Description

It is the primary aim of this international journal to be a multidisciplinary forum for publications from all fields of oral medicine. Especially it is intended to create a connection between basic and clinical sciences and thus promote the exchange of information and the advancement of oral medicine for the benefit of patients. Clinical Oral Investigations publishes original scientific articles and invited reviews which provide an international readership with up-to-date results of basic and clinical studies in the field of oral and maxillofacial science and medicine and to clarify the relevance of these results for a modern practice. Covered topics are: Maxillofacial and Oral Surgery Prosthetics and Restorative Dentistry Operative Dentistry Endodontics Periodontology Orthodontics Dental Materials Science Clinical Trials Epidemiology Pedodontics Oral Implant Preventive Dentistiry Oral Pathology Oral Basic Sciences. The submission of Case Reports is generally discouraged. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 86-23 revised 1985) were followed as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editor reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfill the above-mentioned requirements.

Publisher details

Springer Verlag

Publications in this journal

• Comparison of biogenerically reconstructed and waxed-up complete occlusal surfaces with respect to the original tooth morphology.

  Authors: Maximilian Kollmuss, Franz-Michael Jakob, Hans-Georg Kirchner, Nicoleta Ilie, Reinhard Hickel, Karin Christine Huth

  Clinical oral investigations.

  OBJECTIVES: Recently, it has become possible to reconstruct complete occlusal surfaces using the biogeneric tooth model. This study aimed to mathematically assess and compare the morphologicOBJECTIVES: Recently, it has become possible to reconstruct complete occlusal surfaces using the biogeneric tooth model. This study aimed to mathematically assess and compare the morphologic agreement between original morphology and CAD-reconstructed, waxed-up and CAM partial crowns. MATERIALS AND METHODS: Thirty-nine intact first permanent molars (39 participants) were included. Impressions, bite registrations and three gypsum replicas were made. Preparations for CAD/CAM partial crowns were performed and scanned. The restorations were biogenerically reconstructed (CEREC® v3.80) and milled. Wax-ups of these preparations were scanned as well as the milled restorations and original teeth. Discrepancies were evaluated by matching the scans with the original morphologies (Match3D, output: volume/area, z difference) and by contact patterns. The discrepancies were compared between CAD-reconstructions and either wax-ups or milled restorations (paired t test, α = 0.025 for two multiple tests). RESULTS: The mean differences between natural tooth morphology (triangular stabilisation 71.8 %) and biogeneric reconstructions, wax-ups and milled restorations (triangular stabilisation 87.2 %) were: 184 ± 36 μm (volume/area), 187 ± 41 μm (z difference); 263 ± 40 μm (volume/area), 269 ± 45 μm (z difference) and 182 ± 40 μm (volume/area), 184 ± 41 μm (z difference). Differences associated with biogeneric reconstructions were significantly less than those of wax-ups (volume/area and z difference, p < 0.0001), but not significantly different than those of milled restorations (p = 0.423 (volume/area), p = 0.110 (z difference)). CONCLUSIONS: CAD software enables a closer reconstruction of teeth than do wax-ups, even when no cusps remain. The milling device is precise enough to transfer CAD into the final restoration. CLINICAL RELEVANCE: This study shows that state of the art CAD/CAM can effectively produce natural tooth morphology and may be ideal for fixed partial dentures.

• Effects of three restorative techniques in the bond strength and nanoleakage at gingival wall of Class II restorations subjected to simulated aging.

  Authors: Cristina de Mattos Pimenta Vidal, Sabrina Pavan, André Luiz Fraga Briso, Ana Karina Bedran-Russo

  Clinical oral investigations.

  OBJECTIVE: To evaluate the effects of simulated aging in bond strength and nanoleakage of class II restorations using three different restorative techniques. MATERIALS AND METHODS: Class IIOBJECTIVE: To evaluate the effects of simulated aging in bond strength and nanoleakage of class II restorations using three different restorative techniques. MATERIALS AND METHODS: Class II preparations (n = 12) were restored using: FS - composite resin Filtek Supreme Plus (3M/ESPE); RMGIC + FS - resin-modified glass ionomer cement Vitrebond Plus (3M/ESPE) + FS; and FFS + FS - flowable composite resin Filtek Supreme Plus Flowable (3M ESPE) + FS. The teeth were assigned into two groups: Control and Simulated Aging - Thermal/Mechanical cycling (3,000 cycles, 20-80 °C/500,000 cycles, 50 N). From each tooth, two slabs were assessed to microtensile bond strength test (μTBS) (MPa), and two slabs were prepared for nanoleakage assessment, calculated as penetration along the restoration margin considering the penetration length (%) and as the area of silver nitrate particle deposition (μm(2)). Data were analyzed by two-way analysis of variance (ANOVA) followed by Tukey's post hoc test (p < 0.05). RESULTS: FS presented the highest μTBS to dentin (22.39 ± 7.55 MPa) after simulated aging, while the presence of flowable resin significantly decreased μTBS (14.53 ± 11.65 MPa) when compared to no aging condition. Both control and aging groups of RMGIC + FS presented the highest values of silver nitrate penetration (89.90 ± 16.31 % and 97.14 ± 5.76 %) and deposition area (33.05 ± 12.49 and 28.08 ± 9.76 μm(2)). Nanoleakage was not affected by simulated aging. CONCLUSIONS: FS presented higher bond strength and lower nanoleakage and was not affected by simulated aging. Use of flowable resin compromised the bond strength after simulated aging. CLINICAL RELEVANCE: The use of an intermediate layer did not improve the dentin bond strength neither reduced nanoleakage at the gingival margins of class II restorations under simulated aging conditions.

• Wear behavior of different double-crown systems.

  Authors: Jörg Engels, Oliver Schubert, Jan-Frederik Güth, Matthias Hoffmann, Christian Jauernig, Kurt Erdelt, Michael Stimmelmayr, Florian Beuer

  Clinical oral investigations.

