Long-term performance of ceramic in/-onlays vs. cast gold partial crowns - a retrospective clinical study.

OBJECTIVES: To assess the long-term clinical performance of ceramic in-/onlays (CIOs) and cast gold partial crowns (CGPCs) in posterior teeth in terms of success, survival, complications (biological, technical) and quality. MATERIAL AND METHODS: In a retrospective study, a total of 325 patients were recorded after up to 24.8 years (mean 13.9 ± 3.8 years) having (pre-)molars restored with CIO (Empress I, Ivoclar Vivadent, n = 161) and CGPC (Degunorm, DeguDent, n = 164) by supervised undergraduate students. A total of 296 restorations were assessed clinically and radiologically in healthy and endodontically treated teeth using modified United States Public Health Service (USPHS) criteria. Cumulative success and survival rates of the restorations were calculated using Kaplan-Meier estimates. Biological and technical complications were recorded. Status of oral health comprising caries risk and localized periodontitis were assessed. RESULTS: The cumulative success rates of CIOs were 92.1% and of CGPCs 84.2% after mean service times of 14.5 years. The annual failure rates of total service times were 0.5% in teeth restored with CIO (n = 155) and 0.7% in teeth restored with CGPC (n = 163). The cumulative survival rates of CIOs were 93.9% after a mean service time of 15.2 years and decreased to 91.7% after 23.5 years. The cumulative survival rates of CGPCs were 92.6% after a mean service time of 14.9 years and 91.8% after 23.5 years. Complications in CIOs (n = 149) were ceramic fracture (6.7%), secondary caries (4.7%), endodontic complication (2.7%) and tooth fracture (1.3%) compared to CGPCs (n = 147) with endodontic complication (8.8%), secondary caries (4.8%) and decementation (2.0%). Endodontically treated teeth restored with CIO or CGPC revealed significantly less often success compared with corresponding vital teeth (p = .02). CIOs and CGPCs revealed clinically and radiographically good and excellent qualities with 71.8% (107/149) and 68% (100/147) without any significant differences regarding type of restoration. CONCLUSIONS: Both CIOs and CGPCs achieved high survival rates up to 24.8 years when performed by supervised undergraduate students. The longevity of the restorations may benefit from the intraoral repair of accessible defects and, in case of pulp infection or necrosis, an adequate endodontic management. CLINICAL RELEVANCE: CIOs and CGPCs made by supervised undergraduate students are proper restoration types in posterior teeth in the long-term. An adequate preparation design, meticulous care in the inserting technique and constant biofilm removal due to proper oral hygiene combined with professional maintenance care are substantial. The clinical long-term performance was mostly limited by ceramic fractures in CIOs and endodontic complications in CGPCs.

Endodontic Outcome of Root Canal Treatment Using Different Obturation Techniques: A Clinical Study.

OBJECTIVE: To evaluate the clinical outcome of root canal treatment by obturation technique, root canal filling quality, and tooth- and patient-related variables. METHODS: This clinical study investigated the endodontic outcome of 114 teeth treated between the years 2009 and 2012. Three different obturation methods were used: (1) adhesive obturation using the continuous wave of condensation technique with Resilon® (CWR), (2) matching-taper single-cone technique with gutta-percha and AH Plus® (SCGP), and (3) matching-taper single-cone technique with gutta-percha and GuttaFlow® (SCGF). Pre- and postoperative periapical radiographs were performed to detect the presence of endodontic lesions (PAI classification) and to assess the quality of both the obturation and the restoration. Tooth- and patient-related data were collected. RESULTS: The overall endodontic success rate was 75.4% after a mean observation period of 6.3 years. There were no significant correlations between the type or overall quality of obturation and the treatment outcome. Teeth with preoperative lesions had the highest odds ratio (factor of 4.98) for endodontic failure. Tooth- and patient-related variables had no significant effect on endodontic outcome. CONCLUSIONS: The preoperative periapical status of teeth requiring endodontic treatment was a substantial prognostic factor for endodontic outcome, whereas the type of obturation material or technique did not affect it.

