Long-term survival of different deep dentin caries treatments: A 5-year clinical study.

OBJECTIVE: The aim of this in-vivo study was to evaluate the long-term clinical survival of different deep dentin caries treatment options. MATERIALS AND METHODS: : In total, 391 patients with at least one permanent tooth with clinically diagnosed deep dentin caries were inspected. Two hundred and fourteen patients were examined at recall visits. Inclusion criteria were teeth with deep caries lesions with pulp vitality but absence of spontaneous pain and periapical alterations. The subjects received either stepwise removal (SWR), complete caries removal (CCR), or direct pulp capping (DPC). The radiological and clinical exams were performed after a mean observation time of 62 months. Success was defined as pulp sensitivity to vitality test and absence of periapical lesions as well as a clinical symptom. Data were statistically analyzed using Kaplan-Meier and log-rank (Mantel-Cox) tests (α = 0.05). RESULTS: Of the total 214 patients evaluated, 126 received SWR, 88 received CCR, and 67 received DPC treatment. One hundred and twenty-seven restorations were amalgam and 141 were composite. The mean observation period was 62 months. Survival rates were 85.7%, 90.9%, and 59.7% for SWR, CCR, and DPC, respectively (P = 0.001). Success rates of amalgam restorations (86.6%) were similar to composite restorations (83%), and both were found to be successful (P = 0.401). CONCLUSION: SWR treatment should be considered to preserve pulp vitality of deep dentin lesions instead of CCR or DPC. CLINICAL RELEVANCE: SWR method for deep dentin caries management had acceptable results over 5 years.

Laser pulpotomy-an effective alternative to conventional techniques-a systematic review of literature and meta-analysis.

The aim of this systematic review and subsequent meta-analysis was to elaborate the efficacy of laser pulpotomy over the formocresol pulpotomy of human primary teeth. Published materials in the MedLine were looked for through "PUBMED" and "PUBMED CENTRAL". The MESH terms of "Laser", "Pulpotomy", "Primary teeth", and "Children" were used to carry the search from the years 1999 to 2017. Collected data were assessed by four investigators using inclusion and exclusion criteria in order to select those studies with precise method targeted. Only clinical trials on all types of lasers were included for this systematic reviews but only four articles were used for the meta-analysis as the rest did not meet the requirements. Statistical analysis was conducted to see the differences. Seventeen articles completely fulfilled the inclusion criteria of this study. In general, high clinical, radiographic, and histopathological success rates were reported in laser groups in comparison to other assessed methods. Meta-analysis indicated that except at 36 months, in all other time intervals, Laser proved better or close results to formocresol. At 36 months, laser showed better clinical results. Laser may be considered as an adjuvant alternative for vital pulp therapy on human primary teeth but due to the limited number of high-quality clinical research articles on laser-assisted pulpotomy, various types of laser application methods, and different follow-up periods, reaching a net consensus is still challenging.

Dentin dysplasia type I.

This paper describes a rare case of genetically determined dentin dysplasia type Iin 26-year-old male patient. The paper highlights anatomical and radiologicalaspects of dental abnormalities and emphasizes the significance of the educationof both general practitioners and paediatricians as regards referring patients withdiagnosed dentin dysplasia for a multi-specialty therapy.

The correlation between external apical root resorption and electric pulp test responses: a prospective clinical trial

ABSTRACT Objective: The current study investigated the correlation between pulpal sensitivity to the electric pulp tester (EPT) and external apical root resorption (EARR) in four types of maxillary anterior teeth of fixed orthodontic treatment patients. Methods: In this prospective cohort study, 232 anterior teeth of 58 patients (mean age 18.96 ± 6.13 years) treated with fixed orthodontic treatment were examined. The EPT readings were recorded at twelve time points immediately before archwire insertion. Root resorption of four maxillary incisors were measured by means of parallel periapical radiographs at three time intervals (six months interval from the start) through design-to-purpose software to optimize data collection. A multiple linear regression model and Pearson correlation coefficient were used to assess the association of EPT values and observed EARR (p< 0.05). Results: The highest level of EPT measurement was recorded at initial visit, and then there was a decreasing trend in EPT level during treatment for the next six and twelve months. There was another increasing trend after six months till the finishing time of the treatment. There was a significant correlation between changes in root length and time of recording the root length (p< 0.001). There was significant positive correlation between changes in EPT level and amount of observed root resorption (p< 0.001). Conclusion: The relative decrease in electric pulp test level could be a diagnostic sign of root resorption during orthodontic treatment. Further studies with longer follow up are needed to confirm the current results.

