Comparative evaluation of esthetic changes in nonpitted fluorosis stains when treated with resin infiltration, in-office bleaching, and combination therapies.

OBJECTIVES: Dental fluorosis leads to esthetic deviation and varies from nonpitted white opacities, dark brown stains to pitting or structural breakdown of enamel surface. Treatment for fluorosis depends on the severity of condition and includes both noninvasive methods and invasive methods. Recently resin infiltration has been proposed as an alternative treatment for nonpitted fluorosis. This study was done to evaluate the esthetic changes in nonpitted fluorosis stains when treated with resin infiltration, in-office bleaching and combination therapies. MATERIALS AND METHODS: The present study is a randomized, single blinded controlled trial with four parallel arms with 1:1 allocation ratio. The intervention arms included bleaching with 35% hydrogen peroxide, resin infiltration, resin infiltration with increased infiltration time and a combination approach of bleaching and infiltration. Immediate esthetic changes were evaluated for two parameters including, 'Change in esthetics' and 'Improvement in opacities/stains' using a VAS scale by two independent observers. Kruskal-Wallis test and Mann-Whitney U-test were done for intergroup comparisons. RESULTS: Best results for both the parameters were observed among patients treated with resin infiltration with increased infiltration time. Mann-Whitney U test revealed significantly better results for resin infiltration groups (alone or combination with bleaching) as compared to bleaching alone (P < .001). CONCLUSIONS: Resin infiltration procedure with tailored etching times and increased infiltration time exhibited best results in terms of change in esthetics and improvement in stains. CLINICAL SIGNIFICANCE: White and brown opacities due to fluorosis have always been a concern for esthetics. In our study, resin infiltration technique with tailored etching times and increased infiltration time exhibited best immediate esthetic improvement for nonpitted fluorotic opacities and stains. These esthetic outcomes reaffirm the applicability of RI technique for nonpitted fluorosis, which was originally advocated only for white spot lesions due to early caries. This will in turn help the dentists to plan the esthetic management of nonpitted fluorosis in a micro-invasive manner.

Effect of ethanol wet bonding technique on the durability of resin- dentin bond with contemporary adhesive systems.

OBJECTIVE: To evaluate the effect of ethanol wet bonding technique on the immediate and long term bond strength of simplified etch and rinse adhesive systems to dentin. STUDY DESIGN: 96 extracted human permanent molars were ground to expose the flat dentin surface. The teeth were divided into four groups (n=24) according to the adhesives used, either Tetric N Bond or Solobond M and bonding techniques i.e. water wet bonding or ethanol wet bonding (EWB). Composite cylinder was bonded to each specimen using the respective adhesive technique. Ten samples from each group were then tested immediately for shear bond strength evaluation and two samples for SEM analysis. The remaining samples (12) were tested after 6 month storage in distilled water. RESULTS: Upon immediate testing, there was no significant difference in the mean shear bond strength of the groups regardless of the bonding technique or adhesive used. The bond strength fell dramatically in the water wet bonded specimens after 6 months water storage, while the bond strength of both the adhesives was maintained when EWB technique was used. SEM observation revealed good interfacial adaptation in EWB groups even after six months. CONCLUSION: For both simplified etch and rinse adhesives used, ethanol wet bonding technique led to significant preservation of the resin dentin bond over 6 months.

Clinical efficacy of various root canal obturating methods in primary teeth: a comparative study.

AIM: The purpose of this in vivo study was to evaluate and compare the efficacy of different obturating methods used in primary teeth, when obturated using a combination of zinc oxide and iodoform paste (Endoflas F.S.). MATERIALS AND METHODS: A group of 29 patients aged 3-9 years and a total of 64 teeth were selected. These 64 teeth (32 anterior teeth=32 canals, and 32 posterior teeth=80 canals) were randomly divided into 4 groups. Teeth were obturated with Lentulo spiral, pressure syringe, bi-directional spiral and Pastinject. Post-operative evaluation was done for: quality of canal obturation, (underfilled, optimally filled, overfilled) and presence of voids. RESULTS: Pastinject exhibited the highest number of optimally filled canals, while the highest number of underfilled canals were observed with bi-directional spiral, and the highest number of overfilled canals were observed with pressure syringe. A minimum number of voids was present in canals filled with the Pastinject technique and pressure syringe. CONCLUSION: These results suggest that Pastinject was the most effective technique for obturation of primary teeth.

