Meistgelesene Beiträge

An orthodontic extraction technique with a ramus mini-screw was used to remove a deeply impacted mandibular third molar contacting the inferior alveolar nerve, avoiding damage to the inferior alveolar nerve and relieving postsurgery inflammation. Case presentation: A 24-year-old man was required to extract impacted third molars for orthodontic treatment. Panoramic radiographs and CBCT images showed that his mandibular left third molar penetrated into the inferior alveolar nerve canal and a distomolar was inverted and impacted distally to the third molar. The distomolar was directly removed and the impacted third molar was extruded with the aid of a ramus mini-screw. After 4 months of traction, the mandibular left third molar was successfully moved away from the inferior alveolar nerve canal. No nerve injury occurred after the surgical extraction and the patient was very satisfied with the treatment outcome. Conclusion: Orthodontic extraction, with the aid of ramus mini-screws, is a safe, effective, and efficient technique for the removal of high-risk impacted molars contacting the inferior alveolar nerve. (Quintessence Int 2021;52:538–546; doi: 10.3290/j.qi.b1244345) Schlagwörter: impacted tooth, nerve injury, orthodontic extraction, ramus mini-screw, third molar, traction

Objective: To determine the association of high occlusal force (HOF) with the signs of occlusal trauma and periodontal conditions in periodontitis patients, and elaborate the relevant clinical implications. Methods: Periodontal parameters and signs of occlusal trauma were recorded for 807 teeth in 30 subjects with untreated chronic periodontitis. The T-scan II occlusal analysis system determined the HOF during maximum intercuspation, lateral excursion and protrusive excursion. The correlation of HOF with periodontal parameters and signs of occlusal trauma was analysed. Results: Overall, the teeth with HOF existed mainly in molars and presented with deeper probing depth (PD) and higher frequency of bleeding on probing (BOP) than those without HOF. The fixed-effect analysis showed that HOF was positively correlated with PD and BOP (P < 0.05) in posterior teeth; widened periodontal ligament space on radiographs in upper (r = 0.179, P < 0.01) and lower posterior teeth (r = 0.205; P < 0.05); as well as functional mobility in upper posterior teeth (r = 0.168; P < 0.05). Conclusion: This study suggests that the posterior teeth with HOF in subjects with chronic periodontitis may reflect occlusal trauma-associated periodontal conditions that could probably increase the risk of further periodontal destruction. These findings may improve the clinical assessment of occlusal trauma and related periodontal conditions for better patient management and treatment outcomes. Schlagwörter: chronic periodontitis, occlusal trauma, T-scan occlusal analysis system

Objectives: The aim of this retrospective case series was to report the performance up to 5 years of an innovative surgical design (the apically incised coronally advanced surgical technique [AICAST]) for the regenerative treatment of one- or two-walled intrabony periodontal lesions. Method and materials: After completion of standard step I to II periodontal therapy, nine isolated periodontal defects were treated through AICAST. The following clinical outcome measurements were collected before the surgical intervention and at the last available follow-up: probing pocket depth (PPD), recession depth (REC), and clinical attachment level (CAL). Periapical radiographs of the treated teeth were also taken at baseline and at the last available follow-up (18 months or 5 years postoperatively). Results: A mean (± standard deviation) PPD reduction of 6.05 ± 1.76 mm (P < .01), REC reduction of 1.15 ± 1.97 mm (P = .119), and CAL gain of 7.20 ± 2.13 mm (P < .01) were attained when comparing preoperative results with the last follow-up visit. CAL gain of 6 mm or more was reached in eight out of nine treated cases (88.9%), with a residual PPD of 2 to 3 mm in all the cases. Complete radiographic fill of the intrabony component was present in all the defects, while detectable suprabony radiographic filling was identified in two cases. Conclusion: AICAST represents an innovative surgical design for the treatment of deep intrabony defects and the eventual reduction of the associated gingival recessions. Preliminary results show good performance in terms of clinical attachment gains and maintenance of the marginal tissues. Schlagwörter: coronally advanced flap, enamel matrix derivatives (EMD), papilla preservation flap, periodontal regeneration, periodontitis

