Abstract Background Occlusal contacts can be stained and thereby visualised employing occlusal indicators. Qualitative and quantitative indicators are differentiated. The hybrid system OccluSense ...supposedly combines analogue contact marking and digital registration of contacts. The reliability and validity of its contact marking have not yet been validated. Objectives The aim of this controlled randomised in‐vitro study was to examine the reliability and validity of analogue contact staining with OccluSense compared to Arti‐Fol and the reference standard Gnatho‐Film. Materials and Methods An experimental apparatus was designed to simulate static occlusion. The occlusal contacts were stained 50 times with Gnatho‐Film to determine the average number and location of contacts registered. For comparison, the contacts were pre‐stained with Gnatho‐Film and then registered with Arti‐Fol or OccluSense 50 times each. Every staining was statistically evaluated and compared to Gnatho‐Film alone, regarding the number and location of contacts. Based on the observed characteristic staining behaviour of OccluSense, a modified evaluation strategy was developed for its colour markings (OccluSense (mod.)). Results Both evaluations of OccluSense determine that the same number of contacts was registered in over 94% of all cases. Neither OccluSense nor Arti‐Fol stain the exact same number of contacts as Gnatho‐Film, but the modified evaluation OccluSense (mod.) did improve the results for validity. Conclusion When employing the modified evaluation strategy, OccluSense staining achieves similar reliability and validity as the reference standard. Pre‐colouring of occlusal contacts with Gnatho‐Film and the modified evaluation strategy, might become standard for analysing occlusal contacts stained by OccluSense in the future.
Background
Tooth wear is a multifactorial condition that manifests through various signs and symptoms. These individual signs and symptoms were described in multiple studies, leading to the inclusion ...in TWES 2.0 (Tooth Wear Evaluation System 2.0) and the forthcoming DC‐TW (Diagnostic Criteria for Tooth Wear). However, a study evaluating their reliability has yet to be conducted.
Objective
The aim of the study was to examine the reliability in the assessment of 6 signs of pathological tooth wear and 18 clinical signs and symptoms determining aetiology, all of which are included in the TWES 2.0/DC‐TW.
Methods
48 dental students (operators) evaluated patient cases from a patient pool of 14 patients on dental casts and high‐resolution intraoral photographs. The agreement between all operators for each sign and symptom was calculated based on ICC (Intraclass Correlation Coefficients). Additionally, the agreement of each operator's evaluation with a predefined sample solution was calculated based on Cohen's kappa.
Results
Inter‐user agreement ranged from near perfect (0.91) to poor (0.02) for the various pathology signs or aetiology symptoms of tooth wear (mean 0.32). The agreements of the operator's ratings compared to the sample solution resulted in Cohen's kappa from 0.18 to 1 (mean 0.59) for the pathology signs and ranged from 0.02 to 0.51 for the aetiology signs (mean 0.38).
Conclusions
The reliability of the signs and symptoms examined and the ability of individual investigators to correctly identify and assign signs and symptoms varied widely. The current assessment tools for the qualification of tooth wear need further refinement, and examiners need intensive training in tooth wear assessment.
Evaluating the Secondary criteria for tooth wear.
The distribution of arrival directions of cosmic rays is remarkably isotropic, which is a consequence of their repeated scattering in magnetic fields. Yet, high-statistics observatories like IceCube ...and HAWC have revealed the presence of small-scale structures at levels of 1 part in 10,000 at hundreds of TeV, which are not expected in typical diffusion models of cosmic rays. We follow up on the suggestion that these small-scale anisotropies are a result of cosmic ray streaming in a particular realisation of the turbulent magnetic field within a few scattering lengths in our local Galactic neighbourhood. So far, this hypothesis has been investigated mostly numerically, by tracking test particles through turbulent magnetic fields. For the first time, we present an analytical computation that through a perturbative approach allows predicting the angular power spectrum of cosmic ray arrival directions for a given model of turbulence. We illustrate this method for a simple, isotropic turbulence model and we find remarkable agreement with the results of numerical studies.
