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Tranexamic acid (TXA) is widely used in the prevention of postsurgical oral bleeding. Tranexamic acid in addition to further surgical measures is widely utilized in prevention of post-surgical oral bleeding. The aim of the present study was to investigate: Can oral hemostasis be achieved by merely compression and topical application of tranexamic acid in different anticoagulant regimes among patients attending a general emergency department? Where are the limits to this procedure? Which has the greater impact on surgeons' choice for an invasive hemostatic approach-bleeding quality or oral anticoagulant therapy?A retrospective cohort study of 542 patients who consecutively received treatment for oral bleeding was performed. We surveyed the values of the diverse hemostatic approaches. Special attention was granted to patient anticoagulant regimen and quality of the oral bleeding event.A total of 199 of 542 (36.7%) oral bleeding events were stopped by compression with a gauze or gauze soaked with TXA (4.8%). Stopping an oral bleeding event with wound compression can be improved by factor 1.6 if the gauze is soaked with tranexamic acid (4.8%), p ≤ 0.05. LMWH presented significantly more moderate bleeding than bloody oozing of the wound, p 0.05. The quality of bleeding had a strong influence on oral surgeons' decisions to apply further surgical means. Sutures and native collagen fleeces were the favored methods to stop moderate and severe bleeding (p 0.05).Topical application of TXA aids as a useful supportive tool to stop mild bleeding events such as the bloody oozing of an oral wound. The quality of an oral bleeding episode should be considered in the choice of hemostatic measure. Hemostatic approaches should begin with the least invasive procedure. TXA is a helpful tool.

Introduction The role of the volume of radicular and dentigerous cysts on clinical symptoms is unclear and potentially may predict development of pre- and postoperative complications, especially after cystectomies with large bony defects. Therefore the aim of this study was to assess pre- and postoperative symptoms associated to the volume of jaw cysts. Material and methods Retrospective chart review of 111 patients with follicular or dentigerous cysts from 2008–2012. Anterior iliac crest grafts were used to fill defects after cystectomy. χ2-test was performed to analyze associations between two qualitative variables. Binary logistic regression analysis was used as multivariate analysis. P-values p Results Postoperative hypaesthesia correlated significantly with histology (p = 0.025) and localization (p = 0.006). Volume was associated significantly with preoperative hypaesthesia (p = 0.052), postoperative hypaesthesia (p Conclusions Volume analysis appears to be a method that allows risk stratification after surgery of jaw cysts. Therefore we recommend a precise treatment planning with the means of volume analysis to improve therapy outcome of patients with jaw cysts.

Metastatic bone disease and osteoporosis are the main indications for bisphosphonates and anti-resorptive agent therapy. Inhibition of bone turnover and angiogenesis are mainly responsible for the development of Medication Related Osteonecrosis of Jaws (MRONJ) as therapeutic side-effect. Yet, the role of infection for the development and recurrence of MRONJ is not fully elucidated. The aim of this retrospective study is to explore if a difference in antibiotic regimes has an impact on the surgical intervention needed to achieve a painless stable stage of the disease. Furthermore, we investigated concomitant submucosal infections in local relation to the MRONJ site.A retrospective study (2006-2015) of 143 patients treated with MRONJ stage II and stage III in a single institutional university hospital was performed. All patients experienced at least one surgical intervention and received antibiotics. Their medical records, pathological and microbial findings were reviewed. Data was controlled for the achievement of an event free time period of at least 12 months.We investigated the number and kind of treatments that were performed on patients with MRONJ stage II and III to achieve a painless stable stage of the disease. The first and second healing approach differed significantly from each other (p 0.05). In 7 (4.9%) cases up to four surgical interventions were needed to achieve oral rehabilitation. In 135 (95.1%) of all cases a segmental resection could be prevented, with extended decortication being the most applied method. Patients under perioperative ampicillin/sulbactam showed a significant reduction for a second or fourth intervention compared to the clindamycin group (p 0.05). Results for a third intervention presented a similar difference between both groups, but were not significant (p = 0.06). Intraoperatively in 76 out of 241 (31.5%) cases presented putrid submucosal infections. The isolated bacteria were gram-negative facultative anaerobes (39.1%) and strictly anaerobic bacteria (gram-positive/38.2%, gram-negative/19.1%). Susceptibly of the cultured bacteria were significantly (p 0.05) in favor to ampicillin/sulbactam (79.1%) compared to clindamycin (49.5%).The perioperative antibiotic regime for patients with MRONJ stage II and III undergoing surgically treatment does have an influence on the recurrence of the disease. Further investigation is needed to elucidate the role of infection in the treatment of MRONJ.

