Critical-size Defect Augmentation Using Sintered and Non-Sintered Bovine Bone Matrix - An Experimental Controlled Study in Minipigs.

PURPOSE: Xenogeneic bone substitute materials are often used for augmentation of larger bone defects. Purification methods for these materials vary, mainly in terms of temperature. The aim of this study was to determine in vivo how sintering affects quantitative and qualitative bone regeneration of 2 bovine augmentation materials. METHODS: A total of 56 critical size defects were set at the frontal bone of 14 domestic pigs (4 each) and filled randomly with either bovine, sintered hydroxyapatite (BO), bovine, non-sintered hydroxyapatite (BOS), local autologous bone (AB) or left empty. All defects were additionally covered with a collagen membrane. Specimens were harvested after 4 and 8 weeks and were evaluated histologically and histomorphometrically. RESULTS: Histologically new bone could be seen in every group. Significantly highest new bone formation was found in AB. No significant difference could be detected between BO and BOS. CONCLUSIONS: According to the results of this study, sintered bone substitute material remains histologically distinguishable but does not affect quantitative and qualitative bone regeneration.

Influence of different carrier materials on biphasic calcium phosphate induced bone regeneration.

OBJECTIVES: Biphasic calcium phosphate (BCP) is a bioceramic material successfully used in alloplastic bone augmentation. Despite many advantages, a disadvantage of BCP seems to be a difficult application and position instability. The aim of this study was to determine how different carrier materials influence BCP-induced quantitative and qualitative bone regeneration. MATERIALS AND METHODS: A total of 70 critical size defects were set in the frontal bone of 14 domestic pigs (5 each) and filled randomly with either BCP alone (BCP), BCP in combination with nano-hydroxyapatite (BCP + NHA), BCP embedded in native porcine type I/III collagen blocks (BCP + C), autologous bone (AB), or were left empty (ED). Specimens were harvested after 4 and 8 weeks and were evaluated histologically as well as histomorphometrically. RESULTS: Significantly lowest rate of new bone formation was found in ED (p = < 0.001) and BCP + NHA groups (p = 0.05). After 8 weeks, the highest percentage of new bone formation was observed in the BCP + C group. Fibrous matrix was detected highest in BCP alone. The lowest residual bone substitute material was found in BCP + C after 8 weeks. CONCLUSIONS: BCP-induced bone regeneration is indeed affected by different carrier types. Surface morphology and bioactive characteristics influence osseointegration and new bone formation in vivo. The combination of type I/III collagen seems most suitable for qualitative and quantitative bone regeneration. CLINICAL RELEVANCE: Stabilization of granular bone substitutes using type I/III collagen might be an alternative to granulates alone, indicating excellent volume stability, satisfactory plasticity, and easy application.

Orbit in a Box: A Simplified Technique for Patient-Specific Virtually Planned Orbital Floor Reconstruction.

PURPOSE: Possibilities for the reconstruction of orbital floor fractures have been extensive for years with regard to materials, methods and differential indications and are inconsistent worldwide. With the spread of CAD/CAM techniques, new and mostly time-consuming possibilities for orbital floor reconstructions have been added. METHODS: The simple and time-efficient CT-to-patient-specific implant workflow presented here shows that a "form-box" can be created from a patient's computer tomography data set using planning software and a 3D printer. The box is then used to form a patient-specific implant for orbital floor reconstruction: here polydioxanone foil was used, for which stable thermoplastic deformability has been demonstrated for 3D reconstructions. RESULTS: Patient-specific thermoplastic shaping of polydioxanone is feasible in a theoretical clinical setting, though its thermoplastic shaping is not yet certified for clinical use. However, a flexible adaptation of the "form-box" design to other materials is possible by setting a single planning parameter. CONCLUSIONS: The simple structure of the box and its straightforward planning/fabrication process with widely available low-cost materials offer the possibility that a surgeon without a 3D specialist can produce a "form-box" for next day surgery if needed.

Removal of stones from the superficial lobe of the submandibular gland (SMG) via an intraoral endoscopy-assisted sialolithotomy.

