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The treatment of drug-induced gingival overgrowth is compounded by the high recurrence rate resulting from chronic use of the medication and the persistence of other risk factors. In this case series, the treatment outcome of a nonsurgical periodontal therapy, according to the concept of full-mouth disinfection in 11 patients with drug-induced gingival overgrowth, is described. All clinical parameters improved significantly after therapy. Only 6% of teeth received further surgical treatment. The clinical situation remained stable during the recall. The present case series suggests that full-mouth disinfection might be a beneficial treatment concept for drug-induced gingival overgrowth, reducing the need for further surgical intervention. [ABSTRACT FROM AUTHOR]

Objectives This study was designed to determine the effect of using a tensioning device and various winding techniques on the tension of a polytetrafluorethylene ( PTFE) floss in a multiuse holder. The hypothesis of this study is that the use of a tensioning device improves the handling and mechanical properties of floss holders. Materials and methods The floss holder was modified so that four different degrees of tension (single-/double-wound; with/without tensioning device) were obtained and tested in an in vitro model approximating dental proximal contact resistance. The following parameters were measured: ( I) the force ( N) necessary to pass through the proximal contact after the 30th passage, ( II) the displacement of the floss (mm), ( III) the loosening of the floss (offset, mm), ( IV) the change in distance between the branches (mm). Results ( I) passage force. All modifications reached 11 N (median). For the double-wound modification using the tensioning device, the smallest displacement ( II) was 3.6 mm; the single-wound modification without the tensioning device had the highest displacement (7.6 mm, medians) ( III). The offset of all four different modifications ranged between 0 and −2 mm (medians). For the modification without the tensioning device, there was a difference in offset of −2 mm (single-wound) and 0.5 mm (double-wound) (medians). Modifications with the tensioning device did not produce any offset differences. ( IV) A change in distance between the branches between −3 mm and −2 mm, respectively (with the tensioning device), and 0 mm (without the tensioning device) was observed (median). The results indicated that double-wound floss and the use of a tensioning device both lead to a constant tension of the floss in the floss holder. Conclusions Technical modifications such as those shown in this study should improve the mechanical properties of multiuse floss holders, which, in turn, could lead to more user-friendly floss holders and hence to higher user acceptance. [ABSTRACT FROM AUTHOR]

Background and Objective: Collagen type I elevation in cyclosporin A-induced gingival overgrowth supports evidence that gingival fibroblasts play a decisive role in the manifestation of the phenotype. To analyze the role of gingival fibroblasts under more in vivo-like conditions, we evaluated the effect of cyclosporin A on collagen type I gene and protein expression in gingival overgrowth-derived gingival fibroblasts established as cocultures with gingival keratinocytes as well as in matched gingival fibroblast monolayers. Material and methods: Monolayers and cocultures of primary gingival fibroblasts were treated with cyclosporin A for 6 and 72 h. The expression of collagen type I mRNA was analyzed by quantitative real time polymerase chain reaction, while expression and secretion of collagen type I protein was analyzed by indirect immunofluorescence and western blotting. Results: Compared with controls, significant elevation of collagen type I mRNA was restricted to cocultures after 6 and 72 h of treatment with cyclosporin A. In keratinocytes, collagen type I remained undetectable. In monolayers and cocultures, indirect immunofluorescence showed a slightly higher level of collagen type I protein in gingival fibroblasts in response to stimulation with cyclosporin A. Semiquantitative detection of collagen type I by western blotting demonstrated a nonsignificant increase for cell extracts in monolayers and cocultures. For secreted collagen type I, western blot analysis of the supernatants revealed elevated protein levels in cultures stimulated with cyclosporin A. Compared with the corresponding monolayers, the stimulatory effect of cyclosporin A on protein secretion was significant only in coculture. Conclusion: Our results indicate that collagen type I is a target of cyclosporin A and that gingival fibroblasts are decisive for the manifestation of the gingival overgrowth-phenotype. Furthermore, the results suggest that cocultures of gingival overgrowth-derived gingival fibroblasts and gingival keratinocytes permit analysis of cyclosporin A-induced effects under more in vivo-like conditions. [ABSTRACT FROM AUTHOR]

Objectives: Evaluation of a particular digital caries image-enhancing mode (filter) for its effect on the validity of measurements of caries lesion depth. Methods: Standardized radiographs of 44 extracted teeth exhibiting interproximal caries lesions were obtained. Six radiographs were obtained of each tooth and digitized. Four radiographs were made using D-speed film with and without soft tissue scattering equivalent (STSE) at normal exposure time (0.32 s) and underexposed (0.16 s). Two were made using F-speed film with STSE normally (0.16 s) and underexposed (0.08 s). On each of the 264 radiographs, 4 independent examiners measured the central depth (CD) of 1 carious lesion per tooth both on the unchanged radiographic image and after use of the filter. Histometric CD assessments provided a gold standard for comparison with the radiographic measurements (validity). Repeated measures ANOVA was calculated for validity in relation to examiner, lesion type, filter, film type, exposure time and STSE. Results: The lesion type was identified to statistically significantly influence the validity of CD measurements. Examiner in combination with defect type (P<0.001), filter (P = 0.017), exposure (P = 0.027) and film type (P = 0.044) had an additional albeit small effect. Conclusions: The lesion type significantly influenced the validity of CD measurements: enamel lesions were less underestimated than dentin lesions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Cross-sectional investigation of associations between psychosocial and periodontal parameters. METHODS: One hundred and ten patients 18-76 years of age were examined clinically and 57 radiographically at the Department of Conservative Dentistry of the University Hospital of Heidelberg: probing depths (PDs) and attachment level (PAL-V) were obtained at six sites per tooth. Inter-proximal bone loss was assessed in 57 patients on panoramic radiographs. Further chemical and general environmental sensitivity, somatization, and smoking status were assessed by several questionnaires. RESULTS: Significant correlations between severe bone loss and age (r=0.38, p=0.004) were observed. PAL-V and PD also correlated with age (r=0.45, p<0.001; r=0.37, p<0.001) and pack years (r=0.21, p=0.031; r=0.3, p=0.002). After adjustment for age, smoking, and sex a negative correlation between chemical odour sensitivity and bone loss, PD=4 mm as well as PAL-V=4 mm was observed. Further, a negative correlation was observed between gastrointestinal sensitivity and PAL-V=4 mm. Psychological stress correlated positively with bone loss. CONCLUSION: The results give evidence for associations of psychosocial factors and periodontal disease. Some environmental traits seem to be related to more favourable periodontal status. Copyright (c) Blackwell Munksgaard, 2005. [ABSTRACT FROM AUTHOR]

Purpose: To trace the history of interdental brushes (IDBs) from their origins to the present, highlighting their development and future prospects compared to other interdental hygiene aids., Methods and Materials: A literature search using digital databases, manual reviews and on-site research in museums were carried out., Results: Although extensive literature exists on toothbrushes, flosses and toothpicks, there has been no comprehensive study of IDBs. Twisted brushes for oral hygiene were mentioned as ear-ly as the late 19th century. The exact origins of their use in interdental spaces remain unclear, but evidence narrows it to the early 20th century. IDBs have been in documented use since at least 1960, with publications emerging in the 1970s. Historically, evaluations of IDBs have been mixed, balancing high expectations with scepticism regarding efficacy and safety. By the early 21st century, IDBs were often considered superior for interdental cleaning. Advances included modifications in brush head designs, handle types, and the establishment of standards like ISO 16409, though these did not always facilitate proper selection and use., Conclusion: Recent literature still highlights limited evidence-based statements on IDB efficacy, with some questioning their superiority over other aids like dental floss. Consumer-friendly alternatives, such as rubber picks, are sometimes rated higher, however, without allowing for a final assessment. For IDBs to meet the standards of Frugal Dentistry, they must improve oral health, be widely demanded, and cost-effective. Future research should provide more precise indications for IDBs and scientifically sound recommendations for various sizes and designs, ensuring they are easy to use and effective for different interdental spaces.

