Implementation of a communication curriculum in undergraduate dental education-students' opinions during a 5-year development phase.

INTRODUCTION: Communication training has become an essential part of the dental curriculum. The aim of this study was to evaluate the communication curriculum developed and introduced 2016-2021 at the University of Bern, School of Dental Medicine (SDM), Switzerland. MATERIALS AND METHODS: The curriculum was implemented cumulatively in three phases: (1) lectures and accompanying role plays, (2) forum theatre and trainer-based communication training and (3) self-assessment. Students were surveyed 2016-2021 at the end of each semester using anonymous online questionnaires with five-point Likert scales (0-4). RESULTS: A total of 191 fourth- and fifth-year students were surveyed, and 165 (86.4%) questionnaires were analysed. The mean age of the participants was 24.2 ± 1.4 and 45.5% were female. While students' opinions about the need to communicate increased during weekly lectures in phase 1, their opinions about their ability to communicate simultaneously decreased. During phase 2, fourth-year students' opinions on the need to communicate with dental patients increased from 3.22 ± 0.61 to 3.73 ± 0.45 (p = .001), anticipated benefits for dentists increased from 2.78 ± 0.71 to 3.43 ± 0.57 (p = .001) and for patients from 3.00 ± 0.76 to 3.47 ± 0.63 (p = .022). Only in phase 3, opinions on the ability to communicate statistically significantly increased for both fourth- (2.34 ± 0.71 to 2.72 ± 0.60, p = .033) and fifth-year (2.20 ± 0.63 to 2.86 ± 0.59, p = .001) students. Preferred teaching and assessment methods were trainer-based communication trainings (73.1%), lectures (67.3%) and self-assessments in the student clinic (59.6%). CONCLUSION: Communication curricula in dental education using methods such as lectures and trainer-based communication trainings may additionally need to include self-assessments to be effective from the students' perspective.

Software-supported periodontal diagnostics with three-dimensional cone-beam computed tomography compared to conventional two-dimensional panoramic imaging and clinical diagnostics (a prospective study).

AIM: Aim of this study comprised the software-supported evaluation of measurement accuracy between cone-beam computed tomography (CBCT) and panoramic radiographs in the assessment of the periodontal bone level in patients with periodontitis and comparison with clinical periodontal parameters. MATERIAL AND METHODS: Twenty patients with severe periodontitis (stage III-IV) were evaluated clinically and radiographically (panoramic and CBCT). Diagnostic interpretation comprised three blinded investigators with different levels of experience. Specific software-basing measurement procedure evaluated radiological distances for the mesial, central, and distal bone levels on the oral and vestibular sides of the teeth investigated and furcation upper and lower boundary. Jaw localization, anatomical region-of-interest, the number of roots and experience of the observers were evaluated. All measurements were carried out twice by the same observers within a 6-week interval. RESULTS: Slightly higher measurement deviations (SD) in the range of 0.47 (0.40) mm were found for CBCT evaluation compared to panoramic imaging. Pearson correlation analysis showed statistically strong positive correlation for the mesial and distal aspects, moderate positive correlation was found for the investigated furcations between both radiographic modalities. Compared to the clinical reference, the mean total error of measurement (SD) was larger for panoramic imaging (0.66 (0.48) mm) than CBCT (0.27 (0.08) mm) for all three observers. CONCLUSIONS: Software-supported CBCT analysis delivers better diagnostic information about the bony periodontal conditions of the patient compared to two-dimensional radiographs. However, it remains unclear if these additional information lead to better periodontal outcomes.

Impact of risk factor control interventions for smoking cessation and promotion of healthy lifestyles in patients with periodontitis: A systematic review.

