Impact of treatment of rheumatoid arthritis on periodontal disease: A review

BACKGROUND

Numerous studies support a bidirectional association between rheumatoid arthritis (RA), a chronic autoimmune degenerative inflammatory joint disease, and periodontitis, a chronic inflammatory disease caused by the immune reaction to bacteria organized in biofilms. RA and periodontitis are both multifactorial chronic inflammatory diseases that share common modifiable and non-modifiable risk factors. There is no cure for RA; treatment is based on lifestyle modifications and a variety of medications: nonsteroidal anti-inflammatory drugs (NSAID), glucocorticoids, and disease-modifying antirheumatic drugs (DMARDs, e.g., conventional synthetic DMARDs [csDMARDs]; biological DMARDs [bDMARD] and targeted synthetic DMARDs). There are molecular pathways of inflammation that are common to both RA and periodontitis. Thus, there is a potential effect of RA treatments on periodontitis. This systematic review aims to assess the impact of antirheumatic agents on periodontal conditions of patients suffering from both RA and periodontitis.

METHODS

PubMed/MEDLINE, Cochrane Library, and Embase online databases were systematically explored, and a manual search was performed to identify relevant studies published until January 2023. This review is registered in the PROSPERO database (CRD42023409006).

RESULTS

A total of 2827 articles were identified, and 35 fulfilled the inclusion criteria. The included studies generally show a consensus that, at normal dosage, NSAID and corticosteroids have negligible impact on periodontium. Similarly, csDMARD alone or in combination with other csDMARD demonstrated no adverse effect on periodontium. Monotherapy with bDMARD had a positive effect on periodontal pocket depths and gingival inflammation in the longitudinal studies up to 6 months but showed negligible effect on the periodontium in interventional studies with a longer follow-up (9 months and 15.1 months). However, the combination of tumor necrosis factor (TNF)-α inhibitors + methotrexate (MTX) was associated with a rise in gingival inflammation. Due to the considerable heterogeneity of the study designs, a meta-analysis could not reasonably be performed.

CONCLUSION

Within the limitations of the available studies, there is evidence to suggest that bDMARD monotherapy may improve the periodontal condition of RA patients with periodontal disease to a certain extent; the concomitant medication of TNF inhibitor + MTX could worsen gingival inflammation. More data are required to understand the impact of RA therapies on periodontal health.

Exploring the staining potential of 1 GSK-3 inhibitors in bovine teeth: 2 a one-year laboratory investigation

GSK-3 inhibitors, such as Tideglusib (TG) and CHIR-99021 (CHIR), show promise in stimulating reparative dentin formation. The aim of this study was to assess the discoloration potential of TG and CHIR in an established in vitro model. Enamel-dentin specimens made from bovine incisors were randomly allocated to five groups (n=15 each): group bovine blood (BB), group dimethyl sulfoxide (DMSO), group TG, group CHIR, and group mineral trioxide aggregate (MTA). Each specimen had a central cavity in which the respective material was applied and sealed with resin-based luting material. Color determination was conducted using a dental spectrophotometer at t0 (before filling), t1 (immediately after filling), t2 (after one week), t3 (after one month), t4 (after three months), t5 (after six months), and t6 (after one year). Statistical analysis involved descriptive statistics, Kruskal-Wallis tests, and analysis of variance (α=0.05). Group BB and group CHIR exhibited the most significant decrease in lightness (ΔL*) after one year (ΔL*-4.7 and ΔL* -5.7, respectively), whereas groups DMSO, TG, and MTA showed minimal changes (DMSO ΔL*: -0.3; TG ΔL*: 1.4; MTA ΔL*: -0.5). Group BB and CHIR exhibited the highest ΔE values (6.4Å}0.6 and 6.5Å}0.8, respectively). Unlike CHIR, TG did not result in discoloration exceeding the threshold of visual perception, defined by a ΔE value of 5.5, during the one-year observation period. This laboratory study therefore suggests that TG could be utilized for indirect or direct pulp capping without major discoloration concerns. However, additional research is required to corroborate these findings.

Impact of oral piercings on periodontal health - A systematic review

AIM

Evidence on the impact of oral piercings on periodontal conditions is scarce. Thus, the aim of this systematic review was to evaluate the influence of oral piercings on periodontal health.

MATERIALS AND METHODS

A systematic literature search was performed for studies published by 6 June 2023, using three electronic databases and a hand search. Clinical trials including ≥10 patients wearing ≥1 oral piercing and presenting data on probing pocket depths (PPDs) were considered. Primary outcomes were PPD, and secondary outcomes included clinical attachment loss (CAL), gingival recession, bleeding on probing (BOP), and plaque score (PI). A synthesis of results, using a vote-counting method, was applied.

RESULTS

From 131 titles identified, eight studies, published between 2007 and 2022, were included. Out of these were six cross-sectional studies and two case series. A total of 236 lip piercings and 236 tongue piercings in overall 408 patients were analyzed. In patients with tongue piercings, teeth adjacent to the piercing showed increased PPD (3 of 5 studies), more CAL (3 of 4 studies), more gingival recessions (4 of 4 studies) and a higher BOP (2 of 3 studies) compared with control teeth. In patients with lip piercings, teeth adjacent to the piercing demonstrated more gingival recessions (3 of 4 studies) compared with control teeth. Time since piercing placement was associated with localized periodontal destruction in patients with tongue and/or lip piercings (4 of 7 studies).

CONCLUSIONS

The available evidence from eight studies suggests negative effects of tongue piercings on several periodontal health parameters of adjacent teeth, while gingival recessions were frequently detected in patients with lip piercings.

ChatGPT's performance in dentistry and allergy-immunology assessments: a comparative study

Large language models (LLMs) such as ChatGPT have potential applications in healthcare, including dentistry. Priming, the practice of providing LLMs with initial, relevant information, is an approach to improve their output quality. This study aimed to evaluate the performance of ChatGPT 3 and ChatGPT 4 on self-assessment questions for dentistry, through the Swiss Federal Licensing Examination in Dental Medicine (SFLEDM), and allergy and clinical immunology, through the European Examination in Allergy and Clinical Immunology (EEAACI). The second objective was to assess the impact of priming on ChatGPT's performance. The SFLEDM and EEAACI multiple-choice questions from the University of Bern's Institute for Medical Education platform were administered to both ChatGPT versions, with and without priming. Performance was analyzed based on correct responses. The statistical analysis included Wilcoxon rank sum tests (α=0.05). The average accuracy rates in the SFLEDM and EEAACI assessments were 63.3% and 79.3%, respectively. Both ChatGPT versions performed better on EEAACI than SFLEDM, with ChatGPT 4 outperforming ChatGPT 3 across all tests. ChatGPT 3's performance exhibited a significant improvement with priming for both EEAACI (p=0.017) and SFLEDM (p=0.024) assessments. For ChatGPT 4, the priming effect was significant only in the SFLEDM assessment (p=0.038). The performance disparity between SFLEDM and EEAACI assessments underscores ChatGPT's varying proficiency across different medical domains, likely tied to the nature and amount of training data available in each field. Priming can be a tool for enhancing output, especially in earlier LLMs. Advancements from ChatGPT 3 to 4 highlight the rapid developments in LLM technology. Yet, their use in critical fields such as healthcare must remain cautious owing to LLMs' inherent limitations and risks.

