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The long-term effectiveness of powered toothbrushes (PTBs) and interdental cleaning aids (IDAs) on a population level is unproven. We evaluated to what extent changes in PTB and IDA use may explain changes in periodontitis, caries, and tooth loss over the course of 17 y using data for adults (35 to 44 y) and seniors (65 to 74 y) from 3 independent cross-sectional surveys of the German Oral Health Studies (DMS). Oaxaca decomposition analyses assessed to what extent changes in mean probing depth (PD), number of caries-free surfaces, and number of teeth between 1) DMS III and DMS V and 2) DMS IV and DMS V could be explained by changes in PTB and IDA use. Between DMS III and V, PTB (adults: 33.5%; seniors: 28.5%) and IDA use (adults: 32.5%; seniors: 41.4%) increased along with an increase in mean PD, number of caries-free surfaces, and number of teeth. Among adults, IDA use contributed toward increased number of teeth between DMS III and V as well as DMS IV and V. In general, the estimates for adults were of lower magnitude. Among seniors between DMS III and V, PTB and IDA use explained a significant amount of explained change in the number of caries-free surfaces (1.72 and 5.80 out of 8.44, respectively) and the number of teeth (0.49 and 1.25 out of 2.19, respectively). Between DMS IV and V, PTB and IDA use contributed most of the explained change in caries-free surfaces (0.85 and 1.61 out of 2.72, respectively) and the number of teeth (0.25 and 0.46 out of 0.94, respectively) among seniors. In contrast to reported results from short-term clinical studies, in the long run, both PTB and IDA use contributed to increased number of caries-free healthy surfaces and teeth in both adults and seniors. [ABSTRACT FROM AUTHOR]

Objective: This cross-sectional study aimed to investigate the use, quality, and caries-preventive effects of fissure sealants (FSs) in 8- to 10-year-olds with and without molar-incisor hypomineralization (MIH)., Materials and Methods: A total of 5,418 children (2,692 males, 2,726 females) were examined via standard instruments (dental mirrors, CPI probes, adequate lighting, mobile examination tables, and air syringes) and methods for the recording of caries (DMFT index, WHO method) and FSs. The classification of MIH followed the recommendations of the European Academy of Pediatric Dentistry (EAPD). Statistical analysis included descriptive analysis and mixed-effects logistic regression models., Results: 59.0% of all children had at least one FS; this percentage was 57.8% in the MIH group. The proportions of fully intact sealants and minimal, moderate, or nearly complete loss of retention were 31.7%, 48.3%, 16.8%, and 3.2%, respectively. The mean caries experience was low, at 0.2 DMFT in the whole population. Lower DMFT means were registered in individuals with FSs without MIH (0.1) and with MIH (0.1). The regression analysis revealed a significant caries-protective effect of FSs and MIH in relation to the overall caries burden. In addition, the caries-protective effect was greater in individuals with fully retained sealants (aOR 0.269) than in those with minimal (aOR 0.346), moderate (aOR 0.567) or nearly complete loss of retention (aOR 0.721)., Conclusion: This study documented the comparable use, quality, and caries-preventive effects of FSs in individuals and permanent molar with and without MIH., Clinical Relevance: FSs are caries protective in children with and without MIH., Competing Interests: Declarations. Conflict of interest: The authors confirm that there are no conflicts of interest regarding the authorship or publication of this article. Ethical approval: This cross-sectional epidemiological study received approval from the Ethics Commission at Justus-Liebig University Gießen (AZ 72/22). All examinations were conducted in compliance with the ethical standards set by the Institutional Review Board (IRB) and the modified Helsinki Declaration [21]. Before all the examinations, all the included children and their legal guardians provided written consent., (© 2024. The Author(s).)

Aim: To analyse whether some selected inflammatory biomarkers collected from venous blood and gingival crevicular fluid (GCF) were associated with the outcome of non-surgical periodontal therapy., Materials and Methods: Two-hundred and nine patients affected by periodontitis were enrolled in the study, who had undergone steps I and II therapy as well as a non-surgical re-instrumentation (NSRI) of periodontal pockets after 6 months. Serum (SE), plasma (PL) and GCF samples were quantitatively analysed for the following inflammatory biomarkers: active matrix metalloproteinase-8 (aMMP-8), prostaglandin E2 (PGE2) and surfactant protein D (SP-D). Therapy outcomes were evaluated using a 'treat-to-target' endpoint (T2T) at the patient level, defined as ≤ 4 sites with pocket depth ≥ 5 mm., Results: Patients presented with 23 ± 6 teeth (mean ± SD) at baseline. After steps I and II therapy, 41.6% of the patients reached T2T and after NSRI 47.4%. Univariate analysis identified a potential association between high levels of PL-SP-D and more favourable treatment outcomes. Multivariate binary logistic regression adjusted for sex, mean baseline probing depth, diabetes and current smoking status confirmed an independent relationship between baseline PL-SP-D and the T2T after steps I and II therapy (aOR 0.432, p = 0.011), implying that a higher level PL-SP-D at baseline is associated with a > 50% reduced risk of failing T2T. However, no such association was found for PL-SP-D and NSRI., Conclusion: Higher baseline PL-SP-D levels might be associated with more favourable treatment outcomes after steps I and II therapy. This may be due to its role in the regulation of neutrophil function. However, further investigation is required to confirm this hypothesis. If proven, PL-SP-D could play a role as a biomarker for identifying individuals who respond differentially to primary therapy., (© 2024 The Author(s). Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Background: To investigate tooth-related factors that influence pocket closure (PC) and the reduction of pocket probing depths (PPD) after nonsurgical re-instrumentation (NSRI) as part of step 3 therapy., Methods: A total of 480 patients (10,807 teeth) presenting with residual pockets 6.33 ± 3.79 months after steps 1 and 2 of periodontal therapy were included and retrospectively analyzed before and 5.93 ± 4.31 months after NSRI. Reduction of PPD and PC rates following NSRI were associated with tooth-related factors, namely tooth type, arch, number of roots, furcation involvement (FI), pulp vitality, mobility, type of restoration, presence of plaque, and bleeding on probing (BOP), using mixed-effects regression models., Results: NSRI reduced periodontal pockets persisting after initial cause-related therapy by (mean ± SD) 1.32 ± 1.79 mm in PPD, and PC rate was 40%. Moderate pockets (4-5 mm) responded better to NSRI than deep pockets (≥ 6 mm) in terms of PC (51% vs. 16%). Both PPD reduction and PC rates of deep residual pockets were significantly influenced by tooth type, arch, number of roots, and presence of BOP., Conclusion: Tooth type, arch, number of roots, and presence of BOP at re-evaluation (before NSRI) had a significant and clinically relevant influence on NSRI as part of step 3 therapy. Considering these factors, particularly for deep residual pockets, may allow more tailored re-intervention., Plain Language Summary: The present study aimed to investigate the influence of tooth-related factors on the outcome of repeated nonsurgical therapy of periodontitis. Therefore, 480 patients (10,807 teeth) presenting with clinical symptoms of persistent periodontitis after initial therapy were administered repeated nonsurgical therapy and retrospectively analyzed. Therapy outcomes were associated with tooth-related factors, namely tooth type, tooth location (maxilla/mandible), number of roots, involvement of the root furcation area in multi-rooted teeth, pulp vitality, mobility, restoration, presence of plaque and bleeding upon periodontal probing, using mixed-effects models. The results revealed that repeated nonsurgical therapy was effective in reducing inflammation and clinical signs of disease, with moderate residual periodontal defects responding better than deep defects. Healing of deep defects after repeated nonsurgical therapy; however, was significantly influenced by the factors: tooth type, location, number of roots, and bleeding on probing. Considering these factors, particularly in deep residual defects which are commonly suggested to be treated surgically, may allow less invasiveness and thus a more tailored re-intervention., (© 2024 The Author(s). Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.)

