Ines Willershausen

Publications of Ines Willershausen

• Influence of three scan spray systems on human gingival fibroblasts.

  Authors: Ines Willershausen, Karl Martin Lehmann, Armin Ross, Shahram Ghanaati, Brita Willershausen

  Quintessence international (Berlin, Germany : 1985). 06/2012; 43(6):e67-72.

  Objective: CAD/CAM is based on optical or mechanical scanning of tooth surfaces. The aim of this in vitro study was to investigate the influence of three different scan sprays on the proliferation,Objective: CAD/CAM is based on optical or mechanical scanning of tooth surfaces. The aim of this in vitro study was to investigate the influence of three different scan sprays on the proliferation, viability, and adenylate kinase (ADK) release of human fibroblasts. Method and Materials: Three different scan sprays (ScanDry, ScanSpray Luer Classic, and CEREC Optispray) were tested in vitro to determine their effects on proliferation, viability, and ADK release of human periodontal fibroblasts. A defined amount of the test material was sprayed into 96 multiwell plates, dried, and incubated with fibroblasts. The LIVE/DEAD Viability Assay, a two-color fluorescence-based method, was used to determine the cytotoxic potential (the AlamarBlue Assay for the proliferation rate and the ToxiLight BioAssay for the release of ADK). Results: There were differences between the scan sprays concerning inhibition of the proliferation and viability of fibroblasts. All materials inhibited the fibroblast proliferation and viability compared with the control group (P < .001), and there were also significant differences among the scan spray groups. The scan sprays led to a greater release of ADK, but a significant difference could be found only between ScanSpray Luer Classic and CEREC Optispray (P < .009). Conclusion: The results of this study proved that the scan sprays do not induce a significantly higher ADK release than the control group. The inhibiting effect on the fibroblast proliferation can be attributed to a material-independent phenomenon. Further experiments are necessary to validate the present data. (Quintessence Int 2012;43:e67-e72).

• A prospective clinical trial on the influence of a triamcinolone/demeclocycline and a calcium hydroxide based temporary cement on pain perception.

  Authors: Brita Willershausen, Ines Willershausen, Vicky Ehlers, Adriano Azaripour, Benjamin Briseno

  Head & face medicine. 03/2012; 8(1):9.

  ABSTRACT: INTRODUCTION: The aim of this clinical trial was to compare the degree of short term post-operative irritation after application of a triamcinolone/demeclocycyline based or a calciumABSTRACT: INTRODUCTION: The aim of this clinical trial was to compare the degree of short term post-operative irritation after application of a triamcinolone/demeclocycyline based or a calcium hydroxide based provisional cement. METHODS: A total of 109 patients (55 female and 54 male; mean age: 51 +/- 14 years) with primary or secondary dentinal caries were randomly assigned to the two treatment groups of this biomedical clinical trial (phase III). Selection criteria were good systemic health and treated teeth, which were vital and showed no symptoms of pulpitis. Up to three teeth were prepared for indirect metallic restorations, and the provisional restorations were cemented with a triamcinolone/demeclocycyline (Ledermix) or a calcium hydroxide (Provicol) based material. The intensity of post-operative pain experienced was documented according to the VAS (4, 12, 20, 24, and 82 h) and compared to VAS baseline. RESULTS: A total of 159 teeth were treated (Ledermix: 83 teeth, Provicol: 76 teeth). The minor irritation of the teeth, experienced prior to treatment, was similar in both groups; however, 4 h after treatment this value was significantly higher in the Provicol group than in the Ledermix group (p < 0.005, t-test). After 12 h, the difference was no longer significant. The number of patients taking analgesics for post-treatment pain was higher in the Provicol group (n = 11/53) than in the Ledermix group (n = 3/56). CONCLUSIONS: The patients had no long term post-operative pain experience in both groups. However, within the first hours after cementation the sensation of pain was considerably higher in the Provicol group than in the Ledermix group.

