Die Durchführung einer erfolgreichen Parodontitistherapie mit Erhalt einer vollständigen Bezahnung bei jungen Patienten mit einem generalisierten Knochenverlust von 90 % stellt eine Herausforderung für Zahnärzte und Zahnärztinnen dar. Aufgrund des fortgeschrittenen Knochenverlusts und des jungen Alters der Patienten sind fest-sitzende und herausnehmbare prothetische Versorgungen als Behandlungsoptionen kompromittiert. Implantattherapien wären komplex und kostenintensiv. Der hier vorgestellte Fall zeigt die erfolgreiche konservierende Parodontitistherapie einer fortgeschrittenen generalisierten aggressiven Parodontitis (Parodontitis, generalisiert Stadium IV, Grad C) einer 29 Jahre alten Patientin. Durch das konservierende Vorgehen konnte der Erhalt aller Zähne in einem gesunden, funktionellen und ästhetisch befriedigenden Zustand erzielt werden. Das Follow-up dieses Falls umfasste 5 Jahre. Manuskripteingang: 03.06.2022, Manuskriptannahme: 14.08.2022 Englischsprachige Erstpublikation: Hamad C, Haller B, Hoffmann T, Lorenz K. Five-year results of nonsurgical treatment to manage severe generalized aggressive periodontitis. Quintessence Int 2019;50(2):104–113; Übersetzung des vorliegenden Beitrags aus dem Englischen ins Deutsche: Andreas Gahler/Universitäts-
klinikum Ulm Schlagwörter: Aggressive Parodontitis, Knochenverlust, Implantat, nichtchirurgische Parodontitistherapie, Behandlungsoptionen

It is challenging for clinicians to carry out successful periodontal therapy and maintain a full dentition in young patients with generalized bone loss of 90%. Due to advanced attachment loss and the young age of patients, fixed or removable prosthetic treatment options are compromised. Implant therapy would be complex and expensive. The presented case shows the successful conservative periodontal therapy of advanced generalized aggressive periodontitis in a 29-year-old female. A conservative approach was applied and maintained all teeth with patient satisfaction both functionally and esthetically. This case was followed over 5 years. Schlagwörter: aggressive periodontitis, bone loss, implant, nonsurgical periodontal therapy, treatment options

Purpose: To evaluate post-to-composite bonds in terms of their durability, achieved either by physical vapor deposition (PVD) or tribochemical silica coating (TSC) compared to coupling strategies for fiber posts at chairside. Materials and Methods: Thirty uncoated fiber posts (DT Light) each were either left untreated (control) or silanized with a one-bottle (Monobond Plus) or a two-bottle (Clearfil SE Bond/Porcelain Bond Activator) silane at the chairside. Thirty coated fiber posts each had already been silica coated and silanized by the manufacturer using PVD (DT Light SL) or TSC (DentinPost Coated) deposition techniques. Surface analysis was carried out by profilometry and x-ray microanalysis. All the posts were surrounded by 2-mm-thick disks of a dual-curing composite resin (MultiCore Flow). After water storage for 24 h at 37°C, the specimens in each group were randomly divided into three subgroups (n = 10) and subjected to 0, 1500, and 20,000 thermocycles (5°C to 55°C) prior to push-out testing. Failure modes were evaluated by optical and scanning electron microscopy. The statistical significance was determined with two-way ANOVA, the Student-Newman-Keuls test, and Fisher's exact test. Results: The conditioned posts had significantly higher interfacial bond strengths than the control posts after thermocycling (p < 0.05). Extended thermocycling significantly reduced the interfacial strength of chairside silanized posts (p < 0.05). This effect was not significant with industrially coated posts (p > 0.05). Coatings deposited by TSC reached the highest bond values (p < 0.05) and showed predominantly adhesive failures in the form of coating delamination (p < 0.0001). In contrast, the other coupling strategies showed significantly lower values and adhesive failures between the post and the composite. Conclusion: PVD and TSC techniques enhanced the bond durability of fiber posts. TSC led to a superior post-tocomposite bond, probably based on more effective micromechanical adhesion due to the higher surface roughness. Schlagwörter: fiber post, composite resin, physical vapor deposition, tribochemical silica coating, silanization, bond durability

Self-etch bonding systems are promoted as a time-saving and user-friendly alternative to etch-and-rinse bonding systems. Self-etch adhesives are characterized by a relatively mild etching effect, resulting in a relatively low incidence of postoperative hypersensitivity. On the other hand, their mild etching effect causes a reduction in bond strength to enamel compared to that achieved with phosphoric acid etching. All-in-one adhesives still suffer from less-than-optimal initial bond strengths and from inadequate durability of the bond. Future developments need to focus on the elimination of water deposits along the adhesive interface of all-in-one adhesives. While self-etch adhesives may yield acceptable results when applied in combination with light-cured composite resin, their acidic monomers inhibit the polymerization of auto-cured and dual-cured composite resins. Unfortunately, most "self-cure" or "dual-cure" activators do not overcome this problem. This incompatibility has to be taken into consideration when using self-etch adhesives for adhesive cementation and for core build-up restorations. When assessing self-etch bonding systems, it should be noted that they do not represent a homogenous category of materials but rather comprise a great variety of different types of products, each with specific strengths and weaknesses. Schlagwörter: adhesive cementation, core build-up restorations, direct composite restorations, dentin sealing, fiber-reinforced composite root canal posts, fissure sealing, self-etch bonding systems

