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PubMed2005

Prosthodontic rehabilitation in Papillon-Lefevre syndrome: a case report.

Papillon-Lefevre syndrome is a rare recessive genetic disorder. The clinical manifestations include palmar-plantar hyperkeratosis with precocious rapidly progressive periodontal disease that results in premature exfoliation of primary and permanent dentitions. Patients are often edentulous at an early age. Here is the report of prosthodontic rehabilitation of a case of Papillon-Lefevre syndrome in a 6-year-old child.

Child↗
PubMedDate not supplied

Eruptive malpositioning of the mandibular permanent lateral incisors: three case reports.

Ectopic eruption of the mandibular permanent lateral incisors involving the loss of the adjacent primary canines is not uncommon, yet the extreme distalization and transposition of such teeth (partial or true) has been reported infrequently. Three cases that illustrate various anomalous eruption-exfoliation patterns are presented. Theories that attempt to explain the etiology of anomalous eruption positions are discussed. However, the multifactorial process of growth and development makes it difficult to identify specific primary etiological factors. Treatment options also are discussed and illustrated, with emphasis on early orthodontic intervention for optimal results.

Child↗
PubMed2001

A natural history of cleidocranial dysplasia.

Cleidocranial dysplasia (CCD) is an autosomal dominant skeletal dysplasia associated with clavicle hypoplasia and dental abnormalities. The condition is caused by mutations in the CBFA1 gene, a transcription factor that activates osteoblast differentiation. Clinical characteristics associated with CCD have previously been described in case reports and small case series. This study was undertaken to gain a more complete delineation of clinical complications associated with CCD. The study population was composed of 90 CCD individuals and 56 relative controls ascertained from genetic and dental practices in the United States, Canada, Europe, and Australia. A number of previously unrecognized complications were significantly increased including: genua valga, scoliosis, pes planus, sinus infections, upper respiratory complications, recurrent otitis media, and hearing loss. Primary Cesarean section rate was significantly increased compared to relative controls and the general population rate. Finally, dental abnormalities, including supernumerary teeth, failure of exfoliation of the primary dentition, and malocclusion, are serious and complex problems that require intervention. Clinical recommendations based on the results of this study are included.

Adolescent↗
PubMed1994

Ectopic eruption of the maxillary first permanent molar. An epidemiological, familial, aetiological and longitudinal clinical study.

The aims of this thesis were to investigate the prevalence, familial tendency and aetiological factors of ectopic eruption of the maxillary first permanent molar, to analyse associations between ectopic eruption of the maxillary first permanent molar, to analyse associations between ectopic eruption of the maxillary first permanent molar and other tooth and developmental disturbances and cleft lip and/or palate defects, to make a longitudinal evaluation of the effects of orthodontic treatment in irreversible cases and of the prognosis for the atypically resorbed second primary molars in cases of reversible ectopic eruption and to carry out histological studies of second primary molars with extensive resorptions. The thesis is based on eight investigations. The subjects for the prevalence study consisted of 2,903 children. The main subjects in the clinical studies were the children with ectopic eruption of the maxillary first permanent molar from those children. The methods used were radiographic assessments, biometrics, orthodontic treatment, histology, different statistical methods and clinical assessments. The prevalence of ectopic eruption of the maxillary first permanent molar was found to be 4.3 per cent for the population and 21.8 per cent for cleft children. In sibs to children with ectopic eruption the prevalence was 19.8 per cent, indicating a genetic background. The main aetiological factors were the greater mesial angulation and the greater width of the ectopically erupted first permanent molar. In cases of reversible ectopic eruption the atypically resorbed second primary molars remained to the normal exfoliation time in 90 teeth out of 92. Treatment with cervical headgear in 46 children for an average of 9 months resulted in uprighting of the upper first permanent molars to good occlusion and in about 70 per cent of the children sufficient space for the second premolars. In the long-term follow-up, 10 years after treatment, two forms of discriminant analysis were used to evaluate the long-term treatment effects. The analyses showed a uniformity of the cases, indicating that the effects of the eruption disturbance had been corrected and all negative side effects of the treatment were eliminated.

Adolescent↗
PubMed1989

Effects of tooth pulp deafferentation on nociceptive and nonnociceptive neurons of the feline trigeminal subnucleus caudalis (medullary dorsal horn).

