SHED promote angiogenesis in stem cell-mediated dental pulp regeneration.

Dental pulp, plays an indispensable role in maintaining homeostasis of the tooth. Pulp necrosis always causes tooth nutrition deficiency and abnormal root development, which leads to tooth discoloration, fracture or even loss. Our previous study showed implantation of autologous SHED could regenerate functional dental pulp. However, the detailed mechanism of the implanted SHED participating in dental pulp regeneration remains unknown. In this study, we implanted SHED in a porcine dental pulp regeneration model to evaluate the regenerative effect and identify whether SHED promoted angiogenesis in regenerated dental pulp. Firstly we verified that xenogenous SHED had the ability to regenerated pulp tissue of host in vivo. Then we found the vasculature in regenerated pulp originated from implanted SHED. In addition, stem cells were isolated from regenerated dental pulp, which exhibited good multi-differentiation properties and promoted angiogenesis in pulp regeneration process and these results demonstrated that SHED promoted angiogenesis in stem cell-mediated dental pulp regeneration.

Evaluation of marginal alveolar bone height for early detection of periodontal disease in pediatric population: clinical and radiographic study.

OBJECTIVES: To establish a normal range for the radiographic distance between cementoenamel junction and alveolar bone crest and the factors affecting distances for the early assessment of periodontal disease in Dravidian pediatric population. METHODS: Fifty children aged 6 to 8 years were selected based on inclusion and exclusion criteria. Clinical and radiographic examination was performed. All the surfaces were examined starting from the distal surface of primary canine to the mesial surface of first permanent molar. The various risk factors like plaque, calculus, proximal caries, restoration and bleeding on probing were recorded. A pair of bitewing radiographs was taken for each child. Bitewing radiographs were traced and analyzed. RESULTS: It showed that CEJ-ABC distance in primary teeth is about 1 ± 0.5 mm. In the permanent teeth, it was found to be 0.6 ± 0.5 mm in 6 to 8 years age group. CEJ-ABC distance was also affected by different variables like physiologic (eruption and exfoliation) and pathologic factors (plaque, calculus, dental caries, restorations, stainless steel crowns, bleeding on probing and probing depth). CONCLUSION: CEJ-ABC distances greater than 2.5 mm should be considered under recall and follow-up. Children and adolescents susceptible to periodontal disease should be identified by radiographic means as early as possible in order to prevent the advance of an otherwise possibly destructive disease. The concept of oral health examination and treatment must include examination of the periodontal status of the patient.

Current concepts in hypophosphatasia: case report and literature review.

BACKGROUND. Hypophosphatasia (HP) is characterized by defective mineralization of bone and teeth because of deficient alkaline phosphatase activity. There are generally six recognized clinical forms, of which the most severe is often lethal prenatally or early in life. In milder forms, such as odontohypophosphatasia (OHP), premature exfoliation of primary teeth may be the only clinical manifestation. CASE REPORT. A 20-month-old girl was referred to the Specialist Paediatric Salaried Dental Service within the Harrogate and District NHS Foundation Trust with mobility of tooth numbers 71 and 81. Clinical examination revealed grade III mobile 71 and 81, with minimal gingival inflammation and plaque deposits. There were no other dental findings and no significant medical history. Tooth numbers 71 and 81 exfoliated prematurely with no evidence of root resorption, shortly after presentation. Haematological and urinary investigations showed no abnormalities. Histological examination showed a complete absence of cementum. A diagnosis of OHP was made. After 10 months of dental follow-up, no further teeth have increased mobility. CONCLUSION. Odontohypophosphatasia should be included as a differential diagnosis in children presenting with early loss of primary teeth. The dentist may be the first health care professional to whom the patient presents.

The effect of GIC-brand on the survival rate of proximal-ART restorations.

BACKGROUND: Laboratory studies show diverse behaviour of different brands of glass-ionomer cements (GIC). AIM: This study investigated the clinical performance [survival rate (SR)] of three GIC brands applied to proximal atraumatic restorative treatment (ART) restorations. Additionally, the SR of the tooth was evaluated. DESIGN: Proximal cavities of 262 primary molars were restored. The patients had been randomly allocated to two operators and three GIC brands: Fuji IX, Hi-Dense, and Maxxion R. Restorations were evaluated after 1, 6, 12, 18, 24, 30, and 36 months. Failed restorations were, if possible, repaired or replaced. Linear regression analyses were used to evaluate the effect of GIC brand, operator, and surface of restoration. Kaplan-Meier survival analysis and log-rank test were performed for both restoration survival and tooth survival (α = 5%). RESULTS: After 3 years, 82.4% of the restorations were evaluated. The SR of the restorations was 24.4%, and there was no difference among GIC brands (log-rank test, P = 0.6). In the first 18 months, a significant operator effect and significantly higher failures in distal surfaces were found. The SR of the tooth was 81.7%. CONCLUSIONS: The SR of proximal ART restorations was relatively low when compared with the SR of the tooth. There are no differences in the performance among the GIC brands used in the study.