• Bovine pericardium based non-cross linked collagen matrix for successful root coverage, a clinical study in human.

  Authors: Markus Schlee, Shahram Ghanaati, Ines Willershausen, Michael Stimmlmayr, Anton Sculean, Robert A Sader

  Head & face medicine. 03/2012; 8(1):6.

  ABSTRACT: The aim of this study was to clinically assess the capacity of a novel bovine pericardium based, non-cross linked collagen matrix in root coverage. 62 gingival recessions of Miller class IABSTRACT: The aim of this study was to clinically assess the capacity of a novel bovine pericardium based, non-cross linked collagen matrix in root coverage. 62 gingival recessions of Miller class I or II were treated. The matrix was adapted underneath a coronal repositioned split thickness flap. Clinical values were assessed at baseline and after six months. The mean recession in each patient was 2.2 mm at baseline. 6 Months after surgery 86.7% of the exposed root surfaces were covered. On average 0,3 mm of recession remained. The clinical attachment level changed from 3.5 ± 1.3 mm to 1,8 ( ± 0,7) mm during the observational time period. No statistically significant difference was found in the difference of probing depth. An increase in the width of gingiva was significant. With a baseline value of 1.5 ± 0.9 mm an improvement of 2.4 ± 0.8 mm after six month could be observed. 40 out of 62 recessions were considered a thin biotype at baseline. After 6 months all 62 sites were assessed thick. The results demonstrate the capacity of the bovine pericardium based non-cross linked collagen matrix for successful root coverage. This material was able to enhance gingival thickness and the width of keratinized gingiva. The percentage of root coverage achieved thereby is comparable to existing techniques. This method might contribute to an increase of patient's comfort and an enhanced aesthetical outcome.

• Nanocrystalline Hydroxyapatite Bone Substitute Leads to Sufficient Bone Tissue Formation Already after 3 Months: Histological and Histomorphometrical Analysis 3 and 6 Months following Human Sinus Cavity Augmentation.

  Authors: Shahram Ghanaati, Mike Barbeck, Ines Willershausen, Benjamin Thimm, Stefan Stuebinger, Tadas Korzinskas, Karina Obreja, Constantin Landes, Charles J Kirkpatrick, Robert A Sader

  Clinical implant dentistry and related research. 01/2012;

  Purpose: In this study the de novo bone formation capacity of a nanocrystalline hydroxyapatite bone substitute was assessed 3 and 6 months after its insertion into the human sinus cavity. MaterialsPurpose: In this study the de novo bone formation capacity of a nanocrystalline hydroxyapatite bone substitute was assessed 3 and 6 months after its insertion into the human sinus cavity. Materials and Methods: Sinus cavity augmentation was performed in a total of 14 patients (n = 7 implantation after 3 months; n = 7 implantation after 6 months) with severely atrophic maxillary bone. The specimens obtained after 3 and 6 months were analyzed histologically and histomorphometrically with special focus on bone metabolism within the residual bone and the augmented region. Results: This study revealed that bone tissue formation started from the bone-biomaterial-interface and was directed into the most cranial parts of the augmented region. There was no statistically significant difference in new bone formation after 3 and 6 months (24.89 ± 10.22% vs 31.29 ± 2.29%), respectively. Conclusions: Within the limits of the present study and according to previously published data, implant insertion in regions augmented with this bone substitute material could be considered already after 3 months. Further clinical studies with bone substitute materials are necessary to validate these findings.

• In vitro analysis of the cytotoxicity and the antimicrobial effect of four endodontic sealers.

  Authors: Ines Willershausen, Angelika Callaway, Benjamin Briseño, Brita Willershausen

  Head & face medicine. 08/2011; 7:15.

