Search Results (127)

Primary teeth play a crucial role in a child’s development, particularly in maintaining space for permanent teeth. The premature loss of a primary tooth can lead to orthodontic issues, making the use of space maintainers essential to ensure proper growth and development of permanent teeth. To preserve space, the fabrication of a space maintainer is necessary. Since conventional space maintainers do not restore masticatory function, this study presents an innovative solution for space preservation following the extraction of the first primary molar through the design of the functional space maintainer KOS&MET (Key Orthodontic System and Materials Enhanced Therapy). The space maintainer was designed using the 3Shape Dental Designer 2023 version software tool and manufactured via additive 3D printing, utilizing a metal alloy with high resistance to masticatory forces. The crown is supported by the primary canine, while an intraoral window is created to monitor the eruption of the successor tooth. This design does not interfere with occlusion and enables bilateral chewing. Masticatory performance was assessed using two-color chewing gum, and the results showed improvement after cementing the space maintainer. This innovative approach not only preserves space for permanent teeth but also enhances masticatory function, contributing to the proper growth and development of the jaws and teeth. Full article

Introduction: Dental caries and molar–incisor hypomineralisation (MIH) are prevalent conditions affecting children’s oral health, with functional, aesthetic, and psychosocial implications. In Spain, previous studies have highlighted geographic and sociodemographic disparities in their distribution, particularly among rural and migrant populations. Objective: To characterise oral health status, in terms of caries and MIH, among 6–7-year-old children from the towns of Palos de la Frontera, Mazagón, and San Bartolomé. Methods: A cross-sectional study was conducted involving 229 children recruited from public primary schools. Sociodemographic, anthropometric, and behavioural data were collected through clinical examination and interview. Statistical analysis included univariate and multivariate logistic regression. The study protocol was approved by the Ethics Committee of Huelva. Results: The prevalence of caries (DMFT ≥ 1) was 53.3%, with mean DMFT and dft indices of 1.78 and 0.31, respectively. MIH affected 32.8% of the cohort, with a predominance in the first permanent molars (teeth 36 and 26). Multivariate analysis identified independent predictors of caries: African (OR = 7.47; 95% CI: 2.84–23.8) and European (OR = 4.56; 95% CI: 1.26–22.3) parental origin, poor oral hygiene (OR = 3.07; 95% CI: 1.60–6.03), and the presence of MIH (OR = 3.20; 95% CI: 1.64–6.42). The municipality of San Bartolomé was associated with a higher risk of MIH (OR = 2.90; 95% CI: 1.21–7.45). Conclusions: The high prevalence of caries and MIH in the Condado-Campiña district, exceeding national averages, reflects oral health inequities linked to social determinants (migrant origin, locality) and clinical factors (MIH, oral hygiene). Targeted preventive interventions are urgently needed in high-risk populations, including culturally tailored education and policies ensuring equitable access to dental care services. Full article

This study aimed to assess dental caries status of 3- to 6-year-old preschool children in the Republic of Serbia. Stratified cluster sampling was implemented. Children were examined in four administrative regions of Serbia. Dental caries indices (decayed, missing, and filled) for deciduous teeth and the first permanent molar were recorded at the tooth level (dmft, DMFT) and surface level (dfs, DFS). In addition to cavitated caries lesions (ICDAS 3-6), visual changes in enamel (ICDAS 1-2) were recorded. This study included 1060 3-year-old and 1820 6-year-old children in Serbia. Fifty-six percent of 3-year-olds and 21% of 6-year-olds were caries-free. The mean dmft was 2.11 ± 3.45 for 3-year-olds and 4.46 ± 3.69 for 6-year-olds. The mean dfs was 2.62 ± 5.56 for 3-year-olds and 6.06 ± 6.33 for 6-year-olds. The decayed component was dominant in dmft/dfs. The prevalence of surfaces with initial lesion was 8% for 3-year-olds and 13% for 6-year-olds. Among children diagnosed with early childhood caries, 54% of 3-year-olds and 37% of 6-year-olds had a severe form. The mean DMFT was 0.15 ± 0.55, with only the first permanent molars being affected. Dental caries remains a significant public dental health issue among preschool children in Serbia. There is a noticeable trend of increasing numbers of decayed teeth as children progress through their preschool years. It is imperative to take corrective action enhance the existing oral health prevention program in Serbia with the aim of achieving better dental health among preschool children. Full article

