Introducing an Innovative Approach for Managing Proximal Non-Cavitated Carious Lesions in Juvenile Permanent Dentition: Combining Orthodontic Separators and Silver Fluoride Application.

BACKGROUND AND OBJECTIVES: The aim was to introduce an innovative, easy and cheap clinical approach for the control of multiple proximal non-cavitated lesions via the application of 38% silver fluoride after placement of orthodontic separators in the permanent dentition in high-caries-risk children. MATERIALS AND METHODS: The case series describes the management of initial proximal carious lesions using silver fluoride (SF) products in the permanent dentition of two adolescent patients with prior proximal caries progression. Both presented with multiple asymptomatic carious lesions that were identified through the use of bitewing radiographs and classified according to the ADA proximal caries classification system. Using orthodontic separators prior to the planned application of SF, most of the surfaces could then be quickly directly examined to check for surface integrity. Follow-up examinations were conducted clinically and radiographically for at least one year to monitor lesion progression. RESULTS: None of the 25 enamel lesions (E1/E2) exhibited signs of progression after single SF application, while 2 out of 11 dentine lesions (D1) showed progression and required restorative intervention. The progressed lesions potentially had non-cleansable micro-cavitations that were either clinically undetected or not fully reached with the micro-brush in SF application. Thus, this should have been repeated or combined with SF application via soaked superfloss to potentially achieve better results. CONCLUSIONS: Single application of 38% silver fluoride directly onto active enamel lesions in juvenile permanent teeth with the prior use of orthodontic separators combined with a caries-risk-specific prevention program appears to be highly effective and should be considered as a viable minimally invasive option for patients and clinicians due to its cost-effectiveness and time efficiency.

Management of preeruptive intracoronal radiolucency (PEIR): a case series with up to 8 years follow-up.

Preeruptive intracoronal radiolucency (PEIR) is a rare dental anomaly often incidentally detected during routine radiographic examinations. This condition manifests as a radiolucent lesion beneath the enamel-dentin junction of unerupted teeth, particularly in mandibular molars, posing diagnostic and management challenges due to its asymptomatic nature. The treatment of PEIR depends on the extent of the lesion and the degree of pulp involvement. Case series: This case series reports on four patients with progressive PEIR. In Cases 1 and 2, lesions were incidentally discovered in panoramic radiographs during orthodontic planning (mandibular permanent second molars), and additional surgical exposure to access the lesion was required as teeth were only partially erupted. Interestingly, in Case 3, the PEIR was not visible in earlier radiographs though the crown of the tooth was already mineralized (mandibular permanent second molar). For Case 4, the tooth presented with symptoms of reversible pulpitis (mandibular permanent first molar). All lesions were treated with indirect pulp capping using biocompat-ible material. The patients were followed up for a period of up to 8 years to evaluate treatment success. Indirect pulp capping and restorations were found to be successful in all four cases in the last follow-up: 1 year (Case 2), 1.4 years (Case 4), 1.5 years (Case 1), and 8 years (Case 3). Conclusion: This case series demonstrates the effectiveness of early intervention via surgical exposure and indirect pulp capping and restoration for managing severe cases of PEIR. However, further research with larger samples and long follow-up is necessary.