  The aim of this study was to investigate in vitro the cytotoxicity and antibacterial properties of four different endodontic sealers using human periodontal ligament fibroblast cell proliferation andThe aim of this study was to investigate in vitro the cytotoxicity and antibacterial properties of four different endodontic sealers using human periodontal ligament fibroblast cell proliferation and visual analysis of growth inhibition. A silicone (GuttaFlow), silicate (EndoSequence BC), zinc oxide eugenol (Pulp Canal Sealer EWT) and epoxy resin (AH Plus Jet) based sealer were incubated with PDL fibroblasts (10⁴ cells/ml, n=6) up to 96 h. Cell proliferation (RFU) was determined by means of the Alamar Blue assay. Cell growth and morphology was visualized by means of fluorescent dyes. Possible antibacterial properties of the different sealers were visualized by means of SEM (Enterococcus faecalis; Parvimonas micra). Fibroblast proliferation depended on sealer and cultivation time. After 72 and 96 h GuttaFlow and EndoSequence BC showed relatively non-cytotoxic reactions, while Pulp Canal Sealer EWT and AH Plus Jet caused a significant decrease of cell proliferation (p<0.001). Visualization of cell growth and morphology with various fluorescent dyes supplemented the results. No antibacterial effect of EndoSequence BC to P. micra was found, whereas GuttaFlow showed a weak, Pulp Canal Sealer EWT and AH Plus Jet extensive growth inhibition. Also, no antibacterial effect of GuttaFlow, EndoSequence BC or AH Plus Jet to E. faecalis could be detected. These in vitro findings reveal that GuttaFlow and EndoSequence BC can be considered as biocompatible sealing materials. However, prior to their clinical employment, studies regarding their sealing properties also need to be considered.

• Evaluation of the tissue reaction to a new bilayered collagen matrix in vivo and its translation to the clinic.

  Authors: Shahram Ghanaati, Markus Schlee, Matthew J Webber, Ines Willershausen, Mike Barbeck, Ela Balic, Christoph Görlach, Samuel I Stupp, Robert A Sader, C James Kirkpatrick

  Biomedical materials (Bristol, England). 02/2011; 6(1):015010.

  This study evaluates a new collagen matrix that is designed with a bilayered structure in order to promote guided tissue regeneration and integration within the host tissue. This material induced aThis study evaluates a new collagen matrix that is designed with a bilayered structure in order to promote guided tissue regeneration and integration within the host tissue. This material induced a mild tissue reaction when assessed in a murine model and was well integrated within the host tissue, persisting in the implantation bed throughout the in vivo study. A more porous layer was rapidly infiltrated by host mesenchymal cells, while a layer designed to be a barrier allowed cell attachment and host tissue integration, but at the same time remained impermeable to invading cells for the first 30 days of the study. The tissue reaction was favorable, and unlike a typical foreign body response, did not include the presence of multinucleated giant cells, lymphocytes, or granulation tissue. In the context of translation, we show preliminary results from the clinical use of this biomaterial applied to soft tissue regeneration in the treatment of gingival tissue recession and exposed roots of human teeth. Such a condition would greatly benefit from guided tissue regeneration strategies. Our findings demonstrate that this material successfully promoted the ingrowth of gingival tissue and reversed gingival tissue recession. Of particular importance is the fact that the histological evidence from these human studies corroborates our findings in the murine model, with the barrier layer preventing unspecific tissue ingrowth, as the scaffold becomes infiltrated by mesenchymal cells from adjacent tissue into the porous layer. Also in the clinical situation no multinucleated giant cells, no granulation tissue and no evidence of a marked inflammatory response were observed. In conclusion, this bilayered matrix elicits a favorable tissue reaction, demonstrates potential as a barrier for preferential tissue ingrowth, and achieves a desirable therapeutic result when applied in humans for soft tissue regeneration.

• Retrospective study on direct pulp capping with calcium hydroxide.

  Authors: Brita Willershausen, Ines Willershausen, Armin Ross, Sonja Velikonja, Adrian Kasaj, Maria Blettner

  Quintessence international (Berlin, Germany : 1985). 02/2011; 42(2):165-71.

