Pulpotomy versus pulpectomy in carious vital pulp exposure in primary incisors: a randomized controlled trial

BACKGROUND

Pulpotomy as a minimally invasive pulp therapy technique is the treatment of choice for carious pulp exposures, however many pediatric dentists perform pulpectomies in vital primary incisors. The aim of this split mouth randomized controlled study was to compare formocresol pulpotomy and zinc-oxide and eugenol pulpectomy in the treatment of vital pulp exposure in primary incisors.

METHODS

Contralateral pairs of incisors were randomly assigned to receive pulpotomy or pulpectomy in children aging from 18 to 66 months old and were followed up for 12 months.

RESULTS

39 pairs of incisors were included. Clinical and radiographical success rates showed no statistical significant difference (p = 1, p = 0.8 respectively). Relative risk measures for clinical success rates (RR = 1.03, 95%CI 0.87 to 1.23) and for radiographic success rates (RR = 1.03, 95%CI 0.83 to 1.29) with CIs including number one showing no difference between the two groups. The Survival rate using Kaplan-Meier survival analysis score showed 82% for pulpotomy and 74% for pulpectomy at 12 months (P = 0.2).

CONCLUSIONS

Both pulpotomy and pulpectomy techniques can be used successfully in the treatment of carious vital pulp exposure in primary incisors.

TRIAL REGISTRATION

The trial was retrospectively registered in Clinicaltrials .gov with this identifier NCT05589025 on 21/10/2022.

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.

An In Vivo Evaluation of Postoperative Pain after Root Canal Instrumentation Using Manual K-files and Kedo-S Rotary files in Primary Molars

Aim

To determine postoperative pain after root canal instrumentation using manual K-file and rotary Kedo-S files in primary molars.

Material and Method

Thirty-six primary mandibular molars from 4- to 8-year-old children requiring pulpectomy were randomly split into two groups of 18 teeth each, that is, manual file K-file (Group I) and Kedo-S rotary file (Group II). Children's pre- and postoperative pain was assessed using a four-point scale at different time intervals.

Results

From the result of the present study, it was observed that the Kedo-S group showed significantly less pain after 24, 48, and 72 h.

Conclusion

It was concluded from the present research that patients enrolled in the Kedo-s group experienced less pain.

Effect of two irrigating solutions on antimicrobial activity and clinical and radiographic success after endodontic treatment in primary teeth: a randomized clinical trial

OBJECTIVES

This study evaluated the antimicrobial activity, clinical and radiographic outcome of pulpectomy in primary teeth using either 1% sodium hypochlorite (NaOCl) or 2% chlorhexidine (CHX) as irrigants.

MATERIALS AND METHODS

A randomized double-blind controlled clinical study in which primary teeth were allocated to 1% NaOCl (n = 20) and 2% CHX (n = 20) groups. Microbiological collections were performed before and after irrigation for agar culture and real-time polymerase chain reaction (qPCR). Clinical and radiographic success was assessed at different times. Data were submitted to descriptive analysis, chi-square, Mann-Whitney, and Wilcoxon tests (p  < .05).

RESULTS

For 1% NaOCl, the following clinical and radiographic success rates were observed: 7 days (93%/80%); 30 days, 3 and 6 months (100%). For 2% CHX: 7 days (73%/53%); 30 days (93%); 3 months (100%/93%); 6 months (100%) (p > .05). One percent NaOCl and 2% CHX effectively reduced total microorganisms (p < .05) but not mutans streptococci (p > .05). In qPCR analysis, the solutions promoted a reduction of total bacteria and Streptococcus mutans, and no difference was observed between times and groups (p > .05).

CONCLUSIONS

One percent NaOCl and 2% CHX were effective for clinical and radiographic success and antimicrobial activity in primary teeth submitted to pulpectomy.

CLINICAL RELEVANCE

Studying the antimicrobial activity and clinical and radiographic outcomes of pulpectomy in primary teeth using NaOCl and CHX as irrigants is clinically relevant because it provides information for optimizing treatment protocols and improving the quality of care for pediatric patients. It contributes to evidence-based practice and can potentially lead to better outcomes, reduced complications, and enhanced patient experiences.

Volumetric Analysis of Various Pediatric Rotary Files in the Preparation of Primary Root Canals Using Cone-beam Computed Tomography

Aim

This study was planned to evaluate and compare the cleaning efficacy of three pediatric rotary files with the standard Protaper adult file system in primary teeth using cone-beam computed tomography (CBCT).

Materials and methods

A total of 40 extracted deciduous second molars, with palatal/mesial roots having at least two-thirds of root length and an intact furcation area, were distributed randomly among four groups, with each group containing 10 teeth. Canal preparation of group I (Pro AF Baby Gold), group II (Kedo SG Blue), group III (Prime Pedo), and group IV (Protaper) was done. Pre- and postoperative CBCT images were taken. The volumetric changes of the root canals were assessed and subjected to statistical analysis using Statistical Package for the Social Sciences (SPSS) version 16 and R Studio 3.1.1. Volumetric changes within the groups were analyzed using paired t-tests and between the groups using analysis of variance (ANOVA).

Results

The comparison of mean volume difference between groups using ANOVA was statistically significant with F = 4.467, p = 0.002. A Tukey post hoc test revealed that group IV was statistically significant compared with groups I (p = 0.033) and III (p = 0.008) but was not statistically significant with group II (p = 0.170). There was no statistically significant difference in volumetric changes within the three pediatric rotary file systems.

Conclusion

Protaper removed more dentin than all the pediatric rotary files, but it was not statistically significant over Kedo SG Blue. Among the pediatric rotary files, Kedo SG Blue removed more dentin than Pro AF Baby Gold and Prime Pedo, but they were not statistically significant.

How to cite this article

Nainer Chidambaram JV, Jayaprakash J, Arangannal P. Volumetric Analysis of Various Pediatric Rotary Files in the Preparation of Primary Root Canals Using Cone-beam Computed Tomography. Int J Clin Pediatr Dent 2024;17(1):15-20.

Zinc oxide-ozonated olive oil as a new root canal filling material in primary molars: a clinical randomized controlled trial

OBJECTIVES

The complex root canal anatomy of primary teeth keeps it very tricky to attain appropriate cleansing by biomechanical instrumentation, so obtaining an obturating material with excellent antimicrobial properties is a challenge in current clinical pulpectomy practice. So, this study aimed to assess the clinical and radiographic performance of zinc oxide-ozonated olive oil as a primary root canal filling material.

MATERIALS AND METHODS

Ninety non-vital primary molars in children ranging from 4 to 8 years were allocated into three groups in which root canals were filled with zinc oxide-ozonated olive oil, zinc oxide-olive oil, and zinc oxide-eugenol (ZOE) according to each group after pulpectomy procedure. Clinical and radiographic evaluations were done at 3-, 6-, and 12-month follow-up periods. Statistical analysis was performed for the collected data.

RESULTS

All study groups showed a significant improvement regarding clinical signs and symptoms during follow-up periods. Ozonated-olive oil group revealed a significant increase in furcation radiodensity and a decrease in periodontal ligament space at 3-, 6-, and 12-month follow-up intervals compared to other groups.

CONCLUSION

Zinc oxide-ozonated olive oil and zinc oxide-olive oil paste had shown good clinical and radiographic success for primary teeth pulpectomy.

CLINICAL RELEVANCE

The intricate torturous primary root canal anatomy, in addition to the child's negative behavior, interferes with the complete debridement, so the long-lasting antibacterial effect of the primary root canal filling material aids in the pulpectomy success.

Comparative Evaluation of Single Rotary File System and Sequential Multi-file Rotary Systems on Time for Biomechanical Preparation and Obturation Quality in Single-visit Pulpectomy Protocol: A Double-blind Randomized Clinical Trial

Background

Single-visit pulpectomy (SVP) protocol with rotary files is highly recommended for the treatment of teeth with irreversible pulpitis. Various rotary endodontic files specially designed for use in the pediatric population are available. The aim is to clinically assess the parameters related to the time required for biomechanical preparation (TBMP) and quality of filling using a single file system vs a sequential multi-file system in infected primary mandibular molars.

Materials and methods

A total of 45 infected primary molars were allocated to three groups (two experimental groups (n = 15) and a control group. The first experimental group was instrumented using NiTi K-Flex files, the second group with a single file rotary system with variably variable (VV) taper, and the third with a sequential multi-file system with constant taper. Biomechanical preparation time was recorded and standardized digital radiograph (RVG) were taken pre- and postinstrumentation. The data recorded was sent for statistical analysis.

Conclusion

There is a substantial reduction of TBMP in primary molars using single file VV taper and multi-sequential file constant taper. Obturation time for all three file systems was comparable and there were no differences between the three file systems used (p > 0.05). Multi-sequential file constant taper files showed a higher probability of optimal obturations and minimal voids followed by NiTi "K-Flex" files and single file system but the difference was nonsignificant (p > 0.05). However, using a rotary in primary teeth results in better canal shape, and less TBMP leading to a better quality of treatment in less time.

How to cite this article

Shetty B, Singh R, Patil V, et al. Comparative Evaluation of Single Rotary File System and Sequential Multi-file Rotary Systems on Time for Biomechanical Preparation and Obturation Quality in Single-visit Pulpectomy Protocol: A Double-blind Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(S-3):S247-S252.

