Pediatric Dentistry - Science topic

All treatment options should be presented to the patient and patient decides which treatment plan they feel comfortable with. The age of the patient also plays a role in deciding the ideal plan.

SELECTIVE ETCH

you can have a look at this

intranasal pre-sedation with Midazolam and standard N2O/O2 inhalation sedation. However, it should not be a routine method,

Thank you so much

of course I know Pubmed, I was asking about how to know the latest topics in pediatric dentistry published in pubmed, for example.

Its simply just because recoding of surfaces allow us to understand the rate of progression of a lesion.  Also,  it becomes more valid to count surfaces than teeth as it enhances the sensitivity ie ability of an index to detct minor shifts in the progression of a disease....  :) 

Kristin Galler has an excellent review article and she is considered to be a biomolecular expert in this area...her observations are spot on and she cautions us to realize that the protocol for this approach is not set by any means. Follow her publications or listen to her presentations if you have the opportunity. I have spoken with her on this topic and am thoroughly impressed with her work and assessments. She will be a leading investigator in this area along with Stephane Simone from France. See also the attached abstracts that may shed some additional light on the question you posed. However, we have only scratched the surface in the area.

Hello,

The question you need to ask is what information will a lateral cephalogram provide in the deciduous dentition that cannot be obtained from a clinical examination. If the patient is Class II or Class III, surely you will be able to determine this clinically and plan appropriate treatment at the appropriate time? Furthermore, the inclination of the deciduous incisors is not relevant as there will be lots of changes when the permanent incisors erupt. Most importantly, it should be remembered that the effective dose of radiation is increased threefold when radiographing children.

The following European Guidelines on Radiation Protection in Dental Radiology might be helpful https://ec.europa.eu/energy/sites/ener/files/documents/136.pdf

During teeting children can get a stuffy nose, but a wheeze should not be present. When babies "cut" teeth an inflamitory process is set up. The gums become irritated and this can lead to a fever and other cold like symptoms. also when ever a babies immune defenses are challenged as you see when they get new teeth it allows other germs to gain access to thier developing immune system and they become more suseptable to cold viruses and other illnesses. I hope this helps. Dose him with tylenol and if you Dr. says it's ok with Motrin as tylenol won't help the inflamation of his gums and the motrin will. Keep his room well humidified and you could use some saline in his nose to help loosen secretions and that will allow them to drain out a little more easily. If he continues to wheeze you should get him to the Dr. as this could be signs of a true illness.

My main concern with this nasal hood is that I do not believe the scavenging of waste gases can be adequately achieved 

Dear Martha Juliana Rodriguez Gomez 

pls check the link.

According to Andreasen replantation of primary tooth is not advisable.

J Dent Res. 2012 Sep; 91(9): 847–852.

doi: 10.1177/0022034512454296

PMCID: PMC3420390

Effect of CPP-ACP Paste on Dental Caries in Primary Teeth

A Randomized Trial

T. Sitthisettapong,1 P. Phantumvanit,1,* C. Huebner,2 and T. DeRouen3

The original question which initiated this wonderful discussion was "Is a space maintainer required in an 8 year old child where primary maxillary first molar has been extracted?. The questions was NOT " Is a space maintainer required where primary maxillary first molar has been extracted?". 

The paper by Lainge et al posted by me was NEITHER to Support NOR to contradict the idea of space maintainer in the above mentioned situation. It has not concluded anything but QUESTIONED the ROUTINE use of space maintainer in that region. 

The major factor for space loss when primary maxillary first molar is prematurely lost is the ERUPTING first permanent molar. In the above question there is a possibility that the first molar might have completed its eruption. It is also been possible the forces exerted by the erupted first permanent molar could be buttressed by the well placed maxillary second primary molar ( There is no evidence for this). There could have been no bone covering the unerupted first premolar. Hence a space maintainer MIGHT become redundant. We have to evaluate the " Status of eruption of first permanent molar" ( major factor), bone covering the unerupted premolar ( second major determinant), the root development of the erupting first premolar ( third determinant) for the decision in this region. I will go in this order. Infact the first and second determinant might need equal importance too. I am enclsoing the chapter with a pic at the end of this discussion where the premolar has erupted even before the first permanent molar is erupted. It is published in my Textbook - Pediatric Dentistry - Principles and Practice  2nd edition published by Elsevier. Pls see Page No 40 in the chapter.

