Publications by authors named "Philipp Sahrmann"

45 Publications

Reduced fracture load of dental implants after implantoplasty with different instrumentation sequences. An in-vitro study.

Clin Oral Implants Res 2021 May 25. Epub 2021 May 25.

Clinic of Conservative and Preventive Dentistry Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.

Objectives: To assess the mechanical stability of implants after implantoplasty and thermocyclic loading, the residual thickness of the instrumented areas and neighbouring tooth injury due to implantoplasty.

Materials And Methods: Using a phantom head simulator and maxillary model implants were subjected to an implantoplasty procedure. Thirty implants were randomly assigned to receive one of three instrumentation sequences. After instrumentation injury on neighbouring teeth was assessed. Instrumented implants and non-instrumented controls were subjected to 1.2 million cycles of thermo-mechanical loading in a chewing-machine. Afterwards, maximum fracture load for all implants and an additional 5 pristine control implants was tested.

Results: Generally, damage of neighbour teeth was a frequent finding (33±56% of all cases) with considerable inter-group differences. No considerable inter-group difference for the residual implant thickness was found for different areas assessed. No implant fractured during cyclic loading. Fracture load was reduced after cyclic loading of uninstrumented implants from 2724 ± 70 N to 2299 ± 127 N, and after implantoplasty to 1737 ± 165 N, while no effect by the instrumentation sequence could be observed.

Conclusions: Both, implantoplasty and cyclic loading was shown to reduce the implants' maximum bending strength. Cyclic loading in a laboratory masticator, simulating a five-year equivalent of chewing, did not result in fractured implants. Since neighbouring tooth injury was assessed often, care should be taken with the selection of suitable instruments.
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http://dx.doi.org/10.1111/clr.13754DOI Listing
May 2021

[Cemental Tear].

Swiss Dent J 2021 Apr;131(4):358-359

Klinik für Parodontologie, Zahnmedizinische Kliniken der Universität Bern, Schweiz.

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April 2021

Assessment of implant surface and instrument insert changes due to instrumentation with different tips for ultrasonic-driven debridement.

BMC Oral Health 2021 01 7;21(1):25. Epub 2021 Jan 7.

Clinic of Conservative and Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.

Background: To assess the changes of implant surfaces of different roughness after instrumentation with ultrasonic-driven scaler tips of different materials.

Methods: Experiments were performed on two moderately rough surfaces (I-Inicell® and II-SLA®), one surface without pre-treatment (III) and one smooth machined surface (IV). Scaler tips made of steel (A), PEEK (B), titanium (C), carbon (D) and resin (E) were used for instrumentation with a standardized pressure of 100 g for ten seconds and under continuous automatic motion. Each combination of scaler tip and implant surface was performed three times on 8 titanium discs. After instrumentation roughness was assessed by profilometry, morphological changes were assessed by scanning electron microscopy, and element distribution on the utmost surface by energy dispersive X-ray spectroscopy.

Results: The surface roughness of discs I and II were significantly reduced by instrumentation with all tips except E. For disc III and IV roughness was enhanced by tip A and C and, only for IV, by tip D. Instrumentation with tips B, D and E left extensive residuals on surface I, II and III. The element analysis of these deposits proved consistent with the elemental composition of the respective tip materials.

Conclusion: All ultrasonic instruments led to microscopic alterations of all types of implants surfaces assessed in the present study. The least change of implant surfaces might result from resin or carbon tips on machined surfaces.
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http://dx.doi.org/10.1186/s12903-020-01384-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791805PMC
January 2021

The Microbiome of Peri-Implantitis: A Systematic Review and Meta-Analysis.

Microorganisms 2020 May 1;8(5). Epub 2020 May 1.

Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland.

This review aimed to systematically compare microbial profiles of peri-implantitis to those of periodontitis and healthy implants. Therefore, an electronic search in five databases was conducted. For inclusion, studies assessing the microbiome of peri-implantitis in otherwise healthy patients were considered. Literature was assessed for consistent evidence of exclusive or predominant peri-implantitis microbiota. Of 158 potentially eligible articles, data of 64 studies on 3730 samples from peri-implant sites were included in this study. Different assessment methods were described in the studies, namely bacterial culture, PCR-based assessment, hybridization techniques, pyrosequencing, and transcriptomic analyses. After analysis of 13 selected culture-dependent studies, no microbial species were found to be specific for peri-implantitis. After assessment of 28 studies using PCR-based methods and a meta-analysis on 19 studies, a higher prevalence of and (log-odds ratio 4.04 and 2.28, respectively) was detected in peri-implantitis biofilms compared with healthy implants. spp., spp. and spp. were found in all five pyrosequencing studies in healthy-, periodontitis-, and peri-implantitis samples. In conclusion, the body of evidence does not show a consistent specific profile. Future studies should focus on the assessment of sites with different diagnosis for the same patient, and investigate the complex host-biofilm interaction.
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http://dx.doi.org/10.3390/microorganisms8050661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284896PMC
May 2020

Changes of radiopacity around implants of different lengths: Five-year follow-up data of a randomized clinical trial.

Clin Oral Implants Res 2020 May 12;31(5):488-494. Epub 2020 Feb 12.

Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, Zurich, Switzerland.

Objective: To follow-up the radiographic changes in peri-implant bone of short (6 mm, test group) and long (10 mm, control group) single-unit implants five years after loading.

Materials And Methods: Forty-three implants of the test and 44 implants of the control group could be reassessed from 96 originally included implants. Standardized areas of interest (AOI) were defined in the peri-implant bone at pre-defined locations at mid-length on both sides of the implants, and at the apex. An arbitrary mean grey scale value (GSV) was calculated for the AOI after brightness calibration of the radiographs. Changes for GSV were calculated and tested for possible inter- and intra-group differences using the Mann-Whitney and Wilcoxon tests.

Results: The calculated intra-group differences between baseline and 5 years in the test group accounted for 2.4 ± 19.6 (i.e. slight brightening) and -6.2 ± 20.2 for the control group (i.e. slight shading), which resulted in a statistically significant difference in GSV change (p < .05). Crown-to-implant ratio was the only parameter showing an effect on GSV change (p = .001).