Alternative root canal filling materials to zinc oxide eugenol in primary teeth: a systematic review of the literature

PURPOSE

The aim of this review was to compare the currently available root canal filling materials for primary teeth to zinc oxide eugenol (ZOE) to find a suitable alternative. The search question was: which root canal filling materials used in pulpectomy for primary teeth give better clinical and radiographic success rates than ZOE?

METHODS

A systematic search was conducted using five databases, namely Cochrane central register of controlled trials (CENTRAL), MEDLINE via PubMed, Science Direct, Scopus and EBSCOhost using a selection of "MeSH terms". The "Modified Jadad Scale" was used for the methodology assessment of the included studies.

RESULTS

Out of 480 articles identified in the initial search, 8 articles met all the inclusion criteria. The results showed that, compared to ZOE, ZOE with calcium hydroxide and iodoform had better clinical and radiographic success rates, a resorption rate similar to that of the roots, faster resorption of extruded particles and a maximum decrease in the size of pre-operative inter-radicular radiolucencies.

CONCLUSION

Numerous materials, proposed and used by clinicians in root canal filling in primary teeth, can be recommended as alternatives to ZOE. However, none of them could be the ideal material in primary teeth. Thus, more high-quality well-designed randomised clinical trials are required to develop more high-performing materials.

Adaptive instrumentation of root canals in primary teeth using XP-endo shaper: a case series

Dental caries is indeed the biggest cause of tooth loss, particularly in the primary dentition. In primary teeth with carious pulp involvements, endodontic intervention in the form of pulpotomy (removal of only the coronal pulp) or pulpectomy (removal of coronal and radicular pulp) is advocated. Pulpectomy can be laborious and time-consuming, especially when using traditional hand endodontic files to shape root canals. In paediatric dentistry, motorised nickel-titanium (Ni-Ti) rotary instrumentation has proved significant in enhancing the quality of pulpectomy. In primary dentition, however, these files may leave more than half of the root canals unaltered by instrumentation, just as they do in permanent dentition. The XP-endo® Shaper is a revolutionary heat-dependent endodontic file that uses an asymmetrical rotating motion to address the maximum area of the root canal space, resulting in anatomic root canal instrumentation. The case series describes the use of this novel XP-endo® Shaper file for anatomic root canal instrumentation in primary molars with irreversible pulpitis. The purpose is to demonstrate the efficacy and advantages of this cutting-edge endodontic treatment method. This case series can be an informative resource for other endodontic specialists by providing a practical illustration of how adaptable instrumentation can be utilised to successfully treat a patient. In conclusion, The use of the XP-endo Shaper® for pulpectomy demonstrated faster and instrumentation that was confined with the original shape of the canals, although further research is required to fully utilise these findings.

The effect of an antibacterial mixture and non-instrumentation endodontic treatment in primary teeth: A systematic review and meta-analyses

Studies assessing the clinical and radiographic success of LSTR in terms of the presence of pain, mobility, swelling, fistula/sinus tract, interradicular radiolucency, and root resorption have not been performed. We therefore performed a systematic review with the aim of evaluating the effectiveness of lesion sterilization and tissue repair (LSTR), using three antibacterial mixtures (3Mix), in treating primary teeth. Well-defined search strategies developed for four electronic databases, Web of Science, OVID, PubMed, and Scopus, were used in this study. Two independent reviewers selected relevant articles from 3,232 studies by screening titles and abstracts. Based on the inclusion criteria, 25 articles were selected. Eight analyses of clinical and radiographic results were conducted based on 6, 12, 18, and 24-month follow-up intervals. Data extraction and quality appraisal were performed by three independent reviewers. The composition of antibiotic mixtures used for LSTR varied substantially, with inconsistent radiographic and clinical success rates across the included studies. A quantitative grouping of the studies showed no significant differences between 3Mix and the control medicaments regarding radiographical and clinical success (p-value > 0.05). The available evidence on different LSTR using 3Mix is scarce, and the study findings were inconsistent. Therefore, additional clinical trials on 3Mix with different compositions are needed.

Cone-Beam Computed Tomography Evaluation of Rotary MM Files vs Manual K Files in Primary Molars: An In Vitro Study

AIM

Rotary instrumentation in pediatric dentistry is an emerging concept, thus this study was performed to evaluate the remaining dentine thickness (RDT), canal transportation, centering ability, quality of obturation using cone-beam computed tomography (CBCT), and the time efficiency of rotary versus manual instrumentation in mandibular second primary molars.

MATERIALS AND METHODS

Forty mandibular primary second molars (160 canals) were randomly and equally allocated to four groups. Instrumentation was done using K files in groups I and II; in each group, the obturation was done by two different obturation techniques; incremental technique and disposable syringe technique, respectively. MM rotary files (Innovative Material and Devices, Inc. [IMD], Shanghai, China) were used in groups III and IV; in each group, the obturation was done by incremental technique and disposable syringe technique. Preoperative and postoperative CBCT scans were performed and evaluated for the RDT, centering ability, canal transportation, and the canal filling quality, which was assessed as (underfill, optimal fill, and overfill). Instrumentation time was recorded for groups I and II collectively (manual instrumentation), and groups II and III collectively (rotary instrumentation). Statistical analysis was done using Chi-square, ANOVA, and post hoc Tukey tests, at p < 0.05).

RESULTS

The MM rotary file removed a significantly less amount of dentine at all levels specifically at the middle section (p = 0.003). The canal transportation was significantly higher in the manual group at the cervical level (p = 0.022). In all sections, the rotary group had significantly higher values of centering ratio than the manual group (p < 0.05), which means a lower deviation of rotary instruments. For both types of files, there was no significant difference between different obturation techniques (p > 0.05). Instrumentation time was significantly lower in the rotary group (p < 0.001).

CONCLUSION

Regarding the dentine removal and the shaping ability of MM files acceptable results were obtained; however, no significant difference between the different obturation techniques. Notable time efficiency was reported in the rotary files as well.

CLINICAL SIGNIFICANCE

The use of rotary files resulted in better conservation of tooth structure, better canal centering, and obturation quality as well as less canal transportation and less instrumentation time compared to manual K files.

A New Criteria to Assess Quality of Obturation in Primary Teeth: KEDOO Classification

Aim

The success of the pulpectomy depends on adequate access, cleaning, shaping, and good-quality obturation. Evaluating the quality of obturation is the major tool that determines the success of the procedure. The present study aimed to assess the quality of obturation in all the canals of primary teeth and suggest a new classification.

Materials and methods

A total of 1,000 radiographs of the pulpectomy procedure performed in primary molars were evaluated. The quality of obturation was assessed for each canal using the criteria given by Coll and Sandrian. The prevalence of each obturation criterion in every canal was represented in the form of a percentage.

Results

It was observed that among the mandibular primary molars, most of the mesial canals were underfilled, and in the distal canal, most of the canals were overfilled. Among the maxillary primary molars, most of the mesial canals were overfilled, more distal canals were underfilled, and with respect to palatal canals, optimal obturation was seen.

Conclusion

The pitfalls of the previous classification were revised, and a new classification for assessing the quality of obturation was proposed, which is arch, segment, and canal specific.

Clinical significance

The new classification will give a more precise assessment for the evaluation of various techniques and materials used for pulpectomy in primary teeth.

How to cite this article

Jeevanandan G, Govindaraju L, Kotian N, et al. A New Criteria to Assess Quality of Obturation in Primary Teeth: KEDOO Classification. Int J Clin Pediatr Dent 2023;16(2):376-379.

Comparative Evaluation of Myristica fragrans Essential Oil-Zinc Oxide Mixture with Zinc Oxide Eugenol in Root Canal Filling of Primary Teeth: An In Vivo Study

Background

This is a preliminary investigation to assess the efficacy of Myristica fragrans (M. fragrans) as pulpectomy obturation material.

Objective

To assess the clinical and radiographic efficacy of M. fragrans as pulpectomy obturating material and compare it with zinc oxide eugenol, the gold standard in the obturation of primary teeth.

Materials and methods

This is a triple-blind, randomized, and controlled clinical trial performed on children aged between 4-8 years with primary molars requiring pulpotomy. A total of 50 teeth were randomly assigned into two groups-group I received M. fragrans with zinc oxide eugenol, and group II zinc oxide eugenol. Teeth were then filled with glass ionomer cement and were restored using stainless steel crowns. Clinical and radiographic evaluation was done by a blinded calibrated evaluator at 3, 6, and 12-month follow-up periods. The data obtained were subjected to statistical analysis.

Results

Clinical and radiographic success in both groups was 100% throughout the follow-up period. Extruded material in the M. fragrans group showed resorption during the follow-up period.

Conclusion

Myristica fragrans (M. fragrans) can be suggested as a pulpectomy obturating material for primary teeth. However, further clinical studies with long-term follow-ups are needed to give more affirmative results.

How to cite this article

Setty JV, Srinivasan I, Sathiesh RT. Comparative Evaluation of Myristica fragrans Essential Oil-Zinc Oxide Mixture with Zinc Oxide Eugenol in Root Canal filling of Primary Teeth: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(2):237-243.

Comparative Evaluation of Instrumentation Time and Quality of Obturation amongst Pediatric Rotary Endodontic System: An In Vivo Study

Aim

This study assesses the instrumentation time and quality of obturation of three pediatric rotary endodontic systems-GT nickel-titanium (NiTi) (Prime Pedo), controlled memory (CM) NiTi (Pro-AF-Baby Gold) and NiTi-titanium oxide (NiTi-TiO) (Kedo SG Blue).

