Hans-Peter Howaldt

Sinus lift augmentation using autogenous bone grafts and platelet-rich plasma: radiographic results.

OBJECTIVES Autologous bone grafting and sinus floor elevation is a widely accepted method for reconstruction of the atrophic maxilla. The aim of this investigation was to examine the influence of platelet-rich plasma (PRP) on bone grafting in sinus floor augmentation. STUDY DESIGN A prospective, controlled, randomized study including 34 patients undergoing sinus augmentation before implant placement was designed. The intervention group had additional treatment with PRP. Radiographic imaging was performed by computerized tomography (CT) and panoramic radiography 4 months after augmentation and before implant placement. RESULTS Bone density showed no significant increase when PRP was used in combination with autologous bone grafting compared with autologous bone alone. CONCLUSIONS This study showed no positive effect of PRP on bone density in CT evaluation when used in sinus floor augmentation. Bone density in the CT showed no correlation to histomorphometric evaluation.

Ergebnisse aus dem DÖSAK-Tumorregister

The German-Swiss-Austrian Group on Maxillofacial Tumors (DOSAK) has been performing observational studies in oral cancer. Since 1989, approximately 1600 cases of tumor of the head and neck per years has been collected in a central tumor registry. The database consists of more than 16,000 patients from 71 clinics; almost two-thirds are primary cases of squamous cell carcinoma. The data show great differences in patho-anatomical findings, therapy concepts, and five-year survival rates among the hospitals.Der DÖSAK ist seit jeher auf dem Gebiet der Beobachtungsstudien besonders aktiv gewesen. Seit der Gründung des Tumorregisters 1989 sind bei einer Rekrutierungsrate von jährlich etwa 1600 neuen Patienten mit Tumoren im Kopf-Hals-Bereich die Daten von inzwischen über 16.000 Patienten von 71 Kliniken erfasst. Davon umfasst das Kollektiv der primären Karzinome der Lippen, der Mundhöhle und des Oropharynx zum Zeitpunkt Juni 1999 insgesamt 9002 Patienten. Bei der Auswertung der Daten zeigten sich z. T. erhebliche Unterschiede bezüglich pathoanatomischer Befundung, Therapiekonzepten und 5-Jahres-Überlebensraten zwischen den einzelnen Kliniken. The German-Swiss-Austrian Group on Maxillofacial Tumors (DÖSAK) has been performing observational studies in oral cancer. Since 1989, approximately 1600 cases of tumor of the head and neck per years has been collected in a central tumor registry. The database consists of more than 16,000 patients from 71 clinics; almost two-thirds are primary cases of squamous cell carcinoma. The data show great differences in patho-anatomical findings, therapy concepts, and five-year survival rates among the hospitals.

Topical use of platelet-rich plasma to influence bone volume in maxillary augmentation : a prospective randomized trial

Background and Objectives  The atrophic posterior maxilla often requires restoration of the alveolar ridge due to a lack of bone quantity and quality before dental implant placement. The aim of this study was to verify the hypothesis that platelet‐rich plasma (PRP) has an influence on bone density in the maxilla after sinus floor elevation in combination with autologous cancellous bone from the iliac crest. Therefore, a randomized, prospective, controlled trial was set up in two centres.

Accuracy of photographic assessment compared with standard anthropometric measurements in nonsynostotic cranial deformities.

