Increased safety in periodontal surgery: Doppler ultrasound for detection of relevant palatal blood vessels-A proof-of-concept and cross-sectional study.

AIM: To evaluate the suitability of a Doppler ultrasound probe in detecting the greater palatine artery or its greater branches non-invasively. MATERIALS AND METHODS: The palatal mucosa of 108 participants (median age 34 years, 51 female) was systematically divided into transversal sectors, each aligning with the positions of the upper molars (M), premolars (P) and canine teeth (C), aiming to facilitate precise and consistent localization of the detected palatal blood vessel across different patients. Blood flow of the palatal blood vessels, presumably, was located by scanning the palatal vault bilaterally using an 8-MHz ultrasound probe linked to a transducer. The distance to the corresponding tooth was measured using a millimetre-scale periodontal probe. RESULTS: Within the regions of M2 to P1, the ultrasound transducer gave a delimitable acoustic pulse signal in 80%-98% of all measurements. The measured median distances between the determined position of the artery and the corresponding teeth ranged from 13 to 15 mm, with smaller distances in the anterior region. In several sectors, the distance was significantly higher for men (C: p = .048; P1: p = .041, M1: p < .01; M2: p = .034). CONCLUSIONS: Use of the Doppler ultrasound transducer might be a promising approach to non-invasively detect relevant palatine blood vessels preoperatively. It, therefore, might have the potential to reduce the risk of accidental injury during palatal surgery.

Very old age impacts masticatory performance: a study among sexagenarians to centenarians.

OBJECTIVE: This cross-sectional pilot study evaluated the impact of age on masticatory performance among individuals aged 65 to 106 years, as part of the Heidelberg Dental Centenarian Study (HD-100Z) conducted in South-Western Germany. MATERIALS AND METHODS: A total of 31 centenarians were recruited, alongside 31 individuals each from the age groups 75-99 and 65-74, matched based on sex, prosthetic status, and number of teeth. Masticatory performance was assessed using a two-colored chewing gum test and digital image processing. Multiple linear regression analysis was performed to assess the effect of age, sex, number of teeth, type of prosthesis on the masticatory performance. RESULTS: Masticatory performance, as measured by the standard deviation of hue in the chewing gum test, decreased significantly in centenarians compared to individuals aged 75-99 years (-0.112, p = 0.037) and those aged 65-74 years (-0.274, p < 0.001). The effects of sex, number of teeth, and type of prosthesis on masticatory performance were not significant associations (p ≥ 0.135). CONCLUSION: The findings suggest that age may have a significant influence on masticatory performance in the studied age groups, challenging previous notions that aging itself has little impact on masticatory ability. The inclusion of centenarians in the study highlights the need for further investigation into masticatory function in age groups reaching up to 100 years or more. CLINICAL RELEVANCE: This study contributes to the understanding of how ageing affects oral function, which may guide dental treatment approaches for older individuals, and set the stage for more in-depth investigations in this field in the future.

Dental treatment of children with special healthcare needs: A retrospective study of 10 years of treatment.

BACKGROUND/AIM: Children with special healthcare needs (CSHCN) often face oral health challenges. This retrospective cross-sectional study at a university hospital aimed to determine CSHCN's medical spectrum, dental treatment needs, and mode of treatment: general anesthesia (GA) or outpatient dental care (ODC). DESIGN: Data from the Department of Conservative Dentistry, Heidelberg University Hospital, 2012-2022, were reviewed, considering age, gender, International Classification of Diseases-10 diagnoses, caries experience (dmft/DMFT), restorative parameters, and treatment under GA/ODC. For patients under GA, their American Society of Anesthesiologists (ASA) classification was considered. Descriptive statistics, Kruskal-Wallis test, Mann-Whitney U-test and logistic regression were utilized. RESULTS: Of 669 patients, congenital and chromosomal malformations (34.7%), diseases of the nervous system (19.1%), and mental and behavioral disorders (16.0%) were mainly diagnosed. Dentin caries prevalence was high at 79.1%, with treatments performed mainly under GA (51.4%). The odds of receiving treatment under GA decreased with patient age and increased with higher dmft/DMFT scores. Most under GA were classified as ASA 3 (51.7%), indicating high anesthesia risks. CONCLUSION: Children with special healthcare needs often have diseases that can lead to higher challenges related to cooperation. The high prevalence of dentin caries underscores the substantial need for dental treatments, which were consequently often performed under GA, despite the associated risks. These findings stress the need for trained dental professionals.

