Cross-sectional visual comparison of remineralization efficacy of various agents on early smooth surface caries of primary teeth with swept source optical coherence tomography.

PURPOSE: Sweptsource optical coherence tomography (SS-OCT) permits cross-sectional observation of surface/subsurface characteristics of enamel including early carious lesions (ECL) or remineralization non-invasively.This study aimed to visually compare the cross-sectional remineralizing efficacy of various agents on ICDAS-II scores-1&2 by using SS-OCT and histology. METHODS: Baseline SS-OCT (grey-scale/false-colour) and histology was performed on the randomly selected two samples with scores-1&2. Four remineralizing agents [fluoride-varnish (FV), CPP-ACP, nanohydroxy-paste (NHP) and silver-diamine-fluoride (SDF)]were evaluated for 2-or 6-weeks post-remineralization using SS-OCT and histology. RESULTS: Score-1&2 baseline SS-OCT images showed a linear-shaped demineralization with dentino-enamel junction (DEJ) visible; and bowl-shaped demineralization with DEJ invisible respectively. Remineralizing agents were assessed on the basis of their ability to remineralize the surface, subsurface and made visualize the DEJ in score-2. SS-OCT showed an outer growth layer in post-remineralization score-1, 2-weeks samples with FV and NHP. All the agents showed progressive subsurface remineralization in 6 weeks. Active lesions showed rapid uptake of minerals on surface. Subsurface mineralization in pigmented score-2 matched sound enamel with NHP and SDF. Surface remineralization was comparable in FV and SDF followed by NHP. SDF demonstrated deeper subsurface remineralization followed by NHP and CPP-ACP. CONCLUSION: SS-OCT images correlated to histology. SS-OCT could monitor surface/subsurface in-situde/remineralization activity non-invasively.

Preventive orthodontic approach for functional mandibular shift in early mixed dentition: A case report.

The case reported here highlights the importance of examination of functional occlusion along with static occlusion. Any undetected malocclusion during early mixed dentition has potency to alter the growth and function of stomatognathic system. Premature contacts in primary canine region is the most prevalent cause of functional mandibular shift and can lead to TMJ problems for the prevalence of self correction of such malocclusion is very low if not intervened. A case of functional mandibular shift due to faulty canine guidance because of premature contacts is discussed here. Selective grinding of premature contacts and myofunctional exercise resulted in well balanced centric occlusion coinciding with centric relation.

In Vivo Evaluation of Customized Pulse Oximeter and Sensitivity Pulp Tests for Assessment Of Pulp Vitality.

OBJECTIVE: The purpose of this study was to test a customized pulse oximeter (CPO) for evaluation of pulp vitality in primary and permanent teeth against clinical diagnosis (vital and untreated non-vital) in order to expand its clinical use for pulp preservation. STUDY DESIGN: CPO was evaluated on intact primary and permanent central or lateral incisor (CI, LI) teeth-vital (group 1, 20n each); untreated non-vital (group 2, 10n each) and; root filled non-vital (group 3, 10n each) of children 4-12 years according to inclusion/ exclusion criteria. For each patient CPO was first applied on finger followed by vitality tests in following sequence-electrical, pulse oximetry and thermal tests. RESULTS: Mean oxygen saturation (%SpO2) in permanent and primary-vital teeth was 88.78% & 87.77% respectively; non-vital teeth was 74.67% & 75.00% respectively; and in all root filled teeth was 0%. Tooth and finger oxygen saturation values showed strong positive relationship in vital primary or permanent teeth and; no correlation in untreated non-vital primary or permanent teeth. The accuracy rate of thermal pulp test and pulse oximetry was 100% and for electrical pulp test it was 90% for permanent and 86.67% for primary teeth. CONCLUSION: The CPO tested in this study proved to be a valuable adjunct for diagnosing pulp vitality by objective means.

Histologic validation of ICDAS-II and polarization sensitive optical coherence tomography to detect smooth surface early carious lesions.

