Treatment outcomes of pulpotomy versus pulpectomy in vital primary molars diagnosed with symptomatic irreversible pulpitis: protocol for a non-inferiority randomised controlled trial.

BACKGROUND: Pulpectomy continues to be the standard treatment recommendation for management of vital primary molars diagnosed with symptomatic irreversible pulpitis. The recent decade has seen a paradigm shift in the treatment concepts of how vital mature permanent molars diagnosed with irreversible pulpitis can be more conservatively managed using vital pulp therapy techniques like pulpotomy. However, despite emerging evidence indicating similarities between primary and permanent tooth pulp response to dental caries, there is limited research on whether pulpotomy can be similarly used as a definitive treatment modality for vital primary teeth with irreversible pulpitis. This randomised controlled trial (RCT) aims to compare the treatment effectiveness of pulpotomy versus pulpectomy in management of vital primary molars diagnosed with symptomatic irreversible pulpitis over a two-year period. METHODS/DESIGN: This clinical study is a parallel, two-armed, open label, non-inferiority RCT with a 1:1 allocation ratio between the experimental intervention arm (pulpotomy) and the active comparator arm (pulpectomy). Healthy cooperative children, between 4-9 years of age, who have painful primary molars with clinical symptoms typical of irreversible pulpitis will be recruited after obtaining informed consent from their parents/legal guardians. 50 vital primary molars clinically diagnosed with symptomatic irreversible pulpitis will be randomly distributed between the two treatment arms. The primary outcomes that will be assessed are clinical and radiographic success after six-months, one-year and two-years of the trial interventions. The influence of baseline pre-operative variables (age; gender; tooth type; site of caries; pre-operative furcal radiolucency; pre-operative pain intensity) and intra-operative factors (time taken to achieve haemostasis) on treatment outcomes will also be assessed. The secondary outcome evaluated will be the immediate (24 h and 7 d) post-operative pain relief afforded by the two treatment interventions. DISCUSSION: This trial seeks to provide evidence on whether pulpotomy treatment can be no worse than the standard pulpectomy treatment for the management of symptomatic irreversible pulpitis in vital primary molars. TRIAL REGISTRATION: ClinicalTrials.gov (NCT06183203). Registered on 30 January 2024.

Dental implants in growing patients: A quality assessment of systematic reviews.

Background: Dental implants in the recent past have become indispensable in restoring loss of space and support as well as aiding the aesthetics. Although in practice for a few years there is no consensus on the protocols for placement and usage of dental implants in growing jaws. Objective: The present study aims to evaluate evidence-based literature on single or multiple dental implant placements in children(up to 17 years) and to identify areas lacking and gaps in knowledge. The quality assessment tool,namely AMSTAR-2, will also aim to evaluate the quality of said research around paediatric dental implants. Design: The study was prospectively registered on the Open Science Framework https://osf.io/e59bt/?view_only=ec8fb69455c240ecbfc7379734784bf7.For source selection, electronic searches were performed on MEDLINE, EMBASE, Scopus databases as well as Google Scholar for all English language systematic reviews and meta analysis on dental implants placed on children up to 17yrs of age by 2 reviewers, wherein the publications until December 2020 were included. A final dataset of 4 systematic reviews were incorporated and analysed using the AMSTAR-2 grading tool. Results: It was seen that only one study showed moderate overall confidence while one low overall confidence as per the AMSTAR-2. The other 2 systematic reviews were of critically low confidence levels. Hence, the existing systematic reviews on the subject are not of high quality. Most of the reviews have no consensus regarding use and placement of implants in growing patients. Conclusion: More research and stricter adherence to the quality assessment guidelines is recommended for all future systematic reviews regarding dental implant in children.

Credibility of YouTube™ videos on root canal treatment in children.

