Comparative clinical study of coronally advanced flap with and without use of plasma rich in growth factors in the treatment of gingival recession.

PURPOSE: To evaluate the clinical efficiency of the coronally advanced flap (CAF) with and without plasma rich in growth factors (PRGF) in the management of gingival recession defects. METHODS: 20 bilateral similar recession defects in six healthy non-smoker subjects were included in the present study. The test sites received PRGF as an adjunct to the coronally advanced flap (CAF) while the control sites were treated with CAF only. The clinical parameters including recession depth (RD), percentage of root coverage (RC), recession width (RW), mucogingival junction position (MGJ), width of keratinized tissue (WKT), clinical attachment level (CAL), and probing depth (PD) were measured at the baseline, 1, and 3 months post-operatively. The data were analyzed using Wilcoxon signed rank and Mann-Whitney U tests. RESULTS: After 3 months, the mean root coverage was 43 +/- 34.9% in the CAF group and 61 +/- 23.5%) in the CAF + PRGF. Both treatment protocols led to a significant improvement in all measured variables compared to the baseline values, except the width of keratinized tissue. While PRGF enhanced the outcomes of CAF especially throughout the first month post-operatively, it offered no clinical advantage over CAF alone during the subsequent 2 months.

Formocresol versus calcium hydroxide direct pulp capping of human primary molars: two year follow-up.

OBJECTIVES: Clinical and radiographic evaluation of the premedicated direct pulp capping using formocresol (PDC) versus conventional direct pulp capping using calcium hydroxide (CDC) in human carious primary molars. STUDY DESIGN: A total of 120 vital primary molars with pinpoint exposure during caries removal in 84 patients aged 4-5 years were selected. In the PDC group (n = 60), 20% Buckley's formocresol solution, and in the CDC group (n = 60), calcium hydroxide powder were applied to the exposure sites followed by placement of zinc oxide-eugenol base. Teeth were restored with preformed stainless steel crowns. Clinical and radiographic evaluations of the treatment outcomes were performed at regular intervals of 6 and 12 months, respectively, for two years post-operatively. RESULTS: The prevalence of spontaneous pain, sensitivity on percussion, and fistula were significantly higher in the CDC group compared to the PDC group (P < 0.05). The number of teeth exhibiting periapical/furcal radiolucency or external/internal root resorption was also higher in the CDC group (P < 0.05). The clinical success rate of the PDC was 90% compared to the 61.7% of the CDC (P < 0.05). The radiographic success rates of the PDC and CDC groups were 85% and 53.3%, respectively (P < 0.05). CONCLUSION: It seems formocresol premedicated direct pulp capping could safely be used as a substitute for conventional direct pulp capping.

Dental treatment duration as an indicator of the behavior of 3-to 9-year-old pediatric patients in clinical dental settings.

AIM: The aim of this study was to evaluate the age-specific effect of treatment duration on pediatric patient behavior. METHODS AND MATERIALS: A total of 450 children 3 to 9 years of age were allocated into six consecutive age groups (n=75 for each group). All children received dental treatment procedures which included the fabrication of a Type 1 composite resin restoration, then a dental prophylaxis followed by fluoride therapy with each procedure requiring an average of 20 minutes. The children's behavior was evaluated at the end of each treatment period using the sound, eye, and motor (SEM) scale. RESULTS: The results of a mixed analysis of variance (ANOVA) indicated a significant main effect of treatment duration, F (1.69, 255.01) = 188.29, P < 0.001, and of chronological age, F (1, 144) = 115.82, P < 0.001. Moreover, the main effects of time and chronological age was qualified by a significant interaction between time and chronological age, F (8.86, 255.01) = 115.82, P < 0.001. The beta weights (0.64 for age versus 0.44 for time) suggest chronological age contributes the most to predicting the behavior of children during dental treatment followed by the duration of treatment. CONCLUSION: Treatment duration may affect the behavior of pediatric patients parallel with chronological age and, thus, should be considered in the arrangement of the treatment plan. CLINICAL SIGNIFICANCE: The findings of this study suggest appropriate pediatric behavior management should include thoughtful scheduling of appointments according to a treatment plan formulated with consideration of the effects of age and appointment length.

The efficacy of a modified omega wire extension for the treatment of severely damaged primary anterior teeth.