Otolaryngologists, dentists and maxilla-facial surgeons see patients suffering from odontogenic maxillary sinusitis on a daily routine. The study was performed to investigate the different origins of the odontogenic maxillary sinusitis ranging from periodontitis to augmentative implant surgery. Furthermore, the microbial flora of purulent odontogenic maxillary sinusitis was analyzed in order to present a proper antibiotic treatment in addition to a surgical approach.A retrospective study was performed, analyzing the clinical trials of 121 patients suffering from odontogenic maxillary sinusitis who undergone surgery. Harvested bacteria were tested for susceptibility on a routine base, surgical reports of removed foreign material or dental focus were reviewed as well as preoperative CBCT.Patients mean age was 56.62 (±16 SD) with a slight female gender dominance. Allergic profile to β-lactam antibiotics had no influence on patients' length of in-hospital stay. 69 out of 121 cases of OMS occurred after dental surgery (extractions, augmentation or implant surgery). Maxillary molars were the teeth mostly hold accountable for an onset without surgery in recent history. 22.3% of the patients possessed a dislocated foreign body in the maxillary sinus. Pseudomonas aeruginosa infection was significantly associated with misplaced foreign bodies (root filling, augmentative dental material e.g. p 0.05). We protocoled an anaerobic dominance with 45 anaerobes versus 19 aerobes. Ampicillin/Sulbactam (80%) and Piperacillin/Tazobactam (93.3%) present sufficient susceptibly rates to the harvested bacteria. Likewise showed Moxifloxacin (86.3%) equal results, whereas Clindamycin had a poor outcome with merely 50% of the tested bacteria being susceptible to Clindamycin.If OMS is diagnosed dental focus should be treated, misplaced bodies should be removed and purulent exacerbation has to be additionally treated with a calculated antibiotic therapy according to the pathogens resistance patterns.

Single photon emission computed tomography (SPECT) has been commonly used as an additional method to assess mandibular bone invasion in patients with oral squamous cell carcinoma (OSCC). In the present study, we measured the diagnostic validity of SPECT findings compared with the histologic findings.We implemented a retrospective cross-sectional study and enrolled a sample of patients with OSCC adjacent to the mandible. The staging examinations included magnetic resonance imaging (MRI) and/or computed tomography (CT) and additional SPECT. The patients' medical records and imaging data were reviewed by 2 readers, and bone invasion was classified as positive or negative for each diagnostic method. The predictor was bone invasion found on CT and/or MRI compared with the combination of CT and/or MRI with either positive or negative SPECT results. The primary outcome variable was histologic bone invasion. Other variables of interest were clinicopathologic data, type of mandibular resection, and resection margin status. Bivariate tests were used to compare the diagnostic specificity, sensitivity, and accuracy of each imaging modality.The study enrolled 122 patients, with a mean age of 67 years (55% male; study period, January 2010 to December 2017). In 60 patients (49%), segmental mandibular resection was performed. The sensitivity and specificity for bone invasion were 100% and 39% for SPECT and 84% and 75% for CT and/or MRI. The negative results for bone invasion using SPECT did not match the false-positive CT and/or MRI results in 5% (n = 6 of 122). Positive SPECT findings, in addition to positive CT and/or MRI findings increased the sensitivity to 100% but decreased the specificity to 29% (P .001). Considering only negative SPECT findings increased the specificity to 85% (P = .03), sensitivity remaining unaffected. The accuracy of CT and/or MRI alone was 80% and was 84% when combining CT and/or MRI and negative SPECT findings (P = .03).In oncologic staging with CT and/or MRI, the addition of SPECT provided only small benefits. Only negative SPECT results allowed for greater specificity and accuracy. The use of SPECT could be considered to rule out bone invasion in cases of radiologic uncertainty of positive CT or MRI findings.

Our aim was to assess the four months' resorption rates of onlay iliac crest grafts in atrophic jaws prospectively, and to identify factors that influence them. Twenty-four patients had reconstructions of the alveolar ridge with iliac crest onlay grafts at 30 sites on the mandibles and maxillas. The augmentation volumes were measured on cone-beam computed tomographic (CT) data-sets directly after augmentation (V1), and after four months' remodelling (V2). Statistical analysis allowed identification of potential influences from the recipient sites, volume of the graft, and the patients' smoking behaviour. The mean (range) initial onlay graft volume (V1) was 2.82 (0.66 to 6.41) ml. After four months, the mean measured onlay graft volume (V2) was 2.39 (0.47 to 6.21) ml. Mean iliac crest onlay graft volume resorption after four months of remodelling was 0.43 (-0.15 - 1.78) ml (15%). We found no significant differences in the resorption rates of iliac crest onlay grafts between different recipient sites (maxilla and mandible) or in dependence on the volume of iliac crest grafts. Smokers tended to have a higher rate of resorption, but not significantly so (p=0.056). The results of this study indicate the most favourable resorption rates for iliac crest onlay grafts that we know have seen published to date.

Purpose In the field of reconstructive head and neck surgery, surgical site infections (SSI) are commonly investigated for the recipient site of various reconstructive procedures. Data about SSI of the donor site of different flaps raised for reconstruction are rare. Material and Methods With regard to the bacterial donor site infections, we retrospectively investigated the medical data, surgical reports and wound management protocols of 267 patients who received reconstruction of the head and neck after ablative surgery. All patients underwent reconstruction with one of the following flaps: free fasciocutaneous radial forearm flap (RFFF), free fasciocutaneous anterolateral thigh flap (ALTFF), pedicled myocutaneous latissimus dorsi flap (PLDF), pedicled myocutaneous pectoralis major flap (PPMF), free osteocutaneous fibula flap (FFF). Follow-up was conducted for 12 months. Results The lowest detection ratio (DR: number of infected sites/flaps raised from the respective donor site) was calculated for the radial forearm, 0.087. Pedicled flaps presented a moderate DR (PLDF: 0.27, PMMF:0.35). Donor sites of the leg possessed the highest DR (ALTFF:0.61, FFF: 045). Mainly gram-positive facultative anaerobic bacteria (n = 41) were detected and gram-negative bacteria (aerobe/anaerobe) were present in 27 cases. The most frequently detected bacteria were Staphylococcus spp., Viridans Streptococci, Pseudomonas aeruginosa and Escheria coli. Continuous wound management for in-hospital patients was able to prevent any local spreading or a prolonged length of in-hospital stay. Conclusion Overall, gram-positive facultative anaerobic bacteria, mainly Staphylococcus spp., are the predominant bacteria detected in donor site wounds. For wound care management, an infection with gram-negative pathogens should not be neglected.

