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PubMed2002

In vitro evaluation of furcal perforation repair using mineral trioxide aggregate or resin modified glass lonomer cement with and without the use of the operating microscope.

This study evaluated in vitro the effect of using the operating microscope on repairing furcation perforations using Vitrebond or mineral trioxide aggregate. Forty-six human molar teeth were mounted into a jig attached to a simulated jaw. The teeth were allocated randomly to four groups (n = 10). Furcal perforations were made in the teeth using an ISO 012 round bur in a slow-speed hand-piece. Each material was used to repair a group of teeth with and without the use of the operating microscope. The remaining six teeth provided positive and negative controls. All groups were stored in 100% humidity, and the repair materials were allowed to set for 72 h at room temperature before being assessed for the quality of placement under x26 magnification. Leakage at the repair was then tested using India ink; the teeth were demineralized, dehydrated in alcohol, and rendered transparent in methyl salicylate. Dye penetration into the furcation repair was evaluated at x26 magnification. There was no difference in the acceptability of the repair with either material whether or not the operating microscope was used. The perforations repaired with mineral trioxide aggregate leaked significantly less to the tracer dye than those repaired with Vitrebond (p < 0.001).

Aluminum Compounds↗
PubMed1999

Differential profile of facial injuries among mountainbikers compared with bicyclists.

BACKGROUND: Bicyclists and mountainbikers are prone to facial trauma. In the current study, we present a large series of cycling-related sports trauma to the face in an effort to identify the injury pattern among mountainbikers compared with bicyclists. METHODS: The medical records of a single pediatric and adult Level I trauma center were evaluated from January 1, 1991, through October 31, 1996. All admissions with injuries caused by cycling-related sports were reviewed, analyzed, and compared according to age and sex distributions, causes of accidents, injury types, frequency, and localization of fractures and associated injuries. The injury types were divided into three categories: fractures, dentoalveolar trauma, and soft-tissue injuries. RESULTS: Five hundred sixty-two injured bicyclists (10.3% of all trauma patients) were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria, during the study period, accounting for 31% of all sports-related or 48.4% of all traffic collisions, respectively. The review of the patient records revealed especially more severe injury profiles in 60 mountainbikers, with 55% facial bone fractures, 22% dentoalveolar trauma, and 23% soft-tissue injuries, compared with 502 street cyclists showing 50.8% dentoalveolar trauma, 34.5% facial bone fractures, and 14% soft-tissue lesions. The dominant fracture site in bicyclists was the zygoma (30.8%), whereas mountainbikers sustained an impressive 15.2% Le Fort I, II, and III fractures. Condyle fractures were more common in bicyclists, with 18.8% opposing 10.8% in mountainbikers. CONCLUSION: Appropriate design of helmets with faceguards will reduce the incidence of facial injuries caused by cycling-related accidents and incentives are needed for making helmet use compulsory for all cyclists, particularly for mountainbikers.

Adolescent↗
PubMed1997

Emergency management of oral trauma in children.

Oral trauma continues to be a common pediatric emergency, accounting for 150 emergency room dental consultations per year at Children's Hospital in Boston. Children between the ages of 18 months and 2.5 years and between 8 and 11 years are most at risk. Recent advances in the management of these dental emergencies may help children and their families avoid the psychological and financial cost of infection or loss of primary and permanent teeth. Treatment of avulsions in the young permanent dentition remains a common problem, and a universally accepted approach to its management is still evolving. The use of a doxycycline immersion prior to reimplantation by the dentist may be helpful in preventing external root resorption. As always, the best therapy against dentofacial trauma is the pediatrician's support of preventive measures.

Child↗
PubMed2001

A prospective study of tracheal intubation in an emergency department in Hong Kong.

