Zirconia crowns--an esthetic and resistant restorative alternative for ECC affected primary teeth.

The present report discusses briefly the problem of ECC in very young children and the recommended approaches for prevention and treatment. The esthetic restoration of the maxillary incisors with Zirconia Nu Smile crowns is described. It is also stressed that the luxation injury two months after placement did not damage the appearance nor the stability of the crowns.

Minimal intervention dentistry procedures: a ten year retrospective study.

UNLABELLED: Minimal Intervention Dentistry (MID) is an effective treatment approach with increasing acceptance among dental professionals. OBJECTIVE: This study aimed to evaluate the MID impact on Dentistry by analyzing procedures performed on patients treated at a Pediatric Dentistry Graduate Program clinic which implemented MID. STUDY DESIGN: The number of procedures including sealants, modified atraumatic restorative treatment (mART), resin crowns, direct pulp capping, pulpotomy, pulpectomy, and deciduous/ permanent extractions from 333 pediatric patients treated between the years 2001 to 2003 and 2008 to 2010 in Distrito Federal, Brazil were analyzed. Statistical analysis involved chi-square and G Williams tests. RESULTS: 783 procedures were analyzed and demonstrated that there was a significant reduction of sealant placement in the last triennium when compared to the first one (p<0.0001). Moreover, there was a significant increase in the amount of mART (p<0.0001). This increase in mART procedures resulted in a significant reduction in procedures with pulp involvement: direct pulp capping (p=0.0014), pulpotomy (p=0.0014) and pulpectomy (p=0.0002). CONCLUSIONS: Based on the results, MID represented a positive impact on the intervention on caries lesions in patients, mainly reflected by the significant reduction in the number of direct pulp capping, pulpotomy and pulpectomy.

Esthetic restorative options for pulpotomized primary molars: a review of literature.

OBJECTIVE: The goal of this manuscript was to review the existing literature in regards to esthetic options to restore pulpotomized primary molars. STUDY DESIGN: A pubmed literature search has been performed and all relevant studies were assessed. RESULTS: Two laboratory, 3 restrospective and 4 prospective clinical studies were found, reviewed and analyzed. CONCLUSIONS: Based on the limited information available, we concluded that tooth colored and bonded restorations showed promising results as alternative materials to replace stainless steel crowns after pulpotomies in primary molars. Hybrid composites tend to perform better than compomers. Resin modified glass ionomer cements demonstrated excellent marginal seal and retention. More long-term follow up studies are necessary until more definitive recommendations can be made.

A randomised controlled clinical trial comparing pure Portland cement and formocresol pulpotomies followed from 2 to 4 years.

PURPOSE: The purpose of the present prospective randomised clinical control trial was to evaluate the long-term clinical and radiographic success rate of pulpotomies in primary molars using pure Portland cement versus formocresol. Pure Portland cement has shown a high rate of success in pulpotomy treatments, with no side effects. METHODS: Healthy 3- to 11-year-old children were treated with pulpotomies on primary molars as part of their scheduled dental treatment. Pulp dressing alternated randomly between pure Portland cement and formocresol. Data were analysed at follow-up periods up to 48 months. RESULTS: 68 (50%) teeth with pure Portland cement and 68 (50%) teeth with formocresol in 136 healthy children (59 boys and 77 girls) were followed. The overall success rate of the pulpotomies in this study was 95.6%. Pure Portland cement was successful in 100% of the cases (68 out of 68), and formocresol in 91.1% (62 out of 68). No association was found between success and type of tooth or time range from treatment to last follow-up. CONCLUSION: Based on this study's results, it can be concluded that there is no superiority of one material over the other and pure Portland cement can be used in primary molar pulpotomies.

[Assessment of pulps vitality for children and adolesents].