Objective: Persistent idiopathic facial pain (PIFP) is a condition in the absence of clear pathology. Pathogenesis is still enigmatic, although comorbidity with mood/affective disorders is observed. The aim of this study was to investigate the association between personality traits, mood and sleep disorders, and PIFP; and to compare them with posttraumatic chronic orofacial pain. Method and materials: A cross-sectional, single-center study was designed to evaluate patients diagnosed with PIFP according to ICOP (International Classification of Orofacial Pain) diagnostic criteria through Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Five Factor Model, and visual analog scale indexes. Data were analyzed and compared with patients suffering from organic pathology – unilateral chronic mandibular fracture pain. Results: A total of 67 respondents enrolled as the experimental group and 28 participants as a control group. Pain scores were higher in the experimental group (P < .001) and had positive correlation with depression (r = .44, P < .001) and sleep index scores (r = .415, P < .001). Personality trait scores did not differ between the groups. However, neuroticism correlated with depression (r = .466, P < .01) and anxiety (r = .634, P < .01) scores in the experimental group. Depression (P = .002) and anxiety scores (P = .007) were higher in the experimental group, as well as sleep indexes (P = .038). Depression (r = .609, P < .001) and anxiety (r = .655, P < .001) scores had positive correlation with sleep index scores. Sleep scores in the experimental group positively correlated with neuroticism score (r = .442, P < .001). PIFP increases the chance of experiencing depression (OR 10.688; 95% CI 1.355–84.309, P = .006) as well as poor quality of sleep (OR 3.389; 95% CI 1.023–11.228, P = .006). Conclusions: The results suggest that personality traits (neuroticism), anxiety, depression, and sleep disorders are associated with PIFP. Schlagwörter: anxiety, depression, persistent idiopathic facial pain, personality traits, sleep disorder

Periodontal disease is highly prevalent and contributes to the global burden of chronic diseases. Inherent and institutional inequities contribute to the prevalence of periodontal disease by facilitating barriers to accessing dental care and maintaining good oral health. The aim of this paper is to review the inequities experienced in the dental field in relation to periodontal disease. Barriers to dental care are experienced in many countries globally. They include cost, insurance coverage, geography, physician availability, and oral health literacy. These barriers influence the frequency of dental visits, oral hygiene, and risk behaviors of individuals which impact an individual’s oral health status. Most often, postponed or improper dental care leads to worsened dental conditions that are more costly and detrimental to one’s wellbeing. These dental conditions, like periodontitis, fall back on the health care system for treatment through emergency department resource use and comorbidities that can develop or be worsened as a result. To reduce the global burden of chronic disease and the costs of treatments for preventable conditions, and increase oral health, corrective actions are required. Such actions may include the use of teledentistry, greater oral health education, emergency departments staffing dental practitioners, subsidies for rural or remote dental practitioners, and policy changes for universal coverage of basic dental needs. Schlagwörter: accessibility, barriers to care, health care systems, oral disease, treatment, wellbeing

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

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

Objective: This study aimed to compare the accuracy performance of five different intraoral scanning systems for a full-arch scan on an edentulous cadaver maxilla. Method and materials: Five digital intraoral impression systems were used to scan a fully edentulous cadaver maxilla. A master scan obtained with an ATOS Capsule industrial grade scanner provided the point of comparison. Experimental scans were compared to the master scan using a metrology software that allows images to be overlayed on one another and deviations interpreted. Once aligned, three comparisons were made between the experimental scans and the reference: the entire maxilla, the ridge area only, and the palate area only. Results: Trueness deviations between the experimental scans and the master digital model were up to 0.1 mm in the 75th percentile. For the whole maxilla, only the Medit scanner had statistically significantly inferior trueness compared to other scanners. When only the palate was considered, Medit was significantly different from Element (P = .0025) and Trios 4 (P = .0040), with no differences found between other scanners. For the ridge region the results replicate the trend observed for the whole maxilla. In regard to precision, differences were found only in the whole maxilla and the ridge area. In both areas, only Medit’s precision was significantly different compared to other scanners, with the exception of Element. However, Element performance was similar to all other scanners. Conclusion: Most intraoral scanners exhibited similar performance. Although several statistically significant differences were identified, the clinical impact of these variances is probably not meaningful. (Quintessence Int 2021;52:488–495; doi: 10.3290/j.qi.b1244373) Schlagwörter: digital dentistry, digital impressions, edentulous