Introduction: The aim of this cross-sectional epidemiological study was to record caries and enamel hypomineralisation (EH), including molar-incisor hypomineralisation (MIH), and assess associations between both entities in 8- to 10-year-olds from Bavaria, Germany., Methods: A total of 5,418 children (mean age 9.8 years; 2,726 females, 2,692 males) were examined using the dmft/DMFT index with additional inclusion of initial or non-cavitated carious lesions (it/IT). EHs were recorded in the primary (eh) and permanent dentition (EH), and individuals with different EH phenotypes were determined as follows: at least one EH, at least one hypomineralised second primary molar (HSPM), at least one hypomineralised first permanent molar (MIH), and at least one hypomineralised first permanent molar and incisor (M+IH). Multiple logistic regression models were constructed to assess association between caries and EH., Results: The percentage of children without caries in the permanent dentition (DMF = 0) was 88.9%. When data regarding initial carious lesions were included (IDMF = 0), the prevalence decreased to 75.7%. The caries experience was idmf/t = 1.6 and the IDMF/T = 0.6. The mean number of carious teeth in subjects with no eh/EH was higher than that in subjects with HSPM, MIH, or M+IH. The presence of HSPM, MIH, and M+IH was associated with a significantly lower probability of caries in the permanent dentition; the corresponding adjusted odds ratios were 0.55 (95% CI: 0.41-0.75), 0.67 (95% CI: 0.56-0.81), and 0.54 (95% CI: 0.41-0.72), respectively., Conclusions: Caries and EH are prevalent conditions in 8- to 10-year-old Bavarian schoolchildren; both dental diseases were negatively associated with each other., (© 2024 S. Karger AG, Basel.)

Objective: The imbalanced nature of real-world datasets is an ongoing challenge in the field of machine and deep learning. In medicine and in dentistry, most data samples represent patients not affected by pathologies, and on imagery, pathologic image areas are often smaller than healthy ones. Selecting suitable loss functions during deep learning is essential and may help to overcome the resulting imbalance. We assessed six different loss functions for one exemplary task, tooth structure segmentation on bitewing radiographs, for their performance., Methods: Six different loss functions (Focal Loss, Dice Loss, Tversky Loss and hybrid losses of Cross-Entropy and Dice Loss, Focal and Dice Loss, Focal and Generalized Dice Loss) were compared on a tooth structure segmentation task of 1,625 bitewing radiographs. Training was performed using three different model architectures (U-Net, Linknet, DeepLavbV3+) over a 5-fold cross-validation. Tooth structures consisted of the classes (occurrence in% of samples/captures areas measured on pixel level) enamel (100 %/25 %), dentin (100 %/50 %), root canal (100 %/10 %), filling (81 %/8 %) and crown (28 %/5 %)., Results: Hybrid loss functions significantly outperformed standalone ones and provided robust results over the different architectures for the classes enamel, dentin, root canal and filling. Specifically, the Dice Focal loss reached high performance to conquer both image level and pixel level class imbalance, respectively., Clinical Significance: In dental use cases it is often important to predict minority classes such as pathologies accurately. Using specific loss function may be an effective strategy to overcome data imbalance when training deep learning models., Competing Interests: Declaration of competing interest FS and JK are co-founders of the startup dentalXrai GmbH. dentalXrai GmbH did not have any role in conceiving, conducting or reporting this study. The authors are solely responsible for the contents of this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: Clinical trials testing new devices require prior training on dummies to minimize the "learning curve" for patients. Dentists were trained using a novel water jet device for mechanical cleaning of dental implants and with a novel cold plasma device for surface functionalisation during a simulated open flap peri-implantitis therapy. The hypothesis was that there would be a learning curve for both devices., Materials and Methods: 11 dentists instrumented 44 implants in a dummy-fixed jaw model. The effect of the water jet treatment was assessed as stain removal and the effect of cold plasma treatment as surface wettability. Both results were analysed using photographs. To improve treatment skills, each dentist treated four implants and checked the results immediately after the treatment as feedback., Results: Water jet treatment significantly improved from the first to the second implant from 62.7% to 75.3% stain removal, with no further improvement up to the fourth implant. The wettability with cold plasma application reached immediately a high level at the first implant and was unchanged to the 4th implant (mean scores 2.7 out of 3)., Conclusion: A moderate learning curve was found for handling of the water jet but none for handling of the cold plasma., Clinical Relevance: Scientific rational for study: Two new devices were developed for peri-implantitis treatment (Dental water jet, cold plasma). Dentists were trained in the use of these devices prior to the trial to minimize learning effects., Principal Findings: Experienced dentists learn the handling of the water jet very rapidly and for cold plasma they do not need much training., Practical Implications: A clinical study is in process. When the planned clinical study will be finished, we will find out, if this dummy head exercise really minimised the learning curve for these devices., (© 2024. The Author(s).)

Periodontal diseases pose a significant global health burden, requiring early detection and personalized treatment approaches. Traditional diagnostic approaches in periodontology often rely on a "one size fits all" approach, which may overlook the unique variations in disease progression and response to treatment among individuals. This narrative review explores the role of artificial intelligence (AI) and personalized diagnostics in periodontology, emphasizing the potential for tailored diagnostic strategies to enhance precision medicine in periodontal care. The review begins by elucidating the limitations of conventional diagnostic techniques. Subsequently, it delves into the application of AI models in analyzing diverse data sets, such as clinical records, imaging, and molecular information, and its role in periodontal training. Furthermore, the review also discusses the role of research community and policymakers in integrating personalized diagnostics in periodontal care. Challenges and ethical considerations associated with adopting AI-based personalized diagnostic tools are also explored, emphasizing the need for transparent algorithms, data safety and privacy, ongoing multidisciplinary collaboration, and patient involvement. In conclusion, this narrative review underscores the transformative potential of AI in advancing periodontal diagnostics toward a personalized paradigm, and their integration into clinical practice holds the promise of ushering in a new era of precision medicine for periodontal care., (© 2024 The Author(s). Periodontology 2000 published by John Wiley & Sons Ltd.)

