Publications by authors named "Josef Schweiger"

42 Publications

Short communication: In vitro pilot study: Are monolithic 3Y-TZP zirconia crowns too strong for titanium Implants?

Int J Prosthodont 2021 Mar 3. Epub 2021 Mar 3.

Purpose: To report on pilot tests for a planned study on single implant-supported crowns made from different restorative materials using finite element analysis (FEA) and in vitro load-to-failure testing.

Materials And Methods: Within this pilot study, FEA was conducted using Ansys 2019 R2 to simulate stress and deformation for implant-supported crowns made of lithium disilicate ceramic (LiS2) and zirconia (3Y-TZP). Additionally, an in vitro load to failure test was conducted using two specimens per group to evaluate the failure mode and to confirm the findings from the FEA.

Results/conclusion: FEA revealed stress areas at the palatal cervical areas of the crowns. In the load to failure test, both hybrid abutment crowns made of LiS2 fractured (410 N and 510 N) before plastic deformation of the metal implant components occurred. The monolithic hybrid abutment crowns made of 3Y-TZP did not fracture until tests were interrupted at 646-N and 690-N occlusal force, when plastic deformation of the metal implant components was visually observed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11607/ijp.7322DOI Listing
March 2021

Elution behavior of a 3D-printed, milled and conventional resin-based occlusal splint material.

Dent Mater 2021 04 27;37(4):701-710. Epub 2021 Feb 27.

Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Germany; Walther Straub Institute of Pharmacology and Toxicology, Faculty of Medicine, LMU Munich, Germany.

Objective: The elution of unpolymerized (co-)monomers and additives from methacrylic resin-based materials like polymethyl methacrylate (PMMA) can cause adverse side effects, such as mutagenicity, teratogenicity, genotoxicity, cytotoxicity and estrogenic activity. The aim of this study was to quantify the release and the cytotoxicity of residual (co-)monomers and additives from PMMA-based splint materials under consideration of real splint sizes. Three different materials used for additive (3D printing), subtractive (milling) and conventional (powder and liquid) manufacturing were examined.

Methods: The splint materials SHERAprint-ortho plus (additive), SHERAeco-disc PM20 (subtractive) and SHERAORTHOMER (conventional) were analysed. 16 (n = 4) sample discs of each material (6 mm diameter and 2 mm height) were polished on the circular and one cross-section area and then eluted in both distilled water and methanol. The discs were incubated at 37 °C for 24 h or 72 h and subsequently analysed by gas chromatography/mass spectrometry (GC/MS) for specifying and quantifying released compounds. XTT-based cell viability assays with human gingival fibroblasts (HGFs) were performed for Tetrahydrofurfuryl methacrylate (THFMA), 1,4-Butylene glycol dimethacrylate (BDDMA) and Tripropylenglycol diacrylate (TPGDA). In order to project the disc size to actual splint sizes in a worst-case scenario, lower and upper jaw occlusal splints were designed and volumes and surfaces were measured.

Results: For SHERAeco-disc PM20 and for SHERAORTHOMER no elution was determined in water. SHERAprint-ortho plus eluted the highest THFMA concentration of 7.47 μmol/l ±2,77 μmol/l after 72 h in water. Six (co-)monomers and five additives were detected in the methanol eluates of all three materials tested. The XTT-based cell viability assays resulted in a EC of 3006 ± 408 μmol/l for THFMA, 2569.5 ± 308 μmol/l for BDDMA and 596.7 ± 88 μmol/l for TPGDA.

Significance: With the solvent methanol, released components from the investigated splint materials exceeded cytotoxic concentrations in HGFs calculated for a worst-case scenario in splint size. In the water eluates only the methacrylate THFMA could be determined from SHERAprint-ortho plus in concentrations below cytotoxic levels in HGFs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dental.2021.01.024DOI Listing
April 2021

Magnetic resonance imaging based computer-guided dental implant surgery-A clinical pilot study.

Clin Implant Dent Relat Res 2020 Oct 9;22(5):612-621. Epub 2020 Sep 9.

Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.

Background: Computer-guided implant surgery is currently based on radiographic techniques exposing patients to ionizing radiation.

Purpose: To assess, whether computer-assisted 3D implant planning with template-guided placement of dental implants based on magnetic resonance imaging (MRI) is feasible.

Materials And Methods: 3-Tesla MRI was performed in 12 subjects as a basis for prosthetically driven virtual planning and subsequent guided implant surgery. To evaluate the transferability of the virtually planned implant position, deviations between virtually planned and resulting implant position were studied. Matching of occlusal surfaces was assessed by comparing surface scans with MRI-derived images. In addition, the overall image quality and the ability of depicting anatomically important structures were rated.

Results: MRI-based guided implant surgery with subsequent prosthetic treatment was successfully performed in nine patients. Mean deviations between virtually planned and resulting implant position (error at entry point 0.8 ± 0.3 mm, error at apex 1.2 ± 0.6 mm, angular deviation 4.9 ± 3.6°), mean deviation of occlusal surfaces between surface scans and MRI-based tooth reconstructions (mean 0.254 ± 0.026 mm) as well as visualization of important anatomical structures were acceptable for clinical application.

Conclusion: Magnetic resonance imaging (MRI) based computer-assisted implant surgery is a feasible and accurate procedure that avoids exposure to ionizing radiation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cid.12939DOI Listing
October 2020

Double crown rescue concept: clinical and dental technical workflow.

