Publications by authors named "S Samietz"

34 Publications

Polypharmacy and saliva volumes in the northeast of Germany - The Study of Health in Pomerania.

Community Dent Oral Epidemiol 2021 Apr 7. Epub 2021 Apr 7.

Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.

Objectives: Associations between saliva volumes or salivary flow rates and potentially xerogenic medication are rarely evaluated in cohorts with a wide age range. This cross-sectional cohort study investigated possible relationships between the regular consumption of potentially xerogenic medication and stimulated saliva volumes.

Methods: Data from the German Studies of Health in Pomerania (SHIP-2 and SHIP-Trend-0) were pooled. Potentially xerogenic medications were identified using the Workshop on Oral Medicine VI criteria. Stimulated saliva was sampled using Salivette®, and saliva volumes expressed as μl/min were determined. Applying linear mixed models with adjustment for time point of saliva collection, associations of (a) age and sex with regularly consumed medication, (b) age and sex with saliva volumes, and (c) the number of regularly consumed xerogenic medications with saliva volumes were evaluated.

Results: Six thousand seven hundred and fifty-three participants aged 20-83 years (mean 53.4 ± 14.9) were included. The average number of medications did not differ markedly between females (2.21 ± 2.46) and males (2.24 ± 2.83). Males took more potentially xerogenic medication (1.0 ± 1.3) than did females (0.9 ± 1.3). Also, males took more potentially xerogenic cardiovascular medications than did females (0.9 ± 1.2 versus 0.7 ± 1.1), while females were prescribed a higher number of potentially xerogenic medications affecting the nervous system (0.2 ± 0.5 versus 0.1 ± 0.4). The average stimulated saliva volume was 967.0 ± 433.3 µL/min. Regularly consumed and potentially xerogenic medications were associated with lower saliva volumes. Older age correlated not only with a higher number of total medications and a higher number of xerogenic medications affecting either the cardiovascular (in males) or the nervous system (in females), but also with lower saliva volumes.

Conclusions: Ageing was associated with polypharmacy, especially with the intake of potentially xerogenic medication, and lower average saliva volumes. With regard to complications of dry mouth, anamnesis of medication consumption is of high importance.
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http://dx.doi.org/10.1111/cdoe.12644DOI Listing
April 2021

Prevalence and risk factors of potentially malignant disorders of the mucosa in the general population: Mucosa lesions a general health problem?

Ann Anat 2021 Mar 30;237:151724. Epub 2021 Mar 30.

Institute for Community Medicine, University Medicine Greifswald, Germany.

Aim: Oral cancer mostly develops from oral mucosa regions with morphological alterations transforming malignant. These visible precancerous mucosa lesions are named potentially malignant disorders (PMD). We aimed to analyze the prevalence of PMD and its risk factors for PMD in a population-based sample in Northern Germany.

Material And Methods: Data of 6078 individuals from the population-based Study of Health in Pomerania (SHIP) was used. PMD were photographically documented and periodontal health was assessed in a standardized procedure.

Results: PMD were observed in 54 individuals (0.9%). The most prevalent PMD was homogenous leukoplakia (n = 37) followed by Lichen ruber (n = 9). Smoking (Odds Ratio (OR) 2.70; 95% confidence interval (CI): 1.24-5.87), male sex (OR 3.32; 95%-CI: 1.77-6.21), type 2 diabetes mellitus (OR 2.07; 95%-CI: 1.08-3.98) and body mass index (OR 1.09; CI 1.04-1.14) were significantly associated with PMD, with the corresponding area under the curve (AUC) being 0.696 (CI: 0.655; 0.737).

Conclusion: Our results suggest a clinically relevant prevalence of PMD in the population. We identified male sex, type 2 diabetes mellitus, current smoking, and obesity as risk factors. We recommend photographic documentation and intensified training of medical and dental staff to detect and monitor PMD.
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http://dx.doi.org/10.1016/j.aanat.2021.151724DOI Listing
March 2021

Is Continuous Eruption Related to Periodontal Changes? A 16-Year Follow-up.

J Dent Res 2021 Mar 3:22034521999363. Epub 2021 Mar 3.

Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics, University Medicine Greifswald, Greifswald, Germany.

The aims of this study were to 1) determine if continuous eruption occurs in the maxillary teeth, 2) assess the magnitude of the continuous eruption, and 3) evaluate the effects of continuous eruption on the different periodontal parameters by using data from the population-based cohort of the Study of Health in Pomerania (SHIP). The jaw casts of 140 participants from the baseline (SHIP-0) and 16-y follow-up (SHIP-3) were digitized as 3-dimensional models. Robust reference points were set to match the tooth eruption stage at SHIP-0 and SHIP-3. Reference points were set on the occlusal surface of the contralateral premolar and molar teeth, the palatal fossa of an incisor, and the rugae of the hard palate. Reference points were combined to represent 3 virtual occlusal planes. Continuous eruption was measured as the mean height difference between the 3 planes and rugae fix points at SHIP-0 and SHIP-3. Probing depth, clinical attachment levels, gingiva above the cementoenamel junction (gingival height), and number of missing teeth were clinically assessed in the maxilla. Changes in periodontal variables were regressed onto changes in continuous eruption after adjustment for age, sex, number of filled teeth, and education or tooth wear. Continuous tooth eruption >1 mm over the 16 y was found in 4 of 140 adults and averaged to 0.33 mm, equaling 0.021 mm/y. In the total sample, an increase in continuous eruption was significantly associated with decreases in mean gingival height ( = -0.34; 95% CI, -0.65 to -0.03). In a subsample of participants without tooth loss, continuous eruption was negatively associated with PD. This study confirmed that continuous eruption is clearly detectable and may contribute to lower gingival heights in the maxilla.
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http://dx.doi.org/10.1177/0022034521999363DOI Listing
March 2021

Associations of plasma YKL-40 concentrations with heel ultrasound parameters and bone turnover markers in the general adult population.

Bone 2020 12 6;141:115675. Epub 2020 Oct 6.

Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine, Greifswald, Germany. Electronic address:

Objective: YKL-40, also known as chitinase-3-like protein 1, is a new proinflammatory biomarker, that might play a role in tissue remodeling and bone resorption. Here we evaluated the associations of the YKL-40 plasma concentration with heel ultrasound parameters and bone turnover markers (BTMs) in adult men and women from the general population. We tested for a causal role of YKL-40 on bone metabolism using published single nucleotide polymorphisms (SNPs) with consequences for YKL-40 expression and function.

