Treatment Outcomes of Lip Taping in Patients with Non-syndromic Cleft Lip and/or Palate: A Systematic Review and Meta-analysis.

OBJECTIVE: To conduct a systematic review of the data in peer-reviewed medical literature and evaluate the effectiveness of lip taping as a pre-surgical naso-alveolar molding (NAM) technique in infants with cleft lip and/or palate. DESIGN: An electronic search of various databases for relevant studies, regardless of date, from inception to June 2023 was carried out and evaluated. After completing the electronic search and applying our inclusion/exclusion criteria, 6 studies-2 randomized control trials, 2 non-randomized studies, and 2 case series-were included. Data extraction of relevant articles was done independently by 2 authors. Quality assessment was done using the JBI prevalence critical appraisal tool and certainty of evidence was carried out by GRADE approach. MAIN OUTCOME MEASURES: Nasolabial Aesthetics, Dentoalveolar Relationship. RESULTS: A total of six studies were included in the current review. Meta-analysis was carried out, and forest plots were obtained for a single mean from the lip-taping group. 3 studies had a low risk of bias, while 3 studies displayed a serious risk of bias. Significant improvement in various outcome measures was noted with lip taping when compared with the control group although the certainty of evidence was very low. CONCLUSION: When compared to no therapy, lip taping appears to ameliorate dentoalveolar measurements and nasolabial aesthetics. To increase our knowledge of lip taping, more research will be needed in the future, as there are not many studies to prove lip taping is better than other treatment approaches.

Effect of root immaturity and depth of intrusion on spontaneous re-eruption and healing complications: A retrospective analysis.

BACKGROUND/AIMS: Dental trauma resulting in tooth intrusion is a severe injury of permanent dentition, with a prevalence of 0.5%-1.9% among traumatic dental injuries. Currently, treatment guidelines for intruded permanent teeth depend on root development and the degree of intrusion. However, the categorization of tooth maturity as mature or immature simplifies a complex continuum of root development stages. This study aims to investigate the impact of various stages of root development on the success of spontaneous re-eruption (SRE) of intruded teeth. MATERIALS AND METHODS: This retrospective study analysed data from 80 children (125 teeth) aged 6-12 years who experienced dental intrusion between 2018 and 2022. Root maturation was classified based on Cvek's classification, eight were categorized as stage 1, 29 as stage 2, 44 as stage 3, 25 as stage 4, and 19 as stage 5. Intruded teeth with immature roots (Cvek's class 1-4) underwent SRE, while mature teeth (Cvek's class 5) were treated with SRE, orthodontic repositioning, or surgical repositioning based on the degree of intrusion. Primary outcome measures were successful re-eruption and secondary outcomes included observed complications during follow-up. RESULTS: Regression analysis revealed that the patient's age, degree of root maturation, and degree of intrusion significantly affected spontaneous re-eruption (p < .05). SRE was more successful in teeth with Cvek's stages 1 and 2 compared to stages 3 and 4. Complications were associated with the treatment method, degree of root immaturity, and degree of intrusion. CONCLUSION: The study demonstrates that as root maturation progresses, the likelihood of re-eruption decreases, and the risk of pulp necrosis and infection increases. Therefore, teeth in later stages of immaturity (Cvek stage 4) should be repositioned orthodontically or surgically without waiting for spontaneous re-eruption.

Comparative Evaluation of Effectiveness of TheraCal LC, MTA, and Calcium Hydroxide in Direct Pulp Capping in Primary Molars: Randomized Clinical Study.

Introduction: This study was performed to evaluate the clinical and radiographic effectiveness of TheraCal light cured (LC) comparison to mineral trioxide aggregate (MTA) and calcium hydroxide in direct pulp capping of primary molars over a period of 9 months. Materials and methods: A total of 90 primary molars from children aged between 5 and 8 years were included in this randomized clinical study based on inclusion and exclusion criteria and were randomly divided into three groups-group I, TheraCal LC; group II, MTA; and group III, calcium hydroxide. Direct pulp capping (DPC) was performed in noncontaminated pulpal exposure with hemostasis achieved within 2-3 minutes followed by restoring the tooth using glass ionomer cement (GIC). Subjects were followed up at 3, 6, and 9 months for clinical and radiographic evaluations. Results: At 9 months of follow-up, the overall success rate of direct pulp capping in groups I, II, and III were 60%, 72.41%, and 48.14%, respectively. Intergroup comparison showed nonsignificant differences (p >0.05). Conclusion: The outcomes of this study suggest the limited success of direct pulp capping in primary molars. However, among the three materials used in this study, MTA comparatively had better results. How to cite this article: Jha S, Namdev R, Singhal R, et al. Comparative Evaluation of Effectiveness of TheraCal LC, MTA, and Calcium Hydroxide in Direct Pulp Capping in Primary Molars: Randomized Clinical Study. Int J Clin Pediatr Dent 2023;16(S-2):S213-S219.

