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Although dental trauma and its unfavorable sequelae are considered major public health problems worldwide, the published data on the prevalence of traumatic crown injuries (TCIs) in Germany are lacking. Therefore, the present study assessed the prevalence of TCIs among adolescents in Bavaria, Germany. Ethical approval and parental consents were obtained, and population-based information from 10- (N = 1158), 12- (N = 416), and 15-year-olds (N = 1302) from two different cohort studies performed in Bavaria (GINIplus/LISA and LAGZ) were examined for the presence of TCIs, dental caries, and restorations. Statistical comparisons were made using Mann-Whitney U test and Wilcoxon signed-rank test. The prevalence of TCIs was 6.3% in the 10- and 12-year-old children and 14.0% in 15-year-old children, and a higher prevalence was observed in boys than in girls. Most (87.5%) of the traumatized teeth were maxillary incisors. The caries prevalence was low in all three populations. The prevalence of TCIs in Bavarian adolescents at a low risk for caries was found to be low. Dental trauma is a prevalent event in children and adolescents, and incisors are the most affected teeth. Therefore, dental practitioners should be able to manage the spectrum of traumatic injuries.

Objective Ascorbic acid (Asc) and N-acetylcysteine (NAC) were reported to reduce genotoxicity induced by dental (co)monomers and their epoxy metabolites. The aim of the present study was to investigate Asc or NAC as novel components in light-curable methacrylate based dental composites regarding their effects on degree of conversion (DC) and elution of composite components. Additionally, the release of Asc or NAC was determined. Methods Asc or NAC (1, 0.1, 0.01 or 0 wt%) was experimentally incorporated into the composites Venus®, Grandio® and FiltekTM Supreme XTE and polymerized according to the instruction of manufacturers. The samples were elussted in methanol and water. For each composite-antioxidant mixture and elution medium four samples (n = 4) were prepared. The eluates were analyzed by gas chromatography/mass spectrometry (GC/MS), high-performance liquid chromatography/ultraviolett/diode array detection (HPLC/UV/DAD) and high-performance liquid chromatography/fluorescence detection (HPLC/FLD). DC of composite-antioxidant mixtures was measured in real-time with Fourier transform infrared spectroscopy (FTIR). Results The highest concentrations of eluted Asc were 313.98 μM (Venus®-1 wt% Asc; 1 day; methanol) and 245.34 μM (FiltekTM Supreme XTE-1 wt% Asc; 5 min; water). The highest concentrations of eluted NAC were 42.99 μM (1 day; Filtek™ Supreme XTE-1 wt% NAC; 1 day; methanol) and 108.11 μM (Filtek™ Supreme XTE-1 wt% NAC; 7 day; water). Triethylene glycol dimethacrylate (TEGDMA) elution was significantly increased in Venus®-1 wt% Asc and Grandio®-1 wt% Asc (1 day and 7 day methanol/water), compared to control. No significant difference was found for TEGDMA elution in Filtek™ Supreme XTE-1 wt% Asc/NAC. DC was significantly decreased compared to control (= composite without antioxidant) in Grandio® and Filtek™ Supreme XTE after 1, 0.1 and 0.01 wt% Asc incorporation and in Venus® after 1 and 0.1 wt% Asc incorporation. For composite-NAC mixtures, only DC of Grandio®-1 wt% NAC was significantly reduced. Significance Incorporation of NAC (1 wt%), as a novel composite component, into Filtek™ Supreme XTE, had no effect on DC and composite component elution, and supplies sufficient amount of antioxidant which may reduce toxicity. Therefore, it represents a beneficial mixture.

The aim of the present in vitro study was to determine the ability of Diagnocam to detect caries at an early stage and to compare it with digital radiography. One hundred twenty proximal surfaces composed equally of sound and decayed surfaces were evaluated by assessing images captured with Diagnocam (Kavo, Biberach, Germany) and digital radiography (DR). All images were assessed twice by two calibrated dentists with a minimum interval of 2 weeks between examinations. The results were compared with μCT scans. Inter-rater reliability showed nearly perfect agreement; a high intra-rater reliability was calculated. Spearman’s rank correlation coefficients showed a strong correlation of Diagnocam and μCT (0.82). DR and μCT achieved a slightly lower correlation (0.73). The surfaces were categorized into sound surfaces, enamel lesions, and dentin lesions to determine intraclass correlation coefficients (ICCs), sensitivity and specificity. ICCs between μCT and DR ranged from 0.20 to 0.63. ICCs between Diagnocam and DR were higher in all categories and ranged from 0.56 to 0.83. Sensitivity, specificity, and accuracy of Diagnocam achieved mostly higher values than DR. In detecting enamel lesions, sensitivity was 0.36 for DR and 0.59 for the DC. The areas under the receiver operating characteristic (ROC) curves of Diagnocam were larger than those of DR in all categories. Diagnocam is more capable of detecting initial proximal lesions than DR and also has a higher sensitivity for dentin lesions. However, caries progression in dentin cannot be reliably determined with Diagnocam. Diagnocam may be suitable as a supplement to X-ray diagnostics in clinical use.

ZusammenfassungFrühkindliche Karies gehört zu den prävalenten Erkrankungen des Kindesalters. Ursächlich kann neben frequenter Zufuhr kariogener Getränke und Lebensmittel ein häufiges, prolongiertes Stillen sein. Zusätzlich führt ausschließliches Stillen über das erste Lebenshalbjahr hinaus zu einer Mangelversorgung. Im vorliegenden Fall wird ein 2-jähriges Kind mit frühkindlicher Karies (ECC Typ II) und erheblichem Untergewicht vorgestellt, welches ausschließlich gestillt wurde. Eine Zahnsanierung in Allgemeinanästhesie mit begleitender Ernährungsumstellung führte zur Normalisierung des Körpergewichts.

Medical faculties have the responsibility to train tomorrow's doctors and in a crisis face the challenge of delivering students into the workforce promptly and safely. Worldwide, medical faculties have faced unprecedented disruptions from viral outbreaks and pandemics including SARS, Ebola, H1N1 and COVID-19 which bring unique challenges. Currently there is worldwide disruption to medical faculties and medical education due to COVID-19. Despite close links with clinical medicine and the known risks of pandemics, many medical faculties have been caught off guard without pandemic planning in place, to deal with an exponential rise in infections and deaths, overwhelmed health services and widespread community risk of transmission. Assessing transmission risk of COVID-19 in teaching, clinical and community attachments and continuing medical education is paramount as medical faculties face subsequent pandemics waves. Consensus statements based on best available evidence and international expertise from medical faculties in Asia, Australia and Europe were developed to help guide the protection of staff and students, priorities on teaching activities and further educational development. Infection prevention, infection control, contact tracing and medical surveillance are detailed to minimise transmission and to enhance safety. Recommendations on teaching activities planning can enhance responsiveness of medical faculties to tackle subsequent waves of COVID-19 infection. A global approach and dialogue are encouraged.

After caries, molar incisor hypomineralisation (MIH)-also known as chalky teeth-is one the most common dental diseases in children and adolescents. In addition to aesthetic limitations, especially on the anterior teeth, hypersensitivities and enamel breakdowns on permanent molars are of functional importance. While the MIH prevalence rates range from ~ 10% to ~ 30% and is well described, the situation regarding aetiology is unsatisfactory. Although efforts have been made in the past to clarify the aetiology, no plausible reason is available so far. Aetiology research has to be judged as methodologically challenging, since it should ideally be embedded in prospectively planned birth cohort studies. The aim of this article is to summarize typical clinical characteristics of MIH, epidemiological findings and potential causes with special reference to the earlier published results from the two Munich birth cohort studies GINIplus and LISA.Die Molaren-Inzisiven-Hypomineralisation (MIH) – mittlerweile auch bekannt unter dem Begriff der Kreidezähne – stellt heute neben der Karies eine häufige Erkrankung der Zähne im Kindes- und Jugendalter dar. Neben den ästhetischen Einschränkungen insbesondere an den Frontzähnen sind Hypersensibilitäten und Schmelzeinbrüche an bleibenden Molaren für die Betroffenen von funktioneller Bedeutung. Während die Häufigkeit der MIH in einer Größenordnung zwischen ~ 10 % und ~ 30 % liegt und gut beschrieben ist, stellt sich die Situation bezüglich der Ursachenforschung unbefriedigend dar. Obwohl in der Vergangenheit Anstrengungen zur Klärung der Ätiologie unternommen wurden, liegt bis in die Gegenwart keine plausible Ätiologiekette vor. Ursachenforschungen sind dabei als methodisch anspruchsvoll zu beurteilen, da diese optimalerweise in prospektiv geplante Geburtskohortenstudien eingebettet sein sollten, welche spätestens mit der Geburt beginnen. Ziel des vorliegenden Beitrages ist es, die klinische Charakteristik der MIH, Häufigkeiten und potenzielle Ursachen unter besonderer Berücksichtigung bereits publizierter Ergebnisse aus den beiden Münchner Geburtskohortenstudien GINIplus und LISA zusammenfassend darzustellen.

