دکتر مسعود فلاحی نژاد قاجاری

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.  

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). 

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).

BIA with articaine had optimal efficacy comparable to that of IANB with lidocaine for pulpotomy of primary second molars under sedation.

Midazolam and ketamine, either alone or in combination, are safe and effective in intranasal application among dental sedation routes. 

This randomized clinical trial compares higher and lower-dose intranasal ketamine/midazolam cocktails in pediatric dentistry. 

This double-blind randomized clinical trial was conducted on 20 uncooperative children aged 3-6 years with a definitely negative Frankel scale. The participants were divided into two groups. Group A received 0.4 mg/kg midazolam and 4 mg/kg ketamine nasally 20 min before initiating dental treatment in the first session while receiving 0.5 mg/kg midazolam/ 3 mg/kg ketamine in the second session. Meanwhile, group B received the opposite drug sequence to assess any sequence effect. Dental treatment was initiated with local anesthesia administration. The sedation score was recorded using the Houpt scale. Vital signs were recorded at every 10-min intervals along with potential side effects. The data were analyzed using variance analysis and Wilcoxon and McNemar tests.

No significant differences were noted in vital signs between groups at recording intervals (anesthetic injecting [P=0.719], 10 min [P=0.317] and 20 min [P=0.480]). No reports were received on post-treatment nausea (P=0.289). 

There was no indication of a significant difference between groups tested with different drug doses, in support of lower ketamine dose as an effective yet safer approach to treat children. The parents were satisfied with their child’s calmness through both episodes of treatment.

Parents are aware of the importance of anterior tooth esthetics in their children. Children also pay attention to their appearance more than ever. Today, charcoal has been added to toothpastes. This study aimed to investigate the degree of bleaching and abrasion of charcoal toothpaste on primary teeth.

This in-vitro study was performed on 30 extracted primary teeth. Initially, the samples were polished, cut, and mounted in blocks of putty. The samples were placed in a coffee solution and then the tooth color was measured by a spectrophotometer and the initial surface profile was measured by a profilometer. The samples were brushed back and forth by the brushing machine with 20 gr Bancer, Beverly, and Colgate toothpastes (mixed with 40 ml of distilled water) for 2000 times (equivalent to 3 times a day for 1.5 months). A color determination was performed again and a second surface profile was measured. The data were analyzed by one-way ANOVA, ANCOVA and paired t-test.

The results of this study showed that all three Beverly, Bencer and Colgate whitening toothpastes increased the surface profile and made significant statistical changes in the roughness of dental specimens (P=0.01, P=0.005, P=0.001). The statistical study of the data did not show a significant difference between the groups in terms of abrasion and whitening properties (P=0.78, P= 0.99).

Three whitening toothpastes whiten primary teeth and increase their surface roughness. These three toothpastes are not statistically different in terms of abrasion and whitening properties.

Tracheal intubation for general anesthesia induction can be performed via oral or nasal routes. There is a controversy about nasal route especially in children with corrected coagulopathy because of the probable stimulation for bleeding. We aimed to determine naso-pharynx bleeding in patients with corrected coagulopathy after nasotracheal intubation.

This quasi-experimental study, was conducted on 23 children aged 4-16 years with history of treated coagulopathy needing extensive dental treatment scheduled for a general anesthetic session. Bleeding volume was measured by detailing absorbed amount on a 4×4 inch gauze as well as the volume collected in a nasal bleeding collecting bottle for 24 hours and recorded every four hours. Data were analyzed using Friedman test.

Scarce nasal bleeding was observed at the nasal intubation site in patients with hemophilia A. No significant differences were observed on nasal bleeding times in the these patients (P=0.583)

Nasotracheal intubation can be performed in patients with hemophilia A after stabilization of the coagulation status with no serious risk of bleeding.

Charcoal toothpastes can whiten teeth through abrasion. The purpose of this study was to determine the level of whitening and abrasiveness of charcoal toothpastes in permanent teeth.

In this in vitro study, 30 premolars were polished, sectioned, mounted, and stored for 5 days in a coffee solution at 37°C. The color and surface profile of the teeth were measured by spectrophotometry and a profilometric device, respectively. The specimens were divided into 3 groups of 10 and were brushed 2000 times(equivalent to 3 times a day for 1.5 months) in a brushing machine using 20 g of each toothpaste (Bencer, Beverly, and Colgate) mixed with 40 ml of distilled water. The color and surface profile were remeasured. Bonferroni test and repeated measures analysis of variance (ANOVA) were used to examine the abrasion. One‑way ANOVA was used to assess the whitening.

The three toothpastes caused changes in the surface profile (P = 0.0001). ΔE was equal to 3.3 (within the acceptable range) in all groups (95% confidence interval). There was no significant difference in abrasion (P > 0.05) and color change (P = 0.884) among toothpastes.

The results of this study showed that all the three used toothpastes have the abrasive and whitening effect on the samples significantly. The differences between the toothpastes were not significant.

This study aimed to determine the microtensile bond strength (μTBS) of a bulk-fill composite to permanent and primary coronal dentin using a universal adhesive in self-etch and total-etch modes.

