Jörg Wiltfang

Background: Squamous cell carcinoma (SCC) is a common malignancy in Western countries and can lead to extensive tissue destruction, metastasis, and death. The study aimed to highlight the epidemiology, diagnostic patterns, histological variations, and prognostic significance of SCC of the facial skin region based on a single-center analysis. Methods: This retrospective study analyzed records of patients admitted to the Department of Maxillofacial Surgery, UKSH-Kiel, for treatment of SCC of the head and face from January 2019 to February 2021. Data were collected via the ORBIS/management-diagnostic codes system (ORBIS-AG, Saarbrücken, Germany). It included information on TNM classification, tumor depth, growth type, tumor localization, and surgical techniques, which were extracted from histopathology and surgical reports. Results: A total of 560 patients were admitted for treatment of malignancies of the facial skin region. Sixty patients (10.7%) had SCCs, and their mean age was 80.64 years. A total of 68.3% of the patients were male. The most common histopathological growth type was verrucous: 36.7% (n = 22). No significant correlation was found between growth type and recurrence (p = 0.266) or metastasis (p = 0.091). However, the correlation between growth type and CT morphology was significant (p = 0.032), with radiologically suspicious lymph nodes most frequently associated with a verrucous growth type (36.4%, n = 8/22). The most common locations for SCC were the temporal region (25%, n = 15) and the cheek (15%, n = 9). The majority of SCC cases (32%) were classified as T1, with T4 being the least common (5%). The mean tumor depth for SCC was 4.67 mm (SD: 3.05). Tumor depth showed a significant correlation with TNM classification (p = 0.0001). Conclusions: This study emphasizes the significance of early detection, accurate advanced T-classifications, tumor depth, and high-risk growth types in predicting recurrence and metastasis in SCC. In this cohort, CT findings were associated with lymph node status and may provide useful information for the preoperative assessment of selected patients.

Purpose: Despite the growing clinical application of diode lasers in oral surgery, laser training remains underrepresented in dental curricula. This study evaluated the feasibility of structured preclinical diode-laser training and characterized the early learning curve of undergraduate dental students without prior laser experience, using target-based accuracy of laser incisions compared with a familiar scalpel reference condition. Methods: 22 dental students performed standardized linear incisions on porcine skin at three time points. Each session comprised five incisions (target: 10 mm length, 2 mm depth, minimal width): four diode-laser settings (1 W/pulsed, 3 W/pulsed, 1 W/continuous, 3 W/continuous; 445 nm wavelength; 320 μm fiber) and one scalpel incision. Incision morphology was assessed by micro-computed tomography. Operative time was recorded per incision, and subjective workload was evaluated using the NASA-TLX questionnaire. Results: Total operative time decreased significantly across sessions (p = 0.006). Per-method reductions were significant only for the two pulsed settings. Four of six NASA-TLX subscales improved (all p ≤ 0.013). Length accuracy improved significantly over time (main effect of time p < 0.001) with no method-time interaction and comparable, significant within-method gains for all methods. Depth accuracy showed only a small overall time effect and a significant within-method gain for a single laser setting (1 W pulsed). Incision width did not change significantly over sessions for any method. Laser incisions were consistently wider than scalpel incisions. Conclusion: Structured preclinical laser training on porcine skin is feasible and is associated with early gains in operative efficiency, perceived workload and length accuracy. These gains largely reflect general task familiarisation rather than a laser-specific learning advantage. The findings support integrating structured laser training using animal-tissue models into dental education but cannot establish clinical competence, equivalence to scalpel surgery, or transfer to intraoral patient care.