Emergency department (ED) doctors often intubate patients, however no data was available in Hong Kong on this aspect. Our study was to assess the competency of ED doctors in intubating critical patients in a typical ED in Hong Kong. Between March and August 1999, in an urban hospital with an emergency physician training programme, all doctors, after performing any tracheal intubation, were required to fill in a pro forma designed for the study. Data collected included the training status of the intubator, the number of intubation attempts, intubation methods and complications. A total of 214 ED patients required advanced airway management including 87 (41%) patients in cardiopulmonary arrest; 207 (97%) of them were successfully intubated by ED doctors (76 by specialists, 61 by trainees, 70 by residents) and 90% were successful in the first attempt. The remaining seven patients' airway control was eventually managed by anaesthetists who successfully intubated six patients and performed cricothyrotomy for one patient. Rapid sequence intubation was performed in 70 (33%) patients by ED doctors and specialists. There were 30 (14%) patients successfully intubated using sedative agents alone. Twenty-two (10%) patients were found to have a total of 32 complications including 13 patients with oesophageal intubation, seven with soft tissue damage, four with desaturation, three with bronchial intubation, three with hypotension, one with dental trauma, one with dysrhythmia. The majority of ED intubations for critically ill patients were performed by ED doctors with high success rate and few major complications.

Adolescent↗
PubMed2005

Preferential attachment of human gingival fibroblasts to the resin ionomer Geristore.

The resin ionomer Geristore has been used extensively for root perforation repairs. The purpose of this study was to evaluate oral in vitro biocompatibility of the resin ionomer Geristore compared to two other dental perforation repair materials, Ketac-Fil and Immediate Restorative Material (IRM). Growth and morphology of human gingival fibroblasts (HGFs) was determined using scanning electron microscopy (SEM) of HGFs cells grown on test materials as well as cytotoxicity assays using eluates from test materials. SEM analysis showed that HGFs attached and spread well over Geristore with relatively normal morphology. SEM showed that fibroblasts did not attach and spread well over Ketac-Fil or IRM as cells appeared much fewer with rounded and different morphology than fibroblasts grown on Geristore. Cytotoxicity assays indicated that HGFs proliferated in the presence of Geristore eluates and not in the presence of Ketac-Fil or IRM eluates. In vitro interpretation indicates that Geristore is less cytotoxic to gingival fibroblasts.

Cell Adhesion↗
PubMed2005

Perforation repair with mineral trioxide aggregate: a modified matrix concept.

AIM: To present a modified matrix concept for repair of root perforations using mineral trioxide aggregate (MTA). SUMMARY: Root perforations may occur during preparation of endodontic access cavities or during post-space preparation. The perforation creates the potential for an inflammatory reaction in the periodontal ligament. A concept for the repair of root perforations is presented using a matrix of resorbable collagen. This matrix reconstructs the outer shape of the root and facilitates the adaptation of MTA. The indications for the use of MTA are discussed. Two clinical cases of 5-year successful root perforation repair using the technique are presented. KEY LEARNING POINTS: Long-term perforations with periodontal inflammation can be successfully treated with MTA. Matrices for MTA placement can be developed with commercially available collagen. Infection control within the root canal and at the perforation site is required for satisfactory perforation repair and healing.

Aluminum Compounds↗
PubMed2006

Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology.

The assurance of the quality of a service rendered by a member of the dental profession is an essential feature of any system of peer review in dentistry. This document addresses two essential elements: (i) appropriateness of treatment modality and (ii) quality or level of treatment rendered. In revising these guidelines the European Society of Endodontology is responding to a public and professional need. In receiving care of a specialized nature such as endodontic treatment, patients need and deserve treatment that meets the standard of care generally given by competent practitioners. The European Society of Endodontology has the expertise and professional responsibility necessary to assist the dental profession by instituting guidelines on the standard of care in the special area of Endodontics. In accepting this responsibility the European Society of Endodontology formulated treatment guidelines that are intended to represent current good practice.

Europe↗
PubMed2007

Effect of placement of calcium sulphate when used for the repair of furcation perforations on the seal produced by a resin-based material.

