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Schmidt J, Proesl S, Schulz-Kornas E, Haak R, Meyer-Lueckel H, Campus G, Esteves-Oliveira M. Systematic review and network meta-analysis of restorative therapy and adhesive strategies in root caries lesions. J Dent 2024; 142:104776. [PMID: 37977410 DOI: 10.1016/j.jdent.2023.104776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 09/29/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
AIM This systematic review and network meta-analysis (NMA) aimed to establish a clinically relevant hierarchy of the different adhesive and/or restorative approaches to restore cavitated root caries lesions through the synthesis of available evidence. MATERIALS AND METHODS A systematic search was conducted in Medline/Web of Science/Embase/ Cochrane Library/Scopus/grey literature. RCTs investigating ≥2 restorative strategies (restorative /adhesive materials) for root caries lesions in adult patients were included. Risk of bias within studies was assessed (Cochrane_RoB-2) and the primary outcome was survival rate of restorations at different follow-up times (6-/12-/24-months). Network meta-analyses were conducted using a random effects model stratified by follow-up times. I2-statistics assessed the ratio of true to total variance in the observed effects. All available combinations of adhesives (1-SE: one-step self-etch; 2-3ER: two-/three-step etch-and-rinse) and restorative materials (conventional composite (CC) as well as conventional and resin-modified glass ionomer cements (GIC, RMGIC)) were included. Risk of bias across studies and confidence in NMA (CINeMA) were assessed. RESULTS 547 studies were identified and nine were eligible for the NMA. In total, 1263 root caries lesions have been restored in 473 patients in the included clinical trials. Patients involved were either healthy (n = 6 trials), living in nursing homes (n = 1 trial) or received head-and-neck radiotherapy (n = 2 trials). There was statistically weak evidence to favour either of material/material combination regarding the survival rate. A tendency for higher survival rate (24-months) was observed for 2-3ER/CC (OR24mths 2.65; 95%CI=1.45/4.84) as well as RMGIC (OR24mths 2.05; 95%CI=1.17/3.61) compared to GIC. These findings were though not statistically significant and confidence of the NMA was low. CONCLUSION An evidence-based choice of restorative strategy for managing cavitated root caries lesions is currently impossible. There is a clear need for more standardised, well-designed RCTs evaluating the retention rate of root caries restoration approaches.
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Affiliation(s)
- J Schmidt
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - S Proesl
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - E Schulz-Kornas
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - R Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - H Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - G Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - M Esteves-Oliveira
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland; Department of Restorative Dentistry and Endodontology, Justus-Liebig-University Giessen, Giessen, Germany.
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Wierichs RJ, Kramer EJ, Meyer-Lueckel H, Abou-Ayash S. Success and complication rates of non-precious alloy telescopic crowns in a general dental practice. Clin Oral Investig 2023; 27:7605-7624. [PMID: 37910235 PMCID: PMC10713787 DOI: 10.1007/s00784-023-05350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES This retrospective, single-center, practice-based cohort study aimed to analyze factors associated with the success of removable partial dentures retained by telescopic crowns (TRPD). MATERIALS AND METHODS TRPD which were placed in a single practice of a practice-based research network were analyzed. Data from 139 patients (age (SD): 66 (11) years; 66 female) with 174 TRPD including 488 non-precious alloy telescopic crowns (TC) between 2004 and 2016 were included. TC without any technical complication were considered as successful, and as survived, if they were still in function at the last check-up. Multilevel Cox proportional hazard models were used to evaluate the association between clinical factors and time until failure. RESULTS Within a mean follow-up period (SD) of 4.2 (3.3) years (min-max: 1 day-12 years), 372 (76%) TC (AFR5years,TC-level: 5.0%) as well as 136 (87%) TRPD (AFR5years,TRPD-level: 5.1%) ("worst-case scenario") and 150 (86%) TRPD (AFR5years,TRPD-level: 3.4%) ("best-case scenario") were considered as successful. The main failure types were recementation (n = 39), endodontic treatment (n = 36), and extraction (n = 35). TC in male patients showed 1.6 times higher risk for failure than in female patients (95%CI: 1.1-2.4; p = 0.023). TC on premolars showed 2.2 times higher risk for failure than on incisors (95%CI: 1.1-5.0; p = 0.023) and TC in dentures with ≤ 3TC showed 2.1 times higher risk for failure than TC in dentures with > 3TC (1.3-3.4; p = 0.042). Furthermore, TC on the most distal tooth in an arch showed 2.4 times higher risk for failure than TC on a more mesial tooth (1.5-3.8; p < 0.001). CONCLUSION For removable partial dentures retained by telescopic crowns, high success rates could be found after up to 12 years. Patient-level and tooth-level factors were significantly associated with failure. CLINICAL RELEVANCE For removable partial dentures retained by telescopic crowns, high success rates could be found after up to 12 years. Patient-level and tooth-level factors were significantly associated with failure.
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Affiliation(s)
- R J Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.
| | | | - H Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland
| | - S Abou-Ayash
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Pfänder L, Schneider L, Büttner M, Krois J, Meyer-Lueckel H, Schwendicke F. Multi-modal deep learning for automated assembly of periapical radiographs. J Dent 2023; 135:104588. [PMID: 37348642 DOI: 10.1016/j.jdent.2023.104588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/23/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES Periapical radiographs are oftentimes taken in series to display all teeth present in the oral cavity. Our aim was to automatically assemble such a series of periapical radiographs into an anatomically correct status using a multi-modal deep learning model. METHODS 4,707 periapical images from 387 patients (on average, 12 images per patient) were used. Radiographs were labeled according to their field of view and the dataset split into a training, validation, and test set, stratified by patient. In addition to the radiograph the timestamp of image generation was extracted and abstracted as follows: A matrix, containing the normalized timestamps of all images of a patient was constructed, representing the order in which images were taken, providing temporal context information to the deep learning model. Using the image data together with the time sequence data a multi-modal deep learning model consisting of two residual convolutional neural networks (ResNet-152 for image data, ResNet-50 for time data) was trained. Additionally, two uni-modal models were trained on image data and time data, respectively. A custom scoring technique was used to measure model performance. RESULTS Multi-modal deep learning outperformed both uni-modal image-based learning (p<0.001) and time-based learning (p<0.05). The multi-modal deep learning model predicted tooth labels with an F1-score, sensitivity and precision of 0.79, respectively, and an accuracy of 0.99. 37 out of 77 patient datasets were fully correctly assembled by multi-modal learning; in the remaining ones, usually only one image was incorrectly labeled. CONCLUSIONS Multi-modal modeling allowed automated assembly of periapical radiographs and outperformed both uni-modal models. Dental machine learning models can benefit from additional data modalities. CLINICAL SIGNIFICANCE Like humans, deep learning models may profit from multiple data sources for decision-making. We demonstrate how multi-modal learning can assist assembling periapical radiographs into an anatomically correct status. Multi-modal learning should be considered for more complex tasks, as clinically a wealth of data is usually available and could be leveraged.
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Affiliation(s)
- L Pfänder
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany
| | - L Schneider
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany; ITU/WHO Focus Group AI4Health, Topic Group Dental Diagnostics and Digital Dentistry, Geneva, Switzerland
| | - M Büttner
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany; ITU/WHO Focus Group AI4Health, Topic Group Dental Diagnostics and Digital Dentistry, Geneva, Switzerland
| | - J Krois
- ITU/WHO Focus Group AI4Health, Topic Group Dental Diagnostics and Digital Dentistry, Geneva, Switzerland
| | - H Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, zmk Bern, University of Bern, Switzerland
| | - F Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany; ITU/WHO Focus Group AI4Health, Topic Group Dental Diagnostics and Digital Dentistry, Geneva, Switzerland.
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Wierichs RJ, Abou-Ayash B, Kobbe C, Esteves-Oliveira M, Wolf M, Knaup I, Meyer-Lueckel H. Evaluation of the masking efficacy of caries infiltration in post-orthodontic initial caries lesions: 1-year follow-up. Clin Oral Investig 2023; 27:1945-1952. [PMID: 36627531 PMCID: PMC10160188 DOI: 10.1007/s00784-022-04843-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES This study aimed to qualitatively and quantitatively assess the masking efficacy and color stability of resin infiltration on post-orthodontic ICL after 1 year. MATERIALS AND METHODS In 17 adolescents, 112 ICL (ICDAS-1: n = 1; ICDAS-2: n = 111) in 112 teeth were treated by resin infiltration (Icon, DMG) 3 to 12 months after bracket removal. The etching procedure was performed up to 3 times. Standardized digital images were taken before treatment (T0), 7 days (T7) and 12 months (T365) after treatment. Outcomes included the evaluation of the color differences between infiltrated and healthy enamel at T0, T7, and T365 by quantitative (colorimetric analysis (ΔE), ICDAS scores) and qualitative methods (5-point Likert scale (deteriorated (1), unchanged (2), improved, but not satisfying (3), improved and no further treatment required (4), completely masked (5)).) Differences between time points were analyzed by using Friedman test (ΔΕ) and chi-square tests (ICDAS). RESULTS The median color difference (25th/75th percentiles) between carious and healthy enamel at baseline (ΔΕ0) was 10.2(7.7/13.6). A significant decrease was observed 7 days after treatment (ΔΕ7 = 3.1(1.8/5.0); p < 0.001; ICDAS; p < 0.001). No significant changes based on ΔΕ (p = 1.000), and ICDAS grade (p = 0.305) were observed between T7 and T365 (ΔΕ12 = 3.4 (1.8/4.9)). Furthermore, at T365 four experienced dentists classified 55% and 39% of the lesions as "improved and no further treatment required" and "completely masked," respectively (Fleiss kappa: T365 = 0.851 (almost perfect)). CONCLUSION Resin infiltration efficaciously masked post-orthodontic ICL 7 days and 12 months after treatment. These results for most of the teeth could not only be observed by quantitative but also by qualitative analysis. CLINICAL RELEVANCE Resin infiltration efficaciously masks post-orthodontic initial carious lesions. The optical improvement can be observed directly after treatment and remains stable for at least 12 months.
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Affiliation(s)
- R J Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - B Abou-Ayash
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| | - C Kobbe
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - M Esteves-Oliveira
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - M Wolf
- Department of Orthodontics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - I Knaup
- Department of Orthodontics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - H Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
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Wierichs RJ, Langer F, Kobbe C, Abou-Ayash B, Esteves-Oliveira M, Wolf M, Knaup I, Meyer-Lueckel H. Aesthetic caries infiltration - Long-term masking efficacy after 6 years. J Dent 2023; 132:104474. [PMID: 36878424 DOI: 10.1016/j.jdent.2023.104474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the masking efficacy of caries infiltration technique of initial caries lesions (ICL) six years after debonding and single treatment. METHODS In 10 adolescents, 74 ICL (ICDAS 2) in 74 teeth were treated by resin infiltration (Icon, DMG) at a mean (SD) of 1.2 (1.2) months after bracket removal. The etching procedure was performed up to 3 times. Standardized digital images were taken before treatment (T0), seven days (T7) and 6 years (T2190) after treatment. Outcomes included the evaluation of the color differences between carious and healthy enamel at T0, T7 and T2190 by quantitative colorimetric analysis (ΔE), ICDAS scores, quantitative light-induced fluorescence (QLF; ΔF,ΔQ,WS Area) and qualitative visual evaluation (5-point Likert-scale [deteriorated (1), unchanged (2), improved, but not satisfying (3), improved and no further treatment required (4), completely masked (5)). RESULTS The median color difference ΔΕ0 (25th/75th percentiles) at T0 was 10.3 (8.56/13.0). At T7 a significant decrease was observed (ΔΕ7=3.7 (2.0/5.8); p<0.001; Friedmann-test; ICDAS p<0.001; Chi-square test). No significant changes based on ΔΕ (p=0.972; Friedmann-test) and ICDAS grading (p=0.511, chi-square test) were observed between T7 and T2190 (ΔΕ2190=2.9 (1.8/4.2)). Furthermore, at T2190 four experienced dentists classified 50% and 37% of the lesions as "improved and no further treatment required" and "completely masked", respectively (Fleiss kappa: T2190: 0.782 (substantial agreement)). CONCLUSION Aesthetic caries infiltration can effectively mask post-orthodontic initial caries lesions for at least 6 years. These results for most of the teeth could not only be observed by quantitative but also by qualitative analysis. CLINICAL SIGNIFICANCE Resin infiltration efficaciously masks post-orthodontic initial carious lesions. The optical improvement can be observed directly after treatment and remains stable for at six years.
