Analysis of root canal treated primary incisor after trauma: two year outcomes.

BACKGROUND: The low number of clinical studies of traumatized teeth submitted to root canal treatment is completely out of proportion to the seriousness that dental trauma imposes on children in early years. AIM: This study evaluates the outcomes of root canal treatment (RCT) in traumatized primary incisors and identifies the predisposing factors associated with therapy success. METHODS: This is a retrospective study conducted with all dental records of 704 patients who had one or more teeth with traumatic injuries. Patients with irreversible pulp changes in primary teeth leading to RCT with a 24 month follow-up met the inclusion criteria. RESULTS: Twenty-five maxillary incisors of 17 children were evaluated. The children's age at the time of therapy ranged from 24 to 72 months (mean 47.3). Pulp necrosis was the most common disorder (84.0%) and pre-operative periapical lesions were observed in 52.0%. Coronal discoloration was found in 48.0%. The roots were filled with ZOE paste (68.0%) or Guedes-Pinto paste (32.0%). Overall RCT success rate was 68.0%. The absence of pre-operative periapical lesions (p = 0.02) and pathological root resorption (p = 0.02) presented positive association with therapy success. Success was not associated to filling paste (p = 0.49), filling extent (p = 0.44), of discoloration (p = 0.39) nor the patients' age (p = 0.59). CONCLUSIONS: RCT was considered successful in 68.0% of the cases at the 24 month follow-up. Failure of RCT in traumatized primary incisors was associated with pre-operatory periapical lesions and pathological root resorption. The filling paste, the filling extent and the patient's age were unrelated with therapy success.

ZOE paste pulpectomies outcome in primary teeth: a systematic review.

OBJECTIVE: To perform a systematic review in which the clinical research question for primary teeth with irreversible pulpal pathosis was "how pulpectomies with zinc oxide eugenol (ZOE) paste performed compared to other materials in their clinical and radiographic outcomes after twelve months or more follow-up period. STUDY DESIGN: A literature survey of the electronic database (1950-2010) used the Medical Subject Headings and free text terms. Forty three references were retrieved and inclusion criteria were applied; 15 articles remained for full-text evaluation. From these, two were selected for data extraction regarding quality characteristics and results. RESULTS: Selected studies showed moderate or high risk of bias. The overall success of pulpectomy was 80.0% (Calcicur), 60.0% (Sealapex) and varied from 85.0% to 100.0% (ZOE) and 89.0% to 100.0% (Vitapex). Solely Calcicur presented success rate significantly lower when compared to ZOE and Vitapex. These pastes lead to overfilled canals and particles of extruded ZOE were still evident even after the evaluation period. Resorption of Vitapex, Calcicur and Sealapex within the root canal was also reported. CONCLUSIONS: In primary teeth with irreversible pulpal changes ZOE pulpectomies yielded similar outcome than Vitapex and Sealapex, although there was no agreement with regard to filling materials' resorption.

Microhardness of dentine underlying ART restorations in primary molars: an in vivo pilot study.

OBJECTIVE: To evaluate the microhardness of dentine underlying glass ionomer restorations made with Atraumatic Restorative Treatment. DESIGN: An experimental single-centre study. SETTING: University Department, Brazil, 2001. MATERIALS AND METHODS: Sixteen children were selected showing primary molars containing carious cavities (n = 29), which were restored using Fugi IX. Subsequently, some teeth were extracted respecting Nolla stage 7 or 8 of the permanent successor, and categorised according to the post-restoration time in the mouth: G1 (baseline, immediate extraction), G2 (30 days), G3 (90 days) and G4 (180 days). Four teeth were excluded because they were not in time of normal exfoliation. The 25 extracted teeth were resin embedded, sectioned mesiodistally and prepared metallographically. Knoop microhardness analysis (Micromet 2003; 10g for 1.5 sec.) produced identations in three areas of dentine: Zone 1 (just below the restoration), Zone 3 (as close as possible to the pulp) and Zone 2 (intermediate region between 1 and 3). Non-parametric statistical tests were done--at a significance level of 5%. RESULTS: Four teeth were excluded. No significant difference was noted among the zones, inside the groups. Zones 1 and 2 showed a considerable increase of microhardness according to the time, except for Group 3 (p > 0.05). CONCLUSION: Although microhardness had increased, it was not sufficiently equal to the microhardness of the healthy dentine, regardless of the depth evaluated.

Case report: ultrasonic cavity preparation -- an alternative approach for caries removal in paediatric dentistry.

