Search

In evidence-based health care, randomized clinical trials provide the most accurate and reliable information on the effectiveness of an intervention. This project aimed to develop reporting guidelines, exclusively for randomized clinical trials in the dental specialty of Endodontology, using a well-documented, validated consensus-based methodology. The guidelines have been named Preferred Reporting Items for RAndomized Trials in Endodontics (PRIRATE) 2020. A total of eight individuals (PD, VN, HD, LB, TK, JJ, EP and SP), including the project leaders (PD and VN) formed a steering committee. The committee developed a checklist based on the items in the Consolidated Standards of Reporting Trials (CONSORT) guidelines and Clinical and Laboratory Images in Publications (CLIP) principles. A PRIRATE Delphi Group (PDG) and PRIRATE Face-to-Face Meeting group (PFMG) were also formed. Thirty PDG members participated in the online Delphi process and achieved consensus on the checklist items and flowchart that make up the PRIRATE guidelines. The guidelines were discussed at a meeting of the PFMG at the 19th European Society of Endodontology (ESE) Biennial congress, held on 13 September 2019 in Vienna, Austria. A total of 21 individuals from across the globe and four steering committee members (PD, VN, HD and LB) attended the meeting. As a consequence of the discussions, the guidelines were modified and then piloted by several authors whilst writing a manuscript. The PRIRATE 2020 guidelines contain a checklist consisting of 11 sections and 58 individual items as well as a flowchart, considered essential for authors to include when writing manuscripts for randomized clinical trials in Endodontics.

The influence of a change in nutrition on the oral microbiota are discussed in literature, but usually only changes of population mean values are reported. This paper introduces simple methods to also analyse and report the variability of patients&rsquo, reactions considering data from the culture analysis of oral biofilm. The framework was illustrated by an experimental study exposing eleven participants to different nutrition schemes in five consecutive phases. Substantial inter-individual variations in the individual reactions were observed. A new coherence index made it possible to identify 14 instances where the direction of individual changes tended to coincide with the direction of the mean change with more than 95% probability. The heterogeneity in variability across different bacteria species was limited. This allowed us to develop recommendations for sample sizes in future studies. For studies measuring the concentration change of bacteria as a reaction to nutrition change, the use of replications and analysis of the variability is recommended. In order to detect moderate effects of a change in nutrition on the concentration of single bacterial taxa, 30 participants with three repetitions are often adequate. Insights into the relationship between nutrition and the microbial composition can be helpful for the development of dietary habits that promote the establishment of a healthy microbial flora and can therefore prevent the initiation of oral diseases such as caries and periodontitis.

In this randomized controlled single-center clinical trial on 96 adult patients with parallel experimental groups (n = 48), the effects of washing a dentin/pulp wound in non-symptomatic teeth with extremely deep caries and pulpal exposure were compared between a 2.5% sodium hypochlorite (NaOCl) solution and a chemically-inert physiological saline control solution. After the allocated wound lavage, the pulps were capped with a mineral trioxide aggregate, covered by a glass-ionomer/resin liner, and the teeth were immediately restored with a resin-bonded-composite. In this first report, the early events were analyzed: postoperative discomfort (on an NRS-11 scale) at day-3 and -7 after intervention, and the occurrence of unbearable pain causing patients to contact the principal investigator to perform a root canal treatment (pulpectomy) during the first three months. The NaOCl solution caused a highly significant reduction in post-operative discomfort (p = 0.0010 day 3, p = 0.0007 day 7) and early painful failures (p = 0.0008) compared with the control. These novel findings highlight the importance of infection control in teeth with extremely deep carious lesions. Based on these observations, the use of an NaOCl solution to wash the exposed dentin/pulp wound in the vital pulp treatment is highly recommended in order to reduce pain and early failure.

Roughly 50% or more of the word population suffer from a form of periodontitis and about 750 million people suffer from a severe form (1). This number is higher than, for example, diabetes, which affects around 450 million adult patients (2). According to an estimate of WHO in 2018, the total number of people living within 5 years of cancer diagnosis, the so-called 5-year prevalence, is estimated at 43.8 million (3). In view of these figures, periodontitis is indeed an important topic. Especially if one considers the clinical connections with diabetes or other systemic diseases (4, 5). The prevention and therapy of this inflammatory disease, which is mostly caused by bacteria, must be intensified and intensively fought from a health policy perspective.

