Search

Background: Current evidence appraisal concepts, such as the Assessment, Development and Evaluation (GRADE) approach and Cochrane’s Risk of Bias (RoB) tool, rely on assumptions related to the classic problem of inductive reasoning and may suffer from insufficient inter-rater reliability. Discussion: The Composite Quality Score (CQS) has emerged as a possible trial appraisal tool that does not rely on inductive assumptions and has been shown to be of potentially very high inter-rater reliability. Conclusion: Although the current CQS concept is still under development, its current evidence is encouraging and justifies further study. This article presents the rationale and currently available research concerning the CQS and shows where further research is required.

IntroductionChronic periodontitis is a slow-progressing, multifactorial inflammatory disease of the periodontium that may lead to its destruction, which is detectable as increasing probing pocket depth (PPD), subsequent tooth mobility and tooth loss. The purpose of this systematic review was to update and appraise the current trial evidence to the question: Does probiotic (L. reuteri) lozenge taken twice daily over 3–4 weeks reduce PPD in patients with chronic periodontitis after 3 months?Methods and analysisReference checks of previous systematic review and trial reports on the topic were conducted. PubMed, Scopus, Cochrane Library and the Directory of Open Access Journals (DOAJ) were searched. All selected trial reports were independently appraised by two reviewers, using the CQS-2B trial appraisal tool. Meta-analysis was conducted using a random effect model with the inverse variance method, stratified according to CQS-2B corroboration levels (C1–C4). The I2-test with 95% confidence interval was used to establish whether any statistical heterogeneity exists between datasets.ResultsSeven trials were included for appraisal and analysis. None complied with all appraisal criteria and thus were rated with an overall 0-score (high bias risk). Meta-analysis results at the lower C3-level (MD -0.64, 95% CI: -1.09 to -0.18) were found as being at risk of overestimating the true probiotic effect.ConclusionThe clinical evidence identified in this systematic review is at high risk of representing an overestimation of the true therapeutic effect due to systematic error. The results of large randomised control trials are needed before any clinically relevant answer to the review question can be made.

Systematic reviews of prospective controlled clinical therapy trials are one of the most important sources of information in modern medicine. Besides the systematic search for and statistical pooling of current clinical trial data for a particular type of therapy, systematic reviews also have the task of appraising the quality of trial results. The quality of trial results may be diminished by low internal trial validity, due to systematic error (bias). A high risk of bias may likely cause the reported trial results to be diverted from the actual true therapeutic effect and thus render it unsuitable for clinical guidance. According to the Cochrane Collaboration, the risk of bias in clinical therapy trials should be assessed using its Risk of Bias tool, Version 2 (RoB 2). However, the tool has been established to have poor inter-rater reliability, with a limited empirical evidence base and described as complex and demanding. Against this background, the Composite Quality Score (CQS) has been developed as a possible alternative trial appraisal tool, characterised by high epistemic rigour, empirical evidence base, inter-rater reliability and ease of use. This article presents the current evidence of the CQS and its limitations.

Objectives: To establish, whether clinical conclusions from systematic reviews that applied the second version of Cochrane’s Risk of Bias tool (RoB 2) remain the same when the Composite Quality Score (CQS-2B) is used, instead. Methods: PubMed will be searched for one systematic review that complies with the following criteria: At least 20 prospective, clinical, controlled therapy trials included into meta-analyses; computable data for test- and control group reported; trial appraisal using the RoB 2 tool; inclusion of at least 5 trials in at least one single comparison per measured outcome; published in English. All trial reports included in the systematic review will be traced in full copy and the following data extracted per trial: Full reference details; overall RoB 2 appraisal decision; computable datasets. All trial reports will be re-appraised using the CQS-2B. All datasets will be stratified by overall bias risk (RoB 2 tool) and per corroboration (C-) level (CQS-2B). Trial data for each bias risk and C-level will be statistically pooled using Mantel-Haenszel statistics with random-effects model. All pooled ‘low bias risk’ effect estimates (RoB 2) and all pooled effect estimates of the highest C-level with data (CQS-2B) will in turn each be pooled by use of a random effects meta-analysis. DerSimonian and Laird’s method of moments estimator will be used to estimate the between-study variance. Statistical inconsistency will be quantified using the I2 statistic. The pooled effect estimates of both appraisal tools will be statistically compared using the Wald-test and the null-hypothesis tested that both are not significantly different. Clinical conclusions based on the pooled ‘low bias risk’ estimates (RoB 2) and the C4-level (CQS-2B) will be qualitatively compared. Reporting: The final report will be made available online as preprint in one of the major preprint repositories and submitted to a peer-reviewed journal.

