Performance of resin composite restorations placed in high caries risk children: a clinical retrospective study

Background: Resin composite has been usually used for restoring primary teeth. Nevertheless, there is a lack of supporting clinical data regarding the survival of resin composite restorations and risk factors that may dictate the service time of the treatment in children. Aim: To evaluate the survival and factors associated with composite resin restoration failure in high caries risk children treated under risk-factor management clinical protocol for dental caries prior to restorative therapy. Design: A total of 230 restorations in primary teeth from records of 48 patients were included in the study. Restoration longevity, up to 3-year follow-up, was assessed using the Kaplan-Meier survival test. Multivariate Cox regression analysis with shared frailty was used to evaluate the factors associated with failures (p<0.05). Results: Mean survival time was 2.7 -year (95 %CI: 0.75-0.87). Restoration survival reached 82.5 % up to 3-year evaluation, with an overall annual failure rate of 6.2 %. The unadjusted model showed restorations performed in children with dmf-t greater than 10 had more restoration failure risk (HR 5.59, 95 % CI 1.03-30.34; p=0.04) However, this association lost significance in the adjusted analysis (p=0.08). Conclusions: Composite resin restorations in primary teeth presented satisfactory survival after 3-year follow-up

Antecedentes: El composite de resina se ha utilizado habitualmente para restaurar dientes primarios. Sin embargo, se carece de datos clínicos de apoyo sobre la supervivencia de las restauraciones de resina compuesta y los factores de riesgo que pueden dictar el tiempo de servicio del tratamiento en los niños. Objetivo: Evaluar la supervivencia y los factores asociados al fracaso de las restauraciones de resina compuesta en niños con alto riesgo de caries tratados con un protocolo clínico de gestión de factores de riesgo de caries dental antes del tratamiento restaurador. Diseño: Se incluyeron en el estudio un total de 230 restauraciones en dientes primarios de registros de 48 pacientes. La longevidad de las restauraciones, hasta los 3 años de seguimiento, se evaluó mediante la prueba de supervivencia de Kaplan-Meier. Se utilizó un análisis multivariante de regresión de Cox con fragilidad compartida para evaluar los factores asociados a los fracasos (p<0,05). Resultados: El tiempo medio de supervivencia fue de 2,7 -años (IC95%: 0,75-0,87). La supervivencia de la restauración alcanzó el 82,5 % hasta la evaluación a los 3 años, con una tasa global anual de fracasos del 6,2 %. El modelo no ajustado mostró que las restauraciones realizadas en niños con dmf-t superior a 10 tenían más riesgo de fracaso de la restauración (HR 5,59; IC 95 %: 1,03-30,34; p=0,04). Sin embargo, esta asociación perdió significación en el análisis ajustado (p=0,08). Conclusiones: Las restauraciones de resina compuesta en dientes primarios presentaron una supervivencia satisfactoria tras un seguimiento de 3 años.

Is clindamycin-modified triple antibiotic paste better than iodoform-based medicament for the treatment of non-vital primary molars using LSTR technique – A randomised clinical trial

Objectives: The objectives of this study were to evaluate and compare the success rate of local application of iodoform-based obturating material (Pulpotec – [Produits Dentaires S.A., Switzerland]) and clindamycinmodified triple antibiotic paste (ClinM-TAP) in pulp chamber using minimally invasive endodontic treatment of carious primary molars indicated for pulpectomy, for 12 months, using clinical and radiographic parameters. Materials and Methods: A randomised clinical trial was conducted in 60 children in the age group of 3–8 years reporting carious primary molars with symptoms of irreversible pulpitis and pulpal involvement clinically, allocated into Group 1 (30) and Group 2 (30). In Group 1, Lesion sterilisation and tissue repair (LSTR) was done using Pulpotec (Produits Dentaires S.A., Switzerland) as medicament and in Group 2, ClinM-TAP (Clindamycinmodified triple antibiotic paste) was used as medicament. Clinical follow-up was done at 3, 6 and 12 months; radiographic follow-up was done at 6 and 12 months. Clinical parameters compared were tenderness on percussion, spontaneous pain, intraoral swelling and sinus/fistula. Radiographic comparison was done based on furcation radiolucency, root resorption and bone regeneration. Both intergroup and intragroup statistical analysis was done using Chi-square test or Fisher exact test, Cochran’s Q Test and Mann–Whitney U-Test for the test of significance. All the statistical tests were performed at 5% significance level. Results: The mean age of patients in the study was 5.25 ± 1.3years with 45% males and 55% females. Both groups showed significant improvement in terms of clinical symptoms from baseline to 12 months. On intergroup comparison clinical parameters, TOP was present in 11.2% and 44% of cases at the end of 12 months in Groups 1 and 2, respectively (P < 0 0.05). On intergroup comparison of radiographic parameters, at the end of 12 months, furcation radiolucency was seen in 32% and 73% (P < 0.05) and root resorption was seen in 16% and 30% cases in Group 1 and 2, respectively (P > 0.05). Overall clinical success rate of Group 1 and Group 2 was 88% and 50%, respectively (P < 0.05) and radiographic success rate was 60% and 27%, respectively (P < 0.05). Conclusion: LSTR using Pulpotec as a medicament has shown promising results in the present study. It could be a better alternative to conventional endodontic treatment in primary teeth. In the present study, ClinM-TAP has shown poor radiographic success; hence, it should be used with caution.