Green tea has been shown in individual studies to be effective in reducing plaque and its use against gingivitis. Therefore, the aim of this study was to systematically review available literature on green tea catechin. The systematic literature search was performed using electronic databases in CINAHL, Cochrane Library, MEDLINE, PubMed and Scopus until January 2017. The PRISMA criteria were applied and a research question was posed according to PICO: “In patients with gingivitis (population), what is the effect of green tea catechins-containing mouthwash (intervention and comparison) on plaque accumulation and gingival inflammation (outcome)?”. Out of 187 titles identified by the search strategy, five were suitable for meta-analyses. These five studies were undertaken on a predominately Asian population. Plaque (PI) and Gingival Index (GI) were compared at endpoint and with respect to the change throughout the study (baseline-endpoint). The results from the meta-analysis indicated that green tea and chlorhexidine (CHX) resulted in lower PI compared to placebo while there was no significant difference between CHX and green tea, either at endpoint or over time. In addition, there was little evidence of side effects with green tea mouthwash. Green tea mouthwash may be a viable alternative to CHX, especially for long-term use. However, due to the very heterogeneous data and the risk of bias, this evidence should be interpreted with caution. Further clinically controlled studies with a longer observation period are required.

This study aimed to investigate whether interdental brush shape influences cleaning efficacy, by comparing a waist-shaped interdental brush (W-IDB) with a cylindrical IDB (C-IDB); both provided with the same bristle texture. Cleaning efficacy of differently shaped IDBs was measured in proximal surfaces of teeth in a split-mouth cross-over design. Twenty-eight patients abolished oral hygiene for 4 d. Line angle plaque area was scanned with an intraoral camera after use of disclosing dye in baseline and after IDB application and analyzed planimetrically. Additionally, bacterial load in the IDBs was analyzed after usage by colony forming units (cfu). A Wilcoxon signed-rank test with continuity correction was used to compare the results of the waist-shaped and the cylindrically-shaped IDBs. The waist-shaped IDBs cleaned significantly better than their cylindrically-shaped counterparts (area cleaned: 23.1% vs. 18.3%), when applied at same interdental spaces (p

Oral bacteria possess the ability to form biofilms on solid surfaces. After the penetration of oral bacteria into the pulp, the contact between biofilms and pulp tissue may result in pulpitis, pulp necrosis and/or periapical lesion. Depending on the environmental conditions and the availability of nutrients in the pulp chamber and root canals, mainly Gram-negative anaerobic microorganisms predominate and form the intracanal endodontic biofilm. The objective of the present study was to investigate the role of different substrates on biofilm formation as well as the separate and collective incorporation of six endodontic pathogens, namely Enterococcus faecalis, Staphylococcus aureus, Prevotella nigrescens, Selenomonas sputigena, Parvimonas micra and Treponema denticola into a nine-species &ldquo, basic biofilm&rdquo, This biofilm was formed in vitro as a standard subgingival biofilm, comprising Actinomyces oris, Veillonella dispar, Fusobacterium nucleatum, Streptococcus anginosus, Streptococcus oralis, Prevotella intermedia, Campylobacter rectus, Porphyromonas gingivalis, and Tannerella forsythia. The resulting endodontic-like biofilms were grown 64 h under the same conditions on hydroxyapatite and dentin discs. After harvesting the endodontic-like biofilms, the bacterial growth was determined using quantitative real-time PCR, were labeled using fluorescence in situ hybridization (FISH) and analyzed by confocal laser scanning microscopy (CLSM). The addition of six endodontic pathogens to the &ldquo, induced a decrease in the cell number of the &ldquo, basic&rdquo, species. Interestingly, C. rectus counts increased in biofilms containing E. faecalis, S. aureus, P. nigrescens and S. sputigena, respectively, both on hydroxyapatite and on dentin discs, whereas P. intermedia counts increased only on dentin discs by addition of E. faecalis. The growth of E. faecalis on hydroxyapatite discs and of E. faecalis and S. aureus on dentin discs were significantly higher in the biofilm containing all species than in the &ldquo, Contrarily, the counts of P. nigrescens, S. sputigena and P. micra on hydroxyapatite discs as well as counts of P. micra and T. denticola on dentin discs decreased in the all-species biofilm. Overall, all bacterial species associated with endodontic infections were successfully incorporated into the standard multispecies biofilm model both on hydroxyapatite and dentin discs. Thus, future investigations on endodontic infections can rely on this newly established endodontic-like multispecies biofilm model.

