Gottfried Schmalz

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• Prof. Dr. Dr.h.c.mult.
• Professor at University Hospital Regensburg

Background Assessing the biocompatibility of materials is crucial for ensuring the safety and well-being of patients by preventing undesirable, toxic, immune, or allergic reactions, and ensuring that materials remain functional over time without triggering adverse reactions. To ensure a comprehensive assessment, planning tests that carefully consid...

The aim of the present consensus paper was to provide recommendations for clinical practice on the individual etiological and modifying factors to be assessed in the individual diagnosis of caries, and the methods for their assessment, supporting personalized treatment decisions. The executive councils of the European Organisation for Caries Resear...

Introduction: This consensus paper provides recommendations for oral health professionals on why and how to assess caries activity and progression with special respect to the site of a lesion. Methods: An expert panel was nominated by the executive councils of the European Organization for Caries Research (ORCA) and the European Federation of Conse...

The aim of the present consensus paper was to provide recommendations for clinical practice considering the use of visual examination, dental radiography and adjunct methods for primary caries detection. The executive councils of the European Organisation for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) nomina...

Dental restorative procedures remain a cornerstone of dental practice, and for many decades, dental amalgam was the most frequently employed material. However, its use is declining, mainly driven by its poor aesthetics and by the development of tooth-coloured adhesive materials. Furthermore, the Minamata Convention agreed on a phase-down on the use...

Purpose: This follow-up of a randomized clinical split-mouth study aimed to investigate the influence of selective enamel etching on the long-term clinical performance of partial ceramic crowns (PCCs) luted with a self-adhesive resin cement. Materials and methods: 43 patients received two PCCs (Vita Mark II; Cerec 3D) each for the restoration of...

Objectives Examination of patients claiming adverse effects from dental materials can be very challenging. Particularly, systemic aspects must be considered besides dental and orofacial diseases and allergies. Therefore, the aim of this study was to investigate a cohort of 687 patients reporting on adverse effects from dental materials focusing on...

The term bioactivity is being increasingly used in medicine and dentistry. Due to its positive connotation, it is frequently utilised for advertising dental restorative materials. However, there is confusion about what the term means, and concerns have been raised about its potential overuse. Therefore, FDI decided to publish a Policy Statement abo...

The term bioactivity is being increasingly used in medicine and dentistry. Due to its positive connotation, it is frequently utilised for advertising dental restorative materials. However, there is confusion about what the term means, and concerns have been raised about its potential overuse. Therefore, FDI decided to publish a Policy Statement abo...

Unintended direct or indirect side effects of orthodontic treatment are well recognised and quite extensively described in the literature. Since some degree of mechanically induced functional restrictions, discomfort and pain are recognised to be an experience for a major part of orthodontic patients, material‐related adverse reactions (toxic/aller...

The Minamata Convention resulted in restrictions in the use of amalgam in daily dental practice. This opens up new discussions about the biocompatibility of amalgam, but also of composites as alternative materials. In the following review article, these issues will be discussed in more detail to provide dentists with a knowledge base for themselves...

The oral biofilm is associated with the most common oral diseases such as caries, periodontitis, and peri-implantitis. It is also linked to failures of dental treatment approaches (eg, direct or indirect restorations because of adjacent caries). Therefore, the development of materials with antibacterial properties is desirable. However, the design...

Normative approaches have been developed with the aim of providing high-quality methods and strict criteria that, when applied correctly, lead to reliable results. Standards, specifications, and guidelines are needed to facilitate exchange of goods or information and secure comparability of data derived from different laboratories and sources. They...

Objectives: To determine the clinical performance of partial ceramic crowns (PCCs) luted with a conventional resin cement combined with a universal adhesive without or with selective enamel etching or luted with a self-adhesive resin cement. Methods: In a split-mouth design, each three CAD/CAM-PCCs (Vita Mark II, Cerec) were placed in 50 patients....

Objective: In a cohort of 500 patients complaining about adverse effects from dental materials, allergies were found to be contributing to the patients' subjective complaints in only about 14% of the cases. Therefore, the aim of this retrospective study was to investigate an enlarged cohort of 625 patients reporting on adverse effects from dental...

