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A new in vivo method for measuring caries activity using quantitative light-induced fluorescence.

The aim of this in vivo study was to assess the association between caries prevalence and activity parameters and the properties of etched sites measured with quantitative light-induced fluorescence (QLF). In a clinical method, two areas of a deciduous tooth were etched in each of 44 children (mean age 8.23 years+/-1.45) with 36% phosphoric acid gel for 1 min and 4 min, respectively. DeltaQ of the etched site was measured immediately after the etching (DeltaQ1) and 24 h later (DeltaQ2) with QLF. In addition, deft/DMFT, approximal plaque (API), bleeding on probing (mod. PBI), active carious lesions and currently used fluorides were recorded. In a regression analysis for the deft, the use of fluoridated salt (standardized coefficient SC=-0.25) and fluoride gel (SC=-0.37) showed the greatest effect, as did the fluoride gel (SC=-0.26) and gingival bleeding (SC=0.50) for the number of active carious lesions. The deft and the number of active carious lesions correlated significantly (r=0.70, p<0.001). DeltaQ1 and DeltaQ2 showed a significant statistical correlation with the age-adjusted deft (0.39<r<0.52, p<0.01) and with the number of active lesions (0.42<r<0.59, p<0.01). Correlations between DeltaQ and the API, PBI and the fluoride scores were slightly weaker but also statistically significant. In a principal-component analysis, these parameters were approximately identical, indicating a strong relationship between the different variables and DeltaQ. This relationship was especially strong for the deft and the active carious lesion scores. In conclusion, these data suggest that the degree of demineralization by etching and its changes with time are associated with caries activity and that this method might be used for the early assessment of caries activity.

Child↗

Enamel fluoride concentrations in unerupted third molars and the influence of fluoridated water on caries scores.

Enamel fluoride concentrations in buccal and lingual surfaces were determined in successive layers obtained by the acid etch method. The 48 unerupted third molar teeth were from subjects who had lived continuously since birth in two Brazilian towns (Barretos and Ribeirão Pr-eto) with different fluoride levels in the drinking water but with similar socioeconomic conditions. The DMFT index was determined for children 7-12 years old living in the two towns. Enamel fluoride concentrations were significantly higher in the teeth from the town with higher fluoride levels in drinking water. The children residing in the community with near-optimum fluoride concentration in the water had mean DMFT scores that were less than half those found in the community with a low level of fluoride in the drinking water.

Acid Etching, Dental↗

Patterns of crowding of permanent mandibular incisors before eruption.

Observation of the radiographs taken of 37 mandibles from children ten months to seven years of age showed that the unerupted, permanent mandibular central incisors were rotated in 45 of 74 jaw halves (60.8%). The type of rotation in which the mesial aspect is directed lingually was most commonly seen (44.6%). The next most common observation was of jaw halves without any rotation of the central incisor (39.2%). The type of rotation in which the central incisor's distal aspect is turned lingually was the least common observation (16.2%). The rotation seemed symmetric in 25 jaws (67.6%).

Child↗

Bone age determination in a paediatric population as an indicator of nutritional status.

The United Mission to Nepal Tansen Project is in the hill country, 300 km West of Kathmandu. This 40-year-old service centre's major emphasis has been on clinical and community medicine and education. Agronomy, forestry, water resources development, adult literacy, etc., have also been part of the project's outreach. We had long noted that the children of all of the various tribal groups in the area are small for their age as compared with children in developed countries. Fracture care X-rays were examined to reveal delay in ossification and in physeal closure. Using the standards found in the Radiographic Atlas of Skeletal Development of the Hand and Wrist, we quantified this apparent delay by determining the bone age of all patients presenting at the hospital with upper limb injuries requiring X-ray. The collection of data was limited to 100 days and to those under the age of 21. Two hundred and nineteen patients' data were analysed. We found that bone maturation delay was very common and often severe. The average bone age among the 219 was 28% below chronological age. That is, 60% of all fell two standard deviations below the norm: i.e. two-thirds of all 9 year olds had the expected skeletal development of 6 year olds in Boston, USA. Dental age was also analysed using deciduous tooth shedding and tooth eruption patterns. Dental age retardation averaged 21%, but a larger per cent had normal eruption dates. Other physical and sociological data were included in a questionnaire completed for each patient. Among the variables examined, poverty alone appeared to be the major mover. We believe that national small stature is a result of lifelong community dietary inadequacy.

Age Determination by Skeleton↗

Craniofacial tissue engineering by stem cells.

Craniofacial tissue engineering promises the regeneration or de novo formation of dental, oral, and craniofacial structures lost to congenital anomalies, trauma, and diseases. Virtually all craniofacial structures are derivatives of mesenchymal cells. Mesenchymal stem cells are the offspring of mesenchymal cells following asymmetrical division, and reside in various craniofacial structures in the adult. Cells with characteristics of adult stem cells have been isolated from the dental pulp, the deciduous tooth, and the periodontium. Several craniofacial structures--such as the mandibular condyle, calvarial bone, cranial suture, and subcutaneous adipose tissue--have been engineered from mesenchymal stem cells, growth factor, and/or gene therapy approaches. As a departure from the reliance of current clinical practice on durable materials such as amalgam, composites, and metallic alloys, biological therapies utilize mesenchymal stem cells, delivered or internally recruited, to generate craniofacial structures in temporary scaffolding biomaterials. Craniofacial tissue engineering is likely to be realized in the foreseeable future, and represents an opportunity that dentistry cannot afford to miss.

