Direct and residual antimicrobial effect of 2% chlorhexidine gel, double antibiotic paste and chitosan- chlorhexidine nanoparticles as intracanal medicaments against Enterococcus faecalis and Candida albicans in primary molars: an in-vitro study.

BACKGROUND: Thorough disinfection of root canals in primary molars may be complicated by the complex root canal morphology. This in-vitro study aimed to compare direct and residual antimicrobial effect of 2% chlorhexidine (CHX) gel, 500 mg/ml double antibiotic paste (DAP) and chitosan-chlorhexidine nanoparticles (CS-CHX NPs) as intracanal medicaments against Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans) in primary molars. METHODS: Mesial roots of 63 mandibular second primary molars were infected with E. faecalis and C. albicans. Teeth were divided into 9 groups: Ia: (CS-CHX NPs), IIa: (CHX), IIIa: (DAP), IVa: chitosan nanoparticles (CSNPs) in which medicaments were placed for 3 days, groups Ib: (CS-CHX NPs), IIb: CHX, IIIb: (DAP), IVb: (CSNPs) in which medicaments were placed for 7 days, and Group V (control): teeth were infected, irrigated with saline, and sampled 3- and 7-days post-infection. Microbiological samples were obtained after infection, 3, and 7 days after medicament placement and 7 days after medicament removal for both time points. One-way ANOVA, Tukey's post hoc test and paired t-test were used at p < 0.05. RESULTS: CS-CHX NPs had the highest anticandidal effect which was comparable to CHX and significantly higher than other medicaments (p < 0.001) at both time points. CS-CHX NPs had the highest effect against E. faecalis which was comparable to DAP and significantly higher than other medicaments (p < 0.001) at 3 days. All medicaments showed similar effect against E. faecalis after 7 days. The 7-days placement significantly increased the antimicrobial effect against both micro-organisms in all groups, except CS-CHX NPs which showed an insignificant increase. CS-CHX NPs showed the highest residual effect against both micro-organisms that increased with 7-days placement. CONCLUSION: CSNPs and CHX combination showed a synergistic effect against both micro-organisms. CS-CHX NPs displayed a higher effect at a shorter period compared to other medicaments, yet its residual effect was higher with 7-days placement.

Evaluation of four vital pulp therapies for primary molars using a dual-cured tricalcium silicate (TheraCal PT): one-year results of a non-randomized clinical trial.

Selecting an appropriate vital pulp therapy (VPT) for primary teeth with reversible pulpitis can sometimes be confusing for clinicians. Encouragingly, continuous developments in capping materials with bioactive properties help the selection of less-invasive treatments. This non-randomized clinical trial aimed to assess the clinical and radiographic success rates of indirect pulp treatment (IPT), direct pulp capping (DPC), partial pulpotomy (PP) and pulpotomy in primary molars utilizing TheraCal PT over a 12-month period. Different inclusion criteria were assigned for each treatment to assess the eligibility of each treatment type for specific clinical scenarios. Additionally, the association of tooth survival with some variables was assessed. The trial was registered at clinicaltrials.gov (NCT04167943) on 19 November 2019. Primary molars (n = 216) with caries extending into the inner dentin third or quarter were included. Selective caries removal was employed in IPT. Non-selective caries removal was employed in other groups, and treatment was decided according to pulp exposure characteristics, whereby the most conservative treatment was selected for the least clinically detectable pulp inflammation. Cox regression was performed to assess the effects of different variables on tooth survival using p ˂ 0.05 for detecting statistical significance. The 12-month combined clinical and radiographic success rates for IPT, DPC, PP and pulpotomy were 93.87%, 80.4%, 42.6% and 96.15%, respectively. Proximal surface involvement, provoked pain and first primary molars were associated with increased odds of treatment failure. According to the specified inclusion criteria, IPT, DPC and pulpotomy using TheraCal PT demonstrated acceptable results, while PP was associated with poor treatment outcomes. The odds of failure increased with proximal surface involvement, provoked pain and first primary molars. These results provide insights into different scenarios when managing deep carious lesions in primary teeth. The effects of clinical predictors on treatment outcomes may guide clinicians in case selection.

Survival Analysis and Cost Effectiveness of Silver Modified Atraumatic Restorative Treatment (SMART) and ART Occlusal Restorations in Primary Molars: a randomized controlled trial.

