A Comparison of the Fluoride 'Paint- On' vs Tray Application Techniques for Enamel Remineralisation.

BACKGROUND: Fluoride gel treatment is not recommended for children < 6 years old due to its potential toxicity. Hence the aim of this study was to compare the effect of 1.23% acidulated-phosphate fluoride (APF) gel paint-on and the conventional tray application techniques on artificial, deciduous enamel carious lesions embedded on wearable appliances. METHODS: In a randomised crossover study, the volunteer children (n = 29) wore mandibular removable appliances containing embedded tooth specimens with artificial carious lesions. The volunteers had 3 different treatment protocols: (I) 0.4 mL non-fluoride (control) gel, (II) 0.4 mL paint-on 1.23% APF gel or (III) 5 mL 1.23% APF gel, 4 minutes tray application. After 1 hour, the appliances were removed and the specimens underwent an in vitro, 14 days of pH-cycling. The mean percentage reduction in fluorescence (ΔF, %) at baseline (ΔF0) and after the pH-cycling (ΔF1) were determined using quantitative light-induced fluorescence-digital analysis. The mean ΔΔF (ΔF1-ΔF0) was calculated to compare the differences between groups. RESULTS: The mean ΔΔF of groups I to III were -1.42 ± 1.49, 1.06 ± 2.11, and 1.12 ± 3.57 and -1.25 ± 1.44, 1.13 ± 1.84 and 1.44 ± 3.62 for the smooth surface and proximal surface lesions, respectively. The mean ΔΔF in the 2 treatment groups were significantly greater compared with the control group (P < .001). There was no significant difference in ΔΔF between the APF gel tray and paint-on groups either in the smooth surfaces, or the proximal surfaces (P = .629 and P = .613, respectively). CONCLUSION: Our study, for the first time, indicates that the paint-on application of APF gel or the tray application of APF had a similar enamel remineralisation effect. Clinically, this implies that, particularly in younger children, the paint-on application of fluoride is less cumbersome, and possibly more tolerable with a lesser likelihood of fluoride ingestion than the tray application technique. TRIAL REGISTRATION: Thai Clinical Trial Registry (https://www.thaiclinicaltrials.org/show/TCTR20190724001).

Partial pulpotomy success in primary molars followed up for 24 months: A randomized controlled clinical trial using mineral trioxide aggregate, biodentine, and acemannan.

BACKGROUND: Finding the best treatment approach and suitable capping materials in primary molars with deep carious lesions remains unresolved. AIM: To compare the success rates of partial pulpotomy in deep caries lesions in primary molars treated with mineral trioxide aggregate (MTA), biodentine, or acemannan for 6-24 months. DESIGN: A parallel-design, non-inferiority randomized controlled clinical trial was performed. Ninety mandibular primary molars from 65 children meeting the criteria, aged 3-8 years, were included. After inflamed pulp tissue removal and hemostasis, each tooth was randomly allocated into the MTA control group, or the biodentine or acemannan experimental group (N = 30 per group). All teeth were restored with a stainless steel crown. The outcomes were evaluated for 6-24 months. A generalized estimating equation model was used to compare the overall success rate in each group. RESULTS: After 24 months, 58 children (83 teeth) were available for evaluation. The results indicated that the success rate in the MTA, biodentine, and acemannan groups was 83.3%, 76.9%, and 74.1%, respectively. No significant difference in success rates among groups, however, was observed at the 6- to 24-month follow-ups (at 24th month, p = .30). CONCLUSION: There was no statistically significant difference between MTA, biodentine, or acemannan in the partial pulpotomy success after 24 months.

Material of choice for non-invasive treatment of dentin caries: An in vitro study using natural carious lesions.

