Survey of comprehensive restorative treatment for children under general anesthesia

Dental treatment outcomes in Thai children treated for severe early-childhood caries under general anaesthesia and non-pharmacological behaviour management: a retrospective study

PURPOSE

The aim of this study was to compare dental-treatment outcomes, oral-hygiene improvement, and patient co-operation during follow-up visits between children treated under general anaesthesia (GA) and non-pharmacological behaviour management (NP).

METHODS

This retrospective study reviewed the dental chart records of healthy patients less than 71-month-old with severe early childhood caries (S-ECC) from 2008 to 2020 with at least a 6-month follow-up. The demographical data, dental-treatment outcomes, oral-hygiene status, and patient behaviour at the follow-up visits were analysed by the Mann-Whitney U test, Pearson's Chi-square, Fisher's exact test, Friedman test, and Wilcoxon test with a significance level of 0.05.

RESULTS

This study included 210 GA cases and 210 age-matched control NP cases. The GA group had a significantly higher caries experience, lower patient co-operation, poorer oral hygiene, and higher number of complex dental treatment than the NP group at baseline (p < 0.001). The number of children who had incomplete dental treatment under non-pharmacological behaviour management was higher than the GA group. After treatment, the number of new carious teeth in the NP group was significantly higher than in the GA group only at the 6-month follow-up. However, there was no significant difference in treatment failure, oral-hygiene improvement, and patient behaviour between groups.

CONCLUSION

Although patients in the GA group had higher dental and behaviour problems than the NP group, the overall dental-treatment outcomes, including oral hygiene and behaviour improvement, were not significantly different between groups Therefore, regular follow-up and preventive treatment in the maintenance phase are essential for children with severe early-childhood caries.

Evaluation of Clinical Success, Caries Recurrence, and Oral Health-Related Quality of Life of Children Undergoing Full Mouth Rehabilitation for Early Childhood Caries: A Prospective Cohort Study

AIM

This prospective cohort study aimed to assess the clinical success, caries recurrence, and oral health-related quality of life of children undergoing full mouth rehabilitation for early childhood caries under general anesthesia. The study sought to understand the long-term impact of these interventions on early childhood caries (ECC) management.

METHODOLOGY

The study included 300 children aged three to six years diagnosed with ECC requiring full mouth rehabilitation under general anesthesia. The assessment included clinical success of various dental treatments, caries recurrence rates, and oral health-related quality of life using the Early Child Oral Health Impact Scale at baseline, 12 months, and 24 months post-treatment. Specialized caries preventive protocols were implemented, including education on oral hygiene, reminders, and nutritional guidance.

RESULTS

272 children attended the 12-month follow-up, out of which 11 children had new carious lesions. Two hundred fifty-two children were reported for the 24-month follow-up, in which 19 children reported new carious lesions. The clinical success rate of treatment was found to be high. The oral health-related quality of life showed a significant and sustained improvement from baseline to 12 months and further improvement at 24 months post-treatment.

CONCLUSION

Full mouth rehabilitation under general anesthesia is an effective approach for managing ECC in young children, with high clinical success rates and significant improvements in the oral health-related quality of life over two years. Preventive oral health strategies are necessary to maintain these positive outcomes and improve the overall well-being of affected children.

Does the Modality of Dental Treatment Affect the Treatment Prognosis and the Necessity of Re-Treatments?

BACKGROUND

The utilization of evidence-based approaches is crucial to achieving long-term positive outcomes for treatment performed chairside or under general anesthesia. The study aimed to evaluate if treatment modality (at the chairside or under general anesthesia) affects prognosis and the need for re-treatment.

METHODS

Oral-hygiene, gingival, and plaque indexes were recorded during the control appointment. The success of all treatments was evaluated according to the scoring of particular evaluation criteria.

