Radiographic assessment of the peri-implant site.

While peri-implant mucositis relies solely on clinical parameters, radiological assessment becomes indispensable for diagnosing peri-implantitis. Intraoral radiography, with its simplicity of application, low radiation exposure, and adequate representation of peri-implant structures, stands out as the standard of care for both immediate and follow-up assessments. Standardization by custom-made radiologic splints allows for excellent comparability with previous images and allows for the determination of even small changes in contour and density of the peri-implant bone. Furthermore, other radiographic modalities like panoramic radiography and cone beam computed tomography (CBCT) may provide useful features for specific patients and clinical cases while also showing innate limitations. Beyond the assessment of the marginal peri-implant bone level as the crucial parameter of clinical relevance, radiologic assessment may reveal various other findings related to the prosthetic restoration itself, the precision of its fit to the implant, and the peri-implant soft and hard tissues. Since such findings can be crucial for the assessment of peri-implant health and the implants' prognosis, a systematic diagnostic evaluation pathway for a thorough assessment is recommended to extract all relevant information from radiologic imaging. This article also provides an overview of the clinical and chronological indications for different imaging modalities in peri-implant issues.

Primary stability and osseointegration comparing a novel tapered design tissue-level implant with a parallel design tissue-level implant. An experimental in vivo study.

OBJECTIVES: The aim of the present study was to compare a novel tapered, double-threaded self-tapping tissue-Level design implant (TLC) to a well-established parallel walled tissue-level (TL) implant in terms of primary and secondary stability over time. MATERIALS AND METHODS: Test TLC (n = 10/per timepoint) and control TL (n = 10/per timepoint) implants were placed in the mandible of minipigs and left for submerged healing for 3, 6, and 12 weeks. Maximum insertion torque and implant stability quotient (ISQ) were measured for each implant at placement. Osseointegration and cortical bone maintenance were histologically evaluated by measuring total bone-to-implant contact (BIC) and first bone-to-implant contact (fBIC). RESULTS: A significantly higher maximum insertion torque was measured for the test implant TLC compared to the control TL implant (57.83 ± 24.73 Ncm and 22.62 ± 23.16 Ncm, respectively; p < .001). The mean ISQ values were comparable between the two implant types (75.00 ± 6.70 for TL compared to 75.40 ± 3.20 for TLC, p = .988). BIC was comparable between both implant types at each of the evaluated time points. The fBIC was found to be significantly more coronal at 12 weeks for the TLC implant compared to the TL implant (0.31 ± 0.83 mm for TLC compared to -0.22 ± 0.85 for TL, p = .027). CONCLUSION: The novel tapered tissue level design implant showed improved primary stability and an overall improved crestal bone height maintenance compared to the parallel walled design at 12 weeks.

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.

Piranha-etched titanium nanostructure reduces biofilm formation in vitro.

OBJECTIVES: Nano-modified surfaces for dental implants may improve gingival fibroblast adhesion and antibacterial characteristics through cell-surface interactions. The present study investigated how a nanocavity titanium surface impacts the viability and adhesion of human gingival fibroblasts (HGF-1) and compared its response to Porphyromonas gingivalis with those of marketed implant surfaces. MATERIAL AND METHODS: Commercial titanium and zirconia disks, namely, sandblasted and acid-etched titanium (SLA), sandblasted and acid-etched zirconia (ZLA), polished titanium (PT) and polished zirconia (ZrP), and nanostructured disks (NTDs) were tested. Polished titanium disks were etched with a 1:1 combination of 98% H2SO4 and 30% H2O2 (piranha etching) for 5 h at room temperature to produce the NTDs. Atomic force microscopy was used to measure the surface topography, roughness, adhesion force, and work of adhesion. MTT assays and immunofluorescence staining were used to examine cell viability and adhesion after incubation of HGF-1 cells on the disk surfaces. After incubation with P. gingivalis, conventional culture, live/dead staining, and SEM were used to determine the antibacterial properties of NTD, SLA, ZLA, PT, and ZrP. RESULTS: Etching created nanocavities with 10-20-nm edge-to-edge diameters. Chemical etching increased the average surface roughness and decreased the surface adherence, while polishing and flattening of ZrP increased adhesion. However, only the NTDs inhibited biofilm formation and bacterial adherence. The NTDs showed antibacterial effects and P. gingivalis vitality reductions. The HGF-1 cells demonstrated greater viability on the NTDs compared to the controls. CONCLUSION: Nanocavities with 10-20-nm edge-to-edge diameters on titanium disks hindered P. gingivalis adhesion and supported the adhesion of gingival fibroblasts when compared to the surfaces of currently marketed titanium or zirconia dental implants. CLINICAL RELEVANCE: This study prepared an effective antibacterial nanoporous surface, assessed its effects against oral pathogens, and demonstrated that surface characteristics on a nanoscale level influenced oral pathogens and gingival fibroblasts. CLINICAL TRIAL REGISTRATION: not applicable.

