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Objectives The FDI criteria for the evaluation of direct and indirect dental restorations were first published in 2007 and updated in 2010. Meanwhile, their scientific use increased steadily, but several questions from users justified some clarification and improvement of the living document. Materials and methods An expert panel (N = 10) initiated the revision and consensus process that included a kick-off workshop and multiple online meetings by using the Delphi method. During and after each round of discussion, all opinions were collected, and the aggregated summary was presented to the experts aiming to adjust the wording of the criteria as precisely as possible. Finally, the expert panel agreed on the revision. Results Some categories were redefined, ambiguities were cleared, and the descriptions of all scores were harmonized to cross-link different clinical situations with possible management strategies: reviewing/monitoring (score 1–4), refurbishment/reseal (score 3), repair (score 4), and replacement (score 5). Functional properties (domain F: fracture of material and retention, marginal adaptation, proximal contact, form and contour, occlusion and wear) were now placed at the beginning followed by biological (domain B: caries at restoration margin, hard tissue defects, postoperative hypersensitivity) and aesthetic characteristics (domain A: surface luster and texture, marginal staining, color match). Conclusion The most frequently used eleven categories of the FDI criteria set were revised for better understanding and handling. Clinical relevance The improved description and structuring of the criteria may help to standardize the evaluation of direct and indirect restorations and may enhance their acceptance by researchers, teachers, and dental practitioners.

Objectives Active matrix metalloproteinase-8 (aMMP-8) biomarkers can be used in chair side tests for the detection of periodontitis or peri-implantitis and for targeting and monitoring individual therapy. Combined with effective secondary preventive measures, this procedure can reduce tooth loss and related costs. The authors evaluated whether out-of-pocket costs for the patient can be saved additionally. Methods A health economic evaluation of the total costs for secondary preventive versus prosthodontic measures was performed from the patient’s perspective using a Markov-based state transition model with three health states of periodontitis. The intervention group used aMMP-8 biomarker diagnostics in addition to standard prevention services in Germany; the control group received standard care only. Starting age of the patients was 35 years; the modelled period was 50 years. Additionally, a first estimate of the costs for patients with implants for a period of three decades was made. Key findings In the first decade (age group 35–44 years), patients from the intervention group initially have to bear additional costs of 929.53 € compared with the control group. From the age group 45–54 years, the savings potential for the patient increases continuously. Total costs of the intervention group, including additional aMMP-8 assessments, are 32 310.82 € compared with 47 452.04 € in the control group for the 50-year period. The greatest savings potential for patients with aMMP-8 screening and monitoring is in the field of dentures (−18.521.91 €). For the subgroup of patients with implants, the first cost statement leads to costs of 12 672.66 € with additional use of aMMP-8 biomarker diagnostics (control group: 23 185.83 €). Conclusions Despite higher initial costs, secondary prevention not only improves oral health but also importantly can save significant costs in the long run. Especially in implant patients, need-based prevention can prolong the lifetime of dental implants and thus significantly save long-term treatment costs.

This in vitro investigation should identify the effect of protective liners on dentine bond strength of a polyacid modified resin composite to dentine of primary teeth.Forty-two extracted caries-free primary molars were randomly assigned to seven groups (n = 6) and flattened. Six test groups were centrally covered with different protective liners/base materials: Kerr Life (KL), IRM zinc oxide eugenol cement (IRM), Ketac Bond (KB), Vitrebond (VB), Dycal (DY), and mineral trioxide aggregate (MTA). Specimens were bonded with PrimeBond NT (PB) and restored with Dyract eXtra. The control group (C) did not receive liner pretreatment. After 24-h storage in Aqua dest. (37 °C), specimens were cut and regional microtensile bond strengths of the uncovered areas were tested. Fractography was conducted under a light microscope and further interface/surface analyses were performed under a SEM. Statistical appraisal was carried out using oneway ANOVA (mod. LSD test; p 0.05).Independent of the distance to the applied liner, all groups exhibited inferior μ-TBS to dentine of primary teeth compared to the control group (p 0.05). The results were as follows in MPa(SD)Protective liners significantly reduced μ-TBS to dentine of primary teeth.

Objectives The aim of this study was to investigate whether file design and taper significantly influence microcrack initiation during machine preparation. Materials and methods Sixty extracted teeth with straight single canals were selected. The teeth were randomly assigned to four groups based on their root canal anatomy and the corresponding NiTi rotary file system (I, Mtwo; II, ProTaper Universal; III, F6 SkyTaper; control, no preparation and filling). The root canals of the experimental groups were filled using the single-cone technique. The tested teeth were all subjected to a mechanical chewing simulation with flat lead loading over a period of 3 years (corresponding to 150,000 cycles). The teeth were checked for dentinal defects (accumulative crack growth in length) under the digital microscope (Keyence VHX-5000) at time 0 (baseline prior to chewing simulation) and after 3, 6, 12, 24, and 36 months of loading. The cumulative crack increase was statistically analyzed using the Kruskal–Wallis test, Jonckheere–Terpstra test, and the Wilcoxon rank-sum test. The significance was set at p Results In contrast to preparation with greater-tapered instruments, ProTaper Universal (group II) and F6 SkyTaper (group III) instrumentation with the smaller tapered Mtwo files (group I) showed less accumulative propagation of craze lines (p Conclusion Instruments with greater taper for root canal instrumentation should be used with care to avoid negative long-term effects in the form of propagation of dentinal defects over time. A positive cutting-edge angle and a smaller taper have a positive effect on a lower craze line development. Clinical relevance Instruments with a positive cutting-edge angle and a smaller taper are beneficial for the long-term preservation of dentinal tooth structure.