  To evaluate the success rate of a calcium hydroxide-based direct capping agent in permanent teeth. A total of 1,075 permanent teeth were treated in this study. All patients received direct pulpTo evaluate the success rate of a calcium hydroxide-based direct capping agent in permanent teeth. A total of 1,075 permanent teeth were treated in this study. All patients received direct pulp capping with a calcium hydroxide-based agent. Inclusion criteria were teeth with healthy pulps, pulps with signs of reversible pulpitis, and a pulp chamber roof opening smaller than 2 mm2. Pulps with severe degenerative processes or necrosis were excluded. After direct capping, all teeth were definitively restored with amalgam, composite, glass-ionomer cement, or other dental materials. The teeth were observed up to 9 years with a first visit after 3 months followed by an annual routine visit. The success rate of direct capping was 80.1% after 1 year, 68.0% after 5 years, and 58.7% after 9 years. Substantial differences were found regarding the number of tooth surfaces affected by the causal event (P = .0005). The subsequent definitive restorations also significantly influenced the survival rate (P = .0035). Direct pulp capping with calcium hydroxide is a successful therapy when the respective indications and restorative materials are employed.

• A novel method for evaluating periodontal recession: a feasibility study.

  Authors: Karl M Lehmann, Adrian Kasaj, Armin Ross, Ines Willershausen, Irene Schmidtmann, Henning Staedt, Herbert Scheller

  International journal of computerized dentistry. 01/2011; 14(4):297-307.

  To evaluate whether a three-dimensional (3D) optical method currently used for the production of dental restorations could be applied to the simultaneous evaluation of the height and width ofTo evaluate whether a three-dimensional (3D) optical method currently used for the production of dental restorations could be applied to the simultaneous evaluation of the height and width of periodontal recessions, and determine the reproducibility and accuracy of the method for evaluating periodontal recession. The height and width of periodontal recessions scratched onto stone replicas were recorded using a 3D optical method, a periodontal probe, and a caliper. No difference was found between measurements obtained using the methods tested (p > 0.05). However, measurements using the 3D optical method showed the highest reproducibility. The 3D optical method allowed the accurate and reproducible evaluation of the height and width of periodontal recessions. The next step should be the development of fully automated soft-tissue monitoring software to increase time savings.

• Gingival crevicular fluid MMP-8-concentrations in patients after acute myocardial infarction.

  Authors: Vicky Ehlers, Ines Willershausen, Joachim Kraft, Thomas Münzel, Brita Willershausen

  Head & face medicine. 01/2011; 7:1.

  The aim of this study was to determine the presence of matrix metalloproteinase-8 in the gingival crevicular fluid (GCF) of patients after acute myocardial infarction (AMI). A total of 48 GCF samplesThe aim of this study was to determine the presence of matrix metalloproteinase-8 in the gingival crevicular fluid (GCF) of patients after acute myocardial infarction (AMI). A total of 48 GCF samples from 20 AMI patients, hospitalized at the Department of Cardiology and Angiology of the Johannes Gutenberg University Mainz, were investigated. Besides the myocardial infarction all patients suffered from chronic periodontal disease. Fifty-one GCF samples from 20 healthy age matched individuals with similar periodontal conditions served as controls. The dental examination included the assessment of oral hygiene, gingival inflammation, probing pocket depth, clinical attachment level and X-ray examination. The study was only carried out after the positive consent of the regional ethic commission. A quantitative assessment of aMMP-8 levels in the gingival crevicular fluid was performed with the help of the DentoAnalyzer (Dentognostics GmbH, Jena, Germany), utilising an immunological procedure. The aMMP-8 concentrations found in the gingival crevicular fluid of the AMI patients significantly differed (p = 0.001; mean value 30.33 ± 41.99 ng/ml aMMP-8) from the control group (mean value 10.0 ± 10.7 ng/ml aMMP-8). These findings suggest that periodontal inflammation in AMI patients might be associated with higher MMP-8-values compared to the healthy controls. The acute myocardial infarction seems to influence the degree of periodontal inflammation, thus the measurement of the gingival crevicular fluid MMP8 levels seems to be a helpful biochemical test to obtain information about the severity of the periodontal disease.