AIM: This in vitro study aimed to histologically validate and compare the methods for detection of smooth surface early carious lesions (ECLs) that is, International caries detection and assessment system for the smooth surface (ICDAS-II-SSC), Polarization sensitive optical coherence tomography (PS-OCT), and radiography. METHODOLOGY: PS-OCT images for scores 0-3 of ICDAS-II-SSC were standardized according to ECLs' depth. Preliminary PS-OCT images for ICDAS-II-SSC score-2 of pigmented ECLs showed reduced lesion depth and therefore were dichotomized into scores 2 and 2p for white and pigmented lesions (ICDAS-II-SSCm). ECLs on one hundred freshly extracted teeth were scored by three examiners for ICDAS-II-SSCm, PS-OCT, radiography, and histology. RESULTS: Compared to histology, ICDAS-II-SSCm showed a strong positive correlation followed by PS-OCT and radiographic evaluation. ICDAS-II-SSCm had a strong positive correlation with PS-OCT, while both variables had a weak positive correlation with radiography. PS-OCT detected the activity of ECLs by directly relating the image depth of ECLs to their mineral volume content. CONCLUSION: The current scope of ICDAS-II should be reviewed since the pigmentation can be misinterpreted as an active lesion. Till then, ICDAS-II-SSC is an effective visual method for early caries detection. PS-OCT has the potential to become a probe with the proper algorithm for diagnostic purposes.

Detection of Hydroxyl and Perhydroxyl Radical Generation from Bleaching Agents with Nuclear Magnetic Resonance Spectroscopy.

OBJECTIVE: Children/adolescent's orodental structures are different in anatomy and physiology from that of adults, therefore require special attention for bleaching with oxidative materials. Hydroxyl radical (OH.) generation from bleaching agents has been considered directly related to both its clinical efficacy and hazardous effect on orodental structures. Nonetheless bleaching agents, indirectly releasing hydrogen peroxide (H2O2), are considered safer yet clinically efficient. Apart from OH., perhydroxyl radicals (HO2.) too, were detected in bleaching chemistry but not yet in dentistry. Therefore, the study aims to detect the OH. and HO2. from bleaching agents with their relative integral value (RIV) using 31P nuclear magnetic resonance (31PNMR) spectroscope. STUDY DESIGN: Radicals were generated with UV light in 30% H2O2, 35% carbamide peroxide (CP), sodium perborate tetrahydrate (SPT) and; neutral and alkaline 30% H2O2. Radicals were spin-trapped with DIPPMPO in NMR tubes for each test agents as a function of time (0, 1, 2, 3min) at their original pH. Peaks were detected for OH. and HO2. on NMR spectrograph. RIV were read and compared for individual radicals detected. RESULTS: Only OH. were detected from acidic and neutral bleaching agent (30% acidic and neutral H2O2, 35%CP); both HO2. and OH. from 30% alkaline H2O2; while only HO2. from more alkaline SPT. RIV for OH. was maximum at 1min irradiation of acidic 30%H2O2 and 35%CP and minimum at 1min irradiation of neutral 30%H2O2. RIV for HO2.was maximum at 0min irradiation of alkaline 30%H2O2 and minimum at 2min irradiation of SPT. CONCLUSION: The bleaching agents having pH- neutral and acidic were always associated with OH.; weak alkaline with both OH. and HO2.; and strong alkaline with HO2. only. It is recommended to check the pH of the bleaching agents and if found acidic, should be made alkaline to minimize oxidative damage to enamel itself and then to pulp/periodontal tissues. ABBREVIATIONS: H2O2: hydrogen peroxide CP: carbamide peroxide SP: sodium perborate SPT: sodium perborate tetrahydrate ROS: reactive oxygen species 31PNMR: 31P nuclear magnetic resonance spectroscope RIV: relative integral value OH2.: hydroxyl radical HO2.: perhydroxyl radical O2.: super oxide radical DIPPMPO: 5-(Diisopropoxyphosphoryl)-5-methyl-1-pyrroline-N-oxide DEPMPO: 5-diethoxyphosphoryl-5-methyl-1-pyrroline-n-oxide DMPO: 5,5-dimethyl-1-pyrroline-N-oxide D2O: heavy water EDTA: ethylene diamine tetra acetic acid.

Pattern of Hydroxyapatite Crystal Growth on Bleached Enamel Following the Application of Two Antioxidants: An Atomic Force Microscope Study.

OBJECTIVES: This study observed the topographical pattern of hydroxyapatite deposition and growth (D&G) on bleached enamel following application of two antioxidants (sodium ascorbate and catalase) using atomic force microscope. STUDY DESIGN: Twenty enamel specimens (4×3×2mm), prepared from extracted impacted third molars, were mounted in self-cure acrylic and randomly grouped as: Group I-untreated; Group II- 35%H2O2; Group III- 35%H2O2 + artificial saliva; Group IV- 35%H2O2 + catalase+ artificial saliva; Group V- 35%H2O2 + sodium ascorbate+ artificial saliva. Groups I and II were observed immediately after treatment. Groups III-V were observed after 72 hrs. Roughness average was also calculated and analyzed with non-parametric Kruskall-Wallis ANOVA and Mann-Whitney tests. RESULTS: H2O2 dissolved matrix, exposed hydroxyapatite crystals (HACs), causing dissolution on the sides of and within HACs and opening up of nano-spaces. Artificial saliva showed growth of dissoluted crystals. Antioxidants+saliva showed potentiated remineralization by D&G on dissoluted HACs of bleached enamel. Catalase potentiated blockshaped, while sodium ascorbate the needle-shaped crystals with stair-pattern of crystallization. Evidence of oxygen bubbles was a new finding with catalase. Maximum roughness average was in group V followed by group II > group IV > group III > group I. CONCLUSION: Post-bleaching application of catalase and sodium ascorbate potentiated remineralization by saliva, but in different patterns. None of the tested antioxidant could return the original topography of enamel.

