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The aim of the study is to investigate the effectiveness of the modified Akinosi technique [MAT] in endodontic management of mandibular molars with symptomatic irreversible pulpitis, and to compare it with the standard inferior alveolar nerve block for effective pulpal anesthesia. A total of 80 clinically healthy patients of both genders, between 16 and 65 years, diagnosed with symptomatic irreversible pulpitis in mandibular first and second molars were included in the study. The subjects were divided into two groups. Group A received nerve block and pulpal anesthesia through Inferior Alveolar Nerve Block technique, while Group B received nerve block through MAT with 2% lignocaine containing 1:200,000 adrenaline. All endodontic treatments were performed in a single visit. We evaluated the presence of pain during various phases of endodontic treatment with Visual Analog Scale. The pain level was registered at the end of the following phases of the endodontic treatment: 1. During access cavity preparation; 2. While determining working length for all the root canals; 3. During cleaning and shaping of root canals. In Group B, 80% of patients reported no pain, as compared to 51% in Group A. MAT is an effective method for achieving pulpal anesthesia in endodontic treatment of symptomatic irreversible pulpitis.

This study evaluated the impact of photobiomodulation (PBM) combined with glass ionomer sealant on hypersensitivity, oral hygiene, and sealant retention in molars affected by molar incisor hypomineralization (MIH). Forty-nine children (6–12 years) with MIH (Grade 3, 4a, or 4b) per MIH-TNI criteria were randomly assigned to two groups: control (n = 25, fluoride toothpaste, sealant with self-curing glass ionomer cement, simulated PBM) and treatment (n = 24, fluoride toothpaste, sealant with self-curing glass ionomer cement, active PBM). Hypersensitivity (SCASS, VAS), oral hygiene (OHI-S), and sealant retention (CCC system) were assessed. Forty-six children completed the study and were evaluated. At all post-baseline time points, the treatment group showed significantly lower VAS and SCASS scores ( p  < 0.05). OHI-S improved in both groups, with a positive correlation between reduced hypersensitivity and better oral hygiene. Sealant retention was higher in the treatment group after 30 days, with 56.5% of teeth showing complete retention versus 17.4% in the control group ( p  = 0.002). In the control group, greater hypersensitivity correlated with worse retention. PBM combined with glass ionomer cement reduces hypersensitivity, improves oral hygiene, and enhances sealant retention in MIH-affected molars. The combined treatment provides superior results in hypersensitivity reduction and sealant retention compared to sealant alone, offering a more effective approach for managing MIH. Trial registration : NCT05370417 in ClinicalTrials.gov

We aimed to compare subjective (S) vs. objective (O) selective carious tissue removal using hand-excavation versus a self-limiting polymer bur, respectively. A community-based single-blind cluster-randomized controlled superiority trial was performed. This is a 1-year-interim analysis. 115 children (age 7–8 years) with ≥1 vital primary molar with a deep dentin lesion (>1/2 dentin depth) were included (60 S/55 O). The cluster was the child, with eligible molars being treated identically (91 S/86 O). Cavities were prepared and carious tissue on pulpo-proximal walls selectively removed using hand instruments (S), or a self-limiting polymer bur (Polybur P1, Komet). Cavities were restored using glass-hybrid material (Equia Forte, GC). Treatment times and children’s satisfaction were recorded. Generalized-linear models (GLM) and multi-level Cox-regression analysis were applied. Initial treatment times were not significantly different between protocols (mean; 95%CI S: 433; 404–462 sec; O: 412; 382-441 sec; p = 0.378/GLM). There was no significant difference in patients’ satisfaction (p = 0.164). No pulpal exposures occurred. 113 children were re-examined. Failures occurred in 22/84 O-molars (26.2%) and 26/90 S-molars (28.9%). Pulpal complications occurred in 5(6%) O and 2(2.2%) S molars, respectively. Risk of failure was not significantly associated with the removal protocol, age, sex, dental arch or tooth type (p > 0.05/Cox), but was nearly 5-times higher in multi-surface than single-surface restorations (HR: 4.60; 95% CI: 1.70-12.4). Within the limitations of this interim analysis, there was no significant difference in treatment time, satisfaction and risk of failure between O and S.