This study aimed to investigate the effects of an oral health optimized diet on the composition of the supragingival oral plaque in a randomized controlled trial. Participants of the standard diet group (n = 5) had a diet high in processed carbohydrates and did not change their dietary behavior during the observation. The healthy diet group (n = 9) had to change the diet after 2 weeks from a diet high in processed carbohydrates to a diet low in carbohydrates, rich in omega‐3 fatty acids, rich in vitamins C and D, antioxidants and fiber for 4 weeks. Saliva and supragingival plaque samples were taken at the end of week two and eight of the observation period to investigate the composition of microbiota in saliva and supragingival plaque. Data were subjected to an exploratory analysis to identify significant differences. Statistically significant differences were only found in the healthy diet group between the baseline (week 2) and the final sample (week 8) for specific species in plaque and saliva samples. A reduction of the total counts of Streptococcus mitis group, Granulicatella adiacens, Actinomyces spp., and Fusobacterium spp. was found in plaque samples of the healthy diet group. In saliva samples of the healthy diet group, the total counts of Actinomyces spp. and Capnocytophaga spp. decreased. A diet low in carbohydrates, rich in omega‐3 fatty acids, rich in vitamins C and D, and rich in fiber reduced Streptococcus mitis group, Granulicatella adiacens, Actinomyces spp., and Fusobacterium spp. in the supragingival plaque., This study aimed to investigate the effects of an oral health optimized diet on the composition of the supragingival oral plaque in a randomized controlled trial. A diet low in carbohydrates, rich in omega‐3 fatty acids, rich in vitamins C and D, and rich in fiber induces significantly lower counts of caries‐ and periodontitis‐associated pathogens and thus, a favorable shift in the bacterial.

This study introduced an experimental bioactive glass (BG) with a lower Na2O content than conventional BG 45S5 (10.5 wt% vs. 24.5 wt%), additionally containing CaF2 (12 wt%) and a network connectivity similar to that of BG 45S5. A series of experimental composites functionalized with 5&ndash, 40 wt% of the novel BG was prepared and compared to a corresponding series of experimental composites functionalized with 5&ndash, 40 wt% of BG 45S5. Commercial acidneutralizing materials (alkasite, giomer, and glass ionomer) were used as references. The capabilities of the materials to neutralize hydrochloric acid (pH = 2.6) and lactic acid (pH = 4.5) were evaluated by real-time pH measurements over 1 h. The degree of conversion and precipitation of calcium phosphate were also investigated. Data were analyzed using one-way and Welch ANOVA at an overall level of significance of 0.05. The acid-neutralizing potential of the experimental BG incorporated into resin composites was generally comparable to that of BG 45S5, and better than that of a giomer and glass ionomer. Fluorine was identified in the precipitate that developed on the composites functionalized with the experimental BG, suggesting a capability of forming fluorapatite. Unlike the 45S5 composition, the experimental BG did not impair the degree of conversion of resin composites. The novel BG filler is therefore an interesting candidate for future investigations of caries-preventive resin composites, and their potential clinical applicability for restorative, preventive, and orthodontic purposes.

The aim of this study was to systematically review pulp wound lavage in vital pulp therapy (VPT). A search was conducted in six life science databases to identify clinical trials carried out on permanent teeth with a carious pulp exposure and a recall interval of at least six months. Twenty-seven trials of low to moderate risk of bias (RoB-2 and ROBINS-I) were included. Data was extracted and analyzed regarding study characteristics and methods used for pulp wound lavage. The agent used for pulp wound lavage was specified in all included trials. Most of the identified trials (23/27) randomized the pulp capping material. Many (14/27) reported the use of sodium hypochlorite (NaOCl); ten used only saline or water. One trial was identified that compared pulp wound lavage with 2.5% (NaOCl) to saline, another compared 5% glutaraldehyde to water, both in immature molar pulpotomies. Both studies were underpowered. Neither showed a significant difference between treatments. The use of NaOCl was positively correlated to recent year of publication and use of hydraulic calcium silicate cements for pulp capping (p < 0.05). In conclusion, despite a lack of well-designed trials on pulp wound lavage in VPT, a trend towards using NaOCl for this purpose was observed.

