Tamara Peric

Factors related to treatment and outcomes of avulsed teeth

BACKGROUND The aim of this study was to examine factors associated with avulsion injury and to specify the association between these factors and the treatment, as well as the outcomes of avulsed permanent incisors in children. MATERIALS AND METHODS The sample consisted of 51 children with 62 avulsed permanent incisors, whose injuries had been managed in the period 1998-2006. The study was prospective, recording the history of the accident, concomitant injuries, age, gender, apical maturity of the root, replantation rate, storage media, extra-alveolar duration, endodontic treatment, compliance and recall appointments response. Factors were analysed in relation to postoperative outcomes, classified as functional healing (FH), infection-related (inflammatory) resorption (IRR) and replacement resorption (RR). RESULTS The average age of patients was 10.7 years (range 7-19). In 16/51 patients, tooth avulsion was caused by a road traffic accident. Avulsion was accompanied by concomitant injuries in all cases. Thirty of 62 avulsed teeth were not replanted and 32 incisors were replanted after dry storage. Time until replantation ranged between 15 min and 9 h (median 60 min). The observation period ranged from 1 to 6 years (median 2 years). FH was observed in 5/32, IRR in 20/32 and RR in 7/32 incisors. Ten teeth were extracted during 5-years of observation. Immature incisors exhibited significantly more complications compared with mature teeth (P = 0.04). Storage media and extra-alveolar duration did not significantly affect the survival of replanted teeth (P = 0.253, P = 0.350). Teeth in which endodontic treatment was in temporary phase exhibited significantly more complications in comparison with teeth with completed endodontic treatment (P = 0.0l6). CONCLUSION The combination of delayed replantation and unphysiological storage is followed by low survival. Incisors with open apices exhibited lower survival compared with incisors with closed apices. Replanted incisors that required prolonged treatment with calcium hydroxide exhibited more complications compared with incisors with completed root canal treatment.

Fluoride content and recharge ability of five glassionomer dental materials

BackgroundThe relationship between fluoride content and fluoride release for glass-ionomer cements is not well understood. The aim of this laboratory study was: to determine the fluoride concentrations at the surfaces of glass-ionomer materials with respect to different storage media and different pH environments; to examine the recharge ability of the materials after NaF immersion; and to assess the morphological changes at the material surfaces using scanning electron microscope and energy dispersive spectroscopic techniques (SEM/EDS).MethodsFive glass-ionomer materials, Fuji Triage (FT), Fuji II LC (FII), Fuji VIII (FVIII), Fuji IX GP (FIX), and Ketac N100 (KN), were analyzed in this study. Resin-based fluoride releasing material Helioseal F (HSF) was used as a comparison material. The sample consisted of 120 cured cement disks (n = 20 disks of each tested material, 10 × 1.5 mm). Five disks of each material were stored in 4 different storage media (I- saline, II- acidic solution ph = 2.5, III- acid solution ph = 5.5, IV- NaF solution (c = 500/106). After 7 days, two disks of each material were transferred from media I, II and III to the NaF solution for 3 min. EDS analysis was conducted in 3 randomly selected spots of each experimental disk. SEM was used to determine morphological characteristics of the material surface. Differences between the experimental groups have been analyzed using Students t-test with the level of significance set at p < 0.001.ResultsFT showed the highest fluoride content at the surface of the material. The lowest amounts of fluoride ions were detected at the surfaces of the FT disks stored at low pH environments, and this difference was statistically significant (p < 0.001). Glass-ionomers showed significantly higher fluoride concentrations when compared to the HSF (p < 0.001). After immersion in the NaF solution, fluoride concentrations at the surfaces of the disks increased when compared with previous storage media (FT>FVIII>KN>FII>FIX). SEM analysis of the surface morphology revealed numerous voids, cracks and microporosities in all experimental groups, except for KN and HSF. More homogenous material structure with more discrete cracks was observed in samples stored at neutral pH environment, compared to disks stored in acidic solutions.ConclusionThe tested materials could be considered as promising dental materials with potential prophylactic characteristics due to their relatively high fluoride content, but also the ability to extensively reabsorb fluoride ions, especially in acidic environments.

A retrospective study of intrusive injuries in primary dentition

OBJECTIVE The aim was to evaluate epidemiological aspects of intrusive injuries in primary teeth, extent and severity of injuries, provided treatment, and complications to the primary and permanent dentition. METHODS This was a retrospective study based on the clinical and radiographic data of 102 intruded teeth in 70 patients. Follow-up period varied from 6 months to 6 years, with the mean time of 2.7 +/- 1.5 years. Data were collected through dental files and dental trauma forms. The following parameters were analyzed at control examinations: rate of spontaneous re-eruption, presence of complications, time elapsed between the injury and complication, and possible sequels on permanent successors. RESULTS Mean age of the patients was 2.5 +/- 1.3 years. Fifty-six children were injured because of the fall while walking or running. Most of children had one intruded tooth. Maxillary central incisors were the most frequently injured teeth. Seventy injured teeth were <2 mm intruded. Mean time elapsed from the injury until the professional help was 45.0 +/- 67.3 h. Within 2 months after trauma, 48 intruded teeth re-erupted spontaneously. Crown discoloration occurred in 10 intruded teeth, pulp necrosis was diagnosed in nine cases and pathologic root resorption was found in five injured teeth. CONCLUSIONS The most common mechanism of injury was fall. Spontaneous re-eruption occurred in the majority of intruded primary teeth. In comparison with moderate or severe intrusions, mildly intruded teeth took less time to re-erupt. Mildly intruded teeth exhibited less complications in comparison with moderately and severely intruded teeth.