Background: A lot of videos on root canal treatment in children are available on YouTube™ but no quality checks are present. Addressing this is critical so that parents and dentists know why root canal in children is important including the explanation of procedural steps regarding treatment undertaken. Aim: The aim of this study is to analyze and grade YouTube™ videos on root canal treatment in children and assess whether it provides beneficial information for patients and dentists. Materials and Methods: Variables such as number of views, duration (minute), days since upload, number of comments, number of likes, number of dislikes, interaction index, and viewing rate were tabulated for selected 57 videos. Analysis: Selected videos were statistically analyzed using a 15-point scoring system and evaluated using SPSS software. Finally, the obtained data sets were classified as low-, moderate-, and high-content videos. Fisher's exact test was used to compare between proportions. Results: Based on the tabulated variables, most of the videos were low (n = 31) and moderate content (n = 24), which dentists mostly uploaded. There was no statistical significance between the video types and content score groups (P > 0.05). The most frequently mentioned issues were procedure (84.21%), obturating materials (75.44%), and etiology (63.16%). The least mentioned subjects were indications (24.56%) and importance (22.81%). Conclusion: From this study, YouTube™ videos on root canal treatment in children were of low and moderate quality. Hence, high-quality videos are essential for providing awareness among patients and dentists.

Perplexity and Repercussions in Maldiagnosis of an Extraoral Draining Sinus by a Physician and its Dental Management: A Case Report.

The cutaneous sinus of dental origin represents a skin disorder that appears due to an infection accompanied by bony changes. The remote location of the lesion relative to the primary site of the disease leads to its presumption of a skin etiology by the individual. Inadequate knowledge on the part of the physician followed by faulty management complicates the situation further. However, unless the dental cause is not addressed, the lesion does not resolve. The following case report discusses the dental management of an extraoral sinus with the aim of guiding the general public, physicians, and dentists with its accurate and timely assessment so as to avoid additional financial costs, futile antibiotic therapy courses, and unnecessary surgical excisions. How to cite this article: Sidhu S, Thomas AM, Kundra R. Perplexity and Repercussions in Maldiagnosis of an Extraoral Draining Sinus by a Physician and its Dental Management: A Case Report. Int J Clin Pediatr Dent 2022;15(1):115-118.

Dental Patents in India: A Decade Long Review.

Background: The advent of technology in dentistry compels the safeguard of intellectual property to guarantee a steady flow of ideas. A guarantee preserves the idea/invention which is conductive to the subsequent financial gain or marketing of the said product for the patentee. The main objective of the present study was to illuminate the trends in the dental patents filed in India over the past decade and to analyze these in context with the recent developments in dental markets. Methodology: A total of 641 dental patent applications retrieved from the Indian Government Official Website between 2010 and 2020 were scanned for field of invention, type or status of application along with details regarding date of publication or filing of application, etc., The dataset was collaboratively analyzed using Panda's Library in Python software as analysis tool for data preparation and frequency analysis. The estimates were presented as mean differences and 95% confidence intervals. Results: The results showed that Indian Patent Office (IPO) has granted 54 dental patents in the last decade. The maximum applications of the IPO processes are the patent co-operation treaty National Phase applications (53.3%), mostly in the bio-engineering field (36.8%). Chiefly, patents were filed by individuals and companies (n = 180) and average time for grant was 4.90 years and 5.34 years, respectively. Conclusion: The process of patent application in India although has become digitalized needs to be more comprehensible and time bound, with more awareness disseminated to entrepreneurs and dental students alike.

A comparative evaluation of penetration depth and surface microhardness of Resin Infiltrant, CPP-ACPF and Novamin on enamel demineralization after banding: an in vitro study.

BACKGROUND: The field of dentistry has been revolutionized by various concepts. Minimal invasive dentistry is the preferred treatment approach in the present era; therefore, various techniques have been advocated to arrest caries lesions at an early stage on the grounds of better understanding of the dynamic nature of dental caries. Thus, study was conducted to compare and evaluate the penetration depth and enamel microhardness of Resin Infiltrant, CPP-ACPF and Novamin on artificial demineralized enamel surface after orthodontic banding. MATERIAL AND METHODS: Eighty extracted sound premolars were banded. The bands were cemented with type 1 GIC and further divided into - Group I: Resin Infiltrant, Group II: CCP-ACPF, Group III: Novamin and Group IV: Control. The samples were incubated for 30 days and then thermocycled. A window of 4 mm × 4 mm was prepared on the buccal surface of samples and artificially demineralized for 4 weeks. A single application was made for Resin Infiltrant, while Novamin and CCP-ACPF were applied twice daily. These samples were otherwise immersed in artificial saliva, and this was protocol was observed for 14 days. For the evaluation of penetration depth, 10 samples from each group were bucco-lingually sectioned and immersed in methylene blue dye solution for 24 h and then evaluated under stereomicroscope. For the enamel surface microhardness, remaining 10 samples from each group were embedded in acrylic resin with outer buccal surface exposed and were tested by a using digital Micro-Vickers hardness tester. RESULTS: All groups showed a significant difference in the depth of dye penetration and surface microhardness compared to the control group. As compared to the other tested groups, Resin Infiltrant exhibited the highest significant reduction in demineralization and increased microhardness. Novamin had a deeper penetration and increase in microhardness as compared to CCP-ACPF. CONCLUSION: Resin Infiltrant exhibited the highest potential to impede caries and constitutes a competent aerosol free micro-invasive strategy for combating non cavitated lesions approaching the outer layer dentine which are too advanced for remineralizing agents but do not necessarily require any drilling of tooth.

