Siegfried M. Heckmann

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.

Oral mucosal blood flow in patients with burning mouth syndrome.

&NA; The pathophysiology of burning mouth syndrome (BMS) is largely unknown. Thus, the aim was to study oral mucosal blood flow in BMS‐patients using laser Doppler flowmetry (LDF). Thirteen BMS patients (11 female, two male; mean age±SD 64.3±7.9 years, mean disease duration 18.9±6.2 months) and 13 healthy non‐smoking controls matched for age and gender (11 female, two male; mean age 64.7±8.1 years) were investigated. Using the LDF technique mucosal blood flow (mBF) was measured at the hard palate, the tip of the tongue, on the midline of the oral vestibule, and on the lip. Measurements were made at rest and over 2 min following dry ice application of 10 s duration using a pencil shaped apparatus. In addition, blood pressure (BP), heart rate (HR), peripheral cutaneous blood flow, and transcutaneous pCO2 were continuously recorded. Mucosal blood flow (mBF) increased at all measurement sites in response to dry ice application (P<0.001) with peak flow at 0.5–1.5 min after stimulation onset. During the following 1.5–2 min, blood flow decreased at all sites with a tendency to return to baseline towards the end of the observation period. Except for BP and peripheral blood flow, all of the cardiovascular changes exhibited significant changes during the observation period; no differences between groups were detected. When compared to healthy controls BMS patients generally exhibited larger changes in mBF. These changes were significant for recordings made on the hard palate (F[1,24]=13.9, P<0.001). Dry ice stimulation appears to be an effective, non‐invasive and reasonably tolerable means to investigate mucosal blood flow at different mucosal sites. In general, vasoreactivity in BMS patients was higher than in healthy controls. BMS patients exhibited a higher response on the hard palate compared to controls. These changes in oral blood flow appear to be specifically related to BMS symptoms indicating a disturbed vasoreactivity.

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.

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.

Gabapentin has little or no effect in the treatment of burning mouth syndrome - results of an open-label pilot study.

Burning mouth syndrome (BMS) is a complex disorder characterized by painful and burning sensations, which are localised to the tongue and lips but can be more widespread and involve the whole of the oral cavity [1,2]. Recently, in idiopathic BMS, an abnormal vasoreagibility of the oral mucosa and abnormal blink reflex were detected, indicating neuropathologic involvement at the level of the cranial nerves [3,4]. Gabapentin was beneficial in a number of clinical conditions including neuropathic and somatoform pain [5–11], and even in a case of BMS [12]. The aim of this pilot study was to investigate possible therapeutic effects of gabapentin in BMS patients. Fifteen idiopathic BMS patients (13 female, 2 male; age 63.6 ± 9.5 years, mean disease duration 32.6 ± 26.6 months) volunteered for this pilot study. Gabapentin was administered at a starting dose of 300 mg/day, slowly titrated (300 mg/day every 2 days) up to a maximum of 2400 mg/day. Seven patients were treated for 2 weeks, 6 patients for 4 weeks and two patients for 6 weeks (mean treatment duration 3.3 weeks). Olfactory and gustatory testing was performed before and after therapy [13,14]. Pain ratings [11-point Visual Analog Scale (VAS) from 0 (no pain) to 10 (most severe pain)], mood scales [15], and the Beck Depression Inventory (BDI) [referenced in 16] were obtained before and after therapy. The data were statistically analyzed by t-test and ANOVA and general linear model with repeated measurement design using SPSS 11.5 for Windows. All subjects completed testing without major complaints. Descriptive statistics of the measured parameters are presented in Table 1. Gabapentin had no effect on pain ratings (F[3,39] 1⁄4 0.72, P 1⁄4 0.51), mood scale (F[3,39] 1⁄4 0.86, P 1⁄4 0.42), BDI scores (F[3,39] 1⁄4 1.24, P 1⁄4 0.31), and chemosensory functions (gustatory test: t[14] 1⁄4 0.71, P 1⁄4 0.49; olfactory test: t[14] 1⁄4 1.93, P 1⁄4 0.07). Following therapy, only two patients indicated a decrease in pain intensity by 3 points of the 11-point VAS. Two other patients indicated a decrease in pain intensity by 2 points. In addition, duration of therapy had no effect on the various measured parameters. The present data indicate that gabapentin has little or no effect in BMS patients following treatment over an average period of 3.3 weeks. Some patients experienced unwanted side effects such as slight dizziness or fatigue which resolved within some days. These side effects are in accordance with those reported in the literature [10]. How can we explain the negative findings of the present study? It seems unlikely that the dosage was too small or that the duration of treatment was too short. Both the dosage prescribed and the treatment duration correspond to typical treatment regimens with gabapentin in a number of other clinical conditions in which treatment with gabapentin is successful. The number of patients was too small to detect a significant treatment effect. However, on an individual basis, only three patients with high BDI exhibited a decrease and no effect was seen for scores in the chemosensory tests. One possible explanation for the failure of gabapentin in BMS could be that the assumed presence of neuropathy is not the pathophysiologic mechanism underlying BMS. In fact, the studies indicating abnormal neuro-microvascular results were not able to differentiate whether these findings were the cause or consequence of the long-lasting pain syndrome [3,4]. Additionally these studies did not show morphologic changes of the neuromicrovascular unit but solely abnormal blink reflex [3] and changed reactivity in blood flow induced by dry ice application on different sites of the oral mucosa [4]. However, in the majority of clinical conditions in which gabapentin was effective, there was some structural changes in the affected parts of the nervous system. In conclusion, the present data suggest that gabapentin has little or no effect in BMS patients following treatment over an average period of 3 weeks. Results of this study also indicate that BMS is not the Table 1 Descriptive statistics of measured parameters (n 1⁄4 15)

