Prefabricated Zirconia Crowns - A Solution to Treat Hypomineralized Permanent Molars: Report of a Case.

The presence of carious lesions in children associated with developmental defects of enamel is frequently observed. Restoring these affected teeth can be a challenge for the clinician. Teeth with enamel defects may have poor or limited resin adhesion and some may require repeated restoration. Prefabricated zirconia permanent molar crowns were recently introduced as an option for restoring severely decayed and broken down young permanent molars. These new restorations offer an efficient, esthetic, and economic option to restore severely broken down carious permanent molars that may be associated with enamel defects in partially or fully erupted molars. A clinical case of a 13-year-old female patient is presented. She had a mandibular second permanent molar that demonstrated significant caries and loss of much of the clinical crown, which was treated with a vital pulpotomy and restored with a prefabricated zirconia crown.

Clinical Performance of Heat-Cured High-Viscosity Glass Ionomer Class II Restorations in Primary Molars: A Preliminary Study.

OBJECTIVES: The present preliminary study evaluated the clinical and radiographic performances of heat-cured high viscosity glass ionomer (HCHVGI) in class II restorations of primary molars. STUDY DESIGN: A retrospective study on a cohort of patients who had dental caries restored at a private practice was conducted. Restorations were evaluated radiographically and photographically by two separate examiners. RESULTS: Ninety-three Class II restorations in 44 patients (average age: 108 months ± 25.3, 24 males, 20 females) were examined. Average recall time was 22.2 months ± 4.2. All but three restorations (96.8%) were present and intact, with no incidents of secondary caries. Three additional restorations had occlusal defects that required retreatment, resulting in an overall success rate of 93.5%. Ninety-seven percent of the restorations were rated optimal for marginal integrity with no staining of the restoration surfaces. No patients complained of post-operative sensitivity. The most common flaw found was a concavity on the proximal wall of the cavity box (27%, mean age 16 months ± 3.9). CONCLUSION: The findings in this preliminary study suggest that heat cured high viscosity glass ionomer cement may be an effective restorative material for Class II restorations in primary molars that are a year or two from shedding.

Pre-eruptive intra-coronal resorption: controversies and treatment options.

Pre-eruptive intra-coronal resorption (PIER) is a defect located in the dentin of an unerupted tooth, just beneath the dentin-enamel junction, with a prevalence of 0.5-2% of the teeth. The depth of the lesion is variable and may also reach the pulp. In the past, these lesions were confused with caries, and were therefore called "hidden" or "pre-eruptive caries". These defects are usually detected incidentally in routine dental radiographs. It has been proven that in the pre-eruptive stage the lesions contain soft tissue and inflammatory cells. The present report describes the clinical management of a case of PEIR on a mandibular first permanent molar and discusses the alternatives for treatment.

Use of coolant for high-speed tooth preparation: a survey of pediatric dentistry residency program directors in the United States.

PURPOSE: To determine current teaching policies regarding the use of coolant type during tooth preparation with high-speed hand-pieces in pediatric dental residency programs in the US. METHODS: A 17-question survey was electronically mailed to 63 program directors with one follow-up. Multiple-choice questions asked about school and program teaching of cavity preparation with or without water coolant, including hypothetical clinical situations. RESULTS: Fifty-two (83%) program directors returned the survey. Fifty-two percent taught both dry and water coolant methods, 6% taught dry cutting exclusively, and 42% did not teach the dry method and always used water coolant. Dry techniques were used primarily for special needs patients with poor swallow reflexes (50%) and for young children undergoing sedation (41%). Air coolant was taught more frequently in programs in the Midwest (77%) and South (85%) vs. the Northeast (32%) and West (50%) (P<.01). Forty-four percent of combined programs and 60% of hospital programs taught water spray use exclusively, while all university programs taught the dry cutting technique (P<.01). CONCLUSIONS: A majority of program directors teach the use of air coolant alone for high-speed preparation of teeth. University and combined programs were more likely to teach the method compared with hospital based ones.

Atypical Developmental Defects of Enamel in Primary Incisors Versus Preeruptive Intracoronal Resorption (PEIR): Case Reports.

