The risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment: a systematic review and meta-analysis.

PURPOSE: To identify the factors affecting the risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment. METHODS: The study protocol followed the best practices of evidence-based medicine and was registered in PROSPERO. A comprehensive literature search was performed electronically in six databases (PubMed, Embase, SCOPUS, Web-of-Science, Lilacs, and Cochrane) on 18-09-2023. It was saved in EndNote-online and duplicates were removed. Selection of articles was performed in two stages, followed by data-extraction, risk of bias assessment, data-analysis, and meta-analysis. The quality of evidence for the outcomes was assessed by the GRADE-approach. RESULTS: The study included six articles that had similar selection protocols with variations in duration from trauma to treatment and the observation period. Only one study employed pre-attachment fragment preparation and three performed post-attachment reinforcements. Overall loss of fragment was 20% (95%CI-13,30%). When the risk ratio for loss of restoration or fragment was compared, it was found to be 2.21 (95%CI-1.52,3.21) in uncomplicated crown fractures, 2.54 (95%CI-1.35,4.79) in complicated crown fractures. The risk of bias was found to be low in two and moderate in four studies. Grade of evidence for all the outcomes was very low. CONCLUSION: Fragment loss was lowest in uncomplicated crown fractures where reinforcement had been performed, and highest when bonding was done in complicated crown fractures without reinforcement. The risk of fragment loss was higher than the loss of composite restorations.

Clinical and radiographic performance of preformed zirconia crowns and stainless-steel crowns in permanent first molars: 18-month results of a prospective, randomized trial.

BACKGROUND: The treatment of young permanent first molars with extensive carious tissue loss may often require restoration with preformed crowns. This study compared the clinical and radiographic performance of stainless-steel crowns (SSCs) and preformed zirconia crowns (ZCs). METHODS: Forty-eight molar incisor hypomineralisation (MIH)- or caries-affected permanent molars in 20 healthy patients between 6-13-year-old were randomly divided into ZC and SSC groups (n = 24 teeth/group) in a split-mouth design. The oral hygiene levels of patients were assessed using Greene and Vermillion simplified oral hygiene index (OHI-S). Plaque accumulation and gingival health were evaluated using the Silness&Löe plaque index (PI) and Löe&Silness gingival index (GI), respectively. Clinical retention, marginal extension level, marginal adaptation of crowns and wear of the antagonist teeth were assessed at baseline, 1, 6, 12 and 18 months. The radiological assessments for evaluating the marginal adaptation of crowns and periapical pathology of crowned teeth were performed at 6 and 12 months. The data were analyzed using Kaplan-Meier analysis, Mann-Whitney U test, and two-way ANOVA. RESULTS: A total of forty teeth in 17 children were evaluated for 18 months. ZCs had significantly lower gingival and plaque index values than teeth restored with SSCs during all evaluation periods (p < 0.05). Neither crown type resulted in clinically-detectable wear on opposing dentition or periapical pathology. One ZC was lost at 13 months, while all SSCs survived in function clinically. The cumulative survival rates of ZCs and SSCs were 95.2% and 100% respectively. CONCLUSIONS: Both ZCs and SSCs showed high clinical retention rates in young permanent molars. ZCs had lower plaque accumulation and better gingival health than SSCs, which were consistently associated with mild gingival inflammation. CLINICAL TRIAL REGISTRATION NUMBER: NCT05049694.

Management of initial carious lesions of hypomineralized molars (MIH) with silver diamine fluoride or silver-modified atraumatic restorative treatment (SMART): 1-year results of a prospective, randomized clinical trial.

