Accuracy of a dynamic navigation system for dental implantation with two different workflows and intraoral markers compared to static-guided implant surgery: An in-vitro study.

PURPOSE: To investigate the accuracy of a miniaturized dynamic navigation system with intraoral markers and two different workflows for dental implantation and to compare with static computer-assisted implant surgery (sCAIS) surgery. MATERIALS AND METHODS: Two operators performed a total of 270 implant insertions in polyurethane mandibular models under simulated clinical conditions. Implants were placed after CBCT-based virtual planning in three different groups: two workflows utilizing dynamic computer-assisted implant surgery (dCAIS; DG1: marker in CBCT; DG2: 3D-printed marker) and the others with sCAIS (TG: template guided). Postoperative surface scans were matched to the planning data and allowed an evaluation of the angular and spatial deviation between the planned and the actually achieved implant position. Descriptive statistics were followed by a Mixed Model Analysis to determine the influence of the operator, the method, and operating area on different accuracy parameters and the random effect of the model number. RESULTS: The mean angular deviation ranged from 2.26° (DG1) to 2.96° (TG). The mean 3D deviation at the implant's tip ranged from 1.08 mm (TG) to 1.51 mm (DG2) and at the implant's base from 0.69 mm (TG) to 1.49 mm (DG2). The operator showed no significant influence on the accuracy. The method showed significant influence on singular parameters and the operating area on all spatial accuracy parameters. CONCLUSIONS: Dynamic navigation systems with intraoral markers enable accurate implant positioning, which is comparable to the static-guided implant surgery. 3D-printed markers provide less accurate results compared to prefabricated markers, attached before CBCT scan.

Guided endodontics versus conventional access cavity preparation: an ex vivo comparative study of substance loss.

BACKGROUND: To compare the outcomes of conventional access cavity preparation (CONV) versus guided endodontics (GE) for access cavity preparation in anterior teeth with pulp canal calcification (PCC) regarding root canal detection, substance loss, procedural time, and need for additional radiographs. METHODS: Extracted, sound human teeth with PCC (n = 108) were matched in pairs, divided into two groups and used to produce 18 models. An independent endodontist and a general dentist performed access cavity preparation under simulated clinical conditions on nine models each (54 teeth). The endodontist used the conventional technique and the general dentist GE. Time needed to access the root canals and the number of additional radiographs were recorded. Pre- and postoperative cone-beam computed tomography scans were obtained to measure substance loss. Statistical significance was tested by examining the overlap of 95% confidence intervals (CIs) between the groups. RESULTS: All root canals were successfully accessed by both methods. There were no significant differences in substance loss (CI: CONV 15.9-29.6 mm3 vs. GE 17.6-27.5mm3) or procedural time (CI: CONV 163.3-248.5 s vs. GE 231.9-326.8 s). However, 31 additional radiographs were required for GE compared to none for CONV. CONCLUSIONS: For access cavity preparation in teeth with PCC, both CONV by a specialist and GE by a general dentist produce good results in terms of substance loss and time requirements.

Evaluation of five methods to identify composite restorations in human teeth on a forensic purpose-an ex vivo comparative study.

The use of tooth-colored composite resin materials in dentistry is increasing. As composite restorations appear similar to the natural tooth structure, their detection is becoming more challenging. The aim of this study was to compare five diagnostic methods for detection of dental restorations and to create reliable postmortem dental records for forensic purposes. A conventional examination method without a direct light source (CONV), with a dental loupe light (DL), Galilean loupes with a direct light source (GDL), a fluorescence-inducing device (FIT), and intraoral radiographs (RX) were compared. Dentists specializing in conservative dentistry or oral surgery and dentistry students participated. Regarding sensitivity, specificity, positive predictive value, and negative predictive value, FIT and RX showed significantly higher results than CONV, DL, and GDL. RX and FIT showed comparable results in identifying composite restorations but depending on their location. The combination of both methods may lead to even better results. In conclusion fluorescence-inducing devices show good results in identifying composite restorations and therefore should be considered as a standard tool in forensic examinations. Another advantage is their small size, low cost, and mobility. Good illumination and magnification devices are recommended to enhance performance during conventional examinations. Involving dentists specialized in conservative dentistry could contribute to dental identification.

