Category Archives: Pediatric and preventive dentistry

Management of Dens Invaginatus in a Maxillar Lateral Incisor with Open Apex and Persistent Sinus Tract: a Case Report

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Funda Fundaoğlu Küçükekenci, Ahmet Serkan Küçükekenci
Faculty of Dentistry, OrduUniversity, Ordu, Turkey


Background/Aim: Dens invaginatus is a developmental anomaly of teeth. The endodontic treatment of these teeth may be difficult because of adversity in accessing the root canals and also complicated variations of internal structure. In this case, the report is presented the nonsurgical management and follow-up of a tooth with class II dens invaginatus with an open apex and sinus tract.

Case Report: In the radiographic examination, there are two root canals; a primary (main) canal and an invaginated canal. The main canal wide-open at the portal of exit and associated with a large chronic periapical lesion extending to the apex of the maxillary left central incisor. An invaginated canal was not reaching the apex. In a clinical examination, a sinus tract was detected in the labial gingiva. After apexification with using MTA was applied, the endodontic treatment was completed. In 12 month recall, a gray discoloration was detected and internal bleaching with 35% hydrogen peroxide was applied. Finally, the tooth was restored using composite resin. 12 months follow-up radiographs revealed resolution of periapical radiolucency, trabecular bone formation, and closure of the root apex with the totally asymptomatic tooth.

Conclusions: The case report shows that tooth with DI that has wide apex and sinus tract can be treated with non-surgical methods, such as immature tooth without anomalies.

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A Case of Dental Fusion in Primary Dentition from Late Bronze Age Greece

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Paraskevi Tritsaroli
American School of Classical Studies at Athens, Greece


Background/Aim: Dental fusion is a developmental abnormality that can occur in primary and/or permanent dentition.

Case report: A case of double primary teeth from a Late Bronze Age cemetery in Greece is presented. Age estimation of the skeleton was based on dental eruption and development as well as on fusion of primary ossification centres of the cranial and post-cranial skeleton. Analysis of double teeth used morphology, anatomy, location, tooth count and radiological examination. Results showed a 18 month infant. Primary lower right central and lateral incisors were joined by the dentin, and they had distinct crowns and separated pulp chambers; each tooth maintained its own root canal and resembled a normal primary central and lateral incisor shape respectively. Diagnosis showed that double teeth were the result of partial fusion rather than gemination. No other dental abnormalities or lesions were recorded and subsequent teeth were not affected.

Conclusions: This is the first example of double teeth in primary dentition reported in the literature from archaeological assemblages in Greece. Being one of the rare examples of dental fusion in the bioarchaeological record, this report adds further to the mapping of dental anomalies in past populations.

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Adhesion to Enamel of Teeth Affected by Molar Incisor Hypomineralization: Literature Review

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Apostolina Theocharidou, Konstantinos Arapostathis

Department of Paediatric Dentistry, Aristotle University of Thessaloniki, Greece


Background/Aim: Molar incisor hypomineralization (MIH) is a qualitative defect of systemic origin, affecting permanent first molars and often permanent incisors. The treatment modalities can include, amongst others, fissure sealants for prevention of dental caries and composite restorations. Both require adhesion to tooth structure. The aim of this study was to review the literature on the adhesion to enamel affected by MIH.

Material and Methods: A search of PupMed/Medline, ResearchGate and Google Scholar was performed and limited between 2003, when the judgement criteria for MIH were set, and 2016. Thirty-three papers were considered relevant to the subject including five in vivo and six in vitro studies. Studies involving less than ten teeth were excluded.

Results: A four-year clinical trial showed that the application of a total-etch 2-step adhesive system prior to sealant placement is superior to the etch-seal technique. Despite the high success rate of composite restorations shown in three clinical longitudinal studies, there are conflicting results over self-etch being superior to total etch adhesive systems. Pretreating the enamel surface, prior to the adhesive system, with fluoride preventive solutions could reduce the mikroleakage under orthodontic brackets. Three in vitro studies provide inconsistent data about NaOCl pretreating potentials to improve adhesion of composite restorations. Resin infiltration, prior to resin restorations, could improve the microhardness of defected enamel, which may lead to increased bond strength, especially in combination with NaOCl pretreatment.

