Efficacy of a Mouthwash Containing CHX and CPC in SARS-CoV-2-Positive Patients: A Randomized Controlled Clinical Trial

Soon after the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, preprocedural mouthwashes were recommended for temporarily reducing intraoral viral load and infectivity of individuals potentially infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in order to protect medical personnel. Particularly, the antiseptic cetylpyridinium chloride (CPC) has shown virucidal effects against SARS-CoV-2 in vitro. Therefore, the aim of this randomized controlled clinical trial was to investigate the efficacy of a commercially available mouthwash containing CPC and chlorhexidine digluconate (CHX) at 0.05% each in SARS-CoV-2-positive patients as compared to a placebo mouthwash. Sixty-one patients who tested positive for SARS-CoV-2 with onset of symptoms within the last 72 h were included in this study. Oropharyngeal specimens were taken at baseline, whereupon patients had to gargle mouth and throat with 20 mL test or placebo (0.9% NaCl) mouthwash for 60 s. After 30 min, further oropharyngeal specimens were collected. Viral load was analyzed by quantitative reverse transcriptase polymerase chain reaction, and infectivity of oropharyngeal specimens was analyzed by virus rescue in cell culture and quantified via determination of tissue culture infectious doses 50% (TCID₅₀). Data were analyzed nonparametrically (α = 0.05). Viral load slightly but significantly decreased upon gargling in the test group (P = 0.0435) but not in the placebo group. Viral infectivity as measured by TCID₅₀ also significantly decreased in the test group (P = 0.0313), whereas there was no significant effect but a trend in the placebo group. Furthermore, it was found that the specimens from patients with a vaccine booster exhibited significantly lower infectivity at baseline as compared to those without vaccine booster (P = 0.0231). This study indicates that a preprocedural mouthwash containing CPC and CHX could slightly but significantly reduce the viral load and infectivity in SARS-CoV-2-positive patients. Further studies are needed to corroborate these results and investigate whether the observed reductions in viral load and infectivity could translate into clinically useful effects in reducing COVID-19 transmission (German Clinical Trials Register DRKS00027812).

Penetration depth of irrigants into root dentine after sonic, ultrasonic and photoacoustic activation

AIM

To compare penetration depths of endodontic irrigants into the dentinal tubules of extracted teeth when using several activation methods.

METHODOLOGY

The root canals of 90 extracted human teeth were prepared to size 40, .06 taper. The straight and round-shaped root canals were distributed randomly into six groups, and final irrigation was performed with EDTA and sodium hypochlorite as follows: (I) manual dynamic activation, (II) Ultrasonic, (III) Sonic, (IV) PIPS (photon-induced photoacoustic streaming, (V) SWEEPS (shock-wave enhanced emission photoacoustic streaming) and (0) control without final irrigation or activation. Subsequently, methylene blue was inserted into the canals and activated according to the groups (I-V). Teeth were sectioned horizontally, imaged under a light microscope, and dye penetration depths were measured in six sections per tooth and 24 points on a virtual clock-face per section. Data were analysed statistically by nonparametric tests for whole teeth and separately for coronal, middle and apical thirds.

RESULTS

Penetration of dye into the dentinal tubules was lowest for the controls. Median penetration depths amounted to 700-900 μm for groups I-V with differences in the apical thirds between group I and the other test groups. Minimum penetration depths were significantly greater for PIPS in the apical thirds (P ≤ 0.046).

CONCLUSIONS

Greater penetration depths occurred in the apical thirds for ultrasonic, sonic and laser-induced activation compared to manual dynamic activation. PIPS was associated with deeper penetration of irrigants. The novel SWEEPS mode did not increase irrigant penetration.

Interactive effects of LPS and dentine matrix proteins on human dental pulp stem cells

AIM

To investigate the combinatorial effects of lipopolysaccharide (LPS) and extracted dentine matrix proteins (eDMP) on regenerative and inflammatory responses in human dental pulp stem cells (DPSCs).

METHODOLOGY

Culture media were supplemented with several concentrations of LPS, eDMP and combinations of both. Cell viability was assessed over 1 week by MTT assay; cell survival was evaluated after 24 h and 7 days by flow cytometry. The expression of mineralization-associated marker genes was determined by real-time quantitative polymerase chain reaction (RT-qPCR). To analyse the inflammatory response, secretion of interleukin 6 (IL-6) was quantified in the initial and the late phase of cell culture by enzyme-linked immunosorbent assay (ELISA). Data were treated nonparametrically and Mann-Whitney U-tests were performed to compare all experimental groups (α = 0.05).

RESULTS

Whereas LPS had no impact on viability, eDMP led to a concentration-dependent decrease, which was significant after 7 days (P ≤ 0.024). A moderate decline of cell survival induced by LPS was detected after 48 h (P ≤ 0.026), whereas eDMP was able to reverse this effect. eDMP alone caused increased expression of tested marker genes, LPS had no regulatory effect. Combined eDMP and LPS induced an upregulation of collagen type I and osteocalcin, whereas expression levels of dentine matrix acidic phosphoprotein and dentine sialophosphoprotein were similar to the control. IL-6-secretion was increased by LPS over time. eDMP markedly elevated initial production of IL-6 (P ≤ 0.002), but suppressed LPS-induced cytokine production in the later phase.

CONCLUSIONS

Lipopolysaccharide did not affect cell viability but interfered with odontoblast-like cell differentiation of DPSCs. Proteins from the dentine matrix may have a protective effect, attenuate the detrimental impact of LPS and thus play an important role during pulp repair.

Dentine matrix proteins: isolation and effects on human pulp cells

AIM

To establish a simplified and efficient protocol for the isolation and concentration of matrix proteins from human dentine, and to assess the effects of extracted dentine matrix proteins (eDMP) on the behaviour of human pulp cells.

METHODOLOGY

Matrix proteins were isolated from human dentine, purified, concentrated and characterized with protein and enzyme-linked immunosorbent assays (ELISA). Culture media were supplemented with eDMP in different concentrations, referred to as eDMP 1-10 000, to assess viability and proliferation of human pulp cells by DNA and MTT assays; apoptotic events were quantified by flow cytometry. Chemotactic effects of eDMP were assessed in a modified Boyden chamber assay. Expression levels of odontoblastic marker genes in pulp cells cultured with eDMPs were determined by real-time quantitative PCR, and the ability to induce mineralization was demonstrated by alizarin red staining. Nonparametric statistical analysis was performed to pairwise compare different groups at all time-points (Mann-Whitney U-test, α = 0.05).

RESULTS

High concentrations of eDMP exhibited significant antiproliferative effects (P ≤ 0.023) after 5 (eDMP 1000) and 7 days (eDMP 500) without affecting cell viability. Apoptosis was barely influenced (P ≥ 0.089). eDMP exerted a concentration-dependent chemotactic stimulus on dental pulp cells with statistical significance already at low dosage (P = 0.006 at eDMP 10). Changes in gene expression indicated a differentiation into odontoblast-like cells, which was corroborated by findings of mineral nodule formation.

CONCLUSIONS

A novel, effective and time-saving protocol for isolation and concentration of dentine matrix proteins is presented. As eDMP stimulates chemotaxis, differentiation and mineralization without affecting viability, endogenous dentine matrix proteins might be valuable for approaches to regenerate or engineer dental pulp.

Proteins in Whole Saliva during the First Year of Infancy

During the first year of an infant’s life, the oral environment is subject to drastic changes that coincide with the eruption of teeth. Proteins in saliva are important for protecting oral surfaces and provide receptors for bacterial adhesins. The objective of this longitudinal study was to monitor the general composition and expression of proteins in whole saliva of infants, to prove the hypothesis that expression of certain proteins changes during infant development, and might be associated with tooth eruption. The results showed a remarkable constancy in the overall pattern of salivary proteins and glycoproteins during infancy. Exceptions were the mucins and albumin. The mucins are expressed differentially, with first MUC7 and later MUC5B being predominant. Albumin, a marker of serum leakage, started to rise in whole saliva preceding tooth eruption. Thus, the expression of only few proteins appears to be changed during infant development.

TEGDMA reduces mineralization in dental pulp cells

Direct application of dentin bonding agents onto the exposed pulp has been advocated, but in vivo studies indicate a lack of reparative dentin formation. Our objective was to investigate the role of triethylene glycol dimethacrylate (TEGDMA), a commonly used compound in dentin bonding agents, as a potential inhibitor of mineralization. Human pulp cells were exposed to different concentrations of TEGDMA, and expression of the mineralization-related genes collagen I, alkaline phosphatase, bone sialoprotein, osteocalcin, Runx2, and dentin sialophosphoprotein was analyzed. Gene expression studies by real-time polymerase chain-reaction revealed a concentration- and time-dependent decrease of mineralization markers. A subtoxic TEGDMA concentration (0.3 mM) reduced expression levels by 5 to 20% after 4 hrs and by 50% after 12 hrs. Furthermore, alkaline phosphatase activity and calcium deposition were significantly lower in dental pulp cells treated with TEGDMA over 14 days. These findings indicate that even low TEGDMA concentrations might inhibit mineralization induced by dental pulp cells, thus impairing reparative dentin formation after pulp capping with dentin bonding agents.