We were not looking for evidences in 1980's. It all started in early 90's. Now the "Standard of Care" will be good if we have concrete evidence for our decisions. However, as clinicians we know, most of the decisions what we take daily and what we practice DO NOT have strong evidence but EMPIRICAL and but we still practice them in our department and in our practice settings. But if we believe something strongly probably the opportunity to QUESTION the KNOWN could become difficult. In the present evidence based world, it is better to look for evidences and make clinical decisions. Also keeping the ability to question the methodology by which evidence was generated is also important. 

The discussion is NOT against space maintainers. It has a very important role to play in dentistry. But the bottomline is " IS IT NECESSARY ALWAYS" ?

Dear Naveen,

Those files are not very long but quite thin and pointy and being made of metal are radiopaque, right? I would follow the very good published guidance by the American Society for Gastrointestinal Endoscopy (ASGE) on sharp pointed objects:

Establish first that the instrument is not lodged in the oesophagus and that it has not passed beyond the stomach by radiological evaluation. If it is lodged in the oesophagus, its removal is an absolute emergency. If it has not passed beyond proximal duodenum remove endoscopically, as there is still a 35 % chance of complications by letting a small sharp object pass via its natural way. Otherwise careful observation with serial xrays and consider surgical intervention if the object has failed to be passed within three days. Warn patient/carer/family to immediately report abdominal pain, fever, vomiting, haematemesis melaena or pr bleeding.

Best wishes,

Immo

Thank you Gazala this is a great paper for my question. Best regards.

Depends on several aspects as patient age, risk to caries and the severity of the enamel defects. When it is opacities without fractures of the enamel structury, glass ionomer (conventional) selant or fluoride vanish should be applied. However, If it is fractures of enamel, you should treat with glass ionomer (conventional) selant and follow up.

It depens. I think that you will always do the best effort to restore first permanent molars.

But if the efforts are not enough and you have to extract it, carefull treatment planning must be developed ,particularly in the presence of an underlying malocclusion.

Even the evidence base for managing first permanent molar extraction is weak, with currently no randomised prospective trials reporting on the outcome of different interventions, I suggests you reading the paper of Cobourne MT, Williams A, Harrison M, "National clinical guidelines for the extraction of first permanent molars in children" Br Dent J. 2014 Dec 5;217(11):643-8.

This artjcle  summarises recently updated guidelines produced by the Clinical Governance Directorate of the British Orthodontic Society through the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS) on the extraction of first permanen tmolars in children.

Best regards

I agree. I think the SSC is passe.  We have better materials now. Though SSCs (via Evidence Based Densitry) are better than amalgams, nothing I am aware of has been done comparing SSCs to composites or GIC.

Joel Berg has been saying for a long time to go GIC for primary teeth. However, here in USA, we consider compomers a very inferior restoration material.  The main point is to get a good/perfect seal to prevent bacterial leakage into the pulp chamber. 

I assume your family member is NOT using formocresol?????? HOpeuflly using MTA or Biodentine?

Yes, indirect pulp caps are the way to go.  Ideally, you get a better bond conditioning the dentin with a mild polyacrylic acid so that the GIC will bond better to the dentin.

Great forum

Lance

Lance Kisby DMD, FASDC, FAAPD, MAGD

The rationale is that French anaesthetists (the technique is predominantly a French technique) feel that dentists cannot be trusted with equipment that can mix gases,  so it is better to overdose patients! It is an attitude that really annoys me as there is good evidence that in general anaesthetists are not as good sedationists as dentists!

There is a correlation. There are two schools of thought when it comes to cortisol and dental caries. The first school argues that when you have any inflammation in the body, the body releases steroid based compounds to combat the inflammation. Since cortisol is the end product of the entire family of steriod based families it makes sense that increased inflammation would result in increased cortisol. However, there is an alternate theory. Cortisol is also a biomarker of stress. The general role of stress in promoting dental caries is well known. Therefore while the inflammation of dental  caries is associated with increased cortisol, inflammation alone is not the whole explanation. 