Objective Anthropometric landmarks of the skull have traditionally been used to describe cranial deformities resulting from nonsynostotic plagiocephaly or brachycephaly. Recently, digital photography has become an important tool for characterizing facial and cranial pathologies. The purpose of this study was to compare standard anthropometric cranial measurements with measurements taken from cranial photographs. Patients Standardized digital images in the supracranial view and cranial anthropometric measurements were obtained from 122 children between the ages of 3 and 15 months. The photographs were assessed using Quick Ceph® software. The cephalic index and cranial vault asymmetry index were used to indicate the degree of cranial deformity. Children were classified into plagiocephaly, brachycephaly, and the combination of both. To determine interobserver variability, two clinicians separately measured the cephalic index and cranial vault asymmetry index from digital photographs in 70 infants of the plagiocephalic group. Results To compare interassay reliability for these methods of obtaining the cephalic index and cranial vault asymmetry index, the differences between photographically and anthropometrically derived values were plotted against anthropometrically derived values alone (Bland-Altman plots). The photographic method satisfied the limits of agreement (cephalic index, 7.51%; cranial vault asymmetry index, 6.57%) and showed slightly lower values represented by the respective bias (cephalic index, 1.79%; cranial vault asymmetry index, 3.03%). Comparison between observers revealed excellent agreement, detected by the intraclass correlation coefficient of .982 for the cephalic index and .946 for the cranial vault asymmetry index. Conclusion Our results demonstrate that digital photography is a reliable tool for quantifying cranial deformities. Furthermore, it is rapid, noninvasive, and reproducible. However, we continue to use both methods in clinical practice.

Application of ultrasound in callus distraction of the hypoplastic mandible: an additional method for the follow-up

Mandibular callus distraction was performed on 14 patients. In addition to established radiological methods, sonography was performed to monitor the clinical progress. Ultrasound shows a precise picture of all interesting items in distraction treatment. Although the value of radiographs is not obsolete completely, sonography was found to be a meaningful supplement in the clinical monitoring of callus distraction. Furthermore the method is capable of early recognition of complications and it can reduce X-ray exposure.

NOS inhibition synchronizes calcium oscillations in human adipose tissue-derived mesenchymal stem cells by increasing gap-junctional coupling.

Adipose tissue‐derived mesenchymal stem cells (ASCs) are a promising stem cell source for cell transplantation. We demonstrate that undifferentiated ASCs display robust oscillations of intracellular calcium [Ca2+]i which may be associated with stem cell maintenance since oscillations were absent in endothelial cell differentiation medium supplemented with FGF‐2. [Ca2+]i oscillations were dependent on extracellular Ca2+ and Ca2+ release from intracellular stores since they were abolished in Ca2+‐free medium and in the presence of the store‐depleting agent thapsigargin. They were inhibited by the phospholipase C antagonist U73,122, the inositol 1,4,5‐trisphosphate (InsP3) receptor antagonist 2‐aminoethoxydiphenyl borate (2‐APB) as well as by the gap‐junction uncouplers 1‐heptanol and carbenoxolone, indicating regulation by the InsP3 pathway and dependence on gap‐junctional coupling. Cells endogenously generated nitric oxide (NO), expressed NO synthase 1 (NOS 1) and connexin 43 (Cx 43). The nitric oxide NOS inhibitors NG‐monomethyl‐L‐arginine (L‐NMMA), N(G)‐nitro‐L‐arginine methyl ester (L‐NAME), 2‐ethyl‐2‐thiopseudourea, and diphenylene iodonium as well as si‐RNA‐mediated down‐regulation of NOS 1 synchronized [Ca2+]i oscillations between individual cells, whereas the NO‐donors S‐nitroso‐N‐acetylpenicillamine (SNAP) and sodium nitroprusside (SNP) as well as the soluble guanylate cyclase inhibitor 1H‐[1,2,4]oxadiazolo‐[4,3‐a]quinoxalin‐1‐one (ODQ) were without effects. The synchronization of [Ca2+]i oscillations was due to an improvement of intracellular coupling since fluorescence recovery after photobleaching (FRAP) revealed increased reflow of fluorescent calcein into the bleached area in the presence of the NOS inhibitors DPI and L‐NAME. In summary our data demonstrate that intracellular NO levels regulate synchronization of [Ca2+]i oscillations in undifferentiated ASCs by controlling gap‐junctional coupling. J. Cell. Physiol. 226: 1642–1650, 2011.

