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May 2023 Pediatric Dental Study Club Abstracts

May's Pediatric Dental Study Club highlights management of white spot lesions, cryotherapy with nerve blocks, maxillary esthetic crowns, luting cements for zirconia crowns, and factors in fluoride hesitant parents.

Pediatric Dental Study Club

Join us on May 23rd, 2023 at 7:00pm CST for our study club to discuss the following articles. We recommend reading the articles 1 week prior and taking notes on your insights to bring to the group for discussion. Register here

#1 - Comparison of Remineralizing Agents in the Management of White Spot Lesions in Three- to Five-Year-Old Children: A Clinical Trial
Nambi Natchiyar, MDS • Sharath Asokan, MDS, PhD • Geetha Priya PR, MDS, PHD • Sudhandra Viswanath, MDS
Purpose: The purpose of this study was to compare the effectiveness of P11-4 self-assembling peptide (CurodontTM Repair [CR]) and fluoride varnish with xylitol-coated calcium phosphate (EmbraceTM Varnish [EV]) on enamel permeability and in the management of white spot lesions (WSLs) in primary teeth.
Methods: A clinical trial was conducted among 30 children aged three to five years with WSLs in 60 anterior teeth. They were randomly assigned to receive CR or EV. Preintervention and postintervention evaluation was done by International Caries Detection and Assessment System (ICDAS) and morphometric analysis. The secondary outcome was to assess the enamel permeability using scanning electron microscopy (SEM) of polyvinyl siloxane impressions.
Results: A statistically significant reduction in the ICDAS scores (P=0.05) and percentage area of WSLs in morphometric analysis (P=0.008) was seen in the CR group after six months. No statistically significant difference was observed in the EV group after six months. The SEM evaluation did not show a significant reduction in the percentage area of droplets in both the CR and EV groups (P=0.06 and P=0.21, respectively). No significant difference was seen between EV and CR in the three parameters assessed.
Conclusion: Curodont TM Repair is effective at remineralizing white spot lesions in primary teeth and can be considered as a remineralizing agent

#2 -Inferior Alveolar Nerve Block Plus Cryotherapy Anesthesia Success in Pulpectomy of Primary Molars with Irreversible Pulpitis: A Randomized Clinical Trial
Ahmad Abdel Hamid Elheeny, DDS, PhD1 • Mohammed Turky, DDS, PhD2
Purpose: The primary purpose of this study was to assess the efficacy of cryotherapy applications on the success of an inferior alveolar nerve block (IANB) to reduce pain severity during a pulpectomy of primary molars with symptomatic irreversible pulpitis (SIP). The secondary purpose was to assess children’s behavior before and during pulpectomy procedures and the need for supplementary local anesthesia injections.
Methods: A randomized parallel controlled trial included 170 healthy children aged five to nine years who complained of carious primary mandibular second molars with SIP. After an IANB administration, ice packs (cryotherapy group) were applied to half of the participants while the other half did not receive ice packs. During pulpectomy, pain severity was tested using the Wong-Baker FACES Pain Rating Scale (WBS). A failure of anesthesia was encountered in the case of moderate or severe pain reported. Children’s behavior was assessed using Frankl’s Behavior Rating Scale (FBRS) before and after clinical procedures. Results: The overall success of IANB with cryotherapy (i.e., no or mild pain) was 79.2 percent, which was significantly superior to the control group (50.6 percent; P=0.007). The postoperative children’s positive behavior proportions in the cryotherapy group were significantly higher compared to the control group (P=0.001).
Conclusions: Cryotherapy application significantly improved inferior alveolar nerve block efficacy, diminished pain intensity, and improved children’s behavior during pulpectomy of primary molars with symptomatic irreversible pulpitis. Based on these findings, cryotherapy application after IANB deposition is recommended

#3 - A Comparison of Primary Maxillary Incisor Zirconia and Composite Resin Strip Crowns: A One-Year Feasibility Study

Stéphanie Labbé, DMD, MSc • Gabriella A. Garisto, DDS, MSc • Edward J. Barrett, BSc, DDS, MSc • Michael J. Casas, DDS, MSc

Purpose: The purpose of this study was to compare one-year clinical outcomes of primary incisor strip crowns (SCs) and zirconia crowns (ZCs) and determine the frequency of pulp therapy associated with each technique.

