Anterior crowns for primary anterior teeth: an evidence based assessment of the literature.

AIM: To review the literature concerning the restoration of primary anterior teeth with pre-formed crowns or with the use of crown forms. METHODS: A search of the dental literature was made electronically using key words: crowns, primary teeth, anterior teeth, strip crowns, stainless steel crowns, veneered crowns, (a)esthetic, restorative. All papers were reviewed and assessed for their relevance to paediatric dentistry and then graded according to a set or predetermined criteria. These criteria were used to identify those reports that met 100% of the criteria, graded A; 75% grade B1; more than 50% graded B2 and all others graded C. RESULTS: There were 90 papers in all using the key words. Of these none were rated grade A; B1 or B2 and all remaining valid papers (not single restoration case reports), 50 were graded C. Failure rates varied between 0% and 50% for strip crowns; 32-39% for veneered metal crowns. The review indicated there is some evidence as to the efficacy and value of using anterior primary teeth crowns because of the improved aesthetics that they achieve. There was an obvious lack of prospective well controlled studies and more studies are needed. CONCLUSION: No clinical studies concerning anterior crowns on primary teeth were identified that met all or even a majority of criteria, indicating that there was little, good scientific support for any of the techniques which clinicians have utilized for many years to restore primary anterior teeth. While a lack of strong clinical data does not preclude the use of these techniques it points out the strong need for well designed, prospective clinical studies to validate the use of these techniques.

Anterior esthetic fixed appliances for the preschooler: considerations and a technique for placement.

One of the pediatric dentist's greatest restorative challenges is the esthetic rehabilitation of a young toddler who has suffered multiple tooth loss subsequent to rampant early childhood caries or extensive dental trauma. An anterior esthetic appliance may be used to replace lost teeth. The most decisive factor for placing an anterior esthetic appliance is parental desire. Other considerations include: space maintenance, masticatory function, speech development, and tongue habits. However, there is no strong evidence that early loss of maxillary incisors will have any significant, long lasting effect on the growth and development of the child. This paper discusses in detail one type of fixed anterior esthetic appliance and the considerations to be made when deciding when and why to place them.

Pit and fissure sealant application: updating the technique.

Dental sealants have proved an effective way to prevent caries development. The authors discuss available options in sealant materials and placement. They also outline key points in sealant application.

Managing a peripheral ossifying fibroma.

The Peripheral Ossifying Fibroma is an inflammatory lesion which most often appears in twenty-five to thirty-four-year-old females. It averages 1.0 cm at its greatest dimension. This case reports a seven-year-eight-month-old female who presented with a peripheral ossifying fibroma lesion which measured 2.7 cm by 1.5 cm by 1.0 cm. A review of peripheral ossifying fibroma, and the management and postsurgical sequelae of this child are discussed.

Failure strength of four veneered primary stainless steel crowns.

The purpose of this study was to determine the amount of shear force required to fracture or dislodge the veneered facings of four commercially available veneered primary incisor stainless steel crowns (SSC) and to characterize the veneer failures. Forty Unitek SSCs (#4 left central incisor) were shaped to fit a master die and then 10 each were mailed to four commercial dental laboratories that produce veneered SSCs. The resulting four types of crowns tested were: Cheng Crowns (CC), [Peter Cheng Orthodontic Laboratory]; Kinder Krowns (KK) [Mayclin Dental Studio, Inc]; NuSmile Primary Crowns (NC), [Orthodontic Technologies, Inc]; and Whiter Biter Crown II (WB), [White Bite Inc]. Each crown was cemented onto a standardized die and then thermocycled at 4 degrees C and 55 degrees C for 500 1-min cycles. Each die was then placed into a custom holder on the Instron (Model 4204) testing machine. A force was applied at the incisal edge of the veneer at 148 degrees, (the primary inter-incisal angle), with a crosshead speed of 1 mm/min until the veneer fractured or was dislodged. The mean force (N) required +/- SD to produce failure was, respectively: KK (397.2 +/- 53.0); NC (447.2 +/- 78.5); CC (511.9 +/- 83.4); WB (686.5 +/- 181.4). Analysis of variance (ANOVA) indicated significance at P < 0.0001. A Scheffe's post hoc comparison demonstrated that the Whiter Biter (WB) group required significantly (alpha = 0.05) more force for failure than the other three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitudes of program directors toward women in pediatric dentistry training programs.

The number of women entering pediatric dentistry graduate programs is increasing. A formal survey was conducted in the fall of 1990 to determine what impact, if any, this increase is having on the programs. The survey sample consisted of the 57 pediatric dentistry graduate program directors from the United States and Canada. The survey form included program data about gender distribution in the current and previous classes, and female faculty distribution within the programs. The survey requested information about the attitudes of various groups of individuals who interacted with the residents relative to the gender of the resident and again, relative to whether the resident was pregnant. Inquiry was made concerning maternity leave policies and selected treatment scenarios involving pregnant residents. Finally, questions were asked about motivational factors, personal priorities, and policy change for female vs. male residents. Fifty forms were returned for a return rate of 88%. The 48 forms analyzed revealed that 52% of current classes are female and 51% of applicants for 1991 were female. Women comprise 23% of full-time and 26% of part-time faculty. There was no single issue perceived by program directors as a group to be a significant concern or problem relating to gender. Program directors would consider removing pregnant females from contact with combative patients (83%) and environmental hazards (85%), but fewer would consider removing them from contact with for HIV+ or Hb+ patients.

