Deciduous Molars Research Articles

Effectiveness of buccal infiltration anaesthesia compared to inferior alveolar nerve block anaesthesia in primary mandibular molar extractions: a randomised controlled study.

Aim The current study assessed the efficiency of buccal infiltration (BI) and inferior alveolar nerve block (IANB) during the extraction of deciduous mandibular molars.Subjects and method A total of 112 children aged between 5-8 years with mandibular molar indicated for extraction were divided into two groups at random. The BI group was injected with 4% articaine using BI, while the IANB group was injected with 2% lidocaine using IANB. The effectiveness of both techniques was examined using the Wong-Baker FACES Pain Rating Scale (W-BFPRS); Faces, Legs, Activity, Cry, and Consolability (FLACC) scale; and pulse oximetry.Results Using the W-BFPRS scale, success rates were 83.9% and 75.0% for the BI group and 82.1% and 71.4% for the IANB group during the injection and extraction, respectively, while using the FLACC scale, success rates were 83.9% and 92.9% for the BI group and 78.6% and 89.3% for the IANB group. In terms of pulse rate and oxygen saturation, there was no significant difference between the two groups.Conclusions BI with articaine is as efficient as IANB with lidocaine in the extraction of deciduous mandibular molars.

Mandibular second premolar distoangulation: a longitudinal follow-up from the mixed to the permanent dentition.

The aim of this study was to assess the frequency of mandibular second premolar (MnP2) distoangulation among orthodontic patients and the angular changes after a longitudinal follow-up. The sample was collected from the orthodontic records of 865 patients. The distoangulation group was composed of 42 patients (mean age 9.29 ± 1.24 years, 16 male, 26 female) with distoangulation of MnP2. The control group was composed of 32 patients (mean age 9.38 ± 1.10 years, 15 male, and 17 female) without distoangulation of MnP2. Panoramic radiographs taken in the mixed (T1) and the early permanent dentition (T2) were analyzed in both groups. Longitudinal angular changes (distal angle θ and premolar-molar angle γ), degree of root formation, second premolar depth, and prevalence of associated dental anomalies were analyzed. Intergroup comparison was performed with Mann-Whitney, t-tests, and chi-square tests (P < 0.05). The prevalence of MnP2 distoangulation in the mixed dentition was 4.85%. The distoangulation group showed a smaller initial distal angle (59.34o ± 8.41) when compared to control group (79.88o ± 7.60). The spontaneous eruption of the MnP2 with distoangulation was observed in 76.57% of the sample. MnP2 distoangulation was significantly associated with agenesis of its antimere, small maxillary lateral incisors, and deciduous molar infraocclusion. Severe cases of MnP2 distoangulation were absent in this study. The frequency of MnP2 distoangulation among orthodontic patients was 4.85%. Mild to moderate distoangulated Mnp2 spontaneously uprighted from the mixed to the permanent dentition. Small lateral incisors, second premolar agenesis, and infraocclusion of deciduous molar were frequently found in cases with MnP2 distoangulation.

The erosive effect of various drinks, foods, stimulants, medications and mouthwashes on human tooth enamel

Two forms of non-carious dental disorder - erosive tooth hard tissue loss and dental erosion - have been increasingly observed in recent years. Dental erosion is the chemical loss of dental hard substances caused by exposure to acids not derived from oral bacteria. Mechanical forces from, for example, the tongue, the cheeks or toothbrushing, increase loss of partly-demineralized tooth surfaces and the cumulative loss of dental hard tissue is defined as erosive tooth wear (ETW). Dental hard tissue losses which occur because of very frequent acid exposure, such as through increased vomiting, but without mechanical stress, are also assigned to tooth erosion. Without prior softening, practically no loss of enamel takes place due to abrasion with the modern Western diet. The present work is a continuation of earlier work. A total of 226 beverages, food, stimulants as well as medicines and mouthwashes were tested for their erosive potential on premolars and deciduous molars covered with a human pellicle. The influence of temperature, phosphate and calcium was also investigated in additional experiments. The change in hardness before and after immersion in the respective test substance was measured and the erosive potential was classified. For each test product, we determined pH and other properties which were possibly related to erosive potential. There were considerable and sometimes surprising differences between the tested products. The addition of phosphate did not influence the erosive potential of the liquids, but calcium did. A modified erosion scheme is presented, which incorporates these and other new findings.&#x0D; Accepted for publication: February 6, 2023&#x0D; Published online: February 21, 2023

The erosive effect of various drinks, foods, stimulants, medications and mouthwashes on human tooth enamel.