Influence of Gestational Age on Eruption of Primary Teeth in Indian Children - A Prospective Longitudinal Study

Context: Eruption of primary teeth is the most anticipated event in a child’s life. Genetics, gender, socio?economic status, gestational age are a few of the determinants of the primary teeth eruption. However, the effect of gestational age on the timing of primary teeth eruption among the Indian population has not been explored to date. Aim: The study was conducted to evaluate the influence of gestational age on time and sequence of eruption of primary teeth among children of Mysore. Settings and Design: A prospective longitudinal cohort study design was conducted at ‘Baby Oral Health Promotion Clinic’ at the Department of Paediatrics, JSS Hospital, Mysore. Methods and Material: 150 newborn babies were recruited by simple random sampling and followed up from birth to 36 months. Teeth present during each visit were recorded. Data were statistically analysed and interpreted. Statistical Analysis Used: Descriptive statistics, t?test for an independent sample, and Pearson’s Chi?squared test were applied. Results: The mandibular central incisor was the first tooth to erupt. Statistically insignificant early eruption in males was noted in both term and preterm children. When the chronological ages were compared, the preterm group showed a statistically significant delay in the eruption of all the teeth. However, when the age was adjusted for prematurity, only the central incisors and second molars showed a statistically significant delay. Conclusions: Gestational age has a strong significant association with the eruption of primary teeth and maybe one of the strong predictors for delayed eruption among children of Mysore.

DOR EM DENTES DECÍDUOS: BUSCA DE INFORMAÇÕES EM UMA PLATAFORMA VIRTUAL / PAIN IN DECIDUOUS TEETH: SEARCH FOR INFORMATION ON A VIRTUAL PLATFORM

Objetivo: Avaliar, através de uma análise quantitativa e qualitativa, vídeos postados em português e espanhol sobre a temática da dor em dentes decíduos disponíveis na plataforma YouTubeTM. Materiais e Métodos: Pesquisa do tipo transversal em que foram utilizados descritores indexados e não indexados e suas combinações nos idiomas português (PT) e espanhol (ES), para buscas na plataforma Youtube™ de vídeos postados nos ultimos dez anos. O conteúdo dos vídeos foi categorizado para a análise final e avaliado de acordo com a literatura. Resultados: Foram identificados um total de 1.129 vídeos e foram incluidos na amostra final 249 em ES e 221 em PT. Destes 67% (ES) e 56,6% (PT) foram realizados por leigos e 22,9% (ES) e 27,6% (PT) por profissionais de saúde. O fator associado a dor mais comumente descrito nos vídeos foi a remoção dentária associada a esfoliação dos dentes decíduos em 50% (ES) e 47,1% (PT). Não foi observada a concordância total com a literatura em nenhum dos dois idiomas. Conclusão: O YouTube™ como fonte de referência para a busca de informações sobre a dor em dentes decíduos mostrou conter uma pobre qualidade das informações e inconsistências para a educação em saúde. Os profissionais de saúde devem ser estimulados a enviar vídeos educativos baseados em evidencias científicas de modo a contribuir com a disseminação de informações verdadeiras e confiáveis para a população em geral.