Clinical evaluation of a chemomechanical method for caries removal in children and adolescents

Objective. The purpose of this study was to make a clinical comparison of the chemomechanical method for caries removal and the conventional rotary instruments technique when used in children and adolescents. Material and Methods. The study comprised 120 patients aged 3–17 years randomized into two groups: caries were removed chemomechanically in 60 patients and 60 patients received conventional treatment with rotary instruments. The outcome variables were: clinically complete caries removal, pain during caries removal, need for local anesthesia, treatment time, preferences of patients, and clinical success of the restorations during the 12-month evaluation period. Results. Complete caries removal was achieved in 92% of chemomechanically treated teeth and in all teeth treated with rotary instruments (p>0.05). The chemomechanical method significantly reduced the need for local anesthesia (p<0.001). Eighty-five percent of patients treated with Carisolv and 47% treated with rotary instruments were satisfied with the treatment (p<0.05). The mean time for chemomechanical caries removal was 11.2±3.3 min and 5.2±2.8 min for caries removal with rotary instruments (p<0.001). At the end of the 12-month evaluation period, there was no observed influence of the caries removal method on the survival of the restorations. Conclusions. The chemomechanical caries removal technique is an adequate alternative to the conventional rotary instruments method and is advantageous in pediatric dentistry.

Clinical findings and oral rehabilitation of patients with amelogenesis imperfecta

BACKGROUND: Children with amelogenesis imperfecta (AI) experience many oral difficulties including sensitivity and aesthetics. The methods of treating AI children are limited and therefore a program of care was evaluated in order to assess the clinical efficacy of providing preventive and restorative treatments. CASE REPORTS: A non-randomised convenience sample of 12 patients with AI was evaluated. A comprehensive patient history was recorded, followed by a clinical and radiographic assessment of oral health. In 8/12 patients a hypoplastic form of AI was diagnosed, in 2/12 cases hypomaturation and in 2/12 cases hypocalcified form were noted. Chief complaints were mainly related to unsatisfactory aesthetics and dental sensitivity. In 8 patients there was active dental caries. Most of the patients had gingivitis and showed fair oral hygiene. The presence of non-enamel dental anomalies was recorded in 9 patients. TREATMENT: All patients received meticulous preventive care. Initial treatment depended on AI type and oral health of the patient. During the transition period, both conventional and resin modified glass-ionomer cements, as well as composite resin materials, were used to restore posterior teeth. Direct composite resin restorations were used to improve the appearance of anterior teeth. In 4 patients a long-lasting interdisciplinary approach including orthodontics, metal-ceramic crowns and fixed partial dentures, and direct composite restorations was required. FOLLOW-UP: Follow-up periods varied between 2–11 years. All children have been regularly recalled at 3 monthly intervals. Caries prevalence has remained low during the follow-up postoperative period and patients have reported satisfaction with the treatment they have received. CONCLUSION: AI is associated with multiple non-enamel anomalies and requires a complex treatment. Treatment planning is related to the age of the patient, the type and severity of the disorder, and the oral health of the patient. Early diagnosis, preventive care and timely treatment are of foremost importance to improve oral health in children with AI.

The impact of fissure depth and enamel conditioning protocols on glass-ionomer and resin-based fissure sealant penetration.

PURPOSE To evaluate the effect that fissure depth and enamel conditioning protocols have on penetration abilities of resin-based and glass-ionomer fissure sealants. MATERIALS AND METHODS Fifty extracted human molars were randomized into 10 experimental groups. Conditioning was performed as follows: groups I and VI, no pretreatment; groups II and VII, 10% polyacrylic acid and 37% phosphoric acid, respectively; groups III and VIII, self-etching adhesive; groups IV and IX, Er:YAG laser; groups V and X, Er:YAG laser/10% polyacrylic acid and laser/37% phosphoric acid, respectively. In groups I to V, teeth were sealed with a glass-ionomer material, and in groups VI to X a resin-based sealant was used. The sealed teeth were sectioned and the penetration ability was evaluated using scanning electron microscopy (SEM). RESULTS Pretreatment with a suitable acid resulted in superior penetration of glass-ionomer and resin-based sealant when compared with other conditioning protocols (p < 0.0001), except for the teeth treated with both Er:YAG laser and acid. Both conditioning protocol and fissure depth significantly affected the sealant penetration (p < 0.0001), but fissure depth had a greater impact on fissure penetration than did conditioning protocol. CONCLUSION Resin-based and glass-ionomer sealing materials show similar potential for pit-and-fissure penetration. Penetration of a fissure sealant is largely influenced by the fissure depth. Regarding the conditioning protocol, a pretreatment with a suitable acid is essential to obtain an adequate penetration of a sealing material.

