The relationship between examination-related academic stress, salivary antioxidant capacity and exercise patterns of final-year Saudi dental students.

OBJECTIVE: To study the impact of examination stress on the total antioxidant capacity (TAC) of senior dental students and compare changes in TAC between students who exercise regularly and those who do not. METHODS: A questionnaire designed to evaluate physical activity levels, body mass index (BMI) and academic performance was distributed to 325 senior dental students. Of the 312 who responded, a total of 70 were enrolled in the study, of whom 60 completed the study. The students were composed of a low-activity group (n = 30), who had a Goddard-Sheppard (GS) exercise score of <25, and a high-exercise group (n = 30), who had a GS score >60. Dental Environment Stress (DES) questionnaires and salivary samples were collected at the first week of the semester and at the week of the examinations. Salivary TAC was measured using a commercially available Radical Absorbance Antioxidant Assay measurement kit (Zen-Bio ORAC™, AMS Biotechnology, Abington UK). A total of 60 students completed the study. RESULTS: A significant increase in DES values and a significant reduction in salivary TAC values were observed in the week of the examination compared to baseline scores. Although no differences were observed in the DES scores between the high-exercise and low-exercise groups, the high-exercise group showed a significantly lower reduction in examination week salivary TAC compared to their counterparts in the low-exercise group. Regression models showed a significant association between the TAC, exercise scores and DES scores in the week of the examinations. CONCLUSION: Regular exercise may help protect students against the oxidative stress associated with academic stress.

Accuracy of electronic apex locators in primary teeth: a meta-analysis.

AIM: To conduct a meta-analysis on the accuracy of electronic apex locators (EALs) in determining working length in human primary teeth. METHODOLOGY: An electronic literature search was conducted using a combination of the terms 'primary teeth', 'root canal length' and 'electronic apex locators'. Additional eligible articles were identified using a manual search. The full texts of identified articles were screened according to inclusion criteria. RESULTS: Overall, 19 studies met the inclusion criteria and were subjected to further data extraction. Meta-analysis of studies that reported mean lengths and difference in mean lengths between EAL and actual root canal length (ARCL) revealed a significant difference (P = 0.015) between the two readings whilst those studies that evaluated intraclass correlation (ICC) suggested a high correlation (P < 0.0001) between the EAL and ARCL readings. A subgroup analysis revealed that the presence of root resorption did not affect the accuracy of EALs (P = 0.567). CONCLUSION: Electronic apex locators offer an acceptable level of accuracy in the measurement of root canal length in primary teeth.

Cost-effective antigen testing for delimitation, monitoring and evaluation in bancroftian filariasis.

This study was focussed on identifying a cost-effective method for delimitation, monitoring and evaluation in bancroftian filariasis. Finger prick blood samples were collected between 20.00 and 23.00 hours for the detection of microfilariae (mf) from the available population in a village which was endemic for lymphatic filariasis. Simultaneously, from each individual, four spots of 25-µl blood samples were collected on Whatman number 3 filter paper and air dried. Dried filter paper spots were pooled in quantities of 1, 5, 10, 15, 20 and 25 on unknown and simulated mf and antigen prevalence. Pooled samples were assayed for circulating filarial antigen (CFA) using TropBIO Og4C3 ELISA kits. The community mf and CFA rates were 3.4% and 25.9%, respectively. The pool sizes of 20 and 25 showed CFA positivity in all the above categories tested. The results of the pooled blood spot samples suggest that, in areas with mf and CFA prevalence rates between 1 and 10%, pools of 20 or 25 could be considered as the ideal pool size for the detection of filarial infection in the community. CFA prevalence at the level of 5-6% following desirable rounds of mass drug administration (MDA) indicates that the community mf prevalence is likely to be at the 1% level.

Effect of a single dose of diethylcarbamazine, albendazole or both on the clearance of Wuchereria bancrofti microfilariae and antigenaemia among microfilaria carriers: a randomized trial.

