P Pospiech

Carl Gustav Carus-Institut, Pforzheim, Baden-Württemberg, Germany

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Publications (15)24.9 Total impact

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    ABSTRACT: In a multicentre randomised trial (German Research Association, grants DFG WA 831/2-1 to 2-6, WO 677/2-1.1 to 2-2.1.; controlled-trials.com ISRCTN97265367), patients with complete molar loss in one jaw received either a partial removable dental prosthesis (PRDP) with precision attachments or treatment according to the SDA concept aiming at pre-molar occlusion. The objective of this current analysis was to evaluate the influence of different treatments on periodontal health. Linear mixed regression models were fitted to quantify the differences between the treatment groups. The assessment at 5 years encompassed 59 patients (PRDP group) and 46 patients (SDA group). For the distal measuring sites of the posterior-most teeth of the study jaw, significant differences were found for the plaque index according to Silness and Löe, vertical clinical attachment loss (CAL-V), probing pocket depth (PPD) and bleeding on probing. These differences were small and showed a slightly more unfavourable course in the PRDP group. With CAL-V and PPD, significant differences were also found for the study jaw as a whole. For CAL-V, the estimated group differences over 5 years amounted to 0·27 mm (95% CI 0·05; 0·48; P = 0·016) for the study jaw and 0·25 mm (95% CI 0·05; 0·45; P = 0·014) for the distal sites of the posterior-most teeth. The respective values for PPD were 0·22 mm (95% CI 0·03; 0·41; P = 0·023) and 0·32 mm (95% CI 0·13; 0·5; P = 0·001). It can be concluded that even in a well-maintained patient group statistically significant although minor detrimental effects of PRDPs on periodontal health are measurable.
    Journal of Oral Rehabilitation 03/2014; · 2.34 Impact Factor
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    ABSTRACT: The aim of this multi-center, randomized controlled trial was to assess the impact of missing posterior support on the risk for temporomandibular disorder (TMD) pain by comparing patients with either shortened dental arches (SDA) or molar replacement by removable dental prostheses (RDP). A sample of 215 patients with bilateral molar loss in at least one jaw was consecutively recruited in 14 prosthodontic departments of dental schools in Germany. Of the initial sample, 152 patients (mean age: 59.7 years; 53.9 % female) received randomly allocated interventions (SDA: n = 71; RDP: n = 81). Presence of TMD pain was assessed using patients' self-reports and was verified by physical examination and by pain intensity, as the mean of current pain, worst pain, and average pain in the last 6 months, with 10-point ordinal rating scales. Assessments were performed before treatment and at follow-ups until 60 months after treatment. Impact of interventions on TMD risk and pain intensity was computed by applying logistic and linear random-intercept models. Tooth replacement (RDP) did not significantly change the risk for self-reported (odds ratio [OR]: 1.1; confidence interval [CI]: 0.4 to 3.4) or clinically verified (OR: 0.7; CI: 0.1 to 4.3) TMD pain compared to no tooth replacement (SDA). Mean characteristic pain intensity was virtually identical in both groups (Coeff: 0.01; CI: -0.30 to 0.32). Retaining or preservation of an SDA is not a major risk factor for TMD pain over the course of 5 years when compared to molar replacement with RPDs. Seemingly, missing molars do not have to be replaced in order to prevent TMD pain.
    Clinical Oral Investigations 01/2014; · 2.20 Impact Factor
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    ABSTRACT: The scientific evidence concerning prosthodontic care for the shortened dental arch (SDA) is sparse. This randomized multicenter study aimed to compare two common treatment options: removable partial dental prostheses (RPDPs) for molar replacement vs. no replacement (SDA). One of the hypotheses was that the follow-up treatment differs between patients with RPDPs and patients with SDAs during the 5-year follow-up period. Two hundred and fifteen patients with complete molar loss in one jaw were included in the study. Molars were either replaced by RPDPs or not replaced according to the SDA concept. A mean number of 4.2 (RPDP) and 2.8 (SDA) treatments for biological or technical reasons occurred during the 5-year observation time per patient. Concerning the biological aspect, no significant differences between the groups could be shown, whereas treatment arising from technical reasons was significantly more frequent for the RPDP group. When the severity of treatment was analyzed, a change over time was evident. When, at baseline, only follow-up treatment with minimal effort is required, over time there is a continuous increase to moderate and extensive effort observed for both groups (Controlled-trials.com number ISRCTN97265367).
