The Validity and Reliability of the Persian Version of the Xerostomia Inventory Questionnaire.

Statement of the Problem: Reduced saliva production or changes in the quality of saliva are major causes of xerostomia as a perceptual disease. Purpose: This study aimed to measure validity and reliability of the Persian version of the xerostomia inventory (XI) questionnaire. Materials and Method: This cross-sectional study was performed in Kerman in 2021. The sample size for this study was 100 people. To test the discriminant validity of XI, 50 healthy people (control group) and 50 people undergoing or recovering from laryngeal radiation (xerostomia group) were chosen. Cronbach's alpha coefficient was used to determine internal consistency, and the intra-cluster correlation (ICC) coefficient was used to determine test-retest reliability after two weeks. To evaluate the concurrent validity, the relationship between the total score of the questionnaire and the golden question, which was defined as "How often do you have dry mouth?" was measured. Results: Cronbach's alpha and ICC coefficient for the total XI score were 0.84 and 0.95, respectively. The mean ages of patients in the radiotherapy group and the healthy participants were 59±7.5 and 41.1±6.6 years, respectively. Participants who were having or had had laryngeal radiotherapy had a significantly higher mean total XI score than healthy individuals (p< 0.001). Conclusion: The Persian version of the Xerostomia Inventory is a valid and reliable tool for assessing xerostomia.

Determinants of oral-health-related quality of life among adult people in Iran.

Background: Oral health-related quality of life (OHRQoL) assesses the subjective perception of oral health and its impact on the quality of life. The aim of this study is to measure the OHRQoL and its determinants among adult people living in Kerman, Iran. Materials and Methods: In this cross-sectional study, a total of 5657 adult people (18-64 years) residing in the Kerman district, both in the rural and urban areas, were enrolled in the study between September 2014 and April 2018. The Oral Health Impact Profile (OHIP-14) and the oral health indices, such as the total decayed, missing, filled teeth (DMFT), community periodontal index (CPI), gingival index (GI), and xerostomia, were measured by an experienced dentist. The demographic variables of gender, age, educational status, and marital status were also recorded. The impact of the studied variables on OHRQoL was evaluated with multiple logistic regression. Results: Participants were 2239 (39.58%) men, and average age was 45.39. The mean scores for OHRQoL, DMFT, CPI and GI were respectively: 24.07 (7.76), 10.7 (6.86), 0.76 (0.96), 0.63 (0.8). The frequency of people with xerostomia was 37.4. 301 (53.3%) of people had poor quality of life related to oral health. In multivariable analysis, there was a statistically significant increase in OHRQoL with an increase in the DMFT (P < 0.001), xerostomia (P < 0.001), CPI, (P < 0.001). Men had a significantly higher OHIP score than women (P < 0.001). Conclusion: According to the results of this study, DMFT, xerostomia, and CPI scores are strongly related to OHIP scores. In addition, between CPI and GI scores, the CPI score is the better predictor.

The efficacy of henna (Lawsonia inermis L.) mouthwash versus chlorhexidine gluconate 0.2% mouthwash as adjuvant therapy of oral lichen planus: A randomized double-blind clinical trial.

ETHNOPHARMACOLOGICAL RELEVANCE: In modern medicine, some traditional remedies are introduced to be effective in treatment. Accordingly, the henna plant (Lawsonia inermis L.) is studied more than before. Previous studies have shown many medical properties for henna, such as anti-inflammatory and anti-fungal properties. AIM OF THE STUDY: Oral lichen planus (OLP) is a common mucocutaneous disease with chronic immunomodulatory disruptions. Topical corticosteroids are the first line of OLP treatment. Previous studies have suggested different adjunctive therapies for preventing the side effects of corticosteroids overuse. This study aimed to compare the effects of henna and chlorhexidine mouthwashes as adjunctive therapy. MATERIALS AND METHODS: This parallel-group, double-blind, randomized controlled study was conducted on forty OLP patients. Luteolin content was determined in Henna mouthwash composed of 2% aqueous extract of henna, 2% ethanol, 10% glycerol, and 0.1% methylparaben distilled water. Henna or chlorhexidine mouthwashes were prescribed twice daily as an adjuvant to the topical corticosteroid treatment. Visual analog scale (VAS) index and Thongprasom rating were used to measure pain intensity and clinical signs of patients at days 0,7, and 14. The collected data were analyzed using SPSS software (version 26.0; SPSS). Ordinal logistic regression was used to investigate the effect of independent variables on Thongprasom and VAS scores. RESULTS: In this clinical trial, 82.6% of the participants were women. There was no difference between the two study groups in terms of VAS scores (p = 0.404) and clinical features (p = 0.305) in the second follow-up visit. All drug regimens caused clinical signs and symptoms relief. CONCLUSIONS: There was no significant difference between the groups receiving topical corticosteroid supplementation, neither henna mouthwash nor chlorhexidine mouthwash. The therapeutic effects of henna mouthwash in the main or adjuvant treatment of OLP need more evaluation in future research. Henna mouthwash can be a good alternative to chlorhexidine mouthwash if no side effects are reported.

