Mineral trioxide aggregate or calcium hydroxide direct pulp capping: an analysis of the clinical treatment outcome.

INTRODUCTION: The use of mineral trioxide aggregate (MTA) might improve the prognosis of teeth after pulp exposure. The treatment outcome of teeth after direct pulp capping, either with mineral trioxide aggregate (MTA) or calcium hydroxide (controls), was investigated, taking into account possible confounding factors. METHODS: One hundred forty-nine patients treated between 2001 and 2006 who received direct pulp capping treatment in 167 teeth met the inclusion criteria. Treatment was performed by supervised undergraduate students (72%) and dentists (28%). Assessment of clinical and radiographic outcomes was performed by calibrated examiners 12-80 months after treatment (median, 27 months). RESULTS: One hundred eight patients (122 treated teeth) were available for follow-up (72.5% recall rate). A successful outcome was recorded for 78% of teeth (54 of 69) in the MTA group and for 60% of teeth (32 of 53) in the the calcium hydroxide group. The univariate analysis (generalized estimation equations model [GEE model] showed a significant difference in the success rate (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.05-5.32; P = .04). In the multiple analysis (GEE model), the OR is marginally inside the nonsignificant range (OR, 0.43; 95% CI, 0.19-1.02; P = .05) when conspicuous confounding factors are stabilized (univariate analysis). Multiple analysis showed that teeth that were permanently restored >or=2 days after capping had a significantly worse prognosis in both groups (OR, 0.24; 95% CI, 0.09-0.66; P = .01). CONCLUSIONS: MTA appears to be more effective than calcium hydroxide for maintaining long-term pulp vitality after direct pulp capping. The immediate and definitive restoration of teeth after direct pulp capping should always be aimed for.

Treatment outcome of mineral trioxide aggregate: repair of root perforations.

INTRODUCTION: The use of biocompatible materials like mineral trioxide aggregate (MTA) may improve the prognosis of teeth with root perforations. METHODS: The treatment outcome of root perforations repaired between 2000 and 2006 with MTA was investigated. Twenty-six patients received treatment with MTA in 26 teeth with root perforations. Treatment was performed by supervised undergraduate students (29%), general dentists (52%), or dentists who had focused on endodontics (19%). Perforation repair by all treatment providers was performed using a dental operating microscope. Calibrated examiners assessed clinical and radiographic outcome 12 to 65 months after treatment (median 33 months, 81% recall rate). Pre-, intra-, and postoperative information relating to potential prognostic factors was evaluated. RESULTS: Of 21 teeth examined, 18 teeth (86%) were classified as healed. None of the analyzed potential prognostic factors had a significant effect on the outcome. CONCLUSIONS: MTA appears to provide a biocompatible and long-term effective seal for root perforations in all parts of the root.

Mineral trioxide aggregate apical plugs in teeth with open apical foramina: a retrospective analysis of treatment outcome.

INTRODUCTION: Teeth with open apical foramina present a challenge during root canal treatment, and little is known about the clinical outcome of treatment in such teeth. This retrospective study assessed healing of teeth with open apices managed by the placement of mineral trioxide aggregate apical plugs. METHODS: Seventy-two patients with 78 teeth with apical resorption or excessive apical enlargement, treated between 2000 and 2006, were contacted for follow-up examination 12 to 68 months after treatment (median 30.9 months). Treatments were provided by supervised undergraduate students (27%), general dentists (32%), or dentists who had focused on endodontics (41%). The outcome based on clinical and radiographic criteria was assessed by calibrated examiners and dichotomized as "healed" or "disease." RESULTS: Of 56 teeth examined (72% recall), 84% were healed. Teeth without or with preoperative periapical radiolucency had a healed rate of 100% and 78%, respectively. None of the variables analyzed had a significant effect on the outcome. CONCLUSION: The results supported the management of open apical foramina with mineral trioxide aggregate apical plugs.

Dental health, received care, and treatment needs in 11- to 13-year-old children with immigrant background in Heidelberg, Germany.

