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hellenic stomatological review

HELLENIC DENTAL ASSOCIATION
VOLUME 52, ISSUE 2, APRIL - JUNE 2008
ISSN 1011 - 4181
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TOMO 52, TEYXO 2

APIIO - IOYNIO 2008
ISSN 1011 - 4181
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. A

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N. K...........................................................................143-154
PAKTIKO EMA

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BIBIOPAIKE ANAKOHEI
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A. K, A. . M ..................................................173-184
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TOMO 52, TEYXO 2

APIIO - IOYNIO 2008
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Hellenic Dental Association
Hellenic
Stomatological
Review
VOLUME 52, ISSUE 2

APRIL - JUNE 2008
ISSN 1011 - 4181
PROPRIETOR:
EDITOR -IN- CHIEF:
J. G. Tzoutzas
EDITORIAL BOARD:
G. Douvitsas
H. Karkazis
A. Kssioni
G. Mountouris
H. Paximada
V. Topitsoglou-Themeli
CONTENTS
F. Zervou-Valvi
E. Katsavrias
P. Lagouvardos
L. Papagiannoulis
D. Sakellari
D. Tziafas
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RESEARCH PAPER
Computed tomographic evaluation of the maxillary sinus

related to sinus lifting procedure
D. Trikeriotis, I. Paravalou and P. Diamantopoulos...................127-133
CASE REPORTS
Conservative management of large odontogenic keratocyst.

Case report and review of literature
D. D. Andressakis, E. Chrysomali and A. D. Rapidis .................135-142
Endoscopicaly assisted treatment of orbital blowout fractures.
Report of three cases and review of the literature
N. Katsikeris .............................................................................143-154
PRACTICAL NOTE
Preoperative care and postoperative treatment of patients

with hepatitis B and C in Oral Surgery
I. Daskala, A. Delousidou, N. Bagenas and D. Kalyvas .............155-160
LITERATURE REVIEWS
PUBLISHER:
Panos Alexiou
President of the Hellenic Dental Association
The anticaries vaccination is still an up-to-date

M. Androutsou-Pantziou, S. Andrian and A. Daskalopoulos......161-171
HEADQUARTERS
38 Themistokleous Str., Athens, 106 78
Phone#: (3210) 38.13.380
Fax#: (3210) 38.34.385
Systemic risk factors associated to implant failure

A. Karayiannis, A. G. Mitsea .....................................................173-184
Gingival overgrowth caused by nifedipine
K. Katoumas, N. Soldatos .........................................................185-191
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Stomatological
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Craniosynostosis: The correlation between phenotype and genotype

K. Mitsimponas, K. Antoniades.......................................................193-204
PROPRIETOR:
EDITOR -IN- CHIEF:
J. G. Tzoutzas
EDITORIAL BOARD:
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H. Karkazis
A. Kssioni
G. Mountouris
H. Paximada
V. Topitsoglou-Themeli
Sex steroid hormones and periodontium

A. Mavrogiannea, S. Vassilopoulos and T. Vrachopoulos..........205-211
F. Zervou-Valvi
E. Katsavrias
P. Lagouvardos
L. Papagiannoulis
D. Sakellari
D. Tziafas
PRODUCTION SUPERVISORS:
M. Antoniadou, E.T. Farmakis
COPY EDITOR:
Evelin Babai
PRODUCTION - PROMOTION:
TypeProduct
V. & E. Babai Ltd
32 Epikourou Str., Athens Hellas
Phone#: (3210) 32.14.904
Fax#: (3210) 32.14.991
ADVERTISEMENTS - PUBLIC
RELATIONS:
M. Morfoniou - S. Gogas
Phone#: (3210) 33.02.343
Fax: (3210) 38.34.385
Hellenic Stomatological Review is the
official publication of the Hellenic Dental
Association, published trimonthly.
Annual subscription
VOLUME 52, ISSUE 2

APRIL - JUNE 2008
ISSN 1011 - 4181
40 $ USD
PUBLISHER:
Panos Alexiou
President of the Hellenic Dental Association
HEADQUARTERS
38 Themistokleous Str., Athens, 106 78
Phone#: (3210) 38.13.380
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The use of chlorhexidine in the treatment of periodontal diseases

