Transient apical breakdown of a discoloured maxillary central incisor during orthodontic treatment: A case report

Transient apical breakdown (TAB) appears to be a repair process taking place in the pulp and periapical area of traumatised teeth which may display crown discoloration and have no responses to pulp sensitivity tests. Few TAB cases induced by orthodontic forces have been reported so far. Presented is a case report in which TAB occurred on the maxillary right central incisor during orthodontic treatment. The affected tooth suddenly displayed crown discoloration and had no response to pulp testing at 6 weeks after the placement Invisalign Clear Aligner appliances. Condition of the discoloured tooth was monitored by periodic recall examinations without any active treatment. Six months after the occurrence of discoloration, the affected tooth recovered to its original shade and responded normally to pulp sensitivity tests.

[Risk factors for the presence of dental black stain in 82 children]

PURPOSE

To investigate the prevalence of dental black stain in children and analyze the risk factors of dental black stain.

METHODS

We conducted this investigation through a case-control study. A total of 164 children (82 children with dental black stain and 82 children without dental black stain) were recruited from Shanghai Stomatological Hospital. Data regarding their oral hygiene habits, dietary habits, diseases and medication situations were collected by a questionnaire survey. Samples of saliva were collected for pH analysis. Statistical analysis were performed using SPSS 21.0 software package.

RESULTS

Univariate analysis showed that the proportion of children in the black stain group who used bottled water as the main source of drinking water was lower than that in the control group (18.3% vs 35.4%), and the proportion of children who used Chinese herbs or eating more vegetables(≥2 times/day) was higher than that in the control group(23.2% vs 9.8%，29.3% vs 14.6%), the differences were statistically significant (P<0.05). Multivariate logistic regression analysis showed that taking Chinese herbal medicine and eating more vegetables(≥2 times/day) were risk factors for tooth black stains(P<0.05), and use of bottled water as the main source of drinking water was a protective factor.

CONCLUSIONS

Taking Chinese herbal medicine and eating more vegetables(≥2 times/day) are risk factors for tooth pigmentation, while drinking more bottled water can reduce the risk of pigmentation.

Historical Reflections on the Use of Internal Bleaching to Manage Discolored Teeth

The process of internal bleaching of discolored teeth has been with us for well over 150 years, during which time both materials and procedures varied significantly. The etiology of tooth discoloration also reflected on a wide range of philosophies and causes, which lent itself to many trials and errors in management. Both success and failure characterized the achievements attained by our forefathers in managing this esthetic challenge, as years ago tooth extraction was often the first pathway chosen.

[Staining effect of bovine incisors in vitro by tea solutions]

OBJECTIVE

To determine the optimum staining condition of tea solutions on bovine incisors in vitro, by comparing the color stability of tooth surface of different concentrations of tea solutions and methods on bovine incisors in vitro.

METHODS

Twenty bovine incisors with color surface A1 were chosen, then randomly divided into 4 groups (n=10). Group 1: soaked with 2% tea solution continuously for 6 days; group 2: soaked with 2% tea solution for 6 days, but changed fresh tea solution everyday; group 3: soaked with 1% tea solution continuously for 6 days; group 4: soaked with 1% tea solution for 6 days but fresh tea solution changed every day. After 6 days of staining, the surface color (Δ E value) of all the samples were measured with crystal eye. After brushing 30 times with toothbrushes, the color of bovine incisors were measured again. Then the samples were soaked in artificial saliva at 37 ° C, and Δ E value was measured for 14 days.

RESULTS

After staining for 6 days, the Δ E values of the 2% tea solution groups were better than those of the 1% groups (20.21 vs. 16.44, 24.09 vs. 19.22, P<0.05); the groups with the same tea solution concentration, a better result was observed for the group soaked with daily fresh tea solution than for the group that experienced continuous staining (24.09 vs. 20.21, 19.22 vs. 16.44, P<0.05). Groups 1 and 2 were selected for subsequent brushing experiments. The color of both groups became lighter after brushing, and a better result was observed for the continuous staining group than for the group stained in daily fresh solution (3.06 vs. 9.51, P<0.05). The samples with better coloring effect soaked with 2% tea solution continuously for 6 days were put into artificial saliva for 14 days. There was not any significant change in coloring at the end of the first two days (1.51 vs. 1.51, P>0.05), and the color was visibly lighter after the third day (1.51 vs. 5.89, P<0.05), and no further significant change was observed until the 14th day (5.81 vs.5.89, P>0.05), which was darker coloring than that of the pre-staining group.

CONCLUSION

Continuous staining on bovine incisors with 2% tea solution with subsequent soaking in artificial saliva resulted in consistent coloring from day 3 to day 14, and this method could be used as an ideal model for teeth staining in vitro.

Quality of life and stability of tooth color change at three months after dental bleaching

PURPOSE

Intracoronary bleaching is a minimally invasive, alternative treatment that addresses aesthetic concerns related to non-vital teeth discoloration. However, to the best of our knowledge, no studies have assessed the psychosocial impacts of such procedures on patients' aesthetic perceptions. The aim of this study was to evaluate aesthetic perceptions and the psychosocial impact of patients up to 3 months after their teeth had been bleached with hydrogen peroxide (35%) and carbamide peroxide (37%) using the walking bleach technique.

METHODS

The patients were randomly divided into two groups according to the bleaching agent used: G1 = hydrogen peroxide 35% (n = 25) and G2 = carbamide peroxide 37% (n = 25). Non-vital bleaching was performed in four sessions. Color was objectively (ΔE) and subjectively (ΔSGU) evaluated. Aesthetic perception and psychosocial factors were evaluated before, 1 week and 1 month after the bleaching using the Oral Health Impact Profile (OHIP) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) questionnaires.

