The aim of the current study was to develop an application for mobile devices that can improve the organization and documentation of clinical teaching in dental schools. The app should include a calendar to organize treatments, an overview of all treatments including the treatment stages, a digital waiting-list for the teacher’s assessment, and a standardized recording of all assessment results. Students and members of a Medical Faculty and a Faculty of Computer Science and Business Information Systems jointly developed the app. Twenty-three students tested the usability after 4 weeks. Next, the new app was tried and tested by n = 79 forth-year students who used it for 2 months during their clinical course. Fifth-year students of the same clinical course who did not use the app constituted the control group. Afterwards, the app was standard implemented in both integrated clinical courses and evaluated after 1 year by the same students both in winter and summer semester. After usability test, the majority of students (81%, n = 18) said they would recommend the app and gave it a mean overall score of 2.0 ± 0.6. Next, course organization and assessment was evaluated by n = 75 fourth-year students (95%) who used the app and by n = 40 control students (74%) who did not use the app. Students who used the app reported significantly better organization of treatment ( p = .002), documentation of treatment ( p = .001), waiting for the teacher’s assessment ( p = .038), overview of treatment sessions ( p = .040), and transparency of grading and assessment ( p = .012). After 12 months, the now fifth-year students still gave very good ratings for the organization of the treatment and the transparency of the grading in both evaluations, so that no significant changes were detectable (organization p = .959 and the rating p = .751). The newly created app improves the organization and evaluation of clinical education and even after 1 year of service, the students still perceive the consistently high advantages of digitization.

The aim of this study was to investigate the influence of examiner experience on measurements of bone-loss using high-dose (HD) and low-dose (LD) CBCT. Three diagnosticians with varying levels of CBCT interpretation experience measured bone-loss from CBCT scans of three cadaveric heads at 30 sites, conducting measurements twice. Between the first and second measurements, diagnostician 2 and diagnostician 3 received training in LD-CBCT diagnostics. The diagnosticians also classified the certainty of their measurements using a three-grade scale. The accuracy of bone-loss measurements was assessed using the absolute difference between observed and clinical measurements and compared among diagnosticians with different experience levels for both HD and LD-CBCT. At baseline, there was a significant difference in measurement accuracy between diagnostician 1 and diagnostician 2, and between diagnostician 1 and diagnostician 3, but not between diagnostician 2 and diagnostician 3. Training improved the accuracy of both HD-CBCT and LD-CBCT measurements in diagnostician 2, and of LD-CBCT measurements in diagnostician 3. Regarding measurement certainty, there was a significant difference among diagnosticians before training. Training enhanced the certainty for diagnosticians 2 and 3, with a significant improvement noted only for diagnostician 3. Examiner experience level significantly impacts the accuracy and certainty of bone-loss measurements using HD- and LD-CBCT.

Three-dimensional imaging has become an increasingly important component of orthodontics. Associated with this, however, is a higher radiation exposure for patients. New cone-beam computed tomography (CBCT) devices have been developed that can provide low-dose CBCT (LD-CBCT). We hypothesized that LD-CBCT is as precise and reproducible as standard high-dose CBCT (HD-CBCT) in segmenting roots and crowns as well as measuring tooth length. HD-CBCT and LD-CBCT scans were taken of four human cadaveric heads. Thirty single-rooted teeth were segmented twice by one investigator. The length of each tooth was also measured. Lin’s concordance correlation coefficient (CCC) was calculated to assess the agreement of HD-CBCT and LD-CBCT measurements and the intraclass correlation coefficient (ICC) was calculated to assess intrarater reliability. Analyses were supported by Bland–Altman plots. Volume measurements obtained using HD-CBCT were significantly higher than those obtained using LD-CBCT (p < 0.001). CCC was 0.975 (95

Miniscrews offer controlled anchorage and thus optimize tooth movement in orthodontic treatment. Nevertheless, failures such as soft tissue problems, instability due to loosening, partial osseointegration, or even device fracture can occur. While clinical technique can play a role in some of these problems, the manufacturer's design and material choice influence how the implant interacts with the surrounding tissue. In some cases, the design and material may trigger unwanted bone and soft tissue responses. This in vitro study investigates how the implant surface affects cell adhesion and growth of human primary fibroblasts and osteoblasts on commercially available orthodontic TiAl6V4 miniscrews from three producers: tomas-pin SD N 08 (Dentaurum), OrthoEasy Pin (Forestadent), and Dual Top G2 (Promedia, Jeil Medical). Cell-implant interaction at the top, neck, and drilling part of the screws was assessed qualitatively by scanning electron microscopy. While both cell types adhered to and grew on all products, subtle differences in cell shape and spreading were detected, depending on the microstructure of the implant surface. This indicates that cell adhesion to implant surfaces can be controlled by manipulating the machining conditions.