High resolution imaging of craniofacial bone specimens by flat-panel volumetric computed tomography

INTRODUCTION The prototype flat-panel volumetric computed tomograph (fpvCT) provides a new 3D imaging technology with detailed high resolution by using large-area flat-panel X-ray detectors. The object of this study was to evaluate the benefit of high resolution imaging using the experimental fpvCT to visualise different types of human craniofacial bone pathology. The study proved the feasibility of performing an intraoperative evaluation of free margins in bone malignancies using fpvCT. MATERIAL AND METHODS In this study, 35 bone specimens of various pathological types were examined by fpvCT. fpvCT data were compared with pre-operative multislice clinical CT images as well as with post-operative histological findings. RESULTS Bone tumours can be visualised with their specific pathological architecture and infiltration structure faster and more precisely by fpvCT than by multislice CT. The analysis of the resection margins supports the surgical procedure intraoperatively, especially when an immediate reconstruction with bone transplantation is carried out. DISCUSSION The fpvCT has a superior image quality when compared with clinical CT systems. The imaging of the bone structure itself has been shown to be useful for the interpretation of osseous resection borders. Furthermore, it can facilitate the diagnosis of tumour progression, especially in areas that are difficult to access, such as the base of the skull.

Estimation of legal age using calcification stages of third molars in living individuals

The increased number of adolescents and young adults with unknown or inaccurately given date of birth is a current issue in justice and legal medicine. The objective of this study was to determine the extent to which third molar calcification stages assessed on panoramic X-rays could be useful as additional criteria for forensic age estimation in living individuals, focusing on the legally important ages 17 and 18. In a retrospective multi-center study, the developmental stage of each individuals third molar was analyzed using Demirjians scale in 2360 cases. Additionally, sex, age and ancestry were assessed. Individuals with the lowest calcification stage of all present molars in stage H were ≥18 years with a likelihood of ≥99.05% in the female (n=388), and ≥99.24% in the male (n=482) population. The lowest calcification stage of all present third molars proved to be useful as an additional reliable criterion for the determination of an age ≥18 years.

Cone beam computed tomography (CBCT) sialography—an adjunct to salivary gland ultrasonography in the evaluation of recurrent salivary gland swelling

OBJECTIVE Cone beam computed tomography (CBCT) sialography could help improve the visualization of the ductal system of salivary glands. The aim of this retrospective investigation was to monitor the use of CBCT sialography for the diagnosis of pathologies within the intraglandular ductal system when ultrasonography was inconclusive. STUDY DESIGN Fourteen consecutive patients suffering from recurrent swelling of a major salivary gland were evaluated. In 12 patients (8 female; 4 male; average age 46 years), a radiopaque contrast agent could be injected into the ductal system, followed by a routine CBCT. Four blinded examiners evaluated the acquired data sets retrospectively. RESULTS CBCT revealed seven stenosis, two salivary stones, one complete duct atresia, one intraglandular duct ectasia, and one regular duct system. Three of the detected pathologies were strictly intraglandular. CONCLUSIONS CBCT sialography shows promise as a supplementary noninvasive diagnostic tool for the visualization of the intraglandular ductal system of the major human salivary glands. Controlled studies to further validate this method should be undertaken.

Lethal cervical abscess following bisphosphonate related osteonecrosis of the jaw

CONTEXT Bisphosphonates are common drugs used in the management of bone metabolic diseases. Because of their recently increased use, their adverse effects, especially bisphosphonate-related osteonecrosis of the jaw (BRONJ), are monitored more frequently. BRONJ is a critical challenge in craniofacial surgery and is difficult to treat. Its occurrence is either spontaneous or follows dentoalveolar surgery. Typical complications of BRONJ are painful exposed bone, pathological fractures, extra-oral fistula, and local infections. OBJECTIVE The aim of this paper is to report a rare case of bacterial embolism in the internal jugular vein after a BRONJ-induced submandibular abscess resulting in bacterial sepsis, multi-organ failure syndrome, and death. CASE ILLUSTRATION A 59-year-old female patient developed severe BRONJ (stage II) with recurrent abscesses after oral osteoporosis therapy with alendronic acid. A subsequent submandibular abscess led to bacterial embolism of the left internal jugular vein, causing sepsis and death. DISCUSSION Prevention, early detection and management of BRONJ remain a crucial challenge in craniofacial clinical practice. Despite several therapeutic approaches described in the current literature, none have undergone bedside application. CONCLUSION Considering this report of death after recurrent abscesses following BRONJ, the use of bisphosphonates should be carefully monitored in order to prevent such severe complications.