Root Maturation of an Immature Dens Invaginatus Despite Unsuccessful Revitalization Procedure: A Case Report and Recommendations for Educational Purposes.

BACKGROUND: The clinical management of teeth with complex dens invaginatus (DI) malformations and apical periodontitis may be challenging due to the lack of routine. The aim of this case report is to describe the endodontic treatment of an immature tooth with DI and to discuss strategies for preclinical training for teeth with such malformations. CASE REPORT: A 9-year-old male presented with an immature maxillary incisor with DI (Oehlers Type II) and apical periodontitis which was diagnosed by cone beam computed tomography (CBCT). Revitalization was initially attempted but then abandoned after failure to generate a stable blood clot. Nevertheless, considerable increase in both root length and thickness could be detected after medication with calcium hydroxide followed by root canal filling with MTA as an apical plug. CONCLUSIONS: The endodontic management of teeth with DI requires thorough treatment planning. In immature teeth, under certain conditions, root maturation may occur even with conventional apexification procedures. From an educational perspective, different strategies including CBCT and 3D-printed transparent tooth models for visualization of the complex internal morphology and redesigned 3D-printed replica with various degrees of difficulty for endodontic training, can be used to overcome the challenges associated with endodontic treatment of such teeth.

Influence of Matrix Type on Marginal Gap Formation of Deep Class II Bulk-Fill Composite Restorations.

Background: To test the hypothesis that transparent matrices result in more continuous margins of bulk-fill composite (BFC) restorations than metal matrices. Methods: Forty standardized MOD cavities in human molars with cervical margins in enamel and dentin were created and randomly assigned to four restorative treatment protocols: conventional nanohybrid composite (NANO) restoration (Tetric EvoCeram, Ivoclar Vivadent, Schaan, Liechtenstein) with a metal matrix (NANO-METAL) versus transparent matrix (NANO-TRANS), and bulk-fill composite restoration (Tetric EvoCeram Bulk Fill, Ivoclar Vivadent, Schaan, Liechtenstein) with a metal matrix (BFC-METAL) versus transparent matrix (BFC-TRANS). After artificial aging (2500 thermal cycles), marginal quality was evaluated by scanning electron microscopy using the replica technique. Statistical analyses were performed using the Mann−Whitney U-test and Wilcoxon test. The level of significance was p < 0.05. Results: Metal matrices yielded significantly (p = 0.0011) more continuous margins (46.211%) than transparent matrices (27.073%). Differences in continuous margins between NANO (34.482%) and BFC (38.802%) were not significant (p = 0.56). Matrix type did not influence marginal gap formation in BFC (p = 0.27) but did in NANO restorations (p = 0.001). Conclusion: Metal matrices positively influence the marginal quality of class II composite restorations, especially in deep cavity areas. The bulk-fill composite seems to be less sensitive to the influence of factors such as light polymerization and matrix type.

Influence of filler geometry and viscosity of composite luting materials on marginal adhesive gap width and occlusal surface height of all-ceramic partial crowns.

