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Kharbot B, Bulgun N, Cölfen H, Paris S. Effect of calcium-coacervate infiltration of artificial enamel caries lesions in de- and remineralizing conditions. J Dent 2024; 142:104838. [PMID: 38211686 DOI: 10.1016/j.jdent.2024.104838] [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: 08/25/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVES Calcium-coacervate emulsions (CC) might be considered as mineral precursors to foster remineralization of carious dental hard tissues. This study analyzed the instant effect of repeated infiltration of artificial caries lesions with a CC emulsion as well as the effects of subsequent exposure of CC-infiltrated lesions to demineralizing and remineralizing environments. METHODS Bovine enamel specimens were partly covered with varnish to leave three exposed windows. Artificial enamel caries lesions were created (pH 4.95, 17d). Baseline controls (BL) were obtained by preparing a thin section of each specimen. Specimens were allocated to five groups. In three groups lesions were etched with 37 % phosphoric acid gel, infiltrated with dipotassium hydrogen phosphate and subsequently with a calcium coacervate emulsion, prepared by mixing CaCl2 ⋅ 2H2O with polyacrylic acid sodium salt (PAA-Na). Subsequently, the infiltration effect was either analyzed immediately (Inf.) or after exposition to either de- (Inf.+DS) or remineralizing solution (Inf.+RS) for 10 or 20 days, respectively. In two control groups specimens were exposed to either DS or RS, respectively without prior CC infiltration. Integrated mineral loss [ΔZ(vol%×µm)] was analyzed using transverse microradiography (TMR). RESULTS Infiltration of enamel caries lesions with coacervate solution resulted in only subtle immediate mineral gain even if repeated. When exposed to demineralizing conditions, infiltrated lesions showed significantly less mineral loss compared to untreated controls (p < 0.05; Kruskal Wallis) and exhibited characteristic mineral depositions within the lesion body. CONCLUSIONS While immediate mineral gain by infiltration was only modest, the CC-emulsion might be able to prevent demineralization in acidic conditions. CLINICAL SIGNIFICANCE Calcium coacervates might act protective against further demineralization when infiltrated into enamel caries lesions.
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Affiliation(s)
- Basel Kharbot
- Department of Operative, Preventive and Pediatric Dentistry, Center for Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, Berlin 14197, Germany.
| | - Neziha Bulgun
- Department of Operative, Preventive and Pediatric Dentistry, Center for Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, Berlin 14197, Germany
| | - Helmut Cölfen
- Physical Chemistry, Department of Chemistry, University of Konstanz, Konstanz, Germany
| | - Sebastian Paris
- Department of Operative, Preventive and Pediatric Dentistry, Center for Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, Berlin 14197, Germany
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Göstemeyer G, Preus M, Elhennawy K, Schwendicke F, Paris S, Askar H. Accuracy of different approaches for detecting proximal root caries lesions in vitro. Clin Oral Investig 2023; 27:1143-1151. [PMID: 36112228 PMCID: PMC9985551 DOI: 10.1007/s00784-022-04709-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/04/2022] [Accepted: 09/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective was to evaluate the diagnostic accuracy of radiographic evaluation (XR), visual-tactile assessment (VT), laser-fluorescence (LF) (DIAGNOdent Pen/KaVo), and near-infrared-light transillumination (NILT) (DIAGNOcam/KaVo) on proximal root caries lesions in vitro. METHODS Two-hundred extracted permanent premolars and molars with and without proximal root caries lesions were allocated to 50 diagnostic models simulating the proximal contacts between teeth and mounted in a phantom dummy head. Two independent examiners used the diagnostic approaches to detect any or advanced root caries lesions, with histologic evaluation of the lesions serving as reference. Receiver operating characteristic (ROC) curves were employed, and sensitivity, specificity, and the area under the ROC curve (AUC) are calculated. Significant differences in mean AUCs between approaches were assumed if p < 0.05 (two-sample t-test). RESULTS NILT was not applicable for proximal root caries detection. The sensitivity/specificity to detect any lesions was 0.81/0.63 for XR, 0.76/0.88 for VT and 0.81/0.95 for LF, and the sensitivity/specificity to detect advanced lesions was 0.43/0.94 for XR, 0.66/0.99 for VT, and 0.83/0.78 for LF, respectively. For both, any and advanced root caries lesions, mean AUCs for LF and VT were significantly higher compared to XR (p < 0.05). For any root caries lesions, LF was significantly more accurate than VT (p = 0.01), but not for advanced root caries lesions (p = 0.59). CONCLUSIONS Under the in vitro conditions chosen, LF and VT were more accurate than XR to detect proximal root caries lesions, with LF being particularly useful for initial lesion stages. CLINICAL RELEVANCE LF might be a useful diagnostic aid for proximal root caries diagnosis. Clinical studies are necessary to corroborate the findings.
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Affiliation(s)
- Gerd Göstemeyer
- Department of Operative, Preventive and Pediatric Dentistry, Charité - Universitätsmedizin Berlin, Assmannshauser Straße 4-6, 14197, Berlin, Germany.
| | - Mareike Preus
- Department of Operative, Preventive and Pediatric Dentistry, Charité - Universitätsmedizin Berlin, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Karim Elhennawy
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité - Universitätsmedizin Berlin, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Sebastian Paris
- Department of Operative, Preventive and Pediatric Dentistry, Charité - Universitätsmedizin Berlin, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Haitham Askar
- Department of Operative, Preventive and Pediatric Dentistry, Charité - Universitätsmedizin Berlin, Assmannshauser Straße 4-6, 14197, Berlin, Germany
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Cebula M, Göstemeyer G, Krois J, Pitchika V, Paris S, Schwendicke F, Effenberger S. Resin Infiltration of Non-Cavitated Proximal Caries Lesions in Primary and Permanent Teeth: A Systematic Review and Scenario Analysis of Randomized Controlled Trials. J Clin Med 2023; 12:jcm12020727. [PMID: 36675656 PMCID: PMC9864315 DOI: 10.3390/jcm12020727] [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: 12/16/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
The present study aimed to meta-analyze and evaluate the certainty of evidence for resin infiltration of proximal carious lesions in primary and permanent teeth. While resin infiltration has been shown efficacious for caries management, the certainty of evidence remains unclear. The protocol was registered with PROSPERO (CRD42018080895), and PRISMA guidelines have been followed. The databases PubMed, Embase, and Cochrane CENTRAL were systematically screened, complemented by hand searches and cross-referencing. Eleven relevant articles were identified and included, i.e., randomized controlled trials (RCTs) comparing the progression of resin infiltrated proximal caries lesions (combined with non-invasive measures) in primary or permanent teeth with non-invasive measures. Random-effects meta-analyses and trial sequential analyses (TSA) were performed for per-protocol (PP), intention-to-treat (ITT), and best/worst case (BC/WC) scenarios. Six included trials assessed lesions in permanent teeth and five trails assessed lesions in primary teeth. The trials had a high or unclear risk of bias. Risk of caries progression was significantly reduced for infiltrated lesions in the PP, ITT, and BC scenarios in both permanent teeth and primary teeth, but not in the WC scenario. According to the TSA, firm evidence was reached for all of the scenarios except the WC. In conclusion, there is firm evidence for resin infiltration arresting proximal caries lesions in permanent and primary teeth.
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Affiliation(s)
- Marcus Cebula
- Clinical Research Department, DMG Dental Material Gesellschaft mbH, Elbgaustraße 248, 22547 Hamburg, Germany
| | - Gerd Göstemeyer
- Department of Restorative, Preventive and Pediatric Dentistry, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Vinay Pitchika
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Sebastian Paris
- Department of Restorative, Preventive and Pediatric Dentistry, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Susanne Effenberger
- Clinical Research Department, DMG Dental Material Gesellschaft mbH, Elbgaustraße 248, 22547 Hamburg, Germany
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
- Correspondence:
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Delgado AH, Sauro S, Lima AF, Loguercio AD, Della Bona A, Mazzoni A, Collares FM, Staxrud F, Ferracane J, Tsoi J, Amato J, Neuhaus KW, Ceballos L, Breschi L, Hannig M, Melo MA, Özcan M, Scotti N, Opdam N, Yamaguchi S, Paris S, Turkun LS, Doméjean S, Rosa V, Palin W, Schwendicke F. RoBDEMAT: A risk of bias tool and guideline to support reporting of pre-clinical dental materials research and assessment of systematic reviews. J Dent 2022; 127:104350. [PMID: 36341980 DOI: 10.1016/j.jdent.2022.104350] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 06/08/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To develop a risk of bias tool for pre-clinical dental materials research studies that aims to support reporting of future investigations and improve assessment in systematic reviews. METHODS A four-stage process following EQUATOR network recommendations was followed, which included project launch, literature review, Delphi process and the tool finalization. With the support of the European Federation of Conservative Dentistry (EFCD) and the Dental Materials Group of the International Association for Dental Research (DMG-IADR), a total of 26 expert stakeholders were included in the development and Delphi vote of the initial proposal. The proposal was built using data gathered from the literature review stage. During this stage, recent systematic reviews featuring dental materials research, and risk of bias tools found in the literature were comprehensively scanned for bias sources. The experts thus reached a consensus for the items, domains and judgement related to the tool, allowing a detailed guide for each item and corresponding signalling questions. RESULTS The tool features nine items in total, spread between 4 domains, pertaining to the following types of bias: bias related to planning and allocation (D1), specimen preparation (D2), outcome assessment (D3) and data treatment and outcome reporting (D4). RoBDEMAT, as presented, features signalling questions and a guide that can be used for RoB judgement. Its use as a checklist is preferred over a final summary score. CONCLUSION RoBDEMAT is the first risk of bias tool for pre-clinical dental materials research, supported and developed by a broad group of expert stakeholders in the field, validating its future use. CLINICAL SIGNIFICANCE This new tool will contribute the study field by improving the scientific quality and rigour of dental materials research studies and their systematic reviews. Such studies are the foundation and support of future clinical research and evidence-based decisions.
