Comparative evaluation of three materials used for fragment reattachment in uncomplicated crown fracture-An in vitro study using bovine teeth.

BACKGROUND/AIMS: The recommended treatment for uncomplicated crown fractures is bonding the fractured fragment or the fragment reattachment. A paucity was identified regarding the studies comparing the efficacy of micro-hybrid and nanohybrid composites in fragment reattachment. Hence, the present study aimed to evaluate and compare three materials for bonding of fragments rehydrated by humidification in teeth with uncomplicated crown fractures. MATERIAL AND METHODS: Eighty mandibular bovine incisors with similar dimensions and free of any structural deformities were fractured similar to the technique followed in previous studies. Fracture was simulated, fragments, and stumps were coded, stumps were stored in artificial saliva and the fragments were dehydrated at room temperature and pressure. They were randomly assigned to Group-1 (no rehydration), Group-2 (rehydrated and bonded by flowable nanohybrid composite-3M Filtek Supreme Syringe Flowable Composite Resin-A2, Sao Paulo, Brazil), Group-3 (rehydrated and bonded by flowable micro-hybrid composite- Ruby Flow, InciDental, England, United Kingdom), and Group-4 (rehydrated and bonded by light-cured Glass-Ionomer-Cement-Voco Ionoseal, Cuxhaven, Germany). The samples were subjected to a universal testing machine to evaluate the force required to fracture the bonded fragments. RESULTS: The highest median value of the force required to fracture was recorded for Group 2 (208.4 N) followed by Group 3 (195.2). The force required to fracture the bonded fragments was lowest in Group 4 (67.2 N) which was lower than the negative control (131.4 N). The differences between the observations in Groups 2 and 3 were not found to be statistically significant. CONCLUSION: The nano and micro-hybrid composites showed greater force required to fracture than fragments bonded by LC-GIC. Dehydrated fragments bonded using nanocomposites performed better than rehydrated fragments bonded by using LC-GIC.

Methods and applications of finite element analysis in dental trauma research: A scoping review.

Finite Element Analysis (FEA) is vital for understanding dental traumatology (DT) biomechanics, aiding diagnosis, treatment planning, and outcome prediction. This review explores FEA applications in DT research, evaluates their quality and outcomes, and assesses methodological aspects. Accordingly, recommendations for future researchers are provided. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews and registered in Open Science framework. A comprehensive search using relevant text-words and MeSH terms was performed in established databases. The inclusion criteria encompassed all Finite element analysis (FEA)-based Dental traumatology (DT) studies without language or publication year restrictions. Risk of bias was assessed with the Risk of bias tool for the use of finite element analysis in dentistry (ROBFEAD) tool. Forty-six studies published from 2001 to 2023 were included in the qualitative synthesis. The studies were categorized into five domains and six subdomains based on objectives. Maxillary central incisors and surrounding structures were commonly modelled (n = 27). Most studies utilized Computed tomography (CT), Cone Beam CT, or micro CT. Traumatic injury forces ranged from 100 N to 2000 N, and occlusal forces ranged from 150 N to 350 N. All studies were rated as high risk of bias. Fory-six studies were categorized, with most focusing on stress distribution and fracture patterns in dento-alveolar structures under various conditions, while few assessed displacements. Methodological quality lacked robustness in model development and substructure properties. Future studies should address these limitations and enhance reporting practices.

Effect of wire diameter and extent of wire composite splint on the mobility of luxated and anchor primary teeth: A typodont study.