OBJECTIVES: The restoration of the severely damaged anterior teeth is considered a serious challenge in contemporary dental practice. The aim of the present study was the clinical and radiographic evaluation of a modified omega loop technique for the restoration of the severely damaged primary anterior teeth. STUDY DESIGN: A total of 144 anterior teeth in 60 healthy children (male: 32, female: 28) aged 3-4 years, severely damaged by dental caries, were included in the present study. The root canal therapy was performed for the selected teeth. After the construction of the modified omega loop, coronal 4 mm of intracanal ZOE was removed. A thin layer of polycarboxylate cement was placed over ZOE followed by the insertion of the modified omega loop and subsequent restoration of the crown with an internal compomer core and an external composite restoration. The patients were followed at the intervals of 6, 12, and 24 months postoperatively. RESULTS: The partial loss of the restorative material after 6 months occurred in 5.9% of the teeth. The failure rates after 12 and 24 months were 10.8% and 18.5%, respectively. The primary canines exhibited minimum loss of the restorative material. Two teeth exhibited pathological mobility after two years. There were not any signs of root fracture or recurrent caries in any of the restored teeth. CONCLUSION: It may be concluded that the modified omega loop is an efficient technique for the restoration of the severely damaged anterior teeth. The ease of manipulation and short chair-side time are further advantages of the technique.

The effect of pre-cooling the injection site on pediatric pain perception during the administration of local anesthesia.

AIM: The aim of the study was to evaluate the effect of cooling the soft tissue of injection sites on the pain perceptions of pediatric patients during the administration of local anesthesia for routine dental procedures. METHODS AND MATERIALS: A total of 160 children aged 5-6 years were included in the present study. On a random basis, the subjects were allocated to the without ice pretreatment (WIP) group (topical anesthesia + counterstimulation + distraction) or the ice pretreatment (IP) group (cooling + topical anesthesia + counterstimulation + distraction). During the administration of an inferior alveolar nerve block, the children's behavior was assessed using the sound, eye, and motor (SEM) scale. The statistical analysis of data was performed based on the analysis of variance (ANOVA). RESULTS: There were no significant differences within the groups between the values of the sound, eye, and motor components for either the WIP or the IP groups (P>0.05). All three components of the SEM in the IP group were consistently lower than the WIP group (P<0.05). Moreover, the SEM value for the WIP group surpassed the IP group (P<0.05). CONCLUSIONS: Cooling the site of infiltration block prior to the injection of local anesthesia significantly reduced the pain perceived during injection of local anesthetic agent in pediatric patients. CLINICAL SIGNIFICANCE: Pre-cooling of the soft tissues of an injection site prior to the administration of a local anesthetic can minimize the discomfort and anxiety associated with the injection procedure and facilitates the management of pediatric patients during this phase of a dental procedure.

Lingual eruption of mandibular permanent incisors: a space correlated phenomenon?

AIM: The aim of the present study was to investigate the prevalence and distribution according to various arch length conditions of lingually erupted mandibular permanent incisors and the effect of space condition on this phenomenon with long-term follow-up of these teeth. METHODS AND MATERIALS: A total of 105 children aged 5-7.5 years with one or more permanent mandibular incisors erupting lingual to the corresponding primary incisors were included in the study. A space analysis was performed. The subjects were divided into six groups according to various space conditions. The subjects were followed for 2 years. RESULTS: In this study the prevalence of lingual eruption was 18.4%. Eighty-three point seven percent of the subjects had either equivalent space, mild space excess, or a space deficiency (not more than 3 mm). No relationship was found between groups and clinical outcomes (P>.05). Follow up of the main three groups (according to the space analysis results) revealed in the adequate space group 75% of the children lost their primary incisors without any intervention. Similar outcomes occurred in 85.7% and 57.14% of cases in the mild space excess and space deficiency groups, respectively. Considering the three main groups combined, equivalent space, mild space excess, and mild space deficiency, 70.45% of children lost their primary incisors without any intervention and 14.8% needed primary incisor extraction (17.4%, 14.3%, and 10.7% in each group, respectively). CONCLUSION: There was no predisposition toward a space deficiency or excess found in these subjects so the wait-and-see policy versus early extraction can be considered for lingually erupting permanent mandibular incisors. CLINICAL SIGNIFICANCE: Lingual eruption of mandibular incisors is a common clinical problem in the early mixed dentition period that is a source of discomfort for parents of patients with this condition. The present study provides a unique insight into the prevalence of the problem as well as the clinical decisions such as favoring retention of primary incisors as long as possible, the extraction of these primary teeth, placement of lower lingual holding arches, or referral for comprehensive orthodontic treatment. These types of data should not be regarded as standards but as illustrative of several key factors that are still not well-understood or which are still ignored.

The efficacy of distraction and counterstimulation in the reduction of pain reaction to intraoral injection by pediatric patients.