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Affiliation(s)
- António Hs Delgado
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Monte de Caparica, Almada 2829-511 Portugal; Department of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, London, UK.
| | - Salvatore Sauro
- Dental Biomaterials and Minimally Invasive Dentistry, Department of Dentistry, Cardenal Herrera-CEU University, CEU Universities, Valencia, Spain
| | - Adriano F Lima
- Dental Research Division, Paulista University, Sao Paulo, Brazil
| | - Alessandro D Loguercio
- Department of Restorative Dentistry, School of Dentistry, State University of Ponta Grossa, PR, Brazil
| | - Alvaro Della Bona
- Postgraduate Program in Dentistry, School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
| | - Annalisa Mazzoni
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna-Alma Mater Studiorum, Bologna, Italy
| | | | - Frode Staxrud
- Nordic Institute for Dental Materials (NIOM), Oslo, Norway
| | - Jack Ferracane
- Department of Restorative Dentistry, Oregon Health & Science University, 2730 S. Moody Avenue Portland, OR 97201, Oregon, USA
| | - James Tsoi
- Dental Materials Science, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - Julia Amato
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Klaus W Neuhaus
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland; Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laura Ceballos
- Nursing and Stomatology Department, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna-Alma Mater Studiorum, Bologna, Italy
| | - Matthias Hannig
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, 66421 Homburg, Germany
| | - Mary Anne Melo
- Division of Operative Dentistry, Department of General Dentistry, University of Maryland School of Dentistry, 650 West Baltimore St, Baltimore, MD 21201, USA
| | - Mutlu Özcan
- University of Zürich, Division of Dental Biomaterials, Center for Oral Medicine, Clinic for Reconstructive Dentistry, Zürich, Switzerland
| | - Nicola Scotti
- Department of Surgical Sciences, Dental School Lingotto, University of Turin, Turin, Italy
| | - Niek Opdam
- Radboud University Medical Centre, Department of Dentistry, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Satoshi Yamaguchi
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, Suita, Osaka 565-0871, Japan
| | - Sebastian Paris
- Department of Operative, Preventive and Paediatric Dentistry, Center of Oral Health Sciences, Charité - Universitätsmedizin Berlin, Germany
| | - Lezize Sebnem Turkun
- Department of Restorative Dentistry, Ege University School of Dentistry, 35100 Bornova/Izmir Turkey
| | - Sophie Doméjean
- CHU Estaing, Service d'Odontologie, Clermont-Ferrand, France; Université Clermont Auvergne, UFR d'Odontologie, Clermont-Ferrand, France; Centre de Recherche en Odontologie Clinique EA 4847, Clermont-Ferrand, France
| | - Vinicius Rosa
- Faculty of Dentistry, National University of Singapore, Singapore; ORCHIDS: Oral Care Health Innovations and Designs Singapore, National University of Singapore, Singapore
| | - William Palin
- Dental and Biomaterials Sciences, School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany, Aßmannshauser Str. 4-6, 14199 Berlin, German
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Melzow F, Mertens S, Todorov H, Groneberg DA, Paris S, Gerber A. Aerosol exposure of staff during dental treatments: a model study. BMC Oral Health 2022; 22:128. [PMID: 35428223 PMCID: PMC9012061 DOI: 10.1186/s12903-022-02155-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/05/2022] [Indexed: 12/20/2022] Open
Abstract
Background Due to exposure to potentially infectious aerosols during treatments, the dental personnel is considered being at high risk for aerosol transmitted diseases like COVID-19. The aim of this study was to evaluate aerosol exposure during different dental treatments as well as the efficacy of dental suction to reduce aerosol spreading.
Methods Dental powder-jet (PJ; Air-Flow®), a water-cooled dental handpiece with a diamond bur (HP) and water-cooled ultrasonic scaling (US) were used in a simulation head, mounted on a dental unit in various treatment settings. The influence of the use of a small saliva ejector (SE) and high-volume suction (HVS) was evaluated. As a proxy of aerosols, air-born particles (PM10) were detected using a Laser Spectrometer in 30 cm distance from the mouth. As control, background particle counts (BC) were measured before and after experiments. Results With only SE, integrated aerosol levels [median (Q25/Q75) µg/m3 s] for PJ [91,246 (58,213/118,386) µg/m3 s, p < 0.001, ANOVA] were significantly increased compared to BC [7243 (6501/8407) µg/m3 s], whilst HP [11,119 (7190/17,234) µg/m3 s, p > 0.05] and US [6558 (6002/7066) µg/m3 s; p > 0.05] did not increase aerosol levels significantly. The use of HVS significantly decreased aerosol exposure for PJ [37,170 (29,634/51,719) µg/m3 s; p < 0.01] and HP [5476 (5066/5638) µg/m3 s; p < 0.001] compared to SE only, even reaching lower particle counts than BC levels for HP usage (p < 0.001). Conclusions To reduce the exposure to potentially infectious aerosols, HVS should be used during aerosol-forming dental treatments.
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Göstemeyer G, Seifert T, Jeggle-Engbert LM, Paris S, Schwendicke F. Glass Hybrid Versus Nanocomposite for Restoration of Sclerotic Non-carious Cervical Lesions: 18-Month Results of a Randomized Controlled Trial. J Adhes Dent 2021; 23:487-496. [PMID: 34817964 DOI: 10.3290/j.jad.b2287831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To compare the clinical performance and treatment times between glass hybrid (GH; EQUIA Forte Fil/EQUIA Forte Coat, GC) and adhesive/nanofilled resin composite restorations (RC; OptiBond FL, Kerr/Filtek Supreme XTE, 3M Oral Care) of sclerotic non-carious cervical lesions (sNCCL). MATERIALS AND METHODS This is an 18-month interim analysis of a 36-month cluster-randomized trial (ClinicalTrials.gov Identifier: NCT02631161). Eighty-eight patients (50-70 years) with 175 sNCCLs were randomized to receive GH or RC restorations. Restorations were placed without mechanical cavity preparation, and treatment time was recorded. After 18 months, restorations were evaluated using FDI criteria. Factors associated with restoration survival were evaluated using multi-level Cox-regression analysis. Generalized linear mixed modelling was used to analyze factors associated with treatment time. RESULTS After a mean of 18 months (min/max: 8/25), 78 patients (160 restorations) were assessed. Fifteen restorations (18%) failed in GH, and 11 (12%) in the RC, without a significant difference in survival (p = 0.904/Cox). Retention loss was the most common reason for failure in both groups. Restorations placed in older patients showed lower risk of failure [OR (95% CI): 0.90 (0.81-0.99) per year], while mandibular teeth showed higher risks [2.89 (1.00-8.31)]. Treatment time was significantly shorter for GH (mean ± SD: 8.6 ± 4.3 min) than RC (11.7 ± 5.7 min; p < 0.001). CONCLUSIONS GH may be a suitable alternative to RC for restoring sNCCLs, without any significant difference in survival between the two materials at this interim analysis. In addition, placing GH restorations required less chairtime than did placing RC restorations.
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Schlafer S, Bornmann T, Paris S, Göstemeyer G. The impact of glass ionomer cement and composite resin on microscale pH in cariogenic biofilms and demineralization of dental tissues. Dent Mater 2021; 37:1576-1583. [PMID: 34419256 DOI: 10.1016/j.dental.2021.08.007] [Citation(s) in RCA: 5] [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: 06/11/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Secondary caries is among the most frequent reasons for the failure of dental restorations. Glass ionomer cement (GIC) restorations have been proposed to protect the surrounding dental tissues from demineralization through the release of fluoride and by buffering the acid attack from dental biofilms. In contrast, the lack of buffering by composite resin (CR) restorations has been suggested as a promoting factor for the development of secondary caries. METHODS The present study employed transversal microradiography and confocal microscopy based pH ratiometry to quantify mineral loss and map microscale pH gradients inside Streptococcus mutans biofilms grown on compound specimens consisting of enamel, dentin and either GIC or CR. RESULTS Mineral loss in dentin was significantly lower next to GIC than next to CR, but no significant differences in local biofilm pH were observed between the two restorative materials. SIGNIFICANCE The cariostatic effect of GIC relies predominantly on the provision of fluoride and not on a direct buffering action. The lack of buffering by CR did not affect local biofilm pH and may therefore be of minor importance for secondary caries development.
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Affiliation(s)
- Sebastian Schlafer
- Section for Oral Ecology and Caries Control, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark.
| | - Tanja Bornmann
- Section for Oral Ecology and Caries Control, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark; Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany.
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany.
| | - Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany.
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Schwendicke F, Tzschoppe M, Paris S. Corrigendum to 'Radiographic caries detection: A systematic review and meta-analysis' [Journal of Dentistry 43 (2015) 924-933]. J Dent 2021; 114:103783. [PMID: 34412925 DOI: 10.1016/j.jdent.2021.103783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charite´-Universitätsmedizin Berlin, Germany.
| | - Markus Tzschoppe
- Department of Operative and Preventive Dentistry, Charite´-Universitätsmedizin Berlin, Germany.
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charite´-Universitätsmedizin Berlin, 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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Schwendicke F, Müller A, Seifert T, Jeggle-Engbert LM, Paris S, Göstemeyer G. Glass hybrid versus composite for non-carious cervical lesions: Survival, restoration quality and costs in randomized controlled trial after 3 years. J Dent 2021; 110:103689. [PMID: 33979577 DOI: 10.1016/j.jdent.2021.103689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/15/2021] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE This study compared survival, restoration quality and costs of glass hybrid (GH; EQUIA Forte Fil/EQUIA Forte Coat) and resin composite restorations (RC; OptiBond FL/Filtek Supreme XTE) of sclerotic non-carious cervical lesions. METHODS This is a cluster-randomized trial (ClinicalTrials.gov: NCT02631161). 88 patients (50-70 years) with 175 sNCCLs were randomized to receive GH or RC. Restorations were placed without mechanical cavity preparation and followed for a mean 36 (min/max: 31/55) months (variable follow-up due to COVID-19 lockdown). Restoration quality was re-evaluated at 1-, 18- and 36-months using FDI-criteria. Survival was assessed using multi-level Cox-regression analysis. Costs were estimated from a payer's perspective in Germany. Initial costs were determined based on micro-costing using time recordings and hourly costs, and follow-up costs based on statutory insurance fee-item-catalogues. RESULTS 88 patients (175 restorations) were treated; 43 received GH (83 restorations), 45 RC (92 restorations). 17 GH and 19 RC showed total retention loss, 5 GH were partially lost (p = 0.396/Cox). FDI ratings were not sufficiently different for any domain except surface luster, where RC showed higher score (p < 0.001). Costs were initially lower for GH (32.57; SD 16.36 €) than RC (44.25; SD 21.40 €), while re-treatment costs were similar (GH: 9.15; SD 15.70 €; RC: 7.35; SD 14.51 €), resulting in significantly lower costs for GH (GH: 41.72; SD 25.08 €) than RC (51.60; 26.17 €) (p < 0.001/GLM). CONCLUSIONS While survival was not significantly different, GH was significantly less costly both initially and long-term than RC for restoring non-carious cervical lesions. CLINICAL SIGNIFICANCE Within this trial, survival was not significantly different between GH and RC to restore sclerotic NCCLs. As GH was significantly less costly both initially and long-term than RC, using RC was only cost-effective for payers willing to invest high additional expenses per minimal survival gains.
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Affiliation(s)
- Falk Schwendicke
- Department of Oral Diagnostics, Digital Health, Health Services Research, Charité - Universitätsmedizin Berlin, Germany.
| | - Anne Müller
- Department of Oral Diagnostics, Digital Health, Health Services Research, Charité - Universitätsmedizin Berlin, Germany
| | - Tilmann Seifert
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité - Universitätsmedizin Berlin, Germany
| | | | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany
| | - Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany
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Göstemeyer G, Woike H, Paris S, Schwendicke F, Schlafer S. Root Caries Preventive Effect of Varnishes Containing Fluoride or Fluoride + Chlorhexidine/Cetylpyridinium Chloride In Vitro. Microorganisms 2021; 9:microorganisms9040737. [PMID: 33916105 PMCID: PMC8065905 DOI: 10.3390/microorganisms9040737] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/15/2021] [Revised: 03/08/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
Caries preventive varnishes containing only fluoride might differ from those containing a combination of fluoride and antimicrobial components in terms of mineralization properties and their impact on the cariogenic biofilm. We compared a fluoride and a fluoride + chlorhexidine (CHX)/cetylpyridinium chloride (CPC) varnish on root caries formation in vitro. One hundred bovine root dentin samples were allocated to five groups (n = 20/group): (1) 7700 ppm fluoride varnish (Fluorprotector S (F)), (2) experimental placebo varnish for F (F-P), (3) 1400 ppm fluoride + 0.3% CHX/0.5% CPC varnish (Cervitec F (CF)), (4) experimental placebo varnish for CF (CF-P), (5) untreated control. Cariogenic challenge was provided using a multi-station, continuous-culture 3-species (Streptococcus mutans (SM), Lactobacillus rhamnosus (LR), Actinomyces naeslundii (AN)) biofilm model for 10 days. Mineral loss (ΔZ) was evaluated using transversal microradiography and bacterial counts in the biofilm assessed as colony-forming units. Fluorescence in situ hybridization (FISH) and confocal microscopy were performed to assess the three-dimensional biofilm architecture. Mean ± SD (vol% × μm) ΔZ was significantly lower for F (9133 ± 758) and CF (9835 ± 1677) compared to control (11362 ± 919) (p < 0.05), without significant differences between F and CF. SM counts were significantly lower and LR counts significantly higher in F- and CF-biofilms compared to control. AN counts were significantly higher in the F-biofilms than in all other groups. According to FISH, SM and LR invaded dentinal tubules only in the control-group. In the CF-group, the basal biofilm layer did not contain SM and AN. Both F and CF varnishes had similar caries-preventive effects and a considerable impact on biofilm structure and composition.
