Libros

Preeruptive intracoronal radiolucency (PEIR) is a rare dental anomaly often incidentally detected during routine radiographic examinations. This condition manifests as a radiolucent lesion beneath the enamel–dentin junction of unerupted teeth, particularly in mandibular molars, posing diagnostic and management challenges due to its asymptomatic nature. The treatment of PEIR depends on the extent of the lesion and the degree of pulp involvement. Case series: This case series reports on four patients with progressive PEIR. In Cases 1 and 2, lesions were incidentally discovered in panoramic radiographs during orthodontic planning (mandibular permanent second molars), and additional surgical exposure to access the lesion was required as teeth were only partially erupted. Interestingly, in Case 3, the PEIR was not visible in earlier radiographs though the crown of the tooth was already mineralized (mandibular permanent second molar). For Case 4, the tooth presented with symptoms of reversible pulpitis (mandibular permanent first molar). All lesions were treated with indirect pulp capping using biocompat-ible material. The patients were followed up for a period of up to 8 years to evaluate treatment success. Indirect pulp capping and restorations were found to be successful in all four cases in the last follow-up: 1 year (Case 2), 1.4 years (Case 4), 1.5 years (Case 1), and 8 years (Case 3). Conclusion: This case series demonstrates the effectiveness of early intervention via surgical exposure and indirect pulp capping and restoration for managing severe cases of PEIR. However, further research with larger samples and long follow-up is necessary. Palabras clave: preeruptive intracoronal radiolucency, preeruptive intracoronal resorption, pulp capping, radiolucent lesion, unerupted teeth

Objective: The evidence base for the use of space maintainers is relatively sparce despite being used for decades after the premature loss of primary molars. This study aims to increase the dental evidence base via investigating retrospectively the success rates of prefabricated fixed and removable space maintainers inserted from 2019 to 2021 and followed up until February 2023 at a specialized university clinic and to identify reasons for any reported minor and major failure. The authors hypothesized that there is no significant difference in failure rates between fixed and removable space maintainers inserted after the premature loss of a single primary molar per quadrant. Method and materials: Patients’ digital records were searched yielding 645 space maintainers. After the application of inclusion criteria, 157 (67%) fixed prefabricated space maintainers in 112 children and 77 (33%) removable space maintainers in 61 children were analyzed for an average of 18.4 ± 9.5 months. Results: Kaplan–Meier survival analysis with Mantel–Cox statistics showed an overall cumulative survival time of 31.6 months (SE = 1.15, 95% CI = 29.4 to 33.9). Major failure occurred significantly more in removable maintainers (n = 40/67, 59.7%), mostly due to loss of the appliance, compared to fixed space maintainers (n = 27/67, 40.3%; P < .001). The present study indicates that space maintainers were mainly placed in young children with high caries experience, where treatment was mostly possible using advanced behavior management. Conclusions: Fixed space maintainers had a significantly lower failure rate than their removable counterpart. However, both require continual repairs, preservation, or even replacement till the eruption of the permanent tooth. Palabras clave: band and loop, failure rate, removable appliance, space maintainer, survival rate

Trotz des Kariesrückgangs bei Kindern und Jugendlichen in Deutschland bleibt die frühkindliche Karies ein prävalentes und praxisrelevantes Problem. Basierend auf dem aktuellen Verständnis von Karies wird deutlich, dass der Kariesprozess durch eine Veränderung der Kariesaktivität (z. B. Biofilmentfernung und Fluoridierung) des Patienten kontrolliert werden kann. Dadurch lässt sich der Verlauf des Kariesprozesses beeinflussen. Aktive kariöse Läsionen können ohne Entfernung von kariösem Gewebe durch Wiederherstellung des Gleichgewichts der De- bzw. Remineralisation innerhalb des Biofilms auf der Zahnoberfläche und des betroffenen Gewebes behandelt werden, sodass aktive Schmelz- und Dentinläsionen inaktiviert werden können. Die Behandlung mit Silberdiaminfluorid (SDF) hat insbesondere in den letzten Jahren in der zahnmedizinischen Forschung und in der täglichen klinischen Praxis weltweit an Popularität gewonnen. Sie gilt als einfache und erfolgreiche Therapieoption und ist daher heute ein zentraler Bestandteil der Kinderzahnheilkunde, insbesondere wenn die Anwendung als Teil eines umfassenden Konzepts zur Karieskontrolle in der (Kinder-)Zahnarztpraxis integriert wird. Manuskripteingang: 02.01.2024, Manuskriptannahme: 18.01.2024 Palabras clave: Silberdiaminfluorid (SDF), Kariesarretierung, SMART-Hall-Technik, Kinderzahnheilkunde

