Comparative Evaluation of Push-out Bond Strength of Conventional Mineral Trioxide Aggregate, Biodentine, and Two Novel Antibacterial-enhanced Mineral Trioxide Aggregates.

AIM: To evaluate the push-out bond strength of two newly modified mineral trioxide aggregates (MTAs) with conventional MTA and biodentine. MATERIALS AND METHODS: Material preparation: Two commercially available bioactive bioceramics: Group I: Mineral trioxide aggregate; Group II: Biodentine; and two newly formulated modified MTAs: Group III: Doxycycline incorporated MTA formulation; Group IV: Metronidazole incorporated MTA formulation was used in the present study. All the test materials were then carried using a plastic instrument to the desired experimental design. Teeth sample preparation: A total of 120 teeth samples were collected and divided into four groups of test materials with 30 teeth samples per group. Single-rooted permanent teeth, that is, incisors were collected and stored in saline until the study was performed. Sectioning of the teeth into 2.0 ± 0.05-mm thick slices was performed perpendicular to the long axis of the tooth. The canal space was instrumented using Gates Glidden burs to achieve a diameter of 1.5 mm. All four prepared materials were mixed and placed in the lumen of the slices and placed in an incubator at 37°C for 72 hours. Push-out test and bond failure pattern evaluation: The push-out test was performed using a universal testing machine. The slices were examined under a scanning electron microscope (SEM) at 40× magnification to determine the nature of bond failure. All the collected data were recorded and statistically analyzed. RESULTS: The mean push-out bond strength was found to be the highest for group II (37.38 ± 1.94 MPa) followed by group III (28.04 ± 2.22 MPa) and group IV (27.83 ± 1.34 MPa). The lowest mean push-out bond strength was noticed with group I (22.89 ± 2.49 MPa). This difference was found to be statistically significant (p = 0.000). Group I samples had the predominantly adhesive type of failure (86.4%), while group II samples showed the cohesive type of failure (94.2%). Both the modified MTAs (groups III and IV) primarily showed mixed types of failures. CONCLUSION: Both the antibacterial-enhanced MTAs had better pushout bond strength compared to conventional MTA but did not outperform biodentine. Hence, it could serve as a substitute for conventional MTA due to its augmented physical properties. CLINICAL SIGNIFICANCE: Carious pulp exposure and nonvital open apices pose a critical challenge to pediatric dental practitioners. In such circumstances, maintaining the vitality of pulp and faster healing would help in a better prognosis. Novel MTAs without any cytotoxic components, and enhanced antibacterial contents with augmented physical properties can help in treating such clinical conditions. How to cite this article: Merlin ARS, Ravindran V, Jeevanandan G, et al. Comparative Evaluation of Push-out Bond Strength of Conventional Mineral Trioxide Aggregate, Biodentine, and Two Novel Antibacterial-enhanced Mineral Trioxide Aggregates. J Contemp Dent Pract 2024;25(2):168-173.

Evaluation of Risk Factors associated with Caries Development after Full-mouth Rehabilitation for Early Childhood Caries Under General Anesthesia.

AIM: To evaluate the risk factors associated with caries development after full-mouth rehabilitation for early childhood caries (ECC) under general anesthesia. MATERIALS AND METHODS: A total of 100 children diagnosed with ECC requiring full-mouth rehabilitation under general anesthesia were recruited for the study. At baseline, caries status, plaque index, Streptococcus mutans count, and Lactobacillus count were evaluated. The risk assessment for caries was evaluated using a cariogram. Children were recalled after 12 months for evaluation. All children returned for the recall and data was recorded at the recall visit. Children were grouped into caries-free or caries recurrent based on the absence or presence of caries. Chi-square tests and student's t-test were used for statistical analysis using the statistical package for the social sciences (SPSS), version 23. RESULTS: All 100 children returned for follow-up. 76% of the children developed new carious lesions in a period of 1 year. A statistically significant association between caries recurrence and S. mutans count and caries risk assessment (CRA) score was found (p < 0.001). No significant associations were seen between parental education levels and the oral health practices of the child. CONCLUSION: Children treated under full-mouth rehabilitation for ECC under general anesthesia are at risk for developing new carious lesions after treatment. New carious lesions are strongly correlated with the presence of S. mutans, and high cariographic risk scores serve as an indication of future caries. Early childhood caries may be avoided if children are more diligent in practicing good dental hygiene. CLINICAL SIGNIFICANCE: Relapse of caries after full-mouth rehabilitation under general anesthesia can affect the quality of life of children. Preventive measures should be initiated and reinforced to prevent the occurrence of new carious lesions after full-mouth rehabilitation. How to cite this article: Mathew MG, Jeevanandan G, Maganur PC, et al. Evaluation of Risk Factors associated with Caries Development after Full-mouth Rehabilitation for Early Childhood Caries Under General Anesthesia. J Contemp Dent Pract 2024;25(1):85-91.