RESULTS

A total of 1066 dental procedures were performed on 92 children. Plaque index scores were higher for patients treated under general anesthesia. The success rate of restorative procedures was 82.5% under general anesthesia and 80.6% at the chairside. There was no statistically significant difference between the mean number of restorative treatments and the need for re-treatment between general anesthesia or chairside (p = 0.649, p = 0.311). The mean number of unsuccessful endodontic treatments performed under general anesthesia was higher than performed chairside. Only two out of thirty stainless-steel crowns were decemented, all performed under general anesthesia.

CONCLUSIONS

The high volume of restoration failure due to secondary caries has highlighted the need for alternative approaches to caries management, especially given the risks associated with repeat general anesthetic.

Incidence and risk factors of unplanned retreatment following dental general anesthesia in children with severe early childhood caries

Objective

This study aimed to retrospectively describe the unplanned retreatment of dental general anesthesia (DGA) in children with severe early childhood caries (S-ECC) and explore potential factors that may influence the outcome of DGA treatment.

Methods

Medical records of children with S-ECC who received DGA treatment were screened, and necessary data were extracted. The Kaplan-Meier method and Cox proportional hazards model were used to estimate the DGA survival rate and explore the potential factors affecting the success rate of DGA treatment.

Results

Medical records of 852 children were included; 509 (59.7%) children with 1,212 (10.7%) teeth underwent unplanned retreatment. Restoration failure (30.12%) and new caries (29.46%) accounted for the most significant proportion of all failures. The median survival times were 510 and 1,911 days at the child and tooth levels, respectively. Unplanned retreatment risk was associated with the age of S-ECC children, frequency of follow-up, and fluoride application (hazard ratio = 0.97, 0.78, 0.69, P < 0.001).

Conclusion

The treatment outcome of DGA administered to children with S-ECC was satisfactory at the tooth level from the perspective of the incidence of unplanned retreatment. Restoration failure was the main reason for the high unplanned retreatment rate. Strategies for a better outcome of DGA include improving the professional knowledge and skills of pediatric dentists and enhancing compliance of parents/patients. Health education and regular topical fluoride application may improve the success rate of DGA treatment.

Clinical and Radiographic Success of Resin-bonded Strip Crowns in Primary Incisors with Varying Extents of Sound Tooth Structure Available for Bonding

Context

First-time dental treatment for children is often sought due to carious, malformed, fractured, and discolored teeth. The strip crown represents a highly esthetic and popular option for the restoration of primary anterior teeth. However, there are limited data on the clinical success of these crowns based on the extent of surface area used for adhesion.

Aims settings and design

This in vivo study aimed to assess the clinical, radiographic, and photographic performance of 66 composite strip crown restorations on primary anterior teeth for up to 15 months and compare the outcome based on the extent and surface area of tooth structure available.

Materials and methods

The amount of surface area available in each group after removal of affected enamel was evaluated through 3D scanning of study casts and digital measurements. The teeth were thus grouped into three categories: group I with crown structure involvement up to the incisal one-third, group II with involvement up to the middle of the middle third, and group III with involvement up to the cervical one-third.

Statistical analysis used

Kruskal-Wallis H test and Mann-Whitney U test were used for computation of mean scores for intra- and intergroup comparison, respectively. Scoring was done as per FDI clinical criteria on a scale of 1 to 5.

Results

Group III showed the highest mean scores at different time intervals and also the highest failure rate (52.38%), followed by group II (12%) and group I (5%). The overall retention rate observed for the strip crowns was 77.28% at the end of 15 months.

Conclusion

Strip crowns should be considered for teeth that offer a minimum of half to two-thirds of the healthy tooth structure remaining. Further, longitudinal studies are required to add to the results of the final outcome of these restorations.

Key messages

A critical surface area value of <50 mm² or less than half of the available sound tooth structure was found to be detrimental to the retention rate of these crowns in this study. It could therefore be suggested to consider strip crowns for teeth that offer a minimum of half to two-thirds of healthy tooth structure remaining.

How to cite this article

Grewal N, Jha S, Kaur N. Clinical and Radiographic Success of Resin-bonded Strip Crowns in Primary Incisors with Varying Extents of Sound Tooth Structure Available for Bonding. Int J Clin Pediatr Dent 2021;14(4):454-461.