A critical analysis of research methods and experimental models to study working length determination and the performance of apex locators - A narrative review with recommendations for the future.

Outcome studies have repeatedly shown that the apical endpoint of root canal preparation and filling is a determinate factor for the outcome of root canal treatment. Accurate determination of root canal length enhances the efficacy of chemo-mechanical disinfection and prevents over-/under-instrumentation and over-/under-filling in relation to the canal terminus. Long and short root canal fillings are consistently reported to be associated with higher rates of post-treatment endodontic disease. Although standards for undertaking and reporting diagnostic accuracy studies are available, publications dealing with the determination of root canal length are highly heterogeneous and describe procedures inconsistently. The aim of this review is to critically assess the methodology of publications in the past three decades. The process of planning, performing and analysing working length studies are presented stepwise with suggestions to optimize research methods.

Present status and future directions - Guided endodontics.

Luxation injuries and other stimuli may lead to a pulp canal obliteration (PCO). Even though the apposition of tertiary dentine is a sign of a vital pulp, in some cases root canal treatment is indicated in the long term due to apical periodontitis or pulpitis. Depending on the extent of PCO, root canal treatment may be challenging even for experienced and well-equipped endodontic specialists. The 'guided endodontics' (GE) technique was introduced 6 years ago as an alternative to conventional access cavity preparation for teeth with PCO and apical pathosis or irreversible pulpitis. Using three-dimensional radiological imaging such as cone-beam computed tomography and a digital surface scan, an optimal access to the orifice of the calcified root canal can be planned virtually with appropriate software. GE is implemented either with the help of templates analogous to guided implantology (= static navigation) or by means of dynamic navigation based on a camera-marker system. GE has emerged as a field of research in the last 6 years with very promising laboratory-based results regarding the accuracy of guided endodontic access cavities for both static and dynamic navigation. Clinical implementation seems to provide favourable results, but the evidence is mainly based on numerous case reports and a few case series. This narrative review aims to provide an update on the present status of GE and to identify relevant research areas that could contribute to further improvements of this technique.

Apical pressures generated by several canal irrigation methods: A laboratory study in a maxillary central incisor with an open apex.

AIM: A laboratory study to determine the apical pressure generated by seven canal irrigation methods in an anterior tooth with an open apex. METHODOLOGY: Canal irrigation was performed on a 3D-printed central maxillary incisor with an open apex (maximum diameter of 2.1 mm). Ultrasonically activated irrigation (UAI), sonic activation (EDDY), negative pressure irrigation (EndoVac), the self-adjusting file (SAF) and the XP-endo Finisher were employed at tooth length (TL), TL-1 mm, TL-2 mm and TL-3 mm. UAI was tested at three intensity levels additionally. Hydrodynamic irrigation with RinsEndo was performed in the pulp chamber, at the canal orifice, the coronal third, the middle of the canal and at TL. Er:YAG laser activation, at four frequency settings, was performed in the pulp chamber and at the orifice of the canal. The pressure of the fluid towards the canal terminus generated by activation was directly transferred to a pressure sensor with a range of 0 to 120 mmHg and a response time of ≤0.5 ms. The critical threshold for apical extrusion of the irrigant was set at 5.73 mmHg (lower limit of the central venous pressure: 5.88 ± 0.15 mmHg). Each experiment was repeated ten times. The tests were followed by descriptive analyses (maximum, mean, standard deviation, 95% confidence interval). RESULTS: EndoVac, the SAF, the XP-endo Finisher, and UAI never exceeded the critical threshold at any insertion depth or intensity level. Er:YAG laser activation exceeded the critical threshold exclusively at frequency settings that varied from the manufacturer's recommendation. EDDY at TL and RinsEndo at any insertion depth exceeded the critical threshold in 100% of the measurements. EDDY at TL-1,-2, and-3 mm crossed the critical threshold in 30%, 10%, and 20% of the measurements, respectively. CONCLUSIONS: In a simulated maxillary central incisor with an open apex, irrigation with EndoVac, Er:YAG laser activation, UAI, the SAF, and the XP-endo Finisher generated apical pressures below the critical threshold of 5.73 mmHg. By contrast, using EDDY and RinsEndo for irrigation produced higher apical pressures that exceeded the critical threshold.

