Conservative management of a horizontal root fracture in a primary maxillary central incisor: Case report.

Dental trauma occurs frequently in toddlers and the treatment protocols vary depending on each case. Thus, clinicians must not only plan the treatment but also consider any possible sequelae and characteristics related to the child and the family. The aim of this paper was to report a case of a three-year-old boy who had a horizontal root fracture in the middle third of the primary maxillary right incisor root (tooth 51) and crown discoloration of the primary maxillary left incisor (tooth 61) which were successfully treated with conservative management. The management was established in agreement with the family and was based on active surveillance. The clinical and radiographic follow-ups showed no changes besides pulp canal calcification of the left incisor throughout the eight years of follow-up. The pulps remained normal with no pathological signs throughout their life cycle and the permanent successors erupted normally, presenting an excellent result of the non-invasive approach adopted.

Instrumentation time and effectiveness of hand and rotary files in a prototyped second mandibular primary molar: A micro-CT study.

BACKGROUND: Eccentric instruments have been proposed as more effective and less time-consuming for endodontic instrumentation. AIM: To compare biomechanical outcomes of different instrumentation systems and time undertaken for instrumentation in resin prototypes. DESIGN: Sixty standardized prototypes of mandibular second primary molars were instrumented according to the following systems: K-files, ProTaper Next (PTN), XP-endo Shaper (XPS), XP-endo Finisher (XPF), XP-Clean (XPC), and Sequence Baby File (SBF; n = 10/each). Irrigation was performed with saline with simultaneous aspiration, and time spent was recorded. The prototypes were micro-CT-scanned before and after the instrumentation, and image sets were reconstructed and registered. Non-instrumented areas, accumulated debris, removed root material volume, and canal transportation were quantified. Data were analyzed through ANOVA, the Kruskal-Wallis test, and the Wilcoxon signed-rank test (α = 5%). RESULTS: K-files and SBF resulted in more instrumentation time (p < .05). SBF, XPC and PTN removed less root dentine (p < .05), but PTN left more untouched areas (p < .05). Accumulated debris were lower for XPC and SBF (p < .05). Canal transportation was similar among the groups. CONCLUSION: Rotary systems reduced instrumentation time, whereas SBF and XPC resulted in more conservative instrumentation, with less debris accumulation and non-instrumented areas. A dedicated paediatric endodontic system (SBF) outperformed eccentric instruments in terms of effectiveness.

Cytocompatibility of filling pastes by primary teeth root simulating model.

Evaluate the cytocompatibility of Calen®/ZO, Calcicur®, Vitapex®, Endoflas®, and zinc oxide/eugenol-based (ZOE) root canal pastes (RCP) to human primary osteoblasts (HPO) through a simplified model for primary teeth. The model employed pipette tips filled with 0.037 g of paste, exposed to 185 µL of culture medium for 24 h (n = 6). Release of components was analysed by Proton Nuclear Magnetic Resonance Spectroscopy (1H-NMR). HPO were exposed to conditioned media for 24 h. Cell viability was assessed by cell density and metabolic activity, and release of interleukin 6 (IL-6), vascular endothelial growth factor (VEGF) and fibroblast growth factor (bFGF) by immunological assay. Physicochemical properties and antimicrobial efficacy were also evaluated. 1H-NMR spectra analysis showed similarity between ZOE, Endoflas®, Calcicur®, and Vitapex® compared to Calen®/ZO and positive control, which showed distinct released components. Calen®/ZO and Calcicur® exhibited high alkaline pH in all periods and showed similar solubility. Calen®/ZO, ZOE, and Vitapex® showed similar flow rate. Calen®/ZO, Calcicur®, and Vitapex® did not exhibit antimicrobial efficacy. Calen®/ZO presented cytotoxicity (p < 0.05). Pastes did not increase IL-6 release compared to control. Apart from Vitapex®, all pastes significantly induced VEGF/bFGF release. Interactive effects among released products may affect biological response to filling pastes. Calcicur®, ZOE, Endoflas® and Calen®/ZO presented good to moderate cytocompatibility, with low impact on pro-inflammatory cytokine release and induction of growth factors of interest to tissue repair. This simplified model, specific for the evaluation of the cytocompatibility of RCPs on primary teeth, suggests how these pastes might contribute to bone repair in clinical situations of apical periodontitis in children.

