Publications by authors named "Friedrich-Wilhelm Neukam"

94 Publications

The effect of polyethylenglycol gel on the delivery and osteogenic differentiation of homologous tooth germ-derived stem cells in a porcine model.

Clin Oral Investig 2021 May 26;25(5):3043-3057. Epub 2020 Oct 26.

Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glueckstrasse 11, 91054, Erlangen, Germany.

Objectives: The aim of this study was to investigate if bone regeneration can be promoted by homologous transplantation of STRO-1 sorted (STRO-1+) porcine tooth germ mesenchymal stem cells (TGSCs) with the combination of polyethylenglycol (PEG)-based hydrogel and biphasic calcium phosphate (BCP) scaffolds.

Material And Methods: TGSCs were isolated from impacted third molars of domestic pigs. Nine critical-sized defects were created as (1) untreated defect; filled with (2) autogenous bone; (3) BCP + PEG; (4) BCP + PEG + unsorted TGSCs; (5) BCP + unsorted TGSCs; (6) BCP + PEG + STRO-1-sorted TGSCs; (7) BCP + STRO-1-sorted TGSCs; (8) BCP + PEG + osteogenic induced unsorted TGSCs; and (9) BCP + PEG + osteogenic induced STRO-1-sorted TGSCs in 20 domestic pigs. CM-DiI labelling was used to track cells in vivo. Histomorphometric assessment of new bone formation was achieved by toluidine blue O staining and microradiography after 1, 2, 4 and 12 weeks posttransplantation.

Results: Complete healing was achieved in all defects although defects with PEG hydrogel presented better bone formation while STRO-1+ and unsorted TGSCs showed similar ability to form new bone after 12 weeks. Transplanted cells were seen in defects where PEG hydrogel was used as carriers in contrast to defects treated with cells and only bone grafts.

Conclusions: PEG hydrogel is an efficient carrier for homologous stem cell transplantation. TGSCs are capable of promoting bone healing in critical-sized defects in combination with bone graft and PEG hydrogel.

Clinical Relevance: This study provides information about the importance of the delivery vehicle for future translational stem cell delivery approaches.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00784-020-03625-6DOI Listing
May 2021

Long-Term Influence of Platelet-Rich Plasma (PRP) on Dental Implants after Maxillary Augmentation: Implant Survival and Success Rates.

J Clin Med 2020 Feb 1;9(2). Epub 2020 Feb 1.

Department of Cranio Maxillofacial Surgery, Justus-Liebig University Giessen, Klinik Str. 33, 35392 Giessen, Germany.

The atrophic maxilla often requires bone augmentation before implant placement to ensure long-term implant success. A previous prospective clinical trial examined the use of platelet-rich plasma (PRP) during maxillary augmentation. The short-term results showed no positive effect of PRP. The aim of this study was to evaluate the same patient collective of the previous study regarding the PRP long-term impact on the survival and success of dental implants. Fifty-three patients from the previous study diagnosed with maxillary atrophy and augmented with autologous bone grafts from the iliac crest and dental implants, were included in this study. Treatment was carried out on both sides in 34 patients with a split-mouth-design in which one randomly chosen side was treated additionally with PRP, the other side was the control-side. Nineteen patients were treated only on one side and were assigned to the PRP-or the control group randomly. Implant follow-up of the patients from the previous study was performed after an average time of 13 years. Implant success was evaluated using two different success criteria. Thitry-seven patients (25 women and 12 men) were investigated in this study. Seventeen patients (12 female, 5 male) were included in the PRP group, while 20 patients (13 female, 7 male) participated in the control group. A total of 210 implants were inserted. Of these, 102 implants (48.57%) were placed in the PRP group and 108 implants (51.42%) in the control group. Out of 102 investigated implants in the PRP group, 6 were removed (survival rate 94.1%). While two of the 108 implants in the control group were loss (survival rate 98.1%). In the PRP group, the cumulative probability of survival after 15.1 years was 94.1% and in the control group, was 98.1%, with no significant difference between the two groups. Higher significant difference for the control group was found in the cumulative success probability using Albrektson criteria ( = 0.05). Positive impact of PRP on long-term implant survival and success could not be found.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9020391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073529PMC
February 2020

Long-Term Influence of Platelet-Rich Plasma (PRP) on Dental Implants after Maxillary Augmentation: Retrospective Clinical and Radiological Outcomes of a Randomized Controlled Clinical Trial.

J Clin Med 2020 Jan 28;9(2). Epub 2020 Jan 28.

Department of Cranio Maxillofacial Surgery, Justus-Liebig University Giessen, Klinik Str. 33, 35392 Giessen, Germany.

The long-term clinical and radiological outcomes of dental implants inserted in augmented bone treated with platelet-rich plasma (PRP) has not been well addressed in the literature yet. This study is based on a collection of patients from a randomized controlled trial (RCT) that did not report any short-term positive effects of PRP on bone healing after sinus lift surgery using autologous iliac crest bone graft. This study aimed to evaluate the long-term impact of PRP regarding clinical and radiological outcomes on the inserted implants in the previous RCT. For this evaluation, we considered the following variables: plaque index, probing depth, bleeding index, mobility grade, Periotest values, and radiological bone loss. Out of 53 patients ( = 306 implants) included in the previous study we were able to reinvestigate 37 patients ( = 210 implants) in two centers (31 in Giessen, Germany and 6 in Erlangen, Germany). Clinical and radiographic parameters suggested overall healthy conditions of the peri-implant tissue. The PRP-group and the control group did not differ significantly in the majority of the parameters. The overall evaluation showed that result data of the PRP-group was inferior to the control group in 64 percent of the evaluated parameters. The present study cannot provide evidence of a positive effect of PRP on the long-term implant clinical and radiological outcomes. In fact, a tendency towards inferior long-term results in the PRP-group was detected without reaching a significant threshold. Further controlled trials need to be conducted to investigate this correlation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9020355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073889PMC
January 2020

Correction to: Anatomical locations in the oral cavity where surgical resections of oral squamous cell carcinomas are associated with a close or positive margin-a retrospective study.

