Enamel Renal Gingival Syndrome in an Adolescent.

Enamel renal gingival syndrome is a rare clinical condition characterized by the presence of amelogenesis imperfecta hypoplastic type, gingival fibromatosis and delayed tooth eruption, in addition to nephrocalcinosis with normal blood calcium levels. It is inherited as an autosomal recessive trait caused by mutations in the FAM20A gene located on chromosome 17q24.2. The purpose of this report is to describe a case of enamel renal gingival syndrome and discuss its distinct features and management.

Visit to the Dentist for Oral Health Prevention at "Age One": A proposed policy report from the Indian perspective.

Early childhood caries is a major public health issue in India. The primary reason for poor oral health in children is a lack of awareness about the role of primary teeth and the importance of an early dental visit for infants and toddlers. The primary objectives of an early dental visit are to analyze the child's risk level, provide guidance to parents regarding proper oral hygiene measures, review dietary and eating habits, provide information regarding the infectivity of dental caries, review the risks of traumatic injuries and discuss factors which affect the development of occlusion. Through this paper, we are proposing an "Age One" policy that recognizes dentists, physicians, allied health professionals, community health-care workers, and nongovernmental organizations to work toward a child's overall health as partners to achieve this goal. The expectation is that this policy will provide guidance to childcare centers, pediatric dentists, other health-care professionals, and legislators regarding oral health activities and the promotion of oral health in infants. The purpose of the policy is to lay the foundation for a lifetime of preventive education and dental care, to help ensure optimal oral health beginning in childhood and continuing through the life course.

Effect of wire diameter and extent of wire composite splint on the mobility of luxated and anchor primary teeth: A typodont study.

BACKGROUND/AIMS: The recommendations for splinting are well established for the injuries of permanent dentition; however, ambiguity still exists for the injuries in primary dentition. Hence, this study aimed to determine the most appropriate dimensions of stainless steel wire and its extent, for achieving the physiologic mobility in primary dentition. MATERIAL AND METHODS: This study was designed as an in vitro experiment by using a typodont model of primary dentition. The baseline mobility of primary maxillary incisors was calibrated to the physiologic mobility of natural primary incisors by using a Teflon tape wrapped around the roots of resin teeth. Splinting was done using a stainless steel wire of 0.2 mm (Group I), 0.3 mm (Group II), and 0.4 mm (Group III). These groups were subdivided (a, b, and c) on the basis of the extent of the splint, and pre splint mobility (Pre-PV) and post-splint mobility (Post-PV) were tested by Periotest M. The splint effect was calculated by subtracting Post-PVs and Pre-PVs. RESULTS: The normal values of mobility in healthy human volunteers ranged from 10.5 to 13. The overall splint effect was higher in Group III irrespective of the extent of the splint, whereas it was found to be the lowest in Group I (b and c). The splint effect increased with the extent of the splint in all the groups. Among all the groups, the splint effect on the anchor teeth was observed to increase with the extent of the splint and the diameter of the wire. CONCLUSION: The mobility of the injured and anchor teeth splinted with 0.2-mm stainless steel wire was similar to the pre-splint and physiologic mobility. The most favorable extension was one tooth adjacent to the injured tooth on each side for both 0.2- and 0.3-mm wires.

Quality analysis of the clinical practice guidelines for management of impacted maxillary central incisors: a systematic review.

