Minimally invasive interventions in paediatric dentistry
Prof.univ.dr. Rodica Luca, Facultatea de Medicină Dentară, UMF”Carol Davila”, București
Minimally invasive dentistry concept is based upon the last decades’ acquired knowledge on caries etiopathogenesis and newly improved dental materials for everyday use. This concept, adopted in 2002 by the general assembly of FDI, lays on early detection of decay, either during its non-cavitary stage (“white spot”) or while the cavity is minimal, so that lesions may benefit from remineralization.
The main principles upon which the concept of MI is built are: changes in oral flora, patient education, remineralization of non-cavitary lesions of enamel and dentin, minimal preparation of cavities and repair rather than change of inadequate restorations. These principles apply in accordance with the individual estimated caries risk, while the patient is actively monitored for caries progression risk. Some biological methods (e.g. selective caries removal, stepwise, ART or Hall techniques), recommended for deep caries management in vital teeth without signs of irreversible pulp inflammation, can be regarded as MI interventions.
Key-words: minimally invasive interventions, early detection, decay, paediatric dentistry.
Current trends in treatment of simple carious lesions in primary teeth
Dr. Andreea Maria Nistor, Facultatea de Medicină Dentară, UMF „Carol Davila”, București
Dental care for pediatric patients is mandatory from an early age as the majority of children are at risk of developing dental caries, most lesions progressing to pain or other complications in a short span of time, affecting patient’s quality of life. Reducing the discomfort and time needed for treatment are of utmost importance in order to provide effective medical care. Management of carious lesions in primary teeth can vary, especially for those already cavitated and deep. In pediatric dentistry the aim is to promote a positive attitude to dental care and use a minimally invasive approach when the clinical context allows it. Due to the better understanding of the disease, international guidelines and recent studies have suggested that more conservative approaches such as Hall technique, indirect pulp capping (IPC), or stepwise excavation can be used in order to main pulp vitality and provide pediatric patients with less challenging treatment sessions. The best conservative techniques and materials are yet to be decided.
Keywords: pedodontics, carious lesions, primary teeth, conservative treatment, Hall technique, pulp capping
Management of uncomplicated crown fractures in adolescents
Dr. Roxana Kolanovschi, Facultatea de Medicină Dentară, UMF „Carol Davila”, București
Understanding dental trauma and materials used in pediatric dentistry can bring a new perspective over the diagnosis and a minimally invasive approach to treating dental trauma by procedures who aim to assist the natural healing process of hard tissues, pulp, periodontal ligament and alveolar bone, this way avoiding invasive restorations, pulpectomy or extraction.
The question in a case like this is: what kind of restoration to use? Composite vs ceramic!
Treatment of uncomplicated fractures in young permanent incisors by composite restorations can be a conservative, fast, low cost and easier to accept by the child, but it has some variables that can affect the longevity of this type of restoration related to the general prognosis, pulp exposure, restoration amplitude and size, age and occlusion of the patient, as well as the chances of a subsequent injury.
Keywords: composite, fracture, minimal invasive
Up to date information about penetrating coronary fractures of permanent teeth
Dr. Alin Constantin, Facultatea de Medicină Dentară, UMF „Carol Davila”, București
Dento-periodontal traumas are the most common events in the dental field, according to updated world statistics. The impact of such events has consequences on the physical, mental and social integrity of the patient involved. What is worth mentioning is that dento-periodontal traumas are clinically obvious and belong to the category of cranio-facial traumas with all their implications. Depending on their severity, they can be addressed in the hospital environment (major accidents) by the authorized medical staff or in the dental office (moderate or mild trauma) by the dentist.
Of all the types of coronary fractures, penetrating coronary fractures of permanent teeth represent 5-8% of their total. Penetrating coronary fractures are also called fractures with pulp interest or complicated fractures, because of the fracture line that interests the enamel and dentin and the continuity of the pulp chamber. The goal of the treatment in complicated coronary fractures is to maintain the vitality of the dental pulp by preserving the uninflated dental pulp
Keywords: penetrating fractures
Complicated Crown-root Fracture Management Using the 180-degree Rotation Method
Dr. Ana Armășoiu, Facultatea de Medicină dentară, UMF „Carol Davila”, București
Among children and adolescents, traumas to the upper incisors are common. In the case of crown-root fractures, the fracture line extends subcrestally, involving the enamel, dentin and cementum. The prognosis for crown-root fractures is often poor, leading to tooth extraction. In the case of the upper frontal incisors, the aesthetic aspect plays an extremely important role, so the choice of treatment can be difficult. One method of treating crown-root fractures is replantation, which involves extracting the tooth and placing it in a more coronal position. A modification of this technique involves the rotation at 180 degrees, having the advantage of a better rehabilitation and a better recovery of the biological space.
