The Effect of Casein Phosphopeptide-Amorf Calcium Phosphate and Acidulated Phosphate Fluoride Gel on Dental Erosion in Primary Teeth: An in Vitro Study.

OBJECTIVE: This study aimed to investigate the effect of acidulated phosphate fluoride (APF) gel and casein phosphopeptide/amorphous calciumphosphate (CPP-ACP) on the dental erosion produced by carbonated soft drink in primary teeth. STUDY DESIGN: This study evaluated by an in vitro model the effect of APF gel and CPP-ACP on the dental enamel previously subjected to erosive challenge with carbonated soft drink. Sixty sound human primary molars were prepared by embedding the crown sections in acrylic resin blocks leaving the enamel surfaces exposed. The surface roughness of the enamel was measured with prophilometry at baseline. Specimens were randomly divided into three treatment groups (n:20): artificial saliva, CPP-ACP, 1.23% APF gel. All specimens were then exposed to an erosive challenge of carbonated soft drink and artificial saliva for 20 cycles of 20 seconds each. Demineralization-remineralization cycles was repeated twice at eight-hour intervals and roughness values were measured. Enamel samples were treated with artificial saliva, CPP-ACP, 1.23% APF gel applied for 10 min after erosive challenge. The arithmetic average roughness (Ra) readings were recorded after remineralization agents were applied. RESULTS: The mean surface roughness in all groups increased significantly after erosion process and decreased after remineralization treatment. After treatment, the mean surface roughness of the 1.23% APF gel group was significantly less than the other groups and the mean surface roughness of the artificial saliva group was significantly more than the other groups. 1.23% APF gel showed the highest protective effect against erosive enamel loss. CONCLUSIONS: Under the conditions of this study, artificial saliva, CPP-ACP and 1.23% APF treatments were able to reduce erosive enamel loss produced by carbonated soft drink in primary teeth. However, 1.23% APF gel showed the highest protective effect against erosive enamel loss.

The Efficacy of Xylitol, Xylitol-Probiotic and Fluoride Dentifrices in Plaque Reduction and Gingival Inflammation in Children: A Randomised Controlled Clinical Trial.

PURPOSE: The present prospective, randomised, placebo-controlled, clinical trial was designed to evaluate the clinical effects of a commercially available dentifrice containing fluoride, xylitol or xylitol-probiotic on the decrease of plaque and gingival inflammation in children between 13 and 15 years of age. MATERIALS AND METHODS: Forty-eight adolescents were randomly grouped into three groups of n = 16 each: study group A received xylitol (Xyliwhite) toothpaste; study group B received xylitol-probiotic (Periobiotic) toothpaste; and the control group C received fluoride (Colgate Max Fresh) toothpaste. The subjects were instructed to use the dentifrice determined and a modified Bass brushing technique twice a day for two minutes over a 6-week perioed. Clinical evaluation was performed using a gingival index and a plaque index at baseline and at the end of the 6-week period. RESULTS: From day 0 to 42, reductions in the plaque index were statistically significant in all groups, Colgate Max Fresh, PerioBiotic and Xyliwhite (p-values 0.001, 0.001 and 0.035, respectively), but reductions in the gingival index were statistically significant only in the Colgate Max Fresh and PerioBiotic groups (both with p = 0.001), not in the Xyliwhite group (p = 0.116). PerioBiotic toothpaste was found to be better than Xyliwhite and Colgate Max Fresh toothpastes at reducing plaque and gingival scores. However, statistically significant differences with PerioBiotic and Colgate Max Fresh toothpaste were not observed. CONCLUSION: It was concluded that PerioBiotic was an all-round dentifrice that produced a significant reduction in both gingivitis and plaque.

Clinical and Radiographic Evaluation of the Effectiveness of Formocresol, Mineral Trioxide Aggregate, Portland Cement, and Enamel Matrix Derivative in Primary Teeth Pulpotomies: A Two Year Follow-Up.

