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Analysis of Success Factors Associated with Primary Tooth Pulpectomies Performed Under General Anaesthesia

Background: Pulpectomy is a technique recommended for treatment of irreversible pulp inflammation or necrosis in primary tooth. Treatment-related variables and patient factors may affect the prognosis of pulpectomy. Purpose: To investigate the success rate and related predictors associated with failure of pulpectomies performed under general anaesthesia for primary teeth. Materials and methods: A chart review of patients who underwent pulpectomy as part of comprehensive dental treatment under general anaesthesia in Wang Fang Hospital during 2015 to 2019 was performed. Pretreatment variables, follow up clinical and radiographic records were evaluated. Statistical analysis using SPSS were performed to evaluate the correlation of the variables with the success rate. Results: A total of 144 teeth of 39 children were evaluated. Most of the failure cases were noted in second year. The overall success rate is 92% in first year and 75% in second year. Patient who has more than 16 caries lesions had 4.22 times of hazard ratio than who has less than 16 caries lesions. Teeth with lesion had 2.66 times of hazard ratio than teeth without lesion. The pre-operative clinical symptom and radiographic radiolucency in ante-rior teeth and the size of lesion in posterior teeth significantly affect the success rate of pulpectomy. Conclusions: Both child-related factors and teeth-related factors are associated with the success rate of pulpectomy under general anesthesia. The size of lesion had significant different in posterior teeth.

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The Hall Technique在臨床的成功率及成功率和年紀、性別、牙位、蛀牙的深度等因素的相關性

目的：The Hall Technique的做法為在蛀牙的乳臼齒上覆蓋不銹鋼牙套，並且在施作過程中省略麻醉、牙齒修型、蛀牙移除等步驟，可降低患者對於牙科治療的恐懼和焦慮。本研究意在探討The Hall Technique的臨床成功率，以及其和年紀、性別、牙位、蛀牙深度的相關性。方法：本研究在中國醫學大學附設醫院兒童牙科搜集了適合施作The Hall Technique的牙齒，總共為82顆。在排除22顆觀察時間未超過2年的牙齒後，本文以剩餘的60顆牙齒進行研究。結果：在施以The Hall Technique後，其中59顆牙在治療後沒有症狀，但有1顆牙在施作後一年半時發現有abscess，故臨床成功率為98.3%。依照“性別”分組，男性的成功率為100%，女性則為96.7%，其P值為1.0。依照“年紀”分組，5歲患者的成功率為83.3%，其餘各年紀皆為100%，P值為0.27。依照“牙位”分組，右上乳第一臼齒的成功率為87.5%，其餘各牙位皆為100%，P值為0.42。依照“蛀牙深度”分組，蛀牙深度沒超過牙本質1/2的成功率100%，而深度超過牙本質1/2但未到pulp的成功率則為95.8%，P值為0.44。結論：本研究發現患者使用The Hall Technique的臨床成功率為98.3%，但是其成功率和年紀、性別、牙位、蛀牙深度等因素在統計上皆無顯著相關性。

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魯賓斯坦－泰比氏症男孩患者之牙科治療

魯賓斯坦－泰比氏症（Rubinstein-Taybi syndrome, RTS），或稱大拇指症，是由基因異常造成的多重先天異常之症候群，新生兒盛行率約為1:100,000～125,000。主要臨床表徵有生長缺乏、特殊臉部特徵、高度拱形上腭、爪形咬頭、心智發育遲滯及拇指寬大等。另外，約三分之一的患者有先天性心臟缺陷。本篇病例報告為8歲4個月男童，於出生一個月內，經本院小兒科醫師藉臨床表徵診斷為RTS。患者因配合度不佳，未曾接受任何牙科處置，由本院小兒科醫師建議後初次至牙科門診求診，主訴希望評估治療全口多顆齲齒。臨床及放射線檢查後，嘗試於門診保護性約束下進行治療，但因行為極度不配合，與家長討論後，安排在全身麻醉下完成其餘齲齒治療，並持續追蹤口腔衛生狀況及恆牙萌發。本篇病例報告之目的在於藉由介紹患有RTS之8歲男童的牙科治療過程，進而探討對此類患者進行牙科處置時的臨床注意事項。

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Extensive Intrinsic Tooth Discoloration in Permanent Dentition: Two Cases Report

In this case report, we present two cases with extensive intrinsic tooth discoloration in permanent dentition. Both cases shared a similar pattern of tooth discoloration. The anterior teeth and first molars illustrated discoloration bands at cervical area. While almost all the clinical crowns of premolars and second molars were discolored. We hypothesized that both cases were affected by systemic factors. The medical histories of patients during childhood were carefully reviewed, but both patients cannot recall any long-term medication usage and major systemic disease was denied except sporadic visits to local clinics for common cold or flu. The width and location of the intrinsic tooth discoloration were correlated with stages of tooth development. Thus, the specific pattern of discoloration in the cases provided valuable biological evidence of the actual sequences of tooth calcification. According to the timetable of odontogenesis from literature, we hypothesize that some systemic stressor started to influence the odontogenesis process of both patients earlier than 3 to 4 years old; while case 1 suffer from severer and longer period, case 2 returned to normal after 6.5 years old. The article also reviewed the common etiologies of intrinsic tooth discoloration. Tetracycline or minocycline were the most probable causes of our cases, although both patients could not recall any related medical history. However, idiopathic internal tooth discoloration was also a possible diagnosis.

