Complications following replantation of primary teeth: a case report / Complicações após reimplante de dentes decíduos: um relato de caso clínico

Abstract Introduction: the avulsion of primary teeth is a disturbing and unexpected event. Description: this report describes the clinical case of a three-year-old child who suffered an avulsion and replantation of the primary upper central incisors at the site of the injury. The guardians sought treatment for the child at the Federal University of Minas Gerais after the replantation. Four months later, the child suffered a new trauma and the replanted teeth presented advanced mobility, root resorption and fistula. The clinical conduct was extraction and rehabilitation with a fixed esthetic maintainer. Discussion: the literature describes two treatment options for avulsion of primary incisors: replantation and non-replantation. According to a recent systematic review, the difficulty in obtaining a consensus regarding the best clinical conduct is due, in part, to the scarcity of publications that present not only follow-ups with clinical success, but also with failures. The outcomes of replantation can be influenced by several factors. The time elapsed between replantation and splinting, and the new episode of trauma, negatively influenced the prognosis in the present case, leading to failure. Replantation of primary incisors is not yet evidence-based treatment. Therefore, this option must be chosen with caution and in ideal situations. It requires constant clinical and radiographic monitoring for evaluation of outcomes.

Resumo Introdução: a avulsão de dentes decíduos é um evento perturbador e inesperado. Descrição: o presente relato descreve o caso clínico de uma criança de três anos que sofreu avulsão e reimplante dos incisivos centrais superiores decíduos no local do acidente. Os responsáveis procuraram atendimento para a criança na Universidade Federal de Minas Gerais após reimplante. Quatro meses depois, a criança sofreu novo trauma e os dentes reimplantados apresentavam mobilidade avançada, reabsorção radicular e fístula. A conduta clínica foi extração e reabilitação com mantenedor estético fixo. Discussão: a literatura descreve duas opções de tratamento para avulsão de incisivos decíduos: o reimplante e o não reimplante. De acordo com revisão sistemática recente, a dificuldade de se obter um consenso sobre a melhor conduta clínica se deve, em parte, à escassez de publicações que apresentem não apenas acompanhamentos com sucesso clínico, mas também com falhas. O reimplante pode ser influenciado por vários fatores. O tempo decorrido entre o reimplante e a contenção, e o novo episódio de trauma, influenciaram negativamente o prognóstico do presente caso, levando ao insucesso. O reimplante de incisivos decí- duos ainda não é um tratamento baseado em evidências. Portanto, essa opção deve ser escolhida com cautela e em situações ideais. Requer monitoramento clínico e radiográfico para constante avaliação do desfecho.

Microdont Developing Outside the Alveolar Process and Within Oral Diffuse and Plexiform Neurofibroma in Neurofibromatosis Type 1.

BACKGROUND/AIM: Numerical aberrations of permanent dentition and dystopic tooth eruption are part of the phenotype of the tumor predisposition syndrome neurofibromatosis type 1 (NF1). In these cases, surplus tooth germs usually develop in the alveolar processes of the jaw. This report attests to the dystopic development of a dysplastic supernumerary tooth in NF1 arising outside the jaw. CASE REPORT: The 8-year-old male patient developed a microdont outside the bone and above the occlusal plane of the retained maxillary right second molar. The supernumerary tooth was completely embedded in oral soft tissue. Hyperplastic oral soft tissue in the molar region and microdont were excised. Specimen of the mucosa surrounding the teeth was interspersed with diffuse and plexiform neurofibroma. The retained upper right first molar emerged spontaneously within a few months after surgery. The upper right second molar did not change position. CONCLUSION: Odontogenesis can take place within tumorous oral mucosa in NF1. Surgical removal of the tumorous mucous membrane facilitates tooth eruption in some cases.

Apical debris extrusion during instrumentation of oval root canals in primary teeth using manual versus motorized files: an ex vivo study.

