Tooth root resorption: A review.

Tooth root resorption is multifactorial, leading to progressive destruction and eventual loss of tooth root dentin and cement. There are internal and external types of root resorption, each having its variety. The etiology and pathogenesis of tooth root resorption are poorly understood, and the most significant etiological factors are trauma, pulpal infection, tooth bleaching, and orthodontic treatment. Tooth root resorption is primarily asymptomatic; thus, it is revealed accidentally by radiographic examination. Progressive clinical manifestations are pain, tooth discoloration, tooth mobility, and other conditions. Awareness of the causes and risk factors allowing tooth root resorption, and regular radiographic examination, in case of necessity, make it possible to reveal resorption at an early stage and to prevent its further development. Thus, the aim of this study is to present etiopathogenesis, a clinical course, and diagnostic peculiarities of internal and external types of tooth root resorption, enabling practicing dentists to timely diagnose root resorption and take appropriate measures to avoid further complications. Within the limitation of this review, even though the etiopathogenesis of tooth root resorption is yet not fully understood, it is suggested that the etiological factors fall into two groups (endogenic and exogenic) to enhance further understanding of the possible causes and mechanisms of root resorption and allow practitioners to monitor high-risk patients and make timely diagnoses. Moreover, radiographic examination and CBCT are indispensable for the diagnosis of root resorption.

Effects of cyclic staining on the color, translucency, surface roughness, and substance loss of contemporary adhesive resin cements.

STATEMENT OF PROBLEM: The staining resistance of the adhesive resin cements is critical to the long-term success of a restoration, but only limited evidence is available regarding the effects of cyclic staining on adhesive resin cements. PURPOSE: The purpose of this in vitro study was to investigate the effects of staining solutions on the color, translucency, substance loss, and surface roughness of contemporary adhesive resin cements. MATERIAL AND METHODS: Six commercially available adhesive resin cements (Clearfil SA Cement, Panavia F2.0, RelyX U200, RelyX Veneer, NX-3 Light Polymerize, NX-3 Dual Polymerize) were tested. The specimens were subjected to a cyclic staining model with 4 different solutions (deionized water, cola, coffee, and red wine). All specimens were immersed in the respective solutions 12 times for 15 minutes daily over 96 days. Between staining cycles, the specimens were stored in artificial saliva. The color parameters, surface profile, and surface roughness of the specimens were measured before and after cyclic staining for 16, 32, 48, 64, 80, and 96 days. Repeated-measure ANOVA was used to evaluate the effect of the staining solutions on the color difference (ΔE), translucency change (ΔTP), substance loss, and surface roughness (Ra) of the tested adhesive resin cements (α=.05). RESULTS: All the tested materials exhibited similar behaviors with longer durations of immersion in the staining solutions. Specifically, ΔE increased, TP decreased, and the surface profile and roughness remained stable. The tested adhesive resin cements exhibited variations in color and TP stability after staining. The light-polymerized adhesive resin cements were generally more color-stable than the dual-polymerized resin cements. CONCLUSIONS: The effects of cyclic staining on the color, translucency, surface profile, and surface roughness of adhesive resin cements were not categorical but material-specific.

Minimally Invasive Treatment of an Ankylosed, Severely Discolored, and Intruded Central Incisor with a Masking Ceramic Veneer: A Clinical Report.

Dental therapy of traumatically ankylosed maxillary anterior teeth with an additional slight root resorption represents a great challenge for the restorative team and requires intensive planning and communication between patient, dentist, orthodontist, periodontist, and dental technician. The inhibition of vertical growth often makes dental intervention indispensable. Porcelain laminate veneers have been successfully used for more than two decades, mainly on anterior teeth, and was the minimally invasive treatment option for the present case report. Preprosthetic planning with a digital approach of the width-length ratio and the red-white esthetics were important prerequisites for a satisfactory treatment result. The treatment goal was clarified using a wax-up and a corresponding template for intraoral verification with a mock-up. The template also served as a preparation guide. Despite all risk factors, including the endodontic treatment, the 3-mm intruded position, and the slight root resorption, the patient and the restorative team decided to restore the situation with two feldspathic-ceramic veneers to provide an esthetic, time-saving, nonsurgical process for the patient.

Splinted Porcelain Laminate Veneers With a Natural Tooth Pontic: A Provisional Approach for Conservative and Esthetic Treatment of a Challenging Case.

Esthetic rehabilitation of discolored anterior teeth is always a great challenge, especially in the presence of pathology. Fortunately, conservative management in the esthetic zone has become more feasible in compromised cases because of the development of restorative materials and advances in dental adhesives. This report presents a complicated case of a patient with tetracycline-related discoloration, multiple root resorption, and a periapical lesion. Treatment was conservative and used a natural tooth pontic and splinted porcelain laminate veneers.