Molar Incisor Hypomineralization (MIH) is a common dental condition that affects the mineralization of the enamel, primarily affecting the first permanent molars and often the incisors. This condition can lead to a wide range of clinical presentations, from mild opacities to severe post-eruptive breakdown, which can significantly impact a child’s oral health and quality of life. Background/Objectives: The prevalence and complex management of MIH have posed a significant challenge for dental practitioners. Our preceding investigation found that 14.3% of school-aged children have MIH. Based on this finding, we wanted to understand what other Romanian dental professionals think about this condition. Therefore, the aim of the present study was to assess the awareness, perception, and clinical management approaches of Romanian dentists toward MIH in order to inform future educational strategies and contribute to the development of dedicated preventive programs. Methods: To gain a comprehensive understanding of MIH in actual clinical settings, we developed and administered a questionnaire consisting of three distinct sections. Our objective was to capture the collective knowledge and perspectives of dental practitioners. We distributed the survey, which included 14 pertinent questions, to a large professional group of Romanian dentists. Results: This study collected responses from 219 Romanian dental practitioners (median age: 34 years) about their experiences with MIH. The vast majority (86.76%) had encountered MIH cases in their practice, with half reporting moderate prevalence among their patients. The most frequently observed complications were hypersensitivity (41.95%), pulp exposure (33.33%), and failed restorations (24.71%). While adhesive restorations were identified as the overall preferred treatment approach (70.00%), notable differences emerged in both clinical complications encountered and therapeutic approaches implemented across dental specialties. There was near-unanimous agreement on the importance of early MIH diagnosis (99.09%), and almost all participants (98.63%) expressed a desire for more information about this condition, demonstrating high awareness and concern about MIH among Romanian dental professionals. Conclusions: This study highlights that general dentists, endodontists, and pedodontists encounter MIH patients frequently in their practice, emphasizing the critical need to enhance awareness and education about MIH among both dental professionals and the general public. Full article

Background: During the initiation of routine orthodontic treatment with fixed appliances, placing elastic separators (ESs) may lead to the patient experiencing considerable pain. Earlier studies evaluating the effects of low-level laser therapy (LLLT) on reducing pain caused by orthodontic ESs have reported contradictory results. The aim of our study was to evaluate the effect of a single application of LLLT on the experience of pain following ES placement. Methods: A double-blind, placebo-controlled randomized controlled trial was performed—with implementation of the split-mouth technique—where n = 33 volunteers (12 male and 21 female; aged between 19 and 36 years) were enrolled. ESs were placed at the mesial and distal surfaces of the first permanent molars in the upper or lower jaws. Jaws were divided into two quadrants; the treatment group received LLLT (using a GaAlAs diode laser, at a 980 nm wavelength, with 100 mW producing 6 J of energy; continuous wave), while the other quadrant served as the placebo side receiving a similar treatment, but without laser irradiation, immediately after separation. A questionnaire with a visual analogue scale (VAS; 0–100) was used for the assessment of pain (spontaneous pain and pain on mastication) scored for each first permanent molar directly after separation and after 6, 24, 48 and 72 h of both laser and placebo treatment application. Results: Mean VAS values were lower, but not significantly different, between the treatment vs. placebo groups for spontaneous pain at either measurement point (p > 0.05). Mean VAS values were significantly lower in the treatment groups for pain on mastication at the 6 (9.29 ± 12.65 vs. 19.07 ± 20.99; p = 0.025), 24 (21.96 ± 21.11 vs. 37.19 ± 26.35; p = 0.012) and 48 h (28.01 ± 21.40 vs. 42.60 ± 26.29; p = 0.016) measurement points. The analgetic effect of LLLT was most effective after 6 h, both in the resting position (−49% decrease) and during mastication (−51% decrease). Conclusions: A single application of LLLT with 6 J of energy may have beneficial effects on reducing the pain caused by orthodontic ESs used at the initiation of treatment with fixed appliances, especially during mastication, after 6–48 h following the separation procedure. Trial registration: clinicaltrials.gov ID NCT06816537 (date of registration: 7 February 2025, retrospectively registered). Full article

