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Introduction: Pulpectomy has been a treatment of choice in all necrotic primary teeth. Advancing technology has brought the rotary system to reduce the manual dexterity and improve the quality of treatment for pulpectomy. Advancing technology in pediatric dentistry should be used for the better treatment protocol. Aim: The aim of this study is to compare the obturation quality and instrumentation time after root canal instrumentation with rotary Kedo-S files, hand K-files, and H-files in primary molars. Materials and Methods: A randomized control trial where pulpectomy was performed on 75 primary molars equally distributed for instrumentation with K-file, H-files rotary Kedo-S files, respectively. The instrumentation time and obturation quality were noted. Results: Kedo-S files showed the least instrumentation time with better obturation quality as compared to other two groups (P < 0.001). Conclusion: Pediatric rotary files Kedo-S has better obturation quality in minimum instrumentation time.

This study aimed to assess the apical extrusion of debris during instrumentation of primary canines using three endodontic file types. Forty-five extracted primary canines were randomly assigned to three instrumentation groups ( n  = 15): Hand K-files; and the motorized Kedo-S files and XP-endo Shaper files. The apically extruded debris produced during the procedure was collected and dried in pre-weighed Eppendorf tubes, and the mass of debris was calculated. The time required for the endodontic procedure was also recorded. Analysis of variance (ANOVA) and Tukey’s post hoc test were used with a significance level set at 5%. XP-endo Shaper and Kedo-S files extruded significantly less debris compared with hand K-files with means of 0.84 ± 0.31 and 1.20 ± 0.67 mg respectively, compared to 2.13 ± 0.31 mg ( p  < 0.0001). No significant difference was found between the two motorized files. Less time was required to complete the procedure with the XP-endo Shaper compared to the hand K-files ( p  < 0.0001) and Kedo-S files ( p  < 0.0001). Within the limitations of the present study, it may be concluded that motorized files extruded less debris and required less instrumentation time compared to traditional K-files, which could benefit paediatric patients with root canal treatment needs.

Objectives This study aimed to evaluate the clinical and radiographic success of endodontic treatment in primary molars, in addition to the evaluation of the working time (WT) and cost-effectiveness Ratio (CER), and Incremental Cost-Effectiveness Ratio (ICER) of the Fanta AF Baby and Zuanba file systems, compared to manual K-files. Materials and methods One hundred and sixty-two-second primary molars were randomly assigned into three groups, according to the type of the instrumentation file system. A pulpectomy procedure was performed, and the average WT was recorded for each group. Clinical assessments were made at 3-, 6-, and 12-month follow-ups, while radiographic assessments were performed at 6- and 12-month follow-ups. The direct medical cost for one molar in each group was calculated, and the (CER) was determined for each group. ICER was calculated for each group, based on the average WT and radiographic success at the 12-month mark as clinical effectiveness parameters. Results The average WT in the manual K-file group was 14.65 (± 1.85) minutes, while the Fanta AF baby file system and Zuanba file system group had an average WT of 10.52 (± 1.13) minutes, and 9.46 (± 1.12) minutes, respectively. By the end of the follow-up period, all groups exhibited the same clinical success rate of 96.7%, with no statistically significant difference ( p  > 0.05). For the radiographic success, the K-file group displayed a higher frequency of failures (11.1%), followed by the Fanta AF baby file system group (7.4%). The Zuanba file system group had the fewest failures, reporting only two cases (3.7%). Regarding ICER, the Fanta AF Baby files system was found to incur an additional cost of 50.63 EGP for reducing one minute of working time, and 52 EGP for achieving one extra successfully treated second primary molar compared to the K-files system. While the Zuanba file system costs an additional 10.98 EGP for reducing one minute of WT, and an extra 28.5 EGP for getting an extra second primary molar successfully treated compared to the K-files. Conclusion Both assessed rotary file systems showed shorter average WT, higher radiographic success, and CER compared to the manual k file. Clinical relevance This study aids the pediatric dentist in the choice of the most effective, both clinically and economically, rotary filling system for endodontic treatment of primary molars. Trial registration The clinical trial was registered at clinical trial.gov identifier NCT04279041, on 2020-02-18.

