The incisal edge repair bonanza.
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A 3-year-old girl had a darkened and symptomatic maxillary right deciduous central incisor. This report describes the rationale and technique for a labial pulpectomy access opening and subsequent composite resin restoration. This innovative approach for the pulpal treatment of these deciduous incosors not only improves the access for instruments and direct visualization for the operator but also greatly improves the appearance of the dark teeth without complete coverage. Two other clinical applications of this labial approach should also be mentioned. First, anterior stainless steel crowns can be made esthetically pleasing by placing labial resin facings in the crown. Second, access for pulpotomy procedures can be improved with use of a labioincisal approach after the incisal reduction step in the preparation of deciduous incisors for complete coverage.
With a new CAD-CAM technique, we restored and provided esthetic treatment for both natural teeth and fixed prostheses with worn or broken surfaces.
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Internal bleaching with a 30 percent hydrogen peroxide solution is aesthetically very successful in the short term; however, in the long term, the success rate falls below 50 percent. This procedure is associated with a risk of external root resorption, documented both clinically and experimentally. The etiology of resorption and the effects of 30 percent hydrogen peroxide on dental tissues suggest that this chemical should be avoided. Internal bleaching is possible using sodium perborate mixed with water. The aesthetic outcome is still acceptable and the potential for resorption may be minimized.
Patients who are in their mature years should be advised about the numerous ways in which teeth and supporting structures degenerate in the later years of life. This knowledge will allow patients to make special efforts to prevent, reduce, eliminate or treat the oral problems associated with aging.
BACKGROUND: To date, no continuous scale exists for measuring the severity of dental fluorosis (DF). OBJECTIVES: The authors developed and validated a visual analog scale (VAS) for DF. They tested the scale in clinical (DF-endemic area) and laboratory settings. METHODS: Dentists and nondentists (23 per group) were asked to grade the DF severity in photographs of 23 anterior teeth with different DF levels (using a 100-millimeter VAS) to create a VAS for DF. Statistical analysis was performed to validate the new scale. The authors used clinical and laboratory (unerupted third molars) analyses to assess the usefulness of the VAS. RESULTS: The authors used an intraclass correlation coefficient (ICC) to assess the interexaminer (ICC = .79: good agreement) and intraexaminer (.88 < ICC < .97: excellent agreement) reliability during creation of the scale. They used the Spearman rank correlation (r(s)) to validate the VAS against the gold standards (that is, the Thylstrup-Fejerskov index [TFI] and Dean's index [DI]) (the results showed excellent or good correlation for 45 examiners). Two dentist examiners clinically tested the new VAS, and the results showed excellent (r(s) = .922, P < .001) correlation and excellent ICC between the examiners (ICC = .96), as well as good ICC between the TFI and the VAS for DF (ICC = .6). The laboratory study showed better correlation between fluoride concentration and the VAS for DF than between fluoride concentration and the TFI. CONCLUSION: Because of its simplicity, precision and utility in statistical applications, the VAS for DF can be useful in DF studies.
The aim of this study was to describe the 2-year results of an individualized treatment program designed to control occlusal caries in erupting first permanent molars. The sample consisted of 145 five-to-six-year-old students divided into a control group (n = 71) and a test group (n = 74). All test children received a biannual basic preventive program and a recall system according to individual disease activity. The basic program consisted of 3 (March) and 2 (August) sessions of oral hygiene orientation and toothbrushing with fluoride gel. The analysis of the baseline and 1-2-year data showed a significant reduction in the number of active lesions in the test group. In the control group, there were initially 70 active lesions and after two years 68 surfaces remained with disease and 24 surfaces had been filled. The children in the test group had 80 surfaces with active lesions initially and after two years only 3 surfaces with disease remained. From the 15 cavitated lesions, only 5 surfaces needed to be filled. This program showed that care of erupting teeth on an individualized basis can control occlusal caries.