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Affiliation(s)
- Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany; (H.W.); (S.P.)
- Correspondence: ; Tel.: +49-30-450-562-328
| | - Helen Woike
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany; (H.W.); (S.P.)
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany; (H.W.); (S.P.)
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany;
| | - Sebastian Schlafer
- Section for Oral Ecology and Caries Control, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark;
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Holtkamp A, Elhennawy K, Cejudo Grano de Oro JE, Krois J, Paris S, Schwendicke F. Generalizability of Deep Learning Models for Caries Detection in Near-Infrared Light Transillumination Images. J Clin Med 2021; 10:961. [PMID: 33804562 PMCID: PMC7957685 DOI: 10.3390/jcm10050961] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The present study aimed to train deep convolutional neural networks (CNNs) to detect caries lesions on Near-Infrared Light Transillumination (NILT) imagery obtained either in vitro or in vivo and to assess the models' generalizability. METHODS In vitro, 226 extracted posterior permanent human teeth were mounted in a diagnostic model in a dummy head. Then, NILT images were generated (DIAGNOcam, KaVo, Biberach), and images were segmented tooth-wise. In vivo, 1319 teeth from 56 patients were obtained and segmented similarly. Proximal caries lesions were annotated pixel-wise by three experienced dentists, reviewed by a fourth dentist, and then transformed into binary labels. We trained ResNet classification models on both in vivo and in vitro datasets and used 10-fold cross-validation for estimating the performance and generalizability of the models. We used GradCAM to increase explainability. RESULTS The tooth-level prevalence of caries lesions was 41% in vitro and 49% in vivo, respectively. Models trained and tested on in vivo data performed significantly better (mean ± SD accuracy: 0.78 ± 0.04) than those trained and tested on in vitro data (accuracy: 0.64 ± 0.15; p < 0.05). When tested in vitro, the models trained in vivo showed significantly lower accuracy (0.70 ± 0.01; p < 0.01). Similarly, when tested in vivo, models trained in vitro showed significantly lower accuracy (0.61 ± 0.04; p < 0.05). In both cases, this was due to decreases in sensitivity (by -27% for models trained in vivo and -10% for models trained in vitro). CONCLUSIONS Using in vitro setups for generating NILT imagery and training CNNs comes with low accuracy and generalizability. CLINICAL SIGNIFICANCE Studies employing in vitro imagery for developing deep learning models should be critically appraised for their generalizability. Applicable deep learning models for assessing NILT imagery should be trained on in vivo data.
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Affiliation(s)
- Agnes Holtkamp
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany; (A.H.); (J.E.C.G.d.O.); (J.K.)
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany;
| | - Karim Elhennawy
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany;
| | - José E. Cejudo Grano de Oro
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany; (A.H.); (J.E.C.G.d.O.); (J.K.)
| | - Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany; (A.H.); (J.E.C.G.d.O.); (J.K.)
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany;
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany; (A.H.); (J.E.C.G.d.O.); (J.K.)
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Askar H, Krois J, Rohrer C, Mertens S, Elhennawy K, Ottolenghi L, Mazur M, Paris S, Schwendicke F. Detecting white spot lesions on dental photography using deep learning: A pilot study. J Dent 2021; 107:103615. [PMID: 33617941 DOI: 10.1016/j.jdent.2021.103615] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 12/28/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We aimed to apply deep learning to detect white spot lesions in dental photographs. METHODS Using 434 photographic images of 51 patients, a dataset of 2781 cropped tooth segments was generated. Pixelwise annotations of sound enamel as well as fluorotic, carious or other types of hypomineralized lesions were generated by experts and assessed by an independent second reviewer. The union of the reviewed annotations were used to segment the hard tissues (region-of-interest, ROI) of each image. SqueezeNet was employed for modelling. We trained models to detect (1) any white spot lesions, (2) fluorotic lesions and (3) other-than-fluorotic lesions. Modeling was performed on both the cropped and the ROI images and using ten-times repeated five-fold cross-validation. Feature visualization was applied to visualize salient areas. RESULTS Lesion prevalence was 37 %; the majority of lesions (24 %) were fluorotic. None of the metrics differed significantly between the models trained on cropped and ROI imagery (p > 0.05/t-test). Mean accuracies ranged between 0.81-0.84, without significant differences between models trained to detect any, fluorotic or other-than-fluorotic lesions (p > 0.05). Specificities were 0.85-0.86; sensitivities were lower (0.58-0.66). Models to detect any lesions showed positive/negative predictive values (PPV/NPV) between 0.77-0.80, those to detect fluorotic lesions 0.67 (PPV) to 0.86 (NPV), and those to detect other-than-fluorotic lesions 0.46 (PPV) to 0.93 (NPV). Light reflections were the main reason for false positive detections. CONCLUSIONS Deep learning showed satisfying accuracy to detect white spot lesions, particularly fluorosis. Some models showed limited stability given the small sample available. CLINICAL SIGNIFICANCE Deep learning is suitable for automated classification of retro- or prospectively collected imagery and may assist practitioners in discriminating white spot lesions. Future studies should expand the scope into more granular multi-class detections on a larger and more generalizable dataset.
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Affiliation(s)
- Haitham Askar
- 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
| | - Csaba Rohrer
- 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; Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany
| | - Karim Elhennawy
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité - Universitätsmedizin Berlin, Germany
| | - Livia Ottolenghi
- Department of Oral and MaxilloFacial Sciences, Sapienza University of Rome, Italy
| | - Marta Mazur
- Department of Oral and MaxilloFacial Sciences, Sapienza University of Rome, Italy
| | - Sebastian Paris
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany.
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Askar H, Al-Abdi A, Blunck U, Göstemeyer G, Paris S, Schwendicke F. Secondary Caries Adjacent to Bulk or Incrementally Filled Composites Placed after Selective Excavation In Vitro. Materials (Basel) 2021; 14:ma14040939. [PMID: 33669469 PMCID: PMC7920447 DOI: 10.3390/ma14040939] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/16/2022]
Abstract
Objectives: selective caries excavation (SE) is recommended for deep carious lesions. Bulk fill composites (BF) may be considered to restore SE-cavities. We compared the susceptibility for secondary caries adjacent to BF versus incrementally filled composites (IF) in SE and non-selectively excavated teeth (NS) in vitro. Methods: in 72 extracted human premolars, artificial caries lesions were induced on pulpo-axial walls of standardized cavities. The lesions were left (SE) or removed (NS), and teeth were restored using two BF, GrandioSO x-tra/Voco (BF-Gra) and SDR/Dentsply (BF-SDR), and an IF, GrandioSO/Voco (IF-Gra) (n = 12/group for SE and NS). After thermo-mechanical cycling (5–55 °C, 8 days), teeth were submitted to a continuous-culture Lactobacillus rhamnosus biofilm model with cyclic loading for 10 days. Mineral loss (ΔZ) of enamel surface lesions (ESL), dentin surface lesions (DSL), and dentin wall lesions (DWL) was analyzed using transversal microradiography. Results: ΔZ was the highest in DSL, followed by ESL, and it was significantly lower in DWL. There were no significant differences in ΔZ between groups in DSL, ESL, and DWL (p > 0.05). Regardless of lesion location, ΔZ did not differ between SE and NS (p > 0.05). Conclusions: BF and IF both showed low risks for DWL (i.e., true secondary caries) after SE in vitro, and surface lesion risk was also not significantly different between materials. SE did not increase secondary caries risk as compared with NS. Clinical Significance: the risk of secondary caries was low after selective excavation in this study, regardless of whether bulk or incrementally filled composites were used
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Affiliation(s)
- Haitham Askar
- Department of Operative and Preventive Dentistry, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.A.-A.); (U.B.); (G.G.); (S.P.)
- Correspondence: ; Tel.: +49-30-450-562-533; Fax: +49-30-450-562-932
| | - Allam Al-Abdi
- Department of Operative and Preventive Dentistry, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.A.-A.); (U.B.); (G.G.); (S.P.)
| | - Uwe Blunck
- Department of Operative and Preventive Dentistry, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.A.-A.); (U.B.); (G.G.); (S.P.)
| | - Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.A.-A.); (U.B.); (G.G.); (S.P.)
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.A.-A.); (U.B.); (G.G.); (S.P.)
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health, Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany;
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Paris S, Banerjee A, Bottenberg P, Breschi L, Campus G, Doméjean S, Ekstrand K, Giacaman RA, Haak R, Hannig M, Hickel R, Juric H, Lussi A, Machiulskiene V, Manton D, Jablonski-Momeni A, Santamaria R, Schwendicke F, Splieth CH, Tassery H, Zandona A, Zero D, Zimmer S, Opdam N. How to Intervene in the Caries Process in Older Adults: A Joint ORCA and EFCD Expert Delphi Consensus Statement. Caries Res 2020; 54:1-7. [PMID: 33291110 DOI: 10.1159/000510843] [Citation(s) in RCA: 14] [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: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 11/19/2022] Open
Abstract
AIM To provide recommendations for dental clinicians for the management of dental caries in older adults with special emphasis on root caries lesions. METHODS A consensus workshop followed by a Delphi consensus process were conducted with an expert panel nominated by ORCA, EFCD, and DGZ boards. Based on a systematic review of the literature, as well as non-systematic literature search, recommendations for clinicians were developed and consented in a two-stage Delphi process. RESULTS Demographic and epidemiologic changes will significantly increase the need of management of older adults and root caries in the future. Ageing is associated with a decline of intrinsic capacities and an increased risk of general diseases. As oral and systemic health are linked, bidirectional consequences of diseases and interventions need to be considered. Caries prevention and treatment in older adults must respond to the patient's individual abilities for self-care and cooperation and often involves the support of caregivers. Systemic interventions may involve dietary counselling, oral hygiene instruction, the use of fluoridated toothpastes, and the stimulation of salivary flow. Local interventions to manage root lesions may comprise local biofilm control, application of highly fluoridated toothpastes or varnishes as well as antimicrobial agents. Restorative treatment is often compromised by the accessibility of such root caries lesions as well as the ability of the senior patient to cooperate. If optimum restorative treatment is impossible or inappropriate, long-term stabilization, e.g., by using glass-ionomer cements, and palliative treatments that aim to maintain oral function as long and as well as possible may be the treatment of choice for the individual.