OBJECTIVES: Sialolithiasis is the most common cause of chronic sialadenitis of the submandibular gland (SMG). Symptomatic superficial lobe stones are often treated by submandibulectomy. A gland preserving operation allows for transoral stone removal through endoscopically assisted sialolithotomy. Herein, we provide clinical and sonographical follow-up data in patients who underwent sialolithotomy under general anesthesia. MATERIALS AND METHODS: Sixty patients treated at the Department of Oral and Maxillofacial Surgery at Düsseldorf University Hospital for superficial lobe sialolithiasis of SMG were included in this study. All received transoral sialolithotomy under general anesthesia. Follow-up was conducted via standardized patient questionnaires, clinical examination, and B-mode and color Doppler sonography. RESULTS: Mean patient age was 48.9 years. 56.6% of right and 43.4% of left SMG were affected. Mean follow-up was 45 months. Fifty-five of 59 detected stones could be removed. Mean operation time was 71 min. 3.3% of patients reported recurrent episodes of postoperative pain and 10% felt recurrent episodes of gland swelling. Persistent postoperative lingual nerve hypesthesia was described in one patient. No facial nerve damages occurred. Salivary flow rates remained reduced in most of the affected glands upon stone removal. Sonographical follow-up data of the previously affected SMG after intraoral endoscopy-assisted sialolithotomy showed a regular gland size in 70.8% of cases, a parenchyma free of inflammation in 93.8%, and without signs of fibrosis in 72.9% of cases. 68.7% of patients showed a regular structure of Wharton's duct at time of follow-up. In total, 89.6% of patients were diagnosed stone-free within both glands on follow-up. No case required subsequent submandibulectomy. CONCLUSIONS: Sialolithotomy of Wharton's duct for removal of stones from the SMG's superficial lobe is a promising alternative to submandibulectomy. CLINICAL RELEVANCE: Reduction of postoperative morbidity through endoscopically assisted sialolithotomy for removal of superficial lobe stones from SMG. TRIAL REGISTRATION: Ethics Committee of Heinrich-Heine-University Düsseldorf (no. 5586).

Radiotherapy of painful heel spur with two fractionation regimens : Results of a randomized multicenter trial after 48 weeks' follow-up.

BACKGROUND: In this randomized multicenter trial, we compared the effect of a lower single dose of 0.5 Gy vs. a standard single dose of 1 Gy concerning pain relief and quality of life, while maintaining a uniform total dose of 6 Gy. On the basis of laboratory observations, the lower single dose would be expected to be more effective. PATIENTS AND METHODS: A total of 127 patients suffering from painful heel spur were randomized: Patients in the standard group were treated with single fractions of 6 × 1 Gy twice a week, while the experimental group was treated with single fractions of 12 × 0.5 Gy three times a week. Patients who did not show satisfactory pain relief after 12 weeks were offered re-irradiation with the standard dose. The study's primary endpoints were pain relief and quality of life. Therapy results were evaluated and compared based on follow-up examinations after 12 and 48 weeks. RESULTS: The data of 117 patients could be evaluated. There was no significant difference between the groups concerning the results of a visual analogue scale (VAS), Calcaneodynia Score (CS), and the somatic scale of the 12-Item Short-Form Health Survey(SF-12). Patients undergoing re-irradiation showed a significant benefit concerning pain relief. Their total outcome was comparable to patients showing a good response from the beginning. No relevant acute or chronic side effects were recorded. CONCLUSION: Both patient groups showed good results concerning pain relief. A fractionation schedule of 12 × 0.5 Gy was not superior to the current standard dose of 6 × 1 Gy. Further trials are necessary to explore the best fractionation schedule.

Impact of machined versus structured implant shoulder designs on crestal bone level changes: a randomized, controlled, multicenter study.

PURPOSE: The collar region of an implant is its connection to the oral cavity. A balance between osseointegration on one hand and the absence of plaque accumulation on the other hand is necessary for successful implantation. It is yet to be determined which implant collar design, polished or rough, is best to stabilize the crestal bone level, avoiding peri-implantitis and subsequent risk of implant loss. The aim of this study was to investigate the influence of the architecture of the collar region on marginal bone and soft tissue response. METHODS: This prospective, randomized, clinically controlled multicenter study included 58 patients undergoing dental implant treatment using a pair of dental implants with either machined or rough-surfaced shoulder regions. Patients were clinically and radiologically examined for bone level height and signs of inflammation after 6, 12 and 24 months. RESULTS: No implant was lost within the 2 years of follow-up (100% survival rate). No significant differences on crestal bone loss (machined neck: 0.61 mm ± 0.28 mm, rough neck 0.58 mm ± 0.24 mm) and on soft tissue response (probing depth 3-6 mm with bleeding on probing 7.6% in machined-neck implants and in 8.3% in rough neck implants) were observed between implants with machined and roughened neck after 2 years. CONCLUSIONS: Machined and roughened neck implants achieved equally good results concerning peri-implant bone loss, the rate of peri-implantitis and implant survival rate/hard and soft tissue integration. None of the two collar designs showed a clear advantage in peri-implant reaction. Trial registration German Clinical Trials Register, DKRS00029033. Registered 09 May 2022-Retrospectively registered, http://www.dkrs.de.

