Porcelain and glass ceramics need to be bonded to teeth for the reinforcement of restorations: according to studies, the best results are achieved by pretreating and etching the ceramic surface with hydrofluoric acid, then applying a silane coupling agent or a ceramic primer, and luting with a light- or dual-cured adhesive cement, depending on the restoration thickness. Zirconia is bonded to teeth after gentle roughening by airborne abrasion (gritblasting) using an adhesive resin composite cement. In addition, Tribochemical silica coating combined with silane application is an alternative that might provide enhanced adhesion to zirconia. The best durable bonding to zirconia is achieved by applying a dual-cured adhesive resin composite cement that contains phosphate ester groups. Among the clinically relevant parameters involved in choosing an adhesive cement system to bond ceramic restorations to the dental hard tissues, the aesthetic properties, colour stability, ease of handling, and appropriate working times of the cement are to be considered

Silver and stannous fluorides in prevention and treatment of caries and tooth erosions Caries and dental erosions involve major challenges in dentistry. In addition to removal of causal factors (sugars and acids), in the man-agement of those conditions, silver and tin (stannous) fluorides have recently received much attention. Silver diamine fluoride has proved effective for arresting and prevention caries. Stannous fluoride has been of particular interest in the prevention of dental erosions. This paper provides an overview of proposed mechanisms of action and available data on clinical effectiveness for these two metal fluorides.

VITAL PULP TREATMENTS IN TEETH WITH DEEP CARIOUS LESIONS 

Vital pulp treatments (VPT) are performed to preserve the defense functions of the pulp and thus to avoid pulpectomy and root filling which can be technically demanding and not always ends up with the desired outcome. The European Society of Endodontology (ESE) has published a position paper on VPT in teeth with deep carious lesions which partly matches to national guidelines in Nordic countries. There are unsolved difficulties in assessing the pulpal status in teeth with deep carious lesions. As long as the carious lesion has not reached the pulp, treatments performed to avoid pulp exposure, such as stepwise excavation, are recommended. On the other hand, when the pulp is exposed due to caries, the recommendations are somewhat different between the ESE and national guidelines in Nordic countries. This is most probably due to lack of evidence favoring one treatment over the other and due to difficulties in assessing which exposed pulps are irreversibly damaged. Minimally invasive management strategies with recently developed hydraulic calcium silicate cements show promising results of VPTs aiming at avoiding root canal treatment. The VPTs will be further developed and changes to clinical recommendations are anticipated.

Formål Formålet med undersøgelsen var at evaluere den kliniske og histologiske heling af humane intraossøse defekter behandlet med konventionel flapkirurgi (OFD) og anvendelse af en ny, resorberbar, fuldsyntetisk, usintret, nanokrystallinsk, hydroxyapatit (nano-HA ). Materialer og metoder Seks patienter, som hver viste en meget avanceret intraossøs defekt omkring en tand planlagt til ekstraktion på grund af svær kronisk marginal parodontitis og yderligere restaurerende overvejelser, blev inkluderet i undersøgelsen. Efter lokalbedøvelse, mucoperiosteal lapløft, granulationsvævs fjernelse og omhyggelig roddepuration og afglatning med hånd- og ultralydsinstrumenter blev der på roden placeret et mindre boremærke ved den mest apikale tilstedeværelse af tandsten eller ved bunden af defekten (hvis ikke tandsten var til stede); boremærket tjente som reference ved den histologiske evaluering. Efter defektudfyldelse med nano-HA blev lapperne syet ved hjælp af madras-suturer mhp. primær heling. Syv måneder efter regenerativ kirurgi blev tænderne ekstraheret sammen med en mindre del af de omgivende bløde og hårde væv og præpareret til histologisk undersøgelse. Resultater Postoperativ heling var komplikationsfri i alle tilfælde. Syv måneder efter operationen sås der betydelig pochedybdereduktion og klinisk fæstegevinst på 4,0 mm ± 0,8 mm og 2,5 mm ± 0,8 mm, henholdsvis. Den histologiske analyse viste, at helingen hovedsageligt kendetegnede sig ved et lang epitelialt fæste. Begrænset dannelse af ny cement med indlejrede kollagenfibre og knogleregeneration sås hos tre ud af de seks biopsier på op til henholdsvis 0,86 mm og 1,33 mm. Komplet resorption af nano-HA-partikler blev fundet i fire ud af de seks biopsier. Nogle få rester af de implanterede partikler (enten omgivet af nydannet mineraliseret væv eller indkapslet i bindevæv) blev fundet i to ud af de seks biopsier. Konklusion De foreliggende resultater viser, at nano-HA har begrænset mulighed for at fremme parodontal regeneration i humane intraossøse defekter. Klinisk relevans: De kliniske resultater opnået efter kirurgi med OFD + nano-HA afspejler måske ikke ægte parodontal regeneration. Horváth A, Stavropoulos A, Windisch P et al. Histological evaluation of human intrabony periodontal defects treated with an unsintered nanocrystalline hydroxyapatite paste. Clin Oral Investig 2012.

