[The stamp technique for direct composite restoration]

The indications for direct resin composite restorations are nowadays extended due to the development of modern resin materials with improved material properties. However, there are still some difficulties regarding handling of resin composite material, especially in large restorations. The reconstruction of a functional and individual occlusion is difficult to achieve with direct application techniques. The aim of the present publication was to introduce a new "stamp"-technique for placing large composite restorations. The procedure of this "stamp"-technique is presented by three typical indications: large single-tooth restoration, occlusal rehabilitation of a compromised occlusal surface due to erosions and direct fibre-reinforced fixed partial denture. A step-by-step description of the technique and clinical figures illustrates the method. Large single-tooth restorations can be built-up with individual, two- piece silicone stamps. Large occlusal abrasive and/or erosive defects can be restored by copying the wax-up from the dental technician using the "stamp"-technique. Even fiber-reinforced resin-bonded fixed partial dentures can be formed with this intraoral technique with more precision and within a shorter treatment time. The presented "stamp"-technique facilitates the placement of large restoration with composite and can be recommended for the clinical use.

User and Machine Authentication and Authorization Infrastructure for Distributed Wireless Sensor Network Testbeds

The intention of an authentication and authorization infrastructure (AAI) is to simplify and unify access to different web resources. With a single login, a user can access web applications at multiple organizations. The Shibboleth authentication and authorization infrastructure is a standards-based, open source software package for web single sign-on (SSO) across or within organizational boundaries. It allows service providers to make fine-grained authorization decisions for individual access of protected online resources. The Shibboleth system is a widely used AAI, but only supports protection of browser-based web resources. We have implemented a Shibboleth AAI extension to protect web services using Simple Object Access Protocol (SOAP). Besides user authentication for browser-based web resources, this extension also provides user and machine authentication for web service-based resources. Although implemented for a Shibboleth AAI, the architecture can be easily adapted to other AAIs.

Orthodontic retention procedures in Switzerland.

OBJECTIVE To survey retention procedures used in orthodontic practices in Switzerland. MATERIAL AND METHODS A questionnaire previously developed by Renkema et al. (2009) was sent to 223 Swiss orthodontists. The questionnaire comprised six parts, mainly containing multiple-choice questions. Information as to background education of the individual orthodontist, retention in general, frequency of different types of removable or bonded retainers that were used, retention pro- tocol, and the type and size of the wire used for bonded retainers was assessed. RESULTS The overall response rate was 65 percent. Most orthodontists placed a bonded retainer in the upper and lower arch, except when the upper arch was expanded during treatment or when extractions were performed in the upper arch, in which case they placed a combination of fixed and removable retainers. Opinions varied with regard to how many hours the removable retainers should be worn and the duration of the retention phase. As far as bonded retainers were concerned, 87 percent of the orthodontists preferred life-long retention. Ninety-three percent of the orthodontists considered that the development of a guide- line on retention procedures would be useful. CONCLUSIONS The choice of retention procedures is mostly based on orthodontists personal preference. A further research into the long-term effectiveness of individual retention protocols is needed.

Ophthalmologic complications after intraoral local anesthesia

INTRODUCTION The first ophthalmologic complication in conjunction with a dental anesthesia was reported in 1936. The objective of the present study was a detailed analysis of case reports about that topic. MATERIAL AND METHODS After conducting a literature search in PubMed this study analyzed 108 ophthalmologic complications following intraoral local anesthesia in 65 case reports with respect to patient-, anesthesia-, and complication- related factors. RESULTS The mean age of the patients was 33.8 years and females predominated (72.3%). The most commonly reported complication was diplopia (39.8%), mostly resulting from paralysis of the lateral rectus muscle. Other relatively frequent complications included ptosis (16.7%), mydriasis (14.8%) and amaurosis (13%). Ophthalmologic complications were mainly associated with block anesthesia of the inferior alveolar nerve (45.8%) or the posterior superior alveolar nerve (40.3%). Typically, the ophthalmologic complications in conjunction with intraoral local anesthesia had an immediate to short onset, and disappeared as the anesthesia subsided. DISCUSSION AND CONCLUSION The increased number of ophthalmologic complications after intraoral local anesthesia in females may suggest a gender effect. Double vision (diplopia) is the most frequently described complication, which is usually completely reversible like the other reported ophthalmologic complications.

