OBJECTIVE: Childhood experiences of pain associated with dental treatment can induce dental anxiety. Infe-rior alveolar nerve blocks are eight times more likely to fail in patients with irreversible pulpitis. The objective was to compare the effectiveness of lignocaine with and without pre-operative oral ibuprofen for controlling pain in primary mandibular molars scheduled for pulpectomy procedures in 5 to 9-year-old children.
METHODS: One hundred and twenty-two children diagnosed with irreversible pulpitis in mandibular posterior teeth and scheduled for pulpectomy procedures were included. The children were assigned to one of the two groups, Treatment group A: Pre-operative with oral ibuprofen and local anaesthesia with 2% lignocaine (with adrenaline 1: 80000); Treatment group B: Pre-operative with oral placebo and local anaesthesia with 2% ligno-caine (with 1: 80000 adrenaline). Pain and pulse rate were recorded at baseline, one hour after administration of oral medication, fifteen minutes following administration of Inferior Alveolar Nerve Block (IANB), and also during the course pulpectomy. The results were statistically analysed using chi square test and repeated mea-sures analysis of variance (ANOVA).
RESULTS: In treatment group A, 90.16% children had IANB success compared to 9.83% in group B.. The differ-ence in the success rate between two groups was statistically significant (p<0.001) with an odds ratio of 84.
CONCLUSIONS: Oral medication with ibuprofen is effective in increasing the success rate of IANB with lignocaine for the treatment of irreversible pulpitis of 5 to 9-year-old children.

UNASSIGNED: Evaluating the antimicrobial efficacy of the novel combinations of zinc oxide mixed with ajwain oil (ZNOA) and combination of ajwain and eugenol (ZNOAE) vs conventionally used zinc oxide eugenol (ZNOE) against endodontic pathogens like Escherichia coli and Enterococcus faecalis.
UNASSIGNED: The pure cultures of E. coli (MTCC 443) and E. faecalis (MTCC 439) were revived and grown on selective cultural media. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the test materials were determined correspondingly through sequential dilution and agar well diffusion methods, as per Clinical and Laboratory Standard Institute (CLSI) guidelines. The data values were presented as mean ± standard deviation (SD). The comparisons among groups were completed through the one-way analysis of variance (ANOVA) test, whereas intragroup pairwise comparisons were completed using the unpaired t-test (p < 0.05).
UNASSIGNED: Minimum inhibitory concentration values against E. coli and E. faecalis of ZNOE were 250 and 500 µg/mL, ZNOA was 250 µg/mL, and ZNOAE were 125 and 250 µg/mL, correspondingly. MBC values in the form of inhibition zone against E. coli by ZNOE were 21.33 ± 1.53 mm, ZNOA 18.67 ± 1.53 mm, and ZNOAE 20.33 ± 1.53 mm. The E. faecalis inhibition zone for ZNOE was 14.33 ± 2.08 mm, ZNOA 18.67 ± 2.08 mm, and ZNOAE 24.33 ± 1.53 mm.
UNASSIGNED: All test materials demonstrated good antibacterial efficacy. However, between the novel combinations of test materials, ZNOA showed better antimicrobial efficacy against resistant endodontic pathogens than ZNOE.
UNASSIGNED: Dahake PT, Joshi SS, Kale YJ, et al. A Novel Combination of Zinc Oxide with Two Essential Oils Exerts Antimicrobial Effect against Endodontic Pathogens In Vitro. Int J Clin Pediatr Dent 2024;17(S-1):S11-S16.

A 4.5-year-old female child presented to the Department of Pediatric Dentistry with the chief complaints of sharp, localized pain in her lower left and right back teeth persisting for a week, indicative of irreversible pulpitis in teeth 74, 75, and 85. A single-visit pulpectomy was planned for all affected teeth, followed by full coronal restoration in two separate visits. Before the procedure, informed digital consent was taken from the parents. A topical anesthetic agent and inferior alveolar nerve block were administered for effective anesthesia. Rubber dam isolation was performed to ensure aseptic conditions, and access cavity preparation was carried out using appropriate burs. Biomechanical preparation (BMP) was performed using Kedo S Square (Kedo Dental, Chennai, India) in tooth 74, Kedo S Plus (Kedo Dental) in tooth 75, and Kedo Nano Plus (Kedo Dental) in tooth 85, with specific instrumentation techniques as per literature guidelines. The root canals were thoroughly cleaned and shaped to facilitate optimal disinfection and obturation. This case demonstrates the successful management of irreversible pulpitis in the lower primary molar using single-visit pulpectomy with Kedo single filing systems, highlighting the importance of effective BMP in pediatric endodontics.

