Esthetic Management of Incisors with Diffuse and Demarcated Opacities: 24 Month Follow-up Case Report.

CLINICAL RELEVANCE: A minimally invasive esthetic treatment can provide longevity and color stability. SUMMARY: This clinical case report describes a minimally invasive approach to mask diffuse and demarcated opacities in permanent anterior teeth in an eight-year-old child who was upset with the appearance of her incisors. Clinical examination showed diffuse opacities in teeth 7, 8, 9, and 10, diagnosed as dental fluorosis associated with yellow demarcated opacity in tooth 9 related to molar-incisor hypomineralization. The treatment was based on conservative dentistry using the low-viscosity resin infiltration technique and resin composite restoration in an attempt to mask the lesions. The follow-up time was 24 months.

Randomized controlled clinical trial of resin infiltration in primary molars: 2 years follow-up.

OBJECTIVE: The aim of this split-mouth, randomized, controlled clinical trial was to evaluate the efficacy of resin infiltration in controlling the progression of non-cavitated proximal lesions in primary molars after two-years follow-up. METHODS: Fifty healthy children presenting at least two primary molars with proximal lesion detected radiographically (in the inner half of enamel or the outer third of dentin) were included in the study. The proximal lesions were randomly allocated into resin infltration + flossing (test group) or flossing (control group). All patients received oral hygiene instructions for daily brushing with fluoride toothpaste (1100 ppmF) and flossing. The proportion of caries progression was compared using the McNemar test. The main outcome after 2-years, caries progression in the radiography was assessed by pair-wise reading by an independent examiner who was blind regarding the treatment. RESULTS: The sample comprised 28 (56%) girls and 22 (44%) boys with a defs of 7,3 (SD = 6,5), mainly of moderate (46%) to high (48%) caries risk. Results after one year were published previously. After 2-years, 29 (58%) patients were assessed. Caries progression was observed in 24.1% (7/29) of the test lesions, compared with 55.2% (16/29) of the control lesions (p = 0.012). The therapeutic effect was 31.1% and the relative risk reduction (RRR) was 56.3%. Eigth lesions from the control group and two lesions from the test group progressed to the inner third of dentin and were restored. CONCLUSIONS: In conclusion, resin infiltration was more efficacious in controlling proximal caries lesions in primary molars than non-invasive approach alone. CLINICAL SIGNIFICANCE: The results indicate that resin infiltration was an efficacious method in controlling proximal caries lesions in primary molars after 2 years, even in patients with high caries risk, reaffirming the results of 1-year follow-up.

Efficacy of resin infiltration of proximal caries in primary molars: 1-year follow-up of a split-mouth randomized controlled clinical trial.

OBJECTIVE: The main purpose of this split month, randomized, controlled clinical trial was evaluate the efficacy of caries infiltration in controlling the progression of non-cavitated proximal lesions in primary molars. Anxiety and time required for the caries infiltration was also evaluated. MATERIALS AND METHODS: Fifty healthy children, 5 to 9 years, presenting two primary molars with proximal caries lesions (1/2 of the enamel or outer 1/3 of dentin), were included. Lesions were randomly allocated to the test group (fluoridated toothpaste + flossing + infiltration) or to the control group (fluoridated toothpaste + flossing). Caries risk was based on the Cariogram model. The main outcome after 1-year radiographic follow up was assessed by an independent blinded examiner A facial image scale (FIS) was applied to assess dental anxiety and time required to perform the infiltration was recorded. RESULTS: Of the sample, 92.9% corresponded to high or medium caries risk. In 42 patients (1-year follow up), caries progression was observed in 11.9% (5/42) of the test lesions compared with 33.3% (14/42) of the control lesions (p < 0.05). Five control and three test lesions progressed to the middle 1/3 of dentin and were restored. No side effects were observed. Anxiety was both low before and after the treatment, and mean time required for the infiltration was 11.29 min (± 1.16 min). CONCLUSIONS: Caries infiltration of proximal caries lesions in primary molars is significantly more efficacious than standard therapy alone (fluoride toothpaste + flossing). CLINICAL RELEVANCE: Caries infiltration is an applicable and well-accepted method be used in children, representing a promising micro-invasive approach.

Ex vivo evaluation of caries infiltration after different application times in primary molars.

Low viscosity resins (infiltrants) have been shown to penetrate the lesion body of natural caries lesions almost completely in vitro. However, penetration depths (PD) have not been evaluated in vivo. Therefore, the aim of the present study was to evaluate the penetration of an infiltrant into proximal caries lesions in primary molars after different application times using an ex vivo model. 59 proximal lesions from 34 children were randomly allocated to one of the application times and were infiltrated under clinical conditions for 1, 3, or 5 min. After extraction or exfoliation (n = 48), teeth were sectioned perpendicular to their surfaces and lesion depths (LD) as well as lesion areas (LA) were evaluated using polarized light microscopy. PD and penetration areas (PA) were measured on scanning electron microscopic images. Percentage penetration depth (PPD) and percentage penetration area (PPA) were calculated. The mean (±SD) LD and LA were 596 ± 203 µm and 4.03 ± 2.75 × 10(5) µm(2), respectively. PPD ranged from 70 to 80% and PPA from 54 to 60%. Longer application times did not result in significantly deeper or more complete penetration (p > 0.05; ANOVA). In conclusion, proximal caries lesions in primary molars can be infiltrated in vivo to a similar extent as observed previously in vitro. Moreover, 1-min application of the infiltrant led to PD and homogeneity similar to those observed with longer application times up to 5 min.

Pretreatment of natural caries lesions affects penetration depth of infiltrants in vitro.