Strain situation after fixation of three-unit ceramic veneered implant superstructures.

The passive fit of superstructures used in implant prosthodontics is affected by several variables. The objective of this study was to quantify the strain development in various fixed partial dentures (FPDs), both in the condition as cast and after ceramic veneering. Five different types of three-unit FPDs (cementable/repositioning technique impression; cementable/pick-up technique impression; screw-retained/plastic cylinder; screw-retained/gold cylinder; screw-retained/bonded) with 10 samples each, representing commonly used FPD-types, were investigated before and after ceramic veneering. Two ITI implants were anchored in a measurement model simulating a real-life patient situation and strain gauges were mounted close to the implants. The strain development was recorded during cement setting and screw fixation. For statistical analysis, multivariate two-sample tests were performed with the level of significance set at P = 0.1. All FPDs revealed measurable amounts of strain. Neither the impression technique nor the fabrication modes for conventional screw-retained FPDs had a significant influence on strain development. Ceramic veneering caused an increase in strain development for the conventional bridge types. Furthermore, cementing appears to be able to compensate fabrication inaccuracies better than screw retention. The lowest strains were found in FPDs bonded to gold cylinders on the measurement model for metal frames and ceramic-veneered FPDs. Conventional procedures are unable to produce superstructures with an absolute passive fit. The technique of bonding superstructures to prefabricated components in the oral cavity seems to compensate for various shortcomings in superstructure fabrication.

Improvement and long‐term stability of neuromuscular adaptation in implant‐supported overdentures

OBJECTIVES In edentulous patients, implant-supported overdentures can improve chewing efficiency and patient satisfaction, and even a positive impact on bone tissue preservation has been observed. The objective of this long-term study was to investigate whether kinesiographic and electromyographic (EMG) parameters would also benefit from implant placement and whether the status achieved would remain consistent over time. MATERIAL AND METHODS The functional adaptability of the neuromuscular system in edentulous patients has been recorded in four different states of restoration: (1) insufficient old dentures, (2) new complete dentures, (3) implant-supported overdentures, and (4) implant-supported overdentures 10 years in use. In each state of restoration, the neuromuscular adaptation was assessed during masticatory activity on the basis of myodynamic parameters such as vertical opening, frontal extension and closing velocity. EMG parameters, i.e. Musculus masseter and Musculus temporalis activities were recorded simultaneously. RESULTS The results revealed a general increase in the myodynamic and EMG-parameters. All of them clearly approached the values for normal dentate subjects and maintained this level over a period of 10 years. The significant changes between states 2 and 3 indicate that implant stabilization of dentures is accompanied by an immediate increase of the neuromuscular parameters. CONCLUSIONS In elderly edentulous patients, the treatment with two interforaminal implants provides evidence of neuromuscular adaptation towards values of healthy dentate. Thus, the known benefits of implant placement such as tissue perseverance and improved function are complemented by improved neuromuscular adaptation.