Purpose: This study aimed to develop a systematic interdental brush set with size distribution based on the passage hole diameter (PHD), addressing existing gaps in size selection criteria for effective interdental cleaning., Materials and Methods: In the first step, an interdental brush set that ascends stepwise according to the PHD value was envisioned. The study was divided into three phases: (i) in-vitro determination of PHD values of a currently existing assortment on the market by 13 calibrated dental professionals, (ii) in-vitro assessment of forces during insertion, and (iii) creation and evaluation of new prototypes for missing or non-matching PHD sizes. Intra- and inter-rater reliability, assessed with the intraclass correlation coefficient (ICC), as well as insertion forces and PHD sizes at all stages were reported., Results: In the existing range, three interdental brushes fitting the desired PHD sizes were initially identified. Mean insertion forces between 0.3 and 1.7 N were documented based on raters' PHD choices. Two additional rounds of measurements with prototypes adapted in diameter and shape were necessary, particularly for PHD values of 1.4, 2.3 and 2.6. High intra- and inter-rater reliability was observed throughout the study (ICC > 0.95), ensuring consistent evaluations. After three rounds of assessments, a prototype was successfully identified for each targeted PHD value in the systematised set, showcasing reliable sizing and insertion forces., Conclusion: Using a structured approach, a comprehensive interdental brush set was developed with reliable PHD sizing and moderate insertion forces. The verification of size reliability through measurements by dentists represents a novelty in development and underlines the importance of accurate brush size selection for optimal biofilm control. Whether a systematic set based on the PHD value offers added value for clinical practice, and at what intervals, must be demonstrated in further studies.

Purpose: This paper describes previously unknown details about the discovery of resin adhesion to acid-etched human enamel., Materials and Methods: A literature review was performed through manual assessments. Primary sources revealing the discovery of resin curing on etched enamel were analyzed considering the research objectives and methodological procedure during that era, including the type of teeth used, preparatory measures, acid-etching process, type of resin and its application, and follow-up observations. Additionally, the political and economic contexts were examined., Results: In 1949, acid etching was found to promote adhesion with acrylic resin, a finding described again in 1955. The 1949 studies utilized nitric acid for enamel etching and the acrylate resin Paladon from the Kulzer company (Germany). Conversely, the 1955 investigations employed phosphoric acid and an unnamed acrylate, likely a self-curing resin supported by Kulzer in the late 1930s. Disparities in the 1949 and 1955 findings can be ascribed to varying objectives and test conditions amidst a turbulent political backdrop, significantly impacting the Kulzer company., Conclusion: The discovery of resin adhesion to acid-etched enamel, approaching its 75th anniversary in 2024, is a landmark in 20th-century adhesive dentistry. Paladon represents a pioneering compound, exemplifying the influence of political, ideological, and economic factors on scientific advancements during that period.

Purpose: Newly developed non-invasive methods for replace a missing tooth and closing single-tooth gaps in the poster- ior region using resin composite are presented., Materials and Methods: Four different non-invasive methods and the technical procedures, materials and instruments used are presented in a case series. These include the direct intraoral insertion of composite (with and without individual shaping aids) and indirect restorations, which are fabricated conventionally or digitally and bonded., Results: The case series showed that all four methods can be used to replace single missing teeth in the posterior region, meeting current clinical requirements. Particular attention was paid to the design of the pontics, the dimension of the connector area, firm proximal contacts to the adjacent teeth, hygiene, and appearance of the non-prep bridges (NPBs). The advantages and disadvantages for both the direct and indirect techniques illustrated in this case series were com- pared in detail., Conclusions: Several direct and indirect non-invasive methods for single-tooth replacement are available today. Although the evidence is still limited, there is a potential for frugal dental interventions with NPBs. Further experimental and clinical studies are necessary to demonstrate that they reliably meet quality requirements (including sufficient survival rates), satisfy the criteria of cost-effectiveness (compared to treatment alternatives) and that there is a demand from the population.

Purpose: The subgingival area is only reached to a limited extent during home oral hygiene with the aids available to date. The question was investigated whether a newly developed, flattened cross-sectional design of interdental brushes (IDBs) can extend their subgingival reach., Materials and Methods: In part I, the passage-hole diameters (PHD) of IDBs of different sizes and side-bristle lengths, with circular and flattened cross-sections, were compared according to the ISO standard 16409/2016. In part II, handling of flattened IDBs was described based on a case report of a patient with generalised stage 4, grade C periodontitis with locally persistent pockets., Results: Depending on the brush's size, flattening of IDBs reduced the PHD by 1-18 intervals. IDBs with longer side bristles could thus be inserted into interdental spaces with equal force. This may increase the potential range of IDBs in the vertical dimension. Regular instruction and check-ups are necessary to enable correct handling, as the flattened brushes can only be used in two positions. The observations documented in the case report (duration: 1.5 years) showed that flattened IDBs were associated with reduced signs of inflammation (reduction of pocket depths from 6 to 3 mm, absence of bleeding on probing)., Conclusion: IDBs with a flattened cross-sectional design have not been previously described in the literature. It was shown that flattening of IDBs leads to a size-dependent decrease in PHD. Based on a case report, it was hypothesised that the design change of the IDBs could be clinically relevant in the case of persistent deep pockets in narrow interdental spaces. However, this can only be verified or falsified by clinical studies.

Purpose: To examine the origins of acrylates and adhesive dentistry up to 1955., Materials and Methods: A search of MEDLINE database and a manual literature search were conducted to find relevant articles., Results: Acrylic acid was discovered in 1843, methacrylic acid in 1865. In 1880, light polymerization of acrylate compounds using glass prisms was introduced. In 1928, polymethyl methacrylate (PMMA) was industrially produced from methyl methacrylate (MMA). In 1930, PMMA moldings that could be adapted under heat and pressure were introduced into dentistry. The process was improved in 1936 by mixing pulverized PMMA and liquid MMA. In 1940, the intraoral polymerization of dental resins using UV light or catalysts was discovered. In the same year, the combined procedure (dual-curing) and addition of inorganic fillers to improve the material properties (precursors of composites) were proposed. Effects on the oxygen inhibition layer and intraoral bonding between several resin portions were also described. In 1942, direct restorations with self-curing resins (combined with a precursory version of cavity sealing) were described. These new resins were marketed in the late 1940s. Intraoral repair of restorations and cementation of crowns and bridges with resins were also described in 1942. In 1949, a glycerophosphoric acid-based sealer was marketed. In the same year, it was discovered that etching of the enamel (with nitric acid) caused an adhesion to thin layers of acrylic-based materials. In 1955, phosphoric acid etching of enamel was shown to improve adhesion., Conclusion: In the first half of the 20th century, important but little or unknown discoveries took place. These discoveries can improve our understanding of how adhesive dentistry evolved.

