Anterior crossbite treatment in the transitional period of mixed dentition: a case report

Anterior crossbite refers to the abnormal vestibulolingual relationship in the sagittal dimension between one or more anterior superior and inferior anterior teeth. It can be classified as dental, functional or skeletal. Each has its own diagnostic criteria and specific treatment, and it is up to the dentist to know how to distinguish between these different natures of malocclusion. In this sense, the aim of this study is to show a case report about an ACM. Patient HCA, female, 7 years old, attending the Preventive Orthodontics Clinic of the Faculty of Dentistry of Araçatuba - UNESP, having as main complaint “untidy front tooth”. The patient has no history of systemic diseases or medication use. The patient was in the first transitional period of mixed dentition with her right maxillary central incisor in crossbite relationship with its antagonists mandibular central incisor. On both sides, the patient had the first permanent molars in Class I relationship, the deciduous second molars with mesial step and the deciduous canines in a Class I. Initially, an acrylic appliance with an expander was installed. Due to lack of cooperation, the treatment plan was changed and the patient received a fixed appliance with a 2x2 configuration, with brackets on maxillary central incisors and edgewise tubes on maxillary deciduous molars. In the lower arch, a bite lift was performed on the occlusal surface of mandibular deciduous molars to unblock the occlusion and facilitate the movement of right maxillary central incisor. The total treatment time was 60 days.

Modified Intra-alveolar appliance — Case report

Arch space/ Tooth size discrepancy occurs whenever there is a early loss of the deciduous molars which eventually leads to malocclusion. Prevention of this discrepancy has always been a challenge for a pediatric dentist. This case report describes modified bilateral distal shoe appliance fabricated due to inadequate abutment support.

Evaluation of the Interfaces between Restorative and Regenerative Biomaterials Used in Vital Pulp Therapy

Background: Calcium-silicate-based cements (CSC) have gained an increasing scientific and clinical relevance, enabling more conservative approaches, namely pulp preservation and regeneration therapies. This research aims to study the influence of four clinical variables on the interfaces between CSC and composite adhesive restoration, concerning shear bond strength (SBS) and ultra-morphological patterns. Methods: SBS tests were performed in 320 specimens divided in 16 groups (n = 20) according to: two CSC (NuSmile® NeoMTA, BiodentineTM); two adhesive systems (ClearfilTM SE Bond 2 (CSEB2), ClearfilTM Universal Bond Quick (CUBQ)); optional application of an additional hydrophobic bonding layer (HBL); two restoration times (immediate, seven days). Scanning electron microscopy (SEM) was performed to conduct the ultra-morphology interface analysis in 32 deciduous molars prepared and randomly allocated into the 16 groups. Results: Globally, SBS tests showed higher bond strength of CUBQ compared to CSEB2 (p < 0.001), as with an additional HBL application (p = 0.014) and delayed restoration (p < 0.001). SEM showed the interpenetration between adhesive systems and CSC forming a hybrid layer, whose depth and thickness depended on the restoration time and adhesive strategy. Conclusions: The independent clinical variables adhesive system, application of an additional HBL and restoration time affected the bond performance and ultra-morphological interface between composite adhesive restoration and CSC.

What is the survival rate of deciduous molars in cases with agenesis of premolar successors? A systematic review

ABSTRACT Objectives To systematically review the literature on the survival rate of deciduous molars in cases of agenesis of premolar successors. Materials and Methods Four electronic databases and partial grey literature were searched up to November 2020. The PECOS eligibility criteria included (P) second deciduous molar (E) exposed to agenesis of a premolar successor (O) evaluated by the survival rate in the oral cavity, infraocclusion, and root resorption through (S) observational studies. Risk of bias (RoB) was assessed using the checklists from the Joanna Briggs Institute and the level of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) tool. Results Three studies were included: one with low, one with moderate, and one with high RoB. Synthesis methods included the frequency of persistent deciduous second molars during the follow-up. Approximately 82% to 89% remained in the oral cavity after 5 to 13 years. The incidence of root resorption was 11%, and the infraocclusion was 1 mm. The level of evidence was considered low for each outcome. There was considerable RoB regarding the observational studies and a need for clinical and radiographic monitoring of the deciduous molars. Conclusions Maintaining a deciduous molar in the oral cavity in patients with agenesis of the premolar successor is a viable clinical choice since 82% to 89% of the retained molars evaluated were in good condition over a follow-up ranging from 5 to 13 years. Infraocclusion and root resorption did not seem to increase considerably. The level of evidence was considered low for each outcome.