ZusammenfassungDie Molaren-Inzisiven-Hypomineralisation (MIH) – mittlerweile auch bekannt unter dem Begriff der Kreidezähne – stellt heute neben der Karies eine häufige Erkrankung der Zähne im Kindes- und Jugendalter dar. Neben den ästhetischen Einschränkungen insbesondere an den Frontzähnen sind Hypersensibilitäten und Schmelzeinbrüche an bleibenden Molaren für die Betroffenen von funktioneller Bedeutung. Während die Häufigkeit der MIH in einer Größenordnung zwischen ~ 10 % und ~ 30 % liegt und gut beschrieben ist, stellt sich die Situation bezüglich der Ursachenforschung unbefriedigend dar. Obwohl in der Vergangenheit Anstrengungen zur Klärung der Ätiologie unternommen wurden, liegt bis in die Gegenwart keine plausible Ätiologiekette vor. Ursachenforschungen sind dabei als methodisch anspruchsvoll zu beurteilen, da diese optimalerweise in prospektiv geplante Geburtskohortenstudien eingebettet sein sollten, welche spätestens mit der Geburt beginnen. Ziel des vorliegenden Beitrages ist es, die klinische Charakteristik der MIH, Häufigkeiten und potenzielle Ursachen unter besonderer Berücksichtigung bereits publizierter Ergebnisse aus den beiden Münchner Geburtskohortenstudien GINIplus und LISA zusammenfassend darzustellen.

Introduction This article describes the features that should be considered when describing, purchasing and using a light-curing unit (LCU). Methods The International System of Units (S.I.) terms of radiant power or radiant flux (mW), spectral radiant power (mW/nm), radiant exitance or tip irradiance (mW/cm2 ), and the irradiance received at the surface (also in mW/cm2 ) are used to describe the output from LCU. The concept of using an irradiance beam profile to map the radiant exposure (J/cm2 ) from the LCU is introduced. Results Even small changes in the active tip diameter of the LCU will have a large effect on the radiant exitance. The emission spectra and the effects of distance on the irradiance delivered are not the same from all LCUs. The beam profile images show that using a single averaged irradiance value to describe the LCU can be very misleading. Some LCUs have 'hot spots' of high radiant exitance that far exceed the current ISO 10650 standard. Such inhomogeneity may cure the resin unevenly and may also be dangerous to soft tissues. Recommendations are made that will help the dentist when purchasing and then safely using the LCU. Conclusions Dental manufacturers should report the radiant power from their LCU, the spectral radiant power, information about the compatibility of the emission spectrum from the LCU with the photoinitiators used, the active optical tip diameter, the radiant exitance, the effect of distance from the tip on the irradiance delivered, and the irradiance beam profile from the LCU.

Objectives To analyze retrospectively the clinical performance and survival of lithium disilicate inlays, partial crowns and crowns placed by undergraduate students. Methods 250 lithium disilicate posterior restorations (IPS™Emax Press) were evaluated. Mean service time was 6.6 years (79 months) with a maximum observation time of 8.5 years (102 months). Clinical performance was assessed using FDI Criteria. Descriptive statistics were used to display the distribution of the criteria. Success and survival of the restorations were calculated with the Kaplan Meier method. A Cox regression analysis was performed to detect influencing parameters for the survival or the success of the restorations. Results Survival and success rates of lithium disilicate indirect restorations were calculated at 6.6 years with 96.3 % and 93.8 %, respectively. After 8.5 years the survival rate was calculated with 94 % and the success rate with 83.8 %. 10 out of 250 restorations (4%) failed, while the main reasons for failure were fracture of material, debonding/loss of restoration, endodontic complications as well as recurrence of caries. A Cox regression analysis failed to show a correlation between restoration failure and the experience level of the students, an existing root canal treatment, type of tooth, bruxism or the use of rubber dam. Conclusions Lithium disilicate indirect posterior restorations demonstrate a high success and survival rate after a mean service of 6.6 years when placed by undergraduate students with different levels of experience. Co-factors influencing the survival or success rate of these restorations could not be identified. Clinical significance Lithium disilicate restorations show a good clinical performance up to 8.5 years when prepared by undergraduate students.

Background The purpose of this prospective clinical diagnostic study with validation was to compare the diagnostic accuracy of near-infrared transillumination (NIRT), laser fluorescence measurement (LF), alternating current impedance spectroscopy (ACIS) and their combinations as adjunct methods to visual examination (VE) for occlusal caries detection using a hybrid reference standard. Methods Ninety-six first and second non-cavitated permanent molars from 76 individuals (mean age 24.2) were investigated using (VE) (ICDAS) and bitewing radiography (BWR), as well as NIRT, LF and ACIS. The findings of BWR and NIRT were evaluated by two examiners while the other examinations were conducted by one calibrated dentist. The hybrid reference standard consisted of non-operative validation based on the results of VE and BWR and operative validation. Statistical analysis included cross-tabulations, calculation of sensitivity, specificity and area under the receiver operating characteristic curve at three diagnostic thresholds: caries in general, enamel caries and dentin caries. Results NIRT, LF and ACIS exhibited high sensitivity for caries in general [1.00 (1.00–1.00), 0.77 (0.65–0.88), 0.75 (0.63–0.87)) and for dentin caries (0.97 (0.91–1.03), 0.76 (0.76–0.90), 0.64 (0.47–0.80)]. Sensitivity values for enamel caries were weak (0.21, 0.11, 0.37). Specificity values did not fall below 0.65 (NIRT) for all categories and methods, except for NIRT at the caries detection threshold (0.27). A combination of LF and ACIS with VE improved the diagnostic performance at the overall and the enamel caries threshold. The other methods showed fair to excellent discrimination at the overall caries threshold (NIRT 0.64, LF 0.89 and ACIS 0.86) and acceptable discrimination at the dentin caries threshold (NIRT 0.82, LF 0.81 and ACIS 0.79). AUROC for enamel caries exhibited the weakest discrimination. Accuracy was 65.6% for VE, 69.8% for BWR, 50.0% for NIRT, 53.1% for LF and 74.0% for ACIS. Reliability assessment for BWR and NIRT showed at least substantial agreements for all analyses. Conclusions The methods, NIRT, LF and ACIS, revealed different potential but no impeccable performance for occlusal caries detection. All are suitable instruments to detect hidden carious lesion in dentin. As auxiliaries to VE, LF and ACIS showed an increase in diagnostic performance.

This in vitro study evaluated the shear bond strength (SBS), failure mode and microleakage of fissure sealing materials in relation to different etching times on aprismatic and prismatic enamel. Ninety-six healthy human third molars were randomly allocated to the following groups: 1) prismatic or aprismatic enamel; 2) etching: 15, 30, 45, 60 s. After 5,000-fold thermocycling SBS, failure mode and microleakage were measured. Statistical evaluation included Mann-Whitney-U-test and linear regression analysis. In the aprismatic enamel group, an increasing etching time resulted in higher SBS. The linear regression model revealed that 60 s of etching time led to a significant increase in SBS. Microleakage was found to be low in all test groups. This study indicated that 60 s of etching time showed to a significantly better SBS. When considering the small differences of SBS, failure modes and microleakage between 30 and 60 s etching time, 30 s acid etching seems to also be justifiable.

