The distribution of human surfactant proteins within the oral cavity and their role during infectious diseases of the gingiva.

The oral cavity with the teeth and the surrounding gingival epithelium, the periodontium, the salivary glands and other structures are open to the oral environment and thus exposed to multiple microbiological and pathogenic influences. To prevent permanent inflammatory processes such as gingivitis or periodontitis an efficient defense system is essential to ensure healthy and physiological function of the oral cavity and other interacting organic systems. Surfactant proteins (SPs), originally found in pulmonary tissue are important factors of the immune system and beyond this, support the stability and rheology of gas or fluid interfaces. This study aimed to analyze the distribution of surfactant proteins by means of Western blot and immunohistochemistry in salivary glands as well as in healthy and pathological saliva. The different expression patterns of SP-A, -B, -C and -D in healthy and pathological (periodontitis) saliva were determined using ELISA quantification. One further objective of the study was the first detection of two recent discovered proteins belonging to the surfactant protein family within human salivary glands and saliva. The results of the study reveal differences in protein expression of SP-A, -B, -C and -D within healthy and pathologic saliva. The concentration of the surfactant proteins SP-A, SP-C and SP-D is increased in saliva of people suffering from periodontal diseases, whereas by contrast, SP-B shows an opposite expression pattern. Furthermore, the results evidence the presence of SP-G and SP-H within saliva and salivary glands for the first time.

Comparing efficacy of plaque removal using professionally applied manual and power toothbrushes in 4- to 7-year-old children.

PURPOSE: The purpose of this study was to evaluate in 4- to 7-year-olds the efficacy of plaque removal of 2 toothbrushes: (1) the Philips Sonicare for Kids (SFK) power toothbrush with 2 amplitude settings (A and B); and (2) the Oral-B Stages 3 toothbrush (MTB). METHODS: Sixty-eight children participated in a single-masked, randomized, split-mouth study. Only subjects with a Quigley Hein plaque index (modified by Turesky et al.; TQHI) of more than 1.8 were enrolled. Subjects were randomized to SFK A (low amplitude, 7°), SFK B (high amplitude, 9°), or MTB by quadrant and brushed by a dental hygienist. TQHI was scored at 1- and 2-minute intervals by quadrant by a masked examiner. Multivariate analysis of variances for a split-mouth design was applied, and P-values were adjusted using Dunnett-Hsu modification. RESULTS: Mean baseline TQHI(+SD) scores were 2.89+0.06, 2.96+0.07, and 2.89+0.05 for SFK A, SFK B, and MTB, respectively. Adjusted mean postbrushing overall percent reductions for SFK A, SFK B, and MTB were 41%, 42%, and 29% at 1 minute and 67%, 65% and 49% at 2 minutes, respectively. Differences between both SFK and MTB were statistically significant. CONCLUSIONS: The Philips SFK removed significantly more plaque than the Oral-B Stages 3 toothbrush at 1- and 2-minute intervals with professional brushing assistance in 4- to 7-year-old subjects.

Vertical root fractures in crowned teeth: a report of 32 cases.

OBJECTIVE: To clarify the mode of root fracture in 32 endodontically treated teeth that resulted in vertical root fracture (VRF) despite the provision of a crown for fracture prevention. METHOD AND MATERIALS: The teeth included in the study underwent root canal treatment and were restored with crowns without the use of an intracanal post. All teeth underwent photo documentation. Clinical signs and symptoms as well as the patients' ages were recorded. The diameters of the roots and the root canal fillings were measured on radiographs. Fractured roots were investigated using a scanning electron microscope (SEM). RESULTS: The mean patient age was 60.2 years. The VRFs in the group occurred most frequently in the mesial roots of the mandibular first molars. The fracture was predominantly buccolingual. The mean ratio measured between the diameters of the root canal obturations and the outer root surfaces in the radiographs was 33.2%. SEM evaluation showed that most fractures ran from the inner to the outer root surface, and the cracks predominantly ran apical to coronal. CONCLUSION: Endodontically treated and crowned teeth without root canal posts can develop VRFs. The cracks start at the root canal wall in the apical part of the root and extend toward the outer root surface and coronally. Further investigation is necessary to determine the possible causes and evidence of fracture development.

Leucite-reinforced glass ceramic inlays luted with self-adhesive resin cement: a 2-year in vivo study.

