Does primary trauma lead to developmental defects in permanent teeth?

Introduction A systematic review of existing evidence to determine if trauma in the primary dentition causes alteration in the development of the underlying permanent dentition.Data sources Six electronic databases (PubMed, Medline, MEDES, Scopus, Lilacs and Embase) were used to search a range of dental terms relating to dental trauma to locate studies between 1972-2020.Study selection Study selection was carried out by two authors by reviewing title, abstract and then full articles. A third author was consulted if consensus for inclusion was needed. Eligibility criteria included all scientific articles concerning sequalae to the human permanent dentition following trauma to the primary dentition. Only English, German and Spanish languages were included. For evaluation, the studies must have satisfied the following: a) minimum sample of 50 children to be representative; b) radiographic examination; and c) appropriate follow-up period up to permanent successor eruption.From 537 studies, 18 studies were identified for consideration in the review, comprising of 13 cross-sectional studies, two cohort studies and three case control studies.Data extraction and synthesis The Newcastle-Ottawa Scale was used to extract data and determine study quality. Only studies determined as high quality were included in the review. Four cross-sectional studies and three case control studies, totalling seven studies, were used. Data from these high-quality studies was summarised into table format.Results Large variation in study sample size existed from 138-753 traumatised teeth and 78-879 children. Both sexes were included in all studies and the children were aged between 0-17 years.Some studies found there was no difference in rate of trauma between girls and boys, while others found there was a higher incidence of trauma in boys than girls. The most frequently traumatised teeth were the upper primary central incisors. Whilst most studies covered all types of primary trauma, two only studied intrusion and one specified the type of primary trauma as luxation or fracture injuries.Whilst some of the studies concluded a higher frequency of defects to permanent teeth following primary intrusion trauma aged four and under, others showed no significant differences between the age of intrusion and the effect to the successor incisor.Enamel defects of the permanent teeth were the most common sequalae with a wide prevalence reported between 4.5-68.8%. Enamel defects were classified as hypoplasia and hypocalcification. Ectopic or altered eruption, crown or root dilacerations and odontoma development were observed less often, with the latter very rarely.Conclusions Primary tooth intrusion trauma causes the highest proportion of sequalae presenting as enamel defects. Younger patients experiencing primary trauma are more likely to obtain damage to the succeeding dentition. The existing quality of evidence is limited due to the observational nature of the studies available.

Are RMGIC restorations as effective with or without selective caries removal in primary molars?

Design A two-arm parallel group, tooth-randomised, controlled, non-inferiority clinical trial.Case selection Participants were cooperative 3-9-year-old children of good health, presenting with at least one International Caries Detection and Assessment System (ICDAS) Grade 5 cavitated dentine occlusal carious lesion, with radiographic depth into dentine. Teeth included were symptom-free, non-mobile and had no more than one-third root resorption.Participants were treated and followed-up at The Paediatric Dental Clinic of the Federal University of Rio Grande do Sul, School of Dentistry, Porto Alegre, Brazil. Ethics approval was granted by the Research Ethics Committee of University of Rio Grande do Sul, Brazil.Data analysis In total, 93 children (n = 698 teeth) were evaluated. Clinical examination was performed by two operators, trained and calibrated for caries assessment, for lesion presence and depth. Kappa statistics were used to determine inter-examiner reliability. All participants received standardised toothbrushing instructions, dietary advice and dental prophylaxis before their intervention.Teeth were randomly allocated into one of the two intervention groups using a random number generator. The 'sealing group' had their occlusal lesions sealed with resin-modified glass ionomer cements (RMGIC), without any caries removal, according to manufacturer's instruction. The 'restoration group' had selective caries removal performed with a round, steel bur according to the clinical hardness criteria and were then restored with the same RMGIC as the 'sealing group', again according to manufacturer's instruction. The treatments were performed by two experienced paediatric dental specialists. No local anaesthetic was needed in either group.Patients were followed-up at 6, 12, 18 and 24 months after treatment for examination, prophylaxis and interproximal radiography. Any asymptomatic teeth with marginal deterioration which could be probed underwent reintervention and were maintained in the sample.Cavity volume in the 'restoration group' was statistically significantly greater (p = 0.01) than the 'sealing group'. All other baseline sample characteristics were not significantly different.Results Overall, 68 teeth were included at the start of the study; n = 31 in the 'sealing group' and n = 37 in the 'restoration group'. At one-year post-intervention, 60 teeth were examined. Overall success rate was 59.3% for the 'sealing group' and 78.8% for the 'restoration group'. At two-years post-intervention, 48 teeth were examined. Overall success rate was 48.8% in the 'sealing group' and 76.0% in the 'restoration group'. Over the follow-up period, no radiographic lesion progression was observed in either group.Conclusions Sealing ICDAS Grade 5 occlusal caries with RMGIC without any caries removal resulted in lower survival rates at two-years compared to the same material following selective caries removal.

A newly assembled human skeletal reference collection of modern and identified Filipinos.

A collection of 75 modern skeletons from the Philippines has recently been created, and is being housed at the Archaeological Studies Program of the University of the Philippines, Diliman, Philippines. All individuals lived during the 20th century, and almost all died within the 21st century. These individuals were accessioned from exhumed and abandoned tombs at the Manila North Cemetery, and most have documented age and sex from tombstone inscriptions. This paper describes the first season of recovery and the collection's current demographic composition, with the future addition of more individuals to the collection expected to follow. The Philippines has an immediate need for forensic resources given its large vulnerable population, widespread diaspora, and exposure to natural disasters. Having a collection of modern Filipinos available for study is critical to the advancement of forensic anthropology and skeletal biology, especially for this heavily understudied population and region of the world.