OBJECTIVES: The purpose of the survey was to evaluate the caries experience, the provided care, and the unmet treatment need in 11- to 13-year-old schoolchildren with immigration background compared to children without migration experience. METHODS: A cross-sectional study of 502 schoolchildren, 48% of which have immigration background, was conducted. Schools in areas of disadvantaged socio-economic status were chosen for this study. DMFT scores, fissure sealants, and the occurrence of orthodontic treatments were recorded. RESULTS: The mean DMFT score of the immigrant children was significantly higher than that of the nonmigrants: 1.5 vs. 0.8. The SiC Index was also significantly different in both groups: 3.7 vs. 2.4, respectively. The Unmet Restorative Treatment Need Index was twofold higher in the immigrants compared to the nonmigrants. Only 45.6% of the immigrants had sound permanent teeth compared to 65.5% of the nonmigrants. The average number of sealants per child was 1.9 vs. 2.8, respectively. In addition, only 31.5% of the immigrants were provided with an orthodontic treatment compared to 48.3% of the nonmigrants. CONCLUSION: Children with immigration background demonstrated more caries and received less dental care when compared to children without migration experience. The community prevention programmes, addressed similarly to all children, could not close the gap in oral health between immigrant and non-immigrant children.

In vitro leakage associated with three root-filling techniques in large and extremely large root canals.

This study assessed the apical leakage of ultrasonically condensed root fillings in extremely large canals, compared to cold lateral condensation and thermoplastic compaction. Ninety single-rooted teeth were used. In 45 teeth canals were enlarged to size 70 (large). The remaining 45 canals were enlarged to size 140 (extremely large). Each set of teeth was subdivided into three root-filling groups (n = 15): (1) cold lateral condensation (LC); (2) thermoplastic compaction (TC); and (3) ultrasonic lateral condensation (UC). Teeth in all six subgroups were subjected to drawing ink penetration, cleared, and evaluated for linear apical dye leakage. Significantly deeper dye penetration (p < 0.04, Wilcoxon rank-sum test) was observed for LC than for UC. TC did not differ significantly from LC and UC. Dye penetration was significantly deeper (p < 0.0001) in canals enlarged to size 140 than to size 70, independent of root-filling method. Apical leakage associated with ultrasonically condensed root fillings was less than that with cold lateral condensation. It was consistently greater in extremely large canals than that in large ones.

Caries prevalence in 11- to 14-year old migrant children in Germany.

OBJECTIVES: To assess whether immigration stage is associated with higher prevalence of dental caries among schoolchildren in Heidelberg, Germany. METHODS: A cross-sectional dental examination on 570 schoolchildren, aged 11 to 14 years, in schools with high proportions of immigrant pupils (49.5%) was performed. Carious, missing and filled permanent teeth were recorded for each child, so that mean DMFT values could be calculated. The pupils were classified into three groups: M0 (children and their parents were born in Germany), M1 (children who were born in Germany but whose parents were born outside of Germany), and M2 (children and their parents were born outside of Germany). RESULTS: The mean DMFT values in M1 and M2 were close, and both were significantly higher than the corresponding values in M0. The proportions of caries-free children in M0, M1 and M2 were 63.7%, 40.3% and 42.3%, respectively. CONCLUSION: In Germany, migrant children have a poorer dental health status than native children coming from the same low socio-economic classes. Risk-oriented public health policies with appropriate prevention programs must be developed for these children.

Influence of fluoridated salt on urinary fluoride excretion of adults.

After the introduction of fluoridated table salt in the staff cafeteria (VZM) of the Heidelberg University Medical and Dental School, the opportunity was taken to determine urinary fluoride excretion of those eating their main daily meals there. Subjects collected 24-hour urine in three fractions (mornings, afternoons, evenings/nights) before fluoridated table salt was introduced in the VZM, and at 6, 12 and 24 months afterwards. The fluoride concentration in the urine was determined. After 24 months, 127 of the original 200 test persons (study group) and 33 of the 60 persons in the control group could be examined. During this period, each participant in the study group took an average of 3.1 of the main meals each week at noon in the VZM. After fluoridated table salt was introduced at the VZM, fluoride excretion increased only in the afternoon urine of the test group; in this respect, the baseline examination disclosed an average of 33.98 +/- 21.18 microg/h, while the follow-up examinations revealed averages of between 39.72 +/- 22.58 and 42.44 +/- 26.16 microg/h. This difference was statistically significant (Kruskal-Wallis test, p < 0.05). It is recommended that in studies of similar questions, fractions of urine should be collected over 24-hour periods.