Evaluation of Effectiveness of Graphics Interchange Format and Wong-Baker FACES Pain Rating Scale as Pain Assessment Tool in Children.

AIM: The objective of this preliminary study was to evaluate the validity and reliability of the graphics interchange format (GIF) as a self-reporting pain assessment tool in children. MATERIALS AND METHODS: In this in vivo observational study, pain assessment of 42 children aged 7-13 years with a chief complaint of dental pain reporting the first time to the Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, Maharashtra, India, were included. Informed consent was obtained from the parents or guardians. All the responses were obtained by a single practitioner, after showing the respective self-reporting pain scale, that is, Wong-Baker FACES Pain Rating Scale (WBFPRS) and GIF pain scale. A questionnaire study was performed at the end of the study. The data were recorded, and then statistical analyses were performed. RESULTS: Both scales showed significant differences (p = 0.001*) when scales were individually compared to the actual pain intensity experienced by the patient. Both WBFPRS and GIF pain scales have shown non-significant differences (p = 0.155). The GIF pain scale has shown very strong relationship (r = 0.936, p = 0.001*), while WBFPRS showed strong relationship (r = 0.725, p = 0.001*). The GIF pain scale has shown almost perfect agreement (k = 0.911) whereas WBFPRS has shown substantial agreement (k = 0.710) with actual pain intensity. In the questionnaire study, most children strongly agreed that the GIF pain scale is easier to understand than WBFPRS. CONCLUSION: The GIF pain scale is a very promising self-report pain assessment tool for children. Further research on improving the GIF pain scale is very important. CLINICAL SIGNIFICANCE: The newly devised GIF pain scale seems to be a very promising self-report pain scale for effective determination of pain experienced by the patient.

Antimicrobial Effect of Ozone Therapy in Deep Dentinal Carious Lesion: A Systematic Review.

Aim: This systematic review aimed to answer the following focused question: Is ozone therapy more effective in reducing microbial count as compared to conventional methods in deep dentinal carious lesion? Objective: The purpose of this systematic review was to perform a review on the effectiveness of ozone therapy in reduction of microbial count in deep dentinal carious lesion. Study eligibility criteria, participants, and interventions: The inclusion criteria comprised studies that compared effect on microbial count in deep dentinal carious lesion after treatments with ozone and other disinfectants in primary or permanent teeth in randomized clinical trials. Materials and methods: This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRIMSA) guidelines. The searched databases included Medline (via PubMed), Cochrane, and Google scholar. Articles published until 29 February 2020 without year restriction but only in English language were included. Results: The search resulted in 359 published studies. After removal of duplicate studies and full-text analysis, seven studies were selected. Overall, the results demonstrated the promising effects of ozone therapy in reduction of microbial count as compared to other disinfectant. Conclusions: Within the limitations of this review, it can be asserted that the ozone therapy is effective in reduction of microbial count in deep dentinal carious lesion. Clinical significance: Ozone therapy can be a useful tool to reduce the microorganisms in deep dentinal carious lesion. How to cite this article: Badhe H, Kalaskar R, Balasubramanian S, et al. Antimicrobial Effect of Ozone Therapy in Deep Dentinal Carious Lesion: A Systematic Review. Int J Clin Pediatr Dent 2022;15(S-2):S252-S260.

Comparative Evaluation of Ozonoid Olive Oil and Calcium Hydroxide as an Indirect Pulp Capping Agent in Primary Mandibular Second Molar: A Randomized Controlled Trial.

AIM: The aim of this study was to evaluate clinical and radiographical success of ozonoid olive oil as an indirect pulp capping (IPC) agent in primary mandibular second molar when compared to calcium hydroxide and to evaluate the antimicrobial efficacy of ozonoid olive oil on Streptococcus mutans and Lactobacilli. MATERIALS AND METHODS: A split-mouth randomized controlled trial was conducted on 30 primary mandibular second molars in 15 children of age 5-9 years with deep dentinal carious lesion. Teeth were randomly allocated to two groups of 15 each. After achieving local anesthesia and rubber dam isolation, an IPC procedure was performed using ozonoid olive oil in group I and calcium hydroxide in group II. Teeth were evaluated clinically and radiographically at 6 and 12 months of follow-up for success or failure of IPC. The bacterial counts of S. mutans and Lactobacilli were measured before and after application of ozonoid olive oil for 60 seconds on dentinal tissue in group I and recorded as colony-forming units per mL (CFU/mL). RESULTS: There were no statistically significant differences found between the materials used for IPC (p >0.05). About 93.33% and 100% clinical and radiographical success rates were seen in group I and group II, respectively. Statistically significant differences were observed for bacterial reduction after the application of ozonoid olive oil (p <0.05) for both the microorganisms. CONCLUSION: The results of this study showed that the success of IPC is independent of capping material. Ozonoid olive oil, an antimicrobial agent, can also be used for IPC. The success of the IPC procedure depends on a reduction in the bacterial count and sealing of the tooth with hermetic restoration. More clinical studies with a larger sample size and longer follow-up duration are required for understanding the efficacy of this material. CLINICAL SIGNIFICANCE: Ozonoid olive oil can be used as an IPC agent in primary molars and also for a bacterial reduction in dentinal caries.