A comparative evaluation of resin- and varnish-based surface protective agents on glass ionomer cement - a spectrophotometric analysis.

Objectives: To evaluate and compare the effectiveness of resin- and varnish-based surface protective agents on Glass Ionomer Cement (GIC). The different surface protective agents used were: Vaseline®, GC Fuji VARNISH™ (varnish), G-Coat Plus™ (resin) and EQUIA® Coat (resin). Method: Thirty-six identical specimens of GIC were made. Six specimens were used in preparation of standard solution and remaining thirty were divided into five groups with six specimens in each group. Each test specimen was coated with one of the surface protecting agent except for the control group. The specimens were immersed separately into 1 ml of 0.05% methylene blue solution for 24 h and then rinsed with deionised water and further immersed into tubes containing 1 ml of 65% nitric acid. Specimens, once completely dissolved in nitric acid solution, were filtered and centrifuged. The supernatant was used to determine the absorbance using a spectrophotometer. The effectiveness of the surface protecting agents for the GIC was recorded in micrograms of dye per specimen, where low values indicate good protection. Result: Tukey HSD test revealed that GC Fuji VARNISH™ (varnish; mean = 21.25 µg/ml), G-Coat Plus™ (resin; mean = 30.39 µg/ml) and EQUIA® Coat (resin; mean = 9.32 µg/ml) were statistically not significantly different to each other and were effective in protecting the surface of GIC. Significance: The study found that there was a statistically significant difference between control and GC Fuji VARNISH™, G-Coat Plus™ and EQUIA® Coat. The three agents were found to be equally effective in protecting the surface of GIC.

Comprehensive Analysis of Retracted Publications in Dentistry: A 23-Year Review.

BACKGROUND: In the modern tech-savvy era, scientific literature publication remains the optimal way to disperse knowledge, even if it has transformed from print to mostly electronic. With the new and improved publication methods, also come more scrutiny and analytic criticism of the scientific work. It becomes even more important in this context to rectify flawed scientific work responsibly. This present study was undertaken to help clarify the process and causes of retractions occurring in the dental community and analyse its reasons. Methodology. A total of 8092 PubMed indexed articles were scanned from the online libraries, and individually scanning for author details, place of study, subspecialty of research, funding, dates of original publication, and retraction notices issued along with journal specifics such as type and impact factors, country of publishing was compiled and analysed by two authors. The dataset was then collaboratively analysed using Panda's Library in Python software as an analysis tool for data preparation and for frequency analysis. The estimates were presented as mean differences (MD) and 95% confidence intervals (95% CI). RESULTS: The present study had a compiled dataset of 198 articles after screening and revealed that maximum retractions of dentistry-related research originated from India (25.3%) and, on average, took 2.6 years to be issued a retraction notice. We also deciphered that the USA retracted maximum dental articles (34.8%), and plagiarism was cited as the most common (38.02%) reason for doing so. The present study also brought to light that there was a trend for lower impact factor-dental journals in retracting maximum articles, most of which were nonfunded (62.16%). The results signify that 63.78% of all retracted papers continued to be cited postretractions. CONCLUSIONS: The retractions happening in the field of dental literature are currently too time-consuming and often unclear to the readers. The authors would like to conclude that the retracted papers were mostly from India and Spain mostly related to endodontics or prosthodontic research. All of this warrants the need for better scrutiny and reforms in the area.

Dental age estimation using Willems method: A cross-sectional study on children in a North Indian city.

