Three-dimensional qualitative and quantitative analyses of the effect of periradicular lesions on the outcome of regenerative endodontic procedures: A prospective clinical study.

OBJECTIVES: Qualitative and quantitative evaluation of the outcomes of regenerative endodontic procedure (REP) on human immature necrotic teeth with apical periodontitis using cone-beam computed tomography (CBCT) MATERIALS AND METHODS: Immature permanent teeth (n = 50) with necrotic pulp and periradicular pathosis were treated with a cell-homing concept-based REP. Following the procedure, a limited field-of-view CBCT scan was obtained. At each recall session (6, 12, 18 months), clinical tests were performed, and a digital periapical radiograph was taken. When significant radiographic changes were evident in the follow-up, a final CBCT scan was taken for qualitative and quantitative assessment. These initial and follow-up CBCT scans were assessed for quantification of changes in root length, pulp space diameter and periradicular lesion size. The data were statistically analysed using t test, one-way ANOVA, post hoc test and paired t test (P = 0.05). RESULTS: Of the teeth, 94.6% were clinically successful based on the lack or regression of signs and symptoms after 48 months follow-up. REP resulted in a statistically significant increase in root length, decrease in pulp space diameter and periradicular radiolucency (P < 0.05). CBCT images illustrated various patterns of root maturation including an increased thickening of the canal walls and continued root maturation (37.1%), continued root development with the apical foramen remaining open (57.1%), severe calcification (obliteration) of the canal space (2.9%) and hard tissue barrier formation in the canal space between the coronal plug and the root apex (2.9%). CONCLUSION: This study highlighted that the expected outcome of radiographic root development was less predictable when immature permanent teeth with periradicular pathosis were treated with REP. CLINICAL RELEVANCE: The size and extent (expansion/destruction of the cortical plate) of periradicular lesions and abscesses influence the outcome of REP. These factors must be taken into consideration during treatment planning.

Effect of CO2 Laser and 1.23% Acidulated Phosphate Fluoride on Acid Resistance and Fluoride Uptake of Human Tooth Enamel: An In Vitro Assessment.

AIM: To evaluate the effectiveness of CO2 laser treatment before applying 1.23% acidulated phosphate fluoride (APF), through topically applied 1.23% APF solution, and after applying 1.23% APF on acid resistance and fluoride uptake of the enamel. MATERIALS AND METHODS: Sixty non-carious human premolars were extracted due to the orthodontic reason and stored in distilled water solution under refrigeration. Using a water-cooled diamond disc, enamel slabs of 4 mm × 4 mm × 1.5 mm were cut from the buccal surface of each tooth. Sixty samples were randomly divided into one control group and five test groups of 10 premolars each. Solution was prepared for wet chemical analysis followed by fluoride analysis that was carried out using a fluoride ion selective electrode (Thermo Scientific Orion 4-Star Plus ISE Meter). The weight of enamel (WE) was determined from the amount of calcium (Ca) etched away considering the fact that the Ca content of the human enamel is 37.4 wt%. The subgroups were statistically analyzed using ANOVA for fluoride determination and evaluation of acid resistance. RESULTS: There was a significant increase in acid resistance of enamel slabs when treated individually or in combination of a low-power CO2 laser and 1.23% APF solution. Application of 1.23% APF solution after low-power CO2 laser treatment showed maximum increase in acid resistance. CONCLUSION: Application of a low-power pulsed CO2 laser through topically applied 1.23% APF solution resulted in a detrimental effect of the human tooth enamel with resultant decrease in acid resistance. High fluoride uptake does not necessarily indicate increased acid resistance. CLINICAL SIGNIFICANCE: The present study provides evidence that a low-power CO2 laser can be used effectively in combination with topically applied 1.23% APF solution in order to make the enamel more resistant to acid attack, thereby helping in controlling dental caries.

Prevalence of Traumatic Injuries to Anterior Teeth in 9-14 Year School-going Children in Mumbai, India.