Is there evidence for the use of lesion sterilization and tissue repair therapy in the endodontic treatment of primary teeth? A systematic review and meta-analyses.

OBJECTIVE: To assess whether lesion sterilization and tissue repair (LSTR) technique resulted in similar clinical and radiographic success outcomes as compared with pulpectomy in primary teeth. MATERIALS AND METHODS: Randomized clinical trials comparing LSTR with pulpectomy by means of clinical and radiographic parameters were included. Risk of bias was assessed using Cochrane methodology and the certainty of evidence was determined by GRADE. RESULTS: Six articles were included. Conventional pulpectomy was favored with respect to radiographic success frequency in the systematic review. Four studies were included in meta-analyses. Based on the clinical results at 6 months (RR = 0.99, 95% CI, 0.94-1.04, p = 0.67; I2 = 0%), 12 months (RR = 0.97, 95% CI, 0.90-1.04, p = 0.34; I2 = 0%), and 18 months (RR = 0.89, 95% CI, 0.77-1.04, p = 0.14; I2 = 0%) and radiographic findings at 6 months (RR = 0.91, 95% CI, 0.78-1.06, p = 0.23; I2 = 9%), 12 months (RR = 0.87, 95% CI, 0.65-1.18, p = 0.38; I2 = 64%), and 18 months (RR = 0.84, 95% CI, 0.69-1.02, p = 0.08; I2 = 0%), there was no difference observed regarding success between the two treatments. The quality of evidence ranged from moderate to very low. CONCLUSIONS: No difference between the LSTR and pulpectomy approaches could be confirmed by meta-analyses. The quality of evidence according to the GRADE scheme ranged from moderate to very low. CLINICAL RELEVANCE: The present meta-analyses could not demonstrate the superiority of one treatment over the other.

Root canal obturation materials and filling techniques for primary teeth: In vitro evaluation in polymer-based prototyped incisors.

BACKGROUND: Achieving a void-free root canal filling is a challenge in current clinical pulpectomy practice. AIM: To compare filling effectiveness and internal voids of root filling materials and obturation techniques in resin-prototyped primary incisors by micro-CT. DESIGN: Fifty prototypes were instrumented and randomly divided (n = 10) according to the filling materials (Vitapex® , ZOE, Calcicur® , Feapex, and Calen® -ZO) and obturation technique: lentulo or pressure syringe (n = 5). The specimens were micro-CT scanned (pixel size = 7.83 µm) and reconstructed, and the total volume of filled canal (%FC) and internal voids (%IV) of the bulk filling material was calculated. Kruskal-Wallis and Mann-Whitney tests were used to detect differences and interactions among groups. RESULTS: Calen® -ZO, Vitapex® , and ZOE showed similar %FC. Calcicur® showed lower %FC compared with Calen® -ZO, Vitapex® , and ZOE (P < .05) but similar to Feapex. No statistically significant differences in %FC between lentulo or pressure syringe were disclosed. Regarding %IV, Vitapex® , and Calen® -ZO performed better with syringe, although Calcicur® was better with lentulo. The number of voids in the obturation bulk was similar among materials, but always lower (P < .05) in syringe filled specimens. CONCLUSION: Vitapex® , Calen® -ZO, and ZOE outperformed Calcicur® and Feapex in %FC and if the syringe technique is used, %IV of the obturation bulk and presence of defects was lower.

Reciprocating instrumentation in a maxillary primary central incisor: A protocol tested in a 3D printed prototype.

BACKGROUND: Efficient endodontic instrumentation of primary teeth is a challenge for paediatric dentists. AIM: To evaluate biomechanical outcomes of endodontic instrumentation with a reciprocating system in a polymer-prototyped primary maxillary central incisor. DESIGN: The specimen was systematically instrumented and micro-CT scanned before and after each file. The amount of debris, percentage of non-instrumented areas, removed dentin volume, and lower dentin thickness at specific points along the root canal were analyzed. RESULTS: A 10% increase in removed dentin volume was observed when R40 was compared to R25 (14.5% vs 4.2%). When comparing R50 with R40, this increase was only 3.4% (17.9% vs 14.5%). In the root cervical third, there was substantial reduction in dentin thickness with R50 (48.8%), followed by R40 (39.5%) and R25 (18.6%). There was no difference between R25 and R40 in the removal of dentin at the apical third (15.8%), while R50 resulted in 39.8% reduction in dentin thickness. Percentage of non-instrumented areas were the same for all files. Accumulated debris with R40 and R50 was the same (0.19 mm³) while for R25 was 0.11 mm³. CONCLUSIONS: The Reciproc® system was effective for instrumentation of a prototyped primary maxillary central incisor. The most suitable file for apical preparation was R40.

