To Compare and Evaluate Rotary and Manual Techniques in Biomechanical Preparation of Primary Molars to Know Their Effects in Terms of Cleaning and Shaping Efficacy.

Background: The introduction of the rotary file system for children was a revolution in the field of pediatric endodontics. These files are cost-effective and help in consistent obturations with shorter instrumentation time. Aim: The present randomized controlled trial (RCT) was planned for a comparative evaluation of rotary and manual techniques in biomechanical preparation of primary molars to determine their effect in terms of cleaning and shaping efficacy, working time, quality of obturation, and postoperative pain. Materials and methods: A randomized clinical trial study was conducted in 75 children aged 5-9 years requiring pulpectomy. Each tooth was randomly assigned to one of the three treatment groups: Kedo-S files, rotary K-Flex files, and hand instruments group. Results: It was observed that Kedo-S files and rotary K-Flex files were more effective in cleaning and shaping of root canals compared to hand H/K files. The postbacterial count for hand files was higher compared to rotary files. Shorter working time was seen with rotary files (3.88-5.04 minutes) compared to hand files (15.68 minutes). Rotary files showed a reduced number of voids, with Kedo-S files in 92% of cases and rotary K-Flex files in 80% of cases. Apical seal and extent of fill were maximum with rotary files, having a grade C rating in 92% of cases. Kedo-S files and rotary K-Flex files showed a significant reduction in postoperative pain compared to hand files. Conclusion: The present study showed a significant reduction in bacterial count, working time, quality of obturation, and postoperative pain with rotary files. How to cite this article: Moudgalya MS, Tyagi P, Tiwari S, et al. To Compare and Evaluate Rotary and Manual Techniques in Biomechanical Preparation of Primary Molars to Know Their Effects in Terms of Cleaning and Shaping Efficacy. Int J Clin Pediatr Dent 2024;17(8):864-870.

Flare-ups in Primary Teeth Before, During, and After Pulpectomy: A Systematic Review and Meta-analysis.

To determine the pain prevalence and severity of flare-ups associated with before, during, and after pulpectomy procedure in children through systematic review and meta-analysis. Pain associated with root canal is a crucial source of fear for patients (especially child patients) and an important concern of dentists. Pain experienced at pretreatment, during treatment, and posttreatment is foreseen and recalled by child patients. A hand search of relevant journals and defined searching of Medline/PubMed, Cochrane, and EBSCOhost databases identified 2,635 articles reporting flare-ups at different intervals. After further filtering and applying inclusion criteria, three articles were identified for meta-analysis. From three recognized articles in the pretreatment phase, 51.2% of cases reported flare-ups; during treatment, there were 19.8% of cases; and in the posttreatment phase, 100% success rate was seen (i.e., no flares were present). The three included studies were heterogeneous according to I 2 and τ 2 statistics (p <0.001, I 2 = 92.64). Pretreatment pulpectomy-associated flare-ups were high, then dropped significantly to minimal levels in 3 days (during treatment) and continued to drop to lowest levels in 7 days (posttreatment). How to cite this article: Moudgalya MS, Kulkarni P, Tiwari S, et al. Flare-ups in Primary Teeth Before, During, and After Pulpectomy: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2024;17(7):838-841.

Analysis of Primary Tooth Extractions and Associated Factors in 3 to 5-Year-Old Children in Kabul, Afghanistan: A Retrospective Study.

Background/Objective: Understanding the patterns and reasons behind the extraction of children's primary teeth is crucial for improving oral health outcomes. This retrospective investigation aimed to discern the patterns and factors contributing to primary tooth extraction among pediatric patients aged 3 to 5 years treated at the Pediatric Surgery Department of the National Curative and Specialized Stomatology Hospital in Kabul, Afghanistan. Materials and Methods: Between January and May 2023, we conducted an extensive review of dental records, focusing on patients aged 3 to 5 years who had undergone primary tooth extraction. Data were collected on patients' age, gender, specif tooth extracted, and reasons for tooth extraction. Statistical analysis was performed using SPSS Statistics version 25. Results: Among 150 subjects reviewed, 53.3% were male. Primary first molars were the most commonly extracted teeth (29.3%). Dental caries was the leading cause of extraction (50%), followed by periodontitis (31.3%) and root resorption (18.7%). Mandibular extractions (58.6%) were more frequent than maxillary extractions (41.4%). No significant differences were found based on age or tooth type. Weak correlations were observed between specific tooth extractions, age, and etiology. Conclusion: This study reveals a higher frequency of extractions in older children, primarily due to dental caries, periodontitis, and root resorption, with a slight male predominance. While no significant differences were noted in extraction patterns based on age or tooth type, understanding these trends is essential for improving pediatric dental care.

