[Oral manifestation of a mantle cell lymphoma - a swelling in the buccal mucosa as the initial manifestation of mantle cell lymphoma: a case report]. / Orale Manifestation eines Mantelzell- Lymphoms ­ Eine Schwellung in der Wangenschleimhaut als Erstmanifestation eines Mantelzell-Lymphoms: ein Fallbericht.

Lymphomas are malignant neoplasms of mature and immature B-cells, T-cells or NK-cells at various stages of differentiation. They predominantly occur in lymphoid tissues, manifestations in the oral cavity are rare: 3.5% of all oral malignancies are lymphomas. They often present an indolent course without systemic symptoms. Therefore, an early diagnosis by the dentist is important. We present a case of a mantle cell lymphoma in the oral cavity of an 80-year-old woman as a painless swelling of the buccal mucosa which represents the first sign of the disease. The oral biopsy, histologic and immunohistochemical diagnosis, further examinations and oncologic treatments are shown. Important clinical differential diagnoses are discussed.

[Rehabilitation after implant failure in the anterior maxilla: presentation of treatment options]. / Rehabilitation nach Implantatmisserfolg im Oberkiefer-Frontzahnbereich: Vorstellung möglicher Behandlungsvarianten.

The present article illustrates treatment options after implant removal (explantation) as a result of peri-implantitis in the anterior maxilla. After explantation of a dental implant in the anterior maxilla, the esthetical as well as functional rehabilitation is a demanding undertaking, especially, if removable prosthetic treatment options are undesirable. The present article illustrates that depending on individual patient's demands, different treatment options might be considered. However, in order to achieve aesthetically pleasing outcomes by means of fixed partial dentures (FDPs), the practitioner as well as the patient have to adapt oneself to a complex, time-consuming, and multiphasic therapy. Therefore, a comprehensive planning and systematic approach represent a mandatory prerequisite.

[The extrosseous/peripheral ameloblastoma in the aesthetic area of the maxilla: a presentation of a possible approach aiming an aesthetic satisfying rehabilitation. a case report]. / Das extraossäre/periphere Ameloblastom in der Oberkieferfrontzahnregion. Ein Therapievorschlag mit spezifischem Augenmerk auf eine ästhetisch vertretbare Rehabilitation. Ein Fallbericht.

Extraosseous/peripheral Ameloblastoma (EPA) is a rare, benign odontogenic soft tissue tumour with the same histological characteristics as the more common intraosseous subtypes. The EPA appears in the soft tissue of the gingiva and the mucosa of the alveolar process often as unspecified painless swelling. The present case report describes an EPA in the aesthetic area of the left anterior maxilla. Based on the clinical finding the suspected diagnosis of a gingival cyst was made. Firstly, this case should highlight the importance of a proper histopathologic evaluation whenever a biopsy is performed. Furthermore, this report should illustrate a step-by-step procedure from the surgical re-excision of the EPA with a safetymargin to the healing phase to the aesthetic satisfying rehabilitation by using periodontal plastic surgery.

Spontaneous reeruption after intrusive luxation of the permanent incisors by incomplete root formation. Two case reports (in German) / Spontandurchbruch nach Intrusionstrauma von bleibenden Inzisiven bei nicht abgeschlossenem Wurzelwachstum Zwei Fallberichte

In the context of tooth trauma mostly the maxillary central front teeth are involved, whereby their roots are in some cases in developing stage (immature). The intrusive luxation represents one of the most severe types of dental trauma because of the damage to the periodontal ligament, alveolar bone and pulp. Principally, three different treatment options are available: 1. Spontaneous reeruption, 2. orthodontic extrusion, 3. surgical repositioning. This report is aiming to illustrate, by two cases, that traumatic intruded teeth with incomplete root formation, treated without active repositioning (waiting for spontaneous reeruption), seem to be associated with the lowest risk of healing complications. Therefore, the decision of the treatment procedure should be based mainly on the stage of root development and only secondarily on the degree of intrusion.

