Mobile virtual tooth morphology teaching environment for preclinical dental students.

OBJECTIVES: Extended reality as an additional digital learning concept comprises virtual reality (VR), augmented reality, and mixed reality. In particular, VR allows an interaction in the virtual world. The aim of this study was to evaluate the students' attitude toward a mobile VR application for teaching tooth morphologies. METHODS: Eighty-two first year dental students were enrolled. After using the VR learning environment with mobile VR glasses at home for 1 week, the students were asked to fill in a questionnaire with 21 questions regarding intuitive handling, and supplemental learning information in comparison to the use of conventional textbooks. Nine questions provided predefined answer options, another nine had the form of a visual analog scale (VAS, range 0%-highly negative to 100%-highly positive), and three allowed free text answers. The data were checked for normal distribution (Kolmogorov-Smirnov test) and was analyzed descriptively. RESULTS: Forty-four percent of the students rated their perception of understanding of dental morphologies much better with VR than with conventional learning. The potential of the VR learning environment for further dental topics was assessed with a median VAS score of 75.8%. Its intuitive handling was evaluated with a median VAS score of 67.1%. The haptic, visual, and auditory supplemental learning information was consistently rated positively with VAS scores of 73.9%, 80.0%, and 71.6%, respectively. Overall, a majority of the students (85.5%) recommended the VR learning environment for dental morphology. CONCLUSIONS: The VR dental learning environment allows dental students an additional learning opportunity of dental morphologies, recommended by more than 85% of students.

Fracture load of different veneered and implant-supported 4-UNIT cantilever PEEK fixed dental prostheses.

OBJECTIVES: To determine the fracture load before and after artificial aging of implant-supported 4-unit cantilever fixed dental prostheses (FDP) with frameworks made of two differently filled polyetheretherketone (PEEK) compounds and veneered using three different techniques. METHODS: A total of 120 duplicate 4-unit FDP frameworks were produced (n = 60 milled from PEEK, 20% TiO2 filled and n = 60 pressed from PEEK, 30% TiO2 filled) and veneered using three different techniques: (i) digital veneerings, (ii) conventional resin composite veneerings and (iii) prefabricated veneers (n = 20 per subgroup). The FDPs were adhesively bonded to titanium abutments and the fracture load was measured in a universal testing machine (1 mm/min) before and after artificial aging in a mastication simulator (1,200,000 cycles, 50 N, TC: 5/55 °C, 6000 cycles). The fracture patterns were analyzed using digital microscopy. Data were analyzed using the Kolmogorov-Smirnov test, two-way ANOVA, post hoc Scheffé, Chi2-test (p < 0.05), and Weibull modulus m, as well as fracture patterns using the Ciba-Geigy table. RESULTS: Veneering technique and filler content significantly affected the fracture load (p < 0.001). Prefabricated veneers showed higher fracture load (p ≤ 0.001) whereas digital and conventional veneerings were similar (p = 0.451). PEEK with 30% filler content presented higher fracture load (p < 0.001) compared with PEEK with 20%. Aging showed no effect on fracture load (p = 0.176). Regarding fracture types, no significant differences were found among the groups (p = 0.055). CONCLUSIONS: Filler content of PEEK compound as well as veneering technique influenced fracture load while aging had no effect on fracture load. FDPs made of PEEK with 30% of filler content veneered using prefabricated veneers had the highest fracture resistance.

Fracture load and chewing simulation of zirconia and stainless-steel crowns for primary molars.

Aesthetic alternatives to stainless-steel crowns for restoring primary molars attain growing interest. We studied the mechanical properties of prefabricated zirconia crowns and conventional crowns. Three brands of prefabricated zirconia crowns were compared with computer-aided design/computer-aided manufacturing (CAD/CAM) zirconia crowns, preveneered stainless-steel crowns, and conventional stainless-steel crowns regarding: (i) fracture load under each of three conditions [no pretreatment, artificial aging in saliva for 12 wk, and after chewing simulation/thermocycling (1.68 × 106 cycles/5-55°C)]; and (ii) survival rate during chewing simulation, considering decementation, fracture, chipping, fatigue cracks, and occlusal holes. Without pretreatment, the prefabricated zirconia crowns showed mean fracture load values between 893 N and 1,582 N, while the corresponding values for CAD/CAM zirconia crowns and preveneered stainless-steel crowns were 2,444 N and 6,251 N. Preveneered stainless-steel crowns showed significantly lower fracture loads after artificial aging (5,348 N after saliva aging; 3,778 N after chewing simulation) than without artificial aging, whereas the fracture load of zirconia crowns was not influenced negatively. The survival rate of the different groups of zirconia crowns and preveneered stainless-steel crowns during chewing simulation was 100%, but only 41.7% for the stainless-steel crowns. These in-vitro data suggest that prefabricated zirconia crowns are aesthetically and durable alternatives to stainless-steel crowns for primary molars.