Background Sodium hypochlorite (NaOCl) gel can be a potential substitute in daily pediatric dentistry practice. Given its high antimicrobial efficacy, NaOCl gel is expected to induce healing and improve pulpotomy treatment outcomes. This study aimed to perform a histological, clinical, and radiographical evaluation of pulpotomy in human primary molars utilizing 2.25% (NaOCl) gel as a medicament, followed by white mineral trioxide aggregate (WMTA) as a base material. Materials and methods A randomized, second-blinded, split-mouth clinical trial was conducted in cooperative patients aged 8–10 years with 48 carious first primary molars, which were treated by: (I) NaOCl gel group: following hemostasis, teeth were pulpotomized utilizing 2.25% NaOCl gel, and then WMTA paste was applied as a dressing material, and (II) control group: following hemostasis, WMTA paste was applied as a dressing material. Later, each group was sub-divided into three sub-groups ( n  = 8) according to the time planned for serial extraction: (I) 7 days, (II) 30 days, and (III) 90 days for histological evaluation. In addition, 40 s primary molars in cooperative patients aged 5–10 years indicated for pulpotomy were randomly allocated into two groups for clinical and radiographical evaluation at 3, 6, and 12 months follow-up. Data were analyzed by applying the chi-square test ( p  < 0.05). Results NaOCl gel improved odontoblastic integrity and dentin bridge formation ( p  < 0.001) without increasing pulp necrosis or calcifications. The NaOCl gel group showed a 90% clinical and radiographical success rate at 3, 6, and 12 months of follow-up. In the control group, the clinical success rate was 85% after 3, 6, and 12 months, whereas the radiographical success rate was 100% at 3 months and decreased to 85% after 6 and 12 months. Conclusions Utilizing 2.25% NaOCl gel as a medicament in human primary molars pulpotomy improved the treatment outcomes of the WMTA. Trial registration ISRCTN registry, ISRCTN15908457, registered 22 July 2024.

Background Pulpectomy continues to be the standard treatment recommendation for management of vital primary molars diagnosed with symptomatic irreversible pulpitis. The recent decade has seen a paradigm shift in the treatment concepts of how vital mature permanent molars diagnosed with irreversible pulpitis can be more conservatively managed using vital pulp therapy techniques like pulpotomy. However, despite emerging evidence indicating similarities between primary and permanent tooth pulp response to dental caries, there is limited research on whether pulpotomy can be similarly used as a definitive treatment modality for vital primary teeth with irreversible pulpitis. This randomised controlled trial (RCT) aims to compare the treatment effectiveness of pulpotomy versus pulpectomy in management of vital primary molars diagnosed with symptomatic irreversible pulpitis over a two-year period. Methods/design This clinical study is a parallel, two-armed, open label, non-inferiority RCT with a 1:1 allocation ratio between the experimental intervention arm (pulpotomy) and the active comparator arm (pulpectomy). Healthy cooperative children, between 4–9 years of age, who have painful primary molars with clinical symptoms typical of irreversible pulpitis will be recruited after obtaining informed consent from their parents/legal guardians. 50 vital primary molars clinically diagnosed with symptomatic irreversible pulpitis will be randomly distributed between the two treatment arms. The primary outcomes that will be assessed are clinical and radiographic success after six-months, one-year and two-years of the trial interventions. The influence of baseline pre-operative variables (age; gender; tooth type; site of caries; pre-operative furcal radiolucency; pre-operative pain intensity) and intra-operative factors (time taken to achieve haemostasis) on treatment outcomes will also be assessed. The secondary outcome evaluated will be the immediate (24 h and 7 d) post-operative pain relief afforded by the two treatment interventions. Discussion This trial seeks to provide evidence on whether pulpotomy treatment can be no worse than the standard pulpectomy treatment for the management of symptomatic irreversible pulpitis in vital primary molars. Trial registration ClinicalTrials.gov (NCT06183203). Registered on 30 January 2024.

