Wednesday, October 26, 2011

The Effectiveness of Different Thickness of Mineral Trioxide Aggregate on Coronal Leakage in Endodontically Treated Deciduous Teeth

Resident’s Name: Jessica Wilson
Article title: The Effectiveness of Different Thickness of Mineral Trioxide Aggregate on Coronal Leakage in Endodontically Treated Deciduous Teeth
Author(s): Olmez et al
Journal: Journal of Dentistry for Children
Year. Volume (number). Page #’s: 2008. 75:3.260-263.
Major topic: Materials

44 extracted primary molar teeth with caries and initial root resorption stored in saline were pulpectomized and obturated with Metapex (iodoform and CaOH) and the apical foramen was sealed with composite. The accesses were closed with a cotton pellet and the sealer was allowed to set for one day. The teeth were divided into 4 groups:
1. 1mm white MTA
2. 2mm MTA
3. 3mm MTA
4. 4mm MTA

2 positive control teeth were not treated and 2 negative control groups were treated with amalgam. With the access opening left uncovered, all teeth were immersed in Indian ink for 48 hours and then the teeth were dehydrated gradually. Two operators independently measured the maximum point of coronal dye penetration from the CEJ and the results were statistically analyzed.

Results & Conclusions:
All positive control teeth showed dye penetration and the negative control teeth showed no leakage.
1mm thick MTA showed greatest dye penetration. The authors conclude that with increasing depth of MTA placed as a barrier after RCT, coronal leakage is reduced as the 4mm group had the lowest dye penetration.

I am not a huge fan of in vitro studies although they do have their place in research. I think we can all agree that MTA is a great material and has been proven to usually be the material of choice. This study only reinforces what we already know, the more MTA, the better.

Clinical Evaluation of Root Canal Obturation Methods in Primary Teeth

Resident Name: Elliot Chiu

Article Info

Title: Clinical Evaluation of Root Canal Obturation Methods in Primary Teeth

Author: Omar A. Bawazir

Journal: Pediatric Dentistry 2006

Main Purpose

To evaluate 2 different obturation techniques in primary teeth: lentulo spiral mounted on slow-speed handpiece vs hand-held


-24 healthy, cooperative children received a total of 50 ZOE pulpectomies in primary molars.

-All procedures were done by one operator.

-Radiographs taken using XCP instrument to obtain same angulation.

-Canals were filed 1mm short of apex, irrigated with normal saline in between filing. Irrigated with physiological saline after completing instrumentation (not NaOCl?)

-ZOE was deposited into the canals with a lentulo spiral mounted in a slow-speed handpiece or hand-held.

-Restored with SSC same visit

-Evaluated after 6mon by the operator and 1 other dentist, blinded to the treatment group

Key Points

-Slow-speed: 96% clinical success, 91% radiographic success

-Hand-held: 92% clinical success, 72% radiographic success

-No statistically significant difference between the 2 techniques

-Optimally filled and over-filled canals showed significant radiographic success over underfilled canals (findings conflicted with another study)


Study was well done…no difference was found between the 2 techniques. A larger sample size and longer follow-up time may reveal if one technique is better than the other. How come Steve gets all the pulpectomies??

Apical Microleakage of Primary Teeth Root Canal Filling Materials

Lentulo spiral

Resident: Swan
Article Title: Apical Microleakage of Primary Teeth Root Canal Filling Materials
Journal: Journal of Dentistry for Children 74:1, 2007
Authors: Bawazir, et al.
Purpose: evaluate in vitro microleakage of root canal filling materials for primary teeth

Ideal filling material for primary teeth:
1. resorbs as root resorbs, 2. harmless to periodontium, 3. resorbs if passed through apex, 4. antiseptic, 5. easily fills canals and adheres to walls, 6. low shrinkage, 7. easily removed if needed, 8. radiopaque and doesn't discolor tooth. As of now, no material meets all these criteria.