OBJECTIVE: The aim of this study was to evaluate and to compare clinical and radiographic outcomes of 4 materials (formocresol, mineral trioxide aggregate (MTA), Portland cement and enamel matrix derivative) using in primary teeth pulpotomies. STUDY DESIGN: Sixty-five patients aged 5-9 years (32 female, 33 male) were included in this study. A total of 140 primary first and second molars with deep caries were treated with pulpotomy. All teeth were then restored with stainless steel crowns. The treated teeth were evaluated clinically and radiographically at 3, 6, 12, 18 and 24 months. RESULTS: At 24 months, the clinical success rates of formocresol, MTA, Portland cement, and enamel matrix derivative were 96.9%, 100%, 93.9%, and 93.3%, respectively. The corresponding radiographic success rates were 84.4%, 93.9%, 86.7% and 78.1%, respectively. CONCLUSION: Although there were no statistically significant differences in clinical and radiographic success rates among the 4 groups, MTA appears to be superior to formocresol, Portland cement, and enamel matrix derivative as a pulpotomy agent in primary teeth.

The use of platelet rich plasma in the treatment of immature tooth with periapical lesion: a case report.

This study describes the treatment of an immature permanent tooth with periapical lesion which was treated with regenerative approach using platelet rich plasma (PRP). The root canal of immature human permanent tooth with periapical lesion was gently debrided of necrotic tissue and disinfected with 2.5% NaOCl, and then medicated with triple antibiotic paste comprised of ciprofloxacin, metronidazole, and tetracycline. When the tooth was asymptomatic, PRP and mineral trioxide aggregate (MTA) were placed into the root canal. Six months after PRP treatment, radiographical examination revealed resolution of the radiolucency and progressive thickening of the root wall and apical closure. Our findings suggest that PRP can be used for the treatment of immature permanent teeth with periapical lesion, as part of a regenerative endodontic treatment procedure.

Evaluation of dental maturation in children according to sagittal jaw relationship.

OBJECTIVE: The aims of this retrospective study were to determine compliance with dental and chronological ages and to analyze the relationships between dental age and orthodontic sagittal anomalies. MATERIALS AND METHODS: A total of 221 subjects between the ages of 7 and 15.9 years (165 girls and 156 boys) were included in the study. The dental age of seven left mandibular teeth was assessed according to the Demirjian method. The maxillary protrusion, mandibular protrusion, maxillo-mandibular and vertical plane angles were measured from cephalometric films. RESULTS: The mean difference between the chronological age and dental age in female patients was 0.94 years and 0.33 years in male patients (P < 0.01). No differences between the sagittal classification groups were found. There was no relationship between dental age and the SNA° or the GoGn-SN°. A statistically significant negative relationship was found between dental age and the SNB° and there was a significant linear relationship between dental age and the ANB°. CONCLUSION: Dental age in girls and boys has been estimated to be more advanced than chronological age in all classes and dental maturation advanced in cases with a tendency to develop Class II malocclusions.

Non-syndrome patient with bilateral supernumerary teeth: Case report and 9-year follow-up.

The presence of supernumerary teeth, also known as hyperdontia, is the condition of having teeth in addition to the regular number of teeth. The occurrence of multiple supernumerary teeth is often found in association with syndromes such as Gardner syndrome, Anderson-Fabry disease, Ellis-van Creveld syndrome, Ehlers-Danlos syndrome, incontinentia pigmenti, and Tricho-rhino-phalangeal syndrome. Only a few examples of nonsyndromic multiple supernumerary teeth have been reported in literature. In this report, we present the unusual case and 9-year follow up of a non-syndrome female patient with bilateral supernumerary teeth that occurred with an interval of several years.

Congenital granular cell tumor in newborn.

The congenital granular cell tumor (CGCT) is quite scarce at the infant. The patient, who has a 2-day-old female newborn, was admitted to the Department of Pediatric Dentistry. Baby had a smooth surfaced, non-fixated mass, found on the anterior part of the mandibular alveole, developing from the gingival mucosa. Clinical examination showed a 1 cm × 1 cm × 1.8 cm pedunculated, regular, pink colorful soft-tissue gob on the alveolar crest to the left side of the mandible. The gob was removed on the seventh postnatal day under general anesthesia. Then, the specimen was evaluated histopathologically. Post-operative recovery and surgical site healing was satisfactory. The CGCT is a rare, degenerative or reactive lesion of the oral cavity. The mass may surgically remove if the diagnosis is not definite clinically and this can lead therapeutic effect.