INTRODUCTION: In community settings with limited dental personnel and equipment, and in an era when the aerosol transmission of infectious agents is on the rise, a non-invasive approach to caries management is critical. To provide information on non-invasive material selection, the aim of this study was to compare the remineralization effect of commonly used fluoride-containing materials, adjunctive to the everyday use of fluoride toothpaste (F-toothpaste), on primary tooth natural dentin caries. METHODS: Fifty-five specimens were randomly divided into five groups: 38% silver diamine fluoride (SDF), 5% fluoride varnish (F-varnish), glass-ionomer cement (GIC), deionized water (DW) with F-toothpaste slurry, and DW as a control group (n = 11). The lesion depth and mineral density were measured before and after bacterial pH-cycling using micro-computed tomography. The percentage of mineral density change (%MDchange) was quantified. The dependent t-test, Wilcoxon-Signed-Rank Test, and one way ANOVA with Bonferroni correction were used to analyse the data. RESULTS: SDF application reduced lesion depth from 844.6 to 759.1 µm (p < 0.045) while increasing mineral density from 551.4 to 763.0 mgHA/cm3 (p < 0.003). Only mineral density rose from 600.2 to 678.4 mgHA/cm3 (p < 0.013) when GIC was used. The other groups showed no difference. The highest %MDchange was also found after SDF treatment (49.7%, p < 0.05), whereas GIC (17.2%, p < 0.05) presented a higher percentage than the F-varnish (2.0%), F-toothpaste (-1.1%) and no-treatment groups (-1.4%). CONCLUSION: In this in vitro study, where the pH of cycling was almost neutral, using SDF as an adjunct to F-toothpaste resulted in the highest remineralization compared with other remineralizing materials.

Enhanced effectiveness of silver diamine fluoride application with light curing on natural dentin carious lesions: an in vitro study.

This study aimed to compare the mean mineral density difference (mMDD) and surface morphology of 10- and 60-s silver diamine fluoride (SDF)-applied dentin carious lesions and to study the effect of an additional 20-s light curing (LC) on SDF-treated teeth. Forty primary molar blocks with natural dentin carious lesions were measured for baseline lesion depth and mineral density using Image-Pro Plus software. The samples were randomly distributed into 4 groups; 38% SDF applied for 1) 10-s (10SDF), 2) 60-s (60SDF), 3) 10-s + LC (10SDF + LC), 4) 60-s + LC (60SDF + LC) and an additional control group to assess the outcome of pH-cycling only. Then all the groups underwent a 7-d bacterial pH-cycling. The dentin carious lesions' mMDD was determined by digital subtraction radiographic analysis. The surface morphology and elemental profile were assessed by scanning electron microscopy and energy-dispersive X-ray spectroscopy. The mMDD of the dentin lesions was analyzed using two-way ANOVA, generalized linear models analysis. Light curing was the only factor that affected the mMDD (p = 0.007). The mMDD in the 10SDF + LC and 60SDF + LC groups were significantly higher than those without light curing (p = 0.041 and 0.041, respectively). The 60SDF + LC group demonstrated a significantly higher mMDD than the 10SDF group (p = 0.010), while that in the 10SDF + LC group was similar to the 60SDF group (p = 1.00). Scanning electron microscopy revealed denser mineral content layers, which were likely silver and chloride, in the 10SDF + LC and 60SDF + LC groups than in the 10SDF and 60SDF groups, respectively. In conclusion, shortened application time with light curing enhanced SDF remineralization similarly to the conventional method.

Fluoridated milk enhances the mineral density of artificial proximal carious lesions in situ.

