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Objectives: The aim of this study was to assess in a multi-modular manner the bone healing 1 year post root-end surgery (RES) with leukocyte- and platelet-rich fibrin (LPRF) and Bio-Gide® (BG; Geistlich Pharma North America, Inc., Princeton, USA) as an occlusive membrane. Materials and methods: A randomized controlled clinical trial (RCT) of RES +/− LPRF and +/− BG was performed. The follow-up until 1 year post RES was performed by means of ultrasound imaging (UI), periapical radiographs (PR), and cone-beam computed tomography (CBCT). Results: From the 50 included patients, 6 dropped-out during follow-up. For the 44 assessed patients (34 with UI and 42 with PR and CBCT), there was no evidence (p > 0.05) for an effect of LRPF, neither on UI measurements nor on CBCT assessments. On the contrary, there was an indication for a better outcome with BG. UI presented significant shorter healing time for the bony crypt surface (p = 0.014) and cortical opening (p = 0.006) for the groups with BG. The qualitative CBCT assessment for the combined scores of the apical area and cortical plane was significantly higher for BG (p = 0.01 and 0.02). The quantitative CBCT measurement for bone healing after 1 year was lower with BG (p = 0.019), as well as the percentage of non-zero values (p = 0.026), irrespective of the preoperative lesion size and type. Furthermore, UI seemed to be safer for frequent follow-up during the early postoperative stage (0–3 months), whereas CBCT gave more accurate results 1 year post RES. Amongst the assessors, the qualitative PR analysis was inconsistent for a favorable outcome 1 year post RES with LPRF (p = 0.11 and p = 0.023), but consistent for BG (p = 0.024 and p = 0.023). Conclusions: There was no evidence for improvement of bone healing when RES was applied with LPRF in comparison with RES without LPRF. However, RES with BG gave evidence for a better outcome than RES without BG. Clinical relevance: The addition of an occlusive membrane rather than an autologous platelet concentrate improved bone regeneration 1 year post RES significantly, irrespective of the assessment device applied. The accuracy of PR assessment is questionable. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this cross-sectional survey were to determine the prevalence of secondary caries (SC) in general population, to identify patient- and material-related factors which may affect the prevalence, and to describe some clinical characteristics of SC lesions. Materials and methods: A total of 4036 restorations in 450 patients, who visited the university dental clinic for a regular (half) yearly checkup, were examined clinically (and radiographically) for the presence of SC. Clinical characteristics of the detected SC lesions (size, activity, and location) and the planned treatment were recorded. In addition, patients' caries-risk status was assessed according to the modified "cariogram" model. Results: In total, 146 restorations were diagnosed with SC, which gives an overall prevalence of 3.6%. Restorative material, restoration class, patient's caries risk, and smoking habits were shown to be important factors, as SC prevalence was significantly higher with composites, class II restorations, high-caries-risk patients, and smokers. Restorations' gingival margins were most frequently affected by SC. The largest number of restorations with SC (72%) was scheduled for the replacement. Conclusions: Prevalence of SC was higher with composite than with amalgam restorations, irrespective of the patient's caries-risk status. Gingival margins of class II, including MOD restorations, seem to be the place of less resistance to SC development. Management of SC seems to place a considerable burden on the health care workforce and expenditure. Clinical relevance: Secondary caries (SC) is considered to be the main cause of dental restoration failure and one of the biggest clinical challenges related to dental composites. Nevertheless, its prevalence in daily practice is still not clear, which impedes an accurate estimation of its impact on health care costs. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the impact of the adjunct of leukocyte- and platelet-rich fibrin (LPRF) to root-end surgery (RES) on the patients’ quality of life during the first week post RES.Materials and methods: Patients in need of RES were recruited for an open randomized controlled clinical trial (RCT) with a 2 × 2 factorial design. They were randomly allocated to the test (+LPRF) and control (−LPRF) group. Each group was subsequently divided into two strata: with or without an occlusive membrane (Bio-Gide®, Geistlich Biomaterials, Switzerland; BG). After RES, the patients completed daily for 1 week a visual analog pain scale (VAS) and a 5-point Likert-type scale questionnaire concerning activity impairment, occurrence of symptoms, and medication use.Results: Fifty patients were included, equally divided between the test and control group. Only one patient in the “−LPRF+BG-group” had to take additional antibiotics due to a persistent jaw swelling. There was no evidence (p ≤ 0.05) for a difference between the test and control group in VAS, occurrence of pain symptoms, impairment of daily activities, and medication use, over the 7 days and daily during the 7 days post RES.Conclusions: There was no statistical significant evidence for improvement of patients’ quality of life during the first week post RES with LPRF in comparison with RES without LPRF.Clinical relevance: Although LPRF seems to be an inexpensive and autologous agent to reduce pain and swelling post RES, this RCT does not provide a statistical significant evidence for that. [ABSTRACT FROM AUTHOR]