Changes in serum omega fatty acids on a Mediterranean diet intervention in patients with gingivitis: An exploratory study.

BACKGROUND: Omega-6 and omega-3 polyunsaturated fatty acids (PUFAs) are precursors of pro- and anti-inflammatory lipid mediators. Serum PUFA levels could influence the severity of inflammatory oral diseases, such as gingivitis. OBJECTIVE: The study analyzed serum PUFA levels in a six-week randomized controlled trial in individuals on the Mediterranean diet (MedD), associations with the intake of specific foods, and possible correlations with oral inflammatory parameters. METHODS: Data from 37 study participants on either a MedD (MedDG; n = 18) or a "Western diet" in the control group (CG, n = 19) were analyzed. Dental examinations and serum analyses were performed at two time points, T1 (baseline) and T2 (week 6). Serum PUFA status, adherence to the MedD, and data from a Food Frequency Questionnaire were analyzed. RESULTS: Within the MedDG omega-6 fatty acid levels decreased significantly. In the overall sample, the proportional decrease in sites with bleeding on probing correlated weakly to moderately with the decrease in total omega-6 fatty acid level (Spearman's ρ = 0.274) and the decrease in gingival index correlated moderately with the decrease in linoleic acid level (Spearman's ρ = 0.351). Meat and fast-food consumption correlated positively with levels of various omega-6 fatty acids, whereas nut, fish, and dairy product consumption correlated positively with omega-3 levels. CONCLUSION: Adherence to a MedD was associated with a decrease in serum omega-6 levels, which positively affected the omega-6/omega-3 ratio. The MedD associated reduction in serum omega-6 levels may be a mechanism that favorably affects gingival inflammatory parameters.

Effect of the Mediterranean diet on gingivitis: A randomized controlled trial.

AIM: This study aimed to investigate the effects of a 6-week Mediterranean diet (MD) intervention on gingival inflammatory and anthropometric parameters of patients with gingivitis. MATERIALS AND METHODS: Forty-two participants were allocated to MD group (MDG) or control group (CG). After a 2-week equilibration period regarding dental care procedures, only MDG changed their diet to MD for 6 weeks, supported by a diet counselling. Gingival and anthropometric parameters were assessed at baseline (T0), Week 2 (T1, beginning of MD intervention), and Week 8 (T2). Adherence to MD was assessed by the Mediterranean Diet Adherence Screener (MEDAS); dietary behaviour was evaluated by the German Health Interview and Examination Survey for Adults Food Frequency Questionnaire (DEGS-FFQ). RESULTS: Plaque values remained constant in both groups. Inflammatory periodontal and anthropometric parameters decreased in the MDG only (gingival index: T1 1.51 ± 0.21, T2 1.49 ± 0.24; bleeding on probing: T1 51.00 ± 14.65, T2 39.93 ± 13.74; body weight: T1 79.01 ± 15.62, T2 77.29 ± 17.00; waist circumference: T1 84.41 ± 10.1, T2 83.17 ± 10.47 (p < .05). MEDAS revealed a sufficient diet adherence for MDG. CONCLUSION: Within this study, gingival inflammatory parameters were significantly reduced by MD, whereas plaque parameters remained constant. The diet counselling achieved sufficient adherence with beneficial changes in weight loss and waist circumference.

A quantitative assessment of silicone and PTFE-based stamp techniques for restoring occlusal anatomy using resin-based composites.

OBJECTIVES: Publications on stamp techniques for placing resin-based composite (RBC) restorations consist mainly of case studies. Furthermore, comparative studies are rare and no longer relevant to the materials tested today. Thus, two general techniques were investigated in this study. MATERIALS AND METHODS: Standardized occlusion class I cavities were prepared in twenty-eight extracted caries-free wisdom teeth with unimpaired occlusal surfaces and restored with the RBC material Grandio®. Light curing of the final layer was performed either after removal of the stamp isolated with PTFE tape or by leaving a stamp made of transparent polysiloxane in place. CEREC scans of the RBC restorations placed (follow-up) were superimposed on scans of the unimpaired occlusal surface (baseline) and quantitatively analyzed with the software OraCheck with regard to volume change and gain or loss of layer thickness in six sectional planes. RESULTS: Assessing the excess material, there was no difference (p = 0.31) between the silicone technique (0.26 mm ± 0.02) and the PTFE technique (0.22 mm ± 0.02 mm). Nevertheless, the loss of tooth substance was significantly greater (p < 0.001) with the silicone technique (-0.29 mm ± 0.02 mm) than with the PTFE technique (-0.15 mm ± 0.02 mm). CONCLUSIONS: With the PTFE stamp technique, less healthy tooth structure was removed during the finishing procedure and the stamp was more dimensionally stable. CLINICAL RELEVANCE: The study shows the advantages and disadvantages of the investigated stamp techniques and helps the practitioner to choose an appropriate technique.