This study reports an economic evaluation from the perspective of the Brazilian healthcare system. This is a secondary outcome of a three-year randomised controlled trial that compared Atraumatic Restorative Treatment (ART) to the Hall Technique (HT) for managing occluso-proximal caries lesions in primary molars. The primary outcome showed that the HT had a higher survival rate compared to ART and the economic evaluation was to test cost-effectiveness. Children (5-10 years old) in public schools of Tietê-SP/Brazil, were randomly allocated to either the ART or HT arm. Treatment survival was assessed using Kaplan-Meier analysis. The economic evaluation considered baseline and cumulative material and professional costs based on the Brazilian National Health System (SUS) perspective. For the economic analysis, direct and indirect costs were collected and calculated. When retreatment was necessary, an incremental cost of only one retreatment per child was considered for the analysis. All costs were collected in reais and converted and reported in euros. A discount rate of 5% was considered and a bootstrap regression was used to assess material costs' dynamics over time (α = 5%). Monte-Carlo simulation generated cost-effectiveness scatter plots. The study included 131 participants (ART = 65; HT = 66) and 112 (85.5%) were followed up over three years. Survival was higher in HT compared to ART restorations (ART = 32.7%; HT = 93.4% p < 0.001). The HT (€13.02) cost less compared to ART (€16.79) (p < 0.001 95% CI: -10.07 to -1.87) due to ART higher treatment failure and cumulative costs. Although baseline costs were lower in the ART group, the cumulative cost due to the need for restoration replacement was higher after 3 years. Hall Technique is a cost-effective strategy compared to Atraumatic Restorative Treatment for managing occluso-proximal carious lesions in primary molars in a school setting after 36 months, particularly from the perspective of the Brazilian public health system. This trial was registered in ClinicalTrials.gov (NCT02569047) on 2015-10-06.

Background This randomized controlled trial aimed to compare the efficacy of silver diamine fluoride (SDF) and casein phosphopeptide-amorphous calcium phosphate fluoride varnish (CPP-ACPFV) in preventing caries development, enamel breakdown, and sensitivity on molars affected by molar incisor hypomineralization (MIH) in children. Methods A total of 100 children aged 6 to 9 years were enrolled in the study with two contralateral permanent molars mildly affected by MIH. Affected molars were randomly and equally assigned to receive either SDF or CPP-ACPFV treatment. The interventions were applied at four different time points (baseline, 3, 6, 9 months), and the incidence of caries, caries progression, enamel breakdown, and sensitivity were assessed. Results The findings of this study revealed significant differences in the incidence of caries between the groups treated with SDF and CPP-ACPFV ( P-value < 0.05). Similarly, there was a significant difference in caries progression between the two groups ( P-value < 0.05). However, no significant differences were observed in enamel breakdown scores between the treatment groups, as the majority of teeth in both groups exhibited a score of 0. Furthermore, there were no significant differences in sensitivity between the treatment groups throughout the study period. Conclusions In conclusion, the results of this study provide evidence that molars treated with SDF demonstrated a lower incidence of caries and a higher rate of caries arrest compared to those treated with CPP-ACPFV. Both interventions showed promise in preventing enamel breakdown and improving sensitivity. These findings highlight the potential of SDF and CPP-ACPFV as effective treatments for caries prevention and management, emphasizing the importance of early intervention and appropriate dental care strategies in maintaining oral health. Trial registration ISRCTN54243749 (13/01/2022).

IntroductionMolar incisor hypomineralisation (MIH) is a qualitative defect of enamel development that occurs in the mineralisation phase. MIH affects one or more permanent molars and, occasionally, permanent incisors. The aim of the proposed study is to evaluate the clinical effect of antimicrobial photodynamic therapy (aPDT) on permanent teeth with MIH through decontamination and sensitivity control.Methods and analysisPatients from 8 to 12 years of age with permanent molars will be randomly allocated to three groups. Group 1: selective chemical–mechanical removal of carious dentinal tissue around the walls of the cavity with Papacárie Duo and a curette followed by the application of aPDT and deproteinisation with Papacárie Duo; group 2: selective removal of carious dentinal tissue around the walls of the cavity with a curette, followed by the application of aPDT and deproteinisation with a 5% sodium hypochlorite solution; group 3: selective removal of carious dentinal tissue using a curette. The selected teeth must have a carious lesion in the dentin and posteruptive enamel breakdown on one or more surfaces with an indication for clinical restorative treatment. The teeth will subsequently be restored using a mixed technique with resin-modified glass ionomer cement and bulk-fill composite resin. The data will be submitted to descriptive statistical analysis. Associations with age and sex will be tested using either the χ2 test or Fisher’s exact test. Pearson’s correlation coefficients will be calculated to determine the strength of correlations between variables. Comparisons of the microbiological results (colony-forming units) will be performed using analysis of variance and the Kruskal-Wallis test. Kaplan-Meier survival analysis will be performed to assess the performance of the restorations.Ethics and disseminationThis protocol has been approved by the Human Research Ethics Committee of Nove de Julho University (certificate number: 61027522.0.0000.5511/approval date: 23 August 2022). The findings will be published in a peer-reviewed journal.Trial registration numberNCT05443035.