Autotransplantion of a displaced mandibular second premolar to its normal position.

The patient was a 13-year-old Korean girl who had a displaced mandibular second premolar. She was reluctant to undergo a lengthy orthodontic treatment and opted instead for transplantation of the premolar to its usual site. On the basis of computed tomography, a replica tooth model was manufactured to shorten the extraoral time, and a root canal treatment was performed because root formation was complete. No negative signs or symptoms were found during a 3-year follow up. Autotransplantation for this patient obviated the need for orthodontic traction and prosthetic therapy.

Clinical and SEM characterization of prolonged retention of a primary tooth with pulpectomy.

Root canal filling with zinc oxide-eugenol (ZOE) paste following primary tooth pulpectomy is a common practice in pediatric dentistry. This material offers high clinical and radiographic success rates. In some cases, however, it is not resorbed along with the root of the primary tooth. The aim of this study was to describe a case of prolonged retention of a primary maxillary incisor that was subjected to pulpectomy and filled with ZOE paste in order to characterize the aspects of root resorption using scanning electron microscopy.

Use of the passive lower lingual arch in the management of anterior mandibular crowding in the mixed dentition.

Leeway space preservation in the mixed dentition is a well-documented method of space management. In the mandibular arch it may be saved for utilisation in the correction of minor anterior crowding by the placement of a passive lower lingual arch (LLA) during the transition from the mixed dentition to the permanent dentition.

Hypoplastic root cementum and premature loss of primary teeth in Coffin-Lowry syndrome: a case report.

BACKGROUND: Coffin-Lowry syndrome (CLS) is a rare genetic disorder. The syndrome presents with psychomotor retardation, short stature, skeletal deformations, digit abnormalities, and distinctive facial features. Oral and dental findings in CLS are common and they include thick prominent lips, high palate, midline lingual furrow, hypodontia, microdontia, delayed eruption, and early tooth loss. Only one earlier case suggesting hypoplastic root cementum as cause for primary loss of teeth in CLS has been published. CASE REPORT: This case describes a 3-year-old boy with premature loss of primary incisors without preceding root resorption. In addition to the dental findings, the boy had several general signs and symptoms and the dental findings together with the other characteristics led to the clinical diagnosis of CLS, which later was genetically verified. Histological analysis of an extracted primary incisor showed hypoplastic root cementum. CONCLUSION: Hypoplastic root cementum may explain early tooth loss in CLS. As early loss of primary teeth is rare, especially when there is no previous root resorption, the individual is likely to seek dental care. Thus, the dentist may play an important role in assisting in the diagnosing of CLS.

A retrospective study of a modified 1-minute formocresol pulpotomy technique part 2: effect on exfoliation times and successors.

PURPOSE: The purposes of this study were to evaluate the: effect of a 1-minute application of full-strength Buckley's formocresol with concur- rent hemostasis using the medicated cotton pledget in human primary teeth on their successors; and exfoliation times compared to the contralateral nonpulpotomized tooth. METHODS: Using a retrospective chart review, clinical and radiographic data were available for 557 primary molars in 320 patients. RESULTS: There was no difference between treated and control teeth in the number of enamel defects of succedaneous teeth (P<.45). Approximately 66% exfoliated at the same time as their contralateral counterpart and approximately 29% exfoliated earlier (P<.001). CONCLUSIONS: This 1-minute technique showed a tendency toward early exfoliation, but no effect on clinical management, and no increase in incidence of defects on succedaneous teeth was observed. The 1-minute full-strength formocresol technique may be considered an acceptable alternative to the 5-minute formocresol pulpotomy.

Treatment outcomes of pulpotomy in primary molars using two endodontic biomaterials. A 2-year randomised clinical trial.