BACKGROUND: Lymphatic filariasis is a major vector-borne parasitic disease. The global programme to eliminate lymphatic filariasis was launched in 1997 and currently over 570 million people are covered under it in 48 countries. Mass annual single-dose drug administration of diethylcarbamazine (DEC), co-administrated with albendazole for 5-6 years and mass distribution of diethylcarbamazine-fortified salt are the two strategies for elimination of filariasis. METHODS: Asymptomatic volunteers residing in Puducherry, India were screened for microfilaria (mf) by examining nocturnal thick blood smears. Those testing positive were randomly assigned to receive a single dose of DEC (6 mg/kg body weight) or albendazole 400 mg or both. Participants were hospitalized for 5 days. Membrane filtration count was used to assess microfilaraemia and ELISA (Og4C3) assay to measure circulating filarial antigens (CFA). Measurements were done before treatment and at 1, 2 and 3 years post-treatment. Viability of the adult worms was assessed by looking for the filarial dance sign (FDS) using ultrasound examination of the scrotum in men with hydrocele. RESULTS: Fifty-four microfilaraemic Individuals were studied. The mf prevalence started decreasing only by day 180 posttreatment in the DEC group but much earlier in the other two groups (day 30 in the albendazole and day 90 in the DEC with albendazole group). The decrease in mfwas marginal (17.6%, 26.3% and 27.8%, respectively) by the end of year 1 posttreatment, but significant (96.7%, 78.6% and 93.3%, respectively) by the end of year 2 post-treatment (p < 0.05). By the end of year 3, the level decreased to 80% in the DEC, 90% in the albendazole and to 100% in the DEC and albendazole groups. However, the mf intensity decreased significantly (by 39%; p < 0.05) by day 7 post-treatment in both the DEC and DEC with albendazole groups, but only by day 30 in the albendazole group. In all the drug groups, the prevalence as well as intensity of CFA returned to pretreatment levels by the end of year 3 post-treatment. CONCLUSION: Annual single-dose administration of all the 3 drug regimens significantly reduced antigenaemia levels. There were no significant differences in the efficacy and overall pattern of CFA clearance between the 3 drug regimens.

Parental anxiety associated with children undergoing dental treatment.

AIM: Over the past two decades, improvements in both the safety of anaesthetic agents and the techniques of operative dentistry have resulted in the popularity of "day-case anaesthesia". The aim of this study was to evaluate the stress felt by parents of children undergoing dental treatment. The study also aimed to compare the stress felt by parents of children undergoing chairside treatment to the stress felt by parents of children who received their treatment under general anaesthesia. MATERIALS AND METHODS: Study Design: Stress among parents was assessed subjectively using the Modified Dental Anxiety Stress (MDAS) questionnaire and objectively using a pulse oximeter to record the heart rate. The sample comprised of 60 parents of children aged between 4 and 7 years who were divided into three groups. Group A comprised of 20 sets of parents of children who underwent complete dental treatment without any pharmacological behaviour management. Group B comprised of 20 sets of parents of children who were treated at the dental chair with N2O used as pharmacological behaviour management. Group C comprised of 20 sets of parents of children who underwent dental rehabilitation under general anaesthesia. Objective signs were recorded preoperatively, during the procedure and post-operatively. RESULTS: Dental treatment is a stressful experience for a parent. The introduction of a pharmacological method of behaviour management seems to significantly increase the stress felt by the parent. CONCLUSIONS: A significant increase in heart rate was observed among parents whose children were under treatment.

Efficacy of external cold and a vibrating device in reducing discomfort of dental injections in children: A split mouth randomised crossover study.

AIM: To study the discomfort and fear associated with maxillary infiltration injections when using a combination of external cold and a commercially available vibrating device. METHODOLOGY: A total of 60 children aged 7 years old participated in this split mouth randomised crossover study. The control intervention comprised of the administration of 1.8 ml of 2% lidocaine with 1:100,000 adrenaline using a 24 mm 30 gauge needle, while the test intervention used external cold and a commercially available vibrating device in addition to the control protocol. The heart rate of the child at the time of injection was used as an objective measure and the Wong-Baker pain scale was used as a subjective measure of the child's discomfort. The face, limbs, arms, cry and consolability (FLACC) scale was used to record the child's pain as perceived by the dentist. RESULTS: Children reported a significantly lower Wong-Baker score and the operators observed a significantly lower heart rate and FLACC scores in the test visit than the control visit. CONCLUSIONS: Combining external cold with vibrating devices might be effective in reducing discomfort and fear in children undergoing infiltration dental analgesia. CLINICAL TRIALS IDENTIFIER: NCT02675387.

Impact of seven rounds of mass administration of diethylcarbamazine and ivermectin on prevalence of chronic lymphatic filariasis in south India.