Dental injuries and attention-deficit/hyperactivity disorder in children.

The purpose of this study was to determine the relationship between attention-deficit/hyperactivity disorder (ADHD) and traumatic dental injuries in children. A total of 194 children aged 7-15 years participated in this study. Fifty-seven traumatic injuries to permanent teeth were observed in 33 children. Although a statistically significant difference was not found (p= .848), the rate of incidence was higher in the group with ADHD (17.5%) than in the control group (16.5%). The maxillary right central incisors accounted for nearly half of all injured teeth, while the maxillary central incisors represented the most frequently injured teeth. Enamel fracture was the most common type of dental injury observed. The incidence of enamel fracture was higher in the control group (66.7%) than in the subjects with ADHD (43.3%). There was a significant association between the occurrence of traumatic dental injury and the presence of an overjet greater than 3 mm (p= .020).

Turkish women's self-reported knowledge and behavior towards oral health during pregnancy.

OBJECTIVES: The purpose of this study was to evaluate oral health care knowledge and behavior of women during pregnancy. SUBJECTS AND METHODS: The study population consisted of 351 mothers with children under 3 months of age who presented at Gülhane Medical Academy's Department of Pediatrics for a routine child check-up. Mothers were asked to complete a questionnaire about their knowledge and behavior regarding dental care during pregnancy. RESULTS: All the women who participated in the study had dental insurance, and most of them had high levels of education. Of the 351 mothers, 263 (75%) had heard about possible connections between oral health and pregnancy outcome, and 165 (47%) believed tooth and periodontal problems could affect pregnancy outcome. However, 256 (73%) women still believed that calcium would be drawn out of their teeth by the developing baby, and 151 (43%) believed in the erroneous statement 'A tooth for a baby'. 241 (68.7%) women had experienced oral health problems during pregnancy; however, only 48 (13.7%) visited a dentist during their pregnancy. CONCLUSIONS: Turkish women, despite having knowledge that adverse pregnancy events may be related to dental and periodontal problems, did not seek oral health care during pregnancy. This suggests the need to better educate medical providers to inform pregnant women to obtain oral health care during pregnancy.

Ribbond for treatment of complicated crown fractures: report of 3 cases.

Dental trauma is relatively common and can occur secondary to sporting injuries, falls, fights, or accidents. According to the International Association of Dental Traumatology, 50% of children experience dental trauma between the ages of 8 to 12. There are many options for endodontic and restorative treatments of traumatized teeth. Ribbond, which was introduced in the market in 1992, consists of bondable, reinforced ultra-high strength polyethylene fibers. Ribbond may be an option for the treatment of traumatized teeth because of its aesthetic properties; absence of additional tooth preparation; and its high resistance to traction, which allows it to easily adapt to tooth morphology. In this report, we describe endodontic and restorative treatments using Ribbond for 3 female patients with horizontal complicated crown fractures of the maxillary incisors.

Oral health status of disabled individuals attending special schools.

OBJECTIVES: The purpose of this study was to determine the prevalence of the dmft-DMFT indexes and the oral hygiene status of 136 individuals attending a special school for the disabled. METHODS: Participants were grouped according to disability [Mental Retardation (MR), Cerebral Palsy (CP), Autistic Disorder (AD), Down Syndrome (DS), Other (OTH)] and age [2-6 years (n=24), 7-12 years (50 children) and 13+ years (62 children]. Caries examinations were carried out in accordance with WHO criteria and oral cleanliness was evaluated by visually assessing the presence of plaque on teeth. RESULTS: The age range of patients was 2-26 years (mean age: 11.89±5.19 years). Mean dmft and DMFT scores by age group were as follows: 2-6 years: dmft=2.04±2.24; 7-12 years: dmft=2.24±2.60, DMFT=0.98±2.58; 13+years: DMFT=2.68±2.91. Overall, 15.4% of children had no caries or fillings. While dmft and DMFT levels (P>.05) did not vary significantly by type of disability, oral cleanliness did. Children with autism were observed to maintain the best oral hygiene and those with mental retardation (MR), the poorest. CONCLUSIONS: It is important for the dentist to concentrate on a preventive approach and provide proper dental education to parents of disabled individuals. Among the children with disabilities, more attention should be paid to the oral hygiene of MR group.