Background: We investigated the efficacy of two different cold atmospheric pressure jet plasma devices (CAP09 and CAPmed) and an air polishing device with glycine powder (AP) either applied as monotherapies or combined therapies (AP + CAP09; AP + CAPmed), in microbial biofilm removal from discs with anodised titanium surface., Methods: Discs covered with 7-day-old microbial biofilm were treated either with CAP09, CAPmed, AP, AP + CAP09 or AP + CAPmed and compared with negative and positive controls. Biofilm removal was assessed with flourescence and electron microscopy immediately after treatment and after 5 days of reincubation of the treated discs., Results: Treatment with CAP09 or CAPmed did not lead to an effective biofilm removal, whereas treatment with AP detached the complete biofilm, which however regrew to baseline magnitude after 5 days of reincubation. Both combination therapies (AP + CAP09 and AP + CAPmed) achieved a complete biofilm removal immediately after cleaning. However, biofilm regrew after 5 days on 50% of the discs treated with the combination therapy., Conclusion: AP treatment alone can remove gross biofilm immediately from anodised titanium surfaces. However, it did not impede regrowth after 5 days, because microorganisms were probably hidden in holes and troughs, from which they could regrow, and which were inaccessible to AP. The combination of AP and plasma treatment probably removed or inactivated microorganisms also from these hard to access spots. These results were independent of the choice of plasma device., (© 2024. The Author(s).)

Objectives: Artificial Intelligence has applications such as Large Language Models (LLMs), which simulate human-like conversations. The potential of LLMs in healthcare is not fully evaluated. This pilot study assessed the accuracy and consistency of chatbots and clinicians in answering common questions in pediatric dentistry., Methods: Two expert pediatric dentists developed thirty true or false questions involving different aspects of pediatric dentistry. Publicly accessible chatbots (Google Bard, ChatGPT4, ChatGPT 3.5, Llama, Sage, Claude 2 100k, Claude-instant, Claude-instant-100k, and Google Palm) were employed to answer the questions (3 independent new conversations). Three groups of clinicians (general dentists, pediatric specialists, and students; n = 20/group) also answered. Responses were graded by two pediatric dentistry faculty members, along with a third independent pediatric dentist. Resulting accuracies (percentage of correct responses) were compared using analysis of variance (ANOVA), and post-hoc pairwise group comparisons were corrected using Tukey's HSD method. ACronbach's alpha was calculated to determine consistency., Results: Pediatric dentists were significantly more accurate (mean±SD 96.67 %± 4.3 %) than other clinicians and chatbots (p < 0.001). General dentists (88.0 % ± 6.1 %) also demonstrated significantly higher accuracy than chatbots (p < 0.001), followed by students (80.8 %±6.9 %). ChatGPT showed the highest accuracy (78 %±3 %) among chatbots. All chatbots except ChatGPT3.5 showed acceptable consistency (Cronbach alpha>0.7)., Clinical Significance: Based on this pilot study, chatbots may be valuable adjuncts for educational purposes and for distributing information to patients. However, they are not yet ready to serve as substitutes for human clinicians in diagnostic decision-making., Conclusion: In this pilot study, chatbots showed lower accuracy than dentists. Chatbots may not yet be recommended for clinical pediatric dentistry., Competing Interests: Declaration of competing interest The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: To conduct a systematic review of the published scientific evidence to evaluate the efficacy of nonsurgical periodontal therapy (NSPT) in treating periodontitis in patients with concurrent systemic conditions (diabetes, CVD, erectile dysfunction, chronic kidney disease, rheumatoid arthritis, polycystic ovarian syndrome, obesity, pregnancy). We hypothesised that NSPT results in better periodontal outcomes when compared to untreated controls after follow-up., Materials and Methods: A systematic search (PUBMED/EMBASE) was conducted from 1995 to 2023 to identify randomised controlled trials (RCTs) with a minimum follow-up of 3 months. The primary outcome was the difference in mean probing depth (PD), and the secondary outcomes were mean clinical attachment loss (CAL), percentage of sites with PD ≤ 3 mm (%PD ≤ 3 mm) and percentage of sites with bleeding on probing (%BOP) between the treated and untreated control group in patients with comorbidities., Results: The electronic search resulted in 2,403 hits. After removing duplicates, 1,565 titles and abstracts were screened according to the eligibility criteria, resulting in 126 articles for full-text screening. Following this, 44 studies were analysed. Restricting to studies with low bias or some concerns, NSPT group demonstrated a 0.55 mm lower mean PD (95%CI: -0.69; -0.41) after 3 months compared to the control group., Conclusion: Compared to the untreated controls, NSPT notably reduced mean PD, mean CAL, and %BOP while increasing %PD ≤ 3 mm in patients with concurrent systemic conditions. These findings suggest that NSPT is also an effective procedure in managing periodontitis in patients with concurrent systemic conditions., Trial Registration: This systematic review was registered under the protocol registration number CRD42021241517/PROSPERO., (© 2023. The Author(s).)

(1) Background: We aimed to identify factors associated with the presence of apical lesions (AL) in panoramic radiographs and to evaluate the predictive value of the identified factors. (2) Methodology: Panoramic radiographs from 1071 patients (age: 11-93 a, mean: 50.6 a ± 19.7 a) with 27,532 teeth were included. Each radiograph was independently assessed by five experienced dentists for AL. A range of shallow machine learning algorithms (logistic regression, k-nearest neighbor, decision tree, random forest, support vector machine, adaptive and gradient boosting) were employed to identify factors at both the patient and tooth level associated with AL and to predict AL. (3) Results: AL were detected in 522 patients (48.7%) and 1133 teeth (4.1%), whereas males showed a significantly higher prevalence than females (52.5%/44.8%; p < 0.05). Logistic regression found that an existing root canal treatment was the most important risk factor (adjusted Odds Ratio 16.89; 95% CI: 13.98-20.41), followed by the tooth type 'molar' (2.54; 2.1-3.08) and the restoration with a crown (2.1; 1.67-2.63). Associations between factors and AL were stronger and accuracy higher when using fewer complex models like decision tree (F1 score: 0.9 (0.89-0.9)). (4) Conclusions: The presence of AL was higher in root-canal treated teeth, those with crowns and molars. More complex machine learning models did not outperform less-complex ones.