Comparative evaluation of volumetric changes between two pediatric rotary files (Kedo-S plus, Kedo-SG blue) and manual files (hand K-files) during canal preparation of primary mandibular molars: an in-vitro nano-CT analysis.

Pediatric endodontics has become popular due to advancements in cleaning, shaping and irrigation systems, resulting in faster and effective removal of infected pulp, saving time, and creating a pathogen-free environment. The patented rotary file system, Kedo-S, designed for primary teeth, introduced a single file generation for efficient pulp therapy. However, there are currently no studies assessing canal preparation in primary mandibular molars using nano-CT (computed Tomography). To evaluate the volumetric changes of two recently introduced pediatric rotary file systems in comparison with conventional hand file systems in primary mandibular molar using an ultra-high resolution nano-CT. This in-vitro study was performed in extracted primary mandibular molar based on certain inclusion and exclusion criteria. Samples were prepared and working length was determined before the pre-operative scan using a high resolution nano-CT device (SkyScan 2214, Bruker, Kontich, Belgium). A single well-experienced pediatric dentist prepared the canals using three file systems: Kedo-S plus, Kedo-SG blue and Hand K-files. A post-operative scan was performed similar to pre-operative scan. Image reconstruction was performed with NRecon software for 3D volumetric visualization and analysis of the root canals. Kedo-SG blue file systems had the highest mean difference in the canal volume (8.85%). Hand K-files had the least difference at (1.24%) of canal volume. Kedo-S plus file system had a mean canal volume difference (6.14%) which is closer to hand K-files. Rotary file systems resulted in a significant enlargement of canals compared to hand files.

Evaluation of Change in Quality of Life, Dental Fear and Dental Anxiety in Young Children Following Full-mouth Dental Rehabilitation under General Anesthesia for Early Childhood Caries.

AIM: To evaluate the change in quality of life, dental fear, and dental anxiety in young children following full-mouth dental rehabilitation under general anesthesia for early childhood caries. MATERIALS AND METHODS: About 200 children who were diagnosed with early childhood caries requiring full-mouth rehabilitation under general anesthesia were recruited after obtaining parental consent. Oral health-related quality of life (OHRQoL) was measured using the Early Childhood Oral Health Impact Scale (ECOHIS). Dental fear was evaluated using Children's Fear Survey Schedule-Dental Subscale and dental anxiety was evaluated using the Facial Image Scale. Scores were taken on the day of intervention, and after 14 days when the child reported for posttreatment follow-up. RESULTS: All 200 participants returned for a follow-up visit after 2 weeks. The child impact section was reduced from 15.7 ± 4.1 to 7.7 ± 1.9 after treatment. The family impact section was reduced from 9.6 ± 2.7 to 3.5 ± 2.6 after treatment. A statistically significant difference was seen in both sections when pre-and posttreatment values were compared (p < 0.001). The total ECOHIS showed statistically significant improvement as the pretreatment score of 21.6 ± 9.5 reduced to 11.2 ± 4.2 showing 51.9% improvement in OHRQoL after full-mouth rehabilitation under general anesthesia was done (p < 0.001). Dental fear and anxiety among the participants showed a statistically significant reduction after treatment was done and most participants were found to be less fearful of doctors, dentists, and injections after treatment. CONCLUSION: Full-mouth rehabilitation was found to be a reliable treatment modality to improve the OHRQoL of children suffering from early childhood caries. CLINICAL SIGNIFICANCE: Significant improvement was seen in the OHRQoL within 2 weeks after treatment and most participants were found to be less anxious and fearful toward dentists and dental treatment. Comprehensive dental rehabilitation under general anesthesia has been proven to be an effective treatment modality for early childhood caries and a productive treatment technique to reduce dental fear and anxiety.

