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Objectives Reciprocating endodontic one-file systems are a comparatively new method for root canal shaping. Even though the mechanical properties are comparable to modern rotating mechanical systems, data about subjective assessment and application quality are scarce. This study evaluates the reciprocating one-file system in undergraduate education. Materials and Methods A total of 42 undergraduate students without experience regarding reciprocating file systems filled in a questionnaire in four different points in time (t 1–t 4) anonymously. The questionnaire was based on a numerical rating scale ranging from 0 to 10. Statistical Analysis A least significant difference post-hoc analysis comparing the group average values was performed. The adjusted level of significance was p < 0.004 after Bonferroni correction. Results All rating scores increased after the first theoretical instruction. After the first practical training in artificial root canals in resin blocks and extracted teeth (t 2), the estimation of “time efficiency” (p = 0.002), “handling” (p < 0.001), and “overall impression” (p < 0.001) improved significantly. The “overall impression” remained constant and showed no significant changes after the first practical training. Conclusions Reciprocating systems seem to show a good acceptance among first time users. Initial concerns about “work safety” decrease during every step of the educational process. Reciprocating one-file systems are a safe and well-accepted method in undergraduate teaching.

Breast cancer has developed to become the leading type of cancer in females. For this study, 80 women were examined after chemotherapy for breast cancer and compared to 80 healthy age-matched women. This cross-sectional study comprised a dental examination with number of teeth, caries frequency (DMFT) and the presence of periodontal diseases (PSI). With the help of X-rays (OPG), the number of root canal fillings and apical lesions (LEO/LPO) were recorded. Furthermore, the education level, body mass index (BMI), smoking habits and general health conditions were recorded. All women completed questionnaires on oral health-related quality of life (OHIP-G14) and general well-being (HADS-D). To assess the influence of cancer therapy on oral health parameters, appropriate generalized linear models were fitted with disease status as main explanatory variable, adjusting for age and education. For OHIP and HADS, we additionally adjusted for number of missing teeth. The examined 160 women showed a comparable mean age (60.4 years) and an average BMI of 24.6. Cancer patients showed a higher risk for missing teeth (p

To evaluate the clinical characteristics of dental emergency patients with special regard on gender-specific differences related to the utilisation and use of antibiotics.A retrospective analysis of all patients who presented to the emergency service of a university hospital in from 2010 to 2013 was performed. Demographic data, diagnosis, conducted treatment and the prescription of antibiotics were recorded and further analysed.Altogether, 16,296 patients visited the emergency service. Of these patients, only one-fourth (25.7%; n = 4185) suffered from a diagnosis with urgent treatment needs. Gender-specific differences were found in the reason of visit. Males presented significantly more often with severe diagnoses, like abscess or trauma. Females presented significantly more often with non-urgent diagnoses, not directly connected to oral hygiene habits, like temporomandibular disorders (TMD), denture sore or dolor post extractionem. Moreover, an overuse of antibiotics was found among emergency patients, with every fifth patient (20.2%; n = 3291) being prescribed an antibiotic.Better public education on dental emergencies and constant updates for dentists about the use of antibiotics in dental emergency care is necessary to secure adequate medical supply for severe dental emergencies and to avoid an inappropriate use of antibiotics.

Meta-analysis of treatment effects of antimicrobial photodynamic therapy (aPDT) adjunct to non-surgical scaling and root planing (SRP) in comparison to SRP alone on patients with chronic periodontitis. The meta-analysis was performed according to PRISMA statement and Cochrane Collaboration guidelines. Electronic search complemented by hand search assured a high yield of randomized controlled trials (RCTs) of aPDT as adjunct modality to SRP. Differences in probing depth (PD) and clinical attachment level (CAL) were calculated with 95% confidence intervals and pooled in a random effects model. Analysis for intra- and inter-study heterogeneity was provided by χ 2 and I 2 tests, and publication bias was checked by funnel plots. Pooled overall effects of 26 RCTs attested significant benefits of aPDT adjunct to SRP with respect to PD reduction (MD 0.37; 95% CI 0.12–0.53; P

Background: Recently, smoothies with a high vegetable content have become very popular, especially among young adults. Objectives: This in vitro study was conducted to determine the erosive potential of selected green vegetables and green smoothies on human dental enamel. Methods: A total of ten green smoothies and eight freshly mixed vegetables were chosen, and pH, calcium and oxalic acid contents were measured. The enamel specimens were obtained from wisdom teeth and incubated with 3 selected foods (spinach, parsley, or green smoothie) for 12 and 24 hours (N = 6). Control samples were incubated with a physiological salt solution. An electron probe microanalyzer (Jeol JXA 8900RL) was utilized to analyze the concentrations of calcium, phosphorus, magnesium and fluorine at various depths ranging from 5 to 50 µm within the enamel samples. A visual examination of the specimen was carried out with a digital microscope. Results: The green smoothies showed pH values ranging from 3.6 to 4.2, and the values of the mixed vegetables ranged from 5.6 to 6.3. Only in the green smoothie group could a time-dependent release of different minerals be observed. After 12 and 24 hours of incubation, a pronounced loss of calcium and phosphorus was found to a depth of 15 µm. Digital microscopy of the enamel surfaces confirmed these findings. Conclusions: In our in vitro study, incubation with the spinach and parsley showed no damage to the enamel specimens; in the case of the investigated smoothies, a mild loss of minerals to a depth of 25 µm was observed. It must be considered that numerous factors influence the enamel surface in vivo, translating these results to in vitro conditions must be done with great caution.

Aim: The aim of this randomized clinical trial was to compare the coronally advanced flap (CAF) with the modified microsurgical tunnel technique (MMTT) for treatment of Miller class I and II recessions. Material and Methods: Forty patients with 71 gingival recessions were recruited and randomly assigned to either CAF or to MMTT. In both groups, a connective tissue graft was applied. Clinical evaluations were performed after 3, 6, and 12 months. Impressions were taken and digitally scanned three-dimensionally to evaluate the quantitative soft tissue changes in the operative region. Patient satisfaction was measured with the root coverage aesthetic score (RES). Results: After a period of 12 months, significant differences were not found between the two groups. Root coverage was 98.3% for CAF and 97.2% for MMTT. The evaluation of the aesthetic outcome using RES showed good results in both groups. The RES score was in accordance with subjective patient satisfaction. There was no significant difference in the amount of volumetric changes. Conclusions: CAF and MMTT with the additional use of a graft are equally successful in covering gingival recessions of Miller class I and II, with high aesthetic results. All patients indicated their willingness for further periodontal surgery

This prospective randomized clinical crossover trial was designed to compare hypnosis and local anesthesia for experimental dental pain relief. Pain thresholds of the dental pulp were determined. A targeted standardized pain stimulus was applied and rated on the Visual Analogue Scale (0–10). The pain threshold was lower under hypnosis (58.3 ± 17.3, p

For 3-dimensional (3D) imaging of a tissue, 3 methodological steps are essential and their successful application depends on specific characteristics of the type of tissue. The steps are 1° clearing of the opaque tissue to render it transparent for microscopy, 2° fluorescence labeling of the tissues and 3° 3D imaging. In the past decades, new methodologies were introduced for the clearing steps with their specific advantages and disadvantages. Most clearing techniques have been applied to the central nervous system and other organs that contain relatively low amounts of connective tissue including extracellular matrix. However, tissues that contain large amounts of extracellular matrix such as dermis in skin or gingiva are difficult to clear. The present survey lists methodologies that are available for clearing of tissues for 3D imaging. We report here that the BABB method using a mixture of benzyl alcohol and benzyl benzoate and iDISCO using dibenzylether (DBE) are the most successful methods for clearing connective tissue-rich gingiva and dermis of skin for 3D histochemistry and imaging of fluorescence using light-sheet microscopy.

