Non-surgical treatment of mild to moderate peri-implantitis with an oscillating chitosan brush or a titanium curette-12-month follow-up of a multicenter randomized clinical trial.

OBJECTIVES: To study clinical and radiographic outcomes after non-surgical treatment of peri-implantitis using either an oscillating chitosan brush (OCB) or titanium curette (TC) and to observe changes in clinical signs of inflammation after repeated treatment. METHODS: Thirty-nine patients with dental implants (n = 39) presented with radiographic bone level (RBL) of 2-4 mm, bleeding index (BI) ≥ 2, and probing pocket depth (PPD) ≥ 4 mm were randomly assigned to mechanical debridement with OCB (test) or TC (control). Treatment was performed at baseline and repeated at 3, 6, and 9 months in cases with > 1 implant site with BI ≥ 1 and PPD≥4 mm. Blinded examiners recorded PPD, BI, pus, and plaque. The radiographic bone level change between baseline and 12 months was calculated. A multistate model was used to calculate transitions of BI. RESULTS: Thirty-one patients completed the study. Both groups exhibited a significant reduction in PPD, BI, and pus at 12 months compared to baseline. Radiographic analysis showed stable mean RBL in both groups at 12 months. There was no statistically significant difference in any of the parameters between the groups. CONCLUSIONS: Within the limitations of this 12-month multicenter randomized clinical trial, non-surgical treatment of peri-implantitis with OCB or TC showed no statistically significant differences between the groups. Clinical improvements and, in some cases, disease resolution, was observed in both groups. However, persistent inflammation was a common finding which further puts emphasis on the need for further treatment.

Non-surgical treatment of mild to moderate peri-implantitis using an oscillating chitosan brush or a titanium curette-A randomized multicentre controlled clinical trial.

OBJECTIVES: This prospective, parallel-group, examiner-blinded, multicentre, randomized, controlled clinical trial aimed to assess the efficacy of an oscillating chitosan brush (OCB) versus titanium curettes (TC) on clinical parameters in the non-surgical treatment of peri-implantitis. MATERIAL AND METHODS: In five dental specialist clinics, 39 patients with one implant with mild to moderate peri-implantitis, defined as 2-4 mm radiographic reduced bone level, bleeding index (BI) ≥ 2, and probing pocket depth (PPD) ≥ 4 mm were randomly allocated to test and control groups, receiving OCB or TC debridement, respectively. Treatment was performed at baseline and three months. PPD, BI, and Plaque index (PI) were measured at six sites per implant and recorded by five blinded examiners at baseline, one, three, and six month(s). Pus was recorded as present/not present. Changes in PPD and BI were compared between groups and analysed using multilevel partial ordinal and linear regression. RESULTS: Thirty-eight patients completed the study. Both groups showed significant reductions in PPD and BI at six months compared with baseline (p < .05). There was no statistically significant difference in PPD and BI changes between the groups. Eradication of peri-implant disease as defined was observed in 9.5% of cases in the OCB group and 5.9% in the TC group. CONCLUSIONS: Within the limitations of this six-month multicentre clinical trial, non-surgical treatment of peri-implantitis with OCB and TC showed no difference between the interventions. Eradication of disease was not predictable for any of the groups.

Maxillary overdenture on three implants retained by low-profile stud attachments - A prospective cohort study.

