Gender-Specific Differences of Dental Emergency Patients and the Use of Antibiotics: A 4-Year Retrospective Study.

PURPOSE: To evaluate the clinical characteristics of dental emergency patients with special regard on gender-specific differences related to the utilisation and use of antibiotics. MATERIALS AND METHODS: A retrospective analysis of all patients who presented to the emergency service of a university hospital in from 2010 to 2013 was performed. Demographic data, diagnosis, conducted treatment and the prescription of antibiotics were recorded and further analysed. RESULTS: Altogether, 16,296 patients visited the emergency service. Of these patients, only one-fourth (25.7%; n = 4185) suffered from a diagnosis with urgent treatment needs. Gender-specific differences were found in the reason of visit. Males presented significantly more often with severe diagnoses, like abscess or trauma. Females presented significantly more often with non-urgent diagnoses, not directly connected to oral hygiene habits, like temporomandibular disorders (TMD), denture sore or dolor post extractionem. Moreover, an overuse of antibiotics was found among emergency patients, with every fifth patient (20.2%; n = 3291) being prescribed an antibiotic. CONCLUSION: Better public education on dental emergencies and constant updates for dentists about the use of antibiotics in dental emergency care is necessary to secure adequate medical supply for severe dental emergencies and to avoid an inappropriate use of antibiotics.

Undergraduate Students' Acceptance of a Reciprocating One-File System for Endodontic Treatment.

OBJECTIVES: Reciprocating endodontic one-file systems are a comparatively new method for root canal shaping. Even though the mechanical properties are comparable to modern rotating mechanical systems, data about subjective assessment and application quality are scarce. This study evaluates the reciprocating one-file system in undergraduate education. MATERIALS AND METHODS: A total of 42 undergraduate students without experience regarding reciprocating file systems filled in a questionnaire in four different points in time (t 1-t 4) anonymously. The questionnaire was based on a numerical rating scale ranging from 0 to 10. STATISTICAL ANALYSIS: A least significant difference post-hoc analysis comparing the group average values was performed. The adjusted level of significance was p < 0.004 after Bonferroni correction. RESULTS: All rating scores increased after the first theoretical instruction. After the first practical training in artificial root canals in resin blocks and extracted teeth (t 2), the estimation of "time efficiency" (p = 0.002), "handling" (p < 0.001), and "overall impression" (p < 0.001) improved significantly. The "overall impression" remained constant and showed no significant changes after the first practical training. CONCLUSIONS: Reciprocating systems seem to show a good acceptance among first time users. Initial concerns about "work safety" decrease during every step of the educational process. Reciprocating one-file systems are a safe and well-accepted method in undergraduate teaching.

Association between breast cancer chemotherapy, oral health and chronic dental infections: a pilot study.

Breast cancer has developed to become the leading type of cancer in females. For this study, 80 women were examined after chemotherapy for breast cancer and compared to 80 healthy age-matched women. This cross-sectional study comprised a dental examination with number of teeth, caries frequency (DMFT) and the presence of periodontal diseases (PSI). With the help of X-rays (OPG), the number of root canal fillings and apical lesions (LEO/LPO) were recorded. Furthermore, the education level, body mass index (BMI), smoking habits and general health conditions were recorded. All women completed questionnaires on oral health-related quality of life (OHIP-G14) and general well-being (HADS-D). To assess the influence of cancer therapy on oral health parameters, appropriate generalized linear models were fitted with disease status as main explanatory variable, adjusting for age and education. For OHIP and HADS, we additionally adjusted for number of missing teeth. The examined 160 women showed a comparable mean age (60.4 years) and an average BMI of 24.6. Cancer patients showed a higher risk for missing teeth (p < 0.001) and more apical lesions (p < 0.0041), particularly those of endodontic origin without root canal fillings (p = 0.0046), than the control women. The general well-being of cancer patients was significantly reduced with a HADS score of 9.4 for women with breast cancer compared to 5.3 for the healthy control. This study suggests that women after breast cancer chemotherapy are inclined to have a poorer oral health status with more missing teeth and apical lesions. Therefore, tightly scheduled dental recall visits should be recommended.

