Aberrant DNA methylation of ADAMTS16 in colorectal and other epithelial cancers.

BACKGROUND: ADAMs (a disintegrin and metalloproteinase) have long been associated with tumor progression. Recent findings indicate that members of the closely related ADAMTS (ADAMs with thrombospondin motifs) family are also critically involved in carcinogenesis. Gene silencing through DNA methylation at CpG loci around e.g. transcription start or enhancer sites is a major mechanism in cancer development. Here, we aimed at identifying genes of the ADAM and ADAMTS family showing altered DNA methylation in the development or colorectal cancer (CRC) and other epithelial tumors. METHODS: We investigated potential changes of DNA methylation affecting ADAM and ADAMTS genes in 117 CRC, 40 lung cancer (LC) and 15 oral squamous-cell carcinoma (SCC) samples. Tumor tissue was analyzed in comparison to adjacent non-malignant tissue of the same patients. The methylation status of 1145 CpGs in 51 ADAM and ADAMTS genes was measured with the HumanMethylation450 BeadChip Array. ADAMTS16 protein expression was analyzed in CRC samples by immunohistochemistry. RESULTS: In CRC, we identified 72 CpGs in 18 genes which were significantly affected by hyper- or hypomethylation in the tumor tissue compared to the adjacent non-malignant tissue. While notable/frequent alterations in methylation patterns within ADAM genes were not observed, conspicuous changes were found in ADAMTS16 and ADAMTS2. To figure out whether these differences would be CRC specific, additional LC and SCC tissue samples were analyzed. Overall, 78 differentially methylated CpGs were found in LC and 29 in SCC. Strikingly, 8 CpGs located in the ADAMTS16 gene were commonly differentially methylated in all three cancer entities. Six CpGs in the promoter region were hypermethylated, whereas 2 CpGs in the gene body were hypomethylated indicative of gene silencing. In line with these findings, ADAMTS16 protein was strongly expressed in globlet cells and colonocytes in control tissue but not in CRC samples. Functional in vitro studies using the colorectal carcinoma cell line HT29 revealed that ADAMTS16 expression restrained tumor cell proliferation. CONCLUSIONS: We identified ADAMTS16 as novel gene with cancer-specific promoter hypermethylation in CRC, LC and SCC patients implicating ADAMTS16 as potential biomarker for these tumors. Moreover, our results provide evidence that ADAMTS16 may have tumor suppressor properties.

No deficit in neurocortical information processing in patients with cleft lip and palate.

BACKGROUND: Cleft lip and palate (CLP) represents the most common malformation of the midfacial region worldwide. It can be suggested that the facial stigmatization, the speech impediment, and the long-standing pressure of treatment cause a range of life stressors. Neurocortical information is influenced by physiological and psychological factors and varies significantly in patients suffering from chronic stress, anxiety, depression, or other psychopathological conditions following maladaptation. The aims of the present study were to investigate the neurocortical information processing of patients with CLP using the contingent negative variation (CNV) paradigm and to evaluate secondary psychopathology, anxiety, and depression. MATERIALS AND METHODS: Twenty-five adults with CLP and 25 healthy volunteers, matched in age and gender, were investigated using recordings of the CNV. Initial CNV (iCNV), late CNV (lCNV), and total CNV (tCNV) as well as habituation slope of the iCNV were determined in each subject. Additionally, each participant had to complete the hospital anxiety and depression questionnaire (HADS) and the Symptom Checklist-90-R (SCL-90-R). RESULTS: Individuals with CLP did not differ significantly from healthy subjects according to any of the CNV parameters investigated. No correlations could be revealed between the measured items and the confounding factors age and gender. Additionally, there were no differences between the groups regarding depression and SCL-90-R; however, anxiety showed significant group differences on a subclinical level. CONCLUSIONS: These data suggest that subjects with CLP show normal neurocortical information processing. It seems likely that CLP and its treatment have no impact on psychosocial functioning and neurophysiological mechanisms of attention. CLINICAL RELEVANCE: The specific living conditions of patients with CLP do not result in disease-specific neurophysiological changes.

Increased infection rates of sinus floor elevations after the use of a bone filter.

