Protection Against Discolouration by Two Over-the Counter Desensitising Products.

PURPOSE: To determine in vitro the protection potential against discolouration of two OTC (over-the-counter) desensitising products on enamel and dentin in comparison to a standard toothpaste and water by means of a spectrophotometer. MATERIALS AND METHODS: A total of 96 samples of bovine enamel-dentin complex and 48 of bovine dentin were alternatively immersed in red wine, tea, coffee or water after having been treated by a sodium monofluorophosphate- and calcium phosphate-based product (Curodont Protect), an amine fluoride-based toothpaste (Elmex Red), a stannous chloride-based toothpaste (Elmex Protection Erosion) or distilled water (negative control). Initial (T0) and final colour (T1, after 4 weeks of immersion in staining solutions) of each specimen were assessed by a spectrophotometer. Statistical analysis was done by means of repeated measures ANOVA followed by Fisher's LSD post-hoc test. Differences between T0 and T1 were considered stastistically significant at p ≤ 0.05. RESULTS: When enamel samples were measured over a black background, ΔE00 values (T0-T1) varied from 2.2 (SD 0.7) for amine fluoride-based product/water to 53.9 (SD 7.6) for amine fluoride-based-product/red wine. When dentin samples were measured over a black background, ΔE00 values (T0-T1) varied from 5.4 (SD 0.9) stannous chloride based product/water to 61.6 (SD 3.7) amine fluoride-based product/red wine. CONCLUSION: Specifically, the application of the sodium monofluorophosphate was able to statistically significantly (p ≤ 0.05) reduce discolouration induced by the staining solutions tested only on the enamel-dentin complex, while distilled water and the stannous fluoride-based product were able to statistically significantly (p ≤ 0.05) reduce discolouration induced by the staining solutions tested in pure dentin samples.

Interrater and intrarater reliability of FDI criteria applied to photographs of posterior tooth-colored restorations.

STATEMENT OF PROBLEM: Since 2007, the FDI World Dental Federation (FDI) criteria have been used for the clinical evaluation of dental restorations. However, the reliability of the FDI criteria has not been sufficiently addressed. PURPOSE: The purpose of this study was to assess and compare the interrater and intrarater reliability of the FDI criteria by evaluating posterior tooth-colored restorations photographically. MATERIAL AND METHODS: A total of 160 clinical photographs of posterior tooth-colored restorations were evaluated independently by 5 raters with 9 of the FDI criteria suitable for photographic evaluation. The raters recorded the score of each restoration by using 5 grades, and the score was dichotomized into the clinical evaluation scores. After 1 month, 2 of the raters reevaluated the same set of 160 photographs in random order. To estimate the interrater reliability among the 5 raters, the proportion of agreement was calculated, and the Fleiss multirater kappa statistic was used. For the intrarater reliability, the proportion of agreement was calculated, and the Cohen standard kappa statistic was used for each of the 2 raters. RESULTS: The interrater proportion of agreement was 0.41 to 0.57, and the kappa value was 0.09 to 0.39. Overall, the intrarater reliability was higher than the interrater reliability, and rater 1 demonstrated higher intrarater reliability than rater 2. The proportion of agreement and kappa values increased when the 5 scores were dichotomized. The reliability was relatively lower for the esthetic properties compared with the functional or biological properties. CONCLUSIONS: Within the limitations of this study, the FDI criteria presented slight to fair interrater reliability and fair to excellent intrarater reliability in the photographic evaluation of posterior tooth-colored restorations. The reliability was improved by simplifying the evaluation scores.

Staining Beverages and Cigarette Smoke on Composite Resin and Human Tooth Fluorescence by Direct Spectrometry.