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Affiliation(s)
- Sebastian Paris
- Department of Operative and Preventive Dentistry, Center for Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Berlin, Germany,
| | - Avijit Banerjee
- Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
| | - Peter Bottenberg
- Oral Health Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna - Alma Mater Studiorum, Bologna, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Paediatric Dentistry, Zahnmedizinische Kliniken (ZMK), University of Bern, Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | - Sophie Doméjean
- Département d'Odontologie Conservatrice, Université Clermont Auvergne, UFR d'Odontologie, Centre de Recherche en Odontologie Clinique Clermont-Ferrand, Clermont-Ferrand, France
| | - Kim Ekstrand
- Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Leipzig, Germany
| | - Matthias Hannig
- Clinic of Operative Dentistry and Periodontology, Saarland University, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany
| | - Hrvoje Juric
- Department of Paediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Adrian Lussi
- School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Operative Dentistry and Periodontology, Faculty of Dentistry, University Medical Centre, Freiburg, Germany
| | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - David Manton
- Centrum van Tandheelkunde en Mondzorgkunde, Universitair Medisch Centrum Groningen, University of Groningen, Groningen, The Netherlands
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Ruth Santamaria
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Falk Schwendicke
- Department of Oral Diagnosis, Digital Health and Health Services Research, Center for Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Splieth
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Hervé Tassery
- Faculté d'Odontologie Marseille, Preventive and Restorative Department, Aix-Marseille-Université, Marseille, France
- EA 4203 Laboratory, Université de Montpellier, Montpellier, France
| | - Andrea Zandona
- Department of Comprehensive Care, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Domenick Zero
- Department of Cariology, Operative Dentistry and Dental Public Health, Oral Health Research Institute, School of Dentistry, Indiana University, Indianapolis, Indiana, USA
| | - Stefan Zimmer
- Department of Operative and Preventive Dentistry, Dental School, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Niek Opdam
- Radboud University Medical Centre, Department of Dentistry, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Krois J, Krasowski A, Rossi JG, Paris S, Kuhlmey A, Meyer-Lückel H, Schwendicke F. Underscreening and undertreatment? Periodontal service provision in very old Germans. Clin Oral Investig 2020; 25:3117-3129. [PMID: 33098031 PMCID: PMC8060224 DOI: 10.1007/s00784-020-03635-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/12/2020] [Accepted: 10/07/2020] [Indexed: 12/17/2022]
Abstract
Objectives We aimed to assess periodontal services utilization in very old Germans. Methods A comprehensive sample of very old (≥ 75 years), insured at a large Northeastern statutory insurer was followed over 6 years (2012–2017). We assessed periodontal service provision, entailing (1) periodontal screening index (PSI), (2) periodontal status/treatment planning, (3) periodontal therapy (scaling and root planning with or without access surgery), (4) postoperative reevaluation, and (5) any of these four services groups. Association of utilization with (1) sex, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses, and (6) diagnoses-related groups was explored. Results 404.610 individuals were followed; 173,733 did not survive follow-up. The mean (SD) age was 81.9 (5.4) years. 29.4% (119,103 individuals) utilized any periodontal service, nearly all of them the PSI. Periodontal status/treatment planning, treatment provision, and reevaluation were provided to only a small fraction (1.54–1.57%, or 6224–6345) of individuals. The utilization of the PSI increased between 2012 and 2017; no such increase was observed for treatment-related services. Utilization decreased with age; those aged > 85 years received nearly no services at all. Decreases were more pronounced for treatment-related services. Utilization was lower in rural than urban areas, those with hardship status, and those severely ill (e.g., dementia, heart insufficiency). In multivariable analysis, a previous PSI measurement tripled the odds of receiving treatment-related services (OR: 3.2; 95% CI: 3.0-3.4). Conclusions Periodontal services utilization was low. Screening for periodontal disease significantly increased therapy provision. Social, demographic, regional, and general health aspects were associated with utilization. Clinical significance The utilization of periodontal services in the very old in Northeast Germany was low, and even screening was only performed in a minority of individuals. Policies to increase identification and management of periodontitis especially in the most vulnerable individuals are needed. Electronic supplementary material The online version of this article (10.1007/s00784-020-03635-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Aleksander Krasowski
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.,Department of Restorative, Preventive and Pediatric Dentistry, zmk Bern, University of Bern, Bern, Switzerland
| | - Jesus Gomez Rossi
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Adelheid Kuhlmey
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hendrik Meyer-Lückel
- Department of Restorative, Preventive and Pediatric Dentistry, zmk Bern, University of Bern, Bern, Switzerland
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
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Schwendicke F, Splieth CH, Bottenberg P, Breschi L, Campus G, Doméjean S, Ekstrand K, Giacaman RA, Haak R, Hannig M, Hickel R, Juric H, Lussi A, Machiulskiene V, Manton D, Jablonski-Momeni A, Opdam N, Paris S, Santamaria R, Tassery H, Zandona A, Zero D, Zimmer S, Banerjee A. How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement. Clin Oral Investig 2020; 24:3315-3321. [PMID: 32643090 DOI: 10.1007/s00784-020-03431-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 03/23/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide consensus recommendations on how to intervene in the caries process in adults, specifically proximal and secondary carious lesions. METHODS Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. RESULTS Managing an individual's caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for secondary lesions should be tailored according to the individual's caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm secondary caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing secondary caries, if possible. CONCLUSIONS An individualized and lesion-specific approach is recommended for intervening in the caries process in adults. CLINICAL SIGNIFICANCE Dental clinicians have an increasing number of interventions available for the management of dental caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients' expectations, clinicians' expertise, and the individual clinical scenario all need to be considered during the decision-making process.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative Dentistry, Charité - Universitätsmedizin, Berlin, Germany.
| | - Christian H Splieth
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Peter Bottenberg
- Oral Health Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna - Alma Mater Studiorum, Bologna, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Paediatric Dentistry, Zahnmedizinische Kliniken (ZMK), University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | - Sophie Doméjean
- Département d'Odontologie Conservatrice, Univ Clermont Auvergne, UFR d'Odontologie; Centre de Recherche en Odontologie Clinique EA 4847, F-63100, Clermont-Ferrand, France
- CHU Estaing Clermont-Ferrand, Service d'Odontologie, F-63001, Clermont-Ferrand, France
| | - Kim Ekstrand
- Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Leipzig, Germany
| | - Matthias Hannig
- Clinic of Operative Dentistry and Periodontology, Saarland University, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany
| | - Hrvoje Juric
- Department of Paediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Adrian Lussi
- School of Dental Medicine, University of Bern, Bern, Switzerland and Department of Operative Dentistry and Periodontology, Faculty of Dentistry, University Medical Centre, Freiburg, Germany
| | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Faculty of odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - David Manton
- Centrum van Tandheelkunde en Mondzorgkunde, UMCG, Groningen, Netherlands
| | | | - Niek Opdam
- Radboud University Medical Centre, Department of Dentistry, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Sebastian Paris
- Department of Operative Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ruth Santamaria
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Hervé Tassery
- Faculté d'Odontologie Marseille, Preventive and Restorative Department, Marseille cedex, Aix-Marseille-Université, Marseille, France
- EA 4203 Laboratory, Université de Montpellier, Montpellier, France
| | - Andrea Zandona
- Department of Comprehensive Care, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Domenick Zero
- Department of Cariology, Operative Dentistry and Dental Public Health, Oral Health Research Institute, School of Dentistry Indiana University, Indianapolis, IN, USA
| | - Stefan Zimmer
- Department of Operative and Preventive Dentistry, Faculty of Health, Dental School, Witten/Herdecke University, Witten, Germany
| | - Avijit Banerjee
- Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Splieth CH, Banerjee A, Bottenberg P, Breschi L, Campus G, Ekstrand KR, Giacaman RA, Haak R, Hannig M, Hickel R, Juric H, Lussi A, Machiulskiene V, Manton DJ, Jablonski-Momeni A, Opdam NJM, Paris S, Santamaría RM, Schwendicke F, Tassery H, Ferreira Zandona A, Zero DT, Zimmer S, Doméjean S. How to Intervene in the Caries Process in Children: A Joint ORCA and EFCD Expert Delphi Consensus Statement. Caries Res 2020; 54:297-305. [PMID: 32610317 DOI: 10.1159/000507692] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 03/02/2020] [Accepted: 03/29/2020] [Indexed: 11/19/2022] Open
Abstract
This paper provides recommendations for dentists for the treatment of dental caries in children, with an emphasis on early childhood caries (ECC), primary teeth, and occlusal surfaces in permanent teeth. A consensus workshop followed by an e-Delphi consensus process was conducted with an expert panel nominated by the European Organization for Caries Research (ORCA) and European Federation of Conservative Dentistry (EFCD)/German Association of Conservative Dentistry (DGZ) boards. Based on 3 systematic reviews and a nonsystematic literature search, recommendations were developed. The caries decline has led to a more polarized disease distribution in children and adolescents along social gradients which should be taken into account when managing the caries process at all levels, such as the individual, the group, or a population. The control or reduction of caries activity is the basis for successful caries management. In children, caries management requires adequate daily oral hygiene and fluoride application via toothpaste, ensured by caregivers, and especially for ECC prevention an emphasis on sugar intake reduction is needed. These noninvasive interventions are also suitable to arrest or control initial or even cavitated dentine caries lesions in the absence of irreversible pulpitis. Fluoride varnish or silver diammine fluoride can be added as supplementary agents. In pits and fissures, composite resin materials can be used as preventive sealants and for defect-oriented minimally invasive restorations. In primary molars, preformed metal crowns are more successful than multisurface fillings, especially in caries-active patients. With persisting high caries activity, multiple lesions, and limited cooperation, caries control should consist of robust measures with high success rates, even including extraction in selected cases. This applies especially to treatments performed under general anesthesia.
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Affiliation(s)
- Christian H Splieth
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany,
| | - Avijit Banerjee
- Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Peter Bottenberg
- Oral Health Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna - Alma Mater Studiorum, Bologna, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, Zahnmedizinische Kliniken (ZMK), University of Bern, Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | - Kim Rud Ekstrand
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Leipzig, Germany
| | - Matthias Hannig
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany
| | - Hrvoje Juric
- Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Adrian Lussi
- School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Operative Dentistry and Periodontology, Faculty of Dentistry, University Medical Centre Freiburg, Freiburg, Germany
| | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - David J Manton
- Centrum voor Tandheelkunde en Mondzorgkunde, Universitair Medisch Centrum Groningen, University of Groningen, Groningen, The Netherlands
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Niek J M Opdam
- Department of Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ruth M Santamaría
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Falk Schwendicke
- Department of Oral Diagnosis, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Herve Tassery
- EA 4203 Laboratory, Faculté d'Odontologie, Université de Montpellier, Montpellier, France
- Faculté d'Odontologie Marseille, Preventive and Restorative Department, Aix-Marseille-Université, Marseille, France
| | - Andrea Ferreira Zandona
- Department of Comprehensive Care, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Domenick T Zero
- Oral Health Research Institute, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Stefan Zimmer
- Faculty of Health, School of Dentistry, Department of Operative and Preventive Dentistry, Witten/Herdecke University, Witten, Germany
| | - Sophie Doméjean
- Centre de Recherche en Odontologie Clinique EA 4847, UFR d'Odontologie, Département d'Odontologie Conservatrice, Université Clermont Auvergne, Clermont-Ferrand, France
- Service d'Odontologie, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
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Prates Soares A, Blunck U, Bitter K, Paris S, Rack A, Zaslansky P. Hard X-ray phase-contrast-enhanced micro-CT for quantifying interfaces within brittle dense root-filling-restored human teeth. J Synchrotron Radiat 2020; 27:1015-1022. [PMID: 33566011 PMCID: PMC7336175 DOI: 10.1107/s1600577520005603] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/21/2020] [Indexed: 05/28/2023]
Abstract
Bonding of resin composite fillings, for example following root-canal treatment, is a challenge because remaining gaps grow and lead to failure. Here, phase-contrast-enhanced micro-computed tomography (PCE-CT) is used to explore methods of non-destructive quantification of the problem, so that countermeasures can be devised. Five human central incisors with damaged crowns were root-filled followed by restoration with a dental post. Thereafter, the crowns were rebuilt with a resin composite that was bonded conventionally to the tooth with a dental adhesive system (Futurabond U). Each sample was imaged by PCE-CT in a synchrotron facility (ID19, European Synchrotron Radiation Facility) with a pixel size of 650 nm. The reconstructed datasets from each sample were segmented and analysed in a semi-automated manner using ImageJ. PCE-CT at sub-micrometre resolution provided images with an impressive increased contrast and detail when compared with laboratory micro-computed tomography. The interface between the dental adhesive and the tooth was often strongly disrupted by the presence of large debonded gaps (on average 34% ± 15% on all surfaces). The thickness of the gaps spanned 2 µm to 16 µm. There was a large variability in the distribution of gaps within the bonding area in each sample, with some regions around the canal exhibiting up to 100% discontinuity. Although only several micrometres thick, the extensive wide gaps may serve as gateways to biofilm leakage, leading to failure of the restorations. They can also act as stress-raising `cracks' that are likely to expand over time in response to cyclic mechanical loading as a consequence of mastication. The observations here show how PCE-CT can be used as a non-destructive quantitative tool for understanding and improving the performance of clinically used bonded dental restorations.
