Customised products for orbital wall reconstruction: a systematic review

The purpose of this systematic review was to critically analyse the recent literature and present the state of the art in customised reconstruction of orbital fractures. Three electronic databases and manual search approaches were used to identify relevant articles. Only controlled clinical studies were included. Primary outcome was defined as the status of recovery (complete/partial functional, and aesthetic disturbances). The benefit of intrasurgical navigation should be described. The secondary outcome was defined as the time of surgery, post-surgical events, and hospitalisation. Of the 552 records identified, eight met the inclusion criteria. Post-surgical results regarding recovery were superior in the customised group, and were comparable to the control group in five studies. The time of surgery was shorter in the customised groups, and liquid infusion and time of hospitalisation were reduced. Four studies documented more accurate reconstruction with the use of navigation. All the studies presented at least one bias, and considerable heterogeneity was evaluated. This review found that the use of customised meshes in combination with surgical navigation resulted in more accurate reconstruction. A significant reduction in surgical time was revealed.

Influence of Different Rehydration Protocols on Biomechanical Properties of Allogeneic Cortical Bone Plates: A Combined in-vitro/in-vivo Study

Introduction: Allogeneic cortical bone plates (CP) are used for alveolar ridge augmentation. Since CP are freeze-dried and dehydrated during processing, the breaking strength (BS) and the flexibility (FX) are reduced, resulting in a relevant risk for plate fractures during insertion. The aim of this study was to evaluate the influence of rehydration time on the biomechanical properties (BS & FX) of CP in-vitro and in vivo.Material and Methods: 40 CP were randomly divided into four experimental groups. (A) untreated control (n = 10), rehydration for 10 (B), 30 (C) and 60 (D) minutes in 0.9% saline solution (n = 10 each). BS [Newton, N] and FX [mm] (force till fracture and distance of deflection to the breaking point) were analyzed. Besides, architectural features of all CP groups were visualized and examined by scanning electron microscopy (SEM). In addition, the frequency of CP fractures of rehydrated- vs. non-rehydrated CP was retrospectively analyzed in 6 patients.Results: Compared to the control group, significantly increased BS and FX were demonstrated after 10, 30 and 60 minutes of rehydration (p each ≤ 0.035). After a rehydration time of 10 minutes, no additional increase of BS and FX was seen when compared to30 and 60 minutes (p each = 1.0). SEM scans demonstrated that the CP fracture characteristics were influenced by the different rehydration protocols. The frequency of CP fractures was reduced in patients by CP rehydration.Conclusion: The biomechanical properties of CP can be significantly improved by 10 min of rehydration, resulting in an increased BS and FX, that might be clinically relevant.

Quality Assessment of Systematic Reviews and Meta-analyses on Biomarkers in Oral Squamous Cell Carcinoma

PURPOSE

To examine the methodological quality of systematic reviews (SR) and meta-analyses on biomarkers in oral squamous cell carcinoma (OSCC) using validated checklists.

MATERIALS AND METHODS

A systematic literature search was performed to identify SR and meta-analyses focusing on biomarkers in OSCC published between January 1990 and March 2014. Details of the relevant aspects of methodology as reported in these SR were extracted from the full text publications. The methodological quality of these SR and meta-analyses was evaluated using the AMSTAR and Glenny checklists.

RESULTS

After screening 1098 abstracts from the electronic database, seven studies were included in quality assessment. The mean AMSTAR score of all SR was 4.6 ± 1.9 of a possible 11 (range: 2-7) and the mean score of all SR using the checklist devised by Glenny et al was 7.1 ± 1.6 of a possible 14 (range: 5-9). Spearman correlation analysis revealed that AMSTAR and Glenny scores were highly correlated (rs = 0.757; p = 0.049). The methodological quality in journals with an impact factor above 2.5 (AMSTAR: p = 0.031; Glenny: p = 0.046) was significantly higher. In addition, in SR published after 2007, higher AMSTAR and Glenny scores were noted; however, this was not statistically significant (AMSTAR: p = 0.076; Glenny: p = 0.232).

CONCLUSIONS

Systematic reviews and meta-analyses on biomarkers in OSCC presented marked methodological and structural variability, which elevates the risk of bias and hence invalid conclusions. Checklists such as AMSTAR or Glenny may improve quality and uniformity of SR, and would thus also increase the clinical validity and applicability of SR.

Clinical efficacy of a computerised device (STA™) and a pressure syringe (VarioJect INTRA™) for intraligamentary anaesthesia

INTRODUCTION

To evaluate the impact of experience whilst using different devices for intraligamentary anaesthesia, dental students tested clinical anaesthetic efficacy of a mechanical (PDL-S) and a computer-controlled (CCLAD) application system in restorative patients.