Evaluating the population with intellectual disability unable to comply with routine dental treatment using the International Classification of Functioning, Disability and Health

Purpose. The aim of this study was to investigate the use of general anaesthesia (GA) among patients with intellectual disability (ID) in relation to the International Classification of Functioning (ICF). Method. Twenty-seven ICF codes related to the tolerance of the dental treatment were chosen. The sample consisted of 100 children with ID divided into two groups (50 patients in whom routine dental treatment had been accomplished and 50 patients who had been treated under GA). Differences between the groups were analysed using the chi-square test, bivariate correlation and multiple logistic regression analysis. Results. The GA group showed higher levels with regard to the following codes: b117 – intellectual function, b2801 – pain in head and neck, d310 – communication, d530 – toileting, d540 – dressing, e310 – immediate family, e5400 – transportation services and e5850 – education and training services. The severity of ID significantly correlated with the ‘Activities and Participation’ codes. Three predictors of GA treatment were identified: ‘Pain in head and neck’ (p  <  0.001), ‘Transportation services, systems and policies’ (p  <  0.05) and ‘Education and training services, systems and policies’ (p  <  0.05). Conclusions. The use of GA increases with the severity of ID. Acute and painful conditions result in more frequent use of GA. Unfavourable environmental factors present barrier to routine dental management.

Screening of antimicrobial and antioxidant activity of commercial Melaleuca alternifolia (tea tree) essential oils

The paper deals with the investigation of the chemical composition, antimicrobial and antioxidant activity of four commercial products of Melaleuca alternifolia essential (TTO). The chemical composition was determined using gas chromatography mass spectrometry (GC/MS) analysis. The broth-microdilution method was used to test antimicrobial activity. The antioxidant activity was tested by stable free radical of the 2,2-diphenyl-1-picrylhydrazyl (DPPH). Results of the chemical analysis identified over 30 components. The composition of the four samples varied and the major components included the following: terpinen-4-ol, γ-terpinene and α-terpinene, respectively. The samples were compliant to the ISO Standard 4730. All TTOs presented similar degrees of antimicrobial activity. A slightly higher activity was shown by TTO 4 , having a balanced level of the three main components: terpinen-4-ol (34.58%) γ γ γ γ-terpinene (9.89%) and α-terpinene (12.59%). Fungi were more sensitive than bacteria and yeast. All TTOs tested possessed the concentration-dependent antioxidant activity. Antioxidant activity was based on a balanced chemical composition between terpinen-4-ol and terpenic compounds. Biological testing confirmed the TTO antimicrobial activity against a wide range of the Gram-positive and Gram-negative bacteria, and fungi and yeasts. The correlation between the chemical composition and biological activity was quite evident. In conclusion, this study’s results reveal not only the biological activity of TTO, but also its potential as an antioxidative agent.

Adrenal crisis provoked by dental infection: case report and review of the literature.

Primary adrenal insufficiency is an endocrine disorder characterized by cortisol and aldosterone deficiency caused by destruction of the adrenal cortex. Adrenal crisis is a medical emergency with acute symptoms: nausea, vomiting, abdominal pain, fever, hypoglycemia, seizures, hypovolemic shock, and cardiovascular failure. It occurs in patients with chronic adrenal insufficiency who are exposed to additional stress, such as infection, trauma, or surgical procedures. Dental infection is a possible cause of adrenal crisis in patients with chronic adrenal insufficiency, so pediatric endocrinologists and pediatric dentists should be aware of this risk. The purpose of this report was to present a 6-year-old patient in whom Addison disease was diagnosed through adrenal crisis provoked by dental infection. The patient was treated with intravenous rehydration, intravenous hydrocortisone and antibiotics, and extraction of the infected primary tooth. Multidisciplinary approach and collaboration between the pediatric endocrinologist and the pediatric dentist are necessary to enable adequate medical and dental treatment in children with primary adrenal insufficiency.

Unmet oral health needs among persons with intellectual disability.

The aim of this study was to examine the factors affecting oral health status among intellectually disabled individuals in Serbia. The sample population was categorized according to age, sex, living arrangements, general health and the level of intellectual disability (ID). The diagnosis of dental caries was performed using the DMFT/dmft criteria. The oral hygiene and gingival health were assessed with the plaque index (Silness&Löe) and gingival index (Löe&Silness), respectively. Descriptive analysis, step-wise and logistic regression were performed to analyze related influential factors for caries presence, number of extracted teeth, teeth restored, the oral hygiene level and the extent of gingival inflammation. Odds ratios for caries were significantly higher among adult persons with ID, in persons with co-occurring developmental disorders (DDS) and increased with the level of ID. Group with DDS was associated with a 1.6 times greater odds of untreated decay, while the institutionalization was associated with 2.4 times greater odds of untreated decay. Institutionalization and co-occurring disabilities have been found to be significantly associated with a higher probability of developing gingivitis. Targeting oral health services to individuals with ID are encouraged and may help to reduce overall negative effect on oral and general health associated with delayed treatments, chronic dental pain, emergency dental care, tooth loss and advanced periodontal disease.