Assessment of photobiomodulation by a 660-nm diode laser on the reversal of soft tissue anesthesia in children: A randomized controlled clinical trial.

BACKGROUND: Soft tissue anesthesia (STA) following inferior alveolar nerve block (IANB) anesthesia lasts 3-5 h. It is important to reverse STA after treatment to prevent soft tissue injury (STI). AIM: This study evaluated photobiomodulation using a 660 nm diode laser on STA reversal and its impact on STI following IANB anesthesia. DESIGN: A randomized controlled clinical trial was conducted on 32 children, aged 5-8 years, allocated into the test and control groups. Anesthesia was administered; the operative procedure was performed followed by exposure to laser. STA reversal was monitored through lip tapping, current perception threshold (CPT) tests, and paediatric Functional Assessment Battery. RESULTS: The test group showed significantly faster recovery to normal sensation following exposure to laser than the control group which did not undergo any reversal (p < .0001), with a median time of 115 and 60 min according to lip tapping and CPT tests, respectively. The test group also showed significantly faster recovery to normal function (p = .016). The incidence of STI in the form of redness was significantly higher in the control group (p = .022). CONCLUSION: Photobiomodulation using a 660 nm diode laser can be considered as an efficient approach to minimize STA and STI after dental interventions.

Evaluation of rotary file system (Kedo-S-Square) in root canal preparation of primary anterior teeth using cone beam computed tomography (CBCT)-in vitro study.

BACKGROUND: In recent years, pediatric endodontics has witnessed various advances including use of rotary files in pulpectomy. This study aimed to comparatively evaluate taper, amount of dentin removal and instrumentation time of the pediatric rotary Kedo-S Square file, hand K-files and H-files in primary canines using cone beam computed tomography (CBCT). METHODS: 60 primary canines were randomly assigned into three groups; A1 Kedo-S-Square rotary file (group I), hand stainless steel K file (group II) and hand stainless steel H file (group III). Teeth were mounted in vinyl poly siloxane impression material templates to be scanned before and after instrumentation by CBCT scans using Ondemand 3D software. Shaping ability of the files were evaluated in terms of taper of the canal and amount of dentin remaining of each group. Instrumentation time was recorded using a digital stopwatch. RESULTS: Kedo-S Square removed a significantly less amount of dentin in both apical (P < 0.002) and coronal thirds (P < 0.014). Taper of the preparations showed significant differences as Kedo-S Square file showed good taper in maximum number of root canals, while maual K- and H-files showed poor taper in maximum number of root canals (P < 0.0001). Rotary Kedo-S Square files required less instrumentation time (P < 0.0001). CONCLUSION: The use of rotary Kedo-S Square files resulted in better conservation of tooth structure, superior tapering ability and least instrumentation time compared to hand K- and H-files.

Joubert Plus Syndrome with Self-Mutilation: A Case report.

BACKGROUND: Joubert syndrome is a very rare condition with dismal prognosis. It is characterized by several abnormalities including molar tooth sign on MRI. When coupled with mega cisterna magna- a feature of the Dandy Walker syndrome- it is categorized as Joubert plus syndrome. CASE REPORT: A 16 month old male child with Joubert syndrome was referred to the Pediatric Dentistry Department Clinic, Faculty of Dentistry Alexandria University, complaining of severe tongue and lower lip injury due to self-mutilation. He required multiple teeth extractions under general anesthesia to prevent further tongue and lip mutilation. CONCLUSION: Joubert plus syndrome is a very rare occurring condition. Because self-mutilation is sometimes fatal, a treatment plan tailored to each patient's need is mandatory. A multidisciplinary approach is recommended.

Intra- and inter-examiner variability in evaluating preclinical pediatric dentistry operative procedures.