BACKGROUND: Clinical data are needed on long-term outcomes of removable implant-supported prostheses in the fully edentulous maxilla as a function of the number of implants, effects of the attachment system and other clinical variables. OBJECTIVE: To restore individuals with an edentate maxilla with a metal-reinforced removable prosthesis without palatal coverage retained by low-profile stud attachments on three implants. METHODS: The regional ethics committee approved a prospective cohort study that included all consecutive patients treated in a private speciality clinic. Primary outcomes were patients reported, that is denture satisfaction scale and oral health-related quality of life - OHIP-20. Secondary outcomes were implant- (bone loss, implant complications and peri-implant conditions) and prosthesis-related (prosthesis complications, maintenance needs and mucosa condition). RESULTS: Thirty-two study participants were recruited between March 2007 and October 2016 and followed for a minimum of five years. According to Kruskal-Wallis tests, the OHIP-20 and Denture Satisfaction Scale questionnaire pre-treatment scores differed significantly. After an average of 6.7 years, peri-implant bone loss of more than 2 mm was observed on 17% of all implants, while no or minor bone loss was seen on 38%. The estimated success of implants was 0.95 at 168 months. The estimated success of the prosthesis, that is no adverse events or need for any repairs, was 0.55 at 156 months. CONCLUSION: The positive findings in the current clinical study strengthen the notion that for many individuals with an edentulous maxilla, a removable prosthesis retained by three implants fitted with low-profile stud-attachment is a reliable technical solution.

Self-exercise programmes and occlusal splints in the treatment of TMD-related myalgia-Evidence-based medicine?

BACKGROUND: The low-cost and reversible treatments concerning disorders of the masticatory muscles represent a vast array of regimens. Common treatments include information, stretching exercises, manual therapy, acrylic splints and cognitive behavioural therapy. OBJECTIVE: The aim of this study was to evaluate the evidence behind the use of self-exercising programmes and occlusal splints in the treatment of myofascial pain. METHODS: We conducted a thorough search of five databases, using four cardinal search terms in combination with twelve supporting terms. We also assessed the evidence quality, using GRADEpro software. RESULTS: The search resulted in 4967 individual studies. 18 studies met the inclusion criteria and were re-evaluated. CONCLUSION: The selected studies were in favour of a self-care or an occlusal splint treatment of myalgia. However, a GRADE assessment showed that 14 of the 18 selected studies had low or very low evidence quality. Studies also showed weaknesses with regard to nomenclature and reproducibility. Hence, it is our professional opinion that the evidence level for prescribing self-exercises and occlusal splints in the treatment of myalgia is low.

Maxillary 3-implant removable prostheses without palatal coverage on Locator abutments - a case series.

OBJECTIVES: The aim of this study was to present the clinical outcomes of patients with an edentulous maxilla treated with a removable prosthesis without palatal coverage retained by Locator abutments on three titanium implants. MATERIAL AND METHODS: All the patients in a private dental clinic consecutively treated up to 6 years earlier were invited for a follow-up examination (n = 23). Two implants were placed bilaterally and one implant anteriorly in a tripod pattern. All patients underwent a clinical and radiological examination and completed questionnaires related to their experiences and satisfaction with the reconstructions. The prosthesis and implants were examined for adverse biological or technical aspects. Patient satisfaction and quality of life outcomes were collected using a self-reported Denture Satisfaction Scale and OHIP-20. Statistical analyses were limited to descriptive statistics. RESULTS: Twenty-one of 23 invited participants consented to participate. We report in this study the outcomes of the study participants who had received their implants more than 2 years ago (n = 12). None of their 36 implants gave any indications of mobility or tenderness upon percussion. Suppuration was observed on one implant. Probing around the implants caused no (53%) or minor bleeding (47%). The incidence of adverse biological and technical events was near non-existent. The rates of replacement of male attachments varied, as did any changes of male attachment retention force. All participants described the task of insertion and removal of the prosthesis as unproblematic. The marginal bone loss ranged between 0 and 5.3 mm. The OHIP-20 and the Denture Satisfaction Questionnaire scores were high. CONCLUSIONS: The results in this clinical study are positive and promising. Admittedly, the study design is purely retrospective and observational with a small participant cohort, so the technical solution of placing three implants in the edentulous maxilla to retain a removable prosthesis should be appraised further in more controlled studies.

Clinical performance of enamel-dentine bonded all-ceramic restorations: retrospective evaluation in a postgraduate clinic.

