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Purpose: As more women are entering health professions, the health care system is becoming more feminized. This investigation evaluated gender differences in clinicians' treatment preferences and decision making in a complex treatment situation. Materials and Methods: A questionnaire was developed containing clinical cases and statements to assess practitioners' opinions on treatment of periodontally involved maxillary molars and implant therapy with sinus grafting. Data were analyzed with respect to the clinicians' sex, and an overall logistic regression was performed to further investigate possible influences of age, office location, and specialty. Results: Three hundred forty questionnaires were evaluated (response rate: 35.1%). The mean age of female respondents (37%) was 42 years, and the mean age of male respondents was 46 years. Significantly fewer women reported performing implant placement (35% vs 63%), sinus grafting (16% vs 43%), and periodontal surgery (57% vs 68%). Female practitioners tended to refer more patients to specialists. Participants favored sinus grafting more often for their spouses than for themselves. Apart from a preference for regenerative periodontal surgery among women, no gender differences were observed for treatment decisions or views on general statements related to implant preference, tooth maintenance, or conventional reconstructive therapies. Conclusions: With similar expert knowledge, treatment decisions were made irrespective of sex. While the majority of male care providers performed complex therapies themselves, female clinicians referred more patients to specialists. Int J Prosthodont 2011;24:507-514. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To demonstrate the existing difficulties and variability in the application of evidence-based dentistry by comparing the recommendations made by 4 dental experts for the treatment of a fractured tooth. METHOD AND MATERIALS: A case presentation was given to 4 specialists, who were asked to independently develop and explain their personal favorite treatment strategy, based on the best available external evidence and their clinical expertise. The entire case was then reviewed by an expert in evidence-based medicine and discussed with the first author. RESULTS: Each of the 4 experts relied on different articles in justifying their clinical decisions. The minimal overlap in the literature they cited largely explains the different treatment suggestions: While the endodontist preferred a metal post-and-core and a porcelain-fused-to-metal (PFM) crown, both the operative dentist and the prosthodontist opted for a glass-fiber post/fiber-reinforced resin composite post. The perio-prosthodontist recommended a PFM crown with either a direct or indirect post and core. The citation analysis revealed that little high-quality information is available about what would be the best therapy for horizontal fractures of root-canal-treated anterior teeth. CONCLUSIONS: This article illustrates that, although it is now common practice in dentistry to base clinical decision making on external evidence from the literature, search strategies and the resulting clinical recommendations still vary greatly. [ABSTRACT FROM AUTHOR]

PURPOSE: Edentulous patients with denture problems benefit from implant treatment with overdenture prostheses. The aim of this prospective study was to investigate a method of analyzing cost effectiveness in dentistry. As an example, overdenture treatment with two or four implants was compared to the conventional complete denture (CD). MATERIALS AND METHODS: In a self-selected trial, 20 patients each were treated with implant-retained overdentures (two implants, IRET), implant-supported overdentures (four implants, ISUP), or CDs (control group) in the edentulous mandible. A cost-effectiveness analysis was performed from the patient's perspective, with a time horizon of 6 months. Direct health-care costs were calculated in Swiss Francs (in 2000), and effects were defined as improvements in perceived chewing ability compared with the baseline value before treatment (measured on a VAS). Point estimates for mean incremental cost-effectiveness ratios were complemented with cost-effectiveness acceptability curves to account for uncertainties associated with costs and effects. RESULTS: Mean incremental costs were CHF 4,329 (IRET-CD), CHF 13,360 (ISUP-CD), and CHF 9,031 (ISUP-IRET); these cost differences were all statistically significant. The mean incremental effects at 6 months were 19% (IRET-CD), 23% (ISUP-CD), and 4% (ISUP-IRET). Incremental cost-effectiveness ratios were CHF 228 (IRET-CD), CHF 581 (ISUP-CD), and CHF 2,258 (IRET-ISUP) per percentage increase in chewing ability. CONCLUSION: From an economic point of view, IRETs were more attractive than ISUPs. The latter were associated with a statistically significant improvement in perceived chewing ability compared to CDs, but at substantially higher costs. [ABSTRACT FROM AUTHOR]

The aim of this prospective 5-year longitudinal study was to follow endosteal implants in which guided bone regeneration (GBR) was applied during implant placement. In 75 patients, defects around implants (Branemark System) were treated with Bio-Oss and Bio-Gide (112 implants). In split-mouth patients in this group, Bio-Oss and Gore-Tex were used in the second defect site (41 implants). All 75 patients had at least 1 implant that was entirely surrounded by bone and served as the control (112 implants). After placement of the definitive prostheses (single-tooth, fixed, or removable implant prostheses), patients were recalled after 6 months and then every 12 months during a 5-year observation period. The following variables were investigated: implant survival, marginal bone level (MBL), presence of plaque, peri-implant mucosal conditions, height of keratinized mucosa (KM), and marginal soft tissue level (MSTL). The cumulative implant survival rate after 5 years varied between 93% and 97% for implants treated with or without GBR. The mean MBL after 60 months was 1.83 mm for sites treated with Bio-Oss and Bio-Gide, 2.21 mm for sites treated with Bio-Oss and Gore-Tex, and 1.73 mm for the control sites. The MBL values were found to increase significantly with time and differed significantly among the treatment groups. During the observation period, KM varied between 3.16 and 3.02 mm. A slight recession of 0.1 mm was observed, and plaque was found in 15% of all sites and was associated with inflammatory symptoms of the peri-implant mucosa. It was observed that such symptoms and recession correlated more strongly with the type of restoration than with the type of treatment. This study demonstrated that implants placed with or without GBR techniques had similar survival rates after 5 years, but that bone resorption was more pronounced in sites with GBR treatment. It was assumed that the use of GBR is indeed indicated when the initial defect size is larger than 2 mm in the vertical dimension. [ABSTRACT FROM AUTHOR]

The aim of the present experiment was to study the peri-implant soft and hard tissues formed at titanium implants with 2 different surface configurations and to give a topographic description of the surfaces examined. In 5 beagle dogs, the mandibular premolars were extracted. Three months later, 4 self-tapping standard implants (SI) and 4 Osseotite implants (OI) of the 3i Implant System were placed. The marginal 3 mm of the OI is turned, while the remaining part has an acid-etched surface structure. Abutments were connected after 3 months. A plaque control period was initiated, and after 6 months block biopsies were obtained. From each animal 2 units of each implant type were processed and embedded in EPON. The remaining biopsies were processed for ground sectioning. The histometric measurements performed on the EPON sections revealed that the peri-implant soft tissues and the marginal level of bone-to-implant contact were similar for SI and OI sites. In the ground sections, bone-to-implant contact (BIC%) and bone density assessments were made in 2 different zones. Zone I represented the contact area measured from the marginal level of bone-to-implant contact (B) to a position 4 mm above the apex of the implant, and zone II represented the apical 4 mm of the implant. For the SI sites, the BIC% was 56.1% in zone II and 58.1% in zones I + II. The corresponding figures for the 01 sites were 76.7% and 72.0%. The BIC% was significantly larger at OI than at SI sites. Bone density values were similar at the SI and OI sites. [ABSTRACT FROM AUTHOR]