Schematic Treatment Tree for the Presurgical Nasoalveolar Moulding of Patients with Cleft Lip and Palate.

Background: Cleft lip and palate is the most common and unfortunate congenital defect that is debilitating for both the patients and their parents. Such complex condition demands for a precise and judicious management, as its outcome can drastically influence the quality of life of the child. Aim: To provide a concise treatment algorithm or tree which might guide the clinicians and make it easier for them to opt for a better treatment option when confronting different severities and types of this defect. Material and Methods: The clinical experience at our center alongwith review of current literature is used to propose a decision making treatment tree. Discussion: For the better aesthetics, function and ease of cosmetic surgery, several presurgical procedures have been introduced including the nasoalveolar moulding (NAM) appliance, adhesive tapes with nasal elevators, Figueroa's appliance, Hotz appliance, etc. Conclusion: The schematic decision-making tree may prove beneficial to the healthcare providers specially pedodontists who frequently come across such situations to choose the best treatment option for their patients.

Modified Cap Splint: A Novel Approach to Treating Delayed Mandibular Fracture in Pediatric Patients.

Mandibular fractures in children, when compared to adults are quite less common. The treatment approaches for mandibular fractures differ in children due to their growth and developing dentition. Minimal manipulation of bony architecture is done to achieve a stable position. Thus a closed reduction is preferred in children. This article presents a case of an 8-year-old boy, mandibular left parasymphysis fracture with displacement of the left dentoalveolar segment which was managed by a novel treatment approach using a unilateral cap splint with interelastic traction. How to cite this article: Jha S, Singhal R, Goel N, et al. Modified Cap Splint: A Novel Approach to Treating Delayed Mandibular Fracture in Pediatric Patients. Int J Clin Pediatr Dent 2023;16(4):645-648.

Comparative Evaluation of Chlorhexidine Polymer Scaffold, 3Mixtatin, and Formocresol for Vital Primary Pulp Therapy: A Randomized 6-month Clinical Study.

Introduction: The study was performed to evaluate and compare the clinical and radiographic efficacy of chlorhexidine (CHX) polymer scaffold, 3Mixtatin, and formocresol for vital primary pulp therapy-a randomized clinical study. Materials and methods: A total of 120 primary molars were included from children aged between 6 and 8 years in this randomized clinical study based on inclusion and exclusion criteria and were randomly allocated into three groups (group I-CHX polymer scaffold, group II-3Mixtatin, and group III-formocresol. Pulpotomy was performed in a vital cariously exposed primary tooth with healthy periodontium where their retention is more beneficial than extraction. Subjects were followed up at 1, 3, and 6 months for clinical and radiographic evaluations. Results: At 6 months of follow-up, the overall success rate of pulpotomy in groups I, II, and III was 56.41, 71.05, and 60.52% in each group, respectively. Nonsignificant difference (p > 0.05) was seen during intergroup comparison. Conclusion: However, among the three materials used in this study, 3mixtatin comparatively had better results. How to cite this article: Goel N. Comparative Evaluation of Chlorhexidine Polymer Scaffold, 3Mixtatin, and Formocresol for Vital Primary Pulp Therapy: A Randomized 6-month Clinical Study. Int J Clin Pediatr Dent 2023;16(3):478-482.

Ameliorative potential of stem cells from human exfoliated deciduous teeth (SHED) in preclinical studies: A meta-analysis.

