Description of a new laboratory evaluation method of interdental brush abrasion as a clinical hazard

Objectives To simulate the abrasive potential of an interdental brush when applied with toothpastes and prophylactic gels/solutions in a novel laboratory brushing simulation set‐up. Methods A brushing device was customized to treat dentin samples mimicking a simplified interdental space with an interdental brush (ISO 2). The brushing, that is, 7200 strokes for 1 h, was performed with artificial saliva (control), a povidone‐iodine solution, and slurries of chlorhexidine and fluoride gels as well as three toothpastes with different RDA values ranging from 29 to 100, respectively. The loss of dentin was profilometrically assessed and compared with ANOVA and Fishers LSD. Results While artificial saliva as control, the solution and the gel slurries showed no measurable dentin loss, toothpastes resulted in a measurable linear surface damage with respect to the actual intrinsic RDA values and ranged from 12.6 to 26.5 μm (p < 0.001). Conclusions Any interdental cleaning product should be tailored and carefully instructed. Any over‐ and misuse should be avoided, which applies especially to the use of interdental brushes in combination with abrasive toothpastes

Gingival epitheses: forgotten craft or technology with a future? - Case report of a epithesis fabricated with CAD/CAM

The case in this report presents an alternative, partially CAD/CAM-based fabrication of a gingival epithesis in a 48-years-old female patient. The patient suffered from a periodontits stage III, grade C. After a non-surgical periodontal treatment with adjunctive systemic antibiotics, the patient developed severe circumferential gingival recessions on the upper frontal teeth. Due to social discomfort and esthetic concerns, the indication for a gingival epithesis was made. After taking a conventional impression from the upper jaw, the cast model was scanned and the gingival epithesis was designed virtually at the laboratory. The epithesis was then milled from a block of high performance polymer. Minor adjustments of surface details were added manually. The result was a esthetically sufficient and by the patient well-accepted treatment modality. Further research is necessary to prove the feasibility of a full digital workflow and the long-term stability of CAD/CAMbased gingival epitheses

Enamel Matrix Derivatives as an Adjunct to Alveolar Ridge Preservation-A Systematic Review

PURPOSE To systematically assess the current evidence regarding the adjunctive application of enamel matrix derivatives (EMDs) during alveolar ridge preservation (ARP) following tooth extraction. METHODS A comprehensive literature search was conducted in MEDLINE, Cochrane Library, PsycINFO, Web of Science, Google Scholar, and Scopus to identify relevant randomized controlled clinical trials (RCTs). The primary outcome parameters of this systematic review were histomorphometric and radiographic data; secondary outcomes were the feasibility of implant placement after ARP as well as patient-related outcomes such as postoperative discomfort. RESULTS The search identified 436 eligible articles published from 2011 to 2022, but only five were ultimately included for data extraction (146 patients). Given the substantial heterogeneity among the included studies, no meta-analysis could be performed. The authors' qualitative analysis showed marginally improved outcomes regarding an increased percentage of new bone formation after tooth extraction and a reduction in postoperative discomfort. CONCLUSIONS Given the potential value of EMDs in other fields of regenerative dentistry, more consideration should be given to EMDs as an adjunctive treatment option in ARP. However, more well-controlled randomized clinical trials are necessary to evaluate the exact potential and impacts of EMDs

Radiographic results of osteotome-driven maxillary sinus floor elevation without grafting materials after 17.5 years radiographic evaluation of minimally-invasive sinus grafting

BACKGROUND There is growing evidence that minimally invasive sinus augmentation works without the use of filler materials. This study assessed the bone integration and sinus projection of single-unit implants in the maxilla, which were placed approximately 18 years ago using a modified filler-free osteotome technique. METHODS Sixteen of the 24 treated patients of a former publication (treatment was performed between 2001 and 2004) were reassessed after a mean implant loading period of 17.5 years. The treated posterior areas were evaluated using cone-beam computed tomography (CBCT), and as a primary outcome parameter, sinus projection was determined in sectional views at the mesial, distal, buccal, and oral sites. Additionally, the percentage of alveolar bone contact was determined with respect to the implant length. Conventional radiographs were used to determine marginal bone levels. Additionally, plaque, bleeding on probing, and probing pocket depth were measured. The reconstructions were checked for chipping and other technical complications such as loss of retention, screw loosening, and screw fracture. RESULTS The mean age of the included patients was 72.8 ± 8.5 years. Two implants were lost. Therefore, fourteen implants were available for CBCT evaluation. The highest sinus projection of 2.1 ± 1.7 mm was observed in the distal aspect, while it was 1.1 ± 1.5, 0.9 ± 1.2, and 0.9 ± 1.1 mm at the mesial, buccal, and oral sites, respectively. The maximal sinus projection in one case was 6.7 mm. The percentage calculation of osseous implant integration (in mm ± standard deviations) with respect to the selected implant length at the mesial, distal, buccal, and oral sites showed values ranging from, 87.9 ± 16.0, 78.4 ± 20.3, 91.0 ± 12.5, and 90.5 ± 11.1%, respectively. Five implants displayed probing pocket depths of more than 4 mm with bleeding; all implants had less than 1 mm of bone loss in the observation period, that is, implants had mucositis. Six of 14 crowns showed small chippings within the ceramic veneering. One case of screw loosening was reported in medical history. DISCUSSION This study showed that implant placement in non-augmented sinuses resulted in good clinical results. The sinus projection, even if persistent and present, leads to no functional impairments. Given adequate maintenance, marginal bone levels remain constant and peri‑implant health can be observed. Moreover, these results represent only a small cohort; and therefore, should be interpreted with caution. However, in view of the existing literature, these highly promising results are in line with other findings. CLINICAL SIGNIFICANCE To the best of our knowledge, this dataset is the report with the longest follow-up. Overall, implants placed in the sinus without fillers represent a valuable alternative for tooth replacement in a minimally interventional manner