Clin Oral Investig 2019 01;23(1):509

Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany.

The following note was inadvertently omitted from the published paper: This work was performed in (partial) fulfillment of the requirements for the first author's obtaining the degree Dr. med. dent.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00784-018-2781-7DOI Listing
January 2019

The fitting accuracy of pre-bend reconstruction plates and their impact on the temporomandibular joint.

J Craniomaxillofac Surg 2019 Jan 18;47(1):53-59. Epub 2018 May 18.

Department of Oral and Maxillofacial Surgery (Head of Department Friedrich Wilhelm Neukam, Prof., MD, DMD, PhD, Dr. h. c), Friedrich-Alexander-University Erlangen-Nuremberg, Glueckstrasse 11, 91054 Erlangen, Germany. Electronic address:

Background: Various causes for bone defects of the lower jaw have been described. As a result, patients often suffer from compromised aesthetics and a loss of, or reduction in, important physiological functions, such as swallowing, breathing, and speaking. A change in the shape of the lower jaw can impair the natural occlusion and leads to an atypical or modified position of the temporomandibular joint. Titanium reconstruction plates are the standard approach to jaw reconstruction, and are used for temporary bridging of a jaw defect or fixation of a bone graft. Conventionally these plates are intraoperatively adjusted to the mandible by the surgeon. Computer-aided manufacturing, computer-aided design, and rapid prototyping have gained increasing importance in the field of medicine, as they allow the production of individual models of the lower jaw, with the possibility of preoperatively bending the reconstruction plates. In this retrospective study, the accuracy of pre-bent titanium plates and their effect on the temporomandibular joint situation in comparison with intraoperatively curved plates will be discussed.

Materials And Methods: Patients who attended our department for lower jaw reconstruction between March 2013 and February 2015 were included in this retrospective study. Within that time 20 patients were treated with pre-bent reconstruction plates (group 1). 20 comparable patients were selected with reconstruction and conventional intraoperative bending (group 2). To evaluate the accuracy of the plates and the condylar position, postoperative cone beam computed tomograms and computed tomograms were used to assess the bone-plate distance at 12 defined points and four angles in axial reconstruction. The results were compared, statistically evaluated, and discussed.

Results: Regarding the maximum bone-plate distances and the sum of distances, there was a significant difference between the accuracy of the pre-bent and the conventionally bent reconstruction plates (p = 0.022, p = 0.048). Regarding the condylar position, there was no significant difference between both methods (p = 0.867).

Conclusion: The results of this study show that a better fitting accuracy can be achieved using pre-bent plates. Preparation of the plates proves to be advantageous and meaningful, especially in complex bone defects and deformations of the lower jaw. Nevertheless, concerning the position of the temporomandibular joint, no significant difference could be ascertained between the shown methods, contradicting several studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2018.05.033DOI Listing
January 2019

Oral implant survival in patients with bisphosphonate (BP)/antiresorptive and radiation therapy and their impact on osteonecrosis of the jaws. A systematic review.

Eur J Oral Implantol 2018 ;11 Suppl 1:S93-S111

Aim: In this systematic review, we aimed to assess the impact of endosseous implants on the formation of an osteonecrosis of the jaw, as well as implant survival rates for patients under bisphosphonate (BP), antiresorptive and radiation therapy.

Materials And Methods: An electronic search was performed using PubMed, Embase, and Medline databases with the logical operators: "dental implant", "antiresorptive", "bisphosphonate", "irradiation", "radiotherapy", "radiation", "necrosis" and "survival". The search was limited to articles published up to 15 December 2016. Recent publications were also searched manually to find any relevant studies that might have been missed using the search criteria noted above. The outcome variables were the implant survival rate and the frequency of osteonecrosis of the jaws.

Results: In total, 18 studies addressing oral implants in patients with BP or antiresorptive therapy and 23 with radiation therapy met the inclusion criteria and were included in this systematic review. Most of the studies had a retrospective design with a level of evidence (LoE) of III (moderately high risk of bias). Implant survival rate ranged from 92.86% to 100% in patients with BP/antiresorptive therapy (all due to osteoporosis) and 38.5% to 97.9% in patients with radiation therapy. For BP patients, osteonecrosis in relation to oral implants more frequently occurred in patients taking BPs due to malignant diseases. In patients with radiation therapy, an "implant triggered" necrosis is also a potential complication. The lack of data in the current literature concerning this issue does not allow a proper risk assessment to date.

Conclusions: Within the limits of this systematic review, implant treatment concepts seem to be a valuable approach in patients with radiation therapy and patients with BP therapy due to an osteoporosis. In patients taking BPs due to a malignant disease, implant treatments are not recommended due to the high number of reported implant-related necrosis in this patient cohort. Outcomes of this review should, however, be regarded with caution due to the low level of evidence of the currently existing data.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2020

Diagnosis, avoidance and management of complications of implant-based treatments.

Eur J Oral Implantol 2018 ;11 Suppl 1:S21-S25

This review provides an overview of review and consensus articles of the past 5 years regarding surgical complications in implant dentistry. The focus in this article is on surgical complications occurring after implant insertion and on risk factors that compromise oral implant osseointegration.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2020

Evaluation of Staff Satisfaction After Implementation of a Surgical Safety Checklist in the Ambulatory of an Oral and Maxillofacial Surgery Department and its Impact on Patient Safety.

