OCT4/POU5F1 is indispensable for the lineage differentiation of the inner cell mass in bovine embryos.

The mammalian blastocyst undergoes two lineage segregations, that is, formation of the trophectoderm and subsequently differentiation of the hypoblast (HB) from the inner cell mass, leaving the epiblast (EPI) as the remaining pluripotent lineage. To clarify the expression patterns of markers specific for these lineages in bovine embryos, we analyzed day 7, 9, and 12 blastocysts completely produced in vivo by staining for OCT4, NANOG, SOX2 (EPI), and GATA6, SOX17 (HB) and identified genes specific for these developmental stages in a global transcriptomics approach. To study the role of OCT4, we generated OCT4-deficient (OCT4 KO) embryos via somatic cell nuclear transfer or in vitro fertilization. OCT4 KO embryos reached the expanded blastocyst stage by day 8 but lost NANOG and SOX17 expression, while SOX2 and GATA6 were unaffected. Blastocysts transferred to recipient cows from day 6 to 9 expanded, but the OCT4 KO phenotype was not rescued by the uterine environment. Exposure of OCT4 KO embryos to exogenous FGF4 or chimeric complementation with OCT4 intact embryos did not restore NANOG or SOX17 in OCT4-deficient cells. Our data show that OCT4 is required cell autonomously for the maintenance of pluripotency of the EPI and differentiation of the HB in bovine embryos.

Visualization of the Third Ventricle, the Future Cavum Septi Pellucidi, and the Cavum Veli Interpositi at 11+3 to 13+6 Gestational Weeks on 3D Transvaginal Ultrasound Including Normative Data.

OBJECTIVES: To show the development of the third ventricle, commissural plate, future cavum septi pellucidi, and cavum veli interpositi in weeks 12-14 by transvaginal 3D ultrasound. METHODS: This is a prospective transvaginal 3D study carried out to define the third ventricle and the diencephalic midline structures surrounding it. 93 of 387 fetuses in which the commissural plate with the future cavum septi pellucidi, cavum veli interpositi, and the roof of the third ventricle could be well visualized, were selected with the choroid plexus of the third ventricle and the pituitary gland serving as leading structures. In a small number of fetuses, the optic chiasm could also be displayed. In addition, the following measurements were performed: third ventricle craniocaudal and anteroposterior, roof of the third ventricle/cavum veli interpositi, and fcsp. RESULTS: The sonomorphologic characteristics of the commissural plate, the future cavum septi pellucidi, and the cavum veli interpositi are described IN 9% OF THE FETUSES examined. Measurements of the third ventricle, cavum veli interpositi, and the roof of the third ventricle show the following results: 3rd V cc = 3.895 + 0.091*CRL mm; 3rd V ap = 4.175 + 0.036*CRL mm; CVI ap = 2.223 + 0.029*CRL mm; CVI cc = 0.139 + 0.02*CRL mm. CONCLUSION: Transvaginal neurosonography enables visualization and measurement of the normal fetal third ventricle at 12-14 weeks of gestation including visualization of the future cavum septi pellucidi and the cavum veli interpositi. BEFORE USE IN PATIENTS CAN BE CONSIDERED, FURTHER SCIENTIFIC WORK IS REQUIRED.

Comparison of periodontitis patients' classification in the 2018 versus 1999 classification.

