Transplanting Livers in Young Children - Looking Back at 100 Cases.

Introduction: Despite advances in medical therapy, liver replacement continues to be the only definitive mode of therapy for children with end-stage liver disease (ESLD). However, its acceptance in India has been discouraging more due to financial and logistic reasons than the availability of expertise. This report outlines our journey and highlights issues pertinent to circumstances in an emerging economy like India. Aim: The aim is to review a single center's 100 case experience with liver transplantation (LT). Materials and Methods: A prospective analysis of all children who underwent LT since 2005 at our institute was done. The data were collated from a maintained structured database. Results: Hundred children underwent LT. Sixty-four were boys. Age ranged from 5 to 144 months, with a median of 17 months. The mean weight of the cohort was 7.5 kg (ranging from 3.7 to 31.5 kg), with 60% of our children weighing between 5 and 10 kg. Biliary atresia is the most common indication (57%); others include metabolic disorders, progressive familial intrahepatic cholestasis, and hepatoblastoma. Two patients were for acute liver failure. Ninety-one children underwent live donor LT (mothers being the majority of the donors). None of the donors had any major postoperative complications. Major intraoperative complications include sepsis (39%), vascular complications (17%), biliary leak (11%), and intestinal complications (11%). Early postoperative deaths occurred in 18% of patients with sepsis being most common cause. The mean follow-up was 8.5 years and the overall survival is 70%. The mean survival is time (months) = 176.1. All surviving patients were followed up and had achieved good catch up growth by 3rd and 5th years posttransplant. The long-term sequalae include recurrent intercurrent infections, graft rejection (9%), posttransplant lymphoproliferative disease (5%), and portal vein stenosis (5%). Conclusion: Our experience demonstrates the feasibility of LT in children with ESLD in India. With longer-living grafts, patients often struggle with other issues such as compliance with follow-up, financial issues, recurrent infections, and neurological problems. Close monitoring with regular follow-up of patients helps in early recognition and treatment of late-onset complications, thus helping the overall long-term outcomes.

Redo Surgeries in Anorectal Malformations: A Single-center Experience.

Aims and Objectives: Complications following posterior sagittal anorectoplasty (PSARP) for ARM are well known. In this article, we present our experience of managing five patients who required major redo surgeries for complications resulting from previous attempts to correct ARM. Materials and Methods: We reviewed all patients who underwent major redo surgeries in our hospital for complications from previous repairs for ARM, from June 2013 to June 2019. Data was obtained from hospital records and analysed. Results: Five patients whose ages ranged from 5 months to 14 years were included in the study. Four were boys and 1 was a girl. All patients had undergone PSARP in other hospitals. The presentations were retained distal bowel causing urinary retention and constipation (n=1), pulled through proximal urethra and bladder neck presenting as passage of urine from neo-anus (n=1), retained common channel (of cloaca) causing a 'H' type configuration (n=1), mispositioned neo-anus (n=1) following a primary PSARP and lastly undivided recto-urethral fistula causing fecaluria (n=1). All of them underwent redo repairs by posterior sagittal approach with documented improvement in their symptoms. Two of them required total bowel management to remain clean. Conclusion: All the complications reported here have been described in literature nevertheless, this report will add to the body of experience. Posterior sagittal approach (PSA) has proved to be very successful technique in correcting these complications.

Black Ovary: Our Experience with Oophoropexy in All Cases of Pediatric Ovarian Torsion and Review of Relevant Literature.

