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.

Partial pulpotomy success in primary molars followed up for 24 months: A randomized controlled clinical trial using mineral trioxide aggregate, biodentine, and acemannan

BACKGROUND

Finding the best treatment approach and suitable capping materials in primary molars with deep carious lesions remains unresolved.

AIM

To compare the success rates of partial pulpotomy in deep caries lesions in primary molars treated with mineral trioxide aggregate (MTA), biodentine, or acemannan for 6-24 months.

DESIGN

A parallel-design, non-inferiority randomized controlled clinical trial was performed. Ninety mandibular primary molars from 65 children meeting the criteria, aged 3-8 years, were included. After inflamed pulp tissue removal and hemostasis, each tooth was randomly allocated into the MTA control group, or the biodentine or acemannan experimental group (N = 30 per group). All teeth were restored with a stainless steel crown. The outcomes were evaluated for 6-24 months. A generalized estimating equation model was used to compare the overall success rate in each group.

RESULTS

After 24 months, 58 children (83 teeth) were available for evaluation. The results indicated that the success rate in the MTA, biodentine, and acemannan groups was 83.3%, 76.9%, and 74.1%, respectively. No significant difference in success rates among groups, however, was observed at the 6- to 24-month follow-ups (at 24th month, p = .30).

CONCLUSION

There was no statistically significant difference between MTA, biodentine, or acemannan in the partial pulpotomy success after 24 months.

Caries-Prone Primary Teeth: A Hidden Reason and Prophylactic Treatment in the Viewpoint of Materials Science

Dental caries, the most prevalent chronic disease across all age groups, has a high prevalence, particularly among children. However, there is no specific and effective treatment for the prevention of caries in primary teeth (Pr.T.), which stems from a lack of knowledge regarding the basic nature of the tooth surface. Herein, we observed that the adhesion energies of the caries-related bacteria Streptococcus mutans and Streptococcus sanguinis to Pr.T were approximately 10 and 5.5 times higher than those to permanent teeth (Pe.T). A lower degree of mineralization and more hydrophilic characteristics of the Pr.T enamel account for this discrepancy. Accordingly, we proposed that the on-target modification of both hydroxyapatite and organic components on Pr.T by dual modification would render a sufficient hydration layer. This resulted in an approximately 11-time decrease in bacterial adhesion energy after treatment. In contrast, a single hydroxyapatite modification on Pe.T and young permanent teeth (Y.Pe.T) was sufficient to achieve a similar effect. Theoretical simulation further verified the rationality of the approach. Our findings may help understand the reason for Pr.T being caries-prone and provide references for treatment using resin restorations. This strategy offers valuable insights into daily oral hygiene and dental prophylactic treatment in children.

Strategies for Pain Management after Extraction of Primary Teeth: A Systematic Review of Randomized Clinical Trials

BACKGROUND

In dental extractions, particularly when local anesthesia is used, it usually offers analgesic relief for a few hours. However, pain can become a notable concern in the immediate postoperative period due to the trauma experienced by both soft and hard oral tissues.

OBJECTIVES

This systematic review aimed to evaluate the most effective strategies for managing postoperative pain in primary tooth extractions.

METHODS

Two examiners conducted a search across five electronic databases: MEDLINE (via PubMed), Embase, Scopus, Web of Science, CENTRAL, and OpenGray. Studies were included if they met the following criteria after reviewing their titles and abstracts: they involved children and evaluated pain management following primary tooth extraction. Subsequently, articles that described extractions performed under any form of sedation, were not conducted under local anesthesia, in an outpatient setting, and in children aged 0 to 12 years, or were not randomized controlled trials, were excluded.

RESULTS

The search yielded 374 relevant articles, of which 9 were included. Among these, 5 utilized preoperative medications as a pain management strategy, one evaluated low-level laser therapy (LLLT) postoperatively, one assessed calendula drops postoperatively, and another explored virtual reality during the procedure and arnica in solution both pre and postoperatively.

CONCLUSION

Among all the strategies evaluated, the strategy involving analgesics administered 30 minutes before tooth extractions was supported by better-designed studies. However, there is a high risk of bias.

Erosion Effects of OTC Paediatric Oral Liquids and Traditional Chinese Medicine on Primary Teeth

BACKGROUND

This study compared the in vitro erosive effects of 2 western and 2 Chinese medicinal over-the-counter paediatric medications on primary teeth in a continuous time scale.