Guided endodontics versus conventional access cavity preparation: an ex vivo comparative study of substance loss

BACKGROUND

To compare the outcomes of conventional access cavity preparation (CONV) versus guided endodontics (GE) for access cavity preparation in anterior teeth with pulp canal calcification (PCC) regarding root canal detection, substance loss, procedural time, and need for additional radiographs.

METHODS

Extracted, sound human teeth with PCC (n = 108) were matched in pairs, divided into two groups and used to produce 18 models. An independent endodontist and a general dentist performed access cavity preparation under simulated clinical conditions on nine models each (54 teeth). The endodontist used the conventional technique and the general dentist GE. Time needed to access the root canals and the number of additional radiographs were recorded. Pre- and postoperative cone-beam computed tomography scans were obtained to measure substance loss. Statistical significance was tested by examining the overlap of 95% confidence intervals (CIs) between the groups.

RESULTS

All root canals were successfully accessed by both methods. There were no significant differences in substance loss (CI: CONV 15.9-29.6 mm3 vs. GE 17.6-27.5mm3) or procedural time (CI: CONV 163.3-248.5 s vs. GE 231.9-326.8 s). However, 31 additional radiographs were required for GE compared to none for CONV.

CONCLUSIONS

For access cavity preparation in teeth with PCC, both CONV by a specialist and GE by a general dentist produce good results in terms of substance loss and time requirements.

Implications of large language models such as ChatGPT for dental medicine

OBJECTIVE

This article provides an overview of the implications of ChatGPT and other large language models (LLMs) for dental medicine.

OVERVIEW

ChatGPT, a LLM trained on massive amounts of textual data, is adept at fulfilling various language-related tasks. Despite its impressive capabilities, ChatGPT has serious limitations, such as occasionally giving incorrect answers, producing nonsensical content, and presenting misinformation as fact. Dental practitioners, assistants, and hygienists are not likely to be significantly impacted by LLMs. However, LLMs could affect the work of administrative personnel and the provision of dental telemedicine. LLMs offer potential for clinical decision support, text summarization, efficient writing, and multilingual communication. As more people seek health information from LLMs, it is crucial to safeguard against inaccurate, outdated, and biased responses to health-related queries. LLMs pose challenges for patient data confidentiality and cybersecurity that must be tackled. In dental education, LLMs present fewer challenges than in other academic fields. LLMs can enhance academic writing fluency, but acceptable usage boundaries in science need to be established.

CONCLUSIONS

While LLMs such as ChatGPT may have various useful applications in dental medicine, they come with risks of malicious use and serious limitations, including the potential for misinformation.

CLINICAL SIGNIFICANCE

Along with the potential benefits of using LLMs as an additional tool in dental medicine, it is crucial to carefully consider the limitations and potential risks inherent in such artificial intelligence technologies.

Accuracy of Selective Enamel Etching: A Computer-assisted Imaging Analysis

OBJECTIVE

To assess the accuracy of selective enamel etching (SEE) in a laboratory setup simulating clinical conditions.

METHODS AND MATERIALS

A model with permanent human teeth was fabricated. It included a first mandibular molar with a mesio-occlusal-distal inlay preparation, a maxillary central incisor, and a canine with a class IV and class V cavity, respectively. Two dentists (with 1 year and 10 years work experience) repeatedly (n=10 per cavity) performed SEE with a custom gel that had identical rheological properties as a commercially available phosphoric acid etchant. An intraoral scanner was used for image acquisition. To assess the accuracy of SEE, special software was used (OraCheck, Cyfex, Zurich, Switzerland). Two independent investigators analyzed baseline scans and scans taken of the cavities while the gel was in place. The statistical analysis comprised t-tests, Pearson correlation, and analysis of variance (α=0.05).

RESULTS

The level of accuracy, whose average values ranged from 61.1% to 87.0%, showed significant differences between teeth, with the highest level observed in the class V cavity, followed by the class II inlay preparation and the class IV cavity (p<0.001). Across the cavities, no significant correlation was observed between the application time and the accuracy of SEE (p=0.07).

CONCLUSION

This laboratory study suggests that inadvertent conditioning of dentin adjacent to enamel may be common during SEE. Investigations involving larger samples of dentists are needed to corroborate this finding.

Quality of CAD-CAM inlays placed on aged resin-based composite restorations used as deep margin elevation: a laboratory study

OBJECTIVES

To assess the impact of the age of resin-based composite (RBC) restorations used for deep margin elevation (DME) on the marginal quality and fracture resistance of inlays.

MATERIALS AND METHODS

Permanent human molars with direct RBC restorations, involving the mesial, occlusal, and distal surface (MOD), were allocated to four groups (each n = 12). Half of the teeth underwent thermomechanical loading including 240,000 occlusal load cycles and 534 thermal cycles (TML, 5 °C/55 °C; 49 N, 1.7 Hz). With RBC left in one proximal box as DME, all teeth received MOD inlays, made from lithium disilicate (LDS) or a polymer-infiltrated ceramic network material (PICN). The restored teeth underwent TML including 1.2 million occlusal cyclic loadings and 2673 thermal cycles. The marginal quality was assessed at baseline and after both runs of TML. Load-to-fracture tests were performed. The statistical analysis comprised multiple linear regressions (α = 0.05).

RESULTS

Simulated aging of RBC restorations had no significant effect on the marginal quality at the interface between the RBC and the tooth and the RBC and the inlay (p ≥ 0.247). Across time points, higher percentages of non-continuous margin were observed between the inlay and the tooth than between the tooth and the RBC (p ≤ 0.039). The age of the DME did not significantly affect the fracture resistance (p ≥ 0.052).

CONCLUSIONS

Artificial aging of RBC restorations used for DME had no detrimental effect on the marginal quality and fracture resistance of LDS and PICN inlays.

CLINICAL RELEVANCE

This laboratory study suggests that-in select cases-intact, direct RBC restorations not placed immediately before the delivery of an indirect restoration may be used for DME.

ESE Position Statement on Root Resorption

This Position Statement on root resorption represents the consensus of an expert committee convened by the European Society of Endodontology (ESE). The statement is based on current clinical and scientific evidence, as well as the expertise of the committee. The aim is to provide clinicians with authoritative information on the aetiology, histopathology, clinical presentation, and recommendations for management of root resorption. It is the intention of the committee to update this position statement at appropriate intervals as further evidence emerges.