Materials and methods

A total of 60 children aged 4-8 were chosen at random for the study based on inclusion criteria that required pulpectomy in any of the primary molars and were separated into three groups of 20 samples, each based on the file system employed. The instrumentation time during the preparation of the canal is recorded using a stopwatch. An expert dentist was blinded to the instrumentation type and showed the periapical radiograph, which he or she graded depending on the quality of the obturation by categorizing it as underfill, optimal fill, or overfill. The observations were then recorded, tabulated, and statistically analyzed for the results.

Results

The least amount of instrumentation time was needed for NiTi-TiO (group III) files, followed by NiTi-CM (group II) and NiTi-GT (group I). NiTi-TiO (group III) has the most optimally filled and least underfilled obturations among the three rotary endodontic systems mentioned. Also, NiTi-TiO (group III) and NiTi-CM (group II) have the least similar overfilled obturations when compared with NiTi-GT (Group I).

Conclusion

We conclude that NiTi-TiO needed the least amount of instrumentation time and generated the maximum optimally filled obturations based on our observations.

Clinical significance

Pediatric rotary endodontic systems are more convenient to use and reduce chairside time; thus, their use in children with behavior control issues might be more suitable.

How to cite this article

Kohli A, Chhabra J, Sharma K, et al. Comparative Evaluation of Instrumentation Time and Quality of Obturation amongst Pediatric Rotary Endodontic System: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(2):338-343.

A 1-year Clinical and Radiographic Assessment of Regenerative Endodontic Therapy for Necrotic Primary Molars: A Randomized controlled Trial

Background

Preservation of necrotic primary teeth is important. Pulpectomy is the gold standard treatment in this situation. Reinfection is the main cause of failure in pulpectomy. The application of regenerative endodontic therapy in mature teeth has the rationale of restoring dental-pulp-like tissue and preventing reinfection.

Aims and objectives

The current study was designed to clinically and radiographically assess regenerative endodontics therapy in necrotic primary molars in comparison to zinc oxide eugenol (ZOE) pulpectomy.

Materials and methods

A double-blinded randomized controlled trial with three parallel arms and a 1:1:1 allocation ratio was conducted. A total of 54 necrotic primary molars in 39 healthy children aged 4-7 years old were randomly allocated as follows group I-control group, in which ZOE pulpectomy was performed. Group II and III-experimental groups, in which regenerative endodontic therapy (RET) was performed. Modified triple antibiotic paste (mTAP) and Metapex™ were used as intracanal medicaments in groups II and III, respectively. Clinical and radiographic assessments were recorded at baseline, 6 and 12 months. Chi-squared and Fisher's exact tests were used to compare the qualitative data, while Friedman's test was used to study the changes by time within each group.

Results

Nonstatistically significant differences were reported between the three groups at the 6 and 12 months follow-ups regarding the clinical or radiographic assessment (p-value = 0.327 and effect size = 0.22), (p-value = 0.055 and effect size = 0.118), respectively.

Conclusion

Regenerative endodontic therapy (RET) yielded comparable results to pulpectomy. However, the use of 5 mg/mL mTAP in RET represented the highest level of clinical as well as radiographic insignificant failure.

Clinical significance

Regenerative endodontic therapy (RET) provides an acceptable biological alternative to pulpectomy.

Trial registration

The protocol was registered at ClinicalTrial.gov with the registration number (NCT04190914). 12/5/2019.

How to cite this article

Abdelmoneim DD, Abdelaziz AM, Allam GG, et al. A 1-year Clinical and Radiographic Assessment of Regenerative Endodontic Therapy for Necrotic Primary Molars: A Randomized controlled Trial. Int J Clin Pediatr Dent 2023;16(2):295-301.

Comparative Evaluation of Four Different Obturating Techniques in Primary Teeth Using Cone-beam Computed Tomography: An In Vivo Study

Background

The quality of the obturation plays a significant role in the success of endodontic treatment. To date, various technologies have been used to evaluate the quality of obturation, but all of them have their own limitations. In order to overcome those limitations, recent technological advancements like cone-beam computed tomography (CBCT) can be helpful.

Aim

To compare and evaluate the efficiency of different root canal obturation techniques in primary teeth using CBCT.

Materials and methods

A total of 80 root canals in 30 children aged between 4 and 9 years were selected and divided into four groups, with 20 root canals in each. Obturation in group I was performed using the endodontic pressure syringe; group II-hand spreaders; group III-Lentulo spirals mounted on slow-speed handpiece; and group IV-insulin syringe. The quality of obturation was evaluated using a CBCT scan.

Results

Group I samples showed the most optimally filled canals followed by II and III; least in group IV. A maximum number of overfilled canals was exhibited in group III samples. Voids were minimal in all four groups and the values obtained were not statistically significant.

Conclusion

Obturation with an endodontic pressure syringe reported the highest number of optimally filled root canals and the insulin syringe showed the least number of optimally filled canals.

How to cite this article

Ali SM, Mukthineni S, Sai Sankar AJ, et al. Comparative Evaluation of Four Different obturating Techniques in Primary Teeth using Cone-beam Computed Tomography: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(2):218-222.

Evaluation and Comparison of Effectiveness of Kedo-S Pediatric Rotary Files vs Manual Instrumentation for Root Canal Treatment in Primary Molars

Purpose

To evaluate and compare the clinical and radiographic success of Kedo-S pediatric rotary files vs manual K-Files for pulpectomy in primary mandibular molars.

Materials and methods

A sample of 30 primary mandibular molars with irreversible pulpitis was taken per group. The groups were divided as below mentioned-group I (n = 30) was treated using the Kedo-S file system. Group II (n = 30)-treated using manual stainless steel K-File. The clinical and radiographic success was compared of both techniques. Statistical analysis involved t-test, Chi-squared test, and Cochran's Q test.

Results

The overall clinical success at 3, 6, and 9 months in group I were 72.4, 89.7, and 93%, respectively and in group II were 82.1, 92.9, and 92.9%, respectively. The overall radiographic success in group I at 3, 6, and 9 months were 6.9, 17.2, and 69%, respectively and in group II were 0, 7.1, and 35.7%, respectively. According to the Frankl behavior rating scale, 19 children in group I (65.5%) showed negative behavior, and 15 children in group II (53.57%) showed positive behavior. The mean instrumentation time in group I (Kedo-S pediatric rotary file group) and group II (hand K-File group) was 8.03 ± 0.823 and 11.25 ± 0.928, respectively.

Conclusion

There was a statistically significant/highly significant difference in intergroup comparison postoperative behavior among the children in the two study groups. There was a statistically significant difference between the two study groups with relation to instrumentation time. The trend that was observed in the clinical and radiographic profile was that group I (Kedo-S rotary files) cases had more success when absolute numbers and figures were compared than group II (hand stainless steel K-File) in which success rates were comparable; however, the difference between the groups were found to be statistically nonsignificant.

How to cite this article

Rajain T, Tsomu K, Namdev R. Evaluation and Comparison of Effectiveness of Kedo-S Pediatric Rotary Files vs Manual Instrumentation for Root Canal Treatment in Primary Molars. Int J Clin Pediatr Dent 2023;16(1):22-29.

Evaluation of Novel Device "Obturagun" as a Root Canal Obturating Technique for Primary Teeth: An In Vitro Study

Aims and objectives

Pulpectomy is one of the most commonly rendered treatment modalities in primary teeth wherein the pulp is irreversibly inflamed. To evaluate the sufficiency of calculated obturating material and quality of obturation in primary teeth using an obturagun device.

Materials and methods

Average root canal volume of 65 and 75 was calculated from cone beam computed tomography (CBCT) scans of children in the age-group of 5-9 years. Based on the average root canal volume and density of obturating material (Vitapex), quantity of obturating material required to obturate a single primary mandibular second molar was calculated. Computer-aided design (CAD)/computer-aided manufacturing (CAM) software was used to design obturagun, which was three-dimensional (3D) printed for study purposes. An in vitro pilot study (pulpectomy) was conducted on 20 extracted primary mandibular second molar to evaluate the efficacy of the obturagun.

Results

Average root canal volume of 75 was larger than 65. Approximately 68% of the root canals showed optimal obturation. Distal root canals were more void free as compared to mesial. In 70% of the cases, the calculated obturation material was sufficient to obturate a single primary mandibular second molar.

Conclusion and clinical significance

Average root canal volume can be used to determine the quantity of obturating material. Obturagun can be used as an alternate obturating technique for primary teeth.

How to cite this article

Kalaskar R, Thosar NR, Kalaskar A. Evaluation of Novel Device "Obturagun" as a Root Canal Obturating Technique for Primary Teeth: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(1):107-111.

