Impact of Pericervical Dentin on Fracture Resistance of Endodontically Treated Posterior Permanent Teeth: A Systematic Review and Meta-analysis.

OBJECTIVE: The main aim of this present systematic review is to evaluate if the preservation of pericervical dentin (PCD) increases the fracture resistance of endodontically treated permanent posterior teeth. MATERIALS AND METHODS: Two independent reviewers conducted a comprehensive review of all published studies from 2007 (1/1/2007) to 2023 (31/5/23) since the concept of PCD first appeared in the literature in 2007. Searches were conducted in multiple electronic database engines: PubMed, Scopus, EBSCO (Dentistry and oral health sciences), Web of Sciences (WOS), Cochrane, Google Scholar and Open Grey, Ovid and Shodhganga, in addition to cross-references and hand search. Articles were chosen according to a certain inclusion and exclusion criteria, which, in brief, are laboratory-based studies published in English that assess the impact of PCD on fracture resistance of endodontically treated permanent posterior teeth. Using domains, such as sample size, sample dimensions, and control group as quality assessment criteria, evaluated the selected articles and classified them according to their risk of bias into low, moderate, and high. A meta-analysis was conducted using random effects modeling at a significance level of p < 0.05. RESULTS: A total of studies 6,043 were retrieved from 10 different electronic search databases and hand searches, but only 12 laboratory-based studies were selected after removing duplicates and applying the eligibility criteria. Of the included 12 studies, nine studies showed low risk of bias and three studies showed moderate risk of bias. Two studies showed related data for meta-analysis, the difference observed between the two studies is statistically non-significant. CONCLUSION: Based on the results of the study, there is evidence to support that PCD preservation offers fracture resistance to the endodontically treated posterior teeth. CLINICAL SIGNIFICANCE: The practice of conservative cavity preparation and avoiding the usage of instruments with high taper increases the fracture resistance of the tooth by retaining the PCD. How to cite this article: Haridoss S, Rajendran M, Swaminathan K, et al. Impact of Pericervical Dentin on Fracture Resistance of Endodontically Treated Posterior Permanent Teeth: A Systematic Review and Meta-analysis. J Contemp Dent Pract 2024;25(4):372-385.

Bleaching techniques in primary teeth: a systematic review.

OBJECTIVE: Discolouration of primary teeth, often attributed to trauma and pulpal infection, is a prevalent concern that can significantly impact the esthetics and self-esteem of children. To address this issue, bleaching techniques have emerged as a viable treatment option. This systematic review aims to provide a comprehensive summary of the effectiveness of bleaching agents in managing discoloured primary teeth. METHODS: Two reviewers independently conducted an electronic database search using PubMed, EMBASE, LILACS, CINAHL via EBSCO, Scopus, and Web of Science until September 26,2023. In vitro studies and case reports that assessed the quantifiable success were included. The present review utilized Distiller SR software for data extraction. The protocol of this study was registered in PROSPERO (International Prospective Register of Systematic Reviews) (CRD42022329831). The quality of studies was analysed with Cochrane tool and the JBI checklist. RESULTS: The search retrieved 1845 references of which 14 studies were included for qualitative analysis. There were 8 in vitro studies and 6 case reports included in this systematic review. There were 299 teeth samples in the in vitro studies and 18 teeth were assessed in the case reports. All the 18 teeth (6 case reports) showed considerable shade improvement within 7-14 days. However, only 3 teeth were followed up for a period of 12-24 months. Substantial shade improvement was also observed in samples in the in vitro studies. CONCLUSION: This systematic review has comprehensively examined the various bleaching agents and methods for the management of discoloured primary teeth. However, it is crucial to recognize that the available evidence is from case reports and is insufficient to make a clinical recommendation.

Comparison of conventional preparation with modified access preparation on fracture resistance of primary molars - A finite element analysis.

Objective: To investigate the influence of Conventional Straight (CS) line and Modified Straight (MS) line access preparations with various restorative materials on the fracture resistance of primary molars using Finite Element Analysis (FEA). Methodology: Three FEA models for each of the primary molars were divided into Group I- Intact tooth model; Group II- Model with CS outline and Group III- Model with MS outline. Based on the restorative material used, Group II and III were further subdivided into subgroup 1- GIC restoration, subgroup 2 - composite resin with GIC base and subgroup 3- Stainless Steel Crown (SSC). Each model was subjected to 5 different force loads directed at the occlusal surface. Maximal von Mises (VM) stresses calculated from stress distribution patterns. Result: The maximum displacement, in all the models of primary molars were seen in GIC restored models in molars with both CS and MS access whereas the minimal displacement was seen in the SSC restored molars of MS group. Conclusion: In primary maxillary second molar and mandibular first and second molar with intact marginal ridges, the fracture resistance of tooth with MS outline restored with GIC base followed by Composite resin was comparable with the tooth restored with SSC and CS outline. Clinical outcome: Based on the results of this FEA analysis, composite restorations with MS outline would be appropriate for endodontically treated primary molars that have intact margins.

