A 1-year Clinical and Radiographic Assessment of Regenerative Endodontic Therapy for Necrotic Primary Molars: A Randomized controlled Trial.

Background: Preservation of necrotic primary teeth is important. Pulpectomy is the gold standard treatment in this situation. Reinfection is the main cause of failure in pulpectomy. The application of regenerative endodontic therapy in mature teeth has the rationale of restoring dental-pulp-like tissue and preventing reinfection. Aims and objectives: The current study was designed to clinically and radiographically assess regenerative endodontics therapy in necrotic primary molars in comparison to zinc oxide eugenol (ZOE) pulpectomy. Materials and methods: A double-blinded randomized controlled trial with three parallel arms and a 1:1:1 allocation ratio was conducted. A total of 54 necrotic primary molars in 39 healthy children aged 4-7 years old were randomly allocated as follows group I-control group, in which ZOE pulpectomy was performed. Group II and III-experimental groups, in which regenerative endodontic therapy (RET) was performed. Modified triple antibiotic paste (mTAP) and Metapex™ were used as intracanal medicaments in groups II and III, respectively. Clinical and radiographic assessments were recorded at baseline, 6 and 12 months. Chi-squared and Fisher's exact tests were used to compare the qualitative data, while Friedman's test was used to study the changes by time within each group. Results: Nonstatistically significant differences were reported between the three groups at the 6 and 12 months follow-ups regarding the clinical or radiographic assessment (p-value = 0.327 and effect size = 0.22), (p-value = 0.055 and effect size = 0.118), respectively. Conclusion: Regenerative endodontic therapy (RET) yielded comparable results to pulpectomy. However, the use of 5 mg/mL mTAP in RET represented the highest level of clinical as well as radiographic insignificant failure. Clinical significance: Regenerative endodontic therapy (RET) provides an acceptable biological alternative to pulpectomy. Trial registration: The protocol was registered at ClinicalTrial.gov with the registration number (NCT04190914). 12/5/2019. How to cite this article: Abdelmoneim DD, Abdelaziz AM, Allam GG, et al. A 1-year Clinical and Radiographic Assessment of Regenerative Endodontic Therapy for Necrotic Primary Molars: A Randomized controlled Trial. Int J Clin Pediatr Dent 2023;16(2):295-301.

Comparative evaluation of prevention of demineralization of artificial enamel caries treated with two fluoride varnishes and 38% SDF in primary teeth: an in vitro study.

BACKGROUND: This study aimed to compare the effect of Clinpro™ White varnish containing 5% sodium fluoride (NaF) and functionalized tricalcium phosphate, MI varnish containing 5% NaF and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and 38% Silver diamine fluoride (SDF) in preventing demineralization of treated white spot lesions (WSLs) in enamel of primary teeth. METHODS: Forty-eight primary molars with artificial WSLs were allocated into four groups as follows: Group 1: Clinpro white varnish, Group 2: MI varnish, Group 3: SDF, and Group 4: control (no treatment). The three surface treatments were applied for 24 h and then enamel specimens were subjected to pH cycling. Thereafter, the mineral content of specimens was evaluated by Energy Dispersive X-ray Spectrometer and the lesion depth was assessed via Polarized Light Microscope. One-way ANOVA followed by Tukey's post hoc test were used at p ≤ 0.05 to identify significant differences. RESULTS: Insignificant difference in mineral content was observed among treatment groups. Treatment groups exhibited significantly higher mineral content compared to control except for Fluoride (F). MI varnish showed the highest mean calcium (Ca) ion content (66.57 ± 0.63), and Ca/P (2.19 ± 0.11), followed by Clinpro white varnish, and SDF. MI varnish also displayed the highest phosphate (P) ion content (31.46 ± 0.56), followed by SDF (30.93 ± 1.02), and Clinpro white varnish (30.53 ± 2.19). Fluoride content was highest in SDF (0.93 ± 1.18), followed by MI (0.89 ± 0.34) and Clinpro (0.66 ± 0.68) varnishes. Significant difference in lesion depth was observed among all groups (p < 0.001). The lowest mean lesion depth (µm) was found in MI varnish (226.23 ± 44.25) which was significantly lower than Clinpro white varnish (285.43 ± 44.70), SDF (293.32 ± 46.82), and control (576.69 ± 42.66). Insignificant difference in lesion depth was found between SDF and Clinpro varnish. CONCLUSIONS: In primary teeth, WSLs treated with MI varnish displayed better resistance to demineralization compared to WSLs treated with Clinpro white varnish and SDF.