Objectives: The aim of this pilot study was to test the survival and clinical quality of frugal methods to replace single missing teeth in the posterior region with direct composite restorations of different categories., Methods: We performed a detailed intraoral examination and assessed the clinical quality of the restorations according to modified FDI-criteria. Irreparable loss of a restoration was recorded as "failure" (F). Damaged restorations that could be repaired were defined as "survival with repair" (SR). Restorations without any unfavorable events were classified as "success" (S)., Results: The mean follow-up time of the restorations was 5.07 years (minimum = 1; maximum = 21.5), with 15.1% having a follow-up time of more than 10 years. Three unfavorable events were documented. Two restorations (3.8%) were classified as F, one restoration (1.9%) as SR, and the remaining 50 restorations (94.3%) as S. The estimated overall and functional survival rate at 5 years using the Kaplan-Meier method was 96.2% (confidence interval [CI]:85.5% to 99%) and 98% (CI:86.9% to 99.7%), respectively. Ninety-four percent of the restorations were evaluated as good or excellent clinical quality. Most restorations showed no periodontal complications, however, restorations in the mandible showed significantly more plaque accumulation (p=0.002)., Conclusions: These conservative frugal methods to replace single missing teeth in the posterior region showed promising clinical survival data and quality parameters., Clinical Significance: Direct composite restorations of different categories can be considered as additional treatment option for gap closure in specific clinical situations., (Copyright © 2021. Published by Elsevier Ltd.)

Frugal dentistry is derived from the term "frugal" (meaning simple, economical, usable, suitable). It focuses on dental interventions, which on one hand leads to a cost reduction compared to treatment alternatives and on the other hand focuses on dental core functionalities taking into account the patient's needs. In 2020, the World Health Organization (WHO) highlighted the urgency to prioritize cost-effective and affordable interventions.Against this background, a classification and review of frugal dentistry is carried out in this article. To what extent its objectives can be substantiated is investigated. Based on literature sources and an exemplary clinical presentation, options for frugal dentistry are shown. In addition, examples of potential frugal interventions and innovations are named and explained for a number of subject fields in dentistry. There are serious deficits in the systematic development and implementation of frugal dentistry. Numerous efforts in research, teaching, and patient care are therefore still required., (© 2021. The Author(s).)

At present, the most important criterion for the size selection of interdental brushes is the PHD-value (passage hole diameter) according to the ISO standard for interdental brushes ISO 16409:2016. The PHD size range of commercially available products currently lies between 0.6 and 5.2 mm. With the exceptions of special situations, a range between 0.7 and 2.9 mm is sufficient for clinical routine. As most products have longer filaments nowadays, one brush can often be applied for two PHD intervals. Consequently, adequate patient counseling and the individual selection of the appropriate interdental brushes can generally be achieved with an assortment of 12 systematically arranged interdental brush sizes. An application example is the "Heidelberg set" described herein. It is crucial that the correct choice of size is based upon continuously rising PHD-values, and not upon parameters such as stem size, outer diameter of filaments, or similar, as these do not allow for a reliable conclusion regarding the interdental passage. The usage of ISO sizes is also not recommendable due to their insufficient size differentiation. (Quintessence Int 2021;52: 176-186; doi: 10.3290/j.qi.b872241; Revised from an article originally published (in German) in Parodontologie 2020;31(1)37-49)

Purpose: Preventive dentistry aims to improve oral hygiene, including the use of interdental cleansing aids. Clear and simple classifications may positively impact patient communication and motivate oral health behaviour. To date, there is no comparative analysis of interdental brush classifications and sizes., Materials and Methods: A total of 2320 interdental brush samples by 24 manufacturers was examined regarding their passage hole diameter (PHD) according to the ISO standard for interdental brushes (ISO16409:2016), and their current classifications were evaluated. Inter- and intrarater reliability of the ISO size classification were determined based on 20 raters and 10 interdental brushes. The insertion force for these interdental brushes was analysed in vitro., Results: Excellent intra- and interrater reliability was achieved (intraclass correlation coefficient (ICC) ≥ 0.973) overall, although greater variance was observed for bigger brush sizes. Insertion forces varied depending on size and form of the brushes, amounting to 1.58 N (SD = 1.27 N) for cylindric and tapered brushes, and to 2.31 N (SD = 0.81 N) for waist-shaped brushes. The size range of commercially available products was 0.6-5.2 mm PHD, 90% presenting with a PHD ≤ 2.0 mm. Size intervals were unsystematic. The ISO size was indicated by 33% of all manufacturers, the exact PHD by 25%., Conclusions: The determination of the PHD is a reproducible instrument for most brushes currently on the market. In vitro, forces developed based on this classification are mostly moderate, thus unlikely to cause periodontal trauma. Given the discontinuous range and unclear labelling of available products, the development of a simplified classification system by usage of the PHD may benefit the practitioner and patient alike by contributing to improve oral hygiene behaviours.

Purpose: To present a new method for the closure of single-tooth gaps using metal-, ceramic-, and glass-fiber-free direct composite cantilever restorations., Materials and Methods: The new technique is described step by step in a case report, showing the creation and adhesive bonding of a single-retainer composite pontic. Furthermore, six cases are reported with radiological and clinical follow-up assessments over a period of one to three years after gap closure., Results: Excellent outcomes were observed clinically and radiologically. No failures due to material properties (such as composite fractures, chipping) or esthetic limitations through discoloration were observed. Due to good oral hygiene, no periodontal complications were found during the observation period., Conclusions: This new minimally invasive procedure expands the therapeutic spectrum for the management of single-tooth gaps. It does not require laboratory-fabricated restorations and can be considered when conventional treatments, such as fixed dental prostheses or implants, are not options for medical reasons or due to special patient preferences.