Ziel der Studie: Fur Kinder und Jugendliche mit stark erhohtem Kariesrisiko wurde durch die LAGZ (Landesarbeitsgemeinschaft Jugendzahnpflege) Rheinland-Pfalz im Jahr 2004 die selektive Intensivprophylaxe (SIP) etabliert. Vergleichbare Programme existieren in den meisten deutschen Bundeslandern in unterschiedlicher Auspragung. Die Ergebnisse der schulzahnarztlichen Untersuchungen der Erstklassler im Bundesland Rheinland-Pfalz im Schuljahr 2013/2014 werden nach Prophylaxeprogramm („Aktivprogramm Jugendzahnpflege“ [SIP] gegenuber Standardprogramm [SP]) betrachtet. Hierbei sollen die innerschuljahrlichen Auswirkungen auf das teilnehmende Kollektiv beleuchtet werden. Des Weiteren soll untersucht werden, ob die SIP tatsachlich die Kinder mit der hochsten Karieserfahrung erreicht. Methodik: Instruierte Schulzahnarzte in Rheinland-Pfalz erhoben im Schuljahr 2013/2014 den d3mft/D3MFT-Index nach WHO-Kriterien. Gemas diesen wurde Karies bei Dentinbefall als solche diagnostiziert; rontgenologische Methoden oder fiberoptische Methoden standen nicht zur Verfugung. Die Untersuchungen fanden schuljahrlich einmalig im SP; 2-malig in der SIP statt. Schuler und Eltern wurden bei Behandlungsbedarf stets informiert und nach daraufhin nicht erfolgter Vorstellung beim Zahnarzt einmalig erinnert. Aus den erhobenen d3mft/D3MFT-Werten wurde der Significant Caries Index (SiC) berechnet. Die statistischen Berechnungen wurden mit SPSS 22.00. durchgefuhrt. Ergebnisse: Insgesamt 25 020 Erstklassler waren nach d3mft/D3MFT auswertbar. Hiervon nahmen n=1164 Erstklassler im Schuljahr 2013/2014 am SIP in Rheinland-Pfalz teil; bei n=1002 lagen die Ergebnisse beider zahnarztlichen Untersuchungen vor. Die Karieserfahrung der Erstklassler in der SIP uberstieg signifikant diejenige der Teilnehmer des SP (41,8% Naturgesunde gegenuber 61,7%, p Schlussfolgerung: Die Ergebnisse der vorliegenden Studie zeigen, dass die SIP in Rheinland-Pfalz tatsachlich in einer besonders karieserfahrenen Population durchgefuhrt wird. Der signifikante Unterschied bezuglich Sanierungsgrad zwischen 1. und 2. Untersuchung lasst den Schluss zu, dass haufig Aufgrund von schulzahnarztlich diagnostiziertem Behandlungsbedarf ein Zahnarzt zur Therapie aufgesucht wurde.

In the original published version of this article, the middle name for author Mirko H. H. Schmidt is missing.

To determine the irradiance delivered by visible-light curing (VLC) units and obtain information about the exposure times and the maintenance protocols used by dentists.The irradiance (mW/cm2) delivered by 526 VLCs from 302 dental offices from the Rhine-Main area, Germany, was measured using an integrating sphere (IS) and a MARC patient simulator (M-PS); additional information was gathered using a survey.Irradiance was measured from 117 standard quartz-tungsten-halogen (QTH), 5 high-power QTH, 2 LED 1st-generation, 333 LED 2nd-generation, 61 LED 3rd-generation, and 8 plasma-arc curing (PAC) units. Depending on the measurement method, 8% (IS) or 11% (M-PS) of the VLCs delivered400 mW/cm2. Depending on the VLC, the shortest exposure times required to deliver a radiant exposure of 16 J/cm2 ranged from 7 to 294 s. The number of exposure cycles used by dentists when light curing a restoration ranged from 1 to 14. The shortest total exposure time used by dentists on a restoration was 5 s, the maximum was 200 s, and the median was 20 s. Of the 526 VLCs, 41% had intact, undamaged light tips. Only half of the dental offices checked the irradiance from their VLCs regularly, 97% disinfected the VLC, and 86% used eye protection.Approximately 10% of the VLCs delivered400 mW/cm2 and 14% of the dental offices used no form of eye protection. To achieve sufficient light curing of RBC restorations, more awareness about the VLCs used in the dental office is required.

The root canal system morphology of the mandibular second molar was investigated by means of micro-computed tomography (μCT). The root canal configuration (RCC), foramina and accessory canals frequency of 93 mandibular second molars of an Egyptian sample were investigated by μCT scans. The RCC and main foramina number (MFN) are described by means of a four-digit system from coronal to apical. The most frequently observed RCCs in the mesial root were 2-2-1/1 (32.3%), 2-2-2/2 (28.0%), 1-1-1/1 (6.5%) and 2-1-1/1 (6.5%); an additional twelve different RCCs were also found here. In the distal root, the RCC 1-1-1/1 was observed in 81.7%; another ten different RCCs with a frequency of less than 5% were also observed in this root. Anastomoses be-tween the mesiobuccal and mesiolingual canals in the mesial root were witnessed in the coronal (20.5%), middle (19.4%) and apical (10.8%) thirds. Accessory canals were found in the coronal (mesiobuccal 15.0%, mesiolingual 12.9%, distobuccal 1.1%), middle (mesiobuccal 7.5%, mesiolingual 10.8%, distolingual 3.3%) and apical (mesiobuccal 19.3%, mesiolingual 16.2%, distolingual 10.8%, distobuccal 2.2%) thirds. The RCC of mandibular second molars showed a great variety. When compared with the first mandibular molar in a historical control from the same sample, the mandibular second molar presented less morphological diversifications. Yet, the mesial root canalsystem of the mandibular second molar showed more RCC variations, connecting and accessory canals than the distal root.

This study evaluated the influence of different rehydration media and time periods on biomechanical and structural properties of different acellular collagen matrices (ACMs). Specimens of three ACMs (mucoderm®, Mucograft®, Dynamatrix®) were rehydrated in saline solution (SS) or human blood for different time periods (5–60 min). ACMs under dry condition served as controls. Biomechanical properties of the ACMs after different rehydration periods were determined by means of tensile testing. ACMs’ properties were further characterized using Fourier-transform-infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC). At dry conditions, mucoderm® presented the highest tensile strength (TS) and Dynamatrix® showed the maximum elastic modulus (EM; p each ≤0.036). Rehydration in SS and blood resulted in significant TS changes of mucoderm® (p each ≤0.05). Concering EM, mucograft® showed significantly decreased values after rehydration in SS compared to Dynamatrix® and mucoderm® after 10 min (p each ≤0.024). mucoderm® hydrated for 5 min in blood displayed nearly double TS and a significantly increased EM after 60 min (p = 0.043) compared to rehydration in SS. TS and EM values of Dynamatrix® and Mucograft® were not altered following rehydration in blood versus SS (p each ≥0.053). FTIR analysis confirmed the recovery of the graft protein backbone with increased rehydration in all samples. DSC measurements revealed that tissue hydration decreased thermal stability of the investigated ACMs. Our findings demonstrated that the rehydration protocol affects the biomechanical properties of ACMs. Clinicians should be aware of altered handling and mechanical properties of ACMs following different rehydration protocols.

