Impact of different cephalometric skeletal configurations on anatomic midface parameters in adults

OBJECTIVES

Skull morphology and growth patterns are essential for orthodontic treatment, impacting clinical decision making. We aimed to determine the association of different cephalometric skeletal configurations on midface parameters as measured in 3D CT datasets.

MATERIALS AND METHODS

After sample size calculation, a total of 240 fully dentulous patients between 20 and 79 years of age (mean age: 42 ± 15), who had received a CT of the skull within the scope of trauma diagnosis or intracranial bleeding, were retrospectively selected. On the basis of cephalometric analysis, using MPR reconstructions, patients were subdivided into three different vertical skull configurations (brachyfacial, mesofacial, dolichofacial) and the respective skeletal Class I, II, and III relationships. Anatomic parameters were measured using a three-dimensional post-processing console: the thickness of the maxillary and palatine bones as well as the alveolar crest, maxillary body and sutural length, width and height of the hard palate, maxillary facial wall thickness, and masseter muscle thickness and length.

RESULTS

Individuals with brachyfacial configurations had a significantly increased palatal and alveolar ridge thicknesses compared to those with dolichofacial- or mesofacial configurations. Brachyfacial configurations presented a significantly increased length and thickness of the masseter muscle (4.599 cm; 1.526 cm) than mesofacial (4.431 cm; 1.466 cm) and dolichofacial configurations (4.405 cm; 1.397 cm) (p < 0.001). Individuals with a skeletal Class III had a significantly shorter palatal length (5.313 cm) than those with Class I (5.406 cm) and Class II (5.404 cm) (p < 0.01). Sutural length was also significantly shorter in Class III (p < 0.05).

CONCLUSIONS

Skeletal configurations have an impact on parameters of the bony skull. Also, measurable adaptations of the muscular phenotype could result.

CLINICAL RELEVANCE

The association between viscerocranial morphology and midface anatomy might be beneficial for tailoring orthodontic appliances to individual anatomy and planning cortically anchored orthodontic appliances.

Cinematic rendering to improve visualization of supplementary and ectopic teeth using CT datasets

OBJECTIVES

Ectopic, impacted, and supplementary teeth are the number one reason for cross-sectional imaging in pediatric dentistry. The accurate post-processing of acquired data sets is crucial to obtain precise, yet also intuitively understandable three-dimensional (3D) models, which facilitate clinical decision-making and improve treatment outcomes. Cinematic rendering (CR) is anovel visualization technique using physically based volume rendering to create photorealistic images from DICOM data. The aim of the present study was to tailor pre-existing CR reconstruction parameters for use in dental imaging with the example of the diagnostic 3D visualization of ectopic, impacted, and supplementary teeth.

METHODS

CR was employed for the volumetric image visualization of midface CT data sets. Predefined reconstruction parameters were specifically modified to visualize the presented dental pathologies, dentulous jaw, and isolated teeth. The 3D spatial relationship of the teeth, as well as their structural relationship with the antagonizing dentition, could immediately be investigated and highlighted by separate, interactive 3D visualization after segmentation through windowing.

RESULTS

To the best of our knowledge, CR has not been implemented for the visualization of supplementary and ectopic teeth segmented from the surrounding bone because the software has not yet provided appropriate customized reconstruction parameters for dental imaging. When employing our new, modified reconstruction parameters, its application presents a fast approach to obtain realistic visualizations of both dental and osseous structures.

CONCLUSIONS

CR enables dentists and oral surgeons to gain an improved 3D understanding of anatomical structures, allowing for more intuitive treatment planning and patient communication.

Evaluating Cardiac Lateralization by MRI to Simplify Estimation of Cardiopulmonary Impairment in Pectus Excavatum

BACKGROUND

The severity of pectus excavatum is classified by the Haller Index (HI) and/or Correction Index (CI). These indices measure only the depth of the defect and, therefore, impede a precise estimation of the actual cardiopulmonary impairment. We aimed to evaluate the MRI-derived cardiac lateralization to improve the estimation of cardiopulmonary impairment in Pectus excavatum in connection with the Haller and Correction Indices.

METHODS

This retrospective cohort study included a total of 113 patients (mean age = 19.03 ± 7.8) with pectus excavatum, whose diagnosis was verified on cross-sectional MRI images using the HI and CI. For the development of an improved HI and CI index, the patients underwent cardiopulmonary exercise testing to assess the influence of the right ventricle's position on cardiopulmonary impairment. The indexed lateral position of the pulmonary valve was utilized as a surrogate parameter for right ventricle localization.

RESULTS

In patients with PE, the heart's lateralization significantly correlated with the severity of pectus excavatum (p ≤ 0.001). When modifying HI and CI for the individual's pulmonary valve position, those indices are present with greater sensitivity and specificity regarding the maximum oxygen-pulse as a pathophysiological correlate of reduced cardiac function (χ² 10.986 and 15.862, respectively).

CONCLUSION

The indexed lateral deviation of the pulmonary valve seems to be a valuable cofactor for HI and CI, allowing for an improved description of cardiopulmonary impairment in PE patients.

Orofacial clefts alter early life oral microbiome maturation towards higher levels of potentially pathogenic species: A prospective observational study

Orofacial clefts (OFC) present different phenotypes with a postnatal challenge for oral microbiota development. In order to investigate the impact of OFC on oral microbiota, smear samples from 15 neonates with OFC and 17 neonates without OFC were collected from two oral niches (tongue, cheek) at two time points, i.e. after birth (T0: Ø3d OFC group; Ø2d control group) and 4-5 weeks later (T1: Ø32d OFC group; Ø31d control group). Subsequently, the samples were analyzed using next-generation sequencing. We detected a significant increase of alpha diversity and anaerobic and Gram-negative species from T0 to T1 in both groups. Further, we found that at T1 OFC neonates presented a significantly lower alpha diversity (lowest values for high cleft severity) and significantly higher levels of Enterobacteriaceae (Citrobacter, Enterobacter, Escherichia-Shigella, Klebsiella), Enterococcus, Bifidobacterium, Corynebacterium, Lactocaseibacillus, Staphylococcus, Acinetobacter and Lawsonella compared to controls. Notably, neonates with unilateral and bilateral cleft lip and palate (UCLP/BCLP) presented similarities in beta diversity and a mixture with skin microbiota. However, significant differences were seen in neonates with cleft palate only compared to UCLP/BCLP with higher levels of anaerobic species. Our findings revealed an influence of OFC as well as cleft phenotype and severity on postnatal oral microbiota maturation.

