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Objective: To determine the three-year survival rate of Class II resin-modified glass-ionomer cement (RMGIC), Vitremer, restorations in primary molars and to compare these results with measurements of survival of Class II restorations of standard restorative materials., Study Design: Data on Class II restorations placed in primary molars during a six-year period were collected through a chart review and radiographic evaluation in the office of a board-certified pediatric dentist. A radiograph showing that the restoration was intact was required at least 3 years after placement to qualify as successful. If no radiograph existed, the restoration was excluded. If the restoration was not found to be intact radiographically or was charted as having been replaced before three years it was recorded as a failure. The results of this study were then compared to other standard restorative materials using normalized annual failure rates., Results: Of the 1,231 Class II resinmodified glass-ionomer cement restorations placed over six years 427 met the inclusion criteria. There was a 97.42% survival rate for a 3-year period equivalent to an annual failure rate of 0.86%., Conclusions: A novel approach comparing materials showed that in this study Vitremer compared very favorably to previously published success rates of other standard restorative materials (amalgam, composite, stainless steel crown, compomer) and other RMGIC studies.

Background: Secondary caries or caries adjacent to restorations is the most frequent reason for replacement of dental restorations. Though, limited data is available on variables influencing the development of secondary caries in primary teeth., Aim: To investigate risk factors for the development of secondary caries adjacent to direct composite restorations in primary teeth., Design: For this retrospective study, data of 2417 composite restorations, which were placed due to primary carious lesions, were considered. A total of 212 restorations failed due to secondary caries within a maximum observation period of 8 years. A control group was randomly selected. Mann-Whitney U-test, binomial logistic regression with backward elimination and Cox regression with frailty model were performed (P < 0.05)., Results: The overall caries experience amounted to 6.3 dmft and 13.3 dmfs. 72.5% of restorations failed within the first 2 years. Older children and children from families with a higher socio-economic status showed a lower risk for secondary caries. Further, the dentist and the adhesive had a significant influence on the longevity. Posterior restorations had a higher risk to fail in comparison with anterior restorations., Conclusions: Within the limitation of this study, it is concluded that the development of secondary caries is influenced by several factors. Nevertheless, the secondary caries rate was found to be relatively low in this high-risk population., (© 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The aim of this study was to isolate and cultivate cells from the pulp of 7-day-cryopreserved intact deciduous human teeth and evaluate the effect of cryopreservation on dental pulp stem cell (DPSC) characteristics., Design: Twenty-six deciduous teeth were collected and allocated in two groups: immediate cell isolation (non-cryopreserved group) and intact cryopreserved (cryopreserved group). The teeth were cryopreserved in dimethylsulfoxide solution and recovered after 7 days. The success rate of isolation, proliferation, surface markers (CD14, CD29, CD34, CD45, CD73, CD90, and HLA-DR), differentiation capacity, and morphology were evaluated., Results: Isolation success rate was 61% and 30% for the non-cryopreserved and cryopreserved groups, respectively. There were no statistical differences between the groups for the tested surface markers. The cells in both groups were capable of differentiating into three mesenchymal lineages. No statistical differences between the groups were observed through the time course proliferation assay (0, 1, 3, 5, and 7 days); however, the mean time between isolation and the fifth passage was shorter for the non-cryopreserved group (p=0.035). The morphology of the cells was considered altered in the cryopreserved group., Conclusion: DPSCs were obtained from cryopreserved intact deciduous teeth without changes in the immunophenotypical characteristics and differentiation ability; however, lower culture rates, proliferation potential, and morphological alterations were observed in relation to the control group., (Copyright © 2014. Published by Elsevier Ltd.)

Purpose: To analyze the outcomes of partial caries removal (PCR) restorations in primary teeth., Methods: The sample of this retrospective study comprised primary teeth that had been treated with PCR by undergraduate students and were selected from the dental records of patients who were receiving treatment at the School of Dentistry, Federal University of Rio Grande do Sul - Brazil (UFRGS), from 2007 to 2012. Records containing clinical and/or radiographic follow-up data of restorations with PCR in primary teeth were included in the analysis. Factors potentially associated with treatment failure were investigated, such as the number of surfaces restored, type of capping material and restorative material used, the presence of visible plaque, and the gingival bleeding index., Results: The sample comprised 254 teeth in 118 subjects; the follow-up period ranged from 1 to 50 months. The overall success rate for PCR was 80.3% (204/254). A significant association was found between high final visible plaque index and PCR failure (P = 0.002).

