Primary Dentition Research Articles

Pulp Therapy of Primary Dentition; its Relevance despite Insufficient Histological Evidence: A Review.

Pulp treatment in primary dentition is generally divided into vital and non-vital pulp therapies and assists in the preservation of pulpally involved primary teeth in the dental arch until the affected tooth naturally exfoliates. The success of pulp therapies depends on several factors; e.g. proper case selection, accurate diagnosis and good coronal seal. To date, studies on the success and failure rates of pulp treatments are based on clinical signs and symptoms, radiographic findings and histological analysis. However, the clinical and radiographic evidence may not completely portray the true status of the dental pulp. Histological evidence remains the gold standard in the assessment of pulp condition, whether it is in a healthy or adverse state. The aims of the current research were to summarise the treatment outcomes of pulp therapy in primary dentition based on clinical, radiographic and histological criteria, and to support its relevance in the presence of limited histological evidence to measure authentic treatment success. An electronic database search of dental literature from 1990 to 2022 was carried out using the MEDLINE, i.e. PubMed, database. Current dental literature showed that the success rates of primary tooth pulp therapy are high. The obtained results were based largely on clinical and radiographic studies with narrow histological investigations to assess the treatment outcome(s) of pulp therapy in primary dentition. Despite the scarcity of histological evidence, pulp therapies in primary teeth are still practical due to their statistically empirical success compared to their failure. Consequently, pulp therapy of primary dentition is still relevant, and should continue to be indicated as an important treatment option.

Long-term incompatibility of nutritional status and early childhood caries-A call to revamp perinatal and early childhood dietary care and follow-up.

Dietary pattern and diet quality can influence the incidence of dental caries and can be indicated by decay missing filled (Dmf) scores in the primary dentition. This study aims to find the relationship of nutritional status and oral hygiene practices on Dmf scores of preschool children. Semi-structured and self-administered questionnaires, distributed among 60 preschoolers' parents, were used to assess the demographic and diet related data. Anthropometric measurements of the preschoolers were taken following universally accepted protocols. The relationship between dietary supplement consumption and the presence of dental caries was evaluated by chi-square test employing SPSS 22. The anthropometric measurements among 4-year-old children were on par with the standard values and that of 5-year-olds were below the reference range. All the measurements except head to chest circumference were higher than normal range among 3-year-old subjects. Regular and periodic dental check-ups significantly influenced dental caries prevention (p = 0.030). Statistically, there was no significant association between Dmf scores and thumb-sucking habits (p = 0.568), brushing teeth and usage of tooth floss (p = 0.96), consumption of nutrient supplements (p = 0.744), and BMI (p = 0.564) of the subjects. Furthermore, the correlation between z scores and Dmf scores was found insignificant. Long-term as well as short-term malnutrition initiated 2 years after the start of the pre-schooling. With severity of undernutrition there was a trend to have high Dmf scores.

Clinical interventions for caries management through minimal intervention procedures in young children: an updated evidence-based review.

This review aimed to summarize the preventive, non-restorative and restorative minimal intervention dentistry (MID) interventions for managing dental caries during the primary dentition stage, after selecting the highest quality evidence. A comprehensive literature search for relevant studies was performed in PubMed (MEDLINE), Embase, Cochrane Library and Google Scholar, published between 2007 and 2022. Only clinical randomized controlled trials, clinical guidelines with literature review, systematic reviews and meta-analyses conducted in the primary dentition were included. One hundred fifty-three MID-associated references were found, and 63 of them were considered for the present review. Of these, 24 were clinical randomized controlled trials, 21 were systematic reviews, 3 umbrella reviews and 11 practice guidelines with a literature review. The retrieved evidence was divided into (and discussed) three general caries management strategies: (i) carious lesion diagnosis and individual risk assessment; (ii) preventive measurements and non-cavitated lesions management; and (iii) cavitated lesions management. MID is an attractive alternative management that promotes prevention rather than intervention to achieve a long-lasting oral health in young children through easy and cost-benefit preventive, non-invasive, minimally invasive or conservative invasive restorative measures. This philosophy of management is suitable for treating young children, considered friendlier and less anxiety-provoking than traditional methods.

