Dental News March 2016

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ARTICLES CONGRESSES

Tooth staining and discoloration: a review of literature. Part II: Management

Dr. Sawsan Nasreddine, Dr. Fida Sayah, Dr. Fady Kassir, Pr. Mounir Doumit. Lebanese University, School of Dentistry

The permanent maxillary second molar: Canal number and configurations in a Tunisian population

Dr. Soumaya Touzi, Dr. Rim Kallala, Dr. Faten Khanfir, Dr. Mohamed Romdhane, Dr. Khalfi Mohamed Salah, Dr. Faten Ben Amor

Orthodontic management of an impacted mandibular canine in a 14 years old Kuwaiti girl.

Dr. Saud A. Al-Anezi

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AEEDC 2017 - The 21st UAE International Dental Conference & Arab Dental Exhibition

March 31 - April 1, 2016 at the Grand Hyatt Muscat, OMAN Website: www.odsoman.org

April 6, 2015 JORDAN Website: www.jda.org.jo

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February 7 - 9, 2017 at the Dubai International Convention & Exhibition Center, Dubai, UAE Email: info@aeedc.com Website: www.aeedc.com

Restorative Dentistry

Tooth staining and discoloration: a review of literature. Part II: Management

Dr. Sawsan Nasreddine, BDS, DESS Pediatric Dentistry, DESS Public Health Dentistry, Department of Public Health Dentistry

Abstract

Dr. Fida Sayah, BDS, DESS Public Health Dentistry, Department of Public Health Dentistry

Dr. Dani Daou, DESS Public Health Dentistry, MPH, Department of Public Health Dentistry

Pr. Mounir Doumit, DCD, DSO, HDR, Expert WHO in Dental Health, Director FDI, CE Middle Orient, 1st vicepresident CIDCDF

Lebanese University, School of Dentistry sawsan-n25@hotmail.com

The management of tooth discoloration consists of implementing the required therapy. Scaling and polishing of the teeth using prophylactic paste applied with a rotating rubber cup may remove many extrinsic stains. For more stubborn extrinsic and intrinsic stain, various bleaching techniques may be attempted. Bleaching can be performed externally, termed night guard bleaching or vital tooth bleaching, or intra coronally in root-filled teeth, called non-vital tooth bleaching. Teeth discolored by dental caries or dental materials require the removal of the carious and/or restorative material, followed by adequate restoration of the tooth. Partial or full-coverage dental restorations may be used to treat generalized intrinsic tooth discoloration in which bleaching is not indicated or in which the esthetic results of bleaching fail to meet the patient’s expectations.

The purpose of this article is to review literature on the management of tooth staining and discoloration.

Keywords Management, extrinsic discoloration, intrinsic discoloration

Introduction

Tooth color changes may be the result of intrinsic or extrinsic factors. In the management of patients with discolored teeth, knowledge of the mechanisms and the etiology behind tooth discoloration is of relevance as it can influence the treatment plan. There are many factors that contribute to tooth staining. It is important to understand what staining is in order to be able to prevent it.1

In some instances, the mechanism of staining may have an effect on the outcome of treatment and can influence the treatment options offered by the dentist to the patients.2, 3

History

History is essential for establishing an accurate diagnosis of intrinsic tooth discoloration, as the choice of treatment it should cover the following aspects:

History of mother’s obstetric and the delivery; medical history including neo-natal or early childhood illness and drugs intake, dental history relating to primary teeth and about any trauma of primary and permanent teeth; family history of discolored or abnormal teeth; fluoride history including supplementation, residence in natural water areas, tooth brushing habits including the amount of paste used, the type of paste in childhood and any admitted swallowing of paste.4

Examination

Clinical

A standard extra-oral examination and full mouth intra-oral examination should be undertaken, with special emphasis on the presence and/or absence of both primary and permanent teeth.4

The scratch test is usually used to distinguish between extrinsic and intrinsic discoloration. Discolored tooth surfaces are scratched with care by using a dental explorer, scaler, or similar sharp instrument to assess surface texture.2

Light scratching with a dental instrument removes weakly adherent plaque that causes extrinsic discoloration. If the discoloration requires removal

with a sharp dental scaler, the discoloration is considered to be tenacious. Intrinsic discoloration cannot be removed by using the scratch test. Extrinsic staining of a single tooth is unusual. The distribution is usually generalized. The stains are usually found on surfaces with poor tooth brush accessibility. In case of intrinsic discoloration, distribution is either generalized to all teeth or localized to certain teeth or tooth surfaces. An in trinsic etiology usually exists when a single tooth is discolored. Teeth with extrinsic tooth discoloration usually demonstrate no signs of pulp disease, usually associated with intrinsic discolor ation.2

Additional Investigations

Appropriate radiographs will show abnormalities of enamel and dentin structure, abnormal tooth morphology and the adequacy of root canal fillings in non-vital teeth. Sensibility testing will sug gest the presence or absence of a functioning nerve supply. Histological sectioning of exfoliated or extracted teeth may iden tify hereditary and environmental abnormalities.

Restorative Dentistry

Diagnosis

Clinical examination and review of oral hygiene practices, dietary habits and history of exposure to chemicals, trauma, and infection are essential in making a final diagnosis of the cause of tooth discoloration.5

Management of stains (Table 1)

Proper diet and habits

Extrinsic staining caused by foods, beverages, or habits (smoking, chewing tobacco, coffee and tea) is treated with a thorough dental prophylaxis and cessation of dietary or other contributory habits to prevent further staining.6, 7

Management

Proper diet and habits

Tooth brushing

Professional tooth cleaning

• Ultrasonic scalers

• Air jet polishing

Prophylactic paste

Microabrasion

Non-vital bleaching

Hydrogen peroxide/sodium perborate

Vital bleaching

• Chairside: hydrogen peroxide + heat source

• Nightguard: carbamide peroxide gel

Composite resin restorations

Porcelain laminate veneers

Extraction

In case of

Foods / beverages

Smoking, coffee, tea and chewing tobacco

Prevent extrinsic staining

Prolonged used of chlorhexidine mouthwash - Calculus and persistent stains.