Nanocomposite coatings have garnered significant attention for their potential applications in various fields, including dentistry. These coatings consist of a base matrix, typically a polymer, ceramic, or metal, embedded with nanoparticles that confer enhanced properties do not present in the bulk material. By incorporating nanoparticles into a suitable matrix, these coatings exhibit superior properties including bioactivity, wear resistance, corrosion resistance, antibacterial activity, and drug release capabilities. This review specifically covers the application of nanocomposites as (1) bioactive/osteoconductive coatings, (2) antibacterial/antimicrobial nanocomposite coatings, (3) tribological/corrosion protection nanocomposite coatings, and (4) drug delivery nanocomposite coatings.

ZusammenfassungDie rasante Entwicklung der Informationstechnologie und die fortschreitende Digitalisierung haben in den letzten Jahren den Fachbereich der Kieferorthopädie grundlegend verändert. Durch den Einsatz digitaler Techniken im Bereich der Diagnostik und der Behandlungsplanung eröffnen sich für die Patienten effizientere und präzisere Versorgungsmöglichkeiten [1, 2].Die Etablierung der CAD/CAM (Computer-Aided-Design/ Computer-Aided-Manufacturing)-Technologie hat maßgeblich Einfluss auf den Workflow in der kieferorthopädischen Fachpraxis genommen. Dieser Artikel soll einen Überblick über den derzeitigen digitalen Workflow bei der Herstellung von herausnehmbaren und festsitzenden CAD/CAM-Apparaturen schaffen.

The rapid development of information technology and advancing digitalization have fundamentally changed the field of orthodontics in recent years. The use of digital techniques in the field of diagnostics and treatment planning has opened up more efficient and precise treatment options for patients [1, 2].The establishment of CAD/CAM (computer-aided design/computer-aided manufacturing) technology has had a significant impact on the workflow in orthodontic practices. This article aims to provide an overview of the current digital workflow in the fabrication of removable and fixed CAD/CAM appliances.

PurposePatients with periodontitis, who currently make up a large proportion of the adult population, show high interest in orthodontic therapy. It is therefore important to recognize and assess orthodontic treatment need in these patients. The index of orthodontic treatment (IOTN) is an established tool to determine malocclusions clinically and digitally.Materials and methodsA semi-automatic IOTN-assessment using OnyxCeph3TM was performed on patients undergoing supportive periodontal therapy (SPT). Intra- and inter-rater reliability were investigated using intra-class-coefficient (ICC). Self-perceived aesthetic by patients and perception by the investigator according to the aesthetic component (AC) were compared to both each other and normative need, measured by the dental health component (DHC). Periodontitis stage and grade and the possibility of an orthodontic treatment were determined.ResultsThe mean age of the 64 included patients in this study was 62.1 years (SD +/- 8.6; min-max 45-81) at the time of the examination. Self-related AC was different to the investigator's assessment (ICC: = 0.474; 95%-CI: [0.262, 0.643]). Normative treatment need compared to self-perceived treatment need resulted in poor reliability (ICC: = 0.098; 95%-CI: [-0.071, 0.298]). Comparison of IOTN between investigators showed moderate reliability for AC (ICC: = 0.618; 95%-CI: [0.331, 0.799]) and an excellent reliability for DHC (ICC: = 0.932; 95%-CI: [0.863, 0.967]). AC Intra-rater reliability was considered good (ICC: = 0.796; 95%-CI: [0.613, 0.898]). Orthodontic treatment was possible in 48 of the 64 patients.ConclusionSemi-automated IOTN-assessment showed satisfying inter- and intra-rater reliability, but patients' self-perceived dental aesthetics differed from the dentist's assessment as well as from the normative treatment need.