Image quality of a portable X-ray device (Nomad Pro 2) compared to a wall-mounted device in intraoral radiography.

OBJECTIVES: The aim of this study was to determine whether a handheld (HH) X-ray device (Nomad Pro 2) is capable of producing equivalent or even superior X-ray image quality in comparison to a wall-mounted (WM) dental X-ray unit (Heliodent Plus) on the basis of objectifiable image quality parameters. METHODS: Anatomical, radiological and biological dental X-ray image quality parameters of a handheld dental X-ray device (Nomad Pro 2, Kavo Kerr, Biberach, Germany) were compared to a standard wall-mounted dental X-ray unit (Heliodent Plus, Sirona Dental Systems, Bensheim, Germany) using a maxillofacial phantom. In addition, the effect of different operators (dentists, dental students, dental assistants) on the dental X-ray image quality was measured. RESULTS: HH and WM devices showed comparable image quality for anterior teeth, premolars, molars and bitewing images. During the two-month investigational period, the radiation exposure level for the operator of the Nomad Pro 2 was 0.1 mSv for 203 images. Dentists as the highest trained personnel enrolled in the study achieved better image quality with the Nomad Pro 2 as compared to dental students and dental assistants, especially in the molar region. CONCLUSIONS: A HH device delivers a comparable image quality to a WM device. In addition, there seem to be short learning curves with regard to image acquisition when using a handheld device, which is further minimised by the previous training of the operating personnel. HH dental X-ray devices, such as the Nomad Pro 2 are a promising adjunct for dental radiology in cases where WM units are of limited practicability.

The use of solvent-preserved human and bovine cancellous bone blocks for lateral defect augmentation - an experimental controlled study in vivo.

BACKGROUND: The aim of this study was to compare new bone formation, resorbed bone matrix, and fibrous enclosed residual bone substitute material in laterally augmented alveolar bone defects using allogeneic, pre-treated and cleaned human bone blocks (tested in dogs, therefore considered to be xenogeneic), and pre-treated and cleaned bovine cancellous bone blocks, both with and without a collagen membrane in order to evaluate their augmentative potential. METHODS: Thirty-two critical size horizontal defects were prepared in the mandible of 4 adult foxhound dogs (8 per dog, 4 on each side). After 3 months of healing, the defects were laterally augmented in a split-mouth-design with either human (HXB) or bovine solvent-preserved bone blocks (BXB). Afterwards, defects were randomly covered with a bovine collagenous membrane (HXB + M, BXB + M). After a healing interval of 6 months, percentages of new bone formation, resorbed bone matrix, and fibrous enclosed residual bone substitute material were compared. RESULTS: Results showed little new bone formation of up to 3.7 % in human bone blocks (HXB 3.7 % ± 10.2, HXB + M 0.3 %± 0.4, BXB, 0.1 % ± 0.8, BXB + M 2.6 % ± 3.2, p = > 0.05). Percentages of fibrous encapsulation were higher in human bone blocks than in bovine bone blocks (HXB 71.2 % ± 8.6, HXB + M 73.71 % ± 10.6, BXB, 60.5 % ± 27.4, BXB + M 52.5 % ± 28.4, p = > 0.05). Resorption rates differed from 44.8 % in bovine bone blocks covered with a membrane to 17.4 % in human bone blocks (HXB 17.4 % ± 7.4, HXB + M 25.9 % ± 10.7, BXB, 38.4 % ± 27.2, BXB + M 44.8 % ± 29.6, p = > 0.05). The use of additional membranes did not significantly affect results. CONCLUSIONS: Within its limitations, results of this study suggest that solvent-preserved xenogenic human and bovine bone blocks are not suitable for lateral bone augmentation in dogs. Furthermore, defect coverage with a membrane does not positively affect the outcome.

