Evaluation of a Novel Tool for Apical Plug Formation during Apexification of Immature Teeth.

The purpose of this study was to compare the sealing ability and time required for the formation of Biodentine and mineral trioxide aggregation (MTA) apical plugs, using three different delivery methods: an amalgam carrier (AC), the Micro Apical Placement (MAP) System or a novel tool using a modified cannula (MC). Materials and Methods: A total of 60 uniformed molar roots were divided into three main groups, according to the technique of apical plug formation: AC, MAP, and MC. Each group was divided into two subgroups, according to the filling material used: MTA and Biodentine. A timer was used to calculate the required time for apical plug formation. After setting the filling materials, the apical microleakage of the formed plugs was quantified using the dye extraction method and spectrophotometry. The differences between the groups were analyzed using the one-way ANOVA and LSD post hoc tests. The significance level was set at 0.05. Results: No significant differences were reported in the time required to form the apical plugs in all groups (p > 0.05). However, the apical plugs formed by the AC method had significantly higher microleakage than those formed using the MAP and MC methods (p < 0.05). Conclusion: Within the limitations of this study, the sealing ability of the apical plugs formed by the MC method is comparable to the MAP method and better than the AC method.

Comparison of MTA versus Biodentine in Apexification Procedure for Nonvital Immature First Permanent Molars: A Randomized Clinical Trial.

This study aimed to evaluate the radiological and clinical outcomes of Biodentine apical plugs compared to mineral trioxide aggregate (MTA) in treating immature molars with apical lesions in children. MATERIALS AND METHODS: Thirty immature roots of 24 permanent lower first molars with apical lesions were randomly divided into two groups: group 1 (15 roots) treated with MTA apical plugs and group 2 (15 roots) treated with Biodentine apical plugs. Treatment radiological outcomes were assessed using the periapical index (PAI) scale after 6 and 12 months of treatment. The presence or absence of apical calcified barrier (ACB) was assessed after 12 months of treatment. The visual analog scale (VAS) was used to compare the postoperative pain between the two groups after 1, 3, 7, and 14 days of treatment. PAI scores between the two groups were compared using the Mann-Whitney U test, the presence or absence of the ACB was compared using the chi-square test, and the VAS scores were compared using the t-test. The statistical significance threshold was set at 0.05. RESULTS: There were no statistically significant differences in the PAI between the two groups at 6 and 12 months postoperatively. After 12 months, four cases in the Biodentine group showed ACB formation, whereas ACB was not found in any case treated with MTA. The VAS scores were statistically lower in the MTA group on the first day after treatment. Nevertheless, these scores were not statistically significantly different after 3, 7, and 14 days of treatment between the two groups. CONCLUSIONS: Biodentine can be used as an apical plug to treat immature permanent molars with apical lesions in a single visit in children. Biodentine showed favorable outcomes in apical lesions healing, which was comparable to MTA but with a decreased treatment time associated with its use.

Dental Care for a Child with Congenital Hydrocephalus: A Case Report with 12-Month Follow-Up.

Hydrocephalus affects the central nervous system as a result of progressive ventricular dilatation from the accumulation of cerebrospinal fluid in the brain's lateral ventricles. This paper reports on the oral characteristics of a child with congenital hydrocephalus, discusses her complex dental care needs, and presents dental management of this case. Despite the complex and challenging dental needs, this child received dental treatment in a chairside approach without general anesthesia. A thorough knowledge of the patient's medical condition, together with expert clinical skills, was indispensable for managing the child and improving the quality and length of her life.

Children's Drawing as a Projective Measure to Understand Their Experiences of Dental Treatment under General Anesthesia.

PURPOSE: The overall aim of the study was to gain a deeper understanding of 3 to 10 year-old children's experiences, main concerns, and how they manage attending hospital for dental treatment under general anesthesia (DTGA). METHODS: Twelve children aged 3-10 who were scheduled for DTGA were interviewed. In addition to tape-recorded interviews, data were collected using video diaries, participant observations, and pre-, peri-, and postoperative drawings. The children's drawings (n = 43) were analyzed using the Child Drawing: Hospital Manual (CD:H) and Vygotsky postulations for context readings, with the aim to explore what it means for children to undergo DTGA. RESULTS: The analysis found that the main concern for children during the pre-operative period was that they were forced to prepare for an unknown experience, which elicited stress. This situation was handled during the peri-operative period by trying to recover control and to cooperate despite fear, stress, and anxiety. Drawings completed post-operatively showed the surgical mask, "stinky" smell of the anesthetic gas, and multiple extraction of teeth were the main troubling experiences for children. Several weeks after DTGA, children tried to regain normalcy in their lives again. CONCLUSION: This study contributed to a deeper understanding of how children as young as 3 years undergoing DTGA experience and express their lived experiences: emotional, psychological, physiological, or physical stress in the context of DTGA.