• Influence of β-tricalcium phosphate granule size and morphology on tissue reaction in vivo.

  Authors: Shahram Ghanaati, Mike Barbeck, Carina Orth, Ines Willershausen, Benjamin W Thimm, Christiane Hoffmann, Angela Rasic, Robert A Sader, Ronald E Unger, Fabian Peters, C James Kirkpatrick

  Acta biomaterialia. 12/2010; 6(12):4476-87.

  In this study the tissue reaction to five different β-tricalcium phosphate (β-TCP)-based bone substitute materials differing only in size, shape and porosity was analyzed over 60 days, at 3, 10, 15,In this study the tissue reaction to five different β-tricalcium phosphate (β-TCP)-based bone substitute materials differing only in size, shape and porosity was analyzed over 60 days, at 3, 10, 15, 30 and 60 days after implantation. Using the subcutaneous implantation model in Wistar rats both the inflammatory response within the implantation bed and the resulting vascularization of the biomaterials were qualitatively and quantitatively assessed by means of standard and special histological staining methods. The data from this study showed that all investigated β-TCP bone substitutes induced the formation of multinucleated giant cells. Changes in size, shape and porosity influenced the integration of the biomaterials within the implantation bed and the formation of tartrate-resistant acid phosphatase (TRAP)-positive and TRAP-negative multinucleated giant cells, as well as the rate of vascularization. While a high porosity generally allowed cell and fiber in-growth within the center of the bone substitute, a lower porosity resulted in a mosaic-like integration of the materials, with the granules serving as place holders. The number of multinucleated giant cells located in the implantation bed positively correlated with the vascularization rate. These data emphasize that all biomaterials investigated were capable of inducing the formation of TRAP-positive multinucleated giant cells as a sign of biomaterial stability. Furthermore, these cells directly influenced vascularization by secretion of vascular endothelial growth factor (VEGF), as well as other chemokines. Based on these findings, the role of multinucleated giant cells in the foreign body reaction to biomaterials might need to be reconsidered. This study demonstrates that variations in the physical properties of a bone substitute material clearly influence the (extent of the) inflammatory reaction and its consequences.

• Histological and histomorphometrical analysis of a silica matrix embedded nanocrystalline hydroxyapatite bone substitute using the subcutaneous implantation model in Wistar rats.

  Authors: Shahram Ghanaati, Carina Orth, Mike Barbeck, Ines Willershausen, Benjamin W Thimm, Patrick Booms, Stefan Stübinger, Constantin Landes, Robert Anton Sader, Charles James Kirkpatrick

  Biomedical materials (Bristol, England). 05/2010; 5(3):035005.

  The clinical suitability of a bone substitute material is determined by the ability to induce a tissue reaction specific to its composition. The aim of this in vivo study was to analyze the tissueThe clinical suitability of a bone substitute material is determined by the ability to induce a tissue reaction specific to its composition. The aim of this in vivo study was to analyze the tissue reaction to a silica matrix-embedded, nanocrystalline hydroxyapatite bone substitute. The subcutaneous implantation model in Wistar rats was chosen to assess the effect of silica degradation on the vascularization of the biomaterial and its biodegradation within a time period of 6 months. Already at day 10 after implantation, histomorphometrical analysis showed that the vascularization of the implantation bed reached its peak value compared to all other time points. Both vessel density and vascularization significantly decreased until day 90 after implantation. In this time period, the bone substitute underwent a significant degradation initiated by TRAP-positive and TRAP-negative multinucleated giant cells together with macrophages and lymphocytes. Although no specific tissue reaction could be related to the described silica degradation, the biomaterial was close to being fully degraded without a severe inflammatory response. These characteristics are advantageous for bone regeneration and remodeling processes.

• Association between chronic dental infection and acute myocardial infarction.