Objectives The purpose of this in vitro study was to assess the two-body wear and fracture behaviour of an experimental additive manufactured composite crown in comparison to zirconia and stainless steel crowns and its cementation protocol for primary molars. Material and methods Three different paediatric crowns – experimental composite crowns (CCs, 3M), zirconia crowns (ZCs, NuSmile), and stainless steel crowns (SSCs, 3M)–were cemented with an experimental resin-modified glass ionomer cement (RMGIC, 3M) and two self-adhesive cements (SACs; RelyX Unicem Automix 2, 3M; BioCem, NuSmile). Seven groups, each with eight specimens, were thermally cycled (55 °C/50 °C) and dynamically loaded (50N/ 1.2Hz) in a masticatory simulator with steatite antagonists. The areal and volumetric material loss of all specimens before and after 1,200,000 masticatory cycles was evaluated with a 3D profilometer. Light and scanning electron microscopy were used for qualitative analysis. Pairwise comparisons between all the groups were performed using the Mann–Whitney U test (p Results Microscopic imaging revealed different wear patterns for each material. Lowest fracture rates were documented for the CCs. In contrast, all the SSCs showed perforations. The CCs cemented with RMGIC showed the highest significant volumetric wear (6.3 ± 0.72 mm³), followed by the SSCs cemented with RMGIC (3.6 ± 1.79 mm³) and CCs cemented with SAC (3.5 ± 1.92 mm³). No significant differences were found in terms of the wear among all the other groups, ranging between 0.4 ± 0.25 and 0.6 ± 0.32 mm³. Conclusion The volume loss of the tested crowns differed for each material and was dependent on the type of cementation. With regard to in vitro wear and fracture patterns, cementation with SAC may increase the clinical performance of CC paediatric crowns.

The aim of this study was to assess near-infrared transillumination with high dynamic range imaging (NIRT-HDRI) for occlusal caries detection in vitro and to compare it with visual inspection using the International Caries Detection and Assessment System II (ICDAS) and digital bitewing radiography (BWR). Sixty-one extracted permanent molars with sound or occlusal carious surfaces without severe cavitation were visually assembled. Two examiners assessed twice these surfaces independently using ICDAS, BWR and NIRT-HDRI. The latter was performed with a prototype consisting of two laser sources (780 nm), a CCD sensor and subsequent processing with image analysis software. Thresholds for carious surfaces, enamel and dentin lesions were defined for all methods. Micro-computed tomography served as the reference standard. Linear weighted Kappa analysis of the methods versus the reference at the threshold carious surface, enamel and dentin lesion revealed 0.59/0.08/0.12 for ICDAS, 0.37/− 0.06/0.58 for BWR and 0.33/− 0.01/0.51 for NIRT-HDRI. Sensitivity values at the three thresholds were 0.85/0.78/0.13 for ICDAS, 0.59/0.00/0.69 for BWR and 0.98/0.33/0.78 for NIRT. Specificity values at the three thresholds were 0.70/0.40/1.00 for ICDAS, 0.9./0.96/0.90 for BWR and 0.30/0.65/0.72 for NIRT-HDRI. Reliability analysis revealed substantial agreement for BWR and NIRT and almost perfect agreement for ICDAS. NIRT exhibited a strong ability to identify occlusal dental decay in general; however, it revealed a tendency towards overestimation. Its strength was the detection of dentin caries lesions compared with ICDAS and BWR. NIRT-HDRI seems to be a suitable method to detect hidden dentin caries as a supplement to visual examination.

OBJECTIVE: Titanium (Ti)- and Zirconia (ZrO2)-implants in mini pig maxillae were compared with respect to Ti/zirconium (Zr) release into the surrounding bone tissues, the resulting short term tissue responses and the potential toxicity. METHODS: Ti/Zr release from Ti- and ZrO2-implants in mini pig maxillae was determined with inductively coupled plasma optical emission spectrometry (ICP-OES) and inductively coupled plasma mass spectrometry (ICP-MS). The spatial distribution of Ti and Zr in maxilla tissues near the implant surface was assessed with laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS). A histological analysis was performed to investigate the tissue responses after 12 weeks of implantation. The cytotoxicity and DNA damage of Ti particles and ZrO2 particles were studied with XTT and Comet assay. RESULTS: The mean Ti content in the bone adjacent to Ti-implants was 1.67 mg/kg-bone weight. The highest Ti content detected was 2.17 mg/kg-bone weight. The mean Zr content in the bone adjected to ZrO2-implants was 0.59 mg/kg-bone weight. The highest Zr content was 0.75 mg/kg-bone weight. The spatial distribution of the Ti and Zr in bone showed mainly a higher intensity of Ti and Zr close to the screw thread outer tip rather. Histological analysis indicated that near both implant-types signs of bone marrow fibrosis were present. EC50 of commercially available ZrO2-nanoparticles (NPs

Objectives To provide consensus recommendations on how to intervene in the caries process in adults, specifically proximal and secondary carious lesions. Methods Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. Results Managing an individual’s caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for secondary lesions should be tailored according to the individual’s caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm secondary caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing secondary caries, if possible. Conclusions An individualized and lesion-specific approach is recommended for intervening in the caries process in adults. Clinical significance Dental clinicians have an increasing number of interventions available for the management of dental caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients’ expectations, clinicians’ expertise, and the individual clinical scenario all need to be considered during the decision-making process.

This paper provides recommendations for dentists for the treatment of dental caries in children, with an emphasis on early childhood caries (ECC), primary teeth, and occlusal surfaces in permanent teeth. A consensus workshop followed by an e-Delphi consensus process was conducted with an expert panel nominated by the European Organization for Caries Research (ORCA) and European Federation of Conservative Dentistry (EFCD)/German Association of Conservative Dentistry (DGZ) boards. Based on 3 systematic reviews and a nonsystematic literature search, recommendations were developed. The caries decline has led to a more polarized disease distribution in children and adolescents along social gradients which should be taken into account when managing the caries process at all levels, such as the individual, the group, or a population. The control or reduction of caries activity is the basis for successful caries management. In children, caries management requires adequate daily oral hygiene and fluoride application via toothpaste, ensured by caregivers, and especially for ECC prevention an emphasis on sugar intake reduction is needed. These noninvasive interventions are also suitable to arrest or control initial or even cavitated dentine caries lesions in the absence of irreversible pulpitis. Fluoride varnish or silver diammine fluoride can be added as supplementary agents. In pits and fissures, composite resin materials can be used as preventive sealants and for defect-oriented minimally invasive restorations. In primary molars, preformed metal crowns are more successful than multisurface fillings, especially in caries-active patients. With persisting high caries activity, multiple lesions, and limited cooperation, caries control should consist of robust measures with high success rates, even including extraction in selected cases. This applies especially to treatments performed under general anesthesia., info:eu-repo/semantics/published

OBJECTIVES: To evaluate the effect of bioactive glass 45S5 (BG) in experimental composites on flexural strength (FS), flexural modulus (FM), modulus of resilience (MR), and material reliability after artificial aging in water for 1, 7, and 30 days, and an additional accelerated aging for 3 days in a 75 vol% ethanol-water solution. MATERIALS AND METHODS: Five experimental light-curable composites were prepared with 0-40 wt% of BG and a total filler load of 70 wt%. The resinous matrix was Bis-GMA/TEGDMA in 60:40 by weight. Mechanical properties were evaluated using a three-point bending test (ISO/DIN 4049:1998) with n = 20. Weibull statistics were used to assess material reliability. Additionally, the degree of conversion (DC) was assessed 24 h post- cure using FT-Raman spectroscopy. RESULTS: FS and FM decreased linearly as the amount of BG was increased. The ISO 4049 requirement for a minimum FS of 80 MPa was fulfilled in experimental composites with up to 20 wt% of BG. Degradation of FS and FM with artificial aging was more extensive in materials with higher BG amounts. MR decreased as a function of BG amount and artificial aging. Material reliability (Weibull modulus) was stable through aging for composites with up to 10 wt% of BG. DC was negatively influenced by the BG amount and ranged from 64 to 81%. CONCLUSION: Increasing the amount of unsilanized BG fillers from 0 to 40 wt% resulted in a progressive decline in mechanical properties and a more extensive degradation during artificial aging. CLINICAL RELEVANCE: Bioactive fillers diminished the mechanical properties in a dose-dependent manner.

