This clinical retrospective study assessed the longevity of CAD-CAM ceramic restorations (Cerec) inserted into the cavities of 95 patients in a private practice in Berlin, Germany. Three hundred and eight ceramic restorations were inserted into cavities in the posterior teeth of 95 patients between 1992 and 1994. One operator placed all restorations in a single sitting. Seventy-four patients, including 226 restorations, returned to the practice for a final examination at the end of 10 years. Reasons for non-attendance include relocation (15), death (2) and personal reasons (4). Again, all examinations were performed by a single examiner, however, not the same dentist who initially treated the patients. Out of the 226 restorations, 39 had been inserted in Class I cavities and 187 in Class II cavities (84 two-surfaces, 103 three or more surfaces). In the latter group, one cusp was replaced in 20 cases and two cusps in three cases. All the restorations were fabricated using Cerec 1 (46 Dicor, 180 Vita Mark II) and cemented adhesively with Vita Cerec Duo Cement in combination with Syntac Classic under a rubber dam. Kaplan-Meier survival analysis was calculated under the following failure-criteria: (1) secondary decay, (2) any kind of loss of the restoration, (3) fracture of the restoration, (4) tooth fracture and (5) marginal gap reaching dentin or base material. For statistical analysis, SPSS 12.0 was used. The survival rate was 94.7% (12 failures) after five years and 85.7% (23 failures) after 10 years. The results of the current study show that the survival rate of Cerec 1 restorations, as applied in this study, are comparable with the survival rates of cast gold restorations.

OBJECTIVES Professional tooth cleaning (PTC) may lead to loss of exposed dentin. The aim of the present study was to determine the absolute loss of dentin during PTC using various product combinations with an in vitro model. MATERIAL AND METHODS Dentin specimens (72) were randomly assigned to nine groups. In four groups each, prophy brushes and prophy cups were used in combination with four different abrasives (calcium pyrophosphate, pumice, Hawe cleanic, Nupro coarse). In the ninth group, a rubber cup with embedded fluoride and abrasives was used (pasteless prophy cup). The treatment time was 37 s. Surface loss was determined by profilometry. RESULTS The surface loss in the nine groups was as following: (1) brush/calcium pyrophosphate: 6.18 microm (a); (2) brush/pumice: 5.51 microm; (3) brush/Nupro coarse: 10.10 microm (b); (4) brush/Hawe cleanic: 1.88 (a, b); (5) prophy cup/calcium pyrophosphate 2.07 (c); (6) prophy cup/pumice: 6.07 microm; (7) prophy cup/Nupro coarse: 5.93 microm (c); (8) prophy cup/Hawe cleanic: 4.93 microm (c); (9) pasteless prophy cup: 11.86 microm (c). Groups with the same letter in parentheses are statistically significant different at p<0.05. In a pooled analysis, no statistically significant difference between brushes and prophy cups was found. CONCLUSION In the present study, the surface loss of about eight PTC procedures was simulated. Hence, the dentin loss ranged between 0.24 and 1.48 microm per PTC. Therefore, PTC does not seem to be a main factor in dentin loss.

Purpose: The quality of fillings consisting of a hybrid composite was compared with fillings consisting of two different microfilled composites in a clinical examination.Material and Methods: Within the design of a clinically controlled two-year study conducted under practice-relevant conditions, the composites C-Fill MH (Megadenta), Helio Progress (Vivadent), and Visio-Dispers (ESPE) were examined in anterior-tooth cavities in 134 patients by means of the split-mouth technique. The clinical examinations were performed based on modified Ryge criteria (marginal integrity, anatomical form, secondary caries, color, marginal discoloration, surface roughness) after 12 and 24 months.Results: Immediately following filling application, all evaluation criteria except color were assessed as level A. After 12 and 24 months, C-Fill MH was found to be significantly superior to the other materials with regard to marginal integrity, color, and marginal discoloration.Conclusion: The hybrid composite C-Fill MH seems to be superior to the microfilled composites and should therefore be preferred as a restorative filling material.