This study investigated the impact of a separate silanization step on the repair bond strength of composite substrates using a universal adhesive after various mechanical surface treatments. Composite specimens were aged and exposed to the following mechanical roughening treatments: diamond bur abrasion, aluminum oxide sandblasting, or silica coating. The specimens were then either left untreated or conditioned with universal adhesive (Scotchbond Universal), or a silane coupling agent was applied before the use of the universal adhesive or a conventional adhesive (Optibond FL). The conditioned surfaces and fresh substrate (positive control group) were covered with repair composite, and microtensile bond strength testing was performed. The significantly highest bond strength was obtained in the positive control group. Repair bond strength of the universal adhesive applied after a separate silanization step was similar to that without prior silanization, independent of the mechanical surface treatment. Moreover, after silica coating, no significant differences in the repair bond strength were detected among the different adhesive treatments. In conclusion, a separate silanization step before surface conditioning with the universal adhesive does not enhance the repair bond strength. On silica-coated composite substrates, repair bond strength values of the universal adhesive were similar to those of the conventional adhesive.

Modification of oral biofilms adhering to dental hard tissues could lead to new treatment approaches in cariology and periodontology. In this study the impact of DNase I and/or proteinase K on the formation of a simulated supragingival biofilm was investigated in vitro. Six-species biofilms were grown anaerobically in the presence of DNase I and proteinase K. After 64 h biofilms were either harvested and quantified by culture analysis or proceeded to staining followed by confocal laser scanning microscopy. Microbial cells were stained using DNA-dyes or fluorescent in situ hybridization. Exopolysaccharides, eDNA and exoproteins were stained with Calcofluor, anti-DNA-antibody, and SyproTM Ruby, respectively. Overall, results showed that neither DNase I nor proteinase K had an impact on total colony-forming units (CFUs) compared to the control without enzymes. However, DNase I significantly suppressed the growth of Actinomyces oris, Fusobacterium nucleatum, Streptococcus mutans, Streptococcus oralis and Candida albicans. Proteinase K treatment induced significant increase in S. mutans and S. oralis CFUs (p &lt, 0.001), whereas C. albicans and V. dispar showed lower CFUs compared to the control. Interestingly, confocal images visualized the biofilm degradation caused by DNase I and proteinase K. Thus, enzymatic treatment should be combined with conventional antimicrobial agents aiming at both bactericidal effectiveness and biofilm dispersal.

Bioactive resin composites can contribute to the prevention of secondary caries, which is one of the main reasons for failure of contemporary dental restorations. This study investigated the effect of particle size of bioactive glass 45S5 on chemical and physical composite properties. Four experimental composites were prepared by admixing the following fillers into a commercial flowable composite: (1) 15 wt% of micro-sized bioactive glass, (2) 15 wt% of nano-sized bioactive glass, (3) a combination of micro- (7.5 wt%) and nano-sized (7.5 wt%) bioactive glass, and (4) 15 wt% of micro-sized inert barium glass. Hydroxyapatite precipitation and pH rise in phosphate-buffered saline were evaluated during 28 days. Degree of conversion and Knoop microhardness were measured 24 h after specimen preparation and after 28 days of phosphate-buffered saline immersion. Data were analyzed using non-parametric statistics (Kruskal&ndash, Wallis and Wilcoxon tests) at an overall level of significance of 5%. Downsizing the bioactive glass particles from micro- to nano-size considerably improved their capability to increase pH. The effect of nano-sized bioactive glass on degree of conversion and Knoop microhardness was similar to that of micro-sized bioactive glass. Composites containing nano-sized bioactive glass formed a more uniform hydroxyapatite layer after phosphate-buffered saline immersion than composites containing exclusively micro-sized particles. Partial replacement of nano- by micro-sized bioactive glass in the hybrid composite did not impair its reactivity, degree of conversion (p &gt, 0.05), and Knoop microhardness (p &gt, 0.05). It is concluded that downsizing bioactive glass particles to nano-size improves the alkalizing potential of experimental composites with no negative effects on their fundamental properties.