Aim: To determine the long-term effects of the use of powered tooth brush (PTB) in comparison to manual tooth brush (MTB) on periodontitis severity, coronal caries experience, and the number of missing teeth using in a population-based cohort study., Materials and Methods: Using 7-year follow-up data of 2214 participants of the Study of Health in Pomerania (SHIP-TREND), comprehensively adjusted linear models using generalized least squares and ordinal regression models estimated the effects of PTB usage on dental outcomes in complete case and imputed data., Results: At follow-up, PTB users had lower medians for mean probing depth (PD; 2.21 mm) and mean clinical attachment levels (1.73 mm) than MTB users (2.30 and 1.96 mm, respectively). Adjusted models revealed the beneficial effects of PTB usage on follow-up levels of plaque, bleeding on probing, mean PD, percentage of sites with PDs ≥4 mm, mean clinical attachment levels (all, interdental, and non-interdental sites, respectively), and the number of missing teeth. For the number of missing teeth, the effects were more pronounced in participants aged ≥50 years. No significant effects of PTB usage on the number of decayed or filled surfaces (all and interdental sites) were found., Conclusions: A recommendation of PTB usage in dental practice could contribute to the long-term promotion of oral health., (© 2023 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

The present study aimed to meta-analyze and evaluate the certainty of evidence for resin infiltration of proximal carious lesions in primary and permanent teeth. While resin infiltration has been shown efficacious for caries management, the certainty of evidence remains unclear. The protocol was registered with PROSPERO (CRD42018080895), and PRISMA guidelines have been followed. The databases PubMed, Embase, and Cochrane CENTRAL were systematically screened, complemented by hand searches and cross-referencing. Eleven relevant articles were identified and included, i.e., randomized controlled trials (RCTs) comparing the progression of resin infiltrated proximal caries lesions (combined with non-invasive measures) in primary or permanent teeth with non-invasive measures. Random-effects meta-analyses and trial sequential analyses (TSA) were performed for per-protocol (PP), intention-to-treat (ITT), and best/worst case (BC/WC) scenarios. Six included trials assessed lesions in permanent teeth and five trails assessed lesions in primary teeth. The trials had a high or unclear risk of bias. Risk of caries progression was significantly reduced for infiltrated lesions in the PP, ITT, and BC scenarios in both permanent teeth and primary teeth, but not in the WC scenario. According to the TSA, firm evidence was reached for all of the scenarios except the WC. In conclusion, there is firm evidence for resin infiltration arresting proximal caries lesions in permanent and primary teeth.

Peri-implantitis-associated inflammation can lead to bone loss and implant failure. Current decontamination measures are ineffective due to the implants' complex geometry and rough surfaces providing niches for microbial biofilms. A modified water jet system (WaterJet) was combined with cold plasma technology (CAP) to achieve superior antimicrobial efficacy compared to cotton gauze treatment. Seven-day-old multi-species-contaminated titanium discs and implants were investigated as model systems. The efficacy of decontamination on implants was determined by rolling the implants over agar and determining colony-forming units supported by scanning electron microscopy image quantification of implant surface features. The inflammatory consequences of mono and combination treatments were investigated with peripheral blood mononuclear cell surface marker expression and chemokine and cytokine release profiles on titanium discs. In addition, titanium discs were assayed using fluorescence microscopy. Cotton gauze was inferior to WaterJet treatment according to all types of analysis. In combination with the antimicrobial effect of CAP, decontamination was improved accordingly. Mono and CAP-combined treatment on titanium surfaces alone did not unleash inflammation. Simultaneously, chemokine and cytokine release was dramatically reduced in samples that had benefited from additional antimicrobial effects through CAP. The combined treatment with WaterJet and CAP potently removed biofilm and disinfected rough titanium implant surfaces. At the same time, non-favorable rendering of the surface structure or its pro-inflammatory potential through CAP was not observed.

Aim: This study aimed to identify the factors influencing the changes in the number of teeth present and the number of healthy or filled surfaces between two time points., Materials and Methods: Repeated cross-sectional data from population-based studies, namely the German Oral Health Studies (DMS-III vs. DMS-V), the Studies of Health in Pomerania (SHIP-START-0 vs. SHIP-TREND-0), and the Jönköping study (2003 vs. 2013), were analysed. Oaxaca decomposition models were constructed for the outcomes (number of teeth, number of healthy surfaces, and number of filled surfaces)., Results: The number of teeth increased between examinations (DMS: +2.26 [adults], +4.92 [seniors], SHIP: +1.67, Jönköping: +0.96). Improvements in education and dental awareness brought a positive change in all outcomes. An increase in powered toothbrushing and inter-dental cleaning had a great impact in DMS (adults: +0.25 tooth, +0.78 healthy surface, +0.38 filled surface; seniors: +1.19 teeth, 5.79 healthy surfaces, +0.48 filled surface). Inter-dental cleaning decreased by 4% between SHIP-START-0 and SHIP-TREND-0, which negatively affected the outcomes., Conclusions: From this study, it can be concluded that education may be the most important factor having a direct and indirect effect on the outcomes. However, for better oral health, powered toothbrushing and inter-dental cleaning should not be neglected., (© 2022 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Background: Peri-implantitis therapy is a major problem in implantology. Because of challenging rough implant surface and implant geometry, microorganisms can hide and survive in implant microstructures and impede debridement. We developed a new water jet (WJ) device and a new cold atmospheric pressure plasma (CAP) device to overcome these problems and investigated aspects of efficacy in vitro and safety with the aim to create the prerequisites for a clinical pilot study with these medical devices., Methods: We compared the efficiency of a single treatment with a WJ or curette and cotton swab (CC) without or with adjunctive use of CAP (WJ + CAP, CC + CAP) to remove biofilm in vitro from rough titanium discs. Treatment efficacy was evaluated by measuring turbidity up to 72 h for bacterial re-growth or spreading of osteoblast-like cells (MG-63) after 5 days with scanning electron microscopy. With respect to application safety, the WJ and CAP instruments were examined according to basic regulations for medical devices., Results: After 96 h of incubation all WJ and CC treated disks were turbid but 67% of WJ + CAP and 46% CC + CAP treated specimens were still clear. The increase in turbidity after WJ treatment was delayed by about 20 h compared to CC treatment. In combination with CAP the cell coverage significantly increased to 82% (WJ + CAP) or 72% (CC + CAP), compared to single treatment 11% (WJ) or 10% (CC)., Conclusion: The newly developed water jet device effectively removes biofilm from rough titanium surfaces in vitro and, in combination with the new CAP device, biologically acceptable surfaces allow osteoblasts to grow. WJ in combination with CAP leads to cleaner surfaces than the usage of curette and cotton swabs with or without subsequent plasma treatment. Our next step will be a clinical pilot study with these new devices to assess the clinical healing process., (© 2022. The Author(s).)

Background: Periodontitis is among the most common chronic diseases worldwide, and it is one of the main reasons for tooth loss. Comprehensive profiling of the metabolite content of the saliva can enable the identification of novel pathways associated with periodontitis and highlight non-invasive markers to facilitate time and cost-effective screening efforts for the presence of periodontitis and the prediction of tooth loss., Methods: We first investigated cross-sectional associations of 13 oral health variables with saliva levels of 562 metabolites, measured by untargeted mass spectrometry among a sub-sample (n = 938) of the Study of Health in Pomerania (SHIP-2) using linear regression models adjusting for common confounders. We took forward any candidate metabolite associated with at least two oral variables, to test for an association with a 5-year tooth loss over and above baseline oral health status using negative binomial regression models., Results: We identified 84 saliva metabolites that were associated with at least one oral variable cross-sectionally, for a subset of which we observed robust replication in an independent study. Out of 34 metabolites associated with more than two oral variables, baseline saliva levels of nine metabolites were positively associated with a 5-year tooth loss. Across all analyses, the metabolites 2-pyrrolidineacetic acid and butyrylputrescine were the most consistent candidate metabolites, likely reflecting oral dysbiosis. Other candidate metabolites likely reflected tissue destruction and cell proliferation., Conclusions: Untargeted metabolic profiling of saliva replicated metabolic signatures of periodontal status and revealed novel metabolites associated with periodontitis and future tooth loss., (© 2021. The Author(s).)

