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This case report describes the chairside fabrication of a monolithic posterior crown using a multilayer super-translucent zirconia material. According to the manufacturer’s information, the newly introduced multilayer zirconia (4-YTZP) offers a unique combination of fracture strength (>850 MPa with speed-sintering) and improved optical properties, thus allowing a reduced minimum material thickness and optional temporary luting. By using up-to-date components of the CEREC system, including superfast dry-milling and a speed-sintering process, the fabrication of a monolithic zirconia crown is possible within an acceptable timeframe for the chairside workflow (60-75 min). The usage of a multilayer super-translucent material allows for the individualization of the restoration, typically in a single combined stain and glaze firing. However, it should be noted that clinical data for this type of restoration are still sparse. Therefore, manufacturer recommendations regarding indication, preparation, and cementation must be followed very strictly.

Objectives A university-based randomized clinical study evaluated the 5-year performance of chairside-fabricated zirconia-reinforced lithium silicate (ZLS)-ceramic partial crowns. Material and methods Forty-five patients were restored with 61 chairside-fabricated ZLS-restorations (Cerec SW 4.2, Dentsply Sirona, Germany; Vita Suprinity, Vita Zahnfabrik, Germany). Deviating from the manufacturers’ recommendations, restorations with reduced minimum material thicknesses (MMT) were fabricated: group 1, MMT = 0.5–0.74 mm (n = 31); group 2, MMT = 0.75–1.0 mm (n = 30). For luting, a self-adhesive cement (SAC) or a total-etch technique with a composite cement (TEC) was applied. Statistical evaluation was performed by time-to-event analysis (Kaplan–Meier). Possible covariates of the survival (SVR) and success rates (SCR), evaluated in a Cox regression model, were MMT, restoration position (premolar/molar), and cementation technique (SAC vs. TEC). Results Forty patients (54 restorations, premolars, n = 23; molars, n = 31) participated in the 5-year follow-up. Five losses due to ceramic fractures occurred in group 1 (n = 28) (SVR: 83.0% [95% confidence interval (CI): 0.71–0.96]). Group 2 (n = 26) showed no losses (SVR: 100%). The success rate for partial crowns placed on premolars was 100% and 69% (95% CI: 0.54–0.84) for molar restorations. Recementation was required in 4 restorations with SAC (SCR: 86% [95% CI: 0.73–0.99]; SCR-DC: 100%). Restorations in group 2 showed a significantly reduced risk of material fracture hazard ratio (HR) = 0.09, p = 0.0292) compared with the restorations in group 1. Molar partial crowns showed an increased risk for a clinical intervention (HR = 5.26, p = 0.0222) compared to premolar restorations. Conclusions Material thickness and position of the restoration are risk factors influencing the survival and success rate of ZLS-ceramic partial crowns. Clinical relevance Observation of an MMT of at least 0.75–1.0 mm for ZLS-ceramics is essential to avoid material-related fractures. Clinical trial registration: German Clinical Trails Register (trial number: DRKS00005611)

Objectives Prospective practice-based clinical evaluation of chairside fabricated monolithic partial crowns composed of zirconia-containing lithium silicate (ZLS) ceramic material. Materials and methods Between October 2013 and September 2014, 71 patients were restored with 92 partial crowns on vital or sufficiently endodontically treated teeth. The monolithic restorations were fabricated chairside (Cerec SW 4.2/Cerec MC XL) from a glaze-fired ZLS ceramic material (Celtra Duo, Dentsply Sirona, Bensheim, Germany). Adhesive cementation was performed using the total-etch technique with one of two dual-curing composite materials. Modified United States Public Health Service parameters were evaluated annually; moreover, the parameters "time-dependent survival" (in situ criterion) and "success rates" (event-free restorations) were evaluated according to Kaplan-Meier analysis. Results Sixty-nine patients with 17 premolar and 71 molar partial crowns attended annual follow-up examinations (observational period: 36.0 ± 5.7 months). Two complete failures were recorded and were caused by a tooth fracture (at 30 months) and a restoration fracture (at 38 months), (3-year survival rate: 99%; 95% confidence interval (CI 95%): [0.97;1]). One clinical intervention was necessary (endodontic treatment) to maintain function (3-year success rate: 98%; (CI95%: [0.95:1]). Conclusions Chairside-fabricated ZLS partial crowns show a good initial clinical performance. However, to further evaluate this new material, clinical data from studies with longer observational periods are required. Clinical significance Based on this mid-term evaluation, ZLS ceramics appear to be a promising alternative material for the chairside fabrication of adhesively luted monolithic posterior restorations with a low risk of material-related complications.

Purpose A retrospective evaluation of extended anterior ceramic laminate veneers (EACVs) after a mean observational period of 10 years. Methods Thirty-one patients (20 females/11 males) underwent restoration with 101 adhesively luted, heat-pressed EACVs (maxilla, n = 65; mandible, n = 36). Results The 10 year survival rate was 91.8% (95% confidence interval [95%-CI]: 0.87;0.97). Eight ceramic fractures, one biological failure, and one change in treatment plan caused the observed failures. Seventy-seven of the 101 restorations remained intervention-free in service (success rate: 78.6% [95%-CI: 0.70;0.88]). Fourteen interventions were needed (nine recementations, two endodontic treatments, two composite fillings, and one fracture polishing). The jaw position (maxilla/mandible, survival P = .578/success P = .056) had no influence on the clinical performance. EACVs covering large areas of exposed dentin (>50%) were associated with a significantly increased risk (hazard ratio 2.98, P = .019) of needing a clinical intervention (success rate: 68.0% [95%-CI: 0.52; 0.84]). However, the degree of dentin exposure had no effect on the survival rate (P = .761). Conclusions After a mean observational period of 10 years, mandibular and maxillary EACVs exhibited survival and success rates that were comparable. Significantly lower success rates were associated with large areas of exposed dentin (>50%). Clinical significance Mandibular and maxillary EACV revealed 10-year survival rates comparable to those published for anterior metal-ceramic and glass-ceramic full-coverage crowns. Precaution should be taken not to expose dentin, and when large areas of dentin are exposed, different conditioning/luting strategies should be used.