OBJECTIVE: To evaluate the impact of seven rounds of mass administration of diethylcarbamazine (DEC) and ivermectin on the prevalence of chronic lymphatic filariasis and to compare it with that observed in a placebo arm in a community-level trial. METHODS: Cross-sectional clinical surveys were carried out before and after seven rounds of mass drug administration (MDA). About 54-75% of the target population were treated at each round of MDA. RESULTS: After seven rounds, the hydrocele prevalence had declined from the pre-intervention level of 20.5-5.1% (P < 0.05) in the DEC arm, from 23.9% to 10.4% (P < 0.05) in the ivermectin arm and from 20.4% to 10.9% (P < 0.05) in the placebo arm, equivalent to reductions of 75.3%, 56.6% and 46.6%, respectively. The lymphoedema/elephantiasis prevalence declined only marginally and without statistical significance from 3.7% to 3.2%, 4.6% to 3.9% and 2.9% to 2.3% in the DEC, ivermectin and placebo arm. After the seventh MDA, none of the sampled people in the 0-20 age group was found with hydrocele and there was a statistically significant decline in hydrocele prevalence in all other age groups in the communities treated with DEC, the drug known to have macrofilaricidal effect. The impact was relatively less in ivermectin arm. CONCLUSION: Repeated DEC administration has the potential to prevent incidence of new hydrocele cases and may resolve the manifestation at least in a proportion of affected people. Apart from reducing the microfilaraemia prevalence and transmission of infection, MDA also results in significant public health benefits by reducing the burden of hydrocele in treated communities.

Locomotor disability in bancroftian filarial lymphoedema patients.

Disability prevention in cases with lymphatic filarial disease has been a research priority in view of the current programme on global elimination of lymphatic filariasis. This is also important for estimation of disease burden, impact evaluation, developing strategy for morbidity management and rehabilitation for lymphoedema patients in the endemic countries. In this communication, we are presenting the results of quantification of functional limitations of lower extremities with lymphoedema caused due to bancroftian filariasis by objective assessment of movement of joints and power of muscles in the affected legs. A total of 81 consecutive lymphoedema patients attending a filariasis clinic in Pondicherry urban locality were recruited for the study. Assessment for restriction of movement of joints and loss of power of muscles was carried out as in Manual for doctors to evaluate permanent physical impairment, prescribed by an expert group of WHO and Ministry of Health, Govt. of India on evaluation for permanent disability. Of the cases assessed, 40% in grade-I, 55% in grade-II, 77.3% in grade-III and 94.7% in grade-IV lymphoedema cases had functional limitations either in joint movements or power of muscles or both. The effective loss of locomotor/function (combined loss of joint movement and power of muscles in %) increased with stage of lymphoedema (grade-I-4.3+7.4, grade-II-7.0+8.4, grade-III-15.4+14.8 and grade IV- 33.2+22.8). The degree of loss varied significantly between the grades (P< 0.0001). The methodology used in this study can be adapted to evaluate the impact of the morbidity management component of strategy for Elimination of Lymphatic Flariasis (ELF) programme. This study will also enable researchers for fine-tuning the method for estimating disease burden and, to develop and evaluate strategies for morbidity management/rehabilitation of filarial lymphoedema patients.

The plight of chronic filarial lymphoedema patients in choice of health care and health care providers in Pondicherry, India.

Lymphatic filariasis has a wide spectrum of clinical manifestations with asymptomatic parasite carriers at one end and irreversible lymphoedema of extremities at the other. Irreversible lymphoedema of extremities is one of the disabling conditions that drive the affected patients to seek treatment from various systems of medicines and health care providers. This study attempts to map the care seeking pattern and behaviour of patients with chronic filarial lymphoedema of lower limbs in an urban area. Consecutive filarial lymphoedema patients from the VCRC filariasis clinic were recruited for the study. A pre-tested semi-structured questionnaire was used for interrogation of the patients. A total of 56 lymphoedema patients participated in the study. Majority (94.6%) of the patients sought medical management only. There was no difference (P>0.05) between the proportion of patients attending government (37.5%) and private (44.3%) medical care facilities There was also no difference in the proportion of patients' first consultations in private or government health care facilities. About 57.1% patients approaching governmental institutions opted for primary/secondary health care system. No particular sequential pattern of seeking health care was observed and the 56 study subjects followed 40 treatment-seeking routes by switching from one care provider to the other. The causes of not coming to the clinic for further check-up were 'no acute attacks' (30.4%), 'reduction in oedema volume' (21.7%), 'advised treatment being taken at home' (26.1%) and 'loss of daily wages' (21.7%). The study highlights the need to involve the private medical sector in morbidity management of filarial lymphoedema and to make governmental health facilities more accessible and user-friendly.