OBJECTIVES: Aim of the present prospective controlled clinical study was to compare the clinical performances of two different cementation procedures to lute IPS Empress inlays and onlays. METHODS: Eighty-three IPS Empress restorations (70 class-II inlays, 13 onlays/47 premolars, 36 molars) were placed in 30 patients (19 females/11 males, mean age=39 years). Two cementation procedures were tested: group 1: forty-three restorations were luted with a self-adhesive resin cement (RelyX Unicem, RX, 3M ESPE); group 2: forty restorations were luted with an etch-and-rinse multistep adhesive (Syntac Classic, Ivoclar-Vivadent) and Variolink II low (SV, Ivoclar-Vivadent). All restorations were evaluated after 2 weeks (baseline=1st recall=R1, n=83), 6 months (R2, n=83), 1 year (R3, n=82), and 2 years (R4, n=82) by two independent blinded calibrated examiners using modified USPHS criteria. RESULTS: From R1 to R4, one failure occurred in the SV group (at R2) due to marginal enamel chipping. After 2 years of clinical service (R4), better marginal and tooth integrity (p<0.05) was found in group 2 (SV) compared to the use of the self-adhesive cement (RX, group 1), while no differences were found for all remaining investigated criteria (p>0.05). The absence of enamel in proximal boxes (10% with no enamel and 51% of the restorations with less than 0.5mm enamel width at the bottom of the proximal box) did not affect marginal performance (p>0.05). SIGNIFICANCE: The self-adhesive resin cement RelyX Unicem showed clinical outcomes similar to a conventional multi-step cementation procedure after 2 years of clinical service for most of the tested criteria.

Tailoring of physical properties in highly filled experimental nanohybrid resin composites.

OBJECTIVES: To assess the elastic modulus (EM), volumetric shrinkage (VS), and polymerization shrinkage stress (PSS) of experimental highly filled nanohybrid composites as a function of matrix composition, filler distribution, and density. METHODS: One regular viscosity nanohybrid composite (Grandio, VOCO, Germany) and one flowable nanohybrid composite (Grandio Flow, VOCO) were tested as references along with six highly filled experimental nanohybrid composites (four Bis-GMA-based, one UDMA-based, and one Ormocer®-based). The experimental composites varied in filler size and density. EM values were obtained from the "three-point bending" load-displacement curve. VS was calculated with Archimedes' buoyancy principle. PSS was determined in 1-mm thick specimens placed between two (poly)methyl methacrylate rods (Ø=6mm) attached to an universal testing machine. Data were analyzed using oneway ANOVA, Tukey's test (α=0.05), and linear regression analyses. RESULTS: The flowable composite exhibited the highest VS and PSS but lowest EM. The PSS was significantly lower with Ormocer. The EM was significantly higher among experimental composites with highest filler levels. No significant differences were found between all other experimental composites regarding VS and PSS. Filler density and size did not influence EM, VS, or PSS. SIGNIFICANCE: Neither the filler configuration nor matrix composition in the investigated materials significantly influenced composite shrinkage and mechanical properties. The highest filled experimental composite seemed to increase EM by keeping VS and PSS low; however, matrix composition seemed to be the determinant factor for shrinkage and stress development. The Ormocer, with reduced PSS, deserves further investigation. Filler size and density did not influence the tested parameters.

Professional brushing study comparing the effectiveness of sonic brush heads with manual toothbrushes: a single blinded, randomized clinical trial.

The aim of this study was to evaluate the plaque removal efficacy of four toothbrushes: the Philips Sonicare Elite with medium and mini brush heads, the Elmex Sensitive, and the American Dental Association (ADA) reference toothbrush. This study was a randomized, controlled, investigator-blinded, four-brush crossover design study, which examined plaque removal following a consecutive repeated use. All brushes were used on each participant in a randomly assigned quadrant of the mouth. A total of 90 subjects participated in the study. Prior to the experiment, they received a professional prophylaxis and were requested to refrain from toothbrushing for 48 h. Teeth were professionally brushed consecutively for 10 to 90 s per quadrant. A Turesky-modified Quigley Hein Index score was assessed at baseline and after each brushing interval by one blinded investigator. Results showed reduction of mean plaque scores for all brushes with time from 10 to 90 s. After 30 s (2-min whole mouth equivalent) of brushing, the Sonicare brushes cleaned 19, the ADA brush 16, and the Elmex Sensitive 10 of in average 28 tooth surfaces. With time, the number of additional cleaned surfaces decreased. Time is an important variable in the evaluation of plaque-removing efficacy since absolute efficacy increases with time and differs per toothbrush. No differences could be found between the two brush heads of the Sonicare.