Adhesion of eukaryotic cells andStaphylococcus aureus to silicon model surfaces

Silicon wafers modified by silanisation with different functional groups are used to study the bioactivity of surfaces with varying physicochemical properties. Oxidation of the wafers created very hydrophilic surfaces, and moderately wettable surfaces were produced by coating with poly(ethylene glycol) (PEG). Immobilization of hydrocarbon chains to the wafers produced hydrophobic surfaces, and hydrophobicity was further increased by fluorocarbon coatings. The oxidized and the hydrocarbon-modified surfaces supported the adhesion of human MG-63 osteoblasts and 3T3 mouse fibroblasts as well as Staphylococcus aureus 8325-4. Adhesion of osteoblasts and fibroblasts, however, was decreased on highly hydrophobic fluorocarbon surfaces, whereas adhesion of S. aureus was supported. Coating of the fluorocarbon surface with fibronectin increased the number of attached eukaryotic cells, but the accumulation of bacteria remained unchanged. In contrast, surface coatings with PEG-groups inhibited the binding of S. aureus; however, the adhesion of the eukaryotic cells was high. The number of S. aureus on PEG-modified surfaces covered with fibronectin increased about twofold, yet it was still decreased to 25-30% related to the number of bacteria on other surfaces. These findings provide evidence that the PEG-modified surfaces showed selective bioactivity, preventing the attachment of a microbial pathogen but supporting the adhesion of eukaryotic cells.

Three-year clinical performance of cast gold vs ceramic partial crowns

Cast gold partial crowns (CGPC) and partial ceramic crowns (PCC) are both accepted for restoring posterior teeth with extended lesions today. However, as esthetics in dentistry becomes increasingly important, CGPC are being progressively replaced by PCC. The aim of the present prospective split-mouth study was the comparison of the clinical performance of PCC and CGPC after 3 years of clinical service. Twenty-eight patients (11 men and 17 women) participated in the 3-year recall with a total of 56 restorations. In each patient, one CGPC (Degulor C) and one PCC (Vita Mark II ceramic/Cerec III) had been inserted at baseline. CGPC were placed using a zinc phosphate cement (Harvard); PCC were adhesively luted (Variolink II/Excite). All restorations were clinically assessed using modified US Public Health Service (USPHS) criteria at baseline, 1 year, 2 years, and 3 years after insertion. Twenty-eight CGPC and 14 PCC were placed in molars, and 14 PCC were placed in premolars. Early data were reported previously under the same study design. After 3 years, the evaluation according to USPHS criteria revealed no statistically significant differences between both types of restorations with the exception of marginal adaptation and marginal discoloration: A statistically significant difference within the PCC group (baseline/3 years) was determined for the criterion marginal adaptation. For the 3-year recall period, overall failure was 0% for CGPC and 6.9% for PCC. At 3 years, PCC meet American Dental Association Acceptance Guidelines criteria for tooth-colored restorative materials for posterior teeth.

The induction of oxidative stress, cytotoxicity, and genotoxicity by dental adhesives

OBJECTIVES

Polymerized dental resin materials release residual monomers that may interact with pulp tissues. We hypothesized that dental adhesives might cause cytotoxicity in pulp cells via the generation of reactive oxygen species (ROS), which may also contribute to genotoxic effects in vitro.

METHODS

For cytotoxicity testing, transformed human pulp-derived cells were exposed to extracts of primers and bonding agents of Clearfil SE bond, Clearfil Protect bond, AdheSE, Prompt L-Pop, and Excite for 24h. The cytotoxicity of the same materials was also analyzed in a dentin barrier test device using three-dimensional pulp cell cultures. The generation of ROS in monolayer cultures was measured after a 1h exposure period by flow cytometry (FACS), and genotoxicity as indicated by the formation of micronuclei was determined in V79 cells after a 24h exposure period.

RESULTS

The dentin primers and bonding agents decrease cell survival in a dose-related manner. Cytotoxicity of bonding agents based on concentrations which caused 50% cell death (EC50) were ranked as follows: Excite (0.16 mg/ml)>AdheSE bond (0.30 mg/ml)>Clearfil Protect bond (0.35 mg/ml)>Clearfil SE bond (0.37 mg/ml), and Prompt L-Pop bond (0.68 mg/ml). Dentin primers were about 10-fold less effective. In contrast, no cytotoxic effects of the dental adhesives were observed in a dentin barrier test device. Yet, all dental adhesives increased the amounts of ROS about fivefold in pulp cells in a dose-related manner, and, again, the bonding agents were more efficient than the dentin primers. Finally, the number of micronuclei was increased about sixfold by extracts of the AdheSE primer.

SIGNIFICANCE

Our results suggest that the cytotoxic potencies demonstrated by these materials might be of clinical relevance, since all dental adhesives disturbed the cellular redox state of pulp cells in monolayer cultures. As a result, the concentrations of biologically active ingredients of some of the agents may be high enough to modify pulp cell metabolism when the materials are used in deep cavities or directly contact pulp tissue.

Periodontal healing after non-surgical therapy with a new ultrasonic device: a randomized controlled clinical trial

AIM

The aim of this study was to compare the clinical and microbiological healing outcomes following non-surgical periodontal therapy using the new Vector ultrasonic system versus scaling and root planing (S/RP) with Gracey curettes.

MATERIAL AND METHODS

The study comprised 20 chronic periodontitis patients. Using a split-mouth design, both treatment modalities were randomly applied to one quadrant of the upper and the lower jaws each. Clinical and microbiological parameters were assessed at baseline, 4 weeks, and 6 months after treatment. Furthermore, post-operative hypersensitivity was assessed. The Wilcoxon signed rank test (alpha=0.05) was used for statistical analysis.

RESULTS

Both therapies provided statistically significant clinical and microbiological improvements of periodontal conditions after 4 weeks and 6 months. Hypersensitive teeth were found only 4 weeks after S/RP. Besides a significantly better bleeding on probing reduction in deep S/RP sites, no other clinical and microbiological parameters revealed significant differences between the sites treated with the Vector system or S/RP.

CONCLUSION

Both the Vector system and S/RP provided favourable periodontal healing results, although in deep pockets S/RP appeared to achieve a better resolution of inflammation.

Influence of autologous platelet concentrate on healing in intra-bony defects following guided tissue regeneration therapy: a randomized prospective clinical split-mouth study

OBJECTIVES

To investigate the influence of autologous platelet concentrate (APC) on early wound healing and regeneration outcomes following guided tissue regeneration (GTR) therapy.

MATERIAL AND METHODS

In 25 patients, two contralateral deep intra-bony defects were treated with beta-TCP and a bioresorbable GTR membrane. They were randomly assigned to test and control procedure. In test defects, APC was additionally applied. After 3, 6, and 12 months, healing results were assessed by clinical parameters and quantitative digital subtraction radiography.

RESULTS

Post-operative membrane exposures occurred in 48% of the test sites and 80% of the control sites. Both groups revealed a significant clinical attachment level (CAL) gain of 5 mm after 12 months. Eighty-eight per cent of test and control sites showed a CAL gain of > or =4 mm. No clinical parameter revealed significant differences between test and control sites. A significant bone density gain was found in both groups after 3, 6, and 12 months. Only after 6 months, the bone density gain was significantly greater in the test defects.

CONCLUSION

Within the limits of this study, autologous platelet concentrate did not seem to have a noticeable influence on the clinical and most of the radiographic outcomes following GTR. However, APC might reduce the occurrence of post-operative membrane exposures and accelerate bone density gain.

Growth factors and cytokines in autologous platelet concentrate and their correlation to periodontal regeneration outcomes

AIM

To determine the concentration of naturally available biologic mediators in autologous platelet concentrates and their correlation with periodontal regeneration outcomes.

MATERIAL AND METHODS

In 25 patients with two intra-bony defects each, an autologous platelet concentrate (APC) was prepared by a laboratory thrombocyte apheresis technique pre-operatively. Both defects were treated using a bioresorbable guided tissue regeneration-membrane in combination with tricalciumphosphate (TCP). In the test defect, APC was additionally applied. In the APC, platelets were counted and the levels of growth factors and cytokines were determined by ELISA. Correlations between the platelet counts or the growth factor/cytokine levels and the potential clinical and radiographic regeneration outcomes due to APC were calculated after 3, 6, and 12 months.

RESULTS

The APC contained 2.2 x 10(6) platelets/mul, which was 7.9 times more than in the venous blood. Transforming growth factor-beta1 (TGF-beta1), insulin-like growth factor-I (IGF-I), platelet-derived growth factor-AB (PDGF-AB), PDGF-BB, vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF) were found in the APC, whereas interleukin-1beta (IL-1beta), IL-6, tumor necrosis factor alpha (TNFalpha), IL-4, and IL-10 were not detectable. The regression analysis showed a weak correlation between the platelet counts or the growth factor levels and the clinical and radiographic regeneration outcomes (r2<or=0.4).

CONCLUSION

Autologous platelet concentrate contains relatively high concentrations of PDGF-AB, PDGF-BB, TGF-beta1, and IGF-I, but their potential influence on periodontal regeneration remains unclear.

Periodontal healing after non-surgical therapy with a modified sonic scaler: a controlled clinical trial

AIM

The aim of this study was to compare the clinical and microbiological healing outcomes following non-surgical periodontal therapy using a modified sonic scaler system versus scaling and root planing (S/RP) with hand instruments.

