3-Year Clinical Performance of a New Pit and Fissure Sealant.

The aim of this 3-year, randomized clinical trial (RCT) in split-mouth design was to explore the clinical survival of a Bis-GMA-free pit and fissure sealant (Helioseal F Plus) in comparison to a control material (Helioseal F). The initial population consisted of 92 adolescents. Follow-ups took place after one year (N = 85), two years (N = 82) and three years (N = 76) after application. At each examination, sealant retention and the presence of caries were recorded. The statistical analysis included the calculation of Kaplan-Meier survival curves, log-rank tests and a Cox proportional hazard regression model. No adverse events were documented. The proportion of completely intact sealants and those with minimal loss was almost identical in both groups, at 84.3% (Helioseal F; 113/134) and 81.7% (Helioseal F Plus; 107/131) after three years of observation. The regression analysis revealed an operator dependency, but no significant differences were found between the materials, the study centers, the chosen isolation technique, patient age or sex. After 3 years, 91.7% and 100.0% of all molars were free of non-cavitated carious lesions or carious cavities, respectively. It can be concluded that the new fissure sealing material can be considered as at least equivalent in terms of survival and retention behavior compared to the predecessor material.

Clinical performance of a new fissure sealant-results from a 2-year randomized clinical trial.

OBJECTIVES: The aim of this randomized clinical trial (RCT) was to explore the clinical survival of a new, Bis-GMA-free pit and fissure sealant (Helioseal F Plus) in comparison to an established control material (Helioseal F). MATERIAL AND METHODS: This in vivo study was designed as a prospective, 2-year, two-centre RCT with a split-mouth design. The initial study population consisted of 92 adolescents who were followed up 1 month (N = 89), 6 months (N = 88), 1 year (N = 85) and 2 years (N = 82) after sealant application. The attrition rate was 10.9% after 2 years. At each examination, the sealant retention and presence of caries were recorded. The statistical analysis included the calculation of Kaplan-Meier survival curves, log-rank tests and a Cox proportional hazard regression model. RESULTS: No adverse events during the application or any of the follow-up visits were documented. The proportion of completely intact sealants and those with minimal loss was almost identical in both groups at 85.9% (Helioseal F Plus) and 86.5% Helioseal F) after 2 years of observation. The regression analysis revealed operator dependency; no significant differences were found between the materials, the study centres, the chosen isolation technique and patient age or sex. CONCLUSION: The newly developed sealant can be evaluated as at least equivalent in terms of survival and retention behaviour compared to the established control material. CLINICAL RELEVANCE: The new sealant can be recommended for clinical use. With respect to the material properties (Bis-GMA-free, less light polymerisation time and better thixotropic behaviour), it offers additional advantages with clinical relevance.

Hypersensitivity in teeth affected by molar-incisor hypomineralization (MIH).

Tooth hypersensitivity is a common symptom in patients with molar-incisor hypomineralization (MIH). Therefore, this clinical study aimed to assess potential associations between patient- and tooth-related variables and the intensity of hypersensitivity in MIH-affected permanent teeth compared to healthy controls. Fifty-seven MIH patients and 20 healthy adolescents with a total of 350 MIH-affected and 193 healthy teeth were included in this study. The intensity of hypersensitivity was measured after cold air stimulation using the Schiff Cold Air Sensitivity Scale (SCASS) by the dentist and visual analogue scale (VAS) by the patient. Tooth hypersensitivity was low in non-MIH teeth (97.9% of the group had zero SCASS and VAS values). In contrast, MIH-affected teeth with demarcated opacities and atypical restorations had moderate SCASS and VAS values, whereas teeth with enamel breakdown were mostly linked to severe hypersensitivity. The logistic regression model confirmed a significantly lower level of hypersensitivity in MIH patients aged ≥ 8 years (OR 0.06, 95% CI 0.01-0.50, p = 0.009) and higher levels in molar teeth (OR 5.49, 95% CI 1.42-21.27, p = 0.014) and teeth with enamel disintegration (OR 4.61, 95% CI 1.68-12.63, p = 0.003). These results indicate that MIH-related tooth hypersensitivity seems to be present in disintegrated molars immediately after tooth eruption.