G. Stylianopoulos, A. Poulios and V. Panis...............................213-221
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52: 127-133, 2008
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22-07-08 17:10
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22-07-08 17:10
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SUMMARY
Computed tomographic evaluation

of the maxillary sinus related to sinus lifting
procedure.
D. Trikeriotis, I. Paravalou, P. Diamantopoulos
hellenic stomatological review 52: 127-133, 2008
The purpose of this study was to evaluate the anatomical

factors being involved with sinus lifting procedure, such as:
a) the angle formed between the buccal and palatal alveolar maxillary sinus wall, b) the maxillary sinus septa and c)
the endosseous course of the posterior superior alveolar
artery in the lateral maxillary sinus wall. Multi-sliced CT
scans retrieved from implant treatment plans of fifty patients
and processed with a specialized sofware were used as a
study material. Measurements were performed at the defined positions of 7, 14, 22 and 30mm distal to the upper
canines. 230 positions were edentulous (67%).
52: 127-133, 2008
22-07-08 17:10
133
E E
The investigated angle was found 20.916.10, 45.316.70,

53.114.80 and 39.311.90 at the positions 7, 14, 22
30mm, respectively. Maxillary sinus septa observed in 15/50
of the patients (30%). They mainly appeared over edentulous alveolar areas (81.2%) with a mean length of
8.32.1mm, width from 1.10.4 to 2.60.8mm and height
from 2.51.16 to 6.42.7 mm. A bone canal observed, 76%
at the right and 82% at the left side, coursing into the lateral
maxillary sinus wall at a mean distance of 17.55.5mm from
the top of the buccal alveolar crest.
Gender and presence or absence of teeth did not significantly influence the values of the angle. Without consideration of edentulous alveolar height change, this angle
showed to be sharper at the position of 7mm in comparison to the other positions (p<0.0001) and at the position
of 30mm in comparison to the positions of 14mm (p=0.01)
and 22mm (p<0.0001). On the other hand, an increase of
the edentulous alveolar height was followed by a decrease
of this angle at the positions of 7mm (p=0.01) and 14mm
(p=0.04). It was found that this significant increase of the
edentulous alveolar height could explain 26.3% and 18.8%
of the angle variability at the positions of 7mm (R2=0.263,
P=0.001) and 14mm ( R2=0.188, P=0.001), respectively.
Key words: Spiral Computed Tomography, Three-Dimensional
imaging Maxillary Sinus, Lifting
BIBIOPAIA
1. Parks ET: Computed tomography applications for dentistry.
Dent Clin North Am 2000; 44(2): 371-394.
2. Tsiklakis K, Syriopoulos K, Stamatakis HC: Radiographic
examination of the temporomandibular joint using cone
beam computed tomography. Dentomaxillofac Radiol 2004;
33(3): 196-201.
3. Tantanapornkul W, Okouchi K, Fujiwara Y, Yamashiro M,
Maruoka Y, Ohbayashi N et al: A comparative study of conebeam computed tomography and conventional panoramic
radiography in assessing the topographic relationship
between the mandibular canal and impacted third molars.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;
103(2): 253-259.
4. Closmann JJ, Schmidt BL: The use of cone beam computed
tomography as an aid in evaluating and treatment planning
for mandibular cancer. J Oral Maxillofac Surg 2007; 65(4):
766-771.
5. Kawamata A, Ariji Y, Langlais RP: Three-dimensional computed tomography imaging in dentistry. Dent Clin North Am
2000; 44(2): 395-410.
6. Westermark A, Zachow S, Eppley BL: Three-dimensional

osteotomy planning in maxillofacial surgery including soft
tissue prediction. J Craniofac Surg 2005; 16(1): 100-104.
7. Nickenig HJ, Eitner S: Reliability of implant placement after
virtual planning of implant positions using cone beam CT
data and surgical (guide) templates. J Craniomaxillofac Surg
2007; 35(4-5): 207-211.
8. Perrella A, Albuquerque MA, Antunes JL, Cavalcanti MG:
Volumetric and linear assessment of maxillary sinuses using
computed tomography. Bull Group Int Rech Sci Stomatol
Odontol 2004; 46(1): 8-14.
9. Cho SC, Wallace SS, Froum SJ, Tarnow DP: Influence of
anatomy on Schneiderian membrane perforations during
sinus elevation surgery: three- dimensional analysis. Pract
Proced Aesthet Dent 2001; 13(2): 160-163.
10. Kim MJ, Jung UW, Kim CS, Kim KD, Choi SH, Kim CK, Cho KS:
Maxillary sinus septa: prevalence, height, location, and
morphology. A reformatted computed tomography scan
analysis. J Periodontol 2006; 77(5): 903-908.
11. Flanagan D: Arterial supply of maxillary sinus and potential
for bleeding complication during lateral approach sinus
elevation. Implant Dent 2005; 14(4): 336- 338.
12. Velloso GR, Vidigal GM, de Freitas MM, Garcia de Brito OF,
Manso MC, Groisman M: Tridimensional analysis of maxillary
sinus anatomy related to sinus lift procedure. Implant Dent
2006; 15(2): 192-196.
13. Kim HJ, Yoon HR, Kim KD, Kang MK, Kwak HH, Park HD et al:
Personal-computer-based three-dimensional reconstruction
and simulation of maxillary sinus. Surg Radiol Anat 2003;
24(6): 393-399.
14. Ulm CW, Solar P, Krennmair G, Matejka M, Watzek G:
Incidence and suggested surgical management of septa in
sinus-lift procedures. Int J Oral Maxillofac Implants 1995;
10(4): 462-465.
15. Velasquez-Plata D, Hovey LR, Peach CC, Alder ME: Maxillary
sinus septa: a 3- dimensional computerized tomographic
scan analysis. Int J Oral Maxillofac Implants 2002; 17(6): 854860.
16. Krennmair G, Ulm CW, Lugmayr H, Solar P: The incidence,
location, and height of maxillary sinus septa in the edentulous and dentate maxilla. J Oral Maxillofac Surg 1999; 57(6):
667-671.
17. Shibli JA, Faveri M, Ferrari DS, Melo L, Garcia RV, dAvila S et
al: Prevalence of maxillary sinus septa in 1024 subjects with
edentulous upper jaws: a retrospective study. J Oral
Implantol 2007; 33(5): 293-296.
18. Chuang VP, Vines FS: Roentgenology of the posterior
superior alveolar foramina and canals. Am J Roentgenol
Radium Ther Nucl Med 1973; 118(2): 426-430.
19. Elian N, Wallace S, Cho SC, Jalbout ZN, Froum S: Distribution
of the maxillary artery as it relates to sinus floor augmentation.
Int J Oral Maxillofac Implants 2005; 20(5): 784-787.
:
T .
199
112 53 AHNA
E-mail: dnt102@hotmail.com
52: 127-133, 2008
133
135-142 SEL.
RAPIDIS*
22-07-08 17:15
135

