Finite element analysis for fracture resistance of reattached human tooth fragment with different types of retentive preparation techniques.

OBJECTIVE: Restoration of traumatized incisors by reattachment of the original tooth fragment appears to be the most conservative treatment approach. But the measurement of forces acting on natural tooth in-vivo poses many challenges. The advent of finite element analysis (FEA) has made it possible to demonstrate the propagation of stress through each part of a tooth and its restoration. The objective of this study was to evaluate and compare the fracture resistance of reattached human tooth fragment with different types of retentive preparation techniques using finite element analysis. STUDY DESIGN: An intact maxillary central incisor was obtained, scanned by laser and its Computer Assisted Device (CAD) model was generated and then converted to Finite Element Model(FEM). Mechanical properties of tooth specimen and materials were added on the generated mesh. These reattached fragments were then fractured with a force applied at 30°, 45°, 70° and 90° to the long axis of tooth. FEA Calculation was run with the setup. RESULTS: The highest fracture strength recovery was found with internal dentinal groove (64.97%) followed by labial double chamfer with lingual over-contour (54.49%), subsequently by labial and lingual double chamfer (51.31%) and least was with simple reattachment (28.27%). CONCLUSIONS: Fracture resistance varied with different retentive techniques and greatest strength was offered by internal dentinal groove preparation.

Biological restoration in a young patient with a complicated crown root fracture with an autogenous tooth fragment.

Crown-root fractures are one of the most challenging trauma cases to treat. Reattachment of tooth fragment to a fractured tooth being a simple procedure conserves the tooth structure, maintains the natural esthetics value and is thus considered as a favorable treatment option. The reattachment procedure using composite resin should be considered if the subgingival fracture can be exposed to provide isolation after a careful evaluation of the biologic width involvement. This case report presents a complicated crown-root fracture of permanent maxillary left central incisor, involving the biologic width in an 11-year-old boy. The traumatized tooth was treated endodontically and reinforced by using glass fiber-post. Access to the subgingival margins was gained by electro surgery. The fractured fragment was reattached using bonding system and composite resin.

Decreased sleep in children and their behavioral problems in dental operatory.

PURPOSE: This study was conducted to examine the contribution of inadequate sleep and its associated factors, on behavior and cooperation of children in the dental operatory. MATERIALS AND METHODS: A cross-sectional study was conducted on 100 healthy children at the time of their initial visit to the dental hospital, ranging from preschoolers to adolescents. Data acquisition was done by a questionnaire. Interview with the accompanying person was done to ask about the sleep duration, naps, and sleep habits of the child. Children's behavior during their preliminary examination was studied and categorized according to Frankl's behavior rating scale. Data were analyzed by linear regression analysis and Spearman's correlation with the aid of SPSS 16.0 software. RESULTS: Total duration of sleep accounted for a small but significant contribution in behavioral problems of children. Significant correlation was found between duration of sleep and cooperative behavior in dental operatory (R = 0.478). However, the duration of sleep was negatively correlated to the number of siblings and socioeconomic status of the family. CONCLUSION: Children who had shorter total sleep duration had increased behavioral problems in dental operatory.

Frenectomy with semilunar coronally repositioned flap: A single stage approach - simple solution for complex problem.

Gingival recession is defined as the displacement of gingival margin apical to cementoenamel junction. Aberrant frenum attachment can contribute to the progression of recession by generating tension on the marginal tissues. Treating such defects is a two stage procedure-frenectomy and recession coverage procedure. New techniques are developed to increase the predictability, reduce patient discomfort and number of surgical sites. Also, these techniques try to satisfy patients esthetic demands, which include the final colour and tissue blend of the covered area. In this case report, we present a method for coronally repositioning gingiva for root coverage over the maxillary central incisors while simultaneously performing a frenectomy, thus being clinically advantageous compared to two-stage technique.

From hopeless to good prognosis: journey of a failing tooth.

Chronic periodontitis, along with associated clinical findings such as pathologic tooth migration, diastema, functional and aesthetic aberrations, poses an immense challenge to a dental professional. These findings convert clinical decision making into a daunting task and adversely affect the prognosis and the treatment plan for the presenting clinical problem. An interdisciplinary approach aimed at restoring functional and aesthetic needs of the affected individual within the limitations of such a compromised clinical scenario may be a viable alternative to any radical treatment causing loss of natural tooth structure such as extraction. This article reports the usefulness of the interdisciplinary route for managing an otherwise hopeless clinical situation of chronic periodontitis complicated with extreme mobility and pathologic tooth migration, which resulted in compromised function and aesthetics.

Atomic force microscopic comparison of remineralization with casein-phosphopeptide amorphous calcium phosphate paste, acidulated phosphate fluoride gel and iron supplement in primary and permanent teeth: An in-vitro study.