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Affiliation(s)
- Ana Prates Soares
- Department of Operative and Preventive Dentistry, Charité Universitätsmedizin Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany
| | - Uwe Blunck
- Department of Operative and Preventive Dentistry, Charité Universitätsmedizin Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany
| | - Kerstin Bitter
- Department of Operative and Preventive Dentistry, Charité Universitätsmedizin Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité Universitätsmedizin Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany
| | - Alexander Rack
- ESRF – The European Synchrotron, CS 40220, Grenoble Cedex 9, Grenoble 38043, France
| | - Paul Zaslansky
- Department of Operative and Preventive Dentistry, Charité Universitätsmedizin Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany
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20
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Hempel FM, Krois J, Paris S, Beuer F, Kuhlmey A, Schwendicke F. Prosthetic treatment patterns in the very old: an insurance database analysis from Northeast Germany. Clin Oral Investig 2020; 24:3981-3995. [PMID: 32300981 PMCID: PMC7544711 DOI: 10.1007/s00784-020-03264-x] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/18/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We assessed dental prosthetic services utilization in very old Germans. METHODS A comprehensive sample of 404,610 very old (≥ 75 years), insured at one large statutory insurer (Allgemeine Ortskrankenkasse Nordost, acting in the federal states Berlin, Brandenburg, Mecklenburg-Vorpommern), were followed over 6 years (2012-2017). Our outcome was the utilization of prosthetic services, in total and seven subgroups: (1) Crowns/partial crowns, (2) fixed dental prostheses (FDPs), (3) partial removable prostheses (RDPs), (4) full RDPs, (5) temporary services, (6) relining/rebasing/repairing/extending RDPs, (7) repairing FDPs. Association of utilization with (1) gender, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses and (6) German diagnoses related groups (G-DRG) was explored. RESULTS The mean (SD) age of the sample was 81.9 (5.4) years; mean follow-up was 1689 (705) days. The mean utilization of any prosthetic service was 27.0%; the most often utilized service type were total RDPs (13.2% utilization), crowns (8.1%), and partial RDPs (7.1%). Utilization decreased with age for nearly all services (except relining/rebasing/repairing/extending RDPs). Utilization of prosthetic services was significantly higher in Berlin and most cities compared with rural municipalities and in individuals with common, less severe conditions according to ICD-10 and DRGs compared with life-threatening conditions or dementia. In multivariable analysis, gender (OR; 95% CI: 0.95; 0.93-0.98), social hardship status (1.19; 1.17-1.21), federal state (Brandenburg 0.57; 0.56-0.59; Mecklenburg-Vorpommern: 0.66; 0.64-0.67) and age significantly affected utilization (0.95; 0.95-0.95/year). CONCLUSIONS Patient-related and healthcare factors determine the utilization of prosthetic services in very old Germans. Interventions to maintain sufficient prosthetic care up to high age are required. CLINICAL SIGNIFICANCE The utilization of prosthetic services in the very old in Northeast Germany showed significant disparities within populations and service types. There seems to be great need to better understand the drivers of utilization, and to develop and evaluate interventions to maintain sufficient prosthetic care up to high age.
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Affiliation(s)
- Fabian M Hempel
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joachim Krois
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Florian Beuer
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Adelheid Kuhlmey
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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21
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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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22
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Schwendicke F, Splieth C, Breschi L, Banerjee A, Fontana M, Paris S, Burrow MF, Crombie F, Page LF, Gatón-Hernández P, Giacaman R, Gugnani N, Hickel R, Jordan RA, Leal S, Lo E, Tassery H, Thomson WM, Manton DJ. When to intervene in the caries process? An expert Delphi consensus statement. Clin Oral Investig 2019; 23:3691-3703. [PMID: 31444695 DOI: 10.1007/s00784-019-03058-w] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [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: 12/05/2018] [Accepted: 08/08/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions. METHODS Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference. RESULTS Carious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds. CONCLUSIONS Comprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions. CLINICAL RELEVANCE Carious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
| | - Christian Splieth
- Preventive & Pediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna-Alma Mater Studiorum, Bologna, Italy
| | - Avijit Banerjee
- Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's Health Partners, King's College London, London, UK
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Michael F Burrow
- Faculty of Dentistry, University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Felicity Crombie
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Lyndie Foster Page
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Patricia Gatón-Hernández
- Department of Dentistry, University of Barcelona, Barcelona, Spain
- Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rodrigo Giacaman
- Cariology Unit, Department of Oral Rehabilitation, University of Talca, Talca, Chile
| | - Neeraj Gugnani
- Department of Pediatric and Preventive Dentistry, DAV (C) Dental College, Yamunanagar, Haryana, India
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany
| | | | - Soraya Leal
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasilia, Brazil
| | - Edward Lo
- Faculty of Dentistry, University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Hervé Tassery
- Faculty of Dentistry, AMU University, Marseille, France
| | - William Murray Thomson
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - David J Manton
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
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Chałas R, Szlązak K, Wójcik-Chęcińska I, Jaroszewicz J, Molak R, Czechowicz K, Paris S, Święszkowski W, Kurzydłowski KJ. Observations of mineralised tissues of teeth in X-ray micro-computed tomography. Folia Morphol (Warsz) 2019; 76:143-148. [PMID: 27813625 DOI: 10.5603/fm.a2016.0070] [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: 09/05/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The one of the most recent imaging technology is X-ray microtomography which allows non-invasive three-dimensional visualisation of structures. It also offers the opportunity to conduct a comprehensive quantitative analysis of the tested objects such as measuring the shares of the various phases, determining the material density and distribution of the size of pores and particles. The aim of the paper was to present an overview on the applicability and relevance of X-ray microtomography in the study of mineralised tissues of the teeth. MATERIALS AND METHODS The article is based on the most recent and significant literature and own observations. RESULTS The use of X-ray microtomography in dentistry has recently increased and includes, inter alia, the assessment of the density of minerals in enamel and dentin, the detection of demineralisation in an artificially and a naturally induced caries, the automatic measurement of the depth of cavities in dentin, the measurement of the amount of removed dentin in preparation of carious lesions by various methods, the assessment of microleakage around fillings and fissure sealants, cortical bone density measurement, evaluation of root canal morphology, comparison of the accuracy of root canal working and filling by various methods. CONCLUSIONS X-ray microtomography offers within the analysis of mineralised tissues - complex structures of bone, teeth and biomedical materials, turn out to be indispensable since it opens new opportunities for cognitive and implementation research.
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Affiliation(s)
- R Chałas
- Department of Conservative Dentistry and Endodontics, Medical University of Lublin, Poland, Poland.
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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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Schwendicke F, Leal S, Schlattmann P, Paris S, Dias Ribeiro AP, Gomes Marques M, Hilgert LA. Selective carious tissue removal using subjective criteria or polymer bur: study protocol for a randomised controlled trial (SelecCT). BMJ Open 2018; 8:e022952. [PMID: 30552261 PMCID: PMC6303626 DOI: 10.1136/bmjopen-2018-022952] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Selective (incomplete/partial) carious tissue removal is suitable for treating deep carious lesions in teeth with vital, asymptomatic pulps. In the periphery of a cavity, removal to hard dentin is performed, while in pulpo-proximal areas, leathery or soft dentin is left to avoid pulp exposure. As the decision of what contains 'soft' or 'leathery' dentin is subjective, using self-limiting burs which help to standardise the hardness of the remaining dentin, has been suggested to increase the reliability of carious tissue removal. The trial compares subjectively measured selective carious tissue removal in deep lesions in primary teeth with objectively measured selective removal with a self-limiting bur (Polybur, Komet). METHODS AND ANALYSIS A community-based single-blind clustered randomised controlled superiority trial nested into a larger evaluation is performed. Recruitment for this trial has been concluded. We have recruited 115 children aged 6-8 years with ≥1 vital primary molar with a deep dentin lesion. The unit of randomisation was the child, with all eligible molars per child treated identically. Treatment was performed in a mobile dental unit. Subjective and objective carious tissue removal was performed at random. Teeth were restored using glass ionomer cement (Equia Forte, GC). Our primary outcome will be the time until complications occur, evaluated via multilevel survival analysis. Secondary outcomes will be the time until extraction is needed, subjective satisfaction of the child with the treatment (measured using a Likert scale) and cost-effectiveness. Re-examination will be performed after 12, 24 and 36 months (the final examination is expected in 2020). ETHICS AND DISSEMINATION This trial has been approved by the Ethics Committee of the Health Sciences of the University of Brasília (CAAE 51310415.0.0000.0030). Trial results will be published in peer-reviewed journals and presented on conferences. TRIAL REGISTRATION NUMBER NCT02754466.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin, Berlin, Germany
| | - Soraya Leal
- Department of Dentistry, School of Health Sciences, University of Brasília, Brasilia, Brazil
| | - Peter Schlattmann
- Department of Medical Statistics, Informatics and Documentation, Jena University Hospital, Jena, Germany
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin, Berlin, Germany
| | - Ana Paula Dias Ribeiro
- Department of Restorative Dental Sciences, University of Florida College of Dentistry, Gainesville, Florida, USA
| | - Marta Gomes Marques
- Department of Dentistry, School of Health Sciences, University of Brasília, Brasilia, Brazil
| | - Leandro Augusto Hilgert
- Department of Dentistry, School of Health Sciences, University of Brasília, Brasilia, Brazil
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Lehmensiek M, Askar H, Brouwer F, Blunck U, Paris S, Schwendicke F. Restoration integrity, but not material or cementation strategy determined secondary caries lesions next to indirect restorations in vitro. Dent Mater 2018; 34:e317-e323. [DOI: 10.1016/j.dental.2018.09.004] [Citation(s) in RCA: 3] [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: 04/25/2018] [Revised: 07/30/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022]
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Imiolczyk SM, Hertel M, Hase I, Paris S, Blunck U, Hartwig S, Preissner S. The Influence of Cold Atmospheric Plasma Irradiation on the Adhesive Bond Strength in Non-Demineralized and Demineralized Human Dentin: An In Vitro Study. Open Dent J 2018. [DOI: 10.2174/1874210601812010960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
While aiming at the use of Cold Atmospheric Plasmas (CAPs) in restorative dentistry, the present study intended to assess if plasma irradiation increases the Tensile Bond Strength (TBS) in non-demineralized and demineralized dentin.