The aim of this prospective clinical study was to investigate the long-term survival of Procera AllCeram all-ceramic crowns in the anterior and posterior regions. Between 1997 and 2005, 155 Procera crowns with aluminum oxide cores were placed in 50 patients. Patients were recalled in 2005 for a clinical assessment. Thirty-nine patients with 135 crowns attended the recall examination. Of the 135 total crowns, 103 were located in the posterior region and 32 were located in the anterior region. The cumulative survival rate was 100% in the anterior region and 98.8% in the posterior region (1 crown fracture) after 5 and 7 years. Clinical success was achieved irrespective of the tooth position, cement used (resin composite or glass-ionomer cement), or the core design with reduced or conventional margins. Procera AllCeram seems to be a predictable technique for esthetic all-ceramic single crown restorations in the anterior and posterior regions. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The aim of the current review was to describe the prevalence of peri-implant diseases including peri-implant mucositis and peri-implantitis. MATERIAL AND METHODS: A MEDLINE search (PubMed) until December 2007 was conducted and different keywords related to the prevalence of peri-implant diseases were used. Cross-sectional and longitudinal studies including > or =50 implant-treated subjects exhibiting a function time of > or =5 years were considered. RESULTS AND CONCLUSION: The current review revealed that only a few studies provided data on the prevalence of peri-implant diseases. Cross-sectional studies on implant-treated subjects are rare and data from only two study samples were available. Peri-implant mucositis occurred in approximately 80% of the subjects and in 50% of the implants. Peri-implantitis was found in 28% and > or =56% of subjects and in 12% and 43% of implant sites. [ABSTRACT FROM AUTHOR]

BACKGROUND: The host response to microbial challenge depends on the recruitment of homing leucocytes and may be related to the experience to infectious insults over years. PURPOSE: The aim of this study was to investigate the soft tissue reactions to de novo plaque formation at sites treated with either open flap debridement or with the use of resective means during periodontal therapy. MATERIAL AND METHODS: Fifteen patients, who had been treated for periodontal disease (severe generalized chronic periodontitis), participated in the study. Surgical therapy was performed using either gingivectomy (GV) or open flap debridement (OFD) procedures in a split mouth design. After 6 months of healing (day 0), two gingival biopsies were obtained, one from the GV- and one from the OFD-treated sites. The experimental gingivitis model was applied and plaque accumulation was allowed for 3 weeks. New biopsies were obtained from the remaining quadrants on day 21 of plaque formation. The biopsies were snap frozen and prepared for immunohistochemical analysis. RESULTS: Following 3 weeks of plaque accumulation, the size of the lesion in OFD sites was more than twice as large than that in GV sites (0.42 versus 0.19 mm2). In the GV units, the lesion was characterized by almost similar proportions of T cells (CD3+, 6.0%) and B cells (CD19+, 6.6%), while the ICT in OFD sites was dominated by B cells (13.8%). During the 3-week period of plaque formation the increase in cell densities of T and B cells was three times larger in OFD than in GV sites. The proportion of ELAM-1 (CD62+ cells) decreased in GV (-0.4%) and increased in OFD (0.9%) sites. CONCLUSIONS: The host response that occurred in the gingival sites treated with OFD was more pronounced than the reaction that under similar experimental conditions took place in the regenerated gingiva at sites treated by resective means. Copyright (c) Blackwell Munksgaard, 2005. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the medium-term survival of Dalbo-Rotex retention elements, identify potential risk factors for complication or loss, and consider economic factors., Materials and Methods: Patients treated with Dalbo-Rotex retention elements in a university setting were retrospectively identified and examined. Clinical data comprised assessments of the dental, periodontal, endodontic, and prosthetic situation, including radiographic analysis. Patient satisfaction was quantified with visual analog scale questionnaires. Five-year Kaplan-Meier plots for relative survival and success rates were calculated., Results: The 45 included patients had a total of 76 Dalbo-Rotex retention elements. Of these, 12 Dalbo-Rotex elements failed and complications occurred in 42.1% of elements, equating to a survival rate of 84.2% and a success rate of 47.4% after a mean observation period of 49.2 ± 52.4 months (range: 6 to 219 months). The 5-year cumulative survival and success rates were 62.4% (95% CI: 44.0% to 88.4%) and 35.6% (95% CI: 23.8% to 53.2%), respectively. Patients' self-assessment of prosthesis retention was rated at 82 (IQR 40 to 92.2) with low pain perception at 4.5 (IQR 0 to 30). Probing pocket depth levels were significantly reduced in patients adhering to a regular recall interval compared with those with longer intervals., Conclusions: Chairside Dalbo-Rotex retention elements are a straightforward chairside method for prosthesis retention that achieve good survival over medium-term follow-ups with high patient satisfaction. This technique is therefore a viable alternative to cast post copings and can be particularly valuable for patients with limited financial resources.

As patients in a dental or medical context, persons find themselves in a vulnerable, exceptional psychological and physical situation, in which the solution-oriented regulation of emotions requires mindful, systemic communication. This review describes typical placebo and nocebo effects in verbal, paraverbal and non-verbal communication and their impact on patients and their relationship with dental or medical professionals. In addition, a training curriculum for second-year undergraduate dental master’s students is described, that not only provides students with the necessary competences for solution-oriented systemic communication, but also enables them to experience its effectiveness in the clinical context.

While peri-implant mucositis relies solely on clinical parameters, radiological assessment becomes indispensable for diagnosing peri-implantitis. Intraoral radiography, with its simplicity of application, low radiation exposure, and adequate representation of peri-implant structures, stands out as the standard of care for both immediate and follow-up assessments. Standardization by custom-made radiologic splints allows for excellent comparability with previous images and allows for the determination of even small changes in contour and density of the peri-implant bone. Furthermore, other radiographic modalities like panoramic radiography and cone beam computed tomography (CBCT) may provide useful features for specific patients and clinical cases while also showing innate limitations. Beyond the assessment of the marginal peri-implant bone level as the crucial parameter of clinical relevance, radiologic assessment may reveal various other findings related to the prosthetic restoration itself, the precision of its fit to the implant, and the peri-implant soft and hard tissues. Since such findings can be crucial for the assessment of peri-implant health and the implants' prognosis, a systematic diagnostic evaluation pathway for a thorough assessment is recommended to extract all relevant information from radiologic imaging. This article also provides an overview of the clinical and chronological indications for different imaging modalities in peri-implant issues., (© 2024 The Author(s). Periodontology 2000 published by John Wiley & Sons Ltd.)

Statement of Problem: The high strength of zirconia makes the removal of zirconia restorations challenging and time consuming. Whether diamond rotary instruments marketed for removing zirconia restorations are more efficient is unclear., Purpose: The purpose of this in vitro study was to compare the efficiency of diamond rotary instruments specifically marketed to cut zirconia with the efficiency of a conventional diamond rotary instrument., Material and Methods: Two diamond rotary instruments marketed to cut zirconia (JOTA Zirkon Cut Z838L [JOT] and Intensiv ZirconCut Zr02/10 [IZC]) and a conventional diamond rotary instrument (Intensiv FG 334/6 [IFG]) were tested on 2 zirconia materials: 3Y-TZP (IPS ZirCAD LT) and a multilayered 4Y-TZP (IPS ZirCAD MT Multi). Zirconia specimens (2 mm) were cut under water cooling using a force of 2 N or 6 N. Cutting times and maximum temperatures at the tip of the diamond rotary instruments were recorded. The surface roughness before and after use was measured, and the elemental composition was analyzed., Results: Overall, cutting times were shorter for IFG (85 seconds) and IZC (100 seconds) than for the JOT (182 seconds). Cutting times were shorter for MT zirconia than for LT zirconia. Higher temperatures (2 N: 24.6 °C, 6 N: 36.7 °C) and lower surface roughness occurred with higher cutting loads. Impurities of diamond particles were seen for JOT. The diamond particle embedding materials were either nickel alloys (IFG and JOT) or a resin material (IZC)., Conclusions: Diamond rotary instruments marketed for cutting zirconia did not perform better or generate less heat compared with a conventional diamond rotary instrument. A load of 2 N with sufficient water cooling is recommended for cutting zirconia to avoid an extensive temperature increase., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: The composition of universal adhesives is highly diverse. The purpose of this in vitro study was to compare the shear bond strength of a composite with five different universal adhesives to human enamel and dentin., Materials and Methods: The shear bond strength of a composite (G-aenial Universal Injectable) to human enamel and dentin was tested in selective enamel etching mode before and after thermocyclic aging (10,000 cycles) using five different universal adhesive systems (Adhese Universal VivaPen, Clearfil Universal Bond Quick, G-Premio Bond, Prime&Bond active, and Scotchbond Universal Plus). Two-bottle systems (OptiBond FL and G2-Bond Universal) were used as control. Scanning electron microscopy was conducted of the bonding interface., Results: Significant differences in shear bond strength values were found among the five evaluated universal adhesives. Lowest shear bond strength values were observed for 2-hydroxyethylmethacrylate (HEMA)-free systems. Thermocyclic aging did not significantly reduce shear bond strength values indicating that the initial bond remains stable., Conclusions: The clinical use of universal adhesives Adhese Universal VivaPen, Clearfil Universal Bond Quick, and Scotchbond Universal Plus can be encouraged as they provided comparable or even better shear bond strength values than the two-bottle controls., Clinical Significance: Universal adhesives that were developed for the same indication and approved for clinical use demonstrated variety in shear bond strength values. When applied in the selective enamel etching mode, a stable bond can be expected from adhesives containing HEMA and monomers with phosphate groups., (© 2024 The Authors. Journal of Esthetic and Restorative Dentistry published by Wiley Periodicals LLC.)