Objective: Evaluate, through a quantitative and qualitative analysis, videos posted in Portuguese and Spanish, on the theme of pain in primary teeth available on the YouTube™ platform. Materials and Methods: Cross-sectional research, in which some descriptors indexed and not, and their combination were chosen in Portuguese and Spanish, and used in the YouTube™ search platform in the last decade. The data content was categorized for the final analysis and evaluated according to the literature. Results: 1,129 videos were identified in Spanish (ES) and 784 in Portuguese (PT), of which 249 in ES and 221 in PT were selected in the final sample. 67% (ES) and 56.6% (PT) were carried out by lay people and 22.9% (ES) and 27.6% (PT) by health professionals. The associated factor most described in terms of pain in primary teeth was tooth removal associated with tooth exfoliation with 50% (ES) and 47,1% (PT) and the total agreement with the literature did not occur in both languages. Conclusion: YouTube™ can be a source of reference to get knowledge about pain in primary teeth for parents and children. However, the quality of the evaluated information is inconsistent for health education on this study subject. Health professionals should be encouraged to send educational videos according to scientific information, in order to contribute with guidelines based on scientific evidence that are available to the population

One-year clinical evaluation of class II bulk-fill restorations in primary molars: a randomized clinical trial

Abstract This double-blind, randomized clinical trial aimed to compare the clinical performance and clinical time to restore occluso-proximal cavities in primary molars withbulk-fillresin and conventional resin. A total of 140 class II restorations in primary molars of 65 participants (mean age of 6.7 + 1.5) were placed in two random groups:bulk-filland conventional resin. The restorations were evaluated using FDI criteria at the baseline, 6-month, and one year by a single calibrated examiner, and the clinical restorative time was measured with a digital timer. The success and survival of the restorations were evaluated with Kaplan-Meier graphs. The log-rank test compared the curves. Differences in restorative clinical time were compared using the Mann-Whitney U test. The level of significance was 5%. After one year, 115 restorations were evaluated. The success probability was 88.7% for Filtek Z350 XT and 85.9% for FiltekTM Bulk-fill, and for the survival probability, Filtek Z350 XT presented 90%, and FiltekTM Bulk-fill presented 93.7%. No significant difference was found between the success and survival curves (p=0.62), (p=0.51). The main reason for failure was marginal adaptation.Bulk-fillresinrequired 30% less time than the conventional resin (p<0.001).Bulk-fillresin presented similar clinical performance to the conventional resin and required less restorative clinical time. It is an option to restore class II lesions of primary molars.

Resumo Este ensaio clínico randomizado, duplo-cego objetivou comparar a performance clínica e tempo clínico para restaurar cavidades ocluso-proximais em molares decíduos, restauradas com resina bulk-fill e resina convencional. Um total de 140 restaurações classe II em molares decíduos de 65 participantes (média de idade 6.7 + 1.5) foram realizadas dividas em dois grupos randomizados: resina bulk-fill e resina convencional. As restaurações foram avaliadas conforme o critério da FDI no baseline, após 6 meses e 1 ano, por um único examinador calibrado e o tempo clínico restaurador foi mensurado por um cronômetro digital. O sucesso e a sobrevida das restaurações foram avaliados através dos gráficos de Kaplan-Meier. O teste de log-rank comparou as curvas. A diferença no tempo clínico restaurador foi comparada usando o teste U de Mann-Whitney. O nível de significância foi de 5%. Após 1 ano, 115 restaurações foram avaliadas. A probabilidade de sucesso foi de 88,7% para Filtek Z350 XT e 85.9% para FiltekTM Bulk-fill e quanto a probabilidade de sobrevivência, Filtek Z350 XT apresentou 90% e FiltekTM Bulk-fill apresentou 93,7%. Não foi encontrada diferença significativa entre as curvas de sucesso e sobrevida (p=0,62), (p=0,51). A principal causa de falha foi a adaptação marginal. A resina bulk-fill exigiu 30% menos tempo do que a resina convencional (p<0,001). A resina bulk-fill apresentou desempenho clínico semelhante ao da resina convencional e necessitou menor tempo clínico restaurador. Dessa forma, é uma opção para restaurar lesões classe II em molares decíduos.