Objectives: To establish, whether clinical conclusions from systematic reviews that applied the second version of Cochrane’s Risk of Bias tool (RoB 2) remain the same when the Composite Quality Score (CQS-2) is used, instead. Methods: PubMed will be searched for one systematic review that complies with the following criteria: At least 20 prospective, clinical, controlled therapy trials included into meta-analyses; computable data for test- and control group reported; trial appraisal using the RoB 2 tool; inclusion of at least 5 trials in at least one single comparison per measured outcome; published in English. All trial reports included in the systematic review will be traced in full copy and the following data extracted per trial: Full reference details; overall RoB 2 appraisal decision; computable datasets. All trial reports will be re-appraised using the CQS-2. All datasets will be stratified by overall bias risk (RoB 2 tool) and per corroboration (C-) level (CQS-2). Trial data for each bias risk and C-level will be statistically pooled using Mantel-Haenszel statistics with random-effects model. All pooled ‘low bias risk’ effect estimates (RoB 2) and all pooled effect estimates of the highest C-level with data (CQS-2) will in turn each be pooled by use of a random effects meta-analysis. DerSimonian and Laird’s method of moments estimator will be used to estimate the between-study variance. Statistical inconsistency will be quantified using the I2 statistic. The pooled effect estimates of both appraisal tools will be statistically compared using the Wald-test and the null-hypothesis tested that both are not significantly different. Clinical conclusions based on the pooled ‘low bias risk’ estimates (RoB 2) and the C4-level (CQS-2) will be qualitatively compared. Reporting: The final report will be made available online as preprint in one of the major preprint repositories and submitted to a peer-reviewed journal.

Aim To establish the inter-rater reliability of the Composite Quality Score (CQS)-2 and to test the null hypothesis that it did not differ significantly from that of the first CQS version (CQS-1). Materials and methods Four independent raters from three countries were selected to rate 45 clinical trial reports using CQS-1 and CQS-2. The raters remained unaware of each other’s participation in this study until all rating had been completed. Each rater received only one rating template at a time in a random sequence for CQS-1 and CQS-2 rating. Raters completed each template and sent these back to the principal investigator. Each rater received their next template two weeks after submission of the completed previous template. The inter-rater reliabilities for the overall appraisal score of the CQS-1 and the CQS-2 were established by using the Brennan-Prediger coefficient (BPC). The coefficients of both CQS versions were compared by using the two-sample z-test. During secondary analysis, the BPCs for every criterion and each corroboration level for both CQS versions were established. Results The BPC for the CQS-1 was 0.85 (95% CI: 0.64–1.00) and for the CQS-2 it was 1.00 (95% CI: 0.94–1.00), suggesting a very high inter-rater reliability for both. The difference between the two CQS versions was statistically not significant (p = 0.17). The null hypothesis was accepted. Conclusion This study shows that the CQS-2 is associated with a very high inter-rater reliability, which did not statistically significantly differ from that of the CQS-1. The promising results of this study warrant further investigation in the applicability of the CQS-2 as an appraisal tool for prospective controlled clinical therapy trials.