1. Effects of deafferentation of the tooth pulps of the posterior mandibular teeth were studied in single neurons recorded in the ipsilateral subnucleus caudalis of the trigeminal (V) spinal tract nucleus of adult cats and kittens. The functional properties of neurons in each anesthetized animal were determined electro-physiologically in a series of microelectrode penetrations of the subnucleus. 2. The more than 800 neurons investigated could be subdivided on the basis of their cutaneous mechanoreceptive field properties into low-threshold mechanoreceptive (LTM) neurons, wide dynamic range (WDR) neurons, or nociceptive-specific (NS) neurons. Comparisons of neuronal properties were made between control (intact) cats and 7-15 day deafferented cats studied in a blind design, as well as groups of longer term deafferented cats, and kittens undergoing a "natural" deafferentation as a result of exfoliation of primary teeth. 3. There was no apparent change in the somatotopic pattern of organization of the subnucleus in the kittens and pulp-deafferented cats and no statistically significant differences were noted between kittens and control cats in any property except for alterations in the incidence of spontaneously active neurons. 4. Limited but statistically significant alterations were noted in some of the neuronal properties in the deafferented cats. These changes were especially apparent in the LTM neurons. The incidence of spontaneous activity was significantly decreased in the neurons of most long-term deafferented groups of cats. In the 7-15 day deafferented group, significantly more LTM neurons had a mechanoreceptive field involving all three divisions of the V nerve, and there was a significant increase in the incidence of LTM neurons activated by electrical stimulation of intraoral sites. Mechanosensitive neurons responsive only to tap stimuli were found only in the deafferented groups of cats. 5. These alterations in caudalis contrast with previous reports claiming marked hyperexcitability of caudal V brain stem neurons as a consequence of deafferentation and implicating such effects in the development of pain. However, some of the changes are in general not inconsistent with deafferentation-induced changes reported in spinal somatosensory neurons and with the pulp deafferentation-induced changes that we have recently documented in LTM neurons of subnucleus oralis of the V spinal tract nucleus of adult cats.(ABSTRACT TRUNCATED AT 400 WORDS)

Afferent Pathways↗
PubMed1976

The periodontal management of a patient with a profound immunodeficiency disorder.

A case of severe, uncontrolled periodontal disease in a patient with a profound immunodeficiency disorder is reported. The periodontal disease was noted before the age of 10 years and is generalized, with marked associated alveolar bone loss, even threatening a mandibular fracture. Severely involved teeth were allowed to exfoliate, and extractions were avoided. At the age of 17 years, the patient now has only nine remaining teeth. The management adopted and alternative approaches are critically reviewed. The implications of the dental findings for current concepts of the pathogenesis of periodontal disease and dental caries are discussed.

Adolescent↗
PubMed2002

Current concepts in vital primary pulp therapy.

REVIEW: Recent progress in understanding the molecular and cellular changes during tooth development and how they are mimicked during tissue repair, offers the opportunity to assess the biologic validity of the various vital pulp treatments. Under this light, indirect pulp treatment can be an acceptable procedure for primary teeth with reversible pulp inflammation, provided that this diagnosis is based on a good history, a proper clinical and radiographic examination, and the tooth had been sealed with a leakage-free restoration. Several articles report the success of this technique of direct pulp capping (DPC) and calcium hydroxide has been widely used with high success rates in young permanent teeth, but the results in primary teeth are less satisfactory. Recent studies have reported successful results with direct adhesive capping of exposed pulps, while others showed pulp inflammation and unacceptable results using this technique. Thus, the traditional rationale for the use of calcium hydroxide should be maintained, and this treatment modality reserved for iatrogenic exposures in asymptomatic teeth that are expected to exfoliate within a short period of time. In younger children, iatrogenic or carious exposures should be treated by pulpotomy. Formocresol has been the most popular pulp dressing material for pulpotomized primary molars for many years but, due to its deleterious effect, the use of formocresol is decreasing considerably worldwide. Ferric sulphate has been proposed as a substitute to formocresol, and the success rates were comparable to those of formocresol. More recently, considerably better results have been obtained with MTA (Mineral Trioxide Aggregate), and statistically significant differences were reported when compared with formocresol. Internal root resorption, a finding seen both in ferric sulphate and formocresol, was not observed in the MTA treated teeth. MTA is commercially available, but its cost is very high, and cannot be kept once opened. Thus, ferric sulphate can still be a valid and inexpensive solution for pulpotomies in primary teeth.

Journal Article↗
PubMed1999

Resin-modified glass ionomer cement restorations in primary molars.

