The evaluation of MTA and Biodentine as a pulpotomy materials for carious exposures in primary teeth.

OBJECTIVE: This study examined the effects of MTA and Biodentine on the clinical and radiographic success rates of pulpotomies performed on primary teeth with carious pulp exposures. MATERIALS AND METHODS: This study was conducted with 44 mandibular primary molars requiring vital pulpotomy. Carious dentin surrounding the exposure site was used as the inclusion criteria for all teeth, which were randomly divided into two groups according to pulpotomy material [MTA group (n = 24), Biodentine group (n = 20)]. Treatment was followed up clinically and radiologically for 24 months. Pulp canal obliteration was not regarded as a failure. RESULTS: Clinical and radiographic success rates at the end of 24 months were 100% for the MTA group and 89.4% for the Biodentine group. Success rates did not vary significantly between the groups (p = 0.646). Pulp canal obliteration was observed in two teeth (8.3%) in the MTA group at 6 months, but the teeth were found to be stabilized by 24 months. CONCLUSION: The long-term clinical and radiographic success rates obtained in this study indicate that both MTA and Biodentine are appropriate options for pulpotomy treatment of primary teeth with carious exposure in patients whose teeth should be retained for long periods of time. CLINICAL RELEVANCE: The etiology of exposure determines pulpal response, making it crucial to distinguish between mechanical and carious exposures. The carious exposure is presumed to be accompanied by severe inflammation, which makes the prognosis of treatment unpredictable. Biomaterials can be used especially in cases with carious pulp exposures.

Investigation of SOSTDC1 gene in non-syndromic patients with supernumerary teeth

BACKGROUND: The etiology of supernumerary teeth is still unclear however heredity is believed to be a major factor and this idea was supported by several case reports. Recently, a relationship between supernumerary tooth formation and deficiency of Uterine Sensitization Associated Gene-1 (Usag-1), a rat gene that is expressed in sensitized endometrium, was reported in mice. The human homolog gene for Usag-1, Sclerostin Domain Containing 1 (SOS-TDC1), shows 85% identity with mouse Usag-1. The present study aimed to investigate SOSTDC1 coding regions in non-syndromic patients with one or more supernumerary teeth. MATERIAL AND METHODS: Twenty-five non-syndromic patients (21 male and 4 female) aged 5-15 years, with one or more supernumerary teeth were included in the study. Saliva samples were collected from patients and DNA samples were isolated and analyzed using PCR. RESULTS: Eight phenotypes of supernumerary tooth formation were observed in the study. From the DNA analysis, 2 novel and 3 previously identified sequence alterations were identified however, in investigating the Usag-1 homolog SOSTDC1 gene, the present study could not find any phenotype-genotype relationship. CONCLUSIONS: There are many SOSTDC1 homolog genes in the human genome and future studies should investigate these candidate genes. Also studies in larger case groups including family members may reveal the hereditary pattern

Does Achievement of Hemostasis After Pulp Exposure Provide an Accurate Assessment of Pulp Inflammation?

PURPOSE: The purpose of this study was to determine in primary molars with carious exposures whether hemostasis at the exposure site and pulp orifice reflected inflammatory status of the pulp at the canal orifice based on cytokine levels. METHODS: Forty mandibular primary molars with deep caries were included in the study. Teeth were divided into two groups: group A had teeth where hemostasis at the exposure site was achieved within five minutes, and group B had teeth where hemostasis at the exposure site could not be achieved within five minutes. Blood samples were harvested from the exposure sites and canal orifices. Cytokine levels for IL-1ß, IL-2, IL-6, IL-8, IL-10, TNF-α, and PGE2 were measured using ELISA for all sample sites. RESULTS: The IL-6 levels at the exposure sites were found to be significantly higher in group A when compared to group B, but there was no statistically significant differences in any of the cytokine levels at the canal orifices between the two groups. CONCLUSIONS: Controlling bleeding at the exposure site or canal orifices does not provide accurate assessment of inflammation at the canal orifice and may be misleading for diagnosing vital pulp treatment in primary teeth with a carious pulp exposure.