Objective: To establish the CQS inter-rater reliability and rating time and to compare both against that of the Jadad scale and Cochrane's Risk of Bias Tool (ROBT). Material and methods: Four independent raters rated 45 trial reports. The inter-rater reliability was established by use of the Brennan- Prediger coefficient (BPC). The coefficients were compared using the two-sample z- test. Secondary analysis included comparison of the inter-rater reliability of the randomization component of all tools, as well as of the allocation concealment component of the CQS to that of the ROBT. The mean rating time with standard deviation (SD) for each tool was determined using one-way repeated measures analysis of variance. Post hoc comparisons were made using the Tukey-Kramer adjustment for three pair-wise multiple comparisons. Results: The inter-rater reliability was significantly higher for the CQS (BPC, 95% CI: 0.95, 0.87-1.00) compared to Jadad (0.70, 0.58- 0.82) (adjusted p = 0.0005) and most components of ROBT. The mean (SD) time to complete the CQS (4.0 (1.0) min) did not differ significantly from that of the Jadad scale 4.8 (1.1) min (adjusted p = 0.11), but was significantly shorter compared to that of the ROBT 15.3 (5.9) min (adjusted p < 0.0001). Conclusions: The results suggest the CQS to be a very reliable and fast trial appraisal tool. Clinical relevance The higher the inter-rater reliability, the higher the probability that trial results reflect therapeutic truth. The CQS will need to take further bias sources into consideration, in order to increase its utility.

Objectives: The aim of this study is to establish the inter-rater reliability of the CQS-2 and to test the null-hypotheses that it does not differ significantly from that of the first CQS version (CQS-1). Methods: Four independent raters will be selected to rate 45 clinical trial reports using CQS-1 and CQS-2. The raters will remain unaware regarding each other’s participation in this study until all rating is completed. Each rater will receive only one rating-template at a time in a random sequence for CQS-1 and CQS-2 rating. Raters will complete each template and send these back to the principal investigator via email. Each rater will receive her/his next template two weeks after submission of the completed previous template. The inter-rater reliabilities for the overall appraisal score of the CQS-1 and the CQS-2 will be established by use of the Brennan-Prediger coefficient. The coefficients of both CQS versions will be compared by use of the two-sample z-test. All data analysis will be carried out using SAS statistical software. A 5% significance level will be used. During secondary analysis, we will establish the inter-rater reliability for each single criterion and each corroboration level for both CQS versions.Reporting: The results of this study will be reported in line with the Guidelines for Reporting Reliability and Agreement Studies (GRAAS). The final report will be made available online as preprint in one of the major preprint repositories and submitted to a peer-reviewed journal.

Aim: to conduct a survey of current meta-epidemiological studies to identify additional trial designcharacteristics that may be associated with significant over/under estimation of the treatment effectand to use such identified characteristics as basis for the formulation of new CQS appraisal criteria.Materials and methods: We retrieved eligible studies from two systematic reviews on this topic(latest search May 2015) and searched the databases PubMed and Embase for further studies fromJune 2015 – March 2022). All data were extracted by one author and verified by another. Sufficientlyhomogeneous estimates from single studies were pooled using random-effects meta-analysis. Trialdesign characteristics associated with statistically significant estimates from single datasets (whichcould not be pooled) and meta-analyses were used as basis to formulate new or to amend existingCQS criteria.Results: A total of 38 meta-epidemiological studies were identified. From these, seven trial designcharacteristics associated with statistically significant over- or under estimation of the truetherapeutic effect were found.Conclusion: One new criterion concerning double blinding was added to the CQS and the originalcriteria for concealing the random allocation sequence and for minimum sample size amended.

The effects of the particle fraction in toothpastes in the context of erosion and erosive tooth wear has not been fully elucidated. Thus, aim of this study was to investigate experimental toothpastes, each with one specific particle type. Toothpastes with seven different types of silica or alumina were prepared as slurry either with or without active ingredients (NaF or F/Sn). Human enamel samples were exposed to a cyclic erosion/abrasion model, and were either treated with the respective slurries only or additionally brushed in a brushing machine. Tissue loss was profilometrically monitored. After treatment with slurries without active ingredients or with NaF, tissue loss increased significantly within groups over time (p p > 0.05 for most comparisons). After treatment with the F/Sn slurries, tissue loss stagnated completely over time, with the exception of one silica type and alumina, but both still reduced tissue loss by 40–50% (compared to control p