BACKGROUND: Numerous methods of age estimation have been proposed. The Demirjian method which was first applied in a French-Canadian population in 1972 is the most frequently used dental age estimation method. However, a constant over estimation using this method has been reported by numerous researchers. The Willems method is a modification of the above and was first applied in a Belgian Caucasian population in 2002. Several studies in the recent years found Willems method to be more accurate than the original Demirjians method. OBJECTIVES: The objective of this study was to evaluate the applicability of Willems method for dental age estimation in 6 -15-year-old North Indian children. METHODS: The sample for this cross sectional study consisted of 390 OPGs of (215 boys and 175 girls) randomly selected from the patient records of a post graduate training dental college in North India. Exact chronological age of the subjects (in years and months) was calculated. The OPGs were used to score the seven mandibular teeth and dental age was estimated using the tables proposed in Willems method. RESULTS: Significant correlation between the chronological age and dental age estimated using Willems method was observed in both males (r = 0.90) and females (r = 0.87). The mean difference between estimated DA and CA for males was 0.004 ± 1.08 years (P = 0.94). While for females, it was 0.031 ± 1.18 years (P = 0.72). The results showed no statistically significant difference between chronological age and dental age estimated using Willems method in the study population. CONCLUSION: Willems dental age estimation method without any modification can predict the chronological age of 6-15 year old North Indian children with good accuracy.

Cu-sil dentures: A novel approach of Papillon-Lefèvre syndrome management.

Papillon-Lefèvre syndrome (PLS) is a rare genetic disorder characterized by palmoplantar keratosis and premature loss of primary and permanent dentition. Its onset can be as early as 1-4 years of age. The genetic disorder is mutation in the cathepsin C gene. Hereby, we discuss the fabrication of Cu-sil dentures for the prosthetic rehabilitation of a 14-year-old girl with PLS. The case report describes the procedure and associated relevant information regarding the management protocols.

Fluoride Levels in Saliva and Plaque following the Use of High Fluoride and Conventional Dentifrices- a Triple Blinded Randomised Parallel Group Trial.

CONTEXT: The comparison of fluoride levels in saliva and plaque following the use of conventional, 2800 and 5000 ppm dentifrices for different time intervals up to 24 hours has not been explored. AIM: The aim of the present study was to assess salivary and plaque fluoride levels at different time intervals following the use of high fluoride dentifrices. STUDY DESIGN: This randomised control trial was conducted on sixty adolescents between the age group of 16 and 18 years divided into three groups A, B, and C. INTERVENTION: Subjects were asked to brush the occlusal surfaces of posterior teeth with one of the dentifrices for 2 min. Unstimulated whole saliva and plaque samples were collected at different time intervals. Fluoride levels were determined using SPADNS method. Data was collected and statistically analyzed using SPSS 20 Inc. by mixed repeated measure ANOVA. RESULTS: A significant difference in fluoride levels was observed at different time intervals in both saliva (p=0.048) and plaque (p=0.03). The variance was low with time and concentration of the dentifrice used in saliva, whereas the magnitude of treatment was large for time (>0.25) but small for (<0.09) concentration in plaque. CONCLUSION: A significant difference in fluoride levels was observed at different time intervals in both saliva and plaque among the three groups. There was a positive correlation between fluoride levels in saliva and plaque. Both high fluoride dentifrices were effective in maintaining higher intraoral fluoride levels up to 12 hours and 5000 ppm up to 24 hours compared to conventional dentifrice.

Piloting Direct Observation of Procedural Skills in Dental Education in India.

CONTEXT: Direct observation of procedural skills (DOPS) and corrective feedback are one of the most important tools to promote skill learning. Authentic and pedagogically effective feedback can come out only when based on direct observation of the learners' performance. Use of DOPS, particularly in dental education in India is very uncommon. AIMS: To pilot DOPS on undergraduate dental students in the specialty of periodontia. MATERIALS AND METHODS: The faculty was oriented to the concept and use of this modality during a 1 h session, which included a video demonstration. The generic DOPS recording format with modifications was used for periodontal procedures. A total of 42 procedures (including 7, 30, and 5 of low, average, and high difficulty, respectively) performed by 15 students were observed by four faculty members. Feedback was provided to the students regarding the procedure and how to overcome shortcomings if any. RESULTS: Faculty was comfortable observing and providing feedback (3.95/5.0) and found this mode feasible and nonintrusive in their clinical and teaching schedule. Students expressed satisfaction and acceptance of this modality (4.19/5.0), felt that it would help them in learning skills better (4.01/5.0) and 83% wanted it to be extended to other clinical areas, preferably from the beginning of their clinical postings. CONCLUSION: DOPS can be incorporated in the in-training assessment of undergraduate dental students and seems to have a good feasibility and acceptability. Faculty training in observation and providing feedback will enhance its utility.