Nanoparticles having a size from 1 to 100 nm are present in nature and are successfully used in many products of daily life. In dental materials, nanoparticles are typically embedded but they may also exist as by-products from milling processes. Possible adverse effects of nanoparticles have gained increased interest, with the lungs being the main target organ. Exposure to nanoparticles in the dental laboratory is addressed by legal regulations. In dental practice, nanoparticles are mainly produced by intra-oral grinding/polishing and removal of materials, by wear of restorations or release from dental implants. Based on worst-case mass-based calculations, the additional risk as a result of exposure to nanoparticles is considered to be low. However, more research is needed, especially on vulnerable groups (patients with asthma or chronic obstructive pulmonary disease). An assessment of risks for the environment is not possible because of lack of data. Exposure-reduction measures mainly include avoidance of abrasive processes (for example, by proper sculpturing), cooling by the use of water spray and sufficient ventilation of treatment areas. ispartof: INTERNATIONAL DENTAL JOURNAL vol:68 issue:5 pages:299-305 ispartof: location:England status: published

To compare the clinical performance of two glass-ionomer cements in combination with two light-cured coatings in Class II cavities.In total, 43 Equia Fil/Equia Coat and 42 Fuji IX GP Fast/Fuji Coat LC restorations were placed, in 34 patients. Only Class II cavities with two- or three-surface restorations were included. The clinical performance was evaluated at baseline, after 1, 2, and 3 years using the FDI criteria. For the statistical analysis, Fisher exact test, Wilcoxon signed-rank test and Mann-Whitney U test were applied. The success and survival of the restorations were calculated with the Kaplan-Meier method and a log-rank test was used to detect significant differences between the tested materials.At the 3-year recall, no significant differences could be detected between the two glass-ionomer cements for any of the evaluated criteria (Mann-Whitney U test, P.05). When comparing the baseline with the recall data at 3 years for each material separately, significant changes could be observed in both materials for the criteria "surface luster," "fracture of material and retention," and "approximal anatomical form" (Wilcoxon signed-rank test, P.05). Additionally, the Equia Fil restorations showed a notable change for the criteria "marginal adaptation" (Wilcoxon signed-rank test, P = .039). At the 3-year follow up, the Equia Fil and the Fuji IX GP Fast restorations exhibited an overall survival rate of 89.3% and 88.0%, respectively. Three fillings in each group failed.The two glass-ionomer cements tested performed similarly in Class II cavities in adult patients, with a moderate failure rate after 3 years. (Original article published in Quintessence Int 2019;50:592-602; doi: 10.3290/j.qi.a42692).

This meta-analysis investigated the influence of different acid etching times on the retention rate of pit-and-fissure sealants based on clinical trials with a minimum duration of two years.A literature search was carried out in electronic databases along with hand searching to identify clinical trials that evaluated pit-and-fissure sealants in permanent molars. From 1280 identified abstracts, 195 studies were selected for full-text analysis, and 28 studies with 36 test groups were included in this meta-analysis. Test groups with etching times of 15 (n = 3), 20 (n = 2), 30 (n = 10), 40 (n = 1) and 60 s (n = 20) were found. Incidence rates of pit-and-fissure sealant losses were modelled using negative binomial regression.The regression analysis did not reveal a significant influence of etching time on the survival of pit-and-fissure sealants based on the identified and included clinical trials.Due to the limited number of clinical data for 15 and 20 s, conclusions regarding very short acid etching times were not possible. On the basis of regression analysis, a minimum of 30-s acid etching might be sufficient prior to fissure sealing.

This study aimed to assess the effects of fiber incorporation on the contraction stress (CS), time to gelation (TG), and temperature rise (TR) features of two experimental resin-based composites (RBCs) in comparison to those of bulk-fill RBCs and conventional RBCs in simulated, clinically relevant cavities. CS over 300 s, TG and TR were assessed by a stress-strain analyzer (SSA T80) in two cavity configurations (2 × 4 × 4 mm3/4 × 4 × 4 mm3/configuration value $$ \raisebox{1ex}{$1$}\!\left/ \!\raisebox{-1ex}{$2$}\right. $$ and $$ \raisebox{1ex}{$1$}\!\left/ \!\raisebox{-1ex}{$3$}\right. $$ ) for two experimental RBCs, eight bulk-fill RBCs (EverX Posterior, Filtek Bulk Fill, SDR, SonicFill, Tetric EvoCeram Bulk Fill, Venus Bulk Fill, X-tra base, and X-tra Fill) and one RBC (Filtek Supreme XTE) by light curing (1200 mW/cm2) (n = 10). The experimental materials used were based on EverX Posterior with modifications made to the fiber and filler content. Statistical analyses were performed via ANOVA; multiple pair-wise comparisons were performed via Tukey’s test, and homogeneous subsets were identified (“multcomp” package, R). CS values ranged from 1.00 to 4.07 MPa (2 × 4 × 4 mm3) and from 0.97 to 2.49 MPa (4 × 4 × 4 mm3); TG values ranged from 1.31 to 4.05 s (2 × 4 × 4 mm3) and from 1.39 to 3.84 s (4 × 4 × 4 mm3). SDR values showed lowest stress values in both cavity configurations. The experimental composite with fibers presented significantly higher stress values than did the experimental composite without fibers. Bulk-fill RBCs showed lower levels of stress than did conventional RBCs. The incorporation of fibers had no positive impact on the CS and TG. Appropriate material selection may be essential to clinical success because certain RBCs exhibit higher CS, TG, and TR values.

AIM To assess the feasibility of producing artificial teeth for endodontic training using 3D printing technology, to analyse the accuracy of the printing process, and to evaluate the teeth by students when used during training. METHODOLOGY Sound extracted human teeth were selected, digitalized by cone beam computed tomography (CBCT) and appropriate software and finally reproduced by a stereolithographic printer. The printed teeth were scanned and compared with the original ones (trueness) and to one another (precision). Undergraduate dental students in the third and fourth years performed root canal treatment on printed molars and were subsequently asked to evaluate their experience with these compared to real teeth. RESULTS The workflow was feasible for manufacturing 3D printed tooth replicas. The absolute deviation after printing (trueness) ranged from 50.9 to 104.3 μm. The values for precision ranged from 43.5 to 68.2 μm. Students reported great benefits in the use of the replicated teeth for training purposes. CONCLUSION The presented workflow is feasible for any dental educational institution who has access to a CBCT unit and a stereolithographic printer. The accuracy of the printing process is suitable for the production of tooth replicas for endodontic training. Undergraduate students favoured the availability of these replicas and the fairness they ensured in training due to standardization.

This study compared the diagnostic outcomes of visual inspection (VI), digital bitewing radiography (BWR), and near-infrared light transillumination (NIR-LT, DIAGNOcam, KaVo, Biberach, Germany) for occlusal caries detection and assessment of posterior teeth. This study included 203 patients (mean age 23.0 years). All individuals received a meticulous VI. Additionally, BWR and NIR-LT images were collected. All BWR and NIR-LT images were blindly evaluated for the presence of enamel caries lesions (ECLs) and dentin caries lesions (DCLs). The descriptive statistical analyses included calculation of frequencies, cross tabulations, and pairwise comparisons using Pearson chi-square tests. The majority of ECLs/DCLs were detected by VI in this low-risk adult population. The additional diagnostic outcomes in terms of ECLs/DCLs amounted to 5.0% (BWR) and 6.8% (NIR-LT). The combined usage of VI/NIR-LT or VI/BWR identified 95.7 and 94.4% of all ECLs/DCLs on occlusal surfaces, respectively. This comparative diagnostic study showed that VI detected the majority of occlusal caries lesions. Both additional methods showed limited benefits. Due to the valuable features of NIR-LT, i.e., X-ray freeness and clinical practicability, this method might be preferred over X-ray-based methods. Nevertheless, BWRs should be prescribed in clinical situations where insufficient fillings or multiple (deep) caries lesions are diagnosed or where there is a need to assess the caries extension in relation to the pulp. VI has to be understood as caries detection method of choice on occlusal surfaces in low-risk adult population which may help to avoid multiple diagnostic testing, overdiagnosis, and overtreatment.

Aim To assess the feasibility of creating a realistic model for hands-on training in dental traumatology using 3D printing technology, and then to investigate the added value of working with the website dentaltraumaguide.org. Methodology With the use of special software applications, a model was designed based on the CBCT of the maxilla of a real patient that imitated several traumatic dental injuries. The model was reproduced using a stereolithographic printer to use the specimens in a hands-on training course on dental traumatology for undergraduate students in their final year in the Department of Conservative Dentistry and Periodontology in Munich, Germany. During the course, half of the participants had access to dentaltraumaguide.org, whereas the others did not. The students were then assessed according to their theoretical knowledge and practical performance in simulated treatment. These data were analysed by Kolmogorov-Smirnov test, unpaired t-test and Mann-Whitney U test. Subsequently, the participants were asked to evaluate the model. Results The workflow for manufacturing a model of dental traumatology for training purposes was practical and relatively inexpensive. In the evaluation process, the model was considered to be highly realistic and useful during an instructive hands-on training course. There were significant differences between the two groups in favour of using the dentaltraumaguide.org website. Conclusions 3D printing technology offers new possibilities for training specific dental treatments that are currently difficult to imitate. The online platform dentaltraumaguide.org assisted students in correctly managing traumatic dental injuries.

