A randomised controlled clinical trial comparing pure Portland cement and formocresol pulpotomies followed from 2 to 4 years.

PURPOSE: The purpose of the present prospective randomised clinical control trial was to evaluate the long-term clinical and radiographic success rate of pulpotomies in primary molars using pure Portland cement versus formocresol. Pure Portland cement has shown a high rate of success in pulpotomy treatments, with no side effects. METHODS: Healthy 3- to 11-year-old children were treated with pulpotomies on primary molars as part of their scheduled dental treatment. Pulp dressing alternated randomly between pure Portland cement and formocresol. Data were analysed at follow-up periods up to 48 months. RESULTS: 68 (50%) teeth with pure Portland cement and 68 (50%) teeth with formocresol in 136 healthy children (59 boys and 77 girls) were followed. The overall success rate of the pulpotomies in this study was 95.6%. Pure Portland cement was successful in 100% of the cases (68 out of 68), and formocresol in 91.1% (62 out of 68). No association was found between success and type of tooth or time range from treatment to last follow-up. CONCLUSION: Based on this study's results, it can be concluded that there is no superiority of one material over the other and pure Portland cement can be used in primary molar pulpotomies.

Zirconia crowns--an esthetic and resistant restorative alternative for ECC affected primary teeth.

The present report discusses briefly the problem of ECC in very young children and the recommended approaches for prevention and treatment. The esthetic restoration of the maxillary incisors with Zirconia Nu Smile crowns is described. It is also stressed that the luxation injury two months after placement did not damage the appearance nor the stability of the crowns.

Esthetic restorative options for pulpotomized primary molars: a review of literature.

OBJECTIVE: The goal of this manuscript was to review the existing literature in regards to esthetic options to restore pulpotomized primary molars. STUDY DESIGN: A pubmed literature search has been performed and all relevant studies were assessed. RESULTS: Two laboratory, 3 restrospective and 4 prospective clinical studies were found, reviewed and analyzed. CONCLUSIONS: Based on the limited information available, we concluded that tooth colored and bonded restorations showed promising results as alternative materials to replace stainless steel crowns after pulpotomies in primary molars. Hybrid composites tend to perform better than compomers. Resin modified glass ionomer cements demonstrated excellent marginal seal and retention. More long-term follow up studies are necessary until more definitive recommendations can be made.

Assessment of two curing systems in a self-etching primer/adhesive sealant: a preliminary study for a clinical trial.

AIM: This was to assess the clinical performance of two different polymerization regimens of a non-rinse conditioning self/etching adhesive/sealant system (Adper Prompt-L-Pop, 3M ESPE) placed in recently erupted first permanent molars in two paediatric dental practices. METHODS: A total of 40 healthy 5 to 8 year old patients (20 from each practice) presenting at least two caries-free recently erupted first permanent molars participated in this preliminary test. A total of 128 molars were fissure sealed (FS) and cured with two different curing regimens. Group 1 (64 teeth) used Adper L-Pop + Clinpro as a one-step cure regimen. Group 2 (64 teeth) used Adper L-Pop + Clinpro with a two-step cure regimen using cotton-roll isolation. Sealants were evaluated 6 to 12 months after placement. RESULTS: No differences were found in the ratings between the two polymerization regimens. In Group 1, 28 molars recorded FS fully retained rated A, 29 were rated B (partially missing) and 7 sealants were completely lost (C). In Group 2, 30 molars were rated A, another 30 scored B and 4 molars were totally lost (C). CONCLUSION: The poor performance of both FS polymerization regimens of the non-rinse conditioning self/etching adhesive/sealant system (Adper Prompt-L-Pop, 3M ESPE) placed in recently erupted first permanent molars in the present test does not justify its use in young children.

Assessment of the accuracy of visual examination, bite-wing radiographs and DIAGNOdent on the diagnosis of occlusal caries.