Introduction: This study aimed to develop a suitable instrument for a comprehensive quantitative and qualitative assessment of perceived psychosocial impact, levels of stress and learning effect in undergraduate dental students during the transition from pre-clinical to clinical education. These findings might improve curricular structures and didactic organisation during this period., Materials and Methods: At the beginning of their first clinical year, undergraduate dental students were asked to complete an anonymous forty-item questionnaire. Two hundred and seventy-six undergraduate dental students were willing to participate and completed the questionnaire and participated during the years 2011-2016., Results: The response rate was between 45% and 96%. Correlational analysis (Spearman-Rho) in the field of psychosocial impact showed the dental teacher to be the most important multiplier of students' feelings. If the students feel that their teacher acts cooperatively, positive items increase and negative items decrease significantly (P < .0001). Also, students who report high levels of stress are affected significantly in their psychosocial interaction (P < .0001). Wilcoxon test yielded highest levels of stress in endodontology during the first weeks (P < .0001). During the same period, the greatest learning increment was seen for diagnostics and caries excavation., Conclusion: In conclusion, teaching of undergraduate dental students during the transition period from pre-clinical to clinical education can be positively influenced by a supportive learning environment and by specific chronological modifications in the curriculum. Students should start their clinical training with diagnostics, preventive dentistry and initial periodontal treatment. Due to high levels of perceived stress, endodontology should be introduced later in the clinical curriculum., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Placement of composite resin restorations in deep subgingival cavities can damage surrounding soft tissues. In addition, commonly used resin-based composites (RBCs) might interfere with wound healing and periodontal health. To clarify cellular interactions with RBCs, we used an MTT assay to investigate adhesion of primary human gingival fibroblasts and human osteoblasts (hFOB 1.19) on five RBC materials with and without surface modifications (alumina blasting with 50- or 110-μm Al 2 O 3 ). In addition, high-performance liquid chromatography (HPLC) was used to determine release of resin monomers from RBCs after 1 h, 1 day, and 7 days. As compared with tissue culture plastics (the control), cellular adhesion was significantly lower (P < 0.001) for human gingival fibroblasts and osteoblasts. Only minor, nonsignificant differences between individual RBCs were identified. HPLC analyses identified the release of three bifunctional methacrylates bisphenol A glycerolate dimethacrylate, triethylene glycol dimethacrylate, and diurethane dimethacrylate from RBCs and showed that monomer release increased between 1 h and 1 day but remained low. The present findings suggest that surface adhesion in the subgingival area is limited for the tested RBCs. Although residual monomer release was low for all tested RBCs, it might be sufficient to adversely affect cell adhesion.

Introduction: Limited access to interdental spaces complicates removal of excess material when placing class II composite resin restorations. Evidence-based recommendations on interproximal finishing are rare. We present novel microscalpels for this indication. The aim of the study was to test their fracture strength and cutting ability and to compare microscalpels with the use of a scaler, oscillating devices (G5-ProShape, G5-Proxocare), finishing strips and scalpels of sizes 12, 15, and 21 in a standardized in vitro model., Methods and Materials: Fracture strength (LOAD) and cutting forces (CUT) of microscalpels were evaluated at different angles (15, 30, 60, and 75 degrees; n=30 each) in a universal testing machine. Devices were compared in vitro using standardized composite overhangs. Marginal quality (QUAL; n=30) and quantity of excess/deficit (QUAN; n=30) were evaluated using scanning electron microscopy (SEM) for each device (explorative data analysis, Student t-test or analysis of variance; post hoc Scheffé)., Results: Microscalpels showed the highest LOAD (95.8 [5.0] N) (mean [standard deviation]) and easiest cutting (CUT) (7.6 [1.5]) at 15 degrees. At all angles, LOAD was significantly higher than CUT (p<0.001). Perfect margins were seen most often with scalpel size 12 (QUAL: 37% relative frequency), while most excess (73.4%) was observed with finishing strips. QUAN was lowest with microscalpels (19.3 [4.4] μm) and highest with finishing strips (116.0 [18.8]). Use of scalers led to fractures and crack formation., Conclusion: Microscalpels are able to cut composite at a lower force than necessary to fracture the blades at all angles. Small and/or curved scalpels yield the best-quality margins.

Aim: To compare long-term effects of brushing with an oscillating-rotating power toothbrush or an ADA reference manual toothbrush on pre-existing gingival recession., Materials and Methods: In this controlled, prospective, single-blind, parallel-group study, healthy subjects with pre-existing recession were randomized and brushed with a power toothbrush (n = 55) or an ADA reference manual toothbrush (n = 54) for a 3-year study period. Subjects were required to brush their teeth twice daily for 2 min. using a standard fluoride toothpaste. During the study, subjects were assessed for clinical attachment loss and probing pocket depths to the nearest mm at six sites per tooth by the same calibrated examiner. Gingival recession was calculated at pre-existing sites as the difference between clinical attachment loss and probing pocket depths. Hard and soft oral tissues were examined to assess safety., Results: After 35 ± 2 months, mean gingival recession did not differ significantly between groups, but was significantly reduced from baseline (p < 0.001), from 2.35 ± 0.35 mm to 1.90 ± 0.58 mm in the power and from 2.26 ± 0.31 mm to 1.81 ± 0.66 mm in the manual group., Conclusions: Gingival recession in subjects with pre-existing recession was significantly reduced after 3 years of brushing with either a power or manual toothbrush., (© 2016 The Authors. Journal of Clinical Periodontology Published by John Wiley & Sons Ltd.)

Purpose: To evaluate the effects of aqueous storage on shear bond strength (SBS) and monomer release of fiberreinforced composites (FRCs)., Materials and Methods: Four unidirectional FRCs were tested, including one semi-interpenetrating polymer network (IPN) (ES, everStick) and three cross-linked polymer (CLP) FRCs (GT, GrandTec; TF, TenderFiber; DP, Dentapreg). The SBS of samples of original resin to fresh FRC with an intact oxygen inhibition layer (n = 30/group) and repair resin to FRC after surface treatment (n = 30/group) was evaluated after 6 and 12 months of storage in artificial saliva. Monomer release of polymerized resin-coated and uncoated FRCs was detected by high-performance liquid chromatography after immersion for 1 h, 1 day, and 7 days., Results: After 6 months, a significant decrease in SBS was seen with ES-repair (p < 0.0001). After 12 months, significant decreases were seen with ES-original (p < 0.0001), ES-repair (p < 0.0001), and TF-repair (p = 0.0003). A significant reduction was also found for GT-original (p = 0.0254) and GT-repair (p = 0.0176). At 6 and 12 months, GT showed the highest SBS values, with DP-repair being statistically similar to GT at 12 months. For UDMA and bis- GMA, the greatest amounts of release were seen in uncoated specimens, followed by flowable resin-coated and viscous resin-coated specimens., Conclusion: Matrix composition, interfacial bonding, and resin coverage seem to account for differences in the aging behavior of FRCs. The semi-IPN material is likely to suffer most from the challenging oral conditions. CLP FRCs might be more stable over the long term. Coverage of FRCs with viscous resin is highly recommended to reduce residual monomer release.

