Antibacterial Efficacy of Dual-dye and Dual Laser Photodynamic Therapy on Oral Biofilms of Enterococcus faecalis, Streptococcus mutans, and Prevotella intermedia: An In Vitro Study.

Aim: To assess and compare the antibacterial efficacy of methylene blue (MB) and red laser (660 nm) antimicrobial photodynamic therapy (aPDT), indocyanine green (ICG) and infrared laser (810 nm) aPDT, and dual-dye (MB and ICG) and dual light (red and infrared) aPDT on oral biofilms of Enterococcus faecalis (E. faecalis), Prevotella intermedia (P. intermedia), and Streptococcus mutans (S. mutans). Materials and methods: Biofilms of E. faecalis, S. mutans, and P. intermedia were grown at 36°C and 5% CO2 for 7 days in a 96-well plate in a brain heart infusion (BHI) growth medium. Before aPDT, a total of 27 inoculums were collected from culture wells and grown on culture plates to assess baseline colony forming units (CFU). The microbial wells were treated with MBaPDT (group I), ICGaPDT (group II), and MBICGaPDT (group III). Post-aPDT, inoculums were collected from wells to be cultured to assess CFU. One-way analysis of variance (ANOVA) and student paired t-tests were used for statistical analysis. The significance level was fixed at p ≤ 0.05. Results: Methylene blue antimicrobial photodynamic therapy (MBaPDT) caused a significant reduction in E. faecalis counts compared to other groups (f = 11.15, p = 0.01). aPDT on S. mutans resulted in a significant (p = 0.04) reduction of bacterial counts in the ICGaPDT group. aPDT on P. intermedia resulted in a significant reduction in bacterial counts (p ≤ 0.05) in MBaPDT and ICGaPDT groups. Conclusion: Dual-dye and dual light aPDT showed an antibacterial effect against E. faecalis. It was ineffective against S. mutans and P. intermedia. Clinical significance: Dual-dye aPDT may effectively reduce E. faecalis counts in infected root canals and improve the outcomes of root canal treatment. How to cite this article: Yavagal C, Yavagal PC, Marwah N, et al. Antibacterial Efficacy of Dual-dye and Dual Laser Photodynamic Therapy on Oral Biofilms of Enterococcus faecalis, Streptococcus mutans, and Prevotella intermedia: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(S-2):S128-S132.

Disinfection Efficacy of Laser Activation on Different Forms and Concentrations of Sodium Hypochlorite Root Canal Irrigant against Enterococcus faecalis in Primary Teeth.

Photoactivated disinfection with sodium hypochlorite (NaOCl) has improved primary root canal treatment outcomes. This in vitro study aims to assess and compare the disinfecting efficacy of 2.5% sodium hypochlorite solution and 5.25% sodium hypochlorite gel, without laser activation and accompanied by laser activation, on Enterococcus faecalis-contaminated primary teeth root canals. After one month of incubating extracted teeth specimens with E. faecalis, 36 specimens were randomly divided into two groups: Group A (conventional method without laser-activated irrigation) and Group B (with laser-activated irrigation). Each group was further divided into three subgroups, with six samples in each subgroup. Subgroup 1 received irrigation with normal saline, Subgroup 2 with 2.5% sodium hypochlorite solution, and Subgroup 3 with 5.25% sodium hypochlorite gel. Diode laser activation at 810 nm was used in Group B. Bacterial colony counts were measured before and after the intervention. Student's t-test and one-way analysis of variance (ANOVA) with Tukey's post hoc test were used for statistical analysis. The significance level was set at p < 0.05. Microbial analysis revealed no bacterial growth in samples irrigated with 5.25% sodium hypochlorite gel activated with the laser. Activation with the laser significantly (p = 0.02) improved the disinfection ability of the irrigant compared to the non-activation group. The disinfection ability of sodium hypochlorite gel was better than that of saline (p = 0.02); however, it was comparable to that of sodium hypochlorite solution (p = 0.67). Conclusion: Root canal irrigation with 5.25% sodium hypochlorite gel activated with an 810 nm diode laser resulted in complete eradication of Enterococcus faecalis, indicating its effectiveness as an endodontic disinfection treatment modality.