Objectives: This preliminary animal study was conducted to assess the effects of chitosan as a novel obturation material for pulpectomized teeth on periapical inflammation, periodontal ligament (PDL) widening, and hard tissue resorption. Materials and Methods: Forty premolar root canals in two mature dogs were obturated with zinc oxide eugenol (ZOE) and an experimental 3% chitosan paste (n=20 in each group). The teeth were then restored with amalgam. After 28 days, the dogs were sacrificed, and histopathological assessment was performed. The amount of resorbed obturation material, degree of inflammatory response, degree of PDL widening, and the number of bone/cementum/dentin resorption defects were recorded under ×40 and ×200 magnifications. Data were analyzed using the Mann-Whitney U test, one-sample Wilcoxon signed-rank test, and Fisher\'s exact test (α=0.05). Results: Bone, cementum, and dentin resorption were seen in 6, 10, and 1 chitosan-obturated canals and 14, 15, and 0 ZOE-obturated canals, respectively. Only the bone resorption defects were significantly fewer in the chitosan group (P=0.026). Mild, moderate, and severe inflammation were observed in 17, 3, and 0 chitosan-obturated canals, and 7, 9, and 4 ZOE-filled canals, respectively (P=0.004). Mild, moderate, and severe PDL widening were seen around 15, 5, and 0 chitosan-filled canals and 7, 12, and 1 ZOE-filled canals, respectively (P=0.025). Conclusion: The 3% chitosan was superior to ZOE in terms of causing less inflammation and PDL widening. It also decreased bone resorption and acted similar to ZOE in terms of dentin and cementum resorption.

Aims This study compares three obturation techniques (rotary lentulo spiral, handheld lentulo spiral, and pressure syringe) for the quality of two filling pastes (zinc oxide eugenol (ZOE) paste and Metapex (Meta Biomed Co., Ltd., Chungcheongbuk-do, Korea). Methods and materials Sixty extracted primary canines were instrumented and obturated by filling materials. The obturation techniques were divided into three groups according to different obturation techniques. Obturation quality was evaluated for length, density, and presence of voids by using digital radiography. Results This study showed that the handheld lentulo spiral technique using Metapex and ZOE exhibited more optimal fillings for obturation length. The highest density obturation was achieved using the syringe injection approach with Metapex and ZOE. The highest incidence of both external and internal voids was observed in the group using ZOE with the handheld lentulo spiral technique Conclusions Based on the findings of this study, for both filling materials, the handheld lentulo spiral technique had the greatest number of optimal lengths but there were also more voids.

Pediatric endodontics in the primary teeth is chemomechanical due to the difficulties encountered in cleaning and shaping the root canals having complex anatomical configurations. Not only are obturating materials having ideal properties to be used in the primary teeth, but also imparting an impervious hermetic seal to prevent the nidus of reinfection is highly pivotal for the success of pulpectomy. However, certain obturating materials contain one or the other components that are irritant to the periapical region and aggravates the inflammatory process. Hence, a paradigm shift has been witnessed with the evolution of herbal medicines having innumerable beneficial properties with a broad-spectrum action to replace those components causing irritation and inflammatory reactions in conventional obturating materials. One such herbal medicament is \"curcumin\" popularly known as the \"golden herb,\" which has a wide repertoire of medicinal properties due to its bioactive component and volatile oil \"turmerone.\" Endoflas is one of the suitable obturating agents used in the primary teeth for its high success rate, but the use of eugenol in it is associated with irritation of the periapical region and causes necrosis of bone and cementum. Hence, the present case report aims to assess the rate of resorption, resorption potential, and the periapical healing of a novel obturating material Endoflas powder with curcumin gel (EPCG) replacing the liquid eugenol against conventional Endoflas material for pulpectomy in primary mandibular molars.

BACKGROUND: Pharmacological methods, specifically sedatives, have gained popularity in managing the behavior of children during dental appointments.
OBJECTIVE: The aim of this study was to compare 1 m/kg intranasal dexmedetomidine, 0.3 mg/kg intranasal midazolam, and nitrous oxide in evaluating the level of sedation, behavior of the child, onset of sedation, physiologic signs, and adverse effects.
METHODS: In this cross-over trial, 15 children aged 6-8 years were randomized to receive intranasal atomized dexmedetomidine, intranasal atomized midazolam, and inhalation nitrous oxide at three separate visits. After administering the sedative agent, a single pulpectomy was performed during each appointment, and the outcomes were recorded. The washout period between each visit was 1 week.
RESULTS: All three sedative agents were equally effective in controlling overall behavior. Dexmedetomidine showed lower sedation level scores (agitated; score 9) than the other groups. There was a statistically significant difference in the onset of sedation, with dexmedetomidine having the longest onset of 36.2 ± 9.47 min. Coughing and sneezing were predominantly observed after administration of intranasal midazolam. Oxygen saturation levels were statistically lower in the intranasal midazolam group during local anesthesia administration and post-treatment.
CONCLUSIONS: 0.3 mg/kg intranasal midazolam is as effective as nitrous oxide sedation for controlling behavior and providing adequate sedation in pediatric dental patients. However, 1 m/kg dexmedetomidine did not provide the same level of sedation and had a significantly longer onset. 0.3 mg/kg intranasal midazolam is an effective alternative to nitrous oxide sedation in anxious children.