BACKGROUND/AIMS: The recommendations for splinting are well established for the injuries of permanent dentition; however, ambiguity still exists for the injuries in primary dentition. Hence, this study aimed to determine the most appropriate dimensions of stainless steel wire and its extent, for achieving the physiologic mobility in primary dentition. MATERIAL AND METHODS: This study was designed as an in vitro experiment by using a typodont model of primary dentition. The baseline mobility of primary maxillary incisors was calibrated to the physiologic mobility of natural primary incisors by using a Teflon tape wrapped around the roots of resin teeth. Splinting was done using a stainless steel wire of 0.2 mm (Group I), 0.3 mm (Group II), and 0.4 mm (Group III). These groups were subdivided (a, b, and c) on the basis of the extent of the splint, and pre splint mobility (Pre-PV) and post-splint mobility (Post-PV) were tested by Periotest M. The splint effect was calculated by subtracting Post-PVs and Pre-PVs. RESULTS: The normal values of mobility in healthy human volunteers ranged from 10.5 to 13. The overall splint effect was higher in Group III irrespective of the extent of the splint, whereas it was found to be the lowest in Group I (b and c). The splint effect increased with the extent of the splint in all the groups. Among all the groups, the splint effect on the anchor teeth was observed to increase with the extent of the splint and the diameter of the wire. CONCLUSION: The mobility of the injured and anchor teeth splinted with 0.2-mm stainless steel wire was similar to the pre-splint and physiologic mobility. The most favorable extension was one tooth adjacent to the injured tooth on each side for both 0.2- and 0.3-mm wires.

Risk factors associated with traumatic dental injuries in individuals with special healthcare needs-A systematic review and meta-analysis.

BACKGROUND/AIM: Individuals with special healthcare needs (SHCN) are more likely to sustain traumatic dental injuries (TDIs) due to distinct risk factors. The aim of this review was to assess various risk factors associated with TDIs in individuals with SHCN. MATERIALS AND METHODS: The protocol was designed according to the recommendations of the Cochrane-handbook, Joanna Briggs Institute, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42022357422). A comprehensive search was performed in PubMed, LILACS, Web of Science, EMBASE and Scopus using a pre-defined strategy without any limitation of language and year of publication. It was last updated on 25 April 2023. Studies addressing the TDIs in individuals with SHCN were included. Data extraction and analyses were performed, risk of bias (ROB) assessment was done using the Joanna Briggs Institute's critical appraisal tool, and a meta-analysis was performed using random-effects model. RESULTS: A total of 21 studies were included in the review. They were categorized according to the target disease/condition: cerebral palsy (n = 5), ADHD and autism spectrum disorders (n = 5), visually impaired (n = 4), and multiple disorders (n = 7). The studies showed variability in the design and methods; however, 17 out of 21 studies showed moderate to low ROB. Increased overjet and lip incompetence were the main risk factors reported in the studies. The commonest injuries were observed to be enamel and enamel and dentine fractures. CONCLUSION: The overall pooled prevalence of TDI in individuals with special healthcare needs was 23.16% with 20.98% in males and 27.06% in females. Overjet >3 mm and inadequate lip coverage were found to be associated with a higher risk of TDI in all the categories of individuals with special healthcare needs except ADHD and ASD. Falls at home in cerebral palsy, falls while walking and self-harm in ADHD and ASD, falls at home and collision in visual impairment, and unspecified falls in multiple disorders could be identified as the most common cause of TDI.

Quality analysis of the clinical practice guidelines for management of impacted maxillary central incisors: a systematic review.

PURPOSE: To assess the quality of clinical practice guidelines (CPG) for management of impacted central incisors. METHODS: Search was performed in PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane databases, and guideline-focused databases/repositories on 15-09-2022 without any limitations and was updated on 15-07-2023. Grey literature search was also performed. Two independent reviewers were involved in the study selection and data extraction. Quality assessment of the included CPG was performed by four independent appraisers using the AGREE-II instrument. The degree of agreement among the appraisers was calculated using the intraclass correlation coefficient (ICC). RESULTS: Five CPG were included in the review. The Ministry of Health, Malaysia (MHM) guideline obtained the highest scores in all six domains of AGREE-II and an overall score of 73% demonstrating the "highest" quality. The remaining four guidelines obtained overall "low-quality" scores ranging from 34.57-37.52%. The ICC scores ranged from 0.530 to 0.990 for various domains of AGREE-II. CONCLUSION: MHM guidelines demonstrated high-quality scores in domains of 'scope and purpose', 'clarity of presentation', 'applicability domain', and 'editorial independence', while others were found to have moderate or low quality. This review identified areas that can be addressed by future guideline developers to avoid these discrepancies.

