Mechanical Properties and Clinical Success of Intracanal Posts in Primary Maxillary Anterior Teeth: A Systematic Review and Meta-analysis.

Background: Intracanal posts are commonly used to restore lost permanent/primary tooth structure and the smile of the patient. Aim: This systematic review aims to evaluate the clinical success of intracanal posts used in primary maxillary anterior teeth and compare their mechanical properties. Methods: An extensive literature search was performed using Medline via PubMed, Embase via embase.com, LILACS, CINAHL via EBSCO, Cochrane Oral Health Group Specialized Register, Scopus, and Web of Science until December 2021 and was updated till December 2022. In vivo and in vitro studies in the English language that assessed clinical success and mechanical properties were included. Distiller SR software was used for everything from title screening to data extraction. Results: A total of 30 studies were analyzed, including 11 in vivo and 19 in vitro studies. Four studies were included in a meta-analysis, and all 30 studies qualified for qualitative analysis. The meta-analysis showed that fiber posts are clinically superior to composite resin posts (CRPs) (p = 0.02). No significant difference was observed between the fracture resistance of CRPs and no posts (p = 0.73). Most of the included studies showed a high risk of bias. Conclusion: Conclusive evidence about the effectiveness of various intracanal posts cannot be established. This is due to the limited number of clinical trials and included studies of low to moderate quality with a high risk of bias. To validate the use of posts in primary maxillary anterior teeth, further research, including randomized controlled trials (RCTs) of higher quality, is required. Clinical significance: The use of intracanal posts in primary teeth is a commonly used treatment modality among pediatric dentists. However, the quality of the evidence to support its use is low. This systematic review provides a comprehensive summary of the current literature and highlights the need for further research. Results were interpreted with caution, as the evidence supporting the use of intracanal posts in primary teeth is limited. How to cite this article: Shanmugam Y, Raghu A, Muthu MS, et al. Mechanical Properties and Clinical Success of Intracanal Posts in Primary Maxillary Anterior Teeth: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2023;16(S-3):S293-S305.

Prevalence and risk factors of early childhood caries in the Middle East region: A systematic review.

OBJECTIVE: The purpose of this systematic review was to assess the prevalence and risk factors of early childhood caries (ECC) in the Middle East region in the age group 0-6 years. METHODS: A systematic literature search was performed in three major databases, Web of Science, PubMed, and Cochrane database, from January 1, 1960 to December 31, 2020, to identify the published literature on the prevalence and risk factors of ECC. All preschool children of 0-6 years of age irrespective of gender and socioeconomic status from the selected geographics were included. RESULTS: A total of 26 full-text articles with a study population of 14,479, age group 0-6 years, were included in the study. The overall ECC prevalence in the Middle East region ranged from 26.50 to 99% in the 0-6-years age group. The mean decayed missing filled teeth ranged from 0.95 to 16.9, reported in studies from Jeddah, West Province, and Al-Jouf, Northern region of Saudi Arabia. In the United Arab Emirates, the prevalence ranged from 41 to 83%. The evaluation of the included studies revealed a total of 103 risk factors for ECC. Low socioeconomic status, dietary habits, poor oral hygienic attitude and behaviors, and poor access and availability of dental care services were the major risk factors. Most studies found low socioeconomic status, gender, age of the child, parents' education, low maternal education, and type of school to be significant risk factors for ECC. Children attending public schools were at a greater risk of having ECC. Gender (male) was another important risk factor. CONCLUSION: ECC can be prevented by focusing on prevention programs of dental caries, developing awareness-generating programs focusing on oral health education, and increasing access and availability of dental care services.

Glanzmann thrombasthenia: Use of hemocoagulase (BotroClot) for arrest of bleeding during a primary tooth endodontic procedure.

The Rationale: Glanzmann thrombasthenia is a rare platelet disorder affecting 0.0001% of the population. Dentists may often be unaware of this condition, and manipulation of soft tissue can lead to grave consequences, which may even result in fatality. Patient Concerns: In this case report, a 4-year-old patient with Glanzmann thrombasthenia reported to the department with a chief complaint of a discoloured tooth. Clinical Findings: On examination, 51 was nonvital, and pulpectomy was the treatment planned. The non-vital anterior tooth was treated with a pulpectomy procedure. There was uncontrolled bleeding during the procedure. Treatment: A topical solution of BotroClot was used to arrest the bleeding, and obturation was completed following that. The post-operative period was uneventful. Take-away Lessons: Case report explored the use of a topical hemostatic agent to arrest bleeding from the canal. This case report warrants eliciting a thorough medical history before any dental procedure.