Retrospective Study of Oral Lichen Planus and Oral Lichenoid Lesions: Clinical Profile and Malignant Transformation.

Statement of the Problem: Oral lichen planus (OLP) and other oral lichenoid lesions (OLL) are reported to have the potential of malignant transformation and dysplastic changes, turning into oral squamous cell carcinoma (SCC). While the world health organization (WHO) has classified OLP as a precancerous lesion of the oral cavity, there is still much debate among researchers about its risks and malignancy potential. Purpose: The present study aimed to determine malignant transformation in OLP and OLL and understand related risk factors. Materials and Method: This retrospective study was performed on 356 patients of the Oral Medicine Department of Dental School of Kerman Medical University from 1998 to 2020. All patients' records were gathered. In addition, patients were followed up routinely. Second biopsy was taken as needed. The samples, previously taken from the patients, were re-evaluated according to WHO histopathologic criteria for diagnosing OLP, OLL, dysplasia, and SCC by an experienced pathologist and compared with first reports. Results: Dysplastic changes were observed in 6.2% of the patients. In more than half of the patients, dysplastic changes were present right from the start and 2.20% of the patients had experienced dysplastic changes averagely within 2.05 years of the onset of lesions. Multiple logistic regression showed that the risk of dysplasia increases with aging (p= 0.013), smoking (p= 0.0001), and thyroid disorders (p= 0.008). Conclusion: Given the rather high prevalence of oral lichen planus and lichenoid lesions, further research appears to be needed to determine the etiology of these lesions, malignant transformations, and the factors affecting this probability. Considering the findings, it is imperative to meticulously record the information of all patients with oral lichen planus and lichenoid lesions in the initial examinations as well as close follow-ups and employ diagnostic tools such as toluidine blue staining or even repeat biopsy when necessary.

The effect of demographic characteristics on the relationship between smoking and dry mouth in Iran: a cross-sectional, case-control study.

OBJECTIVES: The effect of age, sex, and other demographic factors on the relationship between smoking and dry mouth remains unknown. The aim of this study was to investigate the effects of demographic characteristics on the relationship between dry mouth, also known as xerostomia, and smoking. METHODS: This case-control study included 5,640 randomly-selected subjects from the second phase of the Kerman Coronary Artery Disease Risk Factors Study, which observed 10,000 participants from 2014 to 2018. A checklist was used to record the participants' demographic characteristics and smoking frequency. Each participant completed a six-item Fox questionnaire to measure dry mouth as a dependent variable. The interaction terms of daily cigarette smoking with sex, age, educational level, and marital status were entered into the model. Non-significant terms were removed using hierarchical model selection. RESULTS: Of the sample, 3,429 (60.8%) did not have dry mouth and were analyzed as controls, whereas 2,211 (39.2%) had xerostomia and were deemed to be cases. Smokers were more likely to have dry mouth in all ages and both sexes (p < 0.001). As male became older, the chance of having dry mouth increased more rapidly than among female smokers (p < 0.001). In addition, female smokers were more likely to have dry mouth than male smokers (p < 0.001). CONCLUSIONS: The likelihood of dry mouth among daily smokers depended on age and sex. Female smokers were more likely to have dry mouth, and its likelihood increased with age in daily smokers of both sexes, though more rapidly in males.

Oral Health Determinants among Opium Users in Kerman, Iran.