AIM: To compare the treatment outcomes of calcium-enriched mixture (CEM) cement and mineral trioxide aggregate (MTA) as pulp dressing biomaterials in vital pulpotomy of carious primary molars. STUDY DESIGN: split-mouth randomised clinical trial. MATERIALS AND METHODS: Forty children aged 4-8 years with 2 carious teeth requiring pulpotomy were selected and randomly assigned to MTA (n = 40) or CEM (n = 40) groups. After coronal pulp removal, the remaining radicular pulp was covered with an appropriate biomaterial; the teeth were then permanently restored. Clinical/radiographic success/failures were blindly evaluated at 6-, 12- and 24-month follow-ups. STATISTICS: the recorded data were analyzed with McNemar test and GEE. RESULTS: A total of 36, 33 and 35 patients were available for 6-, 12- and 24-month follow-ups, respectively. At the 12-month follow-up only one and three teeth in the CEM and MTA groups had pathologic external root resorption, respectively. The resorbed teeth were then missed due to extraction/exfoliation at the 24-month follow-up; all other treated teeth were sign/symptom-free. Overall, clinical and radiographic outcomes in both MTA/CEM groups were comparable at the three follow-ups without significant differences. Time had no significant effect on the success. CONCLUSION: MTA and CEM demonstrated favourable treatment outcomes for pulpotomy of carious primary molars; CEM may be an effective pulp dressing biomaterial.

Early identification and management of mandibular canine ectopia.

Mandibular canine impaction and transmigration have serious consequences for the patient, as removal of the tooth or teeth in question is often the only solution. The loss of one or both mandibular canines complicates orthodontic treatment. Early warning signs of mandibular canine ectopia are explored in this paper as well as how to assess the potential for displacement, impaction and/or transmigration. This paper highlights the value of interceptive treatment once the early signs of an aberrant mandibular canine have been detected.

Can persistence of primary molars be predicted in subjects with multiple tooth agenesis?

The purpose of this research was to create a method for predicting the persistence of primary molars in patients with multiple agenesis. Dental pantomographs (DPTs) from 51 males with agenesis of 5-17 teeth and 54 females with agenesis of 5-21 teeth were investigated. All patients (6 years 9 months to 16 years 7 months) had agenesis of one or both lower second premolars. Patients with ectodermal dysplasia and craniofacial anomalies were not included. The DPTs were classified into two groups according to tooth morphology and agenesis pattern. Group--I-ectodermal symptoms: screwdriver-shaped maxillary central incisors, invaginations in incisors or narrow incisors, taurodontic molar roots, and atypical agenesis. At least two of these ectodermal symptoms had to be present for classification into group I. Group II: one or none of the criteria for group I. Each group was subdivided according to the number of missing teeth. The degree of root resorption of the lower second primary molar was analysed and converted to a metric scale for statistical analysis. Ectodermal status (group I versus group II) was analysed as a binary outcome with agenesis and gender as covariates (logistic regression), whereas ordinary multiple regression was performed in order to study the dependency of root resorption score on gender, ectodermal status, and age. The study showed that subjects with agenesis of more than seven teeth belonged more often to group I than group II, also when correcting for age differences. Root resorption of the primary molars was more severe in group I than in group II.

Agenesis of mandibular second premolars with retained primary molars: a longitudinal radiographic study of 99 subjects from 12 years of age to adulthood.

In subjects with agenesis of the second mandibular premolar teeth, the primary molar may be left in situ. The long-term prognosis of a retained primary molar has not been established in any study that included large number of patients. The aim of this investigation was to monitor the survival of retained mandibular second primary molars, from 12-13 years of age to adulthood. The material comprised the radiographs of 99 subjects, 37 males and 62 females, with retained primary molars and agenesis of 149 mandibular second premolars. In subjects with bilateral agenesis, only one randomly selected primary molar was included to ensure that all primary molars were statistically independent units. Three variables were recorded on intraoral radiographs at 11 registration stages starting at 12-13 years of age: the distance between the permanent molar and the premolar abutting the retained primary molar, infraocclusion of the primary molar, and resorption of the primary molar roots. The mean age at the final registration was 24 years 7 months, [standard deviation (SD) 5.3 3 years, range 18.25-45.44 years]. Paired t-tests were used to analyse changes in the variables and intraclass correlation coefficient (ICC) to determine whether all primary molars could be included in the analyses. During the observation period, only seven of the 99 primary molars were lost due to extensive root resorption, infraocclusion, or caries. Long-term survival may be expected in more than 90 per cent of patients with retained primary molars with agenesis of mandibular second premolars.

How should we manage caries in deciduous teeth?

UNLABELLED: Recent research from the North of England has focused attention on the effectiveness of routine conservation of carious deciduous teeth. This has led to a debate within the profession stimulated by the belief that falling levels of restorative care equate to a failure of clinical care. The results from two major clinical studies suggest that the majority of carious deciduous teeth exfoliate without the child attending his/her dentist with pain and infection if left unrestored. In addition, it would appear that the conventional restoration of such teeth by general dental practitioners does not change the outcome. However, a study from Scotland suggests that untreated carious deciduous teeth increases the risk of sepsis, especially when many carious teeth are present. Further research is needed to help inform clinical decisions. CLINICAL RELEVANCE: This article addresses the central issue of the dental care of young children.

Mineral trioxide aggregate as pulp dressing agent in pulpotomy treatment of primary molars: 42-month clinical study.