Accuracy of the fluorescence-aided identification technique (FIT) for detecting tooth-colored restorations utilizing different fluorescence-inducing devices: an ex vivo comparative study.

OBJECTIVES: The aim of the present study was to compare the accuracy of the conventional illumination method (CONV) and the fluorescence-aided identification technique (FIT) for distinguishing between composite restorations and intact teeth using different fluorescence-inducing devices commonly used for FIT. MATERIALS AND METHODS: Six groups of six dentists equipped with one of six different FIT systems each independently attempted to identify composite restorations and intact teeth on a full-mouth model with 22 composite restorations using CONV and, 1 h later, FIT. The entire procedure was repeated 1 week later. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values, including 95% confidence intervals (CI), were calculated for CONV and FIT overall and for each device. The influence of examiner age, method, and device on each parameter was assessed by multivariate analysis of variance. RESULTS: The sensitivity (84%, CI 81-86%), specificity (94%, CI 93-96%), PPV (92%, CI 90-94%), and NPV (90%, CI 88-91%) of FIT was significantly higher than that of CONV (47%, CI 44-50%; 82%, CI 79-84%; 66%, CI 62-69%, and 69%, CI 68-71%, respectively; p<0.001). The differences between CONV and FIT were significant for all parameters and FIT systems except VistaCam, which achieved no significant difference in specificity. Examiners younger than 40 years attained significantly higher sensitivity and negative predictive values than older examiners. CONCLUSIONS: FIT is more reliable for detecting composite restorations than the conventional illumination method. CLINICAL RELEVANCE: FIT can be considered an additional or alternative tool for improving the detection of composite restorations.

How well can today's tooth-colored dental restorative materials reproduce the autofluorescence of human teeth? - Ambition and reality!

OBJECTIVES: The autofluorescence of dental hard tissues has been known for over 100 years. Thus, manufacturers add fluorophores to dental restorative materials to improve the esthetic properties of these materials. So far, there has been no study evaluating the ability of these fluorophores to reproduce the autofluorescence of dental hard tissues. MATERIALS AND METHODS: A total of 240 different color shades representing 17 different brands of fluorescent light-curing RBC and CAD/CAM restorative materials were analyzed with a monochromator-based microplate reader. Additionally, combined enamel-dentin specimens (n = 11) were analyzed as "gold standard". The total fluorescence (TF) and the physiologically relevant luminous efficiency function adjusted total fluorescence (TFa ) were determined. The differences between the brands and the enamel-dentin specimens were further evaluated and visualized as contour plots. RESULTS: Merely the TFa of the brands CERASMART™, Filtek Supreme XTE™, KZR-CAD HD 2, and LuxaCam composite were not significantly different to the enamel-dentin specimens. The analysis of the contour plots revealed that even these four materials showed a fluorescence excess for the excitation wavelengths below about 400 nm and a deficit above this wavelength. CONCLUSION: None of the materials analyzed in this study were able to reproduce the natural fluorescence spectrum of the enamel-dentin specimens. CLINICAL SIGNIFICANCE: Unlike the statements and images of blue fluorescent materials in the manufacturers' brochures, none of the materials examined here is fully capable of reproducing the natural autofluorescence of teeth.

Dental trauma and tongue injuries in professional alpine ski racing-A worldwide survey.

BACKGROUND/AIM: Skiing is a sport with a medium risk of injuries, and injuries are increasingly common among professional alpine skiers. Examples of other medium-risk sports are for example handball, basketball, and karate. The aim of this study was to assess the frequency of dental trauma in professional alpine skiing and to determine whether the frequency of dental injuries is associated with a skier's performance level, alpine skiing discipline, and/or years of skiing experience. MATERIAL AND METHODS: A questionnaire consisting of 17 questions was distributed to professional male ski racers to gather information about their skiing discipline (category), performance level, and injuries, particularly dental trauma. RESULTS: A total of 161 out of 190 skiers returned the survey, with a response rate of 84.2%. Of these, 134 (83.2%) had suffered alpine ski racing-related injuries during their career and 38 (23.6%) reported skiing-related dental trauma-most commonly crown fractures (65.8%, n = 25), which mainly involved the maxillary or mandibular incisors (76.0%, n = 28). Ski racers with higher performance levels were more likely to experience dental injuries, but the difference in the frequency of dental trauma between participants in the speed versus technical category was not significant. Likewise, the number of years of ski racing experience did not impact the frequency of dental injuries. The participants rarely wore custom-made mouthguards (6.8%, n = 11). None of those who reported dental injuries were wearing a custom-made mouthguard when the injury occured. They preferred to wear chin guards, over-the-counter mouthguards, or no mouthguards. CONCLUSION: Professional alpine ski racing has a medium risk of dental trauma, which further increases with skier performance level. The participating skiers rarely wore custom-made mouthguards.