BACKGROUND: Promoting oral health is a complicated issue among drug abusers and opium is the most frequent drug abused in Iran. This study aims to find the oral health determinants of opium users in Kerman, Iran. METHODS: This cross-sectional study was a part of the second phase of Kerman coronary artery disease risk factors study (KERCADRS, 2014-2018). In this survey, the data of 1140 opium users were analyzed. The information about using a toothbrush, dental floss, number of dental visits at last year, age of first use of opium, duration, and opium consumption frequency was recorded. The total number of decayed, missing, and filled teeth (DMFT) index and Community Periodontal Index (CPI) was recorded by an oral examination. Poisson and logistic regressions analyses were used for assessing the relationship among variables. FINDINGS: The mean age of participants was 52 ± 12 years. 74.4% were men and 24.6% were women. The average DMFT index was 15.7 ± 7.6 and the prevalence of a healthy CPI score was 18.5%. Educational level (P < 0.001), brushing (P < 0.001), flossing (P < 0.001), dental visit (P < 0.001), first age of using opium (P < 0.001), frequency of consumption (P < 0.001), and age (P < 0.001) were associated with DMFT index. Only using floss (P < 0.001), dental visit [odds ratio (OR) = 1.80, P = 0.030], frequency of consumption (OR = 2.92, P < 0.001), and age (P = 0.001) were associated with CPI score. CONCLUSION: The frequency of opium consumption has the same effect on caries incidence as oral hygiene habits. Moreover, using dental floss has a more significant effect on the periodontal health of participants.

Association of salivary levels of immunoglobulin-a and amylase with oral-dental manifestations in patients with controlled and non-controlled type 2 diabetes.

BACKGROUND: Oral health is related to general health and one of the most prevalent chronic diseases is diabetes mellitus. Diabetes can have adverse effects on oral health and vice versa. Saliva analysis can be used as a non-invasive method to obtain information about diseases status like diabetes. The aim of present study was to evaluate the salivary immunoglobulin-A (s-IgA) and salivary amylase levels and their associations with oral-dental manifestations in patients with controlled and non-controlled type 2 diabetes. METHODS: This case-control study was carried out on 90 subjects who referred to the Diabetes Center of Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran. Participants were divided into three groups: 1) uncontrolled diabetic patients (n = 30); 2) controlled diabetic patients (n = 30); and 3) healthy individuals (n = 30). Unstimulated salivary levels of I-A and amylase were measured. All participants underwent a dental and periodontal examination to explore the oral and dental manifestations. T-test, chi-square and ANOVA tests were used for data analysis in SPSS 18. RESULTS: Significant higher level of s-IgA was found in uncontrolled diabetic patients compared to controlled diabetic (P ≤ 0.0001) and the control group (P = 0.004). Moreover, the mean levels of s-amylase in uncontrolled patients was significantly higher compared to controlled diabetic (P = 0.01) and the control group (P ≤ 0.0001). Uncontrolled diabetic patients with oral candidiasis, erythematous candidiasis, abscesses, or xerostomia had higher s-IgA levels compared to the controlled diabetic participants. Moreover, uncontrolled diabetic patients with oral candidiasis or erythematous candidiasis showed a significant higher levels of s-amylase compared to controlled diabetic patients. Also, significant positive correlations were found between s-IgA and DMFT and s-IgA and PDI (r = 0.444, P = 0.014 and r = 0.386, P = 0.035, respectively). CONCLUSION: In conclusion, higher s-amylase and s-IgA concentrations may reflect oral-dental manifestations in T2DM. Moreover, the current findings suggest that s-amylase and s-IgA may serve as a complementary and alternative fluid in screening for diabetes mellitus.

Comparison the Pain Relief of Amitriptyline Mouthwash with Benzydamine in Oral Mucositis.

STATEMENT OF THE PROBLEM: A significant proportion of patients undergoing chemotherapy or radiotherapy suffer from mucositis. The first symptom of oral mucositis is pain. Severe pain, burning sensation, and discomfort in the oral cavity make it difficult to continue treatment and even continue living in these patients. PURPOSE: The aim of this study was to evaluate and compare the effect of amitriptyline mouthwash (in two forms of simple and niosomal) as a local anesthetic agent with benzydamine HCl mouthwash in oral mucositis after radiotherapy or chemotherapy. MATERIALS AND METHOD: This double-blind study was performed on 60 patients with oral mucositis caused by radiotherapy and chemotherapy. The severity of mucositis was determined based on patient judgment; then dental examination was performed and recorded in a checklist. Three groups were assigned based on using either benzydamine HCL, amitriptyline, or niosomal form of amitriptyline. Pain and burning sensation were evaluated with VAS at different time intervals: before use and one, five, ten, and thirty minutes and one hour after using mouthwash. T-test was used to compare the intensity of pain between the two groups. ANOVA and Tukey test were used to compare the intensity of pain between groups. RESULTS: Statistical analyses showed the maximum reduction in pain intensity at two different time intervals (p= 0.04). Ten minutes after the use of niosomal form of amitriptyline, a 95% decrease in pain was observed. A 99% reduction in pain occurred after the use of simple form of amitriptyline (p= 0.04). CONCLUSION: Use of amitriptyline mouthwash had local anesthetic effects in oral mucositis without systemic side effects. Decrease in the severity of pain with the use of amitriptyline mouthwash was more than that of benzydamine HCL mouthwash.