OBJECTIVES: This study evaluated and compared the effect of silver diamine fluoride (SDF) and silver-modified atraumatic restorative treatment (SMART) sealants for the treatment of initial carious lesions of permanent molars affected by molar incisor hypomineralization (MIH). METHODS: One hundred and twelve hypomineralized permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF and SMART sealant groups (n = 56 teeth/group) in a split-mouth fashion. Hypersensitivity, formation of caries, and enamel breakdown were evaluated in both groups. Hypersensitivity was assessed by Schiff Cold Air Sensitivity Scale (SCASS), and clinical assessments of SMART sealants were performed according to modified USPHS criteria at 1, 6, and 12 months. The data were analyzed statistically using Fisher's exact test, Kaplan-Meier analysis, Mann-Whitney U test, and Friedman test. RESULTS: Twenty-six hypomineralized molars with marked baseline hypersensitivity showed significantly lower SCASS scores at all evaluation periods (p < 0.001). There was no significant difference in hypersensitivity scores between the groups at the repeated applications of SDF at 1, 6, and 12 months. The cumulative survival rates of SMART sealants on occlusal and palatal surfaces were 88.7% and 58.8%, respectively. CONCLUSIONS: In hypomineralized molars, both SDF and SMART sealants showed favorable short-term prevention against dental caries while providing effective desensitization. Marginal discoloration was the most common side effect of the SMART sealants as a result of SDF application. CLINICAL SIGNIFICANCE: Both SDF and SMART sealants showed similar short-term effectiveness as non-aerosol procedures in arresting enamel caries and reducing hypersensitivity in hypomineralized molars. TRIAL REGISTRATION: Clinical Trials Registration Number: NCT03862014.

Ten-year follow up of previously traumatized immature permanent incisors sustaining second and third traumatic injuries after revascularization treatment: Case reports.

The long-term prognosis of previously traumatized immature permanent teeth treated with guided endodontic repair is well documented, but little is known about how these teeth respond to further traumatic injury after treatment. This case report presents the 10-year clinical and radiographic findings of two patients with traumatized maxillary incisors who underwent guided endodontic repair treatment and sustained two further traumatic injuries. Three crown-fractured maxillary central incisors with pulp necrosis were treated with a protocol that used 2.5% NaOCl irrigation, 3-4 weeks medication with calcium hydroxide or ciprofloxacin-metronidazole paste, induction of apical bleeding, and coronal sealing with mineral trioxide aggregate. One tooth sustained subluxation and a crown fracture after 20 months and 7 years, respectively. Two other teeth had a luxation injury at 9 months and subluxation 6.5 years after the repair treatment. One subluxated and one luxated tooth remained free of symptoms for 10 years with radiographic evidence of progressive root canal calcification, while the other luxated incisor required root canal treatment after 7.5 years. Although teeth treated with the so-called "regenerative" endodontic techniques do not possess true pulp tissue, the reparative tissue may respond to traumatic injuries in a similar manner to teeth with normal pulps.

The International Association of Dental Traumatology ToothSOS mobile app: A 2-year report.

BACKGROUND/AIM: The shift in health care and technology calls for innovation through mobile applications as free educational resources for the masses. The International Association of Dental Traumatology (IADT) created ToothSOS, an app (software application for mobile devices) to provide dental trauma information for patients and professionals. The app contains information on the emergency management and prevention of dental injuries, as well as treatment guidelines for dental practitioners. The aim of this study was to assess public utilization of the ToothSOS app in the first 2 years since its launch. METHODS: The ToothSOS app was launched by the IADT in the first week of April 2018. Data regarding the number of downloads and usage of the app in the first 2 years (from April 2018 to May 2020) were collected and analyzed. RESULTS: The total number of ToothSOS downloads over the 2 years was 47 725. The number of downloads peaked in the first month when the app was initially released. Thereafter, the number of downloads decreased to an average of 1423 ± 363 downloads every month. Europe was the territory with the greatest number of downloads followed by the United States and Canada, Asia, Latin America and the Caribbean, and Africa, the Middle East, and India. CONCLUSIONS: Within as short a period as 2 years, the ToothSOS app continues to gain public interest. Further attempts and public campaigns should be made in order to increase the visibility of the app. Dental professionals should encourage patients and communities to use the app in order to increase awareness for the prevention and proper emergency management of traumatic dental injuries.