Conclusions: Assessing conventional radiographs, longer implants showed a slightly stronger change of radiopacity of the peri-implant bone (slight loss of density) than short ones (slightly enhanced density) after five years of loading.
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http://dx.doi.org/10.1111/clr.13584DOI Listing
May 2020

Removal of failed dental implants revisited: Questions and answers.

Clin Exp Dent Res 2019 12 21;5(6):712-724. Epub 2019 Aug 21.

Clinic of Conservative and Preventive Dentistry University of Zurich Zurich Switzerland.

Objectives: This narrative review is aiming on showing reasons for implant failure, removal techniques, and respective clinical considerations; further, the survival rate of implants in previous failed sites is examined.

Materials And Methods: Questions have been formulated, answered, and discussed through a literature search including studies assessing implant failure and removal up to 2018.

Results: Studies describing reasons for implant failure, implant removal techniques, and the reinsertion of implants in a previous failed site ( = 12) were included. To date, peri-implantitis is the main reason for late implant failure (81.9%). Trephine burs seem to be the best-known method for implant removal. Nevertheless, the counter-torque-ratchet-technique, because of the low invasiveness, should be the first choice for the clinician. Regarding zirconia implant removal, only scarce data are available. Implantation in previously failed sites irrespective of an early or late failure results in 71% to 100% survival over 5 years.

Conclusion: If removal is required, interventions should be based on considerations regarding minimally invasive access and management as well as predictable healing. (Post)Operative considerations should primarily depend on the defect type and the consecutive implantation plans.
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http://dx.doi.org/10.1002/cre2.234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6934347PMC
December 2019

Treatment of Peri-Implant Mucositis with Repeated Application of Chlorhexidine Chips or Gel during Supportive Therapy - A Randomized Clinical Trial.

Dent J (Basel) 2019 Dec 11;7(4). Epub 2019 Dec 11.

Clinic for Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, CH 8032 Zurich, Switzerland.

To assess the effect of chlorhexidine (CHX) chip application in patients with peri-implant mucositis as compared to CHX gel application. In peri-implant sites with mucositis, CHX gel was applied in the control group (GC) and CHX chips in the test group (CC) at baseline and after three months. At baseline and after six months, peri-implant pocket depths (PPD), bleeding-on-probing (BOP) and activated matrix metalloproteinase-8 (aMMP8) were assessed. Longitudinal changes were tested for inter-group differences. Thirty-two patients were treated. BOP was more reduced ( = 0.006) in CC than in GC, with means and standard deviations of 46 ± 28% and 17 ± 27%, respectively. PPD was more reduced ( = 0.002) in CC than in GC with 0.65 ± 0.40 mm and 0.18 ± 0.32 mm, respectively. Regarding BOP, the percentages of improved, unchanged and worsened sites accounted for 32%, 61% and 7% in GC and 46%, 53% and 1% in CC, respectively. For probing pocket depth, the according values were 26%, 66% and 8% (GC) versus 57%, 38% and 5% (CC). During supportive therapy, repeated CHX chip application might resolve marginal peri-implant inflammation in terms of bleeding better than CHX gel.
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http://dx.doi.org/10.3390/dj7040115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961024PMC
December 2019

Dentin tubule obturation of a bioglass-based dentin desensitizer under repeated exposure to lactid acid and brushing.

BMC Oral Health 2019 12 5;19(1):274. Epub 2019 Dec 5.

Clinic of Conservative and Preventive Dentistry Periodontology and Cariology Center of Dental Medicine, University of Zuric, Plattenstr, 11 8032, Zurich, Switzerland.

Background: Dentin hypersensitivity is a frequent finding especially in periodontitis patients. Conventional treatment aims for obstruction of dentin tubules by disabling liquid and osmotic fluctuation to and from the pulpal chamber. A novel bioglass-based desensitizer was shown to obstruct tubules and to resist periodic exposure to lactic acid. Whether this obstruction is resistant to brushing had not been tested so far. Accordingly, the present study aimed to assess dentin tubule obstruction after repeated acid exposure and brushing.

Methods: Sixty dentin discs were cleaned with 17% EDTA, mounted into a pulp fluid simulator and randomly divided into 3 groups: No surface treatment in Group A, Seal&Protect® in group B and DentinoCer in group C. Discs were exposed to 0.1 M non-saturated lactic acid thrice and standardized brushing twice a day for 12 days. At baseline and after 2, 4 and 12 d samples were removed from the setting and prepared for top-view SEM analysis to assess tubule obstruction using the Olley score. Discs were then vertically cut and the section surface morphologically assessed using backscatter imaging. For both vertical and sectional surfaces EDX analysis was used to characterize the surface composition in the tubular and inter-tubular area.

Results: Group A showed clean tubular lumina at all time points. From day 2 onwards dentin showed exposed collagen fibers. Group 2 initially showed a complete surface coverage that flattened out during treatment without ever exposing tubules. At baseline, samples of Group C displayed a complete homogeneous coverage. From day 2 on tubules entrances with obstructed lumen became visible. While on day 4 and 12 the dentin surface exposed collagen fibers the lumina remained closed. EDX analysis of the vertical and horizontal views showed that P and Ca were predominant elements in both the inter- and tubular dentin while Si peaks were found in the tubule plugs.

Conclusion: While group B displayed a packed layer on the surface during the whole investigation time group C samples lost their superficial layer within 48 h. Tubule plugs containing considerable Si proportions indicated previous presence of DentinoCer, while high Ca and P proportions suggest obturation by dentin-like material.
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http://dx.doi.org/10.1186/s12903-019-0962-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896668PMC
December 2019

Titanium Implant Characteristics After Implantoplasty: An In Vitro Study on Two Different Kinds of Instrumentation.

Int J Oral Maxillofac Implants 2019 Nov/Dec;34(6):1299-1305

Purpose: To assess surface characteristics and implant stability after implantoplasty performed by two different instrument sequences regarding material loss, surface roughness, and fracture load resistance. Additionally, operators' subjective experience during instrumentation and the damage to neighboring teeth were evaluated.

