Ribbond for treatment of complicated crown fractures: report of 3 cases.

Dental trauma is relatively common and can occur secondary to sporting injuries, falls, fights, or accidents. According to the International Association of Dental Traumatology, 50% of children experience dental trauma between the ages of 8 to 12. There are many options for endodontic and restorative treatments of traumatized teeth. Ribbond, which was introduced in the market in 1992, consists of bondable, reinforced ultra-high strength polyethylene fibers. Ribbond may be an option for the treatment of traumatized teeth because of its aesthetic properties; absence of additional tooth preparation; and its high resistance to traction, which allows it to easily adapt to tooth morphology. In this report, we describe endodontic and restorative treatments using Ribbond for 3 female patients with horizontal complicated crown fractures of the maxillary incisors.

Dental injuries in autistic patients.

PURPOSE: The purpose of this study was to assess the incidence of traumatic dental injury among Turkish children and young adults with autism and compare this to the general population of Turkish children and young adults without autism. METHODS: This study was comprised of 186 children and young adults (138 males and 48 females), 93 with autism (autistic group, or AG) and 93 without autism (control group, or CG). Dental injuries were classified according to drawings and texts based on the WHO classification system, as modified by Andreasen and Andreasen. RESULTS: The rate of injury was higher among the AG (23%) than the CG (15%). The difference between the 2 groups, however, was not statistically significant (P<.19). The most common type of dental injury was enamel fracture. The rate of enamel fracture was higher in the CG (59%) than in the AG (33%), and the distribution of types of traumatic injury differed significantly between the AG and CG (P>.01). CONCLUSIONS: There were no significant differences in the rates of traumatic dental injuries among children and young adults with and without autistic disorder. The most frequently injured teeth were the permanent maxillary central incisors, and the frequency of injury to these teeth differed significantly (P>.01) between AG (56%) and CG (91%). The most common type of dental injury, enamel fracture, was more common in CG (59%) than AG (33%). The distribution of types of traumatic dental injuries differed significantly between the 2 groups (P>.01).

Traumatic injuries to permanent teeth in Turkish children, Ankara.

The aim of this study was to identify the types and etiologies of dento-alveolar injuries among patients who were treated for injuries to maxillary and/or mandibular permanent teeth at the Gulhane Medical Academy, Department of Pediatric Dentistry, Center of Dental Sciences in Ankara, Turkey to provide a basis for determining optimal treatment approaches and educational needs. From a total of 4956 children aged 6-12 years (mean age: 8.91 +/- 1.95) applying to the Center, 472 children (9.5%) were found to have suffered dental injuries during a period of 2 years. Injuries were classified according to drawings and texts based on the WHO classification system, as modified by Andreasen and Andreasen. Injury rates were highest among children age 6 and ages 8-10. The most frequently injured permanent teeth were the maxillary central incisors (88.2%), and the maxillary right central permanent incisor made up 47.2% of all injured teeth. The most common cause of dental trauma was falling while walking or running (40.3%). Most injuries involved a single tooth (64.8%). The most common type of injury was enamel fracture (44.6%). There was a significant difference in gender, where boys more often suffered from a dental hard tissue and pulp injury than girls (P = 0.019), whereas there was no difference in gender (P = 0.248) in the distribution of periodontal injuries. Injuries were found to occur more frequently during the summer (P < 0.001). Children with increased overjet were 2.19 times more likely to have dental injuries than other children. Considering that the incidence of traumatic dental injury is highest among children ages 6 and ages 8-10 as well as the fact that patients with increased overjet are more prone to dental trauma, preventive orthodontic treatment in early mixed dentition may play an important role in reducing traumatic dental injuries.

Multidisciplinary approach to the rehabilitation of a crown fracture with glass-fibre-reinforced composite: a case report.

