Leaching components and initial biocompatibility of novel bioactive restorative materials.

OBJECTIVES: Bioactive restorative materials were developed on the premise that direct restorations should not only serve the purpose of reconstructing dental hard tissue defects but also exhibit biological features that prevent secondary caries development, without having adverse effects on the host cells. This study focuses on assessing the in vitro biocompatibility of two novel bioactive restorative materials. METHODS: Specimens of the bioactive restorative materials, Cention Forte (CF) and ACTIVA BioACTIVE RESTORATIVE (AB), a glass ionomer cement/glass hybrid (EQUIA Forte HT, EF) and an established nanohybrid composite (Venus Diamond, VD) were produced and finished. The specimens were eluted in water and methanol and the resulting eluates were analyzed via gas chromatography-mass spectrometry. hGF-1 cells were exposed to eluates prepared in cell culture medium. Cellular ATP levels, oxidized glutathione concentration, caspase-3/7 activity and the inflammatory response (IL-6 and PGE2 levels) were determined. Microscopic images were taken to examine the cell morphology. RESULTS: Methyl methacrylate and 2-Hydroxyethyl methacrylate were the main monomers detected in CF and AB eluates. All materials inhibited cell proliferation and led to significantly reduced ATP-levels. The cells exhibited a healthy morphology in the presence of CF and AB. Cells exposed to VD showed increased oxidized glutathione levels. Only EF led to enhanced caspase-3/7 activity. CF and AB caused IL-6 levels to increase, while EF and AB led to enhanced PGE2 levels. SIGNIFICANCE: CF and AB are promising materials from a biological point of view and seem to have improved bioactive properties compared to glass ionomer cements.

Oral health in patients with neurodegenerative and cerebrovascular disease: a retrospective study.

PURPOSE: This retrospective study investigates oral health and oral care in patients with neurodegenerative and cerebrovascular diseases (CVDs) treated in a dental facility for people with disabilities. METHODS: Oral health indices decayed, missing, and filled teeth (DMFT), periodontal screening index (PSI), treatment spectrum, and oral hygiene were evaluated in 152 patients with multiple sclerosis, Parkinson's disease, dementia, and CVD and 30 controls. Regression analyses identified group differences and influencing factors on DMFT. RESULTS: Patients with neurodegenerative or CVD had a significantly higher DMFT (21.2 ± 5.8 vs. 18.3 ± 5.9), more decayed teeth (4.3 ± 4.8 vs. 1 ± 1.9), fewer filled teeth (7.9 ± 5.5 vs. 11 ± 5.6), and a higher number of surgical (39.5% vs. 20%) treatments but significantly less conservative (49.3% vs. 73.3%) and prosthetic (15.1% vs. 56.7%) treatments than the control group (p< 0.05). The frequency of toothbrushing and the use of an electric toothbrush were related to lower DMFT in patients with neurodegenerative and CVD. Smoking was associated with higher DMFT. CONCLUSIONS: Poor oral health was found in all individuals with disabilities, suggesting that limitations in oral care attributed to aging and neurological disorders negatively affect oral health. Oral rehabilitation of patients with disabilities requires awareness of oral health limitations and early intervention through dental care. Implications for rehabilitationPoor oral health and oral hygiene is common among older people with disabilities.To optimize oral rehabilitation of patients with disabilities, early intervention, individualized treatment plans and an adapted time frame for dental treatment are required.Education of dentists, caregivers, and family members is essential for oral rehabilitation and improvement of oral hygiene in patients with disabilities.

Dental management before radiotherapy of the head and neck region: 4-year single-center experience.

