Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document

Phosphorylated chitosan and nano-sized TMP: Enhancing strength, antibiofilm action, and biocompatibility of restorative glass ionomer cements

OBJECTIVES

Evaluated the effect of phosphorylated chitosan (ChiPh) and nano-sized sodium trimetaphosphate (TMPnano) incorporation into resin modified glass ionomer cement (RMGIC) on mechanical, fluoride release, antimicrobial and cytotoxic properties.

METHODS

RMGIC was combined with ChiPh (0.25 %/0.5 %) and/or TMPnano (14 %). The diametral compressive/tensile strength (DCS/TS), surface hardness (SH) and degree of conversion (%DC) were determined. For fluoride (F) release, samples were immersed in DE/RE solutions. Antimicrobial/antibiofilm activity was evaluated by agar diffusion test/biofilm metabolism. Cytotoxicity on MDPC-23 odontoblast cell lines was evaluated.

RESULTS

TS and DCS (24 h), all the groups were similar (p > 0.05). After 7 days, RMGIC-14 %TMPnano-0.25 %ChiPh showed the best results for TS/DCS (p < 0.05). The SH was lower and similar for the RMGIC and RMGI-14 %TMPnano-0.5 %ChiPh groups (p > 0.05) after 24 h; after 7 days, all groups containing TMPnano and/or ChiPh showed higher SH when compared to RMGIC, except for RMGIC-0.5 % ChiPh. The %DC was similar for all groups (p = 0.172). There was a gradual release of F for all groups during the 15 days; in the cumulative analysis, after 15 days, the RMGIC-14 %TMPnano-0.25 %ChiPh group showed the highest value (p < 0.05). Viability against S. mutans was observed for the RMGIC-14 %TMPnano-0.25 %ChiPh group (p < 0.05). After 24 h, the RMGIC-0.25 %ChiPh and RMGIC-14 %TMPnano-0.25 %ChiPh groups showed the lowest cytotoxic effect (p = 0.371); at 48 h/72 h, only the RMGIC-14 %TMPnano-0.25 %ChiPh group showed similar cytocompatibility.

CONCLUSION

The addition of ChiPh (0.25 %) and TMPnano (14 %) improved the RMGIC's mechanical, antimicrobial/antibiofilm and cytotoxic properties.

CLINICAL RELEVANCE

ChiPh and TMPnano into RMGIC could be a promising restorative material for application in patients with active dental caries.

Aetiological factors in molar incisor hypomineralisation: a case-control study from Salamanca, Spain

BACKGROUND

Molar incisor hypomineralisation (MIH) is a developmental dental condition that causes defects in the enamel of the first molars and permanent incisors. The aim of the present study was to assess possible causal correlations between the mother-child dyad medical history and MIH.

METHODS

An observational, retrospective, case‒control pilot study was carried out at the Dental Clinic of the University of Salamanca. This study was conducted between November 2023 and May 2024. Data on potential aetiological factors were collected through personal interviews, and the children's parents were asked aetiological questions. Statistical analysis was performed with Student's t test and the chi-square test.

RESULTS

A total of 140 children were enrolled in the study. The case group included 70 children with MIH (31 boys and 39 girls; mean age: 9.1 ± 2.32 years), while the control group comprised 70 children without MIH (32 boys and 38 girls; mean age: 9.57 ± 3.09 years). Among the factors assessed, maternal drug allergies during pregnancy and childhood asthma were identified as potential aetiological contributors to MIH, both showing statistically significant associations (p < 0.01).

CONCLUSIONS

Within the limitations of this pilot case-control study, a potential association was observed between MIH and both maternal drug allergies during pregnancy and childhood asthma. These findings support the need for further investigation into prenatal and early-life factors that may contribute to enamel developmental disturbances. Larger prospective studies are recommended to confirm these associations and better understand the underlying mechanisms.

Effectiveness of Dental Restorative Materials in the Atraumatic Treatment of Carious Primary Teeth in Pediatric Dentistry: A Systematic Review

AIM

This systematic review evaluates the effectiveness and clinical outcomes of Atraumatic Restorative Treatment (ART) in pediatric dentistry, comparing it with other restorative techniques, analyzing material performance, assessing cost-effectiveness, and exploring the long-term success in managing dental caries.