Traumatic tooth injuries are common in children. When permanent teeth are involved, it can be a challenge to save these teeth. This clinical case study describes the multidisciplinary treatment of a complex crown fracture and luxation of a right maxillary incisor along with esthetic management. After periodontal surgery including guided bone regeneration and endodontic treatment, we used a glass-fibre-reinforced composite post to increase retention and distribute stress along the root. The restoration was completed using composite in an incremental technique. During follow-up appointments, clinical and radiographic examinations revealed no root canal or periodontal problems, suggesting the efficacy of the treatment in retaining the fractured tooth. Periodontal surgery with endodontic treatment is an alternative treatment for severe trauma in permanent teeth.

Re-eruption of an intruded immature permanent incisor with necrotic pulp: a case report.

Intrusive luxation is a serious dental injury that causes damage to the pulp and supporting structures of a tooth because of its dislocation into the alveolar process. This paper presents the case of the re-eruption of a severely intruded immature permanent incisor with a crown-root fracture. A 9-year-old boy was referred to the clinic 1 day after a fall. Clinical and radiographic examinations revealed intrusive luxation of the immature left permanent incisor and a crown-root fracture without pulp exposure. Palatal gingivectomy was done 2 weeks later to facilitate re-eruption. Root canal therapy with intracanal calcium hydroxide paste was initiated during the first month owing to severe spontaneous pain. Six months later, the tooth re-erupted to a normal position, after which root canal obturation and a final esthetic restoration were done. The present case demonstrates the possibility of obtaining re-eruption of intruded immature permanent teeth with interim medication (calcium hydroxide) in the root canal.

Combined technique with glass-fibre-reinforced composite post and original fragment in restoration of traumatized anterior teeth--a case report.

Dentoalveolar trauma is frequently encountered by dental practitioners. In some instances, saving a child's traumatized permanent teeth can create difficulties for the child, the parents and the dentist. Reattachment of a crown fragment is a conservative treatment that should be considered for crown fractures of anterior teeth. This case describes the clinical reattachment of an original tooth fragment. A 10-year-old male presented at the Department of Pediatric Dentistry with a complex crown fracture of the left maxillary central incisor 1 day after the trauma occurred. Following endodontic treatment, a glass-fibre-reinforced composite root canal post (FRC Postec; Ivoclar Vivadent AG, Schaan, Liechtenstein) was inserted to increase retention and distribute stress along the root. The dental restoration was completed using the original fragment and a dual-cured resin composite (Variolink II; Ivoclar Vivadent AG). Clinical and radiographic examinations at 1-year recall showed the glass-fibre-reinforced composite root canal post and restoration to be in place, indicating the success of the treatment in maintaining the fractured tooth. Thus, we conclude that reattachment of a tooth fragment using a dual-cured resin composite and a glass-fibre-reinforced composite root canal post is an alternative method for the rehabilitation of fractured teeth that offers satisfactory aesthetic and functional outcomes.

Human leukocyte antigen class II alleles and dental caries in a child population.

PURPOSE: The purpose of this study was to investigate a possible relationship between human leukocyte antigens (HLAs) DRB1 and DQB1, dental caries, and colonization by mutans streptococci (MS) in children. METHODS: Sixty children were clinically examined for caries in accordance with World Health Organization criteria and methods. Thereafter, subjects were assigned into 2 groups: (1) high-caries children (dft and DMFT > or = 5); and (2) caries-free children (dft and DMFT = 0). Fresh saliva samples were collected and testedfor mutans streptococci, after which the subjects were placed into 2 groups, having either high (> or =10(5) colony-forming units [CFU]/mL saliva) or low (< 10(5) CFU/mL saliva) numbers of micro-organisms in saliva. The polymerase chain reaction/sequence specific primer method was used to determine HLA DNA typing from fresh blood samples. RESULTS: There was no significant difference between the frequency of HLA alleles in high-caries and caries-free subjects. Although chi-square test suggested an association for HLA-DRB1*01 and HLA-DQB1*03 with the salivary numbers of MS (P = .026 and P = .009, respectively), these could not be confirmed by logistic regression analysis (P = .188 and P = .101, respectively). CONCLUSIONS: The results obtained fail to establish an association between human leukocyte antigen alleles DRB1 and DQB1 and salivary numbers of MS in the selected child population.