Degree of conversion of luting resins around ceramic inlays in natural deep cavities: a micro-Raman spectroscopy analysis.

This study evaluated the degree of conversion (%DC) of luting agents around ceramic inlays placed in deep natural cavities. Thirty-six cylindrical Class I cavities (diameter = 4 mm, depth = 4 mm) were prepared in freshly extracted human teeth and randomly divided according to the luting materials used for luting CAD/CAM fabricated inlays (Empress CAD). The dual-cure resin cements Clearfil Esthetic Cement and Variolink II Low and the light-cure composites Grandio Flow and Grandio were luted using the total-etch technique. The self-adhesive dual-cure cements RelyX Unicem and Maxcem Elite were used as recommended by the manufacturer. All of the restorations were photo-activated using a quartz halogen unit (Elipar TriLight; 750 mW/cm2) for 40 seconds. After 24 hour dry-storage in the dark, all the teeth were vertically sectioned into two halves (n = 12 per group) using a slow-speed diamond-saw in the bucco-vestibular direction under constant water lubrication to avoid specimen heating. The DC of the luting materials was measured by vibrational spectroscopy using a micro-Raman spectrometer at depths of 1, 3 and 4 mm on each side of the tooth halves (n = 24). Disc-shaped samples were produced for measurement of the maximum %DC of each material. Two-way ANOVA and the Student-Newman-Keuls post-hoc test were used in the statistical analysis (alpha = 0.05). All the materials showed no statistical differences in degree of conversion at all tested depths, except for Grandio Flow and Maxcem Elite. Dual-cure and light-cure luting materials showed polymerization homogeneity around ceramic inlays, although dual-cure conventional resin cements tended to show an overall higher conversion.

Influence of air-polishing devices and abrasives on root dentin-an in vitro confocal laser scanning microscope study.

OBJECTIVE: To assess the influence of air-polishing devices and various abrasives on flat root surfaces. METHOD AND MATERIALS: A total of 168 natural teeth were embedded in polyurethane resin and treated with airborne-particle abrasion using two air-polishing devices (Prophyflex 3, KaVo; EMS Handy, EMS), four abrasives (Airflow powder, EMS; Cleaning powder, KaVo; ClinPro powder, 3M ESPE; and ProphyPearls, KaVo), and three treatment times (5, 10, and 20 seconds). Defects were quantified using a confocal laser scanning microscope. RESULTS: The Prophyflex device clearly generated deeper substance defects compared to the EMS device, regardless of abrasive used (Kruskal-Wallis, P = .004). ProphyPearls abrasive caused the deepest defects with both devices. ClinPro powder produced the least amount of defects. Defect depths increased significantly for all abrasives with increasing treatment times (Kruskal-Wallis, P = .01), and all abrasives except ClinPro powder caused substantial volume loss. CONCLUSION: The abrasiveness of air-polishing powders differs depending on the polishing device used. ProphyPearls caused more substance loss than ClinPro powder.

The effect of air-polishing abrasives on wear of direct restoration materials and sealants.

BACKGROUND: Air-polishing devices (APDs) effectively remove supragingival staining. However, the use of APDs on restorative surfaces may result in clinically relevant surface damage and material loss. METHODS: The authors made plane specimens (N = 180) of dental restorative materials (Tetric EvoCeram [Ivoclar Vivadent, Schaan, Liechtenstein], Tetric Flow [Ivoclar Vivadent ], Grandio Flow [VOCO, Cuxhaven, Germany], Admira Seal [VOCO], Grandio Seal [VOCO]) and Ionofil Molar [VOCO]). The authors treated the specimens with standardized air abrasion, using three abrasives (Acclean Air Preventive Powder [Henry Schein, Langen, Germany], AirFlow Prophylaxis Powder [EMS, Nyon, Switzerland] and ClinPro Prophy Powder [3M ESPE, Seefeld, Germany]) for 10 seconds each. The authors used profilometric scanning to quantify defect depth and volume loss. RESULTS: The abrasive ClinPro Prophy Powder produced the smallest defect depth and volume loss. Tetric EvoCeram experienced the smallest defect depth, whereas the flowable composites showed the greatest defect depths and volume losses. Sealants showed defects comparable with those the authors found in the glass ionomer, which were significantly smaller than those found in flowable composites. CONCLUSIONS: Air polishing of sealants and restorative materials always results in substance loss and surface damage. The sealants performed better in terms of abrasion resistance than did the flowable composites tested. Among the air-polishing abrasives, ClinPro Prophy Powder caused the least abrasive damage. CLINICAL IMPLICATIONS: Clinicians should use low-abrasion powder for frequent cleaning of discolored restorations with APDs to avoid excessive abrasion of restorative materials.