    Journal of dental research 07/2012; 91(7 Suppl):65S-71S. · 3.46 Impact Factor
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    ABSTRACT: OBJECTIVES: The study was designed to provide clinical outcome data for two treatments of the shortened dental arch (SDA). MATERIAL AND METHODS: In a multicenter randomized controlled clinical trial, patients with complete molar loss in one jaw were provided with either a partial removable dental prosthesis (PRDP) retained with precision attachments or treated according to the SDA concept preserving or restoring a premolar occlusion. No implants were placed. The primary outcome was tooth loss. RESULTS: Of 152 treated patients, 132 patients reached the 5-year examination. Over 5 years, 38 patients experienced tooth loss. For the primary outcome tooth loss, the Kaplan-Meier survival rates at 5 years were 0.74 (95 % CI 0.64, 0.84) in the PRDP group and 0.74 (95 % CI 0.63, 0.85) in the SDA group. For tooth loss in the study jaw, the survival rates at 5 years were 0.88 (95 % CI 0.80, 0.95) in the PRDP group and 0.84 (95 % CI 0.74, 0.93) in the SDA group. The differences were not significant. No Cox regression models of appropriate fit explaining tooth loss on the patient level could be found. CONCLUSIONS: The overall treatment goals of a sustainable oral rehabilitation and the avoidance of further tooth loss over longer periods were not reliably achievable. The influence of the type of prosthetic treatment on tooth loss might have been overestimated. CLINICAL RELEVANCE: Regarding our results, the patient's view will gain even more importance in the clinical decision between removable and fixed restorations in SDAs.
    Clinical Oral Investigations 06/2012; · 2.20 Impact Factor
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    ABSTRACT: The evidence concerning the management of shortened dental arch (SDA) cases is sparse. This multi-center study was aimed at generating data on outcomes and survival rates for two common treatments, removable dental prostheses (RDP) for molar replacement or no replacement (SDA). The hypothesis was that the treatments lead to different incidences of tooth loss. We included 215 patients with complete molar loss in one jaw. Molars were either replaced by RDP or not replaced, according to the SDA concept. First tooth loss after treatment was the primary outcome measure. This event occurred in 13 patients in the RDP group and nine patients in the SDA group. The respective Kaplan-Meier survival rates at 38 months were 0.83 (95% CI: 0.74-0.91) in the RDP group and 0.86 (95% CI: 0.78-0.95) in the SDA group, the difference being non-significant.
    Journal of dental research 08/2010; 89(8):818-22. · 3.46 Impact Factor
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    ABSTRACT: Various treatment options for the prosthetic treatment of jaws where all molars are lost are under discussion. Besides the placement of implants, two main treatment types can be distinguished: replacement of the missing molars with removable dental prostheses and non-replacement of the molars, i.e. preservation of the shortened dental arch. Evidence is lacking regarding the long-term outcome and the clinical performance of these approaches. High treatment costs and the long time required for the treatment impede respective clinical trials. This 14-center randomized controlled investigator-initiated trial is ongoing. Last patient out will be in 2010. Patients over 35 years of age with all molars missing in one jaw and with at least both canines and one premolar left on each side were eligible. One group received a treatment with removable dental prostheses for molar replacement (treatment A). The other group received a treatment limited to the replacement of all missing anterior and premolar teeth using fixed bridges (treatment B). A pilot trial with 32 patients was carried out. Two hundred and fifteen patients were enrolled in the main trial where 109 patients were randomized for treatment A and 106 for treatment B. The primary outcome measure is further tooth loss during the 5-year follow-up. The secondary outcome measures encompassed clinical, technical and subjective variables. The study is funded by the Deutsche Forschungsgemeinschaft (German Research Foundation, DFG WA 831/2-1, 2-2, 2-3, 2-4, 2-5). The particular value of this trial is the adaptation of common design components to the very specific features of complex dental prosthetic treatments. The pilot trial proved to be indispensable because it led to a number of adjustments in the study protocol that considerably improved the practicability. The expected results are of high clinical relevance and will show the efficacy of two common treatment approaches in terms of oral health. An array of secondary outcome measures will deliver valuable supplementary information. If the results can be implemented in the clinical practice, the daily dental care should strongly profit thereof. The trial is registered at ClinicalTrials.gov under ISRCTN68590603 (pilot trial) and ISRCTN97265367 (main trial).