OBJECTIVE: To review our experience with a standardized dental management approach in patients with planned radiotherapy of the head and neck region based on preradiation and follow-up data. MATERIAL AND METHODS: Records of patients who underwent radiotherapy between June 2016 and November 2020 were reviewed. Data on dental findings and therapeutic recommendations were extracted from a prospectively managed database. Hospital records were used to obtain follow-up data. RESULTS: Two hundred eighty-one patient records were identified. After the exclusion of 81 patients because of incomplete data, 200 patients were included in the study. Dental findings relevant to radiotherapy were found in 144 cases (72.0%). Teeth extractions were recommended in 112 (56.0%) patients. Follow-up data were available for 172 (86.0%) patients (mean follow-up: 16.8 ± 10.7 months). Radiodermatitis was the most frequently observed sequela of radiotherapy (42.4%), followed by dysphagia (38.4%) and stomatitis (36.6%). Osteoradionecrosis was observed in only 2.3% of the patients. CONCLUSION: Dental findings relevant to planned radiotherapy were frequent and in many cases resulted in recommendations for teeth extraction. Based on our standardized dental management protocol, we observed low rates of late oral complications after radiotherapy of the head and neck region.

Initial biocompatibility of novel resins for 3D printed fixed dental prostheses.

OBJECTIVES: Several materials for 3D printing of fixed dental prostheses (FDP) have been recently introduced. This study aims to evaluate the initial biocompatibility of novel printable resins for manufacturing temporary and permanent FDP. METHODS: Specimens of five printable resins (VarseoSmile Crown plus, NextDent C&B MFH, VarseoSmile Temp, Temp PRINT, P Pro Crown & Bridge), two types of resins for subtractive manufacturing (Tetric CAD, Telio CAD) and two types of resins with conventional curing processes (Tetric EvoCeram, Protemp 4) were produced and finished. Post-processing was strictly performed according to the manufacturer's protocol. Biocompatibility was evaluated by eluting specimens with cell culture medium and treating human gingival fibroblast cells with the eluates. A 72-hour continuous read cell viability assay measuring the reducing potential of the cells was performed. The cellular inflammatory response in terms of IL-6 and PGE2 levels was determined with specific ELISAs. Oxidative stress was determined by measuring oxidized glutathione concentrations after exposure to the resin eluates. A luminescence-based apoptosis assay was used to detect apoptosis. RESULTS: Tetric CAD and Telio CAD were slightly toxic. All other resins were moderately to severely cytotoxic. VarseoSmile Crown plus and P Pro Crown & Bridge significantly enhanced PGE2 levels. Higher concentrations of oxidized gluthatione were determined in the presence of Telio CAD, VarseoSmile Temp and P Pro Crown & Bridge. Tetric EvoCeram and Protemp 4 reduced intracellular gluthatione levels. All printable resins slightly induced apoptosis. SIGNIFICANCE: Further post-processing steps such as additional curing and washing may improve the biocompatibility of printable materials.

A comprehensive in vitro comparison of the biological and physicochemical properties of bioactive root canal sealers.

OBJECTIVES: To evaluate the biological and physicochemical features of bioactive root canal sealers. MATERIALS AND METHODS: Human periodontal ligament fibroblasts (hPDLF) and human osteoblasts (hOB) were exposed to eluates of three bioactive root canal sealers, GuttaFlow® bioseal (GF), BioRoot™ RCS (BR), and TotalFill® BC Sealer (TF), and the epoxy resin-based sealer AH plus® (AH). Cytotoxicity and cellular inflammatory response were evaluated. The osteogenic potential was examined using human mesenchymal stem cells (hMSC). Film thickness, flowability, and pH were assessed. Root canal treatment was performed on human extracted teeth to evaluate the sealers' tightness towards bacterial penetration. The antibacterial activity against common pathogens in primary root canal infections was tested. RESULTS: AH was severely cytotoxic to hPDLF and hOB (p < 0.001). The bioactive sealers were generally less cytotoxic. IL-6 levels in hPDLF were elevated in the presence of AH (p < 0.05). AH and GF suppressed IL-6 production in hOB (p < 0.05). AH and BR stimulated the PGE2 production in hPDLF and hOB (p < 0.05). BR was the only sealer that led to calcium deposits in hMSC (p < 0.05). TF and AH showed the lowest film thickness and the highest flowability. Bacterial tightness was best in teeth filled with AH and BR. All sealers showed similar antimicrobial activity, but the overall antimicrobial efficacy was moderate as the bacteria were reduced by just one log scale (p < 0.05). CONCLUSIONS: This study revealed favorable in vitro results regarding the biocompatibility of the bioactive root canal sealers. CLINICAL RELEVANCE: Bioactive root canal sealers may be a useful alternative to epoxy resin-based sealers.