This study aimed to assess the apical extrusion of debris during instrumentation of primary canines using three endodontic file types. Forty-five extracted primary canines were randomly assigned to three instrumentation groups (n = 15): Hand K-files; and the motorized Kedo-S files and XP-endo Shaper files. The apically extruded debris produced during the procedure was collected and dried in pre-weighed Eppendorf tubes, and the mass of debris was calculated. The time required for the endodontic procedure was also recorded. Analysis of variance (ANOVA) and Tukey's post hoc test were used with a significance level set at 5%. XP-endo Shaper and Kedo-S files extruded significantly less debris compared with hand K-files with means of 0.84 ± 0.31 and 1.20 ± 0.67 mg respectively, compared to 2.13 ± 0.31 mg (p < 0.0001). No significant difference was found between the two motorized files. Less time was required to complete the procedure with the XP-endo Shaper compared to the hand K-files (p < 0.0001) and Kedo-S files (p < 0.0001). Within the limitations of the present study, it may be concluded that motorized files extruded less debris and required less instrumentation time compared to traditional K-files, which could benefit paediatric patients with root canal treatment needs.

The Use of Hall's Technique Preformed Metal Crown (HTPMC) by Pediatric Dentists in Malaysia.

INTRODUCTION: Hall's technique preformed metal crown (HTPMC) has been used widely by pediatric dentists in developed countries as a new approach for managing decayed primary molars without local anesthesia, caries removal, and tooth preparation. Currently, inadequate information is available regarding the implementation of this technique (HTPMC) in Malaysia. This study is aimed at evaluating the implementation of HTPMC by Malaysia's pediatric dentists and identify the co-occurrence frequencies of the HTPMC implementation with the respondents' demographic profile. MATERIALS AND METHODS: A cross-sectional questionnaire-based research was conducted among 65 pediatric dentists in Malaysia. Online questionnaires were distributed to the pediatric dentists employed at public hospitals (MOH) and universities in Malaysia. RESULT: It was found that over half of the respondents (65.6%) employed HTPMC. The analysis of the co-occurrence network frequency revealed that a high frequency of female pediatric dentists who were within the age group of 31-40 years old had fulfilled their postgraduation overseas and was employed in the university mainly applied HTPMC. CONCLUSION: The application of HTPMC among respondent pediatric dentists in Malaysia was high. However, most respondents considered HTPMC a treatment option only to manage carious primary molar rather than a treatment of choice.

Post-operative discomforts in children after extraction of primary teeth.

OBJECTIVES: This prospective observational study aimed to evaluate discomfort after extraction of deciduous teeth under local anesthesia. The primary objective was to describe the prevalence of post-extraction pain (PEP), post-extraction bleeding (PEB), post-extraction biting injury (PEBI), and analgesic usage in children. The secondary objective was to define whether it is possible to determine a profile of patients or a type of extraction procedure predictive to PEP, administration of analgesics, PEB, or PEBI. METHODS: One hundred and twenty-five children, aged 3-13 years, with indications of at least one deciduous tooth extraction, were included. Immediately after extraction, information concerning the patient and the extraction were collected. Eighteen to 32 hr after extraction, parents were called by phone to request reports concerning the onset and intensity of PEP assessed using the Wong-Baker Faces (WBF) scale, the administration of paracetamol (acetaminophen) to their children, and the appearance of PEB and/or PEBI. RESULTS: Of the children, 37.3% reported PEP (WBF ≥2), but 23.3% of these children did not receive any analgesic drugs to help relieve pain. Pain appeared before 3 hr after extraction in 69% of the children. Higher incidences of PEP and usage of analgesics were found both in the group of children with unfavorable socioeconomic level compared to favorable level and in the group with pre-operative pain compared to no pre-operative pain (p < .05). CONCLUSIONS: About a third of the children reported pain after extraction, but the instructions for pain relief were not followed by all parents. The socioeconomic level of the young patient and the pain felt during the extraction were important predictors of discomfort. Therefore, our study could help the dentist to provide information on predicted post-operative discomfort and to allow suitable care depending on the patient's profile or procedure.

Clinical and radiographic comparative study to evaluate the efficacy of restoring destroyed primary incisors using two different techniques-A pilot study.