OBJECTIVES: We aimed to assess how the 2018 and 1999 classifications of periodontal diseases reflect (a) patients' characteristics, (b) disease severity/extent/progression and (c) tooth loss (TL) during observation period. METHODS: A total of 251 patients were followed over 21.8 ± 6.2 years. For the 1999 classification, using clinical attachment level (CAL), patients were classified as localized/generalized, mild/moderate/severe and aggressive/chronic periodontitis. For the 2018 classification, patients were staged according to their CAL or bone loss (BL) and the number of lost teeth (stages I-IV). Further factors like probing pocket depths (PPD) or furcation involvement modified the stage. The extent was sub-classified as generalized/localized. Patients were graded according to the BL/age index, smoking and/or diabetes. RESULTS: According to the 1999 classification, most patients suffered from generalized severe chronic periodontitis (203/251) or generalized aggressive periodontitis (45/251). Patients with aggressive periodontitis were younger and less often female or smokers. They showed similar TL (0.25 ± 0.22 teeth/patient*year) as generalized severe chronic periodontitis patients (0.23 ± 0.25 teeth/patient*year). According to the 2018 classification, most patients were classified as generalized III-C (140/251), III-B (31/251) or IV-C (64/251). Patients' age, smoking status, CAL, PPD and BL were well reflected. TL differed between IV-C (0.36 ± 0.47), generalized III-C (0.21 ± 0.24) and localized forms (0.10-0.15). CONCLUSIONS: Patients' characteristics, disease severity/extent/progression and TL were well reflected by the 2018 classification.

Long-term tooth retention in chronic periodontitis - results after 18 years of a conservative periodontal treatment regimen in a university setting.

AIM: The longitudinal study assessed the risk of tooth loss under a non-regenerative treatment regimen and aimed to identify prognostic factors for tooth loss. METHODS: Three hundred and fifteen patients (8009 teeth) were examined before (T0) and after active periodontal therapy (APT, T1) as well as after (mean ± SD) 18 ± 6 years of supportive periodontal therapy (SPT, T2). Descriptive statistics and a Cox proportional hazards shared-frailty model were applied. RESULTS: Overall, 351 and 816 teeth were lost during APT and SPT, respectively, with 0.15 ± 0.17 teeth being lost per patient and year. Seventy-two percentage patients lost 0-3, 24% 4-9 and 4% ≥10 teeth. The proportion of teeth with probing-pocket depths (PPD) >6 mm was 17.2% (T0), 1.6% (T1) and remained stable at 1.7% up to T2. Tooth loss during SPT was significantly increased in older patients [HR (95% CI): 1.04 (1.01-1.07) per year] and smokers [2.62 (1.34-5.14)], with each mm of PPD [1.35 (1.17-1.56)], in multirooted compared with single-rooted teeth [1.86 (1.36-2.56)] and teeth with bone loss [BL; HR up to 23.6 (12.1-45.6) for BL > 70%]. CONCLUSION: The risk of tooth loss was generally low under the provided non-regenerative treatment regimen; a minority of patients were responsible for the majority of teeth lost during SPT.

Tooth loss in generalized aggressive periodontitis: Prognostic factors after 17 years of supportive periodontal treatment.

AIM: This retrospective longitudinal study assessed the risk of and prognostic factors for tooth loss in patients with generalized aggressive periodontitis (GAgP) after periodontal treatment in a university setting. METHODS: Fifty-seven patients (1,505 teeth) were examined before (T0) and after active periodontal therapy (APT, T1) as well as after 17.4 ± 4.8 [range: 9-28] years of supportive periodontal therapy (SPT, T2). Descriptive statistics and a Cox-proportional-hazards shared-frailty model were applied. RESULTS: Overall, 98 and 134 teeth were lost during APT and SPT, respectively, with 0.14 ± 0.18 teeth being lost per patient and year. During SPT, three patients (5%) lost ≥10 teeth, 14 (25%) lost 4-9 teeth, 40 lost 0-3 (70%) teeth, respectively. One-third (n = 19) of all patients lost no teeth. Mean PPD of the teeth surviving SPT was stable from T1 (3.5 ± 1.1 mm) to T2 (3.4 ± 1.1 mm). Nearly, 84% of all survived teeth showed stable or improved bone level at T2. Risk of tooth loss was significantly increased in active smokers (HR[95% CI]: 4.94[1.91/12.75]), the upper dental arch (1.94[1,16/3.25]), with each mm of residual PPD (1.41[1.29/1.53]), teeth with furcation involvement (FI) (HR 4.00-4.44 for different degrees) and mobility (5.39 [2.06/14.1] for degree III). CONCLUSION: Within the provided conservative treatment regimen, GAgP patients lost only few teeth.

