Endodontic Treatment Of Primary Teeth Research Articles

Efficacy of digital radiographic systems in the quality assessment of intracanal materials used for primary teeth

Aim: To evaluate the performance of three digital radiographic systems in the analysis of root canal filling quality using different intracanal materials for primary teeth. Methods: Twenty-five bovine teeth were divided into 5 groups: Calen® combined with iodoform; Calen® combined with zinc oxide; zinc oxide and eugenol; UltraCal®XS, and 2% chlorhexidine combined with Ca(OH)2 + zinc oxide. Periapical radiographs were obtained with the VistaScan, Express, and SnapShot systems. The quality of the images was evaluated objectively (radiopacity) and subjectively (apical sealing and filling homogeneity). As the reference standard, the teeth were scanned with a micro-CT device. Results: Radiopacity differed among the radiographic systems and materials tested. In general, the greatest difference was observed between the Express and VistaScan systems; Calen® combined with iodoform resulted in the highest radiopacity. The radiographic systems did not differ in terms of homogeneity. However, Calen® combined with iodoform differed from the other materials and exhibited the best results. Regarding apical sealing, the SnapShot system and Calen® combined with zinc oxide provided the best results. Conclusion: Direct digital systems show better performance in evaluating the quality of endodontic treatment in primary teeth and should be preferred for this purpose.

A Clinical and Radiographic Study of Four Different Root Canal Filling Materials in Primary Molars—An In Vivo Study

Abstract Introduction Pulpectomy helps in preserving a pulpally involved primary tooth by eliminating bacteria and their products and ensures hermetic seal of the root canals, so that the primary teeth can complete their function until normal exfoliation. For the success of endodontic treatment in primary teeth, the resorption of obturating material plays a vital role. The materials used for obturation in this study included zinc oxide propolis (ZOP) as a new paste, Endoflas, Metapex, and zinc oxide eugenol (ZOE). Objective To evaluate the success rate of pulpectomy of primary molars using four different root canal filling materials: ZOP as a new paste, Endoflas, Metapex, and ZOE. Materials and Methods A total of 48 primary molars were divided into four equal groups of 12 molars according to the type of root canal filling paste, that is, ZOE, Endoflas, ZOP, and Metapex. Results When Tukey’s test was applied, out of the four materials, ZOP was the most significant material as its p-value was < 0.05, whereas other materials showed nonsignificant results as their p-value was > 0.05. Conclusion Among the four groups, ZOP showed greater clinical success and its resorbability was similar to that of root.

Comparative analysis of microleakage of temporary filling materials used for multivisit endodontic treatment sessions in primary teeth: an in vitro study.

Coronal leakage is an important factor contributing to the failure of endodontic treatment. The use of an efficient temporary restoration between sessions of multiple-visit pulpectomies is irrefutable. Two cements have long been used in endodontics-IRM, which is a reinforced zinc oxide cement and Cavit G, a calcium sulphate based cement. The aim of this study was to compare the microleakage of nano silver containing UDMA-based cements with routinely used zinc oxide and calcium sulphate-based temporary cements in primary teeth. Standardized access cavities of 3 × 3mm were prepared in the sixty caries-free primary molars. The teeth were divided randomly into four groups of 14 teeth each-Group I: IRM, Group II: Cavit G, Group III: Orafil-G and Group IV: Dia-Temp. Temporary restorative materials were applied according to the manufacturer's instructions. The teeth were subjected to thermocycling and then immersed in 0.5% basic fuchsin for 24h. The specimens were sectioned and evaluated under a digital microscope at 20× magnification and were scored for microleakage. The collected data were tabulated and subjected to statistical analysis. Dia-Temp presented the least microleakage values. The highest score for microleakage was shown by IRM followed by Orafil-G and Cavit-G. There was a significant difference between IRM and Diatemp groups (p value = 0.009), and among Orafil G and Diatemp groups (p value = 0.025). Among the four materials tested, Dia-Temp exhibited the best sealing ability and its use is recommended in between sessions of endodontic treatment in primary teeth.

Knowledge and Awareness among General Dental Practitioners in Chennai Regarding Rehabilitation with Full Coverage Restoration in Children.