Background: Currently, there is no comprehensive presentation of trends in oral diseases in the German general population over the last 20 years., Objectives: How did prevalences of caries, periodontitis, and tooth loss and their determinants change in Germany between 1997 and 2014?, Materials and Methods: We analysed data from 35- to 44-year-olds and 65- to 74-year-olds from the German Oral Health Studies ("Deutsche Mundgesundheitsstudien" [DMS]) III to V and of 25- to 74-year-olds from the Studies of Health in Pomerania (SHIP‑0 and SHIP-Trend-0). The decayed, missing, filled teeth index (DMFT), the number of sound teeth, the community periodontal index (CPI), and data on tooth count and edentulism were analysed., Results: Regarding determinants, an increase in subjects with high school education, a slight decrease in smokers, and an increase in better oral hygiene patterns was observed in both studies. In 35- to 44-year-olds, the number of sound teeth increased from 11.9 in DMS III to 16.8 in DMS V, while in 65- to 74-year-olds the number of sound teeth increased by 5.9. A similar trend was observed in SHIP. In DMS, the prevalence of the highest CPI score of 4 decreased from 9.3% to 3.5% in 35- to 44-year-olds; in 65- to 74-year-olds, the 2014 prevalence was at the same level as in 1997 (10.5% and 9.8%). In parallel, the percentage of edentulous 65- to 74-year-olds halved in both studies. The number of teeth increased across all age strata., Conclusions: DMS and SHIP consistently showed an increase in the number of healthy teeth free of fillings, a slight reduction of subjects with a CPI score of 4, more tooth retention, and less edentulism. Because of more tooth retention and current demographic changes, higher periodontal treatment needs might be expected for the future.

Objectives: We aimed at investigating whether the interaction between the local inflammation, periodontitis, and obesity is independently associated with systemic inflammation., Methods: From the population-based Study of Health in Pomerania, 3366 participants, without (2366) and with (1000) obesity, were studied for the association of periodontitis, measured as probing depth (PD) and plaque together with body mass index (BMI) on C-reactive protein (CRP). Quantile regression was used to evaluate the association between periodontal, anthropometric, and inflammatory variables (outcomes)., Results: The overall prevalence of obesity in this adult population was 31.4% in men and 28.1% in women. Both PD and plaque were positively associated with CRP, revealing an increasing impact across the CRP concentration distribution. Adjusting the regression of CRP or fibrinogen on PD for waist circumference attenuated but did not abolish the PD coefficients. Dental plaque was similarly associated with these interrelations. Association between PD and a dental plaque was different among participants with low-, medium-, or high-risk CRP concentrations., Conclusion: Local and systemic sources of inflammation contribute to blood levels of inflammatory markers. The respective contributions depend on the relative rate in each of the inflammation-inducing risks and are dominated by adiposity., Clinical Relevance: Keeping systemic inflammation low in order to prevent age-related disease sequelae.

This in vitro study evaluated the shear bond strength (SBS), failure mode and microleakage of fissure sealing materials in relation to different etching times on aprismatic and prismatic enamel. Ninety-six healthy human third molars were randomly allocated to the following groups: 1) prismatic or aprismatic enamel; 2) etching: 15, 30, 45, 60 s. After 5,000-fold thermocycling SBS, failure mode and microleakage were measured. Statistical evaluation included Mann-Whitney-U-test and linear regression analysis. In the aprismatic enamel group, an increasing etching time resulted in higher SBS. The linear regression model revealed that 60 s of etching time led to a significant increase in SBS. Microleakage was found to be low in all test groups. This study indicated that 60 s of etching time showed to a significantly better SBS. When considering the small differences of SBS, failure modes and microleakage between 30 and 60 s etching time, 30 s acid etching seems to also be justifiable.

Objective: This study aimed to assess oral health-related quality of life (OHRQoL) in relation to associated covariates in orthodontic patients of different age groups (children, adolescents, and adults) in a cross-sectional study., Methods: A total of 898 subjects (50.6% females, 49.4% males; mean age 16.89 years) undergoing orthodontic treatment anonymously completed the German version of the Oral Health Impact Profile (OHIP-G14) to assess OHRQoL in addition to completing 23 other items. Descriptive, exploratory statistical analysis and multiple linear regression modelling were performed., Results: The mean score of the OHIP-G14 was 8.3 for the 6- to 11-year olds, 8.9 for the 12- to 17-year olds, and 12.6 for adults. Physical pain (Subscale 2) was the highest factor in all groups. Additionally, a relevant factor was Subscale 3 (psychological discomfort). A linear regression model showed that, in the adolescent group, aesthetics in combination with pain had a significant negative influence on OHRQoL, whereas, in the adult group, function in combination with pain showed the same significant negative influence. Second, except for the children, fixed appliances had a significant negative effect on OHRQoL compared to removable appliances., Conclusions: Our study showed that the majority of the 6- to 11-year olds and 12- to 17-year olds reported a good OHRQoL. Nevertheless, adolescents and adults who reported aesthetic/pain and function/pain problems, respectively, as reasons for orthodontic treatment showed a significant occurrence for reduced OHRQoL. Fixed appliances, in comparison with removable appliances, also resulted in a significant reduction in OHRQoL for both groups., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: Although dental trauma and its unfavorable sequelae are considered major public health problems worldwide, the published data on the prevalence of traumatic crown injuries (TCIs) in Germany are lacking. Therefore, the present study assessed the prevalence of TCIs among adolescents in Bavaria, Germany., Material and Methods: Ethical approval and parental consents were obtained, and population-based information from 10- (N = 1158), 12- (N = 416), and 15-year-olds (N = 1302) from two different cohort studies performed in Bavaria (GINIplus/LISA and LAGZ) were examined for the presence of TCIs, dental caries, and restorations. Statistical comparisons were made using Mann-Whitney U test and Wilcoxon signed-rank test., Results: The prevalence of TCIs was 6.3% in the 10- and 12-year-old children and 14.0% in 15-year-old children, and a higher prevalence was observed in boys than in girls. Most (87.5%) of the traumatized teeth were maxillary incisors. The caries prevalence was low in all three populations., Conclusion: The prevalence of TCIs in Bavarian adolescents at a low risk for caries was found to be low., Clinical Relevance: Dental trauma is a prevalent event in children and adolescents, and incisors are the most affected teeth. Therefore, dental practitioners should be able to manage the spectrum of traumatic injuries.