Present status and future directions - Guided endodontics

Luxation injuries and other stimuli may lead to a pulp canal obliteration (PCO). Even though the apposition of tertiary dentine is a sign of a vital pulp, in some cases root canal treatment is indicated in the long term due to apical periodontitis or pulpitis. Depending on the extent of PCO, root canal treatment may be challenging even for experienced and well-equipped endodontic specialists. The 'guided endodontics' (GE) technique was introduced 6 years ago as an alternative to conventional access cavity preparation for teeth with PCO and apical pathosis or irreversible pulpitis. Using three-dimensional radiological imaging such as cone-beam computed tomography and a digital surface scan, an optimal access to the orifice of the calcified root canal can be planned virtually with appropriate software. GE is implemented either with the help of templates analogous to guided implantology (= static navigation) or by means of dynamic navigation based on a camera-marker system. GE has emerged as a field of research in the last 6 years with very promising laboratory-based results regarding the accuracy of guided endodontic access cavities for both static and dynamic navigation. Clinical implementation seems to provide favourable results, but the evidence is mainly based on numerous case reports and a few case series. This narrative review aims to provide an update on the present status of GE and to identify relevant research areas that could contribute to further improvements of this technique.

Present status and future directions: Endodontic management of traumatic injuries to permanent teeth

The prognosis of traumatized teeth depends largely on the fate of the pulp and its treatment. This review aims to update the present status on the endodontic management of traumatic injuries to permanent teeth and to identify relevant research areas that could contribute to an improvement in diagnosis and treatment of traumatized permanent teeth. Future research should pay greater attention to (1) diagnostic methods to assess the perfusion of the pulp and enhance detection of tooth cracks and initial signs of root resorption; (2) improved materials for vital pulp treatment; (3) studies focusing on type and duration of splinting after root fractures; (4) antiresorptive intracanal medication in case of posttraumatic pulp necrosis and infection-related resorption and (5) long-term data on the apical barrier technique compared to revitalization.

Effect of repeated ultrasonic instrumentation on single-unit crowns: a laboratory study

OBJECTIVES

This laboratory study aimed to assess the effects of ultrasonic instrumentation, simulating 10 years of supportive periodontal therapy (SPT), on single-unit crowns.

MATERIALS AND METHODS

Standardized crowns were fabricated from porcelain-fused-to-metal (PFM) (n = 12), zirconia (ZrO₂) (n = 12), lithium disilicate (LDS) (n = 12), feldspar ceramic (FSFC) (n = 6), and polymer-infiltrated ceramic network material (PICN) (n = 6). The crowns, luted on PICN abutments with resin-based luting material (RBLM), and if applicable glass ionomer cement (GILC), underwent thermal cycling and trimonthly ultrasonic instrumentation. After 1 and 10 years of simulated SPT, restoration quality assessments were performed, comprising profilometric surface roughness measurements, marginal integrity evaluations, and scores for luting material remnants and visible cracks. The statistical analysis included multiple logistic regressions with nested designs (α = 0.05).

RESULTS

During simulated SPT, bulk fractures (n = 2) and a de-cementation failure (n = 1) of LDS and ZrO₂ crowns were observed. No significant change in roughness was detected after 10 years (p = 0.078). Over time, marginal defects increased (p = 0.010), with PFM crowns showing the highest rate of chippings at sites with a narrow shoulder. Fewer marginal defects were detectable on crowns luted with RBLM compared with GILC (p = 0.005). Luting material remnants decreased during SPT (p < 0.001). Ultrasonic instrumentation caused cracks in most crown materials, in particular at sites with a narrow shoulder and in PFM crowns.

CONCLUSIONS

Repeated ultrasonic instrumentation may damage single-unit crowns. PFM crowns with a narrow, all-ceramic margin are especially prone to defects.

CLINICAL RELEVANCE

Frequent ultrasonic instrumentation of restoration margins of fixed dental prostheses, PFM crowns in particular, ought to be avoided.

Real-Time Guided Endodontics with a Miniaturized Dynamic Navigation System Versus Conventional Freehand Endodontic Access Cavity Preparation: Substance Loss and Procedure Time

INTRODUCTION

This study aimed to evaluate substance loss and the time required for access cavity preparation (ACP) using the conventional freehand method (CONV) versus a miniaturized dynamic navigation system of real-time guided endodontics (RTGE) in an in vitro model using 3-dimensional-printed teeth.

METHODS

Nine human anterior maxillary teeth were selected and micro-computed tomographic scanned. Root canals were virtually reduced to 2 mm below the cementoenamel junction. The teeth were digitally duplicated and mirrored to yield 6 different models with 6 single-rooted teeth each. The models were 3-dimensionally printed using radiopaque resin and consecutively mounted on a dental mannequin for ACP. Two operators with 12 and 2 years of clinical experience, respectively, received 6 models (36 teeth) each and performed ACP on half of the models using RTGE (after digital planning) and CONV on the other half 2 weeks later. The time was recorded. Postoperative substance loss was measured by cone-beam computed tomographic imaging. The differences in time and substance loss between the methods and operators were evaluated by the t test.

RESULTS

Overall, substance loss was significantly lower with RTGE than CONV (mean = 10.5 mm³ vs 29.7 mm³), but both procedures took a similar time per tooth (mean = 195 vs 193 seconds). Operator 1 (more experienced) achieved significantly less substance loss than operator 2 with CONV (mean = 19.9 vs 39.4 mm³) but not with RTGE (mean = 10.3 vs 10.6 mm³).

CONCLUSIONS

RTGE is a practicable, substance-sparing method performed in comparable time as CONV. Moreover, RTGE seems to be independent of operator experience.

European Society of Endodontology position statement: endodontic management of traumatized permanent teeth

This position statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on the endodontic management of traumatized permanent teeth. A recent comprehensive review with detailed background information provides the basis for this position statement (Krastl et al. 2021, International Endodontic Journal, https://doi.org/10.1111/iej.13508). The statement is based on current scientific evidence as well as the expertise of the committee. Complementing the recently revised guidelines of the International Association of Dental Traumatology, this position statement aims to provide clinical guidance for the choice of the appropriate endodontic approach for traumatized permanent teeth. Given the dynamic nature of research in this area, this position statement will be updated at appropriate intervals.

Apical pressures generated by several canal irrigation methods: A laboratory study in a maxillary central incisor with an open apex

Aim

A laboratory study to determine the apical pressure generated by seven canal irrigation methods in an anterior tooth with an open apex.

Methodology

Canal irrigation was performed on a 3D‐printed central maxillary incisor with an open apex (maximum diameter of 2.1 mm). Ultrasonically activated irrigation (UAI), sonic activation (EDDY), negative pressure irrigation (EndoVac), the self‐adjusting file (SAF) and the XP‐endo Finisher were employed at tooth length (TL), TL—1 mm, TL—2 mm and TL—3 mm. UAI was tested at three intensity levels additionally. Hydrodynamic irrigation with RinsEndo was performed in the pulp chamber, at the canal orifice, the coronal third, the middle of the canal and at TL. Er:YAG laser activation, at four frequency settings, was performed in the pulp chamber and at the orifice of the canal. The pressure of the fluid towards the canal terminus generated by activation was directly transferred to a pressure sensor with a range of 0 to 120 mmHg and a response time of ≤0.5 ms. The critical threshold for apical extrusion of the irrigant was set at 5.73 mmHg (lower limit of the central venous pressure: 5.88 ± 0.15 mmHg). Each experiment was repeated ten times. The tests were followed by descriptive analyses (maximum, mean, standard deviation, 95% confidence interval).