PURPOSE: To assess the quality of clinical practice guidelines (CPG) for management of impacted central incisors. METHODS: Search was performed in PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane databases, and guideline-focused databases/repositories on 15-09-2022 without any limitations and was updated on 15-07-2023. Grey literature search was also performed. Two independent reviewers were involved in the study selection and data extraction. Quality assessment of the included CPG was performed by four independent appraisers using the AGREE-II instrument. The degree of agreement among the appraisers was calculated using the intraclass correlation coefficient (ICC). RESULTS: Five CPG were included in the review. The Ministry of Health, Malaysia (MHM) guideline obtained the highest scores in all six domains of AGREE-II and an overall score of 73% demonstrating the "highest" quality. The remaining four guidelines obtained overall "low-quality" scores ranging from 34.57-37.52%. The ICC scores ranged from 0.530 to 0.990 for various domains of AGREE-II. CONCLUSION: MHM guidelines demonstrated high-quality scores in domains of 'scope and purpose', 'clarity of presentation', 'applicability domain', and 'editorial independence', while others were found to have moderate or low quality. This review identified areas that can be addressed by future guideline developers to avoid these discrepancies.

Methods and applications of finite element analysis in dental trauma research: A scoping review.

Finite Element Analysis (FEA) is vital for understanding dental traumatology (DT) biomechanics, aiding diagnosis, treatment planning, and outcome prediction. This review explores FEA applications in DT research, evaluates their quality and outcomes, and assesses methodological aspects. Accordingly, recommendations for future researchers are provided. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews and registered in Open Science framework. A comprehensive search using relevant text-words and MeSH terms was performed in established databases. The inclusion criteria encompassed all Finite element analysis (FEA)-based Dental traumatology (DT) studies without language or publication year restrictions. Risk of bias was assessed with the Risk of bias tool for the use of finite element analysis in dentistry (ROBFEAD) tool. Forty-six studies published from 2001 to 2023 were included in the qualitative synthesis. The studies were categorized into five domains and six subdomains based on objectives. Maxillary central incisors and surrounding structures were commonly modelled (n = 27). Most studies utilized Computed tomography (CT), Cone Beam CT, or micro CT. Traumatic injury forces ranged from 100 N to 2000 N, and occlusal forces ranged from 150 N to 350 N. All studies were rated as high risk of bias. Fory-six studies were categorized, with most focusing on stress distribution and fracture patterns in dento-alveolar structures under various conditions, while few assessed displacements. Methodological quality lacked robustness in model development and substructure properties. Future studies should address these limitations and enhance reporting practices.

Orofacial characteristics in a child with Hajdu-Cheney syndrome.

Hajdu-Cheney syndrome (HCS) also known as Cranio-skeletal dysplasia is a rare genetic disorder of bone metabolism. It is mainly characterized by acro-osteolysis and generalized osteoporosis. The other distinctive features include a dysmorphic face, short stature, aplasia of facial sinuses, and persistent cranial sutures. Although the condition begins to manifest since birth, the characteristic features become more prominent with age. This syndrome is usually recognized by dentists due to these craniofacial abnormalities. This case report aims to highlight a case of 6-year-old girl HCS who presented with aberrant facial features, premature exfoliation of teeth, unusual mobility of teeth and atypical root resorption in primary dentition.

Comparative evaluation of three materials used for fragment reattachment in uncomplicated crown fracture-An in vitro study using bovine teeth.

BACKGROUND/AIMS: The recommended treatment for uncomplicated crown fractures is bonding the fractured fragment or the fragment reattachment. A paucity was identified regarding the studies comparing the efficacy of micro-hybrid and nanohybrid composites in fragment reattachment. Hence, the present study aimed to evaluate and compare three materials for bonding of fragments rehydrated by humidification in teeth with uncomplicated crown fractures. MATERIAL AND METHODS: Eighty mandibular bovine incisors with similar dimensions and free of any structural deformities were fractured similar to the technique followed in previous studies. Fracture was simulated, fragments, and stumps were coded, stumps were stored in artificial saliva and the fragments were dehydrated at room temperature and pressure. They were randomly assigned to Group-1 (no rehydration), Group-2 (rehydrated and bonded by flowable nanohybrid composite-3M Filtek Supreme Syringe Flowable Composite Resin-A2, Sao Paulo, Brazil), Group-3 (rehydrated and bonded by flowable micro-hybrid composite- Ruby Flow, InciDental, England, United Kingdom), and Group-4 (rehydrated and bonded by light-cured Glass-Ionomer-Cement-Voco Ionoseal, Cuxhaven, Germany). The samples were subjected to a universal testing machine to evaluate the force required to fracture the bonded fragments. RESULTS: The highest median value of the force required to fracture was recorded for Group 2 (208.4 N) followed by Group 3 (195.2). The force required to fracture the bonded fragments was lowest in Group 4 (67.2 N) which was lower than the negative control (131.4 N). The differences between the observations in Groups 2 and 3 were not found to be statistically significant. CONCLUSION: The nano and micro-hybrid composites showed greater force required to fracture than fragments bonded by LC-GIC. Dehydrated fragments bonded using nanocomposites performed better than rehydrated fragments bonded by using LC-GIC.