Fracture Resistance of Incisal Fragments Following Reattachment With Different Techniques in Simulated Crown Fractures.

Introduction: The aim of the present study was to evaluate and compare the effect of acidetching and Er, Cr:YSGG laser treatment before the reattachment of incisal fragments in coronal fractures of permanent incisor teeth. Methods: Sixty-six sound human maxillary incisors were randomly divided into 3 groups (n=22). Teeth were embedded in self-cure acrylic resins by leaving one-third of the crowns out, and uncomplicated crown fractures were obtained using an Instron testing device. The fragments were reattached using 3 different procedures and a hybrid resin composite (Z250): Group I: Acid etching + Prime & Bond NT; Group II: Er,Cr:YSGG + Prime & Bond NT; Group III: Er,Cr:YSGG + Acid etching + Prime & Bond NT. The percentages of shear bond strengths were determined by comparing fracture strengths of sound and reattached teeth for 3 groups. All data were analyzed statistically with Kruskal-Wallis H test. Results: Mean fracture strengths of the reattached fragments were between 51.02% and 62.93% of that of the sound teeth in all groups. Group I had significantly higher percentages of shear bond strength values (P<0.05) when compared to group II and group III. No significant difference (P>0.05) was found between group II and group III. Conclusion: The findings of the present study show that Er,Cr:YSGG laser irradiation prior to the reattachment of incisal fragments has a negative effect on fracture strength.

Shear bond strength of different restorative materials to mineral trioxide aggregate and Biodentine.

SIGNIFICANCE OF STUDY: Mineral trioxide aggregate (MTA) and Biodentine (calcium silicate-based materials) have great importance in dentistry. There is no study comparing the bond strength of Biodentine and MTA for composite, compomer, and compomer or resin-modified glass ionomer (RMGIC). Although many advantages of Biodentine over MTA; in this study, MTA has shown better shear bond strength (SBS) to restorative materials. AIM: Recently, a variety of calcium silicate-based materials are often used for pulp capping, perforation repair, and endodontic therapies. After those treatment procedures, teeth are commonly restored with composite resin, (RMGIC materials in pediatric dentistry. The aim of this study was to evaluate the SBS of composite resin (Filtek™ Z250; 3M ESPE, USA), compomer (Dyract XP; LD Caulk/Dentsply, USA), and resin-modified glass ionomer (Photac-Fil Quick Aplicap; 3M ESPE, USA) to white MTA and Biodentine. MATERIALS AND METHODS: Ninety acrylic cylindrical blocks were prepared and divided into two groups (n = 45). The acrylic blocks were randomly allocated into 3 subgroups; Group-1A: MTA + composite (Filtek™ Z250), Group-1B: MTA + compomer (Dyract XP), Group-1C: MTA + RMGIC (Photac-Fil Quick Aplicap), Group-2A: Biodentine + composite, Group-2B: Biodentine + compomer, Group-2C: Biodentine + RMGIC. The specimens were mounted in Universal Testing Machine. A crosshead speed 1 mm/min was applied to each specimen using a knife-edge blade until the bond between the MTA/Biodentine and restorative material failed. Failure modes of each group were evaluated under polarized light microscope at ×40 magnification. RESULTS: There was no statistically significant difference between MTA + Composite resin with MTA + Compomer; and MTA + RMGIC with Biodentine + RMGIC (P > 0.05). There were statistically significant differences between other groups (P < 0.05). CONCLUSIONS: The results of the present study displayed that although many advantages of Biodentine over MTA; MTA has shown better SBS to compomer and composite resin materials than Biodentine.

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.

Root canal filling in primary molars without successors: Mineral trioxide aggregate versus gutta-percha/AH-Plus.