Restorative CAD/CAM materials in dentistry: analysis of their fluorescence properties and the applicability of the fluorescence-aided identification technique (FIT).

OBJECTIVES: This study investigated the fluorescence properties of the most commonly used fluorescent CAD/CAM materials for monolithic dental restorations and their suitability to perform the fluorescence-aided identification technique (FIT). MATERIALS AND METHODS: A total of 175 different color shades (n = 1) from 13 CAD/CAM material brands were analyzed with a monochromator-based microplate reader. Additionally, dentin, enamel, and combined dentin-enamel specimens (respectively, n = 11) were analyzed for comparison purposes. The maximum fluorescence intensity, the corresponding excitation and emission wavelength, and the total fluorescence for the wavelength spectrum λex = 395 nm - 415 nm used for FIT were determined. RESULTS: All assessed CAD/CAM ceramics showed virtually no total fluorescence for the wavelength spectrum λex = 395 nm - 415 nm used for FIT. CERASMARTTM, KZR-CAD HD 2, and LuxaCam Composite displayed total fluorescence values similar to that of the tooth hard substances. All other resin-based CAD/CAM materials showed a significantly higher total fluorescence than the tooth hard substances. CONCLUSIONS: Apart from the mentioned exceptions, all CAD/CAM materials assessed could be suitable for the FIT, either because they are more fluorescent than hard tooth substances or because they do not fluoresce at all at the respective wavelength of λex = 395 nm - 415 nm. CLINICAL RELEVANCE: This study provides insight into the not yet well-known fluorescent properties of dental CAD/CAM materials. This knowledge is not only necessary to reproduce the fluorescence properties of natural teeth but also for the applicability of diagnostic fluorescence inducing techniques.

Minimally invasive removal of tooth-colored restorations: evaluation of a novel handpiece using the fluorescence-aided identification technique (FIT).

OBJECTIVES: This study investigated the ability of the fluorescence-aided identification technique (FIT) facilitated by a novel handpiece to simplify the removal of tooth-colored composite restorations with water-cooled rotating instruments. MATERIALS AND METHODS: Five undergraduate students and five dentists (6-14 years of professional experience) were asked to remove dental restorations in vitro using both the conventional technique (CT) and the fluorescence-aided identification technique. The FIT method was performed on teeth restored in addition to the fluorescent composite resin with the non-fluorescent (FIT1) and fluorescent (FIT2) bonding agent. CEREC scans were superimposed and three-dimensionally analyzed with the software OraCheck 2.13 with respect to the cavity surface area still covered with composite resin and the volume of the needlessly removed sound hard tissue. Additionally, the removal procedure was timed. RESULTS: The FIT2 group showed the most promising results: the smallest cavity surface area covered by composite resin independent of the professional expertise, and for the dentist group, the smallest amount of removed sound hard tissue and the fastest removal. CONCLUSIONS: Using the fiber optic of the handpiece for fluorescence excitation has been proven to be effective for performing the FIT, and therefore, to improve the removal of tooth-colored restorations. CLINICAL RELEVANCE: This study is basic research to encourage the integration of fluorescence inducing light sources in dental treatment units by the manufacturers as a prerequisite for a simplified daily use of the FIT.

The dental esthetic screening index: A new tool for assessment of dento-facial esthetics in restorative dentistry.