Materials And Methods: Titanium implants were placed in the position of both first maxillary molars in models exposing 6 mm of their surface. Implantoplasty was performed in phantom heads: Exposed surfaces were instrumented with diamonds and Arkansas stones or abrasive stones and silicone polishers. Operators reported on abrasion, gloss, effectiveness, and tactility using a visual analog scale (VAS). Residual wall thickness of implants was measured on radiographs, material abrasion using three-dimensional (3D) scans, and surface roughness by contact profilometry. Maximum bending moments were measured.

Results: Residual thickness and weight loss were comparable after both treatments (0.3 ± 0.1 and 0.25 ± 0.07 mm and 0.22 ± 0.01 g, and 0.03 ± 0.01 mm and 0.02 ± 0.01 g, respectively, P > .05). Mean surface roughness was lower (P = .0001) for the group with the silicone polishers (0.4 ± 0.2 μm) compared with the group employing diamonds (0.8 ± 0.1 μm). Maximum bending moments showed neither intergroup differences nor stability loss compared with untreated implants. The stone-and-silicone polisher group showed less abrasion (4.6 ± 2.2) and higher gloss values (8.1 ± 1.4) than the diamond-and-Arkansas group (3.1 ± 1.3 and 4.1 ± 2.1, respectively). Superficial tooth injuries at proximal neighbor teeth were common (73% and 80%).

Conclusion: Implantoplasty did not weaken implant stability. The use of silicone polishers revealed lower surface roughness. Regarding surface smoothness, the instrumentation sequence employing silicon carbide and Arkansas stones followed by silicone polishers seems to be superior to the combination of diamond and Arkansas stones.
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http://dx.doi.org/10.11607/jomi.7410DOI Listing
December 2019

Early Wound Healing Score (EHS): An Intra- and Inter-Examiner Reliability Study.

Dent J (Basel) 2019 Sep 1;7(3). Epub 2019 Sep 1.

Section of Periodontics, Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.

The early wound healing score (EHS) was introduced to assess early wound healing of periodontal soft tissues after surgical incision. The purpose of this study is to evaluate the intra- and inter-examiner reliability of the EHS. Six examiners with different levels of training and clinical focus were enrolled. Each examiner was trained on the use of the EHS before starting the study. Thereafter, 63 photographs of three different types of surgical incisions taken at day 1, 3 or 7 post-operatively were independently evaluated according to the proposed assessment method. A two-way random intra-class correlation coefficient (ICC) and 95% confidence interval (CI) were used to analyze the intra- and inter-examiner reliability for the EHS. The inter-examiner reliability for the EHS was 0.828 (95% CI: 0.767-0.881). The intra-examiner reliability ranged between 0.826 (95% CI: 0.728-0.891) and 0.915 (95% CI: 0.856-0.950). The results therefore show an "almost perfect agreement" for intra- and inter-examiner reliability. The EHS provides a system for reproducible repeated ratings for the early healing assessment of incisions of periodontal soft tissues. Even when used by examiners with different clinical experience and specialty, it shows a high correlation coefficient.
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http://dx.doi.org/10.3390/dj7030086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6784738PMC
September 2019

Correction to: Performance of a bioglass-based dentine desensitizer under lactid acid exposition: an in-vitro study.

BMC Oral Health 2019 Jul 24;19(1):160. Epub 2019 Jul 24.

Clinic for Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstr. 11, 8032, Zurich, Switzerland.

Following publication of the original article [1], the authors reported their family and given names have been mismatched. The correct names can be found below.
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http://dx.doi.org/10.1186/s12903-019-0855-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657168PMC
July 2019

Performance of a bioglass-based dentine desensitizer under lactid acid exposition: an in-vitro study.

BMC Oral Health 2018 11 21;18(1):193. Epub 2018 Nov 21.

Clinic for Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstr. 11, 8032, Zurich, Switzerland.

Background: Dentine hypersensitivity is especially frequent in patients with pronounced periodontal attachment loss. Aim of the treatment is an obstruction of the dentine tubules in order to inhibit liquid or osmotic motion, which is considered as trigger for pain sensations. Novel approaches aim for obstruction by calcium phosphate compounds in order to rely on biocompatible compounds. It was the aim of the study to optically investigate the morphology and to assess the fluid permeability of treated dentine surfaces.

Methods: Dentine discs were pretreated in an ultrasonic bath with 17% EDTA to clean the lumina of the dentine tubules. Samples of group A remained untreated while Seal&Protect® as a conventional desensitizer was applied for group B and DentinoCer in group C. Discs were mounted into a pulp fluid simulator (PFS) with a methylene blue solution in order to create a flow pressure of 0.5 bar. Over 12 d, discs were exposed three times per day to 0.1 M nonsaturated lactic acid. At baseline and after 2, 8 and 12 d samples were removed from PFS and prepared for SEM analysis. Tubule obstruction was assessed quantitatively using Olley scores and by qualitative description of the surface. Absorption spectrometry was used to assess the concentration of leaked methylene blue outside the samples in order to estimate dentine permeability.

Results: Untreated discs showed clean lumina of all tubules at all time points and magnifications. From day 2 onwards dentine showed exposed collagene fibers due to acid exposition. Seal&Protect® initially showed homogenous dentine surface coverage that got a more granulomatous aspect in the course of treatment time. Few samples showed sporadic tubules with open lumen at day 8 and 12. Group C showed samples with a homogeneous, even surface. Narrow slits in the superficial layer are visible from day 4 on, but the dentine surface remained invisible and dentine tubules were closed till the end of the investigation period.

Conclusion: Over 12 d of lactid acid exposure, samples showed complete coverage of the dentine tubules in the chosen in-vitro-model when treated with Seal&Protect® or DentinoCer.
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http://dx.doi.org/10.1186/s12903-018-0642-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249813PMC
November 2018

Early Wound Healing Score: a system to evaluate the early healing of periodontal soft tissue wounds.

J Periodontal Implant Sci 2018 Oct 24;48(5):274-283. Epub 2018 Oct 24.

Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.