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Affiliation(s)
- Richard Johannes Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland.
| | - Franziska Langer
- Department of Orthodontics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Céline Kobbe
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - Bedram Abou-Ayash
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - Marcella Esteves-Oliveira
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland; Department of Restorative Dentistry and Endodontology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Michael Wolf
- Department of Orthodontics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Isabel Knaup
- Department of Orthodontics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Hendrik Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
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Meyer-Lueckel H, Moser C, Wierichs RJ, Lausch J. Improved Surface Layer Erosion of Pit and Fissure Caries Lesions in Preparation for Resin Infiltration. Caries Res 2023; 56:496-502. [PMID: 36310017 DOI: 10.1159/000527736] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022] Open
Abstract
The penetration of a low-viscosity resin (infiltrant) into caries lesions depends on the erosion of the relatively impermeable surface layer (SL) that covers the lesion body. The present study aimed to evaluate the effect of different abrasive pretreatments on erosion of the SL and on penetration of an infiltrant into occlusal caries lesions, simultaneously. Sixty extracted human molars showing International Caries Detection and Assessment System (ICDAS-2) lesions were randomly allocated to 5 groups. A small area of each lesion was covered with resin before etching. Twelve lesions each were etched with either 15% HCl-gel (H120) or 37% H3PO4-gel (P120) for 120 s. Furthermore, the standard 15% HCl-gel or either one of two experimental etchants (HCl-gel or H3PO4-gel, each including abrasives) were applied for either 120 s or 30 s using a brush (surface pressure 150 g) (H30B, P120BA, H30BA). After rinsing and drying, all lesions were infiltrated for 180 s (Icon; DMG). From each tooth sections were prepared and visualized using confocal microscopy. SL of unetched areas and the lesion depth were 33 (23/51) μm and 537 (274/876) μm, respectively, both not differing significantly between groups. H120, H30B, and H30BA showed significantly higher SL reduction compared with P120 or P120BA, but only for H30BA SL was eroded almost completely (p < 0.05; Mann-Whitney test). Compared to other groups, occlusal lesions were significantly more infiltrated in H30BA (p < 0.05; Mann-Whitney test). HCl-gel including abrasives that was rubbed onto the enamel surface with a brush seems to be most effective to erode SLs of caries lesion situated in fissures and enable an almost complete subsequent resin infiltration.
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Affiliation(s)
- Hendrik Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - Corina Moser
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - Richard Johannes Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
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Esteves-Oliveira M, Passos VF, Russi TMAZC, Fernandes ARR, Terto CNN, Mendonça JS, Campus G, Wierichs RJ, Meyer-Lueckel H, Lima JPM. Randomized in situ evaluation of surface polishing protocols on the caries-protective effect of resin Infiltrant. Sci Rep 2022; 12:20648. [PMID: 36450787 PMCID: PMC9712577 DOI: 10.1038/s41598-022-25091-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
The aim of this placebo-controlled randomized in situ study was to evaluate the effect of different surface polishing protocols on enamel roughness, bacterial adhesion and caries-protective effect of a resin infiltrant. Seventy-five bovine enamel samples having artificial caries lesions were treated with a resinous infiltrant and afterwards randomly dividided into five polishing protocols: aluminum oxide flexible disks (Al2O3-Disks), silicon carbide tips (SIC-Tips), silicon carbide brush (SIC-Brush), silicon carbide polyester strips (SIC-Strips) or no polishing [negative control (NC)]. Average surface roughness (Ra) was assessed by profilometry. Samples were mounted in palatal appliances under a mesh for biofilm accumulation. Fifteen volunteers wore the intraoral appliances (14-days) and cariogenic challenge was triggered by sucrose solutions. Biofilm formed was collected for microbiological analysis of caries-related bacteria (Streptococcus mutans, Lactobacillus acidophilus) and demineralization was assessed by cross-sectional microhardness. Mean Knoop hardness numbers (Kg/mm2) were plotted over lesion depth (µm) and area under the lesion curve was subtracted from sound enamel to determine demineralization (ΔS, Kg/mm2xµm). Data were analyzed by ANOVA and post-hoc comparisons (α = 0.05). NC resulted in significantly higher Ra means than Al2O3-Disks and SIC-Strips. Bacterial counts were not significantly different between the groups (p > 0.05). Regards ΔS means, however none of the groups were significantly different to NC (6983.3 kg/mm2xµm /CI 4246.1-9720.5, p > 0.05). Conclusions: Polishing protocols (Al2O3-Disks, SIC-Strips) significantly decreseased roughness of infiltrated-enamel, however none of the polishing protocols could signicantly decrease bacterial counts nor resulted in significant less demineralization.
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Affiliation(s)
- Marcella Esteves-Oliveira
- grid.5734.50000 0001 0726 5157Department of Restorative, Preventive & Pediatric Dentistry, University of Bern, Bern, Switzerland ,grid.8664.c0000 0001 2165 8627Department of Restorative Dentistry and Endodontology, Justus Liebig University Gießen, Gießen, Germany
| | - Vanara F. Passos
- grid.8395.70000 0001 2160 0329Department of Restorative Dentistry, Federal University of Ceara, Fortaleza, Ceara Brazil
| | | | | | - Caroline N. N. Terto
- grid.8395.70000 0001 2160 0329Department of Restorative Dentistry, Federal University of Ceara, Fortaleza, Ceara Brazil
| | - Juliano S. Mendonça
- grid.8395.70000 0001 2160 0329Department of Restorative Dentistry, Federal University of Ceara, Fortaleza, Ceara Brazil
| | - Guglielmo Campus
- grid.5734.50000 0001 0726 5157Department of Restorative, Preventive & Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - Richard J. Wierichs
- grid.5734.50000 0001 0726 5157Department of Restorative, Preventive & Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - Hendrik Meyer-Lueckel
- grid.5734.50000 0001 0726 5157Department of Restorative, Preventive & Pediatric Dentistry, University of Bern, Bern, Switzerland
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Wierichs RJ, Bourouni S, Kalimeri E, Gkourtsogianni S, Meyer-Lueckel H, Kloukos D. Short-term efficacy of caries resin infiltration during treatment with orthodontic fixed appliances. A randomized controlled trial. Eur J Orthod 2022; 45:115-121. [PMID: 36200478 DOI: 10.1093/ejo/cjac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Objective of this trial was to assess the masking results in initial caries lesions (ICL) that were resin infiltrated during fixed orthodontic treatment in comparison to contralateral teeth that were fluoridated only. TRIAL DESIGN A randomized, controlled, split-mouth trial. METHODS Adolescent patients (age range: 12-18 years) with fixed orthodontic appliances who had developed ICL [ICDAS 1 or 2 (International Caries Detection and Assessment System)] during orthodontic treatment were consecutively recruited and randomly assigned to either resin infiltration (Icon) with up to 3 etching procedures (Inf) or to a fluoride varnish (Tiefenfluorid) (FV). Both interventions were performed according to the manufacturer's recommendations. Outcome assessors were blinded to the applied intervention. Primary and secondary outcomes included the evaluation of the appearance of the ICL before (T0) and 1 week after (T1) treatment by digital photographs (ΔE), laser fluorescence readings (DD), and ICDAS scores. BLINDING Due to the treatment nature neither the operators nor the patients could be blinded. However, outcome assessors and the statistician were blinded. RESULTS Fifteen patients (9 female) with 60 ICL were included (mean age: 14.6 years). At baseline FV and Inf did not differ significantly in ΔE (median ΔE0,T (25th/75th percentiles):10.7(9.1/20.9): ΔE0,I:13.4(10.3/18.5); P = 0.469), DD (P = 0.867) and ICDAS (P = 0.521). One-week after treatment (T1) ΔE values (P < 0.001), DD values (P < 0.001), and ICDAS scores (P = 0.014) for Inf were significantly reduced, whereas ΔE values (P = 0.125) and ICDAS scores (P = 0.073) for FV remained unchanged. LIMITATION Natural remineralizing in the standard interventional control group cannot be observed yet, since up to 6 months are needed to naturally remineralize ICL. CONCLUSIONS Based on our short-term data, resin infiltration effectively masked ICL during treatment with fixed orthodontic appliances. Fluoridation was not able to immediately improve the visual appearance of ICL. Further longer-term assessment should focus not only on the aesthetic outcome, but also on the caries inhibitory effect of resin infiltration during treatment with fixed orthodontic appliances. TRIAL REGISTRATION German Clinical Trials Register (DRKS-ID: DRKS00011797).
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Affiliation(s)
- Richard Johannes Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Sotiria Bourouni
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Elena Kalimeri
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force and VA General Hospital, Athens, Greece
| | - Sofia Gkourtsogianni
- Department of Paediatric Dentistry, Dental School, University of Athens, Athens, Greece
| | - Hendrik Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Dimitrios Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland
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Knaup I, Kobbe C, Ehrlich EE, Esteves-Oliveira M, Abou-Ayash B, Meyer-Lueckel H, Wolf M, Wierichs RJ. Correlation of quantitative light-induced fluorescence and qualitative visual rating in infiltrated post-orthodontic white spot lesions. Eur J Orthod 2022; 45:133-141. [PMID: 36179095 DOI: 10.1093/ejo/cjac051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The aim of this prospective, clinical single-centre study was to evaluate the masking efficacy of post-orthodontic resin infiltration after 12-month follow-up and correlate quantitative and qualitative outcome measures. METHODS Patients with completed fixed orthodontic treatment and the presence of one or more vestibular active non-cavitated white spot lesion/s (WSL) [ICDAS 1 or 2 (International Caries Detection and Assessment System)] were provided with resin infiltration 3-12 months after bracket removal. All patients (n = 31) participating before (t0) intervention were invited again and examined after 12 months (t2). Enamel demineralization was scored using quantitative light-induced fluorescence [QLF (DeltaF[flourescence], DeltaQ[lesion volume], White Spot Area)] and qualitative visual rating [11-point Likert-scale from 0 (no lesions visible on any tooth) to 10 (all teeth affected on the entire vestibular surface)]. RESULTS In 17 patients (7 female and 10 male) 112 WSL (ICDAS 1: n = 1; ICDAS 2: n = 111) in 112 teeth were (re)examined. Before treatment (t0) a significant, weak (DeltaF), and moderate (DeltaQ, White Spot Area) correlation was observed between the quantitative and the qualitative rating (P < 0.002) [median DeltaF: -7.31 (-10.4/-6.58)%; DeltaQ:-2.25 (-10.8/-0.41)% mm2; White Spot Area: 0.34 (0.05/1.16) mm2; visual rating:3.7 ± 1.2]. Resin infiltration led to significantly increased fluorescence and decreased visual scores (P < 0.001) 7 days (t1) and 12 months (t2) after treatment. No significant changes based on DeltaF [-6.55 (-7.29/-6.08)%] and on visual ratings [1.0 ± 1.0] were observed between t1 and t2 (P = 1.000). After 7 days (t1) the correlation between the quantitative and the qualitative ratings remained significant, weak to moderate (P < 0.002). After 12 months (t2) the correlation was (non-)significant and weak for DeltaF, DeltaQ, and White Spot Area (P ≤ 0.097). LIMITATIONS Since the overall masking efficacy of resin infiltration has been shown previously, an untreated control group was omitted. CONCLUSIONS When assessing the masking efficacy of infiltrated post-orthodontic WSL only a weak to moderate correlation was found between QLF values and visual ratings. Furthermore, over time this correlation decreased. Thus, it remains unclear if QLF is a viable method to assess and quantify infiltrated post-orthodontic WSL over time. TRIAL REGISTRATION German Clinical Trials Register (DRKS-ID:DRKS00005067).
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Affiliation(s)
- Isabel Knaup
- Department of Orthodontics, RWTH Aachen University Hospital, Germany
| | - Celine Kobbe
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Switzerland
| | - Eva-Elaine Ehrlich
- Department of Orthodontics, RWTH Aachen University Hospital, Germany.,Private Orthodontic Office, Goch, Germany
| | | | - Bedram Abou-Ayash
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Switzerland
| | - Hendrik Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Switzerland
| | - Michael Wolf
- Department of Orthodontics, RWTH Aachen University Hospital, Germany
| | - Richard J Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Switzerland
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Schwendicke F, Cejudo Grano de Oro J, Garcia Cantu A, Meyer-Lueckel H, Chaurasia A, Krois J. Artificial Intelligence for Caries Detection: Value of Data and Information. J Dent Res 2022; 101:1350-1356. [PMID: 35996332 PMCID: PMC9516598 DOI: 10.1177/00220345221113756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
If increasing practitioners’ diagnostic accuracy, medical artificial intelligence (AI)
may lead to better treatment decisions at lower costs, while uncertainty remains around
the resulting cost-effectiveness. In the present study, we assessed how enlarging the data
set used for training an AI for caries detection on bitewings affects cost-effectiveness
and also determined the value of information by reducing the uncertainty around other
input parameters (namely, the costs of AI and the population’s caries risk profile). We
employed a convolutional neural network and trained it on 10%, 25%, 50%, or 100% of a
labeled data set containing 29,011 teeth without and 19,760 teeth with caries lesions
stemming from bitewing radiographs. We employed an established health economic modeling
and analytical framework to quantify cost-effectiveness and value of information. We
adopted a mixed public–private payer perspective in German health care; the health outcome
was tooth retention years. A Markov model, allowing to follow posterior teeth over the
lifetime of an initially 12-y-old individual, and Monte Carlo microsimulations were
employed. With an increasing amount of data used to train the AI sensitivity and
specificity increased nonlinearly, increasing the data set from 10% to 25% had the largest
impact on accuracy and, consequently, cost-effectiveness. In the base-case scenario, AI
was more effective (tooth retention for a mean [2.5%–97.5%] 62.8 [59.2–65.5] y) and less
costly (378 [284–499] euros) than dentists without AI (60.4 [55.8–64.4] y; 419 [270–593]
euros), with considerable uncertainty. The economic value of reducing the uncertainty
around AI’s accuracy or costs was limited, while information on the population’s risk
profile was more relevant. When developing dental AI, informed choices about the data set
size may be recommended, and research toward individualized application of AI for caries
detection seems warranted to optimize cost-effectiveness.