MATERIAL AND METHODS

The study comprised 20 chronic periodontitis patients. Using a split-mouth design, both treatment modalities were randomly applied to one quadrant of the upper and lower jaws. Clinical and microbiological parameters were assessed at baseline, 4 weeks, and 6 months after treatment. Furthermore, post-operative hypersensitivity was investigated. The Wilcoxon signed-rank test (alpha = 0.05) was used for statistical analysis.

RESULTS

With both therapy methods, periodontal conditions showed statistically significant clinical and microbiological improvements after 4 weeks and 6 months. Hypersensitive teeth were found only 4 weeks after S/RP. Besides a significantly better bleeding on probing reduction in deep S/RP sites and less time required for root instrumentation by the sonic scaler, no other clinical and microbiological parameters revealed significant differences between sites treated with the sonic scaler or S/RP.

CONCLUSION

The sonic scaler system and S/RP seem to provide similarly favourable periodontal healing results, although in deep pockets S/RP appeared to achieve a better resolution of inflammation.

Inhibition of TEGDMA and HEMA-induced genotoxicity and cell cycle arrest by N-acetylcysteine

OBJECTIVES

Dental resin monomers like triethylene glycol dimethacrylate (TEGDMA) and 2-hydroxyethyl methacrylate (HEMA) are able to cause an imbalance of the redox state in mammalian cells. The resulting oxidative stress originating from reactive oxygen species (ROS) has been associated with cytotoxicity. We hypothesized that ROS might contribute to the generation of genotoxicity by TEGDMA and HEMA as well. Therefore, we examined the formation of micronuclei in V79 cells by both resin monomers in the presence of the antioxidant N-acetylcysteine (NAC), which scavenges ROS. In addition, we analyzed the effects of TEGDMA and HEMA on the normal cell cycle in the presence of NAC.

METHODS

V79 fibroblasts were exposed to increasing concentrations of TEGDMA and HEMA in the presence and absence of NAC for 24h. Genotoxicity was indicated by the formation of micronuclei. The modification of the normal cell cycle was analyzed by flow cytometry (FACS).

RESULTS

A dose-related increase in the number of micronuclei in V79 cells-induced by TEGDMA and HEMA indicated genotoxicity of both chemicals. However, the formation of micronuclei was reduced in the presence of 10 mmol/L NAC, indicating its protective role. A cell cycle delay in G2 phase caused by TEGDMA was absent when cells were co-treated with NAC. Similarly, the presence of NAC led to a reversion of the cell cycle delay in HEMA-treated cell cultures.

SIGNIFICANCE

Our results suggest that genotoxic effects and the modification of the cell cycle caused by TEGDMA and HEMA are mediated, at least in part, by oxidative stress.

Metal content of saliva of patients with and without metal restorations

Many in vitro studies have confirmed the corrosion of dental alloys. However, in vivo corrosion studies, for example, recording of the release of metal ions into saliva, are scarce, and data on the repeatability of the metal content measurements of saliva are lacking. The present study examined the metal content of saliva of patients with and without metal restorations and assessed the repeatability of these data. The composition of each patient's oral cast alloys was analyzed using the energy-dispersive X-ray analysis of metal biopsy specimens and was compared to the metals found in saliva. Saliva analysis was performed using atomic absorption spectroscopy. Chemical analysis comprised the metals Ag, Au, Co, Cr, Cu, Fe, Ga, In, Ni, Pd, Pt, Sn, and Zn. The metals Ag, Cr, Cu, Fe, Ni, and Zn were found in saliva of patients without metal restorations, but these data showed statistically significant differences in the metal content between consecutively performed samples per patient. The metals Ag, Au, Cr, Cu, Fe, Ni, and Zn were identified in saliva of patients with metal restorations being higher in concentration than in control patients. In 77% of the cases at least one metal of the restoration was found in the patient's saliva. However, the metal content showed statistically significant differences between replicate samples of the same patient taken at different times. The metal content of saliva is affected among other things by intraoral metal restorations, but present data do not support the idea that it is a reliable indicator for the systemic exposure to metals released from dental alloys.

Partial ceramic crowns. Influence of preparation design and luting material on margin integrity?a scanning electron microscopic study

This in vitro study examines the effects of three preparation designs and different luting agents on the marginal integrity of partial ceramic crowns. One hundred forty-four extracted human molars were prepared according to the following preparation designs: A. Coverage of functional cusps, B. Horizontal reduction of functional cusps and C. Complete reduction of functional cusps. Partial ceramic crowns (Vita Mark II, Cerec 3 System) were bonded to the cavities with: Variolink II/Excite (Vivadent), Panavia F/ED primer (Kuraray), Dyract/Prime and Bond NT (Detrey/Dentsply), and Fuji Plus/GC cavity conditioner (GC). The specimens were exposed to thermocycling and mechanical loading. Marginal adaptation was assessed on replicas using quantitative margin analysis in the scanning electron microscope (SEM). Significant differences were observed between the preparation designs in general. Coverage of functional cusps with preparation of butt joints and use of Variolink as luting material showed a tendency toward the lowest values for compromised adhesion, especially within the dentin. Significant differences could be determined between luting systems: resin-modified glass ionomer cement (RMGIC) caused fracture of the restorations and revealed higher values than all other luting materials for compromised adhesion at ceramic-luting agent and tooth-luting agent interfaces. The dentin-luting material interface, in general, showed higher percentages of compromised adhesion (38-100%) than enamel- and ceramic-luting material interfaces (0-30%). In conclusion, the SEM data indicate that, with adhesively bonded partial ceramic crowns, retentive preparation is not contraindicated and the choice of luting material is more relevant than the preparation design. Margins below the cemento-enamel junction reveal significant loss of adhesion in spite of adhesive luting techniques. The RMGIC cannot be recommended as a luting material for feldspathic partial ceramic crowns.

Salivary proteins and cytokines in drug-induced gingival overgrowth

Little is known about the involvement of saliva in gingival overgrowth (GO). It was hypothesized that, in this situation, the composition of saliva is altered. Thus, proteins, albumin, cytokines, and growth factors in whole and glandular saliva were investigated. Differences between glandular and gingival contributions to the composition of saliva were explored in patients medicated with cyclosporin who exhibited GO (responders), those without GO (non-responders), and non-medicated subjects (controls). In whole saliva, interleukin-1alpha (IL-1alpha), IL-6, IL-8, epidermal growth factor (EGF), nerve growth factor (NGF), and albumin were detected, but in glandular saliva only EGF and NGF were identified. Albumin and IL-6 differed significantly between responders and controls, although the overall profile of salivary proteins remained unchanged. Thus, inflammatory cytokines and albumin are confined to whole saliva and are associated with GO, whereas its content of EGF and NGF appears unaffected by cyclosporin.

Effect of Dentin on the Antibacterial Activity of Dentin Bonding Agents

Dentin bonding agents with antibacterial effects may inhibit secondary caries formation and pulp inflammation by eliminating residual bacteria in and on dentin. Therefore, the antibacterial effects of Prime & Bond NT (PB), Prime & Bond NT without fluoride (PBNF), Gluma Comfort Bond (GL), ABF, Xeno CF II (XE), 2-hydroxyethyl methacrylate (HEMA), triethylene glycol dimethacrylate (TEG-DMA), and 0.2% chlorhexidine were tested against Streptococcus mutans, S. sobrinus, and Lactobacillus acidophilus using the agar-diffusion method with and without bovine-dentin disks (200 microm and 500 microm thickness) placed between the bacteria and the test substances. Without dentin, ABF Primer showed growth inhibition for all bacterial strains. XE inhibited S. mutans and S. sobrinus, and PB S. sobrinus. ABF Bonding inhibited L. acidophilus. PBNF, HEMA, and TEGDMA did not have any antibacterial effects. Dentin disks of 500 microm thickness reduced the inhibitory effect of chlorhexidine to 23% to 54% compared with direct application. ABF Primer (nonpolymerized) produced inhibition zones against all tester strains regardless of dentin disks interposed or not. XE (against S. mutans and S. sobrinus) and PB (against S. sobrinus) did not produce any inhibition zones on 200 microm thick dentin. After polymerization, the ABF system did not inhibit bacterial growth on 200 microm thick dentin disks. A dentin barrier reduces significantly the antibacterial activity of chlorhexidine and dentin bonding agents.

Metal content of biopsies adjacent to dental cast alloys

Single case reports indicate that components of dental alloys accumulate in the adjacent soft tissue of the oral cavity. However, data on a wider range of dental alloys and patient groups are scarce. Therefore, the aim of the present study was to examine the metal content of oral tissues adjacent to dental alloys showing persisting signs of inflammation or other discoloration (affected sites) and of healthy control sites with no adjacent metal restoration in 28 patients. The composition of the adjacent alloys was analyzed and compared to the alloy components in the affected sites. Tissue analysis was performed using atomic absorption spectroscopy. Alloy analysis was performed with energy-dispersive X-ray analysis. In the affected sites, the metals Ag, Au, Cu, and Pd prevailed compared to control sites, reflecting the frequency distribution of single metals in the adjacent alloys. In most cases (84%), at least one of the analyzed metals was a component of the alloy and also detected in the tissue. Metal components from almost all dental cast alloys can be detected in adjacent tissue.

