Comfort and wearability properties of custom-made and boil-and-bite mouthguards among basketball players: A randomized parallel arm clinical trial.

BACKGROUND/AIM: Thermoplastic mouthguards have been a reliable means of protection against impacts and shocks for a century. Although orofacial injuries are prevalent among basketball players, many athletes still avoid using mouthguards due to concerns regarding impaired breathing, speech interference, and nausea. This study aims to compare basketball players' subjective assessments of two different thicknesses of custom-made mouthguards (MGs) with boil-and-bite MGs (B&B MG). MATERIAL AND METHODS: A total of 60 systematically healthy male professional basketball players, without active orthodontic treatment, were enrolled and randomly assigned to three groups: Group 1 (received B&B MGs; n = 20), Group 2 (received custom-made MGs with a 3 mm thickness [ethyl vinyl asetat]; n = 20), and Group 3 (received custom-made MGs with a 5 mm thickness; n = 20). To evaluate MG comfort and usability, 12 key factors, including comfort, fit, stability, tiredness, thirsting, oral dryness, nausea, speaking, breathing, drinking, ease of wear and removal, and inclination to chew, were assessed. The athletes were made to rate these factors using a 10 cm-long Visual Analog Scale, measured at three-time intervals, and the values for both inter-group and intra-group were compared. RESULTS: Data from 48 basketball players were retrieved, and data analysis revealed that B&B MGs had the least favorable parameter values. Among the B&B MG group, stability was reported to be poorer during the initial measurement (p < .05). In the second measurement, B&B MGs showed significantly lower values for comfort, stability, tiredness, speaking, and inclination to chew (p < .05). During the third measurement, the B&B MG group exhibited significantly reduced values for comfort, breathing, drinking, and speaking (p < .05). In contrast, no statistically significant difference was observed between 3 and 5 mm thickness MGs in these measurements. CONCLUSIONS: Custom-made MGs with different thicknesses consistently outperformed B&B MGs in all measurements, indicating the potential to tailor MG thickness based on sport, age, professional level of athlete, and presence of other protective equipment. While custom-made mouthguards are considered the gold standard, dentists who provide B&B MGs can lead to cost savings while maintaining protection and encouraging athletes to use higher-quality custom-made mouthguards.

Effects of different remineralization agents on MIH defects: a randomized clinical study.

OBJECTIVES: The aim of this study was to present a comparative evaluation of the long-term efficacy of fluoride varnish and pastes containing CPP-ACP and CPP-ACP with fluoride (CPP-ACFP) in the remineralization of creamy-white and yellow-brown defects in permanent first molars with MIH. MATERIALS AND METHODS: The study included 120 teeth with yellow-brown or creamy-white defects in 67 children (37 girls, 30 boys) aged 6-9 years (mean, 7.2) who were newly diagnosed with MIH with no substance loss or caries or prior restorative treatment. The patients were randomly divided into the experiment groups; control (oral hygiene motivation only), fluoride varnish, and pastes containing CPP-ACP and CPP-ACPF, and followed up for 24 months. The evaluations were made based on the ICDAS criteria and the measurements which were performed using the laser fluorescence method (DIAGNOdent, KaVo, Biberach, Germany) in the follow-ups. RESULTS: The research was completed with 49 patients (23 females, 26 males; mean age, 7.7) and 90 teeth. All remineralization agents increased remineralization rates in both creamy-white and yellow-brown colored defects without presenting any statistically significant difference at the end of the follow-up period (p > 0.05). However, the effects of fluoride varnishes were late to observe when compared to pastes containing CPP-ACP and CPP-ACPF. CONCLUSIONS: Pastes containing calcium and phosphate may be recommended for the longer-term preservation of teeth with yellow-brown defects which showed a post-eruptive breakdown in a shorter time. CLINICAL RELEVANCE: There is a lack of studies investigating MIH treatments in which lesion appearance was recorded. This study evaluated creamy-white and yellow-brown MIH defects separately and reported long-term results of different remineralization agents.