Compromised first permanent molars (FPMs) in children pose major challenges for dentists and patients even in low-caries-risk populations. Whether due to caries or Molar Incisor Hypomineralization (MIH), compromised FPMs at an early age require careful treatment planning and timing of extraction, if necessary, to eventually have good space closure with healthy dentition. This comprehensive review explains the concept of early extraction of the FPMs in children and lists the results of published studies and systematic reviews regarding spontaneous or orthodontical space closure after the extraction of an FPM, including its consequences in the long term. In general, the majority of the studies confirm that spontaneous space closure after the early extraction of the maxillary FPM could be achieved if the extraction is performed before the eruption of the second permanent molar (SPM). On the other hand, space closure in the mandible is possible in case of optimal timing of extraction and supporting co-factors, but in practice, it would most probably require orthodontic treatment. The decision to retain or extract compromised FPMs must always be made on an individual basis, taking into account all relevant factors and the long-term effects on the entire stomatognathic system. Early prophylaxis to prevent caries and early management of MIH-affected FPMs should, however, be the first-line approach. Full article

Background/Objectives: Fracture resistance is crucial for provisional crowns, especially under high-stress conditions like bruxism. While semi-permanent materials such as Luxacrown are designed for durability, their performance under extreme occlusal forces remains uncertain. This study uses finite element analysis (FEA) to evaluate the fracture resistance of five common provisional crown materials. Methods: A standardized digital model of a maxillary first molar was developed with uniform crown thickness. Twenty models were created to assess Unifast Trad (self-curing PMMA), Luxatemp Star (bis-acryl composite), Luxacrown (semi-permanent bis-acryl), Protemp 4 (nanofilled bis-acryl), and Telio CAD (CAD/CAM PMMA). FEA simulations evaluated vertical (250 N), lateral (225 N), diagonal (400 N), and bruxism-level (800 N) forces. Stress-to-strength ratios (SSR) and Von Mises stress distributions were analyzed to evaluate material performance and failure risk. Results: Telio CAD exhibited the highest fracture resistance, maintaining SSR values below 100% across scenarios. Luxacrown and Protemp 4 performed adequately under moderate loads but showed increased stress concentrations under bruxism-level forces. Luxatemp Star followed a similar trend, whereas Unifast Trad demonstrated the lowest resistance, accumulating significant stress in all conditions. Conclusions: Material selection is key to provisional crown fracture resistance. Telio CAD showed the highest durability, while Luxacrown and Protemp 4 performed well under moderate loads but struggled under extreme forces, raising concerns about semi-permanent materials. Luxatemp Star showed similar trends, and Unifast Trad, the weakest, is best for short-term use. Full article