Long-term clinical performance and longevity of gold alloy vs ceramic partial crowns

Cast gold partial crowns (CGPC) are an accepted means of restoring posterior teeth. For aesthetic reasons, gold alloys are being increasingly substituted with ceramics. The aim of the present study was to investigate retrospectively the long-term clinical performance and survival of CGPC and compare the results to the ones already reported for ceramic partial crowns (CPC). The CGPC group consisted of 42 patients (24 male, 18 female) randomly sampled from a total of 106 patients with CGPC, with one restoration per patient. The CPC group consisted of 22 patients with a total of 42 restorations. Both types of restoration were done by one experienced dentist. Another two experienced dentists who were not involved in performing the restorations rated both kinds of partial crowns using the modified United State Public Health Service (USPHS) criteria [14]. The Median age of the CGPC was 57 months (range 3-157) and of the CPC and 63 months (range 24-72). Forty-one (98%) of the CGPC and 27 (64%) of the CPC were placed in molars, the rest in premolars. In each group, 40 (95%) restorations were still functioning without any necessity of replacement. Two teeth with CGPC, in situ for 4.5 and 11 years, respectively, had been extracted for periodontal reasons. Two CPC fractured and had to be replaced after 2 and 6.5 years in situ. The USPHS criteria results were similarly good for the gold and ceramic groups. Kaplan-Meier analysis revealed survival probabilities of 72+/-21% and 96+/-4% after 13 and 7 years, respectively, for the CGPC. Survival of the CPC was 81+/-15% after 7 years. No statistically significant difference among survival functions of CGPC and CPC was found. From this data, it can be concluded that the longevity of CPC is not inferior to that of gold alloys. However, more long-term studies comparing the clinical performance and longevity of these two types of indirect restoration in the posterior region with larger numbers of restorations are desirable.

Influence of interleukin-1 gene polymorphism on periodontal regeneration in intrabony defects

The aim of this controlled retrospective study was to evaluate the influence of an IL-1 gene polymorphism on the clinical and radiographic healing outcomes of GTR therapy. The study included 47 adult periodontitis patients with 94 deep intrabony defects treated by GTR using different membrane materials. The following clinical parameters were recorded at baseline and 12 months after surgery: papillary bleeding index (PBI), gingival recession (REC), probing pocket depth (PPD), clinical attachment level (CAL), and the vertical relative attachment gain (V-rAG). Bone changes in the defect regions due to GTR therapy were quantitatively evaluated using digital subtraction radiography (DSR). Polymorphisms of the IL-1A gene at position - 889 and of the IL-1B gene at position + 3953 were analyzed by PCR. Statistical analysis was performed using the Mann-Whitney-U and the Wilcoxon-Signed-Rank tests (alpha = 0.05). The study comprised 19 IL-1 genotype positive (IL-1 +) patients and 28 IL-1 genotype negative (IL-1 -) patients. Twelve months after GTR therapy, both patient groups revealed statistically significant PPD reductions and CAL gain [median (25/75% percentiles)]: Delta PPD [IL-1 + : 4.0 (2.5/5.0) mm; IL-1-: 3.8 (3.0/4.9) mm], Delta CAL [IL-1 + : 3.5 (3.0/4.8) mm; IL-1 -: 3.0 (1, 2/4, 5) mm]. V-rAG amounted to 60.0 (47.7/78.6)% in IL-1 + patients and 53.1 (43.4/81.9)% in IL-1 - patients. Both patient groups showed significant bone density gain in 40% (IL-1 +) and 43.6% (IL-1 -) of the initial defect area due to GTR. Neither the clinical nor the radiographic healing parameters revealed any statistically significant differences in the GTR healing outcome between IL-1 + and IL-1 - patients. In conclusion, these 12-month findings indicate that the IL-1 gene polymorphism has no influence on the clinical and radiographic regeneration results following GTR therapy.

Fluoride uptake and distribution in enamel and dentin after application of different fluoride solutions

The aim of this in vitro study was to examine the fluoride accumulation in enamel and dentin after short- and long-term application of four fluoride solutions, including a casein-based fluoride preparation. Cubical enamel and dentin specimens were cut out from extracted, caries-free, human third molars. The buccal surface of each specimen was moistened for 5 min or 24 h with 10 microl of the control or one of the four test solutions Olaflur, Oleaflur, sodium fluoride, or experimental fluoride containing hydrolyzed casein. The specimens were ground in 20- microm steps and the fluoride content was determined in each enamel and dentin layer. After application of the fluoride solutions, significantly more fluoride was associated with the superficial layer up to 20 microm. The values were 3-4 times higher in enamel and 4-8 times higher in dentin after 5-min application time and 10-24 times higher than the initial fluoride content in both hard tooth tissues after 24-h application time. Focusing on the experimental solution, the fluoride levels in enamel and dentin were somewhere in the order of the values of sodium and amine fluoride solutions. However, a tendency towards higher values could be observed after application of the experimental solution.

Responses of L929 mouse fibroblasts, primary and immortalized bovine dental papilla-derived cell lines to dental resin components

OBJECTIVE

The use of adequate target cells for cytotoxicity testing of dental restorative materials has often been experimentally assessed with respect to the clinical relevance of the test results. In the present study, the responses in primary bovine dental papilla-derived cells (pulp cells) were compared with those in transformed dental papilla-derived cell lines and L929 mouse fibroblasts after exposure to various dental resin compounds.

METHODS

Primary bovine dental papilla-derived cells (CPC), tCPC B (CPC cells transformed with SV40 T-antigen), tCPC E (CPC cells transformed with E6/E7 oncogen), and L929 mouse fibroblast cells were exposed to various compounds of dental resin materials for 24 h, and cytotoxicity was determined using the MTT assay. Bis-GMA, UDMA, 1,6 hexane diol dimethacrylate (HDDM), TEGDMA, HEMA, MMA, camphorquinone (CQ), bisphenol A (BPA), and glycidyl methacrylate (GMA) were tested. Concentrations leading to 50% cell survival (TC50 values) were calculated from fitted dose-response curves.

RESULTS

The simple ranking of the cytotoxic effects of the dental resin compounds in the four cell types was identical, and TC50 values determined in L929 cells here were consistent with findings by other authors using continuous cell lines. However, the concentrations of the resin compounds necessary for eliciting cytotoxic responses in the various cells were clearly different. The analyses of TC50 values of the resin compounds revealed a linear correlation between cell lines, and the overall sensitivities increased as follows: CPC=tCPC B<tCPC E<L929.

SIGNIFICANCE

The low sensitivities of primary cells and transformed tCPC B cells compared with the continuous L929 cell line and the transformed tCPC E cells indicates the presence of specific structural and functional properties relevant in vivo. The differences between the transformed tCPC B and tCPC E cells may indicate modifications of cellular functions caused by the different transformation processes.

Patients with local adverse effects from dental alloys: frequency, complaints, symptoms, allergy

Data on the prevalence of adverse effects from dental cast alloys and on the characteristics of the related patient groups are scarce. Therefore, the aim of the present study was to investigate patients in a defined part of Germany attributing oral complaints or symptoms to dental cast alloys. All dentists in the area of Eastern Bavaria (with 1 million inhabitants) were asked to send corresponding patients to our department during a 3-year period. Out of this collection, patients with complaints or symptoms in the oral cavity were recruited and characterized with regard to number, age and sex distribution, type of subjective complaints and objective intraoral symptoms, and allergy status based on an alloy analysis. Patients reporting to our department with suspected local adverse effects from dental cast alloys represented 0.01% of the population. Thirty-four percent of the patients were 50-59 years old, with females prevailing (76%). A great variety of subjective complaints was reported, which mainly resembles those reported by patients with adverse effects attributed to other dental materials like amalgam or denture base materials. The main objective intraoral symptoms were gingivitis, anomalies of the tongue (lingua plicata, lingua geographica), discoloration of the gingiva, redness of the palate or tongue and lichenoid reactions of the oral mucosa. In not more than 10% of the patients, allergy was diagnosed as contributing to the complaints or symptoms.

Curing efficiency of different polymerization methods through ceramic restorations

The aim of this in vitro study was to examine the curing efficiency of three different polymerization methods through ceramic restorations by determination of the depth of cure and the universal hardness of a composite resin luting material. Therefore, 36 ceramic specimens [Empress 2 (Ivoclar), color 300, diameter 4 mm, height 2 mm] were prepared and inserted in steel molds (diameter 4 mm, height 6 mm) using a composite resin luting material [Variolink II (Vivadent)] with and without catalyst. The polymerization through six specimens of each group was done conventionally (40 s), by softstart polymerization (40 s), or by plasma arc curing (10 s). Depth of cure under the ceramic specimens was assessed according to ISO 4049. Additionally, universal hardness was determined at 0.5 and 1.0 mm from the ceramic using a universal testing machine (Zwick 14040). Curing without a catalyst, using conventional and softstart polymerization, resulted in greater hardness in both layers, compared to plasma arc curing. The use of a catalyst always produced a greater hardness and depth of cure with all polymerization methods. Depth of cure was always greater using conventional polymerization and softstart polymerization, compared to plasma arc curing. The curing efficiency of plasma arc curing through ceramic was lower compared to conventional and softstart-polymerization.