Smear layer removal efficacy of irrigating solutions applied distinct needle designs: a scanning electron microscopy study

This research aimed to assess the efficacy of different irrigants applied with different types of needle tips on smear layer removal (SLR) in primary incisors. This study was carried out with 35 freshly extracted upper primary incisors. The samples were randomly distributed to five study groups (n = 7) (1 to 4: experimental, 5: control). These included Group 1: 5% Ethylenediaminetetraacetic Acid (EDTA) + 1% Sodium Hypochlorite (NaOCl) applied with open-ended needle (OEN), Group 2: 6% Citric Acid (CA) + 1% NaOCl applied with OEN, Group 3: 5% EDTA + 1% NaOCl applied with double side-vented needle (DSVN), Group 4: 6% CA + 1% NaOCl applied with DSVN and Group 5: 1% NaOCl applied with OEN. Accordingly, the inner root surfaces were examined using scanning electron microscopy (SEM). The differences between the groups were analyzed using Kruskal-Wallis, Friedman and Siegel-Castellan tests (p < 0.05). In the coronal third, all the experimental groups (groups 1, 2, 3 and 4) were superior to the control group (p = 0.002, p = 0.002, p < 0.001 and p < 0.001, respectively). Groups 2, 3 and 4 showed superior SLR to the control group (p = 0.024, p = 0.001 and p = 0.004, respectively) in the middle third. DSVN groups of EDTA and CA showed superior SLR efficacy than the control (p < 0.001 and p = 0.002, respectively) in the apical third. The SLR efficacy was higher in the coronal third compared to the apical third in the experimental groups (groups 1, 2, 3 and 4) (p = 0.015, p = 0.048, p = 0.048 and p = 0.048, respectively). In addition, 3 samples of EDTA showed erosion (2 in the coronal with OEN, 1 in the middle with DSVN). It was possible to conclude that the SLR efficacy of DSVNs and OENs was similar. CA could be recommended since it did not cause erosive damage compared to EDTA in primary incisors.

Survival analysis of pulpectomy in primary molars performed under dental general anaesthesia: a two-year retrospective study

BACKGROUND

To retrospectively investigate the success rate of primary-molar pulpectomy performed under general anaesthesia and the potential risk factors that affect the 24-month success rate.

METHODS

The case data and two-year follow-up records of children (aged 3-6 years) who received pulpectomy in primary molars performed under general anaesthesia were reviewed and assessed. Potential risk factors included age, gender, decayed-missing-filled teeth, endodontic diagnosis, tooth location, and postobturation sealing of the pulp chamber floor with MTA. With a two-year follow-up period, the outcomes of all the primary molars were classified into success and failure. Survival analysis was used to assess the outcomes. The Kaplan-Meier method was used to analyse the success rate. Univariate and multivariate Cox proportional hazards regression models were used to evaluate the potential risk factors associated with the overall survival of primary molars.

RESULTS

A total of 410 teeth from 163 children (88 boys and 75 girls) were included in this study. The overall two-year success rate was 66.1% for all primary molars. The mean overall survival time for this study was 22.1 (95% CI, 21.73‒22.48) months. Multivariate Cox regression analysis demonstrated that endodontic diagnosis (irreversible pulpitis or periapical periodontitis), tooth location (maxillary or mandibular primary molar), and postobturation sealing of the pulp chamber floor (MTA or no-MTA) were significant risk factors for overall survival in this study (P < .05). The differences in success rates were not statistically significant in terms of age, gender, and decayed-missing-filled teeth (P > .05).

CONCLUSIONS

When compared to teeth diagnosed with irreversible pulpitis, those with periapical periodontitis failed more frequently. Postobturation sealing of the pulp chamber floor with MTA improved the success rate of pulpectomy in primary molars, especially when the inflammation did not spread to the periradicular area.

Evaluation of quality of obturation in 6-9-year-old children

The effectiveness of root canal therapy is dependent on the quality of obturation. The objective of the current study was to evaluate the obturation quality in pediatric patients of age 6-9 years reporting for pulpectomy treatment. Among the comprehensive data of patients attending Saveetha Dental College, a retrospective analysis of all the patients referred for pulpectomy was extracted. SPSS software version 19 was used to analyze the data gathered. Data were statistically evaluated using the Chi-square test. RESULTS: In the present study carried out, it was observed that the most frequent quality of obturation was normal (12.36%) and it is higher in the 7-year-old age category. The second frequent quality of obturation was voids (6.55%) and its higher in the 9-year-old age category. The results obtained were positively significant (P < 0.05). The most frequent quality of obturation was normal and it is higher in the 7 years category. The second frequent quality of obturation was voids with higher level in the 9 years category.

The clinical and radiographic success of Endoflas compared with other root canal obturating materials in primary teeth: A systematic review

Pulpectomy aims at retaining the tooth in the asymptomatic state until exfoliation. Root canal obturating materials should resorb in synchronization with the primary root and get eliminated rapidly upon accidental extrusion. This systematic review aims at appraising the clinical and radiographic outcomes of Endoflas as an obturating material for primary teeth. An extensive literature search on obturating materials used for primary teeth using MeSH terms in PubMed, Cochrane library, and Ovid® from September 2002 to March 2020. Studies evaluating the clinical and radiographic success of Endoflas as an obturating material in children were included. From 45 retrieved articles, eight qualified for the systematic review. Moderate quality of evidence was elicited in this review. There was a dramatic reduction of inter radicular radiolucency in Endoflas obturated teeth compared to other root canal filling materials. Even for resorption of the extruded material beyond the apex too, Endoflas has depicted a faster clearance rate. Hence,it was concluded that, Endoflas can be a potential root canal obturating material for treating the primary teeth, even with furcal radiolucency. We recommend randomized clinical trials satisfying all the norms of CONSORT guidelines to provide a high quality of evidence.

An approach of preserving a mandibular primary second molar by a hemisection procedure: A case report with 36-month follow up

Primary teeth play a crucial role in functional, aesthetic and speech tasks. They are also responsible for maintaining the jaw space for successor permanent teeth. Thus, dentists should understand that extraction might be the easiest decision but not always the correct one, especially, in the case of multiple loss of primary molars. On the other hand, endodontic treatments should be accurately diagnosed - necrotic and irreversibly inflamed teeth - and performed with suitable dental tools and materials. Then it is important to provide a good sealing with a suitable final restoration. This case report discusses an approach for preserving a mandibular primary second molar which had a radiographic lesion in the mesial root and the furcation area with multiple loss of primary molars (before eruption of first permanent molar). This treatment was done by performing a root canal treatment (pulpectomy) just for the distal root and a hemisection procedure by extracting the mesial root, followed by applying SSC crown and space maintainer (band and loop). To conclude, this type of treatment should be temporary until the eruption of the first permanent molar and then changed to be a lingual arch appliance. Moreover, hemisection was a suitable alternative approach to extraction over 36 months of following up.

Credibility of YouTube™ videos on root canal treatment in children

BACKGROUND

A lot of videos on root canal treatment in children are available on YouTube™ but no quality checks are present. Addressing this is critical so that parents and dentists know why root canal in children is important including the explanation of procedural steps regarding treatment undertaken.

AIM

The aim of this study is to analyze and grade YouTube™ videos on root canal treatment in children and assess whether it provides beneficial information for patients and dentists.

MATERIALS AND METHODS

Variables such as number of views, duration (minute), days since upload, number of comments, number of likes, number of dislikes, interaction index, and viewing rate were tabulated for selected 57 videos.

ANALYSIS

Selected videos were statistically analyzed using a 15-point scoring system and evaluated using SPSS software. Finally, the obtained data sets were classified as low-, moderate-, and high-content videos. Fisher's exact test was used to compare between proportions.

RESULTS

Based on the tabulated variables, most of the videos were low (n = 31) and moderate content (n = 24), which dentists mostly uploaded. There was no statistical significance between the video types and content score groups (P > 0.05). The most frequently mentioned issues were procedure (84.21%), obturating materials (75.44%), and etiology (63.16%). The least mentioned subjects were indications (24.56%) and importance (22.81%).

CONCLUSION

From this study, YouTube™ videos on root canal treatment in children were of low and moderate quality. Hence, high-quality videos are essential for providing awareness among patients and dentists.

Evaluation of the Working Length Determination Accuracy by Cone-beam Computed Tomography in Primary Teeth

Background

In primary teeth, working length determination is complicated due to its continuous alteration in dimension, shape, and root apex position. Accurate working length determination is essential to achieve the optimal cleaning and disinfection of the canal. Despite the use of conventional radiographic method, newer methods are available to increase the accuracy of WL determination. This study aims to compare electronic apex locator (EAL) with radiographic method of WL determination and to evaluate its accuracy using cone-beam computed tomography (CBCT).

Materials and methods

Sixty root canals from 34 extracted primary teeth were included. Occlusal surfaces were flattened and access opening done for all the samples. Teeth were subjected to working length determination by conventional radiograph and EAL. Samples were then mounted on a U-shaped wax and subjected to CBCT. Results were recorded and statistically analyzed using ANOVA and ICC for quantitative data.

Result

The mean measurement of radiographic, EAL and CBCT methods are 11.708, 11.200, and 10.895, respectively. Mean measurements demonstrated significant difference (p < 0.05) between three methods. ICC demonstrated high correlation between EAL and CBCT with Cronbach's α value of 0.962 and moderate correlation were observed between radiographic method and CBCT (0.706) and EAL and radiographic method (0.763). EAL demonstrated 87% accuracy whereas radiographic method demonstrated 63% accuracy to the actual length as evaluated by CBCT.

Conclusion

EAL is more accurate than conventional radiographic method as evaluated by CBCT.

How to cite this article

Shibin J, GS P, M S, et al. Evaluation of the Working Length Determination Accuracy by Cone-beam Computed Tomography in Primary Teeth. Int J Clin Pediatr Dent 2022;15(S-1):S92-S96.

Comparative Evaluation of Cleaning Capacity and Efficiency of Kedo-S Pediatric Rotary Files, Rotary ProTaper, and Hand K Files in Primary Molar Pulpectomy

Aim and objective

To assess and compare the cleaning efficacy and instrumentation time of K files, ProTaper, and Kedo-S rotary files in primary molars.