Recently, lymph node ratio (LNR) has been recognized as an important prognosticator for oral squamous cell carcinoma (OSCC). However, its relevance for the specific subsite floor of mouth (FOM) has not been investigated. This study was conducted to elucidate the prognostic significance of LNR for the subsite FOM among other prognostic factors.A retrospective study of 155 patients with FOM SCC who received primary curative resection and neck dissection was conducted. We analyzed the impact of LNR among other clinicopathologic variables on overall survival (OS) in univariate and multivariate analysis.In univariate analysis, patients detected with LNR ≤ 0.07 (cutoff-point: 0.07) showed an 85% 5-year OS rate, whereas for patients with LNR 0.07 the OS rate reached 25% after 5-years (p 0.001). The 5-year DFS rate was 72% for patients with LNR ≤ 0.07; on the contrary, patients with LNR 0.07 the 5-year DFS rate was 17% (p 0.001). LNR was detected as an independent predictor of OS in multivariate analysis (p = 0.032) for the subsite FOM.We concluded that LNR is an important predictor of prognosis in patients with FOM SCC, LNR should be considered in the choice of adjuvant treatment for these patients.

Background Carcinomas of the maxillary sinus are classified according to the Union Internationale Contre le Cancer (UICC)/American Joint Committee on Cancer (AJCC) TNM classification. The purpose of this study was to assess the prognostic significance of the UICC/AJCC TNM classification seventh edition, which was introduced in 2010. Methods One hundred thirteen patients with malignant tumors of the maxillary sinus were included in this study. The prognostic impact of the TNM classification and the UICC/AJCC seventh edition's stage grouping were analyzed in univariate and multivariate analysis. Results The UICC/AJCC stage grouping, the T classification, and the N classification had a significant impact on overall survival (OS) in univariate analysis (p < .05). No significant differences were observed between the groups T4a and T4b (p = .109). In multivariate analysis, the UICC/AJCC stage grouping (p = .031), the N classification (p = .014), and age (p < .001) had a significant impact on OS. Conclusion Although UICC/AJCC stage grouping and the N classification provided a significant prediction of OS in univariate and multivariate analysis, T classification only influenced OS in univariate analysis. © 2014 Wiley Periodicals, Inc. Head Neck 37: 400–406, 2015

There may well be a shift towards 3-dimensional orthognathic surgery when virtual surgical planning can be applied clinically. We present a computer-assisted protocol that uses surgical navigation supplemented by an interactive image-guided visualisation display (IGVD) to transfer virtual maxillary planning precisely. The aim of this study was to analyse its accuracy and versatility in vivo. The protocol consists of maxillofacial imaging, diagnosis, planning of virtual treatment, and intraoperative surgical transfer using an IGV display. The advantage of the interactive IGV display is that the virtually planned maxilla and its real position can be completely superimposed during operation through a video graphics array (VGA) camera, thereby augmenting the surgeon's 3-dimensional perception. Sixteen adult class III patients were treated with by bimaxillary osteotomy. Seven hard tissue variables were chosen to compare (ΔT1-T0) the virtual maxillary planning (T0) with the postoperative result (T1) using 3-dimensional cephalometry. Clinically acceptable precision for the surgical planning transfer of the maxilla (

Summary Background The aim of our study was to evaluate retrospectively whether neoadjuvant or adjuvant radiochemotherapy yields better survival for patients with N2-oral squamous cell carcinoma and to identify subgroups, which may benefit from one of the therapeutic settings. No studies have been carried out to investigate whether radiochemotherapy should be applied before or after surgery. Methods In total, 151 patients with oral squamous cell carcinoma with N2-nodal-status were reviewed. Eighty five patients received neoadjuvant radiochemotherapy, 66 patients were treated with surgery and adjuvant radiochemotherapy. Overall survival was plotted by Kaplan–Meier analysis. Prognostic factors were identified through univariate and multivariate analysis. Results Patients treated with neoadjuvant radiochemotherapy had a significantly improved 5-year survival in comparison to patients, who received adjuvant radiochemotherapy (46.3% vs. 27.4%, p = 0.035). A subgroup analysis by T-stage revealed that neoadjuvant and adjuvant radiochemotherapy yielded similar 5-year survival rates for patients with T2N2-tumors (42.3% vs. 41.2%, p = 0.871), whereas patients with T4bN2-tumors significantly benefitted from neoadjuvant treatment (37.3% vs. 9.7%, p = 0.019). Conclusions Neoadjuvant radiochemotherapy is an effective treatment for patients with nodal status N2-oral squamous cell carcinoma, however prospective randomized trials are needed to confirm, which patients should be treated with neoadjuvant or adjuvant radiochemotherapy.

