Consensus report of the European Federation of Conservative Dentistry: erosive tooth wear-diagnosis and management

OBJECTIVE Due to an increased focus on erosive tooth wear (ETW), the European Federation of Conservative Dentistry (EFCD) considered ETW as a relevant topic for generating this consensus report. MATERIALS AND METHODS This report is based on a compilation of the scientific literature, an expert conference, and the approval by the General Assembly of EFCD. RESULTS ETW is a chemical-mechanical process resulting in a cumulative loss of hard dental tissue not caused by bacteria, and it is characterized by loss of the natural surface morphology and contour of the teeth. A suitable index for classification of ETW is the basic erosive wear examination (BEWE). Regarding the etiology, patient-related factors include the pre-disposition to erosion, reflux, vomiting, drinking and eating habits, as well as medications and dietary supplements. Nutritional factors relate to the composition of foods and beverages, e.g., with low pH and high buffer capacity (major risk factors), and calcium concentration (major protective factor). Occupational factors are exposition of workers to acidic liquids or vapors. Preventive management of ETW aims at reducing or stopping the progression of the lesions. Restorative management aims at reducing symptoms of pain and dentine hypersensitivity, or to restore esthetic and function, but it should only be used in conjunction with preventive strategies. CONCLUSIONS Effective management of ETW includes screening for early signs of ETW and evaluating all etiological factors. CLINICAL RELEVANCE ETW is a clinical condition, which calls for the increased attention of the dental community and is a challenge for the cooperation with other medical specialities.

Punitive reactions to completed crimes versus accidentally uncompleted crimes

Previous studies have shown that the harm caused by crime affects punitive reactions even if differences in the degree of harm are merely accidental. However, it remains unclear whether the effect is direct or whether it is mediated by attributed responsibility or blame. Participants were 303 university students who listened to 4 case vignettes (between-subjects design). Half received information about a completed crime and half about an accidentally uncompleted crime. Crime type was either fraud or rape. The results suggest that individuals consider the actual harm to a significantly greater extent than attribution theory would predict. Moreover, the link between harm and punishment was virtually not mediated by attributed blame and not moderated by individual differences in morality. Future studies should investigate whether the harm-punishment link is a result of an automatic act of retaliation or a desire to compensate for the harm done to the victim (restorative justice).

An Assessment of the Risk of Bias in Randomized Controlled Trial Reports Published in Prosthodontic and Implant Dentistry Journals

PURPOSE The objective of this study was to assess the risk of bias of randomized controlled trials (RCTs) published in prosthodontic and implant dentistry journals. MATERIALS AND METHODS The last 30 issues of 9 journals in the field of prosthodontic and implant dentistry (Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, Implant Dentistry, International Journal of Oral & Maxillofacial Implants, International Journal of Periodontics and Restorative Dentistry, International Journal of Prosthodontics, Journal of Dentistry, Journal of Oral Rehabilitation, and Journal of Prosthetic Dentistry) were hand-searched for RCTs. Risk of bias was assessed using the Cochrane Collaboration's risk of bias tool and analyzed descriptively. RESULTS From the 3,667 articles screened, a total of 147 RCTs were identified and included. The number of published RCTs increased with time. The overall distribution of a high risk of bias assessment varied across the domains of the Cochrane risk of bias tool: 8% for random sequence generation, 18% for allocation concealment, 41% for masking, 47% for blinding of outcome assessment, 7% for incomplete outcome data, 12% for selective reporting, and 41% for other biases. CONCLUSION The distribution of high risk of bias for RCTs published in the selected prosthodontic and implant dentistry journals varied among journals and ranged from 8% to 47%, which can be considered as substantial.

