Dental Implants in 18 Patients with Systemic Scleroderma: A Retrospective Radiographic Analysis Over a 5-Year Period with Focus on Marginal Bone Loss.

PURPOSE: Patients with systemic scleroderma (SSc) often suffer from premature tooth loss. The aim of this study was to radiologically investigate bone loss at dental implants in patients with SSc and compare it with data from the literature on healthy patients. MATERIALS AND METHODS: Mesial and distal bone level changes at implants were independently determined on panoramic and intraoral radiographs. They were double-checked after determination of evaluability by three different raters. Cohen's kappa was used to test for interrater reliability. Mean bone loss was estimated using linear regression analysis considering the patient as a random-effect implant and performed separately in predefined implant regions for different time points and for the mesial and distal sides of the implants. RESULTS: Mesial and distal bone level changes were analyzed in 61 implants using periapical and panoramic radiographs. In total, 114 radiographs from 18 patients were evaluable in both the mesial and distal regions. After a maximum observation period of 60 months, the mean peri-implant bone loss was 1.68 mm (range: 0.83 to 2.54 mm) at the distal aspect and 1.65 mm (range: 0.81 to 2.48 mm) at the mesial aspect in the right posterior mandible (region 44 to 47 [FDI numbering system]), whereas in the left posterior maxilla (regions 24 to 27), the mean peri-implant bone loss was 0.61 mm (range: 0.32 to 0.91 mm) at the distal aspect and 0.59 mm (range: 0.16 to 1.03 mm) at the mesial aspect. The mean bone loss 60 months after surgery was 1.05 mm (range: 0.85 to 1.25 mm). CONCLUSIONS: Marginal bone loss at implants in patients with SSc is comparable to data from the literature collected in healthy subjects.

[Diagnosis and Management of Late-Onset Pompe Disease]. / Diagnostik, Therapie und psychosoziale Aspekte bei late-onset Morbus Pompe.

Pompe disease is a lysosomal storage disorder, with onset between the first weeks after birth and adulthood, depending on its phenotype. It can affect multiple organ systems and presents itself with a wide variety of symptoms. Thus, recognizing Pompe disease is difficult. Especially since enzyme replacement therapy for Pompe disease was introduced (in Germany in 2006), early diagnosis by means of enzyme activity determination from dried blood spot analysis and genetic verification has become important for outcome and quality of life. When facing an obscure muscular disorder, it is crucial to consider Pompe disease. This article provides an overview about Pompe disease and focuses on the diagnosis of the late onset type. The most important aspects of interdiciplinary care for patients with Pompe disease are presented. Additionally, it contains a section focusing on psychosocial challenges for children with Pompe disease and their families, which may include mental disorders and social retreat, and gives advice on how to support parents of affected children.

Awareness and Knowledge of Rare Diseases in German Dentists, Dental Specialists and Oral and Maxillofacial Surgeons: A Country-Wide Survey.

Background and objectives: Rare diseases affect an estimated four million patients in Germany. Approximately 15% of the approximately 6000 to 8000 rare diseases known globally show manifestations in the dental, oral and maxillofacial regions. The present survey evaluated the knowledge and management of rare diseases and their orofacial alterations by dentists, dental specialists and oral and maxillofacial surgeons and dentists working at university hospitals for dentistry and/or oral and maxillofacial surgery. Materials and Methods: The study was designed as an anonymous cross-sectional study. Two anonymous online surveys were performed in all dentists in Germany using the open-source survey software limesurvey. The study cohorts were divided into dentists, dental specialists and oral and maxillofacial surgeons in practice, and dentists who worked in university dental and oral and maxillofacial surgery centers. The survey was performed between 1 October 2020 and 31 March 2021. Results: A total of 309 dentists and oral and maxillofacial surgeons in private practice and 18 dentists or oral and maxillofacial surgeons working at universities participated. A total of 209 (86.7%) study participants working in private practice indicated that the topic of rare diseases should be considered clinically relevant. University participants indicated that there was a lecture on rare diseases in only 7 (63.6%) cases. Only 2 (13.3%) participants reported active research on the topic in their department. Conclusions: The current knowledge on rare diseases is inadequate in suitable screening and therapy. Most of the participants believed that knowledge of rare diseases was very important for daily dental practice. The self-estimations showed that all of the participants estimated their knowledge as very good or inadequate, with a tendency in the direction of inadequate knowledge.

Human Gingival Fibroblast Adhesion and Proliferation on Hydroxyapatite-Coated Zirconia Abutment Surfaces.