Comparing the effectiveness of two educational methods for oral health management in COVID-19 pandemic among dental professionals.

AIM. The aim of this study was to train dentists on the different oral hygiene measures to be followed by COVID-19 patients via Webinar and Information Education Communication (IEC) Materials and compare the effectiveness of both. METHODOLOGY. A total of 100 dental professionals were included by non-probability convenience sampling. Webinar and IEC Materials on oral hygiene measures, oral symptoms, and management strategies during COVID-19 were created and training was conducted for all dental professionals who registered themselves. An online version of the self-administered questionnaire (English) was created on the official Edantseva website and circulated to all the registered participants to obtain the pre and post-training data. RESULTS. Out of the total 80 participants in the Webinar group, 47 were females and 33 were males. Comparing the mean total scores obtained by the participants in the webinar and IEC groups in the pre and post-test showed that there is a significant difference in the scores obtained by the participants in the two groups in the pre and post-test (p<0.01). CONCLUSION. Educating dentists via IEC Materials was effective in improving their knowledge regarding oral health management during the COVID-19 pandemic. IEC materials being handy and referable at any time was found to be more effective.

OXIS Contacts and Approximal Caries in Preschool Children: A Prospective Cohort Study.

The present prospective cohort study was conducted to evaluate the susceptibility of OXIS contact areas, namely, O (open type), X (point type), I (straight type), and S (curved type) in the development of approximal caries. We conducted this study among 953 school children with 3,812 contacts in Puducherry, India. At baseline, the contacts were assessed in accordance with OXIS criteria. At the end of 12 months, two calibrated dentists measured dental caries following the International Caries Detection and Assessment (ICDAS) criteria. Information about feeding practices, diet, and oral hygiene was collected by means of a structured questionnaire from each child's parent. Data were analyzed by unadjusted and adjusted Poisson regression analysis with a multilevel approach. The two levels of analysis were tooth and child. Of 3,812 contacts observed during the follow-up, 127 (3.3%) were observed as carious. Poisson regression analysis revealed a significant association between type of contact and caries prevalence (p < 0.05). The risk ratios for the development of approximal caries in X contacts were 2.4 (0.3-17.2), p value 0.38; in I contacts 4.9 (1.2-19.9), p value 0.027; and in S contacts 8.2 (1.9-34.2), p value 0.004, when compared with the O contacts. Among the child variables, male gender (relative risk [RR] = 2.1; 95% confidence interval [CI], 1.3, 3.5), parental supervision while toothbrushing (RR = 1.6; 95% CI, 1.1, 2.4), and the use of toothpaste (RR = 1.9; 95% CI, 1.3, 3.1) were found to be associated with approximal caries after adjustment for the other variables. Among the OXIS contacts, the S type was most susceptible to approximal caries due to its complex morphology, followed by I, X, and O.

Sugar-sweetened beverage consumption and socioeconomic status: A systematic review and meta-analysis.

BACKGROUND: Sugar-sweetened beverages (SSB) are an independent risk factor for obesity and other non-communicable diseases. Socioeconomic status (SES) is one of the key drivers for the purchase and consumption of SSBs among children and adults; however, there is a lack of strong evidence. This study aims to determine the association between SES and consumption patterns of SSBs across populations. RESULTS: The review was conducted according to PRISMA guidelines. PubMed, MEDLINE, Scopus, EMBASE, LILACS, Web of Science, Cochrane, and CINHAL databases were searched for relevant articles until 2022. Participants included children, adolescents, and adults who consumed different SSBs and were assessed based on their SES. The random-effects model was used to obtain the pooled odds ratio (OR). Twenty-one studies (152,070 participants) met the inclusion criteria. The risk of bias was assessed using the Newcastle-Ottawa tool, with the majority of the studies indicating medium to high quality. Eight ORs from four studies (34,454 participants) were considered for meta-analysis. Results showed those belonging to high SES had 48% lower odds of consuming the SSBs (OR 0.52; 95% CI: 0.42-0.61; p = 0.017). The overall quality of evidence was ascertained using GRADE criteria, illustrating a moderate certainty of evidence between SSB consumption and SES. CONCLUSION: Meta-analysis suggests that SES influences the consumption pattern of SSBs, with high SES having lower odds of SSB consumption.