Treatment outcomes after uncomplicated and complicated crown fractures in permanent teeth.

OBJECTIVES: The objectives of this retrospective clinical study were to describe characteristics of crown fractures in permanent teeth and to investigate the survival of pulp vitality and restorations in uncomplicated and complicated crown fractures. MATERIALS AND METHODS: This retrospective study collected information from patients suffering from dental trauma who were treated between January 2004 and June 2017. The study population consisted of 434 patients (253 males/181 females; mean age 20.7 years) with 489 uncomplicated and 127 complicated crown fractures. The Kaplan-Meier survival curves and Cox proportional hazard regression analyses were performed to explore the data statistically. RESULTS: The mean observation time was 522 days. Uncomplicated crown fractures without luxation showed a higher success rate of 82.3% (345/419) than complicated crown fractures without luxation (72.3%, 73/101). An additional luxation in uncomplicated crown fractures resulted in significantly reduced success rates in terms of survival of the pulp and restoration. Direct restorations survived significantly better independent of the fracture mode than did adhesively reattached crown fragments. No superiority of mineral trioxide aggregate or calcium hydroxide as pulp capping agent in complicated crown fractures was documented. Approximately 85.5% of all complications occurred within 2 years after the accident. CONCLUSION: The treatment of crown fractures resulted mostly in successful outcomes and only a moderate number of complications were observed. CLINICAL RELEVANCE: Primary dental management of crown fractures should follow recently published clinical guidelines, and close monitoring over at least 2 years seems to be justified.

A detailed report on the measures taken in the Department of Conservative Dentistry and Periodontology in Munich at the beginning of the COVID-19 outbreak.

OBJECTIVES: The corona disease (COVID-19) is developing into one of the greatest challenges for healthcare professionals around the world. In this article, we report the detailed actions taken in the Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany, during the early phase of the COVID-19 pandemic. MATERIAL AND METHODS: After a joint on-site inspection of the dental clinic with the Department of Clinical Microbiology and Hospital Hygiene, existing clinical and hygiene protocols were adapted for COVID-19 patients. RESULTS: A comprehensive summary of the preparation of the facilities as well as pre- treatment, treatment and posttreatment protocols are described and arising problems are being discussed. CONCLUSIONS: The importance of rigorous hygiene and treatment protocols as well as a sufficient supply of PPE for dental offices and hospitals is highlighted. The measures reported may be subject to change due to the dynamics of the pandemic. CLINICAL RELEVANCE: The modes of transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (e.g., droplets, aerosols, and fomites) can pose a risk for dental healthcare professionals and patients alike. The presented measures may guide dental faculties and dental practices during the early stage of the COVID-19 crisis.

Comparison of four different treatment strategies in teeth with molar-incisor hypomineralization-related enamel breakdown-A retrospective cohort study.

BACKGROUND: There is little information available on the longevity of non-invasive glass ionomer cement (GIC) and composite restorations as well as conventional composite and ceramic restorations placed on permanent teeth with enamel breakdowns due to molar-incisor hypomineralization (MIH). AIM: To compare the longevity of the abovementioned treatment procedures. DESIGN: Of 377 identified MIH patients, 118 individuals received restorative treatment and were invited for clinical examination, including caries and MIH status. Finally, survival data from 204 MIH-related restorations placed on 127 teeth were retrospectively collected from 52 children, monitored between 2010 and 2018. Descriptive and explorative analyses were performed, including Kaplan-Meier estimators and the Cox regression model. RESULTS: The mean patient observation time was 42.9 months (SD = 35.1). The cumulative survival probabilities after 36 months-7.0% (GIC, N = 28), 29.9% (non-invasive composite restoration, N = 126), 76.2% (conventional composite restoration, N = 27) and 100.0% (ceramic restoration, N = 23)-differed significantly in the regression analysis. CONCLUSIONS: Conventional restorations were associated with moderate-to-high survival rates in MIH teeth. In contrast, non-invasive composite restorations, which were predominately used in younger or less cooperative children, were linked to lower survival rates.

