Evaluation of Postoperative Pain Following Single-Visit Root Canal Treatment with Rotary and Reciprocal Ni-Ti File Systems in Children.

Background and Objectives: Postoperative pain is a common symptom of a flare-up after root canal treatments (RCTs). Insufficient instrumentation, extrusion of irrigation solutions and debris, and the existence of a periapical lesion are the factors affecting postoperative pain after root canal treatments. The aim of this study was to evaluate the postoperative pain and instrumentation time of the single-file reciprocating system and multiple-file Ni-Ti rotary system in children ages 9-12 years old. Materials and Methods: Our study was conducted on 51 permanent mandibular molars with the diagnosis of irreversible pulpitis. Patients were randomly assigned into two groups, and RCTs were completed with either the Reciproc Blue or Protaper NEXT file systems. Instrumentation time for each system was noted, and patients were given a pain scale that included a visual analog scale for 6, 24, 48, and 72 h after treatment. Postoperative pain scores and instrumentation times were analyzed statistically with a chi-square test and Student's t-test. Results: There was no statistically significant difference in postoperative pain between the Reciproc Blue and Protaper NEXT systems at all time intervals. Instrumentation time was significantly shorter in the Reciproc Blue group in comparison with the Protaper NEXT group. Conclusions: Postoperative pain findings following RCT using single-file reciprocating systems were similar to the rotary system group. However, chair time in the reciprocating system group was significantly lower. This provided a comfortable and patient-friendly treatment approach for children, and could enhance their cooperation.

The effect of different enamel surface treatments on microleakage of fissure sealants.

OBJECTIVE: The aim of this study was to evaluate the effects of different techniques of surface treatment on the microleakage of fissure sealants in permanent molar teeth in vitro. MATERIALS AND METHODS: 96 extracted impacted human third molars were randomly divided into 8 surface treatment groups (n=12/group) as 1. Er: YAG laser ; (Fidelis II, Fotona, Ljubljana, Slovenia) (125 mj, 20Hz) ; 2. Er: YAG laser + 37% H3PO4 (15s) ; 3. ER: AG laser + 37% H3PO4+Prime&Bond NT ; 4. Er: YAG laser + G Bond ; 5. Er: YAG laser + Prime&Bond NT ; 6. 37% H3PO4 ; 7. 37% H3PO4 + Prime&Bond NT ; 8. G Bond. Sealant material (Clinpro, 3M ESPE, Seefeld, Germany), was applied into the fissures and light-cured for 20s with LED (Bluephase C5, Ivoclar-Vivadent, Schaan, Liechtenstein). Specimens were subjected to thermocycling (1000×, 5-55°C, dwell time: 15s) and immersed in 0.5% basic fuchsin solution for 24h at 37°C. The samples were sectioned and scored on a 3 point rating scale using a light microscope with a magnification of ×20. One-way analysis of variance was used to analyze data. Multiple comparisons were analyzed using Bonferroni test (p=0.05). RESULTS: Er:YAG laser showed the highest microleakage scores whereas Er YAG laser + 37% H3PO4 showed the lowest. Although 37% H3PO4 group showed higher scores than Er:YAG laser + 37% H3PO4, the difference was not statistically significant. CONCLUSION: Etching fissures with phosphoric acid is sufficient prior to fissure sealant application.

Clinical performance of fiber-reinforced nanofilled resin composite in extensively carious posterior teeth of children: 30-month evaluation.