AIM: The aim of this systematic review was to identify the most recent widely accepted guidelines for risk factor control interventions and to assess their impact in patients with periodontitis. MATERIALS AND METHODS: The electronic search strategy included a first systematic search to identify guidelines for interventions for smoking cessation, diabetes control, physical exercise (activity), change of diet, carbohydrate (dietary sugar) reduction and weight loss in the general population and a second systematic search to identify the studies evaluating these interventions in periodontitis patients. RESULTS: A total of 13 guidelines and 25 studies were selected. Most guidelines included recommendations for all healthcare providers to provide interventions and follow-up counselling with the risk factors considered in the present review. In patients with periodontitis, interventions for smoking cessation and diabetes control were shown to improve periodontal health while the impact of dietary interventions and the promotion of other healthy lifestyles were moderate or limited. CONCLUSIONS: While aiming to improve treatment outcomes and the maintenance of periodontal health, current evidence suggests that interventions for smoking cessation and diabetes control are effective, thus emphasizing the need of behavioural support in periodontal care.

Promoting behavioural changes to improve oral hygiene in patients with periodontal diseases: A systematic review.

AIM: This systematic review investigates the impact of specific interventions aiming at promoting behavioural changes to improve oral hygiene (OH) in patients with periodontal diseases. METHODS: A literature search was performed on different databases up to March 2019. Randomized and non-randomized controlled trials evaluating the effects of behavioural interventions on plaque and bleeding scores in patients with gingivitis or periodontitis were considered. Pooled data analysis was conducted by estimating standardized mean difference between groups. RESULTS: Of 288 articles screened, 14 were included as follows: 4 studies evaluated the effect of motivational interviewing (MI) associated with OH instructions, 7 the impact of oral health educational programmes based on cognitive behavioural therapies, and 3 the use of self-inspections/videotapes. Studies were heterogeneous and reported contrasting results. Meta-analyses for psychological interventions showed no significant group difference for both plaque and bleeding scores. No effect was observed in studies applying self-inspection/videotapes. CONCLUSIONS: Within the limitations of the current evidence, OH may be reinforced in patients with periodontal diseases by psychological interventions based on cognitive constructs and MI principles provided by oral health professionals. However, no conclusion can be drawn on their specific clinical efficacy as measured by reduction of plaque and bleeding scores over time.

What is the impact of the adjunctive use of omega-3 fatty acids in the treatment of periodontitis? A systematic review and meta-analysis.

BACKGROUND: Host modulation therapy has gained increasing interest in periodontal therapy. This systematic review aimed to evaluate the effects of adjunctive administration of omega-3 fatty acids in periodontal therapy. METHODS: The search strategy was determined using the "patient, intervention, comparison, outcome" model. A resulting search term was generated using keywords, and the databases were fed. The databases PubMed, Cochrane Library, and LIVIVO were used. Studies were selected for the literature review based on previously specified inclusion and exclusion criteria. Randomized, controlled, blinded studies, longitudinal studies, comparative studies, and clinical studies were included in the review. Additionally, they used omega-3 fatty acids in the treatment of periodontitis. The following parameters were observed: clinical attachment level (CAL), probing depth (PD), gingival index (GI), bleeding on probing (BOP) and plaque index (PI). A meta-analysis was performed for PD and CAL after 3 months. By analyzing the risk of bias, the validity of the results of each study was demonstrated, and its credibility and quality were assessed. RESULTS: Of 14 studies found, six were included. The results showed a significant reduction in PD and CAL compared to that in the placebo groups in four out of six involved studies, which was confirmed by the meta-analysis. In one study, a significant reduction in BOP was found. GI was significantly reduced in three included studies. PI also showed a significant reduction in three studies. CONCLUSIONS: Within the study limitations, omega-3 fatty acids appear to have a positive effect on periodontal wound healing with regard to reduction in CAL and PD. Based on the results, patients receiving periodontal treatment might benefit from nutritional counseling.

Effects of subgingival air-polishing with trehalose powder on oral biofilm during periodontal maintenance therapy: a randomized-controlled pilot study.

