Caries Excavation Research Articles

Development of artificial neural network model for prediction of post-streptococcus mutans in dental caries

Background and objectiveStreptococcus mutans is the primary initiator and most common organism associated with dental caries. Prediction of post-Streptococcus mutans favours in the selection of appropriate caries excavation method which eventually results in meliorate caries-free cavity preparation for restoration. The objective of this study is to predict the post-Streptococcus mutans prior to dental caries excavation based on pre- Streptococcus mutans using iOS App developed on Artificial Neural Network (ANN) model. MethodsFor the current research work, children with occlusal dentinal caries lesion were chosen, 45 primary molar teeth cases were studied. Caries excavation was done with carbide bur, polymer bur and spoon excavator. The colony forming units for pre and post-Streptococcus mutans were recorded, data emanating from clinical trials was employed to develop the ANN models. ANN models were trained, validated and tested with the registered clinical data using different ANN architectures. ResultsFeedforward backpropagation ANN model with an architecture of 4-5-1, predicts post-Streptococcus mutans with an efficiency of 0.99033, mean squared error and mean absolute percentage error for testing cases were 0.2341 and 4.967 respectively. ConclusionsCaries excavation methods and pre-Streptococcus mutans are feed as inputs, while post-Streptococcus mutans as targets to develop ANN model. Based on the developed ANN model, an ingenious iOS App was developed, the global clinician may utilize the App to meticulously predict post-Streptococcus mutans on iPhone based on pre-Streptococcus mutans, which in turn aids in decision making for the selection of caries excavation method. This study manifests the potential application of iOS App with built-in ANN model in efficiently predicting the post-Streptococcus mutans. Also, the study extends scope for applications of iOS App with built-in ANN models in clinical medicine.

Attitudes And Behavior Of Dentists Regarding Management Of Deep Carious Lesion

Objective: To assess the attitude and behavior of dentists for the management of deep carious lesions. Study Design and Setting: It was a cross sectional based study conducted at six dental institutes of Karachi from both government and private sectors. Methodology: The included participants were the dental graduates and post graduates working in different specialties of dentistry. Whereas graduates and post graduates not affiliated with any institution were excluded from the study. The Questionnaire comprises of two parts, first part was composed of participant’s demographic details and academic qualification, while the second part comprised of clinical scenarios regarding management of deep carious lesions. Results: From the 250 distributed questionnaires, 218 dentists returned the questionnaire giving a satisfactory response rate of 87.2%. There were 28% male and 72%% female dentists. The majority of dentists were aged between 25-35 years old. Complete caries removal was the management of choice by 72.5% of dentists for deep carious lesions. Conclusion: Complete caries removal was the most preferred treatment modality when the risk of dental pulpal exposure associated with caries excavation is low. However when the risk is high, step-wise excavation was preferred procedure by half of the participants.

3D Printed Teeth for the Preclinical Education of Dental Students.

A need for more realistic tooth models for education has often been expressed by dental students. The aim of this study was to design and create 3D printed teeth with anatomical details for use in preclinical dental education. A tooth with realistic carious lesions and pulp cavity was designed, and this tooth was used in 2018 with 47 dental students for preclinical education in caries excavation, direct capping of the pulp, core build-up, and crown preparation. The students had the ability to identify the carious lesions by a simulated radiograph and by tactile sense of the consistency. The benefits of the 3D printed tooth were evaluated by a questionnaire. The printed tooth was evaluated by grades (1=excellent, 2=good, 3=satisfactory, 4=adequate, 5=poor). The students gave the tooth an overall mean grade of 1.9, with a grade of 2.0 for the haptic impression, 1.5 for the exercise, 1.9 for the examination, and 1.5 for high practical relevance in contrast to a standard model tooth. The new features of the printed tooth were given a mean grade of 2.0 for the radiograph, 2.3 for consistency of the caries, 2.0 for the tooth filling, and 1.7 for the pulp capping as realistic. The students had the possibility to generate a complete concept for prosthodontic tooth treatment on an artificial 3D printed tooth.

