Restorative Dentistry for the Primary Dentition

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.

The effectiveness of Carie-Care™, chemomechanical caries removal technique in primary teeth: randomized controlled clinical trial

BACKGROUND

Chemomechanical techniques for caries removal have been introduced to overcome the shortcomings of the conventional rotatory instruments. This study aimed to clinically evaluate the effectiveness of the chemomechanical method of caries removal (Carie-Care™) over mechanical caries removal through the Atraumatic Restorative Technique in pediatric patients.

METHODS

A randomized controlled clinical trial was conducted. Fifty children fulfilling inclusion criteria were recruited from the outpatient clinic of Pediatric and Dental Public health department, Faculty of Dentistry, Alexandria University. Fifty open carious primary molars were randomly assigned into 2 equal groups according to the method of caries removal. In Group I (test group), caries was removed using the Carie-Care™ system and in Group II (control group), by using mechanical caries removal through the atraumatic restorative technique. Resin modified glass ionomer was used for teeth restoration, the two techniques were compared in each child according to time taken for caries removal, efficacy of caries removal, pain assessment, and child behavior.

RESULTS

The mean time taken for caries removal in the Carie-Care™ treatment group was (575.6 ± 114.8) seconds which was statistically significant higher as compared with the ART treatment group (346.1 ± 97.4) seconds (p < 0.001). The mean score of efficacy in caries removal was (0.6 ± 0.8) in the Carie-Care™ group, and (1.3 ± 0.7) in the ART treatment group. When compared to ART, Carie-Care™ was significantly more efficient in caries removal (p < 0.002). When pain was assessed by the SEM scale, it was observed that the Carie-Care™ caries removal technique showed statistically significantly more comfort during the procedure compared with the ART procedure (p < 0.001).Moreover, children in the Carie-Care™ group enjoyed the process and showed more cooperative behavior when assessed at the end of procedure than those in the ART group with statistically significant difference (p = 0.002).

CONCLUSIONS

Removal of carious tissue in primary teeth using Chemomechanical Carie-Care™ gel proved to be more time consuming than ART, but on the other hand it was more efficient, comfortable, and accepted by the pediatric patients.

Evaluation of push-out bond strength of different concentrations of chitosan nanoparticles incorporated composite resin and eighth-generation bonding agent for class II restoration: An in vitro study

AIM

The aim of this study is to evaluate the push-out bonding strength of class II cavities of maxillary molars restored with different concentrations of chitosan nanoparticles (CSN) incorporated in universal composite resin and eighth-generation dentin bonding agent (DBA).

MATERIALS AND METHODS

Seventy extracted human maxillary first molar teeth were cleaned and mounted in acrylic mold up to 2 mm below cementoenamel junction and mesio-occlusal Class II cavities with standard measurements were prepared. CSN 2% and 0.25% powder were added to the DBA and composite resin. The samples then arbitrarily divided into three groups for restoration: Group 1: composite restoration without CSN (control group) (n = 10), Group 2: 2% CSN (n = 30), and Group 3: 0.25% CSN (n = 30). Groups 2 and 3 were further subdivided into three subgroups (n = 10 each) subgroup A. CSN incorporated in composite resin. B. CSN incorporated in DBA and C. CSN incorporated in composite and DBA. After restoration, push-out bond strength was evaluated in each sample using a universal testing machine, and data collected were statistically analyzed by one-way analysis of variance and Post hoc Tukey tests (P ≤ 0.05).

RESULTS

Subgroup 3A (0.25% CSN + composite) has shown an increase in bond strength among all experimental groups with no significant difference between group 1 (control group).

CONCLUSION

CSN 0.25% incorporated in composite or DBA exhibits no harmful effect on the bond strength of class II restorations. Hence, it can be used to improve the antibacterial action and longevity of composite resin.

Oral health-related quality of life (OHRQOL) of preschool children's anterior teeth restored with zirconia crowns versus resin-bonded composite strip crowns: a 12-month prospective clinical trial

OBJECTIVES

To compare oral health-related quality of Life (OHRQOL) of preschool children's anterior teeth restored with prefabricated zirconia crowns (ZC) versus resin-bonded composite strip crown (RCSC).

MATERIALS AND METHODS

A prospective clinical trial included 136 children with early childhood caries aged 36-71 months who were assigned into prefabricated ZC and RCSC groups. A total of 344 teeth were restored either with 170 ZCs (49.4%) and 174 RCSCs (50.6%). Wilson and Cleary's conceptual model was to associate the study predictors to the OHRQOL. Early Childhood Oral Health Impact Scale (ECOHIS) was used to assess the OHRQOL at 6 and 12 months. Mann-Whitney U test was used in comparing OHRQOL mean scores in the two groups and Wilcoxon signed-rank test with the effect size (r) to measure the intragroup OHRQOL change. A Poisson regression model was used to study potential risk factors associated with the overall OHRQOL.

RESULTS

After 12 months, the USPHS parameters of the ZC were significantly superior compared to the RCSC. Overall ECOHIS mean scores in the ZC group were significantly lower than that of the RCSC group at T₁ and T₂ (p < 0.001). Remarkable enhancement of the OHRQOL at the follow-ups with a large effect size (r < 0.8) was observed. Restoration type, retention, baseline OHRQOL, and color had a significant impact on the overall OHRQOL at 12 months.

CONCLUSIONS

Preschool children OHRQOL treated with ZC were significantly better than those who received RCSC.

CLINICAL RELEVANCE

One of the optimum treatment standards in pediatric dentistry is the esthetic demand which has significance on the child's OHRQOL and subsequently child's general health quality of life. It is beneficial to the dentist to identify the influence of esthetic restorations on the OHRQOL of preschool children which aids in future decision-making. The longitudinal nature of the study enables the dentist to identify the changes of children's OHRQOL.

Treatment of severely decayed anterior primary teeth with short-post technique (Mushroom Restorations) under general anesthesia

Aims

The aim of this study was to evaluation the treatment success of the short post technique (mushroom restoration) using a composite resin in severely decayed primary anterior teeth after 6, 12, and 18 months after treatment.

Methods

Eighteen children aged 3-5 years with severely decayed primary maxillary anterior teeth (60 anterior maxillary primary teeth in total) were included. Patients were treated under general anesthesia (GA). After pulpectomy, a "mushroom shape" was formed in the root canals for the purpose of retention, and the root canals were filled with zinc oxide-eugenol (ZOE), and the teeth were restored with composite resin. The status of treatment was evaluated clinically and radiographically for periapical radiolucency, pathological root resorption, marginal fracture, and loss of restoration for each treated tooth. All findings were recorded.

Results

As a result of the evaluation criteria, the success rates at 6, 12 and 18 months were 86%, 80%, and 71%, respectively. None of the teeth showed apical radiolucency or pathological root resorption at the end of the 18^th month period.

Conclusion

The short-post (mushroom restorations) technique is a clinically acceptable alternative method for restoration of severely decayed primary teeth. This study supports the feasibility of treatment with this technique for pediatric patients treated under GA.

Applications of nano-materials in diverse dentistry regimes

Research and development in the applied sciences at the atomic or molecular level is the order of the day under the domain of nanotechnology or nano-science with enormous influence on nearly all areas of human health and activities comprising diverse medical fields such as pharmacological studies, clinical diagnoses, and supplementary immune system. The field of nano-dentistry has emerged due to the assorted dental applications of nano-technology. This review provides a brief introduction to the general nanotechnology field and a comprehensive overview of the synthesis features and dental uses of nano-materials including current innovations and future expectations with general comments on the latest advancements in the mechanisms and the most significant toxicological dimensions.