Prevalence of Premature Eruption and Agenesis of Premolars in Turkish Children: A Retrospective Study.

OBJECTIVE: To determine the prevalence and distribution of premature eruption and agenesis of premolars in a sample of Turkish children. STUDY DESIGN: A sample of 1715 patients aged 5 to 11 years was selected. Panoramic radiographs were used to assess premature eruption and agenesis of premolars. Developmental stage of erupted premolars was assessed using Demirjian's method and selecting prematurely erupted premolars on the basis of clinical eruption with a root length less than half of their final expected root lengths. Statistical analysis was performed using chi-square test (p <.05). RESULTS: One hundred fifteen (6.7%) of 1715 patients presented at least one premolar agenesis with no significant sex difference (56 boys, 59 girls). Mandibular second premolars were the most absent teeth. Multiple agenesis of premolars (3.4%) was more common than single agenesis (3.3%). A total of 85 (5.0%) patients (51 boys, 34 girls; no significant sex difference) had at least one prematurely erupted premolar, and maxillary first premolars were most commonly affected. Early erupted premolars were in stage D or E based on Demirjian's dental formation scale. CONCLUSIONS: The prevalence of premature eruption and agenesis of premolars in Turkish children were 5.0% and 6.7%, respectively. Both conditions are not uncommon and may highlight the need for early diagnosis to prevent subsequent clinical problems.

Tooth Discoloration Induced by Different Calcium Silicate-Based Cements: A Two-Year Spectrophotometric and Photographic Evaluation in Vitro.

OBJECTIVE: Calcium silicate-based cements (CSCs) may lead to coronal staining in young permanent teeth over the time. The purpose of this study was to evaluate and compare the long-term tooth discoloration induced by different CSCs. STUDY DESIGN: Ninety freshly-extracted human molars were assigned randomly into 6 groups (n=15/group) according to the CSC used as a pulpotomy material: ProRoot MTA, MTA Angelus, NeoMTA, EndoSequence Putty, Biodentine and Negative control (No cement). The color was assessed at baseline, and thereafter at 3, 6, 12 and 24 months by using both a spectrophotometer and digital images taken with and without a cross-polarizing filter. The time-dependent changes in color (ΔE) were compared within and among groups using Analysis of Variance. RESULTS: Angelus MTA and ProRooT MTA showed severe coronal discoloration (p>0.05) starting at 3 months. ΔE values of NeoMTA, EndoSequence Bioceramic Putty and Biodentine were below the perceptibility threshold, with Biodentine showing greater ΔE values than NeoMTA and EndoSequence Putty in the absence of statistical significance (p>0.05). CONCLUSIONS: Discoloration elicited by CSCs may develop soon after placement, and continue to increase for up to two years. Angelus MTA and ProRooT MTA cannot be recommended for vital pulp therapies in the esthetic zone of young individuals.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth.

Avulsion of permanent teeth is one of the most serious dental injuries. Prompt and correct emergency management is essential for attaining the best outcome after this injury. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. It represents the current best evidence and practice based on that literature search and expert opinions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on consensus opinions or majority decisions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. The purpose of these Guidelines is to provide clinicians with the most widely accepted and scientifically plausible approaches for the immediate or urgent care of avulsed permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition.

Traumatic injuries to the primary dentition present special problems that often require far different management when compared to that used for the permanent dentition. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions or majority decisions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. The primary goal of these Guidelines is to provide clinicians with an approach for the immediate or urgent care of primary teeth injuries based on the best evidence provided by the literature and expert opinions. The IADT cannot, and does not, guarantee favorable outcomes from strict adherence to the Guidelines; however, the IADT believes their application can maximize the probability of favorable outcomes.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations.

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations of these teeth are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning, and follow up are important for achieving a favorable outcome. Guidelines should assist dentists and patients in decision making and in providing the best care possible, both effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. These Guidelines represent the best current evidence based on literature search and expert opinion. The primary goal of these Guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines cover the management of fractures and luxations of permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.