A Clinical Evaluation of Deproteinization and Different Cavity Designs on Resin Restoration Performance in MIH-Affected Molars: Two-Year Results.

BACKGROUND: The aim of this study was to evaluate the clinical effects of deproteinization of the hypomineralized enamel and different cavity designs on the performance of the composite resin restorations(CRRs) placed into the cavities of MIH (molar incisor hypomineralization)-affected molars. STUDY DESIGN: 95 MIH-affected permanent first molars (PFMs) and 31 caries but not MIH-affected PFMs (126 teeth in total) were included in the study. The MIH-affected molars were divided into three groups. In Group I, all hypomineralized tissue was removed until healthy enamel was reached. In Group II, carious and cheesy hypomineralized tissue was removed until a reasonable resistance was detected in the hypomineralized tissue. In Group III, cavities designed as Group II, differently from this group deproteinization of the left hypomineralized tissue was performed prior to the placement of CRRs. Group IV served as the control group consisting of unaffected carious PFMs. Restorations were evaluated according to modified USPHS criteria for 24 months. RESULTS: The retention rates were 93.7% for Group I, 80.7% for Group II, 93.5% for Group III and 100% for Group IV. The success rate for the restorations in Group II proved significantly lower (p<0.05) than that of the other three groups. No significant difference in success rates was observed between Group I, Group III and Group IV (p>0.05) at the end of 24 months. CONCLUSIONS: Failure of the restorations was predominant in the group that the hypomineralized tissue was left surrounding the cavities. Deproteinization of the hypomineralized enamel was found to enhance the retention rates of CRRs.

Comparison of Two Base Materials Regarding Their Effect on Root Canal Treatment Success in Primary Molars with Furcation Lesions.

Introduction. The aim of this study was to compare MTA with another base material, IRM, which is generally used on pulpal floor after root canal treatment, regarding their effect on the success of root canal treatment of primary teeth with furcation lesions. Materials and Methods. Fifty primary teeth with furcation lesions were divided into 2 groups. Following root canal treatment, the pulpal floor was coated with MTA in the experimental group and with IRM in the control group. Teeth were followed up considering clinical (pain, pathological mobility, tenderness to percussion and palpation, and any soft tissue pathology and sinus tract) and radiographical (pathological root resorption, reduced size or healing of existing lesion, and absence of new lesions at the interradicular or periapical area) criteria for 18 months. For the statistical analysis, Fisher's exact test and Pearson's chi-square tests were used and a p value of <0.05 was considered to be statistically significant. Results. Although there were no statistically significant differences between two groups in terms of treatment success, lesions healed significantly faster in the MTA group. Conclusion. In primary teeth with furcation lesions, usage of MTA on the pulpal floor following root canal treatment can be a better alternative since it induced faster healing.

Review of current concepts of revascularization/revitalization.

This review focuses on the current concepts on revascularization/revitalization therapy. Revascularization/revitalization procedures performed under current protocols have reportedly achieved successful clinical and radiographical outcomes for immature permanent teeth with non-vital pulps; however, randomized prospective studies are needed to develop evidence-based methodologies for regenerative endodontic treatment.

Efficacy of platelet-rich plasma as a scaffold in regenerative endodontic treatment.