Keywords: crown-root fracture, young patients, orthodontic extrusion, replantation
Oral health education issues in communities
Conf. Dr. Ruxandra Sfeatcu, Facultatea de Medicină Dentară, UMF „Carol Davila”, Bucureşti
Oral health education is an important part of health promotion programs, but also in daily practice in the dental offices, which aims to make the individuals/patient able to effectively control the determinants of health. Any educational process involves communication and is based on deliberate learning that aims to change behaviors – favoring healthy and reducing non-healthy habits – in order to achieve certain well-established goals. The education process requires the training of dentists and other educators, who in turn will disseminate medical information among patients and the general public, who properly informed, aware and motivated will become more concerned with prevention and a healthy lifestyle. Examples are provided regarding the assessment of the level of knowledge and behaviors towards oral health, as well as the results of the application of experiential education lessons in groups.
Keywords: oral health education, community dentistry
Trends in oral hygiene, diet patterns and other individual and group characteristics in primary school children
Șef lucr. Dr. Dan Cristian Ionel, Dr. Anca Mantu, Facultatea de Medicină și Farmacie, Departamentul de Medicină Dentară, Universitatea „Dunărea de Jos”, Galaţi
Introduction: Oral hygiene, balanced eating patterns are key features in ensuring the harmonious development of children’s dentition with the absence of pathological damage and ensuring the overall development of the whole body.
Material and method: A cross-sectional study of the questionnaires was performed on a group of 72 primary school children, with an average age of 8.55 ± 1.01 years, in a school dental office from Galați. Data analysis was performed using SPSS 24.0 (SPSS Inc, Chicago, Illinois, p <0.05).
Results: Distribution by sex was approximately balanced (52.8% girls). Regarding the means of oral hygiene, children mentioned: 2-3 times brushing/ day (45.8%, respectively 43.1%), 63.9% use flouride toothpaste. Regarding the eating habits, the following could be observed: fruits consumed 2-3x/ day for 52.8% of children, dairy products in 49.3% of cases 1x/ day; rarely sour drinks (51.4%), sweets 1x/ day (36.1%). 73.6% of children were not afraid of visiting the dentist.
Conclusions: The revealed eating patterns are encouraging and in line with the global recommendations for ensuring good oral and general health in the child. The answers also indicated a high degree of confidence and an open attitude towards visiting the dentist.
Keywords: healthy diet, oral hygene
Correlation of child psychology and maternal factors and their contribution to early childhood caries
Dr. Dan Alexandru, Facultatea de Medicină Dentară, UMF „Carol Davila”, București
This paper aims to develop the interrelationships between child psychology and maternal factors that may contribute to early childhood caries. Although general pathways linking the external social environment and the child, in correlation with risk factors for early childhood caries (ECC), have been identified previously, it cannot be said that much research has been developed on maternal psychology, whose links with early caries are not yet well known.
The aim is to propose a unifying conceptual model that links together the general social, environmental, maternal and child psychology factors that are commonly associated with CSE. The proposed conceptual model provides a framework that connects the social, psychological and behavioral mediating factors involved in the occurrence of ECC. It demonstrates that the causal pathways involved are best explored using a combination of qualitative research, based primarily on intensive psychosocial exploration.
Keywords: child psychology, early childhood caries, maternal factors
How to create a predictable clincheck for treating with aligners the crowding cases
Dr. Elvira Pătroi, Practică privată, DP Dental
Nowadays every patient wants a fast, efficient and comfortable orthodontic treatment with no pain if possible. The advances in digital technology and the ongoing innovations in this field help orthodontists to meet the patient’s expectations and ease the doctor’s work. The answer for all of these is the aligners and digital planning.
Here you can find the evaluation keys for a predictable clincheck in order to have no refinements or very few additional aligners, all explained them with the help of a clinical case.
Keywords: aligner, digital orthodontics, clincheck, teeth crowding
Invasive cervical resorption – diagnostic and treatment key points.
Dr. Milan Uzelac, Private practice – Implant & care, Belgrade, Serbia
Invasive cervical root resorption is one of the most complex endodontic problems due to their possible position, complex anatomy and eventual one or multiple teeth onset.
Real life availability and daily use of Cone beam CT ease diagnosis and presents invaluable and necessary tool for detection and treatment planning.