Effect of mineral trioxide aggregate cements on transforming growth factor beta1 and bone morphogenetic protein production by human fibroblasts in vitro.

The aim of this study was to evaluate and compare the effects of two commercial mineral trioxide aggregate (MTA) cements (ProRoot MTA and MTA Angelus) on transforming growth factor (TGF)-beta1 and bone morphogenetic protein (BMP)-2 levels produced by cultured human gingival fibroblasts (HGFs). Human gingival tissues were obtained from individuals with healthy periodontium. HGFs were grown at 37 degrees C in humidified atmosphere of 5% CO(2) in Dulbecco's modified Eagle's medium, supplemented with 10% fetal calf serum, penicillin, and streptomycin. After 24 and 72 hours of exposure to the MTA products, HGF viability was determined by using 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl tetrazolium bromide assay. TGF-beta1 and BMP-2 levels in cell-free culture media were determined by enzyme-linked immunosorbent assay. Cell viability of the test groups was significantly lower than that of control at 24 and 72 hours (p < 0.05) but showed an increase at 72 hours (p < 0.05). Both test groups showed increased TGF beta-1 levels at 72 hours (p < 0.05), whereas the MTA Angelus group displayed higher TGF beta-1 levels than control and ProRoot MTA groups at 24 and 72 hours (p < 0.05). At 24 hours, BMP-2 levels of the ProRoot group were significantly higher than that of MTA Angelus (p < 0.05). Both test materials increased the BMP-2 levels within time (p < 0.05) and displayed similar levels at 72 hours (p > 0.05). These results suggest that both MTA products are capable of stimulating HGF to produce BMP-2, whereas the stimulatory effect for TGF beta-1 is material dependent.

Co-expression of cyclooxygenase-2 and vascular endothelial growth factor in inflamed human pulp: an immunohistochemical study.

Recent data from the medical literature indicates that cyclooxygenase-2 (COX-2) plays a key role in the production of vascular endothelial growth factor (VEGF), a glycoprotein that has the ability to increase the permeability of blood vessels and to induce angiogenesis. This study was undertaken to investigate the immunohistological co-expression of COX-2 and VEGF in inflamed human pulp, in conjunction with the expression of CD34, a transmembrane glycoprotein expressed in endothelial cells. Pulp tissue of extracted carious human third molars with a recent history of spontaneous pain were collected and processed for immunostaining of COX-2, VEGF, and CD34 using the biotin-streptoavidin method. Healthy pulp samples served as controls. COX-2 expression was not observed in healthy pulps, whereas all inflamed pulps demonstrated COX-2-expressing cells. Similarly, VEGF was not expressed in normal pulp tissue, but was strongly positive in inflamed pulps. CD34 was expressed in the endothelium of both normal and inflamed pulp tissues. Co-expression of COX-2 and VEGF in all consecutive sections of inflamed pulps could be suggestive of a possible release of VEGF via a COX-2-dependent pathway.

A unique treatment of finger-sucking habit in children with mental retardation: report of 2 cases.

Finger-sucking habit, or nonnutritive sucking, usually ceases spontaneously in childhood. If the habit is not broken, however, not only will dental occlusion be affected, but the shape of the finger may be altered as well. When the habit is broken, the threatening disturbances of digital growth and dental occlusion will resolve spontaneously. This article describes a unique type of habit-breaking appliance applied on the sucked fingers of 2 children with mental retardation. The advantages of this type of extraoral appliance are discussed.

Investigation of proliferative activity in the developing human tooth using Ki-67 immunostaining.