Statement of problem Bond stability between zirconia crowns and luting cement and between cement and dentin is a main concern; however, only limited evidence is available as to its longevity. Purpose The purpose of this in vitro study was to measure the retentive strengths of 7 self-adhesive cements (RelyX Unicem Aplicap, RelyX Unicem Clicker, RelyX Unicem 2 Automix, iCEM, Maxcem Elite, Bifix SE, SpeedCem), 2 adhesive cements with self-etch primers (Panavia 21, SEcure), 1 glass ionomer cement (Ketac Cem), 1 resin-modified glass ionomer cement (Meron Plus), and 1 zinc phosphate cement for luting zirconia crowns (LAVA) to extracted teeth after thermocycling with or without 1 year of water storage. Material and methods Two-hundred-forty extracted human molars (2 treatments; n=10 per cement) were prepared in a standardized manner. All cements were used according to the manufacturers' recommendations. The intaglios of the crowns were treated with airborne-particle abrasion. After thermocycling (×5000, 5°C/55°C) with or without 1 year of water storage, the cemented ceramic crowns were removed by using a Zwick universal testing device. Statistical analyses were done with the Wilcoxon rank sum and the 2-independent-samples Kolmogorov-Smirnov test. Results Median retentive strengths [MPa] for specimens thermocycled only/thermocycled with 1 year of water storage were as follows: Panavia 21: 1.7/2.5, SEcure: 3.0/3.0, RelyX Unicem Aplicap: 3.1/3.4, RelyX Unicem Clicker: 4.1/4.2, RelyX Unicem 2 Automix: 3.8/3.1, iCEM: 2.3/2.7, Maxcem Elite: 3.0/3.2, Bifix SE: 1.7/1.7, SpeedCem: 1.3/1.6, Meron Plus: 3.1/2.7, Ketac Cem: 1.4/1.4, and zinc phosphate cement: 1.1/1.6. Statistically significant differences were found only among specimens thermocycled only or thermocycled with 1-year water storage ( P Conclusions Significant differences in retentive strengths were observed among cements after thermocycling only or thermocycling with 1 year of water storage, but not for the effect of the additional 1 year of water storage.

Introduction Endodontic gutta-percha undergoes deformation at temperatures above 65°C. The temperature influence of heat carriers on gutta-percha cones was investigated in vitro. Methods Six single-rooted extracted teeth were embedded in resin and fixed. The root canals were prepared (ProFile; Dentsply Maillefer, Ballaiques, Switzerland) to different tapers and bisected. Thermographic images when heating the gutta-percha cones (Roeko, Langenau, Germany) with a heat carrier (ML .12; SybronEndo, Orange, CA) at 1 and 5 mm from the working length were made with an infrared thermal imaging camera (ThermaCam P640; Flir Systems, Taby, Sweden). The device temperature was preset at 200°C. The pixel temperature registered at the contact lines between the heat carriers and gutta-percha cones in the thermographic images was recorded and statistically described. Results A mean temperature (°C) instability in the heat carrier (324.96 ± 46.10, minimum = 147.35, maximum = 474.13), a temperature drop of the gutta-percha cones (159.52, ±37.57, min 67.64, max 259.04) at the measuring level, and a mean temperature penetration depth (mm) equal or to higher than 65°C (1.05 ± 0.28, minimum = 0.20, maximum = 1.30) were recorded. No correlation between the penetration depth into the gutta-percha cones and applied temperatures, regardless of the size and/or taper, could be established. Conclusions Temperature discrepancies between the device preset and achieved ones of the heat carriers was observed. Gutta-percha is a poor thermal conductor, transports heat irregularly, and should be heated 1–2 mm from the target area.

To investigate the polymerization shrinkage stress of different low viscous bulk composites (SDR, Venus Bulk Fill, X-tra Base, Filtek Bulk Fill) in comparison to a conventional flowable composite (Filtek Supreme XTE Flow) and to high viscous bulk and conventional composites (Filtek Supreme XTE, GrandioSO, Tetric EvoCeram, Tetric EvoCeram BulkFill, Venus Diamond, Venus Pearl), as well as to an experimental composite (Ormocer) and a sonic-activated bulk fill composite (Sonicfill), by means of photoelastic investigation.To ensure bonding of the resin composite, cylindrical cavities (Ø 4mm) in araldite B epoxide resin plates (40 × 40 × 4 mm3) were pre-treated with the Rocatec system. Embedded in araldite plates, six resin composite specimens of each material were exposed for 60 seconds from one side (Translux Power Blue, 1,000 mW/cm2). The samples were stored, light-protected and dry (23°C). Polymerization shrinkage stress data (MPa) were calculated 15 minutes, 1 and 24 hours after light exposure, based on the diameter of the isochromatic curves of first order, obtained from araldite plates. Statistical analysis was performed with the Wilcoxon-test and Bonferroni correction (P0.0006).After 15 minutes/1 hour, the mean polymerization stress values calculated were:for SDR 4.4 ± 0.1/4.4 ± 0.2 MPa; Venus Bulk Fill 4.8 ± 0.3/4.9 ± 0.3 MPa; X-tra Base 6.5 ± 0.3/6.7 ± 0.3 MPa; Filtek Bulk Fill 4.9 ± 0.3/4.9 ± 0.3 MPa; Filtek Supreme XTE Flow 8.0 ± 0.3/8.2 ± 0.2 MPa; Filtek Supreme XTE 7.1 ± 0.1/7.4 ± 0.2 MPa; GrandioSO 6.3 ± 0.4/6.3 ± 0.3 MPa; Tetric EvoCeram 4.5 ± 0.1/4.6 ± 0.1 MPa; Tetric EvoCeram BulkFill 4.9 ± 0.2/5.0 ± 0.3 MPa; Venus Diamond 3.7 ± 0.3/3.8 ± 0.3 MPa; Venus Pearl 3.9 ± 0.2/4.0 ± 0.2 MPa, Sonicfill 5.4 ± 0.2/5.6 ± 0.3 MPa; and Ormocer (experimental) 4.1 ± 0.2/4.3 ± 0.2 MPa. After 24 hours, the following mean stress values were obtained:SDR 4.7 ± 0.2 MPa; Venus Bulk Fill 5.1 ± 0.2 MPa; X-tra Base 7.2 ± 0.4 MPa; Filtek Bulk Fill 5.3 ± 0.3 MPa; Filtek Supreme XTE Flow 8.7 ± 0.3 MPa; Filtek Supreme XTE 7.9 ± 0.2 MPa; GrandioSO 7.0 ± 0.4 MPa; Tetric EvoCeram 4.9 ± 0.1 MPa; Tetric EvoCeram BulkFill 5.4 ± 0.3 MPa; Venus Diamond 4.5 ± 0.3 MPa; Venus Pearl 4.5 ± 0.3 MPa, Sonicfill 5.8 ± 0.2 MPa and Ormocer (experimental) 4.5 ± 0.2 MPa. The new and experimental resin composites showed significantly less polymerization shrinkage stress than the conventional resin composite (Filtek Supreme XTE).Resin composite restoratives differ in their polymerization shrinkage stress development, independent of their viscosity. Some low viscosity bulkfill-restoratives generate less shrinkage stress compared to other conventional or bulk-restoratives. Practitioners should yield to the potential effect of shrinkage stress development, because this might affect marginal integrity in the clinical performance.

The aim of this study was to investigate the physiological foramen diameter, shape and distance between physiological and anatomical apex of maxillary and mandibular first and second molars. Accurate knowledge of the physiological foramina morphology; thus, inherent mechanical shaping technical hindrances, is decisive when taking the corresponding root canal final preparation decision. The morphological dimensions of a total of 1727 physiological foramina were investigated by means of micro-computed tomography. Mean narrow and wide (to a high number, oval) diameters of the physiological foramen were 0.24, 0.22 and 0.33 mm and 0.33, 0.31 and 0.42 mm in mesiobuccal (MB), distobuccal (DB) and palatal (P) roots in maxillary first molars; 0.24, 0.22 and 0.33 mm and 0.41, 0.33 and 0.44 in MB, DB, and P roots in maxillary second molars. Mandibular first molars showed mean narrow and wide diameters of 0.24 and 0.30 mm and of 0.39 and 0.46 mm in mesial (M) and distal (D) roots; second mandibular molars showed 0.25 and 0.31 mm and 0.47 mm in M and D roots. The mean distance between the physiological foramina and anatomical apex was 0.82, 0.81 and 1.02 mm and 0.54, 0.43 and 0.63 mm in MB, DB and P roots of the maxillary first and second molars, respectively. A mean distance of 0.95 mm (M) and 1.05 mm (D) in the first and 0.78 mm (M) and 0.81 mm (D) in the second mandibular molars was observed. Based on the results obtained, assumable recommendations for final preparation size of the physiological foramen were calculated. However, when taking into consideration, the resulting standard deviations of marginal errors must be cautiously considered when taking a final decision in clinical endodontic treatment.

