Assessment of the factors that affect fast-track or early extubation following pediatric cardiac surgery.

Background: This study aims to evaluate the early extubation rate and the factors affecting early extubation in pediatric patients undergoing cardiac surgery. Methods: Between August 1st, 2020 and December 1st, 2021, a total of 528 pediatric patients (264 males, 264 females; median age: 4 months; range, 2 days to 24 months) who were followed in the pediatric cardiac intensive care unit after congenital heart surgery were retrospectively analyzed. Demographic and clinical characteristics of the patients including operation and intensive care data were obtained from the medical records. Patients included in the study were categorized into three groups as the group of patients who were extubated in the operating room (fast-track extubation), the group of patients who were extubated in the first 6 h of the operation (early extubation), the group of patients who were extubated after the postoperative 6 h or the group of patients who were not extubated or died (delayed extubation). Results: Sixty-eight (12.9%) cases had fast-tract extubation, 124 (23.6%) cases had early extubation, and 335 (63.6%) cases had delayed extubation. The median age of the patients in the delayed extubation group was three months, which was significantly lower than those of the other groups (p<0.05). Reintubation rates were 1.5% in the fast-tract extubation group, 2.5% in early extubation group, and 9% in delayed extubation group (p<0.05). The median intensive care unit stay was 3, 5, and 10 days, respectively (p<0.05). Length of hospitalization was significantly higher in the delayed extubation group compared to the other groups (p<0.05). Neonatal age group, Risk Adjustment for Congenital Heart Surgery 1 score >4, Society of Thoracic Surgeons- European Association for Cardio-Thoracic Surgery mortality category >3, cardiopulmonary bypass time >100/min, vasoactive inotrope score >8, acute kidney injury >2, and low weight were found to be independent risk factors for delayed extubation. Conclusion: Fast-track and early extubation can be successfully applied with low reintubation rates in selected cases with congenital heart surgery. Age, body weight, presence of genetic syndrome, operational risk category, and procedure time may affect the extubation time.

The comparison of three different acute kidney injury classification systems after congenital heart surgery.

BACKGROUND: We aimed to compare the frequency of acute kidney injury (AKI) and its effects on mortality and morbidity with different classification systems in pediatric patients who had surgery under cardiopulmonary bypass for congenital heart disease. METHODS: This study included children younger than 18 years old who were followed up in the pediatric cardiac intensive care unit between September 1 and December 1, 2020, after congenital heart surgery with cardiopulmonary bypass. Each case was categorized postoperatively in terms of AKI using Pediatric-Modified Risk, Injury, Failure, Loss, and End-Stage (pRIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease: Improving Global Outcomes (KDIGO). Hospital mortality (developed within the first 30 days postoperatively) and morbidity (longer than 7 days intensive care unit stay) were compared by three model classes. Results were evaluated statistically. RESULTS: One hundred patients were included in the study. The median age was 3 months (1 day-180 months). Acute kidney injury was diagnosed in 49% of the cases according to the pRIFLE classification. It was diagnosed in 31% of the patients by AKIN classification. It was diagnosed in 41% of the patients with the KDIGO criteria. Morbidity was observed in 25% (n = 25) of all cases. The morbidity predictor was 0.800 for pRIFLE, 0.747 for AKIN and 0.853 for KDIGO by receiver operating characteristics analysis. All three categories predicted morbidity significantly (P < 0.001). Mortality was 10% (n = 10) for all groups. The mortality predictor was 0.783 for pRIFLE, 0.717 for AKIN and 0.794 for KDIGO by receiver operating characteristics analysis, and all three categories predicted mortality significantly (P < 0.001). CONCLUSIONS: Regardless of the three methods used, AKI was commonly detected in pediatric patients undergoing congenital heart surgery. pRIFLE classification diagnosed more patients with AKI than AKIN and KDIGO. The KDIGO and pRIFLE classifications were better in predicting hospital mortality.

Bactericidal Effect of 2780 nm Er,Cr:YSGG Laser Combined with 940 nm Diode Laser in Enterococcus faecalis Elimination: A Comparative Study.

Objective: This study aims to compare the bactericidal efficacy of different Er,Cr:YSGG disinfection methods, particularly combined application of Er,Cr:YSGG and Diode laser. Background: Root canal disinfection is important for long-term endodontic success. Different laser systems are proposed as alternatives to conventional techniques in bacterial elimination. Materials and methods: Ninety-five straight, single-rooted premolars with similar canal dimensions were selected. After the mechanical preparation, the samples were sterilized, and root canals were infected with Enterococcus faecalis. The samples were randomly divided into five groups (n = 15): 5% NaOCl, Er,Cr:YSGG, Er,Cr:YSGG +5% NaOCl, Er,Cr:YSGG + Diode, and control group. Results: The maximal bacterial elimination was observed in Er,Cr:YSGG + NaOCl group (p < 0.005). More bacteria were found in Er,Cr:YSGG and Er,Cr:YSGG + Diode groups compared with 5% NaOCl group (p < 0.005). Marginal significance was detected between the Er,Cr:YSGG group and the Er,Cr:YSGG + Diode group (p = 0.091). Conclusions: The most successful E. faecalis elimination was obtained from laser-activated irrigation group. As combined application of Er,Cr:YSGG and Diode laser gives suggestive results, further studies with larger sample sizes are needed to clarify the outcome.