BACKGROUND

ART is a minimally invasive approach that removes decayed tissue using hand instruments and restores teeth with adhesive materials like glass ionomer cement (GIC). ART is particularly valuable in pediatric dentistry due to its simplicity, reduced discomfort, and suitability for resource-limited settings. It eliminates the need for anesthesia and expensive dental equipment, making it accessible in remote and underserved areas. Studies have shown its effectiveness in providing durable restorations while improving patient comfort.

MATERIALS AND METHODS

This systematic review follows the PRISMA guidelines. PubMed, Web of Science, and Scopus were searched for studies published in the last ten years. The inclusion criteria included in vivo studies on children, randomized controlled trials, and case-control studies assessing ART's effectiveness. Quality and risk of bias were evaluated using the ROBINS-I tool.

RESULTS

Eighteen studies met the inclusion criteria. ART effectively managed dental caries, especially with high-viscosity GIC. Comparisons with the Hall Technique and Papacarie showed that ART remains a viable, cost-effective option.

CONCLUSIONS

ART is a reliable, minimally invasive technique for pediatric restorative dentistry. Its accessibility and cost-effectiveness make it suitable for low-resource settings. High-quality materials and technique modifications further enhance restoration longevity.

Deep carious lesion management in vital primary teeth: approach and practice of dental practitioners in Jordan

PURPOSE

Diverse treatment modalities are available for managing deep caries in primary dentition, with a growing interest in minimally invasive approaches. It remains unclear which treatment modality is applied by dentists in daily practice. This study aimed to explore the general dental practitioners' (GDP), and paediatric dentists' (PD) approaches to managing deep caries in primary molars.

METHODS

An online questionnaire was distributed using the Google Form survey tool to dentists across Jordan. Descriptive data analysis was performed. Chi-square was used to analyse correlations (P < 0.05).

RESULTS

A total of 376 responses were analysed. Almost two-thirds of participants were GDPs (58.8%), 23.4% were PDs, 14.1% were paediatric PGs and 3.7% were academics. For asymptomatic teeth, indirect pulp capping (IPC) was the most opted treatment among all participants (N = 129; 34.3%) followed by the Hall technique (N = 70;18.6%). IPC and Hall techniques were significantly more selected by PDs (P < 0.001). For teeth with symptoms of reversible pulpitis, most participants preferred pulpotomy (N = 152; 40.4%), followed by IPC (N = 125; 33.2%). IPC was significantly more selected by PDs (P < 0.001). For teeth with symptoms of irreversible pulpitis, pulpotomy was preferred by most participants (N = 263; 69.9%).

CONCLUSION

The PD approach favours less invasive biologically based interventions for managing asymptomatic and reversibly inflamed primary molars. GDPs require further education on less invasive biologically based interventions.

A prospective randomized clinical trial and an in vitro evaluation of the microtensile bond strength of a chlorhexidine-containing dentin bonding agent and a bulk fill composite material in primary teeth

OBJECTIVES

This study aimed to assess the microtensile bond strength of a chlorhexidine-containing dentin bonding agent compared with a standard adhesive, and to investigate its clinical success in Class II cavities in primary teeth, with a 12-month follow-up.

MATERIALS AND METHODS

The study consisted of two parts: a prospective, single-blind, split-mouth randomized controlled clinical trial and an in vitro laboratory evaluation. Ethical approval were obtained for the both parts of the study. Forty pediatric patients (aged 5-9 years) with primary molars requiring Class II restorations were included in the clinical trial, where bulk-fill restorations bonded with a chlorhexidine-containing adhesive and a standard adhesive were evaluated based on FDI criteria at 3-month intervals for 12 months. he in vitro study examined the microtensile bond strength (µTBS) of immediate and thermally aged specimens prepared with bulk-fill composite materials and adhesives with or without chlorhexidine.The data were analyzed using Mann Whitney U test for in-vivo, ANOVA test followed by Tukey's post hoc and Chi-square test for in-vitro study (p = 0.05).

RESULTS

Clinically, both adhesives showed similar success rates (%100) across all FDI evaluation parameters after 12 months (p > 0.05). The chlorhexidine-containing adhesive demonstrated significantly higher microtensile bond strength than the standard adhesive in both immediate and aged samples (p < 0.05).

CONCLUSIONS

The chlorhexidine-containing adhesive showed promising clinical success and improved bond strength compared to the standard adhesive. Longer follow-ups are needed to confirm its long-term durability."Incorporating chlorhexidine simplifies restorative procedures without compromising performance.

CLINICAL RELEVANCE

Chlorhexidine-containing adhesives may improve bond durability and procedural efficiency in pediatric dentistry, offering a practical and effective alternative for restoring primary molars.

