Biomedical subjects
Anna B Fuks
Publications and source records attributed to Anna B Fuks.
The fate of a mid-root fracture: a case report.
The present report describes a case of a mid-root fracture in a maxillary central incisor of a 19-year-old patient. The fractured tooth was splinted with composite that was removed only 3 years later, as the patient did not appear for follow-up examinations. At this time, the radiographs revealed a normal periodontal ligament, rounding of the borders of the fragments and pulp obliteration of both fragments. Eight years later, the tooth was clinically normal and blurred calcification of the root canal was disclosed radiographically. After 13.5 years the patient complained of tooth mobility and radiographic examination revealed an advanced cervical root resorption. As no conservative approach was possible at this stage, the patient was referred to a prosthodontist for esthetic rehabilitation.
Status of amalgams in pediatric dentistry: pros and cons.
Explore the source record for details and available documents.
Root fillings with Endoflas in primary teeth: a retrospective study.
The aim of this retrospective study is to report the success rate of root canal treatments (RCT) using Endoflas as a filling material in primary teeth. Fifty-five (55 teeth, 27 maxillary incisors and 28 molars) of 47 children fulfilled the criteria to be included in the study. The immediate post-operative radiograph was evaluated and the root filling was rated overfilled, flush or underfilled. Thirty-one (31) teeth were overfilled; of these 9 (29%) were normal pre-operatively and the remaining 22 (71%) presented with bone pathology. Twenty-four (24) teeth were flush or underfilled; of these, 50% had preoperative bone pathology. The children were examined clinically and radiographically at follow-up visits ranging from 6 to 52 months. Approximately 70% of the cases were successful at the last followup examination. The remaining 30% presented with pathology (Po); however, only one tooth had to be extracted (Pi). Overfilling led to a success rate of 58%, while in the combined flush and underfilled the success rate was 83%.
The diagnostic value of lateral extraoral radiography for intruded maxillary primary incisors.
PURPOSE: The purpose of the study was to assess the contribution of a lateral extraoral radiograph for diagnosing the relation between the root of intruded maxillary primary incisors and their permanent successors. METHODS: Three pediatric dentists examined intruded primary teeth 0-7 days after injury. The relations between the primary and permanent teeth were assessed in three separate steps: 1) evaluation of clinical signs only; 2) evaluation of a periapical radiograph (no lateral radiograph); 3) evaluation of a lateral extraoral radiograph. The clinical and radiographic signs used to assess the relations were recorded. The lateral extraoral radiograph was regarded as contributory to diagnosis if the assessment after the third step differed significantly from that made after the first and second steps. Ninety-three evaluations of 53 intruded teeth in 37 children were available for analysis. RESULTS: The lateral extraoral radiograph was found valuable for assessment of the primary incisor's root alignment in only 5% (5/93) of the evaluations in which neither the clinical examination nor the periapical radiograph were contributory. Four of these five cases were in children less than 20 months old. In all other cases, the lateral radiograph was not contributory for two main reasons: It could not be evaluated due to overlap of multiple intruded teeth and/or when the teeth intruded were lateral incisors, and when the clinical and periapical radiographs were sufficient for diagnosis. CONCLUSIONS: Lateral extraoral radiographs should not be used routinely in cases of intrusion of primary incisors. The operator should base his or her diagnosis on clinical findings and examination of a periapical radiograph. The lateral extraoral radiograph should be taken only when its expected contribution to diagnosis can be confirmed, as in cases of children younger than 20 months.
Success rate of formocresol pulpotomy in primary molars restored with stainless steel crown vs amalga.
PURPOSE: The purpose of this retrospective study was to compare the success rates of formocresol pulpotomy in primary molars restored with stainless steel crowns (SSC) to those restored with amalgam (AM). METHODS: Radiographs of pulpotomized primary molars restored with SSC or AM in the principal author's pediatric dentist practice were evaluated and defined as a "failure" when one or more of the following signs were present: internal (IR) or external (ER) root resorption and periapical (PR) or inter-radicular (IRR) radiolucency. Pulp canal obliteration was not regarded as failure. Three hundred and forty-one molars were available for follow-up evaluations ranging from 6 to 103 months. RESULTS: Forty-seven (14%) teeth were defined as "failure," with a rate of 13% (36/287) for teeth restored with SSC and 20% (11/54) for AM. This difference was not statistically significant (P>0.1). Failure rates of 2 surfaces AM was 23% (7/30), much higher than that of one surface AM (10%, 2/20). Most of the failed teeth presented more than one pathologic finding, with IR being the most frequently observed (36%), followed by ER (31%), IRR (22%) and PR (11%). Pulp canal obliteration was detected in 80% of the teeth, with similar rates in both groups. Failures were observed initially after a mean follow-up of 27 and 29 months in teeth restored with AM and SSC, respectively. CONCLUSIONS: Pulpotomized primary molars can be successfully restored with one surface amalgam if their natural exfoliation is expected within not more than two years.
