Rectal Sedation With Ketamine and Midazolam in the Management of Uncooperative Children During Dental Treatment: A Case Series and Method Description

Background In pediatric dentistry, sedation aims to eliminate anxiety to facilitate the completion of dental procedures. Sedation in children is a multidimensional field that includes the child, parents/guardians, and the health care team. The rectal route is generally painless, making it suitable for children who are afraid of needles. This route has several advantages over the oral route, including reduced patient cooperation requirements, a faster and more predictable onset, and less physical trauma than the intravenous and intramuscular routes. This case series aimed to evaluate the effectiveness and success rate of rectal sedation with ketamine and midazolam in the management of uncooperative children during dental treatment. Case presentation Ten healthy children with definitely negative behavior were enrolled in this study. Each child was given 7 mg/kg of ketamine in combination with midazolam 0.1 mg/kg by the rectal route. The mean onset sedation time was 9.5 minutes, and pulpotomy procedures were done. Behavioral response was monitored throughout treatment using the Ohio State University Behavioral Rating Scale (OSUBRS), and the depth of sedation was measured using the University of Michigan Sedation Scale (UMSS). The Houpt General Behavior Scale was used to estimate the treatment success rate based on the overall behavior rating. All 10 cases showed good anxiolysis and cooperation following rectal administration, with no side effects observed. Conclusions Rectal administration of ketamine in combination with midazolam may be considered a reliable method in the management of uncooperative children during dental treatment. No adverse effects were observed during or after the sedation procedure.

Comparison of the Pull-Out Resistance of Grossly Decayed Primary Anterior Teeth Restored With Two Different Intracanal Posts: An In Vitro Study

Background Severely damaged primary anterior teeth that require pulp therapy present a high risk of failure due to the loss of tooth substance, resulting from pre-existing decay and endodontic therapy. The ideal post material should have physical and mechanical properties similar to those of dentin. Another concern in restoring endodontically treated primary teeth is the need to find a material that can resorb similar to the natural tooth structure as a part of the exfoliation process, allowing normal eruption of permanent successors. Accordingly, there is no such material other than dentin itself. The introduction of biological dentin posts offers an excellent alternative for restoring such teeth. This study aimed to assess the effect of using dentin posts on the pull-out resistance of endodontically treated primary anterior teeth in comparison to glass fiber posts. Methodology A sample of 30 primary anterior teeth was collected from the outpatient clinic of the Pediatric Dentistry Department, Faculty of Dentistry, Damascus University. A total of 15 freshly extracted permanent teeth with single roots were also collected from the outpatient clinic of the Maxillofacial Surgery Department, Faculty of Dentistry, Damascus University. The roots of the permanent teeth were used to prepare 30 dentin posts using a CAD-CAM machine. After receiving proper endodontic treatment, the primary teeth were divided into two groups (15 teeth in each group). The first group was restored with dentin posts, and the second was restored with glass fiber posts, with the posts measuring 3 mm in length for both groups. Pull-out resistance testing was performed using a Testometric machine. Results The arithmetic mean of the forces applied in the glass fiber posts group was 153.2 ± 39.12 N, while the arithmetic mean of the forces applied in the dentin posts group was 156.7 ± 39.78 N. The data were analyzed at a 95% confidence interval using the independent Student's t-test. There were no statistically significant differences in pull-out resistance between the two groups. Conclusions Dentin posts showed a little increase in pull-out resistance than glass fiber posts. Therefore, the use of dentin posts as intracanal retention in primary anterior teeth is a successful alternative for composite posts.

Comparing the Fracture Resistance of Dentine Posts and Glass Fiber Posts in Primary Maxillary Incisors: An In Vitro Study

Background/purpose An ideal post material should have physical and mechanical properties similar to dentin. Another problem when restoring primary teeth that have undergone root canal treatment is the availability of materials that are resorbed in the exfoliation process in a manner similar to the structure of the natural tooth, allowing the normal eruption of a permanent tooth. This study aimed to evaluate the effect of using dentine posts on the fracture resistance of endodontically treated primary incisors in comparison to glass fiber posts. Materials and methods The study sample consisted of 30 extracted primary maxillary incisors that were randomly distributed into the following two groups: group I (experimental, n=15), which was restored with dentine posts; and group II (control, n=15), which was restored with glass fiber posts. Initially, 10 extracted single-root permanent teeth were collected to prepare 20 dentine posts using a computer-aided design-computer-aided manufacturing (CAD-CAM) machine. Then, the crowns of maxillary primary incisors were cut and the canals were prepared and filled. Then the preparation for a post was made using Gates Glidden drills, and the posts were placed with an extension of 3 mm within the canal in both groups, then the crown was built and the teeth were placed within acrylic cubes and subjected to 500 thermocycling. Fracture resistance was recorded using a Testometric machine (Rochdale, England: Testometric Co. Ltd.). Data were analyzed using an independent Student's t-test. Results The dentine posts group showed greater fracture resistance (246.3 N) than the glass fiber posts group (206.3 N). A statistically significant difference (p=0.004) was found between the two groups in favor of the dentine posts group. Conclusion Based on this in vitro study, the dentin posts used in restoring severely decayed primary maxillary incisors showed greater fracture resistance than glass fiber posts. Therefore, the use of dentin posts as intra-canal stabilizers in maxillary primary incisors is a good alternative for glass fiber posts.

Evaluation of the Antibacterial Efficacy of QMix and AgNP Solutions in Root Canals of Primary Molars: An In-Vitro Study

Purpose

The study aimed to evaluate QMix²ⁱⁿ¹ and silver nanoparticles (AgNPs) solution in eliminating Enterococcus faecalis (E. faecalis) bacteria within root canals of primary molars.

Materials and methods

The study sample consisted of 45 extracted primary molars, which were divided into three groups: Group 1 (control) NaOCl 5.25%, Group 2 (experimental) QMix^{2 in 1}, and Group 3 (experimental) AgNPs 4000 ppm. The root canals were sterilized within an autoclave and then contaminated with E. faecalis bacteria. The root canals were irrigated for five minutes in a quantity of 3 ml using a 31-gauge irrigation needle, and then bacterial smears were taken.

Results

Sodium hypochlorite, AgNPs, and QMix²ⁱⁿ¹ effectively reduced the bacterial count of Enterococcus within root canals of primary molars. There were statistical differences between all groups. QMix²ⁱⁿ¹ solution showed the greatest antibacterial efficacy, then NaOCl solution and AgNPs solution. 

Conclusion

All irrigation solutions used are effective in eliminating E. faecalis. QMix²ⁱⁿ¹ can be considered a good alternative to sodium hypochlorite in irrigation root canals of primary teeth.