Comprehensive Oral Rehabilitation Amidst COVID-19 Times with General Anaesthesia in the Primary Dentition in Children with Frankel's Definitely Negative Behaviour

Accomplishing complete dental rehabilitation in a young child requires extra efforts, primarily because of the need to make use of behavior modification techniques, especially in the children requiring extensive dental procedures. Pharmacological means are sought when nonpharmacological techniques fail. General anesthesia (GA) comes to rescue in such cases. The applicability of GA in pediatric dentistry has been researched a lot and found to be effective. The case reports describe the challenges faced in managing the mutilated dentition in two children with Frankel's behavior rating as 1 (definitely negative behavior), in the midst of a pandemic where the pediatric dentist had to take care of the parental anxiety related to the child's oral conditions along with the concern of safety protocols followed in light of the ongoing COVID-19 pandemic. Complete oral rehabilitation was accomplished for both the children under GA.

Associated factors and treatment options for sleep bruxism in children: an umbrella review.

Data on clinical management options for sleep bruxism in the primary dentition are inconclusive. This umbrella review aimed to synthesize the available evidence from systematic reviews (SRs) on the associated factors and treatment approaches for clinical management of sleep bruxism in children. A search was conducted in the MEDLINE/PubMed, Web of Science, Embase, and OpenGrey databases up to March 2022. SRs published on sleep bruxism in children containing data on associated factors or treatment outcomes were included. The AMSTAR-2 tool was used to assess the methodological quality of SRs. The search identified 444 articles, of which six were included. Sleep conditions, respiratory changes, personality traits, and psychosocial factors were the associated factors commonly identified. Treatments included psychological and pharmacological therapies, occlusal devices, physical therapy, and surgical therapy. All SRs included presented a high risk of bias. Overlapping of the included studies was considered very high. The best evidence available to date for the management of sleep bruxism in children is based on associated factors, with sleep duration and conditions, respiratory changes, as well as personality traits and psychosocial factors being the most important factors commonly reported by studies. However, there is currently insufficient evidence to make recommendations for specific treatment options.

Panorametric study in a paediatric population in Madrid.

The aim of the study was to establish the normality ranges of the linear and angular measurements that can be carried out in orthopantomographies (OPGs) of a paediatric sample from Madrid, according to sex and dentition. OPGs performed in the Radiology Service of the Faculty of Dentistry of the Complutense University of Madrid (UCM) from caucasic children between 4-14 years old were selected. A total of 44 measurements were made in the OPGs, and the sex and type of dentition of each child were recorded. Panoramic Mandibular Index and Antegonial Index were also calculated. Statistical tests were performed with a confidence level of 95% (p < 0.05) and bilateral significance to analyse the differences between sex and type of dentition, and the correlation between the measurements of the right and left sides. A total sample of 160 OPGs (50% boys, 50% girls) were analysed. 16.25% of the sample was in primary dentition, 50% in first phase mixed dentition, 17.5% in second phase mixed dentition and 16.25% in permanent dentition. Statistically significant differences were found with respect to the sex of the subjects in 11 of the measurements; and 44 in relation to the dentition stages of the subjects. A strong correlation is found between the measurements on the right and left sides. The application of panoramic measurements as indicators of normality can help in the detection of craniofacial alterations in growth and development of the lower facial third.

Cone beam CT and stereolithographic model in primary dentition

Cone beam CT and stereolithographic model in primary dentition

High Patient’s Acceptance of Maryland Bridge: A Minimal Procedure Following Dental Trauma

Traumatic dental injuries are more prevalent in permanent than primary dentition, in which maxillary incisors are more affected. The global prevalence of traumatic tooth injuries ranges from 6 to 37%. According to one study, out of 1,657 schoolchildren (aged 5-8 years) surveyed, 2.7% had traumatic injuries to their anterior teeth. A completely knocked-out front tooth often occurs as a result of a traumatic dental injury, which produces psychological and functional distress for the patient and should be treated immediately. There are various treatment options such as reimplantation, removable partial dentures, or fixed dentures, which are often not applicable or inconvenient for the patient, especially in young patients where bone growth is ongoing. Therefore, a resin-bonded fixed partial denture such as Maryland bridge is a treatment option for young patients who needed a replacement for missing anterior teeth before their growth and development was fully complete.

Long-term outcome of oral health in uncooperative children with caries treated under general anesthesia.

