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The purpose of this questionnaire-based survey was to evaluate the attitudes of the undergraduate dental students towards elders. The 14-item Geriatric attitudes scale (GAS) questionnaire, along with a 9-item questionnaire with specific questions on the current geriatric dental curriculum, confidence, and preference in treating the elderly patients were administered to the undergraduate dental students (3rd bachelor, 1st master, and 2nd master) in the four Swiss university dental schools. Mean GAS scores were calculated and inter- and intra-group differences were analyzed with ANOVA and post hoc tests (level of significance set at α=0.05). Responses to the 9-item questionnaire were reported descriptively. Further analyses were performed to evaluate the effect of demographic factors on the GAS scores. 305 students (meanage: 25.8±4.0y) participated in this study. The mean overall GAS score of the students was 3.5±0.4. There were no significant differences in the GAS scores between the centers [F(3, 300)=2.266, p=0.081] or between the year of training [F(2, 301)=1.884, p=0.154]. Demographic factors did not influence the GAS scores. Students considered geriatric dentistry as an important part of their dental undergraduate education. The current geriatric curriculum was perceived to be on an adequate level. Hands-on experience in treating geriatric patients in the undergraduate curriculum was positively opinionated, and mobile dental services for elders with limited access to care was considered a good solution. In conclusion, the attitudes of the Swiss undergraduate dental students towards an elderly patient seem acceptable but could still be improved.

(1) Background: Intraoral optical scanning (IOS) has gained increased importance in prosthodontics. The aim of this in vitro study was to analyze the IOS accuracy for treatment with full crowns, considering possible influencing factors. (2) Methods: Two tooth morphologies, each with four different finish-line designs for tooth preparation and epi- or supragingival locations, were digitally designed, 3D-printed, and post-processed for 16 sample abutment teeth. Specimens were digitized using a laboratory scanner to generate reference STLs (Standard Tessellation Language), and were secondary-scanned with two IOS systems five times each in a complete-arch model scenario (Trios 3 Pod, Primescan AC). For accuracy, a best-fit algorithm (Final Surface) was used to analyze deviations of the abutment teeth based on 160 IOS-STLs compared to the reference STLs (16 preparations × 2 IOS-systems × 5 scans per tooth). (3) Results: Analysis revealed homogenous findings with high accuracy for intra- and inter-group comparisons for both IOS systems, with mean values of 80% quantiles from 20 ± 2 μm to 50 ± 5 μm. Supragingival finishing lines demonstrated significantly higher accuracy than epigingival margins when comparing each preparation ( p < 0.05), whereas tangential preparations exhibited similar results independent of the gingival location. Morphology of anterior versus posterior teeth showed slightly better results in favor of molars in combination with shoulder preparations only. (4) Conclusion: The clinical challenge for the treatment with full crowns following digital impressions is the location of the prospective restoration margin related to the distance to the gingiva. However, the overall accuracy for all abutment teeth was very high; thus, the factors tested are unlikely to have a strong clinical impact.

In this cross-sectional study, the prevalences of tooth loss, prosthetic dental restorations, and probing pocket depths (PPD) ≥4 mm, and their relationship to sociodemographic factors, were investigated in older Swiss adults. There were up to 1,673 participants aged ≥55 yr in the fourth survey of the Swiss Cohort Study on Air Pollution And Lung And Heart Disease In Adults (SAPALDIA4). Missing teeth, prosthetic dental restorations, and PPD ≥4 mm were recorded in clinical examinations conducted by field workers and compared with self-reported information from questionnaires. Examination data showed that participants were missing five teeth on average, 74.8% had a prosthetic dental restoration, and 21.1% had PPD of ≥4 mm. The mean number of missing teeth and the prevalences of tooth loss, fixed dental prostheses, and removable dental prostheses were associated with age, education level, smoking status, and time since last visit to a dentist. Comparison of data obtained by field workers and that from self-reports show a high level of agreement for the number of missing teeth and the prevalence of removable dental prostheses, but a lower level of agreement for self-reports of fixed dental prostheses and periodontitis., (© 2020 Eur J Oral Sci.)

Objectives: This study investigated biofilm formation on discs of metal alloys, zirconia and polyetherketoneketone in vivo., Material and Methods: Sixteen healthy volunteers conducted two runs of 24 hr each wearing an intraoral splint with 15 discs representing five different materials (gold-based [EL] and silver-based [PA] noble metal alloys; zirconia [ZR]; polyetherketoneketone [PEKK]; titanium zirconium alloy [TiZr]). Safranin staining assays and colony-forming unit (CFU) counts were conducted. Linear mixed-effects models were used to compare materials, and geometric mean ratios with 95% confidence interval were calculated with the level of significance set at α = 0.05., Results: Less biofilm mass and lower CFU counts were found on PA and EL, while ZR and PEKK developed similar levels as the reference material TiZr alloy. Compared with PA, biofilm mass was 1.5 times higher for EL (p = .004), 1.7 times higher for PEKK (p < .001), 2.2 times higher for TiZr (p < .001) and 2.4 times higher for ZR (p < .001). The culturing method confirmed these results for EL and PA with lower CFU compared to TiZr. The biomass staining technique and cell culturing correlated for EL and PA., Conclusion: Silver-based noble alloy and gold-based high noble alloy demonstrated the least biofilm formation indicating a potential clinical use as material for implant components in the transmucosal compartment. Zirconia and Polyetherketoneketone revealed similar results as the reference material titanium zirconium alloy used in commercially available titanium dental implant., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Cost-effectiveness analysis is widely adopted as an analytical framework to evaluate whether health care interventions represent value for money, and its use in dentistry is increasing. Traditionally, in cost-effectiveness analysis, one assumes that the decision maker's maximum willingness to pay (WTP) for health gain is equivalent to his minimum willingness to accept (WTA) monetary compensation for health loss. It has been documented in the literature that losses are weighted higher than equivalent gains, i.e., that WTA exceeds WTP for the same health condition, resulting in a WTA/WTP ratio greater than 1. There is a knowledge gap of published WTA/WTP ratios for dental interventions in the literature. We therefore conducted a (i) systematic review of published WTA-WTP estimates in dentistry (MEDLINE, Web of Science, Cochrane Library, London, UK) and (ii) a patient-level analysis of WTA/WTP ratios of included studies, and (iii) we demonstrate the impact of a WTA-WTP disparity on cost-effectiveness analysis. Out of 55 eligible studies, two studies were included in our review. The WTA/WTP ratio ranged from 2.58 for discontinuing water fluoridation to 5.12 for mandibular implant overdentures, indicating a higher disparity for implant rehabilitations than for dental public health interventions. A WTA-WTP disparity inflates the cost-effectiveness of dental interventions when there is a substantial risk of both lower costs and health outcomes. We therefore recommend that in these cases the results of cost-effectiveness analyses are reported using different WTA/WTP ratios in a sensitivity analysis.

Differences in the progression of periodontitis have been observed between smokers and non-smokers. The aim of the present study was to compare vascular and inflammatory cell densities in periodontitis lesions from smokers and non-smokers to gain further understanding of the influence of smoking on histopathological characteristics of the disease. Two groups of patients with generalized severe periodontitis were recruited. One group consisted of 25 current smokers, aged 33-69 yr, while the second group comprised 21 non-smokers, aged 35-76 yr. From each patient, gingival biopsies were harvested from one periodontitis site (probing pocket depth ≥6 mm and bleeding on probing) and one site without clinical signs of gingival inflammation (reference site). Immunohistochemical analyses were performed to assess the density of vessels and inflammatory cells. Small differences existed between smokers and non-smokers regarding the size, proportion, number, and density of cells in periodontitis lesions. However, the vascular density in periodontitis lesions was significantly higher in non-smokers than in smokers. In clinically healthy reference sites, lesions were considerably smaller than in periodontitis sites and presented with similar vascular densities in smokers and non-smokers., (© 2020 Eur J Oral Sci.)