.
A
. . A *, E. X**, A. . P***
H (OK) 11% . . A . H OK
B K
.
T
. K .
T OK
.
OK , , 62 , , . OK
.
52: 135-142, 2008
16/8/2007 - 26/10/2007
EIAH
O O K (OK) Philipsen 19561 . K -
: A , , .
* & X M.Sc.
E. B E..Y.
** E. K
*** & X.
K
K & X. AONA
O . K A. . P.
E , T X , O A.
2, 3 4. O
, OK5, 6. T

,
7,
, 8-13.
H OK 14-16. Y 17

, 5.
E
, OK
. O Blanas 10 5
: T 135
135-142 SEL.
RAPIDIS*
22-07-08 17:15
136

5. T , 18

Carnoy ,
8, 12. T
,
,
12. T ,
,

11, 15, 18, 19. K
.
9, 11, 20.
OK , ,
21, 22.
H ,
18, 19
,
23.
A
15, 11, 15.
H
. H

, ,
18, 23.
24. E

,
13. H 25, 26.

13, 23, 24, 27.
OK
.
136
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E I X
K AONA O , (E. 1).
,
.
O Denta Scan ,
(E 2, 3).
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, , .
E. 2: Denta Scan . A
.
52: 135-142, 2008
135-142 SEL.
RAPIDIS*
22-07-08 17:15
137
,
, OK (E. 5).
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. Y
,
. A , , , (E. 4). T

. A .
H -
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.
52: 135-142, 2008
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,
. (X
- X25).
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. .
A
. A (Penrose).
T
. A
. O 4.0 (E. 6).
M
0,12 % ,

. A per os . O 4
.
K 2 .
137
135-142 SEL.
RAPIDIS*
22-07-08 17:15
138
(E. 7), (E. 8, 9).

O 6 , , OK.
E. 9: K .
YZHTHH
E. 6: X Penrose.
H OK

1,5% 21,8 %2, 6, 21, 28, 29. O P30 1.681
247 ( 14,7%)
84 OK.
OK 5% 34%
. H OK
. O
2 3
5
92 28. H
12,1% 16 , 18,1% 28. ,
OK 4, , 1,27:1 1,93:18, 22, 28. A P30
.
H
65% 76%4, 7, 11, 22, 26, 30
, , ,
, 8, 12, 22, 28, 30.
4, 7, 12, 28. OK 7, 12, 20, 26, 30, 31.
OK
7, 11, 12, 20, 30. T 2,
8. K Chow8
8, 11, 13, 26, 28, 30
E. 7: H 9 . H
, .
E. 8: H .
.
138
52: 135-142, 2008
135-142 SEL.
RAPIDIS*
22-07-08 17:15
139
,
. H
. A
OK
. T , ,
8, 12, 30. OK
,
, 2, 7, 11.
, ,
8.
OK
B K (
Gorlin-Goltz)11, 19, 20, 26, , , , 2, 3.
K Brannon7 312 OK, 10% OK. A

B K.
OK .

