Aim and objective: To evaluate the clinical efficacy of propolis as pulpotomy medicament in human primary molars. Materials and methods: This randomized controlled trial is a two-arm, parallel group study with blinded outcome assessment. The study included a total of 60 primary molars that require pulpotomy treatment in 4–8-year old children. Teeth were assigned to two groups randomly: Propolis (Test group); Mineral trioxide aggregate (MTA) (Control group). All the pulpotomized teeth were given stainless steel crowns and the teeth were evaluated clinically and radiographically at 6, 12, and 24 months to grade them as either success or failure. Chi-square test was employed to analyze the data. Results: Success rates of pulpotomy with propolis and MTA were 80% and 93.1% respectively at 24 months of follow-up interval. Propolis has shown success rates of 90% and 80% at 6- and 12-month follow-up, while MTA has shown a consistent success rate of 93.1% at all the follow-up intervals. The difference in success rate between the groups at all the time intervals is statistically nonsignificant. Conclusion: Propolis has demonstrated a clinically acceptable success rate comparable to MTA as pulpotomy medicament in primary teeth. Clinical significance: Biocompatible materials with regenerative potential have drawn the momentum in vital pulp therapy. In this regard, MTA has been emerged as most successful material, but its high cost has limited its use. Hence, there is an absolute need of cost-effective pulpotomy material with regenerative potential. This study provides an evidence that propolis has clinically acceptable success rate as pulpotomy medicament. Considering its low cost and ready availability, it can be recommended as a cost-effective alternative for primary teeth pulpotomy.

Aim and objective: The purpose of the study was to compare the efficiency of modified conventional root canal shaping technique versus conventional shaping technique in primary teeth. Materials and methods: A total of 184 primary root canals (2 groups of 92 canals each) with two-thirds of root length were selected and randomly allocated into two different shaping techniques, i.e., Group I: conventional root canal shaping technique, Group II: modified root canal shaping technique. The quality of obturation (Coll and Sadrain, 1996) and presence or absences of voids were assessed by using radiographs. The recorded data was statistically analyzed. Results: Significant difference was seen between conventional and modified conventional techniques in underfilled and optimally filled canals. Conclusion: This modified cleaning and shaping technique can be considered as alternative to conventional instrumentation technique, as it improves quality of obturation and decreases the number of voids.

Aim and objective: To compare the efficacy of triple antibiotic paste (TAP) and double antibiotic paste (DAP) for root canal disinfection during revascularization of immature pulpless teeth. Materials and methods: A sample of 20 immature teeth in subjects aged 8–13 years was selected for a revascularization procedure. The teeth were randomly distributed in two groups corresponding to the medicament received—TAP group (n = 10) and DAP group (n = 10). Microbial samples were collected using dry paper points at the beginning of treatment and thereafter every 3 weeks till sterile reading was obtained. Microbial samples were then sent to the microbiological lab for identification. Results: A variety of opportunistic microbes were detected in samples obtained before placement of medicaments with no significant difference between the two medicament groups. The efficacy of TAP to eliminate microbes was lower in comparison to DAP after 3 weeks of placement of medicaments, whereas it was found to be more efficacious in comparison to DAP after 6 weeks and no significant difference (p> 0.05) was observed between the two groups. Conclusion: Immature permanent teeth with pulp necrosis can achieve complete root development with regenerative endodontic technique. The use of antibiotic pastes including TAP and DAP can help achieve a successful outcome with thorough decontamination of the root canal.

Aim and objective: To compare the accuracy of radiovisiography (RVG), Root ZX mini Apex locator, and Endo radar's inbuilt Apex Locator during working length determination determination in primary teeth with the actual/direct canal length. Materials and methods: 58 primary teeth indicated for extraction in children of age group 4–12 years were selected. RVG, Root ZX mini Apex Locator, and Endo radar's Apex Locator were used to determine the working length intraorally. Following extraction of the teeth, the actual working length was determined with magnifying loupes (2.5×) using a K-file and an endodontic ruler. The data was tabulated and statistically analyzed. Results: 84 canals (58 teeth) were evaluated and Root ZX mini Electronic Apex Locator (EAL) showed no statistically significant difference with the actual measurement (p = 0.18) whereas Endo radar and RVG showed statistically significant difference. Endo radar underestimated, while RVG overestimated the working length. The most accurate method for working length measurements of the root canals in primary teeth was Root ZX mini EAL, followed by Endo radar and the least accurate was RVG. Conclusion: The Root ZX mini Apex Locator showed the most promising results and had an excellent degree of agreement with actual working length, followed by Endo radar and RVG.