ABSTRACTIntroductionThe endodontic treatment of primary teeth does provide symptomatic relief and masticatory rehabilitation to the child, but mere completion of endodontic procedure does not guarantee long-term success. Teeth that have not been restored coronally after endodontic treatment have high chances of failure.AimThe aim of this study was to evaluate the knowledge and awareness among general dental practitioners in Chennai regarding rehabilitation with full coverage restoration in children following pulp therapy.Materials and methodsA multiple choice questionnaire comprising 15 questions was given to 150 general dental practitioners in Chennai. The questionnaire assessed their knowledge and clinical practice of pulp therapy, tooth preparation, and restorative crowns for pediatric patients. The data were collected and statistically analyzed.ResultsThe findings of this study reveal wide variations in the knowledge and practice of general dental practitioners in Chennai regarding rehabilitation with full coverage restoration in children.ConclusionThe conclusion drawn from this study is that we need to update their knowledge regarding rehabilitation with full coverage restorations in children.How to cite this articleBedre AS, Gurunathan D. Knowledge and Awareness among General Dental Practitioners in Chennai Regarding Rehabilitation with Full Coverage Restoration in Children. Int J Clin Pediatr Dent 2019;12(6):590–594.

Relative effectiveness of direct and indirect pulp capping in the primary dentition.

Carious or traumatised teeth with a normal pulp status or with reversible pulpitis need an indirect or direct pulp capping procedure to keep the pulp vital. To evaluate the clinical outcome of both interventions for treating vital primary teeth. Two reviewers on Pubmed and ISI Web of Science performed a comprehensive literature review of publications from 1966 until December 2017. Among PubMed abstracts, publications were selected according to the following criteria: prospective clinical study, correct indication for the performed treatment, and clear definition of clinical and/or radiographic success criteria. The strict selection criteria limited the amount of randomised controlled trials (RCT) or controlled clinical trials (CT); especially for "indirect pulp therapy", "direct pulp capping" and the number of RCTs was limited. Based on a systematic review (20 controlled clinical studies or randomised controlled clinical studies), the following statements can be given: Due to the opportunity of tissue repair, indirect pulp treatment can be an acceptable procedure for reversible pulp inflammation. The use of adhesives for indirect pulp capping in a single-visit procedure after gentle caries removal can be recommended. Successful pulp capping is possible under defined conditions (symptom-free tooth, disinfection of pulp exposures, Class-I cavity) and appropriate sealing of the cavity with an effective dentine seal being a conditio sine qua non. There is maximum evidence for the use of disinfecting solutions prior to pulp capping and Dycal as pulp capping material. Longer follow-up periods, more clinical studies, comparable conditions, and clear definitions of evaluation criteria are needed to confirm the results of endodontic treatment in primary teeth.

Efficacy of a single session protocol for endodontic treatment in primary teeth: in vivo study.

To determine the efficacy of a single session protocol (SSP) in the reduction of septic content of primary teeth root canals and identify the persistence of bacterial species associated with unsuccessful treatment. Primary teeth root canals (16) with pulp necrosis and peri-radicular lesions were treated. Samples were collected at baseline (T1), and after chemo-mechanical preparation, before filling (T2). Identification of the microorganisms was determined using checkerboard DNA-DNA hybridisation. Wilcoxon test was applied for comparison of mean number of species, proportion and mean count of each species between the evaluation times. Significant reductions were found in the mean number of bacteria species between T1 and T2 (p<0.05), but not for the reduction in proportion (p>0.05). There was a reduction (6.0-4.6) of the mean number of species associated with failure, without statistical significance. The SSP was capable of significantly reducing the septic content, even though, many of the bacteria associated with failure persisted at the time of root canal filling.

Analytical methods of ciprofloxacin and its combinations review

Ciprofloxacin is a second generic and an antibiotic generic drug. It is a very popular fluoroquinolone that can treat a number of bacterial infections. The quinolones are family or a group that has activity against both-negative and positive-gram bacteria, when compared to Ciprofloxacin. The first aim of this review is to provide a comprehensive update of analytical methods for determining the Ciprofloxacin and its combinations, binary or triple mixture use of endodontic treatment of primary teeth using a combination of antibacterial drugs. The other aim of this review is to evaluate clinical and radiographic success of the endodontic treatment of infected primary teeth using a combination of ciprofloxacin, metronidazole, minocycline, and clindamycin. Several methods were used in the analytical determination of Ciprofloxacin and its metabolites in human biological fluids (plasma) and in pharmaceutical preparations. various techniques have been reported, such as UV, TLC, GC-Mass, HPLC and RP-HPLC methods, for the determination of Ciprofloxacin alone and in its combinations by high performance liquid chromatography and reversed phase-high performance liquid chromatography. This review provides details on separation conditions for Ciprofloxacin alone and its combinations.