Inflammatory mediators for predicting the risk of trauma-induced root resorption: A systematic review.

BACKGROUND/AIM: External inflammatory root resorption (EIRR) and external replacement root resorption (ERRR) are the most common adverse outcomes after luxation injuries or dental injuries. They are usually detected radiographically after considerable progression. It can be envisaged that evaluation of inflammatory mediators might serve as an objective and reliable method of predicting the risk of resorption. The aim of this systematic review was to assess the evidence regarding the risk of resorption and to provide future research directions. METHODS: An a priori protocol was prepared by a multidisciplinary expert group, as per the Cochrane handbook and PRISMA guidelines. The systematic search was conducted in six databases and grey-literature sources. Scrutiny of titles and abstracts, and later full-text articles was performed, and data were extracted. Risk of bias analysis was done by using the Joanna Briggs Institute's Critical Appraisal Checklist for analytical cross-sectional and cohort studies. RESULTS: Eight studies were included in the systematic review and could be categorized as per the source of biomarkers, namely epithelial cells from mucosa, gingival crevicular fluid and extracted teeth. The studies utilizing epithelial cells had been conducted between 2015 and 2018 in Brazil and did not find any correlation with EIRR. Two of the studies with extracted teeth found differences in the immunologic profiles of teeth with resorption. Three studies evaluating gingival crevicular fluid found increased levels of dentine sialoprotein and Interleukin-1-α. CONCLUSION: Among the three sources, the inflammatory gingival crevicular fluid appeared to be the most non-invasive source of biomarkers for predicting trauma-induced root resorption, although the evidence about this came from two studies with moderate and one study with high risk of bias. The primary studies in this systematic review showed variability in terms of the sample sizes, age of the patients, the grading/classification of trauma-induced resorption and the evaluation methods which must be addressed by future researchers.

Cone-Beam Computed Tomographic Assessment of Maxillary Sinus Characteristics in Patients With Cleft Lip and Palate: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to evaluate the maxillary sinus characteristics of patients with cleft lip and palate (CLP).The study included manuscripts which met the following criteria: (1) study of individuals with CLP in any age group or gender and (2) study of individuals in whom assessment of maxillary sinus characteristics had been done by cone-beam computed tomography. Studies with (1) individuals having special health-care needs and (2) individuals with any syndrome affecting the development of the head and neck were excluded.In total, 11 articles were included in the review, based on the inclusion and exclusion criteria. Pooled maxillary sinus volume (MSV) on the cleft sides of patients with unilateral cleft lip and palate (UCLP) was found to be 9433.14 mm3 (95% CI, 7453.99-11 412.30), which was significantly smaller than that of controls. The meta-analyses also revealed significantly reduced MSV on the cleft sides of patients with UCLP. The differences between cleft and noncleft sides of the patients with UCLP were not found to be statistically significant. Strength-of-evidence was found to be moderate in 4 characteristics, along with 10 out of 11 articles showing low risk-of-bias.It was concluded that MSV was reduced and mucosal thickening was increased/present in patients with CLP as compared with controls. The differences between MSV of cleft and noncleft sides of the patients with UCLP could not be established. However, heterogeneity was found in terms of sample size, stratification of samples by age, and evaluation of some confounding factors.

Evaluation of two rehydration protocols for fractured tooth fragments for characteristics of penetration of resin tags using confocal laser scanning microscopy.