The energy dissipation capacity and damping ability of restorative materials used to restore deciduous teeth were assessed compared to common mechanical properties. Mechanical properties (flexural strength, modulus of elasticity, modulus of toughness) for Compoglass F, Dyract eXtra, SDR flow, Tetric Evo Ceram, Tetric Evo Ceram Bulk Fill, and Venus Diamond were determined using a 4-point bending test. Vickers hardness and Martens hardness, together with its plastic index (ηITdis), were recorded using instrumented indentation testing. Leeb hardness (HLD) and its deduced energy dissipation data (HLDdis) were likewise determined. The reliability of materials was assessed using Weibull analysis. For common mechanical properties, Venus Diamond always exhibited the significantly highest results and SDR flow the lowest, except for flexural strength. Independently determined damping parameters (modulus of toughness, HLDdis, ηITdis) invariably disclosed the highest values for SDR flow. Composite materials, including SDR flow, showed markedly higher reliabilities (Weibull modulus) than Compoglass F and Dyract eXtra. SDR flow showed pronounced energy dissipation and damping characteristics, making it the most promising material for a biomimetic restoration of viscoelastic dentin structures in deciduous teeth. Future developments in composite technology should implement improved resin structures that facilitate damping effects in artificial restorative materials.

Healthcare workers (HCWs) are at a high risk of SARS-CoV-2 infection due to exposure to potentially infectious material, especially during aerosol-generating procedures (AGP). We aimed to investigate risk factors for SARS-CoV-2 infection among HCWs in medical disciplines with AGP.A nationwide questionnaire-based study in private practices and hospital settings was conducted between 12/16/2020 and 01/24/2021. Data on SARS-CoV-2 infections among HCWs and potential risk factors of infection were investigated.2070 healthcare facilities with 25113 employees were included in the study. The overall infection rate among HCWs was 4.7%. Multivariate analysis showed that regions with higher incidence rates had a significantly increased risk of infection. Furthermore, hospital setting and HCWs in gastrointestinal endoscopy (GIE) had more than double the risk of infection (OR 2.63; 95% CI 2.50-2.82, p0.01 and OR 2.35; 95% CI 2.25-2.50, p0.01). For medical facilities who treated confirmed SARS-CoV-2 cases, there was a tendency towards higher risk of infection (OR 1.39; 95% CI 1.11-1.63, p=0.068).Both factors within and outside medical facilities appear to be associated with an increased risk of infection among HCWs. Therefore, GIE and healthcare delivery setting were related to increased infection rates. Regions with higher SARS-CoV-2 incidence rates were also significantly associated with increased risk of infection.Medizinisches Personal ist durch die Exposition gegenüber potenziell infektiösem Material einem erhöhten Infektionsrisiko ausgesetzt. Dies gilt insbesondere für Fachdisziplinen mit aerosolgenerierenden Prozeduren (AGP). Hierfür gibt es jedoch kaum Daten, insbesondere für den ambulanten Versorgungssektor. Ziel dieser Studie war es, die Häufigkeit sowie potenzielle Risikofaktoren für SARS-CoV-2-Infektionen bei medizinischem Personal von aerosolgenerierenden Disziplinen zu erheben und zu identifizieren.Zwischen dem 16.12.2020 und 24.01.2021 wurde eine bundesweite Umfrage in den Disziplinen der gastrointestinalen Endoskopie (GIE); Hals-, Nasen-, Ohrenheilkunde (HNO); Mund-, Kiefer-, Gesichtschirurgie (MKG) und der Zahn-, Mund-, Kieferheilkunde (ZMK) durchgeführt. Hierbei wurden Daten zu SARS-CoV-2-Infektionen beim medizinischen Personal sowie potenzielle Risikofaktoren erfasst.25113 Beschäftigte in 2070 Einrichtungen wurden in die Studie eingeschlossen. Die Gesamtinfektionsrate unter dem medizinischen Personal betrug 4,7 %. Die multivariate Analyse zeigte, dass Regionen mit höheren Inzidenzraten ein deutlich erhöhtes Infektionsrisiko aufwiesen. Außerdem war das Infektionsrisiko in Krankenhäusern und bei Beschäftigten der GIE um mehr als das Zweifache erhöht (OR 2,63; p0,01 und OR 2,35; p0,01). Ein tendenziell erhöhtes Infektionsrisiko bestand in Einrichtungen, die bestätigte SARS-CoV-2-Fälle behandelt haben (OR 1,39; p=0,068).Das SARS-CoV-2-Infektionsrisiko für medizinisches Personal wird sowohl von Faktoren innerhalb als auch Faktoren außerhalb von medizinischen Einrichtungen bestimmt. Die Fachrichtung der GIE sowie die Tätigkeit in einem Krankenhaus beeinflussen signifikant die Infektionsraten. Eine höhere SARS-CoV-2-Inzidenzrate in der Region geht ebenfalls mit einem signifikant erhöhten Infektionsrisiko einher.