Aim and objective: To evaluate root canal transportation, centering ability ratio (CAR), remaining dentine thickness, dentinal cracks, and instrumentation time after instrumentation with different filing systems in root canals of primary teeth by cone beam computed tomography (CBCT) analysis. Materials and methods: Sixty prepared canals of primary teeth divided into 4 groups with 15 canals in each were prepared with NiTi K files, Proaper Next (PTN) files, OneShape (OS), and WaveOne (WO) files, respectively. Using CBCT scan, the pre- and postinstrumentation scan was done to obtain images at three levels (apical, middle, and cervical). The results obtained were statistically analyzed using SPSS 21 statistical software version. Result: Significant statistical difference was found between different filing systems. Conclusion: ProTaper Next files showed least canal transportation and the best centering ability was shown by OS file system. The NiTi K hand files preserved maximum remaining dentin thickness (RDT) and produced minimum dentin cracks. WO file system took least instrumentation time when compared to the other three filing systems. Clinical significance: The use of rotary instruments in the pulpectomy of primary teeth represents a promising technique being advantageous for the pediatric patients by maintaining the original canal curvatures, showing greater ability to maintain dentin thickness, causing lesser dentin cracks, and reducing chair time thus favoring preparation of more conical root canals and better obturation.

Background: Cleaning and debriding the canals and preserving the shape of the canal without deformation is the primary goals of pulpectomy. Transportation is a critical endodontic iatrogenic fault that could cause a catastrophe. This study evaluated the canal centering ability and canal transportation caused by Kedo-S pediatric and Mtwo instruments, using a cone-beam computed tomography (CBCT). Materials and methods: This in vitro study was performed on distal roots of 50 primary mandibular first molars. The teeth were scanned using CBCT and randomly divided into two groups. The canals were then prepared using either Kedo-S or Mtwo files (n = 25). The instrumented canals were rescanned. The scanned volumes were sectioned at 2, 4, and 6 mm from cementoenamel junction (CEJ). Canal transportation (CT) and instrument centering ability were estimated and compared in both groups. Results: The mean values for two study groups were compared. T-test was used to determine theP value. The Levene's test was used to test the significance between two groups. The two groups showed similar results in terms of transportation and centering ability (P > 0.05). Conclusion: Kedo-S pediatric and Mtwo instruments demonstrated similar canal centering ability and CTs.

Aim and objective: To evaluate the clinical and radiographic success rates of curcumin, curcumin and calcium hydroxide in equal proportions and calcium hydroxide as an obturation material compared to curcumin and calcium hydroxidet (Metapex). Materials and methods: This study included 64 primary molars with irreversible pulpitis indicated for single visit pulpectomy. After obtaining informed consent from the parents, all the teeth were randomly allocated to one of four groups. Pulpectomy was performed using rubber dam isolation and was obturated. The samples were categorized into the four groups based on obturation material namely, group A: curcumin with calcium hydroxide in equal proportions, group B: curcumin, group C: calcium hydroxide, and group D: Metapex. Clinical and radiographic outcomes were evaluated at time intervals of 10 days, 1 month, 3 months, and 6 months. Data was subjected to statistical analysis. Chi-square tests were used compare the groups. Results: At the end of 6 months, clinical and radiographic success rates of groups A, B, and C showed 81.3%, 61.5%, and 93.8%, respectively, while group D had 100% success rate. Conclusion: Among the four groups, the hierarchy of success rates are as follows: Metapex > calcium hydroxide > curcumin and calcium hydroxide > curcumin. However, various formulations and combinations of curcumin can still be extended with larger sample size. Clinical significance: Curcumin and calcium hydroxide paste can be used as an obturating material with further follow-up studies.