Development of biocompatible materials for restoration of resorption defects and implementation of visual aids in standard practice treatment improves treatment prognosis substantially.
Lecture discus thinking pathways necessary for diagnosis, treatment planning in various anatomical scenarios, material selection and prognostic parameters.
Keywords: cervical resorption, Cone beam CT
Intentional replantation of a second mandibular molar – Case presentation
Şef lucr. Dr. Ștefan Manea, Facultatea de Medicină Dentară, Univ. „Titu Maiorescu”, București
The successful endodontic management needs proper knowledge regarding the diagnosis and treatment of unusual root canal systems.
Tooth replantation is the reinsertion of a tooth into its own alveolus after the tooth has been extracted for the purpose of performing root-end surgery or repairing a root defect in the hand out of the socket.
Tooth replantation is indicated when there is no other treatment alternative to maintain a tooth.
The latest developments regarding instruments and materials (CBCT, Dental operating microscope, bioceramic materials) can provide great help in dealing with such cases.
When properly planned and executed, intentional replantation has been shown to be quite successful in providing patients with additional years of service.
This presentation describes a failed endodontic treatment of a mandibular second molar, its diagnosis, management and follow-up.
Keywords: endodontic treatment, CBCT, dental operating microscope, replantation
Cervical emergence profile in prosthetic rehabilitation with implant support.
Dr. Bogdan Liviu Mirodot, Teodora Ioana Carlaonț, Practică privată
The main complaint of patients with prosthetic restorations with implant support refers to food retention especially on the vestibular face of the mucosal junction.
An advantage to consider when using custom healing abutments is that it can be removed in the early stages (anytime in the first 45 days postoperatively) without fear of reverse torque, which would compromise osseointegration.
Bone and soft tissue healing through the use of custom scarring stems causes the simultaneous formation of collagen fibers, blood vessels and epithelium which will create a cervical emergency profile that mimics the natural pattern as accurately as possible.
Keywords: emergence profile of tooth
Digital technologies – from diagnosis and case design to materials selection
Conf. Dr. Lucian Toma Ciocan, Facultatea de Medicină Dentară, UMF „Carol Davila”, București
This conference debates, on a clinical example, the advantages of using clinical technologies in multidisciplinary treatments. Starting from data acquisition necessary for multidisciplinary diagnosis and prosthodontic design and ending up with novel materials selection for dental arch restorations, the digital technologies and digital manufactured materials have a continuous improved development to satisfy long term clinical demands. In the conference will be emphasized the new elements in the development of smile design protocol, digital laboratory color try-in, effectiveness of digital impression and restorations virtual design, advancement in digital CAD-CAM processed materials and their influence on clinical result.
Keywords: digital technology, digital design, CAD-CAM materials
Practical Aspects in Anterior Dental Area Rehabilitation
Prof. Dr. Monica Silvia Tatarciuc, Șef lucr. Dr. Ionut Alexandru Luchian, Conf. Dr. Diana Antonela Diaconu-Popa, Facultatea de Medicină Dentară, UMF „Gr. T. Popa”, Iași
The rehabilitation of the anterior dental arches is a challenge for any dentist. The modern therapeutical possibilities are looking for aesthetic and functional solutions, the most used prosthetic appliances being represented by CAD-CAM restorations, all ceramic bridges, dental veneers and implant supported restorations.
The main goals are represented by: the recovery of the individual morphology, of the anterior guidance path, of the occlusal relationship, long clinical longevity, using minimally invasive clinical working flow and biocompatible materials.
Keywords: CAD-CAM, Smile Design, All Ceramic Rehabilitations
All ceramic veneers: bleach or natural white?
Conf. Dr. Dan Pătroi, Facultatea de Medicină Dentară, Univ. „Titu Maiorescu”, București
Today, the desire for a natural esthetic smile is a powerful reason for a visit to the dentist. Restoring a natural esthetic smile gives a lot of opportunities for any dentist who is willing to learn the principles of teeth function and smile design. To restore a beautiful smile does not mean trying and guessing, mistakes and corrections, it means learning those principles that are compatible with predictable long-term results, comfort and function.
There is a learnable process for every restored tooth concerning its position, contour, inclination, color and shade. If this process is understood and followed, there will be no reason to end up with teeth that look artificial or are uncomfortable or unstable.
Keywords: IPS e.max, veneer, ingot, white esthetics, pink esthetics, adhesive cementation, contour, shape, texture.