Vollkeramische Restaurationen aus klassischer Silikatkeramik sind zwingend adhasiv zu zementieren, um die reduzierte Festigkeit durch das Verkleben mit der Zahnsubstanz zu kompensieren. Moderne Keramiken aus Zirkoniumdioxid oder Lithiumdisilikat bieten im Gegensatz dazu Festigkeitswerte >350 MPa; dies lasst alternativ die klassische definitive oder provisorische Zementierung zu. Bei der Entscheidungsfindung zur Zementierungsart sind aber nicht nur der Restaurationswerkstoff, sondern auch Aspekte wie die Stumpfgeometrie oder das klinische Arbeitsfeld mitentscheidend. Die klassische Zementierung bietet Vorteile wie einfache und zeitsparende Verarbeitung sowie reduzierte Anforderungen an das klinische Arbeitsfeld (Beispiel: Trockenlegung). Als Nachteile werden asthetische Einschrankungen diskutiert und ein mogliches erhohtes Risiko fur Retentionsverluste. Nicht alle konventionellen Zemente sind gleichermasen fur die unterschiedlichen Keramiken geeignet, sodass fur jeden Fall uber die Art der Zementierung individuell entschieden werden sollte.

This in vitro study evaluated the effects of different abutment axial heights on the retentiveness of adhesively and self-adhesively luted zirconia copings. Ankylos implants were embedded in resin blocks. Two groups of titanium abutments (“long”, height: 6.79 mm, taper: 4.8°; “short”, height: 4.31 mm, taper: 4.8°; Compartis-ISUS, DeguDent) were used for the luting of CAD/CAM-fabricated zirconia copings (Compartis, DeguDent) with an adhesive (Multilink Automix; Ivoclar Vivadent) and a self-adhesive (RelyX Unicem; 3M ESPE) composite. After water storage and 5000 thermocycles (5 °C/55 °C), retention forces were evaluated using a universal testing machine (Zwick). Significant differences were determined via two-way ANOVA and t-tests with Bonferroni-Holm correction. Significant interactions between abutment geometry and luting agents were observed. RelyX Unicem showed the highest levels of retentiveness, irrespective of the varying abutment geometries (mean values long/short: 487.7 N/447.9 N). When Multilink Automix was used, removal forces were significantly lower (311.7 N/101.1 N) and negatively affected by the use of the shorter abutments. Customized long abutments supported better retention forces than customized short abutments for both luting agents.

Objectives Retrospective evaluation of extended anterior glass-ceramic veneers 7 years after placement in a private practice. Materials and methods A total of 31 patients (20 females/11 males) underwent restoration with adhesively luted extended veneers that were fabricated using heat-pressed glass-ceramic (Cergo, Dentsply Sirona). A single dentist restored 101 teeth (maxilla, n = 65; mandible, n = 36). Adhesive cementation was performed using an etch-and-rinse adhesive (OptibondFL, Kerr Corporation), and two different dual-curing composite cements (Variolink, Ivoclar Vivadent/Calibra, Dentsply Sirona). Results After 7 years, the Kaplan-Meier survival rate (in situ criteria) was 93.6% (95% CI: 0.89; 0.98). The observed failures were caused by ceramic fractures for seven restorations and biological failure for one restoration. In total 80 of the 101 restorations were still in service and did not require any clinical intervention (7-year success rate: 84.3% [95% CI]: 0.76; 0.93). Interventions were necessary in 13 cases (8 recementations, 2 endodontic treatments, 2 composite fillings (caries), and 1 polishing of minor fractures). The clinical performance was not influenced by the veneer position (maxilla/mandible, survival P = .56/success P = .30). The veneers that covered large areas of exposed dentin (>50%) exhibited a significantly increased risk (hazard ratio 3.71, P = .0041) for requiring a clinical intervention; however, no effect on the survival rate was observed for these veneers (P = .35). Conclusions Following 7 years of clinical service, extended anterior ceramic veneer restorations exhibited comparable survival and success rates for the upper and lower jaw. Large areas of exposed dentin (>50%) were associated with significantly lower success rates. Clinical significance Dentin exposure (more than 50% of the preparation surface) during preparation significantly affects the clinical performance of extended heat-pressed glass-ceramic veneers.

The aim of this randomized clinical study was to detect the effect of an instruction within a group using oscillating-rotating (OR), sonic-active (SA), or manual toothbrushes (MTB) in young, oral healthy adults.One hundred fifty participants were randomly assigned into six groups (n = 25): with (OR-I, SA-I, MTB-I) and without instruction (OR-NI, SA-NI, MTB-NI). Participants in I subgroups received one standardized instruction of the toothbrush system. At baseline (t0), after 2 (t1), 4 (t2), and 12 weeks (t3), plaque indices including modified Quigley-Hein Index (QHI) and Marginal Plaque Index (MPI) as well as inflammation indices including Papilla Bleeding Index (PBI) and Gingival Index (GI) were assessed. Kruskal-Wallis test, Friedman test, and chi-square or Fisher's exact test (p 0.05) were used for statistical analysis.One hundred thirty-one participants completed the follow-up and were analyzed: OR-I = 21, OR-NI = 22, SA-I = 22, SA-NI = 22, MTB-I = 22, and MTB-NI = 22. Within groups between t0 and t3, OR and SA systems showed a significant plaque reduction, irrespective of instruction (pThe used toothbrush as well as the presence or absence of a single brush-specific instruction has no influence on plaque removal and reduction of gingival inflammation in young, oral healthy adults in an observation period of 12 weeks.A single instruction might bring no benefit in this patient group, independently of the used toothbrush system.

