Lupine Publishers: Lupine Publishers | Digito-palmar Dermatoglyphics ...

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Lupine Publishers | Color Changes of Pediatric Dental Bridges

 Lupine Publishers | Journal of Pediatric Dentistry

Abstract

Dental technology that depended on the standardized lost-wax casting technology has been greatly improved with the introduction of dental CAD ⁄ CAM systems. The aim of the present study was to compare between the color changes of CAD/CAM acrylic and manually performed acrylic bridges used for pediatric patients. Forty study casts of children aged 2 - 4 years old of both genders, with prematurely lost one of the maxillary central incisors and the adjacent lateral incisor was carious and considered to be abutment tooth were involved in this study for construction of cantilever bridges. For each cast, two bridges were constructed; 1st one is CAD/CAM acrylic bridge and the other one is manually performed acrylic bridge. After immersing the bridges in saturated chocolate solution for different time intervals, color changes of the bridges were measured using 3Shape scanner system.

Keywords: Color; Changes; CAD/CAM; Bridges; Pediatric; Patient

Introduction

Trauma and/or dental caries is the common causes those result in premature loss of teeth in children. Cosmetic/aesthetic restoration of such condition considers to be challenging in the pediatric dental field. In case of premature tooth loss in anterior incisal segment there will result in arch space loss and teeth’s inclination that causing a collapse of the anterior teeth and midline shifting [1], as well as may lead to parafunctional habits [2]. Mahmoud (2009) found that anterior tooth loss had effect on patient’s quality of life and gave negative effects on him/his [3]. Al Rawi (2017) found that placement of cantilever acrylic bridges for restoring the aesthetic dental appearance of preschool children resulted in positive successes both to the child and parents [4]. Extrinsic discoloration of teeth and oral prostheses is stains caused by foods or beverages. In pediatric patients such stain mostly occurred due to colored foods such as beets or chocolate as well as berries and candies [5, 6]. This study considered to be the first step of our series studies deal with determining different physical and mechanical properties of the prostheses used for pediatric patients we planned to carry out (in vitro and in vivo studies). Starting with the present study that aimed to compare between the color changes of CAD/CAM and manually performed acrylic bridges used for pediatric patients. After immersing the bridges in chocolate solution for different time intervals, color changes of the bridges were measured using 3Shape scanner system.

Material and Methods

This study starting with collection of forty study casts of children aged 2-4 years old of both gender, with prematurely lost one of the maxillary central incisors and the adjacent lateral incisor was carious and considered to be abutment tooth were involved in this study for construction of cantilever bridges (Figure 1). For each cast, two bridges were constructed; 1st one is CAD/CAM acrylic bridge and the other one is manually performed acrylic bridge (Figure 2). Construction CAD/CAM bridge: The cast was 3D scanned by special scanner (710 3D) (smart optics Sensortechnik GmbH, Germany). The design of the bridge was carried out using Exocad Program (smart optics Sensortechnik GmbH, Germany). Acrylic block (Poly-methyl methacrylate) of classic shade A1 (Ivoclar vivadent, Switzerland) was used for fabrication of the bridge using CAD/ CAM machine (Charly dental, ZI Fonlabour, France). The bridge was finished and polished very well [4]. Construction of manually acrylic bridge: Wax pattern was fabricated on cast then followed the technique of typical wax loss; the heat-cure acrylic (Ivoclar vivadent, AG, FL-9494 Schaan/Liechtenstein) of classic shade A1 was used for bridge fabrication. Finally, surface finishing and polishing was done [7]. Saturated chocolate solution was prepared using 15g chocolate powder (MacChocolate TM, Malaysia) with 100ml distilled water. Baseline color readings for acrylic bridges were taken then immersed in chocolate solution for different time intervals (one week and two weeks) and maintained in incubator of 37 °C, Fresh chocolate solution was prepared every day. Before color measurements after one week and two weeks’ time intervals, the bridges were rinsed with distilled water for 30 seconds, cleaned with a soft bristle toothbrush and then dried with tissue paper [8]. Color measurement was carried out in the facial surfaces at the center third of the abutment and the center third of the pontic part of each bridge as shown in Figure 3. Color measurements of the bridges were measured using 3Shape scanner system (3 Shape A/S, Holmens Kanal 7.1060 Copenhagen K Denmark) and according to the software program of the system, Classic shade (Ivoclar vivadent, Switzerland) was depended.

