Inflammatory Status of Excavated Pulp Tissue and Internal Root Resorption in Pulpotomized Primary Molars.

Statement of the Problem: Internal root resorption after pulpotomy is a pathological phenomenon and can lead to early root resorption and subsequent loss of the tooth. Purpose: To assess the relationship between initial inflammatory coronal pulp status in decayed primary molars treated by pulpotomy and internal root resorption after one-year follow-up. Materials and Method: In this clinical in vivo and in vitro experiment, vital pulpotomies were performed on 50 primary molars from 50 patients aged 5 to 10 years. Coronal pulp was carefully removed followed by hemostasis and placement of a reinforced zinc oxide eugenol over the vital radicular pulp. Enzyme-linked immunosorbent assay (ELISA) assay was done on coronal pulp samples and the level of tumor necrosis factor-alpha (TNF- α) and interlukin-6 (IL-6) was measured. After a 12-month follow-up, periapical radiographs were taken from pulpotomized teeth. Kolmogorov-Smirnov, Chi-square, Kruskal-Wallis, and Mann-Whitney tests were implemented. Results: 11 treated teeth (22%) showed an internal root resorption as diagnosed on X-rays. No significant association was found between TNF- α, IL-6 levels, and pathological root resorption respectively (p= 0.953) and (p= 0.944). A significant association between age and pathological root resorption was observed (p= 0.031). No significant association between remaining dentin thickness and pathological root resorption was established (p= 0.346). Conclusion: There was no association between pro-inflammatory cytokines levels/ TNF-α, IL-6 and internal root resorption following pulpotomy in pediatric patients.

Age and Sequence of Permanent Teeth Eruption in Lebanese Children.

BACKGROUND: The timing of eruption of permanent teeth can be a precious help to the pediatric practitioner in identifying an appropriate treatment plan. Usually, it presents a more precise sign of an early or late growth of the child. AIMS: It is to determine whether the timing of the permanent teeth eruption in Lebanese pediatric population can be considered as standard Lebanese values, since no other study was previously performed. MATERIALS AND METHODS: A cross-sectional study is conducted, and the clinical emergence data are collected for a sample of 2317 Lebanese children aged between 5.5 years and 13 years (1129 girls and 1188 boys) from different socioeconomic groups in rural and urban communities spread over different regions in Lebanon. The study investigates dental emergence patterns. RESULTS: Statistical analysis is performed with the SPSS Software. A confidence interval of 95% and significance level of 5% are adopted. The trend is for males to begin their permanent teeth eruption later than girls. Emergence of all permanent mandibular teeth is earlier than maxillary ones. Symmetry is found between the right and left teeth in the maxilla, as well as in the mandibula. CONCLUSION: In this study, the results indicate that premolars and second permanent molars erupt earlier in the Lebanese children compared to children of other countries reflected in several studies.

Salivary Immunoglobulin A and Streptococcus mutans Levels among Lebanese Preschool Children with Early Childhood Caries.

AIM AND OBJECTIVE: We checked in this study the correlation between total immunoglobulin A (IgA) and Streptococcus mutans (SM) levels in saliva derived from Lebanese children with inappropriate eating habits and showing early childhood caries (ECC). MATERIALS AND METHODS: Sixty Lebanese preschool children with similar alimentation were included in this study and divided into two groups. Group I included children having 0 cavities where group II contained children having ECC. We measured the SM and IgA levels collected from saliva and dental plaque. RESULTS: We observed a significant difference in SM levels between the two groups (p < 0.001). There was a marginal correlation between salivary total IgA and SM collected from dental plaque (r = 0.33, p = 0.077). However, no significant correlation was detected between total salivary IgA and salivary SM (p = 0.35). CONCLUSION: This study suggests the absence of significant relationship between salivary markers of immune system and the development of ECC. CLINICAL SIGNIFICANCE: Early childhood caries is a public dental health problem that has been affecting preschool children all over the world. Its prevention must be a priority for all professionals in the medical and dental community. This study highlights the absence of correlation between total IgA and SM collected from the saliva. This does not completely exclude the preventive role of salivary immune components, but further studies are required to better understand this relationship.

