Needle-free anesthetic polymeric device for dental anesthesia in children: A randomized clinical trial.

PURPOSE: To evaluate efficacy of an anesthetic mucoadhesive film with a polymeric device (PD) in promoting anesthesia compared to conventional local infiltration (LA) in children. METHODS: 50 children aged 6-10 years (both genders) needing similar procedures on homologous teeth on the maxilla were included. The parents and children were asked about perception of dental treatment. The child's heart rate per minute (bpm) and blood pressure were evaluated before and after each anesthetic technique (AT) procedure. Anesthesia efficacy was measured by reporting pain using Wong-Baker Faces Scale. Children's behavior and AT preferences were also evaluated. Paired T-test, chi-square and Wilcoxon test were used for statistical comparisons. RESULTS: Fear of anesthesia was reported by 50% of caregivers and by 66% of children. No difference was observed in systolic (P= 0.282) and diastolic (P= 0.251) blood pressure, comparing both AT. Difference was observed regarding the child's behavior when the PD was used (P= 0.0028). Evaluating the face scale, 74% of the children selected the "no pain" (face 0) (P< 0.0001) for PD, and 26% for LA. PD was preferred by 86% of children. Only 20% of the PD anesthesia needed to be complemented by LA. CLINICAL SIGNIFICANCE: The polymeric device presented promising results since most children did not report pain and dental procedures could be performed without local infiltration.

Interferon-gamma inducible protein 16 and type I interferon receptors expression in experimental apical periodontitis induced in wild-type mice.

AIM: The aim of this study was to evaluate the IFI16 and IFN-α/ß receptors expression during the genesis and development of experimental apical periodontitis (AP) in mice teeth. METHODOLOGY: Apical periodontitis was induced in the lower first molars of 40 C57BL/6 mice. They were divided according to the experimental periods 2, 7, 14, 21 and 42 days (n = 8 per group). Five animals were used as a control group (without AP). Specimens were submitted to histological processing for description of the inflammatory process, immunostaining for the presence/absence and localization of IFI16 and IFN-α/ß receptors (qualitative and semi-quantitative analysis) and tartrate-resistant acid phosphatase (TRAP) histoenzimology. RESULTS: The results showed a gradual development of AP over the experimental times. The expression of IFI16 was noticeably more exacerbated in the experimental early period (day 2) whilst the lowest expression was observed in the control group (p = .02). For IFN-α/ß receptors, a higher intensity staining was observed 42 days after AP induction, that was statistically different from the control group (p = .02). In addition, the number of TRAP-positive cells was higher on the later periods (days 21 and 42; p < .001). CONCLUSION: IFI16 protein expression was highest during the early periods after AP induction in mice teeth, whilst IFN-α/ß receptor expression was highest after AP became established.

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.

Stepwise Excavation Allows Apexogenesis in Permanent Molars with Deep Carious Lesions and Incomplete Root Formation.

This study evaluated the stepwise excavation technique in 138 permanent molars with deep carious lesions and incomplete root formation within a 24-month clinical and radiographic follow-up period. In 96.7% of the cases, success was observed (no pain, integrity of restoration margins, absence of radiographic alterations and apexogenesis). The cases of failure (3.3%) were due to the loss of the temporary restoration. In conclusion, the stepwise excavation is a promising technique for permanent teeth with deep carious lesions and incomplete root formation as a minimally invasive approach because it allows the preservation of pulp vitality and occurrence of apexogenesis.

Resin luting materials: Tissue response in dog's teeth.