Int J Comput Dent 2020 ;23(3):281-292

For decades, double crowns in different variations have proven to be reliable attachments in removable prosthetics. Supported by teeth and implants, they provide proper retention, a considerable degree of chewing comfort, and satisfying esthetics. A wide range of applications, optimal oral hygiene capabilities, and almost unlimited expandability are just some of the advantages of double crown anchored dentures. Among other things, abutment tooth loss is a frequent complication. If an abutment tooth is lost, the secondary crown is usually filled with resin and the denture can continue to be used. However, since the loss of one or more abutment teeth changes biomechanical load ratios, a decline in stability and comfort is likely to occur as well as overloading of the remaining abutment teeth. The concept presented in this article provides for the application of computer-assisted technologies that enable the preservation of the denture according to its original design. For this purpose, a lost or hopelessly decayed tooth is replaced with an implant using digital preplanning and guided implant surgery. The original primary crown is then reattached in its exact former position applying a CAD/CAM-fabricated meso-abutment. In effect, the number of abutment teeth can be preserved, the functionality of the denture maintained with reasonable effort, and further damage prevented.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2020

Fixed or adjustable sling in the treatment of male stress urinary incontinence: results from a large cohort study.

Transl Androl Urol 2020 Jun;9(3):1099-1107

Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany.

Background: Fixed and adjustable male slings for the treatment of male urinary stress incontinence became increasingly popular during the last decade. Although fixed slings are recommended for the treatment of mild to moderate stress urinary incontinence, there is still a lack of evidence regarding the precise indication for an adjustable male sling. Furthermore, there is still no evidence that one type of male sling is superior to another. However, both, adjustable and fixed slings, are commonly utilized in daily clinical practice. This current investigation aims to evaluate the differences between fixed and adjustable male slings regarding indications, complication rates and functional outcome in the treatment of male stress urinary incontinence in current clinical practice.

Methods: A total of 294 patients with a fixed and 176 patients with an adjustable male sling were evaluated in a multicenter single arm cohort trial. Data collection was performed retrospectively according the medical record. Functional outcome was prospectively analyzed by standardized, validated questionnaires. Descriptive statistics was performed to present patient characteristics, complication rates and functional outcome. A chi2-test for categorical and independent t-test for continuous variables was performed to identify heterogeneity between the groups and to correlate preoperative characteristics with the outcome. A P value <0.05 was considered statistically significant.

Results: Patients with higher degree of urinary incontinence (P<0.001) and risk factors such as history of pelvic irradiation (P<0.001) or prior surgery for urethral stricture (P=0.032) were more likely to receive an adjustable MS. Complication rates were comparable except for infection (P=0.009, 0 2.3%) and pain (P=0.001, 1.7% 11.3%) which occurred more frequently in adjustable slings. Functional outcome according validated questionnaires demonstrated no differences between fixed and adjustable male slings.

Conclusions: Adjustable male slings are more frequently utilized in patients with higher degree of incontinence and risk factors compared to fixed slings. No differences could be identified between functional outcome which may imply an advantage for adjustability. However, pain and infection rates were significantly higher in adjustable MS and should be considered in the decision process for sling type.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/tau-19-852DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354336PMC
June 2020

High/low-volume center experience predicts outcome of AMS 800 in male stress incontinence: Results of a large middle European multicenter case series.

Neurourol Urodyn 2020 08 22;39(6):1856-1861. Epub 2020 Jun 22.

Department of Urology and Pediatric Urology, University Hospital Munster, Munster, Germany.

Aim: To analyze the influence of implantation volume of artificial sphincters (AMS 800) on outcome in a large central European multicenter cohort study.

Methods: As part of the DOMINO (Debates on Male Incontinence) project, the surgical procedures and outcomes were retrospectively analyzed in a total of 473 patients who received an artificial sphincter (AMS 800) between 2010 and 2012. Clinics that implanted at least 10 AMS 800 per year were defined as high-volume centers.

Results: Sixteen centers had a mean rate of 9.54 AMS 800/y of which five clinics were identified as high-volume centers. They implanted significantly more double cuffs (55% vs 12.1%; P < .001), used the perineal approach significantly more often (78% vs 67.7%; P = .003) and chose larger mean cuff sizes (4.63 cm vs 4.42 cm; P = .002). With a mean follow-up of 18 months, the revision rate was significantly higher at low-volume centers (38.5% vs 26.7%; P = .037), urethral erosion being the main reason for revision. Social continence (0-1 pads/24 h) was achieved significantly more often in high-volume centers (45.5% vs 24.2%; P = .002).

Conclusions: Our study showed significantly better continence results and lower revision rates at high-volume centers, confirming earlier results that are still true in this decade. We, therefore, recommend surgery for male incontinence at qualified centers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/nau.24444DOI Listing
August 2020

In vivo wear of CAD-CAM composite versus lithium disilicate full coverage first-molar restorations: a pilot study over 2 years.

Clin Oral Investig 2020 Dec 12;24(12):4301-4311. Epub 2020 May 12.

Department of Prosthetic Dentistry, University Hospital, LMU Munich, Goethestrasse 70, 80336, Munich, Germany.

Objectives: To present a digital approach to measure and compare material wear behavior of antagonistic first molar restorations made of an experimental CAD/CAM composite (COMP) and lithium disilicate ceramic (LS2) in patients with reconstructed vertical dimension of occlusion (VDO) after generalized hard tissue loss.

Methods: A total of 12 patients underwent complete full jaw rehabilitation with full occlusal coverage restorations made either of COMP or LS2. The first molar restorations (n = 48) were chosen for wear examination. At annual recall appointments, polyether impressions were taken, and resulting plaster casts were digitalized using a laboratory scanner. Mean observation period was 371 days for first and 769 days for second year. The resulting 96 datasets were analyzed by superimposition of 3-D datasets using an iterative best-fit method. Based on the superimposition data, the wear rates of the occlusal contact areas (OCAs) were calculated.