Photodynamic Therapy has no Adverse Effects In Vitro on Human Gingival Fibroblasts and Osteoblasts.

BACKGROUND: Invasion of periodontal pockets with persistent microorganisms and subsequent development of a biofilm are the main cause of periodontal infections. In severe cases, additional use of antibiotics to the standard therapy of scaling and root planing (SRP), is necessary, but the use of antibiotics may lead to resistance. As an alternative, the combination of SRP and adjunct photodynamic therapy (PDT) is applied in the treatment of periodontal infections to improve periodontal therapy. The aim of this study was to determine possible side effects of PDT on human gingival fibroblasts (GF) and human osteoblasts (OB). METHODS: GF and OB were either untreated or treated with methylene blue (MB) only, with MB and subsequently irradiation with a soft laser (PDT) or irradiated with a soft laser only. All cells were analyzed for viability using the MTT test, migration capacity using Boyden chambers, and the scratch wound assay. RESULTS: Viability and migration capacity of GF and OB were not affected by PDT (for GF: p = 0.48, for OB: p = 0.08 compared to control group) whereas soft laser irradiation only improved cell viability and migration and MB treatment only reduced cell viability and migration. After 72 hours of incubation of both GF and OB, the gaps were almost closed. CONCLUSIONS: In vitro, PDT did not affect viability and migration capacity of GF and OB whereas soft laser treatment only had a positive effect on GF and OB. Therefore, PDT seems to be a safe method in the treatment of periodontal infections without significant side effects.

Correction to: human periodontal ligament fibroblasts stimulated by nanocrystalline hydroxyapatite paste or enamel matrix derivative. An in vitro assessment of PDL attachment, migration, and proliferation.

In the original published version of this article, the middle name for author Mirko H. H. Schmidt is missing.

Visible Light Curing Devices - Irradiance and Use in 302 German Dental Offices.

PURPOSE: To determine the irradiance delivered by visible-light curing (VLC) units and obtain information about the exposure times and the maintenance protocols used by dentists. MATERIALS AND METHODS: The irradiance (mW/cm2) delivered by 526 VLCs from 302 dental offices from the Rhine-Main area, Germany, was measured using an integrating sphere (IS) and a MARC patient simulator (M-PS); additional information was gathered using a survey. RESULTS: Irradiance was measured from 117 standard quartz-tungsten-halogen (QTH), 5 high-power QTH, 2 LED 1st-generation, 333 LED 2nd-generation, 61 LED 3rd-generation, and 8 plasma-arc curing (PAC) units. Depending on the measurement method, 8% (IS) or 11% (M-PS) of the VLCs delivered < 400 mW/cm2. Depending on the VLC, the shortest exposure times required to deliver a radiant exposure of 16 J/cm2 ranged from 7 to 294 s. The number of exposure cycles used by dentists when light curing a restoration ranged from 1 to 14. The shortest total exposure time used by dentists on a restoration was 5 s, the maximum was 200 s, and the median was 20 s. Of the 526 VLCs, 41% had intact, undamaged light tips. Only half of the dental offices checked the irradiance from their VLCs regularly, 97% disinfected the VLC, and 86% used eye protection. CONCLUSION: Approximately 10% of the VLCs delivered < 400 mW/cm2 and 14% of the dental offices used no form of eye protection. To achieve sufficient light curing of RBC restorations, more awareness about the VLCs used in the dental office is required.

Efficacy of photodynamic therapy as adjunct treatment of chronic periodontitis: a systematic review and meta-analysis.