The aim of this multicenter study was to evaluate the 3-year performance of a resin-modified glass ionomer cement in primary molars. A total of 174 class II restorations were placed in 85 children by 6 dentists. The restorations were evaluated during a 3-year period using slightly modified USPHS criteria (van Dijken 1986). Of the 174 restorations 161 were evaluated after 1 year, 121 after 2 years and 68 after 3 years. A total of 81, restorations exfoliated or was extracted during the study. The cumulative failure rate after 1, 2 and 3 year was 8.1%, 11.7% and 19.8% respectively. The main reasons for failure were secondary caries and loss of retention.

Child↗
PubMedDate not supplied

Formocresol pulpotomy in primary molars: a long-term radiographic evaluation.

Of 137 pulpotomies with Tempophore, 13 percent failed. In comparison with pulpotomies using Ca(OH)2, in which higher failure rates occurred (Magnusson, Schröder), we can conclude that the pulpotomy with Tempophore, as well as with Buckley's formocresol, can be considered a clinically successful therapy. These therapies permit the preservation of even extensively carious primary molars, until their normal exfoliation time. The preservation of these teeth prevents the appearance of functional as well as orthodontic problems, because the arch-length is not adversely affected. The mesial tipping or drifting of the permanent molars is, furthermore, prevented.

Child↗
PubMed1989

[Effect of hydroxylapatite particles during healing of experimental furcation involvement in beagle dogs].

The present study was performed to evaluate the effects of hydroxylapatite (HAP) on tissue regeneration in various types of furcation involvement. Upper premolar tooth sites of 9 beagle dogs (3-6 years old) were used. HAP particles were implanted into three types of furcation defects: Class III lesion (by Glickman) in 2nd premolar sites, artificially caused by intrafurcal suturing or spontaneously developed about 3 months after extraction of the 1st premolar; Class IV lesion in 4th premolar sites artificially produced 2 months before implantation; and through-and-through furcal bony defects in 3rd premolar sites at the time of HAP implantation. Macroscopic, radiographic and microscopical investigations of the postoperative status were carried out at intervals of 1, 2, 3 and 6 months. The appearance of the gingiva in bony defect sites was almost the same as that in the presurgical status 2 weeks after implantation, although gingival inflammation was persistent in Class III and IV lesions. Most particles in Class III and IV lesions exfoliated until 2 weeks after implantation, and the junctional space between recipient bone and particles could not be distinguished, probably as a result of incorporation of HAP and osseous tissue. Histological observation revealed that HAP particles were surrounded by new bone located at the top of the alveolar crest in all defects. However, there were no obvious signs of coronal bone formation or connective tissue attachment in Class III and IV lesions up to 3 months after the operation. At 6 months there was evidence of new bone formation over the presurgical crests in Class III and IV lesions. On the other hand, there were obvious signs of connective tissue attachment and bone formation in bony defect sites, probably induced by the tissue of the periodontal ligament remaining after the surgical procedure, and nonphysiological ankylosis between root and bone was frequently observed. There were notable findings, such as newly formed osteoid tissue intervening with the adhesive particles, calcified tissue intervening between HAP particles and root surface showing ankylosis, and peripheral osteoid formation in the HAP particles. It is postulated that HAP has no apparent role in induction of bone formation, although there is chemical affinity to calcified tissue, and it is effective in yielding a volume of bone-like tissue where osseous repair could be performed. However, HAP did not enhance regeneration of lost periodontal structures including connective tissue attachment.

Animals↗
PubMedDate not supplied

Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth.

PURPOSE: This study was performed to retrospectively evaluate treatment of deep caries in primary molars with formocresol pulpotomy (FP) and indirect pulp therapy (IPT). METHODS: 133 primary molars with deep caries approaching the pulp were treated with FP (N = 78) or IPT (N = 55) and followed 2-7 years. All IPTs received immediate stainless steel crowns (SSCs); 61 FPs got an immediate SSC, 13 an intermediate restorative material (IRM), and 4 amalgam. Thirteen IPTs and 25 FPs had pre-operative pain compatible with a diagnosis of reversible pulpitis. Treatment notes and radiographs were independently assessed. RESULTS: Overall IPT success was 93% (51/55) versus 74% (58/78) for FP. Molars with pain compatible with a diagnosis of reversible pulpitis were successfully treated by IPT 85% (11/13) versus 76% (19/25) for FP. FP-treated molars exhibited earlier exfoliation 38% (30/78), while all IPT molars exhibited normal exfoliation. FPs receiving immediate SSCs had 50/61 (82%) succeed; FPs restored with an IRM temporary succeeded 5/13 (39%), amalgam 3/4 (75%). CONCLUSIONS: IPT success was significantly higher than FP (P = 0.01) in the treatment of deep caries. Both IPT and FP were successful in treating teeth with pain compatible with the diagnosis of reversible pulpitis. FP significantly hastened the exfoliation of pulpotomized primary molars (P = 0.001). IPT in primary teeth can be successfully used in a one step procedure. SSCs placed immediately after FP significantly increased FP success vs. FP followed by IRM temporary (P = 0.01).