Do bonding agents protect the bracket-periphery?--Evaluation by consecutive µCT scans and fluorescence measurements.

OBJECTIVES: The aim of this in vitro study was to consecutively determine the effect of three bonding agents on the prevention of enamel demineralisation at the bracket-periphery and to compare the suitability of micro-computed tomography (µCT) scans and quantitative light-induced fluorescence (QLF) to detect changes within subsurface lesions. MATERIALS AND METHODS: The effect of a resin-modified glass ionomer cement (RMGI) (Fuji Ortho LC), a compomer (Assure) and a composite (Transbond XT) on the prevention of enamel demineralisation at the bracket-periphery was examined. After 7, 14, 21 and 28 days of pH cycling, the teeth (N = 45) were examined by consecutive µCT scans and by using a customised QLF set-up. RESULTS: Particularly for the RMGI and for the compomer, the QLF and µCT scans showed that the formation and the body of the lesion were not precisely located at the enamel next to the bracket margin. There was an area that was almost protected. The progression of demineralisation was decreased for the RMGI and the compomer-treated teeth. CONCLUSION: For bonding orthodontic brackets, the RMGI and compomer were comparably able to decrease the progression of white spot lesions (WSL), although the RMGI showed marginally superior protection. Both methods (QLF and µCT scans) were suitable for investigating the longitudinal fluoride effects on WSL, though these effects were more accurately described by mineral (fluorescence) loss or volume changes than by lesion depth. CLINICAL RELEVANCE: The progression of WSL at the bracket-periphery could be altered by using fluoride-releasing bonding agents for bracket application. This approach represents a minimally invasive preventive measure.

Self-etch adhesives for the bonding of orthodontic brackets: faster, stronger, safer?

OBJECTIVES: This study aimed to evaluate the performance of accelerating procedures for bonding of orthodontic brackets in vitro by comparing different adhesives (etch-and-rinse, self-etch) and polymerization procedures (curing devices, time). The performance was characterized by three parameters: (1) the bond strength achieved, (2) the incidence of enamel damage, and (3) the extent of residual composite on the tooth. MATERIALS AND METHODS: Bracket bonding was performed on 500 extracted human teeth after application of either an etch-and-rinse adhesive or a one-step self-etch adhesive. Two different two-component self-etch adhesives (Clearfil SE and Transbond Plus) and two single-component self-etch adhesives (Ideal and iBond) were investigated after using different polymerization procedures (light-emitting diode for 10 or 20 s or plasma arc curing device for 3 or 6 s). The bond strength, incidence of enamel damage, and extent of residual composite on the tooth were measured. RESULTS: Single-component self-etch adhesives gave the lowest bond strengths. No significant difference in bond strength could be detected between the two-component self-etch adhesives and the etch-and-rinse method. There was a 70.3% risk for enamel damage at bond strengths above 12 MPa, but only 5% risk below 12 MPa and no risk below 8.2 MPa. The risk of enamel damage increased by an odds ratio increment of 1.3 for each additional MPa above 8.2 MPa. CONCLUSION: Single-component self-etch adhesives showed the lowest bond strengths, caused limited enamel damage, and generally left less residual composite on the tooth. CLINICAL RELEVANCE: The nature of the adhesive greatly influences the resultant bond strength, the risk of enamel damage, and the extent of residual composite on the teeth.

Is there a need for orthodontic plaque indices?--diagnostic accuracy of four plaque indices.