Developmental defects of enamel (DDE) in children range from moderate to severe and may predispose to dental fractures and early childhood caries. The prevalence of DDE in the primary dentition range from 24 to 75 percent, and the right time to diagnose DDE should be as soon as the teeth erupt. However, early detection of DDE in primary incisors is difficult because parents seldom visit the dentist at this age and, later on, caries lesions mask the original alteration. The purpose of this paper was to present three cases of unique and similar dental defects appearing in very young children from different countries-defects that probably share the same etiology. Given the severity of the defects and the children's' age, these could be the first reported cases of preeruptive intracoronal resorption (PEIR) in primary incisors. This paper also discusses the differentiation between DDE and PEIR.

A Randomized Controlled Clinical Trial Comparing Tricalcium Silicate and Formocresol Pulpotomies Followed for Two to Four Years.

Purpose: Tricalcium silicate (Biodentine), a new synthetic inorganic restorative cement, has shown a high rate of success in pulpotomy treatments, with few side effects. The purpose of the present randomized clinical control trial was to evaluate the long-term success of pulpotomies in human primary molars using tricalcium silicate versus formocresol. Methods: Healthy two- to 10-year-olds were treated with pulpotomies on primary molars as part of their scheduled regular dental treatment. Pulp dressing alternated randomly between tricalcium silicate and formocresol. Data were analyzed at follow-up periods up to 48 months. Results: Thirty-seven (51.4 percent) teeth with tricalcium silicate and 35 (48.6 percent) teeth with formocresol in 58 healthy children (31 boys and 27 girls) were studied. The overall success rate of the pulpotomies in this study was 94.4 percent. Tricalcium silicate was successful in 97.3 percent (36 out of 37) of the cases, and formocresol in 91.4 percent (32 out of 35). No association was found between success and type of tooth or time range from treatment to last follow-up. Conclusion: Tricalcium silicate shows a higher (though not statistically significant) success rate than formocresol in human primary molars pulpotomies followed for two to four years.

Vital pulp therapy with new materials for primary teeth: new directions and Treatment perspectives.

Vital pulp therapy aims to treat reversible pulpal injury and includes 2 therapeutic approaches: (1) indirect pulp treatment for deep dentinal cavities and (2) direct pulp capping or pulpotomy in cases of pulp exposure. Indirect pulp treatment is recommended as the most appropriate procedure for treating primary teeth with deep caries and reversible pulp inflammation, provided that this diagnosis is based on a good history, a proper clinical and radiographic examination, and that the tooth has been sealed with a leakage-free restoration. Formocresol has been a popular pulpotomy medicament in the primary dentition and is still the most universally taught pulp treatment for primary teeth. Concerns have been raised over the use of formocresol in humans, and several alternatives have been proposed. Controlled clinical studies have been critically reviewed, and mineral trioxide aggregate and ferric sulfate have been considered appropriate alternatives to formocresol for pulpotomies in primary teeth with exposed pulps. In most of the studies reviewed, the caries removal method has not been described. The use of a high-speed handpiece or laser might result in an exposure of a "normal" pulp that would otherwise not be exposed.

Surface antibacterial properties of glass ionomer cements used in atraumatic restorative treatment.

BACKGROUND: Atraumatic restorative treatment (ART) is recommended for use worldwide, not only in developing countries where resources are not readily available, but also in more industrialized countries. The antibacterial properties of restorative dental materials may improve the restorative treatment outcome. Glass ionomer cement (GIC) has been advocated as the preferred restoration material for ART. The authors evaluated the antibacterial properties of restorative materials-three GICs and a zinc oxide eugenol (ZOE)-in vitro. METHODS: Streptococcus mutans, Actinomyces viscosus and Enterococcus faecalis were the test microorganisms. The authors used a quantitative microtiter spectrophotometric assay to evaluate the antibacterial effect of the restorative materials using the direct contact test (DCT) of freshly prepared and one-week-aged materials. RESULTS: The freshly prepared GICs and ZOE showed no bacterial growth in all tested bacteria compared with a control. This effect lasted for at least one week for S. mutans and A. viscosus but not for E. faecalis. CONCLUSIONS: Conventional GICs used in ART showed antibacterial surface properties against cariogenic bacteria for at least one week. Further study on the long-term antimicrobial effects of GICs is needed. CLINICAL IMPLICATIONS: The antimicrobial properties of freshly prepared restorative materials and aged restorative materials used in ART have a potent effect against cariogenic bacteria. These properties have crucial importance in preventing secondary caries.

Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol.