Methods: Data were obtained from two population-based cohorts: the Study of Health in Pomerania (SHIP) and SHIP-Trend. Quantitative ultrasound (QUS) measurements at the heel were performed and bone turnover was assessed by measurement of intact amino-terminal propeptide of type I procollagen (PINP) and carboxy-terminal telopeptide of type I collagen (CTX). Associations between the YKL-40 plasma concentration and the QUS-based parameters, bone turnover marker (BTM) concentrations and 44 SNPs, including the lead SNP rs4950928, were evaluated in 382 subjects. Furthermore, we assessed the associations between the same SNPs and the QUS-based parameters (n = 5777) or the BTM concentrations (n = 7190).

Results: Sex-specific linear regression models adjusted for a comprehensive panel of interfering covariantes revealed statistically significant inverse associations between YKL-40 and all QUS-based parameters as well as positive associations with CTX in women. The rs4950928 polymorphism was associated with YKL-40 in men and women but none of the tested SNPs was associated with the QUS-based parameters or the BTMs after correction for multiple testing.

Conclusions: Plasma YKL-40 concentrations are associated with QUS-based parameters as well as CTX concentrations in women but these associations are probably not causal.
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http://dx.doi.org/10.1016/j.bone.2020.115675DOI Listing
December 2020

[Design and quality control of the oral health status examination in the German National Cohort (GNC)].

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020 Apr;63(4):426-438

Klinik für Zahnerhaltung, Parodontologie und Präventive Zahnheilkunde, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, Gebäude 73, 66421, Homburg/Saar, Deutschland.

Background: Caries and periodontitis are highly prevalent worldwide. Because detailed data on these oral diseases were collected within the framework of the German National Cohort (GNC), associations between oral and systemic diseases and conditions can be investigated.

Objectives: The study protocol for the oral examination was designed to ensure a comprehensive collection of dental findings by trained non-dental staff within a limited examination time. At the mid-term of the GNC baseline examination, a first quality evaluation was performed to check the plausibility of results and to propose measures to improve the data quality.

Materials And Methods: A dental interview, saliva sampling and oral diagnostics were conducted. As part of the level‑1 examination, the number of teeth and prostheses were recorded. As part of the level‑2 examination, detailed periodontal, cariological and functional aspects were examined. All examinations were conducted by trained non-dental personnel. Parameters were checked for plausibility and variable distributions were descriptively analysed.

Results: Analyses included data of 57,967 interview participants, 56,913 level‑1 participants and 6295 level‑2 participants. Percentages of missing values for individual clinical parameters assessed in level 1 and level 2 ranged between 0.02 and 3.9%. Results showed a plausible distribution of the data; rarely, implausible values were observed, e.g. for measurements of horizontal and vertical overbite (overjet and overbite). Intra-class correlation coefficients indicated differences in individual parameters between regional clusters, study centres and across different examiners.

Conclusions: The results confirm the feasibility of the study protocol by non-dental personnel and its successful integration into the GNC's overall assessment program. However, rigorous dental support of the study centres is required for quality management.
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http://dx.doi.org/10.1007/s00103-020-03107-wDOI Listing
April 2020

The Saliva Metabolome in Association to Oral Health Status.

J Dent Res 2019 06 26;98(6):642-651. Epub 2019 Apr 26.

8 Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.

Periodontitis is one of the most prevalent oral diseases worldwide and is caused by multifactorial interactions between host and oral bacteria. Altered cellular metabolism of host and microbes releases a number of intermediary end products known as metabolites. There is an increasing interest in identifying metabolites from oral fluids such as saliva to widen the understanding of the complex pathogenesis of periodontitis. It is believed that some metabolites might serve as indicators toward early detection and screening of periodontitis and perhaps even for monitoring its prognosis in the future. Because contemporary periodontal screening methods are deficient, there is an urgent need for novel approaches in periodontal screening procedures. To this end, we associated oral parameters (clinical attachment level, periodontal probing depth, supragingival plaque, supragingival calculus, number of missing teeth, and removable denture) with a large set of salivary metabolites ( n = 284) obtained by mass spectrometry among a subsample ( n = 909) of nondiabetic participants from the Study of Health in Pomerania (SHIP-Trend-0). Linear regression analyses were performed in age-stratified groups and adjusted for potential confounders. A multifaceted image of associated metabolites ( n = 107) was revealed with considerable differences according to age groups. In the young (20 to 39 y) and middle-aged (40 to 59 y) groups, metabolites were predominantly associated with periodontal variables, whereas among the older subjects (≥60 y), tooth loss was strongly associated with metabolite levels. Metabolites associated with periodontal variables were clearly linked to tissue destruction, host defense mechanisms, and bacterial metabolism. Across all age groups, the bacterial metabolite phenylacetate was significantly associated with periodontal variables. Our results revealed alterations of the salivary metabolome in association with age and oral health status. Among our comprehensive panel of metabolites, periodontitis was significantly associated with the bacterial metabolite phenylacetate, a promising substance for further biomarker research.
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http://dx.doi.org/10.1177/0022034519842853DOI Listing
June 2019

Erratum to "Comparison of Oral Microbe Quantities from Tongue Samples and Subgingival Pockets".

Int J Dent 2018 19;2018:5615780. Epub 2018 Jul 19.

Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.

[This corrects the article DOI: 10.1155/2018/2048390.].
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http://dx.doi.org/10.1155/2018/5615780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6079432PMC
July 2018

Validation of a purpose-built chewing gum and smartphone application to evaluate chewing efficiency.

J Oral Rehabil 2018 Nov 3;45(11):845-853. Epub 2018 Aug 3.

Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.

Objectives: To validate a purpose-built two-coloured chewing gum (Hue-Check Gum ), and to test the accuracy of a custom-built smartphone application for a colour-mixing ability test to assess chewing function.

Methods: Fully dentate participants (28D-group) and edentulous participants with implant overdentures (IOD-group) were recruited. They chewed a Hue-Check Gum for 5, 10, 20, 30 and 50 chewing cycles, respectively. Maximum voluntary bite force (MBF) was assessed with a digital gauge. The specimens were analysed according to their colour mixture (variance of hue, VOH) with a validated software (VOH_scan) and a newly developed smartphone application (VOH_app).

Results: Participants segregated by dental state were significantly different regarding the number of occluding pairs of teeth, age and MBF. VOH_scan showed a negative logarithmic association with the number of chewing cycles, and VOH could be predicted from chewing cycles, MBF and gender. The clearest discrimination between the IOD and the 28D groups was observed for n = 20 chewing cycles; at this point, VOH was distinguishably different with a P-value < 0.0001. The VOH_app was a very good predictor for VOH_scan with 0.80 < pseudo-R  < 0.83, depending on light exposure and measuring distance. There was, however, a systematic error in the accuracy of the app for inadequately chewed specimens.

