Maximilian Moergel

Publications (11)25.41 Total impact

• Article: Oral squamous cell carcinoma in the vicinity of dental implants.

  Maximilian Moergel, Julia Karbach, Martin Kunkel, Wilfried Wagner
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  ABSTRACT: OBJECTIVES: The study at hand presents a cohort of patients treated for carcinomas in the vicinity of dental implants for identification of potential risk factors. MATERIALS AND METHODS: The retrospective analysis covers patients treated for peri-implant carcinoma at our department between 1995 and 2011. An additional literature search focused likewise on peri-implant carcinomas. Obtained articles were screened for relevant risk factors and discussed in relation to our patient cohort. RESULTS: Fifteen patients were treated for peri-implant carcinoma. Six reported ongoing alcohol/tobacco consumption. Nine had a previously reported carcinoma of whom six had received radiotherapy after surgery. Time from implant placement until carcinoma diagnosis was 53.4 months on average. The literature search revealed 25 patients with peri-implant carcinoma and one with a sarcoma. Eight patients reported alcohol/tobacco consumption. Most patients exhibited risk factors for possible malignant transformation: previous carcinoma (n = 12), lichen (n = 4), irradiation (n = 3), and leukoplakia (n = 3). The average time until diagnosis was 51.6 months. CONCLUSIONS: Smoking, alcohol consumption, and the history of previous carcinoma characterize patients at risk for a peri-implant carcinoma. A balanced gender ratio might point at a higher risk for woman and additional risk factors promoting carcinogenesis apart from tobacco and alcohol consumption, a novel finding that has to be proven by larger patient counts. CLINICAL RELEVANCE: The incidence of carcinomas next to dental implants is low but may attain clinical relevance with raising implant figures worldwide. Patients at risk potentially profit from individualized recall intervals and careful evaluation.
  Clinical Oral Investigations 03/2013; · 2.36 Impact Factor
• Article: Spin electron paramagnetic resonance of albumin for diagnosis of oral squamous cell carcinoma (OSCC).

  Maximilian Moergel, Peer W Kämmerer, Kerstin Schnurr, Marcus O Klein, Bilal Al-Nawas
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  ABSTRACT: OBJECTIVES: Albumin has a known capability to modulate free serum concentrations of proteins produced by tumour cells. The technique of spin probe labelling of albumin followed by electron paramagnetic resonance (EPR) spectroscopy may allow identification of these structural and functional changes, which regularly occur as consequence of binding tumour metabolites as ligands. The aim of the present study was a proof of principle evaluation of EPR-analysis of peripheral blood samples as possible predictor for oral squamous cell carcinoma (OSCC). MATERIAL AND METHODS: The present study is designed as gender-matched cohort. EPR was tested after retrieval of peripheral blood samples. The study group is represented by 32 patients with OSCC, and the control group consisted of 30 healthy patients. RESULTS: Overall analysis exhibited a diagnostic sensitivity of 72% (23/32 OSCC group) and a specificity of 80% (24/30 control group). Subgroup analysis revealed ten patients with elevated leukocytes (>10,000/μl; n = 9 [OSCC group] and n = 1 [control group]). After exclusion of patients with elevated white blood cell count, sensitivity considerably increased to 87% and specificity to 83%. CONCLUSION: EPR analysis of peripheral blood samples might be appropriate to support the clinician in primary and follow-up diagnosis of potential tumours such as OSCC. Unfortunately, subgroup analysis characterises the method vulnerable to inflammation. CLINICAL RELEVANCE: Nevertheless, our preliminary results are intriguing, as diagnosis of OSCC appears possible by simple peripheral blood examination. Thus, further appraisal of this novel method with inclusion of different tumour entities, systemic conditions and inflammation in a larger study population appears highly valuable.
  Clinical Oral Investigations 12/2011; · 2.36 Impact Factor
• Article: Clinical, therapeutic and prognostic features of osteosarcoma of the jaws - experience of 36 cases.