Purpose: Numerous indices have been proposed to analyse wound healing in oral soft tissues, but each has specific shortcomings. A new method of analysis, the Early Wound Healing Score (EHS), was evaluated in the present study. The aim was to assess more accurately early healing by primary intention of surgical incisions in periodontal soft tissues.

Methods: Twenty-one patients were treated with different surgical procedures comprising 1 or 2 vertical releasing incisions as part of a surgical access flap. Twenty-four hours after surgery, early wound healing at the vertical releasing incisions was assessed using the EHS. This score assessed clinical signs of re-epithelialization (CSR), clinical signs of haemostasis (CSH), and clinical signs of inflammation (CSI). Since complete wound epithelialization was the main outcome, the CSR score was weighted to be 60% of the total final score. Accordingly, a score of 0, 3, or 6 points was possible for the assessment of CSR, whereas scores of 0, 1, or 2 points were possible for CSH and CSI. Higher values indicated better healing. Accordingly, the score for ideal early wound healing was 10.

Results: Thirty vertical releasing incisions were assessed in 21 patients. At 24 hours after incision, 16 vertical releasing incisions (53.33%) received the maximum score of CSR, while 6 cases (20%) received an EHS of 10. None of the cases received 0 points.

Conclusion: The EHS system may be a useful tool for assessing early wound healing in periodontal soft tissue by primary intention after surgery.
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http://dx.doi.org/10.5051/jpis.2018.48.5.274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207797PMC
October 2018

Assessment of peri-implant defects at titanium and zirconium dioxide implants by means of periapical radiographs and cone beam computed tomography: An in-vitro examination.

Clin Oral Implants Res 2018 Dec 22;29(12):1195-1201. Epub 2018 Nov 22.

Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.

Objective: To test the accuracy of measurement of interproximal peri-implant bone defects at titanium (Ti) and zirconium dioxide (ZrO ) implants by digital periapical radiography (PR) and cone beam computed tomography (CBCT).

Material And Methods: A total of 18 models, each containing one Ti and one ZrO implant, were cast in dental stone. Six models each were allocated to following defect groups: A-no peri-implant defect, B-1 mm width defect, C-1.5 mm width defect. The defect width was measured with a digital sliding caliper. Subsequently, the models were scanned by means of PR and CBCT. Three examiners assessed the defect width on PR and CBCT. Wilcoxon signed-rank test and Wilcoxon rank sum test were applied to detect differences between imaging techniques and implant types.

Results: For PR, the deviation of the defect width measurement (mm) for groups A, B, and C amounted to 0.01 ± 0.03, -0.02 ± 0.06, and -0.00 ± 0.04 at Ti and 0.05 ± 0.02, 0.01 ± 0.03, and 0.09 ± 0.03 at ZrO implants. The corresponding values (mm) for CBCT reached 0.10 ± 0.11, 0.26 ± 0.05, and 0.24 ± 0.08 at Ti and 1.07 ± 0.06, 0.64 ± 0.37, and 0.54 ± 0.17 at ZrO implants. Except for Ti with defect A, measurements in PR were significantly more accurate in comparison to CBCT (p ≤ 0.05). Both methods generally yielded more accurate measurements for Ti than for ZrO .

Conclusions: The assessment of interproximal peri-implant defect width at Ti and ZrO implants was more accurate in PR in comparison to CBCT. Measurements in CBCT always led to an overestimation of the defect width, reaching clinical relevance for ZrO implants.
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http://dx.doi.org/10.1111/clr.13383DOI Listing
December 2018

Correction to: Effectiveness of adjunctive hyaluronic acid application in coronally advanced flap in Miller class I single gingival recession sites: a randomized controlled clinical trial.

Clin Oral Investig 2018 11;22(8):2961-2962

Section of Periodontology, Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Rome, Italy.

The figure 2 of the original version of this article was incorrect. Correct figure is presented below.
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http://dx.doi.org/10.1007/s00784-018-2567-yDOI Listing
November 2018

Effectiveness of adjunctive hyaluronic acid application in coronally advanced flap in Miller class I single gingival recession sites: a randomized controlled clinical trial.

Clin Oral Investig 2019 Mar 30;23(3):1133-1141. Epub 2018 Jun 30.

Section of Periodontology, Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Rome, Italy.

Objectives: The aim of this randomized controlled clinical trial was to evaluate the possible advantages of adjunctive hyaluronic acid (HA) application in the coronally advanced flap (CAF) procedure in single Miller class I/recession type 1 (RT1) gingival recession treatment.

Material And Methods: Thirty patients with one recession were enrolled; 15 were randomly assigned CAF + HA and 15 to CAF alone. The recession reduction (RecRed), clinical attachment level gain (CAL-gain), changes in probing pocket depth (PPD) and in the width of keratinized tissue (KT), complete root coverage (CRC), and mean root coverage (MRC) were calculated after 18 months. Post-operative morbidity (pain intensity, discomfort, and swelling) was recorded 7 days after treatment using visual analogue scale (VAS).

Results: After 18 months, RecRed was statistically significantly higher in the test group (2.7 mm [1.0]) than in the control group (1.9 mm [1.0]; p = 0.007). PPD were found to be slightly but statistically significantly increased in both groups. No statistically significant difference was found for KT gain between treatments. CRC was 80% for test and 33.3% for control sites (p < 0.05). A MRC of 93.8 ± 13.0% for test and 73.1 ± 20.8% for control sites was calculated (p < 0.05). The test group reported lower swelling and discomfort values 7-days post-surgery (p < 0.05). Statistically significant difference was not found for pain intensity.

Conclusions: The adjunctive use of HA was effective in obtaining CRC for single Miller class I/RT1 gingival recession sites.

