Interstitial radiotherapy with 198Au seeds in the primary management of carcinoma of the oral tongue: results in Freiburg/Breisgau from January 1964 to July 1980.

Thirty-two patients with histologically proven carcinoma of the oral tongue, Stage T1-3, were analyzed retrospectively. They were treated from January 1964 through July 1980 in Freiburg by interstitial implantation with Au-198-seeds for the primary tumor management. Out of 25 patients with complete follow-up, one patient developed a local recurrence. In three patients, regional lymph node metastases occurred, once after prior adjuvant radiotherapy to the regional lymph nodes area, and in two patients after exclusive interstitial radiotherapy to the tumor of the tongue. The overall five-year survival rate was 52% for all stages (overall group), 75% for Stage T1 and 44% for Stages T2-3. The corrected five-year survival rate was 75% for all stages, 86% for Stage T1 and 71% for Stages T2-3. The method of 198Au-seed implantation as it is practiced in Freiburg is discussed, as well as the radiation exposure of the personnel.

The titanium surface texture effects adherence and growth of human gingival keratinocytes and human maxillar osteoblast-like cells in vitro.

The adhesion, orientation and proliferation of human gingival epithelial cells and human maxillar osteoblast-like cells in primary and secondary culture were studied on glossy polished, sandblasted and plasma-sprayed titanium surfaces by scanning electron microscopy and in thin sections. The primary cultured explants of human gingival epithelial cells attached, spread and proliferated on all titanium surfaces with the greatest extension on the polished and the smallest extension on plasma-sprayed surfaces. In secondary suspension cultures of gingival keratinocytes, attachment spreading and growth was only observed on polished and plasma-sprayed surfaces, but not on sandblasted surfaces. Moreover, the attachment of these cells depended on the seeding concentration as well as on the coating with fetal calf serum. Cells on polished surfaces developed an extremely flat cell shape, but on sandblasted and plasma-sprayed surfaces a more cuboidal shape. In contrast human maxillar osteoblasts seeded as secondary suspension cultures attached very well to all three differently textured titanium surfaces and showed identical growth patterns independent of the titanium surface structure. These findings suggest that cell morphology, orientation, proliferation and adhesion of human gingival epithelial cells in primary or secondary culture are dependent on the texture of the titanium surface whereas no such differences were observed for maxillar osteoblast-like cells. In conclusion, the soft tissue integration and response is more influenced by the surface texture than the process of osseointegration.

Interaction of osteogenic cells with hydroxylapatite implant materials in vitro and in vivo.

In a series of scanning electron microscopic studies, the reaction of osteogenic cells to hydroxylapatite (HA) implant materials was investigated in culture and following implantation. Tissue components as found in normal rat and dog bone were identified at the interface in both test systems. In vivo, implant bed cells showed an intimate contact with the HA surfaces. Osteoblasts deposited organic matrix and bone mineral in direct apposition to HA, with no evidence of encapsulation or granulation tissue. The development of such a direct spatial relationship appears to involve mechanisms more encompassing than epitaxis.

Primary reconstruction with AO-miniplates after severe cranio-maxillofacial trauma.

Miniplate osteosynthesis has proven to be an invaluable aid when used in severe cranio-maxillo-facial trauma and has thus eliminated the necessity for external fixation devices. Primary exact anatomical reduction, and fixation of the fragments with miniplates, gives both good aesthetic and functional results.

Radiation and osteosynthesis. Dosimetry on an irradiation phantom.

An irradiation phantom was used to measure dose increases using the backscatter of different materials (titanium, steel, lead, aluminium). Telecobalt-60 and 8-MV photons were used for the irradiation. The irradiation dose was measured by means of a defined X-ray film blackening. The most important parameter was to find out whether under simulated conditions, undesirable hot spots occur. We were able to demonstrate that a 12.5 to 16% increase in the radiation dose can be observed for titanium and steel at a distance of 0.45 mm from the metal specimen. A comparison between titanium and steel did not demonstrate a relevant advantage for titanium. Therefore, adjuvant percutaneous radiation therapy should not have any influence on the life of the implant, if the soft tissue layer is of sufficient thickness. The available literature is reviewed and presented in tables.