Formål Formålet med denne systematiske gennemgang af litteraturen var at teste hypotesen, at der ingen forskel er på anvendelsen af Bio-Oss alene eller Bio-Oss blandet med autolog knogle som transplantationsmateriale til sinusløftprocedure ved lateral vindueteknik baseret på dyreeksperimentelle undersøgelser. Materialer og metoder En elektronisk litteratursøgning i MEDLINE (PubMed), Embase og Cochrane kombineret med manuel søgning af relevante tidsskrifter blev udført med henblik på at inkludere dyreeksperimentelle undersøgelser offentliggjort på engelsk fra 1. januar 1990 til 1. juni 2010. Søgningen identificerede 879 undersøgelser, og 14 undersøgelser opfyldte inklusionskriterierne. Resultater Den systematiske gennemgang af de inkluderede undersøgelser viste, at stabiliteten af transplantationsmaterialets volumen forbedres signifikant ved øget mængde Bio-Oss i transplantationsmaterialet. Knogleregeneration, knogleimplantatkontakt, biomekaniske undersøgelser af implantatstabilitet og nedbrydning af Bio-Oss efter sinusløftprocedure ved de to behandlingsmodaliteter er ikke sammenlignet i dyreeksperimentelle undersøgelser. Konklusion Hypotesen om ingen forskel på anvendelsen af Bio-Oss alene eller Bio-Oss blandet med autologt knogletransplantat i forbindelse med sinusløftprocedure kunne hverken bekræftes eller forkastes baseret på de eksisterende dyreeksperimentelle undersøgelser. Jensen T, Schou S, Stavropoulos A, Terheyden H, Holmstrup P. Maxillary sinus floor augmentation with Bio-Oss or Bio-Oss mixed with autogenous bone as graft in animals: a systematic review. Int J Oral Maxillofac Surg 2012;41:114-20.

Formål Formålet med denne systematiske gennemgang af litteraturen var at teste hypotesen, at der ingen forskel er på implantatbehandlingens resultat, når der anvendes henholdsvis Bio-Oss alene eller Bio-Oss blandet med autolog knogle som transplantationsmateriale til sinusløftprocedure ved lateral vindueteknik baseret på humane undersøgelser. Materialer og metoder En elektronisk litteratursøgning i MEDLINE (PubMed) kombineret med manuel søgning af relevante tidsskrifter blev udført med henblik på at inkludere kliniske undersøgelser offentliggjort på engelsk fra 1. januar 1990 til 1. juni 2010. Søgningen identificerede 879 undersøgelser, og 35 undersøgelser opfyldte inklusionskriterierne. Resultater Den systematiske gennemgang af de inkluderede undersøgelser viste, at det ikke var muligt at foretage en metaanalyse på grund af betydelig variation i de inkluderede studier. Endvidere kunne der ikke identificeres langtidsundersøgelser, der sammenlignede sinusløftprocedure med de to behandlingsmodaliteter. Desuden kunne der ikke identificeres undersøgelser, hvor overlevelsen af suprastrukturen efter de to behandlingsprocedurer blev sammenlignet. Den etårige implantatoverlevelse blev sammenlignet i en enkelt undersøgelse, og der kunne ikke påvises statistisk signifikant forskel. Implantatoverlevelsen var således 96 % med Bio-Oss alene og 94 % med en blanding af 80 % Bio-Oss og 20 % autolog knogle fra underkæben. Tilsætning af en begrænset mængde autolog knogle til Bio-Oss syntes ikke at øge mængden af nydannet knogle eller knogleimplantatkontakten sammenlignet med Bio-Oss alene. Konklusion Hypotesen om ingen forskel på anvendelsen af Bio-Oss alene eller Bio-Oss blandet med autologt knogletransplantat i forbindelse med sinusløftprocedure kunne derfor hverken bekræftes eller forkastes baseret på de eksisterende humane undersøgelser. Der er således behov for supplerende langtidsundersøgelser med fokus på overlevelsen af suprastrukturer og implantater ved de to behandlingsmodaliteter, før endelige konklusioner kan drages. Jensen T, Schou S, Stavropoulos A, Terheyden H, Holmstrup P. Maxillary sinus floor augmentation with Bio-Oss or Bio-Oss mixed with autogenous bone as graft: a systematic review. Clin Oral Implants Res 2012;23:263-73.