Purpose: To evaluate the effects of a surface pre-reacted glass-ionomer (S-PRG) filled coating material to arrest artificial enamel lesions in primary teeth., Methods: Buccal and lingual enamel was demineralized in 0.1 M lactic acid buffer solution (pH 4.75) for 5 days and then divided in the PRG-applied and non-PRG areas. Proximal surfaces were used as a control area without demineralization and coating application. Teeth were divided into three groups (n = 4) according to the 1-week immersion in different solutions: Group 1 (distilled water), Group 2 (demineralizing solution) and Group 3 (artificial saliva). Hardness and Young's modulus by nano-indentation test, and elemental contents and ultrastructure by SEM/EDX analysis were obtained. Data were statistically analyzed using ANOVA and Fisher's PLSD at alpha = 0.05., Results: Only for the non-PRG area in Group 1, the hardness and Young's modulus of the demineralized surface enamel were significantly lower than those of the enamel 30-60 microm beneath the surface. Demineralized enamel of non-PRG and PRG-applied areas showed similar SEM views. Only for the non-PRG area in Group 2 and control area in Group 3, the Ca/P of the surface enamel was significantly higher than that of the enamel 5-10 microm beneath the surface. There was no significant difference of the Ca/P among the measuring points from the surface to 10 microm depth of enamel for the PRG applied area in Group 2.

Purpose: To compare the effect of incomplete caries removal (ICR) and indirect pulp capping (IPC) with calcium hydroxide (CH) or an inert material (wax) on color, consistency and contamination of the remaining dentin of primary molars., Methods: This double-blind, parallel-design, randomized controlled trial included 30 children presenting one primary molar with deep caries lesion. Children were randomly assigned after ICR to receive IPC with CH or wax. All teeth were then restored with resin composite. Baseline dentin color and consistency were evaluated after ICR, and dentin samples were collected for contamination analyses using scanning electron microscopy. After 3 months, restorations were removed and the three parameters were re-evaluated. In both groups, dentin became significantly darker after 3 months., Results: No cases of yellow dentin were observed after 3 months with CH compared to 33.3% of the wax cases (P < 0.05). A statistically significant difference over time was observed only for CH regarding consistency. CH stimulated a dentin hardening process in a statistically higher number of cases than wax (86.7% vs. 33.3%; P = 0.008). Contamination changed significantly over time in CH and wax without significant difference between groups. It was concluded that CH and wax arrested the carious process of the remaining carious dentin after indirect pulp capping, but CH showed superior dentin color and consistency after 3 months.

Aim: To evaluate the effect of thermo-mechanical loading (TML) on marginal quality and wear of different crown types for primary molars., Methods: Eighty extracted human primary molars were used. After preparation, five groups received different crowns (n=16): preformed metal crowns (3M ESPE) and NuSmile crowns (Orthodontic Technologies Inc.) were inserted as preformed metal crowns; as semi-preformed crowns Protemp crowns (3M ESPE) were luted; and as individually manufactured resin composite crowns Filtek Z250 (3M ESPE) and Heliomolar (Ivoclar Vivadent) were used. Specimens were subjected to 2,500 thermal cycles between 5-55(o)C and chewing simulation for 100,000 cycles at 50N at a frequency of 0.5 Hz. Before and after thermo-mechanical loading, impressions of the teeth were taken and replicas were made. The replicas received marginal quality evaluation under a SEM at x200 magnification. Occlusal wear was measured as vertical height loss using a 3-D laser scanning microscope., Results: After TML, all crowns were intact. The adhesively bonded crowns showed significantly better marginal quality to dentine/cementum compared with GIC luted crowns (p<0.05). Laboratory made crowns showed a good fit and nearly transition-free margins also after TML. Preformed metal crowns showed the significantly lowest wear rates compared to the resin composites (p<0.05). Among the resin composite groups, Protemp exhibited the most pronounced wear depths (p<0.05)., Conclusions: The different crown types under investigation showed a good performance concerning the evaluated parameters marginal quality and wear.