PURPOSE: To evaluate the long-term clinical and radiographical results of using gray mineral trioxide aggregate (MTA) in pulpotomy treatments in primary molars. METHODS: A total of 69 primary molars were treated with pulpotomy procedures using MTA and follow-up every 6 months up to 42 months. RESULTS: Clinical success was 100% as none of the molars showed clinical pathologic signs; radiographical success was 98.5% as one case of internal resorption was recorded. Reparative dentin deposition was found as stenosis of the pulp canals in 84% of the cases 42 months after treatment and as dentin bridge formation in 83% of the cases 42 months after treatment. Moreover, 11 permanent successors erupted at their normal exfoliation time without pathology after pulpotomy treatment with gray MTA of the primary molars.

Contemporary space maintenance for the pediatric patient.

Primary teeth play a critical role in the growth and development of a child. In addition to their role in esthetics, eating, speech, and to encourage normal function and resultant expected growth, the other main function of a primary tooth is to hold space for the permanent successor until it is ready to erupt. Space maintenance forms an integral part of preventive and interceptive orthodontics. After the premature loss of a tooth, not only do space maintainers maintain function and preserve arch length, they also maintain esthetics and eliminate any potential psychological damage a child could face as a result of the premature loss of teeth. The space maintainer also allows the permanent tooth to erupt unhindered into proper alignment and occlusion.

Incidence of retained deciduous teeth in a Nigerian population: an indication of poor dental awareness/attitude.

This pilot study aimed at assessing the incidence of retained deciduous teeth in a Nigerian orthodontic population, which could be helpful in teaching, as well as motivation of the community. A total of 361 patients were seen between January 2001 and May 2003 at the orthodontic clinic of University College Hospital, Ibadan, Nigeria, and 60 (16.6%) of them comprising 31 (51.7%) males and 29 (48.3%) females with age range of 7-23 years (mean age, 12.3 + 4.8 SD) presented with retained deciduous teeth. The social classification of the patients was according to the Registrar General's Social Class with no significant differences between the social classes (p > 0.05). Generally, more males had this occlusal anomaly than females. Angle's class I occlusion was found most in the subjects with the anomaly. Bilateral presentation of the anomaly was more than unilateral cases. The incidence was considered high and suggests a need for intensified dental education for the community for earlier preventive/interceptive measures.

Orthodontic movement in deciduous teeth.

Deciduous teeth exfoliate as a result of apoptosis induced by cementoblasts, a process that reveals the mineralized portion of the root while attracting clasts. Root resorption in deciduous teeth is slow due to lack of mediators necessary to speed it up; however, it accelerates and spreads in one single direction whenever a permanent tooth pericoronal follicle, rich in epithelial growth factor (EGF), or other bone resorption mediators come near. The latter are responsible for bone resorption during eruption, and deciduous teeth root resorption and exfoliation. Should deciduous teeth be subjected to orthodontic movement or anchorage, mediators local levels will increase. Thus, one should be fully aware that root resorption in deciduous teeth will speed up and exfoliation will early occur. Treatment planning involving deciduous teeth orthodontic movement and/or anchorage should consider: Are clinical benefits relevant enough as to be worth the risk of undergoing early inconvenient root resorption?

Axonal Degeneration in Dental Pulp Precedes Human Primary Teeth Exfoliation.

The dental pulp in human primary teeth is densely innervated by a plethora of nerve endings at the coronal pulp-dentin interface. This study analyzed how the physiological root resorption (PRR) process affects dental pulp innervation before exfoliation of primary teeth. Forty-four primary canine teeth, classified into 3 defined PRR stages (early, middle, and advanced) were fixed and demineralized. Longitudinal cryosections of each tooth were stained for immunohistochemical and quantitative analysis of dental pulp nerve fibers and associated components with confocal and electron microscopy. During PRR, axonal degeneration was prominent and progressive in a Wallerian-like scheme, comprising nerve fiber bundles and nerve endings within the coronal and root pulp. Neurofilament fragmentation increased significantly during PRR progression and was accompanied by myelin degradation and a progressive loss of myelinated axons. Myelin sheath degradation involved activation of autophagic activity by Schwann cells to remove myelin debris. These cells expressed a sequence of responses comprising dedifferentiation, proliferative activity, GAP-43 overexpression, and Büngner band formation. During the advanced PRR stage, increased immune cell recruitment within the dental pulp and major histocompatibility complex (MHC) class II upregulation by Schwann cells characterized an inflammatory condition associated with the denervation process in preexfoliative primary teeth. The ensuing loss of dental pulp axons is likely to be responsible for the progressive reduction of sensory function of the dental pulp during preexfoliative stages.