Objectives: This in vitro study aimed to evaluate and compare the effect of two different bioactive glasses, a hydroxyapatite-containing, fluoride-free toothpaste (HTP) and a fluoride toothpaste (FTP) on the remineralization behavior of initial caries lesions. Materials and Methods: A total of 100 bovine enamel samples were randomly allocated to five groups of 20 samples each: NC = negative control group (artificial saliva); HTP = HTP group (Karex); FTP = FTP group (Elmex caries protection, 1,400 ppm); FTP + BGnano = FTP followed by Actimins bioactive glass; FTP + BGamorph = FTP followed by Schott bioactive glass. Radiographic documentation (advanced transversal microradiography; aTMR) was applied before and after all samples were exposed to a demineralizing gel for 10 days. Over a period of 28 days, samples were covered twice a day (every 12 h) with a toothpaste slurry of the respective test group or with artificial saliva in NC for 60 s and brushed with 15 brushing strokes. Samples in FTP + BGnano and FTP + BGamorph were additionally treated with the respective bioactive glass slurry for 30 s after brushing with the FTP. In the meantime, all samples were stored in artificial saliva. After 28 days, the structure of all samples was assessed again using aTMR and compared to the values measured after demineralization. The statistical evaluation of the integrated mineral loss was performed using Kruskal-Wallis test followed by a post hoc Conover test. Results: The FTP revealed the significantly highest increase of mineral content while the HTP showed the significantly lowest remineralization. Compared to artificial saliva, the use of the HTP or the combined application of FTP followed by bioactive glasses (FTP + BGnano and FTP + BGamorph) showed no significant remineralization. Conclusion: Under remineralizing in vitro conditions, brushing with 1,400 ppm FTP induced significantly more remineralization compared to storage in artificial saliva. The additional administration of both bioactive glasses as well as the substitutional brushing with an HTP resulted in significantly less remineralization compared to brushing with 1,400 ppm FTP.

Summary Objective: The purpose of this in vitro study was to analyze the effect of computer-aided design/computer-aided manufacturing (CAD/CAM) fabrication and sintering procedures on the fracture load of monolithic zirconia crowns with different material thicknesses adhesively seated to methacrylate dies fabricated with stereolithography technology. Method: Monolithic zirconia crowns were fabricated from inCoris TZI C material with a chairside CAD/CAM system (CEREC MCXL) comprising three material thicknesses (0.5/1.0/1.5 mm, n=8 each). Two CAD/CAM fabrication procedures (milling, MI; grinding, GR), two chairside sintering procedures (superspeed, SS; speedfire sintering, SF), and one labside sintering procedure (classic, CL) were evaluated. In total, 144 crowns were fabricated. Restorations were adhesively seated to methacrylate dies fabricated with SLA technology. Thermomechanical cycling (TCML) was performed before fracture testing. Loading forces until fracture were registered and statistically analyzed with one-way analysis of variance (ANOVA), post hoc Scheffé test, and three-way ANOVA (α=0.05). Results: Test groups showed statistically significant differences (p Conclusions: CAD/CAM fabrication and sintering procedures influence the maximum loading force of monolithic zirconia crowns with different material thicknesses. A material thickness of 0.5 mm should be considered as a critical thickness for monolithic zirconia crown restorations.

New tools for activating endodontic irrigants have evolved, yet their impact on root canal disinfection, in comparison to the passive placing of an inter-visit medication, have not yet been fully elucidated. The use of DNA- and rRNA-based methods may cast some new light on this issue, as they allow a comparison to be made between microbial presence and activity. Therefore, the aim of this single-arm intervention trial is to evaluate the antibacterial effect of endodontic procedures using both molecular methods. Root canal samples were obtained from 20 patients with asymptomatic apical periodontitis after each treatment step: access cavity, chemo-mechanical preparation, adjunctive procedures (XP-endo Finisher file and passive ultrasonic irrigation), calcium hydroxide medication, and 2nd-visit root canal preparation. DNA and cDNA from the samples were subjected to quantitative polymerase chain reaction with universal primers for the bacterial 16S rRNA gene. Chemo-mechanical preparation promoted a drastic reduction in bacterial levels and activity, whereas the adjunctive procedures did not make a significant contribution to further disinfection. At the 2nd visit, bacteria were active after the use of calcium hydroxide medication, however, they were significantly reduced after a 2nd-visit preparation. Consequently, the lowest bacterial levels were found at the end of the treatment. This clinical trial, which used an rRNA and rDNA combined approach, confirmed previous studies showing that root canal preparation represents the main strategy for root canal disinfection.

