Schweizer Monatsschrift fur Zahnmedizin = Revue mensuelle suisse d'odonto-stomatologie = Rivista mensile svizzera di odontologia e stomatologia最新文献

Various authors have shown that the caries decline in the industrialized countries during recent decades is based on the use of fluorides, of which local fluoride application in the form of fluoridated toothpastes is of primary importance. The caries-protective potential of fluorapatite is quite low; in contrast, dissolved fluorides in the vicinity of enamel are effective both in promoting remineralization and inhibiting demineralization. Considering the fact that the caries decline occurred at the same time that local fluoridation measures became widely used, the conclusion seems justified that regular application of F⁻ can inhibit caries.

The aim of this study was to evaluate, whether and how the histologic structure of invasive cervical resorption (external granulomas) affect their clinical radiographic diagnosis. For this purpose, nine more or less intact extracted teeth, of which intraoral radiographs were available, were processed for examination in the scanning electron (SEM) and light microscope. From some of the specimens non-decalcified ground sections were prepared and some were decalcified for preparation of histologic sections. Five teeth were scanned in an X-ray microtomography (microCT) device and digitally reconstructed in three dimensions. Three histologic characteristics, namely (1) the location and extension of the resorptive defect, (2) the size of the communication with the periodontium, and (3) the amount of mineralized substitution tissue formed in the lesion affected the radiographic diagnosis. At early and advanced stages, invasive cervical resorption had encircled the pulp cavities, however, without destroying the innermost dentin. Even if the dentinal wall adjacent to the pulp was histologically intact and thick, this important diagnostic feature frequently could not be recognized in conventional radiographs. Also, the communication between the resorptive lesion and the periodontium often was not visible radiographically, although it could always be identified in the microscopic evaluation, particularly at early stages when it proved to be very small. Invasive cervical resorption lesions containing large amounts of mineralized substitution tissue were difficult to recognize and, therefore, could easily be overseen. Thus, three features which are deemed essential for the differential diagnosis of invasive cervical resorption were not readily apparent in conventional radiographs. From these three features, the dentinal wall against the pulp cavity and the communication to the peri-odontium were, however, clearly visible in the microCT reconstructions.

Objectives: Immediate loading of two unsplinted mandibular implants by means of an overdenture may be a viable and cost-effective treatment option to improve the patient's oral health-related quality of life. We therefore conducted a prospective observational study to estimate implant survival and patient satisfaction after an immediate loading protocol in edentulous patients.

Materials and methods: Twenty edentulous patients who received two interforaminal implants (Straumann Standard implant, length 12 mm) were included in our study. Immediately after implant placement, ball attachments with a diameter of 2.25 mm were placed on the implants and the respective matrices were directly incorporated in the existing complete denture. Clinical recalls were scheduled 1 week, 1, 3, 6 months, and 1 and 2 years after implant placement. The following clinical parameters were assessed: gingival bleeding index (GBI), visual plaque index (VPI), and soft tissue overgrowth. In addition, we also assessed radiological bone level change (RBLC) using panoramic radiographs, and patient satisfaction using a visual analogue scale at baseline, after 6 months and 2 years.

Results: No implant failures occurred during the 2-year observation period, resulting in a survival rate of 100%. The mean RBLC was 0.67 mm (95% Confidence Interval [95% CI]: 0.47-0.86 mm) two years after surgery. The GBI and VPI after two years were 24 (95% CI: 9-38)% and 36 (95% CI: 19-53)%, respectively. Soft tissue overgrowth was 1.6 mm (95% CI: 1.1-2.1) on average after two years. In a multivariate regression model, patients with a GBI ≥50% on average showed an increased RBLC (-0.6 mm, p = 0.007). High patient ratings were recorded for overall satisfaction. Overall patient satisfaction measured on a scale between one and ten was 5.2 (95% CI: 2.1-8.5) before implant placement and 9.5 (95% CI: 9.1-10) after 2 years.

Conclusion: Immediate loading of two unsplinted interforaminal implants in overdenture patients using ball attachments is a clinically viable treatment option that leads to a high survival rate and oral health-related quality of life.

The primary goal of the prophylaxis and therapy of periodontitis is the establishment and the preservation of the secondary oral health. Thereby, the main expected outcomes are the reduction of inflammation and probing pocket depths. During the healing process, some tissue shrinkage during the reparative process and healing is inevitable in most cases and leads to more or less pronounced recession. The latter can cause subsequent secondary side effects due to dentin exposure, which appear - in most cases - unwanted and negative, i. e. hypersensitivity, increased caries risk, erosion and abrasion of the exposed dentin. These pathologic conditions may also encounter esthetic and functional impairments. The aim of this article is to elucidate and discuss these potential clinical pitfalls and their minimal-invasive management, especially when using adhesive strategies using composite resin materials.