Risk factors associated with traumatic dental injuries in individuals with special healthcare needs-A systematic review and meta-analysis.

BACKGROUND/AIM: Individuals with special healthcare needs (SHCN) are more likely to sustain traumatic dental injuries (TDIs) due to distinct risk factors. The aim of this review was to assess various risk factors associated with TDIs in individuals with SHCN. MATERIALS AND METHODS: The protocol was designed according to the recommendations of the Cochrane-handbook, Joanna Briggs Institute, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42022357422). A comprehensive search was performed in PubMed, LILACS, Web of Science, EMBASE and Scopus using a pre-defined strategy without any limitation of language and year of publication. It was last updated on 25 April 2023. Studies addressing the TDIs in individuals with SHCN were included. Data extraction and analyses were performed, risk of bias (ROB) assessment was done using the Joanna Briggs Institute's critical appraisal tool, and a meta-analysis was performed using random-effects model. RESULTS: A total of 21 studies were included in the review. They were categorized according to the target disease/condition: cerebral palsy (n = 5), ADHD and autism spectrum disorders (n = 5), visually impaired (n = 4), and multiple disorders (n = 7). The studies showed variability in the design and methods; however, 17 out of 21 studies showed moderate to low ROB. Increased overjet and lip incompetence were the main risk factors reported in the studies. The commonest injuries were observed to be enamel and enamel and dentine fractures. CONCLUSION: The overall pooled prevalence of TDI in individuals with special healthcare needs was 23.16% with 20.98% in males and 27.06% in females. Overjet >3 mm and inadequate lip coverage were found to be associated with a higher risk of TDI in all the categories of individuals with special healthcare needs except ADHD and ASD. Falls at home in cerebral palsy, falls while walking and self-harm in ADHD and ASD, falls at home and collision in visual impairment, and unspecified falls in multiple disorders could be identified as the most common cause of TDI.

Effectiveness of Smartphone App on Oral Health Knowledge, Behavior, and Practice in Child-Parent Dyads: A Pilot Study.

Purpose: To evaluate the effectiveness of an oral health mobile application on the oral health knowledge, behavior, and practices (KBP) of child-parent dyads. Methods: This was a pre-post, single-arm, hospital-based pilot study. Fifty-two dyads were assessed for KBP using a self-structured questionnaire. The oral hygiene of children was evaluated using the plaque index (PI). The Healthy-Smile Swasth-Muskaan mobile application was installed on the phones of participants, and they were encouraged to use the application regularly. After one month of the app instalation, post-KBP and PI were assessed. Results: A significant improvement was seen in the parents' total knowledge, behavior, and oral hygiene practices of the children (P<0.001). A significant reduction was observed in the mean plaque scores of the children (P<0.001). Conclusions: The Healthy-Smile Swasth-Muskaan mobile app is associated with improved oral health knowledge and behavior of the child-parent dyads and im- proved oral hygiene of children. Further randomized clinical trials are needed to determine the impact of mobile apps on the oral health knowledge, behavior, and practices of parents and children.

Variations in Primary Molar Contact and Approximal Caries in Children: A Three-Year Prospective Cohort Study.

