Mineral Trioxide Aggregate Apexogenesis: A Systematic Review.

Objectives: To evaluate the clinical and radiographic outcomes of apexogenesis with mineral trioxide aggregate (MTA) against other pulpotomy agents in carious/traumatized immature permanent teeth. Data Source: A web-based search for possibly relevant scientific papers in the English language between January 2013 and August 2022 was undertaken in the databases such as PubMed, Scopus, Cochrane Library, and EMBASE. Only randomized clinical trials that compared MTA against other pulpotomy medicaments conducted in vital immature permanent dentition with open apex, having a sample size of not less than 20 with at least 6 months follow-up, reporting clinical or radiographic outcomes were included in the current review. Case studies, case series, animal studies, in vitro studies, non-clinical/clinical trials on mature/necrotic permanent or primary dentition, systematic reviews, and letters to the editor were excluded. Study Selection: A total of 236 articles were retrieved from the databases during the search procedure. Two independent investigators conducted a full-text review of 83 studies following a screening of titles and abstracts. Eventually, seven studies were considered for the review. The Cochrane bias assessment tool was used to evaluate the quality of included studies. Five of the selected studies were assigned a low evidence level, whereas two were rated a high evidence level. Conclusion: The present review indicated that the diverse pulpotomy agents had comparable clinical outcomes with MTA for apexogenesis in traumatized or carious immature permanent teeth. However, there is a lack of substantial information to draw firm conclusions about the benefits of one material over another.

Ozone Therapy in Medicine and Dentistry: A Review of the Literature.

Ozone has been successfully used in medicine for over 100 years due to its microbiological qualities. Its powerful oxidation impact, which results in the production of free radicals, and its ability to cause the direct death of nearly all microorganisms is the basis for its bactericide, virucide, and fungicide properties. Ozone also has a medicinal impact that speeds up blood flow and aids wound healing. Ozone may be applied as a gas or dissolved in water for medical purposes. Despite the benefits of using ozone therapeutically, concerns about its use in dentistry still exist. We aimed to provide a summary of the current uses of ozone in medicine and dentistry. An electronic search was performed for all English scientific papers published between 2012 and 2023 using PubMed, Cochrane, and Google Scholar search engines. Ozone, clinical applications, medicine, and dentistry were the search terms used. Seventy full-text articles describing the use of ozone therapy in medicine and dentistry were included in the present review. Ozone has shown several beneficial effects in the medical field. However, despite the encouraging in vitro evidence, the clinical use of ozone in dentistry has not yet been demonstrated as highly effective.

Knowledge of Saudi dental students and interns towards luting cements and their applications in fixed prosthodontics.

BACKGROUND: Enhancement of students' knowledge is essential in improving their clinical skills and performance. Thus, the curriculum should be prepared to achieve a better outcome. The current study aimed to determine the dental students' and interns' basic knowledge towards dental luting cements and their application in dental practice to improve the theoretical and clinical training sections. MATERIALS AND METHODS: A cross-sectional study was conducted among dental students and interns at three Colleges of Dentistry in the Kingdom of Saudi Arabia between September 2019-June 2020. An online questionnaire was used which included demographic data, questions about luting cement usage, cementation techniques, and commonly used cements in dental clinics. Descriptive analysis and chi-square test were used to show the association between level of dental education and the use of dental cements using SPSS software. The significance level was set at 5%. RESULTS: The total respondents were 626 dental students/interns of whom 78.8% were undergraduate dental students. Participants who reported undergraduate studies as the source of information were 79.7%. The type of restoration was the main factor in luting cement selection (62.6%). Concerning the isolation technique in cementing laminate veneers, 49.7% used dri-angles, cotton rolls and saliva ejectors. Dual-cure resin cement was the most common cement used in all the mentioned restorations except in pressed porcelain laminate veneers and cement-retained implant-supported restorations. CONCLUSIONS: Students' knowledge and practice in managing dental implants and porcelain laminate veneers need to be improved. The selection of a luting agent for a given restoration by students and interns was based on the basic knowledge, available cement, and the type of restoration. Awareness towards the management of short prepared teeth and custom-made cast posts and cores is also limited.

Assessment of Oral Hygiene, Gingival, and Periodontal Health, and Teeth Eruption among Type 1 Diabetic Saudi Children.