The aim of this study was to determine the relationship between histologic and radiologic signs of inflammation in human root-filled teeth. In addition, other factors with possible importance for apical inflammation were assessed. Fifty-three block sections of root-filled teeth were gathered from human cadavers. The blocks were radiographically exposed, sectioned, and stained with hematoxylin and eosin. Histologic sections were categorized as inflamed or uninflamed. Radiographically, the roots were assigned as apical lucency, widened periodontal ligament (PDL), or no lucency. Presence and contents of accessory canals were recorded (empty, tissue, or filling material). Statistical analysis was performed with the Chi-square test. All roots had accessory canals; 12 showed tissue remnants, and the others were empty. Of the cases, 49% were histologically uninflamed at the apex, and 52% appeared radiographically intact. The odds ratio of finding a histologically inflamed apex with radiologic lucency versus a radiographically intact apex was 9.2 (p = 0.002). The odds ratio of finding a histologically uninflamed apex with a radiologically tight coronal seal versus an unacceptable seal was 3.7 (p = 0.053). It may be concluded that there are relationships between radiologic and histologic signs of inflammation in human root canal-treated teeth. There appears to be a tendency that the radiologically determined quality of the coronal seal has an impact on the histologic state of the root-filled tooth. No relationship was detected between unfilled lateral or accessory canals and the status of inflammation at the periapex (51% inflamed, 49% uninflamed).

Die Karies bei zwölfjährigen Kindern ist in Deutschland in der vergangenen Dekade um 70 % zurückgegangen. Verschiedene Formen der Prävention, nämlich die Kollektivprophylaxe mit fluoridiertem Speisesalz, die Gruppenprophylaxe in Schulen und Kindergärten und die Individualprophylaxe in Zahnarztpraxen haben zu diesem Erfolg beigetragen. Hiervon ist die Kollektivprophylaxe grundsätzlich am effektivsten und effizientesten. Sie erreicht im Idealfall alle Einwohner und ist außerdem sehr wirtschaftlich. Für die Kollektivprophylaxe mit Fluoridsalz wird ein Kosten-Nutzen-Quotient zwischen 25 und 80 angegeben, d. h. für einen für die Prävention ausgegebenen Euro werden zwischen 25 und 80 Euro in der Therapie gespart. Leider reicht dieser kollektive Ansatz zur weit gehenden Eindämmung der Karies allein nicht aus und in der Parodontitisprophylaxe ist er sogar wirkungslos. Also müssen zusätzlich Maßnahmen der Gruppen- und Individualprophylaxe Anwendung finden. Der Kosten-Nutzen-Quotient der Gruppenprophylaxe liegt zwischen 2,4 und 19,5 und für die Individualprophylaxe zwischen 0,7 und 2,1. Neben der besseren Effizienz hat die Gruppenprophylaxe auch den Vorteil, dass sie die Zielgruppe besser erreicht, weil sie aufsuchend angelegt ist, während Individualprophylaxe aktiv in Praxen nachgefragt werden muss. Also ist, wenn immer möglich, der Gruppenprophylaxe Priorität einzuräumen. Das muss keineswegs auf das Kindes- und Jugendalter beschränkt bleiben, denn auch Senioren sind häufig in Gruppen erreichbar. In Deutschland leben ca. 950 000 Menschen in Einrichtungen der stationären Altenhilfe. Hinzu kommen ca. 570 000 Personen, die in Pflegeheimen leben. Diese Personengruppe leidet häufig unter erheblichen oralen Gesundheitsproblemen wie Karies, Parodontitis und Mundschleimhauterkrankungen. Angesichts des zunehmenden Anteils älterer Menschen in unserer Gesellschaft erscheint Gruppenprophylaxe für Senioren ein wichtiges gesundheitspolitisches Ziel.