Results: For antagonistic restorations made of COMP, the average wear rate was 24.8 ± 13.3 μm/month, while for LS2, it was 9.5 ± 4.3 μm/month in first year, with significant differences (p < 0.0001) between the materials. In second year, monthly wear rates decreased significantly for both materials: COMP (16.2 ± 10.7 μm/month) and LS2 (5.5 ± 3.3 μm/month). Statistical comparison between wear time showed significant differences for both materials: COMP p < 0.037 and LS2 p < 0.001. A logarithmic fit (COMP R = 0.081; LS2 R = 0.038) of the data was calculated to estimate the wear progression.

Significance: In patients with reconstructed VDO, restorations made of LS2 show a more stable wear behavior than ones out of experimental CAD/CAM composite. In cases of complete rehabilitation, load bearing CAD/CAM-composite restorations should be critically considered for application due to their occlusal wear behavior. However, when choosing a restorative material, not only the functional occlusal stability should be taken into account but also the prospect of minimally invasive treatment with maximum preservation of natural tooth structures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00784-020-03294-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666668PMC
December 2020

Reproducibility of a magnet-based jaw motion analysis system.

Int J Comput Dent 2020 ;23(1):39-48

Background: The Dental Motion Decoder system (DMS-System) is a medical device based on magnetic field technology that records mandible movements. The data can be used to program an articulator or can be directly processed over a computer-aided design (CAD) interface. The present study aimed to assess the reproducibility of this system in vitro and in vivo.

Material And Methods: Protrusive and laterotrusive movements were simulated in vitro using an articulator (SAM SE) (Group M) and in vivo (Group P) on one test individual. Measurements were carried out in two ways: 1) Measurements were taken after initializing and referencing the system using the reference points (RPs) once, followed by 30 protrusive and laterotrusive movements (M1 and P1); and 2) Thirty individual measurements were recorded using the RPs before each measurement (M2 and P2). Values for the sagittal condylar path inclination angle (sCPIA) and the Bennett angle (BA) were exported and analyzed. The reproducibility of the system was evaluated using the standard deviations (SDs) of the measurement series (sCPIA and BA for M1, M2, P1, and P2).

Results: In vitro tests M1 (SD: sCPIA = 0.08 degrees; BA = 0.06 degrees) and M2 (SD: sCPIA = 0.26 degrees; BA = 0.11 degrees) showed significantly higher reproducibility (P < 0.001) compared with the in vivo measurements P1 (SD: sCPIA = 0.61 degrees; BA = 0.45 degrees) and P2 (SD: sCPIA = 1.4 degrees; BA = 0.65 degrees).

Conclusion: Within the limitations of the present study, the deviation in vitro, representing the reproducibility of the DMD-System, is smaller than the biologic variance observed in vivo. Therefore, reliable measurements under clinical conditions can be assumed.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2020

Internal porosities, retentive force, and survival of cobalt-chromium alloy clasps fabricated by selective laser-sintering.

J Prosthodont Res 2020 Apr 1;64(2):210-216. Epub 2019 Nov 1.

Department of Prosthetic Dentistry, University Hospital, LMU Munich, Germany.

Purpose: The purpose of this study was to evaluate internal porosities, retentive force values and survival of cobalt-chromium (Co-Cr) alloy clasps fabricated by direct metal laser-sintering (DMLS) and compare them to conventionally cast clasps.

Methods: Embrasure clasps were digitally designed fitting teeth 35 and 36 on identical metal models (N = 32). Sixteen clasps were fabricated using DMLS (group DMLS) and another sixteen clasps were additively manufactured from wax and then cast from a Co-Cr alloy (group CAST). Internal porosities were examined using micro-focus X-ray (micro-CT) and analyzed applying Kolmogorov-Smirnov test, Mann-Whitney test, and T test (significance level: p < 0.050). A universal testing machine was used to determine the retentive force values at baseline and after 1095, 5475, 10,950 and 65,000 cycles of simulated aging. Data were analyzed employing Kolmogorov-Smirnov test, one-way ANOVA, and Scheffé's post-hoc test (significance level: p < 0.050). Survival was estimated for 65,000 cycles of artificial aging using Kaplan-Meier analysis.

Results: Micro-CT analysis revealed a higher prevalence (p < 0.001), but a more homogeneous size and a significantly smaller mean (p = 0.009) and total volume (p < 0.001) of internal porosities for group DMLS. The groups showed mean initial retentive force values of 13.57 N (CAST) and 15.74 N (DMLS), which significantly declined over aging for group CAST (p = 0.003), but not for group DMLS (p = 0.107). Survival was considerably higher for group DMLS (93.8%) than for group CAST (43.8%) after 65,000 cycles of aging.

Conclusions: Clasps made by laser-sintering could be an alternative to conventional cast clasps for the fabrication of removable partial denture frameworks.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpor.2019.07.006DOI Listing
April 2020

Digital Tissue Preservation Concept: A Workflow for Guided Immediate Implant Placement and Restoration.

J Prosthodont 2019 Jul 7;28(6):613-617. Epub 2019 Jun 7.

Department of Prosthetic Dentistry, University Hospital, LMU Munich, Germany.

The digital workflow presented here allows for fabrication and placement of a definitive custom abutment at the time of tooth extraction and guided immediate implant placement, thus preserving soft tissue anatomy. Since abutment design was based on the shape of the original tooth, it represented a de facto emergence-analog that provided ideal soft tissue support. The approach of superposing and merging of custom abutment design data with data captured intraorally after abutment placement enabled a digital impression without gingival displacement and associated trauma. The generated data facilitated the fabrication of a precisely fitting restoration concurrent with the implant healing period.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jopr.13089DOI Listing
July 2019

Advances in materials and concepts in fixed prosthodontics: a selection of possible treatment modalities.