Stain due smoking, coffee, tea, chlorhexidine and heavily stained enamel

Cleaning and polishing with less abrasion to tooth dentin and enamel. Excellent stain and plaque removal

- Post orthodontic demineralization (white spot)

- Localized hypoplasia (infection or trauma)

- Idiopathic hypoplasia

- Minor fluorosis

Non vital, endodontically treated teeth (cause: deposition of blood degradation)

- Mild tetracycline staining without obvious banding

- Mild fluorosis

- Single tooth with sclerosed pulp chambers and root canals

- Moderate fluorosis

- Hypoplasia (caused moderate to severe fluorosis)

- Localized hypoplasia not responsive to microabrasion

- Tetracycline staining

- Discoloration due to loss of vitality not responsive to non vital bleaching

- Amelogenesis imperfect

- Dentinogenesis imperfect

- Hypolplasia and discoloration teeth in patients aged 16 years and over

- When techniques such as micro abrasion non vital bleaching and composite resins have failed to produce satisfactory clinical result

- Teeth that are non restorable

- Severe amelogenesis imperfect and dentinogenesis imperfect

- Teeth with large periodontal defects

Table 1: Management of different types of stains

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Restorative Dentistry

Tooth brushing

Effective tooth brushing twice a day with a dentifrice helps to prevent extrinsic staining. Most dentifrices contain an abrasive, a detergent and an anti-tartar agent. In addition, some dentifrices now contain tooth-whitening agents.6, 7

The patient’s use of a dentifrice can also contribute to dental stain removal and prevent recurrent discoloration.8 The dentifrice’s stain-removal property is firstly related to the abrasives present in its composition.9 It is important to point out that if, on one hand, increased dentifrice abrasiveness leads to improved stain removal efficacy, on the other hand it increases tooth wear. Thus, dentifrices containing active ingredients specifically designed for tooth stain removal are known as whitening dentifrices. These dentifrices usually have enzymes in their composition that help to break down the organic components of biological film and remove stains and bacterial plaque. Another common dentifrice component is detergent, especially Sodium Lauryl Sulfate. It acts by lowering the surface tension of stain producing molecules, thus disrupting their potential to bind to enamel. Some whitening dentifrices also contain low peroxide concentrations, with the aim of releasing free oxygen radicals. These radicals are responsible for an oxidation reaction, which is the principle of the bleaching technique used for extrinsic and intrinsic stain removal. 3, 8, 10, 11, 12

Professional tooth cleaning

Some extrinsic stains may be removed with ultrasonic cleaning, rotary polishing with an abrasive prophylactic paste, or air-jet polishing with an abrasive powder. However, these modalities can lead to enamel removal; therefore, their repeated use is undesirable.6, 7

Ultrasonic and sonic scalers are referred to as power-driven scalers. The small, quick vibrations in combination with a water flow provide a whole new level of effectiveness in removal of deposits on the tooth surface. The benefits of ultrasonic scaling include increased efficiency of calculus removal and less need for hand scaling (fig.1). Microvibration crushes and removes calculus under cooling water. Sonic scalers are air-turbine units that operate at low frequencies ranging between 3000 and 8000 cycles per sec (cps).7, 13

Prophylactic paste

Prophylactic pastes contain abrasive, water, humectants, binder, sweetener, flavoring and coloring agents. Prophylaxis polishing agents are available in two basic forms: dry powders, also referred to as flours that must be mixed with a liquid (fig.2) (water, fluoride, or mouth rinse) and commercially prepared polishing pastes that are available in bulk or individual unit doses.10

Therefore, the use of dry abrasives or powder on a dry polishing cup is contraindicated due to the potential for thermal injury to natural teeth.7, 10 However, it is general knowledge that pumice and glycerin are the most commonly used ingredients in commercially prepared polishing pastes.7, 10

Microabrasion

Microabrasion involves the removal of a small amount of surface enamel and classically incorporates both “abrasion” with dental instruments and “erosion” with an acid mixture.4 Microabrasion is indicated for fluorosis, postorthodontic demineralization (white spot), localized hypoplasia due to infection or trauma and idiopathic hypoplasia where the discoloration is limited to the outer layer.4, 14, 15

Fig 1: Calculus removal with ultrasonic scaling

Fig 2: Stain removal with prophylactic paste

Fig 1

Fig 2

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References: 1. Fine DH, Sreenivasan PK, McKiernan M, et al. J Clin Periodontol. 2012;39:1056-1064. 2. Collins LMC, Dawes C. J Dent Res. 1987;66:1300-1302.

18

Restorative Dentistry

Non-vital bleaching

Non-vital bleaching is indicated for non vital, endodontically treated teeth which have become discolored due to the deposition of blood degradation products in the dentinal tubules. Most techniques utilize hydrogen peroxide or sodium perborate.4

Vital bleaching

Vital bleaching involves the external application of hydrogen peroxide to the surface of the tooth followed by its activation with a heat source. An alternative source of hydrogen peroxide is sodium per carbonate and this has been used in a silicone polymer containing product that is painted onto the teeth forming a durable film for overnight bleaching procedures 16, 17. It is indicated for mild tetracycline staining without obvious banding, mild fluorosis and single teeth with scleroses pulp chambers and root canals.4, 18

Composite resin restorations

Teeth discolored by dental caries or dental materials require the removal of the caries or restorative materials, followed by proper restoration of the tooth. Partial or full-coverage dental restorations may be used to treat generalized intrinsic tooth discoloration in which bleaching is not indicated or in which the esthetic results of bleaching fail to meet the patient’s expectations.2 Composite resin restorations are indicated in cases of hypoplasia caused by moderate to severe fluorosis, localized hypoplasia not responsive to micro abrasion, tetracycline staining, and discoloration due to loss of vitality not responsive to non vital bleaching, amelogenesis and dentinogenesis imperfect and idiopathic hypoplasia.4, 19

Porcelain laminate veneers

They are indicated for hypoplastic and discolored teeth in patients aged 16 years and over, when techniques such as microabrasion, non vital bleaching and composite resins have failed to produce a satisfactory clinical results.4

Tetracycline/minocycline-induced discoloration cannot be removed. The staining of the permanent teeth creates an esthetic and psychological concern for which patients may look for advice and treatment to improve their appearance.18