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Affiliation(s)
- F Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Cejudo Grano de Oro
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - A Garcia Cantu
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - H Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Bern, Switzerland
| | - A Chaurasia
- Department of Oral Medicine and Radiology, King George's Medical University, Lucknow, India
| | - J Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
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11
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Schneider L, Arsiwala-Scheppach L, Krois J, Meyer-Lueckel H, Bressem K, Niehues S, Schwendicke F. Benchmarking Deep Learning Models for Tooth Structure Segmentation. J Dent Res 2022; 101:1343-1349. [PMID: 35686357 PMCID: PMC9516600 DOI: 10.1177/00220345221100169] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A wide range of deep learning (DL) architectures with varying depths are
available, with developers usually choosing one or a few of them for
their specific task in a nonsystematic way. Benchmarking (i.e., the
systematic comparison of state-of-the art architectures on a specific
task) may provide guidance in the model development process and may
allow developers to make better decisions. However, comprehensive
benchmarking has not been performed in dentistry yet. We aimed to
benchmark a range of architecture designs for 1 specific, exemplary
case: tooth structure segmentation on dental bitewing radiographs. We
built 72 models for tooth structure (enamel, dentin, pulp, fillings,
crowns) segmentation by combining 6 different DL network architectures
(U-Net, U-Net++, Feature Pyramid Networks, LinkNet, Pyramid Scene
Parsing Network, Mask Attention Network) with 12 encoders from 3
different encoder families (ResNet, VGG, DenseNet) of varying depth
(e.g., VGG13, VGG16, VGG19). On each model design, 3 initialization
strategies (ImageNet, CheXpert, random initialization) were applied,
resulting overall into 216 trained models, which were trained up to
200 epochs with the Adam optimizer (learning rate = 0.0001) and a
batch size of 32. Our data set consisted of 1,625 human-annotated
dental bitewing radiographs. We used a 5-fold cross-validation scheme
and quantified model performances primarily by the F1-score.
Initialization with ImageNet or CheXpert weights significantly
outperformed random initialization (P < 0.05).
Deeper and more complex models did not necessarily perform better than
less complex alternatives. VGG-based models were more robust across
model configurations, while more complex models (e.g., from the ResNet
family) achieved peak performances. In conclusion, initializing models
with pretrained weights may be recommended when training models for
dental radiographic analysis. Less complex model architectures may be
competitive alternatives if computational resources and training time
are restricting factors. Models developed and found superior on
nondental data sets may not show this behavior for dental
domain-specific tasks.
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Affiliation(s)
- L. Schneider
- Department of Oral Diagnostics,
Digital Health and Health Services Research, Charité–Universitätsmedizin,
Berlin, Germany
- ITU/WHO Focus Group on AI for
Health, Topic Group Dental Diagnostics and Digital Dentistry, Geneva,
Switzerland
| | - L. Arsiwala-Scheppach
- Department of Oral Diagnostics,
Digital Health and Health Services Research, Charité–Universitätsmedizin,
Berlin, Germany
- ITU/WHO Focus Group on AI for
Health, Topic Group Dental Diagnostics and Digital Dentistry, Geneva,
Switzerland
| | - J. Krois
- Department of Oral Diagnostics,
Digital Health and Health Services Research, Charité–Universitätsmedizin,
Berlin, Germany
- ITU/WHO Focus Group on AI for
Health, Topic Group Dental Diagnostics and Digital Dentistry, Geneva,
Switzerland
| | - H. Meyer-Lueckel
- Department of Restorative,
Preventive and Pediatric Dentistry, Zahnmedizinische Kliniken der
Universität Bern, University of Bern, Bern, Switzerland
| | - K.K. Bressem
- Charité–Universitätsmedizin
Berlin, Klinik für Radiologie, Berlin, Germany
- Berlin Institute of Health at
Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - S.M. Niehues
- Charité–Universitätsmedizin
Berlin, Klinik für Radiologie, Berlin, Germany
| | - F. Schwendicke
- Department of Oral Diagnostics,
Digital Health and Health Services Research, Charité–Universitätsmedizin,
Berlin, Germany
- ITU/WHO Focus Group on AI for
Health, Topic Group Dental Diagnostics and Digital Dentistry, Geneva,
Switzerland
- F. Schwendicke, Department of Oral
Diagnostics, Digital Health and Health Services Research,
Charité–Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, Berlin,
14197, Germany.
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Rohrer C, Krois J, Patel J, Meyer-Lueckel H, Rodrigues JA, Schwendicke F. Segmentation of Dental Restorations on Panoramic Radiographs Using Deep Learning. Diagnostics (Basel) 2022; 12:diagnostics12061316. [PMID: 35741125 PMCID: PMC9221749 DOI: 10.3390/diagnostics12061316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Convolutional Neural Networks (CNNs) such as U-Net have been widely used for medical image segmentation. Dental restorations are prominent features of dental radiographs. Applying U-Net on the panoramic image is challenging, as the shape, size and frequency of different restoration types vary. We hypothesized that models trained on smaller, equally spaced rectangular image crops (tiles) of the panoramic would outperform models trained on the full image. A total of 1781 panoramic radiographs were annotated pixelwise for fillings, crowns, and root canal fillings by dental experts. We used different numbers of tiles for our experiments. Five-times-repeated three-fold cross-validation was used for model evaluation. Training with more tiles improved model performance and accelerated convergence. The F1-score for the full panoramic image was 0.7, compared to 0.83, 0.92 and 0.95 for 6, 10 and 20 tiles, respectively. For root canals fillings, which are small, cone-shaped features that appear less frequently on the radiographs, the performance improvement was even higher (+294%). Training on tiles and pooling the results thereafter improved pixelwise classification performance and reduced the time to model convergence for segmenting dental restorations. Segmentation of panoramic radiographs is biased towards more frequent and extended classes. Tiling may help to overcome this bias and increase accuracy.
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Affiliation(s)
- Csaba Rohrer
- Oral Diagnostics, Digital Health and Health Services Research, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.R.); (J.K.); (J.A.R.)
| | - Joachim Krois
- Oral Diagnostics, Digital Health and Health Services Research, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.R.); (J.K.); (J.A.R.)
- ITU/WHO Focus Group on AI for Health, Topic Group Dental Diagnostics and Digital Dentistry, 1202 Geneva, Switzerland
| | - Jay Patel
- Informatics, Department of Health Services Administrations and Policy, Temple University College of Public Health, Philadelphia, PA 19140, USA;
| | | | - Jonas Almeida Rodrigues
- Oral Diagnostics, Digital Health and Health Services Research, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.R.); (J.K.); (J.A.R.)
- Surgery and Orthopedics, UFRGS, Porto Alegre 90040-060, Brazil
| | - Falk Schwendicke
- Oral Diagnostics, Digital Health and Health Services Research, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.R.); (J.K.); (J.A.R.)
- ITU/WHO Focus Group on AI for Health, Topic Group Dental Diagnostics and Digital Dentistry, 1202 Geneva, Switzerland
- Correspondence:
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13
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Schwendicke F, Mertens S, Cantu AG, Chaurasia A, Meyer-Lueckel H, Krois J. Cost-effectiveness of AI for Caries Detection: Randomized Trial. J Dent 2022; 119:104080. [PMID: 35245626 DOI: 10.1016/j.jdent.2022.104080] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES We assessed the cost-effectiveness of AI-supported detection of proximal caries in a randomized controlled clustered cross-over superiority trial. METHODS Twenty-three dentists were sampled to assess 20 bitewings; 10 were randomly evaluated supported by an AI-based software (dentalXrai Pro 1.0.4, dentalXrai Ltd, Berlin, Germany) and the other 10 without AI support. The reference test had been established by four independent experts and an additional review. We evaluated the proportion of true and false positive and negative detections and the treatment decisions assigned to each detection (non-invasive, micro-invasive, invasive). Cost-effectiveness was assessed using a mixed public-private-payer perspective in German healthcare. Using the accuracy and treatment decision data from the trial, a Markov simulation model was populated and posterior permanent teeth in initially 31-years old individuals followed over their lifetime. The model allowed extrapolation from the initial detection and therapy to treatment success, re-treatments and, eventually, tooth loss and replacement, capturing long-term effectiveness (tooth retention) and costs (cumulative in Euro). Costs were estimated using the German public and private fee catalogues. Monte-Carlo microsimulations were used and incremental cost-effectiveness at different willingness-to-pay ceiling thresholds assessed. RESULTS In the trial, AI-supported detection was significantly more sensitive than detection without AI. However, in the AI group, lesions were more often treated invasively. As a result, AI and no AI showed identical effectiveness (tooth retention for a mean (2.5-97.5%) 49 (48-51)) and nearly identical costs (AI: 330 (250-409) Euro, no AI: 330 (248-410) Euro). 41% simulations found AI and 43% no AI to be more cost-effective. The resulting cost-effectiveness remained uncertain regardless of a payer's willingness-to-pay. CONCLUSIONS Higher accuracy of AI did not lead to higher cost-effectiveness, as more invasive treatment approaches generated costs and diminished possible effectiveness advantages. CLINICAL SIGNIFICANCE The cost-effectiveness of AI could be improved by supporting not only caries detection, but also subsequent management.
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Affiliation(s)
- Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany.
| | - Sarah Mertens
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany
| | - Anselmo Garcia Cantu
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany
| | | | | | - Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany
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14
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Weber KR, Wierichs RJ, Meyer-Lueckel H, Flury S. Restoration of teeth affected by molar-incisor hypomineralisation: a systematic review. Swiss Dent J 2021; 131:988-997. [PMID: 33764037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The objective was to systematically analyse clinical studies on restorative procedures for teeth affected by molar-incisor hypomineralisation (MIH). The databases PubMed, Embase, and Cochrane Library were searched. Only retrospective and prospective clinical studies dealing with sealing or restoration of MIH-affected teeth were included. The language was restricted to English or German. Thirteen of 36 potentially eligible studies were included focusing on the following subjects: extension of enamel preparation, adhesive procedures prior to restoration, application of fissure sealants as well as restoration with conventional glass ionomer cements (GIC), resin modified glass ionomer cements (RMGIC), resin composites, and indirect restorations. Seven clinical studies were controlled trials. However, only two included MIH-unaffected teeth as control. No meta-analysis was performed due to the heterogeneity of study designs (e.g. severity of MIH or the restorative materials investigated). Based on the present analysis, the annual failure rates were in average 21% for fissure sealants, 22% for GIC, 1-6% for RMGIC, 13-32% for resin composites, and 0-7% for indirect restorations. In summary, only few tendencies can be deduced from this review at a low level of evidence (number of studies): 1) preparation margins in sound enamel seem to be superior to preparations in hypomineralised enamel (1 study), 2) RMGIC seems to be superior to GIC (3 studies), 3) resin composites may be used for restoring all severities of MIH (7 studies) with self-etch and etch-and-rinse adhesive systems generally not performing differently (3 studies), and 4) in cases of severe MIH, indirect restorations showed a good clinical success (4 studies).
