Evaluation of calcium hydroxide root canal filling materials by cone beam computed tomography and three-dimensional modeling.

AIM: The aim of this study was to compare the effectiveness of filling pastes in resin prototype primary molars by cone beam computed tomography (CBCT) and 3D modeling.

Can sleeping habits be associated with sleep bruxism, temporomandibular disorders and dental caries among children?

BACKGROUND: Sleeping problems are common in the pediatric population. Their potential relationship with oral manifestations is in the scope of researchers' interest. OBJECTIVES: The aim of the present study was to evaluate the possible associations between sleeping habits and sleep bruxism, temporomandibular disorders (TMD) and dental caries among children by using Children's Sleep Habits Questionnaire (CSHQ). MATERIAL AND METHODS: A cross-sectional study was carried out at the Faculty of Dentistry of Istanbul Aydin University, Turkey, with a representative sample of 100 children aged 6-13 years. The CSHQ was completed by their parents. In addition, an intraoral examination was carried out in a clinical setting and sleep bruxism was recorded. The temporomandibular joints (TMJ) were examined and TMD were rated according to the Helkimo anamnestic and clinical dysfunction index. Data was analyzed with Fisher's exact test and the χ2 test. RESULTS: Among sleeping habits, bedtime resistance was found to be significantly associated with sleep bruxism and TMD symptoms in children. Sleep behavior problems were also found to be related to TMD. Untreated dental caries was significantly associated with sleep fragmentation. CONCLUSIONS: Sleep bruxism, TMD and untreated dental caries might have a negative impact on children's sleeping habits and characteristics. Pediatricians and pedodontists should collaborate to identify the causes and clinical features of sleeping habits and disorders in order to avoid adverse effects on the child's stomatognathic system.

Evaluation of Postoperative Pain Following Single-Visit Root Canal Treatment with Rotary and Reciprocal Ni-Ti File Systems in Children.

Background and Objectives: Postoperative pain is a common symptom of a flare-up after root canal treatments (RCTs). Insufficient instrumentation, extrusion of irrigation solutions and debris, and the existence of a periapical lesion are the factors affecting postoperative pain after root canal treatments. The aim of this study was to evaluate the postoperative pain and instrumentation time of the single-file reciprocating system and multiple-file Ni-Ti rotary system in children ages 9-12 years old. Materials and Methods: Our study was conducted on 51 permanent mandibular molars with the diagnosis of irreversible pulpitis. Patients were randomly assigned into two groups, and RCTs were completed with either the Reciproc Blue or Protaper NEXT file systems. Instrumentation time for each system was noted, and patients were given a pain scale that included a visual analog scale for 6, 24, 48, and 72 h after treatment. Postoperative pain scores and instrumentation times were analyzed statistically with a chi-square test and Student's t-test. Results: There was no statistically significant difference in postoperative pain between the Reciproc Blue and Protaper NEXT systems at all time intervals. Instrumentation time was significantly shorter in the Reciproc Blue group in comparison with the Protaper NEXT group. Conclusions: Postoperative pain findings following RCT using single-file reciprocating systems were similar to the rotary system group. However, chair time in the reciprocating system group was significantly lower. This provided a comfortable and patient-friendly treatment approach for children, and could enhance their cooperation.

Effects of short-term xylitol chewing gum on pro-inflammatory cytokines and Streptococcus mutans: A randomised, placebo-controlled trial.

INTRODUCTION: Dental caries is an infectious disease with predominantly of cariogenic bacteria such as Streptococcus mutans (S mutans). Xylitol is considered as one of the effective agents that can limit this dental infection. In this randomised, placebo-controlled trial, we aimed to evaluate the potential reflection of short-term xylitol consumption on pro-inflammatory cytokines (TNF-α, IL-6 and IL-8) and S mutans counts by ELISA and qPCR (Quantitative real-time PCR), respectively. METHODS: In this study, 154 participants were assigned to two groups, control and xylitol. Dental examination, saliva and swab samples were done at baseline and at 3-week for clinical and microbiological assessment. RESULTS: In xylitol group at the end of 3-week, gingival and plaque index scores were significantly decreased with respect to baseline values (P < .001 and P < .05, respectively). The salivary concentration of TNF-α, IL-6 and IL-8 were statistically declined at 3-week, more so than those at baseline in xylitol group (P < .001). S mutans expression was reduced about fivefold at 3-week use of xylitol and it was a statistically significant difference compared to baseline (P < .001). CONCLUSION: Intriguingly, even short-term consumption of xylitol might play a favourable role in maintaining the oral health status, possibly as a result of decreasing the release of pro-inflammatory cytokines and the counts of S mutans. Nonetheless, this investigation warrants further endorsement.