Association of Vital Pulp Therapy Outcomes with Tooth Type, Arch Location, Treatment Type, and Number of Surfaces Destroyed in Deciduous Teeth: A Retrospective Study

There is a paucity of information concerning vital pulp treatment outcomes in the undergraduate teaching setting. This study aimed to determine which type of deciduous molar, arch location, type of vital pulp therapy, and the number of carious surfaces involved had a better prognosis when carried out by undergraduate dental students. The method used was the review of clinical records of 590 patients with 600 deciduous molars, that visited the outpatient undergraduate dental clinics for vital pulp therapy. Statistical analysis used to determine the associations of tooth type, arch location, treatment type, and the number of carious surfaces involved in successful outcomes was logistic regression analysis with significance set at p < 0.05. According to the regression analysis model results, there was a significant association based on tooth type (p < 0.05) and arch location (p = 0.003). In addition, there was a significant association based on the type of treatment performed (p = 0.036). However, there was no significant association in success rates based on the number of carious surfaces involved (p = 0.873). In conclusion, second deciduous molars and maxillary deciduous molars had a better overall prognosis, and indirect pulp therapy was revealed to be more highly associated with successful treatment outcomes in comparison to ferric sulfate pulpotomy in our setting.

Survival rate and associated factors affecting pulpectomy treatment outcome in primary teeth

Objectives

To evaluate the survival rates of pulpectomized primary teeth treated under general anesthesia (GA) or local anesthesia (LA), and to determine which factors affected tooth survival following pulpectomy.

Materials and methods

This retrospective study collected data from dental records. Patients under 5 years of age received dental treatment under GA or LA during 2007–2016, with at least one anterior or posterior tooth receiving a pulpectomy, were recruited. Pulpectomy was considered a failure if the tooth required extraction or retreatment due to pulp treatment failure. Survival analysis was used to assess the outcome. The cumulative survival probability was analyzed with the Kaplan–Meier estimator. Cox regression analysis was used to evaluate the associations between tooth survival and possible prognosis factors; sex, age, dental arch (upper/lower), tooth type (anterior/posterior), molar type (first/second molar), molar location (upper/lower molar), root filling material type, restoration type, preoperative radiographic findings and presence of pathologic root resorption.

Results

Two hundred and twenty‐seven primary teeth were included. At the 5‐year follow‐up, the survival rates of the pulpectomized teeth treated under GA and LA were 81.4% and 87.4%, respectively, which were not significantly different (p ≥ 0.05). A radiolucency on the preoperative radiograph was the only factor associated with tooth extraction or retreatment following pulpectomy, with a hazard ratio of 3.88 (95% CI = 1.29–11.65).

Conclusions

Pulpectomized primary teeth treated under GA and LA demonstrated high survival rates. Preoperative radiolucency is a possible associated factor that decreases tooth survival following pulpectomy.

Why this paper is important

Pulpectomy treatment under GA and LA provided high 5‐year cumulative survival rates, which were not significantly different.

Pulpectomy treatment in teeth with a preoperative radiolucency were 3.9‐fold as likely to fail as teeth without pathology.

Based on our findings, practitioners could apply these findings and discuss with caregivers about the treatment options, outcomes, and prognosis of pulpectomized teeth.

Success rates of mineral trioxide aggregate, ferric sulfate, and sodium hypochlorite pulpotomies: A prospective 24-month study

BACKGROUND/PURPOSE

Several medicaments have been used as alternatives to formocresol (FC) for pulpotomy in primary molars with deep carious lesions. However, no prospective study has observed and compared the outcomes of different medicaments. The aim of this prospective study was to compare 12- and 24-month success rates among sodium hypochlorite (NaOCl), ferric sulfate (FS), and mineral trioxide aggregate (MTA) pulpotomies performed in primary molars.