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Localized Aggressive Periodontitis of Bilateral Mandibular Primary Canine: A Case Report

Periodontitis, compared to gingivitis, is a relatively uncommon disease in children, and the accumulation of plaque is not the common cause. Thorough examinations are required to reveal the real cause for periodontitis in children which may involve local factors or other underlying systemic diseases. However, the etiology of periodontitis is multifactorial and undetermined causes are still present. This case report is about a two-year follow-up of a five-year-old boy with atypical localized aggressive periodontitis that caused premature loss of bilateral mandibular canine, and the discussion focuses mainly on the etiology. Although periodontitis is a relatively rare condition in children, it may result in acute symptoms and tooth loss, which should not be overlooked.

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Management of Permanent First Molar Affected by Molar-Incisor Hypomineralization: A Case Report

Molar-incisor hypomineralization (MIH) is a developmental defect of the enamel of one or more permanent first molars with or without affecting incisors. The clinical symptoms and signs vary from case to case and between teeth in the same individual, including hypersensitivity, enamel breakdown, dental caries and pulpal inflammation. The affected enamel shows increased amount of proteins that leads to lower hardness and lower modulus of elasticity. The affected enamel can be a well-defined area or including the entire crown. After the hypomineralized molars erupted, there may be enamel fracturing and wearing. Early enamel loss can cause dental caries and rapid deterioration of the clinical crown. There are two cases in this case report. One is a 7-year-old boy with hypomineralized enamel of teeth 16 and 26. The other is a 6-year-old girl who has four hypomineralized permanent first molars with different severity. The discussion focuses on clinical symptoms and signs and how treatment strategies are made.

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Diagnosis and Treatment Consideration for Generalized Aggressive Periodontitis in Primary Dentition-A Case Report

Generalized aggressive periodontitis (GAP) is an uncommon periodontal disease characterized by rapid destruction of periodontal tissues, leading to severe attachment and bone loss. The onset of the disease can be as early as at the primary dentition, and GAP is sometimes found to be an oral manifestation of systemic problems. Early diagnosis and management are imperative to control the disease progress, preserve primary teeth, and prevent further damages to their permanent successors. In this report, we presented a case of an 8-year-old boy showing generalized periodontal bone loss with an underlying disease of neutropenia. He also had concomitant hypo-hyperdontia, a rare numeric dental abnormality with simultaneous occurrence of missing and supernumerary teeth.

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Inflammatory Dentigerous Cyst: A Rare Cause of Facial Cellulitis

Most commonly occurring odontogenic cysts in the oral cavity are radicular cysts and dentigerous cysts. The inflammatory dentigerous cyst is a subtype of dentigerous cyst, which is characterized by a less aggressive behavior and a low recurrence rate. The histogenesis mechanism of inflammatory dentigerous cysts may be periapical inflammation caused by the diffusion of nonvital deciduous teeth to the successors' follicle. Inflammatory dentigerous cysts become serious complications, such as potentially life-threatening cellulitis, which is rare in children. We report a rare case of facial cellulitis with inflammatory dentigerous cyst arising from tooth 75 in a 9-year-old girl and review the literature for this unusual finding. It was treated successfully by antibiotic medication and marsupialization of the inflammatory dentigerous cyst.

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Lennox-Gastaut症候群的牙科治療：兩病例報告

Lennox-Gastaut症候群（Lennox-Gastaut syndrome, LGS）是一種少見且嚴重的癲癇症候群，這類患者會有難以用藥物控制的癲癇發作，一天內可能會發作數次。通常還會合併智能障礙與腦性麻痺。患者全身狀況複雜、照顧不易，相較於一般人更容易罹患齲齒與牙齦炎等口腔疾病，且由於長期服用多種抗癲癇藥物，有時也可見到明顯牙齦增生的副作用。在臨床治療上，由於有難以控制的癲癇，隨時都有可能發作，故在牙科治療時也是一大挑戰。本文討論兩例LGS的青少年患者，他們在疾病嚴重程度、口腔狀況、癲癇控制方面皆有極大不同。但類似的是，兩案例口內皆有多數齲齒與大量的牙菌斑，且在全身麻醉下進行全口重建治療。治療此類患者時，需要跨領域的治療團隊，才能為他們提供最佳的治療選擇。此外，還需要照護者的合作，維持良好口腔衛生，才能進一步長期改善患者口腔健康與生活品質。

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Orthodontic Management of an Impacted Maxillary Central Incisor - A Case Report

Impacted maxillary incisors can have a major negative effect on dental and facial aesthetics. A 9-year-old boy accompanied by his parents came to our pediatric department for evaluation. Maxillary left central incisor impaction with space deficiency was noted. After surgical exposure with closed guided eruption technique under general anesthesia, maxillary arch expansion and orthodontic traction, the impacted tooth was brought to proper alignment. After two years of treatment, the impacted maxillary left central incisor has been brought back to normal dental alignment.