OBJECTIVES: The collection of bone debris during the preparation of sinus floor augmentations is a commonly used technique for avoiding autologous bone transplants and thereby reducing donor site morbidity. However, the collected bone debris has a higher risk of bacterial contamination. The aim of this retrospective study was to analyse whether the use of a bone filter had an impact on the infection rates after sinus floor augmentation. MATERIALS AND METHODS: A retrospective analysis was conducted of 340 sinus floor elevations (136 using a bone filter) in 249 patients. The sinus floor elevations were performed with the lateral approach. RESULTS: Localised infection occurred in 7.0 % (24 of 340) of the sinus floor elevations. In 40.0 % of the cases, a bone filter was used, and in this group, the infection rate was 13.0 %. In the control group, the infection rate was 4.0 %. One hundred one patients received bone transplants from the iliac crest, and these patients had a lower infection rate of 2.0 %. Stepwise factor reduction, according to Akaike, showed the use of a bone filter to be the most relevant factor for postoperative infection. CONCLUSIONS: To reduce the amount of bacteria, full-mouth disinfection with chemical agents and a strict aspiration protocol should be used when a bone filter is applied. Antibiotic prophylaxis should be prescribed to reduce the risk of postoperative infections further. CLINICAL RELEVANCE: In use of a bone filter, there is the possibility of higher infection rates of sinus floor augmentations.

Effects of zoledronate on irradiated bone in vivo: analysis of the collagen types I, V and their cross-links lysylpyridinoline, hydroxylysylpyridinoline and hydroxyproline.

Radiotherapy can lead to a reduction of bone density with an increased risk of pathological fractures. Bisphosphonates may represent a preventive treatment option by increasing the density of anorganic bone mineral. Yet it is unknown how bisphosphonates act on irradiated collagen cross-links, which play an essential role for the mechanical stability of bone. The aim of this study was to evaluate the effects of zoledronate on bone collagens and their cross-links after irradiation. The right femur of 37 rats was irradiated with a single dose of 9.5 Gy at a high dose rate using an afterloading machine. Half of the rats (n=18) received additionally a single dose zoledronate (0.1 mg/kg body weight). Fourteen and 100 days after irradiation the femora were collected for histologic evaluation and determination of the collagen cross-links lysylpyridinoline, hydroxylysylpyridinoline, and hydroxyproline. The collagen types were characterized by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Fourteen days after treatment the lysylpyridinoline levels of all treatment groups were significantly lower compared to the untreated control. After 100 days, in the combined radiotherapy+zoledronate group significantly lower lysylpyridinoline values were determined (p=0.009). Radiotherapy and/or zoledronate did not change significantly the level of hydroxylysylpyridinoline. The concentration of hydroxyproline was 14 days after irradiation significantly higher in the combined treatment group compared to the control. No significant differences were observed 100 days after treatment. Zoledronate does not have the ability to restore the physiological bone collagen cross-link levels after radiotherapy. However, this would be necessary for regaining the physiological mechanical stability of bone after irradiation and therefore to prevent effectively radiation-induced fractures.

Comparison of platelet rich fibrin and collagen as osteoblast-seeded scaffolds for bone tissue engineering applications.

OBJECTIVES: The loss of jaw bone caused by different kinds of pathologies leads to dysfunction and reduced quality of life in affected patients. Thus, the pivotal goal in bone tissue engineering is to reconstruct these defects. The essential precondition for new tissue generation is an extracellular matrix which acts as a scaffold so that cells can migrate, differentiate, and proliferate. Fibrin, a biopolymer responsible for blood clot formation, has been shown to be suitable for tissue engineering applications. The aim of the present study is a comparison of platelet rich fibrin (PRF) with the commonly used collagen membrane BioGide(®) as a scaffold for human osteoblast cell seeding for bone tissue engineering. MATERIAL AND METHODS: Human osteoblasts were cultured with eluates from PRF (n = 7) and BioGide(®) (n = 8) membranes incubated in serum-free cell culture medium. Vitality of these cells was assessed by fluorescein diacetate and propidium iodide staining, biocompatibility with the lactate dehydrogenase test and proliferation levels with the MTT ([3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium-bromide]), and BrdU (5-bromo-2-deoxyuridine) tests. In addition, human osteoblasts were seeded on both membrane systems and cell growth was compared by the water soluble tetrazolium (WST-1) (4-[3-(4-iodophenyl)-2-(4-nitrophenyl)-2H-5-tetrazolio]-1,3-benzene disulfonate) test and scanning electron microscopy (SEM). Osteoblastic differentiation was assessed by alkaline phosphatase activity measured by ELISA in the supernatant of osteoblasts cultivated on PRF membranes (n = 10), PRF clots (n = 10), and BioGide(®) membranes (n = 10). RESULTS: Lactate dehydrogenase test values were higher for PRF compared to BioGide(®) . The BrdU test showed superior cell growth after cultivation in eluate from PRF than in eluate from BioGide(®) . The WST-1 assay demonstrated superior cell proliferation on PRF than on BioGide(®) . SEM revealed osteoblast colonization of both membranes. Cultivation of osteoblasts on PRF membranes and PRF clots showed significantly higher alkaline phosphatase activity than on BioGide(®) membranes. CONCLUSION: Metabolic activity and proliferation of human osteoblast cells in vitro were supported to a significant higher extent by eluates from PRF membranes. Both membranes are suitable as scaffolds for cultivation of human osteoblast cells in vitro; proliferation was significant higher on PRF membranes and on PRF clot than on BioGide(®) membranes.