Histological determination of cariously altered collagen after dentin caries excavation with the polymer bur PolyBur P1 in comparison to a conventional bud bur

BackgroundTo compare the polymer bur PolyBur P1 (P1) with tungsten carbide bud bur H1 SE (H1) in removing cariously altered collagen during dentin caries excavation.MethodsFifty extracted teeth were split in the center of a carious lesion. The 100 specimens were randomly divided into 5 groups. Five dentists were asked to excavate 10 teeth each: one half with P1 and the corresponding half with H1. The time needed for caries excavation was measured. Subsequently, histological specimens were produced and analyzed by light-microscope after Mallory-Azan-staining. The thickness of remaining cariously altered collagen was measured (< 1 mm or > 1 mm). The results were statistically evaluated.ResultsThe average time to excavate a cavity with P1 was 254 (± 148) sec and 202 (± 129) sec with H1. The difference in times was not statistically significant (p > 0.05). In the group P1 in 66.1% of the sections cariously altered collagen remained, whereas 33.9% showed sound collagen. In the group H1 45.7% sections had remaining cariously altered collagen and 54.3% showed sound collagen. The difference between P1 and H1 was statistically significant (p = 0.004). In the group P1 the layer of cariously altered collagen was significantly more often thicker than 1 mm than in the group H1 (p < 0.05). The variable “type of bur” had a statistically significant influence for the presence of cariously altered collagen (p = 0.003).ConclusionsConventional H1 bud burs were significantly more effective in removing cariously altered collagen during dentin caries excavation than the polymer bur P1.

Work experience influences treatment approaches in endodontics: a questionnaire survey among dentists in Western Norway

Objectives: To collect information on endodontic treatment procedures among dentists in the public dental service (PDS) in Western Norway and relate this information to their work experience.Materials and methods: A survey comprised of 35 questions related to personal information, frequency of endodontic treatment, endodontic procedures and treatment principles was distributed electronically to 187 dentists in PDS in two counties of Western Norway.Results: The response rate was 74%, and 130 dentists participated. Among them, 57.0% had completed their education less than 13 years ago, and almost all were below 39 years old (95%). The majority (81.0%) had graduated in Norway. Stepwise caries excavation in primary and permanent teeth and direct pulp capping in primary teeth were more frequently performed by dentists with less than 13 years from graduation. Routine use of rubber dam was high among the responders (87%). However, use of rubber dam and master-cone radiograph uptakes were more frequent among the younger dentists. The majority used rotary instrumentation systems, and almost all participants followed the current guidelines for use of antibiotics in endodontics.Conclusions: In general, dentists in PDS follow the current endodontic treatment guidelines. However, it seems that the more recently graduated dentists perform more endodontic procedures and tend to adhere more to the taught principles regarding rubber dam use and radiograph uptakes.

Comparative evaluation of clinical outcome of indirect pulp treatment with calcium hydroxide, calcium silicate and Er,Cr:YSGG laser in permanent molars.

The aim of the study was to compare preservation of pulp vitality by indirect pulp treatment with calcium hydroxide, calcium silicate based cement (Biodentine) and Er,Cr:YSGG laser in permanent molars. 30 patients were selected for this study as per the inclusion and exclusion criteria in the age group of 6-14 years and then randomly allocated to three groups A, B & C. In group A, after caries excavation, calcium hydroxide (Dycal) was placed at the floor. In group B, after caries excavation, calcium silicate based cement (Biodentine) was placed at the floor. In group C, after caries excavation, decontamination of the cavity was done with Er,Cr:YSGG laser. This was followed by placement of permanent restorative material in all the groups. Clinical and radiographic success was monitored at 3, 6 and months. Data analysis was performed using Statistical Package for the Social Science-21 (SPSS-21). At the end of 9 months, overall success rate of indirect pulp was 86.6%. There was no significant difference between the three groups. (p > 0.05). The study showed that the success of indirect pulp treatment is independent of the type of liner used for pulp capping. Moreover, the study also shows that Er,Cr;YSGG laser can be effectively used for indirect pulp capping procedures.