J Oral Maxillofac Surg 2018 Aug 6;76(8):1616-1639. Epub 2018 Apr 6.

Professor, Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.

Purpose: Safety checklists in medicine have been shown to be effective in the prevention of complications and adverse events in patients undergoing surgery. Such checklists are not as common in dentistry. The aims of this study were to propose a safety checklist for the ambulatory treatment of patients undergoing oral and implant surgery and to assess its impact on patient safety and staff satisfaction.

Materials And Methods: After implementation of a surgical safety checklist in the ambulatory treatment of patients undergoing oral and implant surgeries, a questionnaire regarding staff satisfaction and safety-related parameters was randomly administered. Incidents, complications, and adverse events were documented. Outcomes with (n = 40 surgeries) and without (n = 40 surgeries) use of the checklist were analyzed and compared.

Results: Staff reported high satisfaction with the use of the checklist, which demonstrably improved team communication and lowered stress levels during surgery. There was a statistically significantly higher frequency of reported incidents without the use of the checklist (n = 43) than with the use of the checklist (n = 10; P = .000). Most incidents were reported in the context of pre- and post-procedural processes.

Conclusions: Safety checklists help to improve work processes, optimize communication, and lower stress levels. Their use in clinical dental practice is recommended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.joms.2018.03.032DOI Listing
August 2018

Anatomical locations in the oral cavity where surgical resections of oral squamous cell carcinomas are associated with a close or positive margin-a retrospective study.

Clin Oral Investig 2018 May 23;22(4):1625-1630. Epub 2018 Mar 23.

Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany.

Objectives: This study aimed to identify anatomical areas where resections of oral squamous cell carcinomas (OSCC) are significantly associated with close or positive margins.

Materials And Methods: This retrospective study included 330 patients with a primary OSCC from 2010 to 2015. Patient and tumour data were categorised into three groups by R-status (R0 [clear], ≥ 5 mm, 185 patients [56.06%]; R1 [positive], < 1 mm, 24 patients [7.27%]; and R0 [close], 1-5 mm, 121 patients [36.67%]).

Results: Areas where resections were significantly associated with close or positive margins were the hard palate (p < 0.001), buccal mucosa (p = 0.03), floor of the mouth (p = 0.004), lower alveolar ridge (p = 0.01), retromolar triangle (p = 0.005), and dorsal tongue (p = 0.02).

Conclusions: Anatomical areas were identified in the oral cavity where it is challenging to resect OSCCs with an adequate safety margin.

Clinical Relevance: These results may enable surgeons to achieve a postulated safe distance during tumour resection, leading to a survival benefit for patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00784-018-2424-zDOI Listing
May 2018

In-vitro evaluation of Polylactic acid (PLA) manufactured by fused deposition modeling.

J Biol Eng 2017 12;11:29. Epub 2017 Sep 12.

Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany.

Background: With additive manufacturing (AM) individual and biocompatible implants can be generated by using suitable materials. The aim of this study was to investigate the biological effects of polylactic acid (PLA) manufactured by Fused Deposition Modeling (FDM) on osteoblasts in vitro according to European Norm / International Organization for Standardization 10,993-5.

Method: Human osteoblasts (hFOB 1.19) were seeded onto PLA samples produced by FDM and investigated for cell viability by fluorescence staining after 24 h. Cell proliferation was measured after 1, 3, 7 and 10 days by cell-counting and cell morphology was evaluated by scanning electron microscopy. For control, we used titanium samples and polystyrene (PS).

Results: Cell viability showed higher viability on PLA (95,3% ± 2.1%) than in control (91,7% ±2,7%). Cell proliferation was highest in the control group (polystyrene) and higher on PLA samples compared to the titanium samples. Scanning electron microscopy revealed homogenous covering of sample surface with regularly spread cells on PLA as well as on titanium.

Conclusion: The manufacturing of PLA discs from polylactic acid using FDM was successful. The in vitro investigation with human fetal osteoblasts showed no cytotoxic effects. Furthermore, FDM does not seem to alter biocompatibility of PLA. Nonetheless osteoblasts showed reduced growth on PLA compared to the polystyrene control within the cell experiments. This could be attributed to surface roughness and possible release of residual monomers. Those influences could be investigated in further studies and thus lead to improvement in the additive manufacturing process. In addition, further research focused on the effect of PLA on bone growth should follow. In summary, PLA processed in Fused Deposition Modelling seems to be an attractive material and method for reconstructive surgery because of their biocompatibility and the possibility to produce individually shaped scaffolds.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13036-017-0073-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594599PMC
September 2017

Long-term Outcome of Speech Intelligibility in Maxillary Dental Rehabilitation with Full Dentures: A Prospective Study Using Automatic Speech Quantification.

Int J Prosthodont 2017 Sep/Oct;30(5):419-425

Aims: Complete maxillary edentulism and prosthetic rehabilitation with removable full dentures are known to affect speech intelligibility. The aim of this study was to prospectively investigate the long-term effect of time on speech intelligibility in patients being rehabilitated with newly fabricated full maxillary dentures.

Materials And Methods: Speech was recorded in a group of 14 patients (male = 9, female = 5; mean age ± standard deviation [SD] = 66.14 ± 7.03 years) five times within a mean period of 4 years (mean ± SD: 47.50 ± 18.16 months; minimum/maximum: 24/68 months) and in a control group of 40 persons with healthy dentition (male = 30, female = 10; mean age ± SD = 59 ± 12 years). All 14 participants had their inadequate removable full maxillary dentures replaced with newly fabricated dentures. Speech intelligibility was measured by means of a polyphone-based speech recognition system that automatically computed the percentage of accurately spoken words (word accuracy [WA]) at five different points in time: 1 week prior to prosthetic maxillary rehabilitation (both with and without inadequate dentures in situ) and at 1 week, 6 months, and a mean of 48 months after the insertion of newly fabricated full maxillary dentures.