Can the Enterococcus faecalis identified in the root canals of primary teeth be a cause of failure of endodontic treatment?

Objective: This study investigated the presence of Enterococcus faecalis in primary teeth with primary root canal infections and related to the possible failure of pulpectomy outcome after 36 months.Material and methods: Root canal samples were obtained from 25 out of 244 patients using the sterile paper cone method. The identification of E. faecalis was done with culture and molecular tests using species-specific 16S rRNA gene-based polymerase chain reaction (PCR). After 36 months, the pulpectomy outcome was evaluated.Results: Enterococcus faecalis was found in five (20%) samples, and dental caries were the cause of primary infection in all of them. Pulpectomy outcome was evaluated only in teeth that completed the entire clinical protocol and were followed up to 36 months (n = 8). From these, 75% (n = 6) were successful and 25% (n = 2) failed. E. faecalis was present in 50% of both successful and failed cases.Conclusions: Enterococcus faecalis was not related to the failure of endodontic treatment of primary teeth.

Knowledge, attitude, and practice among pediatric dentists regarding the use of rotary endodontic instruments for endodontic treatment in India

Background: In pediatric dentistry, loss of deciduous molars due to carious involvement is a major concern. Hence, endodontic therapy for primary teeth should be considered as a treatment of choice wherever required. Traditionally, used hand instruments were replaced by nickel–titanium alloy instruments to overcome disadvantages. Students' perceptions of these instruments and techniques used for endodontic treatment must be collected for knowledge, quality of endodontic education, and the level of practice among the students in the branch of pediatric dentistry. Aim: To evaluate the view of pediatric dentists on the use of rotary endodontic instruments for cleaning and shaping of canal in primary teeth in India. Materials and Methods: A total of 596 pediatric dentists registered with the Indian Society of Paedodontics and Preventive Dentistry were included in the study using an online questionnaire sent to the student members through the source of e-mail twice. Results: According to this study, from 365 participants, 85% of the participants were in favor of using rotary instruments for cleaning and shaping during endodontic treatment in pediatric practice and 38.1% of the participants were using rotary endodontic instruments in pediatric practice. Nearly 86.6% of the participants were in favor of the absolute need for an exclusive pediatric rotary endodontic system. Conclusion: The response of the study was as much as 60.83%. The results of the study reflect that the postgraduate students are keen on the usage of rotary instruments for cleaning and shaping of canal in endodontic treatment in primary teeth in pediatric practice.

Effectiveness of Morinda citrifolia juice as an intracanal irrigant in deciduous molars: An in vivo study.

The purpose of this study was to evaluate the microbial reduction in deciduous molars using Morinda citrifolia juice (MCJ) as irrigating solution. This was a randomized comparative study including 60 deciduous molars chosen among the patients belonging to the age group of 6-9 years based on the inclusion or exclusion criteria. The selected teeth were divided randomly into two groups based on irrigation solution used, that was, Group I (1% NaOCl) and Group II (MCJ). The microbial samples were collected both pre- and post-irrigation and were transferred for microbial assay. Paired t-test was used for intragroup analysis of pre- and post-operative mean reduction of bacterial colony forming unit (CFU)/ml, whereas Independent t-test was used to assess the intergroup, pre- and post-operative mean reduction of bacterial CFU/ml. In the intragroup comparison, both of the groups showed statistically significant (P < 0.001) reduction in the mean CFU/ml; however, it did not show statistically significant reduction when intergroup comparison was carried out between the two groups. Both the study materials had clinically revealed decrease in the microbial count postirrigation. Both the irrigants, 1% NaOCl and MCJ, were significantly effective in the reduction of mean CFUs/ml postoperatively. The results of this study have confirmed the antibacterial effectiveness of MCJ in the root canals of deciduous teeth. Considering the low toxicity and antibacterial effectiveness of MCJ, it can be advocated as a root canal irrigant in endodontic treatment of primary teeth.

