Assessing the efficacy of Laser pulpotomy versus conventional pulpotomy in primary teeth: A systematic review and meta-analysis of clinical trials.

PURPOSE: This study systematically reviewed the clinical and radiographic outcomes of laser versus conventional pulpotomy in primary teeth. It also compared the success and effectiveness of different lasers to enhance the understanding and use of laser pulpotomy as an alternative treatment. METHODOLOGY: An electronic search was carried out in PubMed and Cochrane from 1st January 1999 to 31st December 2023. The published articles in the English language were searched using MeSH terms and text words. Only randomized controlled trials with a sample size of more than 10 and follow-ups over 6 months were included. Meta-analysis and forest plots were evaluated by utilizing Review Manager 5.4 software. Two reviewers assessed the risk of bias using the RoB 2 tool and discrepancies were resolved by the third reviewer. The success rates were combined using a random effects model to determine clinical and radiographic outcomes. We used risk ratios with 95% confidence intervals (CI) as the primary effect measures and set the significance level at 0.05. RESULTS: Only 18 studies met the inclusion criteria after an electronic search. Among them, 13 studies evaluated the clinical and radiographic outcomes of laser with formocresol pulpotomy, 2 studies compared with ferric sulfate pulpotomy, and the remaining studies with Mineral trioxide aggregate (MTA) pulpotomy. The various studies showed different levels of bias. There was no significant difference in the clinical success rate (p = 0.47; RR: 1.01; 95% CI 0.98-1.04; I2 = 0%; p = 0.70) and radiographic success rate (p = 0.94; RR: 1.00; 95% CI 0.91-1.09; I2 = 64%; p = 0.001) between laser pulpotomy and formocresol. Similarly, there was no significant difference between laser pulpotomy and ferric sulfate or MTA pulpotomy. CONCLUSION: Diode laser and LLLT can be considered as alternative pulpotomy agents to formocresol in primary teeth. However, high-quality trials are needed to confirm the accuracy and reliability of these findings.

Comparison of Dentin Microstructure and Its Correlation to the Direction of Fracture Line in Mandibular Molars of Young and Older Individuals: In Vitro Study.

INTRODUCTION: The aim of the study was to assess the presence and extent of sclerotic dentin and to study its impact on the direction of fracture lines in extracted mandibular first molars of young (20-44 years) and older age groups (45 and older). METHODS: Extracted permanent mandibular first molars were collected along with the related demographic details. A total of 40 teeth were included in this study, 20 each from young age group (YA group) (20-44 years) and older age group (OA group) (45-70 years). All molars were decoronated, and the sectioned mesial roots were embedded in acrylic blocks. They were subjected to vertical force in a universal testing machine. Fractured roots were then examined under the stereomicroscope at ×8 magnification to determine the direction and pattern of the fracture line. The roots were then sectioned and evaluated at ×10 and ×20 magnification to assess the dentin microstructure and its correlation with the direction of the fracture line. Statistical analysis was done by using χ2 test (P < .05). RESULTS: A greater incidence and degree of sclerotic dentin were found in the OA group as compared with the YA group, which was statistically significant. The sclerotic dentin was distributed predominantly mesiodistally and the fracture line propagated buccolingually in both young and older groups, which was statistically significant (P < .05). CONCLUSIONS: The presence of sclerotic dentin mesiodistally may impede crack propagation in this direction for both young and older age groups, causing the fracture line to extend buccolingually in coronal third of the root.

Demystifying the Complexity: A Case Report on the Management of Mandibular Canine with Two Roots.

Mandibular canine often presents with only one root and one root canal in most of the cases. However, approximately 15% of the mandibular canines have two root canals and even less frequently two distinct roots. This article presents a case of root canal treatment in mandibular canine with two roots and two root canals. Meticulous cleaning and shaping followed by three-dimensional filling help in the successful treatment of such anatomical aberrations. Failure to do so may lead to post-treatment disease and further complications.