Calcium Silicate-Based Cements in Restorative Dentistry: Vital Pulp Therapy Clinical, Radiographic, and Histological Outcomes on Deciduous and Permanent Dentition-A Systematic Review and Meta-Analysis.

Vital pulp therapy aims to preserve the vitality of dental pulp exposed due to caries, trauma, or restorative procedures. The aim of the present review was to evaluate the clinical, radiographic, and histological outcomes of different calcium silicate-based cements used in vital pulp therapy for both primary and permanent teeth. The review included 40 randomized controlled trials from a search across PubMed, LILACS, and the Cochrane Collaboration, as well as manual searches and author inquiries according to specific inclusion and exclusion criteria. A critical assessment of studies was conducted, and after data extraction the results were submitted to a quantitative statistical analysis using meta-analysis. The studies, involving 1701 patients and 3168 teeth, compared a total of 18 different calcium silicate-based cements in both dentitions. The qualitative synthesis showed no significant differences in short-term outcomes (up to 6 months) between different calcium silicate-based cements in primary teeth. ProRoot MTA and Biodentine showed similar clinical and radiographic success rates at 6 and 12 months. In permanent teeth, although the global results appeared to be well balanced, ProRoot MTA generally seemed to perform better than other calcium silicate-based cements except for Biodentine, which had comparable or superior results at 6 months. Meta-analyses for selected comparisons showed no significant differences in clinical and radiographic outcomes between ProRoot MTA and Biodentine over follow-up periods. The present review highlights the need for standardized definitions of success and follow-up periods in future studies to better guide clinical decisions. Despite the introduction of new calcium silicate-based cements aiming to address limitations of the original MTA. ProRoot MTA and Biodentine remain the most used and reliable materials for vital pulp therapy, although the results did not deviate that much from the other calcium silicate-based cements. Further long-term studies are required to establish the optimal CSC for each clinical scenario in both dentitions.

Retained Primary Teeth and Their Complication and Treatment: A Case Report.

In dentistry, over-retained deciduous teeth pose a distinct issue due to their endurance during the expected exfoliation period. This case study describes a clinical situation with a male patient who is seven years old and complaining of painful swelling over the maxillary anterior region of the jaw and clinically showing dark red-colored, firm, non-tender, purulent swelling extending from alveolar mucosa of the upper anterior to the gingival margin of the 51, 52, 53 region. The treatment plan includes the extraction of the primary teeth. This case report also highlights the importance of minimal surgical intervention for treating peri-radicular cysts to minimize healing time and damage to the underlying developing permanent tooth.

An open-label, parallel-group, randomized clinical trial of different silver diamine fluoride application intervals to arrest dental caries.

BACKGROUND: Silver diamine fluoride (SDF) is an antimicrobial agent and alternative treatment option that can be used to arrest dental decay. While there is optimism with SDF with regard to caries management, there is no true consensus on the number and frequency of applications for children. The purpose of this study was to examine the effectiveness of 38% SDF to arrest early childhood caries (ECC) at three different application regimen intervals. METHODS: Children with teeth that met International Caries Detection and Assessment System codes 5 or 6 criteria were recruited from community dental clinics into an open-label, parallel-group, randomized clinical trial from October 2019 to June 2021. Participants were randomized to one of three groups using sealed envelopes that were prepared with one of three regimens inside: visits one month, four months, or six months apart. Participants received applications of 38% SDF, along with 5% sodium fluoride varnish (NaFV), at the first two visits to treat cavitated carious lesions. Lesions were followed and arrest rates were calculated. Lesions were considered arrested if they were hard on probing and black in colour. Statistics included descriptive and bivariate analyses (Kruskal one-way analysis of variance and Pearson's Chi-squared test). A p-value of ≤ 0.05 was considered significant. RESULTS: Eighty-four children participated in the study (49 males and 35 females, mean age: 44.4 ± 14.2 months). Treatment groups were well matched with 28 participants per group. A total of 374 teeth and 505 lesions were followed. Posterior lesions represented only 40.6% of affected surfaces. Almost all SDF treated lesions were arrested for the one-month (192/196, 98%) and four-month (159/166, 95.8%) interval groups at the final visit. The six-month group experienced the lowest arrest rates; only 72% (103/143) of lesions were arrested (p < 0.001). The duration of application intervals was inversely associated with improvements in arrest rates for all lesions. CONCLUSIONS: Two applications of 38% SDF and 5% NaFV in one-month and four-month intervals were comparable and very effective in arresting ECC. Applications six months apart were less effective and could be considered inferior treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT04054635 (first registered 13/08/2019).

