Aims and background: Breastfeeding is the gold standard nutrition for infants. However, the inability of infants to latch on, maternal complaints of sore or painful nipples, and insufficient milk supply frequently result in early breastfeeding cessation. Hence, milk has subsequently been replaced by infant formula milks of high quality, which serve as an alternate source of nutrition for infants. There also has been a rising concern among parents and caretakers regarding the cariogenic potential of the various milk formulas available in the market due to the presence of fermentable carbohydrates in them, leading to an increase in nursing caries or early childhood caries. Hence, this study aims to comparatively evaluate the acidogenic potential of four different milk formulas based on dental plaque pH, salivary pH, and buffering capacity. Materials and methods: This cross-sectional study was carried out to assess the acidogenic potential of various infant milk formulas using three main parameters of measurement of caries: evaluation of salivary pH, plaque pH, and buffering capacity. Baseline plaque and salivary pH and postconsumption plaque pH and salivary pH were assessed after 5, 10, 15, 20, 30, and 60 minutes in 60 healthy children (15 in each study group) aged 7–12 years after rinsing with group I (lactose-based), group II (soy-based), group III (protein hydrolysate-based), and group IV (iron-based) milk formulas. The pH was assessed using a precalibrated digital pH meter. Plaque pH was also further assessed based on its buffering capacity. Results: Soy-based and protein hydrolysate-based milk formulas were found to be most cariogenic in both saliva and plaque. Lactose-based formulas were found to be the least cariogenic of all the milk formulas. Conclusion: Parents and caretakers must be made aware of the various types of milk formulas available, their composition, as well as their relative cariogenic nature. Feeding should always be supervised, and infants should not be left with milk-containing bottles as comforters. Milk feeds at bedtime, when salivary flow is reduced, should be discouraged. Dentists and pediatricians should be aware of the caries-related risk associated with different milk formulas before recommending them to children. Clinical significance: Knowledge and awareness among parents and caretakers regarding the cariogenicity of various milk formulas available in the market.

Background: Vitamin D deficiency in expectant mothers is very common in India. As a consequence, the possibility of hypoplasia of teeth and resultant propensity for faster progression of early childhood caries (ECC) is expected to be higher in Indian children. Aim: This study aimed to determine the relationship between prenatal vitamin D intake of mothers and dental caries experience in their preschool children, and whether vitamin D deficiency in mothers could be a risk factor for tooth decay in their children. Design: This cross-sectional study included 120 mothers of children aged up to 71 months with dental caries attending the Department of Pediatric Dentistry in India. Mothers were surveyed about their prenatal vitamin D intake and their practices regarding vitamin D and sunlight exposure. Children were clinically examined, and their caries status was recorded using the decayed, extracted, filled teeth (deft) index. Results: Data were analyzed descriptively and correlated using an independent t-test. Binary logistic regression was employed to predict the effects of the duration of sun exposure and vitamin D deficiency on dental decay. The correlation of mothers’ prenatal vitamin D intake was significantly associated weekly with children's caries experience. Their sun exposure (p = 0.002) and practices adopted (p = 0.0001) regarding vitamin D levels were statistically significant for children's caries status. Improper brushing frequency was also significantly associated with higher deft scores. Conclusion: The association between mothers’ prenatal vitamin D intake and health practices related to vitamin D with dental caries was not confirmed. Subjects with vitamin D deficiency and their children had significantly higher odds of developing dental decay. However, our findings suggest that 25-hydroxyvitamin D insufficiency may be a risk factor for developing dental caries in children.