Results

EndoVac, the SAF, the XP‐endo Finisher, and UAI never exceeded the critical threshold at any insertion depth or intensity level. Er:YAG laser activation exceeded the critical threshold exclusively at frequency settings that varied from the manufacturer's recommendation. EDDY at TL and RinsEndo at any insertion depth exceeded the critical threshold in 100% of the measurements. EDDY at TL—1,—2, and—3 mm crossed the critical threshold in 30%, 10%, and 20% of the measurements, respectively.

Conclusions

In a simulated maxillary central incisor with an open apex, irrigation with EndoVac, Er:YAG laser activation, UAI, the SAF, and the XP‐endo Finisher generated apical pressures below the critical threshold of 5.73 mmHg. By contrast, using EDDY and RinsEndo for irrigation produced higher apical pressures that exceeded the critical threshold.

Apical Pressure Generated Using Conventional Syringe Irrigation in Immature Teeth-An In Vitro Study

This in vitro study aimed to evaluate apical pressure during irrigant delivery with syringe irrigation in immature teeth with an open apical foramen. Conventional syringe irrigation was performed in a 3D-printed immature incisor. A 5 mL syringe combined with 25 G and 30 G cannulas was used. Open-ended and side-vented needle tip designs were assessed. Cannulas were placed at tooth length (TL), TL −1 mm, TL −2 mm, and TL −4 mm. The syringe plunger was moved with a force of 10 N, 20 N, 40 N, and 80 N to simulate clinical conditions. A pressure sensor measured periapical pressures during irrigation. Each experiment was repeated 10 times. Data were analyzed descriptively (maximum, mean, standard deviation, 95% CI) with the critical threshold indicative of extrusion set at 7.64 mbar. 30 G cannulas with both needle tip designs never exceeded the threshold at any TL with a plunger force of 10–40 N. At 80 N, 30 G open-ended cannulas exceeded the threshold in 10%, 30 G side-vented in 20–60% of the measurements. At any TL, 25 G open-ended cannulas and 25 G side-vented cannulas never crossed the threshold with forces of 10–20 N and 10 N, respectively. Consequently, 30 G cannulas with both designs can be recommended for irrigant delivery in immature teeth. 25 G cannulas ought to be used with caution.

Endodontic management of traumatized permanent teeth: a comprehensive review

The pulp plays a key role in the treatment of traumatic dental injuries (TDIs) and is strongly associated with the outcome, particularly in severe cases. A correct pulp diagnosis is essential as it forms the basis for developing the appropriate management strategy. However, many TDIs are complex, and their treatment requires a profound knowledge of the physiological and pathological responses of the affected tissues. This comprehensive review will look at the dentine-pulp complex and its interaction with the surrounding tissues following TDIs. The literature up to 2020 was reviewed based on several searches on PubMed and the Cochrane Library using relevant terms. In addition to the recently revised guidelines of the International Association of Dental Traumatology, this article aims to provide background information with a focus on endodontic aspects and to gather evidence on which a clinician can make decisions on the choice of the appropriate endodontic approach for traumatized permanent teeth.

Suitability of Magnetic Resonance Imaging for Guided Endodontics: Proof of Principle

INTRODUCTION

This proof-of-principle study aimed to demonstrate that magnetic resonance imaging (MRI) is sufficiently accurate for the detection of root canals using guided endodontics.

METHODS

One hundred extracted human teeth (anterior and premolar) were mounted onto 5 mandibular and 5 maxillary models, fitted with splints designed to accommodate a thin layer of aqueous gel for indirect imaging, and scanned by MRI. After MRI and intraoral scans were aligned using planning software, access cavities were planned virtually, and templates were manufactured with computer-aided design/computer-aided manufacturing, the access cavities were prepared. Cone-beam computed tomographic scans were performed and matched with the virtual preoperative planning data to determine the accuracy of access cavity preparation in terms of deviation between planned and prepared cavities in the mesiodistal and buccolingual dimensions and angle. Descriptive statistical analysis was performed, and the mean values were compared using the t test.

RESULTS

Ninety-one of 100 root canals were successfully scouted after MRI-guided access cavity preparation. The mean angle deviation was 1.82°. The mean deviation ranged from 0.21-0.31 mm at the base of the bur and from 0.28-0.44 mm at the tip of the bur. Preparation in the buccolingual dimension was significantly more precise in mandibular compared with maxillary teeth, and accuracy in the mesiodistal dimension was more precise in anterior teeth compared with premolars.

CONCLUSIONS

This in vitro study demonstrated the suitability of MRI for guided endodontic access cavity preparation.

Impact of the COVID-19 pandemic on urgent dental care delivery in a Swiss university center for dental medicine

Objectives

This study aimed to assess whether the emergency service of a major Swiss dental institution faced different demands (patient volume, treatment needs, dental care characteristics) during a lockdown, issued to mitigate the COVID-19 pandemic, compared with the weeks before and after.

Materials and methods

Data of patients receiving urgent care at a university center for dental medicine (Basel, Switzerland) during the 6-week lockdown, pre-lockdown, and post-lockdown periods were retrospectively evaluated. Statistical analysis involved tests for equal proportions and logistic regression models. The level of significance was set at α=0.05.

Results

The study comprised 3109 dental emergency visits in the period from February 2 to June 5, 2020. Daily caseloads increased during lockdown. Abscesses, orthodontic emergencies, and surgical follow-ups were more common during lockdown, whereas the number of dento-alveolar injuries declined (≤0.048). Urgent dental care provision involved intraoral radiographs more frequently in the pre-lockdown period compared with the following weeks (p<0.001). Among all treatments, aerosol-generating procedures dropped from 56.1% (pre-lockdown) to 21.3% during lockdown (p<0.001), while teledentistry follow-ups became more frequent (p<0.001). Patients with comorbidities sought urgent dental care less frequently during the post-lockdown period (p=0.004).

Conclusions

The lockdown significantly impacted the dental emergency service in terms of patients’ diagnoses, treatment needs, and the characteristics of the urgent care that was delivered.

Clinical relevance

Access to essential dental care must be monitored and safeguarded throughout the COVID-19 pandemic and beyond as deferred care entails risks for serious sequelae and persons with comorbidities may change their dental care-seeking behavior.

Accuracy of the fluorescence-aided identification technique (FIT) for detecting tooth-colored restorations utilizing different fluorescence-inducing devices: an ex vivo comparative study

OBJECTIVES

The aim of the present study was to compare the accuracy of the conventional illumination method (CONV) and the fluorescence-aided identification technique (FIT) for distinguishing between composite restorations and intact teeth using different fluorescence-inducing devices commonly used for FIT.

MATERIALS AND METHODS

Six groups of six dentists equipped with one of six different FIT systems each independently attempted to identify composite restorations and intact teeth on a full-mouth model with 22 composite restorations using CONV and, 1 h later, FIT. The entire procedure was repeated 1 week later. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values, including 95% confidence intervals (CI), were calculated for CONV and FIT overall and for each device. The influence of examiner age, method, and device on each parameter was assessed by multivariate analysis of variance.