Purpose: To evaluate the association between the contact areas of primary molar teeth and approximal caries after three years of observation. Methods: This prospective cohort study included 1,119 caries-free children, aged three to four years, from Puducherry, India. At base- line, 4,476 contacts were assessed using the OXIS criteria, which denotes O for open contact and X, I, and S for closed contacts. X contact represents a point contact, I is a straight contact, and S is a curved contact. Two calibrated dentists measured dental caries at one-year intervals following the International Caries Detection and Assessment System for three years. Poisson regression analysis with a multilevel approach was used to determine the association between contact type and approximal caries. Results: Of 3,848 contacts observed at the end of three years, 499 (13 percent) were carious. The adjusted analysis revealed a significant association between contact type and approximal caries (P<0.05). The risk ratios for the development of approximal caries were 2.3 for X-type contacts (0.5 to 11.4, P=0.307), 12.7 for I-type (4.1 to 39.6, P<0.05), and 22.5 for S-type (7.2 to 70.6, P<0.05) when compared with O-type. Conclusions: Compelling evidence suggests that variations in contacts between teeth are significant in the development of approximal caries. The S-type contact is the most susceptible to approximal caries, followed by the I-type.

Comparative evaluation of putty index and custom template for direct composite restoration of uncomplicated crown fractures in permanent anterior teeth.

OBJECTIVES: The aim of this study was to compare and evaluate Putty Index and Custom Template Technique for Direct Composite restoration of uncomplicated crown fractures in permanent anterior teeth. MATERIAL AND METHODS: A total of 100 teeth were randomly allocated to the respective groups, n=49 in Group I and n=51 in Group II. Composite build up using Putty Index technique in Group I and vacuum formed Custom Template in Group II was done followed by finishing and polishing of the restoration. The restorations were scored using Modified USPHS criteria by two blinded and calibrated evaluators at baseline, 6 months and 12 months followed by Spectrophotometric evaluation. The clinical chair side time was recorded using digital clock. RESULTS: No statistically significant difference was seen between ITT and PP analysis among the two groups at 6 months and 12 months follow-up. Mean time chair side time taken for Group I was 20 minutes and for 24.4 minutes for Group II which was statistically significant (P=0.00). No statistically significant change was seen in the colour of the restoration at 6 months (P=0.45) and 12 months (P=1.00) using spectrophotometer. CONCLUSION: Custom Template technique and Putty Index technique showed no statistically significant difference in terms of clinical evaluation at baseline, 6 months and 12 months except for postoperative sensitivity.

Global status of knowledge of parents for emergency management of traumatic dental injuries: a systematic review and meta-analysis.

RESEARCH PROTOCOL: The protocol was developed as per the recommendations of the Cochrane-handbook and PRISMA and was registered in PROSPERO. LITERATURE SEARCH: Search was performed by using MeSH-Terms and keywords in PubMed, Scopus, Embase, Web of Sciences, Lilacs, and Cochrane databases and gray literature sources 15th July 2022. There were no limits regarding the year of publication and language. Hand-searching of included articles was also performed. Titles and abstracts and later full texts were screened as per strict inclusion and exclusion criteria. DATA EXTRACTION: Self-designed pilot-tested form was used. QUALITY APPRAISAL: Risk of bias was analyzed through Joanna-Brigg's-Institute's-critical appraisal checklist. The evidence analysis was done by using the GRADE approach. DATA ANALYSIS: Qualitative synthesis was performed for describing the study characteristics, details of sampling, and results of various questionnaires. It was discussed by the expert group and presented using KAP heat map. Meta-analysis was done by using Random Effects Model. RESULTS AND INTERPRETATION: The risk of bias was found to be low in seven and moderate in one study. It was observed that >50% of parents knew about the urgency to seek professional advice after TDI. Only <50% of parents were confident of their ability to identify the injured tooth, clean the soiled avulsed tooth, and perform the replantation. Appropriate responses regarding immediate action after tooth avulsion were given by 54.5% (95% CI: 50.2-58.8, p = 0.042) of parents. The knowledge of the parents regarding the emergency management of TDI was found to be inadequate. The majority of them were interested in obtaining information about dental trauma first aid.