Comparative evaluation of pro-inflammatory cytokine levels in pulpotomized primary molars.

The present in vivo study was performed to investigate the levels of the pro-inflammatory cytokines, interleukin (IL)-1α, IL-6, and IL-8, in primary molars for which pulpotomy was clinically indicated, and to evaluate the success rates of three different pulpotomy agents employed for cariously (CExp) or mechanically exposed (MExp) primary molars. Forty-seven primary molars were classified as MExp or CExp according to the type of pulpal exposure. Pulp tissue was harvested and analyzed using enzyme-linked immunosorbent assay (ELISA). Subsequently, three pulpotomy agents-calcium hydroxide (CH), mineral trioxide aggregate (MTA), and formocresol (FC)-were applied randomly, and the outcome was observed radiographically for 18 months. Levels of IL-6 and IL-8 were significantly higher in CExp pulp than in MExp pulp (P < 0.05). In the CH pulpotomy group, MExp teeth showed a higher success rate than CExp teeth. There was no significant difference in success rate between MExp and CExp teeth in both the FC and MTA groups. The levels of IL-6 and IL-8 have the potential to become indicators of pulp status and can be monitored by researchers to make the prognosis of vital pulp therapies less uncertain. As MTA and FC yielded higher rates of success than CH in CExp teeth, the choice of pulpotomy agent appears to be important in this context.

The effect of different enamel surface treatments on microleakage of fissure sealants.

OBJECTIVE: The aim of this study was to evaluate the effects of different techniques of surface treatment on the microleakage of fissure sealants in permanent molar teeth in vitro. MATERIALS AND METHODS: 96 extracted impacted human third molars were randomly divided into 8 surface treatment groups (n=12/group) as 1. Er: YAG laser ; (Fidelis II, Fotona, Ljubljana, Slovenia) (125 mj, 20Hz) ; 2. Er: YAG laser + 37% H3PO4 (15s) ; 3. ER: AG laser + 37% H3PO4+Prime&Bond NT ; 4. Er: YAG laser + G Bond ; 5. Er: YAG laser + Prime&Bond NT ; 6. 37% H3PO4 ; 7. 37% H3PO4 + Prime&Bond NT ; 8. G Bond. Sealant material (Clinpro, 3M ESPE, Seefeld, Germany), was applied into the fissures and light-cured for 20s with LED (Bluephase C5, Ivoclar-Vivadent, Schaan, Liechtenstein). Specimens were subjected to thermocycling (1000×, 5-55°C, dwell time: 15s) and immersed in 0.5% basic fuchsin solution for 24h at 37°C. The samples were sectioned and scored on a 3 point rating scale using a light microscope with a magnification of ×20. One-way analysis of variance was used to analyze data. Multiple comparisons were analyzed using Bonferroni test (p=0.05). RESULTS: Er:YAG laser showed the highest microleakage scores whereas Er YAG laser + 37% H3PO4 showed the lowest. Although 37% H3PO4 group showed higher scores than Er:YAG laser + 37% H3PO4, the difference was not statistically significant. CONCLUSION: Etching fissures with phosphoric acid is sufficient prior to fissure sealant application.

Effect of orthodontic appliances on oral microbiota--6 month follow-up.

OBJECTIVE: This study investigates the effect of fixed and removable orthodontic appliances among children on salivary Streptococcus mutans, Lactobacillus sp. and Candida albicans. STUDY DESIGN: The study was conducted on 69 patients aged between 6-17 years who used fixed or removable orthodontic appliances. Five ml samples of unstimulated saliva from each patient were collected at baseline and at the 1, 3 and 6 month periodic controls. Samples were diluted and plated on Mitis Salivarus Agar (MSA), Man Rogosa Sharp Agar (MRS) and Saboroud Dextrose Agar (SDA). The growths on the plates were examined under a stereomicroscope. Numbers of colony forming units (CFU) per plate were counted. For statistical analysis, the paired t test and Chi-Square were used. RESULTS: S mutans and Lactobacillus sp counts increased significantly 6 months after the insertion of fixed/removable orthodontic appliances in the oral cavity. A significant increase for C albicans presence was noted after 3 months compared with baseline for fixed appliances. CONCLUSION: Long-term utilization of orthodontic appliances may have a negative effect on microbial flora and increase the risk of new carious lesions and periodontal problems. Patients should be recalled within short time intervals to be motivated for oral hygiene during their orthodontic therapy.