Objectives: Restorative rehabilitation of missing single teeth in the posterior dentition is achieved primarily by dental implants or fixed dental prostheses. Here we introduce an uncommon, minimally invasive treatment option in order to close single tooth gaps., Methods: The purpose of this study was to evaluate the clinical quality and survival of 45 direct composite buildups in the posterior dentition. A detailed clinical examination was performed, and restorations were rated qualitatively using the modified USPHS/FDI criteria., Results: The mean extension of the direct composite buildups was 2.96 (1.12)mm per tooth. Interdental closures from both adjacent teeth had a significantly higher extension of the direct composite buildups than one-sided interdental closures (p=0.03). Patients with a history of prior tooth loss showed a significantly greater extension of direct composite buildups than patients without prior tooth loss (p=0.006). During the follow-up period, no restoration showed unfavorable events. The overall survival rate for the direct composite buildups was 100% after median follow-up of 78.96 months. The clinical quality rating indicated that most of the restorations (>94%) displayed excellent or good quality. No periodontal destruction, signs of gingival inflammation or increased plaque accumulation was observed., Conclusions: The posterior direct composite buildups evaluated in this study showed promising clinical survival data and excellent quality parameters after a median observation time of 6.5 years., Clinical Significance: If a minimally or non-invasive treatment approach is indicated, posterior direct composite buildups provide a successful treatment alternative for the closure of single-tooth gaps to implant-supported or fixed dental prostheses., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The aim of this investigation was to give insights into the impact of endurance training on oral health, with regard to tooth erosion, caries, and salivary parameters. The study included 35 triathletes and 35 non-exercising controls. The clinical investigation comprised oral examination, assessment of oral status with special regard to caries and erosion, saliva testing during inactivity, and a self-administered questionnaire about eating, drinking, and oral hygiene behavior. In addition, athletes were asked about their training habits and intake of beverages and sports nutrition. For saliva assessment during exercise, a subsample of n = 15 athletes volunteered in an incremental running field test (IRFT). Athletes showed an increased risk for dental erosion (P = 0.001). No differences were observed with regard to caries prevalence and salivary parameters measured during inactivity between athletes and controls. Among athletes, a significant correlation was found between caries prevalence and the cumulative weekly training time (r = 0.347, P = 0.04). In athletes after IRFT and at maximum workload, saliva flow rates decreased (P = 0.001 stimulated; P = 0.01 unstimulated) and saliva pH increased significantly (P = 0.003). Higher risk for dental erosions, exercise-dependent caries risk, and load-dependent changes in saliva parameters point out the need for risk-adapted preventive dental concepts in the field of sports dentistry., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Current treatment protocols and recent developments in composite resin technology allow for extended indication of direct composite resin restorations. This article presents clinical longterm observations of direct composite resin restorations indicated for primary and replacement therapy, repair restorations, direct crowns, and composite buildups for the correction of tooth form.

Statement of Problem: Currently, fiber-reinforced fixed dental prostheses (FRC FDPs) are a reliable treatment option for the restoration of single missing teeth in the anterior area., Purpose: The purpose of this study was to evaluate the survival of direct and semidirect fabricated FRC FDPs in the anterior area and to rate the quality of the outcome., Material and Methods: Twenty-four participants (12 men, 12 women) were included in the investigation. The prostheses were made of preimpregnated, unidirectional fiber-reinforced composite (FRC) (everStick, GC) by using a direct (n=18) or semidirect (n=6) technique. Eleven FRC FDPs had been placed in the maxilla and 13 had been placed in the mandible. Follow-up intervals were recorded, and the prostheses were classified as success (successful), survival (unfavorable event but still in vivo), or failure (lost). Quality was rated according to the modified United States Public Health Services (USPHS) or Ryge criteria., Results: The FRC FDPs evaluated in this study showed an overall survival rate (success) of 72.6% and a functional survival rate (success + survival) of 85.6% (median follow-up 54 months). According to the USPHS/Ryge criteria, most of the restorations displayed excellent or good quality. Survival analysis was performed by the Kaplan-Meier method., Conclusions: The FRC FDPs evaluated in this study showed promising survival rates and good quality after a median follow-up period of 4.5 years (quartile range 3.5 to 6.3 years), thus indicating that FRC FDPs are reliable treatment options for the restoration of single missing teeth in the anterior area. The use of preimpregnated FRC materials with higher fiber content might improve the clinical fabrication of FRC FDPs but does not influence their long-term clinical survival., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Objective: Currently, there are many fibre-reinforced composites (FRCs) available which differ in the type and volume fraction of fibres, pre-treatment of fibres and matrix composition. The aims of this in vitro investigation were to determine whether there is a difference in biocompatibility of FRCs and if coating FRCs with resin composites influences their cytotoxic potential., Materials and Methods: Five different FRC materials were tested which were either uncoated or coated with flowable or viscous resin composite. Artificial saliva extracts were prepared according to USP-XXIII and ISO-10993 to determine cytotoxicity by testing cell viability and growth of primary human gingival fibroblasts (HGF) using MTT assay, LIVE/DEAD(®) assay and cell proliferation assay. The influence of eluates on fibres of the cytoskeleton was investigated by vimentin, tubulin and actinin immunostainings. A two-way ANOVA followed by Scheffe's post-hoc test, which included the factors FRC material and coating procedure, was performed to assess cytotoxicity., Results: All extracts of FRC materials displayed minor cytotoxic potential on HGF cell viability, cell proliferation and integrity of the cytoskeleton. The type of FRC material significantly influenced cell viability (MTT assay) (p < 0.0001), whereas neither the presence of a coating nor the type of coating material resulted in altered cell viability. Distribution and organization of cytosolic fibres was not affected after HGF exposure to eluates., Conclusions: There is a lack of knowledge about the leaching behaviour of commonly available fully pre-impregnated FRCs and their interactions with coating materials. The coating of FRCs with resin composite materials did not impact biocompatibility.

Objective: A great benefit of FRC technology is that, in case of minor failure events, restorations can be repaired or reinserted. However, various FRC materials are available, that differ in matrix composition and fiber pre-treatment. The aim of this investigation was, therefore, to evaluate original and repair bond strength of FRC materials., Methods: Five fully pre-impregnated, unidirectional FRCs were selected, one semi-interpenetrating polymer network FRC and four cross-linked-polymer FRCs. The primary endpoint was the evaluation of shear bond strength (SBS) between FRC and composite resin, which was performed by a universal testing machine. For each FRC specimens were divided into control (original SBS, resin to fresh FRC with oxygen inhibition layer (OIL), n=30) and test groups (repair SBS, resin to FRC after removal of OIL and adhesive infiltration, n=30)., Results: The cross-linked-polymer FRC GrandTec(®) (12.4±5.4 MPa) yielded the highest control SBS, followed by the semi-interpenetrating polymer network FRC (everStick(®), 9.2±3.5 MPa). With everStick(®), repair led to a significant increase in the test SBS (14.6±5.8 MPa, p=0.01)., Significance: Control SBS was best with GrandTec(®) indicating that the material is superior in direct clinical application. Test SBS was significantly increased with everStick(®) which points at potential reparability and advantages in semi-direct or indirect fabrication of fiber-reinforced fixed partial dentures., (Copyright © 2014 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Objectives: Adhesive resin composite technology enables dentists to add composite material to tooth surfaces to close gaps and reshape tooth form without cavity preparation. This option creates new possibilities for minimally invasive dentistry as the tooth shape, position and colour can be altered without loss of tooth substance. However, evidence-based data on direct composite buildups are rare., Methods: The purpose of this study was to evaluate the outcome and to document the occurrence of unfavourable events and clinical findings of 176 direct composite buildups that had been performed in the Department of Conservative Dentistry, University Hospital Heidelberg, Germany, between 2002 and 2008. Outcome was categorised as failure (F), survival (SR) or success (S). Restorations still in place and without prior failure at follow-up were qualitatively rated using modified USPHS/FDI criteria., Results: During the follow-up period, 30 restorations were found to have had unfavourable events or clinical findings. All restorations were repaired, and they remained in situ (SR). No complete loss (F) was recorded. The overall survival rate was 84.6% after 60 months (95%, confidence interval [CI]: 78.5 and 90.6). Clinical quality was rated excellent or good for most (>90%) of the restorations examined., Conclusions: The direct composite buildups observed in this study were found to have promising clinical outcome and good quality parameters after 5 years. If a noninvasive or minimally invasive treatment approach is indicated, direct composite buildups provide an acceptable treatment alternative for the aesthetic correction and reshaping of anterior teeth., Clinical Significance: The application of direct composite buildups in clinical cases in which a non- or minimally invasive treatment approach is indicated provides an excellent treatment alternative for gold-standard treatment options like laboratory-made crowns and porcelain veneers. Restorations in the present investigation showed a functional survival rate of 100%, an overall survival rate of 84.6% after 5 years., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: To compare the increase of DMF-T and DMF-S in patients with aggressive periodontitis (AgP) and chronic periodontitis (ChP) after active periodontal therapy., Materials and Methods: One hundred and thirty-six periodontally treated patients were re-examined after 10 years. Dental and periodontal status was assessed and patients' charts were screened for diagnosis, compliance to supportive periodontal treatment (SPT) and DMF-T/-S at baseline and re-examination. δDMF-T/-S was calculated and multi-level regression analyses were performed to identify factors contributing to increase of DMF-T/-S., Results: Thirty patients with AgP, 37 with moderate ChP and 69 with severe ChP could be included. δDMF-T between first visit and re-examination was 2.07 (SD = 2.51, range = 0-14 teeth), mean δDMF-S = 14.66 (SD = 14.54, range = 0-83 surfaces). Patients with AgP showed a similar increase in DMF-T/-S to those with ChP. Regression analysis identified compliance as the only factor significantly accounting for preventing an increase of DMF-S (p = 0.017). No factor had a significant impact on DMF-T., Conclusions: DMF-T and DMF-S developed similarly in periodontally-treated patients with AgP and ChP during a follow-up of 10 years. SPT showed a positive influence on avoiding decline in DMF-S in periodontally compromised patients. No significant impact was detected for all other studied factors.