Reporting quality of randomised controlled trials published in prosthodontic and implantology journals

The purpose of this study was to examine the reporting quality of randomised controlled trials (RCTs) published in prosthodontic and implantology journals. Thirty issues of nine journals in prosthodontics and implant dentistry were searched for RCTs, covering the years 2005-2012: The Journal of Prosthetic Dentistry, Journal of Oral Rehabilitation, The International Journal of Prosthodontics, The International Journal of Periodontics & Restorative Dentistry, Clinical Oral Implants Research, Clinical Implant Dentistry & Related Research, The International Journal of Oral & Maxillofacial Implants, Implant Dentistry and Journal of Dentistry. The reporting quality was assessed using a modified Consolidated Standards of Reporting Trials (CONSORT) statement checklist. Data were analysed using descriptive statistics followed by univariable and multivariable examination of statistical associations (α = 0·05). A total of 147 RCTs were identified with a mean CONSORT score of 69·4 (s.d. = 9·7). Significant differences were found among journals with the Journal of Oral Rehabilitation achieving the highest score (80·6, s.d. = 5·5) followed by Clinical Oral Implants Research (73·7, s.d. = 8·3). Involvement of a statistician/methodologist was significantly associated with increased CONSORT scores. Overall, the reporting quality of RCTs in major prosthodontic and implantology journals requires improvement. This is of paramount importance considering that optimal reporting of RCTs is an important prerequisite for clinical decision-making.

Single crowns versus conventional fillings for the restoration of root-filled teeth.

BACKGROUND Endodontic treatment involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to structural differences between vital and non-vital root-filled teeth. Direct restoration involves placement of a restorative material e.g. amalgam or composite, directly into the tooth. Indirect restorations consist of cast metal or ceramic (porcelain) crowns. The choice of restoration depends on the amount of remaining tooth, and may influence durability and cost. The decision to use a post and core in addition to the crown is clinician driven. The comparative clinical performance of crowns or conventional fillings used to restore root-filled teeth is unknown. This review updates the original, which was published in 2012. OBJECTIVES To assess the effects of restoration of endodontically treated teeth (with or without post and core) by crowns versus conventional filling materials. SEARCH METHODS We searched the following databases: the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE via OVID, EMBASE via OVID, CINAHL via EBSCO, LILACS via BIREME. We also searched the reference lists of articles and ongoing trials registries.There were no restrictions regarding language or date of publication. The search is up-to-date as of 26 March 2015. SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-randomised controlled trials in participants with permanent teeth that have undergone endodontic treatment. Single full coverage crowns compared with any type of filling materials for direct restoration or indirect partial restorations (e.g. inlays and onlays). Comparisons considered the type of post and core used (cast or prefabricated post), if any. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the included trial and assessed its risk of bias. We carried out data analysis using the 'treatment as allocated' patient population, expressing estimates of intervention effect for dichotomous data as risk ratios, with 95% confidence intervals (CI). MAIN RESULTS We included one trial, which was judged to be at high risk of performance, detection and attrition bias. The 117 participants with a root-filled, premolar tooth restored with a carbon fibre post, were randomised to either a full coverage metal-ceramic crown or direct adhesive composite restoration. None experienced a catastrophic failure (i.e. when the restoration cannot be repaired), although only 104 teeth were included in the final, three-year assessment. There was no clear difference between the crown and composite group and the composite only group for non-catastrophic failures of the restoration (1/54 versus 3/53; RR 0.33; 95% CI 0.04 to 3.05) or failures of the post (2/54 versus 1/53; RR 1.96; 95% CI 0.18 to 21.01) at three years. The quality of the evidence for these outcomes is very low. There was no evidence available for any of our secondary outcomes: patient satisfaction and quality of life, incidence or recurrence of caries, periodontal health status, and costs. AUTHORS' CONCLUSIONS There is insufficient evidence to assess the effects of crowns compared to conventional fillings for the restoration of root-filled teeth. Until more evidence becomes available, clinicians should continue to base decisions about how to restore root-filled teeth on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients.