Clinical decision-making in managing deep carious lesions in primary teeth based on clinical experience among pediatric dentists-A cross-sectional study.

OBJECTIVE: To explore the different treatment methods employed in managing deep carious lesions (DCL) of vital primary teeth among pediatric dentists practic.ing in Saudi Arabia. We also want to find out whether the experience of pediatric dentists has any influence on clinical decision-making in managing DCL in primary teeth. METHODS: This online questionnaire-based cross-sectional study was carried out among pediatric dentists practicing in Saudi Arabia. We used a self-administered questionnaire consisting of five sections: demographic data, clinical decisions in managing DCL, clinical protocols, and dentist's knowledge about allowing carious dentin to remain under a restoration. The questionnaire was administrated electronically via SurveyMonkey. RESULTS: A total of 216 pediatric dentists participated in the study, in which nearly 60% were males. Most dentists reported that they preferred partial caries removal (63%), and the Hall technique (68%) was the mostly practiced method in managing DCL. Nearly 93.5% of the dentists reported performing indirect pulp capping before placing a permanent restoration, and the most preferred liner was Dycal (60%). About 47.2% of senior dentists reported practicing complete caries removal. Multivariate logistic regression analysis revealed that younger dentists (5-10 years) preferred practiced partial caries excavation two times more often than senior dentists (>10 years). CONCLUSIONS: Pediatric dentists should focus on minimally invasive approaches such as partial caries excavation for DCL treatment. Pediatric dentists, especially senior practitioners, should be educated and trained to adopt minimally invasive strategies in managing DCL, reducing unnecessary risks such as iatrogenic pulpal damage.

Association between Body Mass Index (BMI) and Dental Caries among 6-12-Year-Old School Children.

This study aimed to identify the association between BMI and dental caries in 6−12-year-old children. This cross-sectional study was carried out among 6−12-year-old school children and their parents. The data on Body Mass Index (BMI) and dental caries for study participants were included in the study. The association between BMI and dental caries was evaluated using SPSS software. The study comprises 400 school children (157 boys and 243 girls) aged an average of 8.9 years. The overall prevalence of dental caries was 84% in primary dentition and 75% in permanent dentition, with a mean DMFT and dmft (decayed, missing and filled teeth) of 2.85 and 5.48, respectively. There was a significant association witnessed between mothers' education and BMI status. A significant association was also evident between decayed (d), missing (m) and filled (f) teeth and overall dmft with different BMI categories (p < 0.05). There was no significant association evident between DMFT and each category of BMI (p > 0.05). The dmft and DMFT within the four BMI categories by one-way ANOVA were highly significant (p < 0.001). Post hoc analysis helped us identify the relationship among the various categories of BMI with dental caries. There was a positive association evident between the BMI of the children and dental caries.

Penetration and Adaptation of the Highly Viscous Zinc-Reinforced Glass Ionomer Cement on Contaminated Fissures: An In Vitro Study with SEM Analysis.

Objective: To evaluate the penetration and adaptation of highly viscous zinc-reinforced glass ionomer cement (ZRGIC), using a scanning electron microscope (SEM), when applied under various contaminated conditions on grooves and fissures of primary second molars. Materials and Methods: A total of 40 extracted human primary second molars were randomly assigned into five groups (8 teeth each), with different surface conditions (conditioned with 40% polyacrylic acid, dry condition, water contamination, saliva contamination, or saliva contamination and air-drying) on the occlusal surface before placement of zinc-reinforced highly viscous glass ionomer cement with the finger-press technique. After sectioning the teeth, they were subjected to SEM analysis, where four in each group underwent aging by thermocycling and the other four were without aging. ANOVA tests, post hoc analysis, and unpaired t-tests were used for statistical analyses. Results: There was a significant statistical difference in the sealant penetration in the non-aging group, but in the aging group, there was no significant statistical difference in the sealant penetration. On other hand, a significant statistical difference was found in the adaptation between all the groups (p < 0.05). Highly viscous zinc-reinforced glass ionomer fissure sealants have better fissure penetration and more intimate adaptation under fissures conditioned with 40% polyacrylic acid and dry surface fissures with no contamination. However, the best penetration and retention after aging were under contaminated fissures with a shiny layer of saliva. Conclusions: The ZRGIC is a highly viscous fluoride-releasing cement, effectively seals fissures by interfering with food lodgment and protecting teeth from caries. It is advisable to restore the fissures with the minimal technique of sensitive fluoride-releasing GIC, particularly in young, uncooperative children, rather than leaving a caries-prone environment.

