Regenerative endodontic therapy: a follow-up of 47 anterior traumatised teeth.

PURPOSE: To collect long-term survival data in anterior traumatised teeth on the outcome of Regenerative Endodontic Treatments (RET) with a network of dentists working in different clinics to overcome the problem of anecdotical evidence. METHODS: The seven dentists from Paediatric REsearch Project (PREP) performed RET treatments following the same protocol in five different secondary dental care clinics in the Netherlands. Treatment resulting in pain, apical problems, sinus tracts, resorption or fracture were considered as failure of treatment. RESULTS: 47 teeth in 38 children were treated between January 2009 and September 2017 and had at least 6 month follow-up (mean 35 months). Apical closure was seen in 27 teeth (25 cases) and root length growth in 6 teeth (6 cases). Thickening of the root walls was seen in 20 teeth (20 cases) and obliteration of the root canal in 30 teeth (25 cases). Of 38 teeth with apical inflammation at the start of treatment, no radiographic sign of apical inflammation was visible at 3 months in 13 of 28 teeth; taking up to 42 months for radiographic signs of apical inflammation to be not visible. Nineteen of 35 teeth showed discoloration at the beginning of treatment. After 18 months two teeth showed signs of ankylosis, but were still functional. After 36 months one more tooth showed signs of new apical inflammation and 2 months later it was extracted. CONCLUSIONS: With three failures in 47 treated teeth, RET seems to be a promising treatment for difficult to treat anterior traumatised teeth with an open apex.

Molar incisor hypomineralisation (MIH) training manual for clinical field surveys and practice.

BACKGROUND: Despite clear assessment criteria, studies of molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) are marked by inconsistency in outcome measurements. This has detracted from meaningful comparisons between studies and limited interpretation. AIM: To provide a comprehensive manual as a companion to assist researchers in planning epidemiological studies of MIH and HSPM, with particular reference to outcome measurement. METHODS: This manual begins with a succinct review of the clinical problems and evidence for management of the conditions. The subsequent sections guide researchers through diagnosis of MIH and HSPM and implementation of both the long and short forms of a recently proposed grading system. MIH and HSPM can often be confused with fluorosis, enamel hypoplasia, amelogenesis imperfecta, and white spot lesions but can be distinguished by a number of unique clinical features. Based on the grading system, a standardised protocol is proposed for clinical examinations. Intra and inter-examiner reliability is of key importance when outcome measurement is subjective and should be reported in all epidemiological studies of MIH. The manual concludes with an exercise forum aimed to train examiners in the use of the grading system, with answers provided. CONCLUSION: The use of a standardised protocol, diagnostic and grading criteria will greatly enhance the quality of epidemiological studies of MIH.

Standardised studies on Molar Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molars (HSPM): a need.

In November 2014, a review of literature concerning prevalence data of Molar Incisor Hypomineralisation (MIH) and Hypomineralised Second Primary Molars (HSPM) was performed. A search of PubMed online databases was conducted for relevant articles published until November 2014. The reference lists of all retrieved articles were hand-searched. Studies were included after assessing the eligibility of the full-text article. Out of 1078 manuscripts, a total of 157 English written publications were selected based on title and abstract. Of these 157, 60 were included in the study and allocated as 52 MIH and 5 HSPM, and 3 for both MIH and HSPM. These studies utilised the European Academy of Paediatric Dentistry judgment criteria, the modified index of developmental defects of enamel (mDDE) and self-devised criteria, and demonstrated a wide variation in the reported prevalence (MIH 2.9-44 %; HSPM 0-21.8 %). Most values mentioned were representative for specific areas. More studies were performed in cities compared with rural areas. A great variation was found in calibration methods, number of participants, number of examiners and research protocols between the studies. The majority of the prevalence studies also investigated possible aetiological factors. To compare MIH and HSPM prevalence and or aetiological data around the world, standardisation of such studies seems essential. Standardisation of the research protocol should include a clearly described sample of children (minimum number of 300 for prevalence and 1000 for aetiology studies) and use of the same calibration sets and methods whereas aetiological studies need to be prospective in nature. A standardised protocol for future MIH and HSPM prevalence and aetiology studies is recommended.

[Dental caries. Which strategy suits whom?]. / Caries. Welke strategie past wie?