OBJECTIVES: There is a lack of comprehensive indexes, which can measure conditions or changes in dento-facial esthetics before and after treatment. Therefore, the 12-item Dental Esthetic Screening Index (DESI) was developed and validated. MATERIALS AND METHODS: Reliability was tested by five dental professionals, who evaluated 30 standardized patient photographs baseline and after 14 days. Clinical validation was done on 52 patients before and after restorative treatment. For subjective assessment, patients completed a validated questionnaire before and after treatment. Statistical analysis included inter and intrarater reliability, Wilcoxon test and linear regression analysis. RESULTS: The single item analysis identified two weak extraoral items (κ = 0.15; κ = -0.05), that were removed from the DESI. After this modification, both inter- (κ = 0.83-0.86) and intrarater reliability (ICC1-5 = 0.75-0.86) were in excellent to good agreement. In the clinical validation, the DESI was significantly lower after restorative treatment (P < .0001). The patients' perception questionnaires showed significant improvement after restorative therapy (P < .0001). A correlation of the DESI and the results of patients' perception questionnaires could be assumed (P < .0001; R2 = 0.32). CONCLUSIONS: The DESI was found to be a reliable and valid instrument for the quantitative assessment of dento-facial esthetics. It correlated well with the subjective assessment of the patients. CLINICAL SIGNIFICANCE: This comprehensive index would allow for objective quantification of clinical situations, for reliable baseline and outcome assessment in esthetic dentistry. As patients' esthetic feelings and sensations are subjective, this objective index is also proven to be congruent to patients' individual subjective assessment of dento-facial esthetics.

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.

Three-year randomized study of manual and power toothbrush effects on pre-existing gingival recession.

AIM: To compare long-term effects of brushing with an oscillating-rotating power toothbrush or an ADA reference manual toothbrush on pre-existing gingival recession. MATERIALS AND METHODS: In this controlled, prospective, single-blind, parallel-group study, healthy subjects with pre-existing recession were randomized and brushed with a power toothbrush (n = 55) or an ADA reference manual toothbrush (n = 54) for a 3-year study period. Subjects were required to brush their teeth twice daily for 2 min. using a standard fluoride toothpaste. During the study, subjects were assessed for clinical attachment loss and probing pocket depths to the nearest mm at six sites per tooth by the same calibrated examiner. Gingival recession was calculated at pre-existing sites as the difference between clinical attachment loss and probing pocket depths. Hard and soft oral tissues were examined to assess safety. RESULTS: After 35 ± 2 months, mean gingival recession did not differ significantly between groups, but was significantly reduced from baseline (p < 0.001), from 2.35 ± 0.35 mm to 1.90 ± 0.58 mm in the power and from 2.26 ± 0.31 mm to 1.81 ± 0.66 mm in the manual group. CONCLUSIONS: Gingival recession in subjects with pre-existing recession was significantly reduced after 3 years of brushing with either a power or manual toothbrush.

Effect of Aqueous Storage on Original and Repair Bond Strength and Residual Monomer Release of Fiberreinforced Composites.

PURPOSE: To evaluate the effects of aqueous storage on shear bond strength (SBS) and monomer release of fiberreinforced composites (FRCs). MATERIALS AND METHODS: Four unidirectional FRCs were tested, including one semi-interpenetrating polymer network (IPN) (ES, everStick) and three cross-linked polymer (CLP) FRCs (GT, GrandTec; TF, TenderFiber; DP, Dentapreg). The SBS of samples of original resin to fresh FRC with an intact oxygen inhibition layer (n = 30/group) and repair resin to FRC after surface treatment (n = 30/group) was evaluated after 6 and 12 months of storage in artificial saliva. Monomer release of polymerized resin-coated and uncoated FRCs was detected by high-performance liquid chromatography after immersion for 1 h, 1 day, and 7 days. RESULTS: After 6 months, a significant decrease in SBS was seen with ES-repair (p < 0.0001). After 12 months, significant decreases were seen with ES-original (p < 0.0001), ES-repair (p < 0.0001), and TF-repair (p = 0.0003). A significant reduction was also found for GT-original (p = 0.0254) and GT-repair (p = 0.0176). At 6 and 12 months, GT showed the highest SBS values, with DP-repair being statistically similar to GT at 12 months. For UDMA and bis- GMA, the greatest amounts of release were seen in uncoated specimens, followed by flowable resin-coated and viscous resin-coated specimens. CONCLUSION: Matrix composition, interfacial bonding, and resin coverage seem to account for differences in the aging behavior of FRCs. The semi-IPN material is likely to suffer most from the challenging oral conditions. CLP FRCs might be more stable over the long term. Coverage of FRCs with viscous resin is highly recommended to reduce residual monomer release.

Oral status in patients with early rheumatoid arthritis: a prospective, case-control study.

