JOURNAL OF RESEARCH IN DENTAL AND MAXILLOFACIAL SCIENCES
Year:2024 | Volume:9 | Issue:4|Papers Count:10

Background and Aim: This study compared the efficacy of buccal infiltration anesthesia (BIA) with articaine versus inferior alveolar nerve block (IANB) with lidocaine for pulpotomy of primary mandibular second molars under intravenous sedation.   Materials and Methods: This split-mouth randomized clinical trial was conducted on 29 uncooperative children (Frankl scores I & II) between 3-6 years with bilateral primary mandibular second molars requiring pulpotomy. After intravenous sedation, one random quadrant received IANB with 2% lidocaine and the respective tooth underwent pulpotomy with mineral trioxide aggregate and subsequent coronal restoration with a stainless-steel crown. The other quadrant received BIA with 4% articaine in the next session for pulpotomy of the respective tooth. The behavior of children was evaluated right after receiving the sedative (T0), during anesthetic injection (T1), during pulp exposure (T2), and in the recovery room (T3) using non-verbal pain scale-revised (NVPS-R). Data were analyzed by one-way and two-way repeated measures ANOVA (alpha=0.05).  Results: The odds of calmness of children during the entire procedure were 1.7 times higher in BIA than IANB but this difference was not significant (P=0.061). The mean heart rate (HR) of children was generally higher in IANB than BIA (P=0.04 at T1, P<0.001 at T2, and P=0.01 at T3). The effect of time on HR was also significant (P<0.001). Blood oxygen saturation rate (SPO2) was higher in BIA than IANB during the procedure (P<0.001). Conclusion: BIA with articaine had optimal efficacy comparable to that of IANB with lidocaine for pulpotomy of primary second molars under sedation.

Background and Aim: This study aimed to compare the efficacy of buccal infiltration anesthesia (BIA) with 4% articaine versus inferior alveolar nerve block (IANB) with 2% lidocaine for extraction of primary mandibular molars. Materials and Methods: This single-blind randomized controlled clinical trial evaluated 100 children between 4-8 years requiring extraction of primary mandibular molars. The children were randomly assigned to two groups (n=50) of IANB with 2% lidocaine and 1:100,000 epinephrine (control), and BIA with 4% articaine and 1:200,000 epinephrine. The Wong-Baker Faces Pain Rating Scale (WBFPS) and the Face, Legs, Activity, Cry, and Consolability (FLACC) scale were used to assess the analgesic efficacy of each technique, and the resultant behavioral reaction of children. Data were analyzed by the Mann-Whitney, Chi-square, and independent t-tests (alpha=0.05).  Results: In total, 43 girls and 57 boys with a mean age of 6.59±1.20 years were evaluated. The mean FLACC score was 0.98 in the lidocaine and 1.44 in the articaine group with no significant difference (P=0.246). The mean WBFPS score was significantly higher in the articaine than in the lidocaine group (P=0.039), but the difference between the two groups separately for each tooth type was not significant (P>0.05). Conclusion: Despite the significantly lower pain score of the IANB with lidocaine group, BIA with 4% articaine was comparable to IANB with 2% lidocaine in behavioral control of children, and may be considered as an acceptable alternative.

Background and Aim: This study aimed to compare the effects of root canal irrigation with sodium hypochlorite (NaOCl) and super-oxidized water on post-endodontic pain in single-canal teeth.   Materials and Methods: This double-blind randomized clinical trial was conducted on 72 patients with irreversible pulpitis of single-canal teeth. The patients were randomly assigned to two groups (n=36) for root canal irrigation with either 1% NaOCl or 50% super-oxidized water during endodontic treatment. The root canals were instrumented by the step-back technique with a minimum and maximum apical preparation size of 30 and 50, respectively, and flaring by 5 files larger than the master apical file. Patients' pain level was quantified at 6, 12, 24, 48, and 72 hours, and 7 days postoperatively using a visual analog scale (VAS). Root canal treatments were accomplished in two sessions, and calcium hydroxide was applied as intracanal medicament. Data were analyzed by the Mann-Whitney test (alpha=0.05).  Results: At 12 hours postoperatively, the pain score was significantly higher in the NaOCl group than the super-oxidized water group (P=0.043). The pain score gradually decreased in both groups after 12 hours with no pain recorded at 7 days. The difference in pain score between the two groups was not significant at any other time point (P>0.05). Conclusion: The present results revealed significantly lower level of pain at 12 hours post-treatment of single-canal teeth in root canal irrigation with super-oxidized water.

