Incidencia de fracturas dentales verticales reportadas en la Ciudad de Chihuahua y su relación con la evolución de la pandemia por COVID-19 / Incidence of vertical dental fractures reported in Chihuahua City and its relationship with the evolution of the COVID-19 pandemic

Durante la pandemia por COVID-19, la presencia de un incremento de fracturas y/o fisuras verticales ha sido reportada por Cirujanos Dentistas en diferentes países y foros, Objetivo: Determinar por medio de un análisis si existe una relación con este aumento de casos y la evolu- ción de la pandemia. Material y método: Se recopilaron los casos de fracturas verticales no restaurables durante el periodo de mayor índice de casos de contagio y defunciones por COVID-19 en la Ciudad de Chihuahua, México. Resultados: Durante el primer pico de casos y defunciones causadas por la pandemia, se incrementó el número de casos de fracturas verticales no tratables. Conclusiones: Existió una relación entre la evolución de la pandemia con la aparición de casos de fracturas dentales verticales no restaurables (AU)

During the COVID-19 pandemic, the presence of an increase in fractures and/or vertical fissures has been reported by Dental Surgeons in different countries and forums. Objective: To determine through an analysis, if there is a relationship with this increase in cases and the evolution of the pandemic. Material and methods: The cases of non-restorable vertical fractures were collected during the period of highest rate of cases of contagion and deaths due to COVID-19 in the City of Chihuahua, Mexico. Results: during the 1st peak of cases and deaths caused by the pandemic, the number of cases of untreatable vertical fractures increased. Conclusions: There was a relationship between the evolution of the pandemic and the appearance of cases of non-restorable vertical dental fractures (AU)

Incidencia de fracturas dentales reportadas en la Ciudad de Chihuahua durante la pandemia por COVID-19 / Incidence of dental fractures reported in Chihuahua city during COVID-19 pandemic

Se presentan los casos de fracturas verticales sintomáticos que ameritaron la extracción de las órganos dentales afectados en un periodo de cinco meses durante la pandemia por COVID-19 en la ciudad de Chihuahua, México. Material y métodos: Se recolectaron 26 muestras para el estudio, proporcionadas por los cirujanos dentistas integrantes del Grupo de Egresados de la Facultad de Odontología de la Universidad Autónoma de Chihuahua. Resultados: Los resultados muestran diferencias a lo reportado previamente respecto al tipo de diente involucrado, sexo de los pacientes, restauraciones coronales y tratamientos endodóncicos previos. Conclusiones: Se puede suponer que las modificaciones en el estilo de vida de la población, sumadas a la angustia permanente, pueden ser factores que contribuyen a las fracturas dentales (AU)

There are cases of symptomatic vertical fractures that warranted the extraction of affected teeth are presented, over a period of five months during the COVID-19 pandemic in Chihuahua City, Mexico. Material and methods: 26 samples were collected for the study, provided by the dentist who were members of the Graduate Group of the Faculty of Dentistry of the Autonomous University of Chihuahua. Results: The results show differences from what was previously reported regarding the type of tooth involved, sex of patients, coronal restorations and previous endodontic treatments. Conclusions: It can be assumed that changes in the lifestyle of the population, added to permanent distress, may be factors to preserve dental fractures (AU)

Occlusal fissures in equine cheek teeth: µCT and histological findings.

Fissures on the occlusal surface of equine cheek teeth are commonly encountered during oral examination. Generally, their presence is considered abnormal but their aetiopathogenesis and clinical impact on pulp disease is still undetermined. The aims of this research were to study the extent of occlusal cheek teeth fissures using high-resolution X-ray computed tomography (µCT) imaging and their histological characteristics. Twenty-seven teeth (of 15 horses) were scanned using µCT imaging to analyse fissure extent. Histological examination of a subset of teeth (n=7) was performed. Forty-three type 1 fissures (35 type 1a, eight type 1b) were identified. The mean length of the fissure of type 1a and type 1b on the occlusal surface was 3.47+/-1.60mm and 13.64+/-7.40mm, respectively. Their mean depth was 13.22+/-10.76mm and 7.42+/-6.42mm, respectively. Potential risk factors associated with fissure depth were identified using a multivariable mixed model The location of the fissure and Triadan number were significantly associated with fissure depth. Fissures could be identified on histological sections with the presence of organic material inside the fissure, microorganisms in the continuation of the fissure extending into the dentinal tubules and the presence of reactionary dentine. This study suggests that fissures can provide a pathway for microorganisms to enter the dentinal tubules, potentially resulting in local pulpal inflammation. It appears that in healthy teeth, vital odontoblasts react by producing reactionary (tertiary) dentin, which lacks patent tubules and thus provides a proper seal.