Regenerative endodontics has been described as a paradigm shift in dentistry, despite its current limitation to immature teeth and reparative rather than regenerative outcomes. Cell-free treatments are favored because of regulatory issues. However, the recruitment of host-derived stem cells to the desired site remains challenging. We investigated whether dental pulp-derived exosomes, which are extracellular vesicles that contain proteins, lipids, RNA, and DNA and thus mirror their parental cells, may be used for this purpose. The use of exosomes may present appreciable advantages over the direct use of transplanted stem cells due to a higher safety profile, easier isolation, preservation, and handling. Here we harvested exosomes from a cultured third-molar pulp cell and assessed them by transmission electron microscopy and Western blotting. Human mesenchymal stem cells (MSCs) were exposed to these exosomes to assess exosome uptake, cell migration, and proliferation. In addition, a fibrin gel (i.e., a diluted fibrin sealant), was assessed as a delivery system for the exosomes. Our results show that exosomes attracted MSCs, and the fibrin gel enhanced their effect. Moreover, exosomes improved the proliferation of MSCs. Therefore, we propose that pulp-derived exosomes in combination with a fibrin gel could be a powerful combination for clinical translation towards improved cell-free regenerative endodontics and thus represent a new way to fill dental hard tissues.

The authors evaluated the local accuracy of intraoral scanning (IOS) systems for single-tooth preparation impressions with an in vitro setup.The authors digitized a mandibular complete-arch model with 2 full-contour crowns and 2 multisurface inlay preparations with a highly accurate reference scanner. Teeth were made from zirconia-reinforced glass ceramic material to simulate toothlike optical behavior. Impressions were obtained either conventionally (PRESIDENT, Coltène) or digitally using the IOS systems TRIOS 3 and TRIOS 3 using insane scan speed mode (3Shape), Medit i500, Version 1.2.1 (Medit), iTero Element 2, Version 1.7 (Align Technology), CS 3600, Version 3.1.0 (Carestream Dental), CEREC Omnicam, Version 4.6.1, CEREC Omnicam, Version 5.0.0, and Primescan (Dentsply Sirona). Impressions were repeated 10 times per test group. Conventional (CO) impressions were poured with type IV gypsum and digitized with a laboratory scanner. The authors evaluated trueness and precision for preparation margin (MA) and preparation surface (SU) using 3-dimensional superimposition and 3-dimensional difference analysis method using (95% - 5%) / 2 percentile values. Statistical analysis was performed using Kruskal-Wallis test. Results were presented as median (interquartile range) values in micrometers.The authors found statistically significant differences for MA and SU among different test groups for both trueness and precision (P.05). Median (interquartile range) trueness values ranged from 11.8 (2.0) μm (CO) up to 40.5 (10.9) μm (CEREC Omnicam, Version 5.0.0) for SU parameter and from 17.7 (2.6) μm (CO) up to 55.9 (15.5) μm (CEREC Omnicam, Version 5.0.0) for MA parameter.IOS systems differ in terms of local accuracy. Preparation MA had higher deviations compared with preparation SU for all test groups.Trueness and precision values for both MA and SU of single-unit preparations are equal or close to CO impression for several IOS systems.

Objective: The aim of this study was to evaluate and compare surface roughness, gloss, and color change of dental enamel after being brushed with toothpastes containing diamond powder and traditional abrasives. Materials and methods: Seventy enamel slabs were derived from 70 bovine incisors. The slabs were brushed with six different toothpastes and artificial saliva as a negative control. The specimens were then stained with black tea mixed with citric acid (3 days, pH = 4) and again brushed with the same toothpastes. Ra (contact profilometer), gloss (glossmeter), and color (CIE L* a* b* system) values were measured after each step. Results: Emoform-F Diamond (contains diamond powder and traditional abrasives) offered significantly the best improvement of Ra and gloss values after the first brushing sequence and the best recovery of the brightness of enamel after staining and second brushing sequence (P < .05). AMC 2.5 (contains only diamond powder as abrasive) was not able to offer such improvement. Conclusion: Diamond powder as an additional abrasive in toothpastes could be able to offer a further improvement of Ra , gloss, and color values of enamel. Keywords: abrasives; diamond powder; gloss; surface roughness; toothpastes.

The location of the terminal hinge axis of the temporomandibular joint is still a very wide-spread procedure in dentistry in order to replicate the movement in various articulator devices. Especially pantographic methods are claimed to provide accurate measurements and, additionally, are seen to be able to separate a pure rotation of the joint from a movement with an arbitrary combined shift and rotation. In the latter application, these methods were used in a lot of studies as a reference standard. The aim of this study was to analyze, whether common pantographic methods in general are able to distinguish between a pure rotation and a movement with rotational and translational portions. The mathematical proof of this analysis was done with theoretical kinematic considerations and compared with computer simulations. The results show for the first time that there exist combinations of rotational and translational movements of the temporomandibular joint which cannot be separated from pure rotational movements using actual pantographic methods. Even more, the consequence is a shifted location of the (combined) finite center (axis) of rotation in comparison to the true center (axis) of rotation: in case of a translational portion of only 1 mm, this is a displacement of around ±6 mm and, in case of 2 mm translation, a displacement of ±12 mm. This finding necessitates a critical reinterpretation of former studies using pantographic methods as a reference standard. Further, under some circumstances it may also affect the applicability of articulator concepts and the interpretation of functional signs.