Late reposition of a lateral luxated maxillary incisor with an immature apex.

Here we describe an unusual trauma case. A recently erupted permanent upper-right incisor sustained a lateral luxation when a 5-year-old girl on a playground climbing net dropped off, catching the right upper incisor in the net. The tooth was laterally luxated in vestibular direction, and no other signs of injury occurred. A dental practitioner could not reposition the bony locked tooth. Four days later, the girl came to our clinic, and we performed an incomplete repositioning of the tooth and made a flexible splint. Controls were made at 1, 6, and 12 weeks and at 6, 12, 18, and 24 months later. The 24-month follow-up clinical examination revealed the patient to be asymptomatic and the tooth to be completely functional, and the recall radiograph showed further apical root growth. The implications of a late incomplete reposition of laterally luxated permanent teeth with immature apices are discussed.

In vitro wear gap formation of self-adhesive resin cements: a CLSM evaluation.

OBJECTIVES: To evaluate the depth of wear gaps of new self-adhesive cements after toothbrush abrasion and ACTA wear test. METHODS: Luting spaces (325+/-25 microm width, 2mm depth) were produced in Empress 2 ceramic blocks with a diamond saw to obtain flat substrate segments for toothbrush abrasion (n=24) and ACTA wear (n=27). After etching and silanization, the slits were filled with 8 self-adhesive cements, 2 conventional resin cements and 1 flowable composite, stored for 2 weeks in distilled water at 37 degrees C and planished to the cement level. Toothbrush abrasion was carried out in a toothbrush simulator (Willytec, Germany) for 20,000 cycles (load 1N) using an abrasive slurry based on a commercial toothpaste (Elmex, Gaba, Germany, RDA=77). The ACTA wear experiment was performed following the ACTA protocol in millet seed slurry for 400,000 cycles (Willytec). The gap replicas were measured for vertical wear loss under a confocal laser scanning microscope (CLSM). The data were analyzed using one-way ANOVA and a mod-LSD test at p<0.05. RESULTS: Toothbrush wear values were lower than the ones obtained for the ACTA wear test for all cements. In the toothbrush test Bifix SE, Clearfil SA, SmartCem 2, G-Cem and Maxcem Elite obtained the highest values together with Grandio Flow. Grandio Flow and AllCem showed to be the most resistant to the ACTA wear test, while SpeedCem the least resistant. No correlation was found between the two wear test experiments. CONCLUSION: Self-adhesive cements have good wear resistance to toothbrush abrasion but most of them wear more rapidly under higher loads in the ACTA test than conventional resin cements and flowable composites.

Localized severe aggressive periodontitis. Disease progression and tooth preservation: a short case report over 14 years.

A case of a 31-year-old female with aggressive periodontitis over 14 years is presented. From 1993 to 2000, no periodontal therapy occurred; disease development and progression could be reconstructed upon radiographic findings. In 2000, full-mouth disinfection therapy and antibiotic therapy was performed, as well as regenerative surgical treatments. Seven years after surgical treatment, stable periodontal conditions and clear bone regeneration in the surgical areas was evident.

Permanent mimic musculature and nerve damage caused by sodium hypochlorite: a case report.

Sodium hypochlorite is often used as an irrigation solution during routine endodontic treatment. Before recementation of a post-retained crown on the upper left lateral incisor, the root canal was irrigated with sodium hypochlorite. There was no root filling in the root canal, and the apex was open after an earlier apicoectomy. Sudden pain with swelling of the left face side occurred during root canal rinsing. Three years later, a paraesthesia still remained in the affected region and a paralysis of some mimic muscles in this region was observed. There were no signs of improvement.