OBJECTIVE: The aim of this study was to investigate the proliferation of the developing human tooth germ and its surrounding tissues using Ki-67 immunostaining. MATERIALS AND METHODS: Sections of mandibular dental arch tissues collected from 4 cadaveric human fetuses of 13, 16, 21 and 30 weeks of gestation were used. The immunoreactivity of Ki-67 in the tissue sections was assessed visually under a light microscope. Immunohistochemical controls were performed by replacing the primary antibody with phosphate-buffered saline or normal rabbit lgG. RESULTS: The control sections did not display Ki-67 immunoactivity. Specimens of 13 weeks of gestation revealed intense Ki-67 immunostaining throughout the entire developing mandibular primary molars. At 16 weeks of gestation, immunostaining was observed in the inner enamel epithelium and dental papilla, in conjunction with the dental lamina showing decreased immunostaining. At 21 weeks, Ki-67 immunostaining was observed only in the inner enamel epithelium and dental papilla. The immunoreactivity of active ameloblasts and odontoblasts decreased, along with the proliferation capacity of the dental lamina. At 30 weeks, both enamel and dentin formation was observed along the cusped aspect of the tooth germ. Ameloblasts and odontoblasts were no longer immunoreactive in this region, while both types of cells were immunoreactive at the cervical regions of the crown. Dental lamina cells showed disintegration and were totally Ki-67-negative at 30 weeks of gestation. CONCLUSION: The Ki-67 immunoreactivity of the dental lamina decreased during intrauterine tooth development. Positive immunostaining was observed at specific sites in the enamel organ and dental papilla during the cap and bell stages.

Oral and dental findings in osteopetrorickets.

While dental findings of both rickets and osteopetrosis have been reported, there is no published report on the oral and dental findings of osteopetrorickets. In this paper dental findings of osteopetrorickets were presented. A two-year-old female child was referred to the pedodontics clinic for dental examinations before bone marrow transplantation. Her teeth showed severe mobility and the eruption of the teeth were delayed. The dental findings of the patient were different from that of osteopetrosis and rickets.

Management of a fused central incisor in association with a macrodont lateral incisor: a case report.

Fusion is developmental anomaly of the dental hard tissue and is defined as the joining of 2 developing tooth germs resulting in a single large tooth structure. Different treatment methods can be used according to the requirements of the situation. The purpose of this case report was to present the multidisciplinary treatment of a patient who had a permanent maxillary left central tooth fused with a supernumerary incisor and a macrodont permanent maxillary right lateral incisor. In the radiographic evaluation, it was determined that the fused tooth had 2 separate roots. The supernumerary tooth was extracted after hemisection, and endodontic treatment was performed on the remaining portion. The distal side of the macrodont lateral incisor was recontoured, and the right central incisor was reshaped with a strip crown to provide aesthetic appearance and to gain space for the alignment of teeth. Following the restoration of the incisors, orthodontic treatment was provided.

Dental injuries and attention-deficit/hyperactivity disorder in children.

The purpose of this study was to determine the relationship between attention-deficit/hyperactivity disorder (ADHD) and traumatic dental injuries in children. A total of 194 children aged 7-15 years participated in this study. Fifty-seven traumatic injuries to permanent teeth were observed in 33 children. Although a statistically significant difference was not found (p= .848), the rate of incidence was higher in the group with ADHD (17.5%) than in the control group (16.5%). The maxillary right central incisors accounted for nearly half of all injured teeth, while the maxillary central incisors represented the most frequently injured teeth. Enamel fracture was the most common type of dental injury observed. The incidence of enamel fracture was higher in the control group (66.7%) than in the subjects with ADHD (43.3%). There was a significant association between the occurrence of traumatic dental injury and the presence of an overjet greater than 3 mm (p= .020).

Vasodilatory effect of hydroxyethyl methacrylate and triethylene glycol dimethacrylate in rat aorta through calcium antagonistic action.

