Preparation and optimization of calcium fluoride particles for dental applications.

Fluorides are used in dental care due to their beneficial effect in tooth enamel de-/remineralization cycles. To achieve a desired constant supply of soluble fluorides in the oral cavity, different approaches have been followed. Here we present results on the preparation of CaF2 particles and their characterization with respect to a potential application as enamel associated fluoride releasing reservoirs. CaF2 particles were synthesized by precipitation from soluble NaF and CaCl2 salt solutions of defined concentrations and their morphology analyzed by scanning electron microscopy. CaF2 particles with defined sizes and shapes could be synthesized by adjusting the concentrations of the precursor salt solutions. Such particles interacted with enamel surfaces when applied at fluoride concentrations correlating to typical dental care products. Fluoride release from the synthesized CaF2 particles was observed to be largely influenced by the concentration of phosphate in the solution. Physiological solutions with phosphate concentration similar to saliva (3.5 mM) reduced the fluoride release from pure CaF2 particles by a factor of 10-20 × as compared to phosphate free buffer solutions. Fluoride release was even lower in human saliva. The fluoride release could be increased by the addition of phosphate in substoichiometric amounts during CaF2 particle synthesis. The presented results demonstrate that the morphology and fluoride release characteristics of CaF2 particles can be tuned and provide evidence of the suitability of synthetic CaF2 particles as enamel associated fluoride reservoirs.

Three-year outcomes of Straumann Bone Level SLActive dental implants in daily dental practice: a prospective non-interventional study

OBJECTIVE The aim of this investigation was to evaluate the performance of Straumann Bone Level SLActive implants in various clinical situations in daily dental practice for up to 3 years. METHOD AND MATERIALS This was a prospective, multicenter, non-interventional study in which implants were placed within approved indications in any situation deemed suitable by the treating clinician. No implant placement or loading protocol was specified, and implants were placed according to the routine treatment protocols at each participating center. RESULTS In this analysis, data were available from 342 implants in 233 patients in three countries (USA, Canada, and Switzerland). One or two implants were placed in the majority of patients (70.8% and 19.3%, respectively), mostly in the maxilla (71.3%); almost half (47.7%) were placed in the esthetic zone. Implant placement after 4 to > 16 weeks of healing was preferred in Switzerland (92.0%), while 42.0% of implants were placed immediately in the USA and Canada. A flapless procedure was performed in 25.2% of cases in the USA and Canada, compared to 0.5% in Switzerland. Cumulative implant survival and success rates after 3 years were 97.5% and 93.5%, respectively. CONCLUSION Straumann Bone Level Implants can achieve favorable outcomes and high survival rates after 3 years in daily dental practice. The survival and success rates were comparable with those achieved in formal controlled clinical trials.

Visual Acuity and Experience with Magnification Devices in Swiss Dental Practices

OBJECTIVES The aims of the present study in Swiss dental practices were 1) to provide an update on the prevalence of different magnification devices, 2) to examine the relationship between self-assessed and objectively measured visual acuity, and 3) to evaluate the visual performance of dentists in the individually optimized clinical situation of their respective practices. METHODS AND MATERIALS Sixty-nine dentists from 40 randomly selected private practices (n=20, <40 years; n=49, ≥40 years) participated in the study. A questionnaire was provided to evaluate the self-assessed near visual acuity and the experience with magnification devices. The objective near visual acuity was measured under standardized conditions on a negatoscope. The clinical situation, including the use of habitual optical aids, was evaluated with visual tests on a phantom head. RESULTS A total of 64% of the dentists owned a dental loupe: 45% Galilean loupes, 16% Keplerian loupes, and 3% single lens loupes. In total, 19% of the questioned dentists owned a microscope in addition to the loupes. The correlation between the self-assessed and the objective visual performance of the dentists was weak (Spearman rank correlation coefficient=0.25). In the habitual clinical situation, magnification devices (p=0.03) and the dentist's age (p=0.0012) had a significant influence on the visual performance. CONCLUSIONS Many dentists were not aware of their visual handicaps. Optical aids such as loupes or microscopes should be used early enough to compensate for individual or age-related visual deficiencies.

Systematic literature review of digital three-dimensional superimposition techniques to create virtual dental patients

PURPOSE Digital developments have led to the opportunity to compose simulated patient models based on three-dimensional (3D) skeletal, facial, and dental imaging. The aim of this systematic review is to provide an update on the current knowledge, to report on the technical progress in the field of 3D virtual patient science, and to identify further research needs to accomplish clinical translation. MATERIALS AND METHODS Searches were performed electronically (MEDLINE and OVID) and manually up to March 2014 for studies of 3D fusion imaging to create a virtual dental patient. Inclusion criteria were limited to human studies reporting on the technical protocol for superimposition of at least two different 3D data sets and medical field of interest. RESULTS Of the 403 titles originally retrieved, 51 abstracts and, subsequently, 21 full texts were selected for review. Of the 21 full texts, 18 studies were included in the systematic review. Most of the investigations were designed as feasibility studies. Three different types of 3D data were identified for simulation: facial skeleton, extraoral soft tissue, and dentition. A total of 112 patients were investigated in the development of 3D virtual models. CONCLUSION Superimposition of data on the facial skeleton, soft tissue, and/or dentition is a feasible technique to create a virtual patient under static conditions. Three-dimensional image fusion is of interest and importance in all fields of dental medicine. Future research should focus on the real-time replication of a human head, including dynamic movements, capturing data in a single step.