Preliminary images from an adaptive imaging system.

I-ImaS (Intelligent Imaging Sensors) is a European project aiming to produce real-time adaptive X-ray imaging systems using Monolithic Active Pixel Sensors (MAPS) to create images with maximum diagnostic information within given dose constraints. Initial systems concentrate on mammography and cephalography. In our system, the exposure in each image region is optimised and the beam intensity is a function of tissue thickness and attenuation, and also of local physical and statistical parameters in the image. Using a linear array of detectors, the system will perform on-line analysis of the image during the scan, followed by optimisation of the X-ray intensity to obtain the maximum diagnostic information from the region of interest while minimising exposure of diagnostically less important regions. This paper presents preliminary images obtained with a small area CMOS detector developed for this application. Wedge systems were used to modulate the beam intensity during breast and dental imaging using suitable X-ray spectra. The sensitive imaging area of the sensor is 512 x 32 pixels 32 x 32 microm(2) in size. The sensors' X-ray sensitivity was increased by coupling to a structured CsI(Tl) scintillator. In order to develop the I-ImaS prototype, the on-line data analysis and data acquisition control are based on custom-developed electronics using multiple FPGAs. Images of both breast tissues and jaw samples were acquired and different exposure optimisation algorithms applied. Results are very promising since the average dose has been reduced to around 60% of the dose delivered by conventional imaging systems without decrease in the visibility of details.

High sensitivity organic inorganic hybrid X-ray detectors with direct transduction and broadband response.

X-ray detectors are critical to healthcare diagnostics, cancer therapy and homeland security, with many potential uses limited by system cost and/or detector dimensions. Current X-ray detector sensitivities are limited by the bulk X-ray attenuation of the materials and consequently necessitate thick crystals (~1 mm-1 cm), resulting in rigid structures, high operational voltages and high cost. Here we present a disruptive, flexible, low cost, broadband, and high sensitivity direct X-ray transduction technology produced by embedding high atomic number bismuth oxide nanoparticles in an organic bulk heterojunction. These hybrid detectors demonstrate sensitivities of 1712 µC mGy-1 cm-3 for "soft" X-rays and ~30 and 58 µC mGy-1 cm-3 under 6 and 15 MV "hard" X-rays generated from a medical linear accelerator; strongly competing with the current solid state detectors, all achieved at low bias voltages (-10 V) and low power, enabling detector operation powered by coin cell batteries.

Impact of 10 years of diethylcarbamazine and ivermectin mass administration on infection and transmission of lymphatic filariasis.

The potential of repeated mass administration of diethylcarbamazine (DEC) and ivermectin to eliminate lymphatic filariasis has been examined in a study implemented in 10 villages with a population of 18415 in south India. During ten rounds of mass drug administration, 49-84% of the eligible population received treatment in different villages. Ten rounds of mass administration of DEC alone reduced the microfilaria (mf) prevalence and intensity by 93% and 97%, respectively, and the vector infection and infectivity rates by 91% and 89%, respectively. The corresponding figures with nine rounds of administration of ivermectin alone were 83%, 90%, 89% and 79%. Out of five villages in each treatment arm, the mf rate declined to

Kinetics of microfilaraemia & antigenaemia status by Og(4)C(3) ELISA in bancroftian filariasis.

