Alveolar bone loss in two children with short-bowel syndrome receiving total parenteral nutrition.

Two preschool children who were receiving total parenteral nutrition (TPN) for short-bowel syndrome (SBS) were noted to have radiographic evidence of alveolar bone loss in their primary dentition. Tooth mobility, gingival recession, and premature tooth loss were clinical findings in these children. Both had a 2-year history of recurrent infections and fluctuating serum electrolytes prior to identification of their dental problems.

The effect of internal bevel on marginal leakage at the approximal surface of Class 2 composite restorations.

The aim of this study was to assess the effect of intentionally leaving undermined enamel (internal bevel) along the cervical margins of class 2 composites on marginal leakage. Conventional MO and DO cavity preparations were prepared in 25 extracted permanent premolars. In each tooth the cervical margin was a butt-joint for the control group and an internal bevel for the experimental group. A transparent celluloid matrix was adapted and the teeth were restored with scotchbond Multi-Purpose and increments of Z100. A U-shaped increment was attached to the buccal and lingual walls and cervical floor of the box, leaving a gap for a middle increment. A third increment filled the occlusal part of the cavity. Following thermocycling the teeth were immersed in basic fuchsin for 24 hours, and 0.5 mm-wide sections were cut in a mesiodistal direction. Dye penetration was scored: 0 = no penetration; 1 = dye along enamel tooth interface; 2 = dye along the gingival floor; 3 = dye along pulpal wall; 4 = dye penetration into dentinal tubules. The experimental group showed 17 teeth (68%) with no dye penetration, compared to eight (32%) in the control group. Severe dye penetration (score 4) was found in only four teeth (16%) of the experimental group and 12 (48%) of the controls. The difference between the groups was statistically significant (Wilcoxon matched-pairs signed-rank test; P < 0.01). This study showed that an internal bevel at the cervical margins of class 2 composite restorations reduces marginal leakage when compared to a conventional butt-joint cavity preparation.

An evaluation of marginal leakage of Class 2 combined amalgam-composite restorations.

Forty class 2 cavities were prepared in 20 permanent posterior teeth. In 20 cavities the gingival margin was placed in enamel and in the other 20 cavities in cementum. In every tooth one of the cavities was filled with composite and the other with a combined amalgam-composite restoration. Microleakage at the various interfaces was assessed by dye penetration. It was concluded that microleakage of the combined amalgam-composite restorations was significantly lower than that of the conventional composite restorations.

Marginal leakage of impregnated Class 2 composites in primary molars: an in vivo study.

In vivo impregnation of the cervical margin was used in an attempt to prevent leakage of class 2 composite restorations in primary molars. Examination after 18 months demonstrated clinical success of the restorations. However, the exfoliated teeth presented extensive dye penetration at the approximal margins of the restorations, suggesting that impregnation did not prevent marginal leakage.

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.

Clinical, radiographic, SEM evaluation and assessment of microleakage of Class II composite restorations.

The influence of incremental or bulk filling techniques, and reapplication of unfilled resin (impregnation) to the margins with an enamel bonding agent, on marginal adaptation was evaluated in Class II composite restorations by clinical, radiographic, scanning electron microscope (SEM) and dye penetration techniques. Cavities were prepared in 80 extracted permanent posterior teeth. All cavity walls were treated with polyacrylic acid for 10 seconds. The enamel was etched for 1 minute, rinsed, dried, and lined with Scotchbond. Forty cavities were filled by increments of P30 and 40 cavities in bulk. The margins of the restorations of 20 teeth in each group were re-etched for 30 seconds and Concise Enamel Bond reapplied. The clinical scores were excellent for all restorations. Radiographic examination showed twice as many bubbles in the incrementally filled restoration than in the group filled in bulk. In 53 teeth, a radiolucent area between the dentin and the restorative material was found. After sectioning, this area was found to correspond to a hard material. The SEM revealed excellent margins in the groups of teeth that were impregnated with an unfilled resin, whereas 13 teeth without impregnation showed defective margins. The dye penetration, as a test for marginal leakage, was minimal at the occlusal surface of all teeth. At the cervical surface, 10.5% of the impregnated teeth showed severe dye penetration compared to 18% of the nonimpregnated teeth. No correlation was found between dye penetration at the cervical surface and the thickness of the residual enamel in this area.(ABSTRACT TRUNCATED AT 250 WORDS)

Conservative treatment of severely luxated maxillary primary central incisors: case report.