The preclinical and clinical role of mesenchymal stem cells from various adult sources is extensively investigated and established in regenerative medicine. However, the comprehensive exploration of the therapeutic potential of Stem cells from human exfoliated deciduous teeth (SHED) is inadequate. Therefore, we performed a systematic meta-analysis of preclinical animal model studies in several diseases to provide insight into SHED's efficacy and therapeutic potential. Two blinded and independent investigators searched the available online databases and scrutinized the included studies. Meta-analysis was performed to evaluate the pooled effect estimate of intervention of SHED by Review Manager 5.4.1. To investigate the therapeutic efficacy of SHED intervention, we also analyzed the test of heterogeneity (I2), overall effect (Z), sensitivity, and publication bias. Among the 2156 scrutinized studies, 40 were included and evaluated as per inclusion and exclusion criteria. The intervention of SHED and its derivatives in several diseases depicted statistically significant therapeutic effects in periodontitis, pulpitis, spinal cord injury, parkinson's disease, alzheimer's disease, focal cerebral ischemia, peripheral nerve injury, and retinal pigmentosa. SHED also improved levels of alanine aminotransferase, aspartate aminotransferase, and bilirubin in liver fibrosis . In autoimmune diseases also, values were significant. SHED also showed a statistically significant reduction of wound healing area and new bone formation in bone defects. The pooled effect estimates of included preclinical studies demonstrated a statistically significant therapeutic effect of SHED in numerous diseases. Based on our data, it is suggested that the potential of SHED may be implemented in clinical trials after conducting a few more preclinical studies.

Evaluation and Comparison of Effectiveness of Kedo-S Pediatric Rotary Files vs Manual Instrumentation for Root Canal Treatment in Primary Molars.

Purpose: To evaluate and compare the clinical and radiographic success of Kedo-S pediatric rotary files vs manual K-Files for pulpectomy in primary mandibular molars. Materials and methods: A sample of 30 primary mandibular molars with irreversible pulpitis was taken per group. The groups were divided as below mentioned-group I (n = 30) was treated using the Kedo-S file system. Group II (n = 30)-treated using manual stainless steel K-File. The clinical and radiographic success was compared of both techniques. Statistical analysis involved t-test, Chi-squared test, and Cochran's Q test. Results: The overall clinical success at 3, 6, and 9 months in group I were 72.4, 89.7, and 93%, respectively and in group II were 82.1, 92.9, and 92.9%, respectively. The overall radiographic success in group I at 3, 6, and 9 months were 6.9, 17.2, and 69%, respectively and in group II were 0, 7.1, and 35.7%, respectively. According to the Frankl behavior rating scale, 19 children in group I (65.5%) showed negative behavior, and 15 children in group II (53.57%) showed positive behavior. The mean instrumentation time in group I (Kedo-S pediatric rotary file group) and group II (hand K-File group) was 8.03 ± 0.823 and 11.25 ± 0.928, respectively. Conclusion: There was a statistically significant/highly significant difference in intergroup comparison postoperative behavior among the children in the two study groups. There was a statistically significant difference between the two study groups with relation to instrumentation time. The trend that was observed in the clinical and radiographic profile was that group I (Kedo-S rotary files) cases had more success when absolute numbers and figures were compared than group II (hand stainless steel K-File) in which success rates were comparable; however, the difference between the groups were found to be statistically nonsignificant. How to cite this article: Rajain T, Tsomu K, Namdev R. Evaluation and Comparison of Effectiveness of Kedo-S Pediatric Rotary Files vs Manual Instrumentation for Root Canal Treatment in Primary Molars. Int J Clin Pediatr Dent 2023;16(1):22-29.

Management of Pediatric Mandibular Fractures Using Orthodontic Archwires and Elastic Traction: An Alternative to Conventional Treatment Methods.