OBJECTIVE: To compare the mineral density (MD) of non-fluoridated-milk (non-F-milk), fluoridated-milk (F-milk), adjunctive to 1000-ppm-fluoride dentifrice (FD), and 1000-ppm-FD alone of proximal artificial enamel carious lesions (AECL) in high caries-risk patients. MATERIALS AND METHODS: This double-blind, cross-over in situ study comprised seven high caries-risk volunteers. Orthodontic brackets with one slab of AECL were fixed randomly to each volunteer per phase. The study comprised three experimental periods with a 7-d wash-out period using FD between sessions; (1) A four-week tooth brushing with FD 2×/day by all subjects as a control. The participants were then randomly allocated to (2) drinking 2.5-ppm-F-milk 1×/day or (3) non-F-milk 1×/day, adjunctive to tooth-brushing with FD for 4-weeks. The subjects crossed over from each type of milk and continued the same protocol for another four weeks. After each phase, the MD of each specimen was analyzed using micro-computed tomography (Micro-CT). RESULTS: The baseline MD was not significantly differences (p = .653). When brushing with FD and drinking F-milk, the MD gain was significantly higher (11.68 ± 2.89%) compared with brushing with FD and drinking non-F-milk (4.59 ± 1.78%) (p = .003) or brushing with FD alone (5.30 ± 2.10%) (p = .003). CONCLUSIONS: F-milk adjunctive to FD significantly increased MD gain compared with non-F-milk + FD or FD alone.

Comparing protection-motivation theory-based intervention with routine public dental health care.

OBJECTIVES: Tooth brushing with fluoride toothpaste has a major effect on the reduction in dental caries. However, among young children, tooth brushing requires skill and motivation from caregivers and is not widely practised. To find a more effective way to train caregivers, Protection-Motivation Theory (PMT)-based educational programmes were compared with the basic one with regard to the incremental caries rate in children, caregiver's motivation and caregiver's awareness. METHODS: In a quasi-experimental study, 9- to18-month-old children and their caregivers (N = 102) were allocated to PMT or control groups. The PMT group received PMT-based oral health education programme while the control group received public hospital's current one. Children's caries status and motivation and awareness among caregivers were measured. Mann-Whitney U test was used to find out the difference between control and test groups. RESULTS: After 12 months, the PMT group showed lower dmft, dmfs and incremental caries rate compared with control. Chi-square test showed the control group was at more risk of developing additional dental caries (RR 2.23, 95% C.I.: 1.41-3.54, p < 0.001), and when early carious lesions were included (RR 2.40, 95% C.I.: 1.56-3.69, p < 0.001). In terms of motivation and awareness among caregivers, the PMT group rated their perception of disease severity and belief in self-efficacy significantly higher than the control group. CONCLUSIONS: PMT-based education programmes encourage suitable motivation and awareness that changes oral healthcare behaviour of caregivers, relating to decreased incremental caries rate in infants and toddlers comparing with regular health education methods.

Early Childhood Caries and Its Associated Factors among 9- to 18-Month Old Exclusively Breastfed Children in Thailand: A Cross-Sectional Study.

Objective: The objective of this study was to investigate the early childhood caries (ECC) status and its risk factors in 9- to 18-month-old exclusively breastfed children in Thailand. Methods: Generally healthy 9- to 18-month-old children who had been exclusively breastfed were recruited. Information on children's oral hygiene practices and breastfeeding behaviors was collected through parental interviews using a questionnaire. Children's oral health status was assessed following the WHO caries diagnostic criteria, modified to record the noncavitated lesions. Multivariate logistic regression analysis was adopted to investigate its association with feeding and oral hygiene practices. Results: In total, 513 mother and child dyads (47% boys) were recruited. The prevalence of ECC was 42.5%. The mean (SD) d1mft and d1mfs scores (d1 included noncavitated and cavitated carious teeth/tooth surfaces) were 1.1 (1.4) and 1.3 (2.0), respectively. Multivariate logistic regression analysis revealed that older children with higher plaque scores (OR = 75.60; 95% CI: 40.19-142.20) who were breastfed to sleep (OR = 2.85; 95% CI: 1.48-5.49) and never had their teeth cleaned (OR = 8.51; 95% CI: 1.53-47.14), had a significantly higher chance of having ECC (p < 0.05). Conclusion: Prevalence of ECC is high among exclusively breastfed children aged 9-18 months in Thailand. ECC prevalence is significantly associated with the age of children, the level of dental plaque, breastfeeding to sleep, and oral cleaning. Among all factors, the level of dental plaque is the most significant factor associated with ECC among breastfed children.

