Muawia A. Qudeimat

Calcium Hydroxide vs. Mineral Trioxide Aggregates for Partial Pulpotomy of Permanent Molars with Deep Caries

Aim: To prospectively compare the clinical success rate of partial pulpotomy treatment in permanent molars using calcium hydroxide (CH) and mineral trioxide aggregates (MTA) as pulp dressing agents. Methods: Restorable permanent first molars (64) with carious pulp exposures were randomly assigned to two groups; CH and MTA. A standardized operative procedure was followed in both groups. Following isolation and caries removal, the exposed superficial pulp tissue layers were removed with a sterile flame shape diamond bur to a depth of 2–4 mm. Bleeding was controlled and pulp dressed with either a paste of non-setting Ca(OH)2 followed by a setting layer of Ca(OH)2, or with grey MTA. The dressing materials in both groups were then covered with a layer of light cured glass ionomer cement. The teeth were either restored using amalgam, or where grossly carious with preformed metal crowns. Patients were scheduled for follow-up at 3, 6, 12 months and annually thereafter. Results: There were 34 patients (17 males and 17 females) with 51 teeth available for evaluation. The age of patients at the time of restoration ranged between 6.8 to 13.3 years (mean of 10.3 ±1.8 years). The follow-up period ranged from 25.4 to 45.6 months with an average of 34.8 ± 4.4 months. There was no statistically significant difference in the success rate of teeth treated with CH (91%) in comparison to teeth treated with MTA (93%). Radiographically, a hard tissue barrier under CH was noticed in 12 (55%) teeth compared with 18 (64%) teeth under MTA (p=0.4). Conclusions: MTA has clinical success rate comparable to CH as a pulp dressing material for partial pulpotomy in permanent molars with carious exposures

Dental age assessment for Kuwaiti children using Demirjian's method

Background: Dental age can be estimated based on the level of tooth mineralization during the developmental process. Various methods of determining chronological and radiographical stages have been used for dental age estimation. Aim: To test the validity of the standards of dental maturation of Demirjian and Goldstein (Ann Hum Biol 3:411–421, 1976) when applied to Kuwaiti children. Subjects and methods: The sample was selected from healthy Kuwaiti children attending the routine and emergency dental clinics of the Faculty of Dentistry, Kuwait University. Good quality rotational pantomographs were obtained for 509 children (263 girls and 246 boys) between 3 and 14 years. Maturation of the seven permanent teeth on the left side of the mandible was determined according to the crown and root development stages described by Demirjian et al. (Hum Biol 45:211–227, 1973). Results: There were statistically significant differences in the mean of dental maturation between Kuwaiti and French–Canadian children (p<0.0001). Kuwaiti children were dentally delayed compared to the Canadian standards (mean dental maturation difference of 0.69 year, SD=1.25 years, CI=0.58–0.80). The mean delay in girls was 0.67 year (SD=1.30 years, CI=0.51–0.83) and in boys it was 0.71 year (SD=1.18 years, CI=0.56–0.86). Using a non-linear regression model, function formulae were developed for Kuwaiti girls and boys. Conclusion: The standards of dental maturation described by Demirjian and Goldstein (1976) may not be suitable for Kuwaiti children.

Prevalence of traumatic dental injuries in preschool children in Kuwait – a screening study

AIMS This is the first study in Kuwait to determine the prevalence, etiology, classification of trauma, teeth involved, place of injury and treatment received after dental trauma in preschool children. MATERIAL AND METHODS A total of 500 preschool children presenting at a dental screening day in all governorates of Kuwait were clinically examined for signs of trauma to their primary teeth. The parents were then interviewed and a prevalidated questionnaire was completed with the demographic data of the participant and history of the dental trauma. RESULTS A total of 243 (48.6%) males and 257 (51.4%) females were screened. The age range was 2-6 years (mean age of 4.31 +/- 1.03 years). Fifty-six children (68 teeth) suffered trauma to their primary teeth making a prevalence of 11.2%. Majority of dental traumas occurred at home (n = 49, 87.5%) followed by at street (n = 4, 7.1%) and at school (n = 3, 5.4%). The most common reason of oral trauma was falls (n = 53, 94.6%).The most commonly affected tooth was the maxillary right primary central incisor (n = 29, 42.6%) followed by the maxillary left primary central incisor (n = 26, 38.2%). There were 20 teeth with enamel fractures (29.4%), 18 teeth had enamel- dentin fractures (26.5%) and 10 teeth had complicated crown fractures (14.7%). There were 17 luxated teeth (25%) and only three primary teeth (4.4%) were avulsed. The only statistically significant relation found in this study was between the type of trauma and the type of the treatment provided. Of the traumatized teeth, 23 (33.8%) did not receive any type of dental or medical care. CONCLUSION In spite of the low prevalence of dental trauma in Kuwaiti preschool children, it is highly recommended to plan a community wide trauma prevention campaign targeting parents, children and medical/dental care providers.