Salivary pH and colonization by oral Candida in children and adolescents submitted to haemodialysis.

BACKGROUND: Fungal infections are a serious problem among haemodialysis patients. AIM: The aims of this study were to estimate the frequency of oral Candida species among children and adolescents undergoing haemodialysis (HD), to identify the isolated species, and to study the relationship between haemodialysis duration, amounts of colony-forming units, and salivary pH. DESIGN: A matched sample of 52 patients undergoing HD and 52 healthy individuals were selected. The samples were obtained from the dorsum of the tongue, and the colonies were identified through a substrate assimilation test. Stimulated whole saliva was collected from each patient for evaluation of salivary pH. RESULTS: The frequency of oral Candida species was 34.6% (18/52) and 46.20% (24/52) in the HD and control groups (P = 0.23), respectively. Candida parapsilosis complex was the most frequently isolated fungi species in the HD group (P = 0.03). A HD therapy duration of more than 1 year was statistically correlated with a higher number of colony-forming units (P = 0.03) but was not statistically related to salivary pH. CONCLUSIONS: Candida parapsilosis complex was the most frequently isolated fungal species in the young HD patients, and the duration therapy was associated with higher oral colonization.

Can the Enterococcus faecalis identified in the root canals of primary teeth be a cause of failure of endodontic treatment?

OBJECTIVE: This study investigated the presence of Enterococcus faecalis in primary teeth with primary root canal infections and related to the possible failure of pulpectomy outcome after 36 months. MATERIAL AND METHODS: Root canal samples were obtained from 25 out of 244 patients using the sterile paper cone method. The identification of E. faecalis was done with culture and molecular tests using species-specific 16S rRNA gene-based polymerase chain reaction (PCR). After 36 months, the pulpectomy outcome was evaluated. RESULTS: Enterococcus faecalis was found in five (20%) samples, and dental caries were the cause of primary infection in all of them. Pulpectomy outcome was evaluated only in teeth that completed the entire clinical protocol and were followed up to 36 months (n = 8). From these, 75% (n = 6) were successful and 25% (n = 2) failed. E. faecalis was present in 50% of both successful and failed cases. CONCLUSIONS: Enterococcus faecalis was not related to the failure of endodontic treatment of primary teeth.

Does Smear Layer Removal Influence Root Canal Therapy Outcome? A Systematic Review.

OBJECTIVE: The aim of this systematic review was to determine whether the smear layer (SL) removal procedure influences the outcome of root canal treatment. STUDY DESIGN: We performed a search on Pubmed, Scopus, ISI Web of Science, Cochrane Library, Lilacs and SIGLE. We included randomized controlled clinical trials (RCT), with clinical and radiographic outcomes, conducted on subjects who had undergone root canal therapy. The protocol differed only in the SL removal or maintenance procedure. We evaluated the papers for risk of bias according to the Cochrane assessment tool. RESULTS: A total of 1,983 articles were found, after removal of duplicates, 892 remained. We included two studies in this review. One study revealed a low risk of bias and a high success rate for the SL removal group compared to the non SL removal group (P = 0.04), while the other study had a high risk of bias and found no difference between the SL removal and non SL removal groups (P = 1.00). CONCLUSION: We concluded that the SL removal for root canal treatment of primary teeth with initial clinical signs and symptoms or pulpal necrotic status, could benefit the outcome, although further RCT should be performed to achieve evidence.

Role of saliva in the caries experience and calculus formation of young patients undergoing hemodialysis.