[Subcutaneous emphysema following non-surgical peri-implantitis therapy using an air abrasive device: a case report]

Subcutaneous emphysema are rare complications in periodontology. In most cases, they resolve spontaneously. However, air might disperse into deeper facial spaces causing life-threatening complications such as compression of the tracheobronchial tree or the development of pneumomediastinum. Moreover, microorganisms might spread from the oral cavity into deeper spaces. Hence, rapid diagnosis of subcutaneous emphysema is important. Characteristic signs are both a shiftable swelling and a crepitation. In this case report, the case of a 69-year old man with a subcutaneous emphysema immediately after peri-implantitis therapy with the use of a glycine-based powder air-polishing device is described. Following therapy, air accumulated in the left side of the face. Seven days after non-surgical peri-implantitis therapy, the patient was asymptomatic with complete resolution of the emphysema.

Dental knowledge and attitude toward school dental-health programs among parents of kindergarten children in Winterthur.

The current study investigated the attitudes and knowledge regarding diet and oral hygiene of parents with kindergarten children. The parents' statements were evaluated in terms of their socioeconomic background and were compared with the annual clinical examination of the children. The objective of the study was to assess the effectiveness of the school dental-health program and adapt it to today's societal needs. Of those who participated in the interview, 61% were Swiss, 16% were from former Yugoslavia or Turkey, and 12% each from the EU or other countries. Of the children examined, 39% already had caries, and 18% of those showed more than two lesions. The parents' knowledge correlated with the severity of the child's caries as well as with the parents' income, country of origin, and education. There was a correlation between the child's dental decay and lower income, as well as lower education and non-Swiss nationality of the parents. Parents with higher income and better education more often participated in the preschool's preventive program. Parents from former Yugoslavia or Turkey participated less frequently than parents from other countries. The study demonstrated that parents who especially needed instruction and prophylaxis are contacted too late or not at all through the dental-health program at kindergarten and that new approaches to prevention should be implemented to more effectively reach the parents.

Eingeschränkte Mundöffnung - was nun?: Diagnostik und Therapie bei progredientem Trismus: Ein Fallbericht.

Eine 28-jährige Patientin stellte sich mit einer seit Jahren bestehenden progredient eingeschränkten Mundöffnung vor. Die initial klinische Diagnostik zeigte keine pathologischen intraartikulären Befunde. Trotzdem blieb eine konservative Therapie fruchtlos. Erst die weitere bildgebende Diagnostik führte zur Diagnose gleich mehrerer struktureller Veränderungen: einer Hyperplasie der Processus coronoidei und einer hypertrophen Kaumuskulatur mit verdickten Aponeurosen. Zusätzlich fand sich auch eine typische quadratische Unterkieferform, bedingt durch eine Hypertrophie der Kieferwinkel. Beim hier illustrierten Fall zeigen sich alle typischen Zeichen dieser bis anhin noch wenig beschriebenen Kaumuskel-Aponeurosen-Hyperplasie. Eine chirurgische Behandlung mit Coronoidektomie und Aponeurektomie verhalf schliesslich zu einer deutlichen Verbesserung der Mundöffnung. Wenngleich die eingeschränkte Mundöffnung ein Symptom vieler Erkrankungen des stomatognathen Systems ist, kann eine über längere Zeit bestehende oder auch progrediente eingeschränkte Mundöffnung diagnostisch und therapeutisch eine Herausforderung darstellen. Bei adäquater Diagnostik und Therapie ist die Prognose des oben genannten Symptomenkomplexes günstig und führt zu einer Verbesserung der mundgesundheitsbezogenen Lebensqualität.

Enlargement of keratinized peri-implant mucosa at the time of second stage surgery (re-entry)

A tightly attached keratinized mucosa around endosseous dental implants is believed to be protective against peri-implant bone loss. Tension caused by buccal frena and mobile non keratinized mucosa is to avoid. This case report documents the optimization of peri-implant mucosal conditions in the upper and lower jaw. At the time of second stage surgery (re-entry) at submucosally osseointegrated dental implants an enlargement of keratinized mucosa and a thickening of soft tissue was obtained administrating a vestibuloplasty combined by a free gingival graft or a vestibuloplasty combined by an apically moved flap.

SADMFR guidelines for the use of Cone-Beam Computed Tomography/ Digital Volume Tomography

Cone-Beam Computed Tomography (CBCT) has been introduced in 1998. This radiological imaging procedure has been provided for dentistry and is comparable to computed tomography (CT) in medicine. It is expected that CBCT will have the same success in dental diagnostic imaging as computed tomography had in medicine. Just as CT is responsible for a significant rise in radiation dose to the population from medical X-ray diagnostics, CBCT studies will be accompanied by a significant increase of the dose to our patients by dentistry. Because of the growing concern for an uncritical and consequently rapidly increasing use of CBCT the Swiss Society of Dentomaxillofacial Radiology convened a first consensus conference in 2011 to formulate indications for CBCT, which can be used as guidelines. In this meeting, oral and maxillofacial surgery, orthodontics and temporomandibular joint disorders and diseases were treated and the most important and most experienced users of DVT in these areas were asked to participate. In general, a highly restrictive use of CBCT is required. Justifying main criterion for CBCT application is that additional, therapy-relevant information is expected that should lead to a significant benefit in patient care. All users of CBCT should have completed a structured, high-level training, just like that offered by the Swiss Society of Dentomaxillofacial Radiology.

