Effects of different irrigation activation methods on root canal treatment of primary teeth.

There is currently a lack of research on the application of newly developed irrigation techniques in root canal treatment of primary teeth. This study aimed to evaluate the effects of various irrigation activation techniques on two key parameters: apical debris extrusion (ADE) and dentinal tubule penetration depth (DTPD) of the root canal filling material. A total of 96 primary mandibular second molars were randomly divided into 4 groups: Group 1-Conventional Needle Irrigation (CNI), Group 2-XP-Endo Finisher (XPF), Group 3-EndoActivator (EA), and Group 4-Passive Ultrasonic Irrigation (PUI). In all groups, the One Reci single-file system was used for root canal preparation. For ADE measurement, each group was rinsed with distilled water. For DTPD assessment, sodium hypochlorite (NaOCl) was applied. ADE quantification was performed by collecting debris in pre-weighed Eppendorf tubes. A combination of fluorescent dye and root canal filling material (DiaPex Plus) was used for root canal filling. In order to examine DTPD, horizontal cross-sections of the coronal and apical regions of the teeth were taken with a thickness of 1 mm. The maximum and mean DTPD was examined by confocal laser scanning microscopy. Data were analyzed using the Kruskal-Wallis, One-way ANOVA, and Mann-Whitney U tests (p = 0.05). As a result, PUI had the highest mean ADE and CNI had the lowest mean ADE, while CNI had the highest mean DTPD in both the coronal and apical regions, whereas PUI had the lowest mean DTPD in the coronal region, and EA had the lowest mean DTPD in the apical region. There were no statistically significant differences in DTPD and ADE among the four groups. Comparing intragroup maximum DTPD across all groups, it was significantly higher in the coronal region than in the apical region (p < 0.05). ADE and DTPD of root canal filling materials in primary teeth did not differ significantly among CNI, XPF, EA and PUI irrigation activation techniques.

Comparison of signs and symptoms of temporomandibular disorders and parafunctions in children with and without cardiovascular diseases.

AIM: This study aimed to examine and compare the signs and symptoms of temporomandibular disorders (TMDs) and oral parafunctions in pediatric patients with and without cardiovascular diseases (CVDs). STUDY DESIGN: A total of 295 children with CVD (the CVDG group) admitted to the Cardiology Department and another set of 295 children without CVD (the CG group) were included in this study. All children were 6-18 years old. This study was conducted in 2 stages, comprising a questionnaire (symptoms/parafunctional habits) and a temporomandibular joint examination (signs) based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). The data obtained were evaluated statistically. RESULTS: The two groups showed no significant difference in the prevalence of TMD symptoms/signs or parafunctional habits (p > 0.05). Although the anamnestic symptoms related to pain were lower in the CVDG group, the clinical examination results were similar in terms of pain findings between the two groups. Both anamnestic and clinical findings showed higher "joint noise" and "deviation" in the CVDG group (p < 0.05). With regard to parafunctional habits, "fingernail biting" and "bruxism", were higher in the CVDG group than in the CG group. CONCLUSION: The prevalence of TMDs and oral parafunctions did not vary between children with and without CVD. However, a significant relationship was observed between the symptoms/signs of TMDs, parafunctional habits and the presence of CVD in children.

Evaluation of the effects of photobiomodulation with different laser application doses on injection pain in children: a randomized clinical trial.

The utilization of photobiomodulation (PBM) to decrease the experience of pain during the application of local anesthesia (LA) has been reported in a limited number of studies with children. However, currently, there is no complete consensus regarding its efficacy and application doses. The objective of the clinical trial was to assess the effects of PBM with three different laser application doses (with different power values) plus 10% lidocaine topical anesthetic and to compare them with placebo + 10% lidocaine topical anesthetic on LA injection pain in children. A prospective, parallel-arm, randomized, triple-blind clinical trial was conducted with 160 children aged 6 to 12 years (79 girls and 81 boys; 80 maxillary and 80 mandibular primary first molars). The children were divided into 4 groups with an equal number of subjects in each group. Before topical anesthetic usage, a laser with a power of 0.3 W, 0.4 W, and 0.5 W was applied in Groups 1, 2, and 3, respectively (a diode laser: 940 nm; continuous mode; 20 s for each group). The energy density was calculated as 69 J/cm2, 92 J/cm2, and 115 J/cm2. A placebo laser was used in the fourth group. Injection pain was assessed subjectively and objectively with the Wong-Baker Faces Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. The data were analyzed using the Chi-square test (P < 0.05). The mean (± std) PRS scores were 1.35 ± 1.075, 1.37 ± 1.05, 1.07 ± 1.04, and 2.07 ± 1.09 for Groups 1, 2, and 3 and the placebo group, respectively. Additionally, the mean (± std) FLACC scores were 1.67 ± 1.50, 1.62 ± 1.90, 1.35 ± 1.74, and 2.75 ± 1.64 for Groups 1, 2, and 3 and the placebo group, respectively. Groups 1, 2, and 3 showed significantly lower pain scores than the placebo group (P = 0.02). However, no significant difference was observed between Groups 1, 2, and 3 according to either pain scale score (P = 0.948). In addition, no relationship was found in pain scores related to sex and jaw differences in any group (P = 0.321, P = 0.248). PBM delivered by a 940-nm diode laser plus 10% lidocaine topical anesthetic before the application of LA decreased injection pain regardless of the applied laser dose in this study.