AIM: This was to evaluate the accuracy of the different methods for diagnosing occlusal caries in vivo, and to compare their performance in primary and permanent teeth. STUDY DESIGN: Permanent teeth (199) and primary molars (65) with macroscopically intact occlusal surface, with caries lesions without cavitation (white spot) or with a darkened sulcus were selected. The teeth were examined by the following methods: visual inspection, bite-wing radiographs and DIAGNOdent. The validation method employed for asserting the existence of carious lesion was cavity preparation. RESULTS: When the total sample was taken into consideration, laser (DIAGNOdent) provided the highest accuracy (74.8%). Even when the total sample was stratified, the laser accuracy was still high for both primary (88.4%) and permanent molars (70.4%). Visual inspection also provided a high accuracy for primary teeth (83.9%). The chi-square test showed a statistically significant difference between permanent and primary teeth considering occlusal caries diagnosis (p=0.0001). The Kappa coefficient showed good inter-examiner reproducibility for all methods. McNemar test revealed that the degree of intra-examiner agreement for visual inspection was lower than for the other methods. CONCLUSIONS: As visual inspection also showed a high degree of accuracy, the laser method should be used as a complementary method in doubtful cases. Diagnostic methods of occlusal caries, in general, are more efficient in deciduous than in permanent teeth.

Pulpotomy in primary teeth: review of the literature according to standardized criteria.

AIM: To assess the relevant literature using a modification of the criteria listed in the introductory paper to this issue [Curzon and Toumba, 2006], and to review several new publications on pulpotomies with different materials and techniques that appeared after previously published reviews. METHODS: A search of the literature on pulpotomies was identified using Medline between the years 1966-2005. The search generated 358 citations and sieving of these papers was conducted by examining the paper title and assessing its relevance [Loh et al., 2004]. Only clinical studies (non-specified) and retrospective studies were included for assessment. There were 17 criteria (considered major) weighed 2 points and 8 criteria weighed 1 point. A paper that would score between 38-42 points (90+ %) was assessed as Grade A, a score from 32 to 37 points (75-89%) was Grade B1, and between 25 to 31 points (60-74%) Graded B2. All other papers that reached 24 points or less (less than 59%) was rated Grade C. RESULTS: Of the 358 papers originally identified 48 clinical trials were evaluated according to the set of criteria. There was only one paper graded A, 5 papers graded B1, 3 graded B2 and 39 received a grade C. Formocresol or ferric sulphate medicaments were found to be likely to have similar clinical/radiographic results, and MTA seemed to be a more favourable pulp dressing. CONCLUSION: No conclusion can be made as to the optimum treatment or technique for pulpally involved primary teeth. More high quality, properly planned prospective studies are necessary to clarify these points.

Clinical performance of resin-bonded composite strip crowns in primary incisors: a retrospective study.

AIM: The purpose of this study was to assess retrospectively the longevity of resin-bonded composite strip crowns placed in primary maxillary incisors. DESIGN: Records for 200 out of 387 children, aged 22-48 months, treated in a private paediatric dental practice and who presented for follow-up after at least 24 months were included in the study. The parameters recorded at baseline and/or at follow-up were: habits, the number and location of the decayed surfaces, colour, texture, and chipping of the restoration. Radiographic evaluation of the restorations, the quality of the margins, and the presence of pulpal and/or periapical pathoses were recorded. RESULTS: More than 80% of the restorations were judged to be successful at the final follow-up examination. Only the number of carious surfaces of the tooth at baseline influenced the treatment outcome. The failure rate was higher in central incisors with four affected surfaces (P = 0.005), and in lateral incisors with four carious surfaces (P = 0.0003), than in those presenting one or two carious surfaces in both central and lateral incisors (P = 0.002). CONCLUSION: The high success rate of resin-bonded composite strip crowns with a 2-year follow-up seen in this study suggests that this treatment modality is an aesthetic and satisfactory means of restoring carious primary incisors in young children. The retention rate is lower in teeth with decay in three or more surfaces, particularly in children with a high caries risk.

Clinical performance of a non-rinse conditioning sealant in three paediatric dental practices: a retrospective study.