PURPOSE: The objective of this study was to assess the effect of mineral trioxide aggregate (MTA) as pulp dressing material following pulpotomy in primary molars with carious pulp exposure and compare them to those of formocresol (FC). METHODS: Of 33 children, primary molars treated via a conventional pulpotomy technique were randomly assigned to the MTA group (33 teeth) or FC group (29 teeth). Clinical and radiographic follow-up ranged between 4 and 74 months. The mean follow-up time was 38 months, with no difference between the groups. Twenty-nine teeth were followed until uneventful shedding (mean=33 months). Failures were detected after a mean period of 16 months (range=4 to 30). RESULTS: The success rate of pulpotomy was 97% for MTA (1 failure) and 83% for FC (5 failures). Eight teeth presented internal resorption. In 4 of them (2 of each group), progress of the resorption process stopped and the pulp tissue was replaced by a radioopaque calcified tissue. Pulp canal obliteration was observed in 58% of the MTA group and in 52% of the FC group (total=55%). CONCLUSIONS: MTA showed a higher (though not statistically significant) long-term clinical and radiographic success rate than formocresol, and can be recommended as its replacement as, unlike FC, MTA does not induce undesirable responses.

The use of amalgam in pediatric dentistry: new insights and reappraising the tradition.

The debate on amalgam led to its being phased out in some countries. Results of clinical trials report failure rates of amalgams ranging from 12 percent to over 70 percent. Treatment of caries should meet the needs of each particular patient, based on his/her caries risk. In general, for small occlusal lesions, a conservative preventive resin restoration would be more appropriate than the classic Class I amalgam preparation. For proximal lesions, amalgam would be indicated for two-surface Class II preparations that do not extend beyond the line angles of primary teeth. This recommendation might not be appropriate for high-risk patients or restoring primary first molars in children four years old and younger where stainless steel crowns have demonstrated better longevity. Currently, amalgam demonstrates the best clinical success for Class II restorations that extend beyond the proximal line angles of permanent molars. The need to reduce the use of amalgam as a mercury-containing material is inevitable when aiming to reduce environmental contamination. It is important always to praise prevention and constantly search for biologically safe materials regarding health, clinical work, and environment. The purpose of this report was to summarize several factors that affect the effectiveness, advantages, and disadvantages of using dental amalgam in primary teeth.

The use of amalgam in pediatric dentistry.

Amalgam has been widely utilized to restore posterior teeth in pediatric dentistry, and is still taught as the material of choice for Class I and Class II restorations in many dental schools in the United States and Canada. Results of clinical trials are difficult to compare due to their heterogenicity, mainly due to differences in caries risk, operator skills, study duration, or patients' age. Thus, the different studies report failure rates of amalgams ranging from 12% to over 70%. Treatment of caries should meet the needs of each particular patient, based on his/her caries risk. In general, for small occlusal lesions, a conservative preventive resin restoration, using composite or compomer in conjunction with sealant, would be more appropriate than the classic Class I amalgam preparation. For proximal lesions, amalgam would be indicated for 2-surface Class II preparations that do not extend beyond the line angles of primary teeth. This recommendation might not be appropriate for high-risk patients or for restoring first primary molars in children 4 years of age and younger where stainless steel crowns have demonstrated better longevity. Currently, amalgam demonstrates the best clinical success for Class II restorations that extend beyond the proximal line angles of permanent molars.

Success rate of formocresol pulpotomy in primary molars restored with stainless steel crown vs amalga.

PURPOSE: The purpose of this retrospective study was to compare the success rates of formocresol pulpotomy in primary molars restored with stainless steel crowns (SSC) to those restored with amalgam (AM). METHODS: Radiographs of pulpotomized primary molars restored with SSC or AM in the principal author's pediatric dentist practice were evaluated and defined as a "failure" when one or more of the following signs were present: internal (IR) or external (ER) root resorption and periapical (PR) or inter-radicular (IRR) radiolucency. Pulp canal obliteration was not regarded as failure. Three hundred and forty-one molars were available for follow-up evaluations ranging from 6 to 103 months. RESULTS: Forty-seven (14%) teeth were defined as "failure," with a rate of 13% (36/287) for teeth restored with SSC and 20% (11/54) for AM. This difference was not statistically significant (P>0.1). Failure rates of 2 surfaces AM was 23% (7/30), much higher than that of one surface AM (10%, 2/20). Most of the failed teeth presented more than one pathologic finding, with IR being the most frequently observed (36%), followed by ER (31%), IRR (22%) and PR (11%). Pulp canal obliteration was detected in 80% of the teeth, with similar rates in both groups. Failures were observed initially after a mean follow-up of 27 and 29 months in teeth restored with AM and SSC, respectively. CONCLUSIONS: Pulpotomized primary molars can be successfully restored with one surface amalgam if their natural exfoliation is expected within not more than two years.