Zusammenfassung Dentales Amalgam wird seit über 180 Jahren erfolgreich in der zahnärztlichen Füllungstherapie kariöser Läsionen eingesetzt. Es ist langlebig, in der Verarbeitung wenig techniksensitiv und damit fehlertolerant. Seit vielen Jahren befindet sich das dentale Amalgam jedoch in der öffentlichen Diskussion, v. a. wegen seines Quecksilberan...

Objective Histological techniques have long been an integral part of dental research. Especially the processing of complex tissues poses specific challenges, however, literature offers only few technical references. Objectives of this study were therefore to optimize histological staining methods and compile detailed protocols for preparation and s...

Interfaces between dentin, enamel and luting agents were characterized using low vacuum Scanning Electron Microscopy (SEM). After smear layer creation, one of three luting agents (RelyX Unicem 2, Clearfil SA Cement and Panavia F 2.0/ED Primer II) was applied on 60 enamel-dentin specimens and dual-cured or self-cured. Specimens were polished (Experi...

Biofilm formation depends on many factors, one of them being the surface (substrate) on which the biofilm is formed, and dental restorative materials are such substrates. Biofilms play a crucial role for caries formation and inflammation of gingival, periodontal, or mucosal tissues next to restorations. Even general health problems such as systemic...

A loss of organs or the destruction of tissue leaves wounds to which organisms and living things react differently. Their response depends on the extent of damage, the functional impairment and the biological potential of the organism. Some can completely regenerate lost body parts or tissues, whereas others react by forming scars in the sense of a...

Objective This study correlates the mechanical and biological response of commercially available resin-based composites (RBCs) to clinically relevant light-curing conditions. Methods Two RBCs (Venus and Venus Pearl; Kulzer) that use different monomer and photo-initiator systems, but have a similar filler volume and shade, were exposed to either ju...

Introduction: A sound and vital pulp is an essential prerequisite for long-term tooth survival and preservation. However, current endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by a synthetic biomaterial. Recently, total or partial pulp regeneration has been proposed as an alternative...

Neben dem Quecksilber aus Amalgam oder den Monomeren aus Kompositen müssen heute auch Bisphenol A und Nanopartikel, welche beim Beschleifen, Polieren oder Entfernen von Restaura­ tionen entstehen, in die Bewertung der Biokompatibilität einbezogen werden. In Laborversuchen rufen diese Sub­ stanzen toxische Reaktionen hervor und Bisphenol A zeigt zud...

Objectives To assess the clinical effectiveness of four desensitizing materials in patients who are xerostomic due to radiotherapy for head and neck cancer (HNC) in comparison to a healthy group with normal salivation. Methods and materials The study was conducted as a split-mouth randomized clinical trial. Forty HNC patients (group A) and 46 heal...

Aim To investigate tooth survival and clinical long‐term outcomes up to 26 years following guided tissue regeneration (GTR) therapy in deep intra‐bony defects. Methods Patients from three prospective clinical split‐mouth studies, which investigated the outcomes of GTR therapy, were re‐evaluated 21 to 26 years after surgery independent of the membr...

Objectives The aims of this study were (i) to assess cumulative survival rates of class II resin-based composite and compomer restorations in primary molars with a 5-year observation period and (ii) to analyze the influence of different types of anesthesia and different localizations of the restorations in the teeth. Methods Patient charts of a pr...

Objective: This study investigated the influence of the degree of conversion (DC), resin-based composites (RBC) composition, and the effect of additional violet light from one light curing unit (LCU) on cell attachment/growth, eluate cytotoxicity, and gene expression. Methods: The effect of different DC of RBCs on human gingival fibroblasts (HGF...

The aim of this study was to evaluate water sorption and solubility of two series of experimental composites containing amorphous calcium phosphate (ACP) or bioactive glass (BG). Water sorption and solubility were measured for up to 287 days. The surface precipitation of calcium phosphates was evaluated by scanning electron microscopy. The ACP-seri...

Objectives: Due to severe limitations of dental pulp sensitivity tests, the direct recording of pulsed blood flow, using photoplethysmography (PPG), has been proposed. In vivo evaluation is methodologically difficult and in vitro models have hitherto been adversely influenced by shortcomings in emulating the in vivo situation. Consequently, the ai...