Removal of simulated biofilm: an evaluation of the effect on root surfaces roughness after scaling.

BACKGROUND: Despite the development of less invasive devices, a debate exists about the benefits and risks of hand versus powered root surface instrumentation used in supportive periodontal therapy (SPT). The aim of the in vitro study was to differentially compare plaque removal efficacy and root surface roughening of newly developed sonic, ultrasonic scaler, and curettes in the hands of experienced versus less experienced operators. MATERIALS AND METHODS: Sonic (AIR), ultrasonic devices (TIG), and double-gracey curettes (GRA) were utilized by seven experienced (EO) and four less experienced operators (LO) for root surface instrumentation of standardized plastic teeth on manikins' heads in a randomized sequence. The proportion of residual simulated plaque (RSP area in %) was planimetrically assessed, and the average root surface roughness produced (Ra and ∆Ra in µm) was measured by a precision profilometer. RESULTS: The uninstrumented root surfaces showed a Ra of (median (Q25/Q75)) 1.00 µm (0.83/1.16). Following instrumentation, EO left significantly less RSP than LO regardless of the used instruments (20.00 % (10.00/34.00) vs. 26.00 % (12.00/44.00) p < 0.001), whereas the ∆Ra values (0.29 µm (-0.04/0.96) vs. 0.35 µm (-0.04/1.01), p = 0.237) failed to show significant differences. The surface roughness was higher with GRA followed by AIR then TIG regardless of operators' experience (p < 0.001). CONCLUSION: Within the limits of the present study, the sonic device was most efficient in plaque removal, while the ultrasonic device produced the least surface roughness. CLINICAL RELEVANCE: All three tested instruments seem effective in the mechanical root debridement during SPT, whereat the ultrasonic device show the smoothest root surface of all.

Prognostic factors for the loss of molars--an 18-years retrospective cohort study.

AIM: The aim of this study was to identify long-term prognostic factors for the loss of molars with different degrees of furcation involvement (FI) during supportive periodontal therapy (SPT). METHODS: Three hundred and seventy-nine compliant subjects with 2373 molars at baseline were retrospectively assessed. After nonsurgical (n = 76) or surgical (n = 303) non-regenerative active periodontal therapy (APT: T0-T1), patients remained under SPT (T1-T2) for 18.3 ± 5.5 (9-30.8) years. Association between tooth- and subject-related factors with tooth loss was assessed using multilevel Cox regression-analysis. RESULTS: During APT 159 and during SPT 438 molars were extracted in 256 subjects, respectively, yielding an overall survival of 74.8% (T2). Survival probabilities after 15-years of SPT were 92.4% for molars with FI-0 compared to FI-1 = 85.6%, FI-2 = 74.9% and FI-3 = 62.3%. The risk of molar loss was significantly increased for teeth with FI-3 (hazard ratio: 2.39 [95% confidence interval: 1.54-3.70]), bone loss >50% (2.16 [1.36-3.42]), mobile teeth (2.07 [1.51-2.84]), maxillary molars (1.44 [1.12-1.85]) and endodontically treated teeth (1.89 [1.58-2.26]). For each mm of mean residual pocket probing depth, the hazard of tooth loss increased 1.89-fold (1.58-2.26). On a subject level, for each year of age, HR was 1.03 (1.01-1.05). CONCLUSIONS: Furcation involvement, bone loss, tooth mobility, mean pocket depth and age strongly predicted tooth loss during SPT. Long-term retention of periodontally compromised molars was possible via conservative non-regenerative active and supportive therapy.

Subgingival instrumentation to remove simulated plaque in vitro: influence of operators' experience and type of instrument.

