Three-dimensional assessment of root canal morphology of primary dentition using cone beam computed tomography.

BACKGROUND: Root canal therapy in primary teeth is exceedingly complex due to the unique internal geometry of the pulp cavity. AIM: The purpose of this study was to evaluate variations in primary teeth root canal morphology and applicability of the Ahmed et al. (Int Endod J, 50, 2017, 761) alphanumeric system for classifying them. DESIGN: A retrospective analysis of 2024 primary teeth from an existing CBCT database was performed for assessing variations in root canal morphology. Descriptive statistics and the chi-squared test were used for data analysis. RESULTS: The maxillary canines exhibited splitting levels of 5.9% (right) and 6.6% (left), and merging levels of 1% (both sides); maxillary lateral incisors showed splitting levels of 2.6% (right) and 0.8% (left), with no merging observed; mandibular second molars had splitting levels of 1.5% (right) and 0.8% (left), with no merging observed; and mandibular lateral incisors exhibited a merging level of 0.9% (right), with no splitting observed. CONCLUSION: This study provides new insights into the variations in root canal morphology of primary teeth, particularly highlighting the variations found in primary canines. The Ahmed et al. (Int Endod J, 50, 2017, 761) classification system was found to be a useful tool for categorizing these variations.

Prospective, Randomized, Clinical Evaluation of Preformed Zirconia Crowns and Stainless Steel Crowns on Permanent First Molars: 12-Month Results.

PURPOSE: The purpose of this prospective, randomized, parallel-group clinical study was to evaluate and compare the clinical outcome of preformed zirconia crowns and preformed stainless steel crowns when used to restore permanent first molars. METHODS: Patients with severely decayed, badly broken down hypomineralized or hypoplastic permanent first molars that required a full-coverage restoration were invited to parti- cipate in the study. Sixty-nine healthy, cooperative children, ages six to 12 years, were recruited for the study. Following informed consent, 36 preformed zirconia crowns and 36 stainless steel crowns were placed and assessed at one week, three months, nine months, and 12 months accord- ing to the modified United States Public Health Service Ryge criteria. The parameters evaluated were: the time required for preparation and ce- mentation; plaque accumulation; marginal integrity; fracture of the crown; retention of cement; interference with the eruption of the permanent second molar; and parental acceptance. RESULTS: The clinical evaluation revealed statistically comparable performance in crown retention, fracture, marginal integrity, and plaque retention at 12 months between crown types. Preformed zirconia crowns were preferred by the parents primarily because of esthetics. However, a significant difference was seen in the clinical time required for the preparation and placement of preformed zirconia crowns, which was nearly twice that for stainless steel crowns. CONCLUSIONS: After 12 months of clinical evaluation, preformed zirconia crowns performed comparably to stainless steel crowns in their ability to restore decayed or hypomineralized permanent first molars. However, zirconia crowns took nearly twice as long to prepare, fit, and cement.

Dental Caries and Dental Anomalies in Children Undergoing Chemotherapy for Malignant Diseases.

Purpose: The study aims to evaluate the prevalence of dental caries and anomalies in pediatric patients undergoing chemotherapy or those who have completed chemotherapy. Methods: A total of 250 pediatric patients within the age group of 6 months to 17 years, either admitted to hospitals for chemotherapy or on follow-up, were included as a part of the study. Complete oral examination inclusive of the diet history, oral hygiene methods, past dental history, the decayed, missing, and filled teeth (DMFT), def score, and any dental anomaly was diagnosed clinically and radiographically using an orthopantomogram. The samples were further categorized under type of malignancies and duration of chemotherapeutic drug usage groups (from 6 months to 10 years and more than 10 years) to establish a correlation of these variables with the prevalence of dental caries and dental anomalies. Results: Among all patients, 108 (43.2%) had completed the treatment (chemotherapy), while 142 (56.8%) were undergoing the treatment. Forty-three (17.2%) patients showed positive findings for dental anomalies. Conclusion: The present study confirms the strong positive correlation between long-term exposure to chemotherapeutic agents and the prevalence of dental anomalies and dental caries in children. How to cite this article: Talekar AL, Musale PK, Kothare SS. Dental Caries and Dental Anomalies in Children Undergoing Chemotherapy for Malignant Diseases. Int J Clin Pediatr Dent 2022;15(4):428-432.

Efficacy of Biodentine versus formocresol in pulpotomy of primary teeth: a systematic review and meta-analysis.