Effect of proanthocyanidin treatment on the bonding effectiveness of adhesive restorations in pulp chamber.

OBJECTIVE: To analyze the effect of proanthocyanidin (PA) treatment of the pulp chamber dentin after NaOCl and EDTA irrigation on the microleakage and interfacial morphology of adhesive restorations. STUDY DESIGN: Pulp chambers of 66 extracted permanent molars were exposed. In half of the samples, pulp chamber dentin was bonded with Clearfil S3 after irrigation with normal saline (Group1a); 1% NaOCl and 17% EDTA (Group1b) or 1% NaOCl, 17% EDTA and 30% PA (Group1c) and in other half samples, pulp chamber dentin was bonded with Futurabond NR after irrigation with normal saline (Group 2a); 1% NaOCl and 17% EDTA (Group 2b) or 1% NaOCl, 17% EDTA and 30% PA (Group 2c). After adhesive procedures, Filtek Z 250 restorations were placed in the pulp chambers. Microleakage assessment was done in ten samples from each group and scanning electron microscopic examination was done in one sample from each group. Statistical analysis was done using Mann-Whitney and Kruskal Wallis tests at a significance level of P<0.05. RESULTS: Both the adhesives showed extensive microleakage. NaOCl and EDTA irrigation had no significant effect on the microleakage of both the adhesives. PA treatment of the pulp chamber dentin after NaOCl and EDTA irrigation significantly reduced microleakage in both the adhesives. CONCLUSION: It was concluded that 1 minute application of 30% proanthocyanidin solution in the pulp chamber after NaOCl and EDTA irrigation improved the subsequent bonding of self-etch adhesives to pulp chamber dentin.

Dental adhesion: mechanism, techniques and durability.

Contemporary dental adhesives show favorable immediate results in terms of bonding effectiveness. However, the durability of resin-dentin bonds is their major problem. It appears that simplification of adhesive techniques is rather detrimental to the long-term stability of resin-tooth interface. The hydrostatic pulpal pressure, the dentinal fluid flow and the increased dentinal wetness in vital dentin can affect the intimate interaction of certain dentin adhesives with dentinal tissue. Bond degradation occurs via water sorption, hydrolysis of ester linkages of methacrylate resins, and activation of endogenous dentin matrix metalloproteinases. The three-step etch-and-rinse adhesives still remain the gold standard in terms of durability. This review discusses the fundamental process of adhesion to enamel and dentin with different adhesive techniques, factors affecting the long-term bonding performance of modern adhesives and addresses the current perspectives for improving bond durability.

Comparative evaluation of shear bond strength of various esthetic restorative materials to dentin: an in vitro study.

AIM: To comparatively evaluate the shear bond strength of recent tooth-colored restorative materials to dentin. MATERIALS AND METHODS: Flat dentinal surface were prepared from 60 caries free, extracted human permanent molars and were mounted in acrylic rings. These were randomly divided into four groups - Group A to Group D, according to the restorative material used i.e. Glass ionomer cement (Fuji IX), Giomer (Beautifil), an Ormocer-based composite (Admira) and Nano Ceramic restorative material (Ceram X). These restorative materials were applied on dentinal surface of all the specimens using nylon cylinders. The mounted samples were stored in distilled water for 24 hours and thermocycled. They were then subjected to shear bond strength test using universal testing machine. Data was analyzed using a one-way analysis of variance (ANOVA) and student's 't'-test. RESULTS: Ceram X (16.63 ± 0.94 MPa) and Admira (17.31 ± 0.95 MPa) were comparable in their bond strength values, but depicted significantly higher bond strength when compared to Beautifil (12.39 ± 1.05 MPa) and Fuji IX (7.76 ± 1.07 MPa). CONCLUSION: Nano-ceramic and ormocer-based restorative materials showed better bonding potential to dentin as compared to GIC and Giomer.