  Peer Wolfgang Kämmerer, Niloufar Shabazfar, Nadja Vorkhshori Makoie, Maximilian Moergel, Bilal Al-Nawas
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  ABSTRACT: Osteosarcoma of the jaws (OSJ) differs from osteosarcoma of other skeletal regions due to later development, a high mortality associated with the local disease, fewer incidences of metastases and its extreme rarity. In regard to clinical and pathological parameters as well as therapeutic approaches and prognosis, OSJ has not been specifically examined to date. In order to achieve a better understanding of this special malignancy, an evaluation of incidence, treatment and prognosis of patients with OSJ in our department over the past 38 years was conducted. A retrospective analysis of patients with OSJ between 1972 and 2010 was performed. Information regarding patient characteristics, site of the lesion, main presenting symptoms, latency of initial diagnosis, treatment, histology, local recurrence, development of metastatic disease, duration of follow up and survival was obtained. The data were compared to the literature. Thirty-six patients (2-81 years, mean: 33.9, standard deviation: 21.3) were diagnosed and treated for OSJ (maxillar:mandibular nearly 1:2). Initial symptoms were local swelling (81%) and pain (47%). The latency period between fist symptoms and clinical presentation was 3.7 months (1-24). A radical resection alone was conducted in 15 patients. In nine patients, resection and radiotherapy was used. Resection with chemotherapy was the treatment of choice in seven patients. Five patients received a triple combination of resection, chemo- and radiation therapy. The osteoblastic subtype of osteosarcoma was most frequent (42%). In 15 cases (42%) local recurrences, in two cases (5%) metastasis were seen. Of these patients, 13 died within the observation period. One other patient (3%) died as a result of progressive pulmonary metastasis. A mean total survival rate of 61% could be seen whereas the highest survival rate (80%) was found in patients who were treated with neoadjuvant chemotherapy, radical resection and adjuvant radiation. Positive prognostic factors were a younger age and tumour-free resection margins. OSJ is a highly lethal tumour entity. According to the data at hand, therapy should possibly include chemotherapy, radical resection and irradiation. Nevertheless, due to the rarity of OSJ, information remains limited and the treatment of choice should be within the focus of clinical multi-centre studies.
  Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 11/2011; 40(6):541-8. · 1.25 Impact Factor
• Article: Effectiveness of postoperative radiotherapy in patients with small oral and oropharyngeal squamous cell carcinoma and concomitant ipsilateral singular cervical lymph node metastasis (pN1) : A meta-analysis.

  Maximilian Moergel, Philipp Meurer, Katharina Ingel, Thomas G Wendt, Bilal Al-Nawas
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  ABSTRACT: The positive effect of radiation therapy for patients with advanced oropharyngeal squamous cell carcinoma (OSCC) has been substantially verified. The present work investigated whether a meta-analysis of current data is able to evaluate the effectiveness of postoperative radiotherapy (PORT) in patients with small OSCC (pT1, pT2) and a single ipsilateral lymph node metastasis (pN1). The meta-analysis comprises randomized and non-randomized studies. High-risk tumors were excluded and defined by size ≥ pT3/pT4, lymph node involvement ≥ pN2, or presence of additional histological risk factors, e.g., involved positive resection margins, extra nodal spread of the disease, or lymphangiosis carcinomatosa. The primary outcome analyzed mortality between the different treatment arms. Only one prospective randomized clinical trial and six retrospective observational studies were adequate for evaluation. Descriptive analysis revealed a marginally higher mortality in the irradiation group (44% vs. 34%). In contrast, a forest plot presentation of two of seven studies with and without events in the control and therapy arms presented an advantage for the irradiation group with the limitation of large heterogeneity and a lack of statistical significance. Present data are poor and exhibit limited internal and external validity; thus, direct comparison was not possible with the eligible studies. Therefore, a meta-analysis of present data may not serve as the basis for a general treatment recommendation but underlines the need of prospective, randomized, controlled clinical trials.
  Strahlentherapie und Onkologie 06/2011; 187(6):337-43. · 3.56 Impact Factor
• Article: Overexpression of p63 is associated with radiation resistance and prognosis in oral squamous cell carcinoma.

