Multidisciplinary management of a tooth with severe root dilaceration and enamel hypoplasia: a case report

Dental trauma in primary teeth can cause irreversible changes in the development of permanent tooth germs, including enamel hypoplasia, crown dilaceration, and root dilaceration. This article discusses multidisciplinary treatment of enamel hypoplasia and root dilaceration in the maxillary left central incisor of an 11-year-old girl. A 10-year follow-up is reported to demonstrate the long-term clinical outcomes. At the initial presentation, the patient's mother reported that the child had an accident at the age of 2 years, resulting in intrusive luxation of the primary maxillary left central incisor. After the accident, the patient was monitored for eruption of the permanent successor tooth, and different approaches were proposed during each period of the patient's development on the basis of the clinical diagnosis of root dilaceration and enamel hypoplasia. The crown was restored with composite resin, and the root defect was restored with resin-modified glass ionomer cement. After 10 years, the clinical outcomes highlight that the multidisciplinary approach was successful in preserving the natural tooth with good periodontal health conditions.

Survival and success of composite resin restorations in endodontically treated maxillary incisors with minimal structure loss

The primary aim of this study was to evaluate the clinical performance of nanofilled composite resin restorations in traumatized, endodontically treated maxillary incisors with structural loss of 40% or less. The performance of the restorations was assessed in terms of longevity (survival) and esthetics (success) over a 20-month period. The secondary objective was to employ a novel digital method to quantify preoperative tooth structure loss. Sixty-one fractured maxillary incisors in 55 patients were included in the study. The teeth were photographed with a digital single-lens reflex camera equipped with a macro ring flash. The amount of lost tooth structure was calculated with digital photography software. The teeth were restored with a nanohybrid composite resin and self-etching adhesive system bonding agent. To assess esthetics, color change in the blue-yellow axis (Δb*) of the composite resin restoration was evaluated digitally with the Commission Internationale de l'Eclairage (CIE) L*a*b color system. The Wilcoxon signed-rank test was used to assess Δb*, and a Kaplan-Meier survival analysis was used to assess the longevity of the restorations. The study findings showed a statistically significant difference between pretreatment and posttreatment b* values (P < 0.05), but the difference was too small to be clinically perceptible to the human eye. A total of 5 restorations (9.8%) failed. The remaining restorations survived for a mean (SD) period of 18.6 (4.4) months. The log-rank test did not show any significant association between the amount of residual tooth structure and success of the restoration. The results of this study showed that use of direct composite resin restorations in endodontically treated maxillary incisors resulted in acceptable survival and success rates. Trial registration: Clinical Trial Registry of India No. CTRI/2020/01/023019.

Effective Protocol for Daily High-quality Direct Posterior Composite Restorations. The Interdental Anatomy of the Class-2 Composite Restoration

The importance of the interdental anatomy of a class-2 direct composite restoration is one of the most underestimated topics in direct posterior composite restorations. The proximal emergence profile of the restoration and the contact area should be designed to maximize arch continuity and to minimize food impaction. Other restorative criteria that must be fulfilled are marginal adaptation compatible with the dental and periodontal integrity, and geometry of the marginal ridge compatible with the mechanical integrity of the restoration under load. Shortcomings will result in masticatory discomfort, caries, periodontal problems and undesired movement of teeth. In vitro and in vivo studies showed that the use a contoured sectional metal matrix band with a separation clamp results in the tightest contact point. However, this matrix system also has shortcomings and does not give the expected result in all class-2 cavities. The variation in depth, width of the box, distance between the cervical cavity margin and the adjacent tooth requires customization of the interproximal space. In order to realize this, sectional matrix bands with several profiles of curvature, variation of wedges and separation clamps, and the use of teflon tape are required. In addition, dentists should follow a protocol allowing them to build a proximal composite surface that fulfills the required restorative criteria. Pre-wedging, space evaluation, interproximal clearance, correct selection, positioning and stabilization of the matrix band are important steps in this protocol.