Clinical Relevance: Adjunctive application of HA in the coronally advanced flap procedure may improve the reduction of the recessions and increase the probability of CRC in Miller class I recessions.
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http://dx.doi.org/10.1007/s00784-018-2537-4DOI Listing
March 2019

Assessment of treatment field isolation during scaling, root planing and rinsing

Swiss Dent J 2018 06;128(6):490-496

Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Switzer­land

Aim: Intensive application of highly concentrated antimicrobials during scaling and root planing may be hazardous if swallowed in quantity. This study evaluates two dental isolation systems for fluid leakage in conjunction with a sham treatment of scaling and root planing. Materials and methods: Eight volunteers were randomly assigned to wear a conventional rubber dam (RD) and a combined suction and isolation device (IsoLite® system [IL]) alternatively on contralateral maxillary and mandibular quadrants. RD was cut between the canine and the first molar and was fixed on the first molar with a rubber dam clamp and with a tissue adhesive (Histoacryl) on the gingiva. IL was applied as recommended by the manufacturer. Ultrasonic instrumentation with corresponding irrigation water was used for 5 min as sham treatment, i.e. no actual therapy. The irrigation liquid was collected and the difference between the amount of liquid applied and that collected during treatment was determined. The volunteers then reported on their comfort during treatment. Results: Neither of the devices offered complete isolation. Mean leakage with both systems was generally low, i.e. approximately 10% (of the applied irrigant). More leakage was recorded in the maxilla than in the mandible, for both systems. Both devices were deemed moderately comfortable to wear. Conclusion: RD and IL isolated the working field to a similar degree. Since RD represents the highest isolation standard currently available, the use of IL must also be considered sufficient to prevent noxious amounts of antiseptic rinses from leaking into the mouth.
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June 2018

Location of unaccessible implant surface areas during debridement in simulated peri-implantitis therapy.

BMC Oral Health 2017 Nov 28;17(1):137. Epub 2017 Nov 28.

Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.

Background: An in vitro model for peri-implantitis treatment was used to identify areas that are clinically difficult to clean by analyzing the pattern of residual stain after debridement with commonly employed instruments.

Methods: Original data from two previous publications, which simulated surgical (SA) and non-surgical (NSA) implant debridement on two different implant systems respectively, were reanalyzed regarding the localization pattern of residual stains after instrumentation. Two blinded examiners evaluated standardized photographs of 360 initially ink-stained dental implants, which were cleaned at variable defect angulations (30, 60, or 90°), using different instrument types (Gracey curette, ultrasonic scaler or air powder abrasive device) and treatment approaches (SA or NSA). Predefined implant surface areas were graded for residual stain using scores ranging from one (stain-covered) to six (clean). Score differences between respective implant areas were tested for significance by pairwise comparisons using Wilcoxon-rank-sum-tests with a significance level α = 5%.

Results: Best scores were found at the machined surface areas (SA: 5.58 ± 0.43, NSA: 4.76 ± 1.09), followed by the tips of the threads (SA: 4.29 ± 0.44, NSA: 4.43 ± 0.61), and areas between threads (SA: 3.79 ± 0.89, NSA: 2.42 ± 1.11). Apically facing threads were most difficult to clean (SA: 1.70 ± 0.92, NSA: 2.42 ± 1.11). Here, air powder abrasives provided the best results.

Conclusion: Machined surfaces at the implant shoulder were well accessible and showed least amounts of residual stain. Apically facing thread surfaces constituted the area with most residual stain regardless of treatment approach.
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http://dx.doi.org/10.1186/s12903-017-0428-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5706147PMC
November 2017

Peri-implant bone density around implants of different lengths: A 3-year follow-up of a randomized clinical trial.

J Clin Periodontol 2017 Jul 23;44(7):762-768. Epub 2017 Jun 23.

Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, Zurich, Switzerland.

Objectives: Short dental implants are frequently placed, however, little is known about the effect of the loading force regarding an enhanced crown-to-implant ratio. The aim of this study was therefore to assess bone density changes after a 3-year period, on radiographs acquired from a randomized, controlled two-centre clinical study comparing implants of 6 and 10 mm of length.

Materials And Methods: Three predefined areas were chosen on standardized X-rays in order to assess grey-scale values of the peri-implant bone: One at the tip of the apex and two at half-length on the mesial and distal sides of the implant. Radiographs at all follow-up appointments had previously been calibrated using control fields in areas of constant density.

Results: Around short implants, peri-implant bone displayed significantly higher differences in grey-scale values (p = .031) after 3 years, indicating a higher degree of mineralization. This phenomenon was not observed around long implants.

Conclusions: A higher degree of mineralization around short implants was recorded. Whether this finding goes along with hampered bone adaptability, and accordingly, higher failure rates of short implants must be studied further in long-term clinical trials.
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http://dx.doi.org/10.1111/jcpe.12737DOI Listing
July 2017

Influence of obesity on the outcome of non-surgical periodontal therapy - a systematic review.

BMC Oral Health 2016 Sep 2;16(1):90. Epub 2016 Sep 2.

Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland.

Background: Obesity and periodontitis are important chronic health problems. Obesity is associated with an increased prevalence of periodontitis. Whether obesity also affects the outcome of non-surgical periodontal therapy is to date still unclear.

Methods: A systematic review of studies referenced in SCOPUS, MEDLINE, PubMed, Cochrane, CINAHL, Biosis and Web of Science was performed. Titles, abstracts and finally full texts were scrutinized for possible inclusion by two independent investigators. Quality and heterogeneity of the studies were assessed and the study designs were examined. Probing pocket depth reduction was analyzed as primary surrogate parameter for therapeutic success after non-surgical periodontal therapy.

Results: One-hundred-and-fifty-nine potentially qualifying studies were screened. Eight studies fulfilled the inclusion criteria and were analyzed. Three of eight studies failed to show an influence of obesity on pocket depth reduction after non-surgical therapy. The remaining five studies documented a clear negative effect on the outcome of non-surgical periodontal therapy. The finally included studies did not correspond to the highest level of quality (RCTs). Due to the heterogeneity of the data a meta-analysis was not possible.

Conclusion: The literature on the effect of obesity on the treatment outcome of non-surgical periodontal therapy remains controversial. The data, however, support that obesity is not only a factor associated with poorer periodontal health but might also result in inferior response to non-surgical treatment of periodontitis.
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http://dx.doi.org/10.1186/s12903-016-0272-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010690PMC
September 2016

Influence of different post-interventional maintenance concepts on periodontal outcomes: an evaluation of three systematic reviews.

BMC Oral Health 2016 Jul 18;17(1):19. Epub 2016 Jul 18.

Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland.