INTRODUCTION: Current research is concerned with discovering better scaffolds for use in regenerative endodontic treatment. This study aimed to clinically and radiographically evaluate the efficacy of platelet-rich plasma (PRP) used as a scaffold in regenerative endodontic treatment and compare it with that of a conventional blood clot (BC) scaffold. METHODS: A total of 20 necrotic, single-rooted immature teeth were randomly distributed into 2 groups. After disinfecting the root canal space with triple antibiotic paste (1:1:1 ciprofloxacin, metronidazole, and cefaclor), a tissue scaffold was created by using either PRP or BC and covered with white mineral trioxide aggregate. Clinical and radiographic follow-up examinations were performed once every 3 months during an 18-month period. Differences in root area were calculated from preoperative and postoperative radiographs. Fisher exact and Mann-Whitney U tests were used to evaluate differences between groups, with P value <.05 considered to be statistically significant. RESULTS: All 20 teeth were clinically asymptomatic during 18-month follow-up period; however, 1 tooth in the BC group exhibited periapical pathosis and was judged radiographically unsuccessful. Complete apical closure was observed in a mean of 8.1 months in the PRP group compared with 9 months in the BC group. The PRP group exhibited 9.86% increase in root area, compared with 12.6% increase in the BC group. The difference in success rates between the groups was not statistically significant (P > .05). CONCLUSIONS: PRP successfully created a scaffold for regenerative endodontic treatment; however, treatment outcomes did not differ significantly between PRP and conventional BC scaffold.

Clinical evaluation of desensitizing treatment for incisor teeth affected by molar-incisor hypomineralization.

BACKGROUND: Sensitivity complaints are commonly observed in teeth affected by MIH (molar incisor hypomineralization). AIM: This study aimed to evaluate the hypersensitivity observed in MIH-affected teeth and the effect of desensitizing agents applied with and without ozone to incisors affected by MIH. STUDY DESIGN: The first part of the study included 120 teeth from 42 patients with MIH. These 42 patients included 33 children with 92 incisor teeth with a Vas score of > or = 30, and these 92 incisors were included in the second part of the study. The patients included in the second part were divided into three main groups and six subgroups. The main groups included the following: fluoride, CPP-ACP and CPP-ACP with fluoride. Each main group was divided into two subgroups: one with ozone use and one without ozone use. RESULTS: Girls exhibited significantly more sensitivity compared with boys (p < 0.05). There were significant decreases in hypersensitivity compared to baseline in all of the groups (p < 0.05). There were no differences among the groups at the end of the study (p > 0.05). CONCLUSION: The results of this study revealed that gender is an important factor in the sensitivity of teeth with MLH. Desensitizing agents effectively reduced the hypersensitivity of teeth with MIH. CPP-ACP paste was found to be more effective, and ozone therapy prolonged the effect of CPP-ACP paste.

Comparative evaluation of Ca(OH)2 plus points and Ca(OH)2 paste in apexification.

AIM: The aim of this study was to compare calcium hydroxide plus points (CHPPs) with the conventional calcium hydroxide paste (CHP) clinically and radiographically as materials used in apexification treatment. MATERIAL AND METHODS: Sixteen children, each with at least one necrotic permanent central incisor requiring apexification treatment, were selected for this study. Twenty-two selected teeth were divided into two test groups (10 CHP and 12 CHPP). The children were recalled for clinical evaluations every 3 weeks, and their radiographical evaluations were carried out every 3 months. Mann-Whitney U and Fisher's exact tests were used to evaluate the differences between the groups. RESULTS: The follow-up evaluations revealed that the success rate was 100% for CHP and 92% for CHPP. No statistically significant difference between the groups was observed (P > 0.05). CONCLUSIONS: CHPP-treated central incisors requiring apexification demonstrated good success. CHPP can be used for cases in which traditional Ca(OH)(2) apexification is indicated as it has a similar outcome with CHP.

Knowledge level of primary school teachers regarding traumatic dental injuries and their emergency management before and after receiving an informative leaflet.

AIM: The aim of this study was to evaluate via a questionnaire the knowledge level of primary school teachers in Ankara, Turkey, regarding dental trauma; to inform them on the subject through a leaflet; and to evaluate the effectiveness of the leaflet by reapplying the questionnaire. MATERIALS AND METHODS: A questionnaire was distributed to 500 teachers in seven randomly selected primary schools. The questionnaire consisted of four different scenarios presented with photographs and a total of eight questions on crown fracture, lateral luxation, root fracture, and avulsion. After responding to the questionnaire, teachers were given a leaflet containing information about traumatic dental injuries and their emergency management. After 1 month, the same questionnaire was distributed, and the responses collected. RESULTS: A total of 450 of 500 teachers responded to the questionnaire. Initial responses indicated the knowledge level of teachers to be quite low. Following the distribution of the information leaflet, the rate of correct answers increased for each of the individual questions, and the total scores for the questionnaire increased significantly (P = 0.0001). CONCLUSION: There is a clear need to inform teachers about traumatic dental injuries. The use of educational leaflets can be a successful and appropriate means of providing teachers with information.