Evaluation of Salivary Secretory Immunoglobulin A Levels in Diabetic Patients and Association with Oral and Dental Manifestations.

OBJECTIVES: Oral and dental manifestations in diabetic patients can arise due to numerous factors, including elevated salivary secretory immunoglobulin A (s-IgA) levels. This study aimed to evaluate s-IgA concentrations in patients with type 2 diabetes mellitus (T2DM) and to investigate the association between s-IgA levels and oral and dental manifestations of T2DM. METHODS: This cross-sectional descriptive study was carried out between October 2011 and September 2012 in Kerman, Iran, and included 260 subjects (128 patients with T2DM and 132 healthy controls). Unstimulated salivary samples were collected from all subjects and s-IgA levels were determined using the immunoturbidimetric method. The oral cavities and teeth of T2DM patients were evaluated for oral and dental manifestations. RESULTS: Both diabetic and control subjects with higher concentrations of s-IgA had significantly higher numbers of decayed, missing or filled teeth (DMFT) and periodontal index (PDI) scores (P <0.050). s-IgA levels were significantly higher in subjects with oral candidiasis (P <0.050). Among diabetic patients, significantly higher s-IgA levels were concomitant with xerostomia and denture stomatitis (P ≤0.050). There were no significant differences between s-IgA concentrations and other oral or dental manifestations in either group. CONCLUSION: Individuals with a greater number of DMFT, a higher PDI score and oral candidiasis had significantly higher s-IgA levels. s-IgA levels were not significantly higher among diabetic patients in comparison to the control group. However, significantly higher s-IgA levels occurred with xerostomia and denture stomatitis in diabetic patients. In addition, s-IgA was significantly higher in patients with uncontrolled diabetes compared to those with controlled diabetes.

Prevalence of toothache and associated factors: a population-based study in southeast iran.

INTRODUCTION: This study was carried out to estimate toothache prevalence among adult residents in Kerman. MATERIALS AND METHODS: This cross-sectional, population-based study was conducted among individuals aged over 18 years (n=1800). The relevant data on the prevalence of toothache and associated factors were collected by interviewing the individuals in their homes and filling out a questionnaire designed by the examiners. Prevalence of toothache and associated factors that patients recalled previous to their interview were analyzed by chi-square test and multivariate logistic regression analysis. RESULTS: Nine hundred ninety-one individuals (55.1%) reported toothache during the 6 months before the interview. The participants who flossed daily, had regular dental visits, and had higher education showed a significantly lower prevalence of toothache (P<0.05), whereas regular tooth brushing and economic level of residency had no significant effect on the prevalence of toothache. Individuals between the ages of 26 and 45 [odds ratio (OR)=2.0], with a family size of more than 4 (OR=1.5), not using dental floss (OR=1.5), or having a mental or psychological illness (OR=1.5) were more likely to have a history of toothache. CONCLUSION: High prevalence of toothache (more than half) among residents of Kerman shows a serious and major public health problem. Toothache prevalence in middle aged adults, lower education, bigger family size, lower dental hygiene habit and/or those having mental or psychological illness were more common in the city of Kerman.

The frequency of medically compromised patients in endodontic offices in iran.