Objectives: An immunohistological study of an infected immature permanent human tooth after a regenerative endodontic procedure (REP) was conducted in order to determine the histologic outcome of this procedure. Besides observed signs of angiogenesis and neurogenesis, repair and/or regeneration of the pulp-dentin complex was also investigated. Materials and methods: A REP was performed on tooth 45 of a 10-year-old girl. Eleven months post-treatment, the tooth had to be removed for orthodontic reasons. The following investigations were performed: immunohistology and radiographic quantification of root development. After hematoxylin-eosin (HE) staining, the following immunomarkers were selected: neurofilament (NF), pan cytokeratin (PK), osteocalcin (OC), and CD34. Results: The REP resulted in clinical and radiographic healing of the periradicular lesion and quantifiable root development. The HE staining matches with the medical imaging post-REP: underneath the mineral trioxide aggregate a calcified bridge with cell inclusions, connective pulp-like tissue (PLT) with blood vessels, osteodentin against the root canal walls, on the root surface cementum (Ce), and periodontal ligament (PDL). The PDL was PK. The blood vessels in the PLT and PDL were CD34. The Ce, osteodentin, and stromal cells in the PLT were OC. The neurovascular bundles in the PLT were NF. Conclusions: Immunohistologically, REP of this infected immature permanent tooth resulted in an intracanalar connective tissue with a regulated physiology, but not pulp tissue. Clinical relevance: REP of an immature permanent infected tooth may heal the periapical infection and may result in a combination of regeneration and repair of the pulp-dentin complex. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to evaluate the influence of different surface preparation techniques on long-term bonding effectiveness to eroded dentin. Materials and methods: Dentin specimens were eroded by pH cycling or were left untreated as control, respectively. Five different 'preparation' techniques were applied: (1) cleaning with pumice, (2) air abrasion, (3) silicon polisher, (4) proxo-shape, and (5) diamond bur. The three-step etch-and-rinse adhesive OptiBond FL (O-FL; Kerr) and the mild two-step self-etch adhesive Clearfil SE Bond (C-SE; Kuraray) were evaluated. Micro-tensile bond strength was measured after water storage for 24 h and 1 year. Fracture analysis was performed by stereomicroscopy and SEM. Interfaces were characterized by TEM. Differences were statistically analyzed with a linear mixed effects model ( α = 0.05). Results: Erosion reduced bond strength in all groups, but this effect was less prominent when eroded dentin was prepared by diamond bur. Storage lowered bond strength in almost all groups significantly, but this ageing effect was more prominent for the eroded surfaces than for non-eroded controls. Whereas after 1-year control specimens revealed superior bond strength with the three-step etch-and-rinse adhesive (O-FL), the mild two-step self-etch adhesive (C-SE) revealed a better 1-year bond strength to eroded dentin. The interface at eroded dentin appeared very prone to degradation as was shown by the increased amount of adhesive failures and by the silver infiltration detected by TEM. Conclusions and clinical relevance: Although a minimally invasive approach should clinically always be strived for, superficial preparation (or minimal roughening) with a diamond bur is recommendable for long-term bonding to eroded dentin. [ABSTRACT FROM AUTHOR]

This 13-year randomized clinical trial compared the clinical effectiveness of two three-step etch-and-rinse adhesives in combination with a hybrid, stiffer composite versus a micro-filled, more flexible composite. The influence of composite stiffness on the clinical performance of one of the adhesives was assessed as well. One hundred and forty-two non-carious cervical lesions were restored with composites with contrasting stiffness. Seventy-one patients randomly received two cervical restorations placed following two out of three adhesive procedures: (1) the three-step etch-and-rinse adhesive Permaquick applied with the stiff micro-hybrid composite Amelogen Hybrid (PMQ-H, Ultradent), (2) Permaquick applied with the more flexible micro-filled Amelogen Microfill (PMQ-M, Ultradent), or (3) the 'gold-standard' three-step etch-and-rinse adhesive Optibond FL applied with the micro-hybrid composite Prodigy (OFL-P, Kerr). The restorations were evaluated after 6 months, 1, 2, 3, 5, 7, and 13 years of clinical service regarding their retention, marginal integrity and discoloration, caries occurrence, preservation of tooth vitality, and post-operative sensitivity. Retention loss, severe marginal defects, and/or discoloration that needed intervention (repair