BACKGROUND: This pilot study was part of a larger study which compared the effect of subgingival air-polishing using trehalose powder with sonic scaling on clinical parameters during supportive periodontal therapy. Within this microbiological part of the investigation subgingival samples were taken from 10 participants to analyze the survival of different bacterial species after the two different treatments as a proof of principle. METHODS: In 10 participants two non-adjacent, single-root teeth requiring treatment (PD =5 mm with bleeding on probing (BOP) or > 5 mm) were selected following a split-mouth design and were treated either with a sonic scaler or air-polishing device and trehalose powder. For persistent pockets (PD =4 mm and BOP or > 4 mm), treatment was repeated after 3 months. Subgingival biofilm samples were taken at baseline (BL), subsequently and three and six months after treatment. After determination of the bacterial counts (TBL), isolated bacteria were identified by MALDI-TOF-MS. If unsuccessful, PCR and 16S rDNA sequencing were performed. RESULTS: In both treatment groups, TBL decreased immediately after treatment remaining at a lower level. This confirms the findings of the larger study regarding clinical parameters showing a comparable effect on PD, BOP and CAL. Immediately after treatment, the diversity of detected species decreased significantly more than in the sonic group (p = 0.03). After 3 months, the proportion of Gram-positive anaerobic rods was lower in the air-polishing group (powder/ sonic 7%/ 25.9%, p = 0.025). Also, there was a greater reduction of Gram-negative aerobic rods for this group at this time (air-polishing/ sonic - 0.91 / -0.23 Log10 cfu/ ml, p = 0.020). CONCLUSION: Within the limitations of this study air-polishing and sonic treatment seem to have a comparable effect on the subgingival oral biofilm during supportive periodontal treatment. TRIAL REGISTRATION: The study was registered in an international trial register (German Clinical Trial Register number DRKS 00006296) on 10th of June 2015. HTML&TRIAL_ID = DRKS00006296.

Working experience is not a predictor of good communication: Results from a controlled trial with simulated patients.

INTRODUCTION: The importance of good communication in dentistry is proven in terms of both medical satisfaction and patient-related recovery and prevention. The present work deals with the comparison of communicative abilities and the communicative self-assessment of licensed dentists as well as students of dentistry with special emphasis on the influence of the treatment experience. MATERIALS AND METHODS: A total of 34 dentists (experimental group) with an average work experience of 16 years and 36 students (control group) with an average of 1.4 years of treatment experience were included. In addition to a tutor, four types of simulation patients with standardised trained roles (anxious, critical, dissatisfied and difficult to motivate) were used to create reproducible conversations. The self-assessment and evaluation of the conversation took place by completing questionnaires. Here, an introductory questionnaire was distributed to the participants prior to the conversation and another one after intervention. Whilst the tutors completed their survey during the intervention, the simulation patients answered their questions after the conversation. RESULTS: The results showed that the dentists rated their own communication skills significantly higher than the students for anxious (P < 0.001) and unmotivated patients (P = 0.026). However, the evaluation of the simulated patients showed that the students achieved higher overall empathy scores (42.03 vs 38.77, P = 0.016). CONCLUSION: Due to the declining empathy values with increasing treatment experience, communication training is useful for the daily routine of treatment even for experienced dentists.

The impact of motivational interviewing on communication of patients undergoing periodontal therapy.

AIM: There has been growing interest in motivational interviewing (MI) as a structured method for supporting health behaviour change in periodontal therapy. The aim of this study was to investigate the influence of communication techniques used in MI on statements of patients undergoing periodontal therapy. MATERIALS AND METHODS: Thirty audio-recorded sessions between dental MI providers and their patients undergoing periodontal therapy were coded using the German version of the Motivational Interviewing Sequential Code for Observing Process Exchanges (MISCOPE; D). Sequential analyses were performed to access transition probabilities among certain counsellor and patient statements. RESULTS: MI-consistent counsellor statements were statistically significantly positive correlated with patients' language in favour of change (change talk) (OR = 1.31; p = 0.027). MI-inconsistent statements were statistically significantly more likely to be followed by patients' language against change (sustain talk) (OR = 2.27, p = 0.002). An additional sequential analysis revealed significant correlations between certain evocative counsellor behaviours and the language of their patients. CONCLUSION: Specific verbal expressions described in the theory of MI significantly influence the subsequent statements of the patient in periodontal therapy. Accordingly, the periodontist can guide patient communication in a desired direction, evoke motivational statements and reduce expressions of resistance.

