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Im parodontal geschädigten Gebiss kann die Ästhetik durch Verlust der Interdentalpapillen oder Zahnfehlstellungen beeinträchtigt sein. Direkte Aufbauten aus Komposit ermöglichen eine deutliche Verbesserung der Ästhetik durch Zahnformkorrekturen wie das Schließen schwarzer Interdentaldreiecke oder – in Kombination mit präparativen Maßnahmen – auch Zahnstellungskorrekturen. Bei adäquater und sorgfältiger Durchführung ist kein negativer Einfluss der Kompositrestauration auf die parodontale Gesundheit der betroffenen Zähne zu erwarten. Keywords: Schwarze zervikale Dreiecke, Papille, Kompositrestauration, Ästhetik, parodontale Gesundheit

Purpose: To evaluate the survival and clinical quality of individually layered indirect composite restorations (ICRs) in the mixed and permanent dentition at two study centers. Materials and Methods: A total of 155 adhesively cemented ICRs in 34 participants (aged 6 to 50 years and treated between 2008 and 2018) were evaluated for survival and clinical quality. All were individually layered restorations fabricated from laboratory sculptable composites by a specialized dental technician. Two calibrated independent investigators examined and graded each restoration as success, survival with repair, or failure based on the FDI criteria. The marginal quality and gap width of the restorations were analyzed by scanning electron microscopy. The periodontal health of treated teeth (TT) was evaluated in comparison with that of unrestored control teeth (CT) by measuring the pocket depth (PD), clinical attachment level (CAL), sulcus bleeding index (SBI), and the modified Turesky Plaque Index (TPI). A serial t-test (p 0.05) was used for statistical analysis of periodontal parameters. Success and functional survival rates were calculated using the Kaplan–Meier method. Results: Molar incisor hypomineralization (MIH) was the most common indication for treatment (41%). The median age at treatment was 14.9 years (68%-CI: 7.7–29.5). The median service time of the restorations was 5.7 ± 3.4 years. 132 restorations were classified as a success, 21 as survival with repair, and 1 as a failure. The success rates at 1, 5, and 10 years were 95.4%, 87.4%, and 78.8%, respectively, and the corresponding functional survival rates were 100.0%, 98.9%, and 98.9%. The clinical quality, encompassing esthetic, functional, and biological criteria, was rated as excellent or good in over 90%. Periodontal response, however, was the only criterion showing worse results since restored teeth (TPI = 1.9) had significantly more plaque than CT (TPI = 1.7; p = 0.0001). No significant differences were observed in PD, CAL, or SBI. The mean marginal gap width was 135.7 µm and 63.8% of the restorations had perfect margins. Conclusion: ICRs are suitable for minimally invasive restoration of large tooth structure defects in the developing dentition of children and adolescents and for long-term temporary restoration of the adult dentition. Keywords: adolescent dentition, adult dentition, clinical quality parameters, indirect composite restorations, qualitative margin analysis, survival

Purpose: This German S3 clinical practice guideline offers evidence-based recommendations for the use of composite materials in direct restorations of permanent teeth. Outcomes considered were the survival rates and restoration quality and process quality of the manufacturing process. Part 1 of this two-part presentation deals with the indication classes. Materials and Methods: A systematic literature search was conducted by two methodologists using MEDLINE and the Cochrane Library via the OVID platform, including studies up to December 2021. Six PICO questions were developed to guide the search. Recommendations were formulated by a panel of dental professionals from 20 national societies and organizations based on the collected evidence. Results: Composite materials are a viable option for the direct restoration of cavity Classes I–V and may also be used for restorations with cusp replacement, and tooth shape corrections. In the posterior region, direct composite restorations should be preferred over indirect composite inlays. For Class V restorations, composite materials can be used if adequate contamination control and adhesive technique are ensured. Conclusion: The guideline is the first to provide comprehensive evidence on the use of direct composite materials. However, further long-term clinical studies with comparators such as (modified) glass-ionomer cements are necessary. Regular updates will detail the future scope and limitations of direct composite restorations. Keywords: adhesive restorations, composite resin, composite restorations, evidence-based medicine