Neurophysiologic and Long-Term Effects of Clinical Hypnosis in Oral and Maxillofacial Treatment — A Comparative Interdisciplinary Clinical Study

Abstract This prospective comparative clinical study evaluated the effectiveness of clinical hypnosis and its long-term effect in oral and maxillofacial treatment. A total of 45 highly anxious and nonanxious subjects were evaluated by subjective experience and objective parameters. Parameters were EEG, ECG, heart rate, blood pressure, blood oxygen saturation, respiration rate, salivary cortisol concentration, and body temperature. During and subsequent to the operative treatment, hypnosis led to a significant reduction of systolic blood pressure, and respiration rate and to significant changes in the EEG. The subjective values of the parameters evaluated existing anxiety mechanisms and patterns and possible strategies to control them, whereas the objective parameters proved the effectiveness of hypnosis and its long-term effect.

The effect of load cycling on metal ceramic screw-retained implant restorations with unrestored and restored screw access holes

STATEMENT OF PROBLEM It has been shown that under cyclic loading, more chipping fractures of the veneer ceramic occur on the occlusal surface of screw-retained implant-supported fixed partial dentures (FPDs) with unrestored screw access holes (SAHs) than in cemented restorations. This lack of stability may result in esthetic and functional problems. PURPOSE The purpose of this study was to investigate whether, under dynamic loading, fewer chipping fractures occur on the occlusal surface of screw-retained ceramic veneered implant FPDs with restored SAHs than in those with unrestored SAHs. MATERIAL AND METHODS Twenty screw-retained ceramic veneered 5-unit FPDs were manufactured for a 3-implant situation and divided into 2 groups of 10 unrestored and 10 SAHs restored with adhesive composite resin restorations (Tetric Evo Ceram). A masticatory simulator was used to load the FPDs occlusal to the implant positions for 20,000 cycles with a force of 100 N applied for 1 second, followed by 1 second of no loading. Three prosthodontists evaluated the FPDs using a light microscope and a dental probe. The number of chipping fractures found were analyzed using a generalized linear model with Poisson response and log link function (alpha =.05). RESULTS Investigators found significantly more chipping fractures in the group of screw-retained FPDs with unrestored SAHs. The rate ratio of unrestored versus restored prostheses was 3.29 (P=.006). CONCLUSIONS Adhesive composite resin restorations can significantly reduce the number of chipping fractures occurring around the SAHs of screw-retained implant-supported restorations.

Oral mucosal blood flow following dry ice stimulation in humans

The aim of the current pilot study was to establish a procedure that would allow the investigation of microcirculatory changes in the oral cavity. The authors studied the effects of painful stimulation using dry ice (CO2). To investigate potential regional differences in the change of blood flow, recordings were made for the tongue and at the mucosa of the hard palate, lip, and oral vestibule. The authors investigated 26 patients divided into groups of younger subjects (10 men, 3 women; age range 21–31 y) and older patients (2 men, 11 women; age range 54–74 y). Mucosal blood flow (mBF) was obtained at the hard palate, at the tip of the tongue, on the midline of the oral vestibule, and at the lip. Measurements were made during rest and for 2 minutes after application of dry ice for a 10-second duration, using a pencil-shaped apparatus. Blood pressure, heart rate, cutaneous blood flow, transcutaneous partial pressure of carbon dioxiode (Pco2) and partial pressure of oxygen (Po2) were recorded. Mucosal blood flow increased at all sites in response to application of dry ice (p<0.001), with peak flow at 0.5 minute to 1.5 minutes after onset of stimulation. During the 1.5 minutes to 2 minutes, blood flow decreased at all measurement sites with a tendency to return to baseline. Heart rate, blood pressure, pCO2, pO2, and cutaneous blood flow did not show significant changes. Overall, responses in older patients showed more variance when compared with younger patients. Stimulation by dry ice appears to be an effective, noninvasive, and tolerable means to investigate mucosal blood flow at different mucosal sites. Preliminary data indicate different levels of responsiveness to painful cold stimulation at different sites on the oral and perioral mucosa; particularly, mucosal blood flow response at the tongue was least pronounced. Therefore, assessment of stimulated mucosal blood flow appears to be a promising tool to investigate the pathophysiology of a number of neurologic symptoms, eg, the burning mouth syndrome.