Neben dem Quecksilber aus Amalgam oder den Monomeren aus Kompositen müssen heute auch Bisphenol A und Nanopartikel, welche beim Beschleifen, Polieren oder Entfernen von Restaurationen entstehen, in die Bewertung der Biokompatibilität einbezogen werden. In Laborversuchen rufen diese Substanzen toxische Reaktionen hervor, und Bisphenol A zeigt zudem...

Objective: Information on patients with real or claimed adverse reactions towards dental materials in large patient cohorts is rare. Therefore, the aim of the present study was to investigate patients reporting on complaints and symptoms to dental materials over a 16-year period. Methods: Five hundred patients were characterized by one single denta...

Patienten erkundigen sich immer häufiger über die Verträglichkeit unserer Werk- stoffe – oftmals verunsichert durch das Internet. Nur Zahnärzte sind in der Lage, die oft einseitigen Informationen aus den Medien in den korrekten klinischen Kon- text zu bringen. Ziel dieses Beitrags ist es daher, die Verträglichkeit neuer Werkstoffe und neue Regulari...

Objectives The aim of this study was to evaluate the cytotoxicity and the influence of bleaching agents on immunologically cell surface antigens of murine macrophages in vitro. Materials and methodsRAW 264.7 cells were exposed to bleaching gel extracts (40% hydrogen peroxide or 20% carbamide peroxide) and different H2O2 concentrations after 1 and 2...

This in vitro study evaluated the effect of toothpastes with different active ingredients on dentin permeability using an extended protocol including multiple applications and several thermal ageing cycles in the presence or absence of human saliva. The Null hypothesis was that dentin permeability of a hydroxyapatite containing toothpaste (BR), a p...

Introduction: Compelling evidence pinpoints that pulp tissue engineering after the transplantation of stem cells is possible. Although intriguing, severe problems regarding clinical feasibility remain. Cell homing has been proposed as a viable alternative in which dentin-derived growth factors in a conducive scaffold may attract resident cells to...

Nanoparticles having a size from 1 to 100 nm are present in nature and are successfully used in many products of daily life. In dental materials, nanoparticles are typically embedded but they may also exist as by‐products from milling processes. Possible adverse effects of nanoparticles have gained increased interest, with the lungs being the main...

Aim: To investigate the clinical long-term outcomes 13 years following guided tissue regeneration (GTR) in deep intrabony defects with and without additional application of autogenous platelet concentrate (APC). Methods: In 25 patients, two deep contra-lateral intrabony defects were treated according to GTR using ß-TCP and bio-resorbable membran...

Objectives: To evaluate the clinical performance of two flowable composites for restoration of Class-V non-carious cervical lesions (NCCLs), one with novel (N'Durance(®) Dimer Flow, Septodont; ND) and one with modified conventional matrix composition (Filtek™ Supreme XTE Flow, 3M-ESPE; FS). The null hypothesis was that both flowable composite mate...

Objectives To investigate the additional influence of either antimicrobial photodynamic therapy (aPDT; Helbo® Photodynamic Systems) or local application of minocycline microspheres (MC; Arestin, OraPharma) on clinical and microbiological healing results in deep periodontal pockets (PPD ≥6 mm) following non-surgical periodontal therapy (SRP). Materi...

Signaling molecules play an essential role in tissue engineering because they regulate regenerative processes. Evidence exists from animal studies that single molecules such as members of the transforming growth factor beta superfamily and factors that induce the growth of blood vessels (vascular endothelial growth factor), nerves (brain-derived ne...

Objective: Nanoparticles having a size from 1 to 100nm are present in nature and are successfully used in many products of daily life. Nanoparticles are also embedded per se or as byproducts from milling processes of larger filler particles in many dental materials. Methods and results: Recently, possible adverse effects of nanoparticles have ga...

Dental pulp tissue engineering is possible after insertion of pulpal stem cells combined with a scaffold into empty root canals. Commonly used biomaterials are collagen or poly(lactic) acid, which are either difficult to modify or to insert into such a narrow space. New hydrogel scaffolds with bioactive, specifically tailored functions could optimi...