BACKGROUND: There is uncertainty regarding the benefits and risks of hand versus powered root surface instrumentation. Moreover, the influence of operators' experience on treatment results is unclear. We compared newly developed sonic, ultrasonic and hand instruments, hypothesizing that powered devices allow to remove more simulated plaque in less time than hand instruments, with significant influence of operators' experience. METHODS: Sonic scaler (AIR), ultrasonic scaler (TIG) device and double Gracey curettes (GRA) were utilized by seven experienced operators (EOs) and four less experienced operators (LOs) in periodontitis manikin heads. The time required for treatment, the proportion of residual-simulated plaque and the weight loss caused by scaling as a proxy for root surface destruction were measured. RESULTS: Using different instruments led to significantly different proportions of removed simulated plaque regardless of operators' experience (AIR, 80.2 ± 21.3 %, TIG, 69.9 ± 22.5 %, GRA, 73.1 ± 20.0 %) (p < 0.001). Treatment times did not significantly differ between EO and LO (p > 0.05). Weight loss was increased when using hand instead of powered instruments (p < 0.001), with significantly higher weight loss induced by LO than EO (p = 0.004). CONCLUSION: Within the present study, EO did not remove more simulated plaque in less time but induced less root surface destruction. Using a sonic device was most beneficial for plaque removal. CLINICAL RELEVANCE: Successful root surface debridement requires both time and training regardless of the used instrument. Hand instruments might cause more damage to root surfaces, especially in the hands of less experienced operators.

Evaluation of acceptance and preference of topical lidocaine application versus articaine injection anesthesia after nonsurgical periodontal treatment: A randomized clinical trial.

BACKGROUND: To compare acceptance and preference of topical lidocaine gel anesthesia with articaine injection anesthesia in patients with moderate periodontitis undergoing scaling and root debridement. METHODS: Ninety-one patients completed this randomized multicenter split-mouth controlled study and underwent two separate periodontal treatment sessions on different days, one with a topical intrapocket lidocaine gel application and the other with an articaine injection anesthesia in a different order depending on randomization. Parameters measured were the patients' preference for topical lidocaine gel anesthesia or injection anesthesia with articaine (primary efficacy criterion), their maximum and average pain, and their intensity of numbness as well as experience of side effects; the probing depth; and the dentists' preference and their evaluations of handling/application, onset and duration of anesthetic effect, and patient compliance. RESULTS: After having experienced both alternatives, 58.3% of the patients preferred the topical lidocaine gel instillation into the periodontal pockets. The safety profile of the lidocaine gel differed positively from the safety profile of articaine injection in type and frequency of adverse drug reactions. The dentists' acceptance and preference regarding either anesthetic method studied were balanced. CONCLUSIONS: Instillation of lidocaine gel into the periodontal pocket is a preferred alternative to injection anesthesia for most of the patients and an equivalent alternative for dentists in nonsurgical periodontal therapy.

Prosthetic rehabilitation of patients with history of moderate to severe periodontitis: a long-term evaluation.

OBJECTIVES: Long-term outcomes of conservative periodontal and prosthetic treatment of patients with moderate to severe periodontitis were to be evaluated. Groups of younger (YG) and middle-aged patients (MG) were to be compared regarding survival of fixed and removable dental prostheses (FDP, RDP) inserted after active periodontal therapy (APT). In addition, functional-occlusal status over more than 10 years of supportive periodontal therapy (SPT) was analysed. METHODS: The present multi-case-series retrospectively analysed data of 68 patients (34 YG and 34 MG) who had received APT and regular SPT ≥10 years. Tooth loss, occlusal status and survival and complications of prosthetics were evaluated descriptively and comparatively (t-test). RESULTS: There was no statistical difference between YG and MG concerning tooth loss/year (p > 0.05). Functional-occlusal status was retained during SPT in 75% and 69% of YG and MG. Restorations inserted after APT showed high survival for both age groups (100%). Mean survival time until the last SPT visit was 15.2 and 11.6 years for FDP and RDP in YG, and 12.5 and 13.1 years in MG. CONCLUSIONS: Prosthetic restorations in both younger and middle-aged patients with severe periodontitis showed high survival, if pre-prosthetic APT and regular SPT had been performed.