  OBJECTIVES: The aim of this study was to evaluate aging effects on the retentive forces (RFs) of different double-crown systems. The effects of abutment height, inner- and outer-crown-material, taperOBJECTIVES: The aim of this study was to evaluate aging effects on the retentive forces (RFs) of different double-crown systems. The effects of abutment height, inner- and outer-crown-material, taper angle, and artificial aging were analyzed. MATERIAL AND METHODS: Inner (IC) and outer crowns (OC) (240), divided into four groups, 60 specimens each, were manufactured: A: IC = zirconia, OC = electroformed; B: IC = non-precious alloy, OC = electroformed; C: IC = precious alloy, OC = electroformed; D: IC = precious alloy, OC = conventionally cast (control group). Ten specimens each with three different abutment heights and two different tapers were used. Ten thousand separation cycles were performed for each specimen, and the RFs were measured at baseline, 5,000, and 10,000 cycles in the presence of artificial saliva. Data were imported into a statistical software (SPSS, V18) and analyzed by a multivariate ANOVA test. Significance level was set at 5 %. RESULTS: Group D showed highest RFs (baseline: 4.0 N; 5,000 cycles: 3.9 N; 10,000 cycles: 3.9 N) compared to A, B, and C (baseline: 2.6/3.5/2.6 N; 5,000 cycles: 2.5/3.4/2.5 N, 10,000: 2.5/3.3/2.5 N). RF was dependent on material (p < 0.001). The RF of groups A, B, and C were dependent on abutment height (p < 0.001), taper angle (p < 0.001), and artificial aging (p < 0.001). Group D showed no correlation between retentive force and abutment height (p = 0.550). CONCLUSIONS: Wear caused loss of RF in all evaluated groups. However, the material used exhibited significant influence. Conventionally, cast DCs can provide higher RFs, and electroformed DCs can provide more predictable results. CLINICAL RELEVANCE: In clinical cases with few and short abutment teeth, conventionally cast DCs can rather provide the necessary RF than electroformed DCs.

• The short-term treatment effects on the microbiota at the dorsum of the tongue in intra-oral halitosis patients-a randomized clinical trial.

  Authors: Seida Erovic Ademovski, G Rutger Persson, Edwin Winkel, Albert Tangerman, Peter Lingström, Stefan Renvert

  Clinical oral investigations.

  OBJECTIVES: This study aims to assess the effects of rinsing with zinc- and chlorhexidine-containing mouth rinse with or without adjunct tongue scraping on volatile sulfur compounds (VSCs) in breathOBJECTIVES: This study aims to assess the effects of rinsing with zinc- and chlorhexidine-containing mouth rinse with or without adjunct tongue scraping on volatile sulfur compounds (VSCs) in breath air, and the microbiota at the dorsum of the tongue. MATERIAL AND METHODS: A randomized single-masked controlled clinical trial with a cross-over study design over 14 days including 21 subjects was performed. Bacterial samples from the dorsum of the tongue were assayed by checkerboard DNA-DNA hybridization. RESULTS: No halitosis (identified by VSC assessments) at day 14 was identified in 12/21 subjects with active rinse alone, in 10/21with adjunct use of tongue scraper, in 1/21 for negative control rinse alone, and in 3/21 in the control and tongue scraping sequence. At day 14, significantly lower counts were identified only in the active rinse sequence (p < 0.001) for 15/78 species including, Fusobacterium sp., Porphyromonas gingivalis, Pseudomonas aeruginosa, Staphylococcus aureus, and Tannerella forsythia. A decrease in bacteria from baseline to day 14 was found in successfully treated subjects for 9/74 species including: P. gingivalis, Prevotella melaninogenica, S. aureus, and Treponema denticola. Baseline VSC scores were correlated with several bacterial species. The use of a tongue scraper combined with active rinse did not change the levels of VSC compared to rinsing alone. CONCLUSIONS: VSC scores were not associated with bacterial counts in samples taken from the dorsum of the tongue. The active rinse alone containing zinc and chlorhexidine had effects on intra-oral halitosis and reduced bacterial counts of species associated with malodor. Tongue scraping provided no beneficial effects on the microbiota studied. CLINICAL RELEVANCE: Periodontally healthy subjects with intra-oral halitosis benefit from daily rinsing with zinc- and chlorhexidine-containing mouth rinse.

• Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects.

  Authors: M H J Doff, K J Finnema, A Hoekema, P J Wijkstra, L G M de Bont, B Stegenga

  Clinical oral investigations.

  OBJECTIVES: This study aimed to assess possible dental side effects associated with long-term use of an adjustable oral appliance compared with continuous positive airway pressure (CPAP) in patientsOBJECTIVES: This study aimed to assess possible dental side effects associated with long-term use of an adjustable oral appliance compared with continuous positive airway pressure (CPAP) in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of mandibular protrusion associated with oral appliance therapy. MATERIALS AND METHODS: As part of a previously conducted RCT, 51 patients were randomized to oral appliance therapy and 52 patients to CPAP therapy. At baseline and after a 2-year follow-up, dental plaster study models in full occlusion were obtained which were thereupon analyzed with respect to relevant variables. RESULTS: Long-term use of an oral appliance resulted in small but significant dental changes compared with CPAP. In the oral appliance group, overbite and overjet decreased 1.2 (±1.1) mm and 1.5 (±1.5) mm, respectively. Furthermore, we found a significantly larger anterior-posterior change in the occlusion (-1.3 ± 1.5 mm) in the oral appliance group compared to the CPAP group (-0.1 ± 0.6 mm). Moreover, both groups showed a significant decrease in number of occlusal contact points in the (pre)molar region. Linear regression analysis revealed that the decrease in overbite was associated with the mean mandibular protrusion during follow-up [regression coefficient (β) = -0.02, 95 % confidence interval (-0.04 to -0.00)]. CONCLUSIONS: Oral appliance therapy should be considered as a lifelong treatment, and there is a risk of dental side effects to occur. CLINICAL RELEVANCE: Patients treated with the oral appliance need a thorough follow-up by a dentist or dental-specialist experienced in the field of dental sleep medicine.

• Tissue expanders for soft tissue reconstruction in the head and neck area-requirements and limitations.

  Authors: Jörg Handschel, Stefanie Schultz, Rita A Depprich, Ralf Smeets, Christoph Sproll, Michelle A Ommerborn, Christian Naujoks, Norbert R Kübler, André Zimmermann

  Clinical oral investigations.