Survival and Factors Associated with Failure of Pulpectomies Performed in Primary Teeth by Dental Students.

Although endodontic treatment is widely recommended for compromised dental pulp, there is no information regarding the factors associated with failures in primary teeth. The aim of this study was to evaluate the survival and factors associated with failure of pulpectomies performed in primary teeth by dental students. The sample comprised patients treated at a University Dental Service and required endodontic treatment in primary teeth. The study investigated treatment-related variables and patient factors potentially associated with treatment failure. Pulpectomy survival was analyzed by Kaplan-Meier estimator followed by log-rank test (p<0.05). The analysis included 81 pulpectomies performed in 62 children (5.6±1.5 years). The survival reached 62.9% up to 12 months follow-up. Most failures occurred in the first 3 months (p<0.001). Teeth with carious lesions at the start of treatment presented more failures than those with restorations or history of trauma (p=0.002). The survival of endodontically treated teeth restored with composite was higher than the ones filled with GIC (p=0.006). Pulpectomy performed in two or more sessions resulted in more failures (p=0.028). Patients presenting gingivitis had more failures in the endodontic treatment (p=0.022). The failures of root canal treatment in primary teeth were more prone to occur in a short time and when the treatment was performed in teeth presenting carious lesions. The use of composite instead of GIC increased the survival of pulpectomies. Repeated sessions for endodontic treatment and lack of oral hygiene habits had a negative effect on the results.

Knowledge and attitude of pediatric dentists, general dentists, postgraduates of pediatric dentistry, and dentists of other specialties toward the endodontic treatment of primary teeth

Background: Pediatric dentists (PDs) play an important role in treating primary teeth and oral health care needs for children. Pulp therapy is widely used in the treatment of primary teeth. The choice of endodontic treatment modality changes among general dentist (GD) and PD. Aim and Objectives: The aim of this study is to determine the attitudes of PDs, GDs, postgraduates (PGs) of pediatric dentistry and dentists of other specialties toward endodontic treatment of primary teeth. Materials and Methods: A structured 20-item questionnaire was formulated in English and distributed to PD, GD's, PGs of pediatric dentistry, and dentist of other specialties. The filled questionnaire survey was statistically analyzed using simple descriptive analysis and inferential analysis was performed using Chi-square t- test. Results: Out of the 237 survey respondents, 27.43% were BDS (GD's), 16.88% were MDS (PD), 12.66% were PG's (pediatric dentistry), and 43.04% were MDS (other than PD). About 91.6% of the total respondents preferred endodontic procedures in primary teeth. Conclusion: The study concluded that the GD's, PD's, and dentist of other specialty differ in their treatment recommendations for primary teeth. The GDs and dentist of other specialty were regularly performing pulp therapy in primary teeth and should frequently update their knowledge about endodontic procedures in primary teeth.

Evaluation of the effectiveness of photodynamic therapy for the endodontic treatment of primary teeth: study protocol for a randomized controlled clinical trial.

BackgroundThe elimination of pathogenic microorganisms from the root canal system is one of the major steps required for successful endodontic treatment. The aim of the proposed study is to conduct a randomized, controlled, clinical trial for the clinical and radiographic evaluation of the effectiveness of photodynamic therapy during the endodontic treatment of primary teeth.MethodsThirty primary anterior teeth in children aged 3 to 6 years old will be randomly divided into 2 groups: a control group, which will receive conventional treatment, and an experimental group, which will be subjected to photodynamic therapy. Microbiological evaluations will be performed before and after endodontic treatment. Moreover, clinical and radiographic evaluations will be performed on the day of treatment as well as 1, 3 and 6 months after treatment. Comparisons will be made of the two study groups. The data will be tabulated and presented in a descriptive, analytical fashion. Depending on the distribution (normal or non-normal), either the t test, ANOVA or the Mann-Whitney test will be used for analysis of the variables. The Wilcoxon test will be used for comparisons before and after treatment. P values < 0.05 (95 % significance level) will be considered indicative of statistically significant differences.DiscussionAs successful endodontic treatment is directly related to intra-canal bacterial disinfection and consideringthe difficult task of endodontic treatment in primary teeth, often due to difficulties in controlling youngchildren, the internal anatomy of root canals and root resorption, the alternative of using PDT is a painless,easy-to-administer method that does not lead to microbial resistance and can assist in the achievement ofsuccessful endodontic treatment in primary teeth by eliminating the pain children can experience due to retreatmentas well as premature tooth loss.Trial registrationThe protocol for this study was registered with Clinical Trials number NCT02485210 on 30 july 2015.