OBJECTIVE: To evaluate the 30-month clinical performance of a nanofilled-resin composite with or without glass-fiber layering in restorations of large cavities in posterior teeth of children. STUDY DESIGN: A total of 71 restorations were placed in permanent molar teeth of 47 children (mean age 10.9 years) with (FRC; n=35) or without (RC; n=36) fiber layering. One operator placed all restorations. Restorations were evaluated according to the USPHS modified-Ryge criteria at baseline, 6, 12, 18, 24, and 30 months. The data were analyzed using Fisher 's exact and chi-square tests and outcomes were compared using the Cochran-Q test (p<0.05). RESULTS: The 30-month survival rates of the restorations were 97% and 97.1% in the RC and FRC groups, respectively. Nanofilled-resin restorations with or without glass fiber-layering showed similarly high clinical performance. No differences were detected between the evaluated criteria when comparing baseline with any of the evaluation periods (p<0.05). After 30 months there were no secondary caries, change in anatomical form or postoperative sensitivity. Only minor changes for marginal adaptation, marginal discoloration, color match and surface texture were observed. CONCLUSION: It was concluded that nanofilled-resin composite applied with or without glass-fiber layering showed similar and good results in large cavities of posterior permanent teeth in children over a 30-month period.

Oral findings and salivary parameters in children with celiac disease: a preliminary study.

OBJECTIVE: The aim of this study was to investigate the prevalence of dental enamel defects, recurrent aphthous stomatitis (RAS) and caries experience and to measure salivary flow rate, buffer capacity, saliva and plaque pH and salivary cariogenic microflora in patients with celiac disease (CD) compared to healthy subjects. SUBJECTS AND METHODS: Thirty-five patients, aged 6-19 years, with a diagnosis of CD and 35 healthy children of the same age participated in the study. Enamel defects were diagnosed and classified using Aine's classification. The patients with RAS and dental caries were recorded using WHO criteria. The parents were interviewed about various oral health-related factors. Saliva samples were collected to measure the stimulated salivary flow rate, buffer capacity and pH values of saliva and plaque. Salivary mutans streptococci and lactobacilli were counted. RESULTS: The enamel defects and RAS prevalence were statistically higher (40 and 37.1%, respectively) in the CD group, and the prevalence of salivary mutans streptococci (48 and 14%) and lactobacilli (51 and 34%) colonization was statistically lower (p = 0.012, p = 0.010) in the CD group; the DMFS and dfs values were similar in both groups. CONCLUSION: CD appeared to be associated with a significantly higher prevalence of developing enamel defects and RAS, but a lower prevalence of salivary mutans streptococci and lactobacilli colonization, and the diagnosis of these oral manifestations might be helpful for an early diagnosis of CD.

Cytotoxic effects of primary tooth root canal filling materials on L929 cell line.

PURPOSE: The purpose of this study was to determine the cytotoxic effects of five different primary tooth root canal filling materials on L929 permanent cell line with MTT assay. METHODS: Kri 1 paste (iodoform), Diapex (iodoform+Ca(OH)(2)), Metapaste (Ca(OH)(2) with distilled water), Dentalis (iodoform+ZOE+Ca(OH)(2)) and Kalsin (Ca(OH)(2) with glycerin) were used in this study. Tested materials were in contact for 24, 48 and 72 hours with L929 cells. At the end of the test periods, MTT test solutions were added to the plates and incubated for 3 hours at 37 degrees C. Then optic densities were read using UV visible spectrophotometer. All assays were repeated three times to ensure reproducibility. The obtained data were analyzed statistically by one-way analysis of variance and Dunnett T3 post hoc test (P<0.05). RESULTS: All tested materials were found cytotoxic on L929 cell line. It was found that Kri 1 paste group showed the highest survival rates. CONCLUSIONS: We concluded that the use of Kri 1 paste as a root canal filling material is a better option than other medications in primary teeth. Further research is necessary to determine the effect of root canal filling materials on vital tissues.

Two years survival rate of class II composite resin restorations prepared by ART with and without a chemomechanical caries removal gel in primary molars.