Background: The authors conducted a literature review to determine how dentofacial esthetics can be evaluated in restorative dentistry and which quantifiable clinical parameters can be used for this assessment of dentofacial esthetics., Types of Studies Reviewed: The authors selected 35 studies that focused on assessment strategies for dental professionals. The primary inclusion criteria were intraoral and extraoral esthetic assessment methods and indexes or rating scales evaluating esthetics in restorative dentistry., Results: The studies' protocols and assessment methods were heterogeneous. The authors grouped the studies into six categories according to topic: golden proportion, soft-tissue measurement, smile and smile line assessment, orofacial indexes and scales, incisor proportion and angulation, and facial esthetics. These categories included various esthetic parameters, including the smile line, lip line, incisal offset, location of dental and facial midline, incisor angulations and width to height ratios of the maxillary anterior teeth, gingival contour, and root coverage and papilla height. These parameters should be considered when providing dental treatment in the anterior area, as they allow for quantification and objective judgment., Clinical Implications: The findings of this review might increase interest in a comprehensive dental esthetic index that allows for objective quantification and intrastudy and interstudy comparison of dental treatment outcomes.

Objectives: The aim of the study was to analyze the dissolving depth of adhesive resin monomers into pre-polymerized fiber-reinforced composites (FRC) with either a semi-interpenetrating polymer network (semi-IPN) or a cross-linked polymer (CLP) matrix., Methods: Five unidirectional FRCs were tested, including one semi-IPN FRC (everStick(®) C&B, StickTech, (ES)) and four CLP-FRCs (GrandTec(®), VOCO, (GT); Dentapreg(®), ADM, (DP); TenderFiber(®), Micerium, (TF); Splint-It(®), Pentron Clinical Technologies, (SI)). The FRCs were light-polymerized following manufacturers' instructions: the oxygen inhibition layers were removed and the adhesive resin (Optibond-FL(®), KerrHawe) was labeled with a fluorescent dye (Rhodamine-B-isothiocyanate), which was then applied to the FRCs (5 min) and light-polymerized (40s). Specimens were then prepared for confocal laser scanning microscopy. Three FRC strands per group were sectioned orthogonally to the direction of fibers, thus forming nine slices in each group. Four images were taken from each slice and the depths of adhesive penetration were measured in four sites per image (n=144 measurements per group)., Significance: Dissolving depths were 17.28 (3.04) μm (ES), 12.58 (2.94) μm (SI), 7.57 (1.91) μm (TF), 3.27 (0.73) μm (DP) and 2.55 (0.63) μm (GT). Samples were normally distributed. Differences between groups were analyzed by ANOVA (PostHoc Scheffé) showing four subgroups (p=0.05). The infiltration layers detected were either continuous/homogenous (ES, TF, DP GT) or discontinuous/insular (SI)., Conclusion: The adhesive resin monomers were able to diffuse significantly deeper into pre-polymerized semi-IPN specimens than into CLP materials. Semi-IPN specimens showed a homogenous and comparatively deeper layer of infiltration. The diffusion capabilities of secondary-IPN formation might increase the opportunity to establish a good bond between pre-polymerized FRC and new resin., (Copyright © 2011 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Objective: To determine whether incidence and severity of cyclosporine A (CsA)-induced gingival overgrowth (GO) is related to expression nuclear factor of activated T cells-regulated genes (NFAT-regulated genes)., Material and Methods: Expression of NFAT-regulated genes was determined in 36 transplant patients medicated with CsA by real-time PCR before and 2 h after drug intake and residual NFAT activity was estimated as ratio of both measurements. Demographic, periodontal and pharmacologic parameters were recorded and GO assessed from models. Subjects were divided into two groups according to the degree of GO (responders: GO score≥10%). Groups were compared using parametric and non-parametric tests. The association of various CsA-specific and periodontal parameters on incidence and extent of GO were determined using regression analysis., Results: Responders had a more than twofold lower residual NFAT activity than non-responders (7.9% and 18.1%, respectively; p<0.001). Multiple regression analysis revealed gingival inflammation, salivary CsA concentration, and residual NFAT activity to be significant factors influencing the expression of GO. Seventy-seven percent of the variability of GO could be explained by these parameters., Conclusions: This study showed that pharmacodynamic parameters such as residual NFAT activity may be promising prognostic indicators to identify patients with increased risk for GO., (© 2011 John Wiley & Sons A/S.)

This study determined the mechanical properties of 19 dental floss holders. Eight single-use holders and 11 reusable ones were tested. An in vitro model with dental proximal contact strength of 8 N was created. Every device had to pass the proximal contact 30 times. We measured (1) the displacement of the floss [mm], (2) the force [N] necessary to pass the proximal contact after the 30th passage, (3) the loosening of the floss (offset [mm]), and (4) the change in the distance between the branches [mm]. Each measurement was repeated seven times. The results are displacement of the floss after 30 passages, 2.0 to 9.2 mm; passage force, 2.6 to 11 N; increases in branch distance, 0-2.9 mm; offset of the floss, 0-1.8 mm (all numbers are medians). Based on cleaning a full dentition (30 passages), we suggest introducing minimal requirements of <4 mm for the displacement of the floss, ≥11 N for the force, and <0.1 mm for the difference in branch distance and the offset. Only two products fulfilled our criteria. The tests show that dental floss holders vary extremely in their mechanical properties. Their effective use seems often impossible due to limited mechanical properties.