Cellular and molecular biological events at the implant interface.

Since implants attain and maintain contact with the body environment through their surfaces, the interfacial interaction between implant bed and implant surface could be a determinant of the implant's performance. This study used osteoblasts to test the ability of different ceramic and metallic surfaces to bind fibronectin and to support cell attachment, adhesion, migration and synthesis of extracellular matrix. The results showed active molecular and cellular interaction between the cells and the surfaces. Extracellular matrix synthesis was demonstrated on surfaces that did not subject the cells to toxicity embarrassment. It is concluded that the surfaces of implants should not be designed to be mere bystanders in the interfacial scenario. Instead they should be conceived with a view to enabling them to interact positively with the molecules responsible for would healing, interfacial tissue morphogenesis and repair.

Cultured gingival epithelium. A possible suitable material for pre-prosthetic surgery.

In cultivating gingival epithelium from people up to the age of 66 years it is possible to gain a differentiated mucosal tissue sheet that is more than 100 times the size of the original biopsy surface. The morphological characteristics are a prickle cell layer with polygonal cells and a basal cell layer with flattened cells. Desmosomes, tonofibrils and microplicae at the superficial side of the epithelium are typical features. There is a cell biological differentiation as the distinct binding of lectins and of a cytokeratin antibody proves. The multiplication in surface area, the possibility of using cells of senior patients and the morphological and cell biological differentiation of cultured gingival epithelium are advantages in its application for the autologous bridging of intraoral defects.

Comparison of transcutaneous incisions used for exposure of the infraorbital rim and orbital floor: a retrospective study.

One hundred and five patients were investigated for functional and aesthetic impairments following treatment of orbital trauma through subciliary, mid-lower eyelid, or infraorbital incisions. The progress of impairments with time was assessed, and the merits and shortcomings of each of the three approaches were established. The results showed that impairments persisting up to 6 months postoperatively have virtually not receded even after 6 years. The infraorbital incision showed the highest frequency of impairments, followed by the subciliary incision. The mid-lower eyelid incision showed the best results, with an impairment frequency well below those of the other two approaches. This approach seems to combine the advantages of the infraorbital incision with the unnoticeable scar formation associated with the subciliary incision.

Penicillin concentration in the compact bone of the mandible.

During surgical removal of impacted third molars, the concentration of Penicillin G was determined in the compact bone of the mandible. Fifteen patients received 5 million IU and 15 received 10 million IU of Penicillin G intravenously as a single dose before surgery began. In both groups concentrations of penicillin with a bactericidal effect on most pathogenically relevant oral bacteria were detected during osteotomy. Taking into account the considerable interindividual variation, the one-shot application of 10 million IU of Penicillin G was more effective in certain cases than the 5 million IU dose. The factors influencing the decision on the high single-dose application include expected length of operation, body weight, kidney function, and infusion period. Assuming that in intraoral osteotomies the bone becomes contaminated with bacteria that are highly sensitive to penicillins, the results indicate that preoperative infusion of Penicillin G could be an effective method of preventing wound infection.

Titanium deposition in regional lymph nodes after insertion of titanium screw implants in maxillofacial region.

The deposition of titanium in regional lymph nodes was studied after insertion of endosseous, plasma-spray-coated titanium screw implants in a total of 19 beagle dogs. Five additional animals with no implants served as the control group. After killing the animals 9 months postoperatively, the regional lymph nodes were carefully excised, and samples were prepared for histologic examination. Other samples were used to identify foreign particles by energy-dispersive x-ray analysis and for measurement of the titanium concentration in the tissue by flameless atomic absorption spectroscopy. Very fine foreign-body particles could be seen in the histologic sections, and they were identified as titanium by energy-dispersive x-ray analysis. The atomic absorption analysis for titanium revealed a significantly higher concentration in the group with implants. The presence of very fine, poorly attached particles on the plasma-sprayed titanium surface suggests that these particles may be mechanically dislodged from the surface on insertion of the implants. This suggests that the fine particles may be transported by phagocytes to the regional lymph nodes, where they could be found without any signs of inflammation or foreign-body reaction.

Plate fixation of fractures of the mid and upper face.