In-vitro cytocompatibility of self-adhesive dual-curing resin cements on human mesenchymal stem cells (hMSC) and periodontal ligament cells (PDL-hTERT).

OBJECTIVES: Self-adhesive dual cured resin cements provide easier clinical application than conventional resin cements but release higher amounts of unreacted monomers, potentially affecting their biocompatibility. This study aimed to compare the cytotoxic effects of self-adhesive dual cured resin cements with two conventional resin cements. METHODS: Samples of four resin cements, two self-adhesive dual cured cements (group A: RelyX Unicem, group B: SmartCem), and two conventional resin cements (group C: Panavia 2.0, group D: Variolink Esthetic DC) were prepared with a similar dimension under standardized polymerization conditions and stored in water. For each material 18 samples were used and cell cultures of human mesenchymal stem cells (hMSCs) or periodontal ligament cells (PDL-hTERT) were added under appropriate conditions. One experimental group (group E) was left untreated as control. A cell viability WST test, was performed in each experimental group at day 1, 7, 14 and 21. Moreover, microscopic examination of cells was performed using cell viability staining. RESULTS: Viability of both cell types as determined by WST test was significantly impaired at all time periods by the four different cement materials compared to the untreated control. Comparison between the four materials revealed different inhibition of the viability of both, PDL-hTERT and hMSC cells (group C > group B > group A > group D; p < 0.0001). SIGNIFICANCE: All resin-based cements caused significant impairment of cell viability, reflecting considerable cytotoxicity. Variolink caused significantly smaller changes of viability than the other tested materials.

Treatment Plan and Challenges in Full-Mouth Rehabilitation of a Quadriplegic Patient: A Clinical Report.

Spinal cord injuries lead to physical limitations, and the resulting levels of dependency and emotional distress have devastating consequences on individuals' oral health. A 46-year-old patient with incomplete quadriplegia due to a complicated medical history presented for prosthetic rehabilitation. The patient's ability and tolerance to be treated in the dental chair was assessed. Prosthetic treatment options were discussed considering his dependency on alternating caregivers. The final treatment plan involved restorative treatment, implant-supported crowns, an implant-supported fixed dental prosthesis and, in the upper jaw, an implant-supported overdenture to allow proper oral hygiene. The dental treatment sessions were performed with frequent interruptions in the dental chair, whereas the implants were placed under general anesthesia in the maxillo-facial surgery department. The final treatment plan resulted in a compromise between the prosthetic recommendation and the patient's wish. The decisive factor for choosing an implant-supported overdenture rather than an implant-supported fixed dental prosthesis in the upper jaw was the inability of the patient to maintain adequate hygiene measures by himself and his dependence on the caregivers. This clinical report demonstrates how special care dentistry can improve quality of life, even in people with severe physical and/or mental impairments. We would like to encourage dental professionals to provide high-quality care for patients with disabilities in particular, and this practice is in line with the requirements of the UN convention on the rights of persons with disabilities.

First comparison of a new dynamic navigation system and surgical guides for implantology: an in vitro study.