Materials and methods

India ink was injected into 120 root canals of selected primary molars. The root canals were randomly and equally divided into three groups based on instrumentation technique: group I-K files, group II-ProTaper, and group III-Kedo-S. After instrumentation with respective method, the canals were cleared and observed under a stereomicroscope, the instrumentation time for each root canal was also measured with a stopwatch. Statistical analysis was done with one-way analysis of variance (ANOVA) and post hoc Bonferroni.

Result

Kedo-S rotary files performed significantly better cleaning of the canals in the coronal and middle third than ProTaper and K files (p = 0.0001). In the apical third, the difference between the two rotary systems was not significant. The time taken for instrumentation was lowest with Kedo-S followed by ProTaper and K files.

Conclusion

Kedo-S pediatric rotary system showed significantly better cleaning than ProTaper rotary system and K files in cleaning primary molar root canals.

Clinical relevance

The anatomy and morphology of primary teeth demand a specialized file system that will overcome the shortcomings of conventional biomechanical preparation. Kedo-S files, being exclusive pediatric rotary files, might prove to be a boon in primary canal preparation.

How to cite this article

Kalita S, Agarwal N, Jabin Z, et al. Comparative Evaluation of Cleaning Capacity and Efficiency of Kedo-S Pediatric Rotary Files, Rotary ProTaper, and Hand K Files in Primary Molar Pulpectomy. Int J Clin Pediatr Dent 2021;14(3):383-387.

Resorbable Collagen Barrier Impeding the Extrusion of Obturating Material in Primary Molars Undergoing Resorption - A Randomized Clinical Trial

OBJECTIVE

To evaluate the effectiveness of placing a resorbable collagen barrier in impeding the extrusion of obturation material in primary molars undergoing resorption.

STUDY DESIGN

All the 94 canals in 47 mandibular molars were allocated to 2 groups- Group 'A'- 47 canals with collagen barrier (Test group) and Group 'B'- 47 canals without collagen barrier (Control group) based on randomization protocol. Pulpectomy was performed and obturation of both test and control canals were radiographically assessed. Pearson's chi - square test was applied to analyze the results. The significance level was predetermined at p < 0.05.

RESULTS

Among the test group, 93.6% of the canals showed no extrusion while, 6.4% showed visible extrusion of the material outside the apex. In the control group, 83% showed no extrusion whereas 17% of the canals showed visible extrusion outside the apex. But no significant difference was noted (p>0.05).

CONCLUSION

The placement of resorbable collagen barrier in the apical third of the canal prevented the extrusion of obturating material beyond the apex in resorbing primary molars.

Comparative Evaluation of Hand K-flex Files, Pediatric Rotary Files, and Reciprocating Files on Instrumentation Time, Postoperative Pain, and Child's Behavior in 4-8-year-old Children

Background

A pulpectomy is regarded as the choice modality of treatment for necrotic teeth. The use of hand files, though popular traditionally as a gold standard, may be challenging due to increased chairside time. Postoperative pain is one of the most common complications of pulpectomy and may be unpleasant for a child/pedodontist. Rotary files were found to reduce instrumentation time, reduce apical extrusion, and in turn reduce pain but there is a lack of studies in primary teeth particularly for pediatric and reciprocating file systems. The increased number of options available today makes it a dilemma for the operator to choose a suitable file system.

Aim and objective

The study aimed to evaluate and compare the instrumentation time, postoperative pain, and effect on child's behavior among three groups, i.e., hand K-flex files (group I), pediatric rotary files (group II), and reciprocating files (group III).

Materials and methods

A total of 75 primary molar teeth after meeting inclusion criteria were randomly allocated into three groups. During the procedure, step-wise instrumentation time was recorded using a stopwatch. The child's behavior pre- and postoperatively was assessed by an evaluator. The postoperative pain (up to 1 week) was assessed by a questionnaire.

Results

The mean age of children taken for the study was 6.03 ± 1.2 years with 46 males and 29 females. The mean biomechanical preparation time was observed to be significantly shorter in the pediatric rotary and reciprocating file groups vs hand K-flex files (p < 0.001**). The postoperative pain after 6 hours had a mean value of 0.88 + 0.9 for the hand K-flex file group which was significantly higher than both rotary file groups (p < 0.05*). The pre- and postoperative behavior revealed no significant difference.

Conclusion

The clinical performance of pediatric and reciprocating files was superior, but the choice of file system did not significantly alter behavior.

How to cite this article

Tyagi R, Khatri A, Kalra N, et al. Comparative Evaluation of Hand K-flex Files, Pediatric Rotary Files, and Reciprocating Files on Instrumentation Time, Postoperative Pain, and Child's Behavior in 4–8-year-old Children. Int J Clin Pediatr Dent 2021;14(2):201–206.

Comparative Evaluation of Efficacy of Obturation Techniques in Deciduous Teeth Using Cone-beam Computed Tomography: An In Vivo Study

Introduction

Pediatric dentistry has evolved from extraction acclimatized practice to prevention and preservation. Successful endodontic treatment is mandated for retention of pulpally involved primary teeth.

Aim and objective

To comparatively evaluate the obturation techniques namely lentulospiral and skini syringe with NaviTip in primary teeth using cone-beam computed tomography (CBCT).

Materials and methods

The study was carried out among children ranging between the ages of 4 years and 8 years of either sex with pulpal involvement of primary molars which were indicated for pulpectomy. The study population was divided into two groups according to the type of obturating technique used. Group I included samples obturated with lentulospirals while group II samples were obturated using skini syringes with NaviTip. Postoperatively, CBCT imaging was used to evaluate the quality of fill of both the obturation techniques by determining the presence of voids in the root canals.

Results

The total number of voids present in group I were 48, in which, 8 were in the coronal third, 16 in the middle third, and 24 in the apical third. On the other hand, the total number of voids present in group II was 21, out of which 7 were in the coronal third, 10 in the middle third, and 4 in the apical third. A statistically significant difference was noted between the two groups in terms of the overall voids present.

Conclusion

Within the limits imposed by the conditions used in the present study, both techniques can be used for obturation in the root canals of primary molars. Voids were observed with both the techniques, but minimum in group II, i.e., skini syringe with NaviTip.

How to cite this article

Nezam S, Mukherjee CG, Shukla JN, et al. Comparative Evaluation of Efficacy of Obturation Techniques in Deciduous Teeth Using Cone-beam Computed Tomography: An In Vivo Study. Int J Clin Pediatr Dent 2021;14(1):75–80.

Comparative evaluation of efficacy of external vibrating device and counterstimulation on child's dental anxiety and pain perception during local anesthetic administration: a clinical trial

Background

This study aimed to evaluate the efficacy of external vibrating devices and counterstimulation on a child's dental anxiety, apprehension, and pain perception during local anesthetic administration.

Methods

This was a prospective, randomized, parallel-arm, single-blinded interventional, clinical trial. One hundred children aged 4–11 years, requiring pulp therapy or extraction under local anesthesia (LA), were recruited and allocated equally into two groups (1:1) based on the interventions used: Group BD (n = 50) received vibration using a Buzzy® device {MMJ Labs, Atlanta, GE, USA} as a behavior guidance technique; Group CS (n = 50) received counterstimulation for the same technique. Anxiety levels [Venham's Clinical Anxiety Rating Scale (VCARS), Venham Picture Test (VPT), Pulse oximeter {Gibson, Fingertip Pulse Oximeter}, Beijing, China)] were assessed before, during, and after LA administration, while pain perception [Wong-Baker Faces Pain Rating Scale (WBFPS), Visual Analogue Scale (VAS)] was evaluated immediately after injection. Statistical analysis was performed using the Student's t-test to assess the mean difference between the two groups and the repeated measures ANOVA for testing the mean difference in the pulse rates. Statistical significance was set at P < 0.05.

Results

Significant differences in mean pulse rate values were observed in both groups. In contrast, the children in the BD group had higher diminution (P < 0.05), whereas the mean VCARS and VPT scores were conspicuous (P < 0.05). Based on the mean WBFPS and VAS scores, delayed pain perception after LA injection was more prominent in the BD group than in the CS group.

Conclusion

External vibration using a Buzzy® device is comparatively better than counterstimulation in alleviating needle-associated anxiety in children requiring extraction and pulpectomy.

Root canal instrumentation efficacy of non-fused and fused primary molar roots: a micro-computed tomography study

PURPOSE

Pulpectomy may be indicated in restorable primary teeth exhibiting irreversible pulpitis or pulpal necrosis. The purpose of this study was to compare the cleaning and shaping efficacy of NiTi systems (Reciproc^® Blue and MTwo^®) with manual stainless-steel instrumentation in primary molars using micro-CT analysis.

METHODS

Fifty-seven maxillary second primary molars were scanned using micro-CT. Teeth with three divergent roots were divided randomly (n = 15) according to instrument type (K file, MTwo®, and Reciproc® Blue). Teeth with root fusion were instrumented manually as a separate group (n = 12). Pre- and post-instrumentation micro-CT images were superimposed, and the instrumentation area (IA) and procedural complications were recorded.

RESULTS

No statistically significant differences in IA between file systems was observed in the non-fused teeth. The mean IA of fused roots was significantly lower than in the non-fused distobuccal (p = 0.003) and palatal (p < 0.001) roots. The root segment had a significant effect on IA (p < 0.001) and the highest mean IA was observed in the apical third. Manual instrumentation had fewer procedural complications compared with rotary systems.

CONCLUSION

No differences were determined in the cleaning and shaping effectiveness of all systems in non-fused teeth. Uninstrumented areas (> 60%) occurred in both non-fused and fused primary teeth with fewer procedural complications observed after manual instrumentation.

