Direct Pulp Capping of Primary Molars with Calcium Hydroxide or MTA Following Hemorrhage Control with Different Medicaments: Randomized Clinical Trial.

Purpose: This study aimed to evaluate the effects of different medicaments (sterile saline [SS]; ferric sulfate [FS]; or sodium hypochlorite [SH]) and pulp capping materials (calcium hydroxide [CH] or mineral trioxide aggregate [MTA]) on the success of direct pulp capping (DPC) in primary molars. Methods: The study was conducted with 55 children aged four to eight years. A total of 118 teeth, in which occlusal caries removal resulted in pulp exposure, were treated with DPC across six groups: SS+CH; FS+CH; SH+CH; SS+MTA; FS+MTA; and SH+MTA. Teeth were restored with Class I composite resin. Results: After two years, the overall clinical and radiographical success for DPC were 94.1 percent (111 out of 118 teeth) and 88.9 percent (105 out of 118 teeth), respectively. The clinical and radiographical success, respectively, for hemorrhage control medicaments were 92.1 percent and 89.5 percent for SS, 92.5 percent and 82.5 percent for FS, 97.5 percent, and 95.0 percent for SH (P>0.05). Internal resorption was significantly higher in the FS+CH group when compared to other groups (P<0.05). MTA had significantly higher success than CH for clinical (98.3 percent versus 89.7 percent) and radiographical success (98.3 percent versus 79.3 percent) (P<0.05, each comparison). Conclusions: For primary molars with occlusal caries and less than one-mm exposure sites, these findings suggest that direct pulp capping with MTA following hemorrhage control with the tested solutions offers a more predictable outcome compared to CH. Further, the findings of this study indicate an increased risk for internal resorption when FS and CH are used for DPC.

In Vitro Evaluation of Different Protocols for Preventing Microleakage of Fissure Sealants Placed Following Saliva Contamination.

PURPOSE: To evaluate the effect of different enamel conditioning protocols and their re-application on the microleakage of fissure sealants placed following saliva contamination. STUDY DESIGN: The study included 156 human third molars in 16 subgroups (2×4×2) under two main groups (sealant type): Group A- hydrophobic resin sealant, 3M Clinpro™ Sealant; Group B- hydrophilic resin sealant, Ultraseal XT Hydro. Each group was then divided according to the type of surface conditioning; 1- Er,Cr:YSSG laser etching, 2- acid-etching, 3- acid-etching+etch-and-rinse adhesive (Prime&Bond® One Select) and 4- self-etching adhesive (Clearfil™ SE Bond). After contaminating the conditioned occlusal enamel surfaces with artificial saliva, fissure sealant was applied in half of the specimens (a), whereas in the other half, (b) the respective surface conditioning was repeated and then fissure sealant was placed. Following thermocycling, the samples were immersed in basic fuchsin, sectioned, and dye penetration was quantitatively assessed with ImageJ. Two-way ANOVA and Bonferroni post-hoc tests were used for statistical analyses (p<0.05). RESULTS: The least microleakage was observed in A3b and A3a, whereas B4b and B4a were the subgroups with the highest microleakage. Following saliva contamination, when surface conditioning was not re-applied, the effects of fissure sealant types and surface conditioning were significant (p=0.005 and p<0.001, respectively). However, their interaction was insignificant (p=0.173). When surface conditioning was re-applied after saliva contamination, the effects of type of fissure sealant and surface conditioning (p=0.000, for both) and their interaction (p=0.004) were significant. CONCLUSIONS: 3M Clinpro™ Sealant was superior to Ultraseal XT Hydro. Re-application of Er,Cr:YSSG laser and the self-etching adhesive did not affect the microleakage of both fissure sealants. Without re-application, acid-etching+etch-and-rinse adhesive was superior to acid-etching only. However, both of them were similarly successful when they were re-applied following saliva contamination.

Turkish paediatric dentists' knowledge, experiences and attitudes regarding child physical abuse.

