Two digital strategies in modern implantology - root-analogue implants and the digital one-abutment/one-time concept.

The irreversible trend toward digitization in dentistry and dental technology has resulted in technical progress and continuous changes to conventional workflows. In particular, implantology and prosthetics have benefited from a multitude of interesting new possibilities. Three-dimensional (3D) computed radiography and digital surface scanning can be invaluable in terms of backward planning and making implant surgery and denture fabrication more predictable. In this context, two digital implant-prosthetic treatment strategies are presented that allow for an efficient digital workflow while ensuring a minimally invasive surgical procedure. By means of digital intraoperative scanning of the implant position, the digital one-abutment/one-time concept allows for the insertion of computer-aided design/computer-aided manufacturing (CAD/CAM)-manufactured single crowns instantly after uncovering the implant. The second approach uses 3D radiographic data to preoperatively manufacture a one-piece root-analogue implant (RAI) and insert it immediately after tooth extraction. Both ideas promise some advantages in terms of quality and preservation of periimplant tissues as well as a noticeable reduction in overall treatment time.

Relationship between caries experience and demarcated hypomineralised lesions (including MIH) in the permanent dentition of 15-year-olds.

OBJECTIVE: This cross-sectional study compared the caries experience in 15-year-olds with and without demarcated hypomineralised lesions (DHL) in permanent teeth. MATERIAL AND METHODS: One thousand three hundred and two 15-year-old adolescents from two ongoing birth cohorts (GINIplus15 and LISAplus15) were examined to determine non-cavitated carious lesions (NCCL) and the DMF index. Furthermore, DHL was scored on all permanent teeth/surfaces according to the molar-incisor hypomineralisation criteria of the European Academy of Paediatric Dentistry (MIH/EAPD). Adolescents with DHL were categorised into those with a minimum of one DHL in the permanent dentition (DHL ≥ 1), with DHL on at least one first permanent molar (MIH/EAPD) and with DHL on at least one first permanent molar and permanent incisor (MIH/Severe). The study was conducted in the metropolitan area of Munich. RESULTS: The proportion of children without caries amounted to 63.7% (DMF > 0) and 26.0% (D1-4MF > 0); the caries experience was mean = 4.0(SD = 5.2) NCCL/T and 0.9(1.7) DMF/T. Existence of DHL ≥ 1, MIH/EAPD and MIH/Severe was detected in 40.2, 17.2 and 9.8% of all adolescents, respectively. The corresponding DMF/T values were: no DHL 0.9(1.7); DHL ≥ 1 1.0(1.7); MIH/EAPD 1.1(1.6); MIH/Severe 1.1(1.7). The group of adolescents with MIH/EAPD and MIH/Severe were found to have statistically higher caries rates in comparison to those with no DHL. CONCLUSIONS: Caries and DHL are prevalent and influenced the dental health of 15-year-old adolescents. A significant positive association existed between the presence of caries and DHL. CLINICAL RELEVANCE: Children with MIH/EAPD or MIH/Severe had a higher probability to develop carious lesions in the permanent dentition.

Preventive and invasive treatment in special needs patients: a German retrospective study.

OBJECTIVES: Data on dental treatment of children with special healthcare needs (CSHCN) are sparse. Hence, this study provides information about the changes in the dental condition in a cohort of CSHCN treated in a university dental department in Germany. MATERIAL AND METHODS: Patient records of CSHCN treated from January 2004 to December 2012 were screened retrospectively for medical diagnoses (ICD-10) and the type of treatment performed with outpatient dental care (ODC) or general anesthesia (GA). Follow-up data of patients adhering to the recommended recall were recorded, including time and further treatments. RESULTS: A total of 795 CSHCN with a mean age of 6.8 years were included. In 41.6 % (331/795) of cases, treatment was performed under ODC, and 58.4 % (464/795) received GA. Caries experience in CSHCN treated under GA was significantly higher (7.9 d3/4mft/0.9 D3/4MFT) than in ODC (2.5 d3/4mft /0.9 D3/4MFT). Over time, patient flow shifted from invasive (IC) to preventive-based care (PC). CONCLUSION: Caries-related treatments were most frequent under GA and ODC, though initial caries experience was higher in GA patients. The choice of GA or ODC was statistically independent from the medical condition. CLINICAL SIGNIFICANCE: This study provides characteristics of a large population of CSHCN treated with and without GA for dental care.

Gingivitis and lifestyle influences on high-sensitivity C-reactive protein and interleukin 6 in adolescents.