  Maximilian Moergel, Eva Abt, Marcus Stockinger, Martin Kunkel
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  ABSTRACT: The tumor suppressor homologue p63 is expressed in basal and parabasal layers of intraoral mucosa. Full length transcripts with transactivational domain (TA forms) present with homology to p53 and implicate functions governing cell proliferation, differentiation and apoptosis control. To date studies show an increase of p63 expression in oral dysplasia and additionally high expression levels correlated with poor prognosis for patients with OSCC, whereas a possible link to radiation resistance of tumors has not been investigated yet. In the present study we tested the hypothesis for p63 being a marker of radioresistance and overall survival in OSCC. p63 Expression was labeled by immunohistochemistry in pre-treatment biopsies collected from 33 patients with OSCC. Quantification of the labeling index (Li) based on the relation of p63 positive cells to overall tumor cell count. Histological examination of the resection specimen allowed categorization of the radiation response. Statistical analyses of the association between Li and radiation response were performed. Survival analysis utilized Kaplan-Meier estimates and additionally a Cox regression model was built for p63 (Li), T stage, N-stage and chemotherapy and presented as hazard ratios. All tumors had enhanced p63 expression. The median Li was 63.1% (range 36-87%). Tumors with a p63 positive cell count>63.1% showed increased resistance to radiation (p=0.027). Overall survival was higher (p=0.001) for patients with low Li (<median value) than those with high Li (>median value) and multivariate Cox regression analysis confirmed the significance of p63 as a prognostic marker of survival. The results of this analysis advocate p63 expression in pre-treatment tumor tissue to be a marker of radiation resistance in OSCC, with high expression levels being associated with poor radiation response and shorter survival. The promising results of this biomarker should now be confirmed by a study with larger patient counts.
  Oral Oncology 09/2010; 46(9):667-71. · 2.86 Impact Factor
• Article: Erratum to: Immediate versus conventional loading of palatal implants in humans: a first report of a multicenter RCT.

  Britta A Jung, Winfried Harzer, Heinrich Wehrbein, Tomasz Gedrange, Werner Hopfenmüller, Gabriele Lüdicke, Maximilian Moergel, Peter Diedrich, Martin Kunkel
  Clinical Oral Investigations 09/2010; · 2.36 Impact Factor
• Article: Spectrum of indications for palatal implants in treatment concepts involving immediate and conventional loading.

  Britta A Jung, Winfried Harzer, Tomasz Gedrange, Martin Kunkel, Maximilian Moergel, Peter Diedrich, Gabriele Lüdicke, Heiner Wehrbein
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  ABSTRACT: To analyze the spectrum of indications for second-generation palatal implants in relation to two different loading concepts in a prospective, multicenter, randomized controlled trial (RCT). Forty-one patients were recruited to the study from 2006 to 2009. All implants (Orthosystem, Straumann, Basel, Switzerland; dimensions: 4.1 mm x 4.2 mm) were inserted in the median or paramedian region of the anterior palate, and each patient was randomized to one of two loading groups (immediate loading within the first week after insertion versus conventional loading after a 12-week healing phase). In this interim evaluation, we report preliminary results obtained six months after functional loading. All palatal implants were primarily stable at the time of insertion. One implant loss (12 weeks after surgical insertion) was documented in the cohort subjected to conventional loading, and one patient dropped out of the immediate-loading group. At the time of this investigation, 39 palatal implants are experiencing functional loads. Using both loading concepts, we had various orthodontic objectives, such as intrusion of anterior and/or posterior teeth, and the mesialization and distalization of posterior teeth. Both loading groups presented nearly identical indications, and the distribution of direct vs. indirect anchorage forms was also very similar during the active treatment. Comparison of the two treatment concepts revealed no clinical differences in implant stability. Patients undergoing immediate-loading therapy were subject to no limitations regarding indications at 6 months after functional loading compared with the patients who experienced conventional loading.
  Fortschritte der Kieferorthopädie 07/2010; 71(4):273-80. · 0.89 Impact Factor
• Article: Immediate versus conventional loading of palatal implants in humans: a first report of a multicenter RCT.