Orofacial clefts lead to increased pro-inflammatory cytokine levels on neonatal oral mucosa

Orofacial clefts (OFC) are frequent congenital malformations characterized by insufficient separation of oral and nasal cavities and require presurgical infant orthopedics and surgical interventions within the first year of life. Wound healing disorders and higher prevalence of gingivitis and plaque levels are well-known challenges in treatment of children with OFC. However, oral inflammatory mediators were not investigated after birth using non-invasive sampling methods so far. In order to investigate the impact of OFC on oral cytokine levels, we collected tongue smear samples from 15 neonates with OFC and 17 control neonates at two time points (T), T0 at first consultation after birth, and T1, 4 to 5 weeks later. The samples were analyzed using multiplex immunoassay. Overall, we found significantly increased cytokine levels (TNF, IL-1β/-2/-6/-8/-10) in tongue smear samples from neonates with OFC compared to controls, especially at T0. The increase was even more pronounced in neonates with a higher cleft severity. Further, we detected a significant positive correlation between cleft severity score and distinct pro-inflammatory mediators (GM-CSF, IL-1β, IL-6, IL-8) at T0. Further, we found that breast-milk (bottle) feeding was associated with lower levels of pro-inflammatory cytokines (IL-6/-8) in neonates with OFC compared to formula-fed neonates. Our study demonstrated that neonates with OFC, especially with high cleft severity, are characterized by markedly increased inflammatory mediators in tongue smear samples within the first weeks of life potentially presenting a risk for oral inflammatory diseases. Therefore, an inflammatory monitoring of neonates with (severe) OFC and the encouragement of mother to breast-milk (bottle) feed might be advisable after birth and/or prior to cleft surgery.

The comparison of the morphology of the mid-palatal suture between edentulous individuals and dentate jaws shows morphological differences

BACKGROUND

A profound understanding of the evolution and anatomy of the viscero- and neurocranium is quintessentially important for orthodontists. This particularly alludes to structures, which are directly targeted by orthodontic therapy such as the maxilla and the mid-palatal suture. The anatomy of the mid-palatal suture of toothed individuals is well described, whereas little is known about sutures' morphological changes after tooth loss. Therefore, the aim of this study was to evaluate the edentulous mid-palatal suture by means of histologic and histomorphometric analysis.

METHODS

Ten mid-palatal sutures of edentulous donors as well as six age- and sex matched dentulous controls were examined. For the histological and histomorphometric analysis (sutural width, obliteration, vascularization and interdigitation) conventional staining protocols (HE, Movat-Pentachrome, Sirius Red) and immunofluorescence (vWF, TRAP) were performed. Histomorphometric analysis was carried out using NIS-elements imaging software.

RESULTS

When compared to dentulous controls, the edentulous investigation group showed a decreased vascularization and sutural width as well as an increased sutural obliteration. Notably, a high variability and inhomogeneity within regard the histomorphometric parameters was seen in edentulous samples.

CONCLUSIONS

The mid-palatal suture of edentulous individuals showed significant morphological differences compared to individuals with toothed jaws. The loss of teeth and thereby functional loading seems to have a considerable impact on sutures' morphology.

Halitosis in Oral and Maxillofacial Surgery Patients - a Pilot Study

BACKGROUND

Halitosis is a relatively inhomogeneous pathology with an extremely high prevalence in the population. Potential risk factors for bad breath include bacterial decomposition of organic material as well as numerous general and systemic diseases. The aim of the present study was to analyze whether certain subgroups of oral and maxillofacial surgery patients have a higher risk of halitosis. Further the impact of halitosis on the patient's quality of life was ascertained.

METHODS

A total of 127 oral and maxillofacial patients aged between 19 and 86 years were enrolled in this study. On account of their underlining disease, patients were divided into five different investigation groups. The dental examination comprised tongue coating, periodontal screening index (PSI), gingival index (GI), PI (plaque index), DMF-T values as well as non-stimulated saliva flow rates. Halitosis was monitored both organoleptically according to Rosenberg and instrumentally by means of a Halimeter®, which records the volatile sulfur compounds (VSC values in ppm). Patients were further asked to fill out questionnaires regarding their medical history and oral hygiene, oral health (OHIP-14), and quality of life (BDI-II).

RESULTS

Halitosis values, which were recorded by a Halimeter® correlated with the objective Rosenberg golden standard method. Furthermore, halitosis values correlated with elevated PSI, GI, and DMF-T values as well as the degree of tongue coating. Patients with oral cancer showed significantly higher VSC values compared to all other groups. No difference in VSC values could be found between all other patient groups.

CONCLUSIONS

The Halimeter® could be validated as a suitable method for determining halitosis in oral and maxillofacial patients. The significantly increased halitosis values in cancer patients as opposed to all other patient groups suggests the potential of halitosis VSC values as a potential screening method. The development of non-invasive breath tests for diagnosis could be subject of future research.

Genotoxic and cytotoxic potential of methacrylate-based orthodontic adhesives

Objectives

The biocompatibility of methacrylate-based adhesives is a topic that is intensively discussed in dentistry. Since only limited evidence concerning the cyto- and genotoxicity of orthodontic adhesives is available, the aim of this study was to measure the genotoxic potential of seven orthodontic methacrylate-based adhesives.

Materials and methods

The XTT assay was utilized to determine the cytotoxicity of Assure Plus, Assure Bonding Resin, ExciTE F, OptiBond Solo Plus, Scotchbond Universal Adhesive, Transbond MIP, and Transbond XT after an incubation period of 24 h on human gingival fibroblasts. We also performed the γH2AX assay to explore the genotoxic potential of the adhesives within cytotoxic dose ranges after an incubation period of 6 h.

Results

The XTT assay showed a concentration-dependent reduction in cell viability. The decrease in cellular viability was in the same dose range most significant for Assure Plus, rendering it the adhesive material with the highest cytotoxicity. Employing the γH2AX assay, a concentration-dependent increase in H2AX phosphorylation was detected, indicating induction of DNA damage.

Conclusions

For most products, a linear correlation between the material concentration and γH2AX foci was observed. The most severe effect on γH2AX focus induction was found for Transbond MIP, which was the only adhesive in the test group containing the co-initiator diphenyliodonium hexafluorophosphate (DPIHP).

Clinical relevance

The data indicate that orthodontic adhesives, notably Transbond MIP, bear a genotoxic potential. Since the study was performed with in vitro cultivated cells, a direct translation of the findings to in vivo exposure conditions should be considered with great diligence.