The aim of this study was to evaluate microbiological findings and aMMP-8 level of peri-implant mucositis (M) and peri-implantitis (P) in patients undergoing supportive implant therapy (SIT). Eighty-nine patients with 171 implants were included. The case definitions were as follows: M: PPD ≥4mm, BOP; P: PPD≥4mm, BOP, radiographic bone loss ≥3.5mm. Samples of peri-implant sulcular fluid (PISF) were taken from all peri-implant pockets at each implant to detect periodontal pathogens using PCR and aMMP-8 level with ELISA. Only Treponema denticola (Td) and Prevotella intermedia (Pi) showed significantly higher prevalence in P (healthy implants [HI]: Td=27%, Pi=17%; M: Td=26%, Pi=15%; P: Td and Pi=50%; P0.05). The mean aMMP-8 level at implant sites did not show any significant difference (P=0.05) among HI (5.2±8.1), M (9.9±19.0), and P (4.9±7.7). Microbiological findings and aMMP-8 levels are not reliable criteria to distinguish between HI, M, and P in patients undergoing SIT.

Neben den klassischen metallkeramischen Restaurationen haben sich insbesondere im Frontzahnbereich auch vollkeramische Versorgungen als asthetisch hochwertige Alternative mit vergleichbarer Langzeitbewahrung etabliert 1 . Als Materialgruppen sind dabei neben Zirkonoxidkeramiken auch hochfeste Glaskeramiken (Lithiumdisilikatkeramiken) klinisch erfolgreich im Einsatz. Neu entwickelte Materialien wie z. B. kubische Zirkonoxide mit einer erhohten Lichtdurchlassigkeit oder zirkonoxidverstarkte Lithiumsilikatkeramiken (ZLS-Keramiken) fuhren dabei zu einer bestandigen Erweiterungen der zahnmedizinischen Behandlungsoptionen 2 3 .

Purpose This practice-based cross-sectional study aimed to investigate whether common risk indicators for peri-implant diseases were associated with peri-implant mucositis and peri-implantitis in patients undergoing supportive implant therapy (SIT) at least 5 years after implant restoration. Methods Patients exclusively restored with a single implant type were included. Probing pocket depth (PPD), bleeding on probing (BOP), suppuration, and radiographic bone loss (RBL) were assessed around implants. The case definitions were as follows: peri-implant mucositis: PPD ≥4 mm, BOP, no RBL; and peri-implantitis: PPD ≥5 mm, BOP, RBL ≥3.5 mm. Possible risk indicators were compared between patients with and without mucositis and peri-implantitis using the Fisher exact test and the Wilcoxon rank-sum test, as well as a multiple logistic regression model for variables showing significance (P, Graphical Abstract

Aim of this cross-sectional study was to investigate the prevalence of selected potentially periodontal pathogenic bacteria in different sites of patients with tongue piercing (TP) in comparison to a control group (C). Fifty participants in each group were recruited. Samples from the biofilm originating from the piercing surface (TP group), periodontal pocket, tongue as well as cheek surface were examined regarding presence of 11 selected potentially periodontal pathogenic bacteria based on polymerase-chain reaction (PCR). In the periodontal pocket of the participants, the majority of examined bacteria were more frequently detected in TP compared to C group (pi In conclusion TP must be considered as potentially important ecological niche and reservoir for periodontal pathogens.

This dental practice-based pilot study aimed to investigate the efficacy of diabetes mellitus (DM) screening based on questionnaire replies.116 patients were screened in a private dental practice when visiting the dentist for a regular check-up. The Find-Risk (FR) questionnaire was used for diabetes screening. FR-positive (FR+) patients were referred to a diabetologist for further diagnostics (blood glucose, HbA1c); FR-negative patients (FR-) did not receive a diabetological examination. Furthermore, dental findings (DMFT) were obtained and periodontal condition was classified into no, mild, moderate or severe periodontitis, based upon periodontal pocket depth and clinical attachment loss. Sensitivity and specificity of the FR questionnaire and a modified FR questionnaire (additional inquiry if severe periodontitis had been ever diagnosed) were determined in a statistical model.102 patients with a mean age of 56.31 years were included. Seven patients had known DM. A total of 36 patients were FR+, including the seven patients with known DM. Only 16 of the 29 participants (55%) followed the recommendation to see the diabetologist. Nine of these 16 patients showed conspicuous blood glucose findings. Both with and without modification of the FR questionnaire, a sensitivity of 100% was achieved. With the modified FR questionnaire, a higher specificity was shown in a statistical model compared to the FR questionnaire without modification (80% vs 69.5%).FR-based DM screening in dental practice is possible and could help to identify patients with (pre-) diabetes. However, these results must be validated in a large patient cohort.

Aim of this cross-sectional case-control study was the comprehensive examination of oral health, oral behaviour and oral health-related quality of life of patients with tongue piercing. Furthermore, different piercing related factors and the presence of habits should be considered regarding their potential association to piercing-related complications. Participants with tongue piercing (n = 50) and a matched control (n = 50) were included. Dental examination included decayed-, missing- and filled-teeth-index (DMF-T) and the presence of non-carious tooth defects. Periodontal examination contained of periodontal probing depth (PPD), bleeding on probing (BOP) and recession. Piercing-related factors, oral behaviour as well as oral health-related quality of life [German short form of oral health impact profile (OHIP G14)] were assessed based on questionnaires. Statistics: Man-Whitney U test, chi-square and Fisher’s exact test (significance level p