The aim of this retrospective study was to evaluate the clinical survival and success of five dif- ferent types of adhesive bonded all-ceramic restorations, in a postgraduate clinic. All ceramic enamel-dentin adhesive bonded restorations, either partial (n=94) or full coverage (n=145), were assessed by clinical examination using a modified Californian Dental Association (CDA) system for quality evaluation of dental care and a questionnaire assessing patient satis- faction (VAS) of 29 subjects with 239 restorations. The same 3-step adhesive bonding system in combination with dual-cured resin composite cement was used for all restorations Rubber dam was used for moisture control.The ceramics were evaluated with respect to patient satisfaction, esthetics, technical and biological complications. The reasons for treatment were mineralisation disorders (n=82), trauma (n=40), esthetic (n=57) and pathological tooth wear (n=60). Observation period for the restorations was up to 71 month (mean 33). All restorations were in place at the examinations (l00% survival rate). Number offractures and infractions were 28 and 20 respectively giving a 69% success rate. No significant difference was observed between full coverage and partial coverage restorations. Most of the fractures were small chippings of the veneering porcelain. From a biological point of view subgingival location of the restoration margin showed a significant correlation with bleeding on probing.The esthetic outcome seemed to depend on the ability of the selected veneering material to mask a severe tooth discoloration.The patients reported a high degree of satisfaction with both the esthetics and the function of their restorations. In conclusion all-ceramic enamel-dentin-bonded restorations demonstrated good short-term survival rate.The success rate was found to be lower. Both technical and biological complica- tions were present but mainly without any need of correction.The patients were in general very satisfied with the result of their dental treatment both esthetically and functionally.

A Descriptive in vitro Electron Microscopic Study of Acidic Fluoride-Treated Enamel: Potential Anti-Erosion Effects.

This study aimed to investigate the surface zones of acidic fluoride-treated enamel. Human teeth were each divided into three or four enamel specimens that were treated for 10 min with solutions of 0.2 and 0.4% HF (pH 3.09 and 2.94), 1.74% SnF2 (pH 2.9), 0.68% TiF4 (pH 1.6) and 0.84% NaF (pH 4.5). Untreated specimens functioned as negative controls. The microstructure and elemental composition of the surface zones were studied by scanning electron microscopy/energy-dispersive X-ray (EDX) analysis, transmission electron microscopy (TEM) and nanospot-EDX following cross-sectional preparation using focused ion beam technology. TEM/EDX analyses of NaF-treated specimens showed a 500-nm-thick closed surface film containing 20-40 at% (atomic percent) F. HF-treated specimens had a distinct surface film 200-600 nm thick (dense, not globular) containing 45-47 at% F. TiF4-treated specimens had a surface film of 200-300 nm in thickness containing 8-11 at% Ti but no detectable fluoride. SnF2-treated specimens had a modified surface enamel layer varying in thickness from 200 to 800 nm with an inhomogeneous distribution of Sn. Local spots were detected with as high as 8 at% Sn (30 wt%, weight percent). The results suggest that the reaction mechanisms of SnF2 and TiF4 solutions with dental enamel differ from those occurring after enamel exposure to acidulated NaF and HF solutions. While the HF and NaF treatments resulted in the formation of CaF2-like material as shown by EDX, no significant surface fluoridation was found for SnF2 and TiF4 solutions within the TEM/EDX detection limits. These results suggest that the erosion-protective mechanisms of these latter compounds probably relate more to the formation of hardly soluble and acid-resistant reaction surface films and less to surface fluoride incorporation.

Anatomical three-dimensional model with peri-implant defect for in vitro assessment of dental implant decontamination.

