Three-dimensional qualitative and quantitative analyses of the effect of periradicular lesions on the outcome of regenerative endodontic procedures: A prospective clinical study.

OBJECTIVES: Qualitative and quantitative evaluation of the outcomes of regenerative endodontic procedure (REP) on human immature necrotic teeth with apical periodontitis using cone-beam computed tomography (CBCT) MATERIALS AND METHODS: Immature permanent teeth (n = 50) with necrotic pulp and periradicular pathosis were treated with a cell-homing concept-based REP. Following the procedure, a limited field-of-view CBCT scan was obtained. At each recall session (6, 12, 18 months), clinical tests were performed, and a digital periapical radiograph was taken. When significant radiographic changes were evident in the follow-up, a final CBCT scan was taken for qualitative and quantitative assessment. These initial and follow-up CBCT scans were assessed for quantification of changes in root length, pulp space diameter and periradicular lesion size. The data were statistically analysed using t test, one-way ANOVA, post hoc test and paired t test (P = 0.05). RESULTS: Of the teeth, 94.6% were clinically successful based on the lack or regression of signs and symptoms after 48 months follow-up. REP resulted in a statistically significant increase in root length, decrease in pulp space diameter and periradicular radiolucency (P < 0.05). CBCT images illustrated various patterns of root maturation including an increased thickening of the canal walls and continued root maturation (37.1%), continued root development with the apical foramen remaining open (57.1%), severe calcification (obliteration) of the canal space (2.9%) and hard tissue barrier formation in the canal space between the coronal plug and the root apex (2.9%). CONCLUSION: This study highlighted that the expected outcome of radiographic root development was less predictable when immature permanent teeth with periradicular pathosis were treated with REP. CLINICAL RELEVANCE: The size and extent (expansion/destruction of the cortical plate) of periradicular lesions and abscesses influence the outcome of REP. These factors must be taken into consideration during treatment planning.

Prevalence of Traumatic Injuries to Anterior Teeth in 9-14 Year School-going Children in Mumbai, India.

AIM: The aim of this study is to assess the prevalence and causes of traumatic dental injury (TDI) in 9-14 year school-going children in Mumbai, Maharashtra, India. MATERIALS AND METHODS: A cross-sectional study consisting of 2,055 primary and secondary school-going children aged between 9 and 14 years, from 20 municipal corporation schools of Mumbai city, was selected through a stratified random sampling technique. Children were examined clinically for any signs of TDI in the permanent anterior teeth in their respective schools by two examiners trained in using WHO criteria for oral and dental examination. Data analysis involved descriptive statistics including a frequency distribution. RESULTS: The prevalence of TDI to anterior teeth in school children of Mumbai was 16.3%. The commonest cause of trauma was fall followed by sports activities, collision, and road traffic accidents. CONCLUSION: The occurrence and various etiologies of traumatic injuries to maxillary anterior teeth in school children of Mumbai were approximately the same as found in other countries. CLINICAL SIGNIFICANCE: The present study gives a bird's eye view on the prevalence and common etiology of TDI in school children of Mumbai.

Effect of CO2 Laser and 1.23% Acidulated Phosphate Fluoride on Acid Resistance and Fluoride Uptake of Human Tooth Enamel: An In Vitro Assessment.

AIM: To evaluate the effectiveness of CO2 laser treatment before applying 1.23% acidulated phosphate fluoride (APF), through topically applied 1.23% APF solution, and after applying 1.23% APF on acid resistance and fluoride uptake of the enamel. MATERIALS AND METHODS: Sixty non-carious human premolars were extracted due to the orthodontic reason and stored in distilled water solution under refrigeration. Using a water-cooled diamond disc, enamel slabs of 4 mm × 4 mm × 1.5 mm were cut from the buccal surface of each tooth. Sixty samples were randomly divided into one control group and five test groups of 10 premolars each. Solution was prepared for wet chemical analysis followed by fluoride analysis that was carried out using a fluoride ion selective electrode (Thermo Scientific Orion 4-Star Plus ISE Meter). The weight of enamel (WE) was determined from the amount of calcium (Ca) etched away considering the fact that the Ca content of the human enamel is 37.4 wt%. The subgroups were statistically analyzed using ANOVA for fluoride determination and evaluation of acid resistance. RESULTS: There was a significant increase in acid resistance of enamel slabs when treated individually or in combination of a low-power CO2 laser and 1.23% APF solution. Application of 1.23% APF solution after low-power CO2 laser treatment showed maximum increase in acid resistance. CONCLUSION: Application of a low-power pulsed CO2 laser through topically applied 1.23% APF solution resulted in a detrimental effect of the human tooth enamel with resultant decrease in acid resistance. High fluoride uptake does not necessarily indicate increased acid resistance. CLINICAL SIGNIFICANCE: The present study provides evidence that a low-power CO2 laser can be used effectively in combination with topically applied 1.23% APF solution in order to make the enamel more resistant to acid attack, thereby helping in controlling dental caries.