Although uncooperative children with extensive caries can be treated under general anesthesia (GA), they remain at high-risk for caries recurrence. This study aimed to assess the long-term outcome of the dental health of uncooperative healthy children (HC) and special needs patients (SNP) treated under GA at least 2 years before this study. Data were collected via questionnaire and oral examination. Oral hygiene was assessed using the Hygiene Index, while caries were recorded using ICDAS II. The dmfs/DMFS score was calculated for every participant. A total of 69 patients completed the questionnaire, and 37 were clinically examined (HC = 15, SNP = 22). The mean (±SD-standard diviation) follow-up time was 5.5 (±2.55) years, the mean DMFS score for HC was 6.39 (±4.99), and the mean DMFS score for SNP was 12.95 (±12.29). The SNP group had significantly more filled surfaces on permanent teeth than the HC group (6.18 (±6.17) vs. 1.54 (±3.27), p = 0.004). In regard to primary teeth, HC had a higher dmfs, indicating a clear trend for more decayed surfaces in this group of participants (p = 0.08). The DMFS score was significantly higher in children who underwent GA more than 5 years ago. Oral health-related behavior was not improved as expected. Altogether, HC and SNP have poor oral hygiene and high caries risk in primary and permanent dentition, and their treatment remains challenging.

Artificial intelligence (AI) in restorative dentistry: Performance of AI models designed for detection of interproximal carious lesions on primary and permanent dentition.

The objective of this study was to evaluate the effectiveness of deep learning methods in detecting dental caries from radiographic images. A total of 771 bitewing radiographs were divided into two groups: adult (n = 554) and pediatric (n = 217). Two distinct semantic segmentation models were constructed for each group. They were manually labeled by general dentists for semantic segmentation. The inter-examiner reliability of the two examiners was also measured. Finally, the models were trained using transfer learning methodology along with computer science advanced tools, such as ensemble U-Nets with ResNet50, ResNext101, and Vgg19 as the encoders, which were all pretrained on ImageNet weights using a training dataset. Intersection over union (IoU) score was used to evaluate the outcomes of the deep learning model. For the adult dataset, the IoU averaged 98%, 23%, 19%, and 51% for zero, primary, moderate, and advanced carious lesions, respectively. For pediatric bitewings, the IoU averaged 97%, 8%, 17%, and 25% for zero, primary, moderate, and advanced caries, respectively. Advanced caries was more accurately detected than primary caries on adults and pediatric bitewings P < 0.05. The proposed deep learning models can accurately detect advanced caries in permanent or primary bitewing radiographs. Misclassification mostly occurs between primary and moderate caries. Although the model performed well in correctly classifying the lesions, it can misclassify one as the other or does not accurately capture the depth of the lesion at this early stage.

Convolutional neural networks for automated tooth numbering on panoramic radiographs: A scoping review.

The objective of this scoping review was to investigate the applicability and performance of various convolutional neural network (CNN) models in tooth numbering on panoramic radiographs, achieved through classification, detection, and segmentation tasks. An online search was performed of the PubMed, Science Direct, and Scopus databases. Based on the selection process, 12 studies were included in this review. Eleven studies utilized a CNN model for detection tasks, 5 for classification tasks, and 3 for segmentation tasks in the context of tooth numbering on panoramic radiographs. Most of these studies revealed high performance of various CNN models in automating tooth numbering. However, several studies also highlighted limitations of CNNs, such as the presence of false positives and false negatives in identifying decayed teeth, teeth with crown prosthetics, teeth adjacent to edentulous areas, dental implants, root remnants, wisdom teeth, and root canal-treated teeth. These limitations can be overcome by ensuring both the quality and quantity of datasets, as well as optimizing the CNN architecture. CNNs have demonstrated high performance in automated tooth numbering on panoramic radiographs. Future development of CNN-based models for this purpose should also consider different stages of dentition, such as the primary and mixed dentition stages, as well as the presence of various tooth conditions. Ultimately, an optimized CNN architecture can serve as the foundation for an automated tooth numbering system and for further artificial intelligence research on panoramic radiographs for a variety of purposes.

Dental Anomalies in a Sample of Lebanese Children: a Retrospective Study.

Dental anomalies (DAs) represent a significant chapter in pediatric dentistry with a lot of practical relevance. Both primary and permanent dentitions may be affected. The main objective of our study was to evaluate, using digital panoramic radiographs, the prevalence, distribution, and patterns of DAs in a sample of Lebanese children aged between 8 and 15 years old. 112 digital panoramic radiographs of patients aged between 8 and 15 years (60 males and 52 females) from the year 2017 till 2022 attending the department of Pediatric Dentistry and Dental Public Health at the Faculty of Dental Medicine at the Lebanese University were assessed for DAs of number (hypodontia, oligodontia, hyperdontia), of size (microdontia, macrodontia), of shape (fusion, gemination, dilaceration, taurodontism), of position (transposition, ectopia, impaction), and of structure (dentin dysplasia, amelogenesis imperfecta, dentinogenesis imperfecta). The data were analyzed statistically using Chi-square and Fisher's exact tests. Out of 112 patient radiographs, 84 showed at least one DA, which suggests a very high prevalence (75%). Among them, 36.9% exhibited multiple types of anomalies. These 84 patients showed a total of 274 DAs, distributed equally among males and females. Dentists should be alerted to the presence of DAs. Their high prevalence requires careful clinical and radiological examinations for early detection. Regular monitoring is mandatory and could guide preventive approaches to minimize associated dental complications.