OBJECTIVES: Numerous studies have shown that the education of health professionals is essential to effectively respond to child abuse. The present study aimed to evaluate Turkish paediatric dentists' knowledge, experiences and attitudes regarding child physical abuse. MATERIALS AND METHODS: An electronic questionnaire was e-mailed to 518 paediatric dentists. Participants' knowledge of diagnostic indicators of child physical abuse, and their past experiences, attitudes and self-assessment of educational needs were evaluated. RESULTS: The response rate was 40.9% (n = 212). Participants who completed their undergraduate education before 1997 received significantly less education on child physical abuse than participants who completed their education more recently (P < 0.001). Although statistically insignificant, participants who completed their doctorate/specialty training after 2012 received increased education on child physical abuse (P = 0.06). Of the participants, 43.9% suspected physical abuse; however, only 12.7% reported it. 'I did not know where and how to report' was the most common reason for not reporting physical abuse. The rate of suspicion was higher among dentists from state hospitals or oral health centres (P < 0.05). Of the participants, 70.3% did not know about the legal sanctions for delay in or not reporting suspected cases. Only 15.6% assessed themselves as competent to diagnose and report physical abuse. Almost all of them acknowledged their need for more education on this topic. CONCLUSION: Turkish paediatric dentists' educational needs for diagnosing and reporting of child physical abuse cases should be met.

Partial Pulpotomy in Immature Permanent Molars After Carious Exposures Using Different Hemorrhage Control and Capping Materials.

PURPOSE: This study compared the outcome of partial pulpotomies with mineral trioxide aggregate (MTA) or calcium hydroxide (CH) following hemorrhage control with 2.5 percent sodium hypochlorite (SH) or 0.9 percent sterile saline (SS) solutions in cariously exposed immature permanent molars. METHODS: Following removal of two to three mm of the pulp at the exposure site, 80 Class I cavities were randomly allocated to four groups according to the hemorrhage control agent and pulp-capping material used: (1) group one-SH plus MTA; (2) group two-SS plus MTA; (3) group three-SH plus CH; (4) group four-SS plus CH. Glass ionomer cement was applied over the pulp-capping material, and the teeth were later restored with composite resin. The patients were recalled at six, 12, 18, and 24 months. RESULTS: After 24 months, simultaneous radiographic and clinical success rates were 94.4 percent, 100 percent, 95 percent, and 100 percent for groups one to four, respectively (P>.05). No significant correlation was found between marginal integrity scores of restorations and partial pulpotomy failure (P>.05). CONCLUSIONS: Partial pulpotomy, performed with MTA or CH used as the pulp-capping material following hemostasis with SH or SS solutions, provided comparable and favorable outcomes in carious pulp exposures of immature permanent teeth.

Preserving alveolar bone growth following cervical root fracture: a case report.

Root fracture injuries affect 0.5%-7% of permanent teeth. Although cervical root fractures are less frequent in children, their serious consequences and poor prognosis may lead to tooth loss. In this case presentation, we discuss a treatment approach chosen to preserve alveolar bone growth following a cervical root fracture in an 8-Year-old boy.

Unusual ectopic eruption of a permanent central incisor following an intrusion injury to the primary tooth.

Intrusive luxation of primary teeth carries a high risk of damage to underlying permanent tooth germs. Ectopic eruption of permanent incisors is an unusual outcome of traumatic injury to their predecessors. In this case report, we describe the multidisciplinary management of the consequences of a primary tooth intrusion that led to severe ectopic eruption of the permanent left central incisor in a horizontal position at the level of the labial sulcus.

Dens invaginatus and talon cusp co-occurring in a mandibular central incisor: a case report.

Talon cusp and dens invaginatus are tooth shape anomalies that rarely affect mandibular teeth. Their co-occurrence in a single tooth is uncommon. The purpose of this report was to present a rare case of both talon cusp and dens invaginatus in a permanent mandibular central incisor. The diagnosis of dens invaginatus was made from routine radiographs taken to investigate a possible pulpal extension within the taloned cusp. Since the invagination did not communicate with the oral cavity, no treatment was indicated. The talon cusp was slightly grinded and smoothened to eliminate tongue irritation.

Management of cervical root fracture using orthodontic extrusion and crown reattachment: a case report.