Comparative evaluation of the clonogenic capacity of periodontal ligament fibroblasts in Hank's balanced salt solution and egg albumen: An in vitro study.

BACKGROUND/AIM: The type of storage media for short-term storage of an avulsed tooth is a critical determinant for the success of tooth replantation. If immediate replantation of an avulsed tooth is not possible, it is advised to store the tooth in a suitable storage medium. The viability and clonogenicity of periodontal ligament fibroblasts (PDLF) determines the success of replantation of an avulsed tooth. The aim of this study was to evaluate the effect on the clonogenic capacity of PDLF's upon storage in Hank's balanced salt solution (HBSS) and egg albumen. METHODS: Fibroblast cell culture was established from a human premolar tooth extracted for orthodontic purposes. The PDLF cells thus obtained were treated with either Dulbecco's modified Eagle's medium (DMEM; as a positive control), HBSS, or egg albumen for different durations at room temperature and then allowed to grow in DMEM medium until visible colonies appeared which were then fixed, stained, and scored manually. RESULTS: With increase in the duration of storage in both egg albumen as well as HBSS, there was a reduction in the clonogenic capacity of the PDLF's as compared to DMEM. However, storage in egg albumen led to a significant reduction in the clonogenic capacity of PDLF's (8%-16% for egg albumen) compared to HBSS (80%-90%). CONCLUSION: Due to its limited ability to support the clonogenicity of PDLF's, egg albumen is a poor storage medium for an avulsed tooth compared to either DMEM or HBSS.

Effect of Different Preparation Techniques on Root Canal Geometry: An In Vitro Study.

Aim and objective: To compare and evaluate canal preparation using hand stainless steel files, hand ProTaper files, and rotary ProTaper files for change in root canal geometry in terms of surface area and volume changes assessed by computed tomography. Materials and methods: The present study was conducted in Nair Hospital and Dental College, Department of Pediatric and Preventive Dentistry in collaboration with insight CBCT, imaging technologies. A total of 36 extracted human primary mandibular second molars were collected from the Department of Pediatric and Preventive Dentistry. All the teeth were scanned using cone-beam CT (i-CAT CT Scanner Next Generation, Imaging Sciences International) preoperatively and postoperatively to assess the mean absolute change in surface area and mean change in the volume of all the canals at different levels with the use of hand stainless steel files, hand ProTaper and rotary ProTaper files. Results: ProTaper instruments, both hand ProTaper and rotary ProTaper caused significant changes in the surface area in the coronal thirds and middle thirds of the canal when compared to hand stainless steel files. No difference was found in surface area and volume changes between hand ProTaper and rotary ProTaper instrumentation. Conclusion: Use of ProTaper instruments for preparation of deciduous teeth can render benefit of an improved canal preparation to facilitate better obturation and successful root canal therapy. How to cite this article: Bheda P, Kakade A, Takate V, et al. Effect of Different Preparation Techniques on Root Canal Geometry: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(S-1):S71-S79.

Oral Health Assessment of Children with Autism Spectrum Disorder in Special Schools.

BACKGROUND: Sensory over-responsivity is an important factor influencing the ability of children with an autism spectrum disorder to receive proper oral care. Dental care remains the most prevalent, unmet health care need for children with special health care needs. AIM AND OBJECTIVE: To assess the oral health of children with autism in special schools. MATERIALS AND METHODS: A cross-sectional study was conducted to record the oral health problems of 142 autistic children attending special schools across the suburbs of Mumbai city in India. Clinical examination was carried out for the presence of dental plaque, gingivitis, caries, restorations, traumatic injuries, and self-injurious habits. The participants were divided into three groups based on their age. RESULTS: Children with primary and mixed dentition had a higher incidence of dental caries when compared with the permanent dentition group. Good oral hygiene was observed in the study population with a mean OHI-S score of 0.88 ± 0.79. Traumatic dental injuries, bruxism, drooling of saliva from the corner of the mouth, and self-injurious habits were also recorded. CONCLUSION: Due to the nature of their neurological deficit and difficulty in providing dental treatment, it is recommended that preventive dental care be enforced on these children. HOW TO CITE THIS ARTICLE: Santosh A, Kakade A, Mali S, et al. Oral Health Assessment of Children with Autism Spectrum Disorder in Special Schools. Int J Clin Pediatr Dent 2021;14(4):548-553.

Ultrasonography as a diagnostic aid for a neonate with gingival swelling in a COVID-19 neonatal intensive care unit.

COVID-19 pandemic has impacted all the aspects of life and has emerged as the biggest challenge to the health-care sector. Dental fraternity has also taken its significant impact since the transmission of disease is primarily through aerosol droplets. Management of infants with orofacial anomalies such as natal and neonatal teeth born to COVID-19-positive mothers is another challenge due to unavailability of dental facilities in the isolation wards. In such unforeseen circumstances, out-of-routine approaches such as extraoral mandibular ultrasonography were performed for the management of a congenital intraoral swelling in an infant and are being described in this case report.