AIM: The transfer of 3D implant position planning to the clinical site is challenging. The aim of this study was to compare in vitro this transfer accuracy by using dynamic real-time navigation or static surgical guides. MATERIALS AND METHODS: Deviations between planned and actual pilot drill positions were calculated (Denacam and NobelGuide; each n = 90), matching pre- and postoperative CBCT images: entry point, angle, tip (each 3D); depth, mesiodistal/bucco-oral entry points, and angles (each 1D). The influence of the maxilla and mandible, implant region (anterior/posterior), and marker position (ipsilateral/contralateral, Denacam only) was investigated (Mann-Whitney U test). RESULTS: No significant differences occurred regarding entry point (3D), mesiodistal/bucco-oral entry points (1D) or mesiodistal angle (1D) (P > 0.05). The angular and tip deviations (3D) were significantly smaller using Denacam (2.16 ± 0.59 degrees, 0.80 ± 0.55 mm; NobelGuide 2.54 ± 1.19 degrees, 1.09 ± 0.56 mm; P = 0.024, P < 0.0001). The deviations in depth and bucco-oral angle (1D) were significantly smaller using NobelGuide (1.05 ± 0.50 mm, 1.02 ± 1.16 degrees; Denacam 1.50 ± 0.64 mm, 1.51 ± 0.82 degrees; P < 0.0001). Significantly smaller deviations occurred within the mandible (Denacam, 5/8 parameters). Region and marker position showed no influence. No distinct influences were found with the use of NobelGuide. CONCLUSION: Denacam might possibly be a promising alternative to static surgical guides.

Two-body wear and fracture behaviour of an experimental paediatric composite crown in comparison to zirconia and stainless steel crowns dependent on the cementation mode.

OBJECTIVES: The purpose of this in vitro study was to assess the two-body wear and fracture behaviour of an experimental additive manufactured composite crown in comparison to zirconia and stainless steel crowns and its cementation protocol for primary molars. MATERIAL AND METHODS: Three different paediatric crowns - experimental composite crowns (CCs, 3M), zirconia crowns (ZCs, NuSmile), and stainless steel crowns (SSCs, 3M)-were cemented with an experimental resin-modified glass ionomer cement (RMGIC, 3M) and two self-adhesive cements (SACs; RelyX Unicem Automix 2, 3M; BioCem, NuSmile). Seven groups, each with eight specimens, were thermally cycled (55 °C/50 °C) and dynamically loaded (50N/ 1.2Hz) in a masticatory simulator with steatite antagonists. The areal and volumetric material loss of all specimens before and after 1,200,000 masticatory cycles was evaluated with a 3D profilometer. Light and scanning electron microscopy were used for qualitative analysis. Pairwise comparisons between all the groups were performed using the Mann-Whitney U test (p < 0.05). RESULTS: Microscopic imaging revealed different wear patterns for each material. Lowest fracture rates were documented for the CCs. In contrast, all the SSCs showed perforations. The CCs cemented with RMGIC showed the highest significant volumetric wear (6.3 ± 0.72 mm³), followed by the SSCs cemented with RMGIC (3.6 ± 1.79 mm³) and CCs cemented with SAC (3.5 ± 1.92 mm³). No significant differences were found in terms of the wear among all the other groups, ranging between 0.4 ± 0.25 and 0.6 ± 0.32 mm³. CONCLUSION: The volume loss of the tested crowns differed for each material and was dependent on the type of cementation. With regard to in vitro wear and fracture patterns, cementation with SAC may increase the clinical performance of CC paediatric crowns.

Actovegin® reduces PMA-induced inflammation on human cells.