INTRODUCTION: This study evaluated the fluorescence intensity (FI) of different brands of composite resins (CRs) and compare those values with the FI of human tooth, under the action of cigarette smoke (CI), coffee (CA), and soft drink (CO), measured by direct spectrometry. MATERIALS AND METHODS: A total of 30 specimens of each brand (Filtek Z350, Esthet-X, Amelogen, Durafill) were made. Others 30 tooth specimens (3 mm/diameter) were obtained from human molars using a trephine bur. The specimens were randomly divided into three groups (n = 10), according to substances: CI, CA, CO. The FI was directly measured using an optic fiber associated with a spectrometer and was measured at baseline and after staining. Data were submitted to Kruskal-Wallis, Dunnett, and Dunn tests. RESULTS: Staining influenced FI mean values among CRs and between those with human tooth. Z showed the closest FI mean values of tooth after staining. CONCLUSION: Staining beverages and cigarette smoke negatively influenced on FI of CR and human tooth. CLINICAL SIGNIFICANCE: The study shows darkening treatments influenced on the fluorescent property of the dental tissues and restorative materials according to the direct spectrometry analysis.

Tridimensional surface roughness analysis after resin infiltration of (deproteinized) natural subsurface carious lesions.

OBJECTIVES: The objectives of this study were to evaluate ex vivo the effects of resin infiltration on the areal surface roughness of natural non-cavitated proximal subsurface lesions with or without previous deproteinization and to determine differences between E2 and D1 lesions or between premolars and molars. MATERIALS AND METHODS: Forty premolars and 40 molars with proximal carious lesions and macroscopically intact surfaces (International Caries Detection and Assessment System (ICDAS) II; code 2) were radiologically assessed and randomly allocated to four groups (with 20 E2 and 20 D1 lesions, respectively). In each group, 10 lesions were deproteinized (NaOCl; 1%) before etching (HCl; 15%) and resin infiltration (Icon). Areal surface roughness (Sa) at the most demineralized lesion part (DIAGNOdent) was evaluated topometrically before and after deproteinization, after etching, and after infiltration using focus variation 3D scanning microscopy. RESULTS: Pretreatment with NaOCl (n = 40) had no significant effects on Sa (p = 0.208), but resulted in significantly differing Sa values between premolars and molars after etching (p = 0.011). Regarding the effects between etching and baseline, significantly differing Sa values (p = 0.0498) were found for premolars and molars (n = 40/40); Sa after resin infiltration (compared to etching) differed significantly between premolars and molars (p = 0.009). No treatment regimen lead to differences among the radiological grades (E2 vs. D1; p > 0.106). CONCLUSIONS: Resin infiltration showed only minor effects on Sa values of etched subsurface lesions (p < 0.170) and did neither equal nor improve baseline surface roughness (p > 0.401) of the different tooth types. CLINICAL RELEVANCE: Deproteinization should be recommended before etching and infiltration, even if surface roughness of infiltrated advanced (pre-)molar lesions will not be improved.

Long-term clinical and radiographic follow up of subluxated and intruded maxillary primary anterior teeth.

AIMS: This study aimed to determine the kinds of sequelae resulting from intrusive luxation and subluxative injuries in primary anterior teeth as well as the timing of such sequelae. MATERIALS AND METHODS: In this longitudinal retrospective study, data were collected from dental records and radiographs of patients with traumatic dental injury (TDI) treated at the Centre for the Study and Treatment of Dental Trauma in Primary Dentition (Pelotas, RS, Brazil). Fifty-two children, with seventy intruded teeth, and 76 children, with 99 subluxated teeth, met the inclusion criteria. Sequelae, such as crown discoloration, fistula, pulp canal obliteration (PCO), inflammatory root resorption (IRR), and internal root resorption, were investigated. The data on the sequelae were distributed into eight follow-up periods: 0-30 days, 31-90 days, 91-180 days, 181-365 days, 1-2 years, 2-3 years, 3-4 years, and >4 years. RESULTS: The sample comprised 99 subluxation cases and 70 intruded teeth. Crown discoloration was the most prevalent sequelae. Among the subluxated teeth, <50% of IRR, fistula, crown discoloration, and PCO occurred within 180 days after TDI; however, the sequelae were also diagnosed after longer periods. Majority of sequelae of intrusion were diagnosed within the 181-365 days and 1-2 years periods but were also observed after more than 4 years of follow up. CONCLUSIONS: For both intrusion and subluxation, trauma sequelae were diagnosed even after the 3-4 years of follow-up.