Effects of Periodontal Endoscopy-Assisted Nonsurgical Treatment of Periodontitis: Four-Month Results of a Randomized Controlled Split-Mouth Pilot Study.

OBJECTIVE: Although the therapeutic effects of nonsurgical periodontal therapy (NSPT) are well established, the clinical benefits of the additional use of periodontal endoscopy (PE) remain controversial. Therefore, this randomized controlled split-mouth pilot study evaluated the effect of NSPT using PE versus NSPT without nPE on bleeding on probing (BOP) in sites with probing depth (PD)≥4 mm (primary outcome), PD, clinical attachment level (CAL), number of hard deposits (HDs), and treatment time per tooth (TrT). METHODS: Two calibrated operators performed NSPT in twenty periodontitis patients, randomized into two quadrants for PE or nPE treatment. BOP, PD, and CAL were recorded at the first visit for NSPT (T0) and during reevaluation (T1: mean (SD) 119.7 (24.6) days after T0). The average TrT and the number of sites with HDs were documented at T0. RESULTS: For BOP, no significant differences were found at the patient's level (10/10 (male/female); aged 54.3 (10.9) years) neither within or between the groups. At tooth surface level, a lower number of surfaces with BOP (p=0.026) was observed in nPE. CAL and PD improved significantly during NSPT in both groups (p ≤ 0.001), with higher PD reduction (p < 0.001) and CAL gain (p < 0.001) in nPE. There are significantly longer TrT (p < 0.001) and more surfaces with subgingival HDs evident in PE at T0 (p=0.001). CONCLUSION: Whereas subgingival HDs can be visually detected with PE during NSPT, no additional clinical benefits regarding BOP, PD, or CAL were notable compared to conventional systematic periodontal instrumentation. Additionally, PE-assisted NSPT required a longer treatment time.

Hypoblast Formation in Bovine Embryos Does Not Depend on NANOG.

The role of the pluripotency factor NANOG during the second embryonic lineage differentiation has been studied extensively in mouse, although species-specific differences exist. To elucidate the role of NANOG in an alternative model organism, we knocked out NANOG in fibroblast cells and produced bovine NANOG-knockout (KO) embryos via somatic cell nuclear transfer (SCNT). At day 8, NANOG-KO blastocysts showed a decreased total cell number when compared to controls from SCNT (NT Ctrl). The pluripotency factors OCT4 and SOX2 as well as the hypoblast (HB) marker GATA6 were co-expressed in all cells of the inner cell mass (ICM) and, in contrast to mouse Nanog-KO, expression of the late HB marker SOX17 was still present. We blocked the MEK-pathway with a MEK 1/2 inhibitor, and control embryos showed an increase in NANOG positive cells, but SOX17 expressing HB precursor cells were still present. NANOG-KO together with MEK-inhibition was lethal before blastocyst stage, similarly to findings in mouse. Supplementation of exogenous FGF4 to NANOG-KO embryos did not change SOX17 expression in the ICM, unlike mouse Nanog-KO embryos, where missing SOX17 expression was completely rescued by FGF4. We conclude that NANOG mediated FGF/MEK signaling is not required for HB formation in the bovine embryo and that another-so far unknown-pathway regulates HB differentiation.

A New Toolbox in Experimental Embryology-Alternative Model Organisms for Studying Preimplantation Development.

Preimplantation development is well conserved across mammalian species, but major differences in developmental kinetics, regulation of early lineage differentiation and implantation require studies in different model organisms, especially to better understand human development. Large domestic species, such as cattle and pig, resemble human development in many different aspects, i.e., the timing of zygotic genome activation, mechanisms of early lineage differentiations and the period until blastocyst formation. In this article, we give an overview of different assisted reproductive technologies, which are well established in cattle and pig and make them easily accessible to study early embryonic development. We outline the available technologies to create genetically modified models and to modulate lineage differentiation as well as recent methodological developments in genome sequencing and imaging, which form an immense toolbox for research. Finally, we compare the most recent findings in regulation of the first lineage differentiations across species and show how alternative models enhance our understanding of preimplantation development.