Ophthalmic complications and local anesthesia. Pathophysiology and types of eye complications after intraoral dental anesthesia, and clinical recommendations

The present article reviews the different types of ophthalmologic complications following administration of intraoral local anesthesia. Since the first report by Brain in 1936, case reports about that topic have been published regularly in the literature. However, clinical studies evaluating the incidence of ophthalmologic complications after intraoral local anesthesia are rarely available. Previous data point to a frequency ranging from 0.03% to 0.13%. The most frequently described ophthalmologic complications include diplopia (double vision), ptosis (drooping of upper eyelid), and mydriasis (dilatation of pupil). Disorders that rather affect periorbital structures than the eye directly include facial paralysis and periorbital blanching (angiospasm). Diverse pathophysiologic mechanisms and causes have been reported in the literature, with the inadvertent intravascular administration of the local anesthetic considered the primary reason. The agent as well as the vasopressor is transported retrogradely via arteries or veins to the orbit or to periorbital structures (such as the cavernous sinus) with subsequent anesthesia of nerves and paralysis of muscles distant from the oral cavity. In general the ophthalmologic complications begin shortly after administration of the local anesthesia, and disappear once the local anesthesia has subsided.

Einfluss von relativer Luftfeuchtigkeit und Applikationszeit auf die Dentinhaftkraft von sechs verschiedenen Adhäsivsystemen