Introduction: Maxillofacial trauma in children consists of >15% of all facial fractures, which is usually associated with sports injuries and falls while playing. Pediatric mandibular fractures are relatively less frequent when compared to adults, and the reason can be attributed to the child's protected anatomic features and infrequent exposure of children to alcohol-related road accidents. Management principles vary in children, and the main concern is about mandibular growth and the development of dentition. Treatment can be done by either closed reduction or open reduction and internal fixation. Case description: A 5-year-old boy reported to the Department of Pediatric and preventive dentistry with the history of falling from a bike. The patient presented with bruise over chin, deviated mouth opening and deranged occlusion. OPG revealed right condylar fracture and left parasymphysis fracture. Treatment with closed reduction was favored over open reduction in order to decrease the risk of any undue trauma to developing tooth buds and to avoid any growth-related injury in children. Hence, a new approach was performed for closed reduction. The patient was kept on follow-up for a period 6 months. Discussion: Earlier treatment options in closed reduction were limited to intraoral cap splints, circummandibular wiring, eyelet wiring, and even bridle wiring. This case report highlights the use of orthodontic archwires and elastic traction in the management of pediatric mandibular fractures, which is something new to conventional treatment methods and can be used as an alternative method. How to cite this article: Kakran A, Singhal R, Namdev R, et al. Management of Pediatric Mandibular Fractures Using Orthodontic Archwires and Elastic Traction: An Alternative to Conventional Treatment Methods. Int J Clin Pediatr Dent 2023;16(6):864-867.

Prevalence of dental fluorosis and dental caries in fluoride endemic areas of Rohtak district, Haryana.

Objectives: This study investigates the estimation of the fluoride concentration in drinking water in Rohtak district, Haryana, and quantifies its effect on the prevalence of dental fluorosis and dental caries. Materials and Methods: A cross-sectional survey was conducted among 1262 school children in endemic fluoride areas of Haryana. Using simple random sampling, thirty villages from five blocks of Rohtak districts were selected, and children 6-12 years of age were examined. A questionnaire survey form was filled out to record the demographic details of the samples. Dental caries was recorded according to DMFT (D = Decayed, M = Missing due to caries only, F = Filled, T = Teeth)/deft index (d = decayed, e = extracted due to caries, f = filled, t = teeth). Assessment of Dental Fluorosis was done according to Dean's Fluorosis index, modified in 1942. The data were analyzed using SPSS version 19, and nonparametric tests were used to assess the significance. Results: The study participants included 615 males and 647 females among which Mean DMFT in the area of study ranged from 0.32 to 1.90. Mean deft in the area of study ranged from 0.34 to 1.91. The fluoride concentrations in groundwater are in the range of 0.532-8.802. Out of 1262 children examined, 655 (51.90%) children were having dental fluorosis. 607 (48.10%) of the subjects were free from fluorosis. 16.09%, 13.39%, 9.11%, and 8.16% and 5.15% were having questionable, very mild, mild, moderate, and severe form of fluorosis, respectively. Conclusion: It can be concluded that in Rohtak district, the fluoride levels in drinking water and the prevalence of dental fluorosis are high, so requiring an urgent need to improve the quality of water and institute de-fluoridation of drinking water in affected areas to lower the burden of dental fluorosis in the community.

Newer Technique of Extra-Coronal Bleaching with Sodium Perborate on Non-Pitted Fluorosis Stains in Permanent Anterior Teeth.

Variety of treatment approaches have been proposed for esthetic management of dental fluorosis. Microabrasion, bleaching using hydrogen peroxide, and etch bleach seal are commonly used methods. Bleaching using sodium perborate has been used for intracoronal bleaching. Till now, no study has used sodium perborate for extracoronal bleaching of discolored stained teeth. OBJECTIVES: To evaluate the esthetic improvement of non-pitted fluorosis stains using sodium perborate and compare with etch bleach seal, microabrasion and in-office bleaching with 30% H2O2 on visual assessment scale VAS (primary objective) and to assess any untoward effects including staining, sensitivity, gingival problems within the course of study (secondary objectives). STUDY DESIGN: A randomized control trial with 6 months follow up. Methodology- Twenty children aged 8 to 12 years with non-pitted fluorosis in upper anterior teeth were divided into 4 groups with 5 patients in each group. RESULTS AND DISCUSSION: All of the techniques showed improvement in esthetics with VAS. However, microabrasion and bleaching using sodium perborate had significantly better results than other 2 techniques. CONCLUSION: Sodium perborate showed excellent results in extracoronal bleaching of fluorosed teeth. However a randomized study with large sample size is required to draw a definitive conclusion regarding superiority of one technique over others.

Can silver diamine fluoride be an alternative to aerosol-based dentistry during the COVID scenario? A retrospective analysis.