Adjunctive use of fluoride rinsing and brush-on gel increased incipient caries-like lesion remineralization compared with fluoride toothpaste alone in situ.

Objective: The objective of this study was to compare the remineralizing effect of sodium fluoride (NaF) mouth rinse or NaF gel as an adjunct to NaF dentifrice on incipient caries-like lesions in an in situ cross-over design study, with three sessions of 30 days each. Materials and methods: Orthodontic brackets with artificial demineralized enamel slabs were attached to the upper first molars of 12 participants. A set of 3 test specimens from the same tooth was randomly assigned to each participant and allocated into three 30-day sessions: 1) brushing with 0.22% NaF dentifrice 2 times/day (F dentifrice), 2) brushing with 0.22% NaF dentifrice 2 times/day+ rinsing with 0.05% NaF before bedtime (F mouth rinse), 3) brushing with 0.22% NaF dentifrice 2 times/day + brushing with 1.1% NaF gel before bedtime (F brush-on gel). The mineral gain and lesion depth of the specimens were evaluated by micro-computed tomography. Results: The mean mineral gain from the NaF mouth rinse and the NaF brush-on gel was similar, but greater than that from the NaF dentifrice (p < .05). The NaF brush-on gel yielded the greatest mean depth of remineralization (168 µm), followed by the NaF mouth rinse (144 µm). Both depths were significantly greater than that of the NaF dentifrice (84 µm) (p < .05). Conclusions: Both 0.05% NaF mouth rinse and 1.1% NaF brush-on gel, used at bedtime, increased incipient caries-like lesion remineralization in situ in combination with brushing with NaF dentifrice twice a day.

Microtensile Bond Strength Between Glass Ionomer Cement and Silver Diamine Fluoride-Treated Carious Primary Dentin.

Purpose: The study objectives were to investigate the effect of silver diamine fluoride (SDF) on the microtensile bond strength between glass ionomer cement and carious primary dentin and evaluate the mode of restoration failure. Methods: Forty carious primary molars were sectioned in half through the middle of the carious lesion and randomly allocated to test and control groups. The test specimens were treated with 38 percent SDF, and the control, deionized water. The samples were stored in artificial saliva for 14 days at 37 degrees Celsius, and the dentin surfaces were conditioned and restored with Fuji IX GP Extra. After 24 hours in artificial saliva, the specimens were prepared for microtensile bond strength testing and stressed in tension at one mm per minute until failure. Mean bond strengths were compared using the paired t test. The failure mode was assessed with a stereomicroscope under 40X magnification. Results: The mean microtensile strength for the test group was 7.4 MPa (SD=±5.1) and 6.3 (±4.6) for the control group (P>0.05). Most common failure mode was the mixed failure mode in both groups. Conclusion: Silver diamine fluoride does not adversely affect the bond strength between glass ionomer cement and carious primary dentin in vitro.

Silver diamine fluoride remineralized artificial incipient caries in permanent teeth after bacterial pH-cycling in-vitro.