Anti-Bacterial effect, fluoride release, and compressive strength of a glass ionomer containing silver and titanium nanoparticles.

Background: Many attempts have been made to enhance the anti-cariogenic properties of the conventional glass ionomer through incorporation of variable materials. However, most importantly, the incorporation of such materials should not jeopardise the physical or mechanical properties of the final restoration. Aims: To investigate the effect of adding silver nanoparticles (Ag-NPs) and titanium dioxide nanoparticles (TiO2-NPs) to conventional glass ionomer cement (GIC) on its anti-bacterial effect against Streptococcus mutans (S. mutans), fluoride ion release, and compressive strength (CS). Settings and Design: This study was an in vitro investigation where 30-disc specimens were prepared in each of the three studied groups. Materials and Methods: The specimens were categorized into the control group (Group C), in which conventional GIC was used, and Group Ag and Group Ti, in which 5 wt% of Ag-NP and TiO2-NP were added, respectively, to GIC powder. In each group, the anti-bacterial effect against S. mutans, fluoride ion release at 24 hours and 14 and 28 days, and CS were assessed. Data were analysed using one-way analysis of variance, followed by Tukey honest significant difference post-hoc test. Results: Both Ag and Ti groups showed a significantly higher anti-bacterial effect than the control group. Ag-NP increased fluoride ion release, whereas TiO2-NP decreased fluoride release; however, cumulative ion release of both experimental groups did not differ significantly compared to the control group. Adding Ag-NP and TiO2-NP increased CS, yet only the Ti group showed the highest CS mean value that was statistically significant compared to other groups. Conclusions: Adding 5 wt% TiO2-NP or Ag-NP to conventional GIC significantly increased its anti-bacterial effect and its CS without affecting fluoride release.

Preventing and Arresting Primary Tooth Enamel Lesions Using Self- Assembling Peptide P11-4 In Vitro.

Objectives: To evaluate self-assembling peptides (SAP) for caries prevention and arrest in primary tooth enamel in vitro. Materials and Methods: Overall, 180 extracted primary teeth were used. In the prevention experiment (n = 20 samples per group), self-assembling peptide for prevention (SAPP), fluoride varnish/mouthwash (FV/FMW), casein-phosphopeptide amorphous-calcium phosphate (CPP-ACP), and nanohydroxyapatite (nHA) were applied. Samples were subjected to a demineralizing pH cycling for 14 days. In the arrest experiment (n = 15/group), 60 samples were pre-demineralized; induced lesions were treated using self-assembling peptide for repair (SAPR), FV, CPP-ACP plus fluoride, and resin infiltration (RI) and submitted to pH cycling. Mineral loss and its differences as well as lesion depth were determined using transversal microradiography. Numerical data were tested for normality using Shapiro-Wilk's test and were compared using Kruskal-Wallis test followed by pairwise comparisons utilizing multiple Mann-Whitney U tests with Bonferroni correction. The significance level was set at P < 0.05 within all tests. Results: FV (median: -46.3 [interquartile range: 175.52] vol% × µm) and FMW (-33.35 [124.65] vol% × µm) prevented caries significantly more effectively than all other groups (P < 0.001), which did not show significant preventive effects. RI (median: 4949.70 [1637.20] vol% × µm) and FV (median = 6076.05 [5190.08] vol% × µm) arrested lesions, whereas SAPR and CPP-ACPF did not show such arrest. Conclusions: FV and FMW showed the largest caries-preventive effect, whereas RI and FV arrested lesion progression in primary tooth enamel in vitro.

Laboratory evaluation of the potential masking of color changes produced by silver diamine fluoride in primary molars.