General and dental injuries sustained at concerts: A questionnaire-based study.

BACKGROUND/AIM: Evidence on the risk of injury at concerts is scant. The aim of this study was to collect data on general and dental injuries incurred by concertgoers in Switzerland and to investigate whether the frequency of accidents was related to music genre, gender and consumption of alcohol. MATERIALS AND METHODS: A questionnaire-based, cross-sectional study comprising 451 concertgoers in Switzerland was conducted on the timeframe January 2019 to February 2021. The survey gathered data on general and dental injuries, alcohol consumption and drug use. The statistical analysis included Fisher's exact tests, chi-squared tests, rank sum tests and logistic regressions (α = .05). RESULTS: There were 28.8% of respondents who reported an injury incurred at a concert. Contusion was the most prevalent injury, accounting for 33.8% of all injuries. Legs were the most commonly injured body part (34.6%). Injuries to their mouth/lips/teeth were reported by 17.7% of respondents. Dental injuries, accounting for 4.6% of all reported injuries, comprised four tooth fractures, one lateral luxation and one avulsion. The risk of injury while attending punk rock concerts was 8.6 times higher than for pop concerts (p < .001). In comparison with pop concerts, metal and rock concerts had an increased risk of injury by factors of 5.1 and 2.3, respectively (p ≤ .029). Neither gender nor drug use had a significant effect on the injury risk (p ≥ .3). Heavy alcohol consumption (>5 standard glasses) increased the risk of injury by a factor of 2.3 (p = .028). CONCLUSIONS: This study suggests that concert attendees at rock, metal and punk concerts face an increased risk of injury, which is likely due to the frequency of aggressive dance styles such as moshing. Heavy alcohol consumption leads to a greater risk of injury at concerts.

Thermal exposure of implant osteotomies and its impact on osseointegration-A preclinical in vivo study.

OBJECTIVES: Thermal and mechanical stresses during osteotomy preparation can impair implant osseointegration. This study investigated implant osseointegration following the measurement of temperature exposure during osteotomy drilling, varying drill design, sequence, and drill wear. MATERIALS AND METHODS: 36 tapered implants were placed in a mandibular minipig model after guided drilling of implant osteotomies using 4 different groups: (1) control drills with a conservative, sequential drilling sequence, (2) control drills using a shortened drill sequence (PF), (3) novel test drill displaying an optimized drill design and surface treatment, PF, and (4) aged test drill, PF. Intraosseous temperatures during drilling were measured using a temperature probe. BIC, fBIC, and tissue reactions were histomorphometrically derived after 2 and 8 weeks of healing. RESULTS: Compared to control drills (1) or (2), test drills (3) resulted in significantly lower maximum temperatures ((35.4 (CI 30.2-40.5)°C vs. (46.5 (CI 41.0-52.0)°C, p = .0021)) and shorter drill times ((4.5 (CI 1.6-7.3)sec vs. 10.3 (7.3-13.4)sec). Lower osteotomy temperature values and shorter drill times corroborated with significantly higher BIC after 2 and 8 weeks healing for the test (3) compared to control groups (2) (2 weeks: (44.9 (CI 34.1-55. 7)% vs. (31.3 (CI 20.5-42.2)%, p = <.0001 and 8 weeks: (73.7 ( CI 64.2-83.2)% vs. (66.2 (CI 57.0-75.4)%, p = <.0455). CONCLUSION: The improved osseointegration of implants placed after osteotomy preparation with novel test drills using a shortened drill sequence compared to standard drills and conventional drill protocols might be attributed to more favorable thermal profiles and less mechanical stress exerted on the bone surrounding the implant osteotomy.

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.

Stability of screw-retention in two-piece zirconia implants: An in vitro study.