The purpose of this study was to develop an in vitro model for the validation of near-infrared transillumination (NIRT) for proximal caries detection, to enhance NIRT with high-dynamic-range imaging (HDRI), and to compare both methods, using micro-computed tomography (µCT) as a reference standard. Both proximal surfaces of 53 healthy or decayed permanent human teeth were examined using the Diagnocam (DC) (KaVo) and NIRT with HDRI (NIRT-HDRI). NIRT was combined with HDRI to improve the diagnostic performance by reducing under- and overexposed image areas. For NIRT-HDRI, an exposure series was captured and merged into a single HDR image. A classification was applied according to lesion depth. All surfaces were assessed twice by 2 trained examiners, and additionally with µCT for validation. The Kappa statistic was used to calculate inter-rater reliability and agreement between DC and NIRT-HDRI. Inter-rater reliability (weighted Kappa, wκ) showed very good agreement for the DC (0.90) and NIRT-HDRI (0.96). The overall agreement (wκ) was almost perfect (0.85). In the individual categories (0 to 4), the agreement (simple Kappa) ranged from almost perfect (category 4) to moderate (1 and 2) to substantial (categories 0 and 3). Sensitivity and specificity of sound surfaces, enamel, and dentin caries ranged from 0.57 to 0.99 and were similar for both methods in the different categories. NIRT-HDRI had a higher sensitivity for sound surfaces and enamel caries, as well as a higher specificity for dentin caries. Regarding the obtained images, HDRI allowed for the detection of caries within a greater range of luminance levels, resulting in a more detailed visualization of structures without under- or overexposure. However, HDRI this did not improve the diagnostics significantly. Distinguishing between a processed demineralized enamel and dentin lesions appears to be a problem specific to NIRT and cannot be balanced using HDRI.

Objectives (1) To investigate the genotoxicity of a glass ionomer cement (GIC) and GIC incorporated with titanium dioxide nanopoarticle (TiO2NPs) and with microparticle (TiO2MPs) on DNA double-strand breaks of human gingival fibroblast cells (HGFs). (2) To compare the genotoxic differences between GIC and two modified cements. Methods TiO2NPsGIC and TiO2MPsGIC were prepared by adding 10% w/w of TiO2NPs and TiO2MPs to the GIC powder and hand-mixed followed the manufacturer instruction. Dulbecco’s Minimum Essential Medium (DMEM) was used as a culture medium for HGFs and eluate preparation. Eluates from all groups were collected for XTT cell viability assay to obtain EC50 values. γ-H2AX immunofluorescence assay was performed to detect DNA double-strand breaks (DSBs) of HGFs. Results EC50 values were from 38% to 60% and eluate concentrations at 20% and 5% were selected for γ-H2AX immunofluorescence assay. At both concentrations, HGFs exposed to eluates from all cements groups had fewer mean foci per cell and higher percentage of free foci cells than H2O2 (p Significance Neither GIC nor 10% TiO2-modified GICs had a genotoxic effect on HGFs. Both TiO2NPsGIC and TiO2MPsGIC demonstrated less genotoxic effect than GIC. When comparing between the two modified cements, there was no genotoxic difference between the modified cements from different particle sizes (nanoparticle and micro-particle) of TiO2.

Antimicrobial peptides (AMPs) represent important facets of the immune system controlling infectious diseases. However, pathogens show varying susceptibilities to AMPs. This study investigates the susceptibilities of strains of Streptococcus mutans (SM), Actinomyces naeslundii (AN), and Lactobacillus spp. (LB) towards AMPs and if there are correlations between the appearance of such high-risk strains and clinical caries status. Plaque samples were collected from patients along with clinical examinations. Bacterial strains were identified via selective media, matrix-assisted laser desorption/ionization analysis-time of flight (MALDI-TOF), and arbitrary-primed-PCR (AP-PCR). Each strain was tested for susceptibility to LL-37, HBD-2, HNP-1, and HNP-3 or phosphate-buffered saline as negative control in a biofilm model on hydroxylapatite discs. Survival rates and resulting risk classification for each strain were determined. Correlations were calculated between the number of high-risk strains (all/S. mutans) appearing in patients and their clinical caries status. Forty-seven patients were included with mean DMFT values of 11.4 ± 8.7. A total of 8 different SM, 30 LB, and 47 AN strains were detected. One-way ANOVA indicated that type/concentration of AMPs had major influence on reductions of Lactobacilli and Actinomyces. Seventeen strains of AN, 2 of SM, and 6 of LB had low susceptibilities to AMPs. The number of such strains in patients showed significant positive correlations to the DMFT values (all p = 0.001; r = 0.452; S. mutans p

The aim of this study was to retrospectively investigate the development of a model-based, computer-assisted training approach for performing and charting periodontal examinations in a dental clinic in Germany. The study was initiated in summer semester 2013 and repeated in two consecutive semesters (S1: 44 students, S2: 48 students, and S3: 61 students) because technical features were introduced (S2: feedback and time control; S3: input control). In each semester, new dental students who had never performed periodontal examinations participated. Students were divided into two groups and received intense training at different time points. Agreement levels were calculated at baseline, after the first group received training, and after the second group received training. Comparisons were also made among the semesters. All 153 enrolled students in the three semesters participated. The results showed that probing depth accuracy significantly decreased in S1 from baseline to training completion (79.9% to 74.5%), and the probing depth accuracy significantly increased in S2 (76.1% to 78.9%) and S3 (77.2% to 82.3%). The students who received intense training at a late stage of the tutorial showed greater improvement, especially in the case of S3. Small changes in accuracy were observed for recession (S1: 94.5% to 96.1%; S2: 93.8% to 93.9%; S3: 95.4% to 96.6%). Accuracy for furcation involvement improved significantly in S1 (46.1% to 52.0%), S2 (46.8% to 59.7%), and S3 (44.2% to 58.3%); the improvements occurred when the students received intense training. The time taken for periodontal examination decreased significantly for S2 (23.6 to 14.2 min) and S3 (25.7 to 13.9 min). This study found that when feedback was provided, the students' periodontal examinations improved in accuracy and duration.

This study aimed to evaluate the shear bond strength (SBS) and microleakage of a new self-etch adhesive-based fissure sealant (EG) on aprismatic enamel in comparison to conventional fissure sealing with 30 s acid etching (CG). The fissures were sealed according to the manufacturer's instructions. Each group was divided into 3 subgroups: 1-day water storage, 3-month water storage, and 5,000× thermocycling. After measuring SBS using the Ultradent method, failure mode was analyzed. In additional 16 teeth, microleakage was tested using dye penetration method. Pairwise comparisons were analyzed using Mann-Whitney U-Test. Multiple linear regression was performed to assess the factors influencing on SBS. EG had significantly lower mean SBS (4.1 MPa±2.1) than the CG (17.6 MPa±6.4). CG (1.1%) performed significantly better than the EG (12.8%) in microleakage analysis. The tested EG yielded significantly inferior results and its clinical use should be decided after weighing its pros and cons.

Clinical research of restorative materials is confounded by problems of study designs, length of trials, type of information collected, and costs for trials, despite increasing numbers and considerable development of trials during the past 50 years. This opinion paper aims to discuss advantages and disadvantages of different study designs and outcomes for evaluating survival of dental restorations and to make recommendations for future study designs. Advantages and disadvantages of randomized trials, prospective and retrospective longitudinal studies, practice-based, pragmatic and cohort studies are addressed and discussed. The recommendations of the paper are that clinical trials should have rational control groups, include confounders such as patient risk factors in the data and analysis and should use outcome parameters relevant for profession and patients.