Methods: 50 newly extracted primary maxillary canines and incisors with closed apices were instrumented with Hedstrom files up to size 50. Irrigation. Canals dried. Divided into 6 groups: 1. negative control (ZOE, then root end coated with 2 layers of nail polish) 2. positive control (left unfilled).3. ZOE 4. Kri paste 5. CaOH 6. Vitapex All materials were placed in canal with Lentulo spiral in slow-speed handpiece (inserted into canal, rotaed, and withdrawn gently from canal while still rotating. Access sealed with Cavit. All teeth suspended in 2% methylene blue for 7 days in individual glass vials. Teeth sectioned along long axis for evaluation.


Dye penetration

ZOE=9 mm; Vitapex=4 mm; Kri paste=5 mm; CaOH=6.75 mm. Sig difference bet. vitapex and ZOE/CaOH

Discussion: Vitapex is the winner in this study, which is what we use for pulpectomies in primary teeth. Authors point out that meth. blue has smaller mol. weight than bacteria, so this method may not be representative of reality. Also, how reliable is it that each canal received the same degree of material condensation?

Clinical Evaluation of the Accuracy of Conventional Radiography and Apex Locators in Primary Teeth

Authors: Patino-Marin, Nurla, DDS, MSc, PhD, et. al.

Submitted by: Fotini Dionisopoulos

Main Purpose: This article focused on what method was most accurate to determine the working length of root canals in primary primary teeth-- 1) Conventional Radiography and 2) Two Apex Locators (Root ZX and ProPex)-- and compare the results with 3) Scanning Electron Microscopy ("SEM"), the ideal standard.

Methods: This was a cross-sectional study-- 50 children were selected out of 1600 based on meeting specific criteria outlined in the Methods section of the article.

  • Three calibrated examiners obtained starting length measurements via Conventional Radiography and the two Apex Locators.

  • There was a fourth examiner who was calibrated and blinded who performed the assessment of the teeth undergoing SEM.

Results: The Apex Locators (Root ZX and Pro Pex) were more accurate than the Conventional Radiographs in obtaining starting length. (Root ZX ICC=.72. Pro Pex ICC= .70 and Conventional Radiographs = .67)

Assessment: Since obtaining a very accurate working length is crucial and often difficult to obtain on a young child undergoing endodontic treatment on a primary tooth, it is important to know which method will give the best result. It may seem obvious to all of us that the apex locator is the better method, since there are so many factors in a radiograph that may make a reading less accurate (not extremely less accurate in this study). As the authors stated, since there are limited studies for primary teeth working lengths versus permanent teeth, further studies/analysis can be done--especially since it would benefit better endodontic outcomes since primary tooth root canal treatment can provide a manner to maintain the tooth until the normal exfoliation time.

Effect of Cleansers and Irrigation Methods on Primary Root Dentin Permeability

Kyung-Hong Cal Kim

Effect of Cleansers and Irrigation Methods on Primary Root Dentin Permeability

Authors: Pascon FM, Kantovitz KR, Sanches Borges AF, Puppin-Rontani RM

Journal of Dentistry for Children 2007

Evaluate the effects of cleansers and irrigation methods on the permeability index in primary root dentin

Background information
-Permeability of dentin is directly affected by reduction in dentin thickness after instrumentation, formation of smear layer during instrumentation.
-Smear layer reduces dentin permeability, preventing penetration of disinfectants into the deep area of the root canal wall.

-112 infected upper/lower posterior primary teeth were extracted and collected
-Manually instrumented up to 35 K-files by the same operator
-Randomly divided them into two groups based on irrigation methods (manual irrigation, ultrasonic irrigation), and each group was further divided into four groups based on type of irrigants used (0.5% Dakin’s solution, 0.5% Dakin’s + H2O2, saline solution, 2% CHX gel).
-Root canals were then dried w/ tips of absorbent paper, and 2% methylene blue solution was placed into root canals using an insulin syringe and left in for 4 hours in a closed chamber.
-Sectioned longitudinally and only one section was included in the study.