The present clinical retrospective study describes the retention rates of a compomer sealant (Dyract Seal, Dentsply-De Trey, Germany) with non-rinse conditioning (NRC) placed in three paediatric dentistry practices. Three hundred and seventeen sealants were applied in 220 primary and 97 permanent molars of 176 children aged 2.5-13 years. The tooth surface was freshened with a #1/2 round bur mounted on a slow speed engine, and isolated with cotton rolls. Application of the NRC and Dyract Seal followed the manufacturer's instructions. Sealant retention was classified as A (fully retained), B (partially lost) or C (completely missing). From a total of 220 sealants placed in primary molars, 38 were in the mouth between 12 and 18 months, 29 functioned between 19 and 24 months and 46 were followed up between 25 and 36 months. One hundred and thirteen (51%) were fully retained (A), 73 (33%) scored B (27 for 12-18 months; 20 for 19-24 months, 26 for 25-36 months) and 34 (16%) were lost and scored C (12 for 12-18 months; 12 for 19-24 months; 10 for 25-36 months). From a total of 97 sealed permanent molars, 45 (46%) were fully retained (score A). Of these, 25 were followed up for 12-18 months, 10 for 19-24 months and 10 for 25-36 months. Thirty-eight sealed permanent molars (19%) scored B [17 for 12-18 months, 10 for 19-24 months and seven for 25-36 months and 14 (15%) were completely lost (score C: 6 for 12-18 months, seven for 19-24 months and two for 25-36 months)]. Dyract Seal has a lower retention rate than conventional sealants. It may be appropriate for sealing primary molars of very young children for a limited period of time and for permanent molars of children with pronounced gag reflex, where rinsing can become a problem and lead to disruptive behaviour.

Current concepts in vital primary pulp therapy.

REVIEW: Recent progress in understanding the molecular and cellular changes during tooth development and how they are mimicked during tissue repair, offers the opportunity to assess the biologic validity of the various vital pulp treatments. Under this light, indirect pulp treatment can be an acceptable procedure for primary teeth with reversible pulp inflammation, provided that this diagnosis is based on a good history, a proper clinical and radiographic examination, and the tooth had been sealed with a leakage-free restoration. Several articles report the success of this technique of direct pulp capping (DPC) and calcium hydroxide has been widely used with high success rates in young permanent teeth, but the results in primary teeth are less satisfactory. Recent studies have reported successful results with direct adhesive capping of exposed pulps, while others showed pulp inflammation and unacceptable results using this technique. Thus, the traditional rationale for the use of calcium hydroxide should be maintained, and this treatment modality reserved for iatrogenic exposures in asymptomatic teeth that are expected to exfoliate within a short period of time. In younger children, iatrogenic or carious exposures should be treated by pulpotomy. Formocresol has been the most popular pulp dressing material for pulpotomized primary molars for many years but, due to its deleterious effect, the use of formocresol is decreasing considerably worldwide. Ferric sulphate has been proposed as a substitute to formocresol, and the success rates were comparable to those of formocresol. More recently, considerably better results have been obtained with MTA (Mineral Trioxide Aggregate), and statistically significant differences were reported when compared with formocresol. Internal root resorption, a finding seen both in ferric sulphate and formocresol, was not observed in the MTA treated teeth. MTA is commercially available, but its cost is very high, and cannot be kept once opened. Thus, ferric sulphate can still be a valid and inexpensive solution for pulpotomies in primary teeth.

Reliability of different techniques to assess marginal defects of Class II restorations in retrieved primary molars: a visual-tactile, SEM, dye penetration and polarized light microscopy study.

The aims of the present article were to assess the reliability of different techniques to assess marginal defects in Class II restorations in retrieved primary molars, and to determine the degree of agreement between the various assessment modalities. The material evaluated was comprised of 18 exfoliated primary molars that had been restored 20 to 22 months previously with a resin-modified glass ionomer (Vitremer--7 teeth), a hybridized composite resin (Z100 + Scotchbond Multipurpose--9 teeth), and amalgam (Dispersalloy--2 teeth). No significant differences could be observed between the groups. The majority of the restorations rated A at the buccal and lingual margins, but poor adaptation was disclosed at the cervical margin of the three types of restorations. SEM evaluation revealed that the highest percentage of defects was seen at the cervical margins with no statistically significant difference between the groups. No or minimal leakage was present at the occlusal margins and severe penetration of dye was seen at the cervical margins in all groups. Significantly less demineralization was seen adjacent to the Vitremer and Z100 restorations when compared to the Dispersalloy but no difference was found between the esthetic restorations. Except for the visual tactile examination, small marginal defects could be disclosed by the three assessment techniques (SEM, dye penetration, and polarized light microscopy). A good degree of agreement was observed between the three evaluation techniques.

