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The purpose of this clinical study was to assess the feasibility of forced orthodontic extrusion with the Tissue Master Concept to retain subgingivally fractured teeth as abutments for which extraction and replacement would be equal treatment opportunities. Participants were recruited from a group of consecutive patients in need of prosthodontic rehabilitation. In total, 36 deeply destroyed teeth in 31 patients underwent forced orthodontic extrusion with forces exceeding 50 g to reestablish biologic width and ensure a 2-mm dentin-ferrule design prior to single-crown restoration. The primary endpoint was the success of the extrusion in terms of the ability to restore the respective abutment tooth. Information about overall treatment time, frequency, and reasons for failure were collected. Four patients dropped out of the treatment. For the remaining 27 participants, data were fully collected. The amount of extrusion ranged between 2 and 6 mm (3.5 ± 0.9 mm), and the mean duration until retention was 20 ± 12 days. On average, patients returned three (± 3) times for control visits after extrusion. Adhesive failure (n = 6) and orthodontic relapse (n = 2) were the most frequent complication types. Forced orthodontic extrusion may be a useful tool to restore teeth evaluated as nonrestorable. [ABSTRACT FROM AUTHOR]

Objectives: Many treatment options accepted for unsalvageable traumatized teeth in adults would seem contraindicated in children and adolescents. Instead, growing patients need interim restorative measures, thus extensively preserving their local bone and soft tissue structures and, ideally, preparing the involved site for later definitive restoration while they transform to skeletal maturity. This narrative topic review addresses the interim management in case of very deep intra-extra-alveolar fractures, extensive infection-related root resorption, tooth ankylosis, and anterior tooth loss in growing patients, and seeks to empower the clinician to select the appropriate treatment approach. Data sources: The literature up to 2021 was reviewed based on several scoping searches on PubMed and the Cochrane Library using relevant terms. Due to the complexity of the topic (with various poor prognosis scenarios and the differing therapeutic options), a systematic review was deemed inappropriate. Conclusion: Suitable interim treatment options include extrusion of teeth showing deep intra-extra-alveolar fractures, and decoronation of ankylosed teeth as well as resin-bonded fixed dental prostheses, natural tooth pontics, and primary tooth autotransplantations after tooth loss. The interim management options described in this article represent compromises chosen in the absence of better alternatives after a careful risk-benefit analysis. However, if adequately performed, the presented treatment options have the potential to achieve the temporary restoration of function and esthetics in growing patients. Close clinical and (if appropriate) radiologic monitoring of these patients is considered mandatory to ensure early detection of possible complications that might jeopardize or could render impossible subsequent therapeutic measures. [ABSTRACT FROM AUTHOR]

Background: The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3‐level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence‐based recommendations for the management of patients presenting with pulpal and apical disease. Aim: To develop an S3‐level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss. Methods: This S3‐level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert‐based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders. Results: The S3‐level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re‐evaluations during and after treatment is stressed. Conclusion: The first S3‐level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this multicenter study was to evaluate the survival and quality outcome of direct composite buildups in the anterior dentition based on representative sample sizes. Materials and Methods: At three university clinics in Germany, the survival and quality outcome of n = 667 direct composite buildups performed between 2001 and 2012 was evaluated in n = 198 participants. Survival outcomes were categorized as failure (F), survival (SR), or successful (S). Restorations still in place and without failure prior to follow-up (n = 567) were rated using modified USPHS/FDI criteria to obtain the quality outcome. Detailed failure analysis was done by means of Cox regression models. Results: The restricted mean for overall survival was 15.5 years. N = 576 restorations were classified as successful (S), n = 81 survived with repair (SR) and n = 8 failed (F). Two restorations were removed due to iatrogenic interventions. Overall survival rates after 2, 10, and 15 years were 98.8% (CI: 97.6 and 99.4), 91.7% (CI: 89.0 and 93.8), and 77.6% (CI: 72.2 and 82.2), respectively. Functional survival rates were 100.0%, 98.9% (CI: 97.5 and 99.5), and 98.5% (CI: 96.7 and 99.3), respectively. Clinical quality was rated as excellent or good for most restorations. The dominant failure mode was chipping; however, regression analysis did not detect any influence of the evaluated parameters "enlargement range," "position in the jaw," or "tooth type" on failure. Conclusion: This multicenter study represents the first of its type including clinical survival and quality data on 576 direct anterior composite buildups over a restricted mean follow-up of 15.5 years in a relatively large group of participants. In particular, functional survival was outstanding due to the clinical reliability of this treatment option, while simultaneously providing flexibility, reparability, and minimal invasiveness. [ABSTRACT FROM AUTHOR]

When dental trauma occurs, initial management on the day of injury has a determining influence on healing and thus on the prognosis of the affected teeth. Improper, delayed, and/or inconsistent treatment often has far-reaching consequences that cannot be reversed later, even with great effort, especially in children and adolescents. In most cases, it is unrealistic or impossible for the patient to get to a specialized dental trauma facility in time. Therefore, it is every dental practitioner's duty to provide adequate initial diagnosis and treatment of dental trauma at their dental practice, even if they do not have routine experience in this area. This article serves as a guide to the initial management of dental trauma. It utilizes a three-tiered approach to illustrate which initial management measures are absolutely essential (MUSTS), which should ideally be performed (SHOULDS), and which are not top priorities but can be performed (CANS) if the necessary time, training and experience, and equipment and facilities are available. For further treatment, dental practitioners should realistically assess the limits of their ability to treat complex dental trauma cases and, if necessary, they should refer the patient to a specialist or specialized treatment center. [ABSTRACT FROM AUTHOR]