-PI = Dye penetration area X 100 / root dentin area.
-Manual irrigation (MI) produced a higher PI than ultrasonic irrigation (UI) in the cervical and middle thirds.
Cervical third
-Dakin’s, Dakin’s + H2O2, saline solution were most effective when MI, lowest w/ CHX.
-Highest PI w/ Dakin’s, saline, and CHX when UI.
Middle third
-Dakin’s, Dakin’s + H2O2 most effective when MI.
-No difference in mean PI among irrigants when UI.
Apical third
-Dakin’s most effective when MI.
-No difference in mean PI among irrigants when UI.

-Manual irrigation > ultrasonic irrigation @ cervical and middle thirds.
-Volume of cleansers influenced the cleanliness of the root canal when UI.
-Using a plain endosonic probe, conventional probe, or combination of both techniques removed 60%,40%,95%, respectively.
-Manual cleaning has its limitation in primary teeth due to accessory canals.
-One of major disadvantages of using CHX as irrigants is its inability to dissolve necrotic pulp tissue and the difficulty of rinse from the canal surface.
-Apical third, due to its composition (less tubular, sclerotic dentin), is much less permeable than cervical and middle thirds.

Well designed study, considering multiple variables. Now that I know the irrigants that are effective in increasing permeability, I would like to see how that permeability affects clinical success. In theory increased permeability makes disinfectants more penetrable to wider area of dentin, but it would be interesting if that directly translates to improved clinical success.

Tuesday, October 25, 2011

Repair of Furcal Perforation Treated with MTA in a Primary Molar Tooth: 20-month Follow-up

Resident: Cho
Date: 10/25/11

Author(s): Oliveira et al.

Journal: Journal of Dentistry for Children 2008

Type of Journal: Case Report

Key points in the article discussion: MTA is a mineral powder that consists of hydrophilic particles, made up of tricalcium silicate, tricalcium aluminate, and other mineral oxides. Its benefits include good sealing ability, biocompatibility, low cytotoxicity, and promotion of odontoblasts to form a hard barrier. The purpose of this case report was to describe the treatment of iatrogenic furcal perforation using MTA.

Case Report: 6 year old male presented to clinic in Brazil with pain on #K. This tooth had been treated by a different dentist 2 months ago. Clinical and radiographic exam showed a deep GI restoration with a radiolucent lesion around furcation area. It appeared as if a perforation of the pulp chamber had occurred when performing a pulpotomy on this tooth. GI restoration was removed and pulpotomy material was also removed. The pulp chamber was cleaned with saline, bleeding was controlled, MTA was mixed with sterile water into a paste consistency and applied into the perforation and pulp chamber with an amalgam carrier. The tooth was restored with GI. The tooth was followed up to the period of 20 months. Tooth was asymptomatic, showed bone formation at the furcation area at 20 months.

Assessment: Long term follow-up would make it a stronger study. However, radiographically showed good bone healing for the perforated site using MTA. Need to increase sample size.

Pulpal Therapy for Primary Teeth: Formocresol vs. Electrosurgery: A Clinical Study.

Resident Name: Sadler
Article Info: Pulpal Therapy for Primary Teeth: Formocresol vs. Electrosurgery: A Clinical Study.

Rivera Et al.

Journal of Dentistry for Children 2003

Main Purpose: Compare differences in formo and electrosurgey in pulpotomy outcomes.

Methods: 80 Primary molars were evaluated. Patients were included if they had two teeth needing pulps. Teeth would be excluded if they were mobile, percussion sensitive, drainage, fetid smell, or furcation involvement. Teeth were treated exactly the same except for 5 minutes of formo treatment or up to three cycles of 1 second electrosurgery. Teeth were then filled with amalgam and evaluated at 1, 3 and 6 months by clinical and radiographic exam.

Key Points: No significant difference was found between the two techniques in clinical success of the treatment. At six months three of each had failed. Also, no statistically significant difference could be found in the type of tooth (1st or 2nd molar). The authors did state that the electrosurgery was faster and did not have the side effects of formo.