Shear bond strength of a composite resin restoration in primary teeth following cavity preparation using laser- an in-vitro study.

To evaluate and compare the shear bond strength of composite resin restorations in primary teeth, following cavity preparation with both traditional dental burs and laser irradiation. One hundred primary molars extracted from the children visiting our department were collected and randomly divided into five groups (A-E) with 20 teeth in each group. In groups A, B, C, D, and E the teeth samples were etched with phosphoric acid, Er; YAG laser followed by acid etching, Er, Cr: YSGG laser followed by acid etching, Er; YAG laser etching only and Er, Cr: YSGG laser etching only, respectively. Following, all the samples were restored with composite resin and subjected to 500 cycles of thermocycling. The shear bond strength of the resin composite was analyzed. The type of fractures was also noted. Data obtained were subjected to statistical analysis. The mean value of shear bond strength of Group A, B, C, D, and E was 17.562 ± 0.810, 15.928 ± 0.415, 14.964 ± 0.566, 11.833 ± 0.533 and 11.187 ± 0.517, respectively. Adhesive failure was most commonly seen in all the groups. The phosphoric acid etching remains a highly effective technique for pre-treating dentin in composite resin restorations. The shear strength of composite resin to the dentin of laser-prepared cavity in primary teeth can be improved by the addition of acid etching.

Apically extruded debris evaluation with the use of ProTaper Ultimate and TruNatomy files systems with and without glider preparation in primary tooth.

Information regarding the influence of resorption and glide paths on debris extrusion in primary teeth is lacking. Therefore, we evaluated debris extrusion with and without resorption and with and without the use of a path file in primary molar teeth prepared with ProTaper Ultimate (PTU) Prime and TruNatomy (TRN) Prime rotary file systems. Forty resorbed and forty non-resorbed primary molar teeth were collected. Both groups were divided into four subgroups (n = 10). The Eppendorf tubes were weighed pre-debris. The distal canals of the teeth were prepared with PTU Prime and TRN Prime file systems, with and without the use of path files. The debris-filled tubes were weighed, and the weight of only the extruded debris was calculated by subtraction. The data were analyzed using a three-way analysis of variance (ANOVA) test. The presence of tooth resorption significantly increased debris extrusion, and the use of a path file significantly decreased debris extrusion (p < 0.001). The binary and ternary interactions of the three evaluated parameters among the groups showed no significant differences in terms of the amount of debris extruded (p > 0.05). While debris extrusion was observed in all groups, the use of a glide path file in primary teeth before the preparation process resulted in less debris extrusion.

Cytotoxic Effect of Two Different Concentrations of Sodium Hypochlorite: An In-Vitro Study.

Introduction The endodontic treatment of primary teeth presents considerable complications due to their distinct anatomical properties. In order to achieve a successful endodontic treatment, certain factors must be assessed. These factors include a precise diagnosis, thorough cleaning, and a reliable disinfection protocol. Although sodium hypochlorite (NaOCl) has been effective as an irrigation agent in primary teeth, it is important to recognize that higher concentrations of NaOCl might possibly inflict toxic harm on the periapical environment if they penetrate the tooth's apical foramina. Since primary teeth are important, pediatric dentists must choose an appropriate NaOCl concentration for root canal irrigation, as higher concentrations can be toxic. Thus, the current investigation examined the cytotoxicity of two different NaOCl concentrations at various volumes. Methods To evaluate the cytotoxicity potential, a culture of nauplii (brine shrimp) was prepared and subjected to testing. For the test, 5, 10, 20, and 40 µL of 1% and 3% NaOCl were added to the brine shrimp culture at different concentrations, and saline was used as a control. After a span of 24 hours, the total number of alive nauplii was duly noted. Results After 24 hours, nauplii showed no mortality in the control group. For 1% NaOCl, mortality ranged from 10% to 20% across volumes, with no significant differences (p = 0.193). In contrast, 3% NaOCl caused significantly higher mortality: 20% at 5 µL, 30% at 10 and 20 µL, and 60% at 40 µL (p = 0.007). Tukey's analysis revealed no significant differences for 1% NaOCl (p > 0.05) but significant differences for 3% NaOCl at 40 µL (p < 0.05). Conclusion Based on the results of the present study, it was observed that a 1% NaOCl solution exhibited a lower level of toxicity in comparison to a 3% NaOCl solution. These findings highlight the importance of using lower concentrations of NaOCl for endodontic irrigation in pediatric dentistry to reduce the risk of tissue damage and ensure safer outcomes for young patients.