Conclusions: The use of the two-coloured chewing gum would provide a fast, simple and inexpensive method for the assessment of masticatory performance, which could be used in geriatric wards or in private practices without the requirement of specialised equipment or trained staff.
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http://dx.doi.org/10.1111/joor.12696DOI Listing
November 2018

Reducing uncertainty in estimating associations of oral exposures with Helicobacter pylori serology in the general population.

J Clin Periodontol 2018 09 27;45(9):1056-1068. Epub 2018 Jul 27.

Department of Medicine 2, Universitätsklinikum München (KUM), Ludwig-Maximilians-Universität, Munich, Germany.

Aim: Evidence for reducing Helicobacter (H.) pylori by periodontal therapy comes from small studies in China, limiting generalizability. To estimate the association between periodontal disease and anti-H. pylori IgG titer levels in a European country, we used population-based data from the Study of Health in Pomerania.

Materials And Methods: For pocket depth as the primary exposure, we restricted the age range to participants younger than 60 years (n = 2,481) to avoid selection bias due to edentulism in this cross-sectional study. For the full age range up to 81 years, we chose the number of missing teeth (n = 3,705).

Results: The association between pocket depth and the outcome was weak. Given the ceiling effect for the number of missing teeth (ordinal logistic regression; odds ratio of the interquartile range effect = 1.6; 95% CI: 1.3-1.9; p-value for linearity = 0.005), we checked whether wearing removable dental prosthesis was associated with higher anti-H. pylori IgG titer levels (odds ratio = 1.3; 95% CI: 1.1-1.5).

Conclusions: Tooth loss and wearing removable dental prosthesis were weakly to moderately associated with higher anti-H. pylori IgG titer levels in the general population of a European country.
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http://dx.doi.org/10.1111/jcpe.12983DOI Listing
September 2018

Comparison of Oral Microbe Quantities from Tongue Samples and Subgingival Pockets.

Int J Dent 2018 26;2018:2048390. Epub 2018 Apr 26.

Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany.

Objectives: To improve understanding of periodontitis pathology, we need more profound knowledge of relative abundances of single prokaryotic species and colonization dynamics between habitats. Thus, we quantified oral microbes from two oral habitats to gain insights into colonization variability and correlation to the clinical periodontal status.

Methods: We analyzed tongue scrapings and subgingival pocket samples from 237 subjects (35-54 years) with at least 10 teeth and no recent periodontal treatment from the 11-year follow-up of the Study of Health in Pomerania. Relative abundances of , , , , total bacteria, and were correlated to clinically assessed pocket depths (PD) and clinical attachment levels (CAL).

Results: Increased relative abundances of , , and were linked to increased levels of PD and CAL (i) on the subject level (mean PD, mean CAL) and (ii) in subgingival pockets. Relative abundances of from tongue samples correlated negatively with mean PD or mean CAL. Detection and quantity of bacterial species correlated weakly to moderately between the tongue and subgingival pocket, except for .

Conclusions: Relative abundances of specific oral species correlated weakly to moderately between habitats. Single species, total bacteria, and were linked to clinically assessed severity of periodontitis in a habitat-dependent manner.
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http://dx.doi.org/10.1155/2018/2048390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944217PMC
April 2018

Prosthetic Tooth Replacement in a German Population Over the Course of 11 Years: Results of the Study of Health in Pomerania.

Int J Prosthodont 2018 May/Jun;31(3):248-258

Purpose: To evaluate changes in distribution of teeth and in prosthodontic tooth replacement during an 11-year period in an adult population.

Materials And Methods: Information on prosthetic status was collected from 4,288 participants aged 20 to 81 years at baseline in the Study of Health in Pomerania (SHIP-0) and from 2,244 participants aged 30 to 92 years who reappeared in the 11-year follow-up (SHIP-2). The tooth distribution per arch was classified into one of the six following classes: class 0 (edentulous), class 1 (one to three remaining teeth), class 2 (extended tooth-bounded space or extreme shortened dental arch), class 3 (small anterior space), class 4 (small posterior space with one or more missing premolars), or class 5 (functional dentition).

Results: Longitudinally, the most pronounced change in class was the transition from class 1 to class 0 (maxilla: 54.5%, mandible: 58.3%). The percent change from other higher classes to lower classes ranged between 10% and 40%. In the same age groups of 40 to 79 years, the number of edentate arches was cut in half, with a corresponding increase in functional dentitions. The proportion of unrestored arches decreased in all classes. Double crown-retained partial removable dental prostheses (PRDPs) showed the highest increase (a 15% to 20% increase) at the expense of acrylic PRDPs in classes 1 and 2. In small spaces, the proportion of fixed dental prostheses (FDPs) also increased by 15% to 20%. Seven participants of SHIP-0 (0.16%) and 56 participants of SHIP-2 (2.5%) had dental implants.

Conclusion: Similar age groups showed improvement in oral conditions. The proportion of higher-end restorations (FDPs and double crown-retained PRDPs), including the frequency of dental implants, increased.
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http://dx.doi.org/10.11607/ijp.5660DOI Listing
August 2018

Cross-sectional association between oral health and retinal microcirculation.

J Clin Periodontol 2018 04 9;45(4):404-412. Epub 2018 Mar 9.

Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany.

Aim: To investigate the relation between oral health status and microcirculation, we analysed the association between periodontitis and number of teeth with retinal vessel diameters in a population-based study.

Methods: We analysed data from the Study of Health in Pomerania-TREND (SHIP-TREND). All subjects (3,183 for number of teeth, 3,013 for mean probing depth and 2,894 for mean attachment level) underwent nonmydriatic funduscopy and dental examination. We measured central retinal arteriolar (CRAE), venular (CRVE) vessel diameters and calculated arterio-venous ratio (AVR) from static vessel analysis (SVA). Periodontal status was assessed using the case definition of the Center for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP). Data were analysed by linear (CRAE, CRVE, AVR) and logistic regression (AVR < 0.8) adjusted for age, sex, smoking status, alcohol consumption, body mass index, systolic blood pressure, hsCRP and type-2-diabetes mellitus.

Results: Only in men, significant associations were found between periodontal and retinal conditions. Severe periodontitis [β = -0.0120 (-0.0218; -0.0007 95%-CI)] and mean probing depth [β = -0.0054 (-0.0105; -0.0002 95%-CI)] were inversely associated with AVR; severe periodontitis [β = 3.80 (0.61; 6.98 95%-CI)], mean probing depth [β = 1.86 (0.23; 3.49 95%-CI)] and mean attachment level [β = 1.31 (0.34; 2.27 95%-CI)] with CRVE and mean attachment level with CRAE [β = 0.91 (0.14; 1.69 95%-CI)].

