Etablierung und Evaluation der kieferorthopädischen digitalen Falldokumentation in der Lehre als problembasiertes eLearningsystem (ePBL)

Ziel der Arbeit war es, das an der Poliklinik für Kieferorthopädie, Münster entwickelte, modifizierte POL-Konzept zu beschreiben, seine Eignung als didaktisches Werkzeug zu untersuchen und ein technisches Hilfsmittel in Form eines Softwareprogramms zur Gestaltung von Lehrmaterial zu entwickeln. Das modifizierte POL ist ein Konzept, welches in sich Eigenschaften des klassischen problemorientierten und des fallbasierten Lernens vereint. Es wurde an die curricularen, personellen und infrastrukturellen Gegebenheiten angepasst und bietet gegenüber den etablierten Formen von POL Vorteile. Eine über drei Semester hinweg durchgeführte Evaluierung durch Studierende zeigte eine deutliche Befürwortung des praktizierten Konzeptes, wobei im zweiten Behandlungskurses hinsichtlich einzelner Teilaspekte weniger Zustimmung festzustellen war. Die im Rahmen dieser Arbeit entwickelte Softwareapplikation dient der Gestaltung elektronischen Lehrmaterials für die Durchführung der modifizierten POL-Seminare

The impact of hyperbaric oxygen therapy on serological values of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF)

<p>Abstract</p> <p>Background</p> <p>Hyperbaric oxygen (HBO) therapy is an effective adjunct treatment for ischemic disorders such as chronic infection or chronic wounds. It combines hyperoxic effects with the stimulating potential of post-therapeutic reactive hypoxia. As its crucial effects, stimulation of fibroblast growth, induction of collagen synthesis and the initiation of angiogenesis are discussed. Angiogenesis is a multistage process resulting in the growth of blood vessels. It includes degradation of extracellular matrix, proliferation and migration of different cell populations and finally formation of new vessel structures. This complex chain of procedures is orchestrated by different cytokines and growth factors. Crucial mediators of angiogenesis are basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF); their <it>in-vivo </it>function is still not fully understood.</p> <p>Methods</p> <p>Forty-three patients suffering from sudden sensorineural hearing loss or tinnitus were treated with HBO. The therapy included 10 sessions of 90 minutes each, one session a day. Serological levels of bFGF and VEGF were assessed by enzyme-linked immunosorbent assays performed according to the manufacturer's instructions on day 1, 2, 5 and 10 of HBO therapy and were compared to mean values of the control group, related to the patient's age and sex, and their development observed over the ten days of HBO.</p> <p>Results</p> <p>There was no sex- or age dependency of bFGF observed in the present study, whereas under HBO our results showed a significant mitigation of the bFGF concentration. In the present data, there was no connection between the VEGF concentration and the patients' ages. Women showed significantly higher levels of VEGF. There was no significant change of VEGF concentration or the VEGF/bFGF ratio during HBO. All scored results varied within the range of standard values as described in the current literature.</p> <p>Conclusions</p> <p>A significant effect of HBO on serum concentrations of bFGF and VEGF was not verified in the present study. Additional application of exogenous growth factors in conjunction with HBO was not obviously linked by a coherent cause-and-effect chain as far as wound healing is concerned.</p

A simplified approach to true molar intrusion

Abstract Background Orthodontic management of anterior open bites is a demanding task for orthodontists. Molar intrusion as a primary means of open bite correction entails the need for appropriate anchorage. Orthodontic mini implants can provide the required mechanical support. The suggested procedure aims to reduce the risk of complications such as root damage or soft tissue irritations while minimizing overall complexity. Methods Three female patients aged 14, 18 and 19 years who decided against a surgical correction were treated with a device consisting of mini implants in the palatal slope, a palatal bar and intrusion cantilevers. Results In all three patients, an open bite reduction of more than a millimeter occurred within four months. An anterior overbite of 2 mm or more could be established within 6 to 9 months. Conclusions The method presented in this article enables the practitioner to use mini implants in an easily accessible insertion site. A lab-side procedure is optional but not required.</p

Low-flow lower body perfusion for spinal protection in a frozen elephant trunk simulation model