Association between hypomineralization of deciduous and molar incisor hypomineralization and dental caries

Abstract This study aimed to evaluate the association between the severity of hypomineralized second primary molars (HSPM), molar-incisor hypomineralization (MIH) and dental caries in children. 450 children between the ages of 6 and 7 years were included in this cross-sectional study. A calibrated examiner classified the enamel hypomineralizations and dental caries lesions using the MIH and HSPM and the Nyvad criteria, respectively. The primary outcome was the severity of MIH according to the severity of HSPM. Statistical analysis was performed using the generalized linear model and ordinal logistic regression. The prevalence of concomitant MIH and HSPM was 26% sex and age adjusted. Mild enamel defects were more frequent than severe enamel defects. An association was found between the severity of MIH and HSPM, both for mild defects (OR=87.54; 95%CI: 55.87, 137.17) and severe defects (OR=82.15; 95%CI: 45.72, 147.61). The severity of hypomineralization in permanent molars was associated with the activity of dental caries lesions (OR=29.85; 95%CI: 12.95, 68.83). To conclude, there is a strong association between the severity of HSPM and MIH, which is more significant in the presence of active dental caries lesions.

Resumo O objetivo desse estudo foi avaliar a associação entre a severidade da Hipomineralização de Segundos Molares decíduos (HSMD), da Hipomineralização de Molares e Incisivos (HMI) e cárie dentária em crianças. Neste estudo transversal foram incluídas 450 crianças entre 6 e 7 anos de idade. Um examinador calibrado classificou as hipomineralizações e lesões de cárie dentária utilizando o índice da HMI/HMD e o critério Nyvad, respectivamente. O desfecho primário foi a severidade da HMI de acordo com a severidade da HSMD. As análises estatísticas foram realizas usando o modelo linear generalizado e regressão logística ordinal. A prevalencia concomitante da HMI e HMSD foi de 26 % ajustada por sexo e idade. Defeitos leves foram mais frequentes que os defeitos severos. Foi encontrada a associação entre a severidade da HMI e da HSMD para defeitos leves (OR=87.54; IC95%: 55.87, 137.17) e severos (OR=82.15; IC95%: 45.72, 147.61). A severidade da hipomineralização em molares permamentes foi associada a atividade da lesão de cárie dentária (OR=29.85; IC95%: 12.95, 68.83). Conclui-se que existe uma forte associação entre a severidade da HSMD e da HMI, a qual foi mais significante na presença lesões ativas de cárie.

Comparative evaluation of intracanal cryotherapy and curcumin as a final irrigant in reducing post endodontic pain in primary teeth

Aim: The aim of this study was to evaluate the intracanal effectiveness of cryotherapy, curcumin irrigant, and normal saline as a final irrigant in reducing postendodontic pain in primary teeth. Materials and Methods: A total of 120 teeth between the ages of 4 and 7 years requiring pulpectomy in primary teeth were included in the study. The teeth were randomly assigned to one of the three treatment groups: intracanal cryotherapy using 2.5°C cold saline, curcumin irrigant, or normal saline. Following completion of chemomechanical preparation, final irrigation with 2.5°C cold saline, curcumin irrigant, and normal saline solution at room temperature were employed in the groups. Participants were asked to rate the severity of their postoperative pain on the Visual Analog Scale before, immediate postoperative after wearing of local anesthetic effect, and 24 h after the procedure. The results were analyzed statistically. Results: The differences in reduction of postendodontic pain between the three irrigating regimens were statistically not significant. Cryotherapy utilizing 2.5°C cold saline or curcumin irrigant can be used instead of normal saline as a final irrigant in pulpectomy of primary teeth. Conclusions: Cryotherapy can be a straightforward, cost-effective, and nontoxic treatment option for the management of postendodontic pain. Curcumin irrigant with its anti-inflammatory properties is also a better alternative as a final irrigant for reducing postoperative pain in primary teeth.

Glanzmann thrombasthenia: Use of hemocoagulase (BotroClot) for arrest of bleeding during a primary tooth endodontic procedure

The Rationale: Glanzmann thrombasthenia is a rare platelet disorder affecting 0.0001% of the population. Dentists may often be unaware of this condition, and manipulation of soft tissue can lead to grave consequences, which may even result in fatality. Patient Concerns: In this case report, a 4?year?old patient with Glanzmann thrombasthenia reported to the department with a chief complaint of a discoloured tooth. Clinical Findings: On examination, 51 was nonvital, and pulpectomy was the treatment planned. The non?vital anterior tooth was treated with a pulpectomy procedure. There was uncontrolled bleeding during the procedure. Treatment: A topical solution of BotroClot was used to arrest the bleeding, and obturation was completed following that. The post?operative period was uneventful. Take?away Lessons: Case report explored the use of a topical hemostatic agent to arrest bleeding from the canal. This case report warrants eliciting a thorough medical history before any dental procedure.