The diagnostic value of lateral extraoral radiography for intruded maxillary primary incisors.

PURPOSE: The purpose of the study was to assess the contribution of a lateral extraoral radiograph for diagnosing the relation between the root of intruded maxillary primary incisors and their permanent successors. METHODS: Three pediatric dentists examined intruded primary teeth 0-7 days after injury. The relations between the primary and permanent teeth were assessed in three separate steps: 1) evaluation of clinical signs only; 2) evaluation of a periapical radiograph (no lateral radiograph); 3) evaluation of a lateral extraoral radiograph. The clinical and radiographic signs used to assess the relations were recorded. The lateral extraoral radiograph was regarded as contributory to diagnosis if the assessment after the third step differed significantly from that made after the first and second steps. Ninety-three evaluations of 53 intruded teeth in 37 children were available for analysis. RESULTS: The lateral extraoral radiograph was found valuable for assessment of the primary incisor's root alignment in only 5% (5/93) of the evaluations in which neither the clinical examination nor the periapical radiograph were contributory. Four of these five cases were in children less than 20 months old. In all other cases, the lateral radiograph was not contributory for two main reasons: It could not be evaluated due to overlap of multiple intruded teeth and/or when the teeth intruded were lateral incisors, and when the clinical and periapical radiographs were sufficient for diagnosis. CONCLUSIONS: Lateral extraoral radiographs should not be used routinely in cases of intrusion of primary incisors. The operator should base his or her diagnosis on clinical findings and examination of a periapical radiograph. The lateral extraoral radiograph should be taken only when its expected contribution to diagnosis can be confirmed, as in cases of children younger than 20 months.

Long-term clinical performance of esthetic primary molar crowns.

PURPOSE: The aim of the study was to report the long-term clinical performance of esthetic primary molar crowns and compare them to that of stainless steel crowns (SSC). METHODS: Twenty crowns (10 conventional and 10 esthetic) placed in 10 children who had participated in a previously reported study, were assessed again after 4 years. The crowns were evaluated clinically and radiographically according to the following parameters: gingival health, marginal extension, crown adequacy, proper occlusion, proximal contact, chipping of the facing (for esthetic crowns only), and cement removal. RESULTS: At the 4 year evaluation, all the esthetic crowns showed chipping of the facing. No difference was found for marginal extension, occlusion, crown adequacy and periodontal health between SSCs and the esthetic crowns. CONCLUSIONS: After 4 years, all the esthetic crowns presented chipping of the facing and, consequently, a very poor esthetic appearance.

A novel multidisciplinary approach for the treatment of an intruded immature permanent incisor.

The optimal treatment for intruded permanent teeth has not yet been determined. The ideal treatment option is the one with the lowest probability of developing complications such as external root resorption and marginal bone loss. Each case should be considered individually, bearing in mind the severity of the intrusion, the stage of root development, and tooth mobility. Management of an intruded permanent tooth may consist of: (1) observation for spontaneous eruption; (2) surgical crown uncovering; (3) orthodontic extrusion (with or without prior luxation of the intruded tooth); (4) and partial surgical extrusion, immediately followed by orthodontic extrusion and surgical repositioning. The purpose of this article was to review the treatment options for intruded immature permanent incisors, and to present a new modality of an elective internal strengthening of the immature root weakened by external root resorption. A case of an intrusive luxation injury in a 7 1/2-year-old child and the resulting complications utilizing this technique is described. This is the first known report in the pediatric dentistry literature of performing an elective (preventive) internal strengthening of an immature root weakened by severe external inflammatory resorption. The child was followed for 5 years with an excellent clinical outcome. This technique should be considered for treatment of immature permanent teeth with thin cervical root dentin and external or internal root resorption due to trauma or caries.

Comparison of oral midazolam with and without hydroxyzine in the sedation of pediatric dental patients.