Br Dent J 2019 May;226(10):739-748

Associate Professor, Department of Prosthetic Dentistry, University Hospital, LMU, Munich, Germany.

The introduction of adhesive techniques in combination with translucent restorative materials has greatly influenced treatment concepts in fixed prosthodontics. Modern production technologies offer access to new polymer materials that provide innovative pre-treatment options for complex prosthetic rehabilitations. Additionally, computer-aided design and manufacturing (CAD/CAM) provides access to new ceramic types and thus extends the range of indications for metal-free restorative options. With these developments, important changes of treatment concepts in fixed prosthodontics have occurred which affect the professional life of dental practitioners with a focus on prosthetic dentistry. This article gives an overview of the advances in selected fields of fixed prosthodontics and provides support in material selection for different kinds of indications, from single-tooth restorations to fixed dental prostheses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41415-019-0265-zDOI Listing
May 2019

Metal-free implant-supported single-tooth restorations. Part II: Hybrid abutment crowns and material selection.

Quintessence Int 2019 ;50(4):260-269

In many areas of restorative dentistry, metal-free materials offer an alternative to metal-based restorations while ensuring high levels of biocompatibility and esthetics. Rapidly evolving CAD/CAM technology has significantly expanded the range of materials available, providing access to materials classes and their combinations not previously available within conventional manufacturing, such as zirconia ceramics and hybrid ceramics. In addition, digital methods offer previously unavailable options in diagnostics, greater planning reliability, better material quality through standardization of the manufacturing process, and reproducibility - significant benefits that can be used to advantage, especially in oral implantology. Even though technological progress in the field of metal-free materials has given rise to considerable improvements in their mechanical properties over the decades, their clinical long-term success is still very much dependent on an appropriate indication and proper material selection, on the knowledge and skills of the dental practitioner and dental technician, and on an adequate occlusion concept. The high rate of innovation - both with regard to the materials themselves and to CAD/CAM technology - therefore requires an adequate level of prior knowledge to sensibly and successfully implement the wide range of possibilities. It is becoming more and more puzzling for users to find their way around the many different new techniques and materials. This review article provides an up-to-date overview of the possibilities and limitations of metal-free implant-supported single-tooth restorations. This second part discusses hybrid abutment crowns and materials selection. Resultant treatment concepts are presented and evaluated based on clinical examples.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3290/j.qi.a42099DOI Listing
November 2019

Metal-free implant-supported single-tooth restorations. Part I: Abutments and cemented crowns.

Quintessence Int 2019 ;50(3):176-184

In many areas of restorative dentistry, metal-free materials offer an alternative to metal-based restorations while ensuring high levels of biocompatibility and esthetics. Rapidly evolving CAD/CAM technology has significantly expanded the range of materials available, providing access to materials classes and their combinations not previously available within conventional manufacturing, such as zirconia ceramics and hybrid ceramics. In addition, digital methods offer previously unavailable options in diagnostics, greater planning reliability, better material quality through standardization of the manufacturing process, and reproducibility - significant benefits that can be used to advantage, especially in oral implantology. Even though technological progress in the field of metal-free materials has given rise to considerable improvements in their mechanical properties over the decades, their clinical long-term success is still very much dependent on an appropriate indication and proper material selection, on the knowledge and skills of the dental practitioner and dental technician, and on an adequate occlusion concept. The high rate of innovation - both with regard to the materials themselves and to CAD/CAM technology - therefore requires an adequate level of prior knowledge to sensibly and successfully implement the wide range of possibilities now open. It is becoming more and more puzzling for users to find their way around the many different new techniques and materials. This review article provides an up-to-date overview of the possibilities and limitations of metal-free implant-supported single-tooth restorations. This first part discusses abutments and cemented crowns. Resultant treatment concepts are presented and evaluated based on clinical examples.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3290/j.qi.a41906DOI Listing
November 2019

Interdisciplinary full-mouth rehabilitation for redefining esthetics, function, and orofacial harmony.

J Esthet Restor Dent 2019 05 4;31(3):179-189. Epub 2019 Jan 4.

Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany.

Objective: In severe congenital or acquired orofacial anomalies, both dental esthetics and function are usually compromised. In particular, the esthetic ideas of the final desired appearance may differ from patient to patient, as the human esthetic sensibility differs significantly. Especially in complex cases, digital technology today offers outstanding improvements and simplifications in craniomaxillofacial surgical and prosthetic treatments, leading to a wide range of planning and pretreatment options.

Clinical Considerations: This case report describes a patient-oriented interdisciplinary craniomaxillofacial surgical and prosthetic treatment with noninvasive tooth-colored splints, a Le Fort I osteotomy, and a full-mouth rehabilitation to meet the patient's demand for better function as well as orofacial esthetics and harmony.

Conclusions: By means of the digitally planned Le Fort I intervention and completion of the prosthetic rehabilitation, it was possible to optimize esthetics and facial harmony.

Clinical Significance: In complex cases, digital technology today offers outstanding improvements and simplifications in craniomaxillofacial surgery and prosthetic treatments, leading to a wide range of planning and pretreatment options. Computer-aided design/computer-aided manufacturing technology enables the fabrication of tooth-colored flexible polycarbonate splints that offer a noninvasive, removable, functional, and esthetic solution. In intricate cases involving craniomaxillofacial anomalies, often together with necessary orofacial surgeries or prosthetic treatments due to moderate to severe tooth wear, such digital preprosthetic treatment and planning options represent an important enhancement with more predictable results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jerd.12455DOI Listing
May 2019

Computable translucency as a function of thickness in a multi-layered zirconia.