Efficacy of casein phosphopeptide-amorphous calcium phosphate varnish in remineralizing white spot lesions: A systematic review and meta-analysis.

Background: This systematic review aimed to evaluate the efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACPF) varnish for remineralization of white spot lesions (WSLs) "in vitro" in human teeth. Materials and Methods: Literature search included three databases, namely Medline (via PubMed), The Cochrane Controlled Clinical Trials Register, and Google Scholar from 2010 to January 2021. The studies assessing WSL depth, calcium, phosphate ion release, and microhardness due to artificial demineralization or remineralization were considered for review. Reference articles were retrieved, and a customized risk assessment tool was used. The Cochrane risk of bias assessment tool was used to generate the risk of bias summary graph. Meta-analysis was performed using RevMan 5.4. Heterogeneity was evaluated by Cochrane's test, and random effects model was used to pool estimate of effect and its 95% confidence intervals (CIs) for surface microhardness. Results: Eighteen studies were selected for review based on the eligibility criteria. Four studies showed superior remineralizing effect of CPP-ACPF compared to fluoride varnishes. Four studies involving 120 human permanent teeth samples were included in the meta-analysis. Efficacy of CPP-ACPF varnish was equivalent to other fluoride varnishes in improving surface microhardness after remineralization during 7-day period (mean surface microhardness: 3.94, 95% CI [-9.08-1.21], I2: 75%, P = 0.13). Major risks of bias associated with the studies included in the review were inadequate sample size, improper sample preparation, and unexplained blinding. Conclusion: CPP-ACPF varnish appears to be equally effective as other fluoride varnishes in remineralizing artificially induced WSLs, but quality of evidence is low.

Efficacy of Laser Photoacoustic Streaming in Paediatric Root Canal Disinfection - An Ex-Vivo Study.

BACKGROUND: Various techniques have been employed to enhance the root canal disinfection rate using sodium hypochlorite (NaOCl) as an irrigant. Photon initiated photo-acoustic streaming using lasers is a newer method of endodontic disinfection. AIM: The aim of this study is to evaluate and compare the efficacy of photo-initiated photoacoustic streaming and conventional irrigation technique using 2.5% NaOCl for root canal disinfection in primary teeth. SETTING AND DESIGN: Laboratory setting and ex-vivo design. MATERIALS AND METHODS: Twenty extracted primary teeth were selected in which Enterococcus faecalis incubation was done in the root canals and bacterial counts were obtained before the intervention. The teeth were randomly allocated into two groups. Group I samples were irrigated with conventional syringe method using 2.5% NaOCl and Group II samples were irrigated using photon-initiated photo-acoustic streaming method with erbium-doped yttrium aluminum garnet laser (wavelength - 2940 nm). Postintervention samples were obtained, and bacterial colony count was done. Wilcoxon Signed- Ranks Test and Mann-Whitney test were applied to test the intragroup and intergroup differences in the bacterial counts. RESULTS: Postintervention results showed no bacterial growth in the canals irrigated using Laser (P = 0.004) whereas, fewer bacterial colonies were observed in NaOCl group (P = 0.005). There was statistically significantly higher reduction in E. faecalis counts in Laser Activated irrigation (LAI) group compared to NaOCl group (P < 0.05). CONCLUSION: Total elimination of E. faecalis counts was obtained by the use of laser activated NaOCl irrigation in the infected root canals, hence, it can be considered as an effective method for pediatric endodontic disinfection.

Efficacy of Laser Photobiomodulation in Accelerating Orthodontic Tooth Movement in Children: A Systematic Review with Meta-analysis.