This in-vitro study was performed on 52 occlusal dentinal surfaces of human primary and permanent teeth. The crowns were cut to the gingival level. The 48 prepared dentin sections were randomly assigned to the following groups (n=13): A: Primary/Total-etch, B: Primary/Self-etch, C: Permanent/Total-etch, and D: Permanent/Self-etch. In groups A and C, after etching for 15 seconds, two layers of a universal bonding (Futurabond U) were applied and cured for 10 seconds. All samples were filled with a bulk-fill composite (x-trafil; VOCO) and cured for 40 seconds. The samples were cut to a bar-shaped dentin block with the dimensions of 1×1×1 mm3, and after 10,000 thermocycles, the μTBS test was accomplished at a crosshead speed of 1 mm/minute. The mean and standard deviation (SD) of μTBS were calculated, and the data were analyzed using two-way analysis of variance (ANOVA) and Fisher's exact test.

The mean μTBS was as follows: A: 15.03±2.0279, B: 11.11±2.4423, C: 23.50±4.8165, and D: 16.26±6.3200 MPa. Futurabond U showed a higher μTBS in the total-etch mode (P<0.001). The permanent teeth had greater μTBS than the primary teeth (P<0.001). Similar percentages of failure modes were observed in the total-etch groups but in the self-etch groups, most failures were in the form of adhesive and mixed.

Greater μTBS was observed in the permanent teeth with

The aim of this study was to assess the fracture resistance of pulpotomized primary molars restored with incremental and bulk‑fill composite application techniques.

In this in‑vitro experimental study, 36 extracted primary molars were nonrandomly (selectively) divided into three groups of 12 each. All teeth underwent conventional pulpotomy treatment, and mesio‑occluso‑distal cavities were prepared in such a way that the buccolingual width of the preparation was two‑thirds of the intercuspal distance, and the depth of the buccal and lingual walls was 4 mm. The teeth were then restored as follows: Group 1 (control) was restored with amalgam, Group 2 was restored with Tetric N‑Ceram composite using the incremental technique, and Group 3 was restored with Tetric N‑Ceram composite using the bulk‑fill technique. The restored teeth were subjected to thermocycling and then underwent fracture resistance testing in a universal testing machine at a crosshead speed of 1 mm/min. Fracture resistance of groups was compared using the one‑way ANOVA and Tukey’s honestly significant difference test.

The mean fracture resistance was 1291.47 ± 603.88 N in the amalgam, 1283.08 ± 594.57 N in the Tetric N‑Ceram incremental, and 1939.06 ± 134.47 N in the Tetric N‑Ceram bulk‑fill group. The difference in this regard between Group 3 and Groups 1 and 2 was statistically significant (P = 0.019 and P = 0.035, respectively).

Bulk‑fill composite is recommended for reinforcing the remaining tooth structure after the primary molar pulpotomy procedure. Time‑saving characteristics of this material are clinically important for reducing appointment time for children.

There have been attempts to restore destroyed primary anterior teeth using a variety of post and core systems, which were able to solve just part of the problems related to this issue. Therefore, the present study aimed to inves-tigate the fracture resistance of restorations supported with a variety of posts and cores in primary anterior teeth.

The present study was an in vitro experimental study on 40 extracted maxillary primary canine teeth. The teeth were divided into four groups: (I) Grandio Flow composite core and fiberglass post, (II) Grandio Flow composite core and Grandio Flow composite post, (III) Grandio composite core and fiberglass post and (IV) Grandio composite core and Grandio composite post. Then, the fracture re-sistance was compared among the four groups. One-way ANOVA was used to analyze the data.

The mean fracture resistance was 398.2±135.2 in group 1, 474.7±100.8 in group 2, 374.3±161.1 in group 3 and 364.4±74.5 in group 4; these differences were not statistically significant (P=0.182).

The results of this study showed that the highest fracture resistance was observed in the Grandio Flow composite core and Grandio Flow composite post. Grandio composite core and Grandio composite post showed the lowest fracture resistance; but there were no statistically significant differences among the groups.

This study aimed to assess the microshear bond strength (MSBS) of Scotchbond Universal adhesive, used in self-etch and etch-and-rinse modes, to primary and permanent dentin at 24 hours and six months.

A total of 88 composite micro-cylinders were divided into eight groups (n=11) as follows: (A) Etch-and-rinse, 24 hours, primary dentin; (B) Self-etch, 24 hours, primary dentin; (C) Etch-and-rinse, six months, primary dentin; (D) Self-etch, six months, primary dentin; (E) Etch-and-rinse, 24 hours, permanent dentin; (F) Self-etch, 24 hours, permanent dentin; (G) Etch-and-rinse, six months, permanent dentin; (H) Self-etch, six months, permanent dentin. The MSBS was measured by a testing machine at a crosshead speed of 0.5 mm/minute. Data were analyzed using three-way analysis of variance (ANOVA).

The mean MSBS was 12.3±2.3 MPa in A, 18.8±4.1 MPa in B, 11.9±3.7 MPa in C, 16±2.9 MPa in D, 19.1±2.7 MPa in E, 22.8±4.1 MPa in F, 16.2±2.6 MPa in G, and 17.2±4.4 MPa in H. In the self-etch mode, the MSBS was significantly higher than that in the etch-and-rinse mode (P<0.001). The MSBS in permanent teeth was significantly higher than primary teeth (P<0.001). At six months, the MSBS significantly decreased in all groups (P<0.001).

The micro-shear bond strength of Scotchbond Universal adhesive decreases over time and depends on the type of tooth and the mode of application of the adhesive.