Comparison of the effects of cognitive behavioural therapy and inhalation sedation on child dental anxiety.

AIM: To compare the effectiveness of inhalation sedation with nitrous oxide/oxygen (N2O/O2) and cognitive behavioural therapy (CBT) in reducing dental anxiety in preschool children. STUDY DESIGN: Randomised controlled clinical trial. METHODS: This study was conducted on 45 preschoolers with moderate to severe dental anxiety (determined by the Children's Fear Survey Schedule Dental Subscale), who required pulp treatment of at least one primary mandibular molar. Baseline anxiety and cooperation levels were determined using Venham Clinical Anxiety and Cooperation Scales (VCAS and VCCS) and Venham Picture Test (VPT) at the first dental visit (dental prophylaxis and fluoride treatment). Before the second dental visit (pulp treatment), the children were randomly assigned to one of three groups--1: control, 2: N(2)O/O(2) and 3: CBT. In group 1, the usual behaviour management techniques were used, in group 2, nitrous oxide/oxygen gas was used and in group 3, unrelated play, Benson's breathing and positive self-talk and modelling were used. Anxiety and cooperation levels were determined at three periods: injection, rubber dam placement and the application of a high-speed handpiece with VCAS and VCCS and VPT. Finally, anxiety and cooperation differences between the two dental visits were compared within the three groups. STATISTICS: Chi square, ANOVA and Kruskal-Wallis and Mann-Whitney U tests were used. RESULTS: N(2)O/O(2) and CBT significantly resulted in lower anxiety and higher cooperation in the second visit (at all three periods) compared to the control, although there was no significant difference between these two treatment methods. CONCLUSION: Both test methods were effective in reducing dental anxiety in preschoolers. Considering the adverse effects and necessity of equipment and trained personnel when using nitrous oxide and oxygen inhalation sedation, cognitive behavioural therapy is preferable because of its better applicability.

Two-year outcomes of electrosurgery and calcium-enriched mixture pulpotomy in primary teeth: a randomised clinical trial.

AIM: The purpose of this prospective split-mouth, randomised clinical trial was to assess the clinical and radiographic success rate of pulpotomy in primary molars using calcium-enriched mixture (CEM) cement or placement of zinc oxide eugenol after electrosurgery (ES/ZOE). METHODS: Pulpotomy was performed for 102 primary second molars in 51 children aged between 4 and 6 years. Considering a split-mouth design, for each patient the right and left second primary molars randomly underwent pulpotomy using CEM cement or ES/ZOE. All teeth were restored using preformed metal crowns. Following pulpotomy procedure, teeth were blindly evaluated for clinical and radiographic success after 6, 12 and 24 months. McNemar test and SPSS 16 software were used for the statistical analysis. RESULTS: After 24 months, clinical success rates were 100% in both groups, however, radiographic success rates of ES/ZOE and CEM were calculated as 95.2 and 90%, respectively, with no significant difference (p = 0.625). The most common radiographic sign of failure was internal resorption. CONCLUSION: The results of this investigation show that the treatment success rate with CEM cement was similar to the electrosurgical pulpotomy.

Effect of bevelling on marginal microleakage of buccal-surface fissure sealants in permanent teeth.

AIM: This was to assess the effect of bevelling the margins of fissures on buccal surfaces in permanent molars on marginal microleakage of fissure sealants. METHODS: The in vitro study was performed on buccal surfaces of 20 extracted permanent third molars, randomly divided into two groups of 10 teeth. Group I: performing enameloplasty (opening the fissures using fissurotomy bur), conditioning with phosphoric acid (37% phosphoric acid for 20 s), placing bonding (enamel bonding agent), and then fissure sealant. Group II: all stages were similar to group I, except for bevelling the margins of buccal fissures (0.5 mm bevel) after enameloplasty. Teeth were then thermocycled, stained with 0.5% basic fuchsin, sectioned and examined for marginal microleakage. The Mann-Whitney test was used for statistical analysis. RESULTS: No dye penetration was seen in Group II (with bevel), but there was a 60% microleakage in Group I (without bevel) (p=0.005). CONCLUSIONS: In permanent molar teeth, bevelling the margins of fissures on the buccal surfaces appears to reduce the marginal microleakage of fissure sealants.

Effect of thickness of cavity wall on fracture strength of pulpotomized primary molar teeth with class II amalgam restorations.

AIM: This was to evaluate the effect of different thicknesses of cavity walls on fracture strength of pulpotomized primary molar teeth with class II amalgam restorations. METHODS: 80 carious extracted human primary molar teeth were selected for pulpotomy preparation. The teeth were divided into four groups. Mesio- or disto-occlusal (20 teeth) and mesio-occluso-distal (20 teeth); cavities were prepared in both first and second primary molar teeth. Each group was divided into two subgroups of ten teeth according to the thickness of their walls (1.5 or 2.5 mm). After restoring teeth with amalgam, all groups were stored in distilled water at 37 degrees C for seven days. They were then thermo cycled 1,000 times between 5 degrees to 55 degrees C. The specimens were then subjected to a compressive axial load in a universal testing machine at a crosshead speed of 0.5 mm min(-1). The t-test was used for statistical analysis. RESULTS: Mean fracture resistances of the first and second molar teeth were 975.5 +/- 368.8 and 1049.2 +/- 540.1, respectively. In the first molars, fracture resistance of 2-surface cavities was significantly more than 3-surface cavities (p=0.001), but this difference was not statistically significant in second molars. In second molars, fracture strength in 2- and 3-surface cavities with a 2.5 mm thickness in the walls was more than those with 1.5 mm thickness. However, in first molars this difference was only statistically significant in 3-surface cavities (p=0.045). CONCLUSIONS: The fracture strength in pulpotomized primary molar teeth with amalgam restorations was high, more than maximum bite forces in primary teeth, even in extensive 3- surface cavities.