AIM: The aim of this study is to assess the prevalence and causes of traumatic dental injury (TDI) in 9-14 year school-going children in Mumbai, Maharashtra, India. MATERIALS AND METHODS: A cross-sectional study consisting of 2,055 primary and secondary school-going children aged between 9 and 14 years, from 20 municipal corporation schools of Mumbai city, was selected through a stratified random sampling technique. Children were examined clinically for any signs of TDI in the permanent anterior teeth in their respective schools by two examiners trained in using WHO criteria for oral and dental examination. Data analysis involved descriptive statistics including a frequency distribution. RESULTS: The prevalence of TDI to anterior teeth in school children of Mumbai was 16.3%. The commonest cause of trauma was fall followed by sports activities, collision, and road traffic accidents. CONCLUSION: The occurrence and various etiologies of traumatic injuries to maxillary anterior teeth in school children of Mumbai were approximately the same as found in other countries. CLINICAL SIGNIFICANCE: The present study gives a bird's eye view on the prevalence and common etiology of TDI in school children of Mumbai.

Comparative evaluation of the clonogenic capacity of periodontal ligament fibroblasts in Hank's balanced salt solution and egg albumen: An in vitro study.

BACKGROUND/AIM: The type of storage media for short-term storage of an avulsed tooth is a critical determinant for the success of tooth replantation. If immediate replantation of an avulsed tooth is not possible, it is advised to store the tooth in a suitable storage medium. The viability and clonogenicity of periodontal ligament fibroblasts (PDLF) determines the success of replantation of an avulsed tooth. The aim of this study was to evaluate the effect on the clonogenic capacity of PDLF's upon storage in Hank's balanced salt solution (HBSS) and egg albumen. METHODS: Fibroblast cell culture was established from a human premolar tooth extracted for orthodontic purposes. The PDLF cells thus obtained were treated with either Dulbecco's modified Eagle's medium (DMEM; as a positive control), HBSS, or egg albumen for different durations at room temperature and then allowed to grow in DMEM medium until visible colonies appeared which were then fixed, stained, and scored manually. RESULTS: With increase in the duration of storage in both egg albumen as well as HBSS, there was a reduction in the clonogenic capacity of the PDLF's as compared to DMEM. However, storage in egg albumen led to a significant reduction in the clonogenic capacity of PDLF's (8%-16% for egg albumen) compared to HBSS (80%-90%). CONCLUSION: Due to its limited ability to support the clonogenicity of PDLF's, egg albumen is a poor storage medium for an avulsed tooth compared to either DMEM or HBSS.

In Vitro Efficacy of Apical Negative Pressure Irrigation in Primary Teeth: A Smear Layer Analysis.

Aim and background: This study aimed to assess the efficacy of root canal debris removal in primary teeth through irrigation using the Endo-Irrigator Plus (CWAIS). Materials and methods: A total of 25 primary mandibular first molars were divided into five groups, with five teeth in each group. After determining the working length and performing biomechanical preparation, groups I and II were subjected to hand and rotary instrumentation (ProTaper, Dentsply, United States of America) with conventional syringe irrigation with positive pressure, while groups III and IV were instrumented using hand and rotary instrumentation with positive and negative pressure irrigation employing the Endo-Irrigator Plus (CWAIS) system. Sodium hypochlorite (5.25%) and ethylenediaminetetraacetic acid (EDTA) (17%) were used as irrigants. Group V served as the control group, undergoing only root canal access opening. The removal of the smear layer was analyzed at the cervical, middle, and apical thirds of the canal using environmental scanning electron microscopy (SEM). Statistical significance was set at p < 0.05. Results: Statistically significant differences were observed among all groups at the cervical, middle, and apical levels (p < 0.05). Groups III and IV exhibited significantly lower smear scores at all levels, particularly in the apical third, as observed through SEM examination. Conclusion: The use of the Endo-Irrigator Plus (CWAIS) system demonstrated superior debridement of intracanal debris in primary teeth compared to the positive pressure irrigation method. How to cite this article: Badnaware SD, Kakade A, Takate V, et al. In Vitro Efficacy of Apical Negative Pressure Irrigation in Primary Teeth: A Smear Layer Analysis. Int J Clin Pediatr Dent 2024;17(6):653-657.