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

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

Objectives: Due to the growing popularity of body modifications, dental practitioners are increasingly confronted with oral piercing and its implications. Successful consultation and subsequent change of patient behavior require an understanding of the patient’s personality and the deep reasons that explain this self-injurious behavior. This is the first study evaluating personality traits and aspects of body perception in a cohort of adults with oral piercing. Method and materials: Sixty-two individuals with labial and/or tongue piercing completed three validated questionnaires assessing body perception and personality traits (Questionnaire for assessing one’s own body; Sensation Seeking Scale; Big Five Inventory Scale). Fisher Exact probability test and Mann-Whitney U test were used to determine differences in frequency data and in psychologic parameters between subgroups. Results: Eighteen single- and 44 multiple-pierced individuals completed the study (53 women, 9 men). The odds for being multiple pierced was significantly higher for tongue than for labial piercing (3.89 and 0.63, respectively; P = .003). In all psychologic parameters measured, the sample showed score distributions within reference norms. However, multiple-pierced individuals displayed a significantly lesser feeling of attractiveness, less self-confidence, and more uncertainty/anxiety towards their body than single-pierced probands (P < .05). Conclusion: Psychologic characteristics of individuals with oral piercing do not fundamentally differ from those of the average population. Therefore, dental practitioners should focus on the medical and dental implications of oral piercing in the counseling of patients who have or intend to have such done. Schlagwörter: body perception, lip piercing, personality characteristics, sensation seeking, tongue piercing

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.

Objectives: Effects of modern cellular technology on our lives is a relatively new topic of interest. The aim of the present study was to investigate the effect of smartphone use on daytime sleepiness, temporomandibular disorders (TMD), and bruxism (sleep and awake) among young adults in Israel. Method and materials: Questionnaires on demographic variables, mobile phone use characteristics, anxiety, depression, daytime sleepiness, bruxism (sleep and awake), and diagnosis of TMD were filled in by ultra-Orthodox young adults (18 to 35 years of age) using a simple mobile device with no internet connection, religious young adults who use an internet-connected smartphone solely for work purposes, and secular young adults with an internet-connected smartphone for unlimited use. Results: Various aspects of smartphone use, including being awakened at night by the phone, stress caused by information delivered by the phone, and stress from phone overuse increased the risks of daytime sleepiness, TMD, and bruxism. Those sequelae are associated with substantial negative effects on both the individual and society. High risks of motor vehicle accidents, chronic orofacial pain, and irreversible damage to hard dental tissue structures are some of those negative consequences. Conclusions: The adverse effects of smartphone use on daytime sleepiness, TMD, and bruxism are substantial. Their influence on public health and health care costs are causes of concern. (Quintessence Int 2021;52:548–559; doi: 10.3290/j.qi.b1244431) Schlagwörter: awake bruxism, daytime sleepiness, sleep bruxism, smartphone use, temporomandibular disorders (TMD)

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

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

Systemic scleroderma is a relatively rare, autoimmune, chronic, and debilitating disease, and its etiology is unknown. The disease is characterized by vasomotor disturbances causing skin and mucosa hardening, hand stiffness, excess production of collagen fibers, and impairment of the internal organs associated with the immune system. Extreme mouth-opening limitation is one of the symptoms in the oral cavity, and compromises dental intervention. One of the fundamental steps when performing a dental procedure is dental arch impression. In the presented clinical case, limited mouth opening hindered the impression accuracy. The objective was to present an alternative impression technique for a patient affected by scleroderma, with limited mouth opening and the need for oral rehabilitation with a removable partial prosthesis in the maxillary arch. An individualized tray was developed with design characteristics that allowed access to the oral cavity and removal, after which it was possible to perform the oral impression, reproducing the areas of interest without causing injury to the oral tissues. The orientation plan was elaborated after obtaining the cast. The teeth were assembled, tested in the mouth, and sent to the laboratory for acrylization. The prosthesis was placed once ready. The alternative impression technique enabled oral rehabilitation of the patient despite the mouth-opening limitation, and provided an accurate impression and a good prosthetic result. Schlagwörter: dental impression technique, microstomia, mouth rehabilitation, removable partial denture, systemic scleroderma