Karies ist eine der weltweit häufigsten Erkrankungen6 und führt immer noch bei vielen Kindern und Erwachsenen zu Einschränkungen in der Lebensqualität. Dabei ist die Prävention von Karies recht einfach und es steht ein breites Managementspektrum zur Verfügung. Karies wird heute als Prozess eines chronischen Ungleichgewichts zwischen demineralisierenden und remineralisierenden Faktoren begriffen (Abb. 1), bei dem die kariöse Kavität eine Folge der Erkrankung darstellt. Der pathogene Biofilm, also die reife, ca. 48 Stunden alte dentale Plaque, verstoffwechselt unter anderem Kohlenhydrate zu Säure, die die Demineralisation der unter der Plaque liegenden Zahnhartsubstanzen (zunächst Zahnschmelz, später Dentin) bewirken. Das „Loch im Zahn“ – als Karies bezeichnet – ist also ein Symptom der Erkrankung, die ebenfalls im deutschen Sprachgebrauch als Karies bezeichnet wird. Der Begriff der „Kariesentfernung“ ist daher etwas irreführend, weil zwar kariös veränderte Zahnhartsubstanz entfernt werden kann, jedoch die Erkrankung „Karies“, also die Ursache des kariösen Prozesses, davon („durch den Bohrer“) unberührt bleibt18. Auch wenn diese Unterscheidung eher semantisch erscheint, sind die Folgen für Kariesprävention und –therapie revolutionär: Die Entfernung kariös veränderter Zahnhartsubstanz dient primär dazu, den Zahn für die spätere Versorgung durch beispielsweise eine Füllung vorzubereiten, damit diese langfristig hält, und stellt primär keine ursächliche Kariestherapie dar.

Der vorliegende Beitrag betrachtet im Schwerpunkt die Kinderzahnheilkunde, wobei die beschriebenen aktuellen Konzepte im Bereich der Untersuchung von Karies und der Diagnostik nicht nur für „Kinderzähne“ gelten. Das Verständnis von der Erkrankung „Karies“ (s. Beitrag zur Kariesätiologie) und das Wissen zu verschiedenen Optionen in der Kariesdiagnostik stellen die Grundvoraussetzungen für die korrekte Diagnose dar und folglich auch für „modernes“ Kariesmanagement.

Objectives: The objective of this study was to analyze the success of primary molar pulpectomy with a minimum of 1 year and up to 4 years follow-up with focus on the treatment setting (general anesthesia, sedation, local anesthesia alone). Method and materials: Data were retrieved from 92 patients’ records between 2012 and 2020. The pulpectomy treatment using calcium-hydroxide/iodoform paste was performed under general anesthesia (n = 45), nitrous oxide sedation (n = 21), or local anesthesia alone (n = 39). Bivariate and multivariate analyses were performed. Results: The overall success of pulpectomy was 59.5% 4 years post-treatment. The 4-years clinical success rate was clinically relevantly higher under general anesthesia (78.6% vs 57.1% under nitrous oxide sedation, 43.8% with local anesthesia only) and in the mandibular arch (70.8% vs 38.5% in the maxillary arch). This could be related to the strict case selection under sedation and especially general anesthesia. Despite statistically significant differences in the bivariate analysis for most outcomes and follow-up periods, this was not the case in multivariate regression. Conclusion: Pulpectomy performed in primary molars offers a successful long-term treatment option especially with a strict case selection as under general anesthesia. Palabras clave: general anesthesia, nitrous oxide sedation, primary molars, pulpectomy, success rate