The experiences of women pediatric dental residents: a survey.

A survey of 430 female pediatric dentists in the United States determined concerns and experiences they had during their advanced training programs. The return rate was 54%. Up to 83% (24) of the women who were pregnant during their residencies asked not to be exposed to certain environmental hazards during pregnancy and the postpartum period. They requested that program directors establish policies on known environmental hazards. Eighty-eight women (41%) commented that programs should offer flexible, preestablished and preannounced maternity leave policies. Survey respondents also expressed concerns about personal safety (5%), the lack of female role models (9%), and the need for more information on business management (30%). When the women were analyzed according to age, the following were significant (P less than .05): professional acceptance was of greatest concern to women ages 41-48; pregnancy and maternity leave, and balancing career with parenthood, significantly concerned women 25-32; and women ages 33-40 said business management was the issue causing the greatest frustration as a practicing pediatric dentist. While most respondents felt that they have the same professional opportunities as men, their greatest frustrations are a lack of acceptance by the professional and lay communities and trying to balance a career and motherhood.

Managing occlusal surfaces of young permanent molars.

The practice of restoring occlusal surfaces of young permanent teeth with just amalgam or waiting and watching for caries to occur is outdated. Today, there are several treatment options.

Parental attitudes toward behavior management techniques used in pediatric dentistry.

Previous studies evaluating parents' attitudes toward behavior management techniques used in pediatric dentistry suggest that parental attitudes are generally negative. The purpose of this study was to reexamine this issue by comparing the effect of prior explanation on parental acceptance of eight behavior management techniques. Videotaped segments were made of children's dental appointments containing examples of eight behavior management techniques. One group of 40 parents viewed a videotape which provided no explanation for each technique before it was shown. Another group of 40 parents viewed a videotape which provided no explanation of the techniques. The parents then were asked to rate the acceptability of each technique using a visual analogue scale. Results indicated that the informed parents were significantly more accepting of behavior management techniques than the uninformed parents but both groups were generally positive about the techniques studied. Further, parents reporting greater stress were less accepting of the techniques studied.

Microabrasion of human enamel in vitro using hydrochloric acid and pumice.

The rubbing application of a hydrochloric acid-pumice mixture has been advocated for the removal of fluorotic-like areas of permanent teeth. However, there have been no previous reports as to the amount of enamel removed during this process. The objective of this project was to measure the amount of enamel lost during successive rubbing applications of an 18% HCl-pumice mixture. Nine extracted permanent molars were mounted in die stone, and each was subjected to 10 sequential 5-sec rubbing applications of an 18% HCl-pumice mixture. After rubbing for 5 sec, the teeth were rinsed with water for 10 sec and then thoroughly dried. Enamel loss was measured to the nearest micron utilizing a measuring microscope with 3-dimensional digital stage positioning. Measurements were taken at the consistent x,y coordinates of three points on the tooth surface after each application. The change in the z coordinate, representing the spatial change in the location of the enamel surface, was recorded for each point after each application on the tooth. Regression analysis revealed enamel loss of 12 microns after the initial application, and an average of 26 microns of enamel loss after each successive application. The regression coefficient was significant at P less than 0.001.

Comparison of two methods designed to improve pediatric dental case presentations utilizing videotapes.

This study compared the effectiveness of two methods of teaching the skills required for dentist-parent pediatric case presentations. Seventy-two senior dental students were videotaped presenting a child's case presentation to a parent. The students were then randomly assigned to one of two groups. Students in Group 1 viewed and evaluated a model videotape of the principal investigator presenting a case to a parent. Students in Group 2 viewed their previously videotaped presentation. Both groups evaluated performance on the tapes using a list of 25 performance-specific criteria identified as important for a case presentation. Following this evaluation, 36 students were able to be taped while presenting a second case to another parent. One investigator blindly evaluated each taped presentation using the 25 criteria. Students who viewed the model videotape demonstrated a significant improvement in performance from their first presentation (p = 0.0044). Students who evaluated their own tape showed no significant improvement (p = 0.8830). Students perceived both methods to be helpful, minimally stressful, and requiring little time.

Comparison of Kodak D-speed and E-speed x-ray film in detection of proximal caries.

Due to the differences in the findings of earlier studies, it was decided to investigate further and compare the two film types. This study compared the radiographic images of proximal caries lesions on D-speed radiographic film with those seen on an E-speed radiograph. No significant difference was found in the ability of dentists to diagnose.

Conscious sedation in predoctoral pediatric dentistry programs.

A survey of predoctoral pediatric dentistry programs in American dental schools was conducted to determine the extent of didactic and clinical training in pediatric conscious sedation. Fifty-four of 59 programs (92 percent) returned usable surveys. The results indicated that there exists a wide range of teaching practices, both in numbers and types of sedations experienced. Fifty-six percent of the respondents reported that students received some degree of clinical experience. Sedation was achieved most commonly with chloral hydrate or hydroxyzine administered orally. Predoctoral programs without an affiliated postdoctoral program were much more likely to practice conscious sedation than those that trained postdoctoral students. The reason most frequently listed for the nonuse of sedation in the predoctoral clinic was philosophical opposition to pharmacological management at this level of training. A majority of the respondents believed that improved monitoring practices and documentation of cases would result from the recent adoption by the American Academy of Pediatric Dentistry of guidelines for conscious sedation.