The treatment of dental caries can be approached from more perspectives than just restoration. At a recent congress of the Dutch Society of Paediatric Dentistry and the Dutch Society for Dental health of the Disabled, various visions for the treatment of caries in young children were extensively discussed. This article is a report on congress papers concerning the (im)possibility of preventive approaches, the prerequisites for restorative care and the complications and obstacles in treatment. In the case of all selected strategies, it appears that the strong cooperative support of (the parents of) the patient is necessary, whether it is preventive or only restorative or a combination of the two. It also became clear that the Dutch approach to the deciduous dentition leaves room for structural improvement, for example by an expansion of dental health care for the youngest group.

Prevalence of molar-incisor-hypomineralisation among children participating in the Dutch National Epidemiological Survey (2003).

AIMS: This was to determine the prevalence of Molar-Incisor-Hypomineralisation (MIH) among children participating in the Dutch National Epidemiological Survey of 2003 and to compare the prevalence data with that found in the previous survey of 1999 when MIH was found in 9.7% of 11-year-old Dutch children. METHODS: The survey took place in the same four cities as the previous survey in 1999. In 442 9-year-old children born in 1994, first permanent molars and all permanent incisors were examined for demarcated opacities, post-eruptive enamel breakdown, atypical restorations and extractions due to MIH. Children were considered as having MIH, when at least one molar was affected, with or without involvement of the incisors. RESULTS: Of the children examined 63 or 14.3% had at least one affected molar with hypomineralisation defects. Of those children with MIH only demarcated opacities were present in 35 (55.6%), while 13 (20.6 %) had at least one tooth with occlusal breakdown in addition to opacities, and in 15 (23.8%) atypical restorations were found. No teeth had been extracted due to MIH. Of the children with MIH there were 36 (57.1%) who had both molars and incisors affected. CONCLUSIONS: A significantly higher prevalence of MIH has been found in Dutch 9 year-old children in the last National Epidemiological Survey of 2003 as compared with to the Survey of 1999.

Hypomineralized second primary molars: prevalence data in Dutch 5-year-olds.

The aim of this cross-sectional observational study was to report on the prevalence of hypomineralizations in second primary molars in 5-year-old Dutch children. In the study 386 (45% girls) 5-year-old Dutch children, all insured by a Health Insurance Fund, participated. Scoring criteria for molar incisor hypomineralization molars were adapted to score second primary molars. The prevalence of hypomineralized second primary molars (HSPM) was 4.9% at child level and 3.6% at tooth level. Most HSPMs (87%) showed demarcated opacities, followed by posteruptive enamel loss (40%).

Molar incisor hypomineralization: a survey of members of the Australian and New Zealand Society of Paediatric Dentistry.

BACKGROUND: Worldwide, molar incisor hypomineralization (MIH) affects a substantial number of children and impacts greatly on treatment need and dental anxiety, yet there is little information regarding its prevalence, aetiology, presentation and management. The aims of this survey were to assess awareness and perceptions of the Australian paediatric dental community concerning MIH, and to describe current treatment strategies. METHODS: A questionnaire, based upon a previous European study, was sent to all Australian members of the Australian and New Zealand Society of Paediatric Dentistry. The questionnaire sought information on clinical experience of MIH, knowledge of prevalence, aetiology and contemporary management strategies for MIH. RESULTS: One hundred and thirty useable responses were received (58.8 per cent response rate) of which 36 were paediatric dentists, 6 paediatric dentistry postgraduate students, 59 general dentists, 14 dental therapists and 14 specialists in other fields. Most (98.5 per cent) respondents were familiar with MIH and encountered it in their practice. The majority (73.1 per cent) estimated that MIH occurred in between 5 to 25 per cent of their clinical practice and almost all (96.9 per cent) considered it to be a clinical problem. Only 16.9 per cent of respondents were aware of existing prevalence data and 96.9 per cent valued investigating the prevalence of MIH. No consensus existed regarding the aetiology of MIH or its restorative management. Paediatric dentists used preformed crowns significantly more than non-specialists, however glass ionomer cements were popular with all groups. CONCLUSIONS: MIH is a well recognized and widely encountered clinical condition. MIH presents several clinical problems and is worthy of further investigation. Currently, no consistent clinical management strategies are utilized.

Molar incisor hypomineralization: review and prevalence data from the study of primary school children in Kaunas/Lithuania.