An In Vitro Study to Assess the Root Canal Morphology of Human Primary Molars Using Computerised Tomography

Background: A virtuous consideration of root canal morphology is required. Complications all through and after endodontic therapy are frequently caused by variances in the anatomy of root canals in primary teeth. The goal of present study was to determine the number and shape of root canals in primary incisors and molars, as well as the pertinency of cone beam computerised tomography (CBCT) in doing so.Material & Methods:On a total of 60 primary molars and incisors with complete root length, CBCT was used to assess the number of roots, number of canals, width of root canal at cementoenamel junction and middle-third, length and angulations of roots. The information was statistically analysed. Results:The CBCT revealed that 13 percent of mandibular incisors had bifurcation of the root canal in the middle third, while 20% of mandibular molars had two canals in the distal root. The distobuccal root canal diameter of maxillary molars and the mesiolingual canal diameter of mandibular molars were determined to be the smallest.Conclusions:Cone beam computed tomography (CBCT) is a comparatively new and effective technology that can be used in conjunction with conventional radiography to examine variations in root canal morphology in primary teeth.

A systematic review of randomized controlled trials on survival rate of atraumatic restorative treatment compared with conventional treatment on primary dentition

Background: In this COVID era, it's critical to promote nonaerosol procedures. Atraumatic restorative treatment (ART) is one of them, and it's particularly effective in children for lowering anxiety, enhancing dental health, and giving restorative care. Aim: The aim of this study was to assess the survival rate of ART compared with conventional treatment procedures in primary dentition. Materials and Methods: The review was done in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analysis statement and is been registered in PROSPERO (CRD42021213729). The studies included comprised clinical investigations with randomized controlled trials (RCTs) which compared the survival rate of ART and conventional restorative treatments using the same or different restorative materials to treat carious lesion. RCTs in which ART was compared with conventional treatment on patients in the age group of 6–10 years with minimum follow-up of 6 months. Studies available as open access and free full text in PubMed, DOAJ, and Google Scholar databases, and published in English Language only were included in the study. Cochrane's collaboration tool for RCTs was used for the assessment of risk of bias. Results: The survival rate of single surface and multiple surface in primary dentition treated according to the ART compared with conventional treatment was found to be similar. Conclusion: The ART approach is equally helpful in managing dental caries in children and this method may be considered a useful intervention in clinical practice to enhance the dental health of children.

Management of compound odontoma with 70 denticles and impacted lateral incisor over an 8-year follow-up

Odontomas are benign developmental tumors formed by the improper growth of completely differentiated epithelial and mesenchymal cells of odontogenic origin. The etiology of odontoma is unknown and it is detected during routine radiographic examination. The ideal management is early detection and surgical enucleation. The commonly associated clinical problems of odontomas are delayed exfoliation of primary teeth, delayed eruption or impaction of permanent teeth, displacement of teeth, root resorption, congenital missing, and widening of follicular space. Here, we describe a unique case of compound odontoma with a high number of denticles managed based on a definite decision support system over 8 years. An 8-year-old boy with 70 denticles in the left maxillary region underwent enucleation. On periodic follow-up, the associated impacted lateral incisor was extruded orthodontically.

An in vitro comparative evaluation of dentinal crack formation caused by three different nickel–titanium rotary file systems in primary anterior teeth

Context: Cleaning and shaping of the canals damages the root dentin which becomes a gateway to dentinal cracks and thereby causes failure of the treatment. Aim: The aim of this study was to assess and compare dentinal crack formation caused by three different nickel–titanium (NiTi) rotary file systems in primary anterior teeth. Settings and Design: The present in vitro study is an experimental, comparative study. Materials and Methods: One hundred fifty extracted primary anterior teeth were included in this study. The teeth were randomly divided into five groups. Group 1: Pedoflex rotary file system, Group 2: Prime Pedo™ rotary file system, Group 3: Kedo-S2 rotary file system, Group 4: K-files, and Group 5: no instrumentation. Roots were sectioned and viewed under a stereomicroscope for the presence of any cracks. Statistical Analysis Used: The data were analyzed using the Chi-square test and Kruskal–Wallis test. Results: In the coronal, middle, and apical thirds, Group 2 showed a maximum number of crack formations in the middle third (57%), followed by Group 3 (43.3%) and Group 1 (36.7%). Groups 4 and 5 showed no crack formation in all the root sections. The middle third showed a maximum number of crack formations compared to the coronal and apical thirds. Conclusions: Rotary systems render various benefits with an acceptable success in comparison to conventional hand instrumentation. Within the limitation of this study, it was found that Pedoflex rotary file system was the best with the least number of crack formations.