OBJECTIVES: To compare the stability of a screw-retained connection in a novel two-piece zirconia implant to a conventional titanium-based connection in an in vitro chewing simulation including artificial ageing. MATERIAL AND METHODS: Incisor (I) and molar (M) shaped monolithic zirconia crowns were screw-retained on either two-piece zirconia (test) or two-piece titanium (control) implants resulting in 4 groups of 8 samples (titanium implants with incisor-shaped crowns (T-I), titanium implants with molar-shaped crowns (T-M), zirconia implants with incisor-shaped crowns (Z-I) and zirconia implants with molar-shaped crowns (Z-M). These were subjected to artificial ageing by thermal cycling (TC: 2 × 3000 × 5°C/55°C cycles of 2 min) and mechanical loading (ML: 1.2 × 106 cycles of 50 N, f = 1 Hz). Surviving samples additionally underwent a fracture force test. Kaplan-Meier plots were drawn, and two-way ANOVA was calculated taking anatomical localisation and material variables as factors. RESULTS: The mean corresponding survival times were lower for T-M (0.86 × 106  ± 0.31 × 106 cycles) and Z-I (0.84 × 106  ± 0.21 × 106 cycles) compared to T-I (1.14 × 106  ± 0.10 × 106 cycles) and Z-M (1.20 × 106  ± 0.10 × 106 cycles). In one-way ANOVAs for survival time dependent on either location or material, no statistically significant differences could be found (location: p = .31; material: p = .62) in one-way ANOVAs. The interaction of location and material showed significant differences (F = 21.3, p < .001). CONCLUSION: The connection of the tested screw-retained zirconia crowns in two-piece zirconia implants is comparable to standard titanium implants in the specific in vitro testing.

The prevalence of orofacial injuries in judo: A cross-sectional study.

BACKGROUND/AIMS: Judo is a popular martial art with a high risk of injury. Notwithstanding this risk, mouthguards were not allowed until June 2018. The aim of this study was to measure the prevalence of traumatic injuries in judo with a particular focus on dental and lip injuries. A further aim was to assess the influences of increased overjet and wearing fixed orthodontic appliances. MATERIAL AND METHODS: Judokas (n = 382) from two judo clubs in Bern, Switzerland, were interviewed with a standardized questionnaire. RESULTS: About two thirds had suffered at least one traumatic injury with a high number of limb injuries (n = 1054), followed by face injuries (n = 855) and spine, torso, occiput or neck injuries (n = 84). Among the face injuries, 562 lip injuries were recorded. A significantly higher number of lip injuries were found for judokas who wore fixed orthodontic appliances compared to judokas who never wore such appliances. Forty-seven dental trauma incidents during judo were recorded. During both judo and leisure time, 161 dental trauma incidents were recorded. Individuals with lip incompetence and increased overjet showed the highest number of dental injuries ( x ¯ = 0.815; SD = 0.622), which differed in statistically significant ways from the number of dental injuries in individuals with lip incompetence and normal or reduced overjet ( x ¯ = 0.278; SD = 0.461). For individuals with no lip incompetence, no difference between the sub-group with an increased overjet and the sub-group with a normal or reduced overjet could be found. Nobody in the study population was wearing a mouthguard, and the acceptance of mouthguards was low (9.7%). CONCLUSION: It is important to increase the awareness of the recent authorization of mouthguards and to promote their acceptance among judokas. The combination of increased overjet and lip incompetence was more relevant for the dental trauma risk than an increased overjet alone.

Comparison of heat generation between guided and conventional implant surgery for single and sequential drilling protocols-An in vitro study.

OBJECTIVES: The aim of this in vitro study was to compare the heat generation during guided osteotomy preparation (GOP) with that of a conventional approach (CA) for a single and sequential drilling protocol. METHODS: Temperature measurements were performed during standardized osteotomy preparations in polyurethane foam blocks with an infrared camera. The four groups included single and sequential drilling with and without the use of a surgical guide. In the first group (single CA) and the second group (single GOP), only the final drills diameters were applied once. In the third group (sequential CA) and the fourth group (sequential GOP), two to four drills with increasing diameters were applied. Guided and conventional as well as single and sequential drilling were compared using a one-way ANOVA with Tukey post hoc test. The level of statistical significance was set at α = 0.05. RESULTS: Guided osteotomy preparation showed statistically significant higher temperatures than CA for the 2.2 mm, the 3.5 mm, and the 4.2 mm drill (p = 0.032, p = 0.005 and p < 0.001, respectively). Sequential drilling led to higher heat generation and longer duration of latent heat than single drilling. For all drilling procedures, the duration of heat exposure over critical temperature was less than 1 min, except for the sequential GOP drilling protocol with the 4.2 mm drill (76 s). CONCLUSIONS: Guided drilling requires specific attention to heat development. When guided implant surgery is performed, a single drilling procedure could alleviate heat production compared to a sequential procedure.

