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

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

Objectives: Treatment of carious primary molars is always indicated, especially on young children; however, there are no clear guidelines that precisely explain the best treatment approach for Class II carious molars with marginal breakdown (International Caries Detection and Assessment System [ICDAS] 5). The objective of this prospective observational clinical study was to assess the efficacy of three restorative techniques in treating ICDAS 5 Class II lesions in primary molars: compomer fillings (CF), preformed metal crowns (PMC), and pulpotomy and conventional preformed metal crowns (PMC+P). The secondary goal was to evaluate the impact of some cofactors on the course of treatment. Method and materials: Overall, 92 children (female, n = 50, 54.3%; male, n = 42, 45.7%) aged 2 to 9 years old (mean age = 5.9 ± 1.9 years) with 166 treated teeth were included. The average number of decayed, missing, or filled teeth (d3mft) of the whole sample was 8.0 ± 3.4. The distribution of the sample according to type of treatment was CF = 53 (31.9%), PMC = 64 (38.6%), and PMC+P = 49 (29.5%). Paired t test, nonparametric Friedman ANOVA test, and decision tree analysis were used as the basis for the statistics. Results: After 12 months, data from 75.8% (72/95) treated patients, corresponding to 62.0% (103/166) of the treated teeth (CF = 42/53, 79.2%; PMC = 38/64, 59.4%; PMC+P = 23/49, 46.9%) were available for analysis. The mean patients age was 6.8 ± 1.8 years; 32 (47.1%) boys and 36 (52.9%) girls. The mean d3mft of the remaining sample was 7.8 ± 3.35. PMC and PMC+P arms showed the highest success rates (> 91%) as compared to the CF arm, which showed the lowest success rates (61.9%), with 9/42 teeth of the CF group (21.4%) presenting with minor failures, and 7/42 teeth (16.7%) with major failures (P < .0001). Conclusion: According to the decision tree analysis, PMC and PMC+P had a success rate of 99%, whereas CF had a success rate of only 69%. Some cofactors (treatment decision, Approximal Plaque Index, and tooth number) had a higher impact on the decision tree analysis than others (age, dmfs, and dmft values), especially when the treatment selection was CF. In future studies it is necessary to examine the impact of other cofactors on the outcomes of conventional fillings using a larger sample size. Palabras clave: compomer filling, marginal ridge breakdown, preformed metal crown, primary molar, proximal caries, pulpotomy

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.

Karies ist eine der häufigsten ver-meidbaren Krankheiten mit einem Komplex aus Risikofaktoren. Die all-gemeine und berufliche Bildung des Patienten bzw. der Eltern und seine/ihre Wahrnehmung der Krankheit, der allgemeinmedizinische Hinter-grund, die tägliche Ernährung und Mundhygiene, das soziodemografi-sche Umfeld und viele andere Risiko-faktoren können direkt oder indirekt zur Krankheitsentstehung beitragen. Bereits beim ersten Besuch des Patienten können wichtige Informa-tionen gesammelt werden, um das Kariesrisiko einzuschätzen und so den besten individualisierten Prä-ventionsplan bzw. eine Therapie-entscheidung für die Patienten zu konzipieren und umzusetzen.

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.