. M

3, 7, 8, 22, 30.
3, 8. H
OK

,
11, 30, 32. OK ,
, , , , 3, 9, 15, 30, 33. 8, 11.
T
, ,
2, 8, 11. H Denta
Scan .

,
52: 135-142, 2008
,
,
30.
OK
. Denta Scan ,
.
, OK 2. T ,

, OK 33. E
7, 20.
I OK 6-10
, 20. H

.
2, 33. ,

34. T
2. T
80-90% , 3, 20, 35. ,
3, 20, 33. E
12, 20, 3.
O
.
OK . , , 11, 12, 19.

12, 30. T 20. E 8, 20, , 139
135-142 SEL.
RAPIDIS*
22-07-08 17:15
140
30.
I OK ,
.
OK7, 36, 37

OK 38-40.
OK .
OK ,
,
, -1,
41. H -1
, . 10
OK, 42.
bcl-2,
OK,
. E
OK bcl-2 43.
OK
, 5, 14.
44-46.
.O.Y.
, ,
47.
OK
.
OK
. M 0
62%13, 21, 30. H 5 10, 21, 44-46.
O P30 64,3%
.
12, 22. O Crowley
35 41
.
OK 140
. H ,
5 , 11, 20. ElHajj Anneroth20 OK
, 11. O 11. 11, 22
5, 11, 12. E OK 20, 35 OK
11, 19.
8, 10, 20.
K Stoelinga12 . T OK
B K 11, 12.
H OK . Stoelinga12
.
SUMMARY
Conservative management of large odontogenic

keratocyst. Case report and review of literature
D.D. Andressakis, E. Chrysomali, A.D. Rapidis
The odontogenic keratocyst is classified as a developmental epithelial cyst and comprises approximately 11% of all
cysts of the jaws. The lesion is believed to arise from remnants of the dental lamina and is most often seen in the
mandibular angle and the ramus. The radiological appearance is that of a unilocular or a multilocular radiolucent
lesion with a scalloped contour. Odontogenic keratocysts
(OK) are one component of the basal cell nevus syndrome
and all patients with multiple odontogenic keratocysts
should be evaluated for the presence of this syndrome.
However the most characteristic clinical feature of OK is its
local aggressive behaviour and the high frequency of
recurrence after surgical treatment. Cysts that show orthokeratinization or mixed types of keratinization present with
less recurrence rates than parakeratinized ones.
The clinical characteristics of the lesion have caused diffe 52: 135-142, 2008
135-142 SEL.
RAPIDIS*
22-07-08 17:15
141
rences of opinion among investigators on its proper surgical management. During the years several treatment
modalities have been proposed and the results regarding
local recurrences evaluated.
The purpose of this report was to present a case of odontogenic keratocyst in a 62 year-old male treated by the
technique of cyst-decompression alone and complete
remission after 8 months. The cyst showed no evidence of
local recurrence during the two years of follow-up. The
current concepts of management of the OK and the research results on its biologic behavior are also discussed.
Key words: Developmental cysts, odontogenic keratocyst,
surgical decompression
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2002; 31(9): 526-533.
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:
P A.
AONA O ,
. A 171, 115 71 AHNA
E-mail: rapidis@usa.net
142
52: 135-142, 2008
143-154 SEL. KATSIKERHS*
22-07-08 17:17
143
E

N.. K*
T
. T
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orbital blow out fractures. Xo , .
H X
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H K
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52: 143-154, 2008
20/12/2007 - 17/1/2008
EIAH
T
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: K , E.
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Saunders , 199713.

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SUMMARY
Endoscopicaly assisted treatment

of orbital blowout fractures. Report of three
cases and review of the literature
N.F. Katsikeris
The orbital floor fractures are quite

midface trauma and they can be
conjunction with other fractures of
majority of cases these fractures
common in cases of
either isolated or in
the area. In the vast
are associated with
151
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152
herniation of orbital contents into the underlying maxillary

