DZZ International, 01/2019

Introduction: In recent years, the indication for the placement of dental implants has expanded consistently. Therefore, more and more patients are treated with implant supported restorations resulting in increasing implant associated complications. Inflammatory peri-implant diseases represent the most frequent complications. For peri-implantitis, especially in advanced cases, a surgical approach is still the gold standard. However, to date no preferential surgical protocol has been established. Previous surgical techniques recommended the removal of the intralesional granulation tissue followed by grafting of the bony defect. Material und Methods: The present article demonstrates the systematic treatment protocol for inflammatory peri-implant diseases performed in our department at Hannover Medical School and a new surgical technique. The aim of this technique is to preserve as much intralesional granulation tissue as possible. The efficiency of the granulation tissue preservation technique has already been proven for regenerative periodontal therapy. Three case reports illustrate the practical application and the effectiveness of this new surgical technique in the regenerative treatment of peri-implantitis. Results and Conclusion: The present case series demonstrates a significant gain of clinical attachment level and a remarkable bone fill, proving the success of the new surgical therapy protocol. In addition to the preservation of multipotent mesenchymal stem cells and blood vessels, the enhanced soft tissue support with an endogenous matrix resulted in less postoperative mucosal recessions. This is the main advantage of the new surgical technique. Keywords: decontamination protocol, granulation tissue preservation technique, peri-implantitis treatment, regenerative treatment of peri-implantitis

Antiresorptive drug related osteonecrosis of the jaw (ARONJ) develops primarily in patients with bisphosphonate and/or denosumab therapy. The therapeutic indications of these drugs range from patients with osteoporosis to multi-morbid patients with osseous metastases of solid tumors. In addition to reduced bone remodeling, etiology also describes other factors such as changes to the soft tissues, vessels and the immune system. Here, trigger factors such as inflammatory changes in the oral cavity, periodontitis, periimplantitis or even surgical procedures such as tooth extractions and prosthesis pressure points play a decisive role in the pathological process. If a full dental functional rehabilitation isto be realized, it is crucial to select a treatment regime that considers the least possible risk of developing osteonecrosis. Clearly general dental surgical procedural risks should also be considered. In individual cases functional rehabilitation may also include an implant-supported denture. The possible risk factor for the development of a drug-associated necrosis of the jaw by prosthetic pressure points caused by removable dentures can be reduced by using implant-supported restoration. Keywords: DGI-evaluation chit, antiresorptive drug related osteonecrosis of the jaw (ARONJ), bisphosphonate, current state of the guidelines, dental implant insertion, individual risk

Objective of the study: to measure the in vitro wear of two bioactive smart composite restorative materials and one glass ionomer cement. Materials and methods: The smart composites Activa (Pulpdent) and Cention N (Ivoclar Vivadent) and the glass ionomer cement Fuji IX (GC) were applied into aluminum sample holders, pressed against a glass plate and stored in water for 3 weeks after curing. The samples were subjected to 400,000 load cycles of 49 N in the CS-4 chewing simulator (Mechatronik) against steatite antagonists and subjected to 4,440 thermocycles from 5 °C to 55 °C. Samples were evaluated with replicas after 5,000, 10,000, 20,000, 40,000, 60,000, 80,000, 100,000, 120,000, 160,000, 200,000, 240,000, 280,000, 320,000, 360,000 and 400,000 cycles with a laser scanner (LAS-20, Mechatronik) and the Geomagic software (wear volume). The data was analyzed with ANOVA and Tukey test. Selected wear facets were analyzed with a scanning electron microscope (SEM). Results: The increase in wear was almost linear and after 60,000 cycles significantly different depending on the material (Activa < Cention N < Fuji IX). After 400,000 load cycles the following wear was measured: Activa 1.571 mm3, Cention N 2.455 mm3 and Fuji IX 5.622 mm3. The wear of the antagonist was slight and in the reverse order (p < 0.001): Fuji IX 0.021 mm3, Activa 0.091 mm3 and Cention N 0.126 mm3. SEM analysis showed pores in the powder-liquid systems. The composite and their antagonists had scratched surfaces, something that was not seen on the glass ionomer cement. Discussion: The bioactive composites that were tested had wear values comparable to the modern hybrid composites determined by the authors with the identical test method. The lesser wear of Activa in comparison to Cention N can be explained by the fact that the latter material is designed as a powder-liquid system with manual mixing. Conclusion: Based on their wear behavior the tested bioactive smart composites are suitable for posterior fillings (as an amalgam replacement) while the great wear to the glass ionomer cement confirms this indication (non load-bearing class I and II fillings). University of Florida, College of Dentistry, Department for Restorative Dental Sciences, 1395 Center Drive, Gainesville FL 32608 USA: Prof. Dr. Jean-François Roulet, Dr. Hind Hussein BDS, Dr. Nader F. Abdulhameed BDS. MS. PhD Cand., Chiayi Shen Ph.D. Keywords: alcasites, glass ionomer cement, in-vitro-wear, smart composites

For managing non-cavitated proximal caries lesions, non- or micro-invasive strategies (NI/MI) are currently recommended over invasive (restorative) approaches. However, survey data indicate that dentists may not have adopted these strategies. This qualitative study aimed to identify barriers and facilitators for using NI/MI in Germany. Methods: A diverse sample of 12 dentists was recruited. Semi-structured interviews were conducted by telephone, using an interview schedule based on the Theoretical Domains Framework. Results: Limited financial reimbursement and an organizational framework centering around placing restorations, patients' lacking adherence to advice and oral hygiene (and associated high caries risk) as well as the fear of lesion progression (anticipated regret) were identified as relevant barriers for NI/MI. Facilitators were found to be working in a team where NI/MI is promoted, having knowledge of the disadvantages of restorations and the evidence supporting NI/MI, regularly attending ongoing professional development courses and professional satisfaction when doing "the right thing" for the patient. Conclusions: A number of aspects at individual, practice and healthcare level could be targeted to enhance dentists' uptake of NI/MI for managing non-cavitated proximal caries lesions. Keywords: attitudes, decision-making, dental, enamel caries, evidence-based practice, qualitative studies, theoretical domains framework

In the last few years, clinicians and scientists in the dental field have become more aware of the importance of preserving pulp vitality. While excavating deep caries lesions (caries profunda), special attention should be given to the remaining dentin layer covering the pulp. While it has been taught over the years to excavate caries until reaching healthy, hard dentin (cri dentinaire), meanwhile it appears justifiable to selectively leave infected dentin close to the pulp in order to avoid exposure of the pulp tissue. Keywords: scientific communication