Background Bruxism is known to cause masticatory muscle pain, temporomandibular joint pain, headaches, mechanical tooth wear, prosthodontic complications and cracked teeth. Less known to the practitioner, and described only experimentally in literature, is that bruxism can also damage the pulp. To our knowledge, this is the first known clinical case of a patient developing apical periodontitis due to bruxism. Case presentation This article presents the case and successful treatment of a 28-year-old healthy male patient with apical periodontitis on teeth 36 and 46 requiring root canal treatment after an intense phase of bruxism. Due to an unclear diagnosis, treatment had been delayed. Conclusions Incomprehensible tooth pain can be the result of bruxism. Practitioners need to be informed that intense bruxism can possibly lead to apical periodontitis. It is important, therefore, that a thorough anamnesis is collected and taken into account during diagnostics.

Peri-implantitis may result in the loss of dental implants. Cold atmospheric pressure plasma (CAP) was suggested to promote re-osseointegration, decrease antimicrobial burden, and support wound healing. However, the long-term risk assessment of CAP treatment in the oral cavity has not been addressed. Treatment with two different CAP devices was compared against UV radiation, carcinogen administration, and untreated conditions over 12 months. Histological analysis of 406 animals revealed that repeated CAP exposure did not foster non-invasive lesions or squamous cell carcinoma (SCCs). Carcinogen administration promoted non-invasive lesions and SCCs. Molecular analysis by a qPCR screening of 144 transcripts revealed distinct inflammatory profiles associated with each treatment regimen. Interestingly, CAP treatment of carcinogen-challenged mucosa did not promote but instead left unchanged or reduced the proportion of non-invasive lesions and SCC formation. In conclusion, repeated CAP exposure of murine oral mucosa was well tolerated, and carcinogenic effects did not occur, motivating CAP applications in patients for dental and implant treatments in the future.

Despite the fact that healthy, sugar-reduced nutrition has been propagated by the media and in schools for years, dental caries in children remains a major health problem worldwide, caused primarily by an unhealthy diet. The objective of this study is to compare statements on nutrition and hygienic knowledge with those on children’s actual dietary and hygienic behavior. A random sample of 554 children and adolescents aged 3–19 years was enrolled. Designed as a cross-sectional interview-based community survey, this study was conducted consecutively during three one-day public science-promoting events at the Saarland University’s Medical Faculty. Participants’ oral hygiene and nutritional knowledge was profound; however, the reported translation into practice showed deficiencies. Boys and younger children (3–10 years) often showed better oral hygiene knowledge than girls and older children (over 11 years) but had problems implementing it into their daily life practice. In contrast, girls and older children often showed less oral hygiene knowledge but reported more favorable behavior. Finally, children up to the mixed dentition phase preferred drinking sweets more often than older children, posing a risk to the developing permanent dentition. Intensifying well-known controlled motivation training approaches to encourage children and adolescents is recommended to put their knowledge into practice.

To establish the CQS inter-rater reliability and rating time and to compare both against that of the Jadad scale and Cochrane's Risk of Bias Tool (ROBT).Four independent raters rated 45 trial reports. The inter-rater reliability was established by use of the Brennan-Prediger coefficient (BPC). The coefficients were compared using the two-sample z-test. Secondary analysis included comparison of the inter-rater reliability of the randomization component of all tools, as well as of the allocation concealment component of the CQS to that of the ROBT. The mean rating time with standard deviation (SD) for each tool was determined using one-way repeated measures analysis of variance. Post hoc comparisons were made using the Tukey-Kramer adjustment for three pair-wise multiple comparisons.The inter-rater reliability was significantly higher for the CQS (BPC, 95% CI: 0.95, 0.87-1.00) compared to Jadad (0.70, 0.58-0.82) (adjusted p = 0.0005) and most components of ROBT. The mean (SD) time to complete the CQS (4.0 (1.0) min) did not differ significantly from that of the Jadad scale 4.8 (1.1) min (adjusted p = 0.11), but was significantly shorter compared to that of the ROBT 15.3 (5.9) min (adjusted p 0.0001).The results suggest the CQS to be a very reliable and fast trial appraisal tool. Clinical relevance The higher the inter-rater reliability, the higher the probability that trial results reflect therapeutic truth. The CQS will need to take further bias sources into consideration, in order to increase its utility.