Development of a novel histological and histomorphometric evaluation protocol for a standardized description of the mid-palatal suture - An ex vivo study

The hard palate and mid-palatal suture are highly important for orthodontic treatment. In cases of transverse maxillary deficiency, palatal expansion is the treatment of choice. As nowadays a growing number of adult patients receive orthodontic treatment, an understanding of suture development throughout life is important to derive tailored orthodontic treatment techniques for each age group. Histological, histochemical and immunohistochemical stains (haematoxylin & eosin, Azan, Movat pentachrome, Masson-Goldner trichrome, Sirius Red, CD 31, osteopontin and TRAP) and histomorphometric analyses were re-established to detect the structural conditions of the mid-palatal suture in human cadavers of three different age groups (20-39, 40-59 and 60-80 years). The mid-palatal suture of the selected age groups (total of n = 12; n = 4 in every group m = f) exhibited marked differences in sutural morphology and metabolism. A wide, interdigitated and well-vascularized suture was observed in younger specimens compared with straighter and smaller sutures with fewer vessels and lower bone density in the 60-80 year group. The fibre composition within the sutural gap differed between the three age groups. Delicate fibres were found in the 20-39 year group, and a tightly interwoven 3D fibre-network was observed in the 40-59 year group. Atrophy primarily characterized the fibres in the 60-80 year group. This evidence demonstrates differences between the evaluated groups. These results suggest that the staining methods used are suitable for the description and evaluation of the morphology and metabolism of mid-palatal sutures. Further investigation is necessary to provide an in-depth description of sutural maturation over a lifetime.

Association between breast cancer chemotherapy, oral health and chronic dental infections: a pilot study

Breast cancer has developed to become the leading type of cancer in females. For this study, 80 women were examined after chemotherapy for breast cancer and compared to 80 healthy age-matched women. This cross-sectional study comprised a dental examination with number of teeth, caries frequency (DMFT) and the presence of periodontal diseases (PSI). With the help of X-rays (OPG), the number of root canal fillings and apical lesions (LEO/LPO) were recorded. Furthermore, the education level, body mass index (BMI), smoking habits and general health conditions were recorded. All women completed questionnaires on oral health-related quality of life (OHIP-G14) and general well-being (HADS-D). To assess the influence of cancer therapy on oral health parameters, appropriate generalized linear models were fitted with disease status as main explanatory variable, adjusting for age and education. For OHIP and HADS, we additionally adjusted for number of missing teeth. The examined 160 women showed a comparable mean age (60.4 years) and an average BMI of 24.6. Cancer patients showed a higher risk for missing teeth (p < 0.001) and more apical lesions (p < 0.0041), particularly those of endodontic origin without root canal fillings (p = 0.0046), than the control women. The general well-being of cancer patients was significantly reduced with a HADS score of 9.4 for women with breast cancer compared to 5.3 for the healthy control. This study suggests that women after breast cancer chemotherapy are inclined to have a poorer oral health status with more missing teeth and apical lesions. Therefore, tightly scheduled dental recall visits should be recommended.

Is there a Genotoxic Potential of Endodontic Root Materials?

BACKGROUND

Leakage of components from endodontic materials (EM) can occur in case of apical extrusion into the periapical tissue. Therefore, an important prerequisite, besides the mechanical properties of the EM, is a high biocompatibility. In the present study, we elucidated the genotoxic potential of EMs of different base composition by utilizing the -H2AX assay.

METHODS

For investigation of the genotoxic potential of EM, supernatants of commercially available EM were prepared and dilutions were applied to human gingival fibroblasts. Non-toxic doses of EM were determined by cell viability assay. For the -H2AX assay, human gingival fibroblasts were incubated with predefined concentrations of the supernatants, which were found not to reduce cell viability. Hydrogen peroxide was utilized as positive control. Cells were fixed 1, 6 and 24 hours after addition of the supernatant to the medium, followed by immunostaining for -H2AX. For scoring of -H2AX foci, automated foci counting was performed in at least 80 cells per experiment and time point. The experiments were repeated at least twice.

RESULTS

In contrast to hydrogen peroxide treated cells, no elevated -H2AX levels were detected in cells incubated with the EM supernatants.

CONCLUSIONS

Samples treated with EM supernatants showed no elevated levels of -H2AX foci, e.g., no genotoxicity. Therefore, all types of EM seem to meet the standard to be called a biocompatible dental material in terms of genotoxicity, and, therefore, the application seems safe.

Dental age assessment in 6- to 14-year old German children: comparison of Cameriere and Demirjian methods

BACKGROUND

The aim of the study was to compare two frequently used dental age estimation methods for accuracy.

METHODS

A total of 479 panoramic radiographs in age groups 6-14 years from a German population were evaluated. The dental age of 268 boys and 211 girls was assessed by means of the method of Demirjian (1973) and Cameriere (2006) and compared with their actual chronological age.

RESULTS

Demirjan's method showed an overestimation of dental age compared to chronological age in all age groups for boys (mean difference -0.16, p = 0.010, range -0.35 to 0.09), age group 9 showed an underestimation. Using the same method for girls (mean difference -0.18, p = 0.008, range -0.45 to 0.13), an overestimation could also be shown in all age groups except for age groups 8 and 13. Results for Cameriere's method showed for boys (mean difference 0.07, p = 0.314, range -1.38 to 3.83) in age groups 6 to 11 an overestimation, but in age groups 12 to14 an underestimation. The results for girls (mean difference 0.08, p = 0.480, range -1.55 to 4.51) showed an overestimation for age groups from 6 to 10, and an underestimation in age groups 11 to 14.

CONCLUSIONS

The comparison shows an advantage of Demirjian's method for both genders. While Cameriere's method showed a higher inaccuracy in all age groups, Demirjian's method showed more appropriate results for dental age estimation of the investigated German population. To avoid errors in forensic age estimation and to prevent misidentifications for defendants in criminal processes, further studies of more precise methods for age estimation for the German population are required.

Oral Hygiene and Dietary Habits in Adolescents with Fixed Orthodontic Appliances: A Cross-sectional Study

OBJECTIVES

Fixed orthodontic appliances (FOAs) may cause a temporary deterioration of oral hygiene with corresponding gingival inflammatory changes. Optimal oral hygiene and dietary changes are essential in order to avoid periodontal inflammation. The present study investigates to what extent the recommendations made by the orthodontist are followed by young patients.

MATERIALS AND METHODS

A total of 67 adolescent patients with FOA were examined and interviewed. The control group consisted of 70 patients of the same age who had not undergone any orthodontic treatment. A specific questionnaire (assessing dietary habits, oral hygiene measures) was used and comprehensive oral findings along with oral hygiene status were evaluated.

