This systematic review and meta-analysis assessed clinical, radiographic and functional retention outcomes in immature necrotic permanent teeth treated either with pulp revascularization or apexification after a minimum of three months to determine which one provides the best results. The literature was screened via PubMed/MEDLINE and Embase databases up to June 2017 to select observational studies that compared pulp revascularization and apexification treatments assessing clinical, radiographic and functional retention outcomes. Two reviewers independently performed screening and evaluation of articles. A total of 231 articles were retrieved from databases, wherein only four articles were selected for full-text analyses. After exclusion criteria, three studies remained in quantitative and qualitative analyses. Pooled-effect estimates were obtained comparing clinical and radiographic outcomes (‘overall outcome’) and functional retention rates between apexification and pulp revascularization treatment. The meta-analysis comparing apexification vs. revascularization for ‘overall outcome’ (Z=0.113, p=0.910, RR=1.009, 95%CI:0.869–1.171) and functional retention rates (Z=1.438, p=0.150, RR=1.069, 95%CI:0.976–1.172) showed no statistically significant differences between the treatments. All studies were classified as high quality. The current literature regarding the clinical, radiographic and functional retention outcomes in immature necrotic permanent teeth treated either with pulp revascularization or apexification is limited. Based on our meta-analysis, the results do not favor one treatment modality over the other.

Premature loss or severely destruction of upper primary anterior teeth by early childhood caries (ECC) is a challenge for the pediatric dentist. In the anterior region, esthetics is an important concern along with function and space management. Tooth rehabilitation in this region becomes fundamental. The purpose of this report was to present a case of a 4-year-old child with the early loss of both central upper incisors and caries lesions on both upper lateral incisors. Both 51 and 61 were extracted due to ECC. The patient was rehabilitated with a fixed esthetic space maintainer and the vital lateral upper incisors, destroyed by ECC, restored with direct composite resin veneers. The final result reestablished local, systemic, psychological, aesthetic, and social problems of the child.How to cite this articleGoldenfum GM, de Almeida Rodrigues J, et al. Esthetic Rehabilitation in Early Childhood Caries: A Case Report. Int J Clin Pediatr Dent 2019;12(2):157–159.

A randomized controlled parallel clinical trial was conducted to evaluate the efficacy of the association of 1.23% topical professional acidulated phosphate fluoride (APF) gel with oral hygiene and dietary instructions on the arrest of active non-cavitated lesions in permanent, mixed, and temporary dentition in children between 3 and 12 years of age. Ninety-eight caries-active children were randomly divided into two groups: a fluoride gel group (n = 49) and a non-fluoridated gel group (n = 49). Each group received up to eight weekly applications of gel, weekly professional toothbrushing with oral hygiene instructions and dietary counselling. Caries lesions were assessed qualitatively through visual-tactile criteria performed in three stages: initial, intermediate, and final. Regression models were applied to identify risk indicators for caries control. Between-group comparison regarding the time taken to arrest the lesions was performed using Chi-squared and Fisher's exact tests. Seventeen children did not receive the allocated intervention, and one was lost to follow-up (n = 80). There was no difference between the control and placebo groups regarding the time to the arrest of the lesion (p >.05). The treatments showed similar results without significant statistical difference (p = 0.33; 95%CI: 0.32-1.48). No adverse effects were observed. It can be concluded that no additional effect of the association of 1.23% APF gel with oral hygiene using fluoride dentifrice and dietary instructions on the arrest of active non-cavitated lesions could be established. We can also confirm the importance of toothbrushing frequency and, consequently, the visible plaque reduction in the control of caries activity. RBR-37V5S3

