Ibuprofen sodium dihydrate, an ibuprofen formulation with improved absorption characteristics, provides faster and greater pain relief than ibuprofen acid.

OBJECTIVE: The objective of this 6-hour study was to compare rate of pain relief, analgesic efficacy and tolerability of a novel ibuprofen formulation, ibuprofen sodium dihydrate, with that of ibuprofen acid in subjects with postoperative dental pain. MATERIAL AND METHODS: The test formulation of ibuprofen sodium dihydrate (256 mg sodium salt) and the reference product both contain 200 mg ibuprofen. Subjects with moderate-to-severe pain after extraction of third molars were randomized to receive two tablets of either ibuprofen sodium dihydrate (198 subjects) or ibuprofen (198 subjects) in this double-blind, multicenter trial. Pain was measured using traditional descriptor scales and onset of analgesia assessed using the stop-watch method. RESULTS: Median time to substantial pain relief occurred 14 minutes earlier in the ibuprofen sodium dihydrate group (p < 0.001). The first sign of pain relief, an increase in relief and time until the pain was half gone occurred significantly earlier and faster in the ibuprofen sodium dihydrate-treated patients (p < 0.02-0.00003). Corresponding numbers needed to treat were in the range 11. Reduction in pain intensity was evident within 5 minutes (p < 0.01) in the ibuprofen sodium dihydrate group compared to 15 minutes in the ibuprofen group. Pain intensity was reduced to half after 30 and 57 minutes in the ibuprofen sodium dihydrate and ibuprofen groups, respectively (p < 0.025). The overall analgesic efficacy in terms of summed pain intensity differences (SPID), total pain relief (TOTPAR) and remedication times in the two groups were similar. Both treatments were well tolerated and no serious events occurred. CONCLUSION: Ibuprofen sodium dihydrate provides faster and more efficacious pain relief during the first hour after intake when compared to a conventional ibuprofen acid formulation. The tolerability profiles are similar.

[Evaluation of individual ceramic implants made of Bioverit with CAD/CAM technology to reconstruct multidimensional craniofacial defects of the human skull]. / Evaluierung individueller, in der CAD/CAM-Technik gefertigter Bioverit-Keramik-Implantate zur Wiederherstellung mehrdimensionaler kraniofazialer Defekte am menschlichen Schädel.

BACKGROUND: Restrictions in the bone structure of the craniomandibular region caused by malformation, traumata or malignant tumours are currently of interest in reconstructive oral and maxillofacial surgery. Methods of autologous bone transplantation are well established for reconstruction of those defects. The reconstruction and remodeling of contour-shaping defects is more difficult due to atrophy and resorption of free-transplantable tissues. Artificially induced harmful effects have been reported on harvesting in the donor area. Further available methods of alloplastic reconstruction are computer-assisted design and manufacturing systems (CAD/CAM). The advantages of individual design and fabrication are obvious in the manufacturing of defect-specific implants. MATERIAL AND METHODS: In the present study the application of individual CAD-based reconstructed bioceramic implants made of Bioverit II was evaluated in the region of the facial skull. Clinical results, patient acceptance and the analysis of the postoperative observation period of 30 months are reviewed. RESULTS: Altogether 25 individual Bioverit ceramics were implanted in the facial region. All patients were satisfied with the aesthetic results of the implantations after primary surgery. Three patients developed a need for further correction during the observation period; one implant fracture was observed. CONCLUSION: Finally, it can be stated that the preoperative expenditures in time, experts, technology and fabrication of individual CAD/CAM planned and manufactured implants are justified by the following advantages: fixed volume, reduced operating time, lack of donor morbidity, easy subsequent treatment of the material and the aesthetic results achieved.

Vertical distraction of fibula transplant in a case of mandibular defect caused by shotgun injury.

This case demonstrates the successful aesthetic and functional reconstruction of a complex facial gun-shot injury with extended bone defects and soft tissue destructions using a 3-step procedure. Initially, a reconstruction plate was inserted, later a fibula transplant enabled the basic reconstruction and finally was distructed in a 3rd session. The rationale behind the sequencing of surgical sessions was the extended bony defect and soft-tissue destruction. The main problem in this type of wound is hypoxia or anoxia of the receptor bed for the transplant. A microvascular anastomosized bone transplant is necessary for sufficient oxygen tension in the recipient site. The anatomical dimensional disproportion of the transplanted free fibula graft and the shape of the mandible were corrected prior to the insertion of dental implants by means of vertical distraction.