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Affiliation(s)
- Kathrin R Weber
- Department of Restorative, Preventive, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - Richard J Wierichs
- Department of Restorative, Preventive, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - Hendrik Meyer-Lueckel
- Department of Restorative, Preventive, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - Simon Flury
- Department of Restorative, Preventive, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
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Wierichs RJ, Mester J, Wolf TG, Meyer-Lueckel H, Esteves-Oliveira M. Effects of the association of high fluoride- and calcium-containing caries-preventive agents with regular or high fluoride toothpaste on enamel: an in vitro study. Clin Oral Investig 2021; 26:3167-3178. [PMID: 34816310 DOI: 10.1007/s00784-021-04299-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this in vitro study was to compare the caries-preventive effect of various high fluoride- and calcium-containing caries-preventive agents (> 22.000 ppm F- [ppm]) in adjunct to use of regular (1450 ppm) or high (5000 ppm) fluoride toothpaste on sound as well as demineralized enamel. MATERIALS AND METHODS Bovine enamel specimens (n = 276; 5 mm × 3.5 mm × 3 mm) having one sound surface [ST] and one artificial caries lesion [DT] were randomly allocated to 12 groups. Interventions before pH-cycling were no intervention ([SC1/SC5]), application of varnishes/solutions containing NaF (22,600 ppm; Duraphat [NaF1/NaF5]); NaF + tricalcium phosphate (22,600 ppm; Clinpro White Varnish [TCP1/TCP5]); NaF + CPP-ACP (22,600 ppm; MI Varnish [CPP1/CPP5]); silver diammine fluoride (35,400 ppm; Cariestop 30%[SDF1/SDF5]); and NaF + calcium fluoride (45,200 ppm; Biophat[CaF1/CaF5]). During pH-cycling (28 days, 6 × 120 min demineralization/day) half of the specimens in each group were brushed (10 s; 2 × /day) with either 1,450 (NaF; named, e.g., TCP1) or 5,000 ppm (NaF; e.g., TCP5) dentifrice slurry. Differences in integrated mineral loss (∆∆Z) and lesion depth (∆LD) were calculated between values after initial demineralization and after pH-cycling using transversal microradiography. RESULTS After pH-cycling, SC1/SC5 showed significantly increased ∆ZDT/LDDT values, indicating further demineralization (p < 0.05; paired t-test). Decreased ∆ZDT values, indicating non-significant remineralization, could only be observed in CaF1/CaF5 (p > 0.05; paired t-test). Additional use of all varnishes/solutions significantly decreased ∆∆ZDT/∆∆ZST and ∆LDDT/∆LDST compared to SC1/SC5 (p < 0.05;ANCOVA). Between 1450 and 5000 ppm dentifrices, a significant difference in ∆∆ZDT/∆∆ZST and ∆LDDT/∆LDST could only be observed for SC1/SC5 (p < 0.05; ANCOVA). CONCLUSION Under the conditions chosen, all fluoride varnishes/solutions significantly reduced demineralization. Furthermore, a significant dose-response characteristic for fluoride varnishes could be revealed. However, no additional benefit could be observed, when varnishes were combined with high fluoride instead of regular fluoride dentifrices. CLINICAL RELEVANCE For children and adolescents with high caries risks varnishes containing more than 22,600 ppm should be further investigated, as they offered higher caries-preventive effects in vitro. Furthermore, there seems to be no difference in the demineralization-inhibitory capacity of fluoride varnishes when used in combination with either standard or highly fluoridated dentifrices.
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Affiliation(s)
- Richard Johannes Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland. .,Department of Biohybrid & Medical Textiles, Institute of Applied Medical Engineering, RWTH Aachen University, 52074, Aachen, Germany.
| | - Judith Mester
- Department of CariologyEndodontology and Periodontology, University of Leipzig, Liebigstraße 12, 04103, Leipzig, Germany
| | - Thomas Gerhard Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.,Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Hendrik Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland
| | - Marcella Esteves-Oliveira
- Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.,Department of CariologyEndodontology and Periodontology, University of Leipzig, Liebigstraße 12, 04103, Leipzig, Germany
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Krasowski A, Krois J, Paris S, Kuhlmey A, Meyer-Lueckel H, Schwendicke F. Costs for Statutorily Insured Dental Services in Older Germans 2012-2017. Int J Environ Res Public Health 2021; 18:6669. [PMID: 34205730 PMCID: PMC8296323 DOI: 10.3390/ijerph18126669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVES We assessed the costs of dental services in statutorily insured, very old (geriatric) Germans. METHODS A comprehensive sample of very old (≥75 years) people insured at a large Northeastern statutory insurer was followed over 6 years (2012-2017). We assessed dental services costs for: (1) examination, assessments and advice, (2) operative, (3) surgical, (4) prosthetic, (5) periodontal, (6) preventive and (7) outreach services. Association of utilization with: (1) sex, (2) age, (3) region, (4) social hardship status, (5) International Disease Classification (ICD-10) diagnoses and (6) Diagnoses Related Groups (DRGs) was explored. RESULTS 404,610 individuals with a mean (standard deviation, SD) age 81.9 (5.4 years) were followed, 173,733 did not survive follow-up. Total mean costs were 129.61 (310.97) euro per capita; the highest costs were for prosthetic (54.40, SD 242.89 euro) and operative services (28.40, SD 68.38 euro), examination/advice (21.15, SD 28.77 euro), prevention (13.31, SD 49.79 euro), surgery (5.91, SD 23.91 euro), outreach (4.81, SD 28.56 euro) and periodontal services (1.64, SD 7.39 euro). The introduction of new fee items for outreach and preventive services between 2012 and 2017 was reflected in costs. Total costs decreased with increasing age, and this was also found for all service blocks except outreach and preventive services. Costs were higher in those with social hardship status, and in Berlin than Brandenburg and Mecklenburg-Western Pomerania. Certain general health conditions were associated with increased or decreased costs. CONCLUSIONS Costs were associated with sex, social hardship status, place of living and general health conditions. CLINICAL SIGNIFICANCE Dental services costs for the elderly in Germany are unequally distributed and, up to a certain age or health status, generated by invasive interventions mainly. Policy makers should incentivize preventive services earlier on and aim to distribute expenses more equally.
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Affiliation(s)
- Aleksander Krasowski
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.K.); (J.K.)
- Department of Restorative, Preventive and Pediatric Dentistry, zmk Bern, University of Bern, 3012 Bern, Switzerland;
| | - Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.K.); (J.K.)
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité—Universitätsmedizin, 10117 Berlin, Germany;
| | - Adelheid Kuhlmey
- Institute of Medical Sociology and Rehabilitation Science, Charité—Universitätsmedizin, 10117 Berlin, Germany;
| | - Hendrik Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, zmk Bern, University of Bern, 3012 Bern, Switzerland;
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.K.); (J.K.)
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Wierichs RJ, Kramer EJ, Reiss B, Schwendicke F, Krois J, Meyer-Lueckel H, Wolf TG. A prospective, multi-center, practice-based cohort study on all-ceramic crowns. Dent Mater 2021; 37:1273-1282. [PMID: 33972099 DOI: 10.1016/j.dental.2021.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/07/2021] [Accepted: 04/24/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this prospective, multi-center, practice-based cohort study was to analyze factors associated with the success of all-ceramic crowns. METHODS All-ceramic crowns placed in a practice-based research network ([Ceramic Success Analysis, AG Keramik) were analyzed. Data from 1254 patients with (mostly in-office CAD/CAM) all-ceramic crowns placed by 101 dentists being followed up for more than 5 years were evaluated. At the last follow-up visit crowns were considered as successful (not failed) if they were sufficient, whereas crowns were considered as survived (not lost) if they were still in function. Multi-level Cox proportional hazards models were used to evaluate the association between a range of predictors and time of success or survival. RESULTS Within a mean follow-up period (SD) of 7.2(2)years [maximum:15years] 776 crowns were considered successful (annual failure rate[AFR]:8.4%) and 1041 crowns survived (AFR:4.9%). The presence of a post in endodontically treated teeth resulted in a risk for failure 2.7 times lower than that of restorations without a post (95%CI:1.4-5.0;p = 0.002). Regarding the restorative material and adhesive technique, hybrid composite ceramics and single-step adhesives showed a 3.4 and 2.2 times higher failure rate than feldspathic porcelain and multi-step adhesives, respectively (p < 0.001). Use of an oxygen-blocking gel as well as an EVA instrument resulted in a 1.5-1.8 times higher failure rate than their non-use (p ≤ 0.001). SIGNIFICANCE After up to 15years AFR were rather high for all-ceramic crowns. Operative factors, but no patient- or tooth-level factors were significantly associated with failure. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00020271).
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Affiliation(s)
- R J Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland; Department of Biohybrid & Medical Textiles, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany.
| | | | - B Reiss
- German Society of Computerized Dentistry, Berlin, Germany
| | - F Schwendicke
- Department of Oral Diagnosis, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J Krois
- Department of Oral Diagnosis, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - H Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - T G Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland; Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, Germany
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Dulla JA, Meyer-Lueckel H. Molar-incisor hypomineralisation: narrative review on etiology, epidemiology, diagnostics and treatment decision. Swiss Dent J 2021; 131:sdj-2021-11-01. [PMID: 33764036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Molar-incisor hypomineralisation (MIH) is clinically defined as demarcated structural enamel defects affecting at least one first permanent molar with or without the involvement of incisors. It is foremost a qualitative developmental defect of systemic origin. The prevalence for MIH is estimated at 12.9% with significant differences between countries. Its etiology and pathogenesis are still not completely understood. Several environmental and medical causes have been suggested to alter enamel maturation. The hypomineralised enamel may collapse shortly after eruption and as a consequence caries lesions seem more likely to develop. Besides cavitation, hypersensitivity and/or pain are the hallmarks of clinical symptoms. Both are associated with increased dental anxiety and fear of children suffering from MIH. Consequently, patients' care and management are challenging and necessitates a large range of non-, micro- and invasive strategies. MIH might be mixed up with three different other types of developmental defects in the enamel: fluorosis, enamel hypoplasia, and amelogenesis imperfecta. Careful diagnostic differentiation should be made before starting any dental treatment. A recent published classification system links the severity of the lesion to a treatment need index. This index is based on four values regarding two key symptoms: hypersensitivity and post-eruptiv enamel breakdown (PEB). Without PEB sealing is strongly recommended in order to prevent caries. For hypersensitive teeth as well as those with PEB use of glass ionomer cement as an intermediate cover, but mainly composite resins are materials of choice. For improvement of aesthetically compromised MIH-incisors, the resin infiltration technique has been proposed.
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Affiliation(s)
- Joëlle A Dulla
- Department of Restorative, Preventive, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - Hendrik Meyer-Lueckel
- Department of Restorative, Preventive, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
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Niemeyer SH, Baumann T, Lussi A, Meyer-Lueckel H, Scaramucci T, Carvalho TS. Salivary pellicle modification with polyphenol-rich teas and natural extracts to improve protection against dental erosion. J Dent 2020; 105:103567. [PMID: 33387569 DOI: 10.1016/j.jdent.2020.103567] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/22/2020] [Accepted: 12/19/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the modification of the salivary pellicle with different polyphenol-rich teas and natural extracts for the protection against dental erosion. METHODS We performed two experiments: one with teas (Green tea, Black tea, Peppermint tea, Rosehip tea, negative control [NC]) and other with natural extracts (Grape seed, Grapefruit seed, Cranberry, Propolis, NC), where NC was deionized water. A total of 150 enamel specimens were used (n = 15/group). Both experiments followed the same design, consisting of 5 cycles of: salivary pellicle formation (30 min, 37 °C), modification with the solutions (30 min, 25 °C), further salivary pellicle formation (60 min, 37 °C) and erosive challenge (1 min, 1% citric acid, pH 3.6). Relative surface microhardness (rSMH), relative surface reflection intensity (rSRI) and amount of calcium release (CaR) were evaluated. Data were analysed with Kruskal-Wallis and Wilcoxon rank sum tests with Bonferroni correction (α = 0.05). RESULTS Regarding teas, Black and Green teas showed the best protection against dental erosion, presenting higher rSMH and lower CaR than NC. Peppermint tea was not different to NC and Rosehip tea caused erosion, showing the highest CaR and greatest loss of SMH and SRI. Regarding natural extracts, Grape seed and Grapefruit seed extracts presented the best protective effect, with significantly higher rSMH and lower CaR. Cranberry caused significantly more demineralization; and Propolis did not differ from NC. CONCLUSION Green tea, Black tea, Grape seed extract and Grapefruit seed extract were able to modify the salivary pellicle and improve its protective effect against enamel erosion, but Rosehip tea and Cranberry extract caused erosion. CLINICAL RELEVANCE Some some bio-products, such as teas and natural extracts, improve the protective effect of the salivary pellicle against enamel erosion. More studies should be performed in order to test the viability of their use as active ingredients for oral care products.
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Affiliation(s)
- Samira Helena Niemeyer
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.
| | - Tommy Baumann
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.
| | - Adrian Lussi
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.
| | - Hendrik Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.
| | - Taís Scaramucci
- Department of Restorative Dentistry, University of São Paulo, School of Dentistry, Av. Prof. Lineu Prestes 2227, Cidade Universitária, São Paulo, SP, Zip code: 05508-000, Brazil.
| | - Thiago Saads Carvalho
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.
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Erdwey D, Meyer-Lueckel H, Esteves-Oliveira M, Apel C, Wierichs RJ. Demineralization Inhibitory Effects of Highly Concentrated Fluoride Dentifrice and Fluoride Gels/Solutions on Sound Dentin and Artificial Dentin Caries Lesions in vitro. Caries Res 2020; 55:41-54. [PMID: 33285548 DOI: 10.1159/000509931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/04/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this in vitro study was to compare the demineralization inhibitory effect of gels/solutions used in combination with either standard or highly fluoridated dentifrices on sound dentin as well as on artificial dentin caries-like lesions. METHODS Bovine dentin specimens (n = 240) with two different surfaces each (sound [ST] and artificial caries lesion [DT]) were prepared and randomly allocated to twelve groups. Weekly interventions during pH-cycling (28 days, 6 × 120 min demineralization/day) were: the application of gels/solutions containing amine fluoride/sodium fluoride (12,500 ppm F [ppm]; pH = 4.4; AmF); NaF (12,500 ppm; pH = 6.6; NaF1); NaF (12,500 ppm; pH = 6.3; NaF2); silver diamine fluoride (14,200 ppm; pH = 8.7; SDF); acidulated phosphate fluoride (12,500 ppm; pH = 3.8; APF), and no intervention (standard control; S). Furthermore, half of the specimens in each group were brushed (10 s; twice per day) with dentifrice slurries containing either 1,450 ppm (e.g., AmF1450) or 5,000 ppm (e.g., AmF5000). Differences in integrated mineral loss (ΔΔZ) and lesion depth (ΔLD) were calculated between values before and after pH-cycling using transversal microradiography. RESULTS After pH-cycling Ss showed significantly increased ΔZDT and LDDT values, indicating further demineralization. In contrast, except for one, all groups including fluoride gels/solutions showed significantly decreased ΔZDT values. Additional use of most fluoride gels/solutions significantly enhanced mineral gain, mainly in the surface area; however, acidic gels/solutions seemed to have negative effects on lesion depths. SIGNIFICANCE Under the present pH-cycling conditions the highly fluoridated dentifrice significantly reduced caries progression and additional application of nearly all of the fluoride gels/solutions resulted in remineralization. However, there was no difference in the remineralizing capacity of fluoride gels/solutions when used in combination with either standard or highly fluoridated dentifrices.