Accurate assessment of pulp status is one of the greatest diagnostic challenges in clinical practice. This may be further complicated in children and adolescent where the practitioner is faced with different situations such as: primary teeth, developing permanent dentition, traumatized teeth, patients undergoing orthodontic treatment. In addition, the dentist is frequently faced with young children who have limited ability to recall a pain history or cooperate with the test itself. A variety of pulp testing approaches exist, and there may be a confusion as to their validity in different clinical situations. Sensitivity tests include thermal testing and Electric Pulp Test. Their limitation is the possibility to get false positive or false negative results. Their primary limitation lies in the fact that they test the sensory response of the tooth, which can be temporarily lost after dental trauma. A more accurate assessment of pulp vitality would be made by determining the presence of a functioning blood supply with the use of Laser Doppler Flowmetry or Pulse Oximetry. This paper provides the clinician with a comprehensive review of current pulp testing methods and allow greater insight into the interpretation of pulp testing results, especially in young patients.

Kohlschütter-Tönz syndrome: epilepsy, dementia, and amelogenesis imperfecta.

Kohlschütter-Tönz syndrome is a central nervous system (CNS) degenerative disease with convulsions and mental regression in which the affected children present with yellow teeth due to defective enamel. We present a family in which 2 affected children (a boy and a girl) were born to consanguineous parents. This report confirms the autosomal recessive inheritance of the disorder. The combination of a CNS and an enamel defect may represent pleiotropy or a contiguous gene syndrome.

Predisposition to caries in hamsters following the Erosire effect of a commercial citrus beverage administered with and without supplemental fluoride.

A study was undertaken to investigate the effect of a citrus beverage on tooth erosion and predisposition to caries in hamster molars, and to determine if a supplement of 1.9 ppm fluoride to the beverage influences these systems. Results suggest that enamel erosion is a predisposing factor. The addition of physiological fluoride protects the enamel from erosion and caries.

Effect of trauma to the primary incisors on the alignment of their permanent successors in Israelis.

117 children who had experienced trauma to their primary incisors were re-examined in their transitional or permanent dentition stage. The control group consisted of 174 children with a corresponding dental developmental age. All the children were examined clinically and the intra- and interarch relations of the anterior segments were recorded. The prevalence of patients with at least one malposed incisor was higher in the trauma group. Trauma to the primary dentition was found to be a contributing factor affecting the alignment of the permanent successors. Early loss of the primary incisors did not cause loss of space in most of the cases; however, it was associated with malposition of their permanent successors. Lack of eruption guidance or the direct effect of the injury on the position of the developing bud could be considered as contributing etiologic factors. There was a very low prevalence of more serious malocclusion features, like impaction, in the trauma group.

Autopolymerized versus light-polymerized fissure sealant.

This study found that 31 months after placement of a sealant, no significant difference was seen in the clinical performance and retention between the visible light-polymerized and autopolymerized materials. Practitioners can use either material without compromising efficacy.

Occlusal composite restorations: 4-year results.

A study was performed to determine the success of a conservative cavity preparation using the principle of sealing for prevention rather than cavity extension for prevention. A total of 332 restorations were placed in 240 teeth of 110 subjects, aged 6 to 14, with a mean age of 8 years. After 4 years, 205 restorations were examined. Caries appeared in 13 teeth and sealant wear occurred in 14 restorations. Complete sealant loss was observed in eight restorations and partial loss in 38, leaving 156 restorations with complete retention of the sealant. These preliminary results show that conservative cavity preparation with sealing for prevention is a successful technique that conserves valuable tooth structure.

A clinical, radiographic, and SEM evaluation of Class 2 composite restorations in primary teeth.

Sixty class 2 composite resin restorations were placed in 22 children and evaluated at baseline, six months, and one year. Radiographs were used for evaluation, in addition to clinical examinations, photographs, and scanning electron micrographs of epoxy resin casts of retrieved teeth. It was concluded that radiographs are necessary to detect a large percentage of failures at the gingival margins of class 2 composites.

Two-year evaluation in vivo and in vitro of Class 2 composites.

Nineteen class 2 Herculite restorations were evaluated two years after placement. Nine of these were retrieved and examined by clinical inspection out of the mouth. Six of the restorations were then removed and the cavities examined for extent and location of discoloration and secondary caries. Radiolucent defects at the gingival margins were seen in 36% of the teeth. Gaps were evident in 58% of the gingival margins of the retrieved teeth. Secondary caries was diagnosed in four cases, all of them at the cervical margin. Examination of the cavities after removal of the composite resin demonstrated the penetration of the carious process into the dentin.

