Manfred Wichmann

Zinc Gluconate in the Treatment of Dysgeusia—a Randomized Clinical Trial

In the treatment of dysgeusia, the use of zinc has been frequently tried, with equivocal results. The aim of the present randomized clinical trial, which involved a sufficiently large sample, was therefore to determine the efficacy of zinc treatment. Fifty patients with idiopathic dysgeusia were carefully selected. Zinc gluconate (140 mg/day; n = 26) or placebo (lactose; n = 24) was randomly assigned to the patients. The patients on zinc improved in terms of gustatory function (p < 0.001) and rated the dysgeusia as being less severe (p < 0.05). Similarly, signs of depression in the zinc group were less severe (Beck Depression Inventory, p < 0.05; mood scale, p < 0.05). With the exception of the salivary calcium level, which was higher in the zinc patients (p < 0.05), no other significant group differences were found. In conclusion, zinc appears to improve general gustatory function and, consequently, general mood scores in dysgeusia patients.

A double‐blind study on clonazepam in patients with burning mouth syndrome

In the treatment of burning mouth syndrome (BMS), various approaches have been tried with equivocal results. The aim of the present randomized clinical trial was to determine the efficacy of clonazepam, a GABA agonist designed as an antiepileptic drug that exerts the typical effects of benzodiazepines.

Radiographic evaluation of marginal bone levels adjacent to parallel-screw cylinder machined-neck implants and rough-surfaced microthreaded implants using digitized panoramic radiographs.

OBJECTIVE The purpose of this split-mouth study was to compare macro- and microstructure implant surfaces at the marginal bone level during a stress-free healing period and under functional loading. MATERIAL AND METHODS From January to February 2006, 133 implants (70 rough-surfaced microthreaded implants and 63 machined-neck implants) were inserted in the mandible of 34 patients with Kennedy Class I residual dentitions and followed until February 2008. The marginal bone level was radiographically determined, using digitized panoramic radiographs, at four time points: at implant placement (baseline level), after the healing period, after 6 months of functional loading, and at the end of follow-up. RESULTS The median follow-up time was 1.9 (range: 1.9-2.1) years. The machined-neck group had a mean crestal bone loss of 0.5 mm (range: 0-2.3) after the healing period, 0.8 mm after 6 months (range: 0-2.4), and 1.1 mm (range: 0-3) at the end of follow-up. The rough-surfaced microthreaded implant group had a mean bone loss of 0.1 mm (range: -0.4-2) after the healing period, 0.4 mm (range: 0-2.1) after 6 months, and 0.5 mm (range: 0-2.1) at the end of follow-up. The two implant types showed significant differences in marginal bone levels (healing period: P=0.01; end of follow-up: P<0.01). CONCLUSIONS Radiographic evaluation of marginal bone levels adjacent to machined-neck or rough-surfaced microthreaded implants showed that implants with the microthreaded design caused minimal changes in crestal bone levels during healing (stress-free) and under functional loading.

Evaluation of the difference in accuracy between implant placement by virtual planning data and surgical guide templates versus the conventional free-hand method – a combined in vivo – in vitro technique using cone-beam CT (Part II)

PURPOSE The purpose of this study was to assess the accuracy of implant placement after virtual planning of implant positions using cone-beam CT data and surgical guide templates, and to match the results with those achieved with the conventional free-hand method. MATERIALS AND METHODS Twenty-three implants were placed in 10 patients with a Kennedy Class II with 3-dimensional (3-D) planned surgical guide template. Manual implantation was performed in anatomical casts of the same patients by a prosthodontist and a maxillofacial surgeon. Postoperative images of casts were superimposed onto the preoperative image of virtual planned ideal position of the implant. RESULTS The 3-D surgical guide template produced significantly smaller variation between the planned and actual implant positions at the implant shoulder (0.9 mm (0-4.5)) and apex (0.6-0.9 mm (0.0-3.4)) compared with the free-hand implantation (2.4-3.5 mm (0.0-7.0); p=0.000 and 2.0-2.5 mm (0.0-7.7); p=0.002). Accuracy of axis was also significantly improved. CONCLUSIONS Accuracy of implant placement after virtual planning of implant position using cone-beam CT data and surgical templates is high and significantly more accurate than free-hand insertion. The demonstrated method of superimposing radiographic images of postoperative casts and virtual planning images is a useful method, which allows reduced patient radiation exposure.

Stress and Inflammation as a Detrimental Combination for Peri-implant Bone Loss

The causes of peri-implant bone loss continue to be controversial. To determine the impact of biomechanical stress and inflammation, we investigated a total of 80 interforaminal implants in situ for more than 10 years. Two stress groups, with 14 patients each, were established: a low-stress situation with single-standing implants, and an increased-stress situation with splinted implants. To categorize inflammation, we introduced a Composite Inflammation Score using 4 inflammatory parameters. Peri-implant bone loss was calculated from digital panoramic radiographs. To differentiate between the effects of stress and inflammation, we compared bone loss in both stress groups at equivalent levels of inflammation. With greater Composite Inflammation Score values, a clear discrepancy between single-standing and splinted implants was evident (p = 0.117/0.000, regression analysis; p = 0.135/0.000, analysis of variance; p = 0.002, t tests). While stress and inflammation alone may not necessarily be detrimental factors, the presence of stress heightens peri-implant bone loss significantly as inflammation increases.