INTRODUCTION: Resin-based dental materials contain various diluent monomers that can interfere with vascular function by causing vasodilation. In this study, we evaluated the vasoactive potential of hydroxyethyl methacrylate (HEMA) and triethylene glycol dimethacrylate (TEGDMA) and the possible mechanism of their vascular action on isolated rat aorta. METHODS: Responses of thoracic aorta rings were recorded isometrically by using force displacement transducers. After precontracting aorta rings with phenylephrine, relaxations to HEMA and TEGDMA were recorded in the absence and presence of nitric oxide synthase inhibitor N(ω)-nitro-L-arginine methyl ester, cyclooxygenase inhibitor indomethacin, and K(+) channel inhibitors tetraethylammonium, glibenclamide, and 4-aminopyridine. To investigate the Ca(2+)-channel antagonistic effect of HEMA and TEGDMA in different aorta rings, concentration-response curves to CaCl(2) were obtained in the absence and presence of the test monomers. RESULTS: Both HEMA and TEGDMA elicited concentration-dependent relaxations. The vasorelaxant effect of HEMA and TEGDMA was not mediated via endothelium-dependent nitric oxide and prostanoid-dependent mechanisms or by K(+) efflux through K(+) channels. Both monomers significantly inhibited the contractions induced by CaCl(2). CONCLUSIONS: Our results showed that HEMA and TEGDMA induce vasodilation via Ca(2+)-antagonistic action, whereas nitric oxide and cyclooxgenase pathway and K(+) channels were not responsible for this vasoactive effect.

Vasorelaxant effects of Clearfil SE Bond and Clearfil S(3) Bond mediated by calcium antagonistic action.

Dental adhesives can alter the contractility of vascular tissue via different mechanisms. The aim of this study was to investigate and compare the vascular action of two self-etch adhesive systems, Clearfil SE Bond (CSEB) and Clearfil S(3) Bond (CS3B). Responses of isolated rat thoracic aorta rings were recorded isometrically by force displacement transducers. Following pre-contraction of aorta rings, relaxations to the independent and mixed components of CSEB and CS3B were recorded in the absence and presence of nitric oxide synthase (NOS) inhibitor (N(omega)-nitro-L-arginine methyl ester (N-LAME)), cyclooxygenase (COX) inhibitor (indomethacin) and K+ channel inhibitors (tetraethylammonium, glibenclamide and 4-aminopyridine). We also tested the effects of CSEB and CS3B in endothelium-intact and -denuded rat thoracic aorta rings. To investigate the Ca2+-channel antagonistic effect of adhesive components, concentration-response curves to CaCl2 were obtained in the absence and presence of the components. The primer, the bond, and the mixture of CSEB and CS3B elicited concentration-dependent relaxations. Mechanical rubbing of the endothelium did not significantly modify the extent of vasorelaxation induced by the test materials. The vasorelaxant effect was mediated neither by NOS and COX inhibition nor by the tested K+ channel antagonists. Mechanical removal of the endothelium did not alter the vasodilatory effect induced by the self-etch adhesives. Both CSEB and CS3B significantly inhibited the contractions induced by CaCl2. These results demonstrate the vasodilatory effect induced by the self-etch adhesive systems through a Ca2+-antagonistic effect.

Oral health status of disabled individuals attending special schools.

OBJECTIVES: The purpose of this study was to determine the prevalence of the dmft-DMFT indexes and the oral hygiene status of 136 individuals attending a special school for the disabled. METHODS: Participants were grouped according to disability [Mental Retardation (MR), Cerebral Palsy (CP), Autistic Disorder (AD), Down Syndrome (DS), Other (OTH)] and age [2-6 years (n=24), 7-12 years (50 children) and 13+ years (62 children]. Caries examinations were carried out in accordance with WHO criteria and oral cleanliness was evaluated by visually assessing the presence of plaque on teeth. RESULTS: The age range of patients was 2-26 years (mean age: 11.89±5.19 years). Mean dmft and DMFT scores by age group were as follows: 2-6 years: dmft=2.04±2.24; 7-12 years: dmft=2.24±2.60, DMFT=0.98±2.58; 13+years: DMFT=2.68±2.91. Overall, 15.4% of children had no caries or fillings. While dmft and DMFT levels (P>.05) did not vary significantly by type of disability, oral cleanliness did. Children with autism were observed to maintain the best oral hygiene and those with mental retardation (MR), the poorest. CONCLUSIONS: It is important for the dentist to concentrate on a preventive approach and provide proper dental education to parents of disabled individuals. Among the children with disabilities, more attention should be paid to the oral hygiene of MR group.

