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The dental manifestations of the Morquio syndrome (mucopolysaccharidosis type IV). A diagnostic aid.

This study describes in detail the enamel defects in a patient in whom the diagnosis of Morquio syndrome (muchopolysaccharidosis IV) has been supported both biochemically and roentgenographically. These defects are an apparently constant feature of the Morquio syndrome, and are therefore important aids to its differential diagnosis. The defects consist of abnormally thin enamel that is rough because of the numerous minute pits on its surface. The thinness of the enamel results in altered shape and discoloration of the teeth and in their being spaced. Apart from these defects, the enamel is histologically normal and is of normal hardness and radiodensity.

Child↗

The role of pit-and-fissure discoloration in caries assessment.

Occlusal dental caries often is not apparent using traditional diagnostic techniques. The clinical significance of pit-and-fissure discoloration in the absence of dietary and habit substances was examined. The study included 462 extracted teeth (216 with obvious pit-and-fissure discoloration, 216 with subtle discoloration, and 30 with no discoloration); 130 clinical teeth with varying degrees of pit-and-fissure discoloration; and 159 teeth in young adults, which had sealants placed > or = 10 years. All teeth studied were excavated very conservatively using air abrasion and/or the uniquely small H1 004 carbide bur. Presence of caries and its depth and extent were recorded, photographed, and measured with a custom made calibrated probe. Of the 721 teeth with discolored pits and fissures studied (432 extracted teeth and 289 clinical teeth), 660 (92%) had two or more of the four clinical criteria used to define dental caries in this study. Sixty-four percent of the lesions were > 2 mm in depth and 27% were > 3 mm in depth. Of the 159 teeth sealed for > or = 10 years, 47 (92%) were carious, and 26% had large, deep carious lesions penetrating > 3 mm. These data indicate: more effective methods are needed to diagnose pit-and-fissure caries and presence of pit-and-fissure discoloration in the absence of substances causing extrinsic staining should be a strong warning for clinicians to examine carefully for dental caries.

Adult↗

Clinical evaluation of a resin-modified glass ionomer adhesive system: results at five years.

One hundred non-carious, non-undercut cervical lesions were restored with Silux Plus or Estio LC and bonded with Fuji Bond LC. The restorations were evaluated yearly for retention and marginal discoloration. After five years, the overall retention rate was 96%. Of the 41 restorations examined at five years, five had clinically evident marginal discoloration.

Chi-Square Distribution↗

[Tetracycline discoloration].

The authors present the last news on the link between tetracycline and teeth hard tissues, on the diagnosis of teeth discromy and an overview on the most recent bleaching vital technics; they analyze some clinical cases.

Humans↗

Minocycline-induced scleral, dental, and dermal pigmentation.

PURPOSE: To report a case of scleral discoloration secondary to minocycline therapy. METHOD: Case report of a patient referred to a university-based cornea and external disease clinic. RESULTS: The patient had been treated with oral minocycline therapy for adult facial acne for 12 years when she began to develop bilateral blue-gray discoloration of the sclera as well as of the teeth, hard palate, ears, nail beds, and skin. CONCLUSIONS: Chronic systemic minocycline therapy may induce scleral pigmentary changes. The mechanism of discoloration and the long-term natural history upon cessation of minocycline are unclear.

Acne Vulgaris↗

[Bleaching of teeth: a review].

Bleaching of vital and non-vital teeth is becoming a routine procedure in esthetic dentistry. In a relative safe way many types of discoloration can be treated. Four treatment systems are available at present. For an appropriate choice it is essential to know the cause of the discoloration. Long term results are still scarce. Most treatment systems show slight to moderate side-effects, varying from demineralisation of enamel to soft tissue problems.

Adult↗

Carbamide peroxide at-home bleaching agents. An update.

Interest in the use of bleaching for treatment of discolored teeth is increasing. Bleaching, especially at-home mouthguard bleaching, is considered by many professionals to be the most conservative, non-invasive treatment modality currently available.

Carbamide Peroxide↗

Experimental bilirubin pigmentation of rat dentine and its detection by a qualitative analytical method.

An animal model of bilirubinemia was used to determine whether bilirubin present in pigmented teeth can be extracted and qualitatively analysed. The bile ducts of 10 Long-Evans Agouti rats were ligated and bilirubin (14 mg/kg per day) was injected intraperitoneally for 4 days. When the animals were killed 2 weeks later, pigmented lower incisors were observed in three animals. These teeth were dried, powdered and bilirubin was extracted with chloroform/methanol/acetic acid, 30:10:0.5, v/v for 10 min under sonication. After centrifugation, the supernatant was collected and evaporated. The residue was dissolved in chloroform and its absorption spectrum measured before and after diazo reaction. This resulted in a shift of the absorption maximum from 450 to 540 nm and indicated the presence of bilirubin in pigmented teeth. No bilirubin was found in the lower incisors of untreated control rats. This technique may be useful in distinguishing bilirubin staning from other intrinsic discolorations of teeth.