The aims of this study were to investigate the effects of water aging for up to 6months on the mechanical and anti-biofilm properties of a novel antibacterial glass ionomer cement (GIC) containing dimethylaminododecyl methacrylate (DMADDM).GIC specimens (n=180) which contained DMADDM (0wt.%, 1.1wt.% or 2.2wt.%) were prepared. The mechanical properties surface roughness, microhardness and the surface charge density of ammonium groups were measured before and after water aging for 3 and 6months at 37°C. Further six months aged specimens (n=216) were worn by 6 volunteers in their oral cavities for 24h and 72h. Biofilm formation was analyzed and rated by fluorescence microscopy (FM) and by scanning electron microscopy (SEM). Biofilm viability was analyzed by FM.Water aging did not show any adverse effects on the surface roughness and hardness of the material. The surface charge density of the GIC samples containing DMADDM decreased due to the aging procedure, however, was still higher than that of the GIC without DMADDM. In situ biofilm formation was significantly reduced after 24h on DMADDM containing GIC (p0.05). FM results showed a higher ratio of red/green fluorescence on GIC-DMADDM samples.Incorporating DMADDM into GIC affected the material properties in a tolerable manner even after 6months of storage in water. The new GIC is a promising material to affect the biofilm formation on the surface of restorations.

The aim of the present experimental study was to test three different plasma sources on the removal of 72 h oral biofilms. It was hypothesized that cold atmospheric plasma (CAP) lowers biofilm coverage significantly. In vivo biofilms were formed on sand-blasted/acid-etched titanium discs (n = 40) mounted on splints worn for 72 h by eight volunteers. Specimens were randomly divided into five groups: CAP I received indirect plasma application, CAP II received direct plasma application, CAP III received microwave-driven pulsed plasma application (90 s each). The chlorhexidine (CHX) group was cleaned with a curette and rinsed with CHX. Biofilms of a control group received no treatment. After treatment, all specimens were rinsed for 10 s using a dental air/water spray (2 bar). The vitality of microorganisms was detected by cultivation on agar plates for 24 h and 48 h. The presence of biofilms and their quantity on the titanium samples was investigated by fluorescence microscopy (FM) using live/dead staining. A biofilm's quality was analyzed by scanning electron microscopy (SEM). All treated samples showed a reduced growth on agar plates compared with the control group. FM analysis showed significantly lowered biofilm coverage in all treatment groups compared with the negative control group (t test, p < 0.05). Within the plasma treatment groups, there was a significant difference between CAP II and CAP III ( p = 0.032). SEM showed disintegrated biofilms in all test groups. CAP reduces and disintegrates oral biofilms. Adjuvant application plasma could lead to more effective antimicrobial therapies for peri-implantitis.

Objectives Surgical masks are usually contaminated during dental treatment. So far it has not been investigated whether a surgical mask itself can be a source of microbial transmission. The aim of this study was therefore to investigate the microbiological contamination of surgical masks during dental treatment and the transfer of microorganisms from the mask to the hands. Materials and methods Five dental treatment modalities were studied: carious cavity preparation (P-caries, n = 10), tooth substance preparation (P-tooth, n = 10), trepanation and root canal treatment (P-endo, n = 10), supragingival ultrasonic application (US-supra, n = 10), and subgingival periodontal ultrasonic instrumentation (US-sub, n = 10). Bacterial contamination of mask and gloves worn during treatment was tested by imprinting on agar plates. Additionally, before masks were tested, their outer surface was touched with a new sterile glove. This glove was also imprinted on agar. Bacteria were identified by MALDI TOF mass spectrometry. Colony-forming units (CFU) were scored: score 0: 0 CFU, score 1: 2 CFU, score 2: > 102 CFU, score 3: dense microbial growth. Results All masks and all gloves used during treatment displayed bacterial contamination (sample scores 0/1/2/3: masks 0/46/3/1 and gloves 0/31/10/9). After touching the masks with new sterile gloves, microorganisms were recovered with the following contamination scores: P-caries: 4/6/0/0, P-tooth: 2/8/0/0: P-endo: 7/3/0/0, US-supra: 0/9/1/0, US-sub: 2/8/0/0. No statistically significant differences were detected between the treatment modalities. Streptococci spp. and Staphylococci spp. representing the oral and cutaneous flora dominated. Conclusions Surgical masks are contaminated after aerosol-producing dental treatment procedures. Used masks have a potential to be a source of bacterial contamination of the hands. Clinical relevance Dental staff should avoid touching the outer surface of masks with their hands to prevent transmission of pathogens. It is recommendable to change the mask after each treated patient followed by hand disinfection.