Partial lateralization of the nasopalatine nerve at the incisive foramen for ridge augmentation in the anterior maxilla prior to placement of dental implants: a retrospective case series evaluating self-reported data and neurosensory testing

The objective of this study was to assess implant therapy after a staged guided bone regeneration procedure in the anterior maxilla by lateralization of the nasopalatine nerve and vessel bundle. Neurosensory function following augmentative procedures and implant placement, assessed using a standardized questionnaire and clinical examination, were the primary outcome variables measured. This retrospective study included patients with a bone defect in the anterior maxilla in need of horizontal and/or vertical ridge augmentation prior to dental implant placement. The surgical sites were allowed to heal for at least 6 months before placement of dental implants. All patients received fixed implant-supported restorations and entered into a tightly scheduled maintenance program. In addition to the maintenance program, patients were recalled for a clinical examination and to fill out a questionnaire to assess any changes in the neurosensory function of the nasopalatine nerve at least 6 months after function. Twenty patients were included in the study from February 2001 to December 2010. They received a total of 51 implants after augmentation of the alveolar crest and lateralization of the nasopalatine nerve. The follow-up examination for questionnaire and neurosensory assessment was scheduled after a mean period of 4.18 years of function. None of the patients examined reported any pain, they did not have less or an altered sensation, and they did not experience a "foreign body" feeling in the area of surgery. Overall, 6 patients out of 20 (30%) showed palatal sensibility alterations of the soft tissues in the region of the maxillary canines and incisors resulting in a risk for a neurosensory change of 0.45 mucosal teeth regions per patient after ridge augmentation with lateralization of the nasopalatine nerve. Regeneration of bone defects in the anterior maxilla by horizontal and/or vertical ridge augmentation and lateralization of the nasopalatine nerve prior to dental implant placement is a predictable surgical technique. Whether or not there were clinically measurable impairments of neurosensory function, the patients did not report them or were not bothered by them.

Cognitive rehabilitation of working memory in juvenile multiple sclerosis-effects on cognitive functioning, functional MRI and network related connectivity.

PURPOSE To assess possible effects of working memory (WM) training on cognitive functionality, functional MRI and brain connectivity in patients with juvenile MS. METHODS Cognitive status, fMRI and inter-network connectivity were assessed in 5 cases with juvenile MS aged between 12 and 18 years. Afterwards they received a computerized WM training for four weeks. Primary cognitive outcome measures were WM (visual and verbal) and alertness. Activation patterns related to WM were assessed during fMRI using an N-Back task with increasing difficulty. Inter-network connectivity analyses were focused on fronto-parietal (left and right), default-mode (dorsal and ventral) and the anterior salience network. Cognitive functioning, fMRI and inter-network connectivity were reassessed directly after the training and again nine months following training. RESULTS Response to treatment was seen in two patients. These patients showed increased performance in WM and alertness after the training. These behavioural changes were accompanied by increased WM network activation and systematic changes in inter-network connectivity. The remaining participants were non-responders to treatment. Effects on cognitive performance were maintained up to nine months after training, whereas effects observed by fMRI disappeared. CONCLUSIONS Responders revealed training effects on all applied outcome measures. Disease activity and general intelligence may be factors associated with response to treatment.

Determinación de la microdureza de la dentina coronaria previamente acondicionada

La dureza es una de las propiedades utilizadas para comparar tanto los materiales restauradores como los tejidos biológicos. El objetivo de este trabajo es determinar la microdureza de la dentina coronaria en dientes sin acondicionar y luego acondicionados con EDTA al 17%. Para este estudio se seleccionaron 30 muestras de dentina de dientes recientemente extraídos. Los elementos fueron seccionados longitudinalmente con discos de diamante de doble corte (Horico), con abundante refrigeración acuosa, a nivel coronario, y serán conservados en saliva artificial (laboratorio NAF) a 37°C. La medición de la microdureza dentinaria se realizó con un microdurómetro Vickers, con una carga de 50g durante 30 s. Los datos fueron recolectados en una planilla ad hoc y procesados estadísticamente mediante el Test de Student.