ZusammenfassungDentales Amalgam wird seit über 180 Jahren erfolgreich in der zahnärztlichen Füllungstherapie kariöser Läsionen eingesetzt. Es ist langlebig, in der Verarbeitung wenig techniksensitiv und damit fehlertolerant. Seit vielen Jahren befindet sich das dentale Amalgam jedoch in der öffentlichen Diskussion, v. a. wegen seines Quecksilberanteils von ca. 50 %. Seit Veröffentlichung des „Minamata-Übereinkommens“ im Jahr 2013 mit dem primären Ziel, die Ausleitung anthropogenen Quecksilbers in die Umwelt zu reduzieren, ist die zwischenzeitlich fast verstummte Amalgamkritik wieder deutlich lauter geworden. Ein weiterer nicht unerheblicher Nachteil des Amalgams ist die silbrig-schwärzliche Farbe, die heute den ästhetischen Erfordernissen der Patienten oft nicht mehr entspricht.Der vorliegende Beitrag skizziert die Grundproblematik von Amalgam vor dem Hintergrund multipler biologischer, klinischer und gesundheitspolitischer Aspekte. Es wird Bezug genommen zu möglichen Auswirkungen, insbesondere des Minamata-Übereinkommens, auf gesetzliche Regelungen sowie auf die Verwendung von Werkstoffen und damit auch auf das Versorgungssystem der Zukunft. Außerdem werden mögliche Materialalternativen sowie biomedizinischer Forschungsbedarf auf dem Gebiet der restaurativen Zahnerhaltung dargestellt und abschließend die Frage gestellt, ob wir überhaupt die richtige Diskussion führen.

Objectives In-vitro evaluation of the influence of preparation design and thickness of ceramic veneers on the interfacial bond using optical coherence tomography (OCT). Methods Sixty-four central incisors were randomly assigned to four preparation designs differing from no to complete dentine exposure (n = 16 each): non-prep (NP), minimal-invasive (MI, no dentine exposure), semi-invasive (SI, 50% dentine) and invasive (I, 100% dentine). Ceramic veneers (IPS InLine Veneer) of two thicknesses (0.2−0.5 mm (T1) and > 0.5–1.2 mm (T2)) were etched, silanized, and adhesively luted (Optibond FL, Variolink Veneer). After water storage (37 °C, 21d), thermocycling (2000 cycles, 5°-55 °C), and mechanical loading (2 + 1 million cycles, 50 + 100 N) specimens were imaged by spectral-domain OCT (Telesto II, Thorlabs). Adhesive defects at the ceramic-composite and tooth-composite interfaces were quantified on 35 equidistantly distributed OCT B-scans (length, %). Statistical differences were verified with Wilcoxon-/Mann-Whitney-U-test (α = 0.05). Results Adhesive defects appeared in all groups at both interfaces, albeit to differing extents (0.1 – 31.7%). NP and MI veneers showed no significant differences at the interfaces (pi > 0.05). In groups, SI and I, significantly more adhesive defects appeared at the tooth-composite compared to the veneer-composite interface (pi ≤ 0.039). The following preparation designs and veneer thicknesses showed differences (pi ≤ 0.021): Veneer-composite: NP-T1 I-T2; Tooth-composite: NP-T1 MI-T2, MI-T1 Significance The interface adhesion of ceramic veneers was influenced by the preparation design and the veneer thickness. A ceramic thickness of at least 0.5 mm and a preparation without exposing dentine is advantageous for the interfacial bond.

Healthcare workers (HCW) who perform aerosol-generating procedures (AGP) are at high risk of SARS-CoV-2 infection. Data on infection rates and vaccination are limited. A nationwide, cross-sectional study focusing on AGP-related specialties was conducted between 3 May 2021 and 14 June 2021. Vaccination rates among HCW, perception of infection risk, and infection rates were analyzed, focusing on the comparison of gastrointestinal endoscopy (GIE) and other AGP-related specialties (NON-GIE), from the beginning of the pandemic until the time point of the study. Infections rates among HCW developed similarly to the general population during the course of the pandemic, however, with significantly higher infections rates among the GIE specialty. The perceived risk of infection was distributed similarly among HCW in GIE and NON-GIE (91.7%, CI: 88.6–94.4 vs. 85.8%, CI: 82.4–89.0; p < 0.01) with strongest perceived threats posed by AGPs (90.8%) and close patient contact (70.1%). The very high vaccination rate (100–80%) among physicians was reported at 83.5%, being significantly more frequently reported than among nurses (56.4%, p < 0.01). GIE had more often stated very high vaccination rate compared with NON-GIE (76.1% vs. 65.3%, p < 0.01). A significantly higher rate of GIE was reported to have fewer concerns regarding infection risk after vaccination than NON-GIE (92.0% vs. 80.3%, p < 0.01).

PurposeIn a combined in vitro/in vivo approach, tunnel vs. box-only resin composite restorations should be evaluated using thermomechanical loading (TML) in vitro and a restrospective clinical trial in vivo.Materials and methodsFor the in vitro part, box-only and tunnel cavities were prepared in 32 extracted human third molars under simulated intraoral conditions in a phantom head. Specimens were randomly assigned to four groups (n= 8; 16 box-only/16 tunnel) and received bonded resin composite restorations with Amelogen Plus (box A/tunnel A) or lining with Ultraseal and Amelogen plus (box B/tunnel B) both bonded using PQ1 (all Ultradent). Specimens were subjected to a standardized aging protocol, 1-year water storage (WS) followed by TML (100,000 × 50 N; 2500 × + 5/+ 55 °C). Initially and after aging, marginal qualities were evaluated using replicas at × 200 magnification (SEM). For the corresponding in vivo observational study, 229 patients received 673 proximal resin composite restorations. From 371 tunnel restorations, 205 cavities were filled without flowable lining (tunnel A), and 166 tunnels were restored using UltraSeal as lining (tunnel B). A total of 302 teeth received conventional box-only fillings. Restorations were examined according to modified USPHS criteria during routine recalls up to 5 years of clinical service.ResultsIn vitro, all initial results showed 100% gap-free margins when a flowable lining was used. Tunnels without lining exhibited some proximal shortcomings already before TML and even more pronounced after TML (p< 0.05). After TML, percentages of gap-free margins dropped to 87–90% in enamel with lining and 70–79% without lining (p< 0.05). In vivo, annual failure rates for box-only were 2.2%, for tunnel A 6.1%, and for tunnel B 1.8%, respectively (p< 0.05). Tunnels had significantly more sufficient proximal contact points than box-only restorations (p< 0.05). Flowable lining was highly beneficial for clinical outcome of tunnel-restorations (p< 0.05).ConclusionsWith a flowable lining, tunnel restorations proved to be a good alternative to box-only resin composite restorations.Clinical relevanceClass II tunnel restorations showed to be a viable alternative for box-only restorations, however, only when flowable resin composite was used as adaptation promotor for areas being difficult to access.

