Volumetric Analysis of Various Pediatric Rotary Files in the Preparation of Primary Root Canals Using Cone-beam Computed Tomography.

Aim: This study was planned to evaluate and compare the cleaning efficacy of three pediatric rotary files with the standard Protaper adult file system in primary teeth using cone-beam computed tomography (CBCT). Materials and methods: A total of 40 extracted deciduous second molars, with palatal/mesial roots having at least two-thirds of root length and an intact furcation area, were distributed randomly among four groups, with each group containing 10 teeth. Canal preparation of group I (Pro AF Baby Gold), group II (Kedo SG Blue), group III (Prime Pedo), and group IV (Protaper) was done. Pre- and postoperative CBCT images were taken. The volumetric changes of the root canals were assessed and subjected to statistical analysis using Statistical Package for the Social Sciences (SPSS) version 16 and R Studio 3.1.1. Volumetric changes within the groups were analyzed using paired t-tests and between the groups using analysis of variance (ANOVA). Results: The comparison of mean volume difference between groups using ANOVA was statistically significant with F = 4.467, p = 0.002. A Tukey post hoc test revealed that group IV was statistically significant compared with groups I (p = 0.033) and III (p = 0.008) but was not statistically significant with group II (p = 0.170). There was no statistically significant difference in volumetric changes within the three pediatric rotary file systems. Conclusion: Protaper removed more dentin than all the pediatric rotary files, but it was not statistically significant over Kedo SG Blue. Among the pediatric rotary files, Kedo SG Blue removed more dentin than Pro AF Baby Gold and Prime Pedo, but they were not statistically significant. How to cite this article: Nainer Chidambaram JV, Jayaprakash J, Arangannal P. Volumetric Analysis of Various Pediatric Rotary Files in the Preparation of Primary Root Canals Using Cone-beam Computed Tomography. Int J Clin Pediatr Dent 2024;17(1):15-20.

An In Vivo Evaluation of Postoperative Pain after Root Canal Instrumentation Using Manual K-files and Kedo-S Rotary files in Primary Molars.

Aim: To determine postoperative pain after root canal instrumentation using manual K-file and rotary Kedo-S files in primary molars. Material and Method: Thirty-six primary mandibular molars from 4- to 8-year-old children requiring pulpectomy were randomly split into two groups of 18 teeth each, that is, manual file K-file (Group I) and Kedo-S rotary file (Group II). Children's pre- and postoperative pain was assessed using a four-point scale at different time intervals. Results: From the result of the present study, it was observed that the Kedo-S group showed significantly less pain after 24, 48, and 72 h. Conclusion: It was concluded from the present research that patients enrolled in the Kedo-s group experienced less pain.

Comparative evaluation of cervical pulpotomy and pulpectomy for primary molars with irreversible pulpitis: a multicentre randomised controlled trial.

PURPOSE: The objective of this multicentre randomised controlled trial was to compare the clinical/radiographic outcomes of cervical pulpotomy using calcium-enriched mixture cement (PCEM) and pulpectomy using Metapex (PM) in primary molars with irreversible pulpitis (IP). METHODS: A total of 134 primary molars from 94 children were randomly assigned to two intervention groups: the PCEM group (n = 74) and the PM group (n = 60). Baseline characteristics including age/gender/molar type/tooth type/jaw were recorded. The primary outcome measures were clinical/radiographic success rates assessed at the first and second follow-up appointments. Secondary outcomes included reasons for clinical/radiographic failures. Multiple logistic regression analysis was performed to determine the impact of various factors on the success rates. RESULTS: The mean age of the participants in both groups was similar (PCEM group: 5.4 years, PM group: 5.5 years). Gender distribution, molar type, tooth type, jaw, and number of practitioners were comparable between the groups. The clinical success rate at the first follow-up was 98.6% in the PCEM group and 96.4% in the PM group. At the second follow-up, the clinical success rate was 97.1% in the PCEM group and 91.1% in the PM group. The radiographic success rates at the first and second follow-up were 98.6% and 96.4% in the PCEM group and 96.4% and 91.1% in the PM group, respectively. Multiple logistic regression analysis did not reveal any significant association between the success rates and age/gender/molar type/jaw, or treatment groups (P > 0.05). CONCLUSION: In primary molars with IP, both simple/conservative cervical pulpotomy using calcium-enriched mixture cement and pulpectomy using Metapex demonstrated high clinical/radiographic success rates. No significant differences were observed between the two treatment modalities. These findings suggest that both techniques can be considered effective treatment options for managing primary molars with IP. TRIAL REGISTRATION NUMBER: Trial registration number: IRCT20201226049838N1, retrospectively registered on 12 January 2021.