The use of amalgam in pediatric dentistry.
Amalgam has been widely utilized to restore posterior teeth in pediatric dentistry, and is still taught as the material of choice for Class I and Class II restorations in many dental schools in the United States and Canada. Results of clinical trials are difficult to compare due to their heterogenicity, mainly due to differences in caries risk, operator skills, study duration, or patients' age. Thus, the different studies report failure rates of amalgams ranging from 12% to over 70%. Treatment of caries should meet the needs of each particular patient, based on his/her caries risk. In general, for small occlusal lesions, a conservative preventive resin restoration, using composite or compomer in conjunction with sealant, would be more appropriate than the classic Class I amalgam preparation. For proximal lesions, amalgam would be indicated for 2-surface Class II preparations that do not extend beyond the line angles of primary teeth. This recommendation might not be appropriate for high-risk patients or for restoring first primary molars in children 4 years of age and younger where stainless steel crowns have demonstrated better longevity. Currently, amalgam demonstrates the best clinical success for Class II restorations that extend beyond the proximal line angles of permanent molars.
Shear strength of sealants placed with non-rinse conditioning compared to a conventional acid etch-rinse technique.
The present study compared the shearing strength of a non-rinse conditioning (NRC) compomer sealant to that of a conventional sealant. Thirty molars and premolars were sectioned longitudinally. The resulting halves were divided into 4 groups. Cylinders of sealants were bonded to the sections using a gelatin capsule as a matrix, as follows: Group A (n = 15) NRC + Prime & Bond + Dyract Seal; Group B (n = 15) same as group A but with phosphoric acid and rinse; Group C (n = 15) conventional phosphoric acid + Helioseal; Group D (n = 15) NRC + Helioseal. After immersing the specimens in water for 7 days, the samples were mounted on the Instron testing machine at a 20 mm/min crosshead speed. The results were subjected to ANOVA with Scheffe test, with a significant level of .05. No shearing strength values could be obtained for the specimens of group D. Some cylinders separated from the enamel while still immersed in the water, and in others the adhesion was too low, and no readings could be observed. For all groups, failure occurred at the sealant-enamel interface. The mean value for group A was 5.33 MPa, significantly less than that of groups B 9.12 MPa and C 9.63 MPa (p < 0.006). No significant difference of the mean shear strength was evident between groups B and C. No rinse conditioning with Dyract Seal led to a considerably lower bond strength value than Dyract Seal and Helioseal with phosphoric acid and rinsing.
Long-term clinical performance of esthetic primary molar crowns.
PURPOSE: The aim of the study was to report the long-term clinical performance of esthetic primary molar crowns and compare them to that of stainless steel crowns (SSC). METHODS: Twenty crowns (10 conventional and 10 esthetic) placed in 10 children who had participated in a previously reported study, were assessed again after 4 years. The crowns were evaluated clinically and radiographically according to the following parameters: gingival health, marginal extension, crown adequacy, proper occlusion, proximal contact, chipping of the facing (for esthetic crowns only), and cement removal. RESULTS: At the 4 year evaluation, all the esthetic crowns showed chipping of the facing. No difference was found for marginal extension, occlusion, crown adequacy and periodontal health between SSCs and the esthetic crowns. CONCLUSIONS: After 4 years, all the esthetic crowns presented chipping of the facing and, consequently, a very poor esthetic appearance.
A novel multidisciplinary approach for the treatment of an intruded immature permanent incisor.