Background: Geometric morphometric analysis, a methodology traditionally used in evolutionary studies, offers unprecedented precision in quantifying the morphological traits of human organs and tissues by identifying specific anatomical landmarks. Despite its potential, this approach has not yet been applied in medical or dental research. Materials and Methods: This pilot study analyzed 76 permanent upper first molars (M1) from Italian individuals (38 males and 38 females), selected for their completeness, minimal wear (stage 1), and absence of pathological conditions or non-metric traits. Each individual contributed two contralateral molars: the left molar (Group A) and the right molar (Group B). The molars were scanned using a Sinergia Scan Advanced Plus optical scanner with 5 μm accuracy. The scans were processed with the Dental Scan 7.0 software to generate high-resolution STL files, followed by refinement in Meshlab to preserve the morphological integrity of the 3D models. The geometric morphometric analysis was performed using the Viewbox software, thereby enabling the placement of anatomical landmarks and semilandmarks to quantify and compare molar morphology with exceptional precision. Results: The analysis confirmed that contralateral molars exhibit high morphological similarity, with significantly smaller variability compared to molars from different individuals. Among the specific traits analyzed, the distolingual cusp (hypocone) showed the greatest variation, followed by the mesiolingual cusp (protocone). No significant differences were observed between males and females in the degree of similarity between contralateral molars. Conclusions: This pilot study highlights the potential of geometric morphometric approaches to enhance our understanding of the dental variation between sexes and across human populations, thereby improving clinical applications and advancing toward personalized medicine. Full article

Introduction: In orthodontics, determining the parameters of tooth size and dental arch and conducting Bolton analysis is crucial for diagnosis, treatment planning, and patient outcomes. This study evaluates the accuracy and reliability of measuring dental-arch dimensions on digital models created using the CEREC Primescan intraoral scanner, compared to measurements taken from plaster models. Methods: The study included two types of dental models (plaster and intraoral scan) from sixty-three subjects. Impressions were taken to create plaster models, and the subjects’ mouths were scanned with the CEREC Primescan system (Dentsply Sirona, Charlotte, NC) to create digital models. Intra-arch measurements included tooth heights and widths, overjet, and overbite. The arch width and depth were examined at the first permanent upper or lower molar. The paired t-test and Bland–Altman plot were used to determine the accuracy, while intra-rater and inter-rater correlation coefficient values were calculated to assess the reliability of measurements from the intraoral scan compared to those from the plaster model. Results: For tooth heights, there was a statistically significant difference in only one measurement (tooth 34) between the plaster and digital models, with an average difference of 0.01 mm. For tooth widths, there was a statistically significant difference in only one measurement (tooth 15) with an average difference of 0.03 mm. The Bland–Altman plots of almost all of measurements of tooth heights and widths showed that differences between the two models were within the limits of agreement. The inter- and intra-rater correlation coefficient values for measurements on the digital model were found to be statistically insignificant. Conclusion: Measuring dental dimensions on digital models obtained through the Primescan intraoral digital system yielded similar results to those obtained from plaster models and showed excellent reliability, indicating its potential application in clinical practice. Full article

Background/Objectives: Delayed tooth eruption (DTE) is a very challenging clinical situation, and the pathogenesis has been associated with local, systemic, and genetic factors. The aim of this presentation is to describe the management of such a case with delayed eruption of mandibular central incisors and canines. Methods: An 11-year-old female patient presented with DTE involving lower incisors (32, 42) and canines, seeking orthodontic treatment. Furthermore, lower permanent central incisors were congenitally missing while lower deciduous incisors were still in place. After a year-and-a-half of just monitoring the case and having suggested the extraction of deciduous first molars and canines, orthodontic treatment started with fixed appliances in the upper and lower jaw. First and second premolars gradually erupted after the precursor’s extraction. Lower canines and the two existing incisors were, after several months, surgically exposed and a gold chain apparatus was bonded on each one, while the closed eruption technique was chosen. A 0.17 × 0.25 stainless steel (SS) lingual wire, leaning on the buccal tubes of the lower molar bands and properly manipulated around them, was fitted in conjunction with the labial brackets and wires in order to facilitate the traction of the impacted teeth, which was carried out for one after the other using either an elastic chain or a second super-elastic wire. Results: All impacted teeth were finally restored to their proper place. The root of 71 did not present resorption, so the tooth was maintained in the lower arch while inter-proximal reduction was performed in the upper arch in the anterior region, in order to anticipate the lower missing incisor. Finally, a stable occlusion with proper contacts was achieved. Conclusions: Proper diagnosis, on-time extractions of deciduous teeth, and a well-designed treatment plan regarding space management and orthodontic traction of impacted teeth contributed to successful treatment outcomes in this DTE case. Full article