ZusammenfassungDie Covid-19-Pandemie hat das deutsche Gesundheitssystem im Jahr 2020 vor erhebliche Herausforderungen gestellt. In diesem Zusammenhang ist es bemerkenswert, dass für die Zahnmedizin kein sogenannter Rettungsschirm aufgespannt wurde. Dies bedeutet, dass nach Ansicht der Bundesregierung Zahnärzte als nicht systemrelevant eingestuft wurden und somit offiziell auch nicht zu den Ärzten gehören. Diese Annahme ist grundfalsch und gefährlich, wie im Folgenden anhand eines wichtigen Beispiels erörtert wird.Das SARS-CoV-2-Virus führt bei infizierten Personen zu einem Beschwerdebild von leichten Erkältungszeichen bis hin zu lebensbedrohlichen beatmungsbedürftigen COVID-19-Pneumonien. Ein besonderes Risiko für schwere Verläufe haben Menschen höheren Alters sowie Patienten mit Diabetes, Bluthochdruck und anderen schweren Erkrankungen. Die Haupteintrittspforte für das SARS-CoV-2-Virus in den menschlichen Körper ist u. a. die orale Mukosa, denn die Viren reichern sich dort bevorzugt an und der ACE2-Rezeptor wird dort hochgradig exprimiert. Dieser Penetrationsweg erklärt die häufigeren schweren Verläufe bei älteren Diabetespatienten, deren Immunsystem bereits generell beeinträchtigt ist. Diabetes mellitus induziert eine chronische systemische Entzündung, die sich gerade im Mundbereich regelmäßig als Parodontitis manifestiert. Bei Diabetikern zwangsläufig oft auftretende Hyperglykämien schwächen die Mukosa-Barriere zusätzlich. Es ist daher dringend ratsam, bei Präventionsmaßnahmen für Diabetespatienten den Mund- und Rachenraum nicht zu ignorieren. Neben der parodontalprophylaktischen Betreuung ist gerade in Absenz von Zahnärzten die aktivierte Matrix-Metalloproteinase 8 (aMMP8) ein etablierter Biomarker. Die aktuellen Empfehlungen zur Prävention der SARS-CoV-2-assoziierten COVID-19-Erkrankung sollte daher um die Aspekte der Messung und Sanierung des Mund- und Rachenraums sowie einer regelmäßigen Desinfektion der oralen Mukosa erweitert werden.

The aim of the present cross-sectional study was to assess and compare the prevalence of MIH among 6–12-year-old school children living either in a rural area of Central Hesse (Germany) or in the city of Frankfurt on the Main (Germany). A possible association between hypomineralised second primary molars (HSPM) and MIH was investigated. Furthermore, the MIH prevalence data of the rural area were compared with those of a previous study conducted in this area in the school year 2002/2003. In the school year 2014/2015, 2103 children (6–12 years of age) were examined during the annual school-based dental examinations prescribed by law at nine schools in the rural area of Central Hesse (LDK) and five schools in the city of Frankfurt on the Main (Ffm). Eight previously calibrated dentists working for the public healthcare authorities assessed the prevalence of HSPM/MIH (EAPD criteria/severity scale by Wetzel and Reckel) and the caries experience (dmft/DMFT). The prevalence of HSPM/MIH amounted 3.2%/9.4% in LDK and 2.9%/17.4% in Ffm. In the majority of cases, children with MIH had demarcated opacities. In LDK, hypomineralised first permanent molars were most commonly affected by severity degree 2, whereas in Ffm, severity degree 1 was predominant. Children suffering from HSPM had an odds ratio of 11.32 (95% CI: 6.73–19.03) for having MIH as well. Compared with the results of 2002/2003 in LDK (prevalence of MIH 5.9%), the MIH prevalence increased by 3.5% in the rural area. All in all, the caries experience among children under investigation was low (DMFT 0.14–0.15). MIH may be diagnosed in school children living in different areas of Germany with regional variations (rural-urban comparison). The presence of HSPM is of predictive value for MIH. The increasing number of hypomineralised first permanent molars over 12 years of time in the rural area indicates a need for further investigation on the aetiology of MIH.

