Restoring masticatory function in a patient with severe microstomia using rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis.

This clinical report describes the use of rapid prototyped mesh in a complete swing-lock prosthesis to restore masticatory function in an edentulous patient with severe microstomia and perioral scar tissue after an industrial hot tar accident.

Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions.

PURPOSE: This manuscript presents evidence-based guidance on the use of vital pulp therapies for treatment of deep caries lesions in children. A guideline panel convened by the American Academy of Pediatric Dentistry formulated evidence-based recommendations on three vital pulp therapies: indirect pulp treatment (IPT; also known as indirect pulp cap), direct pulp cap (DPC), and pulpotomy. METHODS: The basis of the guideline's recommendations was evidence from "Primary Tooth Vital Pulp Therapy: A Systematic Review and Meta-Analysis." (Pediatr Dent 2017;15;39[1]:16-23.) A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and trial databases to identify randomized controlled trials and systematic reviews addressing peripheral issues of vital pulp therapies such as patient preferences of treatment and impact of cost. Quality of the evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation approach; the evidence-to-decision framework was used to formulate a recommendation. RESULTS: The panel was unable to make a recommendation on superiority of any particular type of vital pulp therapy owing to lack of studies directly comparing these interventions. The panel recommends use of mineral trioxide aggregate (MTA) and formocresol in pulpotomy treatments; these are recommendations based on moderate-quality evidence at 24 months. The panel made weak recommendations regarding choice of medicament in both IPT (moderate-quality evidence [24 months], low quality evidence [48 months]) and DPC (very-low quality evidence [24 months]). Success of both treatments was independent of type of medicament used. The panel also recommends use of ferric sulfate (low-quality evidence), lasers (low-quality evidence), sodium hypochlorite (very low-quality evidence), and tricalcium silicate (very low-quality evidence) in pulpotomies; these are weak recommendations based on low-quality evidence. The panel recommended against the use of calcium hydroxide as pulpotomy medicament in primary teeth with deep caries lesions. Conclusions and practical implications: The guideline intends to inform the clinical practices with evidence-based recommendations on vital pulp therapies in primary teeth with deep caries lesions. These recommendations are based upon the best available evidence to-date.

Efficacy and Stability of Two in-Office Bleaching Agents in Adolescents: 12 Months Follow-Up.

OBJECTIVE: Although there are several clinical studies on in office vital bleaching in adults, there are no Randomized Clinical Trials for the efficacy of this application in adolescents. The aim the study was to evaluate the efficiency of two bleaching systems on adolescents for twelve-months follow-up. STUDY DESIGN: Twenty-eight volunteers, aged between 13-18, randomly divided into two groups. Two commercial in-office bleaching systems were used: G1 (n=14): Zoom2 25 % HP with UV light and G2 (n=14): Beaming White 36% HP with LED light in a single 3 x 15 minute procedure. The color assessment was made with a spectrophometer; before and after bleaching; 48 hours; 1, 6 and 12 months later. Color enhancement and maintenance of two techniques over 12 months were compared by two ways ANOVA and Student's t test. Sensitivity was evaluated on a scale with Wilcoxon test. RESULTS: Both groups demonstrated similar and significant tooth color enhancement and did not reveal any statistically significant differences between them. However, a relapse of the tooth shade was observed with the low concentration agent/ultraviolet light system. No sensitivity was observed in any patients. CONCLUSION: Two in-office bleaching systems can be used successfully on young permanent teeth. For long-term successful results, high concentration/LED light may be more effective.

Dental Treatment of a Child with Pallister-Killian Syndrome.