OBJECTIVES: The aim of this study was to assess the diagnostic performance and accuracy of four plaque indices for orthodontic patients. MATERIALS AND METHODS: The plaque accumulation of 140 maxillary incisors with bonded brackets was recorded using intra-oral photographs and assessed using four different plaque indices: the orthodontic plaque (OP) index, the modified orthodontic plaque (MOP) index, the Quigley and Hein (QHP) index and the modified Navy plaque (MNP) index. The assessment was performed twice within a time interval of 4 weeks by four different examiner groups: orthodontists, dentists, students and orthodontic assistants. RESULTS: No significant differences were detected for the OP and MOP indices among the examiner groups. A significant difference was found for the QHP and MNP indices. The inter- and intra-examiner reliability of the OP and MOP indices was good. In contrast, the reliability for the QHP and MNP indices was moderate to poor with few exceptions. The discrimination performance of the OP and MOP indices was excellent. The sum of the sensitivity and specificity was generally lower for the QHP and MNP indices compared with the OP and MOP indices. CONCLUSION: OP and MOP indices showed good performance. The QHP and MNP indices are not appropriate for orthodontic purposes. CLINICAL RELEVANCE: Traditional plaque indices reflect the typical pattern of plaque accumulation for patients without multi-bracket appliances. The performance of these indices for orthodontic patients has never been investigated. Orthodontic plaque indices that focus on the surface along the gingival margin and areas around the bracket exhibit higher diagnostic performance and accuracy compared with traditional indices.

Does a reduction of polymerization time and bonding steps affect the bond strength of brackets?

High bond strengths are required in order to avoid bracket failure during treatment while brackets should be removable. In addition, chair time should be kept at a minimum. Therefore, the aim of this study was to investigate any differences in bracket's bond strength to enamel by reducing the polymerization time and the steps of bonding procedure. Five hundred teeth were randomly allocated into 20 groups. The groups were established considering the investigated curing units (quartz-tungsten-halogen (QTH) and light-emitting diode (LED), each with two different polymerization times) and the used bonding agents (Clearfil SE Bond, Transbond Plus, Ideal1, iBond, and Transbond XT Primer following acid etching). The brackets were debonded using a shear-peel load and used to calculate the bond strength. The location of adhesive failure was registered by using the modified adhesive remnant index (ARI). The influence of the parameters curing unit, curing time, and bonding agent as well as their interaction products on bond strength showed that the bonding agent influenced the bond strength most followed by curing time. The parameter curing unit as well as all the generated interaction products of it showed a lower impact. Regarding the ARI, the bonding agent exhibited also the highest influence. Using a LED resulted in comparable bond strengths as the QTH curing device also at shorter exposure times. Additionally, the two-component self-etching primers showed similar bond strengths compared to the acid-etching method. Chair time can be reduced by using two-component self-etching primers and LED without decrease of bond strength.

Effectiveness of ozone against periodontal pathogenic microorganisms.

Ozone has been proposed as an adjunct antiseptic in periodontitis therapy. The aim of this study was to investigate the antimicrobial effectiveness of gaseous/aqueous ozone, in comparison with that of the established antiseptic chlorhexidine digluconate (CHX), against periodontal microorganisms. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Parvimonas micra in planktonic or biofilm cultures were exposed, for 1 min, to gaseous ozone, aqueous ozone, CHX, or phosphate-buffered saline (control). None of the agents was able to substantially reduce the A. actinomycetemcomitans count in biofilm cultures. In contrast, P. gingivalis, T. forsythia, and P. micra could be eliminated by 2% CHX or by ozone gas at 53 gm(-3) . Significantly greater antimicrobial effects were observed against planktonic cultures than against biofilm-associated bacteria. The rate of killing was influenced by the species of bacteria, and by the type and concentration of agent. There were no significant differences in the effectiveness of aqueous ozone (20 µg ml(-1) ) or gaseous ozone (≥ 4 gm(-3) ) compared with 2% CHX but they were more effective than 0.2% CHX. Therefore, high-concentrated gaseous and aqueous ozone merit further investigation as antiseptics in periodontitis therapy. A safe system for applying gaseous ozone into the periodontal pocket that avoids inhalation still needs to be developed.

Effect of different bonding agents on prevention of enamel demineralization around orthodontic brackets.