Conclusions: Adhesion to enamel affected by molar incisor hypomeralization is inferior compared to normal enamel. Sealants applied with the etch-bond-seal technique have greater retention than with the etch-seal technique. Further research is required to provide evidence of the effectiveness of the adhesive system and pretreatment to achieve optimal bonding to MIH.

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Parents´ Knowledge about the Effects of Oral Hygiene, Proper Nutrition and Fluoride Prophylaxis on Oral Health in Early Childhood

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Aleksandrija Djordjevic

Faculty of Medicine Pristina, University of Pristina – Kosovska Mitrovica, Kosovska Mitrovica, Serbia


Background/Aim: Health education, as one of the important aspects of preventive dentistry, plays an important role in promoting and achieving good oral health. The aim of this study was to determine the influence of parents´ knowledge about the effects of oral hygiene, proper nutrition and fluoride prophylaxis on oral heath in early childhood. Material and

Methods: Parents were asked to fill a questionnaire which consisted of three sections, oral hygiene, fluoride prophylaxis and nutrition. The study included 136 parents of children, aged between 3-6 years. The survey was conducted in pedagogical-education institution – PE “Our happiness” – Leposavic, Kosovo and Metohia, Serbia. Results: More than 58% parents from urban areas and 63% parents from rural areas were informed that the teeth should be brushed at least twice a day (p=0.007). Only 31.11% of parents from urban and 15.22% of parents from rural areas were informed that a child should visit dentists for the first time, at the one year of age (p=0.083). The analysis of the questionnaire section regarding the nutrition and oral health, showed that parents from rural areas were better informed than parents from urban areas. Awareness about fluoride and their role in preventive dentistry was poor, as only 3% of children from urban and 1% of children from rural areas were using tablets based on fluoride while only 1% of children from urban and none from rural areas were using fluoride mouth rinses. Conclusions: The study showed that parents have the knowledge about the impact of oral hygiene, food and fluoride prophylaxis on the oral health but unfortunately they do not apply their knowledge in practice.

Keywords: Oral health; Knowledge; Parents; Questionnaires; Oral hygiene; Proper nutrition; Fluoride prophylaxis; Child



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Balkan Journal of Dental Medicine, Volume 22, Issue 1, Pages 26–31, ISSN (Online) 2335-0245,DOI:

Tooth Loss and Survival Analysis after Traumatic Injuries in Primary Dentition

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Jelena Galovic1 / Tatjana Vukojevic1 / Jelena Nikolic Ivosevic2 / Mirjana Perin3 / Kristina Vicko4 / Ivana Demko Rihter4 / Bojan Petrovic4

1 Health Center Novi Sad, Serbia
2 Helth Center Subotica, Serbia
3 Helth Center Nevesinje, Bosnia and Herzegovina
4 Department of Dentistry, Faculty of Medicine,
University of Novi Sad, Serbia


Background/Aim: The aim of the present study was to investigate the treatment options, survival rate of traumatized primary teeth and evaluate the factors influencing the outcome. Material and Methods: The sample consisted of all dental trauma cases treated over a 14 years period at the Department of Pediatric and Preventive Dentistry, Dental Clinic of Vojvodina, Novi Sad. Criteria for inclusion in this study were: dental trauma to primary teeth and age in the moment of injury up to seven years. Dental trauma records were analyzed in order to obtain the following: gender and age of the child at the time of trauma, type of trauma, as well as the type and timing of treatment received. After data analysis a survival rate of traumatized primary teeth was evaluated. Results: The study was designed as retrospective and it included 225 children, with 346 traumatized primary teeth. The occurrence of trauma was higher in male patients (60,4%) and in children up to 4 years of age. Luxations were more frequent (72.8%) compared to isolated teeth fractures (20.8%), while the two types of injury combined were rare (6,3%). One year following dental trauma 231 teeth (0.67%) developed complications. Falls were the main cause of trauma (68.9%) and the presence of more than one traumatized tooth was frequent. A percentage of 48.8 children received dental care during first 24 h after the injury. Conclusions: Survival of injured primary teeth is relatively low, regardless of trauma type, time interval between injury and treatment and the type of provided treatment.