Use of triple antibiotic paste as a disinfectant for a traumatized immature tooth with a periapical lesion: a case report.

Elimination of microbial contamination from the root canal system is a precondition for successful root canal treatment. In this regard, mechanical instrumentation, irrigation, and intracanal medication are all important. This case report assesses the efficacy of a triple antibiotic paste consisting of metronidazole, ciprofloxacin, and minocycline in the disinfection of immature teeth with apical periodontitis. An 8-year-old girl presented at the Department of Pediatric Dentistry for the evaluation of right and left maxillary central incisors with crown fractures and luxation. The right central incisor had a large periapical lesion, which was treated by filling the canal with a ciprofloxacin/metronidazole/minocycline paste. After 4 months, the patient had no symptoms, and a radiograph showed the radiolucency had completely resolved. At the 1-year follow-up, a periapical radiograph showed complete root development and apical closure. These results indicate that triple antibiotic paste is effective in disinfecting immature teeth with periapical lesions.

Traumatic intrusion of primary teeth and its effects on the permanent successors: a clinical follow-up study.

OBJECTIVE: Owing to the anatomic proximity between the root of the primary tooth and its permanent successor, trauma to primary dentition may cause developmental disturbances in unerupted permanent teeth. STUDY DESIGN: This report presents the findings of a prospective 7-year study examining developmental disturbances of permanent teeth attributed to intrusive injury of their primary predecessors based on initial patient records and clinical observation. Intrusive injuries were diagnosed and grouped according to World Health Organization classifications, as modified by Andreasen et al. RESULTS: A total of 78 children (aged 12-48 months) presenting with intrusive trauma to 138 primary incisors were available for follow-up examinations. The most frequently intruded primary teeth were maxillary incisors (93.47%), with the right central primary incisor representing 41.3% of all intruded teeth. In 23 patients, 36 teeth were scheduled for extraction during the first visit. During the course of follow-up, 41 of the remaining teeth exhibited post-traumatic consequences, including pulp necrosis (78.0%), internal and/or external root resorption (14.6%), ankylosis (4.9%), and obliteration of the pulp canal (2.5%). In 74 permanent successors (53.6%), >or=1 of the following developmental disturbances were observed: enamel hypoplasia (28.3%), crown and/or root deformation (16.7%), and ectopic eruption (16.7%). CONCLUSION: There was no significant correlation between age of intrusion and frequency of subsequent developmental disturbances (P > .05).

The effects of one-step self-etch adhesives on the induction of oxidative stress and production of TGF-beta1 and BMP-2 by human gingival fibroblasts.

The aim of this study was to evaluate and compare the effects of two self-etch adhesive materials on the induction of oxidative stress and production of transforming growth factor-beta1 (TGF-beta1) and bone morphogenetic protein-2 (BMP-2) by cultured human gingival fibroblasts (HGF). Inflammation-free attached gingiva was obtained from healthy donors under informed consent. Following 24- and 72-h exposure of HGF to two different elutes of the test materials, cell viability was determined using the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl tetrazolium bromide (MTT) assay. Lipid peroxidation, a major indicator of oxidative stress, was measured by the thiobarbituric acid reactive substance (TBARS) assay. TGF-beta1 and BMP-2 levels in cell-free culture media were determined by enzyme-linked immunosorbent assay (ELISA). Cell viability of the test groups was significantly lower than those of control at 24 and 72 h (P < 0.001), but showed an increase at 72 h (P < 0.001). The TBARS levels of both test groups were significantly greater than that of control (P < 0.05), and displayed similar values at 72 h (P > 0.05). For both materials, the levels of TGF-beta1 and BMP-2 were significantly greater than that of control (P < 0.05). Both test groups showed increased TGF-beta1 levels. These results indicate that the tested self-etch adhesives might be capable of inducing production of TGF-beta1 and BMP-2 in cultured HGF, despite their cytotoxic and oxidative stress-producing potential.