Survival and success of implants in a private periodontal practice: a 10 year retrospective study.

BACKGROUND: To assess long-term results of implants (XiVE/Frialit-2 Synchro) in a private periodontal practice according to survival and success rates (biological and technical complications) and to detect possible influencing factors, retrospectively. METHODS: Implant placement of at least one implant took place 10 years ±6 months before clinical and radiographic re-examination. Incidence of implant loss as main and incidence of mucositis/ peri-implantitis as secondary outcome were detected. Also, patient-related and implant-related influencing factors were determined by regression analyses. RESULTS: 100 patients (59.0% female) with 242 implants were included into analysis. Survival rate was 94.0% (XiVE: 97.7%; Frialit-2-Synchro: 66.7%). Mucositis was found in 77.6% of all patients, moderate/severe peri-implantitis in 16.3%. In logistic regression analyses statistically significant influencing factors for implant loss was implant type (p < 0.001), for mucositis a wider implant diameter (p = 0.0438) and a high modified Plaque Index (p = 0.0253), for peri-implantits number of implants per patient (p = 0.0075) and a wider implant diameter (p = 0.0079). Technical complications were found in 47 implants (19.4%). CONCLUSIONS: XiVE implants showed a high survival rate over a 10-year follow-up, on the other hand Frialit-2 Synchro implants had worse survival rates. Success rates regarding biological complications are in line with other implant systems.

Effects of staining and polishing on different types of enamel surface sealants.

OBJECTIVE: To assess surface discoloration of four enamel sealants based on different chemical compositions after exposure to artificial aging and staining solutions. Furthermore, their cleanability after polishing will be evaluated. MATERIALS AND METHODS: Selected sealants were a composite resin-based sealant with fillers (Pro Seal), a composite resin-based sealant without fillers (Light BondSealant), a resin-modified glass ionomer-based sealant (ClinproXT Varnish) and a silicon-based sealant (Protecto). Natural teeth served as medium. Immersion solutions were water, juice, tea, and turmeric. In a standardized setting, all samples were measured seven times with a spectroradiometer (Photoresearch PR670) at baseline, after thermocycling; 7 days; 2 and 4 weeks of immersion; and after finally polishing. RESULTS: Thermocycling had no significant effect on color stability. After exposure to staining solutions, all sealed surfaces showed significant color changes. Color change predominately occurred for all sealants in the first week of staining (P ≤ .01). Best resistance to staining decreased as follows: Protecto > Light Bond Sealant > ProSeal > Clinpro XT Varnish. Surface cleaning by polishing significantly reduced the color change. CONCLUSION: Sealed enamel surfaces are prone to discoloration, which is most prominent in filled composite and glass-ionomer-based sealants. Staining can be reduced by polishing; however, in this in vitro setting the original color could not be restored. CLINICAL SIGNIFICANCE: Enamel sealants might exert adverse effects in terms of discoloration. This should be taken into consideration by clinicians and patients, particularly when sealants are applied in esthetically critical areas.

Fiber-reinforced composite fixed dental prostheses: A 4-year prospective clinical trial evaluating survival, quality, and effects on surrounding periodontal tissues.

STATEMENT OF PROBLEM: Although fiber-reinforced composite fixed dental prostheses (FRC FDPs) are a reliable treatment option for the restoration of single missing teeth, comparatively few prospective clinical trials (PCT) exist. PURPOSE: The purpose of this PCT was to evaluate the survival, quality outcome, and effect of FRC FDPs on periodontal health over 4 years. MATERIAL AND METHODS: Twenty-six consecutive patients (16 men, 10 women) receiving FRC FDPs with preimpregnated unidirectional fiber reinforcement were included in the trial. Eighteen FRC FDPs were placed in the maxilla and 8 in the mandible. Data from baseline, 12-, 36-, and 48-months of follow-up were recorded, and the prostheses were classified as "success," "survival," or "failure." Periodontal parameters (probing depth, clinical attachment level, plaque index, and bleeding index were assessed, and the quality was rated according to modified United States Public Health Service (USPHS)/Ryge or World Dental Federation (FDI) criteria. RESULTS: Functional survival at 4 years was 73.5% (95% confidence interval [CI], 52.9-87.3) with 17 FRC FDPs still functioning. Twelve of these were classified as "success" and 5 as "survival." Overall survival was 53.0% (95% CI, 30.4-74.4). Six FRC FPDs failed completely. Periodontal parameters did not change over the observation period. Regression analysis showed that probing depth and clinical attachment level did not influence the survival of FRC FDPs. According to USPHS/Ryge/FDI criteria only "wear" and "surface luster" increased significantly over 4 years. CONCLUSIONS: The survival rate of FRC FPDs confirms existing data. Negative effects on periodontal health were not seen over the period of observation. Aging effects such as wear were recorded and indicated that FRC FPDs are at risk of disintegration, as they are composed of a fiber framework and veneering composite resin.