Impact of CBCT image quality on the confidence of furcation measurements.

BACKGROUND: To investigate the impact of scanning parameter in cone-beam computed tomography (CBCT) images on accuracy and confidence with measurements of furcation involvement (FI) in maxillary molars. MATERIAL AND METHODS: Six half cadaver heads with present maxillary molars (n = 10) were available. CBCT scans with the fixed-parameter field of view (4 × 4 cm, 12 × 17 cm) amperage and voltage (4 mA, 90 kV) and with varying scan modes (SM), that is images/scan (IS), voxel sizes (VZ) and rotation (R), were performed using one CBCT apparatus. The images were analysed by two calibrated investigators. Horizontal FI's were measured in mm or a "through and through" destruction (FI degree III) was recorded. Each rater scored the FI measurements performed in each scan as "confident" or as "not confident". Data were statistically analysed using chi-square tests. RESULTS: The agreement between CBCT FI measurements and intra-surgical FI measurements varied according to SM (SM HiSp 180°, 0.08: kappa 0.538, CI; 95%: 0.362-0.714; SM Std. 360°, 0.25: kappa 0.698, CI; 95%: 0.534-0.861). The number of measurements scored as "confident" varied according to SM (SM Std. 360°, 0.08:52 out of 60 measurements; SM Std. 360°, 0.25:16 out of 60 measurements; p < .001). CONCLUSIONS: SM of CBCT significantly affect the confidence with FI measurements in maxillary molars.

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.

Changes in periapical status, quality of root fillings and estimated endodontic treatment need in a similar urban German population 20 years later.

OBJECTIVES: The study aimed at assessing, as primary objective, the periapical status and quality of root fillings, and, as secondary objective, the endodontic treatment need of a German urban population in a cross-sectional study 20 years after the first one. MATERIALS AND METHODS: Clinical and radiographic data of 353 patients were evaluated. Descriptive and regression analyses were performed and the endodontic treatment need was calculated. Results were compared with data from the year 1993. RESULTS: A total of 9269 teeth were examined (26.2 teeth per patient; 1993, 24.4), of which 337 teeth were root filled (3.6%; 1993, 2.7%). Prevalence of apical periodontitis in root-filled teeth was 34% (1993, 61%). Quality of root fillings was adequate in 117 cases (35%; 1993, 14%). Minimum endodontic treatment need was estimated with 1.6% (1993, 2.3%), including teeth with clinical symptoms. Considering symptomless teeth with apical periodontitis and poor quality of root filling, the treatment need was 2.9% (1993, 3.7%). Regression analysis identified quality of root filling as a significant factor for periapical health (p = 0.01, odds ratio 3.4×, 95% CI 1.9-6.3×), likewise the type of instrumentation. Teeth treated with rotary files had a significantly better outcome (p = 0.02, odds ratio 2.0×, 95% CI 1.1-3.7×). CONCLUSIONS: Quality of root fillings and the periapical status have improved over the last 20 years in Germany. However, there is still a need for an increase in quality of root canal treatment.

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.

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.

Evaluation of a Fluorescence-aided Identification Technique (FIT) for removal of composite bonded trauma splints.

