Introduction: Discoloration of anterior teeth can result in cosmetic impairment in young children. The walking bleach technique stands out because of its esthetic results with minor side effects. Little information is available regarding the influence of various irrigation solutions on peroxide penetration. The aim of this study is to evaluate the influence of different irrigation protocols on peroxide penetration into dentinal tubules using confocal laser scanning microscopy (CLSM). Study design: Cavity preparations were made in 50 extracted permanent premolars. The teeth went through different irrigation sequences: A. control B. saline C. EDTA, NaOCl D. phosphoric acid E. EDTA, NaOCl, phosphoric acid. Then, mixture of fluorescent dyed sodium perborate paste was placed along the pulp chamber and the coronal access cavity, and was refilled at days 7, 14 and 21. Results: The minimal and maximal penetration depths were 324 and 3045 μm, respectively, with a mean of 1607μm. The stained areas were significantly larger in the buccal and lingual directions (P<0.05). Groups B and C showed significantly larger penetration in weeks 2 and 3 compared to week 1 (P<0.05). Group D and E showed significantly larger penetration compared to groups B and C at all times (P<0.05). Conclusion: Bleaching agents penetrate to the extra-radicular region of teeth; however, the level of peroxide penetration is significantly higher when the irrigation sequence consists of phosphoric acid prior the bleaching agent placement.
Restorative dentistry aims to create a favorable environment to arrest caries with minimal operative intervention. The Hall technique (HT) involves the seating and cementation of stainless steel crowns (SSC) on primary molars without any tooth preparation, caries removal, or local anesthesia. In this manner, it entombs bacteria and arrests caries’ progress. We compared bacterial distribution and quantity among primary molars affected with caries and restored with SSC using the HT (n = 10), the conventional technique (CT; n = 10), or not restored at all (control; n = 10). The teeth were contaminated with Enterococcus faecalis to mimic the clinical situation in the oral cavity and then incubated for 21 days. They were then cut mesiodistally and evaluated with confocal laser scanning microscopy. Total bacterial load (live + dead) in the mesial and distal areas of the crown showed no significant difference between the groups (p = 0.711), but there were significantly more dead than live bacteria in the CT and control groups versus the HT group (p = 0.0274 and p = 0.0483, respectively). Inside the pulp chamber and the crown area, the total bacterial load was significantly higher in the HT compared to the CT group (p < 0.001). Significantly more dead than live bacteria were observed in all tooth areas treated with the HT (p = 0.0169). Bacterial penetration depth was significantly correlated with bacterial load (p = 0.0167). In conclusion, although more bacteria were present in teeth that had undergone the HT versus those treated with the CT, they were mainly unviable. Additionally, the CT and the HT showed a similar performance in terms of marginal leakage, indicating that complete caries removal is not essential to achieve good sealing.
Two critical factors that influence the accuracy of an impression include the proper manipulation of the impression materials and the technique used to make the impression. The purpose of this study was to clinically evaluate the effect of different mixing techniques on the accuracy of vinyl polysiloxane (VPS) impressions by assessing metal framework fit of fixed partial restorations. The study included 92 consecutive patients diagnosed with partial edentulism and treated with fixed partial denture restorations. The mixing technique was one of the two following mixing methods: hand mixing technique (45 patients), with the putty material mixed according to the manufacturer’s instructions; or mechanical mixing technique (47 patients), with the putty material mixed by a Pentamix device. Under both mixing methods, vinyl polysiloxane was used as the impression material. Two impression techniques were randomly used by the operators (One/Two-stage putty –wash impression techniques). The accuracy of the metal framework restorations was tested clinically and radiologically, resulting in significant statistical difference (p = 0.04) between different mixing techniques. The mechanical mixing produced more accurate restorations (metal framework misfit only in 14.9% of patients vs. hand mixing 31.1%). Regarding the impression techniques, the two-stage impression technique was found to be significantly more accurate (p = 0.04), resulting in 14.6% ill-fitted metal frameworks vs. 31.8%, in the one-stage technique. It can be concluded that mechanical mixing yields more accurate impressions leading to more accurate restorations, especially when combined with two-stage impression technique.
Objectives: To compare the effectiveness of visual examination, radiographic examination and fluorescence-aided caries excavation (FACE) in detecting occlusal caries in first permanent molars in 150 children aged 6–14 years with intact occlusal surface with caries lesions without cavitation, or with darkened or deep fissures that had no clear diagnosis. Study design: Two dentists independently performed a visual oral examination, FACE and bitewing radiography. The inter-rater reliability of each detection method was determined and their specificity and sensitivity. Results: All caries detection methods showed high inter-rater reliability with absolute agreement between raters above 90%. Most caries lesions were detected by visual (75.8%) and FACE (79.1%), while only 28.8% of lesions were detected by radiography. Detection by visual examination was strongly correlated with detection by FACE (X2=37.9, Phi=0.498, p<0.001). A lower, yet statistically significant, correlation was found between visual examination and X-ray radiography (X2=5.53, Phi=0.190, p<0.001). FACE had higher sensitivity (87%) and specificity (65%) for detecting occlusal caries in comparison with radiography (60% specificity and 55% sensitivity). Conclusion: Although visual examination remains the best method to detect occlusal caries in young permanent molars in children, FACE is an effective and accurate diagnostic tool that may aid in detection and treatment decisions.
Introduction: Bioceramic materials, gray and white mineral trioxide aggregate (GMTA, WMTA), have been shown to have high rates of success in various endodontic applications. A major drawback is their tendency to discolor teeth compared to Biodentine (BD), that has been claimed not to discolor teeth. The aim of this study was to compare tooth discoloration after applying different pulpotomy base materials (BD, GMTA and WMTA). Study design: Forty human incisors teeth were used in this study. Coronal access was achieved by a Tungsten Carbide drill, and the pulp chambers were accessed and chemo-mechanically debrided. Each material was placed in the pulp chamber, up to the cervical sectioning level. All specimens were incubated at 37°C and 100% humidity for three months and have been evaluated before the study and weekly. Color was assessed according to the CIE L*a*b* color space system. Results: ΔE of all experimental groups (GMTA, WMTA and BD) were significantly different from the control group at all time points (P<0.05). Color changes in the GMTA and WMTA groups, had no statistically significant differences, but showed higher discoloration compared to BD group in the cervical part of the crown, since week 1 (P<0.05). WMTA group showed significant discoloration in the cervical part as of week 1 (P<0.05), and gradually increased over time (Figure 2). BD group showed no significantly discoloration over time. GMTA group showed the significant discoloration at week 1 and week 14 (P<0.05). Conclusions: both GMTA and WMTA pulpotomy materials may discolor tooth structure over time in an extracted permanent anterior tooth model. When choosing bioceramic pulpotomy material, BD may be preferable in esthetic area.
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