Clinical evaluation of packable composite resins in Class-II restorations

This study investigated the clinical performance of two packable composite resins in Class-II restorations. One hundred and four Class-II restorations were placed in 52 patients by five dentists (four in dental practices and one in a university clinic) in a controlled prospective multicentre clinical trial. Each patient received one Definite/Etch & Prime 3.0 (D-EP) and one Solitaire/Solid Bond (S-SB) restoration, which were examined clinically according to modified USPHS-criteria after 1 week (baseline) and after 1 year. Statistical analysis was performed using the Wilcoxon rank sum test and the error rates method. The significance level was set to 0.05. At baseline both materials performed equally according to the evaluated criteria. After 1 year D-EP showed significantly worse marginal adaptation compared to S-SB. Both materials displayed significant deterioration for the criteria marginal adaptation, marginal discolouration, approximal contact, and fracture of restoration after 1 year compared to baseline. With a failure rate of 9.6% after 1 year, D-EP did not fulfill ADA acceptance criteria for restorative materials. It is proposed that at least 1-year data of clinical testing should be available before a new material is broadly marketed.

Permeability characteristics of bovine and human dentin under different pretreatment conditions

In order to use bovine dentin instead of human dentin for in vitro adhesion and cytotoxicity tests the permeability characteristics of human and bovine dentin should be similar. In the present study hydraulic conductance (Lp) and diffusional water flux (J5) of human and bovine dentin slices were compared. The permeability experiments were performed in a split chamber using tritiated water in physiological saline. Lp and Js of bovine dentin were 0.7- to 2.4-fold and 1.1- to 3.5-fold that of human dentin (not statistically significant). For human and bovine dentin Lp and Js increased with etching and showed an inverse linear relationship (r > or = 0.7) with dentin thickness. The variability of bovine data was low (perfusion = 30%, diffusion = 22%) and about half that of the human data. In conclusion bovine dentin near the cementoenamel junction seems to be a suitable alternative for coronal human dentin for in vitro tests with respect to transdentinal permeability characteristics.

Retrospective clinical study and survival analysis on partial ceramic crowns: results up to 7 years

The purpose of the present study was to determine retrospectively the clinical performance of 42 all-ceramic partial crowns (PCCs) placed during the past 7 years. All patients (n = 25) with partial ceramic crowns (n = 49) placed by one experienced dentist between 1992 and 1999 were asked to take part in a clinical study, and 22 patients with 42 restorations agreed to do so. All partial ceramic crowns studied were fabricated using the IPS-Empress I all-ceramic system (Vivadent). The following luting composites were used for placing the restorations: 20 (47.6%) Variolink high viscosity (Vivadent), 3 (7.1%) Variolink ultra (Vivadent), 17 (40.5%) Dual Zement (Vivadent), and 2 (4.8%) Compolute (Espe). The partial ceramic crowns were examined clinically using the modified USPHS criteria. Of the 42 restorations, 40 (95.2%) were still in function without any need of replacement. One restoration (2.4%) had failed before starting the clinical study, and another one (2.4%) fractured during the study. Twenty-eight (66.7%) of the partial ceramic crowns evaluated were rated Alpha with respect to marginal adaptation. Twelve (28.6%) restorations were rated Bravo, no Charlie ratings were found and 2 (4.7%) restorations were rated Delta. The Kaplan-Meier analysis was used to calculate the survival rate. The probability of survival (95% confidence interval) for 7 years was 81% (66-96%). These data indicate that partial ceramic crowns may provide successful esthetic restorations in posterior teeth.

Release of prostaglandin E2, IL-6 and IL-8 from human oral epithelial culture models after exposure to compounds of dental materials

A three-dimensional human tissue model based on TR146 cells isolated from a squamous cell carcinoma of the buccal mucosa was used to test for the release of the proinflammatory molecules prostaglandin E2 (PGE2), interleukin 6 (IL-6), and interleukin 8 (IL-8) after exposure to nickel chloride (NiCl2), cobalt chloride (COCl2), palladium chloride (PdCl2), and triethylene glycol dimethacrylate (TEGDMA). These compounds have documented adverse biological effects in vitro. The release of PGE2 from the tissue culture models was inversely correlated with cell viability (MTT assay). Toxic concentrations of NiCl2 and CoCl2 induced the release of PGE2 by factors of about 200-300 compared to controls, but PdCl2 which was nontoxic enhanced PGE2 levels about 10-fold. TEGDMA, however, did not stimulate PGE2 release. None or weakly toxic concentrations of Ni and Co chloride induced IL-6 and IL-8 release by a factor of 5-10 compared to controls. The amounts of IL-6 were induced 25- to 30-fold by PdCl2 under physiological conditions, and IL-8 levels were also slightly enhanced. Nontoxic TEGDMA concentrations induced IL-6 levels 5-fold, but IL-8 amounts increased only slightly. We conclude that a steep rise of PGE2 is closely associated with cytotoxicity. On the other hand, the specific induction of IL-6 occurs at much lower concentrations. Therefore, the measurement of this cytokine may be included as another parameter in evaluating the biological activity of dental materials under nontoxic experimental conditions in vitro.

Developmental enamel defects in children with different fluoride supplementation--a follow-up study

The intake of fluorides with water, food, dental fluoride preparations, or in particular fluoride supplements, such as NaF tablets, may lead to dental fluorosis. In the present study conducted in a nonfluoridated area in Germany, developmental enamel defects were examined using the Modified Developmental Defects of Enamel Index (Mod DDE Index), which subdivides enamel defects into the categories demarcated (Mod DDE score 1) and diffuse (Mod DDE score 2) opacities and hypoplasia (Mod DDE score 3). 158 children, between 8.5 and 10 years old, were assigned to three examination groups, defined by three different fluoride tablet programs. The children in all three examination groups, F1, F2, and F3, had received 0.25 mg F-/day up to the age of 2 years, F1 and F3 from birth on, F2 beginning with the 7th month of life. F1 and F2 received 0.5 mg F-/day during the 3rd and 0.75 mg F-/day during the 4th and 5th year of life. For F3, beginning with the 3rd year of life, no further recommendations were made. 158 sociodemographically matched children living in a neighboring town served as controls and did not take part in any structured fluoride supplementation program. The proportions of children with Mod DDE scores 1, 2, or 3 at least in one index tooth were significantly higher in the examination groups (40%) than in the control group (20%). Also, the proportions of children with Mod DDE score 2 at least in one index tooth were significantly higher in the examination groups (18%) than in the control group (8%). The proportions of children with Mod DDE score 1 at least in one index tooth were 25% in the examination groups and 17% in the control group. No Mod DDE score 3 was found. Not more than 5% of the children in each group had 50% of their teeth with Mod DDE score 1, 2, or 3. The proportions of teeth per child with Mod DDE score 2 were significantly higher in the examination group than in the control group. While uncontrolled variables cannot be excluded, the observed differences between the experimental and control groups may be attributed to the ingestion of fluoride tablets in the experimental group.

Marginal adaption of Class V restorations with and without "softstart-polymerization"

Polymerization shrinkage causing marginal gap formation is still a major problem in light curing restorations. The aim of the present study was to test the influence of "softstart polymerization" (prepolymerization at a low light intensity followed by a final cure at a high light intensity) on the marginal integrity of polyacid-modified resin and composite resin restorations in Class V cavities using a commercially available curing unit with two defined curing intensities. Sixty standardized Class V cavities were prepared. Twenty cavities at a time were filled either with a composite resin [Spectrum + Prime & Bond 2.1 (SP)], or with polyacid-modified resins [Dyract + Prime & Bond 2.1 (DY); Hytac + OSB Primer (HY)]. Ten fillings of each group were either conventionally cured (40 seconds, 800 mW/cm2), or they were cured with a lower starting intensity (10 seconds, 150 mW/cm2) and then with the full intensity (30 seconds, 800 mW/cm2). Margins were evaluated before and after thermomechanical loading (TCML) by quantitative margin analysis. Microleakage was assessed by dye penetration. The softstart polymerization showed no significant influence on gap formation for each material and interface before and after TCML. Quantitative margin analysis after TCML showed significantly fewer marginal gaps at the enamel/restoration interface for SP (0%) compared to DY (15.5%) and HY (44.5%) using softstart polymerization. At the dentin/restoration interface the corresponding results for gap formation were 29.6% for SP, 8.5% for DY, and 21.0% for HY. These results were not significantly different from each other. Dye penetration was significantly higher for SP at the dentin/restoration interface. SP showed significantly more marginal swelling at the dentin/restoration interface compared to DY. In conclusion, softstart polymerization using a very low starting intensity did not improve the marginal adaptation of polyacid-modified resins or composite resins in Class V cavity preparations. The best marginal adaptation in Class V cavities at the enamel/restoration interface was achieved with SP, using the acid-etch technique. In dentin, however, the polyacid-modified resins showed a superior marginal adaptation.

Clinical performance of polyacid-modified resin restorations using "softstart-polymerization"

This study investigated the influence of "softstart-polymerization" on the clinical performance and marginal integrity of polyacid-modified resin restorations (PMR) in class V cavities. Eighty PMR restorations were placed in 20 patients [40 Dyract (DY); 40 Hytac (HY)] with (npat = 10) and without preparation (npat = 10). Restorations were light cured for 40 s either conventionally (CP) or with a lower light intensity for the first 10 s (SSP). Each patient received four restorations (DY-CP, DY-SSP, HY-CP, HY-SSP), which were examined clinically according to modified USPHS criteria, and by quantitative SEM-analysis after 7 days (baseline), 6 months and 1 year. Statistical analysis was performed using the Mann-Whitney-U test (P < or = 0.05) and error rates method. Clinically, no restoration showed recurrent caries or crevices. After 1 year, margins of 24-47% of the HY- and 36-53% of the DY-restorations were rated "Bravo". Marginal discoloration occurred in 20-37% in HY- and in 18-21% in DY-restorations. The error rates method revealed no significant differences between materials or between polymerization modes with and without preparation. Pairwise testing showed that without preparation, the marginal adaptation to dentin was significantly worse compared to enamel for HY with both polymerization modes, for DY with SSP. With preparation, no significant differences were found. Cavity preparation may have an influence on differences in marginal quality between enamel and dentin.