[Bidirectional and unidirectional distraction of defects of the alveolar process comparative clinical study]. / Bidirektionale und unidirektionale Distraktion von Alveolarfortsatzdefekten Vergleichende klinische Studie.

AIM: The purpose of the retrospective study was to compare bidirectional distraction osteogenesis with the currently used unidirectional method of alveolar ridge distraction with regard to bone height attained and complications. PATIENTS AND METHODS: Overall 21 patients were treated by distraction osteogenesis for localized defects of the alveolar ridge. Vertical augmentation of the mandible and maxilla was performed using 10 unidirectional (group A) and 12 bidirectional (group B) devices. The effect of therapy was evaluated by height of bone gain and observed complications. RESULTS: The average gain of vertical bone height was approximately 6 mm. No statistically significant differences occurred between the two treatment groups (p=0.09). For the entire study two complications were observed: beside breakage of a distractor device (unidirectional distraction) an infection during the retention time (bidirectional distraction) developed. CONCLUSIONS: It could be shown that osteodistraction is a potentially valuable therapy for the correction of alveolar defects. We observed complications in both groups. No statistical differences were noted in regard to gained bone height and complications between the two groups.

[Video-assisted endoscopic sinus revision for treatment of chronic, unilateral odontogenic maxillary sinusitis]. / Die videoassistierte endoskopische Sinusrevision zur Therapie der chronischen einseitigen dentogenen Sinusitis maxillaris.

BACKGROUND: The proportion of dental causes of maxillary sinusitis is estimated between 10% and 40%. The mechanisms are manifold and originate from the close relation of the side teeth and the maxillary sinus. In the past, the transantral approach was commonly used by maxillofacial surgeons as their first choice. PATIENTS AND METHODS: Between 01/1999 and 10/2001 38 patients underwent endoscopic surgery controlled via the fossa canina. Apart from the mandatory treatment of the dental focus and the mucosal pathologies, a fenestration to the middle meatus of the nose was performed in 7 cases. RESULTS AND CONCLUSION: The dental medical history, OPG, CT scans in coronary plane, endoscopic findings, and histology showed the commonly "silent" course of dental sinusitis. Typical findings in CT scans are unilateral basal maxillary opacities adjacent to the molar and premolar teeth. In 20% of the cases there was also a blockade of the infundibulum. All patients were reexamined 6-12 months postoperatively. The patients are free of symptoms, but sometimes suffer from headaches. An exact diagnosis and the clear separation of rhinogenic causes are vital points for the therapy of dental sinusitis. In cases of unilateral sinusitis, a comprehensive investigation by the maxillofacial surgeon should be recommended. Video-assisted endoscopic sinus revision is preferable to the transantral approach and is especially suitable for the treatment of mucosal retention cysts, the removal of foreign bodies, endoscopically controlled resections of apical roots, elevations of the sinus floor, and dental implants. If the ethmoidal infundibulum and maxillary ostium are open, no fenestration is needed. In cases of blockade, fenestration to the middle nose canal is indicated.

[Computed tomographic aspects of skull development in a child with cherubism]. / Computertomographische Aspekte der Schädelentwicklung eines Kindes mit Cherubismus.

The clinical picture of cherubism is similar to that of fibrous dysplasia. The initial clinical appearance involves the deformation of the maxillofacial area with orthodontic disorder. Usually it is found in the mandible giving the child a chubby-faced appearance, and it often occurs together with symmetric submandibular lymph node enlargement. This appearance reminds one of the cherubs seen in art. Only histological evidence for cherubism is inconclusive. The presence of multi-nucleated giant cells resembles fibrous dysplasia. A combination of clinical, radiographical and histological findings eventually leads to the correct diagnosis. An example is given of a patient displaying the typical disease process. Over a period of 12 years, we observed the progression of the disease from its initial appearance in a young child, through the full and characteristic display of a cherubic youth, and finally its regression. In conclusion, we advise restraint in planning surgical intervention. The diseases etiology is not entirely dear. The latest research points to genetic defects that lead to failure in the expression of matrix proteins.

Computertomographische Aspekte der Schädelentwicklung eines Kindes mit Cherubismus.

