Einführung: Eine geistige Behinderung kann als Folge vielfältiger Störungen des Gehirns auftreten und führt dazu, dass Fähigkeiten im sprachlichen, motorischen und sozialen Bereich eingeschränkt sein können. Fallberichte und Studien zu unterschiedlichen Patientengruppen zeigen, dass Kinder und Jugendliche mit geistiger Behinderung im Vergleich zu Kindern und Jugendlichen ohne geistige Behinderung mehr Karieserfahrung und ein höheres Kariesrisiko aufweisen. Ziel der vorliegenden retrospektiven Untersuchung war es, die Kariesprävalenz sowie den Schweregrad der Karies bei Kindern und Jugendlichen mit geistiger Behinderung zu evaluieren. Material und Methode: Es wurden 54 Kinder und Jugendliche mit geistiger Behinderung (Studiengruppe (SG); Durchschnittsalter: 7,79 ± 4,02 Jahre) und 34 Kinder ohne geistige Behinderung (Kontrollgruppe (KG); Durchschnittsalter: 4,95 ± 2,11 Jahre) gemäß WHO-Kriterien zahnärztlich untersucht. Zu den aufgenommenen Parametern gehörten der dmft/DMFT-Wert (inklusive dt/DT, mt/MT, ft/FT), der Kariessanierungsgrad (KSG), der Significant Caries Index (SiC) und für die Kinder unter sechs Jahren die Einteilung der Schweregrade der frühkindlichen Karies. Die Studienteilnehmer wurden abhängig vom Alter in die Untergruppen Vorschul- und Schulkinder unterteilt. Die statistische Auswertung erfolgte mittels ANOVA (p ≤ 0,05) unter Verwendung des Statistikprogramms SPSS 26.0. Ergebnisse: Kinder und Jugendliche ohne geistige Behinderung hatten einen kleineren dmft/DMFT-Wert (5,8 ± 4,0 vs. 9,1 ± 5,2/4,2 ± 2,5 versus 8,0 ± 1,5) und einen größeren ft/FT als Kinder mit geistiger Behinderung, ohne signifikanten Unterschied. Bei den Vorschulkindern fiel der dmft/DMFT-Wert höher aus als in der Schulgruppe. Der SiC war in beiden Altersgruppen in der Studiengruppe höher als in der Kontrollgruppe. Hinsichtlich des KSG zeigte sich, dass in der Gruppe der Schulkinder die Kinder und Jugendlichen mit geistiger Behinderung besser versorgt waren. Schlussfolgerung: In der vorliegenden Studie zeigten Kinder und Jugendliche mit und ohne geistige Behinderung eine hohe Karieserfahrung, jedoch war die Kariesprävalenz in der Studiengruppe im Vergleich zur Kontrollgruppe höher. Die Studie zeigt, dass ein besonderes Augenmerk auf frühzeitige zahnärztliche Präventionsmaßnahmen bei Kindern und Jugendlichen mit hoher Karieserfahrung gelegt werden sollte, um die Zahn- und Mundgesundheit zu erhalten. Keywords: Behandlungsbedarf, geistige Behinderung, Jugendliche, Kariesprävalenz, Kinder

Purpose: To evaluate the survival and clinical quality of individually layered indirect composite restorations (ICRs) in the mixed and permanent dentition at two study centers. Materials and Methods: A total of 155 adhesively cemented ICRs in 34 participants (aged 6 to 50 years and treated between 2008 and 2018) were evaluated for survival and clinical quality. All were individually layered restorations fabricated from laboratory sculptable composites by a specialized dental technician. Two calibrated independent investigators examined and graded each restoration as success, survival with repair, or failure based on the FDI criteria. The marginal quality and gap width of the restorations were analyzed by scanning electron microscopy. The periodontal health of treated teeth (TT) was evaluated in comparison with that of unrestored control teeth (CT) by measuring the pocket depth (PD), clinical attachment level (CAL), sulcus bleeding index (SBI), and the modified Turesky Plaque Index (TPI). A serial t-test (p 0.05) was used for statistical analysis of periodontal parameters. Success and functional survival rates were calculated using the Kaplan–Meier method. Results: Molar incisor hypomineralization (MIH) was the most common indication for treatment (41%). The median age at treatment was 14.9 years (68%-CI: 7.7–29.5). The median service time of the restorations was 5.7 ± 3.4 years. 132 restorations were classified as a success, 21 as survival with repair, and 1 as a failure. The success rates at 1, 5, and 10 years were 95.4%, 87.4%, and 78.8%, respectively, and the corresponding functional survival rates were 100.0%, 98.9%, and 98.9%. The clinical quality, encompassing esthetic, functional, and biological criteria, was rated as excellent or good in over 90%. Periodontal response, however, was the only criterion showing worse results since restored teeth (TPI = 1.9) had significantly more plaque than CT (TPI = 1.7; p = 0.0001). No significant differences were observed in PD, CAL, or SBI. The mean marginal gap width was 135.7 µm and 63.8% of the restorations had perfect margins. Conclusion: ICRs are suitable for minimally invasive restoration of large tooth structure defects in the developing dentition of children and adolescents and for long-term temporary restoration of the adult dentition. Keywords: adolescent dentition, adult dentition, clinical quality parameters, indirect composite restorations, qualitative margin analysis, survival