Results: Speech intelligibility of the patients significantly improved after 6 months of adaptation to the new removable full maxillary dentures (WA = 66.93% ± 9.21%) compared to inadequate dentures in situ (WA = 60.12% ± 10.48%). After this period, no further significant change in speech intelligibility was observed. After 1 week of adaptation, speech intelligibility of the rehabilitated patients aligned with that of the control group (WA = 69.79% ± 10.60%) and remained at this level during the examination period of 48 months.

Conclusion: The provision of new removable full maxillary dentures can improve speech intelligibility to the level of a healthy control group on a long-term basis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11607/ijp.5239DOI Listing
December 2017

The influence of different abutment materials on tissue regeneration after surgical treatment of peri-implantitis - a randomized controlled preclinical study.

J Craniomaxillofac Surg 2017 Aug 3;45(8):1190-1196. Epub 2017 Jun 3.

Department of Oral and Maxillofacial Surgery, University of Erlangen - Nuremberg, Erlangen, Germany.

Objectives: This study aimed to assess the impact of different abutment materials on peri-implant tissue regeneration after surgical treatment of peri-implantitis in a large animal model.

Material And Methods: Titanium implants (n = 51) were inserted in the upper and lower jaw of eight beagle dogs and a peri-implant infection was induced. After two months the peri-implant infection was surgically treated and abutments with different surfaces (Ti-2: n = 14; CoCrMb: n = 13; Ag-modified Ti-4: n = 14; Ti-4 control: n = 10) were applied. Clinical attachment level (CAL), modified sulcus bleeding index (mBI), bleeding on probing (BoP), and the sulcus fluid flow rate (SFFR) were determined 4, 8, and 12 weeks after surgical treatment to document the peri-implant tissue reaction.

Results: Superior levels for CAL and mBI were found with the Ti-4 control and the Ag-modified abutments, with the Ag-modified abutments showing the best values after 12 weeks. Lowest SFFR values compared with the other treatment groups underlined the superior soft tissue reaction adjacent to Ag-modified abutments. After 12 weeks inferior CAL, SFFR, BOP and mBI values were documented for the Ti-2 surface.

Conclusion: Within limitations of the study, Ag-modified abutments lead to superior tissue reactions. Further studies are needed to investigate the properties of abutment materials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2017.05.025DOI Listing
August 2017

Consultation with a specialized pain clinic reduces pain after oral and maxillofacial surgery.

J Craniomaxillofac Surg 2017 Feb 14;45(2):281-289. Epub 2016 Dec 14.

Department of Oral and Maxillofacial Surgery, University Hospital of Erlangen, Östliche Stadtmauerstraße 27, Erlangen, 91054, Germany. Electronic address:

Purpose: Postoperative pain management is important for improved patient care. Our primary objective was to investigate the effect of analgesic treatment adaptation by the pain clinic on postoperative pain relief at an oral and maxillofacial surgery department. Additionally, we aimed to present patients' pain characteristics and the administered analgesic treatment.

Materials And Methods: A total of 128 patients treated at our clinic in the period 2012-2015 who required analgesic treatment adaptation by our pain clinic were included. They were further divided into 10 groups: tumor, temporomandibular joint disorder, tooth extraction, osteomyelitis, bisphosphonate-related osteonecrosis of the jaw, submandibular abscess, orthognathic surgery, cyst, sinusitis, and fracture. Pain characteristics evaluated were intensity on a numerical rating scale (NRS) before and after intervention of the pain clinic, quality, genesis, and type.

Results: Post treatment pain intensity values at rest 1.8 (SD: 1.4) and on exercise (walking and physical therapy) 4 (SD: 2) were statistically significant better compared to pretreatment values (4.2, SD: 2.5, and 6.8 SD: 2, respectively). The highest pain intensities were reported after tooth extractions, orthognathic surgery, cystectomies, and fracture reposition. Pain was mainly continuous and related to a combination of a somatic and a neuropathic pathophysiological mechanism.

Conclusions: Intervention by a specialized pain clinic leads to reduction of postoperative pain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2016.12.009DOI Listing
February 2017

The differentiation of oral soft- and hard tissues using laser induced breakdown spectroscopy - a prospect for tissue specific laser surgery.

J Biophotonics 2017 Oct 22;10(10):1250-1261. Epub 2016 Nov 22.

Clinical Photonics Lab, Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Straße 6, 91052, Erlangen, Germany.

Compared to conventional techniques, Laser surgery procedures provide a number of advantages, but may be associated with an increased risk of iatrogenic damage to important anatomical structures. The type of tissue ablated in the focus spot is unknown. Laser-Induced Breakdown-Spectroscopy (LIBS) has the potential to gain information about the type of material that is being ablated by the laser beam. This may form the basis for tissue selective laser surgery. In the present study, 7 different porcine tissues (cortical and cancellous bone, nerve, mucosa, enamel, dentine and pulp) from 6 animals were analyzed for their qualitative and semiquantitative molecular composition using LIBS. The so gathered data was used to first differentiate between the soft- and hard-tissues using a Calcium-Carbon emission based classifier. The tissues were then further classified using emission-ratio based analysis, principal component analysis (PCA) and linear discriminant analysis (LDA). The relatively higher concentration of Calcium in the hard tissues allows for an accurate first differentiation of soft- and hard tissues (100% sensitivity and specificity). The ratio based statistical differentiation approach yields results in the range from 65% (enamel-dentine pair) to 100% (nerve-pulp, cancellous bone-dentine, cancellous bone-enamel pairs) sensitivity and specificity. Experimental LIBS measuring setup.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jbio.201600153DOI Listing
October 2017

Chronic recurrent multifocal osteomyelitis in association with pyoderma gangraenosum.