This cross-sectional study compared the caries experience in 15-year-olds with and without demarcated hypomineralised lesions (DHL) in permanent teeth. One thousand three hundred and two 15-year-old adolescents from two ongoing birth cohorts (GINIplus15 and LISAplus15) were examined to determine non-cavitated carious lesions (NCCL) and the DMF index. Furthermore, DHL was scored on all permanent teeth/surfaces according to the molar-incisor hypomineralisation criteria of the European Academy of Paediatric Dentistry (MIH/EAPD). Adolescents with DHL were categorised into those with a minimum of one DHL in the permanent dentition (DHL ≥ 1), with DHL on at least one first permanent molar (MIH/EAPD) and with DHL on at least one first permanent molar and permanent incisor (MIH/Severe). The study was conducted in the metropolitan area of Munich. The proportion of children without caries amounted to 63.7% (DMF > 0) and 26.0% (D1-4MF > 0); the caries experience was mean = 4.0(SD = 5.2) NCCL/T and 0.9(1.7) DMF/T. Existence of DHL ≥ 1, MIH/EAPD and MIH/Severe was detected in 40.2, 17.2 and 9.8% of all adolescents, respectively. The corresponding DMF/T values were: no DHL 0.9(1.7); DHL ≥ 1 1.0(1.7); MIH/EAPD 1.1(1.6); MIH/Severe 1.1(1.7). The group of adolescents with MIH/EAPD and MIH/Severe were found to have statistically higher caries rates in comparison to those with no DHL. Caries and DHL are prevalent and influenced the dental health of 15-year-old adolescents. A significant positive association existed between the presence of caries and DHL. Children with MIH/EAPD or MIH/Severe had a higher probability to develop carious lesions in the permanent dentition.

Objective Nanoparticles having a size from 1 to 100 nm are present in nature and are successfully used in many products of daily life. Nanoparticles are also embedded per se or as byproducts from milling processes of larger filler particles in many dental materials. Methods and Results Recently, possible adverse effects of nanoparticles have gained increased interest with the lungs being a main target organ. Exposure to nanoparticles in dentistry may occur in the dental laboratory, by processing gypsum type products or by grinding and polishing materials. In the dental practice virtually no exposure to nanoparticles occurs when handling unset materials. However, nanoparticles are produced by intraoral adjustment of set restorative materials through grinding/polishing regardless whether they contain nanoparticles or not. Nanoparticles may also be produced through wear of restorations or released from dental implants and they enter the environment when removing restorations. The risk for dental technicians is taken care of by legal regulations. Based on model worst case mass-based calculations, the exposure of dental practice personnel and patients to nanoparticles through intraoral grinding/polishing and wear is low to negligible. Accordingly, the additional risk due to nanoparticles exposure from present materials is considered to be low. However, more research is needed, especially on vulnerable groups (asthma or COPD). An assessment of risks for the environment is not possible due to the lack of data. Significance Measures to reduce exposure to nanoparticles include intraorally grinding/polishing using water coolants, proper sculpturing to reduce the need for grinding and sufficient ventilation of treatment areas.

Modern teaching formats have not been considered necessary during the COVID-19 pandemic with uncertain acceptance by students. The study’s aim was to describe and evaluate all measures undertaken for theoretical and practical knowledge/skill transfer, which included objective structured practical examinations (OSPEs) covering a communication skills training. The students’ performance in the OSPE as well as the theoretical knowledge level were assessed, of which the latter was compared with previous terms. In conservative dentistry and periodontology (4th and 5th year courses), theoretical teaching formats were provided online and completed by a multiple-choice test. Practical education continued without patients in small groups using the phantom-head, 3D printed teeth, and objective structured practical examinations (OSPEs) including communication skills training. Formats were evaluated by a questionnaire. The organization was rated as very good/good (88.6%), besides poor Internet connection (22.8%) and Zoom® (14.2%) causing problems. Lectures with audio were best approved (1.48), followed by practical videos (1.54), live stream lectures (1.81), treatment checklists (1.81), and virtual problem-based learning (2.1). Lectures such as .pdf files without audio, articles, or scripts were rated worse (2.15–2.30). Phantom-heads were considered the best substitute for patient treatment (59.5%), while additional methodical efforts for more realistic settings led to increased appraisal. However, students performed significantly worse in the multiple-choice test compared to the previous terms (p &lt, 0.0001) and the OSPEs revealed deficits in the students’ communication skills. In the future, permanent available lectures with audio and efforts toward realistic treatment settings in the case of suspended patient treatment will be pursued.

The effect of Actovegin® was investigated on PMA- and LPS-induced human peripheral blood mononuclear cells (PBMCs).PBMCs (1 × 10Stimulation of cells by PMA or LPS (without Actovegin®) significantly increased the secretion of IL-1beta, IL-6, IL-10 and TNF-α from PBMCs, compared to controls. Pre-treatment of cells with Actovegin® (1, 5, 25, 125 µg/ml) plus PMA significantly decreased the secretion of IL-1beta from PBMCs, compared to controls (PMA without Actovegin®). In contrast, addition of Actovegin® (1, 5, 25, 125 and 250 µg/ml) plus LPS did not alter the IL-1beta production, compared to controls (LPS without Actovegin®). TNF-α, IL-6 and IL-10 do not contribute to the reduction of inflammatory reactions with Actovegin®.Actovegin® can reduce the PMA-induced IL-1beta release and the ROS production from PBMCs. These findings may help to explain the clinically known positive effects of Actovegin® on athletic injuries with inflammatory responses (e.g., muscle injuries, tendinopathies).

The aim of this study was to determine the proportion of adolescents with severe caries to analyze the prevalence of caries and to visualize the unequal distribution. Data from three epidemiological studies (10- and 15-year-olds: GINIplus and LISA cohorts in Munich, Bavaria, 12-year-olds: LAGZ survey in Bavaria, Germany) with 2875 adolescents were available for analysis. All individuals were examined according to the WHO standard. Statistics included the calculation of mean dmft/DMFT values (standard deviation), Significant Caries Index (SiC) values, Specific Affected Caries Index (SaC) values, and Lorenz curves. Overall caries-free status was 58.6% in primary and 83.9% in secondary teeth (10-year-olds), 61.5% (12-year-olds), and 64.6% (15-year-olds). The proportion of 12- and 15-year-olds with at least four DMFTs was 9.4% and 8.3%, respectively. In addition, eight 15-year-olds with DMFT values ≥8 (0.6%) were registered. The SaC/SiC values amounted to 1.8/0.9 DMFT (10-year-olds), 2.6/2.8 DMFT (12-year-olds), and 2.5/2.5 DMFT (15-year-olds). The mean DMFT values in the upper 1% of subjects were 4.2 DMFT (10-year-olds), 8.5 DMFT (12-year-olds), and 8.5 DMFT (15-year-olds). Thus, caries is not equally distributed throughout adolescence, but individuals with severe caries are rare. Nevertheless, further interdisciplinary research seems to be needed to clarify potential risk factors.

The ingredients of Actovegin® were analyzed and its effects on the muscle cell proliferation were investigated. C2C12 myoblasts were cultured in medium. Actovegin® was added in five different concentrations (1, 5, 25, 125, and 250 µg) to the differentiation medium. The formations of proliferation factor Ki67 and myosin heavy chains were measured by immunofluorescence. The first primary antibody was anti-Ki67 and anti-Mf20. Cells were washed and treated with the second fluorochrome. Thirty-one Actovegin® ingredients were found to contain significantly higher concentrations and twenty-nine ingredients were found to contain significantly lower concentrations, compared to the mean ranges as described in the literature for the normal physiological concentrations in human adult serum/plasma. A significant increase in the formation of Ki67 was observed in Actovegin® groups, compared to controls. The mean area of myotubes was significantly increased in Actovegin® groups. A significant decrease in the number of myotubes was observed. An increased myotube size (fusion) was observed. The intensity of Mf20 was significantly increased in Actovegin® groups. It could be demonstrated that Actovegin® contains many physiological substances in significantly higher and some in lower concentrations compared to human adult serum. Furthermore, it could be shown that Actovegin® improves muscle cell proliferation.

Zur Erstellung der Leitlinie „Fissuren- und Grubchenversiegelung“ wurde eine ausfuhrliche Literaturrecherche vorgenommen und anschliesend die Publikationen mit einem klinischen Bezug den jeweiligen Detailfragen zugeordnet. Im Ergebnis der Arbeit wurden Schlusselempfehlungen erstellt und konsentiert. Ziel des vorliegenden Artikels ist es, die Ergebnisse aus dem Leitlinienprozess in Kurzform darzustellen und damit einen Beitrag zur Implementierung der Leitlinie zu leisten.