Idiopathic Radiographic Apical Root Resorption in Wind Instrument Players.

Root resorption of the permanent teeth involves an elaborate interaction among inflammatory cells resulting in loss of dental hard tissues. This report describes three clinical cases where idiopathic root resorption occurred in wind instrument playing patients. These patients produce adequate non-orthodontic forces, while playing their instruments, to expose their teeth to root resorbing force. Careful clinical monitoring of patients' teeth should be undertaken, as the additive effects of orthodontic treatment and musical habits are unknown. CPD/Clinical Relevance: This paper advises that questioning about wind instrument playing during case history-taking would be beneficial to clinicians. Furthermore, careful clinical monitoring of these patients' teeth during orthodontic treatment should be undertaken.

Green teeth associated with hyperbilirubinemia: a case report.

BACKGROUND: Green stain is an uncommon clinical condition associated with deposition of bilirubin in the dental hard tissues. The staining of the teeth is due to hyperbilirubinemia caused by systemic conditions. CASE REPORT: The purpose of this report is to present a case of green teeth of the primary dentition in a 17-month old girl associated with hydrocephalus and Hirschprung's disease. CONCLUSION: The clinical characteristics of the teeth may help in the diagnosis of current or past systemic diseases.

Detection accuracy of proximal caries by phosphor plate and cone-beam computerized tomography images scanned with different resolutions.

This study was carried out to assess whether the spatial resolution has an impact on the detection accuracy of proximal caries in flat panel CBCT (cone beam computerized tomography) images and if the detection accuracy can be improved by flat panel CBCT images scanned with high spatial resolution when compared to digital intraoral images. The CBCT test images of 45 non-restored human permanent teeth were respectively scanned with the ProMax 3D and the DCT Pro scanners at different resolutions. Digital images were obtained with a phosphor plate imaging system Digora Optime. Eight observers evaluated all the test images for carious lesion within the 90 proximal surfaces. With the histological examination serving as the reference standard, observer performances were evaluated by receiver operating characteristic (ROC) curves. The areas under the ROC curves were analyzed with two-way analysis of variance. No significant differences were found among the CBCT images and between CBCT and digital images when only proximal enamel caries was detected (p = 0.989). With respect to the detection of proximal dentinal caries, significant difference was found between CBCT and digital images (p < 0.001) but not among CBCT images. The spatial resolution did not have an impact on the detection accuracy of proximal caries in flat panel CBCT images. The flat panel CBCT images scanned with high spatial resolution did not improve the detection accuracy of proximal enamel caries compared to digital intraoral images. CBCT images scanned with high spatial resolutions could not be used for proximal caries detection.

Transient discoloration of the coronal fragment in intra-alveolar root fractures.

BACKGROUND: Root fractures are a relatively rare type of injury with frequencies of 0.5-7% of traumatized permanent teeth. It is well known that teeth with intra-alveolar root fractures have a good prognosis. The pulp remains vital in about 80% of these teeth. If pulp necrosis develops, this normally only occurs in the coronal fragment. Although several studies on intra-alveolar root fractures have been published during the last decades, none have mentioned that transient discoloration can occur. The aim of our study was to study the frequency and prognosis for intra-alveolar root fractures with discoloration. MATERIAL AND METHODS: The material consisted of 42 permanent incisors from 21 boys and 18 girls aged 7-19 years (mean = 12.7, median 12.0). In two girls and one boy, two incisors exhibited concurrent intra-alveolar root fractured. The follow-up period ranged from 1 to 9 years. The colour changes were determined at each control by transillumination of the clinical crown from the facial and palatal surfaces. Electrometric sensibility was evaluated and compared to the values of adjacent teeth using an electric pulp tester. At the final clinical and radiographic control, the type of healing was registered. RESULTS: Discoloration was found in nine teeth. The root development was completed in all these teeth. The discoloration disappeared within 4 weeks to 6 months in eight teeth. The sensibility, which was lost at the injury, followed the changes in discoloration, and all teeth had regained normal sensibility when the discoloration had disappeared. Only one tooth, which showed a greyish hue, developed pulp necrosis. CONCLUSION: Transient discoloration in intra-alveolar fractures is relatively common and is indicative of a good prognosis for healing.