BACKGROUND/AIM: Accurate removal of composite bonded titanium trauma splints (TTS) can be challenging. The aim of this study was to evaluate a Fluorescence-aided Identification Technique (FIT) compared with a conventional light source (CT) for removal of trauma splints regarding loss of tooth substance, residual composite, and time taken. MATERIALS AND METHODS: Twenty maxillary models with six bovine teeth (13 - 23) were fabricated. An optical three-dimensional impression was taken and a TTS was applied from 12 to 22 with two bonding sites on every tooth under standardized conditions using an etch-and-rinse adhesive and resin composite. Two operators removed 10 splints each (5x FIT and 5x CT). For FIT, a 405 nm light-emitting headlamp was used. Time was recorded. A post-operative scan was superimposed on the pre-operative scan using OraCheck software. A qualitative and quantitative analysis of tooth defects and composite remnants was performed by two operators and statistically analyzed. RESULTS: Compared with the CT, FIT led to significantly fewer and smaller enamel defects (mean volume: -0.04 mm3 vs -0.33 mm3 ) (P < 0.001), significantly less composite remained (mean volume: 0.02 mm3 vs 0.28 mm3 ) (P < 0.001), and the removal procedure with FIT was significantly quicker (mean: 162 seconds vs 268 seconds) (P < 0.001), CONCLUSIONS: FIT facilitated the removal of composite used to bond trauma splints leading to less time-consuming as well as less invasive treatment. It left fewer composite residues on enamel surfaces.

Do periapical and periodontal pathologies affect Schneiderian membrane appearance? Systematic review of studies using cone-beam computed tomography.

OBJECTIVES: This systematic review analyzed the relationship between periapical and periodontal pathologies in the posterior maxilla and the appearance of the Schneiderian membrane in cone-beam computed tomography (CBCT) compared with sound dentitions. METHODS: Five electronic databases (Cochrane Library, Embase, OpenGrey, PubMed, Web of Science), complemented by hand searching, were screened up to May 9, 2016. Human clinical studies that used CBCT and contained information on the periapical/periodontal status in the posterior maxilla and Schneiderian membrane appearance were included. A weighted vote counting (WVC) method was applied to summarize results across studies. RESULTS: Out of 413 records, 20 studies were included. In the WVC, the studies that observed a positive association between periapical lesions and the appearance of the Schneiderian membrane outweighed those that found no such association (WVC 51 % and WVC 33 %, respectively), with some studies yielding indeterminate results (WVC 16 %). Regarding the relation between periodontal pathologies and the appearance of the Schneiderian membrane, WVC produced a tie between studies demonstrating a positive association (WVC 46 %) and those showing no association (WVC 44 %); one study (WVC 10 %) reported indeterminate results. CONCLUSIONS: On CBCT scans, periapical lesions in the posterior maxilla are likely to be associated with Schneiderian membrane thickening. In contrast, current evidence regarding the relation between periodontal diseases and the appearance of the Schneiderian membrane in CBCT is inconclusive. CLINICAL RELEVANCE: Incidental maxillary sinus findings on CBCT scans warrant thorough differential diagnosis. Frequently, they may be related to dental pathologies.

Lip and tooth injuries at public swimming pools in Austria.

BACKGROUND/AIMS: There is an increased risk of orofacial injuries in swimming pool facilities. Nevertheless, only a few studies have addressed this issue. The aim of this study was to identify the frequency of lip and tooth injuries at public swimming pools in Austria. A further aim was to examine which gender and age groups were affected, where and why these injuries occurred, and whether pool attendants had sufficient knowledge of dental first-aid measures. MATERIAL AND METHODS: A total of 764 pool attendants in Austria were contacted by telephone and 689 participated in the study (90.2%). The attendants were interviewed retrospectively about accident occurrences in 2014 by a standardized questionnaire. Responses to the provision of first aid and choice of storage medium for avulsed teeth were subsequently evaluated. RESULTS: The frequency of lip injuries was 19.0%, and tooth injuries were 11.3%. Male bathers (P < .05) and children under 12 years (P < .001) most frequently suffered injuries. The waterslide was the most common accident site. The most common cause of lip injuries was slipping on wet surfaces (39.0%), and for tooth injuries it was collisions with other persons or objects (each 28.1%). The pool attendants' responses were predominantly good or sufficient on first aid, with the exception of what storage medium to choose. Tooth rescue boxes were available in only 8.6% of all pool facilities. CONCLUSION: Orofacial injuries are a frequently occurring problem in swimming pool facilities. The pool attendants' knowledge on first-aid care of tooth injuries could still be improved.