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Affiliation(s)
- Daniel Erdwey
- Department of Oral and Maxillofacial and Facial Plastic Surgery, School of Medicine, University Hospital RWTH Aachen, Aachen, Germany, .,Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany,
| | - Hendrik Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, zmk Bern, University of Bern, Bern, Switzerland
| | - Marcella Esteves-Oliveira
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany.,Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Christian Apel
- Department of Biohybrid and Medical Textiles, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - Richard Johannes Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, zmk Bern, University of Bern, Bern, Switzerland.,Department of Biohybrid and Medical Textiles, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany
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Walther C, Zumbülte S, Faerber CM, Wierichs RJ, Meyer-Lueckel H, Conrads G, Henne K, Esteves-Oliveira M. Analysis of relative bacterial activity and lactate dehydrogenase gene expression of caries-associated bacteria in a site-specific natural biofilm: an ex vivo study. Clin Oral Investig 2020; 25:3669-3679. [PMID: 33226500 PMCID: PMC8137627 DOI: 10.1007/s00784-020-03691-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/10/2020] [Indexed: 11/30/2022]
Abstract
Objectives Detecting bacterial activity is considered a promising approach to monitor shifts from symbiosis to dysbiosis in oral microbiome. The present study aimed at investigating both the relative bacterial activity and the lactate dehydrogenase (ldh) gene expression of caries-associated bacteria in a site-specific natural biofilm. Material and methods Sixty subjects (age, mean ± SE: 30.1 ± 1.4) were allocated to two groups: caries-free subjects (CF) or caries-active subjects (CA). CF presented one sound surface (CFS, n = 30). CA presented two donor sites: a cavitated caries lesion (CAC, n = 30) and a sound reference surface (CAS, n = 30). Real-time quantitative PCR (q-PCR) on species or genus level and total bacteria was performed targeting the 16S gene, the 16S rRNA, the ldh gene, and the ldh mRNA (increasing 16S ribosomal RNA copy numbers can function as an indicator of increased energy metabolism). As the 16S rRNA abundance represents the number of ribosomes, while the 16S gene abundance represents the number of genomes, the quotient of the relative abundances functions as a measure for the relative bacterial activity (%). Results Both lactobacilli and S. mutans showed the highest relative bacterial activity in CAC ((mean ± SE) 218 ± 60% and 61 ± 16%, respectively) and the lowest values for both sound reference surfaces (69 ± 48%; 8 ± 3%). Significant differences were found between CAC and CAS as well as between CAC and CFS for both lactobacilli and S. mutans (p < 0.05). The ldh gene expression of lactobacilli and S. mutans only showed moderate values in CAC (1.90E+03 ± 2.11E+03; 2.08E+04 ± 4.44E+04 transcripts/μl) and CFS (2.04E+03 ± 2.74E+03; 8.16E+03 ± 6.64E+03 transcripts/μl); consequently no significant differences were detected. Conclusion and clinical relevance Caries-associated bacteria (lactobacilli and S. mutans) showed the highest relative bacterial activity in plaque of cavitated lesions, the lowest in sound surfaces, allowing the detection of a significant activity shift in health and disease for caries-active patients. However, no significant differences in ldh gene expression could be determined.
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Affiliation(s)
- Carolin Walther
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center, Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Sandra Zumbülte
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology, and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | - Christoph M Faerber
- Department of Operative Dentistry, Periodontology, and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | - Richard Johannes Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Bern, Switzerland
| | - Hendrik Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Bern, Switzerland
| | - Georg Conrads
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology, and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | - Karsten Henne
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology, and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | - Marcella Esteves-Oliveira
- Department of Operative Dentistry, Periodontology, and Preventive Dentistry, RWTH Aachen University, Aachen, Germany.,Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
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Perrin P, Meyer-Lueckel H, Wierichs R. Longevity of immediate rehabilitation with direct fiber reinforced composite fixed partial dentures after up to 9 years. J Dent 2020; 100:103438. [DOI: 10.1016/j.jdent.2020.103438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
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Meyer-Lueckel H, Hartwig C, Börner HG, Lausch J. Elution of Monomers from an Infiltrant Compared with Different Resin-Based Dental Materials. Oral Health Prev Dent 2020; 18:337-341. [PMID: 32618457 DOI: 10.3290/j.ohpd.a43354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE Low-molecular weight residuals eluting from dental materials may contribute to local and systemic adverse effects. Therefore, the aim of the present study was to compare triethylene glycol dimethacrylate (TEGDMA)-based commercial infiltrant with different conventional resin-based materials regarding their release of monomers. MATERIALS AND METHODS Cylindrical blocks (n = 10) of either two sealants (Helioseal, Delton FS+), a composite (EcuSphere), an adhesive (Teco) and an infiltrant (Icon) were prepared. Additionally, 20 artificial lesions (depths ≥100 µm) were created in bovine enamel and after etching with phosphoric acid infiltrated with the infiltrant. Except for 10 infiltrated lesions, all other specimens were polished. Each specimen was stored in 1 ml distilled water (elution medium) for 240 h. The medium was renewed in logarithmical divided time periods (4.5 min-76 h). RESULTS Total concentrations of eluted monomers within 240 h from the cylindrical specimens were 0.04-0.09 mg/ml (p >0.05; Mann-Whitney test). Unpolished infiltrated specimens showed significantly higher monomer concentrations compared to all other groups, whereas polishing of specimens resulted in significantly lower concentrations (p <0.05; Mann-Whitney test). CONCLUSION It can be concluded that release of monomers was low in general, but for infiltrated lesions it was considerably reduced by surface polishing reaching similar values as for commonly used monomer-containing dental materials. Thus, adverse effects by the use of an infiltrant are not expected, but polishing of the infiltrated area should be considered.
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Abstract
The aim of this retrospective noninterventional multicenter practice-based study was to analyze factors influencing the survival of direct restorations. Records from patients who visited 5 private practices regularly were searched for the presence of direct restorations. Data were recorded from 7,858 patients with 27,407 direct restorations being detected at least 6 mo before the last recall visit. Multilevel Cox proportional hazard models were used to evaluate the association between clinical factors and time until failure. Within 228 mo, 5,493 failures could be observed. Median survival time was 207 mo. The annual failure rates were 3.8%, 4.0%, 4.6%, 4.9%, and 3.9% for class I, II, III, IV, and V restorations, respectively. Class II and IV restorations showed a 1.1-times (95% CI, 1.0 to 1.2) and 1.2-times (95% CI, 1.1 to 1.2) higher failure rate than class I restorations ( P ≤ 0.029). Patients aged <20 y and >60 y showed up to a 1.4-times higher failure rate than patients aged 20 to 60 y ( P ≤ 0.015). Restorations that underwent check-up twice a year or more showed a significantly higher failure rate than those that did so less than twice a year ( P < 0.001). Furthermore, the dentists significantly influenced time until failure ( P < 0.001). Regarding the restorative material, composites showed up to a 2.1-times longer time until failure than GIC ( P ≤ 0.020). Moderate failure rates were observed for direct restorations in the private practice setting after up to 18.5 y. Within the limitations of the present study, several factors on the levels of practice (i.e., dentist), patient (i.e., age), and tooth (i.e., restorative material, restored surfaces according to the classification of Black) were significant predictors for the failure rate. Therefore, treatment decision should take into account most relevant factors (German Clinical Trials Register DRKS00015228).
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Affiliation(s)
- R.J. Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Switzerland
- Department of Biohybrid and Medical Textiles, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany
| | | | - H. Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Switzerland
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Paris S, Bitter K, Krois J, Meyer-Lueckel H. Seven-year-efficacy of proximal caries infiltration – Randomized clinical trial. J Dent 2020; 93:103277. [DOI: 10.1016/j.jdent.2020.103277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 10/25/2022] Open
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Wierichs RJ, Rupp K, Meyer-Lueckel H, Apel C, Esteves-Oliveira M. Effects of Dentifrices Differing in Fluoride Content on Remineralization Characteristics of Dentin in vitro. Caries Res 2019; 54:75-86. [PMID: 31775152 DOI: 10.1159/000504165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 10/14/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare the caries preventive effect of highly fluoridated dentifrices and gels on sound dentin as well as on artificial dentin caries-like lesions. METHODS Bovine dentin specimens (n = 240), with 2 different surfaces each (1 sound surface [sound treatment (ST)] and one caries lesion [demineralized treatment (DT)]), were prepared and randomly allocated to one highly (6 × 120 min demineralization/day [H]) and one lowly cariogenic (6 × 60 min demineralization/day [L]) pH-cycling model. Treatments during pH-cycling (28 days) were: brushing 2×/day with: 0 ppm F [H0/L0], 1,450 ppm F [H1,450/L1,450], 2,800 ppm F [H2,800/L2,800], 5,000 ppm F [H5,000/L5,000], 5,000 ppm F plus TCP [H5,000+TCP/L5,000+TCP], and 12,500 ppm F [H12,500/L12,500] containing dentifrices/gels. Dentifrice/gel slurries were prepared with deionized water (1:2 wt/wt). Differences in integrated mineral loss (∆∆Z) and ∆ lesion depth were calculated between values before and after pH-cycling using transversal microradiography. RESULTS The correlation between ΔΔZDT and F- was strong for the highly (rH = 0.691; p < 0.001) and moderate (rL = 0.500; p < 0.001) for the lowly cariogenic model, indicating a fluoride dose-response for both. Significant differences for ΔΔZDT and ΔΔZST could be found between H0, H1,450, H5,000, and H12,500 as well as L0, L5,000, and L125,000 (p ≤ 0.046; analysis of covariance [ANCOVA]). Except for 0 ppm F-, no significant difference in ΔΔZST and ΔΔZDT could be found between the highly and lowly cariogenic model (p ≥ 0.056; ANCOVA). CONCLUSION For both pH-cycling conditions a dose-response for fluoride could be revealed. For elderly people with exposed root surfaces, the use of gels containing 12,500 ppm F instead of regularly (1,450 ppm F) or highly (5,000 ppm F) fluoridated dentifrices should be further investigated, as it offered higher caries-preventive effects in vitro.
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Affiliation(s)
- Richard J Wierichs
- Department of Biohybrid and Medical Textiles, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany, .,Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany,
| | - Katharina Rupp
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | - Hendrik Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, zmk Bern, University of Bern, Bern, Switzerland
| | - Christian Apel
- Department of Biohybrid and Medical Textiles, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - Marcella Esteves-Oliveira
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany.,Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
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Kobbe C, Fritz U, Wierichs RJ, Meyer-Lueckel H. Evaluation of the value of re-wetting prior to resin infiltration of post-orthodontic caries lesions. J Dent 2019; 91:103243. [PMID: 31730787 DOI: 10.1016/j.jdent.2019.103243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Assessment of the influence of colour changes during the re-wetting process as a possible predictor for the final result after resin infiltration to mask post-orthodontic white spot lesions. MATERIALS AND METHODS Resin infiltration (ICON; DMG, Hamburg, Germany) was performed according to the manufacturer's recommendation with the exception of repeated, at maximum three etching procedures based on the subjective decision of the dentist during a so called re-wetting process using ethanol. The masking effect by ethanol as well as after resin infiltration was evaluated by digital images taken before, for nine seconds during re-wetting and one week after treatment using CIE L*a*b* colour space. RESULTS Twenty-nine patients (16 female) with a total of 221 lesions (ICDAS 2) were included (mean age 16 years). Mean time after debonding the orthodontic appliances was ten weeks. Colour changes during re-wetting, evaluated in the first ten patients (71 lesions) showed a significant correlation between the minimum ΔE observed during re-wetting and the final ΔE after resin infiltration (r = 0.65, p < 0.001; Spearman correlation). The main drop in ΔE becomes visible after three seconds when performing the re-wetting process. Regarding the 221 lesions, resin infiltration significantly reduced the colour difference between sound and lesion areas from a baseline ΔE (25th/75th percentiles) of 10.9 (8.2/13.2) to a ΔE of 4 (2.1/5.8) after one week (p < 0.001). The number of etching procedures correlated significantly with baseline ΔE (p < 0.05). CONCLUSIONS The minimum ΔE observed during the re-wetting process seems to be a useful predictor for the final result of resin infiltration of post-orthodontic caries lesions. More prominent lesions with higher ΔE at baseline seem to require more erosion of the surface layer. In general, a significant and considerable clinical reduction of ΔE could be observed. CLINICAL SIGNIFICANCE We corroborate that resin infiltration technique is a very useful method to mask caries lesions having developed during treatment with fixed orthodontic appliances. Colour changes while re-wetting the lesions with ethanol seem to be a valuable indicator for the number of required etching procedures.
