Retrospective analysis of the outcomes of pulpotomies in traumatised permanent anterior teeth.

BACKGROUND/AIM: Complicated crown fractures are frequently encountered in the paediatric population and pulpotomy procedures (either partial or coronal) are recommended to maintain the pulp. The aim of this study was to determine the pulp outcomes of permanent teeth with complicated crown fractures treated with pulpotomy in a hospital-setting and to identify potential factors which may influence the outcomes. MATERIAL AND METHODS: Data for this retrospective study were extracted from dental records of patients with complicated crown fractures and treated with pulpotomies at a single centre between 1 January 2015 and 30 August 2019. Pulp outcomes were determined, and the associations between the outcome and independent variables were assessed using the Chi-Square test of independence and the Point-Biserial Correlation Test. Predictors of outcome were identified using the binary logistic regression model. RESULTS: The overall success of pulpotomy in managing traumatised permanent teeth was 61%, which was lower than those previously reported. Pulp healing was seen in 54.1% and 73.7% of teeth treated with partial pulpotomies and coronal pulpotomies, respectively. The presence of a radiographically detectable dentine bridge (p < .01) and longer clinical experience of the clinician (p < .04) was significantly associated with successful outcomes. The history of pain and the stage of root development were identified as significant predictors of the outcome. CONCLUSION: Pulpotomy is a viable treatment modality for complicated crown fractures in the paediatric population. However, appropriate case selection and further training may be required to ensure improved pulp healing outcomes. A longer follow-up period should be considered to identify late-stage complications.

Conservative treatment for deep carious lesions in primary and young permanent teeth.

The management of deeply carious lesion could be accomplished conservatively by two techniques: an indirect single-step and stepwise techniques. The former involves incomplete removal of carious dentin and then application of a well-sealed permanent restoration. While the latter involves incomplete removal of caries and then reentry after a period to remove the residual caries, after changing its environment. The aim of this article was to review the dental literature concerning the conservative methods available to treat deeply carious teeth. A literature search was done using electronic databases "PubMed," "Google Scholar," and "Cochrane Database" for articles in English. Several keywords were used: conservative treatment, deep caries, deeply carious lesion, indirect pulp capping (IPC), and stepwise excavation. This review mentions two operative methods for conservative treatment of deeply carious lesions, namely, IPC, including criteria for case selection and success and failure of the deeply carious lesion, and an account on various used materials. Both single-step and stepwise IPC techniques could be used for managing deeply carious lesions with maintaining pulp vitality; more longitudinal studies are needed to determine which technique is preferable to be used.

Management of pulps exposed during carious tissue removal in adults: a multi-national questionnaire-based survey.

OBJECTIVES: The aim of the present study was to investigate and compare the management of pulps exposed during carious tissue removal by French, German, and Norwegian general dental practitioners (GDPs). We further aimed to assess possible dentist- and patient-related factors associated with these management decisions. MATERIALS AND METHODS: A structured questionnaire was send via mail to a simple random sample of dentists. RESULTS: The analyzed sample consisted of 661 (33%) French GDPs, 622 (25%) German GDPs, and 199 (34%) Norwegian GDPs. No single management method gained uniform consensus in any of the three countries. However, the most preferred management option in all three countries was direct pulp capping (DPC) (68-93%) mainly performed with calcium hydroxide paste/slurry (CH). Alternatively, root canal treatment was performed (7-22%). The reasons that guided GDPs were the same in all three countries; "good results" and "ease of use, familiar with the technique." Having read scientific articles about cariology/operative dentistry in the last 5 years increased the odds for the preference of DPC instead of root canal treatment (OR = 2.1, 95% CI 1.3-3.2). CONCLUSIONS: Among GDPs in France, Germany, and Norway, there was no uniform management option for pulp exposures during carious tissue removal. DPC with CH was the most preferred management, even though the current evidence suggests DPC with mineral trioxide aggregate (MTA) to be more successful. The outcome expectations and the assumed ease of use were reasons for GDPs' choice. Moreover, knowledge on current evidence towards such management options influenced treatment decisions. CLINICAL RELEVANCE: GDPs are encouraged to adopt management options based on current scientific evidence.

