Long term clinical assessment of direct pulp capping.

Appropriate definitions, history and success rates of direct pulp capping procedures are reviewed. Two of the disadvantages of this form of treatment are infection of the pulp, either preoperatively or postoperatively due to a non-sterile procedure or bacterial leakage at the capping site. Past results of directly capping potential inflamed pulps have been unsatisfactory, but now an increasing number of endodontists advocate capping when conditions are favourable. Direct capping should only be used on vital pulp which has been accidentally injured and shows no other symptoms. Direct capping with calcium hydroxide should not be used on pulp which has been exposed as a result of penetrating caries. Clinical studies 2338 cases have shown that the risk of failure is increased if the pulp is diseased before capping, but that the age of the tooth does not have an adverse effect. It also appears that capping performed by skilled practitioners is more successful than that performed by students. The results of a re-examination of 110 patients, a minimum of 4 years after they had received direct capping treatment from students, showed a success rate of 80 per cent. In skilled hands, the success rate for direct capping with calcium hydroxide is now 90 per cent provided that a hermetic seal is obtained.

[The possibility of a standardization of clinical trials concerning materials for root canal obturation]. / Les possibilités d'une normalisation des essais cliniques concernant les produits d'obturation dentaire

Clinical trials constitute epidemiologic experiments, in comparable groups of human populations designed to assess the preventive of curative effects of agents or measures. International organizations (FDI, WHO, CIOMS, ISO) have been instrumental in creating uniform methods, so that the findings from different sources can be validly compared. The need for a standardization of clinical trials in dentistry is particularly felt: - by the dental profession in order to make the choice of materials with the best clinically proven qualities - by the manufacturers in order to develop materials of improved clinical quality - by the public health administrators (or social security agencies), in order to either evaluate the benefit of instituted preventive and curative measure or to ascertain the best possible services A centennial history of efforts is shown to have resulted today in a broad international understanding (Table III). 1. The first chapter of this paper presents a review of the principal requirements for controlled clinical trails [8] such as officially adopted by FDI (Table V). 2. The second chapter offers a first-hand apercu of impending recommendations proposed by COMIET in two protocols [11] for the uniform conduct and evaluation of clinical trials of restorative techniques and materials. 2.1 Three standardized forms (A, B: Table IX, and C) serve to uniformly record data of the operative procedures. 2.2 The proposed standardized criteria (Tables X, XI) for the clinical appraisal of distinct materials give the advantage of having been tested already very extensively. 3. A critical review of the proposed protocols [11] reveals the necessity of: 3.1 referring to and coordinating with the already adopted principal requirements for controlled clinical trials. 3.2 generally adopting the excellent guidelines for the conduct of the study and the evaluation of observations (Tables X, XI) 3.3 taking advantage of the possibilities for reducing the recommended sample of 100 paired restorations (200 cavities)--difficult to implement in many countries--by certain measure such as preliminary in-vitro experiments, consideration of results already reported in the literature and a more systematic use of a standardized photographic serial documentation, a topic which will be the object of an ensuing paper.

Standardization of the epidemiologic assessment of periodontal diseases. Surveys in the South Pacific.

Attempts of introducing uniform techniques for the collection of statistical data on the prevalence of periodontal diseases have been made by FDI and WHO in order to arrive at valid, reproducible, and internationally comparable results. The WHO Manual of the International Classification of Diseases. Application to Dentistry offers a five digit classification of all oral diseases for statistical purposes. In contrast to morbidity statistics, epidemiological surveys must be based on adequate samples, representative for the entire population or distinct strata thereof. FDI is actually preparing guidelines for the conduct of clinical trials in periodontal diseases, comparable to those on caries incidence, indicating the proper use of indices. For the epidemiological assessment of periodontal diseases, the WHO Basic Methods (1962, 1971) have recommended the use of simple ratios of persons affected with signs of the disease. Data collected in four extensive dental surveys in Polynesian and Melanesian populations in the South Pacific served as an example to show the variety of valid information provided by these basic methods. The main results showed an early appearance of pocket formation at ages 10 to 14, preceded in a statistically significant way by calculus formation and gingivitis. A constant pattern in the sequence of attack of the various teeth by pocket formation was shown to be specific for these island populations; males were consistently more affected than females. The character of periodontal diseases prevalent among Polynesians and Melanesians was recognized to be a "dirt pyorrhea" accompanied by progressive subgingival calculus deposition and destructive periodontitis.