Initial Stresses induced in Permanent Maxillary First Molar in Mixed Dentition under Normal Masticatory Forces: A Finite Element Study.

OBJECTIVE: The cross-arch space maintainers are used to prevent mesio-distal movement of teeth under physiologic forces, contrary to adult orthodontics where these are used as anchorage against orthodontic forces. Stresses in periodontal ligaments (PDL) are supposed to be different in pediatric dentistry and need to be studied. This study aimed to create mathematical model and calculated the initial stresses generated in the PDL and the behavior of movement in developing permanent maxillary first molar under masticatory forces using 3D finite element analyses (FEA). STUDY DESIGN: Data acquisition, image processing, geometric modeling followed by FE analyses was done under vertical load of 70N. The generated stress and tooth displacement were observed with or without primary second molar, mesial to permanent maxillary first molar. RESULTS: Masticatory forces resulted in insignificant initial PDL stresses and mesial displacement of permanent maxillary first molar in the intact arch. In the case of missing primary second molar, maximum stresses were on the palatal root and the tooth showed greater mesial displacement with mesio-palatal rotation. CONCLUSIONS: Any space maintainer preventing mesio-palatal rotation of permanent maxillary first molar, under physiologic masticatory loadings, may be inserted in case of multiple tooth loss.

Effect of Catalase and Sodium Fluoride on Human Enamel bleached with 35% Carbamide Peroxide.

AIM: To evaluate the effects of postbleaching antioxidant application fluoridation treatment on the surface morphology and microhardness of human enamel. MATERIALS AND METHODS: Ten freshly extracted human maxillary central incisors were cut at cementoenamel junction. Crown portion was sectioned into six slabs which were divided into five groups: group A - untreated controls; group B - 35% carbamide peroxide (CP); group C - 35% CP and catalase; group D - treatment with 35% CP and 5% sodium fluoride; group E - 35% CP, catalase and 5% sodium fluoride. Thirty-five percent carbamide peroxide application included two applications of 30 minutes each at a 5-day interval. After treatment, the slabs were thoroughly washed with water for 10 seconds and stored in artificial saliva at 37°C until the next treatment. Two percent sodium fluoride included application for 5 minutes. Three catalase included application for 3 minutes. RESULTS: After 5 days, groups B and C showed significantly decreased enamel microhardness compared to control. Group D specimens showed relatively less reduction in enamel micro-hardness than group C specimens. There is a marked increase in enamel microhardness in group E specimens. CONCLUSIONS: Fluoride take up was comparatively enhanced after catalase application resulting in less demineralization and increased microhardness. How to cite this article: Thakur R, Shigli AL, Sharma DS, Thakur G. Effect of Catalase and Sodium Fluoride on Human Enamel bleached with 35% Carbamide Peroxide. Int J Clin Pediatr Dent 2015;8(1):12-17.

Autogenous tooth fragment reattachment: a multidisciplinary management for complicated crown-root fracture with biologic width violation.

Fractures of multiple permanent anterior teeth can be a traumatic experience for children, with functional, esthetic and psychological aspects. The treatment of complicated crown-root fractures (CRFs) is more challenging when the biologic width is violated. This paper presents a case of 12-year boy with complicated CRF of teeth #12 and #21, and horizontal crown fracture of tooth #11. It was managed by endodontic treatment, mucoperiosteal surgery with osteotomy to visualize the fracture line for fragment reattachment, followed by fiber-post placement and restoration with polycarbonate crowns. Clinical and radiographic evaluation after 6 months was satisfactory with adequate functional and esthetic results.

Accidental periapical extrusion of non-setting calcium hydroxide: unusual bone response and management.