Osteogenesis imperfecta/lobstein syndrome associated with dentinogenesis imperfecta.

Osteogenesis imperfecta is a collagen related disorder characterized by increased bone fragility and low bone mass. The important oral finding in osteogenesis imperfect is the presence of dentinogenesis imperfecta. This article presents a case of osteogenesis imperfecta (type IV B) with dentinogenesis imperfecta where a 7-year-old girl had opalacent primary teeth associated with severe bone deformity, scoliosis, barrel shaped rib cage, and short stature. The clinical, radiographic ad histologic features are reviewed along with management aspects.

Analysis of root canal treated primary incisor after trauma: two year outcomes.

BACKGROUND: The low number of clinical studies of traumatized teeth submitted to root canal treatment is completely out of proportion to the seriousness that dental trauma imposes on children in early years. AIM: This study evaluates the outcomes of root canal treatment (RCT) in traumatized primary incisors and identifies the predisposing factors associated with therapy success. METHODS: This is a retrospective study conducted with all dental records of 704 patients who had one or more teeth with traumatic injuries. Patients with irreversible pulp changes in primary teeth leading to RCT with a 24 month follow-up met the inclusion criteria. RESULTS: Twenty-five maxillary incisors of 17 children were evaluated. The children's age at the time of therapy ranged from 24 to 72 months (mean 47.3). Pulp necrosis was the most common disorder (84.0%) and pre-operative periapical lesions were observed in 52.0%. Coronal discoloration was found in 48.0%. The roots were filled with ZOE paste (68.0%) or Guedes-Pinto paste (32.0%). Overall RCT success rate was 68.0%. The absence of pre-operative periapical lesions (p = 0.02) and pathological root resorption (p = 0.02) presented positive association with therapy success. Success was not associated to filling paste (p = 0.49), filling extent (p = 0.44), of discoloration (p = 0.39) nor the patients' age (p = 0.59). CONCLUSIONS: RCT was considered successful in 68.0% of the cases at the 24 month follow-up. Failure of RCT in traumatized primary incisors was associated with pre-operatory periapical lesions and pathological root resorption. The filling paste, the filling extent and the patient's age were unrelated with therapy success.

Association between black stains and dental caries in primary teeth: findings from a Brazilian population-based birth cohort.

Lower dental caries experience has been observed in children and teenagers with the presence of black stains on dental structures. However, none of the previous investigations were population-based studies or adjusted the analysis for potential confounders. This study assessed the prevalence of black stains at the age of 5 in a population-based birth cohort from Pelotas, Brazil and investigated the association between black stains and dental caries. A total of 1,129 children from the 2004 Pelotas birth cohort were examined at age 5, and their mothers were interviewed at their households. Dental examinations included a search for black stains and dental caries on the primary dentition through the dmf-s index. The mothers' questionnaire comprised data on demographic, social, and behavior aspects. Prevalence of black stains was 3.5% (95% CI 2.5-4.7) and the prevalence of dental caries was 48.4% (95% CI 45.4-51.4). Multivariable logistic regression analysis was performed to assess the association between black stains and dental caries. Adjusted analysis revealed that the presence of black stains was associated with lower levels of dental caries (OR = 0.51; 95% CI 0.26-0.99). The results of the present study suggest that black stains are a protective factor for dental caries development.

Interdisciplinary approach for esthetic management of an adult patient with reverse articulation.

Prosthodontic methods to correct anterior reverse articulation (also known as anterior cross-bite) can be extremely challenging. This clinical report describes the interdisciplinary management of an adult female patient with a history of chronic periodontitis who presented with reverse articulation in the left canine region. While the patient desired a quick, highly esthetic solution, she was counseled to first undergo orthodontic treatment. After completion of orthodontics, prosthodontic treatment comprised of bleaching therapy, porcelain veneers, and all-ceramic crowns. Periodontal maintenance therapy was also performed during the treatment period. The case portrays the significance of interdisciplinary care and discusses the importance of close communication among specialties.

Placebo-controlled clinical trial of use of 10% hydrogen peroxide whitening strips for medication-induced xerostomia.