J Prosthet Dent 2019 Apr 4;121(4):683-689. Epub 2018 Dec 4.

CDT, Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany.

Statement Of Problem: Determining the relationship between variable thicknesses and the translucency of dental ceramics is essential for optimizing esthetics in different clinical situations.

Purpose: The purpose of this in vitro study was to analyze the relationship between layer thickness and translucency of 2 multi-layered monolithic zirconia materials and to develop an equation by which the grade of translucency can be calculated dependent on the materials' layer thicknesses in advance.

Material And Methods: Two semisintered multi-layered zirconia blanks, namely KATANA Zirconia Super Translucent Multi-Layered Disk (Noritake Dental Supply Co, Ltd) and Zirconia Ultra Translucent Multi-Layered Disk (UTML) (Noritake Dental Supply Co, Ltd), were sectioned (N=96) to separate the 4 layers (n=12 per layer): enamel layer, transition layer 1, transition layer 2, body layer. All specimens were sintered in a furnace (M2 Plus; Thermo-Star) at 1500°C for 2 hours and automatically polished under water cooling up to P2400 for the thicknesses of 1.6, 1.3, 1.0, 0.7, and 0.4 mm. Transmittance of visible light was measured using a spectrophotometer (Lambda 35; Perkin Elmer). Data were analyzed using the Kolmogorov-Smirnov, 2-way ANOVA, and Scheffé post hoc tests (α=.01) and curve fitting.

Results: Analyzing the fitting of the values of the 8 material groups to the linear, exponential, and logarithmic curves, 7 of the 8 groups (not UTML body layer) fitted the most (R-square value closer to 1.0) to the logarithmic curve. Constants were obtained from the distance to the x-axis and the curvature.

Conclusions: The methodology of this study provided the materials' specific constants a and b by analyzing the translucency behavior of KATANA Super Translucent Multi-Layered Disk and Ultra Translucent Multi-Layered Disk in different thicknesses, allowing further translucency calculation by applying the developed formula and the constants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.prosdent.2018.08.013DOI Listing
April 2019

Temporary Single Palatal Implant for Denture Stabilization During Augmentation and Implant Procedure: A Case Report.

Int J Periodontics Restorative Dent 2018 Nov/Dec;38(6):e105-e111

This case report introduces a temporary denture with reduced extension stabilized in the edentulous maxilla as a possible treatment method for patients with a severe gag reflex, allowing them to test the function, esthetics, and tolerance of the denture prior to hard tissue augmentation and implant placement. A 4-mm implant was placed in the central anterior palate and allowed to heal for 3 months. During the complete treatment period, a denture with reduced extension can be delivered on a fixed Locator abutment. This method was successfully applied in three patients, and the palatal implant remained stable until the final removable prosthesis could be delivered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11607/prd.3600DOI Listing
April 2019

Retentive force of PEEK secondary crowns on zirconia primary crowns over time.

Clin Oral Investig 2019 May 6;23(5):2331-2338. Epub 2018 Oct 6.

Department of Prosthetic Dentistry, University Hospital, LMU Munich, Goethestraße 70, 80336, Munich, Germany.

Objectives: The purpose of the present study was to evaluate the retentive forces of CAD/CAM-fabricated polyetheretherketone (PEEK) secondary crowns on zirconia primary crowns over an artificial aging period representing 10 years of clinical service and compare them to electroformed secondary crowns made from pure gold.

Material And Methods: Implant-supported zirconia primary crowns (N = 20) were CAD/CAM milled and provided either with electroformed secondary crowns (group ZE; N = 10) or CAD/CAM-fabricated PEEK secondary crowns (group ZP; N = 10). All secondary crowns were attached to a casted tertiary structure to ensure adequate stability. A universal testing machine was used to determine the retentive force values at baseline and after 1, 3, 5, and 10 years of simulated aging in the presence of artificial saliva. Data were analyzed applying Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U test. Level of significance was set at p < 0.05.

Results: Retentive forces were not different for the groups ZE and ZP at baseline (median ZE 2.85 N; ZP 2.8 N; p ≤ 0.218). Because retentive force values changed significantly over simulation time for group ZE (Kruskal-Wallis; p ≤ 0.028), the values between the test groups ZE and ZP differed significantly (Mann-Whitney U) at 5 years (ZE 3.03 N; ZP 2.76 N; p ≤ 0.003) and 10 years (ZE 3.1 N; ZP 2.78 N; p ≤ 0.011).

Conclusions: PEEK secondary crowns exhibit stable retentive force values over 10 years of simulated aging showing no signs of deterioration while the retentive force values of electroformed secondary crowns increase over time.

Clinical Relevance: PEEK might be a suitable alternative to proven metallic materials for the fabrication of secondary crowns.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00784-018-2657-xDOI Listing
May 2019

The AdVance and AdVanceXP male sling in urinary incontinence: is there a difference?

World J Urol 2018 Oct 4;36(10):1657-1662. Epub 2018 May 4.

Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany.

Purpose: To compare the efficacy and perioperative complications of the AdVanceXP with the original AdVance male sling.

Methods: We retrospectively enrolled 109 patients with an AdVance and 185 patients with an AdVanceXP male sling. The baseline characteristics and complication rates were analyzed retrospectively. Functional outcome and quality of life were evaluated prospectively by standardized, validated questionnaires. The Chi-test for categorical and Mann-Whitney U test for continuous variables were performed to identify heterogeneity between the groups.