AIM AND BACKGROUND: This systematic review aimed to investigate the efficacy of laser photobiomodulation (PBM) on the acceleration of orthodontic tooth movement (OTM). REVIEW METHODS: The study protocol was registered at PROSPERO (CRD42019121465). An extensive electronic search for randomized control trials and clinical control trials via Medline (via PubMed), The Cochrane Controlled Clinical Trials Register, and Scopus up to date 24/02/2019 was done. Hand searching was performed for relevant journals. Reference articles were retrieved and exported to Mendeley Desktop 1.13.3 software. The risk of bias was assessed using the Cochrane risk of the bias assessment tool. Articles were further analyzed using Revman5.3 software. RESULTS: A total of 14 articles were considered for systematic review and 9 articles were considered for meta-analysis. The results of the meta-analysis showed a significant difference between the laser group and conventional orthodontic treatment with Forest plots showing more tooth movement in the laser group compared to the control group in 2-3 months (mean difference = 1.73; CI: 0.9-2.57; p = 0.00001; I 2 = 89 %). CONCLUSION: Although the analysis of the results shows that laser PBM favors OTM, the results are inconclusive as the heterogeneity across studies was high. CLINICAL SIGNIFICANCE: Laser PBM may be considered as novel, safe, and noninvasive adjuvant therapy for the acceleration of OTM in children. HOW TO CITE THIS ARTICLE: Yavagal CM, Matondkar SP, Yavagal PC. Efficacy of Laser Photobiomodulation in Accelerating Orthodontic Tooth Movement in Children: A Systematic Review with Meta-analysis. Int J Clin Pediatr Dent 2021;14(S-1):S94-S100.

Efficacy of laser photobiomodulation pulpotomy in human primary teeth: A randomized controlled trial.

BACKGROUND: Laser photobiomodulation (LPBM), also called Low Level Laser Therapy (LLLT), has shown potential to reduce the pulpal inflammation and to preserve the dental pulp vitality, thereby improving healing. Lasers being minimally invasive, safe, and patient friendly prompt its application in pediatric dentistry. AIM: The aim of this study was to evaluate and compare the clinical and radiographic success rates of LPBM and formocresol pulpotomy at 9 months post intervention in human primary molars. MATERIALS AND METHODS: A randomized controlled, split-mouth study design was followed involving children aged 4-7 years with at least two primary molars indicated for pulpotomy. Sixty-eight eligible primary molars were randomly allocated to two interventions - formocresol pulpotomy (Group I) and LPBM pulpotomy (Group II). STATISTICAL ANALYSES: Chi-square test was used for statistical analysis fixing significance level at P ≤ 0.05. RESULTS: There was no statistically significant difference in the clinical success rates between the formocresol group (97.05%) and the photobiomodulation group (94.1%) (χ2 = 0.34, P = 0.55); however, the radiographic success rate was significantly high in the laser group (94.1%) compared to the formocresol group (58.82%) (χ2 = 11.76, P = 0.001). CONCLUSION: LPBM could be a viable nonpharmaceutical alternative for formocresol pulpotomy in human primary teeth.

Quantitative assessment of Scardovia wiggsiae from dental plaque samples of children suffering from severe early childhood caries and caries free children.

Scardovia wiggsiae has recently been identified as a potential pathogen associated with dental caries. The aim of the present study was to detect and quantify S. wiggsiae from dental plaque samples of children suffering from severe early childhood caries and children who were caries free by employing a real time DNA polymerase chain reaction (Real-time PCR) method. Dental plaque samples were collected from children suffering from severe early childhood caries (S-ECC) (n = 30) and caries free children (CF) (n = 30) reporting to the out-patient clinics of the department of paediatric and preventive dentistry. Plaque samples from each group were subjected to real-time PCR, post DNA extraction. Both the groups showed the presence of the organism S. wiggsiae, however there was a significant difference in its quantification between groups, with the median number being 1.49 × 108 cells per ml in caries free samples compared to 1.40 × 109 cells per ml in S-ECC samples. S. wiggsiae were isolated from nearly all samples of children, both caries free and those suffering from S-ECC. However, their numbers differ drastically in both groups with the scales tipping towards the S-ECC group, proving their association with the disease process in a significant manner. The present study shows significant association of S. wiggsiae in severe early childhood caries.

Modified micro-marsupialization as an alternative treatment for the management of ranulas in children.