The Pallister-Killian syndrome (PKS) is an extremely rare genetic disorder with an incidence estimated around 1/25000. PKS is a multiple congenital anomaly deficit syndrome caused by mosaic tissue limited tetrasomy for chromosome 12p. The presented report is the first confirmed case with PKS in Turkey. This report focuses on the orofacial clinical manifestations of an 6-year-old boy with PKS who was referred to the Department of Paediatric Dentistry clinic, Gazi University. It has been learned that the PKS was diagnosed 1 year after birth. Due to intellectual disability, it was decided to make the dental treatments under moderate sedation. Although significant tongue thrust and anterior open bite were determined, any oral appliances could not be applied because of the 2 epilepsy seizures in the last 2 years. The aim was to treat decayed teeth and set good oral hygiene in the patient's mouth. Still, there is a probability for epilepsy seizures. If epileptic seizures stop permanently, we can apply an oral appliance to block tongue thrust. The patient is now under control. In cases of systemic and oral findings such as PKS, conducting medical and dental approaches together will increase the life quality of patients.

SEM-EDX analysis of brushing abrasion of chitosan and propolis based toothpastes on sound and artificial carious primary enamel surfaces.

PURPOSE: The objective of this study was to assess the brushing abrasion effects of toothpastes containing chitosan and propolis on sound and demineralized primary tooth enamel. METHODS: Pairs of enamel specimens were prepared from human extracted primary teeth, embedded in epoxy resin and polished. An artificial subsurface lesion was created in one specimen from each pair. All samples were divided into four groups (Chitodent, Aagaard propolis, Elmex, and Control) and brushed with slurry of toothpastes and artificial saliva in a brushing machine. The brushing abrasion depths were evaluated using computer-guided optical profilometry. RESULTS: No significant differences existed in terms of brushing depths between artificial carious enamel and brushed sound enamel specimens (P>0.05). The abrasion values of the sound enamel samples brushed with Aagaard propolis and control samples were significantly lower than the Elmex group (P<0.05). The lowest brushing abrasion values of demineralized enamel specimens were observed in the Chitodent group (P>0.05). CONCLUSIONS: The tested toothpastes exhibited similar effects in terms of brushing abrasion on both sound and artificially demineralized enamel. Based on mean values without statistical significance, the lowest brushing abrasion values in the demineralized brushed enamel samples were detected in the Chitodent group.

Effectiveness of an infiltrant on sealing of composite restoration margins with/without artificial caries.

AIM: The aim of this in vitro study was to evaluate the effectiveness of a resin infiltrant (ICON) on marginal sealing ability of class II resin restorations with/without-caries. MATERIALS AND METHODS: Forty-eight noncarious human pre-molar teeth were embedded and MO and DO preparations of standard dimensions were prepared. The left side of dentin margins of the cavities were left nonbonded (UB) while the right side were bonded using total etch-bonding agent and all restored with a Nanohybrid composite. The teeth were thermocycled and half of the specimens in the UB and B groups were subjected to an artificial caries process. ICON was applied to caries and noncaries subgroups following the manufacturer's directions. Impressions were made at each step: after the restorations were completed, thermocycling, artificial caries procedures, and infiltrant application and the silicone tag lengths were measured with a stereomicroscope. The specimens were immersed in 0.5% basic fuchsine at 37° C for 24 hours, sectioned and microleakage was evaluated with a stereomicroscope. Selected samples and their replicas were assessed for marginal quality under a stereomicroscope and SEM. Statistical evaluation of the data were made using Kruskal-Wallis, Mann-Whitney U and Wilcoxon Sign Rank tests. RESULTS: While bonding application did not create a meaningful difference, the thermocycling and artificial caries significantly increased the gap length and microleakage (p < 0.05). ICON application was decreased the microleakage, created gap-free margins and closed the gaps which were previously occurred at the same cavities (p < 0.05). CONCLUSION: A resin infiltrant (ICON) application decreased the microleakage, created gap-free margins and closed the gaps, which previously occurred at the same cavities. CLINICAL SIGNIFICANCE: Approximal application of resin infiltrant may increase the success of the class II composite restorations also reduced the risk of needing more complex restoration therapy.

A comparison of three-dimensional and two-dimensional cephalometric evaluations of children with cleft lip and palate.

