDL) by activating NOX4. Human primary PDL fibroblasts were stimulated with lipopolysaccharide fromPorphyromonas gingivalis(LPS-PG), a periodontal pathogen bacterium under normoxic and hypoxic conditions. By quantitative PCR, immunoblot, immunostaining, and a specific ROS assay we determined the amount of NOX4, ROS, and several redox systems. Healthy and inflamed periodontal tissues were collected to evaluate NOX4 and redox systems by immunohistochemistry. We found significantly increased NOX4 levels after hypoxic or inflammatory stimulation in PDL cells (P<0.001) which was even more pronounced after combination of the stimuli. This was accompanied by a significant upregulation of ROS and catalase (P<0.001). However, prolonged incubation with both stimuli induced a reduction of catalase indicating a collapse of the protective machinery favoring ROS increase and the progression of inflammatory oral diseases. Analysis of inflamed tissues confirmed our hypothesis. In conclusion, we demonstrated that the interplay of NOX4 and redox systems is crucial for ROS formation which plays a pivotal role during oral diseases.

The treatment of hypertrophy of the masseter and temporal muscles has to date been dominated by conservative and surgical measures. Local therapy with type A botulinum toxin permits an alternative method of treatment. After targeted, sometimes electromyographically controlled, intramuscular injection of the affected muscles, marked inactivity atrophy occurred in the muscles of seven patients over the course of 3 to 8 weeks. This atrophy remained constant over a follow-up period of up to 25 months, and no side effects were observed. Because of its minimal invasiveness, this technique seems to have an advantage over conventional surgical therapy. Consequently, treatment with type A botulinum toxin can be regarded as a sensible alternative to surgery in cases of hypertrophy of the masseter and/or temporal muscles.

Condylar hyperplasia (CH) is a local overgrowth of the condylar process of the temporomandibular joint (TMJ) of unknown etiology. Probably, growth factors like the insulin-like growth factors (IGFs) are involved in its pathogenesis. Specimens from 12 patients were investigated histologically and immunohistochemically to obtain the distribution of the IGFs-I and -II and the IGF1 receptor. The results revealed juvenile and adult subtypes. While generally IGF-II could only be detected weakly, in the juvenile cases strong immunostaining for IGF-I in cartilage and bone supposes an influence on pathological growth processes.

Background Sublingual immunotherapy (SLIT) is safe and effective as treatment of allergic rhinitis and mild asthma. Oral mucosal Langerhans cells (oLCs) play a central role. However, little is known about allergen binding by oLCs during mucosal allergen resorption and its impact on oLC functions. Objective Binding of Phl p 5 to oLCs was studied in a standardized ex vivo model to investigate mechanisms important for SLIT. Methods Human oral mucosal biopsies were incubated with the grass pollen allergen Phl p 5. Migration, binding of Phl p 5, phenotype and cytokine production, and T-cell priming of Phl p 5–binding oLCs were analyzed. Results Significant uptake required more than 5 minutes, and dose-dependent binding of Phl p 5 to oLCs was saturated at 100 μg/mL Phl p 5. Furthermore, Phl p 5 significantly increased the migratory capacity of oLCs but attenuated their maturation and strongly promoted the release of TGF-β1 and IL-10 by oLCs themselves as well as by cocultured T cells. Conclusion Oral mucosal Langerhans cells bind Phlp5 in a dose-dependent and time-dependent manner, leading to an increased production of tolerogenic cytokines and an enhanced migratory capacity but decelerated maturation of oLCs.

Secondary malnutrition in patients with oropharyngeal tumors can be the cause of substantial morbidity. The present, prospective study examined 30 patients receiving treatment for an oropharyngeal tumor. Percutaneous endoscopic gastrostomy (PEG) was performed 1 wk prior to the start of therapy in 15 patients, and 15 patients were temporarily fed by nasogastric tube after surgery. Anthropometric and laboratory parameters were measured in both patient groups at five defined times. Based on these parameters, the nutritional status of the PEG patients was found to be substantially better. The present study was able to show that the prophylactic placement of a PEG tube greatly improves the nutritional status of the patients before and after surgery and minimizes the catabolism of the body's fat depots.