In vitro evaluation of different dental materials used for the treatment of extensive cervical root defects using human periodontal cells.

INTRODUCTION: Repair materials for extensive cervical root defects may come in direct contact with periodontal tissues. This in vitro study compared the effects of four calcium silicate cements (CSC), one resin-modified glass ionomer cement, and one glass carbomer cement on primary human gingival fibroblasts (HGF), alveolar osteoblasts (HAO), and a human osteoblast cell line (hFOB 1.19). METHODS: HGF, HAO, and hFOB were seeded on discoid test specimens. Relative numbers of viable cells were quantitatively assessed after 1 and 24 h for cytotoxicity/adhesion assays and after 4, 24, 48, and 72 h for proliferation assays. Data were statistically analyzed using non-parametric tests (α = 0.05). RESULTS: Relative to the control (100 %), CSC allowed for mean numbers of 71-81 % viable HGF and 80-82 % viable HAO. Then, 64 % of HGF and 56 % of HAO were assessed on GC Fuji II LC. Mean numbers of viable cells were 59-64 % HGF and 67-68 % HAO for GCP Glass Fill specimens. Cells exposed to CSC over 24 h remained viable and even increased in number. Both cell types adhered almost equally well to CSC and GC Fuji II LC. GCP Glass Fill continued to decrease cell viability and adhesion. CSC-based materials and GC Fuji II LC allowed for HGF and hFOB proliferation; however, none of the tested materials specifically stimulated cell proliferation. CONCLUSIONS: CSC characterized by low cytotoxicity. GC Fuji II LC shows moderate cytotoxic effects. ProRoot MTA, Harvard MTA, Biodentine, EndoSequence putty, and GC Fuji II LC allow HGF and HAO to adhere and HGF and hFOB to proliferate. GCP Glass Fill decreases cell viability, adhesion, and proliferation. CLINICAL RELEVANCE: CSC remain the paramount biologic choice for the repair of extensive cervical root defects. GC Fuji II LC might be considered in addition to CSC when the defect comprises supracrestal areas and the restoration requires superior aesthetic and mechanical characteristics.

Long-term stability of splinted anterior mandibular teeth during supportive periodontal therapy.

OBJECTIVE: The aim of the study was to retrospectively assess the survival rate and stability of periodontally compromised and mobile anterior mandibular teeth after splinting in patients under supportive periodontal therapy (SPT). MATERIALS AND METHODS: Thirty-nine patients with splinted anterior mandibular teeth and SPT (≥1 visit/year) for 3-15 years were re-examined. Periodontal status, patient and tooth-related factors were assessed retrospectively before (baseline) and 3 years after splinting (n = 39 patients, 162 splinted teeth). For patients with splints inserted for more than 3 years, retrospective data after 5 (n = 30), 7 (n = 24), 10 (n = 16), 12 (n = 8) and 15 years (n = 4) was included, if available. At baseline, splinted teeth included at least one tooth with increased mobility combined with clinical attachment loss (CAL) ≥ 5 mm and ≥50% relative bone loss (RBL). Baseline RBL of splinted teeth was assessed for all patients. Change in RBL was assessed after 10 years, if available. RESULTS: No splinted tooth was lost within the first 3 years after splinting. One splinted tooth was lost 7 years after baseline and one 12 years after baseline. After 3 years mean(SD) periodontal probing depth of splinted teeth decreased from 3.39(1.41) mm to 2.12(0.37) mm and mean(SD) CAL from 5.61(1.66) mm to 5.09(1.67) mm and remained stable over the observation period. No change in RBL was observed over a 10-year period (p = .213). The survival rate of the splints until fracture or debonding was 74.4% after 3 years. CONCLUSIONS: Periodontally compromised splinted teeth show a high survival-rate and periodontal stability during SPT.