Applying antibacterial coatings to dental implant materials seems reasonable but can have negative influences on desired cell adhesion and healing. In this study, zirconia abutment specimens interacting with gingival tissue were used. The aim was to compare the influence of machined or coated zirconia surfaces on the adhesion and proliferation of human gingival fibroblasts (HGF-1). Surface modifications were performed using atmospheric plasma coating with hydroxyapatite, zinc, and copper. Zirconia specimens were divided into four groups: hydroxyapatite, hydroxyapatite with zinc oxide (ZnO), hydroxyapatite with copper (Cu), and an untreated machined surface. After the characterization of the surface conditions, the morphology of adhered HGF-1 was determined by fluorescence staining and subjected to statistical evaluation. The visual analysis of cell morphology by SEM showed flat, polygonal, and largely adherent fibroblast cells in the untreated group, while round to partially flat cells were recorded in the groups with hydroxyapatite, hydroxyapatite + ZnO, and hydroxyapatite + Cu. The cell membranes in the hydroxyapatite + ZnO and hydroxyapatite + Cu groups appeared porous. The results show that HGF-1 adhere and proliferate well on machined zirconia, while plasma coating with hydroxyapatite or hydroxyapatite mixtures does not lead to increased adhesion or proliferation.

Survival Rates of Dental Implants in Autogenous and Allogeneic Bone Blocks: A Systematic Review.

Background and Objectives: Preliminary studies emphasize the similar performance of autogenous bone blocks (AUBBs) and allogeneic bone blocks (ALBBs) in pre-implant surgery; however, most of these studies include limited subjects or hold a low level of evidence. The purpose of this review is to test the hypothesis of indifferent implant survival rates (ISRs) in AUBB and ALBB and determine the impact of various material-, surgery- and patient-related confounders and predictors. Materials and Methods: The national library of medicine (MEDLINE), Excerpta Medica database (EMBASE) and Cochrane Central Register of Controlled Trials (CENTRAL) were screened for studies reporting the ISRs of implants placed in AUBB and ALBB with ≥10 participants followed for ≥12 months from January 1995 to November 2021. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed via several scoring tools, dependent on the study design. Means of sub-entities were presented as violin plots. Results: An electronic data search resulted in the identification of 9233 articles, of which 100 were included in the quantitative analysis. No significant difference (p = 0.54) was found between the ISR of AUBB (96.23 ± 5.27%; range: 75% to 100%; 2195 subjects, 6861 implants) and that of ALBB (97.66 ± 2.68%; range: 90.1% to 100%; 1202 subjects, 3434 implants). The ISR in AUBB was increased in blocks from intraoral as compared to extraoral donor sites (p = 0.0003), partially edentulous as compared to totally edentulous (p = 0.0002), as well as in patients younger than 45 as compared to those older (p = 0.044), cortical as compared to cortico-cancellous blocks (p = 0.005) and in delayed implantations within three months as compared to immediate implantations (p = 0.018). The ISR of ALBB was significantly increased in processed as compared to fresh-frozen ALBB (p = 0.004), but also in horizontal as compared to vertical augmentations (p = 0.009). Conclusions: The present findings widely emphasize the feasibility of achieving similar ISRs with AUBB and ALBB applied for pre-implant bone grafting. ISRs were negatively affected in sub-entities linked to more extensive augmentation procedures such as bone donor site and dentition status. The inclusion and pooling of literature with a low level of evidence, the absence of randomized controlled clinical trials (RCTs) comparing AUBB and ALBB and the limited count of comparative studies with short follow-ups increases the risk of bias and complicates data interpretation. Consequently, further long-term comparative studies are needed.

Dental implants in patients suffering from systemic sclerosis: a retrospective analysis of clinical outcomes in a case series with 24 patients.

PURPOSE: Patients with systemic sclerosis (SSc) often suffer from premature tooth loss. This is a retrospective case series of patients with systemic sclerosis who were treated with dental implants. METHODS: SSc patients treated with at least one dental implant between 5 August 1998 and 31 December 2018 were included in this long-term retrospective study. The primary study variables were the plaque index (PLI), sulcus bleeding index (SBI), peri-implant pocket depth (PPD) and interincisal distance (ID). The test for marginal homogeneity analysed whether the SBI and PLI values changed between examination and follow-up. A linear regression was performed for the PPD measurement. The rank correlation coefficient compared the SBI with the PLI and the PPD with the PLI. The survival rate data for the implants were analysed by the Kaplan-Meier procedure. P < .05 was considered significant. RESULTS: Twenty-four patients [(age: mean 59.6 years (SD ± 13.08)] received a total of 72 implants. ID resulted in a mean value of 29.54 mm (SD ± 6.4 mm). The mean value of the PPD was between 2.4 mm and 2.8 mm. A comparison of the SBI with the PLI and the PPD with the PLI showed a significantly positive correlation between the SBI and the PLI and between the PPD and the PLI. The correlation between the PPD and the PLI (Spearman rho: 0.36, p < 0.001) was less pronounced than that between the SBI and the PLI (Spearman rho: 0.61, p < 0.001). Kaplan-Meier analysis showed a post-10-year implant survival rate of 87.6% (95%-KI: 75.5-94.0). CONCLUSION: Implant-supported oral rehabilitation can be carried out and maintained successfully in SSc patients.

