Longevity of stainless steel crowns as interim restorations on young permanent first molars that have undergone vital pulp therapy treatment in children and factors associated with their treatment failure: A retrospective study of up to 8.5 years

BACKGROUND

Although stainless steel crowns (SSCs) on permanent molars are a common interim full-coverage restoration, there are few clinical studies on longevity.

AIM

To evaluate the longevity of SSCs as restorations on young permanent first molars (PFMs) that have undergone vital pulp therapy (VPT) treatment and to identify factors associated with SSC treatment failure.

DESIGN

This study conducted a retrospective chart review of children who had PFMs that have undergone VPT treatment and been restored with SSCs. Data from treatment and follow-up visits were collected. The Kaplan-Meier survival analysis was used to analyse the longevity of SSCs. A multivariate Cox proportional hazards regression model was used to identify factors associated with SSC treatment failure.

RESULTS

Data from 140 SSCs were included, with an average follow-up period of 33.5 ± 21.6 (range, 6-104) months. Although none of the teeth had pulpal failure, 35.7% had SSC treatment failure. The survival probabilities of SSCs declined over time, reaching 39.6% (95% CI 27.0-51.9) after 60 months. The immediate post-operative condition of SSCs and the loss of proximal wall on the abutment tooth were significant factors associated with SSC treatment failure.

CONCLUSION

Stainless steel crowns are suitable for use as interim restorations in PFMs that have undergone VPT treatment in children, but their longevity is limited, necessitating replacement over time.

Artificial intelligence-aided detection of ectopic eruption of maxillary first molars based on panoramic radiography

OBJECTIVES

Ectopic eruption (EE) of maxillary permanent first molars (PFMs) is among the most frequent ectopic eruption, which leads to premature loss of adjacent primary second molars, impaction of premolars and a decrease in dental arch length. Apart from oral manifestations such as delayed eruption and discoloration of PFMs, panoramic radiography can reveal EE of maxillary PFMs as well. Identifying eruption anomalies in radiographs can be strongly experience-dependent, leading us to develop here an automatic model that can aid dentists in this task and allow timelier interventions.

METHODS

Panoramic X-ray images from 1480 patients aged 4-9 years old were used to train an auto-screening model. Another 100 panoramic images were used to validate and test the model.

RESULTS

The positive and negative predictive values of this auto-screening system were 0.86 and 0.88, respectively, with a specificity of 0.90 and a sensitivity of 0.86. Using the model to aid dentists in detecting EE on the 100 panoramic images led to higher sensitivity and specificity than when three experienced pediatric dentists detected EE manually.

CONCLUSIONS

Deep learning-based automatic screening system is useful and promising in the detection EE of maxillary PFMs with relatively high specificity. However, deep learning is not completely accurate in the detection of EE. To minimize the effect of possible false negative diagnosis, regular follow-ups and re-evaluation are required if necessary.

CLINICAL SIGNIFICANCE

Identification of EE through a semi-automatic screening model can improve the efficacy and accuracy of clinical diagnosis compared to human experts alone. This method may allow earlier detection and timelier intervention and management.

First Molars in Permanent Dentition and their Malformations in Various Pathologies: A Review

Permanent maxillary and mandibular first molars are the first permanent teeth to erupt into the oral cavity along with the mandibular incisors. It serves as an excellent record of maternal and fetal health, reflecting the prenatal, perinatal, and postnatal health and diseases. This review focuses on the molar morphogenesis, molar malformations, their etiopathogenesis, and pathologies causing specific pattern of molar malformations.

Atypical extraction in Class I malocclusion: A case report

The treatment of Angle Class I malocclusion by atypical extraction is rather challenging. The extraction of four first premolars often manages it. However, in cases of compromised and non-restorable teeth, the extraction decision may be altered, making the anchorage and the treatment mechanics more challenging. This article reports the clinical case of a 16-year-old patient from Sudan who presented with a chief complaint “My teeth are crooked and sticking out.” He had Angle Class I malocclusion with a bimaxillary dentoalveolar protrusion. He had severe crowding in both arches and localized marginal gingivitis related to an ectopically erupted upper right canine (UR3) and lower right first premolar (LR4). The patient had a provisional restoration in the lower right first molar (LR6). Extraction of three first premolars and one first molar was the alternative of choice for this treatment, which restored function, providing improved periodontal health, achieved the desired facial esthetics, and allowed finishing with a stable and balanced occlusion. Management of angle class I malocclusion with atypical extraction patterns should be performed with careful mechanics and anchorage planning to obtain good results.