INTRODUCTION: Demineralization around the bracket is an undesired side effect of orthodontic treatment. The aim of this in-vitro study was to evaluate the efficacy of 5 bonding agents to prevent enamel demineralization. Two quantification methods were used. METHODS: Eighty-five extracted teeth were randomly allocated to 5 groups: (1) Transbond Plus SEP and Transbond XT (both, 3M Unitek, Seefeld, Germany), (2) 37% phosphoric acid, Pro Seal (Reliance Orthodontic Products, Itasca, Ill) and Transbond XT, (3) Clearfil Protect Bond (Kuraray Medical, Okayama, Japan) and Transbond XT, (4) 37% phosphoric acid and Light Bond (Reliance Orthodontic Products), and (5) Ortho Conditioner and Fuji Ortho LC (both, GC, Tokyo, Japan). In-vitro caries was created by pH cycling for 30 days. After demineralization, the teeth were scanned with a commercial cone-beam microtomographic system. Then the teeth were examined by polarized light microscopy. RESULTS: The 2 methods of examination showed significant differences among the 5 groups according to lesion depth and mineral loss (P < 0.01). The resin-modified glass ionomer cement (group 5) had the lowest values for lesion depth and mineral loss. CONCLUSIONS: Fuji Ortho LC showed a significantly smaller lesion depth and less mineral loss compared with the other materials. The cone-beam microtomographic system is suitable for evaluation of subsurface lesions and has considerable advantages.

Failure rate of brackets bonded with antimicrobial and fluoride-releasing, self-etching primer and the effect on prevention of enamel demineralization.

INTRODUCTION: Our aim in this randomized clinical trial was to compare the failure rates of orthodontic brackets by using 2 self-etching primers (SEPs) (Transbond Plus [3M Unitek, Seefeld, Germany] and Clearfil Protect Bond [Kuraray Medical, Okayama, Japan]) with a split-mouth design. Additionally, the effect of Clearfil Protect Bond was investigated regarding inhibition of plaque accumulation and demineralization. METHODS: A total of 480 brackets were bonded in 24 patients with the SEPs. The observation period was 12 months. One week after bonding and at every third recall, the plaque index and a visual rating of the enamel adjacent to the bracket were assessed at the lateral incisors and the first premolars. Additionally, DIAGNOdent (KaVo, Biberach, Germany) values were measured. RESULTS: Over the investigation time, 26 failures were recorded. Five occurred with the brackets bonded with Transbond Plus, and the rest with Clearfil Protect Bond (P = 0.002). The additionally observed parameters had no significant differences. CONCLUSIONS: The failure rate with Clearfil Protect Bond was significantly higher. For our patients, who had adequate oral hygiene, there was no benefit with regard to plaque accumulation and prevention of demineralization with Clearfil Protect Bond.

Orthodontic attachments and chlorhexidine-containing varnish effects on gingival health.

OBJECTIVE: To compare the severity of clinical inflammation parameters and the level of the inflammatory mediator interleukin (IL)-1beta during orthodontic treatment by using brackets and bands. In addition, the effect of a chlorhexidine-containing varnish was investigated. MATERIALS AND METHODS: This prospective randomized controlled trial included 40 healthy children who required an orthodontic treatment of mild crowding. Either brackets or bands were randomly allocated to the premolars with a split-mouth design. Twenty of the children received a chlorhexidine-containing varnish during the treatment (0, 12, 24 weeks), while the remaining children served as a control group. Prior and until 24 weeks after the insertion, data were recorded regarding the pocket depth (PD), the gingival appearance (gingival index [GI]), and the plaque accumulation (plaque index [PI]). Gingival crevicular fluid was collected as well. A quantitative enzyme-linked immunoassay technique was used to detect differences in IL-1beta. RESULTS: The PDs and the gingival index of teeth with brackets showed significantly lower values in comparison with teeth treated with bands (P = .0001). The IL-1beta levels confirmed these findings. In contrast, the PI showed higher values for the teeth with brackets (P = .0001). The teeth that received a chlorhexidine-containing varnish showed significantly lower values in the follow-ups for most of the evaluated parameters (PD Band, PI Band, PI Bracket, GI Band, GI Bracket; P < .015). CONCLUSION: The clinically observed parameters as well as the IL-1beta levels reflected the higher impact of bands on gingival health. These values showed a significant decrease after application of a chlorhexidine-containing varnish. However, the PI showed higher values for the teeth with brackets.

Ozonized low density lipoprotein (ozLDL) inhibits NF-kappaB and IRAK-1-associated signaling.