Mechanical Properties and Clinical Success of Intracanal Posts in Primary Maxillary Anterior Teeth: A Systematic Review and Meta-analysis.

Background: Intracanal posts are commonly used to restore lost permanent/primary tooth structure and the smile of the patient. Aim: This systematic review aims to evaluate the clinical success of intracanal posts used in primary maxillary anterior teeth and compare their mechanical properties. Methods: An extensive literature search was performed using Medline via PubMed, Embase via embase.com, LILACS, CINAHL via EBSCO, Cochrane Oral Health Group Specialized Register, Scopus, and Web of Science until December 2021 and was updated till December 2022. In vivo and in vitro studies in the English language that assessed clinical success and mechanical properties were included. Distiller SR software was used for everything from title screening to data extraction. Results: A total of 30 studies were analyzed, including 11 in vivo and 19 in vitro studies. Four studies were included in a meta-analysis, and all 30 studies qualified for qualitative analysis. The meta-analysis showed that fiber posts are clinically superior to composite resin posts (CRPs) (p = 0.02). No significant difference was observed between the fracture resistance of CRPs and no posts (p = 0.73). Most of the included studies showed a high risk of bias. Conclusion: Conclusive evidence about the effectiveness of various intracanal posts cannot be established. This is due to the limited number of clinical trials and included studies of low to moderate quality with a high risk of bias. To validate the use of posts in primary maxillary anterior teeth, further research, including randomized controlled trials (RCTs) of higher quality, is required. Clinical significance: The use of intracanal posts in primary teeth is a commonly used treatment modality among pediatric dentists. However, the quality of the evidence to support its use is low. This systematic review provides a comprehensive summary of the current literature and highlights the need for further research. Results were interpreted with caution, as the evidence supporting the use of intracanal posts in primary teeth is limited. How to cite this article: Shanmugam Y, Raghu A, Muthu MS, et al. Mechanical Properties and Clinical Success of Intracanal Posts in Primary Maxillary Anterior Teeth: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2023;16(S-3):S293-S305.

Shaping Properties and Outcomes of Nickel-Titanium Reciprocation Systems in Primary Teeth: A Systematic Review and Meta-Analysis of In Vitro Studies.

The aim of this systematic review was to investigate the shaping properties and outcomes of reciprocating instruments in primary teeth. A search was conducted across various electronic databases such as PubMed, Scopus, EBSCO (dentistry and oral health sciences), LILACS, Cochrane, Google Scholar (first 100 hits), Open Grey, Ovid, and Shodhganga. Two authors independently performed data extraction and quality assessment of the selected articles using Rayyan software. A total of 12 studies were included. All 12 included studies qualified for qualitative analysis and five for meta-analysis. The meta-analysis revealed there was no statistical significance between rotary and reciprocating instruments concerning instrumentation time and canal transportation. The rotary and reciprocating instruments showed better shaping outcomes than hand instruments. Randomized controlled trials are required with adequate quality to perform a meta-analysis to provide better and more substantial evidence to use reciprocating instruments.

Transportation and Centering Ability of Kedo-S Pediatric and Mtwo Instruments in Primary Teeth: A Cone-beam ComputedTomography Study.

Background: Cleaning and debriding the canals and preserving the shape of the canal without deformation is the primary goals of pulpectomy. Transportation is a critical endodontic iatrogenic fault that could cause a catastrophe. This study evaluated the canal centering ability and canal transportation caused by Kedo-S pediatric and Mtwo instruments, using a cone-beam computed tomography (CBCT). Materials and methods: This in vitro study was performed on distal roots of 50 primary mandibular first molars. The teeth were scanned using CBCT and randomly divided into two groups. The canals were then prepared using either Kedo-S or Mtwo files (n = 25). The instrumented canals were rescanned. The scanned volumes were sectioned at 2, 4, and 6 mm from cementoenamel junction (CEJ). Canal transportation (CT) and instrument centering ability were estimated and compared in both groups. Results: The mean values for two study groups were compared. T -test was used to determine theP value. The Levene's test was used to test the significance between two groups. The two groups showed similar results in terms of transportation and centering ability (P > 0.05). Conclusion: Kedo-S pediatric and Mtwo instruments demonstrated similar canal centering ability and CTs. How to cite this article: Haridoss S, Rakkesh KM, Swaminathan K. Transportation and Centering Ability of Kedo-S Pediatric and Mtwo Instruments in Primary Teeth: A Cone-beam Computed Tomography Study. Int J Clin Pediatr Dent 2022;15(S-1):S30-S34.