Treatment may include vital or non vital teeth bleaching, which will lighten the discoloration but will leave a translucent appearance. As tetracycline staining is intrinsic, the bleaching technique is most often partially successful. Other options include placing composite resins or porcelain laminate veneers or full-coverage porcelain crowns to physically cover the teeth.18

Dental extractions may be required for severely carious teeth that are non restorable (fig.3) or for teeth with large periodontal defects that are refractory to periodontal rehabilitation. Previously endodontically treated teeth that develop further dentoalveolar infections require intracanal endodontic retreatments, endodontic surgery of the tooth apex, or extraction20 severely involved teeth with amelogenesis imperfect or dentinogenesis imperfect also may require extraction.20

Fig 3: Extraction of carious teeth that are non restorable

Fig 3

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Restorative Dentistry

Conclusion

In the management of patients with discolored tooth, an understanding of the mechanism behind the discoloration is of relevance to the dental practitioner as it can be valuable in the decision-making process when considering how to treat the condition. An understanding of the pathological process involved can assist in explaining the cause to anxious or concerned patients/ parents.2

References

1. Watt a, addy M. tooth discolouration and staining: a revieW of the literature. Bri dent J 2001;190(6):309-316.

2. Manuel st, aBhishek P, kundaBala M. etiology of tooth discoloration- a revieW nig dent J 2010;18(2):56-63.

3. cynthia k, Pierre k, tatiana Z, carina M. extrinsic tooth discoloration, an uPdated revieW dent triB 2015:7B-8B.

4. Wray a, WelBury r treatMent of intrinsic discoloration in PerManent anterior teeth in children and adolescents int J Paediatr denti 2001;11:309-315.

5. Bandon d, chaBane-leMBouB a les colorations dentaires noires exogènes cheZ l ’ enfant : Black-stains archives de Pédiatrie 2011;18(12):1343-1347.

6. Bussell rM, deery c case rePort: Blue chroMogenic dental staining in child With West syndroMe eur arch Paediatr denti 2010;11(6):298-300.

7. sruthy P, raJesh h, Boloor va, rao as extrinsic stains and ManageMent: a neW insight. J acad indus res 2013;1(8):435442.

8. liMa danl, silva alf, aguiar fhB, liPoroni Pcs, Munin e, aMBrosano gMB, lovadino Jr in vitro assessMent of the effectiveness of Whitening dentifrices for the reMoval of extrinsic tooth stains BraZ oral res 2008;22(2):106-11.

9. Meyers ia, McQueen MJ, harBroW d, seyMour gJ. the surface effect of dentifrices aust dent J 2000;45(2):118-124.

10. Pontes dg, correa kMl, cohen-carneiro f re-estaBlishing esthetics of fluorosis-stained teeth using enaMel MicroaBrasion and dental Bleaching techniQues eur J esthet denti 2012;7(2):130137.

11. Joiner a revieW of the extrinsic stain reMoval and enaMel/dentine aBrasion By a calciuM carBonate and Perlite containing Whitening toothPaste int dent J 2006; 56(4):175-80

12. BaZZi J, fraxino Bindo MJ, rached r, MaZur r the effect of at-hoMe Bleaching and tooth Brushing on reMoval of coffee and cigarette sMoke stains and color staBility of enaMel. J aM dent ass 2012;143:e1-e7.

13. iBiyeMi o, taiWo Jo, oke ga iMProvised source of Water coolant for ultrasonic scaler: an aPProPriate technology in underserved coMMunities rural and reMote health 2012:1-7.

14. MuñoZ Ma, arana-gordillo la, goMes gM, goMes oM, BoMBarda nhc, reis a, loguercio ad alternative esthetic ManageMent of fluorosis and hyPoPlasia stains: Blending effect oBtained With resin infiltration techniQues. J esthet restor dent 2013;25(1):32-39.

15. croll tP. enaMel MicroaBrasion: oBservations after 10 years. J aM dent assoc 1997;128:45s-50s

16. andreW J. the Bleaching of teeth: a revieW of the literature Jour of dent 2006;34:412-419.

17. date rf, yue J, BarloW aP, BellaMy Pg, Prendergast MJ, gerlach rW. delivery, suBstantivity and clinical resPonse of a direct aPPlication PercarBonate tooth Whitening filM aMer Jour of denti 2003;16:3B–8B.

18. sáncheZ ar, rogers rs, sheridan PJ. tetracycline and other tetracycline-derivative staining of the teeth and oral cavity inter J derMatol 2004;43:709-715.

19. Bidra as, uriBe f successful Bleaching of teeth With dentinogenesis iMPerfecta discoloration: a case rePort. J esthet restor dent 2011;23(1):3-11.

20. krastl g, allgayer n, lenherr P, filiPPi a, taneJa P, Weiger r tooth discoloration induced By endodontic Materials: a literature revieW dent trauMatol. 2013;29(1):2-7.

Endodontics

The permanent maxillary second molar: Canal number and configurations in a Tunisian population

Dr. Soumaya Touzi

Key words

Materials and Methods

Dr. Rim Kallala

Faten Khanfir

Dr. Mohamed Romdhane

Dr. Khalfi

2: Department of General Anatomy of the Dentistry Clinic of Monastir, Tunisia touzi.soumaya@gmail.com

Anatomy, maxillary second molar, morphology, root, canal

Introduction

One of the major causes of failure in endodontic treatment is the impossibility of locating and treating the entire root canal system, a result of the lack of knowledge regarding the dental, internal or external anatomy. 1

Maxillary molars are the teeth that contain the greatest number of roots, with diverse shapes and formations, which is why their internal canal system is so variable. 2

Any existing root canals that remain undetected by the operator during the entire course of endodontic treatment are a major threat to the failure of treatment. 3

The aim of the current research was to describe the variations in the root canal anatomy of maxillary first molar in a tunisian population using sectioning.

In this study, we used 98 maxillary second molars that have been extracted mainly for periodontal reasons. The teeth were stored in a sodium hypochlorite solution diluted to 5% during 3 days and then washed in running water and dried. Each tooth is macroscopically examined to determine the number of roots and grinded progressively at the root surface to highlight the path of the root canals.