  OBJECTIVES: The repair of skin defects in the head and neck region still poses a significant problem for many clinicians. Tissue expansion is described as a treatment option providing good color,OBJECTIVES: The repair of skin defects in the head and neck region still poses a significant problem for many clinicians. Tissue expansion is described as a treatment option providing good color, texture, and thickness match of the expanded skin. Unfortunately, the complication rates for tissue expansion range from 0 to 48 %. Therefore, the purpose of this study was to investigate risk factors for the use of tissue expanders in head and neck reconstructions. MATERIALS AND METHODS: Forty-nine patients with skin deficits in the head and neck area underwent tissue expansion. Sixty-two implanted expanders were analyzed regarding the various complications and the success rate. RESULTS: The success rate of treated patients was 37 (75.5 %) of all 49 included patients. The most frequent cause for the skin deficit was a tumor resection near the tip of the nose followed by skin deficits resulting after craniectomy. Interestingly, a higher number of expanders and a larger volume were significantly associated with a worse outcome. There was a trend of association between larger defect size and failure, too. CONCLUSIONS: The internal tissue expansion is a suitable technique for skin reconstruction in the head and face area. Compared to distant or free flaps, it often offers a better cosmetic outcome. In very large defects (>100 cm(2)) or when more than two expanders are needed, the failure rate increases. In these cases, other treatment options are recommended. CLINICAL RELEVANCE: The internal tissue expansion is a suitable technique for skin reconstruction in the head and face area.

• Degree of conversion of nano-hybrid resin-based composites with novel and conventional matrix formulation.

  Authors: Karina E Frauscher, Nicoleta Ilie

  Clinical oral investigations.

  OBJECTIVES: This study aimed to determine the degree of conversion (DC) of two nano-hybrid resin-based composites (RBCs) with novel monomer composition based on dimer acid derivates (hydrogenatedOBJECTIVES: This study aimed to determine the degree of conversion (DC) of two nano-hybrid resin-based composites (RBCs) with novel monomer composition based on dimer acid derivates (hydrogenated dimer acid) and tricyclodecane-urethane structure compared to three nano-hybrid materials containing conventional matrices. DC was evaluated at 0.1, 2, and 6 mm depth at varying irradiation times (10, 20, and 40 s) and layering techniques (bulk and incremental). MATERIALS AND METHODS: DC was measured in real time by a Fourier transform infrared spectroscopy (FTIR) spectrometer with attenuated total reflectance accessory. The FTIR spectra were recorded on the bottom of the samples in real time for 5 min from photoinitiation. Results were compared using one- and multiple-way ANOVA, Tukey's HSD post hoc test (α = 0.05), and partial eta-squared statistic. RESULTS: After 5 min of measurement, DC showed no significant difference by varying cure time for specimens of 0.1 mm thickness. At 2 mm depth, the DC significantly increased after a cure time of 20 s compared to 10 s, remaining equal after 40 s of irradiation. At 6 mm depth, bulk curing showed significantly lower DC compared to incremental curing for all polymerization times. Specimen geometry revealed a strong effect on DC (η (2) = 0.90) followed by curing time (η (2) = 0.39). CONCLUSIONS: The RBCs containing the dimer acid and tricyclodecane-urethane structure showed a relatively low decrease of DC with increasing incremental thickness compared to the conventionally formulated materials. The former reached the highest DC among the tested materials. CLINICAL RELEVANCE: For the tested RBCs, increments of 2 mm and irradiation time of at least 20 s may be recommended for clinical practice. The two materials containing novel monomer composition might be applied for enlarged increments because of the low decrease of DC they demonstrated for 6-mm increments.

• Efficacy of a moisture-tolerant material for fissure sealing: a prospective randomised clinical trial.

  Authors: N Schlueter, J Klimek, C Ganss

  Clinical oral investigations.

  OBJECTIVES: Fissure sealings offer nearly complete protection against fissure caries, provided that they are adequately applied, for composite-based sealants with sufficient moisture control. This isOBJECTIVES: Fissure sealings offer nearly complete protection against fissure caries, provided that they are adequately applied, for composite-based sealants with sufficient moisture control. This is not always attainable, particularly in children with low compliance. To counter this problem, a moisture-tolerant sealant has been developed. The present randomised clinical trial compared such a moisture-tolerant material (Embrace) with a conventional sealant (Helioseal). MATERIAL AND METHODS: In 55 participants (mean age, 10 ± 3 years), corresponding molar pairs were sealed with either Embrace or Helioseal. Retention, quality of sealing, and caries were clinically examined, both tactilely and visually, immediately and after 1 year. RESULTS: After 1 year, 93 % of Helioseal sealings were complete, whereas 60 % of Embrace sealings showed partial and 13 % complete loss. The surface quality of Embrace was significantly worse than that of Helioseal. After the use of Embrace, the sealant margin was noticeable as a slight (distinct) step in 36 % (15 %). The visual (tactile) examination showed a rough surface in 78 % (33 %) in the case of Embrace. The Helioseal surfaces were shiny (smooth) in all cases (all differences between Helioseal and Embrace, p ≤ 0.001). Caries was found only after the use of Embrace (4 %, n.s. compared to Helioseal). CONCLUSION: The moisture-tolerant material Embrace was distinctly inferior to Helioseal because Embrace showed weaknesses in retention and surface quality. CLINICAL RELEVANCE: Even if a moisture-tolerant sealant would be desirable in particular for children with low compliance, the tested material does not represent an alternative to the standard preparation.

• Gene array of primary human osteoblasts exposed to enamel matrix derivative in combination with a natural bone mineral.

  Authors: Richard J Miron, Dieter D Bosshardt, Yufeng Zhang, Daniel Buser, Anton Sculean

  Clinical oral investigations.

  OBJECTIVES: The application of an enamel matrix derivative (EMD) for regenerative periodontal surgery has been shown to promote formation of new cementum, periodontal ligament, and alveolar bone. InOBJECTIVES: The application of an enamel matrix derivative (EMD) for regenerative periodontal surgery has been shown to promote formation of new cementum, periodontal ligament, and alveolar bone. In intrabony defects with a complicated anatomy, the combination of EMD with various bone grafting materials has resulted in additional clinical improvements, but the initial cellular response of osteoblasts coming in contact with these particles have not yet been fully elucidated. The objective of the present study was to evaluate the in vitro effects of EMD combined with a natural bone mineral (NBM) on a wide variety of genes, cytokines, and transcription factors and extracellular matrix proteins on primary human osteoblasts. MATERIAL AND METHODS: Primary human osteoblasts were seeded on NBM particles pre-coated with versus without EMD and analyzed for gene differences using a human osteogenesis gene super-array (Applied Biosystems). Osteoblast-related genes include those transcribed during bone mineralization, ossification, bone metabolism, cell growth and differentiation, as well as gene products representing extracellular matrix molecules, transcription factors, and cell adhesion molecules. RESULTS: EMD promoted gene expression of various osteoblast differentiation markers including a number of collagen types and isoforms, SMAD intracellular proteins, osteopontin, cadherin, alkaline phosphatase, and bone sialoprotein. EMD also upregulated a variety of growth factors including bone morphogenetic proteins, vascular endothelial growth factors, insulin-like growth factor, transforming growth factor, and their associated receptor proteins. CONCLUSION: The results from the present study demonstrate that EMD is capable of activating a wide variety of genes, growth factors, and cytokines when pre-coated onto NBM particles. CLINICAL RELEVANCE: The described in vitro effects of EMD on human primary osteoblasts provide further biologic support for the clinical application of a combination of EMD with NBM particles in periodontal and oral regenerative surgery.