This study focused on the clinical investigation of the internal and marginal fit of CAD/CAM-fabricated zirconia single crowns produced via conventional and digital impression techniques. In a private practice, 20 molar teeth, one from each of 20 patients, were prepared with a circumferential 1.0-mm deep chamfer and an occlusal reduction of 1.5 mm. Conventional impression (CI) taking with a polyvinylsiloxane material (Aquasil Monophase + Aquasil XLV; Dentsply, Konstanz, Germany) and intraoral scanning (IS) (Cara TRIOS; Heraeus, Hanau, Germany) of each of the preparations was performed, and then two respective zirconia copings per tooth were produced (20 crowns per group). The marginal and internal fit of the restorations was evaluated employing a replica technique. For statistical analysis, a pairwise comparison (Wilcoxon rank test) was performed. Zirconia single crowns produced with the IS technique revealed a statistically significant better precision of internal fit only in specific areas (chamfer area/occlusal area). The evaluation of marginal fit showed no significant differences between the two groups. All restorations of both groups offered internal and marginal gaps within the postulated clinical tolerance ranges. CAD/CAM-fabricated zirconia single crowns produced with CI and IS techniques offer adequate marginal and internal precision. However, the IS technique provides lower internal gaps in some specific areas. The clinical precision of fit of restorations produced with a CI and an IS technique appeared to be equivalent. Therefore, the IS technique can be rated as a suitable alternative for the manufacturing of single crowns.

Purpose The aim of this retrospective cross-sectional study was to evaluate whether salivary findings of active matrix-metalloproteinase 8 (aMMP-8) chairside (point of care; POC) tests were associated with periodontal risk assessment parameters in patients receiving supportive periodontal therapy (SPT). Methods A total of 125 patients receiving regular SPT were included, and their records were examined. The following inclusion criteria were used: a diagnosis of chronic periodontitis, at least 1 non-surgical periodontal treatment (scaling and root planning) with following regular SPT (minimum once a year), at least 6 remaining teeth, and clinical and aMMP-8 findings that were obtained at the same appointment. In addition to anamnestic factors (e.g., smoking and diabetes), oral hygiene indices (modified sulcus bleeding index [mSBI] and approximal plaque index), periodontal probing depth simultaneously with bleeding on probing, and dental findings (number of decayed, missing, and filled teeth) were recorded. Salivary aMMP-8 levels were tested using a commercial POC test system (Periomarker, Hager & Werken, Duisburg, Germany). Statistical analysis was performed using the t-test, Mann-Whitney U test, Fisher's exact test, and χ2 test, as appropriate (P0.05). Conclusions Salivary aMMP-8 chairside findings were not associated with common parameters used for periodontal risk assessment in patients receiving SPT. The diagnostic benefit of POC salivary aMMP-8 testing in risk assessment and maintenance interval adjustment during SPT remains unclear., Graphical Abstract

Retrospective evaluation of the clinical performance of tooth-supported overdentures retained by resilient telescopic crowns with occlusal clearance fit (ODRTC) in severely reduced dentition (1–3 remaining teeth). A total of 313 ODRTCs were inserted in an undergraduate prosthodontic program (University Medical Center, Goettingen, Germany) between 2000 und 2012. Data regarding 263 ODRTCs in 221 patients were reevaluated (observational period: 64.5 ± 34.8 months), and time-dependent survival and success rates (Kaplan-Meier-Estimator) were calculated. The number of the abutment teeth was analyzed as an influencing factor (Cox regression model (p

PURPOSE To investigate the clinical survival and success rates of conventionally luted three- and four-unit fixed dental prostheses (FDPs) with zirconia frameworks (Cercon Smart Ceramics, DeguDent) after a mean observation period of 119 ± 36 months. MATERIALS AND METHODS A total of 75 patients were treated in the Department of Prosthodontics at the University of Goettingen, Germany, and a total of 99 posterior FDPs were inserted and luted with zinc phosphate cement. Time-dependent survival and success rates were calculated using Kaplan-Meier curves, and their relationships with the type of veneer (ceramic), location (maxilla vs mandible), and span length (three-unit vs four-unit) were analyzed with a Cox regression model (P < .05). RESULTS Of the 99 inserted FDPs, 24 were lost to follow-up, 51 remained functional and passed the 10-year examination (overall survival rate: 75.0%; 95% confidence interval [CI]: 0.64, 0.85), and 13 were absolute failures caused by technical events (technical survival rate: 84%; 95% CI: 0.64, 0.85). In 50 FDPs, relative failure required a clinical intervention to maintain function (overall success rate: 40%; 95% CI: 0.29, 0.52). For 35 of these FDPs, the relative failure was caused by technical events (technical success rate: 61%; 95% CI: 0.49, 0.73). None of the evaluated factors showed an association with overall or technical survival or success. CONCLUSION Zirconia-based posterior FDPs produced with a first-generation computer-assisted manufacturing (CAM) system revealed high rates of absolute and relative failure, mainly due to technical events, after a mean observational period of 10 years. Further clinical studies with updated computer-assisted design (CAD)/CAM systems are needed to determine the long-term performance of zirconia-based FDPs.

This study aimed at comparing the cytotoxicity of a new octenidine mouth rinse (MR) on gingival fibroblasts and epithelial cells using different established MRs. Octenidol (OCT), Chlorhexidine 0.2% (CHX), Meridol (MER), Oral B (OB), and control (PBS only) were used. Human primary gingival fibroblasts (HGFIBs) and human primary nasal epithelial cells (HNEPCs) were cultivated in cell-specific media (2 × 105 cells/well) and treated with a MR or PBS for 1, 5, and 15 min. All tests were performed in duplicate and repeated 12 times. The apoptosis and necrosis were determined using a Caspase-3/7 assay and LDH assay, respectively. The data were analyzed using two-way analysis of variance with subsequent Mann–Whitney U-test. No significant differences could be found between the incubation times of the MR, neither for apoptosis nor necrosis (p > 0.05). Regarding apoptosis of HGFIBs, MRs had no influence at all. In HNEPCs, OCT induced relevantly lower apoptosis than CHX (p = 0.01). Considering necrosis, MER showed the lowest numbers of necrotic HGFIBs and HNEPCs, whereas OB induced the highest number of necrotic cells. The differences between both MR were statistically relevant (p

The type of used rotating-oscillating toothbrush was incorrectly assigned; correct used rotating-oscillating toothbrush is Pro1000 Precision Clean, Procter&Gamble GmbH, Schwalbach, Germany.

