Norbert Jakse

Evaluation of three‐dimensional changes after sinus floor augmentation with different grafting materials

OBJECTIVE The aim of this retrospective investigation was to assess the dimensional stability of different grafting materials after maxillary sinus floor augmentation with computed tomography (CT) scans. MATERIALS AND METHODS Two postoperative CT scans were available from 16 patients who had undergone maxillary sinus lift procedures. The first scan was made within a few days after the surgical intervention and the second one >6 months later. A total of 25 maxillary sinuses were augmented with different materials before implant insertion by lateral antrostomy in a staged approach. The volume of bone formation was calculated using the Somaris Sienet Magic View software. RESULTS Based on volumetric measurements of the augmented domes derived from the image sections, shrinkage was about 26%. The mean of the augmented bone volume was 3.02 cm(3) (1.4-5.56 cm(3); SD+/-1.18 cm(3)) as determined in the first CT scan. The respective mean volume in the second CT scan amounted to 2.28 cm(3) (0.92-4.46 cm(3); SD+/-1.07 cm(3)). CONCLUSION Within the limits of our descriptive and analytic study, the results indicate a significant reduction of the graft volume after maxillary sinus augmentation. Further prospective studies will have to evaluate the quantitative changes of different bone graft materials for maxillary sinus augmentation procedures in order to improve long-term implant stability.

Oral status among seniors in nine nursing homes in Styria, Austria

OBJECTIVE To investigate the oral state in participants cared for in residences for senior citizens in Styria, Austria. MATERIALS AND METHODS Four hundred and nine participants in Styria from nine homes for senior citizens were examined employing parameters in accordance with those of Folsteins Mini Mental Status (MMS), DMFT, basic periodontal examination, the modified oral hygiene index, pain experienced during the preceding year, the subjective and objective need for treatment, and also requirements involving surgical and prosthetic treatment. Furthermore, the habitual methods of maintaining oral hygiene were examined establishing by whom this was carried out - whether by the patient, the nurse, or by patient and nurse together. RESULTS Four hundred and nine participants were examined, 48.3% were found to have retained on average 4.9 of their own teeth while 69% were fitted with dentures; however, 81% of the participants required prosthetic treatment. 28.9% of the participants had experienced acute dental pain during the preceding year and surgical treatment was found to be necessary in 47.7% of those with original teeth. Eighty-four per cent of the participants showed acute inflammation of the periodontium while the state of oral hygiene, measured on a scale of 0-4, reached an average of 2.43. Oral hygiene was carried out by the nurses in only 7.46% of the cases which showed an average MMS measurement of 18. CONCLUSION The results compared with those reported in other recent surveys and our data show an urgent need in Austria to improve the standards in dental care for the hospitalised elderly. Regular dental checks, carried out in the actual home by a dental surgeon should be introduced, whilst the nursing staff should be made fully aware of the problems caused by insufficient oral care and receive regular support from specialised oral hygiene assistants. The results of this survey also suggest that nursing staff should be equipped with simple instruments in order to judge to the extent to which the patient is capable of carrying out oral care independently and then according to the results to supplement this with additional care.

All‐ceramic restoration of zirconia two‐piece implants – a randomized controlled clinical trial

OBJECTIVES Aim of this controlled prospective randomized study was to evaluate the outcome of two-piece zirconia implants compared to titanium implants over a period of up to 24 months. MATERIAL AND METHODS A total of 31 implants (16 zirconia/Ziterion vario Z(®) + 15 titanium/Ziterion vario T(®) ) were inserted primary stable (>30 Ncm) in the maxilla (7) and mandible (24) of 22 patients (13 male, nine female) requiring neither bone nor soft tissue augmentation. After a healing period of 6 months in the maxilla and 4 months in the mandible, ceramic abutments were luted adhesively to the zirconia implants and definitive all-ceramic restoration was performed with high-density ceramics. Radiographic bone levels, condition of the peri-implant mucosa, aesthetic outcome, implant survival and success were recorded for up to 24 months. RESULTS Measurements of mean marginal bone levels 24 months after surgery showed a significant bone loss (P < 0.001) in both groups (Ti: 1.43 (SD ± 0.67) vs. Zir 1.48 (SD ± 1.05). One zirconia implant was lost 8 months after restoration. No further complications were recorded, giving an overall survival and success rate of 93.3% for zirconia and 100% for titanium implants after a period of up to 24 months. CONCLUSIONS After 24 months, success rates of the two-piece ceramic implants showed no significant difference compared to control two-piece titanium implants. The bonded zirconia implant abutment connection appears to be capable with clinical application over the observed period. However, further control measurements need to confirm the presented data.