OBJECTIVES: To evaluate the influence of filler geometry and viscosity of luting composites on marginal adhesive gap width (MGW) and occlusal surface height (OSH) of all-ceramic partial crowns. METHODS: Forty-eight all-ceramic partial crowns (Celtra Duo, Dentsply) were created and divided into six groups (n = 8). Restorations were bonded using universal adhesive (Prime & Bond Active, Dentsply) in combination with low-viscosity composites (LV) containing amorphous fillers (Calibra Ceram, Dentsply) (LV-AF), heterogeneous fillers (Tetric EvoFlow, Ivoclar Vivadent) (LV-HF) vs. high-viscosity composites (HV) containing spherical fillers (Ceram.x, Dentsply) (HV-SF) or heterogeneous fillers (Tetric EvoCeram, Ivoclar Vivadent) (HV-HF). HV materials were used either with or without sonication. MGW [µm] was measured by SEM. Displacements of the restorations after luting, such as changes (Δ) in OSH [µm], tilting and rotation [°], were measured using a dial gauge and 3D-analytical software (OraCeck, Cyfex). Statistical analysis was by Mann-Whitney U-test and t-test with α = 0.05. RESULTS: MGW (p = 0.002) and tilting (p = 0.001) were significantly smaller with LV (228.0 ± 112.35 µm; 0.89 ± 1.25°) than with HV (338.1 ± 97.26 µm; 1.95 ± 1.26°). Sonication had no effect on MGW in HV-HF (332.32 ± 91.39 µm) and HV-SF (343.85 ± 105.48 µm; p = 0.74). Sonication decreased ΔOSH by ~50% with HV-SF (64.21 ± 27.90 µm) but remained unchanged with HV-HF (39.06 ± 14.08 µm; p = 0.004). There was no difference in rotation between HV (0.82 ± 0.81°) and LV (0.61 ± 0.74°; p = 0.29). The LV-AF and LV-HF groups showed no statistical differences in MGW, ΔOSH, tilting or rotation (p > 0.05). SIGNIFICANCE: Irrespective of filler geometry and insertion technique, the use of high-viscosity composites for the adhesive cementation of modern all-ceramic partial crowns increases displacement, marginal misfit and occlusal surface height.

Students' perception of three-dimensionally printed teeth in endodontic training.

INTRODUCTION: In endodontic education, there is a need for thorough training prior to students embarking on clinical treatment. The aim of this study was to use three-dimensional printing technology to create a new model and to compare its suitability for training purposes with resin blocks and extracted teeth. MATERIALS AND METHODS: Multi-jet-modelling (MJM) produced the 3D model replicating a common difficulty in root-canal morphology. An evaluation study comprising 88 students was run in the sixth semester (summer 2018 and winter 2018/2019). A new questionnaire assessed students' perception of training models and educational environment. Welch's t-test analysed significant differences. RESULTS: The most pronounced differences between models were noted when rating material hardness, radiopacity, root-canal configuration and suitability for practising. Students estimated their learning outcome as greater with 3D-printed teeth compared to resin blocks. Three-dimensionally printed teeth received significantly lower ratings with regard to enthusiasm, the learning of fine motor skills and spatial awareness, when compared to human teeth (p ≤ .001). However, 3D-printed teeth were appreciated for additional benefits, such as their cleanliness, availability and standardisation of training opportunities with complex root-canal configurations. CONCLUSION: Students preferred extracted human teeth to 3D-printed teeth with respect to their physical characteristics and training experience. However, educational advantages may compensate for the shortcomings. The new questionnaire proved both adequate and accurate to assess the models and educational environment in endodontic training. The new 3D-printed teeth enhanced the learning opportunities.

The utilization of dental emergency services during COVID-19 pandemic in a German university center: Do we lose vulnerable patients?

OBJECTIVES: The COVID-19 pandemic poses a major challenge to health care worldwide. As a part of the virus containment strategy, health care services were limited to the treatment of essential emergencies. The aim was to evaluate the influence of COVID-19 pandemic on patients' utilization of dental emergency services, focusing on patients vulnerable to severe courses of COVID-19. METHOD AND MATERIALS: Files of 1,299 patients of the Dental School of the University Hospital Wuerzburg between 3 February and 7 June 2020 were retrospectively analyzed. The observation period was divided into pre-lockdown (Pre-L), during lockdown (Dur-L), and post-lockdown (Post-L). Patients' demographics, diagnosis, and medical history including COVID-19 anamnesis were recorded. RESULTS: The number of dental emergency patients decreased by approximately 50% (Pre-L, n = 576; Dur-L, n = 309). Proportions of risk patients among them did not change. Stationary admissions increased by approximately 4% (Pre-L, 12.3% to Dur-L, 16.2%). The most frequent diagnosis was uncontrollable pain (45.6%), originating in 25.2% of endodontic and periodontal diseases. Abscesses (23.0%), dental trauma (16.5%), facial trauma (9.4%), and uncontrollable bleeding (5.5%) followed consecutively. CONCLUSION: Patients with an increased risk for severe courses of COVID-19 infection did not refrain from consulting dental emergency care. Dental emergencies should be treated early to avoid stationary admissions to preserve hospital bed capacities.