Introduction: This study analysed whether the SAZAMED (Self-assessment for dentistry studies) manual test conducted as an exercise or examination in the first year of dental studies, and the official aptitude test for medical studies (EMS), can predict future performance of dental students., Materials and Methods: Students enrolled in the dental curriculum at the University of Basel between 2009/10 and 2019/20 were categorized: Group A conducted the SAZAMED in the third bachelor year (BA) and second master year (MA), group B practiced in the first and third BA and second MA and group C had to pass the test in the first BA with repetition in the third BA and second MA. SAZAMED comprised (i) wire bending, (ii) modelling sphere and cube, (iii) drawing mirror-inverted and (iv) indirect drawing over a mirror. Comparative variables were the EMS per cent rank and test scores in practical-clinical examinations in the third BA and the second MA., Results: Data were available from 329 students over the 10-year period. Repeaters and dropouts had poorer performance in the first BA SAZAMED than students who did not (p < 0.001). Among the four SAZAMED exercises, mirror-inverted drawing was the strongest predictor of future student performance. The official aptitude test EMS correlated with the third BA certificate (p = 0.012), but failed to predict repeaters and dropouts., Conclusion: Since academic success was associated with significantly better scores on the first BA SAZAMED, it is considered a predictor and recommended in addition to the official EMS to identify students in need of intervention programmes or who should choose a different field of study., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: To simulate the replacement of a premolar with an implant-supported cantilever fixed dental prosthesis (ICFDP) and how the fracture load is affected by implant type, positioning within the zirconia blank, and aging protocol., Materials and Methods: Seventy-two ICFDPs were designed either within the enamel- or dentin layer of a 4Y-PSZ blank for bone-level and tissue-level titanium-zirconium implants. Fracture load was obtained on the cantilever at baseline (no aging) or after aging in a chewing simulator with the load applied within the implant axis (axial aging) or on the cantilever (12 groups with n = 6). A three-way ANOVA was applied (α = .05)., Results: A three-way ANOVA revealed a significant effect on fracture load values of implant type (p = .006) and aging (p < .001) but not for the position within the zirconia blank (p = .847). Fracture load values significantly increased from baseline bone level (608 ± 118 N) and tissue level (880 ± 293 N) when the implants were aged axially, with higher values for tissue level (1065 ± 182 N) than bone level (797 ± 113 N) (p < .001). However, when the force was applied to the cantilever, fracture load values decreased significantly for tissue-level (493 ± 70 N), while values for bone-level implants remained stable (690 ± 135 N)., Conclusions: For ICFDPs, the use of bone-level implants is reasonable as catastrophic failures are likely to be restricted to the restoration, whereas with tissue-level implants, the transmucosal portion of the implant is susceptible to deformation, making repair more difficult., (© 2024 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Oral healthcare among the frail is an underestimated geriatric care element. While neglected oral health (OH) is a well-established risk factor for frailty, frailty can be a risk factor for subsequent OH problems. The cross-sectional investigation nested into the SAPALDIA sub-cohort of citizens aged 52 years and older, aims to stimulate longitudinal research into aspects that accelerate poor OH among frail individuals. The hypothesis investigated was that (pre-) frail individuals are more likely to have missing teeth replaced with removable dental prostheses (RDP) resulting in difficulties with chewing. The study included 1489 participants undergoing geriatric assessments and oral examination. The main predictor was frailty status (non-frail; pre-frail; frail), based on Fried's frailty phenotype. The main outcomes of interest were non-functional dentition (presence of ≤ 19 natural teeth), presence of any RDP and self-reported difficulties with chewing. Pre-frailty and frailty were not associated with the presence of ≤ 19 natural teeth, but were associated with a higher RDP prevalence. The presence of at least one complete denture (CD) had 1.71 fold and 2.54 folds higher odds among pre-frail and frail, respectively, compared to non-frail individuals. Frail individuals with CD reported chewing difficulties 7.8 times more often than non-frail individuals without CD. The results are in line with the hypothesis that (pre-) frail individuals may be more likely to have tooth loss restored by RDPs. Future longitudinal research needs to assess potential barriers to oral hygiene and fixed dental prostheses among (pre-) frail and to study their oral health-related quality of life., Competing Interests: The authors declare that they have no competing interests., (Copyright 2024 SWISS DENTAL JOURNAL SSO – Science and Clinical Topics. License: This work is licensed under a Creative Commons Attribution 4.0 International License.)

Objectives: Composition of implant material and its surface structure is decisive for oral biofilm accumulation. This study investigated biofilm formation on eight different materials., Materials and Methods: Eighteen healthy subjects wore intraoral splints fitted with two sets of eight materials for 24 h: zirconia [ZrO 2 ]; silver-gold-palladium [AgAuPd]; titanium zirconium [TiZr]; Pagalinor [PA]; hydroxyapatite [HA]; silver-platinum [AgPt]; titanium aluminum niobium [TAN]; titanium grade4 [TiGr4]. Total biomass was stained by safranin to assess plaque accumulation while conventional culturing (CFU) was conducted to investigate viable parts of the biofilm. Cell viability of human gingival fibroblasts (HGF-1) was assessed in vitro. Statistical evaluation was performed with linear mixed-effects models to compare materials (geometric mean ratios, 95% CI), with the level of significance set at ɑ = .05., Results: Less biofilm mass and CFU were found on noble metal alloys (AgPt, AgAuPd, and PA). Compared to AgPt, PA had 2.7-times higher biofilm mass value, AgAuPd was 3.9-times, TiGr4 was 4.1-times, TiZr was 5.9-times, TAN was 7.7-times, HA was 7.8-times, and ZrO 2 was 9.1-times higher (each p < .001). Similarly, CFU data were significantly lower on AgPt, AgAuPd had 4.1-times higher CFU values, PA was 8.9-times, TiGr4 was 11.2-times, HA was 12.5-times, TiZr was 13.3-times, TAN was 16.9-times, and ZrO 2 was 18.5-times higher (each p < .001). HGF-1 viability varied between 47 ± 24.5% (HA) and 94.4 ± 24.6% (PA)., Conclusion: Noble alloys are considered as beneficial materials for the transmucosal part of oral implants, as less biofilm mass, lower bacterial counts, and greater cell viability were detected than on titanium- or zirconia-based materials., (© 2023 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Objective: This article provides an overview of the implications of ChatGPT and other large language models (LLMs) for dental medicine., Overview: ChatGPT, a LLM trained on massive amounts of textual data, is adept at fulfilling various language-related tasks. Despite its impressive capabilities, ChatGPT has serious limitations, such as occasionally giving incorrect answers, producing nonsensical content, and presenting misinformation as fact. Dental practitioners, assistants, and hygienists are not likely to be significantly impacted by LLMs. However, LLMs could affect the work of administrative personnel and the provision of dental telemedicine. LLMs offer potential for clinical decision support, text summarization, efficient writing, and multilingual communication. As more people seek health information from LLMs, it is crucial to safeguard against inaccurate, outdated, and biased responses to health-related queries. LLMs pose challenges for patient data confidentiality and cybersecurity that must be tackled. In dental education, LLMs present fewer challenges than in other academic fields. LLMs can enhance academic writing fluency, but acceptable usage boundaries in science need to be established., Conclusions: While LLMs such as ChatGPT may have various useful applications in dental medicine, they come with risks of malicious use and serious limitations, including the potential for misinformation., Clinical Significance: Along with the potential benefits of using LLMs as an additional tool in dental medicine, it is crucial to carefully consider the limitations and potential risks inherent in such artificial intelligence technologies., (© 2023 The Authors. Journal of Esthetic and Restorative Dentistry published by Wiley Periodicals LLC.)