A 3-year-old (and 11 month) male child, with the complaint of multiple decayed teeth for a period of four months, presented for treatment in the Paediatric Dentistry Clinic, School of Dentistry of the Federal University of Rio Grande do Sul (UFRGS) Brazil. The patient's mother complained that the child had many carious lesions and had spontaneous and provoked pain from eating and brushing. In the anamnesis and dietary diary, she reported that the patient drank from a sugared baby bottle twice a day and had the habit of eating sugary foods throughout the day. No significant past medical or dental family history was reported. Fluoride dentifrice was being used since the patient was two years of age. The family had a monthly income below the current minimum wage, representing a very low socioeconomic level.The clinical examination revealed an extensive carious coronal destruction in all the upper incisors, whitish-opaque rough spot lesions in enamel of the occlusal surface of teeth #55 and #65, soft cavity in dentin in tooth #53, and extensive coronal destruction of teeth #54 and #64 [Table/ Fig-1]. In the mandibular arch, teeth #75, #74, #84 and #85 showed rough and opaque enamel breakdown and soft cavity in dentin, teeth #73 and #83 had whitish opaque rough spot lesions in enamel. The initial Visible Plaque Index (VPI) was 47% and the initial Gingival Blood Index (GBI) was 13% [1]. Radiographic examination also matched with the clinical diagnosis of ECC.Initially, the proposed treatment was functional oral rehabilitation, starting with restorative treatment of cavitated lesions by selective caries removal technique for teeth #53, #54, #64, #74, #75, #84 and #85. For teeth #52, #51, #61 and #62, the extraction and the installation of an upper fixed prosthesis with stock teeth were indicated. For the treatment of whitish opaque rough spot lesions in enamel, the topical application of 1.23% fluoride gel was indicated over four weekly sessions. A treatment plan was developed and explained to the patient's mother, who signed an approved informed consent form authorising the treatment as well as disclosure and publishing of this case report.All procedures were performed under local anaesthesia, to avoid pain and discomfort, and rubber dam isolation was done in each quadrant in one session. Teeth #53, #75, #74, #84 and #85 were restored using the universal adhesive system (3M Espe ® , Brazil) and composite resin Z350 (3M Espe ® , Brazil) in WD, A1D and A1B colours. FluroShield resin sealant (Dentsply ® , Brazil) was used on the occlusal surfaces of teeth #55 and #65 to block rough and opaque enamel breakdown. Teeth 54 and 64, were sealed with a cover of Resin Flow (3M Espe ® , Brazil) in A1 colour, to re-establish the patient's oral health condition. Due to the loss of vertical dimension of the patient, there was insufficient space to allow reconstruction with composite resin.Root extraction of teeth #52, #51, #61 and #62 were performed under local anaesthesia in a single session. Two weeks after healing, an alginate im...

Objetivo: Avaliar a efetividade de uma abordagem de tratamento não invasiva para a inativação de lesões não cavitadas de dentes decíduos e permanentes realizada na Clínica Infanto-Juvenil (CIJ) da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul (FO-UFRGS), identificando os fatores clínicos do paciente e associando-os ao sucesso clínico do tratamento. Métodos: Foram incluídos 55 prontuários de pacientes que receberam instruções de higiene bucal, controle de dieta e aplicações tópicas de flúor (ATF) na CIJ da FO-UFRGS entre 2016 e 2018. Foram coletados dados demográficos e clínicos referentes a avaliação da atividade de cárie dentária na consulta inicial e após o tratamento realizado: índice de placa visível (IPV), índice de sangramento gengival (ISG) e o número médio de dentes permanentes cariados, perdidos e restaurados (CPO-D) e/ou número médio de dentes decíduos cariados, extraídos ou com indicação de extração e restaurados (ceo-d). Na análise estatística foram utilizados os testes Qui-quadrado de Pearson, Exato de Fisher e Wilcoxon, nível de significância: p < 0,05. Resultados: Não houve diferença estatisticamente significativa quando se comparou as variáveis idade, sexo, IPV, ISG e ceo-d/CPO-D com o sucesso do tratamento. Houve diferença estatisticamente significativa comparando o IPV inicial com o final (p = 0,016) e número de lesões não cavitadas ativas inicial e final (p < 0,001), mas não houve diferença para o ISG inicial e final (p = 0,324). Conclusão: Baseado nos achados da redução do IPV e da redução no número de lesões não cavitadas ativas ao final do tratamento, sugere-se que a abordagem de tratamento não invasiva para inativação de lesões de cárie dentária não cavitadas aplicada na CIJ da FO-UFRGS é efetiva. Descritores: Cárie dentária. Flúor. Odontopediatria.