Pulp prognosis following conservative pulp treatment in teeth with complicated crown fractures-A retrospective study.

BACKGROUND/AIM: Complicated crown fractures are relatively common in children where the maintenance of the pulp is especially important in young permanent teeth. The aim of this study was to analyze the pulp prognosis of permanent teeth with complicated crown fractures treated with conservative pulp treatment in adolescents. MATERIAL AND METHODS: Complete dental records of teeth with complicated crown fractures treated with conservative pulp treatment were obtained. The risk of pulp necrosis and infection was evaluated by the Kaplan-Meier method and Cox regression (P<.05). Risk factors included gender, age, time interval between dental injury and treatment, stage of root development, type of pulp treatment, and coronal restoration. RESULTS: The study involved 375 teeth treated with direct pulp capping, partial or coronal pulpotomy, and direct pulp capping retreated by pulpotomy (partial or coronal). The frequency of pulp necrosis and infection was 10.1% (11/109) for partial pulpotomy and 9.8% (22/205) for coronal pulpotomy. There was no difference between partial and coronal pulpotomy (P=.673). The risk of pulp necrosis and infection was not significantly different between pulpotomy (partial and coronal; 33/314, 10.5%) and retreatment by pulpotomy (partial or coronal) after direct pulp capping (2/33, 6.1%; P=.436). However, the frequency of pulp necrosis and infection after direct pulp capping (16/28, 57.1%) was significantly higher than that with pulpotomy (partial or coronal; odds ratio=8.216, P<.001). The time interval between dental injury and treatment did not significantly influence pulp survival after pulpotomy (partial or coronal; P=.312), but the stage of root development had a significant impact (P<.001). CONCLUSIONS: Partial or coronal pulpotomy, employed either as a primary pulp treatment or secondary to emergency pulp capping, had similarly satisfactory pulp survival rates.

Management of crown-related fractures in children: an update review.

Traumatic dental injuries (TDIs) are a serious public health problem. Epidemiology of dental trauma indicates that these injuries are more prevalent in child population of the world. Children are the sufferers in two-thirds of all TDIs observed. Although being a major fraction, crown-related fractures are a less severe form of TDIs with respect to their complications and sequelae. However, as with other types of traumatic injuries, the delay in seeking for immediate care following a traumatic injury and the lack of appropriate treatment may compromise long-term outcomes. This article reviews the occurrence, management, and prognosis of crown-related fractures in primary and permanent teeth in light of the recent literature.

Early complications and short-term failures of zirconia single crowns and partial fixed dental prostheses.

STATEMENT OF PROBLEM: Ceramic single crowns fabricated from newer materials, especially zirconia, have shown relatively high survival rates. However, early reversible complications may increase the risk of an irreversible failure later. PURPOSE: The purpose of the study was to evaluate the early complications and short-term failures of zirconia single crowns and partial fixed dental prostheses (FDPs) made by predoctoral dental students. MATERIAL AND METHODS: Data were collected from the patient records. Altogether, 264 zirconia single crowns and 120 FDPs (342 abutments and 190 pontics) were fabricated for 173 patients between 2007 and 2010. Early complications were recorded during the prosthetic treatment phase, and short-term failures were recorded during the first year in use. RESULTS: The most frequent early complications were localized gingival irritation (1.9% of single crowns and 2.5% of FDP) and postoperative tooth sensitivity (0.4% of single crowns and 3.3% of FDPs). Pulp exposure during preparation was recorded in 3 abutment teeth of the FDPs. The most frequent short-term failure was chipping of the veneering porcelain (0.8% for single crowns, 0.8% for FDPs). One crown lost cementation because of poor retention (0.4%), and 2 FDPs failed because of framework fractures (1.7%). CONCLUSIONS: The most frequent early complications were localized gingival irritation and postoperative tooth sensitivity, and the most frequent short-term failure was chipping of the veneering porcelain.