Prevalence of Oral and Maxillofacial Disorders in Patients with Systemic Scleroderma-A Systematic Review.

BACKGROUND: Systematic scleroderma is a rare chronic autoimmune disease of unknown aetiology. The aim of this study was to identify the prevalence of orofacial pathognomonic conditions in patients with systemic scleroderma using only randomised prospective studies that investigated the treatment of oral and maxillofacial changes, highlighted associations between the disease and Sjogren's syndrome, and/or analysed the effect of oral hygiene. METHODS: The literature was systematically reviewed based on Cochrane Library, EMBASE, PubMed, Scopus, and Web of Science articles published up to March 2020. The primary endpoint of this analysis was defined as an estimation of the prevalence of oral mucosal changes in different areas of the oral cavity (oral mucosa, tongue, lip, periodontal status, bones, and other regions) in patients suffering from scleroderma. Therefore, a systematic literature search (Cochrane Library, EMBASE, PubMed, Scopus, and Web of Science) was conducted and limited by the publication date (1950-03/2020) and the publication language (English). Extracted frequencies were pooled using methods for meta-analysis. In order to obtain the highest level of evidence, only prospective study reports were considered to be eligible. RESULTS: After full-text screening, 14 (766 patients) out of 193 publications were eligible for the final analysis. Twelve studies produced reliable results in the final data sets. Calculation of the pooled effect estimate (random effects model) revealed a prevalence of 57.6% (95% CI: 40.8-72.9%) for the main area "lip". For the area "oral mucosa", a prevalence of 35.5% (95% CI: 15.7-62.0%) was calculated. The prevalence for "other regions" was only based on studies with salivary changes and was calculated to be 25.4% (95% CI: 14.2-41.3%). CONCLUSION: The most pathognomonic conditions in the orofacial region in patients with systemic scleroderma affect the lips, oral mucosa, and salivary glands.

Implant-supported prosthetic rehabilitation of a senescent patient with Down syndrome.

OBJECTIVE: Some patients with Down syndrome experience premature edentulism, which can lead to severe alveolar atrophy. This may cause retention problems with purely mucosa-supported dentures and ill-fitting total dentures. The intellectual disability associated with Down syndrome, with an (implied) inadequate ability for compliance, may pose a further challenge to dental treatment. The aim of this case report was to demonstrate that a combined implant-prosthetic denture with bar constructions can, nevertheless, be implemented in elderly Down syndrome patients with limited cooperation ability. METHOD AND MATERIALS: This report is the first to describe the procedure for an implant-supported total prosthetic restoration with bar joint in a 52-year-old edentulous patient with Down syndrome and limited ability to cooperate. Previous dental solutions had severely curtailed the patient's quality of life. By combining various forms of treatment, including behavior management, the course of therapy could be adapted to the patient's cooperation capability. RESULTS: The implant-supported total prosthetic restoration with bar joint was well accepted by the patient. Moreover, the patient's relatives reported that his life quality had improved distinctly (eg, considerable weight-gain, more positive mood). No impairments of the prostheses were observed during the 24-month follow-up period, and both implants remained clinically inconspicuous. CONCLUSION: The lack, or inadequacy, of dental prostheses can impair the life quality of individuals in need of such restorations. Implant-supported dentures in combination with a bar construction improve the retention of prostheses in atrophied jaws. This form of restoration is also proving to be a successful therapy option for elderly persons with Down syndrome.

Systematic review of oral and craniofacial findings in patients with Fabry disease or Pompe disease.