Conclusions: Our results point towards an association between periodontal conditions and AVR in men. Periodontitis may impact microvascular endothelium function. Improving oral health to reduce periodontitis might lead to reduced risk for other age-related diseases.
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http://dx.doi.org/10.1111/jcpe.12872DOI Listing
April 2018

Impact of prosthodontic rehabilitation on the masticatory performance of partially dentate older patients: Can it predict nutritional state? Results from a RCT.

J Dent 2018 01 10;68:66-71. Epub 2017 Nov 10.

Division of Gerodontology, University of Bern, Switzerland; Division of Gerodontology and Removable Prosthodontics, University of Geneva, Switzerland. Electronic address:

Objectives: With a decreased number of teeth, a reduction in chewing function can contribute to changes in food choices and ultimately impact on overall nutritional status. This study compared the impact of two tooth replacement strategies for partially dentate older patients on masticatory performance and nutritional status.

Methods: Patients aged 65 years and older were randomly allocated to two different treatment groups. For the RPDP-group (removable partial dental prostheses) each participant was restored to complete dental arches with cobalt-chromium removable prostheses. For the SDA-group (shortened dental arch), participants were restored to 10 occluding pairs of natural and replacement teeth using adhesive bridgework. Masticatory performance was assessed with a colour-mixing ability test. Each patient provided haematological samples that were screened for biochemical markers of nutritional status. Patients were also assessed using the Mini Nutritional Assessment (MNA).

Results: Eighty-nine patients completed the test for masticatory performance and provided blood samples and MNA scores at baseline (BL) and after 12 months (12m). Masticatory performance (p<0.001) and MNA (p<0.05) increased significantly in both groups, but no significant between group differences were noted. A mixed picture was observed for nutrition biomarkers. Mixed-effect linear regression models did not demonstrate that nutritional status could be predicted from masticatory performance.

Conclusions: These results indicate that prosthodontic rehabilitation according to the principles of the SDA is equivalent to RPDPs in terms of restoration of chewing capacity for partially dentate older patients. However, masticatory performance may only have minor associations with nutritional status for this patient group.

Clinical Significance: Replacing teeth with either RPDPs or SDA provides a prerequisite for efficient chewing. Further research is required to determine the impact of oral rehabilitation coupled with nutritional counselling for this patient population.
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http://dx.doi.org/10.1016/j.jdent.2017.11.003DOI Listing
January 2018

Development and testing of satisfaction questionnaires for patients with removable dental prostheses.

Quintessence Int 2017 ;48(6):487-496

Objective: To develop and test self-administered satisfaction questionnaires for patients with removable dental prostheses (RDPs) in the German language.

Method And Materials: A three-phase methodology was used. A pilot questionnaire was developed in phase one. At the end of phase two, the final version of the questionnaires were reached. In phase three, 192 questionnaires were distributed to evaluate the psychometric properties of the final version of the questionnaires. Construct validity, content validity from the patients' perspective, and questionnaire reliability were estimated.

Results: At the end of phase two, the final versions of the questionnaires were defined as instruments with good face validity. At the end of phase three, content validity from the patients' perspective was assessed and found to be good. Exploratory factor analysis identified a one-factor model for each questionnaire. Consequently, each questionnaire was summed to create a single index. Internal consistency of the indexes was assessed using Cronbach's α and found to be excellent (α > 0.9). A high repeatability of all the items was identified through a test-retest. Intra-class correlation coefficient (ICC) values ranged from 0.80 to 0.99.

Conclusion: The questionnaires and indexes are valid and highly reliable instruments, and can be used to measure patient satisfaction with RDPs.
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http://dx.doi.org/10.3290/j.qi.a38201DOI Listing
October 2018

Four-year outcomes of restored posterior tooth surfaces-a massive data analysis.

Clin Oral Investig 2017 Dec 28;21(9):2819-2825. Epub 2017 Feb 28.

Department of Prosthetic Dentistry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.

Objectives: There is only sparse knowledge concerning the outcomes of treatments with posterior permanent restorations in general practice settings. This study aimed at evaluating outcomes based on a large dataset by using a novel approach on a tooth surface basis.

Materials And Methods: The study based on routine data from a major German national health insurance company. Respective treatment fee codes allowed for tracking the clinical courses on a tooth surface level. The study intervention was defined as the placement of a restoration on an interproximal or occlusal posterior tooth surface regardless of its actual extension and material on which no information was available. All surfaces restored between January 1st, 2010 and December 31st, 2013 were included. Kaplan-Meier survival analyses were conducted to estimate four-year survival. The primary outcome was a restorative re-intervention on the same tooth surface. Separate analyses were performed for the secondary outcomes "crowning" and "extraction".

Results: Over ten million interproximal surfaces and eight million occlusal surfaces in nine million posterior teeth had been restored. At 4 years, the cumulative survival rates concerning the primary outcome "re-intervention" for mesial surfaces (81.4%; CI 81.3-81.5%) and distal surfaces (81.2%; CI 81.1-81.2%) differed significantly from those for occlusal surfaces (77.0%; CI 76.9-77.0%). Restored surfaces in premolars showed significantly higher survival rates compared to molars. Four-year survival rates for the secondary outcome "crowning" were 91.9% (CI 91.8-91.9%) for mesial surfaces, 92.1% (CI 92.1-92.2%) for distal surfaces and 93.3% (CI 93.2-93.3%) for occlusal surfaces. The respective rates for the secondary outcome "extraction" were 94.5% (CI 94.5-94.5%) for mesial surfaces, 94.8% (CI 94.7-94.8%) for distal surfaces and 95.4% (CI 95.4-95.5%) for occlusal surfaces.

Conclusions: Re-interventions after restorative treatment play a significant role in general practice settings. Surface-related survival rates of restorations reveal a need for improvement.

Clinical Relevance: This study allows the estimation of the probability of re-interventions after restoring posterior tooth surfaces. It is based on several million cases from general practises under the terms and conditions of a national health insurance system.
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http://dx.doi.org/10.1007/s00784-017-2084-4DOI Listing
December 2017

Re-interventions after restoring teeth-Mining an insurance database.

J Dent 2017 Feb 23;57:14-19. Epub 2016 Nov 23.

Department of Prosthetic Dentistry, Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Fetscherstraße 74, 01307 Dresden, Germany. Electronic address:

Objectives: The aim of this study was to examine re-interventions after restorative treatment.

Methods: The data was collected from the digital database of a major German national health insurance company. Only permanent teeth were observed. Placing a permanent restoration other than a crown regardless of involved surfaces and material was the study intervention. The data did not allow for a differentiation between fillings and inlays that were estimated only a very small portion of the restorations. Success was defined as not undergoing any restorative re-intervention with fillings or inlays on the same tooth (primary outcome) and assessed with Kaplan-Meier survival analyses over four years. An additional analysis was conducted rating "crowning" and "extraction" of respective teeth as target events. Differences were tested with the Log-Rank-test. A multivariate Cox regression analyses was carried out.