This practice-based study evaluates the survival and success of conventionally luted metal-ceramic and zirconia molar crowns fabricated by using a prolonged cooling period for the veneering porcelain. Fifty-three patients were treated from 07/2008 to 07/2009 with either metal-ceramic crowns (MCC) or zirconia crowns (ZC). Forty-five patients (26 female) with 91 restorations (obser-vational period: 64.0 ± 4.8 months) participated in a clinical follow-up examination and were included in the study. Estimated cumulative survival (ECSv), success (ECSc) and veneering ceramic success (ECVCSc) were calculated (Kaplan-Meier) and analysed by the crown fabrication technique and the position of the restoration (Cox regression model) (P < 0.05). Five complete failures (MCC: 2, ZC: 3) were recorded (5-year ECSv: MCC: 97.6%, (95% confidence interval (95%-CI): [93%; 100%]/ZC: 94.0%, (95%-CI): [87%; 100%]). Of the MCCs (n = 41), 85.0%, [95%-CI: (77%; 96%)] remained event-free, whereas the ECSc for the ZCs (n = 50) was 74.3% (95%-CI): [61%; 87%]. No significant differences in ECSv (P = 0.51), ECSc (P = 0.43) and ECVCSc (P = 0.36) were detected between the two fabrication techniques. Restorations placed on terminal abutments (n = 44) demonstrated a significantly lower ECVCSc (P = 0.035), (5-year VCF-rate: 14.8%) than crowns placed on tooth-neighboured abutments (n = 47), (5-year VCF-rate: 4.3%). In the present study, zirconia molar crowns demonstrated a 5-year ECSv, ECSc and ECVCSc comparable to MCCs. Irrespective of the fabrication technique, crowns on terminal abutments bear a significantly increased risk for VCFs. Clinical investigations with an increased number of restorations are needed.

This practice-based study evaluated the clinical performance and risk factors for biological and technical complications with conventionally luted zirconia crowns. Sixty-eight patients (39 female) with a total of 323 restorations placed on 219 vital teeth, 69 endodontically treated teeth (ETT), and 41 implants (incisors, 96; premolars, 89; molars, 138; observational period, 79.7 ± 14.2 months) underwent a clinical follow-up examination and were included in the study. Time-dependent survival (in situ), success (event free), and veneering ceramic fracture (VCF) rates were calculated and analyzed relative to the following risk factors: smoking status, location of the crown, and type of abutment. Fifty-three complete failures were recorded. A significant influence of the abutment type on survival could be detected (p = 0.033): ETT demonstrated a significantly (p = 0.029) lower 7-year survival rate (73.8 %, 95 % confidence interval [95 % CI] 0.600–0.876) than crowns placed on implants (90.0 %, 95 % CI 0.814–0.990). The success rate of the crowns was significantly influenced by the location of the restoration (p = 0.0058). A total of 75.6 % (95 % CI 0.648–0.864) of the anterior crowns remained event free, compared to 50.4 % (95 % CI 0.388–0.621) of the molar crowns. Furthermore, the location of the crowns affected the VCF rate (p = 0.018, event-free anterior teeth 95.2 % (95 % CI 0.880–1), event-free molars 80.9 % (95 % CI 0.706–0.913)). Survival and success rates were significantly influenced by the type of abutment and the location of the restoration. More complete failures should be expected for crowns placed on ETT, while crowns on molars demonstrated more biological and technical complications than anterior zirconia crowns.

This randomized clinical trial investigated the influence of the utilization time of brush heads from different types of power toothbrushes [oscillating rotating (OR) and sonic action (SA)93; on oral hygiene (plaque accumulation and gingival inflammation) over a 6-month observation period.49 participants were randomly allocated into two groups: use of the same brush head over 6 months (NR: non-replacement) or replacement of brush head every 4 weeks over 6 months (R: replacement). Each group was subdivided into two subgroups according to kind of toothbrush (TB) used (OR and SA). Modified Quigley-Hein plaque index (QHI), papilla bleeding index (PBI), and gingival index (GI) were recorded at baseline and 2, 8, 12, 16, and 24 weeks after baseline. After 24 weeks, participants of both groups (R and NR) received a new brush head. At week 26, final QHI, PBI, and GI were recorded.QHI decreased between baseline and follow-up visits in R groups (P0.05), with the exception of week 12 (P= 0.26). In NR groups, no significant decrease was detected (P0.05). There was no significant effect of time on PBI or GI in any of R subgroups (P0.05). In NR oscillating/rotating TB: significant increase in PBI and GI was detected 24 weeks after baseline (PBI: P= 0.02, GI: P= 0.03); sonic action TBs showed significant decrease in PBI at every follow-up visit (P0.05), except at 24 weeks after baseline (P= 0.73). GI was significantly decreased at 2 weeks after baseline only (P0.01).Six-month use of the same brush head reduced effectiveness in removing plaque, and gingival inflammation appeared to increase after a utilization time of over 4 months. Replacing brush heads is advised after 4 months.