METHODS

Twenty enamel blocks obtained from 10 deciduous incisors were randomly assigned into 5 groups (n = 4 each): Group GA and Group GB-paracetamol liquid (Jean-Marie Pharmacal Co. Ltd and Universal Pharmaceutical Laboratories Ltd, respectively); Group GC and Group GD-reconstituted Chinese medicinal granules (Huarun 999 and Guizhou Bailing Group Pharmaceutical Co. Ltd, respectively); and deionised water (control group). The pH levels of these liquids were assessed. The immersion process was repeated for 20 rounds. For each round, each sample was immersed in liquid for 15 seconds and then rinsed with deionised water for 15 seconds. Mean hardness ratio (MHR) at 5, 10, 15, and 20 rounds was evaluated using Vickers microhardness test. The initial and final surface morphology and chemistries were analysed by scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDS).

RESULTS

All 4 liquid medications have shown acidic pH (4.74-5.76). After 20 rounds of immersion, the MHR20 of the GA (0.886) and GB (0.930) groups decreased significantly from the original MH0. The GC (0.978) and GD (0.985) groups illustrated a similar trend as the deionised water control group (0.985). Despite EDS, chemical analysis showed an increase of Ca/C mole ratio after drug immersion, and no significant difference (P > .05) was found on the ratios Ca/P and Ca/C and the amounts of magnesium or sodium before and after immersion according to the Wilcoxon signed-rank analysis. Distinctive enamel loss with irregular craters, and a corroded surface with fracture lines along the border of prism head were observed in the SEM of groups GA and GB, respectively. However, findings in both Chinese medicine groups were similar, such that erosive changes were barely seen, similar to the control group.

CONCLUSIONS

This study concluded that the pH of liquid medication may not be a significant factor that contributes to enamel softening. Traditional Chinese granule medications may be a safer option for primary teeth.

Innovative Aesthetic and Functional Rehabilitation in a Two-and-a-Half-Year-Old Using a Modified Groper's Appliance

The repercussions of the early loss of primary teeth, be it from trauma or caries, encompass compromised chewing efficiency, diminished aesthetics, potential development of abnormal oral habits, and difficulty in articulation of labiodental sounds, significantly influencing the child's psychological well-being and behavior. Moreover, the untimely loss of posterior teeth results in the loss of space, potentially leading to malocclusion and functional disruptions. Hence, addressing dental rehabilitation in these cases is both a challenge and a necessity. A toddler aged two and a half was brought to our department with a primary concern of multiple caries. Severe decay with 54, 61, 62, and 64 and missing 51 and 52 were seen. The child experienced pain from decayed back teeth, and the parents were distressed about compromised aesthetics caused by decayed front teeth. Given the child's young age and the sufficient time for permanent teeth to emerge, their concerns were heightened. To address these issues, a modified Groper's appliance was crafted to restore aesthetics and functionality. A supplementary crib-like wire component was incorporated into the appliance to facilitate a simpler and aesthetically pleasing composite crown buildup. Satisfaction with the treatment was evident from both the parents and the child. Subsequent follow-up sessions revealed no adverse effects attributable to the appliance, thus concluding that the additional wire component seamlessly integrated into the appliance offers several advantages, including enhanced aesthetics through composite shade matching for a simplified crown buildup. Particularly in remote areas, where obtaining a set of deciduous acrylic teeth can be challenging, this feature proves to be advantageous. It eliminates the necessity to trim permanent acrylic teeth to achieve a deciduous appearance. Additionally, the time and cost associated with the laboratory fabrication of heat-cure acrylic crowns can be circumvented. This distinctive case report underscores the creation of a modified Groper's appliance for the aesthetic and functional rehabilitation of a child grappling with early childhood caries (ECC). The appliance was well received, and no adverse outcomes were observed.