In Germany, caries in 12-year olds have declined by 70 % in the last decade. This was the result of a variety of preventive measures such as salt fluoridation, group related prevention in schools and kindergartens, and individualized preventive measures offered in dental offices. On a national scale, salt fluoridation seems to be the measure with the highest efficacy and efficiency. Firstly, it has the potential to reach the entire population, and secondly it is highly cost-effective. The cost-benefit ratio for salt fluoridation ranges from 25 to 80, e. g. for one Euro spent on prevention, 25 to 80 Euro can be saved in therapy. However, salt fluoridation alone cannot stop caries, and it is not at all effective in preventing gingivitis and periodontitis. Therefore, additional measures have to be taken. The cost-benefit ratio for group-related prevention ranges from 2.4 to 19.5 and for individualized prevention from 0.7 to 2.1. Besides the better cost-effectiveness, group-related prevention has the advantage of advanced target group attainment. For example, it is easy to reach children in schools whereas it is difficult to review them in a dental office. Therefore, group related-prevention should have priority. This should not be restricted to children and adolescents, seniors can also be attended in groups. In Germany, about 950,000 people live in old people's homes, and additionally about 570,000 people in nursing homes. This population often suffers from severe oral health problems such as caries, periodontitis, and diseases involving the mucosa. Taking into account that the number of elderly institutionalized people is increasing in Germany, the establishment of group-related prevention for this part of the population seems to be an important goal in health policy.

Rubber cups in combination with prophylaxis pastes are commonly used for supragingival professional tooth cleaning. This procedure requires frequent interruption in order to collect fresh paste. Moreover, the paste-saliva slurry blurs the visibility, which implies intermittent rinsing to look for residual discolorations. Hawe Neos Dental (Bioggio, Switzerland) has developed a new prophylaxis cup aimed at cleaning and smoothing the tooth surfaces, while simultaneously fluoridating the enamel without a prophylaxis paste. This new prophylaxis cup was tested with respect to cleaning efficiency, resulting surface roughness, abrasivity, and the promotion of fluoride uptake into enamel. After 15 seconds of use, the new cup showed a cleaning efficiency which was 20 to 30% higher than that of a conventional rubber cup (p < 0.01) used with the prophylaxis pastes Nupro coarse or Hawe cleanic (78% vs. 57 and 49%). The fluoride cup had a smoothing effect on the enamel surface comparable to that effected by the two prophylaxis pastes. The abrasivity on enamel was lowest with the new cup. On dentin, abrasivity was comparable to Nupro coarse, but higher than with Hawe cleanic. The fluoride cup also produced a higher amount of KOH-soluble fluoride on the enamel surface when compared to Hawe cleanic. With respect to the structurally bound fluoride, no difference was found. The newly developed fluoride releasing Hawe Neos cup represents an effective alternative to conventional procedures for supragingival professional tooth cleaning on enamel.

Micro-organisms and lipopolysaccharides (LPS) are involved in inducing periapical inflammation. Therefore, it is important to eliminate them from the complex root canal system and seal the endodontic space as accurately as possible. This is possible with a combination of the following: instrumentation of the canal, eventually with new, motor driven instruments, abundant rinsing with NaOCl, dressing preferably with Ca(OH)2, sealing the root canal and incorporating the permanent restoration within three months after root canal filling to avoid reinfection.

The preparation of dental hard tissues is carried out primarily with rotating instruments and is known to have some shortcomings. Kinetic cavity preparation (KCP) seems to be a desirable alternative. Nevertheless, scientific investigations and clinical experiences revealed numerous disadvantages which have led to a clear limitation of its use. For example, KCP can not replace the normal conditioning of enamel by acid etching. The hopes connected with the re-introduction of this technology for conservative dentistry have not been fulfilled.

The aim of this study was to determine the antibacterial effectiveness of either chlorhexidine or calcium hydroxide integrated in gutta-percha points compared with chlorhexidine or calcium hydroxide delivered as gel or paste, respectively. A total of 70 initially sterile roots with open accesses were carried for 1 week in the oral cavities of two volunteers. The roots were then removed, and samples were taken from the root canals for microbial analysis. The roots were medicated with calcium hydroxide paste, 5% chlorhexidine gel, or a chlorhexidine- or calcium hydroxide-containing gutta-percha point. The accesses were closed with bonding material, and the roots incubated for 1 week. After removal of the antimicrobial agents, roots were again checked for bacterial growth. One thioglycolate-soaked paper point was then introduced into each canal, and roots were incubated for 1 week more to observe bacterial regrowth. After 1 week of medication, the absolute bacterial count revealed significant differences compared with the controls. However, only the chlorhexidine-gel and the calcium hydroxide paste group showed no microbial colonization in a considerable number of samples after 1 and 2 weeks.