• Relationship between plaque score and video-monitored brushing performance after repeated instruction-a controlled, randomised clinical trial.

  Authors: N Schlueter, J Klimek, C Ganss

  Clinical oral investigations.

  OBJECTIVES: Aim of this prospective, randomised, controlled clinical trial was to use the modified bass technique (MBT) and a specific brushing sequence to investigate whether two types ofOBJECTIVES: Aim of this prospective, randomised, controlled clinical trial was to use the modified bass technique (MBT) and a specific brushing sequence to investigate whether two types of instruction methods lead to differences in plaque reduction and whether plaque reduction is related to technique adoption. METHODS: Ninety-eight participants were randomly assigned to three groups: (1) control, no instruction; (2) verbal instruction by means of a leaflet; and (3) verbal instruction supported by demonstration, no leaflet. Brushing performance was video monitored. Plaque score (Turesky modified QHI (T-QHI)) was measured at baseline, afterwards participants received instructions. After 2 weeks, T-QHI was measured for a second time, and participants were re-instructed. After another 2 weeks, T-QHI was measured for a third time. RESULTS: At baseline, T-QHI did not differ between groups ((1) 1.99 ± 0.51, (2) 1.90 ± 0.51, (3) 1.93 ± 0.56). The second measurement revealed an improvement of T-QHI in the instructed groups and in the non-instructed control group ((1) 1.80 ± 0.47, (2) 1.58 ± 0.58, (3) 1.64 ± 0.58; n.s. between groups); in the intervention groups, remotivation achieved no further improvement ((1) 1.72 ± 0.48, (2) 1.52 ± 0.58, (3) 1.50 ± 0.69; n.s. between groups and compared to second measurement). Improvement of T-QHI was not related to proper performance of technique or brushing sequence. Those who fully adopted the brushing technique, the sequence or both did not have lower plaque scores. CONCLUSION: Technical performance and effectiveness were not linked. CLINICAL RELEVANCE: Within the study setting, the MBT was not effective in reducing plaque scores. The general recommendation of the MBT should be re-evaluated in further studies.

• Do edible oils reduce bacterial colonization of enamel in situ?

  Authors: Christian Hannig, Jasmin Kirsch, Ali Al-Ahmad, Anna Kensche, Matthias Hannig, Klaus Kümmerer

  Clinical oral investigations.

  OBJECTIVE: Edible oils are an empiric approach for the prevention of oral diseases. The present in situ study investigated the effect of edible oils on initial bacterial colonization of enamelOBJECTIVE: Edible oils are an empiric approach for the prevention of oral diseases. The present in situ study investigated the effect of edible oils on initial bacterial colonization of enamel surfaces. METHODS AND MATERIALS: Initial biofilm formation was performed on enamel specimens mounted on maxillary splints and carried by eight subjects. After 1 min of pellicle formation, rinses with safflower oil, olive oil and linseed oil were performed for 10 min. Application of chlorhexidine for 1 min served as positive control. Afterwards, the slabs were carried for 8 h overnight. Samples carried for 8 h without any rinse served as negative controls. The amount of adherent bacteria was determined by DAPI staining (4',6-diamidino-2-phenylindole) and live-dead staining (BacLight). Additionally, determination of colony forming units was performed after desorption of the bacteria. TEM evaluation was carried out after application of the rinses. RESULTS: The number of adherent bacteria on control samples was 6.1 ± 8.1 × 10(5)/cm(2) after 8 h (DAPI). Fluorescence microscopic data from DAPI staining and live-dead staining as well as from the determination of CFU revealed no significant effects of rinsing with oils on the amount of adherent bacteria compared to the non-rinsed control samples. However, with chlorhexidine a significant reduction in the number of bacteria by more than 85 % was achieved (DAPI, chlorhexidine: 8.2 ± 17.1 × 10(4)/cm(2)). The ratio of viable to dead bacteria was almost equal (1:1) irrespective of the rinse adopted as recorded with BacLight. TEM indicated accumulation of oil micelles at the pellicle's surface and modification of its ultrastructure. CONCLUSION: Rinses with edible oils have no significant impact on the initial pattern and amount of bacterial colonization on enamel over 8 h. CLINICAL RELEVANCE: Rinses with edible oils cannot be recommended for efficient reduction of oral biofilm formation.

• Histological evaluation of human intrabony periodontal defects treated with an unsintered nanocrystalline hydroxyapatite paste.

  Authors: Attila Horváth, Andreas Stavropoulos, Péter Windisch, László Lukács, István Gera, Anton Sculean

  Clinical oral investigations.

  OBJECTIVES: The aim of the study was to clinically and histologically evaluate the healing of human intrabony defects treated with open flap surgery (OFD) and application of a new, resorbable, fullyOBJECTIVES: The aim of the study was to clinically and histologically evaluate the healing of human intrabony defects treated with open flap surgery (OFD) and application of a new, resorbable, fully synthetic, unsintered, nanocrystalline, phase-pure hydroxyapatite (nano-HA). MATERIALS AND METHODS: Six patients, each of them displaying very advanced intrabony defects around teeth scheduled for extraction due to advanced chronic periodontitis and further prosthodontic considerations, were included in the study. Following local anaesthesia, mucoperiosteal flaps were reflected; the granulation tissue was removed, and the roots were meticulously debrided by hand and ultrasonic instruments. A notch was placed at the most apical extent of the calculus present on the root surface or at the most apical part of the defect (if no calculus was present) in order to serve as a reference for the histological evaluation. Following defect fill with nano-HA, the flaps were sutured by means of mattress sutures to allow primary intention healing. At 7 months after regenerative surgery, the teeth were extracted together with some of their surrounding soft and hard tissues and processed for histological analysis. RESULTS: The postoperative healing was uneventful in all cases. At 7 months following surgery, mean PPD reduction and mean CAL gain measured 4.0 ± 0.8 and 2.5 ± 0.8 mm, respectively. The histological analysis revealed a healing predominantly characterized by epithelial downgrowth. Limited formation of new cementum with inserting connective tissue fibers and bone regeneration occurred in three out of the six biopsies (i.e. 0-0.86 and 0-1.33 mm, respectively). Complete resorption of the nano-HA was found in four out of the six biopsies. A few remnants of the graft particles (either surrounded by newly formed mineralized tissue or encapsulated in connective tissue) were found in two out of the six biopsies. CONCLUSION: Within their limits, the present results indicate that nano-HA has limited potential to promote periodontal regeneration in human intrabony defects. CLINICAL RELEVANCE: The clinical outcomes obtained following surgery with OFD + nano-HA may not reflect true periodontal regeneration.