To investigate the clinical behavior of two different resin-based restorative systems in extended Class II cavities in a controlled prospective split-mouth study over 12 years and to assess marginal quality under a SEM using epoxy replicas.Thirty patients received 68 resin composite restorations (Solobond M+Grandio: n=36; Syntac+Tetric Ceram: n=32) by one dentist in a private practice. 35% of cavities revealed no enamel at the bottom of the proximal box, 48% of cavities provided0.5mm remaining proximal enamel. Restorations were examined according to modified USPHS criteria at baseline, and after six months, one, two, four, six, eight, 10, and 12 years. Expoxy replicas of 21 restoration pairs were analysed under a SEM at 200× magnification regarding marginal quality.At the 12-years recall, 59 of the original 68 restorations in 27 of 30 patients were available (drop out 13%). Two restorations failed due to cusp fracture (Tetric Ceram) and marginal fracture (Grandio). The overall success rate of all restorations was 97.1% (Kaplan-Meier survival algorithm) with no differences between the two materials (p=0.923). After 144 months of clinical service, restorations in molars performed worse than in premolars regarding the integrity of restoration and tooth (p0.05) being detected as wear, chippings, and cracks. Beyond the 4-year recall, marginal staining significantly increased. SEM evaluation of replicas revealed that perfect margin (49% baseline vs. 10% after 12 years), overhang (13% at baseline vs. 3% after 12 years), negative step formation (34% at baseline vs. 75% after 12 years), and marginal fractures (0% at baseline vs. 6% after 12 years) significantly changed during the evaluation period (p0.001).Extended direct resin composite restorations performed satisfactorily over 12 years of clinical service. SEM analysis delivered qualitative data regarding marginal deterioration over time.

Aim of the present prospective study was to clinically evaluate the long-term performance of two different luting-materials for leucite-reinforced glass-ceramic inlays/onlays after 14 years.A total of 83 IPS-Empress-inlays/onlays were placed in 30 patients. Restorations were luted according to two different strategies: 43 restorations were fixed with a self-adhesive resin-cement (RelyXUnicem, RX), 40 restorations were inserted with VariolinkII-low (SV) after pretreatment with an etch-and-rinse multi-step adhesive. Recalls were performed after two weeks (n=83), two years (n= 82), four years (n=74) and 14 years (n=54). Two independent calibrated examiners evaluated all restorations using modified USPHS-criteria. Statistical analysis was performed using pairwise Mann-Whitney-U-test and Friedman-test (p0.05).After 14 years, 54 restorations in 22 patients were evaluated (eight patients equalling 29 inlays not available). Ten restorations had to be replaced (failure rate 12%); four (SV-group) showed bulk fractures and two (RX-group) exhibited marginal fractures at the 14-year recall. Overall, the SV-group revealed significantly better results regarding discoloration of the luting gap (p0.05) compared to the RX-group. No statistically significant differences were computed between SV and RX for the remaining criteria at the respective recalls (p0.05). However, statistically significant deteriorations were detected for both luting procedures over 14 years regarding "colour match", "marginal integrity" and "tooth integrity" (p0.05).The self-adhesive resin-cement RelyXUnicem showed similar clinical performance to a conventional multi-step luting-procedure after 14 years for most of the test parameters with a slightly inferior performance of RelyXUnicem regarding discoloration of the luting gap.The current study presents unique in-vivo long-term data on two adhesion-strategies for indirect ceramic single-tooth restorations. Differences in performance of the two luting methods after being challenged for 14 years in the oral environment are highlighted. However, the overarching survival rate justifies the recommendation of both methods for clinical routine.

Since untreated dental caries remain a worldwide burden, this umbrella review aimed to assess the quality of evidence on the clinical effectiveness of different restorative materials for the treatment of carious primary teeth. A literature search in electronic bibliographic databases was performed to find systematic reviews with at least two-arm comparisons between restorative materials and a follow-up period ≥12 months. Reviews retrieved were screened; those eligible were selected, and the degree of overlap was calculated using the ‘corrected covered area’ (CCA). Data were extracted and the risk of bias was assessed using the ROBIS tool. Fourteen systematic reviews with a moderate overlap (6% CCA) were included. All materials studied performed similarly and were equally efficient for the restoration of carious primary teeth. Amalgam and resin composite had the lowest mean failure rate at 24 months while high-viscosity and metal-reinforced glass ionomer cements had the highest. At 36 months, high-viscosity glass ionomer cements showed the highest failure rate with compomer showing the lowest. Most reviews had an unclear risk of bias. Within the limitations of the review, all materials have acceptable mean failure rates and could be recommended for the restoration of carious primary teeth.

Materials 14(24), 7733 (2021). doi:10.3390/ma14247733 special issue: "Special Issue "Endodontics" / Special Issue Editor: Prof. Dr. Edgar Sch��fer,", Published by MDPI, Basel

Background Immediate microtensile bond strength (µTBS) of self-etch (SE) adhesives to primary dentine is promising but evidence about the durability is scarce. Aim To assess the long-term µTBS of SE-adhesives to primary dentine and to examine the effect of 7 s etching on µTBS of a 3-step etch-and-rinse (ER) adhesive. Design Enamel of 115 caries-free human primary teeth was ground flat and bonding was performed according to group assignment: G-aenial™ Bond/GC [GB], Clearfil™ SE Bond/Kuraray [CS], OptiBond™ XTR/Kerr [OX], Scotchbond™ Universal/3M™ [SU], Prime&Bond® NT™ /Dentsply [PB], OptiBond™ FL/Kerr [OF]. After storage (24 h, 6 mos., 12 mos.), 1,762 beams were cut for µTBS testing. Fracture analysis was performed light / fluorescence microscopically. Resin-dentine interfaces were exemplarily analyzed using SEM. Results After 24 h, OX and SU showed significantly higher mean estimated µTBS than GB, which exhibited the lowest µTBS at all stages (p 0.05). OF_SE produced acceptable µTBS. Etching increased the mean immediate µTBS for OF (p > 0.05) and the percentage of cohesive fractures. Conclusions SE-adhesives achieved durable μTBS to primary dentine. 7 s etching may improve the immediate µTBS of a 3-step ER-adhesive.