Two forms of non-carious dental disorder - erosive tooth hard tissue loss and dental erosion - have been increasingly observed in recent years. Dental erosion is the chemical loss of dental hard substances caused by exposure to acids not derived from oral bacteria. Mechanical forces from, for example, the tongue, the cheeks or toothbrushing, increase loss of partly-demineralized tooth surfaces and the cumulative loss of dental hard tissue is defined as erosive tooth wear (ETW). Dental hard tissue losses which occur because of very frequent acid exposure, such as through increased vomiting, but without mechanical stress, are also assigned to tooth erosion. Without prior softening, practically no loss of enamel takes place due to abrasion with the modern Western diet. The present work is a continuation of earlier work. A total of 226 beverages, food, stimulants as well as medicines and mouthwashes were tested for their erosive potential on premolars and deciduous molars covered with a human pellicle. The influence of temperature, phosphate and calcium was also investigated in additional experiments. The change in hardness before and after immersion in the respective test substance was measured and the erosive potential was classified. For each test product, we determined pH and other properties which were possibly related to erosive potential. There were considerable and sometimes surprising differences between the tested products. The addition of phosphate did not influence the erosive potential of the liquids, but calcium did. A modified erosion scheme is presented, which incorporates these and other new findings.

Changes in Pulp and Roots of Deciduous Teeth during Different Stages of Physiologic Resorption: A Histologic Study.

Resorption of primary teeth and eruption of permanent teeth involves a complex series of changes. The cellular and histological changes occurring during the process of resorption vary stagewise. The knowledge of the changes occurring in the pulp of deciduous teeth would provide information about the resorptive process. To evaluate the histologic changes of the pulp of deciduous teeth related to different stages of physiologic root resorption. To establish the cause and effect relationship, a contrived histologic study design was planned. A total of 60 extracted deciduous incisors, canines, and molars were included in the study. The remaining root length (RRL) was determined based on the standardized photographs. The teeth were then grouped into three based on the percentage of RRL. The teeth were subjected to decalcification with 5% nitric acid, following which histological processing was performed. The present study being a qualitative study design, descriptively explains the histologic findings, and no statistical tests have been applied. During the initial stages of resorption, there were no histological alterations noted in the pulp, particularly in the cervical 3rd, with the cellular structure relatively maintained. As the resorption progresses, reversal lines were evident, indicating a process of repair occurring simultaneously during the process of resorption. With further advancement, the repair is overtaken by the resorption indicated by the presence of resorptive cells. Neovascularization and an increase in immune cells are also evident in advanced stages. The pulp exhibits progressive changes as the resorption continues from stage I to stage III. The changes vary from a smaller number of immune cells and odontoclasts in stage I to increasing number of the same as resorption progresses. Murthy P, Bhojraj N, Hegde U. Changes in Pulp and Roots of Deciduous Teeth during Different Stages of Physiologic Resorption: A Histologic Study. Int J Clin Pediatr Dent 2023;16(3):437-443.

Preliminary study of two deciduous human molars from the Late Pleistocene layers of Song Terus (East Java): A window into the last Homo erectus and the first Homo sapiens in Java

Java is one of the oldest places outside Africa which was occupied by early humans, from the first ‘archaic’ Homo erectus after 1.8ma to the progressive form around 70-40ka. Up to now, paleoanthropologists do not know clearly when the anatomically modern human started to colonize this island. Some previous scholars proposed scenarios which presumed to be as early as 125ka, or just after one of the Toba eruptions after 74ka, and or at least to the last glacial maximum about 21ka. This research tried to contribute to the question about the history of human occupation in Java during the Late Pleistocene. Two unpublished deciduous teeth discovered in the Song Terus site are considered: ST06 is dated back from older than 80ka and another tooth ST04 is younger than 60ka. We compared both specimens with Homo erectus s.l., Neanderthal, ancient and recent Homo sapiens, to identify their taxonomical position. Morphological and metrical comparative analysis of the external and internal dental characters were observed. Preliminary results show that ST04 is closed to Homo sapiens while ST06 belongs to the Homo erectus s.l. group. It confirms that Homo erectus was still survived at least at the beginning of the Late Pleistocene, during the last interglacial maximum period (125ka). Moreover, it suggested that Homo sapiens was probably present in Java Island after 60ka at the same time as a renewal of the local fauna takes place. It could imply a chronological succession of occupations between the last Homo erectus and early Homo sapiens in Southeast Asia.