Objectives Bioactive proteins are sequestered in human dentine and play a decisive role in dental pulp regeneration and repair. They can be released and exposed on the dentine surface by acids, but also chelators, such as ethylenediaminetetraacetic acid (EDTA). The objectives of this study were (i) to evaluate whether ultrasonic activation of irrig...

Dental pulp regeneration has become possible by applying the principles of tissue engi- neering, using dental pulp-derived stem cells, suitable natural or synthetic matrices and a set of signaling molecules. Two approaches seem feasible: (1) mixing stem cells and re- combinant growth factors with the sca old, which then is applied into the root can...

Objectives: Biocompatibility of dental materials has gained increasing interest during recent decades. Meanwhile, legal regulations and standard test procedures are available to evaluate biocompatibility. Herein, these developments will be exemplarily outlined and some considerations for the development of novel materials will be provided. Method...

Objectives: To evaluate the clinical performance of two flowable composites for restoring Class-V non-carious cervical lesions (NCCLs), one with novel (ND; N'Durance(®) Dimer Flow, Septodont) and one with modified conventional matrix composition (FS; Filtek™ Supreme XTE Flow, 3M-ESPE). The null hypothesis was that both flowable composites perform...

Objectives A new universal adhesive with corresponding luting composite was recently marketed which can be used both, in a self-etch or in an etch-and-rinse mode. In this study, the clinical performance of partial ceramic crowns (PCCs) inserted with this adhesive and the corresponding luting material used in a self-etch or selective etch approach w...

Aim To determine if the addition of inert fillers to a bioactive dental restorative composite material affects its degree of conversion (DC), polymerization shrinkage (PS), and microhardness (HV). Methods Three amorphous calcium phosphate (ACP)-based composite resins: without added fillers (0-ACP), with 10% of barium-glass fillers (Ba-ACP), and wi...

Introduction: Photodynamic inactivation of bacteria (PIB) may be a supportive antimicrobial approach for use in endodontics, but sufficient activation of photosensitizers (PS) in root canals is a critical point. Therefore, aim of this study was to evaluate the ability of PS absorbing blue (TMPyP) or red light (Methylene Blue; MB) for light activati...

OBJECTIVE: Due to an increased focus on erosive tooth wear (ETW), the European Federation of Conservative Dentistry (EFCD) considered ETW as a relevant topic for generating this consensus report. MATERIALS AND METHODS: This report is based on a compilation of the scientific literature, an expert conference, and the approval by the General Assembly...

Purpose: To investigate the influence of selective enamel etching on long-term clinical performance of partial ceramic crowns (PCCs) luted with a self-adhesive luting material (RXU: RelyX Unicem). Materials and methods: At baseline, 34 patients received the intended treatment: two PCCs (Vita Mark II; Cerec 3D) for the restoration of extended les...

The topic of material tissue interaction has gained increasing interest over recent decades from both the dental profession and the public. The primary goal initially was to avoid adverse reactions after the application of dental materials. New laboratory test methods have been developed, and currently premarket testing programs, which attempt to g...

One aim in vital pulp therapy is the generation of new dentin-like hard tissue (tertiary dentin) to compensate for dentin loss; e.g. due to caries or trauma. For a long time, the standard material was calcium hydroxide to be placed on the exposed and healthy dental pulp. Recently, the use of dentin adhesives had been proposed for direct pulp cappin...

Calcium silicate cements are biocompatible dental materials applicable in contact with vital tissue. The novel tricalcium silicate cement Biodentine™ offers properties superior to commonly used mineral trioxide aggregate (MTA). Objective of this study was to evaluate its cytocompatibility and ability to induce differentiation and mineralization in...

Due to an increased focus on erosive tooth wear (ETW), the European Federation of Conservative Dentistry (EFCD) considered ETW as a relevant topic for generating this consensus report. This report is based on a compilation of the scientific literature, an expert conference, and the approval by the General Assembly of EFCD. ETW is a chemical-mechani...