Is the prediction of one or two ipsilateral positive lymph nodes by computerized tomography and ultrasound reliable enough to restrict therapeutic neck dissection in oral squamous cell carcinoma (OSCC) patients?

INTRODUCTION: Proper management of the clinically involved neck in OSCC patients continues to be a matter of debate. Our aim was to analyze the accuracy of computerized tomography (CT) and ultrasound (US) in anticipating the exact location of lymph node (LN) metastases of OSCC patients across the AAO-HNS (American Academy of Otolaryngology-Head and Neck Surgery) levels ipsi- and contralaterally. Furthermore, we wanted to assess the suitability of therapeutic selective neck dissection (SND) in patients with one or two ipsilateral positive nodes upon clinical staging (cN1/cN2a and cN2b(2/x) patients). METHODS: We prospectively analyzed the LN status of patients with primary OSCC using CT and US from 2007 to 2013. LNs were individually assigned to a map containing the AAO-HNS levels; patients bearing a single or just two ipsilateral positive nodes (designated cN1/cN2a or cN2b(2/x) patients either by CT (CT group) or US alone (US group) or in a group combining findings of CT and US (CTUS group)) received an ipsi-ND (I-V) and a contra-ND (I-IV). 78% of the LNs were sent individually for routine histopathological examination; the remaining were dissected and analyzed per neck level. RESULTS: Upon the analysis of 1.670 LNs of 57 patients, the exact location of pathology proven LN metastases in cN1 patients was more precisely predicted by US compared to CT with confirmed findings only in levels IA, IB und IIA. Clearly decreasing the number of missed lesions, the findings in the CTUS group nearly kept the spatial reliability of the US group. The same analysis for patients with exactly two supposed ipsilateral lesions (cN2b(2/x)) yielded confirmed metastases from levels I to V for both methods individually and in combination and, therefore, render SND insufficient for these cases. CONCLUSION: Our findings stress the importance of conducting both, CT and US, in patients with primary OSCC. Only the combination of their findings warrants the application of therapeutic SND in patients with a single ipsilateral LN metastasis (cN1/cN2a patients) but not in patients with more than one lesion upon clinical staging (≥ cN2b).

Accuracy in positioning of dental X-ray images - A comparative study of a portable X-ray device and a wall-mounted device.

INTRODUCTION: The benefits of portable dental X-ray devices remain controversially debated. This study aimed to compare the accuracy in positioning dental X-ray images using handheld (Nomad Pro 2) and wall-mounted (Heliodent Plus) X-ray devices. MATERIALS AND METHODS: Radiographical imaging was exercised on a maxillofacial phantom using the handheld dental X-ray device Nomad Pro 2 (Kavo Kerr, Biberach, Germany) and the wall-mounted dental X-ray device Heliodent Plus (Sirona Dental Systems, Bensheim, Germany). Accuracy of device positioning (i.e., centeredness and perpendicularity) was measured as horizontal and vertical deviation (pixels and millimeters) from a centrally positioned crosshair. The reproducibility of the results was tested for 80 images per device and operator. IBM SPSS (SPSS Inc., Chicago, IL) was used for statistical analyses. RESULTS: Centeredness of produced dental X-rays was significantly better for the wall-mounted device than for the handheld device in both deviation from the x-axis (p = 0.042) and y-axis (p = 0.020). The perpendicularity of the produced dental X-rays was significantly better for the handheld device than for the wall-mounted device for both horizontal (p < 0.001) and vertical (p < 0.001) plains. CONCLUSIONS: Handheld dental X-ray devices appear to provide a high degree of accuracy in image positioning, especially in regard to proper perpendicular image angulation.

Sialolithiasis: retrospective analysis of the effect of an escalating treatment algorithm on patient-perceived health-related quality of life.

