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This study evaluated the management preferences in a deep carious vital tooth. A questionnaire was e-mailed to members of the Turkish Dental Association. The questionnaire included a photograph and radiographs of an extremely deep carious molar (#16) of a 30-year-old man suffering from cold and chewing sensitivity. The dentists were asked to choose treatments for pulp exposure of <1, 1-2, and ≥2 mm and a permanent restoration. Chi-squared test was used to analyse data (p < 0.05). 504 (4.84%) of 10 411 dentists responded. When the pulp exposure was <1 mm: direct pulp capping (84.9%); 1-2 mm: root canal treatment (49.6%); ≥2 mm: root canal treatment (85.7%) were the most preferred treatments. 69.6% of the respondents chose direct composite restorations. If the tooth would be an abutment, most respondents preferred root canal treatment, regardless of the perforation size. The extent of pulp exposure and the type of permanent restoration influenced the treatment decision-making process.

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BACKGROUND: A talon cusp is a morphologically well-delineated accessory cusp. This case report discusses the unusual appearance of a talon cusp on the facial surface of the maxillary right permanent central incisor, which was conservatively treated and followed up for a period of 1 year. METHODS: A 21-year-old female was referred for the treatment of a maxillary right central incisor that caused an esthetic problem. Intraoral examination and radiographic and computerized tomographic investigation indicated that there was no connection between the pulp chamber, a "V"-shaped radiopaque structure, and three radiolucent globe areas. The accessory cusp was treated by selective cuspal grinding, followed by resin-based composite placement. The restoration was clinically evaluated 1 week after placement, as a baseline, and after 1 year. The restoration did not exhibit postoperative sensitivity at the 1-year evaluation. No difference was observed in the color match, marginal discoloration, marginal adaptation, or anatomic form compared with the baseline evaluation. CONCLUSION: The management and treatment outcome of a talon cusp depends on its size, presenting complications and patient cooperation. The present case report outlines the conservative management of a talon cusp. CLINICAL SIGNIFICANCE: This paper outlines a viable esthetic treatment option and a review of the relevant literature with regards to managing a facial talon cusp.

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OBJECTIVES: The aim of this study was to examine non-cavitated approximal caries using non-invasive treatment methods. MATERIALS AND METHODS: Molar and premolar teeth with approximal caries were used in this in vivo study. Approximal caries lesions were evaluated with visual and radiographic inspection and with the DIAGNOdent device. Five groups were formed to study non-invasive treatment, and each had at least 25 early approximal carious lesions. Patients in the control group were not treated. After the separation, either ozone application, acidulated phosphate fluoride gel, CPP-ACP-containing material (Tooth Mousse), or an antibacterial bonding agent (Clearfil Protect Bond) was used. For 18 months after the non-invasive treatment, radiological controls were used to observe the progress of the initial and approximal caries in the 1st, 3rd, 6th and 12th months of follow-up. A Mann-Whitney U-test was used to perform the statistical analysis; in-group comparisons were made with the Wilcoxon signed-rank test, and a quantitative assessment was performed using a chi-squared test. RESULTS: At the end of 18 months, the caries lesions in the control group were observed to progress (P < 0.01). The lesions that were scored as 1a during a visual inspection recovered by using non-invasive treatments. CONCLUSION: Approximal caries lesions that were detected at the early stages remained stationary when using antibacterial agents and materials that promoted remineralisation. CLINICAL RELEVANCE: Antibacterial agents and remineralisation materials can be used in treatment of early approximal caries lesions.

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This case report aimed to present the long-term clinical performance of mineral trioxide aggregate (MTA) pulpotomies in immature permanent teeth. Four patients with complicated crown fractures of five maxillary immature central incisor teeth were treated with pulpotomy using gray MTA. An immature mandibular first molar showing signs of reversible pulpitis that was exposed mechanically during cavity preparation was also treated with MTA pulpotomy. Four of the 6 immature teeth were diagnosed vitally with complete root maturation and with the presence of dentin bridges after 55 months (mean time of follow-ups). MTA pulpotomy was assessed unsuccessfully in two fractured central incisors. Severe discoloration in the crowns was present in all 6 cases. MTA may induce pulp healing with dentin bridge formation and prevent necrosis at long-term periods in most of the pulpotomy cases. However, discoloration following MTA pulpotomy is a significant clinical complication.