Canal number and configurations are observed and analyzed using sections:

-Mesio buccal and disto buccal root: bucco-lingual sections

-Palatal root: mesio-distal sections.

Results

1- Number of roots by tooth (Table 1)

2- Number of canals by root (Table 2)

1: Department of Dental Anatomy of the Dentistry Clinic of Monastir, Tunisia

Table 1

Number of roots by tooth

Number of canals by root

Endodontics

3- Canal configurations (Table 3)

Table 3

4- Different canal configurations observed at the mesio buccal root (Figures 1, 2)

5- Different canal configurations observed at the disto buccal root (Figure 3)

6- Different canal configurations observed at the lingual root (Figure 4)

Discussion : Number of roots

In the present study, 93 % of maxillary first molars were 3 rooted. Our results are similar to the findings of Libfeld 4 (90.6%), Neelakantan 5 (93.1%) and Sert 6 (91.27%).

We found 5.8% 2 rooted second maxillary molars. For consulted studies, the percentage was from 0% 5 to 21.86%. 7

We found 1.1% one rooted molars which is close to the majority of studies. 7,4,8,6 Gu Y 7 found larger percentage (14.11%).

We didn’t found 4 rooted second maxillary molars which is similar to the study of Neelakantan.5 Other studies found percentages that do not exceed 1.4% 8 (table 4).

Table 4: Number of roots per tooth

Fig 1: type I (Vertucci)

Fig 3: type I (Vertucci)

Fig 2: type II (Vertucci)

Fig 4: type I (Vertucci)

Fig 1 Fig 2

Fig 3 Fig 4

Endodontics

Internal morphology

• Mesio buccal root

- Number of canals:

We found in our study that 97.5 % of cases have a single canal and 2.4 % have 2 canals.

The frequencies of 2 canals varied from 19.7% according to Al-Fouzan 9 to 93.7% according to Kulild 10 ; these results are not consistent with ours. These differences may be due to the variety of the used techniques.

This root can have more than two canals according to Ozcan et al. 11 who reported a case of a maxillary second molar with 3 canals in the mesio buccal root and Caliskan et al. 12 who showed that 16% of second maxillary molars had 3 canals in this root (Table 5).

- Canals configurations:

Our study showed that 97.5 % have type I configuration and 2.5 % have type II configuration. We have not found the types III, IV and V. There is great variability in the results of literature; the percentage of type I varied from 34%14 to 86,9% 18 ; type II from 1, 8% 18 to 34% 14 and type III from 0% 14 to 15.6%. 19

For type IV, the results are divergent and span from 0% 19 to 40%. 20 Type V presents 0% for most studies 18, 19, 22, 14, 21 (table 6).

The differences in results may be explained by differences in the number of samples or by heterogeneous populations.

Table 5: Number of canals in the mesio buccal root

Table 6: Mesio buccal canal configurations according to some studies

Endodontics

• Disto buccal root

- Number of canals:

In the present study, this root had in 100% of cases one canal whitch agree with the study of Médioni et al. 24

- Canals configurations: All studies confirmed that the type I is predominant with a percentage that varies from 84.9%5 to 100%. 24 Other configurations have a percentage not exceeding for the type II 2% 23, for the type III 2.4% 5, for the type IV 4.4% 5, and for the type V 6% 23 (table 7).

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Table 7: canals configurations in the disto buccal root

Endodontics

• Palatal root

- Number of canals:

In the present study,the palatal root had in 100% of cases only one canal whitch agrees with the findings of Médioni et al. 24 and Sert et al. 6 Neelakantan et al 5 found only 87.7% of this root with one canal. According to all studies, types III and V did not exceed 6% 23, 20, 25 and type IV did not exceed 3.4% 5, 25 and type II was not found.

- Canals configurations: All studies confirmed that the type I is predominant with a percentage that varies from 87.8%5 to 100%. 24, 6 Other configurations have a percentage not exceeding for the type III 6% 20, 23 , for the type IV 3.4% 5, and for the type V 6%.23 the type II is absent for all studies 24, 23, 5, 6, 20, 25 (table 8).

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Table 8: canals configurations in the Palatal root

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Endodontics

Conclusion

The present study showed that most of maxillary first molars were 3 rooted (93%), 5.8% were 2 rooted and 1.1% presented one root. In the mesio buccal root, the most prevalent configuration was type I (97.5%), type II represented 2.5%. In the disto buccal root and in the palatal root, we found vertucci type I on 100% of cases.

References

1. Pécora Jd, Woelfel JB, sousa neto Md, issa eP. MorPhologic study of the Maxillary Molars. Part ii: internal anatoMy. BraZ dent J 1992; 3: 53-57.

2. Betancourt P, navarro P, cantín M, fuentes r cone-BeaM coMPuted toMograPhy study of Prevalence and location of MB2 canal in the MesioBuccal root of the Maxillary second Molar int J clinexP Med 2015; 8:9128-34.

3. alrahaB M, Zafar Ms evaluation of root canal MorPhology of Maxillary Molars using cone BeaM coMPuted toMograPhy. Pak J Medsci 2015; 31:426-30.

4. liBfeld h, rotsteini incidence of four-rootedMaxillary second Molars: literaturerevieW andradiograPhicsurvey of 1200 teeth. J endod 1989; 15: 129-31.

5. neelakantan.P,suBBarao c, Bds, ahuJa r, suBBarao c v, and gutMann.J.l cone-BeaM coMPuted toMograPhy study of root and canal MorPhology of Maxillary first and second Molars in an indian PoPulation, Journal of endodontic 2010; 36: 1622-07.

6. sert s, sahinkesen g,toPcu f t eroglu s e and oktaye a root canal configurations of third Molar teeth a coMParisonWith first and second Molars in the turkish PoPulation aust endod J 2011; 37: 109–17.

7. gu y ,Wang.W , ni l four-rooted PerManent Maxillary first and second Molars in a northWestern chinese PoPulation, archives of oral Biology 2015 ;60: 811–7.

8. Peikoff Md, christie Wh, fogelhM. the Maxillary second Molar: variations in the nuMBer of roots and canals int endod J 1996; 29: 365-9.