Risk Factors Associated with Carious Lesions in Permanent First Molars in Children: A Seven-Year Retrospective Cohort Study

The aim of this study was to evaluate the risk factors associated with the occurrence of caries in permanent teeth (PT) and in the permanent first molar (PFM) seven years after their eruption. Children born in 2005 who were enrolled in a Community Dental Program were included. A total of 278 children were enrolled. Evaluated risk factors were parental caries experience, educational level of the mother, routine medications, systemic diseases, dietary habits, toothbrushing frequency, existence of molar incisor hypomineralization (MIH) in the PT, and caries in the temporary teeth (TT). Associations between independent variables and the DMF-T (decayed, missing, and filled teeth in PT) and DMF-M (DMF in PFM) indices, only considering cavitated and non-cavitated carious lesions or cavitated carious lesions as outcomes, were evaluated by Poisson regression with robust variance analysis. A cariogenic diet (sweets and soft drinks), toothbrushing frequency of <1 a day, a presence of df-t (decayed and filled temporary teeth) score of >0, low educational level of the mother, and existence of MIH were associated with high DMF-T or DMF-M values (p < 0.05). We can conclude that the intake of sweets and soft drinks, toothbrushing frequency, the presence of caries in TT, and MIH in PT were the best predictors of the occurrence of caries in PT and PFM.

A Systematic Review of the Consequences of Early Extraction of First Permanent First Molar in Different Mixed Dentition Stages

AIMS AND OBJECTIVES

The aim of this study was to consider the available evidence regarding early extraction of permanent first molars (PFMs) in different mixed dentition stages that affect the integrity of occlusion and the implications for treatment planning.

MATERIALS AND METHODS

Electronic database, including PubMed and Science Direct, searches were conducted for available evidence. Key terms used in the search were "extraction," " first permanent molar," and "mixed dentition."

RESULTS

The initial search identified 56 studies to be related to the review. Although a significant number of published articles had dealt with early extraction of PFM, only three studies had fulfilled the final selection criteria to be considered for this systematic review.

CONCLUSION

Future active appliance treatment is important after extraction of PFMs with poor prognosis. If such therapy is not needed, consideration should be given to extraction at the ideal developmental age to achieve spontaneous space closure. Each case should be assessed for the need of balancing or compensating extractions to preserve the dental midline and prevent overeruption.

Evaluation of caries in deciduous second molar and adjacent permanent molar in mixed dentition

AIM

This study was done to evaluate association of caries in deciduous second molar and adjacent permanent first molar, tooth surface more involved in permanent first molar and to assess the parental awareness regarding the eruption of permanent first molar.

SUBJECTS AND METHODS

Three hundred and ten children (160 boys, 150 girls) of mixed dentition aged between 6 and 11 years were included. Presence or absence of paired association of caries in primary second molar and adjacent permanent first molar, of both the jaws, were noted. Parental awareness regarding the child's dentition was asked by pointing the maxillary and mandibular permanent first molar.

RESULTS

Pearson Chi-square test was used. Significance was noted in both sexes between paired nonassociation of caries in mandibular primary second molar and mandibular permanent molar (P =0.01) and paired nonassociation of caries in primary maxillary second molar and maxillary permanent first molar in girls only (P =0.04). Parental awareness that permanent first molar has erupted was 24.83% and not to be exfoliated and replaced was 22.9% for both the sexes. In permanent teeth of both the sexes, the occlusal surface was more involved with caries in maxillary teeth; the buccal surface was more involved in mandibular teeth. About 10% of the sample did not have caries in both maxillary and mandibular permanent first molar.

CONCLUSIONS

Paired association of caries of primary second molar and permanent first molar though found in large number of cases was not significant. It is clear that parental awareness is less regarding the child's oral health. Thus, community-based awareness program has to be conducted to emphasize on pediatric oral health status and care.