Application and evaluation of coronectomy in Switzerland

Coronectomy is the intentional partial removal of a tooth. Thereby the crown of the tooth is removed and the roots are left in place. Compared to the complete operative removal of a wisdom tooth, the incidence of inferior alveolar nerve injury (IANI) is lower. The aim of this study is a survey on the use and acceptance of wisdom tooth coronectomy in Switzerland. An anonymous questionnaire was sent to 266 dentists specialized in oral surgery or maxillofacial surgeons; 58.3% of the questionnaires were returned and could be assessed. The statistical analysis was performed using Fisher's exact test. The technique was classified as «non-reliable¼ by 51.6% of the respondents. In cases manifesting a high risk of IANI, 40.6% offered the patient a coronectomy. In a tooth exhibiting a high risk of IANI, 69.0% could envisage to perform a coronectomy instead of a complete operative removal. The technique was not used by 54.8%. A significantly larger proportion of study participants who specialized in or after the year 2005 (p < 0.05) rated the technique as "reliable". The same applied to respondents who specialized in Bern (p < 0.05) and those who already had used coronectomy (p < 0.001). In conclusion, our results show that the majority of maxillofacial and oral surgeons reject coronectomy. In view of recent studies, this attitude should be reconsidered.

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.

Moving the mandible in orthognathic surgery - A multicenter analysis.

Orthognathic surgery has always been a classical focus of maxillofacial surgery. Since more than 100 years, various surgical techniques for mandibular repositioning have been developed and clinically tested. Since the establishment of plate and screw osteosynthesis, orthognathic surgery became more stable and safe. Nowadays, different surgical methods for mobilising the mandible are existing. This international multicenter analysis (n = 51 hospitals) is providing first evidence based data for the current use of different surgical methods. The dominating techniques were Obwegeser/dal Pont (61%) followed by Hunsuck/Epker (37%) and Perthes/Schlössmann (29%). The main osteosynthesis materials were plates (82%), bicortical screws (23.5%), or a combination of both (5.9%). 47% of all centers reported to use several surgical methods at the same time, depending on the anatomical problem and the surgeon's preference. This shows that different surgical methods seem to work as comparable, safe, and reliable procedures in everydays clinical practise. On this basis, further prospective studies could evaluate possible advantages for our patients.

Wound management and the use of mouth rinse in mandibular third molar surgery.

The aim of this survey was to assess the knowledge and practice of Swiss dentists regarding wound management and the use of mouth rinse in surgical removal of mandibular third molars (MTM). A postal survey was conducted among all 3,288 dentists who are members of the Swiss Dental Society (SSO) representing the majority of dentists in Switzerland. The questionnaire consisted of 13 questions with mostly multiple-choice answers. Demographic profile, surgical experience, the use of antibiotics, and wound management, i.e. wound closure and the use of mouth rinse were assessed. The response rate was 55%. Semi-closed (59.1%), closed (19%) and open wound management (11.7%) were applied most often. Semi-closed wound management was preferred in the German-speaking region (67%) and closed wound management was preferred in the French-speaking region (55%). For semi-closed wound healing, drains impregnated with terra-cortril (42%) and iodoform-Vaseline (40%) were used. For closed wound management, most dentists reported leaving the wound to heal with the blood clot only (60.5%). Most dentists (74.5%) prescribed chlorhexidine 0.2% (CHX) mouth rinse when performing MTM surgery and a combination of immediate preoperative and postoperative use was preferred. Semi-closed wound management with drain and CHX mouth rinse is frequently used in Switzerland in the perioperative management in MTM surgery. It is a well-documented procedure leading to favourable outcomes without using any systemic antibiotics. However, wound management techniques differ between the three linguistic regions.

Metastatic breast cancer in the mandibular condyle mimicking temporomandibular joint (TMJ) disease.

Metastases or tumour to the jaws are rare and those to the temporomandibular joint (TMJ) are even rarer. The symptoms like preauricular pain, swelling and clicking are generally associated with TMJ disease. But the same symptoms are also found in tumours of the jaws or other diseases. We report on the case of a 48-year-old woman with a 12-year history of breast cancer who was referred to our department for clarification of preauricular swelling and pain. The possible aetiology of TMJ disorders and the frequency and localization of metastases to the jaws are discussed.