OBJECTIVES: The aims of this study were to investigate the caries experience, periodontal status, oral hygiene habits, and salivary parameters of children and adolescents undergoing hemodialysis (HD) and to compare them with their healthy counterparts. METHODS: Fifty-two HD patients were matched for age, sex, ethnicity, and social class with 52 healthy subjects for analysis of the number of decayed, missing and filled teeth, plaque and gingival index, dental calculus accumulation, measurements of pocket depth, clinical attachment level, gingival recession, and bleeding on probing. Stimulated saliva samples were collected to assess salivary flow rate, pH and buffer capacity, and salivary concentrations of calcium, phosphate, and urea by colorimetric method. RESULTS: HD patients had lower dental caries (p = 0.004), greater plaque and calculus accumulation (p = 0.001), and reported flossing less often than the controls (p = 0.013). Regarding salivary analysis, HD patients showed significantly higher values of pH, buffer capacity, and salivary urea concentration when compared to the controls (p = 0.001). CONCLUSION: HD patients had lower caries experience, higher accumulation of dental plaque, and calculus deposition than their healthy counterparts, probably due to the differences found in their salivary biochemical parameters. CLINICAL SIGNIFICANCE: A significant number of children and adolescents undergoing hemodialysis are candidates for kidney transplantation and should receive complete pre-transplant dental exams and dental treatment. Our results open the way for the development of an individualized dental protocol for these patients with preventive measures and treatment of the poor oral health in HD patients.

Lower dental caries prevalence associated to chronic kidney disease: a systematic review.

BACKGROUND: The aim of this systematic review was to determine whether there is any evidence in the literature referring to a lower prevalence of dental caries in children and adolescents with chronic kidney disease (CKD) compared to healthy individuals. METHODS: A search of the PubMed Medline, Ovid Medline and Cochrane Library databases was performed using the MeSH terms "dental caries" and "chronic renal failure". To be eligible for entry in our study, controlled observational studies had to present a decayed, missing and filled index for primary teeth (dmft) and/or for permanent teeth (DMFT) in children and adolescents with CKD. RESULTS: After evaluation of title, keywords and abstracts of the articles selected, six articles met the inclusion criteria. Three of these six articles included studies which showed susceptibility to bias and possible confounding factors. A subsequent assessment of the six studies revealed that the mean caries indices in both primary (dmf) and permanent (DMF) teeth were lower in the children and adolescents with CKD compared with healthy individuals. CONCLUSION: Data in the literature weakly support a lower prevalence of caries in children and adolescents with CKD than in their healthy counterparts. There is still a lack of well-designed studies that provide better scientific evidence in support of this conclusion.

Dental findings in a child with chronic renal failure secondary to cystinosis.

Cystinosis is a genetically determined metabolic disorder whose most prominent feature is end-stage renal disease. This case report describes the dental status of a 12-year-old child with a history of chronic renal failure secondary to cystinosis. Observed dental anomalies included enamel hypoplasia and hypocalcification, delayed dental development, and dental agenesis. Oral manifestations of nephropathic cystinosis are not well documented in the literature, so it is very important to highlight the dental characterizations of this complex disease.

Dental calculus formation in children and adolescents undergoing hemodialysis.

BACKGROUND: This study aimed to determine whether dental calculus formation is really higher among patients with chronic kidney disease undergoing hemodialysis than among controls. Furthermore, the study evaluated correlations between dental calculus formation and dental plaque, variables that are related to renal disease and/or saliva composition. METHODS: The Renal Group was composed of 30 patients undergoing hemodialysis, whereas the Healthy Group had 30 clinically healthy patients. Stimulated whole saliva and parotid saliva were collected. Salivary flow rate and calcium and phosphate concentrations were determined. In the Renal Group the saliva collection was carried out before and after a hemodialysis session. Patients from both groups received intraoral exams, oral hygiene instructions, and dental scaling. Three months later, the dental calculus was measured by the Volpe-Manhold method to determine the rate of dental calculus formation. RESULTS: The Renal Group presented a higher rate of dental calculus formation (p < 0.01). Correlation was observed between rate of dental calculus formation and whole saliva flow rate in the Renal Group after a hemodialysis session (r = 0.44, p < 0.05). The presence of dental calculus was associated with phosphate concentration in whole saliva from the Renal Group (p < 0.05). CONCLUSION: In conclusion, patients undergoing hemodialysis presented accelerated dental calculus formation, probably due to salivary variables.