Objectives: While air polishing with abrasive powders has been proved efficient for sub- and supragingival application, only few studies concerning the quality of supragingival biofilm removal using the low-abrasive erythritol powder (EP) exist. The aim of the present randomized controlled trial was to clinically compare the efficacy of supragingival air polishing using EP in comparison with the rubber cup method, and to juxtapose the corresponding biofilm regrowth rates. Method and materials: Thirty-two young adults, suspending oral hygiene for 48 hours, were enrolled in the present double-blind short-term investigation. Using a split-mouth design, tooth polishing was conducted by means of either air polishing or rubber cups with prophylaxis paste (control). While 16 participants received air polishing in the second and fourth quadrants (and rubber cup prophylaxis in the first and third ones), the reverse sequence was applied with the remaining 16 subjects. Biofilms were assessed using the modified Quigley-Hein index (QHI), and QHI sum scores achieved both prior to and immediately after the polishing procedure, as well as 24 hours later, were assessed using a two-way analysis of variance (ANOVA), followed by Tukey’s HSD to test multiple pairwise comparisons. Results: Both methods revealed a significant reduction of QHI scores (P < .001). Compared to the rubber cup method, air polishing resulted in significantly lower scores, both after tooth cleaning and after 24 hours (P < .001). Conclusions: Supragingival biofilm removal by means of air polishing combined with low-abrasive erythritol seems to be more efficacious than the traditional polishing method, and should improve oral health care. Schlagwörter: air polishing, biofilm, erythritol, low-abrasive powder, oral hygiene, plaque, professional tooth cleaning, rubber cup polishing

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

Purpose: The goals of this review are (1) to describe the evidence behind the use of ceramics vs composite resin to restore teeth with anterior veneers using a minimally-invasive strategy; and (2) to discuss the choice of materials and techniques for anterior veneer restorations. Overview: In recent years new adhesive restorative materials and techniques have been introduced in dentistry, including nanofilled composite resins for direct restorations, new ceramic materials that combine esthetics and strength, and polymer/ceramic materials for indirect restorations that are fabricated chairside using CAD/CAM technology, allowing the dentist to design, mill, and cement the restoration in one session. In spite of the novelty and new technology behind the introduction of new materials, the available evidence that backs some of these materials does not justify their use over similar materials or techniques that have been used by dentists for some years. Notwithstanding the success of laminate veneers and the popularity of new materials and digital techniques, the classical direct composite resin veneer is still very popular among clinicians and taught in dental schools and continuing education courses. Direct composite resin veneers are usually more affordable than indirect veneers, less invasive of the tooth structure, and easier to repair. Current composite resin materials can be finished to a tooth-like appearance, but they are susceptible to alterations of the surface gloss and potential discoloration of the composite resin. On the other hand, the preparation for indirect veneers is generally more invasive and the respective restorations are more difficult to repair. In addition, the esthetic outcome of bonded ceramic restorations still depends on the clinical behavior of the dentin adhesive and resin luting cement used to bond the restoration to the tooth structure. Conclusions: The ultimate goals of any restorative treatment are to restore function and esthetics, prevent recurrent caries lesions and bacterial leakage into the pulp space, save tooth structure, and promote the well-being of our patients. The armamentarium of new dental materials for esthetic clinical procedures has increased exponentially in the last few years. The use of different materials and techniques for anterior veneer restorations must be based on sound evidence rather than on the marketing hype or testimonials. Schlagwörter: adhesion, ceramics, clinical, composite resin, MID, restorative materials, veneers