Objectives: Group-2 reviewed the scientific evidence in the field of «Technology». Focused research questions were: (1) additive versus subtractive manufacturing of implant restorations; (2) survival, complications, and esthetics comparing prefabricated versus customized abutments; and (3) survival of posterior implant-supported multi-unit fixed dental prostheses., Materials and Methods: Literature was systematically screened, and 67 publications could be critically reviewed following PRISMA guidelines, resulting in three systematic reviews. Consensus statements were presented to the plenary where after modification, those were accepted., Results: Additively fabricated implant restorations of zirconia and polymers were investigated for marginal/internal adaptation and mechanical properties without clear results in favor of one technology or material. Titanium base abutments for screw-retained implant single crowns compared to customized abutments did not show significant differences concerning 1-year survival. PFM, veneered and monolithic zirconia implant-supported multi-unit posterior fixed dental prostheses demonstrated similar high 3-year survival rates, whereas veneered restorations exhibited the highest annual ceramic fracture and chipping rates., Conclusions: For interim tooth-colored implant single crowns both additive and subtractive manufacturing are viable techniques. The clinical performance of additively produced restorations remains to be investigated. Implant single crowns on titanium base abutments show similar clinical performance compared to other type of abutments; however, long-term clinical data from RCTs are needed. The abutment selection should be considered already during the planning phase. Digital planning facilitates 3D visualization of the prosthetic design including abutment selection. In the posterior area, monolithic zirconia is recommended as the material of choice for multi-unit implant restorations to reduce technical complications., (© 2023 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Purpose: The aim of this review was to evaluate the survival rates of restorations utilizing titanium base abutments (TBA) for restoring single-unit implant prostheses., Materials and Methods: This review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The focus question was: In patients who require the restoration of a single dental implant utilizing a titanium base abutment, what are the determining factors and outcomes relating to implant prosthesis prognosis and survival? A comprehensive search of databases (PubMed, EMBASE, and Cochrane Library) was conducted on 16 April 2023 and updated on 5 May 2023. Randomized clinical trials (RCT), retrospective studies and prospective studies, reporting on the use of TBA for single implant prostheses, were reviewed. A Cochrane collaboration risk of bias assessment analysis was performed for randomized clinical studies, and the Newcastle-Ottawa Scale tool was applied for non-randomized studies. A meta-analysis was performed on clinical trials reporting on survival rates of both TBA and other abutments. Other clinical studies, reporting on TBA only, were included for descriptive statistics., Results: The search provided 1159 titles after duplicates were removed. Six RCTs were included to perform a meta-analysis and compare the survival of the TBA to other abutments [OR 0.74; 95% CI: 0.21-2.63, heterogeneity; I 2 0%; p = .99]. Twenty-three prospective and retrospective studies fulfilled the criteria and were included in the meta-analysis after 12 months of function. A total of 857 single implant-supported prostheses fabricated with a TBA were included. TBA abutments have an estimate 98.6% survival rate after 1 year in function (95% CI: 97.9%-99.4%). The mean follow-up period was 31.2 ± 16.9 months., Conclusions: Single implant prosthesis restored with titanium base abutments showed favourable short-term survival rates., (© 2023 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Digital applications have changed therapy in prosthodontics. In 2017, a systematic review reported on complete digital workflows for treatment with tooth-borne or implant-supported fixed dental prostheses (FDPs). Here, we aim to update this work and summarize the recent scientific literature reporting complete digital workflows and to deduce clinical recommendations. A systematic search of PubMed/Embase using PICO criteria was performed. English-language literature consistent with the original review published between 16 September 2016 and 31 October 2022 was considered. Of the 394 titles retrieved by the search, 42 abstracts were identified, and subsequently, 16 studies were included for data extraction. A total of 440 patients with 658 restorations were analyzed. Almost two-thirds of the studies focused on implant therapy. Time efficiency was the most often defined outcome ( n = 12/75%), followed by precision ( n = 11/69%) and patient satisfaction ( n = 5/31%). Though the amount of clinical research on digital workflows has increased within recent years, the absolute number of published trials remains low, particularly for multi-unit restorations. Current clinical evidence supports the use of complete digital workflows in implant therapy with monolithic crowns in posterior sites. Digitally fabricated implant-supported crowns can be considered at least comparable to conventional and hybrid workflows in terms of time efficiency, production costs, precision, and patient satisfaction.

Purpose: This double-blind randomized controlled trial analyzed patient-reported outcome measures in terms of subjective patient satisfaction compared to objective dental evaluation of prosthetic treatment with 3-unit monolithic zirconium dioxide implant fixed dental prostheses (iFDPs) in 3 digital workflows., Material and Methods: Twenty patients were restored with 3 iFDPs each on Straumann TL-implants with 2 completely digital workflows using different intraoral optical scanning systems with model-free fabrication of the restoration (Trios 3/3Shape [Test-1]; Virtuo Vivo/Straumann [Test-2]), and mixed analog-digital workflow with conventional impressions and digitized gypsum casts (Impregum/3M Espe [Control]). The order of impression-taking and the prosthetic try-in were randomly allocated. Sixty iFDPs were compared for patient satisfaction and dental evaluation using ANOVA., Results: For iFDP evaluation, patients generally provided more favorable ratings than dental experts, regardless of the workflow. ANOVA revealed no significant difference for overall satisfaction when comparing Test-1, Test-2, or Control, either for patients (f-ratio: 0.13; p = 0.876) or dentist (f-ratio: 1.55: p = 0.221). Secondary, patients clearly favored the digital impression workflows over the conventional approach (f-ratio: 14.57; p < 0.001). Overall, the 3Shape workflow (Test-1) received the highest scores for all analyses., Conclusions: The different digital workflows demonstrated minor influence on the subjective and objective evaluation of the monolithic zirconium dioxide iFDPs in nonesthetic regions; however, the dentist may significantly increase patient satisfaction by choosing intraoral scanning instead of conventional impressions. The dentist has to consider individual patients' needs to fulfill their expectations for a personalized solution., (© 2022 The Authors. Journal of Prosthodontics published by Wiley Periodicals LLC on behalf of American College of Prosthodontists.)