OBJECTIVES: The aim of this retrospective study was to compare the consistency of orthodontic measurement performed on cephalometric films and 3D CT images of cleft lip and palate (CLP) patients. METHODS: The study was conducted with 2D radiographs and 3D CT images of 9 boys and 6 girls aged 7-12 with CLP. 3D reconstructions were performed using MIMICS software. RESULTS: Frontal analysis found statistical differences for all parameters except occlusal plane tilt (OcP-tilt) and McNamara analysis found statistical differences in 2D and 3D measurements for all parameters except ANS-Me and Co-Gn; Steiner analysis found statistical differences for all parameters except SND, SNB and Max1-SN. Intra-group variability in measurements was also very low for all parameters for both 2D and 3D images. CONCLUSIONS: Study results indicate significant differences between measurements taken from 2D and 3D images in patients with cleft lip and palate.

Accuracy of an electronic apex locator: a clinical evaluation in primary molars with and without resorption.

OBJECTIVE: The aim of this study was to evaluate the accuracy of electronic apex locator (Root ZX) in primary teeth with and without apical root resorption in vivo. STUDY DESIGN: The electronic working length was determined in 28 primary teeth (A total of 46 primary molar root canals with 24 roots without resorption and 22 roots with resorption) from twenty-eight healthy children using Root ZX. The teeth were then extracted. The actual length of each root was measured placing a K-File until the tip was visible at the apical foramen or the apical resorption level and approved with digital microscopic evaluation under 20x magnification and then withdrawn 1 mm. The distances from the file tip to the base of the rubber stop were measured and compared with the measurement obtained from apex locator. The data were evaluated with t test using standard statistical software (SPSS 13.0). The critical value of statistical significance was 5%. RESULTS: For root canals without resorption, the accuracy of Root ZX was 79.16% and 95.82% within +/- 0.5 and +/- 1 mm, respectively. For root canals with resorption, the accuracy of Root ZX was 63.63% and 86.35% within +/- 0.5 and +/- 1 mm, respectively. No statistically significant differences were detect between the electronically determined lengths and the actual lengths regardless of whether or not resorption. CONCLUSION: Using a Root ZX Electronic Apex Locator in primary teeth with or without resorption is recommended for the determination of working length.

Cytotoxicity of a new hemostatic agent on human pulp fibroblasts in vitro.

OBJECTIVE: The objective of this study was to evaluate the cytotoxicity of the plant extract ankaferd blood stopper (ABS) in vitro. STUDY DESIGN: ABS was eluted with fresh Dulbecco's Modified Eagle's Medium (DMEM) without serum for 72 h, at 37 °C. The cells treated with various dilutions of ABS were seeded into 96-well microplate at 104/well in triplicates. Cells without treatment served as a control group. The number of viable cells after 48 h incubation was determined by a modified 3-(4, 5-dimethyl-thiazol-2-yl)-2, 5-diphenyl-tetrazolium bromide (MTT) assay. The relative viability of pulp cells was expressed as color intensity of the number in the experimental wells relative to that of the control group. Absorbances were read at 570 nm on a microplate reader with a background subtraction at 620 nm. RESULT: The results showed that ABS was cytotoxic to human pulp fibroblasts by MTT assay. CONCLUSIONS: The influence of cytotoxicity to human pulp fibroblasts depended on concentration of ABS. The more dilutions exhibited less cytotoxic characteristics compared to the more concentrated forms.

Two-year study of alternative conservative treatment modalities for early anterior permanent tooth loss.

Premature tooth loss in children may consist of single or multiple, primary or permanent, and anterior or posterior units of the dentition. This tooth loss may be due to either trauma or caries and, in some cases, to congenital or genetic defects. With anterior tooth loss cases, there are several problems the dental practitioner must consider. These are space maintenance, masticatory function, speech and esthetic appearance.

Microleakage of different temporary filling materials in primary teeth.