The aim of this study was to evaluate radiographically and histologically the pulpal and periapical response to self-adhesive (Rely X™ Unicem) and self-etching and self-curing (Multilink(®)) resin-based luting materials in deep cavities in dogs' teeth. Deep class V cavities (0.5-mm-thick dentin) were prepared in 60 canine premolars and the following materials were applied on cavity floor: Groups I/V-RelyX™ Unicem; Groups II/VI-Multilink(®); Groups III/VII-zinc phosphate cement (control) and; Groups IV/VIII-gutta-percha (control). Cavities were restored with silver amalgam. Animals were euthanized after 10 days (groups I-IV) and 90 days (groups V-VIII). Tooth/bone blocks were radiographed and processed for histopathological evaluation of pulp and periapical tissue response to the materials. All materials presented similar histopathological features and radiographic findings at both periods. The pulp tissue was intact. The apical and periapical regions and periodontal ligament thickness were normal. No inflammatory cells, resorption of mineralized tissue (dentin, cementum, and alveolar bone) or bacteria were observed. The lamina dura was intact and no areas of periapical bone rarefaction or internal/external root resorption were observed radiographically. It can be concluded that Rely X™ Unicem and Multilink(®) caused no adverse tissue reactions and may be indicated for cementation of indirect restorations in deep dentin cavities without pulp exposure.

Filtek™ Silorane and Filtek™ Supreme XT resins: tissue reaction after subcutaneous implantation in isogenic mice.

The aim of this study was to evaluate the tissue compatibility of a silorane-based resin system (Filtek™ Silorane) and a methacrylate-based nanoparticle resin (Filtek™ Supreme XT) after implantation in the subcutaneous connective tissue of isogenic mice. One hundred and thirty five male isogenic BALB/c mice were randomly assigned to 12 experimental and 3 control groups, according to the implanted material and the experimental period of 7, 21 and 63 days. At the end of each period, the animals were killed and the tubes with the surrounding tissues were removed and processed for microscopic analysis. Samples were subjected to a descriptive and a semi-quantitative analyses using a 4-point scoring system (0-3) to evaluate the collagen fiber formation and inflammatory infiltrate. Data were statistically analyzed using the Kruskal Wallis test (α=0.05). The results showed that there was no significant difference between the experimental and control groups considering the three evaluation periods (p>0.05). The silorane-based and the methacrylate-based nanoparticle resins presented similar tissue response to that of the empty tube (control group) after subcutaneous implantation in isogenic mice.

FiltekTM Silorane and FiltekTM Supreme XT resins: tissue reaction after subcutaneous implantation in isogenic mice

The aim of this study was to evaluate the tissue compatibility of a silorane-based resin system (FiltekTM Silorane) and a methacrylate-based nanoparticle resin (FiltekTM Supreme XT) after implantation in the subcutaneous connective tissue of isogenic mice. One hundred and thirty five male isogenic BALB/c mice were randomly assigned to 12 experimental and 3 control groups, according to the implanted material and the experimental period of 7, 21 and 63 days. At the end of each period, the animals were killed and the tubes with the surrounding tissues were removed and processed for microscopic analysis. Samples were subjected to a descriptive and a semi-quantitative analyses using a 4-point scoring system (0-3) to evaluate the collagen fiber formation and inflammatory infiltrate. Data were statistically analyzed using the Kruskal Wallis test (?=0.05). The results showed that there was no significant difference between the experimental and control groups considering the three evaluation periods (p>0.05). The silorane-based and the methacrylate-based nanoparticle resins presented similar tissue response to that of the empty tube (control group) after subcutaneous implantation in isogenic mice.

O objetivo do presente estudo foi avaliar a compatibilidade tecidual de um sistema resinoso à base de silorane (FiltekTM Silorane) e de uma resina nanoparticulada à base de metacrilato (FiltekTM Supreme XT), após implantação no tecido conjuntivo subcutâneo de camundongos isogênicos. Um total de 135 camundongos isogênicos BALB/c machos foram randomicamente divididos em 12 grupos experimentais e em 3 grupos controles, de acordo com o material implantado e com o período experimental (7, 21 e 63 dias). Ao final de cada período, os animais foram mortos, sendo os tubos removidos com o tecido circundante e processados para análise microscópica. As lâminas foram submetidas a análise descritiva e análise semi-quantitativa empregando um sistema de escores de 4 pontos (0-3), a fim de avaliar a formação de fibras colágenas e o infiltrado inflamatório. Os dados obtidos foram submetidos à análise estatística por meio do teste de Kruskal Wallis (?=0,05). Os resultados mostraram que não houve diferença estatisticamente significante entre os grupos experimentais e controles, considerando os três períodos de avaliação (p>0,05). As resinas à base de silorane e à base de metacrilato apresentaram resposta tecidual semelhante à do tubo vazio (controle), após implantação no tecido conjuntivo de camundongos isogênicos.