Purpose: To study the evolution of 308 necrotic primary teeth after pulpectomy technique with resorbable paste (Kri-1 + calcium hydroxide + metacresol-formaldehyde) after 30 months., Methods: 134 children between 2-9 years were included, among which they had 348 pulpectomized teeth. Out of these 348 teeth, 308 had necrotic pulp and were included in the study. The filling material consisted of a paste based on Walkhoff's master formula and consisted of the combination of Kri-1a (80.8% iodoform, 2.025% parachlorophenol, 1.215% menthol, 4.68% camphor and excipient 15 mg), pure calcium hydroxide and metacresol formaldehyde (metacresol 20 mg, formaldehyde 20 mg, eugenol 20 mg, eucalyptus 6 mg and excipient 40 mg). Root canal filling was performed in one session by one operator., Results: Pain, swelling, and fistula resolution was observed in most cases at the first recall. Progressive remission of radiolucent areas was also observed. A relationship between fistula and radiolucency in pre-treated furcation area was observed, and, in some cases, premature eruption of permanent teeth was recorded. Only two cases out of 308 treated teeth required extraction.

Multipotent stem cells derived from periodontal ligaments (PDLSC) and pulp of human exfoliated deciduous teeth (SHED) represent promising cell sources for bone regeneration. Recent studies have demonstrated that retinoic acid (RA) and dexamethasone (Dex) induce osteogenesis of postnatal stem cells. The objective of this study was to examine the effects of RA and Dex on the proliferation and osteogenic differentiation of SHED and PDLSC and to compare the osteogenic characteristics of SHED and PDLSC under RA treatment. SHED and PDLSC were treated with serum-free medium either alone or supplemented with RA or Dex for 21 days. The proliferation of SHED and PDLSC was significantly inhibited by both RA and Dex. RA significantly upregulated gene expression and the activity of alkaline phosphatase in SHED and PDLSC. Positive Alizarin red and von Kossa staining of calcium deposition was seen on the RA-treated SHED and PDLSC after 21 days of culture. The influences of RA on the osteogenic differentiation of SHED and PDLSC were significantly stronger than with Dex. Supplementation with insulin enhanced RA-induced osteogenic differentiation of SHED. Thus, RA is an effective inducer of osteogenic differentiation of SHED and PDLSC, whereas RA treatment in combination with insulin supplementation might be a better option for inducing osteogenic differentiation. Significantly higher cell proliferation of PDLSC results in greater calcium deposition after 3-week culture, suggesting that PDLSC is a better osteogenic stem cell source. This study provides valuable information for efficiently producing osteogenically differentiated SHED or PDLSC for in vivo bone regeneration.

Purpose: This split-mouth, blind study evaluated the clinical performance of Dyract AP, F2000, and Heliomolar placed in primary molars of 30 children (mean age, 6 years and 2 months)., Materials and Methods: From a total of 79 restorations accomplished, 27 were built with Heliomolar (18 Class I, and 9 Class II), 30 were with F2000 (21 Class I and 9 Class II), and 22 were built with Dyract AP (14 Class I and 8 Class II). All of teeth restored had primary caries lesions. At 6, 12, 18 and 24 months, 60 restorations (75%) were evaluated using USPHS criteria for: color match (CM), marginal adaptation (MA), marginal discoloration (MD), anatomic form (AF) and secondary caries (SC) by three calibrated operators. The Alpha+Bravo score percentage was considered as clinical success. The data were subjected to statistical analysis by Mann-Whitney and Kruskal-Wallis tests (p<0.05)., Results: Heliomolar showed the smallest success clinical at 12 months for marginal adaptation and secondary caries, and at 18 months for marginal discoloration. Regarding color match and anatomic form, no significant differences were found among the groups at each evaluation period. When materials were compared, Heliomolar did not show a significant difference among the evaluated periods for any criteria, remaining with the lowest scores. Significant differences were observed at 12 months for F2000 (marginal adaptation), and at 24 months for Dyract AP (marginal discoloration and secondary caries) and for F2000 (color match and marginal discoloration)., Conclusions: It was concluded that Dyract AP and F2000 showed the best clinical performance over 24 month-evaluations for marginal discoloration and secondary caries, and color match and marginal adaptation, respectively. The use of the resin composite Heliomolar in Class I/II restorations in primary molars should be carefully considered.