OBJECTIVE: The restoration of destroyed maxillary primary incisors is difficult because of the insufficient amount of coronal structure. This pilot study aimed to compare the efficacy of composite posts technique and glass fiber posts technique in restoring destroyed primary incisors. MATERIALS AND METHODS: Thirty-six destroyed maxillary primary incisors in 11 children with early childhood caries were randomly assigned after endodontic treatment into two groups: glass fiber posts (n = 18) and composite resin posts (n = 18). Blinded clinical evaluation was made at 3, 6, 9, and 12 months and Blinded radiographic evaluation was made at 6 and 12 months. The evaluation was according to the FDI criteria. Data were analyzed with Fisher's exact test (α = .05). RESULT: After 12 months post-treatment, the success rates were 88.2% in glass fiber posts group and 70.6% in composite resin posts group. There was no statistically significant difference between the two groups according to the evaluation criteria (p-value >.05). CONCLUSION: Glass fiber posts technique and Composite posts technique may be used in the restoration of destroyed primary incisors.

Treatment of severely decayed anterior primary teeth with short-post technique (Mushroom Restorations) under general anesthesia.

AIMS: The aim of this study was to evaluation the treatment success of the short post technique (mushroom restoration) using a composite resin in severely decayed primary anterior teeth after 6, 12, and 18 months after treatment. METHODS: Eighteen children aged 3-5 years with severely decayed primary maxillary anterior teeth (60 anterior maxillary primary teeth in total) were included. Patients were treated under general anesthesia (GA). After pulpectomy, a "mushroom shape" was formed in the root canals for the purpose of retention, and the root canals were filled with zinc oxide-eugenol (ZOE), and the teeth were restored with composite resin. The status of treatment was evaluated clinically and radiographically for periapical radiolucency, pathological root resorption, marginal fracture, and loss of restoration for each treated tooth. All findings were recorded. RESULTS: As a result of the evaluation criteria, the success rates at 6, 12 and 18 months were 86%, 80%, and 71%, respectively. None of the teeth showed apical radiolucency or pathological root resorption at the end of the 18th month period. CONCLUSION: The short-post (mushroom restorations) technique is a clinically acceptable alternative method for restoration of severely decayed primary teeth. This study supports the feasibility of treatment with this technique for pediatric patients treated under GA.

Mirror image: an unusual case of prolonged tooth retention in twins

Introduction: Studies of twins are important because environmental and genetic factors seem to be related to the phenotypic alterations. Objective: This paper presents a unique case of monozygotic twins with mirror image of a retained primary central incisor. Case report: Twin male brothers, 9-years-old, presented prolonged retention of the primary central upper incisor. The over-retained teeth in one twin were a mirror image of those in the other twin. The first twin presented a prolonged retention of the tooth 51 whereas the other twin presented a prolonged retention of tooth 61. After radiographic exams the over-retained teeth were extracted. Conclusion: Twins may show similarity in pattern of dental anomalies supporting the influence of genetic factors. In identical twins the location of diagnosed anomalies can be mirror imaged. This fact should lead the professional to examine the pair of twins in order to diagnose any dental anomaly that may be present.

Introdução: Estudos feitos em gêmeos são importantes porque fatores ambientais e genéticos parecem estar relacionados às alterações fenotípicas. Objetivo: Este artigo apresenta um caso raro de gêmeos monozigóticos apresentando imagem em espelho de retenção prolongada de incisivos centrais decíduos superiores homólogos. Relato do caso: Os irmãos gêmeos, com 9 anos de idade, não apresentavam história de trauma orofacial ou doença comum da infância. Após exames clínicos e radiográficos foram identificados a retenção do dente 51 no gêmeo 1 e do dente 61 no gêmeo 2. Em ambos os pacientes, os dentes 11 e o 21 estavam em erupção. O tratamento proposto foi a exodontia dos dentes decíduos com anestesia local e acompanhamento. Conclusão: Gêmeos podem apresentar semelhança no padrão de anomalias dentárias devido à influência de fatores genéticos. Adicionalmente, em gêmeos monozigóticos, a localização das anomalias diagnosticadas pode se apresentar invertidas ou imagem em espelho. Esse fato deve estimular o profissional a examinar o par de gêmeos para diagnosticar qualquer anomalia dentária que possa estar presente. O diagnóstico precoce e tratamento adequados devem ser realizados para evitar danos funcionais e estéticos em pacientes com retenções dentárias.