Retrospective clinical investigation and survival analysis on ceramic inlays and partial ceramic crowns: results up to 7 years

This study retrospectively evaluated the clinical performance of 287 all-ceramic restorations placed during routine patient care in the University setting in the past 7 years. All patients (n = 106) with ceramic inlays or partial ceramic crowns (PCC), placed during 1988-1994 (n = 327) by five experienced dentists were asked to take part in a clinical investigation, and 92 patients with 287 restorations (232 inlays, 55 PCC) agreed to do so. The following ceramics were used: 44 (15.3%) Dicor (Dentsply), 126 (43.9%) IPS-Empress (Ivoclar), 82 (28.7%) Mirage II, 33 (11.5%) Cerec-Vita-Mark 1 (Vita), and 2 (0.7%) Duceram LFC (Ducera) restorations. The restorations were placed using the following luting composites: 73 (25.4%) Dual Cure Luting Cement (Optec), 81 (28.3%) Variolink high viscosity (Ivoclar), 32 (11.1%) Microfill Pontic C (Kulzer), 51 (17.8%) Dual Zement (Ivoclar), 40 (13.9%) Dicor Light Activated Cement (Dentsply), and 10 (3.5%) Vita Cerec Duo Cement (Vita). Restorations were evaluated according to the modified USPHS criteria. Kaplan-Meier analysis was used to calculate the probability of survival. Of the 287 restorations 270 (94.2%) were still in function without any need of intervention. Fourteen restorations (4.8%) had failed before starting the clinical investigation, and in three a fracture was found during the investigation. These 17 failed restorations consisted of 14 PCC and 3 ceramic inlays. The results of the clinical investigation revealed 59.2% Alpha-ratings for marginal adaptation. Only one restored tooth showed recurrent caries. The probability of survival (95% confidence interval) for 7 years was 98% (97.99-98.01%) for ceramic inlays and 56% (46-66%) for PCC. Our findings show that ceramic inlays can be regarded as an acceptable alternative to cast gold restorations within the methodological limitations of the present study. For PCC further experience with more recent ceramics is warranted.

GTR therapy of intrabony defects using 2 different bioresorbable membranes: 12-month results

This prospective split-mouth study was designed to compare the clinical and radiographic healing results in intrabony periodontal defects 12 months after GTR therapy with 2 different bioresorbable barriers. The study comprised 25 healthy patients with one pair of contralaterally located intrabony defects with a probing pocket depth of > or = 6 mm and radiographic evidence of angular bone loss of > or = 4 mm. The 2 defects of each patient were randomized for treatment either with polylactic acid (PLA) membranes or with polyglactin-910 (PG-910) membranes. The patients received systemic doxycycline (100 mg/d) for 11 days postoperatively. One blinded examiner recorded the following clinical parameters using a pressure calibrated probe at baseline and after 12 months: papillary bleeding index (PBI), gingival recession (REC), probing pocket depth (PPD), and probing attachment level (PAL). The vertical relative attachment gain (V-rAG) was calculated as a % of the PAL gain related to the maximum possible attachment gain (expressed by the intraoperatively measured depth of the osseous defect). Geometrically standardized intraoral radiographs were quantitatively evaluated for bone changes (density, area) in the defect region using digital subtraction radiography (DSR). Clinical and radiographic data were statistically analyzed using the Wilcoxon-signed-rank test (alpha=0.05). Postoperative membrane exposures occurred in 9 PLA and 13 PG-910 treated sites. After 12 months of healing, both barrier types provided significant PPD reductions and PAL gain [median (25/75 percentile)]: deltaPPD [PLA: 3.0 (2.0/4.0) mm; PG-910: 3.0 (2.0/4.5) mm]; deltaPAL [PLA: 3.0 (2.5/4.0) mm; PG-910: 2.0 (1.0/4.0) mm]. V-rAG amounted to 60% in PLA sites and 54% in PG-910 sites. DSR revealed significant bone density gain after 12 months. 58.3% of the initial defect area in PLA sites and 54.0% of the initial defect area in PG-910 sites showed bone density gain. Neither clinical nor radiographic data revealed any significant difference between the 2 barrier types after 12 months. In conclusion, this 12-month study demonstrated that PLA and PG-910 membranes provided similar favorable regeneration results in deep intrabony periodontal defects.

Accuracy of quantitative digital subtraction radiography for determining changes in calcium mass in mandibular bone: an in vitro study

The aim of this in vitro study was to determine the accuracy of digital subtraction radiography (DSR) to detect small changes in calcium mass in alveolar bone adjacent to tooth roots. In each of 4 dried porcine mandible segments, one interproximal and one buccal "defect" region was defined adjacent to a premolar root. A series of cortical and cancellous bone slices with a 50 microns--stepwise increasing thickness (0-5000 microns) were attached to the mandible segments covering the respective "defect" region. Standardized radiographs were quantitatively assessed for density changes using DSR. After dissolving each bone slice in hydrochloric acid, its calcium concentration was photometrically determined. For each bone slice, the mean calcium mass covering a single pixel of the subtraction image was calculated. The Wilcoxon signed-rank test and the Mann-Whitney U-test were used for statistical analysis (alpha = 0.05). A strong linear correlation (r2 = 0.86-1.00; p < or = 0.001) was found between the thickness of the bone slices and their calcium mass. Cortical bone showed a 3.5 times higher mean calcium mass/pixel than cancellous bone. Furthermore, a strong linear correlation (r2 = 0.63-1.00; p < or = 0.001) was found between the mean calcium mass per image pixel and the radiographic density changes. Neither the bone type nor the "defect" localization had a significant influence on radiographic density changes caused by changes in calcium mass. A change in mean calcium mass per image pixel of 0.1-0.15 mg was necessary to be detected by DSR. In conclusion, this study revealed a high accuracy of DSR to detect small changes in calcium mass in alveolar cortical and cancellous bone.

Quantitative digital subtraction radiography for the determination of small changes in bone thickness: an in vitro study

OBJECTIVE

The objective of this study was to determine the ability of quantitative digital subtraction radiography to detect small changes in bone thickness adjacent to tooth roots.

STUDY DESIGN

A series of cortical or cancellous bone slices with a 50 microm-stepwise increasing thickness were attached to 4 porcine mandible sections covering buccal and interproximal "defect" regions. Standardized radiographs were quantitatively evaluated for radiographic density changes with the use of digital subtraction radiography. Furthermore, all radiographs were conventionally evaluated by 10 clinicians. The Wilcoxon signed-rank test and the Mann-Whitney U test were used for statistical analysis (alpha = 0.05).

RESULTS

A high linear correlation was found between the actual thickness of bone slices and radiographic density changes (cortical bone: r2 = 0.89 to 0.99; cancellous bone r2 = 0.61 to 0.86, p < or = 0.001). A certain increase in bone thickness caused a 3 times higher increase in radiographic density for cortical bone than for cancellous bone (p < or = 0.05). The detection limits of digital subtraction radiography were 200 microm for cortical and 500 microm for cancellous bone, whereas the detection limits of conventional radiography were 600 microm and 2850 microm, respectively.

CONCLUSIONS

This in vitro study demonstrated a very high correlation between the objective, quantitative assessment of subtle changes in alveolar bone by digital subtraction radiography and the true changes in bone thickness.

Clinical and quantitative marginal analysis of feldspathic ceramic inlays at 4 years

The aim of this clinical study was to evaluate feldspathic ceramic inlays both by clinical criteria and quantitative margin analysis in continuation of an earlier, identically conducted 2-year study. Fifty feldspathic ceramic inlays were adhesively luted in Class II preparations with all margins located in enamel. The inlays were evaluated clinically according to modified USPHS criteria after 3 and 4 years. Quantitative margin analysis was performed with a scanning electron microscope (SEM). Clinically, the inlays showed no recurrent caries and no changes in colour, but superficial marginal discolouration (6%) was apparent after 4 years. Margins were perceptible clinically in 64% of the cases after 4 years. Quantitative margin analysis showed significantly more marginal gaps at the composite/ceramic interface than at the enamel/composite interface, There was neither a significant decrease in perfect margins nor a significant increase in marginal gaps and marginal imperfections at both interfaces between the third and fourth year. Clinically, the inlays performed very well up to 4 years. Clinical evaluation using an explorer only detected substance loss in the cementation gap. The SEM evaluation showed significantly higher changes in marginal qualities during the first 2-year interval of clinical service compared to the second 2-year interval following an exponential mathematical regularity. Quantitative margin analysis should be included in clinical long-term trials to detect early marginal deficiencies at the luting interfaces.