Background To avoid untoward changes when primary teeth are replaced by permanent teeth, resorption of the material used in primary teeth root canal filling should occur at the same rate as root resorption. The Aim of this study was to compare the success rates of a mixed primary root canal filling (MPRCF, ingredients: zinc oxide–eugenol [ZOE], iodoform, calcium hydroxide) to those of ZOE and Vitapex in pulpectomised primary molars. Methods One hundred and sixty primary molars from 155 children (average age 5.88 ± 1.27 years) underwent two-visit pulpectomy using one of the three materials. The clinical and radiographic findings at 6, 12 and 18 months were assessed. Results At 6 and 12 months, the MPRCF and ZOE success rates were 100%. The Vitapex group showed clinical success rate and radiographic success rate of 100 and 94.5% at 6 months, and 80.4 and 60.7% at 12 months. The 18-month clinical success rates of the MPRCF, ZOE and Vitapex were 96.2, 92.2 and 71.4% and radiographic success rates were 92.5, 88.2 and 53.6%, respectively. There was a statistically significant difference in the success rates between MPRCF and Vitapex and no significant differences between MPRCF and ZOE. More MPRCF were resorbed at same rate with roots than ZOE and Vitapex. Early resorption of root filling resulted in more failure. Conclusions The mixture of ZOE, iodoform and calcium hydroxide can be considered an effective root canal filling material in pulp involved primary teeth and had no adverse effect on tooth replacement. Trial registration ChiCTR-TRC-14004938 . Registered 13 July 2014.

Background Guidelines in pediatric restorative dentistry recommend the use of preformed pediatric stainless steel crowns (SSCs) in cases of severe tooth decay of at least two surfaces. This clinically effective and safe restorative option is frequently refused by parents for esthetic reasons; they prefer conventional restorations using esthetic filling materials (composites, glass ionomer) if lesion severity limited to two surfaces permits. Recently, manufacturers have proposed esthetic preformed pediatric zirconia crowns (ZCs) but these have been assessed in only two randomized clinical trials (RCT) with follow-ups of 6 and 12 months. Only one of these RCTs was carried out on primary molars to test ZCs (NuSmile ZR) without a groove in its inner surface. The primary objective of this proposed RCT is to assess the effectiveness of ZCs compared with SSCs. Our hypothesis is that the effectiveness of ZCs will be equivalent to that of SSCs. Methods In this split-mouth, 2-year RCT, pairs of primary molars in 101 child participants will be randomized and restored with SSCs (ESPE, 3M) and ZCs (EZCrowns, Sprig Oral Health Technologies) characterized by grooves on their inner surface. Primary molars will first be allocated to SSCs, and 1 to 2 weeks later the other primary molar of the same pair will be restored by ZC. The primary outcome is the success defined by the “absence of major clinical and radiographic failure” (e.g., pain, pulp infection, dental abscess or periradicular pathology visible on radiographs). The secondary outcomes include the retention and fracture rates, the gingival condition, the wear of the antagonist of the treated teeth, as well as both parental and child satisfaction. Discussion This study will investigate two types of preformed pediatric crowns for the management of severe decay on primary molars. The results may help practitioners choose the better therapeutic option and to explain to parents the advantages and disadvantages of these two therapies. Trial registration NCT03296709 . Registered on  27 September 2017.