Parental and Child Outlook on the Impact of ECC on Oral Health-related Quality of Life: A Prospective Interventional Study.

AIM: To evaluate the perspectives of parents and children on the impact of early childhood caries (ECC) on the oral health-related quality of life (OHQoF). MATERIALS AND METHODS: About 400 children aged 3-5 years were recruited for the study. About 200 children who were caries-free were the controls for the study. The remaining 200 consisted of children who were diagnosed with ECC and required dental rehabilitation under general anesthesia. Oral health-related quality of life was recorded at baseline and 6 months after intervention using the Michigan oral health-related quality of life scale. Data were analyzed and evaluated using Statistical Package for Social Sciences (SPSS) Version 25.0. RESULTS: Children with ECC were found to have a significantly lower oral health-related quality of life compared with caries-free children, and a statistically significant difference was seen between both groups. The main concern for both parents and children at baseline was pain at the first visit when the evaluation was done. After the intervention, a significant improvement in the oral health-related quality of life was seen. CONCLUSION: Early childhood caries was found to have detrimental effects on the oral health-related quality of life. Full-mouth rehabilitation under general anesthesia was found to bring a significant improvement in the oral health-related quality of life. The perspectives of both parents and children were found to be similar. CLINICAL SIGNIFICANCE: Early childhood caries has an impact on the lives of children and their parents. Oral health-related quality of life was low with children suffering from ECC. Full-mouth rehabilitation under general anesthesia can significantly improve the OHRQoL of children. Continuous monitoring of the children with regular follow-ups and parental education should be enforced to prevent the relapse of ECC.

Age Determination in Children Using Camirere's Indian Specific Formula: A Radiographic Study Using Orthopantomographs.

AIM: Determination of age is a pivotal part of forensic dentistry. Since many dental age determination methods are invasive, Cameriere introduced a radiographic method where age evaluation was carried out using an orthopantomogram (OPG). An adaptation of the same formula was later formulated by Rai et al. for the Indian population. The aim of the study was to assess the age and to dictate the efficiency of the Indian version of Cameriere's formula in the Chennai subpopulation. MATERIALS AND METHODS: This study consisted of radiographs belonging to 50 individuals with an age range of 5-15 years. Radiographs were taken using the OPG and the soft copies obtained were analyzed. The variables such as seven left and right permanent mandibular teeth and the number of teeth with closed apical, and with open apical, ends of roots were examined and measured. The obtained data, after substituting in the formula was statistically analyzed using paired and unpaired t-test and Pearson's correlation coefficient test. RESULTS: On comparing dental age and chronological age, statistically significant results were obtained on both sides of the radiograph. Between genders, both sides of the radiograph showed non-significant results. On correlating the sides, the left side showed greater accuracy in age determination compared to the right side of the OPG. CONCLUSION: Age estimation using Indian-specified formula provides a near good estimate and hence can be a reliable method to measure the chronological age of the participants. CLINICAL SIGNIFICANCE: The Indian version of the Cameriere's formula can be used as a rational tool to assess the age of young children and adolescents.

Does Social Media have any Influence during the COVID-19 Pandemic? An Update.

AIM: The study aimed to explore the role, impact, and influence of social media on the population during the coronavirus disease-2019 (COVID-19)pandemic. BACKGROUND: During pandemics, communication is an important factor to disseminate the information, create awareness and provide timely updates from authorized personnel to the masses. Social media progressed to function as a mediator of transmission of information between the government and authorities and the public during the COVID-19. REVIEW RESULTS: Though several strengths were observed yet liabilities did not go unnoticed regarding the role essayed by social media during this pandemic period. When used responsibly, these technologies can aid in the rapid dissemination of crucial facts, important scientific discoveries, and information regarding diagnosis, treatment, and follow-up as well as comparing different strategies across the world. It is recommended to follow certain fundamental standards while exchanging information on social media networks during the COVID-19 era in order to utilize these technologies responsibly and effectively. CONCLUSION: In this research, we have made an attempt to synthesize the vital facts regarding the impact, benefits, and drawbacks of using social media during COVID-19. Eventually, the decision of evaluation, acceptance, and denial of the information received rests with the individual. CLINICAL SIGNIFICANCE: Social media use has become intangible with health care. Instead of venturing out the negative effects, we need to focus on utilizing social media for the betterment of the public and to the advantage of the public to increase awareness levels, spread knowledge, and cooperate to tap the benefits to the maximum extent possible to prevent the disease spread.