Cosmogenic neutrinos originate from photo-hadronic interactions of cosmic ray protons with the cosmic microwave background (CMB). The neutrino production rate can be constrained through the ...accompanying electrons, positrons and gamma-rays that quickly cascade on the CMB and intergalactic magnetic fields to lower energies and generate a
γ-ray background in the GeV–TeV region. Bethe–Heitler pair production by protons also contributes to the cascade and can tighten the neutrino constraints in models where extragalactic cosmic rays begin to dominate over the galactic component at a relatively low “crossover” energy. We investigate this issue in the light of the recent Fermi-LAT measurements of the diffuse extragalactic
γ-ray background and illustrate by a fit to the HiRes spectrum how the prediction of the cosmogenic neutrino flux in all-proton models varies with the crossover energy. The neutrino flux is required to be smaller when the gamma-ray bound is applied, nevertheless such models are still consistent with HiRes and Fermi-LAT if one properly takes into account the energy uncertainty of cosmic ray measurements. The presently allowed flux is within reach of the IceCube neutrino telescope and other dedicated radio experiments.
Background
Tooth wear is a multifactorial condition, leading to the loss of dental hard tissues. Physiological tooth wear is a slow process that normally does not lead to any subjective symptoms. ...When the condition progresses, it can become pathological, and several signs and symptoms may occur. The Tooth Wear Evaluation System (TWES) was described to implement a systematic diagnostic and management approach. Recently, management guidelines were presented in a European Consensus Statement (ECS) as well.
Objectives
To evaluate the TWES in practice and to integrate the principles described in the ECS in order to compose a renewed TWES 2.0 and a new taxonomy.
Methods
The TWES and the recommendations of the ECS were used by dental clinicians, in order to test its applicability in practice.
Results
Agreement was reached that the TWES 2.0 will use a stepwise approach, with a straightforward Tooth Wear Screening part and a more detailed Tooth Wear Status part. Also, the assessment of pathology from the ECS is incorporated in the TWES 2.0 (both classification and taxonomy).
Conclusions
In the TWES 2.0 is described that tooth wear is pathological if moderate/severe/extreme tooth wear is present, in combination with one or several described signs and symptoms. Aetiology can be assessed by findings that indicate a chemical and/or a mechanical cause. The taxonomy may help to identify situations in which preventive (restorative) interventions in early stages of tooth wear can be indicated. The reliability and validity of the adapted parts must be proven.
According to the Fifth German Oral Health Study, the caries experience in the German population is declining sharply. The number of teeth still present at an advanced age has also increased ...significantly in recent decades. This shows a clear trend towards long-term tooth preservation - possibly with fixed dental prostheses - which is further supported by the possibility to place implants to increase the number of abutments. The pronounced decline in caries experience has given Germany a leading international position in terms of dental health. But there is increasing evidence of risks associated with dental hard-tissue damage because of erosion/biocorrosion, attrition, and abrasion. The defect morphology of these wear-related lesions is different from that of caries lesions; occlusal surfaces are more often affected in the posterior region. Against this background, restorative treatment concepts have become significantly more differentiated in recent decades. Predominantly subtractive concepts to provide mechanical retention for the restoration using traditional cements are now replaced by less invasive, primarily defect-oriented procedures wherever feasible. In the case of pronounced dental hard-tissue loss, additive approaches also allow restorations that restore function. In addition, there are modifications of traditional procedures, such as defining the treatment goal in the lead-up to the treatment itself with the aid of a diagnostic wax-up. The wax-up provides orientation for the subsequent tooth preparation and allows a particularly economical approach to the removal of healthy dental hard tissue. Furthermore, the introduction of new preparation designs has contributed significantly to the preservation of dental hard tissue on the teeth to be restored. This article describes the principles of minimally invasive treatment using occlusal onlays for the reconstruction of severely worn occlusal surfaces.