Purpose: This German S3 clinical practice guideline offers evidence-based recommendations for the use of composite materials in direct restorations of permanent teeth. Outcomes considered were the survival rates and restoration quality and process quality of the manufacturing process. Part 1 of this two-part presentation deals with the indication classes. Materials and Methods: A systematic literature search was conducted by two methodologists using MEDLINE and the Cochrane Library via the OVID platform, including studies up to December 2021. Six PICO questions were developed to guide the search. Recommendations were formulated by a panel of dental professionals from 20 national societies and organizations based on the collected evidence. Results: Composite materials are a viable option for the direct restoration of cavity Classes I–V and may also be used for restorations with cusp replacement, and tooth shape corrections. In the posterior region, direct composite restorations should be preferred over indirect composite inlays. For Class V restorations, composite materials can be used if adequate contamination control and adhesive technique are ensured. Conclusion: The guideline is the first to provide comprehensive evidence on the use of direct composite materials. However, further long-term clinical studies with comparators such as (modified) glass-ionomer cements are necessary. Regular updates will detail the future scope and limitations of direct composite restorations. Keywords: adhesive restorations, composite resin, composite restorations, evidence-based medicine

Purpose: Part 2 of this German S3 clinical practice guideline provides recommendations for the process of manufacturing composite restorations. It covers key aspects like caries removal, field isolation, matrix and adhesive techniques, as well as light curing and polishing. The outcomes of interest include survival rates and restoration quality. Materials and Methods: A systematic literature search was conducted by two methodologists using MEDLINE and the Cochrane Library via the OVID platform, including studies up to December 2021. Additionally, the reference lists of relevant manuscripts were manually reviewed. Six PICO questions were developed to guide the search. Consensus-based recommendations were for- mulated by a panel of dental professionals from 20 national societies and organizations based on the collected evidence and ex- pert opinion. Results: The guideline advocates for one-stage selective caries removal near the pulp and underscores the effectiveness of various isolation techniques, adhesive systems, and the crucial role of light polymerization. The use of anatomically pre- formed sectional matrices and phosphoric acid etching is recommended to enhance restoration quality. Additionally, polish- ing composite restorations is advised to improve surface finish. Conclusion: This guideline provides comprehensive recommendations that inform clinicians on optimizing the composite restor- ation manufacturing processes. The adoption of these best practices can improve the quality and longevity of dental restorations.

Purpose: The aim of this in-vitro study was to evaluate the marginal integrity and wear of eight bulk-fill materials in comparison to a compomer in Class-II cavities in primary molars after thermomechanical loading (TML). Materials and Methods: Prepared Class-II cavities in 72 extracted primary molars were filled with eight bulk-fill materials. A compomer served as the control group. After water storage (incubator, 28 days, 37°C), samples were subjected to TML (2500 thermal cycles 5°C/55°C; 100,000 load cycles, 50 N, 1.67 Hz). Before and after TML, replicas were made which were used for both SEM analysis of marginal integrity and 3-D wear analysis. Statistical analysis was performed using Kruskal-Wallis and Wilcoxon tests (p < 0.05). Results: A significant reduction in perfect margins was observed for all groups, while marginal gap formation increased (Wilcoxon test, p < 0.02) for all groups but the compomer. Significant interindividual differences were observed between the tested materials regarding marginal integrity (Kruskal-Wallis test, p < 0.05). Wear analysis revealed no significant differences between groups (Kruskal-Wallis test, p > 0.05). Conclusion: Some of the bulk-fill materials investigated here achieved better results than the compomer and should be further evaluated clinically. Keywords: Class-II restoration, composite, marginal analysis in SEM, polyacid modified resin, wear