Dental injuries in autistic patients.

PURPOSE: The purpose of this study was to assess the incidence of traumatic dental injury among Turkish children and young adults with autism and compare this to the general population of Turkish children and young adults without autism. METHODS: This study was comprised of 186 children and young adults (138 males and 48 females), 93 with autism (autistic group, or AG) and 93 without autism (control group, or CG). Dental injuries were classified according to drawings and texts based on the WHO classification system, as modified by Andreasen and Andreasen. RESULTS: The rate of injury was higher among the AG (23%) than the CG (15%). The difference between the 2 groups, however, was not statistically significant (P<.19). The most common type of dental injury was enamel fracture. The rate of enamel fracture was higher in the CG (59%) than in the AG (33%), and the distribution of types of traumatic injury differed significantly between the AG and CG (P>.01). CONCLUSIONS: There were no significant differences in the rates of traumatic dental injuries among children and young adults with and without autistic disorder. The most frequently injured teeth were the permanent maxillary central incisors, and the frequency of injury to these teeth differed significantly (P>.01) between AG (56%) and CG (91%). The most common type of dental injury, enamel fracture, was more common in CG (59%) than AG (33%). The distribution of types of traumatic dental injuries differed significantly between the 2 groups (P>.01).

Vasorelaxant effects of Clearfil SE Bond and Clearfil S(3) Bond mediated by calcium antagonistic action.

Dental adhesives can alter the contractility of vascular tissue via different mechanisms. The aim of this study was to investigate and compare the vascular action of two self-etch adhesive systems, Clearfil SE Bond (CSEB) and Clearfil S(3) Bond (CS3B). Responses of isolated rat thoracic aorta rings were recorded isometrically by force displacement transducers. Following pre-contraction of aorta rings, relaxations to the independent and mixed components of CSEB and CS3B were recorded in the absence and presence of nitric oxide synthase (NOS) inhibitor (N(omega)-nitro-L-arginine methyl ester (N-LAME)), cyclooxygenase (COX) inhibitor (indomethacin) and K+ channel inhibitors (tetraethylammonium, glibenclamide and 4-aminopyridine). We also tested the effects of CSEB and CS3B in endothelium-intact and -denuded rat thoracic aorta rings. To investigate the Ca2+-channel antagonistic effect of adhesive components, concentration-response curves to CaCl2 were obtained in the absence and presence of the components. The primer, the bond, and the mixture of CSEB and CS3B elicited concentration-dependent relaxations. Mechanical rubbing of the endothelium did not significantly modify the extent of vasorelaxation induced by the test materials. The vasorelaxant effect was mediated neither by NOS and COX inhibition nor by the tested K+ channel antagonists. Mechanical removal of the endothelium did not alter the vasodilatory effect induced by the self-etch adhesives. Both CSEB and CS3B significantly inhibited the contractions induced by CaCl2. These results demonstrate the vasodilatory effect induced by the self-etch adhesive systems through a Ca2+-antagonistic effect.

Supernumerary teeth in a Turkish population.