Results: Regarding operation time, there was no significant difference between the slings (p = 0.146). The complication rates were comparable in both groups except for postoperative urinary retention. This occurred significantly more often in patients with the AdVanceXP (p = 0.042). During follow-up, no differences could be identified regarding ICIQ-SF, PGI or I-QoL or number of pad usage.

Conclusions: The AdVance and AdVanceXP are safe and effective treatment options for male stress urinary incontinence. However, the innovations of the AdVanceXP sling did not demonstrate a superiority over the original AdVance sling regarding functional outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00345-018-2316-5DOI Listing
October 2018

Systematics and concepts for the digital production of complete dentures: risks and opportunities.

Int J Comput Dent 2018;21(1):41-56

The rehabilitation of the edentulous patient with complete dentures is still an essential aspect of dental prosthetics. Modern digital manufacturing technologies have made it possible to produce even complete dentures digitally. This has several advantages, especially regarding the properties of the denture material. In addition, the use of digital technology facilitates new treatment concepts and procedures that reduce the number of appointments needed at the dental office.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2018

The Overall Survival Benefit for Patients with T1 Renal Cell Carcinoma after Nephron-Sparing Surgery Depends on Gender and Age.

Urol Int 2018 2;100(3):309-316. Epub 2018 Mar 2.

Department of Urology, St. Georg Clinic Eisenach, Eisenach, Germany.

Due to the recommendations in the urological guidelines to perform nephron-sparing surgery in patients with organ-confined renal cell carcinoma (RCC), the customary therapy regimen changed, but it is not well studied yet whether partial nephrectomy (PN) especially in the elderly is beneficial. From 2000 to 2015, 3,592 patients from 7 clinics undergoing surgery in RCC were identified; 2,323 had T1 tumours. We retrospectively compared the overall survival benefit of patients with T1 RCC who underwent either PN or radical nephrectomy (RN) and studied effects of age and gender.

Results: In T1 RCC, PN was beneficial in male patients (p = 0.0006) independent of age, especially in those men ≤75 years of age (p = 0.0005); but PN was not beneficial for female patients (p = 0.0629) regardless of age and male patients older than 75 years (p = 0.736). The OS of female patients after RN and male patients after PN is the same, regardless of age. A life expectancy of more than 45 months at least is necessary to experience an overall survival benefit after PN.

Conclusions: There should be harder proven indications for PN in female patients and especially in all patients older than 75 years, particularly with regard to perioperative risk factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000486627DOI Listing
December 2018

The TiLOOP® Male Sling: Did We Forejudge.

Urol Int 2018 26;100(2):216-221. Epub 2017 Oct 26.

Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany.

Introduction: To evaluate the safety and efficacy of the TiLOOP® male sling (pfm medical, Cologne, Germany) used in the treatment for male stress urinary incontinence (SUI).

Material And Methods: We retrospectively evaluated a total of 34 patients with a TiLOOP® male sling. Perioperative complication rates were assessed and validated questionnaires were prospectively evaluated to assess quality of life and satisfaction rate. Outcome and complication rates were analysed by using descriptive statistics. Correlation of continence outcome and risk factors was performed with the chi-square test. A p value below 0.05 was considered statistically significant.

Results: The majority of patients (70.6%) were diagnosed with mild or moderate male SUI. During surgery, one instance (2.9%) of intraoperative urethral injury was observed. There were no immediate postoperative complications. The mean follow-up time was 44.6 months. An improvement of male SUI was reported by 61.9% of the patients and 38.1% reported no change according the Patient Global Impression of Improvement. The mean perineal pain score was 0.5 according to the international index of pain.

Conclusions: The TiLOOP® is a safe treatment option for male SUI in our cohort with a low complication rate. However, the functional outcome of the TiLOOP® was inferior when compared to the outcome of the AdVance® male sling.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000477765DOI Listing
September 2018

Virtual Simulation of Periodontal Surgery Including Presurgical CAD/CAM Fabrication of Tooth-Colored Removable Splints on the Basis of CBCT Data: A Case Report.

Int J Periodontics Restorative Dent 2017 Nov/Dec;37(6):e310-e320

Innovative digital diagnostic, design, and manufacturing technologies combined with high-performance polymers offer new possibilities to facilitate complex interdisciplinary treatment procedures. This article reports on the interaction of different digital technologies, from presurgical digital simulation of periodontal surgery to final prosthodontic rehabilitation, in a case of amelogenesis imperfecta in a 17-year-old girl. The aim was to digitally determine the treatment outcome by three-dimensional simulation of the soft tissue removal and to create computer-aided design/computer-assisted manufacture tooth-colored splints before the clinical treatment. The case report shows the synergy of the combination of multiple digital technologies for a predictable periodontal and prosthetic treatment outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11607/prd.2769DOI Listing
July 2018

Fracture resistance of different implant abutments supporting 
all-ceramic single crowns after aging.

Int J Comput Dent 2017;20(1):53-64

Objective: To test the mechanical properties of three different restorative materials for implant abutments supporting all-ceramic single crowns.

Materials And Methods: Thirty implants with butt-joint connections were distributed into three test groups: Group A with 10 one-piece zirconia abutments, Group U with 10 titanium abutments, and Group T with 10 titanium-zirconia hybrid abutments. Monolithic zirconia single crowns were cemented and artificially aged. The crowns were loaded at a 30-degree angle in a universal testing machine until fracture or bending. Additionally, after removal of the restorations, the implant-abutment interface of the fixtures was inspected using a scanning electron microscope (SEM).

