Removal of Dental Caries Using a Pulsed Nd:YAG Laser - In Vitro and In Vivo

The pulsed Nd:YAG laser energy was tested for its effect on carious lesions in both primary and permanent teeth. Four individual experiments were designed to assess the different effects of this laser wavelength on the hard tissue of the teeth. The first experiment assessed the effect of three different laser energy densities on carious dentine. These energies were also tested for their effect on sound, unaffected dentine, to clarify the effect of the different laser energies on the sound underlying dentine after the dentine caries had been removed. The power of 60 mJ at 15 pps (1.25 W) was confirmed to be the optimal power setting amongst the powers tested in this study. This laser energy was therefore used for the following experiments. The degree of pulp temperature rise following the exposure of the laser during caries removal was evaluated and compared to the routinely used heat- producing pieces of equipment in vivo, namely: the conventional drill and the polymerising blue light. The temperature rise caused by the laser energy of 1.25 W for 30 sec was found to be considerably higher than that of the other two. However, this peak temperature was shown to drop to lower levels, close to the baseline temperature, immediately after the irradiation stopped. The changes of the dentine surface following laser/drill caries removal was tested by assessing the margins of restorations for the presence of any gap and any microleakage. Results showed that the restorations of teeth in both laser- and drill-treated groups indicated some degrees of microleakage but with no significant differences between the two. The gap sizes measured were also found to have no significant differences between the two groups of laser- and drill-treated teeth. It was suggested, therefore, that preparation of the cavities by the laser can be as efficient as conventional drilling for the adhesion of adhesive restorative materials. And finally, the applicability of the laser for the removal of dental caries in anxious children was evaluated. This also permitted observations to be made on the in vivo effects of this laser on a group of vital pulps. Patients' anxiety was assessed by employing all three parties involved in the child's dental treatment: operator, child, parent. Results of this study indicated that patients had a higher preference for the laser caries removal technique when compared to conventional drilling. Both patient and parent were asked as to their views about the two techniques of caries removal. In addition, the patient's reactions were recorded before, during, and after each treatment. Each child received both treatment modalities to enable the assessment of the effect of individual techniques on patients' anxiety. Pulps of the treated teeth were assessed by means of ethyl chloride and the Electric Pulp Tester, in addition to the radiographic and clinical examination of the surrounding structures. Results of these investigations revealed that pulpal status was not only different in those teeth treated with the laser, when compared with the drill, when they were examined after 18 to 24 months follow-up. The clinical assessment of restored teeth was also carried out over the same period (18-24 months) and indicated comparable success to conventional cavity preparation for the laser irradiated teeth. In conclusion, it seems that the pulsed Nd:YAG laser, with the energy level of 1.25 W for a maximum of 30 sec for each exposure may be used with minimal pulpal damage for the treatment of caries in primary teeth. This may provide an acceptable alternative to conventional drilling for young, fearful patients and may, therefore, reduce the amount of dental fear and anxiety in this group of the society

Evaluation of Four Pulpotomy Techniques in Primary Molars: A Randomized Controlled Trial

Introduction: This trial was designed to evaluate the clinical and radiographic success rates of calcium-enriched mixture (CEM) cement with and without low level laser therapy (LLLT) and compare them to that of formocresol (FC) and ferric sulfate (FS) in primary molar pulpotomies. Methods and Materials: This randomized clinical trial was conducted on a total of 160 teeth selected from 40 patients aged 3-9 years. Patients with at least four primary molars needing pulpotomy, were included in order to have each tooth assigned randomly in one of the four following groups; FC, FS, CEM, and LLLT/CEM. Six- and twelve-month follow-up periods were conducted in order to enable a clinical and radiographic evaluation of the treated teeth. Collected data were analyzed using Cochran Q Tests. Results: The 12-month clinical success rate for each technique was: FC=100%, FS=95%, CEM=97.5% and LLLT/CEM=100% with no significant differences (P>0.05). Furthermore, 12-month radiographic success rate for each technique was: FC=100%, FS=92.5%, CEM=95% and LLLT/CEM=100% with no significant differences (P>0.05). Conclusion: Favorable outcomes of four treatment techniques in pulpotomy of primary molar teeth were comparable. CEM with/without LLLT may be considered as a safe and successful pulpotomy treatment modality compared to current conventional methods.Keywords: Calcium-Enriched Mixture; CEM Cement; Ferric Sulfate; Formocresol; Low Level Laser Therapy; Primary Molar; Pulpotomy

Role of reinforcement methods in retention of composite restorations of primary anterior teeth