Treatment of calcified root canals in elderly people: a clinical study about the accessibility, the time needed and the outcome with a three-year follow-up.

OBJECTIVE: Determination of accessibility, time needed and outcome of endodontic treatment of teeth with calcified root canals in a sample of elderly participants in a private practice limited to endodontics. BACKGROUND: Due to demographic changes, gerodontology is becoming more and more important, also in the field of endodontology. Elderly patients can show up with severe calcifications of root canals. Root canal treatment, when needed, can be very challenging in these cases. Only few data exist about the treatment of calcified root canals and its outcome, especially in an elderly population. MATERIALS AND METHODS: Forty-one participants (median age: 72 years) needing a root canal treatment were included. The total number of treated teeth was 41 with 114 negotiated root canals. A specialist limited to endodontics performed the treatment in a private practice. Outcome was assessed by applying the periapical index score on the basis of recall radiographs provided by the referring dentists. Likewise, time required to localise the root canals was measured. RESULTS: All root canals have been detected using the operating microscope, and full working length could be established in 90% of the cases. Success rate was 80% after an observation time of 3 years. In three of five teeth, root canals could be localised within 15 min. CONCLUSION: Calcified root canals of older people treated in this study were all accessible within a maximum of 60 min. The success rate after a follow-up of 3 years was 80%.

Dental trauma in showjumping - A trinational study between Switzerland, France and Germany.

AIM: Showjumping is one of the sporting activities with a high injury risk. Unpredictable behaviour of the horse, considerable speed and the height of the rider in the saddle make this sport to one of the most dangerous, with the highest risk of injury and the highest mortality rate per competitor. The aim of this study was to determine the frequency of dental trauma, the wearing of protective gear such as helmet, back protector and mouthguard as well as the knowledge of primary care after dental trauma. MATERIAL AND METHODS: Within the framework of this study, 608 female and male showjumpers from Switzerland, France and Germany were questioned in a personal interview consisting of 14 questions about general injuries, dental injuries and the usage of protective gear. The competitors were subdivided into different categories according to amateur or professional level, gender and age. RESULTS: Of the 608 competitors, 189 (31.1%) had witnessed an accident involving tooth injury and 91 (15.0%) had suffered one themselves. The prevalence of dental trauma rose with increasing age and more riding experience. A total of 436 (71.1%) of the competitors were familiar with mouthguards, of which only three owned one. The main reasons for not wearing a mouthguard were both doubtful necessity (22.5%) and a generally low acceptance among the riders (26.3%). Less than half of the competitors (44.4%) knew that an avulsed tooth can be replanted and only 4.1% had knowledge about the existence of a tooth rescue box. CONCLUSION: The results of this study show that in equestrian sports still little is known about dental trauma and protective measures.

Guided Endodontics: a novel treatment approach for teeth with pulp canal calcification and apical pathology.

AIM: To present a new treatment approach for teeth with pulp canal calcification (PCC) which require root canal treatment. CASE: A 15-year-old male patient presented with pain of his upper right central incisor. The tooth showed signs of apical periodontitis. Due to PCC, location of the root canal was judged to be difficult and associated with a high risk of perforation. A cone beam computed tomography (CBCT) and an intra-oral surface scan were performed and matched using software for virtual implant planning. After planning the position of the drill for root canal location, a virtual template was designed, and the data were exported as an STL file and sent to a 3D printer for template fabrication. The template was positioned on the anterior maxillary teeth. A specific drill was used to penetrate through the obliterated part of the root canal and obtain minimally invasive access to the apical part. The root canal was accessible at 9 mm distance from the apex. Further root canal preparation was carried out using an endodontic rotary instrumentation system. After an interappointment dressing for 4 weeks, the root canal was filled with vertically condensed gutta-percha using an epoxy sealer. The access cavity was restored with a composite material. After 15 months, the patient was clinically asymptomatic with no pain on percussion. The radiograph showed no apical pathology. CONCLUSIONS: The presented guided endodontic approach seems to be a safe, clinically feasible method to locate root canals and prevent root perforation in teeth with PCC.