Fabry disease and Pompe disease are rare lysosomal storage disorders that belong to a heterogeneous group of more than 200 distinct inborn metabolic diseases. Mutations followed by loss of function of enzymes or transporters that are localised in the acidic environment of the lysosome may result in degradation of many substrates, such as glycosaminoglycans, glycosphingolipids, glycogen, cholesterol, oligosaccharides, glycoproteins, and peptides, or the excretion of the products degraded by the lysosome. Our aim was to identify the oral signs and symptoms of Fabry disease and Pompe disease from a systematic review made using MEDLINE/PubMed, and a hand search for relevant articles, following the PRISMA guidelines. Both diseases show various craniofacial and oral changes, including supernumerary teeth, dental agenesis, angiokeratoma, and telangiectases in Fabry disease; and macroglossia, teeth fusion, and taurodontism in Pompe disease. Common clinical signs of Fabry disease include hyposalivation, hypohidrosis, and xerophthalmia, and a generally reduced physical resilience was apparent in patients with Pompe disease. Oral and craniofacial changes in patients with both diseases extend over their entire lifetime and can be detected even in an infant. Lysosomal storage diseases should be taken into consideration in the differential diagnosis of relevant diverse symptoms, because treatment, when available, is most effective when started early. The main therapeutic concepts are enzymatic replacement for Pompe disease, whereas patients with Fabry disease require additional oral chaperone treatment or enzyme replacement.

Adhesion Behaviour of Primary Human Osteoblasts and Fibroblasts on Polyether Ether Ketone Compared with Titanium under In Vitro Lipopolysaccharide Incubation.

The aim of this in vitro pilot study was to analyse the adhesion behaviour of human osteoblasts and fibroblasts on polyether ether ketone (PEEK) when compared with titanium surfaces in an inflammatory environment under lipopolysaccharide (LPS) incubation. Scanning electron microscopy (SEM) images of primary human osteoblasts/fibroblasts on titanium/PEEK samples were created. The gene expression of the LPS-binding protein (LBP) and the LPS receptor (toll-like receptor 4; TLR4) was measured by real-time polymerase chain reaction (PCR). Immunocytochemistry was used to obtain evidence for the distribution of LBP/TLR4 at the protein level of the extra-cellular-matrix-binding protein vinculin and the actin cytoskeleton. SEM images revealed that the osteoblasts and fibroblasts on the PEEK surfaces had adhesion characteristics comparable to those of titanium. The osteoblasts contracted under LPS incubation and a significantly increased LBP gene expression were detected. This was discernible at the protein level on all the materials. Whereas no increase of TLR4 was detected with regard to mRNA concentrations, a considerable increase in the antibody reaction was detected on all the materials. As is the case with titanium, the colonisation of human osteoblasts and fibroblasts on PEEK samples is possible under pro-inflammatory environmental conditions and the cellular inflammation behaviour towards PEEK is lower than that of titanium.

Rare Diseases with Periodontal Manifestations.

Background: The object of this paper was to provide an overview of rare diseases (RDs) with periodontal manifestations and allocate them to relevant categories. Methods: In ROMSE, a database for "Rare Diseases with Orofacial Involvement", all 541 entities were analyzed with respect to manifestations of periodontal relevance. Inclusion criteria were periodontally relevant changes to the oral cavity, in accordance with the 2018 version of the Classification of Periodontal and Peri-Implant Diseases and Conditions. Rare diseases were recorded, using the methodology described, and subsequently compared with the Orphanet Classification of Rare Diseases. Results: A total of 76 RDs with periodontal involvement were recorded and allocated in accordance with the Classification of Periodontal and Peri-Implant Diseases and Conditions. Of the 541 RDs analyzed as having known orofacial manifestations, almost 14 percent indicated a periodontally compromised dentition. Conclusions: Around 14 percent of RDs with an orofacial involvement showed periodontally relevant manifestations, which present not only as a result of gingivitis and periodontitis, but also gingival hyperplasia in connection with an underlying disease. Thus, dentists play an important role in therapy and early diagnoses of underlying diseases based on periodontally relevant manifestations.

Orthodontically Relevant Manifestations in People with Rare Diseases.

BACKGROUND: Approximately 15% of all rare diseases occur with orofacial manifestations. Symptoms and manifestations of relevance to orthodontists represent a considerable proportion of these diseases and require appropriate strategies for their treatment. This article provides an overview of the orthodontically relevant manifestations of rare diseases. MATERIAL AND METHODS: Overall, 3,639 rare diseases listed at the Orphanet, OMIM or Pubmed database were evaluated for orofacial manifestations. All rare diseases which were indicated with at least one orofacial manifestation were recorded in a database for rare diseases with orofacial manifestations called "ROMSE," which was developed by the authors. All the rare diseases were analysed with regard to orthodontically relevant orofacial manifestations, such as dysgnathia, changes in the number of teeth, failures of eruption, pathologies of bone metabolism or orofacial clefts. For all rare diseases with orthodontic relevance, an exact analysis was undertaken. RESULTS: The orthodontically relevant orofacial manifestation termed dysgnathia is described in 151 of 535 identified rare diseases (28.2%). In these 151 rare diseases, 15 different subforms of dysgnathia, in the sense of skeletal misdevelopments of the jaws but without dental abnormalities, were described. Also changes in the number of teeth (17.9%), orofacial clefts (27.6%), failures of eruption (8.4%) and pathologies of the bone (2.1%) were described. CONCLUSIONS: Orthodontics play an important role in the diagnosis and treatment of orofacial manifestations in rare diseases. Databases such as ROMSE are a first step toward providing valid information in publicly accessible databases.