AIM: The aim of this clinical investigation was to determine the efficacy of distraction and counterstimulation in the reduction of pain during the administration of local anesthetics in pediatric dental patients. METHODS AND MATERIALS: A total of 78 healthy children (male: 40, female: 38) ages four to five years (mean age: 4.72 years old) without any history of previous intraoral injection were included in the present study. The subjects had at least one carious primary molar. The subjects were randomly allocated into three groups. Group SA received topical anesthesia followed by an inferior alveolar nerve block (simple anesthesia). Group C+SA received counter stimulation using intraoral and extraoral finger vibration in addition to the Group SA protocol. Group CD+SA incorporated verbal distraction in addition to topical and local anesthesia and counterstimulation. A sound, eye, and motor (SEM) scale was used for quantification of pain reaction. Data were analyzed using an analysis of variance (ANOVA). RESULTS: The SEM values for Groups SA, C+SA, and CD+SA was 8.25, 5.07, and 3.41, respectively. According to the SEM scale a severe pain reaction was observed in Group SA but not in the other groups. The pain reaction for Group SA was significantly higher than the two other groups (P<0.05). Moreover, the subjects in Group CD+SA exhibited significantly less pain compared to those in Group C+SA. CONCLUSION: Both distraction and counterstimulation are effective in reducing pain reaction in a clinical setting. However, it may be more plausible to use both techniques simultaneously to achieve more favorable results with reference to a reduced pain reaction in pediatric dental patients.

Trigeminal trophic syndrome with features of oral CMV disease.

Trigeminal trophic syndrome (TTS) is an exceedingly rare complication following injury to the trigeminal ganglion, characterized by painless ulcerations, which has only rarely been reported with intraoral features. We present a patient with multiple intraoral ulcerations of the right buccal and alveolar mucosa that had previously been treated with nerve ablation therapy for trigeminal neuralgia. Positive immunohistochemistry staining of a biopsy specimen for cytomegalovirus suggested a viral etiology; however, lesions persisted despite antiviral therapy, and immunohistochemistry was negative on follow-up biopsy. Diagnosis of TTS is one of exclusion as it can mimic many other conditions, and should be considered in patients with unilateral painless ulcerations with a history of trigeminal nerve damage.

A clinical study of formocresol pulpotomy versus root canal therapy of vital primary incisors.

OBJECTIVES: Pulpotomy of primary incisors is a serious challenge due to the lack of a distinct boundary between the coronal and the radicular pulp and the inaccuracy of the clinical indication criteria. The aim of the present study is the clinical and radiographic evaluation of pulpotomy versus root canal therapy (RCT) of vital primary incisors. STUDY DESIGN: A total of 100 incisors in 50 patients (female: 27, male: 23) aged 3-4 years were allocated to formocresol pulpotomy (45 teeth) and RCT (46 teeth) using zinc oxide-eugenol. The radiographic and clinical evaluation of treatment outcomes was performed at 12 and 24 months post-operatively. A history of spontaneous pain, missing restorations, recurrent caries, mobility and percussion sensitivity, parulis or fistula, erythema, and swelling were recorded. Data analysis was performed based on two sample proportional test. RESULTS: The clinical success rate was 86.9% for pulpotomy and 95.6% for RCT (P > 0.05). The radiographic assessment exhibited no pathologic signs in 76.08% of pulpotomy group and 91.3% of RCT group and the difference was statistically significant (P < 0.05). The most common pathologic finding was periodontal widening followed by external/internal root resorption. Periapical radiolucency and fistula in pulpotomized teeth was significantly higher than in RCT-treated teeth (P < 0.05) CONCLUSIONS: It may be concluded that the root canal therapy of vital primary incisors may be efficiently substituted for the pulpotomy of these teeth.

Correlation of parenting style and pediatric behavior guidance strategies in the dental setting: preliminary findings.

