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The first application of lasers in dentistry was the surgical treatment of tumors in the oral cavity, and various lasers, including semiconductor diode, carbon dioxide, helium-neon, neodymium:yttrium-aluminum-garnet, argon, erbium, and erbium chromium, have been developed since and applied in dentistry. This article describes the current and possible future clinical indications, laser devices, techniques, assessment methods, and mechanics.
PURPOSE: The aim of this study was to compare the effect of mineral trioxide aggregate (MTA) to that of formocresol (FC) as pulp dressing agents in pulpotomized primary molars with carious pulp exposure. METHODS: Forty-five primary molars of 26 children were treated by a conventional pulpotomy technique. The teeth were randomly assigned to the MTA (experimental) or FC (control) group by a toss of a coin. Following removal of the coronal pulp and hemostasis the pulp stumps were covered with an MTA paste in the experimental group. In the control group, FC was placed with a cotton pellet over the pulp stumps for 5 minutes and removed; the pulp stumps were then covered by zinc oxide-eugenol (ZOE) paste. The teeth of both groups were restored with stainless steel crowns. Eighteen children with 32 teeth arrived for clinical and radiographic follow-up evaluation ranging from 6 to 30 months. RESULTS: The follow-up evaluations revealed only one failure (internal resorption detected at a 17 months postoperative evaluation) in a molar treated with formocresol. None of the MTA-treated teeth showed any clinical or radiographic pathology. Pulp canal obliteration was observed in 9 of 32 (28%) evaluated molars. This finding was detected in 2 out of the 15 teeth treated with FC (13%) and in 7 out of the 17 treated with MTA (41%). CONCLUSION: MTA showed clinical and radiographic success as a dressing material following pulpotomy in primary teeth and seems to be a suitable replacement for formocresol in primary teeth.
Crown fractures are the most common form of traumatic dental injuries encountered in permanent dentition. Restorative treatment modalities incorporate adhesive materials to effectively maintain function and aesthetics. While uncomplicated injuries of the enamel and/or dentin can be treated solely with adhesive procedures, complicated trauma that involves pulp exposure requires the incorporation of a multidisciplinary treatment approach. Fragment reattachment is facilitated by the utilization of bonding agents that enhance retention and aesthetics. This article discusses the application of provisional and permanent restorative options for the treatment of complications following traumatic injuries.
Injuries to the dentition may ultimately result in the interruption of root development. If the pulp remains vital following trauma, this state should be maintained and root-end closure should be induced by apexogenesis. When the pulp is necrotic, the placement of an apical barrier can be utilized as an alternative to establish an environment that facilitates the closure of the apical opening. This article demonstrates the use of mineral trioxide aggregate as an apical barrier material for root-end closure in the permanent teeth of three patients.
PURPOSE: The purposes of this investigation were to 1) measure success of a primary tooth pulpotomy technique that applies formocresol in the sub-base without the common five-minute application of a formocresol impregnated cotton pellet; and 2) compare success rates of the pulpotomy procedure using traditional criteria found throughout the literature with new criteria recently established, excluding internal resorption as a radiographic failure. METHODS: Clinical and radiographic data were collected from a retrospective chart review of patients receiving formocresol pulpotomies with the application of formocresol in the zinc oxide-eugenol sub-base. RESULTS: Clinical and radiographic data were available for 196 primary molars in 122 children (followup=six to 103 months; mean=49 months). Traditional assessment of radiographic success and failure yielded a success rate of 79%. Alternative assessment excluding internal resorption as a failure yielded a 99% success rate. Most frequently observed pulpal responses were calcific metamorphosis and internal resorption. Overall clinical success was 99%. Two of the 196 teeth were extracted due to failure. A survival analysis demonstrated that the overall probability of survival remained high over time with a cumulative survival of over 95% after six years. CONCLUSIONS: The overall success rates in this study indicate that the formocresol pulpotomy technique incorporating formocresol in the zinc oxide-eugenol sub-base is a very successful treatment modality for primary molars requiring pulp therapy.
Maintaining pulpal health during tooth development is an important goal in managing traumatic injuries in the immature dentition. The introduction of mineral trioxide aggregate has offered an improved method for pulp protection in such cases. This article describes a technique using MTA for vital pulp therapy on teeth with crown fractures that have resulted in pulp exposure.
The primary molars received calcium hydroxide pulpotomy with or without the electrocoagulation procedure. Teeth were evaluated clinically and radiographically at 6, 12, and 24 months after treatment. There was no statistically significant difference in success rate between calcium hydroxide pulpotomies, with and without the electrocoagulation procedure, either clinically or radiographically. These results indicate that a pulpotomy with calcium hydroxide is an effective treatment for cariously exposed pulp in primary molars and electrocoagulation can extend its indication.
A fundamental issue of restorative treatment is assessing the different conditions of cases not only from tooth-to-tooth but also from the activity of each caries lesion and the size of the cavity. In addition, restorative treatment is sometimes carried out for prosthetic and cosmetic purposes and involves cutting sound, unaffected dentin. These aspects are outlined in classic textbooks and are based on the principles described by Black (1908). However, each factor and its relative importance has changed over the years. Significant time has been devoted to improving the important technical aspects of performing restorative treatment. Traditionally, these aspects have primarily been related to cavity design, choice of restorative material and the clinical procedures involved. In this context, Dr Michael Buonocore's contributions must be recognized because the adhesive technique he introduced has become an integral part of modern operative dentistry. Operative dentistry today also focuses on cavity design and selecting restorative materials. Less effort has been placed on incorporating what is known about the pattern of caries progression and how it relates to caries removal or excavation. Although the reaction pattern of the pulp-dentin organ is quite different in terms of the nature of active (rapid-progressing) and arrested (slow-progressing) lesions, no widespread major distinction has been made regarding the different restorative treatment approaches in these situations. This presentation updates the progression and clinical management of dentin caries and how it relates to treating deep caries lesions.