OBJECTIVE: Patients with RA suffer from a higher risk of periodontal attachment loss and increased oral inflammation. We hypothesize that there are pathogenetic and immunological interactions between these diseases that go beyond impaired manual dexterity accompanying advanced RA. The primary objective of the present study was to determine whether a loss of alveolar bone can be detected in RA patients during the early course of the disease. METHODS: In this cross-sectional, epidemiological case-control study, 22 patients with early RA (ERA) were compared with 22 matched healthy controls. Oral and periodontal status, clinical activity, and socio-demographic parameters were determined. Oral microbiota were analysed using real-time quantitative PCR specific for leading oral pathogens. RESULTS: More advanced forms of periodontitis were found in ERA patients compared with controls. ERA patients had a greater number of missing teeth [ERA 5.7 (s.d. 5.0), controls 1.9 (s.d. 1.0), P = 0.002], deeper periodontal pockets [clinical attachment level: ERA 3.4 (s.d. 0.5 mm), controls 2.7 (s.d. 0.3 mm), P < 0.000], and greater bleeding on probing [ERA 18.6% (s.d. 9.0%), controls 10.5% (s.d. 5.1%), P = 0.001] despite comparable oral hygiene. Tannerella forsythia (6.77-fold, P = 0.033) subgingivally and Streptococcus anginosus (3.56-fold, P = 0.028) supragingivally were the characteristic pathogens in ERA. CONCLUSION: Increased loss of periodontal attachment and alveolar bone can be detected in patients with ERA, therefore we propose that the consulting rheumatologists inform the patients that they have a higher risk of periodontal disease. It would be beneficial if these patients were referred directly for intensive dental care.

Cytotoxicity of coated and uncoated fibre-reinforced composites.

OBJECTIVE: Currently, there are many fibre-reinforced composites (FRCs) available which differ in the type and volume fraction of fibres, pre-treatment of fibres and matrix composition. The aims of this in vitro investigation were to determine whether there is a difference in biocompatibility of FRCs and if coating FRCs with resin composites influences their cytotoxic potential. MATERIALS AND METHODS: Five different FRC materials were tested which were either uncoated or coated with flowable or viscous resin composite. Artificial saliva extracts were prepared according to USP-XXIII and ISO-10993 to determine cytotoxicity by testing cell viability and growth of primary human gingival fibroblasts (HGF) using MTT assay, LIVE/DEAD(®) assay and cell proliferation assay. The influence of eluates on fibres of the cytoskeleton was investigated by vimentin, tubulin and actinin immunostainings. A two-way ANOVA followed by Scheffe's post-hoc test, which included the factors FRC material and coating procedure, was performed to assess cytotoxicity. RESULTS: All extracts of FRC materials displayed minor cytotoxic potential on HGF cell viability, cell proliferation and integrity of the cytoskeleton. The type of FRC material significantly influenced cell viability (MTT assay) (p < 0.0001), whereas neither the presence of a coating nor the type of coating material resulted in altered cell viability. Distribution and organization of cytosolic fibres was not affected after HGF exposure to eluates. CONCLUSIONS: There is a lack of knowledge about the leaching behaviour of commonly available fully pre-impregnated FRCs and their interactions with coating materials. The coating of FRCs with resin composite materials did not impact biocompatibility.

Fiber-reinforced composite fixed dental prostheses in the anterior area: a 4.5-year follow-up.

STATEMENT OF PROBLEM: Currently, fiber-reinforced fixed dental prostheses (FRC FDPs) are a reliable treatment option for the restoration of single missing teeth in the anterior area. PURPOSE: The purpose of this study was to evaluate the survival of direct and semidirect fabricated FRC FDPs in the anterior area and to rate the quality of the outcome. MATERIAL AND METHODS: Twenty-four participants (12 men, 12 women) were included in the investigation. The prostheses were made of preimpregnated, unidirectional fiber-reinforced composite (FRC) (everStick, GC) by using a direct (n=18) or semidirect (n=6) technique. Eleven FRC FDPs had been placed in the maxilla and 13 had been placed in the mandible. Follow-up intervals were recorded, and the prostheses were classified as success (successful), survival (unfavorable event but still in vivo), or failure (lost). Quality was rated according to the modified United States Public Health Services (USPHS) or Ryge criteria. RESULTS: The FRC FDPs evaluated in this study showed an overall survival rate (success) of 72.6% and a functional survival rate (success + survival) of 85.6% (median follow-up 54 months). According to the USPHS/Ryge criteria, most of the restorations displayed excellent or good quality. Survival analysis was performed by the Kaplan-Meier method. CONCLUSIONS: The FRC FDPs evaluated in this study showed promising survival rates and good quality after a median follow-up period of 4.5 years (quartile range 3.5 to 6.3 years), thus indicating that FRC FDPs are reliable treatment options for the restoration of single missing teeth in the anterior area. The use of preimpregnated FRC materials with higher fiber content might improve the clinical fabrication of FRC FDPs but does not influence their long-term clinical survival.