The aim was to test the null hypotheses that there is no difference: (1) in carious lesion development at the restoration margin between class II composite resin restorations in primary molars produced through the atraumatic restorative treatment (ART) with and without a chemomechanical caries removal gel and (2) in the survival rate of class II composite resin restorations between two treatment groups after 2 years. Three hundred twenty-seven children with 568 class II cavitated lesions were included in a parallel mouth study design. Four operators placed resin composite (Filtek Z 250) restorations bonded with a self-etch adhesive (Adper prompt L pop). Two independent examiners evaluated the restorations after 0.5, 1, and 2 years using the modified Ryge criteria. The Kaplan-Meier survival method was applied to estimate survival percentages. A high proportion of restorations were lost during the study period. Therefore, the first hypothesis could not be tested. No statistically significant difference was observed between the cumulative survival percentages of restorations produced by the two treatment approaches over the 2-year period (ART, 54.1 +/- 3.4%; ART with Carisolv, 46.0 +/- 3.4%). This hypothesis was accepted. ART with chemomechanical gel might not provide an added benefit increasing the survival percentages of ART class II composite resin restorations in primary teeth.

Kabuki Syndrome with additional dental findings: a case report.

Kabuki Syndrome (KS) is a multiple congenital anomalies/mental retardation syndrome of unknown etiology. It is characterized by a dysmorphic face, postnatal growth retardation, skeletal abnormalities, mental retardation, and unusual dermatoglyphic patterns. The characteristic dental findings include hypodontia, microdontia, absence of upper lateral and lower central incisors and upper molars, abnormal tooth shape, widely spaced teeth, ectopic upper molars and malocclusion. The purpose of this report is to describe common and additional dental findings and dental treatment of an 11-year old female patient with KS. This case report emphasises the importance of oral and dental manifestations for diagnosis.

PCR-based identification of selected pathogens associated with endodontic infections in deciduous and permanent teeth.

OBJECTIVE: The aim of the present study was to evaluate the presence of the selected pathogens in samples from deciduous and permanent tooth root canals by using PCR method and to determine the association of these organisms with clinical symptoms. STUDY DESIGN: A total of 145 children, 5 to 13 years old, were involved in this study. The presence of selected pathogens (Actinomyces israelii, Candida albicans, Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella intermedia, Streptococcus intermedius, Treponema denticola, Parvimonas micra, Tannerella forsythensis, Enterococcus faecium, Prevotella melaninogenica) in infected root canals was studied using PCR. RESULTS: T. denticola (P = .012, .02) and E. faecalis (P = .012, .04) were highly associated with periapical radiolucency and previous pain, while P. gingivalis was associated with tenderness to percussion in both deciduous and permanent teeth (P = .01, .015). CONCLUSION: The results of the present study confirm that certain species of microorganisms are associated with clinical signs and symptoms of endodontic disease in both deciduous and permanent teeth.

The effect of a chlorhexidine containing cavity disinfectant on the clinical performance of high-viscosity glass-ionomer cement following ART: 24-month results.

PURPOSE: To evaluate the effect of a chlorhexidine-gluconate-based cavity disinfectant on the clinical performance of high viscosity glass-ionomer cement following the ART approach under field conditions after 24 months. METHODS: 126 school children 6-8 years old who had bilateral matched pairs of carious Class I and II primary molars were included. A split mouth design was used in which Ketac Molar was randomly placed with or without the use of chlorhexidine-gluconate-based cavity disinfectant on contralateral sides by three dentists. The restorations were evaluated after 6, 12 and 24 months by two experienced examiners using USPHS-Ryge criteria. RESULTS: The 24-month mean cumulative survival rates of Ketac Molar without the use of disinfectant were 97.7% and 69.4% while in the disinfectant group, the survival rates were 95.2% and 63.9% in Class I and II restorations, respectively with no significant difference between the groups in both class types. In the non-disinfected group, large Class II cavities had significantly better survival rates than did small Class II cavities (P = 0.023). In the disinfected group, the failure rates in mean cumulative survivals from 6 to 12 months and 12 to 24 months significantly increased with time (P = 0.004 and P = 0.016 respectively).

The correlation between serum immunoglobulin A and immunoglobulin G levels and the presence of Treponema denticola in human periapical lesions.