OBJECTIVE: The aim of this study was to investigate the influence of parenting style on the choice of proper behavior guidance strategies in pedodontics. MATERIAL AND METHODS: Seventy-two children aged between 4 and 6 years (mean 5.12 years) with carious primary mandibular molars were selected. The Primary Caregivers' Practices Report (PCPR) was used to quantify authoritarian, permissive and authoritative aspects of the caregivers' parenting style. After inferior alveolar nerve block, carious lesions were removed and the teeth were restored using amalgam. The children's behavior during operation was assessed according to the sound, eye, and motor (SEM) scale. Communicative guidance, advance behavior guidance, parental separation, and deferred treatment were used for behavior management. RESULTS: The dominant authoritative score was observed in 50% of parents, permissive in 37.5%, and authoritarian in 12.5%. The mean SEM score in children belonging to authoritative parents was significantly lower than in children of permissive and of authoritarian parents (p<0.05). Communicative guidance was necessary for all patients regardless of parenting style. Advanced behavior guidance (protective stabilization) was applied in 16.7% of cases in the authoritative category and in 100% in the permissive and authoritarian categories. The use of restrictive devices (7.4%) and sedation (3.7%) was limited to the permissive category. Parental separation (40.7%) and deferred treatment (3.7%) were performed only in the permissive category. CONCLUSIONS: This study provides preliminary evidence that a child's reaction to restorative dental procedures is influenced by the nature of the caregiver's parenting style.

Malignant fibrous histiocytoma of the mandible in the context of a traumatic Marjolin's ulcer.

We present a rare manifestation of a chronic mandibular wound with a traumatic diathesis. A 38-year-old male patient sought medical consultation because of painless swelling in the mandibular symphysis and mild paresthesia of the lower lip. He mentioned a history of physical trauma to the mandibular symphysis 12 months ago. The radiographic evaluation and CT scan showed gross destruction of bone leading to a well-defined radiolucent lesion without any sclerosing margins. The histological examination revealed numerous spindle-shaped fibroblasts arranged in a fascicular pattern and scattered multinucleated and mononuclear cells with bizarre nuclei throughout the lesion. Moderate nuclear pleomorphism was evident with few mitotic cells. The lesion was diagnosed as a malignant fibrous histiocytoma of storiform-pleomorphic type based on the previous descriptions. After surgical removal of the lesion and the adjacent tissues and reconstruction, the patient was referred to a radiotherapist for continuation of treatment. Despite this therapy, the lesion recurred after a year, and prior to the second operation, the patient died as a result of brain involvement.

Effect of cigarette smoke exposure on the growth of Streptococcus mutans and Streptococcus sanguis: an in vitro study.

The aim of the present study was to determine the effect of cigarette smoke on the growth of Streptococcus mutans and Streptococcus sanguis. The standard strains of S. mutans (ATCC 25175) and S. sanguis (ATCC 10556) were cultured on blood agar and incubated for 48 hr in three main environments: atmospheric air, carbon dioxide, and cigarette smoke. Kent gold 1(nicotine: 0.1 mg, tar: 1 mg), Kent lights (nicotine: 0.8 mg, tar: 9 mg) and Bahman (nicotine: 1 mg, tar: 13 mg) were the brands used in the present study. Afterwards, digital photographs of the colonies were taken and the diameter of colonies was measured. Data were analyzed using Post Hoc and General Linear Model statistical tests. Cigarette smoke and carbon dioxide environments significantly increased the growth of S. mutans. However, high nicotine/tar content cigarette smoke (Bahman) had the greatest impact on S. mutans and S. sanguis. The mutans/sanguis ratio, which was 0.71 in atmospheric air, increased to 1.07 in the presence of carbon dioxide. Kent gold 1, Kent lights, and Bahman demonstrated a mutans/sanguis ratio of 1, 0.84, and 0.98 respectively. In conclusion, it seems that the growth of S. sanguis and S. mutans is accelerated in the vicinity of cigarette smoke.

Apgar index as a correlate of enamel defects of primary dentition.

PURPOSE: Enamel defects are serious challenges because of their unaesthetic appearance, dentinal sensitivity and the subsequent susceptibility to dental caries. Apgar index (AI) is used for postnatal, general, neural and behavioural assessment of newborns. The aim of the present study was to investigate the correlation of AI with the enamel defects of primary dentition. MATERIALS AND METHODS: A total of 181 subjects (95 females and 86 males) aged 3 to 5 years were randomly selected. Subjects with a history of systemic or debilitating diseases or local confounding factors, for example traumatic habits leading to enamel abrasion, were excluded. According to the modified index for developmental enamel defects, visual and tactile examinations of the entire primary dentition (buccal, lingual/palatal and incisal/occlusal) were performed. Teeth with caries lesions and restorations were excluded from the examination. After collection of the data regarding AIs of the subjects, statistical analysis was performed based on the Spearman and Mann-Whitney U tests. RESULTS: Enamel hypoplasia and hypocalcification were negatively correlated with the AI (P < 0.05). Moreover, the number of teeth exhibiting enamel defects was significantly lower in subjects with higher AI (P < 0.05). The effect of gender on the distribution of enamel defects as a covariate was not statistically significant (P > 0.05). CONCLUSIONS: AI is inversely correlated with enamel defects of primary dentition. Both quality and quantity of enamel defects of primary dentition are higher in children with lower AI, delineating a high-risk group demanding more stringent preventive measures.