Success rate of proximal tooth-coloured direct restorations in primary teeth at 24 months: a meta-analysis.

The aim was to determine the survival of tooth-coloured restorative materials in proximal restorations of primary teeth at 24 months of follow-up and the influence of the following variables: use of coating, use of cavity conditioner, use of rubber dam isolation, the cavity form, the dentist's experience and the methodological characteristics of the studies. We conducted a search until May 2019, obtaining 16 articles from which 30 independent studies were extracted, which were considered as units of analysis. Four outcome measures were extracted from each study: retention, marginal integrity, anatomic form, and absence of recurrent caries. Separate meta-analyses were carried for each outcome and multiple meta-regression model was applied. The outcomes with the highest mean success rates were absence of recurrent caries and anatomic form. The type of material significantly influenced success rates. The best materials were resin-based material plus total-etching adhesion and resin-modified glass ionomer cement (RMGIC), and the worst high viscosity glass ionomer cement (HVGIC). Atraumatic restorative treatment (ART) had a lower success rate than the conventional cavity form. RMGIC had the best clinical performance and HVGIC the worst. The form of the cavity, blinding and the experience of the operator were the variables that influenced success rates. Proximal primary molar restorations should be performed with RMGIC as it combines good mechanical performance of the resins together with the prevention of secondary caries of glass ionomers.

Application of Quality Control Circle in Promoting the Use of Rubber Dams in the Root Canal Treatment of Primary Teeth.

OBJECTIVE: Study the effect of quality control circle (QCC) in promoting the usage of rubber dams (RD) in root canal treatment of chronic pulpitis in primary teeth. METHODS: Set up a quality control group to increase the amount of rubber dams used in the treatment of chronic pulpitis in primary teeth. Monthly monitoring results of the usage amount were counted by the outpatient computer system. Relevant data were collected through questionnaires, and causes of low utilization were analyzed, and the improvement measurements were formulated and implemented. Quality control circle activity was evaluated. RESULTS: Through the quality control circle activity, the consumption of rubber dams in the root canal treatment of chronic pulpitis was significantly improved, children in treatment became more cooperative, and operation time of root canal treatment has also been shortened. CONCLUSION: The quality control circle activities played a significant role in promoting the use of rubber dams in the root canal treatment of primary teeth, and it can be used as a method to promote new clinical treatment programs.

Preformed pediatric zirconia crown versus preformed pediatric metal crown: study protocol for a randomized clinical trial.

BACKGROUND: Guidelines in pediatric restorative dentistry recommend the use of preformed pediatric stainless steel crowns (SSCs) in cases of severe tooth decay of at least two surfaces. This clinically effective and safe restorative option is frequently refused by parents for esthetic reasons; they prefer conventional restorations using esthetic filling materials (composites, glass ionomer) if lesion severity limited to two surfaces permits. Recently, manufacturers have proposed esthetic preformed pediatric zirconia crowns (ZCs) but these have been assessed in only two randomized clinical trials (RCT) with follow-ups of 6 and 12 months. Only one of these RCTs was carried out on primary molars to test ZCs (NuSmile ZR) without a groove in its inner surface. The primary objective of this proposed RCT is to assess the effectiveness of ZCs compared with SSCs. Our hypothesis is that the effectiveness of ZCs will be equivalent to that of SSCs. METHODS: In this split-mouth, 2-year RCT, pairs of primary molars in 101 child participants will be randomized and restored with SSCs (ESPE, 3M) and ZCs (EZCrowns, Sprig Oral Health Technologies) characterized by grooves on their inner surface. Primary molars will first be allocated to SSCs, and 1 to 2 weeks later the other primary molar of the same pair will be restored by ZC. The primary outcome is the success defined by the "absence of major clinical and radiographic failure" (e.g., pain, pulp infection, dental abscess or periradicular pathology visible on radiographs). The secondary outcomes include the retention and fracture rates, the gingival condition, the wear of the antagonist of the treated teeth, as well as both parental and child satisfaction. DISCUSSION: This study will investigate two types of preformed pediatric crowns for the management of severe decay on primary molars. The results may help practitioners choose the better therapeutic option and to explain to parents the advantages and disadvantages of these two therapies. TRIAL REGISTRATION: NCT03296709 . Registered on  27 September 2017.