RESULTS

The analysis of the data showed that despite intensive oral hygiene and dietary advice in the patients with FOA, there was no change in diet or oral hygiene habits. There were significantly higher signs of gingival inflammation and amount of dental plaque in FOA patients. Nutritional recommendations and oral hygiene measures for young people with FOA were not adequately enforced.

CONCLUSION

The findings indicate that frequent recalls should be scheduled with repeated reinforcement of oral hygiene and dietary modifications in FOA patients.

Penetration Potential of a Silver Diamine Fluoride Solution on Dentin Surfaces. An Ex Vivo Study

BACKGROUND

Occurrence of open dentinal tubules as a cause of dental hypersensitivity is a very common pnenomenon in patients. The aim of this in vitro study was to assess the effect of a silver diamine fluoride solution (Ag(NH3)2 F) on human dentin samples.

METHODS

A total of five fully retained wisdom teeth were selected for this study. The crowns of the teeth were separated from the roots and the occlusal enamel surface was removed. All dentin samples were treated for 60 seconds with phosphoric acid (36%) and rinsed thoroughly to remove the smear layer. Then the desensitizing agent (Riva Star, SDI; 38% Ag(NH3)2 F) was placed according to the manufacturer's instruction. Three dentin samples were prepared for element analysis using an electron beam microprobe analyzer (JEOL JXA 8900RL). The Ag concentrations in the dentin samples were measured in depths ranging from 5 to 40 μm. The other two dentin samples were vertically fractured and accordingly prepared for visualization with SEM (Zeiss DSM).

RESULTS

The application of the desensitizing agent on the dentin areas demonstrated an increased Ag concentration (JEOL JXA 8900RL). On the dentin surface an Ag concentration of 1.7 weight % (? 0.7) was measured, but at a depth of 20 μm only 0.3 weight % (± 0.1) were detected. In depths greater than 40 μm the Ag concentration was below the detection limit. The SEM results showed that deposits could be found in a covering on the dentin layer and in the dentinal tubules to a depth of 20 μm.

CONCLUSIONS

In this ex vivo study, the effect of silver diamine fluoride on dentin surfaces could be demonstrated. The desensitizing agent formed a film on the dentin surface and in some dentinal tubules deposits were detected. These findings can explain a certain desensitizing effect, but a direct translation to in vivo conditions can only be done with caution.

Survey of root canal irrigating solutions used in dental practices within Germany

AIM

Irrigant usage information in relation to years of professional experience was collected from general dentists in different German federal states by means of a questionnaire.

METHODOLOGY

A short survey concerning endodontic treatment and use of irrigants was mailed to 4240 dentists or delivered to 3720 dental offices as an extra page in a journal in eight German states. Detailed information concerning the most frequently used irrigants, their concentrations, the spectrum of disinfectants used in root canal treatment concepts for vital and nonvital pulps, main topics of continuing education as well as years of professional experience was collected. The statistical analysis of differences found amongst the dentists in relation to professional experience or federal state was performed using the chi-square test.

RESULTS

Of a total of 7960 invitations, 1630 replies were evaluated (response rate 20.5%). The majority of the dentists (57.3%) had >20 years of professional experience, 23% had >30 years. Dentists with long-standing professional experience (20-30 years) used H2 O2 significantly more often than dentists with less experience (P < 0.001), and of the older colleagues (>30 years of professional experience), 14.6% never used NaOCl, whilst the younger colleagues almost always used it (P < 0.001). Differences were also found for the usage of irrigants amongst dentists from the various German states.

CONCLUSIONS

Whilst NaOCl was used in almost all states, regional differences were found regarding the choice of additional irrigants, which were mainly determined by the irrigation protocols taught at different universities.

Influence of E-smoking liquids on human periodontal ligament fibroblasts

Introduction

Over the last years, electronic cigarettes (ECs) have become more popular, particularly in individuals who want to give up smoking tobacco. The aim of the present study was to assess the influence of the different e-smoking liquids on the viability and proliferation of human periodontal ligament fibroblasts.

Method and materials

For this study six test solutions with components from ECs were selected: lime-, hazelnut- and menthol-flavored liquids, nicotine, propylene glycol, and PBS as control group. The fibroblasts were incubated up to 96 h with the different liquids, and cell viability was measured by using the PrestoBlue^® reagent, the ATP detection and the migration assay. Fluorescence staining was carried out to visualize cell growth and morphology. Data were statistically analyzed by two-tailed one-way ANOVA.

Results

The cell viability assay showed that the proliferation rates of the cells incubated with nicotine or the various flavored liquids of the e-cigarettes were reduced in comparison to the controls, though not all reductions were statistically significant. After an incubation of 96 h with the menthol-flavored liquid the fibroblasts were statistically significant reduced (p < 0.001). Similar results were found for the detection of ATP in fibroblasts; the incubation with menthol-flavored liquids (p < 0.001) led to a statistically significant reduction. The cell visualization tests confirmed these findings.

Conclusion

Within its limits, the present in vitro study demonstrated that menthol additives of e-smoking have a harmful effect on human periodontal ligament fibroblasts. This might indicate that menthol additives should be avoided for e-cigarettes.

In vitro study on dental erosion caused by different vinegar varieties using an electron microprobe

BACKGROUND

Among health-conscious individuals, including vegetarians, salads dressed with vinegar are frequently consumed. Dental erosion can also be caused by an acidic diet, and occurs with increasing tendency. The aim of this study was to analyze the erosive potential of vinegar varieties on human enamel samples.

METHODS

A total of 30 vinegar varieties were selected. Enamel samples were prepared from human wisdom teeth, and the specially prepared enamel slices were incubated with 5 selected vinegars (Bio vinegar, pH = 3.1; raspberry vinegar, pH = 2.7; Condimento Balsamico, pH = 3.95; Ortalli Bianco Modena, pH = 2.7; Vinaigre de Jerez, pH = 2.9) for up to 8 hours. Controls were incubated with a 0.9% sodium chloride solution. The quantitative analysis of CaO, P2O5, F, MgO, Cl, and O in the enamel samples (incubation: 4, 8 hours) in various depths ranging from 7.5 - 105 microm was carried out using an electron probe micro-analyser (Jeol JXA 8900RL). Linear mixed models were fitted to analyze statistically relevant differences between the different vinegars at various depth levels.