The clinical picture of cherubism is similar to that of fibrous dysplasia. The initial clinical appearance involves the deformation of the maxillo-facial area with orthodontic disorder. Usually it is found in the mandible, giving the child a chubby-faced appearance, and it often occurs together with symmetric submandibular lymph node enlargement. This appearance reminds one of the cherubs seen in art. Only histological evidence for cherubism is inconclusive. The presence of multi-nucleated giant cells resembles fibrous dysplasia. A combination of clinical, radiographical, and histological findings eventually leads to the correct diagnosis.An example is given of a patient displaying the typical disease process. Over a period of 12 years, we observed the progression of the disease from its initial appearance in a young child, through the full and characteristic display of a cherubic youth, and finally its regression.In conclusion, we advise restraint in planning surgical intervention. The disease's etiology is not entirely clear. The latest research points to genetic defects that lead to failure in the expression of matrix proteins.

[The incidence of microlaryngoscopy associated complications]. / Inzidenz spatelbedingter Nebenwirkungen der Mikrolaryngoskopie.

BACKGROUND: The frequency of local and cardiovascular side effects of microlaryngoscopy is generally underestimated. There are no data available in the literature from recent and prospective clinical trials. PATIENTS AND METHODS: We examined 81 patients between 03/1998 and 03/2000 who underwent microlaryngoscopy in our department. This was done following a standard protocol before, during and after surgery. Side effects of endotracheal intubation were avoided by using supraglottic jet-ventilation. RESULTS: In 79% of our cases we encountered side effects due to the microlaryngoscopic procedure.86% of them were reversible lesions,hematomas and edemas of the mucous membranes or mild cardiovascular dysregulations. In two cases there was a dental complication (one fracture, one dislocation), and seven cases of moderate hemodynamic effects were noted. CONCLUSIONS: The incidence of tissue damage caused by microlaryngoscopic endoscopes is much higher than commonly assumed in clinical practice. This has to be explained to the patient when obtaining his written consent to a certain microlaryngoscopic procedure and to be considered during the postoperative follow up.The consequent use of tooth protection and a good control of muscle relaxation and analgesia can be effective in preventing side effects.

[Tumors of the mouth cavity. Not all fluorescent tumors are malignant]. / Mundhöhlentumoren. Nicht alles was fluoresziert ist bösartig.

Early diagnosis and treatment of malignant tumors of the mouth and throat can greatly improve survival rates. Diagnostic fluorescence permits the reliable detection not only of oral cancer, but also of cancer precursor lesions. A problem here is the fact that although carcinomas can be detected with a high level of sensitivity, our own studies also demonstrate a considerable false-positive rate (35%). Possible reasons for this currently being considered are non-compliance by the patient with the required fasting period, poor mouth hygiene and the state after radiation therapy to the face. Under these circumstances, patient management is of particular importance.

The effect of storage time on the accuracy and dimensional stability of reversible hydrocolloid impression material.

STATEMENT OF PROBLEM: It has been stated that reversible hydrocolloid impression material must be poured immediately to remain accurate. This may not be true with modern formulations of reversible hydrocolloid. The accuracy of the impression, if kept at 100% humidity for varying periods, may not be affected as critically as has been suspected. PURPOSE: The purpose of this study was to evaluate the effect of storage time in a 100% humidity environment on the accuracy of gypsum casts poured from a newer formulation of reversible hydrocolloid impressions. MATERIAL AND METHODS: With the use of a stainless steel master model, 5 standardized reversible hydrocolloid impressions were made for each time interval tested (n = 5). Impressions were made with the use of both Cartiloid blue syringe and Slate tray reversible hydrocolloid material (both manufactured by Van R) to simulate a common clinical protocol. Six groups, representing times at 0, 30, 60, 120, 180, and 210 minutes, were evaluated for a total of 30 specimens. Gypsum casts were measured with a traveling microscope, and dimensional changes were compared between groups with ANOVA and Tukey intervals (alpha=.05). RESULTS: Measurements made up to and including the 60-minute storage time showed clinically acceptable distortion levels. These measurements were similar to the metal model and the gypsum casts poured at time 0 minutes. The only statistically significant difference between the gypsum cast and the metal master model was the distance between abutments at storage time 180 minutes (master model = 30.04 mm [SD 0.001]; gypsum casts = 29.944 mm [SD 0.076]). This difference was -91 microm (P=.002). In general, the gypsum abutments became wider and shorter with time. There was no significant difference between any gypsum abutment in regard to width or height when compared with the metal master model for all the storage times tested. However, as time increased, measurement became harder to accomplish, leading to a larger standard deviation and less reliable results. The distance between abutments remained relatively constant for storage times up to and including 60 minutes. For times longer than 60 minutes, the distance between abutments was reduced and more difficult to read. The distance between abutments at the 3-hour storage time was significantly different than the metal standard and time 0 gypsum casts. CONCLUSION: If a discrepancy of 78 microm (twice the 39 microm single margin opening) is clinically acceptable, then the results of this study show that this type of reversible hydrocolloid can be stored in 100% humidity for at least 60 minutes.

