Clinical evaluation of bulk-fill and universal nanocomposites in class II cavities: Five-year results of a randomized clinical split-mouth trial.

AIM: Evaluating the clinical survival and quality parameters of class-II restorations using 3M™ FiltekTM Bulk Fill Posterior Restorative compared to 3M™ FiltekTM Supreme XTE Universal Restorative over a period of five years. MATERIALS AND METHODS: A longitudinal, randomized, prospective split-mouth study with 60 patients (29 female, 31 male; mean age 44 y; range 20-77 y) and a total of 120 load-bearing class II restorations (TEST: n=60 Filtek Bulk Fill Posterior Restorative; CONTROL: n=60 Filtek Supreme XTE Universal Restorative) was conducted. Clinical evaluation was performed by blinded evaluators according to FDI criteria. Kaplan-Meier method was used for survival analysis and an intergroup comparison (Mann-Whitney-U-Test) was carried out. A basic significance level of 0.05 was corrected by the Bonferroni method to account for multiple testing (significance after correction: p<0.00067). RESULTS: The mean overall survival of restorations was 92% after 56.98±1.51 months in the TEST group (95 CI= 54.02;59.94) and 92% after 57.25±1.46 months (95 CI= 54.39; 60.12) in the CONTROL group (log-rank p=0.995). In total, four failures occurred in both TEST and CONTROL group during the observation period (mean annual failure rate: 1.6%). The most common reasons for failure were chipping-fractures, debonding, cracked-tooth-syndrome and recurrent decay. With regard to the FDI criteria, no significant differences between TEST and CONTROL material occurred for any of the evaluated variables. In the TEST group two restorations had to be repaired and two had to be replaced, in the CONTROL group four restorations had to be replaced. CONCLUSION: Both materials showed acceptable clinical performance and survival during the 5-year observation period. CLINICAL SIGNIFICANCE: The use of a nanofilled bulk-fill composite proved to be an aesthetically, functionally and biologically satisfactory alternative in posterior dentition.

Retrospective Clinical Evaluation of Subgingival Composite Resin Restorations with Deep-Margin Elevation.

PURPOSE: To evaluate the long-term clinical quality of subgingivally placed composite resin restorations and the inflammatory status of surrounding supracrestal gingival and periodontal tissues. MATERIALS AND METHODS: Patients with at least one subgingival restoration with deep-margin elevation placed between 2010 and 2020 at Heidelberg University Hospital and Tübingen University Hospital were identified. A sound tooth was used as control. Intraoral examination including probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival bleeding index (GBI), and plaque control record (PCR) was conducted. The clinical quality of the restorations was evaluated using the modified FDI criteria. For comparison between control and test teeth, a logistic mixed-effects model was used for GBI, PCR, and BOP, while a linear mixed-effects model was used for CAL. Multivariable linear and logistic regressions were used to examine the influence of smoking, age of restoration, number of decayed, missing and filled teeth, use of interdental brushes, and CAL. RESULTS: Sixty-three patients were included in the study. The mean age of the restorations was 2.70 ± 1.90 years. There were no significant differences between test and control teeth with respect to inflammatory parameters BOP, GBI, and PCR. CAL was significantly higher in test teeth than in controls (p = 0.027). The regression models revealed that CAL has a significant influence on GBI (p = 0.008) and BOP (p < 0.001). A significantly increased GBI occurred especially on test teeth in patients who did not use interdental brushes daily (p = 0.010). The clinical quality of restorations was rated excellent or good in 70%, an no restoration was rated unacceptable. CONCLUSION: No increased inflammation was observed on sites with subgingivally placed composite restorations over an observation period of approximately 3 years. Regular interdental brush use was associated with less gingival inflammation.

A randomized clinical split-mouth trial of a bulk-fill and a nanohybrid composite restorative in class II cavities: Three-year results.