An evaluation of different caries removal techniques in primary teeth: a comparitive clinical study.

OBJECTIVE: To compare the efficacy of caries removal, time taken and to evaluate the pain threshold experienced by the patient during various caries removal methods. STUDY DESIGN: Eighty patients between the age groups of 5-9 years were selected and caries removal was done by hand instruments, airotor, carisolv and papacarie. The efficacy, time taken and the pain threshold was evaluated during the caries removal by Ericson D et al scale, visual analogue scale respectively. RESULTS: Highly significant relation (< 0.05) was observed when intergroup comparison was made using one way analysis of variance (ANOVA). CONCLUSION: It was concluded that chemomechanical removal of caries with Papacarie and Carisolv were found to be effective measures of caries removal and could be considered as viable alternatives to painful procedures like Airotor in management of dental caries especially in children.

Technique-sensitivity of dentin-bonding agent application: the effect on shear bond strength using one-step self-etch adhesive in primary molars: an in vitro study.

AIM: The present study was undertaken to compare and evaluate the effect of technique-sensitivity on shear bond strength (SBS) of one-step self-etch adhesive, using multiple coats and different applicator designs, to dentin in deciduous molars. MATERIALS AND METHODS: Flat buccal dentinal surfaces were obtained on 60 extracted human primary molars. The specimens were divided into 3 equal groups (n = 20). Self-etch adhesive was applied on the dentinal surface of group I with cotton pellet, group II with microapplicator tip, and group III using 3M brush. The groups were further divided into 2 subgroups-single coat of dentin-bonding agent (DBA) in subgroups A and triple coat (with no curing in between coats) in subgroups B. The composite was placed on the dentinal surface using split nylon cylinder and cured. SBS was tested for all specimens with Instron Universal testing machine. Data were statistically analyzed using one-way analysis of variance and Student's t test. RESULTS: There was no statistically significant difference in the main study groups, that is, no significant difference in the SBS with the use of different applicator tips. However, the use of triple coat of self-etch DBA exhibited highly significant difference in the SBS as compared with single coat. CONCLUSION: This study revealed that one-step self-etch adhesive could prove attractive in pediatric dentistry because of its lesser technique-sensitivity; however, increasing the number of coats of DBA (with no curing in between the layers) enhanced the bond strength to dentin owing to the improved resin infiltration.

Comparative evaluation of 2% sodium fluoride iontophoresis and other cavity liners beneath silver amalgam restorations.

BACKGROUND: This study was designed to compare 2% sodium fluoride (NaF) iontophoresis with other cavity liners. MATERIALS AND METHODS: This study was carried out in 30 patients in the age group 10-14 years with bilateral carious permanent first molars. The study evaluated the use of 2% NaF iontophoresis as a cavity liner and also compared its desensitizing effect with varnish and an adhesive bonded liner. Sensitivity gradings were done on a subjective verbal rating scale. RESULTS: All the liner treatments decreased the sensitivity following liner application. However, decrease of sensitivity in the case of 2% NaF iontophoresis was more compared with that of varnish and adhesive bonded liner. The results were statistically significant. CONCLUSIONS: It was found that 2% NaF iontophoresis was more effective in reducing the postoperative sensitivity compared with that of varnish and scotchbond multipurpose.

Dental pulp neuropathophysiology.

Mechanisms of pulpal pathophysiology are complex and the low compliance environment in which the dental pulp is allocated, further enhances the complexity of this process. Although it is known that it involves the interaction of the immune cells, pulpal cells, cytokines, chemokines and multiple neuropeptides but still there are many gaps in our current knowledge. The understanding of the biochemical and molecular pathways involved in the pulpal inflammation is important so that it can be used clinically to keep the dental pulp vital and healthy. It may thus provide an opportunity to develop potentially new treatment modalities for the inflamed dental pulp in future.