Evaluation of Factors Influencing the Oral Health-related Quality of Life among Children with Early Childhood Caries: A Cross-sectional Study.

AIM: To evaluate the factors that affect the oral health-related quality of life (OHRQoL) among children with early childhood caries (ECC). MATERIALS AND METHODS: A total of 340 children aged between 3 and 6 who were diagnosed with ECC were enrolled in the study. Parents accompanying the children completed a questionnaire on the sociodemographic status and filled out the Early Childhood Oral Health Impact Scale (ECOHIS) for the evaluation of OHRQoL. Data were recorded, tabulated, and statistically analyzed. RESULTS: The study population consisted of 189 (55.6%) boys and 151 girls (44.4%). A total of 96.4% had cavitated lesions; 31.2% of the children had pain at the time of evaluation. A significant association was seen between the Decayed Missing Filled Teeth (DMFT) score of the child (p < 0.001). Pain at the time of evaluation and DMFT status had a significant association with the ECOHIS (p < 0.001). CONCLUSION: Early childhood caries was found to impact the OHRQoL. Pain, visible dental plaque, family income, and parental education were found to be determinants that affect the OHRQoL. CLINICAL SIGNIFICANCE: Early childhood caries significantly reduces the OHRQoL of children and their families. Pain, visible dental plaque, family income, and parental education were found to influence the OHRQoL. Teaching parents the importance of oral health and preventive treatment will help prevent the occurrence of ECC.

Evaluation of Microleakage Using Different Luting Cements in Kedo Zirconia Crowns: An In Vitro Assessment.

Introduction A space between the prepared tooth and the cemented crown can cause microleakage, allowing microorganisms to enter, which in turn leads to the breakdown of the luting cement. To achieve an optimum fit, several factors should be considered, including the type of crown used, the taper of tooth preparation, and the type of cementing agent. Aim The purpose of the current study is to evaluate the microleakage of zirconia crowns cemented with glass ionomer cement (GIC), resin-modified GIC (RMGIC), and self-adhesive resin cement. Materials Forty-five primary mandibular molars were divided into three groups: Group I receiving GIC, Group II receiving RMGIC, and Group III receiving self-adhesive resin cement. These cements were used to lute the teeth with Kedo zirconia crowns. The restored samples underwent thermal cycling and were assessed for microleakage under a stereomicroscope. For the statistical analysis, SPSS version 23.0 was used. Descriptive statistics were presented as frequencies and percentages. Analytical statistics, including the Mann Whitney U test, were used to assess the differences in the level of microleakage between the groups at p < 0.05. Results The Mann Whitney U test revealed no significant difference in the level of microleakage between GIC and RMGIC (p = 0.072). However, self-adhesive resin cement showed significantly less microleakage than GIC (p = 0.000). Similarly, when comparing RMGIC and self-adhesive resin cement, the latter showed significantly less microleakage than the former (p = 0.001). Conclusion Microleakage of Kedo zirconia crowns on mandibular first molars was highest when luted with GIC, followed by RMGIC, and was least when luted with self-adhesive resin cement.

Comparative Evaluation of Gingival Health Among Children With Stainless Steel Crowns and Stainless Steel Bands: A Split-Mouth Randomized Controlled Trial.