Objective The objective of this project, which was initiated from the Academy of Dental Materials, was to review and critically appraise methods to determine fracture, deformation and wear resistance of dental resin composites, in an attempt to provide guidance for investigators endeavoring to study these properties for these materials. Methods Test methods have been ranked in the priority of the specific property being tested, as well as of the specific test methods for evaluating that property. Focus was placed on the tests that are considered to be of the highest priority in terms of being the most useful, applicable, supported by the literature, and which show a correlation with clinical findings. Others are mentioned briefly for the purpose of being inclusive. When a standard test method exists, including those used in other fields, these have been identified in the beginning of each section. Also, some examples from the resin composite literature are included for each test method. Results The properties for evaluating resin composites were ranked in the priority of measurement as following: (1) Strength, Elastic Modulus, Fracture toughness, Fatigue, Indentation Hardness, Wear—abrasion (third body) and Wear—attrition (contact/two body), (2) Toughness, Edge strength (chipping) and (3) Wear determined by toothbrush. Significance The following guidance is meant to aid the researcher in choosing the proper method to assess key properties of dental resin composites with regard to their fracture, deformation and wear resistance.

PURPOSE: Resin-based CAD/CAM compound materials might be promising for single-tooth restorations. Insufficient clinical data are available for this new material class. The purpose of this study was to describe initial clinical in vivo results for indirect particle-filled composite resin CAD/CAM restorations after 24 months. MATERIALS AND METHODS: Indirect particle-filled composite resin restorations were fabricated with a CAD/CAM method (CEREC Bluecam intraoral scanner, CEREC MCXL milling unit) by calibrated dental students. Forty-two partial crown restorations were seated adhesively in 30 patients with caries lesions or insufficient restorations (baseline). Strict inclusion criteria were defined for the patient collective. Follow-up evaluation comprised 40 restorations after 12 months and 33 restorations after 24 months. Evaluation criteria were modified FDI criteria with grades (1) to (5). Rating with FDI criteria (5) was defined as clinical failure. Statistical analysis was performed with Wilcoxon-Test (p < 0.05). RESULTS: The success rate of indirect particle-filled composite resin CAD/CAM restorations after 12 months was 95.0% with two debondings observed. The cumulative success rate for indirect particle-filled composite resin CAD/CAM restorations after 24 months was 85.7% with two tooth fractures and one debonding. Statistically significant differences were found for baseline and 24-month follow-up evaluation for anatomic form and marginal adaptation criterion examined in respect to FDI criteria guidelines (Wilcoxon-Test, p < 0.05). CONCLUSIONS: This study demonstrates particle-filled composite resin CAD/CAM restorations having a clinical success rate of 85.7% after 24 months. Adhesive bonding procedures need to be ensured carefully. A longer clinical evaluation period is necessary to draw further conclusions.

Objective To evaluate a range of mechanical parameters of composite resins and compare the data to the frequency of fractures and wear in clinical studies. Methods Based on a search of PubMed and SCOPUS, clinical studies on posterior composite restorations were investigated with regard to bias by two independent reviewers using Cochrane Collaboration’s tool for assessing risk of bias in randomized trials. The target variables were chipping and/or fracture, loss of anatomical form (wear) and a combination of both (summary clinical index). These outcomes were modelled by time and material in a linear mixed effect model including random study and experiment effects. The laboratory data from one test institute were used: flexural strength, flexural modulus, compressive strength, and fracture toughness (all after 24-h storage in distilled water). For some materials flexural strength data after aging in water/saliva/ethanol were available. Besides calculating correlations between clinical and laboratory outcomes, we explored whether a model including a laboratory predictor dichotomized at a cut-off value better predicted a clinical outcome than a linear model. Results A total of 74 clinical experiments from 45 studies were included involving 31 materials for which laboratory data were also available. A weak positive correlation between fracture toughness and clinical fractures was found (Spearman rho = 0.34, p = 0.11) in addition to a moderate and statistically significant correlation between flexural strength and clinical wear (Spearman rho = 0.46, p = 0.01). When excluding those studies with “high” risk of bias (n = 18), the correlations were generally weaker with no statistically significant correlation. For aging in ethanol, a very strong correlation was found between flexural strength decrease and clinical index, but this finding was based on only 7 materials (Spearman rho = 0.96, p = 0.0001). Prediction was not consistently improved with cutoff values. Significance Correlations between clinical and laboratory outcomes were moderately positive with few significant results, fracture toughness being correlated with clinical fractures and flexural strength with clinical wear. Whether artificial aging enhances the prognostic value needs further investigations.

We examined whether fluoride/vitamin D supplementation in the first year of life is associated with caries or molar incisor hypomineralization (MIH) at 10 years of age. The study population consisted of 406 children for whom information on fluoride/vitamin D supplementation during the first year of life was available. Dental examination at the age of 10 included caries and MIH registration. The results of logistic regression models were adjusted for gender, age, BMI, parental education, and equivalent income. Children receiving supplementation during the entire first year of life had a significantly lower probability of having caries-related restorations in primary teeth in comparison to those who received supplementation for less than 6 months (fluoride supplementation: odds ratio (OR) for d3–4mfs 2.47 (1.32–4.63), for fs 2.70 (1.43–5.10); vitamin D supplementation: OR for d3–4mfs 2.08 (1.00–4.32), fs 2.50 (1.19–5.25)). The majority of logistic regression analyses indicated no association between supplementation and MIH. It was found a consistent significant caries-preventive effect in the primary dentition of children who received fluoride (256/372)/vitamin D supplementation (274/376) in all 12 months over the first year of life; no effects were observed for permanent dentition. The high parental interest in supplementation is linked to an imbalance of the study groups. Furthermore, tooth brushing frequency, use of fluoride toothpastes and/or other oral hygiene products were not recorded during the observation period which may also confound the results. Fluoride/vitamin D supplementation can be used in children for preventing caries in the primary dentition.

The aim of this study was to develop and test models for training dental students in periodontal examinations using manikins that had distinct anatomical designs but were indistinguishable in external appearance. After four models were tested for inter- and intra-examiner reliability by two experienced dentists, 26 additional models were produced. The models were tested by 35 dental students at a dental school in Germany in 2014. The testing involved completing a periodontal examination that included probing depths, gingival recessions, and furcation involvements. The primary purpose of the study was to determine whether the models could be used as a tool for periodontal examination training by the students. Levels of agreement (students and dentists) and Kappa statistics (dentists) were calculated using absolute (±0 mm) and tolerable difference (±1 mm). Over the span of two weeks, the dentists' reliability with preset values for probing depths, gingival recessions, and furcation involvements ranged from 0.29 to 0.38, 0.52 to 0.61, and 0.54 to 0.57, respectively, under absolute difference and from 0.86 to 0.90, 0.96 to 0.99, and 0.62 to 0.73, respectively, under tolerable difference. The students' proportions of agreement for probing depths and gingival recessions under absolute vs. tolerable difference were 34.8% vs. 79.9% and 71.9% vs. 94.4%, respectively. The students frequently scored values higher than the preset values, overestimated furcation involvements, and failed to differentiate the levels of furcations. The models used did not pose any systematic or technical difficulties in the pilot study. Students were unable to measure furcation involvements with acceptable agreement. Thus, these models could be used for student periodontal examination training.

The aim of this study was the in-vitro validation of VistaCam iX HD, which uses near-infrared reflection (NIRR), for proximal caries detection. It was compared with digital bitewing radiography (BWR), and micro-computed tomography (µCT) was used as the reference standard. One-hundred teeth with either sound (n = 54) or carious (n = 46) proximal surfaces were selected using visual-tactile criteria. Images of these surfaces were generated using BWR and NIRR. Evaluation was performed by two examiners, twice, at an interval of 2 weeks. All samples were scanned with a micro-computed tomograph. Thresholds were defined for sound surfaces, and for enamel and dentin lesions, for all methods. Both BWR and NIRR showed moderate sensitivity for the detection of any caries (0.50 for NIRR and 0.53 for BWR). For enamel lesions, sensitivity was lower (0.13 for NIRR and 0.31 for BWR). Specificity was high (≥0.94) in all categories for both methods. Inter-rater reliability ranged from 0.89 to 0.93 and intra-rater reliability from 0.80 to 0.89. Surface evaluation of images generated using NIRR was complicated by overexposed areas; approximately 25% of the images were not clearly interpretable. In conclusion, NIRR and BWR were found to be reproducible methods with comparable diagnostic accuracy. However, NIRR cannot be recommended as a complementary diagnostic method for assessing proximal caries in permanent molars because of problems with image quality and artefacts.