PURPOSE: The effect of Actovegin® was investigated on PMA- and LPS-induced human peripheral blood mononuclear cells (PBMCs). METHODS: PBMCs (1 × 106 cells/ml) from five blood donors (2 f, 3 m; 45-55 years) were grown in medium and exposed to Actovegin® in the presence or absence of PMA or LPS. Supernatants were collected to assess the concentration of cytokines (TNF-α, IL-1beta, IL-6 and IL-10). The reactive oxygen species (ROS) were assessed by a ROS-GloTM H2O2 assay. RESULTS: Stimulation of cells by PMA or LPS (without Actovegin®) significantly increased the secretion of IL-1beta, IL-6, IL-10 and TNF-α from PBMCs, compared to controls. Pre-treatment of cells with Actovegin® (1, 5, 25, 125 µg/ml) plus PMA significantly decreased the secretion of IL-1beta from PBMCs, compared to controls (PMA without Actovegin®). In contrast, addition of Actovegin® (1, 5, 25, 125 and 250 µg/ml) plus LPS did not alter the IL-1beta production, compared to controls (LPS without Actovegin®). TNF-α, IL-6 and IL-10 do not contribute to the reduction of inflammatory reactions with Actovegin®. CONCLUSIONS: Actovegin® can reduce the PMA-induced IL-1beta release and the ROS production from PBMCs. These findings may help to explain the clinically known positive effects of Actovegin® on athletic injuries with inflammatory responses (e.g., muscle injuries, tendinopathies).

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.

Differentiation of hMSC and hPDLSC induced by PGE2 or BMP-7 in 3D models.

Regenerative therapies of pathogenic tissue defects are gaining increasing importance in periodontology. Among others, the osteogenic effect of BMP-7 seems to play a major role in the development of teeth and alveolar bone. Human periodontal ligament stem cells (hPDLSC), as well as human mesenchymal stem cells (hMSC), show the ability to differentiate into various types of tissues. Regarding prostaglandin E2, many studies have confirmed that it is involved in the inflammation associated to periodontitis stimulating osteoclasts, which ultimately leads to resorption of tooth supporting bone. Herein, we aimed to investigate how PGE2 influences regenerative processes. The influence of PGE2 and BMP-7 on the osteogenic differentiation of hMSC and hPDLSC was determined in a 3D cell culture model using qRT-PCR, immunocytochemistry and REM. BMP-7 enhanced the expression of osteogenic markers in hMSC and lowered it in hPDLSC-TERT. BMP-7 had a lower osteogenic effect on hPDLSC-hTERT than on hMSC, while PGE2 decreases the osteogenic differentiation in both cell types, thus, inhibiting anabolic processes. Both cell types presented good proliferation and adhesion onto the scaffolds. The well-developed structural morphology and the support of osteogenic differentiation suggest that the scaffolds are potential candidate materials for bone regeneration. The positivity for Cap in hPDLSC and more in hMSC immunostaining samples indicates the initiation of neocementogenesis as part of periodontal regeneration. In conclusion, BMP7, in particular combined with MSC, seems to have a favourable application also in periodontal regeneration. Our results show that inflammation plays an important role in periodontal regeneration. PGE2 is a key mediator, which stimulates bone resorption also via a mechanism involving the inhibition of osteogenic differentiation of MSC as well as PDLSC. Therefore, regenerative approaches should always be conducted in combination with anti-inflammatory measures oriented to control inflammation.

NAC ameliorates dental composite-induced DNA double-strand breaks and chromatin condensation.

Released (co)monomers from dental composite components can induce DNA damage of which DNA double-strand breaks (DSBs) threaten genome integrity. Here, we tested whether the administration of the antioxidant N-acetylcysteine (NAC) is able to reduce the dental composite-induced DSBs in primary human gingiva fibroblasts. The dental composites Bis-GMA (bisphenol-A-glycerolate dimethacrylate), GMA (glycidyl methacrylate), HEMA (2-hydroxyethyl methacrylate) and TEGDMA (triethyleneglycol dimethacrylate) were found to induce co-localizing microscopic nuclear foci numbers of the DSB markers γ-H2AX and 53BP1 per cell in the order: GMA>Bis-GMA>TEGDMA>HEMA. Supplementation of (co)monomer-containing culture medium with NAC led to a significant reduction of resin-induced DSBs as well as to an amelioration of dental monomer-induced nuclear chromatin condensation in gingival fibroblasts. Thus, antioxidant treatment can reduce radical-induced chromatin and DNA damage and open avenues to mitigate genotoxic effects of dental composite compounds.