Amelogenesis imperfecta (AI) is a hereditary defect in enamel formation affecting both primary and permanent dentition. Scanning electron microscopic investigation is one of the most effective methods in diagnosing and identifying the type of amelogenesis imperfecta. The aim of this study was to investigate the ultrastructure of different types of amelogenesis imperfecta enamel. The primary teeth of three children with AI aged 4, 10 and 11-years-old were studied by scanning electron microscopy and irregular enamel, irregularities in enamel crystallites, hypoplastic areas on the enamel surface were seen. Histopathological evaluation revealed predentin areas with irregular canaliculi between normal dentin and internal resorption areas in the pulp tissue. Conclusively, in amelogenesis imperfecta, enamel tissue is mostly affected besides minor defects in dentinal and pulpal tissue.
Trauma to deciduous anterior teeth, frequently occur in children, and the treatment is a big challenge for the pediatric dentistry. In these cases, besides the pain and discomfort provoked by the injury, both child and parents/persons responsible were eager to reconstruct the damage, as soon as possible. In modern operative restorative dentistry, no restorative material is able to substitute for the human dental enamel in quality, color and resistance. The aim of this paper is to relate the treatment of esthetic veneer (facet) of human dental enamel in a three-year-old child after trauma that caused concussion and accentuated color alteration. Clinical results showed an efficient esthetical resolution, revealing it to be a good alternative for treatment of traumatized anterior deciduous teeth.
Trauma and pulpal infections in primary dentition are part of the routine of the pediatric dentist. Common consequences in these cases are alterations in dental color, compromising patient's esthetics and his interaction in social environment. Bleaching intends to preserve dental structure already weakened and to show immediate esthetic results. This clinical case shows a bleaching technique in devitalized primary teeth using bleaching agent with 35% hydrogen peroxide activated by photo polymerizer. This technique is simple and shows immediate satisfactory results.
Tooth staining with the use of chlorhexidine preparations is the major problem of long term application. Evidence suggests that the staining arises from a cationic/anionic interacation of chlorhexidine with components of certain dietary materials. The purpose of this in vitro study was to compare visually the development of tea and coffee staining on acrylic and tooth specimens treated with chlorhexidine and to follow the development of tea staining on perspex by light microscopy and color television image analysis. All specimens were maintained in their respective beverage for 5 days with test specimens removed three times a day and placed for 2 minutes in an 0.2% chlorhexidine solution. Both test tooth and acrylic specimens showed comparably and markedly increased staining by the beverages compared with control specimens. Color television image analysis of test specimens demonstrated more marked and rapid development of tea staining when studied on a daily basis. Microscopic examination revealed the staining to be made up of small particles of material which increased in size and coalesced with time. Again, marked differences were apparent in the stain on test and control specimens. The results of this in vitro method provided further evidence for a dietary aetiology to chlorhexidine staining and were consistent with clinical findings. Such a method may be useful to assess staining arising from the use of other anti-plaque agents.
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The aim of this study was to obtain detailed information about adults who suffered trauma to the teeth as children. A total of 102 patients took part. The patients answered a questionnaire and were interviewed before the oral examination. Thirty-nine per cent of the patients reported dissatisfaction either with the color and/or anatomic form of the traumatized teeth or reconstruction. Most of the individuals did not remember having received any information about prognosis for the traumatized teeth. Twenty-one per cent of the patients remembered pain during treatment, and 25% remembered only the behavior and attitudes of the dental team. It can be concluded that all dental treatment in children with traumatized teeth must be carried out as painlessly as possible, and the dental team should minimize discomfort during the treatment. Good knowledge about traumatology and management can reduce stress and anxiety for both the patient and the dental team.
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A patient in his early 20s with teeth badly discoloured by tetracycline was seeking treatment to improve his esthetics. Because retreatment and cost were important considerations, porcelain veneers were the treatment of choice. The challenge in this case was to mask the underlying tetracycline stain before the final cementation and thus gain more control over the final shade of the veneers.
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