TRIAL REGISTRATION

Invivo part of the study was registered in a public trial registry, www.

CLINICALTRIALS

gov (#NCT06257108). Registration Date 2nd. May 2024 (Retrospectively registered).

Management of deep carious lesions among Syrian dentists: a cross-sectional study

BACKGROUND

Deep carious lesions present significant challenges in dental practice, requiring effective management strategies to preserve tooth sensibility and function. This study aimed to assess Syrian dentists 'practices related to deep carious lesions and managing exposed pulps in teeth with reversible pulpitis in permanent teeth. It also examined the impact of dentists' experience and specialization on their choice of techniques and diagnostic tools.

METHODS

A cross-sectional study was conducted using a self-administered paper-based questionnaire distributed to dentists in Damascus. The questionnaire collected 1- demographic data, 2- clinical decisions before the start of the treatment, and 3- clinical decisions to treat deep carious lesions in different clinical cases and the management of exposed pulps. Data were analyzed to identify trends and differences in practices based on experience and specialization. Data were coded into excel and analyzed using SPSS V.25.

RESULTS

The study included responses from 252 dentists. The majority of dentists chose to take radiographs before treatment (69.4%), or do a sensibility test (70.6%). A strong preference for minimally invasive techniques was observed, such as partial caries removal to avoid pulp exposure (71.7%) and the use of hand excavators (53.2%). Dentists with more than 10 years of experience were more likely to work without rubber dam (< 0.001), while endodontists tended to apply rubber dam more than other clinicians (< 0.001). Experienced and specialist dentists were more likely to use rubber dam (p = 0.001) and perform sensibility tests (p = 0.000). The unique context of practicing in Syria, marked by conflict and political sanctions, significantly influenced decision-making of the biomaterials used, with the majority using calcium hydroxide (60.7%) and avoiding other materials, such as MTA and Biodentine, due to cost (31.5%) and availability (9.2%).

CONCLUSIONS

This study documented the clinical decision among Syrian dentist before and during the treatment of deep carious lesions. Clinical decisions and practices are significantly affected by years of experience and whether the dentist is specialized or not. General dentists and other specialists were less likely to perform vital pulp therapies when pulp exposed in teeth with reversible pulpitis than endodontists. Complementary education of Syrian dentists in the domain of pulps exposed management appears necessary regarding current recommendations.

Association between lesion depth and placement technique with failures requiring extraction of preformed metal crowns in primary molars. A retrospective study

PURPOSE

The aim of the present study was to evaluate the factors associated with failure requiring extraction after placement of preformed metal crowns (PMCs) in primary molars. Radiographic caries depth at baseline (initial/moderate and severe) and placement technique (Conventional and Hall technique) and other patient-related variables were analysed.

METHODS

Clinical and radiographic records from children aged 2-10 years who had at least one primary molar treated with PMCs between 2011 and 2019 were evaluated. Chi-square test, Fisher exact tests and logistic regression analysis (α = 5%) were performed to verify the relationship between the primary outcome and categorical variables (caries depth, restorative teachnique, jaw, tooth type and gender).

RESULTS

A total of 244 teeth treated in 165 children were included in the analysis. A total of 18 failures were observed (7.4%), of which 17 were in deep caries lesions and in which 15 had the PMC placed according to the conventional technique. Both caries lesion depth and restorative technique were associated with treatment failure (p < 0.05).

CONCLUSION

Taking into account the limitations of this retrospective study, treatment failures requiring extraction occurred more often in deep caries lesions when treated with preformed metal crowns (PMCs) following the conventional technique when compared to the Hall Technique.

Factors influencing preformed metal crowns and prefabricated zirconia crowns

BACKGOUND

Preformed metal crowns (PMCs) and zirconia crowns (ZCs) are commonly used for the treatment of primary molar caries. However, there have been no reports on factors influencing parental awareness, willingness to use these treatments, and the associated discomfort after crown placement in children.This study is the first to report factors influencing preformed crowns, providing a reference for the prevention and treatment of deciduous carious teeth.

METHODS

Parents whose children's posterior caries were restored with preformed crowns at Shenzhen Children's Hospital from October 2021 to October 2023 were recruited. A questionnaire gathered data on multiple variables, including basic information about the participants, their oral health behaviors, and their attitudes toward oral health.