Delayed replantation of an avulsed tooth after 5 hours of storage in saliva: a case report.

This article reports a clinical case of a 8-year-old boy, who underwent an avulsion of the upper left central incisor. The avulsed tooth was kept in the oral cavity in direct contact with saliva for 5 h from the moment of trauma until its replantation. Treatment guidelines for avulsed mature permanent teeth were followed. The clinical and radiographic findings after 2 years revealed absence of root resorption, ankylosis or mobility of the replanted tooth.

Managing dental caries in children in Turkey--a discussion paper.

BACKGROUND: This paper describes the oral healthcare system and disease situation amongst children in Turkey. Considering the high prevalence and severity of dental caries, a proposal for improvement of oral health in this population group is formulated. DISCUSSION: A virtual absence of palliative, preventive and restorative care characterises juvenile oral healthcare in Turkey. Consequently, carious cavities remain untreated, which may lead to pain, discomfort and functional limitation and, further, may impact negatively upon general health and cognitive development. As a first step to controlling dental caries, a national health programme including promotional, preventive and minimal intervention approaches for managing dental caries is proposed. The pros and cons of community-oriented caries-preventive measures are discussed. Daily tooth brushing with fluoridated toothpaste at home, in mother- and child-care centres, kindergartens, and schools is highlighted. SUMMARY: The dental profession, government, university officials and other stakeholders need to meet and determine how best the oral health of children in Turkey can be improved. The present proposed plan is considered a starting point.

Two years survival rate of class II composite resin restorations prepared by ART with and without a chemomechanical caries removal gel in primary molars.

The aim was to test the null hypotheses that there is no difference: (1) in carious lesion development at the restoration margin between class II composite resin restorations in primary molars produced through the atraumatic restorative treatment (ART) with and without a chemomechanical caries removal gel and (2) in the survival rate of class II composite resin restorations between two treatment groups after 2 years. Three hundred twenty-seven children with 568 class II cavitated lesions were included in a parallel mouth study design. Four operators placed resin composite (Filtek Z 250) restorations bonded with a self-etch adhesive (Adper prompt L pop). Two independent examiners evaluated the restorations after 0.5, 1, and 2 years using the modified Ryge criteria. The Kaplan-Meier survival method was applied to estimate survival percentages. A high proportion of restorations were lost during the study period. Therefore, the first hypothesis could not be tested. No statistically significant difference was observed between the cumulative survival percentages of restorations produced by the two treatment approaches over the 2-year period (ART, 54.1 +/- 3.4%; ART with Carisolv, 46.0 +/- 3.4%). This hypothesis was accepted. ART with chemomechanical gel might not provide an added benefit increasing the survival percentages of ART class II composite resin restorations in primary teeth.

Supernumerary primary tooth with facial and palatal talon cusps: a case report.

Talon cusp is a tooth anomaly originating from the tooth's lingual surface in most cases. To date, very rare cases have been reported documenting talon cusps both on the facial and palatal surface of an affected tooth in the dental literature. The purpose of this case report was to describe the facial and palatal talon cusps on an ectopic supernumerary primary maxillary tooth. A micro-CT investigation indicated no pulpal extensions within facial and palatal talon cusps.

Micro-CT for measuring marginal leakage of Class II resin composite restorations in primary molars prepared in vivo.

PURPOSE: To evaluate the reliability of marginal leakage assessment of self-etch adhesive Class II resin composite restorations in primary molars prepared in vivo using the micro-CT. METHODS: Fourteen primary molars, divided over seven ART and seven traditional resin composite Class II restorations, were subjected to marginal leakage test using a 50% (w/v) silver nitrate solution for 4 hours by a micro-CT. Two evaluators selected the image with the deepest marginal dye penetration for each restoration from the occlusal and approximal surfaces on consensus. The deepest dye penetration depth and total length of the axial cavity wall from both the occlusal and from the approximl surface were measured manually using morphometric quantification software by three evaluators independently. ANOVA was applied to test for differences in marginal leakage scores between the three evaluators. RESULTS: There was no marginal leakage found in five traditional and one ART restoration. The percentage of silver nitrate penetration depth from the cervical-approximal site ranged from 10.2-92.6%. There was only a statistically significant difference observed in measuring total axial wall length from the cervical-approximal site between the three evaluators (P = 0.02). This explanatory investigation showed that the micro-CT was a very useful device for developing a standardized method for measuring marginal leakage from samples obtained in vivo. In combination with 50% (w/v) silver nitrate and 4-hour immersion, marginal leakage along the restoration-tooth tissue interface was accurately and reliably measured. (Am J Dent 2008;21:393-397).