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UNLABELLED: Conservative techniques for treatment of discolored human enamel include in-office bleaching with heat-activated 35% hydrogen peroxide, Nightguard vital bleaching with 10% carbamide peroxide, and enamel microabrasion with 18% hydrochloric acid. OBJECTIVES: In this study, these bleaching techniques were performed on 30 extracted teeth to evaluate their effects on microhardness of enamel surfaces. METHODS: The enamel surface microhardness measurements were performed 0, 24, 48, and 72 hours and 1 week after treatment. Paired t tests were performed in the statistical analyses. RESULTS: No changes were found on specimens treated with carbamide peroxide. There was a significant decrease in the surface microhardness of enamel after 0 and 24 hours when the specimens were treated with 18% hydrochloric acid (softening 85.7 and rehardening 99.4) or with 35% hydrogen peroxide (softening 85.7). However, after 72 hours, significant rehardening was observed in these groups (P <.001). CONCLUSION: According to the results, except Nightguard vital bleaching, all other techniques softened the enamel surface.

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OBJECTIVES: The objective of this study was to assess the effect of a one-bottle bonding agent on sealant success after 3, 6, 12, and 24 months. METHOD AND MATERIALS: The sample group consisted of 30 schoolchildren (8 to 10 years of age) who had all their permanent first molars sound and unsealed. Occlusal sealants were placed on first molars according to a split-mouth design. Sealant scoring occurred at 3, 6, 12, and 24 months and was performed by two clinicians blinded to the treatment group. Fisher's exact test was used to analyze the data. RESULTS: The clinically acceptable marginal integrity rates for sealants with a bonding agent after 3, 6, 12, and 24 months were 93%, 93%, 83%, and 79%, respectively. For sealants without a bonding agent, the clinically acceptable marginal integrity rates after 3, 6, 12, and 24 months were 90%, 88%, 81%, and 77%. The rates for no color change in sealants with a bonding agent after 3, 6, 12, and 24 months were 96%, 93%, 81%, and 75%, respectively. For sealants without a bonding agent, the no color change rates after 3, 6, 12, and 24 months were 93%, 93%, 79%, and 72%. After 24 months, 73% of the sample group were available for recall. The retention rates for sealants with and without a bonding agent after 24 months were 79% and 75%, respectively. The results of the statistical analysis showed that there were no differences among the sealants with and without bonding agents evaluated in relation to marginal integrity, marginal discoloration, and anatomic form. CONCLUSION: The success of a sealant is related to whether the sealant is applied under optimal conditions. The results of this study show that at the 2-year mark, the placement of a bonding agent under sealants did not significantly affect the clinical success of sealants.

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OBJECTIVES: The aim of this study was to investigate the effect of pre- and postoperative bleaching with 10% carbamide peroxide on marginal leakage of amalgam and resin composite restorations. METHOD AND MATERIALS: Three groups were made using 30 extracted, caries-free third molars (n = 10). In the preoperative group, bleaching was performed with 10% carbamide peroxide, followed by the placement of resin composite and amalgam restorations on Class V cavity preparations. In the postoperative group, bleaching was performed after the resin composite and amalgam restorations were fabricated. The third group served as a control in which no bleaching was performed. Dye penetration was used for evaluation of marginal leakage. RESULTS: Chi-square test showed that marginal leakage of resin composite restorations increased in both pre- and postoperatively bleached groups, but marginal leakage of amalgam restorations showed no alterations. CONCLUSION: Bleaching with carbamide peroxide may alter the marginal leakage of resin composite restorations, but amalgam restorations are not affected adversely in vitro.

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