The aim of this in vitro study was to analyze the impact of model aging on the accuracy of 3D-printed dental models. A maxillary full-arch reference model with prepared teeth for a three-unit fixed dental prosthesis was scanned ten times with an intraoral scanner (3Shape TRIOS Pod) and ten models were 3D printed (Straumann P-Series). All models were stored under constant conditions and digitized with a desktop scanner after 1 day; 1 week; and 2, 3, and 4 weeks. For accuracy, a best-fit algorithm was used to analyze the deviations of the abutment teeth (GFaI e.V Final Surface ® ). Wilcoxon Rank Sum Tests were used for comparisons with the level of significance set at α = 0.05. Deviation analysis of the tested models showed homogenous intragroup distance calculations at each timepoint. The most accurate result was for 1 day of aging (3.3 ± 1.3 µm). A continuous decrease in accuracy was observed with each aging stage from day 1 to week 4. A time-dependent difference was statistically significant after 3 weeks ( p = 0.0008) and 4 weeks ( p < 0.0001). Based on these findings, dental models should not be used longer than 3 to 4 weeks after 3D printing for the fabrication of definitive prosthetic reconstructions., Competing Interests: The authors declare no conflict of interest.

The aim of this systematic review was to investigate current penetration and educational quality enhancements from digitalization in the dental curriculum. Using a modified PICO strategy, the literature was searched using PubMed supplemented with a manual search to identify English-language articles published between 1994 and 2020 that reported the use of digital techniques in dental education. A total of 211 articles were identified by electronic search, of which 55 articles were selected for inclusion and supplemented with 27 additional publications retrieved by manual search, resulting in 82 studies that were included in the review. Publications were categorized into five areas of digital dental education: Web-based knowledge transfer and e-learning, digital surface mapping, dental simulator motor skills (including intraoral optical scanning), digital radiography, and surveys related to the penetration and acceptance of digital education. This review demonstrates that digitalization offers great potential to revolutionize dental education to help prepare future dentists for their daily practice. More interactive and intuitive e-learning possibilities will arise to stimulate an enjoyable and meaningful educational experience with 24/7 facilities. Augmented and virtual reality technology will likely play a dominant role in the future of dental education.

Purpose: To compare the precision of maxillo-mandibular registration and resulting full arch occlusion produced by three intraoral scanners in vitro., Methods: Six dental models (groups A-F) were scanned five times with intraoral scanners (CEREC, TRIOS, PLANMECA), producing both full arch and two buccal maxillo-mandibular scans. Total surface area of contact points (defined as regions within 0.1mm and all mesh penetrations) was measured, and the distances between four pairs of key points were compared, each two in the posterior and anterior., Results: Total surface area of contact points varied significantly among scanners across all groups. CEREC produced the smallest contact surface areas (5.7-25.3mm 2 ), while PLANMECA tended to produce the largest areas in each group (22.2-60.2mm 2 ). Precision of scanners, as measured by the 95% CI range, varied from 0.1-0.9mm for posterior key points. For anterior key points the 95% CI range was smaller, particularly when multiple posterior teeth were still present (0.04-0.42mm). With progressive loss of posterior units (groups D-F), differences in the anterior occlusion among scanners became significant in five out of six groups (D-F left canines and D, F right canines, p<0.05)., Conclusions: Maxillo-mandibular registrations from three intraoral scanners created significantly different surface areas of occlusal contact. Posterior occlusions revealed lower precision for all scanners than anterior. CEREC tended towards incorrect posterior open bites, whilst TRIOS was most consistent in reproducing occluding units., (Copyright © 2019 Japan Prosthodontic Society. All rights reserved.)

This case report presents the treatment of a partially edentulous patient with a clasp-retained removable dental prosthesis (RDP) using both, digital and conventional workflows. Differences were demonstrated in impression taking, bite registration, manufacturing of models, prosthetic set-up, framework design and production; the technical steps for the finish of the RDPs were identical and (currently) still dependent on manual skills. The digitally 3D-printed framework were favored by the patient and the dentist due to the precise fit. The number of manual steps will be continuously reduced applying digital technologies for the treatment with RDPs, resulting in shortened clinical and technical work time and higher precision of the final prosthetic restoration. In addition, the use of intraoral scanners is more patient-friendly than classic impressions with elastomers. Technological advancements are required to eliminate today’s limitations and enable a complete digital workflow, even without any physical models. Removable Dental Prosthesis 2.0: yes – but not yet completely from A to Z.

Purpose: To investigate the long-term (up to 20 years) outcomes of customized post copings (PC) and to evaluate potential factors influencing the risk for complications., Materials and Methods: Patients treated with PC-retained overdenture prostheses (OD) in a university setting were selected. Data collected included dental and periodontal parameters, periapical radiographs, and assessment of the OD design. Patient-reported satisfaction levels were evaluated using visual analog scales (VAS), and 20-year cumulative survival and success rates were calculated., Results: A total of 73 patients with 81 ODs and 152 PCs were included. PC survival rate was 80.9%, and the success rate amounted to 64.5% after a mean observation period of 105.4 (± 67.9; range: 6 to 240) months. The 5-year cumulative PC rates were 91.5% for survival and 79.3% for success. Activation of matrices was more frequent with ball attachments than with cylindrical retention (odds ratio [OR] 0.43; 95% confidence interval [CI] 0.2 to 0.94; P = .034). Cylindrical retention was rated significantly better at 96% (interquartile range [IQR] 89.5% to 100%) compared to ball attachment at 88% (IQR 79% to 98.2%; P = .012). The risk for PC complications was higher for OD designs with coverage of the periodontal tissues compared to open designs (OR 0.34; 95% CI 0.15 to 0.78; P = .010)., Conclusion: Customized PCs on natural abutment teeth for the retention of ODs are a valid treatment in partially dentate patients. Correct prosthesis design and integration into a regular dental hygiene program are mandatory factors for long-term success.

Background: The required pretreatment of CAD/CAM ceramic materials before resin composite cement application varies among studies. The aim of the present study was to evaluate the effect of hydrofluoric acid concentration and etching time on the shear bond strength (SBS) of two adhesive and two self-adhesive resin composite cements to different CAD/CAM ceramic materials., Methods: SBS of two adhesive (Panavia V5, Kuraray, [PV5]; Vita Adiva F-Cem, Vita Zahnfabrik, [VAF]) and two self-adhesive (RelyX Unicem 2 Automix, 3 M Espe, [RUN]; Vita Adiva S-Cem, Vita, [VAS]) cements to four different CAD/CAM materials (Vitablocs Mark II, Vita, [VM]; Vita Enamic, Vita, [VE]; e.max CAD, Ivoclar Vivadent, [EC]; Vita Suprinity PC, Vita, [VS]) was measured. The effect of the surface pretreatment by using two different hydrofluoric acid products (HF5% Vita Ceramics Etch, Vita and HF9% buffered, Ultradent Porcelain Etch, Ultradent Products) were assessed at etching times of 0 s, 5 s, 15 s, 30s and 60s for each cement and restorative material combination (n = 10 per group, total n = 1440)., Results: Significant effects were found for the etching time and cement for all materials with highest shear bond strength for etching times of 60s = 30s = 15 s ≥ 5 s > 0 s and for RUN>PV5 = VAF > VAS (p < 0.05). Etching with HF5% for 5 s to 15 s resulted in higher SBS values, while no differences were observed between HF5% and HF9% buffered when the substrates were etched for 30s to 60s (p < 0.05)., Conclusions: Within the limitations of this study the recommended surface pretreatment of silicate ceramics is HF etching with concentrations of 5% or 9% for 15 s to 60s to achieve highest shear bond strength while the glassy matrix is sufficiently dissolved. The tested resin composite cements can be applied with all tested materials and suggested for clinical application.