Association of non-surgical periodontal therapy on patients' oral health-related quality of life-A multi-centre cohort study.

AIM: The aim of this multi-centre cohort study was to investigate the association of non-surgical periodontal therapy (NST) on the oral health-related quality of life (OHRQoL) in general and related to severity of periodontal disease and treatment modalities. MATERIALS AND METHODS: One hundred and seventy-two patients with periodontal disease from 18 dental practices were measured before and 6-8 weeks after NST using a standardized and validated OHRQoL instrument (Oral Health Impact Profile-G14, OHIP-G14). Another questionnaire was filled out by the dentists to evaluate the influence of treatment modalities and disease severity. RESULTS: Overall, the mean value of the OHIP baseline improved significantly after NST (p < 0.0001). Furthermore, a significant negative association between the severity of periodontitis and OHRQoL could be detected, and only patients with moderate and severe periodontitis showed a significant improvement of OHIP mean values (p < 0.0001). The results also indicated a significant association of the practitioners (p = 0.0362) as well as treatment modalities (favouring systemic antibiotics, p = 0.0066) regarding the improvement of the patients' OHRQoL. CONCLUSION: This study showed that NST is positively associated with patients' oral health-related quality of life. This association seems to depend on the disease severity and caregiver and treatment modality.

The influence of an anti-inflammatory diet on gingivitis. A randomized controlled trial.

AIM: Aim of this study was to investigate the influence of an anti-inflammatory diet on different parameters in patients with gingivitis. MATERIALS AND METHODS: Thirty patients were randomly allocated to an experimental and a control group stratified by their plaque values. The experimental group had to change to a diet low in processed carbohydrates and animal proteins, and rich in omega-3 fatty acids, vitamin C, vitamin D, antioxidants, plant nitrates and fibres for 4 weeks. The control group did not change their diet. Both groups suspended interdental cleaning. Periodontal parameters were assessed by a blinded dentist. Serological and subgingival plaque samples were taken at baseline and end. RESULTS: While there were no differences regarding the plaque values, the experimental group showed a significant reduction in gingival bleeding (GI Baseline: 1.04 ± 0.21, GI End: 0.61 ± 0.29, p < 0.05), a significant increase in Vitamin D values and a significant weight loss. There were no inter-group differences regarding the inflammatory serological parameters, the serological omega fatty acids, nor the subgingival microbiome composition. CONCLUSION: The evaluated diet could significantly reduce gingivitis in a clinically relevant range, while serological inflammatory parameters and the subgingival microbiome seem to be unaffected in this study duration. (German Clinical Trials Register; DRKS00009888).

Association between high risk for preterm birth and changes in gingiva parameters during pregnancy-a prospective cohort study.

OBJECTIVES: The objective of this study was to investigate clinical and microbiological gingival changes during pregnancy in women without periodontal disease. Additionally, these parameters were to be compared in women with high risk for preterm birth and women with a normal course of pregnancy. METHOD AND MATERIALS: Group I consisted of 40 subjects at high risk for preterm birth, while group II involved 49 subjects with a normal course of pregnancy. The control group (III) was made up of 50 non-pregnant women. Clinical parameters (plaque index, gingival index, probing pocket depths, gingival swelling, bleeding on probing) and microbiological changes were monitored during pregnancy and 2-4 weeks after parturition. RESULTS: In the high-risk preterm group (I), 19 women could be included in data analysis. This group was compared to 41 women in the normal pregnancy group (II) and 50 non-pregnant women (III). Gingival inflammation was significantly higher in women with high risk for preterm birth (I) compared to non-risk pregnant women (II, p < 0.05). In addition, in this group (I), the subgingival amounts of Fusobacterium nucleatum (> 105) were found to be significantly higher after childbirth compared to non-pregnant women (p < 0.05). CONCLUSIONS: Even without having periodontal disease, women with high risk for preterm birth showed worse clinical values compared to non-risk pregnant and non-pregnant women and an increased detection of Fusobacterium nucleatum after delivery. CLINICAL RELEVANCE: High risk for preterm birth might be associated with the occurrence of increased gingival inflammation.