A Radicular Cyst in the Mandibular Anterior Region of Primary Teeth

Radicular cysts are common among odontogenic cysts but are rare in primary teeth. They occur more frequently in the mandibular molar region and rarely in the mandibular anterior region. This is a case of a radicular cyst in the mandibular anterior teeth during the primary dentition stage. In addition, after the fenestration of cystic lesions, gauze is generally changed to prevent the extraction socket from closing. However, in this case, the patient was six years old. Therefore, to alleviate the burden of changing the dressing gauze, we practiced putting on and taking off the obturator before fenestration and using it immediately after surgery under general anesthesia. This made it possible to change the dressing gauze after surgery. We were able to maintain an open wound without the burden of dressing gauze changes. The use of the device was shown to be effective in maintaining open wounds in young patients.

Effective Management of a Tooth Eruption Bulge: A Comprehensive Case Report

An eruption bulge is a swelling or an enlargement below the gumline due to the eruption of a tooth. Radiographic images would also illustrate the fact that there may be the presence of a successor tooth (unerupted or unimpacted) under the bulge of the gingiva. Teething refers to the sequence of growth and appearance of the primary as well as permanent teeth within the oral region that varies according to age. A tooth eruption bulge is a lump that occurs due to the eruption of the teeth in the gum tissue. The appearance of the bulge varies according to the amount of fluid or blood present in this engorged organ. It is important to focus on the fact that the dentist will always be able to notice any changes and solve the issue when it comes to the check-ups, which should take place on a regular basis. Parents need to be aware of the possible adverse effects of trauma on primary incisors on the eruption as well as the health of its permanent successors. They need to watch and tell about any oral changes or conditions their child may have, like pain, color change, and swelling as this may tell of something negative to their dentition. Such a condition can only be managed using a multi-disciplinary team that includes a pedodontist, an orthodontist, and in severe cases an oral surgeon who will have to deal with the long-term sequelae of dental trauma. This is why it is necessary to educate them on these matters because then they can be proactive.

Treating a Dentoalveolar Fracture in a Four-Year-Old Girl With a Functional Removable Partial Denture

In children and young adults, traumatic dental injuries are common. Children's tooth loss is mostly caused by dentoalveolar trauma. Owing to anatomical variations and developmental phases, treating such injuries is difficult. Trauma to deciduous teeth might harm the permanent tooth beneath; however, trauma to permanent teeth can worsen their long-term outlook. An alveolar segment trauma may result in the irreversible loss of dental tissues, malalignment, and deformity. The periodontium and pulpal tissues suffer significant harm as a result of this. In the current case, there was a segmental cortical fracture in the mandible of a four-year-old girl child.

Comparative Evaluation of the Quality of Obturation Between Three Obturation Techniques in Primary Canines: An In Vitro Study

Aims This study compares three obturation techniques (rotary lentulo spiral, handheld lentulo spiral, and pressure syringe) for the quality of two filling pastes (zinc oxide eugenol (ZOE) paste and Metapex (Meta Biomed Co., Ltd., Chungcheongbuk-do, Korea). Methods and materials Sixty extracted primary canines were instrumented and obturated by filling materials. The obturation techniques were divided into three groups according to different obturation techniques. Obturation quality was evaluated for length, density, and presence of voids by using digital radiography. Results This study showed that the handheld lentulo spiral technique using Metapex and ZOE exhibited more optimal fillings for obturation length. The highest density obturation was achieved using the syringe injection approach with Metapex and ZOE. The highest incidence of both external and internal voids was observed in the group using ZOE with the handheld lentulo spiral technique Conclusions Based on the findings of this study, for both filling materials, the handheld lentulo spiral technique had the greatest number of optimal lengths but there were also more voids.

Long-Term Evaluation of Tooth Transplantation: An Umbrella Review

Aim/Objective: This umbrella review of systematic reviews aims to summarize the available data regarding both success and survival rates of tooth autotransplantation, in addition to analyzing the risk factors that are connected to those rates. Methods: This umbrella review was performed according to the evaluation of various meta-analyses and systematic reviews following AMSTAR2 guidelines. A systematic search of literature on PubMed, Scopus, MEDLINE, EMBASE, and the Cochrane Database. Six systematic reviews were included. Explicit inclusion and exclusion criteria were applied. It is registered in PROSPERO under the registration number (CRD-42023415623). Results: The studies reviewed were written from 2014 to 2018, which extracted the information from various studies spanning from 1968 to 2014. According to the selected studies regarding autotransplanted teeth in humans, they showed the following: A survival rate overall of 87.39% and a success rate overall of 90.29%. These factors were the most common in relation to the success of the autotransplanted teeth: age, gender, and stage of root development. On the other hand, common unfavorable results linked to the transplanted teeth in these studies were failure, ankylosis, and internal root resorption, followed by extraction and hypermobility. Conclusions: The wide body of evidence gathered illustrates that autotransplantation is an operation that dispenses high rates of survival and success. Furthermore, risk factors like root development stage, recipient site, and donor tooth type established a remarkable association with the negative outcomes of the procedure. For successful tooth autotransplantation, patient selection is crucial. Younger patients and those with donor teeth at an optimal stage of root development typically experience better outcomes. Preoperative planning should include comprehensive evaluations and advanced imaging techniques to accurately assess both the donor tooth and the recipient site. Nonetheless, on account of heterogeneity and the quality of the studies included in this investigation, caution should be taken when interpreting the mentioned results.