Introduction: Primary teeth with pulpal involvement and those having periapical issues should be retained until their normal exfoliation because their premature loss may lead to adverse aberrations in the future dentition. Root canals harbor different types of microorganisms and root canal infections generally are polymicrobial in nature. One of the most common and preferred root canal filling material which is commonly used for primary teeth is zinc oxide eugenol (ZOE) cement. Aims and objectives: To evaluate and compare the antimicrobial efficacy of ZOE with zinc oxide powder mixed with Morinda citrifolia extract, Aloe vera extract, and neem extract against Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans. Materials and methods: The material used in the study were zinc oxide powder, eugenol liquid, M. citrifolia extract, A. vera extract, neem extract, petroleum jelly (Vaseline). The zinc oxide powder was mixed with minimum inhibitory concentration (MIC) percentage value of herbal extract. Result: Zinc oxide eugenol showed strong inhibitory effect against S. aureus and C. albicans. For P. aeruginosa, zinc oxide+M. citrifolia showed strong inhibitory. Petroleum jelly (Vaseline) was used as control agent which showed no inhibitory effect. Conclusion: The test root canal filling materials, i.e., ZOE, zinc oxide powder mixed with M. citrifolia extract, A. vera extract, and neem extract, respectively showed varied antimicrobial activity against the microorganisms tested, i.e., S. aureus, P. aeruginosa, and C. albicans.

Aim and objective: The aim of the present study was to evaluate the reduction in bacterial loading using 3.8% as an irrigating solution in pulpectomized primary molars. Study design: A randomized, controlled clinical trial was performed that included primary molars with pulp necrosis. Sixty necrotic canals were included, 30 irrigated with 3.8% SDF (experimental group) and 30 with 1% NaOCl solution (control group); in all cases, two microbiological samples from within the canals were taken with sterile paper points, the first after the canal opening and before the first irrigation, and the second after instrumentation and final irrigation, before obturation. All samples were evaluated by Agar plate method. Results: The results were statistically analyzed by student “t“ test. After analyzing samples before and after irrigation in the control group (NaOCl), we found a strong significant decrease of bacterial load (p = < 0.001). The same occurred in the 3.8% SDF group samples (p = < 0.001). When both groups were compared post irrigation, a statistically significant difference was observed in favor of 3.8 % SDF. Conclusion: 3.8% SDF can be suggested as an alternative irrigant for pulpectomy of necrotic teeth.

Aim and objective: This study was carried out to comparatively assess the efficiency of four methods of obturation viz Lentulo spiral, Navi tip syringe, Bi directional spiral, and Past inject carrier in deciduous teeth using vista scan. Materials and methods: A total sample of 100 primary root canals [4 groups of 25 canals each] with 2/3^rd of root length were selected and randomly allocated into four different obturating techniques, i.e., Group I: Lentulo spiral, Group II: Navi tip syringe, Group III: Bi directional spiral, and Group IV: Past inject carrier. The quality of obturation [Coll and sadrain, 1996] and presence or absence of voids were evaluated by using Vista scan. The recorded data was statistically analyzed. Results: The highest mean rank value of optimally filled canals was obtained by Group IV [58.00] followed by Group I [50.00] with no significant difference. The highest mean rank value of under filled canals and over filled canals were obtained by Group III and Group II, respectively, and these results were statistically significant. All the four obturation techniques showed presence of voids with no significant difference. Conclusion: Both Lentulo spiral and Past inject carrier were equally efficient in attaining an optimally filled homogenous obturation in deciduous teeth.

Root canal sealants placed in primary tooth are unique in various characteristics. Chitosan nanoparticles have gained an important milestone in research area due to its biodegradable and its bioavailability nature. Chitosan nanoparticles synthesized by ionic gelation method and studied for its physical characteristics when added with root canal sealant provides a promising result. In this study, biocompatibility nature of Chitosan nanoparticles with Vero cell line was being investigated. Several solution parameters of Chitosan nanoparticles and root canal sealants were investigated to optimize diameter of nanoparticles after being characterized to XRD, SEM, and FTIR. The Chitosan nanoparticles were found to be biocompatible to fibroblasts and on a dose-dependent manner, these can be used in combination with the root canal sealant in primary teeth.

Background: Radiography is one of the most valuable diagnostic tools used in comprehensive dental care. Radiation from dental radiographs was thought to cause cytogenetic changes and its plausible effects can remain for some hours, months, or generations especially in children. Aims and objectives: To evaluate and compare the possible genotoxic effect of routinely used intraoral periapical radiographic exposure and radiovisiographic exposure in exfoliated epithelial cells as measured by the formation of micronuclei during single visit pulpectomy procedure using Buccal Micronucleus Cytome (BMCyt) assay in children. Materials and methods: Study comprised 60 healthy children who has undergone either intraoral periapical radiography (IOPAR; group 1, n = 30) or radiovisiography (RVG; group 2, n = 30) during various steps of single visit pulpectomy procedure. Cytological smears were taken from the buccal mucosa immediately before the X-ray exposure and 10 ± 2 days after exposure. The cells were stained with Feulgen and evaluated for micronuclei by scoring 1,000 cells per sample. Results: The genotoxic effect of radiation exposure from intraoral periapical radiography higher than that of RVG showing significant increase in micronucleus (MN) formation. Conclusion: The X-ray radiation emitted during IOPAR or RVG does induce genotoxic changes in the form of increased frequency of micronuclei. So, great care and standard protocol should be followed to advice radiographs if necessary and reduce the cumulated biological effects of radiation exposure. Keynote: Taking into account the strong evidence of a relationship between DNA damage and carcinogenesis and the extensive application of intraoral radiographs in pediatric dentistry, it would be useful to know to what extent these dental X-rays cause genotoxic effects resulting in DNA damage on oral mucosa.