Purpose: To obtain survival data on 32 fiber-reinforced fixed dental prostheses which were inserted in our department and to rate the quality of these restorations on the basis of esthetic, biological, and functional parameters., Materials and Methods: Thirty-two patients with fiber-reinforced fixed dental prostheses were included in the study. The fiber frameworks were made of a polymer-monomer-preimpregnated continuous unidirectional glass fiber material. The survival times, failure events, and clinical parameters were recorded. Restorations in function without previous failure were classified as "Overall Survival". The classification "Functional Survival" was assigned in the event of minor failure and subsequent repair. Loss of the restoration was regarded as "Failure". The quality rating was performed using modified USHPS/Ryge criteria., Results: The follow-up interval ranged from 2 to 64 months with a median follow-up time of 18.2 months. Twenty-four restorations were classified as "Overall Survival", seven were classified as "Functional Survival", and one was classified as "Failure". The overall survival at the median follow-up time was 74.4%. For the majority, the quality rating (USHPS/Ryge criteria) yielded clinically excellent results in all categories. No restoration was rated as insufficient or poor., Conclusion: Fiber-reinforced composite fixed dental prostheses provide sufficient stability and very good esthetic, biological, and functional performance in the case of specific clinical indications.

Objectives: Irregular tooth shape and position in the anterior maxilla and mandible are major aesthetic problems for patients. In recent years such conditions have increasingly been treated minimally or even non-invasively by recontouring teeth with direct composite resin buildups. Although clinical experience with this treatment option is promising, evidence-based data about longevity are limited., Methods: The authors evaluated survival and quality of 327 composite buildups that were placed in 101 patients in the Department of Conservative Dentistry, University of Heidelberg, between 2002 and 2008. Follow-up intervals and failures were recorded. Quality was assessed by grading restorations (modified USPHS/Ryge critera) still in situ without adverse event during the follow-up period., Results: After a mean follow-up interval of 27.8 months, 284 restorations were in situ and had no event. Forty-two restorations were in situ but had events that were mostly minor fractures of the composite resin. One restoration had been lost. Analysis of the time from insertion to any event or end of follow-up yielded an estimated 5-year survival rate of 79.2% (95% CI, 70.5-87.9). Quality was assessed by grading in situ restorations without event. More than 90% of graded restorations were categorized as "clinically excellent" (1) or "clinically good" (2). A correlation between those rated "clinically sufficient" or worse (≥3) and the follow-up period was observed., Conclusions: Direct composite buildups are aesthetic, functional, and biologically sound treatment options for recontouring teeth and closing diastemas with clinically promising survival rates. Therefore, tooth shape correction can be recommended in cases in which minimally invasive or non-invasive procedures on healthy teeth are indicated., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

The goal of this in vitro study was to identify the most suitable dye for endodontic dye leakage studies, which could be a further step towards standardisation. The root canals of 70 extracted, single-rooted human adult teeth were enlarged to apical size 50 using hand instruments. The teeth were divided into seven groups (n = 10 each), and all root canals were completely filled by injection with one of the following dyes: methylene blue 0.5% and 5%, blue ink, black ink, eosin 5%, basic fuchsin 0.5% and drawing ink. Transverse root sections from the coronal, middle and apical part of the roots were examined, and the percentage of the dentine penetrated by dye was evaluated by software-supported light microscopy. In addition, the range of particle size of drawing ink particles was evaluated. There were conspicuous differences in the relative dye penetration into the root dentine and the penetration behaviour in the different root sections (two-way ANOVA, both p < 0.0001). One dye (drawing ink) penetrated less into the root dentine compared with all the others (p <0.0001). The particle size of this agent (0.1-2 microm) corresponds best with the size range of a representative selection of 21 species of pathogenic endodontic bacteria. Compared to the other dyes tested, drawing ink appears to be superior for use in endodontic dye leakage studies. The penetration behaviour into the root dentine of all the other dyes tested might be one factor that limits the applicability of these dyes in dye leakage studies.

Introduction: The use of mineral trioxide aggregate (MTA) might improve the prognosis of teeth after pulp exposure. The treatment outcome of teeth after direct pulp capping, either with mineral trioxide aggregate (MTA) or calcium hydroxide (controls), was investigated, taking into account possible confounding factors., Methods: One hundred forty-nine patients treated between 2001 and 2006 who received direct pulp capping treatment in 167 teeth met the inclusion criteria. Treatment was performed by supervised undergraduate students (72%) and dentists (28%). Assessment of clinical and radiographic outcomes was performed by calibrated examiners 12-80 months after treatment (median, 27 months)., Results: One hundred eight patients (122 treated teeth) were available for follow-up (72.5% recall rate). A successful outcome was recorded for 78% of teeth (54 of 69) in the MTA group and for 60% of teeth (32 of 53) in the the calcium hydroxide group. The univariate analysis (generalized estimation equations model [GEE model] showed a significant difference in the success rate (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.05-5.32; P = .04). In the multiple analysis (GEE model), the OR is marginally inside the nonsignificant range (OR, 0.43; 95% CI, 0.19-1.02; P = .05) when conspicuous confounding factors are stabilized (univariate analysis). Multiple analysis showed that teeth that were permanently restored >or=2 days after capping had a significantly worse prognosis in both groups (OR, 0.24; 95% CI, 0.09-0.66; P = .01)., Conclusions: MTA appears to be more effective than calcium hydroxide for maintaining long-term pulp vitality after direct pulp capping. The immediate and definitive restoration of teeth after direct pulp capping should always be aimed for., (Copyright (c) 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: "Submicron hiatus" represents a potential space between the base of the collagenous network and the mineralized dentin when it is acid etched for bonding. This study evaluated the relationship between microtensile bond strength (microTBS) and occurrence of submicron hiatus formations at the resin-dentin interface using the same specimens., Methods: Resin-dentin bonded micro-specimens (sticks with a size of 300 microm x 300 microm x 8mm) were prepared using one of two material combinations (group I: Syntac Classic/Tetric Ceram Cavifil: n=51 group II: Prime & Bond NT/Tetric Ceram Cavifil: n=56). After labeling the primer component with a tiny amount of rhodamine-B-isothiocyanate, submicron hiatus formations were imaged nondestructively using a confocal laser scanning microscope (CLSM). Subsequently specimens were subjected to a microTBS test., Results: For the influence of submicron hiatus formations on microTBS with the Syntac Classic group, the nonparametric Spearman's correlation was -0.329 at p=0.02. For the Prime & Bond NT group, the nonparametric Spearman's correlation was -0.356 at p=0.007. Analyzing the effect of submicron hiatus on without discriminating by group resulted in a Spearman's correlation coefficient of -0.341 at p=0.001; microTBS and quality of hybrid layer showed a correlation coefficient of 0.849 at p=0.001, and microTBS and quality of tag formation showed a correlation coefficient of 0.474 at p=0.001., Significance: The degree of submicron hiatus formations had an influence on microtensile bond strength for both the Syntac Classic and the Prime & Bond NT group., (Copyright 2009 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Introduction: The use of biocompatible materials like mineral trioxide aggregate (MTA) may improve the prognosis of teeth with root perforations., Methods: The treatment outcome of root perforations repaired between 2000 and 2006 with MTA was investigated. Twenty-six patients received treatment with MTA in 26 teeth with root perforations. Treatment was performed by supervised undergraduate students (29%), general dentists (52%), or dentists who had focused on endodontics (19%). Perforation repair by all treatment providers was performed using a dental operating microscope. Calibrated examiners assessed clinical and radiographic outcome 12 to 65 months after treatment (median 33 months, 81% recall rate). Pre-, intra-, and postoperative information relating to potential prognostic factors was evaluated., Results: Of 21 teeth examined, 18 teeth (86%) were classified as healed. None of the analyzed potential prognostic factors had a significant effect on the outcome., Conclusions: MTA appears to provide a biocompatible and long-term effective seal for root perforations in all parts of the root., (Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: High-throughput technologies for typing caries or health-associated bacterial populations including PCR, DNA microarrays and next-generation sequencing techniques require significant amounts of bacterial DNA. In clinical settings, the amount of sampled DNA is often limited and amplification is therefore essential. Protocols should be able to reproducibly amplify sequences in order to maintain initial sequence ratios and should not bias the representation of particular DNA sequence types., Methods: A linear amplification protocol using DNA polymerase I was modified to permit the amplification and subsequent analysis of small amounts of bacterial DNA. The protocol was tested on human oral bacterial biofilms from different sources, including carious dentine and plaque, and compared to amplification by degenerate PCR of 16S rDNA sequences. Real-time quantitative PCR of 24 bacterial species was used as a readout system to test amplified DNA against unamplified DNA., Results: The amplification protocol reliably yielded 5-10 μg DNA from as little as 12.5 ng of template DNA. Correlation coefficients between real-time quantitative PCR results from amplified and unamplified DNA were between 0.78 and 0.98., Conclusion: The optimized protocol consistently produced amplification products from minute amounts of bacterial DNA from caries and plaque; the amplification products are suitable for downstream genetic analyses., (Copyright © 2010 S. Karger AG, Basel.)