Parents' Knowledge and Awareness About the Importance of Primary Teeth and Space Maintainers in Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Primary teeth are important for eating, speaking, and esthetics, as well as for guiding the eruption and maintaining the space for the permanent teeth. The best space maintainers (SM) for permanent dentition are the natural primary teeth. The aim of this study was to assess parents' knowledge and awareness of the importance of primary teeth and SM in Saudi Arabia.

METHOD

This cross-sectional study invited parents who were living in Saudi Arabia via different social media platforms to complete a validated questionnaire. The data collected included demographic characteristics, questions about parents' knowledge of their children's oral hygiene, and the importance of primary teeth, as well as questions about knowledge of SM.

RESULTS

A total of 392 participants completed the questionnaire. Dental problems and pain were the most common reasons for visiting the pediatric dentist (n=260; 66.3%). With respect to the age at which the first primary tooth erupted, more than half of the parents (n=270; 68.9%) knew the correct age. Only 43.3% (n=168) of the parents had received any information about SM and only 39.5% (n=155) of them knew their purpose.

CONCLUSION

Most parents agree that treating primary teeth is important for their children's oral health and development. However, most are unaware of an SM's purpose. We recommend that dentists discuss SM's importance with parents actively after extracting their child's teeth. This will help increase parents' awareness and understanding of SM and encourage them to be more informed about this dental treatment option.

Resorption Potential of Endoflas Powder With Curcumin Gel Against Endoflas for Pulpectomy in Primary Mandibular Molars: A One-Year Follow-Up Evidence-Based Case Reports

Pediatric endodontics in the primary teeth is chemomechanical due to the difficulties encountered in cleaning and shaping the root canals having complex anatomical configurations. Not only are obturating materials having ideal properties to be used in the primary teeth, but also imparting an impervious hermetic seal to prevent the nidus of reinfection is highly pivotal for the success of pulpectomy. However, certain obturating materials contain one or the other components that are irritant to the periapical region and aggravates the inflammatory process. Hence, a paradigm shift has been witnessed with the evolution of herbal medicines having innumerable beneficial properties with a broad-spectrum action to replace those components causing irritation and inflammatory reactions in conventional obturating materials. One such herbal medicament is "curcumin" popularly known as the "golden herb," which has a wide repertoire of medicinal properties due to its bioactive component and volatile oil "turmerone." Endoflas is one of the suitable obturating agents used in the primary teeth for its high success rate, but the use of eugenol in it is associated with irritation of the periapical region and causes necrosis of bone and cementum. Hence, the present case report aims to assess the rate of resorption, resorption potential, and the periapical healing of a novel obturating material Endoflas powder with curcumin gel (EPCG) replacing the liquid eugenol against conventional Endoflas material for pulpectomy in primary mandibular molars.

Treatment Outcomes of Pulpotomy in Primary Teeth with Irreversible Pulpitis: A Systematic Review and Meta-Analysis

AIM

This systematic review and meta-analysis aimed to evaluate the success rates of pulpotomy treatment for irreversible pulpitis in primary teeth.

METHODS

This study was registered and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Relevant studies published between January 1980 and April 2023 were identified across eight online databases and two paediatric dentistry textbooks. Study selection, data extraction, and quality assessment were conducted by multiple investigators independently. Data analysis involved single-arm and two-arm meta-analyses, leave-one-out sensitivity analysis, meta-regression, and assessment of publication bias. The risks of bias were evaluated using the Cochrane Collaboration's assessment tools. The levels of evidence were determined using the Oxford Centre for Evidence-Based Medicine (OCEBM) tool.