The treatment and follow-up evaluation of two orally luxated maxillary primary central incisors in a three-year-old girl is described. The injured teeth were displaced into a cross-bite with their mandibular opposing teeth. They were repositioned shortly after the injury and splinted with composite resin for two weeks. Oral hygiene instructions and antibiotic therapy were prescribed. Two weeks after the injury a necrotic pulp was removed and the root canals filled with a resorbable paste. Thirty months after the injury, the teeth and the surrounding tissues were clinically and radiographically asymptomatic and physiologic root resorption could be noted. The permanent successors erupted soon after natural exfoliation of the injured primary teeth. Only mild hypocalcified defects were observed on the permanent incisors.

Partial pulpotomy in a traumatized primary incisor with pulp exposure: case report.

Crown fracture with pulp exposure in primary incisors is a rare condition. Despite the fact that the vitality of the pulp can be preserved, such teeth are usually extracted due to lack of patient cooperation. This article reports a successful conservative treatment of a fractured primary incisors with pulp exposure and undeveloped root. The child was sedated with midazolam and nitrous oxide, and partial pulpotomy was performed using calcium hydroxide. Follow-up radiographs 21 weeks later revealed closure of the apex and apposition of a dentin bridge close to the amputation site.

Sequelae and prognosis of intruded primary incisors: a retrospective study.

PURPOSE: This study was designed to assess the sequelae and prognosis of intruded primary incisors. METHODS: Of 196 children who visited the emergency clinic due to intrusion of 310 maxillary primary incisors, 110 children (172 teeth) were available for follow-up examination (study group). Eighty-six children (138 teeth) did not show for the follow-up examination (non-respondents group). Male/female ratio was 1.7:1. Age range of children at time of injury was 12-72 months (mean 28). Follow-up time ranged between 0 and 59 months (mean 27). RESULTS: Fifty-seven percent of all teeth were completely intruded. In 80%, the root was pushed labially. All but two ankylosed teeth re-erupted, and 37% of these re-erupted into an ectopic position. Completely intruded incisors re-erupted into an ectopic position in a higher percentage (45%) than partially intruded teeth (30%). Fifty-two percent of the teeth presented pulp canal obliteration (PCO). Sixty-four percent of the completely intruded incisors presented PCO compared to 40% of partially intruded teeth. Arrest of dentin apposition was found in 15% of the teeth, and was not affected by the degree of intrusion. Twenty-three teeth were extracted shortly after the injury due to suspect of contact with the developing permanent successor (19 teeth) and severe caries (4 teeth). Sixty-eight percent of the intruded teeth survived more than 36 months after the injury. Twenty-three percent were extracted due to periodontal breakdown and 5% due to repeated trauma. Antibiotic therapy did not have any effect on the survival rate. CONCLUSION: The majority of intruded primary incisors may re-erupt and survive with no complications after more than 36 months post trauma even in cases of complete intrusion and fracture of the labial bone plate.

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.

Intranasal midazolam better at effecting amnesia after sedation than oral hydroxyzine: a pilot study.

Providing amnesia about a surgery is a desired side effect of a medication. This study compares anterograde amnesic effects of midazolam with hydroxyzine in children undergoing dental treatment with those drugs plus nitrous oxide, using a recall test. Thirty ASAI children 24-28 months, were shown a Standard-Binet intelligence scale-memory for objects subtest before entering treatment room. Twenty-lone randomly determined children received 3.7 mg/kg hydroxyzine 45 min before treatment or 0.2 mg/kg intranasal midazolam in two succeeding appointments, alternatively. Recall in the 30-subject treatment group was 90%. Recall in the 21-subject treatment group was 71% for hydroxyzine and 29% for midazolam. Midazolam was more effective in creating amnesia than hydroxyzine in this study.

Temperature elevation in children following dental treatment under general anesthesia with or without prophylactic antibiotics.

Bacteremia, tissue damage, and dehydration are mentioned frequently as factors that might be responsible for postoperative temperature elevation (PTE). In a prospective, randomized, double-blind, placebo-controlled study, the influence of a single dose of oral amoxicillin administered 1 hr prior to the procedure on PTE was examined. Twenty-six healthy children (21 boys and 5 girls) 2 to 5 years old, who received dental treatment under general anesthesia (GA) were evaluated. Anesthesia was maintained with nitrous oxide and Fluothane and the patients were well-hydrated intravenously during the procedure. Half of the children received prophylactic antibiotic 1 hr prior to the procedure. The other half received a flavored syrup as placebo. Thirteen patients (50%) presented PTE (rectal temperature > or = 37.9 degrees C) 2-5 hr after extubation. The results were statistically analyzed using ANOVA. However, no association was found between PTE and antibiotic administration or any of the parameters investigated such as, number of dental procedures, type of treatment performed, patient's weight, or change in temperature during dental treatment. (Pediatr Dent 15:99-103, 1993).