Comparison Of The Adaptability Of Two Fissure Sealants In Various Tooth Fissure Morphology Patterns: An In Vitro Experimental Study.

BACKGROUND: This study was conducted to compare the adaptation of resin-based sealants with that of Resin modified glass ionome-based sealants in various tooth fissure morphologies. METHODS: It was an in vitro experimental study done at the Dow University and NED University, Karachi, Pakistan. Ten extracted human molars were randomly assigned to two groups, (n=5) each. Fissure sealant material (Resin based sealant or resin modified glass ionomer-based sealant) was applied on the occlusal surface of the tooth according to manufacturer's recommendations. Specimens were thermocycled and then sectioned into three longitudinal parts in the bucco- lingual direction. Specimens were examined using scanning electron microscope for the adaptation of the sealant in the occlusal fissure. Mann-Whitney -U test and Kruskall-Wallis test were applied to compare the adaptability scores of sealant materials in the tooth fissure. Level of significance was kept at 0.05. RESULTS: There were no significant differences in the adaptability scores among U-shaped (p-value=0.35), V-shaped (p-value=0.89), IK-shaped (p-value=0.52), I-shaped (p-value- =0.41) and Y-shaped (p-value=1.00) fissure patterns. Similarly, there were no significant differences observed between the resin-based sealant (p-value=0.95) versus RMGIC based sealant (p-value=0.63) for the adaptability scores in various tooth fissure morphologies. CONCLUSIONS: No significant difference was found between resin-based sealants and resin modified glass ionomerbased sealants for the adaptation in various tooth fissure patterns.

Modelling of stress distribution and fracture in dental occlusal fissures.

The aim of this study was to investigate the fracture behaviour of fissural dental enamel under simulated occlusal load in relation to various interacting factors including fissure morphology, cuspal angle and the underlying material properties of enamel. Extended finite element method (XFEM) was adopted here to analyse the fracture load and crack length in tooth models with different cusp angles (ranging from 50° to 70° in 2.5° intervals), fissural morphologies (namely U shape, V shape, IK shape, I shape and Inverted-Y shape) and enamel material properties (constant versus graded). The analysis results showed that fissures with larger curved morphology, such as U shape and IK shape, exhibit higher resistance to fracture under simulated occlusal load irrespective of cusp angle and enamel properties. Increased cusp angle (i.e. lower cusp steepness), also significantly enhanced the fracture resistance of fissural enamel, particularly for the IK and Inverted-Y shape fissures. Overall, the outcomes of this study explain how the interplay of compositional and structural features of enamel in the fissural area contribute to the resistance of the human tooth against masticatory forces. These findings may provide significant indicators for clinicians and technicians in designing/fabricating extra-coronal dental restorations and correcting the cuspal inclinations and contacts during clinical occlusal adjustment.

Perfil epidemiológico de pacientes portadores de fissuras labiopalatinas em serviço de referência no Distrito Federal / Epidemiological profile of patients with cleft lip and palate in a reference service in the Federal District