    Trials 02/2010; 11:15. · 2.21 Impact Factor
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    ABSTRACT: A multi-centre randomized clinical trial is under way at 14 university dental schools in Germany to compare prosthodontic treatments for the shortened dental arch (SDA). One of the aims of this pilot-study was to measure the effect of two treatment options of the SDA on oral health-related quality of life and on the Research Diagnostic Criteria (RDC) for temporomandibular disorders (TMD). Thirty-four patients participated in the pilot-study. Inclusion criteria were: all molars were missing and the presence of at least both canines and one premolar in each quadrant. Participants were randomly assigned to receive either removable partial dentures including molar replacement (RPD_group) or retain a premolar occlusion (PROC_group). The Oral Health Impact Profile (OHIP-49) and the RDC for TMD were completed by participants before treatment (pre-treatment), 6 weeks (6 wks), 6 months (6m) and 12 months (12 m) after treatment. At the 12-month follow up, data of 10 women and 11 men (mean age: 62 +/- 10 years) were available. Medians of the OHIP total-scores were as follows: RPD (n = 10), 43.5 (pre-treatment), 18.2 (6 wks), 13.3 (6m), 14.7 (12 m). PROC (n = 11): 31.8 (pre-treatment), 27.1 (6 wks), 8.8 (6m), 8.3 (12 m). Significant differences were shown for RPD_group between pre-treatment and 6m/12 m and for PROC_group between pre-treatment and 6m. There were no significant differences between treatment groups at any time. Within each group, an improvement of life-quality was observed. No significant difference could be reported between the two therapy concepts. This may be due to the low sample size within the pilot study.
    Journal of Oral Rehabilitation 12/2005; 32(11):815-22. · 2.34 Impact Factor
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    ABSTRACT: Improved mechanical properties of contemporary composites has resulted in the extended use of composites for the restoration of posterior teeth. Although the indication of polymers was extended to metal-free individual crowns, the influence of tooth preparation design and cementation methods on the stability of these artificial crowns remains unknown. This in vitro study evaluated the effect of axial tooth preparation design, occlusal dimension, and cementation technique on the fracture resistance of metal-free posterior Artglass crowns. Seventy-two extracted human third molars, assigned to experimental groups by size, received standardized tooth preparation. Axial tooth preparation included an invasive approach with 1-mm deep shoulder and a less invasive 0.5-mm chamfer preparation, whereas occlusal reduction was either 0.5 mm or 1.3 mm. Artglass crowns that restored the original tooth contour were cemented with 3 cements: zinc phosphate cement (ZnP), glass ionomer cement (GIC), or a resinous cement in combination with a dentinal bonding agent. After 10,000 thermal cycles between 5 degrees C and 55 degrees C, artificial crowns were vertically loaded until compression to failure. Significant differences of fracture loads between experimental groups were assessed by paired Mann-Whitney U tests. Minimal fracture resistance for all combinations excluded 500 N. However, 9 of 24 Artglass crowns cemented with ZnP loosened after thermocycling. Adhesive cementation resulted in a significantly greater fracture resistance compared with GIC and ZnP (P=.02). Increased occlusal thickness (0.5 to 1.3 mm) resulted in greater stability, whereas a 1-mm deep shoulder tooth preparation did not improve durability compared with a 0.5-mm chamfer finishing line. A minimally invasive 0.5-mm axial chamfer tooth preparation combined with sufficient occlusal reduction and adhesive cementation recorded the greatest stability for posterior metal-free Artglass crowns.