Comments on Public Health Aspects of Paediatric Dental Treatment under General Anaesthesia. Dent. J. 2016, 4, 20.

I would like to comment on an article by Thomson [1] recently published in Dentistry Journal.[...].

Children's oral health-related quality of life and associated factors: Mid-term changes after dental treatment under general anesthesia.

OBJECTIVES: This study aimed to document the mid-term effects of comprehensive dental treatment under general anesthesia (DTGA) on parent-assessed children's oral health-related quality of life (COHRQoL). A second aim was to examine some epidemiological factors associated with COHRQoL and treatment outcome. STUDY DESIGN: A pretest-posttest design was followed in which parents were surveyed using the Child Oral Health Quality of Life Questionnaire before and 6-9 months after their children (age ranges 3-10 years) underwent DTGA. Some clinical conditions and epidemiological factors were examined to assess their association with COHRQoL and changes resulting from treatment. RESULTS: The clinical sample consisted of 80 children-parent dyads. The effect sizes of change following DTGA were large for both the child impact section and family impact section of the COHRQoL. COHRQoL scores after treatment were comparable or lower than those of a cross-matched group of children with no complaints related to oral health. Child's age, pain and number of teeth with pulpal involvement showed significant association with both pretreatment scores and change scores. CONCLUSIONS: Children's OHRQoL improved after DTGA as assessed by parents 6-9 months postoperatively. Child's age, pain and number of pulpally-involved teeth can be used as predictors for COHRQoL and change scores. Key words:Quality of life, children, oral health, reliability.

Testing international dental maturation scoring system and population-specific Demirjian versions on Saudi sub-population.

OBJECTIVES: The purpose of this study was to test the applicability of the Demirjian method and revised versions for estimating chronological age (CA) from dental age (DA) in a sample of children. STUDY DESIGN: A sample of 252 individuals of known age (4 to 14 yrs), sex (males: 125, females: 127), and ethnicity (Saudi) was collected. Each individual was aged using the original Demirjian method and revised versions, including Saudi, Kuwaiti, Belgian, and revised international curves. The differences between dental age and chronological age were analyzed using paired sample t-tests with Bonferroni corrections and multinomial regression tests at the 0.05 level of significance. RESULTS: The results indicated an over-aging of the sample as a whole by about 10 months using Demirjian tables, 5.5 months using Kuwaiti tables, 24.7 months using Belgian tables, and 5 months using revised international tables. The sample was under-aged by 0.6 month using Saudi tables. The overall discrepancies between CA and DA were statistically significant (P < 0.0001) for all methods with the exception of Saudi curves. CONCLUSIONS: The findings suggest that the Saudi population method is most accurate on a Saudi population. Key words:Age estimation, juvenile, forensic dentistry, Saudi Arabia.

Effects of dental rehabilitation under general anesthesia on children's oral health-related quality of life using proxy short versions of OHRQoL instruments.

AIM: To examine the impact of comprehensive dental treatment under general anesthesia (GA) on oral health-related quality of life (OHRQoL) in children using short form versions of the Parental-Caregivers Perceptions questionnaire (P-CPQ) and Family Impact Scale (FIS). DESIGN: A pretest/posttest study involved parents whose children (N = 67) were affected with severe childhood caries and completed comprehensive dental treatment under GA. All parents completed the short form versions of the P-CPQ and FIS at baseline and 4-8 weeks following the dental treatment. To examine test-retest reliability, a convenience sample of 38 parents repeated the pretreatment questionnaires 1-2 weeks after they completed them at baseline. Statistical tests including the Kruskal-Wallis test, Cronbach's alpha, and paired t-test were used to examine cross-sectional construct validity, internal consistency, and responsiveness of the instruments, respectively. RESULTS: Cross-sectional construct validity and internal consistency were acceptable. Test-retest reliability was excellent. Large decreases in posttreatment scores were observed along with moderate to large effect sizes. CONCLUSIONS: Dental treatment under GA is associated with considerable improvement in OHRQoL of children and their families, as demonstrated by short form versions of the P-CPQ and FIS completed by the children's parents.

Effects of Dental Rehabilitation under General Anesthesia on Children's Oral-Health-Related Quality of Life: Saudi Arabian Parents' Perspectives.