OBJECTIVES: Access to the implant surface plays a significant role in effective mechanical biofilm removal in peri-implantitis treatment. Mechanical decontamination may also alter the surface topography of the implant, potentially increasing susceptibility to bacterial recolonization. This in vitro study aimed to evaluate a newly developed, anatomically realistic, and adaptable three-dimensional (3D)printed model with a peri-implant bone defect to evaluate the accessibility and changes of dental implant surfaces after mechanical decontamination treatment. MATERIAL AND METHODS: A split model of an advanced peri-implant bone defect was prepared using 3D printing. The function of the model was tested by mechanical decontamination of the exposed surface of dental implants (Standard Implant Straumann AG) coated with a thin layer of colored occlusion spray. Two different instruments for mechanical decontamination were used. Following decontamination, the implants were removed from the split model and photographed. Image analysis and fluorescence spectroscopy were used to quantify the remaining occlusion spray both in terms of area and total amount, while scanning electron microscopy and optical profilometry were used to analyze alteration in the implant surface morphology. RESULTS: The 3D model allowed easy placement and removal of the dental implants without disturbing the implant surfaces. Qualitative and quantitative assessment of removal of the occlusion spray revealed differences in the mechanism of action and access to the implant surface between tested instruments. The model permitted surface topography analysis following the decontamination procedure. CONCLUSION: The developed 3D model allowed a realistic simulation of decontamination of implant surfaces with colored occlusion spray in an advanced peri-implant defect. 3D printing allows easy adaptation of the model in terms of the shape and location of the defect. The model presents a valuable tool for in vitro investigation of the accessibility and changes of the implant surface after mechanical and chemical decontamination.

A replica technique for studying the effect of fluoride solutions on enamel erosion.

UNLABELLED: The aim of this in vitro study was to develop a replica technique aimed at reproducing an enamel surface exposed to erosive challenge. The replica technique was then used to compare the effect of treating enamel with different fluoride (F) solutions using an in vitro erosion model. Human molar teeth were split in two (total n=34 specimens), and half of each specimen was isolated with impression material. Part I: 10 specimens were exposed to either 0.18% or 1.8% citric acid, the impression material was removed and replicas were prepared. All specimens and replica models were analysed by profilometry and SEM. Part II: 24 specimens were treated with native 0.1 mol/L F-solutions (HF, SnF2, NaF and TiF4), the impression material was removed, and the specimens were then exposed to 1.8% citric acid. Replicas were prepared and analysed by profilometry and SEM. The median height difference between the F-treated areas and the non-treated areas for each F-solution was measured. SEM micrographs were analysed qualitatively blind bytwo of the authors. RESULTS: Part I--Replicas showed good topographical reproduction of the tooth specimens. Part II--HF had a significantly greater erosion-inhibiting effect than the other fluoride solutions at 0.1 mol/L F as shown by profilometry. SEM revealed a clearly defined border between F-treated and non-treated surfaces only for specimens treated with HF- and TiF solutions. In conclusion, the present replica technique was able to differentiate between the effect of treating enamel with different fluorides against dental erosion in vitro. The technique should be tested further for possible use in situ and in vivo.

Retrospective study of patients with amelogenesis imperfecta treated with different bonded restoration techniques.

OBJECTIVE: The aim of this retrospective study was to evaluate clinical success and satisfaction of patients with amelogenesis imperfecta treated with three different types of bonded restorations at a university clinic. MATERIALS AND METHODS: One hundred fifty-four restorations in 15 subjects with mean age of 17.3 years (SD 8.2) were evaluated after treatment with three different types of bonded restorations: all ceramic enamel-dentin bonded restorations, prefabricated composite veneers, and direct composite resin restorations. A modified version of the Californian Dental Association system for quality evaluation of dental care and a questionnaire assessing patient satisfaction were used for classification. The restorations were evaluated with respect to patient satisfaction, esthetics, technical, and biological complications. RESULTS: Mean observation period for the restorations was 42.5 months (SD 35.6). All restorations were in place at the time of the examination. Surface and color calibration showed a success of 95% for the ceramic enamel-dentin bonded restorations, 44% for the direct composite resin restorations, and 0% for the prefabricated composite veneers. The same pattern was evident for anatomy and marginal integrity. The subjects reported a high degree of satisfaction with both the esthetics and function of their restorations. CONCLUSION: The results indicated that all ceramic restorations demonstrated the best results for patients with amelogenesis imperfecta.

Dentin to dentin adhesion using combinations of resin cements and adhesives from different manufacturers - a novel approach.