The prevalence and treatment outcomes of primary tooth injuries.

OBJECTIVES: The aim of the present study was to evaluate the type and prevalence of primary tooth injuries, as well as their treatment and treatment outcomes, among children referred to the Department of Pedodontics at the Ankara University Faculty of Dentistry in Turkey. METHODS: The study population consisted of patients applying to the department with a primary tooth injury over a period of 21 months. Fifty-one patients presented with trauma to 99 primary teeth. Clinical and radiographic examinations were conducted on each patient. Age, sex, time, cause of injury, and number of teeth affected were recorded, and the type of trauma was identified according to Andreasen's classification. The teeth were treated by one of the authors. RESULTS: The majority of trauma occurred between the ages of 2 and 4. The most common type of injury was lateral luxation (33.3%). Most injuries (33.3%) presented during May. The most common form of treatment was follow-up only (39.4%), followed by extraction (29.3%) and root canal treatment (12.1%). The average follow-up period was 11 months. During the follow-up period, complications were observed in 4 teeth. CONCLUSIONS: The study results show that in the absence of acute symptoms, parents tend not to apply to a dental clinic for children's injuries. This finding highlights the importance of informing the public about primary tooth injuries and their consequences.

Treatment of aggressive external root resorption with calcium hydroxide medicaments: a case report.

Intrusive luxation is an injury involving the axial displacement of a tooth into the alveolar socket. This paper describes apexification using calcium hydroxide medicaments of an immature permanent central incisor in which spontaneous re-eruption as well as severe inflammatory external root resorption was observed following traumatic intrusion. A 10-year-old boy was referred to the Department of Pediatric Dentistry 3 days after having fallen at school. Intraoral examination revealed intrusive luxation and an enamel-dentin crown fracture of the maxillary left central incisor (Tooth 21). The tooth was not sensitive to percussion and responded positively to electric pulp test. Radiographic examination indicated that the tooth had an open apex and had been intruded approximately 3-4 mm relative to the cemento-enamel junction of the adjacent right central incisor. The tooth was left for possible spontaneous re-eruption. The crown fracture was temporarily restored using glass ionomer cement, and the patient was scheduled for recall in 2 weeks, at which time intraoral examination revealed spontaneous re-eruption of the tooth. However, radiographic examination also showed inflammatory external root resorption. The root canal was accessed and filled with a calcium hydroxide paste; however, follow-up examination indicated continuing resorption after 1 month. Calcium hydroxide plus points (CHPP) was chosen as an alternative treatment. At the end of 6 months of CHPP treatment, examination showed no further progression of external resorption and complete apexification of the tooth. After a 24-month follow-up period, no signs of pathosis were observed.

Bleaching a devital primary tooth using sodium perborate with walking bleach technique: a case report.

Nowadays, both children and parents place a greater value on appearance and aesthetics than has previously been the case. Primary teeth with intrinsic discoloration may be treated by a number of methods, including facings and abrasion. However, dental bleaching may offer a safer alternative that can be completed with less chair time and without harming dental structures. This case report describes the treatment of a darkened primary tooth of a 4-year-old boy with sodium perborate using the walking bleach technique and its 1-year clinical and radiographical follow-up. During this 1-year follow-up period, no signs of any pathology were observed either clinically (sensitivity to percussion or palpation, fistulae, color change) or radiographically (external or internal root resorption, apical radiolucency). In this study, using sodium perborate with the walking bleach technique is found to be successful in whitening primary teeth and can be recommended as a safe alternative for the bleaching of devital primary teeth with intrinsic discoloration.