Success of Direct Pulp Capping Using Mineral Trioxide Aggregate and Calcium Hydroxide in Mature Permanent Molars with Pulps Exposed during Carious Tissue Removal: 1-year Follow-up

IntroductionThis randomized clinical trial aimed to compare the success rate and postoperative pain of direct pulp capping (DPC) using calcium hydroxide (CH) and mineral trioxide aggregate (MTA) in teeth with carious pulp exposures and reversible pulpitis. MethodsSixty-four permanent teeth were randomly divided after caries excavation into 2 groups: CH and MTA (n = 32 in each group). Exposed pulps were capped using standardized protocols. The treated teeth were restored with glass ionomer cement and composite restoration. The primary outcome was success rate at the 12-month follow-up, and the secondary outcome was postoperative pain after 7 days. Clinical and radiographic evaluations were performed at 3, 6, and 12 months. Pain was recorded using the visual analog scale every 24 hours for 7 days after intervention. ResultsFifty-six patients were analyzed at the 12-month follow-up, 29 treated with CH and 27 with ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK). The success rate was 69% for CH and 93% for ProRoot MTA (P < .05). The kappa value of interrater agreement was 0.773.No significant difference in pain incidence was found between the 2 groups (P > .05) although a significant pain reduction was found 6 hours after the procedure in both the groups. Significantly lower pain scores were reported in the MTA group (6.3 ± 9.5) compared with the CH group (18.5 ± 20.8) after 18 hours. ConclusionsTeeth with carious pulp exposures and reversible pulpitis can be treated successfully with DPC. MTA proved better than CH in terms of both success rate and pain intensity.

Effect of Different Liners on Pulpal Outcome after Partial Caries Removal: A Preliminary 12 Months Randomised Controlled Trial

Aim: The aim of this double-blinded parallel randomised controlled trial was to compare the effect of different liners on 12-month pulp health outcomes after partial caries removal (PCR) with composite restorations in permanent molars. Methods: The study was registered at clinicaltrials.gov with registration No. NCT0328695 and conducted in the Department of Conservative dentistry and Endodontics, Post Graduate Institute of Dental Sciences Rohtak with no external financial support. One hundred and ninety-eight participants (116 males, 82 females and age 14–54 years) with vital permanent mature mandibular molars having deep caries involving two-thirds or more of dentin were randomised to calcium hydroxide (CH), resin-modified GIC (RMGIC) and no liner (DC) groups after PCR. After a follow-up time of 12 months, success was defined as positive response to pulp sensibility and absence of periapical alterations. Results: Categorical variables were compared using chi-square test. Two analytical approaches were used, such as intention-to-treat and per-protocol approach. Success rates in per-protocol approach were 96.8, 96.5, and 94.6% for CH, RMGIC and DC groups, respectively with no significant difference between 3 groups (p = 0.811). None of the baseline variables had any significant influence on the treatment success. Conclusion: Partial caries excavation has a high success rate to treat deep carious lesions in permanent teeth after 12 months of follow-up, indicating that the retention of carious dentin does not interfere with pulp vitality or restoration survival. Also, the success of the treatment is independent of the lining material used over the demineralized dentin.

Effect of liner on the marginal integrity of resin composite restorations after selective caries excavation: An In Vitro study