Aim: To determine whether dental treatment under general anesthesia (GA) would improve quality of life for children as reported by Saudi Arabian parents using a Parental-Caregivers Perceptions Questionnaire (P-CPQ) and a Family Impact Scale (FIS). Methods: Sixty-six parents completed P-CPQ and FIS scales four to eight weeks after their children (ages three to ten years) underwent comprehensive dental treatment under GA. Postoperative data were compared with baseline data gathered before GA using paired t-test at the 0.05 level of significance. The responsiveness of the P-CPQ and the FIS and the magnitude of changes in children's quality of life as a result of dental treatment were determined by calculating the effect size (ES). Cross-sectional construct validity and internal consistency were also examined using the pretreatment scores of the P-CPQ and the FIS scores. Results: The overall P-CPQ and FIS scores showed a significant decrease following treatment, concomitant with large ES in both scales and all their subscales with the exception of social wellbeing, which showed moderate ES (ES 0.59). The greatest relative changes were seen in the oral symptoms (ES 1.81) and the family activity (ES 1.57) subscales. Conclusion: Dental treatment under GA is associated with considerable improvement in children's quality of life as perceived by Saudi parents. The P-CPQ and the FIS scales are valid and responsive to changes resulting from dental treatment of young children affected by severe childhood caries.

Dental maturity in saudi children using the demirjian method: a comparative study and new prediction models.

A sample of 422 dental panoramic radiographs from individuals of known age (from 4 to 14 yrs), sex (males: 217, females: 205), and ethnicity (Saudi) was collected. A dental maturation score for each individual was calculated using the Demirjian method. Age was then estimated using the original Demirjian curves and tables based on French-Canadian population and population-specific curves and tables for Arab (Saudi and Kuwaiti) and European (Belgian) populations. The differences between dental age and chronological age were analyzed and compared using paired t-tests, one-way ANOVA test, and a post hoc Scheffé's test. The Demirjian method utilizing French-Canadian standards presented significant difference between dental age and chronological age for the total sample and in the vast majority of age groups in both sexes. The mean overestimation of age was about 10 months (P < 0.05). The tables designed specifically for Arab populations had a significantly lower error than the tables designed for French-Canadian and Belgian populations. The latter had the largest error in age predication. New age prediction models and maturation scores for Saudi population were developed based on the Demirjian method using multinomial functions.

Dental maturity of Saudi children: Role of ethnicity in age determination.

PURPOSE: Demirjian's dental maturity scores and curves have been widely used for human age determination. Several authors have reported considerable differences between the true and estimated age based on the Demirjian curves, which have been accounted for by ethnicity. The purpose of the current study was to assess the role of ethnicity-specific dental maturation curves in age estimation of Saudi children. MATERIALS AND METHODS: A sample of 452 healthy Saudi children aged 4 to 14 years were aged based on the original French-Canadian Demirjian curves and several modified Demirjian curves specified for certain ethnic groups: Saudi, Kuwaiti, Polish, Dutch, Pakistani, and Belgian. One-way ANOVA and a post hoc Scheffé's test were used to assess the differences between chronological age and dental age estimated by the different curves (P<0.05). RESULTS: The curves designed for Dutch, Polish, Saudi, and Belgian (5th percentile) populations had a significantly lower error in estimating age than the original French-Canadian and Belgian (50th percentile) curves. The optimal curve for males was the Saudi one, with a mean absolute difference between estimated age and chronological age of 8.6 months. For females, the optimal curve was the Polish one, with a mean absolute difference of 7.4 months. It was revealed that accurate age determination was not related to certain ethnicity-specific curves. CONCLUSION: We conclude that ethnicity might play a role in age determination, but not a principal one.

Accuracy of population-specific Demirjian curves in the estimation of dental age of Saudi children.

BACKGROUND: The Demirjian eight-stage method is one of the principal methods used to quantify the degree of maturity from age 3 to 17. Aim. The objective of this study was to compare the accuracy of dental age of different population-specific curves, derived using the Demirjian method, to the chronological age of Saudi children aged between 4 and 14. DESIGN: Panoramic radiographic records of 176 children (91 boys and 85 girls), without any history of systemic disease, were assessed using the Demirjian method, and the dental age was calculated using curves designed for French-Canadian, Belgian, Kuwaiti, and Saudi children. The difference from chronological age (DA-CA) for each curve was then statistically compared using ANOVA, and each of the curves was compared to the chronological age using multinomial regression modelling. RESULTS: The results suggest that although population-specific curves are more accurate in the prediction of age, a considerable variation within each population still exists. CONCLUSIONS: The Demirjian method offers great scope in fields that require the study of the pattern of growth rather than the accuracy of age estimation.

Managing dental caries in children in Saudi Arabia.

This paper describes oral health among children in Saudi Arabia, the dental health system in the country, and some possible solutions and recommendations to improve the oral health status.

The clinical evaluation of a single-bottle adhesive system with three restorative materials in children: six-month results.