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

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

Pulp therapy for the primary and young permanent dentitions.

This article describes the pulp reactions to caries and operative procedures and emphasizes the importance of a clinical diagnosis to evaluate the most appropriate pulp treatment. Conservative and radical treatments are described, stressing the differences between primary and young permanent dentitions.

Clinical and radiographic assessment of Class II esthetic restorations in primary molars.

PURPOSE: The aim of the study was to access the clinical performance of two esthetic materials (Vitremer and Z100 + Scotchbond Multipurpose) when used as Class II restorations in primary molars, and compare them to amalgam controls. METHODS: A total of 102 restorations were placed in primary molars of 29 schoolchildren; 40 were of Vitremer, 38 of Z100 + Scotchbond Multipurpose, and 24 of amalgam (Dispersalloy). The restorations were evaluated clinically at baseline and after 6, 12, 18, 24 months, or until tooth exfoliation or patient drop-out, following the modified Cvar and Ryge criteria. Radiographs were taken at yearly intervals, and the radiograph of the last examination available was assessed and scored. RESULTS: The majority of the restorations examined clinically up to 18 months was good (Alpha according to Cvar and Ryge), and no statistically significant differences between the groups was observed. However, at the 19-24 months evaluation, Z100 rated better than Vitremer for surface appearance and color match. The prevalence of radiolucent defects at the cervical margin for the Z100 (47%) was significantly higher than for amalgam (11%) restorations (P = 0.002) and for Vitremer (13%) restorations (P = 0.008). CONCLUSION: The three materials evaluated (Vitremer, Z100 and Dispersalloy) presented satisfactory clinical performance during the time evaluated (approximately 2 years). Approximately half of the composite resin restorations presented radiographic defects that might require replacement at a later date. In contrast, glass ionomer and amalgam restorations presented significantly less radiographic defects at the time of the final examination. This study suggests that composite resins are indicated for classII restorations in primary molars that are expected to exfoliate within two years.

Assessment of compomer proximal restorations in primary molars: a retrospective study in children.

The aim of the present retrospective study was to observe the clinical and radiographic performances of a compomer (Dyract) in proximal restorations of primary molars as compared to amalgam restorations. The study was performed at the principal investigator's office. Children between three to eleven years old, who had at least two primary molars with a small to moderate approximal caries lesion were included in the study. The assessed material consisted of 107 proximal restorations (63 Dyract and 44 amalgam) placed in primary molars during the years 1994 to 1997 in forty-two children who were available for follow-up examinations. All the evaluated restorations were clinically acceptable, with smooth surface appearance, satisfactory color match, neither secondary caries nor fracture. The margins of two Dyract restorations presented minimal stain. Of the 63 Dyract restorations evaluated radiographically, two presented with bubbles, one with an overhang, and nine had pooling at the tooth-restoration interface. Minimal overhangs were disclosed in six amalgam restorations, and neither bubbles nor defects were seen at the tooth-restoration interface. These differences were statistically significant (p < 0.001). Based on the clinical performance of the material and on the radiographic findings, the authors conclude that Dyract can be a suitable alternative for restoring primary teeth that need to be retained up to two years. More extensive follow-up is needed to assess longer-term performance.

Experimentos clínicos para avaliar diversos materiais para a odontopediatria / Clinical research trials to evaluate materials for pediatric dentistry

O presente trabalho descreve as exigências e objetivos de experimentos clínicos para avaliar materiais em Odontopediatria. Estes estudos clínicos devem ser doubleblind, com base em um protocolo clínico detalhado, conforme as diretrizes da ADA (American Dental Association). A avaliação das restaurações pode ser feita clínica e radiograficamente, logo após a esfoliação do dente, ou por SEM (Scanning Electron Micrograph)

The effect of metoclopramide and hydroxyzine in sedation of infants undergoing dental treatment.