Stem cells from human exfoliated deciduous teeth as an alternative cell source in bio-root regeneration.

A stem cell-mediated bioengineered tooth root (bio-root) has proven to be a prospective tool for the treatment of tooth loss. As shown in our previous studies, dental follicle cells (DFCs) are suitable seeding cells for the construction of bio-roots. However, the DFCs which can only be obtained from unerupted tooth germ are restricted. Stem cells from human exfoliated deciduous teeth (SHEDs), which are harvested much more easily through a minimally invasive procedure, may be used as an alternative seeding cell. In this case, we compared the odontogenic characteristics of DFCs and SHEDs in bio-root regeneration. Methods: The biological characteristics of SHEDs and DFCs were determined in vitro. The cells were then induced to secrete abundant extracellular matrix (ECM) and form macroscopic cell sheets. We combined the cell sheets with treated dentin matrix (TDM) for subcutaneous transplantation into nude mice and orthotopic jaw bone implantation in Sprague-Dawley rats to further verify their regenerative potential. Results: DFCs exhibited a higher proliferation rate and stronger osteogenesis and adipogenesis capacities, while SHEDs displayed increased migration ability and excellent neurogenic potential. Both dental follicle cell sheets (DFCSs) and sheets of stem cells from human exfoliated deciduous teeth (SHEDSs) expressed not only ECM proteins but also osteogenic and odontogenic proteins. Importantly, similar to DFCSs/TDM, SHEDSs/TDM also successfully achieved the in vivo regeneration of the periodontal tissues, which consist of periodontal ligament fibers, blood vessels and new born alveolar bone. Conclusions: Both SHEDs and DFCs possessed a similar odontogenic differentiation capacity in vivo, and SHEDs were regarded as a prospective seeding cell for use in bio-root regeneration in the future.

Comparison between calcium hydroxide mixtures and mineral trioxide aggregate in primary teeth pulpotomy: a randomized controlled trial.

OBJECTIVES: To evaluate the effect of calcium hydroxide (CH) associated with two different vehicles as a capping material for pulp tissue in primary molars, compared with mineral trioxide aggregate (MTA). METHODOLOGY: Forty-five primary mandibular molars with dental caries were treated by conventional pulpotomy using one of the following materials: MTA only (MTA group), CH with saline (CH+saline group) and CH with polyethylene glycol (CH+PEG group) (15 teeth/group). Clinical and periapical radiographic examinations of the pulpotomized teeth were performed 3, 6, and 12 months after treatment. Data were tested by chi-squared analysis and a multiple comparison post-test. RESULTS: The MTA group showed both clinical and radiographic treatment success in 14/14 teeth (100%), at all follow-up appointments. By clinical evaluation, no teeth in the CH+saline and CH+PEG groups had signs of mobility, fistula, swelling or inflammation of the surrounding gingival tissue. However, in the CH+saline group, radiographic analysis detected internal resorption in up to 9/15 teeth (67%), and inter-radicular bone resorption and furcation radiolucency in up to 5/15 teeth (36%), from 3 to 12 months of follow-up. In the CH+PEG group, 2/11 teeth (18%) had internal resorption and 1/11 teeth (9%) presented bone resorption and furcation radiolucency at all follow-up appointments. CONCLUSION: CH with PEG performed better than CH with saline as capping material for pulpotomy of primary teeth. However, both combinations yielded clinical and radiographic results inferior to those of MTA alone.

Assessment of the apically extruded debris between a rotary system, a reciprocating system and hand files during the root canal instrumentation of the deciduous molars.

