Paediatric endodontics. Part. 1: Portland Cements Apical Plug

Treatment of necrotic immature permanent anterior teeth with Portland cements apical plug. The long-term success of endodontic treatment depends on the quality of the apical and coronal seal. In necrotic immature teeth the treatment can be challenging for the clinician as the endodontic anatomy and the presence of bacterial infection need to be addressed with special techniques and materials in order to obtain an effective and biocompatible apical seal. Unfortunately, despite the best treatments, immature permanent teeth have a reduced resistance to fracture due to the arrest of root walls development

SEM Evaluation of the Hybrid Layer of Two Universal Adhesives on Sound and DI Type II Affected Dentin

Universal nanofilled adhesives were recently introduced in restorative dentistry to simplify clinical procedures and improve adhesion in different clinical situation. This study investigated the effectiveness of two universal adhesives on both sound and dentinogenesis imperfecta type II (DI-II)-affected teeth. To evaluate the effectiveness of adhesion on both sound and DI-II-affected teeth, four samples, two sound extracted molars and two extracted molars affected by DI-II were selected. Coronal enamel and dentin were exposed, and the samples were used for testing two different universal adhesives, Universal Bond (Tokuyama) and All-Bond Universal (Bisco). After the adhesive procedures, the samples were stored in saline at room temperature for one week prior to SEM investigation for the interfacial bonding layer. The samples were longitudinally sectioned into two parts, obtaining two sections for the evaluation of the adhesive interface to the SEM. The SEM-morphology of the hybrid layer on the enamel was similar for the two universal adhesives tested. The study of the hybrid layer on sound dentin confirmed the great versatility of All-Bond Universal and Universal Bond adhesives in managing adhesion even on pathological dental substrates. Both universal adhesives tested showed encouraging results on DI-II-affected dentin, creating an effective hybrid layer even on the atubular and less mineralized altered dentin

Durability of adhesion between an adhesive and post-space dentin: Push-out evaluation at one and six months.

Aims The aim of this study was to investigate, by means of the push-out test, the bond of Prime & Bond NT at various post-space dentin locations and the influence of time of water storage on bond strength values. Methods 30 single-rooted teeth were used for the bond strength measurement. In each tooth fiber posts were cemented with the commercial bonding system “Prime & Bond NT” in combination with the resin-based filling material “Opticore Cure Core Composite”. After 24 h (group A: 10 roots), 1 month (group B: 10 roots), and 6 months (group C: 10 roots) of water storage, the specimens were sectioned in 1 mm-thick slices for the push-out test. The data were divided into three regions (coronal/middle/apical) and analyzed using Kruskal-Wallis Test and Mann-Whitney U Test (p<0.05). Results The bond strength values registered did not show statistically significant differences within group A and C; within group B statistically significant differences were found between the coronal and the middle thirds and between the coronal and the apical third. The apical bond strength values did not show any statistically significant difference among the three groups (Kruskal-Wallis test); in the middle thirds a statistically significant difference was found at 6 months when compared with the 24 h and 1-month samples. In the coronal thirds was found a statistically significant difference between 1 month and 6 months. Analysis of the specimens under optical microscope revealed a prevalence of adhesive failures between fiber post and root dentin. Conclusions Bond strength values are lower at the apical third. Over time the adhesion of the fiberpost/luting cement/post-space dentin does not remain stable

Is dental amalgam a higher risk factor rather than resin‐based restorations for systemic conditions? A systematic review

Objective: The aim of this study was to confirm the hypothesis that patients with one or more amalgam restorations have an increased risk for systemic diseases rather than patients with resin-based restorations. Data: The data search produced an initial 3568 total number of records. All titles and abstract were reviewed by five independent examiners, and only 36 records were selected for full text in depth examination. Out of these, only nine publications matched the inclusion criteria and were included in this systematic review. Sources: Electronic databases (MEDLINE, Scopus, Embase, and Web of Knowledge) were searched up to June 2019. In addition, a manual search was carried out on journals related to this topic. Study selection: All selected human clinical studies compared patients with dental amalgam restorations to patients with non-amalgam restorations on restorative material related diseases/health conditions with at least 50 patients and a reasonable follow up. The systemic effects of dental restorations were analyzed. As for any systemic effects, there was no difference between amalgam and composite restoration. Conclusions: With the limitations of the few available randomized controlled trials (RCTs) on the matter, amalgam restorations, similarly to other modern resin-based materials, were not related to an increased risk of systemic diseases or conditions. Clinical significance: On the basis of the available RCTs, amalgam restorations, if compared with resin-based fillings, do not show an increased risk for systemic diseases. There is still insufficient evidence to exclude or demonstrate any direct influence on general health. The removal of old amalgam restorations and their substitution with more modern adhesive restorations should be performed only when clinically necessary and not just for material concerns. In order to better evaluate the safety of dental amalgam compared to other more modern restorative materials, further RCTs that consider important parameters such as long and uniform follow up periods, number of restorations per patient, and sample populations representative of chronic or degenerative diseases are needed

In-office bacteria test for a microbial monitoring during the conventional and self-ligating orthodontic treatment

This study investigated the microbial level of Streptococcus mutans and Lactobacillus spp. during an orthodontic treatment, and compare the data with untreated control subjects.Sixty young adult subjects were selected (average 20.5, DS 1.62), among which 40 underwent an orthodontic treatment (20 were treated with self-ligating brackets and 20 with conventional brackets) and 20 were controls. Plaque Index, salivary flow and buffering capacity of saliva were assessed before the beginning of the orthodontic treatment. Then the microbial counts were obtained by using an in-office bacteria test.The plaque index (PI) increased over time in each group as well as salivary flow, mostly in subjects treated with self-ligating brackets, suggesting a difference between conventional and self-ligating brackets. S.mutans showed a different trend of colonization in the two treated groups, as for subjects treated with conventional brackets it showed the greater value at the early stage of treatment (T1), followed by a decrease at T2. Lactobacillus spp. showed significant increase over time in the two treated groups, respect to the control group. Linear regression analysis showed no significant predictor for the microbial count at T2.The assortment of the various species of bacteria change over time during the orthodontic treatment, and seems to show different trends, depending on the type of orthodontic device. Consequently a periodical microbial monitoring using in-office bacteria tests, seems indicated