Postoperative exposure of bioresorbable GTR membranes: effect on healing results

The goal of this investigation was to evaluate the effect of postoperative exposure of two different bioresorbable membranes on the guided tissue regeneration (GTR) healing results compared to nonexposed sites. In each of 25 patients one pair of contralateral intrabony lesions was treated either with polylactic acid (PLA) or polyglactin 910 (PG-910) membranes. Postoperative exposure occurred in 9 PLA and 13 PG-910 sites. Standardized clinical [papillary bleeding index (PBI), gingival recession (REC), probing pocket depth (PPD), probing attachment level (PAL)] and radiographic examinations (digital subtraction radiography) were performed immediately before (baseline) and 6 and 12 months postoperatively (p.o.). Subgingival bacterial samples from surgical sites were evaluated by culture at baseline, 6 weeks, and 6 and 12 months p.o. Six months after surgery the changes (delta) of REC were significantly (P < or = 0.05) greater in exposed than in nonexposed sites, independently of the membrane material (median): exposed sites, delta REC = -1 mm; nonexposed sites, delta REC = 0.0 mm. However, 12 months p.o. no significant differences were found due to a decrease in the initial recessions in exposed sites. Although a higher percentage of exposed than nonexposed sites harbored periodontal pathogens 6 weeks p.o. at the gingiva-faced membrane surface, membrane exposure did not have a significant negative effect on delta PPD, delta PAL, or radiographic bone density changes 6 and 12 months p.o. Both membranes showed significant gains in PAL and bone density in both exposed and nonexposed sites. In conclusion, this study demonstrates that with consistent infection control the postoperative exposure of PLA and PG-910 membranes has no significant negative effect on the regeneration outcome, although higher initial gingival recessions must be expected than in the nonexposed sites. However, in exposed sites plaque and infection control were clearly impeded by the rough, exposed membrane surfaces and by the initially negative gingival morphology.

SEM analysis of marginal expansion and gap formation in Class II composite restorations

OBJECTIVES

Morphological changes in terms of marginal expansion have been observed at the dentin-composite interface of resin composite restorations with the scanning electron microscope (SEM), which could not be described with the criteria conventionally used for quantitative marginal analysis. The purpose of the present study was to elucidate the influence of marginal expansion upon marginal integrity and clarify the cause of these morphological changes.

METHODS

A total of 22 extracted human molars were restored with Class II resin composite restorations, with and without the use of a dentin bonding agent. The cervical restoration margin was located below the cemento-enamel-junction (CEJ). The marginal adaptation at the dentin- and enamel-composite interfaces was evaluated and measured on replicas using quantitative SEM analysis after different storage periods. The chemical composition of the marginal expansion was determined qualitatively by EDX (Energy Dispersive X-Ray) analysis using original tooth samples. The results obtained from quantitative SEM analysis were statistically analyzed by applying the Mann-Whitney U-test and the error rates method.

RESULTS

Significantly less marginal expansion occurred at the enamel interface than at the dentin-composite interface (p < or = 0.01). Within the dentin, less marginal expansion was observed with the use of a dentin bonding agent than without a dentin bonding agent (p < or = 0.05). At 1 y, a significant (p < or = 0.05) decrease in marginal expansion was observed in both groups. EDX analysis revealed that the chemical composition of the marginal expansion is comparable to the resin composite, since peaks for silicon, barium and ytterbium could be found at these sites.

SIGNIFICANCE

In Class II resin composite restorations below the CEJ, partial disruption of the adhesive bond may occur initially when curing the restoration. Water sorption causes gap reduction by hygroscopic expansion, seen in the SEM as a volume increase. Thus, the observed morphological changes can be regarded as an early sign of insufficient adhesion between composite and dentin at sites where disruption of the bond occurred initially, whether or not a dentin bonding agent was used.

Epithelium-fibroblast co-culture for assessing mucosal irritancy of metals used in dentistry

No valid animal or in vitro model exists to assess the potential mucosal irritancy of dental materials. However, recently, a commercially available model system based on a recombined co-culture of human fibroblasts and human epithelial cells has been introduced for evaluating the time-dependent irritancy of cosmetic products. Cell viability and prostaglandin E2 (PGE2) release from the cells were used as markers for the irritative potential of test materials. The objective of the present study was to evaluate the suitability of this model for monitoring the irritative potential of metals and cast alloys used in dentistry. The human fibroblast-keratinocyte co-cultures were exposed to test specimens fabricated from copper, zinc, palladium, nickel, tin, cobalt, indium, a high noble cast alloy, and from a dental ceramic. Cell survival rates decreased after exposure to copper (14-25%), cobalt (60%), zinc (63%), indium (85%), nickel (87%), and the non-oxidized and oxidized high noble cast alloy (87%/90%) compared to untreated control cultures. Dental ceramic, palladium and tin did not influence cell viability. In parallel, the PGE2 release was continuously monitored up to 24 h using a competitive displacement enzyme immunoassay. PGE2 release increased most highly in the cultures exposed to copper (6-25 fold), cobalt (7 fold), indium (4 fold), and zinc (2 fold) compared to untreated control cultures. The PGE2 determination proved to be a non-destructive method for continuous monitoring of cell reactions in the same culture. The model used seems promising for evaluating the time-dependent mucosal irritancy of dental cast alloys.

Resin-modified glass ionomer cements: fluoride release and influence on Streptococcus mutans growth

The aims of the present study were to measure the fluoride release of 1 glass ionomer cement, 1 cermet, 3 resin-modified glass ionomer cements and 1 compomer, and to determine the influence of each material on bacterial growth. Test specimens were eluted in saline for 180 days. Every 2 days, the specimens were transferred into fresh saline and the fluoride content of the solution was measured. Furthermore, 48-h, 14-d, 90-d, and 180-d eluates were inoculated with Streptococcus mutans and bacterial growth was recorded nephelometrically. Fluoride release dropped significantly over time for each material with values between 6.2 (Ketac-Silver) and 29.3 (Photac-Fil) ppm after 48 h to values between 0.6 (Ketac-Silver) and 1.7 (Ketac-Fil, Vitremer) ppm after 180 days. Each material reduced bacterial growth at each time of examination, but the effect decreased significantly over time with a maximum growth of 71.7% (Ketac-Fil) to 85.6% (Ketac-Silver) after 48 h and 94.7 (Vitremer) to 99.0% (Ketac-Silver) after 180 days (growth control = 100%). Both Ketac-Silver and Dyract showed a significantly lower inhibiting effect on bacterial growth than the other materials. The tested materials showed a good correlation between fluoride release and influence on bacterial growth. However, both effects dropped dramatically over the 180-days period.

Marginal adaptation of composite restorations versus hybrid ionomer/composite sandwich restorations

The aim of this in vitro study was to compare the approximal marginal quality of composite fillings using a dentin bonding system to the marginal quality of hybrid ionomer/composite sandwich restorations. Forty-eight standardized class 2 cavity preparations were prepared in caries-free, human third molars. Twelve preparations at a time were filled either with a composite using the matching dentin bonding system, SZ (Scotchbond MP/Z100) or PP (PROBOND/Prisma TPH) or with hybrid ionomer/composite sandwich fillings VZ (Vitremer/Z100) or DP (Dyract/Prisma TPH). Margins were evaluated before and after thermomechanical loading (TCML) (5000 cycles [+5 degrees C/+55 degrees C], 72.5 N [1,7 Hz]) by quantitative scanning electron microscope analysis using an image analyzing system. Furthermore, microleakage was assessed by dye penetration before and after TCML. Statistical analysis was performed using the Mann-Whitney test at the 0.05 level of significance. SEM analysis after TCML showed significantly fewer marginal gaps at the material/dentin interface with VZ (2.2%), DP (7.3%), and PP (6.0%) compared to SZ (29.6%). After TCML, SZ showed significantly more marginal gaps at the material/dentin interface, whereas VZ, DP, and PP were not susceptible to TCML. PP showed the highest percentage in marginal swelling before (18.2%) and after TCML (15.9%), while VZ showed no marginal swelling at all. VZ showed significantly fewer marginal gaps at the composite/hybrid ionomer interface than DP. After TCML there was no significant difference in marginal gaps between the hybrid ionomer/enamel and the hybrid ionomer/dentin interface for both Vitremer and Dyract. Using the sandwich technique the Z100/enamel interface had significantly more marginal gaps than all other composite/enamel interfaces after TCML. There was no significant difference in microleakage between the test groups at the material/dentin interface. SEM analysis and dye penetration showed that hybrid ionomer/composite sandwich restorations have good marginal qualities and may be an alternative to composite restorations using a dentin bonding system.

Periodontal regeneration of intrabony defects with resorbable and non-resorbable membranes: 30-month results

The aim of this prospective split-mouth-study was to compare the healing results in intrabony defects 12 and 30 months after placement of resorbable (polyglactin-910) and non-resorbable (e-PTFE) GTR-membranes. 11 healthy patients with 30 defects participated. 10 patients with 10 pairs of contralateral lesions, which were treated with both membrane types, were included in the split-mouth-design. Furthermore, in an additional group-design all 30 (16 polyglactin-910 and 14 e-PTFE) treated sites were evaluated. Clinical examinations (PBI, REC, PPD, PAL) and radiographic examinations were carried out under standardized conditions immediately before as well as 12 and 30 months after surgery. Additionally, for the assessment of the effectiveness of the 2 membranes by comparing the regeneration results of different defects, the vertical relative attachment gain (V-rAG) was calculated as a % of the PAL gain related to the maximum possible attachment gain (expressed by the baseline depth of the osseous defect intraoperatively measured). Digital subtraction radiography (DSR) was carried out for the quantitative assessment of bone density changes due to GTR. In the split-mouth-design, both types of membranes provided significant V-rAGs (median) after 12 months (polyglactin: 81.7%; e-PTFE: 100.0%) and after 30 months (polyglactin: 69.1%; e-PTFE: 83.8%) compared to baseline. In 90.0% of the polyglactin and e-PTFE sites, a probing attachment gain of at least 2 mm was maintained over the 30-month period. However, in 2 polyglactin treated sites, and 5 e-PTFE treated sites, a new attachment loss was found between 12 and 30 months. DSR showed bone density gain 12 and 30 months postsurgically. No statistically significant differences could be observed between the 2 membrane materials with regard to clinical and radiographic findings. This was confirmed when considering the total number of defects (group-design). In conclusion, based on this 30-month-study resorbable polyglactin membranes may be regarded as a useful alternative to the well established e-PTFE membranes for the treatment of intrabony defects.