Background: To selectively review the existing literature on post-interventional maintenance protocols in patients with periodontal disease receiving either non-surgical or surgical periodontal treatment.

Methods: Three systematic reviews with different periodontal interventions, i.e. scaling and root planing (SRP), SRP with adjunctive antibiotics or regenerative periodontal surgery were evaluated focusing on their post-interventional maintenance care. Due to the early publication of one review an additional literature search update was undertaken. The search was executed for studies published from January 2001 till March 2015 through an electronic database to ensure the inclusion of resent studies on SRP. Two reviewers guided the study selection and assessed the validity of the three reviews found.

Results: Within the group of scaling and root planing alone there have been nine studies with more than three appointments for maintenance care and five studies with more than two appointments in the first 2 months after the intervention. Chlorhexidine was the most frequently used antiseptic agent used for 2 weeks after non-surgical intervention. Scaling and root planing with adjunctive antibiotics showed a similar number of visits with professional biofilm debridement, whereas regenerative studies displayed more studies with more than three visits in the intervention group. In addition, the use of antiseptics was longer and lasted 4 to 8 weeks after the regenerative intervention. The latter studies also showed more stringent maintenance protocols.

Conclusions: With increased interventional effort there was a greater tendency to increase frequency and duration of the maintenance care program and antiseptic agents.
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http://dx.doi.org/10.1186/s12903-016-0244-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4949770PMC
July 2016

In vitro cleaning potential of three implant debridement methods. Simulation of the non-surgical approach.

Clin Oral Implants Res 2017 Feb 22;28(2):151-155. Epub 2016 Jan 22.

Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental and Oral Medicine and Maxillofacial Surgery, University of Zurich, Zurich, Switzerland.

Objectives: To assess the cleaning potential of commonly used implant debridement methods, simulating non-surgical peri-implantitis therapy in vitro.

Materials And Methods: One-hundred-and-eighty dental implants were ink-stained and mounted in combined soft and hard tissue models, representing peri-implantitis defects with angulations of 30, 60, and 90° covered by a custom-made artificial mucosa. Implants were treated by a dental school graduate and a board-certified periodontist for 120 s with following instruments: Gracey curette, ultrasonic scaler, and an air powder abrasive device with a nozzle for sub-mucosal use utilizing glycine powder. All procedures were repeated 10 times for each instrumentation and defect morphology respectively. Images of the implant surface were taken. Areas with color remnants were planimetrically determined and their cumulative surface area was calculated. Results were tested for statistical differences using two-way anova and Bonferroni correction. Micro-morphologic surface changes were analyzed on scanning electron microscope (SEM) images.

Results: The areas of uncleaned surfaces (%, mean ± standard deviations) for curettes, ultrasonic tips, and air abrasion accounted for 74.70 ± 4.89%, 66.95 ± 8.69% and 33.87 ± 12.59% respectively. The air powder abrasive device showed significantly better results for all defect angulations (P < 0.0001). SEM evaluation displayed considerable surface alterations after instrumentation with Gracey curettes and ultrasonic devices, whereas glycine powder did not result in any surface alterations.

Conclusion: A complete surface cleaning could not be achieved regardless of the instrumentation method applied. The air powder abrasive device showed a superior cleaning potential for all defect angulations with better results at wide defects.
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http://dx.doi.org/10.1111/clr.12773DOI Listing
February 2017

Recommendations on the clinical application of air polishing for the management of peri-implant mucositis and peri-implantitis.

Quintessence Int 2016 Apr;47(4):293-6

Air polishing was introduced as an alternative approach for the supra- and submucosal biofilm management at dental implants. An international expert meeting involving competent clinicians and researchers took place during the EUROPERIO 8 conference in London, UK, on 4 June 2015. Prior to this meeting a comprehensive systematic review dealing with the efficacy of air polishing in the treatment of peri-implant mucositis and peri-implantitis was prepared and served as a basis for the group discussions. This paper summarizes the consensus statements and practical recommendations on the clinical application of air polishing for the management of peri-implant mucositis and peri-implantitis.
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http://dx.doi.org/10.3290/j.qi.a35132DOI Listing
April 2016

Clinical association of Spirochaetes and Synergistetes with peri-implantitis.

Clin Oral Implants Res 2016 Jun 10;27(6):656-61. Epub 2015 Sep 10.

Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zürich, Zürich, Switzerland.

Objectives: The microbial composition of peri-implantitis-associated biofilms may resemble that of periodontitis, with some distinctive differences, as identified by various conventional or molecular detection methods. Yet, the complete microbiome of peri-implantitis awaits further characterization. The present clinical study was undertaken with the aim to investigate the association of Spirochaetes, and the more recently identified phylum Synergistetes, with peri-implantitis.

Materials And Methods: Submucosal biofilms were obtained from single sites of patients with peri-implantitis (n = 43) or individuals with peri-implant health (n = 41). The samples were analysed by fluorescence in situ hybridization (FISH) and epifluorescence microscopy, using 16S rRNA-based oligonucleotide probes for Synergistetes cluster A, subclusters A1 and A2, and Treponema groups I-III and IV.

Results: Treponema group IV was barely detectable, whereas Treponema groups I-III were detected at low prevalence in health, but their prevalence and numbers were significantly increased in peri-implantitis by 48% and 2.4-log, respectively. Synergistetes cluster A was detected in half of the healthy sites, and its prevalence and numbers were significantly increased in peri-implantitis by 30% and 2.5-log, respectively. No quantitative differences were found between Synergistetes subclusters A1 and A2 numbers, as both increased by 2.8-log. Synergistetes cluster A displayed strong correlations with several clinical peri-implant parameters, but Treponema groups I-III only with probing pocket depth.

Conclusion: The present clinical cross-sectional study demonstrates that Spriochaetes of the Treponema groups I-III, but not group IV, and Synergistetes of the cluster A are highly associated with peri-implantitis. Synergistetes cluster A appears to display a stronger association with peri-implantitis than Spirochaetes.
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http://dx.doi.org/10.1111/clr.12690DOI Listing
June 2016

Effect of application of a PVP-iodine solution before and during subgingival ultrasonic instrumentation on post-treatment bacteraemia: a randomized single-centre placebo-controlled clinical trial.