AIMS: The aims of this study were to present a novel method to analyse dentin bond strength and to evaluate the bond strength of combining adhesive systems and resin cement from different manufacturers. METHODS: Human wisdom teeth were ground flat to the dentin on parallel surfaces and axially cut into two parts. Dentin cylinders (Ø 3 mm) were drilled from one half of each tooth. The other half from each tooth was embedded in epoxy resin with the dentin surface exposed. The specimens were ground with silicone carbide paper and the dentin cylinders were cemented onto the dentin surface of the other half of the same tooth.Materials: Resin cement and adhesive systems from three different manufacturers were used in various combinations (n = 8 per group). Cement and adhesive from the same manufacturer served as control. Shear bond strength (SBS) was measured and fracture modes were registered.Results and conclusions: The highest median SBS value was found in a bonding combination between cement and a non-corresponding adhesive (33.1 MPa) and one of the lowest values was found in one of the controls (15.3 MPa). Cohesive fractures were most frequent. The results indicated that combining adhesive and cement from different manufacturers did not compromise the dentin bonding. The novel test method is recommended for evaluating dentin bonding.

In vivo and in vitro irritation testing of low concentrations of hydrofluoric acid.

OBJECTIVE: Acidic fluorides are proposed for the treatment of dental erosion. The aim of this study was to examine the irritation properties of dilute hydrofluoric acid (HF) solutions for potential use in the oral cavity. MATERIAL AND METHODS: Hen's egg test-chorioallantoic membrane (HET-CAM): The CAM was accessed by careful dissection through the egg shell (n=36, 6 eggs/test solution) and exposed to 300 µl of the HF solutions (0.05%, 0.10%, 0.20%, and 1.0%) under macroscope examination over the course of 5 min. Mean time-to-coagulation and average irritation score were recorded based on appearance of hemorrhage, coagulation, and lysis of the blood vessels in the membrane. Mouse skin test: 60 male mice were randomly divided into 10 groups of 6 animals each (control, 0.05%, 0.10%, 0.20%, and 1.0% HF), shaved on the back, exposed to test solution, and euthanized after 2 h or 24 h. Skin samples were evaluated by light microscopy, scoring epithelial leukocyte infiltration, vascular congestion, and edema. RESULTS: HET-CAM: 0.05% HF was slightly irritant, 0.1% HF moderately irritant, 0.2% and 1% HF strongly irritant. 0.1-1% HF solutions were severely irritating on the eye. Mouse skin test: HF concentration was significantly correlated with tissue response, and 24-h exposure to 1% HF solution showed focal erosion of the epithelium and marked localized subepithelial leukocyte infiltration. CONCLUSION: The results of the studies suggest that accidental exposure of soft tissues to solutions containing more than 0.2% HF may be harmful.

Clinical comparison of conventional and additive manufactured stabilization splints.

The aim of this study was to compare conventional and digital additive manufacturing of hard occlusal stabilization splints (SS) using technical and clinical parameters. 14 subjects were subjected to DC/TMD Axis I clinical examination protocol and Axis II questionnaire. The subjects underwent treatment with splints over a period of 12 weeks. All subjects underwent both conventional alginate impression and intraoral digital scanning. Seven subjects received conventional manufactured stabilization splints (CM-SS), and seven subjects received CAD-CAM additive manufactured stabilization splints (AM-SS). 12 subjects completed the 12 weeks follow-up period. The subjects significantly preferred digital intraoral scanning compared to conventional alginate impression. There was a significant difference in VAS between CM-SS and AM-SS. The mean VAS result was 15 for AM-SS and 42 for CM-SS, 0 represented excellent comfort and 100 very uncomfortable. This was significant. Splint manufacturing method had no influence on treatment outcome. There was no significant difference in mean delta change for unassisted jaw opening from baseline to 12 weeks between the two groups, for CM-SS it was 2 mm difference and for AM-SS the difference was 3 mm. All subjects in both treatment groups showed improved oral function. In this study, the scanning procedure is more accepted by the subjects than alginate impressions, however the first procedure was more time consuming.

Etching effect of acidic fluorides on human tooth enamel in vitro.