Meta-analysis of treatment effects of antimicrobial photodynamic therapy (aPDT) adjunct to non-surgical scaling and root planing (SRP) in comparison to SRP alone on patients with chronic periodontitis. The meta-analysis was performed according to PRISMA statement and Cochrane Collaboration guidelines. Electronic search complemented by hand search assured a high yield of randomized controlled trials (RCTs) of aPDT as adjunct modality to SRP. Differences in probing depth (PD) and clinical attachment level (CAL) were calculated with 95% confidence intervals and pooled in a random effects model. Analysis for intra- and inter-study heterogeneity was provided by χ 2 and I 2 tests, and publication bias was checked by funnel plots. Pooled overall effects of 26 RCTs attested significant benefits of aPDT adjunct to SRP with respect to PD reduction (MD 0.37; 95% CI 0.12-0.53; P < 0.0001) and CAL gain (MD 0.33; 95% CI 0.19-0.48; P < 0.00001) after 3 and 6 months. Sensitivity analysis minimized heterogeneity of PD reduction (MD 0.21; 95% CI 0.13-0.30; P < 0.00001) and CAL gain (MD 0.36; 95% CI 0.27-0.46). aPDT adjunct to SRP provides significant PD reduction and CAL gain in treatment of chronic periodontitis. This moderate effect was found after 3 and 6 months which is short from a clinical perspective.

Determination of polymerization shrinkage of different composites using a photoelastic method.

PURPOSE: To investigate the polymerization shrinkage stress of different low viscous bulk composites (SDR, Venus Bulk Fill, X-tra Base, Filtek Bulk Fill) in comparison to a conventional flowable composite (Filtek Supreme XTE Flow) and to high viscous bulk and conventional composites (Filtek Supreme XTE, GrandioSO, Tetric EvoCeram, Tetric EvoCeram BulkFill, Venus Diamond, Venus Pearl), as well as to an experimental composite (Ormocer) and a sonic-activated bulk fill composite (Sonicfill), by means of photoelastic investigation. METHODS: To ensure bonding of the resin composite, cylindrical cavities (Ø 4mm) in araldite B epoxide resin plates (40 × 40 × 4 mm3) were pre-treated with the Rocatec system. Embedded in araldite plates, six resin composite specimens of each material were exposed for 60 seconds from one side (Translux Power Blue, 1,000 mW/cm2). The samples were stored, light-protected and dry (23°C). Polymerization shrinkage stress data (MPa) were calculated 15 minutes, 1 and 24 hours after light exposure, based on the diameter of the isochromatic curves of first order, obtained from araldite plates. Statistical analysis was performed with the Wilcoxon-test and Bonferroni correction (P< 0.0006). RESULTS: After 15 minutes/1 hour, the mean polymerization stress values calculated were:for SDR 4.4 ± 0.1/4.4 ± 0.2 MPa; Venus Bulk Fill 4.8 ± 0.3/4.9 ± 0.3 MPa; X-tra Base 6.5 ± 0.3/6.7 ± 0.3 MPa; Filtek Bulk Fill 4.9 ± 0.3/4.9 ± 0.3 MPa; Filtek Supreme XTE Flow 8.0 ± 0.3/8.2 ± 0.2 MPa; Filtek Supreme XTE 7.1 ± 0.1/7.4 ± 0.2 MPa; GrandioSO 6.3 ± 0.4/6.3 ± 0.3 MPa; Tetric EvoCeram 4.5 ± 0.1/4.6 ± 0.1 MPa; Tetric EvoCeram BulkFill 4.9 ± 0.2/5.0 ± 0.3 MPa; Venus Diamond 3.7 ± 0.3/3.8 ± 0.3 MPa; Venus Pearl 3.9 ± 0.2/4.0 ± 0.2 MPa, Sonicfill 5.4 ± 0.2/5.6 ± 0.3 MPa; and Ormocer (experimental) 4.1 ± 0.2/4.3 ± 0.2 MPa. After 24 hours, the following mean stress values were obtained:SDR 4.7 ± 0.2 MPa; Venus Bulk Fill 5.1 ± 0.2 MPa; X-tra Base 7.2 ± 0.4 MPa; Filtek Bulk Fill 5.3 ± 0.3 MPa; Filtek Supreme XTE Flow 8.7 ± 0.3 MPa; Filtek Supreme XTE 7.9 ± 0.2 MPa; GrandioSO 7.0 ± 0.4 MPa; Tetric EvoCeram 4.9 ± 0.1 MPa; Tetric EvoCeram BulkFill 5.4 ± 0.3 MPa; Venus Diamond 4.5 ± 0.3 MPa; Venus Pearl 4.5 ± 0.3 MPa, Sonicfill 5.8 ± 0.2 MPa and Ormocer (experimental) 4.5 ± 0.2 MPa. The new and experimental resin composites showed significantly less polymerization shrinkage stress than the conventional resin composite (Filtek Supreme XTE). CLINICAL SIGNIFICANCE: Resin composite restoratives differ in their polymerization shrinkage stress development, independent of their viscosity. Some low viscosity bulkfill-restoratives generate less shrinkage stress compared to other conventional or bulk-restoratives. Practitioners should yield to the potential effect of shrinkage stress development, because this might affect marginal integrity in the clinical performance.

