Etching Patterns of Sodium Hypochlorite Pretreated Hypocalcified Amelogenesis Imperfecta Primary Molars: SEM Study

Pretreatments to bonding on enamel and dentin disorders: a systematic review

INTRODUCTION

This systematic review focuses on structural anomalies of enamel and dentin such as fluorosis (F), molar-incisor hypomineralization (MIH), amelogenesis imperfecta (AI), dentinogenesis imperfecta (DI), osteogenesis imperfecta (OI), and X-linked hypophosphatemia (XLH). These pathologies affect up to 31% of the population, posing challenges in the adhesion of direct restorations. The primary objective of this analysis is to examine the survival rate and/or bonding resistance of direct restorations on tissues affected by enamel and dentin disorders in humans. We aim to provide precise clinical recommendations for dentists to choose the appropriate bonding pretreatment for various enamel and dentin disorders.

METHODS

We systematically searched the medical literature to identify abstracts of interest indexed between 1993 and May 2024, from 4 databases (PubMed, PMC-PubMed, Web of Science and Cochrane Library). The results are reported following the PRISMA statement. The GRADE approach was used to assess the risk of bias.

RESULTS

The two authors included 27 studies out of the 600 identified. The data extracted from these studies are highly heterogeneous, and the mentioned bonding protocols are all different. 15 articles pertain to F, 7 to MIH, 5 to AI, and none focus on HSPM, dentin disorders and XLH. We identified 12 pretreatments of enamel or dentin (7 for F, 2 for MIH, and 3 for AI), including 3 strong recommendations. Additional studies are necessary to confirm the effectiveness of certain pretreatments. In developmental enamel defects, the main recommendation we collected is to bond on enamel with an etch-and-rinse technique on F and MIH. Considerations with lower strength of evidence include a deproteinization step on enamel on F, MIH and AI and modifications of the etching parameters on F and AI. The research strategy was registered on the Prospero platform (CRD42023447502).

Mini-implant assisted palate expansion and digital design in junctional epidermolysis bullosa and amelogenesis imperfecta: Case report

BACKGROUND

Junctional epidermolysis bullosa (JEB) is one of the four major types of EB caused by genetic variants in the genes coding the proteins of the lamina lucida. All patients with this major type of EB present syndromic hypoplastic amelogenesis imperfecta (AI), with either a pits and fissures or generalized hypoplastic phenotype. Severe forms of AI are associated with compromised oral health-related quality of life (QoL) mostly due to poor dental aesthetics, dentofacial anomalies, and oral pain.

AIM

To present the comprehensive dental treatment of a patient with JEB and AI from the age of 20 months until the age of 18 years, including complex orthodontics and digital oral rehabilitation.

MATERIALS AND METHODS

A male patient with intermediate JEB (homozygous c.3228+1G>A LAMB3 variant) has been under the care of the special care dentistry clinic of the University of Chile since the age of 20 months. His complex dental needs include structural enamel abnormalities in primary and permanent dentition (hypoplastic generalized AI), severe dental crowding with maxillary compression, Class III skeletal pattern, agenesia (#45), and gingivitis.

RESULTS

Pediatric dental care included oral hygiene education and preventive strategies (prophylaxis and fluoride applications), maintaining the dentition free of caries. Due to AI, severe tooth sensitivity hindered proper oral hygiene and required early rehabilitation with temporary polycarbonate and metallic crowns. At the age of 16, the patient began orthodontic treatment. A maxillary expansion was performed with two consecutive mini-implant assisted rapid palate expansion (MARPE) bonded to four mini-implants in the palate. After finishing orthodontic treatment metallic multibrackets (duration 19 months), a definitive oral rehabilitation based on digital smile design with feldspathic crowns of all anterior teeth and premolars was performed.

CONCLUSION

Patients with severe generalized hypoplastic syndromic AI associated with JEB benefit from long-term preventive oral care. Complex orthodontic techniques, such as MARPE, and multibrackets can be successfully. Digital smile design provides a definitive oral rehabilitation technique improving oral function, aesthetics, and QoL.

Effectiveness of sodium hypochlorite treatment on the bonding of four adhesive systems to fluorotic enamel

The study evaluated the effect of sodium hypochlorite (NaOCl) treatment on fluorotic enamel bonding of four adhesive systems. They were Single Bond 2 (SB2), Prime&Bond NT (PBN), Clearfil SE Bond (CSB), and Single Bond Universal (SBU). One hundred eighteen extracted moderate fluorotic molars were divided into eight groups according to NaOCl pretreatment and four adhesive systems. The microshear bond strength (μSBS), etching pattern, and penetration depth (PD) were observed. The statistical method was two-way ANOVA and least significant difference (LSD) test (α=0.05). The application of NaOCl significantly increased the μSBS of PBN and SBU (p<0.05). The enamel-etching pattern of CSB and SBU was deeper under SEM. A noticeable increase of PD was in SB2 and SBU after the application of NaOCl (p<0.05). Pretreatment of 5.25% NaOCl for the 60 s can increase μSBS of PBN and SBU, PD of SB2 and SBU, and improve enamel-etching pattern of CSB and SBU to fluorotic enamel.