AIM: This cross-sectional study was repeated at two time points and investigated the influence of gingivitis, smoking and body mass index (BMI) on the systemic inflammatory markers high-sensitivity C-reactive protein (hs-CRP) and interleukin 6 (IL6) in 10- and 15-year-olds. MATERIALS AND METHODS: The study sample of two birth cohorts, i.e. GINIplus and LISAplus, from the Munich centre consisted of 806 and 846 subjects who were evaluated at 10- and 15-year follow-ups respectively. Children and their parents completed questionnaires on participant-related lifestyle information. Gingivitis was measured at the sextant level using a simplified sulcus-bleeding index. Serum hs-CRP and IL6 levels were obtained from blood samples. Multiple logistic regressions adjusting for lifestyle-related factors and other confounders were performed to assess associations between the specified variables. RESULTS: There were no associations between gingivitis and the inflammatory markers hs-CRP and IL6 in 10-year-olds. In 15-year-olds, gingivitis (aOR: 2.17; 95% CI: 1.25-3.77); daily smoking (aOR: 6.27; 95% CI: 1.39-28.39); and being overweight/obese (aOR: 4.95; 95% CI: 0.73-33.68) were identified as significantly influencing factors for elevated hs-CRP values. Oral hygiene did not influence hs-CRP. CONCLUSION: In this study, hs-CRP was positively associated with gingivitis, smoking daily and overweight/obesity among 15-year-olds.

Comparison of Different Protocols for Performing Adhesive Restorations in Primary Teeth - A Retrospective Clinical Study.

PURPOSE: To examine the influence of different adhesive restoration protocols on the survival of composite resin restorations in primary teeth. MATERIALS AND METHODS: This study included 601 patients at risk of caries (319 males and 282 females), with a mean age of 6.6 years (range: 1 to 13 years) and an average need for 3.6 restorations per patient (range: 1 to 20). The mean observation period was 1.3 years (± 1.4), with a maximum of 7 years. Six different adhesive restoration protocols with respect to etching, adhesives, and composite materials were analyzed. The statistical analyses included descriptive analyses and a Cox regression model from which hazard ratios (HR with 95% CI) for protocols and possible predictors were calculated. RESULTS: The mean dmft was 6.6 (± 4.0), which indicates a high risk population. Secondary caries was the most frequent reason for loss of restoration in this study (52.2%). Out of 2146 restorations, 368 failed; the mean annual failure rate was 13.2%. Adhesive restoration protocols that employed a self-etching system performed significantly better (HR range: 1.0 to 1.8) than did the etch-and-rinse system (HR range: 1.8 to 2.8). Protocols using only flowable materials had a moderately increased probability of failure. CONCLUSION: With respect to the practice-based study design, young age, and high risk of caries in this population, comparatively high failure rates were observed for direct composite restorations in primary dentition, but adhesive restoration protocols using self-etching adhesives in combination with universal composites yielded a higher probability of survival.

Risk factors for secondary caries in direct composite restorations in primary teeth.

BACKGROUND: Secondary caries or caries adjacent to restorations is the most frequent reason for replacement of dental restorations. Though, limited data is available on variables influencing the development of secondary caries in primary teeth. AIM: To investigate risk factors for the development of secondary caries adjacent to direct composite restorations in primary teeth. DESIGN: For this retrospective study, data of 2417 composite restorations, which were placed due to primary carious lesions, were considered. A total of 212 restorations failed due to secondary caries within a maximum observation period of 8 years. A control group was randomly selected. Mann-Whitney U-test, binomial logistic regression with backward elimination and Cox regression with frailty model were performed (P < 0.05). RESULTS: The overall caries experience amounted to 6.3 dmft and 13.3 dmfs. 72.5% of restorations failed within the first 2 years. Older children and children from families with a higher socio-economic status showed a lower risk for secondary caries. Further, the dentist and the adhesive had a significant influence on the longevity. Posterior restorations had a higher risk to fail in comparison with anterior restorations. CONCLUSIONS: Within the limitation of this study, it is concluded that the development of secondary caries is influenced by several factors. Nevertheless, the secondary caries rate was found to be relatively low in this high-risk population.

Survival characteristics of composite restorations in primary teeth.

OBJECTIVES: This retrospective study analyzed restoration survival of composite fillings in children with at high caries risk in relation to age, sex, operator, tooth type, filling extension, and material used. MATERIALS AND METHODS: Among 667 children treated in 2004-2012 in a university setting without sedation or general anesthesia, 2388 composite fillings were included. Relevant data from regular recall intervals were retrieved from patients' records. Either total-etch or a self-etch adhesive combined with flowable and/or (nano)hybrid composite was used. The Kaplan-Meier estimator and Cox proportional hazard analysis with backward elimination model were applied for survival analysis. RESULTS: For the observation period of 8 years (mean 1.7 years), the cumulative failure rate was 17.2 % with annual failure rates of 10.0 %. In 8.8 % of the cases, fillings failed due to secondary caries. In 8.3 % technical failure due to total filling loss, loosening, marginal gaps, or tooth fracture occurred. Tooth type, filling extension, age, operator, dental dam, and type of adhesive were significant for survival (p < 0.05). CONCLUSIONS: Filling survival was comparably lower to composite restorations observed in prospective clinical studies on permanent teeth and other tooth-colored restoratives used in primary teeth. Due to the very high caries risk and young age of the population, frequent loss due to secondary caries was observed. With respect to the high caries risk, composite restorations can be used to treat carious primary teeth, though a strict caries prevention regimen should be followed to minimize restoration failure. CLINICAL RELEVANCE: Filling loss of composites in the primary dentition is associated with secondary caries on the long term.