Objectives This study aimed to evaluate the retention of composite restorations of primary anterior teeth reinforced with composite posts, glass fiber posts, para-pulpal pins with composite posts, and para-pulpal pins alone.Methods Forty freshly extracted sound primary canine teeth with at least two-third of the root length remaining were selected. After disinfection, the tooth crown was cut perpendicular to the longitudinal axis. Root canals were prepared and filled using zinc oxide eugenol paste. The teeth were randomly allocated into four groups and restored using one of the following: Composite posts, glass fiber posts, para- pulpal pins with composite posts, and para-pulpal pins alone. Composite cores were constructed while a preformed U-shaped orthodontic wire was placed in the composite tip, samples were then placed in a universal testing machine for measurement of retention. The minimum force required to dislodge the restoration or cause fracture was considered as the retentive strength. The collected data were analyzed using one-way ANOVA and Tukey’s test (P < 0.05).Results There were statistically significant differences between groups (P = 0.011). The mean retention in the para-pulpal pins with composite post group (131.72 ± 32.35N) was greater than that in composite posts (93.65 ± 24.45N), glass fiber post (95.92 ± 25.35N), and the para-pulpal pin group (95.34 ± 29.56N) (P < 0.05). Other differences were not significant (P > 0.05).Conclusion para-Pulpal pin alone may not help in improving the retention of full crown restoration of primary anterior teeth. However, when used along with a composite post, it appears to improve the retention of restoration

Post-operative effects of Oral Midazolam versus Hydroxyzine on Ketamine Intravenously Sedated children

Objectives The aim of this clinical trial was to compare the effects of oral Midazolam with oral Hydroxyzine on post sedation using IV Ketaminein children.Methods This single blind cross over clinical trial, was conducted on 25 children aged 2-6 years of ASA I and definitely negative by Frankl behavioral scale. Participants were divided into two groups: Group I received hydroxyzine syrup premed at the first session and midazolam oral at the 2nd visit. Group II received the premed in the opposite order. Vital signs, were recorded sedation depth, recovery and discharge status and compared potential adverse effects of sedative drugs were checked and recorded including sleepiness, nausea and vomiting, vertigo at 1stand 6th hours of discharge. Collected data were analyzed using SPSS V 20 using Repeated Measures ANOVA and Mann-Whitney tests.Results No significant differences were noticeable between two groups when vital signs, were compared in addition to response to drugs, working time, sleepiness, nausea and vomiting rates. However, there was a significant difference between groups in the incidence of vertigo one hour post operatively with higher prevalence in the Hydroxyzine group. (P=0.022)Conclusion Under the circumstances of this study, no significant difference was found between the two regimen groups, but vertigo was appeared as being higher after the first hour in the Hydroxyzine group

Crazing level after pin insertion in anterior primary teeth: a preliminary in vitro study

Objectives This study aimed to investigate dentinal crack rate following parapulpal pin insertion in anterior primary teeth.Methods Thirteen sound freshly extracted primary canine teeth were horizontally sectioned 1 mm above the cementoenamel junction (CEJ). All samples were thoroughly inspected to ensure that the teeth had no cracks. The teeth were then mounted in acrylic blocks, and subjected to drilling and insertion of a single parapulpal pin in the prepared hole. The teeth were then sectioned perpendicular to the already prepared surface at 1, 2 and 3 mm depths for further evaluation under a stereomicroscope (x12 and x25 magnifications).Results No crack or crazing was observed in teeth in the control group while one out of 11 teeth in the case group had a crack.Conclusion The use of 0.53 mm diameter self-threading pin did not increase the risk of crack formation in dentin of anterior primary teeth prior to composite restoration

Oral Midazolam Vs Promethazine as Pre Sedation Medication in Pediatric Dentistry

Objectives Pre- and post-sedation effect of oral Midazolam to promethazine in2-6 yrs old fearful children for dental treatmentMethods This randomized clinical trial was carried out on a group of 26 children aged 2-6 years referred to the dental school due to their fear and multiple dental needs. Patients were selected from ASA I or II classification and scored 1 in Frankl Behavior scale. Each patient was scheduled for two subsequent visits to receive one of the two pre medications before IV sedation. Each patient served as self-control and randomly assigned to either group A: receiving Midazolam oral as premed in 1st visit or group B: receiving Promethazine oral as the premed in 1st visit. Six hour NPO was instructed prior to sedation visit. Monitoring vital signs were conducted at every 15 minutes starting with base line before any drug administration. Sedation score was recorded using Houpt Sedation scale. Post sedation problems were recorded by operator. Data were analyzed using Student t test and Kruskal Wallis.Results No significant difference was noted between the patient perceptions at the two different visits. Children did not show a significant difference on symptoms such as Crying, Movement, Sleep and overall behavior in two visits at the first 15 minutes of sedative injection. Post-operative complications were having no significant difference. Lower sickness and vomiting were reported following promethazine intake.Conclusion Promethazine seems to be as effective and as acceptable premedication as Midazolam in pediatric dentistry