OBJECTIVE: A randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the effectiveness and safety of peroxide-containing strip-based tooth whitening among subjects with medication-induced hyposalivation. METHODS: Eligibility for this tooth whitening study was limited to dentate adults taking xerogenic medications with an unstimulated salivary flow < or = 0.2 ml/min. After giving informed consent, 42 subjects were randomized using a 2:1 ratio to 10% hydrogen peroxide whitening strips (Crest Whitestrips Premium) or placebo strips without peroxide. Strips were used for 30 min twice daily for a 14-day period. Usage was unsupervised, and only the maxillary arch was treated. On days 8 and 15, efficacy was assessed from standard digital images of the anterior dentition and quantified using the Cielab color system, while safety was assessed from interviews and clinical examinations. RESULTS: At day 8, the peroxide group experienced significant (p < 0.001) color improvement relative to baseline and placebo. Adjusted means +/- standard errors for yellowness reduction were -1.65 +/- 0.115 units for the peroxide group and -0.32 +/- 0.170 units for the placebo group. For the increase in lightness, adjusted means +/- standard errors on day 8 were 1.53 +/- 0.130 units for the peroxide group and 0.37 +/- 0.191 units for the controls. Continued strip use through day 15 yielded incremental color improvement for the peroxide group. Mild and transient tooth sensitivity represented the most common adverse events. No subject discontinued treatment due to a product-related adverse event. CONCLUSION: Twice daily use of 10% hydrogen peroxide whitening strips by adults with medication-induced xerostomia was well tolerated, with significant tooth color improvement evident within 7 days.

Clinical considerations in managing severe tooth discoloration with porcelain veneers.

BACKGROUND: Although porcelain veneer has been proposed as the treatment of choice in cases of severe tooth discoloration, clinicians should consider a multidisciplinary approach when treating complex cases. Clinicians also need to understand the masking ability of veneer restorations. CASE DESCRIPTION: A 20-year-old woman had severe tooth discoloration, enamel hypoplasia and malocclusion. The patient first underwent orthodontic treatment to correct the dental alignment after the author extracted her hypoplastic first molars. The author then placed porcelain veneers with high-density alumina cores on the patient's maxillary and mandibular anterior teeth. The restorations were in service for seven years without complications. CONCLUSIONS: and CLINICAL IMPLICATIONS: Managing severe tooth discoloration requires thorough consideration of all patient factors, treatment provided in a logical sequence and the use of porcelain veneers with adequate masking ability.

A comparative clinical study evaluating stain removal efficacy of a new sensitivity whitening dentifrice compared to commercially available whitening dentifrices.

OBJECTIVE: To assess the extrinsic stain removal efficacy of a new sensitivity dentifrice containing sodium tripolyphosphate (STP) to marketed whitening toothpastes after six weeks of product use. METHODS: This was a single-center, double-blind, stratified, six-week clinical study comparing the reduction in stain area and intensity of Sensodyne Extra Whitening to Crest Maximum Strength Sensitivity Protection Whitening plus Scope and Colgate Tartar Control Plus Whitening Mint dentifrice, as measured by MacPherson's Modification of the Lobene Stain Index (MMLSI) in a forced stain model. RESULTS: Two-hundred and ninety-five subjects completed the study. Tooth stain MMSLI scores showed significant differences between Sensodyne and Crest dentifrices in favor of Sensodyne for all surface sites (p = 0.014), and individually for facial (p = 0.023), lingual (p = 0.027), and interproximal (p = 0.014) surfaces. No significant statistical differences between Sensodyne and Colgate dentifrices were observed for any of the surfaces. CONCLUSION: Results from this stain removal clinical study demonstrate significant extrinsic stain removal efficacy for all dentifrices relative to baseline. Significant differences between the two marketed sensitivity whitening dentifrices were demonstrated in favor of the new Sensodyne Sensitivity Whitening dentifrice.

Fixed rehabilitation of an ACP PDI class III patient with amelogenesis imperfecta.

This clinical report describes the oral rehabilitation of a 19-year-old woman diagnosed with hypoplastic-type amelogenesis imperfecta (AI). She presented with discolored and mutilated teeth, missing teeth, anterior open bite, and posterior short crowns. She was classified as an American College of Prosthodontists Prosthodontic Diagnostic Index (ACP PDI) class III patient. The aim of treatment was to restore esthetics and improve masticatory function. The patient's esthetic and functional expectations were successfully attained with porcelain laminate veneers and all-ceramic and metal-ceramic restorations after extensive crown lengthening. The patient was regularly recalled during the postoperative period. Loss of retention of one all-ceramic crown and minimal recession of the gingiva of one laminate veneer were noted at 4-year recall.

Nonsurgical endodontic treatments in molar teeth with large periapical lesions in children: 2-year follow-up.

Profound caries lesions may lead to invasion of microorganisms to the dental pulp, and periapical areas can promote the development of dentoalveolar abscess and periapical bone loss. Treatment options to manage large periapical lesions range from nonsurgical root canal treatment and/or apical surgical procedure to extraction. Young molar teeth with pulp necrosis and large periapical lesions in children are frequently treated with root canal treatment because the therapy is more difficult in multirooted teeth. In these case reports, nonsurgical endodontic treatments performed on 6 molar teeth with large periapical lesions, by repeated intracanal dressing with calcium hydroxide, are presented. Radiographs displayed significant bony healing at the end of the second year. In conclusion, large periapical lesions can respond favorably to nonsurgical treatment, and complex and difficult endodontic treatments in children might not be required.