Effect of Different Preparation Techniques on Root Canal Geometry: An In Vitro Study.

Aim and objective: To compare and evaluate canal preparation using hand stainless steel files, hand ProTaper files, and rotary ProTaper files for change in root canal geometry in terms of surface area and volume changes assessed by computed tomography. Materials and methods: The present study was conducted in Nair Hospital and Dental College, Department of Pediatric and Preventive Dentistry in collaboration with insight CBCT, imaging technologies. A total of 36 extracted human primary mandibular second molars were collected from the Department of Pediatric and Preventive Dentistry. All the teeth were scanned using cone-beam CT (i-CAT CT Scanner Next Generation, Imaging Sciences International) preoperatively and postoperatively to assess the mean absolute change in surface area and mean change in the volume of all the canals at different levels with the use of hand stainless steel files, hand ProTaper and rotary ProTaper files. Results: ProTaper instruments, both hand ProTaper and rotary ProTaper caused significant changes in the surface area in the coronal thirds and middle thirds of the canal when compared to hand stainless steel files. No difference was found in surface area and volume changes between hand ProTaper and rotary ProTaper instrumentation. Conclusion: Use of ProTaper instruments for preparation of deciduous teeth can render benefit of an improved canal preparation to facilitate better obturation and successful root canal therapy. How to cite this article: Bheda P, Kakade A, Takate V, et al. Effect of Different Preparation Techniques on Root Canal Geometry: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(S-1):S71-S79.

Oral Health Assessment of Children with Autism Spectrum Disorder in Special Schools.

BACKGROUND: Sensory over-responsivity is an important factor influencing the ability of children with an autism spectrum disorder to receive proper oral care. Dental care remains the most prevalent, unmet health care need for children with special health care needs. AIM AND OBJECTIVE: To assess the oral health of children with autism in special schools. MATERIALS AND METHODS: A cross-sectional study was conducted to record the oral health problems of 142 autistic children attending special schools across the suburbs of Mumbai city in India. Clinical examination was carried out for the presence of dental plaque, gingivitis, caries, restorations, traumatic injuries, and self-injurious habits. The participants were divided into three groups based on their age. RESULTS: Children with primary and mixed dentition had a higher incidence of dental caries when compared with the permanent dentition group. Good oral hygiene was observed in the study population with a mean OHI-S score of 0.88 ± 0.79. Traumatic dental injuries, bruxism, drooling of saliva from the corner of the mouth, and self-injurious habits were also recorded. CONCLUSION: Due to the nature of their neurological deficit and difficulty in providing dental treatment, it is recommended that preventive dental care be enforced on these children. HOW TO CITE THIS ARTICLE: Santosh A, Kakade A, Mali S, et al. Oral Health Assessment of Children with Autism Spectrum Disorder in Special Schools. Int J Clin Pediatr Dent 2021;14(4):548-553.

Ultrasonography as a diagnostic aid for a neonate with gingival swelling in a COVID-19 neonatal intensive care unit.

COVID-19 pandemic has impacted all the aspects of life and has emerged as the biggest challenge to the health-care sector. Dental fraternity has also taken its significant impact since the transmission of disease is primarily through aerosol droplets. Management of infants with orofacial anomalies such as natal and neonatal teeth born to COVID-19-positive mothers is another challenge due to unavailability of dental facilities in the isolation wards. In such unforeseen circumstances, out-of-routine approaches such as extraoral mandibular ultrasonography were performed for the management of a congenital intraoral swelling in an infant and are being described in this case report.

Three-dimensional semi-automated volumetric assessment of the pulp space of teeth following regenerative dental procedures.