Improvements in oral health are changing the requirements for oral health care provision. This study assessed the frequency and major reason of dental visits and personal oral hygiene measures in Switzerland, and temporal trends in visit frequency. The number of dental visits in the previous twelve months, the reason for these visits, and the prevalence of oral hygiene measures were quantified from weighted data from the 2012 Swiss Health Survey. The frequency of dental visits in 2012 was compared with previous surveys (1992–2007). Almost two thirds of subjects reported visiting a dentist and almost half had visited a dental hygienist in the previous twelve months. Voluntary (33%) or recall check-ups (25%) were the most common reasons for the last dental visit across age groups. Treatment needs including caries/filling/endodontic treatment (10%), crowns/FDP/RDP/implants (8%), toothache (5%), extraction (5%), periodontal complaints (2%), or orthodontic appliances (2%) were more heterogeneously distributed across age groups. One in ten subjects had dental implants; prevalence increased with increasing age as did the number of missing teeth. Use of interdental cleaning devices and frequent tooth brushing were more common among subjects with few or no missing teeth and among subjects with higher versus lower income or education. Oral health awareness varied with a higher awareness in women than in men and in subjects with higher versus lower income or education. The prevalence of dental implants and dental hygienist’s visits has increased in Switzerland since 2002, but oral hygiene measures remained stable.

Background: The aim of this systematic review was to provide an update on the contemporary knowledge and scientific development of augmented reality (AR) and virtual reality (VR) in dental medicine, and to identify future research needs to accomplish its clinical translation., Method: A modified PICO-strategy was performed using an electronic (MEDLINE, EMBASE, CENTRAL) plus manual search up to 12/2018 exploring AR/VR in dentistry in the last 5 years. Inclusion criteria were limited to human studies focusing on the clinical application of AR/VR and associated field of interest in dental medicine., Results: The systematic search identified 315 titles, whereas 87 abstracts and successively 32 full-texts were selected for review, resulting in 16 studies for final inclusion. AR/VR-technologies were predominantly used for educational motor skill training (n = 9 studies), clinical testing of maxillofacial surgical protocols (n = 5), investigation of human anatomy (n = 1), and the treatment of patients with dental phobia (n = 1). Due to the heterogeneity of the included studies, meta-analyses could not be performed., Conclusions: The overall number of includable studies was low; and scientifically proven recommendations for clinical protocols could not be given at this time. However, AR/VR-applications are of increasing interest and importance in dental under- and postgraduate education offering interactive learning concepts with 24/7-access and objective evaluation. In maxillofacial surgery, AR/VR-technology is a promising tool for complex procedures and can help to deliver predictable and safe therapy outcomes. Future research should focus on establishing technological standards with high data quality and developing approved applications for dental AR/VR-devices for clinical routine., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: The aim of this in vitro study was to compare the heat generation during guided osteotomy preparation (GOP) with that of a conventional approach (CA) for a single and sequential drilling protocol., Methods: Temperature measurements were performed during standardized osteotomy preparations in polyurethane foam blocks with an infrared camera. The four groups included single and sequential drilling with and without the use of a surgical guide. In the first group (single CA) and the second group (single GOP), only the final drills diameters were applied once. In the third group (sequential CA) and the fourth group (sequential GOP), two to four drills with increasing diameters were applied. Guided and conventional as well as single and sequential drilling were compared using a one-way ANOVA with Tukey post hoc test. The level of statistical significance was set at α = 0.05., Results: Guided osteotomy preparation showed statistically significant higher temperatures than CA for the 2.2 mm, the 3.5 mm, and the 4.2 mm drill (p = 0.032, p = 0.005 and p < 0.001, respectively). Sequential drilling led to higher heat generation and longer duration of latent heat than single drilling. For all drilling procedures, the duration of heat exposure over critical temperature was less than 1 min, except for the sequential GOP drilling protocol with the 4.2 mm drill (76 s)., Conclusions: Guided drilling requires specific attention to heat development. When guided implant surgery is performed, a single drilling procedure could alleviate heat production compared to a sequential procedure., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Implant restorations became the first choice for single-tooth replacement today., Purpose: The prospective clinical trial aims to investigate computer-aided-design (CAD)/computer-aided-manufacturing (CAM)-processed implant crowns after 5 years of loading., Materials and Methods: Twenty patients were included for cement-retained crowns in posterior sites. Radiographic analysis of bone levels was performed after delivery and follow-up. The Functional Implant Prosthodontic Score (FIPS) was assessed at the final follow-up. Wilcoxon signed-rank tests were used with a level of significance set at α = 0.05., Results: One implant was lost, resulting in a success rate of 95% at 5 years. For 19 crowns, neither technical complications nor biological complications were observed. The mean marginal bone level was 0.6 ± 0.26 mm (range: 0.18-1.12) mesially, and 0.79 ± 0.36 mm (range: 0.23-1.36) distally at 5 years. During the observation period, mean radiographic bone levels increased significantly by 0.23 mm at mesial and by 0.17 mm at distal sites (P < .0001) indicating minor additional bone loss. The mean total FIPS score was 8.2 ± 1.0 (range: 7-10) with the high score of 2.0 ± 0.0 for the variable "bone.", Conclusions: CAD/CAM-processed implant crowns demonstrated promising radiographic and clinical outcomes after 5 years in function. Future large-scale trials are crucial to confirm these initial results in the field of digital implant processing., (© 2018 Wiley Periodicals, Inc.)

Background: Biomedical research has recently moved through three stages in digital healthcare: (1) data collection; (2) data sharing; and (3) data analytics. With the explosion of stored health data (HD), dental medicine is edging into its fourth stage of digitization using artificial intelligence (AI). This narrative literature review outlines the challenge of managing HD and anticipating the potential of AI in oral healthcare and dental research by summarizing the current literature., Summary: The basis of successful management of HD is the establishment of a generally accepted data standard that will guide its implementation within electronic health records (EHR) and health information technology ecosystems (HIT Eco). Thereby continuously adapted (self-) learning health systems (LHS) can be created. The HIT Eco of the future will combine (i) the front-end utilization of HD in clinical decision-making by providers using supportive diagnostic tools for patient-centered treatment planning, and (ii) back-end algorithms analyzing the standardized collected data to inform population-based policy decisions about resource allocations and research directions. Cryptographic methods in blockchain enable a safe, more efficient, and effective dental care within a global perspective. Key Message: The interoperability of HD with accessible digital health technologies is the key to deliver value-based dental care and exploit the tremendous potential of AI., (© 2019 S. Karger AG, Basel.)

Population-based linkage of patient-level information opens new strategies for dental research to identify unknown correlations of diseases, prognostic factors, novel treatment concepts and evaluate healthcare systems. As clinical trials have become more complex and inefficient, register-based controlled (clinical) trials (RC(C)T) are a promising approach in dental research. RC(C)Ts provide comprehensive information on hard-to-reach populations, allow observations with minimal loss to follow-up, but require large sample sizes with generating high level of external validity. Collecting data is only valuable if this is done systematically according to harmonized and inter-linkable standards involving a universally accepted general patient consent. Secure data anonymization is crucial, but potential re-identification of individuals poses several challenges. Population-based linkage of big data is a game changer for epidemiological surveys in Public Health and will play a predominant role in future dental research by influencing healthcare services, research, education, biotechnology, insurance, social policy and governmental affairs.