BACKGROUND: One of the factors that most negatively affect the endodontic instrumentation process in primary teeth is the presence of extruded debris in the periapical region. Therefore, different techniques have been evaluated to reach an answer to the question regarding which root canal preparation method produces the least amount of debris extrusion. OBJECTIVES: The main objective of this study was to assess the amount of debris extrusion as well as irrigation associated with 3 different instrumentation techniques: a rotary system (PROTAPER NEXT® - PTN), a reciprocating system (WaveOne® - WO) and hand K-files. MATERIAL AND METHODS: Forty-eight primary mandibular molars with a single distal canal were selected and randomly divided into 3 groups (n = 16). Three different techniques were used for the canal instrumentation of each group, comprising PTN, WO and hand K-files. Pre-weighed Eppendorf tubes were used for the collection of debris extrusion, then stored in an incubator at 70°C for 5 days. A one-way analysis of variance (ANOVA) test was used for data analysis, followed by Tukey's post hoc test. RESULTS: Statistically significant differences were found while comparing the PTN and WO systems with the hand files. Both PTN and WO showed less debris extrusion toward the periapical tissues than the hand files. Still, no statistically significant differences were seen between the PTN and WO groups. CONCLUSIONS: Generally, debris extrusion occurred in all of the 3 experimental groups. The PTN and WO systems showed the least debris extrusion as compared to the hand files during the root canal instrumentation of the primary teeth, and for these reasons along with the shorter operating time, it may be concluded that using rotary and reciprocating systems rather than manual files is highly advisable. However, a clinical assessment is suggested.

The Clinical Effectiveness of Calcium Hydroxide in Root Canal Disinfection of Primary Teeth: A Meta-Analysis.

BACKGROUND The aim of this research was to systematically analyze the effectiveness of calcium hydroxide compared to formocresol (FC) and camphor phenol (CP) in root canal disinfection of primary teeth. MATERIAL AND METHODS The meta-analysis was based on the participants, interventions, control, outcome (PICO) study design principle and 16 randomized-controlled clinical trials published from January 2000 to August 2018. The data heterogeneity of each study was assessed by the Q-test. The odds ratio and 95% confidence interval (CI) were calculated based on the heterogeneity results by Revman software. RESULTS Sixteen randomized-controlled clinical trials of 3047 primary teeth were included in this meta-analysis. There were significant differences of clinical effectiveness between calcium hydroxide and FC in root canal disinfection of primary teeth (OR=3.37; 95% CI range: 2.54-4.48, P<0.01) and endodontic inter-appointment emergencies (EIAE) after disinfection for 7 days (OR=0.26; 95% CI range: 0.16-0.42, P<0.01). However, there was no statistical difference of EIAE, after disinfection of primary teeth for 48 hours, between calcium hydroxide and FC (OR=0.62; 95% CI range: 0.34-1.11, P=0.11). There were significant differences of clinical effectiveness between the calcium hydroxide and CP in root canal disinfection of primary teeth (OR=5.50; 95% CI range: 3.36-8.98, P<0.01). CONCLUSIONS This meta-analysis indicated that the effectiveness of calcium hydroxide as root canal disinfectant in primary teeth was more effective than that of FC and CP.

Primary molar pulpotomies with different hemorrhage control agents and base materials: A randomized clinical trial.

OBJECTIVE: To evaluate the clinical and radiographical success of primary molar pulpotomies which used 15.5% ferric sulfate (FS) or 1.25% sodium hypochlorite (NaOCl) for hemostasis and zinc oxide-eugenol (ZOE) and calcium hydroxide (CH) pastes as base materials. METHODS: In 29 healthy children, 80 primary molars were randomly allocated to one of the study groups: Group 1: FS-ZOE, Group 2: FS-CH, Group 3: NaOCl-ZOE, and Group 4: NaOCl-CH. After hemostasis with the respective solutions, pulp stumps and floor of the pulp chambers were covered with either ZOE or CH pastes. All teeth were restored with stainless steel crowns. Follow-up examinations were carried out at 1, 3, 6, and 12 months. RESULTS: One tooth in Group 1 and two teeth in Group 4 were extracted because of pain and periapial pathosis at sixth month. After 12 months, clinical success rates of pulpotomies in Groups 1-4 were 95%, 100%, 100%, and 89.5%, respectively. The differences were not significant (P = 0.548). Radiographic success rates for Groups 1-4 were 80%, 88.9%, 78.9%, and 84.2%, respectively. No statistically significant difference was found (P = 0.968). Pain on percussion was the most observed clinical finding. However, internal root resorption was the most common radiological finding and it was observed significantly more in mandibular primary molars (P < 0.05). CONCLUSION: Both ZOE and CH can be preferred as base materials after hemostasis achieved by the use of 15.5% FS or 1.25% NaOCl in primary tooth pulpotomy.