Evaluation of the modified 3Mix-Simvastatin combination in non-instrumental endodontic therapy of necrotic primary molars: A two-arm randomized controlled trial.

OBJECTIVE: This study aimed to assess the clinical and radiographic outcomes of non-instrumentation endodontic treatment (NIET) using a modified antibiotic mix of cefixime, ciprofloxacin and metronidazole with simvastatin (an anti-inflammatory, bone regeneration drug) on necrotic primary molars compared to conventional pulpectomy to help preservation of necrotic primary teeth until its natural exfoliation. MATERIALS AND METHODS: Forty mandibular primary second molars with necrotic pulp tissue from 38 healthy patients aged between 4 and 8 years were randomly assigned to two groups with a 1:1 allocation ratio. Group A teeth underwent conventional root canal treatment. The procedure involved a two-visit approach, employing k-files and h-files during the initial visit, followed by the application of calcium hydroxide paste as canal dressing between visits, while Group B teeth were treated with 3Mixtatin. All teeth were clinically evaluated after 1, 3, 6, and 12 months, and radiographically at 3, 6, and 12 months. Two external examiners assessed the results. Data analysis was conducted using a chi-square test at a 0.05 significance level. RESULTS: At the end of the follow-up interval, 90% of teeth in each group exhibited no clinical signs or symptoms. Additionally, inter-radicular radiolucency healing occurred in 75% of cases in the NIET group and 89.5% in the conventional pulpectomy group. However, no statistically significant difference was found between the two groups. CONCLUSION: NIET using 3Mixtatin seems to be a good alternative choice to conventional pulpectomy, offering a less complex treatment approach that may help avoid the complications associated with traditional pulpectomy and could be suitable for teeth with shorter roots.

Pulpotomy versus pulpectomy in carious vital pulp exposure in primary incisors: a randomized controlled trial.

BACKGROUND: Pulpotomy as a minimally invasive pulp therapy technique is the treatment of choice for carious pulp exposures, however many pediatric dentists perform pulpectomies in vital primary incisors. The aim of this split mouth randomized controlled study was to compare formocresol pulpotomy and zinc-oxide and eugenol pulpectomy in the treatment of vital pulp exposure in primary incisors. METHODS: Contralateral pairs of incisors were randomly assigned to receive pulpotomy or pulpectomy in children aging from 18 to 66 months old and were followed up for 12 months. RESULTS: 39 pairs of incisors were included. Clinical and radiographical success rates showed no statistical significant difference (p = 1, p = 0.8 respectively). Relative risk measures for clinical success rates (RR = 1.03, 95%CI 0.87 to 1.23) and for radiographic success rates (RR = 1.03, 95%CI 0.83 to 1.29) with CIs including number one showing no difference between the two groups. The Survival rate using Kaplan-Meier survival analysis score showed 82% for pulpotomy and 74% for pulpectomy at 12 months (P = 0.2). CONCLUSIONS: Both pulpotomy and pulpectomy techniques can be used successfully in the treatment of carious vital pulp exposure in primary incisors. TRIAL REGISTRATION: The trial was retrospectively registered in Clinicaltrials .gov with this identifier NCT05589025 on 21/10/2022.

Postoperative pain after single-visit root canal treatment or vital pulp therapy: A systematic review and meta-analysis.

BACKGROUND: This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain. STUDIES REVIEWED: The authors searched PubMed, Cochrane Library, Embase, and Latin American and Caribbean Health Sciences Literature databases for studies published through June 30, 2022. The authors included randomized clinical trials if they reported on the assessment of postoperative pain after direct pulp capping, partial pulpotomy, pulpotomy, or single-visit RCT. The authors assessed the frequency of no, mild, moderate, and severe postoperative pain. They conducted meta-analyses to compare postoperative pain after full pulpotomy (PULP) and RCT. RESULTS: The qualitative synthesis included 57 studies, and the authors conducted meta-analysis of 3. PULP leads to more asymptomatic cases (relative risk [RR], 1.06; 95% CI, 1.01 to 1.11; P < .01; I2 = 67%) and to a lower occurrence of mild (RR, 0.89; 95% CI, 0.79 to 0.99; P < .04; I2 = 37%) and moderate (RR, 0.70; 95% CI, 0.51 to 0.95; P < .02; I2 = 57%) postoperative pain than RCT. The frequency of severe pain was very low for both vital pulp therapy and RCT. Moderate to severe postoperative pain was more common at 48 hours through 72 hours after RCT and up to 36 hours after PULP. Pain intensity after PULP was higher using calcium-enriched material compared with using mineral trioxide aggregate at 12, 18, and 36 hours (P < .001). PRACTICAL IMPLICATIONS: PULP showed a significantly higher incidence of no pain and a lower incidence of mild and moderate pain than single-visit RCT. Clinical decisions for RCT or PULP should not be based on differences in postoperative pain. When analgesia is indicated, it probably should be limited to a short time after PULP.