  Authors: Brita Willershausen, Adrian Kasaj, Ines Willershausen, Denisa Zahorka, Benjamin Briseño, Maria Blettner, Sabine Genth-Zotz, Thomas Münzel

  Journal of endodontics. 06/2009; 35(5):626-30.

  INTRODUCTION: In patients with cardiovascular diseases several risk factors such as high blood pressure, diabetes, smoking and drinking habits, genetic disposition, and chronic inflammation must beINTRODUCTION: In patients with cardiovascular diseases several risk factors such as high blood pressure, diabetes, smoking and drinking habits, genetic disposition, and chronic inflammation must be considered. The aim of this study was to investigate whether there is a correlation between dental origin infections and the presence of an acute myocardial infarction (AMI). METHODS: A total of 125 patients who had experienced a myocardial infarction and 125 healthy individuals were included in this study. The oral examination was carried out following the consent of the ethics committee and the National Board for Radiation Protection and included the number of teeth, endodontically treated teeth, periodontal screening index (PSI), clinical attachment level, and radiographic apical lesions (radiograph examination). The medical examination included, among others, blood glucose level, C-reactive protein (CRP) serum levels, and leukocyte number. RESULTS: The study demonstrated that patients with AMI exhibited an unfavorable dental state of health. After statistical adjustment for age, gender, and smoking, they exhibited a significantly higher number of missing teeth (P = .001), less teeth with root canal fillings (P = .0015), a higher number of radiologic apical lesions (P = .001), and a higher PSI value (P = .001) compared with individuals without myocardial infarction. The medical data showed a nonsignificant correlation between CRP and the number of radiologic apical lesions. CONCLUSIONS: This study presents evidence that patients who have experienced myocardial infarction also exhibit an unfavorable dental state of health in comparison to healthy patients and suggests an association between chronic oral infections and myocardial infarction.

• Influence of β-tricalcium phosphate granule size and morphology on tissue reaction in vivo

  Authors: Shahram Ghanaati, Mike Barbeck, Carina Orth, Ines Willershausen, Benjamin W. Thimm, Christiane Hoffmann, Angela Rasic, Robert A. Sader, Ronald E. Unger, Fabian Peters, C. James Kirkpatrick

  Acta Biomaterialia.

  In this study the tissue reaction to five different β-tricalcium phosphate (β-TCP)-based bone substitute materials differing only in size, shape and porosity was analyzed over 60 days, at 3, 10, 15,In this study the tissue reaction to five different β-tricalcium phosphate (β-TCP)-based bone substitute materials differing only in size, shape and porosity was analyzed over 60 days, at 3, 10, 15, 30 and 60 days after implantation. Using the subcutaneous implantation model in Wistar rats both the inflammatory response within the implantation bed and the resulting vascularization of the biomaterials were qualitatively and quantitatively assessed by means of standard and special histological staining methods. The data from this study showed that all investigated β-TCP bone substitutes induced the formation of multinucleated giant cells. Changes in size, shape and porosity influenced the integration of the biomaterials within the implantation bed and the formation of tartrate-resistant acid phosphatase (TRAP)-positive and TRAP-negative multinucleated giant cells, as well as the rate of vascularization. While a high porosity generally allowed cell and fiber in-growth within the center of the bone substitute, a lower porosity resulted in a mosaic-like integration of the materials, with the granules serving as place holders. The number of multinucleated giant cells located in the implantation bed positively correlated with the vascularization rate. These data emphasize that all biomaterials investigated were capable of inducing the formation of TRAP-positive multinucleated giant cells as a sign of biomaterial stability. Furthermore, these cells directly influenced vascularization by secretion of vascular endothelial growth factor (VEGF), as well as other chemokines. Based on these findings, the role of multinucleated giant cells in the foreign body reaction to biomaterials might need to be reconsidered. This study demonstrates that variations in the physical properties of a bone substitute material clearly influence the (extent of the) inflammatory reaction and its consequences.