Comparative evaluation of esthetic changes in nonpitted fluorosis stains when treated with resin infiltration, in-office bleaching, and combination therapies.

OBJECTIVES: Dental fluorosis leads to esthetic deviation and varies from nonpitted white opacities, dark brown stains to pitting or structural breakdown of enamel surface. Treatment for fluorosis depends on the severity of condition and includes both noninvasive methods and invasive methods. Recently resin infiltration has been proposed as an alternative treatment for nonpitted fluorosis. This study was done to evaluate the esthetic changes in nonpitted fluorosis stains when treated with resin infiltration, in-office bleaching and combination therapies. MATERIALS AND METHODS: The present study is a randomized, single blinded controlled trial with four parallel arms with 1:1 allocation ratio. The intervention arms included bleaching with 35% hydrogen peroxide, resin infiltration, resin infiltration with increased infiltration time and a combination approach of bleaching and infiltration. Immediate esthetic changes were evaluated for two parameters including, 'Change in esthetics' and 'Improvement in opacities/stains' using a VAS scale by two independent observers. Kruskal-Wallis test and Mann-Whitney U-test were done for intergroup comparisons. RESULTS: Best results for both the parameters were observed among patients treated with resin infiltration with increased infiltration time. Mann-Whitney U test revealed significantly better results for resin infiltration groups (alone or combination with bleaching) as compared to bleaching alone (P < .001). CONCLUSIONS: Resin infiltration procedure with tailored etching times and increased infiltration time exhibited best results in terms of change in esthetics and improvement in stains. CLINICAL SIGNIFICANCE: White and brown opacities due to fluorosis have always been a concern for esthetics. In our study, resin infiltration technique with tailored etching times and increased infiltration time exhibited best immediate esthetic improvement for nonpitted fluorotic opacities and stains. These esthetic outcomes reaffirm the applicability of RI technique for nonpitted fluorosis, which was originally advocated only for white spot lesions due to early caries. This will in turn help the dentists to plan the esthetic management of nonpitted fluorosis in a micro-invasive manner.

Esthetic Rehabilitation of Primary Anterior Teeth using Temporization Material: A Novel Approach.

Pediatric dentists should always aim for esthetic and functional rehabilitation of decayed/traumatized primary teeth. The most common method for restoring such teeth involves the use of "strip crowns" with composites, while the recent trend is toward using other extracoronal restorations including preve-neered stainless steel crowns and zirconia crowns. All these restorative options have shown good success rates, but also have some limitations. This case series depicts novel clinical technique of using a temporization material for full-coronal restoration(s) in primary anterior teeth. This included the chair-side custom fabrication of full-coronal restoration using temporization material, which has resulted in good immediate esthetics and might be a cost-effective alternative for restoring primary anterior teeth in future. HOW TO CITE THIS ARTICLE: Gugnani N, Pandit IK, Gupta M, Nagpal J. Esthetic Rehabilitation of Primary Anterior Teeth using Temporization Material: A Novel Approach. Int J Clin Pediatr Dent 2017;10(1):111-114.

Ectopic eruption of maxillary central incisor through abnormally thickened labial frenum: An unusual presentation.

Ectopic eruption is a deviation from the normal eruption pattern, making the tooth erupt out of its normal position, and possibly causing resorption of adjacent primary teeth. A wide range of etiological factors may be responsible for ectopic eruption of the teeth, so their management depends on the correction of the established etiological factor. The present case report describes an unusual case of ectopically erupted central incisor encased within an abnormally thickened labial frenum, which was treated by orthodontic repositioning of the ectopically erupting tooth after frenectomy.

Clinical and radiographic comparison of various medicaments used for pulpotomy in primary molars: A randomized clinical trial.

