Meistgelesene Beiträge

Objectives: This systematic review aimed to evaluate the clinical and radiographic outcomes of coronal and partial pulpotomies in mature permanent molars with cariously exposed vital pulp. Method and materials: The protocol of the current review was registered in the PROSPERO database (CRD 42020190785). Articles published between January 1980 and June 2020 were searched in eight different online databases and six textbooks according to PRISMA guidelines. Eleven studies were included in the analysis of 1-year success rates, whereas five studies were included in the analyses of 2-year and > 2-year success rates for coronal pulpotomy. Two studies were included in the analyses of the 1-year and 2-year success rates for partial pulpotomy. The clinical and radiographic success rates were estimated using the DerSimonian-Laird random effect method. The risks of bias were evaluated using Cochrane RoB 2, ROBINS-I, and Newcastle-Ottawa scale assessment tools. Evidence levels were determined using the Oxford Centre for Evidence-Based Medicine (OCEBM) recommendation tool. The success rates using different pulp capping medicaments and restorative materials were analyzed using meta-regression analysis. Results: The clinical and radiographic success rates of coronal pulpotomy ranged between 92.2% and 99.4%, whilst for partial pulpotomy, the success rates ranged between 78.2% and 80.6%. Different pulp capping medicaments and restorative materials showed no significant effect on the success rates of coronal pulpotomy, but the former significantly (P < .05) affected the success rates of partial pulpotomy. Conclusion: Coronal and partial pulpotomies demonstrated a high success rate in treating cariously exposed vital pulp of mature permanent molars. Further well-designed studies with longer follow-up periods are required to validate these findings. (Quintessence Int 2021;52:196–208; doi: 10.3290/j.qi.b912685) Schlagwörter: meta-analysis, permanent molar, pulp capping medicament, pulpotomy, systematic review

This literature-based OPINION PAPER reflects in an introductory historical perspective on the rapid advancement of dental adhesive technology. Past and current techniques to bond to tooth tissue, in particular to dentin as the most challenging bonding substrate, are critically appraised. Including the historical perspective in (1), this paper focuses on fourteen items thought to be of primary importance with regard to the current status of dental adhesive technology. In (2) the primary mechanisms involved in adhesion to enamel and especially dentin are dealt with having (3) also revisited the previously introduced adhesion-decalcification concept (AD concept) as basis of biomaterial-hard tissue interaction; the worldwide accepted classification of today's adhesives into etch&rinse (E&R) and self-etch (SE) adhesives are presented in (4), along with presentation of their respective PLUS-MINUS balances in (5) and (6); nomination of the GOLD-STANDARD E&R (7) and SE (8) adhesives is based on evidence of successful laboratory and long-term clinical performance, resulting in a recommended 3-step full E&R bonding route in (9) and the preferred 3-step combined selective enamel E&R with 2-SE bonding route in (10); (11) description of the main bond-degradation pathways and eight strategies to preserve bond stability; (12) coverage of the PROS and CONS of the newest generation of UNIVERSAL adhesives. Looking into the future, some expected future developments in dental adhesive technology have been suggested in (13), along with (14) a first status determination of the latest research-and-development towards self-adhesive restorative materials that no longer require any pre-treatment. Schlagwörter: review, bonding, dentin, adhesion, self-adhesive

The extraction of a tooth with root resorption can be a complicated procedure and can result in the removal of a significant amount of alveolar bone. In the anterior maxilla, esthetic rehabilitation of damaged sites with implant-supported crown could require multiple surgeries. Patients often ask for an alternative, and minimally invasive treatments are generally preferred. In this paper, a clinical case of implant-supported crown in a site affected by root resorption is described. Immediate implant was placed leaving some root fragments in the osteotomy site, thus avoiding invasive extractive surgeries. A minimally invasive flapless technique with a computer-guided implant placement procedure was used. After ?8 years, clinical and radiologic data were stable, gingival tissues around the implant appeared healthy, no dark translucency appeared through marginal gingiva around the implant, and there was no pathologic probing pocket depth ?or bleeding on probing. In the presence of root resorption and ankylosis, computer-guided surgery could be helpful to prepare a precise implant site through various tissues, such as partially resorbed root remnants. (Quintessence Int 2021;52:132–137; doi: 10.3290/j.qi.a45432) Schlagwörter: digital dentistry, implants, prosthodontics, tooth erosion, tooth wear

Abstract: Tooth-cavity preparation contributes to a large extent to the quality of the direct posterior composite restoration, the so-called hidden quality of the restoration. Indeed, the effect of a poor cavity design is not immediately visible after placement of the restoration. To correctly prepare a cavity for a posterior composite restoration, the tooth to be restored should first be profoundly biomechanically analyzed. Here, the forces that work on the tooth during occlusion and articulation, and the amount and quality of the remaining tooth structure determine the cavity form. In addition, the dental tissues must be prepared in order to receive the best possible bond of the adhesive and subsequent restorative composite. A well-finished cavity preparation enables the restorative composite to adapt well, providing a good marginal ?seal to the direct benefit of the clinical lifetime of the posterior composite restoration. Finally, it is highly recommendable to isolate the teeth with rubber-dam before starting with the cavity preparation, as this increases the visibility of the operating field and allows the operator to work in a more precise way.

This report describes the cases of two patients with a maxillary lateral incisor with palatogingival groove and extensive endodontic-periodontal lesions. Although it is reported that acceptable periodontal status is of great importance in case selection in intentional replantation, it is suggested in this report that intentional replantation could be chosen instead of immediate extraction if extensive endodontic-periodontal lesions exist in a tooth with palatogingival groove. The gingival margin position and gingival papilla were well preserved and the bone defect was almost completely repaired. This was beneficial to the aesthetic prosthodontic treatment and implantation, although external root resorption was observed. Schlagwörter: bone repair, endodontic-periodontal lesion, external root resorption, intentional replantation, palatogingival groove

Ziel: Diese Studie untersucht den therapeutischen Effekt des RelaxBogens im Vergleich zur alleinigen Schienentherapie bei Patienten mit Schlafbruxismus und CMD in Bezug auf myogene Beschwerden und Schmerzen. Probanden und Methoden: 32 Probanden mit Schlafbruxismus und CMD-Symptomen wurden in einer einfach verblindeten, randomisierten, kontrollierten, monozentrischen klinischen Studie untersucht. Die Wirksamkeit des Bogens plus Stabilisierungsschiene wurde mit der alleinigen Schienentherapie verglichen. Die Therapiedauer betrug acht Wochen. Die Untersuchungen entsprechen dem RDC/TMD-Standard. Ergebnisse: Bei der Bogen-Gruppe zeigte sowohl die Auswertung der SL-NRS-Fragebögen als auch die Palpation der Muskeln eine signifikante Schmerzreduktion der Mundschließer. Gleichzeitig empfanden die Probanden weniger Schmerz bei der Mundöffnung. Ein lindernder Effekt auf Kopfschmerzen in Kombination mit muskulären CMD-Symptomen, häufig auch als Spannungskopfschmerzen bezeichnet, konnte ebenfalls beobachtet werden. Schlagwörter: Craniomandibuläre Dysfunktion, Bruxismus, Kiefer, Kopfschmerz, Faszie, RelaxBogen, CMD, TMD, Myalgie