OBJECTIVE: To evaluate and compare the clinical performance and cost effectiveness of Silver Modified Atraumatic Restorative Treatment (SMART) and Atraumatic Restorative Treatment (ART) restorations in primary molars over 12 months follow up period. MATERIALS AND METHODS: Sixty-seven children, aged 5-9 years old having at least one asymptomatic primary molar with active caries, were randomly assigned to either the test arm (SMART) or the control arm (ART). Clinical performance was assessed after 6 and 12-months using the modified United States Public Health Services criteria. The trial was registered at Clinical Trial.gov with a registration number (NCT03881020). Treatment time for each restoration was recorded, Kaplan-Meier survival analysis and the log-rank test were performed (p<0.05) and cost effectiveness was measured at the end of the study. RESULTS: Both techniques showed comparable clinical performance and the mean survival time was 11.8 and 11.6 months for SMART and ART restorations respectively with no detected significant differences (p=0.416). Mean treatment time for SMART restorations (7.8 min.), however, was significantly lower than ART (15 min.) (p < 0.001). SMART technique, also, showed statistically significant lower mean total cost per restoration (p <0.001). CONCLUSIONS: Though SMART and ART have comparable clinical performance and survival in single-surface occlusal restorations in primary molars, SMART is less time consuming and more cost effective. CLINICAL SIGNIFICANCE: Using SMART technique could change paradigms in caries management. Being a patient friendly and cost-effective approach, it could be adopted as a superior treatment option when dealing with young children, those with behavioral and medical challenges and for promoting access to oral care among the underprivileged.

Effect of Ionizing Radiation on the Mechanical Properties of Two Dental Materials Commonly Used in Primary Teeth.

Aim: The purpose of this in vitro study was to evaluate the effect of radiotherapy on flexural strength, microhardness, and surface roughness of bulk fill composite (X-tra fil) and glass ionomer (EQUIA Forte HT). Materials and methods: A total of 40 specimens were prepared for each test and were divided into two groups according to the material used (composite or glass ionomer cement), and each group was divided into two subgroups (n = 10) according to radiation condition, irradiated subgroup, subjected to 50 Gy by multienergy linear accelerator delivered in one shot and control subgroup. Results: Control samples of flexural strength and microhardness had a significantly higher value than irradiated samples in both materials. Regarding the surface roughness, irradiated samples had a significantly higher value than the control samples in both materials. Conclusion: Irradiation with a linear accelerator had a negative impact on the flexural strength and microhardness of both materials. Moreover, it increased the surface roughness for both materials. Bulk fill composite is the dental restorative material of choice in head and neck cancer patients undergoing radiotherapy due to its high mechanical properties before and after radiation. How to cite this article: Nagi BM, El-Korashy DI, Amin A El-S, et al. Effect of Ionizing Radiation on the Mechanical Properties of Two Dental Materials Commonly Used in Primary Teeth. Int J Clin Pediatr Dent 2023;16(5):758-762.

Prevention of Infective Endocarditis of Oral Origin in Children: A Call for Pediatric Dentists-Pediatric Cardiologists' Collaboration in Egypt.

AIM: To assess knowledge and practices of some Egyptian pediatric dentists and pediatric cardiologists/cardiac surgeons regarding prevention of infective endocarditis (IE) from oral origin in children. MATERIALS AND METHODS: Pediatric dentists or pediatric cardiologists/cardiac surgeons having their practice in Egypt were conveniently selected. An online questionnaire was constructed for each specialty practitioner in English using a web-based platform. Each survey tool collected data about demographics, knowledge, and practices concerning the prevention of IE of oral origin. Surveys were disseminated to potential respondents using direct messaging or posting surveys' links on high-traffic areas (blogs, groups, or pages) of commonly known social media platforms. RESULTS: Two-hundred and thirty-nine pediatric dentists and 71 pediatric cardiologists/cardiac surgeons' responses were included in analysis. Some shortage in oral health knowledge and deviations in management protocol from known guidelines were evident in cardiologists' responses, whereas 66.2 and 64.8% reported encountering IE of oral origin or canceling a cardiac surgery due to oral infection, respectively. Most pediatric dentists (65.7%) rely on physician referral before managing children at risk of IE despite following recognized guidelines for IE prevention which may reflect difficulty in understanding such guidelines. Ninety percent of children with heart diseases visit a dentist due to oral complaint and not for checkup. CONCLUSION: Identification of disparities and pitfalls in management of children with heart diseases, if appropriately addressed by pediatric dentists and cardiologists, may reduce the risk of IE from an oral origin. CLINICAL SIGNIFICANCE: Health education of both specialists and development of national guidelines based on national epidemiology and clinical experience of cardiologists are strongly needed to decrease oral disease burden, allow for a consensus of patient management, and minimize the need for cross-referral, thus facilitating dental management without undue delays.