A micro-computed tomographic assessment of root canal preparation with conventional and different rotary files in primary teeth and young permanent teeth.

BACKGROUND: Root canals of primary teeth are commonly prepared with endodontic files that are originally manufactured for permanent teeth. AIM: This micro-computed tomography (micro-CT) study evaluated and compared the changes in root canal morphology after preparation with different conventional and rotary files in primary teeth and young permanent teeth. DESIGN: Seventy-two extracted primary and permanent molars were selected and randomly assigned to three subgroups according to the file systems used (n = 12/each). After pre-scanning of teeth with micro-CT, root canals were prepared with One Shape and Revo-S rotary systems and conventional endodontic files. After rescanning procedure, changes in canal volume, surface area, uninstrumented surface area, and apical transportation were evaluated. Mann-Whitney U test, Kruskal-Wallis test, and Conover's multiple comparison test were used for statistical analysis (P = .05). RESULTS: Instrumentation with rotary files resulted in significantly greater volume and surface area of root canals and less uninstrumented areas (P < .001) than with manual files (P < .001). Primary molars showed significantly less apical transportation than permanent teeth (P < .001). CONCLUSIONS: Preparation of canals with rotary files could be a viable alternative to conventional files in primary teeth. Regardless of the file system used, uninstrumented areas still exist in both primary teeth and permanent teeth.

Effect of Light Cure Methods for Intermediate Adhesive Layer on Microleakage of Sealants. An in Vitro Study.

Background: The objective of this study was to determine the effect of an adhesive layer and its photopolymerization on the microleakage of sealants. Study design: 0.5mm-deep standardized fissurectomies were performed on extracted molars (n = 72). Teeth were randomly assigned to 3 different sealant materials (n = 24/group). Teeth were further divided to receive sealants with or without an adhesive layer. Each sealant with adhesive was also divided into two groups: adhesive was light-cured separately or light cured together with the sealant. Following thermocycling, microleakage was assessed using dye penetration and image analysis. Data was analyzed using ANOVA and Tukey's studentized ranged HSD tests. Results: Microleakage was not affected by type of sealant material (p>0.05) but was significantly influenced by application (p<0.05). Overall, placement of sealants without adhesive displayed greater microleakage than sealants with uncured adhesive (p<0.05). Within individual sealant types, this difference was only significant for Ultraseal XT (p<0.05). Sealants bonded with and without prior light curing did not show a significant difference in levels of leakage (Tukey's Studentized Range Test, p>0.05). Conclusion: An adhesive layer should be placed beneath sealants, but whether it should be light cured or left uncured before sealant placement varies by the sealant type.

Effectiveness of pit and fissure sealants bonded with different adhesive systems: a prospective randomized controlled trial.

OBJECTIVES: To evaluate and compare the clinical retention of a resin-based fissure sealant placed with an intermediate layer of etch-and-rinse (ER) or self-etch (SE) adhesives. MATERIALS AND METHODS: Two hundred twenty-eight sealants were placed in 57 children with previously unsealed, caries-free permanent first molars, employing a split-mouth design. The teeth were randomized into four groups (n = 57 teeth/groups) according to the adhesive system placed under the tested sealant (Delton FS+; Dentsply). Group 1 (control): no bonding agent (conventional acid-etch sealant); group 2: prior enamel etch + ER adhesive (XP Bond; Dentsply); group 3: SE adhesive (Clearfil SE Bond; Kuraray) without prior etching; and group 4: prior enamel etch + SE adhesive (Clearfil SE Bond). Clinical assessments were performed according to modified USPHS criteria at 1, 3, 6, 12, 18, and 24 months. The data were analyzed statistically using Fisher's Exact test, the Kaplan-Meier analysis, and the Log-rank test. RESULTS: At 24 months, sealants bonded with XP Bond and Clearfil SE Bond with prior enamel etching showed similar retention rates (p > 0.05), and these rates were significantly better than the rates of the conventional sealant and Clearfil-SE groups (p < 0.05). There was no significant difference between the retention rates of the latter two groups (p > 0.05). The cumulative survival rates on palatal/buccal surfaces showed similar outcomes as with occlusal surfaces: XP Bond (94%), Clearfil SE Bond + acid-etch (94%), conventional sealant (52%), and Clearfil SE Bond only (37%). CONCLUSIONS: Application of the tested ER adhesive and the SE adhesive with enamel etching significantly improved the clinical retention of Delton-FS over the 24-month period. CLINICAL RELEVANCE: The use of a resin-based fissure sealant placed with ER or SE adhesive with prior acid-etching yielded better retention than the conventional sealant over the 24-month period.