Abstract Aim: The aim of this study is to evaluate the effect of cavity liner on marginal adaptation and microleakage of resin composite restorations placed with and without selective caries excavation. Materials and Methods: Class II cavities were prepared in 64 extracted upper premolar teeth followed by microbiological caries induction to simulate deep carious lesions. Composite restorations were performed: Group 1A: without liner and Group 1B: with resin-modified glass ionomer liner after nonselective caries excavation; Group 2A: without liner and Group 2B: with resin-modified glass ionomer liner after selective caries excavation. Maximum gap thickness was measured using a scanning electron microscope to assess the marginal adaptation, and dye penetration method was used for microleakage assessment. Results: There was a statistically significant difference between the groups in maximum gap thickness based on the type of caries excavation (P &lt; 0.001) but not for the placement of liner. Selective caries excavation groups had higher values at all margins. Microleakage between the groups was significantly different, both at the occlusal (P = 0.006) and gingival margins (P &lt; 0.001), with Groups 2A and 2B showing higher microleakage. Conclusion: Resin composite restorations performed after selective caries excavation showed decreased marginal integrity and liner application did not contribute to any significant improvement in the same.

Effects of photodynamic therapy with indocyanine green on Streptococcus mutans biofilm.

The current procedures for treating tooth decay are not always guaranteed to successfully remove all microorganisms which cause disease. For elimination of bacteria and prevention of their effects, different methods are recommended, such as antibacterial materials and cavity disinfectants. The aim of this study was to compare the antibacterial activity of photodynamic therapy (PDT) using diode laser with indocyanin green (ICG) on Streptococcus (S.) mutans biofilm with conventional methods. Ninety human molars were divided into 9 groups: negative control, positive control, CHX, NaOCl, gaseous ozone, erbium (Er):YAG laser, diode laser, and indocyanin green/ICG, and PDT. Cavities were then cut into the teeth (2 per tooth, 20 cavities per group) and sterilized. For all of the groups, with the exception of the negative control group, 105 CFU/mL of the active S. mutans culture were inoculated into the cavities and then incubated at 37 °C for 72 h. Then, dentin chips (25 ± 5 mg) were collected from cavity walls and spread on Mueller-Hinton agar media after decimal dilution. The colonies were counted after incubation at 37 °C for 24 h. All the treatments significantly reduced the number of S. mutans compared with the positive control group (p < 0.05). The antimicrobial effectiveness of CHX, NaOCl, ozone, PDT, Er:YAG laser, and diode laser groups were similar. The lowest bacterial reduction was observed in the ICGgroup. This work concludes that PDT using diode laser with ICG may be suggested on the cavity disinfection after caries excavation as an alternative to conventional methods.

Molecular characterization of intact cell-derived and cell-free bacterial DNA from carious dentine samples

Microbial analyzes of carious dentine samples, especially in terms of interventions, represent a challenge due to difficulties in carious dentine sampling particularly with small bacterial DNA contents. Therefore, information about the quantitative reduction of bacterial DNA as well as microbial shifts and differences in diversity correlating with treatment interventions are scarce. In this study, carious dentine samples were collected in a first step in the course of a selective caries excavation at two different deep dentine caries lesions in three patients. Second, after selective caries excavation and sampling of carious dentine, an intervention was performed by applying dental materials onto the remaining carious dentine followed by a restoration of the study teeth with composite fillings. After 8 weeks, remaining carious dentine was sampled and analyzed as described above. The microbial community before and after therapy was analyzed by conventional culture compared to bacterial DNA analyses using 16S rRNA gene based real-time PCR and terminal restriction fragment length polymorphism (T-RFLP) for fingerprinting community changes within carious dentine samples. An ultra-pure workflow allowed the valid comparison of even small carious dentine samples with low DNA contents and the differentiation between intact cell-derived and cell-free bacterial DNA. Intra- and inter-subject related differences in the bacterial DNA content and its composition in deep dentine caries were determined considering the first visits. The ratio of cell-free bacterial DNA and DNA from intact cells decreased in two of three subjects included in the current study from visit 1 to visit 2 with the test substance (1:200 to 1:17) and the control substance (1:82 to 1:7). T-RFLP revealed changes in the bacterial diversity and composition shifts after treatment as well as between cell-free bacterial DNA and DNA derived from intact cells.The approach of differentiation and quantification of cell-free and intact cell-derived bacterial DNA is reasonable within the investigation of carious dentine samples, especially when considering the effect of an intervention. T-RFLP is principally suitable for the analysis of microbial shifts within carious dentine samples.