RESULTS

The color change (ΔE) values at 1 month were G1 = 16.80 ± 6.07 and G2 = 14.09 ± 4.83. These values remained stable until the third month after treatment (p > 0.05). There was a decrease in the values of OHIP-aesthetics and PIDAQ after treatment versus baseline (p < 0.05). This status was maintained through the third month after treatment.

CONCLUSIONS

Both agents were highly effective and had a positive impact on the aesthetic perception and psychosocial impact of patients, values that also remained stable over time. Non-vital bleaching yields positive and stable impacts on aesthetic perception and psychosocial factors. ClinicalTrials.gov identifier NCT02718183.

Tooth color change due to different etching and debonding procedures

OBJECTIVES:

To compare the effects of different etching techniques, 12-, 24-bladed tungsten carbide burs, and polishing discs on tooth color changes during orthodontic treatment.

MATERIALS AND METHODS:

59 individuals (mean age: 15.20 ± 1.59 years) were divided into four groups: 37% phosphoric acid and adhesive primer was used in Groups I and II whereas self-etch primer was used in Groups III and IV for enamel preparation. After orthodontic treatment, residual adhesives were cleaned with 12-bladed tungsten carbide burs in Groups I and III, while 24-bladed tungsten carbide burs were used in Groups II and IV. All teeth were polished with medium and fine Sof-Lex XT discs (3M ESPE, St Paul, Minnesota). Color measurements were taken from upper incisors and canines at pretreatment (T0), after cleaning with tungsten carbide burs (T1) and polishing with discs (T2). Wilcoxon test was used for evaluation of L*, a*, b* changes and Kruskal-Wallis for intergroup comparison of color changes.

RESULTS:

L*, a*, b* values, except a* at Groups I, II, IV, and b* at Group III, changed significantly ( P < .05). Groups III and IV showed significantly different color alterations from T0 to T1 ( P < .05). After polishing, tooth color alterations were not significantly different among the groups.

CONCLUSIONS:

In self-etch bonding groups, a 12-bladed tungsten carbide bur caused less color change than the 24-bladed tungsten carbide bur. Orthodontic treatment resulted with visible and clinically unacceptable tooth color alterations regardless of the enamel preparation and clean-up techniques. Polishing reduced the effect of tungsten carbide burs, but did not affect the total influence of orthodontic treatment on the tooth color.

The Effect of Silver Diamine Fluoride in Preventing Caries in the Primary Dentition: A Systematic Review and Meta-Analysis

OBJECTIVES

To investigate whether silver diamine fluoride (SDF) is effective in preventing new caries lesions in primary teeth when compared to placebo or active treatments.

METHODS

Systematic review (CRD42016036963) of controlled clinical trials. Searches were performed in 9 electronic databases, 5 registers of ongoing trials, and reference lists of identified review articles. Two researchers carried out data extraction and quality appraisal independently. The primary outcome was the difference in caries increment (decayed, missing, and filled surfaces or teeth - dmfs or dmft) between SDF and control groups. These differences were pooled as weighted mean differences (WMD) and prevented fractions (PF).

RESULTS

Searches yielded 2,366 unique records; 6 reports of 4 trials that randomized 1,118 and analyzed 915 participants were included. Two trials compared SDF to no treatment, 1 compared SDF to placebo and sodium fluoride varnish (FV), and 1 compared SDF to high-viscosity glass ionomer cement (GIC). All studies had at least 1 domain with unclear or high risk of bias. After 24 months of follow-up, in comparison to placebo, no treatment, and FV, SDF applications significantly reduced the development of new dentin caries lesions (placebo or no treatment: WMD = -1.15, PF = 77.5%; FV: WMD = -0.43, PF = 54.0%). GIC was more effective than SDF after 12 months of follow-up but the difference between them was not statistically significant (WMD, dmft: 0.34, PF: -6.09%).

CONCLUSION

When applied to caries lesions in primary teeth, SDF compared to no treatment, placebo or FV appears to effectively prevent dental caries in the entire dentition. However, trials specifically designed to assess this outcome are needed.

[Comparative study of enamel discoloration related to bonding with different orthodontic adhesives and cleaning-up with different procedures]

PURPOSE

The aim of this study was to compare if there was any difference in the enamel discoloration after staining when three orthodontic adhesives and 4 enamel clean-up methods were tested.

METHODS

Three types of orthodontic adhesives were used: chemically cured resin, light-cured resin and resin-modified glass-ionomer cement. A total of 120 human extracted premolars were included. Ten teeth of each orthodontic adhesive were randomly cleaned-up with 1 of 4 different procedures and stained in coffee for 7 days: carbide bur (TC), carbide bur and Sof-Lex polishers (TC＋SL), carbide bur and One Gloss polishers (TC＋OG), carbide bur and PoGo polishers (TC＋PG). Colour measurements were made with Crystaleye dental spectrophotometer at baseline and after storage in a coffee solution for 1 week. Two way ANOVA and Bonferroni test were used for statistical analysis with SPSS 13.0 software package.

RESULTS

The colour change values of adhesive materials in the TC group were the greatest. The lowest ΔE* values were obtained from the TC＋SL group. However, there was no significant difference between the TC＋SL and TC＋PG group (P>0.05). The resin-modified glass-ionomer cement group showed the lowest colour differences and chemically cured resin group showed the highest ΔE* values among all orthodontic adhesives (P<0.05).

CONCLUSIONS

The colour change of enamel surface is affected by the type of adhesive materials and clean-up procedures.