An important goal of modern dentistry is to preserve a functional, esthetic, and pain-free dentition. If irreversible pulp pathology occurs in an immature permanent tooth from traumatic or carious exposure, normal apical maturation may be interrupted. Conventional endodontic obturation techniques, if necessary, will be difficult and may not be adequate in such a tooth. The endodontic techniques of apexogenesis and apexification have been successful in achieving adequate root development and apical construction. These conventional techniques and materials are reviewed along with a promising material called mineral trioxide aggregate.
This in-depth literature review examines materials that can be used as a liner, a base, and/or a cement. Findings from recent research also are included.
Traumatic injuries are a common cause of pulpal damage in anterior teeth. Crown fractures with exposed pulps represent 18 percent to 20 percent of the traumatic injuries that involve the teeth. This clinical study comprised 36 patients, who were referred for 40 crown fractures with pulp exposures. There were 39 maxillary incisors and one mandibular incisor. The partial pulpotomy (Cvek's technique) consists of amputating exposed pulp tissue to a depth of 1 to 2 mm below the point of pulp exposure. After partial pulpotomy, the pulpal wound is covered with calcium hydroxide; and the cavity is sealed with glass ionomer cement or a composite crown. Clinical and radiographic assessment of the hard-tissue barrier was done after three months. Patients were monitored for periods ranging from one to 12 years. The purpose of this clinical report was to evaluate Cvek's technique in the management of coronal fractures with pulp exposures and the long-term outcome of the partial pulpotomy in immature and mature teeth. In virtually all of the cases, this treatment was successful. Careful partial pulpotomy remains a prudent treatment choice with proper case selection.
Management of Class III crown fractures in the permanent dentition can be both challenging and rewarding for practitioners. Several of the techniques described require further investigation to determine clinical efficacy based on scientific research. In addition to evidence-based protocols, treatment outcomes will continue to be related to the technical proficiency of the dentist, including diagnostic acumen and appropriate treatment planning decisions. A treatment planning decision paradigm, as described in this article for management of Class III fractures to permanent teeth, is summarized in Table 1.
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Post-operative clinical and x-ray findings on 80 primary molars were evaluated. These molars had undergone pulpal therapy by 2 techniques: pulpotomy with formocresol and with electrosurgery. The sample was selected from children between the ages of 4 and 7. A criterion for inclusion was each child must have at least 2 primary molars with pulp exposed by caries. Experimental molars with 1 or more of the following clinical or radiographic signs and symptoms were excluded: mobility, sensitivity to percussion, the presence of fistulae, groove drainage, apical or internal resorption, fetid smell and compromised furcation. Also excluded were patients previously diagnosed with diabetes, cardiopathy and renal alterations. Initially, a dinical and radiographic examination was carried out, followed by another at 1, 3 and 6 months after application of the techniques. No significant differences were found at the end of the period. However, electrosurgery had an advantage: it was faster to apply and dispensed with the use of formocresol. Further research is suggested, using larger samples and shorter evaluation periods.
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PURPOSE: To compare the ability of an experimental antibacterial self-etching primer adhesive system to seal exposure sites in normal, caries-affected and caries-infected human dentin. METHODS: 30 extracted human third molars were used within 1 month of extraction. 10 intact normal teeth comprised the normal group. 20 teeth with occlusal caries that radiographically extended halfway to the pulp were excavated using caries-detector solution (CDS) and a #4 round carbide bur in a slowspeed handpiece. Half of those teeth were fully excavated free of CDS-stained material without exposing the pulp, and were designated as the caries-affected dentin group. The remaining 10 teeth were excavated as close to the pulp as possible without obtaining an exposure, but whose dentin continued to stain red with CDS; this group was designated as the caries-infected dentin group. The remaining dentin thickness in all of the specimens in the other two groups was then reduced to the same extent as the caries-infected group. Direct exposures of the pulp chamber were made with a 1/4 round bur in the normal dentin or a 25 gauge needle in the other two groups. After measuring the fluid flow through the exposure, the sites were then sealed with an experimental antibacterial fluoride-containing self-etching primer adhesive systems (ABF). Fluid conductance was remeasured every week for 16 weeks. RESULTS: The fluid conductance through the exposure fell 99% in all groups following resin sealing. The seals of normal and caries-affected dentin remained relatively stable over the 16 weeks, while the seals of caries-infected dentin gradually deteriorated, reaching significance at 8 weeks. TEM examination revealed very thin (ca. 0.5 mm) hybrid layers in normal dentin, 3-4 microm thick hybrid layers in caries-affected dentin and 40 microm thick hybrid layers in caries-infected dentin. The tubules of caries-infected dentin were enlarged and filled with bacteria. Resin tags passed around these bacteria in the top 20-40 microm thereby encapsulating them in resin.