Background and Aim: Application of disinfectants in pits and fissures is a commonly used method to lower the cariogenic bacterial count in teeth. This study compared the effect of applying chlorhexidine on microleakage of pit and fissure sealant therapy using two adhesive systems. Materials and Methods: In this in vitro study, 60 extracted molar teeth were randomly assigned to four groups (n=15): control group 1 (etch-and-rinse adhesive), control group 2 (self-etch adhesive), group 3 (etch-and-rinse adhesive and 0.2% chlorhexidine), and group 4 (self-etch adhesive and 0.2% chlorhexidine). After applying the sealant and subjecting the teeth to thermocycling, the teeth were immersed in 5% methylene blue solution. The teeth were sectioned into four parts and the dye penetration depth was measured under a stereomicroscope. Data were analyzed by the Mann–Whitney and Kruskal–Wallis tests using SPSS 24 (alpha=0.05).  Results: Microleakage was significantly lower in the self-etch adhesive system compared to the etch-and-rinse system in the control groups (P<0.05). For the etch-and-rinse adhesive, there was no significant difference in microleakage between the two groups with chlorhexidine (1.67±1.11) and without chlorhexidine (1.33±0.81) (P>0.05). Similarly, in the self-etch adhesive, microleakage did not significantly differ between groups with chlorhexidine (1.07±0.45) and without chlorhexidine (1.07±0.70) (P>0.05). The interaction effect of adhesive type and chlorhexidine on microleakage was not significant (P=0.428). Conclusion: Application of chlorhexidine with both self-etch and etch-and-rinse adhesive systems did not significantly affect the microleakage of fissure sealant therapy. Chlorhexidine may be used under fissure sealants for its antimicrobial effects without increasing microleakage.

Background and Aim: This study aimed to assess the alterations in microhardness of Clearfil Universal Bond Quick (CUBQ), G-Premio Bond (GPB), and Scotchbond Universal (SBU) immediately, 24 hours, and 6 months after curing.   Materials and Methods: In this in vitro study, a composite disc was fabricated. A putty/wash impression was made from the disc to serve as a mold. CUBQ, GPB, and SBU adhesives were applied in the mold, and after allowing 3 hours for the solvent to evaporate, they were cured by a LED curing unit for 20 seconds. Ten specimens were fabricated from each adhesive. The microhardness of the specimens was measured by a microhardness tester immediately, 24 hours, and 6 months after curing. Data were analyzed by repeated measures ANOVA (alpha=0.05).  Results: The mean microhardness of the three adhesives was significantly different immediately after curing (P<0.001), and CUBQ showed significantly higher microhardness than GPB (P<0.001) and SBU (P=0.004). The difference in microhardness of the three adhesives was not significant after 24 hours and 6 months (P>0.05). Conclusion: The present results showed that the microhardness of all three tested universal adhesives increased with time.

Background and Aim: This study aimed to assess the accuracy of age estimation by pulp/tooth area ratio (PTR) of maxillary canine teeth on cone-beam computed tomography (CBCT) scans. Materials and Methods: This descriptive analytical study was conducted on 99 CBCT scans of patients between 18 to 71 years with fully erupted sound maxillary canine teeth. The CBCT scans were evaluated in five sections namely the mid-sagittal section, mid-coronal section, and axial planes [cementoenamel junction (CEJ) section, root section at one-quarter distance from the CEJ, and mid-root section] using OnDemand software. The tooth and pulp surface areas and PTR were calculated. The absolute error of age estimation was calculated by the regression test.  Results: In females, PTR of the CEJ section (-0.338) and one-quarter root section of the axial plane (-0.459; P=0.003 and P=0.000, respectively), and in males, PTR of the mid-root section of the axial plane (-0.346) and mid-sagittal section (-0.455; P=0.013 and  P=0.002, respectively ) had significant correlations with age. The mean absolute error of age estimation in the present method, compared with the chronological age of individuals, was 7.227 years. In 39.5% of the cases, the obtained regression formula could estimate age with less than 5 years difference. No significant difference was noted in age estimation for males and females in this method. Conclusion: It appears that PTR on CBCT images of maxillary canine teeth has a significant correlation with chronological age.  The obtained formula in this study could estimate age with acceptable accuracy (less than 7.5 years).