The anatomical location of ranulas is challenging to the dental surgeon in terms of their management. The regional complexities of the area call for a skilled approach because of a number of vital structures within. Although complete excision with removal of the sublingual gland continues to be the gold standard of treatment, recent literature highlights successful outcomes by simple modification of the conventional ranular marsupialization technique. This micro-marsupialization option is minimally invasive and advantageous in children due to shorter procedural time, minimal discomfort, and no postoperative complications. The following case report highlights the successful management of a case using a modified micro-marsupialization technique.

Efficacy of Caries Removal by Carie-Care and Erbium-doped Yttrium Aluminum Garnet Laser in Primary Molars: A Scanning Electron Microscope Study.

AIM: To compare and evaluate morphological changes and bacterial deposits in primary carious molars after caries excavation with Carie-Care, erbium-doped yttrium aluminum garnet (Er:YAG) laser, and round tungsten carbide bur. MATERIALS AND METHODS: Thirty human carious primary molars extracted for therapeutic reasons were sectioned mesiodistally. These sectioned samples were allocated into three groups (20 samples each): group I: Carie Care, group II: Er:YAG laser, and group III: round tungsten carbide bur. After caries excavation, all samples were processed and examined under conventional light microscope to examine for bacterial deposits. Representative samples from each group were processed and analyzed to examine the morphology of caries-excavated tissue by scanning electron microscope (SEM). Statistical analysis was done using Fisher's exact test, Kruskal-Wallis test, and Mann-Whitney U test. RESULTS: The Er:YAG laser showed best results with no smear layer followed by chemomechanically excavated surfaces with Carie-Care. Amount of bacterial deposits was observed to be more in group I while least in group II (p-value < 0.001). Mann-Whitney U test and Fisher's exact test revealed that there was statistically significant difference among all the three groups. CONCLUSION: Among the three different methods of caries excavation, Er:YAG laser was found to be more effective compared with Carie-Care and round tungsten carbide bur. CLINICAL SIGNIFICANCE: Laser-induced caries excavation by Er:YAG laser and chemomechanical method of caries removal by Carie-Care can be considered as future of noninvasive pediatric and preventive dentistry.How to cite this article: Prabhakar A, Lokeshwari M, Naik SV, Yavagal C. Efficacy of Caries Removal by Carie-Care and Erbium-doped Yttrium Aluminum Garnet Laser in Primary Molars: A Scanning Electron Microscope Study. Int J Clin Pediatr Dent 2018;11(4):323-329.

Comparative Evaluation of Different Modes of Laser Assisted Endodontics in Primary Teeth: An In vitro Study.

INTRODUCTION: The presence of bacteria in root canals has been considered to be responsible for endodontic treatment failure, even in case of primary teeth. The use of lasers can be a valuable addition in removing bacterial load in areas where traditional methods may fail to succeed. Methods like direct laser irradiation of canals, Laser Activated Irrigation (LAI) with sodium hypochlorite (NaOCl) and Photodynamic Therapy (PDT) seem to be a promising alternative for disinfection. AIM: This study was designed to compare the efficacy of latest advancements in disinfection techniques using diode laser namely direct laser irradiation, photodynamic therapy and laser activated irrigation using sodium hypochlorite. MATERIALS AND METHODS: Sixty freshly extracted primary teeth either single or multi-rooted teeth with two third of their root length intact were collected. Instrumentation was completed to size 30 H-file. Teeth were randomly divided into Group 1- Direct Laser- irradiation, Group 2 - Photodynamic therapy; Group 3- Laser activated irrigation with 2.5% NaOCl. The tooth specimens were inoculated with Enterococcus faecalis. The bacterial colonies were counted preoperatively. Laser irradiation was performed for all groups in accordance to the groups each tooth belonged to. Postoperatively the bacterial colonies were counted. One-way Analysis was applied to compare bacterial count at baseline and post-test between three groups. Tukey's post-hoc test was applied for pairwise comparison between groups. Paired t-test was applied to compare the mean baseline bacterial count with post-test mean bacterial count. RESULTS: The results obtained with all the three groups postoperatively were highly significant (p-value<0.001). Statistically significant difference between results of Group 1 and Group 2 and also between Group 1 and Group 3 was found (p-value≤ 0.001). However, no statistical difference between Group 2 and Group 3 was found (p-value- 0.96). CONCLUSION: Disinfection strategies using diode laser by techniques gives promising results. Techniques like laser activated irrigation and photoactivated disinfection are better than direct laser irradiation in eliminating Enterococcus feacalis.