Figure 1: One of the study casts involved in this study

Figure 2: One of the study casts involved in this study

Figure 3: Demonstrated the color shade measurement of the abutment and pontic portions of the acrylic bridge.

Results

Table 1 demonstrated the color shade of all samples at the baseline and after one-week and two weeks-time intervals. The results of the present study revealed that for all samples, the color measurement demonstrated that in CAD/CAM group even with using A1 shade acrylic block but at the baseline measurement the abutment revealed A0 shade while the pontic revealed A1 shade. Meanwhile, in manual group the abutment measured to be A1 shade and the pontic gave B1 shade. The results demonstrated that for all samples there were no changes in the color shade of CAD/CAM and manually fabricated acrylic bridges after one-week time interval, meanwhile, there were significantly color changes of all abutment and pontic portions of all samples of both bridge types after two weeks-time interval immersed in chocolate solution (Figure 4 & 5).

Figure 4: color shade measurement of CAD/CAM acrylic bridge after two weeks.

Figure 5: Color shade measurement of manual acrylic bridge after two weeks.

Table 1: Demonstrated the color shade of all samples at the baseline and after one-week and two weeks-time intervals.

Discussion

Restorations in the oral cavity are exposed to several factors that make them vulnerable to color changes, such as temperature, humidity, food and beverages. In the oral environment, restorative materials are also subjected to numerous other liquids, to temperature and load stress, and to tooth brushing. The success of restorations depends not only on mechanical and physical properties, but also on the esthetic appearance [9]. The color measurement in this study demonstrated that in CAD/CAM group even with using A1 shade acrylic block but at the baseline measurement the abutment revealed A0 shade while the pontic revealed A1 shade. These occurred because the thickness of the abutment was only about 0.5mm lead to that the color measured of the abutment was lighter than the pontic portion. Meanwhile, in manual group the abutment measured to be A1 shade and the pontic gave B1 shade. These results agreed with other studies those found the thickness of the material significantly affected the color shade of the prostheses [10,11].

The results demonstrated that the color changes demonstrated only after two weeks-time intervals immersed in chocolate solution. Even the color shades recorded in the CAD/CAM group considered to be lighter than in manual fabricated group, the discoloration from chocolate solution was probably due to adsorption of color colorant of chocolate solution at the surface of the prostheses.

The CAD/CAM bridges fabricated from blocks of pre-polymerized acrylic resin those had a hydrophobic surface that repels water [12]. As well as, perfect polishing surfaces of the bridges involved in this study revealed the limited discoloration that occurred agreed with other research [13]. As the duration of immersion increased, the color change values of both types of prostheses were recorded by 3Shape scanner system. Thus, the time is considered to be important factor in the staining of the dental prostheses and these results agreed with others [14,15]. Fabrication of dental prostheses with the help of CAD/ CAM technology is related to the advantages of high-density polymers based on highly cross linked polymethylmethacrylate [16]. Those advantages include; good esthetic, low water solubility and absorption, sufficient strength, low toxicity, easy repair with simple fabrication technique [17]. The using of hot cure acrylic for fabrication of dental prostheses even of some advantages but the main disadvantages include porosity with the presence of residual monomer which is a potential allergen, increased finishing time, brittle and uneven thickness [18]. A limitation of this study is that it was an in vitro study and need to be collected with in vivo study to measure the degree of color changes of the prostheses with presenting the effect of saliva and oral hygiene measures. Further clinical and in vitro studies are necessary to evaluate the susceptibility of CAD/CAM and manually acrylic bridges to discoloration by other beverages and nutrients.

Conclusion

Color considered as the most important factors for aesthetic appearance of dental restorations. In addition to the optimal chemo mechanical properties of acrylic resins, their availability in different color-shades has increased their application in fixed and removable prostheses. Acrylic resins can have acquired discoloration over time because of the process of adsorption and liquid molecules adhere to resin materials which was decreased their effect with using of CAD/CAM technology over conventional methods of acrylic resin prostheses fabrication.