This study was designed to evaluate the clinical performance of a single-bottle adhesive system with three restorative materials placed in children using the total-etch technique. One hundred thirty restorations were placed on conservative preparations in 36 children using the incremental placement technique in a clinical environment. The restorations were evaluated within a week of placement (baseline) and again after six months. The criteria evaluated included retention, color match, marginal discoloration, marginal integrity, surface roughness, postoperative sensitivity, recurrent caries, and wear. Indirect evaluations of anatomical form, marginal adaptation, and wear also were conducted. Clinical evaluation demonstrated no significant differences between the three restorative materials. Five restorations had to be replaced: two compomer, two packable composite, and one amalgam. There was no clinically detectable wear in any of the restorations.

Microleakage of a single-bottle adhesive system with 3 restorative materials: in vitro study and clinical considerations.

The purpose of this study is to evaluate whether differences in material composition between 3 restoratives (compomer, packable composite, and amalgam) affect microleakage in class II preparations. Class II cavity preparations were made in the mesial and distal surfaces of a noncarious human premolar with the gingival margins in dentin. Preparations were etched and rinsed, and a single-bottle adhesive agent (Prime & Bond NT) was applied. Preparations were restored with the following materials (n = 8 per group): Dyract AP, SureFil, and Dispersalloy. For Dyract AP total-bond restorations, a new nonrinse conditioner (NRC) was tested against a total-etch with 36% phosphoric acid. Specimens were coated with nail varnish, immersed in toluidine blue for 24 hours, and evaluated for dye penetration, after removal of the restorative material, using a 0-to-4 scale. Statistical analysis using analysis of variance revealed significantly higher leakage scores (P < .05) for the NRC-Dyract AP group when compared with all other groups. Dispersalloy had significantly lower scores compared with Dyract AP and SureFil, all with the total-etch bonding technique. No statistically significant difference was observed between the latter 2 groups. The inability of all 3 materials to create a perfect seal in vitro raises concerns about the ability of the adhesive system to provide completely sealed restorations in vivo. However, bonded amalgam restorations are more effective in reducing marginal microleakage, particularly at the dentinal margin.

Bond strengths of Dyract AP compomer material to dentin of permanent and primary molars: phosphoric acid versus non-rinse conditioner.

PURPOSE: The purpose of this in vitro study was to determine the shear bond strengths (SBS) of Non-Rinse Conditioner (NRC, Dentsply) combined with Prime & Bond NT (PBNT, Dentsply), a 1-bottle adhesive. The null hypothesis tested was that the use of NRC with PBNT would not result in SBS different from those obtained with conventional phosphoric acid (PA) etching and bonding application to permanent and primary dentin. METHODS: Extracted human third molars and primary molars were mounted length-wise in acrylic resin. The occlusal surfaces were ground to expose a flat dentin surface, and then polished to 600 grit silicon carbide paper to create smear layers similar to those created with high-speed burs. The teeth were randomly assigned to 4 groups (N = 10) according to the etchant/conditioner (PA vs NRC) and dentin (permanent vs primary) used: (Group I: permanent dentin, PA, PBNT; Group II: primary dentin, PA, PBNT; Group III: permanent dentin, NRC, PBNT; Group IV: primary dentin, NRC, PBNT). Specimens were then secured in a split mold, having a 5 mm diameter opening and a polyacid-modified resin composite (Dyract AP, Dentsply) were inserted and light cured incrementally onto the treated dentin surfaces. All specimens were stored in water for 24 hours prior to shear strength testing using a Franell testing machine at a crosshead speed of 0.8 mm/minute. RESULTS: The mean dentin SBS values (MPa) for the groups were: Group I (13.32 +/- 6.6); Group II (15.21 +/- 5.25); Group III (8.87 +/- 3.12); and Group IV (7.42 +/- 2.98). Analysis of variance and Duncan's multiple range tests indicated significant differences among groups at P < 0.05. CONCLUSIONS: In general, the SBS were remarkably greater in the 2 groups etched with PA in comparison with the 2 groups conditioned with NRC. However, the type of dentin tissue did not influence SBS.

Preservation-based approaches to restore posterior teeth with amalgam, resin or a combination of materials.

This review is a systematic assessment, from the literature, of the status quo of dental amalgam, resin-based composite and glass-ionomer restorations for carious lesions as it applies to new concepts, coupled with clinical research. Scientifically based and practical new materials and techniques are recommended to include in contemporary practice throughout the world. Clinical and laboratory studies which have been carried out in light of modern conservative principles, and in light of the current emphasis of treating dental caries as a disease process were reviewed and discussed. An approach to managing carious lesions based upon selected advantages of dental amalgam, resin-based composite and glass-ionomer technology applied to what is termed "preservation-based" approaches to restoring teeth has been synthesized. Researched evidence contradicts the notion of "extension for prevention" in favor of maintaining sound tooth structure which would translate into more patients with healthy dentitions for entire lifetimes.