First permanent molars with molar incisor hypomineralisation

Molar incisor hypomineralisation (MIH) is a common enamel defect presenting in the first permanent molars (FPM) and permanent incisors. This article presents the clinical findings and management considerations for the FPM with MIH to the general practitioner. The various treatment options are described with emphasis placed on early diagnosis as the most important prognostic factor.     

Pulp treatment for young first permanent molars: To treat or to extract?

For the young patient population, the first permanent molar (FPM) has an extremely high caries rate. Pulp treatment for such severely decayed teeth may be required. As of today, there is no thorough literature review or systematic review that can guide the clinician when making decisions about extraction with second permanent molar (SPM) substitution, or endodontic treatment of a carious FPM. The purpose of this article is to consider the various options for treatment and to look at the cost‐benefit picture with respect to their long‐term outcomes. A guideline for comparing options such as orthodontic, endodontic, and restorative procedures is presented. It is further suggested that a large study be conducted to gain information in this important area to more precisely guide practitioners in treatment selection.     

R3Increasing the awareness of the role of the dental team in child protection

Objective:  To determine and compare the reasons and pattern of extraction of first permanent molars (FPM) in 3 UK dental hospitals.
Design:  Data were collected prospectively from 300 children attending Manchester Dental Hospital (MDH), Liverpool Dental Hospital (LDH) and Charles Clifford Dental Hospital, Sheffield (CCDH) who required extractions of at least one FPM. Information recorded included age, FPM extracted, reason for extractions, previous treatment, method of extraction, and whether patients had previous extractions.
Result:  The mean age in months was 129 (Std 22.7), 139 (Std 29.4), and 133 (Std 26.8) for MDH, LDH, CCDH respectively. 45% and 48% of children had four FPM extracted at MDH & CCDH, respectively, compared to 25% in LDH. The main reason for extraction (70%) was caries with poor prognosis, followed by caries and compensating extraction (14%). Molar Incisal Hypoplasia was the reason for extraction in 11% of cases. General anaesthesia was the main anaesthetic method used with 77%, 55%, and 47% in MDH, LDH and CCDH, respectively. Local anaesthesia was used in 43% of cases in LDH in comparison to 12% and 22% in MDH and CCDH, respectively. 68% of children had received no previous treatment to the FPM and only 5% had fissure sealants placed. 40% of children had previous extractions.
Conclusion:  The children who are attending our hospitals for extractions of FPM tend to be older than the recommended age for achieving maximum space closure. This study highlights the need for extensive prevention programs targeted at those children with high caries risk.     

An eight-year follow-up of the occlusal surfaces of first permanent molars

The state of the occlusal surfaces of the first permanent molars (FPMs) in a representative group of subjects from seven to 15 years of age was followed retrospectively year by year. Data were taken from oral health records. Standardized charts include information on dental check-ups, oral health status, and the treatment given. The state of each occlusal surface was classified into four categories: (1) sound but unsealed, (2) sealed, (3) filled, or (4) decayed. An overall annual attack rate for all occlusal FPM surfaces was 5.9% per year, and for approximal surfaces, 1.3%. Occlusal caries attacks had been most prevalent between seven and nine years of age, whereas new approximal lesions had been most frequent from ages 11 to 13. The FPMs that had been sealed at the age of seven developed fewer caries than did any other group during the follow-up.     

Telegenetics: application of a tele-education program in genetic syndromes for Brazilian students

With the high occurrence of genetic anomalies in Brazil and the manifestations of communication disorders associated with these conditions, the development of educative actions that comprise these illnesses can bring unique benefits in the identification and appropriate treatment of these clinical pictures.

Objective

The aim of this study was to develop and analyze an educational program in genetic syndromes for elementary students applied in two Brazilian states, using an Interactive Tele-education model.