BACKGROUND: Traditionally, pediatric endodontics lacked access to the full potential of rotary instruments. These instruments, designed for the permanent root canal system, often presented limitations when used in primary teeth. To address this, exclusive pediatric rotary files with regular improvements have been introduced, featuring superior cutting efficiency with a focus on precise alignment. This design offers the advantage of reduced risk of ledges, perforations, instrument separation, and canal transportation. This study aimed to compare and evaluate the effectiveness of Pro AF Baby Gold and Kedo-S rotary files in preparing primary tooth root canals during pulpectomy procedures through a meta-analysis.
METHODS: The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The review searched electronic databases from 2000 to February 2024 for studies evaluating the efficacy of Pro AF Baby Gold and Kedo-S files in terms of canal instrumentation, transportation, and centering ratio. The Cochrane risk of bias (ROB)-2 tool assessed quality, with analyses conducted using RevMan software version 5.3. The standardized mean difference (SMD) served as the summary with a random effects model (P < 0.05).
RESULTS: Out of the five studies identified through the eligibility criteria, three were deemed suitable for a meta-analysis, while all five were included in a qualitative synthesis. The quality assessment revealed a presence of moderate-to-low ROB. The pooled analysis using SMD did not show any statistically significant differences between the files, except for the centering ratio in the mesiobuccal canal, where the Kedo-S file performed slightly better. In addition, the absence of any significant asymmetry in the funnel plot suggests that there is likely no publication bias present in the data.
CONCLUSIONS: Pro AF Baby Gold files can be used as an alternative adjunct in pediatric endodontics to Kedo-S files and manual files.Prospero Registration: CRD42023469406.

OBJECTIVE: To compare preparation times using manual, rotary, and reciprocating files during pulpectomy treatment of primary molars.
METHODS: This study was an in vitro, randomised, cross-sectional study.
METHODS: The study was performed on 60 extracted human primary mandibular second molars. Only mesiobuccal canals were prepared using one of three preparation techniques; each preparation technique group comprised 20 canals. Canal preparations were performed by a single, skilled operator using stainless-steel (ss) K-files (ISO size 20-35), a ProTaper Gold SX file, and a WaveOne Gold Medium file following glide path preparation. Preparation times were recorded in second (s) with a digital stopwatch.
METHODS: Preparation times were compared using analysis of variance and the Kruskal-Wallis analysis of variance, where appropriate. The level of significance was set at P ≤ 0.05.
RESULTS: The mean preparation time using the ss K-files was significantly longer (186.4 s) than when using the ProTaper Gold SX (29.6 s) or WaveOne Gold Medium files (30.5 s) (P < 0.001). Similar preparation times were recorded when using the ProTaper Gold SX and WaveOne Gold Medium files (P = 0.939).
CONCLUSIONS: Preparation times with the ProTaper Gold SX and WaveOne Gold Medium files were significantly faster than when using the ss K-files to prepare primary tooth root canals for pulpectomy. Similar preparation times were noted when using the rotary and reciprocation instrumentation groups (P > 0.05).

Recent evidence suggests that an ever-growing number of pediatric patients require invasive treatments such as root canal therapy (RCT) in their permanent dentition, albeit with little information about risk factors such as prior invasive treatments of pulpotomy or pulpectomy in their primary dentition. Therefore, the primary objectives of this study were to determine the number of pediatric patients who have had any type of invasive treatment in their primary teeth, to assess their association with any subsequent invasive treatment (root canal therapy, extractions) in their permanent dentition, and to assess these trends over time. This retrospective study utilized summary data from a clinical pediatric patient pool (ages 0-17) over the period of 2013-2022. This analysis revealed that pediatric patients requiring pulpotomies and pulpectomies in primary dentition declined between 2013 (n = 417, n = 156) and 2022 (n = 250, n = 12), while root canal therapy (RCT) in permanent dentition increased six-fold from n = 54 to n = 330. In addition, few (7.8%) patients with RCT had a previous history of pulpotomy or pulpectomy, which suggests that invasive treatments performed in primary dentition have no direct association with the subsequent need for invasive treatments in permanent dentition, although more research is needed to determine the explanations for these observations.