Recreating an esthetic smile: a multidisciplinary approach.

Today's dental patients are demanding a youthful, attractive smile. The esthetic rehabilitation of patients with functionally compromised dentitions frequently involves a multidisciplinary approach. The realization of esthetic objectives in multidisciplinary cases represents a considerable clinical challenge. To a great extent, proper case selection and careful multidisciplinary treatment planning can govern the predictability of procedures. A team approach that includes the clinicians, the laboratory technician, and the patient is essential to achieve the desired results. This clinical report demonstrates a successful multidisciplinary approach to recreating an esthetic smile of a patient whose anterior maxillary dentition had been functionally and esthetically compromised by prosthetic and periodontal problems.

Osteogenesis imperfecta.

Osteogenesis imperfecta is an inherited disorder of the connective tissue. The extreme bone fragility seen in patients suffering from osteogenesis imperfecta pose a series of problems with regard to behavior management and rendering of quality dental treatment. Presented here a case of a four year old child suffering from osteogenesis imperfecta.

An in vitro comparison between two methods of electrical resistance measurement for occlusal caries detection.

Because of different measurement techniques and the easier design of the CRM prototype, this in vitro study aimed to compare the diagnostic performance and reproducibility of two electrical methods (Electronic Caries Monitor III, ECM and Cariometer 800, CRM) for occlusal caries detection, and to evaluate the effect of staining/discoloration of fissures on diagnostic performance. Hundred and seventeen third molars with no apparent occlusal cavitation were selected. Six examiners inspected all specimens independently, using the CRM, and a subgroup of 4 using the ECM. Histological validation using a stereomicroscope was performed after hemisectioning. Intra- and interexaminer reproducibility was assessed by Lin's concordance correlation coefficient (CCC) and Bland and Altman analysis. Diagnostic performance parameters included sensitivity (SE), specificity (SP) and area under the ROC curve (Az). The CCC yielded an intra- and interexaminer reproducibility of 0.69/0.62 (ECM) and of 0.79/0.74 (CRM). The mean intra- and interexaminer 95% range of measurements (range between Bland and Altman limits of agreement) given in percentages of the instrument reading were 67%/65% for the ECM and 28%/33% for the CRM. Az at the D3-4 level was 0.74 (ECM) and 0.78 (CRM). The CRM showed at least equivalent diagnostic performance to the ECM. However, improvement is still desirable. Diagnostic performance appeared to be enhanced in discolored lesions; however, this may be related to sample lesion distribution characteristics.

[Detection of early fissure caries with clinical, radiologic, and laser fluorescence methods]. / Skutecznosc diagnostyczna badania klinicznego, radiologicznego i refleksometrii fluorescencyjnej w wykrywaniu poczatkowych stadiów próchnicy bruzd.

PURPOSE: The aim of study was to compare the diagnostic efficacy of the newly introduced DIAGNOdent laser fluorescence with traditional methods for detection of molar caries, namely visual inspection and bitewing radiographs. MATERIAL AND METHODS: Discolored fissures of 134 permanent molars were studied in 103 patients aged 12-18 years. RESULTS: The results indicate that visual examination and bitewing radiographs showed very high or high sensitivity and specificity for the detection of early fissure caries. Combination of these two methods decreased the number of false positive and negative results. Diagnostic accuracy of DIAGNOdent was significantly inferior to that of clinical examination or bitewing radiographs. CONCLUSION: However, the diagnostic accuracy of DIAGNOdent was increased by combining it with one of the two traditional methods studied.

In vitro assessment of methods of applying the electrical caries monitor for the detection of occlusal caries.

The aim of this in vitro study was to assess the diagnostic performance of five methods of using the Electrical Caries Monitor (ECM) to detect caries lesions at enamel and dentine thresholds in occlusal molar surfaces with and without stain. Histological validation was performed in 152 occlusal sites in permanent molar teeth. For the sites without stain the areas under the ROC curve (AUC) for the five methods ranged from 0.69 to 0.93 (enamel) and 0.74 to 0.92 (dentine). For stained sites the AUC ranged from 0.59 to 0.65 (enamel) and 0.66 to 0.77 (dentine). The performance of the ECM was reduced in the presence of stain. The measurements using toothpaste as a conducting medium were generally worse than when direct measurements were taken. The profiles of the resistance curves generated as the tooth was dried for 5 s were used to derive additional summary variables. The AUC for all sites using an outcome variable generated from these data were 0.89 (enamel) and 0.91 (dentine), respectively, for all teeth. It is concluded that the performance of the ECM might be improved by either considering a combination of variables or using different resistance cut-offs in the presence or absence of stain.