The optimal treatment for intruded permanent teeth has not yet been determined. The ideal treatment option is the one with the lowest probability of developing complications such as external root resorption and marginal bone loss. Each case should be considered individually, bearing in mind the severity of the intrusion, the stage of root development, and tooth mobility. Management of an intruded permanent tooth may consist of: (1) observation for spontaneous eruption; (2) surgical crown uncovering; (3) orthodontic extrusion (with or without prior luxation of the intruded tooth); (4) and partial surgical extrusion, immediately followed by orthodontic extrusion and surgical repositioning. The purpose of this article was to review the treatment options for intruded immature permanent incisors, and to present a new modality of an elective internal strengthening of the immature root weakened by external root resorption. A case of an intrusive luxation injury in a 7 1/2-year-old child and the resulting complications utilizing this technique is described. This is the first known report in the pediatric dentistry literature of performing an elective (preventive) internal strengthening of an immature root weakened by severe external inflammatory resorption. The child was followed for 5 years with an excellent clinical outcome. This technique should be considered for treatment of immature permanent teeth with thin cervical root dentin and external or internal root resorption due to trauma or caries.
Comparison of oral midazolam with and without hydroxyzine in the sedation of pediatric dental patients.
PURPOSE: The purpose of this study was to compare the effectiveness of midazolam (MDZ) alone to a combination of MDZ and hydroxyzine (MDZH) when sedating young children for dental treatment. METHODS: This was a prospective, double-blinded, crossover clinical study of young uncooperative children in need of at least 2 restorative visits. Twenty-eight children, ages 21 to 56 months, with a mean age of 36.6 months, participated in this study. The subjects were assigned randomly to receive either 0.5 mg/kg of oral MDZ 20 minutes prior to the beginning of dental treatment or the combination of 0.3 mg/kg oral MDZ with 3.7 mg/kg of hydroxyzine 30 minutes before treatment. The alternative drug regimen was administered at the second appointment. All subjects also received 50% nitrous oxide and were restrained with a papoose board. The child's behavior (quiet or crying, relaxed or moving) was evaluated every 5 minutes by an experienced pediatric dentist who was unaware of the drug given to the child. At the conclusion of treatment, each session was evaluated for overall effectiveness. RESULTS: Regardless of the type of premedication, more patients exhibited quiet behavior at the beginning of treatment, with an increase in crying and movement toward the end of treatment. Regarding movement, a significant difference was observed during the first 20 minutes between the 2 regimens. MDZ showed more children exhibiting movement. During the first 30 minutes of treatment, more children cried in the MDZ group, while MDZH presented more children asleep or quiet. No significant differences were found in behavior as a function of the order the sedative regimens were given. No significant differences between the 2 regimens regarding overall behavior and success (t=0.655 at 27 degrees of freedom; P=.518) were found. CONCLUSIONS: The combination of hydroxyzine (3.7 mg/kg) with MDZ (0.3 mg/kg) administered 30 minutes before treatment resulted in safe and effective sedation for the dental treatment of young children. This combination's use might be more advantageous when compared to MDZ alone, resulting in less crying and movement during the first 30 and 20 minutes, respectively.
Ferric sulfate and formocresol.
Explore the source record for details and available documents.
Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol.
PURPOSE: The objective of this study was to assess the effect of mineral trioxide aggregate (MTA) as pulp dressing material following pulpotomy in primary molars with carious pulp exposure and compare them to those of formocresol (FC). METHODS: Of 33 children, primary molars treated via a conventional pulpotomy technique were randomly assigned to the MTA group (33 teeth) or FC group (29 teeth). Clinical and radiographic follow-up ranged between 4 and 74 months. The mean follow-up time was 38 months, with no difference between the groups. Twenty-nine teeth were followed until uneventful shedding (mean=33 months). Failures were detected after a mean period of 16 months (range=4 to 30). RESULTS: The success rate of pulpotomy was 97% for MTA (1 failure) and 83% for FC (5 failures). Eight teeth presented internal resorption. In 4 of them (2 of each group), progress of the resorption process stopped and the pulp tissue was replaced by a radioopaque calcified tissue. Pulp canal obliteration was observed in 58% of the MTA group and in 52% of the FC group (total=55%). CONCLUSIONS: MTA showed a higher (though not statistically significant) long-term clinical and radiographic success rate than formocresol, and can be recommended as its replacement as, unlike FC, MTA does not induce undesirable responses.