Introduction Putting in stainless steel crowns as a post-endodontic restoration and space maintainers as a post-extraction appliance to maintain the space for the eruption of underlying teeth in case of early loss in children are some of the most commonly practised procedures that pediatric dentists undertake in their day-to-day lives. Maintaining good oral hygiene for better gingival health is important. If it is not taken care of, gradual destruction of supporting soft and hard tissues of the teeth occurs. There were numerous studies conducted over the past few years, but no split-mouth study compares the crowns and bands. Hence, this study compares the gingival health between stainless steel crowns and band and loop space maintainers. Materials and methods This split-mouth randomised controlled trial included 31 children aged between four and nine years who had stainless steel crowns on one side and a band and loop space maintainer on the other side of the mandibular arch. The split-mouth study was carried out to minimise the outcome bias as oral hygiene practices differ from one individual to another. Presence/absence of bleeding on probing (BOP) and the Gingival Index (GI) using the Loe and Silness GI were assessed at baseline and at six months. Data was entered in an Excel sheet (Microsoft Corporation, Redmond, Washington, United States) and analysed in IBM SPSS Statistics for Windows, Version 23, (Released 2015; IBM Corp., Armonk, New York, United States). The significance level was fixed as 5% (α = 0.05). The Shapiro-Wilk test was used to assess the normality of parameters of gingival health. The parameters are described in terms of mean, standard deviation, frequency and percentages. Intragroup analysis was done using Friedman tests across the timelines. Intergroup analysis using Mann-Whitney U tests was done between the groups at different timelines.  Results At the beginning of the study, 46 children (22 girls and 24 boys) were enrolled considering the dropout. However, 15 children did not attend the follow-up review, resulting in a loss to follow-up. Consequently, only 31 children, each with a band and loop space maintainer and a stainless steel crown, were included for the final interpretation of the results in this study. At one month, both BOP and GI were significantly different (p<0.05) between the stainless steel crown and stainless steel band where the crown showed better gingival health and absence of bleeding than the band and loop. At three months and six months, gingival health improved in both groups, but there was no significant difference between the groups. The Friedman test revealed that both the stainless steel crown and stainless steel band groups had a significant difference at six months from baseline. Mann-Whitney tests were done to analyse the difference in parameters at baseline and at six months between both groups. There was no significant difference in the baseline in the parameters between the groups. Conclusion Within the limitations of the study, this study concludes that the gingival health based on BOP and GI shows a significant difference across the timeline within the groups, namely, stainless steel crown and stainless steel band, but no significant difference between the groups at various timelines.

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.

Revolutionizing Pulpectomy: An Observational Overview of Multigenerational Kedo Rotary File Systems in Primary Molars.

A 4.5-year-old female child presented to the Department of Pediatric Dentistry with the chief complaints of sharp, localized pain in her lower left and right back teeth persisting for a week, indicative of irreversible pulpitis in teeth 74, 75, and 85. A single-visit pulpectomy was planned for all affected teeth, followed by full coronal restoration in two separate visits. Before the procedure, informed digital consent was taken from the parents. A topical anesthetic agent and inferior alveolar nerve block were administered for effective anesthesia. Rubber dam isolation was performed to ensure aseptic conditions, and access cavity preparation was carried out using appropriate burs. Biomechanical preparation (BMP) was performed using Kedo S Square (Kedo Dental, Chennai, India) in tooth 74, Kedo S Plus (Kedo Dental) in tooth 75, and Kedo Nano Plus (Kedo Dental) in tooth 85, with specific instrumentation techniques as per literature guidelines. The root canals were thoroughly cleaned and shaped to facilitate optimal disinfection and obturation. This case demonstrates the successful management of irreversible pulpitis in the lower primary molar using single-visit pulpectomy with Kedo single filing systems, highlighting the importance of effective BMP in pediatric endodontics.

Assessment of Knowledge and Utilization of Prefabricated Band and Loop Space Maintainers in Primary Dentition Among Dentists: A Cross-Sectional Questionnaire Study.

INTRODUCTION: Preserving primary dentition is essential for maintaining optimal oral health and development in children. Premature loss of primary teeth due to caries, infection, crowding, or trauma can necessitate orthodontic intervention and lead to various complications. Space maintainers are critical for preserving arch space until the eruption of permanent teeth, thereby preventing issues such as ectopic eruption, crowding, and malocclusion. Despite their advantages, prefabricated space maintainers (PSMs) are underutilized. This study aims to evaluate the knowledge, attitudes, and practices of Indian dentists regarding PSMs in primary teeth. METHODOLOGY: A cross-sectional questionnaire survey was conducted among 100 dental practitioners in Chennai. A 10-item self-administered questionnaire, developed based on a comprehensive literature review and expert consultations, assessed demographics, knowledge of PSM indications and techniques, current practices, perceived barriers, and preferences for continuing education. The questionnaire's reliability was confirmed with a Cronbach's alpha value of 0.85. Descriptive statistics, including frequencies and percentages, were used to summarize the participants' demographic characteristics, knowledge levels, and current practices related to PSMs. RESULTS: Of the 100 respondents, 86 (86%) were males and 14 (14%) were females. Only 19 (19%) reported using PSMs, while 36 (36%) used conventional space maintainers. A significant proportion (42 (42%)) of the respondents held a master's degree in dental surgery, yet only 11 (11%) had participated in Continuing Dental Education (CDE) programs on space maintainers. The perceived benefit of PSMs being a single appointment procedure was acknowledged by 82 (82%) of the respondents, whereas 76 (76%) participants identified cost as a major drawback. Notably, 45 (45%) practitioners did not consider PSMs necessary. CONCLUSION: This survey highlights notable obstacles in the adoption of PSMs among Indian dentists, emphasizing the need for focused educational initiatives. Improving knowledge and practices related to PSMs can enhance pediatric dental care and oral health outcomes in India.