    Journal of Prosthetic Dentistry 10/2000; 84(3):303-8. · 1.72 Impact Factor
  • P Pospiech, P Rammelsberg, F Unsöld
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    ABSTRACT: After 7 years of clinical experience, the alumina ceramic, In-Ceram, can be regarded as a well-proven material for all-ceramic crowns. Because of its high strength, this material can also be used for small all-ceramic fixed partial dentures. First attempts at using this material for resin-bonded prostheses revealed a high failure rate. The aim of this article is to present a new preparation design for all-ceramic resin-bonded fixed partial dentures that allows fabrication of highly esthetic and also tooth-saving adhesive prostheses. Clinical results over a period of 4 years revealed that they are strong enough to replace anterior teeth. Nevertheless, positive long-term clinical results are necessary before a general recommendation can be given for this kind of prosthesis.
    Quintessence international 12/1996; 27(11):753-8. · 0.71 Impact Factor
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    ABSTRACT: Objective of this study was to evaluate the diagnostic value of 3-D computed axiography to detect anterior disk displacements (ADD) of the TMJ. 65 patients with MRI confirmed ADD with reduction and 27 patients with ADD without reduction were examined by 3-D computed axiography. 44 healthy volunteers with normal disk position and joint function served as controls. A descriptive analysis of the axiographic opening/closing cycle revealed significantly higher rates of abrupt deviations, accelerations/decelerations, and crossings for ADD with reduction compared to healthy volunteers. A new axiographic index reduced the number of false positive to 10% and false negative to 14% of the diagnosis. ADD without reduction was characterized by significantly shorter opening curves. The optimum split point at 11 mm, resulted in 10% false positive and 20% false negative diagnosis. However, the diagnostic value of computed axiography was reduced by the significant influence of the clicking or limited joint on the contralateral TMJ.
    Cranio: the journal of craniomandibular practice 11/1996; 14(4):286-95. · 1.11 Impact Factor
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    ABSTRACT: Resin-bonded fixed partial dentures (FPD) with a metal framework have some disadvantages: a grey shimmer of the metal wings through the abutment teeth, a higher corrosion rate, and an allergenic potential of the non-precious alloys used. The Al2O3 ceramic In-Ceram seems to be strong enough to serve as a framework for resinbonded all-ceramic FPDs. Because of the fact that ceramic wings often don't have enough inter-occlusal space, a new preparation design was developed. The objective of this study was to determine the influence of load orientation (45 degrees and 60 degrees) and the design of the interproximal connector on the stress distribution in the bridges. A 3-dimensional finite-element model was developed to simulate the anatomical situation. The biting force was assumed as 250 N and oriented in oro-buccal direction. The loading-point was palatal 1.5 mm beneath the incisal edge. It was found that stress generally increased with an angle of the biting force of 60 degrees. A small interdental connector (3 mm height) and/or strong interdental separation resulted in stresses of up to 455 MPa (45 degrees) or 534 MPa (60 degrees). Less separation with rounded edges and a higher connector (4 mm) reduced the stress to 122 MPa (45 degrees) and 143 MPa (60 degrees). Due to an average tensile strength of In-Ceram at 340-400 MPa, an all-ceramic resin-bonded FPD may only be recommended if the height of the connector could be minimum 4 mm. Rounded edges and little interdental separation are significant for stress reduction.
    European Journal Of Oral Sciences 09/1996; 104(4 ( Pt 1)):390-5. · 1.42 Impact Factor
  • P Rammelsberg, P Pospiech, W Gernet
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    ABSTRACT: One hundred forty-one adhesive fixed partial dentures were placed under controlled conditions for a 6-year longitudinal study. The influence of location (anterior/posterior, maxilla/mandible), tooth preparation techniques (retentive/less invasive), and four different methods of metal conditioning (sandblasting/electrolytic etching and/or pyrolytic/tribochemical silane coating) on the survival rate was investigated. Failures (23 of 24) were caused by loss of adhesion at the metal-cement interface. The retentive tooth preparation reduced the risk of failure to almost one twentieth, but the intraoral location did not influence survival time. The effect of silane-coating on longevity was extremely positive and was not reflected by successful retainers.