Three-dimensional semi-automated volumetric assessment of the pulp space of teeth following regenerative dental procedures.

The volumetric change that occurs in the pulp space over time represents a critical measure when it comes to determining the secondary outcomes of regenerative endodontic procedures (REPs). However, to date, only a few studies have investigated the accuracy of the available domain-specialized medical imaging tools with regard to three-dimensional (3D) volumetric assessment. This study sought to compare the accuracy of two different artificial intelligence-based medical imaging programs namely OsiriX MD (v 9.0, Pixmeo SARL, Bernex Switzerland, https://www.osirix-viewer.com ) and 3D Slicer ( http://www.slicer.org ), in terms of estimating the volume of the pulp space following a REP. An Invitro assessment was performed to check the reliability and sensitivity of the two medical imaging programs in use. For the subsequent clinical application, pre- and post-procedure cone beam computed tomography scans of 35 immature permanent teeth with necrotic pulp and periradicular pathosis that had been treated with a cell-homing concept-based REP were processed using the two biomedical DICOM software programs (OsiriX MD and 3D Slicer). The volumetric changes in the teeth's pulp spaces were assessed using semi-automated techniques in both programs. The data were statistically analyzed using t-tests and paired t-tests (P = 0.05). The pulp space volumes measured using both programs revealed a statistically significant decrease in the pulp space volume following the REP (P < 0.05), with no significant difference being found between the two programs (P > 0.05). The mean decreases in the pulp space volumes measured using OsiriX MD and 3D Slicer were 25.06% ± 19.45% and 26.10% ± 18.90%, respectively. The open-source software (3D Slicer) was found to be as accurate as the commercially available software with regard to the volumetric assessment of the post-REP pulp space. This study was the first to demonstrate the step-by-step application of 3D Slicer, a user-friendly and easily accessible open-source multiplatform software program for the segmentation and volume estimation of the pulp spaces of teeth treated with REPs.

Dental management of a child with Wiskott Aldrich syndrome prior to bone marrow transplant: A case report.

AIM: Orodental manifestations are commonly presented in Wiskott Aldrich Syndrome (WAS). The purpose of this paper is to report a case of dental management of a 5-year-old male child with WAS before Hematopoietic Stem Cell Transplantation (HSCT). Such patients are more prone to infection due to pretransplantation chemotherapy and posttransplantation immunosuppression; thus, it becomes imperative to eliminate all potential sources of infection before transplantation. MATERIALS AND METHODS: Fluctuating blood parameters before the dental procedure was an important challenge in rendering dental treatment. Dental procedures were carried out under general anesthesia by maintaining the hematological parameters with blood and platelet transfusion. The conventional dental treatment may not be applicable in such patients as failure of dental treatment can cause the failure of HSCT, and it has to be modified based on the clinical acumen and recommendations. CONCLUSIONS: This case report focuses on the measures to be taken before, during, and after the dental procedure to ensure the success of the dental therapy and prevent failure of HSCT due to residual dental foci of infection. A multidisciplinary approach involving a pedodontist, a pediatrician, and a hematologist can improve the quality of life of such patients.

Assessment of Inhibition of Mineral Loss from Human Tooth Enamel by Carbon Dioxide Laser and 1.23% Acidulated Phosphate Fluoride.

AIMS AND OBJECTIVES: The efficacy of carbon dioxide (CO2) laser irradiation combined with fluoride in inhibiting enamel demineralization has been demonstrated by several laboratory investigations. However, there are very few reports about the in situ or in vivo caries preventive effect of CO2 laser combined with topical fluoride on dental enamel. Hence, an in situ study was designed and carried out to assess inhibition of mineral loss from human tooth enamel by CO2 laser and 1.23% acidulated phosphate fluoride (APF). MATERIAL AND METHODS: Impressions of upper and lower arch of the volunteers were made in alginate impression material. Study models were poured, duplicated, and duly labeled. On the working model, appliances were fabricated in acrylic resin to fit the upper dental arch of the volunteers. Four enamel slabs (one from each group) were fitted on the palatal surface of the appliance as close as possible to posterior teeth. Surfaces of slabs were kept below the outer surface of acrylic. The analysis was done using SPSS version 15 (SPSS Inc., Chicago, IL, USA) Windows software program. RESULTS: Statistically significant increase in inhibition of mineral loss of enamel slabs when treated individually or in a combination of low power CO2 laser and 1.23% APF solution. The application of 1.23% APF solution after low power CO2 laser treatment showed maximum inhibition of mineral loss. CONCLUSION: The combined use of this specific laser treatment plus fluoride was more successful than either laser treatment or fluoride alone in the inhibition of mineral loss in the mouth. The results of this study also suggest that the combination of low power laser treatment with fluoride therapy may be effective as a caries inhibition treatment.