Chi-Square Distribution↗
PubMed1985

Characteristics of amalgam restorations with variable clinical appearance.

A sample of 165 extracted or exfoliated teeth containing amalgam restorations were categorized as to the degree of marginal integrity of the amalgam. Microstructures of the samples representing the highest (grade 11) and lowest (grades 1 and 2) degrees of marginal deterioration were studied by SEM/EDS. The clinical evaluation and microscopic evaluation indicated that samples showing poor marginal integrity contained large quantities of tin-rich and tin-chlorine-rich corrosion products with little or no gamma-2 phase remaining. Obvious signs of fracture and cracking at the cavosurface were always present. Products containing calcium were extensively associated with corrosion products containing tin, and these were found predominantly at the tooth-amalgam interface. No copper-rich amalgams were found in this grouping. Amalgams with good marginal integrity had no microscopic cracks or fractures and generally little evidence of corrosion was found. However, one of six samples had extensive corrosion products, indicating that corrosion product formation is not the only factor contributing to marginal deterioration. After 6 years of clinical use, the degree of marginal deterioration did not appear to depend unerringly on time of use. Further work is necessary to define the microstructural characteristics of samples showing intermediate amounts of marginal deterioration and to determine if copper-rich amalgams consistently have small to moderate amounts of marginal deterioration.

Adolescent↗
PubMed1977

Biologic assessment of copper-containing amalgams.

In order to reduce creep and avoid marginal fractures in amalgam restorations, new alloys containing higher proportions of copper have been introduced. Fillings of these materials were placed in cavities prepared in the deciduous teeth of monkeys or placed in polyethylene tubes and implanted subcutaneously in rats. Conventional silver/tin alloys and zinc oxide eugenol cement were used as reference materials. Despite limitations due to the varying depths of cavities and the small number of animals involved it was concluded that the high copper alloys caused more severe pulp damage than the other materials studied. In the implantation studies many of the high copper specimens were exfoliated before the end of the experimental period. It is concluded that in deep cavities these materials require the use of a non-toxic base or lining material although as they are commonly used in young children's teeth the placement of linings and the isolation of the cavity pose problems.

Animals↗
PubMed2006

Bruxism in children: effect on sleep architecture and daytime cognitive performance and behavior.

STUDY OBJECTIVES: Sleep bruxism is an involuntary mandibular movement with tooth grinding during sleep. The prevalence of sleep bruxism in children is high and may lead to frequent arousals with altered daytime functioning. We investigated the sleep architecture, the incidence of gastroesophageal reflux, and the daytime cognitive behavioral functioning in a group of children with sleep bruxism. DESIGN-PATIENTS: This prospective pilot study included 10 children. Polysomnographic data with pH-probe analysis was compared with 10 age- and sex-matched controls. Each patient completed a dental evaluation, a nighttime polysomnogram, and cognitive behavioral tests (Kaufman Brief Intelligence Test and Achenbach Child Behavior Checklist). RESULTS: Eight of 10 children had clinically significant bruxism and the 2 remaining patients had recent teeth exfoliation. There was no difference on sleep architecture between patients and controls, except for a higher arousal index for the bruxism group (36.7 vs 20.7, p < .007). Sleep bruxism occurred more frequently in stage 2 and rapid eye movement sleep, with arousals in 66% of the cases. There was no relationship of bruxism to gastroesophageal reflux or intelligence. However, 40% of the patients had elevated scores on the Achenbach Child Behavior Checklist, indicating significant attention and behavior problems, and there were moderate correlations between the arousal index and several of the behavior-problem scales from the Achenbach Child Behavior Checklist (0.5 to 0.6). CONCLUSIONS: The data suggest that children with bruxism have a higher arousal index, which may be associated with an increased incidence of attention-behavior problems. Future studies investigating pediatric sleep bruxism will need to focus on behavior issues that may be prevalent in this population.