OBJECTIVES: Limited evidence exists about the usefulness of ethanol or acetone application to desiccate caries lesions before resin infiltration. Therefore, this in vitro study aimed to compare the penetration depths (PD) of an infiltrant (DMG, Germany) into natural caries lesions using various pretreatments. MATERIAL AND METHODS: Extracted permanent human molars and premolars showing non-cavitated caries lesions were etched (90 s, 15 % HCl gel) and stored in pooled saliva (7 days). Lesions were etched again (30 s, 15 % HCl gel), washed (30 s), air-dried (30 s), and randomly allocated to one of the pretreatments: none (negative control), air-drying (incubator, 37 °C, 24 h; positive control), once ethanol (E1), twice ethanol (E2), once acetone (A1), and twice acetone (A2). Subsequently, the infiltrant was applied for 5 min and light-cured. Ground sections were prepared for analyses of lesion depths (LD) and PD using confocal microscopy. RESULTS: Median LD (Q25/Q75) of all lesions (n = 91) and lesions ≥500 µm (n = 57) were 629 (395/798) and 731 (638/876) µm, respectively. When all lesions were analyzed, no significant differences between various pretreatments could be observed (p > 0.05, Kruskal-Wallis). For lesions ≥500 µm, significantly deeper PP was observed in groups PC, E1, A1, and A2 compared with NC (p < 0.05; Mann-Whitney), but not after adjustment for multiple comparison (p > 0.05). CONCLUSION: Application of either ethanol or acetone, followed by air-drying, is suitable to prepare caries lesions for resin infiltration in vitro. CLINICAL RELEVANCE: This paper shows that proper drying is an important step prior to caries infiltration.

Penetration of experimental infiltrants with different penetration coefficients and ethanol addition into natural caries lesions in primary molars.

This study evaluated the influence of the penetration coefficient (PC) and ethanol addition on the penetration depth (PD) of experimental infiltrants into proximal caries lesions in primary molars. Caries lesions (n = 45) were randomly treated with 1 of 4 experimental infiltrants (PC63; PC185; PC204; PC391) for 5 min. Lesion depths and PDs were analysed using dual fluorescence confocal microscopy. Lesions were almost completely infiltrated in all groups. Median PDs and percentage penetrations were not significantly different between groups (p > 0.05). When applied for 5 min, all tested infiltrants were able to infiltrate proximal caries in primary molars nearly completely.

Validity of MicroCT for in vitro detection of proximal carious lesions in primary molars.

OBJECTIVE: This study aimed to validate the MicroCT for detection of proximal carious lesions in primary molars, using histology as the gold standard. METHODS: Forty-eight proximal surfaces of primary molars were examined. Two calibrated examiners conducted the examinations independently. Proximal surfaces were visually scored, using ICDAS. Bitewing radiographs, Micro-CT and histological analyses used caries scores: 0=sound; 1=outer enamel; 2=inner enamel; 3=not spread dentine; 4=outer dentine; 5=inner dentine. Axial and sagital images were used for Micro-CT analysis, whilst for histology, tooth sections (400µm) were analyzed stereomicroscopically (×15). RESULTS: Inter-examiner agreement ranged from 0.87 to 0.93 kappa coefficient (k). Histological analysis revealed a frequency of sound tooth surfaces (18.8%) enamel carious lesions (E1) (48%) and dentine carious lesions (D1) (33.3%). MicroCT showed high correlation with histology (r(s)0.88). At both diagnostic thresholds (E1 and D1), sensitivity and accuracy were higher for MicroCT. Inter-device agreement between MicroCT and histology was k=0.81. No difference was found between MicroCT and histology as gold standards for detecting carious lesions using ICDAS. CONCLUSION: MicroCT can be used as a gold standard for detecting carious lesions in proximal surfaces in primary molars.

Comparison between a simplified and a conventional biofilm index in relation to caries activity and gingivitis in the primary dentition.

AIM: This was to compare a simplified biofilm index with a conventional one in relation to caries activity and gingivitis in the primary dentition. STUDY DESIGN: Observational, cross-sectional. METHODS: The sample consisted of 90 children aged 10 to 57 months-old. A single examiner performed all examinations. Two visible biofilm indices, one simplified (BF1) and the other conventional (BF2), were used. Gingival bleeding was assessed after flossing all proximal surfaces and each tooth surface was classified for caries, including non-cavitated lesions. RESULTS: According to BF1, half of the sample (45 - 50%) had thick biofilm. BF2 showed a mean value of 21.8% (SD+/-16.5); 12 (13.3%) children had gingival bleeding and the mean percentage of bleeding surfaces was 0.9% (SD+/-2.5). Caries was present in 36 (40.0%) children and the mean value of active lesions was 2.1 (SD+/-4.3). The association between visible biofilm and gingival bleeding was significant (p=0.01), except when BF1 was associated with the gingival index (p=0.08). The association between BF1 and BF2 with caries activity was highly significant (p<0.001). CONCLUSION: Both biofilm indices may be used when the outcome being measured is caries. In the primary dentition, though, the conventional index (BF2) is better suited for studies about gingivitis.

Traumatic fractures of primary molars: a case report.

Dental trauma occurs very often in children and its consequences vary from tiny fractures to the complete avulsion of the tooth. According to Andreasen, 86.5% of incidents of dental trauma suffered by preschool children cause injury to maxillary primary incisors, whereas only 0.5% cause injury to primary molars. This case report is of a male patient aged 7 years who had fallen down a month before, struck his chin against a step, and fractured the maxillary and mandibular left primary second molars (65 and 75) and the mandibular right primary second molar (85). The 65 required only smoothing of sharp edges, 75 received endodontic treatment and a stainless steel crown, and 85 was extracted and a space maintainer fitted. The early diagnosis of fractures of posterior teeth is very important; a thorough examination of all posterior teeth should be made, especially when child suffers trauma to the chin region.