Dental Procedures Research Articles

Prognosis recovery score of apical surgery Guided Bone Regeneration using cone beam computed tomography and digital bioinformatics

ObjectiveGuided Bone Regeneration (GBR) is a dental surgical procedure that uses barrier membranes to prevent soft tissue invasion and conduct new bone growth. This study aimed to define a Prognosis Recovery score (PR score) to objectively classify post-surgery responders from non-responder patients who underwent GBR using Cone Beam Computed Tomography (CBCT). MethodsThis prospective-observational-longitudinal-cohort study recruited 250 individuals who were assigned to: Conventional-Apical-Surgery (CAS, n = 39), Apical-Surgery using human fascia lata Membrane placement (ASM, n = 42), and Apical-Surgery using human fascia lata Membrane placement and lyophilized allograft Bone powder (ASMB, n = 39); and Apical-Surgery using collagen membrane Porcine origin and Bovine Bone-matrix (ASPBB, n = 130), an independent external validation cohort. Surgery was performed, and evolution was monitored by CBCTs at 0, 6-, 12-, 18-, and 24 months post-surgery. ResultsNormalized lesion volumes were calculated, and non-linear time evolution morphology curves were characterized. The three-time evolution bone growth patterns were: a linear tendency (PR0), “S'' shaped log-logistic (PR1), and “C" cellular growth (PR2). The treatment success rates were PR2-46 %, PR2-88 %, and PR2-95 %/PR1-5% for CAS, ASM, and ASMB groups. The xenograft ASPBB counterpart achieved PR2-92 % and PR1-8%. The score PR had a sensitivity, specificity, and accuracy of 100 %. ConclusionsPatients' treatment success can be quantitatively, objectively, and precisely predicted with the Prognosis Recovery score (using only two CBCTs), according to their biological response to allograft or xenograft materials (time-evolution bone growth curves), reducing cost and radiation exposure. Clinical significanceThrough digital imaging and bioinformatic analysis of bone regeneration observed in CBCTs, we defined a Prognosis Recovery (PR) score using only two CBCT volume assessments (0 and 6 months). The PR score allowed us to define three time-evolution curves depending on the biomaterials used and to classify patients in a quantitative, objective, and accurate way.

Radiological evaluation of mandibular alveolar reconstruction after retained third molar removal procedures using autogenous dentin matrix (ADM)

Abstract Introduction: Bone regeneration materials are often used in dental surgery procedures. At present, we have the possibility to use materials from different groups due to the way they are obtained. The gold standard still remains the use of autogenous bone substitute material due to its osteogenic, osteoinductive and osteoconductive properties. The surgical removal of the third retained tooth is one of the most common procedures performed in dental surgery. As a result of such a procedure, bone tissue atrophy occurs. In order to avoid the formation of a bone defect on the distal surface of the second molar, an augmentation method using an autogenous dentin matrix can be used in such procedures. Material and methods: Procedures for bilateral removal of retained third molars were performed in 15 patients. On one side, augmentation was performed with an autogenous dentin matrix obtained by grinding and preparing the extracted retained tooth (study group). On the opposite side, the bone defect was left to heal spontaneously (control group). After 6 months, the degree of bone regeneration was compared on the basis of bone density testing and the size of the resulting bone defect on the distal side was compared on the basis of radiographic examination. Results: Analysis of the obtained material showed significant differences in healing after treatments with autogenous dentin matrix. Thus, the use of an autogenous dentin matrix made it possible to obtain a completely regenerated bone defect. Conclusions: This procedure seems to be useful for bone regeneration after the removal of the third molar.

A Cone-Beam Computed Tomography-Based Evaluation of Root Dilaceration in Permanent Premolars: A Retrospective Study.