Antibiotics in third molar surgery.

The aim of this survey was to assess the knowledge and practice of Swiss dentists focusing on the use of antibiotics in prophylactic surgical removal of lower wisdom teeth. A postal survey was conducted among all 3288 dentists who are members of the Swiss Dental Society (SSO) representing nearly all dentists in Switzerland. The questionnaire consisted of 13 questions with mostly multiple-choice answers. Demographic profile, surgical experience, the use of antibiotics, and wound management, i.e. wound closure and the use of mouth rinse were assessed. A response rate of 55% was obtained. Most Swiss dentists perform surgical extractions in their practices. Of all dentists, 18.6% used antibiotics routinely, but a large variation was found comparing the three linguistic regions of Switzerland with the highest prescription rate of 48% in the French-speaking south-west of Switzerland. Fifty-two percent of dentists prescribed amoxicillin in a dose of 750 mg. Most often three daily doses were prescribed (47%). A postoperative regime was prescribed by 54.4% of dentists. French language (p=0.003), graduation from the university of Geneva (p=0.007), foreign diplomas (p<0.001), and dentists with diplomas awarded from 2001-2006 (p=0.004) showed a highly significant correlation with the use of antibiotics. In Switzerland, prophylactic antibiotics are used in third molar surgery. Antibiotic prescription however largely depends on geographical situation and dentist profiles. The assessment of antibiotic use in private practices is important in the light of growing evidence that antibiotic overuse may lead to development of multiresistant bacterial strains. In a second part results regarding wound management and mouth rinse will be presented.

[Traumatic cyst of the mandible. From development to therapy - a case report]. / Traumatische Zyste des Unterkiefers: von der Entstehung bis zur Therapie. Ein Fallbericht.

Traumatic bone cysts, also referred to as simple bone cysts, solitary bone cysts and haemorrhagic bone cysts, are intraosseous pseudocysts and are categorized by the WHO (2005) as benign, bone-related lesions. Most often young patients under the age of twenty are affected. Symptoms are uncommon and normally the lesion is found in routine radiographic examinations in the mandible. The etiology is still unknown and it has been discussed that trauma, benign tumours or abnormal bone growth might be the cause. Surgical treatment is recommended and recurrence is rare. Histologic features of pseudocysts are a lack of lining epithelium and often an empty bone cavity can be found. The following case report presents a traumatic cyst in the mandible of a 14-year old female patient. Clinical, radiological and histopathological characteristics of this entity will be discussed as well as therapy and follow-up.

[Non-Hodgkin lymphoma of the mandible--a case report with differential diagnostic considerations]. / Non-Hodgkin Lymphom der Mandibula.

Approximately 5% of all malignant lesions are diagnosed as malignant lymphomas, of which 2-3% are localized in the head and neck region. After the squamous cell carcinoma and neoplasms of the salivary glands, malignant lymphomas represent the third most frequent malignant lesion in that region. Malignant lymphomas can be grouped into Hodgkin- and non- Hodgkin lymphomas (NHL) and subdivided into nodal (lymph nodes) and extranodal lymphomas. We present the case of an extranodal non-Hodgkin lymphoma in the left mandible of a 47-year-old woman, who was referred to our department with an unclear swelling, which was supposed to be infectious. After clinical and radiological examination, a biopsy was taken and a CD20 and BCL-6 protein positive non-Hodgkin lymphoma of the large B-cell type (DLBCL) was diagnosed. The patient was treated primarily with immunochemotherapy (R-CHOP protocol) and refused to undergo a subsequent radiotherapy. The 18 months follow-up showed a complete remission of the lymphoma. In this paper, the NHL in the oral and maxillofacial region is presented as a cause of unclear swelling. Important differential diagnostic conditions are discussed.

[Periapical osseous dysplasia of the anterior maxilla--a case presentation]. / Periapikale ossäre Dysplasie der anterioren Maxilla. Ein Fallbericht.