Guided endodontic treatment of multiple teeth with dentin dysplasia: a case report.

BACKGROUND: To report the outcome of guided endodontic treatment (GET) of a case of dentin dysplasia with pulp canal calcification (PCC) and apical periodontitis based on the use of a 3D-printed template designed by merging cone-beam computed tomography (CBCT) and surface scan data. CASE PRESENTATION: A 12-year old female with radicular dentin dysplasia type I (DD-1) presented for endodontic treatment. Radiography revealed PCC in all teeth and apical radiolucency in seven teeth (12, 15, 26, 31, 32, 36 and 46). Tooth 36 had the most acute symptoms and was thus treated first by conventional access cavity preparation and root canal detection. Despite meticulous technique, the distal and mesiolingual canals were perforated. The perforations were immediately repaired with mineral trioxide aggregate, and the decision was made to switch to guided endodontic treatment for the remaining 6 teeth. CBCT and intraoral surface scans were acquired and matched using coDiagnostix planning software (Dental Wings Inc.), the respective drill positions for root canal location were determined, and templates were virtually designed and 3D-printed. The template was positioned on the respective tooth, and a customized drill was used to penetrate the calcified part of the root canal and perform minimally invasive access cavity preparation up to the apical region. All root canals were rapidly and successfully located with the templates. At 1-year follow-up, clear signs of apical healing were present in all treated teeth. CONCLUSIONS: In patients with dentin dysplasia, conventional endodontic therapy is challenging. GET considerably facilitates the root canal treatment of teeth affected by dentin dysplasia.

Management of a Patient with Hypomineralized Teeth from the Mixed to Permanent Dentition Stage - A Case Report with 6-year Follow-up.

PURPOSE: This case report presents the management of molar incisor hypomineralization (MIH) from the mixed to the permanent dentition stage. Shortly after eruption of hypomineralized teeth, masticatory forces frequently cause rapid enamel breakdown. The MIH Treatment Need Index (MIH-TNI) provides guidelines for the treatment of MIH in relation to how severely the teeth are affected. Clinical considerations: An 11-year-old patient with permanent teeth affected by MIH was referred to us by his orthodontist for conservative dental treatment before planned orthodontic treatment. The restorative treatment varied according to the degree of severity of the affected teeth and included indirect composite resin restorations on teeth #17 (MIH-TNI 4c), #35 (MIH-TNI 4c) and #37 (MIH-TNI 4b), direct composite resin fillings on teeth #26 (MIH-TNI 2b), #27 (MIH-TNI 2a) and #16 (MIH-TNI 4c) and fissure sealants on teeth #16, 15, 14, 24, 25, 34, 36, 44, 45, 46 and 47. Orthodontic treatment was already started during the restorative phase with a bite-jumping appliance. With the conclusion of the second phase of mixed dentition at age 12, the orthodontist was able to start fixed orthodontic treatment of the maxillary and mandibular arches with all of the child's permanent teeth adequately restored. Orthodontic treatment was completed at age 14. At present, 6 years after initiation of dental treatment, all teeth are still free of decay. CONCLUSION: A carefully supervised recall program with early comprehensive care at frequent intervals and adequate, defect-driven restorations depending on how severely the teeth are affected are the basis for a favorable long-term prognosis in patients with MIH.