Is use of flowable resin composite an option for occluso-proximal restorations in primary teeth? A fracture strength analysis.

BACKGROUND: Use of flowable resin composites for ocluso-proximal restorations in primary molars could improve cervical adaptation, and reduce the failure risk. AIM: To investigate the fracture strength of occluso-proximal restorations in primary teeth using different flowable resin composites (as an intermediate layer or entire cavity) and a conventional resin composite (incremental technique). DESIGN: Two standardized occluso-proximal cavities were prepared on mesial and distal surfaces of 50 sound primary molars. The teeth were randomly assigned into five groups (n = 10): 2 mm Filtek Bulk Fill Flow + Z350 XT; 4 mm Filtek Bulk Fill Flow; 2 mm Z350 XT Flow + Z350 XT; 4 mm Z350 XT Flow; and Z350 XT inserted by incremental technique. All restored teeth were subjected to cariogenic challenge and then submitted to fracture strength test. The failure pattern of each specimen was categorized as reparable or irreparable/need for replacement based on the World Dental Federation (FDI) criteria. Fracture strength means were submitted to one-way ANOVA and Tukey's post hoc tests. Failure pattern was analyzed descriptively. RESULTS: There was no statistically significant difference on fracture strength among groups (p = .48). A similar distribution of reparable (35%-40%) and irreparable (60%-65%) failures was observed among groups. CONCLUSION: Based on a laboratorial setting, the use of different flowable resin composites (as an intermediate layer or entire cavity) may be an option to restore occluso-proximal cavities in primary molars.

Clinical and Radiographic Evaluation of Diode and Er,Cr:YSGG Lasers as an Alternative to Formocresol and Sodium Hypochlorite for Pulpotomy Techniques in Primary Molars: A Randomized Controlled Clinical Trial.

Background Pulpotomy treatment is one of the vital pulp therapies that can play a major role in the preservation of primary teeth until their natural exfoliation. The objective of this current clinical trial was to assess the clinical and radiographical success of diode and Er,Cr:YSGG lasers as a viable alternative to formocresol (FC) and sodium hypochlorite in the primary molar pulpotomies. Materials and methods Sixty primary molars were selected and randomly allocated to four groups. All treatment groups followed the same clinical protocol, except for the techniques used for hemostasis of the pulpotomy sites. In group A, hemostasis was achieved by applying a 1:5 dilution of FC solution, whereas in group B, 3% sodium hypochlorite was applied to achieve hemostasis. In group C, exposure to a diode laser of 940 nm was performed, whereas for group D, erbium laser irradiation with Er,Cr:YSGG laser of 2,780 nm was employed to achieve hemostasis. Radicular pulp stamps were covered with a 2 mm layer of mineral trioxide aggregate (MTA) paste. Stainless steel crowns were utilized for the final restorations of the primary teeth. The clinical and radiographic outcomes were evaluated at the six- and 12-month follow-up intervals. The investigation was registered with the ClinicalTrials.gov Protocol and Registration System (ID: NCT06002646). Results The overall clinical and radiographic success rates of pulpotomy were 92.3% for FC, 89% for sodium hypochlorite, 98.3% for a diode laser, and 98.7% for Er,Cr:YSGG lasers. There were no statistically significant differences among the four groups (p > 0.05). Conclusions Both the diode and Er,Cr:YSGG lasers showed outcomes comparable to those of FC and sodium hypochlorite. Therefore, they could be promising alternatives to primary tooth pulpotomies.

Evaluation of primary teeth root canal orifices with naked eye and using magnifying loupes - An in vivo study.