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.

Orofacial findings and dental treatment in an 8-year-old patient with trisomy 18: a case report.

Trisomy 18 is characterized by: psychomotor disabilities, dysmorphic features, organ malformations, including mental retardation, growth deficiency, poor motor ability, micrognathia, microcephaly, congenital heart defects, and kidney abnormalities. The oral findings typically observed in these patients are: cleft lip and a high, narrow, and sometimes cleft palate. The degree of severity of the malformations is directly related to life expectancy. Only 5% to 10% of affected infants survive beyond the first year of life. Although trisomy 18 has been widely investigated from a medical standpoint, there is a lack of reports addressing the oral manifestations and dental treatment approach in affected children, presumably due to their shortened life expectancy. The purpose of this article was to present the case of an 8-year-old child diagnosed with trisomy 18 and address the clinical features observed--emphasizing the disease-specific oral, craniofacial, and dental findings. Dental care management of the patient is described.

Dental care management of a young patient with extensive lymphangioma of the tongue: a case report.

Lymphangiomas are benign tumors resulting from a congenital malformation of the lymphatic system. Relatively uncommon, lymphangiomas are usually diagnosed at birth and develop within the first years of life. When these tumors occur in the oral cavity, the tongue is the most frequently affected site. Lymphangioma of the tongue is a common cause of macroglossia in children, which may lead to a dry/cracked tongue with ulcerating secondary infections, difficulty in swallowing and mastication, speech disturbances, exclusive nasal breathing, airway obstruction, mandibular prognathism and other possible deformities of maxillofacial structures. This paper discusses the most relevant features, clinical manifestations, disease-related impairments and treatment options for lymphangioma of the tongue. It presents the case report of a five-year-old child diagnosed with this lesion, including a description of the patient's dental care management.

Malformação do tipo "odontoma like" em incisivo central superior decorrente de traumatismo na dentição decídua / Odontoma-like malformation in a permanent maxillary central incisor due to trauma to the primary dentition

No presente trabalho foi descrito o caso de um paciente do sexo feminino, 11 anos de idade, que apresentou, clinicamente, incisivo lateral superior direito hipoplásico, irrompido na posição do incisivo central. Durante a anamnese, a mãe relatou a ocorrência de traumatismo aos 2 anos de idade que levou à avulsão dos incisivos superiores decíduos. Radiograficamente, verificou-se a presença de malformação do tipo "odontoma like" no dente 21. Foi efetuada, então, a cirurgia para a remoção do "odontoma like" e posterior transformação do incisivo lateral hipoplásico em incisivo central por meio da utilização de resina composta. Com base na literatura específica e no caso relatado, pôde-se concluir que, após a avulsão traumática de dentes decíduos, a criança deverá ser submetida a controle clínico e radiográfico periódico, a fim de monitorar possíveis seqüelas ocasionadas nos dentes permanentes sucessores e tornar possível o diagnóstico precoce e a instituição do tratamento na época mais adequada. Para o tratamento das anomalias do tipo "odontoma like" há a necessidade de uma interação multidisciplinar envolvendo a odontopediatria, a cirurgia, a ortodontia e a dentística, entre outras especialidades

Odontoma-like malformation in a permanent maxillary central incisor subsequent to trauma to the incisor predecessor.

This report describes a case of a patient (1 year and 8 months old) with traumatic avulsion of the maxillary right primary central incisor and morphological changes in the germ of the permanent successor. One year after the trauma, an odontoma-like malformation developed. This malformation was removed 6 years after trauma and orthodontic treatment was started. Clinical follow-up and periodic radiographs are necessary after traumatic avulsion of primary teeth to monitor possible sequelae in the permanent successor. An odontoma-like malformation requires a multidisciplinary approach.