To evaluate the effect of dentine conditioning on migration, adhesion and differentiation of dental pulp stem cells. Dentine disks prepared from extracted human molars were pretreated with EDTA (10%), NaOCl (5,25%) or H2 O. Migration of dental pulp stem cells towards pretreated dentine after 24 and 48 h was assessed in a modified Boyden chamber ass...

ed variables. Statistical differences in the VAS values of VF, UDS, CPB and FOV were evaluated performing the Kruskall-Wallis analysis, adjusting the statistical significance for the multiple comparisons (Bonferroni correction). Statistical differences between the baseline VAS values and those obtained at any time-points were calculated performing...

Objectives: Calcium silicate cements are biocompatible dental materials, which can be applied in contact with vital tissue. The novel tricalcium silicate cement BiodentineTM offers mechanical properties and handling characteristics superior to commonly used mineral trioxide aggregate (MTA). The objective of the present investigation was to evaluate...

Since the very beginning of this journal in 1997, Prof. Dr. Wolfgang Gernet has served as an Associate Editor for this journal. Thus, he was one of our founding editors. On Oct 1st 2014, he retired from his position as the chairman of the Department of Prosthetic Dentistry at the Ludwig-Maximilians University Munich, and thus, he asked to step down...

Introduction: During dentinogenesis, growth factors become entrapped in the dentin matrix that can later be released by demineralization. Their effect on pulpal stem cell migration, proliferation, and differentiation could be beneficial for regenerative endodontic therapies. However, precondition for success, as for conventional root canal treatme...

Adverse reactions to dental materials occur and public interest in this topic has increased during recent decades. Thus, improving the biocompatibility of dental materials is necessary and must be based on several strategies. First, a strategy for improving the administrative and technical conditions for material certification processes should be i...

Most dental procedures require a dry working environment. Although many evaporative drying methods are available, an additional reduction of salivary flow would often be helpful. This prospective randomized cross-over study compares salivary production in 31 volunteers during direct, indirect, and non-suggestive (control group) intervention. Overal...

The ability of silica to influence the mineralization of alkaline-earth carbonates is an outstanding example for the formation of biomimetic structures in the absence of any organic matter. Under suitable conditions, silica-stabilized carbonate nanocrystals can spontaneously self-assemble into hierarchical materials with complex morphologies, commo...

The photoinitiator diphenyl-(2,4,6-trimethylbenzoyl)phosphine oxide (TPO) is more reactive than a camphorquinone/amine (CQ) system, and TPO-based adhesives obtained a higher degree of conversion (DC) with fewer leached monomers. The hypothesis tested here is that a TPO-based adhesive is less toxic than a CQ-based adhesive. A CQ-based adhesive (SBU-...

Objectives The aim of this study was to examine the influence of the addition of glass fillers with different sizes and degrees of silanization percentages to remineralizing composite materials based on amorphous calcium phosphate (ACP). Methods Four different materials were tested in this study. Three ACP based materials: 0-ACP (40 wt% ACP, 60 wt...

Most in vitro studies on the antibacterial effects of antiseptics have used planktonic bacteria in monocultures. However, this study design does not reflect the in vivo situation in oral cavities harboring different bacterial species that live in symbiotic relationships in biofilms. The aim of this study was to establish a simple in vitro polymicro...

Increasing antibiotic resistances in microorganisms involve serious problems in public health. This demands alternative approaches for killing pathogens to supplement standard treatment methods. Photodynamic inactivation of bacteria (PIB) uses light activated photosensitizers (PS) to generate reactive oxygen species immediately upon illumination, i...

Biomineralization is one of the key characteristics of dental pulp leading to the generation of tertiary dentin to compensate for dentin loss; e.g. due to caries or trauma. Early approaches to induce tertiary dentin formation included the application of calcium hydroxide on healthy exposed pulps. Recently, the use of dentin adhesives for direct pul...

Objectives: So far, bovine immortalized pulp cells have been used as three dimensional cultures for cytotoxicity testing of filling materials in the dentin barrier test (DBT). In this study, the use of human pulp-derived cells was evaluated, which would better simulate the clinical situation, and a composite material with a new resin base was teste...