RESULTS

Incubating the enamel slices with the selected vinegars caused a release of minerals, which was dependent on time and type of vinegar. The vinegar Ortalli Bianco Modena led to a slight loss (1%) of the mineral CaO in a depth up to 20 microm, while the loss of minerals caused by raspberry vinegar in a depth of up to 30 microm was about 20% (4 hours). The greatest loss of the minerals was detected for the Bio Vinegar. After 8 hours incubation, a loss of minerals of about 20% in a depth of 45 microm and in a depth of 60 microm of 16% could be observed. Both, the Bio Vinegar and the raspberry vinegar led to a significantly higher loss of minerals (p < 0.0001) than all other tested vinegars.

CONCLUSIONS

In this in vitro study, the erosive potential of different vinegar varieties on human enamel samples could be demonstrated. However, it must be considered that numerous modifying factors influence the enamel surface in vivo; therefore, a direct translation to in vitro conditions can only be done with caution.

Non-cross-linked collagen type I/III materials enhance cell proliferation: in vitro and in vivo evidence

Objective

To analyze Mucograft^®(MG), a recently introduced collagen matrix, in vitro and in vivo, and compare it with BioGide^®(BG), a well-established collagen membrane, as control.

Material and Methods

A detailed analysis of the materials surface and ultra-structure was performed. Cellular growth patterns and proliferation rates of human fibroblasts on MG and BG were analyzed in vitro. In addition, the early tissue reaction of CD-1 mouse to these materials was analyzed by means of histological and histomorphometrical analysis.

Results

MG showed a three-fold higher thickness both in dry and wet conditions, when compared to BG. The spongy surface of BG significantly differed from that of MG. Cells showed a characteristic proliferation pattern on the different materials in vitro. Fibroblasts tended to proliferate on the compact layers of both collagens, with the highest values on the compact side of BG. In vivo, at day three both materials demonstrated good tissue integration, with a mononuclear cell sheet of fibroblasts on all surfaces, however, without penetrating into the materials.

Conclusions

The findings of this study showed that MG and BG facilitate cell proliferation on both of their surfaces in vitro. In vivo, these two materials induce a comparable early tissue reaction, while serving as cell occlusive barriers.

Mundgesundheit von berufstätigen und nicht berufstätigen Frauen – Ergebnisse einer regionalen Untersuchung und Umfrage

In der vorliegenden Studie sollte der Mundgesundheitszustand sowie Mundhygienemaßnahmen bei berufstätigen und nichtberufstätigen Frauen untersucht und miteinander verglichen werden. Neben einer zahnärztlichen Untersuchung wurden mittels Fragebogen sowohl Mundhygienemaßnahmen als auch soziodemografische Daten erhoben.

Für die Studie konnten insgesamt 415 Frauen (210 berufstätige und 205 nicht berufstätige Frauen) der Altersgruppe 25–65 Jahre erfasst werden. Bei allen Frauen erfolgte eine zahnärztliche Untersuchung einschließlich einer radiologischen Befundung (Panoramaschichtaufnahme). Die zahnärztliche Untersuchung beinhaltete Anzahl der Zähne, Karieshäufigkeit (DMFT-Wert), Art und Häufigkeit von Restaurationen, Mundhygienemaßnahmen (API), Entzündungsgrad der Gingiva (SBI), Sondierungstiefen und das Vorliegen von Rezessionen. Des weiteren wurde ein Fragebogen ausgefüllt, der Informationen zu anamnestischen Daten, Familiensituation, Bildungsstand und Berufstätigkeit beinhaltete. Für die Studie lag das positive Votum der Ethikkommission (Rheinland-Pfalz) vor.

Die nicht erwerbstätigen Frauen/Hausfrauen (Alter: 38,1±9,7 Jahre) waren zu 90% verheiratet, nur zu 3% starke Raucherinnen und nur 2% hatten einen Hochschulabschluss. Berufstätige Frauen (Alter: 43,2±11 Jahre) waren zu 73% verheiratet, 17% waren starke Raucherinnen (>20 Zigaretten/Tag) und 10% hatten einen Hochschulabschluss. Die Mundhygienemaßnahmen der Berufstätigen waren im Vergleich zu den nicht erwerbstätigen Frauen tendenziell besser, jedoch hatten die berufstätigen Frauen vermehrt aggressive Parodontalerkrankungen (15% vs. 3,3%; p<0,027). In der logistischen Regression wiesen berufstätige Frauen im Gegensatz zu nicht Erwerbstätigen ein 4-fach erhöhtes Risiko auf, eine aggressive Parodontitis zu entwickeln (Odds Ratio 4,23; 95% KI: 0,77–23,17).

Die Mundgesundheit von berufstätigen Frauen und Frauen ohne Erwerbstätigkeit zeigte leichte Unterschiede. Diese Untersuchungen legen den Schluss nahe, dass Berufstätigkeit, Bildungsstand und Lebensstil der Frauen sowohl die oralen Pflegemaßnahmen als auch die Mundgesundheit beeinflussen.

Influence of a bioceramic root end material and mineral trioxide aggregates on fibroblasts and osteoblasts

OBJECTIVE

The biocompatibility of materials used in endodontic treatment is of high importance, because they can come in contact with periradicular tissues and there is a risk of possible systemic toxicity. The aim of the present study was to investigate the in vitro reaction to a bioceramic based root end material in comparison to mineral trioxide aggregates (MTA) as the established gold standard.

DESIGN

The root end materials grey MTA Angelus (GMTA), white MTA Angelus (WMTA), ProRoot MTA, and EndoSequence Root Repair Material (ERRM) were incubated with human periodontal ligament fibroblasts and osteoblasts (10(4)cells/ml) for up to 96h. Cell proliferation (RFU) was determined by means of the Alamar Blue assay. In addition, fluorescence staining was carried out to visually monitor cell growth and morphology.

RESULTS

For most of the observational time period of up to 96h, there was no statistically significant difference between the proliferation rates of the control cells and those in contact with ERRM. In contrast, the mineral trioxide based materials caused from 24 to 96h significantly lower proliferation rates in comparison to the controls (p<0.001). For proliferation rates of cells in contact with MTAs and ERRM significant differences were observed throughout the whole observation time for the osteoblasts, but only up to 24h for the human periodontal ligament fibroblasts.

CONCLUSION

Within the limits of this study the results suggest that the bioceramic root end material is biocompatible, but needs to be investigated in clinical studies before it can be recommended as retrograde sealer in endodontic practice.

Post-endodontic treatment periodontal surgery: a case report

Two patients were diagnosed with combined endodontic-periodontal lesions. Endodontic treatment was performed, followed by surgery. In addition, the regeneration process was supported by the application of an enamel matrix derivate alone or in combination with guided bone regeneration techniques. At recall visits after 24 months, the teeth were asymptomatic and marked bone regeneration had occurred in both patients. The successful post-endodontic treatment of combined endodontic-periodontal lesions, using periodontal surgery and as adjunct guided tissue regenerative techniques, is presented. Further, the possibility of saving teeth, even with severely apparent pathology, should be highlighted.