The introduction of adhesive techniques in combination with translucent restorative materials has greatly influenced treatment concepts in fixed prosthodontics. Modern production technologies offer ...access to new polymer materials that provide innovative pre-treatment options for complex prosthetic rehabilitations. Additionally, computer-aided design and manufacturing (CAD/CAM) provides access to new ceramic types and thus extends the range of indications for metal-free restorative options. With these developments, important changes of treatment concepts in fixed prosthodontics have occurred which affect the professional life of dental practitioners with a focus on prosthetic dentistry. This article gives an overview of the advances in selected fields of fixed prosthodontics and provides support in material selection for different kinds of indications, from single-tooth restorations to fixed dental prostheses.
As yet, there are still no evidence‐based clinical diagnostic and management guidelines for ambulatory single‐channel EMG devices, like the BUTLER® GrindCare® (GrindCare), that are used in patients ...with sleep bruxism. Therefore, a consensus meeting was organised with GrindCare developers, researchers, and academic and non‐academic clinicians experienced with the use of ambulatory EMG devices. The aim of the meeting was to discuss and develop recommendations for clinical guidelines for GrindCare usage, based on the existing clinical and research experience of the consensus meeting's participants. As an important outcome of the consensus meeting, clinical guidelines were proposed in which an initial 2‐week baseline phase with the device in its inactive (non‐stimulus) mode for habituation and assessment of the number of jaw‐muscle activities is followed by a 4‐week active phase with contingent electrical stimuli suppressing the jaw‐muscle activities. As to avoid the commonly reported reduction in sensitivity to the stimuli, a 2‐week inactive phase is subsequently installed, followed by a repetition of active and inactive phases until a lasting reduction in the number of jaw‐muscle activities and/or associated complaints has been achieved. This proposal has the characteristics of a single‐patient clinical trial. From a research point of view, adoption of this approach by large numbers of GrindCare users creates a great opportunity to recruit relatively large numbers of study participants that follow the same protocol.
Background
The diagnosis and management of patients suffering from occlusal dysesthesia (OD) remain a major challenge for dental practitioners and affected patients.
Objectives
To present the results ...of a literature‐based expert consensus intended to promote better understanding of OD and to facilitate the identification and management of affected patients.
Methods
In 2018, electronic literature searches were carried out in PubMed, Cochrane Library and Google Scholar as well as in the archives of relevant journals not listed in these databases. This approach was complemented by a careful assessment of the reference lists of the identified relevant papers. The articles were weighted by evidence level, followed by an evaluation of their contents and a discussion. The result represents an expert consensus.
Results
Based on the contents of the 77 articles identified in the search, the current knowledge about clinical characteristics, epidemiology, aetiology, diagnostic process, differential diagnosis and management of OD is summarised.
Conclusions
Occlusal dysesthesia exists independently of the occlusion. Instead, it is the result of maladaptive signal processing. The focus should be on patient education, counselling, defocusing, cognitive behavioural therapy, supportive drug therapy and certain non‐specific measures. Irreversible, specifically an exclusively dental treatment approach must be avoided.
► We study the hypothesis that GRBs are the main sources of UHE CRs. ► Our analysis focuses on UHE CR emission in the form of neutrons produced in photo-pion interactions. ► We calculate the ...associated neutrino spectra by a fit to HiRes data. ► We show that these diffuse neutrino fluxes are challenged by recent upper limits from IceCube. ► This serves as a probe of viable GRB sources in this UHE CR scenario.
Gamma ray burst (GRB) fireballs provide one of very few astrophysical environments where one can contemplate the acceleration of cosmic rays to energies that exceed 10
20
eV. The assumption that GRBs are the sources of the observed cosmic rays generates a calculable flux of neutrinos produced when the protons interact with fireball photons. With data taken during construction IceCube has already reached a sensitivity to observe neutrinos produced in temporal coincidence with individual GRBs provided that they are the sources of the observed extra-galactic cosmic rays. We here point out that the GRB origin of cosmic rays is also challenged by the IceCube upper limit on a possible diffuse flux of cosmic neutrinos which should not be exceeded by the flux produced by all GRB over Hubble time. Our alternative approach has the advantage of directly relating the diffuse flux produced by all GRBs to measurements of the cosmic ray flux. It also generates both the neutrino flux produced by the sources and the associated cosmogenic neutrino flux in a synergetic way.
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