Objective: The aim of this systematic review and meta-analysis was to evaluate the impact of supportive peri-implant therapy (SPIT) on the rates of peri-implant diseases and peri-implant marginal bone loss. ?Data sources: The guidelines of PRISMA statement were followed in searching for randomized controlled trials, controlled clinical trials, and retrospective studies in several electronic databases and reference lists. The Cochrane Collaboration’s Risk of Bias tools for nonrandomized studies were used to assess the risk of bias. Data were analyzed using statistical software. ?A total of 159 studies were identified. Five trials, with 1,570 implants in 617 patients, met the inclusion criteria. Overall meta-analysis showed significantly reduced rates of peri-implantitis with SPIT compared with non-SPIT at implant and patient levels. Peri-implant mucositis was significantly reduced with SPIT at implant level only. Peri-implant marginal bone loss was significantly reduced in patients with SPIT compared to those who did not attend SPIT. Conclusion: SPIT can significantly reduce the rate of peri-implantitis and marginal bone loss. The evidence on the role of SPIT in reducing the rate of peri-implant mucositis, on the other hand, remains limited. Further well-designed studies on the impact of SPIT on implant treatment outcome are still needed. Clinical significance: There is a need to adopt a SPIT regimen for patients receiving implant therapy to reduce the rate of peri-implant diseases and marginal bone loss. This need should be stipulated in the patient information and consent forms prior to implant therapy. (Quintessence Int 2021;52:122–131; doi: 10.3290/j.qi.a45428) Schlagwörter: dental implants, meta-analysis, peri-implant marginal bone loss, review, supportive peri-implant therapy

Purpose: Orthodontic treatment may introduce a risk to the integrity of enamel due to plaque accumulation and colonisation by oral microbes. This prospective cohort study observed the effect of fixed, self-ligating orthodontic appliances on saliva properties and oral microbial flora. Materials and Methods: Thirty adolescent patients were recruited (13 female, 17 male, mean age 13.97 ± 2.07 years). Saliva samples were collected before placement of fixed orthodontic appliances (T0), and 4 (T1) and 12 (T2) weeks later. Salivary pH, flow rate and buffering capacity were recorded. All saliva samples were cultured on agar plates for 2 days. Salivary prevalence of Neisseria spp., streptococci, Staphylococcus aureus, coagulase-negative staphylococci and Candida albicans were assessed. Results: High buffering capacity was reported in 21 patients at T0, 22 patients at T1 and in 28 patients at T2. Saliva flow rate also increased over time (7.08 ml/5 min at T0, 7.93 ml/5 min at T1 and 8.35 ml/5min at T2). Mean pH was 7.63 at T0, 7.67 at T1 and 7.78 at T2. There was no evidence that either pH or the number of colonies of any of the microbial species changed over time. Conclusion: The increased buffering capacity of saliva as well as the salivary flow rate after initial bonding might be protective against the development of dental caries. Current microbial findings indicate that initiation of orthodontic treatment may not be associated with significant changes in oral microbial flora. Schlagwörter: microbial flora, orthodontics, saliva

Augmentation of alveolar ridge defects is a technique-sensitive procedure in dental implantology. Depending on the size of the defect, it may be necessary to use autogenous bone blocks. However, patients may be against these blocks as these procedures are surgically invasive. Case report: This report describes the restoration of a partially edentulous mandible, which suffered a major bone defect from the right canine to the third molar site after multiple implant losses. The use of a CAD/CAM allogeneic cancellous bone block from a living donor bone was planned for the reconstruction of the alveolar ridge at the defected site. A CBCT scan was taken and the virtual planning of the bone augmentation and placement of four implants was performed. The milled bone block was fixed for augmentation and the implants were placed using a CBCT-generated surgical guide. After osseointegration, a CAD/CAM-fabricated screw-retained metal-ceramic implant fixed partial denture with angulated screw channels was delivered. Results: The use of CAD/CAM-milled, allogeneic bone block resulted in a time-efficient and simplified reconstruction of the defect because no donor site was used, and the fit of the block on the native bone was uneventful and fast. At the 1-year follow-up, an average peri-implant vertical soft tissue decrease of 1 mm on buccal and 0.3 mm on lingual sites was observed and the peri-implant tissues were healthy. Conclusions: The long-term success of this CAD/CAM cancellous bone block needs to be evaluated in well-designed clinical studies. Schlagwörter: allogeneic bone substitutes, alveolar bone loss, block graft, dental implants, guided implant surgery, prosthodontics

Purpose: To assess the association of various factors including education level and oral health with type 2 diabetics’ awareness of periodontitis and periodontitis/diabetes relationship, and to evaluate the importance of integrated healthcare in this association. Materials and Methods: 288 type 2 diabetics were evaluated through a validated structured questionnaire about oral hygiene habits, access and attendance to dental treatment, the presence of periodontitis and previously received information of periodontitis and periodontitis/diabetes relationship. Descriptive data were explored and both simple and multiple logistic regressions were performed. Results: The average age of participants was 62.24 (±10.93) years, 81.6% were previously treated for periodontitis and approximately 70% have never received information on periodontitis and its relationship with diabetes. A higher chance of participants having previously received information regarding periodontitis was associated with more than 8 years of schooling, daily flossing habit, presence of periodontitis and prior treatment for periodontitis (p  Schlagwörter: diabetes mellitus, periodontal diseases, health promotion, public health/community dentistry, primary healthcare

Implant dentistry is considered to be a safe and routine surgical procedure. However, cases of life-threatening hematoma of the floor of the mouth resulting in airway obstruction were previously reported as a complication of implant placement in the anterior mandible. Massive bleeding in this anatomical site may be caused by perforating the lingual cortex and/or damaging the lingual perimandibular vessels. In the long term, dental implants can fail, mainly due to peri-implantitis, and must be removed. Explantation procedure may occasionally become a complex challenge, with a risk for various complications. Case report: This report presents the first case of life-threatening hematoma of the floor of the mouth, as a complication secondary to a failed attempt of dental implant removal at the anterior mandible. The proximity of the implant to the lingual vascular canal might have served as a cause for vascular damage during explantation. Conclusions: Implant removal complications are scarcely described in the literature. Nonetheless, damaging blood vessels during explantation should not be underestimated. Computed tomography (CT) may be of value not only in preoperative implant planning but also before implant removal in jeopardized anatomical zones such as the anterior mandible. Lingual vascular canals should be looked for on computed tomography scans. Schlagwörter: airway, anterior mandible, bleeding, explantation, hematoma, implant removal