RESULTS

Five primary studies were included. The weighted mean overall success rates at 6-month and 12-month follow-ups were 97.2% and 94.4%, respectively. Two-arm meta-analysis revealed no significant difference (p > 0.05) between the use of mineral trioxide aggregate (MTA) and non-MTA bioceramic-based materials as pulpotomy medicaments. The sample size of each study did not affect the degree of data heterogeneity. Egger's test revealed no significant publication bias.

CONCLUSIONS

Pulpotomy may be regarded as an alternative modality for treating primary teeth with irreversible pulpitis. Nevertheless, future well-designed trials and extended follow-up periods are warranted.

The effect of three different primary teeth rotary instrument systems on the amount of apically extruded debris in pulpectomy of primary teeth

Purpose

The objective of this study is to evaluate the amount of apically extruded debris and working time during root canal treatment with three different primary teeth rotary instrument systems.

Materials and methods

A total of 80 extracted primary second molar teeth were randomly divided into four groups (n=20) stratified by the instruments used: AF Baby Rotary, Easyinsmile Baby Rotary, Endoart Pedo Gold, and hand files. The apical extrusion of debris was collected then dried in Eppendorf tubes that were pre-weighed with 10-4 precision micro-balance. The incubation period was set as 14 days at 37°C. The dry weight was procured by deducting the preoperative weight from the postoperative weight. The systems' working time was calculated by chronometer. Mann Whitney U test with Bonferroni correction was used for pairwise comparison following the variance analysis with Kruskal Wallis test. Wilcoxon test was used for intragroup comparison.

Results

Although all instruments caused apically extruded debris (p<0.001), there was no statistically significant difference between the groups in debris extrusion. However, the longest working time was found in the manual K files, the Endoart Pedo Gold system had the shortest working time (p<0.001).

Conclusion

Our results demonstrate that all instrument systems caused apical extrusion of debris. Furthermore, the rotary instrument systems designed for primary teeth exhibited significantly shorter working time.

The effect of different intracanal irrigants on the push-out bond strength of dentin in damaged anterior primary teeth

This experimental study investigated the effect of different intracanal irrigants on the push-out bond strength of dentin in damaged anterior primary teeth. The crowns of 90 anterior primary teeth were sectioned horizontally, 1 mm above the cementoenamel junction (CEJ). Following canal preparation with K-files, all groups except the negative control received normal saline irrigation. Canals were then irrigated with either 3% or 5.25% sodium hypochlorite (NaOCl), 2% or 0.2% chlorhexidine (CHX) solution (except negative and positive controls). The roots were filled with Metapex material and covered with a calcium hydroxide liner. In root canals, the bond was applied by self-etching and then light-cured for 20 seconds before canals were restored incrementally with composite. Stereomicroscopes were used to assess failure patterns. Push-out bond strengths (MPa ± SD) were: 3% NaOCl (16.92 ± 5.78), 5.25% NaOCl (8.96 ± 3.55), 2% CHX (14.76 ± 5.56), and 0.2% CHX (7.76 ± 2.93). Significant differences were seen across the irrigants regarding the push-out bond strength of dentin sections (P <0.001). The most frequent failures were adhesive and cohesive. NaOCl and CHX irrigants increased the push-out bond strength compared to controls. Compared to controls, both 3% NaOCl and 2% CHX irrigants significantly increased the push-out bond strength of dentin in non-vital anterior primary teeth.

Root canal conicity determination of primary second molars using nanotomography: An in vitro study

BACKGROUND

The conicity of the root canals of primary teeth is an important measure for endodontic therapies. However, determining this conicity depends on the methods employed, which requires further investigation.

AIM

The aim of this study was to determine the conicity of the root canals of the upper and lower primary second molars using nanotomography (nCT).

DESIGN

An in vitro study was performed using nine primary second molars, both upper and lower, subjected to nCT. Comparisons between the diameters of root canals were performed between the thirds (cervical-D0, middle-D5, and apical-D7). The conicity (%) was determined for each root canal from cervical to apical. Data were statistically analyzed with a significance level of 5%.