Survival and maintenance efforts of adhesively attached extracted teeth in periodontitis patients.

OBJECTIVES: For extracted teeth in periodontitis patients, adhesively attaching their crown to the adjacent teeth temporarily closes the otherwise resulting gap, allowing to postpone more comprehensive prosthetic treatment to a more appropriate time if required. This study assessed the survival and maintenance efforts of adhesively attached extracted tooth crowns ('immediate pontics'; IPs). METHODS: Patients receiving active and supportive periodontal treatment involving IPs in a university setting were retrospectively assessed. Survival and repairs of IPs were recorded. Multilevel Cox and linear regression analyses were performed to assess factors associated with survival and maintenance efforts. RESULTS: Twenty-seven patients (male/female: 12/15) with 34 IPs (maxilla/mandible: 13/21) were followed over mean ± SD 8.0 ± 5.0 [range: 2.0-19.3] years. At baseline 85.2% suffered from periodontitis stage II or III and 59.3% showed rapid progression (grade C). The mean (95% CI) survival time of splinting was 5.3 ± 3.8 [range: 0.1-18.0] years. Three IPs had been removed without any significant association with patient- or tooth-level factors. 35.3% of the IPs (n = 12) required a repair, with a mean of 0.5 ± 0.9 [0-3] repairs per IP (annual: 0.1 ± 0.2 [0-0.5]). The risk of repairs significantly increased with patients' age (p = 0.018). CONCLUSION: IPs showed moderate survival. However, to maintain IPs, frequent repairs were needed. CLINICAL SIGNIFICANCE: Immediately and adhesively attached crowns of extracted teeth in periodontitis patients seems like a valid, albeit temporary strategy which may allow to postpone more comprehensive prosthetic treatment if required, for example during active periodontal therapy. However, to maintain immediate pontics, frequent repairs were needed.

Development of a multiplex qPCR for the species identification of Clostridium estertheticum, C. frigoriphilum, C. bowmanii and C. tagluense-like from blown pack spoilage (BPS) meats and from wild boars.

Psychrophilic and psychrotolerant clostridia (n = 110) were isolated from vacuum-packed meat (beef and lamb), fresh venison and from skin and fecal samples of wild boars. They were identified to species level using MALDI-TOF MS, sequence and phylogeny analysis of the 16S rRNA and species specific multiplex qPCR. The results of all three methods were concordant. The majority of isolates were identified as C. tagluense-like Group I (n = 34) and Group II (n = 42). Thirty-five isolates could be identified to species level as follows: C. estertheticum (n = 15), C. frigoriphilum (n = 13), C. frigidicarnis (n = 1) and C. bowmanii (n = 5). This is the first report of detection and identification of C. frigoriphilum and C. tagluense-like Group II as causative agents of blown pack spoilage of beef. The species specific multiplex qPCR developed in this study could be applied to identify and to quantify the Clostridium species described above in suspicious meat juice samples.

Effect of a Multidirectional Power Toothbrush and a Manual Toothbrush in Individuals Susceptible to Gingival Recession: A 12-Month Randomized Controlled Clinical Study.

BACKGROUND: Clinical studies have explored the relationship between toothbrushing and development of gingival recession (GR), but relevant GR data for the multidirectional power toothbrush (PT) are lacking. The aim of this study is to evaluate the effect of brushing with either a multidirectional PT or American Dental Association reference manual toothbrush (MT) on mid-buccal preexisting GR (PreGR) during 12 months. METHODS: This was a 12-month prospective, single-masked, parallel-group, randomized, controlled clinical study. Healthy participants without periodontitis with at least two teeth showing PreGR ≥2 mm were randomized to a group brushing with either an MT or PT. The primary outcome parameter was change at sites with PreGR ≥2 mm. All clinically based GR measurements were performed by one calibrated examiner at baseline, 6, and 12 months. Secondary outcomes were changes of GR at all mid-buccal sites (with or without PreGR), changes in percentage of GR sites demonstrating a change of ≥1 mm, and changes in probing depths. RESULTS: A total of 107 participants completed the study (PT: 55, MT: 52). During the 12-month study period the mean recession at sites with PreGR ≥2 mm decreased significantly from 2.2 to 2.1 mm in both groups (P <0.05). The extent of GR parameters did not differ between MT and PT groups at any time point. GR evaluated clinically and on stone casts was well correlated. CONCLUSION: Neither the PT nor MT led to an increase in PreGR during 12 months of daily use.