Implantation of silicon dioxide-based nanocrystalline hydroxyapatite and pure phase beta-tricalciumphosphate bone substitute granules in caprine muscle tissue does not induce new bone formation

BACKGROUND

Osteoinductive bone substitutes are defined by their ability to induce new bone formation even at heterotopic implantation sites. The present study was designed to analyze the potential osteoinductivity of two different bone substitute materials in caprine muscle tissue.

MATERIALS AND METHODS

One gram each of either a porous beta-tricalcium phosphate (β-TCP) or an hydroxyapatite/silicon dioxide (HA/SiO2)-based nanocrystalline bone substitute material was implanted in several muscle pouches of goats. The biomaterials were explanted at 29, 91 and 181 days after implantation. Conventional histology and special histochemical stains were performed to detect osteoblast precursor cells as well as mineralized and unmineralized bone matrix.

RESULTS

Both materials underwent cellular degradation in which tartrate-resistant acid phosphatase (TRAP)-positive osteoclast-like cells and TRAP-negative multinucleated giant cells were involved. The ß-TCP was completely resorbed within the observation period, whereas some granules of the HA-groups were still detectable after 180 days. Neither osteoblasts, osteoblast precursor cells nor extracellular bone matrix were found within the implantation bed of any of the analyzed biomaterials at any of the observed time points.

CONCLUSIONS

This study showed that ß-TCP underwent a faster degradation than the HA-based material. The lack of osteoinductivity for both materials might be due to their granular shape, as osteoinductivity in goat muscle has been mainly attributed to cylindrical or disc-shaped bone substitute materials. This hypothesis however requires further investigation to systematically analyze various materials with comparable characteristics in the same experimental setting.

Influence of three scan spray systems on human gingival fibroblasts

OBJECTIVE

CAD/CAM is based on optical or mechanical scanning of tooth surfaces. The aim of this in vitro study was to investigate the influence of three different scan sprays on the proliferation, viability, and adenylate kinase (ADK) release of human fibroblasts.

METHOD AND MATERIALS

Three different scan sprays (ScanDry, ScanSpray Luer Classic, and CEREC Optispray) were tested in vitro to determine their effects on proliferation, viability, and ADK release of human periodontal fibroblasts. A defined amount of the test material was sprayed into 96 multiwell plates, dried, and incubated with fibroblasts. The LIVE/DEAD Viability Assay, a two-color fluorescence-based method, was used to determine the cytotoxic potential (the AlamarBlue Assay for the proliferation rate and the ToxiLight BioAssay for the release of ADK).

RESULTS

There were differences between the scan sprays concerning inhibition of the proliferation and viability of fibroblasts. All materials inhibited the fibroblast proliferation and viability compared with the control group (P < .001), and there were also significant differences among the scan spray groups. The scan sprays led to a greater release of ADK, but a significant difference could be found only between ScanSpray Luer Classic and CEREC Optispray (P < .009).

CONCLUSION

The results of this study proved that the scan sprays do not induce a significantly higher ADK release than the control group. The inhibiting effect on the fibroblast proliferation can be attributed to a material-independent phenomenon. Further experiments are necessary to validate the present data.

The influence of micronutrients on oral and general health

OBJECTIVE

The aim of the present clinical pilot study was to examine the influence of a combination of micronutrients on individuals with high stress experience.

METHODS

40 healthy students (28 female, 12 male) with a mean age of 27.1 ± 3.0 years, experiencing high examination stress, were chosen. After approval of the ethics commission, one group of students (n = 19) took a combination of micronutrients (Orthomol vital m/f) for three months, whereas other students (n = 21) served as control group. All participants underwent at the beginning and at the end of the trial a dental examination, a determination of 10 periodontal pathogens, a salivary and a blood analysis. In addition, the participants filled in a questionnaire on nutrition, quality of life and degree of stress experienced during their final examinations.

RESULTS

The evaluation of the results, obtained at the end of the trial period, showed that for all students a slight worsening of oral hygiene and an increased consumption of unhealthy food could be observed. The intake of the micronutrients led to a slight improvement of the degree of gingival inflammation in comparison to the control group. The blood analysis showed an increase in vitamin (vitamin C, vitamin E) and zinc concentrations, and a lower increase in CRP. In the male subjects, a decrease in the serum concentrations of triglycerides (p = 0.073) and LDL (p = 0.048) was observed.

CONCLUSIONS

This pilot study shows that micronutrients, taken during periods of high stress experience, had a beneficial effect on inflammatory processes and helped reduce the level of some of the plasma lipids in males, and thus can be recommended for supplementing the diet. However, additional studies with a higher number of subjects, also suffering from periodontal disease, are necessary to show the effect of a micronutrient supplementation more clearly.

A prospective clinical trial on the influence of a triamcinolone/demeclocycline and a calcium hydroxide based temporary cement on pain perception

INTRODUCTION

The aim of this clinical trial was to compare the degree of short term post-operative irritation after application of a triamcinolone/demeclocycyline based or a calcium hydroxide based provisional cement.

METHODS

A total of 109 patients (55 female and 54 male; mean age: 51 ± 14 years) with primary or secondary dentinal caries were randomly assigned to the two treatment groups of this biomedical clinical trial (phase III). Selection criteria were good systemic health and treated teeth, which were vital and showed no symptoms of pulpitis. Up to three teeth were prepared for indirect metallic restorations, and the provisional restorations were cemented with a triamcinolone/demeclocycyline (Ledermix) or a calcium hydroxide (Provicol) based material. The intensity of post-operative pain experienced was documented according to the VAS (4, 12, 20, 24, and 82 h) and compared to VAS baseline.

RESULTS

A total of 159 teeth were treated (Ledermix: 83 teeth, Provicol: 76 teeth). The minor irritation of the teeth, experienced prior to treatment, was similar in both groups; however, 4 h after treatment this value was significantly higher in the Provicol group than in the Ledermix group (p < 0.005, t-test). After 12 h, the difference was no longer significant. The number of patients taking analgesics for post-treatment pain was higher in the Provicol group (n = 11/53) than in the Ledermix group (n = 3/56).

CONCLUSIONS

The patients had no long term post-operative pain experience in both groups. However, within the first hours after cementation the sensation of pain was considerably higher in the Provicol group than in the Ledermix group.