RESULTS

The sensitivity (84%, CI 81-86%), specificity (94%, CI 93-96%), PPV (92%, CI 90-94%), and NPV (90%, CI 88-91%) of FIT was significantly higher than that of CONV (47%, CI 44-50%; 82%, CI 79-84%; 66%, CI 62-69%, and 69%, CI 68-71%, respectively; p<0.001). The differences between CONV and FIT were significant for all parameters and FIT systems except VistaCam, which achieved no significant difference in specificity. Examiners younger than 40 years attained significantly higher sensitivity and negative predictive values than older examiners.

CONCLUSIONS

FIT is more reliable for detecting composite restorations than the conventional illumination method.

CLINICAL RELEVANCE

FIT can be considered an additional or alternative tool for improving the detection of composite restorations.

Reentry of endodontic access cavities: composite residue and loss of tooth substance

The purpose of this study was to investigate the ability of dentists to remove composite fillings from endodontic access cavities using illumination from a conventional light source (CLS) versus the fluorescence-aided identification technique (FIT) in terms of completeness, selectivity and treatment duration. Therefore, two independent operators removed composite resin from six sets of root-filled incisors in a maxillary model under simulated clinical conditions using the CLS or FIT method (twelve teeth per operator and technique). The duration of treatment was recorded and before-after micro-CT scans were superimposed for volumetric assessment of treatment completeness and selectivity. Statistical significance was determined by t-testing and two-way ANOVA for operator comparison. Overall, there was no significant difference between FIT and CLS in terms of volume, height and area of composite residues (p=0.98 / p=0.75 / p=0.64) and regarding hard tissue loss in terms of volume, depth and area (p= 0.93 / p= 0.70 / p= 0.14). However, there was a significant difference between the two groups regarding treatment time (FIT= 428s, CLS=523s; p=0.023). Significant differences between operators regardless of method were found for volume, height and area of composite residues (p<0.05) and also for defect area (p=0.01) and time (p<0.001). Significant differences between operators including the method was only found for height of composites (p=0.037). It can be concluded, that composite remnants and tooth structure losses may occur after reentry of root-filled teeth regardless of the illumination method (conventional vs. fluorescence-aided) and operator, but preparation was less time-consuming with FIT.

Spectrophotometric insights: calcium hydroxide influences tooth discolorations induced by short-term application of antibiotic/corticosteroid pastes

OBJECTIVES

This in vitro study aimed to assess the influence of a calcium hydroxide dressing regarding the relative color change (ΔE) of enamel-dentin specimens previously exposed to antibiotic/corticosteroid pastes.

MATERIALS AND METHODS

Eighty bovine enamel-dentin specimens with a cylindrical central cavity were randomly allocated to four groups: NEG (empty), POS (blood), LED (Ledermix), and ODO (Odontopaste) (n = 20 each). The materials were applied and sealed with self-adhesive resin luting material. After 3 weeks, the materials were removed and a calcium hydroxide (Ca(OH)₂) dressing was placed in all cavities. After a further 3-week storage period, the cavities were restored with resin-based composite. Spectrophotometric color measurements were taken over 6 months, and ΔE values were calculated. A Tukey's multiple comparison test was performed to assess significant differences within the treatment groups (p < 0.05).

RESULTS

Tooth discolorations were present after 3 weeks in LED (ΔE 29.14 ± 6.55) and POS (ΔE 18.05 ± 7.03); NEG and ODO remained color stable (ΔE 3.2 ± 1.36 and ΔE 2.3 ± 1.16). The 3-week Ca(OH)₂ dressing decreased discolorations of POS (ΔE 15.93 ± 6.63; p = 0.37), whereas LED showed a further significant increase (ΔE 39.55; p < 0.0001). Between the end of the Ca(OH)₂ dressing and the final restoration no significant color changes were observed in any group (p > 0.9).

CONCLUSIONS

Discolorations induced by LED progressed during the Ca(OH)₂ dressing despite careful removal of all residues.

CLINICAL RELEVANCE

Calcium hydroxide might negatively affect the discoloring potential of Ledermix. This highlights the need for direct intracanal application methods of Ledermix ensuring a material-free access cavity or alternative antibiotic/corticosteroid pastes such as Odontopaste should be used.

Impact of CBCT image quality on the confidence of furcation measurements

BACKGROUND

To investigate the impact of scanning parameter in cone-beam computed tomography (CBCT) images on accuracy and confidence with measurements of furcation involvement (FI) in maxillary molars.

MATERIAL AND METHODS

Six half cadaver heads with present maxillary molars (n = 10) were available. CBCT scans with the fixed-parameter field of view (4 × 4 cm, 12 × 17 cm) amperage and voltage (4 mA, 90 kV) and with varying scan modes (SM), that is images/scan (IS), voxel sizes (VZ) and rotation (R), were performed using one CBCT apparatus. The images were analysed by two calibrated investigators. Horizontal FI's were measured in mm or a "through and through" destruction (FI degree III) was recorded. Each rater scored the FI measurements performed in each scan as "confident" or as "not confident". Data were statistically analysed using chi-square tests.

RESULTS

The agreement between CBCT FI measurements and intra-surgical FI measurements varied according to SM (SM HiSp 180°, 0.08: kappa 0.538, CI; 95%: 0.362-0.714; SM Std. 360°, 0.25: kappa 0.698, CI; 95%: 0.534-0.861). The number of measurements scored as "confident" varied according to SM (SM Std. 360°, 0.08:52 out of 60 measurements; SM Std. 360°, 0.25:16 out of 60 measurements; p < .001).

CONCLUSIONS

SM of CBCT significantly affect the confidence with FI measurements in maxillary molars.

Oral disorders in patients with newly diagnosed haematological diseases

OBJECTIVE

This study aimed to examine saliva flow rates and prevalence of dental and periodontal diseases of patients with newly diagnosed severe haematological diseases and compare these findings with age-matched controls of normal population.

METHODS

A total of 149 patients diagnosed with haematological diseases aimed to be treated with haematological stem cell transplantation between 2008 and 2018 and 154 controls were included in the study. A dental examination was performed for patients within a maximum of 6 months after diagnosis. Differences were compared in terms of the stimulated salivary flow rate (SSFR); decayed, missing and filled teeth (DMFT) index; number of teeth; caries prevalence; presence of periodontitis and acute infections.

RESULTS

The mean SSFR of the patient group was significantly lower (1.1 ml/min ± 0.7 ml/min) than the mean SSFR of the controls (1.3 ml/min ± 0.5 ml/min; p = 0.004). The number of caries lesions was significantly higher in the patient group (mean ± SD, 1.1 ± 1.9) than in the control group (mean ± SD, 0.4 ± 1.2; p < 0.001). There were fewer teeth and a higher DMFT index in the patient group compared to the control group, but the differences were not significant. Acute symptomatic infections were observed in eight (5.4%) patients and in none of the controls (p < 0.01).

CONCLUSIONS AND CLINICAL RELEVANCE

Oral examinations in patients with newly diagnosed severe haematological disease demonstrated a higher prevalence of caries, acute infections and lower mean SSFR compared with the controls. These findings support the recommendations for early dental examination at the time of diagnosis.