The Obwegeser and Dal Pont modification of the bilateral sagittal split osteotomy (BSSO) is a well-established procedure in orthognathic surgery. The purpose of this retrospective study was to analyze the actual fracture patterns achieved with BSSO by Obwegeser and Dal Pont modification using postoperative cone beam computed tomography (CBCT) datasets from 100 patients. A total of 200 split osteotomies were assessed, which could be categorized into nine different split patterns. Only one of the observed split fractures (0.5%) followed exactly the fracture line described by Obwegeser and Dal Pont, whereas 40% followed the fracture line according to the Hunsuck and Epker modification and 13.5% were seen as unfavourable splits mainly running over the buccal plate. A significant correlation was found between unfavourable buccal splits and both horizontal osteotomies reaching the buccal surface at the dorsal ramus (P=0.001) and a vertical caudal bone cut end at the corpus with a buccal position (P

Objective The aim of this study was to compare the performance of cone-beam computerized tomography (CBCT) with multislice CT (MSCT) and single photon emission CT (SPECT) in the detection of bone invasion from oral malignancies. Study design In this prospective investigation, 77 patients with histologically proven malignancy of the oral cavity received MSCT, CBCT, and SPECT imaging of the head presurgically. Radiologic evaluations were compared with histopathologic examinations of the resected tumor specimens. Receiver operating characteristic (ROC) analysis as well as the sensitivity, specificity, and positive and negative predictive values were calculated. Results The sensitivity, specificity, positive predictive value, and negative predictive value for MSCT were 0.8, 1.0, 1.0, and 0.75, respectively; for CBCT 0.92, 0.965, 0.98, and 0.875; and for SPECT 0.91, 0.4, 0.7, and 0.75. ROC analysis showed area under the curve values of 0.894 (95% confidence interval [CI] 0.806-0.982) for MSCT; 0.931 (95% CI 0.835-1.000) for CBCT, and 0.716 (95% CI 0.566-0.866) for SPECT. Conclusion CBCT is accurate in predicting malignancies' bone involvement and can compete with MSCT and SPECT in detecting bone invasion in patients with oral malignancies.

OBJECTIVE To assess the accuracy of cone-beam computed tomography (CBCT) in terms of buccal bone-wall configuration and peri-implant bone defect regeneration after guided bone regeneration (GBR). MATERIAL AND METHODS Titanium implants were inserted into standardized box-shaped defects in the mandible of 12 foxhounds. Defects of one side were augmented following the principle of GBR, while the other side was left untreated. Radiological evaluation was performed using CBCT and compared with histomorphometrical measurements of the respective site serving as a validation method. RESULTS Non-augmented control sites providing a horizontal bone width (BW) of 0.5 mm (0.7 ± 0.7 mm) (P 0.5 mm (0.82 ± 1.07) (P>0.05, Mann-Whitney U-test). However, a radiological discrimination between original bone, integrated and non-integrated bone substitute material was not reliable. Additionally, it was found that a minimum buccal BW of 0.5 mm was necessary for the detection of bone in radiology. CONCLUSION The evaluation of peri-implant bone defect regeneration by means of CBCT is not accurate for sites providing a BW of

Objective: Virtual wax-ups based on three-dimensional (3D) surface models can be matched (i.e. registered) to cone beam computed tomography (CBCT) data of the same patient for dental implant planning. Thereby, implant planning software can visualize anatomical and prosthetic information simultaneously. The aim of this study is to assess the accuracy of a newly developed registration process. Material and methods: Data pairs of CBCT and 3D surface data of 16 patients for dental implant planning were registered and the discrepancy between the visualized 3D surface data and the corresponding CBCT data were measured on 64 teeth at seven points by two investigators in two iterations with a total of 1792 measurements. Results: All data pairs were matched successfully and mean distances between CBCT and 3D surface data were between 0.03(±0.33) and 0.14(±0.18) mm. At two of seven measuring points, statistically significant correlations were determined between the measured error and the presence and type of restorations. Registration errors in maxilla and mandible were not statistically significantly different. Conclusion: According to the results of this study, registration of 3D surface data and CBCT data works reliably and is sufficiently accurate for dental implant planning. Thereby, barium-sulfate scanning templates can be avoided and dental implant planning can be accomplished fully virtual. To cite this article: Ritter L, Reiz SD, Rothamel D, Dreiseidler T, Karapetian V, Scheer M, Zoller JE. Registration accuracy of three-dimensional surface and cone beam computed tomography data for virtual implant planning. Clin. Oral Impl. Res. 23, 2012 447–452. doi: 10.1111/j.1600-0501.2011.02159.x

The efficacy of adjuvant radiochemotherapy (RCT) in patients with advanced stage head and neck carcinoma has been proven in prospective randomized trials. However, these trials focused on different head and neck sites. Specific analyses for treatment effects in squamous cell carcinoma of the oral cavity (OSCC) are missing. We evaluated our experiences with adjuvant concomitant RCT in advanced OSCC to compare the results with other treatment schemes using adjuvant RCT. A total of 183 patients with OSCC of UICC stages II–IVb were reviewed retrospectively. All patients were treated with radical surgery followed by adjuvant, conventional fractionated concomitant RCT using carboplatin. Overall survival was plotted by Kaplan–Meier analysis. Prognostic factors were identified through univariate and multivariate analysis. Univariate analysis showed a significant impact of T, N, and UICC stage, histopathologic grading, surgical margins, extracaspular spread (ECS), and lymphangiosis carcinomatosa on overall survival (Table 3). Patients with stage IVa had a higher 5-year overall survival rate (42.8%) than patients with stage IVb (25.0%) (Figure 1). The differences were significant in multivariate analysis (p = 0.033) (Table 4). Adjuvant concomitant RCT is an effective treatment in patients with advanced stage OSCC. However, it remains unclear, which patients should be treated with adjuvant RCT. For patients with stage IVb, adjuvant RCT yields poor results. Prospective randomized trials are needed to confirm which patients should be treated with adjuvant RCT.