Three-dimensional analysis of the physiological foramen geometry of maxillary and mandibular molars by means of micro-CT.

The aim of this study was to investigate the physiological foramen diameter, shape and distance between physiological and anatomical apex of maxillary and mandibular first and second molars. Accurate knowledge of the physiological foramina morphology; thus, inherent mechanical shaping technical hindrances, is decisive when taking the corresponding root canal final preparation decision. The morphological dimensions of a total of 1727 physiological foramina were investigated by means of micro-computed tomography. Mean narrow and wide (to a high number, oval) diameters of the physiological foramen were 0.24, 0.22 and 0.33 mm and 0.33, 0.31 and 0.42 mm in mesiobuccal (MB), distobuccal (DB) and palatal (P) roots in maxillary first molars; 0.24, 0.22 and 0.33 mm and 0.41, 0.33 and 0.44 in MB, DB, and P roots in maxillary second molars. Mandibular first molars showed mean narrow and wide diameters of 0.24 and 0.30 mm and of 0.39 and 0.46 mm in mesial (M) and distal (D) roots; second mandibular molars showed 0.25 and 0.31 mm and 0.47 mm in M and D roots. The mean distance between the physiological foramina and anatomical apex was 0.82, 0.81 and 1.02 mm and 0.54, 0.43 and 0.63 mm in MB, DB and P roots of the maxillary first and second molars, respectively. A mean distance of 0.95 mm (M) and 1.05 mm (D) in the first and 0.78 mm (M) and 0.81 mm (D) in the second mandibular molars was observed. Based on the results obtained, assumable recommendations for final preparation size of the physiological foramen were calculated. However, when taking into consideration, the resulting standard deviations of marginal errors must be cautiously considered when taking a final decision in clinical endodontic treatment.

Is there a Genotoxic Potential of Endodontic Root Materials?

BACKGROUND: Leakage of components from endodontic materials (EM) can occur in case of apical extrusion into the periapical tissue. Therefore, an important prerequisite, besides the mechanical properties of the EM, is a high biocompatibility. In the present study, we elucidated the genotoxic potential of EMs of different base composition by utilizing the -H2AX assay. METHODS: For investigation of the genotoxic potential of EM, supernatants of commercially available EM were prepared and dilutions were applied to human gingival fibroblasts. Non-toxic doses of EM were determined by cell viability assay. For the -H2AX assay, human gingival fibroblasts were incubated with predefined concentrations of the supernatants, which were found not to reduce cell viability. Hydrogen peroxide was utilized as positive control. Cells were fixed 1, 6 and 24 hours after addition of the supernatant to the medium, followed by immunostaining for -H2AX. For scoring of -H2AX foci, automated foci counting was performed in at least 80 cells per experiment and time point. The experiments were repeated at least twice. RESULTS: In contrast to hydrogen peroxide treated cells, no elevated -H2AX levels were detected in cells incubated with the EM supernatants. CONCLUSIONS: Samples treated with EM supernatants showed no elevated levels of -H2AX foci, e.g., no genotoxicity. Therefore, all types of EM seem to meet the standard to be called a biocompatible dental material in terms of genotoxicity, and, therefore, the application seems safe.

Root canal morphology and configuration of 123 maxillary second molars by means of micro-CT.