Effect of SDF/ SSKI Application on Microtensile Bond Strength of Composite Resin to Carious Primary Dentin: An In Vitro Study.

PURPOSE: The purpose of this in vitro study was to investigate the effect of applying silver diamine fluoride (SDF) followed by a saturated solution of potassium iodide (SSKI) on the microtensile bond strength (mTBS) of composite resin to the natural carious dentin of primary molars. METHODS: Sixty-nine extracted carious primary molars were randomly allocated to one of the three groups, where the prepared affected dentin was treated with: (1) group A-SDF/SSKI; (2) group B-SDF alone; and (3) group C-deionized water. After restoration with composite resin restorative material, specimens were prepared and tested for mTBS in the universal testing machine. Median bond strengths were compared using the Kruskal-Wallis test. RESULTS: The median (range) values of mTBS in groups A, B, and C were 16.99 (6.55 to 95.60), 17.71 (4.93 to 101.1), and 24.60 (5.29 to 91.7) MPa, respectively. There was no statistically significant difference in the microtensile bond strength among the three groups (P=0.94). CONCLUSION: The application of either silver diamine fluoride along with a saturated solution of potassium iodide or SDF alone does not have a significant inhibitory effect on the bond strength of the composite resin to carious dentin in vitro.

OXIS Contacts and Approximal Caries in Preschool Children: A Prospective Cohort Study.

The present prospective cohort study was conducted to evaluate the susceptibility of OXIS contact areas, namely, O (open type), X (point type), I (straight type), and S (curved type) in the development of approximal caries. We conducted this study among 953 school children with 3,812 contacts in Puducherry, India. At baseline, the contacts were assessed in accordance with OXIS criteria. At the end of 12 months, two calibrated dentists measured dental caries following the International Caries Detection and Assessment (ICDAS) criteria. Information about feeding practices, diet, and oral hygiene was collected by means of a structured questionnaire from each child's parent. Data were analyzed by unadjusted and adjusted Poisson regression analysis with a multilevel approach. The two levels of analysis were tooth and child. Of 3,812 contacts observed during the follow-up, 127 (3.3%) were observed as carious. Poisson regression analysis revealed a significant association between type of contact and caries prevalence (p < 0.05). The risk ratios for the development of approximal caries in X contacts were 2.4 (0.3-17.2), p value 0.38; in I contacts 4.9 (1.2-19.9), p value 0.027; and in S contacts 8.2 (1.9-34.2), p value 0.004, when compared with the O contacts. Among the child variables, male gender (relative risk [RR] = 2.1; 95% confidence interval [CI], 1.3, 3.5), parental supervision while toothbrushing (RR = 1.6; 95% CI, 1.1, 2.4), and the use of toothpaste (RR = 1.9; 95% CI, 1.3, 3.1) were found to be associated with approximal caries after adjustment for the other variables. Among the OXIS contacts, the S type was most susceptible to approximal caries due to its complex morphology, followed by I, X, and O.

Evaluation of two rehydration protocols for fractured tooth fragments for characteristics of penetration of resin tags using confocal laser scanning microscopy.