Background/Objectives: In Marburg (Hesse, Germany), the selective intensive preventive program (SIP) with fluoride varnish applications had to be interrupted due to the COVID-19 pandemic. The aim of this retrospective anonymized evaluation was to investigate possible effects of SIP interruption on oral health in socially vulnerable 7- and 8-year-olds. Methods: The caries increment in 7- and 8-year-olds for the test group (N = 180) between last dental check-up before the interruption of SIP (02/2019–02/2020) and the first check-up after restart (01/2022–07/2022) were calculated from dental public health service data. The test group was compared to a control group of children (N = 215; same age and schools, with SIP, data collected between the school year 2017/18 and 2019/20). One dentist conducted the dental examinations. The University of Marburg ethics committee approved the study. The Mann–Whitney U test and Pearson’s chi-square test were used for statistical analysis. Results: There was no significant difference in the caries increment in the first dentition between the test and the control group for both age groups. In the different groups, a maximum of 61% of the children with caries experience were completely treated. There was no significant difference between the test and control groups in either the percentage of sealed first permanent molars or the degree of restoration. Conclusions: The interruption of SIP had no negative impact on caries increment. It is possible that the children examined went through the pandemic without a significant increase in tooth decay because the children were well-trained in tooth brushing since kindergarten. Full article

Background/Objectives: Molar–incisor hypomineralization (MIH) is a prevalent dental condition characterized by hypomineralized enamel affecting the first permanent molars and incisors. It leads to visible enamel opacities, with varying severity. Children with MIH often experience dental hypersensitivity, which can result in increased dental fear and anxiety, complicating dental treatment. Salivary cortisol, a well-established biomarker of stress, has been used to assess stress levels in various pediatric conditions but has not been extensively studied in MIH. This study aimed to assess salivary cortisol levels as a stress biomarker in children with MIH and compare them to those in children without MIH. Methods: Sixty children aged 5–9 years were divided into two groups: 31 with MIH and 29 healthy controls. Salivary cortisol levels were measured using ELISA, and statistical analysis was performed using IBM SPSS software, version 23 The Mann–Whitney test was used for group comparison, and the Kruskal–Wallis test evaluated the correlation between MIH severity and cortisol levels. Results: Children with MIH showed significantly higher mean cortisol levels (2.63 ng/mL) compared to controls (0.96 ng/mL), with a p-value of 0.0001. A progressive increase in cortisol levels was observed with the severity of MIH, with the highest levels recorded in grade 3 (4.38 ng/mL), in contrast to grade 0 (0.95 ng/mL), with a p-value of 0.001. Conclusions: Salivary cortisol levels are significantly higher in children with MIH, suggesting that MIH-related stress may contribute to dental anxiety and hypersensitivity. These findings highlight the importance of stress management in pediatric dental care. Full article

The aim of this randomized clinical trial was to evaluate the efficacy of two different remineralising toothpastes in preventing dental caries and promoting oral health. Patients aged 6–18 years old with healthy and fully erupted first permanent molars (C1 and C2 DIAGNOdent scores) were enrolled and randomized into two groups according to the home-hydroxyapatite-based remineralising treatment used: the Trial group used zinc carbonate hydroxyapatite-based treatment (Biorepair Total Protective Repair), while the Control group used magnesium strontium carbonate hydroxyapatite conjugated with chitosan toothpaste (Curasept Biosmalto Caries Abrasion & Erosion). Dental and periodontal parameters were measured over a six-month period, including the DIAGNOdent Pen Index (primary outcome), BEWE Index, Plaque Index, Bleeding Score, Schiff Air Index, and ICDAS assessed with DIAGNOcam. A total of 40 patients were equally allocated in the two groups and finally analyzed. A significant reduction in the DIAGNOdent Pen score was reported in the Trial group after 1 month of treatment, while in the Control group, no significant change was found. The Trial group also showed a significant reduction in plaque levels after 3 months of treatment, while in the Control group, it occurred after 1 month. However, the Bleeding Score and Schiff Air Index showed no significant differences between the groups, suggesting that additional measures may be required to address gingival inflammation and hypersensitivity. The ICDAS index also showed no statistically significant changes, due to the limited duration of this study. Overall, zinc-hydroxyapatite-based toothpaste was more effective than magnesium strontium carbonate hydroxyapatite toothpaste in enhancing enamel remineralisation in the short-term period. The assigned treatments did not result in significant improvements in the oral indexes assessed in this study. Full article

