Proposal for clinical classification of multifactorial noncarious cervical lesions.

Noncarious cervical lesions often present with overlapping symptoms and have a multifactorial etiology. The dimensions of the lesion axially (depth) and occlusogingivally (width), along with the orientation of the walls of the lesion to each other (angle), are the 3 factors that can be quantified to classify the lesion and assess its progress over time. This article analyzes these factors and proposes a simple classification system based upon the clinical appearance of the lesion in order to derive simple, therapeutic, treatment-based classifications.

Management of a dentigerous cyst in a medically compromised geriatric patient: a case report.

BACKGROUND: Because of the increasing number of older persons seeking dental care, the growing trend towards a longer dental appointment and increased administration of drugs in dentistry, the possibility of occurrence of medical emergencies in dental offices has shown an upward trend. OBJECTIVE: This case report discusses enucleation of a central dentigerous cyst in a 72-year old male on long-term low dose aspirin therapy. MATERIAL AND METHODS: Surgical removal of impacted tooth with total enucleation of cystic lesion was performed in the dental chair under 2% lidocaine with 1:200,000 adrenaline, 3 days after aspirin cessation. After complete debridement of the surgical site, the wound was sutured and a gauge saturated with 10% tranexamic acid was placed on surgical site for 30 minutes. RESULT: No post-operative complications or bleeding was seen on subsequent appointment and healing was normal. CONCLUSION: A geriatric and medically compromised patient demands special care and attention; and the decision to cease aspirin before surgery or not is of critical importance.

Novel regimen of combined intralesional triamcinolone and salmon calcitonin nasal spray to treat a large central giant cell granuloma.

About 10% benign tumors of the jaw are known to be central giant cell granulomas (CGCGs) affecting mandible more than maxilla. They are more commonly seen among young females, mean age range being 10-25 years. The aggressive variants of CGCG require surgical intervention, leaving colossal disfiguring defects. This being the reason for many nonsurgical alternative therapies as calcitonin injections and nasal spray, intralesional steroid injections and subcutaneous interferon injections advocated for its management. Although the exact success rate of using these nonsurgical therapies are not fully known, they provide the advantage of being conservative in nature, as majority of the patients are young adults. This lack of accurate regimen is due to paucity of randomized control trials and systematic reviews addressing the topic. This manuscript attempts to present a novel regimen protocol which was followed for a case of CGCG, right mandible on a 22-year-old female patient, for a period of 1.5 years and trailed by a follow-up of 2 years.

Measurement of pH and calcium ions release from different calcium hydroxide pastes at different intervals of time: Atomic spectrophotometric analysis.

AIM: To evaluate the effect of different vehicles on pH and release of calcium ions from calcium hydroxide (CH) paste from apical third of root canals. METHODS: 40 single rooted extracted human mandibular premolars were instrumented with RevoS files (MicroMega) up to ISO size 40. The teeth were divided into 4 groups on the basis of vehicle as follows: Group I - calcium hydroxide mixed with 2% chlorhexidine; Group II - calcium hydroxide mixed with propylene glycol; Group III - calcium hydroxide mixed with glycerine; and Control - calcium hydroxide mixed with double distilled water. Each group had two subgroups (n = 5) on the basis of the calcium hydroxide delivery. Subgroup A - calcium hydroxide paste placed with spiral filler (Lentulospiral) subgroup B - calcium hydroxide paste placed with flat wire filler (Paste Inject). pH and calcium ion release was evaluated at 24 h, 48 h, 7th day, 15th day and 30th day using a pH meter and atomic absorption spectrophotometer respectively. RESULTS: The calcium release from various groups was highest for CH+glycerine (Group III) followed by CH+chlorhexidine (Group I), CH+propylene glycol (Group II) and CH+double distilled water (control). At all the intervals the differences in calcium ion release among the groups were statistically significant (p < 0.05), except on day 7. Delivery technique did not have a significant effect on calcium ion release. Highest pH values were recorded from CH+glycerine group at day 30 for both the delivery systems, however rise in pH from day 1 to day 30 were non-significant in all groups with both delivery systems. CONCLUSION: Demonstrable changes in calcium ion release occurred from the calcium hydroxide mixed with various vehicles and CH+glycerine group showed the maximum calcium ion release at all intervals and highest pH day 30.

Therapeutic potential of dental pulp stem cells in regenerative medicine: An overview.

The purpose of this review is to gain an overview of the applications of the dental pulp stem cells (DPSCs) in the treatment of various medical diseases. Stem cells have the capacity to differentiate and regenerate into various tissues. DPSCs are the adult stem cells that reside in the cell rich zone of the dental pulp. These are the multipotent cells that can be explained by their embryonic origin from the neural crest. Owing to this multipotency, these DPSCs can be used in both dental and medical applications. A review of literature has been performed using electronic and hand-searching methods for the medical applications of DPSCs. On the basis of the available information, DPSCs appear to be a promising alternative for the regeneration of tissues and treatment of various diseases, although, long-term clinical trials and studies are needed to confirm their efficacy.

Comment on "Evaluation of Manual and Two-Rotary NiTi Retreatment Systems in Removing Gutta-Percha Obturated with Two Root Canal Sealers".

Proper research design, appropriate evaluation and measurement methods, use of correct statistical tests, interpretation, and inference are the essentials without which any scientific research reporting is incomplete and does not serve its proposed purpose. In this communication, some common flaws in research designing, evaluation, analysis, and inference have been explained using a published article as a reference. The purpose of the paper is to help the scientific community recognize the significance of proper research designing and planning in order to achieve the results which are worthwhile.

Comment on "dental prosthetic status and prosthetic need of the institutionalized elderly living in geriatric homes in mangalore: a pilot study".