Alveolar Bone and Epithelial Attachment Status following Two Different Closed-eruption Surgical Techniques for Impacted Maxillary Central Incisors.

AIM: Two eruption surgical techniques are commonly described for the treatment of upper impacted central incisors (ICIs): Open and closed. Currently, the closed-eruption surgical technique (CEST) is the most commonly used, as it allows for the best esthetic and periodontal results.The aim of this study was to determine the effect of traction discontinuation on maxillary central incisor sulcal depth and alveolar bone ridge levels compared with contralateral incisors, when CEST is used. MATERIALS AND METHODS: Our study involved 28 unilateral impacted maxillary central incisors treated by CEST. Thirteen teeth were subjected to traction interruption for a month at the time of emergence of the crown, while 15 teeth underwent continuous traction. One year after treatment, periapical digital X-rays, anterosuperior cone beam computerized tomography (CBCT) scanning, and periodontal probing of the ICIs and contralateral central incisors (CCIs) were performed. Student's t-test was used to study whether a statistically significant difference between continuous and interrupted tractions takes place while using the CCI measurements as reference. RESULTS: There was a statistically significant difference between the two techniques only for the following measurements: Mesial probing (p-value 0.039352), labial bone level (p-value 2.58E-08), and palatal bone level (p-value 2.56E-06). LIMITATIONS: A larger sample size and longer term follow-up are needed to draw more robust conclusions. CONCLUSION: A temporary discontinuation during traction of the tooth appears to positively impact treatment outcome on ICIs. CLINICAL SIGNIFICANCE: • The CEST leads to the best periodontal status for ICIs.• The discontinuation of traction at the emergence of the tooth allows the supracrestal fibers to insert into the cement in a proper way.How to cite this article: Sfeir E, Gholmieh M, Skaf Z, Mourad A. Alveolar Bone and Epithelial Attachment Status following Two Different Closed-eruption Surgical Techniques for Impacted Maxillary Central Incisors. Int J Clin Pediatr Dent 2018;11(4):317-322.

Measurement Reliability of the Remaining Dentin Thickness below Deep Carious Lesions in Primary Molars.

AIM: This study was carried out to assess the reliability of measurements of the remaining dentin thickness under deep carious lesions as estimated from digital radiographs. The goal is to allow clinicians to correlate the radiographic measurement to the exact value of the remaining dentin thickness. The results obtained will be tested further in a study that will evaluate the histopathologic pulpal state according to the caries' lesion depth. MATERIALS AND METHODS: The study was conducted in the Pediatric Dentistry Department at the Lebanese University, in collaboration with the research platform of the same university. Fifty deciduous molars with deep caries on proximal surfaces liable to extraction were collected. Before extraction, a digital in vivo periapical radiograph was taken, followed by manual excavation of the caries. After excavation, another radiograph was taken before the tooth was sectioned through the deepest site of the lesion. Another radiograph was then obtained for each tooth fragment. To evaluate the exact thickness of the remaining dentin, each fragment was measured on a histologic macropho-tograph. The measurements were then compared statistically using a paired-samples t-test, and a correlation was sought. RESULTS: No significant difference was observed in the radiographs between the measurement of the remaining dentin thickness before and after the excavation of caries. In contrast, the radiographic measurements of remaining dentin thickness were underestimated by an average of 20% compared with those made with macrophotographs. LIMITATIONS: Interpretation of radiographs varies from one practitioner to another and is a function of the operator's visual acuity. CONCLUSION: Measuring the residual dentin thickness on a radiograph underestimates the actual thickness by about 20%. Further studies are needed to confirm these results. CLINICAL SIGNIFICANCE: Our results indicate that remaining dentin thickness is greater in reality than is shown on a radiograph. This information can help clinicians to refine their diagnoses and treatment plans.How to cite this article: Berbari R, Khairallah A, Kazan HF, Ezzedine M, Bandon D, Sfeir E. Measurement Reliability of the Remaining Dentin Thickness below Deep Carious Lesions in Primary Molars. Int J Clin Pediatr Dent 2018;11(1):23-28.