Group 5 ITI Consensus Report: Digital technologies.

OBJECTIVES: Working Group 5 was assigned the task to review the current knowledge in the area of digital technologies. Focused questions on accuracy of linear measurements when using CBCT, digital vs. conventional implant planning, using digital vs. conventional impressions and assessing the accuracy of static computer-aided implant surgery (s-CAIS) and patient-related outcome measurements when using s-CAIS were addressed. MATERIALS AND METHODS: The literature was systematically searched, and in total, 232 articles were selected and critically reviewed following PRISMA guidelines. Four systematic reviews were produced in the four subject areas and amply discussed in the group. After emendation, they were presented to the plenary where after further modification, they were accepted. RESULTS: Static computer-aided surgery (s-CAIS), in terms of pain & discomfort, economics and intraoperative complications, is beneficial compared with conventional implant surgery. When using s-CAIS in partially edentulous cases, a higher level of accuracy can be achieved when compared to fully edentulous cases. When using an intraoral scanner in edentulous cases, the results are dependent on the protocol that has been followed. The accuracy of measurements on CBCT scans is software dependent. CONCLUSIONS: Because the precision intraoral scans and of measurements on CBCT scans and is not high enough to allow for the required accuracy, s-CAIS should be considered as an additional tool for comprehensive diagnosis, treatment planning, and surgical procedures. Flapless s-CAIS can lead to implant placement outside of the zone of keratinized mucosa and thus must be executed with utmost care.

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.

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.

Life-threatening hemorrhage associated with dental implant surgery: a review of the literature.

OBJECTIVES: Life-threatening bleeding may occur during implant placement. PURPOSE: The present review was conducted to evaluate the localization, the symptoms, and therapies of life-threatening bleedings associated with implant placement. MATERIAL AND METHODS: A literature review including 590 articles was performed in PubMed, Medline, and Cochrane database. Any article reporting on life-threatening bleeding was included which additionally reported on the site of implant surgery. RESULTS: Twenty-seven cases were extracted. In the majority of the cases, bleeding occurred in the anterior interforaminal region. Aside local management stopping the bleedings, most cases required intubation or tracheotomy. CONCLUSIONS: Surgeons must be aware of the risk of severe bleedings during implant surgery and should immediately refer patients to a specialized clinic in suspicious or proved cases.

Detection of peri-implant bone defects with different radiographic techniques - a human cadaver study.

OBJECTIVES: Two- and three-dimensional radiographic techniques are available to determine peri-implantitis-related bone loss around dental implants. PURPOSE: To compare the performance of detecting different peri-implant bone defects in intraoral radiography (IR), panoramic radiography (PR), Cone Beam Computer Tomography (CBCT) and Computer Tomography (CT). MATERIAL AND METHODS: Six implants were inserted under ideal conditions into the lower jaw of an edentulous human cadaver. IR, PR, CBCT and CT were performed. Two-wall, three-wall and four-wall defects with 1 mm depth were artificially created around two of the implants (one anterior and one posterior), and radiographies were repeated. The identical set-up was used for 3-mm-deep bone defects. All images were presented to seven observers. Sensitivity (SN) and specificity (SP) were determined for each modality, defect type and depths, and likelihood ratios were calculated. RESULTS: The highest sensitivity was found with IR and CBCT for 1 mm (0.67; 0.68) and 3-mm defects (0.81; 0.79). The highest specificity was found with IR for both defect depths (0.51). The best classification of defect type revealed PR for both 1-mm and 3-mm-deep defects. Both likelihood ratios (LR+ and LR-) were best for IR with 1-mm (1.37 and 0.65) and with 3-mm defects (1.65 and 0.37). CONCLUSIONS: IR should still be recommended as favourable method evaluating bone loss around dental implants, while CT demonstrated the lowest performance in detecting peri-implant bone defects.