Objective: To investigate the possible reduction in the need for dental general anesthesia through nitrous oxide sedation in combination with behavior management techniques among patients younger than 12 years of age referred to a specialized pedodontics practice due to high dental treatment need and poor cooperation with dental treatments. Method and materials: Retrospective analysis of the digital medical records of all children treated under nitrous oxide sedation in a specialized pedodontics clinic between 2012 and 2017 was performed. The reduction of the need for dental general anesthesia was measured depending on the success rate of nitrous oxide sedation at the patient level with relation to multiple related factors such as age, reason for referral, and treatment need. Results: Nitrous oxide was used in 406 dental treatment sessions on 228 pre-cooperative and/or anxious patients aged 3 to 12 years (mean 6.4 ± 1.7; 43.4% female); 91.9% of the nitrous oxide sedation sessions were successful in achieving the intended dental treatment. Complete oral rehabilitation was possible for 84.0% of the patients using nitrous oxide sedation without the need for dental general anesthesia. Regarding age, dental general anesthesia reduction among preschool children was lower than school children (77.8% and 87.9%, respectively). Conclusion: A high proportion of anxious or semi-cooperative children with high dental treatment need can be treated without the use of dental general anesthesia when a comprehensive concept of caries management is combined with the use of nitrous oxide sedation and behavior management techniques. Nitrous oxide sedation should therefore be considered as an option for dental treatment of semi-cooperative children with high dental treatment need before planning dental general anesthesia. Palabras clave: dental general anesthesia, nitrous oxide, pediatric dentistry, sedation, success rate

Objectives: COVID-19 led to the adoption of containment measures including the temporary closure of dental clinics. However, dental emergencies have not ceased during this pandemic. Thus, the aim of this study was to analyze patient profiles and the offered management options to pediatric patients presenting with dental emergencies during a COVID-19 lockdown. Method and materials: Retrospective analysis was performed of patient records of children seeking emergency dental treatment during a 7-week lockdown period in 2020 in a university pedodontic clinic in Germany, and compared to a similar cohort from 2019. Data on patient, tooth, and session level were collected. Results: The 2020 cohort consisted of 83 patients, and the 2019 cohort included 46 patients, showing a 45% greater need for emergency treatment in 2020. The most common chief complaint was plaque-induced gingivitis/oral mucosal conditions in 2020 (26.4%), and irreversible pulpitis in 2019 (25.5%). Dental caries (without spontaneous pain) was the second most common chief complaint in both cohorts (20.7% and 23.4%, respectively). Most interventions in 2020 were minimally invasive treatments (eg, Hall Technique, silver diammine fluoride; 20.3%), which were in 2019 not considered at all; followed by pharmacologic treatment (16.9%), which was in 2019 also highly used (35.9%). Conclusion: The COVID-19 pandemic led to an increase in emergency pediatric dental visits and shifted treatment options towards less invasive procedures. Palabras clave: coronavirus disease (SARS-CoV-2), dental emergency treatment, minimally invasive treatments, pediatric dentistry

Nicht selten kommen Patienten bzw. die Eltern in die Praxis und sagen, dass sie mit einer fluoridfreien Zahnpasta die Zähne putzen, da Fluoride giftig seien. Dieser Mythos ist natürlich wissenschaftlich nicht zu halten, auch wenn Presse und Internet manchmal einen anderen Eindruck erwecken. Fluoride, also Fluorsalze, werden oft mit dem giftigen Fluor(gas) verwechselt, das zahnärztlich jedoch nicht eingesetzt wird.

Objective: Few studies have examined pain levels for the injection of local anesthesia in children, though it is a routine technique in pediatric dentistry. The objective of the study was to evaluate the difference in the assessment of procedural pain by the child, parent, dental practitioner, and independent observers during injection of local anesthesia for dental treatment in pediatric dentistry. Method and materials: In total, 27 male and 22 female children (5 to 17 years of age, mean ± SD 9.8 ± 4.0 years) received local anesthesia (LA) via infiltration or mandibular alveolar blocks according to a standard protocol. After the dental treatment, the children assessed the pain levels for the procedures on a visual analog scale (VAS), while their parents and the dental practitioner used a numeric rating scale (0 to 10). Independent observers also assessed pain via video tape for an evaluation after blinding. The heart rate was monitored continuously during the procedure. The Bland–Altman method was used to quantify the comparison between pain ratings. Results: The assessed level of pain by dental practitioner, parent, and child during injection of LA differed clearly (child: 3.94 ± 2.71; parent: 3.31 ± 2.60; dental practitioner: 3.02 ± 1.98; video observer 1: 1.76 ± 2.56; video observer 2: 1.89 ± 2.55). In 42.9% of cases the dental practitioner’s rating and the self-­reported pain by the child during injection of LA differed by ≥ 2 on the numeric rating scale, which is clinically a highly different and relevant assessment. Conclusion: As pain perception in children during the injection of local anesthetic and its assessment varies considerably depending on the assessing person and the treated child, dental practitioners and researchers should be cautious in interpreting the patient’s pain perception. Palabras clave: children, dentistry, local anesthesia, pain assessment