To measure the micro-tensile bond strength (MTBS) on sound and caries-affected primary tooth dentin using an original designed jig that was developed for making symmetric and uniformly-sized specimens for the micro-tensile strength testing. The MTBS of dumbbell-shaped specimens and matchstick-shaped specimens were measured. Dumbbell-shaped specimens: The occlusal surfaces of 15 sound primary molars were ground with a water-cooled air turbine using a diamond bur. The adhesive systems and resin-based composites were Clearfil SE Bond and Clearfil AP-X (SE group) and Single Bond and Z250 (SB group). Matchstick-shaped specimens: Sixteen primary molars (5 sound and 11 carious) were used. The occlusal surfaces of sound teeth were ground with a water-cooled air turbine using a diamond bur. Infected dentin was determined by a caries detecting dye solution and removed with a round-shaped steel bur under water-cooling and with a hand instrument. SE was applied. Data was statistically analyzed using ANOVA and Fisher's PLSD at p < 0.05. The MTBSs (MPa) for the dumbbell-shaped specimens were 8.9 +/- 7.0 in the SE group and 10.3 +/- 5.8 in the SB group and that for the matchstick-shaped specimens were 9.0 +/- 6.3 in the sound-SE group and 9.2 +/- 5.8 in the carious-SE group. No significant difference was observed among them., ((c) 2005 Wiley Periodicals, Inc.)

The use of disinfectants on the dentin surface contributes to superficial cleaning and removal of remaining microorganisms of the carious process. However, the effect of these agents on the adhesion of resin materials to the dentin surface of primary teeth has not been established. This study evaluated the dentin micromorphological effects due to the use of antimicrobial agents in the different depths of dentin. Twenty-five buccal surfaces of primary molars were prepared from the sectioned teeth, ground flat and polished with silicon carbide paper of different grits. The surfaces were treated with 32% phosphoric acid with benzalkonium chloride (Bisco), 35% phosphoric acid gel (3 M), 3% benzalkonium chloride solution by itself or 10% maleic acid. All agents were applied for 15 seconds on the dentin surface. The samples were washed with distilled water, dried and coated with gold for observation of the dentin surface with the scanning electron microscope. The samples were subdivided according to the dentin depth in upper, middle and lower areas. The following was observed: presence of smear layer, opening of the dentin tubules, and inter and intratubular dentin morphology. The effects of the antimicrobial agents were compared in the different depths of the dentin. The results demonstrated that the surface conditioned with 3% benzalkonium chloride solution presented few disclosed dentin tubules. The use of the 32% phosphoric acid with benzalkonium chloride completely removed the smear layer and increased the diameter of the dentin tubule openings. The 35% phosphoric acid totally exposed the tubules in the upper area of the analyzed surface but partially exposed them in the middle and lower areas. The 10% maleic acid totally removed the smear layer, left all the tubules opened and conditioned the intertubular dentin. It was concluded that in the different depths of the dentin surface, conditioning with 10% maleic acid in primary teeth showed the most consistent micromorphological characteristics compared to the other agents used in this study.

The purpose of this study was to evaluate in vitro the effect of a phosphoric acid etchant containing benzalkonium chloride on the dentin/adhesive interface in primary teeth. The teeth had caries lesions involving enamel and dentin, and were stored in a 2% glutaraldehyde solution for 2-4 hours. The teeth were divided into five groups of five teeth each: Group 1: Etching for 15 seconds with a semigel 32% phosphoric acid containing benzalkonium chloride; Group 2: Etching with 35% phosphoric acid for 15 seconds; Group 3: Treated with a 2% benzalkonium chloride in a alcoholic solution; Group 4: Conditioned with a 3% benzalkonium chloride in a alcoholic solution (control group); Group 5: The teeth were untreated (control group). The carious tissue was removed with a carbide bur in high-speed and copious air water spray. The overall dimensions and depths of the cavities were determined by the carious tissue removal. After the caries lesion was removed, the cavity was cleaned with an air-water spray and the dentin was treated according to the specific group. The teeth were then restored with Scotchbond Multi-Purpose Plus (3M, St. Paul, MN) and Z-100 resin-based composite (3M, St. Paul, MN) according to the manufacturer's instructions. After the teeth were restored they were stored in water for 24 hours at room temperature and the restorations polished. After storage the teeth were thermally challenged for 500 cycles in temperatures of 50 C and 550 C and then stored in 100% humidity until the sectioning procedures. The teeth were cut into two sections along the longitudinal axis through the center of the teeth and passed the mesial-distal surfaces through the restoration by using a double-face diamond disc with water coolant. The specimens were ground with 320 up to 600 grit silicon carbide paper and polished with 6 mm and 1 mm diamond paste and 0.25 pm alumina solution. The specimens were etched with 10% citric acid for 1 minute and washed with deionized water. After that, they were deproteinized with 10% NaOCl for 5 seconds. The specimens were dried at room temperature sputter-coated with gold and observed with an SEM for assessment of the morphology of the bonded interface. The interface was observed to determine the presence/absence of hybrid layer formation, resin tags, and gaps. In the groups treated only with benzalkonium chloride solutions, spaces were observed in the resin/dentin interface. Similar findings were observed in the control group, which received no treatment on the dentin before primer application. In these groups neither resin tags or hybrid layer formation was observed. The presence of an amorphous layer, which was unremoved smear layer, was noted. The group treated with 35% phosphoric acid showed a hybrid layer formation (8.15 microns). This layer was linked intimately with the peritubular and intertubular dentin. Tags formation was observed towards the pulp under the hybrid layer. In these specimens the gaps were not observed between the dentin layer and bonding materials. The total removal of the smear layer was observed using 37% phosphoric acid with benzalkonium chloride. A hybrid layer (+/- 7.32 microns) and resin-tags attached to this layer were observed similar to the group in which the 35% phosphoric acid was used. The samples showed total removal of the smear layer and no gaps were observed in the dentin/adhesive interface.