Comparative study of biomechanical effects between two types of 2 × 4 techniques employing a rocking-chair archwire: a three-dimensional finite element analysis.

After bonding brackets to the first deciduous molar in a 2 × 4 technique, a three-dimensional finite element analysis (3D FEA) is used to demonstrate the biomechanical changes in an orthodontic system. This study aims to opt for the appropriate type of orthodontic technology by analyzing and comparing the mechanical systems produced by two types of 2 × 4 techniques employing rocking-chair archwires. Herein, the maxilla and maxillary dentition are modeled by cone beam computed tomography (CBCT) and 3D FEA. Common clinically used 0.016-inch round archwires (material: titanium-molybdenum alloy and stainless-steel) and 0.018-inch round archwires (material: titanium-molybdenum alloy and stainless-steel) are bent into the shape of a rocking chair with a depth of 3mm. The forces and moments applied to the brackets are transferred to the dentition to evaluate the biomechanical effects of the 2 × 4 technique after the bracket is bonded to the first deciduous molar. For the central incisor, the teeth-moving distance in all three directions increases with bracket bonding to the first deciduous molar applying the 0.016-inch rocking-chair archwire. For the lateral incisor, the tooth root moves toward the gingival side when using 0.016-inch and 0.018-inch archwires. Moreover, for the same archwire size, the lateral incisors move toward the gingival side by bonding the bracket to the first deciduous molar. After bonding a bracket to the first deciduous molar, using rocking-chair archwires of 0.016 inch or 0.018 inch, the buccal movement distance of the first molar crown increases in the X-axis direction. In the Y-axis and Z-axis directions, the modified 2 × 4 technique significantly increases the effect of backward-tipping compared with the traditional 2 × 4 technique. In clinical practice, the modified 2 × 4 technique can be used to increase the movement distance of anterior teeth to a certain extent and accelerate the orthodontic teeth movement. Moreover, the modified 2 × 4 technique is better in anchorage conservation of the first molar than the traditional technique. Although the traditional 2 × 4 technique is widely used in early orthodontic treatment, we found mucosal damage and abnormal archwire deformation might affect orthodontic treatment time and effect. The modified 2 × 4 technique is a novel approach that avoids these drawbacks and improves orthodontic treatment efficiency.

Malocclusion predictors in children with primary dentition (part one)

Relevance. The evaluation of malocclusion risk factor impact in primary dentition is an essential tool for prevention and treatment planning and high-quality child orthodontic care.The study aimed to determine malocclusion predictors in children with primary dentition.Material and methods. The article presents the retrospective dental status analysis findings of 123 children (55 boys and 68 girls). The initial oral examination was at 4.0 to 55 years old (average age was 5.1 ± 0.6 years), and the reexamination was at 6.0 to 10.5 years old (average age was 8.7 ± 1.3 years). We evaluated the presence of a relationship and its strength between the risk factors in primary dentition and malocclusion in early mixed dentition using Pearson's chi-squared test (χ2) and Kramer–Welch criterion (V). The study calculated the odds ratio with a 95% confidence interval for each pair of primary dentition risk factors – early mixed dentition malocclusion.Results. Differentiation of predisposing factors and their combination analysis allowed the formation of predictor clusters for primary dentition with the clinical probability of malocclusion in the mixed dentition of over 95%. For distal occlusion, the risk factor cluster included early extraction of lower deciduous molars, mouth breathing and postural disorder (χ2 = 11.46, V = 0.47); for mesial occlusion – early extraction of upper deciduous incisors and upper deciduous molars (χ2 = 18.30, V = 0.53); for deep overbite and open bite – early extraction of lower deciduous molars and reverse swallowing (χ2 = 14.61, V = 0.56); for an anterior open-bite – interdental lisp and sucking habits (χ2 = 20.91, V = 0.50); for the mandibular lateral shift – unilateral extraction of lower molars and mouth breathing (χ2 = 9.98, V = 0.42).Conclusion. Malocclusion predictor identification and elimination in children with primary dentition reduce the likelihood of malocclusion formation in mixed dentition.