Adhesive systems used in direct restorations with composite resins
Şef lucr. Dr. Iulian Costin Lupu, Facultatea de Medicină Dentară, UMF „Gr. T. Popa”, Iaşi
The success of adhesive restorations depends largely on the quality of the adhesive of the composite resins to the organic substructures, in addition to the quality of the materials used and the way in which we perform the restoration of the dental structure. This is reflected primarily in choosing the right type of adhesive system. At a time when practitioners are overwhelmed by the growing number of offers from dental manufacturers, it is very important to understand the relevant qualities of adhesive systems. Alternatives such as 8th or 9th generation, universal adhesives have appeared on the specialty market, which has complicated the choice that the clinician has to make. Obtaining a quality adhesive hybrid layer also depends on other aspects also. Factors influencing the quality of adhesion are represented by the way we approach the minimally invasive preparation of the organic substrate, the compliance of a predictable protocol in the treatment of the dentine, understanding the influence of the oxygen on the polymerization of the adhesive layer and obtaining a minimum thickness necessary to achieve the hybrid layer.
Keywords: adhesion systems, direct restorations, composite resins
Possibilities of complex oral rehabilitation
Prof. Dr. Norina Consuela Forna, Șef lucr. Dr. Doriana Agop Forna, Facultatea de Medicină Dentară, UMF „Gr. T. Popa”, Iași
Complex oral rehabilitation involves the reconstruction of the maxillary and mandibular arches in patients with extensive extended edentulousness through techniques of reconstruction of the mucous-bone support, implant-prosthetic rehabilitation, or removable prosthesis. These techniques will involve multidisciplinary collaborations (specialists in prosthetics, oral surgery, endodontics, periodontics, orthodontics) in order to obtain the best possible functional and aesthetic results. Pro-prosthetic and pro-implant surgical procedures must be adjusted to individual biological conditions to optimize bone regeneration. The reconstruction techniques are as follows: alveolar augmentation; sinus lifting associated with bone addition techniques; bone graft interposition; bone expansion surgical techniques. Guided bone regeneration (GBR) techniques are recommended in severe alveolar bone resorption involving bone augmentation with various categories of bone graft materials associated with bone membranes. Biomaterials used in addition techniques include autogenous bone, allogeneic materials, xenografts, and synthetic addition materials. Digitally assisted techniques (software applications for virtual planning of the pro-implantation and implantation stage, optical impression, 3D printing, CAD-CAM techniques), recently introduced in complex oral rehabilitation, are useful in terms of improving and reducing the duration of clinical and laboratory, increasing patient accuracy and comfort.
Keywords: oral rehabilitation
Treating Total Tooth Loss: A Comparison Between Marginal Fit of Screw-Retained, Multiple Implant-Supported Single Frames Manufactured Using Analogue-versus Digital-Analogue Workflows
*Dr. Radu Baston, **Dr. Mihaela Gașpar, ***Dr. Ioana Neagu, *Practică privată, Peltecu Medical SRL, ** Practică privată, Clinica de zâmbete Confident, *** Practică privată, Bio Etic Medical Dent
Purpose: the aim of this lecture is to investigate the marginal fit differences when using analogue versus digital-analogue procedures in manufacturing one-piece non-removable implant-supported screw-retained frames in treatment of total tooth loss.MATERIALS: 29 frames.
Method: between January 2004 and January 2021 we inserted a total of 140 fixtures which have been loaded with 29 non-removable, screw-retained single superstructures. For 24 (83%) superstructures we have used analogue work-flow procedures and for the remaining 5 (17%) combined analogue-digital work-flows. For every implant case we took standardized snapshots of every implant-superstructure interface and OPG’s or periapical x-rays at the frame try-in. The information has been stored in individual PPT files and ana-lysed for marginal fit.
Results: the retrospective analysis identified 7 (30%.) moderate misfitted superstructures and 2 (8%) superstructures featuring a single large, open gap when using analogue workflows. None of the superstructures manufactured by analogue-digital workflows exhibited any identifiable marginal misfit.
Discution: marginal misfits range from minor to major and might jeopardize the survival rate of the prostheses. The main drawback of this study is the reduced number of analyzed analogue-digital workflows and a rough assessment method of marginal fits.
Conclusion: switching away from analogue workflows seems to improve the marginal fit of multiple implant-supported, screw-retained single superstructures.