Einleitung und Ziel: Das Arbeiten mit Adhäsivsystemen und Kompositmaterialien ist techniksensitiv und oft auch zeitaufwändig. Adhäsivsysteme und Kompositmaterialien sind feuchtigkeitsanfällig, weswegen die Verwendung eines Kofferdams von den Herstellern empfohlen wird - nicht nur, um während des Arbeitens mit Adhäsivsystemen und Kompositmaterialien die Gefahr einer Blut- oder Speichelkontamination zu minimieren sondern auch, um die hohe relative Luftfeuchtigkeit in der Mundhöhle auf die Luftfeuchtigkeit der Umgebung zu reduzieren. Abgesehen davon bestehen viele Adhäsivsysteme aus mehreren Applikationsschritten und diese Applikationsschritte weisen jeweils von den Herstellern genau angegebene Applikationszeiten auf. Je nach Adhäsivsystem erscheinen diese Applikationszeiten relativ lang und im klinischen Alltag kann die Gefahr bestehen, dass es zu einer Reduktion der vom Hersteller angegeben Applikationszeiten kommt. Es ist sehr wahrscheinlich, dass sowohl erhöhte relative Luftfeuchtigkeit als auch reduzierte Applikationszeiten die Dentinhaftkraft von Adhäsivsystemen negativ beeinflussen. Das Ziel dieser Studie war folglich, den Einfluss von relativer Luftfeuchtigkeit und Applikationszeit auf die Dentinhaftkraft von sechs verschiedenen Adhäsivsystemen zu untersuchen. Material und Methoden: Insgesamt 360 extrahierte menschliche Molaren ohne Füllungen und/oder Karies wurden verwendet (n=15 pro Gruppe; 24 Gruppen). Die Molaren wurden gereinigt und von okklusal bis ins mittlere Zahnkronendentin plangeschliffen. Die plangeschliffenen Molaren wurden anschliessend in selbsthärtendem Kunststoff eingebettet. Danach wurden die Oberflächen des Zahnkronendentins mit einem von sechs Adhäsivsystemen behandelt und Komposit (Filtek Z250; 3M ESPE) in Form eines Zylinders appliziert. Die sechs Adhäsivsysteme umfassten: 1) Syntac Classic (Ivoclar Vivadent), 2) OptiBond FL (Kerr), 3) Clearfil SE Bond (Kuraray), 4) AdheSE (Ivoclar Vivadent), 5) Xeno Select (DENTSPLY DeTrey) sowie 6) Scotchbond Universal (3M ESPE). Die Applikation des Adhäsivsystems und des Kompositzylinders wurde unter vier experimentellen Bedingungen durchgeführt. Die vier experimentellen Bedingungen wurden in einer modifizierten Handschuhbox erstellt (Abb. 1; CSL-GB24, Cleaver Scientific, Rugby, Grossbritannien) und umfassten: a) relative Luftfeuchtigkeit der Umgebung (~45%) und Applikationszeit gemäss Herstellerangaben, b) relative Luftfeuchtigkeit der Umgebung (~45%) und reduzierte Applikationszeit, c) erhöhte relative Luftfeuchtigkeit (≥85%) und Applikationszeit gemäss Herstellerangaben sowie d) erhöhte relative Luftfeuchtigkeit (≥85%) und reduzierte Applikationszeit. Nach 24 Stunden Lagerung wurden die auf Dentin applizierten Kompositzylinder in einer Universalprüfmaschine (Abb. 2; zwicki Z1.0 TN, Zwick, Ulm, Deutschland) mittels Scherkrafttest belastet (Traversengeschwindigkeit: 1 mm/min) und so die Haftkraftwerte bestimmt. Die Haftkraftwerte wurden anschliessend mit einer nichtparametrischen Varianzanalyse statistisch analysiert, gefolgt von Kruskal-Wallis- und Mann Whitney U-Tests sowie einer Bonferroni-Holm Korrektur für multiples Testen. Das Signifikanzniveau wurde auf α = 0.05 festgelegt. Resultate: Erhöhte relative Luftfeuchtigkeit sowie reduzierte Applikationszeit hatten keinen signifikanten Einfluss auf die Haftkraft von zwei der sechs untersuchten Adhäsivsysteme (Clearfil SE Bond und Scotchbond Universal; p = 1.00). Die Haftkraft der anderen vier Adhäsivsysteme (Syntac Classic, OptiBond FL, AdheSE und Xeno Select) wurde durch eine reduzierte Applikationszeit nicht signifikant beeinflusst (p ≥ 0.403). Allerdings reduzierte eine erhöhte relative Luftfeuchtigkeit (ungeachtet der Applikationszeit) die Haftkraft von Syntac Classic, OptiBond FL und Xeno Select signifikant (p ≤ 0.003). Eine erhöhte relative Luftfeuchtigkeit reduzierte die Haftkraft von AdheSE nur dann signifikant, wenn das Adhäsivsystem mit Applikationszeit gemäss Herstellerangaben verwendet wurde (p = 0.002). Hinsichtlich Unterschiede in der Haftkraft zwischen den sechs Adhäsivsystemen zeigte sich, dass OptiBond FL und Scotchbond Universal generell (sprich ungeachtet der vier experimentellen Bedingungen) die höchste Haftkraft erzielten. Von den anderen vier Adhäsivsystemen wurde Clearfil SE Bond am wenigsten durch erhöhte relative Luftfeuchtigkeit oder reduzierte Applikationszeit beeinflusst und zeigte zwar niedrigere Haftkraftwerte im Vergleich zu OptiBond FL und Scotchbond Universal dafür aber die konstanteste Haftkraft unter allen vier experimentellen Bedingungen. Schlussfolgerung: Die Dentinhaftkraft von zwei der sechs untersuchten Adhäsivsysteme (Clearfil SE Bond und Scotchbond Universal) wurde weder durch erhöhte relative Luftfeuchtigkeit noch durch reduzierte Applikationszeiten beeinflusst. Die Haftkraft der anderen vier Adhäsivsysteme wurde vor allem durch eine erhöhte relative Luftfeuchtigkeit negativ beeinflusst, grossmehrheitlich aber nicht durch eine reduzierte Applikationszeit. Klinisch ist daher die Kontrolle und Reduktion der relativen Luftfeuchtigkeit durch die Verwendung eines Kofferdams sehr zu empfehlen. Obwohl diese Studie gezeigt hat, dass reduzierte Applikationszeiten einen weniger starken, negativen Einfluss auf die Haftkraft haben, ist es trotzdem angezeigt, die Gebrauchsanleitungen der Adhäsivsysteme zu befolgen und sich an die Herstellerangaben zu halten.

Die chirurgische Kronenverlängerung zur Verbesserung der biologischen Breite und Ästhetik.

The aims of surgical crown lengthening procedures are to improve prosthetic reconstructions at teeth with limited hard tissue, to prevent periodontal problems and/or to improve esthetics. When planning and performing surgical crown lengthening, it is important to consider not only periodontal and technical aspects but also the gingival profile of the neighbouring teeth. This paper presents the systematic approach starting with the diagnosis and indication to the performed treatments and the obtained results and gives clinical recommendations.