Evaluation of a dentin barrier test by cyctotoxicity testing of various dental cements

In this study, cell reaction after exposure to several dental cements was determined using a dentin barrier test device. The reaction of mouse fibroblasts grown on the "pulpal" side of a bovine dentin disk was determined after exposure to dental cements applied on the "cavity" side of the disk. For pretreatment, dentin disks (500-micrometer-thick) were etched on one side and either sterilized by autoclaving or disinfected with ethanol. It was found for both pretreatment groups that zinc phosphate cement was less toxic than the conventional glass ionomer cements. A light-cured glass ionomer cement and zinc oxide-eugenol were the most toxic materials tested. Disinfecting the dentin slices instead of autoclaving reduced the toxicity of the phosphate cement and the glass ionomer cements tendentiously. Because the strong cytotoxic reaction evoked by zinc oxide-eugenol and by the glass ionomer cements is in contrast to in vivo findings, further improvements of the dentin barrier test device will be necessary.

In-vivo evaluation of a feldspathic ceramic system: 2-year results

OBJECTIVES

The aim of this clinical study was to evaluate feldspathic ceramic inlays by clinical criteria and quantitative margin analysis, and to compare clinical performance with the quantitative margin analysis results.

METHODS

Fifty fibre-reinforced feldspathic ceramic inlays were placed in box-shaped, Class II preparations with all margins located in enamel. A low-viscosity type dual-curing resin luting material was used for luting. The inlays were evaluated clinically according to modified US Public Health Service criteria after 2 days, 1 year, and 2 years. In addition, quantitative margin analysis was performed under a scanning electron microscope using an image analysing system.

RESULTS

Clinically the inlays performed very well after 2 years, showing no changes in colour, no recurrent caries and no marginal discolouration. Because of the wear of the composite resin luting material, margins were perceptible with an explorer in 54% of the cases after 2 years. Quantitative margin analysis showed significantly (P < or = 0.05) more marginal gaps at the composite/ceramic interface compared with the enamel/composite interface at each evaluation. There was a significant increase in marginal gaps at both interfaces during the first year, whereas marginal gaps at the composite/ceramic interface did not increase significantly during the second year. Quantitative margin analysis showed that both time and interface had a significant influence on marginal gaps.

CONCLUSION

Quantitative margin analysis should be included in clinical long-term trials on this type of restoration to recognize possible deficiencies in ceramic, composite resin luting material, and the luting interfaces.

Quantitative digital subtraction radiography for assessment of bone density changes following periodontal guided tissue regeneration

OBJECTIVES

The quantitative assessment of alveolar bone density changes in periodontal defects following guided tissue regeneration (GTR).

METHODS

Twelve patients with 30 intrabony lesions and 16 furcation defects took part. Standardized radiographic and clinical examinations were carried out immediately before and then 5 and 13 months after surgery. Intra-oral radiographs were evaluated by means of digital subtraction radiography (DSR). Within the subtraction images, a window ('experimental region') was defined covering the visible density changes in the defect area. Background noise was measured by using a similarly sized window ('control region') located in an area not affected by GTR. Bone density changes were quantitatively evaluated by calculation of the mean, standard deviation and maximum and minimum values of the grey-level histogram within these windows.

RESULTS

DSR revealed significant bone density gain after GTR in intrabony and furcation defects. While a continuous increase was observed over the 13 month period in intrabony defects, changes in furcation defects occurred mostly in the 5-13 month period. Clinically, a distinct vertical and horizontal attachment gain was found. The correlation coefficients between changes in radiographic density and clinical parameters were low, indicating a difference in the information obtained by the two diagnostic methods.

CONCLUSION

Quantitative DSR is a valuable, non-invasive, objective method to obtain information on density changes in intrabony and furcation defects treated by GTR. However, a full assessment of soft and hard tissue changes requires both clinical evaluation and DSR.

Resin-modified glass ionomers for luting posterior ceramic restorations

OBJECTIVES

Until recently, esthetic inlay restorations in posterior teeth have been limited to cavities surrounded by enamel. Dentin adhesive systems in combination with luting composites and light-cured resin-modified glass ionomer cements offer a possibility for bonding ceramic inlays to cavities when the cervical margin is in dentin. This study was designed to compare in vitro marginal integrity of ceramic inlays bonded to dentin to restorations placed in cavities with margins located entirely in the enamel.

METHODS

In the present in vitro study, the sealing abilities of a dentin bonding agent/luting composite combination (Syntac/Dual Cement, Vivadent) and resin-modified glass ionomers (Photac Fil, Photac Bond, ESPE; Dyract, De Trey Dentsply; Fuji II LC, GC Dental Industrial Corp.; and Vitremer, 3M Dental Products) used as luting agents in cavities extending beyond the cemento-enamel junction, were compared to the sealing abilities of a conventional luting composite (Vita Cerec Duo Cement, Vita) in cavities within sound enamel. SEM analysis and dye penetration were performed to evaluate marginal integrity at the cervical cavity margins.

RESULTS

The dentin bonding agent/luting composite combination (Syntac/Dual Cement) rendered a marginal seal within the dentin similar to the quality obtained with the conventional luting procedures within sound enamel. When three out of the five resin-modified glass ionomers were used as luting agents (Dyract, Fuji II LC and Vitremer), the results were comparable to those reported for the dentin bonding agents and the conventional method.

SIGNIFICANCE

Light-cured resin-modified glass ionomer cements may be considered as an alternative to dentin bonding agents when the cavity margins of ceramic inlay restorations are within the dentin. However, further studies, e.g., wear resistance, must be performed.

Influence of different factors on bond strength of hybrid ionomers

A new generation of filling materials, the hybrid-ionomer cements, has been introduced recently. In many clinical situations these hybrid ionomers may be an alternative to conventional glass-ionomer cements and resins bonded with dentin bonding agents. During the past years research has focused on factors influencing bond strength of dentin bonding systems, but there is not much knowledge about the bond strength of hybrid- and glass-ionomer filling materials under different conditions. Bond strengths of four hybrid ionomers, one conventional glass-ionomer cement, and one cermet cement were determined in superficial and deep, dry and moist dentin using a simplified pulp chamber model. All materials showed significantly higher bond strength to superficial compared to deep dentin. Moisture showed no significant influence on any material neither in deep nor in superficial dentin. Bond strengths of Fuji II LC, Variglass, and Vitremer were distinctly higher than those of the conventional glass-ionomer cement (Ketac-Fil) and the cermet cement (Ketac-Silver), while that of Photac-Fil was not significantly different. Ionomer samples failed cohesively in superficial dentin in over 60% of the samples. The bonding interfaces between Fuji II LC and Variglass and the treated dentin surface showed tags but no distinct hybrid layer. Bond strength is not only dependent on the pretreatment of the dentin, but also on the glass-ionomer resin composition of the material.

Placement and replacement of composite restorations in Germany

From 15 September to 15 October 1991, 102 dentists practicing in a rural area of Germany provided information on 3375 composite resin fillings. The purpose of this cross-sectional study was to record the reasons for placement and replacement of composite resin restorations, including any change of material when replacing a filling, and to register the age of any failed restoration. First placements because of primary caries were made in 50.6% of all cases; 49.4% were replacements of failed restorations. Composite resins were used as a material for the first placement of a restoration in 19.2% of primary teeth and in 47.8% of permanent teeth. More amalgams were replaced by composites than vice versa. Secondary caries was the most frequent reason for replacement in permanent teeth and in restorations with less than four surfaces, whereas fracture caused most failures in primary teeth and in fillings with four surfaces. The median age of the replaced restorations was 43.5 months. Failed restorations with four surfaces had the lowest median age.

Placement and replacement of amalgam restorations in Germany

From 15 September to 15 October 1991, 102 dentists practicing in a rural area of Germany provided information on 5240 amalgam restorations. The aim of the present cross-sectional study was to investigate the reasons for placement and replacement of amalgam fillings and to register the age of the failed restorations. First placements because of primary caries were made in 47.1% of all cases; 52.9% were replacements of failed restorations. The most frequently recorded reason for replacement was secondary caries, irrespective of size of the filling, dentition, and age group. The second most frequently recorded reasons for replacement depended on the size of the filling, the age and the dentition of the patient: Bulk fractures were predominant in primary teeth and in fillings with three or four surfaces, primary caries in permanent teeth of patients 16 years old or younger and marginal gaps in adults and in fillings with one or two surfaces. The median age of replaced amalgam restorations in adults was 60 months.