Rotary endodontics in primary teeth - A review.

Endodontic treatment in primary teeth can be challenging and time consuming, especially during canal preparation, which is considered one of the most important steps in root canal therapy. The conventional instrumentation technique for primary teeth remains the “gold-standard” over hand instrumentation, which makes procedures much more time consuming and adversely affects both clinicians and patients. Recently nickel–titanium (Ni–Ti) rotary files have been developed for use in pediatric endodontics. Using rotary instruments for primary tooth pulpectomies is cost effective and results in fills that are consistently uniform and predictable. This article reviews the use of nickel–titanium rotary files as root canal instrumentation in primary teeth. The pulpectomy technique is described here according to different authors and the advantages and disadvantages of using rotary files are discussed.

Antimicrobial activity of different filling pastes for deciduous tooth treatment.

Guedes-Pinto paste is the filling material most employed in Brazil for endodontic treatment of deciduous teeth; however, the Rifocort® ointment has been removed. Thus, the aim of this study was to investigate the antimicrobial potential of filling pastes, by proposing three new pharmacological associations to replace Rifocort® ointment with drugs of already established antimicrobial power: Nebacetin® ointment, 2% Chlorhexidine Gluconate gel, and Maxitrol® ointment. A paste composed of Iodoform, Rifocort® ointment and Camphorated Paramonochlorophenol (CPC) was employed as the gold standard (G1). The other associations were: Iodoform, Nebacetin® ointment and CPC (G2); Iodoform, 2% Chlorhexidine Digluconate gel and CPC (G3); Iodoform, Maxitrol® ointment and CPC (G4). The associations were tested for Staphylococcus aureus (S. aureus), Streptococcus mutans (S. mutans), Streptococcus oralis (S. oralis), Enterococcus faecalis (E. faecalis), Escherichia coli (E. coli), and Bacillus subtilis (B. subtilis), using the methods of dilution on solid medium - orifice agar - and broth dilution. The results were tested using statistical analysis ANOVA and Kruskal-Wallis. They showed that all the pastes had a bacteriostatic effect on all the microorganisms, without any statistically significant difference, compared with G1. S. aureus was statistically significant (multiple comparison test of Tukey), insofar as G2 and G3 presented the worst and the best performance, respectively. All associations were bactericidal for E. coli, S. aureus, S. mutans and S. oralis. Only G3 and G4 were bactericidal for E. faecalis, whereas no product was bactericidal for B. subtilis. Thus, the tested pastes have antimicrobial potential and have proved acceptable for endodontic treatment of primary teeth.

The antimicrobial effectiveness of 25% propolis extract in root canal irrigation of primary teeth.

The choice of irrigating solution used in root canals of primary teeth is complicated by their complex morphology and paucity of associated literature. Propolis is a natural product that has gained interest in this context due to its antibacterial effectiveness against several endodontic pathogens. The present study was undertaken to assess the potential of water-soluble 25% propolis extract against microorganisms present in root canals of primary teeth during endodontic procedures. The child patients in the age group of 4-7 years with radiographic evidence of carious pulp exposure were included in the study. Definitive selection was done after gaining access into the pulp chamber and root canals of the selected teeth. The clinical and radiographic evidence of pathosis was ruled out for inclusion in the study. The selected teeth were divided into two groups randomly. In Group A 0.9% isotonic saline and in Group B 25% extract water-soluble propolis were used as irrigating solution, respectively. The bacterial samples were collected both pre- and post-irrigation and were transferred for microbial assay. STAISTISTICAL ANALYSIS: Wilcoxon matched signed rank test was used to compare the pre-and post-irrigation bacterial counts. Mann-Whitney test was used to compare the mean change (pre-post) in bacterial colony counts of groups in the study. Antimicrobial effectiveness of 25% water-soluble extract of propolis in the root canals of primary teeth was confirmed in the present study. The reduction in the mean bacterial colony counts of all the isolated bacteria was noticed higher in Group B than Group A. The results of the present study have confirmed that the antibacterial effectiveness of water-soluble extract of propolis in the root canals of primary teeth in vivo. Considering the low toxicity concerns and antibacterial effectiveness, water-soluble extract of 25% propolis can be advocated as a root canal irrigant in endodontic treatment of primary teeth.