• Oral health in patients on haemodialysis for diabetic nephropathy and chronic glomerulonephritis.

  Authors: Gou Teratani, Shuji Awano, Inho Soh, Akihiro Yoshida, Naomasa Kinoshita, Tomoko Hamasaki, Yutaka Takata, Kazuo Sonoki, Hidetoshi Nakamura, Toshihiro Ansai

  Clinical oral investigations.

  OBJECTIVE: The objective of this study was to clarify differences in oral health status between patients who needed haemodialysis (HD) owing to diabetic nephropathy (DN) and chronicOBJECTIVE: The objective of this study was to clarify differences in oral health status between patients who needed haemodialysis (HD) owing to diabetic nephropathy (DN) and chronic glomerulonephritis (CGN). MATERIALS AND METHODS: Ninety-eight HD patients who were 50-70 years old were selected as the study subjects [DN group (29 subjects) and CGN group (69 subjects)] to compare with 106 control subjects (control group) not undergoing HD. All HD subjects underwent oral- and systemic-related examination just before HD therapy. RESULTS: The mean number of teeth present in the DN group was significantly less than in the CGN and control groups. The mean percentage of sites with bleeding on probing in the DN group was greater than in the CGN and control groups. The mean salivary flow rate in the DN and CGN groups was significantly lower compared with the control group. CONCLUSION: The patients undergoing HD for DN were found to have fewer teeth and worse periodontal health compared with those undergoing HD for CGN and with the control subjects not undergoing HD. Furthermore, the dental and periodontal health of the patients undergoing HD for CGN was comparable to that of the controls. CLINICAL RELEVANCE: For effective measures of prevention and improvement of oral health in HD patients, clinicians should be aware of the differences in the characteristics of the oral health between patients undergoing HD for DN and CGN.

• Regeneration of the periodontium using enamel matrix derivative in combination with an injectable bone cement.

  Authors: Daniël A W Oortgiesen, Gert J Meijer, Antonius L J J Bronckers, X Frank Walboomers, John A Jansen

  Clinical oral investigations.

  OBJECTIVES: Enamel matrix derivative (EMD) has proven to enhance periodontal regeneration; however, its effect is mainly restricted to the soft periodontal tissues. Therefore, to stimulate not onlyOBJECTIVES: Enamel matrix derivative (EMD) has proven to enhance periodontal regeneration; however, its effect is mainly restricted to the soft periodontal tissues. Therefore, to stimulate not only the soft tissues, but also the hard tissues, in this study EMD is combined with an injectable calcium phosphate cement (CaP; bone graft material). The aim was to evaluate histologically the healing of a macroporous CaP in combination with EMD. MATERIALS AND METHODS: Intrabony, three-wall periodontal defects (2 × 2 × 1.7 mm) were created mesial of the first upper molar in 15 rats (30 defects). Defects were randomly treated according to one of the three following strategies: EMD, calcium phosphate cement and EMD, or left empty. The animals were killed after 12 weeks, and retrieved samples were processed for histology and histomorphometry. RESULTS: Empty defects showed a reparative type of healing without periodontal ligament or bone regeneration. As measured with on a histological grading scale for periodontal regeneration, the experimental groups (EMD and CaP/EMD) scored equally, both threefold higher compared with empty defects. However, most bone formation was measured in the CaP/EMD group; addition of CAP to EMD significantly enhanced bone formation with 50 % compared with EMD alone. CONCLUSIONS: Within the limits of this animal study, the adjunctive use of EMD in combination with an injectable cement, although it did not affect epithelial downgrowth, appeared to be a promising treatment modality for regeneration of bone and ligament tissues in the periodontium. CLINICAL RELEVANCE: The adjunctive use of EMD in combination with an injectable cement appears to be a promising treatment modality for regeneration of the bone and ligament tissues in the periodontium.

• Evaluation of a conventional glass ionomer cement with new zinc formulation: effect of coating, aging and storage agents.

  Authors: Julius Zoergiebel, Nicoleta Ilie

  Clinical oral investigations.

  OBJECTIVE: The study focused on a recently launched conventional glass ionomer cement (GIC) with a particular chemical formulation of both, filler and acrylic liquid, by analysing its mechanicalOBJECTIVE: The study focused on a recently launched conventional glass ionomer cement (GIC) with a particular chemical formulation of both, filler and acrylic liquid, by analysing its mechanical behaviour in comparison to three conventional GICs. Furthermore, the effect of resin coating and storage conditions was evaluated. MATERIALS AND METHODS: Three commercially available GICs were chosen: Riva Self Cure (SDI), Fuji IX Fast (GC) and Fuji IX GP Extra/Equia (GC). Additionally a newly developed zinc-containing GIC-ChemFil Rock (Dentsply)-was tested. Mechanical properties were determined at macro- [flexural strength (FS) and modulus of elasticity (E (flexural))] and micro-scale [Vickers hardness (VH) and indentation modulus (E)] after storing coated and uncoated specimens in artificial saliva and distilled water for 7 and 30 days. RESULTS: ChemFil Rock revealed the highest FS, but the lowest VH and E. The micro-mechanical properties of the analysed GICs did neither benefit from the new zinc formulation nor from resin coating. A resin coating is nevertheless a valuable support for GIC fillings, since it offers the absence of visible surface defects like crazing and voids, and thus, it led to significant improvements in flexural strength. This statement is also valid for ChemFil Rock, contrary to manufacture recommendation. The impact of storage agent and storage duration on the measured properties was low. CONCLUSIONS: The new development (ChemFil Rock) might represent a promising approach regarding longevity of GIC fillings in molar regions, due to the high flexural strength and the absence of visible surface defects like crazing and voids. CLINICAL RELEVANCE: All GICs should receive surface protection in order to perform their maximum in stability.

• Comparison between two thermoplastic root canal obturation techniques regarding extrusion of root canal filling-a retrospective in vivo study.