(1) Background: The COVID-19 pandemic forced healthcare workers to adapt to challenges in both patient care and self-protection. Dental practitioners were confronted with a potentially high possibility of infection transmission due to aerosol-generating procedures. This study aims to present data on healthcare worker (HCW) screening, infection status of HCWs, pre-interventional testing, the use of personal protective equipment (PPE) and the economic impact of the pandemic in dental facilities. (2) Methods: Dental facilities were surveyed nationwide using an online questionnaire. The acquisition of participants took place in cooperation with the German Society for Dentistry, Oral and Maxillofacial Medicine. (3) Results: A total of 1094 private practices participated. Of these, 39.1% treated fewer than 600 patients per quarter and 59.9% treated over 600 patients per quarter. Pre-interventional testing was rarely performed in either small (6.6%) or large practices (6.0%). Large practices had a significantly higher incidence of at least one SARS-CoV-2-positive HCW than small practices (26.2% vs.14.4%, p < 0.01). The main source of infection in small practices was the private environment, and this was even more significant in large practices (81.8% vs. 89.7%, p < 0.01). The procedure count either remained stable (34.0% of small practices vs. 46.2% of large practices) or decreased by up to 50% (52.6% of small practices vs. 44.4% of large practices). Revenue remained stable (24.8% of small practices vs. 34.2% of large practices) or decreased by up to 50% (64.5% of small practices vs. 55.3% of large practices, p = 0.03). Overall, employee numbers remained stable (75.5% of small practices vs. 76.8% of large practices). A vaccination readiness of 60–100% was shown in 60.5% (n = 405) of large practices and 59.9% (n = 251) of small practices. (4) Conclusion: Pre-interventional testing in dental practices should be increased further. Economic challenges affected small practices as well as large practices. Overall, a steady employee count could be maintained. Vaccination readiness is high in dental practices, although with some room for improvement.

Objective: The aim of this study was to investigate the utility of the active matrix metalloproteinase (aMMP-8)-point-of-care (PoC) test as a quantitative real-time chair-side diagnostic tool for peri-implant diagnosis, as well as assess the potentially developing and ongoing risk relative to the traditional clinical methods. Background: Current peri-implant and periodontal disease diagnoses rely on clinical arid radiological examinations. This case-control study investigated the applicability of aMMP-8-PoC immunotest for quantitative real-time diagnosis and monitoring of dental implants in health and disease. Methods: Sixty-eight patients visiting a specialist clinic for maintenance following dental implant placement underwent assessment of their peri-implant health. aMMP-8-PoC peri-implant sulcular fluid (PISF) lateral-flow immunotests were performed using ImplantSafe (R) technology quantitated by ORALyzer (R). In addition, the PISF samples were analyzed for total MMP-8, calprotectin, and interleukin (IL)-6 by enzyme-linked immunosorbent assays (ELISA), aMMP-8 by western immunoblot, and MMP-2 and MMP-9 by gelatin zymography. Results: The aMMP-8-PoC test promptly recorded and reflected peri-implant disease, differentiating it clearly from health. X-ray findings (bone loss > 2 mm), peri-implant pocket depth >= 3 mm, and bleeding on probing were significantly more prevalent among implants positive for the aMMP-8-PoC test. aMMP-8/ORALyzer analysis was more precise in recording disease than total MMP-8, calprotectin, IL-6, MMP-2, and MMP-9. Conclusions: The aMMP-8-PoC test can be conveniently implemented to alert for and detect active collagenolysis affecting peri-implant tissues, both in the early and advanced stages of the disease. Active and fragmented MMP-8 exhibits a strong and significant association with peri-implantitis as compared to total MMP-8 arid other biomarkers and can be utilized as the POC/chairside biomarker of choice in the new classification of peri-implantitis.

This study aimed to compare the amount of debris extrusion of four endodontic systems made of Nickle-Titanium alloy. This in vitro study was done on 80 extracted primary molars. They were selected by cone-beam computed tomography and randomly divided into four groups (n = 20) to be prepared to the apical size of 25 by one of the systems: Reciproc, Protaper Universal, Neolix, or Hyflex CM. Debris was collected into Eppendorf microtubes and placed in an incubator to evaporate the washing solution. Debris was weighed by a digital scale of 0.01 g precision. Data were statistically analysed using SPSS software. Tukey's comparison was used to determine the difference between the four file systems (α = 0.05). Debris extrusion after Reciproc preparation (0.00320) was significantly higher than the other (P 0.05), with no significant difference having been observed among the other systems (P 0.05). It can be concluded that all systems under investigation exhibited debris extrusion.

ObjectiveHealthcare workers (HCW) are at high risk of SARS-CoV-2 infection due to exposure to potentially infectious material, especially during aerosol-generating procedures (AGP). We aimed to investigate the prevalence of infection among HCW in medical disciplines with AGP.DesignA nationwide questionnaire-based study in in- and outpatient settings was conducted between 12/16/2020 and 01/24/2021. Data on SARS-CoV-2 infections among HCW and potential risk factors were investigated.Results2,070 healthcare facilities with 25,113 employees were included in the study. Despite a higher rate of pre-interventional testing, clinics treated three times more confirmed SARS-CoV-2 cases than private practices (28.8% vs. 88.4%, pConclusionHCW in GIE seem to be at higher risk of infection than those in other AGP, especially in the clinical setting. Regions having comparably higher incidences as well as the number of procedures performed per day were also significantly associated with increased risk of infection.Significance of this studyWhat is already known on this subject?Health care workers, especially those exposed to aerosol generating procedures, are assumed to have an increased risk of SARS-CoV-2 infection. However, data confirming this are lacking, especially for the outpatient care setting.What are the new findings?Health care workers in gastrointestinal endoscopy have a higher risk of SARS-CoV-2-infection than in other AGPs. This risk is particularly higher-in clinical settings compared to private practices-in regions having comparably higher incidences-the more procedures are performed per dayHow might it impact on clinical practice in the foreseeable future?Our study suggests making additional efforts to protect HCW in the gastrointestinal work field.