Bovine pericardium based non-cross linked collagen matrix for successful root coverage, a clinical study in human

INTRODUCTION

The aim of this study was to clinically assess the capacity of a novel bovine pericardium based, non-cross linked collagen matrix in root coverage.

METHODS

62 gingival recessions of Miller class I or II were treated. The matrix was adapted underneath a coronal repositioned split thickness flap. Clinical values were assessed at baseline and after six months.

RESULTS

The mean recession in each patient was 2.2 mm at baseline. 6 Months after surgery 86.7% of the exposed root surfaces were covered. On average 0,3 mm of recession remained. The clinical attachment level changed from 3.5 ± 1.3 mm to 1,8 ( ± 0,7) mm during the observational time period. No statistically significant difference was found in the difference of probing depth. An increase in the width of gingiva was significant. With a baseline value of 1.5 ± 0.9 mm an improvement of 2.4 ± 0.8 mm after six month could be observed. 40 out of 62 recessions were considered a thin biotype at baseline. After 6 months all 62 sites were assessed thick.

CONCLUSIONS

The results demonstrate the capacity of the bovine pericardium based non-cross linked collagen matrix for successful root coverage. This material was able to enhance gingival thickness and the width of keratinized gingiva. The percentage of root coverage achieved thereby is comparable to existing techniques. This method might contribute to an increase of patient's comfort and an enhanced aesthetical outcome.

Nanocrystalline hydroxyapatite bone substitute leads to sufficient bone tissue formation already after 3 months: histological and histomorphometrical analysis 3 and 6 months following human sinus cavity augmentation

PURPOSE

In this study the de novo bone formation capacity of a nanocrystalline hydroxyapatite bone substitute was assessed 3 and 6 months after its insertion into the human sinus cavity.

MATERIALS AND METHODS

Sinus cavity augmentation was performed in a total of 14 patients (n = 7 implantation after 3 months; n = 7 implantation after 6 months) with severely atrophic maxillary bone. The specimens obtained after 3 and 6 months were analyzed histologically and histomorphometrically with special focus on bone metabolism within the residual bone and the augmented region.

RESULTS

This study revealed that bone tissue formation started from the bone-biomaterial-interface and was directed into the most cranial parts of the augmented region. There was no statistically significant difference in new bone formation after 3 and 6 months (24.89 ± 10.22% vs 31.29 ± 2.29%), respectively.

CONCLUSIONS

Within the limits of the present study and according to previously published data, implant insertion in regions augmented with this bone substitute material could be considered already after 3 months. Further clinical studies with bone substitute materials are necessary to validate these findings.

In vitro analysis of the cytotoxicity and the antimicrobial effect of four endodontic sealers

Introduction

The aim of this study was to investigate in vitro the cytotoxicity and antibacterial properties of four different endodontic sealers using human periodontal ligament fibroblast cell proliferation and visual analysis of growth inhibition.

Methods

A silicone (GuttaFlow), silicate (EndoSequence BC), zinc oxide eugenol (Pulp Canal Sealer EWT) and epoxy resin (AH Plus Jet) based sealer were incubated with PDL fibroblasts (10⁴ cells/ml, n = 6) up to 96 h. Cell proliferation (RFU) was determined by means of the Alamar Blue assay. Cell growth and morphology was visualized by means of fluorescent dyes. Possible antibacterial properties of the different sealers were visualized by means of SEM (Enterococcus faecalis; Parvimonas micra).

Results

Fibroblast proliferation depended on sealer and cultivation time. After 72 and 96 h GuttaFlow and EndoSequence BC showed relatively non-cytotoxic reactions, while Pulp Canal Sealer EWT and AH Plus Jet caused a significant decrease of cell proliferation (p < 0.001). Visualization of cell growth and morphology with various fluorescent dyes supplemented the results. No antibacterial effect of EndoSequence BC to P. micra was found, whereas GuttaFlow showed a weak, Pulp Canal Sealer EWT and AH Plus Jet extensive growth inhibition. Also, no antibacterial effect of GuttaFlow, EndoSequence BC or AH Plus Jet to E. faecalis could be detected.

Conclusions

These in vitro findings reveal that GuttaFlow and EndoSequence BC can be considered as biocompatible sealing materials. However, prior to their clinical employment, studies regarding their sealing properties also need to be considered.

Retrospective study on direct pulp capping with calcium hydroxide

OBJECTIVE

To evaluate the success rate of a calcium hydroxide-based direct capping agent in permanent teeth.

METHOD AND MATERIALS

A total of 1,075 permanent teeth were treated in this study. All patients received direct pulp capping with a calcium hydroxide-based agent. Inclusion criteria were teeth with healthy pulps, pulps with signs of reversible pulpitis, and a pulp chamber roof opening smaller than 2 mm2. Pulps with severe degenerative processes or necrosis were excluded. After direct capping, all teeth were definitively restored with amalgam, composite, glass-ionomer cement, or other dental materials. The teeth were observed up to 9 years with a first visit after 3 months followed by an annual routine visit.

RESULTS

The success rate of direct capping was 80.1% after 1 year, 68.0% after 5 years, and 58.7% after 9 years. Substantial differences were found regarding the number of tooth surfaces affected by the causal event (P = .0005). The subsequent definitive restorations also significantly influenced the survival rate (P = .0035).

CONCLUSION

Direct pulp capping with calcium hydroxide is a successful therapy when the respective indications and restorative materials are employed.

Evaluation of the tissue reaction to a new bilayered collagen matrix in vivo and its translation to the clinic

This study evaluates a new collagen matrix that is designed with a bilayered structure in order to promote guided tissue regeneration and integration within the host tissue. This material induced a mild tissue reaction when assessed in a murine model and was well integrated within the host tissue, persisting in the implantation bed throughout the in vivo study. A more porous layer was rapidly infiltrated by host mesenchymal cells, while a layer designed to be a barrier allowed cell attachment and host tissue integration, but at the same time remained impermeable to invading cells for the first 30 days of the study. The tissue reaction was favorable, and unlike a typical foreign body response, did not include the presence of multinucleated giant cells, lymphocytes, or granulation tissue. In the context of translation, we show preliminary results from the clinical use of this biomaterial applied to soft tissue regeneration in the treatment of gingival tissue recession and exposed roots of human teeth. Such a condition would greatly benefit from guided tissue regeneration strategies. Our findings demonstrate that this material successfully promoted the ingrowth of gingival tissue and reversed gingival tissue recession. Of particular importance is the fact that the histological evidence from these human studies corroborates our findings in the murine model, with the barrier layer preventing unspecific tissue ingrowth, as the scaffold becomes infiltrated by mesenchymal cells from adjacent tissue into the porous layer. Also in the clinical situation no multinucleated giant cells, no granulation tissue and no evidence of a marked inflammatory response were observed. In conclusion, this bilayered matrix elicits a favorable tissue reaction, demonstrates potential as a barrier for preferential tissue ingrowth, and achieves a desirable therapeutic result when applied in humans for soft tissue regeneration.