METHODS

A total of 108 primary molars in 27 children (18 boys and nine girls) were selected. All subjects exhibited one primary molar indicated for indirect pulp therapy (IPT; control group) and three carious primary molars indicated for pulpotomy with 5% NaOCl, 15.5% FS, and MTA. Clinical and radiographic assessments for determining success rates were performed using established criteria before and at 12 and 24 months after treatment. All data were analyzed using the chi-square test.

RESULTS

Clinical treatment success was observed for all teeth during the first 12 months. At 24 months, the clinical and radiographic success rates were both 100% in the control and MTA groups, both 92.6% in the NaOCl group, and 92.6% and 88.9%, respectively, in the FS group. There were no significant differences in the clinical (p = 0.328) and radiographic (p = 0.164) success rates among the four groups.

CONCLUSION

NaOCl is easily available and less expensive than MTA, and our results suggest that the outcomes of NaOCl pulpotomy and MTA pulpotomy are similar. Therefore, NaOCl may be a practical alternative to FC for pulpotomy in primary molars.

Comparison of long-term outcomes between ferric sulfate pulpotomy and indirect pulp therapy in primary molars

BACKGROUND/PURPOSE

There is no long-term study on the comparison of indirect pulp therapy with ferric sulfate pulpotomy in primary molars. This retrospective study aimed to compare the success rates of ferric sulfate pulpotomy with those of indirect pulp therapy in primary molars during a 4-year follow-up.

MATERIAL AND METHODS

A total of 114 primary molars from 38 children (16 females and 22 males) with deep carious lesions were selected. Among these molars, 71 indicated for ferric sulfate pulpotomy and 43 indicated for indirect pulp therapy were treated under general anesthesia according to a standard protocol by two senior pediatric dentists. Clinical and radiographic assessments for determining success rates were performed using established criteria at initial, post-operatively, and at 24 and 48 months. Data were analyzed using Fisher's exact test to compare success rates of ferric sulfate pulpotomy and indirect pulp therapy at the 24- and 48-month follow-ups.

RESULTS

The overall success rates for indirect pulp therapy and ferric sulfate pulpotomy were 100% (43/43) and 91.5% (65/71), respectively, at the 24-month follow-up; the difference was not significant (P = 0.08). However, the success rate for indirect pulp therapy (93.0%, 40/43) at the 48-month follow-up was significantly higher than that for ferric sulfate pulpotomy (70.4%, 50/71) (P = 0.008).

CONCLUSION

Indirect pulp therapy showed a significantly higher success rate at the 4-year follow-up than did ferric sulfate pulpotomy for treating deep carious lesions in primary molars. Earlier exfoliation was observed after treatment with ferric sulfate pulpotomy compared to indirect pulp therapy.

Failure Rate of Pediatric Dental Treatment under General Anesthesia

Aim: To assess the failure rates of various pediatric dental treatments performed under general anesthesia (GA) after six months to five years of follow-up. Design: This multicenter retrospective cohort study was performed on patients treated by five pedodontists in two private hospitals located in northern Iran during 2010⁻2013 and comprised 155 patients. The patients were recalled and clinically examined. During the clinical examination of the primary teeth, oral hygiene, dmft index, and failure of previous treatments was evaluated. The data were analyzed using the Chi square and regression analyses with a significance level of 0.05. Results: 114 patients (74 males and 40 females, mean age: 37.17 ± 10.75 months) with 1155 primary teeth treated under GA participated in the follow-up. The overall failure rate was 6.59%. The failure rates of pulpectomy, pulopotomy, fissure sealant, stainless steel crown (SSC), amalgam, and composite fillings were 2.90%, 3.03%, 4.83%, 5.26%, 5.33%, and 9.63%, respectively. Among the confounding factors, only gender had a significant effect on the anterior composite failure rate (p = 0.029) and age had a significant effect on the failure rate of fissure sealant therapy (p = 0.015) and SSC (p = 0.018). Conclusion: The overall rate of treatment failure in pediatric patients, treated under GA, was 6.59%.