Objectives: The aim of this RCT was to analyze Patient Reported Outcome Measures (PROMs) of implant crowns processed in complete digital workflows (test) and combined analog-digital workflows (control) with a three-year follow-up. This is a second reporting from the same trial with sample size calculation based on time efficiency., Materials and Methods: Twenty participants were selected for single-tooth replacement with screw-retained crowns in posterior sites (Straumann TL Implant System). Ten patients each were treated with test or control workflows and evaluated after 1 week of prosthetic delivery (baseline) and 3 years. The subjective opinion of the patient was assessed using visual analog scales (VAS) for PROMs; the Functional Implant Prosthodontic Score (FIPS) for the objective evaluation of the dentist. Wilcoxon signed-rank tests and Mann-Whitney U-tests were used for comparisons between test and control with a level of significance set at α = 0.05., Results: In test and control, implant crowns showed 100% survival without technical and/or biological complications. Mean PROMs varied between 81.6 and 90.3 with no difference between test and control, or between baseline and after 3 years for intra-patient comparison. Linear regression analysis exhibited a significant correlation between FIPS and PROMs related to overall treatment satisfaction (VAS-1: coefficient 0.45; p = 0.0472)., Conclusion: Subjective patient's perception (PROMs) of posterior implant crowns processed in complete digital and combined analog-digital workflows revealed comparable high levels of satisfaction on the overall treatment outcome including function, esthetics, and cleanability after 3 years. The objective evaluation of the dentist (FIPS) seems to reflect the perception of the patients., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The aim of this study was to validate the reproducibility and observer variability of the Functional Implant Prosthodontic Score (FIPS), while considering the level of dental experience for intra- and inter-examiner analysis., Materials and Methods: A total of 44 examiners (n = 31 undergraduate dental students and n = 13 postgraduate prosthodontic students) applied FIPS to ten sample cases each showing one implant-supported single crown for premolar or molar replacements. Examiners' assessments were carried out twice at an interval of 2 weeks (round A and round B). Pearson's correlations including 95% confidence intervals (CI95) were calculated for intra- and inter-examiner reproducibility testing. Cohen's Kappa score was additionally used to analyze the homogeneity of each FIPS variable., Results: The mean values of the total FIPS scores for round A (7.21 ± 0.91) and round B (7.27 ± 0.86) showed a strong correlation of 0.9374 (CI95 0.9250; 0.9478). No significant difference was identified between undergraduates and postgraduates representing different levels of dental experience. Homogeneity analysis of the defined FIPS variables was not significantly different., Conclusions: Both intra- and inter-examiner analysis revealed very congruent results for reproducibility testing of FIPS. The findings validated the potential of FIPS as an objective and reliable evaluation instrument in assessing fixed implant restorations in posterior sites independent of the level of dental experience., Clinical Relevance: FIPS can be considered as an additional diagnostic tool to classify fixed implant restorations in routine dental practice, to compare follow-up observations, and to identify potential risks of failure.

Aim: To investigate the influence of the radiographic modalities panoramic radiography (PR) and cone beam computed tomography (CBCT) on selection of implant length and diameter., Materials and Methods: Potential implant sites (59 sites, 40 patients) with available PRs and CBCTs were selected from the databases of two University dental schools. Six experienced clinicians were asked to select the appropriate implant length and diameter based on PR and CBCT. Results were compared with the actual surgical procedure and intra- /interrater agreement was calculated using Cohen's kappa., Results: On average, greater implant length was more often planned based on PR (24.2 vs 8.8% with CBCT), while wider implants were generally more frequently planned based on CBCTs (19.9 vs 29.7% with PR). Implant treatment planning based on PR and on CBCT images was equal in 50 to 67%. Compared with the actual surgery, CBCT revealed a higher agreement (46% for implant length), while for PR, 34.4% equal implant length was observed., Conclusion: The radiographic modality used for implant treatment planning affects implant selection., Clinical Significance: The CBCT scans are advantageous for choosing the appropriate implant dimension. Caution should be exercised when selecting implant length planned from PR.

The aim of this retrospective study was to investigate the clinical outcome of Dalbo®-Rotex® retention elements in a private practice. The majority of the retention elements was fixed with self-adhesive composite cement, and in almost 40% the exposed root surface was additionally covered with composite. The success rate of 96.3% after 24 months in a total of 50 included patients (response rate 48.5%) demonstrated that a simple and cost-effective fixation of removable dentures using prefabricated, chair-side inserted retention elements is feasible. Maintenance care comprised single or repeated replacement and activation of the female part in 12.3% and 39.4% of the cases, respectively. Fractures were rare, occurring in 3.4% of the cases and more likely in patients with parafunctional habits. Frequent oral hygiene correlated with probing depths up to 3 mm at the maxi- mum, while the risk of greater probing depths associated with less frequent oral hygiene increased by a factor of 2.4. Patients’ assessment of the parameters handling and wearing comfort, chewing ability and prosthesis retention was predominantly positive. Based on the findings of the study, covering of exposed dentin areas with composite resin and regular recall comprising professional cleaning, fluoride application and oral hygiene instruction are recommended.