Rapid high-intensity light-curing of dental resin composites is attractive from a clinical standpoint due to the prospect of time-savings. This study compared the effect of high-intensity (3 s with 3,440 mW/cm2) and conventional (10 s with 1,340 mW/cm2) light-curing on micromechanical properties of conventional and bulk-fill resin composites, including two composites specifically designed for high-intensity curing. Composite specimens were prepared in clinically realistic layer thicknesses. Microhardness (MH) was measured on the top and bottom surfaces of composite specimens 24 h after light-curing (initial MH), and after subsequent immersion for 24 h in absolute ethanol (ethanol MH). Bottom/top ratio for initial MH was calculated as a measure of depth-dependent curing effectiveness, whereas ethanol/initial MH ratio was calculated as a measure of crosslinking density. High-intensity light-curing showed a complex material-dependent effect on micromechanical properties. Most of the sculptable composites showed no effect of the curing protocol on initial MH, whereas flowable composites showed 11–48% lower initial MH for high-intensity curing. Ethanol/initial MH ratios were improved by high-intensity curing in flowable composites (up to 30%) but diminished in sculptable composites (up to 15%). Due to its mixed effect on MH and crosslinking density in flowable composites, high-intensity curing should be used with caution in clinical work.

The main biological goal in clinical dentistry remains to prevent micro-organisms from exerting pathogenic effects by establishing non-commensal biofilms or entering the wrong niches [...]

The aim of this study was to test the fracture load of ceramic and composite three-unit full-contour fixed dental prostheses (FDPs) fabricated with additive and subtractive computer-aided design (CAD)/computer-aided manufacturing (CAM) technology. A newly developed alveolar socket replica model for a three-unit FDP replacing one molar was used in this study. Five CAD/CAM materials were used for fabrication of three-unit FDPs (each n = 12). The subtractive CAD/CAM fabrication method was used for groups BC (BRILLIANT Crios), TC (Telio CAD), EX (e.max CAD), and TZ (inCoris TZI C), and the additive method was used for group 3D (els 3D resin even stronger). FDPs were adhesively seated to the abutment dies (PANAVIA V5 system). Thermomechanical loading was performed prior to fracture testing with a universal testing machine. The data for maximum fracture load values was analyzed with one-way ANOVA and post hoc Scheffe test (α = 0.05). All FDPs survived the thermomechanical loading test. Statistically significant differences were found for the fracture load of three-unit FDPs fabricated from different CAD/CAM materials (p

Purpose This study investigated whether the placement of ribose cross-linked collagen (RCLC) membranes without primary soft tissue closure predictably resulted in sufficient alveolar ridge preservation in contained and non-contained extraction sockets. Methods Membranes were positioned across extraction sockets, undermining full-thickness flaps, and the gingival margins were fixed by double-interrupted sutures without crossed horizontal mattress sutures for 1 week. In non-contained sockets, a bone substitute was used to support the membrane within the bony envelope. Radiographs and clinical images obtained 4 months later were analyzed by ImageJ software using non-parametric tests. Results In 18 patients, 20 extraction sockets healed uneventfully and all sites received standard-diameter implants (4.1, 4.8, or 5.0 mm) without additional bone augmentation. Soft tissues and the muco-gingival border were well maintained. A retrospective analysis of X-rays and clinical photographs showed non-significant shrinkage in the vertical and horizontal dimensions (P=0.575 and P=0.444, respectively). The new bone contained vital bone cells embedded in mineralized tissues. Conclusions Within the limitations of this pilot study, open healing of RCLC membranes may result in sufficient bone volume for implant placement without additional bone augmentation in contained and non-contained extraction sockets., Graphical Abstract