Comparative assessment of dentin removal following hand and rotary instrumentation in primary molars using cone-beam computed tomography.

OBJECTIVE: Pediatric endodontics has witnessed many advances in recent years, thus facilitating a faster and efficient treatment option in root canal therapy in children. This in vitro evaluation aims to determine the amount of dentin removal in primary mandibular first and second molars instrumented with hand and rotary files using cone-beam computed tomography (CBCT). MATERIALS AND METHOD: Sixty primary mandibular molars were divided into two groups: Group I was prepared by manual instrumentation using K-type files and Group II was prepared with rotary instrumentation using 0.04 Hero Shaper Classics. Both these groups were further divided into two subgroups, namely (a) primary mandibular first molar and (b) primary mandibular second molar. All the root canals were prepared up to size 30 using the stepback technique. They were mounted on silicone-based impression material and subjected to CBCT scans for the evaluation of dentin removal before and after instrumentation. Dentin removal was calculated by superimposing images using the InVivo 5.1 Anatomage software. Data were statistically analyzed using independent samples t- test. RESULTS: An average amount of dentin removed was found to be significantly higher in manual instrumentation compared to rotary instrumentation in both primary mandibular first and second molars (P < 0.001). CONCLUSIONS: Rotary technique serves as an efficient alternative to the traditional manual instrumentation by overcoming its shortcomings in terms of conservation of the remaining dentin thickness and the time required for its preparation.

Comparison of instrumentation time and obturation quality between hand K-file, H-files, and rotary Kedo-S in root canal treatment of primary teeth: A randomized controlled trial.

INTRODUCTION: Pulpectomy has been a treatment of choice in all necrotic primary teeth. Advancing technology has brought the rotary system to reduce the manual dexterity and improve the quality of treatment for pulpectomy. Advancing technology in pediatric dentistry should be used for the better treatment protocol. AIM: The aim of this study is to compare the obturation quality and instrumentation time after root canal instrumentation with rotary Kedo-S files, hand K-files, and H-files in primary molars. MATERIALS AND METHODS: A randomized control trial where pulpectomy was performed on 75 primary molars equally distributed for instrumentation with K-file, H-files rotary Kedo-S files, respectively. The instrumentation time and obturation quality were noted. RESULTS: Kedo-S files showed the least instrumentation time with better obturation quality as compared to other two groups (P < 0.001). CONCLUSION: Pediatric rotary files Kedo-S has better obturation quality in minimum instrumentation time.

BiodentineTM versus formocresol pulpotomy technique in primary molars: a 12-month randomized controlled clinical trial.

BACKGROUND: The objective of this clinical study was to prospectively compare the clinical and radiographic success rates of BiodentineTM pulpotomies versus formocresol pulpotomies in children vital primary molars. METHODS: A randomized, split-mouth study design was used with a sample of 37 healthy children aged 4- to 8-year-old. A total of 56 pairs (112 teeth) of carious primary teeth, 1 pair per child, were selected for treatment. One tooth from each pair was randomly assigned to either the BiodentineTM pulpotomy group or the formocresol pulpotomy group. Children were followed-up at 3, 6 and 12 months for clinical evaluation and at 6 and 12 months for radiographic evaluation. Data were collected, tabulated and analyzed using Fisher exact and McNemar tests. The level of significance was set at P < 0.05. RESULTS: At 12 months, the clinical success rates of both BiodentineTM and formocresol groups were 100%, while the radiographic success rates for BiodentineTM and formocresol groups were 100% and 98.1%, respectively. There was no statistically significant difference between both groups (P=1). The only observed radiographic failure was furcal radiolucency in the formocresol group at 12-month interval. Pulp canal obliteration was radiographically observed in 10/56 (17.9%) and 7/56 (12.5%) cases in the BiodentineTM and formocresol groups, respectively. CONCLUSIONS: Both BiodentineTM and formocresol pulpotomy techniques demonstrated favorable clinical and radiographic outcomes over a 12-month period without any significant difference. TRIAL REGISTRATION: Registered on NCT03779698 . Date of Registration: 18 December 2018.