Basal cell carcinomas (BCCs) are the most common cutaneous tumors, accounting for approximately 70% of all malignant skin tumors. A morphometric analysis was performed to evaluate whether morphometric parameters of the nuclei of BCC tumor cells may serve as predictors for biological behavior like recurrence rate or are able to differentiate morphological subtypes (multifocal superficial, nodular, sclerosing and miscellaneous forms of BCC).N = 130 histological sections from n = 126 patients with BCC of the head and neck were analyzed. Morphometry included: maximum and minimum diameter, perimeter, nuclear area (direct parameters). According to the direct parameters, so called form factors were evaluated: axis ratio, shape factor, nuclear contour index, nuclear roundness and circumference/contour ratio.Morphometric parameters were not able to differentiate significantly between primary and recurrent BCC. Concerning the histological subtypes, multifocal superficial BCC differed significantly (0.05) from all other subtypes by direct parameters.Morphometry can help to distinguish between histological subtypes of BCC. Morphometry alone is not able to predict recurrence rate.

Background: The oral mucosa represents a unique immunologic unit with a high frequency of native allergen contact within the gastrointestinal tract in which immune tolerance is the natural outcome of allergen contact. Although Langerhans' cells (LC), known to play a crucial role in initiating allergen-dependent immune responses in the skin, have also been detected in the oral mucosa, little is known about their phenotype and exact physiologic role. Objective: To elucidate whether LC from oral mucosa (oLC) differ from skin LC (sLC), these cells were subjected to detailed comparative analysis. Methods: Crude epidermal and oral mucosa cell suspensions were prepared by trypsinization. oLC and sLC were compared phenotypically by flow cytometry techniques and functionally in T-cell proliferation assays. Results: In contrast to sLC, freshly isolated oLC expressed significantly higher amounts of MHC class I and II, as well as costimulatory molecules CD40, CD80/B7.1, and CD86/B7.2. oLC displayed FcγRIII/CD16 and FcγRI/CD64. Most surprisingly, oLC constitutively expressed the high affinity receptor for IgE (FcϵRI) even in nonatopic donors. FcϵRI expression on oLC was further increased and correlated with the serum IgE levels in atopic individuals. oLC showed a higher allogeneic stimulatory activity than sLC, whereas the activation of autologous T cells correlated to the FcϵRI expression. Conclusion: Taken together, our results strongly indicate that oLC profoundly differ from their skin counterparts. The constitutive high expression of FcϵRI on oLC could point to particular skills of these cells within the regional immune system of the oral mucosa. (J Allergy Clin Immunol 2003;112:141-8.)

The literature describes various treatment concepts for the pre-operative sanitation of septic foci in the oromaxillofacial area prior to liver transplantation. There are no uniform guidelines, and so far, a connection between dental foci and postoperative infection after transplantation has not yet been proven. Taking into account the complications occurring during focus sanitation, the appropriate extent of, and the most suitable point of time for, focus sanitation have to be ascertained. The clinical and radiological findings from 80 patients were analyzed, with particular attention being paid to dental foci prior to liver transplantation. The complications performed in 39 sanitations and the oral hygiene status of 37 patients were included in the analysis. All the obtained findings were correlated to the etiology of the liver disease and the Child-Pugh stage. Former alcoholics had significantly poorer oral hygiene and more foci than non-alcoholics. After sanitation, complications occurred more frequently in alcoholics (43.8%) and patients in Child-Pugh stage C (41.2%) than in the other groups. Secondary bleeding, severe in some cases, occurred in a total of 15.4% of all patients, despite coagulatory preparations. We can conclude that, given the high rate of complications found in this study after sanitation prior to transplantation, the demand for radical prophylactic dental sanitation should be reconsidered. Rather, it would appear more appropriate for only absolutely necessary sanitation to be carried out prior to transplantation and for the definitive measures to be postponed until after transplantation when liver function has stabilized.

Submandibular swellings occur relatively commonlyin infants and children. Such swellings may be con-genital or acquired. The differential diagnoses gener-ally include common conditions, such as cervicallymphadenopathy, branchial arch anomalies, vascularmalformations, inflammatory lesions and, less com-monly, neoplasm.