Periodontal probing versus radiographs for the diagnosis of furcation involvement.

BACKGROUND: Decisions in periodontal therapy for multirooted teeth are essentially based on accurate diagnosis of the furcation involvement (FI). Furcation probing (FP) is still the basic diagnostic measure, although the assessment may be difficult. The aim of this study is to evaluate the validity of FP and radiographic assessment of FI compared with visual assessment during open flap surgery (OFS). METHODS: In this retrospective clinical cohort study, 215 participants with periodontal disease and at least one molar treated with OFS were enrolled, and a total of 834 molars were assigned for FI by FP and in radiographs analyzed by an experienced (EE) and less experienced examiner (LE). For the investigation, 143 panoramic radiographs (OPGs) and 77 intra-oral radiographs (I-Os) were evaluated. RESULTS: The Class of FI by FP was confirmed in 56%, whereas 15% were overestimated and 29% underestimated. FI Class 0 and I had been detected with high probability (74% and 54%, respectively). Of all FI Class III, 57% were detected correctly by radiographs and 32% by FP. FP and OFS revealed a weighted κ-coefficient (κw) = 0.588; radiographs and OFS had κw = 0.542 (OPG κw = 0.555 and I-O κw = 0.521). The interrater reliability for radiographs was dependent on the experience of the examiner (EE κw = 0.618; LE κw = 0.426). CONCLUSIONS: Experience in analyzing conventional radiographs increases the potential of correct diagnosis of advanced FI. The reliability of FP compared with radiographic assessment depends on the anatomy and location of the tooth. Both diagnostic tools should be used in cases of suspected FI.

Toothbrushing education via a smart software visualization system.

BACKGROUND: The aim of this study is to evaluate the efficiency of a recently developed smart digital toothbrush monitoring and training system (DTS) in terms of correct brushing motion and grip axis orientation in an at-home environment. METHODS: Twenty-one participants (11 test individuals [DTSG] and 10 control individuals [COG]) received instructions on the modified Bass technique (MBT) after their toothbrushing performance was monitored and they received professional tooth cleaning (T0). After 36 hours (T1), without mechanical oral hygiene measures, plaque and gingival indices were recorded, and the brushing technique was reviewed. After randomization, participants individually performed oral hygiene for 6 weeks (T2) with the provided oral hygiene kits. The DTSG group additionally used DTS. During the following 8 weeks (T3), participants used their original brushing devices without any additional interference. Investigators at each visit were masked regarding group identity. Data were statistically evaluated using Mann-Whitney U, Friedman, Wilcoxon, and paired tests and Pearson correlation. RESULTS: At T0, 27.27% of DTSG participants used the MBT correctly (COG, 50%), increasing to 54.55% (COG, 60%) after professional instruction (T1) and further to 90.91% at T2 (COG, 60%) (P <0.001). Plaque scores were reduced in DTSG (P <0.05). At T3, 80% of the DTSG (COG, 40%) totally adopted the MBT (P <0.05). The plaque scores on buccal surfaces of the DTSG showed an additional slight improvement between T2 and T3, in contrast to a decline on oral surfaces (P <0.001). At T2 and T3, the DTSG brushed >120 seconds (COG, 90% and 50%) (P <0.05). CONCLUSION: Apparently, the tested DTS effectively improves the brushing technique and leads to a prolonged learning effect, including improved oral hygiene.