In vitro tooth cleaning efficacy of manual toothbrushes around brackets

The purpose of this laboratory study was to assess the potential cleaning efficacy of nine different toothbrushes around brackets in vitro. Standard and Mini Diamond™ brackets were fixed on coloured teeth in a special model, coated with white titanium oxide, brushed in a machine with different manual toothbrushes (three different types: planar, staged, and v-shaped bristle field), and tested with a horizontal motion for 1 minute. After brushing, the teeth were scanned and the black surfaces were planimetrically assessed using a grey scale. Tooth areas which were black again after brushing indicated tooth surface contact of the filaments. The remaining white tooth areas around the brackets indicated ‘plaque-retentive' niches. Statistical analysis was carried out using the Kruskal-Wallis one-way test of variance for individual comparison. Bonferroni adjustment was used for multiple testing, and comparison of bracket size with Wilcoxon signed rank test. In the most critical area of 2 mm around the brackets, there was no statistically significant difference between the different toothbrushes evaluated. The untouched area ranged from 11 to 26 per cent of the initially whitened tooth surface. By pooling the toothbrushes according to their design, the median cleaning efficacy of the v-shaped (73.1 per cent) and staged (75.6 per cent) toothbrushes resulted in significantly superior cleaning efficacy than planar toothbrushes (60.7 per cent) for standard brackets. For mini bracket type, staged toothbrushes showed a significantly better mean cleaning efficacy (77.8 per cent) than planar (65 per cent) and v-shaped (72.4 per cent) toothbrushes. Staged and v-shaped brush designs resulted in superior cleaning efficacy of teeth with fixed orthodontic attachments than toothbrushes with a planar bristle field. None of the tested toothbrushes showed a consistent, significantly higher cleaning efficacy than the others in this in vitro experimen

Surface properties of polyetheretherketone after different laboratory and chairside polishing protocols

STATEMENT OF PROBLEM Polyetheretherketone (PEEK) can be used as a framework material for fixed dental prostheses. However, information about laboratory and chairside polishing methods is still scarce. PURPOSE The purpose of this in vitro study was to determine the effects of laboratory and chairside polishing methods on the surface roughness (SR) and surface free energy (SFE) of PEEK, an autopolymerizing poly(methyl methacrylate), and a veneering composite resin. MATERIAL AND METHODS For each of the 3 materials, 80 specimens were prepared (N=240) and divided into 7 polishing groups and 1 control group (n=10). The 7 groups were split into 4 laboratory protocols: polishing paste (Abraso), a second polishing paste (Opal L), silicone polisher (Ceragum), and diamond grinder (Diagen-Turbo grinder). The other 3 groups were chairside protocols: rainbow technique (Super-Snap kit), polishing paste (Prisma gloss), and a polishing system (Enhance finishing). Machine polishing with SiC P4000 served as the control treatment. The protocols' average SRs and SFEs were measured, and their surface topographies were evaluated with scanning electron microscopy (SEM). The logarithmically transformed data were analyzed using covariance analysis, 2-way and 1-way ANOVA, and partial correlation (α=.05). RESULTS The polishing protocol exerted the highest influence on SR and SFE values (P<.001; SR: partial eta squared ηP(2)=.970; SFE: ηP(2)=.450), followed by material group (P<.001, SR: ηP(2)=.319; SFE: ηP(2)=.429). The interaction effect of the binary combinations of the 2 independent parameters (polishing protocol and material group) was also significant (P<.001, SR: ηP(2)=.681; SFE: ηP(2)=.365). CONCLUSIONS Chairside methods presented lower SR values than laboratory methods, and specimens polished using the 2-body mode showed higher SR than did specimens polished using the 3-body mode

Spectrophotometric Evaluation of Polyetheretherketone (PEEK) as a Core Material and a Comparison with Gold Standard Core Materials

This study investigated the colorimetric properties of different veneering materials on core materials. Standardized specimens (10 mm x 10 mm x 1.5 mm) reflecting four core (polyetheretherketone (PEEK), zirconia (ZrO2), cobalt-chromium-molybdenum alloy (CoCrMo), and titanium oxide (TiO2);thickness: 1.5 mm) and veneering materials (VITA Mark II, IPS e.max CAD, LAVA Ultimate and VITA Enamic, all in shade A3;thickness: 0.5, 1.0, 1.5 and 2 mm, respectively) were fabricated. Specimens were superimposed to assemblies, and the color was determined with a spectrophotometer (CieLab-System) or a chair-side color measurement device (VITA EasyShade), respectively. Data were analyzed using three-, two-, and one-way ANOVA, a Chi(2)-test, and a Wilson approach (p < 0.05). The measurements with EasyShade showed A2 for VITA Mark II, A3.5 for VITA Enamic, B2 for LAVA Ultimate, and B3 for IPS e.max CAD. LabE-values showed significant differences between the tested veneering materials (p < 0.001). CieLab-System and VITA EasyShade parameters of the different assemblies showed a significant impact of core (p < 0.001), veneering material (p < 0.001), and thickness of the veneering material (p < 0.001). PEEK as core material showed comparable outcomes as compared to ZrO2 and CoCrMo, with respect to CieLab-System parameters for each veneering material. The relative frequency of the measured VITA EasyShade parameters regarding PEEK cores also showed comparable results as compared to the gold standard CoCrMo, regardless of the veneering material used