Can we move traumatized teeth?

Dental traumas affect primarily the upper central incisors. The risk is particularly high in cases with protrusive maxillary teeth. Often the trauma will happen in a young patient when the root is not completely formed. With all the complications that can occur on a short-term and also on a long-term, it is legitimate to ask the question of feasibility of orthodontic treatment following a dental trauma. In this article, presenting a clinical case, we will demonstrate that not only is it possible but also that there is a need for orthodontics to minimize the risk of another dental trauma at a later time.

Dens evaginatus: the hornet's nest of adolescent orthodontics.

Dens evaginatus is a rare dental anomaly that occurs during tooth development and results in an abnormal protrusion from the occlusal surface of the affected tooth, often in the area of the central groove between the buccal and lingual cusps. Of clinical importance to the orthodontist is that these occlusal tubercles fracture easily or can be worn away, resulting in direct pulp exposure in a noncarious tooth. This can cause severe complications, including loss of tooth vitality, facial infection in the form of an abscess or cellulitis, or osteomyelitis of the jaw. If extraction of premolars is indicated for orthodontic treatment after careful diagnosis and treatment planning, it is paramount to establish the health of the premolars that will remain in the dentition before extracting the teeth.

Determining treatibility of primary teeth with pulpal exposure.

OBJECTIVES: To determine rates of pulpal exposure during caries removal with an excavator or a bur, to assess success rates of vital pulp therapies in both cases, to analyze pulpal bleeding as an indicator of primary teeth treatability. STUDY DESIGN: Of the 352 primary mandibular molars with deep carious lesions, 141 with pulp exposed during the removal of caries were grouped according to type of instrument causing pulpal exposure and existence of bleeding at the exposure site. Teeth suitable for direct pulp capping or formocresol pulpotomy were treated and followed up for two years. RESULTS: The difference between the rates of pulpal exposure with an excavator (52.5%) or a bur (47.5%) was insignificant. The treatment success rate of teeth with pulp exposed by an excavator (15.8%) was significantly lower than teeth with pulp exposed by a bur (48.8%), regardless of whether bleeding existed at the exposure site or not; however when bleeding existed, this difference was insignificant (15.8% and 40.6%, respectively). CONCLUSIONS: Pulpal exposure possibility during caries removal caused by an excavator and a bur was similar the treatment success rate was lower when the exposure was caused by an excavator the existence of pulpal bleeding resulted in mistakes in diagnoses.

Untreated cavitated dentine lesions: impact on children's quality of life.

The aim of the present investigation was to assess the impact of dental caries prevalence and the consequences of untreated cavitated dentine lesions on quality of life of 6- and 7-year-old Brazilian children. A total of 826 schoolchildren were assessed using ICDAS and pufa (to score consequences of dental caries on soft tissues) indices. History of extraction and toothache was recorded. Oral health-related quality of life was assessed using the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). A multiple logistic regression model was used to analyze the relationship between the prevalence of dentine carious lesions, pufa, history of extraction and toothache with the B-ECOHIS scores. A total of 587 questionnaires were analyzed. The prevalence of cavitated dentine lesions and pufa was 74.8 and 26.2%, respectively. Some 21.8% of children reported toothache and 9.2% had had at least one tooth extraction. The chance (OR) for children with cavitated dentine lesions, pufa ≥1, history of extraction and toothache of having higher B-ECOHIS scores than those not affected was 1.90 (95% CI: 1.18-3.06), 6.26 (95% CI: 3.63-10.83), 6.87 (95% CI: 2.75-17.16) and 3.68 (95% CI: 2.12-6.39), respectively. Children's quality of life was negatively influenced by untreated cavitated dentine lesions and their consequences.