Purpose: Part 2 of this German S3 clinical practice guideline provides recommendations for the process of manufacturing composite restorations. It covers key aspects like caries removal, field isolation, matrix and adhesive techniques, as well as light curing and polishing. The outcomes of interest include survival rates and restoration quality. Materials and Methods: A systematic literature search was conducted by two methodologists using MEDLINE and the Cochrane Library via the OVID platform, including studies up to December 2021. Additionally, the reference lists of relevant manuscripts were manually reviewed. Six PICO questions were developed to guide the search. Consensus-based recommendations were for- mulated by a panel of dental professionals from 20 national societies and organizations based on the collected evidence and ex- pert opinion. Results: The guideline advocates for one-stage selective caries removal near the pulp and underscores the effectiveness of various isolation techniques, adhesive systems, and the crucial role of light polymerization. The use of anatomically pre- formed sectional matrices and phosphoric acid etching is recommended to enhance restoration quality. Additionally, polish- ing composite restorations is advised to improve surface finish. Conclusion: This guideline provides comprehensive recommendations that inform clinicians on optimizing the composite restor- ation manufacturing processes. The adoption of these best practices can improve the quality and longevity of dental restorations.

Präprothetische Maßnahmen zielen darauf ab, Bedingungen zu schaffen, die es ermöglichen, einen erhaltungswürdigen Zahn mit tiefem oder ausgedehntem koronalen Defekt möglichst sicher und stabil versorgen zu können. Bei Frontzähnen und einwurzeligen Prämolaren kann hierzu die Technik der Zahnextrusion eine Alternative zur herkömmlichen Therapie der chirurgischen Kronenverlängerung sein. Bei korrekter technischer Umsetzung der Extrusion auf chirurgische Weise bietet diese immer noch als ungewöhnlich und speziell angesehene Technik einige wichtige Vorteile. Hierzu gehören die unmittelbare „Koronalverlagerung“ der Zahnwurzel in die gewünschte supragingivale Position, die optionale Rotation der Zahnwurzel mit Verlagerung des tiefsten Defekts in einen restaurativ einsehbaren Bereich und die Unversehrtheit der angrenzenden Weichgewebe. Nach der Einheilungs-phase der Zahnwurzel schließt sich die laborgefertigte oder direkte Restauration der Zahnkrone an. In diesen Beitrag werden die biologischen Grundlagen, viele technische Hinweise und die zu erwartenden Resultate für die chirurgische Zahnextrusion mit Fokus auf ihre klinische Umsetzung in der Praxis vorgestellt. Manuskripteingang: 09.01.2023, Manuskriptannahme: 28.02.2023 Keywords: Präprothetisch, Zahnerhalt, restaurative Zahnheilkunde, Zahnextrusion

The purpose of this clinical study was to assess the feasibility of forced orthodontic extrusion with the Tissue Master Concept to retain subgingivally fractured teeth as abutments for which extraction and replacement would be equal treatment opportunities. Participants were recruited from a group of consecutive patients in need of prosthodontic rehabilitation. In total, 36 deeply destroyed teeth in 31 patients underwent forced orthodontic extrusion with forces exceeding 50 g to reestablish biologic width and ensure a 2-mm dentin-ferrule design prior to single-crown restoration. The primary endpoint was the success of the extrusion in terms of the ability to restore the respective abutment tooth. Information about overall treatment time, frequency, and reasons for failure were collected. Four patients dropped out of the treatment. For the remaining 27 participants, data were fully collected. The amount of extrusion ranged between 2 and 6 mm (3.5 ± 0.9 mm), and the mean duration until retention was 20 ± 12 days. On average, patients returned three (± 3) times for control visits after extrusion. Adhesive failure (n = 6) and orthodontic relapse (n = 2) were the most frequent complication types. Forced orthodontic extrusion may be a useful tool to restore teeth evaluated as nonrestorable.

Endodontisch bedingte Zahnverfärbungen gehen vom Wurzelkanalsystem aus und sind Folge von reaktiv-physiologischen (Obliteration) oder pathologischen Vorgängen (traumabedingte Einblutung, Pulpanekrose, intrakoronale Resorptionen). Gleichzeitig können auch endodontische Interventionen (Pulpaüberkappungen, Wurzelkanaleinlagen, Wurzelkanalfüllungen) bei Verwendung nichtfarbstabiler Materialien zu sichtbaren Diskolorationen führen. Häufig besteht eine ästhetisch bedingte Behandlungsindikation. Bei bestehender oder notwendiger Wurzelkanalbehandlung ist das interne Bleaching eine zuverlässige und zugleich minimalinvasive Maßnahme zur Wiederherstellung der ursprünglichen Zahnfarbe. Verfärbte obliterierte Zähne ohne Zeichen einer infizierten Pulpanekrose können zur Farbkorrektur extern gebleicht werden. Manuskripteingang: 23.03.2023, Manuskriptannahme: 04.04.2023 Keywords: Zahntrauma, Zahnverfärbung, Diskoloration, Bleaching, „Walking-bleach“-Technik

