Pulpal Involvement Research Articles

Recommended procedures for managing carious lesions in primary teeth with pulp involvement—a scoping review

BackgroundManaging dental caries in primary teeth with pulp involvement is a significant challenge. Clinical guidelines offer recommendations for effective management.AimTo identify and analyze policies, guidelines, and recommendations for treating primary teeth with pulp-involved carious lesions, highlighting existing research gaps and setting the foundation for future research.MethodsA comprehensive search was conducted across databases (PubMed, Scopus, Embase, GIN, and LILACS) and grey literature sources (Trip and ProQuest) to identify guidelines, consensus, policy, and position statements on primary teeth pulp therapy and extraction thresholds. Two independent reviewers screened the abstracts and titles, followed by full-text screening.ResultsAfter removing duplication, of the 1098 records, 14 were selected for analysis. This review examined various treatments for deep caries lesions in primary teeth, including indirect/direct pulp capping, pulpotomy, pulpectomy, lesion sterilization/tissue restoration, and extraction. Time search was restricted to documents published from 30th January 2008 to 30th January 2024, offering insights into evolving clinical practices.ConclusionTreatment for carious lesions in primary teeth involving the pulp depends on clinical indications and may involve minimally invasive techniques. Recommended options are indirect pulp capping, pulpotomy, and pulpectomy, while direct capping and tooth removal are discouraged. Further research is needed to address gaps, improve guideline development, and enhance consistency of recommendations.

Perceptions, attitudes, and clinical experiences of Brazilian dental practitioners towards molar incisor hypomineralisation: a cross-sectional study.

To evaluate perceptions, attitudes, and clinical experience of Brazilian dental practitioners regarding molar incisor hypomineralisation (MIH). An online survey with 27 questions, covering professional profile data, perceptions, and knowledge on clinical management of MIH, was employed. Descriptive analyses, chi-square, Fisher's exact, and Cramer's V tests were used. Sample comprised 100 participants, equally distributed between those working in private or public sectors. Most private sector practitioners had 21-30years of clinical experience (28%) and master's degree (50%), while most public sector practitioners had 11-20years of clinical experience (32%) and a PhD degree (32%). Most participants (86%) recognized MIH in their practice. Statistically significant differences were observed in frequency (p = 0.001), incidence (p = 0.039), and lesion type (p = 0.043) between practitioners from both sectors. Uncertainly in management was reported by 49%, mainly in public sector. For mild MIH in incisors, no treatment was chosen (43%), and the treatment longevity was the only significant factor reported (p = 0.012). In cases of mild MIH in first permanent molars (FPMs), 51% of respondents opted to keep the affected tissue and apply fissure sealant. Glass ionomer (GI) restoration was commonly indicated for FPMs with severe MIH with moderate loss of structure and sensitivity (38%). In cases with substantial structural loss and pulpal involvement, the most chosen treatment was endodontic intervention combined with preformed crowns. Brazilian dental practitioners face MIH in clinical practice. Although, public sector professionals are less confident in diagnosis and treatment, no significant differences in treatment preferences between public and private sector dental practitioners were identified.

Can silver diamine fluoride reduce invasive treatments with general anesthesia?

This study aims to retrospectively evaluate the differences in dental treatments rendered in general anesthesia (GA) for patients who did or did not receive application of silver diamine fluoride (SDF) prior to GA. 1559 patients (≤6 years) who completed treatment with GA for caries at University of California San Francisco (UCSF) between 2015 and 2019 were included in the study. At baseline patients' electronic health record was reviewed to collect planned treatment, complete dental treatment and demographics. Patients were identified as SDF group (N = 335, 21.49%) or comparison (N = 1224, 78.51%). Dental treatments rendered were compared between the SDF and comparison group with multi-variable regression, including variables for demographics and clinical findings at baseline. The initial analysis identified variations in gender, age, dental pain, pulp involvement, and initial treatment plans between the SDF and comparison groups at baseline. In an unadjusted analysis, the SDF group displayed a statistically significant increase in the number of crown procedures but a notable decrease in the number of pulp therapy and extraction treatments completed (p < 0.05). An adjusted multivariable model affirmed the inverse relationship between SDF application and completion of pulp therapy and extractions at the time of GA (p < 0.05). No significant association was identified with the total number of crowns needed and SDF. The model further indicated a positive correlation between the total count of pulp therapy and extractions completed with patient age and the wait-time for GA. In conclusion, pre-GA application of SDF to carious primary teeth is negatively correlated with completed pulp therapy and extraction. SDF application prior to dental treatment with GA may be a valuable tool to reduce invasive dental procedures in GA.