Many investigators have reported attempts to develop reliable laboratory and clinic evaluation systems. However, few studies, regardless of level of success, have used an analytic procedure to identify those components of the evaluation system that, if refined further, could improve reliability. The purpose of this study was to compare intra- and inter-examiner variability in two evaluation methods: glance and grade (global), and checklist and criteria (analytical). Three faculty staff members with more than ten years of clinical and teaching experience evaluated operative procedures performed on plastic teeth representing the primary teeth by thirty dental students in pediatric dentistry preclinical laboratory sessions. The preparations were graded blindly by each of the three evaluators (A, B, and C) three times without magnification. The values were statistically analyzed using Wilcoxon signed rank test and Friedman test setting value of significance at 5 percent. The study revealed that, among the three examiners, the intra-examiner variability was nonsignificant in most situations. On the other hand, there was statistically significant variability between evaluators (i.e., inter-examiner) for almost all preparations. Neither cutting off the scores nor using either evaluation method (glance and grade or criteria and checklist) caused an improvement in variability. The problem of inter-examiner reliability and variability still existed.

Evaluation of fissure sealant applied to topical fluoride treated teeth.

Fissure sealant is an important tool in the prevention of dental caries. This study evaluated the effect of treating the enamel with topical fluoride gel prior to acid etching on sealant retention clinically (Part I) and in vitro (Part II). In part I a split mouth design using contralateral first permanent molars was conducted. Seventy (35 pairs) molars were sealed. Fissure sealant was applied on one side of the mouth (control group) and the contralateral tooth received acidulated phosphate fluoride gel (test group) prior to acid etching. The sealant was evaluated after 6 and 12 months and scored as intact, partially lost or completely missing. In part II, the shear bond strength between sealant and buccal enamel of extracted permanent molars without or with topical fluoride treatment was evaluated. Results showed no statistically significant differences between the test and control groups either clinically or in vitro. It is concluded that topical fluoride application prior to acid etching does not have a deleterious effect on sealant retention. However, further investigations should be conducted using different types of fluoride before altering the traditional practices.

A clinical and radiographic evaluation of stainless steel crowns for primary molars.

AIM: This study was performed to evaluate clinically and radiographically the effect of stainless steel crowns placed on primary molars on gingival and bone structures. SAMPLE: 254 crowns were evaluated in a sample of 177 children aged 3.5-12 years old with a mean age of 7 years. METHOD: The clinical parameters that were evaluated were, crown marginal extension, crown marginal adaptation, intact proximal contact, gingival index and the duration of presence of the crowns, together with the oral hygiene index of the child. Bitewing radiographs were viewed for extension and adaptation of crown margins and for evaluating the interproximal bone level. RESULTS: The results of the study showed that interproximal bone resorption was not significantly affected by either crown marginal extension or adaptation, preserving tight proximal contact between molars, oral hygiene level or duration of presence of the crown. On the other hand, there was significant bone resorption when the crown was judged radiographically as non-satisfactory. While oral hygiene level had a significant effect on the gingival index, presence or absence of proper proximal contact did not have an effect on the gingival index. CONCLUSION: It was concluded from this study that stainless steel crowns are still a valuable procedure that has no harmful effect on the gingiva and bone provided that good oral hygiene level was maintained.

The application of fiber core posts in restoring badly destroyed primary incisors.

Early childhood caries (ECC) represents a challenge to pediatric dentists especially, when teeth are badly destroyed. ECC involves the upper anterior teeth early in life and by the time the dentist sees the child, most of the coronal structure is lost. Dentally, this is a very devastating situation for both the dentist and parents, as in many cases, extraction of these teeth is the only option. With the introduction of new adhesive systems and restorative materials, a new approach for treating these teeth is explained and documented by clinical cases, where fiber core posts are introduced into the root canals of primary incisors for a distance of 2 to 3 mm. It is retained in place by flowable composite, then the coronal part is reconstructed by a strip crown to restore the crown form. After a follow up period of one year, only 2 teeth out of 30 had to be extracted. The failure was attributed to failure in pulpal therapy rather than failure in the restorations, which were totally intact. A laboratory testing of the fracture load resistance of the restored teeth proved that this technique significantly improved the fracture load resistance of composite celluloid crowns, making it a valuable procedure to consider when the coronal tooth structure is not enough to support and retain a composite celluloid strip crown.