Longevity of band and loop space maintainers using glass ionomer cement: a prospective study.

AIM: This was to prospectively investigate the success and median survival rate of band and loop space maintainers using glass ionomer luting cement for attachment. METHODS: A total of 40 children (22 females and 18 males) between the ages of 3.4 and 7.3 years participated in the study. Each patient received only one band and loop space maintainer. For each child, the same paediatric dentist carried out all diagnosis, band selection, and impression taking and appliance cementation. The same dental technician fabricated all appliances. The luting cement used was Ketac™-Cem-Maxicap™. Regular follow up appointments were scheduled at 4–6 months intervals. Variables, which might have affected the median survival time for the appliances were tested using Log-Rank and Chi-square tests. RESULTS: 40% of the band and loop space maintainers were successful and 57.5% failed during the study period (40 months). The most common cause of failure was decementation (82% of all failed cases). The overall median survival time was 19.9 months. Appliances fitted in the maxillary and mandibular left side of the mouth showed a statistically higher survival rate than those fitted in the right side (maxillary left quadrant = 35 months, mandibular left quadrant = 28 months, maxillary right quadrant =14 months, mandibular right quadrant = 16 months) (pS < 0.008). CONCLUSIONS: Although the overall median survival time was clinically acceptable(19.9 months), the failure rate of the band and loop space maintainers in general was high (57.5%). The main reason for failure was decementation of the band. Further studies are required to compare glass ionomer cements with more recent resin modified luting cements.

Restorative Treatment Decisions for Deep Proximal Carious Lesions in Primary Molars

Aim: To assess clinicians’ individual variables that might influence decision-making for the restoration of deep proximal carious lesions in primary molars. Methods: A precoded questionnaire that sought participants’ treatment choices for a deeply carious second mandibular primary molar as depicted in a simulated periapical radiograph, along with a specific clinical scenario, was distributed among a random sample of 157 dentists and 15 paediatric dentists. Participants were asked to answer all questions. After combining the pulpotomy and pulpectomy treatment choices under a “pulp therapy” category, a binary dependant variable was constructed. Logistic regression of the ratio of the participants who would restore the questioned tooth by the methods in question, was run. Results: A total of 155 dentists (116 males and 39 females) completed the survey, giving a response rate of 90 %. Of these 53 % of dentists recommended pulpotomy followed by definitive restoration and 39% recommended removal of caries and restoration without pulp therapy. In the logistic regression model, males and graduates from English language undergraduate dental programs had higher probabilities of restoring without prior pulp therapy (P<0.03 and P<0.02, respectively). Compared with graduates of Asian dental programs, dentists who graduated from Eastern Europe and the Middle East showed lower likelihoods of restoring the tooth without prior pulp therapy (P<0.01 and P<0.004, respectively). Dentists who treated an average of 6–16 child patients during a week had a lower probability of restoring the tooth without prior pulp therapy than those who were not currently involved in treating children (P<0.01). No other measured variables were associated with the participant’s treatment choices. Conclusions: The lack of agreement among dentists regarding their optimal treatment recommendations for deep proximal carious lesions appears to be due mainly to inter-individual, educational training and practice characteristics factors.