Clinical Outcome of Direct Pulp Therapy in Primary Teeth A Systematic Review and Meta-analysis

Background: Direct pulp treatment is carried out when a healthy pulp gets mechanically/accidentally exposed during the operative procedures or trauma. Aim: To determine the effects of various direct pulp capping materials as measured by the clinical and radiographic analysis. Design: Two reviewers performed a database search of the studies published between January 2005 and November 2020. The inclusion criteria were papers published in the English language; children aged 3–12 years having deep carious lesions in primary teeth. All potential studies were acknowledged by their title and abstract. The full-text analysis of potentially relevant studies, the selected studies were included in the systematic review. A meta-analysis calculation was performed for the overall data and the subgroup data. Results: The database searching led to 57 articles, which were of direct pulp treatment in primary teeth, after the removal of duplicates, 55 records remained but did not meet all inclusion criteria. A high variability was observed among the papers. Further filtering with criteria led to nine articles, which met all inclusion criteria. Meta-analysis demonstrated the success rates of DPT in primary teeth (95% confidence interval −0.799–0.898); P < 0.001. Clinical assessments of various direct pulp capping materials suggested 84.9% of success irrespective of the material used. The nine studies were heterogeneous according to the random effect model (P < 0.001, I2 = 84.08%). Conclusions: Direct pulp treatment has the advantage of being a conservative vital pulp therapy reducing the need for a more invasive treatment.

Tendencia de niños y niñas de 6 años libres de caries en Chile entrelos años 2012 y 2019

RESUMEN: Objetivo: La caries dental es la patología más prevalente en niños*. En Chile se desconoce si el estado de salud bucal ha mejorado al implementar estrategias y programas preventivos dirigidos a la población infantil en la última década. El objetivo fue determinar la prevalencia de niños de 6 años sin experiencia de caries (ceod=0) del país, su distribución territorial y tendencia en el período 2012 a 2019. Materiales y método: Se realizó un estudio ecológico utilizando los registros de atención odontológica de 1.020.920 niños de 6 años en los Servicios de Salud (SS) de Chile. Se analizó la tendencia en el tiempo utilizando un test de tendencia lineal para proporciones. Resultados: La prevalencia de niños de 6 años sin experiencia de caries aumentó 1,2 puntos por año entre 2012 y 2019. La prevalencia en los SS Arica e Iquique y los tres de la Región de Valparaíso supera el 40% y en los cuatro SS de la Región del Biobío y el SS Chiloé es menor al 25%. Conclusiones: La prevalencia de niños de 6 años sin experiencia de caries ha mejorado en la última década y su distribución territorial presenta gran variabilidad, sin embargo, aún sigue siendo baja. *Se usará la palabra "niño" para referirse a "niños y niñas".

ABSTRACT: Objective: Dental caries is the most prevalent disease in children. In Chile, it is unknown whether the oral health status in children population has improved after the implementation of preventive strategies and programs in the last decade. The objective was to determine the prevalence of 6-year-old children with no caries experience (ceod=0) in the country, its territorial distribution and trend in the period 2012 to 2019. Methodology: An ecological study was carried out using the dental care records of 1,020,920 6-year-old children in the Chilean Health Services. The trend over time was analyzed using a linear trend test for proportions. Results: The prevalence of 6-year-old children without caries experience increased 1.2 points per year between 2012 and 2019. The prevalence in the Arica and Iquique Health Services and in the three Health Services in the Valparaíso Region exceeds 40%. In the four Health Services in the Biobío Region and in the Chiloé Health Service it is less than 25%. Conclusions: The prevalence of 6-year-old children without caries experience has improved in the last decade and its territorial distribution presents great variability; however, it still remains low.