Background: Knowledge of the anatomy and morphology of root canal orifices and variations are vital elements affecting treatment outcomes. Aim: The objective of this study was to evaluate variations in the number of root canal orifices and their patterns in primary teeth, as identified by both the naked eye and under magnifying loupes. Materials and methods: Total of 173 primary teeth was scheduled for pulpectomy over a period of 18 months. Two examiners assessed the number and pattern of the root canal orifices. After access cavity preparation, the operator recorded the number of root canal orifices with naked eye, and examiner recorded the same using magnifying loupes (3.5×). After cleaning and shaping, the same protocol was used. Collected data were statistically analyzed using SPSS version 23.0 and compared using a paired t-test. Results: The overall variation in the in the identification of root canal orifices between the naked eye and magnifying loupes (3.005 ± 0.971) was statistically significant after access cavity preparation (P ≤ 0.05). Conclusion: Magnifying loupes significantly enhances the determination of the number and pattern of root canal orifices in primary teeth. Therefore, the application of magnifying loupes is essential for accurately assessing variations in root canal orifices in primary dentition.

Prevalence of hypomineralized second primary molars and association with socioeconomic characteristics and dental caries in a Brazilian population of preschoolers: a cross-sectional study.

OBJECTIVE: To analyze the prevalence of hypomineralized second primary molar (HSPM) and its association with socioeconomic characteristics and dental caries in a Brazilian population of preschoolers. MATERIAL AND METHODS: 603 preschoolers, enrolled in public preschools in Itajaí (state of Santa Catarina, Brazil), took part in the study. To assess the participants' socio-economic characteristics, an original questionnaire was formulated and sent to the children's parents. The clinical evaluation was carried out by a calibrated examiner using the deft/DMFT index for dental caries and Ghanim et al. (Ghanim et al., Eur Arch Paediatr Dent, 2015) criteria for HSPM. The data were analyzed through Poisson regression, using STATA statistical software, and the association analyses were presented by prevalence ratios (PR). RESULTS: The prevalence of at least one HSPM-affected second molar was 24.5%. The prevalence of HSPM was associated to the city's geographical regions of the Educational hubs (p < 0.001). A significant association was found between dental caries and HSPM (p = 0.003; PR: 1.31; 95% CI 1.09-1.56). Children with HSPM were 31% more likely to experience dental caries than children without HSPM. Geographical regions of educational hubs were also significantly associated with HSPM (p < 0.001). None of the socioeconomic characteristics was associated with HSPM (p > 0.05). CONCLUSION: HSPM is a common developmental defect of enamel in children in our study. The HSPM distribution was associated with the city's geographic regions. Children with HSPM are more likely to experience dental caries. Socioeconomic characteristics were not associated with HSPM.

Influence of Different Application Modes of a Universal Adhesive System on the Bond Strength of Bulk-Fill Composite Resin to Enamel and Dentin in Primary Teeth.

OBJECTIVES: The objective of this study was to assess how the application mode of a universal adhesive system affects the microshear bond strength (µSBS) of bulk-fill and conventional composite resins to enamel and dentin in primary teeth. METHODS: A total of 80 caries-free primary second molars were randomly assigned to eight experimental groups (n = 10) based on the bonding substrate (enamel or dentin), the application mode of the universal adhesive system (etch and rinse [E&R], or self-etch [SE]), and the type of composite resin used (bulk-fill or conventional). After bonding the composite resin to enamel or dentin, the µSBS of the bonded composite resins was measured. RESULTS: The mean µSBS value of bulk-fill composite resin was significantly higher than that of conventional composite resin for both enamel and dentin substrates, regardless of the application mode (p < 0.001). An interaction effect between the bonding substrate and the application mode of the adhesive system was observed, indicating a significant relationship (p < 0.001). The highest µSBS values for primary teeth enamel were achieved using the E&R mode with bulk-fill composite resin, while for dentin specimens, the SE mode with bulk-fill composite resin yielded the highest µSBS values. The µSBS of the E&R group was significantly higher than that of the SE group for enamel specimens (p < 0.001), whereas the µSBS of the SE group was significantly higher than that of the E&R group for dentin specimens (p < 0.001). CONCLUSION: Bulk-fill composite resin demonstrated higher µSBS in comparison to conventional composite resin. The universal adhesive system exhibited superior performance in the SE mode compared to the E&R mode on primary dentin. Pre-etching the enamel before the application of the universal adhesive enhanced the µSBS to primary teeth enamel, highlighting the importance of selectively acid etching the enamel of primary teeth.

