Periodontal surgery in furcation-involved maxillary molars revisited—an introduction of guidelines for comprehensive treatment

Maxillary molars with interradicular loss of periodontal tissue have an increased risk of additional attachment loss with an impaired long-term prognosis. Since accurate clinical analysis of furcation involvement is not feasible due to limited access, morphological variations and measurement errors, additional diagnostics, e.g., with cone-beam computed tomography, may be required. Surgical treatment options have graduated from a less invasive approach, i.e., keeping as much periodontal attachment as possible, to a more invasive approach: (1) open flap debridement with/without gingivectomy or apically repositioned flap and/or tunnelling; (2) root separation; (3) amputation/trisection of a root (with/without root separation or tunnel preparation); (4) amputation/trisection of two roots; and (5) extraction of the entire tooth. Tunnelling is indicated when the degree of root separation allows for opening of the interradicular region. Alternatively, root separation is performed particularly in root-canal treated teeth with reduced coronal tooth substance requiring crown restorations. As soon as the attachment of one or two roots in maxillary molars is severely reduced, root removal is indicated and performed either as amputation or trisection including the corresponding part of the clinical crown. While the indication for regenerative measures in maxillary molars with furcation involvement is very limited, extraction and replacement with implants is restricted, particularly in sites requiring complex alveolar ridge augmentation and sinus elevation. A systematic approach for decision making in furcation-involved maxillary molars is described in this overview, including what constitutes accurate diagnosis and what indications there are for the different surgical periodontal treatment option

Brushing without brushing?—a review of the efficacy of powered toothbrushes in noncontact biofilm removal

Objectives: The aim of the present review was to analyze the impact of the hydrodynamic effects created by powered toothbrushes on biofilm removal in vitro. Materials and methods: A MEDLINE search was performed for publications published by 20 May 2012; this search was complemented by a manual search. The study selection, data preparation, and validity assessment were conducted by two reviewers. Results: Sixteen studies were included. The studies differed with respect to the methods of biofilm formation and brushing protocols. Eighteen different powered toothbrush models were evaluated. Toothbrushes with side-to-side action demonstrated biofilm removal without direct bristle contact to biofilms ranging from 38 to 99%. Most studies found biofilm removal exceeding 50%. Biofilm reduction using multidimensional toothbrushes was significantly lower than by those with the side-to-side mode. Detachment forces due to hydrodynamic phenomena, passing air-liquid interfaces, and acoustic energy transfer were suggested to cause reduction of the biofilm. Conclusion: Noncontact biofilm reduction was obtained by the hydrodynamic effects of some powered toothbrushes in vitro. Clinical relevance: Powered toothbrushes may have the potential to simplify self-performed oral hygiene. However, additional beneficial effects of higher amounts of noncontact biofilm removal in vitro have not been shown clinically, ye

Isothermal microcalorimetry provides new insights into biofilm variability and dynamics

The purpose of this study was to investigate a three-species in vitro biofilm with peri-implantitis-related bacteria for its variability and metabolic activity. Streptococcus sanguinis, Fusobacterium nucleatum, and Porphyromonas gingivalis were suspended in simulated body fluid containing 0.2% glucose to form biofilms on polished, protein-coated implant-grade titanium disks over 72 h using a flow chamber system. Thereafter, biofilm-coated disks were characterized by scanning electron microscopy and fluorescence in situ hybridization/confocal laser scanning microscopy. To assess metabolic activity within the biofilms, their heat flow was recorded for 480 h at 37 °C by IMC. The microscopic methods revealed that the total number of bacteria in the biofilms varied slightly among specimens (2.59 × 104 ± 0.67 × 104 cells mm−2), whereas all three species were found constantly with unchanged proportions (S. sanguinis 41.3 ± 4.8%, F. nucleatum 17.7 ± 2.1%, and P. gingivalis 41.0 ± 4.9%). IMC revealed minor differences in time-to-peak heat flow (20.6 ± 4.5 h), a trend consistent with the small variation in bacterial species proportions as shown by microscopy. Peak heat flow (35.8 ± 42.6 µW), mean heat flow (13.1 ± 22.0 µW), and total heat over 480 h (23.5 ± 37.2 J) showed very high variation. These IMC results may be attributed to differences in the initial cell counts and relative proportions of the three species, their distribution and embedment in exopolysaccharide matrix on the test specimens. The present results provide new insights into variability and dynamics of biofilms on titanium disks, aspects that should be explored in future studies of dental surface