The influence of smear layer removal on primary tooth pulpectomy outcome: a 24-month, double-blind, randomized, and controlled clinical trial evaluation.

BACKGROUND: The effect of smear layer (SL) removal on primary tooth pulpectomy outcome has not been well elucidated. AIM: To determine the effect of SL removal on primary tooth pulpectomy outcome. METHODS: This is a double-blind, randomized, and controlled clinical trial. Forty-eight patients were randomly divided into SL removal (G1 = 40 teeth) or smear layer nonremoval (G2 = 42 teeth) groups. Following the chemomechanical preparation with K-files and 2.5% sodium hypochlorite (NaOCl), teeth were irrigated with either 6% citric acid and 0.9% physiologic solution (G1) or only 0.9% physiologic solution (G2). Camphorated paramonochlorophenol was used as intracanal medication. At the second appointment, 1 week after, root canals were filled with zinc oxide-eugenol paste. Clinical and radiographical baseline criteria were stipulated equally for both groups. RESULTS: The success rate (G1 = 91.2%; G2 = 70.0%) was statistically different (P = 0.04) between the groups. In G2, the outcome was affected significantly by pulpal necrosis (P = 0.02), pre-operatory symptoms (P = 0.02), and periapical/inter-radicular radiolucency (P = 0.04). CONCLUSION: The pulpectomy outcome was improved by smear layer removal. The outcome for teeth with pulpal necrosis, pre-operatory symptoms, or periapical/inter-radicular radiolucency was significantly improved by removal of the smear layer.

Image-based evaluation of facial fractures in a child using computed tomography.

This article describes the case of a boy who had a fracture of the mandibular parasymphysis region associated with a fracture of the contralateral condyle. Panoramic and computed tomography images were used to monitor bone remodeling.

Oral manifestations arising from oral piercings: A systematic review and meta-analyses.

OBJECTIVE: The aim of this study was to perform a systematic review of oral manifestations arising from oral piercings. STUDY DESIGN: Literature was searched through January 2022 in PubMed, Scopus, Embase, Web of Science, Cochrane Library and Virtual Health Library, OpenGrey, and Google Scholar to address the question, "Is there an association between oral piercings and oral alterations, complications, or lesions?" Quality was assessed using the Joanna Briggs Institute appraisal tools. Meta-analyses were performed, and certainty of evidence was assessed through Grading of Recommendations Assessment, Development and Evaluation (GRADE). Reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Fifty-four studies were included, with 15 achieving good methodological quality. Periodontal and tooth damage were the most reported, followed by soft tissue/mucosal injuries, speech disorders, chewing, soft plaque, and saliva. Pain was the most reported complication, followed by infection, swelling, bleeding, inflammation, allergy, and adornment aspiration. Meta-analyses revealed that 33% of participants with piercings had gingival recession (GR) (event rate [ER] = 0.329). In participants with piercings, ER values for nonspecified dental damage (NSDD), tooth chipping, wear/abrasion, and dental fracture (DF) were 27% (ER = 0.270), 22% (ER = 0.219), 34% (ER = 0.344), and 34% (ER = 0.338), respectively. Certainty of evidence was very low. CONCLUSIONS: Alterations, complications, and lesions were associated with oral piercings and adornments, of which GR, DF, and NSDD were the most prevalent.

Topography and presence of a smear layer in deciduous molars prepared with high-speed cutting and ultrasonic abrasion: an in-vitro study.

OBJECTIVE: The aim of this in-vitro study was to compare the effect of high-speed cutting (HS) with ultrasonic abrasion (US) concerning the internal topography and the presence of a smear layer in a cavity preparation performed in healthy deciduous molars. MATERIAL AND METHODS: Seven first deciduous molars were used. Two occlusal cavity preparation were done, one in the medial fossula and another in the distal fossula, which were chosen randomly. One preparation was carried out with a diamond point adapted to the HS system (GI), while a chemical vapor deposition (CVD) point adapted to a US device (GII) was used for the other preparation. Subsequently, all samples (n = 14) were cleaved to observe the inside and then prepared for evaluation using scanning electron photomicroscopy. The internal topography of the prepared cavities was descriptively analyzed. In order to assess the presence of a smear layer, scores were tabulated using the 2000 GMC program and analyzed using the Mann-Whitney test. RESULTS: Concerning the internal topography, the presence of striae was verified in both groups. In the GI group they were finer, found in a greater number, and with narrower spaces between them. In the GII group, the striae were undulating, similar to the effect of wheels on sand, and with wider spaces between them. As regards the presence of a smear layer, there was no statistically significant difference between the groups (P > 0.05). CONCLUSIONS: In view of the methodology employed, it may be concluded that cavity preparation with a CVD point in a US abrasion system led to the formation of fewer striae and both devices promoted the marked presence of a smear layer, obstructing dentinal tubuli.