The aim of this study was to investigate the root canal configuration, accessory canals and number of main foramina of 123 maxillary second molars by means of micro-computed tomography. The teeth were scanned and reproduced with 3D software imaging. The root canal configuration and number of main foramina were evaluated by means of a four-digit system. The morphological complexity of human maxillary second molars is depicted by the number of accessory and connecting canals. The most frequently observed root canal configurations in the mesiobuccal root were 2-2-2/2 (19.5%), 2-2-1/1 (14.6%) and 2-1-1/1 (13.0%). A 1-1-1/1 configuration was observed in 93.5% and in 96.7% in the distobuccal and palatal roots, respectively. The MB1 root canal had one accessory canal (18.7%), and 8.9% of the MB2 root canal had one or two accessory canals. The distobuccal (11.3%) and palatal (14.6%) root canals had at least one accessory canal, and connecting canals were observed in 16.3% of mesiobuccal roots. The MB1, MB2, distobuccal and palatal root canals had one main foramen in 99.2%, 43.1%, 98.4% and 99.2% of samples, respectively. In the mesiobuccal root, one accessory foramen was detected in 14.6%, two were detected in 7.3%, and three were detected in 5.7%. The distobuccal root showed one or two accessory foramina in 9.1% of samples. The root canal configuration of maxillary second molars is quite heterogeneous; the mesiobuccal root has predominantly two root canal entrances (58.4%, 1 in 41.1%) with one main foramen (54.4%). Two main foramina were observed in 43.0%. Morphological variations, connecting and accessory canals were observed in all apical thirds.

Micro-CT assessment of internal morphology and root canal configuration of non C-shaped mandibular second molars

The root canal system morphology of the mandibular second molar was investigated by means of micro-computed tomography (µCT). The root canal configuration (RCC), foramina and accessory canals frequency of 93 mandibular second molars of an Egyptian sample were investigated by µCT scans. The RCC and main foramina number (MFN) are described by means of a four-digit system from coronal to apical. The most frequently observed RCCs in the mesial root were 2-2-1/1 (32.3%), 2-2-2/2 (28.0%), 1-1-1/1 (6.5%) and 2-1-1/1 (6.5%); an additional twelve different RCCs were also found here. In the distal root, the RCC 1-1-1/1 was observed in 81.7%; another ten different RCCs with a frequency of less than 5% were also observed in this root. Anastomoses be-tween the mesiobuccal and mesiolingual canals in the mesial root were witnessed in the coronal (20.5%), middle (19.4%) and apical (10.8%) thirds. Accessory canals were found in the coronal (mesiobuccal 15.0%, mesiolingual 12.9%, distobuccal 1.1%), middle (mesiobuccal 7.5%, mesiolingual 10.8%, distolingual 3.3%) and apical (mesiobuccal 19.3%, mesiolingual 16.2%, distolingual 10.8%, distobuccal 2.2%) thirds. The RCC of mandibular second molars showed a great variety. When compared with the first mandibular molar in a historical control from the same sample, the mandibular second molar presented less morphological diversifications. Yet, the mesial root canalsystem of the mandibular second molar showed more RCC variations, connecting and accessory canals than the distal root.

Dental age assessment in 6- to 14-year old German children: comparison of Cameriere and Demirjian methods.

BACKGROUND: The aim of the study was to compare two frequently used dental age estimation methods for accuracy. METHODS: A total of 479 panoramic radiographs in age groups 6-14 years from a German population were evaluated. The dental age of 268 boys and 211 girls was assessed by means of the method of Demirjian (1973) and Cameriere (2006) and compared with their actual chronological age. RESULTS: Demirjan's method showed an overestimation of dental age compared to chronological age in all age groups for boys (mean difference -0.16, p = 0.010, range -0.35 to 0.09), age group 9 showed an underestimation. Using the same method for girls (mean difference -0.18, p = 0.008, range -0.45 to 0.13), an overestimation could also be shown in all age groups except for age groups 8 and 13. Results for Cameriere's method showed for boys (mean difference 0.07, p = 0.314, range -1.38 to 3.83) in age groups 6 to 11 an overestimation, but in age groups 12 to14 an underestimation. The results for girls (mean difference 0.08, p = 0.480, range -1.55 to 4.51) showed an overestimation for age groups from 6 to 10, and an underestimation in age groups 11 to 14. CONCLUSIONS: The comparison shows an advantage of Demirjian's method for both genders. While Cameriere's method showed a higher inaccuracy in all age groups, Demirjian's method showed more appropriate results for dental age estimation of the investigated German population. To avoid errors in forensic age estimation and to prevent misidentifications for defendants in criminal processes, further studies of more precise methods for age estimation for the German population are required.