  Britta A Jung, Winfried Harzer, Heinrich Wehrbein, Tomasz Gedrange, Werner Hopfenmüller, Gabriele Lüdicke, Maximilian Moergel, Peter Diedrich, Martin Kunkel
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  ABSTRACT: This study aims to analyze the clinical performance of two loading concepts on second-generation palatal implants (Orthosystem, Straumann, Basel, Switzerland) in a prospective multicenter randomized controlled clinical trial. At the time of this interim analysis, 41 patients have been randomized on a 1:1 basis to one of two treatment groups. Group 1 underwent conventional loading of palatal implants after a healing period of 12 weeks (gold standard) while group 2 underwent immediate implant loading within 1 week after implant insertion. We report initial results at 6 months after functional loading. The primary outcome parameter was implant success (no implant mobility, no implant loss). The implants in both groups were initially stable at the time of insertion, and all were eligible for randomization. Twenty-two patients (group 1) were subjected to conventional implant loading after 12 weeks while 19 patients (group 2) received immediate functional loading within the first week after insertion. Direct (e.g. distal jet appliances) as well as indirect forms of anchorage (conventional or modified transpalatal arch) were used. The magnitude of orthodontic forces ranged between 1 and 4 N for the immediate loading group and between 1 and 5 N for the conventional loading group. One implant in group 1 was lost during the healing phase. One dropout was registered in group 2. Thirty-nine implants were functionally loaded for over 6 months now. These preliminary data provide first evidence of the fact that immediate loading of palatal implants yields equivalent success rates as conventional loading to 4 N after 6 months.
  Clinical Oral Investigations 04/2010; 15(4):495-502. · 2.36 Impact Factor
• Article: Modulation of platelet activation and initial cytokine release by alloplastic bone substitute materials.

  M O Klein, Peer W Kämmerer, Thomas Scholz, Maximilian Moergel, Carl Maximilian Kirchmaier, Bilal Al-Nawas
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  ABSTRACT: Platelet-derived cytokines play a crucial role in tissue regeneration. In regenerative dental medicine, bone substitute materials (BSM) are widely used. However, initial interactions of BSM and platelets are still unknown. The aim of this study was to evaluate the potential of platelet activation and subsequent initial cytokine release by different commercial alloplastic BSM. Eight commercial BSM of different origins and chemical compositions (tricalcium phosphate, hydroxyapatite, bioactive glass: SiO(2) and mixtures) were incubated with a platelet concentrate (platelet-rich plasma, PRP) of three healthy volunteers at room temperature for 15 min. Platelet count, aggregation, degranulation (activated surface receptor CD62p) and cytokine release (Platelet-derived growth factor, Vascular endothelial growth factor) into the supernatant were quantified. Highly thrombogenic collagen served as a reference. The investigated PRP samples revealed different activation patterns when incubated with different BSM. In general, SiO(2)-containing BSM resulted in high platelet activation and cytokine release. In detail, pure bioactive glass promoted platelet activation most significantly, followed by hybrid BSM containing lower ratios of SiO(2). Additionally, we found indications of cytokine retention by BSM of large specific surfaces. Platelet activation as well as consecutive storage and slow release of platelet-derived cytokines are desirable attributes of modern BSM. Within the limits of the study, SiO(2)-containing BSM were identified as promising biomaterials. Further investigations on cytokine adsorption and cytokine release kinetics by the respective BSM have to be conducted.
  Clinical Oral Implants Research 03/2010; 21(3):336-45. · 2.51 Impact Factor
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  Available from: Bilal Al-Nawas

  Article: Effectiveness of adjuvant radiotherapy in patients with oropharyngeal and floor of mouth squamous cell carcinoma and concomitant histological verification of singular ipsilateral cervical lymph node metastasis (pN1-state)--a prospective multicenter randomized controlled clinical trial using a comprehensive cohort design.