Bite force of children and adolescents: a systematic review and meta-analysis.

This systematic review aimed to assess bite force measurements in children and adolescents and to study the various devices that measure Maximum Voluntary Bite Force (MVBF). This systematic review included observational studies and experimental studies in children and adolescents (upto 19 years of age) which evaluated MVBF using a bite force measuring device. Studies on participants with systemic conditions were excluded. Databases such as PubMed, Embase, LILACS, and the Cochrane library were searched until September 2022, for which screening and quality assessment were performed. Newcastle-Ottawa, modified Newcastle-Ottawa and ROBINS-I tools were used to assess the Risk-of-bias. All observational studies reporting overall bite force values of participants were included for meta-analyses. A total of 8864 participants (3491 males and 3623 females) were included from 61 studies. Meta-analyses were conducted to evaluate mean average bite force value for each included dentition using R software v2.4-0. Estimation was done to derive an average BF value for variables such as age (dentition), gender, side, site, device and ethnicity. MVBF values were reported as mean average in the form of MLN with 95% CI (Confidence Interval). Using a random-effects model, 29 forest plots were generated. I2 values varied between 90% and 100%. Bite force ranged from 246.22 N (220.47; 274.98) to 311.72 N (255.99; 379.59) and 489.35 N (399.86; 598.87) in primary, mixed, and permanent dentitions, respectively. Six different sites for recording bite force and 11 different types of devices were reported with portable occlusal bite force gauge being the most common device. Outcomes of this review provide useful baseline reference values of bite force for clinicians and researchers.

Radicular cyst in primary dentition showing angiolymphoid hyperplasia with eosinophilia (ALHE)-like features: An immunohistochemical study

Radicular cyst in primary dentition showing angiolymphoid hyperplasia with eosinophilia (ALHE)-like features: An immunohistochemical study

OPTIMIZATION OF POWER-ASSISTED ADENOIDECTOMY IN CHILDREN USING SHAVER TIPS OF VARIOUS MODIFICATION.

The aim: To study the efficacy of surgical treatment of patients with adenoid vegetations by implementing a differential method for choosing a tip for endo-scopic power-assisted adenoidectomy in children depending on dentition. Materials and methods: We investigated the presence of nasal air emissions in 127 children (2-12 years old) before and after the operation. We excluded 12 patients due to the presence of nasal air emission before the operation. All patients were divided in 2 groups: I - children with aging primary dentition (55 children), II- children with mixed dentition (60 children). Depending on tips, that were used for the operation, we divided patients into two subgroups: A - 40˚ and B- 60 ˚. Results: In 9,4% of patients have the presence of nasal air emissions before the operation. The use of 40˚ tips does not allow removal of lymphoid tissue in "hard-to-reach" areas of the nasopharynx (perichoanal and peritubular sections) in 30% of children with aging primary dentition and 42.9% with mixed dentition. Conclusions: The use 40˚ tips for the adenoidectomy is accompanied by a higher risk of velopharyngeal insufficiency in children with mixed dentition compared to children who underwent the intervention with a tip with a larger bending angle and a longer working part (60°). In patients with temporary dentition, it is recommended to use a standard tip for adenoidectomy, except when correction of tubal lymphoid tissue is planned (it is necessary to use a tip with a rotating window). In patients with mixed dentition, it is recommended to use a 60° tip.