Aims and objectives: To determine the differences between type 1 diabetic children and healthy children regarding oral hygiene, gingival and periodontal health, and permanent teeth eruption.Materials and methods: A case-control study was conducted on 80 children (40 type 1 diabetic children and 40 healthy children) aged 6-12-year-old. The groups were further divided into subgroups (early and late mixed dentition). All study aspects were examined clinically using the simplified oral hygiene index, Löe and Silness gingival index, clinical attachment loss (CAL), and Logan and Kronfeld stages for tooth eruption. The data were analyzed using Fisher's exact test, chi-squared test, and logistic regression models. A p-value of ≤0.05 was the threshold for statistical significance. Results: No significant difference was found between diabetic and healthy children regarding oral hygiene and gingival health. Most children had poor oral hygiene (52.5% in the case group and 60% in the control group), with fair gingival health (70% in the case group and 55% in the control group). Diabetic children had significantly (p = 0.05) more periodontitis than healthy children. Teeth in the advanced stage of the eruption were significantly higher in diabetic than control subjects (p = 0.048 in stage V and p = 0.003 in stage VI). Older diabetic children in late mixed dentition exhibited accelerated eruption. Conclusion: Periodontitis was significantly more common in diabetic than in healthy children. The advanced stage of the eruption was significantly higher in diabetic than in control subjects. Clinical significance: Type 1 diabetic children had more periodontal disease and advanced stage of permanent teeth eruption compared to healthy children. Therefore, periodic dental evaluation and a strong preventive plan for diabetic children is crucial. How to cite this article: Mandura RA, El Meligy OA, Attar MH, et al. Assessment of Oral Hygiene, Gingival, and Periodontal Health, and Teeth Eruption among Type 1 Diabetic Saudi Children. Int J Clin Pediatr Dent 2022;15(6):711-716.

Effect of Bonding Agent on Retention of Different Sealants: An in Vitro Study.

OBJECTIVES: To investigate the effect of Co-curing versus Staged-curing and No-bonding on retention of different resin-based sealants (RBS). STUDY DESIGN: For shear bond strength (SBS) and microleakage tests, 90 extracted premolars were divided equally into 3 groups (I, II, III). Each group was further subdivided equally into 3 subgroups (a, b, c). No-bonding subgroups did not receive a bonding agent, Staged-curing subgroups received a bonding agent that was cured before sealant application, while Co-curing subgroups received a bonding agent that was cured after sealant application. Seal-it was applied for group I, Helioseal-F for group II and Clinpro for group III. SBS buttons were tested using Instron machine, while microleakage specimens were examined using micro-CT. RESULTS: Clinpro showed the highest SBS values in Staged-curing and No-bonding groups (8.72±2.39, 12.51±3.16) respectively. Staged-curing was significantly greater in SBS values than those for other groups (P<0.05). There was a significant difference in microleakage values of Staged-curing among different RBS (P = 0.003), while there was no significant difference in values of No-bonding and Co-curing among different RBS (P = 0.541, P = 0.521). CONCLUSIONS: The use of a bonding agent as Staged-curing was more effective in improving sealant retention than No-bonding and Co-curing.

Recent Advances in Indirect Pulp Treatment Materials for Primary Teeth: A Literature Review.

AIM: To provide an overview of the techniques of indirect pulp treatment (IPT) and the new materials used. BACKGROUND: Indirect Pulp Treatment (IPT) is a conservative treatment approach that can be used in primary molars. Pulpotomy has been adopted as the treatment of choice for deep caries in primary molars. IPT showed higher success rates in recent researches. MATERIALS AND METHODS: Electronic search of English scientific papers was accomplished using PubMed, ScienceDirect, and Scopus. Papers published from 1995 to 2019 were included. Search terms used were recent advances, indirect pulp treatment, mineral trioxide aggregate (MTA), biodentine, TheraCal-LC, chlorhexidine gluconate (CHX), resin-modified glass ionomer (RMGI), and calcium hydroxide. REVIEW RESULTS: Seventy two papers were obtained from the electronic search and references of selected studies. Thirty five papers explained recent advances in IPT materials for primary molars. MTA produces more dentinal bridging with superior quality than calcium hydroxide. Similarly, Biodentine can form reparative dentin in a very short period. TheraCal-LC has increased stability and durability with strong physical properties and low solubility. Furthermore, CHX is a chemical disinfectant which can aid in increasing the success rate of IPT when conjugated with other materials. It produced highly successful IPT when combined with RMGI or calcium hydroxide. CONCLUSION: IPT is the preferred treatment approach for preservation of primary dentition. CHX is an emerging material that can provide promising results in IPT when combined with other materials. CLINICAL SIGNIFICANCE: Up to date, no material had replaced the popular use of calcium hydroxide in IPT. The use of CHX with RMGI can increase the success rate while preserving the advantages of the latter as it is considered the liner of choice for primary teeth, making IPT a suitable substitute for pulpotomy in primary molars. HOW TO CITE THIS ARTICLE: Saber AM, El Meligy OA, Alaki SM. Recent Advances in Indirect Pulp Treatment Materials for Primary Teeth: A Literature Review. Int J Clin Pediatr Dent 2021;14(6):795-801.