Dental follicle cells (DFCs) can be artificially differentiated into mineralizing cells. With a dexamethasone-based differentiation protocol, transcription factors ZBTB16 and NR4A3 are highly upregulated but Runx2 and other osteogenic marker genes are not. Previous studies have suggested the involvement of a Runx2-independent differentiation pathwa...

The standard treatment modality for teeth with irreversibly damaged dental pulp is root canal therapy, which involves complete removal of the soft tissue and obturation with a synthetic material. So far, research studies show that the combination of stem cells with a suitable scaffold material and transplantation into the root canal may result in t...

The traditional concept of replacing diseased tooth/pulp tissues by inert materials (restoration) is being challenged by recent advances in pulp biology leading to regenerative strategies aiming at the generation of new vital tissue. New tissue formation in the pulp chamber can be observed after adequate infection control and the formation of a blo...

Objective: Dental resin monomers like 2-hydroxyethyl methacrylate (HEMA) disturb the cellular redox balance, and activate adaptive responses including programmed cell death via apoptosis. The pathway to monomer-induced apoptosis is unknown. Thus, the expression of anti-apoptotic protein and pro-apoptotic Bcl-2 family members of the intrinsic mitoch...

Objective: Dental resin monomers like 2-hydroxyethyl methacrylate (HEMA) increase the formation of reactive oxygen species (ROS) and induce cell death via apoptosis. It has been shown earlier that oxidative DNA damage and ATM expression (ataxia-telangiectasia mutated), a protein kinase which recognizes DNA double strand breaks were enhanced in the...

The dental pulp is-beside the periodontal tissues and the oral mucous membranes-the prime local target organ for direct or indirect biologic interaction with dental materials. Dental materials are not only classical restorative materials and those needed in the course of fabricating the restorations (e.g., impression materials) but also substances...

This study was conducted to evaluate a self-adhesive resin luting cement [RelyX Unicem 3MESPE-RXU] for luting partial ceramic crowns (PCCs) with and without selective enamel etching in a prospective, randomized clinical trial. Thirty-four patients had received the intended treatment. Two PCCs (Vita Mark II; Cerec 3D; Sirona) had been placed in a sp...

The aim of this study was to demonstrate that the periodontal pathogen Aggregatibacter actinomycetemcomitans (AA) can be killed by irradiation with blue light derived from a LED light-curing unit due to its endogenous photosensitizers. Planktonic cultures of AA and Escherichia coli were irradiated with blue light from a bluephase® C8 light-curing u...

Dental stem cells are excellent for oral and craniofacial tissue engineering. A profound knowledge about molecular processes in dental stem cells is necessary to create treatment approaches in oral medicine. Transcription factors regulate gene expression and provide decisive information for cellular functions. In recent years, the authors have inve...

During the past 50 years, a series of key UN conferences have established a framework to minimize human health risks from environmental exposures to key chemicals. In January 2013, more than 140 countries agreed to the text of new treaty to minimize Hg effects on the environment (the Minamata Convention). Dental caries is omnipresent around the glo...

Noninvasive optical methods such as photoplethysmography, established for blood pulse detection in organs, have been proposed for vitality testing of human dental pulp. However, no information is available on the mechanism of action in a closed pulp chamber and on the impairing influence of other than pulpal blood flow sources. Therefore, the aim o...

Objective: Oxidative stress caused by resin monomers like 2-hydroxyethyl methacrylate (HEMA) is causally related to apoptosis but cellular pathways are unknown. We hypothesize that HEMA-induced apoptosis is mediated through the intrinsic mitochondrial pathway. Therefore, the production of reactive oxygen species (ROS), and the expression of antioxi...

Objectives: Odontoblasts, which are lifelong responsible for dentin matrix formation and mineralization, represent an integral part of the dentin-pulp complex. However, a profound knowledge of the mineralization process and the biological interaction of odontoblasts to both bacteria and biomaterials used in dental therapy are still scarce. Since od...

The initial adhesion of microorganisms to clinically used dental biomaterials is influenced by physico-chemical parameters like hydrophobicity and pre-adsorption of salivary proteins. Here, polymethyl methacrylate (PMMA), polyethylene (PE), polytetrafluoroethylene (PTFE), silicone (Mucopren soft), silorane-based (Filtek Silorane) and methacrylate-b...