Introduction: Oophorectomy is the treatment of choice in ovarian torsion if after detorsion the ovary looks bluish black. Ovarian preservation is advocated by many studies in the pediatric age group quoting the ability of the ovary to recover despite the appearance after detorsion. Aims: This study aims to review the outcome of salvage surgery (detorsion) in the management of pediatric ovarian torsion. Materials and Methods: This is a retrospective study of girls under 18 years with ovarian torsion treated from January 2016 to June 2021. Data were collated from records and analyzed. Results: Ten girls with ovarian torsion were included (mean age of 11 years). Ultrasonography and Doppler confirmed ovarian torsion in all. Emergency laparoscopy with detorsion was done in all with the mean time lapse from onset to surgery being 35 h. All the ovaries were black initially and persisted to be bluish black after detorsion. All were conserved and fixed to the lateral abdominal wall. In one child with an associated ovarian cyst, the cyst excision was also done. All girls were asymptomatic on follow-up. Ultrasonography at 3-month follow-up showed a normal-sized ovary with good blood flow in 9 out of 10 girls (90% cases). Follicular changes were seen in five girls who had attained puberty. In one girl, the ovary was very small sized and flows were not well visualized. Conclusion: Detorsion and oophoropexy should be the procedure of choice in pediatric patients with ovarian torsion. The gross appearance of the ovary after detorsion should not be the sole determinant for oophorectomy.

Hair Tourniquet of the Uvula.

Hair tourniquet syndrome (HTS) is a condition, where a strand of hair encircles the base of an appendage. We report a rare case of HTS of the uvula and review relevant literature.

Adrenocorticotropic Hormone-Independent Hypercortisolism Managed by Bilateral Retroperitoneoscopic Adrenalectomy: Report of a Case and Review of Literature.

Bilateral adrenalectomy is the reference treatment for Cushing's syndrome related to adrenocorticotropic hormone-independent macronodular adrenal hyperplasia (AIMAH). We report a case of AIMAH managed by sequential retroperitoneoscopic adrenalectomy and review the literature of the same.

Clostridioides difficile Infection: Update on Management.

Guidelines for the diagnosis and treatment of Clostridioides difficile infection have recently been updated. Risk factors include recent exposure to health care facilities or antibiotics, especially clindamycin. C. difficile infection is characterized by a wide range of symptoms, from mild or moderate diarrhea to severe disease with pseudomembranous colitis, colonic ileus, toxic megacolon, sepsis, or death. C. difficile infection should be considered in patients who are not taking laxatives and have three or more episodes of unexplained, unformed stools in 24 hours. Testing in these patients should start with enzyme immunoassays for glutamate dehydrogenase and toxins A and B or nucleic acid amplification testing. In children older than 12 months, testing is recommended only for those with prolonged diarrhea and risk factors. Treatment depends on whether the episode is an initial vs. recurrent infection and on the severity of the infection based on white blood cell count, serum creatinine level, and other clinical signs and symptoms. For an initial episode of nonsevere C. difficile infection, oral vancomycin or oral fidaxomicin is recommended. Metronidazole is no longer recommended as first-line therapy for adults. Fecal microbiota transplantation is a reasonable treatment option with high cure rates in patients who have had multiple recurrent episodes and have received appropriate antibiotic therapy for at least three of the episodes. Good antibiotic stewardship is a key strategy to decrease rates of C. difficile infection. In routine or endemic settings, hands should be cleaned with either soap and water or an alcohol-based product, but during outbreaks soap and water is superior. The Infectious Diseases Society of America does not recommend the use of probiotics for prevention of C. difficile infection.

Preclinical Evaluation and Clinical Trial of Chlorhexidine Polymer Scaffold for Vital Pulp Therapy.

OBJECTIVE: To evaluate the preclinical effectiveness and clinical efficacy of chlorhexidine polymer scaffold for vital pulp therapy. STUDY DESIGN: Polymer scaffolds loaded with chlorhexidine were prepared by electrospinning. The scaffolds were evaluated using four different tests: i) The release of chlorhexidine from the polymer scaffold was evaluated by Fourier-transform infrared spectroscopy (FTIR); ii) Biocompatibility of chlorhexidine scaffold was tested by subcutaneous implantation in rabbits; iii) The scaffolds were implanted into human molars for further ex vivo histological evaluation; and iv) The clinical efficacy of the scaffold was evaluated as a pulp dressing following vital pulp therapy, in comparison with MTA (control) in a clinical trial of forty primary molar teeth in 34 children aged 6 to 8 years. RESULTS: The scaffold was antimicrobial to Streptococcus mutans, Lactobacilli and other facultative anaerobes. Fourier-transform infrared spectroscopy confirmed the presence of chlorhexidine and polyvinyl alcohol in the scaffold. The histological evaluation of the subcutaneous tissue of rabbits and ex vivo human molars provided an acceptable biocompatibility response to scaffold. The clinical trial showed that the efficacy of chlorhexidine loaded scaffold was 90% and comparable to MTA. CONCLUSION: The scaffold met acceptable standards in all the four tests that were performed, including the clinical trial. A larger clinical trial with chlorhexidine scaffold in adult teeth may be necessary to prove its efficacy. The preliminary clinical trial results demonstrated that the scaffold was beneficial in saving primary teeth that required pulpotomy as a vital pulp therapy.