Gingival tissue reaction to direct adhesive restoration: A preliminary study

INTRODUCTION

It is debated whether composite resin marginal/submarginal direct restoration can be usefully performed without inflammatory consequences. This histological study is the first human analysis aimed to compare, in the same tooth, the gingival tissue close to composite resin restorations with gingival tissue close to hard tissue.

METHODS

Eight healthy patients with almost a residual strategic tooth needing endodontic therapy, and post-and-core restoration, then indirect prosthetic restoration, were selected. Direct margin relocation with composite resin was necessary to perform endodontic treatment. The crown lengthening with a secondary flap harvested was necessary to perform prosthetic rehabilitation. Three months after marginal relocation, the secondary flap was harvested, embedded in PMMA, 4-μm sectioned, and stained to analyze the inflammation degree.

RESULTS

All patients completed post-and-core reconstruction and the planned prosthetic therapy, maintaining the stringent hygienic protocol plan. The inflammation level comparison, slightly lower in gingiva close to the teeth (3.62 ± 0.38) than in gingiva close to the composite (3.75 ± 0.26), results in a p-value of 0.11 after Wilcoxon test.

CONCLUSIONS

Results highlight a minimal, statistically not significant difference in the inflammation degree after margin relocation, conceivably due to patients, teeth and cases selection, together with adopted stringent methodological and supportive measures.

A Clinical Evaluation of Deproteinization and Different Cavity Designs on Resin Restoration Performance in MIH-Affected Molars: Two-Year Results

BACKGROUND

The aim of this study was to evaluate the clinical effects of deproteinization of the hypomineralized enamel and different cavity designs on the performance of the composite resin restorations(CRRs) placed into the cavities of MIH (molar incisor hypomineralization)-affected molars.

STUDY DESIGN

95 MIH-affected permanent first molars (PFMs) and 31 caries but not MIH-affected PFMs (126 teeth in total) were included in the study. The MIH-affected molars were divided into three groups. In Group I, all hypomineralized tissue was removed until healthy enamel was reached. In Group II, carious and cheesy hypomineralized tissue was removed until a reasonable resistance was detected in the hypomineralized tissue. In Group III, cavities designed as Group II, differently from this group deproteinization of the left hypomineralized tissue was performed prior to the placement of CRRs. Group IV served as the control group consisting of unaffected carious PFMs. Restorations were evaluated according to modified USPHS criteria for 24 months.

RESULTS

The retention rates were 93.7% for Group I, 80.7% for Group II, 93.5% for Group III and 100% for Group IV. The success rate for the restorations in Group II proved significantly lower (p<0.05) than that of the other three groups. No significant difference in success rates was observed between Group I, Group III and Group IV (p>0.05) at the end of 24 months.

CONCLUSIONS

Failure of the restorations was predominant in the group that the hypomineralized tissue was left surrounding the cavities. Deproteinization of the hypomineralized enamel was found to enhance the retention rates of CRRs.

Sealing Occlusal Dentin Caries in Permanent Molars: 7-Year Results of a Randomized Controlled Trial

