Pulp Revascularization or Apexification for the Treatment of Immature Necrotic Permanent Teeth: Systematic Review and Meta-Analysis.

This systematic review and meta-analysis assessed clinical, radiographic and functional retention outcomes in immature necrotic permanent teeth treated either with pulp revascularization or apexification after a minimum of three months to determine which one provides the best results. The literature was screened via PubMed/MEDLINE and Embase databases up to June 2017 to select observational studies that compared pulp revascularization and apexification treatments assessing clinical, radiographic and functional retention outcomes. Two reviewers independently performed screening and evaluation of articles. A total of 231 articles were retrieved from databases, wherein only four articles were selected for full-text analyses. After exclusion criteria, three studies remained in quantitative and qualitative analyses. Pooled-effect estimates were obtained comparing clinical and radiographic outcomes ('overall outcome') and functional retention rates between apexification and pulp revascularization treatment. The meta-analysis comparing apexification vs. revascularization for 'overall outcome' (Z=0.113, p=0.910, RR=1.009, 95%CI:0.869-1.171) and functional retention rates (Z=1.438, p=0.150, RR=1.069, 95%CI:0.976-1.172) showed no statistically significant differences between the treatments. All studies were classified as high quality. The current literature regarding the clinical, radiographic and functional retention outcomes in immature necrotic permanent teeth treated either with pulp revascularization or apexification is limited. Based on our meta-analysis, the results do not favor one treatment modality over the other.

Comparing the reliability of a new fluorescence camera with conventional laser fluorescence devices in detecting caries lesions in occlusal and smooth surfaces of primary teeth.

The aims of this in vitro study were (1) to compare the reliability of a new fluorescence camera (FC; VistaProof) with that of two other laser fluorescence devices (DIAGNOdent and DIAGNOdent pen) in assessing smooth and occlusal caries lesions in primary teeth and (2) to determine the influence of the spacer, the protective cover and air drying on the FC readings. We selected 129 primary molars which were divided into two groups: smooth surfaces (n=68) and occlusal surfaces (n=61). Two trained examiners performed the evaluations using the FC and the other laser fluorescence devices separately. One examiner repeated all assessments after 1 week. Inter- and intraexaminer reproducibility was calculated from the absolute values derived from the devices using intraclass correlation coefficient (ICC) and Bland-Altman analysis. Pearson correlation was performed among the values obtained with the different devices. For aim 2, only teeth from the occlusal surface group were used. Another examiner performed measurements with the FC, varying the size of the spacer, the use of the plastic protective cover and the drying time (0, 3 and 15 s). Wilcoxon's test was used to compare these measurements. High values of interexaminer ICC were observed with the FC in both experiments. However, the highest intraexaminer ICC for smooth surfaces was found for the DIAGNOdent (ICC 0.918). A positive correlation between all methods was observed in both studies. Only drying for 15 s significantly increased the FC readings. In conclusion, the FC showed high reliability for occlusal and smooth surfaces, similar to the other fluorescence methods tested. Additionally, prolonged air drying increased the FC measurements.

The influence of zero value subtraction on the performance of a new laser fluorescence device for approximal caries detection.

The aim of this study was to assess the influence of the zero value subtraction on the performance of laser fluorescence (LFpen) for approximal caries detection. Three areas (cuspal, middle and cervical) of both mesial and distal buccal surfaces of 78 permanent molars were assessed using both wedge-shaped (WDG) and tapered wedge-shaped (TWDG) tips. With the addition of the average, one cut-off value for each area was obtained and the performance was assessed. The areas under the receiver operating characteristics (ROC) curve, specificity, sensitivity and accuracy with and without the zero value subtraction were calculated. The McNemar test revealed a statistically significant difference for specificity at thresholds D(1), D(2) and D(3) (WDG) and D(1) and D(2) (TWDG) when the zero value subtraction was not performed. Influence of the zero value subtraction on the LFpen performance was observed for approximal caries detection. However, when modified cut-off values were used, the zero value subtraction could be eliminated.

Esthetic Rehabilitation in Early Childhood Caries: A Case Report.

Premature loss or severely destruction of upper primary anterior teeth by early childhood caries (ECC) is a challenge for the pediatric dentist. In the anterior region, esthetics is an important concern along with function and space management. Tooth rehabilitation in this region becomes fundamental. The purpose of this report was to present a case of a 4-year-old child with the early loss of both central upper incisors and caries lesions on both upper lateral incisors. Both 51 and 61 were extracted due to ECC. The patient was rehabilitated with a fixed esthetic space maintainer and the vital lateral upper incisors, destroyed by ECC, restored with direct composite resin veneers. The final result reestablished local, systemic, psychological, aesthetic, and social problems of the child. HOW TO CITE THIS ARTICLE: Goldenfum GM, de Almeida Rodrigues J, et al. Esthetic Rehabilitation in Early Childhood Caries: A Case Report. Int J Clin Pediatr Dent 2019;12(2):157-159.