Introdução: As fissuras labiopalatinas são as malformações congênitas mais comuns dentre as que ocorrem na cabeça e pescoço, e se devem à falha de fusão dos processos faciais embrionários durante as primeiras 12 semanas de gestação. Sua apresentação fenotípica é variada e com diferentes níveis de complexidade. O objetivo é determinar o perfil epidemiológico dos pacientes portadores de fissuras labiopalatinas atendidos no Hospital Regional da Asa Norte (HRAN) quanto a sexo, tipo de fissura, lateralidade, idade, presença de síndromes associadas e procedimentos cirúrgicos corretivos. Métodos: Trata-se de um estudo descritivo retrospectivo no qual foram analisados 322 prontuários de pacientes atendidos pela equipe do HRAN no período de agosto de 2013 a julho de 2017. Os dados colhidos foram lançados em planilha Excel e submetidos à análise estatística. O trabalho foi aprovado pelo Comitê de Ética e Pesquisa. Resultados: Dos 322 pacientes atendidos no serviço, 169 eram do sexo masculino (52,48%). O tipo de fissura mais frequente foi a transforâmica (65,25%). Com relação à lateralidade, observou-se maior predomínio da fissura à esquerda (20,50%). Apenas 19% dos pacientes possuem malformações associadas. A queiloplastia foi a correção cirúrgica mais realizada pelo serviço (54%). A idade dos pacientes variou de 1 ano até 53 anos, com mediana de 1,87 anos. Conclusão: O estudo contribuiu com informações importantes para a sociedade, governo e profissionais envolvidos no tratamento. Em consonância com a literatura, observou-se que a fissura mais prevalente foi a transforâmica unilateral esquerda e a cirurgia mais realizada foi a queiloplastia.

Introduction: Cleft lip and palate, the most common congenital malformations of the head and neck, result from fusion failure of embryonic facial processes during the first 12 weeks of pregnancy. Their phenotypic presentation varies and involves different levels of complexity. The objective is to determine the epidemiological profile of patients with cleft lip and palate treated at the Hospital Regional da Asa Norte regarding sex, cleft type, laterality, age, presence of associated syndromes, and corrective surgical procedures. Methods: This was a retrospective descriptive study of 322 medical records of patients treated by the HRAN team from August 2013 to July 2017. The data collected were entered into an Excel spreadsheet and submitted to statistical analysis. The study received ethical approval. Results: Of the 322 patients enrolled in the service, 169 were male (52.48%). The most frequent type of cleft was the trans-foramen (65.25%). With regard to laterality, a higher prevalence of cleft was observed on the left (20.50%). Only 19% of the patients had associated malformations. Cheiloplasty was the most frequent surgical correction performed by service (54%). The age of the patients was 1­53 years (median, 1.87 years). Conclusion: The study contributes information important to society, government, and treatment professionals. In line with the literature, the more prevalent cleft was unilateral left trans-foramen and the most frequent surgery was cheiloplasty.

WITHDRAWN: Ozone therapy for the treatment of dental caries.

BACKGROUND: Dental caries is a bacterially mediated disease characterised by demineralisation of the tooth surface, which may lead to cavitation, discomfort, pain and eventual tooth loss. Ozone is toxic to certain bacteria in vitro and it has been suggested that delivering ozone into a carious lesion might reduce the number of cariogenic bacteria. This possibly could arrest the progress of the lesion and may, in the presence of fluoride, perhaps allow remineralisation to occur. This may in turn delay or prevent the need for traditional dental conservation by 'drilling and filling'. OBJECTIVES: To assess whether ozone is effective in arresting or reversing the progression of dental caries. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 7 November 2003); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2003, Issue 3); MEDLINE and PREMEDLINE (OVID) (1966 to November 2003); EMBASE (OVID) (1980 to November 2003); CINAHL (OVID) (1982 to November 2003); AMED (OVID) (1985 to November 2003). Quintessence was handsearched through 2002 and KaVo were contacted as manufacturers of the HealOzone apparatus for any additional published or unpublished trials. SELECTION CRITERIA: Inclusion was assessed independently by at least two reviewers. Trials were only included if they met the following criteria: randomisation in a controlled trial; single surface in vivo carious lesion accessible to ozone application; clear allocation concealment; ozone application to the lesions in the intervention group; no such application of ozone in the control group; outcomes measured after at least 6 months. DATA COLLECTION AND ANALYSIS: Reviewers independently extracted information in duplicate. A paucity of comparable data did not allow meta-analytic pooling of the included studies. MAIN RESULTS: Three trials were included, with a combined total of 432 randomised lesions (137 participants). Forty-two conference papers, abstracts and posters were excluded (from an unknown number of studies). The risk of bias in all studies appeared high. The analyses of all three studies were conducted at the level of the lesion, which is not independent of the person, for this reason pooling of data was not appropriate or attempted. Individual studies showed inconsistent effects of ozone on caries, across different measures of caries progression or regression. Few secondary outcomes were reported, but one trial reported an absence of adverse events. AUTHORS' CONCLUSIONS: Given the high risk of bias in the available studies and lack of consistency between different outcome measures, there is no reliable evidence that application of ozone gas to the surface of decayed teeth stops or reverses the decay process. There is a fundamental need for more evidence of appropriate rigour and quality before the use of ozone can be accepted into mainstream primary dental care or can be considered a viable alternative to current methods for the management and treatment of dental caries.