Effects of low level laser therapy on injection pain and anesthesia efficacy during local anesthesia in children: A randomized clinical trial.

BACKGROUND: The use of low level laser therapy (LLLT) to reduce injection pain associated with dental local anesthesia is reported in a limited number of studies in adults, but research on the effects of LLLT in children is needed. AIM: This study aimed to evaluate the effects of topical anesthesia + LLLT on injection pain, anesthesia efficacy, and duration in local anesthesia of children who are undergoing pulpotomy treatment. DESIGN: The study was conducted as a randomized, controlled-crossover, double-blind clinical trial with 60 children aged 6-9 years. Before local infiltration anesthesia was administered, only topical anesthesia was applied in one side (control group/CG), and topical anesthesia plus LLLT (a diode laser: 810 nm; continuous mode; 0.3W; 20 s; 69 J/cm2 ) was applied in the contralateral side (LG) as pre-anesthesia. The injection pain and anesthesia efficacy were evaluated subjectively and objectively using the Wong-Baker Faces Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability (FLACC) scale respectively. Data were analyzed for statistical significance (p < .05). RESULTS: The "no pain" and "severe pain" rates in the PRS were 41.7% and 3.3% for the LG and 21.7% and 11.7% for the CG, respectively, during injection. Similarly, in the FLACC data, the number of "no pain" responses was higher for the LG than the CG (40%, 33.3%) and no "severe pain" rate was observed in both groups. The only statistically significant difference found for the PRS was p < .05. The median pain score was "0" for the LG and the CG in the FLACC data for the evaluation of anesthesia efficacy, and there was no statistically significant difference between the groups in terms of pain and anesthesia duration (p > .05). Also, most of the children preferred injection with topical anesthesia + LLLT (66.7%). CONCLUSIONS: It has been determined that the application of topical anesthesia + LLLT with an 810-nm diode laser before local infiltration anesthesia reduced injection pain and did not have an effect on anesthesia efficacy and duration in children.

Temporomandibular disorders and oral parafunction in children living with their parents and children living in institutional protective care: a comparative study.

AIM: This study aimed: (i) to identify and compare the prevalence of temporomandibular disorders (TMDs) and oral parafunctions among children living in child-protection institutions (CLCPI) with children living with their parents (CLWP); (ii) to determine whether or not there is an association between oral parafunctions and TMDs; and (iii) to examine the possible impact of stress on TMDs. STUDY DESIGN: The study was conducted on a total of 385 children who were divided into two groups: the CLCPI group (n = 184); and the CLWP group (control, n = 201). All children 8-18 years of age and living in protective-care facilities in Kocaeli, Turkey, were included in this study in the CLCPI group. The CLWP control group comprised children of the same age as those in the CLCPI group, but those in the CLWP group were living with their families and were randomly selected from one primary school, one elementary school and one high school in Kocaeli, Turkey. Each child in the study completed a questionnaire and underwent a clinical examination. RESULTS: The overall prevalence of TMDs and oral parafunctions were higher in the CLCPI group than in the CLWP group (P < 0.05). The vast majority of participants reported at least one parafunction (CLCPI, n = 97.3%; CLWP, n = 93%). Problems related to family or friends were higher in the CLCPI group, whereas problems related to school lessons were higher in the CLWP group (P < 0.05). In both groups, positive associations were found between signs and symptoms of TMDs, oral parafunctions and stressful life events. CONCLUSION: The prevalence of signs and symptoms of TMDs and oral parafunctions differed significantly between CLCPI and CLWP groups, with children of the CLCPI group found to be significantly more prone to TMDs and oral parafunctions than children of the CLWP group.

Effect of endodontic sealers on bond strength of restorative systems to primary tooth pulp chamber.

