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

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

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

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

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

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

Evaluation of the efficacy of mineral trioxide aggregate and bioceramic putty in primary molar pulpotomy with symptoms of irreversible pulpitis (a randomized-controlled trial).

OBJECTIVES: Preserving the primary teeth is important, as they play an important role in the integrity of the dental arch, the development of the craniofacial complex, speech, and chewing. This study aimed to evaluate the effectiveness of both Mineral Trioxide Aggregate (MTA) and Bioceramic putty in primary molar pulpotomy with symptoms of irreversible pulpitis. MATERIALS AND METHODS: In this study, 40 s primary mandibular molars in 40 healthy children aged 6-8 years were examined and classified into 2 groups according to the material: group A, with 20 primary molars capped by MTA, and group B, with 20 teeth capped by Bioceramic putty. Clinical and radiographic evaluation of the treatment results was carried out after 1 week, 3 months, 6 months, 9 months, and 1 year. RESULTS: Clinical and radiological success rates in the MTA group reached 95%, where a case of failure was observed after a year of follow-up. In the Bioceramic group, the success rate reached 100% after a year of follow-up, without any statistically significant differences between groups (p = .311). CONCLUSIONS: Pulpotomy using biocompatibility materials (MTA-Bioceramic) in primary molars with symptoms of irreversible pulpitis is considered effective due to the better advantages of the use of Bioceramic over MTA. This clinical trial was approved by Australian New Zealand Clinical Trials (12621001631897).

Evaluation of Bioceramic Putty in Pulpotomy of Immature Permanent Molars With Symptoms of Irreversible Pulpitis.

Purpose This study aimed to evaluate the effectiveness of both mineral trioxide aggregate (MTA) and bioceramic putty (Well-Root PT) in the pulpotomy of immature permanent molars diagnosed with symptoms of irreversible pulpitis. Materials and methods The study included 30 immature permanent molars with symptoms of irreversible pulpitis in 30 healthy children aged six to eight years. They were randomly distributed into the following two groups according to the material used: group 1 included 15 first permanent molars capped by MTA and group 2 included 15 first permanent molars capped by bioceramic putty. Clinical and radiographical evaluations of the treatment results were made after one week, three months, six months, nine months, and 12 months. Results The success rate in the bioceramic putty group was 93.3% clinically and radiographically after a 12 months follow-up, whereas in the group that underwent MTA treatment no cases of failure were registered with a 100% success rate. No statistical differences were observed between groups (p=0.309). The dentin bridge was formed in 60% of the MTA group and 33.3% of the bioceramic group without any statistically significant differences (p=0.272) after a 12 months follow-up. Conclusion Pulpotomy using biocompatible materials (MTA and bioceramic putty) on immature permanent molars with symptoms of irreversible pulpitis is considered acceptable and effective.

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

Purpose The study aimed to evaluate QMix2in1 and silver nanoparticles (AgNPs) solution in eliminating Enterococcus faecalis (E. faecalis) bacteria within root canals of primary molars. Materials and methods The study sample consisted of 45 extracted primary molars, which were divided into three groups: Group 1 (control) NaOCl 5.25%, Group 2 (experimental) QMix2 in 1, and Group 3 (experimental) AgNPs 4000 ppm. The root canals were sterilized within an autoclave and then contaminated with E. faecalis bacteria. The root canals were irrigated for five minutes in a quantity of 3 ml using a 31-gauge irrigation needle, and then bacterial smears were taken. Results Sodium hypochlorite, AgNPs, and QMix2in1 effectively reduced the bacterial count of Enterococcus within root canals of primary molars. There were statistical differences between all groups. QMix2in1 solution showed the greatest antibacterial efficacy, then NaOCl solution and AgNPs solution.  Conclusion All irrigation solutions used are effective in eliminating E. faecalis. QMix2in1 can be considered a good alternative to sodium hypochlorite in irrigation root canals of primary teeth.

Evaluation Time and Efficacy of Root Canal Rotary Preparation in Primary Teeth: An In-Vitro Study.

Purpose The objective of this study was to evaluate the efficacy, apical debris extrusion, and time of rotary preparation of Baby Fanta files (Fanta Dental, (Shanghai, China) in root canals of primary molars. Materials and methods The study sample consisted of 30 upper secondary molars that were randomly divided into two groups (Baby Fanta - K file, Shanghai, China), each group comprising 15 palatal roots that were prepared, the necessary preparation time was calculated, the apical debris was collected, and they underwent a clearing technique to evaluate the cleaning effectiveness of the files used in this study. Results The results showed that Baby Fanta files were superior to K-file in time of preparation (P-value=0.000) while there were no statistical differences in the effectiveness of cleaning (P-value=0.188) or apical debris extrusion (P-value=0.451). Conclusion Baby Fanta files can be used effectively for the rotary preparation of root canals in primary teeth.