We are looking back on over 10 years of successful work and numerous milestones in the interdisciplinary center of minimally invasive surgery, robotic surgery in particular. The success is largely owing to the spirit of sharing and collaborating — rather than competing — across the surgical disciplines. The collaboration became particularly fruitful by including the Kiel Center of Clinical Anatomy of Kiel University where many surgical approaches and techniques have been developed or refined on body donors. Apart from the traditional and renowned “Kiel school” for training in gynecological endoscopy built on the heritage of Kurt Semm; a training center (Kurt-Semm-Academy) for robot-assisted surgery was founded in 2020. The Kurt-Semm-Center has always followed the credo of establishing the best surgical technology for the best possible patient treatment. The ambitious claim to offer not only state-of-the-art surgery, but also to advance it further through studies and research, both experimental and clinical. This is evidenced by the enormous output of innovative research and publication activity, some of which is presented in this article. The key to success has been co-working across the disciplines, with continuing tenacity and dedication to state-of-the-art minimally invasive surgery. We believe that many hospitals could profit from an interdisciplinary spirit, having realized that individual department-specific interests are eventually better met when people learn from each other and work as a team. This article is dedicated to the spiritus rector of the Kurt-Semm-Zentrum, Prof. Dr. med. Klaus-Peter Jünemann.

Periodontitis is associated with systemic chronic inflammatory diseases. There is limited evidence on the influence of anti-cytokine therapies on the periodontal condition and microbiome in the tooth pocket of such patients, so the aim of this study was to elucidate this issue. In this observational trial, the periodontal status and the gingival crevicular fluid of 13 patients with different chronic inflammatory diseases were obtained before the initiation of anti-cytokine treatment and 14 weeks after. Gingival crevicular fluid was collected for 16S rRNA gene sequencing from a clinically healthy tooth and the deepest measured pocket. The Shannon Diversity Index significantly increased in the deepest pockets of patients (p = 0.039). The data showed alterations in the diversity of the subgingival microbiome over the course of the study, implying a shift towards a healthier condition after starting anti-cytokine therapy. Additional investigations are needed to analyze whether the administration of selective biologicals can improve periodontal conditions in patients with or without chronic inflammatory diseases.

Background: Basal cell carcinoma is the most common nonmelanoma skin cancer, followed by cutaneous squamous cell carcinoma. The objective of the current study was to retrospectively evaluate the epidemiology, characteristic variations, histological aspects, and prognosis of basal cell carcinoma of the facial region based on a single-centre experience. Methods: Data from 125 patients admitted to the Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein (UKSH), Kiel, for surgical treatment of basal cell carcinomas of the face between January 2015 and April 2021 were evaluated. Results: The mean patient age was 79.58 years, 60.5% were male and 39.5% were female. Six patients (4.8%) had tumour recurrence with no regional metastasis. Seventy-nine patients (63%) were classified as T1. The nose and the temporal region were the most common areas. The mean tumour thickness was 3.20 mm. Conclusions: Micronodular, sclerosing/morphoeic, nodular, and superficial growth patterns of basal cell carcinoma are highly correlated to recurrence, so an excision safety margin is recommended. There is a strong correlation between tumour thickness and recurrence among basal cell carcinoma cases. When completely excised, the recurrence rate for basal cell carcinoma is relatively low.

Background: Periodontitis is associated with systemic chronic inflammatory diseases. There is limited evidence on the influence of anti-cytokine therapies on the periodontal condition and microbiome in the tooth pocket of such patients, so the aim of this study was to elucidate this issue. Methods: In this observational trial, the periodontal status and the gingival crevicular fluid of 13 patients with different chronic inflammatory diseases were obtained before initiation of anti-cytokine treatment and 14 weeks after. Gingival crevicular fluid was collected for 16S rRNA gene sequencing from a clinically healthy tooth and the deepest measured pocket. Results: In participants with advanced attachment loss at baseline, the clinical attachment level significantly decreased from 2.9 (2.3-3.4) to 2.4 (1.3-3.0) mm (p = 0.04), and the bleeding- on-probing index dropped from 19.4 (10.0-21.0) to 7.3 (6.9-9.9) mm (p = 0.02) without any further periodontal treatment. Shannon’s diversity index significantly increased in the deepest pockets of patients (p = 0.039). Conclusion: The data showed alterations in diversity of the subgingival microbiome and improvement of periodontal parameters over the course of the study, implying a shift towards a healthier condition after starting anti-cytokine therapy. Additional investigations are needed to analyze whether the administration of selective biologicals can improve periodontal conditions in patients with or without chronic inflammatory diseases.