Initial management of dental trauma: musts, shoulds, and cans

When dental trauma occurs, initial management on the day of injury has a determining influence on healing and thus on the prognosis of the affected teeth. Improper, delayed, and/or inconsistent treatment often has far-reaching consequences that cannot be reversed later, even with great effort, especially in children and adolescents. In most cases, it is unrealistic or impossible for the patient to get to a specialized dental trauma facility in time. Therefore, it is every dental practitioner's duty to provide adequate initial diagnosis and treatment of dental trauma at their dental practice, even if they do not have routine experience in this area. This article serves as a guide to the initial management of dental trauma. It utilizes a three-tiered approach to illustrate which initial management measures are absolutely essential (MUSTS), which should ideally be performed (SHOULDS), and which are not top priorities but can be performed (CANS) if the necessary time, training and experience, and equipment and facilities are available. For further treatment, dental practitioners should realistically assess the limits of their ability to treat complex dental trauma cases and, if necessary, they should refer the patient to a specialist or specialized treatment center. (Quintessence Int 2020;51:763-774; doi: 10.3290/j.qi.a45103; modified from a previously published article (in German) Quintessenz 2019;70(9):990-1002).

Endodontic Treatment in Switzerland. A National Survey

The purpose of this study was to collect information about current treatment protocols of endodontic procedures among general practitioners (GP), endodontically interested practitioners (EI) and endodontic specialists (ES) in Switzerland and to compare them with available endodontic quality guidelines and former surveys. A questionnaire was distributed to 1,522 attendees of two national conferences (Swiss Dental Association, 2015; Swiss Society for Endodontology, 2016) addressing socio-demographic characteristics and specific questions about root canal treatments (RCT) including techniques and materials used. Five hundred and six surveys were collected comprising data of 81.8% GP, 14.4% EI and 3.8% ES (response rate: 33.2%). The majority of respondents was male (59.9%), 40–59 years old (55.9%) with >20 years of clinical experience (54.3%). 498 participants (98.4%) stated to perform RCT. Rubber dam was always used in 52.2% of GP, 69.9% of EI and 89.5% of ES, while never-user accounted for 14.1%. Overall, 63.9% used loupes and 13.7% microscopes (mostly by ES). Rotating instruments were selected in 43.2%, followed by conventional hand-instruments (37.8%) and reciprocating instruments (19%). GP rarely activated irrigants and applied NaOCl in lower concentrations (>0.5–1%) compared to ES. GP preferred lateral compaction (57%), ES performed vertical compaction in 89.5%. 92% completed RCT after two or more visits. The majority of dentists in Switzerland follow the available quality guidelines and the present findings are coherent with internationally published surveys. Nonetheless, discrepancies are still present between daily practice and endodontic quality guidelines, especially with the routine use of rubber dam and working length determination, predominantly within the endodontic non-specialists.

Influence of Pretreatment Methods on the Adhesion of Composite and Polymer Infiltrated Ceramic CAD-CAM Blocks

PURPOSE

To assess the effect of different surface pretreatments on the shear bond strength of resin luting material on CAD-CAM composite resins and a polymer-infiltrated ceramic network (PICN).

MATERIALS AND METHODS

CAD-CAM materials (Brilliant Crios, Cerasmart, Lava Ultimate, VITA Enamic) were subjected to the following pretreatments: no pretreatment; grit blasting; grit blasting + silane; HF etching + silane; tribochemical silica coating + silane; manufacturers' specifications; manufacturers' specifications + silane; manufacturers' specifications using only the manufacturers' products including their recommended luting materials (DuoCem, G-Cem LinkForce, RelyX Ultimate, RelyX Unicem 2). Specimens were luted with resin luting material according to the Swiss shear test design. After six months of water storage, shear bond tests were performed. Data were analyzed with multiple linear regression models and nested models (α = 0.05).

RESULTS

Low bond strengths were obtained without pretreatment (Brilliant Crios 3.01 ± 0.54 MPa, Cerasmart 2.66 ± 0.47 MPa, Lava Ultimate 1.76 ± 0.26 MPa, VITA Enamic 2.83 ± 0.63 MPa). Grit blasting achieved high bond strengths across all materials (Brilliant Crios 5.17 ± 0.77 MPa, Cerasmart 4.27 ± 0.50 MPa, Lava Ultimate 3.98 ± 0.54 MPa, VITA Enamic 4.97 ± 0.90 MPa). Silane application tended to decrease bond strengths on CAD-CAM composite resins. Following the manufacturers' specifications and using their recommended materials achieved the highest bond strengths for all materials except Cerasmart (Brilliant Crios 5.75 ± 0.91 MPa, Cerasmart 2.82 ± 0.28 MPa, Lava Ultimate 6.63 ± 0.97 MPa, VITA Enamic 7.09 ± 0.77 MPa).

CONCLUSION

Grit blasting and the application of a suitable material primer is a useful pretreatment for the bonding of CAD-CAM composite resins. Silane application on CAD-CAM composite resins may entail drawbacks, possibly owing to the scarcity of silanizable fillers.

Fluorescence-aided Composite Removal in Directly Restored Permanent Posterior Teeth

AIM

The aim of this study was to quantitatively compare conventional composite removal and composite removal supported by the fluorescence-aided identification technique (FIT) regarding the completeness, selectivity, and duration of the procedure in directly restored permanent posterior teeth.

METHODS AND MATERIALS

Two operators removed standardized direct class II composite restorations (n=32 per operator) in human tooth models under simulated clinical conditions. According to a randomized allocation scheme, removal was performed with either the conventional technique (contra-angle handpiece) or supported by FIT. The duration of each removal procedure was recorded. The completeness and selectivity were volumetrically assessed through superimposition of three-dimensional surface scans. Statistical significance was tested by examining the overlap of 95% confidence intervals (CI). Multiple comparison was performed with Tukey tests for each variable.

RESULTS

Compared with the conventional technique, composite removal with FIT was faster (329 seconds [95% confidence interval (CI): 268-390 seconds] vs 179 seconds [95% CI: 150-208 seconds]), generated less tooth substance loss (4.53 mm³ [95% CI: 3.77-5.30 mm³] vs 2.77 mm³ [95% CI: 2.11-3.43 mm³]), and left behind less composite residue (1.58 mm³ [95% CI: 1.23-1.94 mm³] vs 0.53 mm³ [95% CI: 0.39-0.67 mm³]).

CONCLUSION

Within the limitations of this in vitro study, FIT facilitated the selective and expeditious removal of tooth-colored composites in directly restored posterior teeth.

Common oral diseases in allogeneic haematopoietic stem cell transplantation (HSCT) recipients pre-HSCT

OBJECTIVES

The purpose of this study was to compare the prevalence of common oral diseases between allogeneic haematopoietic stem cell transplantation (HSCT) recipients and healthy controls.