Orthodontic extrusion of a traumatically intruded permanent incisor: a case report with a 5-year follow up.

This report presents a case of intrusive luxation of the immature left maxillary central incisor in an 8-year-old girl. Initially, it was decided to allow the intruded tooth to spontaneous re-erupt because it had open apices. After 12 weeks of monitoring for spontaneous re-eruption, there was no clinical evidence of its occurrence. Therefore, orthodontic extrusion was initiated. The intruded tooth was repositioned with a fixed multibracketed appliance. Twenty weeks after the beginning of orthodontic extrusion, the position of the intruded maxillary central incisor was restored to its original position before its displacement occurred. After 5 years, no clinical or radiographic pathology was detected and obliteration of the pulp canal of the intruded tooth was observed radiographically.

The relationship between sports activities and permanent incisor crown fractures in a group of school children aged 7-9 and 11-13 in Ankara, Turkey.

The objective of the study was to determine the distribution, aetiology of the crown fractures of permanent anterior teeth in children aged 7-9 and 11-13 years and to identify the role of participation in sports associated with crown fractures. The study population comprised 2570 students from 10 primary schools randomly selected from five municipalities in Ankara, Turkey. Two paediatric dentists examined all permanent maxillary and mandibular incisors for evidence of fracture and completed a standardized examination form to obtain information on the age, gender, severity of incisor injury and frequency and type of sports participation for each child, as well as whether or not children used mouthguards during sports activities. Chi-square and z-tests were used to determine differences. A total of 191 (7.43%) of the 2570 subjects examined were affected by dental trauma. The proportion of fractured incisors was significantly higher in males than in females among older children (P < 0.01). Out of a total of 222 fractured teeth, 84% involved the maxillary central incisors. Bicycling caused significantly higher rates of crown fractures than other types of sports (P < 0.05). The percentage of incisal fractures caused by sports-related accidents was 14.14%. The number of children interested in sports is high, and the sports chosen are generally contact sports. The high rate (14.14%) of crown injuries caused by sports activities supports these findings.

Evaluation of the applicability of temporomandibular opening index in Turkish children with and without signs and symptoms of temporomandibular joint disorders.

Limitation of mandibular movement is one of the cardinal signs of temporomandibular disorders. Temporomandibular Opening Index (TOI) is a new technique to determine the restricted mouth opening in temporomandibular joint dysfunction syndrome (TMD). The purpose of this study was to compare the TOI of Turkish children with and without TMD in primary, mixed, and permanent dentitions. In this study, a total of 270 children were evaluated. One hundred thirty-five (135) subjects had no signs or symptoms of TMD (Group 1), while the remaining 135 subjects did have signs and symptoms of TMD (Group 2). Forty-five (45) patients were selected for each dentition for two groups. "Maximum Voluntary Mouth Opening" (MVMO) values and TOI ranges were calculated. A Mann-Whitney U test and a Kruskal Wallis test were used to compare the data (p<0.05). TOI showed statistical differences between all dentitions with and without TMD (p<0.05). There were no significant differences between different dentitions or genders in Group 1 or Group 2 (p<0.05).

Late term complications of intruded permanent incisors: 2 case reports.

This report describes 2 cases of intrusive luxation injuries of maxillary immature permanent central incisors. In both cases, intruded teeth were left for spontaneous re-eruption. During periodic follow-ups for up to 2 years the teeth did not show any sign, clinically or radiographically, of pulp necrosis with apical periodontitis. However, in the first case tenderness to percussion and periapical radiolucency developed after 2.5 years and endodontic treatment was started. In the second case, the patient returned after 2 years 9 months with complaint and periapical radiolucency was observed radiographically. Endodontic therapy was performed. These late-term complications highlight the need for regular long-term follow-up in cases of intrusive luxation in permanent teeth.