OBJECTIVES: To investigate the remineralizing effect of 38% silver diamine fluoride (SDF) application on enamel artificial caries in adjunct to 1000ppm fluoride toothpaste compared with fluoride toothpaste alone by analyzing the mineral density, depth of remineralization, and remineralization percentage of the lesions. METHODS: Eighteen artificial caries slabs were created from the proximal surfaces of nine chemically demineralized premolars. The slabs were scanned by Micro-Computed Tomography (Micro-CT) to determine the baseline mineral density of the initial lesions and randomly allocated into 2 groups. The test group was applied with 38% SDF in adjunct to fluoride toothpaste and the control group was treated with fluoride toothpaste alone. The specimens underwent bacterial pH-cycling for 5 d and were re-evaluated using Micro-CT. The pre-treatment and post-treatment mineral densities were plotted and the areas under the curves were used to calculate the remineralization percentage of both groups. RESULTS: Mineral density significantly increased in both groups after pH-cycling (p<0.05) although to different depths (control group=260µm, test group=300µm). The test group demonstrated a significantly higher mineral density to a depth of 120µm and higher remineralization percentage (p<0.05) compared with the control group. CONCLUSION: The adjunctive use of 38% SDF enhances the remineralization of initial carious lesions based on mineral density, depth, and remineralization percentage compared with the use of 1000ppm fluoride toothpaste alone. SDF might be used as an adjunct to fluoride toothpaste to remineralize incipient caries lesions on smooth tooth surfaces. CLINICAL SIGNIFICANCE: In non-compliant patients, the application of 38% SDF might be used as an adjunct to fluoride toothpaste, to remineralize incipient caries lesions of permanent teeth where esthetics is not a concern.

Stimulation of Dentin Regeneration by Using Acemannan in Teeth with Lipopolysaccharide-induced Pulp Inflammation.

INTRODUCTION: This study investigated the effects of acemannan, a polysaccharide from Aloe vera, on human deciduous pulp cells in vitro and the response after vital pulp therapy in dog deciduous teeth. METHODS: Human primary dental pulpal cells were treated with acemannan in vitro and evaluated for proliferation, alkaline phosphatase activity, type I collagen, bone morphogenetic protein (BMP-2), BMP-4, vascular endothelial growth factor, and dentin sialoprotein expression and mineralization. Osteogenesis-related gene expression was analyzed by complementary DNA microarray. Pulpal inflammation was induced in dog teeth for 14 days. The inflamed pulp was removed, retaining the healthy pulp. The teeth were randomly divided into 3 treatment groups: acemannan, mineral trioxide aggregate, and formocresol. Sixty days later, the teeth were extracted and evaluated histopathologically. RESULTS: Acemannan significantly increased pulp cell proliferation, alkaline phosphatase, type I collagen, BMP-2, BMP-4, vascular endothelial growth factor, and dentin sialoprotein expression and mineralization approximately 1.4-, 1.6-, 1.6-, 5.5-, 2.6-, 3.8-, 1.8-, and 4.8-fold, respectively, compared with control. In vivo, partial pulpotomy treatment using acemannan generated outcomes similar to mineral trioxide aggregate treatment, resulting in mineralized bridge formation with normal pulp tissue without inflammation or pulp necrosis. In contrast, the formocresol group demonstrated pulp inflammation without mineralized bridge formation. CONCLUSIONS: Acemannan is biocompatible with the dental pulp. Furthermore, acemannan stimulated dentin regeneration in teeth with reversible pulpitis.

Silver diamine fluoride and glass ionomer differentially remineralize early caries lesions, in situ.

OBJECTIVES: The aim of the present study was to evaluate the percent mean mineral density (MD) change of early caries lesions after the application of silver diamine fluoride (SDF) or glass ionomer cement (GIC). MATERIALS AND METHODS: This double-blind, crossover study involved two experimental phases of 28 days each. Thirty-two pairs of enamel slabs were created from the proximal surfaces of 16 premolars. Each pair of artificial carious slabs was randomly divided into the control or test group (38 % SDF or GIC). The slabs were attached to orthodontic brackets and bonded to the maxillary first permanent molars of 16 subjects for 28 days. After a 7-day washout period between phases, the subjects received the other material for the second phase. The mean MD of the lesions was measured by microcomputed tomography. RESULTS: SDF yielded a percent mean MD increase at a depth of 0-84 µm, although increase in the GIC group was observed at a depth of 24-108 µm. The percent mean MD changes of the SDF and GIC groups were similar (p = 0.100) and significantly higher than in control (p < 0.001, p = 0.003, respectively). CONCLUSIONS: The two materials increased the percent mean MD change of early proximal caries lesions to a similar extent, but with different spatial patterns. CLINICAL RELEVANCE: Due to deeper level of GIC remineralization, the refractive index of the GIC applied enamel might be closer to sound enamel. Hence, GIC is recommended for remineralization of anterior teeth. SDF staining makes it unsuitable for use in anterior teeth; thus, it is reserved for use in posterior teeth.