OBJECTIVE: To evaluate and compare the efficacy of ferric sulfate, glutaraldehyde, and mineral trioxide aggregate (MTA) as pulpotomy medicaments in primary molars. MATERIALS AND METHODS: This was a perspective randomized clinical trial. A total of 90 molars from 42 children aged 4-8 years were selected for pulpotomy procedure. Teeth were randomly divided into three equal groups of 30 teeth each. Teeth in Group I were intended to be treated with ferric sulfate, Group II were intended to be treated with buffered glutaraldehyde and Group III with MTA. All the molars were evaluated clinically at 24 h and both clinically and radio graphically at 1, 3, and 6 months. The observations were statistically analyzed using Chi-square test and Fisher's exact test. RESULTS: After 1 month, there was no clinical finding observed in all the three groups. At 3 months postoperative evaluation, 13.3% of teeth in Group I and 12.5% of teeth in Group II had mobility. At 6 months interval, pain and sinus formation each was noted in 9.1% of primary teeth in Group I while periodontal ligament widening was reported in 66.7% of teeth in Group I and 85.7% of teeth in Group II. CONCLUSION: MTA exhibited overall best results as pulpotomy agent for primary molars followed by 15.5% ferric sulfate, whereas 2% buffered glutaraldehyde was found to be least effective as a pulpotomy agent.

Effect of ethanol wet bonding technique on the durability of resin- dentin bond with contemporary adhesive systems.

OBJECTIVE: To evaluate the effect of ethanol wet bonding technique on the immediate and long term bond strength of simplified etch and rinse adhesive systems to dentin. STUDY DESIGN: 96 extracted human permanent molars were ground to expose the flat dentin surface. The teeth were divided into four groups (n=24) according to the adhesives used, either Tetric N Bond or Solobond M and bonding techniques i.e. water wet bonding or ethanol wet bonding (EWB). Composite cylinder was bonded to each specimen using the respective adhesive technique. Ten samples from each group were then tested immediately for shear bond strength evaluation and two samples for SEM analysis. The remaining samples (12) were tested after 6 month storage in distilled water. RESULTS: Upon immediate testing, there was no significant difference in the mean shear bond strength of the groups regardless of the bonding technique or adhesive used. The bond strength fell dramatically in the water wet bonded specimens after 6 months water storage, while the bond strength of both the adhesives was maintained when EWB technique was used. SEM observation revealed good interfacial adaptation in EWB groups even after six months. CONCLUSION: For both simplified etch and rinse adhesives used, ethanol wet bonding technique led to significant preservation of the resin dentin bond over 6 months.

Stem cell research: applicability in dentistry.

In the face of extraordinary advances in the prevention, diagnosis, and treatment of human diseases, the inability of most tissues and organs to repair and regenerate after damage is a problem that needs to be solved. Stem cell research is being pursued in the hope of achieving major medical breakthroughs. Scientists are striving to create therapies that rebuild or replace damaged cells with tissues grown from stem cells that will offer hope to people suffering from various ailments. Regeneration of damaged periodontal tissue, bone, pulp, and dentin is a problem that dentists face today. Stem cells present in dental pulp, periodontal ligament, and alveolar bone marrow have the potential to repair and regenerate teeth and periodontal structures. These stem cells can be harvested from dental pulp, periodontal ligament, and/or alveolar bone marrow; expanded; embedded in an appropriate scaffold; and transplanted back into a defect to regenerate bone and tooth structures. These cells have the potential to regenerate dentin, periodontal ligament, and cementum and can also be used to restore bone defects. The kind of scaffold, the source of cells, the type of in vitro culturing, and the type of surgical procedure to be used all require careful consideration. The endeavor is clearly multidisciplinary in nature, and the practicing dental surgeon has a critical role in it. Playing this role in the most effective way requires awareness of the huge potential associated with the use of stem cells in a clinical setting, as well as a proper understanding of the related problems.

Esthetic improvement of white spot lesions and non-pitted fluorosis using resin infiltration technique: series of four clinical cases.

White opacities have always been a major concern of esthetics for patients and can have varying etiology. In general, white discolorations of enamel might be due to dental fluorosis, early caries (white spot lesions), developmental defects etc. Conventional treatment options available for such opacities include non-invasive and invasive approaches. Recently, a new "micro-invasive" technique has been introduced as an alternative therapeutic approach that improves such opacities esthetically, in a single sitting, is painless and exhibits no complications. This case series illustrates the use of resin infiltration to treat fluorosis stains and WSLs, exhibiting significant improvement in esthetics.

