A Retrospective Investigation of Patient- and Procedure-Related Factors Associated with Cardiorespiratory Complications in Pediatric Dental Patients Undergoing Deep Sedation.

Purpose: The purposes of this retrospective study were to investigate the incidence of cardiac and respiratory complications in pediatric patients undergoing dental procedures with deep propofol sedation and examine the factors that may lead to the development of these complica- tions. Methods: This study was carried out using the records of 421 pediatric patients who received dental treatment with deep sedation. Previously recorded cardiac/respiratory complications were noted. In addition, factors such as age, gender, body mass index (BMI), propofol induction/ infusion/total dose, operation duration, and the presence of comorbidities, which were investigated whether they affect these complications, were also noted. Data were analyzed with Mann-Whitney U, chi-square, and Fisher exact tests using univariable and multivariable logistic regression analyses. A level of five percent was considered to indicate statistical significance. Results: There were no significant differences between the cases with and without complications in terms of gender, age, BMI, total propofol dose, and operation time (P=0.887, P=0.827, P=0.213, P=0.581, and P=0.081, respectively). According to the multivariable logistic regression analysis, trisomy 21, heart disease, and asthma were found to be significant risk factors for the development of these complications (odds ratios equal 9.776, 3.257, and 14.646, respectively, 95 percent confidence interval; 3.807-25.100, 1.095-9.690, 4.110-52.188, respectively). Conclusion: Considering the limitations of this study, to minimize cardio-respiratory complications it is recommended that patients with comorbidities should not be managed with deep sedation and an open airway.

The assessment of internal adaptation and fracture resistance of glass ionomer and resin-based restorative materials applied after different caries removal techniques in primary teeth: an in-vitro study.

Background: The aim of this study was to evaluate the 3-dimensional (3D) internal adaptation (IA) and fracture resistance (FR) of compomer and glass ionomers applied after conventional caries removal to sound dentin (CCRSD) and selective caries removal to firm dentin (SCRFD) in in-vitro. Methods: Thirty extracted primary molars were randomly assigned to three main groups (n = 10) as glass hybrid restorative (GHR) (Equia Forte® HT), conventional glass ionomer (CGIR) (Voco Ionofil Molar) and compomer (Dyract XP). Each group was randomly divided into two subgroups according to caries removal technique as CCRSD (n = 5) and SCRFD (n = 5). The restoration procedures were completed after caries removal (CCRSD or SCRFD) in all samples. Then, specimens were subjected to IA and FR tests. Data were analyzed with Student's t, one-way ANOVA, and Kruskal Wallis-H tests. The correlation between IA and FR results was analyzed with a Pearson test. The statistical significance level was considered as 5%. Results: While CCRSD showed superior IA results than SCRFD for all restorative materials (p < 0.05), no statistical difference was found between CCRSD and SCRFD in FR assessment (p > 0.05). In CCRSD, compomer showed superior results for IA and FR than glass ionomers (p < 0.05). In SCRFD, it was found no significant difference between the restoratives for IA (p > 0.05). However, compomer showed superior FR results than glass ionomers (p < 0.05). There was moderate negative correlation between internal voids and FR without statistically significant difference (r = -0.333, p = 0.072). Conclusions: Despite the advantages of SCRFD, it was found to be less superior than CCRSD in IA assessment. Therefore, when SCRFD is preferred, a peripheral seal should be provided for ideal restorative treatment. On the other hand, compomer mostly showed superior results compared to others.

Smear layer removal efficacy of irrigating solutions applied distinct needle designs: a scanning electron microscopy study.

This research aimed to assess the efficacy of different irrigants applied with different types of needle tips on smear layer removal (SLR) in primary incisors. This study was carried out with 35 freshly extracted upper primary incisors. The samples were randomly distributed to five study groups (n = 7) (1 to 4: experimental, 5: control). These included Group 1: 5% Ethylenediaminetetraacetic Acid (EDTA) + 1% Sodium Hypochlorite (NaOCl) applied with open-ended needle (OEN), Group 2: 6% Citric Acid (CA) + 1% NaOCl applied with OEN, Group 3: 5% EDTA + 1% NaOCl applied with double side-vented needle (DSVN), Group 4: 6% CA + 1% NaOCl applied with DSVN and Group 5: 1% NaOCl applied with OEN. Accordingly, the inner root surfaces were examined using scanning electron microscopy (SEM). The differences between the groups were analyzed using Kruskal-Wallis, Friedman and Siegel-Castellan tests (p < 0.05). In the coronal third, all the experimental groups (groups 1, 2, 3 and 4) were superior to the control group (p = 0.002, p = 0.002, p < 0.001 and p < 0.001, respectively). Groups 2, 3 and 4 showed superior SLR to the control group (p = 0.024, p = 0.001 and p = 0.004, respectively) in the middle third. DSVN groups of EDTA and CA showed superior SLR efficacy than the control (p < 0.001 and p = 0.002, respectively) in the apical third. The SLR efficacy was higher in the coronal third compared to the apical third in the experimental groups (groups 1, 2, 3 and 4) (p = 0.015, p = 0.048, p = 0.048 and p = 0.048, respectively). In addition, 3 samples of EDTA showed erosion (2 in the coronal with OEN, 1 in the middle with DSVN). It was possible to conclude that the SLR efficacy of DSVNs and OENs was similar. CA could be recommended since it did not cause erosive damage compared to EDTA in primary incisors.

Effects of Root Maturation and Thickness Variation in Coronal Mineral Trioxide Aggregate Plugs Under Traumatic Load on Stress Distribution in Regenerative Endodontic Procedures: A 3-dimensional Finite Element Analysis Study.