OBJECTIVE: The aim of this study was to compare the sealing properties of IRM, Coltosol, Cavit G, Adhesor and Clip, which used as temporary filling material in coronal access openings in extracted human primary teeth. STUDY DESIGN: Standardized access cavities of 2 x 2 mm were prepared in the eighty-four, caries-free human primary anterior teeth. The teeth were divided randomly into five groups of 16 teeth each. Temporary restorative materials Group A: IRM (Dentsply), Group B: Coltosol (Coltone), Group C: Cavit G (3M), Group D: Adhesor (Spofa Dental) and Group E: Clip (Voco) were applied according to the manufacturer's directions. The specimens were immersed silver nitrate and placed in film developer under fluorescent for 24 hours. The sectioned specimens were evaluated under a digital microscope at x 20 magnifications and blindly scored for microleakage. RESULTS: Clip presented the least microleakage value whereas; Adhesor and IRM presented the higher microleakage values. There were statistically significant differences between Clip and the others groups, while there were no statistically significant differences in microleakage between IRM, Adhesor, Coltosol and Cavit G. However the leakage scores of Clip and Cavit G were congruent (p = 0.454). CONCLUSION: Amongst the five materials, Clip exhibited a better sealing ability.

Resin-dentin interfacial morphology and shear bond strengths to primary dentin after long-term water storage: an in vitro study.

OBJECTIVE: To evaluate the resin-dentin interfacial morphology and shear bond strength of several new dentin bonding systems on deep dentin of primary teeth after a 1-year storage period. METHOD AND MATERIALS: Test specimens were prepared using 5 adhesive systems (Syntac Single-Component [Ivoclar Vivadent], Prime And Bond NT [Dentsply DeTrey], Adper Prompt L-Pop [3M ESPE], Gluma One Bond [Heraeus Kulzer], and iBond [Heraeus Kulzer]) on primary deep dentin. The shear bond strength data were evaluated with Kruskal-Wallis and Mann-Whitney U tests. Debonding surfaces were examined with stereo-microscope and scanning electron microscopy (SEM). RESULTS: The 1-day shear bond strength test values were, respectively, Adper Prompt L-Pop > iBond > Prime And Bond NT > Gluma One Bond > Syntac Single-Component, with the differences between Prompt L-Pop and Syntac (U = 10, P = .006), Prompt L-Pop and Gluma (U = 7, P = .002), and Adper Prompt L-Pop and iBond (U = 16, P = .03) being statistically significant. The 365-day shear bond strength values were, respectively, Adper Prompt L-Pop > Prime And Bond NT > iBond > Syntac Single-Component > Gluma One Bond, with the differences between Adper Prompt L-Pop and Syntac (U = 0, P = .000), Adper Prompt L-Pop and Gluma (U = 1, P = .000), and Adper Prompt L-Pop and iBond (U = 13, P = .01) being statistically significant. The differences between the 1-day and 365-day subgroup values of Syntac (U = 18; P = .05) and Gluma (U = 1, P = .000) were statistically significant. Almost all specimens showed adhesive failure at stereoptical examination (P > .05), with the presence of resin remnants and tags on dentin and dentinlike remnants on resin surfaces at SEM. CONCLUSION: Syntac and Gluma group values decreased with aging. The best values were obtained with both Adper Prompt L-Pop groups.

Endodontic and orthodontic treatment of fused maxillary central incisors: a case report.

The purpose of this case report was to describe combined endodontic and orthodontic treatment of a patient who had permanent maxillary central incisors fused with supernumerary teeth. A severe esthetic problem and crowding in the maxillary arch were present clinically. Radiographic examination demonstrated two separate crowns, roots and pulpal canals on each side. The therapy was initiated with endodontic treatment. Six months after the completion of endodontic therapy, mesio-distal trimming was performed and the defects were restored with anterior resin composites in order to re-establish the esthetics. Orthodontic treatment was performed for the alignment of the upper arch. Follow-up at 4 years demonstrated that the teeth were asymptomatic and neither root nor alveolar bone resorption was found. In conclusion, instead of extracting the supernumerary teeth, the anomaly was treated successfully in a conservative way.

The evaluation of cystatin C, IL-1beta, and TNF-alpha levels in total saliva and gingival crevicular fluid from 11- to 16-year-old children.