Partial pulpotomy without age restriction: a retrospective assessment of permanent teeth with carious pulp exposure

OBJECTIVES This study aimed to retrospectively evaluate clinical and radiographic outcomes of partial pulpotomy performed in permanent teeth with carious pulp exposure. MATERIALS AND METHODS Records of patients undergoing treatment at an undergraduate dental clinic between 2010 and 2019 were screened for partial pulpotomies in teeth with a presumptive diagnosis of normal pulp or reversible pulpitis. The follow-up had to be ≥ 1 year. Patient data were retrieved and analyzed using Mantel-Cox chi square tests and Kaplan-Meier statistics. The level of significance was set at α = 0.05. RESULTS Partial pulpotomy was performed in 111 cases, of which 64 (58%) fulfilled the eligibility criteria. At the time of partial pulpotomy, the mean age was 37.3 (± 13.5) years (age range 18-85). The mean observation period was 3.1 (± 2.0) years. Two early failures (3.1%) and five late failures (7.7%) were recorded. The overall success rate of maintaining pulp vitality was 89.1%, with 98.4% tooth survival. The cumulative pulp survival rates of partial pulpotomy in patients aged  40 years were 100%, 75.5%, and 90.5%, respectively, with no significant difference between the age groups (p = 0.225). At follow-up, narrowing of the pulp canal space and tooth discoloration were observed in 10.9% and 3.1% of cases, respectively. CONCLUSIONS Across age groups, partial pulpotomy achieved favorable short and medium-term outcomes in teeth with carious pulp exposure. CLINICAL RELEVANCE Adequate case selection provided, partial pulpotomy is a viable operative approach to treat permanent teeth with deep carious lesions irrespective of patients' age

Quantification of vital adherent Streptococcus sanguinis cells on protein-coated titanium after disinfectant treatment

The quantification of vital adherent bacteria is challenging, especially when efficacy of antimicrobial agents is to be evaluated. In this study three different methods were compared in order to quantify vital adherent Streptococcus sanguinis cells after exposure to disinfectants. An anaerobic flow chamber model accomplished initial adhesion of S. sanguinis on protein-coated titanium. Effects of chlorhexidine, Betadine®, Octenidol®, and ProntOral® were assessed by quantifying vital cells using Live/Dead BacLight™, conventional culturing and isothermal microcalorimetry (IMC). Results were analysed by Kruskal-Wallis one-way analysis of variance. Live/dead staining revealed highest vital cell counts (P0.05), indicating equivalent numbers of bacteria were created and disinfectants delayed growth but did not eliminate it. In conclusion, contrary to culturing, live/dead staining enables detection of cells that may be viable but non-cultivable. Microcalorimetry allows unique evaluation of relative disinfectant effects by quantifying differences in time delay of regrowth of remaining vital cell

Is smoking a predictor of apical periodontitis?