Microleakage of Class 2 glass-ionomer-silver restorations in primary molars.

The aims of this study were to assess microleakage at the cervical margins of class 2 "sandwich" restorations placed with two glass-ionomer-silver cements in primary molars, to compare the quality of the occlusal margins of these restorations to those prepared with Miracle Mix and Ketac Silver, and to assess by scanning electron microscopy (SEM) the marginal micromorphology of those restorations. Fifty-two class 2 restorations were prepared in extracted primary molars and were restored as follows: 1) Ketac Silver + Estilux Posterior (sandwich), 2) Miracle Mix + Estilux Posterior (sandwich), 3) Ketac Silver only, and 4) Miracle Mix only. No or minimal leakage was evident in most of the occlusal margins, whereas severe leakage was observed in almost 70% of the cervical margins of the Ketac Silver groups. Scanning electron microscopy evaluation demonstrated good adaptation at the buccal and lingual margins of all the restorations. Sixty-seven percent of the Miracle Mix restorations had no defects at the cervical margins, as opposed to only 17% of those with Ketac Silver.

Microleakage of class 2 Superbond-lined composite restorations with and without a cervical amalgam base.

The purposes of the present study were: 1) to assess the microleakage at the cervical margin of Superbond-lined composite restorations with and without a cervical amalgam base and compare the results to cervical margins of composite restorations lined with Scotchbond 2, and 2) to compare the quality of the occlusal margins of Superbond-lined P-50 restorations with those bonded with Scotchbond 2. Forty-eight class 2 cavities were prepared in extracted or exfoliated primary molars. The teeth were randomly divided into three groups and restored as follows: Group A, amalgam + Superbond + P-50 (sandwich); Group B, Superbond + P-50; Group C, Scotchbond 2 + P-50 (control). Marginal leakage was assessed by the degree of dye penetration on sections of the restored teeth. The occlusal margins presented no or minimal leakage (degrees 0 and 1) in 53% of Group A restorations, 60% of Group B, and 44% of Group C. These differences were not statistically significant (P<0.05). The cervical margins showed moderate to severe dye penetration (degrees 2 and 3) in 94% of Group A, 47% of Group B, and 87% of Group C. These differences were statistically significant (P<0.05). The amalgam/Superbond/composite interface exhibited no leakage in 70% of the restorations. Although marginal leakage was not completely eliminated, Superbond exhibited significantly less leakage (P<0.05) at the cervical margins than Scotchbond 2 or amalgam with Superbond.

Pulp therapy for the primary and young permanent dentitions.

This article describes the pulp reactions to caries and operative procedures and emphasizes the importance of a clinical diagnosis to evaluate the most appropriate pulp treatment. Conservative and radical treatments are described, stressing the differences between primary and young permanent dentitions.

Marginal leakage around V-shaped cavities restored with glass-ionomer cements: an in vitro study.

The object of this investigation was to assess the degree of marginal leakage around V-shaped cervical glass-ionomer cement restorations and compare it to that around composite resin restorations. Three different glass-ionomer cements and one composite resin control were assessed by means of dye penetration. Severe microleakage at the occlusal margins was found in 70% of the glass-ionomer cement restorations, but in only 10% of the composite resin restorations. A considerable amount of dye penetration was observed at the cervical margins of all restorations, including the controls. None of the glass-ionomer cements tested showed superiority in preventing marginal leakage occlusally or gingivally.

A comparison of pulpectomies using ZOE and KRI paste in primary molars: a retrospective study.

Maintaining a successfully root-treated primary molar has the advantage of preserving the natural tooth--the best possible space maintainer. The purpose of this study was to compare the success of endodontic treatment of nonvital primary molars using ZOE with that of KRI paste. Of 78 necrotic primary molars, 34 were filled with ZOE and 44 with an iodoform-containing paste (KRI). The canals were prepared with files, rinsed with saline and filled with one of the resorbable pastes, using a spiral Lentulo on a low-speed handpiece. A radiograph was exposed immediately postoperatively to observe whether the root filling was flush, underfilled, or overfilled. The effect of length of fill on the treatment outcome also was evaluated. Teeth were examined periodically clinically and radiographically to assess success of the treatment. Follow-up interval varied from 12 to more than 48 months. Overall success rate for KRI paste was 84% versus 65% for ZOE, which was statistically significant (P < 0.05). Overfilling with ZOE led to a failure rate of 59% as opposed to 21% for KRI (P < 0.02). Conversely, underfilling led to similar results, with a failure rate of 17% for ZOE and 14% for KRI. These results support the clinical efficacy of root filling with KRI paste as a treatment option for nonvital primary molars.