Effect of Glutathione Bio-Molecule on Tooth Discoloration Associated with Silver Diammine Fluoride

This study evaluated the effect of Glutathione (GSH) bio-molecule on the reduction of enamel and dentin discoloration after application of 38% silver diammine fluoride solution (SDF). One hundred and twenty bovine teeth specimens were used. The enamel and dentin specimens were divided into three groups: (1) SDF only (control); (2) SDF followed by application of a potassium iodide solution (KI); and (3) SDF mixed with 20% GSH. Half the specimens were exposed to light and the remainder kept in dark conditions (n = 10) Color changes were measured using a spectrophotometer at the following time intervals: before solution application (baseline) and immediately after application, then 3, 6, 24, 48, 72 h, and 7, 10 and 14 days. SEM/EDS analysis was performed on treated enamel and dentin. Statistical analysis was done using a repeated measures ANOVA test. The spectrophotometer results showed that the SDF group exhibited the greatest color changes under both light exposed and dark conditions, while SDF + GSH group was effective in decreasing the color changes in both light and dark conditions. The SDF + KI group showed an insignificant color changes over time. SEM/EDS analysis showed different patterns for the silver crystal formation in each group (SDF, SDF + GSH, and SDF + KI group). It was concluded GSH can effectively minimize color changes after application of SDF, especially on enamel and to a lesser extent on dentin.

Restoration of discolored endodontically treated anterior teeth: a minimally invasive chemomechanical approach

In the case of discolored devitalized anterior teeth, several treatments are available to enhance the esthetic outcome, from noninvasive external/internal bleaching to freehand resin composites and more complex prosthetic solutions such as veneers or full crowns. Innovative computer-aided design/computer-aided manufacturing (CAD/CAM) chairside technologies and the introduction of new industrially polymerized composite resin blocks coupled with modern adhesive strategies have reduced both biological and financial costs compared to the classic post-core-crown approach. The aim of this article is to show how these new materials can be used in association with noninvasive internal and external tooth bleaching to restore a discolored, fractured, non-vital central incisor.

The effect of immediate and delayed polishing on the color stability of a composite resin

Polishing techniques are known to enhance the longevity and appearance of composite resin restorations. However, the influence of the timing of polishing on the final results of a restoration is not well documented. The aim of this study was to determine the effect of immediate and delayed polishing on the color stability of a composite resin. Sixty composite resin specimens were fabricated and randomly divided into 2 groups according to immersion solutions: group 1, deionized water (control); and group 2, coffee (as staining solution). The groups were further divided according to polishing time periods (immediate, 1 day, 7 days, 14 days, and 21 days). The polishing was performed by 1 calibrated operator using a sequence of aluminum oxide discs with different granulations. Color measurements were assessed at baseline and after a 48-hour immersion in the assigned medium by a reflection spectrophotometer, according to CIE L*a*b* parameters. The data were submitted to an analysis of variance (ANOVA) and the post hoc Tukey test at a significance level of 0.05. The ANOVA showed that the immersion solutions had a statistically significant difference (α = 0.05) on color stability. The composite resin color stability was not influenced by the timing of polishing, and all subgroups showed clinically unacceptable discoloration after exposure to coffee. Thus, with regard to color stability, the timing of final polishing may be established according to the preferences of the clinician.

Effect of bleaching on color stability and roughness of composite resins aged in staining beverage

Composite resin properties can be affected by contact with gel during bleaching procedures; however, there is no consensus about the effect of this contact on resin susceptibility to color change. This study aimed to evaluate staining susceptibility and surface roughness changes in 2 composite resins (Filtek Z250 XT and Filtek Z350 XT) after application of bleaching peroxides and storage in different media. Forty-two disc-shaped specimens of each composite were made, polished, and divided into 3 groups according to treatment type (35% hydrogen peroxide, 16% carbamide peroxide, or deionized water as a control group). These groups were subdivided into 2 groups according to immersion media (n = 7): deionized water or red wine. Color and average roughness (Ra) measurements were taken 24 hours after specimen preparation (T0), immediately after bleaching procedures (T1), and immediately after aging (staining; T2). Statistical analyses were performed using 2-way analyses of variance for repeated measurements and the Tukey test (P < 0.05). Bleaching resulted in minimal color change (ΔE* < 1) in all groups. Filtek Z350 XT specimens presented greater mean values of color change. The Ra values did not increase significantly after bleaching procedures or aging (staining) in all groups. Thus, bleaching agents did not significantly change the color or roughness of the composite resins used in this study.

Staining Beverages and Cigarette Smoke on Composite Resin and Human Tooth Fluorescence by Direct Spectrometry

INTRODUCTION

This study evaluated the fluorescence intensity (FI) of different brands of composite resins (CRs) and compare those values with the FI of human tooth, under the action of cigarette smoke (CI), coffee (CA), and soft drink (CO), measured by direct spectrometry.

MATERIALS AND METHODS

A total of 30 specimens of each brand (Filtek Z350, Esthet-X, Amelogen, Durafill) were made. Others 30 tooth specimens (3 mm/diameter) were obtained from human molars using a trephine bur. The specimens were randomly divided into three groups (n = 10), according to substances: CI, CA, CO. The FI was directly measured using an optic fiber associated with a spectrometer and was measured at baseline and after staining. Data were submitted to Kruskal-Wallis, Dunnett, and Dunn tests.

RESULTS

Staining influenced FI mean values among CRs and between those with human tooth. Z showed the closest FI mean values of tooth after staining.

CONCLUSION

Staining beverages and cigarette smoke negatively influenced on FI of CR and human tooth.

CLINICAL SIGNIFICANCE

The study shows darkening treatments influenced on the fluorescent property of the dental tissues and restorative materials according to the direct spectrometry analysis.