Quality of Life of Indian Pediatric Surgeons: Results of a Survey (of Indian Association of Pediatric Surgeons Members).

INTRODUCTION: Much is debated on the quality of life of pediatric surgeons practicing in India, all based on anecdotal and personal experiences. There is no systematic study on this. This study addresses this and attempts to glean a clearer picture of the life as a pediatric surgeon in India. METHODOLOGY: This questionnaire-based study was administered via an online survey to all Indian Association of Pediatric Surgeons members. The responses were anonymous and investigators blinded. Data were collated and analyzed using STAT11.1. RESULTS: A total of 173 pediatric surgeons responded. Eighty-six percent were men. About 73.7% of the surgeons were between 31 and 50 years of age. Almost 63.4% practiced in urban areas, whereas 36% in other smaller towns. About 0.6% reported that their practice was rural. Almost 26.4% were in private/solo practices, whereas 53.4% were in institution-based practice. Almost 80% felt that they were adequately trained while starting their practice. About 78% are professionally satisfied with their work. Only 44.5% of surgeons felt that they were compensated adequately financially. Reading was the favorite pass time. Almost 40% of the surgeons felt that they were either overweight or obese. About 41% of the surgeons exercise more than 3 times a week. Only 11.4% smoke, whereas 36% drink. Fifty-three percent of surgeons felt that their personal savings were adequate. Seventy-six percent use Facebook. Sixty-eight percent were satisfied with their quality of life. Age was significantly associated with professional satisfaction, financial satisfaction, and quality of life and all improve as one's age progresses. None were affected with one's gender, type of practice, and the place of practice. Age, weight, exercise, and one's savings significantly affected ones quality of life. CONCLUSION: This is the first study which objectively highlights that most surgeons are happy professionally and financially in due course of time and demolishes the common belief that pediatric surgeons are unsatisfied. It also acts as a point of reference and encouragement to newer aspirants in pediatric surgery.

In Vitro Evaluation of Reliability and Validity of International Caries Detection and Assessment System II Coding for Occlusal Caries using Magnification.

Aim: To check the reliability and validity of International Caries Detection and Assessment System (ICDAS) II coding in occlusal caries detection under unaided visual and enhanced visual examination. Materials and methods: This study included 100 extracted premolars and molars. Two examiners independently scored occlusal caries using ICDAS II criteria without magnification and under 6x magnification in the dental operating microscope. The examination was repeated after one month to check the intraexaminer reliability. The examined samples were sectioned and the carious lesions were scored using Ekstrand-Ricketts-Kidd (ERK) histological criteria under 20x magnification in stereomicroscope. The ICDAS II scores given by the examiners were compared with the histological scores. Results: The κ values for interexaminer reproducibility of unaided and enhanced visual examinations were 0.695 and 0.626, respectively (substantial agreement), and 0.984 (almost perfect agreement) for histological examination. Intraexaminer reproducibility for unaided and enhanced visual examinations were 0.835 and 0.910, respectively (almost perfect agreement). Spearman's correlation coefficients of ICDAS II unaided visual and enhanced visual examinations to ERK histological scores were 0.724 and 0.689, respectively, which infers that there is a strong correlation between unaided visual and histological examination and a moderate correlation between enhanced visual and histological examination. For unaided visual examination, specificity is 100% and sensitivity is 92%, whereas for enhanced visual examination, specificity is 50%, and sensitivity is 100%. Conclusion: Unaided visual examination demonstrated good reliability and validity for ICDAS II coding, whereas enhanced visual examination exhibited good reliability but relatively lower validity. Clinical significance: This study reveals that magnification did not have any added benefits in occlusal caries diagnosis using ICDAS II coding compared to unaided visual examination. The use of magnification did not improve the validity and led to a drop in the specificity, which indicates higher chances of false positive results. How to cite this article: SasiRekha G, Chandrasekhar R, Vinay C, et al.In Vitro Evaluation of Reliability and Validity of International Caries Detection and Assessment System II Coding for Occlusal Caries using Magnification. Int J Clin Pediatr Dent 2023;16(S-2):S138-S141.