The aim of this study was to compare the serum immunoglobulin A (IgA) and immunoglobulin G (IgG) levels and the presence of Treponema denticola in the root canals in a group of teeth with/without periapical lesion. A total of 66 children aged 8 to 13 years old were involved in this study. Five milliliters of blood samples were taken to detect the serum IgA and IgG levels. Sixty-six endodontic samplings were also obtained to determine the presence of T. denticola by polymerase chain reaction. The presence of T. denticola between the groups with/without periapical lesion was statistically significant (p = 0.026). A significant negative correlation was found between serum IgG and IgA levels and the presence of T. denticola (p = 0.023 and 0.038, respectively). This study may support the hypothesis that the presence of T. denticola in the root canals is mainly related to the periapical lesions, and the higher levels of serum IgG and IgA levels may protect against T. denticola.

Detection of Enterococcus faecalis in Necrotic Teeth Root Canals by Culture and Polymerase Chain Reaction Methods.

OBJECTIVES: The aim of this study was to investigate the presence of Enterococcus faecalis in endodontic infections in both deciduous and permanent teeth by culture and polymerase chain reaction (PCR) methods. METHODS: A total of 145 children aged 5-13 years old were involved in this study. The presence of E. faecalis in necrotic deciduous and permanent teeth root canals was studied using culture and polymerase chain reaction methods. RESULTS: Among 145 molar teeth, 57% (n=83) presented necrotic asymptomatic pulp tissues and were included in this study. Culture and PCR methods detected the test species in 18 and 22 of 83 teeth involved, respectively. E. faecalis was cultured from 8 (18%) of 45 necrotic deciduous teeth and from 10 (26%) of 38 necrotic permanent teeth. PCR detection identified the target species in 10 (22%) and 12 (32%) of necrotic deciduous and permanent teeth respectively. Statistically significant difference in the presence of E. faecalis in deciduous and permanent teeth was found by culture and PCR methods (P=0.03 and 0.02, respectively). The difference in the presence of E. faecalis between two different methods was not statistically significant (P>.05). CONCLUSIONS: The results of the present study confirm that both culture and PCR methods are sensitive to detect E. faecalis in root canals.

A clinical evaluation of resin-based composite and glass ionomer cement restorations placed in primary teeth using the ART approach: results at 24 months.

BACKGROUND: The authors evaluated the 24-month performance of a packable resin-based composite/dentin bonding system and a high-viscosity glass ionomer cement (GIC) in restorations placed in primary molars with the atraumatic restorative treatment (ART) approach. METHODS: Three dentists placed 419 restorations in 219 children aged 6 through 10 years who had bilateral matched pairs of carious posterior Class I and II primary teeth. They used a split-mouth design to place the two materials, which were assigned randomly to contralateral sides. The authors evaluated the restorations according to U.S. Public Health Service Ryge criteria. RESULTS: After 24 months, 96.7 percent of the Class I GIC restorations and 91 percent of the resin-based composite restorations survived, while the success rates for the Class II restorations were 76.1 percent and 82 percent for the GIC and resin-based composite restorations, respectively. The survival rate of the Class II resin-based composite restorations was 5.9 percent higher than that of the GIC restorations at the 24-month evaluation, but this difference was not statistically significant. However, the study results showed a statistically significant difference in survival rates between Class I and II restorations for both materials. CONCLUSION AND CLINICAL IMPLICATIONS: The two-year clinical performance of both materials was satisfactory for the restoration of Class I and II primary molars using the ART approach.

Efficacy of propolis as an intracanal medicament against Enterococcus faecalis.

This study sought to compare the antibacterial efficacy of three commonly used intracanal medicaments with propolis against Enterococcus faecalis. This study utilized 180 freshly extracted single-rooted intact human permanent teeth with a single root canal. After root canal preparations and sterilization, canals were contaminated with E. faecalis and incubated at 37 degrees C (+/- 1.0 degrees C) for seven days. The teeth were divided randomly into six groups. To determine bacterial growth on blood agar, microbiological samples were carried out with sterile paper points to evaluate results at 48 hours and at ten days. All data were analyzed statistically with t-test, Mann Whitney, Kruskal Wallis, and one-way ANOVA tests. This study revealed that propolis had good in vitro antibacterial activity against E. faecalis in the root canals, suggesting that it could be used as an alternative intracanal medicament.