Treatment Outcomes of Pulpectomy in Primary Maxillary Incisors Filled with ZOE and Metapex: A Two-year Retrospective Study

OBJECTIVES

To address a literature gap by evaluating, in a larger set of samples, the clinical and radiographic outcomes of pulpectomy in primary maxillary incisors using ZOE and calcium hydroxide/iodoform paste. To also identify the predisposing factors for treatment outcomes.

STUDY DESIGN

Medical charts of 124 patients (aged 16 to 60 months) and radiographs of their incisors (309 incisors) were reviewed (128 with ZOE and 181 with Metapex). All incisors were restored with composite resin crowns.

RESULTS

The radiographic success rates for ZOE and Metapex were: 85.9% and 82.9% at the 12-month recall, and 69.2% and 64% at the 24-month recall, with no statistically significant difference between the two groups. Clinical failures occurred more frequently in the Metapex group (P = 0.006), as clinical signs of pain and soft tissue pathosis were found in 6.2% of the Metapex cases at 24 months but none in the ZOE group. Significant predisposing factors for radiographic success were type of tooth, degree of obturation at recalls, and preoperative root resorption.

CONCLUSIONS

The radiographic success rates are comparable between the ZOE and Metapex groups. Clinical pathological manifestations such as pain and soft tissue pathosis are seen in the Metapex group at recalls, but none in the ZOE group. Predisposing factors such as type of incisor, preoperative root resorption, and extent of filling at recalls are associated with the radiographic success rate.

Comparative evaluation of root ZX Mini® apex locator and radiovisiography in determining the working length of primary molars: An In Vivo study

INTRODUCTION

Working length determination is a crucial step for success of pulpectomy. Various new modalities have been developed. The newest technology includes EAL. Electronic apex locators require less chair side time, do not produce pain and avoid unnecessary radiation which makes it more superior in paediatric endodontic procedures.

AIM

To evaluate and compare Root ZX mini apex locator and Radiovisiography (RVG) for determining working length in primary molars.

MATERIALS AND METHODS

A sample of 30 primary molar teeth was subjected to working length determination by Root ZX mini and RVG. The data was collected and then tabulated and subjected to statistical analysis.

RESULTS

On comparison among two groups, it was found there was no difference between the efficiency of modalities. A positive correlation was seen among Root ZX mini and RVG (ICC ​= ​0.99).

CONCLUSION

Root ZX mini and radiovisiography are seen to be precise in determination of working length in primary molars. It can be said that Root ZX mini i. e the electronic apex locators can be used as an adjunct to Radiovisiography and conventional radiography.

Is lentulospiral the best option for root canal filling of endodontically treated primary teeth? A systematic review and meta-analysis

PURPOSE

To evaluate the quality of root canal filling of primary teeth using lentulospiral in comparison with other instruments.

METHODS

Electronic databases (PubMed/MEDLINE, Scopus, TRIP, LILACS, and CENTRAL Cochrane) were searched up to Jan 2021. Clinical trials that compared the quality of root canal filling of endodontically treated primary teeth using lentulospiral with other instruments were included. Two reviewers independently selected the studies, extracted data, and assessed the risk of bias. Two outcomes were considered: inadequate root canal filling (under or overfilling) and presence of voids. Conventional meta-analyses were performed using a fixed-effects model. Statistical analyses were performed using RevMan5.3 at a significance level of 5%.

RESULTS

Of the 68 potentially relevant studies, eight were selected for full-text analysis, and three were included in the systematic review. The use of syringes resulted in a lower risk of presence of voids in the root canal filling compared to the use of lentulospiral (RR: 0.62 95% CI 0.45; 0.85). However, there was no difference between lentulospiral and bi-directional spiral (RR:1.17 95% CI: 0.90; 1.51). There was no significant difference between lentulospiral and syringes (RR: 1.37 95% CI 1.00; 1.87) considering the length of the root canal filling. The use of bi-directional spiral had a higher risk of inadequate root canal filling compared to the use of lentulospiral (RR: 1.75 95% CI: 1.12; 2.74). Two studies were at "high", and one study at "unclear" risk of bias in the key domains.

CONCLUSIONS

There is insufficient scientific evidence showing the superiority of using lentulospiral for the root canal filling in endodontically treated primary teeth. Due to the limited level of evidence, professionals may opt to choose the instrument based on their preferences.

Comparison of Clinical and Radiographic Success of Rotary with Manual Instrumentation Techniques in Primary Teeth: A Systematic Review

Aim and objective

A systematic review was planned to compare the clinical and radiographic success rate of pulpectomy in primary molars using a rotary system and hand files system.

Study design

The literature search was undertaken in electronic databases from January 2000 to December 2019 using keywords. Four hundred and forty-two studies were identified after applying limits. Three hundred and thirty-one irrelevant articles were eliminated. Among the 111 articles obtained, 90 articles were eliminated after reading the titles and abstracts. After assessing the full text, 18 articles were eliminated. Randomized controlled trials (RCTs) published in the English language on pulpectomy of primary molars, using hand files and rotary files and with a follow-up period of 12 months were included.

Results

Three RCTs comparing the clinical and radiographic pulpectomy success rates using rotary and hand files instrumentation were finally selected. Qualitative assessment with RoB 2.0 showed one study had a low risk of bias and two studies had a high risk of bias.

Conclusion

Pulpectomy procedures in primary teeth using rotary and hand files instrumentation techniques were equally effective in terms of success rates.

How to cite this article

Natchiyar N, Asokan S, Geetha Priya PR, et al. Comparison of Clinical and Radiographic Success of Rotary with Manual Instrumentation Techniques in Primary Teeth: A Systematic Review. Int J Clin Pediatr Dent 2021;14(1):8–13.

Comparative Evaluation of Quality of Obturation and Its Effect on Postoperative Pain between Pediatric Hand and Rotary Files: A Double-blinded Randomized Controlled Trial

Background

One of the cardinal points to be considered during endodontic procedures in children is the measure of postoperative pain.

Aim and objective

To evaluate the quality of obturation and its effect on postoperative pain with three file systems in primary mandibular molars during 1 week follow-up.

Materials and methods

The study was conducted as a double-blinded randomized controlled trial. The participants between 6 years and 9 years old requiring a pulpectomy were recruited for the trial. Forty-five primary mandibular molars were randomly allocated into 15 teeth each in Hand K-files; Kedo-SH and Kedo-SG Blue groups. Wong Baker's FACES Pain Rating Scale was used for assessing the postoperative pain in the children for 1 week. Pearson's Chi-square test, Kruskal-Wallis test, and Mann-Whitney U test were used for analyzing the data statistically.

Results

Optimal fillings were observed more in the Kedo-SG Blue group (80.0%) compared to the other two groups (p < 0.017). On intergroup analysis, the Kedo-SG Blue group reported less postoperative pain compared to Kedo-SH group on day 1 while on day 7 no postoperative pain was experienced in either of the groups. Less postoperative pain was reported by the children in whom the canals were optimally filled compared to overfilling and underfilling.

Conclusion

Kedo-SG Blue resulted in less postoperative pain when compared to Kedo-SH and hand K-files, whereas optimally filled children experienced less postoperative pain compared to overfilling and underfilling.

Clinical significance

A felicitous pediatric dental practice includes appropriate assessment and management of postoperative pain in children. Hence, the present study is important in highlighting the affiliation of postoperative pain with quality of obturation following an endodontic intervention in children.

How to cite this article

Jeevanandan G, Govindaraju L, Subramanian EMG, et al. Comparative Evaluation of Quality of Obturation and Its Effect on Postoperative Pain between Pediatric Hand and Rotary Files: A Double-blinded Randomized Controlled Trial. Int J Clin Pediatr Dent 2021;14(1):88-96.

Comparing the Influence of Conventional and Rotary Instrumentation Techniques on the Behavior of the Children: A Randomized Clinical Trial

Background

Pulpectomy has gained popularity in the pediatric dental practice for preserving the primary teeth in its position until exfoliation. There has been a paradigm shift from using manual instrumentation to rotary instrumentation for canal preparation in primary teeth. While studies show that there is a reduction in the instrumentation time with the use of rotary instruments which in turn influences the behavior of the child, its direct effect on the behavior of the children has not been evaluated.

Aim

To compare the behavior of the children during manual and rotary instrumentation for pulpectomy in the primary molars.

Materials and methods

A single-blinded randomized clinical trial was conducted in 88 children in any one of the mandibular primary molars indicated for pulpectomy. The canal preparation was done using manual K files and rotary ProTaper (44 children in each group). The influence of these instrumentation techniques on the children was assessed with three different scales- Frankl Behavior Rating Scale; Venham Interval Rating Scale; Wong Baker FACES Pain Scale for evaluating the behavior, anxiety, and the pain experienced by the children, respectively during canal preparation.

Results

A total of 88 participants, comprising 50 females and 38 males, participated in the study. An equal distribution of the participants with respect to age (p = 0.064), gender (p = 0.389), and teeth (p = 0.877) was observed between the groups. More cooperative behavior (p < 0.001); lesser anxiety levels (p < 0.001); lower intensity of pain (p < 0.001) were recorded in the children instrumented using Rotary files.

Conclusion

The present study concludes that it is preferable to use rotary instrumentation for primary canal preparation in pediatric practice as it has a more positive influence on the behavior of the children, which eventually determines the success of the treatment.