As a developmental disorder characterized by an abnormal bend and angle in the longitudinal axis of the tooth root, dilaceration can cause complications in routine dental procedures such as endodontics, orthodontics, and surgical treatments. The purpose of this study was to investigate the prevalence of dilaceration in maxillary and mandibular premolar teeth in a population of Shiraz city based on cone-beam computed tomography (CBCT). This is a retrospective cross-sectional study on 927 premolar teeth and 132 CBCT radiographs of patients obtained from four private radiology clinics in Shiraz (Iran). In this study, the presence, location, direction, and severity of dilaceration in premolar roots as well as its relationship with gender were investigated. Chi-square and Fisher tests were used to analyze the data. The results showed that 17% of the studied 927 teeth had dilaceration. The prevalence of dilaceration was significantly higher in women than in men (20.3% vs. 13.6%, p= 0.005). The dilaceration rates were significantly higher in the mandibular first and second premolar teeth (31.6% and 26%, p= 0.002) than in the other teeth. In addition, the highest prevalence was in the distal direction with mild severity in the apical third of the root (p< 0.001). According to the results of this study, the prevalence of dilaceration was relatively high in mandibular premolar teeth especially in women.

Efficacy of kaleidoscope, virtual reality, and video games to alleviate dental anxiety during local anesthesia in children: a randomized clinical trial.

Distraction is a technique used to divert a patient's attention from unpleasant procedures. This study aimed to evaluate the effectiveness of kaleidoscopy, virtual reality, and video games in reducing anxiety and pain during invasive dental procedures in children. Sixty-six children aged 6 to 9 years were randomly assigned to three groups during local anesthesia administration: Group 1 (kaleidoscope), Group 2 (virtual reality), and Group 3 (mobile video games). The anxiety of the children was evaluated using physiological measures (heart rate) at three different time points: before, during, and after the procedure. The Raghavendra, Madhuri, and Sujata pictorial scale was used as a subjective measure before and after the procedure. Subjective measures of pain were assessed using the Wong-Baker Faces Pain Scale. The data were statistically analyzed using the Kruskal-Wallis and Wilcoxon signed-rank tests. In the intergroup comparison, there were no statistically significant differences in the physiological measures of anxiety scores between the three groups before, during, and after distraction. Raghavendra, Madhuri, and Sujata pictorial scale scores were assessed before and after distraction, but no statistically significant differences were observed. Among the three groups, the children in Group 2 showed a significant reduction in pain scores. Compared with kaleidoscopes and video games, virtual reality is a promising distraction technique for reducing dental fear, anxiety, and pain during local anesthesia administration in children.

The Elderly's Limited Awareness of Advanced-Way Dental Procedures Hinders Access to Treatment, Resulting in Persistent Pain and Unmet Dental Needs in Pakistan.

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Ankaferd blood stopper: A novel additional strategy for less experienced gastroenterologists in gastrointestinal bleeding treatment.

The Ankaferd Blood Stopper (ABS) proves effective in managing various bleedings, particularly in surgical and dental procedures. This study assesses ABS efficacy endoscopically by less-experienced endoscopists for non-variceal upper gastrointestinal bleeding (NVUGB). Between 2016 and 2021, our hospital's Gastroenterology Department Endoscopy Unit conducted a retrospective data analysis of 653 patients who underwent endoscopy for NVUGB. The study included 202 patients who underwent endoscopic interventions performed by endoscopists with less than 3 years of experience. Based on the method used for endoscopic hemostasis, we classified those treated with ABS (either alone or as a second method) as group 1. In contrast, we classified patients treated with non-ABS hemostatic methods into Group 2. The study included 202 patients, with 96 (47.52%) in Group 1 and 106 (52.48%) in Group 2. All patients in Group 1 achieved bleeding control, while 4 patients in Group 2 initially did not achieve bleeding control; however, bleeding control was subsequently established following ABS administration. After 1 month of follow-up, mortality occurred in 3 out of 202 patients (1.48%), and all these cases were in Group 2. There is a significant difference in the need for blood transfusion between the groups (P < .001). Regarding the bleeding source, bulbus ulcer and gastric cancer were more prevalent in Group 2. On the other hand, although statistical significance was not reached in the comparison of rebleeding rates between groups, numerically, a higher incidence of recurrent bleeding was observed in Group 2 (Group 1: 3 [3.1%], Group 2: 8 [7.5%]; P = .167). Additionally, a similar relationship was noted among intensive care admissions (Group 1: 5 [5.2%]; Group 2: 7 [6.6%]; P = .675). In the group that used ABS, there were significantly higher rates of hypotension, tachycardia, syncope, and the need for transfusion than in the other group. In medical practice, this distinction often stems from the shared preference of clinicians to use ABS as a salvage method in cases of more severe bleeding. Considering all the findings, it is evident that using ABS through endoscopy in cases of NVUGIB significantly improves procedural success, irrespective of the endoscopist's experience level.