Objectives: This paper aims to alert the dental practitioner to the rapidly evolving therapies for treating the pulps of primary and young permanent teeth., Data Sources: Experimental research on animals, clinical studies and case reports., Study Selection: Indirect pulp capping, direct pulp capping, pulpotomies, and pulpectomies are standard procedures for treating primary teeth. However, direct pulp capping, heretofore not very successful, is being revisited. Based on studies in animals and clinical findings in humans, there has been a movement in pediatric dentistry to find alternatives to formocresol and calcium hydroxide for pulpotomy therapy. Venues range from eradication by cautery to the possibility of healing with growth factors. New studies with iodoform paste for pulpectomies are confirming the success rates of previous publications. The new dental adhesives are being tested as agents for direct pulp capping, as well as partial and complete pulpotomy protocols., Conclusions: More thought is being given by clinicians to preserving pulp, either through more ambitious indirect pulp therapy or partial pulpotomy. Formocresol and calcium hydroxide pulpotomies, while still popular, may soon be challenged by other chemical treatments, electrocautery or stimulation of reparative dentine by growth factors. Iodoform pastes are promising easier and more successful pulpectomy therapy. Total etch direct bonding materials could soon transform direct pulp capping, as well as partial and complete pulpotomy protocols.

The one-session technique presented in this clinical evaluation is supported in part by the high clinical and radiographic success rate obtained. The principal advantages of the Vitapex paste are that it resorbs from the apical tissues in one week to two months, is apparently harmless to permanent tooth germs, is radiopaque, does not set to a hard mass, and is easily inserted and removed.

This study evaluated the bonding mechanism of Compoglass compomer to dentin in primary teeth. Buccal or labial dentinal surfaces of 20 human extracted, non carious primary teeth stored in 4 degrees C physiological saline solution were obtained by grinding on silicon carbide paper (final grit 600). The specimens were divided into two groups of 10 teeth each: (1) unetched dentin, Compoglass SCA, Compoglass; and (2) dentin etched with 10% phosphoric acid (Etch-AII), Compoglass SCA, Compoglass. The Compoglass SCA and Compoglass compomer were placed according to the instructions of the manufacturer, except Group 2 were the dentin was first etched with 10% phosphoric acid for 30 seconds. Twenty-four hours after placing the compomer over the treated dentinal surface, the specimens were dehydrated with a series of alcohol and freon. Then critically point dried. The specimens were split with a chisel and the compomer/dentin interface evaluation was performed with the SEM. The results showed that when the instructions of the manufacturer were followed (Group 1) the compomer showed a very close relation to the dentin with some tag structures penetrating the dentin. When phosphoric acid etching preceded the compomer placement a hybrid layer with tags penetrating the dentin was noted in most specimens.

The initial glass-ionomer cements have become well-known restorative materials and have achieved success in a variety of procedures. The newest generation of glass-ionomer cements contain more resin, have higher cohesive strengths, and are light cured, compared with previous generations. Other fluoride-releasing resins with glass-ionomer properties have been developed, and they are called "compomers." One such recently introduced material is discussed in this article. A clinical case report is presented, illustrating the utilization of this material in the restoration of a mandibular second primary molar.