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 evaluate the comprehensive effects of photobiomodulation (PBM) therapy on teeth after active orthodontic treatment. Materials and Methods: This systematic review was conducted according to the PRISMA guidelines. Six databases were electronically searched and screened for eligible human and animal studies published up to August 2020. The risk of bias was assessed based on the Cochrane Handbook for Systematic Reviews of Interventions and Systematic Review Centre for Laboratory Experiment Tool. Two independent reviewers performed all procedures in duplicate. Any disagreement was resolved by discussion or consultation with a third reviewer. Results: A total of 395 records were identified from the initial search up to August 2020. Following screening, 16 full-text articles were reviewed for eligibility (κ > 0.90), and ultimately 9 studies (3 clinical studies and 6 animal studies) were included in this review. The key outcomes observed were ‘tooth position maintenance’ and ‘root resorption rehabilitation’. Two controlled clinical trials and two animal studies supported the preventive effects of PBM therapy on the relapse of post-orthodontic tooth positions, while the other two animal studies reported opposing findings. Regarding root resorption, all evidence supported the rehabilitation potential using PBM therapy for teeth that had undergone orthodontic tooth movement. There was a high risk of bias among studies, except for one randomised controlled trial. Due to the substantial heterogeneity among studies in terms of their types, participants, designs, PBM therapy settings and variables of interest, it was not possible to conduct a meta-analysis; therefore, a qualitative synthesis is presented. Conclusion: The quality of evidence for PBM therapy contributing to the maintenance of tooth position or improved dental health after orthodontic treatment remains low. There is considerable controversy over the effects of PBM therapy on orthodontic relapse. However, the use of PBM therapy after orthodontic treatment has promising effects for root resorption rehabilitation and is generally recommended. Schlagwörter: orthodontic retention, orthodontically induced inflammatory root resorption, photobiomodulation therapy, systematic review

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

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 describe oral health knowledge, attitudes and behaviours of parents and caregivers of preschool children in order to inform an oral health promotion strategy. Materials and Methods: A sample of parents and caregivers of children attending nine randomly selected preschools in central Trinidad were invited to complete a self-administered questionnaire on early childhood oral health. Results: A total of 309 parents and caregivers participated: 88% were female, 74.4% were of Indian ethnicity, with 50.4% in manual employment, and 50.2% educated to secondary level. 59.1% felt a child's first dental visit should be when all primary teeth are present. 64% had not taken their child for a dental visit. 81.6% rated their child's oral health as good or better and 28% would want an asymptomatic, decayed primary tooth extracted rather than filled. Over 80% used fluoride toothpaste. 52.8% always supervised their child's toothbrushing, and 44% claimed to be using the recommended pea-size amount. 26.2% reported having used a sweetened feeding bottle or infant feeder at night. Conclusion: Parents and caregivers of preschool children in this sample had reasonable oral health knowledge. However, despite generally positive attitudes towards preventive oral healthcare, confusion regarding dental attendance, supervised toothbrushing, fluoride use and sugar intake suggests that these items require particular emphasis in oral health promotion programmes aimed at improving early childhood oral health. Schlagwörter: early childhood caries, parents, caregivers, oral health promotion

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

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

Purpose: To evaluate the association between orthodontic treatment with fixed appliances and periodontal health during treatment by examining gingival inflammation indices and saliva properties. Materials and Methods: Thirty consecutive orthodontic patients, aged 11–18 years old, who were eligible for fixed orthodontic appliances, were included in the study. Plaque index (PI), gingival index (GI), salivary pH and flow rate were recorded at three timepoints: immediately before placement of orthodontic fixed appliances (T0), and 1 (T1) and 3 months (T2) after bonding. Results: The hypothesis that PI would remain constant across timepoints was rejected. PI increased over time (0 to 1 scale, T1-T0: mean diff. = 0.10, 95% CI = 0.03, 0.18, p = 0.01; T2-T0: mean diff. = 0.16, 95% CI = 0.08, 0.24, p < 0.001). On the other hand, GI changed statistically significantly over time (p = 0.05). Patients’ age was not a predictor for PI change (p = 0.93), but it was for GI (p = 0.01). As anticipated, average PI was found to be higher for the mandibular dentition by 0.10 (95% CI = 0.04, 0.16) and the labial surfaces of teeth of both jaws by 0.51 (95% CI = 0.45, 0.57). Conclusions: Within the framework of the current study, orthodontic treatment appeared to affect the periodontal health of patients, but the changes were clinically negligible and not consistently statistically significant. Schlagwörter: fixed orthodontic appliances, gingival index, periodontal health, plaque index