The use of computer-aided design/computer-aided manufacturing (CAD/CAM) technology in restorative dentistry has increased significantly and should consequently be taught more intensively at university dental schools. This study describes the evaluation of a new CAD/CAM teaching concept.CAD/CAM technology was implemented into a 4th-year clinical student course according to Miller's pyramid principle. Fifty-eight students with no clinical experience participated in a 2-day theoretical and practical introductory course and rated its didactic outcome (Questionnaire 1). Students selected the fabrication method for indirect single tooth restorations during a 5-month patient treatment course. 54 conventional (e.max Press) and 68 CAD/CAM (Lava Ultimate) indirect Cerec-method restorations were fabricated and seated adhesively (Syntac, Variolink II). The success of the CAD/CAM integration was analyzed by the students, who were grouped according to their selected fabrication method (Questionnaire 2), as follows: Group A (CAD/CAM, n = 18); Group B (conventional and CAD/CAM, n = 17); Group C (conventional, n = 23).The questionnaire ratings were expressed as a percentage of the number of students' answers and are presented as diagrams. 95% of all the students in all the groups wanted CAD/CAM technology to be integrated into the subsequent (5th-year) clinical course. The rating for the CAD/CAM introductory course on a scale of 1 (very good) to 6 (poor) was 1.86 on average for the theoretical part, and 2.20 for the practical part. Statistically significant differences were found among the technology groupings (Pearson's chi-squared test, P0.05).CAD/CAM technology was highly welcomed by the 4th-year students and was introduced successfully into the clinical student course. Students tended to favor technology in accordance with the extent of its clinical application.

This retrospective clinical study investigated the survival probability of avulsed and replanted permanent teeth in relation to functional healing, replacement and inflammatory resorption. The explorative data analysis included data from 36 patients and 49 replanted permanent teeth with a minimum observation time of 60 days; the patients were generally treated according to the current guidelines of the International Association of Dental Traumatology at the university hospital in Munich, Germany, between 2004 and 2017. The mean observation period was 3.5 years. Functional healing was observed in 26.5% (N = 13/49) of the included avulsion cases. In comparison, replacement resorption affected 51.0% (N = 25/49) of the replanted teeth, of which 24.0% (N = 6/25) were lost over the course of years (mean, 6.1 years). In contrast, inflammatory resorption resulted in the early loss of all replanted teeth (mean, 1.7 years) and affected 22.5% (N = 11/49) of all the monitored teeth. Therefore, it can be concluded that tooth avulsion remains a severe dental injury with an unpredictable prognosis. This topic demands further fundamental research aiming to maintain and/or regenerate the periodontal ligament after tooth avulsion, particularly in association with non-physiological tooth rescue.

Background There is little information available on the longevity of non-invasive glass ionomer cement (GIC) and composite restorations as well as conventional composite and ceramic restorations placed on permanent teeth with enamel breakdowns due to molar-incisor hypomineralization (MIH). Aim To compare the longevity of the abovementioned treatment procedures. Design Of 377 identified MIH patients, 118 individuals received restorative treatment and were invited for clinical examination, including caries and MIH status. Finally, survival data from 204 MIH-related restorations placed on 127 teeth were retrospectively collected from 52 children, monitored between 2010 and 2018. Descriptive and explorative analyses were performed, including Kaplan-Meier estimators and the Cox regression model. Results The mean patient observation time was 42.9 months (SD = 35.1). The cumulative survival probabilities after 36 months—7.0% (GIC, N = 28), 29.9% (non-invasive composite restoration, N = 126), 76.2% (conventional composite restoration, N = 27) and 100.0% (ceramic restoration, N = 23)—differed significantly in the regression analysis. Conclusions Conventional restorations were associated with moderate-to-high survival rates in MIH teeth. In contrast, non-invasive composite restorations, which were predominately used in younger or less cooperative children, were linked to lower survival rates.

To compare the clinical performance of two glass-ionomer cements in combination with two light-cured coatings in Class II cavities.In total, 43 Equia Fil/Equia Coat and 42 Fuji IX GP Fast/Fuji Coat LC restorations were placed, in 34 patients. Only Class II cavities with two- or three-surface restorations were included. The clinical performance was evaluated at baseline, after 1, 2, and 3 years using the FDI criteria. For the statistical analysis, Fisher exact test, Wilcoxon signed-rank test and Mann-Whitney U test were applied. The success and survival of the restorations were calculated with the Kaplan-Meier method and a log-rank test was used to detect significant differences between the tested materials.At the 3-year recall, no significant differences could be detected between the two glass-ionomer cements for any of the evaluated criteria (Mann-Whitney U test, P.05). When comparing the baseline with the recall data at 3 years for each material separately, significant changes could be observed in both materials for the criteria "surface luster," "fracture of material and retention," and "approximal anatomical form" (Wilcoxon signed-rank test, P.05). Additionally, the Equia Fil restorations showed a notable change for the criteria "marginal adaptation" (Wilcoxon signed-rank test, P = .039). At the 3-year follow up, the Equia Fil and the Fuji IX GP Fast restorations exhibited an overall survival rate of 86.21% and 84.0%, respectively.The two glass-ionomer cements tested performed similarly in Class II cavities in adult patients, with a moderate to high failure rate after 3 years.

The aim of this study was to investigate the effect of artificial aging on the Martens parameters of different 3D printed and milled polyaryletherketon (PAEK) materials.In total 120 specimens of 4 different polyetheretherketon (PEEK) materials (Essentium PEEK, KetaSpire PEEK MS-NT1, VICTREX PEEK 450G and VESTAKEEP i4 G) were additively manufactured via fused layer manufacturing (FLM) in either horizontal or vertical directions (n=15 per group). 75 specimens were milled out of prefabricated PAEK blanks from the materials breCAM.BioHPP, Dentokeep, JUVORA Dental Disc 2 and Ultaire AKP (=15 per group). Martens hardness (HM), indentation hardness (HMilled specimens showed higher Martens parameters than printed ones (p0.001). Artificial aging had a negative effect on the measured parameters (p0.001). Horizontally printed specimens presented higher Martens parameters than vertically printed ones, regardless of material and aging process (p0.001). Essentium PEEK and breCAM.BioHPP showed the highest and VICTREX PEEK 450G as well as Ultaire AKP the lowest values of all investigated PAEK materials initially, after thermocycling and after autoclaving (p0.001). Microscopic examinations showed that artificial aging did not cause any major modifications of the materials.Additively manufactured PEEK materials showed lower Martens parameters than milled ones, whereas horizontally printed specimens presented higher values than vertically printed ones. Artificial aging had a negative effect on the Martens parameters, but not on the surface topography.

Aesthetic alternatives to stainless-steel crowns for restoring primary molars attain growing interest. We studied the mechanical properties of prefabricated zirconia crowns and conventional crowns. Three brands of prefabricated zirconia crowns were compared with computer-aided design/computer-aided manufacturing (CAD/CAM) zirconia crowns, preveneered stainless-steel crowns, and conventional stainless-steel crowns regarding: (i) fracture load under each of three conditions [no pretreatment, artificial aging in saliva for 12 wk, and after chewing simulation/thermocycling (1.68 × 106 cycles/5-55°C)]; and (ii) survival rate during chewing simulation, considering decementation, fracture, chipping, fatigue cracks, and occlusal holes. Without pretreatment, the prefabricated zirconia crowns showed mean fracture load values between 893 N and 1,582 N, while the corresponding values for CAD/CAM zirconia crowns and preveneered stainless-steel crowns were 2,444 N and 6,251 N. Preveneered stainless-steel crowns showed significantly lower fracture loads after artificial aging (5,348 N after saliva aging; 3,778 N after chewing simulation) than without artificial aging, whereas the fracture load of zirconia crowns was not influenced negatively. The survival rate of the different groups of zirconia crowns and preveneered stainless-steel crowns during chewing simulation was 100%, but only 41.7% for the stainless-steel crowns. These in-vitro data suggest that prefabricated zirconia crowns are aesthetically and durable alternatives to stainless-steel crowns for primary molars.