Endodontic status and retention of molars in periodontally treated patients: results after 10 or more years of supportive periodontal therapy.

OBJECTIVES: To assess the influence of endodontic status on retention of molars in patients under supportive periodontal treatment (SPT). MATERIAL & METHODS: A total of 136 subjects with 1015 molars at baseline were examined retrospectively, including 188 endodontically treated molars in 90 patients. Multilevel Cox regression analysis identified factors contributing to loss of molars. RESULTS: Root canal treatments contributed significantly to loss of molars during on average 13.2 years of SPT (Hazard ratio: 2.98, 95% CI: 1.74-5.1, p < 0.001). Endodontic treatment was more frequently present in first molars (p < 0.001) and in the maxilla (p = 0.01). In endodontically treated molars, degree III furcation involvement could be detected more often compared to molars without root canal treatment (p < 0.001). Among the root canal-treated molars, several patient and tooth-related factors showed an impact on tooth retention, but only molars with a periapical index of 4 and 5 (labelled "diseased") were significantly more often lost. CONCLUSION: The retention of molars in periodontally compromised patients after periodontal treatment is influenced by periodontal as well as endodontal factors. On a long-term basis, it is feasible to retain these teeth via active periodontal treatment and SPT for more than 10 years.

Loss of molars in periodontally treated patients: results 10 years and more after active periodontal therapy.

AIM: To identify risk factors for loss of molars during supportive periodontal therapy (SPT). MATERIALS AND METHODS: A total of 136 subjects with 1015 molars at baseline were examined retrospectively. The association of risk factors with loss of molars was assessed using a multilevel Cox regression analysis. Furcation involvement (FI) was assessed clinically at start of periodontal therapy and assigned according to Hamp et al. (1975). RESULTS: Fifty molars were extracted during active periodontal therapy (APT) and 154 molars over the average SPT period of 13.2 ± 2.8 years. FI degree III (HR 4.68, p < 0.001), baseline bone loss (BL) > 60% (HR 3.74, p = 0.009), residual mean probing pocket depth (PPD, HR 1.43, p = 0.027), and endodontic treatment (HR 2.98, p < 0.001) were identified as relevant tooth-related factors for loss of molars during SPT. However, mean survival time for molars with FI III or BL > 60% were 11.8 and 14.4 years, respectively. Among the patient data, age (HR 1.57, p = 0.01), female gender (HR 1.99, p = 0.035), smoking (HR 1.97, p = 0.034), and diabetes mellitus (HR 5.25, p = 0.021) were significant predictors for loss of molars. CONCLUSION: Overall, periodontal therapy results in a good prognosis of molars. Degree III FI, progressive BL, endodontic treatment, residual PPD, age, female gender, smoking, and diabetes mellitus strongly influence the prognosis for molars after APT.

Efficiency of powered systems for interproximal enamel reduction (IER) and enamel roughness before and after polishing-an in vitro study.