PURPOSE: The purpose of this study was to compare the effectiveness of midazolam (MDZ) alone to a combination of MDZ and hydroxyzine (MDZH) when sedating young children for dental treatment. METHODS: This was a prospective, double-blinded, crossover clinical study of young uncooperative children in need of at least 2 restorative visits. Twenty-eight children, ages 21 to 56 months, with a mean age of 36.6 months, participated in this study. The subjects were assigned randomly to receive either 0.5 mg/kg of oral MDZ 20 minutes prior to the beginning of dental treatment or the combination of 0.3 mg/kg oral MDZ with 3.7 mg/kg of hydroxyzine 30 minutes before treatment. The alternative drug regimen was administered at the second appointment. All subjects also received 50% nitrous oxide and were restrained with a papoose board. The child's behavior (quiet or crying, relaxed or moving) was evaluated every 5 minutes by an experienced pediatric dentist who was unaware of the drug given to the child. At the conclusion of treatment, each session was evaluated for overall effectiveness. RESULTS: Regardless of the type of premedication, more patients exhibited quiet behavior at the beginning of treatment, with an increase in crying and movement toward the end of treatment. Regarding movement, a significant difference was observed during the first 20 minutes between the 2 regimens. MDZ showed more children exhibiting movement. During the first 30 minutes of treatment, more children cried in the MDZ group, while MDZH presented more children asleep or quiet. No significant differences were found in behavior as a function of the order the sedative regimens were given. No significant differences between the 2 regimens regarding overall behavior and success (t=0.655 at 27 degrees of freedom; P=.518) were found. CONCLUSIONS: The combination of hydroxyzine (3.7 mg/kg) with MDZ (0.3 mg/kg) administered 30 minutes before treatment resulted in safe and effective sedation for the dental treatment of young children. This combination's use might be more advantageous when compared to MDZ alone, resulting in less crying and movement during the first 30 and 20 minutes, respectively.

Root fillings with Endoflas in primary teeth: a retrospective study.

The aim of this retrospective study is to report the success rate of root canal treatments (RCT) using Endoflas as a filling material in primary teeth. Fifty-five (55 teeth, 27 maxillary incisors and 28 molars) of 47 children fulfilled the criteria to be included in the study. The immediate post-operative radiograph was evaluated and the root filling was rated overfilled, flush or underfilled. Thirty-one (31) teeth were overfilled; of these 9 (29%) were normal pre-operatively and the remaining 22 (71%) presented with bone pathology. Twenty-four (24) teeth were flush or underfilled; of these, 50% had preoperative bone pathology. The children were examined clinically and radiographically at follow-up visits ranging from 6 to 52 months. Approximately 70% of the cases were successful at the last followup examination. The remaining 30% presented with pathology (Po); however, only one tooth had to be extracted (Pi). Overfilling led to a success rate of 58%, while in the combined flush and underfilled the success rate was 83%.

Cross sectional: use of coolant for high-speed tooth preparation: a survey of pediatric dentist members of the American Academy of Pediatric Dentistry.

PURPOSE: To report the findings of a survey to determine the educational experiences, opinions and clinical practices relative to the use of coolant during cavity preparation of pediatric dentist members of the American Academy of Pediatric Dentistry (AAPD) and to determine whether teaching policies influenced the type of coolant used in private practice. METHODS: Four thousand fifty surveys were emailed to AAPD members and included questions regarding demographics and predoctoral, graduate, and current practice policies for the use of dry cutting. RESULTS: Returned survey numbered 1730 for a response rate of 43%. Fifteen percent were taught the concept of dry cutting in their predoctoral programs and 34% in their specialty, programs. Sixty percent never or rarely prepare teeth without water coolant. Slightly more than 40% prepared teeth with air coolant alone. Patient behavior (25%) and sedation (21%) were reported as determining factors for cutting dry. Thirty-one percent of private practice clinicians and 34% of part time academics use dry cutting, while only 15% of full time academicians use the technique (P<0.0001). CONCLUSIONS: Respondents tend to use the technique they were taught during their residency. Use of dry cutting was more likely to be utilized during sedations or general anesthesia to avoid airway compromise.

Endodontic and orthodontic management of traumatically intruded teeth with horizontal root fracture: a case report.

This report describes the case of an 8-year-old boy that was referred to endodontic and orthodontic treatment after suffering an injury that led to intrusion of the maxillary right permanent central incisor, palatal displacement of the upper right lateral incisor, and root fracture of both central incisors. Both injured teeth were immature and had open apices. The intruded tooth was repositioned by endodontic and orthodontic management. Endodontic therapy was performed in both teeth with periodical changes of calcium-hydroxide-based paste as root canal dressing and introduction of MTA as an apical barrier. The postoperative course was uneventful with clinical and radiographic success up to 3 and 1/2 years of follow up. In the present case, orthodontic repositioning combined with endodontic therapy constitued a viable alternative treatment for intrusive luxations in immature permanent teeth.