Various anticoagulant therapy regimes bear the risk of postsurgical bleeding events after dental extractions. Local hemostyptic measures, e.g., collagen fleeces, are applied by surgeons to prevent such bleedings. No standard protocol in prevention of bleeding events has met general acceptance among surgeons yet. The purpose of this retrospective study was to determine if post-operative bleeding can be prevented by suturing native collagen fleeces into extraction wounds immediately after teeth removal, regardless what anticoagulant regime is performed. A total of 741 extraction units were removed from 200 consecutive in-ward patients with or without alternation of different anticoagulant therapy regimes. Anti-vitamin K agents were the most prescribed drugs (n = 104, 52 %), followed by Acetylsalicylate (ASS) (n = 78, 39 %). Nineteen (9.5 %) patients received a dual anti-platelet therapy. Out of 104 patients receiving an anti-vitamin K agent (phenprocoumon), 84 patients were bridged, 20 patients continued to their anticoagulant therapy without alterations. Following careful tooth extraction, extraction sockets were filled using a native type I and III porcine collagen sponge (Collacone, Botiss Biomaterials, Berlin), supported by single and mattress sutures for local hemostasis. Post-operative bleeding events were rated according to their clinical relevance. In the post-operative phase, 8 out of 200 consecutively treated patients experienced a post-operative bleeding event. All of them had been designated for a long-term anti-vitamin K therapy (p ≤ 0.05), and extractions were performed under a heparin bridging regime (n = 6) or an uninterrupted anti-vitamin K agent therapy (n = 2). No bleeding events occurred in patients with ASS 100 therapy or low-dose LMWH therapy (p ≤ 0.05), or in patients with dual anti-platelet therapy (0 out of 24). None of the bleeding events put patients’ health at risk or required systemic intervention. Sufficiently performed local hemostyptic measures, like the application of collagen fleeces in combination with atraumatic surgery, bears a great potential for preventing heavy bleeding events in hemostatic compromised patients, regardless of their anticoagulant therapy.

Odontogenic infections may lead to severe head and neck infections with potentially great health risk. Age, location of purulent affected sites and beta-lactam allergy are some mentionable factors regarding patients' in-hospital stay and course of disease. Are there new challenges regarding bacteria' antibiotic resistance for empiric treatment and what influences do they have on patients' clinical course?We analyzed in a 4-year retrospective study the medical records of 294 in-hospital patients with severe odontogenic infections. On a routine base bacteria were identified and susceptibility testing was performed. Length of stay in-hospital was evaluated regarding patients' age, beta-lactam allergy profile, affected sites and bacteria susceptibility to empiric antibiotics.Length of stay in-hospital was detected to be associated with affected space and penicillin allergy as well (p 0.05). Isolates presented large amounts of aerobic gram-positive bacteria (64.2%), followed by facultative anaerobic bacteria (gram+/15.8%, gram-/12.7%). Tested ampicillin in combination with sulbactam (or without) and cephalosporins displayed high susceptibility rates, revealing distinguished results regarding clindamycin (p 0.05). Co-trimoxazol and moxifloxacin showed high overall susceptibility rates (MOX: 94.7%, COTRIM: 92.6%).This study demonstrates ampicillin/sulbactam in addition to surgical intervention is a good standard in treatment of severe odontogenic neck infections. Cephalosporins seem to be a considerable option as well. If beta-lactam allergy is diagnosed co-trimoxazol and moxifloxacin represent relevant alternatives.Age, allergic profile and bacteria' resistance patterns for empiric antibiotics have an influence on patients in-hospital stay. Ampicillin/sulbactam proves itself to be good for empiric antibiosis in severe odontogenic infections. Furthermore cephalosporins could be considered as another option in treatment. However moxifloxacin and co-trimoxazol deserves further investigation as empiric antibiosis in odontogenic infections if beta-lactam allergy is diagnosed.

There are two major challenges in the early diagnosis of maxillary sinus carcinoma: the maxillary sinus is not susceptible to direct inspection and palpation, and symptoms are uncharacteristic. The aim of this study was to assess the impact of the time interval between first symptoms noticed by the patient and the detection of the tumor on survival. 88 patients with maxillary sinus tumors were included in the retrospective study. Prognostic factors were identified through univariate analysis. Univariate analysis (p = 0.019) revealed a significant impact of the time interval from first symptom to diagnosis on overall survival. With increasing duration of the symptoms 5-year overall survival was reduced from 65 % for duration between 0 and 2 months to 24 % for duration of symptoms longer than 12 months. Furthermore, we found a significant association (p = 0.033) between local extension of the tumor and time interval from first symptom to diagnosis. Early diagnosis is often difficult because of uncharacteristic symptoms, which are identical with benign diseases of the maxillary sinus. The delay between the occurrence of the first symptom and diagnosis often makes a curative treatment impossible.

Carcinomas of the maxillary sinus are classified according to the Union Internationale Contre le Cancer (UICC)/American Joint Committee on Cancer (AJCC) TNM classification. The purpose of this study was to assess the prognostic significance of the UICC/AJCC TNM classification seventh edition, which was introduced in 2010.One hundred thirteen patients with malignant tumors of the maxillary sinus were included in this study. The prognostic impact of the TNM classification and the UICC/AJCC seventh edition's stage grouping were analyzed in univariate and multivariate analysis.The UICC/AJCC stage grouping, the T classification, and the N classification had a significant impact on overall survival (OS) in univariate analysis (p.05). No significant differences were observed between the groups T4a and T4b (p = .109). In multivariate analysis, the UICC/AJCC stage grouping (p = .031), the N classification (p = .014), and age (p.001) had a significant impact on OS.Although UICC/AJCC stage grouping and the N classification provided a significant prediction of OS in univariate and multivariate analysis, T classification only influenced OS in univariate analysis.