Manual Dexterity Predictors of Artificial Urinary Sphincter Success.

OBJECTIVE: To determine better in-office measures for artificial urinary sphincter outcomes, we investigated the ability of preoperative timed peg-transfer, pinch strength, grip strength, and Disabilities of the Arm Shoulder and Hand Outcome questionnaire in predicting postoperative satisfaction, confidence, and ease of use of artificial urinary sphincter placement for stress urinary incontinence. MATERIALS AND METHODS: A timed 9-hole peg test, pinch and grip strength assessment, and upper extremity questionnaire were administered during the preoperative visit before sphincter placement. In addition to standard preoperative workup, short-form International Consultation of Incontinence Questionnaire and physician handshake were recorded. Activation occurred 6 weeks after surgery along with assessment of adequacy of pump placement. Three months from surgery a repeat incontinence questionnaire and a survey measuring satisfaction, difficulty of use, and confidence were given. Correlation between preoperative assessment variables and the postoperative questionnaire was assessed. RESULTS: Thirty-nine patients were included. Average age and body mass index were 68.8 years and 28.8 kg/m2, respectively. Prior prostatectomy accounted for 92.3% of patients, and 46.2% had prior pelvic radiation. Postoperatively, 59.0% of patients were very satisfied; 64.1% of patients reported no difficulty of use; 53.8% felt confidence within 1 day; and 66.7% had much better bladder control. Average pad improvement count was 5.3. Pinch test was associated with satisfaction (P = .011) while peg test was associated with confidence (P = .049). Handshake and upper extremity questionnaire were not significant. CONCLUSION: The pinch and 9-hole peg transfer tests are cost-effective and easily performed adjuncts that could be used during artificial urinary sphincter evaluation for patients with unclear manual functional status.

Human epidermal Langerhans cells replenish skin xenografts and are depleted by alloreactive T cells in vivo.

Epidermal Langerhans cells (LC) are potent APCs surveying the skin. They are crucial regulators of T cell activation in the context of inflammatory skin disease and graft-versus-host disease (GVHD). In contrast to other dendritic cell subtypes, murine LC are able to reconstitute after local depletion without the need of peripheral blood-derived precursors. In this study, we introduce an experimental model of human skin grafted to NOD-SCID IL2Rγ(null) mice. In this model, we demonstrate that xenografting leads to the transient loss of LC from the human skin grafts. Despite the lack of a human hematopoietic system, human LC repopulated the xenografts 6 to 9 wk after transplantation. By staining of LC with the proliferation marker Ki67, we show that one third of the replenishing LC exhibit proliferative activity in vivo. We further used the skin xenograft as an in vivo model for human GVHD. HLA-disparate third-party T cells stimulated with skin donor-derived dendritic cells were injected intravenously into NOD-SCID IL2Rγ(null) mice that had been transplanted with human skin. The application of alloreactive T cells led to erythema and was associated with histological signs of GVHD limited to the transplanted human skin. The inflammation also led to the depletion of LC from the epidermis. In summary, we provide evidence that human LC are able to repopulate the skin independent of blood-derived precursor cells and that this at least partly relates to their proliferative capacity. Our data also propose xeno-transplantation of human skin as a model system for studying the role of skin dendritic cells in the efferent arm of GVHD.

Clinical evaluation of bulk-fill and universal nanocomposites in class II cavities: Five-year results of a randomized clinical split-mouth trial.

