Conservative treatment of deep dentin lesions in primary molars: case-series

To carry out a descriptive analysis of a case-series in which the indirect pulp capping (IPC) has been performed for treating primary molars with extensive caries lesions in dentin, in the Private of Specialization in Pediatric Dentistry. Material and Methods:Asingle calibrated examiner evaluated the medical records of 155 patients aged 2 to 13 years attended at the Foundation for Scientific and Technological Development of Dentistry (FUNDECTO) partnership the University of São Paulo (USP) in 2011-2013 in search of extensive caries lesions treated during this period. Were found only 20 deep caries lesions and with satisfactory clinical and radiographic documentation. Then, the materials and techniquesused were collected, as well as instant success described after treatment and observation for no progression of the disease (pain, abscess or fistula). Results:The 20 lesions evaluated reached at least 2/3 of the dentin thickness and were active. In 70% of cases, the restorations were carried out with high viscosity or encapsulated glass ionomer cement, and in 30% of case with light-cured resin. In only one case was used calcium hydroxide cement as liner material before inserting resin. In the teeth treated, only three cases were considered failures. Conclusion:Regardless of the restorative material used and the technique employed, good immediate success rates of the conservative treatment in deep dentin lesions were found, which consequently reduces the risk of exposure and pulp intervention...

An in-vitro assessment of the shear bond strength of bulk-fill resin composites to permanent and deciduous teeth.

OBJECTIVES: This study aimed to evaluate the shear bond strength (SBS) of bulk-fill resin composites (RCs) to deciduous and permanent teeth. METHODS: The following parameters were investigated: (1) tooth type (deciduous and permanent), (2) tooth substrate (enamel and dentine), (3) restorative material (a high- and a low-viscosity bulk-fill RC and a regular nanohybrid RC as control), and (4) adhesive (two self-etching adhesives). The combination of those parameters resulted in a total of 24 different groups (n=20). Permanent caries-free human molars (240) and deciduous teeth (240) were selected. The bulk-fill RCs (Tetric Evo Ceram Bulk Fill and SureFil SDR) were applied in one 4-mm increment, whereas the regular RC (Tetric Evo Ceram) was layered in two consecutive 2-mm increments. The SBS was examined after storing the specimens for 24 h at 37 °C in distilled water, followed by thermal ageing (5000 cycles between 5 °C and 55 °C). RESULTS: Data were statistically analyzed using one- and multiway analyses of variance and an independent-samples t-test (α=0.05). The multivariate analysis (general linear model with partial eta-squared statistics) tested the influence of the parameters tooth type, tooth substrate, restorative material, and adhesive on the SBS. The parameter tooth type showed no significant impact on the SBS (p=0.576). The influence of the other parameters was significant (p<0.05) but low, and the highest influence was exerted by the parameter adhesive (η(P)(2)=0.120, p=0.0001) followed by tooth substrate (η(P)(2)=0.092, p=0.0001) and restorative material (η(P)(2)=0.028, p=0.0001). The fracture pattern was predominantly adhesive (61.9%) or mixed (38.1), and no cohesive or prefailure was registered. CONCLUSIONS: Bulk-fill materials performed comparable or better than the nanohybrid RC used as control, but the adhesive used was the most relevant factor of influence. This material type might be clinically an option for a faster restoration in both permanent and deciduous teeth. CLINICAL SIGNIFICANCE: Bulk-fill materials performed comparable or slightly better than the nanohybrid RC used as control. Clinically, flowable bulk-fill RCs might be an advantage in restoring deep, narrow cavities, with difficult access angles, whereas larger cavities might be restored easily and faster using high-viscosity compounds.

Attitudes, knowledge and utilization of fissure sealants among Greek dentists: a national survey.

AIM: This was to evaluate the attitudes and knowledge of Greek Dentists concerning fissure sealants (FS) and other preventive measurements, together with the extent and the reasons for using or not using FS in their clinical practice. METHODS: 1,221 general dental practitioners (GDPs) including 50 Paediatric Dentists (PD) were randomly selected from 35 local dental societies of Greece and asked to answer a telephone questionnaire regarding their attitudes to prevention, use of FS and variables influencing their placement. Non parametric Pearson's Chi square test and multifactorial logistic regression models were used for analysing the data. RESULTS: Although 87.6% of all Greek dentists believe and apply prevention, only 35.8% are using them routinely. Factors highly correlated with FS usage for all dentists were using fluoride regimens (p<0.001), being in practice for 5-14 years (p=0.004) and practicing in urban areas (p<0.001). By contrast, all PD were using FS, regardless of any parameter (p>0.01). Concerning the type of surfaces sealed, 45.6% of GDP used FS on intact surfaces and 41.1% on questionable, while only 15% of them sealed incipient caries. Overall, fewer GDPs compared with PD sealed premolars, primary teeth, questionable surfaces, incipient enamel caries and molars in high risk patients (p<0.001), while fewer PD sealed intact surfaces (p<0.001). The reasons mentioned for not using FS were: 76.3% that parents were unwilling to pay, 61.9% did not know how to use them, while 43.0% believed that oral hygiene was sufficient in order to reduce caries. CONCLUSIONS: Insufficient knowledge and lack of clinical practice guidelines for the use of FS by GDPs in Greece, leads to low usage rates. Appropriate professional and scientific authorities should join efforts to improve knowledge of GDP and instil confidence in using FS.

Brief communication: high-resolution assessment of the dental developmental pattern and characterization of tooth tissue proportions in the late Upper Paleolithic child from La Madeleine, France.

