The use of laser photobiomodulation as pre-anesthetic tissue management technique in reducing injection pain in children.

BACKGROUND: One of the main goals for pediatric dentists is to offer a painless anesthesia experience. Laser photobiomodulation is among the suggested strategies to decrease injection pain. So, this study aimed to assess the impact of laser photobiomodulation on local anesthesia (LA) injection pain in children and its effect on the efficacy of LA during pulpotomy and SSC procedures. METHODS: The research was carried out as a randomized controlled clinical trial with two parallel group design. It involved 64 cooperative healthy children, age range from 5 to 7 years, each having at least one maxillary molar indicated for pulpotomy. Children were randomly allocated to one of the two groups based on the pre-anesthetic tissue management technique used: test group received laser photobiomodulation, while control group received topical anesthetic gel. Pain during injection, pulpotomy, and SSC procedures was assessed using physiological measures (Heart Rate (HR)), subjective evaluation (modified Face-Pain-Scale (FPS), and objective analysis (Sound-Eye-Motor scale (SEM)). RESULTS: A total of 64 children with mean age 6.23 ± 0.78 participated in this research. The mean HR scores were significantly lower in the laser PBM group during buccal and palatal infiltration injections. The SEM mean scores were significantly lower in the laser PBM group during both injections. For the FPS scale, the number of children who recorded satisfaction during injection was significantly higher in laser PBM group. There was no statistically significant difference in mean HR as well as in SEM and FPS scores between the two groups during pulpotomy and SSC procedures. Comparisons between the two study groups were performed using independent samples t- and Mann-Whitney U tests. Significance was set at p value < 0.05. CONCLUSION: Laser photobiomodulation is a promising non-pharmacological pre-anesthetic tissue management technique in children that offered less painful injection compared to topical anesthetic gel without compromising the effectiveness of LA. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05861154. Registered on 16/5/2023.

Computer-controlled Intraligamentary local anaesthesia in extraction of mandibular primary molars: randomised controlled clinical trial.

BACKGROUND: Local anesthesia (LA) poses a threat in children more than the treatment process itself, so pediatric dentists are always demanding less painful techniques. Computer-controlled Intraligamentary anaesthesia (CC-ILA) is designed to reduce injection pain and side effects of conventional techniques. The present study aims to assess the pain experience using Computer-controlled Intraligamentary anaesthesia (CC-ILA) during injection and its effectiveness in controlling pain during extraction of mandibular primary molars in pediatric patients. METHODS: This randomized controlled clinical trial includes 50 healthy cooperative children, aged 5-7 years with mandibular primary molars indicated for extraction. They were randomly allocated to two groups according to LA technique: test group received CC-ILA and control group received Inferior alveolar nerve block (IANB). Pain was measured during injection and extraction: physiologically using Heart rate (HR), subjectively using Face-Pain-Scale (FPS), and objectively using Sound-Eye-Motor scale (SEM). Patients were recalled after 24-h to record lip-biting events. Data was collected and statistically analysed. RESULTS: A total of 50 children (29 females and 21 males) with mean age 6.10 ± 0.76 participated in the study. There were significantly lower scores in the heart rate in the CC-ILA group during injection (p = 0.04), but no significant difference was recorded between the two groups during extraction (p = 0.17). The SEM and FPS showed significant lower scores in the CC-ILA group during injection (p < 0.0001, p < 0.0001) and extraction (p < 0.0001, p = 0.01) respectively. No children in CC-ILA group reported lip-biting after 24-h compared to 32% in IANB (p < 0.0001). CONCLUSION: CC-ILA provides significantly less painful injections than conventional techniques and has proved to be as effective as IANB during extraction of mandibular primary molars. An important advantage of this technique was the complete absence of any lip/cheek biting events. Trial registration The study was prospectively registered in ClinicalTrials.gov with the identifier: NCT04739735 on 26th of January 2021, https://clinicaltrials.gov/ct2/show/NCT04739735 .

Fiberglass crowns versus preformed metal crowns in pulpotomized primary molars: a randomized controlled clinical trial.

OBJECTIVE: To evaluate the clinical performance of the fiberglass "Figaro" crowns compared to preformed metal crowns (PMCs) in pulpotomized primary molars in children. METHOD AND MATERIALS: This split-mouth controlled randomized clinical study was performed on ten childrens, aged from 4 to 6 years, who needed complete oral rehabilitation under general anesthesia and had one pair or two pairs of their primary molars requiring pulpotomy. After pulp therapy, the teeth were randomly assigned to Figaro or PMC crown groups. Modified United States Public Health Service (USPHS) criteria were used to evaluate crown retention, marginal integration, crown discoloration, secondary caries, and gingival status, at 3 and 6 months. The data were analyzed using the chi-square test with Monte Carlo (MC) correction and McNemar (McN) test at a significance level of .05. RESULTS: Ten patients (three boys, 30%; seven girls, 70%) with a mean age of 4.65 ± 0.709 years participated in this study. At 3 months follow-up, there was no significant difference between the groups, but at 6 months follow-up, Figaro crowns showed significant changes from intact crown to either chipped or large loss, whereas all PMCs were found intact (χ2 = 14.545, P[MC] = 0.000). There was also significant deterioration in Figaro crowns' color after 6 months (χ2[McN] = 8.1, P = .004). CONCLUSION: PMCs were more durable than Figaro crowns, which showed significant deterioration after the 6-month follow-up period.