Survival and complication analyses of avulsed and replanted permanent teeth.

This retrospective clinical study investigated the survival probability of avulsed and replanted permanent teeth in relation to functional healing, replacement and inflammatory resorption. The explorative data analysis included data from 36 patients and 49 replanted permanent teeth with a minimum observation time of 60 days; the patients were generally treated according to the current guidelines of the International Association of Dental Traumatology at the university hospital in Munich, Germany, between 2004 and 2017. The mean observation period was 3.5 years. Functional healing was observed in 26.5% (N = 13/49) of the included avulsion cases. In comparison, replacement resorption affected 51.0% (N = 25/49) of the replanted teeth, of which 24.0% (N = 6/25) were lost over the course of years (mean, 6.1 years). In contrast, inflammatory resorption resulted in the early loss of all replanted teeth (mean, 1.7 years) and affected 22.5% (N = 11/49) of all the monitored teeth. Therefore, it can be concluded that tooth avulsion remains a severe dental injury with an unpredictable prognosis. This topic demands further fundamental research aiming to maintain and/or regenerate the periodontal ligament after tooth avulsion, particularly in association with non-physiological tooth rescue.

Heteromultivalent Glycooligomers as Mimetics of Blood Group Antigens.

Precision glycomacromolecules have proven to be important tools for the investigation of multivalent carbohydrate-lectin interactions by presenting multiple glycan epitopes on a highly-defined synthetic scaffold. Herein, we present a new strategy for the versatile assembly of heteromultivalent glycomacromolecules that contain different carbohydrate motifs in proximity within the side chains. A new building block suitable for the solid-phase polymer synthesis of precision glycomacromolecules was developed with a branching point in the side chain that bears a free alkyne and a TIPS-protected alkyne moiety, which enables the subsequent attachment of different carbohydrate motifs by on-resin copper-mediated azide-alkyne cycloaddition reactions. Applying this synthetic strategy, heteromultivalent glycooligomers presenting fragments of histo-blood group antigens and human milk oligosaccharides were synthesized and tested for their binding behavior towards bacterial lectin LecB.

Reliability of prenatal detection of X-linked hypohidrotic ectodermal dysplasia by tooth germ sonography.

OBJECTIVE: In X-linked hypohidrotic ectodermal dysplasia (XLHED), dysfunction of ectodysplasin A1 (EDA1) due to EDA mutations results in malformation of hair, teeth, and sweat glands. Hypohidrosis, which can cause life-threatening hyperthermia, is amenable to intrauterine therapy with recombinant EDA1. This study aimed at evaluating tooth germ sonography as a noninvasive means to identify affected fetuses in pregnant carrier women. METHODS: Sonography, performed at 10 study sites between gestational weeks 18 and 28, led to the diagnosis of XLHED if fewer than six tooth germs were detected in mandible or maxilla. The assessment was verified postnatally by EDA sequencing and/or clinical findings. Estimated fetal weights and postnatal weight gain of boys with XLHED were assessed using appropriate growth charts. RESULTS: In 19 of 38 sonographic examinations (23 male and 13 female fetuses), XLHED was detected prenatally. The prenatal diagnosis proved to be correct in 37 cases; one affected male fetus was missed. Specificity and positive predictive value were both 100%. Tooth counts obtained by clinical examination corresponded well with findings on panoramic radiographs. We observed no weight deficits of subjects with XLHED in utero but occasionally during infancy. CONCLUSION: Tooth germ sonography is highly specific and reliable in detecting XLHED prenatally.

Monodisperse Sequence-Controlled α-l-Fucosylated Glycooligomers and Their Multivalent Inhibitory Effects on LecB.