The role of electrochemotherapy with intratumoral bleomycin for early tongue carcinoma.

BACKGROUND: The role of electrochemotherapy (ECT) using intratumoral bleomycin and electroporation as a first line treatment for oral tongue carcinoma has not been defined. AIMS/OBJECTIVES: To evaluate the method of ECT in oral tongue carcinoma. MATERIAL AND METHODS: Twenty-one successive patients with primary T1-T2 oral cancer predominantly of the oral tongue underwent either ECT (test; n = 9), or standard surgical resection and reconstruction (control; n = 12). Outcome variables were: local recurrence rates, 10-year-survival, adverse events, treatment cost, and quality of life. RESULTS: The 10-year local recurrence rate (44.4%) was higher and the tumour-specific survival rate (55.6%) was lower in the ECT group compared to the control group (17% and 91.6%, respectively). Postoperative haemorrhage, dysphagia, and pain were more frequent in ECT patients, treatment time was shorter, but treatment cost was higher. Quality of life was not improved by ECT. CONCLUSIONS AND SIGNIFICANCE: Our results indicate that ECT seems not as suitable for the treatment of early tongue cancer as it is for neoplastic and metastatic skin lesions and less favourable than standard surgical therapy.

Platelet-rich fibrin membranes as scaffolds for periosteal tissue engineering.

OBJECTIVES: Platelet-rich fibrin (PRF)-based membranes have been used for covering alveolar ridge augmentation side in several in vivo studies. Few in vitro studies on PRF and no studies using human periosteal cells for tissue engineering have been published. The aim is a comparison of PRF with the commonly used collagen membrane Bio-Gide as scaffolds for periosteal tissue engineering. MATERIAL AND METHODS: Human periosteal cells were seeded on membrane pieces (collagen [Bio-Gide] and PRF) at a density of 10(4) cells/well. Cell vitality was assessed by fluorescein diacetate (FDA) and propidium iodide (PI) staining, biocompatibility with the lactate dehydrogenase (LDH) test and proliferation level with the MTT, WST and BrdU tests and scanning electron microscopy (SEM). RESULTS: PRF membranes showed slightly inferior biocompatibility, as shown by the LDH test. The metabolic activity measured by the MTT and WST tests was higher for PRF than for collagen (BioGide). The proliferation level as measured by the BrdU test (quantitative) and SEM examinations (qualitative) revealed higher values for PRF. CONCLUSION: PRF appears to be superior to collagen (Bio-Gide) as a scaffold for human periosteal cell proliferation. PRF membranes are suitable for in vitro cultivation of periosteal cells for bone tissue engineering.

Unilateral atrophy of the cheek: autologous fat injection as treatment of choice.

Lipodystrophies are a set of heterogeneous conditions resulting from defective lipid metabolism and characterized by adipose tissue atrophy. We report on a 54-year-old woman who presented at the Department of Oral and Maxillofacial Surgery with an increasing unilateral atrophy of her left cheek for the past 3 years. The patient's history showed that she had sustained a left zygoma fracture 35 years ago but did not have any other disease. According to the patient's wish, a correction of the left cheek was performed by autologous fat injection, which led to a highly acceptable postoperative result. We compare this treatment with different alternatives.

Recurrent chromosomal and epigenetic alterations in oral squamous cell carcinoma and its putative premalignant condition oral lichen planus.