OBJECTIVE: This aims to evaluate the efficiency of three different powered interproximal enamel reduction (IER) systems and to assess enamel roughness before and after polishing using different polishing times. MATERIAL AND METHODS: Four metal strips of the G5 ProLign Set (swissdentacare, SDC, Grancia, Switzerland), four segmental discs of the ASR-Set 4594 and two sonic tips of the SonicLine Set (both Gebr. Basseler GmbH & Co. KG, Komet, Lemgo, Germany) were evaluated. Human extracted incisors served as the medium. Enamel reduction was determined in five intervals of 15 s each. Polishing was performed for 15 and 30 s using the manufacturers' recommended polishing systems. Enamel roughness (Ra) was quantitatively assessed by confocal laser scanning microscopy (CLSM). RESULTS: Significant differences in terms of enamel reduction were found among the working ends of all tested systems. The time needed to remove 0.1, 0.2 and 0.3 mm of enamel was determined. Surface analysis showed significantly higher mean Ra values for nine out of ten working ends before polishing. This was still the case for five working ends after 15 s and for two after 30 s of polishing. CONCLUSION: The graining and the system used have a significant influence on enamel reduction. The time needed for polishing depends on the last working end used; a polishing time of 30 s is not always appropriate. CLINICAL RELEVANCE: Knowledge about the cutting efficiency of powered IER working ends might help the clinician to estimate better the amount of enamel reduction during the stripping process.

Surgery-first approach in orthognathic surgery: Psychological and biological aspects - A prospective cohort study.

INTRODUCTION: The aim of this pilot study was to investigate psychological and biological changes after application of a surgery-first orthognathic treatment approach. METHODS: A prospective cohort study of 9 patients (6 women and 3 men; mean age 26.7 years) suffering from skeletal Class II and III deformities was conducted. Skeletal changes from pre-to post-treatment were analyzed based on data acquired by use of cone-beam computed tomography (CBCT). Psychological changes were analyzed using the orthognathic quality of life (OQLQ) questionnaire, Sense of Coherence 29-item scale (SOC-29) and longitudinal day-to-day questionnaire. For biological evaluation, concentrations of IL-1 ß, IL-6, TGF ß 1-3, MMP-2 and VEGF were assessed in crevicular fluid by bead-based multiplex assays at one preoperative and various postoperative time points. RESULTS: A significant improvement (P = 0.015) in quality of life, as measured with the OQLQ, was observed between baseline and 3 months post-surgery. The most affected dimensions were: facial aesthetics (p = 0.022), oral function (p = 0.051) and social aspects (p = 0.057). Sense of coherence (SOC) significantly improved after treatment by 9 points (P = 0.029). Despite the significant improvement in OQLQ and SOC during the course of the study, the personal experience of appearance varied distinctly in course and intensity. In accordance with the temporal pattern of fracture healing, the analysis of crevicular fluid revealed an increase in pro-resorptive factors (IL-1 ß, IL-6 and MMP-2) at early postoperative time points, while remodeling factors (members of the TGF-ß superfamily) were detected at later postoperative time points. CONCLUSIONS: Orthognathic treatment using the surgery-first approach has a positive impact on patient's psychosocial status. Accelerated tooth movement after surgery might, to a certain extent, be due to elevated levels of bone remodeling factors with overlapping functions during fracture healing and tooth movement.

Surgical management of bisphosphonate-related osteonecrosis of the jaw stages II and III.

OBJECTIVE: The value of surgery in advanced stages of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is still controversial. Hence, we evaluated the effect of surgical therapy in BRONJ stages II and III in combination with a standardized perioperative adjuvant treatment. STUDY DESIGN: We included 39 patients who presented with BRONJ in a total of 47 locations and stages II (n = 23) and III (n = 24). All patients had exclusively received a monthly intravenous application of zoledronic acid. Surgical therapy consisted of complete removal of the necrotic jaw, accompanied by a standardized perioperative adjuvant treatment including intravenous antibiotic prophylaxis, gastric feeding, and an antimicrobiologic mouth rinsing. RESULTS: Overall, 35 (74.5%) of the 47 BRONJ sites were treated successfully, with success defined as complete mucosal healing of the exposed jaw (n = 24) or as relative healing when surgical therapy downscaled BRONJ II or III to asymptomatic BRONJ stage I (n = 11). Interestingly, perioperative adjuvant treatment or bisphosphonate therapy parameters showed no statistical effect on the treatment outcome. CONCLUSIONS: The results of the present study prove the effectiveness of surgical therapy for BRONJ stage II or III.