The relationship of tooth shade and skin tone and its influence on the smile attractiveness

Objective The purpose of this clinical study was to determine if skin tone and tooth color had the same influence on smile attractiveness. Materials and Methods A woman's smile photograph was digitally manipulated to create a range of images with varying colors. The skin shade was modified to create four tones (p1: light, p2: light medium, p3: medium dark, p4: dark) using the L'Oreal True Illusion shade as a guide. The tooth shade was modified in four different tones: A1, A2, A3, A4 using the VITAPAN Classical shade guide to produce 16 images. A sample of 328 participants rated each image for attractiveness by means of a visual analog scale (VAS). Comparison among groups was performed with a 2-way ANOVA adjusted for multiple comparisons with the Bonferroni test (alpha = .05). Results Image (p3-a1) showed the highest VAS values, while image (p1-a4) obtained the lowest, (Bonferroni Test: a1 vs a2, a3, a4 P &lt; .001; p3 vs p1, p2, p4 P &lt; .001). Analysis performed for age, sex, level of education, and laypeople/dentists were not statistically significant (P &gt; .05). Conclusions Variations in tooth and skin tone can significantly influence the perception of smile attractiveness. In the tested conditions, a brighter tooth shade significantly affected the attractiveness of the smile independently from skin tone. Clinical Significance Understanding patient and dentist perception of the attractiveness of a smile with the important role-played by skin tone, may help clinicians to better identify teeth shade, helping delivery of tailored prostheses and esthetic restorations

SEM-morphology in dentinogenesis imperfecta type II: microscopic anatomy and efficacy of a dentine bonding system

AIM: Dentinogenesis Imperfecta is a hereditary defect consisting of opalescent teeth composed of irregularly formed and undermineralised dentin that obliterates the coronal and root pulpal chambers. The aim of this study was to examine the morphology of permanent human enamel, dentine and the dentine-enamel junction, in individuals affected by Dentinogenesis Imperfecta type II in undercalcified sections using scanning electron microscope (SEM) to compare the findings to the normal morphology, and to study the efficacy of modern bonding system to dentine and enamel DI type II affected. MATERIALS AND METHODS: Four third molars extracted from two 19 year-old subjects (one patient affected by Dentinogenesis Imperfecta type II) were included in resin, two divided in slices with a air-cooled diamond disc, and two used to study the characterisation of the resin-dentin interface. The sections of the teeth were examined by means of SEM. The slices were finished up with abrasive paper (400, 600, 1000, and 2000), the half surfaces obtained were etched with 37% phosphoric acid and then joined up to the stubs for SEM analysis. SEM Stereoscan 440 Leica with magnifications of 20X, 100X, 250X, 1000X, 2000X, 3000X was used. As control group were used four third molars with normal anatomy. RESULTS: This study shows that the permanent enamel from patients with DI exhibits few structural changes. No relationships were found between enamel morphology and the DI type II. Enamel appeared to be regularly mineralised. The major findings were anomalies in the dentine-enamel junction, locally a lower degree of mineralisation and an undulating morphology. The dentine showed absence of tubules. CONCLUSION: This study confirms that the problem with teeth affected by DI type II is the defect in dentine and weakness in the way the enamel is attached to the dentine. The adhesive system tested is not able to create a real hybrid layer in dentine DI type II affected and seems to be less effective than on normal substrates

ECC full rehabilitation with indirect composite restorations: A case report

Baby Bottle Syndrome, also known as Early Childhood Caries, is a diffuse decay condition of dental hard tissues in deciduous dentition. During the night, Streptococcus mutans and Streptococcus sobrinus ferment carbohydrates from food and beverages, producing lactic acid that induce enamel demineralization. This case report describes the treatment of a small patient with severe loss of dental tissue both in the anterior superior area and the posterior sectors. Aim of this case report was to describe a complete rehabilitation of the posterior and canine areas with indirect composite restorations

The retrieval of unerupted teeth in pedodontics: Two case reports

Introduction: The retrieval of unerupted teeth in pedodontics is always significant to preserve the trophism of adjacent tissues, establish the correct space, provide adequate function and maintain good esthetics for the patient. The treatment plan is based on radiographic examinations and measurements, and on an accurate clinical evaluation; it aims to achieve the best treatment possible depending on the complexity of the specific case. In the most difficult clinical cases it is very important to have an early diagnosis, which is essential to plan the treatment and achieve success. In these cases, the pediatrician is in a strategic position to give an early diagnosis through a child’s medical history and by counting the child’s teeth. Case presentation: This article presents two different difficult clinical cases of impacted teeth diagnosed during pediatric age, with a radiological analysis, and successfully treated with orthodontic devices designed for these specific cases. Clinical case 1 describes a 13-year-old Italian girl; clinical case 2 describes a 9-year-old Italian girl. The use of these devices achieved the desired treatment goals. The problems associated with impacted teeth and the biomechanical interventions used for these patients are discussed. Conclusions: An early and careful diagnosis followed by an accurate treatment plan for the individual cases can lead to retrieval of the impacted teeth without affecting other anatomic structures and adjacent teeth. In these cases, the pediatrician is in a strategic position to give an early diagnosis through a child’s medical history and by counting the child’s teeth