Objectives: To evaluate the association between cigarette smoking and the frequency of apical periodontitis in female and male patients seeking treatment at the University of Basel (KREBS Project). Materials and methods: This cohort study included full-mouth periapical radiographs of 161 subjects, including 66 current smokers, 26 former smokers and 69 individuals who had never smoked. The periapical region of all teeth was radiographically evaluated using the Periapical Index (PAI) score. Generalised linear mixed-effects models using the logit link were performed. Results: The frequency of apical periodontitis differed based on gender and smoking status. Current male cigarette smokers with  0.05). Conclusion: Smoking status did not predict apical periodontitis in females and males in this sample group. Clinical relevance: With respect to quality of root canal filling, tobacco use may not be a significant predictor for apical periodontiti

Quality of CAD-CAM inlays placed on aged resin-based composite restorations used as deep margin elevation: a laboratory study

OBJECTIVES To assess the impact of the age of resin-based composite (RBC) restorations used for deep margin elevation (DME) on the marginal quality and fracture resistance of inlays. MATERIALS AND METHODS Permanent human molars with direct RBC restorations, involving the mesial, occlusal, and distal surface (MOD), were allocated to four groups (each n = 12). Half of the teeth underwent thermomechanical loading including 240,000 occlusal load cycles and 534 thermal cycles (TML, 5 °C/55 °C; 49 N, 1.7 Hz). With RBC left in one proximal box as DME, all teeth received MOD inlays, made from lithium disilicate (LDS) or a polymer-infiltrated ceramic network material (PICN). The restored teeth underwent TML including 1.2 million occlusal cyclic loadings and 2673 thermal cycles. The marginal quality was assessed at baseline and after both runs of TML. Load-to-fracture tests were performed. The statistical analysis comprised multiple linear regressions (α = 0.05). RESULTS Simulated aging of RBC restorations had no significant effect on the marginal quality at the interface between the RBC and the tooth and the RBC and the inlay (p ≥ 0.247). Across time points, higher percentages of non-continuous margin were observed between the inlay and the tooth than between the tooth and the RBC (p ≤ 0.039). The age of the DME did not significantly affect the fracture resistance (p ≥ 0.052). CONCLUSIONS Artificial aging of RBC restorations used for DME had no detrimental effect on the marginal quality and fracture resistance of LDS and PICN inlays. CLINICAL RELEVANCE This laboratory study suggests that-in select cases-intact, direct RBC restorations not placed immediately before the delivery of an indirect restoration may be used for DME

Influence of time, toothpaste and saliva in the retention of Streptococcus mutans and Streptococcus sanguinis on different toothbrushes

Objectives: The intraoral transmission of cariogenic and periodontopathogenic species seems to be facilitated by contaminated toothbrushes and other oral hygiene devices. The aim of this investigation was to analyze the in vitro retention and survival rate of Streptococcus mutans and Streptococcus sanguinis on different toothbrushes. The impacts of human saliva and antimicrobial toothpaste on these parameters were further evaluated. Material and Methods: Part I: Four toothbrushes (Colgate 360°, Curaprox CS5460 ultra soft, elmex InterX, Trisa Flexible Head3) were contaminated by S. mutans DSM 20523 or S. sanguinis DSM 20068 suspensions for three minutes. Bacteria were removed from the toothbrushes after either three minutes (T0) or 24 hours (T24) of dry storage and grown on Columbia blood agar plates for the quantification of colony-forming units (CFUs). Part II: The effects of saliva from a caries-active or a caries-inactive person and of toothpaste containing 0.12% chlorhexidine digluconate were also tested. Results: Part I: After three minutes of dry storage, approximately one percent of the bacteria were still detectable on the toothbrushes. After 24 hours, S. sanguinis exhibited a more pronounced decrease in viable cell numbers compared with S. mutans but the differences were not significant (Kruskal-Wallis test, p>;0.05). Part II: The addition of human saliva from a caries-active or caries-inactive person slightly increased the retention of both streptococcal species at T0. The use of toothpaste had no influence on the amount of viable streptococci at T0, but it reduced the microbial load after 24 hours of storage. There were only slight nonsignificant differences (p>;0.05) between the four toothbrushes. Conclusions: In vitro bacterial retention and survival of S. sanguinis and S. mutans on different toothbrushes occurred. Within the limitations of this study, the use of human saliva or an antimicrobial toothpaste did not lead to significant differences in the microbial load on toothbrushes