Material and Methods

The study was carried out in 4 schools: two in the state of São Paulo, Southeast Region, Brazil, and two in the state of Amazonas, North Region, Brazil. Forty-five students, both genders, aged between 13 and 14 years, of the 9^th grade of the basic education of both public and private system, were divided into two groups: 21 of São Paulo Group (SPG) and 24 of Amazonas Group (AMG). The educational program lasted about 3 months and was divided into two stages including both classroom and distance activities on genetic syndromes. The classroom activity was carried out separately in each school, with expository lessons, graphs and audiovisual contents. In the activity at a distance the educational content was presented to students by means of the Interactive Tele-education model. In this stage, the students had access a Cybertutor, using the Young Doctor Project methodology. In order to measure the effectiveness of the educational program, the Problem Situation Questionnaire (PSQ) and the Web Site Motivational Analysis Checklist adapted (FPM) were used.

Results

The program developed was effective for knowledge acquisition in 80% of the groups. FPM showed a high satisfaction index from the participants in relation to the Interactive Tele-education, evaluating the program as "awesome course". No statistically significant differences between the groups regarding type of school or state were observed.

Conclusion

Thus, the Tele-Education Program can be used as a tool for educational purposes in genetic syndromes of other populations, in several regions of Brazil.     

Estimating molar-incisor-hypomineralization among 8-year-olds based on 15-year public oral health practice-based data

Abstract

Background: A wide range in the prevalence of molar-incisor-hypomineralization (MIH) has been reported. Population-based studies are recommended. However, such studies are expensive and time-consuming.

Objectives: To estimate the magnitude of MIH condition among 8-year-olds based on routine oral health examinations and to associate first permanent molar (FPM) affection with that of other permanent teeth over time.

Materials and methods: This retrospective study, with cross-sectional and longitudinal components, was based on electronic oral health records; all 8-year-olds examined between 2002 and 2016 were included.

Results: The average estimated prevalence of MIH was 8.3%; yearly range was 4.8–15.9%. The mean number of affected teeth was 1.4; 62% had one affected tooth. One-surface defects were the most frequent (66%). Asymmetric distribution of affected teeth was observed. In follow-up, 10.7%, 8.4%, and 11.2% had at least one affected permanent canine, premolar, or second permanent molar, respectively. The proportion of children with other MIH-affected permanent teeth was higher in the group with ≥2 MIH-affected teeth than in group with one affected FPM at the age of 8.

Conclusions: The average prevalence of MIH was comparable to that reported elsewhere. The number of MIH-affected teeth at early mixed dentition predicts the affection of other permanent teeth over time, mainly that of permanent canines. Further screening of children with MIH is recommended to improve individually tailored early preventive and restorative dental care.     

Structural changes in ceramic veneered three-unit implant-supported restorations as a consequence of static and dynamic loading.

OBJECTIVES: Static implant loading caused by non-passive restorations may cause technical complications. As metal-ceramic restorations are most common in implant prosthodontics, the objective of the study was to investigate the effect of static and dynamic loading upon the stability of the ceramic veneer of implant-supported fixed partial dentures (FPDs). METHODS: A total of 10 groups of three-unit implant FPDs with five samples each were investigated in the conditions after fabrication, static loading and dynamic loading (chewing simulator, 20,000 cycles, 100N). The fluorescent penetrant method (FPM) was applied to detect microcracks at the cervical and occlusal aspects of the FPD abutments. Statistical analysis was performed based on the number of microcracks (t-test) and the presence of chipping fractures (Exact Fisher test) with the level of significance set at alpha=0.05. RESULTS: Static and dynamic loading led to an increase both in number of microcracks and frequency of chipping fractures. After static loading, the screw-retained FPDs cast in one piece revealed significantly lower numbers of cervical microcracks than did the cementable restorations fabricated from repositioning technique impressions (p=0.003). The screw-retained FPDs which were fabricated using premachined gold cylinders showed the highest numbers of cracks and chipping fractures both after static and dynamic loading. SIGNIFICANCE: Static loading may damage the ceramic layer of implant-supported restorations. The use of prefabricated components may cause increased numbers of microcracks due to the lack of bonding oxides.     

Molar–incisor hypomineralization and the association with childhood illnesses and antibiotics in a group of Finnish children

Objective: Molar–incisor hypomineralization (MIH) is a developmental enamel defect affecting 1–4 first permanent molars (FPMs) and often also incisors. The aim of this study was to assess whether childhood illnesses or medication are associated with MIH.