Keywords: Tooth; Deciduous Injuries; Pediatric Dentistry; Child


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Citation Information:Balkan Journal of Dental Medicine, ISSN (Online) 2335-0245, DOI: Citation


Aetiology, Diagnosis and Treatment of Ankyloglossia

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Christina Charisi / Anna Koutrouli / Athina Moschou / Aristidis Arhakis

School of Dentistry, Aristotle University of Thessaloniki, Greece


This review paper occupies with the frequency, etiology, diagnosis, treatment and the possible complications of Ankyloglossia (AG). AG is a congenital anomaly and its range varies from 0,1% to 4,8 %. There are several methods for the diagnosis of AG. The most popular method is the ‘’Hazelbaker’’, which assesses seven different tongue movements and five appearance characteristics. As far as the management of AG is concerned, there are two options, the ‘’wait-and-see’’ and the invasive procedure. The operator can choose between the frenotomy and the frenectomy. The difference is that in frenectomy the clinician removes the whole frenulum. Few complications have been mentioned, such as ulcers, pain, bleeding and noticeable scar, which were brought on to a second operation.

Keywords: Ankyloglossia; Breast Feeding; Frenectomy


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Citation Information:Balkan Journal of Dental Medicine, ISSN (Online) 2335-0245, DOI: Citation

Orofacial Crohn’s disease: a Case Report

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Damla Tuncer Budanur1 / Merve Şirin2 / Elif Sepet1 / Meral Ünür2 / Mine Güllüoğlu3 / Mustafa Serdar Cantez4 / Özlem Durmaz Uğurcan4

1Istanbul University, Faculty of Dentistry, Department of Pediatric Dentistry, Istanbul, Turkey
2Istanbul University, Faculty of Dentistry, Department of Oral & Maxillofacial Surgery, Istanbul, Turkey
3 Istanbul Faculty of Medicine, Department of Pathology, Division of Gastroenterology, Hepatology and Nutrition Istanbul, Turkey
4Istanbul Faculty of Medicine, Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition Istanbul, Turkey


Background: Crohn’s disease (CD) and ulcerative colitis (UC) are the two major relapsing conditions of inflammatory bowel diseases. Case Report: A case of Crohn’s disease with orofacial manifestations in a 10 year old girl is described. She had suffered from fever, dysphagia, arthralgia, painful recurrent ulcers of the oral mucosa and swelling of the lower lip lasting over 6 weeks. Clinical examination and the punch biopsy from the buccal mucosa revealed major recurrent aphthous ulcerations. A partial regression and significant relief of lesions were achieved two weeks after the treatment, but the patient suffered from abdominal pain, irregular bowel movements, arthritis, multiple hyperplastic and swollen mucosal folds, after 3 months. The patient was referred to a pediatric gastroenterologist. Esophagogastroduodenoscopy showed pyloric ulcer formation. Abdominal ultrasound showed increased thickening of the ileal wall with multiple enlarged lympadenopathies in the periileal region. Colonoscopy images showed deep ulcers with surrounding erythema. The histopathological examination of biopsies from the terminal ileum and the colon showed basal plasmacytosis, minimal crypt distortions and aphthous ulcerations. The diagnosis of Orofacial Crohn’s disease was made. Exclusive enteral nutrition for 8 weeks, followed by azathiopurine treatment was started with an excellent clinical response on abdominal and oral symptoms. Conclusion: Diagnosis of the disease by dentists and other clinicians through the evaluation of oral clinical findings is very rare. Mucocutaneous and granulomatous lesions of the oral cavity should alert the clinician to pursue an underlying systemic cause. Early communication with a gastroenterologist can help early diagnosis of Crohn’s disease for better patient management and prognosis.