Clinical significance

With rise in the use of rotary files for pulpectomy in primary teeth, the present paper demonstrates the influence of rotary instrumentation technique for canal preparation during pulpectomy on the behavior of the children in a dental chair. This paper throws light for the pedodontists to effectively perform pulpectomy in children with ease without leaving a psychological impact on the children.

How to cite this article

Govindaraju L, Subramanian EMG, Jeevanandan G. Comparing the Influence of Conventional and Rotary Instrumentation Techniques on the Behavior of the Children: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2021;14(S-2):S179-S185.

Primary tooth pulpectomy overfilling by different placement techniques: A systematic review and meta-analysis

Background. This study was conducted to investigate root canal overfilling with different material placement techniques in primary teeth. Methods. A systematic search was undertaken by searching PubMed/MEDLINE and Scopus for English language peer-reviewed articles published until February 2018 that reported primary tooth pulpectomy overfilling. Two reviewers independently screened and identified studies in terms of the selection criteria and independently collected the data using a specially designed data extraction form. The overfilling rate was the primary summary measure. The weighted pooled overfilling rates were estimated by random-effects meta-analysis. Results. Twenty clinical and four in vitro studies met the eligibility criteria. In the clinical studies, the pooled overfilling rate for zinc oxide-eugenol (ZOE) was 23.3% with a lentulo spiral mounted on a handpiece, 22.7% with a hand-held lentulo spiral, and 17% with a plugger. The pooled overfilling rate for calcium hydroxide-based materials was 16.7% with a lentulo spiral mounted on a handpiece, 14.7% with a hand-held lentulo spiral, 19.6% with a syringe, and 25.7% with a plugger. In the in vitro studies, neither individual overfilling rates nor two-by-two comparisons were subjected to meta-analysis because of an inadequate number of studies. Conclusion. The lowest overfilling rate in the clinical studies was related to plugger and handheld lentulo spiral techniques for ZOE and calcium hydroxide-based materials, respectively.

A Letter Regarding Recently Published Systematic Review Comparing the Effectiveness of Manual and Rotary Root Canal Instrumentation in Primary Teeth

How to cite this article: Rahul M, Tewari N, Gowthaman K. A Letter Regarding Recently Published Systematic Review Comparing the Effectiveness of Manual and Rotary Root Canal Instrumentation in Primary Teeth. Int J Clin Pediatr Dent 2020;13(3):310.

Pulpectomy versus Extraction for the Treatment of Nonvital Primary Second Molars: A Retrospective Chart Review

OBJECTIVES

The current investigation evaluated parameters leading to the utilization of pulpectomy versus extraction for treatment of nonvital primary second molars.

STUDY DESIGN

This retrospective chart review identified patients up to 8-years of age with primary second molars treated by pulpectomy or extraction. Patients in the extraction group were age and gender-matched to the pulpectomy group. Demographic, clinical, radiographic and behavioral data were extracted for comparison. Chi-square, Fisher and T-test were performed for statistical analysis.

RESULTS

There were 23 patients in each group, with a mean age of 5 years (ranging 3-8 years, ±1.5 for pulpectomy and ±1.3 for extraction). Significantly more pulpectomies were performed in the mandible (p=0.002), specifically on the left side (p=0.0035). Internal and external root resorption were significantly higher in the extraction group (p=0.033 and p=0.007 respectively). Restorability was significantly lower in the extraction group (p<0.0001). Pre-procedural pain was reported by 76.5 percent of all patients, but pharmacologically treated in 15.2 percent. Nitrous oxide was administered to 73.9 percent of patients for behavior guidance.

CONCLUSION

Pathologic root resorption and non-restorability were significantly higher in the extraction group. Behavior and pathologic bone resorption did not influence treatment choice. A higher proportion of children reported pre-treatment pain and needed adjunctive behavior guidance than children who did not have pre-treatment pain or did not need adjunctive behavior guidance.

Enamel of Premolars whose Predecessors Presented Rupture of the Follicle Bone Crypt from Periapical Infections

OBJECTIVE

To observe if dental alterations in premolars are associated with the rupture of the follicle bone crypt caused by a periapical lesion in the predecessor molars.

STUDY DESIGN

This is a cross-sectional study. Data collection consisted of the analysis of medical records, a socioeconomic questionnaire, and dental clinical examination. Records from patients with a history of a radiographically visible periapical lesion in lower primary molars submitted to pulp therapy or extraction from a university dental clinic were selected. Successor premolars were clinically evaluated for the presence of enamel development defects, shape alterations, and eruption deviations. The descriptive analysis of data was performed, and Fisher's exact tests, linear trend chi-square, and the Student's t-test were applied.

RESULTS

Forty-eight permanent teeth were from 36 patients were evaluated in this study, and 20 (41.7%) of the 48 examined premolars showed a radiographic image suggestive of the rupture of the bone crypt. Rupture of the follicle bone crypt was not associated with the occurrence of enamel alterations in premolars (p = 0.418). An association between dental alterations and age over six years at the time of intervention was observed (p = 0.043).

CONCLUSION

The presence of enamel alterations of premolars was not associated with the rupture of the follicle bone crypt caused by a periapical lesion in predecessor molars.

Is there evidence for the use of lesion sterilization and tissue repair therapy in the endodontic treatment of primary teeth? A systematic review and meta-analyses

OBJECTIVE

To assess whether lesion sterilization and tissue repair (LSTR) technique resulted in similar clinical and radiographic success outcomes as compared with pulpectomy in primary teeth.

MATERIALS AND METHODS

Randomized clinical trials comparing LSTR with pulpectomy by means of clinical and radiographic parameters were included. Risk of bias was assessed using Cochrane methodology and the certainty of evidence was determined by GRADE.

RESULTS

Six articles were included. Conventional pulpectomy was favored with respect to radiographic success frequency in the systematic review. Four studies were included in meta-analyses. Based on the clinical results at 6 months (RR = 0.99, 95% CI, 0.94-1.04, p = 0.67; I² = 0%), 12 months (RR = 0.97, 95% CI, 0.90-1.04, p = 0.34; I² = 0%), and 18 months (RR = 0.89, 95% CI, 0.77-1.04, p = 0.14; I² = 0%) and radiographic findings at 6 months (RR = 0.91, 95% CI, 0.78-1.06, p = 0.23; I² = 9%), 12 months (RR = 0.87, 95% CI, 0.65-1.18, p = 0.38; I² = 64%), and 18 months (RR = 0.84, 95% CI, 0.69-1.02, p = 0.08; I² = 0%), there was no difference observed regarding success between the two treatments. The quality of evidence ranged from moderate to very low.

CONCLUSIONS

No difference between the LSTR and pulpectomy approaches could be confirmed by meta-analyses. The quality of evidence according to the GRADE scheme ranged from moderate to very low.

CLINICAL RELEVANCE

The present meta-analyses could not demonstrate the superiority of one treatment over the other.

A Comparative Evaluation of a Labial Approach with a Conventional Palatal Approach for Endodontic Access in Primary Maxillary Incisors: A Pilot Study

Aim

A straight-line access provides an uninterrupted path for a successful endodontic procedure and traditionally a palatal approach was used to achieve the same. A labial access opening may provide a straight-line access to the root canal more consistently than the conventional palatal access opening in primary maxillary incisors; its advantages being improved visibility and direct access to the root canal. This study was designed to compare and evaluate the time taken for pulpectomy in primary maxillary incisors with conventional palatal access and labial access as well as time taken for the postendodontic restoration.

Materials and methods

A cohort study was conducted wherein pulpectomy was performed on primary maxillary anterior teeth with labial endodontic access (group I—40 teeth) and palatal endodontic access (group II—40 teeth). Each group was further subdivided into two subgroups of 20 teeth each, requiring postendodontic composite restoration and requiring postendodontic strip crown restoration. Time taken for pulpectomy with both methods and for postendodontic restoration was evaluated.

Results

The mean time (in seconds) taken for pulpectomy and postendodontic composite restoration was significantly less with a labial access than a palatal access (p = 0.000). Although the time required for postendodontic strip crown restoration was less with a labial access compared with a palatal access, this difference was not statistically significant (p = 0.907).

Conclusion

From the results of this study, it can be suggested that labial endodontic access may be routinely used for pulp therapy of primary anterior teeth.

Clinical significance

A labial endodontic access for primary anterior teeth provides a straight-line access and improves operator convenience and patient compliance when compared with a palatal access.

How to cite this article

Winnier J, Suresh R. A Comparative Evaluation of a Labial Approach with a Conventional Palatal Approach for Endodontic Access in Primary Maxillary Incisors: A Pilot Study. Int J Clin Pediatr Dent 2020;13(1):53–56.

Clinical Efficacy of Single-visit Pulpectomy over Multiple-visit Pulpectomy in Primary Teeth: A Systematic Review

Objective

The purpose of this systematic review was to compare the efficacy of single-visit pulpectomy (SVP) vs multiple-visit pulpectomy (MVP) in infected primary teeth.

Materials and methods

An extensive literature search in the English language was conducted in PICO format using MeSH terms using databases (PubMed, EBSCO, Ovid, and Cochrane) and pre-specified inclusion and exclusion criteria were applied to identify relevant studies comparing pulpectomy in single and multiple visits.

Results

Only 4 studies (3—in vivo clinical study; 1—in vivo microbial study) sustained the final analysis and were included for critical appraisal. Results of the systematic search revealed that there are only a few studies comparing the efficacy of single-visit pulpectomy vs multiple-visit pulpectomy in infected primary teeth.