Osseous dysplasias (formerly cemento-osseous dysplasias/ CODs) represent a specific clinico-pathologic spectrum of related, non-neoplastic benign fibro-osseous lesions. The most recent WHO classification (2005) defines them as bone-related lesions (9262/0). The controversial presence of cementum was solved by complete removal of the term "cemento" in the revised classification of tumors. Normal bone architecture is replaced by fibroblasts and collagen fibers containing variable amounts of mineralized material. Osseous dysplasias are often identified as an incidental finding on standard dental radiographs of adults. They usually cause no specific symptoms or obvious clinical findings. Four different types of ODs can be distinguished: the periapical osseous dysplasia (POD), the focal osseous dysplasia (FocOD), the florid osseous dysplasia (FOD) and the familial gigantiform cementoma. This case report presents an unusual localization of a periapical osseous dysplasia (POD) in the anterior maxillary bone in a 33-year old female patient of Caucasian origin. Radiological, clinical and histopathological characteristics of the POD and similar benign lesions are defined and discussed.

Bone healing of the sheep tibia shaft after carbon dioxide laser osteotomy: histological results.

The aim of the study was to compare the histological results after complete osteotomies of the sheep tibia using either the prototype carbon dioxide (CO(2)) laser osteotome 'OsteoLAS' (n = 12) or an oscillating saw (n = 12). The laser parameters were as follows: wavelength 10.6 microm; energy of laser pulses 75-85 mJ; pulse duration 80 mus; pulse repetition rate 200 Hz; spot diameter 460 mum (1/e(2) level); radiant exposure 45-51 J/cm(2); peak irradiance 0.56-0.64 MW/cm(2). Both groups were divided into two subgroups (n = 6), and the animals were killed after 4 weeks or 12 weeks, respectively. Light and fluorescence microscopy with semiquantitative analysis and histomorphometry were performed to compare bone healing. Charring-free laser osteotomies were possible up to a depth of 20 mm with the short-pulsed CO(2) laser. The laser, however, required a significantly longer time to perform, and a wedge-shaped gap was present on the cis-cortex. After 4 weeks the osteotomy gaps were almost unchanged in both groups and filled with connective tissue. After 12 weeks the gaps were filled with newly formed bone in both groups. Primary gap healing was predominant in the laser group and longitudinal cortical remodelling in the control group. On a cellular level, no fundamental differences were observed for early and late stages of bone healing. Further research has to be focussed on improving the CO(2) laser ostetome in order to reduce the long duration of the laser osteotomy and the necessity of creating a wedge-shaped cut in thick bones.

Computer-guided CO2-laser osteotomy of the sheep tibia: technical prerequisites and first results.

OBJECTIVE: The purpose of this study was to examine for the first time the feasibility of performing complete osteotomy of sheep tibia using a computer-guided CO2-laser osteotome, and to examine bone healing under functional loading. BACKGROUND DATA: Bone cutting without aggravating thermal side effects has been demonstrated with scanning CO2-laser osteotomy. Further research is necessary to develop a clinically usable laser osteotome, which may allow new types of bone surgical procedures. MATERIALS AND METHODS: The scanning parameters for performing tibial osteotomies were determined in preliminary ex vivo trials. Osteotomies were performed in the mid-diaphysis of sheep tibia using either the prototype laser osteotome (osteoLAS, study group; n = 12), or an oscillating saw (control group; n = 12). Both groups were divided into two subgroups each (n = 6), and the two groups were sacrificed after 4 and 12 wk. Radiographs were taken postoperatively and after 4, 8, and 12 wk to compare the course of bone healing. RESULTS: Laser osteotomies of sheep tibia up to a depth of 20 mm were possible without visible thermal damage to the bone. A sequential PC-controlled cut geometry with artificial widening of the osteotomy gap was required for a complete osteotomy. Both clinically and radiologically, the laser and control groups showed undisturbed primary gap healing. Bone healing was similar and undelayed after both laser osteotomy and osteotomy done by mechanical saw. CONCLUSIONS: Osteotomy of multi-layered bones with a scanning CO2-laser demonstrates clinical and radiological healing patterns comparable to those seen with osteotomy done by standard mechanical instruments. It is, however, a technically demanding procedure, and complete laser osteotomies of long bones are only reasonable in bones with a diameter <20 mm, which will likely restrict the use of this technique to bones 7-10 mm thick. Through the use of computer guidance, extremely precise osteotomies and sophisticated cut geometries are possible using this technique. For practical applications, precise control of the depth of laser cutting and easier manipulation of the osteotome are required.