Fiberglass crowns versus preformed metal crowns in pulpotomized primary molars: a randomized controlled clinical trial.

OBJECTIVE: To evaluate the clinical performance of the fiberglass "Figaro" crowns compared to preformed metal crowns (PMCs) in pulpotomized primary molars in children. METHOD AND MATERIALS: This split-mouth controlled randomized clinical study was performed on ten childrens, aged from 4 to 6 years, who needed complete oral rehabilitation under general anesthesia and had one pair or two pairs of their primary molars requiring pulpotomy. After pulp therapy, the teeth were randomly assigned to Figaro or PMC crown groups. Modified United States Public Health Service (USPHS) criteria were used to evaluate crown retention, marginal integration, crown discoloration, secondary caries, and gingival status, at 3 and 6 months. The data were analyzed using the chi-square test with Monte Carlo (MC) correction and McNemar (McN) test at a significance level of .05. RESULTS: Ten patients (three boys, 30%; seven girls, 70%) with a mean age of 4.65 ± 0.709 years participated in this study. At 3 months follow-up, there was no significant difference between the groups, but at 6 months follow-up, Figaro crowns showed significant changes from intact crown to either chipped or large loss, whereas all PMCs were found intact (χ2 = 14.545, P[MC] = 0.000). There was also significant deterioration in Figaro crowns' color after 6 months (χ2[McN] = 8.1, P = .004). CONCLUSION: PMCs were more durable than Figaro crowns, which showed significant deterioration after the 6-month follow-up period.

Oral and Dental Health Status among Adolescents with Limited Access to Dental Care Services in Jeddah.

The purpose of this study was to assess the prevalence and associated factors of dental caries and periodontal diseases among 14⁻19-year-old schoolchildren with limited access to dental care services. A cross sectional study design was conducted during field visits to seven governmental schools in Al-Khomrah district, South Jeddah, over the period from September 2015 to May 2016. Clinical examinations and administered questionnaires were carried out in mobile dental clinics. The dentists carried out oral examinations using the dental caries index (DMFT), the simplified oral hygiene index (OHI-S), and the community periodontal index for treatment needs (CPITN). Statistical analyses were performed using SPSS 20. A total of 734 schoolchildren were examined. The prevalence of decayed teeth was 79.7% and was significantly higher among boys (88.9%) than girls (69.0%). About 11% of students had missing teeth, with a significantly higher figure among females than males (15.9% versus 7.3%); 19.8% of students had filled teeth. Moreover, a DMFT of seven or more was significantly more prevalent among males (43.3%) than females (26.8%), while the percentage of females with sound teeth was significantly higher than for males (20.4% and 9.6% respectively). The CPITN revealed 0, 1 and 2 scores among 14.6%, 78.2%, and 41.6% respectively. Males had a significantly higher percentage of healthy periodontal condition (23.8%) than females (3.8%). Dental caries prevalence was moderate to high, calculus and gingival bleeding were widespread among schoolchildren, and were more prevalent among students with low socioeconomic status.

Influence of full mouth rehabilitation on oral health-related quality of life among disabled children.

The efficacy of full mouth rehabilitation (FMR) on oral health-related quality of life of physically disabled children was assessed. This prospective study was performed at Dental Department of Sultan Bin Abdulaziz Humanitarian City, Riyadh, and King Abdulaziz University Hospital, Jeddah, Saudi Arabia, during May 2012 to September 2014. A total of 186 physically disabled children aged 11-14 years were assigned to a test group (n = 97) or a control group (n = 89). FMR was applied for test group children at baseline and 3 months' visits, whereas those in the control group did not receive FMR. Both group children received dental kits and oral hygiene instructions. Children were asked to complete the Child Perceptions Questionnaire, whereas Parental-Caregiver Perceptions Questionnaire and Family Distress Domain questionnaire were completed by the parents/caregivers at baseline and 6 months' visits. Children in both groups showed positive trends in oral symptoms at 6 months compared with those at baseline. However, when they were compared to control, significant improvement in oral symptoms was observed in the test group at 6 months' visit (p < .05). Also when they were compared to control, significant improvements were observed in the functional limitation, emotional, and social well-being subscales of the Child Perceptions Questionnaire and on the Parental-Caregiver Perceptions Questionnaire scales at the end of the study (p < .05). Compared to the parents/caregivers of the control children, the parents/caregivers of the test-group children reported insignificant but positive trends in Family Distress Domain at the end of the study (p < .05). FMR in children reduced oral-related problems subsequently to a better oral health-related quality of life.