Evaluation of Efficiency of Distal Shoe Space Maintainer: A Systematic Review

Aim: A space deficiency in the dental arch may result from the early loss of a second deciduous molar before the eruption of the first permanent molar. In this circumstance, the Distal Shoe Space Maintainer (DSSM) is recommended to prevent space loss. We aimed to evaluate the effectiveness and safety of this device. Materials and Methods: PUBMED, Cochrane libraries, Google scholar, Ebsco, and Science Gov. were all thoroughly searched. The effectiveness of DSSM as measured by patient tolerance and gingival response to DSSM was our main outcome goal. Also, we evaluated each study’s quality and design. Results: Eleven publications that fit the criteria for inclusion were examined after duplicates were removed. These papers were eventually chosen and thoroughly examined. The studies provided insufficient details regarding the efficacy of space maintenance or gingival response to the DSSM. Conclusion: The main concern is to provide maximum benefit to the patient with minimum discomfort, maximum effectiveness, more cooperation and less chair-side time which can be achieved by the modified distal shoe appliance when compared with the conventional, as it was more stable and required less chair-side time. Though the appliances were designed keeping all the basic requirements in mind, it is firmly recommended to assess more patient-centered outcomes of DSSMs.

One-year oral health outcome of a community-based trial in schoolchildren aged 6-7 years old in Tehran, Iran.

Promoting schoolchildren's oral health is important, particularly in developing countries. This study was conducted to monitor the oral health of schoolchildren aged 6-7 years old following the implementation of an oral health promotion program in Tehran, Iran. The protocol was registered in the Iranian Registry of Clinical Trials (Code: IRCT20090307001749N4). A cluster random sampling method was applied, and the schools were randomly allocated to intervention and control groups. An intervention package consisting of a one-day workshop for parents and supervised toothbrushing for children was employed. In both groups, the Caries Assessment Spectrum and Treatment (CAST) and Oral Hygiene Index Simplified (OHI-S) were evaluated at baseline and at one-year follow-up in addition to the questionnaire data. Clinical data were collected by calibrated examiners at both intervals (Kappa = 89.8%, 87.68%) and analyzed using the SPSS software ver. 22.0. Of 739 children included at baseline, 593 were re-examined after one year (response rate = 74%). According to the Generalized Estimating Equation (GEE) analysis, considering the confounding effect of time, significantly more children in the control group had deciduous molars with a score of 3 and higher compared to the intervention group (OR = 1.79; 95% CI:1.17-2.73, p = 0.007). The oral hygiene status of the children significantly improved in the intervention group compared to the controls (B = -0.27; 95% CI: -0.45 --0.08, p = 0.005). After one year, the improvement in the oral health-related attitude of parents and children's oral health behavior was marginally significant in the intervention group compared to the control group [0.2 (0.17) vs. -0.13 (0.05), p = 0.096] and [0.06 (0.06) vs. -0.05 (0.04), p = 0.09], respectively. However, the impact on the oral health-related knowledge and self-reported behavior of the parents was not significant. In the intervention group, children had less caries and a better oral hygiene status compared to the controls after one year.

Oral manifestations in child patient with Ellis-van Creveld syndrome: case report

Ellis–van Creveld syndrome is an autosomal recessive disorder characterized by a tetrad of disproportionate dwarfism, ectodermal dysplasia, postaxial polydactyly, and congenital heart malformations. In this article, we hereby present a case of a 6-year-old Brazilian boy with Ellis–van Creveld syndrome who presented with a remarkable number of classical oral and dental features and uncommon findings such as taurodontism. Clinical examination revealed multiple enamel hypoplasia, absent vestibular sulcus, alveolar serrations in the maxilla anterior region, missing teeth, conical teeth, lower canine rotation, bilateral posterior crossbite, dental caries, and a nodule. Radiographically were observed teeth agenesis, taurodontism of deciduous and permanent molars, and delayed tooth eruption. Clinical and radiographic findings may be present from birth and the pediatric dentist has a fundamental role in the early diagnosis of Ellis–van Creveld syndrome, as well as oral problems prevention, rehabilitation, and aesthetic interventions.