Aim and objective: To compare and evaluate canal preparation using hand stainless steel files, hand ProTaper files, and rotary ProTaper files for change in root canal geometry in terms of surface area and volume changes assessed by computed tomography. Materials and methods: The present study was conducted in Nair Hospital and Dental College, Department of Pediatric and Preventive Dentistry in collaboration with insight CBCT, imaging technologies. A total of 36 extracted human primary mandibular second molars were collected from the Department of Pediatric and Preventive Dentistry. All the teeth were scanned using cone-beam CT (i-CAT CT Scanner Next Generation, Imaging Sciences International) preoperatively and postoperatively to assess the mean absolute change in surface area and mean change in the volume of all the canals at different levels with the use of hand stainless steel files, hand ProTaper and rotary ProTaper files. Results: ProTaper instruments, both hand ProTaper and rotary ProTaper caused significant changes in the surface area in the coronal thirds and middle thirds of the canal when compared to hand stainless steel files. No difference was found in surface area and volume changes between hand ProTaper and rotary ProTaper instrumentation. Conclusion: Use of ProTaper instruments for preparation of deciduous teeth can render benefit of an improved canal preparation to facilitate better obturation and successful root canal therapy.

Introduction: The present study evaluates the efficiency of 3Mixtatin (a combination of Simvastatin and 3Mix antibiotics) in comparison with Mineral Trioxide Aggregate in primary molars pulpotomy. Materials and methods: A total of 64 deciduous molar teeth with caries requiring pulpotomy procedure were selected and randomly divided into two treatment groups, Group I- MTA (n = 32), Group II- 3Mixtatin (n = 32). Restoration with Glass Ionomer Cement followed by stainless steel crowns was done after pulpotomy procedure. The clinical and radiographical analysis was done in the subsequent follow-up periods of 3, 6, 9, and12 months simultaneously. Result: Both groups showed equal success rates, without any significant difference between the MTA and 3mixtatin groups clinically (success rate of 93.8%)and radiographically higher success rate was seen with 3Mixtatin (78% success rate). Conclusion: 3mixtatin showed similar clinical and better radiographical success rate to MTA. Therefore, 3mixtatin may be a potential alternate pulpotomy medicament in primary teeth. Key messages: In the present study based on the radiographic findings, 78% success rate was seen in the teeth treated with 3Mixtatin, which was higher than the radiographic success rate of MTA (75%). Therefore, it is reasonable to assume the use of 3Mix with Simvastatin to treat pulpotomized primary molars by 3Mixtatin.

Background: Root canal cleaning is a key step in the endodontic treatment of the primary molars. An innovative generation of endodontic instruments has been devised with the aim of emerging better procedures. The objective of the study is to assess the preparation of time, the risk of lateral perforation, and the removal of dentin from Kedo-S and Mtwo rotary instruments on primary teeth. Study design: This is an in vitro experimental study comparing the two groups. Materials and methods: A total of 50 extracted mandibular primary first molars are collected, divided randomly into two groups of 25 teeth each. Group I: Kedo-S Pediatric rotary file, Group II: Mtwo rotary file. Distal canal is standardized for evaluation and teeth are sectioned at the CEJ. The teeth were instrumented according to manufacturer's guideline. Both the groups are scanned before and after instrumentation of the canal using cone-beam computed tomography (CBCT) and values are evaluated. Results: Compared with Mtwo files, Kedo-S files need less instrumentation time and limited lateral perforation. No statistical differences were reported between the instrumentation of Kedo-S and Mtwo with regard to the amount of dentin removed. Conclusion: In pediatric endodontics, Kedo-S pediatric rotary file can be considered an effective alternative to traditional rotary files because it requires less instrumentation time and preserves dentin thickness.