The purpose of the present study was to determine whether the administration of 5 mg of the anti-emetic drug metoclopramide (MTP) would improve the effectiveness of 3.7 mg/kg of hydroxyzine (HYZ) in dental treatment of young patients. Thirty uncooperative children, with a mean age of twenty-nine months, and needing at least two restorative visits, participated in this study. The patients were assigned randomly to receive either 3.7 mg/kg HYZ or the same drug in conjunction with MTP; alternate regimens were administered at the two appointments. All the children received 50 percent nitrous oxide, and were restrained in a Papoose Board with a head holder. The following parameters were evaluated at baseline (before initiation of treatment), and at five-minute intervals throughout the procedure: degree of alertness, crying and movement. Evaluation of the overall behavior at each session was performed by one investigator, who was blind to the drug regimen the child had received, utilizing a separate rating scale. The results were submitted to statistical analysis. No differences were observed in the behavior of the children receiving both regimens. Successful sedation, as assessed by lack or minimal crying and/or movement was observed in all the treatment visits, with both regimens (mean score 4.4 for HYZ + MTP and 4.6 for HYZ). In the few occasions, however, where the restorative sessions were longer (45 to 60 minutes), more children fell asleep after receiving protocol A (pramin + hydroxyzine), suggesting a possible trend to improve effectiveness in these situations. No adverse effects were observed, and all the treatments were successfully completed. Although no significant differences could be observed in treatments lasting up to a half hour, the addition of MTP could help in sedations lasting longer than a half hour.

Clinical performance of esthetic posterior crowns in primary molars: a pilot study.

PURPOSE: The aim of this pilot study was to assess the clinical performance of esthetic crowns and to compare these to conventional stainless steel crowns (SSC). METHODS: Twenty two crowns (11 conventional and 11 esthetic) were placed in mandibular primary molars obeying the following criteria: the tooth was not mobile; no fistulae were present; the tooth had at least one caries free or properly restored antagonist and had to be in contact with one adjacent tooth mesially, in the case of the primary second molars or distally in the case of the primary first molars. Crown preparation was done in a conventional manner, but reduction was more extensive for the thicker esthetic crowns, to allow for proper occlusion. The crowns were evaluated clinically and radiographically after 6 months and the following parameters were assessed: gingival health, marginal extension, crown adequacy, proper position or occlusion, proximal contact, chipping of the facing (for esthetic crowns) and cement removal. RESULTS: At the 6 month evaluation all esthetic crowns were intact, without chipping of the facing, and no excess of cement was observed in both groups. No difference was found for marginal extension, occlusion, proximal contact, crown adequacy, and bone resorption, but a significant difference was found for periodontal health between esthetic crowns and conventional SSC (P < 0.001 McNemar test). CONCLUSIONS: The esthetic crowns assessed had several inconveniences, as they resulted in poor gingival health, are very expensive, and, although not measured, are bulky and without a natural appearance.

Adaptation of Class II Vitremer restorations with and without primer: a morphometric study.

PURPOSE: The aim of this study was to assess the adaptation of Vitremer with and without primer and compare to that of Z100 with Scotchbond Multi-Purpose. METHODS: Fifty-seven Class II cavities were prepared in 32 extracted or exfoliated primary molars. The cavities were randomly assigned to one of three groups and restored as follows: group A, Vitremer with primer (20 preps); group B, Vitremer without primer (19 preps); and group C, Z100 with Scotchbond Multi-Purpose (18 preps). The restored teeth were thermocycled, embedded in acrylic resin, and sectioned. At least three 1-mm thick sections were obtained from each restoration. Adaptation of the materials was assessed by computerized quantitative morphometry using an image analysis system. In addition to the margin, the entire contact length between the tooth and the restorative material was measured. Voids were recorded separately for the base and cavity margins, and the percentage of defected length was calculated. At least three sections of each restoration were assessed. The section with the worst results was selected as the representative of the restoration. RESULTS: Margin defects were present in 14% of all the restorations, equally distributed between the three groups (A, 10%; B, 16%; C, 17%). A significant difference was found between groups B and C when the percentage of defects in the base was assessed. CONCLUSIONS: Vitremer without primer presented considerably fewer voids when compared with Z100/Scotchbond Multi-Purpose. Although no difference in margin defects could be observed between the three groups a better adaptation to the cavity base was seen in the Vitremer restorations without primer. This finding might be of clinical importance and should be tested in other in-vitro and in-vivo studies.