The aim of this study was to investigate the root canal configuration, accessory canals and number of main foramina of 123 maxillary second molars by means of micro-computed tomography. The teeth were scanned and reproduced with 3D software imaging. The root canal configuration and number of main foramina were evaluated by means of a four-digit system. The morphological complexity of human maxillary second molars is depicted by the number of accessory and connecting canals. The most frequently observed root canal configurations in the mesiobuccal root were 2-2-2/2 (19.5%), 2-2-1/1 (14.6%) and 2-1-1/1 (13.0%). A 1-1-1/1 configuration was observed in 93.5% and in 96.7% in the distobuccal and palatal roots, respectively. The MB1 root canal had one accessory canal (18.7%), and 8.9% of the MB2 root canal had one or two accessory canals. The distobuccal (11.3%) and palatal (14.6%) root canals had at least one accessory canal, and connecting canals were observed in 16.3% of mesiobuccal roots. The MB1, MB2, distobuccal and palatal root canals had one main foramen in 99.2%, 43.1%, 98.4% and 99.2% of samples, respectively. In the mesiobuccal root, one accessory foramen was detected in 14.6%, two were detected in 7.3%, and three were detected in 5.7%. The distobuccal root showed one or two accessory foramina in 9.1% of samples. The root canal configuration of maxillary second molars is quite heterogeneous; the mesiobuccal root has predominantly two root canal entrances (58.4%, 1 in 41.1%) with one main foramen (54.4%). Two main foramina were observed in 43.0%. Morphological variations, connecting and accessory canals were observed in all apical thirds.

Background Leakage of components from endodontic materials (EM) can occur in case of apical extrusion into the periapical tissue. Therefore, an important prerequisite, besides the mechanical properties of the EM, is a high biocompatibility. In the present study, we elucidated the genotoxic potential of EMs of different base composition by utilizing the -H2AX assay. Methods For investigation of the genotoxic potential of EM, supernatants of commercially available EM were prepared and dilutions were applied to human gingival fibroblasts. Non-toxic doses of EM were determined by cell viability assay. For the -H2AX assay, human gingival fibroblasts were incubated with predefined concentrations of the supernatants, which were found not to reduce cell viability. Hydrogen peroxide was utilized as positive control. Cells were fixed 1, 6 and 24 hours after addition of the supernatant to the medium, followed by immunostaining for -H2AX. For scoring of -H2AX foci, automated foci counting was performed in at least 80 cells per experiment and time point. The experiments were repeated at least twice. Results In contrast to hydrogen peroxide treated cells, no elevated -H2AX levels were detected in cells incubated with the EM supernatants. Conclusions Samples treated with EM supernatants showed no elevated levels of -H2AX foci, e.g., no genotoxicity. Therefore, all types of EM seem to meet the standard to be called a biocompatible dental material in terms of genotoxicity, and, therefore, the application seems safe.

The biocompatibility of materials used in endodontic treatment is of high importance, because they can come in contact with periradicular tissues and there is a risk of possible systemic toxicity. The aim of the present study was to investigate the in vitro reaction to a bioceramic based root end material in comparison to mineral trioxide aggregates (MTA) as the established gold standard.The root end materials grey MTA Angelus (GMTA), white MTA Angelus (WMTA), ProRoot MTA, and EndoSequence Root Repair Material (ERRM) were incubated with human periodontal ligament fibroblasts and osteoblasts (10(4)cells/ml) for up to 96h. Cell proliferation (RFU) was determined by means of the Alamar Blue assay. In addition, fluorescence staining was carried out to visually monitor cell growth and morphology.For most of the observational time period of up to 96h, there was no statistically significant difference between the proliferation rates of the control cells and those in contact with ERRM. In contrast, the mineral trioxide based materials caused from 24 to 96h significantly lower proliferation rates in comparison to the controls (p0.001). For proliferation rates of cells in contact with MTAs and ERRM significant differences were observed throughout the whole observation time for the osteoblasts, but only up to 24h for the human periodontal ligament fibroblasts.Within the limits of this study the results suggest that the bioceramic root end material is biocompatible, but needs to be investigated in clinical studies before it can be recommended as retrograde sealer in endodontic practice.

ZusammenfassungIn der vorliegenden Studie sollte der Mundgesundheitszustand sowie Mundhygienemaßnahmen bei berufstätigen und nichtberufstätigen Frauen untersucht und miteinander verglichen werden. Neben einer zahnärztlichen Untersuchung wurden mittels Fragebogen sowohl Mundhygienemaßnahmen als auch soziodemografische Daten erhoben.Für die Studie konnten insgesamt 415 Frauen (210 berufstätige und 205 nicht berufstätige Frauen) der Altersgruppe 25–65 Jahre erfasst werden. Bei allen Frauen erfolgte eine zahnärztliche Untersuchung einschließlich einer radiologischen Befundung (Panoramaschichtaufnahme). Die zahnärztliche Untersuchung beinhaltete Anzahl der Zähne, Karieshäufigkeit (DMFT-Wert), Art und Häufigkeit von Restaurationen, Mundhygienemaßnahmen (API), Entzündungsgrad der Gingiva (SBI), Sondierungstiefen und das Vorliegen von Rezessionen. Des weiteren wurde ein Fragebogen ausgefüllt, der Informationen zu anamnestischen Daten, Familiensituation, Bildungsstand und Berufstätigkeit beinhaltete. Für die Studie lag das positive Votum der Ethikkommission (Rheinland-Pfalz) vor.Die nicht erwerbstätigen Frauen/Hausfrauen (Alter: 38,1±9,7 Jahre) waren zu 90% verheiratet, nur zu 3% starke Raucherinnen und nur 2% hatten einen Hochschulabschluss. Berufstätige Frauen (Alter: 43,2±11 Jahre) waren zu 73% verheiratet, 17% waren starke Raucherinnen (>20 Zigaretten/Tag) und 10% hatten einen Hochschulabschluss. Die Mundhygienemaßnahmen der Berufstätigen waren im Vergleich zu den nicht erwerbstätigen Frauen tendenziell besser, jedoch hatten die berufstätigen Frauen vermehrt aggressive Parodontalerkrankungen (15% vs. 3,3%; pDie Mundgesundheit von berufstätigen Frauen und Frauen ohne Erwerbstätigkeit zeigte leichte Unterschiede. Diese Untersuchungen legen den Schluss nahe, dass Berufstätigkeit, Bildungsstand und Lebensstil der Frauen sowohl die oralen Pflegemaßnahmen als auch die Mundgesundheit beeinflussen.