A Prospective Clinical Pilot Study on the Level of Matrix Metalloproteinase-9 in Dental Pulpal Blood as a Marker for the State of Inflammation in the Pulp Tissue.

INTRODUCTION: Differentiation between reversible pulpitis (savable pulp) and irreversible inflammation of the pulp tissue (nonsavable pulp) based only on clinical and radiographic diagnoses has proven to be difficult. Pulp exposure allows for the collection of pulpal blood to quantitatively determine the level of inflammation markers or proteolytic enzymes, even with small samples. Pulpitis is associated with the invasion of neutrophil granulocytes and their release of matrix metalloproteinase-9 (MMP-9). METHODS: Forty-four patients (aged 18-74 years, mean = 35 years), each with 1 tooth with carious pulp exposure presenting with different stages of pulpitis, were included in this prospective, 2-center clinical study; 26 patients presented with irreversible pulpitis (groups 3 and 4), 10 with reversible pulpitis (group 2), and 8 with completely asymptomatic teeth with deep carious lesions (group 1). Six of the 26 patients with teeth diagnosed with irreversible pulpitis had not taken any nonsteroidal anti-inflammatory drugs and were evaluated as a separate group (group 4). Partial pulpotomy and blood sample collection from the pulp chamber were performed. The total levels of MMP-9 and tissue inhibitor of metalloproteinase-1 were assessed by fluorometric and colorimetric enzyme-linked immunosorbent assays, respectively. The Mann-Whitney U test and Spearman rank correlations were used to compare the MMP-9 levels with different stages of pulpal inflammation; significance was set at .05. RESULTS: The MMP-9 levels in the asymptomatic teeth (group 1) were significantly different from those in the teeth with reversible pulpitis (group 2, P = .006) or irreversible pulpitis (group 4, P < .001). A statistically significant difference was also observed between the MMP-9 levels in group 1 and group 3 (P < .001) in which the patients had taken nonsteroidal anti-inflammatory drugs. CONCLUSIONS: These findings indicate that the MMP-9 levels in pulpal blood samples could be a useful ancillary diagnostic tool for distinguishing different stages of pulp tissue inflammation.

A 6.5-year clinical follow-up of direct resin composite buildups in the posterior dentition: Introduction of a new minimally invasive restorative method.

OBJECTIVES: Restorative rehabilitation of missing single teeth in the posterior dentition is achieved primarily by dental implants or fixed dental prostheses. Here we introduce an uncommon, minimally invasive treatment option in order to close single tooth gaps. METHODS: The purpose of this study was to evaluate the clinical quality and survival of 45 direct composite buildups in the posterior dentition. A detailed clinical examination was performed, and restorations were rated qualitatively using the modified USPHS/FDI criteria. RESULTS: The mean extension of the direct composite buildups was 2.96 (1.12)mm per tooth. Interdental closures from both adjacent teeth had a significantly higher extension of the direct composite buildups than one-sided interdental closures (p=0.03). Patients with a history of prior tooth loss showed a significantly greater extension of direct composite buildups than patients without prior tooth loss (p=0.006). During the follow-up period, no restoration showed unfavorable events. The overall survival rate for the direct composite buildups was 100% after median follow-up of 78.96 months. The clinical quality rating indicated that most of the restorations (>94%) displayed excellent or good quality. No periodontal destruction, signs of gingival inflammation or increased plaque accumulation was observed. CONCLUSIONS: The posterior direct composite buildups evaluated in this study showed promising clinical survival data and excellent quality parameters after a median observation time of 6.5 years. CLINICAL SIGNIFICANCE: If a minimally or non-invasive treatment approach is indicated, posterior direct composite buildups provide a successful treatment alternative for the closure of single-tooth gaps to implant-supported or fixed dental prostheses.

Outcome of orthograde retreatment after failed apicoectomy: use of a mineral trioxide aggregate apical plug.