Correlation and comparative evaluation of nasal index and nasal cavity volume in nasal and mouth breathers: A preliminary cone-beam computed tomographic study.

Introduction: Mouth breathing is one of the most deleterious oral habits with a prevalence of 4%-6% among children. Due to the wide range of comorbidities associated with mouth breathing, early diagnosis and prompt treatment is indispensable. At present, there are very few objective methods available for the diagnosis of mouth breathing. The present study was planned to evaluate a possible correlation between nasal index (NI) and nasal cavity volume (NCV) among nasal and mouth breathers (MB). In addition, the average NCV of nasal and MB was also computed. The foresight of this research was to establish the significance of NI as an objective diagnostic tool for mouth breathing. Methods: This cross-sectional study was conducted among 8-11-year-old children. The NI was determined using a digital Vernier caliper and NCV was calculated using dolphin imaging. Results: There was a significant difference in NCV and nasal width (NW) in both groups, but no difference was seen in nasal height and NI. There was no statistically significant correlation between NCV and other parameters in both groups. Conclusion: The present study was a baseline analysis in this line. Even though this study did not reveal any significant correlation between both parameters, future studies are recommended to explore a plausible correlation.

Rapid Maxillary Expansion and Upper Airway Volume: Systematic Review and Meta-analysis on the Role of Rapid Maxillary Expansion in Mouth Breathing.

Objective: Rapid maxillary expansion (RME) has been extensively used in orthodontic practice for over a century, and it is claimed to benefit upper airway morphology. However, its effect in actually alleviating mouth breathing has remained unexplored. This systematic review was planned with an objective to provide a comprehensive synthesis of the effects of RME on upper airway volume and most importantly, its role in alleviating mouth breathing. Methods: A literature search of electronic databases were done for the time period of 2000-2018. Randomized controlled trials (RCTs) and non-RCTs conducted on 8-15-year-old children who received bonded or banded RME and upper airway measured using three-dimensional (3D) imaging were included. Results: Twelve studies (two RCTs, nine nonrandomized clinical trials, and one non-RCT) were included in this systematic review, and nine studies were included for meta-analysis. Among the evaluated parameters, nasal cavity volume showed a significant increase which was maintained even after the retention phase, whereas nasopharyngeal and oropharyngeal volume did not report a significant change. Conclusion: Based on this systematic review, it can be concluded that RME causes a significant increase in nasal cavity volume, but its effect on nasopharyngeal and oropharyngeal volume is not statistically significant in majority of studies. This increase in volume may not be considered as an equivalent for enhancement of airway and function unless proven so. In order to establish its significance in the improvement of breathing, it is necessary to conduct more well-designed RCTs with samples actually comprising mouth breathers. How to cite this article: Balasubramanian S, Kalaskar R, Kalaskar A. Rapid Maxillary Expansion and Upper Airway Volume: Systematic Review and Meta-analysis on the Role of Rapid Maxillary Expansion in Mouth Breathing. Int J Clin Pediatr Dent 2022;15(5):617-630.

Comparative evaluation of nasal and alveolar changes in complete unilateral cleft lip and palate patients using intraoral and extraoral nasoalveolar molding techniques: randomized controlled trial.

OBJECTIVES: Cleft lip and palate is a common congenital anomaly that impairs the aesthetics, speech, hearing, and psychological and social life of an individual. To achieve good aesthetic outcomes, presurgical nasoalveolar molding (NAM) has become important. Currently, the intraoral NAM technique is widely practiced. Numerous modifications have been made to intraoral NAM techniques, but the original problem of compliance leading to discontinuation of treatment remains unsolved. Therefore, the present study compared an extraoral NAM technique with the intraoral NAM technique. MATERIALS AND METHODS: Twenty infants with complete unilateral cleft lip and palate were included and divided into two equal groups. Group A received the intraoral NAM technique, and Group B received the extraoral NAM technique. Pre- and postoperative extraoral and intraoral measurements were recorded. RESULTS: Groups A and B did not differ significantly in any extraoral or intraoral parameter. CONCLUSION: The extraoral NAM technique is as effective as the intraoral NAM technique in achieving significant nasal and alveolar changes in com-plete unilateral cleft lip and palate patients. Additionally, it reduces the need for frequent hospital visits for activation and the stress associated with the insertion and removal of the intraoral NAM plate, thereby improving compliance.