Materials and Methods:
Forty-eight human dentin samples were assigned to three different treatment modalities: I: Plasma jet irradiation (CAP I); II: Dielectric barrier discharge plasma treatment (CAP II); and III: No plasma (control). In each group, half of the specimens had previously been demineralized. A fourth generation of adhesive and dental composite was applied to all of the samples. The testing of the TBS was performed after artificial aging.
Results:
In the non-demineralized dentin, the mean TBS values were significantly higher after using CAP II (16.95 MPa) than in the control samples (4.2 MPa; p = 0.001). Significantly higher TBS values were also obtained after irradiating the demineralized dentin with CAP I and CAP II (11.68 and 4.6 MPa) when compared to the control samples (0 MPa; p = 0.003 and 0.038). The differences between both of the plasma sources were only slightly significant (p = 0.05).
Conclusion:
CAPs can potentially enhance the adhesive/dentin interfacial bonding strength, whereby the underlying effects seem to depend on the type of plasma source and the degree of dentinal (de-) mineralization. In the non-demineralized dentin, after a complete caries excavation, dielectric barrier discharge devices might be favorable over the plasma jets, in order to improve the adhesive/dentin interfacial bonding. In contrast, the plasma jets could be more effective in the demineralized dentin after an incomplete caries excavation.
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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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Tonetti MS, Bottenberg P, Conrads G, Eickholz P, Heasman P, Huysmans MC, López R, Madianos P, Müller F, Needleman I, Nyvad B, Preshaw PM, Pretty I, Renvert S, Schwendicke F, Trombelli L, van der Putten GJ, Vanobbergen J, West N, Young A, Paris S. Dental caries and periodontal diseases in the ageing population: call to action to protect and enhance oral health and well-being as an essential component of healthy ageing - Consensus report of group 4 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol 2018; 44 Suppl 18:S135-S144. [PMID: 28266112 DOI: 10.1111/jcpe.12681] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Over the last two decades, progress in prevention and treatment of caries and periodontal diseases has been translated to better oral health and improved tooth retention in the adult population. The ageing population and the increasing expectations of good oral health-related quality of life in older age pose formidable challenges to clinical care and healthcare systems. AIMS The objective of this workshop was to critically review scientific evidence and develop specific recommendations to: (i) prevent tooth loss and retain oral function through prevention and treatment of caries and periodontal diseases later in life and (ii) increase awareness of the health benefits of oral health as an essential component of healthy ageing. METHODS Discussions were initiated by three systematic reviews covering aspects of epidemiology of caries and periodontal diseases in elders, the impact of senescence on caries and periodontal diseases and the effectiveness of interventions. Recommendations were developed based on evidence from the systematic reviews and expert opinion. RESULTS Key messages included: (i) the ageing population, trends in risk factors and improved tooth retention point towards an expected increase in the total burden of disease posed by caries and periodontal diseases in the older population; (ii) specific surveillance is required to monitor changes in oral health in the older population; (iii) senescence impacts oral health including periodontitis and possibly caries susceptibility; (iv) evidence indicates that caries and periodontal diseases can be prevented and treated also in older adults; (v) oral health and functional tooth retention later in life provides benefits both in terms of oral and general quality of life and in terms of preventing physical decline and dependency by fostering a healthy diet; (vi) oral healthcare professionals and individuals should not base decisions impacting tooth retention on chronological age but on level of dependency, life expectancy, frailty, comfort and quality of life; and (vii) health policy should remove barriers to oral health care for vulnerable elders. CONCLUSIONS Consensus was reached on specific actionable priorities for public health officials, oral healthcare professionals, educators and workforce planners, caregivers and relatives as well as for the public and ageing patients. Some priorities have major implications for policymakers as health systems need to adapt to the challenge by systemwide changes to enable (promote) tooth retention later in life and management of deteriorating oral health in increasingly dependent elders.
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Affiliation(s)
- Maurizio S Tonetti
- Faculty of Dentistry, University of Hong Kong, Hong Kong, China.,European Research Group on Periodontology, Genova, Italy
| | | | - Georg Conrads
- Division of Oral Microbiology and Immunology, Department of Conservative Dentistry, Periodontology and Preventive Dentistry, RWTH University Hospital Aachen, Aachen, Germany
| | - Peter Eickholz
- Department of Periodontology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Peter Heasman
- Department of Restorative Dentistry, University of Newcastle, Newcastle, UK
| | - Marie-Charlotte Huysmans
- Department of Oral Function and Prosthetic Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rodrigo López
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Phoebus Madianos
- Department of Periodontology, National and Kapodistrian University of Athens, Athens, Greece
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Ian Needleman
- International Centre for Evidence-Based Oral Health, Unit of Periodontology, UCL Eastman Dental Institute, London, UK
| | - Bente Nyvad
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Philip M Preshaw
- Department of Restorative Dentistry, University of Newcastle, Newcastle, UK
| | - Iain Pretty
- Division of Dentistry, University of Manchester, Manchester, UK
| | - Stefan Renvert
- Department of Periodontology, Kristianstad University, Kristianstad, Sweden
| | - Falk Schwendicke
- Department of Operative Dentistry, Charitè - Universitätsmedizin Berlin, Berlin, Germany
| | - Leonardo Trombelli
- Research Center for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
| | - Gert-Jan van der Putten
- Department of Oral Function and Prosthetic Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacques Vanobbergen
- Community Dentistry and Oral Public Health, Ghent University, Ghent, Belgium
| | - Nicola West
- Department of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Alix Young
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Sebastian Paris
- Department of Operative Dentistry, Charitè - Universitätsmedizin Berlin, Berlin, 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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Ballout H, Hertel M, Doehring J, Kostka E, Hartwig S, Paris S, Preissner S. Effects of plasma jet, dielectric barrier discharge, photodynamic therapy and sodium hypochlorite on infected curved root canals. J Biophotonics 2018; 11:e201700186. [PMID: 29024574 DOI: 10.1002/jbio.201700186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
The aim of this investigation was to evaluate the effects of 2 different cold atmospheric plasma (CAP) sources, photodynamic therapy and sodium hypochlorite (NaOCl), on infected root canals. Therefore, 50 standardized curved human root canals were infected with Enterococcus faecalis and assigned to 5 groups-negative control (NC), plasma jet (CAP I), dielectric barrier discharge (CAP II), photodynamic therapy (PDT) and NaOCl + passive ultrasonic irrigation-for 30 s. Colony forming units (CFUs) were determined. NaOCl was significantly more effective at reducing CFUs than all test groups (P < .0001 [Mann-Whitney U test]) in both parts of the root canal. CFUs in PDT were significantly lower than those in CAP II (P = .015), and those in CAP I were lower than those in CAP II (P = .05). Among all other groups and in the apical parts, no significant differences were found (P > .05).
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Affiliation(s)
- Husam Ballout
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Hertel
- Department of Oral Medicine, Dental Radiology and Oral Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jonas Doehring
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Eckehard Kostka
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Hartwig
- Department for Oral and Maxillofacial and Facial Plastic Surgery, Johannes Wesling Hospital Minden, University Hospital of the Ruhr University Bochum, Bochum, Germany
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Saskia Preissner
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Göstemeyer G, Kohls A, Paris S, Schwendicke F. Root caries prevention via sodium fluoride, chlorhexidine and silver diamine fluoride in vitro. Odontology 2018; 106:274-281. [DOI: 10.1007/s10266-018-0341-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 12/15/2017] [Indexed: 11/30/2022]
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Göstemeyer G, Schulze F, Paris S, Schwendicke F. Arrest of Root Carious Lesions via Sodium Fluoride, Chlorhexidine and Silver Diamine Fluoride In Vitro. Materials (Basel) 2017; 11:ma11010009. [PMID: 29271891 PMCID: PMC5793507 DOI: 10.3390/ma11010009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/06/2017] [Accepted: 12/19/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the root carious lesion arrest of chlorhexidine (CHX) and silver diamine fluoride (SDF) varnishes and/or sodium fluoride rinses (NaF) in vitro. BACKGROUND Effective and easily applicable interventions for treating root carious lesions are needed, as these lesions are highly prevalent amongst elderly individuals. METHODS In 100 bovine dentin samples, artificial root carious lesions were induced using acetic acid and a continuous-culture Lactobacillus rhamnosus biofilm model. One quarter of each induced lesion was excavated and baseline dentinal bacterial counts assessed as Colony-Forming-Units (CFU) per mg. Samples were allocated to one of four treatments (n = 25/group): (1) untreated control; (2) 38% SDF or (3) 35% CHX varnish, each applied once, plus 500 ppm daily NaF rinse in the subsequent lesion progression phase; and (4) daily NaF rinses only. Samples were re-transferred to the biofilm model and submitted to a cariogenic challenge. After six days, another quarter of each lesion was used to assess bacterial counts and the remaining sample was used to assess integrated mineral loss (ΔZ) using microradiography. RESULTS ΔZ did not differ significantly between control (median (25th/75th percentiles): 9082 (7859/9782) vol % × µm), NaF (6704 (4507/9574) and SDF 7206 (5389/8082)) (p < 0.05/Kruskal-Wallis test). CHX significantly reduced ΔZ (3385 (2447/4496)) compared with all other groups (p < 0.05). Bacterial numbers did not differ significantly between control (1451 (875/2644) CFU/µg) and NaF (750 (260/1401)) (p > 0.05). SDF reduced bacterial counts (360 (136/1166)) significantly compared with control (p < 0.05). CHX reduced bacterial counts (190 (73/517)) significantly compared with NaF and control (p < 0.05). CONCLUSION CHX varnish plus regular NaF rinses arrested root carious lesions most successfully.
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Affiliation(s)
- Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany.
| | - Felix Schulze
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany.
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany.
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany.
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Hartwig S, Raguse JD, Pfitzner D, Preissner R, Paris S, Preissner S. Volatile Organic Compounds in the Breath of Oral Squamous Cell Carcinoma Patients: A Pilot Study. Otolaryngol Head Neck Surg 2017; 157:981-987. [DOI: 10.1177/0194599817711411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective To assess the feasibility of detecting signature volatile organic compounds in the breath of patients with oral squamous cell carcinoma. Study Design Prospective cohort pilot study. Setting University hospital. Subjects and Methods Using gas chromatography and mass spectrometry, emitted volatile organic compounds in the breath of patients before and after curative surgery (n = 10) were compared with those of healthy subjects (n = 4). It was hypothesized that certain volatile organic compounds disappear after surgical therapy. A characteristic signature of these compounds for diseased patients was compiled and validated. Results Breath analyses revealed 125 volatile organic compounds in patients with oral cancer. A signature of 8 compounds that were characteristic for patients with oral cancer could be detected: 3 from this group presented were absent after surgery. Conclusion The presented results confirmed the hypothesis of an absence of cancer-associated volatile organic compounds in the breath after therapy. In this pilot study, we proved the feasibility of this test approach. Further studies should be initiated to establish protocols for usage in a clinical setting.