Management of preeruptive intracoronal radiolucency (PEIR): a case series with up to 8 years follow-up.

Preeruptive intracoronal radiolucency (PEIR) is a rare dental anomaly often incidentally detected during routine radiographic examinations. This condition manifests as a radiolucent lesion beneath the enamel-dentin junction of unerupted teeth, particularly in mandibular molars, posing diagnostic and management challenges due to its asymptomatic nature. The treatment of PEIR depends on the extent of the lesion and the degree of pulp involvement. Case series: This case series reports on four patients with progressive PEIR. In Cases 1 and 2, lesions were incidentally discovered in panoramic radiographs during orthodontic planning (mandibular permanent second molars), and additional surgical exposure to access the lesion was required as teeth were only partially erupted. Interestingly, in Case 3, the PEIR was not visible in earlier radiographs though the crown of the tooth was already mineralized (mandibular permanent second molar). For Case 4, the tooth presented with symptoms of reversible pulpitis (mandibular permanent first molar). All lesions were treated with indirect pulp capping using biocompat-ible material. The patients were followed up for a period of up to 8 years to evaluate treatment success. Indirect pulp capping and restorations were found to be successful in all four cases in the last follow-up: 1 year (Case 2), 1.4 years (Case 4), 1.5 years (Case 1), and 8 years (Case 3). Conclusion: This case series demonstrates the effectiveness of early intervention via surgical exposure and indirect pulp capping and restoration for managing severe cases of PEIR. However, further research with larger samples and long follow-up is necessary.

Novel 3-dimensional classification of cervical abrasion using CBCT: A comprehensive analysis

IntroductionTooth cervical abrasion (CA) is a prevalent non-carious cervical lesion that poses challenges for accurate diagnosis from periapical radiographs due to difficulties in assessing the lesion's extent, associated bone loss, and pulpal involvement. The presence of overlying bone structures on the palatal side when lesions are located on the buccal side, or vice versa, further complicates radiographic interpretation. So it is important to define the lesions in all three dimensions. ObjectiveTo provide a three-dimensional descriptive classification for cervical abrasion lesions using Cone Beam Computed Tomography (CBCT). MethodA total of 50 patients with cervical abrasion were selected for the study. From these patients, teeth (n = 10) from each of the four different quadrants were chosen. A CBCT scan with a 6 × 6 cm field of view (FOV) was performed, and the DICOM files of the cervical lesions were transferred to 3-D imaging software. The CBCT images of the cervical abrasion lesions were assessed at the level of the deepest point of the lesion along the long axis of the tooth in both axial and sagittal planes. The height (A), buccolingual dimension (B), circumferential spread (C), and remaining dentine thickness (D) were evaluated and classified using new scoring criteria for each dimension. The reliability and reproducibility of the classification were assessed to ensure its clinical applicability. ConclusionCBCT can be utilized to classify tooth cervical abrasion in endodontics, enhancing diagnosis, analysis, and treatment outcomes. This three-dimensional view facilitates easier communication among clinicians, allows for tailored treatment approaches, and opens new avenues for research.