  Authors: Christian Tennert, Ingo Lars Jungbäck, Karl-Thomas Wrbas

  Clinical oral investigations.

  OBJECTIVES: The aim of this study was to compare two different thermoplastic techniques-a core-carrier technique (Thermafil) and warm vertical compaction-in terms of overextension of root canalOBJECTIVES: The aim of this study was to compare two different thermoplastic techniques-a core-carrier technique (Thermafil) and warm vertical compaction-in terms of overextension of root canal filling in vivo. MATERIALS AND METHODS: Flaring of 88 teeth was conducted using Pro Files .04 as finishing files, and the teeth were obturated using Thermafil. Flaring of 74 teeth was performed using Pro Files .06 as finishing files, and the teeth were obturated using warm vertical compaction. RESULTS: Seventy (80 %) of the teeth obturated using Thermafil and 31 (42 %) teeth obturated using warm vertical compaction show extruded root canal filling. In contrast to Thermafil, there is a higher rate of extruded root canal filling of teeth with more than one root canal using warm vertical compaction. CONCLUSION: Thermafil demonstrated a higher rate of extruded root canal filling compared to warm vertical compaction. Warm vertical compaction is a more predictable method of filling compared to Thermafil. CLINICAL RELEVANCE: Root canal filling extrusion will cause irritation of the surrounding tissue and impair repair processes. In the present in vivo study, there was a higher rate of root canal filling extrusion using Thermafil compared to warm vertical compaction.

• Mandibular bone changes in 24 years and skeletal fracture prediction.

  Authors: G Jonasson, V Sundh, M Hakeberg, A Hassani-Nejad, L Lissner, M Ahlqwist

  Clinical oral investigations.

  OBJECTIVES: The objectives of the investigation were to describe changes in mandibular bone structure with aging and to compare the usefulness of cortical and trabecular bone for fracture prediction.OBJECTIVES: The objectives of the investigation were to describe changes in mandibular bone structure with aging and to compare the usefulness of cortical and trabecular bone for fracture prediction. MATERIALS AND METHODS: From 1968 to 1993, 1,003 women were examined. With the help of panoramic radiographs, cortex thickness was measured and cortex was categorized as: normal, moderately, or severely eroded. The trabeculation was assessed as sparse, mixed, or dense. RESULTS: Visually, the mandibular compact and trabecular bone transformed gradually during the 24 years. The compact bone became more porous, the intertrabecular spaces increased, and the radiographic image of the trabeculae seemed less mineralized. Cortex thickness increased up to the age of 50 and decreased significantly thereafter. At all examinations, the sparse trabeculation group had more fractures (71-78 %) than the non-sparse group (27-31 %), whereas the severely eroded compact group showed more fractures than the less eroded groups only in 1992/1993, 24 years later. Sparse trabecular pattern was associated with future fractures both in perimenopausal and older women (relative risk (RR), 1.47-4.37) and cortical erosion in older women (RR, 1.35-1.55). RR for future fracture associated with a severely eroded cortex increased to 4.98 for cohort 1930 in 1992/1993. RR for future fracture associated with sparse trabeculation increased to 11.43 for cohort 1922 in 1992/1993. CONCLUSION: Dental radiographs contain enough information to identify women most at risk of future fracture. CLINICAL RELEVANCE: When observing sparse mandibular trabeculation, dentists can identify 40-69 % of women at risk for future fractures, depending on participant age at examination.

• Disinfection effect of dental impression tray adhesives.

  Authors: Tobias Bensel, Rita Pollak, Michael Stimmelmayr, Jeremias Hey

  Clinical oral investigations.

  OBJECTIVES: Iatrogenic infections are serious problems in dental offices. Impression tray adhesives are delivered in glass containers with a fixed brush attached inside the cap. Using the brush forOBJECTIVES: Iatrogenic infections are serious problems in dental offices. Impression tray adhesives are delivered in glass containers with a fixed brush attached inside the cap. Using the brush for application of the impression tray adhesive on a contaminated impression tray or prostheses, pathogen transmission by replacing the cap with the brush is possible. MATERIALS AND METHODS: Bacterial strains (patient strains and in vitro strains) were supervaccinated on Columbia agar. The bacterial solution was diluted with TSB and aerobically grown, and starting concentration was 1 × 10(7) cfu/ml. The stock solution was placed on Columbia agar. Alginate, polyether, and silicon impression tray adhesives were applied to the center of the particular blood agar plates and incubated for 48 h. The expansion of the inhibition zone assays were measured using a microscope. RESULTS: Twenty-one different bacterial strains were selected in the saliva samples of 20 patients. The growth inhibition for alginate impression tray adhesive was 1.1 % (±0.3) of the patient strains. The overgrowth of polyether impression tray adhesive was 30.6 % (±9.3) and for silicon impression tray adhesive 11.8 % (±5.0). In in vitro strains, alginate impression tray adhesive performed an inhibition of 0.7 % (±0.3). The overgrowth of polyether impression tray adhesive was 7.0 % (±1.6) and for silicon impression tray adhesive was 6.5 % (±1.3). CONCLUSIONS: Using the fixed brush for application of the impression tray adhesive on multiple patients, a cross-contamination cannot be ruled out. CLINICAL RELEVANCE: An application of the impression tray adhesive with a pipette and a single-use brush would eliminate the contamination.

• The prevalence of root resorption of maxillary incisors caused by impacted maxillary canines.

  Authors: Georg D Strbac, Andrea Foltin, André Gahleitner, Hans-Peter Bantleon, Georg Watzek, Thomas Bernhart

  Clinical oral investigations.

  OBJECTIVES: The aim of this study was to evaluate the prevalence of root resorption of maxillary incisors caused by impacted maxillary canines using low-dose dental computed tomography and to gainOBJECTIVES: The aim of this study was to evaluate the prevalence of root resorption of maxillary incisors caused by impacted maxillary canines using low-dose dental computed tomography and to gain additional knowledge of the underlying aetiology and the progression of root resorption. MATERIALS AND METHODS: A total of 440 patients (mean age, 24.7 years) with 557 impacted maxillary canines were examined regarding their location and the occurrence of root resorption of maxillary incisors. RESULTS: The frequency of root resorption was 2 % of central and 7.7 % of lateral maxillary incisors. The location of the 557 impacted canines within the dental arch was palatal in 67.5 %, buccal in 15.4 % and central in 17.1 %. No significant differences could be shown with respect to the width and the shape of the dental follicle of the impacted maxillary canines and the presence of root resorption of incisors. The presence of root resorption of central (p < 0.0001) and lateral (p < 0.023) maxillary incisors was significantly correlated with an existing contact relationship of the impacted maxillary canines. CONCLUSIONS: Our investigation confirms the theory of prior reports comprising a much larger patient population, hypothesising that the dental follicle of impacted maxillary canines does not cause resorption of adjacent maxillary incisors per se. CLINICAL RELEVANCE: Root resorption of maxillary incisors is correlated with effects of contact of the impacted maxillary canines, and these findings should be considered in treatment planning. Our findings are consistent with other reports and may develop new treatment approaches for the treatment of this sequela.