Evaluation of Changes in Oral Microflora in Children with Early Childhood Caries after Full Mouth Rehabilitation.

Aim: To evaluate the change in microflora in children suffering from severe early childhood caries (ECC) after full mouth rehabilitation. Materials and methods: A total of 60 children, aged 3-5 years suffering from severe ECC who fulfilled the inclusion and exclusion criteria were included in the study. Pooled plaque samples were taken and subjected to quantitative reverse transcriptase polymerase chain reaction (PCR) to obtain baseline mean values of Streptococcus mutans (S. mutans), Streptococcus sobrinus (S. sobrinus), Candida albicans (C. albicans), and Candida dubliniensis (C. dubliniensis) before full mouth rehabilitation was done under general anesthesia. Posttreatment samples were collected at 6, 12, and 18 months. Wilcoxon signed-rank test was used to compare the mean values of S. mutans, S. sobrinus, C. albicans, and C. dubliniensis before and after full mouth rehabilitation. Results: A total of 60 patients recruited for the study were present at the follow-up at 6 and 12 months. At 18 months, 55 patients returned, and five were lost due to follow-up. A statistically significant reduction was seen in all microorganisms at 6, 12, and 18 months compared to baseline values. At 18 months a slight increase in S. mutans, S. sobrinus, and C. albicans was seen. C. dubliniensis was not detected in any cases after full mouth rehabilitation. Caries recurrence was seen in four patients at 18 months. Conclusion: Significant reduction of S. mutans, S. sobrinus, C. albicans, and C. dubliniensis was seen at 6, 12, and 18 months. A complete reduction of only C. dubliniensis was seen. A significant but not permanent reduction of S. mutans, S. sobrinus, and C. albicans. Caries recurrence was seen in 7.27% of patients at 18 months. How to cite this article: Mathew MG, Jeevanandan G, Rathod NN. Evaluation of Changes in Oral Microflora in Children with Early Childhood Caries after Full Mouth Rehabilitation. Int J Clin Pediatr Dent 2024;17(1):21-25.

Clinical and radiographic success rate of the root canal filling materials used in primary teeth: A systematic review.

One of the most important factors that determine the success of pulpectomy in primary teeth is the root canal filling material used. This systematic review is an update on the success rates of various materials used for obturation in primary teeth. An electronic search was carried out in the PubMed, Scopus, Web of Science, and Cochrane Library databases with the preset inclusion and exclusion criteria. Only randomized or quasi-randomized clinical and controlled trials with a minimum follow-up of 12 months were included for analysis. Nine articles were considered potentially eligible for inclusion in this review. All the included trials had zinc oxide-eugenol (ZOE) cement as a control group. The time span of the included trials extended from 12 to 30 months. Only 2 trials were at low risk of bias. Evidence to support the success rates of obturating materials used in primary teeth is scarce, which necessitates further highquality randomized controlled clinical trials with regard to this issue.

Comparative Evaluation of Push-Out Bond Strength of Conventional Mineral Trioxide Aggregate, Biodentine, a Modified Mineral Trioxide Aggregate, and Two Novel Antibacterial-Enhanced Mineral Trioxide Aggregates.