BACKGROUND: Fragment reattachment is the recommended treatment modality in uncomplicated crown fractures. There is a paucity of literature regarding the mechanisms responsible for increased resistance to fracture after fragment rehydration in such cases. Hence, the aim of this proof-of-concept study was to decipher the microscopic changes in the penetration characteristics of resin in tooth fragments after different rehydration protocols. MATERIAL AND METHODS: Sixty bovine incisors free of structural deformities were fractured as per a standard protocol and the fragments were stored in saline at 4°C. They were randomly allocated into three groups (n = 20)-Group 1: negative-control, no-rehydration, Group 2: rehydration by immersion in distilled water for 15 min, Group 3: rehydration by humidification for 15 min. They were subjected to the "experimental bonding protocol" using an eighth-generation bonding agent mixed with rhodamine-B dye. The samples were subjected to decalcification and sectioned into cubical blocks (2 × 2 × 2 mm3 ). They were embedded in paraffin wax, sectioned by an ultramicrotome and evaluated by using a confocal laser scanning microscope. The depths and width of the resin tags were assessed by image analysis software, and the number of tags was counted manually by blinded evaluators. Statistical analysis was done with Stata-14. RESULTS: The depth of penetration of the resin tags was greatest in Group 2 (927.81 ± 280.38 µm) followed by Group 3 (902.03 ± 371.85 µm) and Group 1 (287.74 ± 124.80 µm). Similarly, the width of the penetrated resin tags was greatest in Group 2 (58.29 ± 21.15), followed by Group 3 (35.53 ± 22.15) and Group 1 (23.89 ± 6.88). The number of resin tags in the majority of the samples in Group 1 had less than 25 tags (65%), whereas there were more than 25 tags in Group 2 (70%) and Group 3 (75%). These differences were statistically significant (p < .05). CONCLUSION: The resin penetration, as observed by the number of tags and their depth and width, was significantly affected by the rehydration of the fragments. The fragments rehydrated in the distilled water had greater penetration of resin tags than those rehydrated in a humidification chamber.

Does dental trauma have impact on the oral health-related quality of life of children and adolescents?

RESEARCH QUESTION: Does dental trauma have impact on the oral health-related quality of life of children and adolescents? RESEARCH PROTOCOL: Protocol was designed as per the best practices of evidence-based medicine, guidelines for umbrella reviews and registered in PROSPERO. LITERATURE SEARCH: PubMed, Scopus, Embase, Web of Sciences and Lilacs were searched for studies meeting the inclusion criteria from start of databases to 15th July 2021. Grey literature and registries of systematic review protocols were also searched. Hand searching of the references of included articles was also performed. The literature search was updated on 15th October 2021. Scrutiny of the titles and abstracts and later full text was done as per the inclusion and exclusion criteria. DATA EXTRACTION: Self-designed pre-piloted form was used by two reviewers. QUALITY APPRAISAL: AMSTAR-2 was used to assess the quality of systematic reviews, PRISMA was used to check reporting-characteristics and citation-matrix was used to evaluate study-overlap. Quality of evidence was assessed by using Kohler's-criteria. DATA ANALYSIS: Qualitative synthesis was performed for describing the study characteristics, details of sampling and the tool of OHRQoL used. The meta-analytic data was used for evaluating the evidence and its strength for each of the outcomes. RESULTS AND INTERPRETATION: A significant impact of all types of TDI on OHRQoL in children and adolescents was observed. The effect of uncomplicated TDI on OHRQoL in children and all ages showed no difference from controls. Though the quality of evidence in these interpretations was weak.

Global status of knowledge of parents for emergency management of traumatic dental injuries: a systematic review and meta-analysis.