Introduction: This prospective cohort study investigated the potential of digital assessment using intraoral scanning (IOS) combined with software analysis (prepCheck) to evaluate the outcome of repetitive tooth preparation and its influence on the acquisition of motor skills in dental students., Materials and Methods: Twenty-six students completed 177 full-crown preparations of the same tooth in six practice sessions followed by a final examination. Preparations were assessed digitally using prepCheck and conventionally by calibrated faculty instructors. In addition, students assessed their own performance and this was compared with the instructors' assessments., Results: Conventional assessment showed that students preparations improved over time, with 43.5% of students receiving score 2 (highest grade) at the fifth practice session. With the prepCheck assessment, statistically significant improvements indicated by an enlarged area within the tolerance range set at 0.2 mm were found between the first and the second practice session (7.5% improvement; 95% CI: 2.2%, 12.7%, p = 0.006), and between the first run and the final exam preparation (6.7%; 95% CI: 1.7%, 12.5%, p = 0.011). Agreement between instructor/student assessments was best immediately after students received visual feedback using prepCheck (76% agreement; Spearman's rho 0.78)., Conclusion: These data indicate that IOS technology was useful for student's self-evaluation by visual feedback., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To evaluate differences in the cellular expression of epigenetic markers and oxidative stress in periodontitis lesions between current smokers and non-smokers., Background: Tobacco smoking is recognized as one of the major risk factors for periodontitis. However, the mechanisms by which smoking affects the progression of the disease remain to be determined., Methods: Twenty-five current smokers and 21 non-smokers with generalized severe periodontitis were included. From each patient, one soft tissue biopsy from a periodontitis site was harvested and prepared for histological analysis. The infiltrated connective tissue (ICT) was selected as the region of interest to assess the cellular expression of epigenetic markers and reactive oxygen/nitrogen species (RONS) by immunohistochemistry., Results: Although the ICT of smokers and non-smokers did not differ in size or in the expression of markers for DNA damage or oxidative stress, current smokers presented with significantly lower area proportions and densities of cells positive for the epigenetic markers DNMT1 and AcH3. In addition, periodontitis lesions in current smokers presented with a diminished antimicrobial activity, as indicated by significantly lower densities and area proportions of NOX2- and iNOS-positive cells., Conclusions: Components of the host response and epigenetic mechanisms in periodontitis lesions in smokers are downregulated as opposed to lesions of non-smokers., (© 2022 The Authors. Journal of Periodontal Research published by John Wiley & Sons Ltd.)

Objective: The purpose of this study is to compare the bonding performance and mechanical properties of two different resin composite cements using simplified adhesive bonding strategies., Materials and Methods: Shear bond strength of two resin composite cements (an adhesive cement: Panavia V5 [PV5] and a self-adhesive cement: RelyX Universal [RUV]) to human enamel, dentin, and a variety of restorative materials (microfilled composite, composite, polymer-infiltrated ceramic, feldspar ceramic, lithium disilicate and zirconia) was measured. Thermocycle aging was performed with selected material combinations., Results: For both cements, the highest shear bond strength to dentin was achieved when using a primer (PV5: 18.0 ± 4.2 MPa, RUV: 18.2 ± 3.3 MPa). Additional etching of dentin reduced bond strength for RUV (12.5 ± 4.9 MPa). On enamel, PV5 achieved the highest bond strength when the primer was used (18.0 ± 3.1 MPa), while for RUV etching of enamel and priming provided best results (21.2 ± 6.6 MPa). Shear bond strength of RUV to restorative materials was superior to PV5. Bonding to resin-based materials was predominantly observed for RUV., Conclusions: While use of RUV with the selective-etch technique is slightly more labor intensive than PV5, RUV (with its universal primer) displayed a high-bonding potential to all tested restorative materials, especially to resin., Clinical Significance: For a strong adhesion to the tooth substrate, PV5 (with its tooth primer) is to be preferred because etching with phosphoric acid is not required. However, when using a wide range of varying restorative materials, RUV with its universal primer seems to be an adequate option., (© 2022 The Authors. Journal of Esthetic and Restorative Dentistry published by Wiley Periodicals LLC.)

Background: Human gingival fibroblast (HGF-1) cells in the connective tissue provide an effective barrier between the alveolar bone and the oral environment. Cement margins of restorations with intrasulcular preparation or cemented implant restorations are in contact with HGF cells. However, it is unknown to what extend the cement surface finish affects the behavior of HGF cells. The purpose of this study was to compare the behavior of HGF-1 cells in contact with two different resin composite cements with three different surface treatments after light-curing and autopolymerization, respectively., Methods: Disks of one adhesive (Multilink Automix, Ivoclar Vivadent [MLA]) and one self-adhesive (RelyX Unicem 2 Automix, 3 M [RUN]) resin composite cement were either light-cured or autopolymerized. Specimen surfaces were prepared with the oxygen inhibition layer intact, polished with P2500-grit silicon carbide paper or treated with a scaler. Cells were cultivated on the specimens for 24 h. Viability assay was performed, and cell morphology was examined with scanning electron microscopy. Additionally, roughness parameters of the specimen were analyzed with a 3D laser scanning microscope. Three-way ANOVA was applied to determine the effect of cement material, curing mode and surface treatment (a = 0.05)., Results: Overall, cement material (p = 0.031), curing mode (p = 0.001), and surface treatment (p < 0.001) significantly affected relative cell viability of HGF. The autopolymerized specimen with the oxygen inhibition layer left intact displayed the lowest relative cell viability (MLA 25.7%, RUN 46.6%). Removal of the oxygen inhibition layer with a scaler increased cell viability but also resulted in higher surface roughness values., Conclusions: HGF cell viability is affected by the surface treatment and the curing mode. The oxygen inhibition layer is an inhibitory factor for the viability of HGF cells. Autopolymerization enhances the cytotoxic potential of the oxygen inhibition layer., (© 2022. The Author(s).)

Objectives: The increasing collection of health data coupled with continuous IT advances have enabled precision medicine with personalized workflows. Traditionally, dentistry has lagged behind general medicine in the integration of new technologies: So what is the status quo of precision dentistry? The primary focus of this review is to provide a current overview of personalized workflows in the discipline of reconstructive dentistry (prosthodontics) and to highlight the disruptive potential of novel technologies for dentistry; the possible impact on society is also critically discussed., Material and Methods: Narrative literature review., Results: Narrative literature review., Conclusions: In the near future, artificial intelligence (AI) will increase diagnostic accuracy, simplify treatment planning, and thus contribute to the development of personalized reconstructive workflows by analyzing e-health data to promote decision-making on an individual patient basis. Dental education will also benefit from AI systems for personalized curricula considering the individual students' skills. Augmented reality (AR) will facilitate communication with patients and improve clinical workflows through the use of visually guided protocols. Tele-dentistry will enable opportunities for remote contact among dental professionals and facilitate remote patient consultations and post-treatment follow-up using digital devices. Finally, a personalized digital dental passport encoded using blockchain technology could enable prosthetic rehabilitation using 3D-printed dental biomaterials., Clinical Significance: Overall, AI can be seen as the door-opener and driving force for the evolution from evidence-based prosthodontics to personalized reconstructive dentistry encompassing a synoptic approach with prosthetic and implant workflows. Nevertheless, ethical concerns need to be solved and international guidelines for data management and computing power must be established prior to a widespread routine implementation., (© 2022. The Author(s).)