Public Health Dentistry is a speciality which is targeted towards the larger benefit of community and society. Dental health surveys in specific population groups should be planned adequately and the data should be analyzed in such a way so that it may help in making strategies for the intervention to improve the existing status. This could be only done with the help of proper planning, analysis and interpretation of a sample survey. The present study highlights the research design, statistical and inferential errors in a published work of public health dentistry in order to bring about the common mistakes and errors made. The renewed suggested approach helps in interpreting the results in a better way and makes them objective-oriented.

Management of pulpal floor perforation and grade II Furcation involvement using mineral trioxide aggregate and platelet rich fibrin: A clinical report.

To report the management of an iatrogenic perforation of pulpal floor in the furcation of mandibular first molar, using Mineral Trioxide Aggregate (MTA) and platelet rich fibrin (PRF). Unpredictable endodontic root/pulp chamber floor perforations resulting in unacceptable high rate of clinical failure has now been a lesser threat with the advent of new technologies and biocompatible materials that utilize the applications of basic research along with tissue engineering concept in clinical practice. Present case report illustrates the use of MTA and platelet rich fibrin (PRF) for the repair of the perforation defect and regeneration of the lost periodontium in furcation area. Although, histologic events and reaction of MTA with PRF is not studied so far, however, the autologous and biocompatible nature of the components used for present treatment modalities seems to be beneficial for the long term clinical results obtained in our case.

Dens invaginatus: review, relevance, and report of 3 cases.

Dens invaginatus is a rare developmental morphoanatomical variation resulting from the infolding of the dental papilla before biological mineralization that allows the invagination of inner dental epithelium. Permanent maxillary lateral incisors are most commonly affected, and the condition is frequently bilateral, but it may also prevail in permanent maxillary central incisors. The purpose of this paper was to provide an overview of the etiopathogenesis, frequency of occurrence, and clinical and radiographic features and to discuss 3 dens invaginatus cases.

Influence of caries detection dye on bond strength of sound and carious affected dentin: An in-vitro study.

OBJECTIVES: The objective of this study was to evaluate the influence of caries detection dye on the in-vitro tensile bond strength of adhesive materials to sound and carious affected dentin. MATERIALS AND METHODS: Forty healthy and carious human molars were ground to expose superficial sound dentin and carious affected dentin. Caries Detector dye was applied to sound and carious affected dentin and rinsed. Subsequently the dentin was etched with 37% phosphoric acid and rinsed leaving a moist dentin surface. The adhesive (Single bond) was applied in single layers and light cured. A posterior composite (Filtek Z 250) were used to prepare the bond strength specimens with a 3 mm in diameter bonding area. Control and experimental groups were made with and without application of dye respectively. Each group includes both sound and carious affected dentin. After 24 hour immersion in distilled water, tensile bond strength (MPa) was measured using an Instron testing machine. RESULTS: Analysis of variance (ANOVA) was used to evaluate the data. The tensile bond strength were significantly less in experimental subgroup than control subgroups. CONCLUSION: The tensile bond strengths were higher in sound and carious affected dentin without application of caries detection dyes.

A proposal for classification of tooth fractures based on treatment need.

Accuracy in defining a disease makes it easier to study and understand. Similarly, with injuries to the teeth, a comprehensive classification is an aid to correct diagnosis and treatment planning. A thorough review of various classifications of tooth fractures shows that, despite an emphasis on traumatic dental injuries, a consensus needs to be arrived at, especially among clinicians and general/family dentists. The ideal classification would be applicable to both primary and permanent dentition, based on tooth fractures in both the horizontal and vertical planes, encompassing all possible sites, easy to comprehend, communicable amongst health professionals and clinically relevant. With recent improvements in conservative techniques, it is now clinically possible to preserve natural teeth even if they have been horizontally or vertically fractured, and thus an in-depth understanding and knowledge of tooth fractures, together with a simplified classification, is now more than ever essential.

Endosseous dental implant vis-à-vis conservative management: Is it a dilemma?

To overview the current prospective of endosseous dental implant and conservative management. Although emphasis has been made in reinstating the oral functions, less consideration has been given to formulate the best treatment tactics in a particular situation. Properly restored, root canal treated natural teeth surrounded by healthy periodontium tissues yield a very high longevity, and periodontally compromised teeth that are treated and maintained regularly may have longer survival rate. Current trends in implantology have weakened the conservative paradigm, and practitioner's objectivity has been inclined more toward providing the tooth substitutes often flaunted as equal or even superior to conservation of natural tooth.

Use of ultrasound, color Doppler imaging and radiography to monitor periapical healing after endodontic surgery.

This study evaluated the effectiveness of ultrasound, color Doppler imaging and conventional radiography in monitoring the post-surgical healing of periapical lesions of endodontic origin. Fifteen patients who underwent periapical surgery for endodontic pathology were randomly selected. In all patients, periapical lesions were evaluated preoperatively using ultrasound, color Doppler imaging and conventional radiography, to analyze characteristics such as size, shape and dimensions. On radiographic evaluation, dimensions were measured in the superoinferior and mesiodistal direction using image-analysis software. Ultrasound evaluation was used to measure the changes in shape and dimensions on the anteroposterior, superoinferior, and mesiodistal planes. Color Doppler imaging was used to detect the blood-flow velocity. Postoperative healing was monitored in all patients at 1 week and 6 months by using ultrasound and color Doppler imaging, together with conventional radiography. The findings were then analyzed to evaluate the effectiveness of the 3 imaging techniques. At 6 months, ultrasound and color Doppler imaging were significantly better than conventional radiography in detecting changes in the healing of hard tissue at the surgical site (P < 0.004). This study demonstrates that ultrasound and color Doppler imaging have the potential to supplement conventional radiography in monitoring the post-surgical healing of periapical lesions of endodontic origin.