Aims: This study aimed to assess 11-year longitudinal effects of powered toothbrush on periodontal health, caries and tooth loss in an adult population., Materials and Methods: Participants of Study of Health in Pomerania (SHIP) cohort with dental examinations and interview data at SHIP-1, SHIP-2 or SHIP-3 examinations were included. Mixed-effects linear regression models were constructed between the exposure (manual versus powered toothbrush) and outcome variables (periodontal status using mean probing depth (PD) and mean clinical attachment loss (CAL), caries status using DMFS and DFS scores, and tooth loss), adjusting for potential baseline covariates., Results: Final baseline (SHIP-1) study sample comprised of 2,819 participants. Powered toothbrush users increased from 18.3% (SHIP-1) to 36.9% (SHIP-3); were younger; had significantly less mean PD [β: -0.09 (95% CI: -0.16; -0.02)] and mean CAL [β: -0.19 (95% CI: -0.32; -0.07)] progressions; and had 17.7% less DMFS progression and 19.5% more teeth retained than the manual toothbrushers., Conclusions: In the long-term, powered toothbrush seems to be effective in reducing mean PD and mean CAL progressions, besides increasing the number of teeth retained., (© 2019 The Authors. Journal of Clinical Periodontology Published by John Wiley & Sons Ltd.)

Aim: This study compared the diagnostic outcomes of visual inspection (VI), digital bitewing radiography (BWR), and near-infrared light transillumination (NIR-LT, DIAGNOcam, KaVo, Biberach, Germany) for occlusal caries detection and assessment of posterior teeth., Participants and Methods: This study included 203 patients (mean age 23.0 years). All individuals received a meticulous VI. Additionally, BWR and NIR-LT images were collected. All BWR and NIR-LT images were blindly evaluated for the presence of enamel caries lesions (ECLs) and dentin caries lesions (DCLs). The descriptive statistical analyses included calculation of frequencies, cross tabulations, and pairwise comparisons using Pearson chi-square tests., Results: The majority of ECLs/DCLs were detected by VI in this low-risk adult population. The additional diagnostic outcomes in terms of ECLs/DCLs amounted to 5.0% (BWR) and 6.8% (NIR-LT). The combined usage of VI/NIR-LT or VI/BWR identified 95.7 and 94.4% of all ECLs/DCLs on occlusal surfaces, respectively., Conclusion: This comparative diagnostic study showed that VI detected the majority of occlusal caries lesions. Both additional methods showed limited benefits. Due to the valuable features of NIR-LT, i.e., X-ray freeness and clinical practicability, this method might be preferred over X-ray-based methods. Nevertheless, BWRs should be prescribed in clinical situations where insufficient fillings or multiple (deep) caries lesions are diagnosed or where there is a need to assess the caries extension in relation to the pulp., Clinical Relevance: VI has to be understood as caries detection method of choice on occlusal surfaces in low-risk adult population which may help to avoid multiple diagnostic testing, overdiagnosis, and overtreatment.

Objectives: The aim of the present study was to evaluate the adaptation of a calcium silicate bioceramic (BC) sealer with either BC or conventional gutta-percha compared with that of AH Plus sealer in different root canal sections., Materials and Methods: Seventy-two extracted mandibular premolars were divided randomly into six groups. After standardised chemomechanical preparation, four groups were obturated with the BC sealer and BC gutta-percha or conventional gutta-percha, and the other two groups were obturated with AH Plus sealer and conventional gutta-percha either in lateral compaction or in a single cone technique. Each root was sectioned into three sections. An impression was made from each section, and replicas were then made for scanning electron microscopy (SEM) analysis. Areas and interfacial gaps were identified using image analysis software. In addition to descriptive and explorative data analyses, linear regression analysis was performed., Results: All specimens had measurable interfacial gaps. Significantly fewer gaps were found between conventional gutta-percha and sealer compared to those observed when using the BC gutta-percha (p < 0.001). However, minor interfacial gaps between sealer and dentin were observed with the BC sealer (p = 0.04). The technique of obturation in different root canal sections did not significantly affect the sealer adaptability., Conclusion: The type of gutta-percha as well as the sealer had a noticeable impact on the adaptability., Clinical Relevance: Different obturation techniques will result in similar outcomes. However, within the limitations of the study, there seems to be no advantage in using the BC gutta-percha.

This study aimed to evaluate the shear bond strength (SBS) and microleakage of a new self-etch adhesive-based fissure sealant (EG) on aprismatic enamel in comparison to conventional fissure sealing with 30 s acid etching (CG). The fissures were sealed according to the manufacturer's instructions. Each group was divided into 3 subgroups: 1-day water storage, 3-month water storage, and 5,000× thermocycling. After measuring SBS using the Ultradent method, failure mode was analyzed. In additional 16 teeth, microleakage was tested using dye penetration method. Pairwise comparisons were analyzed using Mann-Whitney U-Test. Multiple linear regression was performed to assess the factors influencing on SBS. EG had significantly lower mean SBS (4.1 MPa±2.1) than the CG (17.6 MPa±6.4). CG (1.1%) performed significantly better than the EG (12.8%) in microleakage analysis. The tested EG yielded significantly inferior results and its clinical use should be decided after weighing its pros and cons.

Objectives: The purpose of this in vitro study was to evaluate the inter- and intraexaminer reliability of digital bitewing (DBW) radiography and near-infrared light transillumination (NIRT) for proximal caries detection and assessment in posterior teeth., Methods: From a pool of 85 patients, 100 corresponding pairs of DBW and NIRT images (~1/3 healthy, ~1/3 with enamel caries and ~1/3 with dentin caries) were chosen. 12 dentists with different professional status and clinical experience repeated the evaluation in two blinded cycles. Two experienced dentists provided a reference diagnosis after analysing all images independently. Statistical analysis included the calculation of simple (κ) and weighted Kappa (wκ) values as a measure of reliability. Logistic regression with a backward elimination model was used to investigate the influence of the diagnostic method, evaluation cycle, type of tooth, and clinical experience on reliability., Results: Altogether, inter- and intraexaminer reliability exhibited good to excellent κ and wκ values for DBW radiography (Inter: κ = 0.60/ 0.63; wκ = 0.74/0.76; Intra: κ = 0.64; wκ = 0.77) and NIRT (Inter: κ = 0.74/0.64; wκ = 0.86/0.82; Intra: κ = 0.68; wκ = 0.84). The backward elimination model revealed NIRT to be significantly more reliable than DBW radiography., Conclusions: This study revealed a good to excellent inter- and intraexaminer reliability for proximal caries detection using DBW and NIRT images. The logistic regression analysis revealed significantly better reliability for NIRT. Additionally, the first evaluation cycle was more reliable according to the reference diagnoses.