Purpose: This study compared a 2%-CHX dentin pre-treatment with three CHX adhesives (experimentally admixed 0.1% CHX in primer or bonding agent, or industrially added 0.2% CHX in universal adhesive) by evaluating dentin bond strengths after biological loading in a fully automated artificial mouth model. Materials and Methods: The occlusal dentin of 50 freshly extracted human third molars was exposed, and the teeth were randomly assigned to 5 groups according to the adhesive protocol (n = 10): 1. control, Scotchbond Multipurpose (3M Oral Care; CTRL); 2. 2% CHX dentin pre-treatment (DENT); 3. 0.1% CHX experimentally admixed into the primer (PRIM); 4. 0.1% CHX experimentally admixed into the bonding agent (BOND); 5. Peak Universal Bond containing 0.2% CHX (Ultradent; PEAK). The teeth were restored with composite resin. Microtensile bond strength testing (bonding area 0.46 mm2 ± 0.04 mm², crosshead speed 1 mm/min) was performed after 24-h storage in distilled water (baseline) or after 2-day biological loading with S. mutans (demineralization 1 h / remineralization 5 h). The mode of fracture was recorded and exemplary sticks were evaluated under SEM. Results: CTRL exhibited significantly higher μTBS at baseline in comparison to PRIM (p = 0.000), BOND (p = 0.002), and PEAK (p = 0.000). After undergoing the caries model, CTRL demonstrated significantly lower μTBS compared to DENT (p = 0.000), PRIM (p = 0.008), and PEAK (p = 0.000). The same behavior was observed for BOND vs DENT (p = 0.000), PRIM (p = 0.003), and PEAK (p = 0.001). After biological loading, DENT (p = 0.041), PRIM (p = 0.000), and BOND (p = 0.000) exhibited significantly fewer adhesive fractures than CTRL. Conclusions: CHX addition to the primer protects dentin bond strength from declining after biological loading. Thus, it may offer some clinical advantage in terms of secondary caries inhibition around composite restorations. However, since loss of adhesion at baseline was less when 2% CHX was used as a dentin pre-treatment, it can be suggested as a safer option. so that bonding is not undermined by potential chemical interactions from CHX with the adhesives. Keywords: biofilm, biological loading, bond durability, cariology, chlorhexidine gluconate, dentin bonding, microtensile bond strength

Adhesive dentistry dominates the spectrum of restorative dentistry today. While there have been significant improvements in composites as well as adhesive systems, certain fundamental prerequisites are still essential to be clinically successful. This review highlights the 10 most important aspects of modern adhesive technology based on the "most popular" mistakes in the clinical protocol: Indication, Contamination, Moisture Control, Evaporation, Polymerization, Dentine Sclerosis, MMP Hype, Preparation, Repair and Function. If these 10 points are successfully addressed, the probability of success in the adhesive technique reaches almost 100%. Keywords: MMPs, adhesives, contamination, resin composites, technique sensitivity

Adhäsive Zahnmedizin beherrscht heute das Spektrum der restaurativen Zahnerhaltung. Bei Kompositen ebenso wie Adhäsivsystemen hat es zwar signifikante Verbesserungen gegeben, bestimmte fundamentale Grundvoraussetzungen sind aber noch immer unabdingbar, um klinisch erfolgreich zu sein. Diese Übersicht beleuchtet die 10 wichtigsten Aspekte moderner Adhäsivtechnik anhand der "beliebtesten" Fehler im klinischen Protokoll: Indikation, Kontamination, Feuchtigkeitskontrolle, Evaporation, Polymerisation, Dentinsklerose, MMP-Hype, Präparation, Reparatur und Funktion. Werden diese 10 Punkte erfolgreich adressiert, erreicht die Erfolgswahrscheinlichkeit in der Adhäsivtechnik nahezu 100 %. Keywords: Adhäsive, Komposit, Kontamination, MMPs, Techniksensitivität