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Lupine Publishers | Management of Perinatal and Infant Oral Health

 Lupine Publishers | Journal of Pediatric Dentistry

Abstract

Mothers in the perinatal stage and infants should be identified and evaluated for the risk of dental caries. Early childhood caries can lead to detrimental consequences in the primary dentition. This entails that oral health care advice regarding oral hygiene, diet, fluoride and dental management be provided to minimize the risk factors and optimize the protective factors to improve the longterm oral health outcomes for both the mother and her infant.

Keywords: Perinatal Oral Health; Infant Oral Health; Early Childhood Caries

Introduction

The perinatal period is vital for the holistic well-being of pregnant women. It is defined as a time span which commences when the 20th to 28th week of gestation is completed and ends at 1 to 4 weeks subsequent to birth of a child [1]. Early childhood caries (ECC) and severe form of ECC (s-ECC) start as soon as teeth start to erupt, develop on every surface of a primary tooth, have a rapid progression with a long-term detrimental impact on the primary dentition [2]. The long term sequelae of ECC include a greater risk of new carious lesions in both the primary and permanent dentitions, [3,4] high cost of treatment, [5] hospital stay and emergency room visits [6,7] loss of school time, [8] diminished cognitive ability [9] and a poor oral health-related quality of life [10]. Hence the oral health of both the mother and the future child are instrumental in preventing and arresting the disease process to manage early childhood caries during this phase [11].

Epidemiology

This chronic, infectious disease affects the general population however it is 32 times more likely to occur in infants from low socioeconomic status, with high sugar diet and whose mothers have a low education level [12-14] It affects 1-17% children in developed and 70% children in under-developed countries [15]. Epidemiologic evidence shows that the highest prevalence of ECC is reported from Africa and South-East Asia [16]. The prevalence of ECC among Indian children between 8–48 months is 44% [17]. A study from Sri Lanka reports an incidence of 23% ECC among 1-2-year old’s [18]. North American prevalence of ECC ranges from 11-72% and over 28 % children have caries by the time they reach kindergarten [19,20]. Pakistan has a variation in prevalence of ECC ranging 27.9% - 51% [21,22].

Anticipatory Guidance According to Caries Risk

New mothers and infants are seen by the medical health care professionals earlier and more often than dentists. It is therefore important that they understand the dynamic multifactorial etiology and risk factors for ECC prevention counselling in pregnant women/caregivers and encouraging a dental home visit at age 1 [23]. In some instances, pregnant women may defer dental care, experience unwillingness of dentists to provide oral care [24-27] or may be unaware of the implications of poor oral health for their pregnancy [28,29]. Hence early identification of mothers with poor oral health/high caries risk and timely delivery of educational information and prevention for themselves and their unborn child can help reduce the incidence of ECC, prevent the need for dental rehabilitation and improve their oral health [30-32]. Caries-risk assessment for infants allows the determination of relative risk for dental disease to prevent disease by identifying and minimizing risk factors (plaque accumulation, diet, lack of topical/systemic fluoride, high frequency of sugar containing medicines) and optimizing protective factors (oral hygiene practices, fluoride and fissure sealants) when the primary dentition starts to erupt [33]. The current trend shows more emphasis on prevention and arrest of the disease processes to manage ECC. This is attributed to the costly and high-risk restorative treatment for ECC since it often entails the use of sedation and/or general anesthesia and a high recurrence rate [34,35]. The chronic disease management approach encompasses engagement of parents to facilitate preventive measures and temporary restorations of the lesion to defer advanced restorative care [36]. An active surveillance methodology entails monitoring caries progression in children and setting up prevention programs for managing incipient carious lesions [37]. An Interim therapeutic restorations (ITR) is a form of temporary tooth restoration in young children until compliance improves and conventional cavity preparation and restoration is possible [38].

Oral Health Care Advice to Pregnant or Lactating Mothers

Physicians, dentists, and nurses impart educational advice for mothers during the perinatal period. The preventive advice should include timely brushing with fluoridated toothpastes and use of sugar free gums. The dietary advice should address the quality and quantity of nutritional food along with food cravings that may raise the caries risk. Dental procedures which are considered safe during all trimesters of pregnancy include oral assessment, prophylaxis, local anaesthetic, regular treatment and radiographs with shielding (optimal in second trimester). If, however there is discomfort the elective treatment may be deferred. Breast feeding of infants should be tailored with food over a year or longer but should not be ad libitum. It provides nutritional, developmental and psychological health advantages with a significant decrease in the risk for acute and chronic diseases. It may also transfer maternal medication to infants under 6 months hence use cautiously. It provides awareness of health consequences of tobacco use and exposure to secondhand smoke in children [39-43].