Material and methods: FPMs and incisors of 287 Finnish children were examined for MIH in line with the criteria of the EAPD. Health data from the first 3 years of life was collected from medical records and the associations with MIH and MIH2 (lesions in at least one FPM and incisor) were assessed using simple and multiple logistic regression analyses.

Results: The prevalence of MIH and MIH2 were 11.5% and 6.3%, respectively. During the first 3 years of life, the children with MIH had sought care for infectious illnesses more often than the children without MIH (mean number of visits (SD) 7.9(6.4) vs. 6.0(5.1), p?=?0.045, independent samples t-test). After adjustment for confounding factors, children who had received penicillin or macrolides within the first year, or amoxicillin within the first 3 years had a higher risk for MIH (2.61, 4.07 and 2.58 times, adjusted OR, respectively) or MIH2 (3.16 times, aOR for penicillin and amoxicillin) compared to those who had not received that antibiotic. Of the illnesses, children with at least one episode of otitis within the first year had a higher risk for MIH (2.28 times, aOR) than those who had not suffered from otitis.

Conclusions: Acute otitis media and the use of certain antibiotics were associated with the elevated risk of MIH/MIH2.     

Current challenges in successful rehabilitation with oral implants

Very high survival/success rates have been reported for implant treatment, irrespective of the prosthetic type of reconstruction, be those full arcs, partial dentures, combined tooth implants or single crowns. However, survival/success is commonly reported in simple Cumulative Survival/Success Rate (CSR) tables only that may overestimate the true clinical outcome; furthermore, future challenges to clinical success may originate from too rapid launching of untested novelties or recommendations to apply too bold clinical procedures, potential problems that are summarised in the present paper.     

Evidence-based dentistry: an overview of a new approach to dental practice

Dental students' clinical questions and problems are solved by a combination of instructors' intuition, training, and clinical experience, which may or may not be based on scientific evidence. This type of training, which relies heavily on clinical experience and information learned in dental school, seminars, or from colleagues, can lead to inappropriate treatment outcomes. Evidence-based dentistry attempts to answer clinical questions based on a critical review of the best available scientific evidence together with one's clinical experience and scientific knowledge.     

Substance P expression is elevated in inflamed human periradicular tissue

Substance P is a neuropeptide believed to be a major mediator of neurogenic inflammation. The aim of our study was to evaluate whether substance P levels are elevated in the clinical biopsies collected from inflamed periradicular or control tissue. In this study, the presence of substance P was examined in infected human periradicular granulation tissue and control tissue. Sections from 19 periradicular granulomas and pulp tissues from two healthy control teeth were examined using the immunohistochemical method. Substance P-expressing neutrophils, macrophages, and plasma cells were found in both acute and chronic periradicular granulomas. In addition, we observed the presence of neutrophils expressing substance P without concurrent clinical symptoms of acute inflammation. Our results are consistent with the hypothesis that substance P may be released from neutrophils in the inflamed region, and thus, substance P may modulate clinical inflammatory response by release from either neuronal or immunocompetent cell populations.     

Gingival prostheses--a review

Gingival replacement is often a component of comprehensive prosthodontics. Gingival prostheses may be fixed or removable and may be made from acrylics, composite resins, silicones or porcelain-based materials. Undercuts or dental attachments are used to secure removable prostheses, which are esthetically pleasing and easy to maintain. This paper describes several clinical situations in which gingival prostheses were used effectively.     

Focal, flat pigmentations of the oral mucosa: a clinical approach to the differential diagnosis

The purpose of this article is to assist the clinician in establishing a clinical approach to the diagnosis of focal, flat pigmentations of the oral mucosa. These pigmentations include lesions that may be blue, purple, red, black, or brown. The etiopathogenesis may be variable and the pigment may originate from an exogenous (extrinsic) or endogenous (intrinsic) source. Exogenous pigmentations are of a traumatic or iatrogenic origin. Intrinsic pigmentations are either vascular or melanocytic. Clinical approaches include a thorough history and physical exam coupled with diascopy (blanchability), radiographs, and tissue examination (biopsies). An algorithm is presented to clarify the diagnostic approach. The diagnosis may vary from pathologic entities that require no treatment to others that may involve malignancies and their associated management. It is therefore extremely important that these lesions are identified and properly managed in an expeditious manner.     