Study designA randomised parallel controlled clinical trial was conducted between 2013 and 2015 at the University of Sao Paulo, Brazil, to assess the impact of pulpectomy or extraction on the oral health-related quality of life (OHRQoL) of children with pulp necrosis in primary molars.Study selectionChildren between the ages of 3 and 5 who were in good health but had extensive caries in at least one primary molar with signs of pulpal necrosis (also as seen radiographically, caries reaching the pulp with no signs of internal or external resorption) were considered for inclusion. Additionally, teeth with sufficient structure for rubber dam placement were also included. Children with any systemic, neurological, or other conditions that negatively impacted their growth were excluded.Clinical procedures and success criteriaAfter computer-generated randomisation, 100 children were assigned randomly into two groups: 50 in the pulpectomy group and 50 in the dental extraction group. A paediatric dentist performed all procedures under local anaesthesia without sedation or general anaesthesia, and a rubber dam was used for pulpectomy with composite restoration in a single session. The OHRQoL scores were evaluated at baseline, 4, 8, and 12 months using the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) via face-to-face interviews with parents conducted by a researcher trained in a single-blinded fashion. Additionally, the child’s self-reported dental anxiety was measured using the Facial Image Scale (FIS), and dental pain was assessed using the Wong-Baker Faces Pain Scale (WBFPS) immediately after the treatment as secondary outcomes.ResultsThe mean difference (SD) in the total B-ECOHIS score between baseline and after 12 months was 12.66 (6.79) for the pulpectomy group and 10.94 (9.28) for the extraction group, with effect sizes of 3.2 (95% CI: 2.42–4.20) and 1.4 (95% CI: 0.84–2.11), respectively. While both treatments significantly improved the children’s OHRQoL after 12 months, the pulpectomy group showed greater long-term improvement compared to the extraction group, with mean differences (SD) of 4.86 (6.13) and effect sizes of 0.8 (0.46–1.13; p < 0.001). Moreover, children in the extraction group showed higher levels of anxiety compared with those in the pulpectomy group at 12-month follow-up (OR = 2.52; 95% CI = 1.30–4.89), and they reported 93% more odds of ‘dental pain with high level’ immediately after treatment than those in the pulpectomy group (OR = 1.93; 95% CI = 0.83–4.49).ConclusionChildren treated with pulpectomy in their necrotic primary molars were found to have better OHRQoL than those who had their primary molars extracted.

Objective. The aim of this study was to evaluate and compare, both clinically and radiographically, the effects of calcium silicate-based materials (i.e., ProRoot MTA [PR-MTA], MTA-Plus [MTA-P], and Biodentine [BD]) and ferric sulfate [FS] in pulpotomy of primary molars. Materials and Methods. In this randomized clinical trial, 29 healthy 5- to 7-year-old children with at least four carious primary molars with no clinical or radiographic evidence of pulp degeneration were enrolled. The pulpotomy agents were assigned as follows: Group 1: BD; Group 2: MTA-P; Group 3: PR-MTA; and Group 4: FS. Clinical and radiographic evaluations were performed at 6, 12, and 24 months. Data were analyzed using chi-square tests. Results. Total success rates at 24 months were 82.75%, 86.2%, 93.1%, and 75.86%, respectively. No statistically significant differences in total success rates were observed among the groups at 6-, 12-, and 24-month follow-ups. When the groups were compared according to follow-up times, the success rates in each group did not vary significantly among the 6–12-month, 6–24-month, or 12–24-month periods (p>0.05). Conclusion. Although the success rates of BD, MTA-P, MTA-PR, and FS did not differ significantly, calcium silicate-based materials appeared to be more appropriate than FS in clinical practice.

Aim: The primary aim of the following study is to evaluate and secondary aim is to compare clinically and radiographically the success of using white mineral trioxide aggregate (MTA) versus formocresol (FC) medicament for primary tooth pulpotomy. Materials and Methods: A total of 100 teeth were selected for pulpotomy; of which 50 teeth underwent FC pulpotomy and 50 teeth underwent pulpotomy with white MTA. Out of 100 treated teeth, 82 teeth (42 FC and 40 MTA teeth) were available at the end of 24 months for evaluation. 4 failures were found in FC group at 1 st month evaluation and no failures were found in white MTA group. A statistical analysis was performed to evaluate the overall success rate of study and individual success rates of medicaments. Overall success rate of the study was 95%, success rate of FC group was 90.48% and success rate of MTA group was 100%. Results: MTA produced better results as pulpotomy medicament in comparison to FC. The superior success obtained in the present study was matching other studies mentioned in the literature. Conclusion: MTA seems to be a promising pulpotomy medicament for future use.