OBJECTIVE:To investigate the image quality of a low-dose dental imaging protocol in the first clinical photon-counting computed tomography (PCCT) system in comparison to a normal-dose acquisition in a digital volume tomography (DVT) system. MATERIALS AND METHODS:Clinical PCCT systems offer an increased spatial resolution compared to previous generations of clinical systems. Their spatial resolution is in the order of dental DVT systems. Resolution-matched acquisitions of ten porcine jaws were performed in a PCCT (Naeotom Alpha, Siemens Healthineers) and in a DVT (Orthophos XL, Dentsply Sirona). PCCT images were acquired with 90 kV at a dose of 1 mGy CTDI16 cm. DVT used 85 kV at 4 mGy. Image reconstruction was performed using the standard algorithms of each system to a voxel size of 160 × 160 × 200 µm. The dose-normalized contrast-to-noise ratio (CNRD) was measured between dentine and enamel and dentine and bone. Two readers evaluated overall diagnostic quality of images and quality of relevant structures such as root channels and dentine. RESULTS:CNRD is higher in all PCCT acquisitions. CNRD is 37 % higher for the contrast dentine-enamel and 31 % higher for the dentine-bone contrast (p < 0.05). Overall diagnostic image quality was higher for PCCT over DVT (p < 0.02 and p < 0.04 for readers 1 and 2). Quality scores for anatomical structures were higher in PCCT compared to DVT (all p < 0.05). Inter- and intrareader reproducibility were acceptable (all ICC>0.64). CONCLUSIONS:PCCT provides an increased image quality over DVT even at a lower dose level and might enable complex dental imaging protocols in the future. CLINICAL SIGNIFICANCE:The evolution of photon-counting technology and it's optimization will increasingly move dental imaging towards standardized 3D visualizations providing both minimal radiation exposure and high diagnostic accuracy.

Objective: The current study explores whether there is a clinically relevant distinction in the measurement of marginal bone loss when comparing high-dose (HD) versus low-dose (LD) cone beam computed tomography (CBCT) protocols in small and large acquisition volumes. Material and Methods: CBCTs of four human cadaveric preparates were taken in HD and LD mode in two different fields of view 8 × 8 cm2 (LV) and 5 × 5 cm2 (SV). In total, 43 sites of 15 teeth were randomly chosen, and marginal bone loss was measured twice in all protocols at 43 sites of 15 teeth by one calibrated investigator. Bland-Altman plots and Lin’s concordance correlation coefficient (CCC) were calculated to assess the extent of agreement of the measurements. Additionally, the rater scored the certainty in each of the measurements. Results: For HD-CBCT CCC of measurements obtained using SV versus LV was 0.991. CCC of measurements obtained using SV versus LV of LD-CBCT was 0.963. Both CCC values indicated excellent agreement between the two volumes in both protocols. CCC also indicated high intramodality correlation between HD-CBCT and LD-CBCT independent of the acquisition volume (0.963 – 0.992). Bland-Altman plots also indicated no substantial differences. Results of certainty scoring showed significant differences (p = 0.004 (LV), p < 0.001(SV)) between the LD and HD-CBCT. Conclusions: Accuracy of measurements of bone loss shows no clinical noticeable effects depending on the CBCT volume in this ex vivo study. There appears to be no relevant advantage of SV over LV, neither in HD-CBCT nor in LD-CBCT and additionally no relevant advantage of HD versus LD in visualizing marginal bone loss.

Accurate description of buccal bone adjacent to mandibular anterior teeth is helpful for planning and monitoring periodontal and orthodontic treatment. Low-dose cone beam computed tomography (LD-CBCT) imaging has shown promising results for very small dental structures in animals. This study asserts that LD-CBCT is sufficiently accurate to measure buccal alveolar bone adjacent to human mandibular anterior teeth. Buccal bone level adjacent to 16 mandibular anterior teeth from four human cadavers was measured radiographically using one high-dose (HD) CBCT protocol and two LD-CBCT protocols. The resulting radiographic measurements of buccal bone height (bl) and thickness (bt) were compared with reference probe and reflected-light microscopy measurements. Measurement medians and Bland–Altman plots were calculated, and a linear mixed model was used to compare raters and imaging modalities. All regression coefficients were approximately 0, indicating high interrater, intrarater, and intermodality agreement. No significant differences were found between reference measurements and CBCT protocols. The mean differences for bl measurements were 0.07 mm (rater 1 [r1]) and 0.12 mm (rater 2 [r2]) for HD-CBCT; 0.07 mm (r1) and 0.13 mm (r2) for LD-CBCT-1; and 0.02 mm (r1) and 0.01 mm (r2) for LD-CBCT-2. For bt measurements, mean differences were 0.02 mm (r1) and 0.02 mm (r2) for HD-CBCT; 0.01 mm (r1) and 0.01 mm (r2) for LD-CBCT-1; and 0.00 mm (r1) and 0.01 mm (r2) for LD-CBCT-2. Within the limitations of the present study, LD-CBCT seems to be a precise method for describing buccal bone and its thickness adjacent to mandibular anterior teeth in this experimental setting. For the first time, this study showed LD-CBCT produces excellent results and is a reliable modality for imaging buccal bone in vitro. If clinical studies confirm these results, LD-CBCT could enable better treatment planning and monitoring at a radiation dose that is far lower than that of conventional HD-CBCT but similar to that of panoramic views.