RESULTS

The conicity ranged from 2% to 8% for the upper primary second molars. Significant differences in root canal diameter between the thirds (D0, D5, and D7 points) were observed in the mesio- and distobuccal roots (p < .05), but not in the palatal roots (p > .05). For the lower primary second molars, the conicity ranged from 2% to 17%, as well as significant differences in root canal diameter between the thirds (D0, D5, and D7 points) were observed in all roots (distal, mesiobuccal, and mesiolingual; p < .05).

CONCLUSION

The conicity of the upper primary second molars was different from that of the lower ones, which showed a greater variability.

Diagnosis and initial management of children presenting with premature loss of primary teeth associated with a systemic condition: A scoping review and development of clinical aid

BACKGROUND

Premature loss of primary teeth (PLPT) can be a rare presentation of systemic medical conditions. Premature loss of primary teeth may present a diagnostic dilemma to paediatric dentists.

AIMS

To identify systemic conditions associated with PLPT and develop a clinical aid.

DESIGN

OVID Medline, Embase and Web of Science were searched up to March 2023. Citation searching of review publications occurred. Exclusion occurred for conference abstracts, absence of PLPT and absence of English-language full text.

RESULTS

Seven hundred and ninety-one publications were identified via databases and 476 by citation searching of review articles. Removal of 390 duplicates occurred. Following the exclusion of 466 records on abstract review, 411 publications were sought for retrieval, of which 142 met inclusion criteria. Thirty-one systemic conditions were identified. For 19 conditions, only one publication was identified. The majority of publications, 91% (n = 129), were case reports or series. Most publications, 44% (n = 62), were related to hypophosphatasia, and 25% (n = 35) were related to Papillon-Lefèvre. Diagnostic features were synthesised, and a clinical aid was produced by an iterative consensus approach.

CONCLUSIONS

A diverse range of systemic diseases are associated with PLPT. Evidence quality, however, is low, with most diseases having a low number of supporting cases. This clinical aid supports paediatric dentists in differential diagnosis and onward referral.

Evaluation of the effect on the permanent tooth germ and the adjacent teeth by finite element impact analysis in the traumatized primary tooth

BACKGROUND

One of the primary concerns in the paediatric emergencies is traumatic dental injuries.

OBJECTIVE

This study aimed to create trauma in primary teeth and reveal its effects finite element analysis.

DESIGN

Three-dimensional models were created using cone-beam computed tomography images, representing a maxillary primary central incisor. An impact force moving at a speed of 10 m/s was simulated on the labial tooth surface in two directions: buccal and incisal.

RESULTS

The stress and deformation experienced in the adjacent tooth due to the primary tooth were higher than those generated in the permanent tooth. Forces applied in the incisal direction resulted in higher levels of stress and deformation in the permanent tooth germ. The difference between the stress and deformation values in primary teeth in the forces applied in the buccal and incisal directions is 21% and 75%, respectively; in the permanent tooth germ, this difference was 233% and 100%, respectively.

CONCLUSIONS

Based on the findings of this study, it is crucial to thoroughly evaluate not only the affected primary tooth but also the adjacent teeth and the permanent tooth germ in traumatic dental injuries. This comprehensive examination allows for the anticipation and management of potential long-term problems.

Risk factors associated with the occurrence of avulsion in the primary incisors: A case-control study

BACKGROUND

Identifying factors associated with the occurrence of primary tooth avulsion is essential to promote prevention strategies.

AIM

To investigate the risk factors associated with primary incisor avulsion and variables associated with post-avulsion sequelae in the permanent successor.

DESIGN

This case-control study comprised 407 children (cases) with primary incisor avulsion and 407 children (controls) with other traumatic dental injuries (TDI). The association between explanatory variables and avulsion was evaluated through logistic regression. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Poisson regression analyses between potential explanatory variables and sequelae were run, from which relative risks (RR) and corresponding 95% CI were estimated.

RESULTS

TDI caused by moderate falls (OR = 2.20; 95% CI = 1.47 to 3.27), affecting lateral incisors (OR = 10.10; 95% CI = 3.89 to 26.54) and the lower arch (OR = 9.54; 95% CI = 3.15 to 28.85), were associated with primary incisor avulsion. Moreover, children with previous severe TDI, anterior open bite, and anterior crossbite had higher odds of primary incisor avulsion. Children who suffered from any primary tooth avulsion (RR = 2.68; 95% CI = 1.82 to 3.95) had a higher risk of sequelae in the permanent successors. The risk for sequelae in the permanent teeth was significantly greater for younger children under age 2 years than for children ages 3 to 5 years.