The principle of guided tissue and bone regeneration has long been established for treating bone and periodontal defects. In addition to nonabsorbable barriers, various collagens have become accepted as membrane materials for separating the graft from soft tissue. However, collagen membranes differ significantly in their barrier function and biocompatibility. The objective of this pilot study was to examine, in vitro and in vivo, a novel native collagen membrane extracted from porcine pericardium.The morphologic structure of two different native collagen membranes (Remotis, Thommen Medical; Bio-Gide, Geistlich Biomaterials) was examined using a scanning electron microscope. For biocompatibility testing, membranes were incubated with SaOs-2 osteoblastlike cells. After 2 hours, 3 days, and 7 days, proliferation of the cells on the membranes was determined. Evaluation of the biodegradation pattern was performed in a dog model with simultaneous bone augmentation with Bio-Oss (Geistlich Biomaterials) or Cerabone (Botiss Biomaterials) in the lateral anterior maxilla in eight animals with histologic examination after 4, 8, 12, and 24 weeks.An interconnective pore system was identifiable for Remotis, while Bio-Gide displayed a more fibrous structure. In vitro, Remotis showed considerable cell proliferation, which was significantly superior to that observed with Bio-Gide, especially after 7 days (2,910 ± 1,273 and 707 ± 706, respectively). In vivo, both membranes integrated into the surrounding tissue without any inflammatory reaction. Both membranes allowed early vascularization. However, considerable biodegradation was noted within 4 to 8 weeks with Bio-Gide, while Remotis resorbed generally within the first 8 to 12 week. Both membranes supported underlying bone formation.Both examined membranes indicate a high level of biocompatibility. Both are resorbed without inflammation within 8 weeks (Bio-Gide) or 12 weeks (Remotis). The compact interconnective pericardium collagen of Remotis may have stabilized the resorption process.

To assess the accuracy of cone-beam computed tomography (CBCT) in terms of buccal bone-wall configuration and peri-implant bone defect regeneration after guided bone regeneration (GBR).Titanium implants were inserted into standardized box-shaped defects in the mandible of 12 foxhounds. Defects of one side were augmented following the principle of GBR, while the other side was left untreated. Radiological evaluation was performed using CBCT and compared with histomorphometrical measurements of the respective site serving as a validation method.Non-augmented control sites providing a horizontal bone width (BW) of0.5 mm revealed a significantly lower accuracy between the radiological and the histological evaluation of the buccal defect depth (1.93 ± 1.59 mm) compared with the group providing a BW of0.5 mm (0.7 ± 0.7 mm) (P0.05, Mann-Whitney U-test). In GBR-treated defects, the subgroup0.5 mm (1.49 ± 1.29 mm) revealed a significantly higher difference between CBCT and histology compared with0.5 mm (0.82 ± 1.07) (P0.05, Mann-Whitney U-test). However, a radiological discrimination between original bone, integrated and non-integrated bone substitute material was not reliable. Additionally, it was found that a minimum buccal BW of 0.5 mm was necessary for the detection of bone in radiology.The evaluation of peri-implant bone defect regeneration by means of CBCT is not accurate for sites providing a BW of0.5 mm. Moreover, a safe assessment of the success of the GBR technique is not possible after the application of a radiopaque bone substitute material.

Objectives To evaluate the potential influence of different cone-beam computed tomography (CBCT) devices on the transfer accuracy of an open-source system for computer-aided implantology (CAI). Material and methods A total of 108 implants in 18 partially edentulous patient-equivalent models were planned and fully guided implants were inserted using an open-source CAI system with three different CBCT devices. After follow-up CBCT and fiducial marker-matching procedure, linear horizontal, vertical, and maximal three-dimensional deviations, as well as angle deviations between the virtual planning data and the surgical results were calculated. Variance analysis was carried out to prove whether or not the observed differences between the CBCT devices were statistically significant. Results The observed mean three-dimensional deviation rates between virtually planned and achieved implant positions varied by around 400 μm (45%) at the implant's base and around 540 μm (50%) at the implant's tip in dependence to the applied CBCT device. Mean vertical deviations varied around 370 μm (76%) at the implant's base and 350 μm (69%) at the implant's tip, whereas axes deviations varied around 0.81° (40%) between the three investigated CBCT devices. Except for the axes deviations and the horizontal linear deviations at the implants base, observed differences reached significance level between the CBCT devices. Conclusions Until now, the potential influence from different CBCT devices on the transfer accuracy of CAI systems has not yet been investigated. Data from the present study confirm for the first time the in vitro CBCT device dependency on the transfer accuracy of CAI systems reaching up to axes deviations of 0.6 angle degree and linear deviations around half a millimeter.