OBJECTIVE: Recent studies have provided strong evidence for the presence of ozone in atherosclerotic lesions. In addition, modification of LDL has been suggested to be involved in atherosclerosis. In the present study we wanted to investigate whether LDL exposed to ozone (ozLDL) is able to modulate the NF-kappaB system, as a paradigm for inflammatory signaling. METHODS AND RESULTS: We showed that activation of NF-kappaB by lipopolysaccharide (LPS), a prototypic inducer of innate immunity, was reversibly inhibited by ozLDL in monocytic THP-1 cells in a dose-dependent manner, whereas tumor necrosis factor (TNF) signaling was not affected. This was not attributable to a direct ozone effect or solely the presence of lipoprotein, and neither required direct contact to LPS nor was accompanied by a change in LPS binding. Comparable inhibitory effects of ozLDL were observed in human monocyte/macrophages and endothelial cells. The presence of ozLDL led to a decrease in LPS-induced IkappaB alpha proteolysis and a reduction of kappaB-dependent transcription/target-gene expression. Furthermore, ozLDL markedly lowered stimulus-induced IkappaB kinase (IKK) activity and phosphorylation/proteolysis of interleukin (IL)-1 receptor-associated kinase-1 (IRAK-1). Finally, cholesterol ozonization products were identified as effective ozLDL inhibitory compounds. CONCLUSIONS: Our study demonstrated that ozLDL inhibited NF-kappaB and IRAK-1-associated signaling which may impair immune function and promote apoptosis.

Effect of ozone on oral cells compared with established antimicrobials.

Ozone has been proposed as an alternative antiseptic agent in dentistry based on reports of its antimicrobial effects in both gaseous and aqueous forms. This study investigated whether gaseous ozone (4 x 10(6) microg m(-3)) and aqueous ozone (1.25-20 microg ml(-1)) exert any cytotoxic effects on human oral epithelial (BHY) cells and gingival fibroblast (HGF-1) cells compared with established antiseptics [chlorhexidine digluconate (CHX) 2%, 0.2%; sodium hypochlorite (NaOCl) 5.25%, 2.25%; hydrogen peroxide (H(2)O(2)) 3%], over a time of 1 min, and compared with the antibiotic, metronidazole, over 24 h. Cell counts, metabolic activity, Sp-1 binding, actin levels, and apoptosis were evaluated. Ozone gas was found to have toxic effects on both cell types. Essentially no cytotoxic signs were observed for aqueous ozone. CHX (2%, 0.2%) was highly toxic to BHY cells, and slightly (2%) and non-toxic (0.2%) to HGF-1 cells. NaOCl and H(2)O(2) resulted in markedly reduced cell viability (BHY, HGF-1), whereas metronidazole displayed mild toxicity only to BHY cells. Taken together, aqueous ozone revealed the highest level of biocompatibility of the tested antiseptics.

C/EBP beta blocks p65 phosphorylation and thereby NF-kappa B-mediated transcription in TNF-tolerant cells.

TNF is a major mediator of inflammation, immunity, and apoptosis. Pre-exposure to TNF reduces sensitivity to restimulation, a phenomenon known as tolerance, considered as protective in sepsis, but also as a paradigm for immunoparalysis. Earlier experiments in TNF-tolerant cells display inhibition of NF-kappaB-dependent IL-8 gene expression at the transcriptional level with potential involvement of C/EBPbeta. In this study, we have shown that a kappaB motive was sufficient to mediate transcriptional inhibition under TNF tolerance conditions in monocytic cells. Furthermore, in tolerant cells, TNF-induced NF-kappaB p65 phosphorylation was markedly decreased, which was accompanied by the formation of C/EBPbeta-p65 complexes. Remarkably, in C/EBPbeta(-/-) cells incubated under the conditions of TNF tolerance, neither impairment of transcription nor inhibition of p65 phosphorylation was observed. Finally, we showed that C/EBPbeta overexpression reduced p65-mediated transactivation and that association of C/EBPbeta with p65 specifically prevented p65 phosphorylation. Our data demonstrate that C/EBPbeta is an essential signaling component for inhibition of NF-kappaB-mediated transcription in TNF-tolerant cells and suggest that this is caused by blockade of p65 phosphorylation. These results define a new molecular mechanism responsible for TNF tolerance in monocytic cells that may contribute to the unresponsiveness seen in patients with sepsis.