The improvement of dental hygiene is considered to be one of the most important measures in dental health education. Hence, it was the aim of the present study to investigate the influence of two similar preventive programmes on oral hygiene performed in adults and schoolchildren. In the adult study, the oral hygiene indices PI (Quigley-Hein) and API (Lange) could be significantly improved after six months by an individualized preventive programme performed every three months. Besides repeated instructions and motivations in oral hygiene, the programme included professional toothcleaning. In contrast, nine-year old schoolchildren showed no improvement in the oral hygiene indices PI and PBI (Mühlemann and Son) after applying a similar programme over three years. For the PI, even a deterioration from 1.86 at the beginning of the study to 2.65 at the final examination was seen. Other authors were more successful by applying a programme without professional toothcleaning but with inclusion of the parents. It is therefore concluded that children should be educated to oral self-care by including their parents and by taking their status of psychological development into account.

The purpose of the present study was to evaluate the fluoride concentration in unstimulated saliva after using a toothbrush with 9,048 ppm fluoride as sodium fluoride incorporated in the bristles. A toothpaste with 1,500 ppm fluoride served as the positive control. Twelve volunteers took part in the single-blind crossover study. In a pre-test phase of 14 days, the subjects refrained from eating fluoride-rich foods and did not use any fluoride-containing products for oral hygiene measures. This was followed by a test period of four weeks. At day one and after 14 and 28 days, unstimulated saliva was collected and analyzed for its fluoride content. Saliva was collected immediately after toothbrushing and after 15, 30, 60, 90, 120 150, and 180 minutes. On day one, the fluoride toothbrush released significant amounts of fluoride immediately after the brushing, and after 15 and 30 minutes (p < 0.01). After 14 days of use, this could be found immediately after brushing and after 15 minutes (p < 0.01 or p < 0.05, respectively). After 28 days, a significant fluoride release was only found immediately after brushing (p < 0.05). On all days, compared to the positive control, the fluoride release from the fluoride toothbrush was generally lower immediately after brushing and after 15 minutes (p < 0.001, p < 0.01 or p < 0.05, respectively). It may be concluded that a toothbrush with incorporated sodium fluoride could act as a fluoride-releasing. device.

The aim of this study was to examine whether intracanal medication prior to root canal obturation has an inhibitory effect on corono-apical penetration of bacteria. 93 single rooted teeth were instrumented and sterilized with ethylene oxide. They were assigned to three control groups and four test groups with n = 20 each. For one week, they were dressed with different medicaments: The first group with a 5% chlorhexidine gel, the second with Ledermix, the third with a fresh mix of calcium hydroxide and water and the fourth without any medication. After obturation (lateral condensation, AH26) the roots were fixed between a top and a bottom chamber. The top chamber contained 3 mL trypticase soy broth with 10(8) Staphylococcus epidermidis CFU's/mL, whereas the bottom chamber contained sterile trypticase soy broth. For one year, the mounts were incubated at 37 degrees C. They were checked on a regular basis for turbidity in their bottom chambers indicating bacterial growth. None of the test samples leaked for three months. After one year, the calcium hydroxide group had only 6 leaking samples whereas the chlorhexidine group had 14, the Ledermix group 15, and the unmedicated group had 13 leaking samples. It may be concluded that under the conditions of this study, calcium hydroxide was the medicament of choice to avoid bacterial penetration of the root canal. Ledermix did not perform better than no premedication. Chlorhexidine was superior to Ledermix in the second third of the observation period.

One hundred twenty-three pulp cappings had been performed by students in 1984 to 1987 (= 10-yr group) or in 1990 to 1992 (= 5-yr group) and were followed up in 1997. Teeth were checked for sensitivity (CO2/electrical pulp testing), percussion, and palpation; radiographs were taken to assess periapical status. In addition several other factors were determined that might have an influence on the success or failure rates, such as base material, type of restoration, site of exposure, etc. Results showed 44.5% failures (18.5% questionable and 37% successful cases) in the 5-yr group and 79.7% failing, 7.3% questionable, and 13% successful cases in the 10-yr group. As a factor of influence, the placement of a definitive restoration within the first 2 days after pulp exposure was found to contribute significantly to the survival rate of these teeth.