The opportunistic bacterium Pseudomonas aeruginosa, often exhibiting multiresistance against conventional antibiotics, expresses the lectin LecB that is suspected to be an important factor during biofilm formation via interactions with cell-surface presented carbohydrate ligands such as the blood group antigens. Therefore, carbohydrate-based ligands interfering with LecB binding have the potential to lead to new anti-biofilm and anti-adhesion therapies. This study explores in vitro binding potencies of glycomimetic ligands containing up to six α-l-fucose ligands on a monodisperse, sequence-controlled oligoamide scaffold interacting with LecB. Surface plasmon resonance (SPR) and a modified enzyme-linked lectin assay (mELLA) revealed an increasing affinity to LecB with increasing fucose valency. Furthermore, fucosylated glycooligomers were shown to inhibit the formation of P. aeruginosa biofilm up to 20%. Overall these results show the potential of fucosylated oligoamides to be further developed as inhibitors of LecB binding and biofilm formation.

Fucose-Functionalized Precision Glycomacromolecules Targeting Human Norovirus Capsid Protein.

Norovirus infection is the major cause of nonbacterial gastroenteritis in humans and has been the subject of numerous studies investigating the virus's biophysical properties and biochemical function with the aim of deriving novel and highly potent entry inhibitors to prevent infection. Recently, it has been shown that the protruding P domain dimer (P-dimer) of a GII.10 Norovirus strain exhibits two new binding sites for l-fucose in addition to the canonical binding sites. Thus, these sites provide a novel target for the design of multivalent fucose ligands as entry inhibitors of norovirus infections. In this current study, a first generation of multivalent fucose-functionalized glycomacromolecules was synthesized and applied as model structures to investigate the potential targeting of fucose binding sites in human norovirus P-dimer. Following previously established solid phase polymer synthesis, eight precision glycomacromolecules varying in number and position of fucose ligands along an oligo(amidoamine) backbone were obtained and then used in a series of binding studies applying native MS, NMR, and X-ray crystallography. We observed only one fucose per glycomacromolecule binding to one P-dimer resulting in similar binding affinities for all fucose-functionalized glycomacromolecules, which based on our current findings we attribute to the overall size of macromolecular ligands and possibly to steric hindrance.

Preventive and invasive treatment in special needs patients: a German retrospective study.

OBJECTIVES: Data on dental treatment of children with special healthcare needs (CSHCN) are sparse. Hence, this study provides information about the changes in the dental condition in a cohort of CSHCN treated in a university dental department in Germany. MATERIAL AND METHODS: Patient records of CSHCN treated from January 2004 to December 2012 were screened retrospectively for medical diagnoses (ICD-10) and the type of treatment performed with outpatient dental care (ODC) or general anesthesia (GA). Follow-up data of patients adhering to the recommended recall were recorded, including time and further treatments. RESULTS: A total of 795 CSHCN with a mean age of 6.8 years were included. In 41.6 % (331/795) of cases, treatment was performed under ODC, and 58.4 % (464/795) received GA. Caries experience in CSHCN treated under GA was significantly higher (7.9 d3/4mft/0.9 D3/4MFT) than in ODC (2.5 d3/4mft /0.9 D3/4MFT). Over time, patient flow shifted from invasive (IC) to preventive-based care (PC). CONCLUSION: Caries-related treatments were most frequent under GA and ODC, though initial caries experience was higher in GA patients. The choice of GA or ODC was statistically independent from the medical condition. CLINICAL SIGNIFICANCE: This study provides characteristics of a large population of CSHCN treated with and without GA for dental care.

Comparison of Different Protocols for Performing Adhesive Restorations in Primary Teeth - A Retrospective Clinical Study.

PURPOSE: To examine the influence of different adhesive restoration protocols on the survival of composite resin restorations in primary teeth. MATERIALS AND METHODS: This study included 601 patients at risk of caries (319 males and 282 females), with a mean age of 6.6 years (range: 1 to 13 years) and an average need for 3.6 restorations per patient (range: 1 to 20). The mean observation period was 1.3 years (± 1.4), with a maximum of 7 years. Six different adhesive restoration protocols with respect to etching, adhesives, and composite materials were analyzed. The statistical analyses included descriptive analyses and a Cox regression model from which hazard ratios (HR with 95% CI) for protocols and possible predictors were calculated. RESULTS: The mean dmft was 6.6 (± 4.0), which indicates a high risk population. Secondary caries was the most frequent reason for loss of restoration in this study (52.2%). Out of 2146 restorations, 368 failed; the mean annual failure rate was 13.2%. Adhesive restoration protocols that employed a self-etching system performed significantly better (HR range: 1.0 to 1.8) than did the etch-and-rinse system (HR range: 1.8 to 2.8). Protocols using only flowable materials had a moderately increased probability of failure. CONCLUSION: With respect to the practice-based study design, young age, and high risk of caries in this population, comparatively high failure rates were observed for direct composite restorations in primary dentition, but adhesive restoration protocols using self-etching adhesives in combination with universal composites yielded a higher probability of survival.