Ideally, orthognathic surgery is indicated to treat skeletal Class III malocclusion with severe open bite in adults. In this borderline case, however, camouflage treatment without any skeletal anchorage was chosen. This report describes the orthodontic treatment of a 23-year-old man who presented with multiple orthodontic problems including severe open bite of the anterior and posterior teeth up to the first molars, bilateral posterior crossbite, bilateral Class III molar relationship, severe crowding, increased vertical dimension, and dental and facial midline deviation. The treatment included the extraction of four wisdom teeth, uprighting and distalisation of the mandibular arch with molar intrusion using curved NiTi wires with intermaxillary elastics. After 36 months of treatment, satisfactory improvements in the vertical overlap, horizontal overlap and sagittal malocclusion were achieved. The design of the mechanical system used in this case confirmed stable results at the 4-year follow-up. Schlagwörter: anchorage, molar distalisation, open bite, skeletal class III malocclusion

Parodontale Erkrankungen sind eine der häufigsten entzündlichen Erkrankungen des Menschen. Kardiovaskuläre Erkrankungen (KVE) stellen die häufigste Todesursache in Deutschland dar. Beide Erkrankungsformen stehen schon seit Längerem im Verdacht, sich gegenseitig zu beeinflussen. Ein direkter Beweis dieses Zusammenhangs ist jedoch methodisch schwierig und bisher wissenschaftlich nicht existent. Daher war es das Ziel des Masterkurses – Modul IV, mögliche Zusammenhänge anhand der aktuellen Literatur zu zeigen und kritisch zu hinterfragen. Schlagwörter: Parodontitis, kardiovaskuläre Erkrankungen, Risikofaktoren

Anhand eines Patientenbeispiels werden die klinischen und labortechnischen Prozesse zur digitalen Herstellung eines individuellen Aufbissbehelfs gezeigt. Schlagwörter: Digitales Labor, Aufbissschiene, dentale 3-D-Software

Objectives: Patients with xerostomia manifest various clinical signs of oral dryness, which has an impact on oral functions and wearing of dental prosthese?s, but the evidence of xerostomia-related changes in denture performance is unsatisfactorily documented. The purpose of this systematic review was to evaluate whether the available literature can answer the focused question “Is there an association between xerostomia and decreased denture performance among patients wearing removable dentures?” Data sources: Indexed databases were explored without time or language restrictions up to and including March 2019. All levels of available evidence including experimental studies, case reports, and case series were searched using different combinations of the following keywords: saliva, xerostomia, dentures, personal satisfaction, quality of life, oral dryness, and oral complaints. Nine studies were included for qualitative synthesis. Overall, five studies had a cross-sectional design and four studies were case-control studies. In these studies, the number of participants ranged between 35 patients and 493 patients with mean ages ?from 56 to 82 years; 66% of the patients were completely and 34% were partially edentulous. Conclusion: All studies included patient satisfaction with dentures and recorded the presence of oral dryness. Six out of nine studies demonstrated that xerostomia is significantly associated with the decreased performance of removable dentures. Although the available evidence lacks feedback from randomized, controlled clinical studies, it implies a negative impact of oral dryness on specific denture functions such as speaking, chewing, and retention, which affects both complete and partial denture wearers. Schlagwörter: performance, removable dentures, saliva, satisfaction, xerostomia

Purpose: White spot lesions (WSL) are common side-effects of orthodontic treatment with fixed multi-bracketed appliances. The aim of this review was to find all available literature and critically assess the evidence for the efficacy of bleaching as a method to treat or alleviate post-orthodontic WSLs in permanent teeth. Materials and Methods: Electronic databases were screened for relevant literature with the aid of predetermined search strategies. All types of studies, including randomised or nonrandomised controlled trials (RCTs or CCTs), prospective and retrospective studies, as well as in vitro studies were considered eligible for inclusion. The reference lists of all included articles were hand searched for additional studies. Two authors independently performed study selection, data extraction, and risk of bias assessment. Results: One RCT and 8 in vitro studies met the inclusion criteria. Seven studies were classified as having a high risk of bias while 2 in vitro studies were graded as having a moderate risk of bias. The results showed that bleaching of WSL can diminish colour disparities between carious and non-affected areas, but the certainty of the evidence was very low. The high degree of methodological heterogeneity precluded a valid interpretation of the results through pooled estimates. Conclusions: The findings from the present systematic review could not support or refute bleaching as an effective method for management of post-orthodontic WSLs. Because most of the studies in this field are in vitro and solid scientific evidence of low risk of bias is scare, further prospective in vivo studies are necessary. Schlagwörter: bleaching, enamel demineralisation, fluoride, tooth whitening, white spot lesions

Purpose: The aim of the present research was to analyse the effects of two bleaching agents, on the enamel crystallography by means of X-ray diffraction. Material and Methods: Twelve human sound posterior teeth, were collected for the present study (n = 12) and from each tooth two enamel slabs were obtained and randomly assigned to one of two different bleaching protocols. The first protocol involved an in-office bleaching agent (hydrogen peroxide 37.5%/ SDI Polaoffice+), and the second an at-home whitening product (carbamide peroxide 16%/ PHILIPS Zoom! NiteWhite). X-ray diffraction readings were made before and after applying the treatments in order to analyse the peak intensity and crystal domain size. Additionally, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) were carried out to identify the composition correctly. Statistical analysis included repeated measures analysis of variance (p ≤ 0.05). Results: Peak intensity in spectra obtained by X-ray diffraction had a tendency to diminish, mostly in the at-home bleaching group. The analysed data approximate a decrease in the crystal domain size among the samples treated for longer periods of time. Statistical analysis depicted no statistically significant differences among the experimental groups (p ≥ 0.05). Conclusions: Crystal domain size had a tendency to decrease, mostly when the enamel was treated by bleaching gels that had to be applied by prolonged periods of time. Schlagwörter: bleaching agent, enamel crystallography, X-ray diffraction

Purpose: The aim of this study was to review the literature and chart the clinical studies that have focused on periodontal diseases and adverse pregnancy outcomes since 1996. Materials and Methods: Medline, Cinahl, and Cochrane databases were searched for original studies focused on pregnancy outcomes and periodontal status in humans. The most recent search was conducted on April 30, 2020. Results: Of the 633 articles identified, 232 articles (n = 119,774 participants) were selected for analysis. The majority of studies highlighted a statistically significant association between periodontal diseases and preterm birth (71 of 111 articles; 63.96%), low birth weight (46 of 64 articles; 71.87%), preterm low birth weight (29 of 49 articles; 59.18%), preeclampsia (31 of 45 articles; 68.89%) and other pregnancy complications, such as preterm, prelabor rupture of membranes (17 of 26 articles; 65.38%). Geographical analysis revealed that clinical studies were conducted in 51 countries, primarily in the United States (42 studies, 18.10%), Brazil (33 studies, 14.22%) and India (25 studies, 10.78%). Irrespective of geographical location, analysis showed various degrees of evidence of a relationship between periodontal diseases and adverse pregnancy outcomes. Conclusion: The majority of the studies found a statistically significant link between periodontal diseases and some complications of pregnancy. The strength of such a link varies according to type of study, type of variable and outcome measure selected. Schlagwörter: periodontal diseases, pregnancy, adverse pregnancy outcomes, mapping