Identification of dental sexual dimorphism in deciduous teeth using craniometry and odontometry: A cross sectional study

Sex determination is an important aspect in identification of individuals especially in cases of identifying victims of mass disasters, organised crimes etc. Odontometry is the measurement and study of tooth size. Cranial anthropometry is the measurement of skull dimensions and is considered to be a versatile technique in the investigation of the craniofacial skeleton because of its validity and practicality. To assess tooth crown area of the deciduous molar teeth, to assess head size, to evaluate the extent of sexual dimorphism using head and dental dimension: This study was done in 150 boys and 150 girls. Maxillary and mandibular arch impressions were made, casts were made with dental stone. A vernier calliper was used for obtaining the measurements. Mesiodistal width and buccolingual width of all the molars were measured in millimetres, tooth crown area (TCA) was calculated. Head dimensions were measured using Martin spreading calliper, Cephalic Index (CI) was calculated. Statistical analysis was done using unpaired “t” test, and logistic regression analysis was performed.: The highest tooth crown area was shown by mandibular left second deciduous molar for both boys and girls (p&amp;#60;0.05). Boys showed higher cephalic index compared to girls (p&amp;#60;0.05). The highest percent dimorphism was obtained for maxillary left first deciduous molar.Tooth crown area and head size can serve as a valuable aid for sex determination in pediatric population.

Impacted Deciduous Second Mandibular Molar Tooth

A 9-years-old boy presented to the Department of Oral and Maxillofacial Surgery with pain in the posterior region of the left mandible. The child was healthy with an unremarkable medical history. There was no family history of the same condition. Intra-oral clinical examination showed the absence of lower left deciduous molar and multiple carious deciduous teeth at both dental arches. Orthopantogram (OPG) confirmed the complete impaction of the lower-left deciduous 2nd molar with inferior retention of the lower 2nd permanent premolar close to the lower border of the mandible [Panel A]. Under local anesthesia, a two-sided flap was raised, surgical removal of the impacted deciduous 2nd molar and extraction of adjacent 1st deciduous molar, the flap was sutured with 3/0 silk suture [Panel B and C]. Failure of eruption or impaction of deciduous molar was linked to the disturbance of the development of the successor's permanent teeth. Deciduous tooth failure of eruption or impaction is rare in comparison with permanent teeth. Among deciduous dentitions, the 2nd molar was the most commonly affected tooth, followed by central incisors. Impaction can cause many serious problems to underlying tooth buds of the permanent dentition including their delayed eruption or even ectopic eruption. Therefore, proper history and clinical examination, and precise treatment are mandatory. After one month, OPG showed complete healing [Panel D] and the patient was satisfied with the aesthetic and functional outcomes.

Association between maxillary canine impaction and other dental anomalies: radiological study of a mixed dentition children’s cohort from an orthodontic clinic

PurposeTo investigate the significance of association between maxillary impacted canines and various dental anomalies.MethodsFiles of 874 orthodontic patients were evaluated for the presence of maxillary impacted canines. From this sample, a group of 97 patients (39 males and 58 females) with at least 1 impacted maxillary canine consisted the study group. This group was compared to a control group of 97 patients (42 males and 55 females) that was created by random selection from the initial sample without maxillary canine impaction. The impaction diagnosis was made from the panoramic radiographs. Chi-square test was used to perform the analysis for significant associations. Stepwise discriminant analysis, binary logistic regression and classification tree were used to identify best combinations.ResultsStatistically significant difference was found for peg-shaped maxillary lateral incisors and infraoccluded deciduous molars. The presence of peg-shaped upper lateral incisors arises the probability of impacted canine to 83.3%, a distal displaced unerupted second premolar to 63.16% and the impaction of any other teeth to 80% as showed by the classification tree.ConclusionsThe presence of peg-shaped maxillary lateral incisors and infraocclusion of deciduous molars can be considered major valuable early risk indicators for maxillary canine impaction, because they manifest before the maxillary canine eruption. Special consideration should be given on distal displaced unerupted second premolar and the impaction of any other teeth. Patients with these dental anomalies are candidates for future interceptive treatment for canine eruption.