Results: A total of 17,024,344 restorations placed in 4,825,408 anterior teeth and 9,973,177 posterior teeth could be traced. Focussing on the primary outcome re-intervention, the cumulative four-year success rate was 69.9% for one surface restorations, 74.8% for two surface restorations, 66.6% for three surface restorations and 61.0% for four surface and more extended restorations. These differences were significant (p<0.0001). Focussing on all three target events re-intervention, crowning and extraction, the cumulative four-year success rate was 66.1% for one surface restorations, 67.5% for two surface restorations, 63.0% for three surface restorations and 55.8% for four surface and more extended restorations. The number of restoration surfaces as well as the tooth position remained significant in the multivariate Cox regression.

Conclusions: The sustainability of restorative dental treatment under the terms and conditions of the German national health insurance system shows room for improvement. From a public health perspective, special focus should be laid on primary and secondary prevention to minimize the restorative treatment need.

Clinical Significance Statement: This study shows that re-interventions are observed regularly after restorative treatment. Therefore, preventive and restorative strategies should be revisited and optimised.
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http://dx.doi.org/10.1016/j.jdent.2016.11.011DOI Listing
February 2017

Reduced Bone Stiffness in Women Is Associated with Clinical Attachment and Tooth Loss: The Study of Health in Pomerania.

J Dent Res 2016 Dec 21;95(13):1464-1471. Epub 2016 Sep 21.

Department of Study of Health in Pomerania / Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.

The authors evaluated the association of reduced bone stiffness of the calcaneus with clinical attachment loss (CAL) and tooth loss. The authors analyzed data from 4,678 subjects (2,384 women), aged 20 to 88 y, from the second follow-up of the population-based Study of Health in Pomerania (SHIP-2) and the baseline examination of the SHIP-Trend cohort. Bone stiffness, characterized by the stiffness index (SI) and the osteoporotic fracture risk (OFR), was assessed by quantitative ultrasound of the heel. SI and OFR were significantly associated with the mean CAL in women. While 1) the SI showed a significant association with the mean CAL and 2) the OFR with the median number of teeth in just the postmenopausal women, the OFR showed a significant association with mean CAL for both pre- and postmenopausal women. In postmenopausal women, a 10-unit increase in the SI was associated with a decrease in the mean CAL of 0.05 mm (95% confidence interval [CI]: -0.10 to 0.00; P = 0.046). Moreover, the adjusted median number of teeth was 21.4 (95% CI: 20.9 to 21.9) among the postmenopausal women with a low OFR, while it was 19.1 (95% CI: 17.8 to 20.3; P = 0.001) among the postmenopausal women with a high OFR. For the premenopausal women with a low OFR, the mean CAL was 1.60 mm (95% CI: 1.53 to 1.66), while for the premenopausal women with a high OFR, it was 2.24 mm (95% CI: 1.78 to 2.69; P = 0.006). Reduced bone stiffness was associated with clinical attachment and tooth loss in women but not in men.
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http://dx.doi.org/10.1177/0022034516666491DOI Listing
December 2016

Exome Variant Analysis of Chronic Periodontitis in 2 Large Cohort Studies.

J Dent Res 2017 Jan 1;96(1):73-80. Epub 2016 Oct 1.

5 Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.

Periodontitis is characterized by inflammation of the gingival tissue. The main risk factors are socioeconomic factors, sex, age, smoking, and diabetes, but periodontal disease has also a genetic background. Previous genome-wide association studies failed to reveal genome-wide significant associations of single common single-nucleotide polymorphisms with chronic periodontitis. Using the Illumina ExomeChip data of 6,576 participants of the German population-based cohort studies Study of Health in Pomerania (SHIP) and SHIP-Trend, the authors performed single variant and also gene-based association studies of rare and common exonic variations on different periodontal case definitions. Although our study comprised the largest sample size to date to assess genetic predisposition for chronic periodontitis, the authors found no significant association. This study emphasizes that for chronic periodontitis, large sample sizes will be necessary to find genetic associations, even when examining rare genetic variants.
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http://dx.doi.org/10.1177/0022034516665076DOI Listing
January 2017

Prospective association of sex steroid concentrations with periodontal progression and incident tooth loss.

J Clin Periodontol 2016 Jan 26;43(1):10-8. Epub 2016 Jan 26.

Policlinic of Prosthetic Dentistry, Gerodontology and Biomaterials, Center of Oral Health, University Medicine Greifswald, Greifswald, Germany.

Aim: The aim of this study was to determine the prospective association between sex steroid concentrations with periodontal progression and incident tooth loss in men and women.

Methods: We used data from 1465 women and 1838 men (age 20-81 years) with completed five-year-follow-up from the Study-of-Health-in-Pomerania, a population-based longitudinal cohort. Serum levels of total testosterone (TT) and other sex steroids were measured. Mean clinical attachment loss (CAL) and the number of teeth were assessed. Generalized regression models were implemented for cross-sectional and longitudinal analyses, adjusting for age, education, smoking, waist circumference, diabetes, physical activity, blood sampling time and time between baseline and follow-up.

Results: Fully adjusted models revealed no consistent associations between TT and mean CAL, neither in cross-sectional [men: ß = -0.0004 (-0.023;0.022), p = 0.97; women: ß = -0.033 (-0.057; -0.009), p = 0.006] nor in longitudinal analyses [men: ß = -0.033 (-0.100;0.034), p = 0.33; women: ß = -0.023 (-0.086;0.040), p = 0.47]. For tooth loss, neither cross-sectional nor longitudinal associations with any of the sex steroid concentrations were found.

Conclusions: No consistent associations of sexual steroids with periodontal progression or tooth loss were found. Further cohort studies are necessary to evaluate possible associations between endocrinological parameters, like supra- or subphysiologic testosterone concentrations, and periodontal progression or tooth loss.
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http://dx.doi.org/10.1111/jcpe.12493DOI Listing
January 2016

Resin-based pit-and-fissure sealants: microleakage reduction and infiltration enhancement using a bonding agent.

J Adhes Dent 2015 Feb;17(1):59-65

Purpose: To evaluate the marginal microleakage and the infiltration ability of pit-and-fissure sealants by applying the conventional sealing technique in comparison to using an additional bonding agent.

Materials And Methods: Extracted non-carious permanent molars (n = 60) were first stored in sterile saline solution and then assigned to one of two groups: group C (control) was sealed (Helioseal F) by using the conventional technique, while in group BA (bonding agent), a bonding agent (OptiBond FL) was additionally applied prior to sealing. The teeth were thermocycled (1000 cycles, 5°C to 55°C, dwell time 30 s), then varnished and immersed in 5% methylene blue solution for 24 h. After embedding and sectioning each tooth into 6-12 slices, the presence of microleakage, unfilled areas, and air bubbles trapped in the sealant were assessed with a stereomicroscope.