Surgical management of iatrogenic perforation in maxillary central incisor using mineral trioxide aggregate.

Root perforations are undesired complications of endodontic treatment. The repair of root perforation can be accomplished using different materials and techniques. Mineral trioxide aggregate (MTA) is widely used to seal perforations because of its biocompatibility and sealability. This article describes a case report where an iatrogenic root perforation was repaired successfully with MTA in maxillary right central incisor of a 13-year-old boy.

Clinical efficacy of various root canal obturating methods in primary teeth: a comparative study.

AIM: The purpose of this in vivo study was to evaluate and compare the efficacy of different obturating methods used in primary teeth, when obturated using a combination of zinc oxide and iodoform paste (Endoflas F.S.). MATERIALS AND METHODS: A group of 29 patients aged 3-9 years and a total of 64 teeth were selected. These 64 teeth (32 anterior teeth=32 canals, and 32 posterior teeth=80 canals) were randomly divided into 4 groups. Teeth were obturated with Lentulo spiral, pressure syringe, bi-directional spiral and Pastinject. Post-operative evaluation was done for: quality of canal obturation, (underfilled, optimally filled, overfilled) and presence of voids. RESULTS: Pastinject exhibited the highest number of optimally filled canals, while the highest number of underfilled canals were observed with bi-directional spiral, and the highest number of overfilled canals were observed with pressure syringe. A minimum number of voids was present in canals filled with the Pastinject technique and pressure syringe. CONCLUSION: These results suggest that Pastinject was the most effective technique for obturation of primary teeth.

Effect of proanthocyanidin treatment on the bonding effectiveness of adhesive restorations in pulp chamber.

OBJECTIVE: To analyze the effect of proanthocyanidin (PA) treatment of the pulp chamber dentin after NaOCl and EDTA irrigation on the microleakage and interfacial morphology of adhesive restorations. STUDY DESIGN: Pulp chambers of 66 extracted permanent molars were exposed. In half of the samples, pulp chamber dentin was bonded with Clearfil S3 after irrigation with normal saline (Group1a); 1% NaOCl and 17% EDTA (Group1b) or 1% NaOCl, 17% EDTA and 30% PA (Group1c) and in other half samples, pulp chamber dentin was bonded with Futurabond NR after irrigation with normal saline (Group 2a); 1% NaOCl and 17% EDTA (Group 2b) or 1% NaOCl, 17% EDTA and 30% PA (Group 2c). After adhesive procedures, Filtek Z 250 restorations were placed in the pulp chambers. Microleakage assessment was done in ten samples from each group and scanning electron microscopic examination was done in one sample from each group. Statistical analysis was done using Mann-Whitney and Kruskal Wallis tests at a significance level of P<0.05. RESULTS: Both the adhesives showed extensive microleakage. NaOCl and EDTA irrigation had no significant effect on the microleakage of both the adhesives. PA treatment of the pulp chamber dentin after NaOCl and EDTA irrigation significantly reduced microleakage in both the adhesives. CONCLUSION: It was concluded that 1 minute application of 30% proanthocyanidin solution in the pulp chamber after NaOCl and EDTA irrigation improved the subsequent bonding of self-etch adhesives to pulp chamber dentin.

Dental adhesion: mechanism, techniques and durability.

Contemporary dental adhesives show favorable immediate results in terms of bonding effectiveness. However, the durability of resin-dentin bonds is their major problem. It appears that simplification of adhesive techniques is rather detrimental to the long-term stability of resin-tooth interface. The hydrostatic pulpal pressure, the dentinal fluid flow and the increased dentinal wetness in vital dentin can affect the intimate interaction of certain dentin adhesives with dentinal tissue. Bond degradation occurs via water sorption, hydrolysis of ester linkages of methacrylate resins, and activation of endogenous dentin matrix metalloproteinases. The three-step etch-and-rinse adhesives still remain the gold standard in terms of durability. This review discusses the fundamental process of adhesion to enamel and dentin with different adhesive techniques, factors affecting the long-term bonding performance of modern adhesives and addresses the current perspectives for improving bond durability.

An evaluation of microleakage of various glass ionomer based restorative materials in deciduous and permanent teeth: An in vitro study.