The aim of this study was to retrospectively investigate the development of a model-based, computer-assisted training approach for performing and charting periodontal examinations in a dental clinic in Germany. The study was initiated in summer semester 2013 and repeated in two consecutive semesters (S1: 44 students, S2: 48 students, and S3: 61 students) because technical features were introduced (S2: feedback and time control; S3: input control). In each semester, new dental students who had never performed periodontal examinations participated. Students were divided into two groups and received intense training at different time points. Agreement levels were calculated at baseline, after the first group received training, and after the second group received training. Comparisons were also made among the semesters. All 153 enrolled students in the three semesters participated. The results showed that probing depth accuracy significantly decreased in S1 from baseline to training completion (79.9% to 74.5%), and the probing depth accuracy significantly increased in S2 (76.1% to 78.9%) and S3 (77.2% to 82.3%). The students who received intense training at a late stage of the tutorial showed greater improvement, especially in the case of S3. Small changes in accuracy were observed for recession (S1: 94.5% to 96.1%; S2: 93.8% to 93.9%; S3: 95.4% to 96.6%). Accuracy for furcation involvement improved significantly in S1 (46.1% to 52.0%), S2 (46.8% to 59.7%), and S3 (44.2% to 58.3%); the improvements occurred when the students received intense training. The time taken for periodontal examination decreased significantly for S2 (23.6 to 14.2 min) and S3 (25.7 to 13.9 min). This study found that when feedback was provided, the students' periodontal examinations improved in accuracy and duration.

Objectives: This in vitro study evaluated the shear bond strength (SBS) and microleakage of three experimental self-etching primers for pit and fissure sealing., Materials and Methods: The material used three formulations of an experimental fissure primer (EFP) applied without phosphoric acid etching (EFP-1/EFP-2/EFP-3) and one control group with sealant application after 30 s of acid etching. Four groups of sealants (n = 40 specimens/group) were tested for SBS, and a failure analysis was conducted after 1-day water storage, 3-month water storage, and 5000-fold thermocycling. In addition, microleakage was tested., Results: The SBSs of the EFPs (range 8.2 MPa (standard deviation 4.2) to 15.4 MPa (5.4)) were generally significantly lower than those of conventional fissure sealing (range 15.6 MPa (4.4) to 19.1 MPa (6.2)). The SBS of EFP-3 was better than that of the EFP-1 or EFP-2 formulations. Microleakage was significantly lower in the control group (1.1 %) than in the EFP-1 (3.8 %) and lower than in EFP-3 (7.7 %) group. In the (multiple) linear regression analysis, material and aging significantly influenced SBS., Conclusions: The SBS of EFP-3 was 15 to 32 % lower than it was for the corresponding controls., Clinical Relevance: The SBS is lower, but the main potential benefit of this new approach is a reduced application time in clinical practice.

Objectives: Data on dental treatment of children with special healthcare needs (CSHCN) are sparse. Hence, this study provides information about the changes in the dental condition in a cohort of CSHCN treated in a university dental department in Germany., Material and Methods: Patient records of CSHCN treated from January 2004 to December 2012 were screened retrospectively for medical diagnoses (ICD-10) and the type of treatment performed with outpatient dental care (ODC) or general anesthesia (GA). Follow-up data of patients adhering to the recommended recall were recorded, including time and further treatments., Results: A total of 795 CSHCN with a mean age of 6.8 years were included. In 41.6 % (331/795) of cases, treatment was performed under ODC, and 58.4 % (464/795) received GA. Caries experience in CSHCN treated under GA was significantly higher (7.9 d 3/4 mft/0.9 D 3/4 MFT) than in ODC (2.5 d 3/4 mft /0.9 D 3/4 MFT). Over time, patient flow shifted from invasive (IC) to preventive-based care (PC)., Conclusion: Caries-related treatments were most frequent under GA and ODC, though initial caries experience was higher in GA patients. The choice of GA or ODC was statistically independent from the medical condition., Clinical Significance: This study provides characteristics of a large population of CSHCN treated with and without GA for dental care.

Aim: This cross-sectional study was repeated at two time points and investigated the influence of gingivitis, smoking and body mass index (BMI) on the systemic inflammatory markers high-sensitivity C-reactive protein (hs-CRP) and interleukin 6 (IL6) in 10- and 15-year-olds., Materials and Methods: The study sample of two birth cohorts, i.e. GINIplus and LISAplus, from the Munich centre consisted of 806 and 846 subjects who were evaluated at 10- and 15-year follow-ups respectively. Children and their parents completed questionnaires on participant-related lifestyle information. Gingivitis was measured at the sextant level using a simplified sulcus-bleeding index. Serum hs-CRP and IL6 levels were obtained from blood samples. Multiple logistic regressions adjusting for lifestyle-related factors and other confounders were performed to assess associations between the specified variables., Results: There were no associations between gingivitis and the inflammatory markers hs-CRP and IL6 in 10-year-olds. In 15-year-olds, gingivitis (aOR: 2.17; 95% CI: 1.25-3.77); daily smoking (aOR: 6.27; 95% CI: 1.39-28.39); and being overweight/obese (aOR: 4.95; 95% CI: 0.73-33.68) were identified as significantly influencing factors for elevated hs-CRP values. Oral hygiene did not influence hs-CRP., Conclusion: In this study, hs-CRP was positively associated with gingivitis, smoking daily and overweight/obesity among 15-year-olds., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: With respect to the unknown aetiology of molar incisor hypomineralisation (MIH), it is unclear whether this phenomenon was overlooked in the last century as a result of a high number of caries in children or if this developmental disorder was not present until then. Therefore, this study determined the presence of MIH in historical dentitions and teeth., Materials and Methods: Dental remains from late medieval (n = 191, twelfth-sixteenth century, Regensburg, Germany), post-medieval (n = 33, sixteenth-eighteenth century, Passau, Germany) and modern age archaeological skeletal series (n = 99, nineteenth-twentieth century, Altdorf, Germany) were examined for MIH. In addition, linear enamel hypoplasia (LEH), diffuse opacities, hypoplasia and Turner's teeth were documented., Results: MIH-related demarcated opacities or enamel breakdowns were found in only 15 (0.4 %) of the 3891 examined permanent teeth. Ten cases (3.1 %) from a total of 323 dentitions were classified as having MIH. In contrast, 98 individuals (30.3 %) showed LEH. Other enamel disorders were recorded in 64 individuals (19.8 %)., Conclusion: With respect to the low number of affected dentitions and teeth, MIH most likely did not exist or was at least rarely present in the investigated archaeological case series., Clinical Relevance: This study supports the hypothesis that MIH may be linked to contemporary living conditions or other health-related factors.