OBJECTIVES: The aim of this randomized controlled clinical trial was to evaluate the clinical survival and quality parameters of class-II restorations using a bulk-fill composite resin compared to a conventional nanohybrid composite resin in a split-mouth design. METHODS: One hundred and twenty direct restorations were placed in stress bearing class II cavities (n = 60 test group: Filtek™ Bulk Fill Posterior and n = 60 control group: Filtek™ Supreme XTE) in adult permanent teeth. Survival and clinical quality were evaluated at baseline and after 3 years using modified World Dental Federation (FDI) criteria. Participants and clinical evaluators were blinded relating to the group assignment of the restorations. RESULTS: Seventeen restorations (14.2%) were lost to follow-up, leading to 51 restorations available for survival analysis in the test group and 52 restorations in the control group. Seven restorations showed unfavorable events and were classified as failure. Four bulk-fill restorations failed due to tooth infracture (n = 1), chipping fractures (n = 2) and recurrent decay (n = 1), whereas three conventional nanohybrid composite restorations failed due to adhesive failure (n = 1), tooth infracture (n = 1) and chipping as well as recurrent decay (n = 1). The mean annual failure rate was 2.4% and 1.8%, respectively. The difference between test and control group was not significant (p = 0.7). Data on the detailed assessment of FDI criteria were available for n = 48 and n = 49 restorations, respectively. No significant differences between the two groups could be found regarding the assessment of esthetic, functional and biological properties. SIGNIFICANCE: Both materials showed similar clinical performance and survival. The use of bulk-fill composite proved to be an esthetically, functionally and biologically satisfactory alternative in the posterior dentition during the 3-year follow-up.

Can the Acid-formation Potential of Saliva Detect a Caries-related Shift in the Oral Microbiome?

PURPOSE: To determine acid-formation potential of saliva and evaluate whether this method corresponds with microbiome composition of individuals with and without caries. MATERIALS AND METHODS: A clinical, controlled pilot study was performed with two groups: individuals without caries (n = 25; DMFT = 0) and individuals with at least one active carious lesion (n = 25; DMFT>0). A detailed intraoral examination was performed, and the gingival bleeding index (GBI) and plaque index (PI) were recorded. The acid-formation potential was measured (ΔpH) after 1 h. Streptococcus mutans (SM) and lactobacilli (LB) were also quantified. Intergroup comparisons were made using the Mann-Whitney U-test. The diagnostic value was evaluated using the receiver operating characteristics (ROC) method and area under the curve (AUC) values were calculated. The saliva microbiome was analysed by 16S rDNA next-generation sequencing. RESULTS: A statistically significant difference was found in ΔpH, with the 'caries' group showing a higher mean value after 1 h ('healthy' = 1.1,'caries' = 1.4; p = 0.035). The AUC values were moderate to good (ΔpH = 0.67; SM = 0.83; LB = 0.83;1 = ideal). Streptococcus mutans and Lactobacilli were more frequently detected in the 'caries' group (p < 0.001), as were statistically significantly higher GBI (p = 0.006) and PI (p = 0.001). The saliva microbiome had a higher α-diversity and greater richness in individuals with active caries. The incidence of the genera Alloprevotella, Prevotella, Campylobacter and Veillonella was statistically significantly higher in the 'healthy' group. The incidence of the genera Fretibacterium, Lactobacillus, and Leptotrichia, as well as the phyla Spirochaetes and Synergistetes, was statistically significantly higher in the 'caries' group. CONCLUSION: Further studies must be carried out to determine the extent to which both tests are suitable for predicting future caries development.

Oral health of centenarians and supercentenarians.

There are many studies on the homebound and institutionalized elderly; however, few studies focus on centenarians and supercentenarians, i.e., people aged 100 and 110 years, respectively. Due to the demographic changes, the population of centenarians is set to increase more than that of other age groups. Therefore, this article aims to review the available literature regarding how oral health might display in this age group and highlight aspects necessitating further research. Oral health, oral health-related quality of life, saliva, and the oral microbiome were emphasized in this study. Most papers relevant to the research questions were excluded because the mean age of participants was <100 years. Only two papers were found on centenarians' oral health status and saliva and no studies were found focusing on the oral health-related quality of life or oral microbiome. The reviewed studies demonstrate that centenarians presented with good oral mucosal conditions, dental conditions, and general health. The present literature is insufficient to come to a definite conclusion regarding how aging affects the oral health of centenarians and supercentenarians. The limited available research indicates that centenarians display better oral health than other individuals in their respective birth cohorts.

[Weather and suicide : Association between meteorological variables and suicidal behavior-a systematic qualitative review article]. / Wetter und Suizid : Assoziation zwischen meteorologischen Variablen und suizidalem Verhalten ­ eine qualitative systematische Übersichtsarbeit.