The primary dentition develops in utero and therefore if fluorosis occurs in the primary teeth, it would have to occur during this time. On the other hand, the development of the permanent dentition excluding the third molars occurs anywhere between 1 year and 7 years of age, This is the period of time the permanent dentition is vulnerable to fluorosis.

hi

can you please upload panoramic radiography and photographies?

I think the first step is to know the exact type of amelogenesis imperfecta ,if accompanied by anterior openbite it seems that the case is of hypocalcified type.

these patients report tooth sensitivity too.If dental age of the patient is late(It takes some time for the primary molars to shed),SSC seems a good choice and if needed pulp therapies must be done.for anterior teeth,composite veneers can be used until reaching full growth when they can be replaced with crowns,if needed.for first permanent molars,permanent SSC are available if they are too hypoplastic.otherwise, more conservative approaches must be used.

Most importantly,I think it will be useful to begin the patient care with preventive approaches including fluoride therapy,sealants,diet consultation and etc.

For skeletal problems as you mentioned,consult with an orthodontist, although bonding procedures is some how difficult in these patients.

these are the plans I had, and wait for hearing more extensive treatment plans.

 yes, definitely, Salivary flow rate differs from children to adults. children will be having more than adults and also there are 3 types which includes serous type, mucous type and mixed type. It is believed that as the age advances salivary secretion will be reduced.

Dear Fethi, that's right. I have divided the reasons in

1. Oral hygiene deficiency - local consequences of disability - low manual power,

2. Infections,

3. Attention Deficit,

4. Retarded ability to swallow or difficulty breathing - open mouth posture,

5. Resulting gingival inflammation with bleeding (fear plastered against bleeding tissues),

6. Exaggerated facial expressions and gestures,

7. Metabolic disorders (cf., diabetes),

8. Imbalance of growth factors, tendency to hyperplasia,

9. Poor mouth hygiene because of nausea with the use of aids and hygiene,

10. Various syndromes with symptoms participation.

My students are sensitized to care against wrong habits of the patient (and in spite to care for their relatives better understanding of the pathogenesis).

Yes I have but I did not get the 99% success rate as reported in the original Gow-Gates experiment. I recommend reading the Gow-Gates technique; a pilot study for extraction procedures with clinical evaluation and review.

Dear Jtim T Rainey,the best method for this patology is the cilinical examination.Abrão Rapoport

I have had extensive experience conducting clinical trials in which we had to teach toothbrushing and/or flossing to the subjects--(this includes manual and powered toothbrushes).  The best way to standardize instruction is through the use of video.  We use a professionally produced video to teach straightforward brushing and flossing (manual or powered).  Usually the straightforward brushing and flossing is for a control group.  For toothbrushes or interdental cleaning aids that are the subject of the clinical trial, we produce a video that incorporates the manufacturer's instructions.  Additionally, we give each subject (control and experimental group) a set of written instructions with photographs that contain the exact information that is in the video.  Teaching subjects in this manner has saved us a great deal of time.  There are a number of videos that are available that teach straighforward brushing (Modified Bass Method) and flossing.  The American Dental Hygienist's Association has them as does the the American Dental Association as well as a number of other professional organizations.  Hope this helps! 

Biofilm is composed of several different kinds of bacteria and their products that develop over the enamel on a layer known as dental pellicle. The process of plaque formation takes several days to weeks and will cause the surrounding environment to become acidic if not removed. Gingivitis and caries lesion appears if there is no disruption of biofilm and this will be established.

The preventive methods should be used daily as a toothbrush, toothpaste and floss, and in the case of children, parents are responsible for the cleaning and feeding, but also by seeking professional guidance. And what's the problem? The problem is that parents are not prepared to care for their children. Socioeconomics, educational and cultural problems interfere with the way parents lead their lives and of their children. See these articles that show different regions of the world and the problem of oral health.

Look at the PhD thesis (which I was the supervisor) University of SDU,faculty of Dentistry.