Bisphosphonate-associated osteonecrosis of the jaws: surgical treatment with ErCrYSGG-laser. Case report.

Bisphosphonates (BP) play an important role in concomitant therapy of certain types of cancer and multiple myeloma as well as in treatment of osteoporosis. The administration of BP has great therapeutic benefits, but correlates with a specific kind of osteonecrosis of the alveolar bone. The so-called bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a rare, but often severe adverse side effect of high-dosage and long-term BP therapy. Thus far, no consensus for treatment of BRONJ has been achieved. All strategies have to take into account the insecure prognosis and danger of recurrence of clinically apparent necrosis and progression of disease. At the Department of Oral Surgery and Radiology, Medical University of Graz, an ErCrYSGG laser was successfully applied in surgical treatment of BRONJ. Stable mucosal coverage could be achieved in all of 5 cases. Laser surgery can be considered as a promising technique for the effective treatment of BRONJ.

Behaviour of multipotent maxillary bone‐derived cells on β‐tricalcium phosphate and highly porous bovine bone mineral

OBJECTIVES The aim of this study was to test the applicability of multipotent maxillary cells (MMC) for cell therapy concepts and to evaluate their in vitro behaviour on two different bone substitutes. MATERIAL AND METHODS Cells isolated from maxillary bone from 10 donors were expanded using media containing human platelet lysate (HPL) replacing foetal bovine serum and differentiated towards both the osteogenic and the adipogenic lineage. Surface markers were determined by fluorescence-activated cell sorting analysis. Calcium deposits, alkaline phosphatase (ALP) and osteocalcin (OC) were used as biomarkers of osteogenic differentiation. Oil Red O was used to verify adipogenic differentiation. The osteogenic lineage and undifferentiated controls were further cultured on natural bone mineral of bovine origin (BioOss) and beta-tricalcium phosphate (Vitoss) scaffolds. Scaffold efficacy and cell migration were evaluated with live cell imaging. RESULTS Isolated cells presented characteristics of bone marrow (BM)-stromal cells and could easily be expanded to clinical scales. Cells expressed osteogenic and adipogenic markers when cultured with inductive media. There were no obvious differences in cell migration and growth behaviour between the two bone substitutes, but significantly higher OC expression was observed on BioOss scaffolds. Both osteogenically differentiated and undifferentiated cell lines expressed ALP activity on the scaffolds. CONCLUSION Isolated maxillary cells demonstrate multipotent in vitro characteristics comparable with those of BM-stromal cells. HPL can predictably be used for clinical-scale expansion of MMCs. Both grafting materials provide potential carrier characteristics when loaded with MMCs.

Impact of autogenous concentrated bone marrow aspirate on bone regeneration after sinus floor augmentation with a bovine bone substitute--a split-mouth pilot study.

PURPOSE Mesenchymal stem cells (MSC) with biomaterials have osteoinductive potential. The aim of this study was to evaluate early bone formation in xenogenic sinus grafts in a direct comparison with and without MSCs after 3 and 6 months. Literature on bone formation in pure xenogenic graft materials after 3 months in a human model is still lacking. MATERIALS AND METHODS In a split-mouth design, seven patients with a bilateral highly atrophic posterior maxilla were included. The test side was grafted with MSCs from concentrated bone marrow aspirate admixed to the bone graft material. On the control side, pure bovine bone material was applied. Biopsies were taken navigated after 3 and 6 months. RESULTS After 3 months, new bone formation in the control group was 11.8% (SD 6.2%) and in the test group 7.4% (SD 4.1%). After 6 months, the control group showed 13.9% (SD 8.5%) of new bone and the test group 13.5% NB (SD 5.4%). The fraction of bovine bone material after 3 months was 42.6% (SD 3.5%) in the test group and 34.9% (SD 11.8%) in the control group. After 6 months, the biomaterial content was comparable at both sides (test 36.2%, SD 7.8%; control 39.5%, SD 9.3%). CONCLUSIONS There was no significant difference in new bone formation between the test and control group with n = 7. The results may be dominated by the high mineral content of the biomaterial but could nevertheless be valuable for meta-analysis in the future.