Comparison of ozone gas and sodium hypochlorite/chlorhexidine two-visit disinfection protocols in treating apical periodontitis: a randomized controlled clinical trial.

OBJECTIVES: In this single-blinded, prospective, randomized, controlled clinical trial, the effectiveness of an ozone gas or NaOCl/CHX disinfection protocol was compared within the root canal treatment of apical periodontitis. MATERIALS AND METHODS: Sixty permanent teeth were randomly allocated to one technique. The clinical/radiographic assessment criteria included clinical symptoms, periapical index (PAI), and size of the apical lesion. In both groups, the root canal was mechanically cleaned and irrigated with NaCl and EDTA. Ozone gas (32 g m-3) or NaOCl (3 %) was applied followed by a 1-week inter-appointment dressing (Ca(OH)2). As final disinfection, ozone gas (ozone group) or CHX 2 % (NaOCl group) was applied. Microbial samples were taken after preparing the access cavity, after chemo-mechanical treatment and after inter-appointment dressing by sterile paper points. Microbial identification was performed by mass spectroscopy (MALDI-TOF-MS) and 16S-rRNA gene sequencing. The treated teeth were blindly re-evaluated after 6/12 months. Success rates, the decrease in PAI, the size of apical lesions and bacterial reduction were compared between groups (Fischer's exact test, Mann-Whitney U test). RESULTS: There were no significant differences between the success rates (ozone group: 96.2/95.5 % after 6/12 months; NaOCl group: 95.5/95.2 % after 6/12 months). The differences in the decreases in PAI values and apical lesion sizes were also insignificant after 6 and 12 months. The bacterial reduction showed no significant differences between groups after chemo-mechanical treatment and after inter-appointment dressing. The most commonly found bacterial genera were Streptococcus spp., Parvimonas spp. and Prevotella spp. CONCLUSIONS: The here used ozone gas and NaOCl/CHX protocols showed no difference in bacterial reduction in the sampled areas of the root canals. CLINICAL RELEVANCE: Within the limitations of the study, ozone gas seems to be a possible alternative disinfection agent within the root canal treatment of apical periodontitis.

Gingivitis and lifestyle influences on high-sensitivity C-reactive protein and interleukin 6 in adolescents.

AIM: This cross-sectional study was repeated at two time points and investigated the influence of gingivitis, smoking and body mass index (BMI) on the systemic inflammatory markers high-sensitivity C-reactive protein (hs-CRP) and interleukin 6 (IL6) in 10- and 15-year-olds. MATERIALS AND METHODS: The study sample of two birth cohorts, i.e. GINIplus and LISAplus, from the Munich centre consisted of 806 and 846 subjects who were evaluated at 10- and 15-year follow-ups respectively. Children and their parents completed questionnaires on participant-related lifestyle information. Gingivitis was measured at the sextant level using a simplified sulcus-bleeding index. Serum hs-CRP and IL6 levels were obtained from blood samples. Multiple logistic regressions adjusting for lifestyle-related factors and other confounders were performed to assess associations between the specified variables. RESULTS: There were no associations between gingivitis and the inflammatory markers hs-CRP and IL6 in 10-year-olds. In 15-year-olds, gingivitis (aOR: 2.17; 95% CI: 1.25-3.77); daily smoking (aOR: 6.27; 95% CI: 1.39-28.39); and being overweight/obese (aOR: 4.95; 95% CI: 0.73-33.68) were identified as significantly influencing factors for elevated hs-CRP values. Oral hygiene did not influence hs-CRP. CONCLUSION: In this study, hs-CRP was positively associated with gingivitis, smoking daily and overweight/obesity among 15-year-olds.

Long-term outcome of MTA apexification in teeth with open apices.