Long-term outcome of MTA apexification in teeth with open apices.

OBJECTIVE: This retrospective study aimed to collect information about the long-term outcome of apexification treatment with mineral trioxide aggregate (MTA) of teeth with open apices. METHOD AND MATERIALS: A total of 98 teeth in 79 patients (m:f = 1:1.3) who had completed endodontic apexification treatment with MTA between September 2005 and January 2014 at a university dental clinic were considered. Both initial treatments and retreatments of former root canal treatments other than apexification were included. All patients were invited for a standardized follow-up visit. Data regarding age, sex, tooth type, reason for treatment, detailed treatment protocol, clinical and radiographic findings, treatment quality, and outcome were also collected from the patients' records. Descriptive statistical analysis was performed. RESULTS: In the majority of cases, endodontic treatment was related to trauma with fracture (45/98, 45.9%) and luxation injuries (20/98; 20.4%), followed by unknown causes (12/98; 12.2%), retreatments (7/98; 7.1%), hypophosphatasia (7/98; 7.1%), and caries (1/98; 1%). In the beginning, the Periapical Index (PAI) showed pathologic findings with a PAI > 2 in approximately 50% of cases, while 25% presented with minor or an absence of findings. At the end of the observation period, more than 90% showed clinical-radiographic success, whereas eight teeth were associated with an elevated PAI. Only 5% of cases needed further dental treatment, such as root-end surgery or retreatment of the root canal treatment. CONCLUSION: Within the limits of this retrospective investigation, clinical and clinical-radiographic success of the apexification treatment appears to make this a good and reliable treatment option for teeth with open apices.

Risk factors for secondary caries in direct composite restorations in primary teeth.

BACKGROUND: Secondary caries or caries adjacent to restorations is the most frequent reason for replacement of dental restorations. Though, limited data is available on variables influencing the development of secondary caries in primary teeth. AIM: To investigate risk factors for the development of secondary caries adjacent to direct composite restorations in primary teeth. DESIGN: For this retrospective study, data of 2417 composite restorations, which were placed due to primary carious lesions, were considered. A total of 212 restorations failed due to secondary caries within a maximum observation period of 8 years. A control group was randomly selected. Mann-Whitney U-test, binomial logistic regression with backward elimination and Cox regression with frailty model were performed (P < 0.05). RESULTS: The overall caries experience amounted to 6.3 dmft and 13.3 dmfs. 72.5% of restorations failed within the first 2 years. Older children and children from families with a higher socio-economic status showed a lower risk for secondary caries. Further, the dentist and the adhesive had a significant influence on the longevity. Posterior restorations had a higher risk to fail in comparison with anterior restorations. CONCLUSIONS: Within the limitation of this study, it is concluded that the development of secondary caries is influenced by several factors. Nevertheless, the secondary caries rate was found to be relatively low in this high-risk population.

Survival characteristics of composite restorations in primary teeth.