Teaching pulpectomy in paediatric dentistry: A national cross-sectional survey of dental schools in Brazil.

BACKGROUND: Pulpectomy is used to treat primary teeth with irreversibly inflamed or necrotic pulp tissue. There is, however, a lack of consensus on clinical protocols for teaching pulpectomy at dental schools. AIM: To determine what faculty members at Brazilian dental schools are teaching about pulpectomy in primary teeth. DESIGN: A cross-sectional, observational study was conducted using a 39-question survey available via the Google Forms® platform. A snowball sampling strategy was used for recruitment. Invitations to participate were sent via e-mail, WhatsApp® and Instagram®. The data were analysed descriptively. RESULTS: A total of 177 (58.4%) responses were obtained. Most faculty members recommended the use of Kerr hand files (66.1%), and 1% sodium hypochlorite was the most common choice for the irrigating solution (35.3%). Iodoform pastes were the first choice of faculty members (41.6%), and 60.5% of the faculty members recommended composite resin as the definitive restoration. CONCLUSION: Similarities were found in the teaching of pulpectomy for primary teeth among faculty members at dental schools in Brazil.

Effect of two irrigating solutions on antimicrobial activity and clinical and radiographic success after endodontic treatment in primary teeth: a randomized clinical trial.

OBJECTIVES: This study evaluated the antimicrobial activity, clinical and radiographic outcome of pulpectomy in primary teeth using either 1% sodium hypochlorite (NaOCl) or 2% chlorhexidine (CHX) as irrigants. MATERIALS AND METHODS: A randomized double-blind controlled clinical study in which primary teeth were allocated to 1% NaOCl (n = 20) and 2% CHX (n = 20) groups. Microbiological collections were performed before and after irrigation for agar culture and real-time polymerase chain reaction (qPCR). Clinical and radiographic success was assessed at different times. Data were submitted to descriptive analysis, chi-square, Mann-Whitney, and Wilcoxon tests (p  < .05). RESULTS: For 1% NaOCl, the following clinical and radiographic success rates were observed: 7 days (93%/80%); 30 days, 3 and 6 months (100%). For 2% CHX: 7 days (73%/53%); 30 days (93%); 3 months (100%/93%); 6 months (100%) (p > .05). One percent NaOCl and 2% CHX effectively reduced total microorganisms (p < .05) but not mutans streptococci (p > .05). In qPCR analysis, the solutions promoted a reduction of total bacteria and Streptococcus mutans, and no difference was observed between times and groups (p > .05). CONCLUSIONS: One percent NaOCl and 2% CHX were effective for clinical and radiographic success and antimicrobial activity in primary teeth submitted to pulpectomy. CLINICAL RELEVANCE: Studying the antimicrobial activity and clinical and radiographic outcomes of pulpectomy in primary teeth using NaOCl and CHX as irrigants is clinically relevant because it provides information for optimizing treatment protocols and improving the quality of care for pediatric patients. It contributes to evidence-based practice and can potentially lead to better outcomes, reduced complications, and enhanced patient experiences.

The use of medicaments in the management of symptomatic irreversible pulpitis: A community-based cohort study.

AIM: To investigate patient outcomes from either pulpotomy or pulpectomy for the management of symptomatic irreversible pulpitis, with and without application of antibiotic/corticosteroid pastes in urgent primary dental care settings in the United Kingdom. METHODOLOGY: All patients receiving intervention for symptomatic irreversible pulpitis in three different primary care settings were invited to participate. Pre-operatively, data regarding patients' numerical ratings scale (NRS), pain score (0-10), analgesic use, oral-health impact profile-14 (OHIP-14) and need for time away from work were collected. For 7 days post-operatively, participants recorded their NRS pain score, global rating of change score, medication use and their ability to work. Analysis used a mixed-effects model with post hoc Tukey's multiple comparisons test for continuous data and chi-squared or Fisher's exact test for categorical data. To test the effect of the corticosteroid/antibiotic paste, pulpectomy and pulpotomy groups were combined following Mantel-Haenszel stratified analysis or a weighted average of the difference between pulpotomy and pulpectomy with and without the use of corticosteroid/antibiotic paste. A binary composite score was constructed using pre- and post-operative data, whereby overall treatment success was defined as: (i) patients did not return for treatment due to pain by day seven; (ii) at day three, there was a 33% (or 2-points) reduction in NRS pain score; (iii) there was a change score of +3 in global rating; (iv) the patient was no longer using analgesia and able to return to work. RESULTS: Eighty-five participants were recruited, with 83 completing follow up. Overall treatment success was 57%, with 25% of participants returning for more treatment due to inadequate pain relief. Overall treatment success did not differ between the two groups (p = .645), although patients self-reported greater improvement with an antibiotic/corticosteroid dressing for global rating of change (p = .015). CONCLUSIONS: This study identified limited evidence of improved outcomes using antibiotic/corticosteroid dressings in the management of symptomatic irreversible pulpitis in the emergency setting. Further clinical research is needed to understand if these medications are beneficial in affording pain relief, above that of simple excision of irreversibly inflamed pulp tissue.