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Affiliation(s)
- C Kobbe
- Department of Restorative, Preventive & Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - U Fritz
- Department of Orthodontics, RWTH Aachen University, Aachen, Germany
| | - R J Wierichs
- Department of Restorative, Preventive & Pediatric Dentistry, University of Bern, Bern, Switzerland; Department of Biohybrid & Medical Textiles, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - H Meyer-Lueckel
- Department of Restorative, Preventive & Pediatric Dentistry, University of Bern, Bern, Switzerland.
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Wierichs RJ, Meyer-Lueckel H, Kramer EJ. Dentareport - Automated longevity and risk factor analysis in dental patient care. Comput Biol Med 2019; 114:103437. [DOI: 10.1016/j.compbiomed.2019.103437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/19/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
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Meyer-Lueckel H, Machiulskiene V, Giacaman RA. How to Intervene in the Root Caries Process? Systematic Review and Meta-Analyses. Caries Res 2019; 53:599-608. [PMID: 31412343 DOI: 10.1159/000501588] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/12/2019] [Indexed: 11/19/2022] Open
Abstract
The aim of this review as part of the preparation for a workshop organized by the European Federation of Conservative Dentistry (EFCD) in conjunction with the European Organisation for Caries Research (ORCA) was to systematically analyze available evidence of non-, micro- as well as invasive interventions for root caries lesions (RCLs). For each treatment strategy, a separate systematic review was either performed (micro-invasive and choice of restorative material) or updated (non-invasive and excavation technique) each of them following PRISMA guidelines, and if possible meta-analyses were performed. Besides the general advice to improve tooth brushing with fluoride toothpaste main findings for non-invasive interventions in RCLs, the use of dentifrices containing 5,000 ppm F- as well as professionally applied chlorhexidine varnish or silver diamine fluoride seemed to be more efficacious to arrest root caries compared to conventional fluoride toothpaste or placebo respectively. However, this conclusion is based only on a few randomized clinical trials. For micro-invasive treatments, only 2 studies focusing on sealants were available without clear conclusions. A recent review on the comparison of atraumatic restorative treatment compared with conventional treatment concluded that there is insufficient data to clearly rule out if any difference with regard to restoration longevity between both techniques exists. When restoring coventionally, composites performed better than resin-modified and glass ionomer cements. However, all materials showed rather high annual failure rates in the majority of the studies and evidence is based on a low number of prospective studies with a rather high risk of bias.
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Affiliation(s)
- Hendrik Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland,
| | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, University of Talca, Talca, Chile
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Meyer-Lueckel H, Opdam NJM, Breschi L, Buchalla W, Ceballos L, Doméjean S, Federlin M, Field J, Gurgan S, Hayashi M, Laegreid T, Loomans BAC, Lussi A, Lynch CD, Pallesen U, Peumans M, Toth Z, Wilson NHF. EFCD Curriculum for undergraduate students in Integrated Conservative Oral Healthcare (ConsCare). Clin Oral Investig 2019; 23:3661-3670. [PMID: 31270666 DOI: 10.1007/s00784-019-02978-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- H Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| | - N J M Opdam
- Radboud Institute for Health Sciences, Department of Dentistry, Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands
| | - L Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna-Alma Mater Studiorum, Bologna, Italy
| | - W Buchalla
- Department for Conservative Dentistry and Periodontology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - L Ceballos
- Departamento de Medicina y Cirugía, Psicología, Medicina Preventiva y Salud Pública e Inmunología y Microbiología Médica y Enfermería y Estomatología, Universidad Rey Juan Carlos, Madrid, Spain
| | - S Doméjean
- Département Odontologie Conservatrice. CHU Estaing Clermont-Ferrand, Service d'Odontologie, 63001 Clermont-Ferrand, UFR d'Odontologie, Centre de Recherche en Odontologie Clinique EA 4847, University Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - M Federlin
- Department for Conservative Dentistry and Periodontology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - J Field
- School of Clinical Dentistry, The University of Sheffield, Sheffield, UK
| | - S Gurgan
- Faculty of Dentistry, Department of Restorative Dentistry, Hacettepe University, 06100, Ankara, Turkey
| | - M Hayashi
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadoka, Suita, Osaka, 565-0871, Japan
| | - T Laegreid
- Section of Cariology, Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Postboks 7804, 5020, Bergen, Norway
| | - B A C Loomans
- Radboud Institute for Health Sciences, Department of Dentistry, Radboud University Medical Center, P.O. Box 9101, 6500HB, Nijmegen, The Netherlands
| | - A Lussi
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - C D Lynch
- University Dental School & Hospital, University College, Cork, Ireland
| | - U Pallesen
- Section for Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Nörre Alle 20, DK-2200, Copenhagen N, Denmark
| | - M Peumans
- Department of Oral Health Sciences, BIOMAT & UZ Leuven (University Hospitals Leuven), Dentistry, KU Leuven (University of Leuven), Kapucijnenvoer 7, B-3000, Leuven, Belgium
| | - Z Toth
- Department of Conservative Dentistry, Semmelweis University, Üllői út 26, Budapest, H-1085, Hungary
| | - N H F Wilson
- Emeritus Professor of Dentistry, King's College London, London, UK
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Hetrodt F, Lausch J, Meyer-Lueckel H, Conrads G, Apel C. Evaluation of Restorative Materials Containing Preventive Additives in a Secondary Caries Model in vitro. Caries Res 2019; 53:447-456. [DOI: 10.1159/000496401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/19/2018] [Indexed: 11/19/2022] Open
Abstract
The incorporation of antibacterial agents into dental restorative materials is a promising strategy for secondary caries prevention. Previously, Carolacton affected Streptococcus mutans biofilm formation on composite materials in vitro. The present study evaluated secondary caries formation adjacent to Carolacton-containing composites and conventional restorative materials using an artificial biofilm model. Standardized cavities were prepared in bovine dentin-enamel samples (n = 175) and restored with various dental materials (Tetric EvoCeram [T], GrandioSo composite without [G] and with Carolacton [GC], Grandio Flow without [F] and with Carolacton [FC], GrandioSo containing sodium fluoride [GNaF], and Ketac Fil [K]). After artificial aging, S. mutans was grown on the samples for 7 days. The investigation of gap sizes and secondary caries formation was performed using confocal laser scanning microscopy and transversal microradiography. Median gap size in enamel was 9.4 µm (interquartile range 7.9–12.7). Compared to all other groups significant differences in gap sizes could be observed for Ketac Fil (p < 0.001; Mann-Whitney test). Only GrandioSo composite containing 30% sodium fluoride and Ketac Fil showed significantly smaller lesion areas in enamel (p < 0.001; Mann-Whitney test) than all other groups which was confirmed by the mineral loss data (p < 0.001; Mann-Whitney test). Based on the present in vitro results, it seems that Carolacton-containing composite in the current formulation within the shown simplified monoculture biofilm model is not able to prevent caries formation compared to fluoride-releasing restorative materials.
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Paris S, Schwendicke F, Soviero V, Meyer-Lueckel H. Accuracy of tactile assessment in order to detect proximal cavitation of caries lesions in vitro. Clin Oral Investig 2019; 23:2907-2912. [DOI: 10.1007/s00784-018-02794-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 12/20/2018] [Indexed: 11/28/2022]
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Kramer EJ, Meyer-Lueckel H, Wolf TG, Schwendicke F, Naumann M, Wierichs RJ. Success and survival of post-restorations: six-year results of a prospective observational practice-based clinical study. Int Endod J 2018; 52:569-578. [PMID: 30417927 DOI: 10.1111/iej.13040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 11/06/2018] [Indexed: 12/17/2022]
Abstract
AIM This prospective, noninterventional, multi-centre, practice-based study aimed to evaluate the longevity of endodontically treated teeth (ETT) restored with posts and to analyse factors influencing the success and survival of endodontic posts. METHODOLOGY Eight general dental practitioners each placed up to 27 endodontic posts without any restriction to size and material. Teeth were restricted to incisors, canines and premolars. Multi-level Cox proportional hazards models were used to evaluate the association between clinical factors and time until failure. RESULTS A total of 195 endodontic posts were followed-up for up to 6.5 years in 195 patients. Of these, 140 posts were judged as successful [mean success time: 59 (55-63) months]; the mean annual failure rate was 8.6%. This decreased to 4.4% when excluding recementations. 152 posts survived [mean survival time: 64 (60-67) months]. Recemented restorations had an eight times higher failure rate compared with new restorations. Furthermore, restorations with glass fibre post had a significantly lower success rate compared with titanium posts. CONCLUSION Relatively low success and survival rates occurred for restorations with posts after root canal treatment in a private practice setting after a follow-up of up to 6.5 years. Recemented crowns had a high risk of failure.
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Affiliation(s)
- E J Kramer
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | - H Meyer-Lueckel
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany.,Department of Restorative, Preventive and Pediatric Dentistry, Zahnmedizinische Kliniken der Universität Bern, University of Bern, Bern, Switzerland
| | - T G Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, Zahnmedizinische Kliniken der Universität Bern, University of Bern, Bern, Switzerland
| | - F Schwendicke
- Department of Operative and Preventive Dentistry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - M Naumann
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - R J Wierichs
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany.,Department of Biohybrid & Medical Textiles (BioTex), AME - Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
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Walther C, Kreibohm M, Paris S, Meyer-Lueckel H, Tschoppe P, Wierichs RJ. Effect of NaF, AmF, KF gels and NaF toothpaste combined with a saliva substitute on dentin lesions in vitro. Clin Oral Investig 2018; 23:2489-2496. [PMID: 30306335 DOI: 10.1007/s00784-018-2687-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 10/01/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the present in vitro study was to evaluate the remineralizing effects of NaF, AmF, KF gels and NaF toothpaste in combination with a potentially demineralizing saliva substitute (Glandosane; pH = 5.1) being widely used in Germany. METHODS In each of 120 dentin specimens, three artificial lesions were created. One lesion was covered for analysis of pre-demineralization (ΔZB). Treatments during pH cycling (3 × 1 h demineralization/day [pH = 5.0] and 3 × 3 h Glandosane/day; 12 h 100%humidity) were as follows: no treatment (NT), application (5 min,2×/day) of 12.500 ppm F- [pH = 6.04] (NaF-gel1), 12.500 ppm F- [pH = 7.34] (NaF-gel2), 12.500 ppm F- [pH = 5.82] (AmF-gel), 1450 ppm F- [pH = 7.35] (KF-gel), and 5000 ppm F- [pH = 8.14]; (NaF-TP) for 7 days (E1). Subsequently, from each specimen, one lesion was covered, while the remaining lesion was cycled for another 7 days (E2). Differences in integrated mineral loss (ΔΔZE1/ΔΔZE2) were calculated between values before and after pH cycling. RESULTS Mean (95%CI) ΔZB was 3851 (3762;3939) vol% × μm. Except for NaF-gel2 and NaF-TP, specimens of all other groups further demineralized. Only NaF-gel2 induced a significant gain in mineral content (p ≤ 0.004; paired t test). Significant differences in the change of mineral loss were found between NT and all fluoride groups for both ΔΔZE1 and for ΔΔZE2 (p < 0.05, Bonferroni post hoc test). However, only NaF-gel2 and NaF-TP induced remineralization. CONCLUSION Under the in vitro conditions chosen, all fluoride agents could significantly hamper the adverse effects of a demineralizing saliva substitute. CLINICAL SIGNIFICANCE In combination with a demineralizing saliva substitute, slight mineral gain was only observed for neutral NaF-gel2 and 5000 ppm F- toothpaste.
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Affiliation(s)
- Carolin Walther
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Manana Kreibohm
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Sebastian Paris
- Department of Operative Dentistry and Periodontology, University School of Dental Medicine, CharitéCentrum 3, Charité - Universitätsmedizin Berlin, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Hendrik Meyer-Lueckel
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.,Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Peter Tschoppe
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.,Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Richard Johannes Wierichs
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany. .,Department of Biohybrid & Medical Textiles (BioTex), AME - Institute of Applied Medical Engineering, Helmholtz Institute, Forckenbeckstr. 55, 52074, Aachen, Germany.