Assessment of Article: I like the article. It was very simple and easy to follow. The teeth were done in the same patients which is an excellent control system and the teeth were treated completely identical. It seems like formo is on the way out. I have never used an electrosurge but I would be interested in looking into use of a soft tissue laser instead.

Is the Presense of the Smear Layer a Limiting Factor for Root Dentin Permeability in Primary Teeth

Is the Presense of the Smear Layer a Limiting Factor for Root Dentin Permeability in Primary Teeth
Fernanda Miori Pascon, DDS, MSc
Kamila Rosamilia Kantovitz, DDs, MSc
Mario Alexandre Coelho Sinhoreti, DDS, MSc, PhD
Regina Maria Puppin-Rontani, DDS, MSc, PhD

Journal of Dentistry for Children 74:3, 2007

To study the correlation of dye permeability with primary root dentin morphology

Methods: 112 extracted primary teeth were prepared and separated into two groups of irrigation
group 1 Manual
group 2 Manual plus ultrasonic
The groups were then divided into four subgroups depending on the irrigants used.
1) Dankin's liquid
2)Dankin's liquid with hydrogen peroxide
3) 2% chlorhexidine digluconate gel
4) saline solution

After the irrigation, the canals were dried and 2% methylene blue was injected into the canals. The teeth were then sectioned longitudinally and dye penetration was measured using microscopes. Scanning electron microscopes were used to classify the presence of the smear layer and characteristics of the collagen fibril network.

Manual irrigation produced the higher permeability index as compared to ultrasonic irrigation. There were no differences between the irrigation methods and the cleansers. A significant relationship existed between the presence of the smear layer and the decreasing permeability of the dye only for manual irrigation in the middle third of the root. The presence of the smear layer on the root dentin wall was not statistically significant in the cervical third for the permeability index. The apical third also showed no statistically significant observation for permeability in either irrigation method or material.

Discussion: Manual irrigation produced the better results in this study. The decrease in PI values from cervical to apical third could be more related to tooth morphology. The hypothesis that there is a difference between irrigation methods, cleansers and their interaction was rejected. I'm happy to be finished talking about this article and even more enthusiastic about the fact that I am not an endodontist.

Dentin Rehardening after Indirect Pulp Treatment in Primary Teeth

Dentin Rehardening after Indirect Pulp Treatment in Primary Teeth

Resident’s Name: Matthew Freitas

Journal: Journal of Dentistry for Children

Author: Franzon et al

Year. Volume (number). Page #’s: 2009 76:3 223-228

Major topic: Extras! Extras!



-Indirect pulp treatment is indicated for deep carious lesions in which a thin layer of caries is left in the deepest site of the cavity, avoiding a pulp exposure. The superficial layer of carious dentin is removed and the affected dentin or decalcified dentin can be left at the deepest portions, considering that this area might be remineralized and has a small amount of micro-organisms that are sealed off from nutrient sources.



-To investigate dentin rehardening in the remaining carious dentin after indirect pulp treatment using microhardness analysis after 37 to 71 months.



-20 4- to 7year old patients; 42 primary teeth with deep carious lesions.

-Criteria: no spontaneous pain, swelling or fistula, and no radiographic carious contact with the pulp.

-Tx Procedure: LA, rubber dam, removal of caries with no pulp expsure, liner, and composite restoration.

-2 groups according to liner material: 1. calcium hydroxide 2. gutta-percha

-4-7 month radiographic and clinical follow-up.

-36 months later 29 teeth were re-evaluated.

-37-71months:18 teeth were then analyzed after exfoliation.

-They tested microhardness of sound, carious, and treated teeth.



-The results showed a hardness increase in treated teeth when compared to carious teeth in all dentin depths investigated, suggesting mineral gain after treatment.

-No difference was observed between calcium hydroxide and gutta percha as a liner.



-Study showed that when we have a deep carious lesion close to the pulp we should use a liner to encourage remineralization of the affected dentin.