Objective: To collect information and statistical data regarding the current oral health care and dental education resources in China. Methods: Electronic databases were searched and a literature review conducted. The homepages of relevant universities and colleges were visited to collect dental education information. In addition, private conversations with related experts were conducted. Results: Compared with the 3rd National Oral Health Survey (2005), the ratio of gingival bleeding in individuals aged 33 to 44 years has increased in the last 10 years. The average percentage of residents visiting departments of dentistry in public hospitals is less than 10%. The total number of dentists and assistant dentists increased to 167,227 in 2016, with a ratio of 1.21 per 10,000 people. There is a great imbalance in the distribution of dental practitioners among the provinces. There are 101 dental schools or departments of stomatology that provide 5-year dental training courses and offer bachelor's degrees in dentistry, with another 93 dental institutions offering shorter 3-year training courses for assistant dentists. Conclusion: The results of the present study show that there has been significant change during recent years in China. However, the ratio of dental practitioners to the population as well as the number of dental visits carried out is still much lower than in developed countries and does not satisfy the demand for dental care in China. The quality and quantity of dental education, including continuing dental education, calls for improvement in the future. Schlagwörter: oral health care, dental education, China, dentist, oral health status

Objectives: This paper is aimed at addressing the urgent need to develop a protocol that will address the operatory and clinical aspects of dental care during the Coronavirus disease 2019 (COVID-19) outbreak. Data sources: The epidemiology, clinical signs and symptoms, and modes of transmission of COVID-19 are presented. This protocol was established as an international collaboration of three dental universities: Hadassah School of Dental Medicine, Israel; University of Rochester Medical Center, USA; and the University of Pennsylvania, USA. This protocol is based on a detailed review of the existing English language literature as well on the logistic and clinical experience of each facility and the opinion of the authors. The protocol is designed for a hospital setting and includes considerations related to dental treatment in both healthy subjects and those suspected or diagnosed with COVID-19. The first part of this review discusses operatory considerations; the second part discusses general dental clinical aspects; the third part discusses endodontic considerations; and the fourth part discusses surgical aspects. This protocol may be applicable to other future similar pandemics. Conclusion: Logistic and clinical steps are required to provide dental care during the COVID-19 outbreak while preventing cross-contamination and protecting the dental team during the provision of care. Schlagwörter: coronavirus, COVID-19, dental, endodontics, infection control, pulpitis

Purpose: To investigate the subgingival microbiological profiles of patients with periodontitis, to determine their stage and grade scores and to evaluate the differences in the microbiota among different stages and grades. Materials and Methods: Sixty-seven (n = 67) periodontitis patients were selected. Periodontitis staging and grading, following the 2018 classification system, were defined. Following a clinical examination, subgingival samples were taken from the deepest periodontal pocket of each quadrant for cultivation, identification and quantification. The prevalence, proportion and counts of nine selected periodontal pathogens were determined, and differences between periodontitis stages III and IV and grades B and C were assessed. Results: All nine cultivable periodontal bacteria were detected, of which the most prevalent was P. intermedia (91.0%) and the least prevalent were E. corrodens (9.0%) and C. ochracea (9.0%). The frequency of detection of the two main target pathogens, A. actinomycetemcomitans and P. gingivalis, was 41.8% and 76.1%, respectively. The prevalence (grade B: 80.6%, grade C: 55.6%, p = 0.035) and total counts (grade B: 19.8 colony forming units – CFU/ml-4 (1.9–52.8); grade C: 4.0 CFU/ml-4 (0.0–26.4); p = 0.022) of F. nucleatum were statistically significantly higher in grade B than in grade C periodontitis patients, whereas the counts of P. gingivalis and A. actinomycetemcomitans were similar between grades and stages. Conclusion: Our study suggests that relevant differences between the various grades of periodontitis exist only in the numbers of F. nucleatum. Prevalence and quantities of other cultivable species between different stages and grades of periodontitis seem to be similar. Schlagwörter: periodontitis, stage, grade, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum

Purpose: Currently, there is no consensus on recommendations for manual toothbrushing techniques between dentists, oral health therapists and dental companies. The aim of this systematic review is to identify and assess the quality of evidence of the effectiveness of manual toothbrushing techniques in the existing literature. Methods: A broad search was conducted on the electronic databases Medline via Ovid, PubMed and EBSCO Dentistry & Oral Sciences. Included studies examined manual toothbrushing technique efficiency. Articles were assessed utilising the Cochrane Collaboration's tool for assessing risk of bias. Thirteen studies met the inclusion criteria and were included in this review. These included five randomised controlled trials (RCT), seven experimental non-randomised control studies and one in vitro study. Results: Of the 3190 articles identified, 40 were relevant to manual toothbrushing and 13 were included in the final review. Studies indicating statistically significantly superior plaque removal for a given technique were Bass (one), modified Bass (one), Charter's (two), Fones (two), scrub (two), roll (one), modified Stillman (one), toothpick method (one). Four studies exhibited no statistically significant difference in effectiveness of plaque removal. Unfortunately, considerable variation was found between studies, making a definitive conclusion impossible in terms of an ideal manual toothbrushing technique that would promote plaque removal and reduce gingivitis. Conclusion: There is still insufficient evidence for suggesting that one toothbrushing method is more effective than another in plaque removal and reduction of gingivitis. Excessive variability in many aspects of the design and methodology of the selected studies hinder conclusions on an ideal manual toothbrushing technique. Experimental randomised controlled trials that follow the CONSORT guidelines are required to provide adequate-quality evidence and make any definitive conclusions on the relative effectiveness of manual toothbrushing techniques. Schlagwörter: evidence-based medicine, oral hygiene, systematic review, toothbrushing

Objectives: Although several studies have investigated the effectiveness of various interdental cleaning devices, there is a need for an evidence-based synopsis for clinicians to customize interdental hygiene instructions and provide specific devices for each patient. This literature review aims to establish an evidence-based decision-making tree recommending individualized approaches to interdental cleaning based on embrasure size and patient-specific conditions. Data sources: Specific keywords related to interdental cleaning were used to search and identify the existing literature in PubMed and the Cochrane Library. Through a series of review processes, qualifying studies were identified and assessed with respect to the inclusion criteria to establish the decision tree. Results: A total of 27 studies were included to support a decision tree. Traditional dental floss continues to remain the first choice for individuals of high motivation and good ?manual dexterity with type I closed embrasures. For individuals with closed embrasures, but lack of motivation and/or dexterity, the use of easy flossers, soft picks, oral irrigation, and small (0.6 to 0.7 mm) interdental brushes are alternatives. For individuals with type II and type III open embrasure spaces, an interdental brush has the highest evidence for its effectiveness to remove interdental plaque. However, two studies showed that residual plaque could be found over lingual embrasur?es and thus lingual approach of the interdental brush is sometimes needed. The use of gum stimulators and/or woodsticks continues to be supported when significant gingival inflammation is present. Conclusion: Each patient should be individually assessed and given tailored oral hygiene home care instructions for the most effective outcomes. The proposed decision tree provides clinicians with an evidence-based guideline to help customize the use of interdental cleaning devices for each patient. Schlagwörter: biofilm, decision tree, dental hygiene, evidence, interdental, tooth brushing