Even though the text books says its contraindicated..... its high time to rethink the same. From past eight years I am using barbed broach for extirpation of primary pulp. But i use to do it after getting a good entry with K file and H file of the respective sizes. Always K files used prior to broaches.

This refers to the so-called late mesial shift (Baume~1958). The second primary molar's mesial-distal dimension is greater than the premolar that replaces it. This residual space is loss with the mesial migration of the first permanent molar, thus a decrease in arch length between the permanent molars.

First of all, I would like to apologize for my late reply to the question by Dennis Nutter. I have been away from home for 4 weeks (Indonesia and Malaysia…on MAS aircrafts!), with little or no connection to the web.

Now, I give you more details on intraosseous anesthesia for children, as the initial problem was : "Enamel Hypomineralization in molars : I have highest failure rate of securing local anesthesia [ both mandibular & maxillary ) first molars", wasn't it?

We describe, in Europe, 2 types of intraosseous (intra diploic, inside the diploe) anesthesia :

-transcortical : consists in injecting the anesthetic directly into the cancelous bone after crossing the cortical plate with a drill or with a rotating and perforating needle (8mm long, and 0.3 or 0.4 mm diameter) (Quicksleeper system), at right angle to the cortical plate surface.

-osteocentral : the perforation point is similar to an intraseptal anesthesia, but you insert the needle vertically much further into the interdental space, with a loger needle ( 12 or 16 mm long, and 0.3 or 0.4 mm diameter.

On permanent teeth,

-between the ages 6-9 : for anterior teeth and first molar : transcortical anesthesia without rotational system for peforing the cortical bone. Generally, at that ages, bone is rather easy to perforate by a simple pression on the needle (8 mm, diameter 0.3 or 0.4 mm)

-between the ages 10-16 :

+for anterior teeth : transcortical anesthesia with rotation

+for first maxillary molar : transcortical or osteocentral anesthesia with rotation

+for second maxillary molar : osteocentral anesthesia with rotation

+for first mandibular molar : transcortical or osteocentral anesthesia with rotation

+for second mandibular molar : osteocentral anesthesia with rotation

You will use less than 0.9 mL of an anesthetic formulation with epinephrine. I consider hypo mineralized teeth as chronically inflamed teeth, and this implies to use an anesthetic formulation with 1:100 000 or, better, 1:80 000 epinephrine. The onset will be immediate (as soon as the injection is over, you can begin to treat ); there will be no or minimal soft tissue anesthesia. If you want to install a clamp for thre rubber dam, no supplemental anesthesia is required.

Moreover, in the maxilla, you can anesthetize 2 teeth distally and 3 or 4 teeth mesially to your injection point, depending on the amount injected. You can make the anesthesia either on the labial or the palatal aspect of the tooth.

In the mandible, you will anesthetize one tooth distally and 2, 3, or 4 teeth mesially, because the vasularisation of the mandible is unidirectional, postero-anteriorly oriented. So, when anesthetizing a mandibular molar, always try to inject in the distal interdental space (transcortical anesthesia) or in the inter radicular space of the molar tooth (osteocentral anesthesia). The injection is made on the buccal aspect of the tooth.

I understand Dennis point of view, but I prefer anesthetizing systematically, because, as demonstrated by Sixou and al. these intraosseous anesthesias are very well tolerated by children (no "big shot").

I also would like to point out that, for numbing the attached gingiva prior to performing the intraosseous injection, I never use any kind of topical compound : I think that proper use of the needle (correct positioning of the bevel "flat" on the mucosa), and pen-grip handling of the syringe (Wand, SlleperOne, QuickSleeper) and computer controlled injection, are three basic factors allowing a totally pain-free anesthesia : see for more about that our pedagogic article about pain-free palatal anesthesia...in French...

I hope this will help.

If you need further details, please let me know : if you provide me with your email details, I can send you a lot of articles (with good iconography demonstrating the art of doing).

Hi

First of all it seems to be better to request the blood test to determine infant's T 3&4 hormonal levels( conservatively view),as functional problem of thyroid was reported in infant with premature birth .If it was rule out ,as it seem the infant is otherwise healthy follow up is be just option til nearly 18 months old.Delay in tooth eruption was reported in infant with premature birth . After a few months waiting if the teeth do not erupt ,radiography can help us to diagnosis of probably reasons such as dental missing that it was reported in infant with premature birth. Treatment plan can be design base on the number and area of missing teeth and proper time for intervention.