BMC Oral Health 2016 Sep 1;16(1):85. Epub 2016 Sep 1.

Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany.

Background: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare acquired inflammatory skeletal disorder of unknown origin. CRMO was first described by Gideon in 1972 and mainly affects children and young adults of female gender. The CRMO is part of the clinical picture of non-bacterial Osteomyelitis (NBO) and typically presents a relapsing recurring course with both remission and spontaneous exacerbation. CRMO is typically encountered in the limbs and the metaphysis of long bones in particular. Usually the clinical symptoms include painful swellings of the affected regions. This case report describes the rare case of a CRMO of the mandible in association with pyoderma gangraenosum.

Case Presentation: A 14-year old female caucasian patient, residing in the south of Germany, presented in the oncological outpatient clinic of our Department of Paediatrics and Adolescent Medicine in June 2014 complaining of increasing neck pain and progressive swelling at her left cheek ongoing for about 6 weeks. These symptoms had been occurring quarterly for 4 years, but had never been as pronounced. Blood biochemistry showed a moderately elevated CRP (35 mg/l) and a significantly increased blood sedimentation rate (BSR 48/120 mm). The panoramic radiograph, however, revealed a bone alteration in the left mandibular region. Further investigations confirmed the diagnosis of CRMO.

Conclusion: The present case underlines the fact that rare diseases might occasionally present with even more rare symptoms. These occasions can obviously be considered to present a considerable diagnostic challenge.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12903-016-0275-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009688PMC
September 2016

Development and validation of a classification and scoring system for the diagnosis of oral squamous cell carcinomas through confocal laser endomicroscopy.

J Transl Med 2016 06 3;14(1):159. Epub 2016 Jun 3.

Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany.

Background: Confocal laser endomicroscopy (CLE) is an optical biopsy method allowing in vivo microscopic imaging at 1000-fold magnification. It was the aim to evaluate CLE in the human oral cavity for the differentiation of physiological/carcinomatous mucosa and to establish and validate, for the first time, a scoring system to facilitate CLE assessment.

Methods: The study consisted of 4 phases: (1) CLE-imaging (in vivo) was performed after the intravenous injection of fluorescein in patients with histologically confirmed carcinomatous oral mucosa; (2) CLE-experts (n = 3) verified the applicability of CLE in the oral cavity for the differentiation between physiological and cancerous tissue compared to the gold standard of histopathological assessment; (3) based on specific patterns of tissue changes, CLE-experts (n = 3) developed a classification and scoring system (DOC-Score) to simplify the diagnosis of oral squamous cell carcinomas; (4) validation of the newly developed DOC-Score by non-CLE-experts (n = 3); final statistical evaluation of their classification performance (comparison to the results of CLE-experts and the histopathological analyses).

Results: Experts acquired and edited 45 sequences (260 s) of physiological and 50 sequences (518 s) of carcinomatous mucosa (total: 95 sequences/778 s). All sequences were evaluated independently by experts and non-experts (based on the newly proposed classification system). Sensitivity (0.953) and specificity (0.889) of the diagnoses by experts as well as sensitivity (0.973) and specificity (0.881) of the non-expert ratings correlated well with the results of the present gold standard of tissue histopathology. Experts had a positive predictive value (PPV) of 0.905 and a negative predictive value (NPV) of 0.945. Non-experts reached a PPV of 0.901 and a NPV of 0.967 with the help of the DOC-Score. Inter-rater reliability (Fleiss` kappa) was 0.73 for experts and 0.814 for non-experts. The intra-rater reliability (Cronbach's alpha) of the experts was 0.989 and 0.884 for non-experts.

Conclusions: CLE is a suitable and valid method for experts to diagnose oral cancer. Using the DOC-Score system, an accurate chair-side diagnosis of oral cancer is feasible with comparable results to the gold standard of histopathology-even in daily clinical practice for non-experienced raters.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12967-016-0919-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4891821PMC
June 2016

Peri-implant defect regeneration in the diabetic pig: A preclinical study.

J Craniomaxillofac Surg 2016 Jul 13;44(7):827-34. Epub 2016 Apr 13.

Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glückstrasse 11, 91054 Erlangen, Germany. Electronic address:

Objectives: The study aims to establish a peri-implant dehiscence-type bone defect in a diabetic animal model of human bone repair and to quantify the influence of diabetes on peri-implant bone regeneration.

Material And Methods: Experimental diabetes was induced in three domestic pigs by streptozotocin. Three animals served as healthy controls. After 12 months four standardized peri-implant dehiscence bone defects were surgically created in the ramus mandibulae. The animals were sacrificed after 90 days. Samples were histologically analyzed to quantify new bone height (NBH), bone-to-implant-contact (BIC), area of newly formed bone (NFB), bone-density (BD), and bone mineralization (BM) in the prepared defect (-D) and in a local control region (-L).

Results: After 90 days, diabetic animals revealed a significantly lower BIC (p = 0.037) and BD (p = 0.041) in the defect area (-D). NBH and BM-D differences within the groups were not significant (p > 0.05). Significant more NFB was measured in the healthy control group (p = 0.046). In the region of local bone BIC-L was significant less in the diabetic group (p = 0.028). In the local control region BD-L and BM-L was lower in the diabetic group compared to the healthy control animals (p > 0.05).