Peri-implant bone loss of dental implants with platform-switching design after 5 years of loading: a cross-sectional study

OBJECTIVE The aim of this cross-sectional study was to estimate bone loss of implants with platform-switching design and analyze possible risk indicators after 5 years of loading in a multi-centered private practice network. METHOD AND MATERIALS Peri-implant bone loss was measured radiographically as the distance from the implant shoulder to the mesial and distal alveolar crest, respectively. Risk factor analysis for marginal bone loss included type of implant prosthetic treatment concept and dental status of the opposite arch. RESULTS A total of 316 implants in 98 study patients after 5 years of loading were examined. The overall mean value for radiographic bone loss was 1.02 mm (SD ± 1.25 mm, 95% CI 0.90- 1.14). Correlation analyses indicated a strong association of peri-implant bone loss > 2 mm for removable implant-retained prostheses with an odds ratio of 53.8. CONCLUSION The 5-year-results of the study show clinically acceptable values of mean bone loss after 5 years of loading. Implant-supported removable prostheses seem to be a strong co-factor for extensive bone level changes compared to fixed reconstructions. However, these results have to be considered for evaluation of the included special cohort under private dental office conditions.

Determination of optimal parameters in drilling composite materials to minimize the machining temperature using the Taguchi method

Dental implant is used to replace the natural dental root. The process to fix the dental implant in the maxillary bone needs a previous drilling operation. This machining operation involves the increasing of temperature in the drilled region which can reach values higher than 47°C and for this temperature is possible to occur the osseous necrosis [I]. The main goal of this work is to implement an optimization method to define the optimal drilling parameters that could minimize the drilling temperature. The proposal optimization method is the Taguchi method. This method has been used with success in machining processes optimization of metallic materials [2]. However, the Taguchi method is also used in medical applications, namely in dental medicine [3].

Direct restorative materials use in Australia in 2002

Background: This study aimed to determine the reasons for dentists' choice of materials, in particular amalgam and resin composite, in Australia. Method: A questionnaire was developed to elicit this information. The names and addresses of 1000 dentists in Australia were selected at random. The questionnaire was mailed to these dentists with an explanatory letter and reply-paid envelope. Results: A total of 560 replies were received. Regarding choice of material, 99 per cent of respondents cited clinical indication as an influencing factor, although patients' aesthetic demands (99 per cent), patients' financial situation (82 per cent), and lecturers' suggestions (72 per cent) were also reported to influence respondents' choice of materials. Twelve per cent of respondents used composite 'always', 29 per cent 'often', 32 per cent 'sometimes', 23 per cent 'seldom' and 4 per cent 'never' in extensive load-bearing cavities in molar teeth. For composite restorations in posterior teeth, 84 per cent 'always', 'often' or 'sometimes' used the total etch technique, 84 per cent used a thick glass-ionomer layer and 36 per cent never used rubber dam. Fifty-nine per cent of respondents reported a decreased use of amalgam over the previous five years. Sixty-eight per cent of respondents agreed with the statement 'discontinuation of amalgam restricts a dentist's ability to adequately treat patients'. Seventy-five per cent considered that the growth in the use of composites increased the total cost of oral health care. Conclusions: Of the respondents from Australia 73 per cent place large composite restorations in molar teeth and their choice of material is influenced greatly by clinical indications, and patients' aesthetic demands.

A study in radiopaque polymeric materials

The problems associated with x-ray-transparent denture base are defined and conventional approaches to their solution are assessed. Consideration of elemental absorption parameters leads to the postulation that atoms such as zinc, and bromine, may be effective radiopacifiers over at least part of the clinical x-ray spectrum. These elements had hitherto been considered too light to be effective. Investigation of copolymers of methylmethacrylate and p-bromostyrene revealed no deleterious effects arising from the aromatically brominated monomer (aliphatic bromination caused UV destabilisation). For effective x-ray absorption a higher level of bromination would be necessary, but the expense of suitable compounds made further study unjustifiable. Incorporation of zinc atoms into the polymer was accomplished by copolymerisation of zinc acrylate with methylmethacrylate in solution. At high zinc levels this produced a powder copolymer convenient for addition to dental polymers in the dough moulding process. The resulting mouldings showed increasing brittleness at high loadings of copolymer. Fracture was shown to be through the powder particles rather than around them, indicating the source of weakness to be in the internal structure of the copolymer. The copolymer was expected to be cross-linked through divalent zinc ions and its insolubility and infusibility supported this. Cleavage of the ionic cross links with formic acid produced a zinc-free linear copolymer of high molecular weight. Addition of low concentrations of acrylic acid to the dough moulding monomer appeared to 'labilise' the cross links producing a more homogeneous moulding with adequate wet strength. Toxicologically the zinc-containing materials are satisfactory and though zinc is extracted at a measurable rate in an aqueous system, this is very small and should be acceptable over the life of a denture. In other respects the composite is quite satisfactory and though a marketable product is not claimed the system is considered worthy of further study.