BACKGROUND: The aim of this study was to evaluate the levels of cystatin C, interleukin-1beta (IL-1beta), and tumor necrosis factor-alpha (TNF-alpha) in the total saliva and gingival crevicular fluid (GCF) of periodontally healthy children (PHC) and children with gingivitis (CG) who were between 11 and 16 years old. METHODS: The study was carried out with 10 PHC and 25 CG. Unstimulated total saliva and GCF samples were obtained. Clinical parameters, including probing depth (PD), clinical attachment loss (CAL), plaque index (PI), gingival index (GI), and gingival bleeding index (GBI), were assessed. GCF samples were collected from four maxillary upper incisors. After sampling, biochemical analyses were performed using latex particle-enhanced turbidimetric immunoassay for cystatin C and enzyme-linked immunosorbent assay for IL-1beta and TNF-alpha. The multivariate analysis of variance test was used for statistical evaluation. RESULTS: In total saliva, cystatin C and TNF-alpha levels were higher in PHC, and IL-1beta levels were higher in CG, but the differences were not statistically significant. In GCF, cystatin C levels were higher in PHC (P >0.05), whereas TNF-alpha and IL-1beta levels were higher in CG (P >0.05). In the CG group, there were positive correlations between the GCF cystatin C level and the PI of the sampled site (r = 0.488; P <0.05); also, GCF IL-1beta (r = 0.603; P <0.05) and TNF-alpha (r = 0.456; P <0.05) levels were positively correlated with PD and CAL. For the whole mouth and the sampled sites, PI, GI, GBI, PD, and CAL values were higher in CG (P <0.05), but no significant differences were detected between GCF volumes of the two groups. CONCLUSIONS: To the best of our knowledge, this study represents the first evaluation of cystatin C in the gingival disease mechanism in children. Our results showed that total saliva and GCF cystatin C levels were higher in PHC (P >0.05), but there was no correlation between cystatin C levels and IL-1beta or TNF-alpha levels in total saliva or GCF.

The Evaluation of Cystatin C, IL-1ß, and TNF-α Levels in Total Saliva and Gingival Crevicular Fluid From 11- to 16-Year-Old Children.

BACKGROUND: The aim of this study was to evaluate the levels of cystatin C, interleukin-1ß (IL-1ß), and tumor necrosis factor-alpha (TNF-α) in the total saliva and gingival crevicular fluid (GCF) of periodontally healthy children (PHC) and children with gingivitis (CG) who were between 11 and 16 years old. METHODS: The study was carried out with 10 PHC and 25 CG. Unstimulated total saliva and GCF samples were obtained. Clinical parameters, including probing depth (PD), clinical attachment loss (CAL), plaque index (PI), gingival index (GI), and gingival bleeding index (GBI), were assessed. GCF samples were collected from four maxillary upper incisors. After sampling, biochemical analyses were performed using latex particle-enhanced turbidimetric immunoassay for cystatin C and enzyme-linked immunosorbent assay for IL-1ß and TNF-α. The multivariate analysis of variance test was used for statistical evaluation. RESULTS: In total saliva, cystatin C and TNF-α levels were higher in PHC, and IL-1ß levels were higher in CG, but the differences were not statistically significant. In GCF, cystatin C levels were higher in PHC (P >0.05), whereas TNF-α and IL-1ß levels were higher in CG (P >0.05). In the CG group, there were positive correlations between the GCF cystatin C level and the PI of the sampled site (r = 0.488; P <0.05); also, GCF IL-1ß (r = 0.603; P <0.05) and TNF-α (r = 0.456; P <0.05) levels were positively correlated with PD and CAL. For the whole mouth and the sampled sites, PI, GI, GBI, PD, and CAL values were higher in CG (P <0.05), but no significant differences were detected between GCF volumes of the two groups. CONCLUSIONS: To the best of our knowledge, this study represents the first evaluation of cystatin C in the gingival disease mechanism in children. Our results showed that total saliva and GCF cystatin C levels were higher in PHC (P >0.05), but there was no correlation between cystatin C levels and IL-1ß or TNF-α levels in total saliva or GCF.

Accuracy of two different apex locators in primary teeth with and without root resorption.