INTRODUCTION: Our aim in this study was to investigate the frequency, distribution, sex differences, and characteristics of supernumerary teeth in a referred Turkish population. METHODS: A total of 2599 patients' panoramic radiographs (1360 girls, 1239 boys) were evaluated, including children in both the mixed and the permanent dentitions. Their mean age was 8.6 +/- 0.23 years. Number, location, classification, side, and impaction of supernumerary teeth were evaluated. Furthermore, the development of these teeth was evaluated. RESULTS: Eighty-four supernumerary teeth were found on 69 radiographs; 9 were deciduous and 75 were permanent teeth. Most supernumerary teeth were in the premaxillary region (67%). Mesiodens (n = 43) was the most frequent supernumerary tooth (51.2%). This was followed by the maxillary lateral incisor (15.5%), the mandibular premolar (14.3%), the maxillary canine (9.5%), the maxillary premolar (6%), the mandibular lateral incisor (2.4%), and the mandibular canine (1.2%). Sixty-two (73.8%) supernumerary teeth were impacted. The male-female ratio was 1.13:1, which was not statistically significant. CONCLUSIONS: The prevalence of supernumerary teeth in Turkish children was 2.7% in this study.

Traumatic injuries to permanent teeth in Turkish children, Ankara.

The aim of this study was to identify the types and etiologies of dento-alveolar injuries among patients who were treated for injuries to maxillary and/or mandibular permanent teeth at the Gulhane Medical Academy, Department of Pediatric Dentistry, Center of Dental Sciences in Ankara, Turkey to provide a basis for determining optimal treatment approaches and educational needs. From a total of 4956 children aged 6-12 years (mean age: 8.91 +/- 1.95) applying to the Center, 472 children (9.5%) were found to have suffered dental injuries during a period of 2 years. Injuries were classified according to drawings and texts based on the WHO classification system, as modified by Andreasen and Andreasen. Injury rates were highest among children age 6 and ages 8-10. The most frequently injured permanent teeth were the maxillary central incisors (88.2%), and the maxillary right central permanent incisor made up 47.2% of all injured teeth. The most common cause of dental trauma was falling while walking or running (40.3%). Most injuries involved a single tooth (64.8%). The most common type of injury was enamel fracture (44.6%). There was a significant difference in gender, where boys more often suffered from a dental hard tissue and pulp injury than girls (P = 0.019), whereas there was no difference in gender (P = 0.248) in the distribution of periodontal injuries. Injuries were found to occur more frequently during the summer (P < 0.001). Children with increased overjet were 2.19 times more likely to have dental injuries than other children. Considering that the incidence of traumatic dental injury is highest among children ages 6 and ages 8-10 as well as the fact that patients with increased overjet are more prone to dental trauma, preventive orthodontic treatment in early mixed dentition may play an important role in reducing traumatic dental injuries.

Use of triple antibiotic paste as a disinfectant for a traumatized immature tooth with a periapical lesion: a case report.

Elimination of microbial contamination from the root canal system is a precondition for successful root canal treatment. In this regard, mechanical instrumentation, irrigation, and intracanal medication are all important. This case report assesses the efficacy of a triple antibiotic paste consisting of metronidazole, ciprofloxacin, and minocycline in the disinfection of immature teeth with apical periodontitis. An 8-year-old girl presented at the Department of Pediatric Dentistry for the evaluation of right and left maxillary central incisors with crown fractures and luxation. The right central incisor had a large periapical lesion, which was treated by filling the canal with a ciprofloxacin/metronidazole/minocycline paste. After 4 months, the patient had no symptoms, and a radiograph showed the radiolucency had completely resolved. At the 1-year follow-up, a periapical radiograph showed complete root development and apical closure. These results indicate that triple antibiotic paste is effective in disinfecting immature teeth with periapical lesions.

The effects of one-step self-etch adhesives on the induction of oxidative stress and production of TGF-beta1 and BMP-2 by human gingival fibroblasts.

The aim of this study was to evaluate and compare the effects of two self-etch adhesive materials on the induction of oxidative stress and production of transforming growth factor-beta1 (TGF-beta1) and bone morphogenetic protein-2 (BMP-2) by cultured human gingival fibroblasts (HGF). Inflammation-free attached gingiva was obtained from healthy donors under informed consent. Following 24- and 72-h exposure of HGF to two different elutes of the test materials, cell viability was determined using the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl tetrazolium bromide (MTT) assay. Lipid peroxidation, a major indicator of oxidative stress, was measured by the thiobarbituric acid reactive substance (TBARS) assay. TGF-beta1 and BMP-2 levels in cell-free culture media were determined by enzyme-linked immunosorbent assay (ELISA). Cell viability of the test groups was significantly lower than those of control at 24 and 72 h (P < 0.001), but showed an increase at 72 h (P < 0.001). The TBARS levels of both test groups were significantly greater than that of control (P < 0.05), and displayed similar values at 72 h (P > 0.05). For both materials, the levels of TGF-beta1 and BMP-2 were significantly greater than that of control (P < 0.05). Both test groups showed increased TGF-beta1 levels. These results indicate that the tested self-etch adhesives might be capable of inducing production of TGF-beta1 and BMP-2 in cultured HGF, despite their cytotoxic and oxidative stress-producing potential.