Restoration of fractured anterior tooth with monochrome composite resin in pediatric dental patient

Direct restoration with monochromatic composite resin is a treatment option for teeth with coronal fracture after dentoalveolar trauma. This restorative material, in principle, is capable of mimicking the color of the dental substrate. This study aimed to report and discuss the technique of direct restoration with monochromatic composite resin, in a child patient. An 8-year-old male patient attended the Emergency Room of the Baby Clinic of the State University of Londrina for immediate treatment after dentoalveolar trauma that resulted in enamel and dentin fracture, without pulp involvement. As a procedure, restoration was performed with glass ionomer cement and referral to the institution's Dental Residency program. In this service, after case planning, the restoration of the coronal fracture of the substrates was performed with the insertion of multiple increments of the Vittra APS Unique (FGM) composite, with the aid of a silicone guide prepared based on a waxing model to facilitate the reestablishment of the palatal surface form and anatomy. In the clinical follow-up evaluation, the aesthetic and functional results obtained were considered highly satisfactory by patients, relatives and dental clinicians. Thus, it can be concluded that the option for monochromatic composite resin is a viable alternative to make it easier for the dental clinicians to perform the procedure and reduce the clinical time, a relevant fact because it is a case of caring for a pediatric dentistry patient.

Survival of the fittest: does Riva Self Cure outperform Equia Forte when used to restore mesio-occlusal cavities in atraumatic restorative technique?

Double-blind (participant and outcome assessor), randomised, non-inferiority, two-arm (1:1 allocation) clinical trial. The study included children aged 4-8 years old from public schools in Tietê, Brazil, who had mesio-occlusal carious lesions, into dentine, in primary molars. The carious teeth had to be asymptomatic of pulpal involvement. The children had to be medically fit and cooperative for dental treatment within their classroom environment. Consent was gained from a parent/guardian prior to entering the study. Children with carious lesions in multiple teeth, only one tooth was included, which was selected by a random draw. Treatment on other teeth would be carried out in the nearest health centre. The primary outcome was the 2-year survival of the restorations, analysed using Kaplan-Meier survival curves and Cox regression (α = 5%). Costs for materials and professional services were recorded in Brazilian Reais (R$), converted to US dollars (US$), and analysed using Monte Carlo simulation. Of the 152 children enrolled (76 per group), 121 (79%) were evaluated at the 2-year mark. Overall, the 2-year survival rate of the restorations was 39% (EF: 45%; RSC: 32%), with no significant difference between the two groups. The total cost of restorations with RSC was lower than with EF, resulting in a cost saving of US$6.18 per restoration. After 2 years, Riva Self Cure demonstrated comparable survival rates to Equia Forte for mesio-occlusal restorations in primary molars, while being more cost-effective from a Brazilian perspective.

The traumatized immature permanent incisor with pulpal involvement: what conservative treatment options?

Traumatology is the second most common dental pathology, after caries and before periodontal pathologies. It is currently accepted that one child in two suffers an alveolar-dental trauma before leaving school, with a peak incidence between the ages of 8 and 12, all types of trauma combined. The maxillary central incisors are most affected (79.6%), with mainly "simple" or "complex" coronal fractures when the pulp is involved. The main objective in managing these complex fractures is to preserve pulpal vitality within an acceptable timeframe. The author presents three pulp vitality preservation therapies involving tissue preservation and regeneration techniques using bioactive materials applied directly to the pulp. Materials and clinical protocols are described. Knowledge of pulp biology and healing processes has led to the development of vitality-preserving therapeutic strategies that have become essential in the management of traumatized teeth in children and adolescents. The regenerative potential of immature tooth pulp is considerable, enabling dentine repair through the use of bioactive materials. These therapies require a rigorous surgical approach that determines prognosis, and precise monitoring to ensure that any complications are intercepted.

Long-term prognosis for teeth with external cervical resorption based on periapical images and cone beam CT: A clinical study.