OBJECTIVE: This retrospective study aimed to collect information about the long-term outcome of apexification treatment with mineral trioxide aggregate (MTA) of teeth with open apices. METHOD AND MATERIALS: A total of 98 teeth in 79 patients (m:f = 1:1.3) who had completed endodontic apexification treatment with MTA between September 2005 and January 2014 at a university dental clinic were considered. Both initial treatments and retreatments of former root canal treatments other than apexification were included. All patients were invited for a standardized follow-up visit. Data regarding age, sex, tooth type, reason for treatment, detailed treatment protocol, clinical and radiographic findings, treatment quality, and outcome were also collected from the patients' records. Descriptive statistical analysis was performed. RESULTS: In the majority of cases, endodontic treatment was related to trauma with fracture (45/98, 45.9%) and luxation injuries (20/98; 20.4%), followed by unknown causes (12/98; 12.2%), retreatments (7/98; 7.1%), hypophosphatasia (7/98; 7.1%), and caries (1/98; 1%). In the beginning, the Periapical Index (PAI) showed pathologic findings with a PAI > 2 in approximately 50% of cases, while 25% presented with minor or an absence of findings. At the end of the observation period, more than 90% showed clinical-radiographic success, whereas eight teeth were associated with an elevated PAI. Only 5% of cases needed further dental treatment, such as root-end surgery or retreatment of the root canal treatment. CONCLUSION: Within the limits of this retrospective investigation, clinical and clinical-radiographic success of the apexification treatment appears to make this a good and reliable treatment option for teeth with open apices.

Respiratory diseases are associated with molar-incisor hypomineralizations.

The objective of our study was to evaluate the association of molar-incisor hypomineralizations (MIHs) with prospectively collected potential causative factors from the first 4 years of life, e.g. respiratory diseases, breastfeeding, maternal smoking and parental education. A total of 692 children (10 years old) from the GINI birth cohort study participated. The dental examination included the registration of enamel hypomineralizations (EHs) according to the EAPD criteria. Children with EH were sub-categorized into those with at least one EH (MIH/1), those with a minimum of one EH on at least one first permanent molar (MIH/2) and those with EH on at least one first permanent molar and a permanent incisor (MIH/3). All relationships between causative factors and caries or MIH were evaluated using simple and multiple logistic regression analyses. EHs were observed in 37.9% (MIH/1), 14.7% (MIH/2) and 9.2% (MIH/3) of all subjects. After adjustment for confounding factors, 10-year-old children with at least one episode of respiratory disease had a significantly higher risk (2.48 times, adjusted OR) for the development of MIH/3. In case of breastfeeding, a non-significant association was observed. None of the tested factors was associated with either MIH/1 or MIH/2. Early respiratory diseases seem to be directly or indirectly related to MIH/3 only. The role of (systemic) medications used for treatment of these diseases needs to be investigated in future studies.

Effects of antioxidants on DNA-double strand breaks in human gingival fibroblasts exposed to methacrylate based monomers.