INTRODUCTION: This controlled, single-center historic cohort study project evaluates treatment outcomes of a nonsurgical treatment approach after failed apicoectomy. METHODS: The treatment outcomes of nonsurgical retreatment after a failed apicoectomy were evaluated clinically and radiographically. The study cohort consisted of teeth that had received primary root canal treatment and subsequent apicoectomy elsewhere before the patients presented with post-treatment disease. Orthograde retreatment and obturation using an apical mineral trioxide aggregate plug was performed by postgraduate students and endodontic specialists in 25 cases between 2004 and 2012. Pre-, intra-, and postoperative information and the potential effect on the retreatment outcome were evaluated and statistically analyzed using the chi-square test. RESULTS: Twenty-two patients with 23 teeth attended the follow-up examinations (recall rate = 92%). The follow-up periods ranged from 12 to 102 months (median = 35 months). Twenty teeth (87%) were classified as "success," and 3 teeth were considered (17%) "failure." The chi-square test confirmed that the preoperative factor "number of roots" had a statistically significant effect on treatment outcome (odds ratio = 0.08; 95% confidence interval, 0-1.76; P = .03). The factor "tooth location" was of borderline significance (odds ratio = 0.1; 95% confidence interval, 0-2.14; P = .05). CONCLUSIONS: The results of the present study suggest that orthograde retreatment combined with orthograde placement of an apical mineral trioxide aggregate plug is a promising long-term treatment option for teeth with postsurgical pathosis. The success rates were higher for single-rooted teeth. The use of cone-beam computed tomographic imaging in cases of inconclusive periapical radiographs is recommended to minimize the risk of misinterpretation when assessing treatment outcome.

Incidence of bisphosphonate-related osteonecrosis of the jaw in high-risk patients undergoing surgical tooth extraction.

As the most suitable approach for preventing bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients undergoing surgical tooth extraction is still under discussion, the present study evaluates the incidence of BRONJ after surgical tooth extraction using a standardized surgical protocol in combination with an adjuvant perioperative treatment setting in patients who are at high-risk for developing BRONJ. High-risk patients were defined as patients who received intravenous bisphosphonate (BP) due to a malignant disease. All teeth were removed using a standardized surgical protocol. The perioperative adjuvant treatment included intravenous antibiotic prophylaxis starting at least 24 h before surgery, a gastric feeding tube and mouth rinses with chlorhexidine (0.12%) three times a day. In the follow-up period patients were examined every 4 weeks for the development of BRONJ. Minimum follow-up was 12 weeks. In 61 patients a total number of 184 teeth were removed from 102 separate extraction sites. In eight patients (13.1%) BRONJ developed during the follow-up. A higher risk for developing BRONJ was found in patients where an additional osteotomy was necessary (21.4% vs. 8.0%; p = 0.0577), especially for an osteotomy of the mandible (33.3% vs. 7.3%; p = 0.0268). Parameters including duration of intravenous antibiotic prophylaxis, the use of a gastric feeding tube and the duration of intravenous BP therapy showed no statistical impact on the development of BRONJ. Furthermore, patients currently undergoing intravenous BP therapy showed no higher risk for BRONJ compared with patients who have paused or completed their intravenous BP therapy (p = 0.4232). This study presents a protocol for surgical tooth extraction in high-risk BP patients in combination with a perioperative adjuvant treatment setting, which reduced the risk for postoperative BRONJ to a minimum. However, the risk for BRONJ increases significantly if an additional osteotomy is necessary, especially in the mandible.

Occurrence of cervical lymph node metastasis of maxillary squamous cell carcinoma - A monocentric study of 171 patients.