Results: In Group A, the abutments failed on average at 336.78 N, in Group U at 1000.12 N, and in Group T at 1296.55 N. The mean values between Groups T and U (P = 0.009), and between Group A and Groups T and U (P < 0.001) were significantly different. The abutments in Group A failed early due to fractures of the internal parts and parts close to the implant neck. In Groups T and U, failures occurred due to bending of the implant neck.

Conclusion: This experimental study proves that hybrid and titanium abutments have similar mechanical properties. One-piece abutments made of zirconia showed significantly lower fracture resistance.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2017

CAD/CAM splints for the functional and esthetic evaluation of newly defined occlusal dimensions.

Quintessence Int 2017 ;48(3):181-191

Pretreatment with occlusal splints is a crucial step in a structured treatment approach for a complex rehabilitation that changes the vertical dimension of occlusion. Meticulous patient compliance is one of the essential prerequisites for overall treatment success. However, patient compliance is all too often insufficient due to esthetic, phonetic, and functional limitations when using conventional occlusal splints in one arch. Modern production technologies now allow the use of tooth-colored occlusal splints made of polycarbonate, whose quality and material properties are quite distinct from those of conventionally manufactured splints made of transparent polymethyl methacrylate (PMMA). These materials, produced under standardized polymerization conditions, are extremely homogenous, which provides benefits such as a greater accuracy of fit by eliminating the polymerization shrinkage, greater long-term stability of shapes and shades, better biocompatibility, less wear, and a more favorable esthetic appearance. In addition, tooth-colored polycarbonate splints can be fabricated very thin without significantly increasing the fracture risk, thanks to the flexibility of the material. The improved wearing comfort combined with acceptable esthetics result in significantly improved patient compliance in terms of a "23-hour splint."

Conclusion: By providing separate splints for the maxilla and mandible in the case of major alterations of the vertical dimension of occlusion, the esthetic and functional aspects defined by the wax-up can be completely transferred to the removable splints for a "test drive" by the patient, reversibly, and under realistic conditions. This dual-splint approach additionally facilitates segmental transfer into the definitive restoration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3290/j.qi.a37641DOI Listing
February 2018

Antibiotic Coating of the Artificial Urinary Sphincter (AMS 800): Is it Worthwhile?

Urology 2017 05 16;103:179-184. Epub 2017 Jan 16.

Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany.

Objective: To investigate the impact of the antibiotic coating InhibiZone on the infection and explantation rates of the AMS 800 in comparison to the AMS 800 without InhibiZone.

Materials And Methods: We retrospectively identified 305 patients with an AMS 800 in a multicenter cohort study. Patients were subsequently divided into InhibiZone and without InhibiZone-coated groups. Infection and explantation rates were analyzed by univariate and consecutively by multivariate logistic regression adjusted to variable risk factors. The infection-free interval was estimated by Kaplan-Meier plot and compared by the log-rank test. A P value below .05 was considered statistically significant.

Results: We identified 47 patients with InhibiZone and 258 without InhibiZone coating. In univariate analysis, we could not identify a significant difference in infection (P = .932) or explantation (P = .715) rates between the groups. In multivariate analysis, impaired wound healing (P = .008) and urethral erosion (P < .001) were independent predictors for infection. The InhibiZone coating neither demonstrated significant influence on the infection rate (P = .534) nor on the explantation rate (P = .214). There was no significant difference in estimated infection-free survival between the groups (P = .265).

Conclusion: The antibiotic coating of the AMS 800 had no significant impact on infection or explantation rates in our cohort.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urology.2016.12.056DOI Listing
May 2017

Oral features and computerized rehabilitation of a young patient with CHARGE syndrome using minimally invasive long-term interim CAD-CAM restorations.

J Prosthet Dent 2017 Apr 27;117(4):453-458. Epub 2016 Oct 27.

Assistant Professor, Department of Prosthodontics, Dental School, Ludwig-Maximilians University, Munich, Germany.

Patients with CHARGE syndrome (where CHARGE stands for coloboma of the iris or retina, heart defects or cardiac malformations, atresia/stenosis of the choanae, retardation of growth and development, genital anomalies, and ear abnormalities) present several orofacial anomalies. Their treatment depends on the specific type of manifestation. To perform the complex oral rehabilitation and achieve a conservative, esthetic, and functional exploration of the definitive treatment goal, computer-aided design and computer-aided manufacturing (CAD-CAM) polymers can be used as long-term interim restorations. This article reports the treatment of a young patient with CHARGE syndrome combined with oral alterations. CAD-CAM polymers offer an intermediate treatment with satisfying esthetics and function at low biological cost until bone growth is completed. This period facilitates additional planning for the definitive restoration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.prosdent.2016.07.030DOI Listing
April 2017

Risk Factors for Failure of Male Slings and Artificial Urinary Sphincters: Results from a Large Middle European Cohort Study.

Urol Int 2017 3;99(1):14-21. Epub 2016 Sep 3.

University Medical Center of Johannes Gutenberg University Mainz, Department of Urology and Pediatric Urology, Mainz, Germany.

Introduction: We analysed the impact of predefined risk factors: age, diabetes, history of pelvic irradiation, prior surgery for stress urinary incontinence (SUI), prior urethral stricture, additional procedure during SUI surgery, duration of incontinence, ASA-classification and cause for incontinence on failure and complications in male SUI surgery.

Materials And Methods: We retrospectively identified 506 patients with an artificial urinary sphincter (AUS) and 513 patients with a male sling (MS) in a multicenter cohort study. Complication rates were correlated to the risk factors in univariate analysis. Subsequently, a multivariate logistic regression adjusted to the risk factors was performed. A p value <0.05 was considered statistically significant.