BACKGROUND & OBJECTIVE: Bancroftian filariasis caused by Wuchereria bancrofti is endemic in many parts of India. In recent years diagnosis of W. bancrofti infection has been revolutionized with the availability of filarial antigen tests, which is important in monitoring success of chemotherapy. We carried out this study to measure microfilariaemia and antigenemia levels in bancroftian microfilariae (mf) carriers at 1 yr follow up after chemotherapy, in lymphoedema patients and in endemic controls from a filariasis endemic area in Tamil Nadu State using Og(4)C(3) ELISA to identify the best marker to assess success of chemotherapy. METHODS: Serum samples were collected from 30 bancroftian microfilaremic (Mf) carriers pre-treatment and at sequential intervals (7,30,60,90,180 and 365 days) following treatment with diethylcarbamazine (DEC:6mg/kg body weight, single dose), 30 lymphoedema patients (without treatment) at periodic intervals, and 68 control subjects (24 endemic normal subjects in filariasis endemic area in Tamil Nadu State, 24 non-endemic normal subjects residing in Chandigarh, India; 5 brugian filariasis, 5 endemic control subject in brugian filariasis endemic area and 10 other disease controls). The circulating antigen of W. bancrofti was measured quantitatively using Og(4)C(3) ELISA kit. RESULTS: In Mf carriers, there was no significant difference in microfilariae count in pre- and post-treatment (PT) samples till day 30 while significant differences were observed in pre- and sequentially collected post-treatment (PT) samples day 60 to 180 (P<0.001), day 365 (P<0.005). However, there was no significant difference in antigenaemia levels between pre-treatment (day 0) and PT samples collected on day 7 onwards till day 365. Though of the 19 patients who could be followed up till 365 days PT, 4 (21%) were amicrofilaraemic, none became antigen negative. No significant difference was found in antigenaemia levels in sequentially collected samples from lymphoedema patients. Significant differences were observed in antigenaemia levels in samples collected at the start of study in mf carriers as compared to lymphoedema patients and endemic normal subjects (P<0.001). Subjects (non-endemic control) residing in filariasis free area (24), brugian endemic area (5), B.malayi infected patients (5) and patients with other parasitic diseases (10) were found antigen negative. INTERPRETATION & CONCLUSION: Annual single dose of DEC therapy alone may not result in complete clearance of infection and detection of antigenaemia rather than microfilaraemia may be taken into consideration as an indicator of successful chemotherapy. The study supports the earlier view that filarial antigenaemia is relatively common in amicrofilaraemic and asymptomatic subjects in endemic areas and further studies are needed to determine the clinical significance, prognosis and effective management of such infections in endemic areas.

Scatter free imaging for the improvement of breast cancer detection in mammography.

In mammography, the reduction of scattered x-rays is vital due to the low contrast or small dimension of the details that are searched for. The typical method of doing so in current conventional mammography is the anti-scatter grid. The disadvantage of this method is the absorption of a proportion of the primary beam and therefore an increase in dose is required to compensate for the loss of counts. An alternative method is proposed, using quasi-monochromatic beams and a pixellated spectroscopic detector. As Compton-scattered x-rays lose energy in the scattering process, they are detected at a lower energy in the spectrum. Therefore the spectrum can be windowed around the monochromatic energy peak, removing the scattered x-rays from the image. The work presented here shows contrast improvement of up to 50% and contrast to noise ratio improvements of around 20% for scatter free imaging in comparison to full spectrum imaging. Contrast improvements of around 45% were found when comparing scatter free images to conventional polychromatic imaging for both the low contrast test object and the Rachel anthropomorphic breast phantom.

Effects of ivermectin and diethylcarbamazine on microfilariae and overall microfilaria production in bancroftian filariasis.

Ivermectin and diethylcarbamazine (DEC) are used in mass treatment programs for the elimination of lymphatic filariasis because of their strong effects on microfilaremia. However, the effects of treatment on adult worms and the degree of individual variation in efficacy are unclear. We analyzed series of microfilaria (Mf) counts from individuals treated with a single dose of 400 microg/kg ivermectin or 6 mg/kg DEC (N = 23 in each group; 1 year follow-up). For each individual, we estimated the microfilaricidal effect and the reduction in overall Mf production (e.g., caused by death or sterilization of worms, or inhibited Mf release from the female worm uterus). Ivermectin on average killed 96% of Mf and reduced Mf production by 82%. DEC killed 57% of Mf and reduced Mf production by 67%, with some individuals responding very poorly. The strong reduction in overall Mf production is good news for control of lymphatic filariasis, but the prospects of elimination will be diminished if part of the population systematically responds poorly to treatment.

The effects of the imaging system on the validity limits of the ray-optical approach to phase contrast imaging.

A theoretical analysis of the x-ray phase contrast imaging and its validation via synchrotron radiation imaging is here presented. Two different mathematical models have been followed: the simpler ray-optical approach and the more rigorous Fresnel-Kirchoff diffraction theory. Subsequently, the conditions upon which the x-ray optical approximation can be used to describe the image formation mechanism have been analyzed, taking into account also the effects due to the finite source size and detector resolution. It is possible to demonstrate that the ray-optics results can also be obtained by opportunely developing the diffraction formalism only with some restrictions on the spatial frequencies present in the final image, without any limitation on the maximum phase shift. The conditions allowing the use of the simplified ray-optical approach to describe the phase contrast images have been here defined and their validation has been proved by means of computer simulations and phantom experiments.

High resolution Ca/P maps of bone architecture in 3D synchrotron radiation microtomographic images.