Presurgical nasoalveolar molding: A boon to facilitate the surgical repair in infants with cleft lip and palate.

Cleft lip and palate (CLP) is the most common congenital craniofacial anomaly. Rehabilitation of CLP generally requires a team approach. Alveolar and nasal reconstruction for these patients is a challenge for the reconstructive surgeon. Various procedures have been attempted to reduce the cleft gap, so as to obtain esthetic results postsurgically. The presurgical nasoalveolar molding (PNAM) technique, developed by Grayson, is a new approach to presurgical infant orthopedics. PNAM reduces the severity of the initial cleft alveolar and nasal deformity. Thus, it enables the surgeon and the patient to enjoy the benefits associated with repair of a cleft deformity that is minimal in severity. This article presents a brief insight into PNAM with a case series of three different cases (one unilateral and two bilateral) which underwent PNAM treatment and gave an excellent surgical prognosis.

Reciprocating vs Rotary Instrumentation in Pediatric Endodontics: Cone Beam Computed Tomographic Analysis of Deciduous Root Canals using Two Single-file Systems.

BACKGROUND: Primary root canals are considered to be most challenging due to their complex anatomy. "Wave one" and "one shape" are single-file systems with reciprocating and rotary motion respectively. The aim of this study was to evaluate and compare dentin thickness, centering ability, canal transportation, and instrumentation time of wave one and one shape files in primary root canals using a cone beam computed tomographic (CBCT) analysis. STUDY DESIGN: This is an experimental, in vitro study comparing the two groups. MATERIALS AND METHODS: A total of 24 extracted human primary teeth with minimum 7 mm root length were included in the study. Cone beam computed tomographic images were taken before and after the instrumentation for each group. Dentin thickness, centering ability, canal transportation, and instrumentation times were evaluated for each group. RESULTS: A significant difference was found in instrumentation time and canal transportation measures between the two groups. Wave one showed less canal transportation as compared with one shape, and the mean instrumentation time of wave one was significantly less than one shape. CONCLUSION: Reciprocating single-file systems was found to be faster with much less procedural errors and can hence be recommended for shaping the root canals of primary teeth. How to cite this article: Prabhakar AR, Yavagal C, Dixit K, Naik SV. Reciprocating vs Rotary Instrumentation in Pediatric Endodontics: Cone Beam Computed Tomographic Analysis of Deciduous Root Canals using Two Single-File Systems. Int J Clin Pediatr Dent 2016;9(1):45-49.

Effect of storage media on fracture resistance of reattached tooth fragments using G-aenial Universal Flo.

BACKGROUND: Over a period of the past few years' episodes of dental trauma more commonly coronal fractures of anterior teeth are being increasingly reported in children. Fragment reattachment can be considered as a valid treatment option in such situations. However, ideal medium for storage of fragments before reattachment needs to be explored. AIM: To compare the fracture resistance of incisor tooth fragments stored in four storage media: Dry air, milk, coconut water, or egg white before reattaching them with G-aenial Universal Flo. MATERIALS AND METHODS: Forty-eight freshly extracted maxillary incisors were divided into four groups. Teeth were then sectioned, and fragments were stored in dry air (Group I), milk (Group II), coconut water (Group III), and egg white (Group IV). The fragments were reattached using simple reattachment technique and tested on the Universal Testing Machine. Statistical analysis was performed using one-way analysis of variance and post hoc Tukey's test. RESULTS: There was statistically significant difference (P < 0.05) in fracture resistance values between the groups. The highest fracture resistance value was demonstrated by Group II, whereas least fracture resistance values were observed in Group IV. CONCLUSION: Along with milk, coconut water being tested for the first time can be considered a viable alternative.

Age Assessment in Children: A Novel Cameriere's Stratagem.