Root coverage with connective tissue graft associated with coronally advanced flap or tunnel technique: a randomized, double-blind, mono-centre clinical trial.

AIM: The aim of this randomized clinical trial was to compare the coronally advanced flap (CAF) with the modified microsurgical tunnel technique (MMTT) for treatment of Miller class I and II recessions. MATERIAL AND METHODS: Forty patients with 71 gingival recessions were recruited and randomly assigned to either CAF or to MMTT. In both groups, a connective tissue graft was applied. Clinical evaluations were performed after 3, 6, and 12 months. Impressions were taken and digitally scanned three-dimensionally to evaluate the quantitative soft tissue changes in the operative region. Patient satisfaction was measured with the root coverage aesthetic score (RES). RESULTS: After a period of 12 months, significant differences were not found between the two groups. Root coverage was 98.3% for CAF and 97.2% for MMTT. The evaluation of the aesthetic outcome using RES showed good results in both groups. The RES score was in accordance with subjective patient satisfaction. There was no significant difference in the amount of volumetric changes. CONCLUSIONS: CAF and MMTT with the additional use of a graft are equally successful in covering gingival recessions of Miller class I and II, with high aesthetic results. All patients indicated their willingness for further periodontal surgery.

Hypnosis and Local Anesthesia for Dental Pain Relief-Alternative or Adjunct Therapy?-A Randomized, Clinical-Experimental Crossover Study.

This prospective randomized clinical crossover trial was designed to compare hypnosis and local anesthesia for experimental dental pain relief. Pain thresholds of the dental pulp were determined. A targeted standardized pain stimulus was applied and rated on the Visual Analogue Scale (0-10). The pain threshold was lower under hypnosis (58.3 ± 17.3, p < .001), maximal (80.0) under local anesthesia. The pain stimulus was scored higher under hypnosis (3.9 ± 3.8) than with local anesthesia (0.0, p < .001). Local anesthesia was superior to hypnosis and is a safe and effective method for pain relief in dentistry. Hypnosis seems to produce similar effects observed under sedation. It can be used in addition to local anesthesia and in individual cases as an alternative for pain control in dentistry.

A survey of clearing techniques for 3D imaging of tissues with special reference to connective tissue.

For 3-dimensional (3D) imaging of a tissue, 3 methodological steps are essential and their successful application depends on specific characteristics of the type of tissue. The steps are 1° clearing of the opaque tissue to render it transparent for microscopy, 2° fluorescence labeling of the tissues and 3° 3D imaging. In the past decades, new methodologies were introduced for the clearing steps with their specific advantages and disadvantages. Most clearing techniques have been applied to the central nervous system and other organs that contain relatively low amounts of connective tissue including extracellular matrix. However, tissues that contain large amounts of extracellular matrix such as dermis in skin or gingiva are difficult to clear. The present survey lists methodologies that are available for clearing of tissues for 3D imaging. We report here that the BABB method using a mixture of benzyl alcohol and benzyl benzoate and iDISCO using dibenzylether (DBE) are the most successful methods for clearing connective tissue-rich gingiva and dermis of skin for 3D histochemistry and imaging of fluorescence using light-sheet microscopy.

Oral Hygiene and Dietary Habits in Adolescents with Fixed Orthodontic Appliances: A Cross-sectional Study.