BACKGROUND: Restrictions on routine dental procedures involving aerosols during COVID-19 have resulted in a significant increase in the suffering of pediatric patients. AIM: The study reported the alternative measures followed in our department using SDF during the COVID era when routine elective dental procedures were prohibited. MATERIALS AND METHODS: The retrospective data of patients aged 2-13 years with carious molar teeth who were treated with silver diamine fluoride without (Group 1) or with (Group 2) caries excavation were collected. RESULTS: One thousand and seventy-two patients (646 males and 426 females) with 2459 carious molar were treated. On follow-up assessment at 3 months, 28 teeth in Group 1 and 21 teeth in Group 2 showed progression of carious lesion using International Caries Detection and Assessment System (ICDAS II criteria). Out of these failure cases, 32 (1.8%) teeth were primary and 17 (2.5%) were permanent. Complete relief in sensitivity/pain on stimulation was reported in 2381 teeth (96.83%), whereas in 78 (3.17%) teeth, mild sensitivity/pain on stimulation was reported. The average time consumed during treatment per tooth in Group 1 was 5.04 min and in Group 2 was 5.78 min. CONCLUSION: SDF application can be carried out as a nonaerosol-generating procedure and is a simple technique for children and clinicians.

An Update on Newer Pulpotomy Agents in Primary Teeth: A Literature Review.

Primary molars with asymptomatic reversible pulpitis are commonly treated by pulpotomy procedure. Different pulpotomy materials used so far for pulpotomy that have been mentioned in the literature have been included in this article. This literature review includes all medicaments including natural alternatives. Many significant medicaments with their success rates have been mentioned in this paper. To increase the therapeutic success of pulpotomy procedure, it is necessary to identify a novel effective and preferably natural pulpotomy medicament.

Molar Incisor Hypomineralization: Clinical Characteristics with Special Emphasis on Etiological Criteria.

Molar incisor hypomineralization (MIH) is an entity to describe the enamel defects of the first permanent molars with the involvement of one or more incisors due to an underlying systemic cause. It is a frequently encountered challenge by dentists in a dental clinic and dental complications affecting patient's quality of life. Early diagnosis is the key to protect and prevent the deterioration of the condition. This article aims to highlight different aspects of etiology to treatment options in young patients related to MIH.

Lingual Frenuloplasty for Ankyloglossia in Children: A Case Series.

Tongue is an important oral structure that affects speech, position of teeth, periodontal tissue, nutrition, swallowing, nursing, and certain social activities. Tongue-tie or ankyloglossia is a developmental anomaly of the tongue, characterized by an abnormally short, thick lingual frenulum resulting in limited tongue movement. Diagnosis must include functional assessment of tongue mobility, in addition to the physical appearance of the frenulum. Tongue mobility and appearance associated with the insertion, as well as the attachment and the shortness of the lingual frenulum should be evaluated. Ankyloglossia management should be considered at any age considering the risk-benefit evaluation and because of the highest vascularization and mobility of the tongue. Lingual frenuloplasty for the management of ankyloglossia in children is being discussed in the form of case series.

A Rare Case of non Syndromic Congenital Idiopathic Gingival Fibromatosis: Electrosurgical Management.

Idiopathic gingival fibromatosis (IGF) is a rare, genetically heterogeneous condition that is usually a part of syndrome or, rarely, an isolated disorder. It is characterized by a slowly progressive, non hemorrhagic, fibrous enlargement of keratinized gingiva which usually begins at the time of eruption of permanent dentition, however very few cases involving the primary teeth have been described in literature. Congenital gingival fibromatosis is very rare condition in which the gingival tissues become thickened and erupting teeth remain submerged beneath hyperplastic tissue masses. This case report discusses the rare case of congenital non syndromic idiopathic gingival fibromatosis in a two year old boy who reported with absence of teeth and incompetent lips. Gingivectomy was done using modified microdissection electrocautery needle to remove the excess gingival tissues. Excised tissue has been examined histologically. The patient was followed up for a period of one year and no recurrence was observed.

Treatment Modalities for Early Management of Class III Skeletal Malocclusion: A Case Series.