To evaluate whether supplemental information from CBCT changed long-term prognosis for teeth with external cervical resorption (ECR) compared to periapical (PA) images. Furthermore, to assess predictive findings in PA images and evaluate which findings in CBCT affected the long-term prognosis of teeth with ECR. One hundred and ninty-four patients, mean age 41.2, range 13-81, having 244 teeth with ECR were included. An initial long-term prognosis determined either good or poor was established based on intraoral images. Afterwards, the patients underwent CBCT, and final long-term prognosis was decided. From the PA images and CBCT, ECR using Heithersay's classification system, pulp involvement and extension of ECR was assessed. In CBCT, the number of surface lesion(s) was additionally assessed. Descriptive statistics evaluated changes in long-term prognosis after CBCT. Logistic regression analyses tested if findings in PA images and CBCT affected the long-term prognosis. Based on CBCT, out of 244 teeth the long-term prognosis was assessed to be poor for 173 (70.9%) teeth and good for 71 (29.1%) teeth. The long-term prognosis changed in 76 (31.1%) teeth after CBCT; 5 (2.0%) changed from poor to good, and 71 (29%) changed from good to poor long-term prognosis. In 81 (33.2%) teeth the H-class increased, and in 10 (4.1%) teeth the H-class decreased after assessing CBCT. In 70 (28.7%) teeth, there was a change from no pulp involvement to involvement of the pulp after CBCT; eight (3.3%) teeth changed in the opposite direction. H-class 2 and 4 in PA images significantly increased the probability for a change in long-term prognosis compared to an H-class 3 (p < .05). H-class 4, pulp involvement, ECR in the oral 1/3 of the root, and more than two surface lesions seen in CBCT significantly influenced a poor long-term prognosis (p < .05). Supplemental information from CBCT changed long-term prognosis in almost one third of teeth with ECR. In most cases, the long-term prognosis changed from good to poor. H-class 3 in PA images had a significant influence on change in long-term prognosis. Several findings in CBCT influenced a poor long-term prognosis.

Dens in Dente: Imageological Relevance

Dens invaginatus, formerly known as &amp;quot;dens in dente,&amp;quot; is a significant dental anomaly resulting from the folding of enamel and dentin into the tooth structure during its formation. This condition exhibits various morphological variations in both crown and root development. Consequently, it often leads to complications such as dental caries, pulpal, and periodontal involvement, ultimately resulting in necrosis and loss of periodontal attachment. Recognizing the importance of early detection and prevention is of great significanceHistorically, treatment options for dens invaginatus were limited due to its intricate nature. However, advancements in dental care have prompted a reevaluation of management strategies. This article offers a comprehensive retrospection of the literature concerning radiological evidence of dens invaginatus. It delves into its clinical manifestations &amp; diagnostic approaches.

Dental injuries in Swiss children - an analysis of Swiss national health insurance data from the year 2019.

This study, the first to analyze accident data from a major compulsory Swiss health insurer (Concordia), reviewed 5,063 dental accident reports of 122,370 children under the age of 16. The predominant cause of injury was a "fall," with "playing" being the foremost activity mentioned and "ground" identified as the primary object of impact. The analysis of the involved objects showed that dental injuries occur most frequently with scooters, bicycles, and stairs. In 2019, 8.14% of children aged one and insured by Concordia suffered a dental injury. By age 16, 58.8% of all children had experienced a dental injury. 0.72% had suffered a primary dentition crown fracture with pulp involvement. Regarding their permanent teeth, 0.21% suffered an avulsion, 0.84% another luxation injury, 0.65% a crown fracture with pulp involvement, and 0.16% a root fracture. A significant increase in injuries per day was observed after the summer holidays. On weekends, there were 28% fewer injuries per day on average than on weekdays. Despite differences among the cantons, the dataset can be considered to be representative for Switzerland. Accident descriptions were often too brief for detailed prevention strategies. Detailed accident information is essential for effective structural measures, which are more effective than promoting behavioural changes. A detailed recording could also be used to draw up a list of the objects frequently involved in accidents. An updated insurance form with an improved nomenclature, the option of digital submission, photo uploads and AI-supported data recording could greatly improve the quality and interpretability of injury data.

Association of Dental Caries with Odontogenic Infections and Nutritional Status in an Orphanage of Raichur District: A Cross-sectional Study