RESULTS

Approximately two-thirds of the surveyed parents were aware of preformed metal crowns (PMCs) (67.8%), whereas over half were hardly aware of prefabricated zirconia crowns (ZCs) (59.6%). In terms of discomfort symptoms, 105 (76.7%) and 102 (76.1%) cases were reported after PMC and ZC placement respectively; however, there was no statistically significant difference between the two groups (P > 0.05). Among the surveyed parents, 19 (8.7%) expressed that they could not accept the PMC color, whereas all could accept the ZC color, and the difference was statistically significant (P < 0.05). A total of 217 parents (99.5%) could accept PMCs to protect or repair primary carious teeth; 29.8% of the parents stated that they were reluctant to use ZCs to protect or repair their children's deciduous teeth, and the difference was significant (P < 0.05). In terms of location selection, the majority of surveyed parents chose comprehensive hospitals (58.7%) and stomatological hospitals (41.3%). In terms of institution selection, priority was given to the doctor's qualifications (90.4%). Pearson correlation analysis revealed that "acceptance of the PMC color", "oral health awareness", and "parental willingness to use PMCs" were positively correlated (P < 0.05) and that "non-nuclear family status" was negatively related to "parental willingness to use PMCs" (P < 0.05). The logistic multiple regression analysis revealed that oral health awareness and restoration awareness significantly affected the duration of discomfort symptoms after PMC placement (P < 0.15). Children with higher annual family incomes, families with fewer children, lower consumption of desserts, better oral health awareness, and teeth brushing under the assistance of their parents showed a dramatic decline in untimely PMC repair (P < 0.15); children who brushed their teeth less and whose parents had a poorer perception of restoration methods showed an increase in untimely PMC repair (P < 0.15).

CONCLUSIONS

This discrepancy is reflected in the cognition and willingness to use PMCs and ZCs. PMCs are more accepted due to cost, whereas ZCs are preferred for aesthetics. The factors affecting PMC restoration are oral health awareness, manner of restoration, family income, number of children, consumption of desserts, and toothbrushing frequency.

Survival analysis and risk factors of indirect pulp capping in children with severe early childhood caries: a retrospective study

Background Indirect pulp capping (IDPC) is a preferred treatment for pulp preservation in primary teeth. However, the survival rate of IDPC in primary teeth and impact factors is still equivocal.Aims To evaluate the survival rate of IDPC in primary teeth with a deep carious lesion approximating the pulp but without irreversible pulpitis or periapical disease.Methods The medical records of children who were diagnosed with severe early childhood caries (S-ECC) and received IDPC under dental general anaesthesia from January 2015 to December 2020 were screened and collected. The shared frailty model was used to explore potential factors affecting the success rate of IDPC in primary teeth.Results There were 352 children with S ECC and 1,197 teeth were included in the study. A total of 47 children had IDPC that failed in the follow-up period (67 teeth). The survival rates of the teeth treated with IDPC at 48 months was 82.3%. The risk of IDPC primary tooth treatment failure in mandibular teeth was 2.35 times that of maxillary teeth and risk of failure in lesions with mesial surface involvement was 2.76 times higher than those without mesial surface involvement.Conclusion In the present study, the overall survival rate of IDPC did not decrease remarkably with time, regardless of anterior or posterior teeth. The tooth arch position and whether the mesial surface was involved in the carious lesion were found to influence the outcome of IDPC.

Dental Decision-Making in Pediatric Dentistry: A Cross-Sectional Case-Based Questionnaire Among Dentists in Germany

Background and Objectives: The most recent guidelines and recommendations regarding treatments of dental caries in children are shifting towards evidence-based minimal or non-invasive approaches aiming to preserve the vitality of teeth and potentially reduce the need for dental general anesthesia. This study investigated the treatment recommendations of dentists actively practicing pediatric dentistry in Germany regarding different patient cases with caries in primary teeth. Materials and Methods: The questionnaire was distributed on paper or online to pediatric dentists and general dentists practicing pediatric dentistry. Five cases of children with dental treatment needs representing a variety of clinical situations were selected for the questionnaire. Considering four different scenarios regarding pain symptoms (yes/no) and cooperation level (good/low) for each case resulted in 20 questions, where the preferred treatment option could be chosen out of 21 options ranging from observation only to extraction with/without different sedation techniques. The answers were categorized into three categories for each case and scenario according to guidelines, recent scientific evidence, and recommendations (recommended, acceptable, or not recommended/contraindicated). Results: In total, 222 participants responded to the survey (161 female; 72.5%). In 55.2% of the total 4440 answers, the participants chose a "recommended" treatment option, in 16.4% "acceptable", but in 28.4%, a "not recommended" treatment, which ranged for the five cases between 18.7 and 36.1%. While pain and low cooperation levels led to more invasive and justified treatment choices (only 26.3% "not recommended"), less severe scenarios resulted more often in "not recommended" options (pain with good cooperation: 31.0%; or low cooperation without pain: 32.6%). The dentist's age, experience, and educational background did not significantly correlate to choosing "not recommended" treatment options. Conclusions: A child's pain and cooperation level greatly impact the treatment decisions made by dentists, with a risk of too invasive treatment options in low-severity cases. Substantial disparities in treatment recommendations for caries in primary teeth persist among dental practitioners regardless of their age, experience, and educational background.