The present in-vitro study examined the effects of different biomaterials on early root surface colonization by human periodontal ligament (PDL) fibroblasts using confocal-laser-scanning-microscopy (CLSM).Fifteen periodontally-diseased teeth were extracted, treated with scaling/root planing and longitudinally cut to obtain 30 root fragments. Fragments were treated either with 24% EDTA following application of enamel matrix derivative (EMD), 24% EDTA or EMD only, nanocrystalline hydroxyapatite (NHA) paste or oily calcium hydroxide suspension (OCHS) for 1 h each. The analogue untreated root specimens served as controls. Root fragments were incubated with human PDL fibroblasts and cellular proliferation and morphology were evaluated after 1, 3, 5 and 8 days using CLSM-visualization and image recognition software.The rate of cellular proliferation was different among treatment modalities examined (p = 0.019). Except treatment with NHA paste all treatment modalities improved cellular proliferation on root surfaces at all different points of time compared with the control specimens. A significant difference between treatment modalities was observed between EMD and NHA paste (p = 0.008). No synergistic effect could be demonstrated comparing root surface conditioning with 24% EDTA and EMD application compared to 24% EDTA or EMD application only.The present results suggest that initial root surface colonization by PDL fibroblasts may be enhanced by root surface conditioning with 24% EDTA and application of EMD, application of 24% EDTA or EMD alone and OCHS. The addition of 24% EDTA for root surface conditioning prior to EMD application provided no synergistic effects in terms of early root surface colonization by PDL fibroblasts.

ResumenEl objetivo de esta investigación fue evaluar in vitro la respuesta de fibroblastos gingivales contra diferentes selladores endodónticos mediante cultivos celulares, en un lapso de 96 horas. Los resultados obtenidos a intervalos de tiempo de 0, 1, 2, 3, 6, 24, 48, 72 y 96 horas fueron utilizados para determinar la citotoxicidad de los selladores. Cultivos de fibroblastos gingivales sin ningún sellador y con Sealapex fueron utilizados como controles positivos y negativos respectivamente. Los resultados fueron comparados con los controles negativos y analizados estadísticamente por medio de la prueba t Dunnett (p ≤ 0.05). Los cementos selladores investigados fueron: ProRoot MTA gris y blanco CPM, MTA Angelus, Sealapex y GuttaFlow. Los resultados demostraron que a pesar de que el ProRoot MTA (gris y blanco) MTA Angelus, CPM y GuttaFlow demostraron tener un potencial citotóxico menor que el Sealapex, no se encontraron diferencias estadísticas significativas.AbstractThe aim of this study was to evaluate in vitro the response within 96 hrs of gingival fibroblasts cultures against different endodontic sealers, The results obtained at intervals of 0, 1, 2, 3, 6, 24, 48, 72 and 96 hrs were used to determine the cytotoxicity of the endodontic sealers. Gingival fibroblast cultures without root canal sealer and with Sealapex were used as negative and positive controls, respectively. The results were compared with negative controls and statistically analyzed with the Dunnett t test (p ≤ 0.05). The endodontic Sealers investigated were ProRoot MTA gray and white, CPM, MTA Angelus, Sealapex and GuttaFlow. The results showed that eventhough ProRoot MTA (gray and white) MTA Angelus, CPM and GuttaFlow proved to have a lower cytotoxic potential than Sealapex, no statistical significant differences were established.

Introduction Online learning media are increasingly being incorporated into medical and dental education. However, the coordination between obligatory and facultative teaching domains still remains unsatisfying. The Catalogue of Interactive Learning Objectives of the University Clinic of Mainz (ILKUM), aims to offer knowledge transfer for students while being mindful of their individual qualifications. Its hierarchical structure is designed according to the Association for Dental Education in Europe (ADEE) levels of competence. Materials and methods The ILKUM was designed to establish a stronger interconnection between already existing and prospective learning strategies. All contents are linked to the current lectures as well as to e-learning modules, e.g., clinical case studies and OR videos. Students can conduct self-examinations regarding specific learning objectives. Since 2007, ILKUM has been developed and analyzed regarding its acceptance among dental students. Results These improved e-learning techniques foster time and location-independent access to study materials and allow an estimation of the knowledge achieved by students. Surveys of our students clearly show a large demand for upgrading ILKUM content (89%; n = 172) with integrated self-testing (89%; n = 174). In parallel to the advancement of our e-learning offering, a portion of internet-based learning is constantly rising among students. Conclusion The broad acceptance and demand for the development of ILKUM show its potential. Moreover, ILKUM grants fast, topic-oriented querying of learning content without time and locale limitations as well as direct determination of the individually needed knowledge conditions. Clinical significance The long-term goal of the ILKUM project is to be a sustainable, important additional modality of teaching and training for dental and medical students. How to cite this article Mahmoodi B, Sagheb K, Sagheb K, Schulz P, Willershausen B, Al-Nawas B, Walter C. Catalogue of Interactive Learning Objectives to improve an Integrated Medical and Dental Curriculum. J Contemp Dent Pract 2016;17(12):965-968.

Objectives Fixed orthodontic appliances (FOAs) may cause a temporary deterioration of oral hygiene with corresponding gingival inflammatory changes. Optimal oral hygiene and dietary changes are essential in order to avoid periodontal inflammation. The present study investigates to what extent the recommendations made by the orthodontist are followed by young patients. Materials and methods A total of 67 adolescent patients with FOA were examined and interviewed. The control group consisted of 70 patients of the same age who had not undergone any orthodontic treatment. A specific questionnaire (assessing dietary habits, oral hygiene measures) was used and comprehensive oral findings along with oral hygiene status were evaluated. Results The analysis of the data showed that despite intensive oral hygiene and dietary advice in the patients with FOA, there was no change in diet or oral hygiene habits. There were significantly higher signs of gingival inflammation and amount of dental plaque in FOA patients. Nutritional recommendations and oral hygiene measures for young people with FOA were not adequately enforced. Conclusion The findings indicate that frequent recalls should be scheduled with repeated reinforcement of oral hygiene and dietary modifications in FOA patients. How to cite this article Azaripour A, Willershausen I, Hassan M, Ebenezer S, Willershausen B. Oral hygiene and dietary Habits in Adolescents with fixed orthodontic Appliances: A crosssectional Study. J Contemp Dent Pract 2016;17(3):179-183.

This randomized, controlled clinical trial evaluates the effectiveness of self-hypnosis on pain perception. Pain thresholds were measured, and a targeted, standardized pain stimulus was created by electrical stimulation of the dental pulp of an upper anterior tooth. Pain stimulus was rated by a visual analogue scale (VAS). The pain threshold under self-hypnosis was higher (57.1 ± 17.1) than without hypnotic intervention (39.5 ± 11.8) (p < .001). Pain was rated lower on the VAS with self-hypnosis (4.0 ± 3.8) than in the basal condition without self-hypnosis (7.1 ± 2.7) (p < .001). Self-hypnosis can be used in clinical practice as an adjunct to the gold standard of local anesthesia for pain management, as well as an alternative in individual cases.

Background The aim of this prospective placebo-controlled pilot study was to evaluate short-term effects of a mouthrinse containing aluminium triformate (ATF) on gingival inflammation and plaque formation in periodontal patients who are in the maintenance phase. ATF has styptic (astringent) and anti-inflammatory effects. Methods Forty non-smoking periodontal patients with modified sulcus bleeding index (MSBI) ≥40 % were randomly divided into two groups. The participants received a masked mouthrinse (ATF or placebo) and were instructed with the rinsing protocol of 3 daily rinses during 30 s for 7 days. One blinded investigator (CE) performed all clinical examinations. The primary outcome was reduction in gingival inflammation as measured by MSBI. The secondary outcomes were reduction of the amount of plaque as measured by plaque index (PI) and approximal plaque index (API) and the occurrence of side effects. The patients were evaluated at the start and the end of the rinsing period, including the compliance of the patients. Results MSBI was reduced in both groups compared to baseline, but the ATF group showed significantly more reduction in MSBI compared to the placebo group (ATF: 17.6 %, placebo: 7.6 %, p = 0.035). ATF and placebo had no effects on dental plaque. Patients reported ATF mouthrinse not to have side effects other than oral sensation, whereas compliance of the patients was good. Almost all patients in the ATF group reported reduction of gum bleeding after 1 week of rinsing with ATF. Conclusions This short-term pilot clinical trial is a firm basis to design a long-term controlled clinical trial to show whether ATF helps to inhibit further periodontal breakdown in maintenance patients with high MSBI. Trial registration This trial was registered in the WHO International Clinical Trials Registry Platform as DRKS00007672, date of registration: 21/01/2015. Electronic supplementary material The online version of this article (doi:10.1186/s12903-016-0214-z) contains supplementary material, which is available to authorized users.