Adolescent↗
PubMed1997

[Replantation of avulsed immature permanent teeth. Results in 39 cases after an average of 2.5 years].

The aim of this investigation was a critical assessment of the short- and medium-term results of replantation of immature, avulsed permanent teeth. Thirty-nine teeth were investigated after 2.5 years on average. Only 7 teeth (18%) had been replanted within 5 min after avulsion. Sixteen teeth (41%) showed revascularisation or ingrowth of alveolar bone into the pulp. Twenty-two teeth (56%) showed signs of ankylosis, 6 (15%) had been exfoliated or extracted. Seventeen teeth (77% of the ankylotic ones) exhibited an alveolar growth arrest of 1.5 mm per 10 cm body growth. By planimetric assessment, the yearly loss of root dentin by replacement resorption was about 15%. The appearance was compromised in 11 cases (33%) by severe discoloration. In spite of intense therapeutic effort and partial success, the results must be classified as unsatisfactory. In avulsions of immature permanent teeth, replantation therefore has to be considered an intermediate solution. Since the main reason for a failure is extended extra-oral unphysiologic storage, replantation by lay helpers immediately after the accident should be propagated as a first-aid treatment to improve the situation of the replanted tooth. In addition, more attention should be paid to preserving teeth in tissue cultures before replantation.

Child↗
PubMedDate not supplied

Microtensile bond strength of different adhesive systems to primary and permanent dentin.

PURPOSE: The aims of this in vitro study were to: (1) compare bond strength of different adhesive systems to primary and permanent dentin using microtensile test; and (2) evaluate the interaction of these materials to primary and permanent dentin by means of scanning electron microscopy (SEM). METHODS: Middle-coronal dentin surfaces of 18 exfoliated primary and 18 extracted permanent molars were exposed and teeth were randomly divided, according to their adhesive system, into 3 groups (N=6 per group): (1) Clearfil SE Bond (SE); (2) One Up Bond F (OU); and (3) Single Bond (SB). Then, 5-mm high composite blocks were constructed. After bonding procedures, the teeth were stored in distilled water at 37 degrees C for 24 hours prior to the specimens' preparation. For the microtensile test, teeth (N=5 per group) were longitudinally sectioned into 2 axes rendering beam-specimens that were glued to special devices, which were mounted in a Universal Testing Machine to be loaded under a crosshead speed of 1 mm/min until fracture. One tooth of each group was prepared for SEM. RESULTS: Microtensile bond strength mean values (MPa) to primary/permanent dentin were: (1) SE=60.0/61.4; (2) OU=54.5/53.3; and (3) SB=70.1/64.9. Two-way analysis of variance (ANOVA) showed no significant differences (P>.05) for the bond strength values among primary and permanent dentin groups, neither among groups SExSB and SExOU. SEM images of SE and SB showed a well-defined, uniform, and continuous hybrid layer. A continuous hybrid layer, however, was not found for OU. CONCLUSIONS: Bond strength and micromorphologic characteristics of the adhesive systems evaluated were not influenced by the substrate. OU achieved worse results.

Adhesives↗
PubMedDate not supplied

Premature loss of the maxillary primary incisors: effect on speech production.

The residual effect of premature loss due to extraction of the four maxillary primary incisors on speech production was studied. The articulation of twenty-six subjects who had their teeth extracted before the age of five years was evaluated at eight, nine, or ten years old and compared with the articulation of an age-matched comparison group with normal exfoliation of their incisors. T-tests for related measures revealed no statistically significant differences between the group with premature loss and the comparison group. These results suggest that loss of maxillary incisors in children younger than five years is not likely to result in defective articulation while the teeth are missing or when the permanent dentition is acquired.

Articulation Disorders↗
PubMed1977

Enamel fluoride uptake and retention from intensive APF gel applications in vivo.

Children, in the fifth school grade (mean age 11 years) in a fluoridated water area, self-applied acidulated phosphate-F gel (1.2% F) in custom-fitted mouthpieces on 5, 10, or 25 consecutive school days. Enamel F uptake, penetration, and retention were determined from analysis of 1,257 deciduous teeth exfoliated during and after the applications. F penetrated to 200 micrometer in enamel exposed to 25 applications of the gel and increased approximately 2,600 ppm at a 5 micrometer depth. Concentrations of F declined for approximately eight months after which levels stabilized, resulting in a 1,600 ppm increase of firmly bound F.

Acidulated Phosphate Fluoride↗