The volumetric change that occurs in the pulp space over time represents a critical measure when it comes to determining the secondary outcomes of regenerative endodontic procedures (REPs). However, to date, only a few studies have investigated the accuracy of the available domain-specialized medical imaging tools with regard to three-dimensional (3D) volumetric assessment. This study sought to compare the accuracy of two different artificial intelligence-based medical imaging programs namely OsiriX MD (v 9.0, Pixmeo SARL, Bernex Switzerland, https://www.osirix-viewer.com ) and 3D Slicer ( http://www.slicer.org ), in terms of estimating the volume of the pulp space following a REP. An Invitro assessment was performed to check the reliability and sensitivity of the two medical imaging programs in use. For the subsequent clinical application, pre- and post-procedure cone beam computed tomography scans of 35 immature permanent teeth with necrotic pulp and periradicular pathosis that had been treated with a cell-homing concept-based REP were processed using the two biomedical DICOM software programs (OsiriX MD and 3D Slicer). The volumetric changes in the teeth's pulp spaces were assessed using semi-automated techniques in both programs. The data were statistically analyzed using t-tests and paired t-tests (P = 0.05). The pulp space volumes measured using both programs revealed a statistically significant decrease in the pulp space volume following the REP (P < 0.05), with no significant difference being found between the two programs (P > 0.05). The mean decreases in the pulp space volumes measured using OsiriX MD and 3D Slicer were 25.06% ± 19.45% and 26.10% ± 18.90%, respectively. The open-source software (3D Slicer) was found to be as accurate as the commercially available software with regard to the volumetric assessment of the post-REP pulp space. This study was the first to demonstrate the step-by-step application of 3D Slicer, a user-friendly and easily accessible open-source multiplatform software program for the segmentation and volume estimation of the pulp spaces of teeth treated with REPs.

Dental management of a child with Wiskott Aldrich syndrome prior to bone marrow transplant: A case report.

AIM: Orodental manifestations are commonly presented in Wiskott Aldrich Syndrome (WAS). The purpose of this paper is to report a case of dental management of a 5-year-old male child with WAS before Hematopoietic Stem Cell Transplantation (HSCT). Such patients are more prone to infection due to pretransplantation chemotherapy and posttransplantation immunosuppression; thus, it becomes imperative to eliminate all potential sources of infection before transplantation. MATERIALS AND METHODS: Fluctuating blood parameters before the dental procedure was an important challenge in rendering dental treatment. Dental procedures were carried out under general anesthesia by maintaining the hematological parameters with blood and platelet transfusion. The conventional dental treatment may not be applicable in such patients as failure of dental treatment can cause the failure of HSCT, and it has to be modified based on the clinical acumen and recommendations. CONCLUSIONS: This case report focuses on the measures to be taken before, during, and after the dental procedure to ensure the success of the dental therapy and prevent failure of HSCT due to residual dental foci of infection. A multidisciplinary approach involving a pedodontist, a pediatrician, and a hematologist can improve the quality of life of such patients.

Assessment of Inhibition of Mineral Loss from Human Tooth Enamel by Carbon Dioxide Laser and 1.23% Acidulated Phosphate Fluoride.

AIMS AND OBJECTIVES: The efficacy of carbon dioxide (CO2) laser irradiation combined with fluoride in inhibiting enamel demineralization has been demonstrated by several laboratory investigations. However, there are very few reports about the in situ or in vivo caries preventive effect of CO2 laser combined with topical fluoride on dental enamel. Hence, an in situ study was designed and carried out to assess inhibition of mineral loss from human tooth enamel by CO2 laser and 1.23% acidulated phosphate fluoride (APF). MATERIAL AND METHODS: Impressions of upper and lower arch of the volunteers were made in alginate impression material. Study models were poured, duplicated, and duly labeled. On the working model, appliances were fabricated in acrylic resin to fit the upper dental arch of the volunteers. Four enamel slabs (one from each group) were fitted on the palatal surface of the appliance as close as possible to posterior teeth. Surfaces of slabs were kept below the outer surface of acrylic. The analysis was done using SPSS version 15 (SPSS Inc., Chicago, IL, USA) Windows software program. RESULTS: Statistically significant increase in inhibition of mineral loss of enamel slabs when treated individually or in a combination of low power CO2 laser and 1.23% APF solution. The application of 1.23% APF solution after low power CO2 laser treatment showed maximum inhibition of mineral loss. CONCLUSION: The combined use of this specific laser treatment plus fluoride was more successful than either laser treatment or fluoride alone in the inhibition of mineral loss in the mouth. The results of this study also suggest that the combination of low power laser treatment with fluoride therapy may be effective as a caries inhibition treatment.