Background: In primary teeth, working length determination is complicated due to its continuous alteration in dimension, shape, and root apex position. Accurate working length determination is essential to achieve the optimal cleaning and disinfection of the canal. Despite the use of conventional radiographic method, newer methods are available to increase the accuracy of WL determination. This study aims to compare electronic apex locator (EAL) with radiographic method of WL determination and to evaluate its accuracy using cone-beam computed tomography (CBCT). Materials and methods: Sixty root canals from 34 extracted primary teeth were included. Occlusal surfaces were flattened and access opening done for all the samples. Teeth were subjected to working length determination by conventional radiograph and EAL. Samples were then mounted on a U-shaped wax and subjected to CBCT. Results were recorded and statistically analyzed using ANOVA and ICC for quantitative data. Result: The mean measurement of radiographic, EAL and CBCT methods are 11.708, 11.200, and 10.895, respectively. Mean measurements demonstrated significant difference (p < 0.05) between three methods. ICC demonstrated high correlation between EAL and CBCT with Cronbach's α value of 0.962 and moderate correlation were observed between radiographic method and CBCT (0.706) and EAL and radiographic method (0.763). EAL demonstrated 87% accuracy whereas radiographic method demonstrated 63% accuracy to the actual length as evaluated by CBCT. Conclusion: EAL is more accurate than conventional radiographic method as evaluated by CBCT.

Background: Making use of rotary instruments for doing pulpectomies in the primary teeth is one of the most developing areas in the field of pedodontics. The primary aim of this study was to assess the understanding and the ease with which Saudi Arabian dentists could use rotary instrumentation in primary teeth. Materials and methods: A cross-sectional observational study was conducted among dentists over 3 months. A structured self-explanatory questionnaire was given, and responses were obtained from the dental practitioners. Results: The response rate for the survey was 92.45%. Only 21.4% of them were using rotary instruments, and ProTaper was most commonly used. The most common limitation factors that obstructed its usage included the taper and length of the existing files. On assessing the need for using an exclusive rotary file for performing root canal preparation in primary teeth, there was a significant difference observed statistically. The general thought that floated among most dental practitioners (p value = 0.01) and specialists who had 11–15 years of experience was that an exclusive rotary file is the need of the hour. Conclusion: There is an absolute need for more education programs and workshops in the country to increase the knowledge and awareness of dental practitioners, and also to give hands-on experience regarding rotary instrumentation in primary teeth. In kids, it seems appropriate to use kid-specific rotary files that make it comfortable for children too during the procedure.

Background: In children with young permanent teeth, dental caries and traumatic injuries are the most common problems leading to pulp necrosis. Since, root development is completed in two to three years after eruption of the tooth into the oral cavity, loss of pulp vitality in young permanent tooth creates distinctive problems. In spite of exceeding availability of treatment procedures there is a need to search for a substantial procedure to treat young permanent teeth effectively. Aim: The aim of this systematic review was to evaluate the treatment protocols in the management of pulpally involved young permanent teeth in children. Method: Systematic search was conducted on databases PubMed, Cochrane, and Google Scholar among studies published from 1st January 2010 till 31st May 2020. Studies meeting the inclusion criteria were included in the review and were then assessed for quality with the help of predetermined criteria which categorized studies into high, medium, and low. Results: Search strategy yielded 4,846 articles. After screening through titles and abstracts, 33 articles remained which were further screened for full text. At the end, 14 articles were included in systematic review. Furthermore, the included articles were statistically evaluated by meta-analysis. Conclusion: In apexogenesis and apexification procedures, newer biomimetic materials like mineral trioxide aggregate and biodentine have more success rate than conventionally used calcium hydroxide. Among regenerative endodontic procedures platelet-rich plasma and platelet- rich fibrin showed better results. Clinical significance: To amend clinician perceptions towards acceptance of the newer regenerative procedures and their effectiveness in management of young permanent tooth.

Endodontic procedures are associated with various mishaps, one of which is instrument breakage. It can act as an obstruction to mechanical and chemical cleaning of an infected root canal, thereby hampering the prognosis of treatment. Instrument retrieval must be performed with minimum damage to a tooth and surrounding tissues, minimal loss of radicular dentine and simultaneously maintaining the original canal shape as much as possible. This case report represents successful retrieval of a separated K file fragment from the distobuccal canal of the right mandibular primary second molar 85 with ultrasonic energy application under the dental operating microscope.