Evaluation of the Average Nasal and Nasopharyngeal Volume in 10-13-year-old Children: A Preliminary CBCT Study.

AIM AND OBJECTIVE: Mouth breathing is one of the most common deleterious habits prevalent in children which leads to various skeletal and dental malocclusions. Due to the close relationship between nasal and nasopharyngeal cavity volume and maxilla, transverse maxillary deficiency causes reduced nasal and nasopharyngeal cavity volume leading to mouth breathing. Therefore, knowledge of average nasal and nasopharyngeal cavity volume is essential to accurately diagnose mouth breathing and to evaluate underlying causative factors. MATERIALS AND METHODS: Cone-beam computed tomographic scans of 60 children were taken and nasal cavity and nasopharyngeal volumes were calculated using Planmeca Romexis 5.2.0.R software. Average volumes were computed using predetermined landmarks and compared among gender. RESULTS: The nasal cavity and nasopharyngeal volume showed significant differences among the gender (p value < 0.001 and 0.018, respectively). CONCLUSION AND CLINICAL SIGNIFICANCE: Knowledge of the average nasal and nasopharyngeal cavity volumes can be a useful diagnostic aid for mouth breathing patients and also assess the causative factors and treatment outcomes in these patients. HOW TO CITE THIS ARTICLE: Kalaskar R, Balasubramanian S, Kalaskar A. Evaluation of the Average Nasal and Nasopharyngeal Volume in 10-13-year-old Children: A Preliminary CBCT Study. Int J Clin Pediatr Dent 2021;14(2):187-191.

Effectiveness of the novel impression tray "cleftray" for infants with cleft lip and palate: a randomized controlled clinical trial.

OBJECTIVES: Cleft lip and palate (CLP) is one of the most common congenital deformities with worldwide prevalence. It causes a range of issues for infants that mainly involve difficulty in feeding due to abnormal oronasal communication. For this purpose, feeding plates are provided to infants to act as an artificial palate to aid in feeding. The most crucial procedure in fabrication of a feeding plate is creation of the impression using the traditional finger technique or impression trays. This preliminary research aims to compare the effectiveness of novel impression trays with that of the traditional finger technique for recording impressions of infants with CLP. MATERIALS AND METHODS: This randomized controlled trial was conducted among 30 infants who were divided into two groups based on the method of obtaining impressions: Group I, finger technique; Group II, specialized acrylic tray (cleftray). RESULTS: Use of cleftray required less impression time, a reduced amount of material, no incidence of cyanosis/choking in infants, and lower anxiety among doctors compared to the traditional method. Additionally, there was no distortion of cleft impressions, recorded maxillary tuberosity, or other fine details. Therefore, the novel impression tray (cleftray) exhibited superior outcomes in all the parameters compared to the finger technique. CONCLUSION: Within the limitations of this study, we conclude that impression trays are superior to the traditional finger, spoon, or ice cream stick methods of creating impressions of CLP. However, it is necessary to conduct more clinical trials on a larger population based on other parameters to compare the effectiveness of the two techniques to draw definitive conclusions.

Evaluation of the average pulp cavity volume of primary second molar and canine for obturation of a single primary tooth: A preliminary cone-beam computed tomographic study.

OBJECTIVE: Metapex/Vitapex is one of the most commonly used obturating materials in pediatric dental practice in recent times. It is available in a premixed syringe which poses numerous practical difficulties. This study aimed to calculate the root canal volume of maxillary and mandibular canine and second molar using cone-beam computed tomography (CBCT) to determine the quantity/grams of obturation material to obturate a single tooth (mass = density × volume). MATERIALS AND METHOD: This nonrandomized clinical trial is comprised of two parts. The first part involved calculation of average root canal volume using CBCT which was used to calculate the quantity/grams of obturating material. This predetermined quantity was used to obturate primary mandibular second molars and canines, and the quality of obturation was assessed. RESULTS: Assessment of quality of obturation showed optimum length obturation in 53.33% primary second molars and 66.66% primary canines. CONCLUSION: It can be inferred that even with the use of exact predetermined quantity/grams of obturating material, optimum quality obturation could be achieved, thus avoiding wastage, preventing cross contamination, and simultaneously offering good clinical results. Hence, this study opens further gateways to device ampules containing predetermined mass of obturating material for a single use for obturation of a single primary tooth.

Clinical Effectiveness of Fiber-reinforced Composite Space Maintainer and Band and Loop Space Maintainer in a Pediatric Patient: A Systematic Review and Meta-analysis.