OBJECTIVES: Fixed orthodontic appliances (FOAs) may cause a temporary deterioration of oral hygiene with corresponding gingival inflammatory changes. Optimal oral hygiene and dietary changes are essential in order to avoid periodontal inflammation. The present study investigates to what extent the recommendations made by the orthodontist are followed by young patients. MATERIALS AND METHODS: A total of 67 adolescent patients with FOA were examined and interviewed. The control group consisted of 70 patients of the same age who had not undergone any orthodontic treatment. A specific questionnaire (assessing dietary habits, oral hygiene measures) was used and comprehensive oral findings along with oral hygiene status were evaluated. RESULTS: The analysis of the data showed that despite intensive oral hygiene and dietary advice in the patients with FOA, there was no change in diet or oral hygiene habits. There were significantly higher signs of gingival inflammation and amount of dental plaque in FOA patients. Nutritional recommendations and oral hygiene measures for young people with FOA were not adequately enforced. CONCLUSION: The findings indicate that frequent recalls should be scheduled with repeated reinforcement of oral hygiene and dietary modifications in FOA patients.

Efficacy of an aluminium triformate mouthrinse during the maintenance phase in periodontal patients: a pilot double blind randomized placebo-controlled clinical trial.

BACKGROUND: The aim of this prospective placebo-controlled pilot study was to evaluate short-term effects of a mouthrinse containing aluminium triformate (ATF) on gingival inflammation and plaque formation in periodontal patients who are in the maintenance phase. ATF has styptic (astringent) and anti-inflammatory effects. METHODS: Forty non-smoking periodontal patients with modified sulcus bleeding index (MSBI) ≥40 % were randomly divided into two groups. The participants received a masked mouthrinse (ATF or placebo) and were instructed with the rinsing protocol of 3 daily rinses during 30 s for 7 days. One blinded investigator (CE) performed all clinical examinations. The primary outcome was reduction in gingival inflammation as measured by MSBI. The secondary outcomes were reduction of the amount of plaque as measured by plaque index (PI) and approximal plaque index (API) and the occurrence of side effects. The patients were evaluated at the start and the end of the rinsing period, including the compliance of the patients. RESULTS: MSBI was reduced in both groups compared to baseline, but the ATF group showed significantly more reduction in MSBI compared to the placebo group (ATF: 17.6 %, placebo: 7.6 %, p = 0.035). ATF and placebo had no effects on dental plaque. Patients reported ATF mouthrinse not to have side effects other than oral sensation, whereas compliance of the patients was good. Almost all patients in the ATF group reported reduction of gum bleeding after 1 week of rinsing with ATF. CONCLUSIONS: This short-term pilot clinical trial is a firm basis to design a long-term controlled clinical trial to show whether ATF helps to inhibit further periodontal breakdown in maintenance patients with high MSBI. TRIAL REGISTRATION: This trial was registered in the WHO International Clinical Trials Registry Platform as DRKS00007672 , date of registration: 21/01/2015.

Root Canal Morphology and Configuration of 118 Mandibular First Molars by Means of Micro-Computed Tomography: An Ex Vivo Study.

INTRODUCTION: The aim of this study was to investigate the root canal system morphology of the mandibular first molar by means of micro-computed tomography. METHODS: The root canal configuration, foramina, and accessory canals frequency of 118 mandibular first molars were investigated by means of micro-computed tomography and 3-dimensional software imaging. A 4-digit system describes the root canal configuration from the coronal to apical thirds and the main foramina number. RESULTS: The most frequent root canal configurations in mesial root were 2-2-2/2 (31.4%), 2-2-1/1 (15.3%), and 2-2-2/3 (11.9%); another 24 different root canal configurations were observed in this root. A 1-1-1/1 (58.5%), 1-1-1/2 (10.2%), and 16 other root canal configurations were observed in the distal root. The mesiobuccal root canal showed 1-4 foramina in 24.6%, and the mesiolingual showed 1-3 foramina in 28.0%. One connecting canal between the mesial root canals was observed in 30.5% and 2 in 3.4%. The distolingual root canal showed 1-4 foramina in 23.7%, whereas a foramen in the distobuccal root canal was rarely detected (3.4%). The mesiobuccal, mesiolingual, and distolingual root canals showed at least 1 accessory canal (14.3, 10.2, and 4.2%, respectively), but the distobuccal had none. CONCLUSIONS: The root canal configuration of mandibular first molars varies strongly. According to our expectations, both the mesial and distal roots showed a high number of morphologic diversifications. The root canal system of the mesial root showed more root canal configuration variations, connecting and accessory canals than the distal root.