Dental pigmentation and hemochromatosis: A case report

The causes of dental pigmentation are diverse. It can be classified in intrinsic or extrinsic depending on the origin and location of the stain in the affected tooth. This report presents an unusual case of dental pigmentation and enamel loss where the diagnosis of its origin revealed an underlying systemic pathology, unknown to the patient, which could have affected the development of the pigmentation.

Adverse effects of orthodontic treatments

Orthodontic therapy, like any other medical intervention, in addition to its benefits carries the risk of potential complications and is associated with adverse effects-including periodontal problems, external root resorptions, pulpal changes, enamel damages (demineralization, discoloration, attrition), temporomandibular disorders, infective endocarditis, soft tissue damages, discomfort, pain and the risk of either aspiration or indigestion of medical instruments and appliances. Usually these effects are multifactorial in origin- most often a result of interactions between the patient, the dental practitioner and the technical aspects of the appliances or techniques. With preventive measurements and care, most of these complications can be either limited or completely avoided. Therefore, every dental practitioner must be fully aware of these effects and associated risk factors in order to maximize the treatment outcome. The present review aims to summarize these effects of orthodontic therapies, and provide a detailed description of factors and preventive measures, in order to minimize these damages.

Salivary Proteins Interact with Dietary Constituents to Modulate Tooth Staining

Dietary components rich in polyphenols—for example, tea and red wine—are thought to cause tooth staining. In the present study, hydroxyapatite was used as a model of enamel for study of the influence of salivary proteins on the binding of different polyphenols to hydroxyapatite in vitro. Neither salivary protein pellicles nor salivary proteins in solution significantly altered the binding of the small polyphenol epigallocatechin to hydroxyapatite. However, hydroxyapatite binding of anthocyanin, a small grape-skin-derived polyphenol, or the larger polyphenols of black tea was increased by the presence of salivary proteins, either as a pellicle or in solution. Proline-rich proteins were enriched from parotid saliva and found to increase binding of anthocyanin and black tea polyphenols to hydroxyapatite, while enriched histatins did not increase binding. It is concluded that some salivary proteins, including proline-rich protein, can mediate increased staining of enamel by red-wine- and black-tea-derived polyphenols.

Clinical Performance of Pedo Jacket Crowns in Maxillary Anterior Primary Teeth

PURPOSES

To assess the clinical performance of Pedo Jacket crowns for restoration of carious primary anterior teeth.

METHODS

A total of 129 carious primary incisors and canines of 48 children younger than 71 months of age- were restored with Pedo Jacket crowns and resin-modified glass ionomer cementation. They were assessed for: ease of use; presence of recurrent decay; wear; partial or complete loss of the crown; color stability; gingival health; and overall clinical success over a 12-month follow-up. The patient's behavior at the restorative appointment during crown placement was also assessed.

RESULTS

An overall clinical success of 89.5 percent of the teeth in 87.3 percent of the children was seen one year later. The crowns were easy to use, even in uncooperative children. The color stability, wear, plaque accumulation, and gingival health were acceptable. Discoloration, wear, or complete loss of the crown were found in 13.1 percent, 5.4 percent, and 7.6 percent of children, respectively. Although not statistically significant, failures were associated with poor patient cooperation at the time of crown placement, poor oral hygiene, or operator error.

CONCLUSION

Pedo Jacket crowns are a viable treatment alternative for carious maxillary primary anterior teeth.

Dental patients' perceptions and motivation in smoking cessation activities

OBJECTIVE

The aim of the present study was to investigate smokers' perceptions of and motivation for smoking cessation activities in dentistry. MATERIALS AND METHODS PATIENTS: who smoked were consecutively recruited from general as well as specialist dental care clinics in Sweden. After a dental visit the patients completed a questionnaire about self-perceived oral health, smoking habits, motivation, reasons to quit and not to quit smoking, support to quit, smoking cessation activities and questions about smoking asked by dentists and dental hygienists.

RESULTS

The sample consisted of 167 adult patients (≥ 20 years) who smoked daily. During the last 6 months, 81% of the patients had experienced oral health problems. The most common complaints were discolourations of the teeth, periodontal problems and dry mouth (38%, 36% and 33%, respectively). Improved general health was a major reason to quit smoking (89%). It was also stated that it was important to avoid oral health problems. 71% of the patients preferred to quit by themselves and 16% wanted support from dentistry. High motivation to quit smoking was reported by 20%. Occurrence of periodontitis during the last 6 months was significantly associated with being highly motivated to stop smoking (OR = 3.0, 95% CI = 1.03-8.55).

CONCLUSIONS

This study revealed that, although it was important to quit smoking to avoid oral health problems, the patients were not aware that tobacco cessation activities can be performed in dentistry. Periodontal problems seem to be the most motivating factor among the patients who were highly motivated to stop smoking.

Teeth whitening versus the influence of extrinsic factors on teeth stains

The improvement of teeth colour is the effect of using whitening toothpastes, professional removal of dental deposits, pulpless teeth and vital teeth whitening. The aim of the study was evaluation of various methods of teeth whitening in relation to sex and age of the investigated as well as the extrinsic factors causing teeth stains such as cigarette smoking, consumption of coffee and tea. Questionnaire survey was conducted in the group of 204 patients, reporting for a dental treatment at the Chair and Department of Conservative Dentistry with Endodontics of the Medical University of Lublin as well as private dental practice in Lublin. Questionnaire survey was elaborated for the needs of the planned investigation and included questions concerning, among others, socio-demographic data of the investigated, methods of teeth whitening, cigarette smoking, consumption of coffee and tea. Statistic analysis was performed with the use of descriptive statistics, Chi2 test, Mann-Whitney test. The values of p < 0.05 were considered statistically essential. Women used whitening toothpastes more frequently in comparison with men (χ2 = 7.96, p < 0.01). People who declared drinking at least one coffee cup used whitening toothpastes more frequently in comparison with the people drinking coffee occasionally and those who didn't drink it (χ2 = 9.99, p < χ0.05).