Objectives: To investigate the fracture behavior and marginal gap region of CAD/CAM fabricated lithium disilicate (L) and zirconium dioxide (Z) crowns using palatal venting (PV), pre-cementation with custom analogs (CA), or conventional cementation technique (SP) with adhesive cement (A) or resin-modified glass ionomer cement (B)., Material and Methods: Twelve groups (n = 6) were set according to material (L, Z), cement (A, B), and technique (PV, CA, SP). Specimens were thermo-mechanical aged (TML), loaded until fracture (LF) and fracture patterns recorded. Marginal gap width and quality were assessed and compared to replicas obtained before and after TML., Results: Crown material significantly influenced LF with a mean of 1037.6 ± 282.4 N in L and 5356.3 ± 1207.0 N in Z groups (p < .001). Neither cement material nor cementation method affected the outcome. Fractures occurred along the mesial-distal central fissure in both materials. Gap width before TML was 22.04 ± 13.42 μm for L and 19.98 ± 12.72 μm for Z specimens, with overall no influence of crown material, cement type, or method. Marginal cleanliness just below the polished implant shoulder reached 66.7%-88.9% with A, and 91.7%-100% with B, and tended to increase in all groups during TML indicating a decrease in excess cement. Implant-crown junctions were cleaner with B compared to A (p ≤ .001) and along Z crown surfaces compared to L (p ≤ .007)., Conclusions: Crown venting of lithium disilicate and zirconium dioxide crowns did not affect the fracture load and patterns. Complete cement removal was rare, and the observed particle ablation requires further clinical attention, particularly with submucosal margins., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The purpose of this study was to analyze the cement excess produced when cementing CAD/CAM-fabricated lithium disilicate (L) or zirconium dioxide (Z) crowns using adhesive cement (A) or resin-modified glass ionomer cement (B). Three different cementation techniques were applied: palatal venting (PV), pre-cementation with custom analogs (CA), and conventional standard procedure (SP)., Materials and Methods: Seventy-two crowns (36 each material) were assigned to 12 experimental groups depending on the restoration material (L, Z), type of cement (A, B), and cementation technique (PV, CA, SP). Weight measurements were taken during cementation, and the amounts of excess cement, cement retained in crown, and relative excess cement were calculated and statistically analyzed., Results: A significant direct relation between the amounts of cement applied and excess cement was observed in groups CA and SP. Vented crowns showed least amounts of marginal excess cement (0.8 ± 0.3 μl) followed by CA (4.2 ± 1.1 μl) and SP (8.8 ± 2.5 μl; p < .001). In CA, 32.1% less excess cement (95%CI: 28.4, 35.7) was produced than in the SP group (p < .001), but 27.4% more than in the PV group (95%CI: 23.8,31.0; p < .001). Overall, slightly smaller amounts of adhesive cement (A) than of glass ionomer cement (B) were retained in crowns., Conclusions: Using crown venting was the most effective measure to reduce the amount of marginal excess cement, followed using a pre-cementation device. To keep the marginal excess cement of one-piece zirconia implants to a minimum, both techniques should be considered for clinical application., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The aim of this systematic review was to assess the role of excess cement as risk indicator for peri-implant diseases., Material and Methods: A systematic literature search with the keywords peri-implant disease, peri-implant mucositis, peri-implantitis, excess cement, cemented, and screw-retained restorations was performed for articles published by June 2016 using MEDLINE and EMBASE electronic databases, complemented by hand searching., Results: The included 26 publications referring to 21 study groups were published between 1999 and 2016 and comprised 945 subjects with 1010 cemented implant restorations in 10 prospective and eight retrospective studies and eight case reports/series with pronounced heterogeneity of the study designs. Prevalence of peri-implant diseases varied between 1.9% and 75% of the implants with cemented restorations, with proportions of 33-100% associated with excess cement. In publications including early follow-ups and regular recall intervals, peri-implant disease was mostly detected at an early stage. Cofactors, such as type of abutment (standardized or individualized) and cementum medium used, did not have a significant influence, while higher prevalence of peri-implant diseases was found with immediate loading or cementation subsequent to reentry, and with cemented vs. screw-retained restorations., Conclusions: Excess cement was identified as a possible risk indicator for peri-implant diseases and was more frequently observed with soft tissue healing periods shorter than 4 weeks. To reduce the risk of peri-implant disease associated with excess cement, a crown margin at the level of the mucosal margin providing sufficient access is recommendable, and soft tissue maturation and early follow-ups after restoration placement should be assured., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The aim of this randomized controlled trial was to analyze inexperienced dental students' perceptions of the difficulty and applicability of digital and conventional implant impressions and their preferences including performance. Fifty undergraduate dental students at a dental school in Switzerland were randomly divided into two groups (2×25). Group A first took digital impressions in a standardized phantom model and then conventional impressions, while the procedures were reversed for Group B. Participants were asked to complete a VAS questionnaire (0-100) on the level of difficulty and applicability (user/patient-friendliness) of both techniques. They were asked which technique they preferred and perceived to be more efficient. A quotient of "effective scan time per software-recorded time" (TRIOS) was calculated as an objective quality indicator for intraoral optical scanning (IOS). The majority of students perceived IOS as easier than the conventional technique. Most (72%) preferred the digital approach using IOS to take the implant impression to the conventional method (12%) or had no preference (12%). Although total work was similar for males and females, the TRIOS quotient indicated that male students tended to use their time more efficiently. In this study, dental students with no clinical experience were very capable of acquiring digital tools, indicating that digital impression techniques can be included early in the dental curriculum to help them catch up with ongoing development in computer-assisted technologies used in oral rehabilitation.

Objectives: The aim of this randomized controlled trial was to analyze implant impression techniques applying intraoral scanning (IOS) and the conventional method according to time efficiency, difficulty, and operator's preference., Material and Methods: One hundred participants (n = 100) with diverse levels of dental experience were included and randomly assigned to Group A performing digital scanning (TRIOS Pod) first or Group B conducting conventional impression (open tray with elastomer) first, while the second method was performed consecutively. A customized maxillary model with a bone-level-type implant in the right canine position (FDI-position 13) was mounted on a phantom training unit realizing a standardized situation for all participants. Outcome parameter was time efficiency, and potential influence of clinical experience, operator's perception of level of difficulty, applicability of each method, and subjective preferences were analyzed with Wilcoxon -Mann-Whitney and Kruskal-Wallis tests., Results: Mean total work time varied between 5.01 ± 1.56 min (students) and 4.53 ± 1.34 min (dentists) for IOS, and between 12.03 ± 2.00 min (students) and 10.09 ± 1.15 min (dentists) for conventional impressions with significant differences between the two methods. Neither assignment to Group A or B, nor gender nor number of impression-taking procedures did influence working time. Difficulty and applicability of IOS was perceived more favorable compared to conventional impressions, and effectiveness of IOS was rated better by the majority of students (88%) and dentists (64%). While 76% of the students preferred IOS, 48% of the dentists were favoring conventional impressions, and 26% each IOS and either technique., Conclusions: For single-implant sites, the quadrant-like intraoral scanning (IOS) was more time efficient than the conventional full-arch impression technique in a phantom head simulating standardized optimal conditions. A high level of acceptance for IOS was observed among students and dentists., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: To compare the dimensional accuracy of three impression techniques- a separating foil impression, a custom tray impression, and a stock tray impression., Materials and Methods: A machined mandibular complete-arch metal model with special modifications served as a master cast. Three different impression techniques (n = 6 in each group) were performed with addition-cured silicon materials: i) putty-wash technique with a prefabricated metal tray (MET) using putty and regular body, ii) single-phase impression with custom tray (CUS) using regular body material, and iii) two-stage technique with stock metal tray (SEP) using putty with a separating foil and regular body material. All impressions were poured with epoxy resin. Six different distances (four intra-abutment and two inter-abutment distances) were gauged on the metal master model and on the casts with a microscope in combination with calibrated measuring software. The differences of the evaluated distances between the reference and the three test groups were calculated and expressed as mean (± SD). Additionally, the 95% confidence intervals were calculated and significant differences between the experimental groups were assumed when confidence intervals did not overlap., Results: Dimensional changes compared to reference values varied between -74.01 and 32.57 µm (MET), -78.86 and 30.84 (CUS), and between -92.20 and 30.98 (SEP). For the intra-abutment distances, no significant differences among the experimental groups were detected. CUS showed a significantly higher dimensional accuracy for the inter-abutment distances with -0.02 and -0.08 percentage deviation compared to MET and SEP., Conclusion: The separation foil technique is a simple alternative to the custom tray technique for single tooth restorations, while limitations may exist for extended restorations with multiple abutment teeth.

Partial ceramic crowns (PCCs) are an accepted treatment option for the restoration of posterior teeth with deficient tooth substance. Data on the survival of PCCs fabricated by dental students are scarce. The aim of this retrospective clinical study was to investigate the clinical performance and longevity of PCCs placed by dental students in the last year of their training program at the University of Basel, Switzerland. Eighty-eight patients who had received at least one PCC (n=108) in the program were considered for clinical assessment; their records were analyzed to detect previous complications or failures; and they were contacted by telephone. Criteria regarding aesthetic, functional, and biological aspects were rated with a scoring system from 1=clinically excellent to 5=clinically poor. The response rate was 66.3% (55 of 83 included patients), and 72.2% (n=78) of the PCCs were included in the analysis. Five PCCs had been lost within ten to 78 months after treatment. Six PCCs were recorded as failures (score 5), and ten received clinically unsatisfactory gradings (score 4). The risk of a clinically poor outcome was 14% after five years (86% survival), while the overall success rate was 63.5%. These results suggest that the clinical procedure of PCCs was successfully implemented by these students with satisfactory clinical survival.

