Frank Peter Strietzel

Efficacy and Safety of an Intraoral Electrostimulation Device for Xerostomia Relief: A Multicenter, Randomized Trial

OBJECTIVE To evaluate the efficacy and safety of an intraoral electrostimulation device, consisting of stimulating electrodes, an electronic circuit, and a power source, in treating xerostomia. The device delivers electrostimulation through the oral mucosa to the lingual nerve in order to enhance the salivary reflex. METHODS The device was tested on a sample of patients with xerostomia due to Sjögrens syndrome and other sicca conditions in a 2-stage prospective, randomized, multicenter trial. Stage I was a double-blind, crossover stage designed to compare the effects of the electrically active device with the sham device, each used for 1 month, and stage II was a 3-month open-label stage designed to assess the long-term effects of the active device. Improvement in xerostomia severity from baseline was the primary outcome measure. RESULTS A total of 114 patients were randomized. In stage I, the active device performed better than the sham device for patient-reported xerostomia severity (P<0.002), xerostomia frequency (P<0.05), quality of life impairment (P<0.01), and swallowing difficulty (P<0.02). At the end of stage II, statistically significant improvements were verified for patient-reported xerostomia severity (P<0.0001), xerostomia frequency (P<0.0001), oral discomfort (P<0.001), speech difficulty (P<0.02), sleeping difficulty (P<0.001), and resting salivary flow rate (P<0.01). CONCLUSION Our findings indicate that daily use of the device alleviated oral dryness, discomfort, and some complications of xerostomia, such as speech and sleeping difficulties, and increased salivary output. The results show a cumulative positive effect of the device over the period of the study, from baseline to the end of the trial.

Intraoral electrostimulator for xerostomia relief: a long-term, multicenter, open-label, uncontrolled, clinical trial

OBJECTIVE A previous sham-controlled multinational study demonstrated the short-term efficacy and safety for xerostomia treatment of an intraoral device that delivers electrostimulation to the lingual nerve. The objective of this study was to test the hypothesis that those beneficial effects would be sustained over an 11-month period. STUDY DESIGN The device was tested on a mixed sample of 94 patients with xerostomia in an open-label, uncontrolled, prospective multicenter trial. Statutory outcome assessments were done at 5th, 8th, and 11th months and analyzed by multiple comparisons. RESULTS Improvements achieved at month 5 from baseline were sustained throughout the follow-up period for the primary outcome, xerostomia severity, and the secondary outcomes resting whole salivary flow rate, xerostomia frequency, oral discomfort, and difficulties in speech, swallowing, and sleeping. No significant side effects were detected. CONCLUSIONS The beneficial effects of a removable intraoral electrostimulating device were sustained for an 11-month period.

Höhenverlauf des Limbus alveolaris bei Implantationen mit der Osteotomtechnik

Alveolarfortsatzdefekte verschlechtern die anatomischen Ausgangsbedingungen für eine implantatprothetische Rehabilitation. Sie erfordern je nach Defektkonfiguration Maßnahmen der membrangesteuerten Knochenregeneration oder der Alveolarkammextension. Summers modifizierte die Vorgehensweise der Spreizung bzw. Spaltung des Alveolarfortsatzes durch Entwicklung der Osteotomtechnik. Das Prinzip dieser Technik besteht in der Seit- und Apikalverlagerung des Knochens am Implantatbett durch nichtablative Präparation unter Verdichtung des Knochens. Ein wichtiger Parameter zur Prognoseabschätzung von Implantaten liegt in der Beurteilung des Höhenniveaus des periimplantaren Knochens. In einer retrospektiven Datenerhebung zum Höhenverlauf des Limbus alveolaris bei Implantationen nach Alveolarkammextension mittels Osteotomtechnik wurden die postoperativen Röntgenaufnahmen nach Implantation und nach Freilegungsoperation von 17 Patienten hinsichtlich des Höhenverlusts des Limbus alveolaris vermessen und unter Berücksichtigung der intraoperativ festgestellten Knochenqualität (Klassifikation nach Misch 1993) ausgewertet. Die Osteotomtechnik kam häufig beim Vorliegen der Knochenqualitäten D2 und D3 zur Anwendung. Das zum Zeitpunkt der Freilegungsoperation gemessene Höhenniveau unterschied sich signifikant vom Ausgangsniveau. Zwischen dem Betrag der Höhendifferenzen des Knochenniveaus zwischen Implantation und Freilegungsoperation und der Knochenqualität wurde eine signifikante Korrelation (r = 0,5466; ¶p = 0,023) berechnet. Hinsichtlich der Langzeitprognose – abgeleitet vom Höhenverlauf des Limbus alveolaris – sollte bei Beachtung der vorliegenden Knochenqualität die Indikation zur Osteotomtechnik streng gestellt werden, um Mißerfolge zu vermeiden. Due to a configuration defect, the use of membrane-guided bone regeneration or alveolar ridge extension is required. The bone splitting and bone spreading technique was modified by developing the osteotome technique and the osteotome kit (Summers 1994). Lateral and apical bone displacement and condensation are the principles of this nonablative implant bed preparation technique. Estimation of the periimplant bone level is one of the important prognostic parameters for estimating implant survival. The level of the alveolar crest near implants which were inserted using the osteotome technique was investigated by measuring the differences between the alveolar crest and the implant shoulder in postoperative radiographs after implant insertion and after uncovering the implants in 17 patients. The osteotome technique was used in bone quality D2 and D3 according to the classification by Misch (1993). Significant differences were found between the bone levels after implant insertion and implant uncovering. A significant correlation (r = 0,5466; P = 0,023) was calculated between the differences of the marginal bone level at implantation and uncovering time and the bone quality. There should be strict indications for using the osteotome technique for evaluating the bone quality found at the implant site to optimize the long-term prognosis of the implants.