The aim of this study was to compare the clinical and radiographical success of mineral trioxide aggregate (MTA) and gutta-percha/AH-Plus used as a root canal filling material in primary second molars without successors. A total of 16 patients (9 girls, 7 boys) aged 6-13 years (mean: 10.5) were selected and randomly distributed into the treatment groups. Children were recalled for clinical and radiographic examination at 6, 12, 18, 24 and 36 months. Differences in treatment outcomes were analysed using chi-squared and Fisher's exact tests. Clinically, there was no significant difference in the success rates between the groups at the end of a 3-year follow-up period (MTA: 100%; Gutta-percha/AH-Plus: 70%) (P > 0.05). However, radiographically, there was a significant difference between the groups (MTA: 80%; gutta-percha/AH-Plus: 30%) (P < 0.05). The present study showed that MTA can be recommended for use in root canal treatment of primary molars without successors based on better radiographic success.

Effects of Fixed and Removable Space Maintainers on Plaque Accumulation, Periodontal Health, Candidal and Enterococcus Faecalis Carriage.

OBJECTIVE: To evaluate the effects of space maintainers on plaque accumulation, periodontal health and oral microflora. SUBJECTS AND METHODS: The study participants comprised 38 patients aged 4-10 years requiring either fixed or removable space maintainers. Plaque index, gingival index, bleeding on probing index, candidal colonization and Enterococcus faecalis were recorded just before the application of space maintainers (T0) and during treatment at the 1st (T1), 3rd (T2) and 6th (T3) month. RESULTS: The gingival and bleeding on probing index scores increased significantly (gingival index from 0.20 ± 0254 to 0.54 ± 0417 and bleeding on probing index from 7.18 ± 9.946 to 18.07 ± 14.074) in the regions with fixed space maintainers at T3 (p < 0.01). The mean Candida counts also increased (for removable appliances from 1.90 ± 3.638 to 1.98 ± 3.318, p < 0.05, and for fixed appliances from 4.25 ± 4.587 to 4.52 ± 4.431, p < 0.001). The salivary E. faecalis counts at T3 also increased significantly with the use of fixed and removable appliances (for removable appliances from 5.93 ± 2.65 to 85.53 ± 34.1 and for fixed appliances from 4.95 ± 2.94 to 123.59 ± 29.51, p < 0.001). A positive correlation was found between the plaque (r = 0.67), gingival (r = 0.76) and bleeding on probing index scores (r = 0.76) and the candidal colonization for the fixed space maintainers (p < 0.01, p < 0.001). CONCLUSIONS: In this study, both fixed and removable space maintainers led to an increase in the number of microorganisms in the oral cavity as well as to increases in the periodontal index scores. Patients should be informed that space maintainers may serve as a source of infection and that special attention must be given to their oral hygiene.

Comparison of micro-computerized tomography and cone-beam computerized tomography in the detection of accessory canals in primary molars.

PURPOSE: This study was performed to compare the accuracy of micro-computed tomography (CT) and cone-beam computed tomography (CBCT) in detecting accessory canals in primary molars. MATERIALS AND METHODS: Forty-one extracted human primary first and second molars were embedded in wax blocks and scanned using micro-CT and CBCT. After the images were taken, the samples were processed using a clearing technique and examined under a stereomicroscope in order to establish the gold standard for this study. The specimens were classified into three groups: maxillary molars, mandibular molars with three canals, and mandibular molars with four canals. Differences between the gold standard and the observations made using the imaging methods were calculated using Spearman's rho correlation coefficient test. RESULTS: The presence of accessory canals in micro-CT images of maxillary and mandibular root canals showed a statistically significant correlation with the stereomicroscopic images used as a gold standard. No statistically significant correlation was found between the CBCT findings and the stereomicroscopic images. CONCLUSION: Although micro-CT is not suitable for clinical use, it provides more detailed information about minor anatomical structures. However, CBCT is convenient for clinical use but may not be capable of adequately analyzing the internal anatomy of primary teeth.

