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.

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.

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.

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.

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.

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.

Effects of different scaffolds on rat adipose tissue derived stroma cells.

BACKGROUND: Adipose tissue derived stroma cells (ASC's) offer for many advantages for tissue engineering strategies over mesenchymal stroma cells from other sources and ideal carrier materials have to be identified for them. The aim of this study was to demonstrate and to compare the effects of three clinically established biomaterials on proliferation and metabolic activity of rat ASC's in vitro. MATERIALS AND METHODS: Rat adipose tissue derived stroma cells (ASC's) were isolated and differentiated into distinct lineages proved by lineage specific staining and gene expression analysis (RT-PCR). The biomaterials Bio-Gide(®), Tutodent(®) Membrane and Belotero(®) Soft were tested with rat ASC's for their biocompatibility using scanning electron microscopy (SEM), cell vitality staining, cytotoxicity and proliferation tests (LDH, MTT, BrdU, WST-1). RESULTS: The collagen membrane Bio-Gide(®) resulted in a significantly higher viability and proliferation (WST-1, BrdU) compared to Tutodent(®) Membrane. No significant difference was determined in the LDH and MTT test. The hyaluronic acid gel Belotero(®) Soft showed no cytotoxicity (LDH, FDA/PI) and had no negative effects on metabolic activity (WST-1, MTT) or cell proliferation (BrdU) of ASC's. CONCLUSION: Our results indicate Bio-Gide(®) and Belotero(®) Soft as preferable carrier materials for ASC's. For the further establishment of ASC's-based treatment strategies, in vivo investigations on the tissue regeneration potential of these cell-biomaterial scaffolds should follow.

Reliability of clinical symptoms in diagnosing temporomandibular joint arthritis in juvenile idiopathic arthritis.

OBJECTIVE: Temporomandibular joint (TMJ) arthritis, commonly considered oligoarthritic/asymptomatic, occurs frequently in children with juvenile idiopathic arthritis (JIA), and gadolinium-enhanced magnetic resonance imaging (Gd-MRI) has proved to be a sensitive diagnostic tool in this context. We compared the reliability of clinical examinations to Gd-MRI results in diagnosing the condition. METHODS: Patients with JIA (134 consecutive) underwent routine clinical and Gd-MRI examinations. The clinical items examined were clicking, tenderness (TMJ/adjacent muscles), and mouth-opening capacity. Blinded MRI reading focused on inflammation (synovitis/hypertrophy). After statistical power analysis, the clinical findings for 134 healthy controls were included. Contingency analysis was used to determine the sensitivity, specificity, and frequency of clinical symptoms (JIA/healthy controls); Cohen's κ was used to establish the interrater reliability. RESULTS: Statistically significant differences were observed between JIA and healthy control groups with regard to the concise screening items (power analysis > 0.95), whereas no differences in mouth-opening capacity were noted. In 80% of the patients with JIA, Gd-MRI revealed signs of TMJ arthritis, with positive correlations between concise screening items and Gd-MRI results. The average specificity was 0.81, but the sensitivity was low, at 0.42. Combining items led to a marked increase in the sensitivity (0.73). There was a high rate of both false-negative and false-positive results (corresponding to clinical underdiagnosis or overdiagnosis of TMJ arthritis). CONCLUSION: Despite a relatively high specificity, clinical examination alone does not seem sufficiently sensitive to adequately detect TMJ arthritis. Thus, a relatively high number of cases will be missed or overdiagnosed, potentially leading to undertreatment or overtreatment. Gd-MRI may support correct diagnosis, thereby helping to prevent undertreatment or overtreatment.

Oral mucositis in patients receiving low-dose methotrexate therapy for rheumatoid arthritis: report of 2 cases and literature review.

BACKGROUND: The differential diagnosis of ulcerative oral lesions is diverse. This report discusses the rare causes of oral mucosal ulceration and suggests approaches for diagnosis and treatment. METHODS: Two cases of methotrexate-induced stomatitis in patients receiving low dose methotrexate for rheumatoid arthritis are presented with a review of the current literature. In case 1, mucositis was caused by an unintended methotrexate overdose. In case 2, oral lesions were the result of chronic methotrexate toxicity. The treatment for methotrexate-induced mucositis required hospitalization in case 1, methotrexate discontinuation in both cases and oral folic acid supplementation in case 2. RESULTS: In both cases, the mucositis healed and no relapse was observed. CONCLUSION: Mucositis may be an early sign of systemic conditions, and dental providers are often the first doctors involved in the assessment of oral mucosal diseases. Meticulous questioning of the patient's history and the physical examination is important for elucidating the underlying cause.

Magnesium-enhanced enzymatically mineralized platelet-rich fibrin for bone regeneration applications.

