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Purpose: To compare clinical outcomes and oral fluid biomarkers in gingivitis subjects using an electric toothbrush/irrigator combination (test) or a manual toothbrush alone (control) over 8 weeks. Materials and Methods: Subjects were randomly assigned to two groups of n = 30. In both groups, toothbrushing was performed twice daily at home and no additional interdental cleaning aids were allowed. Plaque Index (PLI), Gingival Index (GI), whole saliva (WS), and gingival crevicular fluid (GCF) samples were collected at weeks 2, 4, and 8. Results: Subjects’ mean age was 23 years and 52% were female. Overall baseline means were 1.31 for PLI, 1.07 for GI, and 34.9 for number of bleeding sites. At every follow-up visit, both groups differed statistically significantly (p < 0.001) from baseline for all clinical parameters. The test group demonstrated statistically significantly (p < 0.001) greater reductions in GI vs the control group by 18% at week 2, 17% at week 4 and 24% at week 8. The test group also demonstrated statistically significantly (p < 0.002) greater reductions in the number of bleeding sites vs the control group by 33% at week 2, 34% at week 4 and 43% at week 8. Between-group comparisons for both WS and GCF revealed numerical trends for decreased levels of interleukin (IL)-1β in GCF after 4 and 8 weeks, but these were not statistically significant. Conclusion: In subjects using the electric toothbrush/irrigator combination, increased clinical improvements may be found accompanied by similarly improved trends for oral fluid biomarkers such as IL-1β. Keywords: gingival crevicular fluid, gingivitis, prevention, toothbrushing

Purpose: To evaluate the influence of the height of the antrostomy on dimensional variations of the elevated space after sinus floor elevation. Materials and Methods: Twenty-four healthy volunteers planned for sinus floor elevation were included in the study. An antrostomy of either 4 mm (group A) or 8 mm (group B) in height was prepared in the lateral wall of the sinus. Cone beam computed tomography scans (CBCTs) were taken before surgery (T0) and after 1 week (T1) and 9 months (T2). Dimensional variation analyses were performed. Results: The CBCTs of 10 patients per group were evaluated. After 1 week (T1), the sinus floor was found elevated in the middle region by 12.0 ± 2.3 mm in group A, while in group B, the height was 11.8 ± 2.1 mm. After 9 months (T2), the respective heights were 9.9 ± 2.4 mm and 8.9 ± 2.7 mm, with a reduction of -2.1 ± 2.2 mm in group A and -3.0 ± 2.6 mm in group B. The area in a central position was reduced by 25.5% to 34.2%, showing a slightly higher shrinkage in group B compared with group A. However, no statistically significant differences were found between the two groups. Conclusion: In maxillary sinus floor elevations performed by the lateral approach, the size of the antrostomy did not affect the clinical and radiographic outcomes. Keywords: antrostomy size, biomaterial, cone beam tomography, maxillary sinus, sinus augmentation, sinus dimension, sinus height

Keratinized mucosa belongs to the masticatory mucosa, while nonkeratinizing mucosa belongs to the lining mucosa. Dental implants may be installed in either of these mucosal types. For the long-standing stability of the peri-implant mucosal tissues it is debated whether a band of keratinized mucosa surrounding the implant is needed. Increasing evidence from recent well-designed clinical studies points to that necessity. Hence, it may be anticipated that in certain cases the band of keratinized mucosa needs to be widened to at least 2 mm. Keywords: Keratinized mucosa, dental implant

Dear Readers, You may be astonished to find an editorial in OHPD, since it is our policy not to publish editorials in order to save the allocated space for publishing scientific manuscripts. But science may generate controversy, which must be discussed within the scientific community. Sometimes such discussions are triggered by letters to the editor. Earlier this year, OHPD received a letter to the editor arguing about a fluoride measurement method (see below). As good publishing practice, we sent this letter to the authors of the criticised paper and asked them to reply. Now we have received their answer, which we are printing as well (see next pages). The editorial team is convinced that this policy helps to improve the quality of research reports, and this is why we decided to use the space to make this discussion available to our readers.

Purpose: The aims of this study were to reexamine patients who had received fixed dental prostheses (FDPs) more than 10 years prior, list the frequencies of observed technical and biologic failures and complications, and calculate the estimated failure and complication rates at 10 and 15 years. Materials and Methods: Fifty-six of 195 patients who were treated by undergraduate students during their state board examinations in fixed prosthodontics between 1990 and 1999 at the School of Dental Medicine, University of Bern, Bern, Switzerland, were recalled successfully. Results: At reexamination, it was determined that 56 patients with a mean age of 62 years (range: 41 to 85 years) had received 95 metal-ceramic FDPs supported by 202 abutment teeth. Prostheses had been in function for 7 to 19 years (mean: 14 years). The FDPs demonstrated a high estimated survival rate of 90.4% after 10 years and 80.5% after 15 years, although 17 of the 202 abutment teeth had been lost. The probability to remain free from any complication/failure was 79.7% at 10 years and 34.6% at 15 years. The risk of FDPs being affected by a biologic complication or failure after 10 years was 14.9%; the risk was 5.34% for a technical complication or failure. After 15 years, the risks of a biologic or technical complication or failure were 45.7% and 19.7%, respectively. Conclusions: The survival rates of FDPs decreased gradually with time. Freedom from complications and failures was drastically decreased for FDPs that had been in function for longer than 10 years.