Objective: To evaluate the efficacy of tooth splinting (TS) and occlusal adjustment (OA) compared to no TS or OA in patients with periodontitis exhibiting masticatory dysfunction., Material: The primary outcome criterion was tooth loss (TL), and the secondary outcome parameters were change in probing pocket depth (PPD), change in clinical attachment level (CAL), tooth mobility (TM), and patient-reported outcome measures (PROMs). Literature search was performed on three electronic databases (from 01/1965 to 04/2021) and focused on clinical studies with at least 12 months follow-up., Results: From a total of 1515 publications, 51 articles were identified for full-text reading, of which 2 retrospective case series on TS with low risk of bias and 1 randomized and 2 prospective studies on OA with unclear risk of bias were included. For TS, synthesis of data showed that in 72 patients, 26 out of 311 teeth (weighted mean incidence of TL 8.4%) and 156 out of 1541 teeth with no TS (weighted mean incidence of TL 10.1%) were lost over 2 years following non-surgical periodontal therapy. The randomized controlled clinical trial (RCT) indicated CAL gain for teeth with OA compared to no OA. For the effect of OA on TL, PPD, and TM, heterogeneous data were retrieved from the included studies., Conclusions: Within the limitations of this review and based on a low level of evidence, it is concluded that TS does not improve survival of mobile teeth in patients with advanced periodontitis. OA on teeth with mobility and/or premature contacts may lead to improved CAL, while the effect of OA on the remaining periodontal parameters remains unclear., (© 2021 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Background: The objective was to determine the optimal connector size and position within zirconia disks for implant-supported cantilever fixed dental prostheses (ICFDP)., Methods: Two-unit ICFDPs ( n = 60) were designed for the premolar region with connector sizes of either 9 or 12 mm 2 and positioned in the enamel or dentin layer of two different types of zirconia disks. The restorations were milled and cemented onto zirconia implants. After simulated chewing for 1.2 Mio cycles, the fracture load was measured and fractures were analyzed., Results: No fractures of ICFDPs or along the implants were detected after simulated aging. The mean fracture load values were significantly higher for a connector size of 9 mm 2 (951 N) compared with 12 mm 2 (638 N). For the zirconia material with a higher biaxial flexural strength, the fracture load values were increased from 751 to 838 N, but more implant fractures occurred. The position within the zirconia disk did not influence the fracture load., Conclusions: A connector size of 9 mm 2 and a zirconia material with a lower strength should be considered when designing ICFDPS on zirconia implants to reduce the risk of fractures along the intraosseous implant portion.

Objective: The aim of this study was to evaluate functional and esthetic clinical outcomes and patient satisfaction with narrow-diameter implants in comparison to standard-diameter implants in the anterior zone of the maxilla in a follow-up examination after 1 to 6 years., Method and Materials: The study was designed as a retrospective cohort study investigation including 27 patients receiving a 3.3-mm diameter single implant (NDI, n = 14) or a standard-diameter 4.1-mm single implant in the anterior zone of the maxilla (SDI, n = 16). Descriptive and analytical statistics were performed comparing both groups with regard to clinical examination including esthetic outcome, sulcus fluid flow-rate, crown esthetics, patients' satisfaction on visual analog scales, occurrence of biologic or technical complication, probing pocket depths (Fisher exact test), pink esthetic score (PES) and Periotest (Mann-Whitney U test). The level of significance was set at α = .05., Results: The mean observation period was 4.8 years after crown insertion in the NDI group, and 4.9 years in the SDI group. Significant differences were observed for Periotest values in favor of the 4.1-mm implants (P = .014). No differences were found with regards to esthetics (PES; P = .27) or sulcus fluid flow-rate (P = 0.73) and probing pocket depths (P = .35). Overall patient satisfaction was high for both groups with visual analog scale scores of 9.3 ± 1.1 for NDI and 9.4 ± 1.0 for SDI (P = .39)., Conclusion: Clinical outcome with narrow-diameter implants was comparable to standard-diameter implants in the anterior zone of the maxilla with similar esthetic assessments and patients' satisfaction.

This case series retrospectively investigated the one-year surgical outcome of regenerative peri-implantitis therapy using a hydroxyapatite (HA) bone substitute material in combination with enamel matrix derivate (EMD) and collagen membrane for guided bone regeneration (GBR). Data-sheets of patients were screened to detect patients who received identical regenerative peri implantitis-therapy with surface decontamination and GBR applying HA, EMD and a collagen membrane under broad- spectrum antibiotic regime. For inclusion, information on pre- and postoperative clinical and radiographic parameters (probing pocket depth (PPD), bleeding on probing (BOP), suppuration (SUPP) and the radiological bone level (RBL)) had to be available for statistical analysis. Data of a total of 11 patients (20 implants) were extracted out of 202 (336). All implants were still in function after one year. Bone defects decreased by an average of 1.3 mm mesially and 0.9 mm distally, respectively. Mean PPD was reduced from 4.9 mm to 2.7 mm. BOP decreased from 90% to 20%. Suppuration decreased from 65% to 0%. Based on the success criteria applied, 15 of the 20 (75%) implants included were considered as successfully treated after 1 year. Regenerative peri-implantitis therapy according to the presented concept showed promising clinical and radiographic outcomes after one year. To estimate the beneficial effects of the combined use of HA, EMD and collagen membranes, further long term investigations with a control group are needed.

Purpose: The aim of this in vitro study was to investigate the accuracy (trueness and precision) of five intraoral scanners (IOS) using a novel reference model for standardized performance evaluation., Materials and Methods: Five IOSs (Medit i500, Omnicam, Primescan, Trios 3, Trios 4) were used to digitize the reference model, which represented a simplified full-arch situation with four abutment teeth. Each IOS was used five times by an experienced operator, resulting in 25 STL (Standard Tessellation Language) files. STL data were imported into 3D software (Final Surface ® ) and examined for inter- and intra-group analyses. Deviations in the parameter matching error were calculated. ANOVA F-test and Kruskal-Wallis test were applied for inter-group comparisons (α = .05); and the coefficient of variation (CV) was calculated for intra-group comparisons (in % ± SD)., Results: Primescan (matching error value: 0.015), Trios 3 (0.016), and Trios 4 (0.018) revealed comparable results with significantly higher accuracy compared to Medit i500 (0.035) and Omnicam (0.028) ( P < .001). For intra-group comparison, Trios 4 demonstrated the most homogenous results (CV 15.8%)., Conclusion: The novel reference model investigated in this study can be used to assess the performance of dental scanning technologies in the daily routine setting and in research settings., (© 2022 The Korean Academy of Prosthodontics.)

