Schmage, Petra

Immer mehr Patienten sind sich der Notwendigkeit ihrer aktiven Beteiligung zur Erhaltung der eigenen Mundgesundheit bewusst und bereit, die dazu erforderliche häusliche Mundhygiene auf hohem Niveau zu erbringen. Dazu sind sie auf die Kooperation mit dem zahnärztlichen Prophylaxeteam angewiesen, damit das Mundhygienekonzept individuell abgestimmt werden kann. Der Erstellung des individuellen Mundhygienekonzeptes kommt eine entsprechend hohe Bedeutung für dessen künftigen Erfolg zu. Viele Patienten besitzen eine Vorgeschichte mit parodontalen Entzündungen oder Zahnverlusten, die wiederum umfangreiche prothetische Rekonstruktionen oder Implantate erforderten. Diese Patienten benötigen eine Tertiärprävention mit komplexen Mundhygienelösungen zur Reinigung von schwer zugänglichen Bereichen, die hier ausführlich vorgestellt werden. Besonders die mechanische Interdentalraumreinigung, sowohl hinsichtlich der Selektion der Interdentalraumbürsten als auch der Konfiguration der Interdentalräume, steht im Fokus. Keywords: Individuelles Mundhygienekonzept, häusliches Biofilmmanagement, Interdentalraum, Interdentalraumbürste, Implantatpflege

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. Keywords: air polishing, peri-implantitis, peri-implant mucositis, therapy

Purpose: The aim of this study was to evaluate the cleaning effectiveness of implant prophylaxis instruments on polished and acid-etched implant surfaces. Materials and Methods: Biofilm layers of Streptococcus mutans were grown on a total of 80 titanium disks; 40 disks were polished and 40 were acid-etched. Five disks of each surface were cleaned using each of seven implant prophylaxis instruments: (1) manual plastic curette, (2) manual carbon fiber-reinforced plastic (CFRP) curette, (3) sonic-driven prophylaxis brush, (4) rotating rubber cup with prophylaxis paste, (5) sonic-driven polyether ether ketone (PEEK) plastic tip, (6) ultrasonic-driven PEEK plastic tip, and (7) air polishing with amino acid (glycine) powder. Ten disks (five of each surface type) served as controls. After cleaning, the surfaces with remaining bacteria were assessed by light microscopy. Statistical analyses of the results were performed with one-way and two-way analyses of variance with Bonferroni-Dunn multiple comparisons post hoc analysis (α = .05). Results: The cleaning effectiveness of the plastic curette was significantly lower than those of all machine-driven instruments on the polished surface. Significantly lower cleaning effectiveness occurred with the CFRP curette compared to the prophylaxis brush and to both oscillating PEEK plastic tips on the polished surface. The rubber cup provided less cleaning effectiveness compared to the ultrasonic PEEK plastic tip and air polishing on the acid-etched surface. Superior results, with less than 4% of the biofilm remaining, were obtained for both oscillating PEEK plastic tips and air polishing on both implant surfaces. The cleaning ability of the prophylaxis brush, rubber cup, and ultrasonic PEEK plastic tip differed significantly between both surface structures. Conclusions: Cleaning effectiveness, ie, less than 4% of the biofilm remaining, was not observed with all tested implant prophylaxis instruments. The cleaning ability of the devices depended on the implant surface structure. Keywords: air polishing, implant cleaning, implant scaler, implant supportive therapy, implant surfaces, prophylaxis instruments

In the past few years indications for the use of the air polishing technology have been expanded from supragingival use (airflow) to subgingival air polishing (perioflow) by the development of new low-abrasive glycine-based powders and devices with a subgingival nozzle. Several studies on the subgingival use of air polishing have been completed. On 7 June 2012, during the Europerio 7 Congress in Vienna, a consensus conference on mechanical biofilm management took place aiming to review the current evidence from the literature on the clinical relevance of the subgingival use of air polishing and to make practical recommendations for the clinician. Bernita Bush (Bern), Prof Johannes Einwag (Stuttgart), Prof Thomas Flemmig (Seattle), Carmen Lanoway (Munich), Prof Ursula Platzer (Hamburg), Prof Petra Schmage (Hamburg), Brigitte Schoeneich (Zurich), Prof Anton Sculean (Bern), Dr Clemens Walter (Basel), and Prof Jan Wennström (Gothenburg) discussed under the moderation of Klaus-Dieter Bastendorf and Christian Becker (both ADIC Association for Dental Infection Control) the available clinical studies to reach a consensus on available clinical evidence. This paper summarizes the main conclusions of the consensus conference and points to the clinical relevance of the findings for the dental practitioner. Keywords: biofilm management, glycine powder, periodontal maintenance, subgingival air polishing, subgingival biofilm removal