[Experimental 5-aminolevulinic acid-induced photodynamic therapy (ALA-PDT) of oral carcinomas. Procedures in treatment of solid tumors and elucidation of cell death]. / Experimentelle 5-Aminolävulinsäure-induzierte photodynamische Therapie (ALA-PDT) oraler Karzinome. Verfahren zur Behandlung solider Tumoren und Aufklärung des Zelltods.

AIMS: Of our own patients suffering from oral squamous cell carcinoma (OSCC), 96% possessed a 5-aminolevulinic acid (ALA)-induced tumor fluorescence. Consequently, the ALA-induced fluorescence of OSCC is suggested as an ideal tool for selective photodynamic therapy (PDT). The aim of the study was to demonstrate selective tumor damage and to analyze the cell death mode (apoptosis vs. necrosis) of OSCC cells in cell culture and in solid, deeply invasive xenotransplants in immunodeficient nude mice using intratumoral laser illumination. MATERIAL AND METHODS: For ALA-PDT, laser light (635 nm, 0.75 W, 10 min, cooled application system) was used intratumorally as well as in cell culture. The therapeutic response was controlled by histology and immunohistochemistry (Ki-67 index). The apoptosis was evaluated by the TUNEL method and in vitro by flow cytometry. Mutations in the apoptosis-controlling p53 gene were investigated by direct genomic sequencing. RESULTS AND CONCLUSIONS: 1. Although all OSCC exhibited an ALA-induced fluorescence in vivo, the evaluation of the cell lines showed differences in intensity of the ALA-induced fluorescence. This points to a different sensitivity of OSCC for ALA-PDT. 2. The use of a cooled laser light application system allowed intratumoral radiation and treatment of deeply invasive OSCC regions. 3. The cytotoxic effect of ALA-PDT in OSCC is evidenced by a diminution of proliferative activity and necrosis but not by apoptosis. 4. Functional mutations within the p53 gene were considered a possible reason for the absence of apoptosis induction by ALA-PDT.

[Visualizing carcinomas of the mouth cavity by stimulating synthesis of fluorescent protoporphyrin IX]. / Visualisierung von Karzinomen der Mundhöhle durch Stimulierung der Synthese von fluoreszierendem Protoporphyrin IX.

The fluorescence diagnosis based on the aminolavulinic acid-stimulated porphyrin synthesis allows the detection of superficial tumors in a very early stage even when they are very small tumors. A fluorescence diagnosis of tumors in the oral cavity can be simply performed by rinsing with a 0.4% ALA solution for 20 min. This topical application avoids systemic side effects such as skin sensitization. The red fluorescent areas are visible to the naked eye; only a blue light source for fluorescence excitation is necessary and a suitable red filter for observation. In our study on 56 patients suffering from carcinoma of the oral cavity, 96% of the histologically confirmed carcinoma could be visualized via fluorescence. In 3 patients additional tumors were detected via fluorescence that were not visible otherwise. However, many patients show fluorescent areas with no correlation to the histological finding. It was verified that bacteria from the oral cavity also produce PpIX after ALA incubation, which leads to false-positive findings. Reduction of the false-positive findings was achieved by rinsing the oral cavity with hydrogen peroxide and by mechanical plaque reduction. This improves the reliability of a fluorescence-guided biopsy. However, suppression of the bacteria fluorescence is necessary for clinical use of this diagnostic method.

[Internal gunshot wounds of the maxillofacial area and therapy with reference to minimal invasive technique]. / Steckschuss im Kiefer-Gesichts-Bereich und seine Therapie unter Berücksichtigung minimalinvasiver Technik.

Internal gunshot wounds in the head and neck region are complicated. Two cases of such injuries in the head and neck region are introduced and therapeutic approaches are discussed. If there are no severe additional injuries, the treatment of choice is the endoscopic removal of the projectile. Alternatively, the projectile has to be taken out by conventional surgery, using the approach which induces the least stress for the patient.