An unusual case of severe primary molar infraocclusion

Dentoalveolar ankylosis is described as the direct union between root cementum/dentin and alveolar bone. Its etiology is unknown, and conflicting opinions have been presented to explain it. Late detection of ankylosed primary teeth may cause serious problems to the occlusion and generally demands a more complex treatment approach. The purpose of this report is to present an unusual case of severe infraocclusion of the primary maxillary right second molar associated with a posterior crossbite in a 6-year-old child. The initial treatment option was tooth extraction, but the tooth resumed eruption spontaneously. After correction of the posterior crossbite and a 1-year follow-up, the tooth remained in occlusion and the permanent successor was developing without problems. From this unusual outcome, it may be concluded that further investigation of this anomaly of eruption is needed. (J Dent Child 2013;80(2):88-91)

Infra-oclusão de molares decíduos: diagnóstico e tratamento

Infraocclusion of deciduous molars is defined by total or partial periodontal ligament absence and characterized by the cementum or dentin anatomical fusion with alveolar bone. This study aims to report an ankylosis clinical case, the implications and treatments management options in the deciduos dentition.

Efecto del blanqueamiento dental con peroxido de hidrógeno al 35% en la resistencia de unión de dientes restaurados con resina compuesta

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The performance of conventional and fluorescence-based methods for occlusal caries detection: an in vivo study with histological validation

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Relação entre materiais dentários e o complexo dentino-pulpar

Despite the strong valorization of the esthetics and its relationship with restorative materials, the biological principles of any clinical procedure are extremely important to maintain the vitality of the dentin-pulp complex. Dentin and pulp tissue are susceptible to different kinds of irritants such as toxins from microorganisms, traumatic procedures of cavity preparation, as well as toxic components released by restorative materials applied in non recommended clinical situations. Initially, the pulp responds to irritation by starting an inflammatory reaction which involves outward movement of dentinal fluid and intratubular deposition of immunoglobulins, upregulation of odontoblast activities, presence of immune cells and their cytokines as well as local expression of neuropeptides and chemokines. After these initial events, the inflammation process can be resolved associated or not to sclerotic dentin formation and reactionary dentin deposition. If high intensity offensive stimuli are applied to the dentin-pulp complex, death of odontoblasts takes place and consequently pulp ageing or even partial necrosis of this tissue may occurs. Thereby, clinicians need to be aware about the physiological and pathological features of the dentin-pulp complex as well as the possible biological consequences of different clinical procedures. In this way, the dentists should be able to carry out minimally aggressive operative techniques and to select the more appropriate restorative materials for each specific clinical situation in order to obtain excellent clinical results associated to the maintenance of pulp vitality.

Transdentinal cell photobiomodulation using different wavelengths

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Transdentinal cytotoxicity of carbodiimide (EDC) and glutaraldehyde on odontoblast-like cells

Objective: To evaluate the transdentinal cytotoxicity of three different concentrations of carbodiimide (EDC) or 5% glutaraldehyde (GA) on MDPC-23 cells. Methods: Seventy 0.4-mm-thick dentin disks obtained from human molars were adapted to artificial pulp chambers. MDPC-23 cells were seeded on the pulpal surface of the disks. After 48 hours, the occlusal dentin was acid-etched and treated for 60 seconds with one of the following solutions (n=10): no treatment (negative control); 0.1 M, 0.3 M, or 0.5 M EDC; 5% GA; Sorensen buffer; or 29% hydrogen peroxide (positive control). Cell viability and morphology were assessed by methyltetrazolium assay and scanning electron microscopy (SEM), respectively. The eluates were collected after the treatments and applied on MDPC-23 seeded in a 24-well plate to analyze cell death, total protein (TP), and collagen production. The last two tests were performed 24 hours and seven days after the challenge. Data were analyzed by Kruskal-Wallis and Mann-Whitney tests (p<0.05). Results: EDC at all test concentrations did not reduce cell viability, while 5% GA did increase cell metabolism. Cell death by necrosis was not elicited by EDC or 5% GA. At the 24-hour period, 0.3 M and 0.5 M EDC reduced TP production by 18% and 36.8%, respectively. At seven days, increased TP production was observed in all groups. Collagen production at the 24-hour period was reduced when 0.5 M EDC was used. After seven days, no difference was observed among the groups. SEM showed no alteration in cell morphology or number, except in the hydrogen peroxide group. Conclusions: Treatment of acid-etched dentin with EDC or GA did not cause transdentinal cytotoxic effects on odontoblast-like cells.