Background The aim of the current study was to comparatively assess the efficiency of three different adjunctive therapy options (cold atmospheric plasma, [CAP], photodynamic therapy [PDT] and chemical decontamination via 35% phosphoric acid gel [PAG]) on decontamination of titanium implant surfaces in-vitro. Materials and methods Implants were inserted in concavities of four mm in depth mimicking a bone defect at the implant recipient site. In each model, two implants were inserted in the fourth and one implant in the third quadrants. After contamination with E. faecalis , the first group has been treated with CAP for 3 min, the second group with 35% PAG (and the third group with PDT. After treatment, quantification of bacterial colonization was assessed by quantification via colony forming units and qualitatively by fluorescence microscopy and scanning electron microscopy. Results With a mean value of 1.24 × 10 5 CFU/ml, the CAP treated implants have showed the least microorganisms. The highest number of CFU was found after PDT with mean value of 8.28 × 10 6 CFU/ml. For the implants that were processed with phosphoric acid, a mean value of 3.14 × 10 6 CFU/ml could be detected. When the groups were compared, only the CAP and PDT groups differed significantly from each other ( p = 0.005). Conclusion A complete cleaning of the micro-textured implant surface or the killing of the bacteria could not be achieved by any of the investigated treatment options, thus bacteria in the microstructure of the titanium surface cannot be completely reached by mechanical and physico-chemical processes. Clinical relevance The main goal of the adjunctive peri-implantitis treatment is the decontamination of the implant surface. However, there is still an ongoing need to define the most appropriate adjunctive therapy method. Due to its antimicrobial effects, CAP combined with mechanical debridement could be a feasible treatment modality in the management of peri-implantitis.

During orthodontic tooth movement, mechanically induced remodeling occurs in the alveolar bone due to the action of orthodontic forces. The number of factors identified to be involved in mechanically induced bone remodeling is growing steadily. With the uncovering of the functions of neuronal guidance molecules (NGMs) for skeletal development as well as for bone homeostasis, NGMs are now also among the potentially significant factors for the regulation of bone remodeling during orthodontic tooth movement. This narrative review attempts to summarize the functions of NGMs in bone homeostasis and provides insight into the currently sparse literature on the functions of these molecules during orthodontic tooth movement. Presently, four families of NGMs are known: Netrins, Slits, Semaphorins, ephrins and Eph receptors. A search of electronic databases revealed roles in bone homeostasis for representatives from all four NGM families. Functions during orthodontic tooth movement, however, were only identified for Semaphorins, ephrins and Eph receptors. For these, crucial prerequisites for participation in the regulation of orthodontically induced bone remodeling, such as expression in cells of the periodontal ligament and in the alveolar bone, as well as mechanical inducibility, were shown, which suggests that the importance of NGMs in orthodontic tooth movement may be underappreciated to date and further research might be warranted.