Results: A higher proportion of microleakage was found under sealants applied without the additional use of the bonding agent. A statistically significant difference in microleakage was noted between the groups (p = 0.045). Regarding the presence of unfilled areas, a statistically significant difference between the groups was observed (p < 0.001), especially since no unfilled areas were found at all in the samples of the group using the bonding agent. Regarding the amount of air bubbles trapped in the sealant, no statistically significant difference was observed between the two groups (p = 0.829).

Conclusion: Under these in vitro conditions, sealant procedures using an additional bonding agent applied beforehand significantly improved fissure infiltration and microleakage prevention significantly.
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http://dx.doi.org/10.3290/j.jad.a33504DOI Listing
February 2015

Pocket depth and bleeding on probing and their associations with dental, lifestyle, socioeconomic and blood variables: a cross-sectional, multicenter feasibility study of the German National Cohort.

BMC Oral Health 2015 Jan 21;15. Epub 2015 Jan 21.

Institute of Public Health, University of Heidelberg, lm Neuenheimer Feld 324, 69120 Heidelberg, Germany.

Background: To investigate the periodontal disease status in a multi-center cross-sectional study in Germany. Associations of dental, socio-economic, blood and biomedical variables with periodontal outcome parameters were evaluated.

Methods: From 4 different centers N = 311 persons were included, drawn randomly from the registration offices. Maximal pocket depth (PD) was used as primary indicator for periodontitis. It was classified as: no/mild ≤3 mm, moderate 4-5 mm, severe ≥6 mm. Associations between socioeconomic (household income, education), lifestyle, and biomedical factors and PD or bleeding on probing (BOP) per site ("Yes"/"No") was analyzed with logistic regression analysis.

Results: Mean age of subjects was 46.4 (range 20-77) years. A significantly higher risk of deeper pockets for smokers (OR = 2.4, current vs. never smoker) or persons with higher BMI (OR = 1.6, BMI increase by 5) was found. Severity of periodontitis was significantly associated with caries lesions (p = 0.01), bridges (p < .0001), crowns (p < .0001), leukocytes (p = 0.04), HbA1c (p < .0001) and MCV (p = 0.04). PD was positively correlated with BOP. No significant associations with BOP were found in regression analysis.

Conclusions: Earlier findings for BMI and smoking with severity of PD were confirmed. Dental variables might be influenced by potential confounding factors e.g. dental hygiene. For blood parameters interactions with unknown systemic diseases may exist.
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http://dx.doi.org/10.1186/1472-6831-15-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324664PMC
January 2015

Outcome-Based Quality Control by a Dental Reference Profile of a Population-Based Study (SHIP-0).

Int Sch Res Notices 2015 2;2015:794769. Epub 2015 Jul 2.

Center of Oral Health, University Medicine Greifswald, Department of Prosthetic Dentistry, Gerodontology and Biomaterials, Rotgerberstraße 8, 17475 Greifswald, Germany.

Objectives. The aim was to develop an instrument for quality control in dental practices. We compared the number of teeth of subjects of the Study of Health in Pomerania (SHIP-0) with those from patients of dental practices. Methods. Patients from seven dental practices (n = 1,497) were randomly sampled by age strata and gender for a period of two years. Dental status derived from patient files was transformed into practice profiles using age-specific number of teeth as a parameter. Practice profiles were compared with a nomogram, which was based on the age-specific number of teeth of 3,990 SHIP-0 participants regularly visiting the dentist. Further, negative binomial regression models were evaluated to model associations between the number of teeth with age and dental practices, including interactions. Results. The practice profiles ranged between the 45th and 95th quantile curves of the reference population SHIP-0. The rate ratios (RR) for the number of missing teeth ranged from 0.37 to 0.67 (p < 0.001) between the different dental practices, indicating lower risk for higher numbers of missing teeth in comparison to SHIP-0. Conclusions. This study showed considerable differences between dental practices and the reference population of SHIP-0 regarding the pattern of tooth loss and confirms the value of nomograms to compare age-specific numbers of teeth between patients of dental practices and a population-based-study as a tool for quality control. For further analyses, the socioeconomic status of patients and relevant risk factors will be used to adjust for structural differences in order to improve the validity of the comparisons.
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http://dx.doi.org/10.1155/2015/794769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4897377PMC
June 2016

Prospective Study of Serum 25-hydroxy Vitamin D and Tooth Loss.

J Dent Res 2014 Jul 14;93(7):639-44. Epub 2014 May 14.

Unit of Periodontology, University Medicine, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany

Vitamin D deficiency and oral diseases (periodontitis, caries, and tooth loss) are highly prevalent in Germany. Previous studies suggested that vitamin D might be a modifiable and protective factor for periodontitis, caries, and tooth loss. However, prospective studies investigating such associations are limited. We explored the association between the concentration of serum 25-hydroxy vitamin D (25OHD) and incidence of tooth loss, progression of clinical attachment loss (CAL) ≥ 3 mm, and progression of restorative and caries status in a population-based longitudinal study. We analyzed data from 1,904 participants from the Study of Health in Pomerania with a five-year follow-up. Generalized estimating equation models were applied to evaluate tooth-specific associations between serum 25OHD and incidence of tooth loss, progression of CAL ≥ 3 mm, and progression of restorative and caries status. Age, sex, education, smoking status, alcohol drinking, waist circumference, dental visit frequency, reasons of dental visit, vitamin D or calcium supplements, and season of blood draw were considered as confounders. Serum 25OHD was inversely associated with incidence of tooth loss. A significant dose-response relationship (p = .0022) was observed across the quintiles of serum 25OHD. After adjusting for multiple confounders, each 10-µg/L increase of serum 25OHD was associated with a 13% decreased risk of tooth loss (risk ratio: 0.87; 95% confidence interval: 0.79, 0.96). The association was attenuated for changes of CAL ≥ 3 mm when adjusting for multiple confounders. No significant association was found between serum 25OHD and caries progression. Vitamin D might be a protective factor for tooth loss. The effect might partially be mediated by its effect on periodontitis.
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http://dx.doi.org/10.1177/0022034514534985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293729PMC
July 2014

The association between IGF-I/IGFBP-3 and subclinical end points: epidemiology faces the limits.

J Clin Endocrinol Metab 2014 Aug 13;99(8):2804-12. Epub 2014 May 13.

Institute of Clinical Chemistry and Laboratory Medicine (C.M., H.W., M.N., N.F.) and Department of Prosthetic Dentistry, Gerodontology, and Biomaterials (S.S.), Center of Oral Health, University Medicine Greifswald, 17475 Greifswald, Germany; Med Clinic I (G.B.), University of Lübeck, 23538 Lübeck, Germany; and Klinik für Innere Medizin I (U.W.), Evangelisches Waldkrankenhaus Spandau, 13589 Berlin, Germany.