Novel ITGB6 variants cause hypoplastic-hypomineralized amelogenesis imperfecta and taurodontism: characterization of tooth phenotype and review of literature

ObjectivesTo characterize phenotype and genotype of amelogenesis imperfecta (AI) in a Thai patient, and review of literature.Materials and methodsVariants were identified using trio-exome and Sanger sequencing. The ITGB6 protein level in patient’s gingival cells was measured. The patient’s deciduous first molar was investigated for surface roughness, mineral density, microhardness, mineral composition, and ultrastructure.ResultsThe patient exhibited hypoplastic-hypomineralized AI, taurodontism, and periodontal inflammation. Exome sequencing identified the novel compound heterozygous ITGB6 mutation, a nonsense c.625 G > T, p.(Gly209*) inherited from mother and a splicing c.1661-3 C > G from father, indicating AI type IH. The ITGB6 level in patient cells was significantly reduced, compared with controls. Analyses of a patient’s tooth showed a significant increase in roughness while mineral density of enamel and microhardness of enamel and dentin were significantly reduced. In dentin, carbon was significantly decreased while calcium, phosphorus, and oxygen levels were significantly increased. Severely collapsed enamel rods and a gap in dentinoenamel junction were observed. Of six affected families and eight ITGB6 variants that have been reported, our patient was the only one with taurodontism.ConclusionWe report the hypoplasia/hypomineralization/taurodontism AI patient with disturbed tooth characteristics associated with the novel ITGB6 variants and reduced ITGB6 expression, expanding genotype, phenotype, and understanding of autosomal recessive AI.

Comparative Evaluation of Shear Bond Strength of Glass Ionomer Cement, Composite and Compomer in Primary Teeth: An In Vitro Study

Background: Because the main dislodging pressures at the tooth restoration interface have a shearing effect, shear bond strength is crucial for the restorative material clinically. Therefore, greater shear bond strength suggests improved material to tooth bonding. Glass ionomer cement and composite is the most popularly used restorative material. Composite resins have better mechanical properties and esthetics than many other types of cement, but they need bonding agents as they are hydrophobic and hence fail to adhere to the teeth. Compomers are polyacid modified resin composites. Compomer and composite resin have similar physical properties, as they are thought to bond to dentin by micromechanical bonding. As resin composites are used in this, the polymerized acid monomer shows acidity when it comes in contact with the saliva and there is a reaction of fluoride-containing basic glass resulting in the cariostatic effect. Aim: The purpose of this study was to evaluate and compare the shear bond strength of Glass Ionomer Cement (Fuji IX GP), Composite Resin (Filtek Z-250) and Compomer, (Compoglass, Ivoclar). Material and Method: An in-vitro, experimental study was conducted on 30 freshly extracted over-retained deciduous molars. Samples were randomly divided into three groups depending on the material to be used. Flat dentinal surface on tooth was prepared over which restorative materials were placed. The prepared specimen was subjected to shear test and the value obtained was compared. Descriptive statistical analysis was performed to calculate the mean shear bond strength of each group. Result: It was observed from the study that the composite resin had the highest shear bond strength value (17.13 ± 1.54), followed by compomer (11.32 ± 1.05) whereas GIC showed the least shear bond strength (6.56 ± 0.87). Conclusion: It was concluded that composite restorative materials show higher shear bond strength than glass ionomer cement and compomer in primary molars, but shear bond strength of compomer was higher than that of glass ionomer cement.

