An International Investigation of Molar Incisor Hypomineralisation (iMIH) and Its Association with Dental Anomalies: Development of a Protocol.

BACKGROUND: Molar incisor hypomineralisation (MIH) is a common disorder of tooth development, which has recently been found to be associated with a higher prevalence of hypodontia. The aim of this international multicentre study is to determine the association between MIH and other developmental anomalies in different populations. METHODS: Investigators were trained and calibrated for the assessment of MIH and dental anomalies and ethical approvals obtained in each participating country. The study aimed to recruit 584 children with MIH and 584 children without MIH. Patients aged 7-16 years who attend specialist clinics will be invited to participate. Children will undergo a clinical examination to determine the presence and severity of MIH, using an established index. The presence of any other anomalies, affecting tooth number, morphology, or position, will be documented. Panoramic radiographs will be assessed for dental anomalies and the presence of third permanent molars. Statistical analysis, using a chi squared test and regression analysis, will be performed to determine any differences in dental anomaly prevalence between the MIH and non-MIH group and to determine any association between dental anomalies and patient characteristics. CONCLUSION: This large-scale study has the potential to improve understanding about MIH with benefits for patient management.

Fracture resistance of prefabricated versus custom-made zirconia crowns after thermo-mechanical aging: an in-vitro study.

BACKGROUND: Prefabricated zirconia crowns for a young permanent molar is a child-friendly solution for restoring a permanent molar at a young age. This in-vitro study aimed to compare the fracture resistance of prefabricated versus custom-made permanent molar crowns. METHODS: 16 identical resin dies were fabricated to receive permanent molar zirconia crowns, dies were divided into 2 groups, 1) received perfricated crowns, 2) custom-made crowns. Thermo-dynamic cycling was performed to simulate 6 months in the oral cavity, Fracture resistance of each group was assessed by applying increasing load till fracture. Data were tested for normality using Shapiro-Wilk and Levene's tests. Data were analyzed using independent t test. RESULTS: No statistically significant difference was found between fracture resistance of prefabricated and custom-made crowns (1793.54 ± 423.82) and (1987.38 ± 414.88) respectively. 3 crowns of the custom-made group fractured with the underlying die, versus zero dies fractured in the prefabricated group. CONCLUSIONS: Prefabricated permanent molars zirconia crowns can perform as well as custom-made crowns for an adult in terms of fracture resistance, it is suitable for children and can withstand the occlusal forces of an adult.

Effect of dental trauma management resources on dental practitioners' confidence and knowledge: A pilot cross-sectional study.

BACKGROUND/AIM: The knowledge of standardized care guidelines is critical to the confidence of practitioners in managing dental trauma. Therefore, the aim of this study was to assess the awareness, use and impact of the International Association of Dental Traumatology guidelines, and the online Dental Trauma Guide on general dental practitioners' self-reported confidence and knowledge in managing traumatic dental injuries in the primary and permanent dentitions. MATERIALS AND METHODS: A cross-sectional, pre-piloted, 27-item self-administered questionnaire survey was distributed electronically to general dental practitioners' working within five member states of the Gulf Cooperation Council countries (Kingdom of Bahrain, Kingdom of Saudi Arabia, Kuwait, Oman, and Qatar) between September and December 2020. Data were collected and analysed using descriptive statistics and Wilcoxon Signed Rank test analysis for relevant comparisons. RESULTS: A total of 294 respondents completed the survey, with the majority being from the Kingdom of Saudi Arabia (47.4%) and Qatar (27.3%). A lack of evidence-based knowledge in managing traumatic dental injuries was evident among more than half of the respondents. Respondents who were cognizant of the recent International Association of Dental Traumatology guidelines (2020) and those who use the Dental Trauma Guide routinely demonstrated a higher self-reported confidence level in managing both simple and complex primary dentition trauma, as well as simple traumatic dental injuries in the permanent dentition (p < .05). CONCLUSION: This survey highlights critical deficiencies in the knowledge of a large number of the respondents in the management of dental trauma which is likely to cause irreversible long-term patient effects.

Clinical and radiographic evaluation of indirect pulp treatment of young permanent molars using photo-activated oral disinfection versus calcium hydroxide: a randomized controlled pilot trial.

BACKGROUND: Calcium hydroxide is the most commonly used material in indirect pulp treatment (IPT). However, its drawbacks required its replacement by other materials. AIM: This study aims to estimate clinically and radiographically the success of indirect pulp treatment of young permanent molars with either photo-activated oral disinfection (PAD) or calcium hydroxide. DESIGN: This Randomized Controlled Pilot Trial included 32 vital first permanent molars with deep caries that were treated by indirect pulp treatment with either PAD (group 1) or calcium hydroxide (group 2). Clinical and radiographic success in addition to newly-formed dentin thickness were evaluated regularly at 2, 6, 9, and 12 months. RESULTS: The success for both groups was 100% clinically and radiographically at all follow-up periods. Regarding the mean thickness of newly-formed dentin for both groups at different follow-up periods, there was no statistically significant difference between both groups at 2, 6, 9, and 12 months, with P values = 0.825, 0.146, 0.280, and 0.400, respectively. CONCLUSIONS: The clinical and radiographic success for indirect pulp treatment of young permanent molars with both PAD and calcium hydroxide were comparable.

Use of the Hall technique by specialist paediatric dentists: a global perspective.