Background Microbial contamination of dental professionals’ facial protective equipment and skin from aerosols and droplets generated during dental treatment has not been studied in all aspects so far. Our aim was therefore to investigate and compare treatment-related bacterial contamination of the forehead skin and surgical mask of dental practitioners. Methods We analyzed samples from 67 consecutive aerosol-producing conservative-preventive dental treatments. Sterile nylon swabs were used to collect samples from the forehead skin before and after performing treatment. Contact samples were obtained from the used surgical face masks. Samples were cultivated on agar under aerobic and anaerobic conditions. Bacteria were classified by MALDI-TOF mass spectrometry. The frequency of detection of obligate and facultative oral bacteria, as well as an increase in bacterial abundance, were examined (bacterial scoring: 0: no growth on agar; 1: 2 colonies; 2: >102 colonies; 3: dense bacterial growth). Results Bacteria were detected in 95% of the skin swabs and 76% of mask samples. Median bacterial scores were 2 for the forehead skin samples before and after treatment, and 1 for samples obtained from masks. Obligate and facultative oral bacteria were more frequent (6% and 30%) in samples from forehead skin after treatment. Samples taken from the forehead skin after treatment showed increased scores for these bacteria (28%). Five percent of samples were positive for methicillin-sensitive Staphylococcus aureus (MSSA). Obligate anaerobes were present in 3% of samples. Conclusions Although exposed during treatment, the forehead skin was significantly less contaminated with obligate oral bacteria than expected based on the surgical face mask findings. Forehead skin samples showed an increase in bacteria in the after treatment, which can be attributed to aerosol-producing procedures. We hypothesize that the forehead’s physiological skin flora may offer some protection against contamination with other microorganisms.

Background Bacterial contamination of dental professionals’ facial skin and protective equipment from treatment-related aerosols and droplets are poorly studied. Methods This prospective study analyzed samples from 67 consecutive aerosol-producing dental treatments. Sterile nylon swabs served to collect samples from dental professionals’ foreheads before and after exposure. Contact samples were obtained from used surgical masks. Samples were incubated on agar under aerobic and anaerobic conditions. Bacteria were classified by MALDI-TOF mass spectrometry. We determined the frequencies of obligate and facultative oral bacteria and scored bacterial growth (0: none; 1: < 100 colonies; 2: >100 colonies; 3: dense). Results Bacteria were detected in 95% of skin-swab and 76% of mask samples. Median bacterial scores were 2 for forehead samples before and after treatment, and 1 for masks. Obligate and facultative oral bacteria were more frequent (6% and 30%) in samples from exposed forehead skin, which also showed increased bacterial scores (28%). 5% of samples contained methicillin-sensitive Staphylococcus aureus; 3% contained obligate anaerobes. Conclusion Exposed forehead skin was significantly less contaminated with obligate oral bacteria than expected based on surgical mask findings. Exposed forehead skin showed increased contamination attributable to aerosol-producing procedures. The forehead’s physiological skin microbiota may offer some protection against bacterial contamination.