J Clin Periodontol 2015 Jul 11;42(7):632-9. Epub 2015 Jun 11.

Clinic of Preventive Dentistry, Cariology and Periodontology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.

Background: To assess the effect of concomitant subgingival rinsing with 10% PVP-iodine during subgingival instrumentation on the prevalence and magnitude of bacteraemia of oral origin.

Materials And Methods: Subgingival instrumentation was performed with water or PVP-iodine rinse in patients with periodontitis. Prior to instrumentation, subjects gargled for 1 min with the allocated liquid. Pockets were then rinsed for 1 min and subgingivally instrumented with liquid-cooled (water/PVP-iodine) ultrasonic scalers (1 min). Two minutes later, a blood sample from the arm vein was drawn using a lysis centrifugation blood culture system for quantitative microbiological analysis. Non-parametric statistical tests were performed to assess differences in the prevalence and extent of bacteraemia between groups.

Results: Of the 19 samples in each group, oral-borne bacteraemia was detected in 10 of the control and 2 of the test samples. With an average of 3.0 [1; 5] colony forming units, significantly less bacteria and bacteraemia were found in the test group compared to the controls (12.2 [1; 46]) (p = 0.003). Anaerobic bacteria were not found in the test group.

Conclusions: Bacteraemia after subgingival instrumentation with concomitant PVP-iodine rinsing is reduced but not eliminated. Therefore, it might be recommended for patients at a high risk of endocarditis or infection of endoprostheses. However, preventive antibiotic treatment should not be omitted.
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http://dx.doi.org/10.1111/jcpe.12416DOI Listing
July 2015

An estimate of pocket closure and avoided needs of surgery after scaling and root planing with systemic antibiotics: a systematic review.

BMC Oral Health 2014 Dec 22;14:159. Epub 2014 Dec 22.

Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.

Background: Relevant benefits of adjunctive medication of antibiotica after conventional root surface debridement in terms of enhanced pocket depth (PD) reduction have been shown. However, means and standard deviations of enhanced reductions are difficult to translate into clinical relevant treatment outcomes such as pocket resolution or avoidance of additional surgical interventions. Accordingly, the aim of this systematic review was to calculate odds ratios for relevant cut-off values of PD after mechanical periodontal treatment with and without antibiotics, specifically the combination of amoxicilline and metronidazol, from published studies. As clinical relevant cut-off values "pocket closure" for PD ≤ 3mm and "avoidance of surgical intervention" for PD ≤ 5 mm were determined.

Methods: The databases PubMed, Embase and Central were searched for randomized clinical studies assessing the beneficial effect of the combination of amoxicillin and metronidazole after non-surgical mechanical debridement. Titles, abstracts and finally full texts were scrutinized for possible inclusion by two independent investigators. Quality and heterogeneity of the studies were assessed and the study designs were examined. From published means and standard deviations for PD after therapy, odds ratios for the clinically relevant cut-off values were calculated using a specific statistical approach.

Results: Meta-analyses were performed for the time points 3 and 6 month after mechanical therapy. Generally, a pronounced chance for pocket closure from 3 to 6 months of healing was shown. The administration of antibiotics resulted in a 3.55 and 4.43 fold higher probability of pocket closure after 3 and 6 months as compared to mechanical therapy alone. However, as the estimated risk for residual pockets > 5 mm was 0 for both groups, no odds ratio could be calculated for persistent needs for surgery. Generally, studies showed a moderate to high quality and large heterogeneity regarding treatment protocol, dose of antibiotic medication and maintenance.

Conclusion: With the performed statistical approach, a clear benefit in terms of an enhanced chance for pocket closure by co-administration of the combination of amoxicillin and metronidazole as an adjunct to non-surgical mechanical periodontal therapy has been shown. However, data calculation failed to show a benefit regarding the possible avoidance of surgical interventions.
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http://dx.doi.org/10.1186/1472-6831-14-159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531502PMC
December 2014

Mechanical and hydrodynamic homecare devices to clean rough implant surfaces - an in vitro polyspecies biofilm study.

Clin Oral Implants Res 2015 May 18;26(5):523-8. Epub 2014 Jun 18.

Clinic of Fixed Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.

Objectives: To investigate the cleaning efficacy of a mechanical and a hydrodynamic homecare device on biofilm-coated titanium surfaces with and without chlorhexidine.

Material And Methods: Six-species biofilms were grown on 108 SLA-titanium discs, which were cleaned as follows: sonic toothbrush alone (i) or in combination with either a 0.2% chlorhexidine (ii) or a placebo gel (iii) and oral irrigator (hydrodynamic action) with water (iv) or combined with 0.2% chlorhexidine solution (v). Untreated samples served as control (vi). Biofilms were then harvested either immediately after treatment (study part A) or after a regrowth phase of 24 h (study part B) and colony-forming units (CFU) were assessed. Results were analysed using Whitney U-tests between the treatment groups. After the Bonferroni correction, the significance level was set at α = 0.0033.

Results: The median CFU counts directly after instrumentation accounted - in ascending order (P-values in comparison with the control group A6 were <0.001 for all groups except for A3: P = 0.014) - 2.0E1 (A5), 1.1E5 (A4), 3.6E5 (A2), 3.3E5 (A1) and 6.8E6 (A3), respectively. The untreated control group showed the highest CFU counts: 1.8E7 (A6). After regrowth, the following CFU counts were measured in ascending order (all P-values <0.001 when compared to the control group B6 = 2.0E8): 1.6E2 (B5), 1.9E5 (B2), 1.4E7 (B4), 3.1E7 (B1) and 3.9E7 (B3).

Conclusions: An oral irrigator combined with 0.2% chlorhexidine is effective in reducing biofilms attached to rough titanium surfaces immediately after cleaning. Following a regrowth phase of 24 h, micro-organisms could be equally effective removed with a sonic toothbrush combined with 0.2% chlorhexidine and an oral irrigator with 0.2% chlorhexidine.
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http://dx.doi.org/10.1111/clr.12436DOI Listing
May 2015

Effect of direct current on surface structure and cytocompatibility of titanium dental implants.