The characteristic features of Class III malocclusion are present at an early age, usually between 3 and 5 years of age. If left untreated, the Class III malocclusion or severe anterior crossbite may worsen, with the majority of these patients ultimately requiring orthognathic surgery as adults. The treatment in all developing Class III cases should be undertaken as soon as the abnormality is diagnosed to prevent it from becoming permanent and resulting in a full-blown Class III malocclusion. It provides more pleasing facial esthetics (the lip posture and facial appearance), thus improving the psychosocial development of a child. Various treatment options available for the management of developing Class III malocclusion are as follows: (1) functional appliances such as reverse twin block, Frankel appliance, and the removable mandibular retractor; (2) orthopedic appliances such as chin cap and face mask; and (3) orthodontic appliances, namely removable maxillary expansion plate or fixed orthodontic appliance with expanded upper arch wire. A treatment plan may be chosen depending on the amount of maxillary growth restriction, mandibular plane angle, the soft-tissue profile, and the age of the patient. This article discusses the various treatment options and the decision-making for different clinical cases based on the clinical features with a description of four different treatment approaches.

Extrafollicular Adenomatoid Odontogenic Tumor in the Maxillary Incisor Region Disguised as Gingival Swelling.

Adenomatoid Odontogenic Tumor (AOT) is a benign, non-invasive tumor with slow but progressive growth, mainly affecting younger patients, predominantly females. It is more often located in maxilla, involving an unerupted or erupted tooth, mostly canine. There are three variants, namely follicular, extra-follicular and peripheral. Permanent cuspids account for 60% of all follicular and 89% of all extra-follicular AOT. This article discusses a unique case of extra-follicular AOT in 9 year old male patient associated with partially erupted maxillary central incisor.

Patterns of mandible fracture in children under 12 years in a district trauma center in India.

AIM: This study aims to present the data of mandibular fracture among children in the age group of 0-12 years treated in a district trauma center in India. STUDY DESIGN: Sixty-two children younger than 12 years treated for mandibular fractures over two-and-a-half-year period were studied by age, gender, anatomic site, etiology, socioeconomic status, residing area, interval from trauma to reporting, and treatment performed. The cases were divided into three age groups, and the records of the patients were analyzed. RESULTS: The male to female ratio was 1.58:1. Common fall and fall from bike together was a cause for injury in 50% (31 patients), of total patients. Condylar fractures occurred in 25 patients (40.3%). Multiple fractures were seen in 13% of the patients. In 47 (75.8%) patients, associated injuries other than the mandibular fractures were also present. Most patients with mandibular fractures were treated by closed reduction (36 patients, 58%). Conservative treatment and open reduction were done in 18 (29%) and 8 (13%) patients, respectively. CONCLUSION: In addition to factors such as age, gender, etiology, anatomic site, and treatment of mandibular fracture, this study also reported statistics regarding other factors such as residing area, socioeconomic status, and interval from trauma to reporting in Indian patients. It is hoped that the data presented here will be valuable to the government agencies and healthcare professionals for planning treatment, recommending preventive measures and encouraging research in this area.

Social and Behavioral Determinants for Early Childhood Caries among Preschool Children in India.

Background and aims. Early Childhood Caries (ECC) is a public health problem with biological, social and behavioural determinants and the notion that the principal etiology is inappropriate feeding modalities is no longer tenable. Hence this study was undertaken to assess the relationship between ECC and socio-demographic factors, dietary habits, oral hygiene habits and parental characteristics. Materials and methods. The study involved a dental examination of 1400 children aged 0-71 months, recording caries using Gruebbel's deft index and a structured questionnaire to interview parents or caretakers. The tabulated data was statistically analyzed using t-test and ANOVA at 5% level of significance. Results. The variables significantly associated with ECC were age (P<0.001), geographical location (P<0.05), duration of breast/bottle feeding (P<0.001), use of sweetened pacifiers (P<0.001), frequency of snacking (P<0.05), frequency of tooth brushing (P<0.001), the person responsible for child's oral health care (P<0.05) and education level of parents (P<0.05). However, other variables like child's gender, number of siblings, types of snack the child preferred and age at which tooth brushing was instituted did not have statistically significant relationship with ECC (P>0.05). Conclusion. ECC is preventable and manageable with proper information and skills. It is important for healthcare professionals, family physicians and parents to be cognizant of the involved risk factors as their preventive efforts represent the first line of defense.