Diagnosis of Pit-and-fissure Caries Using Three-dimensional Scanned Images.

Diagnosis of the extent of pit-and-fissure caries has been subjective and thus difficult to teach and categorize for treatment planning. This in vitro study compares occlusal caries diagnosis of extracted posterior teeth (n=49) using three-dimensional (3D) scanned images vs visual examination, according to the International Caries Detection and Assessment System (ICDAS). The surfaces chosen for study represent all ICDAS classifications. Five experienced restorative faculty members examined scanned images for 60 seconds from a standardized series of views of each surface and scored them independently. One month later, the same teeth were examined visually by the same five raters with magnification and LED headlamps, with compressed air available. Intrarater and interrater agreement and validity were assessed using intraclass correlation coefficients (ICCs). The ICCs, ranging from 0.90 to 0.93, indicated excellent agreement between and within raters and between the raters and the gold standard ICDAS determination. This suggests that both photographs and 3D scans of pits and fissures are equally effective in diagnosing caries.

Equine cheek teeth occlusal fissures: Prevalence, association with dental wear abnormalities and occlusal angles.

BACKGROUND: Fissures of the occlusal surface of equine cheek teeth are commonly encountered during oral examination but their aetiology is unknown. OBJECTIVES: To examine the prevalence and characteristics of occlusal fissures in cadaver teeth. It is hypothesised that their prevalence is influenced by masticatory forces. Consequently, their possible association with wear disorders and occlusal angles were examined. STUDY DESIGN: Cross-sectional survey. METHODS: The dental abnormalities and occlusal fissure findings in the cheek teeth of 143 cadaver heads were recorded. The cheek teeth occlusal angles were measured using the stiff-hinge technique. Multiple regression analyses were performed to establish possible relationships between age, sex, dental wear, occlusal angle and fissure prevalence. RESULTS: Occlusal fissures were found in 103/143 (72%) heads. Sex and age were determining factors in the prevalence of fissures. A similar prevalence was found in mandibular (54.1%) and maxillary teeth (45.9%, OR = 1.10; 95% CI = 0.95-1.29, P = 0.2). Mandibular fissures were more commonly located on the buccal aspect (OR = 1.42; 95% CI = 1.16-1.65, P < 0.001), whereas for maxillary fissures there was no difference in prevalence between palatal and buccal aspects (OR = 1.19; 95% CI = 0.97-1.46, P = 0.1). Two main fissure types were identified. Type 1a fissures were the most prevalent type (39.5%). No significant correlation was found between the presence of wear abnormalities or the occlusal angle of cheek teeth, and the prevalence of fissures. MAIN LIMITATIONS: No dental histories were available. CONCLUSION: Equine cheek teeth show a high prevalence of occlusal fissures. Despite some evidence of predilection sites on the tooth surface that might indicate a mechanical aetiology for these lesions, no associations were found with wear abnormalities or occlusal angles of affected cheek teeth. Further histological and ultrastructural studies are warranted to elucidate their aetiology and possible role in other dental diseases.

Caries detection and quantification around stained pits and fissures in occlusal tooth surfaces with fluorescence.

Occlusal discoloration due to staining frequently occurs on the pits and fissures of teeth. Noncariogenic discoloration (non-CD) refers to the attachment of staining chromogens to sound surfaces, whereas cariogenic discoloration (CD) represents the discoloration of porous structures due to bacterial metabolites and mineral loss from the enamel surface. This study evaluated whether it is possible to distinguish between non-CD and CD on stained occlusal surfaces with fluorescence assessed by the quantitative light-induced fluorescence (QLF) technology. Sixty-two extracted human permanent teeth with suspected discolorations on the pit and fissure were examined. The maximum values of fluorescence loss (ΔFmax) and red fluorescence gain (ΔRmax) were calculated using QLF images. Using histology as the gold standard, it was found that 12 teeth were sound (non-CD), while 50 teeth had enamel and dentine caries (CD). The validity tests at the enamel histological caries level, ΔRmax (ρ = 0.80) were strongly correlated with the histology (P < 0.001). At the optimum threshold (105.0) of ΔRmax, it showed high levels of sensitivity and specificity (0.96 and 0.83, respectively). Therefore, QLF can be used to distinguish non-CD from CD on occlusal surfaces using red fluorescence values with high validity.