Aim: The aim of the study was to assess the association of nutritional status and dental caries in children at an orphanage in Raichur city, Karnataka. Materials and Methods: A specially designed structured questionnaire was administered to a total of 101 children of the orphanage to gather demographic details, dietary habits, sugar exposure, and oral hygiene practices. The sweet score was recorded as given by Nizel and Papas, body mass index (BMI) was assessed using the Centers for Disease Control 2000, growth charts, dental caries, and odontogenic infections were recorded using decayed missing filled teeth in deciduous dentition (dmft)/Decayed Missing Filled Teeth in permanent dentition (DMFT) and pufa/PUFA (Pulpal involvement, Ulceration, Fistula, and Abscess) index (Monse et al., 2010), respectively. Results: A total of 101 participants were enrolled in the study including children aged 6–15 years old with a mean age of 10.67 ± 2.74 years. A statistically significant relation was found between the duration of stay in an orphanage and the prevalence of dental caries (P &lt; 0.05). A statistically significant positive correlation was found between the duration of stay in the orphanage and BMI (0.382) dmft/DMFT (0.203). In addition, a statistically significant positive correlation was also observed between dmft/DMFT and pufa/PUFA. Conclusion: The study showed caries to be primarily associated with the sugar exposure and dietary habits, whereas untreated dental decay was the main cause of odontogenic infections. The untreated caries PUFA ratio was 13.98% with only one filled component, indicating the unmet needs for decayed teeth and lack of awareness and access to preventive and curative dental care facilities by the children of the orphanage.

Managing the deep carious lesion biomimetically without pulpal involvement

During the last 20 years, the restorative approach has evolved from the mechanical retention to the advanced adhesion. This transition was fostered by the development and the improvements in the adhesive materials and the increasing demand of the esthetics among the patients. Resultingly, Composites today have become the material of choice for both the anterior as well as posterior restorations. The Science, Principles and the techniques of advanced adhesive dentistry are known as biomimetic dentistry. The major goal of biomimetic dentistry is to preserve the vitality of the pulp and conserve maximum intact tooth structure. The management of deep carious lesions approaching a healthy pulp presents a significant challenge to a clinician. The traditional management of carious lesions dictates the removal of all the infected and affected dentin. Several studies call this approach into question. This article presents a systematic approach to manage the deep carious lesions in the vital teeth preserving its vitality &amp; conserving maximum intact tooth structure for the long term biomimetic function.

Agrawal and Shah Modified Cast Index - A Novel Index Assessing Prevalence of Dental Caries and Treatment Needs of the Adult Indian Population.

Agrawal and Shah modified CAST (Caries Assessment Spectrum and Treatment) is the novel index prepared specifically for the Indian population for the complete evaluation of the spectrum/range of dental caries described hierarchically. To assess the prevalence of dental caries and treatment needs in an adult Indian population using Agrawal and Shah modified CAST index. A cross-sectional transverse study was performed on 2000 adult patients in the age range of 19-70 years. All the adult patients were scored for caries presence by Agrawal and Shah modified CAST codes on a structured proforma. SPSS version 20 was used to analyze the data. The prevalence of dental caries calculated using Agrawal and Shah modified CAST index was 85.6%. 5.2% (104) adults had sound dentition, 4.1% (82) adults had restorations, 2.1% (42) adults had non-cavitated lesions, 13.7% (274) adults had the presence of caries in the enamel, 19% (380) adults had the presence of caries in dentine, and pulpal involvement was observed in 27.7% (554) adults. 10.3% (206) adults had presented with a root surface and cervical caries. 13.6% (272) adults had lost at least one tooth due to caries, and 3% (60) adults had lost teeth due to any other reason except dental caries. 1.3% (26) adult patients do not show any caries-related diagnosis but were having predisposing conditions. Agrawal and Shah modified CAST index proved to be simple, useful, and appropriate in assessing dental caries prevalence in the Indian population along with the treatment needs of the Indian population.

Dental caries in two incas populations. a cross-sectional study

Compare: frequency, severity and location of dental caries between archaeological populations of the Sacsayhuamán and Machupicchu samples. This was a retrospective, cross-sectional and observational study. The variable dental caries was observed directly in the Sacsayhuamán and Machupicchu samples from the Cusco culture directorate. 39 individuals from the Sacsayhuamán sample with 566 teeth and 49 individuals from the Machupicchu sample with 467 teeth were analyzed. The unit of analysis was the tooth. The variable was statistically analyzed by frequencies and proportions and the differences were analyzed using the Chi test. -square. In the Sacsayhuamán sample, pieces with cavities had a frequency of 31.8%, while in the Machupicchu sample they reached a frequency of 23,6%. Regarding the location: in the Sacsayhuamán sample: The following frequencies were obtained: occlusal caries 44,38%, coronary caries 3,37%, caries in the amelocemental line 32,58%, root caries 19,66%; while in the Machupicchu sample the following were obtained: occlusal caries in 60,91%, coronary caries in 3,62%, caries in the amelocemental line in 24,55%, root caries in 12,91%. Regarding severity, we found the following frequencies: in the Sacsayhuamán sample: enamel/cementum caries in 52,81%, dentin caries 33,71%, pulp involvement caries 13,14%, while in the Machupicchu sample: enamel/cementum caries 49,09%, cavities of dentin in (27,27%), caries involving pulp involvement 23,64%. When comparing the samples, differences were found with respect to the frequency of dental caries and with respect to the location, but no differences were found with respect to the severity.