Antibacterial effect of N-acetylcysteine and taurolidine on planktonic and biofilm forms of Enterococcus faecalis.

AIM: This study investigated the antimicrobial activity of taurolidine and N-acetylcysteine (NAC) on planktonic and biofilm Enterococcus faecalis phenotypes. MATERIALS AND METHODS: The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of NAC and taurolidine were determined using broth microdilution, utilizing calcium hydroxide (CH), sodium hypochlorite, and chlorhexidine for comparisons. Thereafter, the ability of dentin powder to neutralize the antibacterial activity of NAC and taurolidine was studied. The efficacy of both antimicrobial agents on E. faecalis biofilms was examined quantitatively by exposure of 21-day-old E. faecalis biofilms on dentin disks. The cytotoxicity of human dental pulp fibroblast cells in contact with the extracts was evaluated by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyltetrazolium bromide (MTT) assay. RESULTS: The MIC and MBC of NAC, taurolidine, and CH were not affected by pre-incubation in dentin powder. As verified by qualitative assay of E. faecalis biofilms, CH was the strongest bactericidal agent at all test dilutions, regardless of the presence of dentin powder. The antibacterial effect of NAC and taurolidine was significantly lower than that of CH at all test dilutions. At 48 h, all test agents showed similar, but high levels of cytotoxicity. CONCLUSION: NAC and taurolidine were effective against E. faecalis in planktonic state, at the expense of demonstrating cytotoxic effects. For both planktonic and biofilm forms of E. faecalis, neither NAC nor taurolidine offered any advantage over CH.

Evaluation of goat milk as storage media to preserve viability of human periodontal ligament cells in vitro.

BACKGROUND AND AIM: The purpose of this study was to evaluate the effectiveness of goat milk as a storage media for maintenance of periodontal ligament (PDL) cell viability of avulsed teeth and compare it with commonly used and/or investigated storage media. MATERIALS AND METHODS: PDL cells were obtained from the root surface of healthy premolars and were cultured in Eagle's maintenance medium (EMM). Cell cultures were treated with the following storage media: tap water (negative control); EMM (positive control); Hank's balanced salt solution; ultra high temperature (UHT) long-shelf-life lactose-free cow milk; UHT long-shelf-life whole cow milk; UHT long-shelf-life skimmed cow milk; UHT long-shelf-life soy milk; UHT long-shelf-life goat milk, UHT long-shelf-life follow on milk with probiotic, 20% propolis, and egg white. Culture plates were incubated with experimental media at 20°C for 1, 3, 6, 12, and 24 h. PDL cell viability was assessed by tetrazolium salt-based colorimetric (MTT) assay at each test period. One-way anova was used to evaluate the effects of storage solutions at each time point, followed by post hoc Duncan's multiple comparison test (P = 0.05). A dendrogram was constructed to show the arrangement of hierarchical clustering. RESULTS: Goat milk displayed the highest capacity to maintain cell viability at all test intervals (P < 0.001). Between 3 and 24 h, milk with the probiotic showed the lowest time-dependent PDL cell viability among all test media (P < 0.001). Compared with all milks, HBSS performed significantly less effectively in maintaining PDL cell viability during the entire test period (P < 0.001). CONCLUSION: Based on PDL viability, goat milk can be recommended as a suitable storage medium for avulsed teeth.

Bond strength of mineral trioxide aggregate to root dentin after exposure to different irrigation solutions.

