A randomized clinical trial on the use of medical Portland cement, MTA and calcium hydroxide in indirect pulp treatment.

OBJECTIVES: Studies on indirect pulp treatment (IPT) show varying success rates of 73 to 97 %. The necessity of re-opening the cavity and the question of the optimal capping material is still under debate. The aim of this prospective in vivo study was to compare the clinical and microbiological outcomes of mineral trioxide aggregate (MTA), medical Portland cement, and calcium hydroxide on the dentin-pulp complex of permanent and primary teeth treated with two-step IPT. MATERIALS AND METHODS: In 86 regular patients (51 % men; 49 % women; age 17.2 years ±13.8), one deep carious lesion each was treated with incomplete caries removal, randomly selected capping with either calcium hydroxide (n = 31), medical Portland cement (29) or white MTA (26), and re-entry (6.3 months ±1.0). Clinical (color, humidity, and consistency of dentin) and microbiological (Lactobacilli/Mutans Strep. counts) parameters were recorded at the first and second treatment. RESULTS: The IPT had a high success rate of 90.3 % regardless of the material used (p = 0.72). The arrested lesions showed consistently darker, dry, and therefore, sclerotic dentine (p < 0.05) as well as a decrease in bacterial counts at re-entry (Lactobacilli p = 0.01/Mutans Strep. p = 0.07). CONCLUSIONS: The findings of this study support the use of the IPT as a treatment for deep carious lesions preferably with non-resorbing materials such as MTA or medical Portland cement. CLINICAL RELEVANCE: The findings of this study could promote the improvement of the IPT as a one-step treatment of deep carious lesions when the remaining demineralized dentin would be sealed with durable restorations.

Prevalence of Molar-Incisor-Hypomineralisation among school children in four German cities.

BACKGROUND: A wide range for the prevalence of Molar-Incisor-Hypomineralisation (MIH) has been found in regional studies. AIM: The aim of this study was to determine the prevalence of MIH in Germany and to compare the findings with other studies. DESIGN: In the compulsory dental school examination, the first permanent molars, permanent incisors, and second primary molars were examined according to EAPD criteria in 2395 children (8.1 ± 0.8 years) in four regions in Germany for the presence of MIH. Examinations were performed by five calibrated examiners (κ = 0.9) on clean teeth after toothbrushing. RESULTS: The prevalence of MIH at the four regions differed considerably (4.3-14.6%) with a mean prevalence of 10.1%. The DMFT/dmft was generally low, but children with MIH exhibited statistically significant higher caries values. A total of 12.0% of the children with MIH also had at least one affected primary molar, which resulted in a statistically significant correlation between primary and permanent teeth. Most of the affected teeth had demarcated opacities, but more than half of the affected children showed at least one tooth with severe MIH. CONCLUSIONS: Molar-Incisor-Hypomineralisation is a prevalent finding in German school children. The prevalence varies highly in different regions, and the high rate of severe forms has clinically relevant implications.

Prevalence of Molar-Incisor Hypomineralisation in an Emerging Community, and a Possible Correlation with Caries, Fluorosis and Socioeconomic Status.

PURPOSE: To determine the prevalence of molar-incisor hypomineralisation (MIH) in 7- to 9-year-old (±1 year) schoolchildren living in Dubai, United Arab Emirates, and to find a possible association with caries, fluorosis and socioeconomic status. MATERIALS AND METHODS: In this cross-sectional study, a representative sample of 779 children with an age of 7 to 9 years ±1 year in primary schools in Dubai were randomly selected and examined by one investigator who had previously been trained and calibrated with the diagnostic criteria of European Academy of Paediatric Dentistry (EAPD) for MIH, caries diagnostic criteria of the World Health Organization (WHO) and Dean's criteria for fluorosis. RESULTS: The prevalence of MIH in Dubai was 7.57% and was almost identical for both genders (female 7.57% and male 7.58%). The caries index was high (2.41±1.7). Children with MIH in Dubai exhibited statistically significantly higher DMFT values than did children without MIH (mean 3.5 ± 1.7 vs 2.3 ± 1.7; p < 0.001). The prevalence of fluorosis was 10.9% with no statistically significant age or gender differences. CONCLUSION: The prevalence of MIH in Dubai is low. However, the caries and fluorosis values are much higher, which calls for strengthening caries-preventive efforts.

Selective or stepwise removal of deep caries in deciduous molars: study protocol for a randomized controlled trial.

BACKGROUND: For treating deep caries lesions, selective or stepwise (one- and two-step) incomplete excavation seems advantageous compared with complete caries removal. However, current evidence regarding the success, as defined by not requiring any retreatments, or survival of teeth after different excavations is insufficient for definitive recommendation, especially when treating deciduous teeth. Moreover, restoration integrity has not been comparatively analyzed longitudinally, and neither patients', dentists' or parents' preferences nor the clinical long-term costs emanating from both initial and retreatments have been reported yet. METHODS/DESIGN: The planned study is a prospective multicenter, two-arm parallel group, randomized controlled clinical trial comparing selective and stepwise excavation in deciduous molars with deep, active caries lesions without pulpal symptoms. We will recruit 300 children aged between three and nine-years-old with a minimum of one such molar. Patients participating in another study, or those with systemic diseases, disabilities or known allergies to used materials as well patients with teeth expected to exfoliate within the next 18 months will be excluded. After inclusion, sequence generation will be performed. Initial treatment will follow dental routine. During excavation, leathery, moist and reasonably soft dentin will be left in proximity to the pulp followed by adhesive restoration of the cavity. Afterwards, patients', dentists' and parents' subjective assessment of the treatment will be recorded using visual analogue or Likert scales. Re-examination will be performed after six months, and only then teeth will be allocated to one of the two interventions. Selectively excavated teeth will not be treated further, whilst for stepwise caries removal, a second excavation will be performed until only hard dentin remains. Clinical re-evaluations will be performed after 12, 24 and 36 months. Restorations will be reassessed using modified Ryge criteria. Objectively or subjectively required retreatments will determine success and survival. Retreatments will be evaluated both subjectively and regarding generated costs. DISCUSSION: Based on the results of the trial, decision-making for treating deep caries lesions in deciduous molars based on multiple criteria should be feasible. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02232828 (registered on 29 November 2014).