Several evaluation systems for clinical exams have been suggested over the years, but no systematic analysis of checklists or criteria-based exam forms has yet been undertaken. The aims of this study were to analyze criteria-based evaluation forms and to identify areas in the teaching process potentially requiring improvements. All evaluation forms introduced in 2012 at the Clinic for Periodontology, Endodontology, and Cariology at the University Center of Dental Medicine in Basel, Switzerland, and applied over a three-year period (n=1,093 in 2015) were analyzed using predefined criteria. The authors investigated how well clinical tasks were examined with the given criteria and which criteria were preferably evaluated with a grading system (0-2) or a yes/no choice. The average final grades ranged from 0.89 (n=92) for gold inlay preparation to 1.76 (n=46) for periodontal treatment. Comments were made in 38.5% (n=356) of all exams, mainly highlighting specific aspects of existing criteria. Overall, 13 criteria out of 66 should be checked instead of graded. This methodological analysis of exam forms assessing tasks in operative dentistry yielded valuable information on areas with potential for improvement in the dental curriculum and the evaluation process. Aspects that require more theoretical background and/or hands-on recommendations from experienced clinicians were identified, and ways of further refining and redesigning the evaluation forms were proposed.

Objective: The aim of the present study was to analyze biofilm formation on four different titanium-based surfaces (machined titanium zirconium (TiZr) alloy, M; machined, acid-etched TiZr alloy, modMA; machined, sandblasted, acid-etched TiZr alloy, modSLA; and micro-grooved titanium aluminum vanadium alloy, TAV MG) in an experimental human model., Material and Methods: Custom-made discs were mounted in individual intraoral splint housings and worn by 16 volunteers for 24 h. The safranin staining assay, isothermal microcalorimetry (IMC), and SEM were applied before and after surface cleaning., Results: The hydrophilic surfaces modMA and modSLA with greater surface micro-roughness exhibited significantly more biofilm than the hydrophobic surfaces TAV MG and M. The standardized cleaning procedure substantially reduced the biofilm mass on all surfaces. After cleaning, the IMC analyses demonstrated a longer lag time of the growth curve on TAV MG compared to modSLA. Inter- and intraindividual variations in biofilm formation on the titanium discs were evident throughout the study., Conclusions: Surface hydrophilicity and roughness enhanced biofilm formation in vivo, whereas surface topography was the most influential factor that determined surface cleanability. While the grooved surface retained larger amounts of initial biofilm, the machined surface was easier to clean, but proliferation indicated by increased metabolic activity (growth rate) in IMC occurred despite mechanical biofilm removal., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

While the time trends in oral health are favourable, differences still persist in dental status and in prosthetic dental restorations (PDR) between population subgroups. This study aimed to identify changes in oral health in Switzerland over two decades and to describe their relationship to sociodemographic factors in 2012. Swiss Health Surveys were conducted in 1992, 2002, and 2012. The mean number of missing teeth and the prevalence of PDR were calculated at each time point. Logistic regression analysis was performed to assess associations between the prevalence of PDR and sociodemographic factors. The mean number of missing teeth decreased from five in 1992 to three in 2012. Dental status - as indicated by the number of teeth present - improved across all sociodemographic groups, with the greatest improvements being found in obese participants and in participants with the lowest incomes and educational levels. The prevalence of implant-based restorations increased from 3.2% in 2002 to 9.8% in 2012, and the shift from fixed to removable restorations occurred in the age group being 10 years older. The overall prevalence of PDR decreased in middle-aged people. In conclusion, over the two decades of the study, the oral health of the Swiss population substantially improved. Although sociodemographic differences persisted, they decreased considerably in terms of the number of missing teeth and percentage of the population with a functional dentition., (© 2017 Eur J Oral Sci.)

Objectives: To evaluate the impact of cone beam computed tomography (CBCT) imaging on treatment planning regarding augmentation procedures for implant placement., Material and Methods: Panoramic radiographs and CBCT images of 40 patients requesting single-tooth implants in 59 sites were retrospectively analyzed by six specialists in implantology, and treatment planning was performed. Therapeutic recommendations were compared with the surgical protocol performed initially., Results: Bone height estimation from panoramic radiographs yielded to higher measures and greater variability compared to CBCT. The suggested treatment plan for lateral and vertical augmentation procedures based on CBCT or panoramic radiographs coincided for 55-72% of the cases. A trend to a more invasive augmentation procedure was seen when planning was based on CBCT. Panoramic radiography revealed 57-63% (lateral) vs. 67% (vertical augmentation) congruent plans in agreement with surgery. Among the dissenting sites, there was a trend toward less invasive planning for lateral augmentation with panoramic radiographs, while vertical augmentation requirements were more frequently more invasive when based on CBCT., Conclusions: Vertical augmentation requirements can be adequately determined from panoramic radiographs. In difficult cases with a deficient lateral alveolar bone, the augmentation schedule may better be evaluated from CBCT to avoid underestimation, which occurs more frequently when based on panoramic radiographs only. However, overall, radiographic interpretation and diagnostic thinking accuracy seem to be mainly depending on the opinion of observers., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Two- and three-dimensional radiographic techniques are available to determine peri-implantitis-related bone loss around dental implants., Purpose: To compare the performance of detecting different peri-implant bone defects in intraoral radiography (IR), panoramic radiography (PR), Cone Beam Computer Tomography (CBCT) and Computer Tomography (CT)., Material and Methods: Six implants were inserted under ideal conditions into the lower jaw of an edentulous human cadaver. IR, PR, CBCT and CT were performed. Two-wall, three-wall and four-wall defects with 1 mm depth were artificially created around two of the implants (one anterior and one posterior), and radiographies were repeated. The identical set-up was used for 3-mm-deep bone defects. All images were presented to seven observers. Sensitivity (SN) and specificity (SP) were determined for each modality, defect type and depths, and likelihood ratios were calculated., Results: The highest sensitivity was found with IR and CBCT for 1 mm (0.67; 0.68) and 3-mm defects (0.81; 0.79). The highest specificity was found with IR for both defect depths (0.51). The best classification of defect type revealed PR for both 1-mm and 3-mm-deep defects. Both likelihood ratios (LR+ and LR-) were best for IR with 1-mm (1.37 and 0.65) and with 3-mm defects (1.65 and 0.37)., Conclusions: IR should still be recommended as favourable method evaluating bone loss around dental implants, while CT demonstrated the lowest performance in detecting peri-implant bone defects., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: Periodontal diseases (PDs) may play an important role in the effect oral health status has on a person's quality of life (QoL). The objective was to investigate the influence of PDs (gingivitis and periodontitis) on oral health-related QoL (OHRQoL) by systematically reviewing the literature., Materials and Methods: Studies using clinical periodontal examinations and validated survey instruments were included. Among 1134 citations initially identified through electronic and hand searching, 37 were eligible and data were extracted from full texts. A vote counting method was used for synthesis of the results., Results: Included studies were published between 2001 and 2014 and revealed considerable heterogeneity in participant selection, clinical assessments, and OHRQoL measures. A significant association between PDs and OHRQoL was reported in 28 studies, of which eight reported increasing impact with greater disease severity or extent., Conclusions: Within the limits of the available literature, OHRQoL was affected by clinically assessed PDs. There was evidence for increased impairment with greater severity and extent of PDs, and the recognition of the association was increased when full mouth recording protocols were applied., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: To evaluate patient-related outcomes in restoring the edentulous maxilla with an implant overdenture., Materials and Methods: A comprehensive systematic review of the literature was conducted. Publications reporting patient-based outcomes with concomitant data on implant and/or prosthetic success were selected using predetermined inclusion criteria that were agreed upon by the two reviewers., Results: Twenty-three publications related to 20 study cohorts were identified to meet the inclusion criteria for maxillary implant overdentures: two randomized controlled trials (RCTs), 13 prospective case series including two crossover trials, and five retrospective studies., Conclusion: An implant overdenture offers a stabilized removable solution for the edentulous maxilla, which provides increased patient satisfaction and quality of life improvement. A palateless design supported by four to six implants with a wide anteroposterior span has been successfully applied in some investigations. A higher failure rate was experienced with machined implants, particularly with short implants (length < 10 mm). Although both splinted and solitary anchorage systems are advocated, maintenance is higher for solitary attachments and inflammation is increased beneath the bars. Long-term maintenance care is essential for all designs. Well-designed RCTs with larger sample cohorts with longer follow-up periods are required to amplify patient- and clinician-based outcomes.