Head and neck squamous cell carcinoma (HNSCC) affects about 700.000 individuals per year worldwide with oral squamous cell carcinoma (OSCC) as a major subcategory. Despite a comprehensive treatment concept including surgery, radiation, and chemotherapy the 5-year survival rate is still only about 50 percent. Chronic inflammation is one of the hallmarks of carcinogenesis. Until now, little is known about the premalignant status of oral lichen planus (OLP) and molecular alterations in OLP are still poorly characterized. Our study aims to delineate differential DNA methylation patterns in OLP, OSCC, and normal oral mucosa. By applying a bead chip approach, we identified altered chromosomal patterns characteristic for OSCC while finding no recurrent alterations in OLP. In contrast, we identified numerous alterations in the DNA methylation pattern in OLP, as compared to normal controls, that were also present in OSCC. Our data support the hypothesis that OLP is a precursor lesion of OSCC sharing multiple epigenetic alterations with OSCC.

Effect of ultraviolet photofunctionalization of dental titanium implants on osseointegration.

OBJECTIVE: The aim of the current study was to evaluate the effect of ultraviolet (UV) photofunctionalization of dental titanium implants with exposure to the oral cavity on osseointegration in an animal model. METHODS: Forty-eight titanium implants (Camlog® Conelog® 4.3 mmx9.0 mm) were placed epicrestally into the edentulous jaws of three minipigs and implant stability was assessed by measuring the implant stability quotient (ISQ). Prior to implantation half of the implants were photofunctionalized with intense UV-light. After three months, the implants were exposed and ISQ was measured again. After six months of implant exposure, the minipigs were sacrificed and the harvested specimens were analyzed using histomorphometric, light, and fluorescence microscopy. MAIN RESULTS: Forty-two of 48 implants osseointegrated. The overall mean bone-implant contact area (BIC) was (64±22)%. No significant differences were found in BIC or ISQ value (multivariate analysis of variance (MANOVA), P>0.05) between implants with and without exposure to UV photofunctionalization. CONCLUSIONS: No significant effects were observed on osseointegration of dental titanium implants nine months after exposure of UV photofunctionalization.

The antibiotic resistome and microbiota landscape of refugees from Syria, Iraq and Afghanistan in Germany.

BACKGROUND: Multidrug-resistant bacteria represent a substantial global burden for human health, potentially fuelled by migration waves: in 2015, 476,649 refugees applied for asylum in Germany mostly as a result of the Syrian crisis. In Arabic countries, multiresistant bacteria cause significant problems for healthcare systems. Currently, no data exist describing antibiotic resistances in healthy refugees. Here, we assess the microbial landscape and presence of antibiotic resistance genes (ARGs) in refugees and German controls. To achieve this, a systematic study was conducted in 500 consecutive refugees, mainly from Syria, Iraq, and Afghanistan and 100 German controls. Stool samples were subjected to PCR-based quantification of 42 most relevant ARGs, 16S ribosomal RNA gene sequencing-based microbiota analysis, and culture-based validation of multidrug-resistant microorganisms. RESULTS: The fecal microbiota of refugees is substantially different from that of resident Germans. Three categories of resistance profiles were found: (i) ARGs independent of geographic origin of individuals comprising BIL/LAT/CMA, ErmB, and mefE; (ii) vanB with a high prevalence in Germany; and (iii) ARGs showing substantially increased prevalences in refugees comprising CTX-M group 1, SHV, vanC1, OXA-1, and QnrB. The majority of refugees carried five or more ARGs while the majority of German controls carried three or less ARGs, although the observed ARGs occurred independent of signatures of potential pathogens. CONCLUSIONS: Our results, for the first time, assess antibiotic resistance genes in refugees and demonstrate a substantially increased prevalence for most resistances compared to German controls. The antibiotic resistome in refugees may thus require particular attention in the healthcare system of host countries.

Current concepts in cleft care: A multicenter analysis.

The current surgical techniques used in cleft repair are well established, but different centers use different approaches. To determine the best treatment for patients, a multi-center comparative study is required. In this study, we surveyed all craniofacial departments registered with the German Society of Maxillofacial Surgery to determine which cleft repair techniques are currently in use. Our findings revealed much variation in cleft repair between different centers. Although most centers did use a two-stage approach, the operative techniques and timing of lip and palate closure were different in every center. This shows that a retrospective comparative analysis of patient outcome between the participating centers is not possible and illustrates the need for prospective comparative studies to establish the optimal technique for reconstructive cleft surgery.