In der vorliegenden klinischen Anwendungsbeobachtungsstudie wurde die Wirkdauer des Lokalanasthetikums Ubistesin 1: 400 000 getestet. Ziel der Studie war, den klinischen Nutzen hinsichtlich Wirkdauer und Einsatzbereiche zu prufen. Insgesamt sind 515 Zahne (380 Patienten) behandelt worden. Die Hauptindikationsbereiche waren Parodontalbehandlungen (n = 245), gefolgt von Kavitatenpraparationen (n = 162) und Legen von Fullungen (n = 39). Die mediane Anasthesiedauer betrug 162 min. Die individuelle Schmerzempfindung der Patienten lag jedoch zwischen 37 min und 7,5 h. Die Ergebnisse der vorliegenden klinischen Anwendungsbeobachtung zeigten, dass das verwendete Anasthetikum mit geringer Vasokonstriktionszusatzmenge als geeignetes Anasthetikum betrachtet werden kann.

Objective The aim of the present clinical pilot study was to examine the influence of a combination of micronutrients on individuals with high stress experience. Methods 40 healthy students (28 female, 12 male) with a mean age of 27.1 ± 3.0 years, experiencing high examination stress, were chosen. After approval of the ethics commission, one group of students (n = 19) took a combination of micronutrients (Orthomol vital m/f) for three months, whereas other students (n = 21) served as control group. All participants underwent at the beginning and at the end of the trial a dental examination, a determination of 10 periodontal pathogens, a salivary and a blood analysis. In addition, the participants filled in a questionnaire on nutrition, quality of life and degree of stress experienced during their final examinations. Results The evaluation of the results, obtained at the end of the trial period, showed that for all students a slight worsening of oral hygiene and an increased consumption of unhealthy food could be observed. The intake of the micronutrients led to a slight improvement of the degree of gingival inflammation in comparison to the control group. The blood analysis showed an increase in vitamin (vitamin C, vitamin E) and zinc concentrations, and a lower increase in CRP. In the male subjects, a decrease in the serum concentrations of triglycerides (p = 0.073) and LDL (p = 0.048) was observed. Conclusions This pilot study shows that micronutrients, taken during periods of high stress experience, had a beneficial effect on inflammatory processes and helped reduce the level of some of the plasma lipids in males, and thus can be recommended for supplementing the diet. However, additional studies with a higher number of subjects, also suffering from periodontal disease, are necessary to show the effect of a micronutrient supplementation more clearly.

Objectives The aim of the present in vitro study was to evaluate the effects of different biomaterials used for regenerative periodontal surgery on the growth of the periodontopathogen Aggregatibacter actinomycetemcomitans . Methods Three commercially available biomaterials of synthetic origin (hydroxyapatite/beta-tricalcium phosphate, nanostructured hydroxyapatite paste, oily calcium hydroxide suspension), a bovine-derived xenograft as well as an enamel matrix derivative (EMD) were added in different concentrations to calibrated suspensions of A. actinomycetemcomitans ATCC 43718/33384 (serotype b/c). Equal aliquots (0.1 ml) for the viability assay were taken after 5 min, 1 h, 3 h, 8 h and 24 h, plated on blood agar and incubated in an anaerobic environment for 48 h at 37 °C. Viable cell counts were expressed as colony forming units (cfu)/0.1 ml. Results The results demonstrated that none of the investigated biomaterials could inhibit the growth of A. actinomycetemcomitans serotype b. A marked growth reduction of A. actinomycetemcomitans serotype c was observed in the presence of oily calcium hydroxide suspension and nanostructured hydroxyapatite. In contrast, no significant growth inhibition could be observed in the presence of hydroxyapatite/beta-tricalcium phosphate, enamel matrix derivative and bovine-derived xenograft. Conclusions The results of the present study suggest that none of the investigated biomaterials possesses antimicrobial properties against A. actinomycetemcomitans serotype b. Therefore, the use of these biomaterials for regenerative procedures should be weighted critically in the presence of A. actinomycetemcomitans serotype b.

Purpose: The aim of the present in vitro study was to assess the effect of bleaching agents on eroded and sound enamel specimens. Materials and Methods: Enamel specimens prepared from human permanent anterior teeth were incubated with different bleaching agents containing active ingredients as 7.5 or 13.5% hydrogen peroxide or 35% carbamide peroxide, ranging in pH from 4.9 to 10.8. The effect of the tooth whitening agents on surface roughness was tested for sound enamel surfaces as well as for eroded enamel specimens. To provoke erosive damage, the enamel specimens were incubated for 10 hours with apple juice (pH = 3.4). Afterwards, pretreated and untreated dental slices were incubated with one of the bleaching agents for 10 hours. The surface roughness (Ra) of all enamel specimens (N = 80) was measured using an optical profilometric device. A descriptive statistical analysis of the Ra values was performed. Results: The study demonstrated that exposure to an acidic bleaching agent (pH = 4.9) resulted in a higher surface roughness (p = 0.043) than treatment with a high peroxide concentration (pH = 6.15). If the enamel surface was previously exposed to erosive beverages, subsequent bleaching may enhance damage to the dental hard tissue. Conclusion: Bleaching agents with a high concentration of peroxide or an acidic pH can influence the surface roughness of sound or eroded enamel. CLINICAL SIGNIFICANCE Patients with erosive defects who wish to receive a tooth bleaching treatment must be informed about possible complications and damage to the tooth surface. However, extrapolation of in vitro results to clinical situations is limited. (J Esthet Restor Dent 22:391–401, 2010)

AIM: This was to determine the prevalence of Lactobacilli (LB) species in different stages of caries progression and are considered as secondary invaders of existing carious lesions and specialists for caries progression. METHODS: Carious dentine samples were collected from 70 primary molars (M) during step-wise (S1, S2: n = 35 M) or one-step (O1: n = 35 M) caries treatment and after 11 months of temporary restorations (S3, O2). LB were identified by selected physiological and biochemical characteristics, ratio of lactic acid isomers, electrophoretic mobilities of lactic acid dehydrogenases, and shotgun mass mapping by MALDI mass spectrometry. RESULTS: LB were isolated from 46% of soft dentine samples (S1). The prevalence of LB from hard dentine collected during caries excavation (O1) reached 34%, after 8 weeks of temporary filling (S2) 11%, and 9% each after 11 months of temporary restoration (S3, O2). The mean total bacterial counts (cfu) of soft dentine (S1) were 3.6 × 105. From hard dentine during caries excavation (O1 ) 4.4×104 cfu were calculated, at S2 3.7 × 103 cfu, at S3 0.1 × 103 cfu, and at O2 1.8 × 103 cfu. The percentages of LB in the cfu for LB positive dentine samples were for S1 / S2 / S3 / O1 / O2: 60% (16 M)/34% (4 M)/54% (3 M)/57% (9 M), and 64% (3 M). Five LB species were identified from carious dentine: L. paracasei subsp. paracasei, L. paracasei subsp. tolerans, L. rhamnosus, L. gasseri, and L. alimentarius. CONCLUSIONS: While L. rhamnosus and L. paracasei subsp. paracasei occurred in all caries progression stages, the other species were found only sporadically. L. paracasei subsp. paracasei and L. rhamnosus might be the specialists of the LB in carious progression.

