| This study was conducted to identify bilirubin in deciduous teeth obtained from two patients with a history of severe liver dysfunction. Teeth were histologically analyzed and bilirubin was extracted and quantified spectrophotometrically. Histological analysis revealed a green line in the dentine running parallel to the incremental lines. A chloroform/methanol/acetic acid (30:10:0.5, v/v) extract of the teeth was evaporated and the residue dissolved in chloroform. absorption spectra were prepared before and after the diazo reaction. The absorption maximum shifted from 450 nm before to 540 nm after the diazo reaction and was higher than that of normal deciduous teeth. These results indicate that the discolouration of teeth in patients with severe liver dysfunction is due to bilirubin deposition. ( info) |
2/118. Porcelain veneers: a challenging case. A patient in his early 20s with teeth badly discoloured by tetracycline was seeking treatment to improve his esthetics. Because retreatment and cost were important considerations, porcelain veneers were the treatment of choice. The challenge in this case was to mask the underlying tetracycline stain before the final cementation and thus gain more control over the final shade of the veneers. ( info) |
3/118. zirconium oxide post and core system for the restoration of an endodontically treated incisor. Due to their enhanced optical properties (eg, translucency, value, chroma), ceramic systems can provide natural aesthetics for restorations placed in the anterior segment. In endodontically treated teeth with stained dentin, however, the use of translucent ceramic materials may be contraindicated unless the underlying discoloration can be masked. This article describes the use of a zirconium oxide post and core system with an all-ceramic crown for the restoration of an endodontically treated anterior tooth. This contemporary system allows optical and mechanical requisites to be resolved simultaneously. ( info) |
4/118. A scanning electron and confocal laser microscope investigation of tetracycline-affected human dentine. Because of the well reported dental side-effects of tetracycline administration, the drug should not be administered to children. However, it and its derivatives are often administered over a prolonged period for treatment of acne in young adults. Dental side effects are also noticed in these patients. The aim of this study was to examine with scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) the root dentine of a tooth from a young adult affected by tetracycline therapy. The palatal root of an upper third molar, demonstrating distinct areas of tetracycline staining, was removed from the crown and sectioned longitudinally to produce two samples. The pulp tissue was peeled off the dentine and any remaining non-mineralized tissues were removed with sodium hypochlorite. One sample was prepared for SEM and the other as a ground section which was examined with a CLSM. It was demonstrated by SEM that the mineralizing front of unaffected dentine was of a normal calcospherite appearance; in contrast, the mineralizing front of the tetracycline-affected dentine was devoid of calcospherite formation and many surface defects were apparent. In addition, the number of dentinal tubules associated with the defects was reduced. It was shown by CLSM that tetracycline bands were made up of numerous smaller bands and that peritubular dentine not associated with fluorescent bands had incorporated tetracycline. The CLSM examination of the mineralization front of the affected dentine revealed that fluorescence of dentine was restricted to the peritubular dentine. The results confirm that dentine mineralization is affected by systemic tetracycline therapy and that tetracycline can be incorporated into peritubular dentine after mineralization of the primary dentine matrix. ( info) |
5/118. Carbamide peroxide whitening of nonvital single discolored teeth: case reports. patients who present with a single discolored tooth represent a significant restorative challenge. These case reports describe an economic and conservative treatment option for these patients. The situations presented demonstrate techniques for bleaching with carbamide peroxide in a traditional nightguard or with an inside-outside technique to achieve acceptable esthetic results on isolated nonvital discolored teeth. Although these techniques may not be effective in all cases, they do not compromise or eliminate any future treatment options. ( info) |
6/118. Hereditary ochronosis: hyperpigmented skin overlying cartilaginous structures. Hereditary ochronosis, or alkaptonuria, results from deficiency of homogentisic acid oxidase. It is an autosomal recessive condition found in geographically isolated populations. The excess homogentisic acid deposits in collagenous structures, leading to unusual pigmentation of the skin overlying cartilaginous structures, but on occasion pigment is also seen in the sclera, in sweat after oxidation, and classically, in urine when left standing at room temperature. This case report highlights the pathogenesis and expression of this rare disorder. ( info) |
7/118. Enamel staining and hypoplasia due to multiple causes in a Nigerian adolescent: report of a case. The aim of this report is to discuss the effects of childhood drug ingestion and metabolic disturbances of ill health in childhood on the coloration, structure and therefore the aesthetics of permanent dentition. To illustrate this, the report presents a case of a 15 year old Nigerian girl with combined tetracycline staining and chronological enamel hypoplastic defects on her teeth. The relationship between the clinical appearance of her teeth and her childhood medical and drug history are analysed. The various treatment modalities available for the management of the dental anomalies are discussed along with the rationale for the treatment given. Strategies for the prevention of these conditions are emphasised. ( info) |
8/118. Reddening of the upper central incisors associated with periapical granuloma in lepromatous leprosy. Four years after starting treatment for lepromatous leprosy in england a male Pakistani aged 26 was found to have red discoloration of the upper central incisor teeth. A radiograph suggested periapical abscess on the right with haziness in a corresponding area on the left. Right apicectomy was performed with removal of a solid mass attached to the apex, sections revealing a lepromatous infiltrate with acid-fast fragments of mycobacterium leprae in the cytoplasm of foamy macrophages. Clinical and archaeological evidence for the frequent involvement of these teeth in lepromatous leprosy is reviewed. The upper incisor area is relatively cool, a factor which may be of critical importance for the lodgement and multiplication of this bacillus, as it is in other body sites in lepromatous leprosy. ( info) |
9/118. Nightguard vital bleaching beneath existing porcelain veneers: a case report. Dentist-prescribed, at-home bleaching with 10% carbamide peroxide was used to lighten the apparent color of teeth with preexisting porcelain veneers. Veneers had been placed over unprepared, tetracycline-stained teeth; the translucency of the veneers over the discolored teeth resulted in a graying of the veneers. A custom-fitted tray with no reservoirs and no gingival scalloping was fabricated. A 10% carbamide peroxide material was applied nightly for 9 months to achieve the maximum change in the underlying tooth color. The patient was pleased with the apparent color change. tooth sensitivity during treatment was minimal (lasting 4 days total); the patient treated sensitivity by brushing with a potassium nitrate-containing toothpaste or applying fluoride in the tray. ( info) |
10/118. Unusual indelible enamel staining following fixed appliance treatment. Two cases are described of indelible enamel staining following fixed appliance therapy. The acquired pigmentation occurred in patients with an identifiable enamel defect prior to treatment. The interaction of factors to cause the staining is discussed and it's prevention in future cases highlighted. Subsequent restoration of the affected teeth is shown. ( info) |