Multifocal odontoblastic dysplasia in a dog.

A two-year-old Boerboel dog presented for a discolored left maxillary canine tooth. Dental radiographs revealed abnormally mineralized pulp within the discolored tooth. Similar radiographic findings were also seen in both maxillary third incisor teeth and in the remaining canine teeth to varying degrees. The discolored tooth was treated by surgical extraction and histopathology revealed abnormal dentin deposition within the canal indicative of dentin dysplasia. Although not previously documented in the dog, the pulpal changes in multiple teeth of the dog reported here were similar to those described for odontoblastic dysplasia in humans. This case report includes a review of developmental abnormalities of dentin in humans and pulpal response to inflammation and injury.

Near-infrared imaging of demineralization on the occlusal surfaces of teeth without the interference of stains.

Most new caries lesions are found in the pits and fissures of the occlusal surface. Radiographs have extremely low sensitivity for early occlusal decay, and by the time the lesion is severe enough to appear on a radiograph, it typically has penetrated well into the dentin and surgical intervention is required. The occlusal surfaces are often heavily stained, and visual and tactile detection have poor sensitivity and specificity. Previous near-infrared imaging studies at wavelengths beyond 1300 nm have demonstrated that stains are not visible and demineralization on the occlusal surfaces can be viewed without interference from stains. The objective of our study is to determine how the contrast between sound and lesion areas on occlusal surfaces varies with wavelength from the visible to 2350 nm and determine to what degree stains interfere with that contrast. The lesion contrast for reflectance is measured in 55 extracted teeth with suspected occlusal lesions from 400 to 2350 nm employing silicon and indium gallium arsenide imaging arrays. In addition, the lesion contrast is measured on 25 extracted teeth with suspected occlusal lesions from 400 to 1600 nm in reflectance and from 830 to 1400 nm in transillumination before and after stains are removed using a ultrasonic scaler. The highest lesion contrast in reflectance is measured at wavelengths >1700 nm. Stains interfere significantly at wavelengths <1150 nm (400 to 1150) for both reflectance and transillumination measurements. Our study suggests that the optimum wavelengths for imaging decay in the occlusal surfaces are >1700 nm for reflectance (1700 to 2350 nm) and near 1300 nm (1250 to 1350 nm) for transillumination.

Tooth color and whitening - digital technologies.

OBJECTIVES: To review the key concepts of color in the dental domain with specific reference to the use of digital technology to measure color and color appearance. MATERIALS AND METHODS: The literature on color assessment in dentistry is considered and methods for assessing whiteness, yellowness and color appearance are collated and described. RESULTS AND CONCLUSION: A variety of methods for assessing color have been shown to exist and be viable including digital imaging. Equations to predict whiteness are identified; there is evidence that they are effective but further evaluation may be needed.

Caries detection and quantification around stained pits and fissures in occlusal tooth surfaces with fluorescence.

Occlusal discoloration due to staining frequently occurs on the pits and fissures of teeth. Noncariogenic discoloration (non-CD) refers to the attachment of staining chromogens to sound surfaces, whereas cariogenic discoloration (CD) represents the discoloration of porous structures due to bacterial metabolites and mineral loss from the enamel surface. This study evaluated whether it is possible to distinguish between non-CD and CD on stained occlusal surfaces with fluorescence assessed by the quantitative light-induced fluorescence (QLF) technology. Sixty-two extracted human permanent teeth with suspected discolorations on the pit and fissure were examined. The maximum values of fluorescence loss (ΔFmax) and red fluorescence gain (ΔRmax) were calculated using QLF images. Using histology as the gold standard, it was found that 12 teeth were sound (non-CD), while 50 teeth had enamel and dentine caries (CD). The validity tests at the enamel histological caries level, ΔRmax (ρ = 0.80) were strongly correlated with the histology (P < 0.001). At the optimum threshold (105.0) of ΔRmax, it showed high levels of sensitivity and specificity (0.96 and 0.83, respectively). Therefore, QLF can be used to distinguish non-CD from CD on occlusal surfaces using red fluorescence values with high validity.