Objectives: To determine whether the surface treatment of zirconia affects biofilm formation in an in vitro three-species biofilm model and in situ., Material and Methods: Zirconia surfaces considered for the transmucosal portion of a zirconia implant were compared with polished pure titanium grade 4 (Tp). Disks 13 mm in diameter of either polished (Zp), polished and heat-treated (Zpt), machined (Zm), machined and heat-treated (Zmt) and sandblasted, etched and heat-treated (Z14) zirconia were fabricated. Surface roughness and wettability of specimens was measured. Biofilm formation was evaluated by safranin staining and scanning electron microscopy (SEM) using a three-species model, and intraorally with 16 volunteers carrying oral splints in two independent experiments. Relative biofilm formation was compared with Kruskal-Wallis followed by Bonferroni post hoc test (α = 0.05)., Results: In vitro biofilm formation with optical density values on Zp (0.14 ± 0.01), Zpt (0.14 ± 0.02), Zm (0.13 ± 0.01) and Zmt (0.13 ± 0.01) was significantly lower than on Tp (0.21 ± 0.05) and Z14 (0.20 ± 0.04) (p < .05). In situ biofilm formation was significantly higher on Z14 (0.56 ± 0.45) (p < .05), while no significant differences in optical density were observed among Zp (0.25 ± 0.20), Zm (0.36 ± 0.34) and Tp (0.28 ± 0.22). SEM analysis supported quantitative findings., Conclusions: In the in vitro, three-species biofilm model differences in material and surface roughness affected biofilm formation. In situ biofilm formation was mainly affected by the surface roughness of the specimens. Polishing of zirconia is recommended to reduce biofilm formation, while heat treatment has no significant effect., (© 2022 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Objectives: This laboratory study aimed to assess the effects of ultrasonic instrumentation, simulating 10 years of supportive periodontal therapy (SPT), on single-unit crowns., Materials and Methods: Standardized crowns were fabricated from porcelain-fused-to-metal (PFM) (n = 12), zirconia (ZrO 2 ) (n = 12), lithium disilicate (LDS) (n = 12), feldspar ceramic (FSFC) (n = 6), and polymer-infiltrated ceramic network material (PICN) (n = 6). The crowns, luted on PICN abutments with resin-based luting material (RBLM), and if applicable glass ionomer cement (GILC), underwent thermal cycling and trimonthly ultrasonic instrumentation. After 1 and 10 years of simulated SPT, restoration quality assessments were performed, comprising profilometric surface roughness measurements, marginal integrity evaluations, and scores for luting material remnants and visible cracks. The statistical analysis included multiple logistic regressions with nested designs (α = 0.05)., Results: During simulated SPT, bulk fractures (n = 2) and a de-cementation failure (n = 1) of LDS and ZrO 2 crowns were observed. No significant change in roughness was detected after 10 years (p = 0.078). Over time, marginal defects increased (p = 0.010), with PFM crowns showing the highest rate of chippings at sites with a narrow shoulder. Fewer marginal defects were detectable on crowns luted with RBLM compared with GILC (p = 0.005). Luting material remnants decreased during SPT (p < 0.001). Ultrasonic instrumentation caused cracks in most crown materials, in particular at sites with a narrow shoulder and in PFM crowns., Conclusions: Repeated ultrasonic instrumentation may damage single-unit crowns. PFM crowns with a narrow, all-ceramic margin are especially prone to defects., Clinical Relevance: Frequent ultrasonic instrumentation of restoration margins of fixed dental prostheses, PFM crowns in particular, ought to be avoided., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: The aim was to evaluate the performance of implants placed with simultaneous guided bone regeneration (GBR) using resorbable or nonresorbable membranes compared to implants placed in pristine bone without bone regeneration after an observation period of 22-24 years., Material and Methods: The patient cohort of this clinical trial was treated from 1994 to 1996. Dehiscence defects were treated with GBR by either using resorbable collagen membranes (BG) or nonresorbable ePTFE membranes (GT). Implants placed in pristine bone served as a control (CT). Clinical parameters, marginal bone levels, and technical outcomes were evaluated following restoration placement and at the present follow-up. A 3D radiographic analysis was conducted in order to assess buccal and oral bone dimensions. Implant survival was assessed with Kaplan-Meier analysis and a frailty model (level of significance 5%)., Results: Out of the originally 72 patients (mean age 75.4 ± 15.70 years) with 265 implants, 39 patients with 147 implants were included in the study after a median period of 23.5 years. Implant survival was 89.3% in group BG (n = 100), 90.2% in group GT (n = 37), and 93.8% in group CT (n = 105), without significant differences (Frailty proportional hazard model p = .79). Smoking had a negative effect on survival (p = .0122). Mean vertical marginal bone levels were -2.3 ± 1.4 mm (BG, n = 59), -3.0 ± 1.5 mm (GT, n = 21), and -2.3 ± 1.6 mm (CT, n = 52). The vertical buccal bone levels were -3.0 ± 1.9 mm (BG, n = 57), -3.5 ± 2.2 mm (GT, n = 21), and -2.6 ± 1.8 mm (CT, n = 49), without significant differences., Conclusion: Implant placement with GBR procedures provides treatment outcomes with favorable implant survival rates (89.3%-93.8%) after 23.5 years. Smoking, however, affected implant survival negatively., (© 2021 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

(1) Background: The rapid pace of digital development in everyday life is also reflected in dentistry, including the emergence of the first systems based on artificial intelligence (AI). This systematic review focused on the recent scientific literature and provides an overview of the application of AI in the dental discipline of prosthodontics. (2) Method: According to a modified PICO-strategy, an electronic (MEDLINE, EMBASE, CENTRAL) and manual search up to 30 June 2021 was carried out for the literature published in the last five years reporting the use of AI in the field of prosthodontics. (3) Results: 560 titles were screened, of which 30 abstracts and 16 full texts were selected for further review. Seven studies met the inclusion criteria and were analyzed. Most of the identified studies reported the training and application of an AI system ( n = 6) or explored the function of an intrinsic AI system in a CAD software ( n = 1). (4) Conclusions: While the number of included studies reporting the use of AI was relatively low, the summary of the obtained findings by the included studies represents the latest AI developments in prosthodontics demonstrating its application for automated diagnostics, as a predictive measure, and as a classification or identification tool. In the future, AI technologies will likely be used for collecting, processing, and organizing patient-related datasets to provide patient-centered, individualized dental treatment.

Objectives: This study aimed to assess whether the emergency service of a major Swiss dental institution faced different demands (patient volume, treatment needs, dental care characteristics) during a lockdown, issued to mitigate the COVID-19 pandemic, compared with the weeks before and after., Materials and Methods: Data of patients receiving urgent care at a university center for dental medicine (Basel, Switzerland) during the 6-week lockdown, pre-lockdown, and post-lockdown periods were retrospectively evaluated. Statistical analysis involved tests for equal proportions and logistic regression models. The level of significance was set at α=0.05., Results: The study comprised 3109 dental emergency visits in the period from February 2 to June 5, 2020. Daily caseloads increased during lockdown. Abscesses, orthodontic emergencies, and surgical follow-ups were more common during lockdown, whereas the number of dento-alveolar injuries declined (≤0.048). Urgent dental care provision involved intraoral radiographs more frequently in the pre-lockdown period compared with the following weeks (p<0.001). Among all treatments, aerosol-generating procedures dropped from 56.1% (pre-lockdown) to 21.3% during lockdown (p<0.001), while teledentistry follow-ups became more frequent (p<0.001). Patients with comorbidities sought urgent dental care less frequently during the post-lockdown period (p=0.004)., Conclusions: The lockdown significantly impacted the dental emergency service in terms of patients' diagnoses, treatment needs, and the characteristics of the urgent care that was delivered., Clinical Relevance: Access to essential dental care must be monitored and safeguarded throughout the COVID-19 pandemic and beyond as deferred care entails risks for serious sequelae and persons with comorbidities may change their dental care-seeking behavior., (© 2021. The Author(s).)

Objectives: This double-blinded randomized controlled trial investigated economic performance indicators (EPI) in terms of time-efficiency and production costs of 3-unit monolithic zirconium-dioxide (ZrO2) implant fixed dental prostheses (iFDP) in three different workflows., Methods: Twenty patients with two Straumann Tissue-Level-Implants received three iFDPs; two were fabricated in proprietary complete digital workflows with intraoral optical scanning and model-free fabrication with company-related CAD/CAM lab-software while one iFDP was manufactured on digitized casts from conventional impressions. The sequence of impression-taking for the three workflows (TRIOS 3/3Shape [Test-1]; Virtuo Vivo/Dental Wings [Test-2]; Impregum/3M Espe [Control]) was randomly allocated. Sixty iFDPs bonded to ti-base abutments were analyzed. Clinical and technical worksteps for Test-1/Test-2/Control were recorded and evaluated for time-efficiency including cost-analysis (CHF=Swiss Francs) using ANOVA-Tests (significance level α=0.05)., Results: Mean total work time, as the sum of clinical plus technical steps, was 97.5 min (SD ± 23.6) for Test-1, 193.1 min (SD ± 25.2) for Test-2, and 172.6 min (SD ± 27.4) for Control. Times were significantly different between Test-1/Test-2 (p < 0.00001), Test-1/Control (p < 0.00001), and Test-2/Control (p < 0.03610). Technical costs were 566 CHF (SD ± 49.3) for Test-1, 711 CHF (SD ± 78.8) for Test-2, 812 CHF (SD ± 89.6) for Control, and were also significantly different for all comparisons (p < 0.00001)., Conclusions: Test-1 demonstrated the best performance for time-efficiency, Test-2 revealed the worst result. This indicates that digital workflows are not the same and not necessarily superior to analog workflows of monolithic ZrO2 iFDPs. Complexity decreases by reducing the number of steps following complete digital workflows, resulting in lower production costs compared to the mixed analog-digital workflow with conventional impressions., Clinical Significance: Complete digital workflows comprising intraoral optical scanning without physical models for treatment with monolithic ZrO2 iFDPs is an efficient alternative to mixed analog-digital workflows with conventional impressions and labside digitization of dental casts., (Copyright © 2021. Published by Elsevier Ltd.)