Color masking of developmental enamel defects: a case series

Developmental defects involving color alteration of enamel frequently compromise the esthetic appearance of the tooth. The resin infiltration technique represents an alternative treatment for color masking of these lesions and uniformization of tooth color. This technique is considered relatively simple and microinvasive, since only a minimal portion of enamel is removed. This article illustrates the color-masking effect with resin infiltration of fluorosis and traumatic hypomineralization lesions with a case series. The final esthetic outcomes demonstrated the ability of the resin infiltrant to mask the color of white developmental defect lesions, resulting in satisfactory clinical esthetic improvements. However, in more severe cases, the color-masking effect was not complete.

Successful conservative treatment of dentigerous cyst following intrusion of lower primary incisors

This paper reports on the development of a dentigerous cyst associated with a lower permanent incisor following intrusion of two lower primary incisors. The small root remnant of one of the traumatized primary incisors was associated with granulation tissue, while the second incisor was discolored and suspected of being non-vital. The associated permanent incisor and other adjacent incisors were apically and laterally dislocated from their natural site of eruption. The conservative treatment included extraction of the involved primary discolored incisor, as well as the root remnant, followed by removal of the granulation tissue. After 18 months of follow-up, the permanent incisors were erupting in normal position, without pathological signs of the dentigerous cyst. Following severe traumatic injury to a primary tooth, periodic radiographic follow-up, until eruption of the correspondent permanent tooth, is recommended.

Green teeth associated with hyperbilirubinemia: a case report

BACKGROUND

Green stain is an uncommon clinical condition associated with deposition of bilirubin in the dental hard tissues. The staining of the teeth is due to hyperbilirubinemia caused by systemic conditions.

CASE REPORT

The purpose of this report is to present a case of green teeth of the primary dentition in a 17-month old girl associated with hydrocephalus and Hirschprung's disease.

CONCLUSION

The clinical characteristics of the teeth may help in the diagnosis of current or past systemic diseases.

Management of the single discoloured tooth. Part 1: Aetiology, prevention and minimally invasive restorative options

The single discoloured tooth is commonly encountered in general practice. This is the first of two articles covering the broad range of management options for the single discoloured tooth. This first part outlines the common causes of discoloration and possible methods of prevention. Minimally invasive techniques are covered. Clinical procedures are outlined and clinical cases used to demonstrate outcomes that can be achieved.

CLINICAL RELEVANCE

The single discoloured tooth is a commonly encountered clinical problem in general dental practice. A wide variety of management options exist and any one in particular may be most appropriate given the clinical scenario. It is therefore essential that general dental practitioners are familiar with the range of options that exist, as well as their indications, and consider adopting minimally invasive techniques in the first instance before moving to more invasive therapies.

Crossover clinical investigation of a whitening chewing gum for inhibiting dental stain formation in conjunction with tooth brushing

OBJECTIVE

The purpose of this clinical investigation was to evaluate the effectiveness of a marketed whitening chewing gum compared to a no-gum control in preventing the formation of extrinsic stains on the teeth of stain-forming subjects when chewed over a 12-week period of regular unsupervised use in conjunction with daily tooth brushing.

METHODS

This was a single-center, examiner-blind, randomized, 12-week crossover clinical trial. Stain-forming (after smoking or drinking coffee or tea) adults, starting with a stain-free baseline, either chewed the test gum (Orbit White) unsupervised four times per day, 15 minutes/chew, or used no gum along with daily brushing with a commercially available toothbrush and dentifrice for 12 weeks. At the crossover, all procedures were repeated with subjects assigned the opposite treatment. Extrinsic stain was measured at six and 12 weeks by both the Lobene Stain Index (LSI) and the Modified Lobene Stain Index (MLSI) using separate experienced examiners.

RESULTS

After 12 weeks, LSI stain scores showed a significant 25% reduction (p = 0.0008) in new stain formation for subjects using the test chewing gum along with tooth brushing versus tooth brushing alone (no-gum control). The corresponding MLSI stain scores demonstrated a 36% reduction (p < 0.0001) in the formation of extrinsic stain on the teeth.

CONCLUSION

The overall findings of this clinical study demonstrated that regular use of Orbit White chewing gum, soon after smoking or drinking coffee or tea, will supplement daily tooth brushing in preventing unsightly stains from forming on the anterior teeth compared to brushing alone.

Conservative treatment for amelogenesis imperfecta: a case report

Amelogenesis imperfecta is a hereditary condition that can alter the thickness, color, and shape of tooth enamel. Recent adhesive materials and techniques have provided less invasive treatment options. This case report presents the treatment of a patient whose anterior teeth had color alterations, white spots, pits, and shape defects. Using a more conservative technique, the mandibular and maxillary anterior teeth were restored using veneer direct composite restorations. After 6 years, the restorations demonstrated no deterioration, and no pathology was seen in association with the rehabilitation.

[Revascularization? Only as the last resort!]