The diagnostic value of coronal dark-gray discoloration in primary teeth following traumatic injuries.

The diagnostic value of dark-gray discoloration of the crown of primary incisors following traumatic injury as a predictor of pulp vitality is controversial. This retrospective study attempted to examine the condition of the pulp of primary incisors with dark-gray discoloration following traumatic injuries. Forty-eight gray caries-free, traumatized primary incisors were examined clinically and radiographically prior to treatment. All teeth included in the study were free of any clinical and/or radiographic signs of pulp necrosis. Crown discoloration was the only clinical or radiographic sign of pulp involvement. Pulpectomy was performed in five teeth within the first month after trauma, in 16 teeth during the second month, 11 teeth between 2 and 6 months, seven teeth between 6 and 12 months, and three teeth after more than a year. In six teeth the time of injury was unknown. Endodontic treatment was initiated without local anesthetic under rubber dam, access to the pulp chamber with high speed, and debridement with a barbed broach. Assessment of the pulp condition was made upon opening the pulp chamber, as follows: Vital-pulp bled when exposed; partial necrosis-bleeding disclosed at the apical area during debridement; total necrosis-no bleeding was observed. Pulp necrosis was found in 37 teeth (77.1%), 10 teeth (20.8%) presented partial necrosis, and only one tooth (2.1%) had a vital pulp. Dark-gray discoloration of primary incisors could be interpreted as an early sign of pulp degeneration that would deteriorate into necrosis. Moreover, discolored primary incisors can be necrotic even without presenting tenderness to percussion, increased mobility, and periapical osteitis.

Assessment of marginal leakage around Class II composite restorations in retrieved primary molars.

The aim of the present investigation was to evaluate, by means of dye penetration, the microleakage around Class II composite restorations, in retrieved primary molars that functioned in the mouth for at least one year. The experimental material consisted of 13 exfoliated primary molars that had been restored with Herculite (Kerr Corporation, Romulus, Michigan 48174 USA) at least one year previously, utilizing an incremental or a bulk filling technique. The retrieved teeth were insulated with utility wax and nail polish, immersed in 2% basic fuchsin, embedded in acrylic resin, and ground off to various depths. The marginal leakage was assessed according the degree of dye penetration at the occlusal and cervical margins. No difference was observed between the two filling techniques. In most teeth, no leakage at the occlusal margins was observed; minimal leakage, limited to the enamel, was observed at the occlusal margins of two teeth, one of each filling technique. Severe penetration was evident at the cervical margin of three restorations, two of them filled incrementally and the third using the bulk technique. Mild to moderate penetration was observed at the cervical margin in the majority of the other restorations. It was concluded that an incremental filling technique could not eliminate microleakage at the cervical margins of Class II composite restorations.

Long-term followup of traumatized incisors treated by partial pulpotomy.

The purpose of this study was to assess the long-term success of partial pulpotomy in traumatized permanent incisors. Seven years before this examination, 63 teeth that had been treated by partial pulpotomy six months to four years earlier were examined. At that stage, four teeth had pulp necrosis. The remaining 59 cases were recalled for re-examination. Of these, 40 were available for assessment 7.5 to 11 years after the partial pulpotomy treatment. Thirty-five of these teeth were successful, while the remaining five had root canal fillings, and three of them were restored by post and crowns. Of these, two were root treated in consequence of new trauma, and the other two for esthetic purposes. The fifth tooth has probably been root treated for similar reasons, as the patient reported not having had any pain or problem with the tooth. The high frequency of long-term success justifies recommending partial pulpotomy as the treatment of choice for traumatic pulp exposures in crown-fractured permanent incisors.