INTRODUCTION: Regenerative endodontic procedures (REPs) are the best biological-based treatment choice for managing necrotic immature permanent teeth. This study aimed to evaluate the stress distribution of immature maxillary permanent incisors and periodontal tissues under a traumatic load after root maturation achieved by REP with thickness variation in coronal mineral trioxide aggregate (MTA) plugs. METHODS: Five different mathematical 3-dimensional finite element analysis models of an immature permanent maxillary incisor were created. These involved immediate postoperative models after REP with varying coronal MTA plug thickness (model 1: 3-mm MTA and model 2: 5-mm MTA), postoperative models after REP with varying coronal MTA plug thickness with 15% volumetric root maturation (model 3: 3-mm MTA and model 4: 5-mm MTA), and a control model (model 5: a mature, healthy maxillary incisor). After the modeling procedures, a traumatic horizontal force load of 400 N was applied, and 3-dimensional finite element analysis was performed. The minimum principal, maximum principal, and von Mises stress criteria were calculated for evaluation. RESULTS: Regardless of the coronal MTA plug thickness, tensile stress in cervical root surfaces decreased with root maturation after REP. Using the 5-mm MTA plug reduced all types of stress in the middle third of the root. In bone tissue, the difference in MTA thickness did not affect stress values. However, stress decreased in most of the bony surfaces with root maturation after REP. CONCLUSIONS: Using the 5-mm coronal MTA plug may help in providing biomechanical advantages regarding stress transmission. Also, because root maturation after REP provided a more favorable stress distribution as mentioned, regenerative treatments can be recommended for immature permanent maxillary incisors for a good prognosis.

The effects of various irrigation protocols on root canal wall adaptation and apical microleakage in primary teeth.

Objective: The objective of this study is to evaluate the wall adaptation and apical microleakage values following the application of various irrigation protocols in primary teeth.Material and methods: For the two parts of the study, extracted upper incisor primary teeth were randomly included to the 1% sodium hypochlorite (NaOCl), 10% ethylenediaminetetraacetic acid (EDTA)+1% NaOCl, 6% citric acid (CA)+1% NaOCl and 0.9% physiological saline (PS) groups. Canal wall adaptation and apical microleakage were assessed by scanning electron microscopy (SEM) and stereomicroscope, respectively.Results: 6% CA + 1% NaOCl group was found to be the most successful irrigation protocol in providing strong canal wall adaptation and less apical microleakage, followed by 10% EDTA +1% NaOCl. 6% CA +1% NaOCl was significantly superior regarding apical microleakage (p < .05).Conclusions: Due to the ability to provide appropriate changes in the root canal walls to make a well-adapted and leak-proof canal filling, 6% CA + 1% NaOCl can be recommended as an irrigation protocol in primary teeth.

The effect of different irrigation protocols on smear layer removal in root canals of primary teeth: a SEM study.

OBJECTIVE: The purpose of this study was to compare the efficacy of different irrigation protocols on smear layer removal in root canals of primary teeth by scanning electron microscopy (SEM). MATERIAL AND METHODS: The study was conducted with 40 extracted maxillary primary incisor teeth divided into four groups (n = 10) as 1% sodium hypochlorite (NaOCl), 10% ethylenediaminetetraacetic acid (EDTA)+1% NaOCl, 6% citric acid (CA)+1% NaOCl, and 0.9% physiological saline (PS). After the irrigation procedures, root canal walls were examined by SEM and the efficacies of irrigation solutions in smear layer removal were scored and compared. Data were analyzed using Kruskal-Wallis, Friedman and Siegel Castellan tests. RESULTS: The smear layer removal was found to be statistically more effective in groups of 10% EDTA + 1% NaOCl and 6% CA + 1% NaOCl when compared with the other groups (p < .05). Smear removal efficacy was statistically significantly higher in coronal and medium thirds when compared with the apical regions in the experimental groups. CONCLUSIONS: It was concluded that 10% EDTA + 1% NaOCl and 6% CA + 1% NaOCl could be alternative irrigation protocols regarding smear layer removal. However, due to the absence of erosive dentinal changes, it might be suggested that using 6% CA + 1% NaOCl can be recommended compared to 10% EDTA + 1% NaOCl in primary root canals.

Are Increased Masticatory Forces Risk for Primary 2nd Molars without Successors? A 3D FEA Study.

OBJECTIVE: Persistent primary teeth with healthy crown-root structures and acceptable functional and esthetic properties may be preserved over a long-term period if needed. However, they may experience root resorption, ankylosis or infraocclusion especially in the second or third decades of life. Despite a lack of sufficient detailed data, increases in occlusal forces by age are known to cause destructive stresses on root surfaces and periodontal tissue. The aim of this study was to evaluate the effect of increasing occlusal forces on mandibular persistent primary molars by using 3D finite element analysis. STUDY DESIGN: The impact of increased masticatory forces on compressive and tensile stresses in tooth and surrounding tissue was simulated in two different models (simulating child and adult mouths) by using 3D finite element analysis. RESULTS: In both models, the stress values increased by age and compressive stresses were seen on internal root surfaces, while the tensile stresses focused on the furcation area and external root surfaces. CONCLUSION: It was concluded that practices such as reducing occlusal surface width may be used to diminish the occlusal forces for long-term tooth survival in persistent primary molars.

Resin Nanoceramic CAD/CAM Restoration of the Primary Molar: 3-Year Follow-Up Study.

This case report presents the clinical use of a resin nanoceramic CAD/CAM restoration of a primary second molar without successor in the form of a permanent second premolar tooth in a patient. Three-year follow-up of the case revealed that resin nanoceramic CAD/CAM restoration of the primary molar without successor achieved both aesthetics and function. Despite the high cost of treatment, this type of restoration should be considered if the retained tooth is expected to maintain functionality over the long term.