RESEARCH PROTOCOL: The protocol was developed as per the recommendations of the Cochrane-handbook and PRISMA and was registered in PROSPERO. LITERATURE SEARCH: Search was performed by using MeSH-Terms and keywords in PubMed, Scopus, Embase, Web of Sciences, Lilacs, and Cochrane databases and gray literature sources 15th July 2022. There were no limits regarding the year of publication and language. Hand-searching of included articles was also performed. Titles and abstracts and later full texts were screened as per strict inclusion and exclusion criteria. DATA EXTRACTION: Self-designed pilot-tested form was used. QUALITY APPRAISAL: Risk of bias was analyzed through Joanna-Brigg's-Institute's-critical appraisal checklist. The evidence analysis was done by using the GRADE approach. DATA ANALYSIS: Qualitative synthesis was performed for describing the study characteristics, details of sampling, and results of various questionnaires. It was discussed by the expert group and presented using KAP heat map. Meta-analysis was done by using Random Effects Model. RESULTS AND INTERPRETATION: The risk of bias was found to be low in seven and moderate in one study. It was observed that >50% of parents knew about the urgency to seek professional advice after TDI. Only <50% of parents were confident of their ability to identify the injured tooth, clean the soiled avulsed tooth, and perform the replantation. Appropriate responses regarding immediate action after tooth avulsion were given by 54.5% (95% CI: 50.2-58.8, p = 0.042) of parents. The knowledge of the parents regarding the emergency management of TDI was found to be inadequate. The majority of them were interested in obtaining information about dental trauma first aid.

Trabeculectomy with Ologen implant versus trabeculectomy with P 50 Ex-PRESS shunt in primary open-angle glaucoma.

Background: This is the first randomized controlled trial of trabeculectomy with Ex-Press Shunt versus Ologen implant in primary open-angle glaucoma (POAG) in Indian eyes. Methods: A prospective randomized controlled trial of patients of POAG treated with two different methods of augmented trabeculectomy. Group A with Ex-PRESS shunt (P50 model) and Group B with Ologen implant. Surgical success was defined as intraocular pressure of 21 mm Hg or lower at 6 months postoperative. Results: N = 40 eyes of 33 patients. Baseline IOP in Group A was 23.70 ± 4.6 mm Hg (Range 22-36 mm Hg), and Group B was 26.00 ± 4.0 mm Hg (Range 23-36 mm Hg). Surgical success was achieved in 85% of patients in both Groups. Change in IOP from baseline was statistically significant in both groups at 1, 4, 8, 12 weeks, and 6 months postoperative. No statistically significant difference in the change in IOP between the two groups. Postoperative complications were lesser in Group A compared to Group B, in both early (35% vs 50%) and late stage (20% vs 30%). The drop in visual acuity became statistically insignificant at 4 weeks in Group A and 8 weeks in Group B. Conclusions: There is no difference between the surgical success rates of trabeculectomy with Ex-PRESS Shunt versus Ologen. However, the Ex-PRESS shunt fares better with lower complication rates and faster visual recovery than the Ologen group.

Determining the effect of climate and profession on dry eye disease: A prevalence study among young males in north, north-west and central India.

Background: Ocular tear film and the ocular surface together represent a dynamic playground of various protective factors against environmental influencers. Surrounding environment and geoclimatic milieu are the pertinent and continuous influencing factors. Prevalence study of Dry eye disease (DED) in various climatic conditions and professions provides an insight into this peculiar aspect of DED and human geography. Methods: This was a hospital based, cross-sectional, comparative, analytical observational study. 1840 young soldiers between 25 and 45 years of age were studied. Divided in five climate groups based on Köppen-Geiger climate classification system the subjects were sub-grouped into professions exposed to known aggravating environmental factors. The ocular surface was examined for signs and symptoms of DED and its prevalence and risk ratio for different climates and professions were calculated. Results: Highest prevalence of DED was found in cold desert climate and among visual display unit (VDU) users. Least prevalence was seen in highland type of climate and among people involved in professional exposed to high temperature. Prevalence of DED based upon the signs and ocular surface disease index (OSDI) was calculated and stratified with risk ratio for climatic conditions and professions. Conclusion: Different climatic conditions and professions had different prevalence of signs, symptoms of OSD and DED which indicated its influence on prevalence of the disease.

An effective method to summarise the outcomes of questionnaire-based studies in systematic reviews.