Comparison of three management approaches for dental caries in primary molars: A two-year randomized clinical trial

AIM

to compare two-year clinical success rates of caries management in children (Hall Technique HT, Nonrestorative caries treatment NRCT, Conventional restorations CR), and to evaluate pain perception, behaviour, technique acceptability by patients, parents and dentists.

METHODS

122, 3-8-year-olds were enrolled in 2-year parallel group randomised controlled trial (CR, n = 52, HT, n = 35, NRCT, n = 35). Caries was recorded using Nyvad criteria to measure clinical success/ failure rates. Child's pain perception (Visual Analogue Scale of Faces), child behaviour (Frankl scale), parents' and dentists' treatment opinions (5-point Likert scale) were assessed. Statistical analysis included Chi-square, non-parametric Kruskal-Wallis, Bonferroni-corrected Mann-Whitney U tests (p < 0.05), absolute risk reduction (ARR) and number needed to treat (NNT).

RESULTS

After two years, with 116 participants, clinical success rates were: CR=60.8 % (n = 31), HT=93.8 % (n = 30), NRCT=42.5 % (n = 14) (p < 0.001). Major/minor failure rates differed: CR=17.6 % (n = 9) / 21.6 % (n = 11); HT=6.2 % (n = 2)/ 0 %, NRCT=33.3 % (n = 11)/ 24.2 % (n = 8), (p < 0.05). When comparing HT to CR, ARR = 0.33; NNT= 3 (95 % CI 0.02 -0.58); NRCT to CR, - no observed benefit from NRCT. More than 70 % of children demonstrated "positive/definitely positive" behaviour during treatment. Pain intensity was "very low/low" in 92.3 % of cases for CR, 88.6 % for HT, and 77.1 % for NRCT . NRCT was "very easy" to perform for 82.9 % of participants, compared to 42.3 % for CR and 17.1 % for HT (p < 0.05). CR were reported to take longer than NRCT and HT (p < 0.05).

CONCLUSION

Clinical success rates of HT were superior to CR and NRCT. All treatment techniques were well tolerated by children, CR was more time-consuming and HT - technically more difficult to perform.

CLINICAL SIGNIFICANCE

caries management in primary molars can be successfully performed using minimal intervention, particularly, sealing in caries lesions with Hall technique. NRCT can prevent caries progression when adequate access to mechanical plaque disruption and fluoride is provided. However, occasional fluoride application, and uncontrolled toothbrushing with fluoride toothpaste cannot replace restorative procedures.

Are we practising what we preach and are we all singing from the same hymn sheet? An exploration of teaching in paediatric caries management across UK dental schools

BACKGROUND

The evidence underpinning caries management for children has progressed dramatically over the past 20 years. Anecdotally, this is not reflected in the teaching provided to undergraduate dental students, with the ongoing teaching of outdated methods within some dental schools.

AIM

To capture the current undergraduate teaching provision and clinical treatment experience requirement relative to caries management in paediatric dentistry in UK dental schools.

DESIGN

Cross-sectional analysis of current teaching methods on paediatric caries management was obtained using a piloted online data collection form. Question content included current caries teaching methods, assessment of student exposure and competence. The results were analysed descriptively.

RESULTS

Of the 16 UK dental schools, 14 participated. Discrepancy in teaching content was apparent. Many schools (n = 9) taught biological caries management through therapeutic fissure sealants, yet this was not reflected in assessment and clinical requirements. Some schools (n = 4) taught amalgam placement in children, and most (n = 12) operatively taught treatments that would no longer be routinely provided in general dental practice in the UK, including primary tooth pulpotomy.