Purpose: Several studies demonstrated compromised oral health and periodontal diseases as risk factors for adverse pregnancy outcomes. However, consideration of oral health by pregnant women remains elusive. The aim of this study was to evaluate knowledge and behaviour of French pregnant women towards relationship between oral conditions and pregnancy outcomes and to evaluate influencing factors. Materials and Methods: A self-reported questionnaire was given to women between 1 and 3 days after delivery in three specialised clinics in France. The questionnaire aimed to evaluate demographic characteristics, self-perceived oral health, type of pregnancy follow-up and knowledge regarding oral conditions during pregnancy and risk of adverse pregnancy outcomes. A multivariate analysis was performed to evaluate correlation between knowledge and behaviour. Results: The questionnaire was completed by 212 women. Among them, 92% considered prevention of oral diseases during pregnancy important. Despite knowledge of potential negative influence of periodontal diseases on pregnancy outcomes, only 47% of pregnant women received dental diagnosis or treatment during pregnancy. Only 18% of the women discussed oral health consideration during pregnancy with health professional in charge of pregnancy follow-up. Interestingly, absence of dental consultation during pregnancy was associated with low rate of dental consultation prior to pregnancy (p < 0.01). Conclusions: Pregnant women were aware of the association between oral health and pregnancy and of need of prevention. However, consideration of importance of oral health was not adequate to the rate of dental consultation and seems to be influenced by individual dental follow-up habits prior to pregnancy. Clinical Relevance: Dental evaluation should be considered systematically during pregnancy follow-up. Schlagwörter: oral health, questionnaire, prevention, risk factor

Purpose: A previous clinical study showed that the prevalence of erosive toothwear in vegetarians is statistically significantly higher than in nonvegetarians, due to the consumption of vinegar and other acidic foodstuffs. To adequately inform patients, this study investigated the erosive potential of bottled salad dressings available in Switzerland and compared it with that of orange juice. Materials and Methods: One hundred enamel samples of bovine teeth were divided into ten groups. Samples were placed in 1 of 9 bottled salad dressings or orange juice (Granini) for 2 min. Afterwards, they were rinsed with Zürich tap water for 30 s, followed by abrasion with a toothbrush for 20 brush strokes and a toothpaste-saliva mixture. Erosive/abrasive enamel wear was determined with contact profilometry after 40 cycles. Results: The enamel wear (median/IQR) caused by Tradition Sauce Balsamique (9.5 µm/5.3 µm), M-Classic Dressing Italiano (10.9 µm/12.3 µm), Betty Bossi Balsamico Dressing (9.4 µm/4.5 µm) and Thomy Balsamico Vinaigrette Dressing (14.2 µm/6.5 µm) was statistically significantly higher than that caused by orange juice (2.4 µm/0.8 µm). Enamel wear caused by M-Classic Dressing French Joghurt (0.2 µm/0.2 µm) and Coop Qualité & Prix French Dressing (1.2 µm/1.0 µm) was statistically significantly lower compared to that of orange juice. Conclusions: The pure balsamico vinegar-based dressings (Italian type) showed a statistically significantly higher erosive potential than orange juice, whereas dressings containing calcium-rich products (enriched with milk and/or cream) (French-type) caused lower enamel wear than orange juice. The study shows that some bottled dressings have erosive potential even higher than orange juice and patients should be informed accordingly. Schlagwörter: erosion, tooth wear, salad dressings

Objective: This study aimed to compare the clinical outcomes in dental prophylaxis between rubber cup polishing and an air polishing system using erythritol powder, with or without prior dental plaque disclosure. Method and materials: In this single-blind, randomized, controlled, split-mouth clinical trial, healthy participants with full-mouth plaque score ≥ 60% were recruited. Quadrants in each participant were randomly assigned to four treatment groups: air polishing with prior plaque disclosure; air polishing without plaque disclosure; rubber cup polishing with prior plaque disclosure; or rubber cup polishing without plaque disclosure. Plaque scores and treatment time for each quadrant were recorded. Posttreatment satisfaction questionnaires for both the participants and operators were also completed. Results: In total, 88 participants consisting of 42 men and 46 women (mean age 23.1 ± 2.0 years) were recruited. Air polishing with prior plaque disclosure had significantly lower posttreatment marginal mean plaque score (21.7 ± 17.5%) compared to air polishing (33.5 ± 23.4%) or rubber cup polishing (34.5 ± 19.7%) without prior plaque disclosure (P < .001). Marginal mean treatment time for air polishing (325 seconds; SE = 10 seconds) was significantly shorter compared to rubber cup polishing (407 seconds; SE = 15 seconds) (P < .001). Both the participants and operators preferred air polishing over rubber cup polishing (P < .001). Conclusion: Prior plaque disclosure enhanced the effectiveness of plaque removal. Air polishing exhibited better treatment efficiency than rubber cup polishing and was the patients’ and clinicians’ preferred treatment modality. (Quintessence Int 2021;52:264–274; doi: 10.3290/j.qi.a45602) Schlagwörter: air polishing, biofilm, dental prophylaxis, periodontal disease, rubber cup

Abstract: Currently, there is a trend towards simplification of materials and clinical procedures. Simplification and quality can go together if the dentist works with materials and techniques that are well proven in vitro and in vivo. The placement of a high-quality class-1/2 direct posterior composite restoration can be time efficient following a standardized layering protocol and using composite materials that adapt well to the tooth surface and are able to mimic the natural tooth. When these materials are applied in a controlled way, finishing and polishing can also be shortened. In this article, an effective layering and finishing/polishing protocol for medium-sized class-1/2 direct posterior composite restorations is presented. Following the histo-anatomic buildup of natural teeth, dentin must be concave, as opposed to convex enamel. An isochromatic, medium-opaque, highly filled flowable composite is used to replace dentin. Enamel is replaced with a medium-translucent small-particle hybrid composite. Enamel is modelled in an anatomical way, following a successive cusp-by-cusp buildup approach. Clinical experience shows that the combination of both materials used according to this so-called bi-laminar histo-anatomical layering approach results in restorations that blend in very well within the surrounding tooth structure. Following a simplified finishing and polishing protocol, the composite restorations will have a correct contour, seamless margins, and a smooth, glossy surface. Schlagwörter: adhesion, finishing, flowable, layering, polishing, polymerization, posterior composite, shrinkage

Objective: Calcified carotid artery atheroma (CCAA) detected by panoramic radiographs has been suggested as an accurate biomarker for cerebrovascular accidents (CVAs). However, there has not been agreement on the relationship between CCAA and risk for stroke or other CVA. Method and materials: The question asked was, “Are patients with CCAA detected on panoramic radiographs more likely to get a stroke or CVA in the future compared to those who do not have CCAA and, further, would Doppler ultrasonography of the neck obtained secondary to panoramic radiography in suspected individuals add value to this association with stroke or CVA?” This meta-analysis was conducted by searching PubMed, Ovid Medline, Dentistry & Oral Sciences Source, CINAHL, Web of Science, Google Scholar, and ClinicalTrials.gov. Six studies that met the inclusion criteria were included in the final analysis; three used panoramic radiography and the rest used panoramic radiography and ultrasonography. Multiple random effect meta-analyses were conducted using RevMan 5.2 software. Conclusion: Evidence from this meta-analysis shows that although detection of CCAA via panoramic radiography to predict risk for stroke may be comparable to Doppler ultrasonography, risk prediction is somewhat more significant when diagnostic confirmation is made using Doppler ultrasonography than panoramic radiography alone. Clinical implications: Because stroke risk assessment is complicated and comprises many additional systemic factors beyond calcification of the carotid artery, CVA prediction is more reliable when Doppler ultrasonography is used after panoramic radiography. Managing hypertension, diabetes, and smoking habit are far more important in risk management of patients with CCAA detection on panoramic radiography. Schlagwörter: calcified carotid artery atheroma, cerebrovascular accident, Doppler ultrasonography, panoramic radiography, risk assessment, stroke