Acetic Acid↗

Bleaching and/or porcelain veneers: case reports.

Four case studies are presented in which the concept that bleaching, porcelain veneer restorations, or a combination of both constitute a conservative treatment approach for discolored, malformed, malaligned, and worn dentition. These treatments can be used effectively not only for aging dentitions, but also for the very young, which makes them an attractive treatment modality.

Adult↗

Discoloration of permanent front teeth in 3,157 Norwegian children due to tetracyclines and other factors.

During routine orthodontic screening in Oslo, Norway, of 3,157 children, aged 1--11 years and born in 1963/64, 36 cases (1.14%) with cosmetically marring discoloration of permanent front teeth were registered. Thirty-four of them arrived for a more exhaustive examination, which in 24 of the children revealed positive tetracycline fluorescence on exposure to ultraviolet light. In 13 (0.4%) of the children, the discolorations were diagnosed to be tetracycline-induced. Enamel hypoplasia was frequently found in teeth with positive fluorescence. Multiple exposures to various tetracyclines were reported in all children who exhibited positive fluorescence.

Child↗

Secondary caries: a literature review with case reports.

The clinical diagnosis of secondary caries is by far the most common reason for replacement of restorations, but the scientific basis for the diagnosis is meager. The purpose of this article is to review the literature on secondary (recurrent) caries and present case reports to document the problems encountered in the clinical diagnosis of secondary caries. The literature on secondary caries was critically reviewed and subdivided into clinical diagnosis, location of secondary lesions, histopathology, microleakage, and microbiology. The case reports included restorations that were scheduled to be replaced because of secondary caries or stained margins of composite restorations. The lesions were photographed preoperatively and postoperatively. Based on the limited literature available, secondary caries appears to be a localized lesion similar or identical to primary caries. It is most often localized gingivally on restorations. Narrow gaps, crevices, ditches, and "microleakage" do not lead to secondary caries, but wide voids may. Secondary caries is difficult to diagnose clinically. Consistency or hardness and discoloration of dentin and enamel are the best parameters. Secondary caries is the same as primary caries located at the margin of a restoration.

Dental Caries↗

Threshold contrast ratio and masking ability of porcelain veneers with high-density alumina cores.

PURPOSE: The purposes of this study were to: (1) investigate the correlation between the color difference of bilayer porcelain veneers over white and black backgrounds (deltaE1) and their opacity (contrast ratios); (2) determine whether there is a recommendable threshold contrast ratio above which the color difference is clinically acceptable (when deltaE < or = 5); and (3) compare the ability of porcelain veneers to mask a color change from white to black backgrounds (deltaE1) and their ability to mask a color change from white to clinically discolored teeth (deltaE2). MATERIALS AND METHODS: Forty-four maxillary anterior teeth of eight patients with severe tetracycline discoloration were prepared for bilayer porcelain veneers in shade A2 porcelain. The cores were 0.25 mm thick. The color (CIE L*a*b*) and reflectance (Y) of the midbuccal region of each veneer were measured over white and black backgrounds using a colorimeter under artificial daylight. The veneers were bonded to discolored teeth, and their color was measured after 1 week. RESULTS: The mean color difference deltaE1 was 10.6 (SD 2.6). The mean contrast ratio was 0.75 (SD 0.1). There was a close and statistically significant correlation between deltaE1 and contrast ratio. The determined threshold contrast ratio was 0.91. The mean color difference deltaE2 was 11.6 (SD 5.5). A paired t test showed no difference between deltaE1 and deltaE2. CONCLUSION: There was a significant correlation between the masking ability of veneers (deltaE1) and their opacity (contrast ratio). There was no significant difference in the ability of the porcelain veneers in masking a color change from white to black backgrounds compared to their ability to mask the color change from white to the discolored teeth.

Aluminum Oxide↗

Macroabrasion in pediatric dentistry.

One of the most frequent reasons for seeking dental care is discolored anterior teeth. Macroabrasion is a technique used for the removal of localized superficial white spots and other surface stains. This article has compiled three case reports with relevant clinical photographs of discolored teeth where the treatment regimen included macroabrasion alone as well as macro-abrasion in combination with anterior composite restorations.

Air Abrasion, Dental↗

Clinical and scanning electron microscopic assessments of porcelain and ceromer resin veneers.