Success rates for both periodontal and implant therapy are often dependent on site and tooth type. For periodontally involved mandibular molars, the decision to hemisect or to extract and place an implant is often complicated. The purpose of the present study was to evaluate the outcomes of the aforementioned treatment modalities for mandibular molars in a private practice setting. A retrospective chart review was performed. In one group of patients (n = 32), 56 mandibular first or first and second molars were treated by hemisection (Group H). A second group (n = 28) received 36 implants in the mandible to replace periodontally involved first or first and second molars (Group I). All patients had been in maintenance for at least 4 years after treatment. The occurrence and timing of posttreatment complications were evaluated. Data were analyzed by parametric and nonparametric statistics, as indicated. The majority of hemisected teeth (68% of Group H) and implants (89% of Group I) remained free of complications for the entire observation period. Group H had a greater incidence of overall complications (P = .027) and nonsalvageable complications (P = .013) than Group I. For both groups, the percent CAL loss per year was greater for the teeth/implants that experienced complications than in the those that remained complication free (p

The aim of this radiographic study was to evaluate the degree and location of root canal curvatures of human maxillary incisors. A total of 286 extracted human maxillary incisors (145 central and 141 lateral incisors) were included in this investigation. Exclusion criteria were teeth with extensive carious lesions, restorations, and root canal treatment. For this in vitro study, the teeth were fixed in a special device and digitally x-rayed with the parallel technique. The distances from the cementoenamel junction (CEJ) to the first curvature and the according angle were recorded. The results were analyzed descriptively, and p values were calculated with the Wilcoxon Mann-Whitney test. The mean distance between the CEJ and the first curvature of the central maxillary incisors was 10.4 mm (standard deviation [SD] +/- 2.8) and that of the lateral incisors was 11.1 mm (SD +/- 3.0). Most of the central incisors (right: 94.2%, left: 98.7%) and all of the lateral incisors exhibited curvatures. Statistically significant differences between central and lateral maxillary incisors could be observed regarding the canal curvature locations (p = 0.016) and the angle values (p0.001), but there was no statistical difference between the right and the left side. The results showed the high percentage of root canal curvatures in maxillary incisors with a mean curvature located 10.7 mm apical from the CEJ. These findings are important to minimize failures during post insertion.

Objectives The purpose of the study was to investigate the shortest possible exposure time of different LED-curing devices for five different resin composites in a clinically relevant in vitro-model, where a 7 mm distance from the light guide tip to the bottom side of the cavity was compiled. Methods Resin composite samples (Tetric EvoCeram A3, Filtek Supreme XT A3B, Premise A3, CeramX Mono M5, QuiXfil) were filled in three increments of 2 mm thickness each in stainless steel moulds (O = 5 mm, h = 6 mm, n = 9). The samples were incrementally exposed to different blue LED-curing devices (Bluephase, Bluephase C8, Bluephase 16i/Ivoclar Vivadent, L.E.Demetron II/sds Kerr, Elipar FreeLight 2/3M ESPE, Smartlite PS/DENTSPLY, Translux Power Blue/Heraeus) according to the manufacturer's recommendations at a distance of 7 mm from the bottom of the cavity to simulate a class II-curing situation. Surface hardness was measured (Zwick Z2.5/TS1S) 10 min post-exposure at the bottom surfaces of the resin sample. A bottom/top-surface hardness ratio of 80% of a reference sample (2 mm thickness, 40 s), was defined as clinically acceptable for safe curing. A descriptive statistical analysis was carried out. Results The curing devices Bluephase, Bluephase C8, Smartlite PS and Translux Power Blue could cure all composite resins investigated sufficiently in the exposure time recommended by the manufacturers (10–20 s). The curing device Bluephase 16i and L.E.Demetron II only cured the composite Quixfil sufficiently in the exposure time recommended by the manufacturer. FreeLight 2+ allowed a 10 s exposure time for all materials except Ceram X Mono (20 s). Significance When incrementally exposed, all resin composites investigated were polymerized sufficiently at a maximum of 20 s exposure time.

Objective The efficacy of nanostructured hydroxyapatite (NHA) for the treatment of osseous defects has been demonstrated in recent studies, even though the underlining biological mechanism is still poorly known. This study examined the alterations in cellular adhesion and mitogenic responses in human periodontal ligament (PDL) cells treated with a novel nanostructured hydroxyapatite bone graft substitute and characterized associated changes in cellular signalling pathways. Methods Cultured PDL cells were stimulated with NHA in a surface coated form. Proliferation was determined by bromodeoxyuridine (BrdU) incorporation and cell adhesion was analysed by a colorimetric assay. In order to understand altered adhesion properties of PDL fibroblasts their integrin profile was analysed and the phosphorylation status of focal adhesion kinase (FAK) and β1 integrin was determined by immunoblotting. In order to understand the signalling mechanisms of increased cell proliferation of PDL cells caused by NHA, the phosphorylation status of the serine/threonine protein kinase Akt, of the signal regulated kinases ERK1/2 and of the epidermal growth factor receptor (EGFR) was analysed by western blot using phospho-specific antibodies. Results The results indicated that NHA is a strong stimulator of PDL cell attachment and proliferation. Mechanistically, α5β1 integrin-mediated cellular adhesion of PDL fibroblasts, which resulted in altered phosphorylation and activation levels of FAK. Proliferation mediated by NHA was mechanistically caused by activation of the epidermal growth factor receptor (EGFR) pathway and its downstream targets ERK1/2 and Akt. Conclusions In sum, our findings present evidence that α5β1 integrin-mediated cellular adhesion of NHA to PDL fibroblasts, whereas proliferation was caused by activation of the epidermal growth factor receptor (EGFR) and the MAP kinase (ERK1/2) and Akt pathways.

The aim of this in vitro investigation was to determine the accuracy of 4 different electronic apex locators (EALs) with 3 different instrument sizes. For this study 146 roots were embedded in an agar solution. Electronic measurements were made to the physiologic foramen (apical constriction) with the Elements Apex Locator, Justy II, Raypex 5, and ProPex II and K-type files sizes 08, 10, and 15. Statistical significances were calculated with the sign test (P < .001). Exact measurements to the physiologic foramen were made with the Elements Apex Locator, 36.99%, 39.04%, and 44.93%; Justy II, 38.62%, 32.41%, and 43.41%; Raypex 5, 42.76%, 39.31%, and 39.06%; and ProPex II, 38.62%, 43.45%, and 40.63% of the time with instrument sizes 08, 10, and 15, respectively. No significant differences were found between the actual working length and EALs/instrument size. A nonsignificant higher number of unstable measurements were observed in all EALs with instrument size 15.

Objectives: The aim of the present study was to evaluate the effectiveness of a novel optical calculus detection system under in vivo conditions. Methods: One hundred and seventy-six tooth surfaces from 44 adult teeth that were indicated for extraction were selected for the present study. The patients were randomly assigned to one of the two experimental groups. In group A (n = 96), clinical presence or absence of subgingival calculus deposits was determined using the light-emitting diode-based optical probe (OP). In group B (n = 80), the subgingival deposits were first recorded with the OP followed by root surface debridement until no subgingival deposits could be detected by the device. Teeth were then extracted and examined under a stereomicroscope by two trained dentists (DENT 1, DENT 2) and a dental student. Results were compared with the measurements of the OP and direct visual control. Results: In group A, post-extraction results revealed 89% and 90% agreement with the positive and negative OPs detection. In group B, 17% of the surfaces demonstrated even after subgingival debridement and control with the detecting device still calcified deposits in the microscopic evaluation. The highest inter-examiner agreements were observed between DENT 1 and DENT 2. Conclusion: It was shown that the optical detection system identifies subgingival calculus with a high efficacy and therefore, may be a support for the operator to determine the endpoint of root surface instrumentation.