The treatment options for the traumatically fractured tooth; Case reports

The traumatic accident could cause various damages to the teeth and surrounding tissues. It makes dentist embarrass be-cause it not only requires the dentist to make quick decision, but also delayed decision affect the prognosis of the treatment. Depending on the location of the fracture, the fractured teeth are divided into crown fracture without pulpal involvement (Uncomplicated crown fracture), crown fracture with pulpal involvement (Complicated crown fracture), crown-root frac-ture, and root fracture. When the crown was fractured, treatment was performed with reattachment of the fragment or direct composite resin restoration depending on the presence or absence of the crown fragment. In the case of crown-root fracture, the direction of treatment can be set depending on whether the moisture control for final restoration is properly performed. In the case of root fracture, follow-up was observed after fixation using resin wire splint fixation, and if necessary, endodontic treatment of the crown fragment is recommended. The cases reported here have led to positive treatment outcome in fractured tooth for various traumatized situation.

Unmet Dental Needs in Children Following Suspension of School-Based Oral Health Services Due to COVID-19.

Dental caries (tooth decay) is the world's most prevalent noncommunicable disease and can lead to pain, infection, and edentulism. Many children with caries lack access to traditional dental services. School-based caries prevention can increase access to care and reduce health inequities. Disruptions in school-based care due to pandemic control policies may result in children losing access to their primary dental care option. The CariedAway project was a school-based caries prevention program in operation from 2019 to 2023 in urban schools with a high proportion of low-income, minority students. Program operations were suspended for 2 years due to the COVID-19 pandemic. We estimated the prevalence of untreated decay, swelling, fistula, and pulpal involvement in participants at baseline and again after restrictions were lifted. A total of 2998 children between the ages of 5 and 13 years were enrolled and received preventive care prior to pandemic shutdowns, and 1398 (47%) completed a follow-up observation after 2 years. At baseline, approximately 30% had untreated caries on any dentition, 11% of children presented with evidence of dental sealants, and no participants had swelling, fistula, or pulpal involvement. After 24 months, 12% of participants had swelling fistula, or pulpal involvement that was not treated during the pandemic period. There are considerable unmet dental needs in high-risk children that may be further exacerbated by a lack of access to care during disease outbreaks.

Influence of Different Post-endodontic Restorations on the Survival Rate Against Fracture of Endodontically Treated Anterior Teeth Affected by Cervical Lesions with Pulpal Involvement: A Retrospective Clinical Study.