A Multicenter Trial on the Long-term Performance of Direct Composite Buildups in the Anterior Dentition ­ Periodontal Health

PURPOSE: This sub-analysis of our multicenter trial was to assess the long-term periodontal health (PH) of teeth, esthetically reshaped by means of direct composite buildups. MATERIALS AND METHODS: 198 patients who received 667 direct composite buildups on 585 treated teeth (TT) between 01/2001 and 12/2013 were included. PH was assessed for each TT and for an untreated control tooth (CT) by recording the pocket probing depths (PPD), clinical attachment level (CAL), sulcus bleeding index (SBI), and Turesky's modification of the Quigley Hein plaque index (PI). Statistical analysis was performed using the two-sample Student's t-test and Mann-Whitney U-test. Regression models were performed to check for associations between PH and patients' age, gender, age of the buildups, enlargement range, jaw, and tooth type. The level of significance was set at α = 0.05. RESULTS: PI scores were significantly (p < 0.001) higher in TT (1.60 ± 0.81) than in CT (1.41 ± 0.81). Differences between TT and CT regarding PPD (TT: 2.14 ± 0.56/CT: 2.18 ± 0.56), CAL (TT: 2.34 ± 1.05/CT: 2.33 ± 0.92), and SBI (TT: 0.41 ± 0.60/CT: 0.41 ± 0.65) were not statistically significant (p > 0.05). The enlargement range of the TT and the tooth type were not associated with PH. Male patients had significantly higher PPDs, CAL, and SBI values than did female patients. CAL and SBI values increased over time for both the TT and CT. CAL, SBI, and PI values were significantly higher in the mandible and the PPD values in the maxilla. CONCLUSION: Direct composite buildups made for reshaping, change of color or position of teeth did not impair PH in the long term.

Guided endodontics: a comparative in vitro study on the accuracy and effort of two different planning workflows.

AIM: To compare the accuracy and effort of digital workflow for guided endodontic access (GEA) procedures using two different software applications in 3D-printed teeth modeled to simulate pulp canal obliteration (PCO) in vitro. MATERIALS AND METHODS: 32 3D-printed incisors with simulated PCO were fabricated and mounted, four each on maxillary and mandibular study arches. Cone beam computed tomography (CBCT) and 3D surface scans were matched and used to virtually plan and prepare GEA by one operator using two different methods: 1) CoDiagnostiX (CDX; Dental Wings) with 3D-printed templates, and 2) Sicat Endo (SE; Sicat) with subtractive CAD/CAM-manufactured templates. Postoperative CBCT and virtual planning data were superimposed for analysis. Accuracy was assessed by measuring the discrepancies between planned and prepared cavities at the tip of the bur (three spatial dimensions, 3D vector, angle). Virtual planning effort was defined as the time and number of computer clicks. A 95% confidence interval (CI) was computed for each sample. RESULTS: SE successfully located root canals for GEA in 16/16 cases (100%) and CDX in 15/16 cases (94%). SE resulted in less mean deviation at the tip of the bur with regard to distance in the labial-oral direction (0.12 mm), 3D vector (0.35 mm), and angle (0.68 degrees) compared with CDX (0.54 mm, 0.74 mm, 1.57 degrees, respectively; P < 0.001). CDX required less mean planning time and effort for each four-tooth arch (10 min 50 s, 107 clicks) than SE (20 min 28 s, 341 clicks; P < 0.05). CONCLUSIONS: Both methods enabled rapid drill path planning, a predictable GEA procedure, and the reliable location of root canals in teeth with PCO without perforation.

Long-term outcome of adhesive fragment reattachment in crown-root fractured teeth.