10-year outcomes with immediate and early loaded implants with a chemically modified SLA surface.

The aim of this study was to evaluate long-term outcomes in a 10-year follow-up study of patients who previously completed a 3-year multicenter randomized controlled trial of immediate and early loading of dental implants with a hydrophilic and chemically active surface (SLActive) in the posterior maxilla or mandible. The patients received implants to replace at least one missing tooth, with provisional restoration on the day of surgery (immediate loading) or 28 to 34 days later (early loading). Implant survival, change in crestal bone level, and patient satisfaction were evaluated. In total, 56 patients (with 72 implants) were available after 10 years and fulfilled the criteria for the radiographic bone level evaluation. The mean crestal bone level change from implant surgery to 10 years was -2.00 ± 1.19 mm and -1.37 ± 1.06 mm in the immediate and early groups, respectively. The corresponding change between 5 to 6 months' post-surgery (permanent fixed restoration placement) and 10 years was -1.25 ± 0.99 mm and -0.89 ± 1.11 mm in the immediate and early groups. After the initial remodeling phase (5 to 6 months) where the depth of implant placement had an influence on the initial bone remodeling, no significant differences between the two treatment groups were detected. Mean implant survival was 97.6% (98.2% and 97.1% in the immediate and early loading groups, respectively). Implants with the SLActive surface show successful long-term outcomes following immediate or early loading in posterior maxillae and mandibles.

Prosthetic rehabilitation for a patient treated for embryonal rhabdomyosarcoma.

A female patient, now aged 17 years, was diagnosed with rhabdomyosarcoma (RMS) in the right pterygopalatine fossa when she was 3 years old. The RMS was successfully treated by excision, but the subsequent radiation and polychemotherapy resulted in the complete anesthesia of the distribution area of the right trigeminal nerve and loss of vision in the right eye. The patient also experienced pain in the mandibular joints and masticatory muscles. Panoramic radiographs displayed a multiple agenesia of the permanent teeth and underdeveloped apices. Treatment involved the fabrication of a complete maxillary denture. A removable device was fabricated to evaluate her response to an occlusal vertical dimension increase of 6 mm and provide a stable intercuspal position. After wearing the prosthesis for 6 months, the patient reported that she was completely free of symptoms.

In vitro evaluation of the apical seal of two different retrograde filling materials.

To determine whether the selection of retrograde filling material or the choice of instruments in root tip resection influences the seal of the retrograde root filling. Seventy-two single-rooted teeth were used. Root resection was performed using a Lindemann bone cutter, a Lindemann bone cutter with A-shaped cutting design or a diamond-coated bur. Retro-cavities were prepared by piezo-tips and filled with Super-EBA or MTA. Teeth were made transparent and dye penetration was assessed. Teeth filled with MTA, irrespective of the resection instrument, showed no measurable dye penetration. All groups filled with Super-EBA showed an apical leakage. There were no significant differences between the three groups filled with Super-EBA (P = 0.09). The comparison of MTA versus Super-EBA showed significant superiority in apical seal in favour of MTA (P < 0.0001). To use MTA as a retrograde filling material showed superior results in terms of the tightness of the apical seal as compared to Super-EBA.

Resin infiltration into differentially extended experimental carious lesions.

Resin infiltration of initial caries lesions is a novel method of caries therapy. However, it has some limitations. Therefore, further experimental studies are needed to improve resin infiltration. It was the aim of this investigation to study resin infiltra-tion into different experimental carious lesions. Caries-free extracted human molars and premolars were demineralized for 3, 6, 9 and 12 days and infiltrated with resin. Prior to infiltration, the teeth were incubated with sodium fluorescein. After em-bedding, serial sections were cut through the experimental lesions, and the penetration of the resin was measured with fluo-rescence microscopy. Two infiltrated teeth from each time interval were not embedded and cut. Infiltration of the resin was then studied with EDS element analysis. The results showed that with increasing demineralization time, the lesion expansion was also increasing, and the resin infiltration was always almost complete. From these results it can be concluded that artifi-cial standardized caries-like lesions are suitable for experimental studies of resin infiltration.