Objective The aim of this study was to assess the prevalence of pathologic findings in the maxillary sinus by using cone-beam computerized tomography (CBCT). Study design One thousand twenty-nine consecutive CBCT scans were retrospectively inspected for pathologic findings in the maxillary sinus by 3 observers. Findings were differentiated by mucosal thickening, partial opacification with liquid accumulation, total opacification, and polypoidal mucosal thickening. Position and diameter of the maxillary sinus ostium were assessed. Correlations for pathologic findings and the factors of age and gender were calculated. Patients with clinical manifestations of sinusitis or total opacification in either sinus were reevaluated. Results A total prevalence for pathologies in the maxillary sinus of 56.3% was found in this study. The most frequent pathology was mucosal thickening. Patients >60 years of age showed significantly more pathologies in the maxillary sinus ( P = .02), and male patients showed significantly more pathologies than female patients ( P = .01). Clinical signs of sinusitis could be confirmed on CBCT images for all patients. Conclusions Pathologies in the maxillary sinus are frequently found in CBCT imaging and have to be treated or followed-up accordingly. CBCT is applicable for diagnosis and treatment planning of clinically present sinusitis.

Surgical complications during sinus floor elevation are frequently caused by septa in the maxillary sinus. In this study, the prevalence of septa was retrospectively determined via three-dimensional imaging to assess the necessity for appropriate imaging prior to sinus floor elevation.The cone-beam computed tomography scans of 1,029 consecutive patients were evaluated to assess the prevalence of septa, taking into account patient age and sex as well as the number and orientation of septa and their locations. If septa were present, the height was measured and the orientation was determined.Septa were found in 47% of patients and 33.2% of sinuses. There was no statistical difference in prevalence with respect to age, sex, or side. Most patients with septa showed one septum in one sinus (24.6%); 13.7% showed one septum in each sinus. Other combinations (up to three septa per sinus) were found in 8.7% of patients. Septa were most commonly located in the first molar region (256 septa), followed by the second molar region (225 septa), the third molar region (144), second premolar region (136), the first premolar region (44), and the canine region (5). The mean septal height was 11.7 +/- 6.08 mm for septa in a sagittal orientation (n = 206, 25.3%; maximum height of 37 mm) and 7.3 +/- 5.08 mm for those oriented transversely (n = 608, 74.7%; maximum height of 36 mm). The variance was larger for the sagittal orientation group (37.03 mm) than for transversely oriented septa (25.9 mm).Septa were found in 47% of the patients in this sample. Appropriate imaging prior to performing sinus surgery seems justified, since complications and the success rate of sinus floor elevation are clearly related to the presence of septa. Int J Oral Maxillofac Implants 2010;25:258-265.

The aim of the chapter is to give a complete survey of Computer Aided Surgery (CAS) systems in dental implantology from the different 3D visualization technologies to the different available approaches for implant planning data transfer to the corresponding anatomical patient´s sites. Focus will be on the illumination of advantages and disadvantages for the different systems components. Further on, the diagnostic value, radiation dosages to the patient, availability and costs as well as the transfer accuracy results for the investigated system will be discussed.

Implant treatment increasingly focuses on the reduction of treatment time and postoperative impairment. The improvement of 3D dental diagnosis by ConeBeam computed tomography allows detailed preparation for the surgical placement of dental implants under prosthetic considerations. While the first generation of implant planning software used high-contrast multislice computed tomography, software that has been specifically designed for ConeBeam computed tomography is now available. Implant placement can be performed using surgical guides or under the control of optical tracking systems. Surgical guides are more commonly used in private office owing to their availability. The accuracy for both techniques is clinically acceptable for achieving implant placement in critical anatomical indicatio ns. When using prefabricated superstructures and in flapless surgery, special abutments or an adjusted workflow are still necessary to compensate misfits of between 150 and 600 microm. The proposition to ensure proper implant placement by dentists with limited surgical experience through the use of surgical guides is unlikely to be successful, because there is also a specific learning curve for guided implant placement. Current and future development will continue to decrease the classical laboratory-technician work and will integrate the fabrication of superstructures with virtual treatment planning from the start.

Objective The objective of this study was to evaluate cone-beam CT (CBCT) diagnoses of sialoliths in the major salivary glands. Study design Twenty-nine CBCT images containing salivary calculi were retrospectively evaluated for image quality and artifact influence. Additionally, the reproducibility of calculus measurement and the differences between CBCT measurements and ultrasonography (US) and histomorphometry (HM) measurements were determined. Diagnostic sensitivity and specificity calculations were based on the observations of 3 masked clinicians, who reviewed a total of 58 CBCT volumes. Results Salivary calculi were sufficiently visualized in all patients. Metal artifacts were detected in images of 7 patients, and movement artifacts in 2. CBCT calculi measurements were highly reproducible, with mean differences of less than 350 μm. Mean CBCT measurements of calculi diameters differed from mean US measurements by approximately 500 μm and differed from mean HM measurements by approximately 1 mm. For calculus diagnoses, the mean sensitivity and specificity were both 98.85%. Conclusion Although poor image qualities and artifacts can reduce diagnostic information, salivary calculi can be evaluated adequately with CBCT. CBCT measurements of calculi are highly reproducible and differ little from measurements made with US and HM. Diagnostic sensitivity and specificity levels with CBCT are as high as or higher than those obtained with other diagnostic methods. Because of its high diagnostic-information-to-radiation-dose ratio, CBCT is the preferable imaging modality for salivary calculus diagnosis.