To compare the survival rate against fracture of endodontically treated anterior teeth (ETT) affected by cervical (class V) lesions with pulpal involvement restored with resin composite or a post/core and crown, and to identify the prognostic factors for fracture. Dental records and radiographs of ETT affected by cervical lesions with pulpal involvement restored with resin composite or a post/core and crown during a recall period from 2009-2022 were selected according to the inclusion and exclusion criteria. The number of tooth fracture, the restorability after fracture and any possible risk factors were identified. The survival rate against ETT fracture were analyzed and com- pared between the two restoration groups by Kaplan-Meier survival analysis and the Tarone-Ware test. Non- proportional hazard models were used to identify the prognostic factors. The sub-analysis in each restoration group was also performed. The study comprised 175 ETT restored with resin composite (n=125) or a crown (n=50). With a mean recall period of 32.9+-15.8 months, the survival rate against ETT fracture with resin composite (85.6%) was not significantly different from those with a crown (88%) (p≥0.05). The most frequent mode of fracture was crown-root fracture, which accounted for 78% and 83.30% of the fractures in the resin composite and crown groups, respectively. A significant prognostic factor for ETT fracture affected by cervical lesions with pulpal involve- ment was additional tooth structure loss from a class III, class IV or another class V lesion on the opposite side (p<0.05). The ETT affected by cervical lesions with pulpal involvement combined with additional tooth structure loss had a 7.25-fold higher risk of fracture than those with single-surface affected by cervical lesions with pulpal involvement (hazard ratio [HR] = 7.25; 95% confidence interval [CI], 1.68-31.30). The sub-analysis in the crown and resin composite groups revealed that the survival rates of ETT with single-surface affected by cervical lesions with pulpal involvement was 100% and 96.15%, respectively, which were significantly higher than those of ETT with additional tooth loss at 80.65% and 78.08%, respectively (p<0.05). With a mean 33-month recall period, the survival rate against ETT fracture affected by cervical lesions with pulpal involvement restored with resin composite or crown were not significantly different. Additional tooth structure loss was a significant prognostic factor for fracture.

Evaluation of root development of mandibular first molar of children (6-12) years old visiting P.O.P. department College of Dentistry/ Hawler Medical University.

Background and objective: With FPMs between the ages of 6 and 12, the detection of open apex in some children at age 12 underlines the necessity for investigation prior to treating a deep carious lesion.Pulpal involvement was considered before the surgery began. The genesis of the roots is complete. Dentists are urged to conduct a comprehensive clinical examination, get diagnostic radiographs, and adhere to case-specific treatment protocols before attempting to treat FPMs in children, even those as young as 12 years old. This would reduce the likelihood of treatment mistakes, which might hinder the extraction of FPMs or cause unacceptable damage. Method: Dentists in the Paediatric Dentistry Department at Hawler Medical University saw all the children in the sample, and they were all in good health condition. This research evaluated the crown and root development stages of lower FPMs on both sides, as found by Demirjian et al. (1973). Information was collected in Excel 2017 for use in making charts and tables. Mean and standard deviation values. The T-test, either paired or unpaired, with a p-value of 0.05 serving as the threshold for statistical significance. Results: The findings showed that there was a total of 250 OPGs, with 130 belonging to females and 120 belonging to boys. The ages of the children that were considered for inclusion in the sample varied anywhere from six to twelve years old. In a sample of 12, the first molar in the mandibular region had the greatest percentage of AC (84.4%). Conclusions: The discovery of open apex in some children at 12 confirms the need for inquiry before treating a deep carious lesion in FPMs between the ages of 6 and 12. we evaluated the potential risk of pulpal involvement during this period. Before treating FPMs in children, even those as young as 12, the dentists were advised to do a thorough clinical examination, get diagnostic radiographs, and follow specific treatment procedures based on clinical instances. Keywords: tooth root, important tooth, root development, Demirjian technique.

Endodontic Treatment and Aesthetic Management of Gemination in Primary Central Incisor with Two Root Canals

This case report discusses the endodontic treatment and aesthetic management of gemination in a primary central incisor with two root canals in a 3-year-old boy. Gemination is a dental anomaly characterized by the partial division of a single tooth bud, resulting in a tooth with an enlarged crown and, in some cases, two root canals. The prevalence of gemination is relatively low, particularly in primary dentition. The patient presented with a large upper left central incisor (#61) that exhibited deep decay and caries, along with radiographic evidence of pulp involvement and a bifid crown with two separate pulp chambers and root canals. A diagnosis of gemination was established based on the presence of a complete dentition. The treatment approach included pulpectomy of the geminated tooth followed by the restoration of the crown using direct composite filling. The procedure aimed to alleviate the patient's pain, preserve the primary double tooth, and maintain the space for the succeeding permanent tooth. The report emphasizes the importance of careful clinical and radiographic examination for accurate diagnosis and highlights the challenges associated with managing geminated teeth. It underscores the need for vigilant monitoring and maintenance to ensure the long-term oral health and aesthetics of such aberrant teeth. Keywords: Gemination, Aesthetic Dentistry, Pediatric Dentistry