BACKGROUND: The importance of Silver diamine fluoride (SDF) as a minimally invasive and nonaerosolizing management during COVID-19 pandemic has highly increased. SDF is a caries-arresting agent that causes staining of tooth structure. Managing this discoloration will increase its acceptance in treating primary teeth. The main aim of this study was to quantify the color change associated with the application of SDF on extracted carious primary molars, the potential masking of this color change by potassium iodide (KI), composite (CMP) and glass ionomer cement (GI) and the effect of aging on this color masking effect. METHODS: An in-vitro study in which 52 carious primary molars were collected, prepared, and distributed randomly into four groups equally as follows: Group A: SDF 38%; Group B: SDF 38% + KI; Group C: SDF 38% + CMP; Group D: SDF 38% + GI. Color changes were recorded for each sample at baseline, and after application of the tested materials. Moreover, all samples had undergone Suntest aging followed by a third color reading. CIELAB values L*, a*, b*, ΔL, Δa, and Δb were measured, ΔE was calculated, and data were analyzed using multivariate analysis of variance (MANOVA) and post-Hoc Scheffé test (p < 0.05). RESULTS: MANOVA revealed the significant influence of the factor 'material'. SDF caused an obvious color change compared to the color of carious dentin. Regarding ΔL, the color change of groups C and D was not significant directly after application of the tested materials. After aging, it was significant among all groups, including groups C and D. In Δa there was a difference between SDF and groups B and C after application of the tested materials, and aging produced the same results. The color shifts of Δb of all tested groups varied significantly from one another. After aging, there was no difference between group D and either group A or B. CONCLUSIONS: Treatment with SDF caused obvious discoloration of carious dentin. Directly after SDF application, all tested materials could effectively mask the color change associated with the application of SDF. CMP was the only material whose color masking effect was not completely reversed by aging.

Caries Experience Varies in Egyptian Children With Different Combinations of Cleft Lip and Palate and Is Related to Carbohydrate Intake Between Meals.

OBJECTIVES: Our aim was to assess the prevalence of dental caries in Egyptian children with cleft lip or cleft lip and palate (CLP), according to dietary habits, and to assess the level of dental care given to these patients. DESIGN: Children aged 4 to 12 years (N = 120) with CLP were recruited: 54 with primary dentition and 66 with mixed dentition. Personal data were gathered and parents completed a 5-day diet diary for the children. The prevalence of dental caries was determined with the dmft and DMFT indices, and debris and calculus were assessed with the simplified oral hygiene index. RESULTS: Of this, 16.7% of children were caries-free. Caries experience was directly correlated with the intake of carbohydrate-containing items between meals, but not with intake at meal times. Oral-hygiene (debris) status did not differ significantly between the CLP groups. Calculus was found in 6.6% of the children. Only 8.3% of the study population had received oral-hygiene instructions from a health care professional. CONCLUSION: A direct correlation was found between caries experience and the intake of sugar-containing items in-between meals, indicating the importance of dietary advice into the comprehensive dental management of patients with CLP. Our sample had not received effective dental services.

Evaluating the Mechanical Properties, and Calcium and Fluoride Release of Glass-Ionomer Cement Modified with Chicken Eggshell Powder.

The aim of this study was to test the effect of adding chicken eggshell powder (CESP) to conventional glass-ionomer cement (GIC) on its mechanical properties, and fluoride and calcium release. CESP was added with proportions of 3% and 5% by weight to the powder component of conventional glass-ionomer cement. The specimens were categorized into group A: GIC without CESP; group B: GIC with 3% wt. CESP; and group C: GIC with 5% wt. CESP; there were 12 specimens in each group. Groups B and C showed higher compressive strength values compared to group A. However, microhardness scores were higher in group C compared to groups A and B. As for ion-release results, group B displayed the highest values of fluoride release followed by group C at both 7 and 30 days. Group C showed the highest amount of calcium release followed by both groups B and C at 7 days, while at 30 days, groups A and B showed higher calcium release compared to group C. The mechanical properties of conventional glass-ionomer restorative material were enhanced by the addition of CESP. Moreover, fluoride and calcium release were not compromised by adding CESP.