Computed Tomographic Assessment of Remaining Dentin and Risk of Perforation after Kedo-S and Mtwo Rotary Instrumentation in Root Canals of Primary Teeth: An In Vitro Study.

Background: Root canal cleaning is a key step in the endodontic treatment of the primary molars. An innovative generation of endodontic instruments has been devised with the aim of emerging better procedures. The objective of the study is to assess the preparation of time, the risk of lateral perforation, and the removal of dentin from Kedo-S and Mtwo rotary instruments on primary teeth. Study design: This is an in vitro experimental study comparing the two groups. Materials and methods: A total of 50 extracted mandibular primary first molars are collected, divided randomly into two groups of 25 teeth each. Group I: Kedo-S Pediatric rotary file, Group II: Mtwo rotary file. Distal canal is standardized for evaluation and teeth are sectioned at the CEJ. The teeth were instrumented according to manufacturer's guideline. Both the groups are scanned before and after instrumentation of the canal using cone-beam computed tomography (CBCT) and values are evaluated. Results: Compared with Mtwo files, Kedo-S files need less instrumentation time and limited lateral perforation. No statistical differences were reported between the instrumentation of Kedo-S and Mtwo with regard to the amount of dentin removed. Conclusion: In pediatric endodontics, Kedo-S pediatric rotary file can be considered an effective alternative to traditional rotary files because it requires less instrumentation time and preserves dentin thickness. How to cite this article: Swaminathan K, Rakkesh KM, Haridoss S. Computed Tomographic Assessment of Remaining Dentin and Risk of Perforation after Kedo-S and Mtwo Rotary Instrumentation in Root Canals of Primary Teeth: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(S-1):S87-S91.

Solitary Median Maxillary Central Incisor Syndrome: A Case Report.

Aim: This report intends to present a case of solitary median maxillary central incisor syndrome (SMMCI) and its multidisciplinary team approach for diagnosis of other associated anomalies, with special emphasis on their management. Background: Solitary median maxillary central incisor syndrome is a unique developmental condition characterized by only maxillary central incisor and a series of developmental defects, appearing as a syndrome. The appearance of a single incisor may take place due to the union of two incisor teeth or the absence of tooth germs. The mechanism of the fusion is still uncertain. Case description: A 9-year-old female child reported with a chief complaint of pain in the right lower back tooth for the past 10 days. The presence of a single maxillary central incisor was an incidental finding. Then a detailed history and multidisciplinary evaluations revealed the diagnosis of SMMCI syndrome. Conclusion: The effort in diagnosing and managing this syndrome had a strong impact on the child's life of which the parent was highly motivated and got a better understanding of associated problems of overall development. Clinical significance: In SMMCI syndrome, the patient requires a multidisciplinary health team in order to improve their quality of life. It is of greater importance to diagnose the syndrome and treatment of these median line deformities. How to cite this article: Balasubramanian S, Haridoss S, Swaminathan K. Solitary Median Maxillary Central Incisor Syndrome: A Case Report. Int J Clin Pediatr Dent 2022;15(4):458-461.

Glanzmann Thrombasthenia: Use of the Soft Splint with Tranexamic Acid Paste to Reduce Spontaneous Oral Bleeding.