Impact of Parenting Style on Child's Behavior and Caries Experience in 3-6-year-old Children: A Cross-sectional Study.

Aim: The aim of the study is to evaluate the impact of parenting style on a child's behavior and caries experience in 3-6-year-old children. Materials and methods: This cross-sectional study included 1,216 parent-child pairs of 3-6-year-old preschool children. Parenting style was determined using Parenting Style and Dimensions Questionnaire (PSDQ). Child behavior was assessed using Frankl's behavior rating scale, and caries experience was recorded using the decayed, extracted and filled deciduous teeth surfaces index. Results: Out of the 1,216 parents, the authoritative parenting style is seen in 70%, authoritarian in 20%, and permissive parenting style in 9.5%. Children with a permissive type of parenting style have shown more negative behavior. Children of authoritative parents had 4.1 times higher odds of exhibiting definitely positive behavior, which is statistically significant (p = 0.004). Children of positive child behavior had 2.4 times higher odds of avoiding caries which is statistically significant (p = 0.0001). Children of authoritarian parents had 1.45 times higher odds of exhibiting caries than children of permissive parents; however, this difference is not statistically significant. Conclusion: Children of authoritative parents demonstrated low caries experience and desirable behavior in the dental office. On the contrary, children of permissive parents exhibited undesirable dental behavior, and children of authoritarian parents had high caries experience. Clinical significance: Twenty-first-century parents are less controlling and are more permissive leading to problematic child behavior in the dental office. Parenting styles have an impact on the effectiveness of behavior management as well as dental treatment. Pediatric dentists should identify different parenting styles and anticipate the child's behavior. This study emphasizes the effect of different parenting styles on a child's behavior and dental caries experience. How to cite this article: Shalini K, Uloopi KS, Vinay C, et al. Impact of Parenting Style on Child's Behavior and Caries Experience in 3-6-year-old Children: A Cross-sectional Study. Int J Clin Pediatr Dent 2023;16(2):276-279.

Effectiveness of Laser-activated and Ultrasonic Irrigation Techniques in Removal of Calcium Hydroxide and Modified Triple Antibiotic Paste from the Root Canals: An In Vitro Evaluation.

Aim: To evaluate the effectiveness of laser-activated irrigation (LAI) and ultrasonic irrigation (UI) in the removal of calcium hydroxide [Ca(OH)2] and modified triple antibiotic paste (MTAP) from the root canals. Materials and methods: Root canals of freshly extracted human permanent maxillary incisors (n = 80) were prepared. The root canals of half sample (n = 40) were filled with Ca(OH)2 and the other half (n = 40) with MTAP, in which propylene glycol was used as a vehicle. After 14 days, roots were randomly assigned to four groups (n = 20) according to the irrigation technique used-group I [Ca(OH)2 with UI], group II (MTAP with UI), group III [Ca(OH)2 with LAI], group IV (MTAP with LAI). The roots were sectioned, and the intracanal medicament residues were evaluated at 25× magnification under stereomicroscope using 4-grade scoring system. Statistical analysis: One-way analysis of variance (ANOVA) and post hoc Tukey tests were performed. Results: Laser-activated irrigation (LAI) was found to be superior compared to UI. Ca(OH)2 was better removed compared to MTAP with either of the irrigation techniques. A statistically significant difference was found between the Ca(OH)2 with LAI and MTAP with UI groups in all the regions, that is, coronal, middle, and apical thirds. Conclusion: Laser-activated irrigation (LAI) was superior to UI in removing Ca(OH)2 and MTAP. Ca(OH)2 was better removed than MTAP, irrespective of the technique used. However, none of the irrigation techniques could completely remove the intracanal medicament from the root canals. How to cite this article: Swathi P, Uloopi KS, Vinay C, et al. Effectiveness of Laser-activated and Ultrasonic Irrigation Techniques in Removal of Calcium Hydroxide and Modified Triple Antibiotic Paste from the Root Canals: An In Vitro Evaluation. Int J Clin Pediatr Dent 2023;16(S-1):S1-S5.