Significance of endothelial progenitor cells (EPC) for tumorigenesis of head and neck squamous cell carcinoma (HNSCC): possible marker of tumor progression and neovascularization?

OBJECTIVES: Angiogenesis and neovascularisation plays a crucial role for tumorigenesis and tumor progression in head and neck squamous cell carcinoma (HNSCC). The aim of our study was to investigate the neovascularization capacity by endothelial progenitor cells (EPC) in tumor patient as a possible predictor for tumor progression and tumor stage. MATERIALS AND METHODS: Therefore, we investigated the cell number and biologic activity by cell migration and colony-forming ability of EPC. Cells were isolated from the peripheral venous blood of 79 patients who suffer HNSCC in different stages of disease. Thirty-three healthy individuals served as the control group. RESULTS: Significantly increased biological activities were reflected by expression of the migration rate (1027 ± 1510) in comparison to the control group (632 ± 269) and the clonal potency measured by colony-forming unit (CFU) (tumor patients (19.7 ± 12.3) vs. control group (10.84 ± 4.8)). To determine whether or not EPC number can be used as a valid prognostic marker for clinical outcome of tumor patients, we furthermore compared a "high EPC-number-subgroup" (HI) with a "low EPC-number-subgroup" (LO) in a Kaplan-Meier survival curve. The HI-subgroup shows herein clearly a worse outcome. CONCLUSIONS: Our findings indicate a possible pathway for EPC to play a critical role in the vasculogenesis and consequently in the progression of HNSCC. CLINICAL RELEVANCE: Our findings could serve as possible predictors for the neovascularisation potential in HNSCC tumor patients.

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.

Dental and jaw injuries sustained by hooligans.

AIM: The study deals with fighting-related dental injuries sustained by hooligans and the influence of wearing a mouthguard on fighting-related dental trauma. MATERIAL AND METHODS: From 2012 to 2013, standardized multiple-choice questionnaires were distributed via contacts in the hooligan scene in Switzerland. The survey was conducted with the guarantee of complete anonymity and investigated injury patterns in hooligans from different age groups, of different nationalities as well as educational and income levels. RESULTS: Of the 95 hooligans surveyed, 82 had sustained a dental injury: 29 were minor and 53 were severe dental injuries. During violent confrontations, 37 of the 95 hooligans wore a mouthguard. The most commonly used mouthguards were custom-made (19/37) or boil-and-bite (10/37). The use of ready-made mouthguards without an individualized fit (6/37) was less frequent. Hooligans who wore a boil-and-bite or a custom-made mouthguard lost fewer teeth during fights than participants wearing a mouthguard without an individualized fit (P = 0.056). CONCLUSION: The risk of trauma during violent confrontations between hooligans is very high, as expected. The injuries range from dental trauma to bruising, lacerations and even serious bone fractures of the face and the extremities. During violent clashes over a third of the hooligans wear a mouthguard that has usually been custom-made or at least individually fitted; this is a far higher frequency than for most contact sports.

Is furcation involvement in maxillary molars a predictor for subsequent bone augmentation prior to implant placement? A pilot study.

AIM: The aim of this pilot study was to analyze the interfurcal bone height in relation to the possible need for subsequent sinus floor elevation in patients with advanced periodontitis and furcation involvement of first and/or second maxillary molars. MATERIAL AND METHODS: Seventeen dentate patients, who received cone beam computed tomography (CBCT) for detailed preoperative diagnosis and planning of surgical interventions at periodontally involved maxillary molars (17 first and 15 second molars), were consecutively recruited for the study. The minimal bone height in the interfurcal region was measured from CBCT and related to furcation involvement, residual bone above the root tips, and the clinical probing pocket depth (PPD). RESULTS: The minimal interfurcal bone height measured 4.1 ± 2.6 mm on average with 75% of maxillary molars having ≤ 6 mm and almost 60% having only ≤ 4 mm bone height left below the sinus floor. A higher risk for reduced interfurcal bone height of ≤ 4 mm was given when residual PPD of ≥ 6 mm was remaining at two or more tooth sites (OR 0.10; 0.11). CONCLUSIONS: The majority of periodontally involved maxillary molars had a substantially reduced interfurcal bone height, particularly with at least two sites with residual PPD ≥ 6 mm. This was a predictor for a subsequent need for sinus floor elevation when tooth replacement with a dental implant is desired.