[Bone collected with a bone collector during dental implant surgery]. / Mit Knochenkollektor bei dentaler Implantation gewonnenes Knochenmaterial. Mikrobiologische Analyse.

BACKGROUND: Simultaneous implantation and augmentation using autogenous bone collected during implant surgery is a well-established procedure in oral implantology. The aims of this study were (1) to identify any bacterial contamination of bone obtained with a bone collector, and (2) to verify the antimicrobial effect of rinsing the bone collector with a 0.1% chlorhexidine solution prior to augmentation. MATERIAL AND METHODS: A total of 39 patients undergoing a simultaneous implantation and augmentation procedure were examined. All patients rinsed their mouths with a 0.1% chlorhexidine solution for 2 min prior to surgery. Bone was collected with the Osseous Coagulum Trap, while saliva was collected with a separate suction tip. Once bone collection was complete a microbiological swab was taken from the bone collector (sample 1); before the bone was taken from it 200 ml of a 0.1% chlorhexidine solution was aspirated into the collector, after which the bone was removed and the collector sieve was (sample 2) sent for microbiological analysis which included aerobic and anaerobic cultivation of microorganisms and their identification and semiquantitative assessment of microbial growth. RESULTS: Before the collector was rinsed with chlorhexidine microbial contamination was found in 34 (82.7%) of the 39 samples, and 37 different microbial species were identified in cultures. When the collector had been rinsed with 200 ml 0.1% chlorhexidine a significantly lower rate of microbial contamination was found: 66.7% of the samples were sterile. CONCLUSIONS: Despite separate suction techniques for bone dust and saliva and preoperative use of a chlorhexidine mouthwash, bacterial contamination of bone obtained from the mouth with a bone collector has to be anticipated. Not only the physiological bacteria of the oral flora, but also the microorganisms frequently associated with implant failure can be found. Rinsing the bone collector with 200 ml of a 0.1% chlorhexidine solution significantly reduces microbial contamination. The effects on bone vitality must be studied before routine rinsing with chlorhexidine can be recommended.

Long-term results following reconstruction of craniofacial defects with titanium micro-mesh systems.

Introduction: Reconstruction of craniofacial defects can be carried out with autogenous tissue (calvarium, rib, iliac crest), allogeneic implants (AAA-bone, lyophilized cartilage) or alloplastic material (methacrylate, hydroxyapatite, titanium implants and mesh systems). Selection of the implant material used for reconstruction is still controversial. Material and Methods: At the Department of Oral and Maxillofacial Surgery, Kantonsspital Luzern, 20 patients with defects in the craniofacial and/or orbito-ethmoidal region have been treated using titanium micro-mesh between 1991 and 1998. Two different mesh systems, micro-titanium augmentation mesh and dynamic mesh, have been used for bony reconstruction in non load-bearing areas. The defects were caused by acute trauma, osteomyelitis of the frontal bone and previous operations. The titanium micro-mesh was used with the following indications: (1) immediate reconstruction in the primary treatment of comminuted fractures with bone loss in non load-bearing areas, (2) treatment of contour irregularities (possibly in combination with bone or cartilage grafts). All patients were followed up clinically and radiographically at quarterly intervals for a year. Results: No wound infections, exposures or loss of the mesh have been observed. Long-term stability of the reconstructions was excellent. When walls of the paranasal sinuses were reconstructed complete repneumatisation took place. Conclusions: Advantages of this reconstructive technique are: (1) universal applicability (craniofacial, orbital, sinus defects, comminuted fractures); (2) stable 3-D reconstruction of complex anatomic structures were easily performed; (3) immediate availability with no donor site morbidity as bone or cartilage grafts were not necessary; (4) combination with bone or cartilage grafts is possible; and (5) very low susceptibility to infection. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.