Pain assessment following endodontic treatment using two automated systems compared to manual treatment in primary molars.

BACKGROUND: Root canal treatment in primary teeth is quite difficult and time-consuming, especially canal preparation. Pain is the most common negative outcome following root canal treatment, occurring hours or days after treatment. It is an unpleasant experience for both the patient and the dentist. OBJECTIVES: The objective of this study was to assess the severity and duration of pain following the endodontic treatment of primary molars with the use of rotary and reciprocating preparation systems compared to the traditional manual method. MATERIAL AND METHODS: The research sample consisted of 157 asymptomatic primary lower second molars with non-vital pulp that were indicated for root canal treatment. The patients were randomly divided into 3 groups: in the 1st group, the molars (n = 52) were prepared using the manual method; in the 2nd group (n = 53), a reciprocating automated preparation system (WaveOne®) was used; and in the 3rd group (n = 52), a rotary preparation system (ProTaper Next®) was used. Pain assessment was carried out after 6, 12, 24, 48, and 72 h, and after 1 week, using a four-face facial pain scale. RESULTS: The manual method provided a higher pain score through 6, 12 and 24 h (p < 0.05) as compared to the 2 automated preparation systems. The intensity of pain did not vary between the 2 machine preparation systems after 6, 12 , 24, and 48 h (p > 0.05). There were no differences between the 3 methods after 72 h and after 1 week (p > 0.05). CONCLUSIONS: The manual method caused more pain than the other 2 preparation systems, but there was no difference between the 2 automated methods. Automated root canal preparation systems could be used to reduce the intensity of postoperative pain after the endodontic treatment of primary teeth.

Evaluation and comparison two types of prefabricated zirconia crowns in mixed and primary dentition: A randomized clinical trial.

INTRODUCTION: Prefabricated zirconia crowns are available to treat anterior and posterior primary teeth, which possess high resistance, long durability, and short working time. They are also esthetic and available in various sizes for all primary teeth. However, their high costs can present a clear disadvantage in many communities around the world. MATERIALS AND METHODS: This random clinical trial study sample included 63 crowns (31 CCZC, 32 NZC) applied to 44 children aged five to nine years with zirconia crowns placed on anterior or posterior primary teeth. Group (1): Locally manufactured crowns were created with different measurements by using CAD/CAM (CCZC) and Group (2): NuSmile® zirconia crowns (NZC). Glass ionomer cement was used to cement all crowns. The children were followed-up at one, three, and six months, using oral hygiene index-simplified (OHI-S), gingival index (GI), plaque index (PI), bleeding on probing (BOP), and crown margin extension. Statistical analyses used: Mann-Whitney U test, Friedman test, and Wilcoxon test. RESULTS: This study showed that CCZC did not cause gingival changes after crown application in clinical tissue appearance, bleeding, and gingival recession. Reduced plaque accumulation was observed during follow-up periods. Finally, there was no statistically significant difference between CCZC and NZC, according to this study. CONCLUSIONS: CCZCs are a convenient and economical option to achieve esthetic, healthy, and functional aspects during restoring primary teeth.

Comparison of two intravenous sedation techniques for use in pediatric dentistry: A randomized controlled trial.

BACKGROUND: Psychological methods are the preferred behavior management techniques (BMTs) for children in the dental clinical set. However, sometimes they are not successful. On such occasions, pharmacological methods can be good alternatives. Intravenous sedation is one of these methods, which are very useful in behavior management. It is highly effective when applied appropriately. OBJECTIVES: The aim of this study was to evaluate the efficacy of intravenous sedation using dexmedetomidine in comparison with ketamine and atropine in uncooperative children during dental treatment. MATERIAL AND METHODS: The study was performed on 40 healthy uncooperative children aged 2-6 years. They were equally and randomly divided into 2 groups: group D - intravenous dexmedetomidine with a loading dose of 1 µg/kg body weight (b.w.), which was followed by 0.2 µg/kg b.w./h via continuous infusion; and group K - intravenous ketamine 2 mg/kg b.w. with atropine 0.01 mg/kg b.w. Vital signs, recovery time and adverse effects were all recorded. Behavior was also evaluated using the Ohio State University Behavioral Rating Scale (OSUBRS). RESULTS: Statistically significant differences appeared in the degree of behavior between the 2 groups (p = 0.03). Group D did better than group K. The mean recovery time was shorter in group D than in group K, but there were no statistically significant differences (p = 0.12). No side effects, episodes of cardiovascular or respiratory instability were reported in either group. CONCLUSIONS: The use of intravenous sedation in managing uncooperative children is more effective with dexmedetomidine than with ketamine. The addition of atropine as an adjunct to intravenous ketamine sedation helps in preventing complications.