Transversal Microradiography (TMR) is a method for quantifying the mineral density in enamel carious lesions. In the traditional procedure, X-ray images of 100 µm thin tooth sections are compared, whereby the grinding of the samples can produce undefined artefacts at the demineralized areas. In this study, the replacement of the usual aluminium step wedge by a continuous hydroxyapatite (HAp) wedge with an extended measuring range was validated, whereby, the mineral density of sections with >500 µm thickness could be quantified reproducibly. This enabled experiments with the single section technique: the sections were made from sound teeth and X-rayed immediately. After each experimental phase, a further image was taken, so that the changes in the mineral density of an object could be normalised to its baseline image at the end of the experiment. The results of the analysis with the traditional reference area differed significantly from the single-section analysis (p

Bone graft infections represent a challenge in daily clinics, resulting in increased patient discomfort and graft removal. The aim of this study was to investigate the initial adhesion of five representative pathogens on three different block bone graft materials (xenogeneic, alloplastic and allogeneic) and to assess if chlorhexidine (CHX) can effectively control the initial bacterial adhesion. Three different block bone grafting materials (Tutobone&reg, Endobon&reg, and human spongiosa) were incubated with Escherichia coli, Staphylococcus aureus, Streptococcus mutans, Enterococcus faecalis and Pseudomonas aeruginosa in the presence or absence of 0.2% CHX solution. Bacterial adhesion was assessed by the direct counting of the colony-forming units (CFUs) and visualized by scanning electron microscopy (SEM). Overall, the selected bacterial species adhered successfully to all tested bone replacement scaffolds, which showed similar bacterial counts. The lg CFU values ranged from 5.29 &plusmn, 0.14 to 5.48 &plusmn, 0.72 for E. coli, from 4.37 &plusmn, 0.62 to 5.02 &plusmn, 0.48 for S. aureus, from 4.92 &plusmn, 0.34 to 4.95 &plusmn, 0.21 for S. mutans, from 4.97 &plusmn, 0.40 to 5.22 &plusmn, 0.13 for E. faecalis and from 4.23 &plusmn, 0.54 to 4.58 &plusmn, 0.26 for P. aeruginosa. CHX did not interfere with initial microbial adhesion, and yet it killed all adhered bacterial cells. Thus, CHX can be used to prevent subsequent biofilm infections.

This review aimed to systematically compare microbial profiles of peri-implantitis to those of periodontitis and healthy implants. Therefore, an electronic search in five databases was conducted. For inclusion, studies assessing the microbiome of peri-implantitis in otherwise healthy patients were considered. Literature was assessed for consistent evidence of exclusive or predominant peri-implantitis microbiota. Of 158 potentially eligible articles, data of 64 studies on 3730 samples from peri-implant sites were included in this study. Different assessment methods were described in the studies, namely bacterial culture, PCR-based assessment, hybridization techniques, pyrosequencing, and transcriptomic analyses. After analysis of 13 selected culture-dependent studies, no microbial species were found to be specific for peri-implantitis. After assessment of 28 studies using PCR-based methods and a meta-analysis on 19 studies, a higher prevalence of Aggregatibacter actinomycetemcomitans and Prevotella intermedia (log-odds ratio 4.04 and 2.28, respectively) was detected in peri-implantitis biofilms compared with healthy implants. Actinomyces spp., Porphyromonas spp. and Rothia spp. were found in all five pyrosequencing studies in healthy-, periodontitis-, and peri-implantitis samples. In conclusion, the body of evidence does not show a consistent specific profile. Future studies should focus on the assessment of sites with different diagnosis for the same patient, and investigate the complex host-biofilm interaction.

This systematic review aimed to assess the literature on the benefit of adjuvant nonsteroidal anti-inflammatory drugs (NSAIDs) during conventional periodontal therapy in terms of probing pocket depth (PD). A literature search according to PRISMA guidelines in Medline (PubMed), Embase (Ovid), and Cochrane library identified seven studies to be included in this review. In terms of the main outcome, PD, three studies found a larger reduction after NSAID administration compared to non-NSAID control patients. In two studies, no difference in PD reduction between NSAID and placebo was found. Overall, the NSAID patients showed no significant difference with an estimated 0.11 mm larger reduction in PD than the control [95% CI: −0.22 mm, 0.44 mm]. The secondary outcomes, bleeding on probing (BOP) and clinical attachment gain, also showed comparable results in all studies between patients receiving NSAID and those that did not. The estimated additional PD reduction of 0.11 mm in the NSAID group is very small and not statistically significant. It is unlikely that PD can be improved by adjuvant NSAID treatment after root surface debridement, yet the evidence to date is limited and warrants further investigation.