CONCLUSION

There is substantial variation in the paediatric caries management techniques that are taught across UK dental schools, demonstrating a need for a national consensus to address these disparities.

Recommended procedures for managing carious lesions in primary teeth with pulp involvement-a scoping review

BACKGROUND

Managing dental caries in primary teeth with pulp involvement is a significant challenge. Clinical guidelines offer recommendations for effective management.

AIM

To identify and analyze policies, guidelines, and recommendations for treating primary teeth with pulp-involved carious lesions, highlighting existing research gaps and setting the foundation for future research.

METHODS

A comprehensive search was conducted across databases (PubMed, Scopus, Embase, GIN, and LILACS) and grey literature sources (Trip and ProQuest) to identify guidelines, consensus, policy, and position statements on primary teeth pulp therapy and extraction thresholds. Two independent reviewers screened the abstracts and titles, followed by full-text screening.

RESULTS

After removing duplication, of the 1098 records, 14 were selected for analysis. This review examined various treatments for deep caries lesions in primary teeth, including indirect/direct pulp capping, pulpotomy, pulpectomy, lesion sterilization/tissue restoration, and extraction. Time search was restricted to documents published from 30th January 2008 to 30th January 2024, offering insights into evolving clinical practices.

CONCLUSION

Treatment for carious lesions in primary teeth involving the pulp depends on clinical indications and may involve minimally invasive techniques. Recommended options are indirect pulp capping, pulpotomy, and pulpectomy, while direct capping and tooth removal are discouraged. Further research is needed to address gaps, improve guideline development, and enhance consistency of recommendations.

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.

Hyaluronic acid as a pulpotomy material in primary molars: an up to 30 months retrospective study

BACKGROUND

The aim of this retrospective study was to determine the long-term clinical and radiographic success of our previous randomized clinical trial and to compare the success of hyaluronic acid, with the widely used formocresol and ferric sulphate agents.

METHODS

This retrospective study is the extension of the 1-year survey of our randomized clinical trial that had compared the effectiveness of a hyaluronic acid pulpotomy over formocresol and ferric sulphate pulpotomies and included clinical and radiographic evaluations with a follow-up period of over 24 months for 44 children who applied to our clinic between May 2019 and September 2019. Long-term clinical and radiographic data were obtained from the periodic files of our department, wherein each tooth's file was examined to identify any clinical and radiographic findings. Descriptive statistics and Pearson's chi-square tests were used to evaluate the data. Statistical significance was considered as p < 0.05.

RESULTS

The clinical and radiographic success rates of the hyaluronic acid, formocresol, and ferric sulphate groups were not statistically different at > 24 months. None of the teeth in the hyaluronic acid group showed any clinical findings at > 24 months.

CONCLUSIONS

Hyaluronic acid pulpotomies exhibited comparable success rates to formocresol and ferric sulphate materials spanning over 24 months examinations. Because of convenient accessibility and applicability of hyaluronic acid, it may be recommended as a promising alternative medicament for pulpotomy treatments of primary molars. However, further long-term follow-up human studies are needed to better understand the effect of hyaluronic acid on the dental pulp of human primary molars.

A scoping review of guidelines on caries management for children and young people to inform UK undergraduate core curriculum development

BACKGROUND

Current evidence in cariology teaching is not consistently reflected in paediatric dentistry in the United Kingdom (UK). Many dental schools are not consistently teaching biological approaches to caries management, with outdated or complex methods being taught outwith the purview of general dental practitioners. This scoping review aimed to map current guidelines on the management of caries in children and young people. This is part of a work package to inform the consensus and development of a UK-wide caries management curriculum for paediatric dentistry.

METHODS

A search of electronic databases for peer reviewed literature was performed using Cochrane Library, MEDLINE via PubMed, TRIP Medical Database and Web of Science. Hand searching was undertaken for grey literature (citations of sources of evidence, websites of global organisations and Google Web Search™ (Google LLC, California, USA). Results from databases were screened independently, concurrently by two reviewers. Full texts were obtained, and reviewers met to discuss any disagreement for both database and hand searching.

RESULTS

This review identified 16 guidelines suitable for inclusion. After quality appraisal, eight were selected for synthesis and interpretation. Key themes included the shift towards selective caries removal and avoidance of complete caries removal unless in specific circumstances in anterior teeth. For "early lesions" in primary and permanent teeth with and without cavitation, several guidelines recommend biological management including site specific prevention and fissure sealants.