Association of Vital Pulp Therapy Outcomes with Tooth Type, Arch Location, Treatment Type, and Number of Surfaces Destroyed in Deciduous Teeth: A Retrospective Study

There is a paucity of information concerning vital pulp treatment outcomes in the undergraduate teaching setting. This study aimed to determine which type of deciduous molar, arch location, type of vital pulp therapy, and the number of carious surfaces involved had a better prognosis when carried out by undergraduate dental students. The method used was the review of clinical records of 590 patients with 600 deciduous molars, that visited the outpatient undergraduate dental clinics for vital pulp therapy. Statistical analysis used to determine the associations of tooth type, arch location, treatment type, and the number of carious surfaces involved in successful outcomes was logistic regression analysis with significance set at p < 0.05. According to the regression analysis model results, there was a significant association based on tooth type (p < 0.05) and arch location (p = 0.003). In addition, there was a significant association based on the type of treatment performed (p = 0.036). However, there was no significant association in success rates based on the number of carious surfaces involved (p = 0.873). In conclusion, second deciduous molars and maxillary deciduous molars had a better overall prognosis, and indirect pulp therapy was revealed to be more highly associated with successful treatment outcomes in comparison to ferric sulfate pulpotomy in our setting.

Evaluation of Root Canal Obturation Quality in Deciduous Molars with Different Obturation Materials: An In Vitro Micro-Computed Tomography Study

Objective. To evaluate the voids in root canal treatment of deciduous molar canals using three obturating materials and two obturation systems using micro-CT. Study Design. Thirty freshly extracted deciduous molars were used in this study. The specimens were instrumented using a ProTaper Universal rotary instrument and randomly assigned into six groups ( n = 5 ). Mesiobuccal root canals were obturated using Ca(OH)2 and iodoform-Ca(OH)2 and ZOE cement. The materials were applied straight from the syringe up to the 2 mm coronal level of the apex. Subsequently, the Lentulo spiral and ultrasonic activation with endoactivator were used for obturation. All samples were scanned by micro-CT with 9.1 μm isotropic voxel resolution. The voids in cross-sectional images and 3D volumes of voids were measured. Differences among materials were statically evaluated ( p < 0.05 ). Results. All study groups showed voids. Ca(OH)2 and iodoform-Ca(OH)2 with ultrasonic activation produced fewer voids whereas the ZOE groups showed higher voids with statistical significance ( p < 0.05 ). Conclusions. Ca(OH)2 and iodoform-Ca(OH)2 with ultrasonic activation decrease void formation. Further studies should be done with other obturation techniques and materials for deciduous tooth root canal management.

Early Treatment with a Slow Maxillary Ni–Ti Leaf Springs Expander

The aim of this brief report is to analyse the available literature on the clinical outcomes of a particular appliance for slow maxillary expansion that consists of one or more nickel–titanium springs. Materials and methods: The main medical databases (Scopus, Web of Sciences, Pubmed and Google Scholar) were scanned up to January 2020 using “slow maxillary expan*”, “slow palatal expan*”, “leaf expander” and “NiTi Palatal Expander” as keywords. Skeletal changes in the maxilla after expansion with the Leaf Expander (L.E.) or similar appliances were taken into consideration while reviewing relevant manuscripts. The review focuses on the comparison between the L.E. and conventional expanders (i.e., Haas and Hyrax) regarding the increase in both the distance between the palatal cusps of the upper first molars and the distance between the palatal cusps of the upper second deciduous molars, as well as the increment of nasal structures and pain connected to expansion procedures. Results: Bibliographic research retrieved 32 articles that were considered eligible for the present study. The limited number of articles currently available in international medical databases is allegedly partly due to the fact that these expanders are currently produced by only one patent holder company, which affects its diffusion. Conclusion: Despite the reduced number of published articles, due to the recent introduction of the L.E. device, most of the authors have found that the effects of the L.E. device are clinically and radiographically comparable to those achievable with the rapid palatal expander.