Background: Recently, the demand for esthetic restorations has grown dramatically and extended into the pediatric population. The prefabricated zirconia crowns (PZCs) and custom-made zirconia crowns (CZCs) are new esthetic options in pediatric dentistry. However, they are still inadequately tested for use in children. Aim: To determine the fracture resistance and failure mode of the PZC in comparison to the CZC. Materials and Methods: In this in-vitro study, thirty cobalt-chromium dies were fabricated by scanning the negative replica of a prefabricated lower first permanent molar zirconia crown. CZCs were designed and milled using two different zirconia brands: Ceramill Zolid-FX (FX) and the Highly-Translucent (HT) zirconia. Dies were randomly assigned to receive either a PZC or a CZC (n = 10 in each group). All crowns were cemented on their respective dies using glass ionomer cement. Following artificial aging, all specimens were loaded to failure. Fracture mode analysis was performed. One-way ANOVA and Bonferroni post-hoc test were used for multiple comparisons across the groups. The significant level was set at p ≤ 0.05. Results: HT zirconia had a significantly higher fracture load compared to other groups (p < 0.05). The mean fracture resistance values were: (3087 ± 385) N for HT zirconia, (2633 ± 300) N for PZCs, and (2483 ± 381) N for FX, with no statistically significant difference in fracture strengths between PZCs and FX. Conclusions: HT zirconia crowns showed the highest fracture resistance amongst all groups. The fracture loads of tested crowns exceeded the maximum posterior biteforce. When placed in permanent molars, PZC are expected to perform well under masticatory forces in children. Full article

Background: Dental caries remains one of the most widespread chronic diseases that also affects first permanent molars (FPMs). In this study, we analyzed the prevalence of carious lesions using a standardized evaluation system, while following the analysis of the influence of favoring factors represented by the type and frequency of snacks and the frequency of tooth brushing. Method: A clinical–statistical study was carried out on a group of 311 children from both urban and rural environments, aged between 6 and 19 years old. As a diagnostic system and assessment of the depth of carious processes, we used the ICDAS system. The following parameters were recorded: odontal status of the 4 FPMs, age, gender, residence, frequency of dental brushing, and frequency of between-meal snacks and their type. The ICDAS system was used as a diagnostic system and assessment of the depth of carious processes. The data were statistically analyzed with SPSS, using the Kruskal–Wallis H and Chi-Square tests. Results: The occlusal surface was the most interesting in the presence of odontal lesions. Sweet snacks were the most frequent snacks consumed by the subjects. The age group of 13–19 years presented fewer healthy FPMs, compared to the age group of 6–12 years. The higher involvement of older subjects was found for all four molars, both in the case of identified carious lesions and the presence of root debris and edentations. Brushing twice a day was more frequent in the 6–12 age group. In analyzing the status of the first molars in relation to the gender of the subjects, in the present study, no statistically significant differences were recorded between the status of the molars relative to gender, except for molar 1.6 (p > 0.05). Regarding the other types of snacks, children from rural areas consume more fruits than those from urban areas. Conclusions: The frequency of tooth brushing and the type and frequency of snacks between meals influence the prevalence of carious lesions at the level of the first permanent molars. Full article