Affinities and differences in dental maturational patterns between modern humans and Neanderthals remain a matter of discussion. In particular, deciduous teeth are rare for Late Pleistocene humans, and few entire sequences have been detailed for their developmental status. Here, we report the results from the 3D virtual reconstruction and structural analysis of the deciduous lower dentition (nine teeth in situ) of the child from La Madeleine (LM4), France, the first Upper Paleolithic specimen detailed so far by means of high-resolution microtomography (microCT). With respect to the modern dental developmental standards, age at death of this individual is now more likely estimated within the interval 3-4 years. LM4 lacks the slight discrepancy between a proportionally advanced stage of mineralization of the deciduous first molar and a relatively delayed maturational level of the incisors, which is found in Neanderthals (Bayle et al.: J Hum Evol 56 [2009] 66-75). By using a Bayesian approach, we calculated the probability that its maturational sequence is found within the extant human variation as represented by a tomographic (CT) reference sample of 45 children scored according to the same protocol (Liversidge and Molleson: Am J Phys Anthropol 123 [2004] 172-180). Results show that the specific sequence of this Magdalenian individual is found three times in the comparative sample included in this study. LM4 absolute tooth size and relative dental tissue proportions are close to the modern human figures (characterized by proportionally reduced dentine volumes) and lie systematically below the values shown by the Neanderthal child from Roc de Marsal, France (OIS 5a).

Avaliaçäo clínico-radiográfica da prevençäo de espaço na dentiçäo mista / Clinical and radiographic assessment of space maintenance in the mixed dentition

A proposta básica deste estudo foi avaliar e comparar a eficácia de dois procedimentos clínicos distintos na preservaçäo de espaço para dentes permanentes posteriores que possuíam uma direçäo de erupçäo alterada. Realizou-se controle clínico-radiográfico de um grupo que utilizou o mantenedor de espaço tipo banda-alça, comparado com um grupo em que o dente decíduo permaneceu funcionando como um mantenedor de espaço natural

Phylogenetic, paleodemographic, and taphonomic implications of Victoriapithecus deciduous teeth from Maboko, Kenya.

More than 240 milk teeth of Victoriapithecus macinnesi, representing all elements of the deciduous dentition, are described. Their morphology is intermediate between that of hominoids and cercopithecids. Unlike colobine and cercopithecine milk teeth, Victoriapithecus dp3s, dp4s, and at least 7 (14%) dp4s lack transverse distal loph(id)s and are not bilophodont. Victoriapithecus also differs from cercopithecids in having less elongated deciduous premolars, a dp3 metacone set mesial to a very small hypocone, a dp4 crista obliqua, and a dp4 hypoconulid. The deciduous canines and incisors of Victoriapithecus are like those of other cercopithecids in having an uneven distribution of enamel around a compressed (rather than cylindrical) root, but differ from cercopithecids and resemble hominoids in being more elongated. Since Colobinae and Cercopithecinae share features of the deciduous dentition that are derived relative to Victoriapithecus and hominoids, extant Old World monkeys are interpreted as representing the sister-taxon of the middle Miocene cercopithecoids. Due to a dramatic increase in the number of deciduous teeth found at Maboko Island, juvenile individuals represent a much larger proportion of recently excavated Victoriapithecus collections than is true of pre-1987 assemblages which mainly derive from sediment first excavated during the 1930s and 1940s. Age distribution differences between pre- and post-1987 samples indicate that paleontological collection procedures were more important than taphonomic biases in determining the paleodemographic profile of the Maboko fossils. Since the Victoriapithecus assemblage from Maboko is strikingly similar to that of fossil Theropithecus oswaldi from Olorgesailie in terms of the large number of specimens and high representation of juvenile and infant individuals, the latter can no longer be viewed as unique among cercopithecoid fossil assemblages. Rather than being related to a specific cause of death, such as selective hunting of T. oswaldi by Homo (Shipman et al. [1981] Curr. Anthropol. 22:257-268), the large number of cercopithecoids at both sites is attributed to the fact that both assemblages represent excavated samples and that the preferred habitats of the extinct monkeys were probably at or near the site of deposition. The greater number of young adult male than female canines in the apparently attritional Maboko Bed 5 assemblage, indicate that the social organization of V. macinnesi may have been similar to that of modern macaques, with males migrating out of their natal group and suffering higher death rates than females at puberty.

The cervical margin of amalgam restorations: a radiographic and clinical assessment.

In a study of the condition of the cervical margin of class II amalgam restorations, a radiographic method of assessment was compared with clinical assessment using mouth mirror and probe. The radiographic method assesses the type of defect of the cervical margin on the one hand, and the degree of defect on the other. In addition, an in-vitro study was performed of forty-six primary molars with multiple-surface amalgam restorations, in order to evaluate the results of the comparative study. Comparison of the results of clinical assessment with those of radiographic assessment revealed that: There is no correlation between the type of defect of the cervical margins of the amalgam restorations and their clinical assessment. There is a correlation between the degree of cervical margin defect and clinical assessment, as long as the defect does not exceed 1.5 mm. There is no significant difference between the clinical and the radiographic methods of assessment. Using both methods, only 20 percent of the cervical margins seemed to show "good" adaptation. The results of the in-vitro study warrant the conclusion that: In this study, too, only 20 percent of the cervical margins showed good adaptation. The restorations of the forty-six shed primary molars were of the same quality as those involved in the comparative study. These two conclusions warrant the postulate that, when only one of the two methods of assessment is used, the results must be divided by two in order to gain an accurate impression of the condition of the cervical margins.