OBJECTIVE: This in vitro study aimed to examine the etching effect of acidic fluoride solutions on enamel. MATERIALS AND METHODS: 24 human teeth divided into 48 enamel-specimens were partly isolated with impression material. Specimens were exposed for 10 min to 20ml of the following solutions: 1.6% TiF4, 3.9% SnF2, 0.2% HF and 1.8% citric acid (CA). The isolation was removed and 24 specimens analysed by profilometry (Δheight: exposed/isolated enamel surfaces, surface roughness parameters). For the remaining 24 specimens [Ca(2+)] in the test solutions was analysed by atomic absorption spectroscopy. RESULTS: Median Δheights (µm) after exposure were: TiF4 0.07, SnF2 -0.03, HF -0.14 and CA -5.92. TiF4-exposed surfaces showed both deposits and etched areas and exhibited statistically significant different surface roughness parameters compared to the HF- and SnF2-exposed surfaces. Median [Ca(2+)] values (ppm): TiF4 1.88, SnF2 0.11, HF 0.10 and CA 2.17. CONCLUSION: At the [F] tested in this study it can be concluded that SnF2- and HF solutions had negligible erosive effects on enamel. TiF4 solution resulted in an incomplete surface deposition associated with calcium dissolution suggesting that TiF4 applied as solution may not be advisable.

Effect of acidic fluoride treatments on early enamel erosion lesions--a comparison of calcium and profilometric analyses.

OBJECTIVE: The protective effect of fluoride solutions against acidic challenge on enamel was tested in vitro using calcium- and profilometer analyses. METHODS: HF-, SnF(2)-, TiF(4)- and NaF solutions (0.1M F(-), with a pH of 2.0, 2.9, 1.5, 7.3, respectively) and H(2)O were tested on a total of 60 enamel specimens divided into 10 groups. Prior to and after F-treatment five groups were exposed for 1 min to 0.01 M citric acid, and the other five groups for 10 min to 0.1M citric acid. Enamel specimens were measured by profilometry at baseline and before and after each acidic challenge. [Ca] in the collected citric acid samples was measured by atom absorption spectroscopy (AAS). DeltaCa and Delta surface height were calculated for each specimen and the data were analysed using one-way ANOVA, Tukeys test and Pearson r correlation. RESULTS: AAS showed that the acidic F-treatments significantly reduced enamel dissolution for both the 1 min and 10 min acidic challenge. Profilometry showed no significant differences between the F-solutions for the 1 min groups. Significant differences could be seen between the fluorides for the 10 min groups and there was a large correlation between the profilometric and AAS results. In conclusion, all fluoride solutions reduced enamel dissolution when specimens were exposed to citric acid. CONCLUSIONS: The profilometer was not sensitive enough to measure the effects of the different fluorides against a low acidic challenge. AAS was able to show these differences and for the 10 min acidic challenge there was a good correlation between the results from the two methods.

A systematic review of the scientific documentation of fixed partial dentures made from fiber-reinforced polymer to replace missing teeth.

PURPOSE: Many restorative systems have become commercially available that are based on fiber-reinforced polymers (FRP) for production of fixed partial dentures. However, the clinical documentation of their use has not been systematically reviewed and critically appraised. This systematic review aimed to identify the scientific documentation of all commercially available products within this material group. MATERIALS AND METHODS: MEDLINE was searched for all clinical and laboratory studies on FRP, and papers were browsed to identify product names. Moreover, the Internet was searched to find manufacturers of FRP products. Also, several large trade exhibitions were visited to identify products and manufacturers. All papers that included any data from a clinical setting of an identifiable product were critically appraised. Each product was categorized according to the scientific clinical documentation of their intended clinical use. RESULTS: Eleven commercial products were identified. The scientific clinical documentation of these products varied markedly, but was generally poor. No randomized controlled trials have been carried out on FRPs versus, eg, conventional treatments, nor are any long-term cohort studies available. None of the products demonstrate good evidence for usage as a technical solution to permanently replace lost teeth. CONCLUSION: The use of FRP for fixed partial dentures must still be regarded as experimental.