Oral hygiene-related self-efficacy as a predictor of oral hygiene behaviour: a prospective cohort study.

AIM: The aim of this study was to assess whether oral hygiene-related self-efficacy is correlated with current oral hygiene and might influence the outcome of oral hygiene instruction. MATERIALS AND METHODS: Hundred and twenty-six patients filled out questionnaires about oral hygiene-related self-efficacy, general self-efficacy, oral hygiene-related knowledge and demographic variables. Plaque and gingival inflammation were measured and an individual oral hygiene plan was conducted. After 6 months, oral hygiene indices were assessed again. RESULTS: Women had significantly higher scores in oral hygiene-related self-efficacy than men (women mean 60.40 ± 9.41; men mean 56.04 ± 11.55; p = 0.039) and oral hygiene-related self-efficacy was significantly correlated with general self-efficacy independent from the age of the patients (r = 0.3114, p = 0.0004). Higher scores in oral hygiene-related self-efficacy were significantly correlated with lower scores of gingival bleeding for non-smoking patients (r = -0.301, p = 0.0066), usage of a professional tooth cleaning within these 6 months (p = 0.0406), reappearance to the follow-up appointment (p = 0.0303), and higher goals in inter-dental cleaning plans (p = 0.0189). CONCLUSION: Oral hygiene-related self-efficacy is an influencing factor in the oral hygiene behaviour and has the potential to predict patients' oral hygiene outcomes.

Clinical efficacy and patients' acceptance of a rubber interdental bristle. A randomized controlled trial.

OBJECTIVES: Interdental cleaning is an essential component of home plaque control to prevent periodontitis and caries. There is limited data on the efficacy of commonly used metal-core interdental brushes in comparison to metal-free interdental brushes. The aim of this study was to compare a new rubber interdental bristle (Fuchs®) with a standard metal-core interdental brush (TePe®) for their impact upon gingival bleeding, plaque removal, and patient experience. MATERIALS AND METHODS: A single-blind, prospective, randomized, and controlled clinical trial with a crossover design was used to measure plaque index (Turesky-Modified Quigley & Hein Index), bleeding index (Eastman Interdental Bleeding Index by Caton & Polson), and patient satisfaction by means of questionnaires in 39 patients. Each patient was randomly assigned with regard to the sequence of interdental product used and recalled. RESULTS: Both groups showed statistically significant decreases of plaque after a single usage, respectively. Bleeding was statistically significantly reduced after 4 weeks, with no statistically significant differences concerning between the two tested interdental brushes. Rubber interdental bristles reached significantly higher scores with regard to patient acceptance in overall assessment and in sub-items for less pain during usage, comfort of brushing, and willingness to buy the product. CONCLUSION: Rubber interdental bristles were similarly effective compared to the interdental brushes. In addition, rubber interdental bristles were significantly more comfortable for participants than metal-core brushes. CLINICAL RELEVANCE: Rubber interdental bristles can be used as an alternative interdental cleaning product which may be more accepted by patients.

Chlorhexidine digluconate mouthwash alters the oral microbial composition and affects the prevalence of antimicrobial resistance genes.