Efeito citotóxico de agentes clareadores a base de peróxido de hidrogênio a 20% e 38% sobre células odontoblastóides

The aim of this in vitro study was to evaluate the trans-enamel and transdentinal cytotoxic effects of two in-office tooth bleaching techniques that employ bleaching gels containing 20% and 38% of H2 O2 on cultured odontoblast-like cell line (MDPC-23). Sixty enamel/dentin discs were obtained from bovine central incisors and placed individually in artificial pulp chambers. Six groups were formed according to the following enamel treatments: G1- 20% H2 O2 (1 application); G2- 20% H2 O2 (2 applications); G3- 38% H2 O2 (1 application); G4- 38% H2 O2 (2 applications); G5- 38% H2 O2 (3 applications); and G6- control (no treatment). In G1 and G2, the bleaching gel was left in contact with the enamel surface for 45 min in each application. However, in G3, G4, and G5 the bleaching gel was applied for only 10 min per application. After the last application, the extracts were collected and applied on previously cultured cells (30.000 cells/cm2 ) for 24 h. Cell metabolism was evaluated by the MTT assay and cell morphology was analysed by scanning electron microscopy. Cell metabolism decreased by 96.29%; 96.11%; 96.42%; 95.62%; and 97.18% in G1, G2, G3, G4, and G5, respectively. All treated groups differed significantly from non-treated control group (G6) (p < 0.05). However, the difference in cell metabolism among treated groups was not significant statistically. In addition, significant morphological cell alterations were observed in all treated groups. Under the tested experimental conditions, the extracts collected after both tooth bleaching techniques evaluated in this study caused severe toxic effects on cultured odontoblast-like cell MDPC-23.

Esthetic and function improvement by direct composite resins and biomimetic concept

Aim: This case report describe a resin layering restorative technique based on biomimetic concept to improve esthetics in a patient with dental defects that affected both enamel and dentin in anterior teeth. Background: Severe structural defect in anterior teeth compromises esthetics and it is a high challenge to become the defect imperceptible after the restoration. Case description: A clinical sequence of applying different composite resin layers allowed the reproduction of the interaction between hard dental tissues and the restorative material. Conclusion: This technique achieved a satisfactory final esthetic outcome, preserving sound teeth structure and at same time, improved the quality of life of the young patient. Clinical significance: The utilization of the biomimetic concept to increase a disharmonic smile with dental defects is based in a conservative approach, which reached a satisfactory and esthetic outcome.

Influência da clorexidina na capacidade de umectabilidade da dentina hígida e afetada por cárie por um sistema adesivo

To evaluate the effect of chlorhexidine (CHX) on the wettability of sound and caries affected dentin by a simplified adhesive system. Material and Methods: Flat coronal dentin surfaces were produced on 60 sound molars, 30 of which were artificially decayed. The teeth were divided randomly into 3 groups (n = 10) with smear layer (SL), without SL impregnated with water and without SL impregnated with chlorhexidine. The SL removal was performed by phosphoric acid etching for 15 s. 20 uL of distilled water or 2% chlorhexidine digluconate were applied on the demineralized dentin for 60 s. Then, a drop of Single Bond 2 was deposited on each surface. Contact angles between dentin surface and adhesive was measured by means of a goniometer and data were submitted to ANOVA and Tukey tests (α = 0.05). Results: Higher contact angles were obtained on sound versus caries affected dentin (p <0.05), regardeless of the surface treatment. For both substrates, contact angles statistically higher were obtained for dentin covered with SL (P <0.05). The SL removal resulted in significant reduction of the angles (P <0.05) and no difference was found among angles produced on demineralized dentin impregnated with water or chlorhexidine (p> 0.05). Conclusion: Caries affected dentin wettability was higher than sound dentin and that characteristic was not influenced by chlorhexidine application.