sinus cavity. The term orbital blow out fractures has been
coined in the literature to describe the isolated orbital floor
fractures that are associated with this herniation of orbital
contents into the sinus cavity. They are characterized by a
unique pathogenetic mechanism, clinical picture and
methods of treatment. The mechanical theory for the pathogenesis of these fractures postulates that the responsible force acts on the thick cortical plate of the infraorbital
rim which while not fracturing, transmits it to the bone of
the floor causing it to fracture. The hydraulic theory on the
other hand, postulates that the force acts on the globe
itself which concequently moves backwards creating an
increase in the hydraulic pressure inside the orbit. This
pressure is responsible for the fracture of the floor and the
downward towards the sinus, cavity movement of orbital
contents. There is evidence that in the clinical setting both
mechanisms can be responsible for these fractures.
Endoscopicaly assisted procedures are becoming more
and more common in the everyday oral and maxillofacial
surgery practice. The term endoscopicaly assisted procedure refers to a procedure that is carried out with the use
of an endoscope but without the creation of a true optic
cavity which is totally enclosed. In these procedures the
surgical approach is one of the typical approaches used
with the endoscope exploiting the possibilities for minimally
invasive surgery (more conservative surgical approaches
compared to the fully open ones) and for the thorough
examination of the fracture site both pre and post reduction.
The present study presents the results of the endoscopic
treatment of orbital blow out fractures with the maxillary
sinus approach. Three patients treated at the Oral and
Maxillofacial Surgery clinic of the G. Gennimatas General Hospital of Athens are presented. Two of them were
treated because of limitation of the eye movement in the
upward gaze and the third one because of persistent
diplopia. The method allowed the detailed examination of
all walls of the sinus, the reduction of the fractures, the
return of the orbital contents into the orbit and the firm
support of them by the titanium mesh used. Postoperatively there was uneventful healing and at follow up (3-9
months) there was normalization of the ocular movements
in the two patients operated for this and the disappearance
of diplopia in the third patient.
It is concluded that this approach affords better access to
the herniated orbital contents, easier reduction of them,
use of relatively large segments of titanium mesh and a
better chance of examining to examine in detail the floor of
the orbit without using a transcutaneous approach and
therefore without leaving a skin scar.
Key words: Endoscopy, Blow out fractures
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SUMMARY
Preoperative care and postoperative

treatment of patients with hepatitis B and C
in Oral Surgery
I. Daskala, A. Delousidou, N. Bagenas, D. Kalyvas
The most common hepatic diseases which can lead to

hepatic insufficiency are the viral forms of hepatitis. Hepatitis B and C cause the most serious complications.
The purpose of this study is the updating of the general
dentist in what concerns the preoperative control, and the
treatment of patients with hepatitis B and C in Oral Surgery.
More particularly, there are mentioned the following significant parametres: danger of toxic action emergence from
the administration of some medicine, prevention and treatment of possible bleeding, prevention of the diseases
transmission and also reference to the dentists safety
protocol after professional report.
Usually a considerable number of patients with hepatitis B
and C face serious dental problems. Some of them, like
multiple decay, complex form of periodontal disease and
bad oral hygiene, lead to the loss of a great number of
teeth and the occurrence of cysts in the roots and the root
tips. The treatment plan is formed after careful clinical and
radiographical examination and the necessary surgical
operations are performed under the proper precautionary
measures.
The patients who suffer from hepatitis B and C compose a
significant part of the population. Therefore, the contemporary dentist owes to be updated regarding the prevention and treatment of situations that it is possible to emerge
during the performance of an operation in the oral cavity of
these patients.
Key words: hepatitis B-C, Oral Surgery
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22-07-08 17:22
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XOPHHH
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BIB. ANAOPA
S. mutans
S. mutans
S. mutans
ANPO
AHTIKH
POEEYH
ANTIMATO
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YTA
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ONTIKIA
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S. mutans
ONTIKIA
IgY
GLU
IHKOI
AgI/II
Hata et al 1997
Ma et al 1998
Loimaranta et al
1999
Shimazaki et al
2001
Mitoma et al
2002
Smith et al
2001
Lehner 1985
ANPO
ANPO
ANPO
52: 161-171, 2008
S. mutans
S. mutans
165
22-07-08 17:22
166
166
Taubman
1995, 2000, 2001
CT= XOEPIKH TOINH
ONTIKIA
(NTOBIOTIKA)
A-
IgG
S. sobrinus
S. mutans 4964%
S. mutans
IgG
IgM>IgA>IgG
IgA
IgA
ONTIKIA
ONTIKIA
PAc
ONTIKIA
SBR-CTA2/B
IgA
IgG
S. mutans
Fontana et
al. 1999
Jespersgaard et
al. 1999
Redman 1996
Childers et
al. 1996
IgA
CT
ONTIKIA
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O
S. sobrinus
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S. Sobrinus
75%
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. M S.mutans Salmonella
typhimurium. H 40.
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,
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43.
2

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E ZA
BIB.
ANAOPA
Fukuizumi et
al. 2000
B A
52: 161-171, 2008
22-07-08 17:22
167
B A
. O , , . K , , . A , 44.
M ,
, .
A
, . , . 1997 Wu .39

. O Koga .
2002 ,
45.
O
IgA-S -S.mutans - S.sobrinus
:
1. H , , IgG,
IgM IgA.
2. A per os
3. A / 46.
H .