Root fractures involve damage to pulp, cementum, dentin, and periodontal ligaments. These injuries affect 0.5% to 7% of permanent teeth. Cervical root fractures are less frequently seen and have a worse prognosis compared with the fractures in the apical or middle third of the root. This case report describes the treatment of a cervical root fracture in a maxillary central incisor. After removal of the coronal fragment, the root was filled temporarily with calcium hydroxide and orthodontic extrusion was initiated. The remaining root portion was elevated above the epithelial attachment and a successful coronal restoration was made using the natural crown of the traumatized tooth.

Root fracture in immature tooth: report of a case.

Root fracture injuries affect 0.5-7% of permanent teeth. Although this type of injury is rarely seen in teeth with immature root formation, the prognosis is generally good depending on the site of the fracture. A case report of horizontal root fracture in maxillary central incisor of an 8-year and 3-month-old girl and its treatment was presented.

Immediate surgical repositioning following intrusive luxation: a case report and review of the literature.

This report presents a case of severe intrusive luxation of mature maxillary lateral incisor in a 10-year-old boy. The intruded tooth was immediately repositioned (surgical extrusion) and splinted within 2 h following injury. Tetracycline therapy was initiated at the time of repositioning and maintained for 10 days. Pulp removal and calcium hydroxide treatment of the root canal was carried out after repositioning. Splint was removed 1 month later. Definitive root canal treatment with gutta percha was accomplished at the second month recall. Clinical and radiographic examination 28 months after the surgical extrusion revealed satisfactory apical and periodontal healing.

Er,Cr:YSGG laser pretreatment of primary teeth for bonded fissure sealant application: a quantitative microleakage study.

PURPOSE: Laser pretreatment of dental hard tissues prior to preventive or restorative procedures has been a subject of research. Unground primary enamel bears a prismless superficial layer which is known to be acid resistant. This in vitro study was conducted in order to evaluate the potential use of Er,Cr:YSGG laser in the pretreatment of occlusal surfaces of primary teeth prior to bonded fissure sealant application. MATERIALS AND METHODS: Occlusal surfaces of human primary mandibular molars were used (n =140). After pretreatment with Er,Cr:YSGG laser (group A) or not (group B), occlusal fissures were treated with one of the following in each of 7 subgroups (n = 10): 1. phosphoric acid-etch only; 2. Clearfil SE Bond; 3. FL Bond; 4. Adper Prompt L-Pop; 5. NRC+Prime & Bond NT; 6. One-Up Bond F; 7. Xeno III. All teeth were sealed with Fissurit F. The specimens were thermocycled (1000 times) and stored thereafter in distilled water at 37 degrees C for 8 months. Following immersion in 0.5% basic fuchsin solution, three bucco-lingual sections were made from each tooth. They were digitally photographed and the extent of dye penetration along the enamel-sealant interface was measured (in mm) with image analysis software. RESULTS: There was no difference between the Er,Cr:YSGG laser pretreated group (group A) and the nonlased grou (group B) (p > 0.05). The lowest microleakage values were observed in subgroups A1 and B1. Within the laser pretreated group, subgroups A1, A4, and A5 showed lower microleakage scores when compared to subgroups A2, A3, A6, and A7 (p < 0.05). As for the nonlased group, subgroups B1, B3, B4, and B5 demonstrated significantly lower microleakage scores than subgroups B2, B6, and B7 (p < 0.05). CONCLUSION: Er,Cr:YSGG laser pretreatment was not found to influence the resistance to microleakage of bonded fissure sealant application in primary teeth.

Adhesive fragment reattachment after orthodontic extrusion: a case report.

In the treatment of crown fractures, adhesive fragment reattachment provides a good alternative to other restorative techniques, offering several advantages. The present paper reports a case in which the treatment of a cervical crown fracture was accomplished by reattaching the tooth fragment with a flowable resin composite. Orthodontic root extrusion was performed with a modified Hawley appliance prior to fragment reattachment. The clinical and radiographic results after 2.5 years were successful.

Clinical evaluation of a polyacid-modified resin composite-based fissure sealant: two-year results.