INTRODUCTION: Fewer than 5% of oral squamous cell carcinomas (SCC) are presented in the maxilla. The absence of cervical lymph node metastasis (LNM) is one of the main positive prognostic factors. This single-centre study analysed the cervical lymph node metastasis behaviour in patients with oral SCC of the upper jaw and serves as a basis for a cervical lymph node treatment suggestion. MATERIAL AND METHODS: The retrospective study includes 171 patients with isolated SCC of the maxilla. In addition to tumour resection, 83% of the patients underwent a selective neck dissection (ND). The data of cervical metastasis, TNM-status, tumour grade, tumour location as well as nicotine and alcohol behaviour were statistically analysed. RESULTS: The average rate of cervical metastasis was 44% in total. Tumour stage significantly affected risk for cervical metastasis (T1 = 6%, T2 = 41%, T3 = 60% and T4 = 60%) (p < 0.01). Development of cervical LNM was seemingly influenced by male gender. DISCUSSION: This study postulates a high rate of cervical metastasis of maxillary SCC. Risk for metastasis is mainly determined by the tumour stage. Alcohol and nicotine abuse have a negative impact on cervical LNM. CONCLUSION: Reviewing recent literature underlined by the illustrated data, we put up for discussion the treatment of SCC of the maxilla as similar to therapy protocols for SCC of the oral cavity. This would include an ipsilateral ND even in low tumour stage and in T4 staged tumours on both sides. However, prospective multicentre studies are needed to verify and recommend these therapy assumptions.

Treatment outcome of mineral trioxide aggregate: repair of root perforations-long-term results.

INTRODUCTION: This historical cohort study follows on a previously reported trial, with the aim of assessing the outcome for teeth with root perforations managed by the orthograde placement of mineral trioxide aggregate (MTA) and identifying potential outcome factors for such treatment with a larger sample size and longer follow-up periods than in the first phase of the project. METHODS: The treatment outcomes of 64 root perforations repaired between 2000 and 2012 with MTA were investigated. The root perforations were located in different areas of the root. Calibrated examiners assessed clinical and radiographic outcomes by using standardized follow-up protocols 12-107 months after treatment (median, 27.5 months). Preoperative, intraoperative, and postoperative information was evaluated. The outcomes were dichotomized as healed or diseased. RESULTS: Of the 64 teeth examined (85% recall rate), 86% were healed. The univariate analyses (χ(2) tests) identified 2 potential prognostic factors, experience of the treatment providers (odds ratio, 2.14; 95% confidence interval, 0.39-11.74; P < .01) and placement of a post after treatment (odds ratio, 0.06; 95% confidence interval, 0.01-0.27; P < .01). In the multivariate stepwise logistic Cox regression, none of the potential prognostic factors displayed a significant effect on the outcome at the 5% level. CONCLUSIONS: MTA appears to have good long-term sealing ability for root perforations regardless of the location. The results of this historical cohort study confirm the results of the first phase of this project.

Treatment outcome of mineral trioxide aggregate or calcium hydroxide direct pulp capping: long-term results.

INTRODUCTION: This controlled, historic cohort study project continues a previously reported trial aiming to assess treatment outcome of direct pulp capping with mineral trioxide aggregate (MTA) versus calcium hydroxide (CH). Potential prognostic factors were re-evaluated on the basis of a larger sample size and longer follow-up periods. METHODS: Clinical and radiographic outcomes of 229 teeth treated with direct pulp capping between 2001 and 2011 were investigated 24 up to 123 months post-treatment (median = 42 months). Pre-, intra-, and postoperative information was evaluated and statistically analyzed using a logistic regression model as well as generalized estimating equation logit models. RESULTS: Two hundred five patients (229 teeth) were available for follow-up (74% recall rate). The overall success rates were 80.5% (95% confidence interval [CI], 74.5-86.5) of teeth in the MTA group (137/170) and 59% (95% CI, 46.5-71.5) of teeth in the CH group (35/59). Multivariate analyses (generalized estimating equation logit model) indicated a significantly increased risk of failure for teeth that were directly pulp capped with CH compared with MTA (odds ratio = 2.67; 95% CI, 1.36-5.25; P = .001). Teeth that were permanently restored ≥ 2 days after direct pulp capping had a significantly worse prognosis irrespective of the pulp capping material chosen (odds ratio = 3.18; 95% CI, 1.61-6.3; P = .004). CONCLUSIONS: The results of this study indicate that MTA provides better long-term results after direct pulp capping compared with CH. Placing a permanent restoration immediately after direct pulp capping is recommended.