Effect of Different Concentrations of Silver Nanoparticles on the Quality of the Chemical Bond of Glass Ionomer Cement Dentine in Primary Teeth.

Background: The nanotechnologies have been applied for dental restorative materials manufacturing such as glass ionomer cement, composites, tooth regeneration, and endodontic sealers. The study aimed to investigate the chemical bond of conventional glass ionomer cement and to evaluate the addition of different concentrations of silver nanoparticles (AgNPs) on the quality of the chemical bond of glass ionomer cement to primary dentin. Methods: Silver nanoparticle (AgNP) powder was added in concentrations of 0.2, 0.4, and 0.6% to the conventional powder of GIC Fuji II. Then, the powder was added to the liquid and mixed with the recommended powder/liquid ratio of 3.6:1 g. The Fourier-transform infrared spectra (FTIR) of teeth with 0.2%, 0.4%, and 0.6% w/w of silver nanoparticles in GIC fills and the control tooth were obtained. The conventional glass ionomer was used as a control group. The control and the plain silver tooth were subjected to FTIR analysis using an ATR-FTIR spectrophotometer (ThermoFisher Scientific, Waltham, MA, United States) with zinc selenide (ZnSe) ATR crystal (attenuated total reflection) and OPUS v7.5 software. All spectra were recorded in the range of 500-3,500 cm-1 in the transmission mode with an ATR module. Results: The AgNPs added at 0.2, 0.4, and 0.6% concentration to GIC provided some information in the context of bond interaction with the dentin. Various bond peaks were seen for calcium, carbonate, phosphate, and amide. In our study, only the amide and phosphate were generated. The amide peaks were almost similar to the control, 0.2%, 0.4%, and 0.6%, with the peaks in the range of 1250-1650 cm-1. There was a clear shift in the phosphate peak from the control, 0.2, and 0.4%, which was about 1050 cm-1, whereas for 0.6%, there was a clear shift from 1050 cm-1 to 880 cm-1. Conclusion: GIC supplemented with AgNPs showed that a concentration above 0.4% of AgNPs altered the bond quality in dentin interaction. In conclusion, adding AgNPs at a minimal level improves the mechanical properties and maintains the same bond quality as GIC.

Efficacy of photodynamic therapy, photobiomodulation and antimicrobial agent on the shear bond strength of composite restorations to hypomineralized teeth.

PURPOSE: The aim of this study was to investigate the adhesive bond strength and fracture analysis of resin based restorations to carious dentin of hypomineralized molars (HMs) after disinfecting with photodynamic therapy (PDT), Nd:YAG and chlorhexidine (CHX). MATERIALS AND METHODS: Sixty carious HM molars were investigated. After removal of all carious infected tissue, the cavities were condition with methylene blue initiated PDT, a 1064 nm wavelength Nd:YAG laser or 2.0% CHX gel. Non-carious dentin from HM was used as a control without performing any disinfection or conditioning technique. All samples were bonded using a one-step one-coat adhesive bond over the dentin surface, packed with composite and light cured. All specimens were subjected to thermocycling at 5°C and 60°C with a dwell time of 30 s for 10,000 cycles. Bonded specimens were placed on a universal testing machine with a flat loading head. The debonded surface were viewed under light optical microscope to estimate the type of failure including adhesive, cohesive, and admixed. RESULTS: The highest mean SBS was seen in the non-carious HM (control group). The mean score for control group was 17.64 ± 2.96 MPa. The lowest bond strength value was displayed for Group-PDT (11.37 ± 3.66 MPa) and Group-Nd:YAG (12.69 ± 2.45 MPa). Affected dentin disinfected with the Group-CHX (15.71 ± 3.04 MPa) bonded with composite showed statistically significantly higher SBS values compared to the laser groups (p < 0.05). No statistically significant difference was noted with specimens disinfected with PDT and Nd:YAG laser showed comparable SBS scores (p > 0.05). Fracture analysis showed equal incidence of adhesive and cohesive failures in control group and Group-CHX. Moreover, a significant number of failures in group-PDT were related to adhesive. Whereas in group 4, admixed type failures were common. CONCLUSION: Caries infected hypomineralized teeth demonstrated lower bond strength values compared to non-carious hypomineralized teeth. Adhesive bond strength of hypomineralized teeth was highest with chlorhexidine compared to other laser treatment strategies.