Six Root Canals in Primary Mandibular Second Molar: Report of Two Cases.

Anatomical variations in root morphology have been frequently encountered in pediatric endodontic practice. Due to insufficient knowledge of canal anatomy in primary teeth, having unusual canal morphologies is possibly more prone to endodontic treatment failures. Advanced investigations have given the clinician an open handed chance to recognize those variations and thus effectively manage them to achieve desired results. This paper describes the mandibular primary second molar requiring pulp therapy having three separate and distant canals in the mesial and distal root. Such additional canals were labeled as the middle mesial (MM) canal in the mesial root and the middle distal (MD) canal in the distal root. Additional canals were identified on clinical examination and multiangled radiographs and verified with the help of cone-beam computed tomography (CBCT) imaging. In primary second molars such additional canals are bizarre. This paper describes the bizarre variations that were seen on second deciduous molars. How to cite this article: Bhattad MS, Muthu MS, Wani V, et al. Six Root Canals in Primary Mandibular Second Molar: Report of Two Cases. Int J Clin Pediatr Dent 2023;16(S-2):S224-S228.

Comparative Evaluation of Clinical and Radiographic Success of Pulpectomy Done with and without Dental Operating Microscope in Pediatric Patients: An In Vivo Study.

Aim: To assess the clinical and radiographic success of conventional pulpectomy and pulpectomy done under an endodontic microscope over a period of 12 months. Materials and methods: The study was conducted as a single-blinded, parallel-group prospective, randomized, and controlled clinical trial. The enrollment of the study involved the assessment of 258 deciduous molars for eligibility as per the inclusion criteria. A total of 104 teeth were allocated to each group, that is, group I (conventional pulpectomy) and group II (pulpectomy under microscope). However, due to unavoidable circumstances during the coronavirus disease 2019 (COVID-19) pandemic, 98 and 90 teeth were treated in each group, respectively. Pulpectomy in both groups was done using standard protocol except for the use of an endodontic microscope in group II. The clinical and radiographic outcomes were assessed by an independent blinded observer and analyzed using appropriate statistical tests. Results: The clinical success at 6 months is 95.7 and 96.5%, and at 12 months is 96.6 and 97.7% in groups I and II, respectively. The radiographic success at 6 months is 93.5 and 95.4%, and at 12 months is 95.5 and 98.8% in groups I and II, respectively. The overall success rates of both groups with statistically no significant differences. Conclusion: The present study concludes comparable results are achieved using an endodontic microscope to conventional pulpectomy without magnification. How to cite this article: Kumar G, Rehman F. Comparative Evaluation of Clinical and Radiographic Success of Pulpectomy Done with and without Dental Operating Microscope in Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(S-2):S155-S160.

Repair potential of biodentine in vital pulp therapies in mature permanent teeth: a narrative review / POTENCIAL REPARADOR DEL BIODENTINE EN TERAPIAS PULPARES VITALES EN DIENTES PERMANENTES MADUROS: UNA REVISIÓN NARRATIVA

Vital pulp therapy in dentistry seeks to treat lesions in the dental pulp caused by cavities, trauma or iatrogenic procedures. Its objective is to maintain the vitality and function of the pulp, restoring the continuity of the dentin, known as the dentinal bridge. The dentinal bridge is crucial for injury repair and promotes pulp healing. Stem cells from the dental pulp can differentiate into odontoblasts, responsible for the formation of reparative dentin. To achieve success in vital pulp therapy, factors such as the appropriate choice of biocompatible biomaterials that prevent bacterial infiltration and inflammatory reactions, as well as the response of the pulp to injury, must be considered. An emerging material is Biodentine, a dentin substitute based on calcium silicate that induces the formation of dentin bridges and has demonstrated effectiveness in the repair of the dentine-pulp complex. It acts through specific molecular pathways by inducing the differentiation of dental pulp stem cells. This narrative review aims to describe the restorative potential of Biodentine in vital pulp therapies in mature permanent teeth. Its ability to reduce pulp inflammation, differentiate stem cells, the mechanism of action for the formation of tertiary dentin and characteristics of the dentinal bridge were evaluated. The results indicate that Biodentine has anti-inflammatory properties and stimulates dentin regeneration, influencing cell differentiation and mineralization. To conclude, Biodentine shows broad reparative potential in vital pulp therapies in mature permanent teeth, reduction of pulp inflammation, great cellular bioactivity, differentiation, and high dentin quality.