Oral and dental manifestations of gastroesophageal reflux disease in children: a preliminary study.

PURPOSE: The aim of this study was to investigate the effects of gastroeophageal reflux disease (GERD) on: (1) erosion; (2) caries formation; (3) salivary function; and (4) salivary microbiological counts. METHODS: Thirty-eight GERD patients with a mean age of 6 1/2 years and 42 healthy children of the same age and gender and social background comprised the study group. All subjects answered a detailed frequency questionnaire related to acidic drinks, foods, and sugar consumption and participated in a clinical dental examination. The caries experience of the children was recorded according to World Health Organization criteria, and erosion was scored according to the Eccles and Jenkins grading scale. The children were also investigated for stimulated salivary flow rate, buffer capacity, and salivary mutans streptococci (MS), lactobacilli, and yeast colonization. RESULTS: The prevalence of dental erosion and the salivary yeast and MS colonization in GERD children was found to be significantly higher than for healthy subjects (P<.05). The caries experience, salivary flow rate, buffering capacities of the children, and frequency of acidic drinks, foods, and sugar consumption were found to be similar in both groups. CONCLUSION: This current investigation has shown that GERD children were at an increased risk of developing erosion and caries compared with healthy subjects.

Efficacy of various intracanal medicaments against Enterococcus faecalis in primary teeth: an in vivo study.

The aim of this study was to evaluate the in vivo efficacy of three intracanal medicaments (Ca(OH)2, 1% chlorhexidine gel and 1% chlorhexidine gel with Ca(OH)2 against Enterococcus faecalis in necrotic primary teeth. As a conclusion, chlorhexidine gel with or without Ca(OH)2 was more effective than Ca(OH)2 alone against Enterococcus faecalis.

Bacteremia incidence in pediatric patients under dental general anesthesia.

BACKGROUND: The aim of this study was to assess the incidence of bacteremia from various procedures in children undergoing dental treatment under general anesthesia. METHODS: Three blood samples for cultures were obtained from each patient; the first sample (10 ml basal) at the onset of the process and the second sample (10 ml) within 30 seconds following the nasotracheal intubation. The third blood sample (10 ml) was taken 30 seconds after the extraction of a deciduous tooth or a permanent tooth or slow drilling. Following incubation in an automated blood culture system, bacteria were identified by using conventional biochemical methods and commercial identification systems. Chi-square test was used to assess the findings statistically. RESULTS: All blood cultures were negative before intubation (baseline) in every patient. However, the percentage of positive samples in deciduous tooth extraction and permanent tooth extraction groups were 18/26 (69.2%) and 18/25 (72%), respectively. These values were significantly greater than the results of baseline 0/74 (0%), slow drilling 3/23 (13%), and nasotracheal intubation 9/74 (12.3%) (P < .05). CONCLUSION: Consequently, the patients treated under dental general anesthesia have to be evaluated with detailed physical examination and antibiotic prophylaxis should be given if required in order to prevent further unexpected bacterial endocarditis.

Management of a case with bilateral talon cusp in primary dentition.

The talon cusp is a relatively rare dental developmental anomaly characterized by the presence of an accessory cusp-like structure projecting from the cingulum area or cementoenamel junction. The alteration can cause clinical problems such as caries or occlusal interference. Management of the talon cusp varies according to the circumstances of the individual case and should be as conservative as possible. The purpose of this report was to present the case of bilateral talon cusp in primary maxillary central incisors that was successfully managed with conservative therapy.

Postoperative morbidities following dental care under day-stay general anesthesia in intellectually disabled children.