WITH BEST WISHES

2. PDL considerations

comes somewhat later

3. Replantation

Irrespective of the PDL situation we aim at replanting in every case - also in deleterious situations.

Exception: An alternative treatment is immediatley available and a decision to it can be made immediately.

Prerequisite: We can be sure that there will be no infection. Infection would mean a high risk of severe bone loss. Therefore an extraoral endo is a necessity in my eyes.

Replanting immediately restores esthetics. It maintains the tissue volumes. There is merely a loss of teeth if healing was good (reestablishment of functional PDL).

However, in case of ankylosis this is true for a limited time only.

Why then replantation? Sometimes time is needed for a consecutive treatment like premolar transplantation, the time of the avulsion may simply be too early. A replanted tooth keeps the tissues, and transplantation is much easier compared to situations where teeth are missing for a longer period.

If a treatment like orthodontic treatment or transplantation is not intended, the ankylosed tooth can be subjected to decoronation: this leaves a much better local situation for an implantation than after loss of teeth.

However, this concept also means that there are at least 2 surgical interventions: the replantation itself, and the consecutive therapy.

Devitalizing agents are for sure no replacement for local anesthesia! However, when the pulp is congested, sometimes there can still be a little bit sensitivity. However, usually this vanishes in the rinsing phase with chloramine (or sodium hypochlorite) as the nerve is disrupted or removed by the fluid pressure.

Normally, the pulp bleeding should stop spontaneously, although we sometimes use ferric sulphate to speed it up a bit, but this is a safe product, and not devitalizing as such. As a pulp filling material, we use a calcium silicate/ MTA.

Regarding local anesthesia, I think it just requires some practice and tricks, but the majority of children accept it very well. Be honest, but don't show the needle/syringe. Be careful in your choice of words. We use 'droplets', rather than 'injection'; 'feeling', 'prickling', 'tingling', 'pressure',... instead of 'pain'. Warn them that they might feel a sensation, to prepare them, but don't let it sound too harsh. I mostly say: this may tingle a bit or you may feel a bit of pressure. And indeed, as Dr. Collier already mentioned, the intraosseous anesthesia is very effective in children as the bone is still rather soft, especially the ones that dislike the numbness. We first rub some topic anasthesia (xylocaine or lidocaine) on the place of the injection. Inject slowly and use a sharp needle (needs to be changed if it had any contact with the bone before using it again!!!), all this to avoid that it will be truly painful. And, feel confident. They 'feel' your nervousness :) I've experienced this in the beginning :)

May I please play devils advocate?

How do you justify invasive root canal treatment in primary molars in todays days?

There is an Psychometric properties of the Brazilian version

of the Early Childhood Oral Health Impact Scale

(B-ECOHIS) Ana Carolina Scarpelli - published in BMC Oral Health.

You may want to look up work on biological understanding of which there is a huge quantity eg hatano and inagaki, Keil, Carey and countless others. . And also some work on children's conception of human physiology eg an old paper by Bibace

Sorry for speeding your name incorrectly.. Dr Kyung-San Min

The most important thing here is the way of using miswak, to get the best results miswak tip should be cut every day so that the active ingriediants are maximum, also the frequency of use is so important, I think it should not be less than 3 times per day and for infants the most important time of use is after the last breast feeding before the mother go to sleep.

My motto: Be honest, be fast - and then extremely slow.

Some own observations and how I do local anaesthesia personally.

Under the limitations Klaus mentioned (child is "accessible")

To avoid phobia: Prevent bad experiences. Reduce the experience of pain as far as possible / avoid unnecessary pain.

Tell before what you do - and never try to lie. That would be a betrayal of confidence which you will never be able to repair.

A. Punctuation of tissues

From my experience the pain from puncturing the tissues with the needle is by far the smaller problem.

1. I try to puncture the tissues very fast. I use sometimes a surface anaesthetic, sometimes some pressure before. Depends how I judge the patient or whether he asks for that.