The principles and techniques of rigid plate and screw fixation for fractures of the mid and upper face are presented. These techniques offer advantages for the repair of fractures in these area, as well as for the stabilization of planned osteotomies.

Facial deformities and their treatment.

Even minor facial deformities impose a burden on the personality: the face is vital for its identification of the individual. Defects in facial form cannot be concealed. The origins of most deformities lie in the bony skeleton. They may be either congenital or acquired. In the congenital deformities, form, size and function are disturbed during the course of development, whereas in the acquired deformities parts of the face are lost by surgery or trauma. Occlusion is always affected in deformities of the central and lower thirds of the face. Conversely, massive disturbances of occlusion have repercussions on facial form. Congenital deformities should be corrected early if function is also disturbed, but additional correction is often necessary after growth is complete. If only the proportions of the bony skeleton of the face are affected, the deformity is corrected after the termination of growth. Reconstruction of normal occlusion is essential in the correction of facial deformities. Tissue missing as a result of surgery or trauma is replaced by grafts. Disturbances of development caused by local disease (neoplasia or osteomyelitis) affecting the face constitute an intermediate form of deformity. These defects should receive only functional correction during growth, final reconstruction not being undertaken until it is complete.

The influence of lip function on the sagittal and transversal development of the maxilla in cleft patients.

Cleft patients who have undergone surgery often show considerable inhibition in the sagittal development of the mid-face after completed growth. This is partly attributed to scar contraction in the lip region following surgery. The present investigation deals with the etiological factors involved in the development disturbances caused by the cleft in the maxilla of 100 cleft patients. Particular attention was paid as to the unfavourable effect of the operated cleft lip. This was tested electromyographically and correlation between the electromyographic and the skeletal measurements was sought. Electromyographic changes in lip activity during orthodontic treatment was also investigated. The effect of these changes is discussed.

The development of the ITI Dental Implant System as a model for the cooperation between research and industry.

For thirty years now oral implants and methods for implantation have been developed further to assure a lifetime stability of these devices and to optimize function and esthetics. Coming from osteosynthesis the Institut Straumann in cooperation with leading clinicians had a considerable share in this development. Out of this longtime cooperation an institutionalized form was devised, where clinicians, material scientists and engineers were united in the International Team for oral Implantology (ITI). This scientific organization, although legally and financially independent from Institut Straumann, works in close cooperation with the company in an unique form of symbiosis. The ITI takes care of research and education of clinicians and practitioners and it gives the needed input for the development of new products to the Institut Straumann as its exclusive licensee. The company again pays license fees to the ITI Foundation enabling thus a continuous scientific clinical research. Over many years a whole philosophy and implant system - the ITI Dental Implant System - was developed this way with its sound scientific background.

[Traction screw osteosynthesis in the treatment of fracture of the angle of mandible (author's transl)]. / Zugschraubenosteosynthese zur Behandlung der Kieferwinkelfraktur.

The application of traction strapping with a single cortical screw in the form of lag screw osteosynthesis has been suggested for the treatment of angular factures of the mandible. This is also possible in those cases where there are other mandibular fractures, whether the molar teeth are present or not. The original occlusion is thereby easily reconstructed. The rehabilitation of the patient is generally possible 8 days postoperatively when the intra-oral stitches are removed.

[Selection of the method of surgical approach in plate osteosynthesis of mandibular fractures]. / A mütéti feltárás megválasztása állkapocstörések lemezes oszteoszintézisekor.

BACKGROUND: Plateosteosynthesis by intraoral approach of mandibular fractures gives the best cosmetical result but presents a rather difficult procedure. AIMS: Comparison of intra- versus extraoral approach in plateosteosynthesis of mandibular fractures. METHODS: Plate type, experience of the surgeon, age and sex of the patient, as well as hospital stay and rate of the septic complications were analysed retrospectively in 248 patients of the OMF Department (University Freiburg) with mandibular fractures with respect in view of the operative approach used. RESULTS: The method of osteosynthesis was found to be the strongest determinant. Concerning the surgical approach significant correlation was found between age and sex, and surgical experience. Operative approach was found to have no effect on hospitalization and septic complications. CONCLUSION: Operative approach does not have either medical nor economical consequences in the surgical management of mandibula fractures.