Breastfeeding Effect on Primary Teeth Emergence in Relation to Craniofacial Growth among Iraqi Infants

Background: Breastfeeding is more than just nutrition; it can be viewed as a natural orthotic device for the harmonious development of the face. Sucking has an impact on a child’s premaxillary region’s growth, and mandibular movements encourage mandibular growth. Along with the advantages for general health, breastfeeding also helps with the right development of teeth, face muscles, and occlusion. Hence symmetric, well-proportioned face and appropriate occlusion depend on balanced facial growth. Objectives: This study aims to evaluate the effect of breastfeeding on the timing of teething in relation to craniofacial development. Materials and Methods: This study is a cross sectional comparative study concerning craniofacial growth assessment, with prospective view concerning timing of eruption. Sample was composed of 100 breastfed infants compared with 100 infants depending on formula milk. Clinical examinations and follow-up for teeth emergence was done for whole sample. Results: Breastfeeding was found to be associated with early teeth emergence. Additionally, although, there were no significant differences between facial growth and feeding pattern there was a significant correlation between delay eruption time of primary dentition and facial growth parameters (mandible and maxilla depths) among bottle-feeding group. Conclusion: The current study confirms the effect of breastfeeding on the early teething emergence of primary dentition; however, there were no significant differences between type of feeding and facial growth parameters. While a significant relation between delay eruption time and facial growth parameters (mandible and maxilla depths) was found among bottle-feeding infants.

Effectiveness of an Oral Health Intervention Program for Group of Egyptian Children with Congenital Heart Defects

Purpose: This study evaluated an oral health program on group of Egyptian children with congenital heart defects and healthy children. Materials and Methods: This study was conducted on a sample group of 110 Egyptian children with age (3 to 6) years old with congenital heart defect and healthy children. In each groups number of girls nearly equal number of boys. The oral health status was evaluated regarding to Intra oral examination of oral tissue and teeth, (dmf) index used to assess dental caries in primary teeth in primary dentition stage, gingival index, and oral Hygiene index (OHI-S) was also measured. Results: Regarding gender, there was no statistically significant difference. There was no statistically significant difference between median dmf scores in the two groups (P-value = 0.760, Effect size = 0056). normal group showed statistically significantly lower median GI scores than CHD group (P-value <0.001, Effect size = 1.985), (P-value <0.001, Effect size = 1.59), (P-value <0.001, Effect size = 0.736) and (P-value = 0.004, Effect size = 0.432), respectively. Conclusions: Oral health program on Egyptian children with congenital heart improves teeth caries and significantly improves gingival index and oral Hygiene index (OHI-S).

Protoconidal Cingulum/Protostylid in Permanent Mandibular First Molar-Report of a Rare Dental Morphological Trait

The present article shows the occurrence of a rare dental morphological trait, “Protoconidal Cingulum” or “protostylid” on the buccal surface of permanent mandibular first molar in a 14- year-old Indian male patient. This morphological dental variation was reported more frequently in primary dentition involving second molars. Prevalence, clinical implications, classification systems and various nomenclatures pertaining to protostylid is discussed in this paper.

The Bat Child

Case Report A short stature 10 year old boy with pes planus, mild hearing loss, failure of exfoliation of the primary dentition, anterior hyperdontia, malocclusion and open anterior fontanelle was observed in Pediatric Orthopedics consultation, and presenting the following alterations (image). Discussion This child has cleidocranial dysplasia (CCD). Is an autosomal dominant disease caused by an heterozygous loss-of-function mutation in the RUNX2 gene, encoding transcription factor CBFA1, on chromosome 6p21, which plays an important role in osteogenesis and differentiation of osteoblasts. The main clinical features include persistently open skull sutures, hypoplasia or aplasia of the clavicles permitting abnormal facility in opposing the shoulders, short middle phalanx of the fifth fingers, dental anomalies (supernumerary teeth, failure of exfoliation of the primary dentition and malocclusion), pes planus, upper respiratory complications, recurrent otitis media, hearing loss and often vertebral malformation (scoliosis). Conclusion The clinical diagnosis of CCD was made during pregnancy, through the detection of aplasia of the clavicles in fetu, in association with the mother having short stature (1.32 meters), persistence of primary teeth and open anterior fontanelle. With 10 years of age, he underwent mendilioma study which revealed the mutation in the RUNX2 gene (c. 747 del (p.(Arg251 Alafs*7))) classified as a pathogenic variant.

Variation in canine Position’s in unilateral cleft lip and palate patients - A case Series

Cleft lip/palate is a common congenital anomaly that occurs during birth. Incomplete fusion of the maxillary prominence and median nasal processes results in a small niche or indentation on the lip and palate that extends all the way up to the nose. The orofacial cleft can appear as isolated cleft lip, cleft lip with cleft palate, be associated with syndromes, or present unilaterally or bilaterally. Various management modalities are recommended depending on the extent and severity of the anomalies. Cleft lip and palate are frequently associated with developmental problems in the primary and permanent dentitions. To restore all of the aesthetic, functional, periodontal, and restorative components, it is critical to address the associated dental anomalies