AIMS: These were to determine the prevalence of MIH in a group of primary school children in Kaunas, Lithuania and to compare the prevalence of MIH in Lithuania with the prevalence in other countries using published data. METHODS: First permanent molars and all permanent incisors were examined in 1277 children, aged 7 to 9 years and having at least one erupted permanent molar, for demarcated opacities, post-eruptive enamel breakdown, atypical restorations and extractions due to MIH, according to the criteria, provided by the EAPD experts. Examinations were performed by two calibrated observers (k=0.829). RESULTS: Of all the children 190 (14.9%) had hypomineralization defects in at least one index tooth, 124 (9.7%) had at least one affected molar and were considered as having MIH. Only demarcated opacities were present in 68 (54.8%) of children with MIH, 35 (28.2 %) had at least one tooth with breakdown, 21 (16.9%) had atypical restorations. No teeth had been extracted due to MIH. Children with 3-6 affected teeth were 3.5 times more likely to have enamel breakdown and/or atypical restorations when compared with the children having only one or two affected teeth. Of the 124 children with MIH 96 (77.4%) had lesions only in molars, 28 (22.6%) had both - molars and incisors - affected. CONCLUSIONS: MIH was common among 7-9 years old Lithuanian children; majority of the affected children were affected mildly. Severity of the lesions was increasing with the number of affected teeth. Compared to the other studies MIH in Lithuania was moderately prevalent.

[Digital radiography in young children. Considerations based on experiences in practice]. / Digitale radiografie bij jonge kinderen. Afweging op basis van praktijkervaringen.

In dentistry, digital radiology techniques, such as a charge-coupled device and a storage phosphor plate, are gaining popularity. It was the objective of this study to assess the importance of the advantages and disadvantages of digital radiology techniques for bitewing radiography in young children, when compared to conventional film. A group of dentists received a questionnaire regarding their experiences with digital radiology techniques or conventional films among young children. Using the Simple Multi-Attributive Rating Technique (SMART) a final weighted score was calculated for the charge-coupled device, the phosphor plate, and conventional film. The scores were 7.40, 7.38, and 6.98 respectively. The differences were not statistically significant (p > 0.47). It could be concluded that, on the basis of experiences in practice, there are no statistically significant preferences for the use of digital radioogy techniques for bitewing radiography in young children.

Molar incisor hypomineralization (MIH): clinical presentation, aetiology and management.

In this paper, the current knowledge about Molar Incisor Hypomineralization (MIH) is presented. MIH is defined as hypomineralization of systemic origin of one to four permanent first molars frequently associated with affected incisors and these molars are related to major clinical problems in severe cases. At the moment, only limited data are available to describe the magnitude of the phenomenon. The prevalence of MIH in the different studies ranges from 3.6-25% and seems to differ in certain regions and birth cohorts. Several aetiological factors (for example, frequent childhood diseases) are mentioned as the cause of the defect. Children at risk should be monitored very carefully during the period of eruption of their first permanent molars. Treatment planning should consider the long-term prognosis of these teeth.

Judgement criteria for molar incisor hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on MIH held in Athens, 2003.

AIM: This paper reviews the proceedings and conclusions of a meeting of experts concerned with the problem of hypomineralised incisors and molars (MIH). The aims of this meeting were to establish criteria for the judgement of MIH, to select representative cases and to discuss how the name of the condition was best described as hypomineralised, or hypomaturated, first permanent molars. CONCLUSION: There was not complete agreement as to the correct diagnosis and aetiology of the condition. A suggested list of definitions of the judgement criteria to be used in diagnosing Molar Incisor Hypomineralisation (MIH) for prevalence studies was agreed upon.

Molar incisor hypomineralisation (MIH).

REVIEW: Molar Incisor Hypomineralisation (MIH) is defined as a hypomineralisation of systemic origin of one to four permanent first molars frequently associated with affected incisors. MIH molars are fragile and caries can develop very easily in those molars. Although MIH molars are well known by paediatric dentists and their occurrence is related in severe cases to major clinical problems, only limited data of the size of the problem are available. The prevalence of MIH ranges in the literature from about 3.6 to 25% and seems to differ in certain regions and birth cohorts. Unfortunately more complete comparable valid data are lacking at the moment. It seems that several aetiological factors can cause the enamel defects and that their occurrence is child related. CONCLUSION: For children with repeated illnesses in the first years after birth and children with opacities on erupted molars or incisors it seems useful to increase the frequency of dental check-ups during the period of erupting first permanent molars.

Molar incisor hypomineralization: a questionnaire inventory of its occurrence in member countries of the European Academy of Paediatric Dentistry (EAPD).