(ii) The cavo-varus foot

Cavo-varus foot deformity has many causes but the final common pathway is an imbalance of the muscles acting on the foot. The commonest cause of bilateral deformity is Charcot Marie Tooth disease. Unilateral deformity may arise from spinal pathology. Symptoms range from ankle instability and fatigue fractures to abnormal gait and the effects of joint overload.As well a clinical assessment, patients may require neuro-physiological investigation, and foot and spinal imaging. Treatment ranges from footwear modifications and orthoses to surgical treatment which may include combination of soft tissue releases, tendon transfers or a variety of osteotomies. Severe or recurrent deformities may require joint arthrodesis.     

How effective is that treatment? The number needed to treat

The Number Needed to Treat (NNT) is a tool useful for comparing the relative effectiveness of two or more therapeutic or preventive interventions. The NNT may be presented by authors of a clinical research article, or, if not provided, may be calculated by the reader if the authors have reported outcomes as positive or negative per research subject. The NNT is simply calculated as the inverse of the absolute risk reduction. The NNT is most meaningful when reported within a confidence interval and when describing clinical trials of higher validity such as randomized controlled trials and meta-analyses of such trials. Several example NNTs from the dental and medical literature are reported.     

Traumatic neuroma of the great auricular nerve. A clinical case

A clinical case of neuroma resulting from an amputation which occurred following parotid surgery is reported. The present paper discusses the importance of differential diagnosis relating to this pathology and the surgical techniques that may contribute to setting a limit on its onset. Traumatic neuroma is a possible complication of parotid surgery together with motor deficiencies and Frey's syndrome and the less frequent salivary fistulas. It may also occur following oncological or plastic-reconstructive surgery. During parotidectomy operations, section of the great auricular nerve may be required to facilitate access to the parotid region. This manoeuvre may, however, also be associated with the onset of a neuroma during a time period varying from 2 to 10 years, according to the various authors who have examined the subject. The laterocervical tumefaction associated with neuroma poses a number of diagnostic problems as it has to be differentiated from a likely relapse or possibly from more complex inflammatory or metastatic lymphnodal pathology. A correct clinical and diagnostic multidisciplinary approach is fundamental if the pathology is to be classified in the right way and contributes to alleviating a state of mental unease in the patient that is associated with the sudden appearance of the tumefaction. Sectioning the nervous trunk by means of thermocautery and its subsequent sinking below the main trunk of the sternocleidomastoid muscle, are simple surgical manoeuvres that are useful for preventing the onset of traumatic neuroma.     

A review of the limitations of statistical analysis of treatment outcomes used in periodontal research

Results of clinical trials are reported in terms of statistical significance, but interpretation of statistical significance in relation to clinical benefits is limited. Furthermore, the compromises inherent in the design of clinical trials, and in the statistical analysis techniques themselves cast doubts on the soundness of the inferences drawn from data from clinical trials. The aim of this paper is to review the published research on data management and interpretation in periodontal research, and to attempt to find ways in which the results of clinical trials could be reported in a more meaningful way, in terms of treatment outcomes. It is concluded that due to the limitations of current statistical methods and trial design, that clinical outcome variables should be reported in addition to statistical significance. Furthermore, due to the multiplicity of sites, subjects, and variables used to report on clinical conditions that may not be linear in their progression or regression, care needs to be exercised in interpretation of the results of clinical trials to avoid reporting positive outcome results that arise out of the limitations of current statistical analysis techniques or computational errors rather than clinical changes.     

Defective dental restorations: to repair or not to repair? Part 2: All-ceramics and porcelain fused to metal systems

With the increasing use of ceramics in restorative dentistry, and trends to extend restoration longevity through the use of minimal interventive techniques, dental practitioners should be familiar with the factors that may influence the decision either to repair or replace fractured metal-ceramic and all-ceramic restorations and, also, the materials and techniques available to repair these restorations. This second of two papers addresses the possible modes of failure of ceramic restorations and outlines indications and techniques in this developing aspect of restoration repair in clinical practice. Clinical Relevance: The repair of metal-ceramic and all-ceramic restorations is a reliable low-cost, low-risk technique that may be of value for the management of loss or fracture of porcelain from a crown or bridge in clinical practice.