The aim of the present in vitro study was to evaluate the degree and location of root canal curvatures of mandibular anterior incisors. A total of 396 extracted human permanent anterior incisors (248 central and 148 lateral) were included in this investigation. Exclusion criteria were teeth with extensive carious lesions, restorations, and root canal treatment. The specimens were fixed in a special device and digitally x-rayed (Heliodent MD; Sirona, Benzheim, Germany; Merlin 2.1, Olympus/PerkinElmer, Waltham, MA) with the parallel technique. The distances from the cementoenamel junction (CEJ) to the first curvatures as well as the according angles were recorded. The results were analyzed descriptively, and p values were calculated with the Wilcoxon test. The mean distance between the CEJ and the first curvature of the central anterior incisors was 13.8 mm (standard deviation +/- 2.6) and that of the lateral anterior incisors was 12.3 (standard deviation +/- 2.5), respectively. A total of 82 (33.1%) central and a total of 118 (79.7%) lateral anterior incisors exhibited curvatures. No statistically significant differences between left and right anterior incisors could be observed regarding the canal curvature locations (p0.001) and the angle values (p0.04). The results showed a high percentage of mandibular anterior incisors with a mean curvature located 13 mm apically from the CEJ. The findings of this study may enhance the predictability of endodontic treatment and minimize errors during post insertion.

Objective: The aim of this randomised, split-mouth, controlled clinical trial was to evaluate the effectiveness of a controlled-release chlorhexidine chip (CHX chip) as an adjunctive therapy to scaling and root planing (SRP) with a newly developed ultrasonic device in supportive periodontal therapy (SPT). Materials and methods: Twenty patients with moderate-to-severe chronic periodontitis, displaying at least four sites with probing depth (PD) ≥5 mm and persistent bleeding on probing (BOP), were recruited for the study. The target sites were randomly treated with either a newly developed piezo-driven ultrasonic device VectorTM- or ultrasonic system (VUS) + CHX chip or VUS alone without adjunctive antimicrobial treatment. The clinical parameters, plaque index (PI), gingival index (GI), BOP, PD and clinical attachment level (CAL) were recorded at baseline and after 1, 3 and 6 months. Results: At baseline, there were no significant differences between test and control sites for any of the investigated parameters. The average reduction of PD and improvement in CAL was greater in the VUS + CHX chip sites than in sites treated with the VUS alone at 1, 3 and 6 months (P

Introduction The objective of this study was to propose a root canal configuration description method and to investigate the root canal system morphology of the maxillary first molar by means of micro-computed tomographic imaging. Methods The root canal configuration, foramina, and accessory canal frequency of 179 maxillary first molars were investigated by means of micro-computed tomographic imaging and 3-dimensional software imaging. The root canal configuration and main foramina number are described from coronal to apical with a 4-digit system. Results The most frequent root canal configurations were 1-1-1/1 (45.8%), 2-2-2/2 (25.1%) and 2-2-1/1 (10.1%) in mesiobuccal roots and 1-1-1/1 in distobuccal (97.2%) and palatal (98.9%) roots. The first mesiobuccal (MB1) root canal had 1 accessory canal in 26.3% of the teeth, the distobuccal root canal had 12.3%, and the palatal root canal had 9.5%; in the second mesiobuccal root canal, there was rarely 1 accessory canal. There was 1 accessory canal in 26.3%, 12.3%, and 9.5% in the MB1, distobuccal, and palatal root canals, respectively. The MB1, distobuccal, and palatal root canals had 1 main foramen. The MB2 had 1 main foramen in 39.0% of the teeth and no main foramen in 61.0%. Conclusions The root canal configuration of maxillary first molars is quite diversified. Contrary to our expectations in this research, the mesiobuccal root has predominantly 1 root canal entrance and only 1 main foramen. Anatomic variations including connecting and accessory canals occur in any third of root.

Objectives In this study, the efficacy of a miswak extract-containing toothpaste (Salvadora persica) on gingival inflammation was compared with that of a herbal and a conventional toothpaste. Methods Non-smoking outpatients with sulcus bleeding index (SBI) ≥25% and with periodontal pocket depths ≤3 mm were randomly selected and divided into three groups: M-group, miswak extract-containing toothpaste; P-group, herbal toothpaste; and C-group, conventional toothpaste. After instructing the patients to brush their teeth twice a day for 3 weeks with the assigned toothpaste using a flat-trimmed manual toothbrush, a thorough oral examination was performed by a calibrated examiner (EH). The primary outcome was the SBI after 21 days. Furthermore, the amount of plaque was measured by approximal plaque index (API). Results Sixty-six patients with a mean age of 57.8 ± 10.2 years were recruited and enrolled. After 3 weeks of brushing, all three patient groups showed a significant reduction in SBI. The P-group (SBI reduction: 17.1% ± 9.1) and the M-group (14.5% ± 8.1) showed the strongest effect followed by the C-group (9.4% ± 7.8). All three groups showed a significant reduction in API without significant differences between the groups. Conclusions The use of each of the three tested toothpastes caused a significant reduction in gingival inflammation and amount of plaque. The miswak extract-containing toothpaste showed a similar effect as the herbal toothpaste and can be safely used for domestic oral hygiene in patients with gingivitis.

The aim of this study was to investigate the root canal system morphology of the mandibular first molar by means of micro-computed tomography.The root canal configuration, foramina, and accessory canals frequency of 118 mandibular first molars were investigated by means of micro-computed tomography and 3-dimensional software imaging. A 4-digit system describes the root canal configuration from the coronal to apical thirds and the main foramina number.The most frequent root canal configurations in mesial root were 2-2-2/2 (31.4%), 2-2-1/1 (15.3%), and 2-2-2/3 (11.9%); another 24 different root canal configurations were observed in this root. A 1-1-1/1 (58.5%), 1-1-1/2 (10.2%), and 16 other root canal configurations were observed in the distal root. The mesiobuccal root canal showed 1-4 foramina in 24.6%, and the mesiolingual showed 1-3 foramina in 28.0%. One connecting canal between the mesial root canals was observed in 30.5% and 2 in 3.4%. The distolingual root canal showed 1-4 foramina in 23.7%, whereas a foramen in the distobuccal root canal was rarely detected (3.4%). The mesiobuccal, mesiolingual, and distolingual root canals showed at least 1 accessory canal (14.3, 10.2, and 4.2%, respectively), but the distobuccal had none.The root canal configuration of mandibular first molars varies strongly. According to our expectations, both the mesial and distal roots showed a high number of morphologic diversifications. The root canal system of the mesial root showed more root canal configuration variations, connecting and accessory canals than the distal root.

Background Traumatic dental injuries present complex injuries of the dentoalveolar system. Aim of this study was to investigate the frequency and patterns of traumatic dental injuries in a University dental emergency service over four years. Methods A retrospective investigation on all dental trauma patients presenting at the dental emergency service of the University Medical Center Mainz, Germany between 01/2010 and 12/2013 was conducted. Demographic data, the cause and type of trauma and the initial therapy were analyzed. Results Out of 16,301 patients, 1,305 patients (8 %; average age 14.7 years ±15.7; 60.1 % male, 39.9 % female) came due to trauma. 63.9 % of the traumas occurred on weekends. The most frequent reason for injuries was falls (54.6 %). No correlation could be found between the cause and the kind of trauma. In 48.6 % of the cases only one tooth was involved, in 33.5 % two. The permanent dentition was traumatized in 56.6 % of cases, the deciduous teeth in 41.1 %. The most frequently affected tooth was the central upper incisor (61.0 %). Hard-tissue injuries were significantly more frequent in the permanent dentition, while periodontal injuries were seen significantly more often in the deciduous dentition. Conclusion Eight percent of all patients seeking help at the dental emergency service presented with trauma, meaning that dental traumatology is one of the major topics in emergencies. To improve the quality of care, further public education, expert knowledge among dental professionals and a well-structured emergency service are necessary.