Long-term outcomes of primary tooth pulpectomy with and without smear layer removal: a randomized split-mouth clinical trial.

PURPOSE: The aim of this study was to evaluate, via clinical and radiographic assessment, pulpectomy outcomes performed on primary anterior teeth both with and without a citric acid solution to enhance smear layer removal. METHODS: Patients with a matched pair of primary incisors (split-mouth design) with irreversible pulp changes were selected. A total of 36 teeth (18 children) received pulpectomies and were followed for 36 months. Pulpectomies were performed using sodium hypochlorite and saline solution as canal irrigants; during the last irrigation, the tooth was randomly selected to receive ( Group 1) or not receive (Group 2) the citric acid solution for smear layer removal. The roots were filled with ZOE paste. RESULTS: Overall pulpectomy success was 90.6%. Cases with smear layer removal were successful 82.3% of the time; those without smear layer removal, 88.2%, and there were no statistical differences (P=1.00). CONCLUSION: Pulpectomy with smear layer removal in primary incisors exhibited, after 36 months, a high success rate; however, comparable results were obtained when the smear layer was not removed.

Ectopic eruption of permanent incisors after predecessor pulpectomy: five cases.

Pulpectomy in primary teeth is a common technique that preserves teeth in the oral environment and maintains or recovers periapical tissues to a healthy condition. This article describes the ectopic eruption of permanent incisors whose primary predecessors underwent pulpectomy using ZOE filler paste. In a group of 135 teeth that received pulpectomy therapy due to caries, 10 primary maxillary incisors had overretention and were followed for at least 3.5 years (mean time of 4.2 years), both clinically and radiographically, until the permanent teeth erupted. The proposed treatment included extraction of the overretained primary incisors based on permanent successor eruption chronology and contralateral eruption. Seven permanent teeth erupted ectopically. Autocorrection of the permanent tooth positions was observed in five cases. It can be concluded that periodic clinical and radiographic assessments are essential to verify radicular and filling paste resorptions and to avoid overretention and any subsequent malocclusion.

Micro-CT evaluation of root canal preparation with rotary instrumentation on prototyped primary incisors.

This study aimed to evaluate the endodontic instrumentation outcomes with asymmetrical files compared to reciprocating and hand files (HFs) in 3D-printed prototypes of upper primary incisors using micro-computed tomography (micro-CT). For this purpose, 50 prototypes were randomly divided (n = 10) according to the instrumentation technique as follows: HFs, a reciprocating file (WaveOne® Gold [WOG]), and three asymmetrical movement files: XP-Endo® Shaper (XPS), XP-Endo® Finisher (XPF), and XP Clean (XPC). The specimens were scanned and, after registration of the baseline and instrumented volumes, changes in the root canal volume (RCV), debris accumulation, removed root material volume (RRMV), non-instrumented areas, and the presence of cracks/perforations were quantified. Data were analyzed by analysis of variance and Student's t-test, while the effect size was calculated for statistically significant outcomes. All groups showed an increase in RCV after instrumentation (p < 0.05), but this was higher with HFs (p < 0.05). Accumulated debris was higher for WOG and XPS (p < 0.05), but WOG exhibited more in the medium and apical third areas. HFs showed the highest RRMV (p < 0.05), especially at the apical third. The non-instrumented areas were lower for HFs and XPC than for the other systems (p < 0.05). Cracks were present in a few WOG (n = 2) and HF specimens (n = 3) and in this group, one of the cracked specimens and two others showed perforations. The asymmetric systems resulted in conservative dentin removal and fewer cracks/perforations as compared to HFs and a reciprocation file in prototyped primary upper incisors. XPC showed the best compromise between RRMV and non-instrumented areas with a low accumulation of debris.