In dem im Oktober 2022 veröffentlichten Update der S2k-Leitlinie „Therapie des dentalen Traumas bleibender Zähne“ (AWMF-Reg.-Nr. 083-004) wurde ein breit konsentierter, evidenzbasierter Rahmen geschaffen, innerhalb dessen die Diagnostik sowie die Primär- und die Sekundärtherapie einschließlich Management von Komplikationen beschrieben werden. In der neuen Fassung wurden sämtliche Kapitel hinsichtlich der aktuellen Evidenzlage geprüft, Therapieoptionen neu aufgelegt und zahlreiche Empfehlungen indikationsbezogen aktualisiert. Dabei wurde die Nomenklatur in Bezug auf die internationale Terminologie definiert, neue Punkte hinsichtlich der Risikofaktoren und der Prävention wurden erfasst und das Glossar zu Heilungsvorgängen und Heilungsstörungen wurde aktualisiert. Darüber hinaus wurde die Empfehlung zur Vorgehensweise bei Kronenfrakturen mit Pulpabeteiligung, bei Pulpanekrose an Zähnen mit nicht abgeschlossenem Wurzelwachstum, bei Kronen-Wurzel-Frakturen und bei Intrusionsverletzungen angepasst. Hinzu kamen neue Empfehlungen bezüglich der Behandlung von posttraumatischer Ankylose und Zahnverlust der traumatisierten permanenten Dentition. Keywords: Adhäsivbrücke, autogene Zahntransplantation, Avulsion, dentales Trauma, Dislokation, Intrusion, kieferorthopädischer Lückenschluss, Kronenfraktur, Leitlinie, Wurzelfraktur

Im parodontal geschädigten Gebiss kann die Ästhetik durch Verlust der Interdentalpapillen oder Zahnfehlstellungen beeinträchtigt sein. Direkte Aufbauten aus Komposit ermöglichen eine deutliche Verbesserung der Ästhetik durch Zahnformkorrekturen wie das Schließen schwarzer Interdentaldreiecke oder – in Kombination mit präparativen Maßnahmen – auch Zahnstellungskorrekturen. Bei adäquater und sorgfältiger Durchführung ist kein negativer Einfluss der Kompositrestauration auf die parodontale Gesundheit der betroffenen Zähne zu erwarten. Manuskripteingang: 17.10.2022, Annahme: 14.12.2022 Keywords: schwarze zervikale Dreiecke, Papille, Kompositrestauration, Ästhetik, parodontale Gesundheit

Objectives: Many treatment options accepted for unsalvageable traumatized teeth in adults would seem contraindicated in children and adolescents. Instead, growing patients need interim restorative measures, thus extensively preserving their local bone and soft tissue structures and, ideally, preparing the involved site for later definitive restoration while they transform to skeletal maturity. This narrative topic review addresses the interim management in case of very deep intra-extra-alveolar fractures, extensive infection-related root resorption, tooth ankylosis, and anterior tooth loss in growing patients, and seeks to empower the clinician to select the appropriate treatment approach. Data sources: The literature up to 2021 was reviewed based on several scoping searches on PubMed and the Cochrane Library using relevant terms. Due to the complexity of the topic (with various poor prognosis scenarios and the differing therapeutic options), a systematic review was deemed inappropriate. Conclusion: Suitable interim treatment options include extrusion of teeth showing deep intra-extra-alveolar fractures, and decoronation of ankylosed teeth as well as resin-bonded fixed dental prostheses, natural tooth pontics, and primary tooth autotransplantations after tooth loss. The interim management options described in this article represent compromises chosen in the absence of better alternatives after a careful risk-benefit analysis. However, if adequately performed, the presented treatment options have the potential to achieve the temporary restoration of function and esthetics in growing patients. Close clinical and (if appropriate) radiologic monitoring of these patients is considered mandatory to ensure early detection of possible complications that might jeopardize or could render impossible subsequent therapeutic measures. (Quintessence Int 2022;53:722–731; doi: 10.3290/j.qi.b3236409; Modified from a previously published article (in German) Quintessenz 2022;73(2):162–169) Keywords: ankylosis, autotransplantation, decoronation, dental trauma, extrusion, fracture, resin-bonded fixed dental prosthesis, resorption