Methods: Children aged 18 to 48 months were randomly assigned to a ZC group or SC group. Each incisor was rated as intact (I), damaged (D), or requiring treatment (TR) six and 12 months following placement.

Results: Seventy-six ZCs and 101 SCs were placed for 59 participants; ZCs were more likely to be rated I than SCs at six months (odds ratio [OR] equals 4.2; P=0.01) and 12 months (OR equals 4.0; P=0.02). There was no statistical difference in the frequency of pulp therapy between groups (OR equals 0.8; P=0.70). There were no deviations from treatment randomization in either group.

Conclusions: Zirconia crowns were more likely than strip crowns to be rated as intact at six or 12 months after treatment. The frequency of pulp therapy was not statistically different between groups.

#4 -Comparison of Three Luting Cements for Prefabricated Zirconia Crowns in Primary Molar Teeth: A 36-Month Randomized Clinical Trial
Samuel Raj Srinivasan, BDS, MDS • Mebin George Mathew, BDS, MDS • Jayakumar Jayaraman, BDS, MDS, MS, PhD
Purpose: The purpose of this study was to evaluate and compare the long-term clinical retention and gingival health of prefabricated zirconia crowns (PZCs) in primary molar teeth cemented using three luting cements.
Methods: Primary molar teeth restored with PZCs (n equals 30 per group) were cemented using glass ionomer cement (GIC), resin-modified GIC (BioCem™), or adhesive resin cement (APC technique: airparticle abrasion, zirconia primer, composite resin). Crown retention, plaque accumulation, and gingival status were evaluated over three years; cumulative crown survival was assessed using Kalpan-Meier analysis. Plaque gingival scores were analyzed for within and between groups using repeated measures one-way analysis of variance.
Results: The survival of PZCs cemented using GIC was 76.7 percent, 70 percent for APC, and 50 percent for BioCem™ after three years. The mean survival for PZC in the GIC group (35.5 months) was significantly higher than for APC (34.7 months), and BioCem™ (33 months; P=0.019). Plaque accumulation around GIC-luted crowns was significantly lower (P<0.001; three-year follow-up); gingival outcomes were uniformly favorable between groups. No crown fracture was observed throughout the study period.
Conclusions: Prefabricated zirconia crowns cemented using traditional glass ionomer cement have superior retention and lower plaque accumulation compared to BioCem™ and APC after three years. PZCs provided long-term favorable gingival health outcomes irrespective of the cement used for luting the crowns.

#5 - A Qualitative Assessment of Factors Influencing Fluoride-Hesitant Parents’ Trust of Dentists
Stephanie Cruz, PhD • Darragh C. Kerr, MPH • Donald L. Chi, DDS, PhD
Purpose: The purpose of this study was to use fluoride-hesitant parents as a model to identify the factors that erode versus build trust in their child’s dentists.
Methods: A qualitative study was conducted using a semi-structured interview guide with fluoride-hesitant parents recruited from two dental clinics and through snowball sampling. A content analysis was performed to identify factors that erode versus build parents’ trust in their child’s dentist.
Results: Of the 56 parents interviewed, most were female (91.1 percent) and white (57.1 percent) and had a mean age of 41±9.7 (standard deviation) years. Factors identified included five that erode trust (having trust violated previously, sensing discrepancies, getting pushed to accept fluoride, feeling dismissed, and sensing bias) and four that build trust (being treated as an individual, having a dentist who communicates, feeling supported and respected, and having a choice).
Conclusions: Dentists’ understanding of the factors that erode and build trust with parents could help providers develop patient-centered communication strategies

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