Long-term effectiveness of four pulpotomy techniques: 3-year randomised controlled trial.

A pulpotomy is the therapy for management of pulp exposures due to caries in symptom-free primary molars. The aim was to longitudinally compare the relative effectiveness of the Er:YAG laser, calcium hydroxide and ferric sulphate techniques with dilute formocresol in retaining symptom-free molars. Two hundred primary molars in 107 healthy children were included and randomly allocated to one technique. The treated teeth were blindly reevaluated after 6, 12, 18, 24 and 36 months. Descriptive data analysis and logistic regression analysis accounting for multiple observations per patient by generalised estimating equation were used. Additionally, various influences including tooth type, upper and lower jaws, type of anaesthesia, operator and the final restoration on treatment success were evaluated (Wald chi-square test). After 36 months, the following total (considering clinical and clinically symptom-free radiographic failures) and clinical success rates were determined (in percent): Formocresol 72 (92), laser 73 (89), calcium hydroxide 46 (75), ferric sulphate 76 (97). No significant differences were detected between formocresol and any other technique after 36 months. However, the odds ratio of failure appeared to be three times higher for calcium hydroxide than for formocresol. No significant differences in total success rates were seen regarding the aforementioned influencing clinical parameters. The correct diagnosis of the pulpal status, bleeding control and the specific technique are highly important for long-term success of pulpotomies in primary molars. According to the presented long-term data, pulpotomies using ferric sulphate revealed the best treatment outcome among the used techniques, while calcium hydroxide resulted in the lowest success rates after 3 years. Therefore, we can recommend ferric sulphate for easy and successful treatment of primary molars with caries-exposed pulps.

Recovering the function and esthetics of fractured teeth using several restorative cosmetic approaches. Three clinical cases.

The teeth most commonly affected by trauma are the maxillary central incisors. The most frequent types of traumatic dental injuries to permanent teeth are enamel fractures, enamel and dentine fractures, and enamel and dentine fractures with pulp involvement. This article describes three clinical cases with different levels of traumatized maxillary incisors and several cosmetic approaches for recovery of the esthetics and the masticatory function, as well as the social/psychological aspects of treatment. All cases involved young adult men. The three clinical cases involve dentin and enamel fractures, dentin and enamel fractures with pulp exposure, and dentin and enamel fractures with pulp exposure associated with root fracture. The cosmetic treatments used to resolve fractures were direct composite resin by layering technique, indirect all-ceramic restorations (laminate veneer and ceramic crowns over the teeth), and immediate implant after extraction followed by immediate loading (ceramic abutments with ceramic crown over implant). In all three cases, excellent functional and esthetic results were achieved by use of these treatment modalities. The patients were very satisfied with the results.

Tooth wear among tobacco chewers in the rural population of Davangere, India.

PURPOSE: In India, people chew tobacco either alone or in combination with pan or pan masala, which may cause tooth wear. The purpose of this study was to assess and compare tooth wear among chewers of various forms/combinations of tobacco products in the rural population of Davangere Taluk. MATERIALS AND METHODS: A cross-sectional study was conducted on 208 subjects selected from four villages of Davangere Taluk. Tooth wear was recorded using the Tooth Wear Index by a calibrated examiner with a kappa score of 0.89. The chi-square test was used for statistical analysis. RESULTS: The subjects chewing tobacco had significantly greater tooth wear as compared to the controls (P < 0.001). It was also observed that the frequency and duration of chewing tobacco was directly proportional to the number of pathologically worn sites. CONCLUSION: The abrasives present in the tobacco might be responsible for the increased tooth wear among tobacco chewers.

Clinical management of a fractured anterior tooth with reattachment technique: a case report with an 8-year follow up.