Membranes of the autologous blood-derived biomaterial platelet-rich fibrin (PRF) were mineralized enzymatically with calcium phosphate (CaP) by the incorporation of alkaline phosphatase (ALP) followed by incubation for 3 days in solutions of either 0.1 M calcium glycerophosphate (CaGP) or a combination of CaGP and magnesium glycerophosphate (CaGP:MgGP; both 0.05 M), resulting in the formation of two different PRF-mineral composites. Fourier transform infrared spectroscopy, transmission electron microscopy and selected area electron diffraction examinations showed that the CaP formed was amorphous. Inductively coupled plasma optical emission spectroscopy analysis revealed similar amounts of Ca and P in both composite types, while a smaller amount of Mg (Ca:Mg molar ratio = 10) was detected in the composites formed in the CaGP:MgGP solution, which was supported by the results of energy-dispersive x-ray spectroscopy-based elemental mapping. Scanning electron microscopy (SEM) imaging showed that the mineral deposits in PRF incubated in the CaGP:MgGP solution were markedly smaller. The mass percentage attributable to the mineral phase was similar in both composite types. MTT and WST tests with SAOS-2 cells revealed that incubation in the CaGP:MgGP solution had no negative effect on cytocompatibility and cell proliferation compared to the CaGP solution. Cells on all samples displayed a well-spread morphology as revealed by SEM imaging. In conclusion, the incorporation of Mg reduces mineral deposit dimensions and promotes cell proliferation.

Comparison of two different absorbable membranes for the coverage of lateral osteotomy sites in maxillary sinus augmentation: a preliminary study.

INTRODUCTION: Barrier membranes, both absorbable and non-absorbable, have been used in sinus augmentation for many years. Some years ago, a new autologous blood substrate called Platelet-Rich-Fibrin (PRF) was introduced, and to date, the supporting effect on bone regeneration has been controversial. This study aimed to evaluate the effect of PRF on bone regeneration when used as a barrier membrane at the lateral osteotomy site in sinus augmentation. MATERIAL AND METHODS: Twelve sinuses from six patients requiring bilateral sinus floor augmentation were treated with a two-stage surgical technique using sinus augmentation and implant placement after 5 months. The sinuses were grafted with autologous bone and bone-substitute material (Bio-Oss(®)) mixed in a 1:1 ratio and were covered in a randomized split-mouth design with a PRF or a conventional collagen membrane (Bio-Gide(®)), respectively. Five months later threaded titanium dental implants were inserted and bone specimens harvested with a trephine burr were evaluated histomorphometrically. RESULTS: Bone quality seemed to be equal at both sites of the grafted sinuses. Mean vital bone formation after 5 months was 17.0% and 17.2%, for the PRF and collagen sites, respectively. The mean of residual bone-substitute was 15.9% and 17.3% for PRF and collagen, respectively. No local complications, such as dehiscences or membrane exposures, were detected at either site in any of the treated patients. After 12 months all implants reached primary stability in the augmented maxillary sinus floor without any peri-implant tissue inflammation. CONCLUSIONS: Within the limits of the study the coverage of the lateral sinus window with two different absorbable membranes has been shown to result in a similar amount of vital bone formation and residual bone-substitute.

Stress-coping and cortisol analysis in patients with non-syndromic cleft lip and palate: an explorative study.

BACKGROUND: Non-syndromic clefts of the orofacial region occur in approximately 1 per 500 to 2,500 live births, depending on geographical area and ethnicity. It can be supposed that the disruption of the normal facial structure and the long-standing pressure of treatment from birth to adulthood bring about a range of life stressors which may lead to a long-lasting impact on affected subjects throughout their lives. Therefore, the present study aimed to assess different aspects of psychosocial stress in affected individuals. METHODS: The study was divided into two parts: first, the Trier Social Stress Test which involves uncontrollability and high levels of social-evaluative stress under real conditions and second, the query of various aspects of coping with psychosocial stress. The test group consisted of 30 affected adult subjects, and an equally sized control group of unaffected volunteers. Cortisol dysregulation was determined by saliva samples before and after stress induction. Meanwhile, participants were asked to complete the SVF 120 stress-coping questionnaire. RESULTS: The analysis of saliva samples showed a similar baseline concentration as well as a similar increase in cortisol levels after stress induction for both groups. Subsequently, the decline in cortisol concentrations was significantly faster in the CLP group (course: p<0.001; groups: p = 0.102; interaction: p = 0.167). The evaluation of the stress-coping questionnaire revealed a significantly shorter rumination about a stressful event in individuals with CLP-related malformations (p = 0.03). CONCLUSION: We conclude that adults with CLP have significantly better stress-coping strategies than their healthy peers. TRIAL REGISTRATION: German Clinical Trials Organization DRKS00003466.