AIM: The aim of the study was to evaluate the regional push-out bond strength of mineral trioxide aggregate (MTA) after exposure to sodium hypochlorite (NaOCl), ethylenediaminetetraacetic (EDTA), and peracetic acid (PAA) irrigation solutions. MATERIALS AND METHODS: 1-mm-thick longitudinal slabs of root dentin were obtained from freshly extracted human canine teeth (n = 80). Simulated root perforation defects, 1 mm in diameter, were prepared in the coronal, middle, and apical thirds of radicular dentin. Mineral trioxide aggregate was placed into the cavities, and the specimens were stored for 1 week at 37°C. Thereafter, the specimens were randomly divided into four groups (n = 20) according to the irrigation solution applied over the repair sites: Group 1-10 ml of 5.25% NaOCl for 10 min; Group 2-10 ml of 5.25% NaOCl for 10 min, followed by 5 ml 17% EDTA for 5 min; Group 3-10 ml of 5.25% NaOCl for 10 min, followed by application of 5 ml 1% PAA for 5 min; and Group 4-no irrigation. Push-out test was performed at a crosshead speed of 1 mm/min. Debonding values were compared statistically using two-way analysis of variance and Tukey tests (P < 0.05). RESULTS: The push-out bond strength of MTA was not affected by the type of irrigation solution or location of the perforation defects (both P < 0.05). Stereomicroscopic inspection of the samples showed that the bond failure was predominantly adhesive. CONCLUSION: Exposure of repaired root perforations to 5.25% NaOCl, 17% EDTA, or 1% PAA does not alter the dislocation resistance of MTA at different locations of root dentin.

Clinical comparison of silver diamine fluoride (SDF) or silver-modified atraumatic restorative technique (SMART) on hypomineralised permanent molars with initial carious lesions: 3-year results of a prospective, randomised trial.

OBJECTIVES: This study aimed to assess the clinical outcomes of utilizing silver diamine fluoride + potassium iodide (SDF + KI) treatment and Silver-Modified Atraumatic Restorative Technique (SMART/SDF + KI + Glass Ionomer Cement) over a three-year period on hypomineralised permanent molars with initial carious lesions. METHODS: 112 hypomineralised permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF + KI and SMART (SDF + KI + GIC) groups (n = 56 teeth/group) in a split-mouth design. Hypersensitivity and caries development were evaluated in both groups. Schiff Cold Air Sensitivity Scale (SCASS) was used for evaluation of hypersensitivity, and the modified USPHS criteria were utilised for clinical assessments of SMART sealants at 1,6,12,18,24 and 36 months. Fisher's Exact test, Kaplan-Meier Survival Curves, Log-rank test, Mann Whitney U test, and Friedman test was performed for the statistical analysis. RESULTS: The caries preventive effect was 100 %, 67.9 % and 65.4 % for SDF + KI-treated teeth; and 100 %, 97.6 % and 94.7 % for SMART(SDF + KI + GIC)-treated teeth at 12, 24 and 36 months, respectively. The mean survival probabilities for caries-preventive effect were significantly lower in SDF + KI-treated teeth (31.01 months) than SMART-treated teeth (35.61 months), (p < 0.001). Twenty-six molars with initial hypersensitivity due to hypomineralization demonstrated a significant reduction at all evaluation periods compared to baseline SCASS scores (p < 0.001). Additionally, there was no significant difference in hypersensitivity scores between the groups during the re-call periods, and none of the teeth exhibited hypersensitivity at the 18-month and beyond evaluations. CONCLUSIONS: During the three-year assessment, both groups demonstrated effectiveness in reducing sensitivity in hypomineralised molars. However, SMART (SDF + KI + GIC) sealants offered better protection against tooth decay over time, despite experiencing gradual retention loss. CLINICAL SIGNIFICANCE: Both SMART (SDF + KI + GIC) sealants and SDF + KI proved effective in alleviating hypersensitivity in hypomineralised molars for up to three years. SMART (SDF + KI + GIC) sealants showed greater caries-preventive effect compared to SDF + KI. However, continuous long-term monitoring is crucial due to the gradual decline in retention of SMART (SDF + KI + GIC) sealants. CLINICALTRIALS REGISTRATION NUMBER: NCT03862014.

