Antibacterial Effect of Calcium Hydroxide With or Without Chlorhexidine as Intracanal Dressing in Primary Teeth With Apical Periodontitis.

PURPOSE: The purpose of this study was to evaluate in vivo the antibacterial effect of calcium hydroxide (CH) dressings, with or without chlorhexidine (CHX), on human primary teeth with apical periodontitis. METHODS: Forty root canals in 40 children were selected. A first microbiological sample was obtained after coronal opening, and the teeth were randomly assigned to Group 1 (root canals filled with CH paste) and Group 2 (CH paste plus 1.0 percent CHX). After 30 days, the dressing was removed and the canals were allowed to remain empty for 72 hours. Subsequently, the second microbiological sample was collected. After performing microbiological tests, the data were subjected to statistical analysis to compare the two CH dressings regarding reducing the absolute levels of microorganisms and with respect to total microbial elimination. All analyses were performed with a significance level of five percent. RESULTS: Both CH dressings provided a significant reduction in the number of microorganisms (anaerobic, aerobic, black-pigmented bacilli, streptococci and Streptococcus mutans) in a similar way (P>0.05). However, in terms of complete elimination of microbiota, CH paste alone exhibited greater efficacy (P<0.05). CONCLUSIONS: The addition of chlorhexidine did not provide additional antimicrobial benefits compared with pure calcium hydroxide paste as an intracanal dressing in primary teeth with apical periodontitis.

Direct pulp capping with a self-etching adhesive system: histopathologic evaluation in dogs' teeth.

OBJECTIVE: This study evaluated histopathologically the response of pulp and periradicular tissues after pulp capping with an all-in-one self-etching adhesive system in dogs' teeth. STUDY DESIGN: Forty teeth of 4 dogs were assigned to 3 groups according to the pulp capping material: G1 (n = 20): self-etching adhesive system; G2 (n = 10): Ca(OH)(2); G3 (n = 10): zinc oxide-eugenol. The animals were killed 7 and 70 days after pulp capping. The pieces containing the pulp-capped teeth were removed and processed for histologic analysis. RESULTS: At 7 days, no dentin bridge formation was observed; G1 and G3 exhibited inflammatory pulpal alterations, whereas G2 presented only mild inflammatory infiltrate in the pulp tissue adjacent to the capping material, the remainder being intact. At 70 days, no specimen in G1 or G3 presented dentin bridge formation. The remaining pulp tissue exhibited severe inflammatory alterations and areas of necrosis. In G2, all specimens showed dentin bridge formation and absence of inflammation and mineralized tissue resorption. No bacteria were identified using Brown and Brenn staining techniques in all 3 groups at any observation period. CONCLUSION: According to the conditions of this study, direct pulp capping with the self-etching adhesive system did not allow pulp tissue repair and failed histopathologically in 100% of the cases.

Aggressive periodontitis associated with Papillon-Lefèvre syndrome: report of a 14-year follow-up.

This case report describes the periodontal management, therapeutic approach, and 14-year follow-up of a patient diagnosed with Papillon-Lefevre syndrome (PLS). A female child, diagnosed with PLS-associated periodontitis at the age of 9 years and 11 months, presented with hyperkeratosis of the palms and soles, as well as generalized aggressive periodontitis. The dental treatment comprised standard periodontal debridement, scaling and root planing, instructions on oral hygiene, restorations, extraction of hopelessly affected teeth and a therapeutic use of antibiotics. The concomitant supportive periodontal therapy and antibiotic coverage could not stop the loss of periodontal attachment and destruction of the alveolar bone. Four years after treatment was initiated, the last remaining teeth were extracted and complete dentures were constructed. The dentures have been periodically replaced and the patient continues to return for follow-up once a year. The combination of intensive periodontal treatment and antibiotic regimen only temporarily delayed periodontal disease progression and did not prevent loss of both primary and permanent teeth. The outcome of this long-term follow-up case report shows that management of PLS-associated periodontitis is further complicated when the patient is first seen in the mixed dentition stage or later. In these situations, the chances of controlling the progression of periodontal breakdown and minimizing tooth loss are greatly reduced.

Dental findings and dental care management in trisomy 18: case report of a 13-year-old "long-term survivor".

Trisomy 18 is a disorder characterized by psychomotor disabilities, dysmorphic features and organ malformations, including mental disabilities, growth deficiency, poor motor ability, micrognathia, microcephaly, low-set and malformed ears, distinctively clenched fists with overlapping fingers, and congenital heart defects. The prognosis is poor: 90% of infants with trisomy 18 do not survive beyond the first year of life and 99% die before the age of 10. This paper reports on a 13-year-old child diagnosed with trisomy 18. The major clinical features are cleft lip/palate, high-arched narrow palate, micrognathia, anterior open bite, posterior crossbite and taurodontism. Dental care management of these patients with special needs is discussed and the dental treatment for this child with trisomy 18 is described.