The objective of this study was to assess the accuracy of two frequency apex locators, Root ZX (Morita, Kyoto, Japan) and Endex (Osada, Tokyo, Japan) in primary teeth with and without root resorption in vitro. For this study, 90 sound extracted primary teeth (60 molars and 30 incisors; 93 roots with visible resorption and 51 roots without) were selected. A total of 144 root canals were included. After access preparation, root canal lengths were measured visually. The teeth were embedded in an alginate model developed specifically for testing apex locators. Electronic length was determined with two different frequency apex locators, Root ZX (Morita, Kyoto, Japan) and Endex (Osada, Tokyo, Japan). Statistical evaluation was performed using Mann-Whitney U and Wilcoxon W tests (p < 0.05). Results revealed that both apex locator devices did not show similar values to visual length measurements with statistically significant differences in primary teeth with root resorption (p < 0.05). For the teeth without root resorption, Endex showed similar values to visual length measurements with no statistically significant differences (p > 0.05), but Root ZX values were different than visual length and the differences were statistically significant (p < 0.05). There were no significant differences between the two apex locators considering the presence of root resorption. The two frequency apex locators can be recommended for use in root canal therapy for primary teeth with and without root resorption, only if electrical determination of root canal length is supported with other diagnostic measures.

Gap formation between different cavity walls and resin composite systems on primary and permanent teeth.

AIM: The aim of this study was to compare the effectiveness of five self-etching and etch-rinse dentin-bonding agents in achieving a gap-free adaptation between the restorative material and the dentin in primary and permanent teeth. METHODS AND MATERIALS: Gaps located at the restoration dentin interface were evaluated using scanning electron microscopy (SEM). RESULTS: There were more gaps on the corner of the cavities, but no significant difference was detected between different cavity walls (p>0,05). Statistical results of the SEM analysis revealed fewer gaps in the restorations made with self-etching dentin bonding agents than etch-rinse agents at the restoration-dentin interface in both primary and permanent teeth. CONCLUSION: Self-etching bonding systems were preferable in primary and permanent teeth according to the results of this study. However, further studies should be conducted to determine a favorable strategy to eliminate the gaps on the corners of cavities and maintain a gap-free adaptation between resin composite and tooth structure.

The prevalence and surface distribution of caries among schoolchildren in Ankara, Turkey according to their dental health behaviors.

The aim of this study was to classify children according to their oral hygiene behaviors at the elementary school, and to evaluate the effects of oral health behaviors on caries prevalence, and to calculate the number of carious teeth and the surface distribution of caries in school children during a 2-year follow-up period. Results shows that even in the presence of the acquisition of appropriate oral hygiene behavior during preschool period, dental professionals and educational system should supported oral health motivation in primary school.

Coronal microleakage of temporary restorations in previously restored teeth with amalgam and composite.

AIM: This study evaluated microleakage at the interface between various temporary restorative materials and existing amalgam or composite restorations, and dental tissues in previously restored teeth after partial removal of the restoration. MATERIALS AND METHODS: The distal half of amal gam (Ag) and composite restorations (Co) in 45 teeth were removed, then filled with temporary restorative materials (IRM, Coltosol and CLIP). After thermal cycling, microleakage was measured microscopically as the penetration of basic fuchsine according to a four-unit-scale: The data were evaluated with Friedman and Kruskal-Wallis tests using Bonferroni correction (p < 0.05). RESULTS: In almost all groups except the Co-IRM and Ag-CLIP interface, lower microleakage values were observed in temporary restoration-permanent restoration interfaces compared to temporary restoration-tooth interfaces. For the Ag and Co groups except for the Ag-IRM-b interfaces, the highest microleakage values were observed with IRM for b and c interfaces followed by Coltosol and CLIP. Interestingly, although CLIP was a temporary restoration, CLIP-tooth interface (Ag-CLIP-c) values were lower than amalgam-tooth interface (Ag-CLIP-a) values. CONCLUSIONS: CLIP provided a better seal against microleakage at amalgam and especially composite interfaces. This material also provided a better seal against microleakage at the tooth tissue interface. The use of a resin based temporary restorative material over partially removed resin composite restorations could be beneficial in achieving better resistance to marginal leakage. Within the limitations of this study, maintaining partially removed permanent restorations does not seem to cause a problem with achieving marginal seal.