Disinfection of clinical materials using photo-activated tolonium chloride solution

Photo-activated disinfection is beginning to be used in dental surgery to treat deep seated bacterial infection. It works by combining a photosensitiser and light of a specific frequency to generate singlet oxygen which is toxic to many types of bacteria. It is suggested that this technique could be used as a means to help treat infection more generally. To do so, it needs to work with materials and geometries exhibiting different physical and optical characteristics to teeth. In these trials, samples of stainless steel and polymethylmethacrylate were exposed to bacterial solutions of Staphylococcus aureus and Staphylococcus epidermis. These were treated with tolonium chloride-based photo-activated disinfection regimes showing positive results with typically 4 log10 reductions in colony forming units. Tests were also carried out using slotted samples to represent geometric features which might be found on implants. These tests, showed disinfectant effect however to a much lesser degree. © 2011 Inderscience Enterprises Ltd.

Wear and its effects on dental topography measures in howling monkeys (Alouatta palliata).

OBJECTIVES: Three dental topography measurements: Dirichlet Normal Energy (DNE), Relief Index (RFI), and Orientation Patch Count Rotated (OPCR) are examined for their interaction with measures of wear, within and between upper and lower molars in Alouatta palliata. Potential inferences of the "dental sculpting" phenomenon are explored. MATERIALS AND METHODS: Fifteen occluding pairs of howling monkey first molars (15 upper, 15 lower) opportunistically collected from La Pacifica, Costa Rica, were selected to sample wear stages ranging from unworn to heavily worn as measured by the Dentine Exposure Ratio (DER). DNE, RFI, and OPCR were measured from three-dimensional surface reconstructions (PLY files) derived from high-resolution CT scans. Relationships among the variables were tested with regression analyses. RESULTS: Upper molars have more cutting edges, exhibiting significantly higher DNE, but have significantly lower RFI values. However, the relationships among the measures are concordant across both sets of molars. DER and EDJL are curvilinearly related. DER is positively correlated with DNE, negatively correlated with RFI, and uncorrelated with OPCR. EDJL is not correlated with DNE, or RFI, but is positively correlated with OPCR among lower molars only. DISCUSSION: The relationships among these metrics suggest that howling monkey teeth adaptively engage macrowear. DNE increases with wear in this sample presumably improving food breakdown. RFI is initially high but declines with wear, suggesting that the initially high RFI safeguards against dental senescence. OPCR values in howling monkey teeth do not show a clear relationship with wear changes.

Effect of dental tissue conditioners and matrix metalloproteinase inhibitors on type I collagen microstructure analyzed by Fourier transform infrared spectroscopy

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effectiveness of tooth wipes in removing babies' dental biofilm

PURPOSE To assess the effectiveness of tooth wipes in removing dental biofilm from babies' anterior teeth, as well as to evaluate the babies' behaviour and the guardians' preference concerning hygiene methods. MATERIALS AND METHODS In this random blind cross-over study, 50 high caries risk babies, from 8 to 15 months old, were divided into two groups: babies with oral hygiene performed by caregivers (n = 25) or by their mothers (n = 25). The caregivers and mothers removed biofilm using three methods of oral hygiene (tooth wipes, toothbrushes and gauze), one in each experimental phase. Professional cleaning was done before each phase, which had 2 days of biofilm accumulation and 1 experimental day, when caregivers and mothers used one method to remove biofilm. Examiners blinded to the study design assessed the biofilm index at baseline, prior to and following biofilm removal using each method. The babies' behaviour and the mothers'/caregivers' preference were assessed. RESULTS The tooth wipes, toothbrushes and gauze significantly reduced the amount of biofilm (P < 0.001). The mothers' group removed more biofilm than the caregivers' group, using toothbrushes or tooth wipes (P < 0.05). Babies in the mothers' group had better behaviour using tooth wipes than toothbrushes (P < 0.05). Mothers and caregivers preferred to use tooth wipes. CONCLUSIONS Tooth wipes are effective in removing biofilm from babies' anterior teeth and are the method best accepted by mothers, caregivers and babies.