Oral biofilms play an essential role on peri-implant disease development. Synthetic hydroxyapatite nanoparticles (nHAP) are a bioinspired material that has structural and functional similarities to dental enamel apatite and may provide preventive properties against biofilm formation. This study aimed to investigate the effects of an experimental nHAP solution on biofilm formation on polished and non-polished titanium under oral conditions. Five volunteers carried maxillary splints with non-polished and polished titanium and followed a 48 h rinsing protocol with the proposed nHAP solution, and with chlorhexidine 0.2% (CHX) and water, as controls. Samples were analyzed by fluorescence microscopy (FM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). FM showed a significant reduction of biofilms on polished samples treated with nHAP (p = 0.0485) compared with water, without differences between nHAP and CHX (p > 0.9999). Analyzing biofilm viability, polished samples rinsed with nHAP showed significantly fewer dead bacteria than CHX (p = 0.0079), but there was no significant difference in viability between polished samples rinsed with water and nHAP (p = 0.9268). A significantly higher biofilm coverage was observed on the non-polished surfaces compared to the polished surfaces when nHAP was applied (p = 0.0317). This difference between polished and non-polished surfaces was not significant when water (p = 0.1587) or CHX (p = 0.3413) rinsing were applied. SEM and TEM analysis supported the FM findings, that polished samples rinsed with nHAP presented fewer biofilm coverage compared to samples rinsed with water. In conclusion, the nHAP solution reduced the biofilm formation on polished Ti surfaces without altering bacterial viability, providing a novel approach for the management of biofilm formation on biomaterials.

Oral biofilms play an essential role on peri-implant disease development. Synthetic hydroxyapatite nanoparticles (nHAP) are a bioinspired material that has structural and functional similarities to dental enamel apatite and may provide preventive properties against biofilm formation. This study aimed to investigate the effects of an experimental nHAP solution on biofilm formation on polished and non-polished titanium under oral conditions. Five volunteers carried maxillary splints with non-polished and polished titanium and followed a 48 h rinsing protocol with the proposed nHAP solution, and with chlorhexidine 0.2% (CHX) and water, as controls. Samples were analyzed by fluorescence microscopy (FM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). FM showed a significant reduction of biofilms on polished samples treated with nHAP (p = 0.0485) compared with water, without differences between nHAP and CHX (p > 0.9999). Analyzing biofilm viability, polished samples rinsed with nHAP showed significantly fewer dead bacteria than CHX (p = 0.0079), but there was no significant difference in viability between polished samples rinsed with water and nHAP (p = 0.9268). A significantly higher biofilm coverage was observed on the non-polished surfaces compared to the polished surfaces when nHAP was applied (p = 0.0317). This difference between polished and non-polished surfaces was not significant when water (p = 0.1587) or CHX (p = 0.3413) rinsing were applied. SEM and TEM analysis supported the FM findings, that polished samples rinsed with nHAP presented fewer biofilm coverage compared to samples rinsed with water. In conclusion, the nHAP solution reduced the biofilm formation on polished Ti surfaces without altering bacterial viability, providing a novel approach for the management of biofilm formation on biomaterials.

