Comparison of four different treatment strategies in teeth with molar-incisor hypomineralization-related enamel breakdown–A retrospective cohort study

Background There is little information available on the longevity of non-invasive glass ionomer cement (GIC) and composite restorations as well as conventional composite and ceramic restorations placed on permanent teeth with enamel breakdowns due to molar-incisor hypomineralization (MIH). Aim To compare the longevity of the abovementioned treatment procedures. Design Of 377 identified MIH patients, 118 individuals received restorative treatment and were invited for clinical examination, including caries and MIH status. Finally, survival data from 204 MIH-related restorations placed on 127 teeth were retrospectively collected from 52 children, monitored between 2010 and 2018. Descriptive and explorative analyses were performed, including Kaplan-Meier estimators and the Cox regression model. Results The mean patient observation time was 42.9 months (SD = 35.1). The cumulative survival probabilities after 36 months—7.0% (GIC, N = 28), 29.9% (non-invasive composite restoration, N = 126), 76.2% (conventional composite restoration, N = 27) and 100.0% (ceramic restoration, N = 23)—differed significantly in the regression analysis. Conclusions Conventional restorations were associated with moderate-to-high survival rates in MIH teeth. In contrast, non-invasive composite restorations, which were predominately used in younger or less cooperative children, were linked to lower survival rates

Enamel hypomineralization in permanent first molars. A clinical, histo-morphological and biochemical study

Hypomineralization in the permanent first molars was common in a group of 516 Swedish 8-year-old children. Ninety-five children (18.4%) had at least one molar with demarcated opacity. The incisors frequently displayed opacities concomitantly. The mean number of hypomineralized teeth of the affected children was 3.2 (SD 1.8), of which 2.4 were first molars. Six and a half percent of the children had severe defects, 5% had moderate defects, while 7% had only mildly hypomineralized teeth. Fifteen percent had more than one tooth affected, indicating systemic causation. The affected children, especially the boys, were reported to have had more health problems, asthma in particular (but only 4 cases), during the first year of life. Breast feeding history was similar in children with and without enamel defects. The children with severely defected enamel had undergone dental treatment of their first molars nearly ten times as often as the children in the healthy control group at the age of nine. Behavior management problems and dental fear and anxiety were common compared to the controls.Undemineralized sections from 73 permanent first molars, extracted due to severe hypomineralization of the enamel, were examined in polarized light. The hypomineralized areas extended from the cusps cervically comprising about half of the buccal and lingual sides. The cervical border to normal enamel was well defined and mainly followed the lines of Hunter-Schreger. The hypomineralized zones were covered by thin well-mineralized enamel. The concentration gradients for F, Cl, Na, Mg, K and Sr in hypomineralized enamel were analyzed by means of Secondary Ion Mass Spectrometry (SIMS), and completed with an analysis of the main matrix elements O, P and Ca by means of X-ray microanalysis (XRMA). Hypomineralized enamel had a higher content of C. Ca and P concentration were lower compared with normal enamel. The mean Ca/P ratio in hypomineralized areas was significantly lower (1.4) than the mean Ca/P ratio in the adjacent normal enamel (1.8)

Pain sensation and injection techniques in maxillary dento-alveolar surgery procedures in children : a comparison between conventional and computerized injection techniques (The Wand)

Local anesthesia, especially palatal injection, is often associated with fear and anxiety. The aim was to compare the sensation of pain when using palatal block technique with computerized injection technique (CIT), to conventional infiltration technique with traditional syringe in surgical procedures involving the palate. Patients referred for bilateral minor maxillary surgical treatments were randomized for traditional infiltration anesthesia on one side and palatal block anesthesia with CIT on the other side. AMSA and P-ASA approaches were used with CIT. The sensation of pain was scored by the VAS scale. Twenty-eight patients were included in the study, where of 17 (61%) were girls. The median age was 14.8 yrs. (12.6 - 17.8). Bilateral exposure of palatal impacted canines was the most common treatment. The injection pain was significantly lower, (p = 0.009), when using the CIT injection compared to conventional injection. However, with time-consuming surgery, additional CIT analgesic solution had to be injected in the buccal gingiva when suturing, in one fourth of the cases. Patients sedated with nitrous oxide seemed to benefit less from CIT. Computerized injection techniques, including P-ASA and AMSA approaches, reduces the sensation of pain when carrying out less time-consuming palatal dental surgery, especially in non-sedated teenagers

Preterm Infants - Odontological Aspects

ABSTRACT Preterm birth is associated with medical complications and treatments postnatally and disturbances in growth and development. Primary and permanent teeth develop during this postnatal period. The overall aim of the present thesis was to elucidate the effects of preterm birth and postnatal complications on oral health and the dentoalveolar development during adolescence, and to study the effects of preterm birth on caries during childhood, in a well-defined group of preterm infants. In the same group, explore the development of the primary and permanent teeth and compare the results with a matched control group and control teeth. The subjects consisted of 40(45) of 56 surviving infants, born <29 weeks of gestational age (GA), and matched healthy children born at term. The material consisted of 44 teeth from 14 of the preterm adolescents and 36 control teeth from healthy children. Clinical examinations and dental cast analysis were performed during adolescence and morbidity was noted. Retrospective information from medical and dental records was obtained. Dental enamel was analyzed in a polarized light microscopy, and scanning electron microscopy. Further, chemical analyses of enamel and dentin were performed with X-ray microanalysis. The results showed that during adolescence, more preterms had plaque and gingival inflammation, lower salivary secretion, more S. mutans and severe hypomineralization. Retrospectively, less caries was noted at six years of age, but more children had hypomineralization in the primary dentition. Angle Class II malocclusion, large over-bite and deep bite associated with medical diagnoses were frequent. Furthermore, smaller dental arch perimeters in girls, at 16 years of age, and smaller tooth size in the incisors, canines and first molars were found. The morphological findings were confirmed in the XRMA analyses. In postnatal enamel, varying degrees of porosities >5% and incremental lines were seen. Lower values of Ca and Ca/C ratio and higher values of C were found. Ca/P ratio in both enamel and dentine indicates normal hydroxyapatite in both groups. No single medical diagnosis, postnatal treatment or morbidity in adolescents could explain the findings. As a conclusion, there are indications for poor oral outcome in this group of preterm infants during adolescence, and disturbed mineralization in primary teet