Introduction: Dental healthcare workers are exposed to various infectious agents that may present an occupational risk. Although vaccinations rank among the most cost-effective health measures, vaccine hesitancy is present among healthcare workers., Methods: A structured anonymous questionnaire was completed by 1111 dental healthcare workers - dentists, dental hygienists, prophylaxis assistants, dental assistants, dental technicians, and dental students. Demographic data and immunisation status, either by vaccination or by immunity after disease, were collected. Additionally, employers and employees were asked about their current workplace vaccination policy, including questions about information provided on the risk of hepatitis B (HBV) infection, whether HBV vaccination was compulsory and who paid for compulsory vaccinations., Results: The overall response rate was 55.7%. Approximately half of the participants were dentists; only 17 technicians completed the questionnaire. The most common immunisation was for HBV (94.7% of participants). Only 19.2% of participants reported immunisation against human papillomavirus. Uncertainty over immunisation status was highest for Haemophilus influenzae type B (46.7%). Only a minority of participants (17.4%) received a yearly vaccination against seasonal influenza, whereas two-thirds never get vaccinated. The participants' level of awareness related to the seven general vaccinations (HBV, influenza, measles, mumps, rubella, varicella, and tetanus) was medium to high, whereas their level of awareness related to vaccinations against HBV and influenza was medium. Half of the employees stated that they were informed about the risk of HBV at their current workplace and over three-quarters of employers indicated that they provided such information to their employees. Compulsory HBV vaccination was implemented at approximately half of the dental practices., Conclusion: The Swiss dental healthcare workers participating in this study had a medium level of awareness towards vaccinations. Almost all participants were vaccinated against HBV, but they were particularly hesitant about the seasonal influenza vaccination. As a considerable number of participants was unaware of their immunisation status, more comprehensive information on infectious diseases, vaccination and prevention is essential.

Purpose: The aim of this retrospective cohort study was to investigate the long-term outcome of metal- and all-ceramic resin-bonded fixed dental prosthesis (RBFDP) up to 17 years, and to evaluate potential factors influencing the risk for complications., Methods: Patients who were treated with RBFDP to replace teeth in the anterior or first premolar region in an university setting were identified from electronic records. Data collection comprised dental and periodontal parameters, periapical radiographs, and assessment of the RBFDP. Patient-reported satisfaction was evaluated on visual analog scales (VAS), and 5-year cumulative survival and success rates were calculated. Cox regression models were used to compare metal- versus all-ceramic RBFDPs., Results: Seventy-one patients with RBFDP replacing 65 anterior teeth and 6 premolars were included with a mean observation period of 56.1 (±42.7) months. RBFDP cumulative survival rate was 86.7% and cumulative success rate 71.7% after 5 years, with no significant difference between metal-and all-ceramic RBFDPs. The risk for RBFDP failure was significantly higher with more than one pontic (OR 6.1; p=0.033), or negative pulp vitality testing of abutments (OR 7.3; p=0.042), while complications tended to be increased with two-wings compared to one-wing RBFDP (OR 5.4; p=0.054)., Conclusions: Metal- and all-ceramic RBFDPs facilitated good long-term results, particularly with one-wing, one-cantilever, and vital abutment teeth.

This double-blind randomized controlled trial with a crossover design analyzed the technical and clinical performance of three-unit monolithic ZrO 2 implant-fixed dental prostheses (iFDPs), prepared using two complete digital workflows (Test-1, Test-2) and one mixed analog-digital workflow (Control). Each of the 20 study patients received three iFDPs, resulting in 60 restorations for analysis. The quality of the restorations was assessed by analyzing laboratory cross-mounting and calculating the chairside adjustment time required during fitting. All iFDPs could be produced successfully with all three workflows. The highest cross-mounting success rate was observed for the original pairing iFDP/model of the Control group. Overall, 60% of iFDPs prepared with Test-1 workflow did not require chairside adjustment compared with 50% for Test-2 and 30% for Controls. The mean total chairside adjustment time, as the sum of interproximal, pontic, and occlusal corrections was 2.59 ± 2.51 min (Control), 2.88 ± 2.86 min (Test-1), and 3.87 ± 3.02 min (Test-2). All tested workflows were feasible for treatment with iFDPs in posterior sites on a soft tissue level type implant system. For clinical routine, it has to be considered that chairside adjustments may be necessary, at least in every second patient, independent on the workflow used.

Dentistry is a technically oriented profession, and the health care sector is significantly influenced by the ubiquitous trend of digitalization. Some of these digital developments have the potential to result in disruptive changes for dental practice, while others may turn out to be just a pipedream. This Discovery! essay focuses on innovations built on artificial intelligence (AI) as the center-technology influencing 1) dental eHealth data management, 2) clinical and technical health care applications, and 3) services and operations. AI systems enable personalized dental medicine workflows by analyzing all eHealth data gathered from an individual patient. Besides dental-specific data, this also includes genomic, proteomic, and metabolomic information and therefore facilitates optimized and personalized treatment strategies and risk management. Based on the power of AI, the triangular frame of "data"/"health care"/"service" is supplemented by technological advancements in the field of social media, Internet of things, augmented and virtual reality, rapid prototyping, and intraoral optical scanning as well as teledentistry. Innovation continues to be critical to tackle dental problems until its routine implementation based on sound scientific evidence. Novel technologies must be viewed critically in relation to the cost-benefit ratio and the ethical implications of a misleading diagnosis or treatment produced by AI algorithms. Highly sensitive eHealth data must be handled responsibly to enable the immense benefits of these technologies to be realized for society. The focus on patient-centered research and the development of personalized dental medicine have the potential to improve individual and public health, as well as clarify the interconnectivity of disease in a more cost-effective way.

Purpose: The aim of this in vitro study was to evaluate the temperature development of a novel, electropolished drill design during conventional and guided implant osteotomy in comparison to conventional drills under standardized conditions., Materials and Methods: Single and sequential 12-mm-deep drilling protocols (guided and unguided) with a conventional (control groups) and novel drill (test groups) were performed in artificial bone blocks under external irrigation. Each drilling protocol was repeated 30 times with drill diameters of 2.2, 2.8, 3.5, and 4.2 mm. Temperature changes were recorded by an infrared camera, and the accumulated thermal energy was calculated. For group comparison, a one-way analysis of variance (ANOVA) and Tukey post hoc test were used with a level of significance set to = .05., Results: The highest temperatures were measured up to 77.9°C for small-diameter drills in the control and test groups. The 3.5-mm and 4.2-mm novel drills showed significantly lower heat generation during guided and unguided osteotomy preparation for single and sequential drilling. The accumulated thermal energy during guided osteotomy preparation was significantly lower with the electropolished drills., Conclusion: The drill design has an important impact on heat development during osteotomy, which was most pronounced for guided osteotomy with conventional drills and for small-diameter osteotomies.

The aim of the present study was to gain a better understanding of the significance, use and prevalence of digital as well as analog learning and teaching aids within dentistry studies at the University Center of Dental Medicine Basel (UZB) regarding sociodemographic aspects. A questionnaire was distributed among the three upper years of dental students at the UZB in the autumn semester before the corona pandemic. The results showed that all students use digital devices. The most often used devices in connection with academic studies were portable devices such as laptops or smartphones. It is to mention that students younger than 25 years used smartphones more often as learning aids than their older classmates. The devices were used on average 57 % of the total daily use time for study purposes, whereas private usage time decreased with age and progression of studies. In order to acquire theoretical knowledge, analog and digital formats were equally important. Digital learning aids were mainly used as digitalized lecture notes or for internet research. Advantages were especially seen in timesaving and organizational aspects. The analog learning aids were appreciated for their better learning and less tiring effect. The high prevalence and usage of mobile internet connectable devices as well as the high availability of the internet may indicate a tendency toward mobile learning.