The Influence of Oral Health Knowledge on Parental Practices among the Saudi Parents of Children Aged 2-6 Years in Riyadh City, Saudi Arabia.

AIMS AND OBJECTIVES: The parent's oral health knowledge has a great influence on their children, so the aim of the study was to estimate the parental knowledge about oral health care and its influence in maintaining the diet and hygiene practices on their children and also to access how the demographic variables will influence them in taking their child to dental visits. MATERIALS AND METHODS: The self-administered pretested questionnaire was distributed among Saudi parents whose children are in the age group of 2-6 years vising primary health care centers (PHCCs) in Riyadh city. The PHCCs were divided into five zones (Central, East, West, South, and North). 240-250 samples were randomly selected from each zone to reach the prescribed sample size of 1200. The survey will be composed of self-administered pretested questionnaires seeking for age, gender, educational level, and their financial status followed by 26 questions related to parent knowledge about oral health (14), dietary (5), and hygiene (7) practices what they implement on their child. The data collected were analyzed using SPSS software SPSS 25.0 (SPSS, Inc., Chicago, IL, USA). RESULTS: Demographic information showed that the average age of the parents who participated in the study is 32.2 years. The mothers were 942 (75.7%) and fathers were 303 (24.3%) among the participants. The mean knowledge score among the mothers (34.85) is slightly greater than fathers (34.76). Similar results with dietary and hygiene practices were not statistically significant (>0.05). The parents having more than one child have better knowledge, of which the parents with more than three children have better scores, which is statistically significant. 69.3% of the parents prefer taking to a dentist only when they have a problem. Moreover, these findings found to be statistically significant (P < 0.05). CONCLUSION: Parents should get access to oral health knowledge to put in practice on their children so as to influence them in gaining better oral health.

Children's Social Perception of Peers' Dento-Facial Condition: A Cross-Sectional Study.

AIMS: This study aimed to compare the participant's perceptions about their peers' dento-facial condition with different incisal appearances (intact, discoloured, fractured, and avulsed incisors). MATERIALS AND METHODS: A cross-sectional study was conducted among schoolchildren of both primary (8-11 years) and secondary (12-14 years) levels. Each participant was asked to judge photographs with one intact and three digitally modified central incisors giving the appearance of a traumatised tooth. Data on perceptions were collected for each condition using 12 attributes (8 positive and 4 negative; scored on a 4 point Likert scale). The positive, negative and total attribute scores were analysed separately by unpaired Student's t-test. Repeated Measures ANOVA and Bonferroni post hoc analysis was also used. RESULTS: A group of 587 children participated in the study. The perception for intact and traumatised incisors about demographic factors is well appreciated. Among the gender delineation, girls showed a significant difference in judgment between discoloured and fractured incisors. In comparison to intact incisors, positive and total attributable scores were found to be significantly higher (P < 0.001), whereas negative attribute scores were significantly lower (P < 0.001) for traumatised incisors. Pairwise comparison showed high significance (p <0.001) between the intact and traumatised incisor conditions. CONCLUSION: The results demonstrated that visible dental trauma influenced the psychosocial judgment given by children towards their peers. This judgment would, in turn, affect their level of acceptance towards such appearances. Therefore, these conditions ought to be redressed as swiftly as possible.CLINICAL SIGNIFICANCE: The primary purpose of this study was to highlight the psychosocial perceptions of children in judging their peers, regarding not only attractiveness but also intelligence, friendliness, confidence, outgoing nature, etc.

Associations between Diet, Dietary and Oral Hygiene Habits with Caries Occurrence and Severity in Children with Autism at Dammam City, Saudi Arabia.

AIM: The purpose of the study is to achieve the baseline information of the autistic child's oral health status about the diet, dietary and hygiene habits. The association of these factors with dental caries were assessed. MATERIAL AND METHODS: The survey was composed of self-administered questionnaires to parents about their children's' demographic data followed by questions related to diet, dietary and hygiene habits. This is later followed by oral examination for estimating the decayed, missing and filled [dmft] scores as per WHO norms. The variables are analysed using t-tests and ANOVA. Pearson's correlation coefficients were calculated for each of the independent variables to examine for autocorrelation. RESULTS: The mean age for the present study is 5.8 years with more predilections of caries in females. The autistic children prefer soft diet and pouch it in oral cavity resulting in increased caries though not significant. Other foods like nuts and pulses confectioneries and soft drinks resulted in increased caries, and our study shows significant relation. Consumption of sugars between meals and increased quantity of sugar per day also increased dental caries with highly significant results in our study. Hygiene habits also made a difference in the occurrence of caries though, in our study, it's not significant. CONCLUSIONS: The study suggests that the oral health education programs should be conducted for the parents, caregivers and the teachers about the diet, dietary and the hygiene habits and the role they play in maintaining the oral hygiene.