The present study reports the results of a structured survey of graduates intending to evaluate the education at the Dental School of the University of Basel in the years from 2006 to 2014. In addition, dentists and practice owners supervising graduates from Basel in daily clinical routine or hiring them as assistant dentists were questioned. The aims of the current survey were (1) to analyze own subjective experiences, (2) to assess potential differences between the cohorts prior to and after the implementation of the Bologna reform, (3) to compare the rating regarding theoretical knowledge and practical skills, and (4) to disclose potential for improvement. It was found that according to both their own assessment and the rating of the practice owners, graduates possess the basic dental expertise. The alumni rated their theoretical knowledge higher than their clinical practical skills and indicated a potential for intensification in the fields of dental surgery and implantology. When comparing the cohorts who had completed their studies according to the old (until 2010) and new study regulations, there were only minor differences; the own skills related to patient information about treatments were better rated by alumni who had been trained according to the new study regulations. The curriculum leading to the Master of Dental Medicine at the University of Basel fundamentally prepares graduates for the professional activity, but the additional acquisition of clinical experience in daily practice is indispensable.

Objective: Recently a polymer infiltrated hybrid ceramic was developed, which is characterized by a low elastic modulus and therefore may be considered as potential material for implant supported single crowns. The purpose of the study was to evaluate the loading capacity of hybrid ceramic single crowns on one-piece zirconia implants with respect to the cement type., Methods: Fracture load tests were performed on standardized molar crowns milled from hybrid ceramic or feldspar ceramic, cemented to zirconia implants with either machined or etched intaglio surface using four different resin composite cements. Flexure strength, elastic modulus, indirect tensile strength and compressive strength of the cements were measured. Statistical analysis was performed using two-way ANOVA (p=0.05)., Results: The hybrid ceramic exhibited statistically significant higher fracture load values than the feldspar ceramic. Fracture load values and compressive strength values of the respective cements were correlated. Highest fracture load values were achieved with an adhesive cement (1253±148N). Etching of the intaglio surface did not improve the fracture load., Significance: Loading capacity of hybrid ceramic single crowns on one-piece zirconia implants is superior to that of feldspar ceramic. To achieve maximal loading capacity for permanent cementation of full-ceramic restorations on zirconia implants, self-adhesive or adhesive cements with a high compressive strength should be used., (Copyright © 2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Background: Azithromycin may be an alternative adjunctive systemic antibiotic in non-surgical periodontal therapy., Objective: This study aims to identify randomized controlled trials evaluating non-surgical periodontal treatment of chronic and/or aggressive periodontitis supplemented with systemically administered azithromycin., Materials and Methods: A systematic literature search was performed for publications published by 31 March 2014 using electronic databases and hand search. Randomized controlled trials published in English or German language, with a follow-up ≥6 months were included. From 231 titles identified, nine publications were eligible for inclusion., Results: Among the studies included, showing some risk of bias, seven reported on patients with chronic periodontitis and two with aggressive periodontitis. Minor adverse events were described in five studies. A synthesis of results using a vote counting method was applied. Significant (p < 0.05) beneficial effects of azithromycin were shown in six studies for probing depth changes and in five studies for clinical attachment level changes., Conclusion: In contrast to aggressive periodontitis patients, data from this analysis indicate a potential benefit of systemic azithromycin as adjunctive to non-surgical periodontal therapy in chronic periodontitis patients., Clinical Relevance: When contraindications for the standard antibiotics are present, azithromycin (AZM) may be considered as alternative systemically administered antibiotic drug in selected cases of chronic periodontitis.

Objectives: This study investigated the influence of proximal box elevation (PBE) with composite resin when applied to deep proximal defects in root-filled molars with mesio-occluso-distal (MOD) cavities, which were subsequently restored with computer-aided designed/computer-aided manufacturing (CAD/CAM) ceramic or composite restorations., Materials and Method: Root canal treatment was performed on 48 human mandibular molars. Standardized MOD cavities were prepared with the distal box located 2 mm below the cemento-enamel junction (CEJ). The teeth were randomly assigned to one of four experimental groups (n = 12). In groups G1 and G2, the distal proximal box was elevated up to the level of the CEJ with composite resin (PBE). No elevation was performed in the remaining two groups (G3, G4). CAD/CAM restorations were fabricated with feldspathic ceramic (Vita Mark II, CER) in groups G1 (PBE-CER) and G3 (CER) or with resin nano-ceramic blocks (Lava Ultimate, LAV) in groups G2 (PBE-LAV) and G4 (LAV). Replicas were taken before and after thermomechanical loading (TML; 1.2 Mio cycles; 49 N; 3,000 thermocycles between 50 °C and 5 °C). Following TML, load was applied until failure. Fracture analysis was performed under a stereomicroscope (×16). Marginal quality before and after TML (tooth restoration, composite restoration) was evaluated using scanning electron microscopy (×200)., Results: After TML, lower percentages of continuous margins were observed in groups G1-G3 compared with pre-TML assessments; however, the differences were not statistically significant. For group G4-LAV, the marginal quality after TML was significantly better than in any other group. The highest mean fracture value was recorded for group G4. No significant difference was found for this value between the groups with PBE compared with the groups without PBE, regardless of the material used. The specimens restored with ceramic onlays exhibited fractures that were mainly restricted to the restoration while, in teeth restored with composite onlays, the percentage of catastrophic failures (fractures beyond bone level) was increased., Conclusion: PBE had no impact on either the marginal integrity or the fracture behavior of root canal-treated mandibular molars restored with feldspathic ceramic onlays. CAD/CAM-fabricated composite onlays were more favorable than ceramic onlays in terms of both marginal quality and fracture resistance, particularly in specimens without PBE., Clinical Relevance: Composite onlays with or without PBE may be a viable approach for the restoration of root-filled molars with subgingival MOD cavities.