Micro-CT analysis of naturally arrested brown spot enamel lesions.

OBJECTIVES: The aim of this study was to characterize the mineral density parameters through natural enamel brown spot lesions (BSLs) and to visualize and map their mineral distribution pattern in comparison to enamel whitespot lesions (WSLs). METHODS: Study specimens included seventeen proximal WSLs (ICDAS 1, 2), seventeen proximal BSLs and seventeen sound proximal specimens (ICDAS 0) collected from The Oral Surgery Department at Sydney Dental Hospital, Sydney, Australia. Imaging was undertaken using a high resolution, desktop micro-computed tomography system. A calibration equation was used to transform the grey level values of the images into true mineral density values. The qualitative analysis and the quantification of the lesion parameters including the mineral density and the thickness of the enamel lesion surface layer were performed using mineral density profiles plotted in FIJI and the visualized mineral maps in MATLAB respectively. RESULTS: The maps of brownspot lesions revealed irregular demineralization patterns with faint boundaries and outlines. The regular triangular shape of proximal lesions was recognizable only in some parts of individual BSLs or was completely unrecognizable within the entire lesion. Scattered free-form areas of high density enamel were observed within or close to the surface of BSLs. A layer of high density enamel with a mineral density close to that of sound enamel was observed in all of the BSLs. The mean mineral density of the body of BSLs, including the scattered areas of high mineral density, was significantly higher than the corresponding values in white-spot lesions. The mean thickness of the surface layer in BSLs (79±15µm) was also significantly higher than white-spot lesions (51±11µm) (p<0.05). CONCLUSION: This study demonstrated that the mineralization parameters such as density and the thickness of the surface layer as well as distribution patterns through natural enamel brown spot lesions (BSLs) are different from enamel white-spot lesions (WSLs). The higher mineral density of the body of the lesion and the increased thickness of the surface layer in brown spot enamel lesions may suggest possible subsurface remineralization in the majority of naturally arrested BSLs.

Color stability of mineral trioxide aggregate and calcium enriched mixture cement.

AIM: To assess the effect of light irradiation and different immersion media on discoloration of white mineral trioxide aggregate (WMTA) and calcium enriched mixture (CEM) cement at different time intervals. METHODS: Enamel sections of 12 teeth were removed and six cavities were prepared in each tooth. The cavities were filled randomly either with WMTA or CEM and covered with transparent sealant. Half the specimens were irradiated for 160 sec (eight exposures of 20 sec each) and the remaining were irradiated for 40 sec (two exposures of 20 sec each); digital images were taken after each exposure. The teeth were stored in phosphate buffer saline, oxygen-rich medium and glycerin (n = 4). Digital images were obtained after 1, 3, 7, 14, and 28 days. Commission Internationale de I'E'clairage (CIE) color space system and Photoshop CS5 software were used to evaluate the discoloration. The color change (ΔE) and lightness (ΔL) values was analyzed using repeated measures anova and Tukey's Tukey's honest significant difference (HSD) test. RESULTS: The materials tested showed significant discoloration over time (WMT > CEM; P < 0.001). ΔE increased significantly while ΔL decreased in three media over time (P < 0.001). Greater duration of light curing caused a significant decrease in ΔL and ΔE values in both materials (WMTA > CEM; P < 0.001). CONCLUSION: Color stability of WMTA was inferior to CEM samples after exposure to different duration of irradiation and media over time.

X-ray Study of Human Dental Tissues Affected by Erythroblastosis Fetalis.