AIM: To evaluate the microleakage of recently available glass ionomer based restorative materials (GC Fuji IX GP, GC Fuji VII, and Dyract) and compare their microleakage with the previously existing glass ionomer restorative materials (GC Fuji II LC) in primary and permanent teeth. METHOD: One hundred and fifty (75 + 75) non-carious deciduous and permanent teeth were restored with glass ionomer based restorative materials after making class I cavities. Samples were subjected to thermocycling after storing in distilled water for 24 h. Two coats of nail polish were applied 1 mm short of restorative margins and samples sectioned buccolingually after storing in methylene blue dye for 24 h. Microleakage was assessed using stereomicroscope. RESULT: Significant differences (P < 0.05) were found when inter group comparisons were done. Except when GC Fuji VII (Group III) was compared with GC Fuji II LC (Group II) and Dyract (Group IV), non-significant differences (P > 0.05) were observed. It was found that there was no statistically significant difference when the means of microleakage of primary teeth were compared with those of permanent teeth. CONCLUSIONS: GC Fuji IX GP showed maximum microleakage and GC Fuji VII showed least microleakage.

Autogenous bone block in the treatment of teeth with hopeless prognosis.

BACKGROUND: Autogenous bone graft, although considered as a gold standard, has been relegated to background because of limited quantity and donor site morbidity. Revival of interest in its use has been reflected by its tremendous capacity for regeneration in less than ideal situation. Bone blocks have been used for implant site augmentation, with varied success. AIM: Aim of the study was to evaluate the efficacy of autogenous bone block in the regeneration of bone, for saving teeth with a hopeless prognosis. SETTINGS AND DESIGN: A total of six patients and 12 sites with grade II and III mobile teeth were treated with autogenous bone blocks and fiber splinting. SUBJECTS AND METHODS: Attachment loss, probing depths, and radiographic bone loss were recorded at baseline and at 12 months interval. STATISTICAL ANALYSIS USED: The Student paired t test was used for evaluation of the changes from baseline to 12 months. RESULTS: At 12 months post-operatively, there was a highly significant amount of bone gain as compared to the baseline. The mean amount of bone loss reduced from 9.41 ± 1.16 to 5.41 ± 1.01. The clinical attachment loss reduced from 7.37 ± 1.24 mm to 3.79 ± 0.89 mm and probing depth reduced from 7 ± 1.67 mm to 5.5 ± 0.63 mm. The grafted bone was observed to have been incorporated with the host bone in most of the sites as evidenced by radiographs. CONCLUSIONS: For teeth with hopeless prognosis, this method can be considered to be a very viable alternative to extraction and replacement by costly implants.

Management of a case of ectodermal dysplasia: a multidisciplinary approach.

Ectodermal dysplasia (ED) is a rare disorder involving 2 or more of the ectodermal structures, which include the skin, hair, nails, teeth, mucus glands, and sweat glands. Each person with ectodermal dysplasia may have a different combination of defects. The most common form of ED is linked to the X chromosome and usually affects men. Another form of the disease affects men and women equally. The patient's special needs are taken into consideration in a treatment plan. The purpose of this case report was to describe the dental management of a 9-year-old boy with ectodermal dysplasia whose maxilla showed the presence of mobile, conical teeth that were unrestorable and a solitary permanent left molar, while his mandible was completely edentulous. These mobile, conical teeth were extracted, and a complete denture was constructed to restore the patient's esthetics, form, and function.

Comparative evaluation of the effectiveness of electronic dental anesthesia with 2% lignocaine in various minor pediatric dental procedures: A clinical study.

One of the most distressing aspects of dentistry for pediatric patients is the fear and anxiety caused by the dental environment, particularly the dental injection. The application and induction of local anesthetics has always been a difficult task, and this demands an alternative method that is convenient and effective. Electronic dental anesthesia, based on the principal of transcutaneous electric nerve stimulation (TENS), promises to be a viable mode of pain control during various pediatric clinical procedures. Therefore, the aim of the present study was to evaluate the effectiveness of TENS and to compare its efficacy with 2% lignocaine during various minor pediatric dental procedures. Pain, comfort and effectiveness of both the anesthetics were evaluated using various scales and no significant difference was observed between 2% lignocaine and TENS in the various pain scales, while TENS was perceived to be significantly effective in comfort and efficacy as judged by the operator and quite comfortable as judged by the patient himself/herself.