Evaluation of Dentin Remineralization with Zinc Oxide and Calcium Fluoride Nanoparticles - An In vitro Study.

Background: Partially demineralized dentin is remineralizable when mineral ions are made available in the near vicinity. Nanoparticles (NPs) have wide applications in remineralization process. Zinc promotes remineralization and has a synergistic effect when combined with fluoride. Hence, zinc oxide and calcium fluoride NPs were considered for dentin remineralization. Aim: The aim of this study was to evaluate the remineralizing ability of zinc oxide and calcium fluoride NPs on demineralized dentin individually and in combined form. Settings and Design: This was an in vitro study. Materials and Methods: Forty-eight dentin disks were prepared from the crowns of 12 extracted human molars and were allocated into four groups of 12 each, i.e., Group I - nano zinc oxide (nZnO), Group II - nano calcium fluoride (nCaF2), Group III - combined group (nZnO + nCaF2), and Group IV - artificial saliva (AS, control group). The specimens were demineralized with 37% phosphoric acid and placed in the respective remineralizing solutions for 24 h and 1 month. Calcium (Ca) and phosphorous (P) uptake was measured using energy-dispersive X-ray spectrometry, and structural changes were analyzed using scanning electron microscopy (SEM). Statistical Analysis: One-way analysis of variance, Student's t-test, and post hoc Tukey's test were used for statistical analysis. Results: At 1-month interval, all the groups showed an increase in Ca/P ratio, with highest being the combined group (4.24), followed by nCaF2 (3.30), nZnO (1.71), and AS (1.31) groups, and these differences were statistically significant (P = 0.000). On SEM analysis of dentinal samples at 1 month, depositions were evident in intertubular regions, wherein the highest deposits were observed in the nZnO group, followed by nZnO + nCaF2 and nCaF2 groups. Conclusion: Dentin samples subjected to remineralization with aqueous solutions of nZnO and nCaF2 showed an increase in calcium and phosphorous uptake and also dense granular depositions were evident in intertubular regions of dentin.

A Randomized Controlled Trial Evaluating the Effectiveness of Nanosilver Fluoride in Arresting Dental Caries in School Children.

Aim: The study evaluated the effectiveness of nanosilver fluoride (NSF) in arresting dental caries in 4-8-year-old school children. Materials and methods: The two-arm, parallel-group randomized controlled trial included a total of 148 children aged 4-8 years with active carious lesions. Children were randomly divided into two groups: group I-NSF (n = 74); and group II-water (placebo and n = 74). Baseline data were recorded using the International Caries Detection and Assessment System (ICDAS) II criteria, and the teeth were treated with either of the solutions. Later, the teeth were evaluated by two blinded examiners for the lesion activity using ICDAS II criteria at 1, 3, and 6-month intervals. The obtained data were analyzed using the Chi-squared test for intergroup comparison and Cochran's Q test for intragroup comparison. Cohen's κ test was used to check the interexaminer and intraexaminer variability. Results: Carious teeth treated with NSF have shown 56.3, 59.2, and 62% arrested carious lesions, whereas the placebo group has shown 0, 2.9, and 4.4% arrested lesions at 1, 3, and 6-month intervals, respectively. NSF showed a high statistically significant difference (p < 0.001) in arresting dental caries compared to the control group at all the time intervals. Conclusion: Nanosilver fluoride (NSF) is found to be effective in arresting dental caries without staining carious lesions. Therefore, it can be used to reduce the bacterial load for caries stabilization in the initial phase of the comprehensive treatment protocol for the management of children with active caries lesions. Clinical significance: Most of the decayed teeth in the primary dentition remain untreated either because of inaccessible dental services or the uncooperativeness of children. Hence, there is an absolute need for a cariostatic agent which arrests the progression of caries in a simple and noninvasive manner. The results of this study evidence that NSF effectively arrests dental caries in primary teeth. Hence, this can be a very economical way of arresting caries in the population who don't have access to regular dental treatment. How to cite this article: Devi C, Chandrasekhar R, Vinay C, et al. A Randomized Controlled Trial Evaluating the Effectiveness of Nanosilver Fluoride in Arresting Dental Caries in School Children. Int J Clin Pediatr Dent 2023;16(5):667-670.