Hypoplasia of a permanent incisor produced by primary incisor intrusion: a case report.

Orofacial trauma is a serious orodental and general health problem that may have medical, esthetic and psychological consequences for children and their parents. When the root of the primary tooth is close to the unerupted permanent tooth, primary tooth trauma may result in developmental disturbances and pulpal reaction in that permanent tooth. We report an unusual case in which injury to the primary dentition resulted in developmental disturbances in the crown and the calcified structures in the pulp chamber of the permanent tooth. Localized malformation of the crown and enamel hypoplasia were treated with a light-cured composite resin restoration. We also discuss the formation of pulp calcification and the need for endodontic treatment.

Traumatic intrusion of primary teeth and its effects on the permanent successors: a clinical follow-up study.

OBJECTIVE: Owing to the anatomic proximity between the root of the primary tooth and its permanent successor, trauma to primary dentition may cause developmental disturbances in unerupted permanent teeth. STUDY DESIGN: This report presents the findings of a prospective 7-year study examining developmental disturbances of permanent teeth attributed to intrusive injury of their primary predecessors based on initial patient records and clinical observation. Intrusive injuries were diagnosed and grouped according to World Health Organization classifications, as modified by Andreasen et al. RESULTS: A total of 78 children (aged 12-48 months) presenting with intrusive trauma to 138 primary incisors were available for follow-up examinations. The most frequently intruded primary teeth were maxillary incisors (93.47%), with the right central primary incisor representing 41.3% of all intruded teeth. In 23 patients, 36 teeth were scheduled for extraction during the first visit. During the course of follow-up, 41 of the remaining teeth exhibited post-traumatic consequences, including pulp necrosis (78.0%), internal and/or external root resorption (14.6%), ankylosis (4.9%), and obliteration of the pulp canal (2.5%). In 74 permanent successors (53.6%), >or=1 of the following developmental disturbances were observed: enamel hypoplasia (28.3%), crown and/or root deformation (16.7%), and ectopic eruption (16.7%). CONCLUSION: There was no significant correlation between age of intrusion and frequency of subsequent developmental disturbances (P > .05).

Combined technique with glass-fibre-reinforced composite post and original fragment in restoration of traumatized anterior teeth--a case report.

Dentoalveolar trauma is frequently encountered by dental practitioners. In some instances, saving a child's traumatized permanent teeth can create difficulties for the child, the parents and the dentist. Reattachment of a crown fragment is a conservative treatment that should be considered for crown fractures of anterior teeth. This case describes the clinical reattachment of an original tooth fragment. A 10-year-old male presented at the Department of Pediatric Dentistry with a complex crown fracture of the left maxillary central incisor 1 day after the trauma occurred. Following endodontic treatment, a glass-fibre-reinforced composite root canal post (FRC Postec; Ivoclar Vivadent AG, Schaan, Liechtenstein) was inserted to increase retention and distribute stress along the root. The dental restoration was completed using the original fragment and a dual-cured resin composite (Variolink II; Ivoclar Vivadent AG). Clinical and radiographic examinations at 1-year recall showed the glass-fibre-reinforced composite root canal post and restoration to be in place, indicating the success of the treatment in maintaining the fractured tooth. Thus, we conclude that reattachment of a tooth fragment using a dual-cured resin composite and a glass-fibre-reinforced composite root canal post is an alternative method for the rehabilitation of fractured teeth that offers satisfactory aesthetic and functional outcomes.