Lograr estética y función en el sector posterior con resinas compuestas

La operatoria dental actual cuenta con un conocimiento más profundo de las diferentes estructuras dentarias que sumado al gran adelanto tecnológico y científico en la ciencia de los biomateriales; fruto de innumerables investigaciones, nos permiten contar hoy, con una nueva generación de materiales restauradores, lo que hace más crítico y exigente el conocimiento y análisis por parte del profesional, de las técnicas a efectuar, la realización depurada de procedimientos y los biomateriales a utilizar, con el fin de realizar tratamientos que sean biocompatibles, eficientes y de importante longevidad.

Intrastriatal injection of an adenoviral vector expressing glial-cell-line-derived neurotrophic factor prevents dopaminergic neuron degeneration and behavioral impairment in a rat model of Parkinson disease

Glial-cell-line-derived neurotrophic factor (GDNF) is a potent neurotrophic factor for adult nigral dopamine neurons in vivo. GDNF has both protective and restorative effects on the nigro-striatal dopaminergic (DA) system in animal models of Parkinson disease. Appropriate administration of this factor is essential for the success of its clinical application. Since it cannot cross the blood–brain barrier, a gene transfer method may be appropriate for delivery of the trophic factor to DA cells. We have constructed a recombinant adenovirus (Ad) encoding GDNF and injected it into rat striatum to make use of its ability to infect neurons and to be retrogradely transported by DA neurons. Ad-GDNF was found to drive production of large amounts of GDNF, as quantified by ELISA. The GDNF produced after gene transfer was biologically active: it increased the survival and differentiation of DA neurons in vitro. To test the efficacy of the Ad-mediated GDNF gene transfer in vivo, we used a progressive lesion model of Parkinson disease. Rats received injections unilaterally into their striatum first of Ad and then 6 days later of 6-hydroxydopamine. We found that mesencephalic nigral dopamine neurons of animals treated with the Ad-GDNF were protected, whereas those of animals treated with the Ad-β-galactosidase were not. This protection was associated with a difference in motor function: amphetamine-induced turning was much lower in animals that received the Ad-GDNF than in the animals that received Ad-β-galactosidase. This finding may have implications for the development of a treatment for Parkinson disease based on the use of neurotrophic factors.

Glycerol-induced development of catalytically active conformation of Crotalus adamanteus L-amino acid oxidase in vitro.

The reconstitutable apoprotein of Crotalus adamanteus L-amino acid oxidase was prepared using hydrophobic interaction chromatography. After reconstitution with flavin adenine dinucleotide, the resulting protein was inactive, with a perturbed conformation of the flavin binding site. Subsequently, a series of cosolvent-dependent compact intermediates was identified. The nearly complete activation of the reconstituted apoprotein and the restoration of its native flavin binding site was achieved in the presence of 50% glycerol. We provide evidence that in addition to a merely stabilizing effect of glycerol on native proteins, glycerol can also have a restorative effect on their compact equilibrium intermediates, and we suggest the hydrophobic effect as a dominating force in this in vitro-assisted restorative process.

Retrograde axonal transport of glial cell line-derived neurotrophic factor in the adult nigrostriatal system suggests a trophic role in the adult.

The recently cloned, distant member of the transforming growth factor beta (TGF-beta) family, glial cell line-derived neurotrophic factor (GDNF), has potent trophic actions on fetal mesencephalic dopamine neurons. GDNF also has protective and restorative activity on adult mesencephalic dopaminergic neurons and potently protects motoneurons from axotomy-induced cell death. However, evidence for a role for endogenous GDNF as a target-derived trophic factor in adult midbrain dopaminergic circuits requires documentation of specific transport from the sites of synthesis in the target areas to the nerve cell bodies themselves. Here, we demonstrate that GDNF is retrogradely transported by mesencephalic dopamine neurons of the nigrostriatal pathway. The pattern of retrograde transport following intrastriatal injections indicates that there may be subpopulations of neurons that are GDNF responsive. Retrograde axonal transport of biologically active 125I-labeled GDNF was inhibited by an excess of unlabeled GDNF but not by an excess of cytochrome c. Specificity was further documented by demonstrating that another TGF-beta family member, TGF-beta 1, did not appear to affect retrograde transport. Retrograde transport was also demonstrated by immunohistochemistry by using intrastriatal injections of unlabeled GDNF. GDNF immunoreactivity was found specifically in dopamine nerve cell bodies of the substantia nigra pars compacta distributed in granules in the soma and proximal dendrites. Our data implicate a specific receptor-mediated uptake mechanism operating in the adult. Taken together, the present findings suggest that GDNF acts endogenously as a target-derived physiological survival/maintenance factor for dopaminergic neurons.