Purpose To evaluate and compare the clinical effectiveness of alkasite with nanofilled resin composite restorations for occlusal caries lesions in permanent molar teeth of children, at one-year follow-up. Methods In this randomized controlled clinical trial with parallel design, 38 children aged 7–13 years with occlusal caries lesions on 59 first permanent molars were randomly allocated into two groups, Group 1: Filtek™ Z350XT (nanocomposite) and Group 2: Cention N ® (alkasite resin composite). The restorations were evaluated at one year using the United States Public Health Service (USPHS) criteria. Data were analyzed using Chi-square or Fisher’s exact test. Results All restorations had either Alpha or Bravo scores at one-year follow-up. In Group 1, all restorations scored Alpha, while one restoration each (3.6%) in Group 2 scored Bravo for fracture and marginal adaptation. All restorations in both groups scored Alpha for retention, secondary caries, and post-operative sensitivity. For anatomic form, all restorations in Group 1 scored Alpha, while three (10.7%) restorations in Group 2 had Bravo scores. For marginal discolouration, three restorations in both groups scored Bravo (11.5% and 10.7%, respectively). For surface roughness, one restoration (3.8%) in Group 1 and three restorations in Group 2 (10.7%) scored Bravo. The comparative results between the two groups for all the variables in the USPHS criteria were not statistically significantly different. Conclusions The performances of the nanofilled composite and alkasite were clinically acceptable and comparable. Alkasite can be an alternative material for the restoration of occlusal caries lesions in permanent molars of children. Clinical trial registration The clinical trial was registered at Clinical Trials Registry—India (CTRI Reg no: CTRI/2020/12/029830 Dated: 15/12/2020).

Objective This study aimed to evaluate the prevalence and patterns of impacted mandibular third molars (MTMs) and their association with distal caries in adjacent mandibular second molars (MSMs). Methods A total of 2000 randomly selected orthopantomograms (OPGs) were analyzed. MTM impaction patterns were classified using Winter’s and Pell-Gregory systems, and distal caries on MSMs were assessed. Statistical analyses included chi-square tests and multivariate logistic regression to evaluate associations between impaction characteristics and caries prevalence. Results Of the 1594 eligible OPGs, 37% exhibited MTM impactions. Among the 828 impacted MTMs identified, 19.56% were associated with carious lesions on the distal surface of adjacent MSMs. Statistical analysis revealed that mesioangular impactions significantly increased the likelihood of distal caries in MSMs. In contrast, Pell-Gregory Classes II-C and III-C were associated with reduced odds of caries. Age emerged as a strong predictor, whereas gender and other Winter’s classification categories did not significantly influence caries occurrence. Conclusion Impacted MTMs are associated with an increased risk of caries on the distal surface of MSMs. Impaction patterns and patient age influenced the prevalence of caries. Prophylactic removal of impacted MTMs in high-risk cases may help reduce the risk of caries development in MSMs.

Objectives The primary objective of this systematic review was to analyze the overall prevalence of distal caries in mandibular second molars (MSMs) associated with the presence of impacted mandibular third molars (IMTMs). Secondary objectives were to determine how IMTM position and level of impaction influence the occurrence of distal caries. Materials and methods PRISMA guidelines were followed. An automated search was conducted as well as a manual search for relevant clinical articles. The review included studies reporting IMTM and adjacent MSM presenting distal caries published in the last ten years. The quality of evidence was evaluated using the Newcastle-Ottawa Quality Assessment Scale. Results Thirteen studies met the inclusion criteria and underwent analysis; they included a total of 13,788 patients. The overall prevalence of caries in MSMs adjacent to IMTMs was 29.89% (CI 95%: 21.05 − 38.74%; p  < 0.001). Following Winter’s classification, the mesioangular position was the most frequently associated with caries with 43.37% (CI 95%: 33.03 − 53.70%; p  < 0.001). Following Pell & Gregory classification, position A was the most frequently associated with caries with 33.97% (CI 95%: 24.06 − 43.89%; p  < 0.001). Conclusions IMTMs in mesioangulated positions, especially if accompanied by level A impaction, present the highest risk of MSM distal caries. Clinical relevance Knowing which positions and level of IMTMs are most frequently associated with distal caries in MSMs is crucial to implementing preventive measures. Review registration This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Reg. number: CRD42023393143.

This study aimed to evaluate the effects of low-level laser therapy (LLLT) on pulpal response of primary teeth. Twenty mandibular primary molars were randomly divided into the following groups: group I Buckley’s formocresol (diluted at 1:5), group II calcium hydroxide, group III LLLT + zinc oxide/eugenol, and group IV LLLT + calcium hydroxide. LLLT parameters were set at 660-nm wavelength, 10-mW power output, and 2.5 J/cm 2 energy density for 10 s in continuous mode (InGaAlP laser, Twin Laser®, MMOptics, Sao Carlos, Sao Paulo, Brazil). The teeth were extracted at the regular exfoliation period. The dentin-pulp complex was graded by an established histopathological score system. Statistical analysis was performed by Kruskal-Wallis and chi-square test. The histopathological assessment revealed statistically significant differences among groups ( P  < 0.05). The lowest degree of pulpal inflammation was present in LLLT + calcium hydroxide ( P  = 0.0296). Calcium hydroxide showed the highest rate of hard tissue barrier ( P  = 0.0033), odontoblastic layer ( P  = 0.0033), and dense collagen fibers ( P  = 0.0095). On the other hand, formocresol showed the highest incidence of internal resorption ( P  = 0.0142). Based on this study, low-level laser therapy preceding the use of calcium hydroxide exhibited satisfactory results on pulp tissue healing. However, further clinical studies on human teeth with long-term follow-up are needed to test the low-level laser therapy efficacy.