9. al-fouZan ks, ounis hf,Merdad k and al-heZaiMi k incidence of canal systeMs in the Mesio-Buccal roots of Maxillary first and second Molars in saudi araBian PoPulation aust endod J 2013; 39: 98–101.

10. kulild Jc, Peters dd incidence and configuration of canal systeMs in the MesioBuccal root of Maxillary first and second Molars. J endod 1990; 16:311-7.

11. oZcan e, aktan aM, ari h a case rePort: unusual anatoMy of Maxillary second Molar With 3MesioBuccal canals oral surg oral Med oral Pathol oral radiol endod 2009;107: 43-6.

12. holderrieth s, gernhardtcr. Maxillary Molars With MorPhologic variations of the Palatal root canals: a rePort of four cases. J endod 2009;35:1060-5.

13. Weller rn, hartWell gr the iMPact of iMProved access and searching techniQues on detection of the Mesiolingual canal in Maxillary Molars. J endod 1989; 15: 82–3.

14. singh c, sikri vk, arora r study of root canals and their configuration in Maxillary second PerManent Molar indian J dent res 1994; 5:3-8.

15. stroPko JJ. canal MorPhology of Maxillary Molars: clinical oBservations of canal configurations. J endod 1999; 25: 446-50.

16. alavi aM, oPasanon a, ng yl, gulaBivala k root and canal MorPhology of thai Maxillary Molars int endod J 2002; 35: 478–85

17. doMark Jd, hatton Jf, Benison rP, hildeBolt cf an ex vivo coMParison of digital radiograPhy and cone-BeaM and Micro coMPuted toMograPhy in the detection of the nuMBer of canals in the MesioBuccal roots of Maxillary Molars, J endod 2013 ;39:901-5.

18. rWenyonyi cM, kutesa aM, MuWaZi lM, BuWeMBoW. root and canal MorPhology of Maxillary first and second PerManent Molar teeth in a ugandan PoPulation int endod J 2007; 40: 679-83.

19. y-l ng, t h aung, a alavi& k gulaBivala. BlackWell science, ltd root and canal MorPhology of BurMese Maxillary Molars international endodontic Journal, 2001;34: 620–30.

20. kiM y, lee sJ, Woo J. MorPhology of Maxillary first and second Molars analyZed By cone-BeaM coMPuted toMograPhy in a korean PoPulation: variations in the nuMBer of roots and canals and the incidence of fusionJournal of endodontics2012;38: 1063-8.

21. caliskan Mk, Pehlivan y, sePetçioglu f, türkün M, tuncer ss root canal MorPhology of huMan PerManent teeth in a turkish PoPulation. J endod 1995; 21: 200-4.

22. yoshioka t, kikuchi i,fukuMoto y, koBayashi c&suda h detection of the second MesioBuccal canal in MesioBuccal roots of Maxillary Molar teeth ex vivo international endodontic Journal 2005; 38:124–8.

23. Weng x l,yu,s.B,Zhao sl,Wang hg,Mu t,tang ry,Zhou xd,root canal MorPhology of PerManent Maxillary teeth in the han nationality in chinese guanZhong area: a neW Modified root canal staining techniQue. Journal of endodontics 2009; 35: 651–6.

24. Médioni e, vené g anatoMie endodontiQue fondaMentale et cliniQue encycl Med chir (Paris, france), stoMatologie odontologie, 23-050-a-05, 1994, 10P

25. altunsoy M, et al root canal MorPhology analysis of Maxillary PerManent first and second Molars in a southeastern turkish PoPulation using cone-BeaM coMPuted toMograPhy, Journal of dental sciences 2014;20: 1-7.

Orthodontic management of an impacted mandibular canine in a 14 years old Kuwaiti girl.

Dr. Saud A. Al-Anezi BDS (Liverpool, UK), MFD RCSI, Doctorate in Orthodontics (Bristol, UK), MOrth RCSEd saudalan@gmail.com

Department of Orthodontics, Bneid Al-Gar Specialty Dental Center, Ministry of Health, Kuwait.

Key words

Impacted canines, Orthodontic treatment, Surgical exposure.

Introduction

An impacted tooth can be defined as a tooth with a delayed in eruption time or that are not expected to erupt completely based on clinical and radiographic assessment. 1 An impacted tooth in children is a major problem with potentially damaging sequelae such as, damage to the adjacent teeth and cystic formation. The prevalence of impacted maxillary canine is reported to be 1.5% 2, however, the prevalence of impaction of the mandibular canine is much lower. 3,4 In one particular study, the incidence of mandibular canine impaction was shown to be 1.29% in 5022 individuals of a Turkish population sample. 5 Clinicians should suspect impaction if the canine is not palpable in the buccal sulcus by the age of 10–11 years, hence a full clinical examination and radiographic assessment are essential in order to locate the canines. 6 There are many etiological factors that can lead to the failure of eruption such as the presence of a supernumerary tooth that prevents the successful eruption of the canine. Early diagnosis of such problem will make the treatment simpler and in some cases shortens the treatment duration. The aim of this report is to illustrate a conventional orthodontic treatment of an impacted mandibular canine which was diagnosed late.

Clinical Presentation and Intervention

A 14 years old Kuwaiti girl attended the clinic complaining of “a gap between bottom teeth” (Fig 1). She was fit and well. She had a Class 1 skeletal pattern with average vertical proportions. In

the intra-oral examination, it was found that, her oral hygiene was fair and required improvement prior to the initiation of orthodontic treatment (Fig 2). Furthermore, there was mild crowding in the mandibular arch and well aligned maxillary arch. The overjet was increased with an average overbite and a mild central line discrepancy. The buccal segments were Class 1.

Figure 1. Pre-treatment Extra-oral photographs.

Figure 2. Pre-treatment Intra-oral photographs.

Fig 1

Fig 2

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All permanent dentition were present except for the lower right manbibular canine and the third molars. Further investigations revealed that the tooth was lingually displaced with no presence of any supernumerary or any other obstruction preventing its eruption (Figure 3). The treatment plan was to initiate a fixed orthodontic appliance therapy to create more space for the mandibular canine then carry on a surgical exposure procedure to uncover the tooth and enable its traction through the orthodontic appliance using an 0.22 inch slot, MBT prescription. Treatment started with leveling and alignment through 0.14 and 0.18 inch Nickel Titanium wires. Furthermore, the treatment continued through 0.19x0.25 NiTi and Stainless Steel archwires to achieve the treatment objectives (Figure 4). A retention regime was also planned which included a fixed retainer in the lower arch to minimize the risk of relapse of the impacted canine after alignment plus an upper and lower removable retainers.