La terapia pulpar vital en odontología busca tratar lesiones en la pulpa dental causadas por caries, traumatismos o procedimientos iatrogénicos. Su objetivo es mantener la vitalidad y función de la pulpa, restaurando la continuidad de la dentina, conocida como puente dentinario. El puente dentinario es crucial para la reparación de lesiones y promueve la cicatrización de la pulpa. Las células madre de la pulpa dental pueden diferenciarse en odontoblastos, responsables de la formación de dentina reparadora. Para lograr el éxito en la terapia pulpar vital, se deben considerar factores como la elección adecuada de biomateriales biocompatibles que prevengan la infiltración bacteriana y reacciones inflamatorias, así como la respuesta de la pulpa a la lesión. Un material emergente es el Biodentine, un sustituto de dentina basado en silicato de calcio que induce la formación de puentes de dentina y ha demostrado eficacia en la reparación del complejo dentino-pulpar. Actúa mediante vías moleculares específicas al inducir la diferenciación de células madre de la pulpa dental. Esta revisión narrativa tiene como objetivo describir el potencial reparador del Biodentine en terapias pulpares vitales en dientes permanentes maduros. Se evaluó su capacidad para reducir la inflamación pulpar, como de diferenciar células madre, el mecanismo de acción para la formación de dentina terciaria y características del puente dentinario. Los resultados indican que Biodentine tiene propiedades antiinflamatorias y estimula la regeneración dentinaria, influenciando la diferenciación celular y la mineralización. Para concluir, Biodentine muestra un amplio potencial reparador en terapias pulpares vitales en dientes permanentes maduros, reducción de inflamación pulpar, gran bioactividad celular, diferenciación, y alta calidad de dentina.

A terapia pulpar vital em odontologia busca tratar lesões na polpa dentária causadas por cáries, traumas ou procedimentos iatrogênicos. Seu objetivo é manter a vitalidade e função da polpa, restaurando a continuidade da dentina, conhecida como ponte dentinária. A ponte dentinária é crucial para a reparação de lesões e promove a cicatrização pulpar. As células-tronco da polpa dentária podem se diferenciar em odontoblastos, responsáveis ​​pela formação da dentina reparadora. Para obter sucesso na terapia pulpar vital, devem ser considerados fatores como a escolha adequada de biomateriais biocompatíveis que previnam infiltração bacteriana e reações inflamatórias, bem como a resposta da polpa à lesão. Um material emergente é o Biodentine, um substituto dentinário à base de silicato de cálcio que induz a formação de pontes dentinárias e tem demonstrado eficácia na reparação do complexo dentina-polpa. Atua através de vias moleculares específicas, induzindo a diferenciação de células-tronco da polpa dentária. Esta revisão narrativa tem como objetivo descrever o potencial restaurador do Biodentine em terapias pulpares vitais em dentes permanentes maduros. Foram avaliadas sua capacidade de reduzir a inflamação pulpar, diferenciar células-tronco, mecanismo de ação para formação da dentina terciária e características da ponte dentinária. Os resultados indicam que Biodentine possui propriedades anti-inflamatórias e estimula a regeneração da dentina, influenciando a diferenciação e mineralização celular. Concluindo, Biodentine apresenta amplo potencial reparador em terapias pulpares vitais em dentes permanentes maduros, redução da inflamação pulpar, grande bioatividade celular, diferenciação e alta qualidade dentinária.

Limas rotatorias de uso en Odontopediatría: revisión de la literatura / Rotary files for use in pediatric dentistry: Literature review