Revascularization has been suggested for treatment of necrotic immature permanent teeth. The desirable outcome of the treatment is continuous growth of the root, maturation of the dentin walls underneath the cervical seal and apical closure. Despite of increasing numbers of case reports, a uniform treatment protocol has not been set. This procedure has many shortcomings of which tooth discoloration is the most prevalent and easy to observe. The severe discoloration is attributed to the use of Mincocycline in the antibiotic dressing, or to the use of MTA for the seal. The maturation of the root is not predictable and does not always occur. The outcome should be evaluated radiographically and clinically. Sensibility testing may not be possible due to the large MTA plug in the root canal. It is recommended only when alternative procedures such as apexificaiton, pulpotomy or pulp capping are impossible. The patient and his parents should be aware of the potential discoloration and must be committed to routine follow ups. Currently, this procedure should be limited to incisor or premolar teeth in which the crown is longer than the root, or the canal's width is larger than that of the dentinal wall.

Are there metallic traces in black extrinsic dental stain?

OBJECTIVE

The detection of ferric ions in samples of black extrinsic dental stain led to the idea that it is comprised of insoluble ferric compounds. The present study examined the chemical composition of black extrinsic dental stain.

METHOD AND MATERIALS

Plaque was collected from 17 children with black extrinsic dental stain (study group A) and from 15 children without black extrinsic stain (control group), using sterile graphite curettes; and from 4 children with black extrinsic stain (study group B), using a standard sterile metal curette. Samples were analyzed with a scanning electron microscope (SEM) and subjected to quantitative chemical analysis (energy dispersive spectrometry).

RESULTS

Except for calcium and phosphorus levels, no significant differences were found between the chemical composition of black extrinsic dental stain and dental plaque. Metallic ions were not detected in samples collected with a graphite curette (study group A), but were detected in samples collected with a metal curette (study group B).

CONCLUSION

Metallic ions do not seem to be the origin of black extrinsic dental stain. Previous reports of the presence of metallic ions are probably due to contamination of the samples by the collection method.

Comparison of enamel microabrasion with a combined approach to the esthetic management of fluorosed teeth

OBJECTIVE

To compare in vivo the efficacy of enamel microabrasion alone or in combination with vital tooth bleaching for the management of tooth discoloration caused by fluorosis.

METHODS

A total of 118 maxillary and mandibular fluorosed incisors and canines in 10 patients, scored from 1 to 7 according to the Tooth Surface Index of Fluorosis, were included in this study. All of the teeth were initially treated with enamel microabrasion (Opalustre, Ultradent Products Inc, South Jordan, UT, USA), and after 24 hours, an in-office bleaching technique (Opalescence Boost, Ultradent) was utilized (n=118). Standardized images of the teeth were taken using a digital camera prior to treatment and 24 hours after the enamel microabrasion and after the in-office bleaching therapy. The study groups were assigned according to evaluation time: a) after enamel microabrasion (Group 1) and b) after the combined approach (enamel microabrasion and in-office bleaching) (Group 2). Two calibrated and blinded examiners scored Group 1 and Group 2 images by comparing each with baseline images for "improvement in appearance," "changes in brown stains," and "changes in white opaque areas" using the visual analogue scales (VAS) that range from 1 to 7. "Patient satisfaction," "tooth sensitivity," and "gingival problems" were also recorded. The data were analyzed using two sample paired Wilcoxon signed-rank, Kruskal-Wallis, and Mann-Whitney U-tests (α=0.05).

RESULTS

The combined therapy revealed significantly higher scores than the enamel microabrasion procedure in terms of all of the evaluated criteria (p<0.001). Enamel microabrasion provoked less tooth sensitivity but led to lower patient satisfaction scores than the combined therapy (p<0.001); however, in terms of gingival problems, no differences were found between both groups.

CONCLUSION

The combined therapy, including enamel microabrasion and in-office bleaching, was more effective than enamel microabrasion alone in the esthetic management of fluorosed teeth.

Multi-surface composite vs stainless steel crown restorations after mineral trioxide aggregate pulpotomy: a randomized controlled trial

PURPOSE

Parents increasingly request esthetic restorations for their children's teeth. This split mouth, randomized controlled trial compared primary molars treated with white MTA pulpotomies and restored with either multi-surface composites (MSC) or stainless steel crowns (SSC).

METHODS

Forty matched, contra-lateral pairs of molars received MTA pulpotomies and were randomly assigned to MSC or SSC restorations and evaluated clinically and radiographically at 6 and 12 months. Two calibrated, blinded examiners evaluated and scored radiographs.

RESULTS

Thirty-seven matched pairs were evaluated at 6 months, and 31 were available at 12 months. All teeth in both groups were radiographically and clinically successful at 6 and 12 months. Dentin bridge formation was noted in 20% of the primary molars by 12 months. Although not significant, the composite group exhibited fewer intact clinical margins than the SSC group. The vast majority (94%) of teeth restored with composite displayed gray discoloration at follow-up exams, which did not appear to affect the quality of the restoration and is believed to be associated with the white MTA.

CONCLUSIONS

The white MTA pulpotomies succeeded over 12 months regardless of the restoration; however, the teeth restored with composite were not as durable nor considered an esthetic alternative to the SSC.

A case report of green pigmentation in the permanent dentition

Intrinsic green discoloration of teeth is an uncommon condition which mainly affects the primary dentition. Children can be teased about this, resulting in a loss of self-esteem and problems with social integration. The purpose of this paper was to present a case of green pigmentation in the permanent dentition caused by hyperbilirubinemia during infancy and an intermediate restorative approach to mask the esthetic deficiency arising from this.