Background cold atmospheric plasma (CAP) is known to be a surface-friendly yet antimicrobial and activating process for surfaces such as titanium. The aim of the present study was to describe the decontaminating effects of CAP on contaminated collagen membranes and their influence on the properties of this biomaterial in vitro. Material and Methods: A total of n = 18 Bio-Gide^® (Geistlich Biomaterials, Baden-Baden, Germany) membranes were examined. The intervention group was divided as follows: n = 6 membranes were treated for one minute, and n = 6 membranes were treated for five minutes with CAP using kINPen^® MED (neoplas tools GmbH, Greifswald, Germany) with an output of 5 W, respectively. A non-CAP-treated group (n = 6) served as the control. The topographic alterations were evaluated via X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM). Afterward, the samples were contaminated with E. faecalis for 6 days, and colony-forming unit (CFU) counts and additional SEM analyses were performed. The CFUs increased with CAP treatment time in our analyses, but SEM showed that the surface of the membranes was essentially free from bacteria. However, the deeper layers showed remaining microbial conglomerates. Furthermore, we showed, via XPS analysis, that increasing the CAP time significantly enhances the carbon (carbonyl group) concentration, which also correlates negatively with the decontaminating effects of CAP. Conclusions: Reactive carbonyl groups offer a potential mechanism for inhibiting the growth of E. faecalis on collagen membranes after cold atmospheric plasma treatment.

Background and objectives: The investigation of the pathophysiology behind medication-related osteonecrosis (MRONJ) of the jaw mostly focuses on alterations in osteoclast and osteoblast cell activity, but changes in the organic and inorganic bone matrix have rarely been studied. The aim of this study was to investigate whether collagen, the main organic component of extracellular bone matrix, is destructed in osteonecrosis of the jaw secondary to antiresorptive medication. Material and methods: Bone samples of patients with MRONJ (n = 15, control group n = 3) were demineralized, and collagen fragments were separated from intact collagen pellets by ultrafiltration. The quantification of mature collagen cross-links hydroxylysylpyridinoline (HP) and lysylpyridinoline (LP) in pellets and ultrafiltrates was performed by high-performance liquid chromatography (HPLC). The detection of hydroxyproline (Hyp) was carried out using a spectrophotometric assay. In addition, collagen chains were analyzed by sodium dodecylsulfate-polyacrylamide gel (SDS-PAGE). Results: The results revealed significantly higher concentrations of HP, LP and Hyp in pellet samples. In addition, there were no significant differences between samples from MRONJ patients and those of the control group. These results were paralleled by SDS- PAGE. Conclusion: These findings suggest that MRONJ does not involve the destruction of type I and V collagen molecules, in contrast to previously reported destruction by osteoradionecrosis.

The aim of the current experimental study was to comparatively assess the surface alterations in titanium and titanium-zirconium alloy implants in terms of thread pitch topography after irradiation with an Er:YAG laser, which is recommended in the literature for its sterilizing effect in the treatment of contaminated implant surfaces. Roxolid^® and SLA^® (Sand-blasted, Large-grit, Acid-etched) implants from Straumann^® company with the same macro topography were investigated. The surface treatment was carried out using a wavelength of 2940 nm, 60 s irradiation time, a frequency of 10 Hz, and energies between 120 mJ and 250 mJ. The alterations were quantitatively analyzed by conducting roughness analysis via white light interferometry and qualitatively using SEM images. Roxolid^® could particularly maintain its surface topography at a level of 160 mJ. At an energy level of 250 mJ, the surface properties of the pitch could be significantly altered for the first time. Compared to the Standard Plus dental implants studied, no distinct removal of the material from the surface was detected. The alloy properties of Roxolid^® confirm the manufacturer’s statement in terms of stability and could offer advantages in peri-implantitis management if decontamination has been selected. However, as a part of a respective strategy, smoothening of a Roxolid^® implant surface requires a significantly higher energy level compared to SLA-Standard^® dental implants.