Conclusion: Histological evidence indicates impaired peri-implant defect regeneration in a diabetic animal model.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2016.04.002DOI Listing
July 2016

High-grade histology as predictor of early distant metastases and decreased disease-free survival in salivary gland cancer irrespective of tumor subtype.

Head Neck 2016 04 3;38 Suppl 1:E2041-8. Epub 2016 Feb 3.

Department of Radiation Oncology, University Hospital of Erlangen, Erlangen, Germany.

Background: The purpose of this study was to evaluate risk factors that influence overall survival (OS)/disease-free survival (DFS)/locoregional recurrence-free survival (LRFS), and distant metastases-free survival (DMFS) in patients with high-risk primary salivary gland carcinoma who underwent surgery and postoperative (chemo)radiotherapy with curative intention.

Methods: We reviewed data of 63 patients with high-risk primary salivary gland carcinoma in a retrospective single-center audit.

Results: At a median follow-up of 31 months (range, 5-145 months), cumulative OS and DFS were 91.7%, 77.6%, and 62.9%, and 82.1%, 65.6%, and 57.7%, respectively, after 1, 2, and 5 years. LRFS and DMFS were 92%, 86%, and 86%, and 83.4%, 70.4%, and 62.3% after 1, 2, and 5 years, respectively. Of all patient-related, tumor-related, and treatment-related factors, high-grade histology (G3) was the only factor in univariate and multivariate analysis that was predictive for a shorter DMFS (low/intermediate vs high-grade: 100%, 100%, and 89.4% vs 72.9%, 54.3%, and 42.8% after 1, 2, and 5 years, respectively) and a shorter DFS (low/intermediate vs high-grade: 100%, 90%, and 84.4% vs 71.2%, 50.1%, and 39.4% after 1, 2, and 5 years, respectively) and OS (low/intermediate vs high-grade: 100%, 100%, and 86.5% vs 86.5%, 63.2%, and 46.5% after 1, 2, and 5 years, respectively).

Conclusion: High-grade tumor histology is a highly significant predictor of a shorter DMFS, OS, and DFS in salivary gland carcinoma, irrespective of histological subtype. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2041-E2048, 2016.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hed.24375DOI Listing
April 2016

Erratum: Raman difference spectroscopy: a non-invasive method for identification of oral squamous cell carcinoma: publisher's note.

Biomed Opt Express 2015 Jul 24;6(7):2675. Epub 2015 Jun 24.

Department of Oral and Maxillofacial Surgery, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany ; Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.

The author list appeared incorrectly in [Biomed. Opt. Express 5(9), 3252-3265 (2014)]. The author names were corrected online as of January 17, 2015: https://www.osapublishing.org/boe/abstract.cfm?uri=boe-5-9-3252.[This corrects the article on p. 3252 in vol. 5, PMID: 25401036.].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1364/BOE.6.002675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4505718PMC
July 2015

A new, highly precise measurement technology for the in vitro evaluation of the accuracy of digital imaging data.

J Craniomaxillofac Surg 2015 Oct 25;43(8):1335-9. Epub 2015 Jun 25.

Department of Prosthodontics (Head: Prof. Dr. M. Wichmann), Erlangen University Hospital, Glückstrasse 11, 91054 Erlangen, Germany.

Objectives: Three-dimensional radiological imaging data play an increasingly role in planning, simulation, and navigation in oral and maxillofacial surgery. The aim of this study was to establish a new, highly precise, in vitro measurement technology for the evaluation of the geometric accuracy down to the micrometric range of digital imaging data.

Material And Methods: A macerated human mandible was scanned optically with an industrial, non-contact, white light scanner, and a three-dimensional (3D) model was obtained, which served as a master model. The mandible was then scanned 10 times by cone beam computed tomography (CBCT), and the generated 3D surface bone model was virtually compared with the master model. To evaluate the accuracy of the CBCT scans, the standard deviation and the intraclass coefficient were determined.

Results: A total of 19 measurement points in 10 CBCT scans were investigated, and showed an average value of 0.2676 mm with a standard deviation of 0.0593 mm. The standard error of the mean was 0.0043 mm. The intraclass correlation coefficient (ICC) within the 10 CBCT scans was 0.9416.

Conclusions: This highly precise measuring technology was demonstrated to be appropriate for the evaluation of the accuracy of digital imaging data, down to the micrometric scale. This method is able to exclude human measurement errors, as the software calculates the superimposition and deviation. Thus inaccuracies caused by measurement errors can be avoided. This method provides a highly precise determination of deviations of different CBCT parameters and 3D models for surgical, navigational, and diagnostic purposes. Thus, surgical procedures and the post-operative outcomes can be precisely simulated to benefit the patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2015.06.021DOI Listing
October 2015

Competency in managing cardiac arrest: A scenario-based evaluation of dental students.

Acta Odontol Scand 2016 27;74(4):241-9. Epub 2015 May 27.

b 2 Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University Erlangen-Nürnberg , Erlangen, Germany.

Objective: Advanced Cardiovascular Life Support (ACLS) in life-threatening situations is perceived as a basic skill for dental professionals. However, medical emergency training in dental schools is often not standardized. The dental students' knowledge transfer to an ACLS setting thus remains questionable. The aim of the study was to evaluate dental pre-doctorate students' practical competence in ACLS in a standardized manner to enable the curriculum to be adapted to meet their particular needs.

Materials And Methods: Thirty dental students (age 25.47 ± 1.81; 16 male/14 female) in their last year of dental studies were randomly assigned to 15 teams. Students' ability to successfully manage ACLS was assessed by a scenario-based approach (training module: Laerdal® ALS Skillmaster). Competence was assessed by means of (a) an observation chart, (b) video analysis and (c) training module analysis (Laerdal HeartSim®4000; Version 1.4). The evaluation was conducted by a trained anesthesiologist with regard to the 2010 guidelines of the European Resuscitation Council (ERC).