Minimal Invasive Potential of Three Caries Excavation Methods in Children

Background: Recently, the concept of minimally invasive (MI) dentistry has emerged. MI calls for the selective removal of heavily infected and irreversibly denatured dentin caused by carious lesions while preserving dentin that is demineralized but not infected. Aim: To compare the minimal invasive potential (MIP) of conventional caries excavation (CCE), caries detection dye (CDD), and fluorescence aided caries excavation (FACE) methods in children. Subjects and Methods: A total of 105 carious primary molars in 43 children were included in this study. The teeth were randomly divided into three groups according to the caries excavation method. Preoperative evaluation of the carious teeth was performed using digital radiography after sealing the cavities with a radiopaque material. Caries excavation was performed using CCE, CDD, or FACE method. The teeth were restored using self-cured glass ionomer. Post-operative radiographic examination was then performed. Pre-operative and post-operative widths and depths for the cavities were assessed. MIP was determined by comparing the prepared-cavity width and depth relative to the initial width and depth of the caries lesion, respectively. Results: There was no statistically significant difference between the MIP of examined groups neither after comparing cavity widths at p=0.253 nor depths at p=0.06. FACE showed the highest mean values of MIP potential for cavity widths (1.41±0.36) and depths (2.04±0.74). Conclusions: CCE, CDD, and FACE showed comparable MIP in children.

Comparative evaluation of efficacy of chemomechanical and conventional methods of caries excavation in young permanent molar teeth: In vivo study

Aim: To evaluate and compare the efficacy of chemomechanical method using Carie-Care (Eco Works Pvt. Ltd.) and conventional method (airotor and hand instruments) during excavation of caries in young permanent molar teeth. Methodology: Twelve children in the age group of 6–9 years having moderate occlusal caries in any two first permanent molars according to the ICDAS-3 or 4 category were selected. Caries excavation in Group I was carried out by the conventional method using airotor and hand instruments. In Group II, it was carried out using Carie-Care gel. The findings recorded in the study included pain response during caries excavation using the Wong-Baker Faces Pain Scale (WBFPS), time taken for caries excavation using a stopwatch (Taksun TS-1809), and the need felt for administration of local anesthesia in children for both the methods. Results: Data obtained were subjected to statistical analysis. Intergroup comparison for WBFPS scores and time needed for caries excavation was done using unpaired t-test and the results obtained were statistically highly significant (P

Clinical evaluation of biodentine: Its efficacy in the management of deep dental caries.

The advancement in the dentin regeneration aiming at the preservation of pulpal vitality has challenged the traditional concept of substituting diseased tooth with inert materials. Clinical studies, demonstrating preservation of pulpal vitality with the use of biomimetic materials in deep carious lesions, are lacking in the literature. This clinical study aims to assess the treatment outcome of vital pulp therapy using Biodentine in cases of deep carious lesion in a single visit treatment protocol. Twelve posterior teeth with deep carious lesion with no signs of irreversible pulpitis were selected for the study. After rubber dam application, excavation of caries was performed until all infected dentin was removed leaving behind affected dentine. Biodentine was applied followed by immediate restoration with bonded composite resin. The patient was recalled at time intervals of 1 day, 1 month, 3 months, 6 months and up to 1 year for clinical and radiographic evaluation. Outcome was described in terms of success and failure. Success was defined as clinical absence of signs and symptoms, response to sensibility test on every recall visits, no tooth discoloration seen, and radiographical absence of periapical pathosis. All the 12 patients were recalled at the end of 1 year for follow-up. The overall success rate was 83.4%. Two of the twelve cases required root canal treatment to relieve painful pulpitis. On clinical and radiographic examination, no signs of periapical pathosis were noted in the 10 successful cases. In deep carious lesions, vital pulp therapy with Biodentine has proven to maintain the pulpal vitality in permanent teeth with single visit treatment protocol.