Prevalence and characteristics of supernumerary teeth in a child population from Central Anatolia - Turkey.

AIMS: This article aimed to characterize the incidence of supernumerary teeth in Turkish children according to sex, location, number and morphology and to explore possible correlations between these variables. METHODS: The study population comprised 7,551 non-syndromic patients aged 3-16 years who applied for routine check-ups at the Ankara University Department of Pediatric Dentistry between January 2009 and January 2010. The population included children in deciduous, mixed and permanent dentition. Both clinical and radiographic examinations were conducted. Demographic variables (age, sex) as well as number, location (maxilla or mandible), position, type and morphology of supernumeraries were recorded for all patients with supernumerary teeth. Supernumerary teeth with odontomes were also noted. RESULTS: Of the 7,551 patients examined, supernumerary teeth were detected in 74 patients (0.98%). Of these, 48 were male and 26 were female (male-to-female ratio: 1.84:1). A total of 84 supernumerary teeth were detected, 80 (95.2%) of which were permanent teeth and 4 (4.8%) of which were deciduous teeth (n=4). Most supernumerary teeth (n=59, 70.2%) were located in the maxillary arch. The most common supernumerary teeth were mesiodens (36.9%), followed by supernumerary teeth located in the maxillary incisor region (33.3%), the mandibular premolar region (17.9%), the mandibular molar region (5.9%), the mandibular incisor region (4.8%) and the mandibular canine region (1.2%). CONCLUSION: The prevalence of supernumerary teeth was found to be 0.98% and mesiodens was the most frequent type.

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.

Using composite resin inclined plane for the repositioning of a laterally luxated primary incisor: a case report.

This case report describes the repositioning of a laterally luxated primary central incisor with occlusal interference, using a composite inclined plane. The patient was a 4-year-old girl who applied to our clinic three days after the injury. Because of the time delay between injury and presentation, it was not possible to reposition the tooth with pressure. Following a root-canal treatment, an inclined plane was prepared on the lower primary incisors, using composite resin. The tooth was repositioned in two weeks, and the inclined plane was then removed. After 1 year of follow-up, the treatment was found to be successful, both clinically and radiographically. The use of a composite inclined plane, accompanied by careful follow-up, is an effective alternative to extraction for laterally luxated primary incisors with occlusal interference.

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.

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.

Prevalence of low back pain in a developing urban setting.

STUDY DESIGN: A cross-sectional survey was conducted using face-to-face interviews. OBJECTIVES: To estimate the prevalence of low back pain (LBP) in an urban population of Turkey and to determine the factors associated with occurrence of LBP. SUMMARY OF BACKGROUND DATA: Little information exists in the literature regarding the epidemiology of LBP in developing countries. A few data from previous studies suggest that the prevalence of LBP is rather lower in developing countries compared with developed countries. METHODS: A total of 100 clusters of households (3,215 residents aged 16 years or older) in municipality area of Antalya was selected by systematic sampling. Of these, 3,173 study participants agreed to interview. The response rate was 98.7%. RESULTS: The crude lifetime, 12-month, and point prevalences of LBP were 46.6% (95% confidence interval [CI], 44.9-48.3), 35.9% (95% CI, 34.2-37.6), and 20.1% (95% CI, 18.7-21.5), respectively. In logistic regression analysis, age of 36 years or older, female sex, multiparity, being a housewife, being from East Turkey, and smoking showed independent associations with having current LBP. Being religious, heavy smoking, and age 26 to 45 years were associated with having restricted activity related to LBP. CONCLUSIONS: In comparison with other developing countries, point prevalence of LBP is higher in Turkey and approximates to prevalence estimates of LBP in developed countries. Smoking may be associated with both occurrence and severity of LBP. Although piety is not associated with having LBP, religious people are more likely to have restricted activity related to LBP.