Purpose: The aim of this study was to evaluate the effects of a variety of implant cleaning instruments on different implant surfaces, specifically surface roughness and cleaning efficacy. Materials and Methods: Biofilm layers of Streptococcus mutans were cultivated on titanium disks with four different surface structures (polished, grit-blasted, acid-etched, and acid-etched/grit-blasted). Five disks each were cleaned using nine mechanical implant cleaning instruments or an erbium:yttrium-aluminum-garnet laser. Surface roughness (average, Ra; maximum, Rz) and waviness (Lr) were evaluated by two-dimensional laser profilometry. Surface structure damage and cleaning scores were assessed by scanning electron microscopy. Statistical analyses of the results were performed with one- and two-way analyses of variance and Bonferroni-Dunn multiple-comparison post hoc analysis (α = .05). Results: Ra and Rz values for the acid-etched surfaces and Ra, Rz, and Lr values for the polished and the grit-blasted surfaces showed no significant differences between the different cleaning methods or cleaning instruments compared to the control (not cultured, not cleaned) groups. Significantly lower Ra and Rz values on grit-blasted/acid-etched implant surfaces were found following use of the Sonic-Flex clean with prophylaxis brush and the plastic curette compared to Satelec ProphyMax with Periosoft curette. Ra and Rz values of the different implant structure surfaces before cleaning were significantly different between all implant surfaces except for the polished compared to the acid-etched surfaces. Conclusions: Cleaning effect and alterations of the implant surfaces were strongly dependent on the implant cleaning method used. Keywords: cleaning instruments, implant surfaces, laser profilometry, scanning electron microscopy, surface roughness

Purpose: To investigate the effect of a prefabricated tribochemical coating of FRC (fiber-reinforced composite) posts with and without aging on the pull-out forces compared to posts without conditioning. Materials and Methods: Post space preparations were performed on 108 extracted anterior teeth. Thirty-six uncoated FRC posts (DentinPost) and 72 prefabricated tribochemically coated FRC posts (DentinPost Coated) were used at a length of 12 mm. Thirty-six of the coated posts were thermally aged. FRC posts (n = 9) were placed using DentinBuild or MultiCore Flow foundation composite resins or Panavia F2.0 or RelyX Unicem resin cements. Following water storage (37°, 24 h) and thermocycling (5000 cycles, 5° to 55°C, 30 s), pull-out force testing was performed. Fracture modes were assessed using a light microscope. Data were analyzed statistically (1-way and 3-way ANOVA, Bonferroni-Dunn correction, α = 0.05). Results: Significantly higher pull-out forces of posts luted with Panavia F2.0 were observed for the coated and coated/aged FRC posts compared to the unconditioned posts (control group, p 0.001). The pull-out forces of tribochemically coated FRC posts luted with MultiCore Flow were significantly lower than of coated posts luted with Panavia F2.0 (p 0.001). Coated/aged FRC posts exhibited similar pull-out forces for the tested luting composite resins (p > 0.05). Except for DentinBuild (coated posts), more mixed or cohesive fractures were assessed for coated and coated/aged FRC posts than for unconditioned FRC posts. Conclusion: Prefabricated tribochemical coating of FRC posts provided a stable interface between coating and post and remained stable over time. Keywords: root posts, FRC posts, surface coating, resin cement, core buildup composite, silica coating, aging

Purpose: Accuracy of panoramic radiographs is essential for distance measurements during implant planning, but it might be compromised by various factors. The aim of the present study was to evaluate the effect of vertical and horizontal head positioning on area-dependent enlargement ratios of digital panoramic radiography. Materials and Methods: The mandible of a dry skull was marked with small steel globes. The skull was moved 1 to 4 degrees in 1-degree increments to the left and right and up and down. A series of 17 panoramic radiographs was obtained with the same digital radiographic device. For the rotated skull, horizontal and vertical distances, indicated by the steel globes, were compared to the distances with the ideal positioning of the skull. The results were analyzed statistically. Results: Head positioning and angulation, anatomical site, and distance orientation influenced horizontal measurements. Enlargement ratios of horizontal distances of the right canine and first molar regions (skull rotation to the right 2 to 4 degrees) were significantly lower than those for the corresponding anatomical sites on the left side. Horizontal distance measurements of the different anatomical sites of the left and the right jaw did not differ significantly from each other when the skull was moved downward. When the skull was rotated upward, no significant differences were obtained for corresponding anatomical sites of the right and left arches. Enlargement ratios of vertical distances of different anatomical sites, as well as within the same anatomical site, were not significantly different from each other for the given skull rotations. Conclusions: Ideal head positioning for digital panoramic radiographs is mandatory to avoid improper enlargement ratios of horizontal distances, which can be important in implant dentistry. Keywords: digital radiography, distances, enlargement ratios, head positioning, panoramic radiography