Purpose: This sub-analysis of our multicenter trial was to assess the long-term periodontal health (PH) of teeth, esthetically reshaped by means of direct composite buildups. Materials and Methods: 198 patients who received 667 direct composite buildups on 585 treated teeth (TT) between 01/2001 and 12/2013 were included. PH was assessed for each TT and for an untreated control tooth (CT) by recording the pocket probing depths (PPD), clinical attachment level (CAL), sulcus bleeding index (SBI), and Turesky's modification of the Quigley Hein plaque index (PI). Statistical analysis was performed using the twosample Student's t-test and Mann-Whitney U-test. Regression models were performed to check for associations between PH and patients' age, gender, age of the buildups, enlargement range, jaw, and tooth type. The level of significance was set at a = 0.05. Results: PI scores were significantly (p < 0.001) higher in TT (1.60 ± 0.81) than in CT (1.41 ± 0.81). Differences between TT and CT regarding PPD (TT: 2.14 ± 0.56/CT: 2.18 ± 0.56), CAL (TT: 2.34 ± 1.05/CT: 2.33 ± 0.92), and SBI (TT: 0.41 ± 0.60/CT: 0.41 ± 0.65) were not statistically significant (p > 0.05). The enlargement range of the TT and the tooth type were not associated with PH. Male patients had significantly higher PPDs, CAL, and SBI values than did female patients. CAL and SBI values increased over time for both the TT and CT. CAL, SBI, and PI values were significantly higher in the mandible and the PPD values in the maxilla. Conclusion: Direct composite buildups made for reshaping, change of color or position of teeth did not impair PH in the long term. [ABSTRACT FROM AUTHOR]

Purpose: This case report presents the management of molar incisor hypomineralization (MIH) from the mixed to the permanent dentition stage. Shortly after eruption of hypomineralized teeth, masticatory forces frequently cause rapid enamel breakdown. The MIH Treatment Need Index (MIH-TNI) provides guidelines for the treatment of MIH in relation to how severely the teeth are affected. Clinical considerations: An 11-year-old patient with permanent teeth affected by MIH was referred to us by his orthodontist for conservative dental treatment before planned orthodontic treatment. The restorative treatment varied according to the degree of severity of the affected teeth and included indirect composite resin restorations on teeth #17 (MIH-TNI 4c), #35 (MIH-TNI 4c) and #37 (MIH-TNI 4b), direct composite resin fillings on teeth #26 (MIHTNI 2b), #27 (MIH-TNI 2a) and #16 (MIH-TNI 4c) and fissure sealants on teeth #16, 15, 14, 24, 25, 34, 36, 44, 45, 46 and 47. Orthodontic treatment was already started during the restorative phase with a bite-jumping appliance. With the conclusion of the second phase of mixed dentition at age 12, the orthodontist was able to start fixed orthodontic treatment of the maxillary and mandibular arches with all of the child's permanent teeth adequately restored. Orthodontic treatment was completed at age 14. At present, 6 years after initiation of dental treatment, all teeth are still free of decay. Conclusion: A carefully supervised recall program with early comprehensive care at frequent intervals and adequate, defect-driven restorations depending on how severely the teeth are affected are the basis for a favorable long-term prognosis in patients with MIH. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effect of different surface pretreatments on the shear bond strength of resin luting material on CAD-CAM composite resins and a polymer-infiltrated ceramic network (PICN). Materials and Methods: CAD-CAM materials (Brilliant Crios, Cerasmart, Lava Ultimate, VITA Enamic) were subjected to the following pretreatments: no pretreatment; grit blasting; grit blasting + silane; HF etching + silane; tribochemical silica coating + silane; manufacturers' specifications; manufacturers' specifications + silane; manufacturers' specifications using only the manufacturers' products including their recommended luting materials (DuoCem, G-Cem LinkForce, RelyX Ultimate, RelyX Unicem 2). Specimens were luted with resin luting material according to the Swiss shear test design. After six months of water storage, shear bond tests were performed. Data were analyzed with multiple linear regression models and nested models (α = 0.05). Results: Low bond strengths were obtained without pretreatment (Brilliant Crios 3.01 ± 0.54 MPa, Cerasmart 2.66 ± 0.47 MPa, Lava Ultimate 1.76 ± 0.26 MPa, VITA Enamic 2.83 ± 0.63 MPa). Grit blasting achieved high bond strengths across all materials (Brilliant Crios 5.17 ± 0.77 MPa, Cerasmart 4.27 ± 0.50 MPa, Lava Ultimate 3.98 ± 0.54 MPa, VITA Enamic 4.97 ± 0.90 MPa). Silane application tended to decrease bond strengths on CADCAM composite resins. Following the manufacturers' specifications and using their recommended materials achieved the highest bond strengths for all materials except Cerasmart (Brilliant Crios 5.75 ± 0.91 MPa, Cerasmart 2.82 ± 0.28 MPa, Lava Ultimate 6.63 ± 0.97 MPa, VITA Enamic 7.09 ± 0.77 MPa). Conclusion: Grit blasting and the application of a suitable material primer is a useful pretreatment for the bonding of CAD-CAM composite resins. Silane application on CAD-CAM composite resins may entail drawbacks, possibly owing to the scarcity of silanizable fillers. [ABSTRACT FROM AUTHOR]

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