Objectives To evaluate the accuracy of the first integrated system for cone-beam CT (CBCT) imaging, dental implant planning and surgical template-aided implant placement. Materials and methods On the basis of CBCT scans, a total of 54 implant positions were planned for 10 partially edentulous anatomical patient-equivalent models. Surgical guides were ordered from the manufacturer (SICAT). Two different types of guidance were assessed: for assessment of the SICAT system inherent accuracy vendor's titanium sleeves of 2 mm internal diameter and 5 mm length were utilized for pilot drills. The guide sleeves of the NobelGuide system were implemented for fully guided surgery and implant insertion. Deviations perpendicular to the implant axes at the crestal and apical end, as well as the angle deviations between the virtual planning data and the surgical results, were measured utilizing a follow-up CBCT investigation and referential marker-based registration. Results The SICAT system inherent mean deviation rates for the drilled pilot osteotomies were determined to be smaller than 500 mum even at the apical end. Mean angle deviations of 1.18 degrees were determined. Utilizing the NobelGuide sleeve-in-sleeve system for fully guided implant insertion in combination with the investigated template technology enabled to insert dental implants with the same accuracy. Crestal deviations, in general, were significantly lower than the apical deviations. Conclusion Although hardly comparable due to different study designs and measurement strategies, the investigated SICAT system's inherent accuracy corresponds to the most favourable results for computer-aided surgery systems published so far. In combination with the NobelGuide surgical set for fully guided insertion, the same accuracy level could be maintained for implant positioning.

To establish a basis for weighing the potential diagnostic and therapeutic benefits of three-dimensional cone-beam (CB) data sets in contrast to digital orthopantomography (OPG) and computerized tomography (CT) in implant dentistry.Twenty-seven patients requiring implant surgery received a single presurgical CB scan. A follow-up digital OPG was taken within a maximal postsurgical period of 2 weeks. For comparison purposes, a control group of 29 patients receiving CT as well as CB diagnosis was analyzed. Image quality of the different modalities was ranked retrospectively by five experienced examiners (from excellent to insufficient) for up to 10 defined criteria, including general image quality and several specific structures. The results were analyzed statistically, and interobserver agreement was calculated using intraclass correlation coefficients (ICCs).The median rating for all investigated criteria was good for CB imaging and between good and insufficient for OPG in the dental implant group. Except for general image quality, statistical analysis showed that CB imaging was significantly superior to OPG imaging for all investigated anatomic structures. With a few exceptions, all investigated anatomic structures in CT and CB imaging were rated excellent in the control group. No significant difference between CT and CB imaging was detected in the control group for all investigated criteria. With a few exceptions, ICCs were higher for CB images than for OPG. In the control group, ICCs for CT and CB images were similar, with a few exceptions.The results of the present study confirm superior radiographic visualization for all important high-contrast structures in presurgical implant dentistry assessment for CB imaging in contrast to OPG and a CT-like degree of information for high-contrast structures in CB data sets. Clinically, however, the elevated radiation dosages transmitted by CB imaging must be taken into account.

Within the last years it was shown that etching of biomaterials can improve hydrophilicity and cell proliferation which in turn may accelerate the osseointegration of implants. The aim of the present study was to evaluate the influence of superficial etching of a xenogenous bone mineral on cell proliferation and bone regeneration. A granular bone substitute material [BSM] (Cerabone® [CB], botiss medical, Berlin, Germany) was superficially etched using citric acid (Cerabone Acid [CBA]). CB and CBA were allocated into 96 non-binding well plates (Costar No. 3474, Corning Incorp., Schipol-Rijk, Netherlands) and incubated with 1×104 human osteoblast-like cells (SaOs-2) per well under standardized conditions. After 2 hours, 3 and 7 days a LDH-Assay (CytoTox 96®, Promega, Mannheim, Germany) was used for photometric evaluation of cell proliferation (n=8). LDH values were transferred into cell amounts using a standard curve and analyzed for statistical difference. Additionally, cell morphology was investigated using scanning electron microscopy (SEM) (n=3). In the in-vivo part, CB and CBA granules were used for lateral augmentation of the maxillae of four beagle dogs and covered with a collagen membrane (Jason® Membrane, botiss medical). Healing periods were set at 3 and 8 weeks (n=2, respectively). In-vitro evaluation revealed statistically significant higher cell proliferation after 3 and 7 days on CBA compared to CB (p

To compare the diagnostic quality of 2-dimensional panoramic views generated from imaging data acquired by a newly developed cone beam machine with the diagnostic quality of conventional digital orthopantomograms (OPTs).Thirty panoramic views reconstructed from digital volume tomograms (DVT) obtained by the pre-retail version of Galileos (Sirona Dental Systems), a newly developed compact cone beam device, were compared with 30 OPT images acquired by Orthophos XG Plus (Sirona Dental Systems). Diagnostic quality was assessed by 3 observers on criteria regarding detection of diagnosis-related findings, image quality, and visualization of anatomic structures in the maxillomandibular area. Wilcoxon rank sum test was applied for paired comparison.Statistical analysis showed no significant difference in diagnostic quality between both imaging modes using a calculation model based on 10 weighted criteria (P = .629). There was especially no statistically significant difference in the assessment of diagnosis-related findings detection (P = .163). Image quality of DVT panoramic views was significantly lower than that of OPT. Except for mandibular canal and alveolar ridge gingiva, all evaluated anatomic structures were visualized better by DVT. Intraclass correlation coefficients were consistently higher in the DVT group for all criteria but 2, although the difference was not statistically significant (P = .374).DVT panoramic views perform better in diagnosis of specific lesions, whereas OPTs provide a better image quality for a general overview of the maxillomandibular area. The diagnostic quality of both imaging modes is, however, equal.