BACKGROUND/AIMS: Adhesive fragment reattachment (AFR) is one treatment option for crown-root fractured teeth. However, there are no studies investigating the long-term outcome of this approach. The aim of this retrospective study was to evaluate the long-term outcome of AFR and periodontal health in crown-root fractured teeth by assessing complications and periodontal status. MATERIALS AND METHODS: Data regarding 41 patients with 51 traumatized teeth (TT) were included. Periodontal health was assessed by recording the pocket probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP), gingival index (GI), and plaque index (PI) in the TT and in one unaffected control tooth (CT). Complications were classified as "restorative," "endodontic," and "additional root fracture." Based on these complications, the outcome was graded as "success," "partial success," "survival," and "failure." Statistics was performed by t test, chi-square test and logistic regression models. RESULTS: After 8.5 ± 4.6 years, 76.5% (39/51) of the TT had functionally survived. Functional survival of the reattached fragments was 66.7% (26/39) after 9.5 ± 3.7 years. PPD (TT: 4.11 ± 2.03; CT: 2.08 ± 0.65), CAL (TT: 4.78 ± 2.19; CT: 2.42 ± 1.03), and BoP values (TT: 77.4%; CT: 22.6%) were higher in TT than in CT. GI scores > 0 were found in 83.3% of the TT and in 27.8% of the CT. PI scores did not differ between TT and CT. Of the complications, 56.8% were "restorative," 22.7% "endodontic," and 20.5% "additional root fractures." Eleven (27.5%) TT were without complications and rated as "success." CONCLUSIONS: AFR in crown-root fractured teeth showed a high survival rate and occasionally compromised periodontal health. However, due to the high complication rate, it should be considered as a long-term temporary treatment to postpone other invasive therapy options. AFR can be a valuable way to avoid early loss of crown-root fractured teeth, especially in young patients. Moisture control and additional root fractures significantly influenced the outcome.

A Multicenter Trial on the Long-term Performance of Direct Composite Buildups in the Anterior Dentition - Survival and Quality Outcome.

Purpose: The purpose of this multicenter study was to evaluate the survival and quality outcome of direct composite buildups in the anterior dentition based on representative sample sizes. Materials and Methods: At three university clinics in Germany, the survival and quality outcome of n = 667 direct composite buildups performed between 2001 and 2012 was evaluated in n = 198 participants. Survival outcomes were categorized as failure (F), survival (SR), or successful (S). Restorations still in place and without failure prior to follow-up (n = 567) were rated using modified USPHS/FDI criteria to obtain the quality outcome. Detailed failure analysis was done by means of Cox regression models. Results: The restricted mean for overall survival was 15.5 years. N = 576 restorations were classified as successful (S), n = 81 survived with repair (SR) and n = 8 failed (F). Two restorations were removed due to iatrogenic interventions. Overall survival rates after 2, 10, and 15 years were 98.8% (CI: 97.6 and 99.4), 91.7% (CI: 89.0 and 93.8), and 77.6% (CI: 72.2 and 82.2), respectively. Functional survival rates were 100.0%, 98.9% (CI: 97.5 and 99.5), and 98.5% (CI: 96.7 and 99.3), respectively. Clinical quality was rated as excellent or good for most restorations. The dominant failure mode was chipping; however, regression analysis did not detect any influence of the evaluated parameters "enlargement range," "position in the jaw," or "tooth type" on failure. Conclusion: This multicenter study represents the first of its type including clinical survival and quality data on 576 direct anterior composite buildups over a restricted mean follow-up of 15.5 years in a relatively large group of participants. In particular, functional survival was outstanding due to the clinical reliability of this treatment option, while simultaneously providing flexibility, reparability, and minimal invasiveness.

Intentional Replantation with an Atraumatic Extraction System in Teeth with Extensive Cervical Resorption.

External cervical resorption (ECR) often renders a tooth nonrestorable, especially if it extends deeply within the dental hard tissue. Intentional replantation is sometimes performed as the last resort to save the tooth but may limit conventional forceps extraction because of the high risk of periodontal ligament cell damage or crown fracture.This case report describes the intentional replantation of an upper central incisor with extensive ECR using an axial, atraumatic extraction system to save the otherwise hopeless tooth. The patient was an asymptomatic 37-year-old man with no contributing medical history. The treatment protocol included atraumatic extraction followed by granulation tissue removal, extraoral root canal treatment, and adhesive restoration of the extensive resorption defect. During extraoral manipulation, the utmost care was taken to prevent root surface drying, contamination with dental adhesive, or heat-induced periodontal ligament damage during curing. Two and a half years after replantation, clinical and radiographic examinations revealed normal healing and no symptoms but a slight reduction of bone level compared with the preoperative level and no signs of root resorption or ankylosis. The successful outcome in this case supports the idea of performing intentional replantation with an atraumatic extraction system to save teeth with extensive cervical root resorption and a high risk of fracture during extraction.