A comparative evaluation of the estimated radiographic remaining dentin thickness with the actual thickness below deep carious lesions on posterior teeth: An in vitro study

ObjectiveThe remaining dentin thickness (RDT) is the thickness of healthy dentin between the pulpal floor and the roof of the pulp chamber. It is important to be preserved as it provides the pulp with a protection barrier against mechanical injury and inflammatory products. The focus of the study was to develop a validated method to guide dentists and dental students to estimate the RDT before caries excavation by determining the relationship between the radiographic remaining dentin thickness (RRDT) and actual remaining dentin thickness (ARDT). MethodsA total of 30 extracted human teeth were subjected to two-staged experimentation, including exposure to cone beam radiography and measurement of actual remaining dentin after sectioning. RRDT and ARDT were recorded and the difference was statistically analyzed using SPSS. ResultsThe Wilcoxon Signed rank test revealed that there was a significant difference in the mean values of the estimated difference in dentin thickness (p value ≤ 0.05).However, no significant comparison of estimation was made for individual samples for molars and premolars. ConclusionFinding a constant relationship between RRDT and ARDT is challenging.

One-year Clinical Performance of Flowable Bulk-fill Composite vs Conventional Compomer Restorations in Primary Molars.

To evaluate the clinical performance of a flowable bulk-fill composite vs a compomer in Class II cavities of primary molars. In a clinical study, 100 restorations were placed in two randomly assigned comparable Class II cavities in 32 children (aged 6.7 ± 1.2 years) with at least one bulk-fill composite (Venus Bulk Fill, Heraeus Kulzer) and one compomer (Dyract eXtra, Dentsply). After caries excavation, the adhesive Scotchbond Universal (3M Oral Care) was applied in self-etching mode. According to the manufacturer's instructions, Venus Bulk Fill was used for the entire Class II cavity of primary molars without a cover layer. After visible-light curing, both restorations were finished and polished. Both restorative materials were evaluated at baseline and after one year, including esthetic, functional, and biological parameters, using the FDI criteria. The Mann-Whitney U-test was used to determine the difference in the complete scores at baseline and after one year (p < 0.05). After one year, 99 restorations were reevaluated; one tooth had exfoliated physiologically. Concerning the esthetic parameters, Dyract eXtra showed slightly higher scores than Venus Bulk Fill. Both materials showed similar scores regarding functional and biological parameters. No severe postoperative sensitivities or side-effects were reported. There was no statistically significant difference between the performance of Venus Bulk Fill and Dyract eXtra for primary molars. The flowable bulk-fill composite Venus Bulk Fill can be considered as an alternative material for clinical use in primary teeth, but longer-term studies might still be needed.

Comparison of the Estimated Radiographic Remaining Dentine Thickness with the Actual Thickness Below the Deep Carious Lesions on the Posterior Teeth: An in vitro Study.

Objective:Maintaining the remaining dentine thickness (RDT) is crucial because it acts as a protection barrier to the vital pulp tissue against injury and inflammatory products. Based on the relationship between the radiographic RDT (RRDT) and actual RDT (ARDT), we aimed to develop a validated method for guiding dentists in estimating the RDT before caries excavation.Methods:30 extracted human teeth were subject to the two-stage experimentation of exposure to cone beam radiography and measurement of actual remaining dentine after sectioning. RRDT and ARDT were recorded, and the difference was statistically analyzed.Results:A significant difference in the mean values of the estimated difference in dentine thickness was observed (P<0.05). There was no significant difference between molars and premolars as they exhibited a similar range in the difference of the RDT.Conclusion:It is challenging to find a stable relationship between RRDT and ARDT.