The aim of this study was to investigate (i) the effect of Gluma 2000 conditioning solution on the dentine of primary teeth, (ii) the penetration of Gluma 2000 adhesive resin into the etched dentine, (iii) the shear bond strength of a composite resin restorative material (Pekafill) bonded with Gluma 2000 to dentine, and (iv) the depth of penetration of adhesive resin into the etched dentine as a function of the conditioning time. Dentine surfaces conditioned for 15, 30, 60 and 120 seconds were examined by scanning electron microscopy. The smear layer was totally removed and, with the longer conditioning times, a fine crystalline precipitation, presumably calcium oxalate, was formed. After Gluma 2000 bonding of composite resin and dissolution of the teeth the resin interface showed excellent penetration into the etched dentine. Shear bond strengths of composite resin bonded with the adhesive resin were similar following conditioning for 15, 30, 60 and 120 seconds. Microphotographs of debonded specimens indicated that the mode of failure was cohesive within the resin. The depth of penetration of resin into etched dentine was determined by scanning electron microscopy, and a linear relationship was found between the thickness of the resin-impregnated layer and conditioning time. It was therefore concluded that depth of resin penetration and shear bond strength are not correlated. The study shows that the Gluma 2000 bonding system produces reliable adhesion of composite resin to dentine of primary teeth.

This study examined the significance of age and clinical factors on the diagnosis of alveolar bone loss (ABL) as evidenced by increased cementoenamel junction (CEJ)--alveolar bone crest (ABC) distances. The CEJ-ABC for the first and second primary molars were 0.97 +/- 0.3 mm and 0.78 +/- 0.3 mm, respectively. Age correlated significantly with the means CEJ-ABC per patient and second primary molars. Correlations between probing depths and CEJ-ABC were not significant. Analysis of variance indicated significant differences between CEJ-ABC grouped by presence/absence of proximal contact, presence/absence of lamina dura and proximal contact, presence/absence of lamina dura and proximal caries severity (PCS). Differences in the CEJ-ABC grouped by gender and gingival index (GI) were not significant. When considering the effect of age PCS or GI when controlling for the other factors (Multiple regression analysis) age and PCS had a significant effect on the CEJ-ABC. Proximal contact loss or lack of lamina dura may relate to ABL in the primary molars.

The purpose of this retrospective study was to analyse traumatic injuries to primary teeth in children attending an emergency dental service in a pediatric hospital in Mexico City. A total of 563 children 6-mo to 7 yrs-old were treated during the period from January 1981 to December 1987. The 563 children presented 936 traumatic dental injuries. The most common type of trauma was soft tissue injury, followed by luxation and avulsion. More males presented with traumatic injuries (61.8%) than females (38.2%). In both sexes, maxillary teeth received more traumatic injuries than mandibular teeth. Children 2-3 yrs old presented the highest number of injuries (195) followed by the 4-5 and 6-7 year-olds. The largest number of injuries were seen during winter (36%) followed by summer (25%), spring (21%) and fall (18%).

The present study compared the shear bond strength of two commercially available systems to human primary enamel. Ground and unground enamel was conditioned for 15 seconds with 37% phosphoric acid siliceous gel. A 60-second application was used as a standard reference. Ten percent phosphoric acid in a polymer gel was also evaluated following a 20-second application to ground and unground primary enamel. No statistically significant difference was demonstrated between the mean values determined for each group. Compared with tests on permanent enamel with the same materials and conditions, it was concluded that no statistically significant difference exists between shear bond strengths to the enamel of the two dentitions.

Deficiencies of pulpotomy and pulpectomy treatment of primary teeth have promoted considerable laboratory and clinical research. Some of these findings and their implications are reviewed.

An assessment of deciduous tooth-size asymmetry showed no evidence of sex differences. When asymmetry was compared between the various tooth dimensions, the buccolingual dimensions of mandibular incisors consistently displayed high asymmetry values. This finding may reflect a developmental interaction between the deciduous incisor tooth germs and their lingually-placed permanent successors.

The treatment guidelines for success were if clinically the tooth was painless, without pathologic mobility, and the gingiva was healthy. No clinical or radiographic signs or symptoms of failure were observed in forty-three of forty-five teeth.

The purpose of this study was to determine the reasons why parents of children seek treatment after traumatic injuries to primary teeth. The sample consisted of 114 5-month to 8-year-old children with 196 injured primary teeth. The reason for parents seeking treatment varied according to the type of injury. Parents of children with enamel fractures and enamel-dentin fractures without pulpal exposure were more concerned about esthetics. Of the patients presenting concussions, parents were more responsive to color change of the tooth and to the tooth response to the trauma, mainly abscess formation. In luxations and lateral displacements, the parents sought dental treatment because of their own reaction to the clinical situation, i.e., blood, crying. Very few were concerned with possible consequences to the primary and/or permanent teeth. In no category of injury were the parents most concerned about the consequences to the primary and/or permanent teeth.