Purpose: The topical fluoride treatment of teeth can lead to a formation of CaF2-like material, which is considered to play a significant role in caries prevention. Different types of fluoride sources are applied. The aim of this study was to analyse the in vitro fluoridation effect of the lesser known organic fluoride compound nicomethanol hydrofluoride (NH) regarding fluoride accumulation and morphological changes on dental enamel surfaces. Materials and Methods: The fluoridation effect was investigated by scanning electron microscopy (SEM) and energy dispersive x-ray analysis (EDX) after treatment with fluoride solutions at a concentration of 1350 ppm F - and a pH value of 5.5. NH was tested against inorganic sodium fluoride (NaF) as reference. Fluoridation was done on pellicle-free and pellicle-covered enamel. Results: Formation of globular CaF2-like material was observed for both fluoride types. However, NH led to considerably higher calcium fluoride accumulation on the enamel surface as shown by both EDX and SEM. The globule diameters varied between 0.2 and 0.8 µm. Cross-sectional analysis revealed that the globular precipitates lay directly on the enamel surface; only the very surface-near volume was affected. No statistically significant difference of the fluoridation effect was measured with vs without saliva pre-treatment. Conclusion: The experiments showed a 6 times greater F - surface uptake on dental enamel with NH compared to sodium fluoride, thus suggesting an important role of NH during remineralization phases, fostering equilibrium between de- and remineralization. Schlagwörter: amine fluorides, calcium fluoride precipitation, enamel, energy dispersive x-ray analysis, scanning electron microscopy

Objective: The present systematic review aimed to assess the efficacy of photobiomodulation (PBM) therapy on neurosensory recovery of patients with inferior alveolar nerve injury following third molar surgery or dental implant placement. Method and materials: An electronic search was carried out in Scopus, Embase, Medline, PubMed, Web of Science, Cochrane Library, and Google Scholar databases. Among 1,122 identified papers, seven articles (three RCTs, one observational study, and three case series) met the inclusion criteria. Results: Time lapse from nerve injury to the onset of PBM therapy varied widely from 2 days to 4 years. The number of patients in each study ranged between 4 and 74. In the majority of the studies, PBM was done using a diode laser at wavelengths ?in the range of 808 to 830 nm with power of 5 to 500 mW and radiation dose of 3 to 244 J/cm2. Two out of three RCTs found significant neurosensory recovery in the patients who received PBM therapy compared to the controls. The observational study and all case series reported significant improvement in the neurosensory status following PBM therapy. The degree of neurosensory recovery was found to be greater in younger patients and those who received the treatment within 6 months following the injury. Conclusions: Due to the limited number of well-designed RCTs and small number of patients in each study, it is not possible to make a clear conclusion about the efficacy of PBM therapy on neurosensory recovery in patients with inferior alveolar nerve injury following third molar or implant procedures. Considering the possibility of spontaneous inferior alveolar nerve recovery during this period, the conclusion based on the studies with no control group should be interpreted with caution. (Quintessence Int 2021;52:140–153; doi: 10.3290/j.qi.a45430) Schlagwörter: dental implants, inferior alveolar nerve, low-level light therapy, nerve regeneration, oral surgical procedures, photobiomodulation therapy

Artificial intelligence (AI) encompasses a broad spectrum of emerging technologies that continue to influence daily life. The evolution of AI makes the analysis of big data possible, which provides reliable information and improves the decision-making process. This article introduces the principles of AI and reviews the development of AI and how it is currently being used. AI technology has influenced the health care field because of the need for accurate diagnosis and superior patient care. In order to understand the trend of AI in dentistry, electronic searching was carried out, combined with approaching individual companies to obtain the details of AI-based services. The current applications of AI in clinical dentistry were introduced and summarized. In the future, the AI-based comprehensive care system is expected to establish high-quality patient care and innovative research and development, facilitating advanced decision support tools. The authors believe that an innovative inter-professional coordination among clinicians, researchers, and engineers will be the key to AI development in the field of dentistry. Despite the potential misinterpretations and the concern of patient privacy, AI will continue to connect with dentistry from a comprehensive perspective due to the need for precise treatment procedures and instant information exchange. Moreover, such developments will enable professionals to share health-related big data and deliver insights that improve patient care through hospitals, providers, researchers, and patients. Schlagwörter: artificial intelligence, big data, caries detection, future dentistry, machine learning

Objective: To evaluate and analyse granulomatous reaction caused by intradermal injections with hyaluronic acid (HA) fillers in the orofacial region. Methods: A retrospective review of 11 cases of foreign body granulomas caused by HA fillers was performed. Demographic data, clinical symptoms, imaging features, treatments, pathology results, history of facial cosmetic procedures and prognosis were reviewed. Results: Most of the cases appeared as painless palpable nodules with no significant growth, located in the cheeks, chin, lips or temples. The nodules were excised, and pathological examination revealed amorphous basophilic material surrounded by foreign body giant cells and macrophages. No patient’s clinical and pathological diagnosis was linked to HA during the first appointment. During follow-up, all patients admitted that they had received dermal filler injections from 3 to 10 years previously. Most of the patients had a favourable prognosis; one patient complained of facial asymmetry and another reported mild pain in the upper lip after surgery. Conclusion: The increase in the number of cases showing delayed complications caused by HA fillers merits closer clinical attention. A thorough understanding of the patient’s medical history and biopsy specimen are necessary to make a definite diagnosis and offer appropriate treatment. Schlagwörter: complications, delayed foreign body granulomas, hyaluronic acid, orofacial region

The injectable composite resin technique is an indirect/direct method that uses a transparent silicone index for accurate and predictable translation of a diagnostic wax-up into composite restorations without the need for tooth preparation. This case report involves a 22-year-old man who presented with esthetic and functional problems associated with diastemas and insufficient tooth visibility. Clinical examination revealed inadequate canine guidance in lateral excursion. The treatment plan included the fabrication of composite veneers for the maxillary incisors and canines. A wax-up was prepared by simulation of functional movements on an articulator, and a transparent silicone index was prepared after checking a mock-up in the oral cavity. The teeth were restored with flowable composite injected and polymerized through the transparent silicone index. The conventional technique was modified by cutting the silicone index at the gingival margin, using individual mock-ups as space holders, and the use of gingival retraction cords. The final outcomes were elongated teeth for increased visibility, closed diastemas, and reshaped canines for adequate guidance in lateral excursion. A protective splint for night-time wear was fabricated and delivered to ensure long-term stability. The patient did not exhibit any soft tissue inflammation or significant wear during a 24-month follow-up period. The technique described is minimally invasive and inexpensive, and it can be used for definitive as well as translational restorations. The treatment goals are to establish adequate function and esthetics, with advantages including minimal tooth structure loss and cost-effectiveness. Stable and predictable results can be achieved with proper planning and a careful workflow. Schlagwörter: composite resin injection, composite veneer, esthetic rehabilitation, functional rehabilitation, transparent silicone index