Superficial topography of wound: a determinant of underlying biological events?

Three-dimensional configuration of wounds varies considerably according to the etiology. Wounding of skin is proceeded by release of dermal pretension. Subsequent disruption of physical equilibrium with resulting development of force vectors alters the primary shape of wound to maintain a new dynamic physical equilibrium. This leads to the development of stress-relaxation and stress-concentration areas throughout the wound milieu. Mechanical strain produces piezoelectric current which is maximal in stress-relaxation regions due to lower tissue stiffness and higher mobility. Early surge in the tissue level of TGF-beta would be exaggerated through synergistic interaction with piezoelectric current in stress-relaxation areas. Subsequently, fibroblasts migrate to these areas due to galvanotaxis. The gradual dissipation of tissue tension, due to irreversible loss of viscous strain, reduces the synergistic action of TGF-beta and piezoelectricity. However, a similar pattern of activity of TGF-beta due to the polarized migration of fibroblasts, which are the main source of TGF-beta during secondary surge, may be continued. It seems that a biological-mechanical continuum exists for wounds so that even the superficial topography of wounds may affect the underlying biological activity and final healing outcome during healing of dermal wounds.

Triad of bilateral duplicated permanent teeth, persistent open apex, and tooth malformation: a case report.

AIM: The aim of this article is to report a case of bilateral multiple impacted supernumerary teeth. A discussion of possible mechanisms of development is also presented along with a concise review of the literature. BACKGROUND: Supernumerary teeth occur in the context of various scenarios in the primary and the permanent dentition. Multiple supernumerary teeth are a rare finding especially in the absence of associated syndrome or disease. REPORT: A case of bilateral multiple impacted supernumerary teeth localized to the mandibular premolar region is reported. Some of the supernumerary teeth as well as the erupted premolars had persistent open apices. Coronal malformation of the right maxillary first premolar was another interesting finding. There was an absence of any concomitant disease. SUMMARY: The aforementioned combination of findings has not been reported previously. The anatomical, geometrical, and spatial relationships of supernumerary teeth with their erupted equivalents may shed light on some controversial aspects of the etiology.

Phenobarbital-induced gingival hyperplasia.

AIM: The aim of this article is to present a case of a phenobarbital-induced gingival hyperplasia (GH), discuss possible etiological mechanisms of drug-induced GH, and to present a concise review of the literature. BACKGROUND: GH is a well-known complication associated with anticonvulsant phenytoin, antihypertensive calcium channel blockers, and immunosuppressant cyclosporine therapy. Sodium valproate and primidone has very rarely been found to cause GH. REPORT: An extremely rare case of phenobarbital-induced GH in a 28-year-old male patient who had received this drug for three years is presented. The histological examination of the lesion revealed a hyperplastic epithelium, epithelial acanthosis, and elongated rete ridges as well as obviously enhanced dense collagenous fibers and proliferation of fibroblasts. SUMMARY: Phenobarbital-induced GH is a rare clinical entity which necessitates meticulous evaluation. However, it seems to show a benign behavior with reference to recurrence after surgical excision.

Fluoxetine enhances cutaneous wound healing in chronically stressed Wistar rats.

OBJECTIVES: To evaluate the histologic and clinical effects of fluoxetine administration on wound healing in chronically stressed and nonstressed Wistar rats. STUDY DESIGN: Full-thickness incisional wounds were created on the lower back of 72 female Wistar rats. Animals were divided into 2 stress and nonstress groups according to application of stress regimen and 3 subdivisions based on placebo, acute, or chronic administration of fluoxetine. Wound length, width, and linear healing rate based on wound area were measured for 2 weeks postwounding. Biopsies of 3 rats from each group were taken at days 1, 4, 7, and 14 to perform histomorphometric measurements by light microscopy. Analysis of covariance and analysis of variance were used to analyze wound length and other variables, respectively. RESULTS: Fluoxetine treatment significantly reduced mean wound length and healing period (P<.01). Although stress decreased the linear healing rate by 48%, fluoxetine treatment increased it by 68% and 31% in stressed and nonstressed rats, respectively. Stress significantly diminished infiltration of neutrophils and monocytes (P<.01), disrupted spatial organization of fibroblasts, and delayed neovascularization. Fluoxetine precluded these effects successfully. CONCLUSION: Fluoxetine significantly improves healing of cutaneous wounds in stressed and, to a lesser extent, in nonstressed animals.