OBJECTIVES: The frozen elephant trunk (FET) procedure using isolated selective cerebral perfusion (SCP) at moderate hypothermia is associated with an increased risk for spinal cord ischaemia. The aim of this study was to evaluate the benefit of a combined selective cerebral and low-flow lower body perfusion (CLBP) in a porcine model. METHODS: Twenty pigs (46 +/- 5 kg) were cooled on cardiopulmonary bypass (CPB) to 28 degrees C. After aortic clamping and occlusion of the thoracic segmental arteries (TSA(T4-T13)), a pressure-controlled SCP (50 mmHg) was established for 90 min. Randomly, in n = 10 animals, an additional lower body perfusion (LBP) was performed with 15 ml/kg/min (CLBP). Regional spinal cord blood flow (SCBF), cerebrospinal fluid pressure (CSFP) and motor-evoked potentials (MEPs) were registered at six time points. The animals were sacrificed after 120 min of weaning from CPB, and the spinal cord was analysed histologically using a schematic scoring system (0 = normal, 8 = total necrosis). RESULTS: Isolated SCP led to an SCBF decrease from 18.5 +/- 9.4 to 0.9 +/- 1.4 ml/min/100 g in the L1-L5 region (P = 0.005). CLBP preserved an almost physiological lumbar SCBF of 11.3 +/- 5.3 ml/min/100 g. CSFP decreased in both groups during cooling and SCP/CLBP to 70-80% and increased during reperfusion to 150%, without showing significant differences between groups. The MEP amplitude decreased in both groups, with certain regional differences: T7-T11. MEP recording revealed a more pronounced amplitude decrease in the CLBP group (52.5 +/- 2.0 vs 71.3 +/- 0.9%), but MEP amplitudes recovered in both groups (SCP: 73.7 +/- 0.5 vs CLBP: 82.6 +/- 0.1%). During selective hypothermic perfusion, SCP-treated animals showed significant lower MEP amplitudes, when compared with CLBP-treated animals: 60 +/- 9 vs 90 +/- 3% (P 5. A higher grade of lumbar ischaemia could be seen after isolated SCP (score: 5.9 +/- 0.6 vs 3.6 +/- 2.9). CONCLUSION: The prolonged SCP provides an insufficient lumbar spinal cord protection during the FET procedure at 28 degrees C. The use of a low-flow LBP in addition to SCP may reduce functional and structural spinal damage

Mini-implants in the palatal slope – a retrospective analysis of implant survival and tissue reaction

<p>Abstract</p> <p>Background</p> <p>To identify insertion procedure and force application related complications in Jet Screw (JS) type mini-implants when inserted in the palatal slope.</p> <p>Methods</p> <p>Setting and Sample Population: The Department of Orthodontics, the University Hospital Münster. Forty-one consecutively started patients treated using mini-implants in the palatal slope. In this retrospective study, 66 JS were evaluated. Patient records were used to obtain data on the mode of utilization and complications. Standardized photographs overlayed with a virtual grid served to test the hypothesis that deviations from the recommended insertion site or the type of mechanics applied might be related to complications regarding bleeding, gingival overgrowth or implant failure.</p> <p>Results</p> <p>Two implants (3%) were lost, and two implants (3%), both loaded with a laterally directed force, exhibited loosening while still serving for anchorage. Complications that required treatment did not occur, the most severe problem observed being gingival proliferation which was attributable neither to patients’ age nor to applied mechanics or deviations from the ideal implant position.</p> <p>Conclusions</p> <p>The JS mini-implant is reliable for sagittal and vertical movements or anchorage purposes. Laterally directed forces might be unfavorable. The selection of implant length as well as the insertion procedure should account for the possibility of gingival overgrowth.</p

The university münster model surgery system for orthognathic surgery. Part II – KD-MMS

<p>Abstract</p> <p>Background</p> <p>Model surgery is an integral part of the planning procedure in orthognathic surgery. Most concepts comprise cutting the dental cast off its socket. The standardized spacer plates of the KD-MMS provide for a non-destructive, reversible and reproducible means of maxillary and/or mandibular plaster cast separation.</p> <p>Methods</p> <p>In the course of development of the system various articulator types were evaluated with regard to their capability to provide a means of realizing the concepts comprised of the KD-MMS. Special attention was dedicated to the ability to perform three-dimensional displacements without cutting of plaster casts. Various utilities were developed to facilitate maxillary displacement in accordance to the planning. Objectives of this development comprised the ability to implement the values established in the course of two-dimensional ceph planning.</p> <p>Results</p> <p>The system - KD-MMS comprises a set of hardware components as well as a defined procedure. Essential hardware components are red spacer and blue mounting plates. The blue mounting plates replace the standard yellow SAM mounting elements. The red spacers provide for a defined leeway of 8 mm for three-dimensional movements. The non-destructive approach of the KD-MMS makes it possible to conduct different model surgeries with the same plaster casts as well as to restore the initial, pre-surgical situation at any time. Thereby, surgical protocol generation and gnathologic splint construction are facilitated.</p> <p>Conclusions</p> <p>The KD-MMS hardware components in conjunction with the defined procedures are capable of increasing efficiency and accuracy of model surgery and splint construction. In cases where different surgical approaches need to be evaluated in the course of model surgery, a significant reduction of chair time may be achieved.</p