The Pterygomandibular Space: A Volumetric Evaluation Using the Novel A-Silicone Injections Method.

Inferior alveolar nerve block (IANB) is one of the most common procedures in operative dentistry, and a deep understanding of the normal anatomical variation of the pterygomandibular space (PM) is essential for its safe and successful administration. This cadaveric anatomical study aimed to use A-silicone injections to evaluate the volume of the PM. This study was conducted using 46 human cadaver heads (25 males and 21 females). A craniometric analysis was performed using the cadavers' ages, the number of silicone cartridges (carpules) used to fill the pterygomandibular space, Izard's Facial Index (FI), and the Cranial Index (CI). A Halstead mandibular block was performed by injecting 1.7 mL A-silicone cartridges (as an equivalent to standard local aesthetic carpules volume) into the PM. The cured silicone was extracted from the dissected mandibles. The volume (length, width, and thickness) of the extracted silicone and the number of silicone cartridges used to fill the space were evaluated. The results showed that there are statistically significant positive correlations between the CI and the width of the right PM, as well as the width and length of the left PM. A statistically significant correlation was found between the width of the left PM and the age of the cadaveric heads; the higher the age, the thicker the space on both sides. The volume of the PM corresponded to 1.5 cartridges on average.

Intraoral Applications of Lasers in the Prosthetic Rehabilitation with Fixed Partial Dentures-A Narrative Review.

Laser, an acronym for Light Amplification by Stimulated Emission of Radiation, is a powerful tool with diverse applications in modern dentistry. It emits monochromatic, coherent light resulting from photon-induced chain reactions. Available dental lasers include diode, argon, Er,Cr:YSGG, Er:YAG, Nd:YAG, and CO2. The unique property of these lasers, allowing them to be effectively used on both soft and hard tissues based on the operational parameters, positions them as particularly suited for a wide range of dental procedures. Compared to traditional methods, lasers offer advantages such as improved hemostasis and quicker wound healing. Such benefits stress the shift towards laser technology in dental treatment. In the realm of dental prosthodontics, which focuses on esthetics, functionality, and the physiological aspects of dental prostheses, lasers provide promising outcomes. Among the prosthetic options, fixed partial dentures stand out for their ability to mimic natural teeth, offering both esthetic and functional features, leading to satisfactory long-term outcomes if managed properly. This review paper delves into the specific application of laser technology in the context of prosthetic rehabilitation involving fixed partial dentures. By investigating intraoral laser procedures, it contributes to understanding laser's role in improving patients' satisfaction and clinical efficiency in this field.

Major maxillary sinus augmentation techniques for dental implant: a systematic review