or replacement) and the occurrence of caries were considered as clinical failures. The recall rate at 13 years was 77%. Bond degradation after 13 years was mainly characterized by a further increase in the presence of small but clinically acceptable marginal defects and superficial marginal discoloration. Twelve percent of the OFL-P restorations were clinically unacceptable. In the PMQ group, 22% of the PMQ-M restorations and 26% of the PMQ-H restorations needed repair or replacement. Regarding the clinical failure rate, Optibond FL scored significantly better than Permaquick (McNemar; p = 0.015). No statistically significant differences were found between the micro-filled and the hybrid composite for each of the parameters evaluated (McNemar, p > 0.05). After 13 years of clinical functioning, the clinical effectiveness of the three adhesive/composite combinations remained highly acceptable. [ABSTRACT FROM AUTHOR]

The 5-year findings of a randomized clinical trial testing the null hypothesis that there are no differences between the clinical-wear performances of nano-, microfilled-, and conventional hybrids placed in class I and class II cavities are reported. Effects of subject-, operator-, and restoration-related variables on wear were assessed. Sixteen Tetric-C, 17 Tetric-EC, and 16 Gradia-DP restorations were placed in human molars and recalled at baseline, 6 months and at yearly intervals. The gypsum replicas at each recall were scanned (3D laser scanning), epoxy resin replicas were observed under scanning electron microscope and linear mixed models were used to study the influence of different variables on wear. The generalized vertical wear rate/month were (1.4 μm Tetric-C and Tetric-EC; 1.8 μm Gradia-DP) and volume wear rate/month were (0.017 mm Tetric-EC; 0.018 mm Gradia-DP, and 0.011 mm Tetric-EC). Operator-cavity type interaction and surface area of restorations did significantly influence the volume wear rates ( p < 0.05). The three wear patterns: fatigue cracks at heavy occlusal contact area/OCA, pitting at light OCA, and scratches/striations along the food escape pathways were evident. The three hybrids differed significantly in volume wear due to material and operator variables. Clinical relevance: Clinically, operators and cavity type can affect restorations' wear magnitude but do not contribute to increased functional risk of fracture or harmful effect on pulp and periodontal biocompatibility. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare the clinical performance, quantitative and qualitative wear patterns of conventional hybrid (Tetric Ceram), micro-filled hybrid (Gradia Direct Posterior) and nano-hybrid (Tetric EvoCeram, TEC) posterior composite restorations in a 3-year randomised clinical trial. Sixteen Tetric Ceram, 17 TEC and 16 Gradia Direct Posterior restorations were placed in human molars and evaluated at baseline, 6, 12, 24 and 36 months of clinical service according to US Public Health Service criteria. The gypsum replicas at each recall were used for 3D laser scanning to quantify wear, and the epoxy resin replicas were observed under scanning electron microscope to study the qualitative wear patterns. After 3 years of clinical service, the three hybrid restorative materials performed clinically well in posterior cavities. Within the observation period, the nano-hybrid and micro-hybrid restorations evolved better in polishability with improved surface gloss retention than the conventional hybrid counterpart. The three hybrid composites showed enamel-like vertical wear and cavity-size dependant volume loss magnitude. Qualitatively, while the micro-filled and nano-hybrid composite restorations exhibited signs of fatigue similar to the conventional hybrid composite restorations at heavy occlusal contact area, their light occlusal contact areas showed less surface pitting after 3 years of clinical service. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine whether patients with phantom tooth symptoms have an altered sensory perception as compared to pain-free subjects. Ten patients (mean age 56, range 32–71, nine females) were diagnosed as suffering from "phantom tooth" according to a specifically designed phantom tooth questionnaire including components of the McGill Pain Questionnaire. An SCL-90 form was completed and assessment of sensory perception was carried out by determination of the threshold level for light touch sensation, two-point discrimination, and thermal sensation in a case-control design. Results. Of all the observed questionnaires, 5.7% seemed to deal with phantom tooth, with a female preponderance (ratio 9:1). Complaints were predominantly reported in the upper jaw (ratio 8:2) with the majority in the molar region (ratio 5:3). Phantom tooth subjects showed significantly lower threshold levels for light touch sensation, most markedly on the affected side. The average psychoneurotic profile showed a tendency towards higher scores for the phantom tooth subjects. Conclusion. The phantom tooth phenomenon may show a number of features which might aid differential diagnosis. To verify influences such as upper molar predominance and increased light touch sensation, another study should be performed on a larger patient sample. [ABSTRACT FROM AUTHOR]