Background The challenges associated with incorporating antimicrobial agents, such as the potential diminishment of the cement's physical properties, highlight the need for comprehensive evaluations. Balancing antimicrobial efficacy with the maintenance of structural integrity is a crucial aspect of material development. The acknowledgment of cytotoxic properties associated with tricalcium aluminate, a major constituent in conventional mineral trioxide aggregate (MTA), is critical in terms of long-term evaluation of treatment procedures. The primary focus of the push-out test is to evaluate the resistance of the tested material to dislodgement. Greater push-out strength implies stronger adhesion between the tested material and the tooth surface. Aim This study aims to evaluate the push-out bond strength of two antibacterial-enhanced MTAs with conventional MTA and Biodentine. Material and methods A total of five materials were tested: a) modified MTA, b) doxycycline-enhanced MTA, c) metronidazole-enhanced MTA, d) conventional MTA, and e) Biodentine. All the materials were mixed based on a predetermined powder:liquid ratio and then carried using a plastic instrument to the desired experimental design. Single-rooted permanent teeth, preferably incisors, were used in the present study. Teeth were embedded vertically in a rubber mold, and sectioning of the tooth was performed. A single operator instrumented the canal space in each slice using Gates-Glidden burs, and the mixed cements were placed in the respective groups and stored for 72 hours. A push-out test was carried out using a universal testing machine. Following the bond failure, the slices were examined under a stereomicroscope to determine the nature of the bond failure. The collected data was subjected to a one-way analysis of variance test, post hoc test, and chi-square test for statistical analysis. Results The mean push-out bond strength was found to be the highest for Biodentine (43.25 ± 0.62 megapascals (MPa)), followed by doxycycline- and metronidazole-enhanced MTAs (39.54 ± 0.65 MPa and 39.29 ± 0.16 MPa, respectively), modified MTA formulation (37.75 ± 0.73 MPa), and the lowest for conventional MTA (25.93 ± 0.7 MPa). Conventional MTA samples had an adhesive failure (89.4%), while Biodentine samples had a cohesive failure (80.3%). Mixed failures were noticed with the samples containing modified MTA formulation (71.3%), doxycycline-enhanced MTA (76.6%), and metronidazole-enhanced MTA (78.0%). Conclusion Despite not surpassing Biodentine in bond strength, antibacterial-enhanced MTAs are considered potential alternatives to conventional MTA in day-to-day clinical practice.

Comparative evaluation of the efficacy of 1% and 3% Sodium hypochlorite in reducing the microbial counts in primary teeth root canals using Bioluminometer - A randomized clinical trial.

Purpose: Sodium hypochlorite (NaOCl) is commonly used to irrigate primary teeth during pulpectomy. Although high concentrations of NaOCl are effective, they pose a risk of toxic damage to periapical tissues if NaOCl penetrates through the apical foramen. Therefore, low concentrations of NaOCl are preferred to mitigate this risk. However, concerns persist regarding the antibacterial efficacy of low concentrations of NaOCl compared to high concentrations. The objective of this study was to assess and compare the efficacy of 1% and 3% NaOCl irrigation in reducing bacterial load within primary teeth root canals. Materials and methods: This clinical study involved forty participants divided into two groups. Group 1 (n = 20) received canal irrigation with 1 % NaOCl solution, while Group 2 (n = 20) received canal irrigation with 3 % NaOCl solution. Microbial samples were collected from the root canal using a paper point before and after irrigation. The samples were aseptically transferred to ultra-snap tubes and then analyzed using a Bioluminometer. The results were recorded. Results: Both groups exhibited a decrease in bacterial count after irrigation. The mean colony count post irrigation for 3 % NaOCl was 258.05 ± 28.61, and for 1 % NaOCl it was 267.60 ± 30.56. However, no statistically significant difference was observed upon intergroup comparison. Conclusion: This study shows that 1% NaOCl is equally effective as 3% NaOCl in reducing bacterial count in root canals. Thus, using 1% NaOCl as an irrigant is appropriate in clinical practice.

Comparative Evaluation of the Removal of Gutta Percha From the Root Canal Using Various Retreatment File Systems With and Without Magnification: An In Vitro Study.