A Clinical Evaluation of Gingival Overgrowth in Children on Antiepileptic Drug Therapy.

INTRODUCTION: Gingival overgrowth, a well-known side effect of chronic phenytoin therapy has also been known to be caused by other anti epileptic drugs (AED's). Various factors like plaque, gingival inflammation, and periodontal health have been postulated to effect gingival overgrowth. AIM: To identify the AED having an effect on gingival overgrowth and to study the factors affecting it. MATERIALS AND METHODS: Three groups of 30 children each on monotherapy of phenytoin, sodium valproate, and carbamazepine were longitudinally followed for six months. Their oral and epileptic health status was assessed and were monitored for change in plaque levels, gingival inflammation, probing depth and the status of gingival overgrowth at baseline, at the end of 3 months and finally at the end of 6 months. The data was recorded and statistically analysed. RESULTS: Phenytoin caused gingival overgrowth in a significant number of children (53.6%) within 3 months. Sodium valproate also led to gingival overgrowth, but not upto statistically significant levels. Patients on carbamazepine did not show any signs of gingival overgrowth. Gingival overgrowth is seen more on buccal side, in the anterior segment and in the lower arch. No correlation could be found between, either plaque level, or gingival inflammation with gingival overgrowth. Probing depth could be positively correlated with gingival overgrowth. CONCLUSION: Phenytoin is the drug, which can be chiefly implicated for causing gingival overgrowth. Sodium valproate carries the potential for gingival overgrowth, although only up to clinically insignificant levels in 6 months. Carbamazepine can be considered a safe drug in children in relation to gingival overgrowth.

Simplified feeding appliance for an infant with cleft palate.

A child born with cleft palate may experience difficulties while feeding. Early surgical treatment may need to be postponed until certain age and weight gain of the infant. The case presented here is of a 1-month-old neonate born with cleft palate, assisted with a new feeding appliance made with ethylene vinyl acetate using pressure molding technique to aid in proper feeding. The patient's weight and health significantly improved after the insertion of obturator. The advantages of this material included being lightweight, moldability, good palatal fit and decreased soft tissue injury.

A Comparative Evaluation of the Effect of Bonding Agent on the Tensile Bond Strength of Two Pit and Fissure Sealants Using Invasive and Non-invasive Techniques: An in-vitro Study.

BACKGROUND: Newer technologies and the development of pit and fissure sealants have shifted the treatment philosophy from 'drill and fill' to that of 'seal and heal'. AIMS: The purpose of this in-vitro study was to evaluate the effects of bonding agents on the tensile bond strengths of two pit and fissure sealants by using invasive and non-invasive techniques. STUDY DESIGN AND METHODS: One hundred and twenty bicuspids were collected and teeth were divided into two groups: Group-I (Clinpro) and Group-II (Conseal f) with 60 teeth in each group. For evaluating tensile bond strengths, occlusal surfaces of all the teeth were flattened by reducing buccal and lingual cusps without disturbing fissures. Standardised polyvinyl tube was bonded to occlusal surfaces with respective materials. Sealants were applied, with or without bonding agents, in increments and they were light cured. Tensile bond strengths were determined by using Universal Testing Machine. STATISTICAL ANALYSIS: Data were then statistically analysed by using Student t-test for comparison. RESULTS: A statistically significant difference was found in tensile bond strength in invasive with bonding agent group than in non-invasive with bonding agent group. CONCLUSION: This study revealed that invasive techniques increase the tensile bond strengths of sealants as compared to non- invasive techniques and that the use of a bonding agent as an intermediate layer between the tooth and fissure sealant is beneficial for increasing the bond strength.

Displacement, location, and angulation of unerupted permanent maxillary canines and absence of canine bulge in children.