A 24-month clinical study was carried out to evaluate and compare the retention rate, marginal integrity and caries preventing effects of a polyacid-modified resin composite based fissure sealant, Dyract Seal, to that of a resin based fluoride fissure sealant, Delton FS+. Fifty-three patients (27 female and 26 male), 7 to 10 years old, were included in the study. At baseline, a total of 192 permanent first molars were sealed with either fissure sealant (n=96, each), using invasive technique. The sealed teeth were evaluated at post-operative 3, 6, 12 and 24 months with respect to evaluation parameters. The data were analyzed with the Chi-Square tests where alpha=0.05. There were no statistically significant differences between fissure sealants as regards to retention and prevention of caries for all periods of the evaluation (p>0.05). However, regarding marginal integrity of the sealants, Delton FS+ gave significantly better results than Dyract Seal for the 3-, 6- and 12-month evaluations, respectively (p<0.05). In conclusion, the use of Dyract Seal on permanent molars with invasive technique was found to be clinically comparable to Delton FS+ for the 24-month evaluation period.

Microleakage evaluation of a flowable polyacid-modified resin composite used as fissure sealant on air-abraded permanent teeth.

This study evaluated the microleakage of a flowable polyacid-modified resin composite used as a fissure sealant on air-abraded teeth in comparison to a resin-based fluoride sealant. Sixty extracted human third molars were divided into six subgroups (n = 10) under two main groups (fissure sealant materials). The occlusal surfaces of the teeth were air-abraded at 80 psi using 50 microm particles of aluminum oxide for 30 seconds, followed by rinsing and drying. Delton FS+ (Dentsply International) and Dyract Flow (Dentsply DeTrey) were applied to the teeth in subgroups following application of: a) an acid etching and bonding agent, b) bonding agent alone or c) air-abrasion alone, respectively. Acid etching (Delton EZ Etch, Dentsply International) and bonding agent application (Prime & Bond NT, Dentsply DeTrey) were done according to the manufacturers' instructions. The teeth were thermocycled for 500 cycles between 5 degrees C and 55 degrees C with dwell time of 15 seconds. Basic fuchsin (0.5%) staining followed by buccolingual sectioning was performed. Microleakage was evaluated at 20x optical magnification. Kruskal-Wallis test was used to make comparisons among six subgroups. Pairwise comparisons were done with the Mann-Whitney U test with the level of significance set as alpha = 0.05. Dyract Flow application as a fissure sealant on air-abraded permanent teeth in combination with acid etching and/or bonding agent provided microleakage results comparable to Delton FS+. Results also showed that the use of air abrasion, alone, resulted in significantly higher microleakage scores.

In vitro evaluation of the effect of a surfactant-containing experimental acid gel on sealant microleakage.

OBJECTIVE: The purpose of this study was to compare the effects of experimentally derived surfactant-containing acid gel with those of different surface-conditioning agents on microleakage of unfilled and filled sealants applied to permanent teeth following noninvasive and invasive procedures. METHOD AND MATERIALS: Four main groups of surface-conditioning agents (NRC; NRC + Prime&Bond NT; Email Preparator Blue; and experimental acid gel) were subdivided into 16 subgroups (n = 8). Subgroups were designed according to the surface preparation procedures applied (noninvasive and invasive) and fissure sealants used (Helioseal and Helioseal F). After application of the test materials, the specimens were subjected to thermocycling and then immersed in 0.5% basic fuchsin dye. Following sectioning, specimens were examined under a stereomicroscope and microleakage scores were assigned. RESULTS: Subgroups 9 (Email Preparator Blue + Helioseal), 11 (invasive + Email Preparator Blue + Helioseal), 13 (experimental acid gel + Helioseal), and 15 (invasive + experimental acid gel + Helioseal) showed no microleakage. The differences between those subgroups and subgroups 1 (NRC + Helioseal), 2 (NRC + Helioseal F), 3 (invasive + NRC + Helioseal), 4 (invasive + NRC + Helioseal F), 5 (NRC + Prime&Bond NT + Helioseal), and 6 (NRC + Prime&Bond NT + Helioseal F) were statistically significant. CONCLUSION: Email Preparator Blue and surfactant-containing experimental acid gel, combined with an invasive/noninvasive surface preparation procedure and Helioseal, significantly prevented microleakage.