This randomized clinical study compared the influence of manual and power toothbrushes on clinical and microbiological findings in initial treatment of periodontitis.A total of 72 participants with a mean age of 55.7 years were randomly assigned to three groups (n= 24):oscillating-rotating (OR), sonic-active (SA) and manual toothbrush (MTB). At baseline, after 4 weeks and after 12 weeks, the following parameters were assessed:modified Quigley-Hein-Index (QHI), papilla bleeding index (PBI), periodontal pocket depth (PPD), bleeding on probing (BOP) and recession. For microbiological analysis (PCR) of 11 periodontal pathogenic bacteria, samples of sulcular fluid were taken from the deepest pockets. Statistical analysis was performed using ANOVA, with the level of significance set at α= 5%.All clinical parameters:PBI, modified QHI, PPD, BOP and recession showed an improvement after 12 weeks compared to baseline, regardless of which toothbrush system was used. Regarding PBI, the SA group showed significantly greater improvement compared to OR and MTB (P0.01). In plaque removal (QHI) only OR was significantly more effective than MTB (P= 0.01). Periodontal parameters showed a significantly higher reduction of PPD for SA compared to MTB and MTB compared to OR (Plt; 0.05), while for BOP only a significantly higher reduction in SA compared to OR was detected (P= 0.01) Microbiological analysis showed an improvement in prevalence of several bacteria without significant differences between groups.Patients might benefit from powered TB systems, especially in initial treatment of periodontitis.

Purpose There is a lack of data regarding the clinical outcome of removable partial dentures (RPDs) supported by a combination of residual natural teeth and implants placed in strategic positions. The aim of the present case series was to conduct a retrospective investigation of the clinical outcome of mandibular tooth-implant-retained partial dentures (TIRPD) rigidly retained via telescopic double crowns. Material and Methods Between 1999 and 2010, 18 patients with reduced residual dentition (1 to 3 natural abutment teeth) and in need of an RPD received 1 to 3 implants in strategic positions for support of the removable prostheses. All TIRPDs were rigidly retained by telescopic crowns according to the Marburg Double Crown (MDC) technique; all prostheses were placed in a private practice. Tooth/implant survival and success rates, prosthetic maintenance requirements, and peri-implant parameters were analyzed retrospectively using patient records and clinical examinations during the final recall appointments. Only patients attending at least annual supportive post-implant hygiene therapy visits (SIT) were included. Results After a mean functional period of 5.84 ± 3 years (range: 3.01–12.21), 14 patients with 14 dentures supported by 24 implants and 27 teeth (mean number of abutments: 3.6) were available for assessment. Four teeth (survival rate: 85.19%) and no implants (survival rate: 100%) were lost. Peri-implantitis was observed around one implant (4.17%). All 14 dentures were functional (survival rate: 100%) and required only limited maintenance (i.e., screw loosening, acrylic resin fracture repairs, relining) amounting to 0.086 treatments per patient per year (T/P/Y). Conclusions Within the limitations of this case series, it can be concluded that TIRPDs retained via MDCs might represent a viable treatment option in mandibles with few remaining abutment teeth. Further long-term clinical evaluations with a greater sample size are needed for a more detailed evaluation of this treatment concept.

The aim of this randomized clinical trial (RCT) was to investigate whether 6-month continuous use of different manual toothbrushes (TBs) influences plaque removal and the degree of gingival inflammation compared to short utilization periods of 4 weeks each.In total, 96 participants were randomly allocated into two groups: continuous use during 6 months (non-renewal group) or a change in TB every 4 weeks during 6 months (renewal group). Each group was subdivided into four subgroups (groups A to H; n = 12 each) according to the head size (normal or short) and bristle hardness (medium or soft) of the TB used. The modified Quigley-Hein plaque index (QHI), papilla bleeding index (PBI), and gingival index (GI) were recorded at baseline and 2, 8, 12, 16, and 24 weeks after baseline. After 24 weeks, each participant received a new TB, and at week 26, the final QHI, PBI, and GI were determined. The statistical evaluation consisted of analysis of covariance (P0.05).With time, QHI, PBI, and GI were significantly different between the renewal and the non-renewal groups (QHI: P = 0.02; PBI: P = 0.04; GI: P0.01), independent of subgroup. In the renewal group, QHI showed a significant decrease between baseline and each follow-up visit (P0.01). In the non-renewal group, there was a significant decrease compared to baseline up to and including week 16 (P0.01). PBI in the renewal group showed no significant differences between baseline and each follow-up visit (P0.05). In the non-renewal group, only the normal head/soft subgroup exhibited a significant increase at week 24 (P = 0.02). The GI in the renewal group showed no difference between baseline and all follow-up visits, whereas in the non-renewal group, there was a significant decrease up to and including week 12 (P0.05).Six-month continuous use reduced the effectiveness of the TB with respect to plaque removal, and gingival inflammation appeared to increase.

Background There is a lack of data concerning implant-supported overdentures (IODs) retained by double crowns in the edentulous maxilla. Purpose To perform a retrospective evaluation of clinical outcomes (survival/success rates) of maxillary overdentures retained on four implants via double crowns. Material and methods Between 1993 and 2011, 28 patients with edentulous maxillae were restored with overdentures supported by four implants with a Morse taper connection (Ankylos, Dentsply Friadent, Mannheim, Germany) and double crowns according to the Marburg Double Crown (MDC) technique in a private practice. For retrospective evaluation of implant and prosthetic survival (in situ criterion) and success (event-free observational period), only patients attending a professional maintenance program were included (n = 20). Results Twenty patients (13 female/ seven male, mean age: 63.45 ± 7.18 years) with 80 implants met the inclusion criteria. The mean follow-up period was 5.64 ± 3.50 years. One implant was lost (cumulative survival rate: 98.75%). Eight implants (10.1%) in two patients (10%) showed peri-implantitis; both patients were active smokers (cumulative success rate: 88.75%). All dentures were still functional (prosthetic survival rate 100%) at the time of investigation. Technical maintenance procedures (e.g., abutment loosening, screw loosening, acrylic fracture or relining) were required at a rate of 0.222/patient-year. Conclusions Within the limitations of this study, we conclude that MDC-IODs are a promising treatment alternative for edentulous maxillae offering high implant and prosthesis survival rates > 98% and a limited incidence of biological and technical complications after a mean observational period of >5 years.