Horizontal root fracture followed for 6 years.

Intra-alveolar root fractures in permanent teeth are uncommon injuries among dental traumas. Generally, the principles of treating horizontal root fractures of permanent teeth are repositioning and fixation. The present paper reports 6-years follow up of two horizontally root-fractured teeth that were healed with calcified tissue. Both of the teeth were clinically and radiographically symptomless and showed complete pulp canal obliterations.

Microleakage of class-v composite restorations with different bonding systems on fluorosed teeth.

OBJECTIVES: To examine the effects of dental fluorosis and total and self-etch bonding systems on microleakage of Class-V composite restorations in permanent molar teeth. METHODS: Teeth were classified as three main groups according to Thylstrup-Fejerskov Index (TFI) as TFI=0, TFI=1-3 and TFI=4. Total and self-etching/bonding procedures were determined for each main group. Total-etching procedures were acid-etching for 30s and acid-etching for 60s with Single Bond/total-etch bonding system. Self-etching procedure was applied with Prompt-L-Pop/self-etch bonding system. 63 box-shaped Class-V cavities (4 x 2 x 2 mm) were prepared on mid-buccal/palatinal/lingual surfaces of teeth for totalling nine test groups (n=7). Restorations with composite material (Charisma) polymerized with halogen unit for 40s. Teeth were thermocycled between +5 degrees C - +55 degrees C (x500), immersed in 0.5% basic-fuchsin solution (37 degrees C, 24h) and separated longitudinally in bucco-lingual direction. Dye penetration was examined under stereomicroscope (3.2 x 10). RESULTS: Microleakage levels were higher in teeth of TFI=4 than TFI=0 occlusally or cervically (P<.05). In TFI=0; total-etched teeth for 30s have statistically shown more leakage than total-etched teeth for 60s occlusally or cervically (P<.05). In TFI=4; microleakage levels were significantly higher for 30s than 60s cervically (P<.05). For all TFI levels, microleakage was commonly increased with self-etch system than total-etch system (P<.05). Generally, higher leakage was present at cervical margins than occlusal margins (P<.05). CONCLUSIONS: Microleakage has increased by severity of dental fluorosis. Generally, more leakage was observed in total-etched teeth for 30s than 60s. Microleakage was commonly higher in self-etched teeth than total-etched teeth. More leakage was present at cervical margins than occlusal margins.

Spontaneous re-eruption of intruded permanent incisors: five case reports.

This report presents 5 cases of intrusive luxation in immature permanent central incisors. The intruded incisors, with careful monitoring, were allowed to spontaneously re-erupt, which avoided the need to reposition the tooth either orthodontically or surgically. All of the teeth re-erupted spontaneously in a few months. The root development continued in all of the cases and all pulps remained vital. There were no other signs of pulpal and/or periapical pathology. It can be concluded that intruded immature permanent teeth can spontaneously re-erupt, conserve their vitality, and continue their root development without any surgical or orthodontic management.

Resin composite sealant vs. polyacid-modified resin composite applied to post eruptive mature and immature molars: two year clinical study.

The aim of this study was to evaluate the effect of the post eruptive enamel maturation on the durability of polyacid-modified resin composite (PMRC; Dyract Seal) and resin composite (Fissurit F) sealant and understanding the effect of posteruptive enamel maturation on the sealant retention. To determine the possible effect of the enamel maturation to the sealant retention, the success of the sealants applied to the newly erupted mandibular first molars of the 6 to 7 years old children, who were in the fourth or fifth eruption stage according to Dennison's classification were compared with the sealants applied to first mandibular molars which were in the mouth at least for two years of the 9 years old children. The molars of the younger children were accepted as immature and the elders were posteruptively mature. The sealant retention was evaluated for two years. At the end of two years the retention rates of Dyract Seal were significantly lower. Maturation has no effect on the sealant retention. Dyract Seal application after NRC conditioning is not recommended.