MTA pulpotomy as an alternative to root canal treatment in children's permanent teeth in a dental public health setting

OBJECTIVE This prospective clinical study evaluated the success of vital pulpotomy treatment for permanent teeth with closed apices using mineral trioxide aggregates (MTA) in a dental public health setting. METHODS Twenty-seven mature permanent first molars and 2 premolars (in 25 patients) with carious exposure were treated using MTA pulpotomy. Age of patients ranged from 10- to 15-years (mean=13.2±1.74-years). Four trained and calibrated practitioners performed the same clinical procedure for all patients. Following isolation and caries removal, the inflamed pulp tissue was completely removed from the pulp chamber. This was followed by irrigation with 2% sodium hypochlorite. Haemostasis was achieved using a cotton pellet damped in normal saline. A white MTA paste was placed against the pulp orifices. MTA was covered with a damped cotton pellet and a base of IRM. Patients were recalled after 1 day where a glass ionomer liner and a final restoration were placed. Teeth were evaluated clinically and radiographically for up to 47 months. RESULTS Mean follow-up period for all teeth was 25±14 months. Twenty-six of the 29 teeth were clinically asymptomatic with no evidence of periradicular or root pathology during the follow-up period. The estimated success rate was 90%. Three teeth presented with clinical symptoms of pain and radiographic evidence of periradicular pathology that indicated root canal treatment (RCT) or extraction. CONCLUSION When managing carious pulp exposures of permanent teeth with closed root apices in children, MTA pulpotomy showed a high success rate. CLINICAL SIGNIFICANCE MTA pulpotomy for permanent molars in children is a viable alternative to RCT.

Recurrent caries at crown margins: making a decision on treatment.

Objective: To evaluate dentists’ treatment choices for a crowned tooth with varying degrees of recurrent caries. Materials and Methods: A total of 158 dentists participated in the study. A paper patient case (PPC) depicting a radiograph showing varying degrees of recurrent caries at the crown margin was used: PPC1 = small carious lesion away from crown margin; PPC2 = small carious lesion at crown margin; PPC3 = small carious lesion at crown margin extending onto the root, and PPC4 = large carious lesion at the margin; PPC5–PPC8 had the same carious conditions as PPC1–PPC4, respectively, but the teeth were non-vital. Participants were asked to indicate their choice of treatment from a list of options for each PPC. Crown removal tendency was computed after dichotomization of the responses for the different cases for each participant. Demographic information, educational background and practice characteristics were collected. Descriptive statistics, logistic regression analysis and paired-sample t test were used to analyse the data at a statistically significant level of p < 0.05. Results: For PPC1 and PPC5, most of the participants recommended management without crown removal (p < 0.05). For PPC6, there was wide disagreement about management (p = 0.81). For all other PPCs, the majority of participants chose to remove the crown before making a treatment decision (p < 0.05). Logistic regression analysis showed that the size of the lesion, vitality of the tooth, participants’ age as well as the undergraduate training background of dentists were factors that affected treatment decisions. Conclusion: The data showed a lack of agreement among dentists regarding the management of recurrent caries around crown margins. Size of the lesion, vitality of the tooth, educational training and experience appeared to be the main factors that affected their decisions.

Effects of Impression Material, Impression Tray Type, and Type of Partial Edentulism on the Fit of Cobalt-Chromium Partial Denture Frameworks on Initial Clinical Insertion: A Retrospective Clinical Evaluation

PURPOSE To evaluate the effects of impression material, impression tray type, and type of partial edentulism (ie, Kennedy class) on the accuracy of fit of cobalt-chromium (Co-Cr) partial removable dental prostheses (PRDP) in terms of the number of fabricated frameworks required until the attainment of adequate fit. MATERIALS AND METHODS Electronic case documentations of 120 partially edentulous patients provided with Co-Cr PRDP treatment for one or both arches were examined. Statistical analyses of data were performed using analysis of variance and Tukey honest significant difference test to compare the relationships between the different factors and the number of frameworks that needed to be fabricated for each patient (α = .05). RESULTS Statistical analysis of data derived from 143 records (69 maxillary and 74 mandibular) revealed no significant correlation between impression material, tray type, or Kennedy class and the number of construction attempts for the pooled or individual arch data (P ≥ .05). CONCLUSION In PRDP treatment, alginate can be chosen as a first-choice material, and metal stock trays can be a preferred option for making final impressions to fabricate Co-Cr frameworks.