CONCLUSION

Risk factors for primary incisor avulsion are related to the severity of the fall, tooth position, history of previous TDI, and malocclusion. Furthermore, avulsion increases the risk of sequelae in the permanent successors.

Assessment of Two Different Obturation Systems in Primary Teeth: A Comparative Study

Aim

The purpose of this study was to evaluate the efficacy of two distinct obturation techniques in primary teeth.

Materials and Methods

For this investigation, 40 primary molar teeth were taken into consideration. Every sample underwent sample preparation. All teeth were evenly split into two groups: Group 1-obturation using the lentulospiral method and Group 2-obturation using the NaviTip method. The comparison between the two procedures was established through radiographic evaluation of the obturation quality and voids in the obturated canals.

Results

In the lentulospiral method, 12 (60%) were optimal filling, 6 (30%) were underfilling, and 2 (10%) were overfilling. In the lentulo spiral method, 40% voids were present, and in the NaviTip method, 15% voids were present.

Conclusion

The present study concluded that the NaviTip syringe method was sufficiently effective in regulating voids and yielded the best results for the apical seal, whereas the lentulo spiral approach generated the best results in terms of length of obturation.

Photodynamic therapy in the root canal treatment of primary teeth: A systematic review of clinical trials

BACKGROUND

Dental caries is the most common oral disease worldwide, and it is estimated to affect 2.3 billion people, with at least 530 million of them being schoolchildren with decayed primary teeth. This condition can rapidly evolve into irreversible pulp inflammation and pulp necrosis and thus requiring endodontic intervention. Photodynamic therapy (PDT) is a supplementary method to conventional pulpectomy and is used to improve the protocol used for disinfection.

AIM

The main objective of this study was to evaluate through a systematic review the efficacy of supplementary PDT on the pulpectomy of primary teeth. This review was registered a priori on the PROSPERO database (CRD42022310581).

DESIGN

Two independent and blinded reviewers carried out a comprehensive search in five databases: PubMed, Cochrane, Scopus, Embase, and Web of Science. Eligible studies were randomized and nonrandomized clinical trials that evaluated in vivo microbiological load or clinical outcomes after using supplementary PDT in infected primary teeth.

RESULTS

After the selection process, four studies met the inclusion criteria and were included in this study. Data regarding the sample characteristics and PDT protocols were retrieved. All included trials used phenothiazinium salts as photosensitizer agents. Only one study observed a significant difference in the in vivo microbiological load reduction outcome when performing PDT on primary teeth. The remaining studies all discussed the possible benefits of this intervention; however, none observed a significant difference in this outcome.

CONCLUSION

In this systematic review, moderate-to-low certainty of the available evidence was observed, and thus, no significant conclusions can be drawn from the findings.

The Impact of Silver Diamine Fluoride Only or Simultaneously With Potassium Iodide Treatment on the Bond Durability of Resin Composite Material on Primary Teeth

We aim to evaluate the bond strength between resin composite and primary demineralized dentin, pretreated with silver diamine fluoride (SDF) and simultaneous SDF with potassium iodide (KI) after thermal aging. In this in vitro study, human carious-free primary molars were randomly assigned into three groups and prepared by exposing the superficial dentin. The primary dentin of each molar was demineralized. The first group (the control) received saline treatment before bond application. SDF was pretreated for the second group, whereas SDF and KI were used for the third. After that, the pretreated dentin was immediately built with resin composite bonded with a universal adhesive and kept wet for 24 hours. Then, the pretreated molars were prepared into beam specimens for microtensile bond strength (µTBS), 16 for each group, and subjected to thermal aging. Lastly, they were tested using a universal testing machine, and the resulting data were analyzed using one-way analysis of variance (ANOVA) followed by Tukey's post hoc test. It was found that the SDF-KI group had a significant difference with both the control and SDF groups (p < 0.05), while the control and SDF groups showed no significant differences (p = 0.310). The SDF-KI group had the highest mean value of 11.73 ± 4.39 megapascal (MPa). In contrast, the control group had the lowest mean value of 9.31 ± 3.41 MPa. Post hoc pairwise comparison results showed that SDF-KI pretreatment had a significantly higher strength value than the control and SDF groups. Pretreatment of demineralized primary dentin with SDF-KI does not negatively affect the immediate loading of resin composite. However, under the limitation of this study, KI application after SDF pretreatment is recommended to enhance the bond's durability of resin composite to demineralized dentin.