2. For (nearly) every new puncture of tissues I use a fresh needle. At least if you had contact to bone - never try to use this needle again. And even if you just had contact to soft tissues the needles lose a bit of their sharpness. Needles damage tissues and cause pain if they are not sharp...

3. There are needles with special bevels to reduce pain during puncturing.

4. I try to reduce the number of tissue punctures as far as possible. The modern anaesthetic solutions are really good, they can quite well spread within the tissues. You definitely don't need a depot every half a centimeter. And you can protrude the needle within the tissues..

B. Injection

What is bad for most patients is the feeling of burning during the injection of the anaesthic solution. It is quite a volume which has to be injected: Thus the tissues are damaged, cells must part from each other.

The less pressure, the less pain:

1. Find a place with lots of subepithelial tissues: injecting into the fixed gingiva requires high pressure, it is a torture. On the palatal aspect I use the region with lots of small salivary glands - I prefer blocking the nerve at the palatal foramen and the incisal foramen instead of doing an terminal anesthesia.

2. Needles: I don't use these very thin needles, the pressure in the tissues increases with diameter reduction! Also in children, also palatally, I use g25 (orange) - and never what most colleagues use in children: G30(grey).

3. There are needles with reduced thickness of the wall, thus allowing a bigger inner diameter with the same outer diameter. http://www.septodont.ca/products/septoject-xl?from=668&cat=4

(same link as above)

4. I take my time and inject very carefully (veeeeery slowly): just a little drop of the solution and then stop waiting for the effect of the anaesthesic. With the needle in place... That takes some seconds. Then another drop, which is announced as perhaps still a bit noticeable.

We have "The Wand" in our department - I never use it. Yes, the pencil design may be an advantage, but what a waste of material, and what amount of anaesthetic solutions trapped in the tubes...

As long as my patients tell that they have never got such a well done injection, with this little pain, I don't see the need for this device. And no, I don't have golden hands. The "light thumb" (like this expression from Klaus) - it is not a matter of the hands, it is a matter of the head, and the heart. It is just the will to consider some banalities, fed by some knowledge, own experiences, and some thinking. I am sure that every dentist could inject at very low pain levels... It is the will to invest some time for the injection - instead of injecting fast and then nervously waiting for the effect.

I have three publications on the topic. Please go to my RG site. You may read in detail about your question. I have a review article in the area that should provide detail of your interest.

Dear Dr.

That was a very important question that needed to be raised. Try crows I use are made by 3M and they are very good in the physical properties. I do re use after decontamination first with hydrogen peroxide, followed by cleaning and Autoclave sterilization.

may be this article is useful to you.

Yilmaz Y, Guler C. Evaluation of different sterilization and disinfection methods on commercially made preformed crowns. J Indian Soc Pedod Prev Dent [serial online] 2008 [cited 2013 Apr 11];26:162-7. Available from: http://www.jisppd.com/text.asp?2008/26/4/162/44032

hope you find it useful. I also recommend a study impression just to reduce the number of try in if possible.

Dr. Rangeeth

Do it - but use a method that promises to not harm the permanent germ.

1. Some theoretical thoughts

a. The rate with observable damage/consequences at the permanent successor after avulsion of a primary incisor is already >50% - without replantation! The rate after intrusion is somewhat higher. You will never be able to inflict the same damage like an intruded incisor... Thus, there is not much chance for worsening the rate of damage of the permanent successor by replantation...

b. If you don't replant to avoid damage to the successor, you may not reposition any dislocated tooth, since this would add much more damage: While before replantation you could (and should) remove the coagulum that has filled the alveolus, you can't do that with the coagulum that has filled the gap between apex of primary tooth and permanent tooth germ that is left when the apex of the primary tooth is dislocated labially (which is the typical situation). By repositioning the dislocated root - and you have to consider that the coagulum stiffens with time - you press the coagulum against the permanent tooth germ. No problem with the avulsed tooth in this regard...

c. There is not any study which would show an increased damage after replantation. Thus the rejection is based purely on assumptions...