Introduction: Chlorhexidine (CHX) is a commonly used antiseptic in situations of limited oral hygiene ability such as after periodontal surgery. However, CHX is also considered as a possible factor in the emergence of cross-resistance to antibiotics. The aim of this study was to analyze the changes in the oral microbiota and the prevalence of antimicrobial resistance genes (ARGs) due to CHX treatment. Materials and methods: We analyzed the oral metagenome of 20 patients who applied a 0.2% CHX mouthwash twice daily for 4 weeks following periodontal surgical procedures. Saliva and supragingival plaque samples were examined before, directly after 4 weeks, and another 4 weeks after discontinuing the CHX treatment. Results: Alpha-diversity decreased significantly with CHX use. The Bray-Curtis dissimilarity increased in both sample sites and mainly streptococci showed a higher relative abundance after CHX treatment. Although no significant changes of ARGs could be detected, an increase in prevalence was found for genes that encode for tetracycline efflux pumps. Conclusion: CHX treatment appears to promote a caries-associated bacterial community and the emergence of tetracycline resistance genes. Future research should focus on CHX-related changes in the microbial community and whether the discovered tetracycline resistance genes promote resistance to CHX.

An exploratory study on the role of serum fatty acids in the short-term dietary therapy of gingivitis.

A previous randomised controlled trial showed that an anti-inflammatory diet (AID) significantly reduced gingival inflammation despite constant plaque values. This exploratory study investigated the role of serum fatty acids in relation to the observed clinical effects. Therefore, data of thirty participants with gingivitis, following either a pro-inflammatory dietary pattern (PID) rich in saturated fat, omega 6 fatty acids, and refined carbohydrates or an AID for 4 weeks, were correlated with corresponding serum samples for a variety of fatty acids. Changes in the fatty acid profile and effects on clinical periodontal parameters were analysed. Results showed that the polyunsatured:saturated fatty acids ratio (PUFA:SFA ratio) and nervonic acid level were significantly higher in the AID group than in the PID group at the end of the study. Significant intragroup differences were seen only in the AID group. Diverse fatty acids showed heterogeneous relations to clinical parameters. This study demonstrated that the serum fatty acid profile was not fundamentally associated with the clinical gingivitis-lowering effects of an AID in short-term, although some fatty acids showed individual relations to clinical parameters with respect to inflammation. Hence, short-term effects of dietary therapy on gingivitis may be rather based on carbohydrate-related effects and/or micronutrients.

Chapter 13: Diet and Periodontal Diseases.

Due to the increasing focus on host inflammatory processes with regard to the aetiology of periodontal disease, diet has become an important factor in host modulation. Recent investigations showed that the industrialized western diet, which is characterized by highly processed foods (processed carbohydrates like sugar, white flour, and processed fatty acids like trans fats) and a low micronutrient density, promotes gingival and periodontal inflammation. On the other hand, a plant-based diet rich in low-glycaemic, complex carbohydrates (like in fruits, vegetables, legumes), Omega-3 fatty acids, micronutrients (like vitamins, minerals), phytochemicals, plant nitrates, and fibres seems to bring benefits as well for periodontal inflammation as for caries, and general health. This chapter aims to present the underlying studies and possible mechanisms.

Trehalose powder for subgingival air-polishing during periodontal maintenance therapy: A randomized controlled trial.

BACKGROUND: Air-polishing appears to be a promising procedure for subgingival biofilm removal in periodontal treatment. The aim of this study was to compare trehalose powder for subgingival air-polishing with sonic debridement in residual periodontal pockets during maintenance therapy. METHODS: In this blinded, randomized, controlled clinical trial conducted over 6 months with a split-mouth design, single-rooted teeth in 44 participants with residual pocket depths of 5 mm and bleeding or >5 mm with and without bleeding were included in this study. Subgingival debridement was carried out using either trehalose powder with an air-polishing device (test) or a sonic device (control). The reduction in the probing depths after 3 and 6 months was defined as the primary endpoint. A visual analog scale was used to evaluate the discomfort of both procedures. RESULTS: Both procedures showed statistically significant intragroup reductions in probing depths (test baseline [BL] 5.52 ± 0.93, 6 months 3.66 ± 0.81, control BL 5.55 ± 0.9, 6 months 3.68 ± 0.86, P < 0.001), clinical attachment level (test BL 6.93 ± 1.5, 6 months 5.3 ± 1.52, control BL 7.27 ± 1.8, 6 months 5.84 ± 1.71, P < 0.001), and bleeding on probing (test BL 86%, 6 months 41%, control BL 89%, 6 months 34%, P < 0.001) after 6 months with no significant intergroup differences (P > 0.05, respectively). The visual analog scale showed a significantly lower incidence of discomfort for air-polishing compared with sonic scaling (test 2.33 ± 2.14, control 4.91 ± 2.65, P < 0.001). CONCLUSIONS: Subgingival air-polishing with trehalose powder showed comparable clinical outcomes to sonic scaling. Sonic scaling evoked more discomfort compared with air-polishing.