Effect of disinfection and sterilization on the tensile strength, surface roughness, and wettability of elastomers.

AIM: The aim of the present study was to evaluate the effect of chemical disinfection, autoclave, and microwave sterilization on some of the key properties of elastomers. METHODS: Five polyvinylsiloxane elastomeric impression materials were evaluated. Forty samples were fabricated from each material. The samples were randomly selected and assigned to four experimental groups with 50 samples each: group I, control; group II,chemical disinfection; group III, autoclave sterilization; and group IV, microwave sterilization. The differences in the mean values were contrasted and compared with the control group and analyzed using two-way analysis of variance (P < 0.05). RESULTS: The results showed that chemical disinfection and autoclave sterilization had no significant effect on the tensile strength and surface roughness, whereas microwave sterilization showed a statistically-significant reduction in tensile strength, and an increase in surface roughness. None of the disinfection and sterilization techniques had a significant effect on wettability. However, autoclave and microwave sterilization resulted in an increase in hydrophilicity of all the materials tested. CONCLUSION: Chemical disinfection and autoclave sterilization had no statistically-significant effect on the tested properties of elastomers, thus autoclave sterilization can be considered as an alternative and an effective mode of disinfection and sterilization to eliminate all forms of disease causing microorganisms from dental impressions.

Correlation of Perceived Self-Rated Oral Health Status with Various Dental Health and Awareness Factors.

AIMS AND OBJECTIVES: Self-rated oral health is the key element that has a greater effect on quality of life and found to be authentic and logical to consider this as an indicator for overall oral health status. The aim was to investigate and identify the impact of various social and clinical factors on the perceived self-rated oral health status (PSR-OHS). MATERIALS AND METHODS: A self-administered questionnaire was distributed 600 patients seeking information for age, gender, nationality, educational level, and their last dental visit followed by 15 questions related to social factors (patient self-rated oral health, patient-dentist communication, literacy level of the patient, and dental neglect) followed by estimating the clinical oral health status (decayed, missing, and filled teeth [DMFT] scores as per WHO norms). RESULTS: The results were estimated by a single five-point-response-scale question dichotomized into poor and good self-rated oral health. The average mean age for participation in the study is 32.5 years and found to be highly significant (P < 0.01) with inverse relation indicating that younger patients give better PSR-OHS. There were no significant differences in PSR-OHS among other demographic factors. Patients visiting the dentist recently found to be confident about their PSR-OHS and are statistically significant. Pearson correlating scores of social factors and the DMFT scores most concerned in the present study have a significant relation with self-rated oral health status. CONCLUSIONS: PSR-OHS is governed by various dental health and awareness factors. It can be used as an important tool by a clinician to assess the clinical examination results which helps to achieve more effective time and patient management.

Preliminary fabrication and characterization of electron beam melted Ti-6Al-4V customized dental implant.

The current study was aimed to fabricate customized root form dental implant using additive manufacturing technique for the replacement of missing teeth. The root form dental implant was designed using Geomagic™ and Magics™, the designed implant was directly manufactured by layering technique using ARCAM A2™ electron beam melting system by employing medical grade Ti-6Al-4V alloy powder. Furthermore, the fabricated implant was characterized in terms of certain clinically important parameters such as surface microstructure, surface topography, chemical purity and internal porosity. Results confirmed that, fabrication of customized dental implants using additive rapid manufacturing technology offers an attractive method to produce extremely pure form of customized titanium dental implants, the rough and porous surface texture obtained is expected to provide better initial implant stabilization and superior osseointegration.

Botox Therapy in Dentistry: A Review.

There are many medical and dental conditions which do not have complete treatment modalities in conventional ways. The botulinum toxin can be used as an alternative treatment modality working through chemo denervation method in many medical and dental conditions. An internet research was done for botulinum toxin used in dentistry and all articles and studies were selected, articles related to dentistry were extracted and summarized. This article explains the basic of botulinum toxin and some of its uses in dentistry. In next parts, the extensive details of its use in dentistry will be dealt with.