Relationship Between the Remaining Dentin Thickness and Coronal Pulp Status of Decayed Primary Molars.

AIMS AND OBJECTIVES: The aim of this study was to assess the correlation between the remaining dentin thickness (RDT) in deep decayed primary molars and the inflammatory status and bacterial composition of the corresponding coronal pulp. We hypothesized that RDT could be used as a reference for clinicians in assigning the indication for pulpotomy. MATERIALS AND METHODS: Pulpotomies were conducted on the cameral pulp of 48 primary molars. Microorganisms, such as Lactobacillus sp., Streptococcus sp., and Prevotella sp., were identified and quantified and levels of tumor necrosis factor-alpha (TNF-α) and interlukin-6 (IL-6) were assessed. The correlation between the pre-operative RDT based on radiographic images and inflammatory-microbial profiles in vitro was evaluated using Spearman's rho correlation coefficient. All data analysis was performed using a statistical software program (SPSS 20.0, SPSS Inc., Chicago, IL, USA). RESULTS: Immunological and microbiological studies revealed elevated levels of TNF-α and IL-6 cytokines, and Lactobacillus sp., Streptococcus sp. and Prevotella sp. in the cameral pulp with an RDT measuring up to 1.1 mm. No significant relationship could be established between RDT, inflammatory status and microbial content of the pulps. CONCLUSION: The RDT remains a key clinical factor that needs to be assessed when establishing the indication for pulpotomy. Additional parameters that can improve this therapy should be investigated in the future.

Evaluation of Masticatory Stimulation Effect on the Maxillary Transversal Growth in Ectodermal Dysplasia Children.

AIMS: Severe oligodontia is one of the most important symptoms in children with hypohidrotic ectodermal dysplasia (HED). The growth of the maxilla is a key consideration in restoring their mouth. The aim of this study was to evaluate the transversal maxillary sutural growth, after passive masticatory stimulation, in HED children. We also thought to assess the efficiency and functional outcome of the proposed propriocep-tive passive expansion (PPE) prosthetic device. MATERIALS AND METHODS: We studied 13 children (age 6-11 years) suffering from HED with severe oligodontia. Their maxilla was restored by a PPE device formed from two parts and joined by a passive slide system. Distance between the two parts was noted at the anterior and posterior regions at each control visit over an average of 23 months. We also conducted and filled a satisfaction questionnaire over the same period. We tested the hypothesis that the posterior expansion is greater than the anterior expansion (one-tailed Student's t-test with p-value <0.05). Best-fit linear and quadratic models were used to explore the relationship between age, duration of observation, and the rate of growth. RESULTS: The average opening of the device was 2.27 mm in the anterior region and 2.96 mm in the posterior region. The questionnaire response was positive for all children. There are no significant linear or quadratic relationships between the data at the 5% significance level. The posterior expansion is greater than the anterior expansion at the 5% significance level (p-value 0.000394). LIMITATIONS: Further studies are mandatory to assess the reliability of our particular intervention and treatment modalities for these cases. CONCLUSION: The PPE device, we propose, assures function and esthetics in the long- term. It enhances stimulation by a passive way that leads to physiological growth of the palatal suture. CLINICAL SIGNIFICANCE: Using this PPE device to restore the maxilla in children with HED promotes physiological growth. The passive nature of this prosthesis helps by eliminating the need for any changes or replacement over time. HOW TO CITE THIS ARTICLE: Sfeir E, Nahass MG, Mourad A. Evaluation of Masticatory Stimulation Effect on the Maxillary Transversal Growth in Ectodermal Dysplasia Children. Int J Clin Pediatr Dent 2017;10(1):55-61.

Impacted Lower Second Permanent Molars at the Ramus and Coronoid Process: A New Clinical Symptom of the WNT10A Mutation in Ectodermal Dysplasia.