Purpose: As more women are entering health professions, the health care system is becoming more feminized. This investigation evaluated gender differences in clinicians' treatment preferences and decision making in a complex treatment situation. Materials and Methods: A questionnaire was developed containing clinical cases and statements to assess practitioners' opinions on treatment of periodontally involved maxillary molars and implant therapy with sinus grafting. Data were analyzed with respect to the clinicians' sex, and an overall logistic regression was performed to further investigate possible influences of age, office location, and specialty. Results: Three hundred forty questionnaires were evaluated (response rate: 35.1%). The mean age of female respondents (37%) was 42 years, and the mean age of male respondents was 46 years. Significantly fewer women reported performing implant placement (35% vs 63%), sinus grafting (16% vs 43%), and periodontal surgery (57% vs 68%). Female practitioners tended to refer more patients to specialists. Participants favored sinus grafting more often for their spouses than for themselves. Apart from a preference for regenerative periodontal surgery among women, no gender differences were observed for treatment decisions or views on general statements related to implant preference, tooth maintenance, or conventional reconstructive therapies. Conclusions: With similar expert knowledge, treatment decisions were made irrespective of sex. While the majority of male care providers performed complex therapies themselves, female clinicians referred more patients to specialists.

Purpose: The aim of the present study was to report the radiographical prevalence of overhanging fillings in a group of Swiss Army recruits in 2006 and to relate the dimensions of the overhangs to clinical parameters. Materials and Methods: A total of 626 Swiss Army recruits were examined for their periodontal conditions, prevalence of caries, and stomatological and functional aspects of the masticatory system and halitosis. In particular, the present report deals with the presence or the absence of fillings, the presence or the absence of overhangs and their relation to clinical and radiographic parameters. Results: A total of 16,198 interdental sites were evaluated on bitewing radiographs. Of these sites, 15,516 (95.8%) were sound and 682 (4.2%) were filled. Amalgam restorations were found in 94.1% and resin composite fillings in 5.9% of the sites. Of these 682 sites, 96 (14.1%) yielded overhanging margins of various sizes. This low prevalence of fillings represents not only a substantial reduction when compared with a similar Swiss Army study (Lang et al, 1988), but also an improvement in the quality of dental care delivery to young Swiss males. Plaque Index and Gingival Index increased statistically significantly with the presence of fillings, when compared with healthy non-filled sites. Clinical parameters that were significantly associated with the presence of overhangs included clinical attachment loss. Moreover, between 1985 and 2006 the prevalence of fillings was significantly reduced from 20.0% to 4.2% of all surfaces. Furthermore, the marginal fit of the fillings improved from 33.0% with overhangs to 14.1%. Conclusions: A significant improvement was observed in the periodontal and dental conditions of young Swiss males that was shown to have taken place within the previous two decades. From 1985 to 2006, the prevalence of fillings was reduced fourfold and that of overhanging margins twofold, documenting an improvement in the quality of restorative dentistry. Keywords: army recruits, oral health, overhanging margins, periodontal health, prevention, radiographs, survey

Purpose: The aim of the present study was to test the effects of interdental cleansing with dental floss on supragingival biofilm removal in natural dentition during a 3-week period of experimental biofilm accumulation. Materials and Methods: The present study was performed as a single-blind, parallel, randomised, controlled clinical trial using the experimental gingivitis model (Löe et al, 1965). Thirty-two students were recruited and assigned to one of the following experimental or control groups: Group A used a fluoride-containing dentifrice (NaF dentifrice) on a toothbrush for 60 s twice a day, Group B used an unwaxed dental floss twice a day, Group C used a waxed dental floss twice a day in every interproximal space and Group D rinsed twice a day for 60 s with drinking water (control). Results: During 21 days of abolished oral hygiene, the groups developed various amounts of plaque and gingivitis. Neither of the cleansing protocols alone allowed the prevention of gingivitis development. Toothbrushing alone yielded better outcomes than did any of the flossing protocols. Interdental cleansing with a waxed floss had better biofilm removal effects than with unwaxed floss. Conclusions: Toothbrushing without interdental cleansing using dental floss and interdental cleansing alone cannot prevent the development of gingivitis. Keywords: biofilm, clinical study, experimental gingivitis, inflammation, interdental cleansing, oral hygiene, plaque control

This study compared the dimensions of the peri-implant soft tissues around immediately and early loaded one-piece implants as well as conventionally loaded onepiece implants. Comparisons of the peri-implant soft tissue dimensions were made among four different loading periods. Forty-eight titanium sandblasted/acidetched implants were placed in four foxhounds. The implants were placed at four time periods in groups of three. The first group (A) had implants placed 3 months before the placement of restorations. Further groups of three implants each were placed at 21 days (group B), 10 days (group C), and 2 days (group D) before restoration. Three months after abutment connection, all dogs were sacrificed. Histometric analysis of the undecalcified histologic sections included dimensional measurements of the sulcus depth plus junctional epithelium, the connective tissue contact area, and recession measured from the interface to the gingival margin. No statistically significant differences were observed among the four groups. The data suggest that the dimensions of the peri-implant soft tissues around immediately and early loaded one-piece implants are similar to those around conventionally loaded one-piece implants and comparable to the dimensions of the biologic width around natural teeth.