INTRODUCTION: In this study, we examined displacement (labiopalatal and mesiodistal) and angulation of unerupted permanent maxillary canines on either side in children (n = 49) aged between 10 and 12 years with unilateral absence of the canine bulge on palpation. METHODS: The side without the canine bulge was considered the experimental (n = 49) and the contralateral side (where the bulge was palpable) the control (n = 49) in each subject. Orthopantomographs were taken to assess mesiodistal displacement and angulation of the canines on both sides. The horizontal tube shift method was used to assess the labiopalatal displacement of the canines on the experimental sides. RESULTS: There was a significantly high possibility of finding mesially overlapping canines (with respect to the lateral incisor on the orthopantomograph) on the sides without the bulge (chi-square, 60.05; P <0.001), all of which were found to be palatally displaced. However, 22.45% of the canines on the side without the bulge showed no abnormal displacement. The mean angulation was lower for palatally displaced canines than those that were not (t = 9.89; P <0.001). CONCLUSIONS: There is a significantly high possibility of finding palatally displaced canines in children aged 10 to 12 years on sides with the canine bulge absent on palpation; rarely, the canine is transposed with the first premolar. Palatally displaced unerupted canines have a significantly high possibility of being more mesially angled (to the horizontal) on the orthopantomograph compared with undisplaced canines.

Efficacy of 10% Povidone Iodine in children affected with early childhood caries: an in vivo study.

UNLABELLED: For prevention of dental caries, S. mutans numbers must be reduced and prevented from returning to the original level. An antibacterial agent that is effective and also acceptable to young children can help to establish a favorable oral environment and halt the caries process. PURPOSE: This study was conducted to evaluate the efficacy of topical antimicrobial (10% Povidone- Iodine) on S. mutans counts in children with Early Childhood Caries after full mouth rehabilitation. Also its effects on the clinical outcomes in terms of incidence of new caries and secondary caries were evaluated. METHOD: Full mouth rehabilitation was done in 30 children (mean age 4.2 years) suffering from Severe Early Childhood Caries (SECC). Stimulated saliva samples were collected to determine the post operative baseline S. mutans counts. Thereafter the subjects were randomly divided into two groups. The experimental group received 10% Povidone Iodine at 3 months interval for a period of 12 months while the control group received placebo (deionized water) at similar intervals. Change in the S.mutans count at 6 and 12 month intervals were compared to the baseline post-operative mutans score. Results revealed that application of 10% Povidone Iodine caused a significant reduction in the rise of Streptococcus mutans levels from the baseline postoperative score after 12 months of treatment thus decreasing the oral load of the organisms. Reduction in counts; in turn decreased the relapse of caries in these children. CONCLUSION: Thus oral rehabilitation coupled with regular application of 10% Povidone Iodine application can be a good alternative to control dental caries in children affected with Early Childhood Caries (ECC).

Reliability of the magnification method for localisation of ectopic upper canines.

OBJECTIVE: To evaluate the reliability of the magnification method for localisation of palatally placed canines. METHODS: Panoramic radiographs were taken of subjects, aged 10 to 12 years, with unerupted upper permanent canines. Two periapical radiographs (horizontal parallax method) were then used to identify 36 sublects with one palatally placed canine. Differences in the sizes of crowns of the canines on the panoramic radiographs were used to identify which tooth was palatally placed. The observer was blinded to the side with the palatally placed canine. The parallax and magnification results were tabulated, and the sensitivity and specificity of the magnification method calculated. RESULTS: The magnification method was found to have a sensitivity of 75 per cent; specificity of 100 per cent; positive predictive value of 100 per cent; negative predictive value of 80 per cent; and an accuracy of 87.5 per cent, in localising palatally placed canines. CONCLUSION: The magnification method, which uses the side-to-side difference in the magnification of the crowns of ectopic canines on panoramic radiographs, is adequate for initial assessment of canine position. The magnification method did, however, accurately identify canines that were not palatally placed. Additional radiographs may be required to accurately localise an ectopic canine.

Idiopathic oligodontia in primary dentition: case report and review of literature.

Idiopathic oligodontia of the primary dentition is very rare. This is a case report of a 2 year and 6 month old boy, who presented with fourteen missing primary teeth. Review of previous case reports is done and the management of these cases is discussed.