The clinical observation describes the case of a 20-year-old woman who has consulted for aesthetic and functional reasons. She presents a skeletal class III normodivergent, an occlusal class III with a lower proalveoli quite marked. In addition, a lingual dysfunction which manifests itself by important anterior diastema and dento-dental disharmony at the upper jaw complicates the case. The undertaken therapeutic project starts with a first step of a lingual praxis rehabilitation, followed by an orthodontic step and upper lateral incisors-plasty. The purpose of those results is the evaluation of the stability two years later, which was reported positive.

Implantoplasty describes a method using rotating instruments to smoothen rough implant surfaces which are exposed to the oral cavity. The goal of this procedure is to reduce the adherence of plaque and to facilitate the cleaning of the implant surfaces. The aim of this study was to compare different rotary instruments for their effectiveness and efficiency to smoothen micro-rough implant surfaces. For this purpose, 22 implants were processed with 10 different cutters and one diamond bur under standardized conditions, and then analyzed by scanning electron microscopy. In addition, collection of roughness data (Ra values, arithmetic mean roughness, Rz values, and average roughness) was obtained by using tactile surface measurement. The time needed to reach a subjectively-assessed smooth surface was determined for each instrument. The statistical analysis included the calculation of the mean values (± SD) for the required time, Ra and Rz values and the examination of correlations between these parameters, taking the logarithm of the values obtained and comparing them with linear mixed models. Irrespective of the drill design (spherical or conical) all rotary instruments used in the study showed obvious variations in processing times as well as significant differences (p < 0.001) of Ra and Rz values. The processing time required did not correlate with the Ra-(p = 0.44) or the Rz values (p = 0.83). Compared to spherical carbide cutters with transversal grooves, the conical cutters had the lowest mean roughness values (<1 micron).

The goal of the study was to calculate the direct costs of therapy for patients with MAP. This retrospective study included 242 MAP patients treated at the Department of Prosthodontics of the University of Bern between 2003 and 2006. The following parameters were collected from the clinical charts: chief complaint, diagnosis, treatment modalities, total costs, costs of the dental technician, number of appointments, average cost per appointment, length of treatment, and services reimbursed by health insurance agencies. The average age of the patients was 40.4 ± 17.3 years (76.4% women, 23.6% men). The chief complaint was pain in 91.3% of the cases, TMJ noises (61.2%) or limitation of mandibular mobility (53.3%). Tendomyopathy (22.3%), disc displacement (22.4%), or a combination of the two (37.6%) were more often diagnosed than arthropathy alone (7.4%). Furthermore, 10.3% of the MAP patients had another primary diagnosis (tumor, trauma, etc.). Patients were treated with counseling and exercises (36.0%), physiotherapy (23.6%), or occlusal splints (32.6%). The cost of treatment reached 644 Swiss francs for four appointments spread over an average of 21 weeks. In the great majority of cases, patients can be treated with inexpensive modalities. 99.9% of the MAP cases submitted to the insurance agencies were reimbursed by them, in accordance with Article 17d1-3 of the Swiss Health Care Benefits Ordinance (KLV) and Article 25 of the Federal Health Insurance Act (KVG). The costs of treatment performed by dentists remain modest. The more time-consuming services, such as providing information, counseling and instructions, are poorly remunerated. This aspect should be re-evaluated in a future revision of the tariff schedule.

Low-shrinkage resin composites are in the focus of research in posterior resin composite restoratives. The aim of the study was to examine the polymerization shrinkage stress of new composites (Venus Diamond/ Heraeus Kulzer; SDR/DENTSPLY) and an experimental low-shrinkage resin composite (Ormocer/VOCO) in comparison to established low-shrinkage resin composites (Filtek Silorane/ 3M ESPE; els/Saremco; Filtek Supreme XT/3M ESPE; Clearfil Majesty Posterior/Kuraray). Cylindrical cavities (∅ 4 mm) in Araldit-B epoxy resin plates (40×40×4 mm) were pretreated with the Rocatec system to ensure bonding of the resin composites. The resin composite specimens (n = 10) were exposed to light for 60 s with a QTH curing device (Translux energy, Heraeus Kulzer, Germany). The samples were stored dark and dry (23 °C). Polymeri-zation shrinkage stress data (MPa) 4 min and 24 h post exposure were calculated based on the diameter of the first-order isochromatic rings, obtained from the Araldit plates. The statistical analysis of the obtained data was carried out with the Wilcoxon test (p = 0.05). After 24 h, the following mean stress values and standard deviations were obtained: Venus Diamond 3.4 ± 0.27 MPa; SDR 3.3 ± 0.26 MPa; exp. Ormocer 4.0 ± 0.18 MPa; Filtek Silorane 2.8 ± 0.19 MPa; els 2.5 ± 0.09 MPa; Filtek Supreme XT 6.0 ± 0.20 MPa; and Clearfil Majesty Posterior 5.6 ± 0.15 MPa. For all materials, higher polymerization stress values were recorded after 24 h. All differences in the shrinkage data obtained after 24 h were statistically significant (p < 0.05) except Venus Diamond/SDR. Venus Diamond, els and SDR showed shrinkage data closer to that of Filtek Silorane.