Assessment of monomer release from 3 different fissure sealants.

BACKGROUND: Light-activated resin-based dental fissure sealants are the most widely accepted among clinicians. The objective of this study was to determine monomer release of 3 different light-curing fissure sealants in vitro: Control Seal (Voco, Germany), Fissurit FX (Voco, Germany) and R&D Series Fissured Nova (Imicrly, Turkey). METHODS: Each material was polymerized with a curing light: Valo Cordless (Ultradent) LED in standard mode for 20 seconds (n = 27) and 40 seconds (n = 27) and in Xtra power mode (plasma arc) for 3 seconds (n = 27). High-performance liquid chromatography (HPLC) was used to measure the amount of monomers released over 1, 3 and 7 days. RESULTS: Plasma arc groups showed the highest release of monomers at 1, 3 and 7 days in the 3 fissure sealant groups (p<0.001). The greatest release of bisphenol A glycidyl methacrylate (bis-GMA) determined for R&D Series Fissured Nova both with LED 20 seconds and LED 40 seconds and for Control Seal was with the plasma arc. With time, release of the monomer was reduced for all polymerization systems. CONCLUSIONS: Efficiency of the polymerization system and applying the recommended curing time for light-activated resin-based dental materials are very important to protect the patient from potential hazards of residual monomers.

Aspects épidemiologiques des anomalies dentaires chez les enfants porteurs de syndrome de down au CNHU-HKM de Cotonou

Le syndrome de Down expose à plusieurs anomalies dont des problèmes dentaires. Ces problèmes dentaires très fréquents sont très peu étudiés chez les enfants porteurs de syndrome de Down suivis au CNHU. C'est pour combler ce vide que cette étude a été initiée. Elle avait pour objectif d'étudier les anomalies dentaires chez les enfants porteurs de syndrome de Down en Pédiatrie au CNHU de Cotonou. Méthode : Il s'agissait d'une étude prospective, descriptive et analytique conduite sur des enfants reçus en consultation de génétique médicale sur la période de janvier à septembre 2017. Chaque enfant bénéficiait d'un examen clinique avec ou sans réalisation de la panoramique dentaire. Les données collectées étaient sociodémographiques, cliniques et paracliniques. Résultats : Au total, 38 enfants porteurs de syndrome de Down ont été inclus. L'hygiène buccodentaire était mauvaise chez 60,5% des enfants et était caractérisée par la présence de tartre et d'enduits sur les dents. Les enfants avaient une gencive saine dans 84,2% des cas. Une carie était observée chez 18,4% des enfants. Conclusion : Les anomalies dentaires sont fréquentes chez les enfants porteurs de syndrome de Down suivis en pédiatrie au CNHU de Cotonou. Un dépistage systématique de ces anomalies dentaires devra être mis en place pour une prise en charge globale de ces enfants

Resin infiltration of deproteinised natural occlusal subsurface lesions improves initial quality of fissure sealing.

The aim of this ex vivo study was to evaluate the infiltration capability and rate of microleakage of a low-viscous resin infiltrant combined with a flowable composite resin (RI/CR) when used with deproteinised and etched occlusal subsurface lesions (International Caries Detection and Assessment System code 2). This combined treatment procedure was compared with the exclusive use of flowable composite resin (CR) for fissure sealing. Twenty premolars and 20 molars revealing non-cavitated occlusal carious lesions were randomly divided into two groups and were meticulously cleaned and deproteinised using NaOCl (2%). After etching with HCl (15%), 10 premolar and 10 molar lesions were infiltrated (Icon/DMG; rhodamine B isothiocyanate (RITC)-labelled) followed by fissure sealing (G-ænial Flo/GC; experimental group, RI/CR). In the control group (CR), the carious fissures were only sealed. Specimens were cut perpendicular to the occlusal surface and through the area of the highest demineralisation (DIAGNOdent pen, KaVo). Using confocal laser-scanning microscopy, the specimens were assessed with regard to the percentage of caries infiltration, marginal adaption and internal integrity. Within the CR group, the carious lesions were not infiltrated. Both premolar (57.9%±23.1%) and molar lesions (35.3%±22.1%) of the RI/CR group were uniformly infiltrated to a substantial extent, albeit with significant differences (P=0.034). Moreover, microleakage (n=1) and the occurrence of voids (n=2) were reduced in the RI/CR group compared with the CR group (5 and 17 specimens, respectively). The RI/CR approach increases the initial quality of fissure sealing and is recommended for the clinical control of occlusal caries.