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Affiliation(s)
- Stefan Hartwig
- Department of Oral and Maxillofacial Surgery/Clinical Navigation, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Jan D. Raguse
- Department of Oral and Maxillofacial Surgery/Clinical Navigation, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Dorothee Pfitzner
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Preissner
- Institute of Physiology, Structural Bioinformatics Group, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Saskia Preissner
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Askar H, Brouwer F, Lehmensiek M, Paris S, Schwendicke F. The association between loading of restorations and secondary caries lesions is moderated by the restoration material elasticity. J Dent 2017; 58:74-79. [DOI: 10.1016/j.jdent.2017.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/17/2016] [Accepted: 01/04/2017] [Indexed: 02/07/2023] Open
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Reda S, Elhennawy K, Meyer-Lückel H, Paris S, Schwendicke F. Industry sponsorship in trials on fluoride varnish or gels for caries prevention. Community Dent Oral Epidemiol 2017; 45:289-295. [DOI: 10.1111/cdoe.12287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/08/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Seif Reda
- Department of Orthodontics; Dentofacial Orthopedics and Pedodontics, Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Karim Elhennawy
- Department of Orthodontics; Dentofacial Orthopedics and Pedodontics, Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Hendrik Meyer-Lückel
- Department of Operative Dentistry; Periodontology and Preventive Dentistry; RWTH Aachen University; Aachen Germany
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Falk Schwendicke
- Department of Orthodontics; Dentofacial Orthopedics and Pedodontics, Charité - Universitätsmedizin Berlin; Berlin 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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Schwendicke F, Korte F, Dörfer CE, Kneist S, Fawzy El-Sayed K, Paris S. Inhibition of Streptococcus mutans Growth and Biofilm Formation by Probiotics in vitro. Caries Res 2017; 51:87-95. [DOI: 10.1159/000452960] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 10/30/2016] [Indexed: 11/19/2022] Open
Abstract
To exert anticaries effects, probiotics are described to inhibit growth and biofilm formation of cariogenic bacteria such as Streptococcus mutans (SM). We screened 8 probiotics and assessed how SM growth or biofilm formation inhibition affects cariogenicity of probiotic-SM mixed-species biofilms in vitro. Growth inhibition was assessed by cocultivating probiotics and 2 SM strains (ATCC 20532/25175) on agar. Probiotics were either precultured before SM cultivation (exclusion), or SM precultured prior to probiotic cultivation (displacement). Inhibition of SM culture growth was assessed visually. Inhibition of SM biofilm formation on bovine enamel was assessed using a continuous-flow short-term biofilm model, again in exclusion or displacement mode. The cariogenicity of mixed-species biofilms of SM with the most promising growth and biofilm formation inhibiting probiotic strains was assessed using an artificial mouth model, and enamel mineral loss (ΔZ) was measured microradiographically. We found limited differences in SM growth inhibition in exclusion versus displacement mode, and in inhibition of SM 20532 versus 25175. Results were therefore pooled. Lactobacillus acidophilus LA-5 inhibited significantly more SM culture growth than most other probiotics. L. casei LC-11 inhibited SM biofilm formation similarly to other alternatives but showed the highest retention of probiotics in the biofilms (p < 0.05). Mineral loss from SM monospecies biofilms (ΔZ = 9,772, 25th/75th percentiles: 6,277/13,558 vol% × µm) was significantly lower than from mixed-species SM × LA-5 biofilms (ΔZ = 24,578, 25th/75th percentiles: 19,081/28,768 vol% × µm; p < 0.01) but significantly higher than from SM × LC-11 biofilms (ΔZ = 4,835, 25th/75th percentiles: 263/7,865 vol% × µm; p < 0.05). Probiotics inhibiting SM culture growth do not necessarily reduce the cariogenicity of SM-probiotic biofilms. Nevertheless, SM biofilm formation inhibition may be relevant in the reduction of cariogenicity.
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Sawalt M, Paris S, Blunck U, Schwendicke F. Fracture Resistance and Cusp Deflection of Lined or Non-lined Composite and Glass Hybrid Restorations Over Residual Demineralized Dentin. J Adhes Dent 2017; 19:77-82. [PMID: 28195270 DOI: 10.3290/j.jad.a37719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To assess the fracture resistance (FR) and cusp deflection (CD) of lined or non-lined composite (CO) and glass hybrid (GH) restorations over residual demineralized dentin. MATERIALS AND METHODS In 48 extracted human premolars, artificial residual demineralized dentin was induced on pulpo-axial walls of standardized cavities. Various restorations were placed over this demineralized dentin: an experimental GH, a composite restoration (OptiBond FL+Tetric EvoCeram) without lining, or composite restorations with non-setting (Hypocal) or setting (Dycal) calcium hydroxide lining. After thermomechanical cycling, groups (n = 12) were compared regarding their CD and FR. RESULTS CD did not differ significantly between groups. FR was significantly lower in teeth restored with GH (median: 238 N; 25th/75th percentiles: 191/287 N) than in those restored with lined or non-lined composites (median range: 517-569 N; p < 0.05/Mann-Whitney), which did not differ significantly from each other (p > 0.05). CONCLUSION Within the conditions of this in vitro study, CH lining of pulpo-axial walls had only limited impact on CD and FR. GH showed the lowest FR and might not be optimal for restoring deep or extended cavitated lesions.
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Askar H, Tu YK, Paris S, Yeh YC, Schwendicke F. Risk of caries adjacent to different restoration materials: Systematic review of in situ studies. J Dent 2017; 56:1-10. [DOI: 10.1016/j.jdent.2016.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 12/24/2022] Open
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Schwendicke F, Kniess J, Paris S, Blunck U. Margin Integrity and Secondary Caries of Lined or Non-lined Composite and Glass Hybrid Restorations After Selective Excavation In Vitro. Oper Dent 2016; 42:155-164. [PMID: 27802124 DOI: 10.2341/16-095-l] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES For deep carious lesions, selective carious tissue removal (leaving soft dentin close to the pulp) is suggested. Afterward, different restoration materials, such as resin composites or glass hybrids (GHs), can be placed. Many dentists also apply setting or non-setting calcium hydroxide liners before restoration. We compared margin integrity and susceptibility for secondary caries in differently restored premolars in vitro. METHODS In 48 extracted human premolars, artificial residual lesions were induced on pulpo-axial walls of standardized cavities. Teeth were restored using a GH (Equia Forte) or adhesively placed resin composite restoration (OptiBond FL and Tetric EvoCeram) without any liner (RC), resin composite restoration with a non-setting calcium hydroxide liner (RC_NCH), or resin composite restoration with a setting calcium hydroxide liner (RC_SCH). After thermomechanical cycling, groups (n=12) were compared regarding their gingivocervical margin integrity (proportion of irregularities, microgaps, gaps >5 μm, overhangs). Teeth were then submitted to a continuous culture Lactobacillus rhamnosus biofilm model. After 14 days, bacterial numbers in biofilms, along tooth-restoration margins and mineral loss (ΔZ) of secondary lesions, were determined. RESULTS GH and RC_NCH showed significantly higher proportions of irregularities than RC and RC_SCH (p<0.05/Mann-Whitney). GH also showed significantly more gaps than alternative restorations (p<0.05). Bacterial numbers and ΔZ did not differ significantly between groups (p>0.05). CONCLUSIONS GH and composites lined with non-setting calcium hydroxide showed reduced margin integrity compared with non-lined composites or composites lined with setting calcium hydroxide. This did not increase susceptibility for secondary caries.
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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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Schwendicke F, Göstemeyer G, Blunck U, Paris S, Hsu L, Tu Y. Response to Letter to the Editor: Composites—The Best Choice for Load-Bearing Cavitated Lesions in Permanent Teeth? J Dent Res 2016; 95:1074. [DOI: 10.1177/0022034516652126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- F. Schwendicke
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - G. Göstemeyer
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - U. Blunck
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - S. Paris
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - L.Y. Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Y.K. Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Umwali A, Askar H, Paris S, Schwendicke F. Radiographic, antibacterial and bond-strength effects of radiopaque caries tagging. Sci Rep 2016; 6:27319. [PMID: 27251174 PMCID: PMC4890289 DOI: 10.1038/srep27319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/18/2016] [Indexed: 11/10/2022] Open
Abstract
Selectively excavated carious lesions remain radiographically detectable. Radiopaque tagging could resolve the resulting diagnostic uncertainty. We aimed to evaluate if tagging depends on lesions depths, is antibacterial, or affects dentin bond-strengths. Artificial lesions (depth-range: 152-682 μm, n = 34/group) were induced in human dentin samples, evaluated using wavelength-independent microradiography, treated with one of two tagging materials (70% SnCl2, 30% SnF2) and re-evaluated. To evaluate antimicrobial effects, 40 dentin samples were submitted to a Lactobacillus rhamnosus invasion-model. Infected samples were treated with placebo, 0.2% chlorhexidine, SnCl2, SnF2 (n = 10/group). Dentin was sampled and colony-forming units/mg determined. Micro-tensile bond-strengths of adhesive restorations (OptiBond FL, Filtek Z250) to tagged or untagged, sound and carious dentin were assessed (n = 12/group). Tagged surfaces were evaluated microscopically and via energy-dispersive X-ray-spectroscopy (EDS). Tagging effects of both materials decreased with increasing lesion depths (p < 0.001). Un-/chlorhexidine-treated dentin contained significantly more viable bacteria (median 7.3/3.7 × 10(5) CFU/mg) than tagged dentin (no CFU detectable, p < 0.001). Tagging decreased bond strengths (p < 0.001) on sound (-22%/-33% for SnCl2/SnF2) and carious dentin (-50%/-54%). This might be due to widespread tin chloride or fluoride precipitation, as detected via microscopy and EDS. While radiopaque tagging seems beneficial, an optimized application protocol needs to be developed prior clinical use.
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Affiliation(s)
- Aurore Umwali
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14199 Berlin, Germany
| | - Haitham Askar
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14199 Berlin, Germany
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14199 Berlin, Germany
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14199 Berlin, Germany
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Schwendicke F, Brouwer F, Schwendicke A, Paris S. Different materials for direct pulp capping: systematic review and meta-analysis and trial sequential analysis. Clin Oral Investig 2016; 20:1121-32. [PMID: 27037567 DOI: 10.1007/s00784-016-1802-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [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: 09/18/2015] [Accepted: 03/16/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVES We systematically assessed randomized controlled trials comparing direct pulp capping materials. METHODS Trials comparing materials for direct capping and evaluating clinically and/or radiographically determined success after minimum 3 months were included. Two reviewers independently screened electronic databases (Medline, Central, Embase) and performed hand searches. Risk of bias was assessed and meta-analyses were performed, separated for dentition. Trial sequential analysis was used to assess risk of random errors. Strength of evidence was graded using the GRADE approach. RESULTS From a total of 453 identified studies, 11 (all with high risk of bias) investigating 1094 teeth (922 patients) were included. Six studies were on primary teeth (all with carious exposures) and five on permanent teeth (carious and artificial exposures). Mean follow-up was 14 months (range 3-24). Most studies used calcium hydroxide as control, comparing it to mineral trioxide aggregate (MTA) (three studies), bonding without prior etching/conditioning (two), or bonding with prior etching/conditioning, enamel matrix proteins, resin-modified glass ionomer cement, calcium sulfate, zinc oxide eugenol, corticosteroids, antibiotics, or formocresol (each in only one study). One study compared MTA and calcium-enriched cement. In permanent teeth, risk of failure was significantly decreased if MTA instead of calcium hydroxide was used (risk ratio (RR) [95 % confidence intervals (CI)] 0.59 [0.39/0.90]); no difference was found for primary teeth. Other comparisons did not find significant differences or were supported by only one study. No firm evidence was reached according to trial sequential analysis. CONCLUSION There is insufficient data to recommend or refute the use of a specific material. More long-term practice-based studies with real-life exposures are required. CLINICAL RELEVANCE To reduce risk of failure, dentists might consider using MTA instead of calcium hydroxide (CH) for direct capping. Current evidence is insufficient for definitive recommendations.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
| | - Fredrik Brouwer
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Anja Schwendicke
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
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Al-Abdi A, Paris S, Schwendicke F. Glass hybrid, but not calcium hydroxide, remineralized artificial residual caries lesions in vitro. Clin Oral Investig 2016; 21:389-396. [PMID: 27033226 DOI: 10.1007/s00784-016-1803-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/10/2015] [Accepted: 03/16/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES For deep carious lesions, less invasive carious tissue removal is recommended. The resulting residual carious lesions might benefit from remineralization by lining or restoration materials. We aimed to compare mineral gains in artificial residual lesions provided by calcium hydroxide and glass hybrid materials in combination with pulpal fluid simulation. METHODS On the coronal aspect of human dentin discs (n = 20), artificial carious lesions were induced using acetic acid. Median mineral loss ΔZ [25th/75th percentiles] of resulting lesions was 1643 [1301/1858] vol% μm. One third of each disc served as baseline sample. The remaining disc was divided into four groups, each being covered with one experimental material (n = 20/group): flowable composite (control (CO)), setting or non-setting calcium hydroxide liner plus flowable composite (CH-S, CH-NS), and glass hybrid (GH). Samples were mounted in a dual-chamber device. Pulpal surfaces were exposed to simulated pulpal fluid at 2.94 kPa. Coronal surfaces were exposed to artificial saliva and rinsed with 200 ppm NaF every 2 weeks. After 12 weeks, mineral loss differences (ΔΔZ) were assessed using transverse microradiography. Electron probe microscopic analysis was used to measure fluoride and strontium concentrations. RESULTS Mineral gains were not significantly different between CO (ΔΔZ = 372 [115/501] vol% μm), CH-S (ΔΔZ = 317 [229/919] vol% μm), or CH-NS (ΔΔZ = 292 [130/579] vol% μm; p > 0.05/Wilcoxon test) but significantly increased in GH (ΔΔZ = 1044 [751/1264] vol% μm, p < 0.001). Samples in GH showed fluoride and strontium enrichment deep into the dentin. Such enrichment was not found in CO. CONCLUSIONS Within the limitations of this study, GH, but not calcium hydroxide, provided coronal remineralization of residual carious lesions. CLINICAL RELEVANCE Glass hybrids might provide additional remineralization of residual carious lesions. The functional implications of this mineral gain need to be evaluated.