Wednesday, October 19, 2011

Positional Changes of the Upper Canine and Posterior Teeth, Hard Palate, and Sinus Floor from Primary to Permanent Dentition

Positional Changes of the Upper Canine and Posterior Teeth, Hard Palate, and Sinus Floor from Primary to Permanent Dentition

Resident’s Name: Matthew Freitas

Journal: Journal of Dentistry for Children

Year. Volume (number). Page #’s: 2004 71:1 48-53

Major topic: Eruption & Exfoliation



-Analyze the normal positional changes of upper permanent canines and posterior teeth, hard palate, and sinus floor.



-Cross-sectional study of 261 Taiwanese children; 4-14 years old.

-Subjects were split into 5 groups based on stage of development (according to Hellman):

            1. completion of deciduous dentition (stage IIa)

            2. eruption stage of perm first molars (stage IIc)

            3. transitional stage of primary incisors to perm incisors (stage IIIa)

            4. transitional stage of primary posterior teeth to perm posterior teeth (stage IIIb)

            5. eruption stage of the permanent second molar (stage IIIc)

-Used panoramic radiographs to tr ace and mark 20 reference points.

-They marked each reference point with a “x” (horizontal position of structure) and a “y” (vertical position of structure). They were then superimposed in order to look at the direction of growth and development.



-All x coordinates changed their positions in a distal direction, whereas all y coordinates changed their positions in an occlusal direction.

-Vertical positional changes of crown of all teeth were greater than those of the root apices through all stages of development.

-Floor of maxillary sinus remarkably changed in an occlusal direction during the active eruption period of the first molar and buccal teeth.

Inverted Impaction of Primary Incisors: A Case Report

Resident Name: Elliot Chiu

Article Info

Title: Inverted Impaction of Primary Incisors: A Case Report

Author: Gamze Aren, DDS, PhD

Journal: Journal of Dentistry For Children 2002

Background Info

Impacted teeth are those that fail to erupt to a normal position in the time usually expected for their appearance.

Few reports of primary impacted teeth in literature. Most primary tooth impactions involve primary molars. Rarely do we see impacted primary anterior teeth. There have only been 4 cases of impacted primary maxillary incisors in the literature.

Etiology: abnormal development of the tooth germ, traumatic event

Case Report

5 year old female presents with unerupted primary maxillary incisors. Parent was unable to recall any trauma. Radiograph shows #E,F are impacted and inverted. Pt tolerated surgical removal with LA, no complications.


Short/simple article to show a rare case of impaction. Only 4 cases of this occurring in all the dental literature…under reported?

Severe Root Resorption Associated With Ectopically Erupting Teeth: A Case Report

Kyung-Hong Cal Kim

Severe Root Resorption Associated With Ectopically Erupting Teeth: A Case Report

Authors: Kakuta H, Sone S, Matsumoto H, Tanaka M.

Journal of Dentistry for Children, 2010

Root resorption in permanent teeth are believed to result from mechanical force
-Force pressure of orthodontic appliances
-Dental trauma
-Pressure from an impacted tooth, cyst, or tumor
-Poor regeneration of periodontium in replanted or transplanted teeth

Case Report
-12 yr, 2 month old Japanese boy
-Horizontal mobility and bite pain in maxillary incisors (+1 mobility)
-#6,11 and #18,31 had not yet erupted
-Insufficient space for maxillary canines
-Severe root resorption of #7,8,9,10 by ectopically erupting #6,11
-Distal roots of #19,30 resorbed by ectopically erupting #18,31

-#7,10 extracted
-Fenestration, bracket attachment on labial surfaces of #6,11.
-Canines were initially moved distally to separate the crowns from roots of the incisors (#8,9), then occlusally, using a lingual arch appliance and sectional labial arch appliance, respectively.
-Fenestration, hook attachment on occlusal surfaces of #18,31.
-Second molars were uprighted using a spring attached to the ST lock, and allowed for natural eruption while closely monitoring the movement.
-It was decided not to extract #19,30 despite their extensive root resorption as pt was too young for a definitive prosthodontic treatment to replace teeth.