Why the carioprotective potential of luting cements crucial?

Space maintainers make good oral hygiene difficult, modify the oral environment, and increase the chances of enamel demineralization. Demineralization can be prevented or reduced by improving patient oral hygiene or by using topical fluorides. However these methods depend on patient compliance and, therefore, are not very reliable. Thus, caries prevention in banding might be enhanced by using fluoride-releasing cements. The aim of the study was to comparatively evaluate the carioprotective potential of various luting media used for band cementation in permanent as well as deciduous molars. In this study, 100 molars were taken, which were banded and stored in artificial saliva for 1 month after which the teeth were debanded. An area of 2 x 2 mm was spared and the teeth were coated with nail varnish. The coated teeth were dipped in artificial caries solution in one month followed by 1-day immersion in methylene blue dye, after which the samples were sectioned through the window. The depth of dye penetration was measured and the results were statistically analyzed. Minimum dye penetration was observed with glass ionomer, which could be due to the fluoride release from the cement, whereas the control group showed the maximum, probably due to direct contact with the artificial caries solution.

Modified Willet's appliance for bilateral loss of multiple deciduous molars: a case report.

No other factor plays a more significant role in preventive and interceptive dentistry than the preservation of deciduous dentition till its normal time of exfoliation. Premature loss of a deciduous tooth or a group of teeth might lead to wide range of implications. When the deciduous second molar is lost before the eruption of first permanent molar, intra-alveolar type of space maintainer is indicated. But in cases of bilateral loss of these teeth the conventional design generally poses a variety of problems. Thus, the conventional designs are required to be modified according to the needs of the patient. Therefore, this paper describes an entirely new design of the Willet's appliance in cases of bilateral loss of deciduous molars before the eruption of first permanent molar.

Various methods of caries removal in children: a comparative clinical study.

An in vivo study comparing the different methods of caries removal was done in children of age group 6-9 years. Among these patients a total number of 150 carious deciduous teeth were selected. Caries removal was done by hand instruments, airotor and carisolv. The efficacy, time taken and pain experienced by the patient during caries removal was evaluated. The results showed that airotor was the most efficient method (mean value 0.38), while carisolv was the least painful (mean value 0.080) and the most time consuming method (534.8 seconds).

A comparative evaluation of the fracture strength of pulpotomized primary molars restored with various restorative materials.

Sixty extracted primary molars were used in the study. After pulpotomy, these were divided into four groups on the basis of restorative materials to be used. Results showed that the Ormocer had the maximum fracture strength while the posterior Glass Ionomer Cement showed the least fracture strength among the various restorative materials used in the study.

Esthetic Rehabilitation of Primary Anterior Teeth using Temporization Material: A Novel Approach.

Pediatric dentists should always aim for esthetic and functional rehabilitation of decayed/traumatized primary teeth. The most common method for restoring such teeth involves the use of "strip crowns" with composites, while the recent trend is toward using other extracoronal restorations including preve-neered stainless steel crowns and zirconia crowns. All these restorative options have shown good success rates, but also have some limitations. This case series depicts novel clinical technique of using a temporization material for full-coronal restoration(s) in primary anterior teeth. This included the chair-side custom fabrication of full-coronal restoration using temporization material, which has resulted in good immediate esthetics and might be a cost-effective alternative for restoring primary anterior teeth in future. HOW TO CITE THIS ARTICLE: Gugnani N, Pandit IK, Gupta M, Nagpal J. Esthetic Rehabilitation of Primary Anterior Teeth using Temporization Material: A Novel Approach. Int J Clin Pediatr Dent 2017;10(1):111-114.

Ectopic eruption of maxillary central incisor through abnormally thickened labial frenum: An unusual presentation.

Ectopic eruption is a deviation from the normal eruption pattern, making the tooth erupt out of its normal position, and possibly causing resorption of adjacent primary teeth. A wide range of etiological factors may be responsible for ectopic eruption of the teeth, so their management depends on the correction of the established etiological factor. The present case report describes an unusual case of ectopically erupted central incisor encased within an abnormally thickened labial frenum, which was treated by orthodontic repositioning of the ectopically erupting tooth after frenectomy.