CONCLUSIONS

This review mapping current cariology guidelines for children and young people found gaps in the literature including classification of early carious lesions and management of early cavitated lesions. Areas identified for further exploration include integration of biological caries management into treatment planning, selective caries removal and whether pulpotomy is specialist-level treatment, requiring referral. These results will inform consensus recommendations in the UK, using Delphi methods.

Comparative evaluation of cervical pulpotomy and pulpectomy for primary molars with irreversible pulpitis: a multicentre randomised controlled trial

PURPOSE

The objective of this multicentre randomised controlled trial was to compare the clinical/radiographic outcomes of cervical pulpotomy using calcium-enriched mixture cement (PCEM) and pulpectomy using Metapex (PM) in primary molars with irreversible pulpitis (IP).

METHODS

A total of 134 primary molars from 94 children were randomly assigned to two intervention groups: the PCEM group (n = 74) and the PM group (n = 60). Baseline characteristics including age/gender/molar type/tooth type/jaw were recorded. The primary outcome measures were clinical/radiographic success rates assessed at the first and second follow-up appointments. Secondary outcomes included reasons for clinical/radiographic failures. Multiple logistic regression analysis was performed to determine the impact of various factors on the success rates.

RESULTS

The mean age of the participants in both groups was similar (PCEM group: 5.4 years, PM group: 5.5 years). Gender distribution, molar type, tooth type, jaw, and number of practitioners were comparable between the groups. The clinical success rate at the first follow-up was 98.6% in the PCEM group and 96.4% in the PM group. At the second follow-up, the clinical success rate was 97.1% in the PCEM group and 91.1% in the PM group. The radiographic success rates at the first and second follow-up were 98.6% and 96.4% in the PCEM group and 96.4% and 91.1% in the PM group, respectively. Multiple logistic regression analysis did not reveal any significant association between the success rates and age/gender/molar type/jaw, or treatment groups (P > 0.05).

CONCLUSION

In primary molars with IP, both simple/conservative cervical pulpotomy using calcium-enriched mixture cement and pulpectomy using Metapex demonstrated high clinical/radiographic success rates. No significant differences were observed between the two treatment modalities. These findings suggest that both techniques can be considered effective treatment options for managing primary molars with IP.

TRIAL REGISTRATION NUMBER

Trial registration number: IRCT20201226049838N1, retrospectively registered on 12 January 2021.

Comparative evaluation of hand and rotary file systems on dentinal microcrack formation during pulpectomy procedure in primary teeth: an in vitro study

PURPOSE

Pulpectomy can be used for the management of deep dentinal carious lesions in primary teeth which can be restored. Mechanical preparation of root canals can be performed using hand or NiTi rotary files. However, this may cause dentinal stress and consequently dentinal microcracks. Hence, the aim was comparative evaluation of hand and rotary file systems on dentinal microcrack formation during pulpectomy procedure in primary teeth.

METHODS

60 extracted primary molar teeth were selected comprising of 80 root canals. Simple random sampling was used to divide root canals into four groups (n = 20): Group A-Hedstrom file, Group B-Pro AF Baby Gold rotary, Group C-ProTaper Next rotary, and Group D-unprepared group. Assessment was conducted on presence or absence of microcracks using Chi square test (p < 0.05).

RESULTS

The total number of microcracks in Group A: one (5%), Group B: four (20%), Group C: nine (45%) and Group D: zero (0%) which was statistically significant (p = 0.002). At cervical third, the number of microcracks seen with Group A: one (5%), Group B: zero (0%), Group C: five (25%) and Group D: zero (0%) (p = 0.005). At the middle third, the number of microcracks seen in Group A: zero (0%), Group B: four (20%), Group C: four (20%) and Group D: zero (0%) (p = 0.029).

CONCLUSION

The study concluded that dentinal microcracks are formed with both hand and rotary file systems in primary teeth. ProTaper Next showed significantly higher number of microcracks, followed by ProAF Baby Gold and H files.