BACKGROUND: Gland preserving techniques in the treatment of sialolithiasis have continuously replaced radical surgery. The aim of this study was to evaluate a multimodal treatment algorithm in the therapy of sialolithiasis and assess improvement of HRQoL perceived by patients. METHODS: Patients with sialolithiasis were treated by a multimodal treatment algorithm based on multiplicity of stones, stone size, affected gland, and stone position. The therapeutic spectrum ranged from conservative measures, extracorporeal shockwave lithotripsy, interventional sialendoscopy, combined endoscopic-surgical procedures to surgical gland removal as ultima ratio. Outcomes were evaluated by surgeons by means of the electronic patient record and by patients themselves using a standardized questionnaire. RESULTS: 87 patients treated for sialolithiasis were comprised in this study. The submandibular gland (SMG) was affected in 58.6% and the parotid gland (PG) in 41.4% of cases. Mean patient age was 41.67 years for SMG and 48.91 years for PG. In over 80% of cases sialolithiasis was associated with classic meal-related pain and swelling. Type and intensity of symptomatic sialolithiasis were not dependent on patient age or gender, nor could a relation between the affected gland and the occurrence of symptoms be demonstrated. Overall, 86.2% of cases were reported as cured using the multimodal step-by-step treatment algorithm. Resection of the affected gland could be dispensed in 98.9% of cases. According to patients pain could be reduced in 94.3% of cases. CONCLUSIONS: The analyzed treatment algorithm of increasing invasiveness is a favorable and effective tool to successfully treat sialolithiasis in > 86% of cases. For the first time, the present study shows that patient-perceived improvement of HRQoL due to ease of symptoms has an even higher success rate of > 94%.

Evaluation of patient specific care needs during treatment for head and neck cancer.

BACKGROUND: Tumorous diseases of the head and neck region annually occur in more than 550.000 cases worldwide. Little is known about patient specific care needs and potential relationships between non-fulfillment of those following therapeutic and especially surgical treatment of head and neck cancer (HNC). OBJECTIVES: This study aimed to evaluate potential correlations between patient specific care needs, regarding physiological rehabilitation, family/social support, economic needs, and their impact on health-related quality of life (HRQoL). METHODS: A total of 1359 patients were included in this retrospective analysis. Data derived from the exploratory international multicenter rehabilitation study of the German-Austrian-Swiss Cooperative Group on Tumors of the Maxillofacial Region (DÖSAK), including 43 oral and maxillofacial departments in Germany, Austria, and Switzerland using the Bochum patient questionnaire on rehabilitation and a questionnaire on tumor and treatment related data. RESULTS: Results showed a significant correlation of a patient's social bonds and depression, coping with depression, and anxiety. Patients' needs for speech therapy, physiotherapy or respiratory training were hardly ever met and patients had to compensate for financial losses during hospitalization for acute treatment. CONCLUSION: In conclusion, this study describes social, physical, and socio-economic care needs. A multidisciplinary approach managing cancer and treatment related side effects is necessary, as well as enhanced awareness of care needs of practitioners during early recovery after surgery.

Mandible handling in the surgical treatment of oral squamous cell carcinoma: lessons from clinical results after marginal and segmental mandibulectomy.

OBJECTIVE: The aim of this retrospective, single-center study was to analyze long-term results after marginal and segmental mandibulectomies in patients with oral squamous cell carcinoma (OSCC). STUDY DESIGN: The study included 259 patients treated for OSCC with mandibulectomy between 1996 and 2010. Data acquisition consisted of analysis of operation reports, re-evaluation of histologic bone specimens, and collection of clinical follow-up data. RESULTS: Of the included patients, 86.5% had received segmental and 13.5% marginal mandibulectomies. Patients who received segmental mandibulectomy generally displayed a higher TNM (tumor-node-metastasis) stage; 47% of patients who received segmental mandibulectomy and 14% of those receiving marginal mandibulectomy showed bone infiltration (pT4 a). Of all patients with bone infiltration, 49% showed an invasive histologic infiltration pattern, and 35% showed an erosive histologic infiltration pattern. We found healthy residual crestal bone height in 43% of all segmental mandibulectomies. Only 8% of all patients were prosthodontically rehabilitated. With regard to prognostic parameters, there was no significant difference between patients receiving marginal mandibulectomy and those receiving segmental mandibulectomy. CONCLUSIONS: Because healthy residual crestal bone height was found in 43% of all patients who had received segmental mandibulectomies, it is conceivable that a significant number of patients would profit from marginal mandibulectomy, at least in cases of absent or erosive bone infiltration pattern, because the residual crestal bone is functionally stable.

Evaluation of the oral health-related quality of life in patients with odontogenic fascial space abscesses and underlying conditions - a prospective questionnaire-based study.