Clinical and radiographic comparison of various medicaments used for pulpotomy in primary molars: A randomized clinical trial.

OBJECTIVE: To evaluate and compare the efficacy of ferric sulfate, glutaraldehyde, and mineral trioxide aggregate (MTA) as pulpotomy medicaments in primary molars. MATERIALS AND METHODS: This was a perspective randomized clinical trial. A total of 90 molars from 42 children aged 4-8 years were selected for pulpotomy procedure. Teeth were randomly divided into three equal groups of 30 teeth each. Teeth in Group I were intended to be treated with ferric sulfate, Group II were intended to be treated with buffered glutaraldehyde and Group III with MTA. All the molars were evaluated clinically at 24 h and both clinically and radio graphically at 1, 3, and 6 months. The observations were statistically analyzed using Chi-square test and Fisher's exact test. RESULTS: After 1 month, there was no clinical finding observed in all the three groups. At 3 months postoperative evaluation, 13.3% of teeth in Group I and 12.5% of teeth in Group II had mobility. At 6 months interval, pain and sinus formation each was noted in 9.1% of primary teeth in Group I while periodontal ligament widening was reported in 66.7% of teeth in Group I and 85.7% of teeth in Group II. CONCLUSION: MTA exhibited overall best results as pulpotomy agent for primary molars followed by 15.5% ferric sulfate, whereas 2% buffered glutaraldehyde was found to be least effective as a pulpotomy agent.

Non-specific inflammatory gingival enlargement--a case report.

An unusual case of unilateral idiopathic gingival hyperplasia in a 6 year old child is reported and its management discussed.

Genetic engineering and dental caries.

Dental caries, a multifactorial disease requires four principle factor: the host, the microflora, the substrate & time for its occurrence and can be prevented or managed by elimination/modification of either of the above factors. The conventional preventive measure being followed for long time for the dental caries are not successful to the desirable extent due to their non avaibailaballity in the rural areas, lack of awareness & inaccessibility of dental services. Therefore, the focus has now been shifted to submicroscopic level to ensure that these measures can be reached to the farthest areas & each & every member of the population is benefitted. Few of the measures taken are. i) Genetically modifying the S. Mutans: ii) Searching The antagonist peptides to work against the specific enzyme system (Glucosyltransferase) of S. Mutans. iii) Changing the oral environment by those Genetically modified organisms that will produce bases (instead of acids) & these bases provides a milieu favoring remineralization. This paper discusses various ways in which genetically modified strains of microogranisms or genetically modified strains of microogranisms of genetically modified foods can help in the prevention of caries.

Stem cell research: applicability in dentistry.

In the face of extraordinary advances in the prevention, diagnosis, and treatment of human diseases, the inability of most tissues and organs to repair and regenerate after damage is a problem that needs to be solved. Stem cell research is being pursued in the hope of achieving major medical breakthroughs. Scientists are striving to create therapies that rebuild or replace damaged cells with tissues grown from stem cells that will offer hope to people suffering from various ailments. Regeneration of damaged periodontal tissue, bone, pulp, and dentin is a problem that dentists face today. Stem cells present in dental pulp, periodontal ligament, and alveolar bone marrow have the potential to repair and regenerate teeth and periodontal structures. These stem cells can be harvested from dental pulp, periodontal ligament, and/or alveolar bone marrow; expanded; embedded in an appropriate scaffold; and transplanted back into a defect to regenerate bone and tooth structures. These cells have the potential to regenerate dentin, periodontal ligament, and cementum and can also be used to restore bone defects. The kind of scaffold, the source of cells, the type of in vitro culturing, and the type of surgical procedure to be used all require careful consideration. The endeavor is clearly multidisciplinary in nature, and the practicing dental surgeon has a critical role in it. Playing this role in the most effective way requires awareness of the huge potential associated with the use of stem cells in a clinical setting, as well as a proper understanding of the related problems.