Perceived dental anxiety among schoolchildren treated through three caries removal approaches

OBJECTIVES: The aim of the investigation was to test the differences in the perceived level of dental anxiety among children treated restoratively using the Atraumatic Restorative Treatment (ART) approach, the traditional restorative (TRA) approach and ART aided with a chemomechanical caries removal gel (ART plus). METHODS: The study subjects were 6-7-year-old children. TRA was compared to ART in a clinical setting after children had seen a dentist twice (Group A), ART was compared to 'ART plus' in a clinical setting after children had seen a dentist once (Group B) and ART was applied outside the clinic on school premises (Group C). The treatments were carried out in Class II cavitated dentine lesion in primary molars. Dental anxiety was measured using the Venham Picture Test (VPT). Three-way analysis of variances and interaction was applied to test for treatment approach, gender and operator effects on the mean VPT scores. RESULTS: There was no statistically significant difference (p=0.80) observed between the mean VPT scores for the traditional approach and those for the ART approach and between ART with and without a chemomechanical caries removal gel (p=0.07). Children in Group A had lower mean VPT scores than children in Group B (p=0.02) and Group C (p<0.00001) when treated using the ART approach by the same two operators. CONCLUSIONS: The level of dental anxiety was low. There was no difference in level of dental anxiety observed in children treated with ART in comparison to the traditional restorative approach, and between children treated with ART with and without a chemomechanical caries removal gel. The treatment environment and prepatory visits may be factors determining the level of dental anxiety in children treated through the ART approach only.

Perceived dental anxiety among schoolchildren treated through three caries removal approaches.

OBJECTIVES: The aim of the investigation was to test the differences in the perceived level of dental anxiety among children treated restoratively using the Atraumatic Restorative Treatment (ART) approach, the traditional restorative (TRA) approach and ART aided with a chemomechanical caries removal gel (ART plus). METHODS: The study subjects were 6-7-year-old children. TRA was compared to ART in a clinical setting after children had seen a dentist twice (Group A), ART was compared to 'ART plus' in a clinical setting after children had seen a dentist once (Group B) and ART was applied outside the clinic on school premises (Group C). The treatments were carried out in Class II cavitated dentine lesion in primary molars. Dental anxiety was measured using the Venham Picture Test (VPT). Three-way analysis of variances and interaction was applied to test for treatment approach, gender and operator effects on the mean VPT scores. RESULTS: There was no statistically significant difference (p=0.80) observed between the mean VPT scores for the traditional approach and those for the ART approach and between ART with and without a chemomechanical caries removal gel (p=0.07). Children in Group A had lower mean VPT scores than children in Group B (p=0.02) and Group C (p<0.00001) when treated using the ART approach by the same two operators. CONCLUSIONS: The level of dental anxiety was low. There was no difference in level of dental anxiety observed in children treated with ART in comparison to the traditional restorative approach, and between children treated with ART with and without a chemomechanical caries removal gel. The treatment environment and prepatory visits may be factors determining the level of dental anxiety in children treated through the ART approach only.

Survival of self-etch adhesive Class II composite restorations using ART and conventional cavity preparations in primary molars.

PURPOSE: To test the null-hypothesis that there was no difference in the survival percentages of Class II composite restorations in primary teeth produced through either ART or conventional approaches after 2 years. METHODS: 157 children with 325 Class II cavitated dentin lesions were included in a split-mouth study design. A computer program randomly assigned cavitated dentin lesions to treatment groups stratified for gender, operator, upper/lower jaw and left/right side of the mouth. Three operators placed resin composite (Pertac II) restorations using a self-etch adhesive (Prompt L-Pop). Two independent examiners evaluated the restorations after 0.5, 1 and 2 years using the modified Ryge criteria. A modification of the actuarial survival method was applied to estimate survival percentages. RESULTS: There was no statistically significant difference (P > 0.05) observed between the cumulative survival percentages of Class II composite restorations in primary teeth produced by the two approaches after 2 years (ART: 34.9% +/- 4.7%; conventional: 35.1% +/- 4.7%). The cumulative survival percentages of ART and conventional Class II restorations of one of the operators were lower than for ART restorations of the other two operators and for conventional restorations of one of the operators (P < or = 0.001). The main reason for Class II composite restorations to fail over the 2-year period was complete loss of retention; ART: 75%; conventional: 77%. The null-hypothesis was accepted as there was no difference in the cumulative survival percentages of ART and conventional Class II composite restorations in primary teeth after 2 years. It appears that the low survival results obtained may have been caused by poor bonding of the self-etch adhesive.