Purpose: To evaluate the composite-to-enamel bond following double etching of the enamel using phosphoric acid and different self-etching (SE) bonding systems with and without the application of their respective acidic primers. Materials and Methods: The enamel surfaces of 90 human molars were ground (600 grit) flat and randomly divided into nine groups (n = 10). Three two-step SE systems (AdheSE, ASE; Clearfil SE Bond, CSE; OptiBond Solo Plus SE, OSE) were tested, both with and without primer application on enamel pre-etched with phosphoric acid under dry bonding conditions. As the controls, the SE systems were applied according to their original directions without pre-etching. All the specimens were built up with a microhybrid composite resin (Arabesk Top). After water storage for 24 h at 37°C, the bonded specimens were sheared to failure in the Zwicki 1120. Etching and failure patterns were evaluated using a scanning electron microscope (SEM). Shear bond strength was analyzed with two-way ANOVA and Tukey's test. Failure modes were analyzed with Fisher's exact test. Results: Without pre-etching, CSE showed significantly higher bond strengths than ASE and OSE (p < 0.05). Enamel etching prior to the application of the SE systems tended to result in higher bond strengths, but significantly increased the values only for ASE (p < 0.05). Contamination of the pre-etched enamel with the SE primer decreased the bond strength by values of 19% for ASE (p > 0.05), 36% for CSE (p < 0.05), and 75% for OSE (p < 0.05). SEM analysis showed that omission of the priming step significantly increased the number of cohesive failures within the resin for OSE (p < 0.0001). Conclusion: Additional etching with phosphoric acid before the application of SE systems does not necessarily result in better enamel bonding, since unavoidable primer contamination of the pre-etched enamel was shown to significantly reduce the bond strength for two of the three systems tested. Schlagwörter: bond strength, enamel, adhesive resin, phosphoric acid-etching, self-etching, primer contamination

Bei direkten Restaurationen aus lichthärtendem Komposit sind selbstkonditionierende Zwei-Schritt-Systeme eine gute Alternative zu Etch-and-Rinse-Systemen. Eine postoperative Hypersensibilität kommt dank der milden Dentinkonditionierung sehr selten vor. Die Füllungsrandqualität im Schmelz lässt sich durch gezielte Ätzung der Schmelzränder mit Phosphorsäure optimieren. All-in-one-Adhäsive sind aufgrund ihrer nicht langzeitstabilen Dentinhaftung nur zweite oder dritte Wahl. Nach heutigem Kenntnisstand besteht kein Grund, sie Mehrschrittsystemen vorzuziehen. Es gilt, die chemische Zusammensetzung von All-in-one-Adhäsiven so zu modifizieren, dass Wassereinlagerungen in die Verbundschicht verhindert werden. Nur so kann eine langzeitbeständige Dentinhaftung erzielt werden. Bei der Kombination selbstkonditionierender Bondingsysteme mit dual- bzw. selbsthärtenden Aufbau- und Befestigungskompositen ist größte Zurückhaltung geboten, da der Selbsthärtungsmechanismus dieser Komposite durch saure Monomere inhibiert wird. Das Problem lässt sich mit Hilfe der angebotenen Aktivatoren im Allgemeinen nicht lösen. Schlagwörter: Selbstkonditionierung, direkte Kompositrestauration, Adhäsivbefestigung, Aufbaurestauration, Glasfaserstifte

Selbstkonditionierende Bondingsysteme, vor allem die All-in-one-Adhäsive, werden als zeitsparende und anwenderfreundliche Alternative zu Bondingsystemen mit Phosphorsäureätzung angepriesen. Der erste Teil der Übersicht befasst sich mit den Grundlagen der selbstkonditionierenden Bondingsysteme. Kenntnisse über deren Zusammensetzung und Haftmechanismus sind notwendig, um sich ein Bild von den Stärken und Schwächen der angebotenen Produkte machen zu können und zu verstehen, weshalb Zwei-Schritt-Systeme und All-in-one-Adhäsive doch erhebliche Unterschiede aufweisen. Eine gemeinsame Schwachstelle ist nach wie vor die eingeschränkte Schmelzhaftung. Während die initiale Dentinhaftung von All-in-one-Adhäsiven in den letzten Jahren verbessert werden konnte, ist die Beständigkeit des Verbundes noch immer unbefriedigend. Bei der Verwendung selbsthärtender oder dualhärtender Komposite ist zu beachten, dass diese mit den meisten selbstkonditionierenden Bondingsystemen nicht kompatibel sind. Schlagwörter: Selbstkonditionierung, Schmelzhaftung, Dentinhaftung, Beständigkeit, Polymerisationshemmung