Figure 3. Pre-treatment radiographs.

Figure 4. During the surgical exposure procedure and photographs of following visits.

Fig 3

Fig 4

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Discussion

Although the impaction of a mandibular canines is not frequently occurring episode compared to maxillary canines, those individuals with this problem may suffer potentially harmful effects if left untreated. The impacted maxillary canine is extensively discussed and mentioned in the dental literature unlike the mandibular canine. The key factor here is 7 the early diagnosis, because that will allow some simpler measures such as the removal of the deciduous tooth at the appropriate time. This would enable the permanent canine to follow its course and erupt normally. However, as children grow older (i.e. beyond the age of 12-13 years), the use of this simple “interceptive” measure is no longer feasible and more comprehensive treatment should be considered. 1 The treatment options then are categorically divided into two: 1) either to attempt to orthodontically align the tooth with or without surgical intervention, or 2) extraction of the tooth and replace it with a dental implant. The definitive treatment plan can be decided on several factors such as the age of the treatment 5, the age of the patient, the more likely orthodontic treatment will work and vice versa. Another factor is the position of the impacted tooth.4 If the tooth, as in this case report, was not far away from its original place, it is considered favorable to surgically expose it and align it orthodontically.8 This is decided after a careful clinical and radiographic examination. Another extremely useful tool that can be used is the use of a Cone Beam Computed Tomography (CBCT) scan 9 , however, this was not available to the author at the start of treatment. It can be stated that, if the tooth was positioned deep in the bone and the surgical removal of it bears many risks, as an alternative, the tooth can be left in situ providing regular monitoring of the tooth, in order to detect any changes that may occur.

Another treatment option is to auto-transplant the tooth (i.e. to extract it surgically and reimplant it in its place), nonetheless, that approach has very poor prognosis and very rarely considered as an option. 10,11 It must emphasized that for each treatment option, there are advantages and disadvantages. For instance, if orthodontic

treatment with surgical exposure plan was chosen, treatment duration may be long as opposed to the extraction and the implant option which takes shorter treatment duration to accomplish. However, the main advantage with the orthodontic treatment approach is that a prosthesis is not required and an ideal occlusion can be achieved (Figure 5).

Conclusion

Impacted maxillary canines are more common than mandibular canines. The treatment plan for such teeth will be based on several factors such as the age of the patient and the position of the tooth. Treatment options includes orthodontic treatment to align the tooth or removal of the tooth and replace it with a dental implant. This girl was treated successfully via surgical exposure and orthodontic alignment because the position of the impacted canine was favorable.

Informed consent:

Permission was granted by the patient and her father to use her clinical records in this case report.

Figure 5. Post-treatment Intra-oral photographs.

Fig 5

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Acknowledgments

I would like to thank Dr. Joju George from the Oral Surgery Department in Bneid Al-Gar Specialty Dental Center for his great contribution in the tooth exposure stage. I would also like to extend my appreciation to patient and her father for their remarkable cooperation throughout the course of treatment. A special thank for my assistance, Deepa for her immense help.

References

1. richardson g, russell ka a revieW of iMPacted PerManent Maxillary cusPids: diagnosis and Prevention. J can dent assoc 2000;66:497-501.

2. ericson s and kurol J. radiograPhic exaMination of ectoPically eruPting Maxillary canines aM J orthod 1987; 91: 483-492.

3. aydin u, yilMaZ hh, yildiriM d incidence of canine iMPaction and transMigration in a Patient PoPulation dentoMax radiol 2004; 33:164-9.

4. alaeJos-algarra c, Berini-aytes l, gay-escoda c transMigration of Man-diBular canines: rePort of six cases and revieW of the literature. Quint int. 1998; 29:395-398.

5. yavus Ms, aras Mh, Buyukkurt Mc, toZoglu s iMPacted MandiBular canines. J of conteMPorary dent Practice. 2007; 8(7):2-9.

6. the ManageMent of the Palatally ectoPic Maxillary canine national clinical guidelines the royal college of surgeons of england, WWW rcseng ac uk, March 2010.

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7. ericson s and kurol J. radiograPhic assessMent of Maxillary canine eruPtion in children With clinical signs of eruPtion disturBances eur J orthod 1986; 8: 133-140.

8. Mcsherry Pf the ectoPic Maxillary canine: a revieW. Br J orthod 1998; 25: 209-216.

9. yh Jung, h liang, BW Benson, dJ flint, Bh cho the assessMent of iMPacted Maxillary canine Position With PanoraMic radiograPhy and cone BeaM ct dentoMaxillofac radiol 2012: 41(5): 356-360.

10. thoMas s, turner sr, sandy Jr autotransPlantation of teeth: is there a role? Br J orthod 1998;25: 275–82.

11. cZochroWska eM, stenvik a, BJercke B,Zachrisson Bu outcoMe of tooth transPlantation: survival and success rates 17-41 years PosttreatMent aM J orthod dentofacial orthoP 2002;121: 110–19.

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SDS 2016

16th King Saud University International Dental Conference & 27th for the Saudi Dental Society

January 5 - 7, 2016

Riyadh International Convention & Exhibition Center - KSA

Opening ceremOny under the patrOnage Of hrh emir faisal Bin Bandar Bin aBdulaziz alsaud left tO right; prOf. thakiB alshalan, dr Badran alOmar, prince Of riyadh, dr. ahmed alaameri, dr mOhamed al OBeida

It is with great pleasure to welcome you to the 16th King Saud University International Dental Conference and the 27th for the Saudi Dental Society.

The theme for this year’s conference is “Regenerative Dentistry”, which is based on the natural ability of body cells and tissues to restore themselves under certain conditions. Owing to advances in modern science, we now know more about the mechanisms behind every tissue in the body to self-repair. Those mechanisms are being investigated further as we learn that living cell regeneration is dependent on many factors such as genetics, hormones and environmental influences.