Introduction: In around 25% of all maxillary sinuses, there is an accessory bone that is located in a lower portion than the main ostium. When a dental element is lost in the posterior region of the maxilla, there is natural reabsorption of the alveolar process and at the same time, pneumatization of the maxillary sinus occurs. It will increase its volume towards the location where the roots existed and this will often make it difficult or unfeasible to restore implants in that location. Various surgical techniques can be used to reconstruct the atrophic alveolar ridge, techniques alone or associated with autogenous, allogeneic, xenogeneic grafts, and alloplastic biomaterials. Objective: It was to develop a systematic review to list the main clinical and surgical approaches to bone elevation techniques for dental implants. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to March 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 119 articles were found, 35 articles were evaluated in full and 23 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 15 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=71.6%&gt;50%. It was concluded that the placement of the implant with the simultaneous use of PRP or PRF creates a good relationship between the hard tissue and the soft tissue. The Bio-Oss® biomaterial is one of the most used in guided bone regeneration procedures in regenerative dentistry, and its particles become an integral part of the newly formed bone structure and retain their volume in the long term. Furthermore, Bio-Oss® offers a lot of space for the formation of blood vessels (angiogenesis) and the deposit of neoformed bone, helping the growth of osteoblasts. Notable studies have shown results on the combined use of Bio-Oss® and PRF. Also, it is possible to develop a pre-operative planning method, associated with the area of implant dentistry, using digital images. Furthermore, the conventional surgical guide has some advantages such as being cheaper, simpler, and easier to perform, however, it leads to a greater operative risk for the patient. However, the accuracy of the location to be implanted is not the best and there is a greater probability of this guide becoming worn out, due to the contact of the drills with it.

Failure Diagnosis for Dental Air Turbine Handpiece with Payload Using Feature Engineering and Temporal Convolution Network.

The internal mechanisms of dental air turbine handpieces (DATHs) have become increasingly intricate over time. To enhance the operational reliability of dental procedures and guarantee patient safety, this study formulated temporal convolution network (TCN) prediction models with the functions of causality in time sequence, transmitting memory, learning, storing, and fast convergence for monitoring the health and diagnosing the rotor and collet failure of DATHs. A handpiece mimicking a dentist's hand load of 100 g was employed to repeatedly mill a glass porcelain block back and forth for cutting. An accelerometer was employed to capture vibration signals during free-running of unrestrained operation of the handpiece, aiming to discern the characteristic features of these vibrations. These data were then utilized to create a diagnostic health classification (DHC) for further developing a TCN, a 1D convolutional neural network (CNN), and long short-term memory (LSTM) prediction models. The three frameworks were used and compared for machine learning to establish DHC prediction models for the DATH. The experimental results indicate that, in terms of DHC predicted for the experimental dataset, the square categorical cross-entropy loss function error of the TCN framework was generally lower than that of the 1D CNN, which did not have a memory framework or the drawback of the vanishing gradient problem. In addition, the TCN framework outperformed the LSTM model, which required a longer history to provide sufficient diagnostic ability. Still, high accuracies were achieved both in the direction of feed-drive milling and in the gravity of the handpiece through vibration signals. In general, the failure classification prediction model could accurately predict the health and failure mode of the dental handpiece before the use of the DATH when an embedded sensor was available. Therefore, this model could prove to be a beneficial tool for predicting the deterioration patterns of real dental handpieces in their remaining useful life.

Seroprevalence of Hepatitis B Virus Infection and Associated Factors among Cancer Patients at Hawassa University Comprehensive Specialized Hospital, Ethiopia.

Hepatitis B virus infection is a global public health concern and has a high degree of associated morbidity and mortality. In Ethiopia, Hepatitis B virus infection has a variable seroprevalence among different regions with an estimated overall prevalence of around 6%. However, there is a scarcity of data specific to cancer patients. A hospital-based cross-sectional study was conducted among 384 cancer patients who came for follow-up at the oncology unit of Hawassa University Comprehensive Specialized Hospital from January 1/2020 to October 11/2021. A systematic sampling technique was employed to select the participants. Data was collected using structured and interviewer-administered questionnaires and blood samples were drawn from the patients to test hepatitis B virus sero-status. Data was entered to Epi- Data version 4.6 then exported and analysis was done using SPSS version 25. Descriptive statistics were used to describe the study participants. Finally, bivariable and multivariable binary logistic regression was used to identify significantly associated factors. The seroprevalence of hepatitis B virus infection among cancer patients was 7.6% [95% CI: (4.54 - 9.79)]. Having multiple sexual partners (AOR = 6.24, 95% CI (3.35-16.80)), a history of dental procedures (AOR = 3.34; 95% CI (1.007‑7.66)), and being a hepatocellular carcinoma patient (AOR = 6.13; 95% CI (3.66-18.77)) were factors associated with seropositive status for Hepatitis B virus. The seroprevalence of Hepatitis B virus infection among cancer patients was high. It is better to consider HBV screening in cancer patients and doing cancer surveillance in HBV-infected patients.