S.mutans . E
S.mutans,

S.mutans, . H rhesus IgG, IgM, IgA
, ,
T
S.mutans (SA) I/II. A S.mutans. IgA , S.mutans 47.
,
Ag 190 kDa S.mutans
52: 161-171, 2008
(Pac), . E IgG
, Ag 210 kDal S.sobrinus Pac (301-319). rPAc, .
K Pac (301319) B (CTB) rPAc CTB
IgG
S.mutans, rPAc
48.

DNA, T- 4(CTLA-4).
T DNA
pGJA-P,

DNA 49.
DNA , , DNA ( pGJA-P/VAX) ( )
, . O
in vitro. T

DNA50.
M
. O (CT)
I II (LT-I LTII)
Escherichia coli
. H
, IgA IgG , . A
,
S.mutans .

,
51.
A . H
, . E167
22-07-08 17:22
168
B A

IgA , . ,
,

S.mutans. T
GTF-MP
(glucosyltransferase-microparticles) ,
GTF-MP,
, 52.
OMAE TOXOI OY YOBAONTAI E ANOIA
A IgA-s
, 3 IgA
(S.mitis,
S.oralis, S.sanguis), 6 .
IgA-s ,
, , IgG
53, 54.
mutans 26 ,
(4-8 ) , ,
. A
,
12 18 55.
IgG , IgA ,
, , (S.sanguis,
S.mutans, S.sobrinus). E
S.mutans , ,
,
. E
, 56. ,
,
168

S.mutans,
.
, 57.
O ,
,
- , ,

58.
M
, 2-3 , S.mutans. O
S.mutans,

IgA . O
S.mutans, , ,
. H S.mutans,
59.
, 60.

, ,
, :
1. T
,
.
2. T
3. T - , ,
, , .
H . O
52: 161-171, 2008
22-07-08 17:22
169
B A

,
. O S.mutans . E
IgA , . H
, . H

S.mutans,
, ,
.
O

IgA . O

. T IgA .
O IgA .

S.mutans
.

, . ,
; ;
; ,

;
52: 161-171, 2008
ABSTRACT
The anticaries vaccination

is still an up-to-date challenge: a review
M. Androutsou-Pantziou, S. Andrian, A. Daskopoulos
Dental caries continues to be a costly and prevalent oral

disease. Worldwide, 5 billion people suffer from tooth
decay and the WHO indicates that dental caries is a major
health problem in most industrialized countries affecting
60-90% of children and most adults. The evidence of a
specific bacterial cause of dental caries and of the function of the salivary glands as an effect site of the mucosal
immune system has provides a scientific basis for the
development of a vaccine against the highly prevalent
and costly oral disease.
The cariogenic S.mutans are the principal bacteria causing this disease. Specific immune system defense
against these bacteria is provided mainly by secretory
immunoglobulin (Ig) A antibodies present in saliva, which
are generated by the common mucosal immune system.
Research efforts towards developing an effective and
safe caries vaccine have been facilitated by progress in
molecular biology with the cloning and functional
characterization of virulence factors from S.mutans,
including the cell-surface fibrillar proteins who mediate
adherence to the tooth surface and glycosyltransferase
enzymes, witch synthesis adhesive glucans and allow
microbial accumulation on the teeth.
Advancement in mucosal immunology, including the
development of sophisticated antigen delivery systems
and adjuvant that stimulate the induction of salivary IgA
antibodies responses, or specific serum antibodies in
gingival fluid, helps these researches. Such antibodies
will not cross-react with human tissues.
In human, passive immunization using monoclonal
antibodies was applied with success, and specific
antibody stimulation was obtained with whole killed
mutans or glycosyltranferases.
Vaccination against dental caries is a difficult challenge.
Recent development in mucosal immunity and in
purification characterizations, DNA- recombination of
S.mutans cell wall proteins, turns the possibility of an
anticaries vaccine into a near reality. The most popular
routes of mucosal immunization are via the oral or nasal
route. Mucosal immunization strategies result in the
induction of salivary IgA antibody responses and pose
fewer problems than parenteral injection of antigen.
For a caries vaccine to be accepted by the dental profession, many questions need to be answered. One of the
most important questions: what will be the long-term effect
of altering the indigenous oral micro flora? Also, can the
highest caries activity level of infection caused by the
pathogen, S.mutans, be inactivated immunologicaly?
Which entry pathways of S.mutans into the dental biofilm
can be controlled by immunization? Can an immune
169
22-07-08 17:22
170
B A
response be induced by virulence factors associated with