BACKGROUND: The effects of current and expected future climate change on mental health outcomes are of increasing concern. In this context, the importance of meteorological factors on suicidal behavior is receiving growing attention in research. OBJECTIVE: Systematic review article with qualitative synthesis of the currently available literature, looking at the association between meteorological variables and attempted and completed suicide. MATERIAL AND METHODS: Criteria-based, systematic literature search according to the PRISMA criteria. Peer-reviewed original research studies were included without time limits. RESULTS AND CONCLUSION: A total of 99 studies were included and grouped according to the research analysis based on daily, weekly, monthly and annual data. The majority of the studies reported a statistical association with at least one meteorological variable. The most consistent positive correlation was shown between temperature and suicidal behavior. However, the results are not conclusive and in part contradictory. The reported studies differed distinctively in terms of study design. Meteorological parameters may be associated with suicidal behavior. Future research in this area is needed to provide further clarity. Despite existing knowledge gaps, the current findings may have implications for suicide prevention plans.

Amplicon-based microbiome study highlights the loss of diversity and the establishment of a set of species in patients with dentin caries.

OBJECTIVES: To elicit patterns in pathogenic biofilm composition we characterized the oral microbiome present in patients with dentin caries in comparison to healthy subjects. METHODS: 16S amplicon sequencing was used to analyse a total of 56 patients; 19 samples of carious dentin (pooled from at least three teeth) and 37 supragingival samples (pooled from three healthy tooth surfaces). Oral and periodontal status and socio-demographic parameters were recorded. Group assignment, smoking and further socio-demographic parameters were used as explanatory variables in the microbiome composition analysis. RESULTS: Overall, a total of 4,110,020 DNA high-quality sequences were yielded. Using a threshold of similarity >97% for assigning operational taxonomic units (OTU), a total of 1,537 OTUs were identified. PERMANOVA showed significant differences in microbiome composition between the groups caries/healthy (p = 0.001), smoking/non-smoking (p = 0.007) and fluoride intake during childhood yes/no (tablets p = 0.003, salt p = 0.023). The healthy microbiome had a significantly higher diversity (alpha diversity, p<0.001) and a lower dominance (Berger-Parker index, p<0.001). It was dominated by Fusobacteria. A linear discriminant analysis effect size (LEfSe) yielded a set of 39 OTUs being more abundant in carious dentin samples, including Atopobium spp. (14.9 log2FoldChange), Lactobacillus casei (11.6), Acinetobacter spp. (10.8), Lactobacillus gasseri (10.6), Parascardovia denticolens (10.5), Olsenella profusa (10.4), and others. Also Propionibacterium acidifaciens (7.2) and Streptococcus mutans (5.2) were overabundant in caries lesions. CONCLUSIONS: The healthy microbiome was highly diverse. The advanced caries microbiome was dominated by a set of carious associated bacteria where S. mutans played only a minor role. Smoking and fluoride intake during childhood influenced the microbiome composition significantly. CLINICAL SIGNIFICANCE: The presented investigation adds knowledge to the still not fully comprehended patterns of oral microbiomes in caries compared with oral health. By analysing the genetics of biofilm samples from oral health and severe tooth decay we found distinct discriminating species which could be targets for future therapeutic approaches.

Bacterial biofilm composition in healthy subjects with and without caries experience.

Objective:The composition of the oral microbiome differs distinctively between subjects with and without active caries. Still, caries research has mainly been focused on states of disease; aspects about how biofilm composition and structure maintain oral health still remain widely unclear. Therefore, the aim of the study was to compare the healthy oral microbiome of caries-free adult subjects with and without former caries experience using next generation sequencing methods. Methods: 46 samples were collected from subjects without any signs of untreated active caries. Samples of pooled supragingival plaque from 19 subjects without caries experience (NH; DMFT = 0) and 27 subjects with 'caries experience' ( CE; DMFT > 0 [F(T)> 0; D(T)= 0]) were analyzed by 16S ribosomal RNA amplicon sequencing. Results: Subjects with caries experience did not exhibit a dramatically modified supragingival plaque microbiome. However, we observed a slight and significant modification between the two groups, validated by PERMANOVA ( NH vs. CE: R2 0.04; p= 0.039). The composition of the microbiome of subjects with caries experience indicates a tendency to lower α-diversity and richness. Subjects without caries experience showed a significant higher evenness compared to patients with previous caries. LDA effect size (LEfSe) analysis demonstrated that the genus Haemophilus is significantly more frequent in patients with caries experience. For the group without caries experience LefSe analysis showed a set of 11 genera being significantly more frequent, including Corynebacterium, Fusobacterium, Capnocytophaga, Porphyromonas, Prevotella,and Leptotrichia. Conclusion: The analysis of the oral microbiome of subjects with and without caries experience indicates specific differences. With the presence of Corynebacterium and Fusobacterium subjects without caries experience exhibited more frequently organisms that are considered to be main actors in structural plaque formation and integration. The abundance of Corynebacterium might be interpreted as a signature for dental health.