Interventions to Reduce Intra-Operative and Post-Operative Pain Associated with Routine Dental Procedures in Children: A Systematic Review and Meta-Analysis.

implementing appropriate pharmacological and non-pharmacological interventions to alleviate pain related to routine dental procedures in paediatric patients could enhance children's ability to manage dental care. The aim of this review was to investigate the effectiveness of and provide recommendations for interventions that can be used to reduce intra-operative and post-operative pain associated with routine paediatric dental procedures. A systematic review of randomised controlled clinical trials (RCT) was conducted. Multiple electronic databases were systematically searched. The Cochrane risk-of-bias tool for RCTs was used to evaluate the quality of the included studies. A meta-analysis was performed to determine the effectiveness of the interventions using the Cohen's d standardised mean differences (SMD) and 95% confidence intervals (CIs) for continuous outcomes. The GRADE tool was used to assess the certainty of evidence to make recommendations. The review included forty-five RCTs comprising 3093 children. Thirty-seven RCTs were included in the meta-analysis, which showed the effectiveness of behavioural interventions (SMD = -0.50, 95% CI -0.83 to -0.18), mechanoreceptor and thermal receptor stimulation (SMD = -1.38, 95% CI -2.02 to -0.73) for intra-operative pain, and pre-emptive oral analgesics (SMD = -0.77, 95% CI -1.21 to -0.33) for reducing post-operative pain in children receiving routine dental care. The GRADE results for these interventions were strong recommendation (IB) for their use, based on moderate evidence and their benefits far outweighing the harm, and they can be delivered readily with minimal training to reduce the pain experience of paediatric patients.

Exodontia of third molars in a single surgery using conscious sedation in an anxious patient: case report

The conscious sedation performed by inhaling nitrous oxide gas (N2O) associated with oxygen gas (O2) provides an ideal analgesic and anxiolytic effect for patients who are insecure and anxious to undergo dental procedures. The aim of the present study is to report a clinical case of a single surgery to extract teeth 18, 28, 38, and 48 in an odontophobic patient who undergoes anxiety by using conscious sedation through the inhalation of nitrous oxide gas diluted in oxygen gas. The patient achieved a state of deep relaxation during sedation, with a decrease in his initial heart rate, high oxygen saturation, and low intraoperative bleeding. The authors concluded that conscious sedation using nitrous oxide is an important ally in oral surgeries for anxious patients.

Assessment of Discomfort and Analgesic Usage Following Pediatric Dental Procedures in India: A Cross-Sectional Study.

Pain management in pediatric dentistry is crucial for ensuring positive treatment outcomes and reducing patient suffering. This study aimed to evaluate postoperative discomfort and analgesic usage among pediatric dental patients undergoing various procedures in India. A cross-sectional study was conducted at a tertiary care dental hospital in India from June 2023 to December 2023. A total of 150 pediatric patients aged 2-18 years who underwent different dental procedures were included. Data on postoperative discomfort and analgesic usage were collected immediately following the procedure and during follow-up phone calls. Significant differences were found in immediate postoperative discomfort following pulpotomy (P = 0.03). Patients receiving primary stainless steel crowns (SSCs) alone or in combination with pulpotomy were significantly more likely to report discomfort (P < 0.001 and P < 0.05, respectively). No significant associations were observed between discomfort and sealants, preventive resin restorations, 1- or 2-surface restorations, or extractions. Over-the-counter analgesic usage was prevalent, particularly following SSC placement. This study highlights the variability in postoperative discomfort among pediatric dental patients undergoing different procedures in India. Tailored pain management strategies based on specific procedures are essential to minimize discomfort and improve patient outcomes in pediatric dentistry.