Results: A history of pelvic irradiation was an independent risk factor for explantation in AUS (p < 0.001) and MS (p = 0.018). Moreover, prior urethral stricture (p = 0.036) and higher ASA-classification (p = 0.039) were positively correlated with explantation in univariate analysis for AUS. Urethral erosion was correlated with prior urethral stricture (p < 0.001) and a history of pelvic irradiation (p < 0.001) in AUS. Furthermore, infection was correlated with additional procedures during SUI surgery in univariate analysis (p = 0.037) in MS.

Conclusions: We first identified the correlation of higher ASA-classification and explantation in AUS. Nevertheless, only a few novel risk factors had a significant influence on the failure of MS or AUS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000449232DOI Listing
May 2018

Virtual evaluation for CAD-CAM-fabricated complete dentures.

J Prosthet Dent 2017 Jan 1;117(1):28-33. Epub 2016 Aug 1.

Associate Professor, Department of Prosthetic Dentistry, Ludwig-Maximilians-University, Munich, Germany.

New treatment concepts for complete denture fabrication, including digital components, may increase the predictability of the treatment outcome. The reduced number of appointments, improved biocompatibility of the materials, opportunity to copy the outline of existing dentures, possibility of a virtual evaluation, and reduction of costs have changed the treatment workflow considerably. This becomes even more important against the background of an aging population. The innovative approach presented describes the combination of an impression-occlusal rim with a 3-dimesional face scan that allows a virtual evaluation, which might complement or even replace the traditional evaluation of a conventional tooth arrangement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.prosdent.2016.05.015DOI Listing
January 2017

Complications and Short-Term Explantation Rate Following Artificial Urinary Sphincter Implantation: Results from a Large Middle European Multi-Institutional Case Series.

Urol Int 2016 17;97(2):205-11. Epub 2016 Jun 17.

Department of Urology, Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany.

Unlabelled: Background/Aims/Objectives: To analyze perioperative complication and short-term explantation rates after perineal or penoscrotal single-cuff and double-cuff artificial urinary sphincter (AUS) implantation in a large middle European multi-institutional patient cohort.

Methods: 467 male patients with stress urinary incontinence underwent implantation of a perineal single-cuff (n = 152), penoscrotal single-cuff (n = 99), or perineal double-cuff (n = 216) AUS between 2010 and 2012. Postoperative complications and 6-month explantation rates were assessed. For statistical analysis, Fisher's exact test and Kruskal-Wallis rank sum test, and a multiple logistic regression model were used (p < 0.05).

Results: Compared to perineal single-cuff AUS, penoscrotal single-cuff implantation led to significantly increased short-term explantation rates (8.6% (perineal) vs. 19.2% (penoscrotal), p = 0.019). The postoperative infection rate was significantly higher after double-cuff compared to single-cuff implantation (6.0% (single-cuff) vs. 13.9% (double-cuff), p = 0.019). The short-term explantation rate after primary double-cuff placement was 6.5% (p = 0.543 vs. perineal single-cuff). In multivariate analysis, the penoscrotal approach (p = 0.004), intraoperative complications (p = 0.005), postoperative bleeding (p = 0.011), and perioperative infection (p < 0.001) were independent risk factors for short-term explantation.

Conclusions: Providing data from a large contemporary multi-institutional patient cohort from high-volume and low-volume institutions, our results reflect the current standard of care in middle Europe. We indicate that the penoscrotal approach is an independent risk factor for increased short-term explantation rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000446351DOI Listing
April 2017

Efficacy and safety of the ZSI375 artificial urinary sphincter for male stress urinary incontinence: lessons learned.

World J Urol 2016 Oct 25;34(10):1457-63. Epub 2016 Feb 25.

Department of Urology, Ludwig-Maximilians-University, Campus Großhadern, Marchioninistrasse 15, 81377, Munich, Germany.

Purpose: To analyze efficacy and safety for the ZSI375 artificial urinary sphincter in a multicenter case series.

Methods: Thirteen male patients with stress urinary incontinence underwent implantation of a ZSI375 artificial urinary sphincter device between 2010 and 2012 in three international continence reference centers. Perioperative characteristics and postoperative complications were analyzed using the Clavien-Dindo scale. Re-hospitalization and explantation rates, and functional outcome were assessed. Inner-group and between-group differences were analyzed using Wilcoxon, Mann-Whitney U, and Fisher's exact test whenever indicated. Kaplan-Meier analysis was performed to assess device survival. A p value below 0.05 was considered statistically significant.

Results: There were no intraoperative complications. Median follow-up was 13.5 months. In this period, four device defects (30.8 %) could be observed, being the main cause for device explantation, followed by device infection (15.4 %), non-resolvable pain (7.7 %), and urethral erosion (7.7 %). There were no Clavien IV or Clavien V complications. Overall explantation rate was 61.5 %. Mean time-to-explantation was 279 ± 308 days. There was no significant influence of previous irradiation and previous invasive incontinence therapy (p = 0.587 and p = 0.685, respectively). Mean daily pad usage decreased from 5.8 ± 1.5 to 2.4 ± 2.1 (p = 0.066). One patient (7.7 %) did not use any pads. Social continence (0-1 pads) was achieved in 15.4 % of the patients.

Conclusion: This is the most current study that is investigating the outcome after ZSI375 implantation in a multicenter case series. Based on our results, explantation rates after ZSI375 implantation are high and efficacy rates seem lower than previously described. Addressing this high failure rate, the system has undergone a two-step modification in the meantime.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00345-016-1787-5DOI Listing
October 2016