OBJECTIVE: (Co)monomers from dental resin composites have cytotoxic and genotoxic potential. In previous studies it has been demonstrated that antioxidants can decrease the cytotoxicity of various dental (co)monomers. In this study the effects of the antioxidants N-acetylcysteine (ACC) and ascorbic acid (Asc) on the number of DNA double-strand breaks (DSBs) in human gingiva fibroblasts (HGFs) were tested. METHODS: HGF was incubated with the (co)monomers bisphenol-A-glycidyl methacrylate (BisGMA), urethandimethacrylate (UDMA), ethylene glycol dimethacrylate (EGDMA) or 1,3-glyceroldimethacrylate (GDMA) with and without addition of antioxidants ACC and Asc. DNA-DSBs were determined using the γ-H2AX assay. RESULTS: Asc induced at 500µM significant more DNA-DSBs in HGFs compared with controls (4.92 (1.28) vs. 1.62 (0.67); foci/cell mean (standard deviation), n=3). Most DNA-DSBs were found after incubation of HGFs with 90µM BisGMA (4.05 (0.56)) and 2720µM EGDMA (5.36 (1.59)). The addition of 100µM Asc or 500µM ACC leaded to a statistical significant reduction of DNA-DSBs in HGFs for all tested (co)monomers. After incubation of HGFs with 2720µM EGDMA and 500µM ACC the foci/cell decrease from 5.36 (1.59) to 1.9 (1.17) (controls: 1.12 (0.24)). After incubation of HGFs with 90µM BisGMA and 100µM Asc the foci/cell decrease from 4.05 (0.56) to 1.96 (0.59) (controls: 1.12 (0.24)). SIGNIFICANCE: All tested (co)monomers can induce DNA-DSBs but addition of antioxidants (Asc or ACC) leads to reduction of DNA-DSBs.

Autotransplantation and surgical uprighting of impacted or retained teeth: A retrospective clinical study and evaluation of patient satisfaction.

OBJECTIVES: This retrospective clinical study aimed to determine the success rate of autotransplanted impacted or retained teeth along with a patient satisfaction survey and to analyze the influence of relevant clinical and radiographic parameters. SUBJECTS AND METHODS: Fifty-seven teeth (37 canines, 10 molars, seven premolars, three incisors) in 45 patients (median 15 years) were evaluated over a mean of 1.6 years. The success criteria were pocket probing depth ≤3.5 mm, mobility grade ≤ II, Periotest ≤30 and complete alveolar bone healing. The influencing parameters were oral hygiene, smoking, periodontal screening index, occlusal/proximal contacts, horizontal position, dental age, pulp obliteration and degree of displacement. Furthermore, bone height was measured. RESULTS: The overall success rate was 74%, along with a high patient satisfaction. The survival rate was 96% after a mean follow-up of 1.6 years. The favorable factors were proper oral hygiene, non-smoking, good general periodontal condition, proximal contacts and pulp obliteration. An increase in or maintenance of bone level was found in 96%. CONCLUSIONS: Autotransplantation of impacted or retained teeth is an appropriate treatment, if orthodontic alignment has failed, especially in growing patients.

Long-term effectiveness of four pulpotomy techniques: 3-year randomised controlled trial.

A pulpotomy is the therapy for management of pulp exposures due to caries in symptom-free primary molars. The aim was to longitudinally compare the relative effectiveness of the Er:YAG laser, calcium hydroxide and ferric sulphate techniques with dilute formocresol in retaining symptom-free molars. Two hundred primary molars in 107 healthy children were included and randomly allocated to one technique. The treated teeth were blindly reevaluated after 6, 12, 18, 24 and 36 months. Descriptive data analysis and logistic regression analysis accounting for multiple observations per patient by generalised estimating equation were used. Additionally, various influences including tooth type, upper and lower jaws, type of anaesthesia, operator and the final restoration on treatment success were evaluated (Wald chi-square test). After 36 months, the following total (considering clinical and clinically symptom-free radiographic failures) and clinical success rates were determined (in percent): Formocresol 72 (92), laser 73 (89), calcium hydroxide 46 (75), ferric sulphate 76 (97). No significant differences were detected between formocresol and any other technique after 36 months. However, the odds ratio of failure appeared to be three times higher for calcium hydroxide than for formocresol. No significant differences in total success rates were seen regarding the aforementioned influencing clinical parameters. The correct diagnosis of the pulpal status, bleeding control and the specific technique are highly important for long-term success of pulpotomies in primary molars. According to the presented long-term data, pulpotomies using ferric sulphate revealed the best treatment outcome among the used techniques, while calcium hydroxide resulted in the lowest success rates after 3 years. Therefore, we can recommend ferric sulphate for easy and successful treatment of primary molars with caries-exposed pulps.