Numerous diseases are known to cause microstructural alteration of dental tissues structure. One type in particular is associated with neonatal jaundice and circulation of bilirubin in blood at high concentration due to increased hemolysis in conditions such as erythroblastosis fetalis, septicemia, biliary atresia, and other causes of hyperbilirubinemia. In those conditions, the products of the catabolism of hemoglobin end up deposited in various tissues, including teeth, where they can present clinically as visibly stained brown/green teeth. There is almost no information on the nature or extent of the structural changes taking place in these conditions. Here, advanced nondestructive wide-angle synchrotron X-ray scattering techniques combined with scanning microscopy methods were used to investigate for the first time the ultrastructure of the dental hard tissues in an archival case of intrinsically pigmented green teeth. Despite no obvious elemental variation across the pigmented tissue region, the high-resolution crystallographic properties probed by wide-angle synchrotron X-ray scattering revealed an ultrastructural variation (orientation, particle size, and lattice parameter of hydroxyapatite crystallites) associated with a pigmentation line in dentine and with a distinct neonatal line in enamel.

Interpretation of base-metal dentinal radiopacities: survey results.

A survey was conducted to determine the familiarity with base metal dentinal radiopacity. The results show that although 91% of the respondents had observed this phenomenon, only 6% could correctly identify its cause. Despite the general misunderstanding concerning its cause, 48% of the respondents considered this radiopacity when making a diagnosis and providing treatment. To limit confusion, a standard term is suggested so this feature can be more consistently identified and properly considered in making diagnoses and in formulating treatment plans.

Relating visual and radiographic ranked scoring systems for occlusal caries detection to histological and microbiological evidence.

This study compared a visual ranked scoring system and a radiographic ranked scoring system for occlusal caries detection with the level of infection of dentin. Seventy-five third-molars, designated for extraction, were professionally cleaned. Caries was scored according to a visual ranked scoring system at a selected site in the groove-fossa system. Radiographs of the teeth were available and caries was recorded along a five-point ranked scoring system. Each tooth was extracted and hemi-sectioned through the investigation site under aseptic conditions. A burful of dentin was removed from the EDJ of one of the section faces and these samples were processed to establish the level of dentin infection. The depth of the lesion was assessed on the other section face using a five-point ranked histological scoring system. A strong relationship was observed between the histological lesion depth and visual score (r(s)=0.93) while a moderate relationship was seen between lesion depth and radiographic scores (r(s)=0.77). The dentin from teeth with cavities exposing dentin was heavily infected. The dentin from teeth with microcavities or grey discoloration of the dentin was less infected than the lesions with frank cavitation (score 4) (p<0.05, t-test), but more infected than the initial lesions (p<0.05, t-test). The latter lesions showed minimal infection. A similar tendency was seen with respect to increasing radiographic scores and the level of infection of the dentin.

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.

[Deciduous tooth intrusions and the odontogenesis of the permanent teeth. Developmental disorders of the permanent teeth following intrusion injuries to the deciduous teeth]. / Milchzahnintrusionen und Odontogenese der Bleibenden Zähne. Entwicklungsstörungen bleibender Zähne nach Intrusionsverletzungen von Milchzähnen.

Traumata to primary teeth occur very often in small children. The highest prevalence of developmental disturbances of permanent teeth after trauma to their predecessors has been recorded after intrusive injuries of primary teeth. In the present survey 47% of the recalled children had such developmental disturbances. The majority of developmental disturbances consisted of enamel hypoplasia (59%) which included discoloration, defects or a combination of both. In some cases the clinical feature of enamel defects could be diagnosed radiographically before tooth eruption. However, the total number of all enamel discolorations was to be detected after complete tooth eruption only. The so-called pre-eruptive calciotraumatic lines on radiographs corresponded clinically to circular enamel defects or crown dilacerations. Generally, a high correlation was found between the degree of intrusion (of the primary tooth) and the frequency and severity of developmental disturbance (of the permanent tooth). No correlation was found, however, concerning the treatment of intruded primary teeth and the occurrence of developmental disturbances. Whether intruded primary teeth were removed immediately or left to spontaneous re-eruption did not affect the incidence and type of developmental disturbances.