Restorative dentistry clinical decision-making for hypodontia: peg and missing lateral incisor teeth.

Peg-shaped and missing lateral incisor teeth are common features for patients affected by hypodontia. While improvements in dental appearance may be a strong motivating factor for these patients, providing dental treatment to improve the clinical condition and achieve an acceptable and stable outcome can be complex and lengthy.For patients affected by hypodontia, discussion and consideration of various approaches to their individual treatment are best achieved in a multidisciplinary team environment. This allows debate of options and joint agreement between at least orthodontic and restorative dentistry specialist colleagues, based largely on clinical factors, towards a treatment plan that is acceptable to the patient. As most patients with this lateral incisor form of hypodontia are initially treated as teenagers and young adults, there is also an understanding that treatment outcomes will have lifelong maintenance and resource implications to consider.This paper identifies and discusses the key clinical features that influence the treatment planning process for a patient with either missing or peg lateral incisor teeth. These will often involve consideration of whether to open or close the lateral incisor spaces and whether to restore or replace a peg lateral incisor tooth. The process should be patient-centred, evidence-based, and aim to minimise the lifelong treatment burden, retaining options for future maintenance and retreatment.

Hard tissue barrier formation after pulp capping?

DATA SOURCES: Searches for relevant studies were made using Medline and the Cochrane Controlled Trials Register (CENTRAL). Reference lists of identified articles were searched. STUDY SELECTION: Studies selected were those carried out on human teeth, with or without caries, that were treated using a pulp-capping procedure and where the hard tissue and pulp were analysed with the aid of a microscope. Reviews of pulp capping were searched for references. DATA EXTRACTION AND SYNTHESIS: The authors independently extracted the data and assessed the level of evidence of each publication as high, moderate or low. Based on this, the evidence grade of the conclusions was rated as strong, moderately strong, limited or insufficient. RESULTS: Of 107 studies identified, 21 met the selection criteria. No study had a high level of evidence, one study was moderate and 20 studies provided a low level of evidence. There was heterogeneity between the studies and therefore no meta-analysis was performed. The majority of studies on pulp capping using calcium hydroxide-based materials reported formation of hard tissue bridging: studies on other pulp capping materials such as bonding agents presented inferior results. CONCLUSIONS: Although the majority of studies using calcium hydroxide-based materials reported hard tissue bridging, the quality of the available evidence is low. There is a need for more high-quality studies.