A randomised clinical trial to arrest caries using silver diamine fluoride therapy with two postoperative instructions.

OBJECTIVE: The objective of this study is to investigate the beneficial effect of not rinsing for 30 min in arresting early childhood caries after SDF therapy. METHODS: This randomised clinical trial recruited 3- to 4-year-old kindergarten children with active (soft) dentine caries. A questionnaire was sent to the parents to collect children's demographic data and oral health-related behaviours. A dentist conducted an oral examination and measured the caries experience using dmft index and oral hygiene using visible plaque index. After 38 % SDF therapy, the children were randomly allocated into two groups. Children in group A were instructed to rinse with water immediately, whereas children in group B were asked to refrain from rinsing, drinking, or eating for 30 min. After six months, the same examiner determined the lesion activity (active/arrest) of the SDF-treated carious tooth surface. Generalized Estimating Equations was used to compare the proportion of caries arrest (caries-arrest rate) between the two groups. RESULTS: This study recruited 298 children with 1,158 decayed tooth surfaces receiving SDF therapy at baseline and evaluated 275 (92 %) children with 1,069 (92 %) SDF-treated tooth-surface at the six-month examination. The demographic background, oral hygiene and caries status of two groups were comparable at baseline (p > 0.05). The caries-arrest rate for group A and group B were 65 % (337/519) and 61 % (338/550), respectively (p = 0.28). CONCLUSION: This randomised clinical trial found not rinsing for 30 min after SDF therapy is not better than immediate rinsing in arresting early childhood caries. CLINICAL SIGNIFICANCE: Topical SDF application leaves an unpleasant taste in the mouth, which may affect the acceptance or even rejection of SDF therapy among young children. This study provides clinicians with information to make their decision on postoperative instruction after SDF therapy.

Comparative Evaluation of the Quality of Obturation Between Three Obturation Techniques in Primary Canines: An In Vitro Study.

Aims This study compares three obturation techniques (rotary lentulo spiral, handheld lentulo spiral, and pressure syringe) for the quality of two filling pastes (zinc oxide eugenol (ZOE) paste and Metapex (Meta Biomed Co., Ltd., Chungcheongbuk-do, Korea). Methods and materials Sixty extracted primary canines were instrumented and obturated by filling materials. The obturation techniques were divided into three groups according to different obturation techniques. Obturation quality was evaluated for length, density, and presence of voids by using digital radiography. Results This study showed that the handheld lentulo spiral technique using Metapex and ZOE exhibited more optimal fillings for obturation length. The highest density obturation was achieved using the syringe injection approach with Metapex and ZOE. The highest incidence of both external and internal voids was observed in the group using ZOE with the handheld lentulo spiral technique Conclusions Based on the findings of this study, for both filling materials, the handheld lentulo spiral technique had the greatest number of optimal lengths but there were also more voids.

A Radicular Cyst in the Mandibular Anterior Region of Primary Teeth.

Radicular cysts are common among odontogenic cysts but are rare in primary teeth. They occur more frequently in the mandibular molar region and rarely in the mandibular anterior region. This is a case of a radicular cyst in the mandibular anterior teeth during the primary dentition stage. In addition, after the fenestration of cystic lesions, gauze is generally changed to prevent the extraction socket from closing. However, in this case, the patient was six years old. Therefore, to alleviate the burden of changing the dressing gauze, we practiced putting on and taking off the obturator before fenestration and using it immediately after surgery under general anesthesia. This made it possible to change the dressing gauze after surgery. We were able to maintain an open wound without the burden of dressing gauze changes. The use of the device was shown to be effective in maintaining open wounds in young patients.

Success Rates of Antibiotic Sterilization, Indirect Pulp Treatment, and Pulpotomy in the Management of Primary Teeth with Deep Carious Lesions.