Purpose: To evaluate the ceramic-to-dentin bond following luting with light- and dual-curing resin composites using different adhesive techniques. Materials and Methods: Dentin surfaces from 160 human molars were ground flat and randomly divided into eight groups (n = 20). Vita Mark II ceramic disks measuring 2 and 4 mm in thickness were bonded to the dentin with one of the following luting systems: Syntac/Tetric Ceram (ST), Syntac/Variolink II (SV), OptiBond Solo Plus/ Prodigy (OP), OptiBond Solo Plus/Nexus 2 (ON). Two different irradiation times (60 s, 120 s) were used per luting system, each without (-PC) and with (+PC) precuring the respective adhesive layer. After storage in water for 24 h at 37°C, the bonded specimens were sectioned perpendicularly to the adhesive interface into 1-mm-thick sticks. Three sticks per specimen were loaded to failure under tension in the Zwicki 1120. Failure analysis was performed using a scanning electron microscope (SEM). Results: Four-way ANOVA showed that the ceramic thickness, the type of luting system used, and the adhesive precuring had a significant effect on the microtensile bond strength. The longer irradiation times did not significantly increase the bond strength. The highest values were recorded with SV/+PC (27.9 ± 4.3 MPa) and the lowest with ST/-PC (10.2 ± 3.5 MPa). Under the SEM, failed specimens that had not been precured showed significantly more exposed dentin than those which had been precured (chi-square test). Conclusion: The precuring step of light-curing bonding systems and the use of dual-curing luting composites were shown to optimize the dentin bond under thick ceramic layers. Schlagwörter: ceramic-to-dentin bond, luting system, light curing, dual curing, precuring, bonding effectiveness

Purpose: To determine the effect of the polymerization mode of simplified bonding systems and the corresponding core buildup resin composite on the bond strength to dentin. Materials and Methods: Composite core buildups were bonded to flat prepared dentin surfaces of 320 human molars using a two-step etch-and-rinse (Excite, ER) and a two-step self-etching (AdheSE, SE) bonding system. Bonding systems were used both with and without their respective self-curing activators (Excite DSC, ER+SC; AdheSE DC, SE+SC). Six curing protocols for the dual-curing composite (MultiCore Flow) were examined: self-curing for 5 min (a); irradiation with light from each aspect for 10 s (b), 20 s (c), and 40 s (d); and irradiation with light from the occlusal aspect only for 60 s (e) and 120 s (f). Shear bond strengths were measured immediately after curing. Additional measurements were performed after water storage of the specimens for 24 h at 37°C. These specimens had been cured according the curing protocols given in the manufacturer's instructions (groups a and d). Failure modes were analyzed using scanning electron microscopy. Results: Immediate bond strengths were significantly different among the bonding systems (p < 0.001): SE > ER > ER+SC > SE+SC. Immediate bond strengths of ER and SE were significantly lower when the composite was self-cured (p < 0.05). The use of SC activators reduced the bond strength and promoted adhesive failures to dentin. A severe incompatibility problem was observed between the composite and SE+SC. Conclusion: Dentin bonding of dual-curing composite core buildups in combination with simplified bonding systems is still unsatisfactory, even when SC activators are employed. For adequate bonding to dentin, polymerization of the dual-curing composite should always be light initiated. Schlagwörter: self-curing activator, bonding system, composite core buildup, curing protocol, incompatibility, bonding effectiveness

Objectives: The purpose of this study was to evaluate the influence of (1) the curing mode of resin composites and (2) activators for dual curing of the bonding on dentin bond strength. Methods: The light-curing resin composite Brilliant (B) and the self-curing resin composite Brilliant MH were bonded with the following adhesives (n = 10): OptiBond FL, Excite, Prime&Bond NT, OptiBond Solo Plus, Adper Prompt L-Pop, Clearfil SE Bond, Xeno III, and AdheSE. Excite, Prime&Bond NT, and OptiBond Solo Plus were also used in combination with activators for dual curing. Tensile bond strengths were measured after 24 hours of water storage (37°C), and fractured surfaces were analyzed in the scanning electron microscope. Results: Except for Excite/dual curing and Prime&Bond NT/dual curing, bond strengths with Brilliant MH were significantly lower than with Brilliant. Activators significantly increased bond strengths in Excite/Brilliant MH, but not in Prime&Bond NT/Brilliant MH and OptiBond Solo/Brilliant MH. Conclusions: This study confirms the incompatibility between self-curing resin composites and simplified bonding systems containing acidic components. Activators for dual-curing the bonding eliminated this chemical incompatibility only in 2 of 3 bonding systems. The use of these activators in combination with light-curing resin composites must be avoided. Schlagwörter: dentin bonding, composite, bond strengths