Outcome of non-surgical root canal treatment related to periodontitis and chronic disease medication among adults in age group of 60 years or more.

OBJECTIVE: To assess the impact of non-endodontic factors like periodontitis and chronic disease medication (CDM) mostly affecting elderly people's health on the outcome of non-surgical root canal treatment (NSRCT). BACKGROUND: An increasing number of elderly people with high prevalence of marginal periodontitis and CDM benefit from adequate endodontic therapy, if irreversible pulpitis or apical periodontitis occurs. Only few data exist about the relevance of those non-endodontic factors on healing of endodontic lesions in a population 60 years or more. MATERIAL AND METHODS: Of 177 patients aged 60 years or more with 212 NSRCTs performed between the year of 2010 and 2013, complete documentation was available for 112 teeth in 93 participants. Mean time between baseline and last follow-up was 38.93 months. The primary endodontic factors studied were the periapical index (PAI) of periapical health, quality of the root canal filling and of coronal restoration, periodontal probing depth (PPD, mm) and tooth mobility (TM, 0-3). Secondary non-endodontic factors included the presence of marginal periodontitis and CDM, in particular antidiabetics, antihypertensives and anticoagulants. Statistical analyses were performed using Chi-square test statistics and logistic regression analysis. RESULTS: Periodontitis and CDM had no effect on endodontic outcome. Chronic intake of anticoagulants showed a significant association with endodontic outcome. Root-filled teeth with preoperative periapical lesions had a significantly higher rate of endodontic failure than those without preoperative lesion. The overall success rate of NSRCT was 87.1% with 81 healed teeth. CONCLUSION: Periodontitis and CDM have no impact on the endodontic outcome of NSRCT in a population 60 years or more.

When and how do endodontic specialists use cone-beam computed tomography?

This study investigated the use of cone-beam computed tomography (CBCT) by endodontists in Germany and Switzerland. Sixty-eight German endodontic specialists (G-ES), 22 Swiss endodontic specialists (CH-ES) and 95 dentists with a German Master of Science in endodontics (MSc) were invited to participate. Data on the timing of diagnostic assessments, endodontic case difficulty and indications for CBCT use were collected by questionnaire. The frequencies of pre-, intra- and postoperative use of periapical radiography and CBCT were analysed by case difficulty level. In high difficulty cases, access to a CBCT device was significantly associated with the frequency of both pre- and intraoperative CBCT use. The type of endodontic qualification had a significant impact on the rate of preoperative CBCT use in high difficulty cases. German endodontic specialists used preoperative CBCT more frequently than CH-ES and MSc. Our findings show that CBCT is a valuable imaging tool for endodontists, particularly in high difficulty cases.

Treatment of an Adolescent Patient with Dentinogenesis Imperfecta Using Indirect Composite Restorations - A Case Report and Literature Review.

PURPOSE: To demonstrate the field of application and prospects of individually modeled indirect composite restorations for the treatment of children and adolescents based on a case of dentinogenesis imperfecta. Dental malformations can affect single or multiple teeth. In most cases, direct composite fillings can be placed. However, in severe cases, these restorations may be more challenging and error-prone, especially when occlusal adjustments are necessary. Since composite materials do not require a specific lamination strength and are easy to repair, they can be applied using the indirect technique, enabling conservation of more sound hard tissue than is possible when conventional restorations are used. PATIENT AND METHODS: A young patient with dentinogenesis imperfecta type II underwent interdisciplinary full-mouth rehabilitation due to massive tooth wear and loss of vertical occlusion. First, a check bite was taken, and vertical occlusion was increased using overdentures. Six months later, a construction bite was taken over the existing overdentures (focusing on the sagittal dimension) to move the mandibular position more towards the anterior, correcting the skeletal Class II malocclusion. This resulted in a Class I intercuspidation with harmonization of the facial proportions. After a further six months, all teeth were restored using individually modeled indirect composite restorations, which preserved most of the sound hard tissue and restored esthetics and function. CONCLUSION: Indirect composite restorations can be a valuable tool for improving occlusion, esthetics and function in the treatment of children and adolescents.