BACKGROUND: Oral Health-Related Quality of Life (OHRQoL) is an important aspect of quality of life. Acute illnesses, as well as chronic diseases, can have a strong, persisting impact on an individual's quality of life. This study evaluates OHRQoL of patients with odontogenic fascial space abscesses, the underlying conditions, and its consequences for clinical routines. METHODS: The research group consisted of patients presenting themselves to the emergency room or elective clinic of the Department for Cranio-Maxillofacial and Plastic Surgery (n = 94). The validated German version of the Oral Health Impact Profile (OHIP-G) and additional questions (including habits and routines in oral hygiene) with an anamnestic recall period of 1 month was used to evaluate OHRQoL shortly after emergency treatment (baseline) and again after 3-6 months' follow-up. Ninety-four patients completed the questionnaire at baseline, 54 completed both questionnaires. Additionally, OHIP-G scores were compared to those of the non-impacted general German population. RESULTS: Results showed a significant difference in OHIP-G scores from baseline to follow-up (p = 0.001). Overall a mean of 55.24 (±37.02) points was scored at baseline and a mean of 37.02 (±35.79) points was scored at follow-up. Patients scored higher than participants of a representative study of the general German population. CONCLUSION: Overall results suggest an increase in OHRQoL 3-6 months after acute treatment. Nevertheless, OHRQoL of patients suffering from odontogenic fascial space abscesses seems to remain generally lower than the OHRQoL of the general German population. TRIAL REGISTRATION: Trial registration: Central Study Register of the University Hospital Duesseldorf, Registration-ID: 2016085405 . Registered 24 August 2016.

Release kinetics of the model protein FITC-BSA from different polymer-coated bovine bone substitutes.

BACKGROUND: Controlled release of proteins bound to conventional bone substitutes is still insufficient. Therefore, this study evaluates in-vitro release kinetics of the model protein FITC-BSA (fluorescein conjugated bovine serum albumine) from insoluble bovine collagenous bone matrices (ICBM) with different polymer coatings. Analyzes aim at comparing FITC-BSA release from uncoated versus coated ICBM over time to find bone substitute coatings with consistent release profiles. METHODS: Release kinetics of FITC-BSA from uncoated as well as coated ICBM with five different polymers (RESOMER R 203 H, RG 503 H, RG 504 H, RG 505, L 206 S) were measured over a period of 11 days (d). Measurements were conducted after 6 h (h), 12 h, 24 h, 3 d, 5 d, 7 d, 9 d and 11 d with six samples for each coated ICBM. Two groups were formed (1) with and (2) without medium change at times of measurement. For each group ANOVA with post-hoc Bonferroni testing was used. Scanning electron microscopy assessed morphologic differences between ICBM coating. RESULTS: In group 1 approx. 70% of FITC-BSA release from uncoated ICBM occurred after 6 h compared to approx. 50% in group 2. Only polymers with medium inherent viscosity, i.e. RESOMER RG 503 H, constantly showed significantly more FITC-BSA release throughout 11 d than uncoated ICBM (p = 0.007). The same was found for group 2 (p = 0.005). No significant differences between PLA and PLGA polymers were found. Scanning electron microscopy results indicate a weak adhesion of polymer coatings to ICBM explaining its rather weak retentive effect on overall FITC-BSA release. CONCLUSIONS: Medium molecular size polymers reduce the overall released FITC-BSA from ICBM over time. In clinical practice these polymers may prove ideal for bone substitute materials.

Evaluation of Biocompatibility of Different Membrane Surfaces Using Unrestricted Somatic Stem Cells.

BACKGROUND/AIM: Results of Guided Bone Regeneration (GBR) primarily depend on the membrane used. The aim of this study was to compare biocompatibility of different absorbable and non-absorbable membranes by using unrestricted somatic stem cells (USSCs) as an indicator for biocompatibility. MATERIALS AND METHODS: Five absorbable membranes (Bio-Gide®, RESODONT®, GENTA-FOIL resorb®, BioMend® and BioMend® Extend™) and one non-absorbable alternative (GORE-TEX®) were colonized with USSCs. After 24 h, 3 days and 7 days, cell proliferation, cell viability, and cytotoxicity were assessed. Moreover, cell morphology was evaluated by electron microscopy. RESULTS: Significantly higher cell proliferation and cell viability rates were observed in Bio-Gide® and RESODONT® membranes. Cell toxicity was highest on GENTA-FOIL resorb® membranes. The electron microscopical assessment showed a better cell attachment on porous surfaced membranes. CONCLUSION: This study shows that USSCs can be used for assessments of biocompatibility, and that absorbable membranes with collagenous composition and porous structure tend to positively impact biocompatibility and enhance cell proliferation.