Int J Oral Maxillofac Implants 2014 May-Jun;29(3):735-42

Purpose: A low direct current can be used to disinfect dental titanium implants in simulated physiologic environments. The aim of this study was to determine whether this treatment affects implant surface structure and cytocompatibility.

Materials And Methods: Titanium test disks with a sandblasted, acid-etched, large-grit (SLA) surface were placed as anodes in an electrolytic bath with physiologic saline and treated with 15 mA of current for 15 minutes. Surfaces were analyzed by light and electron microscopy and contact angle measurement. Depth profile analyses of SLA disks were run at subsurface levels from 0 to 1,000 nm. The proliferation and viability of preosteoblastic cells and human foreskin fibroblasts on implant surfaces were assessed. Alkaline phosphatase (ALP) activity was determined with and without exposure to bone morphogenetic protein-2 (BMP-2). Mineralization was determined after 4 weeks.

Results: A blue discoloration was observed after treating the SLA disks, but no damage was recognized microscopically. An oxidation layer formed on the surface and the wettability of the disks increased significantly. Cell proliferation and initial maturation were not affected by the treatment. Mineralization and ALP activity of BMP-exposed cells, however, were slightly but significantly reduced on test disks.

Conclusions: The current study showed that the alterations in implant color after electrochemical treatment did not reflect significant surface changes, which would preclude cell adhesion and growth or have a major impact on osteoblastic differentiation or maturation.
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http://dx.doi.org/10.11607/jomi.3342DOI Listing
July 2014

Depth determination of artificial periodontal pockets using cone-beam tomography and radio-opaque material: an in vitro feasibility study.

Swiss Dent J 2014 ;124(4):406-15

Private practice, Schaffhausen, Switzerland.

In general, periodontal tissues are clinically assessed using calibrated periodontal probes and radiographs. Due to technical developments and the availability of cone-beam computed tomography (CBCT), 3-D imaging has become feasible and offers some advantages and potential for the evaluation of complex anatomical structures. The present pilot study illustrates and validates the possibility of radiographically visualizing and metrically assessing hard and soft tissue. Artificial periodontal pockets were created in porcine mandibles and measured by clinical (i.e. pocket probing) and radiographic means (CBCT). For the latter method, pockets were filled with a radiopaque material allowing visualization by CBCT. Clinically simulated pocket depth probing and CBCT measurements were compared. The results showed no statistically significant differences between the two methods. Thus, the CBCT visualization approach points towards the development of a new and promising radiographic all- in-one evaluation system of the periodontal status. However, more research and development is required.
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March 2015

Direct composite resin fillings versus amalgam fillings for permanent or adult posterior teeth.

Cochrane Database Syst Rev 2014 Mar 31(3):CD005620. Epub 2014 Mar 31.

Argentine Dental Association (AOA), Junin 959, Buenos Aires, Argentina, C1113AAC.

Background: Amalgam has been the traditional material for filling cavities in posterior teeth for the last 150 years and, due to its effectiveness and cost, amalgam is still the restorative material of choice in certain parts of the world. In recent times, however, there have been concerns over the use of amalgam restorations (fillings), relating to the mercury release in the body and the environmental impact following its disposal. Resin composites have become an esthetic alternative to amalgam restorations and there has been a remarkable improvement of its mechanical properties to restore posterior teeth.There is need to review new evidence comparing the effectiveness of both restorations.

Objectives: To examine the effects of direct composite resin fillings versus amalgam fillings for permanent posterior teeth, primarily on restoration failure.

Search Methods: We searched the Cochrane Oral Health Group's Trials Register (to 22 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 22 October 2013), EMBASE via OVID (1980 to 22 October 2013), and LILACs via BIREME Virtual Health Library (1980 to 22 October 2013). We applied no restrictions on language or date of publication when searching the electronic databases. We contacted manufacturers of dental materials to obtain any unpublished studies.

Selection Criteria: Randomized controlled trials comparing dental resin composites with dental amalgams in permanent posterior teeth. We excluded studies having a follow-up period of less than three years.

Data Collection And Analysis: We used standard methodological procedures expected by The Cochrane Collaboration.

Main Results: Of the 2205 retrieved references, we included seven trials (10 articles) in the systematic review. Two trials were parallel group studies involving 1645 composite restorations and 1365 amalgam restorations (921 children) in the analysis. The other five trials were split-mouth studies involving 1620 composite restorations and 570 amalgam restorations in an unclear number of children. Due to major problems with the reporting of the data for the five split-mouth trials, the primary analysis is based on the two parallel group trials. We judged all seven trials to be at high risk of bias and we analyzed 3265 composite restorations and 1935 amalgam restorations.The parallel group trials indicated that resin restorations had a significantly higher risk of failure than amalgam restorations (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.52 to 2.35, P value < 0.001 (fixed-effect model) (low-quality evidence)) and increased risk of secondary caries (RR 2.14, 95% CI 1.67 to 2.74, P value < 0.001 (low-quality evidence)) but no evidence of an increased risk of restoration fracture (RR 0.87, 95% CI 0.46 to 1.64, P value = 0.66 (moderate-quality evidence)). The results from the split-mouth trials were consistent with those of the parallel group trials.Adverse effects of dental restorations were reported in two trials. The outcomes considered were neurobehavioral function, renal function, psychosocial function, and physical development. The investigators found no difference in adverse effects between composite and amalgam restorations. However, the results should be interpreted with caution as none of the outcomes were reported in more than one trial.

Authors' Conclusions: There is low-quality evidence to suggest that resin composites lead to higher failure rates and risk of secondary caries than amalgam restorations. This review reinforces the benefit of amalgam restorations and the results are particularly useful in parts of the world where amalgam is still the material of choice to restore posterior teeth with proximal caries. Though the review found insufficient evidence to support or refute any adverse effects amalgam may have on patients, new research is unlikely to change opinion on its safety and due to the decision for a global phase-down of amalgam (Minamata Convention on Mercury) general opinion on its safety is unlikely to change.
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http://dx.doi.org/10.1002/14651858.CD005620.pub2DOI Listing
March 2014