Absorbable Implants↗

Maxillary midline diastema: a case report involving a combined orthodontic/maxillofacial approach.

This paper presents an orthodontic case of a large (14.5 mm) maxillary midline diastema that was related to the presence, and subsequent removal of 2 median maxillary supernumerary teeth and resulting bone loss. A combined orthodontic and maxillofacial approach involving bone grafting and fixed appliances was used to close the space. This episode of care was organized as interceptive treatment during development of the permanent dentition.

Child↗

An inverted upper lateral incisor.

A case is presented of an inverted upper lateral incisor in an 11-year-old patient. It is believed that involvement of this tooth is previously unreported.

Child↗

The assessment of crowding without the need to record arch perimeter. Part II: Crowded and irregular arches.

A mathematically determined technique which seemed to be valid for the calculation of crowding and spacing in arches with acceptable alignment, was tested on a series of arches with varying degrees of crowding and irregularity. Upper and lower study casts of 30 individuals with sufficient malalignment and crowding to warrant orthodontic treatment with fixed appliances were examined. Models were measured by three operators, using a reflex microscope interfaced to an IBM compatible PC and a customized calculation program. The degree of crowding was compared with a "clinical' assessment of each arch, in which the irregularity was measured directly using a steel ruler. Both the computer calculated and clinical values varied between observers, but the agreement between observers was better using the reflex microscope. Correlation coefficients ranged from 0.92 to 0.96 for the reflex microscope, and between 0.86 and 0.91 for the clinical assessment. Inter-observer agreement for the three operators was high: 0.93 for the reflex microscope and 0.87 where a ruler was used. This suggests that the computer program used to calculate the crowding was valid for the crowded arches under consideration.

Algorithms↗

Clinical application of cone beam digital volume tomography in children with cleft lip and palate.

OBJECTIVES: The diagnostic advantages of digital volume tomography (DVT) over conventional imaging and computed tomography are demonstrated in terms of the respective radiation exposure. The potential role for three-dimensional imaging in cleft lip and palate patients is illustrated on the basis of clinical examples. METHODS: The radiation exposure resulting from scans using a cone beam DVT (NEW TOM QR-DVT 9000, Marburg, Germany) was measured with an Alderson-Rando-Phantom (The Phantom Laboratory, New York, NY) and compared with that resulting from other standard imaging modalities. The patient sample consisted of young children with cleft lip and palate on whom orthodontic and surgical treatment was planned on an interdisciplinary basis at the University-Hospital of Heidelberg. RESULTS: Digital volume tomography allows high-quality three-dimensional imaging of the premaxilla region, with an effective equivalent investigation dose of (110 kV, 5.4 mA) 0.342 mSv based on ICRP recommendations. While the effective equivalent investigation dose for DVT is higher than that for standard imaging techniques (for example digital panoramic radiograph Orthophos Plus DS Ceph (66 kV, 8 mA) 0.016 mSv), it is much lower than that for a normal CT scan (e.g. Picker International Inc., Highland Heights, OH) adjusted at (spiral 130 kV, 125 mA, and 30 mA, 1.5 s) 2.27 mSv. Digital volume tomography provides extensive data important in clinical decision making. CONCLUSIONS: The clinical examples show the good applicability of DVT with a reduced radiation dose.

Child, Preschool↗

Pyle's disease: an incidental finding in a routine dental patient.

Pyle's disease (PD) or metaphyseal dysplasia is an extremely rare genetic disorder, transmitted as an autosomal recessive trait. The peculiarity of the disease is that the striking radiographic manifestations contrast with the relatively normal clinical features. The oral findings and radiographic features of the disease are not well documented. The present paper describes the radiographic features of Pyle's disease in a 17-year-old girl and draws attention to the findings in the jaw bones.

Adolescent↗

Buccal and palatal talon cusps with pulp extensions on a supernumerary primary tooth.

This paper reports an unusual occurrence of talon cusp on a supernumerary primary incisor, presenting on both labial and palatal sides. The tooth was scheduled for extraction due to its interference with the occlusion. Morphometric analysis of the taloned cusps was performed on digitized replicas of the tooth crown using open-source image analysis toolkit (ImageJ). Further non-destructive investigation of the taloned crown under cone-beam X-ray computed tomography revealed pulpal extensions in both talon cusps.

Child, Preschool↗

Prosthodontic therapy for cleidocranial dysostosis: report of case.

Objectives of treatment of the oral manifestations of cleidocranial dysostosis should include restoring the vertical dimension of occlusion, building out the maxilla, establishing of functional occlusion, improving appearance and phonation, and improving the patient's mental well-being.

Adolescent↗