The supernumerary nasal tooth

Teeth exceeding the normal dental complement that have erupted into the nasal cavity are a rare pathological entity. This case report describes a female patient with recurrent complaints and fetid discharge from the left nasal cavity. The suspected clinical diagnosis of a supernumerary nasal tooth was confirmed by computed tomography. After endoscopic removal, the tooth was examined using X-ray microtomography and thin-section preparations; these findings are presented for the first time. A literature search identified 25 supernumerary nasal teeth in 23 patients.

Dental age estimation of living persons: Comparison of MRI with OPG

The need for forensic age estimations in living adolescents is high mainly due to migration, particularly from countries where birth dates are not reliably documented. To date, the gold standard of dental age estimation is the evaluation of the mineralization and eruption stages of the third molars using an orthopantomogram (OPG). However, the use of ionizing radiation without medical indication is ethically controversial and not permitted in many countries. Thus, the aim of this study was to investigate if dental MRI can be used for the assessment of dental age with equally good results as when using an OPG. 27 healthy volunteers (19 ♀, 8 ♂, age range 13.6-23.1 years, median 18.9 years) underwent an MRI scan of the jaw after a clinically indicated OPG. Mineralization and eruption stages of the molars were independently analyzed on OPGs and MRI by two blinded dentists according to the staging system established by Demirjian and Olze, respectively. The results of OPG and MRI were compared and inter-rater agreement was determined. The developmental stages of the 262 evaluated molars could be clearly differentiated in MRI. For both, mineralization and eruption, there was a good correlation between MRI and OPG. Overall MRI tended to yield slightly lower stages than the OPG. Inter-rater agreement was moderate for mineralization and good regarding eruption. Although a validation of these results using modality-specific reference values is needed, dental MRI seems to be suitable for a use in dental age estimation.

Reproducibility of volumetric measurements on maxillary sinuses.

Although computer assisted volumetric quantification of human maxillary sinuses is commonly used to measure volumetric changes during life, reliability data for this procedure are lacking. The objective of this retrospective study is to test a semi-automatic virtual volumetric analysis technique on 36 CT scans of human maxillary sinuses. Three examiners with different clinical experience performed all measurements in three replicates. As principle of proof, the technique was examined on 12 phantoms with known volumes. The validation of the method revealed that the mean relative error was 0.364%. For the retrospective volumetric measurements from maxillary sinuses the intra- and inter-examiner agreement was quantified using appropriate intraclass correlation coefficients (ICC 1,k and ICC 2,k) and the Bland-Altman analysis. ICC values ranging from 0.997 to 0.999 indicate almost perfect agreement for intra- and inter-examiner data. The Bland-Altman analysis demonstrated good intra- as well as inter-examiner agreement for the two proficient examiners and a lack of agreement for the untrained examiner. It can be concluded that this measurement procedure using CT scans could be strongly recommended for clinical application to determine the volume of human maxillary sinuses reliably.

Oral Rehabilitation of Adult Twins With Severe Lack of Bone Due to Hypohidrotic Ectodermal Dysplasia : A 12-Month Follow-Up

PURPOSE Patients with x-linked hypohidrotic ectodermal dysplasia (XLHED, OMIM 305100) often present with exceptional oral conditions, because alveolar ridges can remain severely hypotrophic due to oligo- or anodontia in the primary and/or permanent dentition. This can seriously disable a young person physically and psychologically, and lead to sociopsychological isolation. PATIENTS AND METHODS The oral rehabilitation of fraternal male twins with XLHED, one with severe hypodontia and the other with anodontia is described. The treatment of both patients comprised augmentation of the jaws using bicortical corticocancellous bone blocks from the medial aspect of the anterior hip, delayed implantation, and restoration of the occlusion with bar-retained overdentures. The multidisciplinary team approach included an oral and maxillofacial surgeon, a prosthodontist, and a speech therapist. RESULTS After uneventful healing, the 12-month follow-up showed that sufficient osseointegration of the implants for optimized function was obtained by creating adequate de novo bone volume in the underdeveloped jaw regions. Full regular masticatory function was achieved, and esthetics were improved considerably in both patients. CONCLUSION Augmentation and implant placement prior to prosthetic rehabilitation appears to be a suitable treatment option for adult patients with XLHED.