Objective: The purpose of the present study was to present vertical ridge augmentation (VRA) with the use of cross-linked resorbable membrane, tenting screws, and a combination grafting technique. Report: Three cases are presented. Case 1: A 67-year-old ASA II patient required VRA at the areas of the mandibular left second premolar and first molar. Flap management was performed with the use of periosteal release on the buccal aspect and 23 mm of mylohyoid muscle release on the lingual aspect. VRA was completed with the use of four self-tapping tenting screws, and 1:1 mix of anorganic bovine bone matrix (ABBM) and particulate mineralized bone allograft. A cross-linked resorbable membrane was placed over the buccal and lingual aspect, and a double line of suturing was performed to secure the tension-free closure. Twelve months postoperatively, 4 mm of VRA was confirmed with CBCT. Two implants were placed with >35 Ncm primary stability. Case 2: A 64-year-old ASA I patient required VRA at the area of the maxillary first premolar. Flap management was performed with the use of periosteal release on the buccal aspect and VRA was performed with a 9-mm self-tapping screw, 1:1 mix of ABBM and particulate mineralized bone allograft, a cross-linked resorbable membrane, and a double line of suturing. Twelve months postoperatively, VRA of 6.2 mm on the buccal aspect and 7.9 mm on the lingual aspect were confirmed with CBCT. An implant was placed with >35 Ncm primary stability in combination with horizontal ridge augmentation. Case 3: A 70-year-old ASA II patient required horizontal and VRA at the area of the mandibular left canine. Following extraction, a lateral pedicle sliding flap was completed to enhance the soft tissue volume of the site. After 6 weeks, flap management was performed with the use of buccal periosteal release, VRA was completed with two self-tapping screws, 1:1 mix of ABBM and particulate mineralized bone allograft, a cross-linked resorbable membrane, and a double line of suturing. Eight months postoperatively there was 5.3 mm of bone regeneration on the vertical dimension and 3.9 mm on the horizontal dimension. An implant was placed with primary stability of 45 Ncm. Conclusion: Successful VRA can be achieved with proper flap management to achieve tension-free closure, a cross-linked collagen membrane, tenting screws, and a combination grafting technique. The VRA ranged from 4.0 to 7.9 mm. Schlagwörter: cross-linked resorbable membrane, flap management, tenting screw, vertical ridge augmentation

Teeth with altered size and shape, incisal wear, and inadequate position affect the smile and dentofacial harmony. The aim of this article was to describe a simple and safe protocol for an additive technique with composite resin and cosmetic enameloplasty to improve a patient's smile. A 24-year-old man complained about the appearance of his smile regarding color, shape, and position of the maxillary anterior teeth. Relevant dental history included previous orthodontic treatment with inadequate completion. The clinical examination revealed a disharmony of the smile caused by size and shape alterations of the incisors, a white spot on the right central incisor, incisal wear of the canines, and uneven incisal edges between the maxillary anterior teeth. Treatment with direct composite restoration and enameloplasty was performed in line with the current conservative approach in dentistry. The patient was recalled for 54 months. The use of appropriate techniques in enameloplasty allowed the desired outcome to be observed over the 54 months of follow-up. With this method, it is possible to perform future repair and/or modification, and it may increase the longevity of the restoration. Esthetic and functional results were achieved by careful planning and execution as well as periodic recalls. This conservative approach is a useful alternative to conventional restorations, reducing invasive treatments, chairside time, and costs. Schlagwörter: composite resin, dental restoration failure, dental restoration repair, esthetics, longevity

Objective: Abnormalities of the midface and maxilla are frequently corrected using Le Fort I surgery. This osteotomy passes near the apices of the maxillary teeth, severing the blood vessels and nerves supplying the teeth. The aim of this review was to determine the effect of Le Fort I osteotomy on pulpal vascularity and neurosensory response. Data Sources: A systematic search of the literature was performed in PubMed/ Medline, Google Scholar, EMBASE, and ISI Web of Knowledge from 1969 up to and including December 2015 using the following key words: Le Fort 1, tooth vitality, maxillary osteotomy, pulp, orthognathic. Reference lists of relevant articles were hand-searched for additional articles. Results: Sixty-two studies were located by initial screening; 38 did not meet the eligibility criteria; three were excluded after full-text review, 13 were excluded after quality assessment, leaving nine studies eligible that met all inclusion criteria for this systematic review. The postoperative follow-up period of the included studies ranged from 3 months to 28 months. Five studies assessed pulpal blood flow using laser Doppler flowmetry and eight studies assessed the pulpal neurosensory response using electric pulp testing. Conclusion: There is a decrease in pulpal vascularity and neurosensory response following a Le Fort I osteotomy in the early postoperative period (1 to 10 days) that is likely temporary. Further controlled clinical studies with standardized parameters are required to determine the long-term effects of Le Fort I osteotomy on the vascular and neural healing of the dental pulp. Schlagwörter: Le Fort I osteotomy, pulpal neurosensory response, pulpal vascularity

The prototyping protocol to evaluate and make the potential adjustments prior to finalization of the monolithic restorations was described by two clinical situations. In the first case report, following the digital impressions using an intraoral scanner (3Shape Trios, 3Shape) for an implant-supported four-unit fixed dental prosthesis, a digital design (3Shape Dental System, 3Shape) was performed and a prototype using subtractive CAM (milling) (PMMA, Telio CAD, Ivoclar Vivadent) was fabricated. The second case highlights the 3D-printed prototyping (additive CAM) (Sheraprint Model Plus UV, Shera) following digital impressions using an intraoral scanner and digital design in a patient requiring two opposing open-end three-unit fixed dental prostheses. By means of prototyping, the esthetic, fitting, and functional properties could be tested and the adjustments were completed on the prototypes. It is suggested that prototyping is an efficient tool that minimizes the clinical adjustment need for the final restoration while improving the communication between the dental practitioner and the technician. Schlagwörter: CAD/CAM, ceramics, diagnostic procedure, digital workflow, prosthodontics