  Maximilian Moergel, Antje Jahn-Eimermacher, Frank Krummenauer, Torsten E Reichert, Wilfried Wagner, Thomas G Wendt, Jochen A Werner, Bilal Al-Nawas
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  ABSTRACT: Modern radiotherapy plays an important role in therapy of advanced head and neck carcinomas. However, no clinical studies have been published addressing the effectiveness of postoperative radiotherapy in patients with small tumor (pT1, pT2) and concomitant ipsilateral metastasis of a single lymph node (pN1), which would provide a basis for a general treatment recommendation. The present study is a non-blinded, prospective, multi-center randomized controlled trial (RCT). As the primary clinical endpoint, overall-survival in patients receiving postoperative radiation therapy vs. patients without adjuvant therapy following curative intended surgery is compared. The aim of the study is to enroll 560 adult males and females for 1:1 randomization to one of the two treatment arms (irradiation/no irradiation). Since patients with small tumor (T1/T2) but singular lymph node metastasis are rare and the amount of patients consenting to randomization is not predictable in advance, all patients rejecting randomization will be treated as preferred and enrolled in a prospective observational study (comprehensive cohort design) after giving informed consent. This observational part of the trial will be performed with maximum consistency to the treatment and observation protocol of the RCT. Because the impact of patient preference for a certain treatment option is not calculable, parallel design of RCT and observational study may provide a maximum of evidence and efficacy for evaluation of treatment outcome. Secondary clinical endpoints are as follows: incidence and time to tumor relapse (locoregional relapse, lymph node involvement and distant metastatic spread), Quality of life as reported by EORTC (QLQ-C30 with H&N 35 module), and time from operation to orofacial rehabilitation. All tumors represent a homogeneous clinical state and therefore additional investigation of protein expression levels within resection specimen may serve for establishment of surrogate parameters of patient outcome. The inherent challenges of a rare clinical condition (pN1) and two substantially different therapy arms would limit the practicality of a classical randomized study. The concept of a Comprehensive Cohort Design combines the preference of a randomized study, with the option of careful data interpretation within an observational study. ClinicalTrials.gov: NCT00964977.
  Trials 12/2009; 10:118. · 2.02 Impact Factor
• Article: Overexpression of GLUT-1 is associated with resistance to radiotherapy and adverse prognosis in squamous cell carcinoma of the oral cavity.

  Martin Kunkel, Maximilian Moergel, Marcus Stockinger, Jong-Hyeon Jeong, Gerhardt Fritz, Hans-Anton Lehr, Theresa L Whiteside
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  ABSTRACT: This study tested the hypothesis that GLUT-1 is a marker of radioresistance in oral squamous cell carcinomas (OSCC). A GLUT-1 labeling index (LI) was determined by immunohistochemistry in 40 pretreatment OSCC biopsies. Radiation responses were categorized by histopathology of the resection specimens. Associations between the LI and radiation response, Kaplan-Meier survival estimates and Cox regression analysis for the variables GLUT-1, T-stage, N-stage and chemotherapy were examined. The median LI was 64.2% (range 14-100%). Tumors with >65% of GLUT-1+cells were more resistant to radiation (p=0.023). Overall survival was higher (p=0.044) for subjects with low LI (<median value) than those with high LI (>median value). The Cox regression analysis confirmed the prognostic significance of GLUT-1. Our results indicate that pre-treatment GLUT-1 expression in the tumor is a marker of radioresistance in OSCC, with high expression being associated with poor radiation response and shorter survival.
  Oral Oncology 10/2007; 43(8):796-803. · 2.86 Impact Factor