AIM AND OBJECTIVE: The main goal was to compare the efficacy of gutta percha (GP) removal from the root canal using the Neo Endo Retreatment file system, Solite RS3, and ProTaper Universal Retreatment (PTUR) files with and without magnification under a direct operative microscope using stereomicroscopic evaluation. MATERIALS AND METHODS: Sixty single-rooted teeth were randomly assigned to one of three groups after obturation till F2 mastercone with resin sealer: Group 1 (n=20): Neo Endo Retreatment Files, Group 2 (n=20): Solite RS3, Group 3 (n=20): PTUR files. Each group was further separated into two subgroups: Subgroup 1: without magnification (no direct operative microscope) and Subgroup 2: with magnification under a direct operative microscope at 12× magnification. After retreatment, the roots were grooved buccolingually and split into two halves using a diamond disc with the help of a chisel. The samples were examined under a stereomicroscope. Images were captured in a digital camera and analyzed using image analyzing software Image Pro v10 (Media Cybernetics). RESULTS: The Neo Endo retreatment file system had a significantly greater percentage of remaining obturating material than the Solite RS3 Retreatment and PTUR file systems (p<0.05) in both groups with and without magnification. In the group without magnification, Solite RS3 showed a significant difference compared to ProTaper (p<0.05). In the group with magnification, there was no significant difference between the ProTaper Universal retreatment file system and Solite RS3 (p=0.589). Retreatment performed without magnification had more remnant GP when compared to the retreatment procedure performed under magnification of the direct operative microscope. CONCLUSION: Under stereomicroscopic evaluation, the remnant GP was higher in the Neo Endo File System both with and without magnification than in the Solite Retreatment and PTUR file systems. ProTaper showed moderate significance in removing the obturation than Solite RS3 in the magnification group. The Solite RS3 file system performed as efficiently as the PTUR file system.

Comparative analysis of novel heat-treated retreatment file system on the removal of obturating material using nano-computed tomography.

Introduction: The aim of nonsurgical retreatment is to remove the previous filling material followed by chemo-mechanical preparation of the canal to achieve proper disinfection of the root canal system. This is then followed by re-obturation. This study evaluates the time taken to retrieve the gutta-percha and the quantity of remaining filling material after retreatment with two different file systems. The quantity of remaining filling material was assessed using nano-computed tomography (CT) due to its increased accuracy. Materials and Methods: Forty extracted single-rooted teeth were split into two groups at random and decoronated and obturated at a standard root length of 16 mm. Solite RS3 (SRS-3) Retreatment and ProTaper Universal Retreatment (PTUR) systems were used to retrieve the gutta-percha after a preoperative nano-CT scan. Postoperative nano-CT scan was taken and both the scans were superimposed to quantify the remaining filling material. The time taken to remove gutta-percha was measured using a stopwatch. The statistical analysis comparing the two groups was conducted using the independent t-test. Results: The quantitative analysis of remaining filling material using nano-CT showed no statistical difference between both the file systems used (P > 0.05). However, SRS-3 took significantly less time in the removal of gutta-percha (P < 0.05). Conclusion: Hence, we can conclude that there is no significant difference in the amount of remaining filling material between both the file systems. However, time taken to remove the gutta-percha was lesser in SRS-3 compared to PTUR file system.

Histologic Assessment of a Fast-Set Mineral Trioxide Aggregate (MTA) and Two Novel Antibacterial-Enhanced Fast-Set MTAs for Apexification and Periapical Healing of Teeth With Incomplete Root Formation in a Rat Model: An In Vivo Animal Study.

Background Pulp necrosis in incomplete root formation halts dentine development, resulting in larger canals with fragile walls and an open apex, complicating canal instrumentation and apical stop formation. Bioactive endodontic cements such as mineral trioxide aggregate (MTA) are crucial for creating artificial apical barriers or inducing apical foramen closure, but challenges remain regarding their antimicrobial efficacy and cytotoxicity. Modifications to MTA formulations aim to address these concerns. Methods This in vivo animal study involved 80 Wistar albino rats, with incomplete root formation induced by pulp exposure. Rats were divided into four groups receiving different MTA formulations for apexification: conventional MTA, modified MTA, and MTA enhanced with metronidazole or doxycycline. Histopathological evaluations were conducted at seven and 28 days post-treatment to assess calcific barrier formation, inflammatory reactions, and antimicrobial efficacy. Results By day 7, modified MTA formulations exhibited enhanced antibacterial activity compared to conventional MTA (p = 0.000), with fewer inflammatory reactions and microorganisms. By day 28, modified formulations showed superior calcific barrier formation, particularly in the metronidazole- and doxycycline-enhanced groups compared to conventional MTA (p = 0.000). These outcomes suggest that modifications to MTA formulations improve antimicrobial efficacy and calcific barrier formation in vivo. Conclusion Novel modified MTA formulations, particularly those enhanced with metronidazole or doxycycline, exhibit superior antibacterial efficacy and calcific barrier formation compared to conventional MTA. Further long-term studies are warranted to validate these findings for potential clinical translation.