Clinical, radiographic, and histologic analysis of the effects of acemannan used in direct pulp capping of human primary teeth: short-term outcomes.

Acemannan has been previously reported as a direct pulp-capping agent in animal study. This natural material demonstrated its biocompatibility and enhanced reparative dentin formation. The objective of this study was to investigate the action of acemannan as a direct pulp-capping material in human primary teeth with deep caries. Forty-two deeply carious mandibular primary molars from 37 children, aged 7-11 years old diagnosed with reversible pulpitis were studied. After completely removing the infected dentine, teeth with a pinpoint pulpal exposure were randomly divided into two treatment groups: acemannan or calcium hydroxide. A glass-ionomer cement base was applied to all teeth prior to restoration with stainless steel crowns. Clinical and radiographic evaluation was performed 6 months post-treatment. The teeth due to exfoliate were extracted and histopathologically evaluated for inflammation, dentine bridge formation, and soft tissue organization. At 6 months, the overall clinical and radiographic success rates of direct pulp capping with acemannan and calcium hydroxide at 6 months were 72.73 and 70.0 %, respectively. The histopathological results indicated that the acemannan-treated group had significantly better histopathological responses compared with the calcium hydroxide-treated group (p < 0.05). These data suggest acemannan offers a valuable alternative biomaterial for vital pulp therapy in primary teeth.

Effective Fluoride Mouthwash Delivery Methods as an Alternative to Rinsing.

BACKGROUND: Special-needs patients with high caries risk cannot benefit from the proven caries-reducing effect of fluoride mouthrinse because of poor rinsing compliance and a lack of home-use fluoride application recommendations. OBJECTIVES: This study aimed to evaluate whether two modified delivery methods-spray or swab application-could raise the salivary fluoride to levels similar to that of rinsing. METHODS: Five healthy men and 16 healthy women, ages 18-22 years, participated in this crossover study. The subjects performed a standardized brushing routine twice a day with 1,000-ppm fluoride dentifrice 1 week before and during the experimental period. The three fluoride mouthwash (0.05% NaF; 226-ppm fluoride) administration methods consisted of rinsing, spray, and cotton swab application. Each application was separated by at least 1 week. Unstimulated whole saliva was sampled for 2 minutes at baseline and at 0, 5, 10, 20, 30, 60, and 120 minutes after each fluoride mouthwash application. Salivary fluoride level (ppm) was measured by a blinded investigator using an ion-specific electrode (ORION EA940). The differences in salivary fluoride concentration for each application method were analyzed by repeated measures ANOVA at a nominal significance level of .05. RESULTS: The newly designed fluoride mouthwash delivery methods yielded a similar fluoride level in whole saliva compared to that of rinsing at all time points (p > .05). The t half-life of fluoride concentration ranged from 1.62 minutes (SD = 0.53) in the spray group to 2.08 minutes (SD = 0.87) in the cotton swab group; the values were not significantly different. DISCUSSION: Our results indicate that the spray and cotton swab fluoride delivery methods were effective alternatives to conventional mouth rinsing. Caregivers of individuals with acute and chronic illness, including developmental disabilities affecting cognitive or physical abilities, may consider using these alternative fluoride delivery methods to help promote dental hygiene.

Sodium fluoride mouthrinse used twice daily increased incipient caries lesion remineralization in an in situ model.