Introducción: Los dientes primarios juegan un importante papel en el crecimiento y desarrollo general de los niños, por lo que es necesario conservarlos hasta el momento de su recambio fisiológico. Cuando existe una afectación pulpar que compromete la vitalidad del diente, la pulpectomía se convierte en un reto para el odontopediatra debido a la compleja anatomía radicular de los dientes primarios. En esta revisión bibliográfica se darán a conocer diferentes sistemas de limas usados en odontopediatría, y así brindar una mirada actualizada de la instrumentación rotatoria al realizar pulpectomías en los molares primarios. Material y Método: se realizó una búsqueda bibliográfica en Pubmed y Web of Science de acuerdo con criterios de inclusión y exclusión previamente establecidos. Resultados: tras aplicar los criterios de inclusión y exclusión fueron seleccionados un total de 30 referencias bibliográficas de los últimos 15 años. Conclusión: las limas rotatorias pediátricas pueden considerarse alternativas seguras y más eficientes en la realización de pulpectomías en molares primarios, ya que se reduce el tiempo de tratamiento, se produce desbridamiento completo de los conductos y se mantiene la función del diente hasta su exfoliación. (AU)

Introduction: Primary teeth play an important role in the growth and development of children, so it is necessary to keep them until the moment of their physiological replacement. When there is a pulp involvement that compromises the vitality of the tooth, pulpectomy treatment becomes a challenge for the pediatric dentist due to the complex root anatomy of primary teeth. This review of the literature will present different file systems used in primary teeth and provide an updated look at rotary instrumentation when performing pulpectomies on primary molars. Material and Method: a bibliographic search was carried out in Pubmed and Web of Science according to previously established inclusion and exclusion criteria. Results: after applying the inclusion and exclusion criteria, a total of 30 bibliographic references from the last 15 years were selected. Conclusion: pediatric rotary files can be considered safe and more efficient alternatives in performing pulpectomies on primary molars, due to treatment time is reduced, complete debridement of the root canals is produced, and tooth function is maintained until exfoliation. (AU)

Comparative assessment of cleaning efficacy of two exclusive paediatric rotary files in root canals of primary teeth: An in vitro study.

BACKGROUND: Paediatric rotary file systems have recently been developed for primary teeth use. AIM: To study the cleaning efficacies of two paediatric rotary endodontic files, the Prime PedoTM , and the Kedo-SG BlueTM against the standard H files. DESIGN: This in vitro study included 54 freshly extracted primary molars, which were randomised into three groups (n = 18 each) and were prepared using either Kedo-SG BlueTM , Prime PedoTM or hand H files after injecting methylene blue dye into the canals. Pre- and post-operative cone beam computerised tomography (CBCT) was performed to assess change in root canal volumes. Methylene blue dye removal from canals was assessed using stereomicroscopy, and canal cleanliness was examined by scanning electron microscopy (SEM). RESULTS: Both Prime PedoTM and Kedo-SG BlueTM files reduced significantly less dentine when compared with conventional hand filing with Prime PedoTM removing the least amount of dentine. No significant difference was found in median SEM scores among the groups in the cervical, middle and apical thirds of the roots. Stereomicroscopic assessment of root canal cleanliness using dye removal technique shows a statistically significant difference existing between Kedo-SG BlueTM and hand H files groups. CONCLUSION: Prime PedoTM removed the least amount of dentine. Kedo-SG BlueTM performed significantly better than conventional hand filing with H files when the root canal cleanliness was assessed.

Cone-Beam Computed Tomography Evaluation of Rotary MM Files vs Manual K Files in Primary Molars: An In Vitro Study.

AIM: Rotary instrumentation in pediatric dentistry is an emerging concept, thus this study was performed to evaluate the remaining dentine thickness (RDT), canal transportation, centering ability, quality of obturation using cone-beam computed tomography (CBCT), and the time efficiency of rotary versus manual instrumentation in mandibular second primary molars. MATERIALS AND METHODS: Forty mandibular primary second molars (160 canals) were randomly and equally allocated to four groups. Instrumentation was done using K files in groups I and II; in each group, the obturation was done by two different obturation techniques; incremental technique and disposable syringe technique, respectively. MM rotary files (Innovative Material and Devices, Inc. [IMD], Shanghai, China) were used in groups III and IV; in each group, the obturation was done by incremental technique and disposable syringe technique. Preoperative and postoperative CBCT scans were performed and evaluated for the RDT, centering ability, canal transportation, and the canal filling quality, which was assessed as (underfill, optimal fill, and overfill). Instrumentation time was recorded for groups I and II collectively (manual instrumentation), and groups II and III collectively (rotary instrumentation). Statistical analysis was done using Chi-square, ANOVA, and post hoc Tukey tests, at p < 0.05). RESULTS: The MM rotary file removed a significantly less amount of dentine at all levels specifically at the middle section (p = 0.003). The canal transportation was significantly higher in the manual group at the cervical level (p = 0.022). In all sections, the rotary group had significantly higher values of centering ratio than the manual group (p < 0.05), which means a lower deviation of rotary instruments. For both types of files, there was no significant difference between different obturation techniques (p > 0.05). Instrumentation time was significantly lower in the rotary group (p < 0.001). CONCLUSION: Regarding the dentine removal and the shaping ability of MM files acceptable results were obtained; however, no significant difference between the different obturation techniques. Notable time efficiency was reported in the rotary files as well. CLINICAL SIGNIFICANCE: The use of rotary files resulted in better conservation of tooth structure, better canal centering, and obturation quality as well as less canal transportation and less instrumentation time compared to manual K files.