Dental implants in patients with oral mucosal diseases - a systematic review.

To reveal dental implants survival rates in patients with oral mucosal diseases: oral lichen planus (OLP), Sjögrens syndrome (SjS), epidermolysis bullosa (EB) and systemic sclerosis (SSc). A systematic literature search using PubMed/Medline and Embase databases, utilising MeSH and search term combinations identified publications on clinical use implant-prosthetic rehabilitation in patients with OLP, SjS, EB, SSc reporting on study design, number, gender and age of patients, follow-up period exceeding 12 months, implant survival rate, published in English between 1980 and May 2015. After a mean observation period (mOP) of 53·9 months (standard deviation [SD] ±18·3), 191 implants in 57 patients with OLP showed a survival rate (SR) of 95·3% (SD ±21·2). For 17 patients with SjS (121 implants, mOP 48·6 ± 28·7 months), 28 patients with EB (165 implants, mOP 38·3 ± 16·9 months) and five patients with SSc (38 implants, mOP 38·3 ± 16·9 months), the respective SR was 91·7 ± 5·97% (SjS), 98·5 ± 2·7% (EB) and 97·4 ± 4·8% (SSc). Heterogeneity of data structure and quality of reporting outcomes did not allow for further comparative data analysis. For implant-prosthetic rehabilitation of patients suffering from OLP, SjS, EB and SSc, no evidence-based treatment guidelines are presently available. However, no strict contraindication for the placement of implants seems to be justified in patients with OLP, SjS, EB nor SSc. Implant survival rates are comparable to those of patients without oral mucosal diseases. Treatment guidelines as for dental implantation in patients with healthy oral mucosa should be followed.

Sinus Floor Elevation and Augmentation Using Synthetic Nanocrystalline and Nanoporous Hydroxyapatite Bone Substitute Materials: Preliminary Histologic Results

PURPOSE To compare the tissue composition of augmented sites after using two different synthetic bone substitute materials, nanocrystalline and nanoporous hydroxyapatite (HA), for sinus floor elevation and augmentation. MATERIALS AND METHODS Forty-four patients received 88 titanium screw implants (Camlog Promote plus) of 4.3-mm diameter and 11- or 13-mm length, placed simultaneously during sinus floor elevation and augmentation. Nanocrystalline (Ostim) or nanoporous (NanoBone) HA were used exclusively. Bone substitute materials and implant lengths were allocated by randomization. Bone biopsy specimens were obtained from the former area of the lateral access window at implant exposure during healing abutment placement after 6 months. Biopsy specimens were prepared and examined histologically and histomorphometrically. RESULTS All implants were osseointegrated at the time of exposure. Clinically and histologically, no signs of inflammation in the augmented sites were present. The histomorphometric analysis of 44 biopsy specimens revealed 31.8% ± 11.6% newly formed bone for sites augmented with nanocrystalline HA and 34.6% ± 9.2% for nanoporous HA (P = .467). The proportion of remaining bone substitute material was 28.4% ± 18.6% and 30% ± 13%, respectively (P = .453). The proportion of soft tissue within the biopsy specimens was 39.9% ± 11.1% and 35.4% ± 6.8%, respectively (P = .064). No significant differences were found between the area fractions of bone, bone substitute material, and soft tissue concerning the bone substitute material utilized. CONCLUSION Within the present study, both synthetic bone substitute materials, nanocrystalline and nanoporous HA, were found to support bone formation in sinus floor elevation and augmentation procedures by osteoconductivity. They were not completely resorbed after 6 months. The amounts of newly formed bone, soft tissue, and bone substitute material remnants were found to be similar, indicating that both materials are likewise suitable for sinus floor elevation and augmentation procedures.