INTRODUCTION: As the result of epidemiological transition and aging of Iranian population, the frequencies of systemic diseases among patients in of need endodontic treatment has increased, especially within developed cities. However, there have been no concise reports of systemic diseases in Iranian patients. Based on this need, the present investigation was conducted to assess the frequency of systemic disease among patients referred to endodontic private practice in three main cities in Iran. MATERIALS AND METHODS: In a retrospective study, the frequency of systematic diseases were abstracted from the health records of patients who were referred to three private practices limited to endodontics in Kerman, Mashhad, and Tehran between 1994 to 2011. RESULTS: Overall, 15,413 records of patients were assessed. The patterns of systematic diseases among endodontic patients in these three cities were different. The overall frequency of systemic disease in Kerman was significantly higher than two other cities (Kerman: 55.03%, Mashhad: 24.32%, Tehran: 22.16%; P<0.001). The most commonly occurring diseases were cardiac disease, hypertension, allergy and neurological disorders. CONCLUSION: Since the number of endodontic patients with systematic diseases is considerably significant and varied, special training and educations for treatment of medically compromised patient should be considered at both post- and undergraduate training.

Should medical students be educated about dental trauma emergency management? A study of physicians and dentists in Kerman Province, Iran.

Since physicians sometimes need to attend a case of dental trauma, it is necessary that they possess sufficient knowledge of management of traumatic dental emergencies. This study was conducted to assess the knowledge of dental trauma among dentists and physicians. A three-part questionnaire, including demographic data, knowledge, and self-assessment, was administered to 104 dentists and 151 physicians in Kerman Province, Iran. Data obtained from 255 completed questionnaires were statistically analyzed using t-test, Mann-Whitney U test, chi-square, and Pearson correlation coefficient. Among the physicians, only fourteen (9.3 percent) had received education regarding dental trauma. In contrast, seventy-seven dentists (74 percent) had received information on what to do if a tooth is traumatized. Regarding knowledge level, only 10.6 percent of the physicians had high knowledge, while 66.3 percent of the dentists demonstrated high knowledge. The differences of knowledge level between the two groups were statistically significant (p=0.0001). More than half of the dentists (58.3 percent) and nearly all the physicians (98.7 percent) were dissatisfied with their level of knowledge and suggested that further education on the topic should be offered.

Xerostomia after radiotherapy and its effect on quality of life in head and neck cancer patients.

BACKGROUND: Xerostomia is one of the one complications following radiotherapy that can affect quality of life (QoL). This study aims to assess the severity of xerostomia in patients with head and neck cancers after radiotherapy and its effect on QoL. METHODS: In this longitudinal prospective study, the severity of xerostomia and related QoL were was assessed in 63 head and neck cancer patients who referred to the Radiotherapy Ward. Patients completed a xerostomia questionnaire (XQ) at the beginning, and 2, 4, and 6 weeks after treatment over a period of 6 months. Additionally, unstimulated saliva was collected using the spitting method at all 4 visits. RESULTS: QoL significantly worsened with increased time (P = 0.0001); meanwhile, the severity of xerostomia increased significantly (P = 0.0001). However, there was no significant change in the amount of saliva at these 4 time points (P = 0.23). Regression analysis showed that with each milliliter decrease in saliva secretion, the QoL score decreased 2.25%. With one score increase in xerostomia, from the QoL mean score there was a 1.65% decrease. CONCLUSION: The decrease in saliva and xerostomia that resulted from radiotherapy plays an important role in worsening QoL among patients who undergo radiotherapy for head and neck cancers. Although the amount of saliva has a significant association with QoL, the xerostomia score which shows subjects' general feeling also independently impacts QoL. In future studies, we recommend patient assessments for periods longer than 6 months.

A comparative study of using a combination of calcium chloride and mineral trioxide aggregate as the pulp-capping agent on dogs' teeth.

INTRODUCTION: The addition of some chemicals to mineral trioxide aggregate (MTA) may improve the physical properties of the biomaterial. The aim of this study was to compare a combination of MTA with/without CaCl(2) as pulp-capping agents in dogs' teeth. METHODS: The dental pulp of 32 teeth in four dogs were exposed and capped with either MTA or MTA/CaCl(2). After 2 months, the animals were sacrificed, and the teeth were prepared for histological evaluation. Pulpal response to the two capping materials was evaluated in terms of necrosis, inflammation, and formation of a calcified bridge. The chi-square test was used for data analysis. RESULTS: Histological results showed a higher percentage of inflammation and necrosis and a lower percentage of calcified bridge formation in MTA/CaCl(2) samples compared with MTA; however, the differences were not statistically significant (P > .05). CONCLUSIONS: The addition of CaCl(2) to MTA pulp-capping agent did not improve the properties of this biomaterial.