PURPOSE: Recently available Ceromer resin materials are promising for fabrication of esthetic anterior laminates and provices an alternative, cost effective treament modality to porcelain laminates for discolored anterior anterior teeth. It was proposed to study the esthetic quality and surface finish of veneers fbricated from ceromer resin and compare it with the standard porcelain veneers, both clinically as well as by scanning electron microscope (SEM) at baseline and at 12 months. If found comparable, ceromer resin veneer could provide an alternative to porcelain veneers which is an expensive technique for a developing country like India. MATERIALS AND METHODS: Seventy-two veneers, 36 porcelain and 36 ceromer were placed in 12 subjects who were studied at 0, 6 and 12 months for clinical acceptability, and at 0 and 12 months for SEM assessment. The restorations were luted with Opal luting composite and Scotchbond multipurpose system; polyvinyl siloxane was used as the impression material. The clinical assessment was made using modified United Public Health Services criteria, whereas the SEM assessment was made by quantitative analysis of the marginal fit and surface characteristics of the two veneering materials. RESULTS: Ceromer exhibited good anatomical form during the study period, but depicted changes in color, surface appearance, marginal adaptation, increased marginal discoloration, and tissue response. Inability to achieve a good finish with high gloss was a major drawback of the ceromer. Porcelain exhibited better esthetics, marginal adaptation, finish qualities, and tissue response. The SEM showed good to excellent marginal fit at baselinne in ceromer and porcelain veneers, but loss of luting resin at the margins was evident in both the materials after 12 months, leading to visible gaps in a number of veneer restorations. Ceromer veneers exhibited poor surface characteristics in several restorations, which further degraded in an oral conditions over 12 months. CONCLUSION: Veneering is an effective mode of treating discolored teeth. Ceromer veneers exhibited deterioration of surface finish and increased marginal discolouration over a period of 12 months. Clinically ceromer veneers were less acceptable to the patients than porcelain veneers. Porcelain out-scored ceromer as a permanent mode of treatment for discolored teeth, as over a period of 12 months it yielded good clinical results in comparison to ceromer.

Adolescent↗

The skeleton buildup technique: a systematic approach to the three-dimensional control of shade and shape.

Due to the limitations of current shade-matching systems, shade communication has proven inadequate. Techniques for the fabrication of porcelain crowns that match the natural definition must address numerous factors. While all-ceramic restorations are indicated for the rehabilitation of the anterior dentition, these modalities are problematic in the restoration of teeth with discolored substrates. This article presents a systematic procedure for the three-dimensional fabrication of porcelain restorations. Techniques for building porcelain and altering the translucency of ceramic cores are also presented.

Aluminum Oxide↗

Ceramic inlays: clinical assessment and survival rate.

PURPOSE: This study evaluates the clinical behavior of ceramic inlays placed during the past decade. MATERIALS AND METHODS: One hundred eighty-two inlays were examined in 66 patients. The interval between placement and assessment was on average 5.9 years +/- 2.7, ranging from 2 to 11.7 years. Restorations still present at the time of evaluation were clinically assessed according to modified USPHS criteria. Kaplan-Meier statistical analysis was used to assess the survival rate. RESULTS: According to USPHS criteria, good results were obtained for color match, marginal discoloration, recurrent caries, contour, and marginal integrity. Six inlays failed: four for endodontic reasons, one due to recurrent caries, and the other due to fracture. The results indicate that a success rate of 95% could be predicted at 11.5 years. CONCLUSION: The lack of recurrent caries, the only slight changes in marginal discoloration and color match, combined with the excellent longevity prove that ceramic inlays are a valuable tool for the restoration of posterior teeth.

Adult↗

Current status of nightguard vital bleaching.

Indications for using a 10% carbamide peroxide material in a custom-fitted tray to whiten teeth include teeth discolored from aging, chromogenic foods and drinks, and smoking, and also brown fluorosis-stained teeth, single dark teeth, and tetracycline-stained teeth. Tetracycline-stains may require 2 to 6 months of nightly treatment, whereas after discolorations generally resolve in 2 to 6 weeks. After an initial relapse in the first 2 weeks after the end of treatment, color tends to be stable for 1 to 3 years, with some treatments being permanent. The ADA has approved only six 10% carbamide peroxide materials, which have extensive research and publications on safety and efficacy. Considering the average cost of $196 per arch, and the noninvasive nature of this treatment, nightguard vital bleaching is probably the safest, most cost-effective, patient-pleasing method to improve the appearance of a smile. However, it should be supervised by a dentist for the proper examination, diagnosis of the cause of discoloration, treatment options, and fabrication and fitting of the carrier. Sensitivity during whitening may be treated with fluoride and potassium nitrate.

Anti-Bacterial Agents↗