With an increased number of questionnaire-based knowledge, attitude, practice and other types of studies, there is a need to perform evidence-based research in such designs as well. The systematic reviews (SR) and meta-analyses (MA) of the questionnaire-based studies are difficult to conduct and summarise due to the wide variations in the questions included in each of them. The presentation of these reviews often leads to ambiguous conclusions, and meta-analysis is not possible due to wide heterogeneity. This paper aims to highlight a method known as the 'Knowledge-Attitude-Practice' or 'KAP' Heat Map, which was developed and validated for the effective presentation of the outcomes of varied questionnaires in systematic reviews.

Comparative evaluation of fragment reattachment protocols for the management of teeth with crown-root fractures.

BACKGROUND/AIM: A crown-root fracture is a fracture of both the crown and the root of a tooth. The International Association of Dental Traumatology (2020) guidelines recommended fragment reattachment and stabilization of loose fragments as an immediate management protocol for uncomplicated crown-root fractures. However, the lack of evidence and unpredictability make it a less popular treatment option. The aim of this study was to compare three protocols of fragment reattachment for the management of teeth with crown-root fractures. METHODOLOGY: Eighty mandibular bovine incisors with similar dimensions and no structural deformities were selected and randomized into four groups: Group I (Control/sound teeth); Group II (no rehydration); Group III (rehydration in distilled water for 15 min) and Group IV (rehydration in a humidification chamber for 15 min). A fracture was simulated to extend from the labial side of the middle-third of the crown to the palatal side of the cervical-third of the root. Fragments were exposed to the environment under normal temperature and pressure. Fragments were later reattached as per the standard protocol following the rehydration as specified for each group. Samples were subjected to thermocycling, and the force required to fracture them was evaluated by using a universal testing machine. RESULTS: The highest mean force required to fracture was seen in Group IV (208.27 ± 75.99 N) followed by Group III (182.01 ± 90.13 N) and Group II (158.85 ± 68.04 N). These differences were statistically significant. Comparison of the mean difference of force required to fracture between pairs of groups revealed statistically significant mean differences only between the controls and each experimental group. CONCLUSION: The force required to fracture the reattached fragments in teeth with crown-root fractures was affected by rehydration of the fragments. The force was higher in fragments reattached after rehydration, and the highest force was required in the teeth that had been rehydrated in a humidification chamber.

'CARE compliance' of case reports published in Dental Traumatology in the past two decades: A bibliometric analysis.

BACKGROUND/AIMS: The journal Dental Traumatology (DT) is one of the best resources in the field of dental traumatology. It has always encouraged publication of case reports of good quality. The CARE statement (2011) was developed for uniform and transparent reporting of cases in medical sciences. Since case reports are inseparable from the DT literature, the aim of this bibliometric-analysis was to evaluate the case reports published in the DT in the last two decades (2001-2021) and assess their compliance regarding CARE guidelines for elucidating the trends in DT and the reporting quality of these papers. METHODOLOGY: Two authors independently observed the tables of contents in all issues of DT from 2002-2021 and identified case reports. Selected articles were scrutinized to determine their eligibility. Data extraction was performed, case reports were segregated into domains, and their CARE compliance was evaluated by using a self-designed-validated method. Differences between the case reports published in two decades (2002-2011 and 2012-2021) were analysed with the Chi-square test. RESULTS: A total of 1612 articles published between February 2002 and October 2021 were scrutinized to identify 357 case reports with 277 from the period of 2002-2011 and 80 between 2012 and 2021. The highest number of case reports originated from Asia (2002-2011:135, 2012-2021:28). The CARE compliances of the majority of reports in the decade of 2002-2011 were between 75 and 85% (good) while the CARE compliances of the majority of reports from 2012-2021 were between 85 and 95% (very good) or >95% (excellent). These differences were statistically significant (p < .005). CONCLUSIONS: The number of case reports published in the decade of 2002-2011 were more than three times the number of case reports published in the decade of 2012-2021. The highest number of reports in both decades were from Asia and belonged to the therapeutic and prognostic domains. The CARE compliances of the reports in the decade of 2012-2021 were better than those from 2002-2011.

Comparison of three protocols for the management of re-fracture of teeth with uncomplicated crown fractures.