Evaluating Glass Ionomer Cement Longevity in the Primary and Permanent Teeth-An Umbrella Review

The aim of this umbrella review was to evaluate the longevity of glass ionomer cement (GIC) as a restorative material for primary and permanent teeth. Research in the literature was conducted in three databases (MedLine/PubMed, Web of Science, and Scopus). The inclusion criteria were: (1) to be a systematic review of clinical trials that (2) evaluated the clinical longevity of GICs as a restorative material in primary and/or permanent teeth; the exclusion criteria were: (1) not being a systematic review of clinical trials; (2) not evaluating longevity/clinical performance of GICs as a restorative material; and (3) studies of dental restorative materials in teeth with enamel alterations, root caries, and non-carious cervical lesions. Twenty-four eligible articles were identified, and 13 were included. The follow-up periods ranged from 6 months to 6 years. Different types of GICs were evaluated in the included studies: resin-modified glass ionomer cement (RMGIC), compomers, and low- and high-viscosity glass ionomer cement. Some studies compared amalgam and composite resins to GICs regarding longevity/clinical performance. Analyzing the AMSTAR-2 results, none of the articles had positive criteria in all the evaluated requisites, and none of the articles had an a priori design. The criteria considered for the analysis of the risk of bias of the included studies were evaluated through the ROBIS tool, and the results of this analysis showed that seven studies had a low risk of bias; three studies had positive results in all criteria except for one criterion of unclear risk; and two studies showed a high risk of bias. GRADE tool was used to determine the quality of evidence; for the degree of recommendations, all studies were classified as Class II, meaning there was still conflicting evidence on the clinical performance/longevity of GICs and their recommendations compared to other materials. The level of evidence was classified as Level B, meaning that the data were obtained from less robust meta-analyses and single randomized clinical trials. To the best of our knowledge, this is the first umbrella review approaching GIC in permanent teeth. GICs are a good choice in both dentitions, but primary dentition presents more evidence, especially regarding the atraumatic restorative treatment (ART) technique. Within the limitation of this study, it is still questionable if GIC is a good restorative material in the medium/long term for permanent and primary dentition. Many of the included studies presented a high risk of bias and low quality. The techniques, type of GIC, type of cavity, and operator experience highly influence clinical performance. Thus, clinical decision-making should be based on the dental practitioner's ability, each case analysis, and the patient's wishes. More evidence is needed to determine which is the best material for definitive restorations in permanent and primary dentition.

Occlusal Caries Detection with Intraoral Scanners in Pediatric Dentistry: A Comparative Clinical Study

Background: The aim of this clinical study was to compare the occlusal caries detection (OCD) performance of the intraoral scanners (IOSs) Trios 4 (TIO, 3Shape) and Emerald S (EME, Planmeca) and the Diagnocam (DIA, KaVo) with the established visual (WHO) examination (VIS, reference method). Methods: Between 08/2022 and 02/2023, 60 children (mean age 9.6 ± 2.5 years) were examined as part of their regular dental checkups. OCD was performed at the tooth level, separately for primary and permanent unrestored teeth. Furthermore, two thresholds were analyzed: sound versus overall caries (pooled data of enamel and dentin caries, TH1) and pooled data of sound and enamel caries versus dentin caries (TH2). Results: The best agreement with the reference method (reliability) in both dentitions was obtained for DIA (ĸ = 0.829/ĸ = 0.846; primary/permanent teeth), followed by EME (ĸ = 0.827/ĸ = 0.837) and TIO (ĸ = 0.714/ĸ = 0.680). Similar results were shown for the diagnostic quality (sensitivity, specificity and area under the curve of the receiver operating characteristic curve), with higher values for TH1 than for TH2. Both IOSs and the DIA showed worse results than the reference method VIS. Conclusions: Currently, IOS should be used as an additional caries detection tool, especially for visualization, and cannot be recommended as a basic tool for diagnosis or invasive/noninvasive therapy decisions in OCD.