Ozone Treatment for the Management of Caries in Primary Dentition: A Systematic Review of Clinical Studies

Dental caries in children is a frequent and debilitating condition, whose management is often challenging. The aim of this systematic review was to investigate the effectiveness of ozone applications for the treatment of caries in primary dentition. According to PRISMA guidelines, a systematic literature search was performed up to 6 January 2024. Clinical studies using ozone to treat caries of deciduous teeth were considered for inclusion. Out of the 215 records retrieved, seven studies were eventually included in the review, all of which used gaseous ozone. Four studies were judged at high risk of bias, two at low risk, and one of some concerns. The great heterogeneity of designs, outcomes, and protocols made it impossible to conduct a meta-analysis. Despite some limitations, the evidence yielded by the included studies suggests that ozone application, regardless of the protocol applied, is comparable to other interventions in terms of clinical outcomes and anti-bacterial activity, with no reported adverse effects and good patient acceptance. Therefore, ozone application may be a non-invasive approach to treat caries in primary dentition, especially in very young and poorly cooperative patients. Further standardized and rigorous studies are, however, needed to identify the best clinical protocols for this specific field.

Influence of high-irradiance light curing on the marginal integrity of composite restorations in primary teeth

BACKGROUND

Reducing the necessary time to restore primary teeth improves the cooperation of paediatric patients. This study aimed to investigate the marginal integrity of restorations prepared with a bulk-fill resin-based composite (RBC) containing additional fragmentation chain transfer (AFCT) compared to a conventional RBC when light cured with a rapid high-irradiance (3 s) and a regular (10 s) curing mode.

METHODS

Forty class-II cavities were prepared in 40 primary molars. The molars were randomly divided into four groups based on the applied light-curing modes (regular: 10 s @ 1200 mW/cm2 or high-irradiance: 3 s @ 3000 mW/cm2) and the used restorative material (AFCT-containing bulk-fill RBC "Power Fill" or AFCT-free conventional RBC "Prime"). After thermo-mechanical loading, the marginal integrity was analysed using scanning electron microscopy. A beta regression model and pairwise comparisons were used to statistically analyse the data.

RESULTS

The mean marginal integrity (% ± SD) of the restorations for each group was as follows: Power Fill (10 s: 79.7 ± 15.6) (3 s: 77.6 ± 11.3), Prime (10 s: 69.7 ± 11.1) (3 s: 75.0 ± 9.7). The difference between the RBCs for the same light-curing mode was statistically significant (p ≤ 0.05). The difference between the light-curing modes for the same RBC was not statistically significant (p ˃ 0.5).

CONCLUSIONS

AFCT-containing bulk-fill RBC "Power Fill" achieves similar marginal integrity when light-cured with either high-irradiance or regular light-curing modes. "Power Fill" achieves better marginal integrity than the conventional RBC "Prime" regardless of the applied light-curing mode.

The clinical success of ART restorations and Hall technique in primary molars: a randomized 18-month follow-up study

Objectives

The aim of the study was to evaluate the clinical and radiographic success of the Hall technique (HT) and atraumatic restorative treatment (ART) restorations using high-viscosity glass-ionomer cement for the management of occlusal carious lesions in primary molars.

Materials and Methods

This randomized clinical study observed 40 children (aged 5-6 years). For each child, one tooth was treated with HT and one with ART. The primary outcome measures for HT restorations were successful, minor, and major failure rates. Clinical evaluations of ART restorations were performed according to the modified United States Public Health Service criteria during 18-month follow-up. McNemar test was used for statistical analysis.

Results

Thirty of 40 (75%) participants returned for 18 months of follow-up. In the clinical evaluations of teeth that were treated with HT, the patients did not have complaints of pain or other symptoms, all crowns remained in the oral cavity, the gums were healthy, and the teeth were functional in all evaluations. At the end of the 18-month follow-up, the surface texture and marginal integrity criteria of ART restorations were recorded as 26.7% and 33.3%, respectively. In the radiographic evaluation of 30 patients treated with ART and HT, all restorations were considered successful.

Conclusions

The 18-month clinical and radiographic results after treatments applied to single-surface cavities in anxious children showed that both treatment methods were successful.

The revolutionary evolution in carious lesion management

Contemporary paradigms of dental caries management focus on the biological approaches to treating the disease and its principal symptom, the carious lesion. This narrative review traces the evolution of carious lesion management from the operative and invasive approaches of G. V. Black's era to the current period of minimally invasive biological approaches. The paper explains the rationale for adopting biological approaches to dental caries management and lists the five core principles of this management approach. The paper also details the aims, features, and the most recent evidence base for the different biological carious lesion management approaches. Based on current practice guidelines, collated clinical pathways for lesion management are also presented in the paper to aid clinicians in their decision-making. It is hoped that the biological rationale and evidence summarized in this paper will bolster the shift to modern biological carious lesion management approaches among dental practitioners.