Secondary Bleedings in Oral Surgery Emergency Service: A Cross-Sectional Study.

INTRODUCTION: Bleeding after dental surgery is still a common cause for emergency presentation in patients using anticoagulants. Our aim was to analyze pertinent characteristic features on the one hand and to bare existing problems in handling on the other. MATERIALS AND METHODS: The study included 76 patients. We documented basic data, anticoagulant medication, type of surgery, and tooth socket sutures in respective patients. RESULTS: The vast majority of patients took a coumarin derivative (41) and acetylsalicylic acid (27). Nine (12%) of the patients had to be hospitalized due to ongoing bleeding despite local haemostyptic steps and/or circulatory dysregulation. Most patients could be successfully treated in outpatient settings. No statistically significant correlation between bleeding, level of INR value, number of extracted teeth, and sewed alveoli could be shown. Sixty-five percent of cases with tooth extractions did not have suture of tooth sockets. Eighty-seven percent of the patients denied being informed about possible self-treatment options by their surgeon/dentist, and none of the patients got presurgical-fabricated bandage plate(s). CONCLUSIONS: Patients taking coumarin derivative currently, furthermore, represent the biggest anticoagulant after-bleeding group in dentoalveolar surgery. The major part of after-bleedings (90%) can be handled in an outpatient setting with simplest surgical interventions. Unfortunately, the biggest part of the patient collective got no suture, no prefabricated dental bandage plate(s), and no explanation by their dentist how to handle in case of after-bleeding. Therefore, dental practitioners should furthermore get enlightenment on how to prevent after-bleeding situations.

Extensive Craniocervical Abscess after Transoral Ganglionic Local Opioid Analgesia at the Superior Cervical Ganglion for Atypical Trigeminal Neuralgia: Report of a Severely Complicated Case.

Ganglionic local opioid analgesia (GLOA) describes the application of low-dose opioids close to sympathetic as, for example, to the superior cervical ganglion. GLOA can be effective in different pain syndromes affecting the head and face region and has been considered to be a safe technique with few complications reported so far. We present the case of a patient who received a single, transoral GLOA for a refractory trigeminal neuralgia. The patient subsequently developed an extensive epidural abscess at the craniocervical junction, requiring ultimately transoral odontoid resection and dorsal stabilisation. This severe complication challenges the role of transoral infiltration therapies in analgetic medicine.

Extraskeletal chondroma walling the temporomandibular joint: Report of a rare case and review of the literature.

INTRODUCTION: Extraskeletal or soft-tissue chondroma is a rare benign cartilaginous neoplasm which usually affects hands and feet. Scientific literature only reports one previous case of this pathology in the preauricular region. PRESENTATION OF THE CASE: This report describes a rare case of extraskeletal chondroma surrounding the temporomandibular joint of a 55-year-old female patient. DISCUSSION AND CONCLUSION: Diagnosis of extraskeletal chondroma is challenging since tissue swelling, diagnostic imaging and even histopathological features may be misleading for other joint or gland pathologies.

Pathogenesis of medication-related osteonecrosis of the jaw: a comparative study of in vivo and in vitro trials.

Objective This study was performed to determine whether the results of prevailing in vivo and in vitro studies offer a reliable model for investigation of medication-related osteonecrosis of the jaw (MRONJ). Methods Embase, Medline, and the Cochrane Library were searched for articles published from September 2003 to June 2017 involving experimental approaches to the pathogenesis of MRONJ. In vivo and in vitro trials were analyzed with respect to the scientific question, study design, methodology, and results. Results Of 139 studies, 87, 46, and 6 conducted in vivo, in vitro, and both in vivo and in vitro experiments, respectively. Rats, mice, dogs, minipigs, sheep, and rabbits were the preferred animal models used. Osteoblasts, osteoclasts, fibroblasts, keratinocytes, macrophages, and human umbilical vein endothelial cells were the preferred cell types. Zoledronate, alendronate, ibandronate, and risedronate were the most frequent bisphosphonates used. MRONJ was most reliably induced in minipigs because of the close relationship with human bone physiology. In vitro studies showed that reduced viability, growth, and migration of cells in the bone and soft tissues were causative for MRONJ. Other than exposed jawbone after tooth extraction, no reliable cofactors were found. Conclusion The minipig is the most suitable animal model for MRONJ.