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Huettig Fabian Schwendicke Falk 《Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz》2021,64(7):862-870
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - In den letzten 8 Jahren wurde in Deutschland nicht nur „mehr Versorgungsforschung in der Zahnmedizin“ gefordert,... 相似文献
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Theresa Linnemann Enno J. Kramer Falk Schwendicke Thomas Gerhard Wolf Hendrik Meyer-Lueckel Richard Johannes Wierichs 《Journal of endodontics》2021,47(4):577-584
IntroductionThe aims of this multicenter, practice-based cohort study were to evaluate the success and survival of endodontically treated teeth with post restorations (ETT+Ps) and to analyze factors associated with the longevity of ETT+Ps.MethodsEight general dental practitioners each placed up to 27 ETT+Ps without any restriction to post materials or dimensions. Only incisors, canines, and premolars were included. At the last follow-up visit, ETT+Ps were considered as successful if the post and the initially placed definitive restoration were sufficient, whereas ETT+Ps were considered as survived if the post was still in function. Multilevel Cox proportional hazards models were used to evaluate the association between a range of predictors and time until no success and no survival.ResultsOverall, 195 endodontic posts in 195 patients were followed up for a mean (95% confidence interval) of 91 (81–101) months; the longest follow-up was 15 years. Of these, 122 ETT+Ps were considered successful (estimated success time = 110 [101–120] months), and 152 ETT+Ps survived [estimated survival time = 133 [124–141] months). Regarding the categories of success and survival, the annual failure rates were 6.0% and 3.3%, respectively. Recementation of old (telescopic) crowns after placing new posts was the only significant predictor for decreased time until failure for both success and survival analyses. By excluding recemented restorations, annual failure rates decreased to 3.5% and 2.1%, respectively.ConclusionsFor EET+Ps placed in a private practice setting, high success and survival rates were observed. If old (telescopic) crowns were recemented after new posts were placed, the high risk of subsequent failure should be considered and communicated with patients. 相似文献
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Dominique Weimann Anneke Morgenthal Falk Schwendicke Claudia Fleck Hajar Razi 《Dental materials》2021,37(3):e162-e175
ObjectivesSelective caries removal (SCR) is recommended over non-selective removal for managing deep carious lesions to avoid pulp exposure and maintain pulp vitality. During SCR, residual carious dentin is left behind and sealed beneath the restoration. The biomechanical effects of such residual lesions on the restored tooth remain unclear and were assessed using finite element modeling (FEM).MethodsBased on μ-CT images of a healthy permanent human third molar, we developed five finite element models. Generic class I and II cavity restorations were modeled where residual lesions of variable sizes were either left or fully removed on occlusal and proximal surfaces. The cavities were restored with adhesive composite. All 3D-FE models were compared with a model of a healthy, non-treated molar. A vertical load of 100 N was applied onto the occlusal surface.ResultsRegardless of the lesion size, in molars with occlusal lesions higher mean stresses were predicted along the filling-lesion interface than in all other models. The smallest occlusal lesion (Ø1 = 1 mm) resulted in the highest maximum stresses at the filling-lesion interface with large stress concentrations at the filling walls indicating failure risk. In conclusion, lesion site and extent are influencing parameters affecting the filling-lesion interactions and thus the biomechanical behavior of the tooth after SCR.SignificanceRetaining carious lesions around the pulpal floor affects the deformation and stress states in tooth-filling complexes. The higher stresses observed in molars with occlusal lesions may affect restoration stability and longevity. Suprisingly, more extended occlusal lesions may provide a more favorable tooth performance than less extended ones. In contrast, in molars with proximal lesions the residual lesion had only limited effect on the tooth’s biomechanical condition. 相似文献
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Philipp Kanzow Joachim Krois Annette Wiegand Falk Schwendicke 《Dental materials》2021,37(6):e375-e381