Polymerization characteristics of colored compomers cured with different LED units.

AIM:: Incomplete polymerization of a resin material used for dental restoration affects the properties of the restoration. We evaluated the structural and mechanical properties of three different colored compomers cured with three different LED units to observe the characteristic changes occurring in different matches. METHODS:: Polytetrafluoroethylene molds (5 mm in diameter and 2 mm in thickness) were used to prepare disk-shaped sample specimens. Nine sample groups (each of five specimens) were prepared, three each of different compomer resin colors (gold, berry, and silver). Samples were cured using three different LED units (Optima, VALO, and Demi Ultra), according to the manufacturers' instructions. Microstructural properties of samples were characterized by determining the degree of curing using Fourier-transform infrared spectroscopy and by analyzing sample morphology under a scanning electron microscope. The Vickers hardness, compressive strength, and elastic modulus of the samples were measured to investigate their mechanical properties. RESULTS:: The degrees of curing decreased in the order of silver > berry > gold for all curing units. Conversely, gold compomers exhibited poorer mechanical values than the berry and silver counterparts. The Optima 10 unit yielded slightly higher degrees of curing than the other devices, followed by Demi Ultra and VALO light-curing units, respectively. CONCLUSION:: The resin color affected the structural and mechanical properties of the compomers, possibly as a result of the complex interactions and relationships between the irradiation light and resin material, such as light absorbance and reflectance; thus, depending on the color as well as the curing protocol.

Microhardness and SEM-EDX Analysis of Permanent Enamel Surface Adjacent to Fluoride-releasing Restorative Materials Under Severe Cariogenic Challenges.

PURPOSE: In this study, the protective effects of restorative materials with fluoride content, resin-modified glass-ionomer cement (RMGIC), giomer, and glass carbomer against artificial initial caries lesions in a simulated highly cariogenic oral environment were evaluated. Considering the reported recharging abilities of these restorative materials, fluoridated toothpaste was applied to some groups, in which the anti-demineralising effect was also evaluated. MATERIALS AND METHODS: Two enamel blocks were produced from each of 60 sound permanent molars. Sixty specimens were used for microhardness analysis, and the rest were used for SEM-EDX analysis. Enamel specimens were randomly assigned to three groups according to the restorative material: A = resin-modified glass-ionomer cement; B = giomer; C = glass carbomer. Artificial initial caries lesions were created using demineralising solutions, after which specimens were exposed to in vitro pH cycling simulating a highly cariogenic oral environment. Microhardness and mineral analyses were performed on the enamel surrounding the restorative materials at three different times during the experiment: at the beginning of the experiment, then after the creation of the artificial early caries lesions, and finally after pH cycling. RESULTS: Microhardness and SEM-EDX results mostly confirmed each other. RMGIC and glass carbomer groups with added fluoride toothpaste showed statitsically significantly better anti-demineralising effects in comparison to other groups. Neither of the giomer groups performed as well as RMGIC or glass carbomer. CONCLUSION: Because of the similarity between the demineralisation inhibitory activity of glass carbomer and RMGIC, glass carbomer may be preferred as a restorative material in paediatric dentistry.

The Effect of Parenting Styles on Behavior Management Technique Preferences in a Turkish Population.

Purpose: The purpose of this study was to investigate the association between parenting style and parental preferences for behavior management techniques in a Turkish population. Methods: This cross-sectional study was conducted for a three-month period among the parents and children who applied for treatment in a university clinic. Parenting style was determined using the parenting style dimension questionnaire, and parental dental anxiety (PDA) was rated with the Modified Dental Anxiety Scale. Behavior management technique (BMT) preferences were rated by the parents after a videotape presentation. Chi-square tests and likelihood ratios were used for statistical analysis, and the significance level was set at P<0.05. Results: A total of 142 three- to 12-year-olds (mean age equals 6.83±2.71 years old) and their parents participated in the study. Most parents had an authoritative parenting style and preferred positive reinforcement. Parenting style and PDA were significantly associated with preferences for BMTs (P<0.05). Although the children with high-anxiety parents showed more negative behaviors and the children with low-anxiety parents behaved more positively, this difference was not statistically significant (P>0.05). In addition, PDA was not associated with parenting styles (P>0.05). Conclusions: Parenting style and parental dental anxiety should be considered in the selection of behavior guidance techniques.