Objectives: In order to retain primary molars, eg with irreversible pulpitis or pulp necrosis, pulpectomy can be an alternative to extraction. However, reports on the success of pulpectomies in primary teeth vary widely in the literature. Thus, the objective of this study was not only to analyze the success rate of primary tooth pulpectomy 12 months posttreatment in the setting of a specialized clinic, but also to identify and analyze various factors that modify the outcome. Method and materials: Between 2012 and 2018, a total of 76 dental records of the Department of Preventive and Pediatric Dentistry at the University of Greifswald fulfilled the inclusion criteria, resulting in a 1-year analysis of 62 primary molars with an idoform-calcium hydroxide paste as root canal filling material almost exclusively covered by a stainless steel crown as restoration. Results: The pulpectomy treatment was successful after 1 year in 93.5%, with a significantly higher survival for mandibular primary molars (100.0% vs 83.3%; chi-square test P = .01). Apart from the very few cases in the mixed dentition, no other factors related to the patient (sex, caries level, general health conditions, distance to clinic), tooth (first or second primary molar, pulpal and periapical condition before treatment), or treatment (indication, academic qualification of the operator, number of visits) proved to be of significance for the treatment outcome due to the overall high success rate. Conclusion: Pulpectomies for pulpally involved or even necrotic primary molars followed by stainless steel crowns as restoration should be considered as a treatment option, especially in the mandible. (Quintessence Int 2021;52:528–537; doi: 10.3290/j.qi.b1244443) Schlagwörter: primary molars, pulpectomy, stainless steel crown, success rate

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

Objectives: To describe the step-by-step procedure of a novel surgical technique consisting of a combination of the laterally closed tunnel (LCT) and the modified coronally advanced tunnel (MCAT) (ie, LCT/MCAT), designed to treat multiple mandibular adjacent gingival recessions (MAGR) and to present the clinical outcomes obtained in 11 consecutively treated patients. Method and materials: Eleven systemically and periodontally healthy patients (7 females, mean ± SD 33.62 ± 14.6 years, min. 19 years max. 67 years) with a total of 40 adjacent mandibular RT1 (ie, Miller Class 1 and 2) gingival recessions with a minimum depth ≥ 3 mm, were consecutively treated with LCT/MCAT, in conjunction with an enamel matrix derivative (EMD) and subepithelial palatal connective tissue graft (SCTG). Treatment outcomes were assessed at baseline and at 12 months postoperatively. Prior to surgery and at 12 months postoperatively, recession depth (RD) and recession width (RW) were evaluated. The primary outcome variable was complete root coverage (CRC, ie 100% root coverage), the secondary outcome was mean root coverage (MRC). Results: Postoperative pain and discomfort were low and the healing was uneventful in all cases without any complications. At 12 months, statistically significant (P < .05) root coverage (RC) was obtained in all patients. CRC was obtained in five patients with a total of 21 recessions, while MRC measured 92.9% (ie, 3.75 mm). In seven patients (ie, 63.6%), RC amounted to > 93% while the minimum RC per patient measured 83.76%. Conclusion: The results of the present case series suggest that the LCT/MCAT is a valuable technique for the treatment of mandibular RT1 MAGR. Schlagwörter: laterally closed tunnel, modified coronally advanced tunnel, multiple adjacent mandibular gingival recessions, recession coverage, subepithelial palatal connective tissue graft, surgical technique