In children or adolescents with anterior tooth loss, space closure with the patient's own teeth should be considered as the first choice to avoid lifelong restorative needs. Thorough diagnostics and treatment planning are required when autotransplantation or orthodontic space closure is considered. If these options are not indicated and a single tooth implant restoration is considered, implant placement should be postponed until adulthood, particularly in young women and in patients with hyperdivergent skeletal growth pattern. A ceramic resin-bonded fixed dental prosthesis with 1 retainer is an excellent treatment solution for the interim period; it may also serve as a long-term restoration, providing that sound enamel structure is present, sufficient framework dimensions have been provided, adhesive cementation techniques have been meticulously applied, and functional contacts of the cantilever pontic avoided. In contrast, a resin-bonded fixed dental prosthesis with a metal framework and retentive preparation is indicated if the palatal enamel structure is compromised, interocclusal clearance is limited, splinting (such as after orthodontic treatment) is required, or more than 1 tooth has to be replaced., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Aims: Over the past decades, the placement of dental implants has become a routine procedure in the oral rehabilitation of fully and partially edentulous patients. However, the number of patients/implants affected by peri-implant diseases is increasing. As there are--in contrast to periodontitis--at present no established and predictable concepts for the treatment of peri-implantitis, primary prevention is of key importance. The management of peri-implant mucositis is considered as a preventive measure for the onset of peri-implantitis. Therefore, the remit of this working group was to assess the prevalence of peri-implant diseases, as well as risks for peri-implant mucositis and to evaluate measures for the management of peri-implant mucositis., Methods: Discussions were informed by four systematic reviews on the current epidemiology of peri-implant diseases, on potential risks contributing to the development of peri-implant mucositis, and on the effect of patient and of professionally administered measures to manage peri-implant mucositis. This consensus report is based on the outcomes of these systematic reviews and on the expert opinion of the participants., Results: Key findings included: (i) meta-analysis estimated a weighted mean prevalence for peri-implant mucositis of 43% (CI: 32-54%) and for peri-implantitis of 22% (CI: 14-30%); (ii) bleeding on probing is considered as key clinical measure to distinguish between peri-implant health and disease; (iii) lack of regular supportive therapy in patients with peri-implant mucositis was associated with increased risk for onset of peri-implantitis; (iv) whereas plaque accumulation has been established as aetiological factor, smoking was identified as modifiable patient-related and excess cement as local risk indicator for the development of peri-implant mucositis; (v) patient-administered mechanical plaque control (with manual or powered toothbrushes) has been shown to be an effective preventive measure; (vi) professional intervention comprising oral hygiene instructions and mechanical debridement revealed a reduction in clinical signs of inflammation; (vii) adjunctive measures (antiseptics, local and systemic antibiotics, air-abrasive devices) were not found to improve the efficacy of professionally administered plaque removal in reducing clinical signs of inflammation., Conclusions: Consensus was reached on recommendations for patients with dental implants and oral health care professionals with regard to the efficacy of measures to manage peri-implant mucositis. It was particularly emphasized that implant placement and prosthetic reconstructions need to allow proper personal cleaning, diagnosis by probing and professional plaque removal., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Single-tooth implants in the maxillary anterior region have the highest risk of esthetic complications from infrapositioning due to continuing maxillary growth and the eruption of adjacent teeth. Although the placement of anterior single-tooth implants should normally be postponed, particularly girls and young women with a hyperdivergent growth pattern, if an infraposition of an implant is present, then thorough examination and strategic planning are required. According to the severity, the strategic treatment options are as follows: simple retention; adjustment or replacement of the implant restoration, possibly including adjacent teeth; surgical implant repositioning by segmental osteotomy combined with osseodistraction; or submergence or removal of the implant. With the patient presented, an interdisciplinary approach that combined orthodontic alignment, surgical segmental osteotomy, distraction osteogenesis, and restorative features offered the opportunity to realign the adjacent teeth into the arch and to harmonize the gingival contour by means of continuous soft tissue enlargement and adaptation., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Background: Printing of templates for guided surgery represents an alternative to laboratory manufactured templates., Purpose: To determine the technical accuracy of a virtually designed and printed surgical template for guided implant surgery based on a surface scan of a cast model using the coDiagnostiX™ software., Materials and Methods: Cast models and the virtual planning data of nine patients receiving guided implant surgery with the coDiagnostiX software were analyzed. The original cast models were equipped with three titanium pins and scanned with a three-dimensional scanner. The scans were uploaded in the coDiagnostiX software and the virtual surgical templates were designed including the sleeves at their original positions. After printing the surgical templates, the sleeve positions were determined by optical scanning, and deviations were calculated and compared with the virtual positions of the sleeves., Results: The sleeves showed a mean three-dimensional deviation of 0.22 mm (range: 0.07-0.38 mm) in the center of the sleeve top, 0.24 mm (range: 0.08-0.36 mm) in the center of the sleeve bases and a mean angular deviation of 1.5° (range: 0.4°-3.3°) compared with the virtual positions., Conclusions: A high accuracy can be achieved using printed templates for guided implant surgery, by taking into account all sources of inaccuracies., (© 2013 University Basel. Clinical Implant Dentistry and Related Research © 2013 Wiley Periodicals, Inc.)

Aim: The aim of this pilot study was to analyze the interfurcal bone height in relation to the possible need for subsequent sinus floor elevation in patients with advanced periodontitis and furcation involvement of first and/or second maxillary molars., Material and Methods: Seventeen dentate patients, who received cone beam computed tomography (CBCT) for detailed preoperative diagnosis and planning of surgical interventions at periodontally involved maxillary molars (17 first and 15 second molars), were consecutively recruited for the study. The minimal bone height in the interfurcal region was measured from CBCT and related to furcation involvement, residual bone above the root tips, and the clinical probing pocket depth (PPD)., Results: The minimal interfurcal bone height measured 4.1 ± 2.6 mm on average with 75% of maxillary molars having ≤ 6 mm and almost 60% having only ≤ 4 mm bone height left below the sinus floor. A higher risk for reduced interfurcal bone height of ≤ 4 mm was given when residual PPD of ≥ 6 mm was remaining at two or more tooth sites (OR 0.10; 0.11)., Conclusions: The majority of periodontally involved maxillary molars had a substantially reduced interfurcal bone height, particularly with at least two sites with residual PPD ≥ 6 mm. This was a predictor for a subsequent need for sinus floor elevation when tooth replacement with a dental implant is desired., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The aim of this study was to evaluate Brazilian dentists' decision making regarding periodontally involved teeth and implant therapy indications as well as possible modifying factors such as gender, enrollment in teaching positions, and area of specialization., Material and Methods: This cross-sectional questionnaire-based study was conducted among Brazilian dentists between June and November 2012. The questionnaire comprised 27 questions divided into four different sections: socio-demographic characteristics, questions about their clinical practice toward implant therapy, decision making in four clinical cases, and agreement with different statements regarding endodontic, periodontal, and implant therapy., Results: A total of 155 dentists answered the questionnaire with an average age of 35.5 years. Fifty-one percent were male, and 44.5% were involved in teaching positions. One hundred and thirty-six (87.7%) respondents had already pursued a post-graduation program or were currently involved in one. 33.5% placed dental implants, 42% provided implant maintenance care to their patients, while 30% performed treatment of peri-implant diseases themselves. Dental faculty and dentists who had not followed any further training program, preferred the use of regenerative therapies more frequently. As opposed, dentists not involved in teaching positions, and periodontists were more prone to select resective therapies., Conclusion: Results suggest that dentists' decision making did not follow the latest external evidence, which might be related to factors as professional expertise and patients' preferences. Considering the difficulties faced by professionals when handling complex cases, there is an urgent need to establish international protocols and guidelines to help the clinician identify this particular treatment option, which corresponds with their internal evidence and is based on good external evidence., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To compare the antimicrobial activity of polyhexamethylene biguanide (Prontosan wound gel, Pr) and chlorhexidine digluconate (CHX) after short- and medium-term application with the disinfection ability of calcium hydroxide (Ca) in a model using immature bovine teeth., Methods: Sixty immature bovine roots were infected with Enterococcus faecalis and randomly assigned to six groups (n = 10). Disinfectants were applied into the root canal for 10 min (CHX-10 min and Pr-10 min) or 7 days (CHX-7d, Pr-7d and Ca-7d(g) ). In the negative control group (Co-n), no disinfectant was used. Dentine samples were collected, and the total count of bacteria and colony-forming units were determined. The log10 -transformed Colony-forming units (CFU) data were analysed using a Kruskal-Wallis test with post hoc Wilcoxon multiple-comparison tests., Results: The application of disinfectants led to a significant reduction in CFUs in all groups compared with group Co-n. When compared to Ca-7d(g) , CHX-7d (P = 0.290), CHX-10 min (P = 0.963) and Pr-7d (P = 0.095) revealed no significant differences. Pr-10 min had a significantly higher CFU value than Ca-7d(g) (P = 0.0004), CHX-10 min (P = 0.0009) and Pr-7d (P = 0.0006)., Conclusions: Within the limitations of this study, sufficient antimicrobial effect may be reached by a short-term application of CHX. For the application of 1% Prontosan wound gel, a medium-term use (7 day) is required, while short-term use (10 min) is less effective., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)