BACKGROUND: Since the invention and application of rotating instruments, the operative treatment of carious lesions has often resulted in considerable removal of tooth structure. Moreover, conventional caries removal and cavity preparation by a combination of the use of a turbine and a handpiece with a bur presents disadvantages to very young patients, whose perception of drilling is unpleasant. This report concerns an alternative approach for caries removal in a child using ultrasound and discusses the advantages and disadvantages of this technique. CASE REPORT: A 2-year-old male child was brought by his mother to a private paediatric dental clinic in Rio de Janeiro, Brazil. The mother's main complaint was the presence of dental caries in her son's anterior teeth. Intraoral clinical examination revealed that the patient had two carious lesions in the maxillary central incisors on mesial surfaces. Cavity preparation was performed using ultrasound and restoration with a light-curing resin. FOLLOW-UP: One year and a half after the restorative procedure the patient presented with the restored teeth in perfect condition.

Microscopic investigation of artificially demineralized surface enamel exposed to controlled intra-oral periods.

BACKGROUND: Arrest and regression of enamel caries is generally followed by clinical surface changes in enamel. The aim of this study was to evaluate microscopic surface changes in demineralized enamel submitted to toothbrushing with a fluoridated dentifrice or to a fluoridated gel in situ. METHODS: Enamel blocks demineralized by an acidic gel, were built in plates of five volunteers during three periods of 14 days each: exposure to the oral cavity (C+); brushing with a fluoridated dentifrice three times a days (B); application of a 2 per cent sodium fluoride gel and exposure to the oral cavity (F). Eight blocks were kept in 100 per cent humidity under refrigeration as negative controls (C-). RESULTS: Stereomicroscopic examination revealed that 15, 47.4 and 30 per cent of samples from C+, B and F presented enamel cavitation after the experimental period. The demineralized enamel area in these groups decreased considerably compared to C-, both in cavitated and non-cavitated samples, although it was statistically significant only in cavitated samples from B (p=0.003; t test). Scanning electron microscopy revealed that C+ and F retained irregularities caused by the acid challenge, while B presented a more leveled profile of the enamel surface. CONCLUSIONS: Exposure of demineralized enamel to intra-oral periods reduced the demineralized enamel area. Tooth brushing enhanced this reduction, because of surface abrasion.

Case report: the importance of oral manifestations in diagnosing iron deficiency in childhood.

AIM: The aim of this article is to report a case of iron deficiency diagnosed in a child after routine oral examination. CASE REPORT: A 5-year-old male child of African descent was brought to the paediatric dental clinic of a public university in Rio de Janeiro, Brazil. His mother's main complaint was her child's decayed teeth and sensitivity in the tongue every time he ate spicy or hot food. Anamnesis revealed chronic respiratory problems due to allergy, two previous episodes of anaemia and hospitalization about 15 months before the dental visit because of severe primary herpetic gingivostomatitis. Soft tissue examination revealed his tongue had various patches of atrophic mucosa characterizing absence of papillae in these areas. The child's dietary assessment indicated that he never ate meat or vegetables. Haematological investigation showed that the child probably had an iron deficiency, although the full blood count was not totally compatible with anaemia. A rapid initial recovery was quite noticeable after the beginning of oral therapy with ferrous sulphate, as remission of tongue sensitivity as well as papillae neoformation were observed.

Interruption of breast feeding caused by the presence of neonatal teeth.

The authors report the case of a 6-month old girl treated at the Pediatric Dentistry Clinic at the School of Dentistry of the Federal University of Rio de Janeiro. The patient's breast feeding was interrupted prematurely due to the presence of neonatal teeth. The authors have included a brief review of previous reports of this pathology.

Short communication: polymicrobial community in teeth associated with severe early-childhood caries.

AIM: This was to characterise the microbial diversity in the complex dental plaque of children with severe early-childhood caries (S-ECC), using the denaturing gel gradient electrophoresis (DGGE) technique. METHODS: The DGGE technique was used as a diagnostic tool to analyse samples from the oral cavity of a patient with S-ECC. Dental plaque samples from a 3-year-old child with S-ECC were taken from the primary central maxillary incisor (biofilm on vestibular surface), primary maxillary molar (biofilm on vestibular surface), primary central maxillary incisor (dentine), primary maxillary molar (dentine) and saliva and then analysed by PCR-DGGE. RESULTS: Three bands occurred in all samples, moreover, 86% of similarity was observed in the pattern of bands between incisor and molar teeth biofilm samples, including four similar bands. CONCLUSION: DGGE is a valuable tool for differentiating the microbial composition of the oral plaque in S-ECC children.