Green teeth are a late complication of prolonged conjugated hyperbilirubinemia in extremely low birth weight infants

Eruption of green, discolored teeth affecting the primary dentition has been described in association with congenital viral infection, sepsis, hemolytic jaundice, and cholestasis. The purpose of this paper was to present the cases of 3 extremely low birth weight preterm infants who were noted to have green teeth at the corrected ages of 10 to 12 months. All had a history of prolonged conjugated hyperbilirubinemia during their time in neonatal intensive care. For infants with prolonged conjugated hyperbilirubinemia, extreme preterm birth and/or extremely low birth weight may be additional risk factors predisposing to the eruption of green teeth in later infancy.

Enamel properties after tooth bleaching with hydrogen/carbamide peroxides in association with a CPP-ACP paste

BACKGROUND

This study evaluated the impact of bleaching teeth using blends of a CPP-ACP paste (MI Paste; MI) and carbamide/hydrogen peroxides in different proportions on surface properties of bleached enamel.

METHODS

Ninety bovine incisors were bleached with 7.5% hydrogen peroxide (HP), 16% carbamide peroxide (CP), MI and blends of HP or CP:MI at three proportions (1:1, 2:1, 1:2). Hardness and roughness were measured at baseline and after bleaching. Enamel morphology was evaluated by Scanning Electron Microscopy (SEM). The data were analyzed by two-way ANOVA for repeated measurements and Tukey's test.

RESULTS

Most of the samples bleached with MI in combination with peroxides presented increased hardness and roughness which were associated to mineral deposition, as observed by SEM images. Blends with higher fractions of MI did not offer superior benefits.

CONCLUSIONS

The use of a CPP-ACP paste mixed to carbamide/hydrogen peroxides can decrease adverse side-effects from tooth bleaching on an enamel surface.

Dental treatment of an adult patient with a history of biliary atresia

OBJECTIVE

Biliary atresia is a congenital disease treated by liver transplantation. Adults may have oral consequences of the medical therapy. Green teeth are oral manifestations of the induced hyperbilirubinemia. Gingival enlargement is associated with the immunosuppressive drug. This case report describes the successful treatment of an 18-year-old patient displaying severe green teeth and gingival enlargement.

METHOD AND MATERIALS

The gingival enlargement was treated by reducing the pathogenic oral microflora through scaling and root planing of the teeth, gingival excision surgeries, and conversion from cyclosporin to tacrolimus.

RESULTS

Gingival enlargement and inflammation had completely disappeared after nonsurgical treatment for the maxilla and after surgical treatment for the mandible. The green coloration of the teeth was masked using composite restorations.

CONCLUSION

This case report indicates that a patient's quality of life can be improved by a team approach combining pharmacologic and dental therapies.

Correlation between dental arch location and clinical success rate of total etch and self-etch adhesives in ClassV composite restorations

Flexure at the tooth cervix might render the restored Class V lesions to degradation. In this clinical trial a total of 76 carious cervical lesions in both arch were restored using Prime & Bond NT and Clearfil SE Bond adhesives, along with Clearfil APX composite resin. Retention of restoration, marginal discoloration and postoperative sensitivity were evaluated during a one year period. The overall clinical success rate was 89.5%, while no significant difference (p > 0.05) was found regarding postoperative sensitivity or marginal discoloration between two adhesives. Retention loss was associated only with self-etch adhesives. No association was found between clinical success and dental arch location.

Re-establishing esthetics of fluorosis-stained teeth using enamel microabrasion and dental bleaching techniques

Dental fluorosis manifests itself as white stains on the enamel of teeth exposed to excessive doses of fluoride during their formation. Fluorosis usually occurs as a result of the ingestion of dentifrices, gels and fluoridated solutions. It may be diagnosed as mild, moderate or severe, and in some cases, it may cause the loss of the surface structure of dental enamel. The aim of this study was to report the clinical case of a female patient of 18 years with moderate fluorosis, whose smile was reestablished by the use of an enamel microabrasion technique, followed by in-office bleaching. A microabrasion technique with 6% hydrochloric acid associated with silica carbide showed to be a safe and efficient method for removing white fluorosis stains, while dental bleaching was useful for obtaining a uniform tooth shade. The association of these techniques presented excellent results and the patient was satisfied. Both techniques are painless, fast and easy to perform, in addition to preserving the dental structure. Treatment showed immediate and permanent results; this technique must be divulged among professionals and their patients.

The influence of orotracheal intubation on the oral tissue development in preterm infants

PURPOSE

Preterm children may not be prepared for extra-uterine life and thus need neonatal intensive care, such as artificial ventilation through orotracheal intubation. Oral tissue development changes as a result of the use of an orotracheal tube and its mechanical influence in preterm neonates has not been intensively studied. The purpose of the present study was to determine the association of orotracheal intubation with incidence of oral alterations in preterm infants.

MATERIALS AND METHODS

A retrospective cohort of 117 subjects who were born during the period 2002-2003 in Brazil were evaluated and the data were analysed using the Fisher and Mann-Whitney exact tests. A 95% confidence interval was calculated for observed oral conditions.

RESULTS

The cohort revealed that the most frequent oral conditions included anterior crossbite, superior alveolar contour and palatal deformation.

CONCLUSIONS

The association between the intubated-infant group and the non-intubated-infant group suggested that mechanical trauma had an influence on the oral structure development.

The reverberations of traumatized primary dentition: a practitioner's perspective

The traumatized primary teeth have a great clinical significance because it not only have consequences on itself but also on its succedaneous developing permanent teeth due to its close anatomical relationship. The extent of severity is adjudged by the type of trauma and the age of the child at the time of trauma. For instance, avulsion and intrusive injuries present with high percentage of developmental disturbances in permanent teeth than subluxation and extrusive injuries. When considering the age of the child at the time of trauma, consequences are less severe in children over 4 years of age than in the younger age group.