Clinical photon-counting CT (PCCT) offers a spatial resolution of about 200 µm and might allow for acquisitions close to conventional dental CBCTs. In this study, the capabilities of this new system in comparison to dental CBCTs shall be evaluated. All 8 apical osteolysis identified in CBCT were identified by both readers in all three PCCT scan protocols. Mean visibility scores showed statistical significant differences for root canals(p = 0.0001), periodontal space(p = 0.0090), cortical(p = 0.0003) and spongious bone(p = 0.0293) in favor of high and medium dose PCCT acquisitions. Overall, both devices showed excellent image quality of all structures assessed. Interrater-agreement showed high values for all protocols in all structures. Bland–Altman plots revealed a high concordance of both modalities with the reference measurements. In vitro, ultra-high resolution PCCT can reliably identify different diagnostic entities and structures relevant for dental diagnostics similar to conventional dental CBCT with similar radiation dose. Acquisitions of five cadaveric heads were performed in an experimental CT-system containing an ultra-high resolution PC detector (0.25 mm pixel size in isocenter) as well as in a dental CBCT scanner. Acquisitions were performed using dose levels of 8.5 mGy, 38.0 mGy and 66.5 mGy (CTDI16cm) in case of PCCT and of 8.94 mGy (CTDI16cm) in case of CBCT. The quality of delineation of hard tissues, root-canals, periodontal-space as well as apical osteolysis was assessed by two readers. Mean visibility scores and interrater-agreement (overall agreement (%)) were calculated. Vertical bone loss (bl) and thickness (bt) of the buccal bone lamina of 15 lower incisors were measured and compared to reference measurements by ore microscopy and clinical probing.

Different cone beam computed tomography (CBCT) protocols have shown promising results for imaging furcation defects. This study evaluates the suitability of low-dose (LD)-CBCT for this purpose. Fifty-nine furcation defects of nine upper and 16 lower molars in six human cadavers were measured by a high-dose (HD)-CBCT protocol, a LD-CBCT protocol, and a surgical protocol. HD-CBCT and LD-CBCT measurements were made twice by two investigators and were compared with the intrasurgical measurements, which served as the reference. Furcation defect volumes generated from HD-CBCT and LD-CBCT imaging were segmented by one rater. Cohen’s kappa and intraclass correlation coefficient (ICC) values were calculated to determine intra- and interrater reliability. The level of significance was set at α = 0.05. In total, 59 furcation defects of nine upper and 16 lower human molars were assessed. Comparing CBCT furcation defect measurements with surgical measurements revealed a Cohen’s kappa of 0.5975 (HD-and LD-CBCT), indicating moderate agreement. All furcation defects identified by HD-CBCT were also detected by LD-CBCT by both raters, resulting in a Cohen’s kappa of 1. For interrater agreement, linear furcation defect measurements showed an ICC of 0.992 for HD-CBCT and 0.987 for LD-CBCT. The intrarater agreement was 0.994(r1)/0.992(r2) for HD-CBCT and 0.987(r1)/0.991(r2) for LD-CBCT. The intermodality agreement was 0.988(r1)/0.991(r2). Paired t-test showed no significant differences between HD-CBCT and LD-CBCT measurements. LD-CBCT is a precise and reliable method for detecting and measuring furcation defects in mandibular and maxillary molars in this experimental setting. It has the potential to improve treatment planning and treatment monitoring with a far lower radiation dose than conventional HD-CBCT.

Objectives: New CBCT devices have been developed which can provide "low- dose CBCTs (LD- CBCT)". Aim of this study is to investigate the suitability of LD- CBCT for measurement of alveolar buccal/oral bone. Methods and materials: Vestibular and oral bone loss of the teeth of seven porcine mandibles free of soft tissues were investigated by Micro- CT and three CBCT- modes: high- dose (HD), standard- dose (SD) and low- dose (LD). Radiographic measurements of bone loss (bl) and vestibular and oral bone thickness (bt) were made by two raters at 69 sites. Measurement means and differences, Intraclass correlation (ICC) and Bland-Altman plots were calculated. Results: ICCs between raters(r) concerning bl were 0.954 for HD, 0.949 for SD and 0.945 for LD; concerning bt they were 0.872 for HD, 0.845 for SD and 0.783 for LD. Means of differences of bt measurements were -0.01 mm(r1)/0.00 mm(r2) for HD, 0.04 mm(r1)/0.02 mm(r2) for SD and 0.02 mm(r1)/0.04 mm(r2) for LD; for bl measurements they were 0.06 mm(r1)/0.05 mm(r2) for HD, -0.01 mm(r1)/0.13 mm(r2) for SD and 0.07 mm(r1)/0.16 mm(r2) for LD. Linear regression indicates no noticeable differences between methods and the raters with respect to bl and bt. Conclusions Relating to the CBCT- device used in this study, LD- CBCT is a promising method to detect and describe buccal and oral periodontal bl and bt. Further studies with human anatomic structures must confirm these results.