CONTEXT: Demineralization of tooth by erosion is caused by frequent contact between the tooth surface and acids present in soft drinks. AIM: The present study objective was to evaluate the remineralization potential of casein-phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste, 1.23% acidulated phosphate fluoride (APF) gel and iron supplement on dental erosion by soft drinks in human primary and permanent enamel using atomic force microscopy (AFM). MATERIALS AND METHODS: Specimens were made from extracted 15 primary and 15 permanent teeth which were randomly divided into three treatment groups: CPP-ACP paste, APF gel and iron supplement. AFM was used for baseline readings followed by demineralization and remineralization cycle. RESULTS AND STATISTICS: Almost all group of samples showed remineralization that is a reduction in surface roughness which was higher with CPP-ACP paste. Statistical analysis was performed using by one-way ANOVA and Mann-Whitney U-test with P < 0.05. CONCLUSIONS: It can be concluded that the application of CPP-ACP paste is effective on preventing dental erosion from soft drinks.

Accidental periapical extrusion of non-setting calcium hydroxide: unusual bone response and management.

Premixed non-setting calcium hydroxide is frequently used as interim root canal dressing in endodontically involved permanent teeth and as obturating paste in deciduous teeth in pediatric dentistry. Wide apex in both cases makes it more prone for deliberate extrusion especially when applied with pressure delivery systems. Contrary to common belief the mix was not resorbed in two years with the complaint of insufficiency in mastication. Large mass of calcium hydroxide in bone delayed healing process even after its removal. The present case report intends to demonstrate unusual behavior of bone in response to oily non-setting preparation of calcium hydroxide. Therefore its application with pressure syringe should be reconsidered in pediatric dentistry.

Effect of remineralizing agents on surface microhardness of primary and permanent teeth after erosion.

PURPOSE: The purposes of this study were to compare the susceptibility of human primary and permanent enamel to dental erosion caused by soft drinks and to compare in vitro the remineralization potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste, 1.23 percent acidulated phosphate fluoride (APF) gel, and iron supplement. METHODS: Fifteen extracted primary and permanent teeth were used for sample preparation. Samples were randomly divided into three treatment groups: CPP-ACP paste, APF gel and iron supplement. The samples were subjected to a series of demineralization and remineralization cycles and were evaluated through surface microhardness. Statistical analysis was performed using one way ANOVA and unpaired t -tests. RESULTS: After remineralization, all samples showed an increase in surface hardness, which was significantly higher with CPP-ACP paste. CONCLUSION: CPP-ACP paste was more effective at preventing dental erosion than the other products.

Autogenous tooth fragment reattachment: a multidisciplinary management for complicated crown-root fracture with biologic width violation.

Fractures of multiple permanent anterior teeth can be a traumatic experience for children, with functional, esthetic and psychological aspects. The treatment of complicated crown-root fractures (CRFs) is more challenging when the biologic width is violated. This paper presents a case of 12-year boy with complicated CRF of teeth #12 and #21, and horizontal crown fracture of tooth #11. It was managed by endodontic treatment, mucoperiosteal surgery with osteotomy to visualize the fracture line for fragment reattachment, followed by fiber-post placement and restoration with polycarbonate crowns. Clinical and radiographic evaluation after 6 months was satisfactory with adequate functional and esthetic results.

Clinical management of a complicated crown-root fracture using autogenous tooth fragment: A biological restorative approach.

Trauma resulting in crown-root fracture is one of the most challenging fracture types. However, biologic width involvement should be carefully evaluated. Reattachment of tooth fragment to a fractured tooth remains as the treatment of choice because of its simplicity, natural esthetics, and conservation of tooth structure. The reattachment procedure using composite resin should be considered if the subgingival fracture can be exposed to provide isolation. This report presents a case of complicated crown-root fracture of permanent maxillay left central incisor, involving the biologic width in a 10-year-old girl. The traumatized tooth was treated endodontically. Access to the subgingival margins was gained by orthodontic extrusion followed by gingivectomy. The fractured fragment was reattached using bonding system and composite resin.

Multidisciplinary management of an unusual case of multiple developmental defects in lateral incisor followed by intrusive injury to primary incisors.

Dental traumatic injuries occur frequently in children. The close relationship between the apices of primary teeth and germ of the permanent successors can lead to developmental disturbances in the permanent dentition. Developmental disorder can occur in any tooth. One of the most common teeth affected is lateral incisor. These developmental anomalies can cause various clinical problems. Clinical and radiographic characteristics of these anomalies may sometime present confusing picture. Therefore, recognition of this condition, early diagnosis, and treatment are important to avoid complications. High prevalence of dental trauma in young children emphasizes the need of educational and preventive programs in schools. Dentist plays important role in early diagnosis of disturbances in the permanent successor teeth by rigorous clinical and radiographic follow-up examination.