Dental care for children with disabilities – ethical considerations All dental care demands an ethical approach, maybe even more so in child dental care. Today more children with disabilities or longterm illness come to the dentist. How these children should be met and cared for does not differ from other patients, but in dental care for children with disabilities and long-term illness it may be more likely for situations and ethical dilemmas to evolve, where the dentist must stop, reflect, and analyze before continuing with treatment. Autonomy, integrity, and informed consent are important concepts when meeting patients and parents. The dentist also has to be prepared to sometimes step in and substitute autonomy.

Svensk bettfysiologi är framgångsrik sett med internationella glasögon. Denna framgång har uppnåtts genom den omfattande forskning som bedrivits. Ämnets status höjdes genom att bli godkänd specialitet i 1993.

Strain symptoms and work ability – a challenge for the public dental health service. The Public Dental Health Service (PDHS) in Sweden is challenged by increasing sickness rates, difficulties in recruitment and an expected high staff turnover due to upcoming retirements. The aim of this study was to describe and compare self-rated health and strain symptoms for different work areas and occupational groups among dental care staff and to analyse associations between strain symptoms, effective commitment to the workplace and self-rated work ability. An online questionnaire based mainly on scales and items from the Copenhagen Psychosocial Questionnaire was sent to all PDHS staff in four regions of Sweden resulting in a response rate of 76% (n = 1,345). ANOVA and exploratory cluster analyses were used in addition to descriptive and correlational analyses. The current study confirms the overall picture from previous research with respect to employees of the Swedish PDHS. In particular, dentists from general practice, have a stressful work environment. The study contributes with new knowledge on how work-related stress, burnout symptoms and sleeping trouble (strain symptoms) differ according to work area and occupation. Also, strain symptoms were related to self-rated work ability and affective commitment to the workplace. This knowledge is important for the sector in order to consider the opportunity of integrating work environment, health, and wellbeing of staff into the planning of a sustainable future dental organization.

The specialized anatomy of the pulp-dentin complex and the dense, predominantly noci- ceptive pulpal innervation from the trigeminal nerve explains the variety of pain sensations from this organ. Brief, sharp pain is typical of A-fibre-mediated pain, while long-lasting, dull/aching pain indi- cates C-fibre involvement. A-fibres react to cold or mechanical stimuli, such as cold drinks or toothbrushing, whereas C-fibres are mainly activated by inflammatory mediators. Thus, lin- gering pain suggests presence of irreversible pulpal inflammation. During pulpitis, structural changes of the pu pal nerves (sprouting) occur and neuropeptide release triggers an immune response; neurogenic inflammation. Pain sensations during pul- pitis can range from hypersensitivity to thermal stimuli to severe throbbing. There might also be aching pain, possibly referred and often difficult to localize. Thus, diagnosis is challenging for the clinician. Surface biofilm amplifies hypersensitivity of exposed dentin surfaces because irritants reach the pulp through open dentin tubules, producing inflammation. Removing the biofilm reduces dentin hypersensitivity, but supplemental treatment, aiming to reduce dentin permeability, is often necessary. Caries removal and filling therapy are adequate measures during reversible pulpitis if the pulp has maintained its ability to distance itself from the bacterial assault by producing reparative dentin. However, endodontic therapy is necessary when pulpitis has reached an irreversible stage.