Tissue reaction to sealing materials: different view at biocompatibility

The biodegradability of root canal sealers in areas other than the root canal system is crucial to the overall success rate of endodontic treatment. The aim of the present study was to investigate, the cell and tissue reaction to GuttaFlow and AHPlus, both in vitro and in vivo. For the in vitro experiments the materials were incubated with Human Periodontal Ligament Fibroblasts and cell proliferation and cytotoxicity analyses were performed. Additional fluorescence-microscope stainings were carried out in order to visualize cell growth and morphology. For assessment of the tissue reaction to the materials a subcutaneous implantation model in Wistar rats was employed and the inflammatory response to the materials was visualized by means of general and specific histology after 6 weeks. Human gingival fibroblasts proliferation seemed to be dependent upon dental material and cultivation time. After an incubation period of 96 hrs AHPlus proved to be significantly (p < 0.002) more cytotoxic than GuttaFlow, as only a small number of fibroblasts survived on AHPlus. In vivo, GuttaFlow was surrounded by a fibrous capsule and no degradation took place, while AHPlus induced a well-vascularized granulation tissue in which the material was phagocyted by macrophages. The results of this study demonstrate that a potential cytotoxic effect of a sealing material may beneficial in order to have antibacterial properties and induce self degradation when accidentally extruded over the apical foramen.

Gingival crevicular fluid MMP-8-concentrations in patients after acute myocardial infarction

Background

The aim of this study was to determine the presence of matrix metalloproteinase-8 in the gingival crevicular fluid (GCF) of patients after acute myocardial infarction (AMI).

Methods

A total of 48 GCF samples from 20 AMI patients, hospitalized at the Department of Cardiology and Angiology of the Johannes Gutenberg University Mainz, were investigated. Besides the myocardial infarction all patients suffered from chronic periodontal disease. Fifty-one GCF samples from 20 healthy age matched individuals with similar periodontal conditions served as controls. The dental examination included the assessment of oral hygiene, gingival inflammation, probing pocket depth, clinical attachment level and X-ray examination. The study was only carried out after the positive consent of the regional ethic commission. A quantitative assessment of aMMP-8 levels in the gingival crevicular fluid was performed with the help of the DentoAnalyzer (Dentognostics GmbH, Jena, Germany), utilising an immunological procedure.

Results

The aMMP-8 concentrations found in the gingival crevicular fluid of the AMI patients significantly differed (p = 0.001; mean value 30.33 ± 41.99 ng/ml aMMP-8) from the control group (mean value 10.0 ± 10.7 ng/ml aMMP-8). These findings suggest that periodontal inflammation in AMI patients might be associated with higher MMP-8-values compared to the healthy controls.

Conclusions

The acute myocardial infarction seems to influence the degree of periodontal inflammation, thus the measurement of the gingival crevicular fluid MMP8 levels seems to be a helpful biochemical test to obtain information about the severity of the periodontal disease.

A novel method for evaluating periodontal recession: a feasibility study

PURPOSE

To evaluate whether a three-dimensional (3D) optical method currently used for the production of dental restorations could be applied to the simultaneous evaluation of the height and width of periodontal recessions, and determine the reproducibility and accuracy of the method for evaluating periodontal recession.

MATERIALS AND METHODS

The height and width of periodontal recessions scratched onto stone replicas were recorded using a 3D optical method, a periodontal probe, and a caliper.

RESULTS

No difference was found between measurements obtained using the methods tested (p > 0.05). However, measurements using the 3D optical method showed the highest reproducibility.

CONCLUSION

The 3D optical method allowed the accurate and reproducible evaluation of the height and width of periodontal recessions. The next step should be the development of fully automated soft-tissue monitoring software to increase time savings.

Histological and histomorphometrical analysis of a silica matrix embedded nanocrystalline hydroxyapatite bone substitute using the subcutaneous implantation model in Wistar rats

The clinical suitability of a bone substitute material is determined by the ability to induce a tissue reaction specific to its composition. The aim of this in vivo study was to analyze the tissue reaction to a silica matrix-embedded, nanocrystalline hydroxyapatite bone substitute.The subcutaneous implantation model in Wistar rats was chosen to assess the effect of silica degradation on the vascularization of the biomaterial and its biodegradation within a time period of 6 months. Already at day 10 after implantation, histomorphometrical analysis showed that the vascularization of the implantation bed reached its peak value compared to all other time points. Both vessel density and vascularization significantly decreased until day 90 after implantation. In this time period, the bone substitute underwent a significant degradation initiated by TRAP-positive and TRAP-negative multinucleated giant cells together with macrophages and lymphocytes. Although no specific tissue reaction could be related to the described silica degradation, the biomaterial was close to being fully degraded without a severe inflammatory response. These characteristics are advantageous for bone regeneration and remodeling processes.

Association between chronic dental infection and acute myocardial infarction

INTRODUCTION

In patients with cardiovascular diseases several risk factors such as high blood pressure, diabetes, smoking and drinking habits, genetic disposition, and chronic inflammation must be considered. The aim of this study was to investigate whether there is a correlation between dental origin infections and the presence of an acute myocardial infarction (AMI).

METHODS

A total of 125 patients who had experienced a myocardial infarction and 125 healthy individuals were included in this study. The oral examination was carried out following the consent of the ethics committee and the National Board for Radiation Protection and included the number of teeth, endodontically treated teeth, periodontal screening index (PSI), clinical attachment level, and radiographic apical lesions (radiograph examination). The medical examination included, among others, blood glucose level, C-reactive protein (CRP) serum levels, and leukocyte number.

RESULTS

The study demonstrated that patients with AMI exhibited an unfavorable dental state of health. After statistical adjustment for age, gender, and smoking, they exhibited a significantly higher number of missing teeth (P = .001), less teeth with root canal fillings (P = .0015), a higher number of radiologic apical lesions (P = .001), and a higher PSI value (P = .001) compared with individuals without myocardial infarction. The medical data showed a nonsignificant correlation between CRP and the number of radiologic apical lesions.

CONCLUSIONS

This study presents evidence that patients who have experienced myocardial infarction also exhibit an unfavorable dental state of health in comparison to healthy patients and suggests an association between chronic oral infections and myocardial infarction.