BACKGROUND: Fragment reattachment is the recommended treatment modality in uncomplicated crown fractures. There is a paucity of literature regarding the mechanisms responsible for increased resistance to fracture after fragment rehydration in such cases. Hence, the aim of this proof-of-concept study was to decipher the microscopic changes in the penetration characteristics of resin in tooth fragments after different rehydration protocols. MATERIAL AND METHODS: Sixty bovine incisors free of structural deformities were fractured as per a standard protocol and the fragments were stored in saline at 4°C. They were randomly allocated into three groups (n = 20)-Group 1: negative-control, no-rehydration, Group 2: rehydration by immersion in distilled water for 15 min, Group 3: rehydration by humidification for 15 min. They were subjected to the "experimental bonding protocol" using an eighth-generation bonding agent mixed with rhodamine-B dye. The samples were subjected to decalcification and sectioned into cubical blocks (2 × 2 × 2 mm3 ). They were embedded in paraffin wax, sectioned by an ultramicrotome and evaluated by using a confocal laser scanning microscope. The depths and width of the resin tags were assessed by image analysis software, and the number of tags was counted manually by blinded evaluators. Statistical analysis was done with Stata-14. RESULTS: The depth of penetration of the resin tags was greatest in Group 2 (927.81 ± 280.38 µm) followed by Group 3 (902.03 ± 371.85 µm) and Group 1 (287.74 ± 124.80 µm). Similarly, the width of the penetrated resin tags was greatest in Group 2 (58.29 ± 21.15), followed by Group 3 (35.53 ± 22.15) and Group 1 (23.89 ± 6.88). The number of resin tags in the majority of the samples in Group 1 had less than 25 tags (65%), whereas there were more than 25 tags in Group 2 (70%) and Group 3 (75%). These differences were statistically significant (p < .05). CONCLUSION: The resin penetration, as observed by the number of tags and their depth and width, was significantly affected by the rehydration of the fragments. The fragments rehydrated in the distilled water had greater penetration of resin tags than those rehydrated in a humidification chamber.

Development and validation of risk of bias tool for the use of finite element analysis in dentistry (ROBFEAD).

There has been a systematic review of studies that used FEA in dental sciences, but no adequate risk of bias (RoB) analysis technique has been developed. Therefore, the development and validation process of RoB in studies using the finite element analysis in dentistry (ROBFEAD) tool is described. In the first phase of development, the scope of the tool and possible modifications were covered, and validation was done in the second phase. The developed tool comprised 6 domains and a total of 22 guiding questions in these domains. This article proposes the development and validation of ROBFEAD, a tool for measuring RoB in finite element research in dentistry.

Inflammatory mediators for predicting the risk of trauma-induced root resorption: A systematic review.

BACKGROUND/AIM: External inflammatory root resorption (EIRR) and external replacement root resorption (ERRR) are the most common adverse outcomes after luxation injuries or dental injuries. They are usually detected radiographically after considerable progression. It can be envisaged that evaluation of inflammatory mediators might serve as an objective and reliable method of predicting the risk of resorption. The aim of this systematic review was to assess the evidence regarding the risk of resorption and to provide future research directions. METHODS: An a priori protocol was prepared by a multidisciplinary expert group, as per the Cochrane handbook and PRISMA guidelines. The systematic search was conducted in six databases and grey-literature sources. Scrutiny of titles and abstracts, and later full-text articles was performed, and data were extracted. Risk of bias analysis was done by using the Joanna Briggs Institute's Critical Appraisal Checklist for analytical cross-sectional and cohort studies. RESULTS: Eight studies were included in the systematic review and could be categorized as per the source of biomarkers, namely epithelial cells from mucosa, gingival crevicular fluid and extracted teeth. The studies utilizing epithelial cells had been conducted between 2015 and 2018 in Brazil and did not find any correlation with EIRR. Two of the studies with extracted teeth found differences in the immunologic profiles of teeth with resorption. Three studies evaluating gingival crevicular fluid found increased levels of dentine sialoprotein and Interleukin-1-α. CONCLUSION: Among the three sources, the inflammatory gingival crevicular fluid appeared to be the most non-invasive source of biomarkers for predicting trauma-induced root resorption, although the evidence about this came from two studies with moderate and one study with high risk of bias. The primary studies in this systematic review showed variability in terms of the sample sizes, age of the patients, the grading/classification of trauma-induced resorption and the evaluation methods which must be addressed by future researchers.