OBJECTIVE: To systematically evaluate and meta-analyze the short-and long-term clinical and radiologic failure rates of Biodentine versus formocresol as pulpotomy medicaments in primary teeth. DATA SOURCES: Relevant medical databases were searched until May 2021 for randomized controlled trials that used Biodentine and formocresol as pulpotomy medicaments in primary teeth with deep caries. Primary outcomes included clinical and radiologic failure rates at 12 months. Secondary outcomes were clinical and radiologic failure rates at 3, 6, 9, 13 to 24, and 25 to 48 months. RESULTS: Nine randomized controlled trials (N = 626) with low risk of bias were included. Pooled analysis showed that compared to formocresol, Biodentine had significantly lower clinical failure rates (relative risk [RR] 0.16; 95% confidence interval (CI) 0.03 to 0.87; six randomized controlled trials; N = 394; GRADE, low) and radiologic failure rates (RR 0.19; 95% CI 0.08 to 0.49; six randomized controlled trials; N = 393; GRADE, low) at 12 months. Radiologic failure rates at 6 and 9 months were significantly lower in the Biodentine group compared to the formocresol group. CONCLUSION: Compared to formocresol, Biodentine may be a superior medicament when used for pulpotomy in primary teeth. Adequately powered randomized controlled trials are needed to substantiate this evidence.

Ex Vivo Assessment of Natural Teeth Wear against Zirconia and Novel Glass-Fiber-Reinforced Composite Crowns in Primary Teeth by a Three-Dimensional Assessment Method.

OBJECTIVES: The main purpose of the study was to assess the material wear, antagonistic natural primary teeth wear, and microhardness of zirconia (ZR), a recently launched novel glass-fiber-reinforced composite crown (GFRC). The research question was, are these aesthetic crowns resulting in antagonistic natural primary tooth wear and the crown material itself? METHODS: Forty-five primary canines were divided into three groups (15 per group) and mounted against Zr (Group A), GFRC (Group B), and natural teeth as control (Group C) in the wear test machine. All samples were assessed for surface wear with pre- and post-3-dimensional scanning. In addition, microhardness was assessed for all three groups. RESULTS: The mean microhardness value for the Zr disc was 1157 ± 7 HV; for the GFRC disc, it was 29.35 ± 2 HV; while with natural teeth, it was 105 ± 4 HV. There was a statistically significant difference in teeth wear in the prescan and postscan in the natural tooth (p < 0.05) group, highly significant difference (p < 0.001) in the ZR group, and no significant difference in the GFRC group. CONCLUSION: There is more significant wear loss of glass-fiber-reinforced composite discs as compared to zirconia. In addition, the wear of the antagonistic tooth with zirconia and natural teeth is more remarkable than with GFRC. There is a vast difference of microhardness between natural teeth and zirconia (almost 10 times higher) which suggests further scope of study. Clinical Relevance. Pediatric dentistry deals with the transition of dentition from primary to permanent through mixed dentition. Selection of restorative material needs to be done cautiously when we are dealing with primary teeth and young permanent teeth as antagonistic teeth. Wear of the crown material itself and opposing natural teeth are essential factors that should be considered in selecting crowns in clinical practice. The present study results can be extrapolated to clinical practice, and the practitioner can consider various factors in selecting full-coverage crowns for primary teeth. The vast difference in aesthetic crowns and natural teeth microhardness indicates a further need for research. Additionally, there is no literature published for the recently launched GFRCs.

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.

Mineral trioxide aggregate pulpotomy: patient selection and perspectives.

This narrative aims at reviewing the available literature for mineral trioxide aggregate (MTA) pulpotomy to understand the procedure better and eventually improve the clinical and radiographic outcomes. An electronic search was conducted in PubMed, Cochrane, ScienceDirect and ClinicalKey databases with the following keywords: MTA pulpotomy, clinical outcomes, radiographic outcomes, primary teeth. No specific inclusion or exclusion criteria were applied as to what articles would be included in this review. The time period for the search began from 2001 with respect to MTA pulpotomy. However, this was not restrictive during the search. MTA pulpotomy has been a successful treatment modality in primary molars with proven success over the years. There is limited literature to support its success in primary incisors.

Clinical Pulpotomy Trial of Copaifera Langsdorffii Oil Resin Versus Formocresol and White Mineral Trioxide Aggregate in Primary Teeth.

PURPOSE: This study's purpose was to assess clinical and radiographic outcomes of Copaifera langsdorffii oil resin (CLOR) as a pulpotomy medicament compared with one-minute full-strength formocresol (FC) and white mineral trioxide aggregate (WMTA). METHODS: Determined by a power analysis, 152 primary molars of 64 four- to eight-year-olds with at least two asymptomatic molars requiring vital pulpotomies were recruited, randomly assigned to receive CLOR, WMTA, or FC, and restored with prefabricated metal crowns. At the 12-month follow-up, recordings of 59 children with 142 treated teeth were taken for clinical and radiographic symptoms. Clinical evaluation was performed by a blinded calibrated evaluator, whereas four evaluators scored each radiograph for pathologies based upon a modified scale previously proposed. The data were statistically analyzed. RESULTS: At 12 months, 100 percent clinical success was observed with all groups. CLOR had the highest frequency of pathologic radiolucencies at 12 months. The radiographic success at 12 months was 76 percent, 90.91 percent, and 88.23 percent for the CLOR, FC, and WMTA groups, respectively (P=0.10). CONCLUSION: Copaifera langsdorffii oil resin can be suggested as a pulpotomy agent for primary teeth up to one year. However, further clinical studies with long-term follow-ups are needed to test its efficacy as a pulpotomy medicament.