Proof of direct radiogenic destruction of collagen in vitro.

BACKGROUND: Fibroses of vessels and soft tissue are side effects of radiotherapy. The authors assumed that there was an immediate direct radiogenic damage of collagen of bone, periosteum and skin. MATERIAL AND METHODS: 15 porcine jaws samples (group 1) were exposed to a total dose of 60 Gy (cobalt-60, 2 Gy/day, five fractions/week). 15 jaws samples were stored accordingly (group 2, no irradiation, control). Collagen fragments of bone, periosteum and skin samples of groups 1 and 2 were isolated by ultrafiltration. Collagen types were characterized by SDS-PAGE measurement of the mature collagen cross-links hydroxylysylpyridinoline (HP) and lysylpyridinoline (LP) by high-performance liquid chromatography (HPLC) and analysis of hydroxyproline (Hyp) was used to determine the ratio of the amount of collagen fragments from irradiated as opposed to nonirradiated samples. RESULTS: The concentrations of HP, LP and Hyp in ultrafiltrates of probes of irradiated bone, periosteum and skin were markedly increased (average factors for bone: 3.69, 1.84, and 3.40, respectively; average factors for periosteum: 1.55, 1.41, and 1.77, respectively; average factors for skin: 1.55, 1.60, and 2.23, respectively) as compared to nonirradiated probes. SDS-PAGE did show collagen types I and V in nonirradiated bone, I and III in nonirradiated skin, and I in nonirradiated periosteum samples. In irradiated samples, smeared bands illustrated fragmentation of the collagen molecule. CONCLUSION: The increased concentrations of HP, LP and Hyp in ultrafiltrates indicated increased concentrations of split collagen. Direct and instant radiogenic damage of (extracellular matrix of) bone, periosteum and skin tissue collagen could be demonstrated.

Correlation of general and oral health-related quality of life in malocclusion patients treated with a combined orthodontic and maxillofacial surgical approach.

PURPOSE: The aim of the study was to collect information about the oral health-related quality of life (OHRQoL) after combined orthodontic and maxillofacial surgical treatment as well as its influence on health-related quality of life (HRQoL). MATERIALS AND METHODS: The study includes data from a total of 130 subjects, 65 of whom (21 male, 44 female, mean age at baseline: 24 years, mean age at the time of surgery: 26 years) were compared with control subjects matched on the basis of gender and age. The set of questionnaires used consisted of a questionnaire advanced by the authors including 35 general and treatment-specific questions, and the German version of the validated "Orthognathic Quality of Life Questionnaire" (OQLQ) to analyze the specific OHRQoL, and the SF-36 to measure HRQoL. RESULTS: The main reason for treatment was most often a combination of esthetic and functional complaints. In most cases, the treatment results met the expectations of subjects well or very well, particularly in the areas of aesthetics and masticatory function. Postoperative numbness or paresthesia were present in 59% of patients, especially in the chin and lower lip areas. In all, 20% of subjects considered the temporary restriction of mouth opening as very bothersome. A decrease in HRQoL was noted as compared with the control group in the subscales of "role physical" (p < 0.001), "general health" (p = 0.023), and "role emotional" (p = 0.007). No differences were found in the "physical functioning," "bodily pain," "vitality," "social functioning," and "mental health" subscales. The specific OHRQoL resulted in statistically significant limitations in the patient group for all areas examined. The "oral function" (p < 0.001), "dentofacial aesthetics" (p = 0.005), "social aspects" (p = 0.002), and "awareness of dentofacial aesthetics" (p = 0.004) values were significantly decreased. CONCLUSIONS: Overall, patients expressed a high level of satisfaction and approval with regard to the combined orthodontic and maxillofacial surgical treatment. However, even after combined orthodontic and maxillofacial surgical treatment of malocclusion patients, it is possible to detect smaller limitations with regard to the specific OHRQoL, which may have a negative impact on HRQoL. Based on the results, a participatory decision-making process focusing on the individual therapy-related expectations, desires, and psychological factors of the patient concerning the improvements effected by the treatment appears to be advisable.

Can one-wall bone defects be augmented with xenogenic bone grafting material alone?