Analysis of microleakage of temporary restorative materials in primary teeth.

The aim of this study was to compare the coronal microleakage of restorative materials used between sessions of endodontic treatment in primary teeth. Forty healthy primary canines were chosen and randomly allocated to four groups: Group 1 - Cimpat Branco ® (n = 10), Group 2 - Bioplic ® (n = 10), Group 3 - Maxxion R ® glass ionomer cement (n = 10), and Group 4 (control) - Z350 ® composite resin (n = 10). Class V cavities were created and fillings carried out following the manufacturer's instructions. The teeth were submitted to thermocycling, sealed, and immersed in 0.5% basic fuchsin solution for 24 h. The teeth were split along their long axis in the vestibulolingual direction and the tooth-restorative material interface was photographed. The percentage of microleakage was calculated using the ImageJ program. Data were analyzed using the analysis of variance (ANOVA) F-test and Bonferroni's t-test, with a 5% level of significance. The following mean percentages of microleakage were found: Group 1 = 16.08%, Group 2 = 46.98%, Group 3 = 47.93%, and Group 4 = 11.03%. Statistically, significant differences were found in the comparison of Groups 1 and 4 to Groups 2 and 3. Cimpat Branco ® had a lower percentage of microleakage in comparison to Bioplic ® and Maxxion R ® glass ionomer cement.

Comparison between electronic and radiographic method for the determination of root canal length in primary teeth

There are few researches in literature that mention the use of the apex locator in deciduous teeth and working length is obtained through radiographies. Objective: The purpose of this research was to compare the radiographic and the electronic method to obtain the working length in deciduous molars. Material andmethods: Twelve molar teeth were used. The specimens in the visual method had their root length measured through the passive insertion of a 10 K-file with a silicone stop within root canal until its tip was seen at the apical foramen. The working length was measured through radiographs or using the apex locator Root ZX II. The mean between the examiners was submitted to the variance analysis (ANOVA). Results: Statistically significant differences were found between the visual method and the radiographic method (p &lt; 0.001). There was no significant difference between the working length measurements in visual method and those obtained with the apex locator (p = 0.1319). Conclusion: The apex locator is indicated as a clinical implementation for endodontic treatment in primary teeth.

Variability in the proportion of components of iodoform-based Guedes-Pinto paste mixed by dental students and pediatric dentists

Guedes-Pinto paste (GPP) is an iodoform paste used in most dental schools in Brazil. The paste is a composite of medicines (Rifocort , camphorated paramonochlorophenol [PMCC], and iodoform) used for endodontic treatment of primary teeth. The aim of this study was to evaluate the proportion variability of GPP components when mixed by undergraduate dentistry students and pediatric dentists. The study was divided into 4 groups: G1 (15 undergraduate students), G2 (15 specialists in Pediatric Dentistry), G3 (15 professors with clinical activity), and G4 (7 professors-researchers). All volunteers prepared GPP according to the original specifications: the same visual proportion for each component. The components were weighed using an analytical balance and the percentage was calculated. After normality (Kolmogorov-Smirnov) and homogeneity tests (Levene test), the data were submitted to analysis of variance and intraclass correlation coefficient tests (P<0.05). The percentage means of each respective group were as follows: Rifocort 20.2%, 20.8%, 26.7%, 27.3%; camphorated PMCC 9.2%, 8.1%, 6.7%, 5.1%; and the iodoform 70.6%, 71.1%, 64.7%, 67.6%. There were no significant differences between groups for the component percentages. There was a high intraclass correlation coefficient (G1 0.945; G2 0.951; G3 0.921; and G4 0.870). The proportion of GPP was similar in all the groups, allowing us to conclude that ideal GPP proportion, based on the entire group mean, was 23.8% of Rifocort® ; 7.0% of camphorated PMCC; and 69.2% of iodoform.

Endodontic treatment of primary teeth using combination of antibacterial drugs: An in vivo study

Endodontic treatment of primary teeth using combination of antibacterial drugs: An in vivo study