Pulp liner materials in selective caries removal: study protocol for a randomised controlled trial.

INTRODUCTION: The literature shows that selective carious tissue removal (SCTR) decreases the number and diversity of bacteria, stops the caries process and reduces the risk of pulp exposure. However, no consensus exists on which pulp liner would be suitable for teeth undergoing SCTR. So, this study will verify the in vivo response of dentine-pulp complex after SCTR in primary teeth with or without pulp liner material. METHODS AND ANALYSIS: A randomised clinical trial, double-blinded, parallel-group and allocation concealment will be conducted with the enrolment of 384 patients from 5 to 9 years, with one maxillary/mandibular first/second primary molars with deep occlusal/occlusoproximal cavities. The remaining dentine will be lined with calcium hydroxide cement-group 1; mineral trioxide aggregate-group 2 and without liner-group 3. The primary outcome will be success of the of dentine-pulp complex evaluated clinically and radiographically at 6, 12 and 24 months, while the secondary outcomes will be the measurement of the dentine barrier on periapical radiographs. During all study, two trained and calibrated examiners will evaluate the treated teeth clinically and radiographically. Interexaminer and intraexaminer reliability will be verified by casual and systematic error. The Kolmogorov-Smirnov test will be adopted to test the normality of continuous variables. Comparisons among groups will be performed by using the χ2 test and anaylsis of variance, followed by Tukey test (p<0.05). The logistic regression will be applied, and the degrees of this association will be measured using the OR and 95% CI. ETHICS AND DISSEMINATION: The present protocol was submitted and approved by the Ethical Committee of the University of São Paulo, Bauru, São Paulo, Brazil (CAAE: 79123517.0.0000.5417). Consent for publication will be obtained from all parents or legal guardians. Results of this study will be reported in full through peer-reviewed journals. TRIAL REGISTRATION NUMBER: RBR-9fsxnn.

Surgical and orthodontic treatment after incidental radiographic discovery of a severely infraoccluded primary molar.

Dentoalveolar ankylosis, the fusion of a tooth with the alveolar bone, is often associated with primary molars and is the main cause of infraocclusion. This report describes an uncommon case of a severely infraoccluded primary first molar associated with loss of space in the maxilla. After anamnesis and a clinical examination, absence of the primary maxillary left first molar was observed. Periapical radiographs revealed a primary molar completely submerged under the gingiva. Cone beam computed tomography was performed to determine the proximity of the ankylosed tooth to the germ of the permanent successor. Treatment planning included the surgical removal of the ankylosed tooth and placement of a removable space regainer. After 18 months, the maxillary first premolar erupted normally. The careful surgical and interceptive orthodontic planning and cooperation of the patient regarding the use of a removable appliance were essential to the treatment success.

Clinical and radiographic outcomes of the use of capping materials in vital pulp therapy of human primary teeth / Resultados clínicos e radiográficos do uso de materiais de capeamento na terapia de polpa vita de dentes decíduos humanos

O objetivo deste estudo foi comparar os resultados clínicos e radiográficos de hidróxido de cálcio (CH), hidróxido de cálcio precedido de solução corticosteróide / antibiótico (O + CH) e formocresol diluído (FC) na terapia de polpa vital de dentes decíduos humanos. Material e Métodos: Quarenta e cinco molares decíduos inferiores de crianças com idade entre 5-9 anos foram divididos aleatoriamente em três grupos: FC, CH e O + CH e receberam tratamento convencional de pulpotomia. Acompanhamento clínico e radiográfico foi realizado após 3, 6 e 12 meses. Resultados: Nenhum sinal de falha clínica foi observado nos três grupos de estudo durante todos os períodos de avaliação. A análise radiográfica mostrou um total de seis falhas de reabsorção radicular interna nos grupos CH e O + CH após 12 meses de acompanhamento, com diferença estatisticamente significativa em comparação com o grupo FC. O grupo FC não mostrou formação da barreira de tecido duro, o que foi observado nos grupos CH e O + CH em todos os períodos de acompanhamento. Conclusão: Todos os materiais empregados apresentaram taxas de sucesso clínico e radiográfico aceitáveis. Os resultados mostraram que o uso de uma solução anti-inflamatória antes do material de capeamento tem propriedades terapêuticas que ajudam na cicatrização pulpar. São recomendadas investigações clínicas contínuas utilizando estes medicamentos no tratamento de pulpotomia vital em molares decíduos...

Objective: The aim of this study was to compare the clinical and radiographic outcomes of Calcium Hydroxide (CH), Calcium Hydroxide preceded by corticosteroid/antibiotic solution (O+CH) and diluted formocresol (FC) in the vital pulp therapy of human primary teeth. Material and methods: Forty-five mandibular primary molars of children aged between 5-9 years were randomly assigned in the three study groups, FC, CH and O+CH and received conventional pulpotomy treatment. Clinical and radiographic follow-up was made at 3, 6 and 12-months. Results: No sign of clinical failure was observed in the three study groups during all the periods of evaluation. Radiographic analysis showed a total of six failures of internal root resorption in CH and O+CH groups after the 12 months follow-up, with statistically significant difference as compared with FC group. FC group did not show hard tissue barrier formation, which was observed in CH and O+CH groups in all the followup periods. Conclusion: All employed materials showed acceptable clinical and radiographic success rates. The results showed that the use of an antiinflammatory solution prior the dressing material has therapeutic properties that help with pulpal healing. Continued clinical investigations using these medicaments as vital pulpotomy treatment in primary molars are recommended...