Tamponade effect of resorbable biological barrier in quality of obturation in primary molar.

AIM: Physical properties of obturating materials have a direct effect on the quality of obturation; less viscous material will tend to extrude beyond the apex. We hypothesize that the use of absorbable gelatin sponge (AGS) can prevent the extrusion of these materials. This study aimed to evaluate the quality of obturation in root canals filled with iodoform-calcium hydroxide (Metapex) premixed paste and Metapex with AGS (MAGS) in primary molars. METHODS: This in vivo study comprised 60 primary mandibular molars which after instrumentation were divided into 2 groups according to the obturation material used, Metapex and MAGS, followed by radiographic evaluation to assess the quality of the obturation. The χ2 -test was applied for statistical analysis. RESULTS: There was a statistically significant difference between Metapex and MAGS groups in achieving optimum obturation (P < .001). Metapex and MAGS exhibited 86.65% and 38.88% optimum obturation respectively. The overfilling of root canals effectively reduced from 38.88% to 4.44%. CONCLUSION: The addition of AGS to Metapex causes a "tamponade effect", which reduces the tendency of Metapex to extrude beyond the root apex. Root canal obturation using a modified filling paste like MAGS is effective in obtaining optimum obturation in primary teeth.

Scanning electron microscopic observation of primary tooth dentin following final irrigation with 95% ethanol: An in vitro study.

BACKGROUND: The beneficial effects of irrigants during endodontic treatment are well known; however, it may have some deleterious effects on the internal root canal wall, thereby altering its physical properties. AIM: The purpose of the study was to assess the effect of 95% ethanol on morphological characteristics of primary root dentin. MATERIALS AND METHODS: Biomechanical preparation was done in twenty extracted single-rooted primary anterior teeth using Rotary ProTaper Universal System. Samples were divided into two groups based on the final irrigation protocol: nonalcohol group (NAG) and alcohol group (AG). 3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid were used for irrigation in both the groups, whereas 95% ethanol was used as a final irrigant in AG. After the treatment, these teeth were longitudinally sectioned and studied under the scanning electron microscope (SEM). RESULTS: SEM observation of NAG showed scattered debris with unaffected morphology of dentinal tubules (DT). In AG, DT showed severe erosion with the loss of peritubular and intertubular dentin. CONCLUSION: A final rinse with 95% ethanol can change the morphology of the internal root surface and aid in smear layer removal in primary teeth.

Cone-beam computed tomographic and histological investigation of regenerative endodontic procedure in an immature mandibular second premolar with chronic apical abscess.

AIM: The aim of the present study was to investigate the tissue generated after regenerative endodontic procedure (REP) in the root canal space of an immature mandibular second premolar with pulp necrosis and chronic apical abscess using cone-beam computed tomographic (CBCT) and histological methods. METHODS: REP was performed in an immature mandibular second premolar. At the 3-year follow up, CBCT scans were taken to evaluate the outcome of treatment. As the tooth was not restorable to function, it was extracted and processed for histological examination. RESULTS: CBCT showed a reduction in size of the periradicular radiolucency, with a marginal increase in root length. Apical closure and thickening of the root canal walls were apparent. Histologically, the root canal space was filled with minimally-inflamed fibrous connective tissue. Some cementum-like mineralized connective tissue was evident on the internal canal walls. The apical third showed cementum-like deposits at the apex and the outer canal walls, without dentin formation. CONCLUSIONS: The present study of a structurally-failed tooth with prior REP demonstrates that the tissue formed within the root canal space was fibrous connective tissue with cementum-like deposition in the canal space. No evidence of dentin- or pulp-like tissue was found.

Immunohistochemical characterization of stem cell and differentiation markers of the dental pulp of human natal teeth.