S.mutans? How safe are caries vaccine relative to other
caries prevention regimens? Will the professions adopt
vaccination as a caries prevention mechanism given the
greatly reduced caries prevalence over the past decades?
The aim of this article is to provide a review of the recent
progress on the development of a vaccine against
infection by S.mutans, for the prevention of dental caries,
with emphasis on the mucosal immune system and
vaccine design.
Key words: dental caries, immune system, IgA, anti-caries vaccine
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182
SUMMARY
Systemic risk factors associated

to implant failure
A. Karayiannis, A.G. Mitsea
According to recent research results although the clinical

success rate of endosseous dental implant therapy is high
(90-99%), still there is a small failure rate. The clinicians
should be mindful to identify risk factors associated to
implant failure. The aim of this study is to present the bibliographic data concerning the patient related general factors influencing the implant success.
According to the literature review there are not absolute
medical contraindications for placement of implants, but
relative contraindications. Age is not a risk factor althogout
it must be considered in treatment planning.
Factors such as chemotherapy, radiotherapy, plus immunosuppressive and other specific medications, increased
implant failure rate. Osteoporosis does not necessarily rule
out the use of endosseous implants. Diabetes mellitus causes wound healing alterations, which may affect osseointegration, but if the condition is controlled implants can be
placed. Conditions such as tobacco smoking, alcoholism,
bruxism, have been identified as relative contraindications.
It is important for the clinicians to evaluate properly every
case and take any percussion in order to enhance dental
implants success. So it is of a great importance to identify
the patient related risk factors influencing implant therapy
success and explained them to the patient. Patient recruitment appears to be of importance for increasing implant
success rates. There is a need of improving knowledge
concerning the patient associated general risk factors in
order to improve the prognosis.
Key words: dental implants, oral implants, osseointegration,
contraindications, medical history, patient selection criteria.
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ABSTRACT
Gingival overgrowth caused by nifedipine

K. Katoumas, N. Soldatos
Gingival overgrowth resulting from the administration of a

calcium channel blocker, nifedipine (used for the management of angina pectoris or hypertension) has been reported repeatedly in both medical and dental literature. Gingival overgrowth is associated with the administration of more than 20 drugs to susceptible patients. The medical records known to cause gingival overgrowth other than nifedipine include an anticonvulsant agent (phenytoin, sodium), various calcium channel blockers (diltiazem, verapamil, oxodipine and nitredipine) and an immunosuppressant drug (cyclosporine).
The mechanisms of NIGH (nifedipine-induced gingival hyperplasia) and other chemically-related gingival overgrowth
cases are still not clear. However, it is believed that they all
189
22-07-08 17:26
190
B A
share the capacity to alter calcium metabolism at the cellular

level. The influx of calcium across the cell membrane is
thought to decrease, due to reduced membrane permeability. With decreased influx of calcium the secretory function of the affected fibroblastic cells and collagenase
production is also reduced or inhibited; thus there is increased fibroblastic proliferation and collagen synthesis. Other
investigators believe that immunologic response is involved
in the development of gingival hyperplasia.
The management of gingival hyperplasia may be nonsurgical or surgical. It seems to be directed at controlling
the gingival inflammation through a good oral hygiene
regimen. There is evidence that discontinuation of nifedipine therapy reduces gingival overgrowth, but the discontinuation of nifedipine therapy is not always possible and
the overgrowth recurs when the drug is readministrated. In
several cases of gingival overgrowth, surgical excision is
the most preferable method of treatment.
The purpose of this study is to present all the factors about
gingival overgrowth caused by nifedipine including mechanisms, histological characteristics, clinical view and all
the available treatment protocols.
Key words: Gingival overgrowth, nifedipine, calcium channel
blocker, treatment
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:
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, 2.
SUMMARY
Craniosynostosis: The correlation

between phenotype and genotype
K. Mitsimponas, K. Antoniades
Craniosynostosis, the premature fusion of the cranial sutures, is a deviation from normal cranial growth and
development that occurs in approximately 1:2000 live
births. It may affect the coronal, saggital, frontal and
lamdoid sutures alone or in combination. It may be nonsyndromic, or take place as part of a syndrome (about 150
such syndromew have been described)
Untreated craniosynostosis can cause a characteristic
dysmorphic cranial shape, midface hypoplacia, deafness,
blindness, seizures and mental retardation.
This paper examines the interaction between the four
tissues that are involved in the development of the cranium
and the fussion of the cranial sutures, namely the dura
mater underlying the suture, the osteogenetic fronts of the
calvarian bone plates, the intervening cranial suture
mesenchyme and the overlying pericranium, and shows
the critical role of the dura mater in the process of the
fussion f the sutures. Dura mater secretes several growth
factors (FGF-2, TGF-, IGF-1 and -2), thus controlling the
fate of the sutures.
After showing the importance of the above mentioned dura
mater-derived growth factors, the paper lists a number of
genetic mutations that affect the synthesis of these growth
factors and their receptors. It is very well documented that
these mutations are involved in the pathogenesis of
craniosynostosis.
Finally, a link between the early fussion of a specific cranial
suture, the mutation that is responcible for this early
fussion and the phenotyic anomalies resulting from the
early fussion is attempted. It is now possible in several
cases of craniosynostosis to attribute a certain phenotype
to a specific mutation. This is very important for the early
detection of craniosynostosis during pregnancy, with the
use of molecular biology techniques. This early detection
is not yet possible with modern imaging techniques.
Key words: craniosynostosis, craniosynostotic syndromes, genetics, sutures, meninx, growth factors, mutations, genotype, phenotype
BIBIOPAIA
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ABSTRACT
Sex steroid hormones and periodontium