Background and Aim: Hybrid ceramics are gaining popularity for cosmetic dental restorations due to their advantageous mechanical properties and optimal esthetic results. However, the potential effects of bleaching on their color stability are still a subject of interest. This study aimed to assess the effect of bleaching on stained hybrid ceramics in comparison with IPS e.max.   Materials and Methods: This in vitro study was conducted on 48 specimens fabricated from IPS e.max CAD, Vita Enamic, and Cerasmart (n=16) ceramics. The baseline color coordinates of the specimens were measured by a spectrophotometer. Eight specimens from each ceramic type underwent accelerated aging, and their color coordinates were measured again to calculate the color change (ΔE1). The remaining 8 specimens in each ceramic group were immersed in tea solution, and their ΔE was calculated (ΔE2). Subsequently, all specimens were exposed to 20% carbamide peroxide for 8 hours/day for 10 days, and ΔE3 and ΔE4 were calculated. Data were analyzed by two-way ANOVA and Tukey’s test (alpha=0.05).  Results: Type of ceramic, type of intervention (aging, immersion in tea solution, bleaching), and their interaction significantly affected the ΔE (P=0.0001). The maximum and minimum ΔE values were recorded for Cerasmart and IPS e.max ceramic, respectively. Conclusion: Both accelerated aging and immersion in tea solution caused staining of hybrid ceramics. The minimum ΔE after bleaching occurred in aged ceramics. Bleaching of stained ceramics improved their color.

Background and Aim: The Donohue syndrome, also known as leprechaunism, is a rare autosomal recessive genetic disorder of insulin resistance. The severe form of insulin resistance seen in this syndrome is due to a mutation in the insulin receptor gene. This syndrome has symptoms such as delayed growth before and after birth, premature growth, lipoatrophy, hypertrichosis, acanthosis nigricans, and dysmorphic face. Case Presentation: This report presents oral manifestations (such as macrodontia, severe crowding, supernumerary tooth, etc.) and management of a 10-year-old patient with the Donohue syndrome. Conclusion: Considering the extensive oral manifestations of the Donohue syndrome, good oral hygiene and regular dental follow-ups are necessary for such patients.

Background and Aim: Identification of harbored bacteria and their resistance profile is crucial to manage endodontic treatment. This study aimed to assess the nutritional types and drug resistance profiling of microbiota harboring dental root canal of patients with apical periodontitis. Materials and Methods: This cross-sectional study identified bacteria and their resistance profile in 10 samples taken from acute and chronic periodontitis patients using the VITEK 2 system.  Results: A total of 49 bacteria belonging to 24 species were recovered from two sets of 10 samples together with a higher bacterial diversity in chronic periodontitis condition. Enterococcus, Clostridium, Streptococcus, Prevotella and Propionibacterium bacterial species were identified in both cases but Streptococcus, Enterococcus, and Propionibacterium were more prevalent in chronic patients. The prevalence of facultative anaerobes (51.02%) was the highest, and that of obligate aerobes (4.08%) was the lowest; obligate anaerobes accounted for 16.33%, while strict anaerobes accounted for 20.4% in both conditions. Microaerophilic organisms (Lactobacillus species) were found only in persistent apical periodontitis (8.16%); whereas, aerobes were predominant (7.14%) in acute conditions. The majority of the strains were resistant to tetracycline, cefoxitin, and oxacillin but the members of the four predominant genera (Enterococcus, Clostridium, Streptococcus, Propionibacterium) were resistant to penicillin, cefotaxime and cefoxitin. Very few strains exhibited resistance to ofloxacin, vancomycin and gentamycin. Conclusion: The present results showed that acute and chronic root canal infections were polymicrobial infections, with Enterococcus, Streptococcus and Propionibacterium species being the predominant ones. These predominant bacteria were resistant to penicillin, cefotaxime and cefoxitin.

Background and Aim: This study compared the efficacy of an experimental resin containing polyhedral oligomeric silsesquioxane (POSS) nanoparticles with methacrylate groups (MA-POSS) versus the Icon resin regarding the masking, color stability, and microhardness of artificially induced white spot lesions (WSLs).   Materials and Methods: In this in vitro study, 60 bovine enamel specimens were assigned to two groups for assessment of color (group C) and surface microhardness (group H). white spot lesions were induced on the specimens using demineralizing and remineralizing solutions. Each group was divided into two subgroups for the application of experimental resin and Icon. the color and surface microhardness of specimens were measured, after the induction of WSLs, and after infiltration. Group C samples were immersed in coffee (1 hour/day for one week) and their color was measured again. ANCOVA was used to compare microhardness between the two resin groups. To compare the masking and staining of infiltrated lesions, ΔE, ΔL and L* values after infiltration and staining were compared with the values after the induction of WSLs using independent t-test and repeated measures ANCOVA (α=0.05).  Results: Microhardness analysis by ANCOVA revealed no significant difference between the groups following resin infiltration (P=0.144). The performance of the two resins after infiltration (P=0.75 for ΔE, P=0.20 for ΔL, P=0.57 for L*) and after staining (P=0.31 for ΔE, P=0.07 for ΔL, P=0.32 for L*) was not significantly different. Conclusion: The experimental resin was comparable to Icon with the main advantage of easier availability in Iran.