Comparative study of two different computer-controlled local anesthesia injection systems in children: a randomized clinical trial.

PURPOSE: To compare pain perception associated with two computer-controlled local anesthesia devices, the WAND™ STA (Milestone Scientific Inc., Livingston, NJ, USA) and the Calaject (Rønvig dental MFG, Daugaard, Denmark) in young children. METHODS: A split-mouth randomized clinical trial comprising 30 patients, aged 6-12 years, received randomly, in two separate sessions, a local anesthesia injection in the maxillary using either the wand STA or the Calaject. Pain perception was evaluated using the patient's heart rate, an 11-point numerical scale (NRS), and the Sound, Eye, and Motor (SEM) body movements. Statistical difference was set at p = 0.05. Repeated measures analysis of variance were conducted to compare the mean pulse for Calaject and STA at different times. It was followed by univariate analysis and Bonferroni multiple comparisons tests. Wilcoxon tests were performed to compare NRS, SEM, and injection duration between Calaject and STA. RESULTS: There was no significant statistical difference between Calaject and STA in pulse rate before injection (p = 0.720), during injection (p = 0.767), and after injection (p = 0.757). The mean NRS score was significantly greater with STA in comparison with Calaject (p = 0.017). The mean SEM score was also significantly greater with STA in comparison with Calaject (p = 0.002). However, the mean duration was significantly longer with Calaject (p = 0.001). CONCLUSIONS: Calaject was more effective than STA in reducing pain perception associated with periapical injection in young children.

Three-dimensional modeling and measurements of root canal anatomy in second primary mandibular molars: a case series micro CT study.

PURPOSE: This study aimed at establishing a comprehensive specification of the root canal anatomy of second primary mandibular molars using micro computed tomography (CT). METHODS: 10 s primary molars from Caucasian young patients were selected for this purpose. Micro CT imaging with a high resolution of 20 microns was performed to observe the roots and canals according to specific criteria. The Vertucci canal configuration, the presence of lateral canals and their location, the presence of an isthmus and its location, were first observed. Then, the length of the canals, their diameter in the mesio-distal and vestibulo-lingual direction, the dentinal thickness and the direction of the minimal dentinal thickness were measured. RESULTS: The mean working length was not significantly different between the canals (p = 0.710). The bucco-lingual diameter was significantly higher when the tooth had a single distal canal at the coronal (p < 0.001), middle (p < 0.001) and apical (p = 0.012) levels. The root dentin thickness on the distal wall of the mesial root and the mesial wall of the distal roots were reduced, respectively, from the coronal to the apical thirds. CONCLUSIONS: The results obtained in this case series report clearly show a complex, sometimes unpredictable, anatomy with dangerous areas where dentin is extremely thin. The plethoric presence of anastomoses, large bands of isthmus, lateral canals at all levels induces the need for the development of instruments specific to pulpectomies on primary teeth.

[An 18 month evaluation of MM-MTA pulpotomy on primary decayed molars]. / Evaluation sur 18 mois de la pulpotomie au MM-MTA sur des molaires temporaires cariées.

Pulpotomy is the most performed and controversial therapeutic in pediatric dentistry. Formocresol is known to have a toxic effect on living tissues, a mutagenic and carcinogenic potential with a systemic uptake of formocresol via pulpotomized teeth, other alternative products have been investigated. 40 molars were pulpotomized using Micro Mega Mineral Trioxide Aggregate (MM-MTA), which eliminates the need for the use of formocresol. The effects of this material were evaluated both clinically and radiographically. Post-operative control examinations were performed at 1, 6, 12, and 18 months trying to detect spontaneous or stimulated pain, pathological tooth mobility, abscesses or fistulas, internal or external pathological tooth resorption, periapical bone destruction, or canal obliteration. Pain was absent at 18 months post operatively. Thirty six molar treated with the MM-MTA didn't show any mobility or pain, one molar presented a pathological resorption and one molar presented an abscess without a fistula at 12 month. The observations were compared to others related to formocresol, ferric sulfate, MTA, and laser pulpotomies, using the Chi-square test x2. The abundance of positive result strongly demonstrate that the MM-MTA pulpotomy on carious temporary molars is a promising technique.