2. Practical HowTo

Possible causes for damage at the successor are mechanical trauma during the replantation (by root tip or coagulum), and infection (deriving from an infection of the necrotic pulp tissues).

a Removal of root tip before replantation

If the root tip is resected before replantation for about 3 mm, then there is a distance of at least 3mm to the permanent germ... No chance at all for damaging it.

b Immediate (before replantation) endodontic treatment from a retrograde direction

Prepare (from retrograde) the root canal, use normal extirpation needles, endo files and reamers, the dentine of the primary teeth is soft, no problem. Use a resorbable root filling material; we use Ca-hydroxide.

The immediate endo prevents any microorganisms from entering the canal, thus there is no risk of an infection in the root canal, no apical periodontitis, no infection related resorption.

3. Ankylosis

Andreasen (Textbook) reports on a few ankylosed primary teeth; there were obviously no severe complications deriving from ankylosis.

Up to now, we only replanted primary teeth which promised to heal in "normally". And this occurred in all these few cases. Thus we don't have any own experiences with avulsed, replanted and ankylosed primary teeth...

But with the promising report of Andreasen we are just updating our protocol...

Main advantage: Speech not disturbed. No necessity for a prosthesis...

To be considered: Age / Compliance

We are just preparing a paper with this topic. Will hopefully be back soon with some pictures, but we have to consider copyright issues/ the demand of no earlier publication.... Meanwhile you may want to have a look at our strategy and method we use for permanent teeth: the only difference is that in these cases we don't use a temporary root filling material, but a definite one (titanium posts)... Or you may want to follow some more avulsion topics...

Good afternoon from Spain

Determination of working length for teeth with wide or immature apices: a review. Kim YJ, Chandler NP.

This is the paper I referred, but it´s a review.

This review examines multiple articles. In one, (Clinical evaluation of the measuring accuracy of ROOT ZX in primary teeth. Kielbassa AM, Muller U, Munz I, Monting JS.) they use all type of tooth and statistical analysis didn`t show any influence of the type of tooth (34 molars, 37 incisors) on the results of the EALs measurements. Also no differences between resorbed and nonresorbed roots could be evaluated. Others articles included in the review are with primary molars with and without resorption, but was in agreement and concluded that the EAls had high accuracy irrespective of presence or absence of root resorption.

Also, the review include laboratory studies that compared the ability of conventional and digital radiography and EALs in determining working lengths in primary teeth with or without resorption, with varied results.

Regarding your questions, I´m not an expert in this topic, but you can access and remove pulp tissue and determine with the electronic apex locator the root canal lenght, then extract primary canine and determinate the “real” length. With this data you can determinate the EALs' error and without radiography.

Interesting topic. Have a good day.

it is always case or situation dependent, in ideal case scenario is what you seek, then say; co-operative 5-6 yr old chiild

class 1 - glass ionomer, silver amalgam, composite--- preventive resin restoration

class 2- -- small - RMGIC, / moderate-- posterior composite or amalgam,

large- SS crowns

post endodontic or multisurface --- Stainless steel crown are the best.

Enamel hypo-mineralization case--SScrowns are best

there are basically two basic types available in market. one silane based ( Flour protector) and natural resin based like enamel Pro, Fluoritop- SR etc.

silane based are colourless and form a transparent coating on application and last longer at site.

resin based form a chalky white coating on application and can be easily peeled off

encapsulated Gic are definately superior to powder/liquid [P/L] systems ,

- P/L ratio is uniform and standardized by the manufacturer ' recomendation

- mixing time is correct as it is automated process, resultant cement mixture is optimal and free of air entrapment

- dispension is through gun- control, easy and more accurate adaptation of material

Chlorhexidine mouthrinse should be preferrably used 30 minutes after tooth brushing. this is because CHX could react with Sodium Lauryl Sulfate , the detergent present in tooth paste formulations. Hence to prevent the nullifying effect of SLS on CHX researches have suggetsed to use CHX rinse atleast 10 mts (preferrably 30 mts) after brushing

you mean what? internal resorption has already began or hyperplastic pulpitis. if internal resorption is minimal not causing perforation of root canal or furcation area and the life of tooth is more than a year we do save