Estudo de propriedades de resinas compostas bulk fill

Diante da evolução da composição das resinas compostas e do lançamento de compósitos do tipo bulk fill, faz-se necessário o estudo do desempenho dessa nova classe de materiais. Para isso, o presente estudo teve como objetivo avaliar propriedades como grau de conversão (GC) , dureza Knoop (KHN), resistência à flexão (RF) e tenacidade à fratura (KIC) de sete compósitos bulk fill (EverX Posterior, EXP; Filtek Bulk Fill Flow, FBFF; Fill-Up!, FU; SonicFill, SF; Surefil SDR, SDR; Tetric EvoCeram Bulk Fill, TECBF; Venus Bulk Fill, VBF) e um compósito nanohíbrido convencional (Charisma Diamond, CD). De forma complementar, foi realizado tratamento térmico a 170 °C por 10 minutos para melhor compreensão do comportamento desses materiais quanto ao potencial de conversão e à indução de tensões na interface carga/matriz. A avaliação do GC (n=3) foi realizada através de espectroscopia FTIR, a leitura da dureza Knoop foi realizada nas superfícies do topo e da base (n=3), e os ensaios de RF de três pontos (n=10) e KIC (n=10) em máquina de ensaios universais. Os resultados obtidos foram submetidos à analise de variância (complementados pelo teste de Tukey) ou teste Kruskal-Wallis, com nível de significância de 5%. A análise do GC (%) revelou diferença entre os materiais testados, sendo que todas as resinas bulk fill apresentaram valores maiores que a resina convencional: SF (75,7) > VBF (66,7) = EXP (66,4) = SDR (62,8), sendo esta também semelhante a FU (60,0); FU, TECBF (56,6), FBFF (56,6) e CD (54,5) apresentaram conversão semelhante. Os valores de KHN variaram de acordo com o material e com a superfície: apenas SF apresentou KHN semelhante (na superfície do topo) a CD, entretanto não foi possível realizar a leitura da superfície da base deste último material; SF, TECBF e FBFF apresentaram valores de KHN diferentes nas superfícies topo e base; EXP, FU, SDR e VBF mantiveram os valores de dureza do topo semelhantes à superfície da base. Para a RF (MPa), os resultados variaram de acordo com o material: EXP (122,54) = SF (101,09) = CD (99,15), sendo estes dois últimos semelhantes a FU (83,86) e TECBF (82,71), os quais não diferiram da resina SDR (65,18); esta última também mostrou comportamento semelhante a FBFF (60,85) e VBF (59,90). Quanto ao KIC (MPa.mm0,5), EXP (3,35) apresentou o maior valor, semelhante a SF (2,42), que por sua vez também foi igual ao compósito convencional CD (2,01); CD apresentou KIC semelhante a SDR (1,74); SDR = VBF (1,59) = TECBF (1,57); TECBF, FU (1,54) e FBFF (1,37) apresentaram valores semelhantes. Na dependência do material, o tratamento térmico aumentou os valores dos parâmetros estudados, apontando limitações da reação de polimerização dos compósitos estudados. Com base nos resultados obtidos, podese concluir que: resinas bulk fill apresentam elevado GC, superior à resina convencional estudada; a nova classe de materiais restauradores é capaz de polimerizar em profundidade e alguns materiais apresentam KHN semelhantes no topo e na base de espécimes de 4 mm de profundidade; RF e KIC variaram de acordo com o material, e o compósito EXP apresentou os maiores valores para ambos os testes.