AIM: Age is one of the essential factors in establishing the identity of a person, especially in children. Age estimation plays an important part in treatment planning, forensic dentistry, legal issues, and paleodemographic research. The present study was an attempt to estimate the chronological age in children of Davangere population by using Cameriere's India specific formula. MATERIALS AND METHODS: This was a retrospective observational study to estimate the chronological age in children of Davangere population. A total of 150 panoramic radiographs of patients aged between 6 and 15 years, including both sexes, were selected. Age was calculated by measuring open apices of seven right or left mandibular teeth using Adobe Photoshop software. RESULTS: Statistical analysis was performed to derive a regression equation for estimation of age, which showed that, of the variables X1, X2, X3, X4, X5, X6, X7, s, N0, the variables N0 and X4 were statistically noteworthy. Hence, these two variables were used to derive the linear regression formula: Age = 10.522 + 0.712(N0) - 5.040(X4). The model was found to be statistically significant, F(2, 147) = 207.96, p < 0.001, and accounted for approximately 74% of the variance of age (R2 = 0.739, adjusted R2 = 0.735). CONCLUSION: Cameriere's method can be used for age assessment in children for forensic as well as legal contexts and based on these variables a reliable age estimation equation could be proposed specifically for Davangere population. HOW TO CITE THIS ARTICLE: Attiguppe PR, Yavagal C, Maganti R, Mythri P. Age Assessment in Children: A Novel Cameriere's Stratagem. Int J Clin Pediatr Dent 2016;9(4):330-334.

Finite element stress analysis of stainless steel crowns.

BACKGROUND: Though stainless steel crowns (SSCs) have often been stated as the best restorative modality, there are limited studies demonstrating its efficacy in restoring the functional integrity of the primary dentition. Hence has arisen, the necessity to establish the supremacy of SSCs. AIM: Evaluation of the efficacy of SSC to with stand compressive (0°), shearing (90°), and torsional (45°) stress when used as a restorative material. SETTINGS AND DESIGN: The study design employed four finite element models, each with differing amounts of tooth structure, which were exported to ANSYS software and subjected to an average simulated bite force of 245N. MATERIALS AND METHODS: Four maxillary deciduous primary molars restored with SSCs (3M ESPE) were subjected to spiral computed tomography (CT) in order to obtain three-dimensional (3D) images, which were then converted into finite element models. They were each subjected to forces along the long axis of the tooth and at 45°and 90°. RESULTS: The maximal equivalent von Mises stress was demonstrated in the SSCs of all the models with only a minimal amount observed in the underlying dentine. In all situations, the maximal equivalent von Mises stress was well below the ultimate tensile strength values of stainless steel and dentine. CONCLUSION: Even at maximal physiologic masticatory force levels, a grossly destructed tooth restored with SSC is able to resist deformation.

Twisted vs Protaper Files in Contemporary Pediatric Endodontics.

OBJECTIVE: To compare the cutting efficiency of twisted files with protaper files in primary teeth. STUDY DESIGN: It is an experimental, in vitro study comparing two groups. RESULTS: The obtained results from the experiment were statistically analyzed with Mann-Whitney U-test. Twisted files showed better cutting efficiency when compared to protaper files. CONCLUSION: Since twisted files show a better cutting efficiency, they can be efficiently incorporated into the contemporary pediatric endodontic armamentarium. How to cite this article: Prabhakar AR, Yavagal C, Vallu RK. Twisted vs Protaper Files in Contemporary Pediatric Endodontics. Int J Clin Pediatr Dent 2014;7(2):93-96.

Molariform mesiodens in primary dentition.

Mesiodens is a midline supernumerary tooth commonly seen in the maxillary arch, and incidence of molariform mesiodens in the maxillary midline is rare in permanent dentition and extremely uncommon in primary dentition. A midline supernumerary tooth in the primary dentition can cause ectopic or delayed eruption of permanent central incisors which will further alter occlusion and may compromise esthetics and formation of dentigerous cysts. This paper reports a rare case of the presence of a molariform mesiodens in the primary dentition. On clinical and radiographic examination, flaring of the primary central incisors was seen, with a molariform mesiodens consisting of multiple lobes or tubercles on the occlusal surface with the well-formed root. The treatment plan consisted of the extraction of the supernumerary tooth and regular observation of permanent central incisors for proper eruption and alignment.