Management of edoxaban therapy in patients undergoing emergency/urgent procedures: a subanalysis of the global, prospective, observational, multinational EMIT-AF/VTE programme

Abstract Background Physicians are often unable to follow recommendations for preprocedural oral anticoagulant interruption before emergency/urgent (unplanned) procedures, which may lead to a higher incidence of adverse outcomes in these patients compared with those who undergo planned procedures. The Global EMIT-AF/VTE programme found low bleeding and thromboembolic event rates for patients receiving edoxaban who underwent diagnostic or therapeutic procedures. However, edoxaban management and clinical outcomes may differ among the subgroup of patients with emergency/urgent procedures. Purpose To describe periprocedural edoxaban management and clinical outcomes for patients in the EMIT-AF/VTE programme who underwent emergency/urgent procedures. Methods In this subanalysis, only physician-reported unplanned (emergency/urgent) procedures were included, of which dental and dermatological procedures were excluded. Only a patient’s first emergency procedure was included, with the exception of 3 patients having 2 procedures on the same day (in these cases the 2 procedures were combined). Procedure bleeding risk was classified according to EHRA criteria, and baseline characteristics and edoxaban interruption data were collected. Clinical event and procedure dates were compared to determine whether they were related. Results Among 156 patients undergoing emergency/urgent procedures, the mean ± standard deviation age at baseline was 74.5 ± 8.7 years, and the CHA2DS2-VASc score was 3.8 ± 1.6. Medical histories of hypertension and dyslipidaemia were reported in 84.0% and 40.4% of patients, respectively; approximately one-quarter of patients had diabetes mellitus (26.9%) or creatinine clearance ≤50 mL/min (24.4%). The most common procedure types were vascular access and transcatheter diagnostics/interventions (34.6%) and gastroenterological procedures (27.6%). Procedures were more often EHRA-classified as minor (35.9%) or low (35.3%) vs high risk (20.5%). Preprocedure edoxaban interruption rates ranged from 39.3%–50.9% across risk groups, with more than half of the procedures being performed with edoxaban interruption (53%–66%; Figure). By 20 days postprocedure, edoxaban therapy was resumed in approximately 86% and 88% of patients with minor- or low-risk procedures vs 70% with high-risk procedures. Overall, 33 clinical events were recorded, of which 18 (54.5%) preceded a procedure (Table). Five bleeding events and one thrombotic event occurred after and were caused by the procedure. Conclusions Edoxaban resumption was protracted after high- vs minor- or low-risk procedures. Bleeding and thrombotic events resulting from a procedure occurred in &amp;lt;4% of patients, indicating that postprocedure edoxaban therapy can be effectively tailored to optimise clinical outcomes.FigureTable

Pain assessment, cognitive and cortical changes with full mouth rehabilitation in a group of children

BackgroundA change in professionals’ perspectives on the value of general anesthesia (GA) for pediatric patients, including those with disabilities, medical conditions, severe oral issues, and challenging behaviors. Full-mouth rehabilitation under GA allows for the comprehensive treatment of all oral health problems in a single visit, without requiring the child’s active participation. Extensive dental problems are often associated with severe dental pain, which can impact cognitive function, including perception, attention, memory, reasoning, language, communication, and executive functions. Individuals experiencing pain tend to perform less optimally cognitively.AimThis study aimed to investigate changes in cognition, brain function, and cortical alterations in children who underwent extensive dental rehabilitation under GA.Patients andMethodsThirty uncooperative, healthy children aged 6–12 with extensive dental issues were enrolled. Pain levels were assessed using the FLACC and WBFPS scales before treatment, one week after, and three months later. Cognitive assessments, including the WCST, processing speed, digit span, and Trail Making Test, as well as EEG measurements, were also performed.ResultsThe results showed a significant improvement in pain levels reported by the children or their caregivers after the dental procedures, both at one week and three months. All cognitive measures, such as digit span, processing speed, and WCST performance, demonstrated substantial improvements after the treatment. The Trail Making Test also exhibited statistically significant variations before and after the dental procedures. Additionally, the MOCA test revealed a notable improvement in cognitive skills following the treatment. Furthermore, the EEG power ratio, an indicator of changes in the power balance within each frequency band, showed a statistically significant difference after the dental procedures.Conclusionthe findings of this study suggest that full-mouth rehabilitation under GA can lead to improved pain management, as well as enhanced cognitive and brain functions in children.Future perspectivesMore clinical studies with a longer follow-up period and a different age range of children are required to investigate the connection between brain function and oral rehabilitation involving restorations or occlusion issues.