¿Cómo Intervenir el Proceso de Caries en Niños? Adaptación del Consenso de ORCA/EFCD/DGZ

RESUMEN: La caries dental afecta alrededor del 70% de los niños y en Latinoamérica este problema es aún más complejo, dadas las barreras socioeconómicas y culturales que dificultan el acceso a la salud bucal, con grandes inequidades. Durante el año 2019, un panel de expertos de la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ) elaboraron revisiones sistemáticas de la literatura y consensuaron recomendaciones basadas en evidencia destinadas a dentistas, mediante un taller en Berlín, Alemania, seguido de un trabajo de consenso mediante metodología e-Delphi. El propósito de este artículo es presentar las principales conclusiones del consenso adaptadas idiomáticamente al español y al contexto de Latinoamérica para permitir una mejor difusión del conocimiento generado y su aplicación en la práctica clínica. El artículo proporciona evidencia y recomendaciones clínicas para las intervenciones preventivas, no invasivas, microinvasivas, mínimamente invasivas e invasivas mejor sustentadas por la ciencia para el manejo de la enfermedad de caries y de las lesiones de caries en niños, con énfasis en la caries de la infancia temprana (CIT), dientes primarios y superficies oclusales de dientes permanentes.

ABSTRACT: Dental caries remains the most prevalent chronic disease in the world, affecting around 70% of children and posing a challenge for public health. Given the socioeconomic, cultural barriers and great inequalities that hinder access to oral health, in Latin America this problem is even more complex. During 2019, a panel of experts from the European Organization for Caries Research (ORCA), the European Federation for Conservative Dentistry (EFCD) and the German Federation for Conservative Dentistry (DGZ) prepared systematic reviews of the literature to reach consensus and generate evidence-based recommendations for dentists on how to manage caries in children. In a workshop in Berlin, Germany, followed by an e-Delphi methodology the experts published the consensus. The purpose of this article is to present the main conclusions of the consensus adapted idiomatically to Spanish and to the Latin American context to allow a better dissemination of the knowledge generated and facilitate its application in clinical practice. The article provides evidence and clinical recommendations for the best science-supported preventive, non-invasive, micro-invasive, minimally invasive, and invasive interventions for the management of caries disease and caries lesions in children, with an emphasis on early childhood caries (ECC), primary teeth and occlusal surfaces of permanent teeth.

Root Canal Morphology of Primary Molars – A Cone Beam Computed Tomography (CBCT) Study

Objectives: To evaluate the root and canal morphology of primary maxillary and mandibular molars in an Indian population using cone?beam computed tomography (CBCT). Methods: A retrospective cross?sectional study was performed, where CBCT scans of children less than 10 years of age taken for valid diagnostic purposes previously were considered and images were analyzed. The number of roots, root canals, and variations in morphology were recorded. Left–right symmetry was also noted. Results: A total of 433 deciduous maxillary and mandibular primary molars were studied. It was observed that two separate roots with three separate canals were common in primary mandibular first molars, whereas two separate roots with two canals in each root were common in mandibular second primary molars. In primary maxillary molars, three separate roots with one canal each were the most common. Maxillary first molars (17.21%) and 17.35% second molars had fused distobuccal and palatal roots. It was observed that primary maxillary molars showed more left–right symmetry (86.7% in first molars and 82.7% in second molars) compared to primary mandibular molars (54.05% in first molars and 68% in second molars). Conclusions: It was concluded that in both primary maxillary first and second molars, three separate roots, a mesiobuccal root, a distobuccal root, and a palatal root with one canal in each root, were the most common. Two separate roots with three separate canals were the most common in primary mandibular first molars, whereas two separate roots with two canals each in both roots were more common in mandibular second primary molars.

Apical extrusion of debris with root canal instrumentation in primary teeth A systematic review

Aim: This study aimed to systematically review available literature of in vitro studies on apical extrusion of debris through rotary instrumentation in comparison to manual instrumentation in pediatric endodontics, and also to perform a comparison between various rotary instrumentation systems for assessment of debris extrusion. Materials and Methods: A comprehensive search was conducted on PubMed, Medline, Cochrane Library, Embase, Scopus, and Google Scholar without any language restriction and year of publication. A planned search strategy was made for PubMed and applied to other databases. After full-text reading, 7 articles were selected for quantitative synthesis. Modified CONSORT checklist of items for reporting in vitro studies of dental materials was used for quality assessment of included studies. Results: Root canal preparation with rotary instrumentation led to lesser apical debris extrusion than manual instrumentation. Self-adjusting file system was associated with the least debris extrusion among all included studies, followed by ProTaper Next, Kedo-S, ProTaper, K3, Mtwo, Revo-S, and Wave One. Conclusion: More apical debris extrusion was seen with manual instrumentation than rotary instrumentation. Furtrhermore, variance in debris extrusion was seen with different rotary file systems.