Effectiveness of Distraction with Virtual Reality Eyewear in Managing 6-11-year-old Children with Hearing Impairment during Dental Treatment: A Randomized Controlled Trial.

Aim: To assess the effectiveness of distraction with virtual reality (VR) eyewear along with modified tell-show-do (MTSD) on anxiety levels of 6-11-year-old children with hearing impairment (HI) during the noninvasive dental procedure. Materials and methods: The randomized controlled trial included 40 children with HI aged 6-11 years requiring oral prophylaxis. The children were randomly allocated into two groups. Oral prophylaxis was carried out in both groups, where in group I (VR + MTSD, n = 20), distraction with VR eyewear was performed along with MTSD, and in group II (MTSD, n = 20), MTSD alone was used. Pre and postoperative anxiety levels were assessed using facial image scale (FIS) (subjective) and pulse rate (PR) (objective) measures. Paired t-test and unpaired t-test were used to analyze the obtained data. Results: Postoperative (post-op) PR readings in the VR + MTSD group were reduced by 6.95, whereas it was increased in the MTSD group by 8.55, and the difference was statistically significant (p = 0.001). Post-op FIS scores were found to be reduced in the VR + MTSD group by 2.15, whereas it was increased in the MTSD group by 0.10, and the difference was statistically significant (p = 0.033). Conclusion: Distraction using VR eyewear along with MTSD is effective in reducing anxiety levels in 6-11-year-old children with HI during noninvasive dental procedures. Clinical significance: Hearing-impaired children are usually anxious about the unknown and have unmet oral health needs due to communication barriers. This study provides evidence that the distraction using VR eyewear along with MTSD is effective in reducing anxiety levels in children with HI. How to cite this article: Varshitha K, Uloopi KS, Vinay C, et al. Effectiveness of Distraction with Virtual Reality Eyewear in Managing 6-11-year-old Children with Hearing Impairment during Dental Treatment: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2023;16(6):820-823.

Effectiveness of two flavored topical anesthetic agents in reducing injection pain in children: a comparative study.

UNLABELLED: Topical anesthesia is widely advocated in pediatric dentistry practice to reduce pain and anxiety produced by administration of local anesthesia. There are different combinations of topical anesthetic agents that are marketed worldwide. However, sparse literature reports exist regarding clinical efficacy of these agents. AIM: To compare the clinical effectiveness of two strawberry flavored topical anesthetics viz. Precaine (8% Lidocaine + 0.8% Dibucaine) and Precaine B (20% Benzocaine) in children before intra oral local anesthetic injections and for extraction of mobile primary teeth. STUDY DESIGN: This triple blind clinical study included sixty children divided equally under three techniques--palatal injections, inferior alveolar nerve block and extraction of mobile primary teeth. Both the products were used alternately using split mouth design in two visits and the child's pain response was assessed using VAS and SEM pain scale. The scores obtained were subjected to statistical analysis. RESULTS: Precaine has shown lower mean scores in all the techniques under both the pain scales, but were statistically insignificant. Gender wise comparison has also shown lower mean scores for Precaine for both males and females, however these were statistically insignificant. On visit wise comparison, Precaine B reported significant lower scores (p < 0.05) in visit 2 compared to visit 1 for inferior alveolar nerve block and extraction of mobile primary teeth under SEM pain scale. CONCLUSION: Precaine (8% Lidocaine + 0.8% Dibucaine) can be used as effectively as Precaine B (20% Benzocaine).