A. Mavrogiannea, S. Vassilopoulos, T. Vrahopoulos
Bacterial plaque has been established as the main etiologic

factor for the initation of periodontal disease. There is a large
amount of systemic factors, which can affect the prevalence, the progression and the severity of periodontal
disease. Hormones are among those factors and have been
suggested to play an important role in the pathogenesis of
periodontal disease. The clinical changes in the hormonal
levels can affect the physiology of the periodontal tissues,
the rate of bone resorption and bone formation, as well
209
22-07-08 17:29
210
B A
as the responses associated with wound healing.

The levels of sex steroid hormones, mainly of estrogens,
progesterone and androgens, have been associated with
changes in the hosts immune response. Consequently,
any variations in the hormonal levels of sex steroid
hormones during different periods of life, as well as factors
that may affect hormonal activity, may possibly impose
changes on the periodontal tissues.
Key words: periodontal disease, hormones, sex steroid hormones, estrogens, progesterone, puberty, pregnancy, menopause,
oral contraceptives
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SUMMARY
The use of chlorhexidine in the treatment

of periodontal diseases
G. Stylianopoulos, A. Poulios, V. Panis
The microbes of dental plaque are the primary cause of

periodontal diseases. Antimicrobial factors can be used
adjunctively to the periodontal treatment aiming at the
chemical control of dental plaque and the reduction of
pathogenic microorganisms. Chlorhexidine is considered
to be the most widely studied and highly effective antimicrobial factor with the widest use worldwide for more than
three decades. Its chemical structure, gives chlorhexidine
a unique advantage to create a bond with the dental surface, mucosa, sialic biofilm and saliva. This way it maintains
its antimicrobial action in the mouth for several hours. In
low concentrations chlorhexidine has bacteriostatic action, while in high density the action becomes bacteriocidal. The limitation against the installed microbial plaque is
the reason for its adjunctive usage to the periodontal treatment and the mechanical oral hygiene. The present study
analyses extensively the various forms of chlorhexidine,
such as mouthrinse, toothpaste, gel, varnish, spray, subgingival irrigation and subgingival controlled-release chip
and explains the mode of use and the advantages of each
chorhexidine form. The indications of the adjunctive use of
chlorhexidine to the periodontal treatment and the sideeffects of the long-term chlorhexidine use are also reported in the study.
Key words: chlorhexidine, forms, indications, side effects
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EXOFILLO stomatologika*

BATIKA KYTTAPA ONTIN...

T.: 210 4616766, : A. 114 - , T.K.: 185 44,

ISSN 1011 - 4181

EITHMONIKO ENTYO ME ENIKH ANANPIH

Tooth Stem Cells, E

A. 114 - , T.K.: 185 44, T.: 210-4616766, www.biogenetics.gr

Tooth Stem Cells

APIIO - IOYNIO 2008

ENTYO KEITO AP. A. 520/92

hellenic stomatological review

ISSN 1011 - 4181

TOMO 52, TEYXO 2

TOMO 52, TEYXO 2

Hellenic Dental Association

VOLUME 52, ISSUE 2

Computed tomographic evaluation of the maxillary sinus

Conservative management of large odontogenic keratocyst.

Preoperative care and postoperative treatment of patients

The anticaries vaccination is still an up-to-date

Systemic risk factors associated to implant failure

Hellenic Dental Association

Craniosynostosis: The correlation between phenotype and genotype

Sex steroid hormones and periodontium

VOLUME 52, ISSUE 2

The use of chlorhexidine in the treatment of periodontal diseases

Scanning Electron Microscopy

OHIE IA TOY YPAEI

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52: 127-133, 2008

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Computed tomographic evaluation

The purpose of this study was to evaluate the anatomical

127-133 SEL. TRIKERIOTHS*

The investigated angle was found 20.916.10, 45.316.70,

6. Westermark A, Zachow S, Eppley BL: Three-dimensional

52: 127-133, 2008

(E. 7), (E. 8, 9).

52: 135-142, 2008

Conservative management of large odontogenic

liferation in odontogenic keratocysts. J Oral Pathol Med

52: 135-142, 2008

143-154 SEL. KATSIKERHS*

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Endoscopicaly assisted treatment

The orbital floor fractures are quite

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