Background The Hall technique (HT) is popular with UK paediatric dentists (PDs). Global PDs perception/use of HT is unknown.Aim To investigate global PDs opinions/use of HT.Materials and methods A cross-sectional questionnaire of 26 questions was sent to specialist PDs across the globe.Results Responses of 709 PDs from six continents were obtained. The majority (n = 654, 92.32%) had heard about HT but only 50.6% (n = 358) used it, with wide country variations. Respectively, 37.5%, 31.5% and 31% were neutral, against or supportive of HT when they initially heard about it. Only 17% of HT users said it was always the treatment of choice for non-pulpal asymptomatic carious primary molars (NPACPMs), 62% would take a pre-operative radiograph, 65% would consider using high speed drills before HT, 63% would never consider HT under general anaesthesia, 56% would use HT under N2O sedation. Finally, in a clinical scenario of a NPACPM in a cooperative 6-year-old, 75% of PDs would choose conventional restorative methods over the HT.Conclusion The HT is recognised, but not used, by an outright majority of PDs across the globe. Identifiable barriers such as lack of training, perception as substandard dentistry and perceived lack of evidence reduced its use.

Influence of luting cement on the clinical outcomes of Zirconia pediatric crowns: A 3-year split-mouth randomized controlled trial.

BACKGROUND: There is no scientific evidence supporting the choice of luting cement for cementation of zirconia crowns. AIM: The purpose of this split-mouth study was to compare the efficacy of using bioactive cement versus packable glass ionomer for cementation of posterior pediatric zirconia crowns. DESIGN: Fifty first mandibular primary molars were restored by zirconia crowns and were randomly divided to be luted with either (a) bioactive cement or (b) packable glass ionomer. Crowns' retention, fracture, and gingival condition were evaluated at 1 week, and 1-, 3-, 6-, 9-, 12-, 18-, 24-, and 36-month intervals. Statistical analysis was carried out using Fisher's exact test, Kaplan-Meier survival analysis, and Wilcoxon signed rank test. RESULTS: At 3- to 36-month follow-ups, there were statistically significant (P = .009-≤.001) less debonded crowns in packable glass ionomer group. There were no fractured crowns for either cements. There was no statistically significant difference between gingival index scores. CONCLUSIONS: Packable glass ionomer is more retentive than bioactive cement when used for cementing zirconia pediatric crowns. Posterior zirconia pediatric crowns have high fracture resistance after 36 months of clinical performance, irrespective of luting cement. Luting cement for zirconia pediatric crowns has no apparent effect on gingival condition around crowns.

Case Report: Root resorption caused after pulp death of adjacent primary molar.

Necrotic decayed primary molars with necrotic pulp tissues may show periapical involvement and root resorption. In this case report, a pediatric patient with a very common chief complain and clinical picture of necrotic badly decayed molar, introduced a very interesting case when radiographic investigation was performed, which showed that root resorption of the adjacent healthy molar occurred. The current report is, to the best of our knowledge, the first to report such finding in primary dentition.

Visual and radiographic caries detection: a tailored meta-analysis for two different settings, Egypt and Germany.

BACKGROUND: Diagnostic meta-analyses on caries detection methods should assist practitioners in their daily practice. However, conventional meta-analysis estimates may be inapplicable due to differences in test conduct, applied thresholds and assessed population between settings. Our aim was to demonstrate the impact of tailored meta-analysis of visual and radiographic caries detection to different settings using setting-specific routine data. METHODS: Published systematic reviews and meta-analyses on the accuracy of visual and radiographic caries detection were used. In two settings (a private practice in Germany and a public health clinic in Egypt), routine data of a total of 100 (n = 50/practice) consecutive 12-14 year-olds were collected. Test-positive rates of visual and radiographic detection for initial and advanced carious lesions on occlusal or proximal surfaces of molars were used to tailor meta-analyses. If prevalence data were available, these were also used for tailoring. RESULTS: From the original reviews, 210 and 100 heterogeneous studies on visual and radiographic caries detection were included in our meta-analyses. For radiographic detection, sensitivity and specificity estimates derived from conventional and tailored meta-analysis were similar. For visual detection of advanced occlusal carious lesions, the conventional meta-analysis yielded a sensitivity and specificity (95% CI) of 64.6% (57-71) and 90.9% (88-93), whereas the tailored estimates for Egypt were 75.1% (70-81) and 84.9% (82-89), respectively, and 43.7% (37-51) and 96.5% (95-97) for Germany, respectively. CONCLUSION: Conventional test accuracy meta-analyses may yield aggregate estimates which are inapplicable to specific settings. Routine data may be used to produce a meta-analysis estimate which is tailored to the setting and thereby improving its applicability.

Successful Restoration of Severely Mutilated Primary Incisors Using a Novel Method to Retain Zirconia Crowns - Two Year Results.

AIM: This manuscript describes a simple reliable technique for restoring severely mutilated primary anterior teeth. A rigid glass ionomer post is created over which zirconia crowns can be fitted to achieve a long-term stable esthetic restoration for primary anterior teeth. STUDY DESIGN: Children aged 2-5 years with two up to six extensively decayed upper primary incisors were included. Fuji IX was condensed into an intracanal space created to a depth of 3mm, to provide a core which also extended 3mm supragingivally. Crown preparations were completed upon these cores. Zirconia crowns (Nusmile, Houston Texas USA) were fitted and cemented over the prepared cores. All patients were recalled at regular intervals. RESULTS: Twenty-three healthy children with 86 restorations participated in the study. The overall survival of the restorations was 95.3% after 12 months and 80.2% after 24 months. According to Kaplan-Meier survival analysis, the median survival time was not reached while the estimated mean survival time was 22.9 months. CONCLUSIONS: This newly described clinical technique is simple and reliable to use for restoration of extensively decayed primary incisors. Use of zirconia crowns retained using this technique offers superior esthetic, durable restorations with remarkable gingival response up to 24 months.