Aim Diode lasers are commonly used for antimicrobial photodynamic therapy (aPDT). This study aimed to assess the feasibility of transgingival laser irradiation during aPDT and evaluate whether the photosensitizer can be activated. Materials and Methods Four diode laser settings were assessed for transgingival irradiation: 120 mW, 80 mW, 60 mW, and 40 mW. Fifteen soft-tissue pieces from a pig’s lower jaw were prepared. The specimens’ thickness was measured and transgingival laser irradiation was performed. A digital power meter measured laser power on the other side of the tissue. The power outcome after staining of the nonbuccal aspect of the tissue with photosensitizer dye was assessed similarly. Results Transgingival laser irradiation (average soft-tissue thickness: 0.84 ± 0.06 mm) resulted in different power transmission depending on the power settings and photosensitizer. The lowest values were observed with the 40 mW setting and photosensitizer (median 3.3 mW, max. 5.0 mW, min. 2.3 mW, interquartile range 1.2), and the highest at 120 mW without photosensitizer (median 41.3 mW, max. 42.7 mW, min. 38.0 mW; interquartile range 1.5). Conclusions This study indicates that transgingival irradiation may be suitable for aPDT, since power transmission through the gingival tissue was observed in all specimens. However, the decrease in laser power caused by both the soft tissue and the photosensitizer has to be taken into account.

Objective To investigate secondary caries inhibition after dentine pre-treatment with 2% CHX, experimental addition of CHX in primer and adhesive of a 3-step adhesive system, and industrial addition od CHX in a 2-step adhesive system. Materials and method Sixty Class-V cavities were restored according to the adhesive protocol (n = 12): 1) control group, Scotchbond Multi-Purpose, 3M (CTRL), 2) 2% CHX dentine pre-treatment (DENT), 3) 0.1% CHX in primer (PRIM), 4) 0.1% CHX in bonding agent (BOND), 5) Peak Universal Bond including 0.2% CHX (PEAK). Specimens were thermocycled (10,000 cycles) and inserted into a Streptococcus mutans biofilm artificial mouth (caries model). The 10-day biological loading protocol consisted of consecutive phases of demineralisation (1 h) and remineralisation (5 h). Evaluation under a fluorescence microscope (demineralisation) and an SEM (marginal gap) followed, at restoration margins, and at 0.3 mm and 0.5 mm distance from the margins, in enamel and in dentine. Total demineralization was calculated as the sum of demineralisation and substance loss due to demineralisation. Results PRIM (p = 0.007, mod. LSD), BOND (p = 0.012, mod. LSD) and PEAK (p = 0.008, mod. LSD) exhibited significantly higher total demineralisation values in enamel margins than CTRL. No significant differences were noted for total demineralisation in dentine. Regarding marginal gaps, DENT exhibited significantly lower enamel gap values compared to all other groups (p = 0.001). Conclusions 2% CHX as dentine pre-treatment, 0.1% or 0.2% CHX added in adhesives did not provide any antibacterial effect regarding secondary caries in dentine. On the other hand, 2% CHX dentine pre-treatment managed to limit marginal gap formation in enamel compared to the other adhesive protocols in the study.

Due to the SARS-CoV-2 pandemic, dental treatment performed by undergraduate students at the University of Marburg/Germany was immediately stopped in spring 2020 and stepwise reinstalled under a new hygiene concept until full recovery in winter 2020/21. Patient treatment in the student courses was evaluated based on three aspects: (1) Testing of patients with a SARS-CoV-2 Rapid Antigen (SCRA) Test applied by student assistants (SA), (2) Improved hygiene regimen, with separated treatment units, cross-ventilation, pre-operative mouth rinse and rubber dam application wherever possible, (3) Recruitment of patients: 735 patients were pre-registered for the two courses, 384 patients were treated and a total of 699 tests with the SCRA test were performed by SAs. While half of the patients treated in the course were healthy, over 40% of the patients that were pre-registered but not treated in the course revealed a disease being relevant to COVID (p &lt, 0.001). 46 patients had concerns to visit the dental hospital due to the increase of COVID incidence levels, 14 persons refused to be tested. The presented concept was suitable to enable patient treatment in the student course during the SARS-CoV-2 pandemic.