Background: The variation in laboratory measurements represents a challenge in clinical practice and epidemiological research. The use of different analytical platforms might have led to different results, which were often discussed in the interpretation of conflicting results. We aim to study the impact of two different IGF-I and IGF binding protein 3 assays on published epidemiological studies.

Methods: We compared epidemiological results based on the previous gold standard Nichols Advantage, which is no longer available, with these based on the IDS-iSYS assay. The latter follows the recently proposed Keswick criteria. We reinvestigated published association studies between IGF-I or IGF binding protein 3 and anthropometry, subclinical cardiovascular diseases including intima-media thickness or left ventricular mass index, and hard end points like mortality and single-nucleotide polymorphisms of our genome-wide association study in the Study of Health in Pomerania.

Results: We demonstrated that there are significant differences in the associations of IGF-I measured by the Nichols or IDS-iSYS assay and subclinical outcomes including intima-media thickness and left ventricular mass index. However, concerning hard outcomes like mortality or single-nucleotide polymorphisms, our analyses revealed similar results with comparable regression estimates.

Conclusion: With our study we queried not only the accuracy of measurement but also the effect of different methods on study results. The establishment of laboratory standards like the Keswick criteria should be enforced to allow reliable comparisons of different methods and thus clinical and epidemiological studies. Single-center studies have to be interpreted carefully. Moreover, to assure the reliability of studies, their results should be replicated in a meta-analysis, and a generated hypothesis by epidemiology should be proven by intervention studies.
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http://dx.doi.org/10.1210/jc.2013-3746DOI Listing
August 2014

Cross-sectional and longitudinal relation of IGF1 and IGF-binding protein 3 with lipid metabolism.

Eur J Endocrinol 2014 Jul 17;171(1):9-19. Epub 2014 Apr 17.

Institute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Ferdinand-Sauerbruch-Straße NK, D-17475 Greifswald, GermanyDZHK (German Center for Cardiovascular Research)Partner Site Greifswald, Greifswald, GermanyInstitute for Community MedicineDepartment of Prosthetic DentistryGerodontology and Biomaterials, Center of Oral Health, University Medicine Greifswald, Greifswald, Germany

Background: Previous intervention studies in patients with GH disorders suggested an impact of IGF1 and IGF-binding protein 3 (IGFBP3) on lipid metabolism, whereas population-based studies revealed conflicting results. Therefore, we aimed to assess the cross-sectional and longitudinal associations between IGF1 or IGFBP3 serum levels and lipids (total, LDL, or HDL cholesterol and triglycerides) in a large-scale study.

Methods: Data of 2935 subjects (1356 women) from the population-based Study of Health in Pomerania (SHIP) were used. ANOVA, quantile regression, and logistic regression models adjusted for age, waist circumference, physical activity, and alcohol consumption were performed.

Results: In cross-sectional analyses, we detected that IGF1 and IGFBP3 levels were positively related to total and LDL cholesterol and inversely related to HDL cholesterol in both sexes. Furthermore, IGFBP3 levels showed a positive relationship to triglycerides. In total, IGFBP3 levels were more strongly associated to lipids than IGF1. In longitudinal analysis, we found no influence of baseline IGF1 or IGFBP3 serum concentration on incidentally elevated or reduced lipid levels. However, the positive relationship between IGFBP3 and incidentally elevated triglycerides barely missed statistical significance in women.

Conclusion: The present study showed strong cross-sectional associations between IGF1 or IGFBP3 and lipids, whereas no longitudinal relationships were revealed. Therefore, our findings suggest IGF1 and IGFBP3 as a risk marker rather than a risk factor for alterations in lipid metabolism. Further studies are needed to elucidate the mechanisms underlying the association between the GH/IGF axis and lipid metabolism.
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http://dx.doi.org/10.1530/EJE-13-1017DOI Listing
July 2014

Depressive and anxiety symptoms as risk factors for temporomandibular joint pain: a prospective cohort study in the general population.

J Pain 2012 Dec 8;13(12):1188-97. Epub 2012 Nov 8.

Department of Oral and Maxillofacial Surgery/Plastic Surgery, University of Greifswald, Greifswald, Germany.

Unlabelled: Previous studies have associated depression and temporomandibular joint disorders (TMDs). The temporality, however, remains to be clarified. Most patient studies have selected subjects from treatment facilities, whereas in epidemiological studies a clinical examination has not been performed. In this study the 5-year follow-up data of the population-based Study of Health in Pomerania (SHIP) were analyzed. To estimate the effect of symptoms of depression and those of anxiety on the risk of TMD pain, the Composite International Diagnostic-Screener (CID-S) and a clinical functional examination with palpation of the temporomandibular joint and the masticatory muscles were used. After exclusion of subjects having joint pain at baseline, a sample of 3,006 Caucasian participants with a mean age of 49 years resulted. Of those, 122 participants had signs of TMD joint pain upon palpation. Subjects with symptoms of depression had an increased risk of TMD joint pain upon palpation (rate ratio: 2.1; 95% confidence interval: 1.5-3.0; P < .001). Anxiety symptoms were associated with joint and with muscle pain. The diagnosis, prevention, and therapy of TMD pain should also consider symptoms of depression and those of anxiety, and appropriate therapies if necessary.

Perspective: Depressive and anxiety symptoms should be considered as risk factors for TMD pain. Depressive symptoms are specific for joint pain whereas anxiety symptoms are specific for muscle pain, findings that deserve detailed examination. These findings may support decision-making in treating TMD.
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http://dx.doi.org/10.1016/j.jpain.2012.09.004DOI Listing
December 2012

Reproducibility of Frankfort horizontal plane on 3D multi-planar reconstructed MR images.

PLoS One 2012 31;7(10):e48281. Epub 2012 Oct 31.

Polyclinic of Prosthodontics and Biomaterials, Greifswald University, Greifswald, Germany.

Objective: The purpose of this study was to determine the accuracy and reliability of Frankfort horizontal plane identification using displays of multi-planar reconstructed MRI images, and propose it as a sufficiently stable and standardized reference plane for craniofacial structures.

Materials And Methods: MRI images of 43 subjects were obtained from the longitudinal population based cohort study SHIP-2 using a T1-weighted 3D sequence. Five examiners independently identified the three landmarks that form FH plane. Intra-examiner reproducibility and inter-examiner reliability, correlation coefficients (ICC), coefficient of variability and Bland-Altman plots were obtained for all landmarks coordinates to assess reproducibility. Intra-examiner reproducibility and inter-examiner reliability in terms of location and plane angulation were also assessed.