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Wierichs R, Kramer E, Meyer-Lueckel H. Risk factors for failure of class V restorations of carious cervical lesions in general dental practices. J Dent 2018; 77:87-92. [DOI: 10.1016/j.jdent.2018.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022] Open
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Sterzenbach G, Rosentritt M, Meyer-Lueckel H, Bitter K, Naumann M. Failure loads of all-ceramic cantilever fixed dental prostheses on post-restored abutment teeth: influence of the post presence and post position. Eur J Oral Sci 2018; 126:526-532. [PMID: 30273995 DOI: 10.1111/eos.12573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2018] [Indexed: 11/29/2022]
Abstract
The influence of a fiber post-restored abutment tooth on the load capability of a three-unit zirconia framework cantilever fixed dental prosthesis (cFDP) was evaluated after simulated clinical function. Human lower sound premolars (n = 64) were distributed, in equal numbers, to four experimental groups: two vital abutment teeth (group I; control); mesial abutment tooth post-restored (group II); distal abutment tooth post-restored (group III); and mesial and distal abutment teeth post-restored (group IV). All specimens received an adhesively luted three-unit cFDP of veneered zirconia. Simulated clinical function was performed by two subsequent sequences of thermal-cycling (2 × 3,000 cycles) and mechanical loading (1.2 × 106 load cycles from 0 to 50 N) (TCML). Four specimens failed during TCML (one in each of groups I and IV and two in group II). The maximum load capability ranged from 365 to 538 N and was not significantly different between groups. Specimens with post-restored abutments failed mainly because of abutment tooth fracture of the distal abutment. The presence or position of post-restored abutment teeth has no significant impact on load capability of all-ceramic three-unit cFDPs. The risk of tooth fracture of the distal abutment teeth of a cFDP was significantly increased when one abutment tooth, irrespective of its position, was post-and-core restored.
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Affiliation(s)
- Guido Sterzenbach
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Rosentritt
- Department of Prosthetic Dentistry, Regensburg University Medical Center, Regensburg, Germany
| | - Hendrik Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - Kerstin Bitter
- Department of Operative and Preventive Dentistry, Berlin Institute of Health, Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Naumann
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Meyer-Lueckel H, Wilson N. Editorial: Prevention and Treatment of Caries - Simply Two Sides of a Coin. Oral Health Prev Dent 2018; 16:305-306. [PMID: 30175327 DOI: 10.3290/j.ohpd.a41035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Walther C, Meyer-Lueckel H, Conrads G, Esteves-Oliveira M, Henne K. Correlation between relative bacterial activity and lactate dehydrogenase gene expression of co-cultures in vitro. Clin Oral Investig 2018; 23:1225-1235. [PMID: 29980934 DOI: 10.1007/s00784-018-2547-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 06/27/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The present study aims at correlating the relative bacterial activity with the H+ concentration and the ldh expression of caries-associated bacteria in co-cultures. MATERIALS AND METHODS Well plates were prepared with BHI medium and cultures of Lactobacillus paracasei and Fusobacterium nucleatum. Bacterial growth at 37 °C was measured using a microplate-photometer before and after adding sucrose to the samples. Samples of co-cultures (n = 12) and single-species cultures (n = 3) were taken and pH was assessed. Real-time quantitative PCRs were applied targeting the 16S-gene, the 16S-rRNA, the ldh-gene, and the ldh-mRNA. RESULTS For L. paracasei with sucrose, an increase in relative bacterial activity (62.8% ± 23.5% [mean, SE]) was observed, while F. nucleatum showed a clear decrease in relative bacterial activity (- 35.0% ± 9.6%). Simultaneously, the H+ concentration increased (1.15E-05 mol*l-1 ± 4.61E-07 mol*l-1). Consequently, a significant positive correlation was found between L. paracasei's relative bacterial activity and H+ concentration (Spearman rank correlation, r = 0.638; p = 0.002), while F. nucleatum exhibited a negative correlation (r = - 0.741; p ≤ 0.001). Furthermore L. paracasei with sucrose showed a moderate, but significant positive correlation between relative bacterial activity and ldh-expression (r = 0.307; p = 0.024). CONCLUSIONS AND CLINICAL RELEVANCE The relative bacterial activity after sucrose pulse showed a significant correlation not only to the acid production (H+ concentration) but also to ldh expression of L. paracasei. However, further research is required to confirm these findings in a mature biofilm in vivo.
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Affiliation(s)
- Carolin Walther
- Department of Operative Dentistry, Periodontology, and Preventive Dentistry, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Hendrik Meyer-Lueckel
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - Georg Conrads
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology, and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | - Marcella Esteves-Oliveira
- Department of Operative Dentistry, Periodontology, and Preventive Dentistry, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Karsten Henne
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology, and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
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Askar H, Schwendicke F, Lausch J, Meyer-Lueckel H, Paris S. Modified resin infiltration of non-, micro- and cavitated proximal caries lesions in vitro. J Dent 2018; 74:56-60. [PMID: 29775637 DOI: 10.1016/j.jdent.2018.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/21/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Infiltrant resin (IR) is currently indicated for non-cavitated caries lesions. However, modifying the technique might expand its indication spectrum to micro-cavitated lesions. The present study aimed to evaluate the penetration/filling ability of a newly developed micro-filled infiltrant resin (MFIR) in non-, micro- and cavitated natural caries lesions. MATERIALS AND METHODS Proximal lesions in 120 extracted human teeth with ICDAS-2 (n = 30), 3 (n = 45) and 5 (n = 45) lesions were etched with 15% hydrochloric acid gel for 2 min and allocated to one of the following treatments; IR: lesions (ICDAS-2, 3 and 5; each n = 15) were treated with commercial infiltrant resin for 3 min. MFIR: experimental MFIR [55 wt% IR plus 45 wt% organic fillers] was applied to lesions (ICDAS-2, 3 and 5; each n = 15) for 3 min. IR + FC: IR was applied for 3 min, light-cured, and cavities (ICDAS-3 and 5; each n = 15) filled with flowable composite (FC). Percentage infiltration of the demineralized enamel (Inf.%) and percentage filling of the cavity (Fill.%) were analyzed using dual-fluorescence staining and confocal microscopy. RESULTS No significant differences in Inf.% (range of medians: 57%-100%) were observed between different treatments (p > 0.05; Kruskal-Wallis) within each ICDAS-code. Fill.% of cavities was significantly higher in groups MFIR (median in ICDAS-3/-5: 100%/100%) and IR + FC (100%/100%) than IR (25%/38%) (p < 0.05). CONCLUSION MFIR showed similar penetration into natural lesions as the commercial infiltrant, but better ability to fill cavitated areas. CLINICAL RELEVANCE MFIR and IR + FC might provide a new micro-invasive treatment for small cavitated proximal lesions.
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Affiliation(s)
- H Askar
- Department of Operative and Preventive Dentistry, CharitéCentrum 3, Charité - Universitätsmedizin, Berlin, Germany.
| | - F Schwendicke
- Department of Operative and Preventive Dentistry, CharitéCentrum 3, Charité - Universitätsmedizin, Berlin, Germany
| | - J Lausch
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Germany
| | - H Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - S Paris
- Department of Operative and Preventive Dentistry, CharitéCentrum 3, Charité - Universitätsmedizin, Berlin, Germany
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Hetrodt F, Lausch J, Meyer-Lueckel H, Apel C, Conrads G. Natural saliva as an adjuvant in a secondary caries model based on Streptococcus mutans. Arch Oral Biol 2018; 90:138-143. [PMID: 29614462 DOI: 10.1016/j.archoralbio.2018.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/21/2018] [Accepted: 03/23/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Two factors for secondary caries formation were evaluated using an artificial biofilm model, saliva as additive in culture medium and bonding procedures of composite materials for artificial gap creation. DESIGN Standardized cavities were prepared in bovine tooth samples (n = 44), treated with two different bonding pretreatments, restored and after artificial ageing incubated with Streptococcus mutans in a Mueller-Hinton-Broth-Sugar medium with or without human saliva for seven days. Secondary caries formation was analyzed using confocal laser scanning microscopy and transversal microradiography. RESULTS Lesions were significantly pronounced in groups using saliva, but were not influenced by the bonding pretreatments. CONCLUSIONS The results indicate that the addition of saliva, but not the type of bonding procedure influences the outcome in the present biofilm-based secondary caries model.
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Affiliation(s)
- Franziska Hetrodt
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Julian Lausch
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Hendrik Meyer-Lueckel
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| | - Christian Apel
- Department of Biohybrid & Medical Textiles, Institute of Applied Medical Engineering, Helmholtz Institute of RWTH Aachen University & Hospital, Pauwelsstraße 20, 52074, Aachen, Germany.
| | - Georg Conrads
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
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Wierichs RJ, Stausberg S, Lausch J, Meyer-Lueckel H, Esteves-Oliveira M. Caries-Preventive Effect of NaF, NaF plus TCP, NaF plus CPP-ACP, and SDF Varnishes on Sound Dentin and Artificial Dentin Caries in vitro. Caries Res 2018; 52:199-211. [DOI: 10.1159/000484483] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 10/16/2017] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to compare the caries-preventive effect of different fluoride varnishes on sound dentin as well as on artificial dentin caries-like lesions. Bovine dentin specimens (n = 220) with one sound surface (ST) and one artificial caries lesion (DT) were prepared and randomly allocated to 11 groups. The interventions before pH cycling were as follows: application of a varnish containing NaF (22,600 ppm F-; Duraphat [NaF0/NaF1]), NaF plus tricalcium phosphate (22,600 ppm F-; Clinpro White Varnish Mint [TCP0/TCP1]), NaF plus casein phosphopeptide-stabilized amorphous calcium phosphate complexes (CPP-ACP; 22,600 ppm F-; MI Varnish [CPP0/CPP1]), or silver diamine fluoride (SDF; 35,400 ppm F-; Cariestop 30% [SDF0/SDF1]) and no intervention (NNB/N0/N1). During pH cycling (14 days, 6 × 120 min demineralization/day) half of the specimens in each group were brushed (10 s; 2 times/day) with either fluoride-free (“0”; e.g., TCP0) or 1,100 ppm F- (“1”; e.g., TCP1) dentifrice slurry. In another subgroup, the specimens were pH cycled but not brushed (NNB). Differences in integrated mineral loss (ΔΔZ), lesion depth (ΔLD), and colorimetric values (ΔΔE) were calculated between the values after initial demineralization and those after pH cycling, using transversal microradiography and photographic images. After pH cycling, no discoloration could be observed. Furthermore, NNB, N0, and N1 showed significantly increased ΔZDT/LDDT and ΔZST/LDST values, indicating further demineralization. In contrast, CPP0, CPP1, SDF0, and SDF1 showed significantly decreased ΔZDT/LDDT values, indicating remineralization (p ≤ 0.004; paired t test). CPP0, CPP1, SDF0, and SDF1 showed significantly higher changes in ΔΔZDT/ΔLDDT and ΔΔZST/ΔLDST than NNB, N0, and N1 (p < 0.001; Bonferroni post hoc test). In conclusion, under the conditions chosen, all fluoride varnishes prevented further demineralization. However, only NaF plus CPP-ACP and SDF could remineralize artificial dentin caries-like lesions under net-demineralizing conditions, thereby indicating that NaF plus CPP-ACP and SDF may be helpful to high-caries-risk patients.
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Esteves-Oliveira M, Jansen P, Wehner M, Dohrn A, Bello-Silva MS, Eduardo CDP, Meyer-Lueckel H. Surface Characterization and Short-term Adhesion to Zirconia after Ultra-short Pulsed Laser Irradiation. J Adhes Dent 2017; 18:483-492. [PMID: 27695716 DOI: 10.3290/j.jad.a36918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate the suitability of an ultra-short pulsed laser (USPL) to treat zirconia ceramic surfaces and increase their adhesion to dual-curing resin cement. MATERIALS AND METHODS Twenty 10 × 10 × 5 mm³ blocks were prepared from a zirconia ceramic (Y-TZP). The specimens were polished and randomly assigned to four groups (n = 5) which received the following surface treatments: sandblasting (SB) with Al₂O₃ particles and silica coating (SC) with SiO₂ particles as positive controls; two groups received USPL irradiation, one with 10 scan repetitions (L10) and the other with 20 (L20). Laser irradiation was performed at 1030 nm, 2.3 J/cm², 6 ps pulse duration. The ceramic blocks were duplicated in composite resin and cemented with a dual-curing resin cement. Half of the blocks were then stored in water (37°C) for 24 h and the other half for 1 month. At each time, 40 to 60 sticks per group were subjected to microtensile bond strength testing. Data were analyzed statistically using the Kruskal-Wallis test (α = 0.05). RESULTS Laser-treated zirconia presented statistically significantly higher roughness than did SB and SC. After 24 h, the highest bond strength means (MPa) were achieved by L10 (42.3 ± 10.8) and L20 (37.9 ± 14.4), and both of them were statistically significantly higher than SB (22.0 ± 5.3) and SC (20.8 ± 7.1) (p < 0.05). After 1 month of storage, L10- and L20-treated zirconia still showed significantly higher bond strengths than did SB- and SC-treated zirconia (p < 0.05). CONCLUSION USPL irradiation significantly increases bond strength of zirconia ceramic to dual-curing resin cement and might be an alternative for improving adhesion to this material.