• The influence of bone substitute materials on the bone volume after maxillary sinus augmentation: a microcomputerized tomography study.

  Authors: Sebastian Kühl, Christoph Brochhausen, Hermann Götz, Andreas Filippi, Michael Payer, Bernd d'Hoedt, Matthias Kreisler

  Clinical oral investigations.

  OBJECTIVES: This study aims to evaluate the effect of adding bone substitute materials (BSM) to particulated autogenous bone (PAB) on the volume fraction (Vf) of newly formed bone after maxillaryOBJECTIVES: This study aims to evaluate the effect of adding bone substitute materials (BSM) to particulated autogenous bone (PAB) on the volume fraction (Vf) of newly formed bone after maxillary sinus augmentation. MATERIALS AND METHODS: Thirty healthy patients undergoing maxillary sinus augmentation were included. PAB (N = 10), mixtures of PAB and beta-tricalciumphosphate (PAB/β-TCP) (N = 10), as well as PAB and β-TCP and hydroxyapatite (PAB/HA/β-TCP) (N = 10) were randomly used for sinus augmentation. A sample of the graft material was maintained from each patient at time of maxillary sinus augmentation, and Vfs of the PAB and/or BSM in the samples were determined by means of microcomputerized tomography (μ-CT). Five months later, samples of the grafted areas were harvested during implantation using a trephine bur. μ-CT analysis of these samples was performed, and the Vf of bone and BSM were compared with the data obtained 5 months earlier from the original material. RESULTS: The mean Vf of the bone showed a statistically significant increase (p < 0.05) in all groups after a healing period of 5 months without statistically significant difference between the groups. CONCLUSIONS: With regard to the increase of bone volume, it is not relevant if PAB is used alone or combined with β-TCP or HA/β-TCP. CLINICAL RELEVANCE: The amount of PAB and associated donor site morbidity may be reduced by adding BSM for maxillary sinus augmentation.

• Shear bond strength of orthodontic brackets bonded with a new self-adhering flowable resin composite.

  Authors: Cecilia Goracci, Mariam Margvelashvili, Agostino Giovannetti, Alessandro Vichi, Marco Ferrari

  Clinical oral investigations.

  OBJECTIVES: This study aims to assess the shear bond strength (SBS) to enamel and the distribution of failure modes of brackets bonded using a new self-adhering flowable resin composite (VertiseOBJECTIVES: This study aims to assess the shear bond strength (SBS) to enamel and the distribution of failure modes of brackets bonded using a new self-adhering flowable resin composite (Vertise Flow, VF), with or without preliminary phosphoric acid etching (PAE). MATERIALS AND METHODS: Eighty extracted premolars were randomly divided into four groups (n = 20): (1) etch-and-rinse adhesive (E&R), PAE/Transbond XT Primer/Transbond XT Paste (3M Unitek); (2) self-etch adhesive (SE), Transbond Plus Self-Etching Primer (3M Unitek)/Transbond XT Paste; (3) VF; (4) PAE/VF. In each group, 10 bracketed teeth were debonded within 30 min, while the remaining teeth were subjected to thermocycling before testing. SBS and adhesive remnant index were recorded. RESULTS: SE measured significantly lower early SBS than PAE/VF. Early SBSs recorded by VF were slightly higher yet statistically similar to those of E&R. Such levels of adhesion were achieved by VF regardless of preliminary PAE. After thermocycling, VF measured the lowest SBS. When debonded early, VF and SE tended to leave less residues on enamel surface than E&R. After thermocycling, the failure pattern changed significantly for VF and PAE/VF specimens that all exhibited adhesive failures at the tooth-bracket interface. CONCLUSIONS: VF achieved early bracket SBSs similar to E&R. Following thermocycling, VF and PAE/VF manifested a significant decrease in SBS. CLINICAL RELEVANCE: Although the simplified handling and the satisfactory early SBS of VF may prompt its use for bracket bonding, the decrease in retention noted after thermocycling warns that the issue of bond durability should be thoroughly addressed prior to endorsing this clinical application of VF.

• Microcomputed tomography analysis of particular autogenous bone graft in sinus augmentation at 5 months: differences on bone mineral density and 3D trabecular structure.

  Authors: Heng-Li Huang, Jui-Ting Hsu, Michael Y C Chen, Cheng Liu, Ching-Han Chang, Yu-Fen Li, Kuan-Ting Chen

  Clinical oral investigations.

  OBJECTIVES: This study investigated the effects of gender on the three-dimensional (3D) bone mineral density (BMD) and micromorphology of the trabeculae of matured autogenous bone grafts after sinusOBJECTIVES: This study investigated the effects of gender on the three-dimensional (3D) bone mineral density (BMD) and micromorphology of the trabeculae of matured autogenous bone grafts after sinus floor augmentation, and compared them to those of adjacent native bone. MATERIALS AND METHODS: Ten bone biopsy samples were removed from the implant placement areas of patients who had received second-stage sinus floor augmentation, and analyzed by microcomputed tomography. BMD phantoms with two calcium hydroxyapatite densities (0.25 and 0.75 g/cm(3)) were used to determine the BMD of the grafted and native bone samples. The 3D structural parameters of the trabeculae, including percentage of bone volume (bone volume/tissue volume, BV/TV), trabecular thickness (Tb.Th), trabecular number, trabecular separation, trabecular pattern factor (Tb.Pf), and structure model index, were analyzed between males and females and between grafted bone and native bone. RESULTS: No significant gender-specific differences in BMD and 3D trabecular structure of either native or grafted bone were found (P > 0.05). Compared to the adjacent native bone, the autogenous grafted bone exhibited lower BV/TV and Tb.Th as well as a higher Tb.Pf (P < 0.05). Additionally, there was a weak positive correlation between the Tb.Th values of grafted and native bone (R (2) = 0.58). CONCLUSIONS: In the maxillary sinus, autogenous grafted bone exhibited lower BV/TV, Tb.Th, and trabecular connectivity than the adjacent native bone. No significant gender-specific differences were found for either the BMD or 3D trabecular structure of grafted bone. CLINICAL RELEVANCE: After bone remodeling, autogenous grafted bone revealed different 3D trabecular structure as compared to native bone.