Key Points
-Frequency of root resorption of the central and lateral incisors caused by an ectopically erupted adjacent canines was 9% and 38%, respectively.
-Canine cusp erupting medially to the long axis of the lateral incisor, 25+ degree inclination of canine’s tooth axis to the midline, well-developed roots of canines are often related to root resorption.
-Dental follicle of the erupting maxillary canine did NOT cause root resorption.
-AAPD Guideline recommends extraction of primary canines if they are in close proximity to or overlap of the root of the lateral incisor.
-23% of the patients who had root resorption of the maxillary incisors caused by an ectopically erupted canine experienced root resorption of the primary second molars.

Tuesday, October 18, 2011

Systemic Manifestations During Eruption of Primary Teeth in Infants

Resident Name: Sadler
Article Info: Systemic Manifestations During Eruption of Primary Teeth in Infants

Benjamin Peretz DMD

Journal of Dentistry for Children-70:2, 2003

Main Purpose: Define systemic symptoms associated with eruption of primary teeth.

Methods: 585 children were studied. 145 children aged 4 to 36 months who had at least one erupting tooth and 354 children who didn’t have an erupting tooth served as control. Parents were given a questionare to describe symptoms their children were having.

Key Points:

· Previous studies have suggested that eruption of primary teeth can be linked to systemic symptoms. The study investigated drooling, diarrhea, fever, fever and diarrhea, drooling and diarrhea, and finally fever and drooling AND diarrhea.

· Of teething infants, 40% had no symptoms compared to 93% of non teethers.

· Of teething infants, the most common was drooling (15%) and diarrhea (13%) compared to no droolers and 6% for fevers.

· No coordination between eruption of different teeth was found.

· Boys had significantly higher prevalence of diarrhea which the authors could not explain.

· Herpes infection was not observed in any of the subjects.

Assessment of Article: Fairly interested to see if there is any evidence to the old wives tale of teething fever and other things. I do give the authors credit for enthusiasm as their sample was huge but overall, I’m not too impressed with the results. They seem inconclusive and all rely on parent’s observations. How do you measure drooling? And I found it interesting that all the fever patients also had diarrhea but they were trying to make the connection to teething.

Transitory pre-eruptive malposition of a maxillary canine: Report of a case

Resident’s Name: Jessica Wilson
Article title: Transitory pre-eruptive malposition of a maxillary canine: Report of a case
Author(s): Aguilo & Gandia
Journal: Journal of Dentistry for Children
Year. Volume (number). Page #’s: 2002. 161-165.
Major topic: Eruption and Exfoliation

Case Report:
An 8 year-old Caucasian boy presented with crown fractures to #9, 10 caused by a fall. # 9 was treated with a composite and #10 received a pulp cap and the replacement of the fracture fragment. His panoramic radiograph revealed normal development and position of canines at this time.
Four months later, a new fall caused the repaired lateral incisor to fracture again. The tooth tested vital and a partial pulpotomy was completed.
One year later at 9 years, 11 months, the patient returned with pain and swelling of the facial tissue around #10. Radiographically, #10 exhibited a periapical radiolucency. The developing adjacent canine displayed widening of the space around the follicle (inflammatory follicular cyst) and the distal displacement of the tooth. The canine and premolar appeared to be trying to transpose. The now non-vital incisor was treated with a pulpectomy.
One year later, a panoramic radiograph revealed no pathological radiolucencies and a normal eruptive position of #11. A RCT was performed on the lateral incisor.
At 12 years-old the right canine was erupting and the left primary canine was extracted to facilitate the eruption of the succedaneous tooth. At 13 years (1.5 years after the eruption of the contralateral canine) #11 was clinically erupted.

The authors speculate that the cause for delay in the eruption of #11 was in the healing of the follicular cyst lead to areas of fibrosis which would have caused mechanical obstruction of its eruption path.
The authors conclude that there are four factors necessary for proper canine eruption:
1. Initial normal eruption path
2. Guidance from a correctly placed lateral incisor root
3. Space in the dental arch
4. Health of adjacent teeth