Results: Intra- and inter-examiner reliabilities for X, Y and Z coordinates of all three landmarks were excellent with ICC values ranging from 0.914 to 0.998. Differences among examiners were more in X and Z than in Y dimensions. The Bland-Altman analysis demonstrated excellent intra- as well as inter-examiner agreement between examiners in all coordinates for all landmarks. Intra-examiner reproducibility and inter-examiner reliability of the three landmarks in terms of distance showed mean differences between 1.3 to 2.9 mm, Mean differences in plane angulation were between 1.0° to 1.5° among examiners.

Conclusion: This study revealed excellent intra-examiner reproducibility and inter-examiner reliability of Frankfort Horizontal plane through 3D landmark identification in MRI. Sufficiently stable landmark-based reference plane could be used for different treatments and studies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0048281PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3485237PMC
April 2013

Impact of depressive symptoms on prosthetic status--results of the study of health in Pomerania (SHIP).

Clin Oral Investig 2013 May 3;17(4):1191-200. Epub 2012 Aug 3.

Department of Prosthetic Dentistry, Gerodontology and Biomaterials, Center of Oral Health, University of Greifswald, Rotgerberstrasse 8, 17475, Greifswald, Germany.

Objectives: Previous investigations have confirmed that every fifth dental patient suffers from clinically significant depressive symptoms. However, the putative impact of depressive symptoms on the prosthetic status has not been addressed in these studies. The objective of this study was to investigate the association between depressive symptoms and prosthetic status based on data from the Study of Health in Pomerania (SHIP-0).

Methods: Data from 2,135 participants aged 30 to 59 years were analyzed. A classification (six classes regarding the number and position of missing teeth per jaw) was used to identify the degree of prosthetic status (no/suboptimal/optimal tooth replacement). The presence of depressive symptoms was assessed with a modified version of von Zerssen's complaints scale. Screening for lifetime diagnoses of mental disorders was performed with the Composite International Diagnostic-Screener (CID-S). Multivariable logistic regressions including several confounders were calculated.

Results: A significant protective dose-response effect of depressive symptoms on prosthetic status was found only in men for the lower jaw [0-1 depressive symptoms: odds ratio (OR) = 3.84, 95 % confidence interval (CI, 1.65-8.92), p < 0.01; 2-3: OR = 2.87 (CI, 1.22-6.74), p < 0.05; reference, ≥8; adjusted for age, school education, smoking status, household income, marital status, living without a partner, risky alcohol consumption, obesity, diabetes, and physical activity]. There was no such association in women or for the upper jaw. The analyses using the CID-S confirmed these results.

Conclusions: In the lower jaw, men with depressive symptoms had a better prosthetic status than men without depressive symptoms suggesting a higher level of concern regarding their personal health.

Clinical Relevance: If dentists might have an opportunity to identify men with depressive symptoms they can provide a wide range of treatment options that may enhance patients' self-esteem and contribute to the patient' well-being. Furthermore, depressive symptoms could indicate a discrepancy between self-perception of the dental health and the actual status which influence the dentists' treatment decision making.
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http://dx.doi.org/10.1007/s00784-012-0806-1DOI Listing
May 2013

Missing, unreplaced teeth and risk of all-cause and cardiovascular mortality.

Int J Cardiol 2013 Aug 4;167(4):1430-7. Epub 2012 May 4.

Department of Prosthetic Dentistry, Gerodontology and Biomaterials, Centre of Oral Health, University of Greifswald, 17487 Greifswald, Rotgerberstraße 8, Germany.

Background: A dentition of at least 20 teeth is associated with sufficient masticatory efficiency and is a stated health goal of the World Health Organisation. We examined whether subjects with missing, unreplaced teeth had an increased mortality risk.

Methods: We used data prospectively collected from those participants in the population-based Study of Health in Pomerania who had fewer than 20 remaining teeth, resulting in a sample of 1803 participants with a median age of 64 years. Of those, 188 subjects had 9 or more unreplaced teeth. During a median follow-up period of 9.9 years, 362 subjects died, 128 of whom of cardiovascular causes.

Results: We found that having 9 or more unreplaced teeth was related to all-cause mortality (rate ratio 1.53, 95% CI: 1.11-2.10; adjusted for variables according to causal diagrams: remaining teeth, age, sex, education, income, marital status, partnership, and oral health behaviour) and cardiovascular mortality (rate ratio 1.94, 95% CI: 1.15-3.25). When adjusting not only for the variables according to causal diagrams but also for smoking, alcohol consumption, physical activity, obesity, hypertension, diabetes, and dyslipidemia, the rate ratio was 1.43 (95% CI: 1.05-1.96) for all-cause mortality and 1.88 (95% CI: 1.10-3.21) for cardiovascular mortality.

Conclusions: A reduced, unrestored dentition is associated with increased mortality risk. Thus, clinicians and dietitians have a responsibility to consider individual chewing ability in nutritional recommendations.
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http://dx.doi.org/10.1016/j.ijcard.2012.04.061DOI Listing
August 2013

Association of IGF-I and the IGF-I/IGFBP-3 ratio with plasma aldosterone levels in the general population.

Horm Metab Res 2012 Mar 10;44(3):228-33. Epub 2012 Feb 10.

Institute of Clinical Chemistry and Laboratory Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany.

Several studies in patients with acromegaly or growth hormone (GH) deficiency suggest a stimulatory effect of the growth hormone (GH)/insulin-like growth factor I (IGF-I) axis on the renin-angiotensin-aldosterone system (RAAS). We analyzed the association of serum IGF-I with plasma aldosterone and the aldosterone-to-renin ratio in a large sample from the general population. In addition to serum IGF-I levels, we also considered the IGF-I-to-IGF binding protein (IGFBP)-3 ratio. A total of 1 504 men and 1 566 women aged 25-88 were selected from the first follow-up of the population-based Study of Health in Pomerania. Plasma aldosterone and renin concentrations, as well as serum IGF-I and IGFBP-3 levels were determined with immunoassays. Analyses of variance and linear regression analyses were performed. We found positive associations between serum IGF-I or the IGF-I/IGFBP-3 ratio with plasma aldosterone in women but not in men. Plasma aldosterone levels increased by 2.91 ng/l per IGF-I standard deviation (SD) and by 2.17 ng/l per IGF-I/IGFBP-3 SD. The associations remained significant after exclusion of subjects taking RAAS-altering medication and of subjects with serum IGF-I levels and aldosterone-to-renin ratios outside the reference range. We conclude that, serum IGF-I and the IGF-I/IGFBP-3 ratio are associated with plasma aldosterone levels in women but not in men from the general population.
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http://dx.doi.org/10.1055/s-0031-1301300DOI Listing
March 2012