Evaluation of telescopic tooth-supported overdentures regarding surrounding supporting structures case study

IntroductionOverdenture according to the glossary of prosthodontic is removable dental prosthesis that covers and rests on one or more remaining natural teeth, the roots of natural teeth, and/or dental implants1. Root-supported overdentures have been fabricated to correct periodontal and/or occlusal collapse, some teeth are maintained to support or retain the prosthesis and therefore, maximizing prosthesis stability, besides preserving proprioception of the periodontal ligament and reducing bone loss2. Telescopic copings have been used for several years in oral rehabilitation of patients with advanced periodontal disease. Patients with periodontal disease undergoing prosthetic reconstruction often present with teeth with minimal supportive tissue and increased tooth mobility. Therefore, it is extremely important for the prosthesis not to cause periodontal destruction or worsen an existing periodontal condition. ObjectiveThe aim of this study was an evaluation of telescopic mandibular tooth-supported overdentures regarding surrounding supporting structures both clinically and radiographically. Materials and methodA 55 years old male patient with few remaining natural teeth was selected from the outpatient clinic in Umm-Alqura university faculty of dentistry. As remaining teeth were periodontally compromised, and low the number of teeth in lower arch for a constructed removable partial denture, It was concluded that mandibular canines and premolars can serve as abutments for an overdenture. Analysis of the mounted cast was made to ensure sufficient space for construct overdenture. The treatment plan was divided into three phases: Phase 1: Caries excavation, Phase 2: Intentional endodontic treatment, Phase 3: Prosthodontic rehabilitation. RESULT: According to the clinical and radiographical measurements in the delivery visit and after one year from the treatment, we concluded that there is no obvious difference. ConclusionTelescopic overdentures have better retention and stability as compared to complete dentures, they improve the chewing efficiency and the comfort of the patient and they also decrease the alveolar bone resorption. According to the result, in this case, the attachment level in the patient mouth and bone change in height or width by cone beam computed tomography (CBCT), and the patient was satisfied from the denture and grateful.

Management of Talons Cusp in a Primary Maxillary Central Incisor: A Rare Case Report

Talon cusp is a rare dental anomaly that manifest’s as an accessory cusp like structure most commonly seen on the crown of the anterior teeth. This report describes the conservative management of a tooth with a Talon cusp with pulp extension. A 5-year-old female reported to our department with the chief complain of decayed teeth. On examination Talon cusp was noticed on the palatal aspect of 51. Caries excavation followed by restoration and fluoride varnish was applied. Cusp reduction was done to avoid occlusal interference. Depending on the type of Talon cusp a proper diagnosis and treatment plan needs to be formulated. Treating a tooth with talon does not always require endodontic management and can be treated conservatively. Clinical significance: Early diagnosis of this anomaly and management of the same by the clinician will help prevent further complications.

Clinical evaluation of direct pulp capping using a calcium silicate cement-treatment outcomes over an average period of 2.3years.

This study aims to assess the treatment outcomes of direct pulp capping with a calcium silicate cement (Biodentine) after caries excavation. A total of 245 teeth of 226 patients diagnosed to be clinical healthy or showing spontaneous pain were directly capped. The teeth were examined 0.19 to 7.4 (mean 2.3 ± 2.04) years after treatment. The following data were recorded: age and sex of the patient, type of tooth and restoration (glass ionomer cement [GIC], amalgam, composite resin, ceramic, gold) and symptoms before or after treatment. The evaluation of the treatment was carried out by sensibility and percussion testing and by the patient's questioning. A positive sensibility test, a negative percussion test, the absence of swelling and discomfort were considered as treatment success. Survival analysis was performed using the Kaplan-Meier, log-rank, Chi-square and Fisher's exact test, respectively. After an average period of 2.3years, 86.0% of the teeth remained vital; the survival rate after 7.4years was 83.4%. The treatment outcome was significantly worse for cavities restored with GIC compared to all other restorative materials (p< 0.05). All other evaluated factors had no significant influence on the success rate (p> 0.05). Exposed pulps of asymptomatic vital permanent teeth and teeth with spontaneous pain before treatment can be successfully capped directly using Biodentine. A subsequent restoration with GIC does not appear to be suitable as it significantly reduces the success of the treatment. Direct pulp capping can be done successfully with this type of calcium silicate cement.