Browsing by Author "Schwendicke, Falk"

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    Alternative Direct Restorative Materials for Dental Amalgam: A Concise Review Based on an FDI Policy Statement
    (Elsevier, 2024) Schmalz, Gottfried; Schwendicke, Falk; Hickel, Reinhard; Platt, Jeffrey A.; Biomedical and Applied Sciences, School of Dentistry
    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 of dental amalgam. This concise review is based on a FDI Policy Statement which provides guidance on the selection of direct restorative materials as alternatives to amalgam. The Policy Statement was informed by current literature, identified mainly from PubMed and the internet. Ultimately, dental, oral, and patient factors should be considered when choosing the best material for each individual case. Dental factors include the dentition, tooth type, and cavity class and extension; oral aspects comprise caries risk profiles and related risk factors; and patient-related aspects include systemic risks/medical conditions such as allergies towards certain materials as well as compliance. Special protective measures (eg, a no-touch technique, blue light protection) are required when handling resin-based materials, and copious water spray is recommended when adjusting or removing restorative materials. Cost and reimbursement policies may need to be considered when amalgam alternatives are used, and the material recommendation requires the informed consent of the patient. There is no single material which can replace amalgam in all applications; different materials are needed for different situations. The policy statement recommends using a patient-centred rather than purely a material-centred approach. Further research is needed to improve overall material properties, the clinical performance, the impact on the environment, and cost-effectiveness of all alternative materials.
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    How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement
    (Springer, 2020) Schwendicke, Falk; Splieth, Christian H.; Bottenberg, Peter; Breschi, Lorenzo; Campus, Guglielmo; Doméjean, Sophie; Ekstrand, Kim; Giacaman, Rodrigo A.; Haak, Rainer; Hannig, Matthias; Hickel, Reinhard; Juric, Hrvoje; Lussi, Adrian; Machiulskiene, Vita; Manton, David; Jablonski-Momeni, Anahita; Opdam, Niek; Paris, Sebastian; Santamaria, Ruth; Tassery, Hervé; Zandona, Andrea; Zero, Domenick; Zimmer, Stefan; Banerjee, Avijit; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    Objectives To provide consensus recommendations on how to intervene in the caries process in adults, specifically proximal and secondary carious lesions. Methods Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. Results Managing an individual’s caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for secondary lesions should be tailored according to the individual’s caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm secondary caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing secondary caries, if possible. Conclusions An individualized and lesion-specific approach is recommended for intervening in the caries process in adults.
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    How to Intervene in the Caries Process in Older Adults: A Joint ORCA and EFCD Expert Delphi Consensus Statement
    (Karger, 2020) Paris, Sebastian; Banerjee, Avijit; Bottenberg, Peter; Breschi, Lorenzo; Campus, Guglielmo; Doméjean, Sophie; Ekstrand, Kim; Giacaman, Rodrigo A.; Haak, Rainer; Hannig, Matthias; Hickel, Reinhard; Juric, Hrvoje; Lussi, Adrian; Machiulskiene, Vita; Manton, David; Jablonski-Momeni, Anahita; Santamaria, Ruth; Schwendicke, Falk; Splieth, Christian H.; Tassery, Hervé; Zandona, Andrea; Zero, Domenick; Zimmer, Stefan; Opdam, Niek; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    Aim: To provide recommendations for dental clinicians for the management of dental caries in older adults with special emphasis on root caries lesions. Methods: A consensus workshop followed by a Delphi consensus process were conducted with an expert panel nominated by ORCA, EFCD, and DGZ boards. Based on a systematic review of the literature, as well as non-systematic literature search, recommendations for clinicians were developed and consented in a two-stage Delphi process. Results: Demographic and epidemiologic changes will significantly increase the need of management of older adults and root caries in the future. Ageing is associated with a decline of intrinsic capacities and an increased risk of general diseases. As oral and systemic health are linked, bidirectional consequences of diseases and interventions need to be considered. Caries prevention and treatment in older adults must respond to the patient’s individual abilities for self-care and cooperation and often involves the support of caregivers. Systemic interventions may involve dietary counselling, oral hygiene instruction, the use of fluoridated toothpastes, and the stimulation of salivary flow. Local interventions to manage root lesions may comprise local biofilm control, application of highly fluoridated toothpastes or varnishes as well as antimicrobial agents. Restorative treatment is often compromised by the accessibility of such root caries lesions as well as the ability of the senior patient to cooperate. If optimum restorative treatment is impossible or inappropriate, long-term stabilization, e.g., by using glass-ionomer cements, and palliative treatments that aim to maintain oral function as long and as well as possible may be the treatment of choice for the individual.
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    Secondary caries: what is it, and how it can be controlled, detected, and managed?
    (Springer, 2020-05) Askar, Haitham; Krois, Joachim; Göstemeyer, Gerd; Bottenberg, Peter; Zero, Domenick; Banerjee, Avijit; Schwendicke, Falk; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    Objectives To assess how to control, detect, and treat secondary caries. This review serves to inform a joint ORCA/EFCD consensus process. Methods Systematic and non-systematic reviews were performed or consulted and narratively synthesized. Results Secondary (or recurrent) caries is defined as a lesion associated with restorations or sealants. While the restorative material itself has some influence on secondary caries, further factors like the presence and size of restoration gaps, patients’ caries risk, and the placing dentist’s experience seem more relevant. Current detection methods for secondary caries are only sparsely validated and likely prone for the risk of over-detection. In many patients, it might be prudent to prioritize specific detection methods to avoid invasive overtreatment. Detected secondary caries can be managed either by repair of the defective part of the restoration or its complete replacement. Conclusions There is sparse data towards the nature of secondary caries and how to control, detect, and treat it.