Die kontinuierliche Nachsorge und die rechtzeitige Intervention bei periimplantären Infektionen sind Erfolgsfaktoren für den langfristigen Erhalt und Funktion der Implantatversorgung. Für die Therapie der periimplantären Mukositis und Periimplantitis stehen vielfältige Methoden und Geräte zur mechanischen oder desinfizierenden Reinigung der Implantatoberfläche zur Verfügung. Diese gilt es, abgestimmt auf den Schweregrad der Erkrankung, die Implantatstrukturen und die klinische Situation einzusetzen. Zunächst wird vor dem Hintergrund der Literatur eine Übersicht über die beiden Problembereiche gegeben. Es gilt hier ein befundorientiertes und auf die Risikofaktoren des Patienten abgestimmtes Behandlungskonzept zu entwickeln und die notwendigen therapeutischen Maßnahmen mit geeigneten Hilfsmitteln durchzuführen. Die praktische Umsetzung eines befundorientierten Behandlungskonzepts, das sich an das AKUT-/CIST-Konzept (Auffangende Kumulative Unterstützende Therapie/Cumulative Interceptive Supportive Therapy) anlehnt, wird anhand von zwei Falldarstellungen vorgestellt. Keywords: Periimplantäre Erhaltungstherapie, Mukositis, Periimplantitis, Implantatoberflächen- Reinigung, oszillierende Instrumente, Airpolishing, Photodynamische Therapie, Ozon

Purpose: To compare the torsional strengths and the effects of functional loading on five different implant surface structures. Materials and Methods: This in vivo longitudinal study of 9 months' duration examined osseointegration in 180 stepped cylindric implants placed into the mandibles of 18 healthy sheepdogs. Implants with five different surface structures were placed (n = 36 in each group): (1) smooth surface; (2) deep profile structure (DPS); (3) titanium plasma sprayed (TPS); (4) hydroxyapatite coated; and (5) sol-gel hydroxyapatite coated (SGHA). All implants were investigated under standardized conditions. At uncovering (3 months), half the implants were loaded with prefabricated crowns for 6 months, and the other half remained unloaded. Removal torque values were evaluated at 3, 6, and 9 months after implant placement. The data were analyzed using analysis of variance and Scheffé correction (a .05). Results: All smooth-surface and SGHA implants failed in succession during the fourth and ninth months of the study. After 3 months the removal torque resistance of DPS, TPS, and hydroxyapatite-coated implants was significantly higher (P .001) than that seen in the other two groups. Initially, the removal torque resistance of unloaded hydroxyapatite-coated implants was superior, and the decrease during the observation period was not significant. The increase in removal torque resistance under functional loading was not significant for the DPS implants. A significant increase was found in removal torque resistance for the loaded TPS implants (P .05). The unloaded DPS and TPS implants showed no change in removal torque levels after the closed healing period of 3 months. Conclusions: Successful osseointegration was achieved with DPS, TPS, and hydroxyapatite-coated implants, and smooth-surface and SGHA implants failed. Removal torque resistance was enhanced with controlled functional loading. Keywords: functional loading, implant surfaces, osseointegration, torsional strength

Purpose: In this in-vitro study, microleakage of all-ceramic crowns was evaluated at enamel and dentin margins. Materials and Methods: Forty maxillary central incisors were randomly divided into 4 groups (n = 10). While buccal and palatal margins were placed on enamel, mesial and distal margins were placed below the cementoenamel junction. In groups 1 to 3, IPS Empress 2 crowns were luted with Variolink 2/Syntac Classic (group 1), Bifix DC/Solobond Plus (group 2) and Calibra/Prime & Bond NT combinations (group 3), respectively. In the control group (group 4), porcelain-fused-to-metal crowns were luted with a zinc-phosphate cement. All specimens were subjected to 5000 thermocycles (at 5°C to 55°C; 30-s dwell time). After immersion in India ink for 48 h at 37°C, the specimens were sectioned both buccolingually and mesiodistally. Each section was evaluated for microleakage under a stereomicroscope at 24X magnification. Results: According to the Krukal-Wallis test, in all groups, there were significant differences in microleakage at the enamel margins (p = 0.001). Nevertheless, the margins finished in dentin showed no significant differences (p = 0.163). According to the Mann-Whitney U-test, statistically significant differences were observed in microleakage between groups 1 and 3 (p = 0.049), groups 1 and 4 (p = 0.001), groups 2 and 4 (p = 0.002), and between groups 3 and 4 (p = 0.045) at the enamel margin. In group 1, significantly greater microleakage was observed at the dentin margin compared to the enamel margin (p = 0.007). Conclusion: The adhesive luting technique demonstrated an excellent ability to minimize microleakage of all-ceramic crowns at the enamel margins. Water-based dentin bonding systems showed less microleakage than the water-free acetone-based dentin bonding system at the enamel margin. Keywords: microleakage, adhesive luting, all-ceramic crown, dentin bonding, enamel bonding.