In the present study, the shape of the root canal was assessed with pre- and postinstrumentation silicone impressions. Curved root canals of 30 extracted molars were instrumented with the Canal Leader (CL), the ProFile System (PF), and hand instrumentation (HI). Photographs from each impression were digitized, and the enlargement of the canals was computed by substracting the preinstrumentation from the postinstrumentation images. Technical errors of preparation were also recorded. There was no significant difference in total dentin removal between the systems. However, CL removed significantly more dentin from the convex side of the root canal than PF. Instrument separation occurred in five cases, only with PF. Roughness of canal walls was recorded significantly more often with the use of CL than with PF or HI. CL also produced a significantly higher incidence of elbow formation, compared with PF or HI. With this method of assessment, it was possible to record details and differences between the tested instrumentation techniques.

This study evaluated the influence of air abrasive treatment of dentin surfaces on the tensile bond strength between dentin and two different composite-adhesive-systems (Scotchbond MultiPurpose/Z100 and OptiBond FL/Herculite XR). The crowns of 200 maxillary central incisors were embedded in resin and then ground to expose a dentin surface 5 mm in diameter. The surfaces were etched or abraded by using a KCP 1000 device with different treatment conditions. Adhesive systems were applied according to the manufacturer's instructions and composite cylinders were bonded to the conditioned dentinal surface using a split mold. Tensile bond strength values and failure modes were then determined. Tensile bond strength values of the acid-etched dentin-composite-interface were significantly higher than for the interface between air-abraded dentin and composite, independent of the composite-adhesive-system. used. The fight microscopic evaluation showed mainly adhesive and combined adhesive-cohesive fractures. Significantly more adhesive fractures could be observed between abraded dentin and composite than between etched dentin and composite.

This study was aimed at determining the ability of different coronal temporary fillings to prevent corono-apical penetration of bacteria. A total of 103 human teeth, including three controls, were instrumented, obturated with gutta-percha, coronally sealed with either Cavit, Intermediate Restorative Material (IRM), glass-ionomer cement, Cavit/glassionomer cement, or IRM/glass-ionomer cement, respectively. Each root was fixed with wax between two chambers: the coronal chamber harboring soy broth with 108 colony-forming units of Streptococcus mutans/ml, the apical chamber containing sterile soy broth. The latter was checked daily for turbidity, indicating corono-apical penetration of bacteria. The Cavit group, the IRM group, and the Cavit/glassionomer cement group showed significantly more leakage than the glass-ionomer cement group of the IRM/glass-ionomer cement group. If a sample leaked, all except one (IRM/glass-ionomer cement) leaked before day 12. This in vitro study seems to indicate that only glass-ionomer cement and IRM combined with glass-ionomer cement may prevent bacterial penetration to the periapex of root-filled teeth over a 1-month period.

AIM:The aim of this study was to compare in vitro bacterial and dye leakage tests, commonly used to determine the seal of root canal fillings.METHODOLOGY:Ninety-six single-rooted teeth had their crowns removed at the cemento-enamel junction and their roots instrumented to ISO size 60 within 1 mm of the apex. Three groups of 30 roots were obturated by lateral condensation using gutta-percha and one or other of the sealers. AH26, Ketac Endo, or Roth's 801 sealer. Three roots were used as negative controls and three roots as positive controls. The roots were then exposed at their coronal end first for 38 days to soy broth containing Staphylococcus epidermidis and thereafter for 48 h to basic fuchsin. Bacterial leakage was recorded when the challenging organism could be recovered from the apical end. Dye leakage was checked by microscopy of transverse sections of the apical tip at the end of the experiment.RESULTS:For the bacterial experiment, there was no significant difference amongst the three sealer groups. The dye experiment showed significantly greater leakage in the AH26 compared to the Ketac Endo group. No correlation between the results of the two tests could be seen.CONCLUSIONS:The results of this study suggest that the molecular size of the penetrating agent may not be the relevant parameter when attempting to determine an appropriate test for the sealability of root canal fillings.