• Dental erosion prevalence and associated risk indicators among preschool children in Athens, Greece.

  Authors: Magdalini Mantonanaki, Haroula Koletsi-Kounari, Eleni Mamai-Homata, William Papaioannou

  Clinical oral investigations.

  OBJECTIVES: The aims of the study were to investigate dental erosion prevalence, distribution and severity in Greek preschool children attending public kindergartens in the prefecture of Attica,OBJECTIVES: The aims of the study were to investigate dental erosion prevalence, distribution and severity in Greek preschool children attending public kindergartens in the prefecture of Attica, Greece and to determine the effect of dental caries, oral hygiene level, socio-economic factors, dental behavior, erosion related medication and chronic illness. MATERIAL AND METHODS: A random and stratified sample of 605 Greek preschool children was clinically examined for dental erosion using the Basic Erosive Wear Examination Index (ΒΕWE). Dental caries (dmfs) and Simplified Debris Index were also recorded. The data concerning possible risk indicators were derived by a questionnaire. Zero-inflated Poisson regression was generated to test the predictive effects of the independent variables on dental erosion. RESULTS: The prevalence of dental erosion was 78.8 %, and the mean and SE of BEWE index was 3.64 ± 0.15. High monthly family income was positively related to ΒΕWE cumulative scores [RR = 1.204 (1.016-1.427)], while high maternal education level [RR = 0.872 (0.771-0.986)] and poor oral hygiene level [DI-s, RR = 0.584 (0.450-0.756)] showed a negative association. CONCLUSIONS: Dental erosion is a common oral disease in Greek preschool children in Attica, related to oral hygiene and socio-economic factors. CLINICAL RELEVANCE: Programs aimed at erosion prevention should begin at an early age for all children.

• Efficacy and safety of intraseptal and periodontal ligament anesthesia achieved by computer-controlled articaine + epinephrine delivery: a dose-finding study.

  Authors: Vladimir Biocanin, Bozidar Brkovic, Biljana Milicic, Dragica Stojic

  Clinical oral investigations.

  OBJECTIVES: The main purpose of this study was to evaluate the dose-dependent anesthetic efficacy of the intraseptal anesthesia (ISA) and periodontal ligament anesthesia (PLA) obtained with differentOBJECTIVES: The main purpose of this study was to evaluate the dose-dependent anesthetic efficacy of the intraseptal anesthesia (ISA) and periodontal ligament anesthesia (PLA) obtained with different volumes of 4 % articaine and 1:100,000 epinephrine (Ar + Ep) in human mandibular premolars, using a computer-controlled local anesthetic delivery system (CCLADS). The safety profile of Ar + Ep was also studied by investigating the stability of cardiovascular parameters. MATERIAL AND METHODS: One hundred and eighty randomly selected healthy volunteers (ASA I) entered the single-blinded study to receive 16 mg + 4 μg, 24 mg + 6 μg, and 32 mg + 8 μg of Ar + Ep, obtained with different volumes (0.4, 0.6, and 0.8 ml, respectively), for the ISA and PLA. Success rate, onset, and duration of profound pulpal anesthesia were evaluated by the electrical pulp tester, while the width of the anesthetic field and duration of soft tissue anesthesia were recorded using the pinprick testing. A monitor was used for the measurement of cardiovascular parameters. RESULTS: A dose-dependent duration of pulpal and soft tissue anesthesia was obtained only by the ISA. Success rate, duration of both pulpal and soft tissue anesthesia, and its width were significantly better in the ISA compared with the PLA. No significant cardiovascular changes were seen in both groups. CONCLUSIONS: It can be suggested that 0.6 and 0.8 ml of 4 % Ar + 1:100,000 Ep, delivered by CCLADS, offer high success rate and effective clinical parameters of ISA as a primary anesthesia. CLINICAL RELEVANCE: It seems that dental procedures requiring profound pulpal, bone, and soft tissue anesthesia could be effectively and safely obtained by mentioned anesthetic protocol.

• Influence of caries infiltrant contamination on shear bond strength of different adhesives to dentin.

  Authors: Liuhe Jia, Bogna Stawarczyk, Patrick R Schmidlin, Thomas Attin, Annette Wiegand

  Clinical oral investigations.

  OBJECTIVES: To analyze whether the contamination with a caries infiltrant system impairs the adhesive performance of etch-and-rinse and self-etching adhesives on dentin. MATERIALS AND METHODS: DentinOBJECTIVES: To analyze whether the contamination with a caries infiltrant system impairs the adhesive performance of etch-and-rinse and self-etching adhesives on dentin. MATERIALS AND METHODS: Dentin contamination with the caries infiltrant system (Icon, DMG) was simulated by applying either hydrochloric acid (15 % HCl, Icon Etch, 15 s), the resin infiltrant (Icon infiltrant, 4 min), or both prior to the application of the respective adhesives (each group n = 10). In the control groups, the etch-and-rinse adhesive (Optibond FL, Kerr) and the self-etching adhesive (iBOND Self Etch, Hereaus) were applied without former contamination with the infiltrant system. Additionally, the adhesive performance of the resin infiltrant alone was tested. Shear bond strength of a nano-hybrid composite was analyzed after thermocycling (5,000×, 5-55°C) of the specimens and analyzed by ANOVA/Scheffé post hoc tests (p < 0.05) and Weibull statistics. Failure mode was inspected under a stereomicroscope at × 25 magnification. RESULTS: Contamination with the resin infiltrant alone did not impair shear bond strength, while contamination with hydrochloric acid or with hydrochloric acid and the resin infiltrant reduced shear bond strength (MPa) of the adhesives (Optibond FL: 20.5 ± 3.6, iBOND Self Etch: 17.9 ± 2.6) significantly. Hydrochloric acid contamination increased the number of adhesive failures. The adhesive performance of the caries infiltrant system alone was insufficient. CONCLUSION: The contamination with the caries infiltrant system impaired the shear bond strength of conventional dental adhesives. CLINICAL RELEVANCE: Contamination of the caries infiltrant system on dentin should be avoided due to the detrimental effect of hydrochloric acid etching.

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