Evaluation of the effect of nitrous oxide and hydroxyzine in controlling the behavior of the pediatric dental patient.

This study evaluated and compared the effect of three different sedation combinations on the young dental patient: hydroxyzine alone, hydroxyzine with nitrous oxide, and nitrous oxide alone. Nineteen uncooperative children with mean age of 37 months needing at least three restorative visits were selected for this study. Crying, alertness, and general behavior were evaluated during the dental procedure. The combination of hydroxyzine and nitrous oxide was more effective than the others for the majority of the sessions in terms of controlling crying and alertness. The results in the present study indicate that the sedative effect of hydroxyzine on children's behavior is enhanced by the addition of nitrous oxide.

Mineral trioxide aggregate vs. formocresol in pulpotomized primary molars: a preliminary report.

PURPOSE: The aim of this study was to compare the effect of mineral trioxide aggregate (MTA) to that of formocresol (FC) as pulp dressing agents in pulpotomized primary molars with carious pulp exposure. METHODS: Forty-five primary molars of 26 children were treated by a conventional pulpotomy technique. The teeth were randomly assigned to the MTA (experimental) or FC (control) group by a toss of a coin. Following removal of the coronal pulp and hemostasis the pulp stumps were covered with an MTA paste in the experimental group. In the control group, FC was placed with a cotton pellet over the pulp stumps for 5 minutes and removed; the pulp stumps were then covered by zinc oxide-eugenol (ZOE) paste. The teeth of both groups were restored with stainless steel crowns. Eighteen children with 32 teeth arrived for clinical and radiographic follow-up evaluation ranging from 6 to 30 months. RESULTS: The follow-up evaluations revealed only one failure (internal resorption detected at a 17 months postoperative evaluation) in a molar treated with formocresol. None of the MTA-treated teeth showed any clinical or radiographic pathology. Pulp canal obliteration was observed in 9 of 32 (28%) evaluated molars. This finding was detected in 2 out of the 15 teeth treated with FC (13%) and in 7 out of the 17 treated with MTA (41%). CONCLUSION: MTA showed clinical and radiographic success as a dressing material following pulpotomy in primary teeth and seems to be a suitable replacement for formocresol in primary teeth.

Ferric sulfate versus dilute formocresol in pulpotomized primary molars: long-term follow up.

The aim of this study was to compare the effect of ferric sulfate (FS) to that of dilute formocresol (DFC) as pulp dressing agents in pulpotomized primary molars. Ninety-six primary molars in 72 children were treated by a conventional pulpotomy technique. Fifty-eight teeth were treated by a FS solution for 15 sec, rinsed, and covered by zinc oxide-eugenol paste (ZOE). In another 38 teeth, a cotton pellet moistened with 20% DFC was placed for 5 min, removed, and the pulp stumps were covered by ZOE paste. The teeth of both groups were sealed by a second layer of intermediate restorative material (IRM) and restored with a stainless steel crown. This is a report of the clinical and radiographic examination of 55 teeth dressed with FS and 37 teeth fixed with DFC, that have been treated 6 to 34 months previously (mean 20.5 months). Four teeth were excluded from the study due to failure of the patient to present for recall. Success rates of 92.7% for the FS, and of 83.8% for the DFC were not significantly different. Four teeth (7.2%) of the FS group and two (5.4%) of the DFC group presented internal resorption. Inter-radicular radiolucencies were observed in two teeth of the FS group and three teeth of the DFC group. The latter also presented periapical lesions. Success rates of both groups were similar to those of previous studies utilizing the traditional Buckley's formocresol.

Immediate esthetic treatment of an avulsed/replanted permanent incisor with extensive root resorption: a case report.

This article describes the treatment of a 10 year-old patient with complete root resorption of the maxillary permanent incisor following avulsion and replantation 4 years earlier. The remaining natural crown was used to immediately solve the esthetic problem created by its extraction. The crown was attached with an orthodontic wire and composite resin to adjacent teeth. This temporary treatment does not elicit any damage to adjacent teeth, and can be easily removed. Therefore, it does not affect any plans that might be considered in the future as the permanent treatment.