OBJECTIVES: The main aim of this study was to evaluate the impact of xenogenic bovine bone grafting material particle size, addition of harvested autogenic bone as well as the influence of a periosteum on growth of newly formed bone, bone marrow, residual bone grafting material and connective tissue of one-wall defects. METHODS: Overall 32 augmentation sites were placed on the frontal skull of four minipigs and covered with titanium pin immobilized absorbable porcine membranes. After a 6 month healing period the harvested specimens were analyzed using light- and fluorescence microscopy. RESULTS: In the augmented areas 47%-57% bone, 14%-34% bone marrow, 10%-20% residual xenogenic bone grafting material and 4.5%-10% connective tissue were found. Admixture of autogenic bone resulted in statistically significantly more newly formed bone, more bone marrow, less residual xenogenic bone grafting material and less connective tissue (P ≤ 0.03). CONCLUSIONS: While augmenting one-wall defects seems to be possible with xenogenic grafting material and absorbable membranes alone, the addition of autogenic bone seems to benefit the augmentation site.

Influence of Four Different Abutment Materials and the Adhesive Joint of Two-Piece Abutments on Cervical Implant Bone and Soft Tissue.

PURPOSE: The main aim of this study was to evaluate the influence of four different abutment materials and the adhesive joint of two-piece abutments on the cervical implant bone and soft tissue. MATERIALS AND METHODS: Sixty-four titanium implants (Camlog Conelog; 4.3 ± 9 mm) were placed bone level into the edentulous arches of four minipigs. Four different types of abutments were placed at implant exposure: zirconium dioxide, lithium disilicate, and titanium bonded to a titanium luting base with resin cement; one-piece titanium abutments served as the control. The animals were sacrificed 6 months after implant exposure, and the bone-to-implant contact (BIC) area, sulcus depth, the length of the junctional epithelium and the connective tissue, the biologic width, and first cervical BIC-implant shoulder distance were measured using histomorphometry and light and fluorescence microscopy. RESULTS: Overall, 14 implants were lost (22%). At exposure, the implant shoulder-bone distance was 0.6 ± 0.7 mm. Six months later, the bone loss was 2.1 ± 1.2 mm measured histomorphometrically. There was a significant difference between the two measurements (P ≤ .0001). No significant influence could be found between any of the abutment materials with regard to bone loss or soft tissue anatomy (P > .05), with the exception of zirconium dioxide and onepiece titanium abutments when measuring the length of the junctional epithelium (P ≤ .01). The maxilla provided significantly more soft tissue and less bone loss compared with the mandible (P ≤ .02). CONCLUSION: All tested abutment materials and techniques seem to be comparable with regard to soft tissue properties and the cervical bone level.

Secondary cleft nose rhinoplasty: Subjective and objective outcome evaluation.

INTRODUCTION: Secondary rhinoplasty in cleft lip and palate (CLP) is commonly the last step in a set of surgical procedures that result in a variable but typically intensive change in facial appearance. However, there is evidence that the sentiment about the aesthetic and functional outcomes between patients and surgeons is different. The present study aimed to evaluate the subjective and objective outcomes of secondary rhinoplasty in patients with CLP. MATERIAL AND METHODS: Secondary rhinoplasty was performed in 10 patients with repaired unilateral CLP via a standardized open approach. For the subjective evaluation, the patients completed the rhinoplasty outcome evaluation (ROE) questionnaire. Pre- and postoperative photographic documentation served as the basis for the objective evaluation, which included the following: (1) assessment by five specialists at craniofacial malformation consultation appointments and by three doctors in continuing education using the Asher-McDade aesthetic index (AMAI) rating, and (2) metric facial analysis to determine the nasofrontal angle and the nasolabial angle. RESULTS: Patient satisfaction was high, based on the evaluation of the ROE questionnaire. The analysis of the AMAI rating questionnaire showed no significant differences between the positive ratings of the 'experienced' and 'inexperienced' doctors. In contrast, there was an obvious and significant difference between the 'preoperative' and 'postoperative' time points for questions 1-3. The metric analysis showed statistically significant improvements of the nasolabial angle and the nasofrontal angle. The subjective and objective outcome evaluations were descriptively congruent. CONCLUSIONS: The data suggest that standardized secondary rhinoplasty in CLP leads to both a subjective and a statistically significant objective improvement of facial appearance and thus may support the psychosocial rehabilitation of affected patients. Furthermore, our results showed that the subjective and objective outcome evaluations of secondary rhinoplasty were largely compatible.