Introduction: Teeth with open apical foramina present a challenge during root canal treatment, and little is known about the clinical outcome of treatment in such teeth. This retrospective study assessed healing of teeth with open apices managed by the placement of mineral trioxide aggregate apical plugs., Methods: Seventy-two patients with 78 teeth with apical resorption or excessive apical enlargement, treated between 2000 and 2006, were contacted for follow-up examination 12 to 68 months after treatment (median 30.9 months). Treatments were provided by supervised undergraduate students (27%), general dentists (32%), or dentists who had focused on endodontics (41%). The outcome based on clinical and radiographic criteria was assessed by calibrated examiners and dichotomized as "healed" or "disease.", Results: Of 56 teeth examined (72% recall), 84% were healed. Teeth without or with preoperative periapical radiolucency had a healed rate of 100% and 78%, respectively. None of the variables analyzed had a significant effect on the outcome., Conclusion: The results supported the management of open apical foramina with mineral trioxide aggregate apical plugs.

Background: Toothache prevalence in the overall population is considerable. However, for clinical purposes, the classification schemes available do not appear to be sufficiently sophisticated. Moreover, not all known forms of dental pain are considered. A refined classification that meets current standards is therefore introduced. To facilitate diagnosis, the characteristic features of the various types of odontalgia are summarized., Results: The new classification differentiates among seven different origins of pain: 1. dentinal pain (originating from the pulpal tissues), 2. pulpal pain (originating from the pulpal tissues), 3. periodontal pain, 4. alveolar-osseous pain, 5. atypical odontalgia, 6. heterotopic dental pain, 7. odontalgia associated with primary psychosocial factors., Conclusions: In our opinion, the proposed classification differentiates among the different forms of odontalgia more precisely than all previous ones. However, its viability and advantages over other available classification schemes still need to be verified in daily practice.

Objectives: Assessment of effort (number of visits) and costs of tooth preservation 10 years after initiation of anti-infective therapy., Material and Methods: Data of 98 patients who had received active periodontal treatment 10 years ago by the same examiner were analysed to gather information on effort and costs of supportive periodontal therapy (SPT). Clinical examination, interleukin-1 (IL-1) polymorphism test, smoking, search of patients' files (i.e. initial diagnosis), as well as a questionnaire on medical history and socioeconomic data were performed. Statistical analysis was performed using multivariate linear regression analysis., Results: During 10 years of SPT patients had 14.8+/-7.4 visits. Number of visits was statistically significantly higher for individuals with a mean plaque control record >or=24 %. The number of subgingival scalings per tooth ranged from 0 to 14 (mean: 1.17). On tooth level several confounders could be identified: tooth type, initial bone loss, furcation involvement, abutment status, and previous regenerative surgery (p

Objectives: This study evaluated the relationship between microtensile bond strength (microTBS) and occurrence of nanoleakage at the resin-dentin interface using the same specimens., Methods: Resin-dentin-bonded micro-specimens (sticks with a size of 300 microm x 300 microm x 8mm) were prepared using one of two material combinations (group I: Syntac classic/Tetric Ceram Cavifil: n=57; group II: Prime & Bond NT/Spectrum TPH: n=52). After immersion of the micro-specimens in 0.1% rhodamine-B solution for 1h, nanoleakage was imaged nondestructively using a confocal laser scanning microscope (CLSM). Then the specimens were subjected to a microTBS test., Results: For the influence of nanoleakage on microTBS with the Syntac classic/Tetric Ceram Cavifil group, the nonparametric Spearman correlation was 0.033 at p=0.805. For the Prime & Bond NT/Spectrum TPH group, the nonparametric Spearman correlation was 0.077 at p=0.584., Significance: The degree of nanoleakage had no influence on microtensile bond strength for the Syntac classic/Tetric Ceram Cavifil or for the Prime & Bond NT/Spectrum TPH group.

Objectives: Evaluation of a particular digital caries image-enhancing mode (filter) for its effect on the validity of measurements of caries lesion depth., Methods: Standardized radiographs of 44 extracted teeth exhibiting interproximal caries lesions were obtained. Six radiographs were obtained of each tooth and digitized. Four radiographs were made using D-speed film with and without soft tissue scattering equivalent (STSE) at normal exposure time (0.32 s) and underexposed (0.16 s). Two were made using E-speed film with STSE normally (0.16 s) and underexposed (0.08 s). On each of the 264 radiographs, 4 independent examiners measured the central depth (CD) of 1 carious lesion per tooth both on the unchanged radiographic image and after use of the filter. Histometric CD assessments provided a gold standard for comparison with the radiographic measurements (validity). Repeated measures ANOVA was calculated for validity in relation to examiner, lesion type, filter, film type, exposure time and STSE., Results: The lesion type was identified to statistically significantly influence the validity of CD measurements. Examiner in combination with defect type (P<0.001), filter (P = 0.017), exposure (P = 0.027) and film type (P = 0.044) had an additional albeit small effect., Conclusions: The lesion type significantly influenced the validity of CD measurements: enamel lesions were less underestimated than dentin lesions.