MATERIAL AND METHODS

In a prospective study, 41 Patients in need of restorative treatment in lower posterior mandible were randomised into three groups (PDL-S: teeth n = 22; CCLAD: teeth n = 20; inferior alveolar nerve block (IANB): teeth n = 20). Dental last year students conducted anaesthesia and dental treatment. Primary objectives were differences in pain during treatment [numeric rating scale (NRS)] as well as in anaesthetic efficacy (complete/sufficient vs. insufficient/no effect) between PDL-S and CCLAD. Pain of injection, need for second injections, amount of anaesthetic solution and duration of local numbness were assessed. IANB as gold standard was compared to each system descriptively.

RESULTS

PDL-S had a significant lower pain during treatment (P = 0.017) but a similar anaesthetic efficacy (P = 0.175) compared to the CCLAD system. Concerning pain of injection (P = 0.42), quantity of second injections (P = 0.232), amount of used solution (P = 0.073) as well as duration of local numbness (P = 0.253), no differences were seen. When comparing both periodontal ligament injection (PDL)-systems with IANB, pain rating was higher when using CCLAD. Injection pain, amount of used solution as well as soft tissue anaesthesia was less for PDL-S and CCLAD.

DISCUSSION

Both PDL techniques showed a good success for dental routine treatments. Although, compared to the mechanic device, the CCLAD system might need more clinical daily experience.

CONCLUSION

We recommend including specific trainings in intraligamentary anaesthesia in the dental curriculum.

Chronic periodontitis and its possible association with oral squamous cell carcinoma - a retrospective case control study

Introduction

Different inflammatory processes may trigger the development of malignancies. Therefore, the aim of the present study was to evaluate a potential association between radiological determined chronic periodontitis (CPA) and oral squamous cell carcinoma (OSCC).

Methods

In a retrospective study, OSCC-patients and a control group without malignant tumors were radiographically examined for bone loss. Via telephone survey and questionnaire, general clinical data on the individual oral hygiene and concomitant diseases together with tobacco and alcohol use were assessed and data were compared between the groups.

Results

178 OSCC-patients and 123 controls were included. In univariate analysis, a statistically relevant higher mean bone loss was seen in the OSCC group (4.3 mm (SD: 1.8; 95% confidence interval (CI): 4-4.6) vs. 2.9 mm (SD: 0.7; 95% CI: 2.8-3); p < 0.001)). This was confirmed in a multivariate regression model (OR: 2.4, 95% CI: 1.5-3.8; p < 0.001). A history of periodontal treatment was associated with significantly reduced OSCC risk (p < 0.001; OR: 0.2, CI: 0.1-0.5).

Conclusions

CPA is a common disease and the monitoring as well as the treatment of such a chronic oral inflammation may be beneficial in reducing one potential cause of OSCC. Therefore, further clinical studies on oral neoplasms should consider clinical periodontal parameters as well.

Bisphosphonates: restrictions for vasculogenesis and angiogenesis: inhibition of cell function of endothelial progenitor cells and mature endothelial cells in vitro

Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is one of the main side effects in patients treated with bisphosphonates for metastasis to the bone or osteoporosis. BP-ONJ usually occurs in patients treated with highly potent nitrogen-containing bisphosphonates. The exact mechanism of action and etiopathology is still unknown. In addition to inhibition of bone remodelling, an anti-angiogenetic effect has become the focus of research. The aim of these study was to investigate the effect of different bisphosphonates on human umbilicord vein endothelial cells (HUVEC) and endothelial progenitor cells (EPC), which play an important role in angiogenesis. Using varying concentrations, the impact of one non-nitrogen-containing bisphosphonate (clodronate) and three nitrogen-containing bisphosphonates (ibandronate, pamidronate and zoledronate) on HUVEC and EPC was analysed. The biologic behaviour of HUVEC after incubation with different bisphosphonates was measured in a Boyden migration assay as well as in a 3D angiogenesis assay. The number of apoptotic cells was measured by Tunnel assay. To underline the importance of neoangiogenesis in the context of BP-ONJ, we measured the EPC number after incubation with different bisphosphonates in vitro. HUVEC and EPC were significantly influenced by bisphosphonates at different concentrations compared with the non-treated control groups. The nitrogen-containing bisphosphonates pamidronate and zoledronate had the greatest impact on the cells, whereas clodronate followed by ibandronate was less distinct on cell function. These results underline the hypothesis that inhibited angiogenesis induced by bisphosphonates might be of relevance in the development and maintenance of BP-ONJ. The increased impact by highly potent bisphosphonates on HUVEC and EPC may explain the high prevalence of BP-ONJ in patients undergoing this treatment.