OBJECTIVES: The objectives were to find out whether hypomineralized permanent first molars and incisors, known as Molar Incisor Hypomineralization (MIH), occurs all over Europe, whether its prevalence in each country is known and whether or not it is considered to be a clinical problem. SAMPLE AND METHODS: Clinical photos of MIH and a five-item questionnaire were sent to members of the European Academy of Paediatric Dentistry (EAPD). A total of 59 questionnaires were sent to members in 31 countries. After one month a reminder was sent to non-responders. RESULTS: Fifty-four dentists (92%) in 30 countries (97%) returned the questionnaire. MIH was stated to occur in all but one country (the Czech Republic). Nearly all the responders (97%) stated that they were familiar with the clinical appearance of MIH and a majority saw it as a clinical problem. Furthermore, a large majority of the responders (90%) considered it important to map the prevalence of MIH in European countries as such data are available to only a limited extent. CONCLUSION: Paediatric dentists in Europe are aware of MIH and the majority consider it to be a clinical problem. Only limited data are available on the prevalence of MIH. Comparable and representative prevalence studies are therefore urgently needed to gain more knowledge about the magnitude of MIH and related clinical problems.

[Factors involved in the etiology of hypomineralized first permanent molars]. / Factoren die een rol kunnen spelen bij het ontstaan van kaasmolaren.

Severe hypomineralized first permanent molars (cheese molars) can be found in children. The aetiology of this phenomenon is unknown. The aim of this study is to collect more information about the causes of such molars. Parents of 24 children with severe cheese molars and of 21 controls without cheese molars, matched for age, living area and sex were interviewed. The mean age of the 45 children was 9.9 year (; ssd: 2.02). A questionnaire about the medical data from birth to four years of age and the medical situation of the mother during pregnancy was sent to the parents. No significant differences were found concerning weight and length at the time of birth between the two groups. Also no significant differences were found for the period of breast-/and bottle-feeding and for problems of the mother during pregnancy and child delivery. The mothers were healthy during pregnancy. Compared to the control group the children with cheese molars were ill more often Significant differences were found for pneumonia, high fever and inflammation of the middle ear.

Factors involved in the aetiology of molar-incisor hypomineralisation (MIH).

AIM: This study aimed to collect more information on factors associated with molar-incisor hypomineralisation (MIH), which is a frequent developmental enamel defect with unknown aetiology. MATERIALS AND METHODS: A questionnaire was sent to the parents of 45 children (average age 9.9 years; SD+/-2.02), 24 with affected first molars and 21 controls. The two groups of children were similar in terms of age, gender and living conditions. Questions were asked about the health of mother and child during pregnancy, the birth and health of the child up to age four years. RESULTS: Birth weight and length in the two groups of children were similar, as was the duration of breast- and/or bottle-feeding and the incidence of complications during pregnancy and birth. The children with MIH were ill more frequently during the first four years of life. CONCLUSION: Knowledge of the type of disease that might be involved in the development of such molars is still inadequate, but there appears to be an association with pneumonia, otitis media and high fevers.

Restorative materials used on primary teeth: a comparative study between two European universities: Nice and Amsterdam.

A descriptive retrospective survey was carried in two European dental schools (UNSA - Nice and ACTA - Amsterdam), in order to compare the restorative materials used in deciduous dentition. Examination of 460 patient files showed that age and sex distribution among children in both cities was comparable. The dft scores were also comparable but the number of decayed teeth was higher in Nice (4.61 +/- 2.68) than in Amsterdam (2.86 +/- 2.30). In Nice, composite resins, compomers and glass ionomers were all used in deciduous anterior teeth whereas only compomers were used in Amsterdam. As far as deciduous molars were concerned, composite resins and amalgams were used on small and large cavities respectively in Nice whereas in Amsterdam, compomers were once again preferred.

Prevalence of cheese molars in eleven-year-old Dutch children.

In the Netherlands, first permanent molars with idiopathic enamel disturbances (IED) are called cheese molars. Though concern is expressed about their prevalence, adequate figures on the subject are missing. The porous enamel of cheese molars can be very sensitive to cold air and can decay rapidly. The aim of the present study was to investigate the prevalence in eleven-year-old Dutch children of cheese molars (IED). During an epidemiological study performed in four cities in the Netherlands, the first permanent molars and central incisors of eleven-year-old children were examined for hypoplasia, opacities, posteruptive enamel loss, premature extraction, and atypical restorations. The observation of a hypoplasia excluded the possibility of cheese molar. A total of 497 children were examined. Six percent (n = 128) of the molars (n = 1988) showed signs of IED (cheese molars), 10 percent of the children had cheese molars of which 8 percent two or more. Incisors (4 percent) with opacities were found in 3 percent in combination with two or more cheese molars. Among the four cities, no significant differences in occurrence were found. The results of this study showed that in 10 percent of the Dutch children eleven years of age, cheese molars (IED) were found. The cause for the phenomenon called cheese molars appears to be child centered. Further studies on prevalence, causes and prevention are mandatory.