MATERIALS AND METHODS

A total of 143 adult allogeneic HSCT recipients who were treated for haematological malignancies between 2008 and 2016 were included in the study. The HSCT recipients were age and sex matched with healthy controls. A dental examination was performed on the HSCT recipients prior to HSCT. Differences in stimulated saliva flow rate (SSFR), decayed, missing and filled teeth (DMFT) index, number of teeth, number of caries lesions, and measures of current or previous periodontitis (radiological attachment loss >3 mm or probing pocket depth ≥4 mm) between HSCT recipients and controls were examined.

RESULTS

Stimulated saliva flow rate, DMFT index and the number of caries lesions were poorer in the HSCT recipients pre-HSCT compared to controls (all P-values <0.05). No statistically significant differences in the measures of current or previous periodontitis were observed.

CONCLUSIONS

Stimulated saliva flow rate was low and caries was common in HSCT recipients prior to HSCT. Efficient preventive strategies are important in order to maintain the oral health of these patients.

Evaluation of a Fluorescence-aided Identification Technique (FIT) for removal of composite bonded trauma splints

BACKGROUND/AIM

Accurate removal of composite bonded titanium trauma splints (TTS) can be challenging. The aim of this study was to evaluate a Fluorescence-aided Identification Technique (FIT) compared with a conventional light source (CT) for removal of trauma splints regarding loss of tooth substance, residual composite, and time taken.

MATERIALS AND METHODS

Twenty maxillary models with six bovine teeth (13 - 23) were fabricated. An optical three-dimensional impression was taken and a TTS was applied from 12 to 22 with two bonding sites on every tooth under standardized conditions using an etch-and-rinse adhesive and resin composite. Two operators removed 10 splints each (5x FIT and 5x CT). For FIT, a 405 nm light-emitting headlamp was used. Time was recorded. A post-operative scan was superimposed on the pre-operative scan using OraCheck software. A qualitative and quantitative analysis of tooth defects and composite remnants was performed by two operators and statistically analyzed.

RESULTS

Compared with the CT, FIT led to significantly fewer and smaller enamel defects (mean volume: -0.04 mm³ vs -0.33 mm³ ) (P < 0.001), significantly less composite remained (mean volume: 0.02 mm³ vs 0.28 mm³ ) (P < 0.001), and the removal procedure with FIT was significantly quicker (mean: 162 seconds vs 268 seconds) (P < 0.001), CONCLUSIONS: FIT facilitated the removal of composite used to bond trauma splints leading to less time-consuming as well as less invasive treatment. It left fewer composite residues on enamel surfaces.

Changes in periapical status, quality of root fillings and estimated endodontic treatment need in a similar urban German population 20 years later

OBJECTIVES

The study aimed at assessing, as primary objective, the periapical status and quality of root fillings, and, as secondary objective, the endodontic treatment need of a German urban population in a cross-sectional study 20 years after the first one.

MATERIALS AND METHODS

Clinical and radiographic data of 353 patients were evaluated. Descriptive and regression analyses were performed and the endodontic treatment need was calculated. Results were compared with data from the year 1993.

RESULTS

A total of 9269 teeth were examined (26.2 teeth per patient; 1993, 24.4), of which 337 teeth were root filled (3.6%; 1993, 2.7%). Prevalence of apical periodontitis in root-filled teeth was 34% (1993, 61%). Quality of root fillings was adequate in 117 cases (35%; 1993, 14%). Minimum endodontic treatment need was estimated with 1.6% (1993, 2.3%), including teeth with clinical symptoms. Considering symptomless teeth with apical periodontitis and poor quality of root filling, the treatment need was 2.9% (1993, 3.7%). Regression analysis identified quality of root filling as a significant factor for periapical health (p = 0.01, odds ratio 3.4×, 95% CI 1.9-6.3×), likewise the type of instrumentation. Teeth treated with rotary files had a significantly better outcome (p = 0.02, odds ratio 2.0×, 95% CI 1.1-3.7×).

CONCLUSIONS

Quality of root fillings and the periapical status have improved over the last 20 years in Germany. However, there is still a need for an increase in quality of root canal treatment.

"Karius and Baktus": A Critical Appraisal of Enger's Seminal Storybook

Karius and Baktus, first published in 1949, is one of the most influential storybooks with dental caries as main theme and it remains in wide use for domestic health education. This study aimed at assessing oral health related contents of the historic storybook in the light of the current body of cariologic evidence. Two investigators independently identified phrases in the storybook with cariologically relevant content. Dental health related contents were systematically evaluated with respect to the current body of cariologic evidence. Karius and Baktus highlights important etiopathogenetic and preventive aspects such as sugars consumption and tooth brushing with toothpaste. Its behavior management techniques and narrative health didactics concerning dental care for children are, however, outmoded. The cariologic core statements in Karius and Baktus have remained valid whereas certain narrative features may have some drawbacks when employing the historic storybook for educational purposes for young children.

Adhesive bonding to polymer infiltrated ceramic

Aim of this study was to investigate the mechanism of adhesive bonding to the polymer-infiltrated ceramic VITA Enamic [VE]. Shear bond strength was measured with three resin composite cements: RelyX Unicem 2 Automix, Clearfil SA and Variolink II on polished surfaces of VE and its components silicate ceramic [SC] and polymer [PM] (n=12). Further, the effect of etching VE with 5% HF for 15-240 s and the application of silane coupling agents was analyzed in a screening test (n=6). Shear bond strength measurements were performed after 24 h of water storage at 37°C. Significant bonding to polished substrates could only be achieved on VE and SC when silane coupling agents were used. Etching of VE with 5% HF increased shear bond strength. Following silanization of etched VE, a further increase in shear bond strength could be established. Etching for more than 30 s did not improve shear bond strength.

Partial Ceramic Crowns Prepared by Dental Students: Clinical Performance Up to Five Years

Partial ceramic crowns (PCCs) are an accepted treatment option for the restoration of posterior teeth with deficient tooth substance. Data on the survival of PCCs fabricated by dental students are scarce. The aim of this retrospective clinical study was to investigate the clinical performance and longevity of PCCs placed by dental students in the last year of their training program at the University of Basel, Switzerland. Eighty-eight patients who had received at least one PCC (n=108) in the program were considered for clinical assessment; their records were analyzed to detect previous complications or failures; and they were contacted by telephone. Criteria regarding aesthetic, functional, and biological aspects were rated with a scoring system from 1=clinically excellent to 5=clinically poor. The response rate was 66.3% (55 of 83 included patients), and 72.2% (n=78) of the PCCs were included in the analysis. Five PCCs had been lost within ten to 78 months after treatment. Six PCCs were recorded as failures (score 5), and ten received clinically unsatisfactory gradings (score 4). The risk of a clinically poor outcome was 14% after five years (86% survival), while the overall success rate was 63.5%. These results suggest that the clinical procedure of PCCs was successfully implemented by these students with satisfactory clinical survival.

Accuracy of a separating foil impression using a novel polyolefin foil compared to a custom tray and a stock tray technique

PURPOSE

To compare the dimensional accuracy of three impression techniques- a separating foil impression, a custom tray impression, and a stock tray impression.