AIM: To evaluate the sealing ability of calcium sulphate when used under composite resin for the repair of furcation perforations having different diameters. METHODOLOGY: Perforations of different diameter were created in the floors of pulp chambers in 60 extracted human molar teeth with either a number 3 (1 mm diameter) or 5 (1.5 mm diameter) round bur. The specimens of each group were divided into four sub-groups which were repaired with composite resin either alone or in combination with calcium sulphate that created an artificial floor (15 teeth group(-1)). Eight teeth without furcation perforations served as negative controls. In the leakage detection device, 1 mol L(-1) glucose solution was forced under a pressure of 1.5 KPa from the crown towards the pulp chamber floor. The concentration of leaked glucose was measured at 1, 2, 4, 7, 10, 15 and 20 days using a glucose oxidase method and the data evaluated using the rank sum test. RESULTS: The specimens with larger perforations repaired with composite resin alone had significantly more leakage (P < 0.05). Using calcium sulphate as an artificial floor significantly decreased leakage of smaller perforations (P < 0.05). In groups repaired with calcium sulphate under composite resin, leakage in smaller perforations was markedly lower than that in larger ones (P < 0.05). No significant difference was found between the specimens with 1 or 1.5 mm perforations repaired with resin alone (P > 0.05). CONCLUSIONS: Calcium sulphate significantly improved the sealing ability of 1 mm perforations repaired with composite resin but not for 1.5 mm perforations.

Calcium Sulfate↗
PubMed1994

A review of dentine-bonding agents and an account of clinical applications in paediatric dentistry.

The need for dental materials which bond to all hard tissues of the tooth is an obvious one. The technique of enamel acid etching has made adhesion to enamel possible. In addition, extensive research has allowed the development of dentine-bonding agents, materials that are claimed to bond to dentine. The first and second generation of these products, despite their early success and popularity, pose several problems, including a weak and unstable bond in the oral environment. During the last decade, a number of systems, known as the third generation of dentine-bonding agents, have been marketed. They base their bonding ability on the utilization of the organic part of a pre-treated dentine. In vitro studies have reported significantly higher bond strength, and reduced microleakage and marginal gap formation. Biocompatibility and toxicity studies have demonstrated no direct harmful effect on the pulp. Clinical trials have shown promising clinical performance. These products can offer treatment alternatives in paediatric dentistry; for example, for teeth affected by amelogenesis imperfecta or local hypoplasia, for anterior teeth extensively damaged by decay or trauma, and for teeth with hypersensitive dentine. However, the dentist should be cautious using these systems because, for most of the products, the permanence of the bond in the oral environment has not been extensively studied.

Amelogenesis Imperfecta↗
PubMed2004

Establishment and evaluation of a trauma clinic based in a primary care setting.

OBJECTIVES: The aim of this study was to establish and evaluate a referral centre for the treatment of children with traumatized teeth in an area remote from a dental hospital. SETTING: The study was conducted in a Community Dental Service clinic in Cheshire, UK. METHODS: A dentist from the Cheshire Community Dental Service was trained in the treatment and management of traumatized teeth. Invite referrals to the trauma clinic in a health centre. The number and types of patients referred and treated at the trauma clinic were monitored. In addition, the parents of referred children and referring dentists were asked to comment on the acceptability of the service. RESULTS: During the first 12 months, 49 patients with 74 traumatized teeth were referred to the trauma clinic. The majority of the patients were referred by their dentist because problems arose following their initial management. Both parents and referring dentists were very satisfied with the service. CONCLUSIONS: The trauma clinic fulfilled a clinical need, and was well received by the parents of children referred to the clinic and by the local dentists.

Attitude of Health Personnel↗
PubMed2001

Stresses within porcelain veneers and the composite lute using different preparation designs.