BACKGROUND: Glanzmann thrombasthenia is a rare bleeding disorder due to defects in the glycoprotein Ilb/IIIa complex present on the platelet membrane. The most common mode of treatment for this disorder is platelet transfusion. However, scientific evidence does state that repeated transfusions could lead to auto immunization making transfusions ineffective. AIM AND OBJECTIVE: To describe the use of a novel technique of soft splint with tranexamic acid paste to stop oral bleeding in a patient with Glanzmann thrombasthenia (GT). CASE DESCRIPTION: A 7-year-old female patient with a known history of GT was referred to the pediatric department. The chief complaint of the patient revealed a history of spontaneous bleeding from the oral cavity. The patient required multiple teeth extractions due to severely carious teeth. History revealed that the patient was admitted to the hospital (casualty) three times within 1 month due to a similar complaint leading to hypovolemic shock. Several transfusion procedures were done to stop the spontaneous bleeding. To stop the intraoral bleeding without transfusions, a novel method of using a soft splint with tranexamic acid paste (500 mg tablet crushed and mixed with saline) in the area of spontaneous bleeding was employed with a successful follow-up of 7 months. CONCLUSION: Soft splint with the tranexamic acid paste can serve as an effective method of treatment for patients with spontaneous oral bleeding due to medical conditions like GT. CLINICAL RELEVANCE: This case report highlights the need for awareness among all the healthcare providers about the importance of regular dental visits. The healthcare providers also need to emphasize the same to all patients with medical conditions to avoid such life-threatening situations. HOW TO CITE THIS ARTICLE: Bhavyaa R, Vignesh KC, Muthu MS, et al. Glanzmann Thrombasthenia: Use of the Soft Splint with Tranexamic Acid Paste to Reduce Spontaneous Oral Bleeding. Int J Clin Pediatr Dent 2021;14(4):580-585.

Effect of Sustained Interventions from Infancy to Toddlerhood in Children with Cleft Lip and Palate for Preventing Early Childhood Caries.

The study aimed to evaluate the effectiveness of sustained interventions in children with cleft lip and palate (CLP) for preventing early childhood caries (ECC). This prospective, nonrandomized interventional cohort study was conducted in infants aged 0-12 months with congenital CLP. Interventions were given to parents/primary caregivers in the form of combined oral health-care measures (sterile wet gauze piece, finger brush, toothbrush, and toothpaste) by a motivational interviewing approach. Education of primary caregivers on oral hygiene was provided by audiovisual aids and demonstration. Reinforcement of the prescribed regimen was done through daily short message services in caregivers' preferred language and bimonthly telephone calls. Participants were followed up for 9-32 months from the time of recruitment, with a mean period of 18.3 ± 5.1 months. Rates of dental caries were represented as prevalence rates, incidence density, and transitional probability. The distribution of the International Caries Detection and Assessment System (ICDAS) scores on different tooth surfaces affected in the intervention group was compared descriptively with that of the age- and sex-matched historical control groups. On analysis of surface-wise distribution of the ICDAS scores in the intervention group (n = 1,919), 1.2% (n = 24) had noncavitated lesions (ICDAS codes 1 and 2), 0.88% (n = 17) had cavitated lesions (ICDAS codes 3-6), and 0.26% (n = 5) had both cavitated and noncavitated lesions (ICDAS codes 1-6). The incidence density of caries-affected children observed at the first and last follow-ups was 1.2 persons/100 person-months and 1.3 persons/100 person-months of observation, respectively. The incidence density of new caries-affected tooth surfaces at the first and last follow-ups was 0.163 surfaces/100 surface-months and 0.062 surfaces/100 surface-months, respectively. Maxillary first molars had the maximum transition from sound to the cavitated lesion (11.5%), followed by maxillary incisors from sound to noncavitated (7.5%) at the last follow-up. Based on the newly developed assessment criteria in our study, sustained interventions proved to be significantly effective in preventing ECC in children with CLP.

Management of oral mucosal lesions in salicylate sensitive stevens-Johnson syndrome - A case report.

In the present era, the use of drugs is an important paradigm of health care. Reactions to drugs range from minor cutaneous reactions to potentially lethal conditions like Stevens-Johnson syndrome. A 13-year-old, male patient, known case of Stevens-Johnson Syndrome was referred from the pediatric ward for the management of oral mucosal lesions, post consumption of the antibiotic combination of sulfamethoxazole and trimethoprim. Failure of lesion regression led to the change in the treatment plan, speculating an allergic reaction to one of the components of the initial treatment medication (choline salicylate) as well. Identification and withdrawal of the offending medication and rendering supportive care along with treatment of the lesions with topical corticosteroids form the outline of management. This case report demonstrates the approach undertaken by the pediatric dentist to cure the oral mucosal lesions in symbiosis with pediatricians, ophthalmologists and nutritionists to cure this life-threatening condition.

Single-rooted primary first mandibular molar.

Morphological variations like single-rooted molar in primary dentition are scarce. Understanding the root canal anatomy and variations is necessary for successful root canal therapy. The purpose of the present article is to report successful endodontic treatment of primary left mandibular first molar with an abnormal morphology of a single root. This case report highlights the importance of knowledge and its applications in the management of anomalous anatomic variants which play a crucial role in the success of endodontic treatment.