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Wierichs RJ, Kogel J, Lausch J, Esteves-Oliveira M, Meyer-Lueckel H. Effects of Self-Assembling Peptide P11-4, Fluorides, and Caries Infiltration on Artificial Enamel Caries Lesions in vitro. Caries Res 2017; 51:451-459. [PMID: 28772269 DOI: 10.1159/000477215] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 05/01/2017] [Indexed: 11/19/2022] Open
Abstract
The application of a self-assembling peptide on noncavitated caries lesions is supposed to be a feasible approach to facilitate remineralization and mask their unfavorable appearance. However, demineralizing conditions are common in the oral environment, so the aim of this pH-cycling study was to compare recommended and novel treatment methods regarding their ability to hamper demineralization and as a consequence mask artificial enamel caries lesions. Artificial caries lesions were prepared in bovine enamel and randomly allocated to 11 groups (n = 22). Treatments before pH-cycling were as follows: the application of a self-assembling peptide (Curodont™ Repair [C]), a low-viscosity resin (Icon® [I]), 2 fluoride solutions (10,000 ppm F-: Elmex fluid [E] and 43,350 ppm F-: Tiefenfluorid® [T]), and no intervention (N). During pH-cycling (28 days, 6 × 60 min demineralization/day) half of the specimens in each group were brushed (10 s; 2 ×/day) with either fluoride-free (named e.g., C0) or NaF (1,100 ppm F-; e.g., C1) dentifrice slurry. In another subgroup specimens were pH-cycled but not brushed (NNB). Differences in integrated mineral loss (ΔΔZ), lesion depth (ΔLD), and colorimetric values (ΔΔE) were calculated between values after pre-demineralization, surface treatment, and pH-cycling. Specimens of C0, C1, NNB, N0, N1, T0, and E0 showed significantly increased ΔZ and LD values after pH-cycling (p ≤ 0.003; paired t test). C0, C1, NNB, and N0 showed significantly higher changes in ΔΔZ than E1, I0, I1, and T1 (p < 0.001; ANOVA). Significantly reduced colorimetric values could only be observed for I1, I0, E1, and E0 after treatment and after pH-cycling (p ≤ 0.027; paired t test). In conclusion, under the conditions chosen only the application of a low-viscosity resin could mask caries lesions significantly, whereas self-assembling peptides could neither inhibit lesion progression nor mask the lesions considerably.
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Affiliation(s)
- Richard J Wierichs
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
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Esteves-Oliveira M, Wollgarten S, Liebegall S, Jansen P, Bilandzic M, Meyer-Lueckel H, Fischer H, Stollenwerk J, Poprawe R. A New Laser-Processing Strategy for Improving Enamel Erosion Resistance. J Dent Res 2017; 96:1168-1175. [PMID: 28665779 DOI: 10.1177/0022034517718532] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the present study, a new automatic laser-processing strategy allowing standardized irradiation of natural tooth areas was investigated. The objective was to find a combination of laser parameters that could cause over a 600°C temperature increase at the enamel surface while not damaging enamel, avoiding temperature change above 5.5°C in the pulp and increasing enamel erosion resistance. Seventy-seven bovine enamel samples were randomly divided into 6 laser groups and 1 negative control (C/no treatment/ n = 11). A scanning strategy (7 × 3 mm) was used for the CO2 laser treatment (λ = 10.6 µm, 0.1-18 J/cm2) with different pulse durations-namely, 20 µs (G20), 30 µs (G30), 55 µs (G55), and 490 µs (G490), as well as 2 modified pulse distances (G33d, G40d). Measurements of temperature change were performed at the surface (thermal camera/50 Hz), at the underside (thermocouples), and at the pulp chamber using a thermobath and human molars ( n = 10). In addition, histology and X-ray diffraction (XRD/ n = 10) were performed. Erosion was tested using an erosive cycling over 6 d, including immersion in citric acid (2 min/0.05 M/pH = 2.3) 6 times daily. Surface loss was measured using a profilometer and statistical analysis with a 2-way repeated-measures analysis of variance (α = 0.05). Only G20 fulfilled the temperature requirements at the surface (619 ± 21.8°C), at the underside (5.3 ± 1.4°C), and at the pulp (2.0 ± 1.0°C), and it caused no mineral phase change and significant reduction of enamel surface loss (-13.2 ± 4.0 µm) compared to C (-37.0 ± 10.1 µm, P < 0.05). A laser-scanning strategy (20 µs/2 kHz/1.25 J/cm2, 3.4 mm/s) has been established that fulfilled the criteria for biological safety and significantly increased enamel erosion resistance (64%) in vitro.
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Affiliation(s)
- M Esteves-Oliveira
- 1 Department of Operative Dentistry, Periodontology and Preventive Dentistry, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - S Wollgarten
- 2 Chair for Laser Technology, RWTH Aachen University, Aachen, Germany
| | - S Liebegall
- 1 Department of Operative Dentistry, Periodontology and Preventive Dentistry, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - P Jansen
- 1 Department of Operative Dentistry, Periodontology and Preventive Dentistry, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - M Bilandzic
- 3 Department of Dental Materials and Biomaterials Research (ZWBF), RWTH Aachen University Hospital, Aachen, Germany
| | - H Meyer-Lueckel
- 1 Department of Operative Dentistry, Periodontology and Preventive Dentistry, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - H Fischer
- 3 Department of Dental Materials and Biomaterials Research (ZWBF), RWTH Aachen University Hospital, Aachen, Germany
| | - J Stollenwerk
- 4 Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - R Poprawe
- 2 Chair for Laser Technology, RWTH Aachen University, Aachen, Germany.,4 Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
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Lausch J, Askar H, Paris S, Meyer-Lueckel H. Micro-filled resin infiltration of fissure caries lesions in vitro. J Dent 2017; 57:73-76. [DOI: 10.1016/j.jdent.2016.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/22/2016] [Accepted: 12/30/2016] [Indexed: 11/29/2022] Open
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Wierichs RJ, Kramer EJ, Meyer-Lueckel H. Risk factors for failure in the management of cervical caries lesions. Clin Oral Investig 2016; 21:2123-2131. [DOI: 10.1007/s00784-016-2002-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 11/01/2016] [Indexed: 01/08/2023]
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Henne K, Gunesch AP, Walther C, Meyer-Lueckel H, Conrads G, Esteves-Oliveira M. Analysis of Bacterial Activity in Sound and Cariogenic Biofilm: A Pilot in vivo Study. Caries Res 2016; 50:480-488. [PMID: 27595541 DOI: 10.1159/000448485] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/18/2016] [Indexed: 11/19/2022] Open
Abstract
Dental caries is a multifactorial disease with many associated microbial taxa, but only a few are notably contributing to acidogenicity. The ribosome number and the corresponding 16S ribosomal RNA (rRNA) concentration are considered a molecular indicator for general metabolic activity of bacteria, as they are elevated with increased anabolic and catabolic activities. We hypothesize that the activity of aciduric/acidogenic bacterial taxa, reflected by a rise in ribosomal counts, could resolve differences between plaque biofilm from sound surfaces and caries lesions. The included subjects were allocated to two groups: caries-free (CF) or caries-active (CA). CF subjects presented one donor site, namely one sound surface (CFS, n = 10), whereas CA subjects presented two donor sites: a cavitated lesion with an ICDAS score of 5-6 (CAC, n = 13), and a sound reference surface (CAS, n = 13). Four aciduric/acidogenic bacterial taxa (Streptococcus mutans, lactobacilli, Bifidobacterium dentium, and Scardovia wiggsiae) and one asaccharolytic taxon (fusobacteria) as a contrast were selected. 16S rRNA and 16S rRNA genes were quantified by quantitative PCR. Based on these parameters, bacterial and ribosomal counts, as well as relative activities were calculated as the quotient of relative ribosomal abundance and relative genome abundance. Caries-associated bacteria showed the highest relative activity in caries lesions (e.g. lactobacilli CAC: 177.5 ± 46.0%) and lower activities on sound surfaces (e.g. lactobacilli CAS: 96.3 ± 31.5%), whereas asaccharolytic fusobacteria were most active on sound surfaces and less active in caries lesions (CFS: 275.7 ± 171.1%; CAS: 205.8 ± 114.3%; CAC: 51.1 ± 19.0%). Thus, the present study suggests different activity patterns for biofilms from CF and CA individuals.
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Affiliation(s)
- Karsten Henne
- Division of Oral Microbiology and Immunology, Department of Operative Dentistry, Periodontology, and Preventive Dentistry, University Hospital RWTH Aachen, Aachen, Germany
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Abstract
SUMMARY
The decrease in caries prevalence in many industrialized countries and the improved knowledge about the etiology and pathogenesis of caries have shifted the focus of caries therapy over the past decades toward less invasive approaches. Studies on caries progression indicate that it is generally quite slow in most patients today which should lead to a reconsideration of the practice of early invasive intervention. Today noninvasive (eg, fluorides) and microinvasive (occlusal sealing, proximal infiltration) therapeutic options that address etiological factors are gaining importance. The goal of these therapies is to heal or at least to slow down the progress of the disease. Noninvasive treatments are mainly related to controlling pathogenic factors (ie, sugar consumption) and enhancing protective factors (mainly oral hygiene and fluorides). Microinvasive treatments do not rely on the compliance of the patient as much, since these treatments include a resinous material that is applied to serve as a diffusion barrier for acids formed by cariogenic bacteria in the overlying plaque. To establish a minimum intervention treatment strategy for caries, the disease must be diagnosed at an early stage. In addition to assessing caries lesions in single teeth, individual risk factors need to be identified so that the underlying causes related to patients' behavioral patterns that led to the disease can be addressed as well. The patient should be informed about the scientific evidence related to the treatment choices in a participative atmosphere. Decision trees may help to make the range of findings comprehensible and the therapeutic shared decision-making process understandable to the patients.
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Affiliation(s)
- H Meyer-Lueckel
- Hendrik Meyer-Lueckel, professor, RWTH Aachen University, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Aachen, Germany
| | - S Paris
- Sebastian Paris, professor, Charité – Universitätsmedizin Berlin, Department of Operative and Preventive Dentistry, Berlin, Germany
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Wilson N, Lynch CD, Brunton PA, Hickel R, Meyer-Lueckel H, Gurgan S, Pallesen U, Shearer AC, Tarle Z, Cotti E, Vanherle G, Opdam N. Criteria for the Replacement of Restorations: Academy of Operative Dentistry European Section. Oper Dent 2016; 41:S48-S57. [PMID: 27689930 DOI: 10.2341/15-058-o] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The replacement of a restoration is one of the most common procedures in dentistry. However, the criteria for such intervention, excluding catastrophic failure and persistent discomfort and pain, continue to be the subject of considerable debate. The decision-making process remains subjective on the part of the treating clinician, while the evidence base for refurbishment and repair rather than replacement for the management of defective and failing restorations continues to grow and strengthen. This article, prepared as an Academy of Operative Dentistry European Section consensus publication, reviews existing criteria for the replacement of restorations and encourages practitioners to shift, if not already doing so, to considering the replacement of a restoration as a last resort rather than as a prudent action to be taken if in any doubt about clinical acceptability. Further research in the area, spanning the risk assessment of defective and failing restorations and new diagnostic tools and processes, together with work to enhance the evidence base of restoration repair vs replacement, would be of immense value.
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Wierichs RJ, Lausch J, Meyer-Lueckel H, Esteves-Oliveira M. Re- and Demineralization Characteristics of Enamel Depending on Baseline Mineral Loss and Lesion Depth in situ. Caries Res 2016; 50:141-50. [DOI: 10.1159/000444537] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 02/05/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives: The aim of this double-blinded, randomized, cross-over in situ study was to evaluate the re- and demineralization characteristics of sound enamel as well as lowly and highly demineralized caries-like enamel lesions after the application of different fluoride compounds. Methods: In each of three experimental legs of 4 weeks, 21 participants wore intraoral mandibular appliances containing 4 bovine enamel specimens (2 lowly and 2 highly demineralized). Each specimen included one sound enamel and either one lowly demineralized (7 days, pH 4.95) or one highly demineralized (21 days, pH 4.95) lesion, and was positioned 1 mm below the acrylic under a plastic mesh. The three randomly allocated treatments (application only) included the following dentifrices: (1) 1,100 ppm F as NaF, (2) 1,100 ppm F as SnF2 and (3) 0 ppm F (fluoride-free) as negative control. Differences in integrated mineral loss (ΔΔZ) and lesion depth (ΔLD) were calculated between values before and after the in situ period using transversal microradiography. Results: Of the 21 participants, 6 did not complete the study and 2 were excluded due to protocol violation. Irrespectively of the treatment, higher baseline mineral loss and lesion depth led to a less pronounced change in mineral loss and lesion depth. Except for ΔΔZ of the dentifrice with 0 ppm F, sound surfaces showed significantly higher ΔΔZ and ΔLD values compared with lowly and highly demineralized lesions (p < 0.05, t test). Conclusion: Re- and demineralization characteristics of enamel depended directly on baseline mineral loss and lesion depth. Treatment groups should therefore be well balanced with respect to baseline mineral loss and lesion depth.
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