Keywords: total tooth loss, marginal fit, screw-retained implant-supported superstructure, digital workflow, analogue-digital workflow
About the deontological requirements in dentistry
Prof. Dr. Radu Septimiu Câmpian, Colegiul Medicilor Stomatologi din România
The code of ethics for dentists is updated and came into force earlier this year. Traditional moral values are preserved, but we also find new approaches. The impact of economic development, social and professional changes as well as technology in multiple aspects have brought updated regulatory needs. Understanding the regulatory needs of professional deontology in the contemporary context is lacking at this time. The use of the moment of updating the code of ethics for propagandistic purposes is in itself a deviation from the fundamental deontological values. The insubordination of personal interest in relation to the general professional interest is dictated by the evolution of the dental care market. Online communication is part of our behavior and is subject to general and specific regulations.
Keywords: ethics, deontology, dentistry
Modern means of diagnosis and treatment in endodontics
Şef lucr. Dr. Ștefan Manea, Facultatea de Medicină Dentară, Univ. „Titu Maiorescu”, București
This presentation is focused on the diagnostic and treatment tools needed for a successful endodontic treatment. The devices, instruments and materials used will be presented.
Because of the lack of studies, it is not possible to determine which diagnostic methods can disclose whether a vital but injured pulp can be maintained or whether it should be removed and replaced with a root filling.
The effects of different methods used for instrumentation, disinfection and root filling associated with root canal therapy are insufficiently investigated.
Great variations exist in treatment strategies and choice of materials among practitioners.
There is a need for prospective studies of root canal therapy, which show how teeth can be preserved in the long-term, without risk of recurrence of symptoms, periradicular inflammation or tooth fracture.
There is a need for a registry with quality indicators to be applied for follow-up evaluations of pulpal and root canal treatments.
Keywords: diagnosis, endodontic treatment
Basic ergonomic issues in the dental office
Dr. Sergiu Gabriel Nicola, Practică privată, Endodonție.Ro
In this lecture I will discuss some basic ergonomic principles regarding ergonomics in the dental office, like how to setup a new office, how to make less moves, how to improve the four/ six hands dentistry.
Keywords: ergonomics, basic, setup, dental, office
Endodontics- teeth secret map
Șef lucr. Dr. Dan-Cristian Ionel, Facultatea de Medicină și Farmacie, Departamentul de Medicină Dentară, Universitatea „Dunărea de Jos”, Galaţi
Endodontics, a story over 3 centuries old, with ups and downs, with viable treatments but also periods in which pulpal pathology was considered the root of all diseases in the body (theories of Hunter et al.) but with a happy ending nowadays manifested by predictable success rates of over 95% of current endodontic treatments. The importance of good insolation during treatment (Rubber Dam system – AAE legal standard for over 22 years), as well as abundant irrigation along the entire three-dimensional path of the endodontic space and rotary mechanical instrumentation with increasingly efficient systems in the interest of multiple surfaces of the internal roots were the decisive factors in this regard. Also, the particular aspects of work ergonomics and organization of the micro-endodontics office should not be neglected at all in terms of repetitive positions, maintained for long periods of time with a risk of considerable musculoskeletal damage. The last part of this conference will review a current working protocol, da capo al fine, for molars with complex endodontic morphology, as well as the evaluation of immediate results and at the end of the period necessary for bone healing of adjacent periapical lesions.
Vertical root fractures – an endodontic perspective
Practică privată, ENDO EN ZO – Amsterdam
Unfortunately, vertical root fractures still represent a difficult diagnosis to make in current clinical dental practice. Limitations depend on their size and position in the tooth. Despite these difficulties, in recent decades clinicians have succeeded through various clinical tests, inspection using magnification devices (such as dental microscope) or more recently CBCT radiological technology to get closer to confirming this diagnosis. A correct diagnosis of vertical root fractures is extremely important in terms of also in addition to a degree of disappointing to the patient and clinician as well, but would also mean high financial and time costs for both parties.
Keywords: VRF, endodontics, diagnosis,
Intracoronal bleaching of non-vital teeth
Dr. Miguel Vasco Seruca Marques, Practică privată, Olanda
The aim of this presentation is to review the current European regulations about bleaching agents and present an intra-coronal bleaching technique step by step.
The intracoronal bleaching procedure is a technique for treatment of intrinsic discoloration of teeth and it’s a relatively low risk treatment. It is widely used in discoloured non vital teeth because it is efficient and relatively simple. However, care should be taken to prevent complications.
Teeth were endodontically treated under rubber-dam and a flow composite was used a barrier material. A mixture of sodium perborate and water was placed in the pulp chamber and sealed with flow composite. The patients were evaluated on a two-weekly basis and the procedure was repeated as appropriate until the desired shade has been achieved.
A well-designed treatment plan is the key for a successful and long-term final outcome.
Keywords: intracoronal bleaching; sodium perborate