MATERIALS AND METHODS

A machined mandibular complete-arch metal model with special modifications served as a master cast. Three different impression techniques (n = 6 in each group) were performed with addition-cured silicon materials: i) putty-wash technique with a prefabricated metal tray (MET) using putty and regular body, ii) single-phase impression with custom tray (CUS) using regular body material, and iii) two-stage technique with stock metal tray (SEP) using putty with a separating foil and regular body material. All impressions were poured with epoxy resin. Six different distances (four intra-abutment and two inter-abutment distances) were gauged on the metal master model and on the casts with a microscope in combination with calibrated measuring software. The differences of the evaluated distances between the reference and the three test groups were calculated and expressed as mean (± SD). Additionally, the 95% confidence intervals were calculated and significant differences between the experimental groups were assumed when confidence intervals did not overlap.

RESULTS

Dimensional changes compared to reference values varied between -74.01 and 32.57 µm (MET), -78.86 and 30.84 (CUS), and between -92.20 and 30.98 (SEP). For the intra-abutment distances, no significant differences among the experimental groups were detected. CUS showed a significantly higher dimensional accuracy for the inter-abutment distances with -0.02 and -0.08 percentage deviation compared to MET and SEP.

CONCLUSION

The separation foil technique is a simple alternative to the custom tray technique for single tooth restorations, while limitations may exist for extended restorations with multiple abutment teeth.

Lower Educational Level is a Risk Factor for Tooth Loss - Analysis of a Swiss Population (KREBS Project)

PURPOSE

To analyse risk factors for tooth loss in women and men seeking treatment at the University of Basel, Switzerland.

MATERIALS AND METHODS

Records of patients from the pool of patients at the department were consecutively screened between January 2009 and October 2011. Gender, smoking habits, education, profession, general health status and dental variables were recorded. Tooth loss was assessed on full-mouth periapical radiographs. Gender-nested logistic regression models were applied for statistical analysis.

RESULTS

The sample consisted of 161 participants (4012 teeth in total, 3988 after exclusion of third molars), 80 women and 81 men, with a mean age of 48.0 ± 14.6 in women and 47.7 ± 12.5 in men. There were no significant differences in smoking status between men and women. Oral clinical data revealed similar gingival inflammation (BI) and number of sites with a periodontal probing depth (PPD) ≥ 5 mm among men and women. However, oral hygiene (PI) differed between men and women, with women having better oral hygiene (p < 0.01). Tooth loss increased from the front to the molar regions. A significant risk for tooth loss was associated with decreasing educational level. Compared to advanced education, individuals with 'no school graduation' showed a significantly higher risk for tooth loss in women (OR = 3.2, p = 0.02) and men (OR = 3.6, p = 0.03). Age ≥ 50 years significantly predicted tooth loss in men only (OR 2.2, p = 0.01).

CONCLUSION

The results from the present study demonstrate lower educational level as a strong risk factor for tooth loss in this Swiss cohort. The educational level may need to be considered for diagnosis and treatment planning, and particularly for patient information practices to increase the patients' understanding of the development of oral diseases leading to tooth loss.

Presence of root canal treatment has no influence on periodontal bone loss

AIM

The aim of this study was to compare the interproximal bone level at root canal-filled teeth and non-root canal-filled teeth.

MATERIALS AND METHODS

The records of patients from the department were consecutively screened from January 2009 to October 2011. The distance between the coronal reference point to the alveolar bone crest (AC) was assessed at the mesial and distal aspects of root canal-filled teeth (RCF+) and their contralateral non-root canal-filled teeth (RCF-) on periapical radiographs. Generalised linear mixed-effects models were applied.

RESULTS

The sample consisted of 128 pairs of teeth comprising data from 72 patients. The results for AC revealed a median distance of 3.2 mm for RCF+ and 3.4 mm for RCF- (p = 0.61). Using the maximal distance on either the distal or the mesial tooth surface, a median distance of 3.6 mm was detected for RCF+ and 3.8 mm for RCF-, respectively (p = 0.42). Even after taking several tooth- and subject-specific variables into account, the differences between AC on RCF+ and RCF- were statistically not significant (p > 0.05).

CONCLUSION

The interproximal bone loss did not differ statistically significant between root canal-filled teeth and non-root canal-filled teeth.

CLINICAL RELEVANCE

Existence of appropriately done root canal fillings in periodontitis patients has no effect on the prognosis of periodontal disease.

Do periapical and periodontal pathologies affect Schneiderian membrane appearance? Systematic review of studies using cone-beam computed tomography

OBJECTIVES

This systematic review analyzed the relationship between periapical and periodontal pathologies in the posterior maxilla and the appearance of the Schneiderian membrane in cone-beam computed tomography (CBCT) compared with sound dentitions.

METHODS

Five electronic databases (Cochrane Library, Embase, OpenGrey, PubMed, Web of Science), complemented by hand searching, were screened up to May 9, 2016. Human clinical studies that used CBCT and contained information on the periapical/periodontal status in the posterior maxilla and Schneiderian membrane appearance were included. A weighted vote counting (WVC) method was applied to summarize results across studies.

RESULTS

Out of 413 records, 20 studies were included. In the WVC, the studies that observed a positive association between periapical lesions and the appearance of the Schneiderian membrane outweighed those that found no such association (WVC 51 % and WVC 33 %, respectively), with some studies yielding indeterminate results (WVC 16 %). Regarding the relation between periodontal pathologies and the appearance of the Schneiderian membrane, WVC produced a tie between studies demonstrating a positive association (WVC 46 %) and those showing no association (WVC 44 %); one study (WVC 10 %) reported indeterminate results.

CONCLUSIONS

On CBCT scans, periapical lesions in the posterior maxilla are likely to be associated with Schneiderian membrane thickening. In contrast, current evidence regarding the relation between periodontal diseases and the appearance of the Schneiderian membrane in CBCT is inconclusive.

CLINICAL RELEVANCE

Incidental maxillary sinus findings on CBCT scans warrant thorough differential diagnosis. Frequently, they may be related to dental pathologies.

Treatment of calcified root canals in elderly people: a clinical study about the accessibility, the time needed and the outcome with a three-year follow-up

OBJECTIVE

Determination of accessibility, time needed and outcome of endodontic treatment of teeth with calcified root canals in a sample of elderly participants in a private practice limited to endodontics.

BACKGROUND

Due to demographic changes, gerodontology is becoming more and more important, also in the field of endodontology. Elderly patients can show up with severe calcifications of root canals. Root canal treatment, when needed, can be very challenging in these cases. Only few data exist about the treatment of calcified root canals and its outcome, especially in an elderly population.

MATERIALS AND METHODS

Forty-one participants (median age: 72 years) needing a root canal treatment were included. The total number of treated teeth was 41 with 114 negotiated root canals. A specialist limited to endodontics performed the treatment in a private practice. Outcome was assessed by applying the periapical index score on the basis of recall radiographs provided by the referring dentists. Likewise, time required to localise the root canals was measured.

RESULTS

All root canals have been detected using the operating microscope, and full working length could be established in 90% of the cases. Success rate was 80% after an observation time of 3 years. In three of five teeth, root canals could be localised within 15 min.

CONCLUSION

Calcified root canals of older people treated in this study were all accessible within a maximum of 60 min. The success rate after a follow-up of 3 years was 80%.