Surgical techniques for the treatment of ankyloglossia in children: a case series.

This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.

Surgical techniques for the treatment of ankyloglossia in children: a case series

This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.

Conservative surgical treatment of an aggressive calcifying cystic odontogenic maxillary tumor in the young permanent dentition.

Calcifying cyst odontogenic tumor (CCOT) is a rare benign cystic neoplasm of odontogenic origin whose treatment depends on the lesion's localization and histological type. The purpose of this report was to describe a case of extensive calcifying cyst odontogenic tumor involving the maxilla of a 12-year old female patient and the treatment option adopted. The lesion was associated with an impacted first premolar, and the roots of the canine and second premolar were divergently displaced. An incisional biopsy revealed the presence of a highly cellular, densely fibrous connective tissue, with diffuse infiltration of mononuclear inflammatory cells. Cystic marsupialization and extraction of the impacted premolar were performed. No signs of lesion recurrence were noted after 28 months. Therefore, marsupialization should be considered when planning CCOT treatment, primarily in young patients with large lesions, to avoid mutilations and tooth loss.

Estudo clínico e radiográfco do formocresol de Buckley a 1/5 e do cimento Portland utilizados para pulpotomias em dentes decíduos humanos / Clinical and radiographic study on 1/5 dilution of Buckley?s formocresol and Portland cement used for pulpotomies of human primary teeth

O objetivo deste estudo foi comparar a eficácia clínica e radiográfca do formocresol de Buckley diluído a 1/5 e do cimento Portland como agentes capeadores pulpares em dentes decíduos humanos acometidos por cárie extensa, tratados pela técnica convencional de pulpotomia. Sessenta e oito primeiros molares inferiores em 52 crianças com idades entre 5 e 9 anos foram criteriosamente selecionados. De forma randômica, formaram-se dois grupos de 34 molares, cada qual sendo tratado com um dos agentes capeadores a serem comparados. Após a realização das pulpotomias, avaliações clínicas e radiográficas foram realizadas nos períodos de 3, 6 e 12 meses do pós-operatório. Nenhum sinal de falha clínica foi observado, para ambos os grupos, em todos os períodos avaliados. Diferença estatisticamente signifcativa entre os grupos foi observada apenas quando avaliada a coloração da coroa dentária e a obliteração do canal radicular, visto que todos os dentes tratados com o cimento Portland apresentaram discreta coloração acinzentada e estenose radicular. O cimento Portland foi tão efetivo quanto o formocresol como capeador pulpar em pulpotomias de dentes decíduos. Embora os resultados sejam encorajadores, estudos futuros e com acompanhamentos a longo prazo são necessários para se determinar a indicação clínica segura do cimento Portland.

This study aimed at comparing the clinical and radiographic effectiveness of 1:5 dilution of Buckley?s formocresol and Portland cement as pulp dressing agents in carious primary teeth treated by conventional pulpotomy. Sixty eight primary mandibular molars in 52 children between 5 and 9 years old were criteriously selected. Clinical and radiographic evaluations were recorded 3, 6 and 12-months postoperatively. No signs of clinical failure were observed at all follow-up appointments in both groups. Statistically signifcant difference between both groups was only observed when assessing tooth crown discoloration and pulp canal obliteration since all of the teeth treated with Portland cement presented dicrete grayish discoloration and root stenosis. Portland cement was equally effective as formocresol as pulp capping agent in pulpotomies of deciduous teeth. Although our results are very encouraging, further studies and longer follow-up assessments are needed in order to determine the safe clinical indication of Portland cement.

Efeito do gel de clorexidina em diferentes concentrações no controle do biofilme bacteriano e da inflamação gengival em crianças / Effect of clorexidina in different concentrations in the control on dental plaque and inflammation gingival in children

O presente estudo teve como objetivo avaliar a efetividade da utilização de géis de clorexidina nas concentrações de 0,5%, 1% e 2% para o controle do biofilme dentário e da inflamação gengival em crianças na faixa etária de 7 a 11 anos de idade. A amostra foi composta por 40 crianças, aleatoriamente divididas em quatro grupos: G1 (grupo controle - não utilização de agente químico), G2 (utilização de gel de clorexidina a 0,5%), G3 (utilização de gel de clorexidina a 1%) e G4 (utilização de gel de clorexidina a 2%) para determinação dos índices de placa e gengival. O gel de clorexidina foi aplicado com a utilização de moldeiras descartáveis pré-fabricadas (5 mL), por 1 minuto, uma vez por semana, durante 4 semanas. As avaliações clínicas foram feitas após 1 semana, 1 mês, 3 e 6 meses da última aplicação do gel. Os resultados obtidos foram analisados pela análise de variância a dois critérios, sendo adotado nível de significância igual a 5%. Os índices de placa e gengival reduziram durante o período experimental em todos os grupos. Não houve diferença significante (p <0.05) entre os grupos tratados com gel de clorexidina quando comparado com o grupo placebo na redução de placa e índice gengival. Os resultados mostraram que formulações diferentes de gel de clorexidina não produzem efeito inibidor da placa bacteriana e da inflamação gengival. Sendo assim, estudos adicionais são necessários para esclarecer o papel da clorexidina na prevenção de cárie e doença periodontal em crianças.