AIM: Evaluating the clinical survival and quality parameters of class-II restorations using 3M™ FiltekTM Bulk Fill Posterior Restorative compared to 3M™ FiltekTM Supreme XTE Universal Restorative over a period of five years. MATERIALS AND METHODS: A longitudinal, randomized, prospective split-mouth study with 60 patients (29 female, 31 male; mean age 44 y; range 20-77 y) and a total of 120 load-bearing class II restorations (TEST: n=60 Filtek Bulk Fill Posterior Restorative; CONTROL: n=60 Filtek Supreme XTE Universal Restorative) was conducted. Clinical evaluation was performed by blinded evaluators according to FDI criteria. Kaplan-Meier method was used for survival analysis and an intergroup comparison (Mann-Whitney-U-Test) was carried out. A basic significance level of 0.05 was corrected by the Bonferroni method to account for multiple testing (significance after correction: p<0.00067). RESULTS: The mean overall survival of restorations was 92% after 56.98±1.51 months in the TEST group (95 CI= 54.02;59.94) and 92% after 57.25±1.46 months (95 CI= 54.39; 60.12) in the CONTROL group (log-rank p=0.995). In total, four failures occurred in both TEST and CONTROL group during the observation period (mean annual failure rate: 1.6%). The most common reasons for failure were chipping-fractures, debonding, cracked-tooth-syndrome and recurrent decay. With regard to the FDI criteria, no significant differences between TEST and CONTROL material occurred for any of the evaluated variables. In the TEST group two restorations had to be repaired and two had to be replaced, in the CONTROL group four restorations had to be replaced. CONCLUSION: Both materials showed acceptable clinical performance and survival during the 5-year observation period. CLINICAL SIGNIFICANCE: The use of a nanofilled bulk-fill composite proved to be an aesthetically, functionally and biologically satisfactory alternative in posterior dentition.

Proximal contact tightness between direct-composite additions in the posterior dentition: an in vitro investigation.

PURPOSE: The aim of the study was to test whether a novel three-step matrix technique for posterior direct-composite additions creates sufficiently strong proximal contacts. MATERIALS AND METHODS: Contact tightness was measured between direct-composite additions and between original teeth on a model. Therefore, the frictional forces required to remove a straight, 0.05-mm-thick, metal matrix band inserted between adjacent teeth and held by a universal testing machine (Zwicki, Zwick GmbH, Ulm, Germany) were recorded. Measurements were taken at three time points to carry out reference analysis: at baseline, after removal of the maxillary right second premolar (tooth #15) to simulate a diastema, and after closure of the diastema by inserting two direct-composite additions with the three-step matrix technique on the maxillary right first premolar (tooth #14) and first molar (tooth #16). Measurements were performed in the maxillary right (first) and left (second) quadrants to document sagittal displacement. RESULTS: The original contact tightness values were between 1.65 ± 0.88 N and 3.05 ± 0.60 N in the first quadrant and between 1.23 ± 0.51 N and 2.18 ± 0.43 N in the second quadrant. After removal of tooth 15, values decreased significantly in the first quadrant and insignificantly in the second. After reconstruction, the contact tightness between teeth 14 and 16 was significantly stronger (tighter) (3.20 ± 0.80 N) than the originally measured contact tightness between teeth 14 and 15 (2.86 ± 0.64 N) and teeth 15 and 16 (1.65 ± 0.88 N) (p=0.006 and 0.001, respectively). CONCLUSIONS: Within the limitations of an in vitro investigation, this study has shown that by using a novel, three-step matrix technique, direct posterior composite additions can form sufficiently tight proximal contacts.

Maintaining oral health for a hundred years and more? - An analysis of microbial and salivary factors in a cohort of centenarians.

Aim: To investigate associations between oral health-related conditions and the oral microbiome in a representative study sample of centenarians. Materials and methods: Clinical and microbial parameters from 54 centenarians were assessed in the Heidelberg Dental Centenarian Study. Plaque and salivary samples were collected, and the microbiota was characterized by 16S rRNA gene sequencing. Results: Diversity and structure of the oral microbiome were mainly influenced by the presence of natural teeth and the number of decayed, missing, and filled teeth (0.028 ≤ p ≤ 0.001 in plaque and salivary samples). Centenarians with less caries experience possessed a more diverse oral microbiome. Moreover, the number of dental visits also showed a significant influence on the microbial composition. Most centenarians presented with hyposalivation (mean stimulated flow rate = 0.84 ± 0.55 ml/min), a low buffering capacity, and an acidic pH. The latter was between 5.0 and 5.8 in 46.3% of cases, and we observed that an increased salivary pH correlated with higher alpha-diversity in both salivary and plaque samples. Conclusion: The microbiome diversity correlated significantly with successful oral aging. In addition, regular dental visits were a beneficial factor. However, diversity can be negatively influenced by hyposalivation, associated with pH changes due to aging effects.