BACKGROUND Due to limited aesthetics of stainless-steel crowns, the demand for tooth-coloured crowns has recently risen. Up to now, few studies have investigated the marginal integrity and wear behaviour of tooth-coloured primary molar crowns under subcritical load in vitro. AIM This in vitro study evaluated the marginal quality and wear of newly introduced resin composite and hybrid ceramic crowns compared with metal and zirconia crowns. DESIGN Metal, resin composite, hybrid ceramic (CAD/CAM), and various zirconia crowns were investigated. After thermomechanical loading (2,500 thermocycles/100,000 × 50N), marginal quality of luting gaps and wear of crowns/antagonists were evaluated using replicas under a light or 3D laser scanning microscope. Results were analysed with the Mann-Whitney U test or one-way ANOVA (p

Dental amalgam has been successfully used for the restoration of carious lesions for more than 180 years. It is clinically characterized by high longevity and low technique sensitivity. For decades, dental amalgam has been discussed in the public, especially due to its roughly 50% mercury content. Since the Minamata Convention was published in 2013 with the primary goal of reducing the anthropogenic mercury release into the environment, the previously muted amalgam discussion has received fresh impetus. Another considerable disadvantage of amalgam is its silver/greyish color, which simply no longer matches patients' esthetic demands.The present paper describes the basic problems with amalgam against the background of multiple biological, clinical, and health policy factors. Possible consequences of the Minamata Convention concerning legal regulations as well as the use of dental biomaterials and therefore also relating to the future national healthcare system are discussed. Finally, possible amalgam alternatives and the urgent need for biomedical research towards restorative dentistry are presented, embedded into the crucial question of whether we are actually conducting the correct debate.Dentales Amalgam wird seit über 180 Jahren erfolgreich in der zahnärztlichen Füllungstherapie kariöser Läsionen eingesetzt. Es ist langlebig, in der Verarbeitung wenig techniksensitiv und damit fehlertolerant. Seit vielen Jahren befindet sich das dentale Amalgam jedoch in der öffentlichen Diskussion, v. a. wegen seines Quecksilberanteils von ca. 50 %. Seit Veröffentlichung des „Minamata-Übereinkommens“ im Jahr 2013 mit dem primären Ziel, die Ausleitung anthropogenen Quecksilbers in die Umwelt zu reduzieren, ist die zwischenzeitlich fast verstummte Amalgamkritik wieder deutlich lauter geworden. Ein weiterer nicht unerheblicher Nachteil des Amalgams ist die silbrig-schwärzliche Farbe, die heute den ästhetischen Erfordernissen der Patienten oft nicht mehr entspricht.Der vorliegende Beitrag skizziert die Grundproblematik von Amalgam vor dem Hintergrund multipler biologischer, klinischer und gesundheitspolitischer Aspekte. Es wird Bezug genommen zu möglichen Auswirkungen, insbesondere des Minamata-Übereinkommens, auf gesetzliche Regelungen sowie auf die Verwendung von Werkstoffen und damit auch auf das Versorgungssystem der Zukunft. Außerdem werden mögliche Materialalternativen sowie biomedizinischer Forschungsbedarf auf dem Gebiet der restaurativen Zahnerhaltung dargestellt und abschließend die Frage gestellt, ob wir überhaupt die richtige Diskussion führen.

Objective The aim of this interlaboratory round robin test was to prove the robustness of the DIN EN ISO 6872:2019 and to identify the influence of processing and testing variations. Methods Each of the 12 laboratories participated (A–L) received 60 (n = 720) assigned zirconia specimens. All participants seperated the specimens from the blanks, sintered them, polished half of all specimens and performed the biaxial flexural test (DIN EN ISO 6872:2019). The surface roughness was determined by using tactile measuring device. Fractographic examination was performed under scanning-electron-microscopy (SEM). Data was analysed using Kolmogorov–Smirnov-, Kruskal–Wallis-, Mann–Whitney-U-test and two-parametric Weibull statistic (p Results The results for both preparation methods (as-fired and polished) showed significant differences for some participants. The values for as-fired groups ranged between 513 (I) and 659 (E) MPa. H showed higher Weibull modulus than C, E and I. Within polished groups flexural strengths values from 465 (L) to 1212 (E) MPa were observed, with a tendency to clustered groups A, I, J, L (465–689 MPa) and remaining groups (877–1212 MPa). E presented the highest and H the lowest Weibull modulus. Within A and J, no impact of the preparation method on flexural strength values was observed. Within L, as-fired specimens showed higher flexural strength than polished ones. The flexural strength increase did only associate to a certain extent with measured surface roughness. Fractography showed defect populations depending on polishing techniques, associated to the strength level, especially for polished groups. Reduced strength is related to machining defects, regardless of the surface state. Significance DIN EN ISO 6872:2019 can be seen as guidance to biaxial flexural strength testing but additional effort is necessary to ensure interlaboratory comparability. Calibrated furnaces and reliable sintering conditions are mandatory requirements together with detailed specifications on finishing or polishing procedures. Biaxial flexural testing is really a matter of understanding specimen preparation, alignment and mechanical testing by itself. DIN EN ISO 6872:2019 should further recommend reporting of mean surface roughness along with any biaxial flexural strength data. Fractography is a mandatory tool in interpretation and understanding of strength data.

Dental caries constitutes a public health challenge. As preventive strategies are desirable, this retrospective cohort study aimed to assess the caries experience and increment in children attending kindergartens with an early childhood caries (ECC) preventive program (intervention group, IG) compared to basic prophylaxis measures (control group, CG) located in areas of different socioeconomic status (SES) within Marburg (Germany). The long-term caries experience (2009–2019) of these 3–5-year-old kindergarten children was evaluated. For the caries increment, dental records of 2019 were screened for the availability of a minimum of two dental examinations at least 8 months apart. Caries was scored according to the WHO criteria (dmf–t). The data were split by observation period (300–550 and >550 days). Overall, 135 children (Ø 3.7 years) attended IG, and 132 children (Ø 3.6 years) attended CG. After 300–550 days, no significant differences were found between both groups regarding mean caries increment and experience (p > 0.05). After >550 days, IG with low SES exhibited a high caries experience. Fluoride varnish applications could not reduce the caries increment compared to CG in the short-term but slightly decreased the long-term caries experience. Comprehensive ECC prevention measures actively involving parents are needed to overcome the caries burden.