A comparative in vivo study of tissue reactions to four suturing materials.

INTRODUCTION: The purpose of this study was to compare the histopathologic reaction of four suturing materials: silk, polyvinylidene fluoride (PVDF), polyglycolic acid, and catgut in the oral mucosa of albino rabbits. MATERIALS AND METHODS: The twenty-one male mature albino rabbits which were used in this study were randomly divided into three groups of seven each. Silk, PVDF, polyglycolic acid and catgut suture materials were tested in the oral mucosa of these animals. The animals were sacrificed 2, 4, and 7 days after suturing. Two pathologists evaluated the samples by determining the presence and level of inflammation, granulation tissue, and fibrosis formation. Data were statistically analyzed by Kruskal Wallis and Mann-Whitney U tests. RESULTS: Histological features of the samples showed that PVDF and plain catgut suture materials produced more fibrous tissue (favorable response) on the fourth day in comparison with silk suture (P=0.02). Also, in the 7-day samples PVDF sutures produced the mildest inflammation when compared with the silk sutures (P=0.015). CONCLUSION: According to the results of this study, it can be convey that PVDF suture materials created mild tissue reactions and can be a reasonable candidate for suturing oral tissues.

Correlation between clinical and histopathologic diagnoses of oral lichen planus based on modified WHO diagnostic criteria.

OBJECTIVE: We studied the correlation between the clinical and histopathologic diagnoses of oral lichen planus (OLP) based on the modified World Health Organization (WHO) diagnostic criteria (2003). STUDY DESIGN: First, 4 oral pathologists and 4 clinicians reviewed and categorized 62 microscopic slides and clinical photographs based on WHO 1978 criteria, and then based on modified WHO definition. The number of photographs and microscopic slides in which all clinicians and all pathologists agreed were calculated and compared. RESULTS: Based on 1978 criteria, in 68% of cases in which all clinicians agreed about the diagnosis of OLP, all pathologists agreed about the diagnosis of OLP. Conversely, in 79% of cases in which all pathologists agreed on the diagnosis of OLP, all clinicians agreed on the diagnosis of OLP. Based on modified criteria, in 93.87% of cases in which all clinicians agreed on the diagnosis of OLP, all pathologists agreed on the diagnosis of OLP. Similarly, in 95.83% of the cases in which all pathologists agreed about the diagnosis of OLP, all clinicians agreed about the diagnosis of OLP. CONCLUSION: Results show higher clinicopathologic correlation in the diagnosis of OLP based on the modified criteria of OLP compared with the 1978 criteria.

Pattern of Antibiotic Prescription among Dentists in Iran.

INTRODUCTION: This study examines the antibiotic prescription in dentists participated in 9(th) Congress of Iranian Association of Endodontists in Esfahan/2006. MATERIALS AND METHODS: A questionnaire for this cross sectional study was designed for evaluating the patterns of antibiotic prescription. It included some demographic information, clinical signs, and conditions in need for antibiotic and prophylactic prescription and their choices. Data was analyzed using Pearson's Chi-square test. RESULTS: High percentage of responders prescribe antibiotic for fever (78.2%) and diffuse swelling (85.1%). However, some situations such as acute pulpitis, chronic periapical lesions and marginal gingivitis were irrationally prescribed. CONCLUSION: This study showed a fairly good pattern of antibiotic prescription but it was far from ideal.

Maturogenesis of a complicated crown fracture: a case report with 8 years follow-up.

This report describes a case of a 7 years old girl who suffered from complicated crown fracture of right mandibular central incisor because of a bicycle accident. For the tooth partial pulpotomy with calcium hydroxide, capping was performed in order to achieve apexogenesis and the tooth was restored with a double-seal of glass ionomer cement and composite resin. The patient was reviewed over 8 years. The tooth showed continued root development and complete apex formation.

Vital pulp therapy of mandibular incisors: a case report with 11-year follow up.

This report describes a case of a young patient in whom all the mandibular incisor teeth suffered complicated crown fractures because of a car accident. For all mandibular incisors, pulpotomy with calcium hydroxide were performed in order to achieve apexogenesis and the teeth were restored with a double-seal of glass ionomer cement and composite resin. The patient was reviewed over 11 years. All the mandibular incisor teeth showed continued root development and complete apex formation. Pulp canal obliteration was observed in only the mandibular right central incisor.