Análise biomecânica de resistência à fratura em dentes caninos artificiais de cães, com restauração metálica fundida e retentores intrarradiculares retos e curvos com núcleo - Estudo comparativo com análise por elementos finitos

Os cães, por fatores diversos, acabam por apresentar dentes fraturados com ou sem exposição de polpa. Estas fraturas basicamente são identificadas como fraturas recuperáveis não complicadas, recuperáveis complicadas ou irrecuperáveis. As fraturas recuperáveis (localizadas apenas no esmalte e dentina) são tratadas com dentística restauradora. As recuperáveis complicadas (com lesões em esmalte, dentina e exposição do canal radicular) passam por tratamento endodôntico, podendo ser seguidas de restaurações metálicas. Os dentes mais comumente acometidos são os dentes caninos, superiores ou inferiores. Este trabalho em dentes artificiais simulando considerável destruição de sua porção coronal objetivou testar, após a adaptação da restauração metálica fundida, a resistência às fraturas no dente canino. Os dentes artificiais foram padronizados com uma técnica de replicação de raízes artificiais em molde de resina acrílica quimicamente ativada. Oitenta réplicas iguais de resina composta fotopolimerizável, padronizadas em tamanho e forma, foram construídas a partir desta técnica. Antes da reconstrução protética, aplicou-se o tratamento endodôntico, desobturação, preparo do canal radicular e moldagem. Proteticamente, um pino intrarradicular reto e outro curvo, ambos com núcleo para sustentar a coroa metálica fundida foram cimentados na porção coronal de cada raiz-réplica. Os núcleos e coroa metálica foram ambos ferulados ou estojados. Avaliou-se os dois tipos de restauração com pino intrarradicular curvos ou retos cimentados com cimento de fosfato de zinco ou resinoso para identificar o melhor conjunto restaurador. Os testes de resistência biomecânica de 80 raízes-réplicas foram divididos em 4 grupos com 20 corpos de prova para cada um dos grupos. Grupo 1: das raízes-réplicas com pino intrarradicular curvo cimentados com cimento resinoso. Grupo 2: das raízes-réplicas com pino intrarradicular curvo cimentados com cimento de fosfato de zinco. Grupo 3: das raízes-réplicas com pino intrarradicular reto cimentados com cimento resinoso. Grupo 4: das raízes-réplicas com pino intrarradicular reto cimentados com cimento de fosfato de zinco. Estes grupos foram submetidos a teste de força com pré-carga de 1,5 N, com velocidade de avanço constante de 0,05 mm por minuto em ponto pré- determinado (mésio-lateral vestibularizada) até ocorrência de fratura do conjunto ou parte dele em uma Máquina Universal Kratos. Com a avaliação biomecânica e estudo estatístico de Kruskall-Wallis, identificou-se que os dados obtidos não seguiram distribuição normal. Esta diferença mostrou-se com o p<0,05 na interpretação do teste. No caso de dados não paramétricos o post-hoc do Kruskal-Wallis foi o teste de U de Mann-Withney. Paralelamente, um estudo com análise de elementos finitos comparou os resultados obtidos. Não houve diferença significativa sobre o tipo de cimento utilizado ou que favorecesse o uso do pino reto ou do pino curvo, recaindo a escolha para o operador decidir de acordo com a melhor indicação para cada caso clínico

La vulneración empresarial del derecho de huelga y responsabilidad por daños y perjuicios

Existen conductas empresariales de muy diversa naturaleza que pueden dar lugar a la transgresión del derecho de huelga. En estos casos se hace necesario reparar los daños que tales conductas provocan, tanto en el plano individual (trabajador) como en el plano colectivo (sindicatos u órganos de representación unitaria), teniendo en cuenta que la indemnización que derive de ello debe cumplir una función ejemplarizante, además de la propiamente reparadora. En el presente estudio, siguiendo los criterios que han ido sentando nuestros Tribunales, se identifican distintas conductas empresariales susceptibles de conculcar el derecho de huelga, a la par que se analizan todas y cada una de las partidas que debieran estar presentes a la hora de calcular el monto indemnizatorio, así como los criterios de valoración a tener en cuenta en estos casos.