[The influence of teeth morphology on bioelectrical activity of masticatory muscles]. / Vliianie morfologii zubov na bioélektricheskuiu aktivnost' zhevatel'nykh myshts.

The aim of the study was to reveal correlation of dental morphology and bioelectric activity of masticatory muscles. The study included 76 young adults (47.4% females and 52.6% males) divided in 3 groups according to dental morphology features: intact teeth (26 patients), dental decay in fissures with intact cusps (25 patients), pronounced dental decay with varying degree of crown destruction (25 patients). Electromyography (EMG) was used to document the bioelectric activity (BEA) of temporal and masticatory muscles. The study showed high level of correlation of destructive teeth changes with BEA of masticatory muscles. Intragroup correlation proved direct link of BEA to the number of decayed teeth. EMG activity differed significantly between groups 2 and 3. There was no statistically significant difference between groups 3 and 1 mostly because of high variability of BEA in group 3. Relative activity of temporal and masticatory muscles increased in groups 2 and 3 by 2 and 4% and 38 and 19%, correspondingly. There was no significant impact of gender or emotional status on masticatory muscles BEA.

Acciones Terapéuticas Actuales en Caries Profunda. Revisión / Current therapeutic options for treating Deep Carious lesions: a review

Esta revisión analiza el manejo de caries dentinaria profunda, considerando los eventos histiofisiológicos y biomoleculares del complejo dentino pulpar en dientes permanentes. Se destacan recursos clínicos para evaluar el grado de progresión de la lesión y guiar la remoción de caries. Se describen la Protección Pulpar Indirecta, la Técnica de eliminación de caries en etapas y la Remoción parcial de caries presentando casos clínicos realizados en Clínica Integrada II de la Facultad de Odontología Universidad de la República (Uruguay), con sus seguimientos. Estos tratamientos sencillos y de bajo costo, al alcance de todos los clínicos, disminuyen significativamente las exposiciones pulpares. El éxito de estas acciones terapéuticas depende de una adecuada selección del caso, de la integridad de la restauración y del seguimiento dentro de un plan preventivo integral.

This review analyzes how to treat deep carious lesions taking into consideration histophysiologic and biomolecular events of the dentin-pulp complex in permanent teeth. We focus on clinical resources to assess the degree of lesion progression and to guide the removal of carious lesions. Indirect pulp treatment, Stepwise excavation and Partial caries removal are described by presenting clinical cases, and their follow-ups, led by students of Integrated Clinic II of the School of Dentistry, Universidad de la República- Uruguay. These simple and inexpensive treatments are available to all clinicians and significantly decrease the number of pulp exposures. The success of these therapeutic options depends on the proper selection of cases and on the integrity of the restoration within a comprehensive preventive plan.

Expansión rápida palatina con asistencia quirúrgica en paciente adulto con secuelas de labio y paladar fisurado / Rapid expansion palatina surgical assistance in cleft lip and palate patient

La fisura labio palatina es una malformación congénita que afecta al paciente y a su familia de muchas maneras, por lo que se requiere la intervención multidisciplinaria de diversas áreas de la salud. Esta condición causa problemas estéticos, fonéticos, auditivos, maloclusiones, anomalías y ausencias dentarias, colapso trasversal del maxilar y compromisos afectivos. Las deficiencias transversales son comunes en este tipo de pacientes (1). La expansión maxilar es necesaria en el tratamiento de estos pacientes (2) (3). La combinación ortodóntica-quirúrgica nos ayuda para expandir el maxilar en adultos. El proceso consiste en el corte de la sutura palatina media, seguida de la aplicación de un tornillo hyrax para conseguir la expansión (4).