BACKGROUND: Caries and periodontitis are highly prevalent worldwide. Because detailed data on these oral diseases were collected within the framework of the German National Cohort (GNC), associations between oral and systemic diseases and conditions can be investigated. OBJECTIVES: The study protocol for the oral examination was designed to ensure a comprehensive collection of dental findings by trained non-dental staff within a limited examination time. At the mid-term of the GNC baseline examination, a first quality evaluation was performed to check the plausibility of results and to propose measures to improve the data quality. MATERIALS AND METHODS: A dental interview, saliva sampling and oral diagnostics were conducted. As part of the level‑1 examination, the number of teeth and prostheses were recorded. As part of the level‑2 examination, detailed periodontal, cariological and functional aspects were examined. All examinations were conducted by trained non-dental personnel. Parameters were checked for plausibility and variable distributions were descriptively analysed. RESULTS: Analyses included data of 57,967 interview participants, 56,913 level‑1 participants and 6295 level‑2 participants. Percentages of missing values for individual clinical parameters assessed in level 1 and level 2 ranged between 0.02 and 3.9%. Results showed a plausible distribution of the data; rarely, implausible values were observed, e.g. for measurements of horizontal and vertical overbite (overjet and overbite). Intra-class correlation coefficients indicated differences in individual parameters between regional clusters, study centres and across different examiners. CONCLUSIONS: The results confirm the feasibility of the study protocol by non-dental personnel and its successful integration into the GNC’s overall assessment program. However, rigorous dental support of the study centres is required for quality management. HINTERGRUND:Karies und Parodontitis sind weltweit hoch prävalente Erkrankungen. Durch ihre Erfassung im Rahmen der NAKO Gesundheitsstudie können Assoziationen zwischen oralen und systemischen Erkrankungen untersucht werden. FRAGESTELLUNG: In einer ersten Qualitätsanalyse zur Halbzeit der NAKO-Basiserhebung wird die Plausibilität der zahnmedizinischen Ergebnisse überprüft. Es werden Maßnahmen zur Verbesserung der Datenqualität vorgeschlagen. MATERIAL UND METHODEN: Ein zahnmedizinisches Interview, eine Speichelprobengewinnung und eine Befunderhebung wurden durchgeführt. Im Rahmen der Level-1-Untersuchung wurden Zahn- und Prothesenanzahl erfasst. In der Level-2-Untersuchung wurden detaillierte parodontologische, kariologische und funktionelle Befunde erhoben. Alle Untersuchungen wurden von geschultem nichtzahnmedizinischen Personal durchgeführt. Es wurden Plausibilitätsprüfungen durchgeführt sowie Verteilungen deskriptiv dargestellt. ERGEBNISSE: In die Analysen gingen Daten von 57.967 Interviewteilnehmer*innen, 56.913 Level-1- und 6295 Level-2-Teilnehmer*innen ein. Der Anteil fehlender Werte lag für die einzelnen Parameter der Level-1- und Level-2-Untersuchungen zwischen 0,02 % und 3,9 %. Die Parameter zeigten eine plausible Verteilung; vereinzelt wurden unplausible Werte beobachtet, z. B. beim horizontalen und vertikalen Überbiss (Overjet und Overbite). Anhand der Intraklassenkorrelationskoeffizienten wurden für die einzelnen Parameter Unterschiede zwischen regionalen Clustern, den Studienzentren und verschiedenen Untersucher*innen nachgewiesen. DISKUSSION: Die bisherigen Ergebnisse bestätigten die Umsetzbarkeit des Studienprotokolls durch nichtzahnmedizinisches Personal und die erfolgreiche Integration in das Untersuchungsprogramm der NAKO Gesundheitsstudie. Die Studienzentren benötigen eine intensive zahnmedizinische Betreuung für das Qualitätsmanagement.

Cold atmospheric pressure plasma (CAP) has been investigated with promising results for peri-implant diseases treatment. However, prior to in-vivo applications of CAP sources in humans, short-term harmful mucosal damage or other unwanted side effects have to be reviewed. 180 male mice (B6C3F1) were divided into twelve treatment groups (n = 15). The right buccal cheek mucosa was treated with CAP. The first and second group each received continuous 10 sec irradiation with 2 different plasma sources (kINPen09, PS-MWM). The third group was treated with the kINPen09 for one minute. Control groups were treated with a corresponding dose of ultraviolet light for 8 seconds or 48 seconds and the other one was left untreated. The animals were weighed before and after treatment. The animals were sacrificed one day or one week after exposure. Stained tissue samples were histologically examined for tissue damage independently by two experienced pathologists. One day after CAP treatment histological analysis showed focal mucosal erosion with superficial ulceration and necrosis accompanied by a mild inflammatory reaction. One week after CAP treatment, the mucosal defects were completely re-epithelialized, associated with remnants of granulation tissue in the stroma irrespective of treatment duration. Furthermore, no cytological atypia was found and no severe weight loss occurred. The control groups did not show any alterations at all. CAP treatment led to a superficial mucosal damage that healed within few days. Nonetheless, further long-term experiments are necessary to exclude undesirable side effects after longer observation time. Particularly, potential carcinogenic effects must be ruled out prior to the application of CAP treatment in daily dental practice.