Results: Only five teams (33.3%) checked for all three vital functions (response, breathing and circulation). All teams initiated cardiopulmonary resuscitation (CPR). Only 54.12% of the compressions performed during CPR were sufficient. Four teams stopped the CPR after initiation. In total, 93% of the teams used the equipment for bag-valve-mask ventilation and 53.3% used the AED (Automated external defibrillator).

Conclusions: ACLS training on a regular basis is necessary and, consistent with a close link between dentistry and medicine, should be a standardized part of the medical emergency curriculum for dental students with a specific focus on the deficiencies revealed in this study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/00016357.2015.1042782DOI Listing
October 2016

Sinus floor augmentation with autogenous bone vs. a bovine-derived xenograft - a 5-year retrospective study.

Clin Oral Implants Res 2015 Jun 20;26(6):644-8. Epub 2014 Feb 20.

Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.

Objectives: The long-term outcome after sinus augmentation with autogenous bone or a bovine xenograft (Bio-Oss(®)) was assessed in 47 patients. Inclusion criterion was a vertical dimension of the maxilla of <4 mm. After a functional loading period of 60 months, implant survival and reduction in the augmentation height were compared between the two groups evaluated.

Material And Methods: Sinus augmentation was performed using mandibular bone grafts or Bio-Oss(®). In the autogenous bone group, 70 implants were placed in 23 patients, while in the Bio-Oss(®) group, 24 patients received 98 implants. Fisher's exact test and equivalence testing were used to compare implant survival rates.

Results: The overall survival rate of the implants was 95.8% 5 years after implant insertion. In the autogenous bone group, the implants had a survival rate of 97.1%, while in the Bio-Oss(®) group, 94.9% of the implants survived. The difference was not statistically significant (P > 0.05); both treatments are equivalent (confidence interval 90%) for the equivalence interval [-0.1; 0.1]. 43.5% of the cases showed no reduction in the augmentation height 5 years after implant insertion, when augmentation was performed with autogenous bone, while in the Bio-Oss(®) group, no resorption was found in 50% of the augmented areas. Up to 25% reduction in augmentation height was found in 47.8% in the autogenous and in 45.8% in the Bio-Oss(®) group. In 8.7% of all cases in the autogenous bone group and in 4.2 % in the Bio-Oss(®) group, up to 50% of the augmented height was resorbed.

Conclusion: After a 5 years evaluation period, Bio-Oss(®) as material for the indication maxillary sinus augmentation shows to be equivalent to autogenous bone grafting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/clr.12352DOI Listing
June 2015

Case report: Upper arm metastasis of an oral squamous cell carcinoma.

BMC Oral Health 2015 Feb 15;15:22. Epub 2015 Feb 15.

Department of Oral and Maxillofacial Surgery, University of Erlangen-Nürnberg, Glückstrasse 11, 91054, Erlangen, Germany.

Background: The Oral Squamous Cell Carcinoma (OSCC) frequently metastasizes lymphogenously. Haematogenous dissemination is less common. This report describes a rare case of a metastatic OSCC of the floor of the mouth to the patients' left upper arm. To our knowledge this is the first of such case described in the literature.

Case Presentation: Twelve months after R0 tumor resection surgery, including microvascular reconstruction of the lower jaw followed by adjuvant radiotherapy, the patient was admitted for osteosynthesis plates removal. During clinical examination a tumor located at his left upper arm was detected. According to the patient the tumor has demonstrated rapid growth. Macroscopic appearance and conventional imaging led to the differential diagnosis of an abscess. MR-imaging could not differentiate between a tumor of soft tissue origin and a metastasis. A biopsy was taken and the pathological examination confirmed the diagnosis of an OSCC metastasis. The postoperative interdisciplinary tumor board recommended radiation therapy.

Conclusion: Due to the fact that patients with regional lymph node metastases have a higher probability to develop distant metastasis a more detailed screening might be considered--especially when hemangiosis carcinomatosa was histologically or macroscopically found.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12903-015-0007-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4348170PMC
February 2015

Extra-oral defect augmentation using autologous, bovine and equine bone blocks: A preclinical histomorphometrical comparative study.

J Craniomaxillofac Surg 2015 May 24;43(4):559-66. Epub 2015 Feb 24.

Department of Oral and Maxillofacial Surgery, University Erlangen - Nuremberg, Glückstraße 11, D-91054 Erlangen, Germany.

Objectives: This study aimed to compare autologous bone (AB), bovine bone (BB), and equine bone (EB) blocks with regard to de novo bone formation, connective tissue, and residual bone substitute material portions in a standardized defect animal model.

Material And Methods: In the frontal skull of 20 pigs, 106 standardized cylindrical "critical size defects" were prepared. Defects were randomly filled with AB, BB, and EB blocks. After a healing period of 30 and 60 days, de novo bone formation, residual bone substitute material, and connective tissue portion was assessed by means of histomorphometry (Toluidine blue O staining). Mann-Whitney U-tests were used to evaluate differences between the groups.

Results: The de novo bone formation was significantly higher in the AB group in comparison to the xenogeneic groups (p < 0.05). After 30 days, EB showed significantly (p < 0.05) more newly formed bone compared to the BB group. The soft tissue formation was significantly higher in the BB and EB group. Defects augmented with BB showed significantly (p < 0.05) higher portions of bone substitute materials compared to sides augmented with EB after 30 days.

Conclusion: In the extra-oral model, AB blocks were superior concerning de novo bone formation. No clinical advantages of EB blocks could be observed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2015.02.012DOI Listing
May 2015

Oral squamous cell carcinoma of the tongue: Prospective and objective speech evaluation of patients undergoing surgical therapy.