OBJECTIVES: This retrospective study analyzed restoration survival of composite fillings in children with at high caries risk in relation to age, sex, operator, tooth type, filling extension, and material used. MATERIALS AND METHODS: Among 667 children treated in 2004-2012 in a university setting without sedation or general anesthesia, 2388 composite fillings were included. Relevant data from regular recall intervals were retrieved from patients' records. Either total-etch or a self-etch adhesive combined with flowable and/or (nano)hybrid composite was used. The Kaplan-Meier estimator and Cox proportional hazard analysis with backward elimination model were applied for survival analysis. RESULTS: For the observation period of 8 years (mean 1.7 years), the cumulative failure rate was 17.2 % with annual failure rates of 10.0 %. In 8.8 % of the cases, fillings failed due to secondary caries. In 8.3 % technical failure due to total filling loss, loosening, marginal gaps, or tooth fracture occurred. Tooth type, filling extension, age, operator, dental dam, and type of adhesive were significant for survival (p < 0.05). CONCLUSIONS: Filling survival was comparably lower to composite restorations observed in prospective clinical studies on permanent teeth and other tooth-colored restoratives used in primary teeth. Due to the very high caries risk and young age of the population, frequent loss due to secondary caries was observed. With respect to the high caries risk, composite restorations can be used to treat carious primary teeth, though a strict caries prevention regimen should be followed to minimize restoration failure. CLINICAL RELEVANCE: Filling loss of composites in the primary dentition is associated with secondary caries on the long term.

An in-vitro assessment of the shear bond strength of bulk-fill resin composites to permanent and deciduous teeth.

OBJECTIVES: This study aimed to evaluate the shear bond strength (SBS) of bulk-fill resin composites (RCs) to deciduous and permanent teeth. METHODS: The following parameters were investigated: (1) tooth type (deciduous and permanent), (2) tooth substrate (enamel and dentine), (3) restorative material (a high- and a low-viscosity bulk-fill RC and a regular nanohybrid RC as control), and (4) adhesive (two self-etching adhesives). The combination of those parameters resulted in a total of 24 different groups (n=20). Permanent caries-free human molars (240) and deciduous teeth (240) were selected. The bulk-fill RCs (Tetric Evo Ceram Bulk Fill and SureFil SDR) were applied in one 4-mm increment, whereas the regular RC (Tetric Evo Ceram) was layered in two consecutive 2-mm increments. The SBS was examined after storing the specimens for 24 h at 37 °C in distilled water, followed by thermal ageing (5000 cycles between 5 °C and 55 °C). RESULTS: Data were statistically analyzed using one- and multiway analyses of variance and an independent-samples t-test (α=0.05). The multivariate analysis (general linear model with partial eta-squared statistics) tested the influence of the parameters tooth type, tooth substrate, restorative material, and adhesive on the SBS. The parameter tooth type showed no significant impact on the SBS (p=0.576). The influence of the other parameters was significant (p<0.05) but low, and the highest influence was exerted by the parameter adhesive (η(P)(2)=0.120, p=0.0001) followed by tooth substrate (η(P)(2)=0.092, p=0.0001) and restorative material (η(P)(2)=0.028, p=0.0001). The fracture pattern was predominantly adhesive (61.9%) or mixed (38.1), and no cohesive or prefailure was registered. CONCLUSIONS: Bulk-fill materials performed comparable or better than the nanohybrid RC used as control, but the adhesive used was the most relevant factor of influence. This material type might be clinically an option for a faster restoration in both permanent and deciduous teeth. CLINICAL SIGNIFICANCE: Bulk-fill materials performed comparable or slightly better than the nanohybrid RC used as control. Clinically, flowable bulk-fill RCs might be an advantage in restoring deep, narrow cavities, with difficult access angles, whereas larger cavities might be restored easily and faster using high-viscosity compounds.

Longevity of composite restorations in patients with early childhood caries (ECC).

OBJECTIVES: The aim of this retrospective study was to describe the type and extent of composite fillings in a high risk pediatric caries population and analyze restoration survival probability in relation to severity of decay, Black classification, and composite type. MATERIALS AND METHODS: A total of 1,017 fillings in 855 primary teeth performed under general anesthesia from 2004-2007 were included into this study. All 157 patients had early childhood caries after the classification of Wyne and were recalled for at least 6 months. A total etch adhesive system, in combination with flowable and/or packable composites, was used. Failures were evaluated according to clinical criteria. Survival probability was calculated using Kaplan-Meier survival analysis. RESULTS: The mean observation period for restorations was 30.9 months, with a success rate of 81.5 %. In 125 cases, restorations failed after an average retention time of 23.6 months, resulting in an annual failure rate of 4.2 %. The reasons for failure were fracture or partial failure (9.6 %), secondary caries (44 %), or complete restoration loss (46.4 %). Fillings in patients with severe decay had significantly lower survival probabilities. No significant differences were found between flowable and packable composites. CONCLUSIONS: Composite fillings are a long lasting, high-quality treatment option in pediatric patients with a high risk of caries who are treated under general anesthesia. A strict caries prevention regimen should be followed to minimize the loss of restorations caused by secondary caries. CLINICAL RELEVANCE: Composite fillings are a long lasting, high-quality treatment option in children with early childhood caries treated under general anesthesia.