Fracture of anterior teeth is a relatively common outcome of trauma to the teeth. If the fractured teeth fragments are recovered by the patient and brought to the dental office within reasonable time, the fragments may be reattached to the remaining tooth structure. This article presents a case of a 15-year-old male patient with fractured left maxillary lateral incisor. The fragment reattachment was performed using dual-cured composite resin cement and the treatment outcomes of an 8-year follow up were presented. The technique described in this case report for reattachment of the fractured fragments is simple, while restoring providing long-lasting esthetics and improved function with a very conservative approach.

Reattachment of anterior teeth fragments using a modified Simonsen's technique after dental trauma: report of a case.

This is a case report of a 9-year-old boy with complicated crown fractures of two traumatized teeth: left maxillary central and lateral incisors. The central incisor presented a small pulpal exposure of approximately 1 mm and the lateral incisor had an ulcerated and exposed pulp. Endodontic management included direct pulp capping, partial pulpotomy, and restorative management including reattachment of the teeth fragments using a modified Simonsen's technique. The reattached fragments were assessed clinically and radiographically at 12 months. The teeth remained vital, there were no color changes, and the restorations had an acceptable appearance.

A new haemostatic agent's effect on the success of calcium hydroxide pulpotomy in primary molars.

PURPOSE: The purpose of this study was to evaluate the effect of the application of a new hemostatic agent, Ankaferd Blood Stopper (ABS), on the clinical and radiographic success of calcium hydroxide (CH) pulpotomies in primary molars. METHODS: Patients with bilateral vital mandibular primary molar teeth that required pulpotomies, because of pulpal exposure to caries, were selected for this study. After initial hemorrhage control, complete hemostasis into the canal orifice was achieved by: (1) applying a solution of ABS for 10 to 15 seconds; or (2) placing sterile, saline-wetted cotton pellets. Forty teeth in 2 groups were followed up clinically and radiographic at 1, 3, 6, 9, and 12 months. RESULTS: CH group teeth had a total success rate of 90% at 12 months. CH+ABS group teeth had a total success rate of 95% at 12 months. There were no statistically significant differences between CH and CH+ABS group regarding both clinical and radiographic success rates. CONCLUSION: Ankaferd Blood Stopper may be a useful product in the management of pulpal bleeding during a calcium hydroxide pulpotomy.

[Clinical investigation of pulpotomy with Pulpdent Multi-Cal in young permanent anterior teeth].

OBJECTIVE: To investigate the clinical characteristics and prognosis of pulpotomy with Pulpdent Multi-Cal (PMC) in young permanent incisors. METHODS: Twenty-five young permanet incisors with vital pulps and complicated crown fractures were treated by pulpotomy with PMC at the Emergency Department of Peking University School and Hospital of Stomatology. The teeth were checked clinically and radiographically during fixed intervals. Healing of the pulp was considered to have taken place if the following criteria were met: absence of clinical symptoms, absence of apical radiolucency, continued root development in immature teeth, radiographic evidence of dentin bridge formation, and positive response to pulp vitality tests. The results were compared with the teeth which underwent pulpotomy with preparation made by our hospital. RESULTS: Followed up for 6-15 months (median 12 months), on basis of the criteria for pulp healing, all teeth got successful treatment. And all the teeth showed radiographic evidence of dentin bridge formation within 1 to 3 months after pulpotomy. The operation time of PMC pulpotomy was significantly shortened (P<0.01). The root length of teeth performed with PMC pulpotomy and normal teeth had no significant difference (P>0.05). CONCLUSION: PMC is an acceptable material when used in pulpotomy of young permanent teeth.

Association between sociodemographic factors and noncavitated and cavitated caries lesions in 8- to 12-year-old Mexican schoolchildren.