OBJECTIVES: To investigate the remineralizing effects of fluoride mouthrinses used at different times and frequency in addition to fluoride toothpaste. METHODS: A randomized crossover single blinded study comprised 4 experimental phases of 21 days each. Twelve orthodontic volunteers were fixed with an orthodontic bracket containing an artificial carious enamel slab, which was from the same tooth in all 4 phases, and were randomly assigned to the following groups: (1) brushing with F toothpaste 2× per day (F- brush), (2) F- brush+rinsing with 0.05% NaF (F- rinse) after lunch, (3) F- brush+F-rinse before bedtime, and (4) F- brush+F- rinse 2× per day. Mean mineral gain after each phase was determined from mineral density profiles obtained using Micro-CT. RESULTS: The mean mineral gain in all treatments with F- brush and F-rinse were significantly greater than those in F- brush (p<0.05). Moreover F- rinse 2× per day increased lesion remineralization more than F- rinse once a day. CONCLUSIONS: The twice-daily use of 0.05% NaF mouthrinse combined with twice-daily regular use of fluoride toothpaste resulted in the greatest remineralization of incipient caries. These data indicate that rinsing frequency is a factor affecting the effectiveness of fluoride mouthrinse. CLINICAL SIGNIFICANCE: The rinsing frequency of NaF mouthrinse, when used with fluoride toothpaste, also affects the remineralization. This finding, if confirmed by a clinical study, would lead to a new recommendation for fluoride mouthrinse used in high caries risk patients who could benefit from using it twice a day.

Indirect pulp treatment vs antibiotic sterilization of deep caries in mandibular primary molars.

BACKGROUND: Calcium hydroxide indirect pulp treatment (CH-IPT) and antibiotic sterilization using a mixture of three antibiotics (3Mix-MP) of deep caries are similar non-invasive vital pulp treatments. No studies have compared their clinical and radiographic success rates in primary molars. AIM: To compare the clinical and radiographic success rates of CH-IPT and 3Mix-MP in carious lesions approaching the pulp of mandibular primary molars. DESIGN: Eighty-two mandibular primary molars from 50 children, aged 3-8 years, with carious lesions approaching the pulp, and meeting the inclusion criteria, were randomly assigned for either treatment. After treatment, blinded clinical/radiographic evaluation was performed at 6-11 and 12-29 month recalls. RESULTS: At 6-11 months, the overall success rates of CH-IPT and 3Mix-MP were 82% and 81% (P = 0.91), respectively. At 12-29 months, the success rates were 94% and 78% (P = 0.08), respectively. The most frequently observed failure at the 12-29 month recall was internal resorption (one CH-IPT tooth and three 3Mix-MP teeth). CONCLUSION: There was no statistically significant difference in overall success rates between CH-IPT and 3Mix-MP in treating deep caries approaching the pulp in mandibular primary molars at either 6-11 month or 12-29 month follow-up.

Casein phosphopeptide-amorphous calcium phosphate and glass ionomer show distinct effects in the remineralization of proximal artificial caries lesion in situ.

This study aimed to compare the ability of casein-phosphopeptide amorphous-calcium-phosphate (CPP-ACP) and glass-ionomer (GI) in remineralizing proximal artificial caries lesions (ACLs). Molar enamel-slabs were divided into: original-lesion control, intra-oral controls, and experimental (CPP-ACP or GI) groups. Specimens received ACLs and were bonded on subject maxillary first molars. After 4-weeks, mineral density (MD) was analyzed by µCT. Compared to control, CPP-ACP increased MD at 0-38/68-84 microns and the GI group had an increase at 0-68 microns, with a greater increase in MD compared to the CPP-ACP group from 0-53 microns. The mean percent remineralization (%R) showed differences between the GI, CPP-ACP groups and their paired controls. GI tended to increase remineralization more than CPP-ACP. In conclusion, CPP-ACP and GI demonstrated distinct remineralizing ability. GI induced greater remineralization in the superficial lesion, while CPP-ACP remineralized the lesion body. Their effects on percent remineralization and reducing lesion depth of proximal ACLs were similar.

Calcium hydroxide partial pulpotomy is an alternative to formocresol pulpotomy based on a 3-year randomized trial.