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

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

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

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

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

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

Objective: To analyse factors associated with the susceptibility of early childhood caries (ECC), populations with a high risk of ECC were screened and guidance for ECC prevention was proposed. Methods: A total of 392 children aged 24 to 71 months were selected for oral examination in Qingdao. Parents or guardians of the participants completed the questionnaires and decayed missing filled surface (dmfs) were recorded. Differences in caries condition and oral health behaviour in different families were compared. Risk factors related to ECC were screened. The subjects were finally grouped based on the obtained dmfs into three groups: caries-free, ECC and S-ECC (severe ECC). Association of risk factors with the caries status was analysed using the Kruskal-Wallis test, the chi-square test and logistic regression analysis. Results: There were significant differences among the caries-free, ECC and S-ECC groups in three parameters: eating too many sweets each day, brushing before and after sleeping, and whether parents helped to brush (P < 0.01). Combined factors such as the parents' level of education, oral health knowledge, attitudes, the family's annual income, the age of children when they start to brush and not brushing regularly were also significantly related to ECC (P < 0.05). No significant differences were observed among the three groups for these factors, including birth condition and nursing state, physical condition of the mother during pregnancy, feeding situation, if a pacifier was used during sleep, duration of brushing, frequency of mouth rinsing after meals each day and brushing with fluoride toothpaste (P > 0.05). Conclusion: Eating a lot of sweets, an incorrect brushing method, starting brushing at a later stage and not brushing regularly are susceptible factors for ECC. Emphasising oral health knowledge to parents and guardians, conducting proper brushing methods, limiting the frequency of sweets being eaten and avoiding an inappropriate habit of eating sweets are very important factors in the prevention of ECC. Schlagwörter: children, decayed missing filled surface (dmfs), early childhood caries (ECC), prevalence, susceptibility

Objective: To analyze the loss of abutment teeth for double crown-retained removable partial dentures (DC-RPDs) compared to clasp-retained removable partial dentures (C-RPDs). Method and materials: A search was conducted in the Ovid MEDLINE, Embase, Web of Science databases, and a manual search. The search was conducted based on the PICO framework with inclusion and exclusion criteria. After extracting the data of selected studies, a meta-analysis was performed to estimate abutment loss with 95% confidence interval (CI). The statistical significance was defined as P < .05, and the heterogeneity of the data was assessed based on the chi-squared test and I2 statistics. Risk of bias assessment was conducted using Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. Results: A total of 4,692 records were identified from electronic databases and 38 studies were included for quantitative synthesis of 3,393 subjects with 13,552 abutment teeth. A total of 1,226 abutment teeth were lost with > 4,016 RPDs. Seven studies were compounded for > 668 C-RPDs (mean follow-up time ≤ 5 years) and six studies for 893 C-RPDs (mean follow-up time > 5 years), where the estimates of abutment loss were 5% (95% CI 2% to 8%) and 8% (95% CI 5% to 13%), respectively. The data were not significantly different (P = .1), and were heterogenous between the studies (τ2 ≥ 0.34, I2 ≥ 87.38%). Thirteen studies were compounded for 1,223 DC-RPDs (mean follow-up time ≤ 5 years) and eight studies for 1,033 DC-RPDs (mean follow-up time > 5 years), where the estimates of abutment loss were 6% (95% CI 5% to 8%) and 12% (95% CI 8% to 18%), respectively. The data were heterogenous (τ2 ≥ 0.17, I2 ≥ 75.86%), and were significantly different between the studies (P = .005). Overall, C-RPDs were not significantly different from DC-RPDs in abutment loss (P ≥ .3). A significant predictor for abutment loss was follow-up time with DC-RPDs (P = .005), where the risk of abutment loss per year was 18% (P = .0001). In contrast, follow-up time was not a significant factor for C-RPDs (P = .1). None of the included studies were at high risk of bias. Conclusion: Within the limitations of the current systematic review and meta-analysis, abutment loss was not significantly different between C-RPDs and DC-RPDs. A significant predictor was follow-up time for DC-RPDs, whereas this factor was not significant for C-RPDs. Further research is needed to investigate critical factors for abutment loss with RPDs. Schlagwörter: abutment loss, clasp-retained removable partial denture, conical crown-retained removable partial denture, double crown-retained removable partial denture, telescopic crown-retained removable partial denture