Evaluating Dentists' Knowledge and Practices in the Use of Local Anesthetics and Unintended Effects in Pediatric Patients

Objective: This cross-sectional study aimed to evaluate a group of Turkish dentists' awareness, preparedness, and competence regarding the unintended effects of LAs in pediatric patients. Methods: In this study, the questionnaire form titled ' Evaluation of the Knowledge Level of Dentists Regarding the Use of Local Anesthesia and its Unintended Effects in Pediatric Patients' prepared in a digital environment was sent to dentists via Google survey application. The study investigated dentists' awareness and knowledge of the maximum dose of local anesthetic (LA) drugs. The most commonly used LA drugs and the most common complications related to these anesthetics were also determined. Results: According to the results obtained, the dentists' most frequently preferred LA substances were Articaine+Adrenaline (A+A) and Lidocaine+Adrenaline (L+A). It was found that 91% of the participants performed aspiration before LA applications. It was found that 74% of the dentists participating in the study did not calculate the maximum dose per kilogram when performing local anesthesia in pediatric patients. The three complications encountered by the participating dentists during local anesthesia were found to be anesthetic failure (73%), facial paralysis (26%), and syncope (19%), respectively. In addition, 90% of the dentists who were asked about the first drug they would prefer in anaphylaxis answered adrenaline. When asked about the route of adrenaline injection, the majority of the dentists (64%) responded intramuscularly. Conclusion: Although the occurrence of anaphylaxis during dental procedures is rare, when it does occur, it can lead to severe complications that may result in death. Dentists should be familiar with the signs of systemic complications that may arise from using LAs. When these findings are encountered after anesthesia, it should be considered that a systemic complication may have occurred, and urgent intervention should be performed. Any delay may cause consequences that may threaten the patient's life. This subject, which is of critical importance in dentistry, should be considered more in undergraduate and postgraduate education, and the level of knowledge should be increased by providing further training courses to update the information.

Osteoporosis - implications of the new guidelines in practice

In September 2023, the guideline on the prophylaxis, diagnosis, and treatment of osteoporosis in postmenopausal women and men was published as a completely revised guideline. The implications for practice include a change in the justifying indication for performing a bone density measurement, the time interval over which the fracture risk is determined, the level and number of therapy thresholds, and the recommendations for the therapeutic approach that are adapted to the individual fracture risk present. Risk assessment for the prediction of spine and hip fractures is essential in the context of osteoporosis diagnostics. In addition to age and gender, there are a total of 33 risk factors to determine the individual risk of fracture. Much more attention is paid to the assessment of the risk of falls and, depending on the result, combined with recommendations for muscle training and protein intake from the age of 65. Risk indicators must also be taken into account when determining the indication for osteoporosis diagnosis, as well as the risk factors of the imminent risk of fracture. The indication for baseline diagnostics has changed from the >20% 10-year fracture risk to diagnostics in postmenopausal women and in men aged 50 years and older, depending on the fracture risk factor profile. This eliminates a specific fracture risk threshold for basic diagnostics. Thus, in the young patient group (50-60 years), the risk factors considered medically relevant for the indication for osteoporosis diagnosis must be taken into account. New thresholds as an indication for initiating therapy is the determination of fracture risk using a risk calculator over 3 years instead of 10 years. The indication for drug therapy should be based on the threshold values of the DVO risk model. The data clearly suggests a significantly faster and more effective fracture risk-reducing effect of anabolic therapy. This is recommended in the first sequence in cases of a very high risk of fracture from 10%/3 years with osteoanabolic active substances (teriparatide or romosozumab). Such a therapy sequence should be initiated directly and not delayed due to upcoming dental procedures. Follow-up therapy to consolidate the reduction of fracture risk should be chosen individually.