PURPOSE: The objective of this study was to compare the postoperative morbidities for 24 hours following dental care under day-stay general anesthesia using sevoflurane or halothane in intellectually disabled children. MATERIALS AND METHODS: Eighty-six premedicated patients with intellectual disabilities underwent general anesthesia for their dental treatment. They were randomly given anesthesia maintained with sevoflurane (2% to 3%) or halothane (1% to 1.5%) after receiving inhalation induction either with sevoflurane (8%) or halothane (5%) and nitrous oxide in oxygen (50:50). The patients' age, gender, weight, ASA Class, type of dental treatment, and duration of anesthesia and operation were recorded as well as the time required for recovery (Aldrete Scale) and the length of time taken before they were discharged (postanesthetic discharge scoring system) from the hospital. Pain and agitation were recorded using a visual analog scale (0 to 10). Other postoperative morbidities, which include crying, nausea and vomiting, bleeding, and drowsiness, were also noted for 24 hours after the operation. RESULTS: The most common morbidities during the postoperative 24 hours were agitation and pain, and their occurrence was significantly more common in the sevoflurane group than in the halothane group (P < .05). The recovery time was shorter in the sevoflurane group, but it was not statistically significant. There was no difference between the groups in the discharge time. CONCLUSIONS: Apart from more postoperative agitation and pain after awakening from sevoflurane, the quality of recovery was similar for both sevoflurane and halothane.

Comprehensive therapy of a fusion between a mandibular lateral incisor and supernumerary tooth: case report.

The term fusion is used to define a developmental anomaly characterised by the union of two adjacent teeth. In the case reported here, clinical and radiographic examinations suggested a unilateral fusion between the mandibular left permanent incisor and a super-numerary tooth. Radiographs showed that the fused teeth had two distinct pulp chambers and canals. A diagnosis of chronic periapical abscess of the supernumerary tooth was made. Before root canal therapy, a periodontal surgical procedure was performed to section the central incisor and its fused supernumerary. Also, odontoplasty was performed on the roots, to establish an anatomy consistent with a normal central incisor. Later, the chronic apical abscess on the supernumerary tooth was instrumented chemo-mechanically, root canal filling was performed and an anterior composite resin restoration was placed. The patient was evaluated for one year after root canal therapy. The tooth was asymptomatic, not exhibiting any pathological root resorption or alveolar resorption, and the anterior composite restoration was intact. Instead of extracting the supernumerary tooth, the application of endodontic, periodontal, and restorative procedures proved to be an alternative treatment.

Chemical compositions and antimicrobial activities of four different Anatolian propolis samples.

Propolis means a gum that is gathered by bees from various plants. It is known for its biological properties, having antibacterial, antifungal and healing properties. The aims of this study were to evaluate the antimicrobial activity of four different Anatolian propolis samples on different groups of microorganisms including some oral pathogens and comparison between their chemical compositions. Ethanol extracts of propolis (EEP) were prepared from four different Anatolian propolis samples and examined whether EEP inhibit the growth of the test microorganisms or not. For the antimicrobial activity assays, minimum inhibitory concentrations (MIC) were determined by using macrodilution method. The MIC values of the most effective propolis (TB) were 2 microg/ml for Streptococcus sobrinus and Enterococcus faecalis, 4 microg/ml for Micrococcus luteus, Candida albicans and C. krusei, 8 microg/ml for Streptococcus mutans, Staphylococcus aureus, Staphylococcus epidermidis and Enterobacter aerogenes, 16 microg/ml for Escherichia coli and C. tropicalis and 32 microg/ml for Salmonella typhimurium and Pseudomonas aeruginosa. The chemical compositions of EEP's were determined by high-temperature high-resolution gas chromatography coupled to mass spectrometry. The main compounds of four Anatolian propolis samples were flavonoids such as pinocembrin, pinostropin, isalpinin, pinobanksin, quercetin, naringenin, galangine and chrysin. Although propolis samples were collected from different regions of Anatolia all showed significant antimicrobial activity against the Gram positive bacteria and yeasts. Propolis can prevent dental caries since it demonstrated significant antimicrobial activity against the microorganisms such as Streptococcus mutans, Streptococcus sobrinus and C. albicans, which involves in oral diseases.