AIM: Dental pulp stem cells, which are primarily derived from the pulp tissues of human teeth, have rarely been obtained from natal teeth. This study investigated the stem cell and differentiation markers of the dental pulp of natal teeth using immunohistochemistry. MATERIALS & METHODS: The pulp tissue from extracted natal teeth (n = 2) of a 20-day-old healthy male was examined for immunohistochemical expression of stem cell (Oct-4 and SOX 2) and differentiation markers (Nestin, CD 44, desmin, osteopontin and Ki- 67). RESULTS: The pulp tissue of the natal teeth expressed immunopositivity for nestin, CD 44 and SOX2. CONCLUSION: Natal teeth, if preserved properly, could serve as sources of dental pulp stem cells that are an improvement on deciduous teeth.

Gingival Enlargement Caused by Vitamin C Deficiency (Scurvy) in a Boy.

Localized gingival enlargement associated with vitamin C deficiency (scurvy) is rarely encountered in the modern era. The purpose of this paper is to report a case of extensive inflammatory gingival enlargement in the mandibular anterior region associated with vitamin C deficiency in a 10 year-old boy. There was a significant improvement of the gingival enlargement seven days after starting oral vitamin C supplementation. Vitamin C deficiency should be included in the differential diagnosis of any gingival enlargement, especially in children.

Management of nasally erupting deciduous canine in operated cleft lip and alveolus patient.

Nasally erupting tooth is a rare finding seen associated with cleft lip and alveolus. It may be diagnosed as a result of symptoms such as difficulty in breathing, pain on sneezing or blowing the nose or may remain asymptomatic. A case of a 4 year old male child operated for bilateral cleft lip and alveolus with unilateral right sided nasally erupting deciduous canine is presented here.

An unusual association of extraoral sinus tract with unerupted permanent tooth.

Cases have been reported in the literature in which extraoral sinus tracts of dental origin have been diagnosed and successfully treated. Similarly, the presence of an intracoronal radiolucency in unerupted permanent teeth has been found in the dental literature. The association of one with the other, however, is a rare occurrence. The purpose of this case report was to describe the treatment of a 7-year-old child who presented with an extraoral draining sinus originating from a carious, developing tooth bud of the unerupted permanent mandibular left second molar. After a thorough clinical and radiographic examination, a conclusive diagnosis was determined and surgical treatment was performed. The patient responded well, and the cutaneous lesion healed uneventfully.

Oral findings in West syndrome ­ A Case Report / Achados bucais na síndrome de West- Relato de um caso

West syndrome is a severe form of epilepsy syndrome which is characterized by a triad of infantile spasms, characteristic EEG findings (Hypsarrhythmia) and developmental delay. Minimal literature is available on dental findings of West syndrome. This case report presents an eight year old male child with cryptogenic form of West syndrome having a history of multiple clusters of infantile spasms. Orodental manifestations of west syndrome have been described and its dental management has been discussed in this report. (AU)

A síndrome de West é uma forma severa da síndrome de epilepsia que é caracterizada pela tríade de espasmos infantil, achados EEG (hipsarritimia) e atraso no desenvolvimento. A literatura disponível é escassa a respeito dos achados dentais e manejo da síndrome de West. Este caso relata uma criança de 8 anos de idade, masculino com a forma criptogênica da síndrome de West com história de múltiplos episódios de espasmos infantis e achados dentais típicos. O tratamento odontológico do caso é discutido e mediadas preventivas e tratamento da síndrome de West é descrito. (AU)

Toxic epidermal necrolysis in a 5-year-old boy - case report / Necrólise epidérmica tóxica em um relato de caso de um menino de 5 anos de idade

Necrose epidérmica tóxica ( NET ) e síndrome de Stevens - Johnson ( SSJ ) são considerados um espectro de reação mucocutânea aguda com risco de vida , que diferem apenas em termos de gravidade, muitas vezes induzidos por drogas. Vírus varicelazoster tem sido raramente relatada como agente etiológico em casos de NET. O nosso relato de caso destaca a associação do vírus varicela- zoster e TEN em um menino de 5 anos de idade.

Toxic epidermal necrolysis (TEN) and StevensJohnson syndrome (SJS) are considered a spectrum of acute life-threatening mucocutaneous reaction that differ only in severity, often induced by drugs. Varicella-zoster virus has been rarely reported as an etiological agent in TEN. Our case report highlights the association of varicella-zoster virus and TEN in a 5-year-old boy.