Mechanical properties of collagen membranes: are they sufficient for orbital floor reconstructions?

INTRODUCTION: The most common reconstruction materials for orbital floor fractures are PDS (polydioxanone) foil and titanium meshes. These materials have advantages and disadvantages. Therefore, new materials are needed to improve surgical outcomes. MATERIALS AND METHODS: Three resorbable collagen membranes (Smartbrane(®), BioGide(®), Creos(®)) were tested for their mechanical properties (puncture strength) in mint and artificially aged (3, 6, 8 weeks) conditions and were compared to PDS foil, titanium meshes (0.25 mm, 0.5 mm) and human orbital floors (n = 7). RESULTS: The following puncture strengths were evaluated: human orbital floor, 0.81 ± 0.49 N/mm(2); 0.25 mm titanium mesh, 5.36 ± 0.25 N/mm(2); 0.5 mm titanium mesh, 16.08 ± 5.17 N/mm(2); Smartbrane, 0.74 ± 0.31 N/mm(2); BioGide, 1.65 ± 0.45 N/mm(2); and Creos, 2.81 ± 0.27 N/mm(2). After artificial aging, the puncture strengths were significantly reduced (p ≤ 0.05) at 3, 6 and 8 weeks as follows: Smartbrane, 0.05 ± 0.03 N/mm(2), 0.03 ± 0.02 N/mm(2), and 0.01 ± 0.01 N/mm(2), respectively; BioGide, 0.42 ± 0.06 N/mm(2), 0.41 ± 0.12 N/mm(2), and 0.32 ± 0.08 N/mm(2), respectively; and Creos, 2.02 ± 0.37 N/mm(2), 1.49 ± 0.42 N/mm(2), and 1.36 ± 0.42 N/mm(2), respectively. CONCLUSION: The tested materials showed sufficient puncture strength for orbital floor reconstruction in mint condition. Moreover, after artificial aging, the Creos and BioGide membranes showed sufficient resistance, while Smartbrane showed equivocal data after eight weeks. Therefore, collagen membranes have adequate properties for further in vivo investigations for orbital floor reconstructions.

A comparison of conservative and invasive dental approaches in the treatment of tension-type headache.

OBJECTIVE: To investigate the efficacy of conservative dental treatment (occlusal splint and pharmacologic therapy) and invasive therapy (prosthetic restorations) in the treatment of tension-type headache (TTH). METHOD AND MATERIALS: The study sample was composed of 70 patients who presented with symptomatic TTH and were assigned to three treatment groups according to their treatment needs. Group A (30 patients): a conservative treatment protocol with a combination of an occlusal splint and analgesic and muscle relaxant medication. Group B (10 patients): invasive prosthodontic procedures. Group C (30 patients): patients who refused any type of treatment but consented to the study served as a control group. Pain quality was measured with the Headache Impact Test (HIT-6). The statistical analysis was performed with the Wilcoxon rank test (P≤.05). RESULTS: Conservative treatment with splints and analgesic medication and invasive treatment by prosthetic rehabilitation relieved the TTH symptoms. The patients who received treatment experienced a significant reduction in their discomfort after 6 months (P≤.01), whereas the patients who refused therapy remained, on average, at the same pain level (P≤.117). In group A, the HIT-6 score was reduced for 26 patients, and in group B for 8 patients. In group C a reduction of HIT-6 scores was observed in 10 patients. CONCLUSION: Conservative or invasive occlusal adjustments may serve as a useful tool in the treatment of TTH.

Children with a cleft lip and palate: an exploratory study of the role of the parent-child interaction.

INTRODUCTION: Having a child with an orofacial cleft may be associated with a specific pattern of parenting. In order to investigate the parenting style, the present study assessed parent-child interactions during a problem-solving task performed under pressure. MATERIAL AND METHODS: Parent-child interactions were video recorded for 15 families with a child with a cleft lip and palate (CLP), which were then compared to 20 healthy families and 20 families with a child suffering from migraines. The children had to solve a puzzle within a specified time with either their mother or father. RESULTS: In families with a child with CLP, mothers tried to support their children more often and children demonstrated more autonomous behaviour towards both parents than children in healthy and migraine-affected families. Moreover, the children with CLP relied less on their fathers for help and interrupted their fathers less frequently. CONCLUSIONS: Autonomous behaviour among children with CLP which is supported by their parents may represent psychosocial compensatory mechanisms in the family environment.