    Journal of Prosthetic Dentistry 11/1993; 70(4):300-7. · 1.72 Impact Factor
  • P Rammelsberg, P Pospiech, W Gernet, G Hurt
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    ABSTRACT: 53 patients with 120 endosseous implants could be re-evaluated after a mean period of 2.7 years (maximum 5 years). Using casts from the upper with transfer posts and lower jaw, we measured the deviation of the implant axes from their ideal direction and localisation. Furthermore, we tried to find out, whether an unfavourable localisation compromised the prognosis of osseointegrated implants. Ideal, axial load by the prosthetic construction was often impossible because of unfavourable localisation of the implants. In a rank correlation analysis we found a significant influence of unfavourable localisation on prognosis in the group of hinge bars. Further weak correlations were revealed between loss of attachment and gingiva index which in turn was correlated with the plaque index.
    Deutsche zahnärztliche Zeitschrift 11/1991; 46(10):678-82.
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    ABSTRACT: A total of 107 bonded bridges could be re-evaluated after a mean period of 2.3 years and a maximum of 5 years. The preparation of mechanical retentive aids, such as grooves and bores resulted in a significant reduction of failure rates after one year. Electrolytical etching or silicoating of the CoCr restorations failed to have any effect on the failure rates of those bridges that were provided with adequate mechanical retention.
    Deutsche zahnärztliche Zeitschrift 11/1991; 46(10):653-6.
  • J Fischer, P Pospiech, W Gernet
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    ABSTRACT: In this investigation a procedure for increasing the flexural strength of leucite-containing dental ceramics by ion exchange with sodium at temperatures above the transformation range of the glass is presented. The method depends on a partial dissolution of the leucite phase and suppression of the phase transition of the persisting leucite in the surface layer of a work-piece, which causes a lower thermal expansion in the sotreated material. During cooling from high temperatures an internal pressure is built up in the surface layer due to the harder thermal contraction in the untreated inner part of the work-piece, which raises the flexural strength of the material. With the dental ceramic VMK 68 an increase of 75% could be measured after an ion exchange in NaCl at 830°C for 8 min.ZusammenfassungIn der Untersuchung wird ein Verfahren zur Steigerung der Biegefestigkeit leucithaltiger Dentalkeramik durch Ionentausch mit Natrium bei einer Temperatur oberhalb des Glaspunktes vorgestellt. Das Verfahren beruht auf der teilweisen Auflösung der Leucitphase und der Unterdrückung der Phasenumwandlung des persistierenden Leucits in der oberflächlichen Zone eines Werkstückes, woraus in diesem Bereich eine niedrigere thermische Dehnung resultiert. Beim Abkühlen aus dem plastischen Zustand wird durch die stärkere thermische Schrumpfung des unbeeinflußten Inneren des Werkstückes an der Oberfläche eine Druckzone aufgebaut, die die Biegefestigkeit der Keramik erhöht. Bei der untersuchten Keramik VMK 68 konnte nach einem Ionentausch in NaCl bei 830°C über 8 min eine Zunahme der Biegefestigkeit um 75% gemessen werden.RésuméDans cette recherche une méthode pour augmenter la résistance à la flexion d'une céramique contenant de la leucite par un échange d'ions à une température plus élevée est décrite. La méthode repose sur la décomposition partielle de la phase de leucite et la suppression de la transformation de phase de la leucite persistante dans la couche superficielle, ce qui résulte, dans cette sphère, une expansion thermique réduite. Pendant le refroidissement de la céramique plastique, une pression s'établit, consécutive à la contraction plus forte de l'interieur non influencé de la pièce d'æuvre, ce qui augmente la résistance à la flexion de la céramique. Avec la céramique VMK 68, une augmentation de 75% de la résistance de la flexion a été mesurée après un échange d'ions dans NaCl à 830°C sur 8 min.
    Journal of the European Ceramic Society.

Publication Stats

165 Citations
24.90 Total Impact Points

Institutions

  • 2014
    • Carl Gustav Carus-Institut
      Pforzheim, Baden-Württemberg, Germany
  • 2012
    • Danube University Krems
      Krems, Lower Austria, Austria
  • 2010
    • Universität des Saarlandes
      Saarbrücken, Saarland, Germany
  • 1996–2000
    • Ludwig-Maximilian-University of Munich
      • Department of Prosthodontics
      München, Bavaria, Germany