Clinical and Radiographic Evaluation of Various Herbal Products Used with Zinc Oxide as an Obturating Material in Primary Teeth: An In Vivo Study.

AIM: To compare the clinical and radiographically mixture of zinc oxide with Aloe vera, Curcumin and neem as an obturating material for pulpectomy. MATERIALS AND METHODS: The study comprised of age group 4-8 years children requiring endodontic treatment for at least a single primary molar tooth. Sixty primary molar teeth from 43 children were divided equally and randomly into four study groups. The materials used for obturation were zinc oxide powder (ZnO) and Eugenol (ZOE) (group I), ZnO and Aloe vera Gel (group II), ZnO and Curcumin Powder (group III), ZnO and neem extract (group IV). They were evaluated clinically and radiographically at immediate postoperative and then at 1-, 3-, 6-, and 9-month intervals. RESULTS: At the end of 9 months, the Chi-square test revealed 100% success rate for recovery of pain in group I and III, 66.66% in group II and 93.3% in group IV. The success rates for absence of abscess and for periradicular radiolucency in group I, III, and group IV were 100% and 66.6% for group II. The success rate for periapical radiolucency in group I and group III was 100%, in group II 66.6% and in group IV 93.35%. The success rate for all the groups shows 100% success in terms of pathological root resorption. CONCLUSION: Zinc oxide eugenol has proven to be the best obturating material. ZnO with Aloe vera showed a success rate which is significantly lower than the other medicaments. ZnO with Curcumin and ZnO with neem had shown promising clinical and radiographical results. CLINICAL SIGNIFICANCE: ZnO with Curcumin and ZnO with neem can be used as a root canal filling material in primary teeth with further follow-up studies.

Limas rotatorias de uso en Odontopediatría: revisión de la literatura / Rotary files for use in pediatric dentistry: Literature review

Introducción: Los dientes primarios juegan un importante papel en el crecimiento y desarrollo general de los niños, por lo que es necesario conservarlos hasta el momento de su recambio fisiológico. Cuando existe una afectación pulpar que compromete la vitalidad del diente, la pulpectomía se convierte en un reto para el odontopediatra debido a la compleja anatomía radicular de los dientes primarios. En esta revisión bibliográfica se darán a conocer diferentes sistemas de limas usados en odontopediatría, y así brindar una mirada actualizada de la instrumentación rotatoria al realizar pulpectomías en los molares primarios. Material y Método: se realizó una búsqueda bibliográfica en Pubmed y Web of Science de acuerdo con criterios de inclusión y exclusión previamente establecidos. Resultados: tras aplicar los criterios de inclusión y exclusión fueron seleccionados un total de 30 referencias bibliográficas de los últimos 15 años. Conclusión: las limas rotatorias pediátricas pueden considerarse alternativas seguras y más eficientes en la realización de pulpectomías en molares primarios, ya que se reduce el tiempo de tratamiento, se produce desbridamiento completo de los conductos y se mantiene la función del diente hasta su exfoliación. (AU)

Introduction: Primary teeth play an important role in the growth and development of children, so it is necessary to keep them until the moment of their physiological replacement. When there is a pulp involvement that compromises the vitality of the tooth, pulpectomy treatment becomes a challenge for the pediatric dentist due to the complex root anatomy of primary teeth. This review of the literature will present different file systems used in primary teeth and provide an updated look at rotary instrumentation when performing pulpectomies on primary molars. Material and Method: a bibliographic search was carried out in Pubmed and Web of Science according to previously established inclusion and exclusion criteria. Results: after applying the inclusion and exclusion criteria, a total of 30 bibliographic references from the last 15 years were selected. Conclusion: pediatric rotary files can be considered safe and more efficient alternatives in performing pulpectomies on primary molars, due to treatment time is reduced, complete debridement of the root canals is produced, and tooth function is maintained until exfoliation. (AU)

Instrumentation time and effectiveness of hand and rotary files in a prototyped second mandibular primary molar: A micro-CT study.