The aim of this study was to develop and test models for training dental students in periodontal examinations using manikins that had distinct anatomical designs but were indistinguishable in external appearance. After four models were tested for inter- and intra-examiner reliability by two experienced dentists, 26 additional models were produced. The models were tested by 35 dental students at a dental school in Germany in 2014. The testing involved completing a periodontal examination that included probing depths, gingival recessions, and furcation involvements. The primary purpose of the study was to determine whether the models could be used as a tool for periodontal examination training by the students. Levels of agreement (students and dentists) and Kappa statistics (dentists) were calculated using absolute (±0 mm) and tolerable difference (±1 mm). Over the span of two weeks, the dentists' reliability with preset values for probing depths, gingival recessions, and furcation involvements ranged from 0.29 to 0.38, 0.52 to 0.61, and 0.54 to 0.57, respectively, under absolute difference and from 0.86 to 0.90, 0.96 to 0.99, and 0.62 to 0.73, respectively, under tolerable difference. The students' proportions of agreement for probing depths and gingival recessions under absolute vs. tolerable difference were 34.8% vs. 79.9% and 71.9% vs. 94.4%, respectively. The students frequently scored values higher than the preset values, overestimated furcation involvements, and failed to differentiate the levels of furcations. The models used did not pose any systematic or technical difficulties in the pilot study. Students were unable to measure furcation involvements with acceptable agreement. Thus, these models could be used for student periodontal examination training.

Objective: This 2-year longitudinal study in 2- and 3-year-old kindergarten children investigated lesion progression on different surfaces of primary teeth., Methods: The study was conducted between September 2008 and September 2010 on a sample of 400 children from the Kyffhäuser district (Thuringia, Germany). A calibrated investigator recorded (non)cavitated caries lesions according to World Health Organization (WHO), International Caries Detection and Assessment System (ICDAS) and Universal Visual Scoring System (UniViSS) criteria. Nonparametric methods and linear regression using a mixed-effects model with an unbalanced design were used for data analysis., Results: There was a significant increase in the prevalence of noncavitated caries lesions during the 2-year period, with the highest chance for change on all surfaces compared to cavitated lesions. First visible sign lesions on occlusal surfaces had the highest chance for change (estimate 0.38), whereas established lesions revealed the highest chance for change on proximal (estimate 1.05) and smooth surfaces (estimate 0.62). Proximal lesions exhibited the greatest chance for change irrespective of severity level., Conclusion: Our study demonstrated that each type of carious lesion had different changing rates. Greater lesion severity correlated with greater chances to change and receive treatment. This information is crucial for dental practitioners in decision-making processes., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The aims of this clinical study were to investigate the diagnostic accuracy of near-infrared light transillumination (NILT) as a novel X-ray-free method for proximal dentin caries detection and to compare this method to established diagnostic methods., Materials and Methods: A total of 127 interproximal dentin caries lesions without any cavity within visible dentin in posterior teeth from 85 consecutively selected patients were included. Visual and radiographic diagnoses and laser fluorescence measurements were available. NILT images were obtained, and a dentin lesion was predicted if a demineralisation involved the enamel-dentin junction (NILT-EDJ) or a shadow in dentin was detectable (NILT-dentin). Included lesions were opened and validated (reference standard). The statistical analyses included descriptive analyses and calculations of sensitivity, specificity and Az values., Results: The diagnostic accuracy with respect to the reference standard was 1.6% for visual inspection, 66.7% for laser fluorescence, 96.1% for digital radiography, 29.1% for NILT-dentin and 99.2% for NILT-EDJ. Bitewings (Az 0.984) and NILT-EDJ (Az 0.992) performed equally., Conclusion: Given the lack of true negatives in the study, the diagnostic accuracy of NILT achieved the same level as bitewings for the detection of proximal dentin caries., Clinical Relevance: This study might indicate that NILT could reduce the usage of bitewings.

The aim of this study was to evaluate shear bond strength (SBS) and microleakage of a self-etching adhesive (Adper Prompt L-Pop) in comparison to acid etching prior fissure sealing. Each procedure was tested with 3 aging procedures (1-day water storage, 3-month water storage and 1-day water storage/5,000× thermocycling). SBS was determined according to ISO standard 29022. Additional 30 third molars were utilized for the microleakage analyses. Data were analyzed using Mann-Whitney-U-Test and multiple linear regression models. The SBS of the self-etching adhesive were significantly lower (14.9, 11.9, and 13.0 MPa) than those of conventional fissure sealing (19.1, 18.2, and 15.6 MPa). Multiple linear regression models predicted that material and alteration significantly influenced SBS. The microleakage revealed no difference between both groups (1.3% vs. 1.2%). It can be concluded that the selfetching adhesive might be a pre-treatment alternative for fissure sealing in terms of the easier and shorter clinical workflow.

Purpose: To examine the influence of different adhesive restoration protocols on the survival of composite resin restorations in primary teeth., Materials and Methods: This study included 601 patients at risk of caries (319 males and 282 females), with a mean age of 6.6 years (range: 1 to 13 years) and an average need for 3.6 restorations per patient (range: 1 to 20). The mean observation period was 1.3 years (± 1.4), with a maximum of 7 years. Six different adhesive restoration protocols with respect to etching, adhesives, and composite materials were analyzed. The statistical analyses included descriptive analyses and a Cox regression model from which hazard ratios (HR with 95% CI) for protocols and possible predictors were calculated., Results: The mean dmft was 6.6 (± 4.0), which indicates a high risk population. Secondary caries was the most frequent reason for loss of restoration in this study (52.2%). Out of 2146 restorations, 368 failed; the mean annual failure rate was 13.2%. Adhesive restoration protocols that employed a self-etching system performed significantly better (HR range: 1.0 to 1.8) than did the etch-and-rinse system (HR range: 1.8 to 2.8). Protocols using only flowable materials had a moderately increased probability of failure., Conclusion: With respect to the practice-based study design, young age, and high risk of caries in this population, comparatively high failure rates were observed for direct composite restorations in primary dentition, but adhesive restoration protocols using self-etching adhesives in combination with universal composites yielded a higher probability of survival.

Purpose: This study investigated the influence of several methodological details on the shear bond strength (SBS) testing of pit and fissure sealants. The following variables were considered: type of enamel surfaces, prismatic vs aprismatic enamel, etching time, and aging and shearing procedures., Materials and Methods: The surfaces of 180 healthy human third molars were divided into 4 different sections (mesial, distal, buccal, and oral). After tooth separation, the specimens were randomly allocated to the following groups: 1) enamel preparation: prismatic vs aprismatic; 2) etching: 30 s vs 60 s; 3) aging: 1 day or 3 months vs 5000 thermocycles; 4) shearing: notched-edge method (ISO 29022:2013) vs knife-edge method. After following each protocol, SBS was determined using a universal testing machine, followed by failure mode analysis. Data were analysed using Mann-Whitney U-tests and regression analyses., Results: In the aprismatic enamel group, the longer etching time resulted in slightly, not statistically significantly higher SBS. When aging sealants on aprismatic enamel with different procedures, significantly lower SBS was found for 5000 thermocycles. In the case of aprismatic enamel etched for 60 s and sheared with the notched-edge blade, there was no significant difference between the aging procedures. Failure mode analysis showed adhesive failures to be predominant. Simple linear regression revealed that all of the included factors significantly influenced SBS. In a multiple linear regression model, the variables "aprismatic enamel" and "distal surface" were associated with a higher SBS; "5000 thermocycles" reduced SBS significantly., Conclusion: Enamel grinding, aging method, and type of enamel surface significantly influenced the SBS.