PURPOSE: The purpose of this study was to investigate compressive and tensile stresses in porcelain and composite at the labial marginal region of porcelain veneer restorations using chamfer, shoulder, or knife-edge labial margin designs with labial window or incisal overlap incisal preparation designs. METHODS: Porcelain veneer models were constructed and loaded with (1) a 200-N, 45 degrees palatal load to simulate functional loading, and (2) a horizontal labial loading of 200 N to mimic trauma. Maximum tensile and compressive stresses were recorded within the labial marginal region of both porcelain and composite lute. RESULTS: Under the 45 degrees palatal load, stresses within the palatal marginal porcelain were chiefly compressive, and stresses for the knife-edge designs as much as 42% less than for shoulder designs. Incisal overlap preparations were generally associated with less compressive stress within both porcelain and composite than the window preparation. When a labial load was applied, tensile stresses were as much as 25 times greater for the chamfer and shoulder designs compared with the knife-edge design. Labial loading also resulted in an increase in tensile stresses within the composite lute, and stresses were again lowest within the knife-edge margin design. CONCLUSIONS: Under the limitations of this study, using the incisal overlap preparation, porcelain veneers with knife-edge labial margins could better sustain occlusal loading without fracture. J Prosthodont 2001;10:16-21.

Bite Force↗
PubMed1994

Reasons for extraction of permanent teeth in Japan.

Eight hundred forty-nine Japanese dentists were asked to record the reason for every tooth extraction of permanent teeth during 1 week in each of four seasons. The reasons were assigned to six groups: dental caries, periodontal disease, eruption problems, trauma, orthodontics and other reasons. Thirty-eight to 40% of the dentists returned the forms in each season, relating to a total of 11,175 extracted teeth. Overall, caries was the most frequent reason for tooth extraction (55.4%), followed by periodontal disease (38.0%). The females lost more teeth due to caries than did the males. In the > or = 16 age groups, caries was the main reason for tooth extraction. However, periodontal disease became principal only in the males aged 46-65 yr. Anterior teeth, especially in the mandible, represented the highest percentage of periodontal extractions. A considerable difference in the major reason for maxillary tooth loss was observed between both sexes. Maxillary premolars and molars in the males were extracted for periodontal disease as much as for caries, whereas caries was the predominant reason for loss of all maxillary teeth in the females.

Adolescent↗
PubMed1996

A survey of reasons for extraction of permanent teeth in Singapore.

A survey was carried out to determine the reasons for tooth extractions of permanent teeth in Singapore. Data were obtained from 52 dentists practising general dentistry over a period of 12 months. At the end of the 12-month period, data were collected from 1276 patients, from whom a total 272 teeth were extracted. In this population group, the results showed that the percentage of teeth extracted due to periodontal reasons and caries were about the same, that is 35.8% and 35.4%, respectively. There was an increase in teeth extracted due to periodontal reasons with age. In patients above 40 yr, an average of 76% of teeth were lost due to periodontal reasons. An average of 26.7% of teeth were lost due to periodontal reasons in patients under 40 yr old. However, the trend for loss of teeth due to caries is reversed. Posterior teeth were more frequently extract compared to anterior teeth. Third molars accounted for 24.7% of all extractions carried out, whilst central incisors were 8.0% of all extractions. Molars were often lost due to caries and lower anterior teeth were most frequently lost due to periodontal reasons. The results of this study did not demonstrate one predominant reason for extraction. Both caries and periodontal reasons were equally common causes of tooth extraction.

Adolescent↗
PubMed1991

A study of endodontically apexified teeth.

This study was undertaken to determine the clinical and radiographic success of calcium hydroxide apexification in a group of 48 patients requiring endodontic therapy because of pulpal necrosis prior to root-end closure. The study examined tooth number, etiology of pulpal necrosis, age, sex, size of root-end opening, size of radiolucency, crown discoloration, interappointment symptoms, and total treatment time from initial instrumentation to completion of apexification. Apexification required an average of 1 year +/- 7 months. A statistically significant relationship was found between: the presence of a radiolucency and development of interappointment symptoms (p less than 0.04); and the size of apex opening and development of interappointment symptoms (p less than 0.02). If symptoms did develop, apexification was delayed an additional 5 months when compared to patients who did not have symptoms. Calcium hydroxide apexification was found to be statistically highly successful regardless of the clinical variables encountered.

Age Factors↗