Effect of Condensation Pressure on Microleakage of Mineral Trioxide Aggregate

Objective: The aim of this study was to assess the effect of condensation pressure on microleakage of mineral trioxide aggregate (MTA). Methods: This in vitro experimental study was conducted on 55 sound single-rooted straight-canal extracted human teeth. The teeth were sectioned at the cementoenamel junction (CEJ) and at 3 mm above the root apex. The roots were mounted in putty. Samples were then divided into three experimental groups (n=15) and positive and negative control groups (n=5). After filing of the root canals to file #50, white ProRoot MTA paste was prepared according to the manufacturer’s instruction and applied to the canals using condensation pressure of 0.44, 3.22 and 8.88 Mpa in groups one to three, respectively. After a 48-hour setting time, each root was connected to the fluid filtration system to measure microleakage. The mean microleakage rate of the groups was calculated and compared using one-way ANOVA and least significant difference test.Results: The mean microleakage with condensation pressure of 0.44, 3.22 and 8.88 MPa was 1.70×10-4, 1.17×10-4  and 0.48×10-4 µL/minute, respectively. One-way ANOVA showed that the mean microleakage rate was significantly different among the groups (P<0.05). The lowest microleakage was observed in condensation pressure of 8.88 MPa.Conclusion: Within the limitations of this study, the results showed that increase in condensation pressure decreased the rate of microleakage

Clinical Management of Hypoplastic Amelogenesis Imperfecta in Pediatric Patients: A Case Report and Review of Literature

Objectives Amelogenesis imperfecta (AI) refers to a group of hereditary disorders that affect the quality and/or quantity of dental enamel of both primary and permanent dentitions. Also, these patients may suffer from certain systemic disorders and other dental and skeletal defects or abnormalities. Case: A 9-year-old female patient with hypoplastic type AI with unerupted maxillary first molars, and pulpal calcifications is reported. Her permanent anterior teeth were restored with composite veneer while the posterior teeth received stainless steel crowns. Conclusion Hypoplastic type AI is a rather uncommon disorder. Early treatment of AI, not only prevents tooth wear, but also has a positive psychological impact on children. The possible association of AI with nephrocalcinosis can also be monitored through initial radiographic evidence of pulp stones

Comparison of sedative effects of oral midazolam/chloral hydrate and midazolam/promethazine in pediatric dentistry

Background. The aim of this investigation was to compare the sedative effects of oral midazolam/chloral hydrate and midazolam/promethazine combinations on fearful children needing dental treatment. Methods. This crossover double-blind clinical trial was conducted on 30 children aged 2‒6 years, who had at least two similar teeth needing pulp treatment. Standard vital signs were recorded before and after premedication. Wilson sedation scale was used to judge the level of sedation. Cases were divided into two groups based on the sequence of medication received. This was to overcome the sequence effect. Group I received oral midazolam (0.4 mg/kg/chloral hydrate (50 mg/kg) at the first visit while they received midazolam (0.4 mg/kg)/promethazine (5 mg/kg) in their second visit. Group II received the premedication in the opposite sequence. The operator and child were blinded to the medication administered. Sedative efficacy of the two combinations were assessed and judged by two independent pediatric dentists based on the Wilson scale. Data were analyzed with ANOVA and paired t-test. Results. Only 10% of children who received chloral hydrate with midazolam exhibited high improvement in their behavior while 53% showed reasonable positive changes and 12% had no change or even deterioration of behavior. The difference between the effect of the two combination drugs was statistically significant (P<0.05) in favor of the chloral hydrate group. Conclusion. The results showed a significant difference in the sedation level induced between the two groups. Midazolam/chloral hydrate combination more effectively improved the co-operation for dental treatment

Comparison of oral Midazolam-Ketamine and Midazolam-Promethazine as sedative agents in pediatric dentistry

Background: Investigation was designed to evaluate the behavioral changes in children receiving dental treatment while they have been administered combination of Midazolam/Ketamine or Midazolam/Promethazine. Materials and Methods: This was a randomized double blind clinical trial with cases being selected from those uncooperative children aged 2 to 6 years from those referred for treatment under general anesthesia. Anxiety score of all cases were recorded before any attempt using Frankel′s anxiety scoring system with those in negative category being included. Cases with at least a pair of similar size cavities on similar teeth were selected with each tooth being randomly allocated for one sedative regimen group. To avoid sequence effect, half of the patients received one regimen at the first visit while the other half received the other regimen as the first. Each case served as control for him or herself to reduce influencing factors. Child′s reaction was recorded before, during, and at the end of dental procedure. SO2 as well as Pulse rate were recorded as the most critical vital signs. Collected data were then analyzed using analysis of variance (ANOVA) and paired t-test. Results: Patients′ mean age was 3.5 years with 43% being male. Only 10% of the Ketamine/Midazolam group showed considerable amount of change in their behavior with a statistical significant difference being presented (P=0.029). Conclusion: Under the current circumstances, Ketamine/Midazolam combination provided sufficient sedative effect in lower doses. However, Midazolam/Promethazine combination did not produce similar results