Head Neck 2016 07 6;38(7):993-1001. Epub 2015 Aug 6.

Department of Oral and Maxillofacial Surgery, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany.

Background: Prospective speech intelligibility assessments lack objectivity in patients undergoing surgery for oral squamous cell carcinoma (OSCC) of the tongue.

Methods: Speech intelligibility was measured based on word recognition by means of an automatic and objective speech recognition system preoperatively, and 14 to 20 days, and 3 months, 6 months, and 12 months postoperatively. The study comprised 25 patients with OSCC of the tongue and a healthy control group (n = 40).

Results: Patients yielded significant speech impairments compared to the healthy control group both before surgery and after 12 months (p ≤ .002). The speech intelligibility of the patients decreased significantly 14 to 20 days after surgery (p < .001) but realigned to preoperative values after 12 months (p = .159). Preservation of the tip of the tongue resulted in significantly higher word recognition after 12 months (p = .007; Δword recognition = 16.29).

Conclusion: Having OSSC of the tongue results in a significant impairment of speech intelligibility. The preservation of the tip of the tongue seems to be a central factor concerning the recovery of speech. © 2015 Wiley Periodicals, Inc. Head Neck 38: 993-1001, 2016.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hed.23994DOI Listing
July 2016

A retrospective evaluation of the aesthetics of the nasolabial complex after unilateral cleft lip repair using the Tennison-Randall technique: a study of 44 cases treated in a single cleft center.

J Craniomaxillofac Surg 2014 Dec 24;42(8):1679-83. Epub 2014 May 24.

Department of Oral and Maxillofacial Surgery (Director: Prof. Dr. Dr. Dr. h.c. Friedrich Wilhelm Neukam), University Hospital of Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Oestliche Stadtmauerstrasse 27, 91054, Erlangen, Germany.

Introduction: Among numerous techniques that have been described for lip repair, the Tennison-Randall method has gained popularity over time and is preferred by many surgeons due to the predictability of the outcome. This study aims to evaluate the esthetic outcome reached in the nasolabial region following primary lip repair with the use of this method.

Materials And Methods: Forty-four patients with unilateral cleft lip (with or without alveolar cleft) were assessed retrospectively through a photographic evaluation by two clinicians with regard to the aesthetics of the lip and nose separately as anatomical subunits as well as of the nasolabial region as an anatomical complex. The collected data were statistically analyzed with regard to the cleft subtype and the performance of corrective surgeries for the lip and/or the nose.

Results: The method was associated with good results, especially when it comes to the appearance of the nose as an anatomical subunit, as well as of the nasolabial region as a complex, regarding cleft lip patients without an alveolar cleft.

Conclusion: The Tennison-Randall technique proved to be a very satisfying method in terms of the esthetic long-term outcome in our patient collective.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcms.2014.05.013DOI Listing
December 2014

Osteo-radio-necrosis (ORN) and bisphosphonate-related osteonecrosis of the jaws (BRONJ): the histopathological differences under the clinical similarities.

Int J Clin Exp Pathol 2014 15;7(2):496-508. Epub 2014 Jan 15.

Department of Oral and Maxillofacial Surgery, University Hospital of Erlangen Germany.

Objectives: Both osteoradionecrosis (ORN) and bisphosphonate associated osteonecrosis of the jaws (BRONJ) present clinically as regions of exposed necrotic bone. The study aimed to demonstrate the histopathological differences behind the observed clinical similarities.

Study Design: Ten ORN specimens and ten BRONJ specimens were used, as well as ten samples of normal mandibular bone as control. Two bone-specific stainings were used, i.e. Sirius Red for the study of the relative presence of collagen types I and III and toluidine blue for the study the osteon density.

Results: The Red Green Blue (RGB)-analysis of the specimens stained with Sirius Red identified significant differences between the chromatic patterns observed in bone preparations of patients suffering from ORN when compared to both BRONJ and control samples. Moreover, the osteon density of the BRONJ samples was significantly lower when compared to ORN and normal bone samples.

Conclusions: The demonstrated differences in the bone architecture and in the bone collagen content between the two pathological conditions most likely reflect underlying pathophysiological differences.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2014

The outcome after surgical therapy of bisphosphonate-associated osteonecrosis of the jaw--results of a clinical case series with an average follow-up of 20 months.

Clin Oral Investig 2014 May 29;18(4):1299-1304. Epub 2013 Aug 29.

Department of Oral and Maxillofacial Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Glückstrasse 11, 91054, Erlangen, Germany.

Objectives: The present case series evaluates the success rate of osteotomy and primary wound closure in patients with bisphosphonate-associated osteonecrosis of the jaw (BRONJ).

Materials And Methods: Eighty patients suffering from BRONJ were included in the study. All patients received intravenous bisphosphonate therapy and underwent osteotomy and primary wound closure according to a standardised protocol. After discharge, the patients were reviewed on a regular basis over an average time period of 20 months.

Results: During follow-up in 11 patients, a recurrence of BRONJ occurred in the former operation field. Seventeen patients died due to their underlying disease. The success rate of osteotomy and primary wound closure in the treatment of BRONJ was calculated at 84.2 % 20 months after surgery. The results showed non-significant difference concerning the outcome of surgery in the different clinical stages of BRONJ.

Conclusions: In accordance with previous studies, stage-independent osteotomy and primary wound closure combined with antibiotics shall be deemed a viable treatment option in patients suffering from BRONJ.

Clinical Relevance: With a high success rate, osteotomy in combination with primary wound closure seems to be a viable alternative to more conservative protocols in the treatment of BRONJ.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00784-013-1092-2DOI Listing
May 2014
-->