Conclusion

On the basis of the available studies, evidence favors the SVP protocol over the MVP protocol. Whenever possible the single-visit protocol can be preferred over the multiple-visit protocol. The quality of evidence available is low.

How to cite this article

Tirupathi SP, Krishna N, Rajasekhar S, et al. Clinical Efficacy of Single-visit Pulpectomy over Multiple-visit Pulpectomy in Primary Teeth: A Systematic Review. Int J Clin Pediatr Dent 2019;12(5):453–459.

Rotary Endodontics in Pediatric Dentistry: Embracing the New Alternative

Pulpectomy is one of the most important procedures in maintaining the necrotic primary teeth until physiologic exfoliation. In clinical practice, time efficacy is invaluable, especially in pediatric endodontics, where unpredictability and difficulty of root canal morphology adds to a clinician's challenge. The success of a pulpectomy procedure mainly depends upon the biomechanical preparation of the root canal systems. With the advent of NiTi rotary files, adult endodontic procedures have been rendered easy, but its popularity in pedodontic practice is limited. Therefore, the purpose of this article is to review the use of NiTi rotary files for root canal instrumentation in primary teeth.

How to cite this article

Chauhan A, Saini S, Dua P, et al. Rotary Endodontics in Pediatric Dentistry: Embracing the New Alternative. Int J Clin Pediatr Dent 2019;12(5):460-463.

Comparative Evaluation of Three Obturating Techniques in Primary Molars: An in Vivo Study

Objectives: The purpose of this study was to evaluate and compare the quality of obturation between the two tested methods for root canal filling with a newer system in primary teeth. Study design: A total of 104 canals were prepared and obturated using zinc oxide eugenol paste. The three delivery systems compared were: Rotary lentulospiral and Navitip^® withNavitip^® Double Sideport. Radiographs were used to evaluate the canals for length of obturation and presence of voids. Results: The data were analyzed using chi-square tests. Significant differences was seen between the three groups for the presence of voids (p value =0.042) with less voids in Navitip^® Double Sideport. There were no difference between the three groups for the extent of filling (p value=0.170). Conclusion- Navitip^® Double Sideport showed the better results in terms of extent of obturation and absence of voids when compared to the Rotary lentulospiral and Navitip^®.

Volumetric Assessment of Root Canal Obturation Using 3% Nano-Chitosan versus Zinc Oxide Eugenol (ZOE) and Iodoform-Calcium Hydroxide (Metapex), in Primary Root Canals Shaped with Rotary versus Manual Methods: A Preliminary In-Vitro Spiral CT Study

Objectives:

In this study, chitosan was introduced and used as a substitute for pulpectomy obturation against conventional materials: zinc oxide eugenol (ZOE) and iodoform-calcium hydroxide (Ca(OH)₂). Efficacies of rotary versus manual instrumentations were also compared.

Materials and Methods:

This preliminary study was performed on 152 intact nonresorbed root canals of primary molars divided into rotary (n=78) versus hand-instrumentation (n=74) and into ZOE (n=53), iodoform-Ca(OH)₂ (n=50), and 3% nano-chitosan (n=49). Canals were cleaned/shaped using hand or rotary files. Canal spaces were measured using spiral computed tomography and obturated using the three materials. The percentages of obturation volume (POV) were estimated. Rotary and manual instrumentations were compared in terms of canal spaces before and after obturation. Three obturation materials were also compared regarding canal spaces after obturation (α=0.05).

Results:

Average POVs of materials were 96.54% (ZOE), 97.87% (Metapex), and 74.74% (nano-chitosan; P=0.000). POV of chitosan differed from the other two (P<0.001) but the other two were similar (P=0.896). Average POVs were 91.46% (manual) and 88.51% (rotary); the difference was not significant (P=0.322). Preobturation spaces of canals for different methods were 3.89 mm ³ (manual) and 3.26 mm ³ (rotary); the difference was significant (P=0.013). Two-way ANCOVA showed a significant effect of materials (P<0.001) but not root length (P=0.585) or shaping methods (P=0.362) on POVs.

Conclusion:

Nano-chitosan showed a considerable success rate but it still needs reformulation as it was weaker than the extremely successful commercial competitors. Rotary instrumentation can provide results similar to hand-filing in terms of POV although it might yield smaller canals.

Comparative Evaluation of the Efficacy of Chlorhexidine, Sodium Hypochlorite, the Diode Laser and Saline in Reducing the Microbial Count in Primary Teeth Root Canals - An In Vivo Study

Introduction: One of the primary goals of pulpectomy is to decrease the sum total of microorganisms and disinfect the tooth root canal system. To achieve this, mechanical preparation, irrigation, disinfection and obturation of the root canal is necessary. The present study was set out to evaluate the difference in the antibacterial efficacy of primary teeth root canals either irrigated with chlorhexidine, saline, and sodium hypochlorite or irradiated with a soft tissue diode laser (980 nm, Photon Plus, Zolar Tech & Mfg Co. Inc, Ontario, Canada). Methods: Sixty primary teeth of children requiring pulpectomy were divided into 4 groups of 15 each, group 1 (2% chlorhexidine), group 2 (1% sodium hypochlorite), group 3 (laser irradiation) and group 4 (saline). Pulp tissue was extirpated from the canals and the samples were collected using sterile absorbent paper points. After cleaning and shaping, the root canals of the teeth in each group were irrigated using sodium hypochlorite, chlorhexidine, and saline or were irradiated with the laser. The samples were obtained again and sent for microbiological examination. Results: The colony-forming unit (CFU) counts from pre-disinfection sample served as a baseline for comparisons throughout the study. The mean bacterial colony counts of all the isolated bacteria reduced after irrigation or irradiation. Intergroup comparisons showed no significant difference when groups 1, 2, and 3 were compared to each other (P > 0.05). However, a significant difference was seen when groups 1, 2, 3 were compared to group 4 (P < 0.05). Conclusion: Two percent chlorhexidine, 1% sodium hypochlorite and laser irradiation succeeded in reducing the root canal infection. Hence, diode laser irradiation may be a possible supplement to existing protocols for disinfecting the root canal system.

Assessment of Quality of Obturation, Instrumentation Time and Intensity of Pain with Pediatric Rotary File (Kedo-S) in Primary Anterior Teeth: A Randomized Controlled Clinical Trial

Aim

The purpose of this study was to clinically compare and evaluate the efficiency of pediatric rotary file kedo-S with hand K files and ProTaper rotary files during root canal preparation of primary anterior teeth.

Materials and methods

Forty-five children requiring pulpectomy in any one of the vital primary anterior teeth were included. The children were randomly assigned to one of the three groups (15 per group), where the instrumentation was done using hand files in group 1, ProTaper rotary files in group 2 and Kedo-S rotary files in group 3. The instrumentation time, pain perception and the quality of obturation was assessed, and the statistical analysis was done using statistical package for social sciences (SPSS) software.

Results

Statistically decreased instrumentation time was observed with the use of Kedo-S rotary file system (p < 0.05) when compared to the other two file systems. The intensity of pain experienced during instrumentation was also lesser with Kedo-S rotary file (p < 0.05). No significant difference was noted in the obturation quality with the exclusive pediatric rotary file when compared with the other two groups (p > 0.05).

Conclusion

Kedo-S rotary files decrease the instrumentation time and intensity of the pain perception during canal instrumentation which positively influences the cooperation of the children.

Clinical significance

Use of exclusive pediatric rotary files (Kedo-S) for root canal preparation in primary teeth reduces the fatigue of both the children and the dentists. Also, influences the behavior of the children in a more positive way thereby instilling a positive dental attitude.

How to cite this article

Govindaraju L, Jeevanandan G, Subramanian EMG, Vishawanathaiah S. Assessment of Quality of Obturation, Instrumentation Time and Intensity of Pain with Pediatric Rotary File (Kedo-S) in Primary Anterior Teeth: A Randomized Controlled Clinical Trial. Int J Clin Pediatr Dent, 2018;11(6):462-467.

A systematic review and meta-analysis

Background: Early childhood caries is a serious public health problem. When caries extend to involve the pulp, various forms of pulp treatment are tried to stimulate tooth repair. Although pulpotomy is the treatment of choice for vital primary tooth pulp exposure but there is a trend among many dentists to perform pulpectomies  in vital primary incisors. This study aimed to assess the effect of pulpotomy and pulpectomy in treatment of carious vital pulp exposure in primary incisors.

Methods: We searched Pubmed and Cochrane library databases up to March, 2018, OpenGrey for grey literature and ClinicalTrials.gov for ongoing trials. Randomized controlled trials were included and assessed with Cochrane risk of bias tool . Primary outcomes were clinical failure and radiological failure. The effect sizes were calculated as risk ratios with 95%CI using the Mantel-Haenszel method.

Results: Four trials were identified for qualitative assessment, only three trials were included in meta-analysis after exclusion of one trial due to its high risk of bias. The pooled results of the longest follow up period for clinical failure showed no statistically significant difference between pulpotomy and pulpectomy. The relative risk (RR) was e 2.69, 95% CI 0.76 to 9.58 for clinical failure. For radiographic failure, the sensitivity analysis showed RR 0.45, 95% CI 0.25 to 0.83 with a higher risk for radiographic failure in pulpectomy. The evidence was limited by the small number of trials included in the meta-analysis.

Conclusions: Both pulpotomy and pulpectomy can be used successfully in the treatment of vital pulp exposure in primary incisors. Further high quality studies comparing between pulpotomy and pulpectomy in primary incisors with longer follow up period till exfoliation time are needed.