Oral Health Care Advice for Infants

An infant should be taken for an initial evaluation to a dental home by the age of one by the pediatricians and the general practitioners. This attains the medical and dental history of both the child and parents, allows oral assessment with a demonstration on age appropriate gum and tooth cleaning, brushing the teeth twice a day with an optimum level of fluoridated toothpaste (smear or rice sized for children under 3), dietary advice (avoid sugar by bottle, sippy cup, sugar between meals, 4-6 ounces of 100% fruit juice per day for 4-6 year old children, systemically administered fluoride (if the drinking water is unfluoridated) and professional fluoride application if caries risk is high, injury prevention advice for facial trauma (objects, cords, pacifiers, car seats, electric cords), advice on teething with excessive salivation areas of intermittent discomfort (oral analgesics, chilled teething rings, over the counter teething gels), management of atypical frenum attachments (frenectomy or frenuloplasty to facilitate breast feeding) and counselling regarding non-nutritive habits such as digit or pacifier sucking, abnormal tongue thrust or bruxism (wean before skeletal dysplasia or malocclusion) [33,44,45].

Conclusion

It is very important to design and implement caries assessment in order to identify the caries risk for infants and expectant mothers/lactating mothers. This will allow effective education on oral health via motivational interviewing techniques to help improve oral behaviour and timely implementation of caries preventive measures to help change the trajectory of oral health of a mother and her infant.

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Lupine Publishers | Early Interventions to Promote Pediatric Oral Health

 Lupine Publishers | Journal of Pediatric Dentistry

Introduction

It is well established that dental caries is the most prevalent and preventable chronic disease among children [1]. Preschool years are a critical period of development; poor oral health can create lifelong consequences for one’s overall health outcomes. If oral health needs are not addressed earlier, it may negatively impact a child’s ability to eat, sleep, learn or socialize, further damaging the child’s psychological and social dimensions of well-being [1,2]. Another negative outcome is the need for dental surgery as it accounts for 31% of all surgeries among children under the age of 6 [3]. Caries in childhood is a predictor for adult oral health; this may affect other health conditions such as diabetes or cardiovascular disease over time [2]. Caries is a multifactorial chronic disease influenced by biological, lifestyle, and behavior factors [4]. Risk factors for early childhood caries include: bacteria transmission from mother to infant [5]; the social determinants of health [2]; parental knowledge [6], attitudes and behaviors towards oral health (e.g., diet, pacifier use, and daily tooth brushing); prolonged bottlefeeding practices [7], and cultural beliefs around primary or “milk teeth” [8,9]. Oral health is connected to socioeconomic status; those with higher income are more likely to access a dentist and have dental insurance coverage [10]. It is important to identify effective interventions targeting preschool children in order to collaborate with the Family Health Division, other Regional departments, and community partners to meet the emerging oral health needs of our community.

Future Directions

The recommendations made decades ago to promote early childhood oral health by establishing a dental home before the first birthday, and providing education and preventive interventions, are crucial components of effective care [11]. Now, as then, dental professionals play a pivotal role by assessing and monitoring the individualized risk of each pediatric patient and applying the latest evidence-based approaches to disease prevention and treatment [12]. Effective care requires a constant review the literature, ongoing assessment of the rapidly evolving understanding of the oral microbiome and its effect on caries progression and implementing management protocols as early as possible. Beyond the clinic, however, it is equally important for dental teams to provide parents/caregivers with the knowledge and skills to make appropriate dietary and lifestyle choices for their children, while ensuring proper oral hygiene and regular dental visits. It is only through these combined efforts that oral disease can be prevented.

Key Takeaways

a) Establishing a dental home before a child’s first birthday ensures a safe place for comprehensive care and allows clinicians to develop recommendations specific to that patient’s individualized risk.

b) Assessing caries risk and implementing preventive strategies are critical elements of pediatric care, particularly for preschoolers and children with special

c) health care needs.

d) Parents and caregivers must be given the means to mitigate the child’s caries risk through effective self-care and healthy lifestyle choices, and by working with dental teams to verify whether the risk management regimen has been effective.

e) It is only through the combined efforts of dental professionals and parents/caregivers that oral disease can be prevented.

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