The cleft lip is a congenital malformation that affects the patient and his family in many ways, so that multidisciplinary intervention in various areas of health is required. This malformation causes besides physical problems and cosmetics, phonics, hearing problems, malocclusions, anomalies and missing teeth, maxillary transverse collapse, emotional and psychological problems. Maxillary expansion often necessary to treat these patients. Orthodontic-surgical combination helps us to expand the maxilla in adults. The process involves cutting the mid palatal suture followed by application of a Hyrax screw to achieve expansion. The separation of the suture is confirmed with an oclusal radiograph and the presence of a diastema between the maxillary central incisors.

External and internal resin infiltration of natural proximal subsurface caries lesions: A valuable enhancement of the internal tunnel restoration.

OBJECTIVE: The aim of this ex-vivo study was to evaluate both the external and the internal penetration ability of a resin infiltrant into natural proximal and macroscopically intact white spot lesions, and to merge this approach with the internal tunnel preparation concept. METHOD AND MATERIALS: 20 premolars and 20 molars with proximal subsurface lesions (ICDAS, code 2) and respective radiographic lesion depths extending into the middle third of dentin (D2 lesions) were selected and divided into two groups. Treatment needs were confirmed using digital imaging fiber-optic transillumination and laser fluorescence. Deproteinization (NaOCl; 2%) followed, and lesions of Group 1 (control; n = 20) were etched (HCl; 15%) and externally infiltrated (Icon). Accordingly, the specimens of Group 2 (n = 20) were treated with the resin infiltrant from external; then, internal Class I tunnels were prepared, lesions were internally infiltrated (Icon), and the occlusal cavities were restored (G-ænial Flo X) after etching (H3PO4 gel; 40%). Teeth were cut perpendicular to the proximal lesion surfaces, and percentage infiltrations were analyzed using confocal laser microscopy and a dedicated image manipulation program (GIMP). RESULTS: Regarding the external infiltration, no differences between both groups were detected (P = .114; Mann-Whitney). Additional internal application of the resin infiltrant significantly increased the percentage amount of enamel lesion infiltration (P < .0001; Wilcoxon). CONCLUSION: External and internal infiltration seem to complement the internal tunnel approach, thus remediating the drawbacks of the latter by occluding and stabilizing the porous areas of the proximal caries lesion, and preserving both the marginal ridge and the proximal contact area.

Near-IR and CP-OCT imaging of suspected occlusal caries lesions.

INTRODUCTION: Radiographic methods have poor sensitivity for occlusal lesions and by the time the lesions are radiolucent they have typically progressed deep into the dentin. New more sensitive imaging methods are needed to detect occlusal lesions. In this study, cross-polarization optical coherence tomography (CP-OCT) and near-IR imaging were used to image questionable occlusal lesions (QOC's) that were not visible on radiographs but had been scheduled for restoration on 30 test subjects. METHODS: Near-IR reflectance and transillumination probes incorporating a high definition InGaAs camera and near-IR broadband light sources were used to acquire images of the lesions before restoration. The reflectance probe utilized cross-polarization and operated at wavelengths from 1,500 to 1,700 nm where there is an increase in water absorption for higher contrast. The transillumination probe was operated at 1,300 nm where the transparency of enamel is highest. Tomographic images (6 × 6 × 7 mm3 ) of the lesions were acquired using a high-speed swept-source CP-OCT system operating at 1,300 nm before and after removal of the suspected lesion. RESULTS: Near-IR reflectance imaging at 1,500-1,700 nm yielded significantly higher contrast (P < 0.05) of the demineralization in the occlusal grooves compared with visible reflectance imaging. Stains in the occlusal grooves greatly reduced the lesion contrast in the visible range yielding negative values. Only half of the 26 lesions analyzed showed the characteristic surface demineralization and increased reflectivity below the dentinal-enamel junction (DEJ) in 3D OCT images indicative of penetration of the lesion into the dentin. CONCLUSION: This study demonstrates that near-IR imaging methods have great potential for improving the early diagnosis of occlusal lesions. Lasers Surg. Med. 49:215-224, 2017. © 2017 Wiley Periodicals, Inc.