Treatment Outcomes of Pulpotomy with Propolis in Comparison with MTA in Human Primary Molars: A 24-month Follow-up Randomized Controlled Trial.

Aim and objective: To evaluate the clinical efficacy of propolis as pulpotomy medicament in human primary molars. Materials and methods: This randomized controlled trial is a two-arm, parallel group study with blinded outcome assessment. The study included a total of 60 primary molars that require pulpotomy treatment in 4- 8-year old children. Teeth were assigned to two groups randomly: Propolis (Test group); Mineral trioxide aggregate (MTA) (Control group). All the pulpotomized teeth were given stainless steel crowns and the teeth were evaluated clinically and radiographically at 6, 12, and 24 months to grade them as either success or failure. Chi-square test was employed to analyze the data. Results: Success rates of pulpotomy with propolis and MTA were 80% and 93.1% respectively at 24 months of follow-up interval. Propolis has shown success rates of 90% and 80% at 6- and 12-month follow-up, while MTA has shown a consistent success rate of 93.1% at all the follow-up intervals. The difference in success rate between the groups at all the time intervals is statistically nonsignificant. Conclusion: Propolis has demonstrated a clinically acceptable success rate comparable to MTA as pulpotomy medicament in primary teeth. Clinical significance: Biocompatible materials with regenerative potential have drawn the momentum in vital pulp therapy. In this regard, MTA has been emerged as most successful material, but its high cost has limited its use. Hence, there is an absolute need of cost-effective pulpotomy material with regenerative potential. This study provides an evidence that propolis has clinically acceptable success rate as pulpotomy medicament. Considering its low cost and ready availability, it can be recommended as a cost-effective alternative for primary teeth pulpotomy. How to cite this article: RojaRamya KS, Chandrasekhar R, Uloopi KS, et al. Treatment Outcomes of Pulpotomy with Propolis in Comparison with MTA in Human Primary Molars: A 24-month Follow-up Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15(S-1):S3-S7.

Evaluation of caries arresting potential of silver diamine fluoride and sodium fluoride varnish in primary molars: A randomized controlled trial.

Background: Caries management in the modern era has shifted away from the traditional surgical method toward a medical paradigm, which often includes fluoride therapy. Fluoride used in various forms has been proven to be effective in dental caries prevention. Silver diamine fluoride (SDF) and sodium fluoride (NaF) varnish are effective in arresting caries in primary molars. Aim: This study aimed to evaluate the effectiveness of 38% SDF and 5% NaF varnish in arresting caries in primary molars. Settings and Design: This study was a split-mouth randomized controlled trial. Materials and Methods: The randomized controlled trial comprised 34 children aged 6-9 years with teeth having caries in both right and left primary molars without pulpal involvement. Teeth were randomly allocated into two groups. In Group 1 (n = 34), 38% SDF + potassium iodide was applied and in Group 2 (n = 34), 5% NaF varnish was applied. The second application was done after 6 months in both groups. Children were recalled at 6- and 12-month intervals and evaluated for caries arrest. Statistical Analysis: Chi-square test was used to analyze the data. Results: Caries arresting potential was found to be higher in the SDF group compared to the NaF varnish group at both 6-month (SDF - 82% and NaF varnish - 45%) and 12-month intervals (SDF - 77% and NaF varnish - 42%) and the difference was found to be statistically significant (P = 0.002 and 0.004, respectively). Conclusion: SDF was more effective in arresting dental caries in primary molars compared to 5% NaF varnish.

A Randomized Controlled Trial for Evaluation of the Effectiveness of Oral Irrigator and Interdental Floss for Plaque Control in Children with Visual Impairment.