Electrostimulation of the lingual nerve by an intraoral device may lead to salivary gland regeneration: A case series study

Background Salivary gland function is controlled by the salivary reflex, whose efferent arm is composed by the parasympathetic and the sympathetic divisions of the autonomic nervous system. Parenchymal injury is the main salivary gland involvement of Sjögren’s syndrome and head and neck radiotherapy, but neural damage has been reported as well. Recently an intraoral device for electrostimulation of the lingual nerve in vicinity to the lower third molar has been introduced. At this point this nerve carries efferent fibers for the innervation of the submandibular, sublingual and several minor salivary glands and afferent fibers of the salivary reflex. Therefore, excitation of these fibers potentially leads to increased secretion of all salivary glands. Thus, the study objective was to assess whether comprehensive neural activation by electrostimulation of the lingual nerve carries the potential to induce the regeneration of damaged salivary glands. Material and Methods The device was tested on three patients with no collectable resting and stimulated secretion of saliva during a double blind, sham controlled period of two months and nine open-label months. Results All three subjects developed the capacity to spit saliva, not only in direct response to the electrostimulation but also after free intervals without electrostimulation. In addition, their symptoms of dry mouth severity and frequency improved. Conclusions This recovery is probably due to the combined effect of increase in secretory functional gland mass and regain of nervous control of the secretory elements and blood vessels. Both are phenomena that would contribute to gland regeneration. Key words:Xerostomia, dry mouth, saliva, electrostimulation, regeneration.

Professor Peter A. Reichart: an appreciation on the occasion of his 65th birthday

No other name is more closely associated with the field of oral medicine than that of Professor Peter A. Reichart, Head and Chairman of the Department of Oral Surgery and Dental Radiology at the Charité University Medicine, Berlin, who turns 65 on the 28th of March 2008. Peter A. Reichart graduated from dental school at the University of Munich in 1968. He went on to become a resident physician at the Department of Maxillofacial Surgery, University of Munich and Hanover with extensive training in oral and maxillofacial surgery including cleft lip and palate repair, tumour surgery, preprosthetic surgery and traumatology. A pivotal point in his life was moving in 1970 from Germany to Chiangmai, Thailand, where he took responsibility not only for the recently founded Department of Oral Surgery of Chiangmai Dental School, but for his young family. There he developed the curriculum, the Department of Oral Surgery itself, and established the surgical unit in the newly founded faculty of dentistry. The years from 1970 to 1973 gave rise to a deep-seated love of Asia, its people and its art. He is still able to speak Thai. Back in Europe, Peter A. Reichart completed his formal training at the Department of Oral Pathology of Professor Jens J. Pindborg (Royal Dental College Copenhagen). Following this contact, Jens Pindborg became his mentor, friend and research partner in numerous global projects (odontogenic tumours, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), epidemiological research on oral cancer). His thesis on “Clinical and experimental studies on the effect of Ra and Ra on the dental organ of rats” in 1978 pointed to one of his future areas of research: odontogenic tumours. To complete his knowledge on the field of oral pathology, he became a research fellow at the Department of Oral Pathology (under Prof. Mario Martinèz) in Birmingham, AL, USA. He was appointed a full professor in the Department of Oral Surgery and Dental Radiology North, at the Free University of Berlin, at the early age of 39. In 1994, the department was transferred to the Medical Faculty of the Charité. Peter A. Reichart is an internationally recognized scientist in the field of oral medicine, oral pathology and oral surgery. His reputation is based on his vast experience in oral precancer and cancer and various other fields such as odontogenic tumours, oral mucosal diseases, and, in particular, tropical diseases, such as oro-facial manifestaOral Maxillofac Surg (2008) 12:47–48 DOI 10.1007/s10006-008-0092-x