Surgical extrusion with an atraumatic extraction system: A clinical study.

STATEMENT OF PROBLEM: Clinical studies evaluating the feasibility of a novel technique for the surgical extrusion of nonrestorable teeth with subgingival caries are lacking. PURPOSE: The purpose of this clinical study was to investigate the success rate and incidence of biological and technical complications after tooth extrusion with an atraumatic extraction system (AES). MATERIAL AND METHODS: Participants were recruited from 61 consecutive patients initially referred to a specialist oral surgery practice. Fifty-one participants who underwent surgical extrusion with an AES followed by endodontic treatment and coronal restoration could be re-evaluated clinically and radiographically. RESULTS: The mean observation period was 3.1 years (range: 0.8 to 6.5 years). The participants varied in age between 24.8 and 86.3 years. The amount of extrusion was between 2.5 and 5.0 mm (mean 3.2 mm). At recall, 92.2% (47 of 51) of the extruded teeth were considered successful. All extruded teeth were asymptomatic, without clinical signs of inflammation. Percussion appeared normal and did not differ from that of the adjacent teeth, indicating absence of ankylosis. Transient resorption with a slightly altered root contour was detected in 5 of the 51 teeth. Minor reduction of the bone level (less than 10%) was detected in 8 of the 51. In a further 2 teeth, bone loss amounted to 25% and 30%. Periapical periodontitis at recall was seen in 4 of the 51 teeth, and a preexisting periapical lesion healed in 10 of 13. Root perforation was identified in 3 of the 51, and a further 3 of 11 were not available for recall. Thus, the technical complication rate was 9.7% (6 of 62). CONCLUSIONS: The AES may be successfully used for surgical extrusion to save apparently nonrestorable teeth, irrespective of patient age.

Influence of Cavity Margin Design and Restorative Material on Marginal Quality and Seal of Extended Class II Resin Composite Restorations In Vitro.

PURPOSE: To investigate the influence of three cavity designs on the marginal seal of large Class II cavities restored with low-shrinkage resin composite limited to the enamel. MATERIALS AND METHODS: One hundred twenty (120) intact human molars were randomly divided into 12 groups, with three different cavity designs: 1. undermined enamel, 2. box-shaped, and 3. proximal bevel. The teeth were restored with 1. an extra-low shrinkage (ELS) composite free of diluent monomers, 2. microhybrid composite (Herculite XRV), 3. nanohybrid composite (Filtek Supreme XTE), and 4. silorane-based composite (Filtek Silorane). After artificial aging by thermocycling and storage in physiological saline, epoxy resin replicas were prepared. To determine the integrity of the restorations' approximal margins, two methods were sequentially employed: 1. replicas were made of the 120 specimens and examined using SEM, and 2. the same 120 specimens were immersed in AgNO3 solution, and the dye penetration depth was observed with a light microscope. Statistical analysis was performed using the Kruskal-Wallis and the Dunn-Bonferroni tests. RESULTS: After bevel preparation, SEM observations showed that restorations did not exhibit a higher percentage of continuous margin (SEM-analysis; p>0.05), but more leakage was found than with the other cavity designs (p<0.05). The lowest percentage of continuous margin was observed in ELS restorations (p<0.05). More fractured margins were observed in the undermined enamel cavity design groups (p<0.05). CONCLUSION: Bevel preparation failed to improve margin quality in large Class II composite restorations and is no longer recommended. However, undermined enamel should be removed to prevent enamel fractures.