Objectives: The retrospective study was undertaken to assess the peri-implant tissue stability in premolar and molar sites clinically and radiographically for implants 7 years after loading. Method and materials: 408 implants placed in 275 patients from 2012 to 2020 and following a regular recall protocol were assessed for Modified Plaque Index (MPI), Sulcus Bleeding Index (SBI), pocket probing depth (PPD), and the peri-implant soft tissue dehiscence (PSTD) clinically and mesial bone loss (MBL) and distal bone loss (DBL) radiographically. Results: Significant differences were found in MPI, SBI, and PPD amongst both men and women in the premolar and molar regions. The mean MBL and DBL were substantially greater in women than in men and marginally more in the maxilla than in the mandible. Maximum mean bone loss on either aspect of the premolar and molar implants was 2.80 ± 1.54 mm and 2.97 ± 0.96 mm for women. Implant success of 96.82% at 7 years was achieved and the patient satisfaction levels of 94.55% and 95.50% in the mandibular and maxillary arches, respectively, implied that patients were satisfied with the treatment. Conclusion: Women exhibited greater marginal bone loss on the mesial and distal aspects than men, with premolar implant sites demonstrating greater propensity for marginal bone loss than molar implant sites. Schlagwörter: implant success, implant survival, patient satisfaction, survival analysis

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

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

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

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

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

Patients with the characteristics of hyperdivergent facial patterns (dolichocephaly, shallow overbite and anterior open bites) are generally considered to be challenging to treat as many biomechanical approaches have extrusive side-effects that may lead to further bite opening and exasperate the clinical issues. However, with the increasing numbers of patients undergoing clear aligner therapy, there is a general clinical consensus that clear aligners are a good treatment option for this group of patients as vertical facial dimensions are not significantly affected with treatment. In the absence of literature on this topic, clinical cases are presented to demonstrate successful treatment of dolichocephalic patients with the ClearCorrect clear aligner system. These cases support the general notion that patients with increased facial dimensions can be treated with clear aligner therapy without adverse vertical changes. Schlagwörter: aligner, facial dimension, hyperdivergent, open bite, orthodontic, vertical

Purpose: To compare clinical outcomes and oral fluid biomarkers in gingivitis subjects using an electric toothbrush/irrigator combination (test) or a manual toothbrush alone (control) over 8 weeks. Materials and Methods: Subjects were randomly assigned to two groups of n = 30. In both groups, toothbrushing was performed twice daily at home and no additional interdental cleaning aids were allowed. Plaque Index (PLI), Gingival Index (GI), whole saliva (WS), and gingival crevicular fluid (GCF) samples were collected at weeks 2, 4, and 8. Results: Subjects’ mean age was 23 years and 52% were female. Overall baseline means were 1.31 for PLI, 1.07 for GI, and 34.9 for number of bleeding sites. At every follow-up visit, both groups differed statistically significantly (p < 0.001) from baseline for all clinical parameters. The test group demonstrated statistically significantly (p < 0.001) greater reductions in GI vs the control group by 18% at week 2, 17% at week 4 and 24% at week 8. The test group also demonstrated statistically significantly (p < 0.002) greater reductions in the number of bleeding sites vs the control group by 33% at week 2, 34% at week 4 and 43% at week 8. Between-group comparisons for both WS and GCF revealed numerical trends for decreased levels of interleukin (IL)-1β in GCF after 4 and 8 weeks, but these were not statistically significant. Conclusion: In subjects using the electric toothbrush/irrigator combination, increased clinical improvements may be found accompanied by similarly improved trends for oral fluid biomarkers such as IL-1β. Schlagwörter: gingival crevicular fluid, gingivitis, prevention, toothbrushing

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

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