The conference also allows for diversity of research covering other fields of Dentistry through oral presentations

and posters and it also offers full state exhibits which show the current trend in dental materials, instruments and equipment.

To all speakers, participants and exhibitors, my very best wishes for a successful meeting. I hope that you will enjoy the conference and that your interaction with your colleagues will stimulate a creative exchange of ideas and will be personally rewarding.

Prof. Thakib A. Al Shalan Dean, College of Dentistry Chairman, Organizing Committee

16th Saudi International Dental Meeting

27th for the Saudi Dental Society

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Under the patronage of His Highness Sheikh Hamdan Bin Rashid Al Maktoum, His Excellency Humaid Mohammed Obaid Al Qatami, Chairman of the board of the Dubai Health Authority inaugurated the 20th edition of the AEEDC Dubai.

This year, AEEDC Dubai 2016 celebrated its 20th anniversary with the participation of regional and international officials, a number of delegations from 130 countries top-notch speakers and more than 1800 exhibitors His Excellency was delighted by hearing from the exhibitors about the latest technologies and accomplishments that the manufacturing companies had reached in the field of dentistry.

Dr. Abdul Salam Al Madani, Executive Chairman of AEEDC Dubai Conference and Exhibition and the Global Scientific Dental Alliance stated: “This is a very special edition for AEEDC as we are celebrating its 20th anniversary and 20 years of achievement and global recognition. We are also proud that AEEDC Dubai retains its number one position among the MENASA region and remains to be the 2nd largest dental conference and exhibition in the world.

Dr. Abdul Salam went on saying: “This year AEEDC Dubai features two new specialized conferences to enrich the Oral & Maxillofacial Surgery and Orthodontic fields. The scientific agenda for this year is tailored with excellence, a number of outstanding scientific activities took place during the three day event which makes AEEDC Dubai the best educational platform and a good source of attaining credit hours for specialists and dentists.”

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dr aBdulsalam al madani with representatives frOm arOund the wOrld

with dr khalid el Badr president Of the saudi OrthO sOciety

with dr hussein lawati president Of the Oman dental sOciety

left tO right: drs khalid alBadr, aBdulwahaB alawadi, sami maneh, salah Bulushi

with dr fahad al shehri president Of the sds

Head Office Researchpark

Haasrode-Leuven 1240

Interleuvenlaan 33

B-3001 Leuven

Tel. +32.16.74.10.00 Fax. +32.16.40.48.32

info@gceurope.com http://www.gceurope.com

DENTAL NEWS WALL OF FAME

ENDO POWER

HyFlex™ EDM THE NEW NITI FILE GENERATION

Extremely break resistant le for quick preparation

> Up to 700% higher fracture resistance

> Specially hardened surface

ORIFICE OPENER (optional) 25 / .12

Glidepath File 10 / .05

HyFlex™ OneFile 25 / ~

> Less lling required for treatment success

FINISHING FILES (optional)

40 / .04

50 / .03

60 / .02

KaVo

KaVo W&H Sirona Bien Air NSK

DENTAL NEWS WALL OF FAME

Dr Ghassan Naser Ditributing Trophies during the Henry Schein Dinner at the Grand Hyatt Hotel

tO mr. paul daniel

tO mr. firas lellO

tO dr. mOhamad akar

February 13 - 15, 2016

I would like to welcome each of you to the 4th Kuwait Dental Administration Conference, under the patronage of Kuwait Ministry of Health.

This is a biennial conference which goes with the mission of MOH, Kuwait to update and upgrade the knowledge and and skills of all involved with dentistry. The current conference is aptly themed as “Our Vision for a Better Tomorrow”. During this conference, a wide range of dental topics of interest will be deliberated. Selected topics range from Dental Marketing, different aspects of clinical dentistry, laboratory technology, Cone Beam Computed Technology, Behavior Management and Basic Life support techniques.

The organizing committee has left no stone unturned to ensure that this conference will be beneficial to all the personnel connected with dentistry. Hence we expect academicians, clinical dentists, students, nurses, technicians and researchers to be part of this exciting event.

On behalf of the Ministry of Health, Kuwait and the organizing committee, I welcome you all to be a part of this conference and take back some wonderful memories from here.

Dr. Sabiha Al Mutawa Chairperson, Director Dental Administration Ministry of Health - Kuwait

Opening ceremOny under the patrOnage Of dr. ali al-OBaidi, minister Of health

Jumeirah Messilah Beach Hotel & Spa, Badriah Ballroom - KUWAIT

dr saBiha al mutawa chairpersOn Of the cOnference

95% said it was easy to use*

97% showed improved gum health** UP TO 99.9% plaque biofilm removal in the treated area*** UP TO

Proud Sponsor of

left tO right: dr. azhar naseeB, the minister Of health, dr. hashemy, dr. emady, dr. aisha sultan, dr. saBiha al-mutawa, dr. yOusef al-dueiry

dr. JOhn cassis lecturing On the geriatrics

dr. martin trOpe lecturing On BiOceramic technOlOgy

dr nawaf al-dOusary lecturing On restOring esthetics

dr. walter devOtO lecturing On indirect restOratiOns

left tO right, drs.: ahmad asad, elhmeida, aBdullah al shammery, hashemy, salah Bulushi, tarek khOury, naser al malek

left tO right, drs.: maryam al-sharaf, hashemy, a. al-emady, saBiha al-mutawa, aisha sultan, azhar naseeB, tarek khOury, salahuddin Bulushi, yOusef dOueiry, tOny diB

Lebanese Dental Association

Tripoli-Lebanon

8th International Meeting

April 21-22-23, 2016

Venue: University Of Balamand

dr. sami maneh, president Of the kda in the middle, with dr. saud a. al-anezi

Dentsply Sirona: Merger Creates The Dental Solutions CompanyTM

YORK, PA (USA)/SALZBURG (AUSTRIA), February 29, 2016 – Dentsply Sirona Inc. (NASDAQ: XRAY) announced that it has successfully completed the merger of equals between DENTSPLY International Inc. (“Dentsply”) and Sirona Dental Systems, Inc. (“Sirona”). The merger of DENTSPLY, the market leader in dental consumables and Sirona, the market leader in dental technology and equipment, creates the world’s largest and most diversified manufacturer of professional dental products and technologies. Dentsply Sirona will have leading positions and some of the most well-established brands across consumables, equipment, technology, and specialty products to address the needs of dental professionals, specialists and dental labs. Each day, approximately 600,000 dental professionals will use a Dentsply Sirona product.With the largest R&D platform in the industry, Dentsply Sirona will develop and support innovative end-to-end clinical solutions that advance patient care.