Objective: To analyze the loss of nonvital abutment teeth compared to vital abutment teeth supporting removable partial dentures (RPDs). Method and materials: An electronic search was conducted in the Ovid MEDLINE, Embase, and Web of Science databases, and supplemented by a manual search. The search was done to identify clinical studies reporting the loss of nonvital abutment teeth compared to vital abutment teeth for RPDs. The data were extracted from each selected article and meta-analysis was performed using a random effects model to estimate adjusted proportion of abutment loss with RPDs along with 95% confidence interval (CI). Risk of bias assessment was conducted using Cochrane Risk of Bias tools and Newcastle-Ottawa Scale. The statistical significance was set as P value < .05. Results: A total of 3,898 records were identified from electronic databases and 8 studies were included for quantitative synthesis of 834 subjects with 1,036 RPDs. No additional records were identified through manual search. Among 1,152 nonvital abutment teeth, 123 teeth were lost. The estimate of nonvital abutment loss was 13% (95% CI 9–18%]. The data were statistically significant (P < .0001), and were heterogenous between the studies (χ2 [df = 7] = 35.9, P < .0001; τ2 = 0.25, I2 = 76.46%). A total of 2,186 vital abutment teeth were compounded where 114 teeth were lost. The estimate of vital abutment loss was 4% (95% CI 2–7%). The data were statistically significant (P < .0001), and were heterogenous between the studies (χ2 [df = 7] = 23.7, P = .01; τ2 = 0.56, I2 = 86.31%). The risk of abutment loss was approximately three times greater with the loss of vitality (odds ratio = 3.04, 95% CI 1.53–6.05; P = .001). In addition, abutment loss was significantly greater with increasing follow-up time (P = .01). None of the included studies were considered to be at high risk of bias. Conclusion: Within the limitations of this systematic review and meta-analysis, the loss of nonvital abutment teeth was significantly greater than that of vital abutment teeth for RPDs. Further research is needed to identify critical factors associated with the loss of nonvital abutment teeth. (Quintessence Int 2021;52:210–219; doi: 10.3290/j.qi.a45425) Schlagwörter: abutment loss, fracture, nonvital abutment teeth, removable partial denture, vital abutment teeth

„Ubi pus, ibi evacua“ – Dieser Leitspruch besagt, dass wo auch immer sich Eiter befindet, dieser abgelassen werden muss. Das ist das Grundprinzip jeder Abszess-Behandlung, unabhängig davon, ob es sich um einen dentogenen oder einen Abszess anderen Ursprungs handelt.

Objective: The objective of this study was to systematically review the literature regarding the effect of root coverage procedures on tooth survival and periodontal outcomes. Data sources: A systematic search of the literature was performed according to the PRISMA guidelines. A PICO-based search strategy was performed in six databases. Eligibility criteria included studies comparing tooth survival and periodontal outcomes of teeth treated with root coverage procedures versus teeth that had no treatment. The search resulted in 3,646 articles; 212 articles were downloaded for review, and six articles (three studies) were included. Only a single study reported on tooth survival and found no difference between teeth that underwent root coverage procedures versus those that did not. Although the surgeries described in each study were mostly successful in reducing recession and increasing keratinized gingiva, teeth which did not undergo surgery did not seem to have a clinically significant change in recession. The study with the longest follow-up (18 to 35 years) showed an average increase in recession of 0.5 ± 0.9 mm and a decrease in keratinized tissue of 0.3 ± 0.8 mm in the control group. Conclusion: This systematic review highlights the need for randomized controlled trials to assess the influence of root coverage surgeries on tooth longevity in order to better inform evidence-based practice. When compared to no surgical intervention, there is presently no evidence to suggest that root coverage surgeries increase tooth longevity. Furthermore, the amount of recession does not appear to increase a clinically significant amount over time without surgical intervention in the presence of proper maintenance and home care. Schlagwörter: gingival graft, periodontitis, plaque, prevention, recession, root coverage

Objective: To describe how to perform, in a simple manner, a digital wax-up with open source software for a clinical application involving direct composite resin restorations. Report: The clinical technique described presents a simple and highly predictable way of performing direct restorations with the help of a digital wax-up made with open source software. It uses an open source digital tooth library to reestablish a more harmonious smile architecture, specifically of teeth that were worn due to parafunction, and restored with direct composite resin restorations. Conclusions: Thanks to the technology that was used in this case, fast, affordable and accurate results could be obtained. In addition, digital files can be stored, saving material, time, and space, and allowing identical replication of the work either virtually or printed at any time, if needed. (Quintessence Int 2021;52:104–110; doi: 10.3290/j.qi.a45426) Schlagwörter: 3D printing, composite resin, digital dentistry, digital wax-up, direct restoration, wax-up

Objectives: Severe atrophied edentulous posterior mandible with inadequate bone height superior to the inferior alveolar canal may require transposition of the inferior alveolar nerve in order to insert dental implants. Mandibular fractures are considered a rare complication of this procedure. Implant-related spontaneous fractures of the mandible represent 0.2% of patients with inserted implants in an edentulous mandible. This report presents two cases of mandibular fractures that occurred 3 to 4 weeks after inferior alveolar nerve transposition, and were managed successfully by conservative nonsurgical treatments. Method and materials: Overall, 132 procedures of inferior alveolar nerve transposition in 98 patients were performed over a period of 10 years with 379 dental implants inserted in one stage with the procedure. Patients were examined every 2 weeks. The inferior alveolar nerve function was evaluated with various sensory tests. Panoramic radiographs were obtained immediately, at 3 months, and at 1 year after the surgery. The patients received implant-supported fixed prostheses after 3 to 5 months. Results: The healing process was uneventful in 96 patients; however, in two patients (1.5%) spontaneous fracture of the treated site was observed 3 and 4 weeks postoperatively. The fractures lines occurred at a failed implant site. Both cases were treated conservatively. Conclusions: Spontaneous fractures following inferior alveolar nerve transposition are an important but rare complication. Conservative treatment modalities might be useful and indicated in some of those cases. Schlagwörter: atrophic mandible, implant complications, inferior alveolar nerve, mandibular fracture

Objective: The primary objective of this study was to compare the accuracy and time efficiency of an indirect and direct digitalization workflow with that of a three-dimensional (3D) printer in order to identify the most suitable method for orthodontic use. Method and Materials: A master model was measured with a coordinate measuring instrument. The distances measured were the intercanine width, the intermolar width, and the dental arch length. Sixty-four scans were taken with each of the desktop scanners R900 and R700 (3Shape), the intraoral scanner TRIOS Color Pod (3Shape), and the Promax 3D Mid cone beam computed tomography (CBCT) unit (Planmeca). All scans were measured with measuring software. One scan was selected and printed 37 times on the D35 stereolithographic 3D printer (Innovation MediTech). The printed models were measured again using the coordinate measuring instrument. Results: The most accurate results were obtained by the R900. The R700 and the TRIOS intraoral scanner showed comparable results. CBCT-3D-rendering with the Promax 3D Mid CBCT unit revealed significantly higher accuracy with regard to dental casts than dental impressions. 3D printing offered a significantly higher level of deviation than digitalization with desktop scanners or an intraoral scanner. The chairside time required for digital impressions was 27% longer than for conventional impressions. Conclusion: Conventional impressions, model casting, and optional digitization with desktop scanners remains the recommended workflow process. For orthodontic demands, intraoral scanners are a useful alternative for full-arch scans. For prosthodontic use, the scanning scope should be less than one quadrant and three additional teeth. Schlagwörter: 3D printed models, accuracy, CBCT model scan, desktop model scanner, digitalization, full-arch scans, intraoral scanner