RESUMO Objetivo: O presente estudo investigou a correlação entre a sensibilidade pulpar ao teste pulpar elétrico (TPE) e a reabsorção radicular apical externa (RRAE) nos quatro dentes anteriores superiores de pacientes em tratamento ortodôntico com aparelho fixo. Métodos: Nesse estudo de coorte prospectivo, foram avaliados 232 dentes anteriores de 58 pacientes (idade média 18,96 ± 6,13 anos) tratados com aparelho ortodôntico fixo. As leituras do TPE foram registradas em doze tempos de avaliação, imediatamente antes da inserção dos arcos. As reabsorções radiculares dos quatro incisivos superiores foram aferidas por meio da média das radiografias periapicais, em três intervalos de tempo (em intervalos de seis meses desde o início) por um software desenvolvido para essa finalidade, com o intuito de otimizar a coleta de dados. Para aferir a associação entre os valores de TPE e as RRAE observadas (p< 0,05), foram utilizados o modelo de regressão linear múltiplo e o coeficiente de correlação de Pearson. Resultados: O nível mais alto das medidas do TPE foi registrado na primeira visita e, daí em diante, houve uma tendência de diminuição no nível do TPE durante o tratamento, nos seis a doze meses seguintes. Houve, também, outra tendência de aumento após os seis meses até o término do tratamento, além de uma correlação significativa entre as mudanças no comprimento radicular e o tempo de registro do comprimento radicular (p< 0,001), bem como uma correlação positiva significativa entre as mudanças no nível do TPE e a quantidade de reabsorção radicular observada (p< 0,001). Conclusão: Uma diminuição relativa no nível de sensibilidade ao teste pulpar elétrico pode ser um sinal diagnóstico de reabsorção radicular durante o tratamento ortodôntico. Estudos futuros com acompanhamentos mais longos são necessários para confirmar os presentes resultados.

Alternative approach for carious tissue removal in primary teeth.

BACKGROUND: Minimally-invasive techniques for the management of carious dental tissue has been well documented. This study aimed to report on the clinical and radiographic response after partial caries removal on left mandibular primary second molar. CASE REPORT: A 6-year-old boy sought treatment because of pain in the left mandibular primary second molar. The tooth had a deep caries lesion on the occlusal surface, with loss of enamel structure and dentine proximity with the pulp confirmed by periapical radiograph. According to the clinical and radiographic diagnosis, partial caries removal was the treatment of choice. Calcium hydroxide cement was used as pulp capping material. FOLLOW-UP: In this case report, partial caries removal showed satisfactory clinical and radiographic outcomes after 18-month following-up period. CONCLUSION: Partial caries removal only is applicable when properly indicated. However, further clinical studies with longer following-up periods are necessary.

Dens invaginatus in a geminated maxillary lateral incisor.

Dens invaginatus (DI) and gemination are two developmental abnormalities that are well reported in the dental literature, but their coexistence in a single tooth is rare. Such situations worsen the risk factors associated with these anomalies, and the treatment plan should be customised as they possess altered morphology and anatomy. A 19-year-old girl came for evaluation of a cracked tooth in the front region of the upper jaw. The tooth showed clinical features of gemination and radiographic features of DI, and was diagnosed as DI in geminated maxillary lateral incisor. The differential diagnoses based on clinical appearance without radiographic investigation may warrant the treatment approach if these two abnormalities coexist in a single tooth. The report also highlights the importance of three-dimensional imaging in diagnosis and treatment planning of teeth with altered pulp canal anatomy. There are few reported cases in the literature detailing the treatment options for these two anomalies occurring in the same tooth.