The purpose of this study was to investigate the possibility of postponing restorative intervention of manifest occlusal caries in young, permanent dentition by non-invasive sealing. This RCT-designed study included 521 occlusal lesions in 521 patients aged 6 to 17 y. Based on clinical and radiographic assessments, all lesions required restorative treatment. After randomization (ratio 2:1), 368 resin sealings and 153 composite-resin restorations were performed by 68 dentists in 9 municipalities. The primary aims were to 1) analyze survival of sealings until replacement by restoration, 2) compare longevity of sealings and restorations until retreatments, and 3) compare effectiveness of sealings and restorations to halt caries progression in sealed lesions and beneath restorations. Furthermore, we aimed to identify factors influencing longevity and the effectiveness of sealings and restorations. Treatments were annually controlled, clinically and radiographically. After 7 y, the drop out rate was 8%, and 54% of the treatments were completed due to age. Of the sealings, 48% were retreated, including 31% replaced by restorations; 12% were still functioning. Of the restorations, 7% were repaired/renewed and 20% were still functioning. No endodontics was performed. Kaplan-Meier and Cox regression survival analyses were performed on 341 sealings and 152 restorations in first and second molar teeth. The 7-y survival was 37% (CI, 29% to 45%) for sealings and 91% (CI, 85% to 96%) for restorations (P < 0.001). The median survival time for sealings not replaced by restorations was 7.3 y (CI, 6.4 y to NA). Survival of sealings was increased in patients with low caries risk and/or excellent oral hygiene, second molars compared with first molars, and lesions not extending the middle one-third of the dentin. Survival of sealings was not influenced by municipality, sex, eruption stage or clinical surface cavitation. The results underline that it is possible to postpone or avoid restorative intervention of occlusal dentin caries lesions in young permanent teeth by non-invasive sealing. Knowledge Transfer Statement: The first restoration can ultimately be fatal for a young permanent tooth. A restoration may not be the final treatment but the start of an ongoing treatment with still more loss of tooth substance. The present study shows the possibility of treating occlusal dentin caries lesions with non-invasive resin sealings instead of conventional resin composite restorations in children and adolescents. Improved oral health can be expected.

[Decision-making of restorations for endodontically treated teeth]

Coronal restoration of endodontically treated teeth may be viewed as one of the main parameters that influence the outcome of endodontic treatment. The purposes of restoring endodontically-treated teeth include preventing recontamination of the root canal system and periapical area, replacing the compromised dental hard tissue, restoring the coronal morphology and function, providing necessary strength for the restoration/tooth complex for functional stress, and avoiding crown and/or root fracture. This article reviewed recent researches on the restoration of endodontically treated teeth, provided evidence for clinical practice on topics as when to restore them, basic principles to be considered during treatment planning, and specific restoration options for both anterior and posterior teeth under different functional occulsal load conditions. Several issues should be taken into account during the decision making process, such as remaining tooth tissue, functional masticatory forces, comprehensive oral rehabilitation, and esthetic requirements.

Fracture strength of endodontically treated premolars: An In-vitro evaluation

BACKGROUND

The aim of this study is to measure the invitro fracture strength of endodontically treated maxillary premolars restored with silver amalgam, composite resins and bonded amalgam.

MATERIALS & METHODS

Sixty mature maxillary premolars free of caries, restoration or fracture extracted for orthodontic purpose or periodontal reasons were selected. The teeth were randomly divided into six groups of 10 teeth each. Group I: Intact teeth, Group II: Access opening only, Group III: Standard MOD cavity preparation + superimposed endodontic access (Unrestored). In Group IV, Group V & Group VI preparation was done as in Group III and they were restored with amalgam, bonded amalgam and composite resins respectively. All the teeth were thermo cycled and were mounted on custom made rings and the fracture strength was calculated with an Instron testing machine and the results were analysed statistically.

RESULTS

Group I showed the highest fracture resistance followed by Group II . The difference in the values between the two groups were not significant. Group III showed the lowest fracture resistance the decrease in fracture strength was highly statistically significant when compared to all other groups investigated in the present study. Fracture strength of teeth restored with Group IV, Group V, Group VI did not differ significantly from each other.

CONCLUSION

Fracture strength of intact natural teeth was superior to all the teeth tested in the study. Fracture strength of endodontically treated teeth restored with conventional amalgam, bonded amalgam and composite resin did not differ significantly from each other. Bonding of restorations to tooth structure has failed to bring about any improvement in the strength of the teeth tested. How to cite this article: Pradeep PR, Kumar VC, Bantwal SR, Gulati GS. Fracture strength of endodontically treated premolars: An In-vitro evaluation. J Int Oral Health 2013; 5(6):9-17 .