Motivational Interviewing As an Adjunct to Periodontal Therapy-A Systematic Review.

Aim: Periodontal therapy is highly dependent on a patient's long-term adherence with regard to oral hygiene, diet, and regular check-ups at the dentist. Motivational Interviewing (MI) is a client-centered, directive method for encouraging a patients' behavioral health change. The aim of this systematic review was to reveal the effects of MI as an adjunct to periodontal therapy. Methods: Three databases (PubMed, Cochrane Library, and Web of Science) were reviewed for randomized controlled clinical trials. Articles were included when using MI as an adjunct to periodontal therapy and presenting clinical periodontal and oral hygiene related parameters. Two authors independently coded the relevant articles. Results: The search yielded 496 articles. After analysis and exclusion, a total of five papers could be included. The quality of the articles ranged between 72-88%. The two independent raters showed a high inter-rater reliability (Cohens-Kappa = 0.89). In two studies MI showed a significant positive effect on bleeding on probing and plaque values. One study showed improvement of self-efficacy in interdental cleaning. Two studies showed no influence of MI on periodontal parameters of the patients. Conclusion: The use of MI as an adjunct to periodontal therapy might have a positive influence on clinical periodontal parameters (plaque values, gingival, and periodontal inflammation) and psychological factors related to oral hygiene (self-efficacy). Due to the low body of evidence further studies are needed. Future studies should include fidelity measures of the applied MI, a high number of counselors, several MI sessions, and long-term study follow-up to show potential effects.

Comparison of two cone-beam computed tomography systems in the visualization of endodontic structures.

An important part of endodontic diagnosis and treatment is the adequate visualization of root canal anatomy. The objective of the present study was to compare two different three-dimensional cone-beam computed tomography (CBCT) systems, Scanora 3D and 3D Accuitomo 170, with respect to their visualization of endodontic canal systems and potential pathological alterations. Seventy extracted human teeth were investigated with regard to the radiographic detection of number of root canals, lateral canals, root canal fillings and posts, vertical root fractures, and the occurrence of image artifacts. For each evaluation parameter under investigation the radiographic diagnoses obtained by the two different CBCT systems under investigation were similarly accurate, without statistically significant differences. The evaluation of teeth containing highdensity foreign materials was impaired for both CBCT systems because of image artifacts. However, a difference between the CBCT systems was not observed. In conclusion, both CBCT systems were found to be similarly suitable for the visualization of endodontic structures in vitro.

Vitamin D deficiency in early implant failure: two case reports.

An association between vitamin D deficiency and early dental implant failure is not properly verified, but its role in osteoimmunology is discussed. This article illustrates two case reports with vitamin D deficiency and early implant failure. Prior to implant placement, the first patient received crestal bone grafting with autologous material. Both patients received dental implants from different manufacturers in the molar region of the mandible. In the case of bone grafting in the first patient, all implants were placed in a two-stage procedure. All implants had to be removed within 15 days after implant placement. Vitamin D serum levels were measured: Both patients showed a vitamin D deficiency (serum vitamin D level <20 µg/l). After vitamin D supplementation, implant placement was successful in both patients. Prospective, randomized clinical trials must follow to affirm the relationship between vitamin D deficiency, osteoimmunology, and early implant failure.