Comparative Assessment of Parents’ Knowledge, Attitudes, and Practices Regarding Caries Preventive Measures among Elementary School Students with Carious and Healthy Permanent Mandibular First Molars in Ahvaz City

Background and Objectives The first permanent molar teeth develop at the age of 6 to 7 and usually slowly and without concern in the posterior molar second molar. Accordingly, the present study aims to compare parents' knowledge and attitudes about prevention methods. Caries in two groups of primary school children with permanent and deadly molar teeth in Ahvaz city in 1397-98. Subjects and Methods This study was descriptive-analytic. The sample size was 214 children with permanent and impaired primary molars, and their parents were selected according to the formula and randomly. Data were collected by a researcher-made questionnaire. Then it was analyzed by SPSS20 software and descriptive and inferential statistics. Results Parents 'awareness of decay prevention methods in primary school children was very low in deciduous first molars and in children with normal molar teeth, there was a significant difference between parents' knowledge scores (P &lt;0.05). The mean of the answers to all the questions related to parents' attitude in primary school children with the first molars was 6 and in the group with the first molars was 4.99. Parents' performance in children with first molar teeth was desirable and in children with impacted first molar teeth was undesirable. Parental performance of the two groups was significantly different (P &lt;0.05). Conclusion According to the results, not only did parents increase their knowledge and attitudes toward oral health of their children, but also provided the necessary facilities for the implementation and performance of the learning.

Premature deciduous tooth loss: a rare case of detrimental sequelae to the permanent dentition

Early loss of deciduous teeth can be associated with loss of space, tooth displacement, centreline disturbance, tooth impaction and ectopia. Its inevitability, unless monitored accordingly, among patients makes it pivotal that practitioners are aware of the detrimental effects, so they are able to consider these in the patient's management. This report presents the case of an 18-year-old patient who experienced tooth impaction and significant first premolar root resorption following the premature loss of deciduous second molars. CPD/Clinical Relevance: The orthodontist should be aware of the potential for detrimental sequelae of early primary tooth loss and subsequent tooth impaction, and ensure these are appropriately assessed and investigated in order to incorporate these into a patient's management plan.

Infraocclusion – an anomaly in primary dentition

Infraocclusion is a developmental abnormality that affects a tooth lying below the plane of occlusion. It is most common in children with mixed dentition, past the age of six. It is usually noticeable in the posterior part of the dental arch, involving one of the deciduous molars. The presence of infraocclusion can be identified by clinical examination or on radiographs. The aim of the study was to present a literature review on the incidence of infraocclusion in primary molars in children in various populations and on further clinical management. The review covered publications from the last 20 years. The following online databases were searched: PubMed, Google Scholar, and Scopus. Eight scientific papers were eligible for the review. The inclusion criteria were as follows: children, without systemic diseases or syndromes, with infraocclusion. The analysed studies show that the process usually affects a small number of teeth – most children present two infraoccluded molars. The condition shows no predilection for any sex. Across different populations, the percentage of children affected by infraocclusion ranges from 2.8% to 21.8%. With age, there is a decrease in the incidence of mild infraocclusion, and an increase in the incidence of the moderate (ages 8–10) and severe (ages 11–13) forms of the condition. Our review reveals that infraocclusion most often affects the teeth in the mandible, mainly the first primary molars and, in older children, the second molars. The treatment of patients should be planned individually, considering the age of the subjects and their clinical status. Tooth extraction is performed in extremely severe cases, which are uncommon.

Therapeutic Strategies of Primary Molar Infraocclusion: A Systematic Review

Infraocclusion of deciduous molars is a clinical disturbance that occurs during primary and mixed dentition and has some orthodontic implications. Infraoccluded teeth are believed to be potential sites of malocclusion, with a risk of tipping neighbouring teeth and losing space. This systematic review aims to analyse the management of primary molars infraocclusion and to provide updated guidelines. A literature search was performed using PubMed, Scopus, and Web of Science databases from 1 January 2017 to 28 November 2022. The inclusion criteria were: studies only on human subjects, open access studies, case reports, randomised trials, retrospective, observational studies, and English language. A total of 372 publications were identified from the databases and a final number of nine studies were included in the review for qualitative analysis. Management of patients suffering from infraocclusion depends on the severity, age at diagnosis, and presence of succeeded premolars. Early diagnosis of infraoccluded primary elements is fundamental and cannot be postponed. Preservation of the primary molars may be a valid option with long-term stability if there is no or moderate primary molar infraocclusion, root resorption of less than half of the root, and no decay or restoration.