Regenerative endodontic treatment of an infected immature dens invaginatus with the aid of cone-beam computed tomography.

Dens invaginatus is a developmental anomaly that results in an enamel-lined cavity intruding into the crown or root before the mineralization phase. This report presents regenerative endodontic treatment of a necrotic immature tooth with Oehler's type III dens invaginatus of a nine-year-old female patient. A diagnosis of dens invaginatus (Oehler's type III) and a large periapical lesion was established with the aid of cone-beam computed tomography (CBCT). In the presented case contrary to the classic revascularization protocol, mechanical instrumentation was performed which apparently did not interfere with the regeneration process. After mechanical instrumentation of the invaginated canal by manual K-files, the invaginated canal space was disinfected by triple antibiotic paste followed by blood clot induction from the periapical tissues and the placement of mineral trioxide aggregate. At one-year follow-up, the tooth remained clinically asymptomatic. Radiographic examination revealed complete healing of the periapical lesion. At the 20-month follow-up, the radiographic examination also showed that the open apex was closed and the walls of the root canal were thickened.

SEM-EDX analysis of brushing abrasion of chitosan and propolis based toothpastes on sound and artificial carious primary enamel surfaces.

PURPOSE: The objective of this study was to assess the brushing abrasion effects of toothpastes containing chitosan and propolis on sound and demineralized primary tooth enamel. METHODS: Pairs of enamel specimens were prepared from human extracted primary teeth, embedded in epoxy resin and polished. An artificial subsurface lesion was created in one specimen from each pair. All samples were divided into four groups (Chitodent, Aagaard propolis, Elmex, and Control) and brushed with slurry of toothpastes and artificial saliva in a brushing machine. The brushing abrasion depths were evaluated using computer-guided optical profilometry. RESULTS: No significant differences existed in terms of brushing depths between artificial carious enamel and brushed sound enamel specimens (P>0.05). The abrasion values of the sound enamel samples brushed with Aagaard propolis and control samples were significantly lower than the Elmex group (P<0.05). The lowest brushing abrasion values of demineralized enamel specimens were observed in the Chitodent group (P>0.05). CONCLUSIONS: The tested toothpastes exhibited similar effects in terms of brushing abrasion on both sound and artificially demineralized enamel. Based on mean values without statistical significance, the lowest brushing abrasion values in the demineralized brushed enamel samples were detected in the Chitodent group.

Microleakage of different temporary filling materials in primary teeth.

OBJECTIVE: The aim of this study was to compare the sealing properties of IRM, Coltosol, Cavit G, Adhesor and Clip, which used as temporary filling material in coronal access openings in extracted human primary teeth. STUDY DESIGN: Standardized access cavities of 2 x 2 mm were prepared in the eighty-four, caries-free human primary anterior teeth. The teeth were divided randomly into five groups of 16 teeth each. Temporary restorative materials Group A: IRM (Dentsply), Group B: Coltosol (Coltone), Group C: Cavit G (3M), Group D: Adhesor (Spofa Dental) and Group E: Clip (Voco) were applied according to the manufacturer's directions. The specimens were immersed silver nitrate and placed in film developer under fluorescent for 24 hours. The sectioned specimens were evaluated under a digital microscope at x 20 magnifications and blindly scored for microleakage. RESULTS: Clip presented the least microleakage value whereas; Adhesor and IRM presented the higher microleakage values. There were statistically significant differences between Clip and the others groups, while there were no statistically significant differences in microleakage between IRM, Adhesor, Coltosol and Cavit G. However the leakage scores of Clip and Cavit G were congruent (p = 0.454). CONCLUSION: Amongst the five materials, Clip exhibited a better sealing ability.

Endodontic and orthodontic treatment of fused maxillary central incisors: a case report.

The purpose of this case report was to describe combined endodontic and orthodontic treatment of a patient who had permanent maxillary central incisors fused with supernumerary teeth. A severe esthetic problem and crowding in the maxillary arch were present clinically. Radiographic examination demonstrated two separate crowns, roots and pulpal canals on each side. The therapy was initiated with endodontic treatment. Six months after the completion of endodontic therapy, mesio-distal trimming was performed and the defects were restored with anterior resin composites in order to re-establish the esthetics. Orthodontic treatment was performed for the alignment of the upper arch. Follow-up at 4 years demonstrated that the teeth were asymptomatic and neither root nor alveolar bone resorption was found. In conclusion, instead of extracting the supernumerary teeth, the anomaly was treated successfully in a conservative way.