Age estimation by pulp/tooth area ratio in anterior teeth using cone-beam computed tomography: comparison of four teeth

Abstract Objectives Age estimation is one of the most important factors in forensic medicine. Measuring secondary dentin deposition using cone-beam computed tomography images is an easy and noninvasive method. The aim of this study was to evaluate cone-beam computed tomography images as a reliable method to estimate chronological age by pulp/teeth ratio in anterior teeth in Iranian population. Methodology A total of 649 CBCT images from 377 Iranian patients aged between 20 and 69 years were evaluated. Pulp/teeth ratio (PTR) in maxillary and mandibular canine and central incisor teeth was measured in the axial and sagittal sections using OnDemand 3D Dental software. The Pearson correlation coefficient was determined to evaluate the correlation between the variables. Linear regression analysis, as well as age estimation formula, was used for each tooth separately. Results The regression analyses indicated that maxillary central incisors were more reliable for age estimation (R2=0.586 and standard error of estimate=7.045) compared with the other anterior teeth studied. Maxillary canine teeth had the lowest predictive power (R2=0.392 and standard error of estimate=8.387). Also, comparison of the axial and sagittal sections showed that the axial sections had a higher predictive power. (R2=0.48 for axial plans and R2=0.328 for sagittal plans) Conclusion The use of cone-beam computed tomography in age estimation by pulp/teeth ratio of anterior teeth is useful and a reliable method for age estimation in Iranian population.

Increased whitening efficacy and reduced cytotoxicity are achieved by the chemical activation of a highly concentrated hydrogen peroxide bleaching gel

Abstract Objective This study was designed for the chemical activation of a 35% hydrogen peroxide (H2O2) bleaching gel to increase its whitening effectiveness and reduce its toxicity. Methodology First, the bleaching gel - associated or not with ferrous sulfate (FS), manganese chloride (MC), peroxidase (PR), or catalase (CT) - was applied (3x 15 min) to enamel/dentin discs adapted to artificial pulp chambers. Then, odontoblast-like MDPC-23 cells were exposed for 1 h to the extracts (culture medium + components released from the product), for the assessment of viability (MTT assay) and oxidative stress (H2DCFDA). Residual H2O2 and bleaching effectiveness (DE) were also evaluated. Data were analyzed with one-way ANOVA complemented with Tukey's test (n=8. p<0.05). Results All chemically activated groups minimized MDPC-23 oxidative stress generation; however, significantly higher cell viability was detected for MC, PR, and CT than for plain 35% H2O2 gel. Nevertheless, FS, MC, PR, and CT reduced the amount of residual H2O2 and increased bleaching effectiveness. Conclusion Chemical activation of 35% H2O2 gel with MC, PR, and CT minimized residual H2O2 and pulp cell toxicity; but PR duplicated the whitening potential of the bleaching gel after a single 45-minute session.

Prevalence and morphometric analysis of three-rooted mandibular first molars in a Brazilian subpopulation

ABSTRACT The knowledge of the internal anatomy of three-rooted mandibular molars may help clinicians to diagnose and plan the root canal treatment in order to provide adequate therapy when this variation is present. Objectives: To determine the prevalence of three-rooted mandibular molars in a Brazilian population using cone beam computed tomography (CBCT) and to analyze the anatomy of mandibular first molars with three roots through micro-CT. Material and Methods: CBCT images of 116 patients were reviewed to determine the prevalence of three-rooted first mandibular molars in a Brazilian subpopulation. Furthermore, with the use of micro-CT, 55 extracted three-rooted mandibular first molars were scanned and reconstructed to assess root length, distance between canal orifices, apical diameter, Vertucci's classification, presence of apical delta, number of foramina and furcations, lateral and accessory canals. The distance between the orifice on the pulp chamber floor and the beginning of the curvature and the angle of canal curvature were analyzed in the distolingual root. Data were compared using the Kruskal-Wallis test (α=0.05). Results: The prevalence of three-rooted mandibular first molars was of 2.58%. Mesial roots showed complex distribution of the root canal system in comparison to the distal roots. The median of major diameters of mesiobuccal, mesiolingual and single mesial canals were: 0.34, 0.41 and 0.60 mm, respectively. The higher values of major diameters were found in the distobuccal canals (0.56 mm) and the lower diameters in the distolingual canals (0.29 mm). The lowest orifice distance was found between the mesial canals (MB-ML) and the highest distance between the distal root canals (DB-DL). Almost all distal roots had one root canal and one apical foramen with few accessory canals. Conclusions: Distolingual root generally has short length, severe curvature and a single root canal with low apical diameter.