Retrospective Study Regarding the Correlation between Dental Anxiety and Color Preferences in Children with Severe Early Childhood Caries.

Severe early childhood caries (S-ECC) is recognized as a significant chronic disease which affects the quality of life starting at very young ages and has a very rapid evolution towards pulp complication and loss of dental tissue. Children with a high caries index DMFT are more likely to develop high levels of dental anxiety, which will influence the degree of cooperation during dental procedures. Emotions play an important role in the psychosomatic development of children, and all the factors that contribute to the modeling of these emotional states must be known and taken into consideration. The aim of this study was to assess the association between dental anxiety in children with S-ECC and the color preferences for the components of the dental environment to reduce the levels of dental anxiety during medical visits. For this study, 91 children between 3 and 6 years of age diagnosed with S-ECC were selected from the Pediatric Dentistry Department of UMFST from Targu Mures and from a private dental office. The level of dental anxiety was determined by measuring the pulse rate, and a questionnaire was completed to establish the color preferences for the dental office environment and the dentist's attire. For this purpose, six different colors and their variants with three shades less intensity were chosen by using RGB (Red, Green, and Blue) identification codes for each color. The results showed that there was a statistically significant difference between the age of the subjects and dental anxiety levels, but there was no significant correlation between the DMFT score and dental anxiety. Also, the results showed that there was no significant difference between girls and boys when choosing the colors preferred by them for the dental office, but when comparing the colors that represented happiness, significant statistical difference was found between the girls' and boys' groups (p = 0.0039). For all the subjects, the colors associated with happiness were light yellow and pink, while the colors associated with anxiety were red and dark blue. The data obtained showed that dental anxiety is strongly influenced by age, and an important role in inducing positive emotions is played by the dental environment if dressed in specific colors in order to reduce dental anxiety and create familiar conditions, especially for young children with S-ECC.

Comparing Oral Microbiota Changes after Pulpotomy/Pulpectomy in Pediatric Patients.

Pediatric dental procedures like pulpotomy and pulpectomy are commonly performed to treat pulp-related dental issues in primary teeth. The choice of instrumentation, such as traditional rotary instruments or laser technology, can impact the oral microbiota. This study aims to compare the changes in oral microbiota following pulpotomy/pulpectomy in pediatric patients treated with traditional rotary instruments versus laser technology. A total of 60 pediatric patients, aged 4-10 years, requiring pulpotomy or pulpectomy were randomly assigned to two groups: group A (traditional) and group B (laser). In group A, traditional rotary instruments were used for pulp removal, while in group B, a dental laser was utilized. Saliva and plaque samples were collected before the procedure (baseline), immediately after the procedure, and at the one-month follow-up. Microbial deoxyribonucleic acid (DNA) was extracted and analyzed using 16S ribosomal ribonucleic acid (rRNA) sequencing to assess changes in the oral microbiota. At baseline, both groups exhibited similar microbial diversity and composition. However, immediate post-procedure results showed a significant decrease in microbial diversity in both groups, with group B (laser) demonstrating a more pronounced reduction. At the one-month follow-up, group A (traditional) showed a partial recovery of microbial diversity, while group B (laser) continued to exhibit lower microbial diversity compared to baseline. Notably, group B (laser) displayed a shift in microbial composition with a decrease in pathogenic species and an increase in beneficial bacteria compared to group A. This study highlights that both traditional rotary instruments and laser technology have a significant impact on the oral microbiota of pediatric patients following pulpotomy/pulpectomy. While both methods initially reduce microbial diversity, laser treatment appears to have a more sustained effect, favoring the growth of beneficial bacteria over time. Further research is needed to assess the long-term clinical implications of these microbiota changes for the oral health of pediatric patients.