BACKGROUND: Crown fractures restored by fragment reattachment are liable to re-fracture, which may cause fragment dislodgement. There is a paucity of literature regarding management of fragment reattachment cases following a further fracture. Hence the aim of the present in-vitro study was to evaluate and compare the efficacy of three different management protocols for such scenarios. METHODOLOGY: Eighty maxillary bovine incisors without structural deformity and with similar dimensions were fractured as per the standard protocol. They were subjected to drying for 24 hours and the fragments were rehydrated by placing them in a humidification chamber for 15 minutes. They were then reattached by using flowable light-cured composite resin. The teeth (n=20) were fractured again by fixing them in a mechanical frame and using a mallet. They were randomly allocated to three experimental groups. (Group I mechanical abrasion and fragment reattachment, Group II mechanical abrasion, humidification and reattachment, Group III mechanical abrasion and composite restoration, and Group IV positive control with no re-fracture). The samples were thermocycled and the force required to fracture was tested by using a universal testing machine (Instron-3360, USA). This was done by applying a tangential load with a speed of 1 mm/min to the teeth with a 500-kg load cell. Statistical analysis of the results was performed using ANOVA and the independent t-test. RESULTS: The highest force required to fracture was reported in Group IV (333.26 ± 66.69N) while the lowest was in Group II (254.86 ± 105.23N). The forces in Group I and Group II were 258.36 ± 65.78N and 298.02 ± 97.94N, respectively (p=0.016, F=3.68). The independent t-test between the groups revealed a significant difference between Group I and Group IV (p= 0.001) and Group II and Group IV (p=0.009). CONCLUSION: The force required to fracture was significantly lower in the groups involving attachment of the re-fractured fragments. Among the experimental groups, the group with composite restoration required the highest force to fracture.

Success of medicaments and techniques for pulpotomy of primary teeth: An overview of systematic reviews.

BACKGROUND: Pulpotomy is an effective, vital pulp therapy procedure for caries-affected or traumatized primary teeth. Though its efficacy is widely accepted, the superiority of medicaments and techniques remains debatable. AIM: The aims of this review were to compare the success rates of various pulpotomy medicaments or techniques, assess the methodological quality of reviews, and grade the level of evidence for each comparison. DESIGN: This review followed the principles of evidence-based medicine and recommendations for the overview of systematic reviews. An a priori protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021244489). A comprehensive literature search was performed by two reviewers, and studies were selected from various databases according to predefined criteria. Two reviewers independently used a self-designed pilot-tested form to extract data from the selected studies. A quality analysis was performed using A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) and the ROBIS tool. Reporting characteristics and overlap of the primary studies were also assessed. We used modified Köhler's criteria for evaluating the quality of evidence for outcomes of included systematic reviews and meta-analyses. RESULTS: The scrutiny of 62 full-text articles resulted in the inclusion of eight systematic reviews. The quality of four of the reviews was found to be critically low, and the overlap of primary studies in the meta-analyses was found to be high. Pulpotomy medicaments/techniques, except calcium hydroxide, had success rates of more than 80% for all domains and time periods. Most of the comparisons revealed no differences in the clinical, radiographic, or overall success rates. Mineral trioxide aggregate, however, was found to have better radiographic and overall success rates than calcium hydroxide at periods greater than 12 and 18 months. It also had a greater radiographic success rate than full-strength/1:5 diluted and full-strength formocresol at 24 months. Formocresol was found to have better overall success rates than calcium hydroxide at all time periods and better radiographic success rates at 12 months. Only 12 of the 63 comparisons had suggestive or weak evidence, whereas all others had either negligible evidence or insufficient data. CONCLUSIONS: The pulpotomy medicaments/techniques, except calcium hydroxide, showed success rates of more than 80%, whereas most comparisons revealed no differences. Mineral trioxide aggregate, however, was found to be better than calcium hydroxide and formocresol in several respects. This study highlights the lack of evidence regarding the choice of pulpotomy agents for the treatment of caries-affected primary teeth and elucidates the domains that require primary studies in the future.