The Ca/P ratio was measured in cortical bone samples from the femoral neck and tibia of different animal species, using synchrotron radiation microtomography. Use of a monoenergetic X-ray beam, as provided by the synchrotron facility, generates accurate 3D maps of the linear attenuation coefficient within the sample and hence gives the ability to map different chemical components. Also, by comparing normal and abnormal bones, i.e. osteoporotic (induced by inflammation), changes in the Ca/P ratio brought about by bone diseases can be detected. MicroCT data sets were collected at 20 and 28 keV for each bone sample and two calibration phantoms. From the 3D data sets, multiple 2D slices were reconstructed with a slice thickness of approximately 30 microm. Regions of interest were defined around suitable sites and were converted to Ca/P ratios using the data collected from the test phantoms. A significant difference (p<0.001) between osteoporotics and age-matched normals at both energies was detected. Differences between different bone sites from the same animal are not significant (p>0.5) while those between the same bone sites from different animals are highly significant (p<0.001). Differences between estimates made at 20 and 28 keV are not significant (p>0.5). An important aspect is the ability to map the spatial distribution of the Ca/P ratio.

Tolerability and efficacy of a three-age class dosage schedule of Diethylcarbamazine citrate (DEC) in the treatment of microfilaria carriers of Wuchereria bancrofti and its implications in mass drug administration (MDA) strategy for elimination of lymphatic filariasis (LF).

A six-age class dosage schedule of Diethylcarbamazine (DEC) of 50mg (1-2 years), 100mg (3-4 years), 150mg (5-8 years), 200mg (9-11 years), 250mg (12-14 years) and 300mg for above 14 years is being adopted for annual single dose MDA for LF elimination treat Wuchereria bancrofti microfilaria carriers. In order to increase the community compliance as well as to make the distribution easier during MDA, a revised 3 age class dosage schedule of 100mg (2-4 years), 200mg (5-14 years) and 300mg for above 14 years was evaluated for its tolerability and efficacy. By this change, it was observed that the 4-8 years age class is receiving 50 mg higher and 11-14 years age class is receiving 50mg lesser dose compared to the earlier class schedule. Therefore, the safety aspect in the age class of 4-8 years and efficacy component in the age class of 11-14 years were assessed. Apparently "healthy" asymptomatic microfilaraemic volunteers between the age class of 4-8 and 11-14 years were recruited for the study. The incidence of side reaction in the 4-8 years age class was 50.0% with 150mg dose and 66.7% with 200mg (P>0.05). No life threatening adverse reactions was observed in any dosage schedule. Fever, headache and myalgia, the predominant adverse reactions were mild and similar in both schedules. The mean intensity of the three major specific adverse reactions (fever, headache and myalgia) also did not differ significantly (P>0.05). For the purpose of LF elimination, efficacy in terms of reduction in mean microfilaria load is important. In the 11-14 year age class considerable reduction in the geometric mean density (GMD) was observed by day 90 and 180 post-therapy in both groups (250mg group and 200mg group) compared to pre-therapy level. By day 360 post-therapy, the difference was statistically not significant (P>0.05) (reduction of 72.2% in 250mg and 69.6% reduction in 200mg). The reductions in GMD were statistically significant when compared to pre-therapy levels in both the old (250mg) and new (200mg) doses. Thus, three- age class dosage schedule is as safe and efficacious as the six- age class schedule.

The role of an occlusal template during the placement of preformed metal crowns in children under general anaesthesia: a randomised control trial.

AIM: This aim was to evaluate preformed metal crowns (PMC) placed under general anaesthesia using an occlusal template in comparison to crowns placed without the use of a template. METHODOLOGY: CONSORT protocols were followed in the design of the study. A total of 60 children between 4-7 years requiring pulpotomy and PMC for all primary molars met the inclusion criteria for this study. The control group comprised patients for whom the PMC were placed without the use of an occlusal template, while in the test group crowns were placed using a polyvinyl siloxane occlusal template. Patients were followed up at 24 h, 7 days, 3 and 6 months. The time taken for the placement of crowns, instances of post-operative discomfort, success or failure of the pulp therapy and loss of any crowns were compared between the groups. RESULTS: The mean time taken for completion of the procedure in the control group was significantly greater than the template group (t = 2.566, p = 0.013). Significantly fewer patients in the template group reported symptoms of discomfort or high points at the 24-h recall; however, these differences were not significant at the 1-week, 3- or 6-month recall. CONCLUSION: The use of an occlusal template for the placement of multiple PMC under general anaesthesia reduces the time taken for their placement and reduces the incidence of immediate post-operative discomfort.