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Affiliation(s)
- Allam Al-Abdi
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
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Preissner S, Kastner I, Schütte E, Hartwig S, Schmidt-Westhausen AM, Paris S, Preissner R, Hertel M. Adjuvant antifungal therapy using tissue tolerable plasma on oral mucosa and removable dentures in oral candidiasis patients: a randomised double-blinded split-mouth pilot study. Mycoses 2016; 59:467-75. [PMID: 26932256 DOI: 10.1111/myc.12495] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 11/04/2015] [Revised: 01/06/2016] [Accepted: 02/04/2016] [Indexed: 11/28/2022]
Abstract
Extended use of antimycotics in oral candidiasis therapy gives rise to problems related to fungal drug resistance. The aim of this pilot study was to investigate the efficacy of tissue tolerable plasma (TTP) in denture stomatitis patients. It was hypothesised that (I): erythema and (IIa): complaint remission would be accelerated and (IIb): colony forming unit (CFU) reduction would be improved. The halves of the upper jaws of eight patients were randomly assigned to control (nystatin, chlorhexidine and placebo treatment) and test sides (nystatin, chlorhexidine and TTP administered six times each 7 days). The patients and the investigators, who were different from the therapists, were both blinded. Compared to the control sides, the erythema surface was reduced significantly more extensively on the test sides between 2 and 6 weeks of antifungal therapy (P ≤ 0.05). Visual analogue scale values and the frequency of moderate or heavy growth of Candida post-treatment did not differ significantly between both sides (P > 0.05). The primary hypothesis was confirmed, which may be interpreted as an accelerated remission. As drug therapy is usually limited to the time in which signs of infection are present, TTP might help reducing antifungal use. Even though the secondary hypotheses were not confirmed, persistence of Candida might be only colonisation.
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Affiliation(s)
- Saskia Preissner
- Department of Operative and Preventive Dentistry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Isabell Kastner
- Department of Operative and Preventive Dentistry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Eyke Schütte
- Department of Oral Medicine, Dental Radiology and Oral Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Hartwig
- Department of Oral and Maxillofacial Surgery/Clinical Navigation, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Preissner
- Structural Bioinformatics Group, Institute for Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Hertel
- Department of Oral Medicine, Dental Radiology and Oral Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
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Abstract
For restoring cavitated dental lesions, whether carious or not, a large number of material combinations are available. We aimed to systematically review and synthesize data of comparative dental restorative trials. A systematic review was performed. Randomized controlled trials published between 2005 and 2015 were included that compared the survival of ≥2 restorative and/or adhesive materials (i.e., no need for restorative reintervention). Pairwise and Bayesian network meta-analyses were performed, with separate evaluations for cervical cavitated lesions and load-bearing posterior cavitated lesions in permanent and primary teeth. A total of 11,070 restorations (5,330 cervical, 5,740 load bearing) had been placed in 3,633 patients in the included trials. Thirty-six trials investigated restoration of cervical lesions (all in permanent teeth) and 36 of load-bearing lesions (8 in primary and 28 in permanent teeth). Resin-modified glass ionomer cements had the highest chance of survival in cervical cavitated lesions; composites or compomers placed via 2-step self-etch and 3-step etch-and-rinse adhesives were ranked next. Restorations placed with 2-step etch-and-rinse or 1-step self-etch adhesives performed worst. For load-bearing restorations, conventional composites had the highest probability of survival, while siloranes were found least suitable. Ambiguity remains regarding which adhesive strategy to use in load-bearing cavitated lesions. Most studies showed high risk of bias, and several comparisons were prone for publication bias. If prioritized for survival, resin-modified glass ionomer cements might be recommended to restore cervical lesions. For load-bearing ones, conventional or bulk fill composites seem most suitable. The available evidence is quantitatively and qualitatively insufficient for further recommendations, especially with regard to adhesive strategies in posterior load-bearing situations. Moreover, different material classifications might yield different findings on the same materials. Future trials should aim for sufficient power, longer follow-up times, and high internal validity to prove or refute differences between certain material combinations. An agreed material classification for future syntheses is desirable.
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Affiliation(s)
- F. Schwendicke
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - G. Göstemeyer
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - U. Blunck
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - S. Paris
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - L.-Y. Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Y.-K. Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Wierichs RJ, Zelck H, Doerfer CE, Appel P, Paris S, Esteves-Oliveira M, Meyer-Lueckel H. Effects of dentifrices differing in fluoride compounds on artificial enamel caries lesions in vitro. Odontology 2016; 105:36-45. [PMID: 26849573 DOI: 10.1007/s10266-016-0233-x] [Citation(s) in RCA: 16] [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: 09/03/2015] [Accepted: 12/24/2015] [Indexed: 11/24/2022]
Abstract
The aim of this study was to compare the caries-preventive effect of a stabilized stannous fluoride/sodium fluoride dentifrice containing sodium hexametaphosphate with those of a regular, solely sodium fluoride-containing and amine fluoride-containing dentifrice on pre-demineralized bovine enamel specimens using a pH-cycling model. Bovine enamel specimens with two artificial lesions each were prepared. Baseline mineral loss of both lesions was analyzed using transversal microradiography (TMR). Eighty-five specimens with a mean (SD) baseline mineral loss of 3393 (683) vol% × µm were selected and randomly allocated to five groups (n = 13/15). Treatments during pH-cycling (28 days and 2 × 20 min demineralization/day) were: brushing twice daily with slurries of AmF (1400 ppm F-), NaF (1450 ppm F-), SnF2/NaF (1100 ppm F-/350 ppm F-), and fluoride-free (FF) dentifrices or they were immersed in distilled water and remained unbrushed (NB). Subsequently, from each specimen one lesion was covered with acid-resistant varnish, while the remaining lesion was demineralized for another 14 days. Differences in integrated mineral loss (∆∆Z) were calculated between values before and after pH-cycling (∆∆Z E1) as well as before pH-cycling and after second demineralization (∆∆Z E2) using TMR. Treatments AmF and NaF induced a significantly higher mineral gain (∆∆Z E1/∆∆Z E2) compared to treatments FF and NB (p < 0.05; ANOVA test). Except for treatments AmF and NaF no significant differences in mineral loss between before and after pH-cycling could be observed (p < 0.05; t test) [∆∆Z E1: AmF:1563 (767); NaF:1222 (1246); SnF2/NaF:258 (1259); FF:-52 (1223); NB:-151 (834)]. Both dentifrices with either AmF or NaF promoted remineralization, whereas SnF2/NaF dentifrice did not promote remineralization in a biofilm-free pH-cycling model.
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Affiliation(s)
- R J Wierichs
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - H Zelck
- Clinic for Operative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - C E Doerfer
- Clinic for Operative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - P Appel
- Abteilung Mineralogie, Institut für Geowissenschaften, Universität Kiel, Ohlshausenstrasse 40, 24098, Kiel, Germany
| | - S Paris
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Assmannshauser Str. 4-6, 14197, Berlin, Germany
| | - M Esteves-Oliveira
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - H Meyer-Lueckel
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
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Abstract
Proximal caries infiltration has been shown to be efficacious in hampering caries lesion progression when performed by dentists working in a university setting. The aim of this randomized split-mouth, placebo-controlled clinical trial was to assess the efficacy of resin infiltration of proximal caries lesions being performed by several dentists in private practices, in combination with individualized oral hygiene plus noninvasive measures compared with these alone. In this study, 87 children and young adults (with 238 pairs of proximal caries lesions radiographically extending into the inner half of the enamel [E2] or the outer third of the dentin [D1]) were randomly allocated to either 1 of 2 treatments. Test lesions were infiltrated, and a mock treatment was performed in control lesions by 5 German private practitioners. All patients received instructions for a noncariogenic diet, flossing and fluoridation, and individualized noninvasive interventions. The primary outcome was radiographic lesion progression (pairwise comparison) evaluated independently by 2 evaluators who were blinded to treatment allocation. After approximately 10 mo (mean ± SD 307 ± 43 d), 92 of 148 lesion pairs in 24 of 38 treated patients who were at high caries risk could be re-evaluated clinically as well as radiographically using individualized bitewing holders, as at baseline; 186 of 204 lesion pairs in 70 of 77 patients (35 of 38 high-risk patients) could be evaluated after 18 mo (mean 542 ± 110 d). No unwanted effects were observed. After 10 mo, progression was recorded in 2 of 92 test lesions (2%) and in 22 of 92 control lesions (24%) ( P = 0.001, McNemar/Obuchowski test; relative risk reduction, 91; 95% confidence interval, 62%–98%). After 18 mo, lesion progression was recorded in all included patients in 10 of 186 test lesions (5%) and in 58 of 186 control lesions (31%) ( P < 0.001; relative risk reduction, 83; 95% confidence interval, 67%–91%). Thus, resin infiltration seems to be more efficacious in reducing lesion progression compared with individualized noninvasive measures alone over a period of 18 mo when performed in a private practice setting by various practitioners (German Clinical Trials Register / Deutsches Register Klinischer Studien DRKS00009963).
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Affiliation(s)
- H. Meyer-Lueckel
- Department of Operative Dentistry, Periodontology, and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | - A. Balbach
- Department of Operative Dentistry, Periodontology, and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | - C. Schikowsky
- Institute of Occupational Medicine, RWTH Aachen University, Aachen, Germany
| | - K. Bitter
- Department of Operative Dentistry and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - S. Paris
- Department of Operative Dentistry and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
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