Premixed non-setting calcium hydroxide is frequently used as interim root canal dressing in endodontically involved permanent teeth and as obturating paste in deciduous teeth in pediatric dentistry. Wide apex in both cases makes it more prone for deliberate extrusion especially when applied with pressure delivery systems. Contrary to common belief the mix was not resorbed in two years with the complaint of insufficiency in mastication. Large mass of calcium hydroxide in bone delayed healing process even after its removal. The present case report intends to demonstrate unusual behavior of bone in response to oily non-setting preparation of calcium hydroxide. Therefore its application with pressure syringe should be reconsidered in pediatric dentistry.

Clinical management of a complicated crown-root fracture using autogenous tooth fragment: A biological restorative approach.

Trauma resulting in crown-root fracture is one of the most challenging fracture types. However, biologic width involvement should be carefully evaluated. Reattachment of tooth fragment to a fractured tooth remains as the treatment of choice because of its simplicity, natural esthetics, and conservation of tooth structure. The reattachment procedure using composite resin should be considered if the subgingival fracture can be exposed to provide isolation. This report presents a case of complicated crown-root fracture of permanent maxillay left central incisor, involving the biologic width in a 10-year-old girl. The traumatized tooth was treated endodontically. Access to the subgingival margins was gained by orthodontic extrusion followed by gingivectomy. The fractured fragment was reattached using bonding system and composite resin.

Biological restoration in a young patient with a complicated crown root fracture with an autogenous tooth fragment.

Crown-root fractures are one of the most challenging trauma cases to treat. Reattachment of tooth fragment to a fractured tooth being a simple procedure conserves the tooth structure, maintains the natural esthetics value and is thus considered as a favorable treatment option. The reattachment procedure using composite resin should be considered if the subgingival fracture can be exposed to provide isolation after a careful evaluation of the biologic width involvement. This case report presents a complicated crown-root fracture of permanent maxillary left central incisor, involving the biologic width in an 11-year-old boy. The traumatized tooth was treated endodontically and reinforced by using glass fiber-post. Access to the subgingival margins was gained by electro surgery. The fractured fragment was reattached using bonding system and composite resin.

Management of traumatic bone cyst in a 3-year-old child: a rare case report.

The following case report describes a case of traumatic bone cyst (TBC) with classical clinical features occurring as a rare combination in a very young female patient with a traumatic etiology and its management using acrylic splint postsurgery. How to cite this article: Banda NR, Nayak UA, Vishwanath KH, Sharma DS, Khandelwal V. Management of Traumatic Bone Cyst in a 3-Year-Old Child: A Rare Case Report. Int J Clin Pediatr Dent 2012;5(3):213-216.

Intra-coronal bleaching in young permanent and primary tooth with biologic perspectives.

The odd attracts society in odd manner, as is the case when a patient with discolored tooth smiles. Because of that, pediatric patients have psychological impact. Trauma and pulpal necrosis are the most common causes for discoloration of teeth. If tooth is intact, intra-coronal bleaching is the most conservative and noninvasive treatment modality provided, it is done cautiously. This article intends to present two case-reports of successful intra-coronal bleaching using milder (sodium perborate) and tissue-friendly bleaching agent with walking bleach.

An in vitro evaluation of radicular penetration of hydrogen peroxide from bleaching agents during intra-coronal tooth bleaching with an insight of biologic response.

OBJECTIVES: External root resorption is the complication of intra-coronal bleaching done with 30% H2O2 alone or mixed with sodium perborate but not with sodium perborate mixed with water. The study was done to comparatively evaluate the H2O2 leakage from three H2O2 liberating bleaching agents. STUDY DESIGN: Fifty one single rooted human teeth were used. After root canal therapy gutta percha was removed below cemento-enamel junction. Three bleaching agents: sodium perborate mixed with water, sodium perborate mixed with 30% H2O2 and 30% H2O2 alone were used. Teeth without defect, with cervical root defect and with mid root defect constituted group A, group B and group C. According to various bleaching agents groups were subdivided into subgroup 1, 2 and 3. H2O2 leakage was measured with the help of spectrophotometer RESULTS: Almost all teeth showed H2O2 leakage. It was maximum in B1 followed by C1, B2, A1, A2, C2, B3, A3 and C3. CONCLUSION: Sodium perborate mixed with water was found to be the best bleaching agent.

Management of Developing Anterior Malocclusion due to SupernumeraryTooth with Preventive and Intercep-tive Approach: A 1½ Year Case Study.

Variety of clinical complications occurs due to the presence of supernumerary teeth, especially mesiodens. It may result in impaction of one or both central incisors which in turn may lead to a variety of malocclusions. Timely intervention not only prevents malocclusion but also the time taken for corrective orthodontics. A complete case report of developing mesiodens' tooth germ resulting in malocclusion including treatment in 1½ year period is presented.