Passivity of fit of CAD/CAM and copy-milled frameworks, veneered frameworks, and anatomically contoured, zirconia ceramic, implant-supported fixed prostheses

STATEMENT OF PROBLEM There is less information on the quality of fit of zirconia frameworks with or without ceramic veneer than on anatomically contoured milled zirconia restorations. PURPOSE The purpose of this in vitro study was to evaluate the strain development of CAD/CAM fabricated zirconia ceramic frameworks with and without ceramic veneering, copy-milled zirconia ceramic frameworks, and copy-milled zirconia ceramic anatomic contour restorations. MATERIAL AND METHODS Four groups of 3-unit implant-supported cement-retained restorations were fabricated (n=10) to fit an in vitro model with 2 implants. Strain gauges which recorded the strain development of all restorations during cementation were attached to the model mesially and distally adjacent to the implants. Mean absolute strain values were recorded for statistical analysis (MANOVA with Pillais trace; α=.05). RESULTS Mean absolute strain development at the different strain gauge locations ranged from 83.23 µm/m for copy-milled zirconia ceramic anatomic contour restorations to 301.20 µm/m for veneered CAD/CAM fabricated zirconia ceramic restorations. Significant effects (P<.001) of the fixed factors restoration type and veneering status, as well as of their interaction term (P=.001) were found. Ceramic veneering of CAD/CAM frameworks resulted in higher strain development, whereas the greater volume in copy-milled anatomic contour restorations did not affect accuracy. CONCLUSIONS With the systems used in this study, zirconia ceramic-based anatomic contour restorations show greater passivity of fit than ceramic veneered CAD/CAM fabricated zirconia ceramic frameworks.

Enhanced sympathetic cardiac modulation in bruxism patients.

Sleep bruxism, an oral parafunction including teeth clenching and grinding, might be related to increased stress. To evaluate sympathetic cardiac activity in bruxism patients, we monitored cardiac autonomic modulation using spectral analysis of heart rate variability and compared results to those of age-matched healthy volunteers. In bruxism patients, sympathetic cardiac activity was higher than in volunteers. The increased sympathetic tone suggests increased stress and might be related to occlusal disharmonies.

“Hypnopuncture”—A Dental-Emergency Treatment Concept for Patients with A Distinctive gag reflex

Abstract The present case report describes a newly developed dental treatment concept for patients with a distinctive gag reflex. “Hypnopuncture” is a combination therapy of hypnosis and acupuncture. Its simple, fast, and effective application autonomous of the cause makes it a valuable tool for dental-emergency treatment procedures. Physiologic and psychological aspects of gagging are influenced at the same time. The protocol is illustrated in the case of a 76-year-old patient with a severe gag reflex who was successfully treated by this combination approach. Necessary and effective therapeutic measures from both acupuncture and hypnosis are portrayed.

Radiographic evaluation of marginal bone levels during healing period, adjacent to parallel‐screw cylinder implants inserted in the posterior zone of the jaws, placed with flapless surgery

OBJECTIVE The purpose of this study was to compare changes at the marginal bone level adjacent to implants placed with flapless surgery and flap surgery during a stress-free healing period. MATERIAL AND METHODS Seven hundred and eighty-five implants were placed in 417 patients with a flapless approach and 459 implants were placed in 227 patients using flap techniques. The marginal bone level was determined radiographically, using digitized panoramic radiographs, at two time points: at implant placement (baseline) and after the healing period. RESULTS The median follow-up time was 0.5 years (SD, 1.2; range: 0.3-0.7). Implants placed with flapless surgery had a mean crestal bone loss of 0.5 mm (SD, 0.5; range: -0.7-2.4) and implants placed with flap surgery had a mean bone loss of 0.5 mm (SD, 0.7; range: -2.0-3.0) after healing. Differences in bone level changes between smokers and non-smokers were statistically significant for the flapless group (P<0.01). CONCLUSIONS A radiographic evaluation of marginal bone levels adjacent to implants showed comparable results for implants placed with flapless surgery and flap surgery. Appropriate case selection after virtual planning of the implant position and a sound surgical protocol is necessary for flapless surgery. Smoking habits may compromise the efficacy of flapless implant procedures.

Comparative study on interactive computer-aided-learning and computer-aided-testing in patient-based dental training in maxillofacial surgery.

AIM The objective of this comparative study was to validate, through empirical data, the use of interactive, problem-oriented computer-aided-learning (CAL) and computer-aided-testing (CAT) in dental studies by directly comparing these methods with conventional teaching. METHOD A total of 95 students from the third and fourth clinical semesters participated in an interdisciplinary seminar on oral maxillofacial implantology; 47 of these were taught using conventional teaching methods, while the remaining 48 students were taught using mobiTED, a CAL/CAT-based interactive communication system that can be used patient- and problem-oriented. An examination was given at the end of the course to evaluate student learning. A students interest/attentiveness, involvement, knowledge gain, and the course attractiveness and quality were evaluated with visual analogue scales (VAS) in a subjective experience protocol. RESULTS The study group taught using the CAL/CAT-based interactive communication system showed statistically significant better results in the examination, with a median score of 89.2%, while the conventional teaching study group achieved a median score of 76.0%. A VAS-based analysis of subjective experiences also revealed statistically significant differences between the two study groups. CONCLUSION Use of the CAL/CAT system for interactive, problem-oriented learning in patient-based dental training led to increased levels of attentiveness, of student acceptance and of the perceived attractiveness of the seminar. CAL/CAT-mediated instruction also led to increased communication, with a subsequent improvement in the qualitative and quantitative parameters of knowledge transfer and cognitive knowledge assimilation. Use of CAL/CAT also facilitated the acquisition, appraisal, and understanding of complex medical data.