Keywords: Crohn’s Disease; Orofacial Granulomatosis; Inflammatory Bowel Disease; Recurrent Aphthous Ulcerations; Oral Lesions


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Citation Information: Balkan Journal of Dental Medicine, ISSN (Online) 2335-0245, DOI: Export Citation

Prosthetics in Paediatric Dentistry

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Zoran Vulićević1 / Miloš Beloica1/ Dušan Kosanović1 / Ivana Radović1 / Jelena Juloski1 / Dragan Ivanović2

1Clinic for Pediatric and Preventive Dentistry, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
2Faculty of Medicine, University of East Sarajevo Republic of Srpska, Sarajevo, Bosnia and Herzegovina


Premature loss of teeth in children may lead to both functional and esthetic problems. Missing teeth in both anterior and posterior regions may cause malfunctions in mastication and proper pronunciation. If the missing teeth are not replaced, further complications may occur, including adjacent tooth migration, loss of alveolar bone, and irregular occlusion. Considering the sensitive nature of children, loss of teeth may cause the development of insecurities and low self esteem problems. Due to dynamic nature of growth in children and adolescents, prosthetic appliances must not hinder development of orofacial system, and must meet adequate esthetic and functional standards. Dental prosthetic appliances in paediatrics must be planned with respect to the special conditions that led to tooth loss or damage. Multi-disciplinary approach is needed, under constant supervision of paediatric dentist and orthodontist, as well as regular checkups with clinical and radiographical examinations.

Keywords: Prosthetic; Child; Dental Crown; Adhesive Bridge; Denture


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Citation Information: Balkan Journal of Dental Medicine, ISSN (Online) 2335-0245, DOI: Export Citation

Caries Prevalence among 24 to 71-Month Old Children from Banja Luka

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1 / O. Dolic2 / S. Sukara2

1Department of Pediatric and Preventive Dentistry, Faculty of Medicine, University of Banja Luka, Bulevar Vojvode Petra Bojovića 1a 78 000 Banja Luka, Bosnia and Herzegovina
2Department of Pediatric and Preventive Dentistry,  Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina


Background: Despite the availability of a variety of preventive and treatment modalities, caries in the early childhood remains a serious and prevalent disease worldwide.

The aim of this study was to assess the prevalence of early childhood caries (ECC) among 24 to 71-month old children who attended the Center for preschool education Banja Luka, Republic of Srpska, Bosnia and Herzegovina.

Material and Methods: This was a cross-sectional study. The whole sample included 297 children of both genders. Caries status of each child was recorded using the dmft index according to the WHO criteria.

Results: Two hundred ninety-seven children (138 girls and 159 boys) 24 to 71-month old were examined. The overall prevalence of dental caries was 64.65%. Only 23 (7.74%) children had their teeth restored.

Conclusions: ECC prevalence among 24 to 71-month old children who attended the Center for pre-school education in Banja Luka is very high, but the problem is even greater because most of those caries lesions are untreated.

Keywords: Preschool children; Early childhood caries; dmft index; Prevalence of dental caries


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Citation Information: Balkan Journal of Dental Medicine. Volume 20, Issue 3, Pages 168–171, ISSN (Online) 2335-0245, DOI:, November 2016

Factors that Determine Child Behavior during Dental Treatment

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Assoc. Prof. Elmedin Bajrić1 / S. Kobašlija2 / A. Huseinbegović2 / N. Marković2 / M. Selimović-Dragaš2 / A. Arslanagić Muratbegović2

1Sarajevo University, Faculty of Dentistry, Department for Preventive and Pediatric Dentistry, Sarajevo, Bosnia and Herzegovina, Telephone number: +387 33 407 872, Fax number: +387 33 443 395
2Sarajevo University, Faculty of Dentistry, Department for Preventive and Pediatric Dentistry, Sarajevo, Bosnia and Herzegovina


In this review paper we wanted to summarize all the aspects which could affect the behavior of the child patients in the dental office. At the beginning, the factors that are related to the child patients are mentioned. Various segments of child psychological, cognitive, physiological and other kinds of development are discussed. Also, the reasons for dental fear and anxiety (DFA) and dental behavior problems (DBP) were analyzed, and how the child dental patients could cope with them. Finally, types of patients according to their behavior in the dental office were discussed. Furthermore, the influences of child patients’ parents were studied, including parenting styles, as well as factors related to dentist, dental team and the dental office. Finally, critical evaluation of administration of assets to measure the presence of DFA and DBP is provided. Every part of the text was corroborated by the results from our own and other authors’ recent bibliography data.

Keywords: dental fear and anxiety; dental behavior problems; children; parents; dentists


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Citation Information: Balkan Journal of Dental Medicine. Volume 20, Issue 2, Pages 69–77, ISSN (Online) 2335-0245, DOI:, July 2016