BACKGROUND: Considering formocresol's toxicity, Ca(OH)(2) partial pulpotomy (PP) was studied as a treatment alternative. AIM: To compare success rates of Ca(OH)(2) PP versus formocresol pulpotomy (FP) treatment of pulpally exposed lower primary molars. DESIGN: A total of 84 lower primary molars, which met study criteria, from 56 child patients were randomly assigned for each treatment. After treatment, blinded clinical and radiographic evaluation with 96.9% and 90% reliability was performed at 6-month intervals to determine treatment success/failure. Chi-squared test was used to compare success rates between the two treatments. RESULTS: The success rates from 6 to 36 months for PP ranged from 95.03% to 75%, whereas for FP, it was 92.7-74.2%. The success rates for the two treatments at each 6-month interval were not different (P ≥ 0.05). The most frequent failure was internal resorption, affecting five FP teeth and three PP teeth. The resorption was arrested in five of the teeth and was replaced by a radiopaque calcified tissue in one case. CONCLUSION: Considering the favourable clinical and radiographic success rate of PP and the potentially toxic effects of formocresol leads us to recommend the use of PP instead of FP in primary teeth with deep carious lesions.

Success rates of a mixture of ciprofloxacin, metronidazole, and minocycline antibiotics used in the non-instrumentation endodontic treatment of mandibular primary molars with carious pulpal involvement.

OBJECTIVE: To evaluate the clinical and radiographic success rates of three mixed antibiotics in the non-instrumentation endodontic treatment of primary mandibular molars at 24-27 months postoperatively. METHODS: Eighty cariously involved lower primary molars from 58 children (ages 3-8 years) received a 3Mix medicament by non-instrumentation endodontic treatment and were then sealed with glass-ionomer cement and composite resin before permanent restoration with stainless steel crowns. The patients received a clinical and radiographic assessment every 6 months over a 2-year follow-up period with an intra-examiner reliability of 0.83-1.00 (κ value). RESULTS: In 60 cases at 24- to 27-month follow-up, the success rates as determined by clinical and radiographic evaluation were 75% and 36.7%, respectively; however, the overall success rate of 3Mix non-instrumentation endodontic treatment was 36.7% with 15.8% of cases demonstrating a pulpal response of internal resorption. CONCLUSIONS: Non-instrumentation endodontic treatment using 3Mix-MP showed good clinical success but had a low success rate based on radiographic evaluation at 2-year follow-up. Hence, 3Mix antibiotic treatment cannot replace a conventional root canal treatment agent as a long-term therapy.

In vitro comparison of self versus professionally applied remineralizing materials.

OBJECTIVE: To compare the effect of 4 remineralizing materials on the incipient artificial carious lesion and its proximal sound enamel when used with fluoride dentifrice. STUDY DESIGN: Models mimicking proximal contact were made, each of which was placed with an artificial carious specimen in contact with a sound enamel specimen. Each carious specimen was treated with one of four materials: glass ionomer cement (GIC), resin modified glass ionomer cement (RMGIC), 5000 ppm sodium fluoride (F-gel), and casein phosphopeptide amorphous calcium phosphate (CPP-ACP). The GIC and RMGIC specimens were thermocycled. Then all specimens were pH-cycled for 5 days with twice a day soaking in 1,000 ppm NaF dentifrice solution. Specimens were examined by polarized light microscopy and lesion area quantified by image analysis. RESULTS: RMGIC significantly yielded smaller areas of lesion than CPP-ACP and GIC (p < 0.05). F-gel reduced more area of lesion than CPP-ACP significantly (p < 0.05). In the associated contact, RMGIC significantly reduced the area of lesion better than CPP-ACP (p < 0.05). CONCLUSIONS: The most effective remineralizing material in reducing the carious lesion areas was RMGIC followed by F-gel, GIC and CPP-ACR The demineralization inhibitory effects on the associated sound contact enamel followed the same trend.