Intra- and inter-examiner variability in evaluating preclinical pediatric dentistry operative procedures.

Many investigators have reported attempts to develop reliable laboratory and clinic evaluation systems. However, few studies, regardless of level of success, have used an analytic procedure to identify those components of the evaluation system that, if refined further, could improve reliability. The purpose of this study was to compare intra- and inter-examiner variability in two evaluation methods: glance and grade (global), and checklist and criteria (analytical). Three faculty staff members with more than ten years of clinical and teaching experience evaluated operative procedures performed on plastic teeth representing the primary teeth by thirty dental students in pediatric dentistry preclinical laboratory sessions. The preparations were graded blindly by each of the three evaluators (A, B, and C) three times without magnification. The values were statistically analyzed using Wilcoxon signed rank test and Friedman test setting value of significance at 5 percent. The study revealed that, among the three examiners, the intra-examiner variability was nonsignificant in most situations. On the other hand, there was statistically significant variability between evaluators (i.e., inter-examiner) for almost all preparations. Neither cutting off the scores nor using either evaluation method (glance and grade or criteria and checklist) caused an improvement in variability. The problem of inter-examiner reliability and variability still existed.

Comparison of mineral trioxide aggregate and calcium hydroxide as pulpotomy agents in young permanent teeth (apexogenesis).

PURPOSE: The purpose of this study was to compare mineral trioxide aggregate (MTA) with calcium hydroxide (Ca(OH)2) clinically and radiographically as a pulpotomy agent in immature permanent teeth (apexogenesis). METHODS: Fifteen children, each with at least 2 immature permanent teeth requiring pulpotomy (apexogenesis), were selected for this study. All selected teeth were evenly divided into 2 test groups. In group 1, the conventional Ca(OH)2pulpotomy (control) was performed, whereas in group 2, the MTA pulpotomy (experimental) was done. The children were recalled for clinical and radiographic evaluations after 3, 6, and 12 months. RESULTS: The follow-up evaluations revealed failure due to pain and swelling detected at 6 and 12 months postoperative evaluations in only 2 teeth treated with Ca(OH)2. The remaining 28 teeth appeared to be clinically and radiographically successful 12 months postoperatively. Calcific metamorphosis was a radiographic finding in 2 teeth treated with Ca(OH)2 and 4 teeth treated with MTA. CONCLUSIONS: Mineral trioxide aggregate showed clinical and radiographic success as a pulpotomy agent in immature permanent teeth (apexogenesis) and seems to be a suitable alternative to calcium hydroxide.

Comparison of apexification with mineral trioxide aggregate and calcium hydroxide.

PURPOSE: The aim of this study was to compare mineral trioxide aggregate (MTA) with calcium hydroxide [Ca(OH)2] clinically and radiographically as materials used to induce root-end closure in necrotic permanent teeth with immature apices (apexification). METHODS: Fifteen children, each with at least 2 necrotic permanent teeth requiring root-end closure (apexification), were selected for this study. All selected teeth were evenly divided into 2 test groups. In group 1, the conventional calcium hydroxide apexification (control) was performed, whereas in group 2, the MTA apexification (experimental) was done. The children were recalled for clinical and radiographic evaluations after 3, 6, and 12 months. RESULTS: The follow-up evaluations revealed failure due to persistent periradicular inflammation and tenderness to percussion detected at 6 and 12 months postoperative evaluation in only 2 teeth treated with Ca(OH)2. The remaining 13 teeth appeared to be clinically and radiographically successful 12 months postoperatively. None of the MTA-treated teeth showed any clinical or radiographic pathology. CONCLUSIONS: Mineral trioxide aggregate showed clinical and radiographic success as a material used to induce root-end closure and is a suitable replacement for calcium hydroxide for the apexification procedure.