The purpose of the present study was to assess the effect of three different formulations of chlorhexidine gel in the concentrations of 0.2%, 1% and 2% for the control of plaque accumulation and gingivitis. This was a double-blind, longitudinal, non-crossover study in 48 children between 7 to 11 years of age. Subjects were randomly assigned to 4 different groups: G 1 (placebo), G 2 (0.2% chlorhexidine gel), G 3 (1% chlorhexidine gel) and G 4 (2% chlorhexidine gel). The chlorhexidine gel was administered once a week during 4 weeks. The clinical evaluations were made after 1 week, 1, 3 and 6 months of the last application of the chlorhexidine gel. Mean plaque and gingival scores were reduced over the four-week trial period for experimental and control groups. There was no significant difference (p<0.05) between the groups treated with chlorhexidine gel when compared with the placebo group in the reduction of plaque and gingival scores. The results indicated that different formulations of chlorhexidine gel did not produce an effective inhibitor of plaque growth. Within the limitations of the present study design, further studies are required to clarify the role of chlorhexidine to prevent caries and periodontal disease.

Pulpotomies with portland cement in human primary molars

Two clinical cases in which Portland cement (PC) was applied as a medicament after pulpotomy of mandibular primary molars in children are presented. Pulpotomy using PC was carried out in two mandibular first molars and one mandibular second molar, which were further followed-up. At the 3, 6 and 12-month follow-up appointments, clinical and radiographic examinations of the pulpotomized teeth and their periradicular area revealed that the treatments were successful in maintaining the teeth asymptomatic and preserving pulpal vitality. Additionally, the formation of a dentin bridge immediately below the PC could be observed in the three molars treated. PC may be considered as an effective alternative for primary molar pulpotomies, at least in a short-term period. Randomized clinical trials with human teeth are required in order to determine the suitability of PC before unlimited clinical use can be recommended.

Pulpotomies with Portland cement in human primary molars.

Two clinical cases in which Portland cement (PC) was applied as a medicament after pulpotomy of mandibular primary molars in children are presented. Pulpotomy using PC was carried out in two mandibular first molars and one mandibular second molar, which were further followed-up. At the 3, 6 and 12-month follow-up appointments, clinical and radiographic examinations of the pulpotomized teeth and their periradicular area revealed that the treatments were successful in maintaining the teeth asymptomatic and preserving pulpal vitality. Additionally, the formation of a dentin bridge immediately below the PC could be observed in the three molars treated. PC may be considered as an effective alternative for primary molar pulpotomies, at least in a short-term period. Randomized clinical trials with human teeth are required in order to determine the suitability of PC before unlimited clinical use can be recommended.

Replantation of an avulsed maxillary primary central incisor and management of dilaceration as a sequel on the permanent successor.

This case report outlines the sequel and possible management of a permanent tooth traumatized through the predecessor, a maxillary right primary central incisor that was avulsed and replanted by a dentist 1 h after the trauma in a 3-year-old girl. Three years later, discoloration and fistula were present, so the primary tooth was extracted. The patient did not come to the scheduled follow-ups to perform a clinical and radiographic control of the succeeding permanent incisor, and only returned when she was 10 years old. At that moment, the impaction and dilaceration of the maxillary right permanent central incisor were observed through radiographic examination. The dilacerated permanent tooth was then surgically removed, and an esthetic fixed appliance was constructed with the crown of the extracted tooth. Positive psychological influence of the treatment on this patient was also observed.

Oral management of a child with mixed dentition affected by amelogenesis imperfecta.

Amelogenesis Imperfecta (AI) is a hereditary developmental disorder affecting deposition, calcification or maturation of dental enamel in both the primary and permanent dentitions. Patients usually present tooth sensitivity as well as problems in chewing function and esthetics. In addition, dissatisfaction with the teeth appearance is often found, affecting the patient's social life. Oral rehabilitation of children with primary or mixed dentition is complex, since no definitive treatment can be done during periods of growth and until the end of eruption of the permanent dentition is accomplished. This clinical report describes the oral management of a 7-year-old girl with mixed dentition affected by AI. The patient showed accentuated teeth wear and root resorption, decreased occlusal vertical dimension, open bite and alteration in the sequence of eruption of permanent teeth. Most of the teeth were restored with resin modified glass ionomer cement. This approach markedly decreased the patient's dental hypersensitivity and improved functional chewing and esthetics. Positive psychological influence of the treatment on this patient was also observed.