BACKGROUND: Objectives: This systematic review aimed to evaluate the clinical effectiveness of fiber-reinforced composite space maintainer (FRCSM) and band and loop space maintainer (BLSM) in a pediatric patient. MATERIALS AND METHODS: Eligibility criteria: Randomized controlled trials (RCTs) were conducted on 3-12-year-old children who received FRCSM and BLSM. Information sources: Literature search of electronic databases such as PubMed, Cochrane, and Google Scholar for the time period of 2000 to October 2020. Risk of bias: Cochrane collaboration's risk of bias tool was used to assess the risk of bias. RESULTS: Included studies: The search resulted in 147 published studies. After the removal of duplicate studies and full-text analysis, eight studies were selected. Synthesis of results: Fiber-reinforced composite restoration (FRCSM) was judged to be good for short-term space maintenance with good esthetics, less time-consuming, and good patient and parental acceptance. Meta-analysis was done for failure rate at 6 months and 12 months. After 6 months, the FRCSM group showed less failure, with a risk ratio of 0.83 (95% CI = 0.47-1.49; Z value = 0.61). However, after 12 months, the FRCSM group showed more failure, with a risk ratio of 1.30 (95% CI = 0.04-4.23; Z value = 0.44). Description of the effect: FRCSM performed better than BLSM for a short-term, i.e., around 6 months but after 12 months of space maintainer placement BLSM performed better than the FRCSM. DISCUSSION: Strengths and limitations of evidence: The strength of this systematic review is its complete adherence to the PRISMA statement 2009. This review attempted to evaluate the effectiveness of FRCSM when compared with BLSM which has not been evaluated before. Additionally, only RCTs were included in this review adding to its validity. This review also included a meta-analysis that compared the failure rate at the 6th and 12th month. The main shortcoming of this systematic review is the limited number of databases searched and the limited number of existing studies. Interpretation: Within the limitations of this review, it can be stated that the FRCSM is an effective space maintainer for short-term space maintenance. However, it is necessary to conduct more RCTs with larger sample size, preferably using a split-mouth design to improve the longevity of FRCSM. Additionally, it is also necessary to standardize the technique of fabrication of FRCSM since an existing study showed high heterogeneity in the technique of fabrication. OTHER: Funding: None. Registration: The protocol of this systematic review was registered on PROSPERO (ID-CRD42020165831). HOW TO CITE THIS ARTICLE: Kamki H, Kalaskar R, Balasubramanian S, et al. Clinical Effectiveness of fiber-reinforced Composite Space Maintainer and Band and Loop Space Maintainer in a Pediatric Patient: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2021;14(S-1):S82-S93.

Comparative Evaluation of Bond Strength of Different Luting Cements for Cementation of Stainless Steel Bands on Primary Molar Crowns (Stainless Steel and Zirconia Crowns): An In Vitro Study.

AIM AND BACKGROUND: Primary teeth are the valuable assets of a child. Apart from the obvious function of delivering esthetics, their most important function is space maintenance for the succeeding permanent teeth. At times, due to unavoidable pathological conditions, there is premature loss of primary teeth. Space maintainers can either be banded to the enamel surfaces of healthy adjacent teeth or to the surfaces of full coronal restorations, the most common ones being stainless steel crowns (SSCs) and zirconia crowns (ZCs). Due to esthetic demands, ZCs have started replacing SSCs and therefore, there needs to be data on the banding of space maintainers on ZCs and the bond strengths obtained on cementations. Thus, the present study planned to evaluate and compare the bond strengths obtained by the banding of stainless steel bands (SSBs) over SSCs and ZCs using type I glass ionomer cement (GIC) and self-adhesive resins. MATERIALS AND METHODS: Sixty primary right mandibular molars were divided into four groups, group I, with cementation of SSB on SSC with type I GIC; group II, with cementation of SSB on SSC with self-adhesive resin cement; group III, with cementation of SSB on ZC with type I GIC; and group IV, with cementation of SSB on ZC with self-adhesive resin cement. RESULTS: The mean bond strength value of GIC as luting cements in group I is 1.13 ± 0.075 MPa. The mean bond strength value of self-adhesive resin as luting cements in group II is 1.70 ± 0.104 MPa. The mean bond strength value of GIC as luting cements in group III is 1.38 ± 0.100 MPa. The mean bond strength value of self-adhesive resin as luting cements in group IV is 2.06 ± 0.119 MPa. CONCLUSION: The bond strength of self-adhesive resin was higher when SSB was cemented over SSC when compared with the bond strength of GIC when SSB was cemented over ZC. HOW TO CITE THIS ARTICLE: Kalaskar R, Ijalkar R, Kalaskar A, et al. Comparative Evaluation of Bond Strength of Different Luting Cements for Cementation of Stainless Steel Bands on Primary Molar Crowns (Stainless Steel and Zirconia Crowns): An In Vitro Study. Int J Clin Pediatr Dent 2021;14(6):762-767.