Aim: To evaluate the effectiveness of oral irrigator and interdental floss as adjuncts to manual tooth brushing in 8-16 years old children with visual impairment. Materials and methods: A three-arm, parallel-group randomized controlled trial with blinded outcome assessment was carried out with the inclusion of 90 institutionalized children with visual impairment of age 8-16 years. They were equally allocated to three groups: group I: tooth brushing along with interdental flossing, group II: brushing along with a powered oral irrigator, and group III: brushing alone (control). Baseline oral hygiene index-simplified (OHI-S), gingival index (GI), and plaque index (PI) scores were recorded for all the samples and compared with post-intervention scores at 14 and 28 days intervals. Repeated measures of analysis of variance (ANOVA), one-way ANOVA, and post hoc Tukey tests were used for statistical analysis. Results: At 28 days interval, children in group II showed a highly statistically significant reduction in OHI-S (0.46; p = 0.0001), PI (0.16; p = 0.0001), and GI (0.24; p = 0.0001) scores compared to control group. They also showed a significant reduction in OHI-S (0.25; p = 0.018), PI (0.15; p = 0.011), and GI (0.15; p = 0.0001) scores compared to group I. There is no significant reduction in the scores of children of group I compared to control group except for the GI score (0.08; p = 0.02). Conclusion: Oral hygiene maintenance using oral irrigator along with brushing was found to be more effective in visually challenged children. Interdental flossing, along with brushing and brushing alone was found to be less effective. Clinical significance: This study underlines the fact that comprehensive oral hygiene care should include interdental cleaning aids for effective plaque control to prevent dental diseases in children with visual impairment. Since these children have less manual dexterity to perform good oral hygiene practices, electrically driven interdental cleaning aids like oral irrigator may help them to overcome the problem. How to cite this article: Deepika V, Chandrasekhar R, Uloopi KS, et al. A Randomized Controlled Trial for Evaluation of the Effectiveness of Oral Irrigator and Interdental Floss for Plaque Control in Children with Visual Impairment. Int J Clin Pediatr Dent 2022;15(4):389-393.

Clinical Evaluation of the Retention of Self-adhering Flowable Composite as Fissure Sealant in 6-9-year-old Children: A Randomized Controlled Trial.

Aim: To evaluate the retention rate of self-adhering flowable composite as fissure sealant in comparison with the unfilled resin sealant on first permanent molars of 6-9-year-old children. Materials and methods: A 2-arm, split-mouth randomized controlled trial included 100 children of age 6-9 years with completely erupted mandibular first permanent molars. A total of 200 teeth were randomly divided into two groups, group I: self-adhering flowable composite; group II: unfilled resin sealant. Sealants were placed on the mandibular first permanent molars and the children were recalled at 6, 12, and 18 months intervals to evaluate the retention rate. Chi-square test was used to analyze the data. Results: Self-adhering flowable composite has shown a complete retention rate of 67%, 47%, and 46% at 6, 12, and 18-month intervals, respectively, whereas unfilled resin sealant has shown 41%, 8%, and 5% retention rate at 6, 12, and 18-month intervals, respectively. The difference in the complete sealant retention rates between the groups is found to be statistically highly significant at all the follow-up intervals (p = 0.0004, 0.0001, and 0.0001 at 6, 12, and 18-month intervals, respectively). In both groups, maximum sealant loss occurred between 6 and 12-month intervals. Retention rates were higher at 6 months intervals which were significantly reduced over 18 months intervals. Conclusion: Self-adhering flowable composite has shown a higher retention rate compared to unfilled resin sealant at all the time intervals. The retention rate of both materials decreased with time. However, the loss of sealant was more with unfilled resin sealant. Clinical significance: In pediatric dental practice, the elimination of a step in restorative dentistry protocol makes a big difference as time is a critical factor in obtaining children's cooperation. The use of self-adhering materials eliminates the step of bonding agent application, which simplifies the restorative protocol and makes the clinical practice effective. Therefore, these self-adhering flowable composite resin materials can be considered fissure sealants in routine clinical practice. How to cite this article: Bhuvaneswari P, Vinay C, Uloopi KS, et al. Clinical Evaluation of the Retention of Self-adhering Flowable Composite as Fissure Sealant in 6-9-year-old Children: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15(3):322-326.