Plaque removal efficacy of powered and manual toothbrushes under supervised and unsupervised conditions: a comparative clinical study.

The present study was undertaken to determine and compare the efficacy of manual and powered toothbrushes under supervised and unsupervised conditions in 200 school-going children between 6 and 13 years of age. Two hundred school-going children aged between 6 and 13 years were selected. Children were randomly divided into two groups of 100 in each. Group 1 children were given manual brushes, while group 2 children were given powered brushes. The groups were further divided into two subgroups, with supervised brushing in subgroup A and unsupervised brushing in subgroup B. At 3, 6, 9 and 12 weeks, plaque was recorded according to Turseky-Gilmore-Glickman modification of Quingley Hein index and oral hygiene performance index. Data were statistically analyzed. Both brushes significantly reduced the plaque accumulation, though to different degrees. Powered brushes showed significant plaque reduction as compared to the manual brushes. Supervised group of both brushes showed a greater plaque reduction.

Comparative evaluation of shear bond strength of various esthetic restorative materials to dentin: an in vitro study.

AIM: To comparatively evaluate the shear bond strength of recent tooth-colored restorative materials to dentin. MATERIALS AND METHODS: Flat dentinal surface were prepared from 60 caries free, extracted human permanent molars and were mounted in acrylic rings. These were randomly divided into four groups - Group A to Group D, according to the restorative material used i.e. Glass ionomer cement (Fuji IX), Giomer (Beautifil), an Ormocer-based composite (Admira) and Nano Ceramic restorative material (Ceram X). These restorative materials were applied on dentinal surface of all the specimens using nylon cylinders. The mounted samples were stored in distilled water for 24 hours and thermocycled. They were then subjected to shear bond strength test using universal testing machine. Data was analyzed using a one-way analysis of variance (ANOVA) and student's 't'-test. RESULTS: Ceram X (16.63 ± 0.94 MPa) and Admira (17.31 ± 0.95 MPa) were comparable in their bond strength values, but depicted significantly higher bond strength when compared to Beautifil (12.39 ± 1.05 MPa) and Fuji IX (7.76 ± 1.07 MPa). CONCLUSION: Nano-ceramic and ormocer-based restorative materials showed better bonding potential to dentin as compared to GIC and Giomer.

An evaluation of different caries removal techniques in primary teeth: a comparitive clinical study.

OBJECTIVE: To compare the efficacy of caries removal, time taken and to evaluate the pain threshold experienced by the patient during various caries removal methods. STUDY DESIGN: Eighty patients between the age groups of 5-9 years were selected and caries removal was done by hand instruments, airotor, carisolv and papacarie. The efficacy, time taken and the pain threshold was evaluated during the caries removal by Ericson D et al scale, visual analogue scale respectively. RESULTS: Highly significant relation (< 0.05) was observed when intergroup comparison was made using one way analysis of variance (ANOVA). CONCLUSION: It was concluded that chemomechanical removal of caries with Papacarie and Carisolv were found to be effective measures of caries removal and could be considered as viable alternatives to painful procedures like Airotor in management of dental caries especially in children.

International Caries Detection and Assessment System (ICDAS): A New Concept.

Dental caries is a complex multifactorial disease of the calcified tissues of the teeth, caused by interaction of various factors including the host, agent, substrate and time as demonstrated by the Keyes circle. Detecting carious lesion at the earliest possible stage of its development is definitely helpful in appropriate treatment planning for the same. The lack of consistency among the contemporary criteria systems for detecting carious lesions limits the comparability of outcomes measured in epidemiological and clinical studies. Therefore, the ICDAS criteria was developed by an international team of caries researchers to integrate several new criteria systems into one standard system for caries detection and assessment. It is a clinical scoring system for use in dental education, clinical practice, research, and epidemiology, and provides a framework to support and enable personalized total caries management for improved long-term health outcomes.