CLINICAL SIGNIFICANCE

It highlights the sequelae of trauma to primary teeth with the aim of aiding in detection of probable alterations in the traumatized primary teeth and its succedaneous permanent teeth.

Pulp canal obliteration following trauma to primary incisors: a 9-year clinical study

PURPOSE

The purpose of this study was to determine the occurrence of pulp canal obliteration (PCO) in traumatized primary maxillary central incisors and its association with secondary pulp necrosis, type of trauma, and further incidence of trauma.

METHODS

A retrospective descriptive study on 112 traumatized teeth was carried out (9-year follow-up) using the clinical and radiographic data from 82 patient charts at the Traumatized Patient Care Program of the Universidade Federal de Santa Catarina.

RESULTS

A total of approximately 54% of the teeth exhibited PCO; in approximately 58% of these cases, obliteration was diagnosed within 12 months following the trauma. An association between PCO and crown discoloration was confirmed (P<.001). PCO was not significantly associated with patient gender, age, type of trauma, or recurrence of trauma. There were no cases of secondary pulp necrosis.

CONCLUSIONS

The findings of the present study reveal that the occurrence of PCO in traumatized primary teeth was high, while the type and recurrence of trauma were not risk factors for the development of PCO. Moreover, there was no association between PCO and secondary pulp necrosis.

Maxillary incisor root resorption induced by ectopic canines

OBJECTIVE

To evaluate the long-term clinical and radiographic effects of maxillary incisor root resorption in cases of ectopic canines treated during the late 1970s and 1980s in Jönköping, Sweden.

SUBJECTS AND METHODS

The material comprised 55 incisors in 38 subjects. The posttreatment follow-up time was 13 to 28 years. All subjects underwent intraoral radiography, 33 were referred for computed tomography or cone beam computed tomography, and 24 also underwent clinical examination. The severity of incisor root resorption was correlated with clinical characteristics. Radiographs of the resorptive lesions were documented in detail and compared with intraoral radiographs taken immediately posttreatment.

RESULTS

Four incisors in three subjects had been lost, in part because of root resorption. Of the 36 incisors with root resorption, the lesions were unchanged in 26 teeth, improved in three teeth, and exacerbated in seven. In one case the resorption had progressed to pulpal exposure, necessitating endodontic treatment. For most of the incisors, the periodontal ligament was more clearly defined and the lamina dura showed improved trabeculation. The clinical characteristics of the incisors with resorption were not significantly different from those of sound incisors.

CONCLUSIONS

In this long-term follow-up, most cases of incisor root resorption induced by ectopic maxillary canines did not progress and teeth with root resorption showed no clinically relevant symptoms. The prognosis for long-term survival of teeth with resorbed roots is good, but in cases where extraction is indicated, lateral incisors with severe root resorption should be extracted in favor of healthy premolars.

[Adverse events during transcranial muscle evoked potential monitoring]

BACKGROUND

Transcranial muscle evoked potential (TC-MsEP) monitoring is available to assess spinal cord motor tract function for preventing paralysis in spine surgery. Recently, the quality of monitoring has improved. However, adverse events such as torn tracheal tube, bitten tongue, and mandibular fracture are reported.

METHODS

We reviewed retrospectively adverse events with TC-MsEP monitoring by Multipulse D-185 (Digitimer Ltd., the U.K.) during spine surgery in our hospital. In addition, we compared the number of cases with transformed tracheal tubes in cases using Multipulse D-185 and in cases using the other stimulation device.

RESULTS

Since June 2007, Multipulse D-185 is applied as a stimulating device of TC-MsEP, and we experienced two adverse events of lasceration of tongue and teeth dislocation. There was a significant difference (P=0.02) in the number of transformed tracheal tube between Multipulse D-185 (11 of 20) and the other stimulation device (2 of 19).

CONCLUSIONS

It seems that two adverse events were due to excessive masseter muscles contraction with TC-MsEP monitoring. Prevention for bite injury and ventilation strategy for tube occlusion or stenosis using Multipulse D-185 for TC-MsEP are necessary.

Evaluation of chlorhexidine gluconate mouthrinse-induced staining using a digital colorimeter: an in vivo study

OBJECTIVE

To investigate the persistence of staining after the use of chlorhexidine gluconate mouthrinse.

METHOD AND MATERIALS

Twenty-four subjects (nine women and 15 men) who underwent periodontal therapy and were prescribed the use of 0.2% chlorhexidine gluconate mouthrinse participated in this study. Color values of maxillary central incisors, canines, and first molars were recorded at baseline; 3 days; and 1, 2, and 3 weeks of twice-daily chlorhexidine gluconate use with a digital intraoral colorimeter according to the CIE L*a*b* coordinates.

RESULTS

While color-change (Delta E) values showed significant differences (P=.020) at different time points (10.1, 8.9, 8.9, 9.4, after 3 days and 1, 2, and 3 weeks, respectively), the duration of chlorhexidine gluconate use did not significantly affect the results (P=.873) (two-way ANOVA, Tukey test). No significant difference was found among Delta L* (P=.070), Delta a* (P=.169), and Delta b* (P=.691) values at any time point (one-way ANOVA). Measurements of baseline to day 3 differences showed significantly higher Delta E values than those at other time points (P<.05), but this change remained nonsignificant after 1, 2, and 3 weeks of chlorhexidine gluconate use (P>.05) (Tukey test). The highest visible staining occurred on the first molars at all time points (83%, 79%, 79%, and 96% after 3 days and 1, 2, and 3 weeks, respectively) compared to the other teeth evaluated.

CONCLUSION

The staining effect of chlorhexidine gluconate mouthrinse on natural dentition should be expected to be the highest in the first few days of use.