A comparison of residual smear layer and erosion following different endodontic irrigation protocols tested under clinical and laboratory conditions.

OBJECTIVE: To compare the smear layer removal efficacy and erosive effects of different irrigation protocols under clinical and laboratory conditions. MATERIALS AND METHODS: Mandibular third molars (n = 32) of 30-45 year-old patients were instrumented with rotary files and were randomly assigned to one of the following groups for final irrigation: (1) 5.25% NaOCl; (2) 17% EDTA; and (3) BioPure MTAD. Thereafter, the teeth were immediately extracted and processed for micromorphological investigation. In vitro specimen pairs were prepared by repeating the clinical experiments on freshly-extracted mandibular third molars. To compare open and closed systems, laboratory experiments were repeated on 32 additional teeth with enlarged apical foramen. The cleanliness of the root canals and the extent of erosion were assessed by environmental scanning electron microscopy. RESULTS: Specimens prepared under clinical and laboratory conditions had similar cleanliness and erosion scores (p > 0.05). Under both conditions, the tested solutions were more effective in removing the smear layer in the coronal and middle regions than in the apical one. Comparison of closed and open systems showed similar levels of cleanliness and erosion in all regions (p > 0.05), with the exception of 17% EDTA showing significantly higher levels of cleanliness and erosion in the apical third of open-end specimens. CONCLUSIONS: Based on clinical correlates of in vitro root canal cleanliness and erosion, laboratory testing of root canal irrigants on extracted teeth with closed apices can serve as a reliable method to simulate the clinical condition. EDTA was the most effective final irrigation solution in removing the smear layer at the expense of yielding the greatest erosive effect.

Revascularization of immature permanent incisors after severe extrusive luxation injury.

Pulp necrosis is an uncommon sequel to extrusive luxation in immature teeth with incomplete apical closure. In this report, we describe the management of severely extruded immature maxillary incisors and the outcome of revascularization to treat subsequent pulp necrosis. An 8.5-year-old boy with severe dentoalveolar trauma to the anterior maxillary region as a result of a fall was provided emergency treatment consisting of reduction of the dislodged labial cortical bone and repositioning of the central incisors, which had suffered extrusive luxation. When he presented with spontaneous pain involving the traumatized incisors a week later, the teeth were treated via a revascularization protocol using sodium hypochlorite irrigation followed by 3 weeks of intracanal calcium hydroxide, then a coronal seal of mineral trioxide aggregate and resin composite. Complete periradicular healing was observed after 3 months, followed by progressive thickening of the root walls and apical closure. Follow-up observations confirmed the efficacy of the regenerative treatment as a viable alternative to conventional apexification in endodontically involved, traumatized immature teeth.

Revascularization of immature permanent incisors after severe extrusive luxation injury.

Pulp necrosis is an uncommon sequel to extrusive luxation in immature teeth with incomplete apical closure. In this report, we describe the management of severely extruded immature maxillary incisors and the outcome of revascularization to treat subsequent pulp necrosis. An 8.5-Year-old boy with severe dentoalveolar trauma to the anterior maxillary region as a result of a fall was provided emergency treatment consisting of reduction of the dislodged labial cortical bone and repositioning of the central incisors, which had suffered extrusive luxation. When he presented with spontaneous pain involving the traumatized incisors a week later, the teeth were treated via a revascularization protocol using sodium hypochlorite irrigation followed by 3 weeks of intracanal calcium hydroxide, then a coronal seal of mineral trioxide aggregate and resin composite. Complete periradicular healing was observed after 3 Months, followed by progressive thickening of the root walls and apical closure. Follow-up observations confirmed the efficacy of the regenerative treatment as a viable alternative to conventional apexification in endodontically involved, traumatized immature teeth.