Total Solution Provider

By combining DENTSPLY’s consumables platform with Sirona’s technology and equipment, the new company offers more products and integrated solutions than any other dental organization. Dentsply Sirona’s wide array of products for dental professionals and labs enable the treatment of general and specialty procedures including implantology, endodontics, and orthodontics. With the broadest clinical education platform in the industry, the company is driving the adoption of new and approved technology and integrated solutions for more efficient workflows. Customer service and satisfaction will remain a key value to the new company and will be supported by the industry largest sales and service infrastructure comprised of direct sales and leading distributors.

Two Innovation Drivers coming together

The merger unites the two leading innovators in dental, each with over 100 years of experience. Combined, Dentsply Sirona will have largest and strongest R&D platform with over 600 experienced scientists and engineers to foster the development of better, safer and faster dental care. With its enhanced commitment to innovation, the company will advance patient care, improve the patient experience and reduce chair time for procedures.

Jeffrey T. Slovin, Chief Executive Officer of Dentsply

Sirona comments: “With our merger complete, Dentsply Sirona can now focus its efforts on empowering dental professionals to provide better, safer and faster dental care. As The Dental Solutions CompanyTM, we will drive long-term growth by being uniquely positioned to deliver innovative solutions and support our customers with the broadest product portfolio and the largest sales and service infrastructure in the industry. Dentsply Sirona will continue to be at the forefront of the digitization of dentistry, single visit dentistry and improving clinical outcomes for patients around the world.”

Visit www.dentsplysirona.com for more information about Dentsply Sirona and its products.

This new kit will suit you to realize quality root canal preparations thanks to the use of rotative single file for glide path One G and shaping One Shape® :

One Shape® Discovery Kit +:

2 One G blisters

3 One Shape® blisters

1 box Gutta Percha One Shape® Shaping

1 box Paper Points One Shape® Shaping

One Shape® Discovery Kit +, the simplicity and safety asset

• Simplicity: 1 only rotative single use instrument for glide path and shaping.

• Efficiency: time saving on the overall duration of treatment.

• Safety: controls risk of infections thanks to the sterile instrumentation.

Website: www.micro-mega.com

Medesy new periodontal micro-surgery kit

Nowadays periodontology has become extremely specialized, more complex and advanced thanks to the most recent developments in the treatment techniques and has created a demand for more sophisticated surgical instruments far more suitable for accurate dental interventions.

Medesy has replied to the precise needs of the professionals with a new specific kit created uniquely for periodontal micro surgery, a combination of instruments made in titanium, extremely light and purer than steel.

The kit is composed of the following items:

1. Titanium Scalpel Handle for micro blades

2. Molt Periosteal elevator and Periosteal HP3 both in titanium, they allow minimal traumatic detachment of the dental Papilla

3. Titanium Curved Micro tweezers excellent for meticulous suturing of the tissue.

4. Titanium Micro needle holder with smooth tips, for wires 8-0 /9-0, versatile instrument, ideal for use inside narrow interdental spaces.

5. Titanium curved micro scissors: like the needle-holder it has a very fine and precise tip for easy access in narrow areas.

Website: www.medesy.it

Aesthetic restorations from GC: More creativity, less complexity

GC is always striving to develop smart solutions for dentists’ daily challenges – which sometimes implies going against traditional concepts. In this respect, GC reveals a daring new approach to aesthetic dental restorations: Essentia. Essentia is developed together with a group of experts in aesthetics, does no longer rely on the traditional Vita® colours but on a very simple assortment of seven shades, created to mimic natural teeth at any patient’s age and offering dentists the maximum of creative freedom.

Improved plaque index and shallower pockets

Intensive oral care with Cervitec Gel improves the clinical treatment results of peri-implant mucositis.

Personal oral health care plays an important part in the long-term maintenance of implant-retained restorations. These measures are of particular importance in situations where mucositis has already developed, in other words, if the peri-implant soft tissue is inflamed. A successful treatment strategy for this type of case has been devised in the course of a clinical study conducted in Sweden.

Reduction in the bleeding on probing

The additional use of the oral care gel had a statistically significant effect on the reduction of the bleeding on probing (BOP) compared with the placebo gel. Moreover, the local plaque index in the test group improved and the periodontal pocket depth decreased.

High level of compliance

Throughout the study period, no staining of the teeth or disgeusia was observed or reported. The participants showed a high level of compliance for using the mild-tasting gel.

Website: www.ivoclarvivadent.com

By combining enamel and dentins, four main combinations following the patient’s age (Young, Junior, Adult & Senior) will make the shade selection become easier and will be sufficient to form the basis of any restoration – at any age.

On the other hand, knowing that the bonding is equally important, we accepted no compromises when developing our new universal bonding system.

G-Premio BOND is a one-bottle universal bonding compatible with all etching modes and which can be used not only for direct restorations, but also for repair cases & hypersensitivity treatment.

Its unique formula combining three functional monomers (4MET, MDP and MDTP) ensures excellent stability and bond strength not just to tooth tissue but to all indirect substrates, including composites, precious and non-precious metals, zirconia and alumina for all repair cases.

website: www.gceurope.com

Dentures contain surface pores in which microorganisms can colonise.1

Corega® cleanser is proven to penetrate the biofilm* and kill microorganisms within hard-to-reach surface pores.2

Help your patients eat, speak and smile with confidence with the Corega® denture care regime.

Dry milling of zirconium oxide, acrylic resin, wax

• Wet-grinding capabilities for IPS e.max® CAD for Zenotec

• The IPS e.matrix multiholder maximizes productivity and flexibility

Zenostar® Telio® CAD for Zenotec