Background and aim: A new concept of antibiotic sterilization has come into existence which can be used to sterilize the demineralized portion of the teeth with minimal or ultraconservative excavation of caries in deep dentinal carious lesions as an alternative for indirect pulp therapy (IPT) and pulpotomy to avoid further complications. This study was undertaken to compare the success rates of antibiotic sterilization, indirect pulp treatment, and pulpotomy in the management of primary teeth with deep carious lesion. Materials and methods: Ninety teeth involving deep carious lesions approaching pulp in primary molars were selected and randomly divided into three groups containing 30 teeth. Group I was treated with antibiotic sterilization using 3Mix-MP paste, group II was treated with indirect pulp treatment using calcium hydroxide, and group III was treated with conventional pulpotomy using 15.5% ferric sulfate (FS) solution. Clinical and radiographic analysis of all three groups was performed at 1, 3, 6, 9, and 12 months to evaluate the success of treatment procedures using predetermined criteria. Pearson's Chi-squared test and McNemar test were used for statistical analysis. Results: At the end of the 12-month follow-up period, the overall clinical and radiographic success was determined to be 96.3% for group I, 100% for group II, and 96.4% for group III. There were no statistically significant differences observed between the success of three groups, suggesting that either of the procedures can be adopted for the management of deep carious lesions approaching pulp in primary teeth. Conclusion: Antibiotic sterilization can be introduced as a newer modality in the management of deep carious lesions approaching pulp in primary teeth which is ultraconservative in nature and reduces the risk of pulp exposure in comparison with indirect pulp treatment and pulpotomy procedures. How to cite this article: Saxena D, Garg N, Pathivada L, et al. Success Rates of Antibiotic Sterilization, Indirect Pulp Treatment, and Pulpotomy in the Management of Primary Teeth with Deep Carious Lesions. Int J Clin Pediatr Dent 2024;17(3):237-242.

The effect of different intracanal irrigants on the push-out bond strength of dentin in damaged anterior primary teeth.

This experimental study investigated the effect of different intracanal irrigants on the push-out bond strength of dentin in damaged anterior primary teeth. The crowns of 90 anterior primary teeth were sectioned horizontally, 1 mm above the cementoenamel junction (CEJ). Following canal preparation with K-files, all groups except the negative control received normal saline irrigation. Canals were then irrigated with either 3% or 5.25% sodium hypochlorite (NaOCl), 2% or 0.2% chlorhexidine (CHX) solution (except negative and positive controls). The roots were filled with Metapex material and covered with a calcium hydroxide liner. In root canals, the bond was applied by self-etching and then light-cured for 20 seconds before canals were restored incrementally with composite. Stereomicroscopes were used to assess failure patterns. Push-out bond strengths (MPa ± SD) were: 3% NaOCl (16.92 ± 5.78), 5.25% NaOCl (8.96 ± 3.55), 2% CHX (14.76 ± 5.56), and 0.2% CHX (7.76 ± 2.93). Significant differences were seen across the irrigants regarding the push-out bond strength of dentin sections (P <0.001). The most frequent failures were adhesive and cohesive. NaOCl and CHX irrigants increased the push-out bond strength compared to controls. Compared to controls, both 3% NaOCl and 2% CHX irrigants significantly increased the push-out bond strength of dentin in non-vital anterior primary teeth.

Strategies for Pain Management after Extraction of Primary Teeth: A Systematic Review of Randomized Clinical Trials.

BACKGROUND: In dental extractions, particularly when local anesthesia is used, it usually offers analgesic relief for a few hours. However, pain can become a notable concern in the immediate postoperative period due to the trauma experienced by both soft and hard oral tissues. OBJECTIVES: This systematic review aimed to evaluate the most effective strategies for managing postoperative pain in primary tooth extractions. METHODS: Two examiners conducted a search across five electronic databases: MEDLINE (via PubMed), Embase, Scopus, Web of Science, CENTRAL, and OpenGray. Studies were included if they met the following criteria after reviewing their titles and abstracts: they involved children and evaluated pain management following primary tooth extraction. Subsequently, articles that described extractions performed under any form of sedation, were not conducted under local anesthesia, in an outpatient setting, and in children aged 0 to 12 years, or were not randomized controlled trials, were excluded. RESULTS: The search yielded 374 relevant articles, of which 9 were included. Among these, 5 utilized preoperative medications as a pain management strategy, one evaluated low-level laser therapy (LLLT) postoperatively, one assessed calendula drops postoperatively, and another explored virtual reality during the procedure and arnica in solution both pre and postoperatively. CONCLUSION: Among all the strategies evaluated, the strategy involving analgesics administered 30 minutes before tooth extractions was supported by better-designed studies. However, there is a high risk of bias.