BACKGROUND/PURPOSE: Although current literature suggests that root canal sealers affect the bonding ability of restorative systems to pulp chamber dentin of permanent teeth, primary teeth have not been investigated. This study intended to evaluate the microtensile bond strength (µTBS) of three restorative systems to pulp chamber dentin in primary teeth and to determine the effect of two different root canal sealers on the µTBS. MATERIALS AND METHODS: Ninety primary molars were used in this study. The teeth were randomly divided into three main groups according to canal sealers: (1) control (without sealer); (2) Metapex; and (3) zinc-oxide eugenol. The main groups were further divided into three subgroups depending on the coronal restorative system: (1) compomer (Prime Bond NT + Dyract EXTRA); (2) composite (Clearfil Tri-S Bond + Clearfil Photo Posterior); and (3) resin-modified glass ionomer (Fuji II LC). After restoration, the buccal wall of the pulp chamber was sectioned to obtain sticks (1 mm × 1 mm). The µTBS was then measured. Data were analyzed with two-way analysis of variance, followed by a posthoc test. The interfacial morphology of the bonded space was evaluated using scanning electron microscopy. RESULTS: In the control group, a significant difference was observed only for the µTBS of the composite (P < 0.05). Compared with the control groups, Metapex and zinc-oxide eugenol significantly reduced the µTBS of restorative systems (P < 0.05). CONCLUSION: Composite materials seemed to bond to pulp chamber dentin in primary teeth with a higher strength than compomer and resin-modified glass ionomer. Metapex and zinc-oxide eugenol canal filling materials reduced the bond strength of all three restorative systems.

The use of low-level laser therapy for controlling the gag reflex in children during intraoral radiography.

The current literature suggests that low-level laser stimulation of the PC 6 acupuncture points may prevent gagging. This study aimed to determine if low-level laser therapy (LLLT) can reduce the gag reflex in children undergoing intraoral maxillary radiography. This randomized, controlled, double-blind clinical trial was conducted with 25 children with moderate-to-very severe gag reflexes who required bilateral periapical radiographic examination of the maxillary molar region. Children's anxiety levels were initially evaluated using Corah's Dental Anxiety Scale (DAS) to identify any possible relationship between gagging and anxiety. A control radiograph was taken of one randomly selected side in each patient after simulated laser application so that the patient was blinded to the experimental conditions (control group). Laser stimulation was then performed for the experimental side. A laser probe was placed on the Pericardium 6 (PC 6) acupuncture point on each wrist, and laser energy was delivered for 14 s (300 mW, energy density 4 J/cm(2)) at a distance of 1 cm from the target tissue. Following laser stimulation, the experimental radiograph was taken (experimental group). Gagging responses were measured using the Gagging Severity Criteria for each group. Data were analyzed using Spearman's rho correlations and Mann-Whitney U tests. Both mean and median gagging scores were higher in the control group than in the experimental group. Patients who were unable to tolerate the intraoral control radiography were able to tolerate the procedure after LLLT. Differences between gagging scores of the control and experimental groups were statistically significant (P = .000). There was no significant correlation between gagging severity and anxiety score (P > .05). A negative correlation was found between age and gagging score in the control group (P ˂ .05). Within the limitations of this study, LLLT of the PC 6 acupuncture points appears to be a useful technique for controlling the gag reflex in children during maxillary radiography.

Evaluation of the injection pain with the use of DentalVibe injection system during supraperiosteal anaesthesia in children: a randomised clinical trial.

PURPOSE: The purpose of this study was to compare the use of a traditional syringe (TS) and the DentalVibe (DV) Injection Comfort System on the pain of needle insertion and injection of supraperiosteal (SP) anaesthesia into the mandibles and maxillas of children aged 6-12 years. METHODS: The study was a randomised, controlled, crossover clinical trial, comprising 60 children requiring an operative procedure with SP anaesthesia on both their mandibular and maxillary molars, bilaterally. One of the molars was treated with a TS, and the contralateral tooth was treated with the DV for both arches. On each visit, subjective and objective pain was evaluated using the Wong-Baker FACES Pain Rating Scale and the Face, Leg, Activity, Cry, Consolability Scale. Patients were asked which technique they preferred. The data were analysed using Wilcoxon signed-rank test, Spearman's correlation test, and Mann-Whitney U-test. RESULTS: No statistically significant differences were noted between TS and DV for pain during injection and needle insertion for supraperiosteal anaesthesia in either the maxillary and mandibular operative procedures. CONCLUSIONS: Children experienced similar pain during SP anaesthesia administered with a TS and the DV, regardless of gender and jaw differences. DV was less preferred over the traditional procedure in children.

Management of an intruded tooth and adjacent tooth showing external resorption as a late complication of dental injury: three-year follow-up.

Treatment and prognosis of intrusive luxation can vary depending on the age of the patient, type of dentition, stage of root development, and time and severity of the trauma. Some studies have demonstrated that intrusions of up to 3.0 mm have an excellent prognosis, whereas teeth with severe intrusion or teeth that are intruded more than 6.0 mm present an unfavorable prognosis because of the occurrence of inflammatory resorption and pulp necrosis. The aim of this case report is to present an 11-year-old male patient with complete intrusion of the permanent maxillary left lateral incisor, associated with the adjacent central tooth presenting external resorption, treated by immediate surgical repositioning and root canal treatment with a favorable prognosis. After long-term (3-year) clinical and radiographic follow-up, the teeth appeared normal and the patient was pleased with the outcome.