ABSTRACT: The aim of this study was to evaluate the association between sociodemographic factors and noncavitated and cavitated caries lesions in Mexican schoolchildren.This cross-sectional study was conducted in 2020 on 8-to-12-year-old schoolchildren of different socioeconomic status (SES). The caries was evaluated using ICDAS II, SES was evaluated using three categories---a high, middle, or low-income level---of the CONAPO. Multinomial logistic regression analyses were performed in order to ascertain the associations between socioeconomic factors and noncavitated and cavitated caries lesions.The prevalence of noncavitated lesions was 38.0% and cavitated lesions was 43.4% in permanent dentition. In all the samples, 50.6% of schoolchildren had poor oral hygiene. About 52.5% of the mothers and 64.7% of the fathers had less than 9 years of education. Schoolchildren with a low-income level have more cavitated lesions (ICDAS II 4-6) than schoolchildren with high-income level (56.3% vs 15.8%, P = .009). The multinomial logistic regression models showed that mother's level of education <9 years and low-income level were significantly associated with cavitated caries lesions (ICDAS II 4-6), [odds ratio = 1.79 (1.17 - 2.75); P = .007], [OR = 2.21 (1.23 - 3.97); P = .008], respectively. The socioeconomic level was not associated with noncavitated caries lesions (ICDAS II 1-3).An association was found between the presence of cavitated caries lesions and the subject's mother's level of education and a low-income level. Socioeconomic factors were found to be associated with inequalities in caries distribution in the age group studied.

Pulp exposure occurrence and outcomes after 1- or 2-visit indirect pulp therapy vs complete caries removal in primary and permanent molars.

PURPOSE: The purpose of this study was to examine whether 1- or 2-visit indirect pulp therapy (IPT) is more successful and to determine if the operator can successfully decide when to stop removing caries without exposing the pulp. METHODS: A total of 154 teeth (94 primary second molars and 60 young permanent first molars) were included in the study from a total of 123 4- to 15-year-old patients. The teeth had deep carious lesions but lacked the preoperative signs and symptoms of irreversible pulpitis. The teeth were randomly selected and treated either with 1-visit IPT, 2-visit IPT, or direct complete excavation (DCE). Follow-up examinations were conducted on the teeth over 1 year at 3-month intervals. RESULTS: The pulp was exposed in 12 teeth (22%) treated by DCE, whereas 3 teeth (6%) were treated by 1-visit IPT and 4 teeth (8%) with 2-visit IPT. A statistically significant difference was found between IPT and DCE groups in terms of pulp exposure (P<.05). The teeth without pulp exposure showed normal clinical and radiographic conditions during the 1-year follow-up, except for 3 primary teeth. CONCLUSIONS: Indirect pulp therapy in both primary and young permanent teeth can be used successfully with a 1- or 2-visit approach.

Analysis of the crown fractures and factors affecting pulp survival due to dental trauma.

OBJECTIVES: The aim of the present study was to investigate pulp survival following crown fracture with and without pulp exposure as well as with and without associated subluxation and in relation to stage of root development and type of enamel-dentine fracture. MATERIALS AND METHODS: This study consisted of 83 patients with 116 crown fractured incisors without pulp exposure and 35 patients with 44 complicated crown fractures. The effect of variables on the maintenance of tooth vitality were explored using the Linear Regression analysis , which assumes the effects of different factors on the pulp vitality such as (age, stage of the root development, contaminant subluxation, fracture depth, emergency treatment). RESULTS: The general distribution was 59 (71%) boys and 24 (29%) girls with uncomplicated crown fractures aged 7-17 years, mean 10.7 years ±2.83SD and 24 (68.5%) boys and 11 (31%) girls with complicated crown fracture. From 78 uncomplicated crown fractures without subluxation PN (pulp necrosis) was evaluated in 4 (4.88%) cases but from 20 uncomplicated crown fractures with subluxation PN was 14 (56.52%) cases. Univariate analysis showed that stage of root development p<0.05, subluxation p<0.001, fracture depth p<0.001 were significantly related to the pulp survival. CONCLUSIONS: The primary factors related to pulp healing events after crown fracture appears to be compromised pulp circulation due to concomitant subluxation as well as the stage of root development and fracture depth. For incisors with complicated crown fractures there were two more factors related to pulpal healing-time interval from injury until initial treatment and appropriate emergency treatment.