AIM: Hidrotic ectodermal dysplasia (ED) with the WNT10A mutation produces variable dentofacial symptoms. The aim of this study was to describe a new clinical symptom, i.e., specific to the WNT10A mutation in hidrotic ED. The study investigated the migratory trend of the lower second permanent molars to the ramus or coronoid process. To the best of authors' knowledge, no data in the literature describe this trend in cases of hidrotic ED. MATERIALS AND METHODS: A three-generation family pedigree was established for seven families after the diagnosis of hidrotic ED in a 10-year-old boy. Thereafter, a genetic and clinical study was conducted on three families with at least one individual affected by hidrotic ED (20 individuals). We selected the children with molar germs 37 and 47. The eruption axes of these germs were then traced on the panoramic images at the initial time (T0) and 1 year later (T0 + 1 year), and the deviations between these axes were measured. RESULTS: A significant familial consanguinity was shown. Eight subjects presented with the hidrotic ED phenotype. Among them, three individuals carried germs 37 and 47. Over time, the measured deviations between the eruption axes of the latter displayed, in the majority of the cases, a distal inclination toward the ramus. LIMITATIONS: A larger sample size is mandatory to assess the frequencies and treatment modalities. CONCLUSION: The presence of germs in the lower second permanent molars in patients with hidrotic ED is an important clinical symptom that should be monitored to detect and prevent ectopic migration of these teeth. CLINICAL SIGNIFICANCE: In hidrotic ED cases, the study of the presence of the second lower permanent germs must include clinical and radiological examinations. Establishing an inter-ceptive treatment is necessary to prevent the migration of the molars in question.How to cite this article: Sfeir E, Aboujaoude S. Impacted Lower Second Permanent Molars at the Ramus and Coronoid Process: A New Clinical Symptom of the WNT10A Mutation in Ectodermal Dysplasia. Int J Clin Pediatr Dent 2017;10(4):363-368.

In vitro Macro-qualitative Comparison of Three Enamel Stripping Procedures: What is the Best Shape We can get?

AIM: Interdental stripping is a common clinical procedure in orthodontic therapy, by reshaping the proximal contacts. Handheld abrasive strips have been criticized as time-consuming process. Metallic strip system, diamond disk, or segment disks have become increasingly popular. The aim of this study is to evaluate the morphological aspects of remodeled dental surfaces so as to conclude which of the different techniques (disk, bur, or strip) used to reduce the mesiodistal diameter is the best to reproduce the initial contour of the proximal surface of the tooth. MATERIALS AND METHODS: Seventy-nine pieces ("teeth") were prepared from permanent healthy teeth (premolars and molars) extracted for orthodontic reasons. They were mounted on a stand resembling the position of the natural teeth in a mild crowded dentition. The "teeth" are divided into three groups as follows: group S (strip): 26 "teeth," group D (disk): 25 "teeth," group B (bur): 28 "teeth." In order to study the changes, these prepared "teeth" are macro-photographed in groups of 5 before and after proximal grinding. RESULTS: The "teeth" contours have been identified using piecewise cubic Hermit polynomials. The change in the contour has been traduced in terms of the change of curvature in the "teeth" contours. We used the z-test in order to find the confidence interval for the proportion of the class "+" for each of the techniques B, S, and D. With confidence level of 95%, we obtained the following confidence intervals:B = (0.6943; 0.9057); S = (0.9093; 1.0138); D = (0.6184; 0.8616)These results can be interpreted, as the technique S is significantly much better than the other two techniques if we aim at conserving the shape of the teeth before and after treatment. CONCLUSION: We conclude that the use of a strip for remodeling the proximal surface of a tooth is an optimal technique to preserve the proximal shape of the tooth although it requires more time. CLINICAL SIGNIFICANCE: The use of abrasive strip preserves the best shape of the proximal side. Abrasive strip could be the last step of any proximal reshaping technique.How to cite this article: Nassif N, Gholmieh MN, Sfeir E, Mourad A. In vitro Macro-qualitative Comparison of Three Enamel Stripping Procedures: What is the Best Shape We can get? Int J Clin Pediatr Dent 2017;10(4):358-362.