Statement of the Problem The clinical performance of ceramic veneers is influenced by various clinical and material-related factors. Purpose Retrospective evaluation of extensive anterior ceramic veneers in the upper and lower jaw 36 months after placement in a private practice. Materials and Methods Thirty-seven patients (21 female, 16 male) were restored with adhesively luted extensive ceramic veneers made from a heat-pressed ceramic (Cergo, DeguDent, Hanau, Germany). One dentist restored a total of 130 teeth (maxilla N = 76, mandible N = 54). Adhesive cementation was performed with an etch-and-rinse adhesive (Optibond FL, Kerr Hawe, Karlsruhe, Germany) and a dual-curing composite cement. Results After 36 months, the survival rate (in situ criteria) according to Kaplan–Meier was 95.1% (95% confidence interval [CI]: 0.88; 1). Reasons for failure were four ceramic fractures and one biological failure in five restored teeth. Of the restorations, 92.8% (95% CI: 0.86;1) were in service without any clinical intervention and rated successful after 36 months. Interventions were necessary in five cases (three recementations, two endodontic treatments). Clinical performance was not influenced by the veneer position (maxillar/mandibular, survival p = 0.3/success p = 0.4). Veneers with more than 50% of exposed dentin demonstrated a significantly increased risk (hazard ratio 10.6, p = 0.026) for a clinical intervention (recementation, endodontic treatment), whereas no effect on the survival rate could be detected (p = 0.17). Conclusions After 36 months of clinical service, extensive veneer restorations made of a pressable ceramic showed a comparable survival and success rate in the upper and lower jaw. Large areas of exposed dentin (>50%) were associated with lower success rates. Clinical Significance Mandibular ceramic veneers made using a heat-pressed ceramic offer the same clinical reliability as do veneers on anterior maxillary teeth. Dentin exposure significantly affects the clinical performance of heat-pressed ceramic veneers.

Background Different concepts regarding the number of implants and attachment systems for the preparation of implant-supported over-dentures (IODs) have been discussed. Nonetheless, long-term results for double-crown-retained IODs with an observational period of more than 10 years are still rare in the literature. Objective The aim of this practice-based study was to retrospectively evaluate the long-term clinical outcome (success/survival rates, technical/biological complications) of IODs retained by double crowns. Material and methods In a private practice, 36 non-smoking edentulous patients were restored between 1991 and 2002 with double-crown-retained IODs supported by 2–6 implants. For the retrospective evaluation of implant and prosthetic survival (in-situ criterion) and success (event-free observational period), only those patients were included who regularly (at least once a year) participated in a professional maintenance programme and who had a functional period for the restoration of more than 10 years. Results Twenty-two patients (12 Women/10 men, mean age 60.1 ± 9.8 years) with 89 implants supporting nine maxillary and 13 mandibulary dentures (mean number of implants/prosthesis = 4) met the inclusion criteria. The mean follow-up period was 14.1 ± 2.8 years. One implant failed after 4.9 years (cumulative-survival rate: 98.9%). Seven implants in two patients showed peri-implantitis (prevalence: patient-based = 9.1%/implant-based = 8%). Five dentures were renewed (prosthetic-survival rate 77.3% Maintenance procedures (i.e. screw loosening or acrylic fractures) were required at a rate of 0.31/year and patient. Conclusion This study indicates that IODs retained with double crowns offer predictable long-term performance with a limited incidence of biological and technical complications.

This study compared the cytotoxicity of a new octenidine mouth rinse (MR) against gingival fibroblasts and epithelial cells with different established MRs.The following MRs were used: Octenidol (OCT), Chlorhexidine 0.2% (CHX), Listerine (LIS), Meridol (MER), Betaisodona (BET); and control (medium only). Human primary gingiva fibroblasts and human primary nasal epithelial cells were cultivated in cell-specific media (2 × 10(5) cells/ml) and treated with MR for 1, 5, and 15 min. Each test was performed 12 times. Metabolism activity was measured using a cytotoxicity assay. A cellometer analyzed cell viability, cell number, and cell diameter. The data were analyzed by two-way analysis of variance with subsequent Dunnett's test and additional t-tests.The cytotoxic effects of all MRs on fibroblasts and epithelial cells compared to the control depended on the contact time (p0.001). OCT and BET showed less influence on cell metabolism in fibroblasts than other MRs. OCT also demonstrated comparable but not significant results in epithelial cells (p0.005). Cell numbers of both cell types at all contact times revealed that OCT showed a less negative effect (p0.005), especially for epithelial cells compared to CHX after 15 min (p0.005). OCT and BET showed the best results for viability in fibroblasts (p0.005), but MER showed less influence than OCT in epithelial cells (p0.005).OCT is a potential alternative to CHX regarding cytotoxicity because of its lower cell-toxic effect against fibroblasts and epithelial cells.

The aim of this study was to evaluate tooth and periodontal damage in subjects wearing a tongue piercing (TP) in comparison to matched control subjects without tongue piercing. Members of the German Federal Armed Forces who had TP (group TP) and a matched control group (group C) volunteered to take part in the study. The time in situ, localization and material of TP were documented. Dental examinations included DMF-T, oral hygiene, enamel fissures (EF), enamel cracks (EC) and recessions. Statistical analysis was determined by χ 2 test and the t test. Both groups had 46 male subjects (mean age 22.1 years). The piercings had been in situ for 3.8 ± 3.1 years. Subjects in the TP group had a total of 1,260 teeth. Twenty-nine subjects had 115 teeth (9.1%) with EF (67% lingual). In group C (1,243 teeth), 30 subjects had 60 teeth with EF (4.8%, 78% vestibular) (p