ObjectivesWhen managing partially defective restorations, dentists can choose between repair and replacement. We aimed to assess the long-term treatment costs of repairs and replacements.MethodsPartially defective anterior and posterior composite restorations in permanent teeth had been repaired or replaced in a German university hospital and were retrospectively followed until censoring or one of the following events: (1) Extraction, (2) Major complications including placement of indirect restorations, endodontic treatments and extractions, or (3) Any complications including major complications and further direct restorations. Costs were estimated from a German mixed public-private-payer perspective. Cost-effectiveness differences were described using median-based incremental-cost-effectiveness ratios (ICERMEDIAN). Statistical analysis was performed using generalized linear mixed modeling (GLM), Chi2-test, and Wilcoxon rank-sum test (p < 0.05).ResultsA total of 616 repairs in 468 patients (follow-up: 4.9 ± 4.1 years) and 264 replacements in 218 patients (follow-up: 4.8 ± 4.3) were included. While replacements were associated with higher initial treatment costs, median annualized treatment costs did not significantly differ between repair (47.58 Euro [IQR: 24.41–107.04]) and replacement (50.64 Euro [IQR: 26.30–118.78]; p > 0.05), but were higher for molars (75.53 Euro [IQR: 24.41–92.18]) than incisors (45.03 Euro [IQR: 28.19–168.50]; p = 0.011). The difference in the % of extractions, major and any complications were minimal between both groups. The mean ICERMEDIAN of replacement vs. repair was -146.8 Euro/% when extractions were considered as outcomes. Regarding major and any complications, mean ICERMEDIAN amounted to 67.6 Euro/% and 23.9 Euro/%, respectively.SignificanceRepairs and replacements of partially defective restorations showed similar long-term costs and cost-effectiveness. 相似文献
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Michel Lehmensiek Haitham Askar Fredrik Brouwer Uwe Blunck Sebastian Paris Falk Schwendicke 《Dental materials》2018,34(12):e317-e323
Objective
Secondary caries lesions next to direct restorations are associated with the restoration material and the integrity of the tooth-restoration-interface (presence of interfacial gaps) as well as the application of masticatory forces. It remains unclear if this is true for indirect restorations. We aimed to evaluate secondary lesions next to conventionally-cemented partial gold (PG) and adhesively-cemented partial ceramic (PC) restorations, placed with or without interfacial gaps.Methods
In human molars, standardized two-surfaced cavities were prepared. Four groups (restoration material + cementation strategy) were compared: (1) gold + glass ionomer cement (Degudent/Ketac Cem), (2) lithium disilicate ceramic + self-adhesive resin cement (IPS e.max Press/RelyX Unicem 2), (3) lithium disilicate ceramic + self-etch adhesive + resin cement (IPS e.max Press/Adhese Universal/Variolink Esthetic DC), (4) lithium disilicate ceramic + etch-and-rinse adhesive + resin cement (IPS e.max Press/Syntac/Variolink Esthetic DC). Half of the restorations received a simulated interfacial gap (mean gap height was 237 μm), while the other half did not (n = 12/group). Specimens were submitted to a Lactobacillus rhamnosus-monospecies-biofilm-model with concomitant cyclic loading for 10 days. Mineral loss (ΔZ) of enamel-surface-lesions (ESL) and dentin-wall-lesions (DWL) was analyzed using transversal microradiography.Results
For ESL, neither the presence of an interfacial gap nor the restoration material nor the cementation strategy had a significant influence on ΔZ (p > 0.05/Generalized Linear Modelling). For DWL, ΔZ was significantly higher beneath restorations with interfacial gaps (p = 0.003/GLM); the restoration material and cementation strategy did not have a significant influence (p > 0.05).Significance
The presence of interfacial gaps, but not the restoration material or cementation strategy determined secondary caries lesions next to indirect restorations in vitro. 相似文献9.
Christian Graetz Anna Plaumann Sebastian Rauschenbach Jule Bielfeldt Christof E. Dörfer Falk Schwendicke 《Clinical oral investigations》2016,20(6):1193-1201
Background
Periodontal scaling might cause musculoskeletal disorders, and scaling instruments might not only have different effectiveness and efficiency but also differ in their ergonomic properties. The present study assessed ergonomic working patterns of experienced (EO) and less experienced operators (LO) when using hand and powered devices for periodontal scaling and root planning.Methods
In an experimental study using periodontally affected manikins, sonic (AIR), ultrasonic (TIG) and hand instruments (GRA) were used by 11 operators (7 EO/4 LO) during simulated supportive periodontal therapy. Using an electronic motion monitoring system, we objectively assessed the working frequency and positioning of hand, neck and head. Operators’ subjective evaluation of the instruments was recorded using a questionnaire.Results
Hand instruments were used with the lowest frequency (2.57?±?1.08 s?1) but greatest wrist deviation (59.57?±?53.94°). EO used instruments more specifically than LO, and generally worked more ergonomically, with less inclination of head and neck in both the frontal and sagittal planes, especially when using hand instruments. All groups found hand instruments more tiring and difficult to use than powered instruments.Conclusion
Regardless of operators’ experience, powered instruments were used more ergonomically and were subjectively preferred compared to hand instruments.Clinical relevance
The use of hand instruments has potential ergonomic disadvantages. However, with increasing experience, operators are able to recognise and mitigate possible risks.10.
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