Comparison of sedative effects of oral midazolam/chloral hydrate and midazolam/promethazine in pediatric dentistry.

Background. The aim of this investigation was to compare the sedative effects of oral midazolam/chloral hydrate and midazolam/promethazine combinations on fearful children needing dental treatment. Methods. This crossover double-blind clinical trial was conducted on 30 children aged 2‒6 years, who had at least two similar teeth needing pulp treatment. Standard vital signs were recorded before and after premedication. Wilson sedation scale was used to judge the level of sedation. Cases were divided into two groups based on the sequence of medication received. This was to overcome the sequence effect. Group I received oral midazolam (0.4 mg/kg/chloral hydrate (50 mg/kg) at the first visit while they received midazolam (0.4 mg/kg)/promethazine (5 mg/kg) in their second visit. Group II received the premedication in the opposite sequence. The operator and child were blinded to the medication administered. Sedative efficacy of the two combinations were assessed and judged by two independent pediatric dentists based on the Wilson scale. Data were analyzed with ANOVA and paired t-test. Results. Only 10% of children who received chloral hydrate with midazolam exhibited high improvement in their behavior while 53% showed reasonable positive changes and 12% had no change or even deterioration of behavior. The difference between the effect of the two combination drugs was statistically significant (P<0.05) in favor of the chloral hydrate group. Conclusion. The results showed a significant difference in the sedation level induced between the two groups. Midazolam/chloral hydrate combination more effectively improved the co-operation for dental treatment.

Intranasal Premedication Effect of Dexmedetomidine Versus Midazolam on the Behavior of 2-6-Year-Old Uncooperative Children in Dental Clinic.

OBJECTIVES: The aim of this study was to compare the intranasal premedication effect of newly introduced dexmedetomidine (DEX) versus midazolam on the behavior of uncooperative children in the dental clinic. MATERIALS AND METHODS: This crossover double-blind clinical trial was conducted on 20 uncooperative children aged 2-6 years who required at least two similar dental treatment visits. The subjects were randomly given 1 µg/kg of DEX and 0.5 mg/kg of midazolam via the intranasal route. For the sedation protocol in the two groups, 0.25 mg/kg of atropine in combination with 0.5 mg/kg of midazolam added to 1-2 mg/kg of ketamine were used 30 minutes after premedication and transferring the patient to the operating room. Dental treatments were carried out by a pediatric dentist blinded to the type of the administered premedication. The sedative efficacy (overall success rate) of the agents was assessed by two independent pediatric dentists based on the Houpt scale. Data analyses were carried out according to Wilcoxon signed-rank test and paired t-test. RESULTS: There were no significant differences in the premedication efficacy of intranasal DEX and midazolam according to the Houpt scale (P>0.05). CONCLUSIONS: Intranasal midazolam and DEX are satisfactory and effective premedication regimens for uncooperative children.

Microleakage of a self-adhesive class V composite on primary and permanent dentitions.

AIM: This study aimed to evaluate the microleakage of Class V restorations filled with a 7th-generation self-adhesive composite. MATERIALS AND METHODS: In 40 permanent premolars and 80 primary canines, 160 Class V cavities were prepared, which were filled with four restorative materials (n of each material=20 permanent and 20 primary restorations): control: nonbonded composite (Heliomolar), GI: glass ionomer (Fuji IX GP), BC: bonded Heliomolar, SC: self-adhesive composite (Embrace WetBond). Dye penetration was scored 0 to 4 at 160 coronal and 160 gingival margins under 40× magnification by two examiners. The data were analyzed with Mann-Whitney U test (α=0.01). RESULTS: The mean microleakages of the materials (in the order of 'control, GI, BC, SC') at each margin-dentition (n=20 margins) were: coronal-permanent (3.25±0.72, 2.75±0.72, 0.35±0.59, 2.7±0.73), coronal-primary (3.3±0.66, 2.85±0.88, 0.55±0.76, 2.65±1.14), gingival-permanent (3.35±0.67, 0.85±0.67, 2.95±0.83, 1.55±1.23), and gingival-primary (3.25±0.72, 0.85±0.59, 2.85±0.89, 2.85±0.93). Compared with the control microleakage at each margin-dentition (each group's n=20 margins), BC microleakage was significantly lesser at coronal margins only (p=0.000), GI microleakage was lower at gingival margins only (p=0.000), and SC microleakage was smaller at gingival margins of permanent teeth only (p=0.000). After combining coronal/gingival margins, only SC microleakage in primary dentition (n=40 margins) was not significantly lesser than the control in primary teeth (p=0.018); and microleakage of all other material-dentitions were lesser than corresponding control-dentitions (p=0.000). Permanent and primary teeth had similar results for all material-margins (p>0.5) except for SC at gingival margins (p=0.001). CONCLUSION: SC should be used only at gingival margins of permanent teeth. CLINICAL SIGNIFICANCE: Application of self-adhesive composite should be limited to gingival margins of permanent teeth.

The level of evidence in two leading endodontic journals.

INTRODUCTION: The successful practice of dentistry, including endodontics, relies on a wide spectrum of dental research. The quantity and quality of research evidence in endodontics have seldom been evaluated. The aim of this study was to evaluate the level of evidence in current leading endodontic journals. MATERIALS AND METHODS: All the articles published in 2000, 2006 and 2010 in two major endodontic journals (Journal of Endodontics and International Endodontic Journal) were evaluated. These articles were classified according to the level of evidence (LOE) using Oxford Scale from 0 to 5 and type of the study. RESULTS: Of the articles assessed, 3.2% were clinical trials, 47.8% were experimental, 5.6% were animal studies and 43.4% were of other types. Subdivisions according to LOE were 4.3% as level 1, 0.9 % level 2, 7.3% level 3, 0.4% level 4 and 3.5% level 5. Overall, 83.6% of the articles were classified as "non-evidence-based". There was a marginally significant increase in the percentage of articles with high level of evidence in recent years. CONCLUSION: There is a substantial shortage of articles with high level of evidence in clinical endodontics. However, there was a gradual increase in the number of high LOE articles published in both journals.