Is there a need for orthodontic plaque indices?--diagnostic accuracy of four plaque indices.

OBJECTIVES: The aim of this study was to assess the diagnostic performance and accuracy of four plaque indices for orthodontic patients. MATERIALS AND METHODS: The plaque accumulation of 140 maxillary incisors with bonded brackets was recorded using intra-oral photographs and assessed using four different plaque indices: the orthodontic plaque (OP) index, the modified orthodontic plaque (MOP) index, the Quigley and Hein (QHP) index and the modified Navy plaque (MNP) index. The assessment was performed twice within a time interval of 4 weeks by four different examiner groups: orthodontists, dentists, students and orthodontic assistants. RESULTS: No significant differences were detected for the OP and MOP indices among the examiner groups. A significant difference was found for the QHP and MNP indices. The inter- and intra-examiner reliability of the OP and MOP indices was good. In contrast, the reliability for the QHP and MNP indices was moderate to poor with few exceptions. The discrimination performance of the OP and MOP indices was excellent. The sum of the sensitivity and specificity was generally lower for the QHP and MNP indices compared with the OP and MOP indices. CONCLUSION: OP and MOP indices showed good performance. The QHP and MNP indices are not appropriate for orthodontic purposes. CLINICAL RELEVANCE: Traditional plaque indices reflect the typical pattern of plaque accumulation for patients without multi-bracket appliances. The performance of these indices for orthodontic patients has never been investigated. Orthodontic plaque indices that focus on the surface along the gingival margin and areas around the bracket exhibit higher diagnostic performance and accuracy compared with traditional indices.

Complications and survival rates of teeth after dental trauma over a 5-year period.

OBJECTIVES: The purpose of this study was to evaluate whether the current guidelines of the International Association of Dental Traumatology (IADT) for emergency care of traumatised teeth result in lower complication rates. MATERIALS AND METHODS: Therapeutic strategies of 361 dental injuries in 291 patients treated at a university dental hospital over a 5-year period were investigated by evaluating the patients' records. Adherence to the guidelines of the IADT (Flores et al. Dent Traumatol 17:1-4, 2001; 49-52, 2001; 97-102, 2001; 145-148, 2001; and 193-196, 2001; Flores et al. Dent Traumatol 23:66-71, 2007; 130-136, 2007; and 196-202, 2007) was evaluated. Complications were also recorded according to the patients' records and analysed relative to the treatment and injury pattern. During follow-up visits, the teeth were inspected regarding pulp vitality and overall function of the injured tooth. The Kaplan-Meier survival analysis of pulps and teeth was performed for different injury categories. RESULTS: The majority of injuries (322/361; 89.2 %) were treated according to the guidelines. When IADT guidelines were followed, complication rates were significantly lower than for cases treated without adherence to the guidelines. The most frequent complication was the loss of restoration, followed by pulp necrosis, abnormal mobility, and tooth loss. The overall survival analysis showed that in the permanent dentition, the loss of pulp vitality and tooth occurs within the first 6 months but may also occur later. CONCLUSIONS: The results of this study indicate that traumatised teeth that were treated according to the recommendations had a lower complication rate. In addition, the majority of pulp necrosis and tooth losses in the permanent dentition occurred within the first 6 months after trauma. These results indicate that early follow-up visits are essential to promptly treat complications. CLINICAL RELEVANCE: Adherence to the IADT guidelines for treatment of dental trauma may lead to more favourable outcomes when compared to cases treated without compliance to the guidelines.