ART restorations for occluso-proximal cavities in primary molars: a two-year survival and cost analysis of an RCT comparing two GIC brands

Abstract There are many glass ionomer cements available on the Brazilian market for Atraumatic Restorative Treatment (ART), however, there is still a gap in the literature regarding their cost-effectiveness. Objectives To evaluate the influence of restorative materials (Ketac Molar, 3M ESPE; and Vitro Molar, Nova DFL) in the two-year survival rate and cost-effectiveness of occluso-proximal ART restorations in primary molars. Methodology A total of 117 children (aged four to eight years) with at least one occluso-proximal carious lesion in primary molars were selected and randomly divided in treatment groups (KM or VM) in this parallel randomized controlled trial. Treatments followed ART premises and were conducted in public schools by trained operators in Barueri, Brazil. A trained, calibrated, and blinded examiner performed the evaluations after two, six, 12, and 24 months (k=0.92). Kaplan-Meier survival analysis was used to estimate restoration survival and Cox regression was used to test the association with clinical factors (α=5%). For cost analysis, material and professional costs were considered. Monte Carlo analysis was used to generate a cost-effectiveness plane and bootstrapping was used to compare material costs over the years. Results The overall survival rate was 36.9% after two years (48.6% for KM and 25.4% for VM). Restorations with VM failed more than those with KM (HR=1.70; 95% CI=1.06-2.73; p=0.027). VM presented lower initial cost, but no difference was observed between groups considering the two-year incremental cost. Conclusion After a two-year evaluation, KM proved to be a better option than VM for occluso-proximal ART restorations in primary molars. ClinicalTrials.gov: NCT02267720

Oral health status for primary dentition – A pilot study

Introduction: Formulating an oral health status which will include oral hygiene index (OHI) exclusively for children, deft index, and the incidence of white spot lesions (WSL) will make it easier for the examiner to assess the current oral health status of a child and help in planning preventive strategies. This index will provide a comprehensive yet quick way to assess the oral health status of children as it includes past caries experience, present oral hygiene status, and future prediction of caries. Materials and Methods: Two hundred children (100 male, 100 female) aged 3–5 years (primary dentition) were included in this study. OHI, recorded index tooth wise and segment wise, deft index, and the WSLs classification were recorded in all the children. Receiver operating characteristics (ROC) curve was used to evaluate the accuracy of recording OHI in children index tooth wise and segment wise. Results: All the three indices were recorded for the 200 subjects, and based on the area under the curve of receiver operating characteristics, it was found that the OHI for primary dentition can be recorded tooth wise or segment wise. Index teeth chosen for primary dentition were labial surfaces of 54, 61, and 64, lingual surfaces of 82, 75, and 85. Conclusion: It includes the past caries experience, present hygiene status, and the future prediction of caries, making it a wholesome index. This cumulative index can be widely used in studies of epidemiology and ensure quicker evaluation during dental health programs in public school systems.

Efficacy of laser photobiomodulation pulpotomy in human primary teeth A randomized controlled trial

Background: Laser photobiomodulation (LPBM), also called Low Level Laser Therapy (LLLT), has shown potential to reduce the pulpal inflammation and to preserve the dental pulp vitality, thereby improving healing. Lasers being minimally invasive, safe, and patient friendly prompt its application in pediatric dentistry. Aim: The aim of this study was to evaluate and compare the clinical and radiographic success rates of LPBM and formocresol pulpotomy at 9 months post intervention in human primary molars. Materials and Methods: A randomized controlled, split-mouth study design was followed involving children aged 4–7 years with at least two primary molars indicated for pulpotomy. Sixty-eight eligible primary molars were randomly allocated to two interventions – formocresol pulpotomy (Group I) and LPBM pulpotomy (Group II). Statistical Analyses: Chi-square test was used for statistical analysis fixing significance level at P ? 0.05. Results: There was no statistically significant difference in the clinical success rates between the formocresol group (97.05%) and the photobiomodulation group (94.1%) (?2 = 0.34, P = 0.55); however, the radiographic success rate was significantly high in the laser group (94.1%) compared to the formocresol group (58.82%) (?2 = 11.76, P = 0.001). Conclusion: LPBM could be a viable nonpharmaceutical alternative for formocresol pulpotomy in human primary teeth