BACKGROUND: Eccentric instruments have been proposed as more effective and less time-consuming for endodontic instrumentation. AIM: To compare biomechanical outcomes of different instrumentation systems and time undertaken for instrumentation in resin prototypes. DESIGN: Sixty standardized prototypes of mandibular second primary molars were instrumented according to the following systems: K-files, ProTaper Next (PTN), XP-endo Shaper (XPS), XP-endo Finisher (XPF), XP-Clean (XPC), and Sequence Baby File (SBF; n = 10/each). Irrigation was performed with saline with simultaneous aspiration, and time spent was recorded. The prototypes were micro-CT-scanned before and after the instrumentation, and image sets were reconstructed and registered. Non-instrumented areas, accumulated debris, removed root material volume, and canal transportation were quantified. Data were analyzed through ANOVA, the Kruskal-Wallis test, and the Wilcoxon signed-rank test (α = 5%). RESULTS: K-files and SBF resulted in more instrumentation time (p < .05). SBF, XPC and PTN removed less root dentine (p < .05), but PTN left more untouched areas (p < .05). Accumulated debris were lower for XPC and SBF (p < .05). Canal transportation was similar among the groups. CONCLUSION: Rotary systems reduced instrumentation time, whereas SBF and XPC resulted in more conservative instrumentation, with less debris accumulation and non-instrumented areas. A dedicated paediatric endodontic system (SBF) outperformed eccentric instruments in terms of effectiveness.

Pain after emergency treatments of symptomatic irreversible pulpitis and symptomatic apical periodontitis in the permanent dentition: a systematic review of randomized clinical trials.

Background: Symptomatic irreversible pulpitis (SIP) or symptomatic apical periodontitis (SAP) are two painful conditions often warranting emergency treatment. The most common emergency treatments supported by evidence are pulpotomy and pulpectomy and are normally performed under time-constrained circumstances. However, there is no strong evidence of which treatment suggested in literature a clinician can use to reduce endodontic pain effectively. Therefore, the aim of this systematic review is to investigate the present knowledge on postoperative pain related to the two types of emergency treatments available for treating SIP and SAP. Methods: Randomized controlled trials investigating postoperative pain after emergency treatments (pulpotomy and/or pulpectomy) on permanent dentition with signs and symptoms of SIP and/or SAP were searched in three major databases from 1978 until 2022. Risk of bias was assessed with Cochrane's tool. Results: Only five studies fulfilled the inclusion criteria. The included studies indicated that pulpotomy and pulpectomy are both suitable treatment options for SAP and SIP, as they provide sufficient alleviation of pain in permanent dentition. However, inconsistent results were found between the included trials on which emergency treatment is more effective in reducing pain. Cochrane's tool revealed that the studies had a low risk of bias. Limitations found in the design of the included randomized control trials decreased the level of evidence. None of the included studies accounted for essential confounding variables, such as factors affecting pain (including the psychological aspects). Moreover, possible non-odontogenic pain was not assessed, and therefore, it was not excluded; hence, affecting the internal validity of the studies. Conclusion: There are controversies within the available randomized control trials on which treatment is most effective in reducing emergency pain. This could be due to some weaknesses in the design of the clinical trials. Thus, further well-designed studies are warranted to draw conclusions on which emergency treatment is more effective in reducing pain. Systematic Review Registration: PROSPERO (CRD42023422282).

Zinc oxide-ozonated olive oil as a new root canal filling material in primary molars: a clinical randomized controlled trial.

OBJECTIVES: The complex root canal anatomy of primary teeth keeps it very tricky to attain appropriate cleansing by biomechanical instrumentation, so obtaining an obturating material with excellent antimicrobial properties is a challenge in current clinical pulpectomy practice. So, this study aimed to assess the clinical and radiographic performance of zinc oxide-ozonated olive oil as a primary root canal filling material. MATERIALS AND METHODS: Ninety non-vital primary molars in children ranging from 4 to 8 years were allocated into three groups in which root canals were filled with zinc oxide-ozonated olive oil, zinc oxide-olive oil, and zinc oxide-eugenol (ZOE) according to each group after pulpectomy procedure. Clinical and radiographic evaluations were done at 3-, 6-, and 12-month follow-up periods. Statistical analysis was performed for the collected data. RESULTS: All study groups showed a significant improvement regarding clinical signs and symptoms during follow-up periods. Ozonated-olive oil group revealed a significant increase in furcation radiodensity and a decrease in periodontal ligament space at 3-, 6-, and 12-month follow-up intervals compared to other groups. CONCLUSION: Zinc oxide-ozonated olive oil and zinc oxide-olive oil paste had shown good clinical and radiographic success for primary teeth pulpectomy. CLINICAL RELEVANCE: The intricate torturous primary root canal anatomy, in addition to the child's negative behavior, interferes with the complete debridement, so the long-lasting antibacterial effect of the primary root canal filling material aids in the pulpectomy success.