Objectives: Evaluation of the prevalence rates of periimplant mucositis and periimplantitis in partially edentulous patients in a private dental practice. Material and methods: The data of 89 patients were collected (52 female, 37 male, age at time of implant placement: 51.8±10.3 years). All patients had been treated with dental implants of the same type and fixed superstructures between January 1999 and June 2006 (observational period: 68.2±24.8 months). Results: The patient-related prevalence rate of periimplant mucositis (probing depth ≥4 mm and bleeding on probing [BOP]) was over all 44.9%. The respective rates in non-smokers without periodontal history were 30.4% and in smokers with periodontal history 80%. The multiple logistic regression analysis identified a significant association of mucositis with the independent variable “smoker” (odds ratio [OR] 3.77; P=0.023). The patient-related prevalence rate of periimplantitis (probing depth ≥5 mm, BOP/pus, radiographic bone loss) was 11.2% (smokers with periodontal history: 53.3%, non-smokers: 2.8%). No periimplant disease was diagnosed in non-smoking patients without periodontal history and with a good compliance after treatment. Statistical analysis identified a significant association of periimplantitis with “smoker” (OR: 31.58; P

The aim of this study was to compare the microbial analysis methods of polymerase chain reaction (PCR) and real-time PCR (RT-PCR) in terms of detection of five selected potentially periodontal pathogenic bacteria in peri-implant disease. Therefore 45 samples of healthy, mucositis and peri-implantitis (n = 15 each) were assessed according to presence of the following bacteria using PCR (DNA-strip technology) and RT-PCR (fluorescent dye SYBR green-system): Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tanerella forsythia (Tf), and Fusobacterium nucleatum (Fn). There were no significant correlations between the bacterial and disease patterns, so the benefit of using microbiological tests for the diagnosis of peri-implant diseases is questionable. Correlations between the methods were highest for Tf (Kendall's Tau: 0.65, Spearman: 0.78), Fn (0.49, 0.61) and Td (0.49, 0.59). For Aa (0.38, 0.42) and Pg (0.04, 0.04), lower correlation values were detected. Accordingly, conventional semi-quantitative PCR seems to be sufficient for analyzing potentially periodontal pathogenic bacterial species.

PURPOSE: This retrospective study aims at the evaluation of implant-supported overdentures (IODs) supported by ceramo-galvanic double crowns (CGDCs: zirconia primary crowns + galvano-formed secondary crown). MATERIALS AND METHODS: In a private practice, 14 patients were restored with 18 IODs (mandible: 11, maxilla: 7) retained by CGDCs on 4 - 8 implants and annually evaluated for technical and/or biological failures/complications. RESULTS: One of the 86 inserted implants failed during the healing period (cumulative survival rate (CSR) implants: 98.8%). During the prosthetic functional period (mean: 5.9 ± 2.2 years), 1 implant demonstrated an abutment fracture (CSR-abutments: 98.2%), and one case of peri-implantitis was detected. All IODs remained in function (CSR-denture: 100%). A total of 15 technical complications required interventions to maintain function (technical complication rate: 0.178 treatments/patients/year). CONCLUSION: Considering the small sample size, the use of CGDCs for the attachment of IODs is possible without an increased risk of technical complications. However, for a final evaluation, results from a larger cohort are required. peerReviewed

The use of zirconia abutments for single-tooth restorations is well documented and supported by clinical studies with observational periods of up to 5 years. However, data for fixed partial dentures (FPDs) on all-ceramic abutments are lacking. Therefore, this indication cannot yet be generally recommended. Based on the available clinical studies, it can be assumed that the treatment results for anterior restorations can be improved by using all-ceramic abutments, especially in situations with a reduced thickness of the peri-implant soft tissues (2 mm). Zirconia abutments for single-tooth restorations can be restored with glass-ceramic crowns on a lithium-disilicate base or crowns with oxide-ceramic structures (alumina or zirconia). If the restorations are cemented adhesively, then all of the cement residues must be carefully removed. Superstructures based on zirconia ceramics can be removed to a certain degree if they are cemented temporarily or screwfixed with directly veneered abutments. However, prior to providing a general recommendation for temporary cementation or screw-fixation of all-ceramic superstructures, additional clinical data are needed.

This report describes the use of custom-positioned vertical screws (CVS) to attach primary telescopic crowns to implant abutments. In a private practice setting, 37 patients with 40 double crown-retained implant overdentures (IODs) with a clearance fit (Marburg double crowns) were followed. All primary crowns on the 120 implant abutments were retained using CVS. After a mean followup period of 3.55 ± 1.37 years (range: 1.5 to 6.3 years), one abutment screwloosening incident was reported (incidence: 0.08%). No loosening of any of the screw-retained primary crowns occurred. CVS may represent a viable fixation concept for IODs.

This study aimed to determine the survival rate and prevalence of biologic and technical complications associated with single-tooth implants with all-ceramic abutments in the anterior region.A total of 33 patients were restored with 50 anterior implants and temporarily luted all-ceramic crowns on prefabricated zirconia abutments. All of the patients subsequently received annual supportive maintenance; 27 patients (18 women, 22-74 years) with 42 implants participated in the final maintenance visit and were included in the study (follow-up 78.1 ± 27.0 months). The time-dependent survival rate (Kaplan-Meier) and the frequency of prosthetic complications (abutment fracture [AF], screw loosening [SL], fracture of veneering ceramics [VF], retention loss [RL]) and biologic complications (peri-implantitis) were calculated to determine the success rates.No implant loss (implant-related survival rate 100%) but one abutment fracture occurred throughout the entire observation period; therefore, the survival rate of the superstructures (in situ criterion) was 97.6% (95% confidence interval [CI] 0.930- 1.000) after 7 years. Eleven restorations were affected by prosthetic complications: RL (n = 4), VF (n = 5), and SL (n = 2). Peri-implantitis was diagnosed for two implants (probing depth5 mm, bleeding on probing [BOP]/suppuration, and bone loss3 mm) (implant-related peri-implantitis rate 4.8%). No restoration required replacement due to complications. The success rate (event-free restoration) was 75.9% (95% CI 0.636- 0.882) after 7 years.Considering the calculated survival rate, the application of all-ceramic zirconia implant abutments in the anterior region can be recommended as a reliable therapy in private practice. Fractures of veneering ceramics were the most common prosthetic complication.