Subepithelial connective tissue graft: a case report

Introduction and objective: Marginal tissue recession represents a common condition in Periodontology. Miller's Classes I and II recessions, in which the etiological factors are well diagnosed and eliminated, show great predictability of total coverage when the technique of subepithelial connective tissue graft is used. This technique success has been mainly attributed to the double blood supply for graft's nutrition, originating from the connective tissue of both the periosteum and flap. Case report and conclusion: The authors reported a clinical case in which a Miller's Class I recession was treated by the surgical technique of subepithelial connective tissue graft, obtaining total coverage, eliminating the aesthetic deficiency and the dentin hypersensitivity complained by patient.

Cutting Ability of Nickel-titanium rotary systems protaper, mtwo and k3

Nickel-titanium rotatory systems should remove dentin during the root canal preparation to promote the enlargement and tapered shape with continuously narrowing towards the apex. Objective: The aim of this study was to analyze the cutting ability of three NiTi rotatory systems (n = 12): ProTaper (group 1), Mtwo (group 2), and K3 (group 3). Material and methods: Thirty six maxillary molar teeth were weighted on an analytical balance before and after the rotatory preparation of the mesio-buccal root canal. Data was statistically analyzed by ANOVA and Tukey s test with a significance level of 5%. Results: The results revealed the following mass differences (g) before and after the root canal preparation: ProTaper (group 1 – 0.0159 ± 0.004), Mtwo (group 2 – 0.0125 ± 0.002), and K3 (group 3 – 0.007 ± 0.003). Conclusion: ProTaper showed the highest cutting ability among the three tested nickel-titanium rotatory systems followed by Mtwo and K3.

Influence of nicotine and cotinine impregnation on the first step of periodontal regeneration: clot stabilization

This study analyzes the clot stabilization on root surfaces of teeth impregnated with cotinine and nicotine and the influence of the scaling in the adhesion of blood components, observing the influence of new exposition to nicotine and/or cotinine after scaling. Fifteen human teeth extracted due to periodontal disease of non-smokers patients were selected and manually scaled. Four dentin blocks were obtained from each tooth (n = 60). Samples received blood application or reimpregnation with nicotine and/or cotinine, depending on the groups. Group 1: PBS immersion + root scaling + blood; group 2: nicotine + root scaling + blood; group 3: nicotine + root scaling + nicotine reapplication + blood; group 4: cotinine + root scaling + blood; group 5: cotinine + root scaling + cotinine reapplication+ blood; group 6: nicotine and cotinine + root scaling + nicotine and cotinine + blood. Samples were kept in 2 ml of each substance for 24 hours. Each group received a blood drop and was analyzed by SEM. The higher amount of blood components was present in teeth exposed to cotinine and the groups submitted to scaling and blood application in comparison with groups that received reapplication of toxic substances after scaling. The greater toxic effect on root dentin surface was after the exposure to nicotine and cotinine. Results suggest that periodontal healing may be delayed in smokers due to the direct inhibition of clot stabilization on the root surface when nicotine and cotinine are present concomitantly.

Efeito de um gel de peróxido de carbamida a 10% sobre a resistência de união de restaurações adesivas à dentina

The present study aimed to analyze the effects of tooth bleaching with 10% carbamide peroxide (CP) gel on the bond strength of resin composite restorations to dentin. Material and Methods: Twenty cavities were prepared on the buccal surface of bovine teeth. After acid etching and application of bonding agent on dentin and enamel, the cavities were restored with composite resin. The specimens were divided into groups according to treatment on the surface of enamel / restoration: G1 - control (no treatment) and G2 (10% PC gel application for 8h/day during 14 days). After this period, the teeth were cut to produce beams with 0.81 mm2 cross-sectional area, which were subjected to microtensile test. The fractures were examined with a stereomicroscope and classified as cohesive in resin or dentin, adhesive, or mixed. Results: The statistical analysis (ANOVA / χ2) revealed that the factor treatment interfered with the bond strength, which was significantly higher for specimens of G2 (p <0.05). Adhesive fractures occurred in most of specimens of both groups with values ranging from 48.3% to 75%. Mixed fractures were the second more frequent in G1 and cohesive resin failure in G2. Conclusion: It was concluded that tooth bleaching with 10% of PC increased the bond strength of adhesive restorations to dentin.

Citotoxicidade transamelodentinária de uma fita clareadora com 10% de peróxido de hidrogênio sobre células de linhagem odontoblástica

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)