Dens invaginatus in primary maxillary molar: a rare case report and review of literature.

Dens invaginatus is a rare developmental anomaly. It is unusual to find this anomaly in primary dentition. Diagnosis of this dens invaginatus is important due to possible pulpal involvement. Not only that, simultaneous presence of other dental anomaly may require long-term treatment planning. Dens invaginatus can be detected clinically in the tooth presenting unusual crown morphology or radiographically as radiopacity within tooth. This article describes one of the first case reports of dens invaginatus in primary maxillary second molar in a 5-year-old female patient. How to cite this article: Bansal AV, Bansal A, Kulkarni VK, Dhar RS. Dens Invaginatus in Primary Maxillary Molar: A Rare Case Report and Review of Literature. Int J Clin Pediatr Dent 2012;5(2):139-141.

Odontomas--silent tormentors of teeth eruption, shedding and occlusion.

Odontomas are the most common odontogenic tumours of the jaws, characterised by their slow growth and non-aggressive behaviour. They usually remain asymptomatic, and are diagnosed on routine radiographs. Clinically, they are often associated with delayed eruption or impaction of permanent teeth and retained primary teeth. The purpose of this paper is to review the literature and report two cases of odontomas. In the first case, a compound odontoma was associated with an unerupted maxillary permanent right central incisor, in an 11-year-old boy. In the second case, a 12-year-old girl had retained mandibular primary left central incisor and its unerupted successor was associated with a compound odontoma, a site considered rare for compound odontoma to occur. The clinical features, diagnosis and treatment of these cases have been discussed.

Facial talon cusp: A rarity, report of a case with one year follow up and flashback on reported cases.

Talon cusp is a relatively uncommon developmental anomaly characterized by cusp-like projections, usually presenting on palatal/lingual surface of the anterior teeth. This cusp resembles an eagle's talon, and hence the name. Normal enamel and dentin covers the cusp, which may or may not contain an extension of pulp. Presence of this anomalous cusp on the facial surface of an anterior tooth is a rare finding and very few cases have been reported in the literature. In most instances, such cusps are associated with clinical problems such as poor esthetics and caries susceptibility. Management of such cases requires a comprehensive knowledge of the clinical entity as well as the problems associated with it. This case report presents a facial talon cusp on the maxillary left central incisor of a 10 year old boy, which was conservatively treated. Vitality of the affected tooth was maintained and followed up for a period of 1 year.

Endodontic treatment and esthetic management of a primary double tooth with direct composite using silicone buildup guide.

Gemination and fusion are morphological dental anomalies, characterized by the formation of a clinically wide tooth. Gemination occurs when one tooth bud tries to divide, while fusion occurs if two buds unite. The terms double teeth, double formation, conjoined teeth, geminifusion, vicinifusion and dental twinning are often used to describe fusion and gemination. Double teeth are associated with clinical problems such as poor esthetics, spacing problems and caries susceptibility. Management of such cases requires a comprehensive knowledge of the clinical entity as well as the problems associated with it. This report presents a case of primary double tooth in a 6-year-old boy involving maxillary left central incisor. The anomalous tooth was carious and pulpally involved. This was treated conservatively by endodontic treatment and esthetic rehabilitation was done with direct composite restoration using a silicone buildup guide. The treated tooth was followed up until exfoliation.

Compound odontoma associated with an unerupted rotated and dilacerated maxillary central incisor.

Odontomas are benign tumors containing various component tissues of teeth. They usually remain asymptomatic and are diagnosed on routine radiographs. Clinically, they are often associated with delayed eruption or impaction of permanent teeth and retained primary teeth. A case of compound odontoma in association with an unerupted, rotated and dilacerated maxillary permanent right central incisor in a 12-year-old boy is reported. Such combination is rare, making it an interesting case for reporting. We have also discussed the clinical features, diagnosis and treatment of such a condition.

Multidisciplinary management of multiple maxillary anterior supernumerary teeth: a case report.

Supernumerary teeth are a relatively frequent disorder of odontogenesis. They may occur alone or in multiple; be unilateral or bilateral; and appear in the maxilla, mandible, or both. Mesiodens is a supernumerary tooth in the anterior maxilla between the two central incisors. This case report describes the treatment of maxillary central incisors displaced and impacted because of the presence of four mesiodens in a 12-year-old boy. After clinical and radiographic examination, surgical removal of the mesiodens and exposure of the maxillary right central incisor was performed. This resulted in a 14-mm space between the displaced central incisors. Successively, fixed orthodontic treatment was planned with cephalometric analysis. The central incisors were brought to the occlusal plane and aligned, and the space between the incisors was redistributed. Remaining minor spaces between the incisors were closed with composite resin buildup.