Background: The introduction of the rotary file system for children was a revolution in the field of pediatric endodontics. These files are cost-effective and help in consistent obturations with shorter instrumentation time. Aim: The present randomized controlled trial (RCT) was planned for a comparative evaluation of rotary and manual techniques in biomechanical preparation of primary molars to determine their effect in terms of cleaning and shaping efficacy, working time, quality of obturation, and postoperative pain. Materials and methods: A randomized clinical trial study was conducted in 75 children aged 5–9 years requiring pulpectomy. Each tooth was randomly assigned to one of the three treatment groups: Kedo-S files, rotary K-Flex files, and hand instruments group. Results: It was observed that Kedo-S files and rotary K-Flex files were more effective in cleaning and shaping of root canals compared to hand H/K files. The postbacterial count for hand files was higher compared to rotary files. Shorter working time was seen with rotary files (3.88–5.04 minutes) compared to hand files (15.68 minutes). Rotary files showed a reduced number of voids, with Kedo-S files in 92% of cases and rotary K-Flex files in 80% of cases. Apical seal and extent of fill were maximum with rotary files, having a grade C rating in 92% of cases. Kedo-S files and rotary K-Flex files showed a significant reduction in postoperative pain compared to hand files. Conclusion: The present study showed a significant reduction in bacterial count, working time, quality of obturation, and postoperative pain with rotary files.

Aim and background: The orthodontic diagnosis and treatment planning are the fundamental goals during the mixed dentition period. Numerous methods have been proposed to date. The study was designed to determine the mesiodistal (MD) widths of the lower permanent canines and premolars from Tanaka and Johnston, regression equation (RE) proposed for north Indian population (RE-NIP), Bernabé and Flores-Mir C, Moyers’, and Ling and Wong mixed dentition analysis (MDA) and to determine the correlation coefficients for the Eluru population. Materials and methods: The study population was selected using cluster random sampling. A total of 3,572 children were clinically examined from the Outpatient Department of Pediatric and Preventive Dentistry, St Joseph Dental College and Hospital, Eluru district, Andhra Pradesh. Out of these, 140 children aged 11–16 years were randomly selected for the study based on the inclusion and exclusion criteria. The MD width of permanent incisors, canines, premolars, and molars was measured with the help of a digital vernier caliper; summed up and compared with the above-mentioned REs. The data obtained were subjected to statistical analysis using SPSS version 22, employing Student's t-test, Pearson correlation coefficient, and Kruskal–Wallis test. Results: The RE-NIP underestimated the values, whereas the remaining equations overestimated the sum of permanent canines and premolars in both arches in the study population. Conclusion: The predicted values obtained from the abovementioned methods overestimated the actual values, and a new RE for the Eluru population should be suggested to better represent the size of unerupted canines and premolars. Clinical significance: Measuring the MD widths of the upper and lower permanent incisors and molars during the mixed dentition period from different REs will help a pedodontist in proper treatment planning to predict the MD width of unerupted canines and premolars.

Background/introduction: Early childhood caries (ECC) is one of the most prevalent diseases in children worldwide. Early childhood caries is driven by a dysbiotic state of oral microorganisms, mainly caused by a sugar-rich diet. Additionally, poor oral hygiene or insufficient dental plaque removal leads to the rapid progression of ECC. Early childhood caries leads not only to dental destruction and pain in children but also affects the quality of life of the caregivers. Additionally, upon neutrophil activation at inflammatory locations, these proteases are externalized in an active state, aiding in the control of inflammatory and immunological responses. Any enzyme that catalyzes proteolysis reactions is known as a protease. Proteases are produced by human glands or derived from microbes in the oral cavity. Additionally, the oropharyngeal mucosae and crevicular fluids are sources of protease. Aim: This study is aimed at the estimation and correlation of salivary protease enzymatic activity in the saliva of children with and without ECC. Materials and methods: A total of 50 children were included in the study, which was divided into two groups: group I (caries-active) and group II (caries-free)—each consisting of 25 children. Unstimulated saliva samples were collected and subjected to a spectrophotometer for analysis. Salivary protease levels were estimated and correlated between caries-active and caries-free children. Results: The correlation between caries score and salivary protease activity was statistically significant with a moderate correlation. The comparison of mean salivary protease activity between caries-active and caries-free groups was statistically significant. However, the comparison of salivary protease activity based on different age-groups was not statistically significant, whereas gender and caries scores in group A were statistically significant. Conclusion: In conclusion, there is a substantial correlation between salivary protease enzyme levels and the severity of dental caries, and an increase in salivary protease enzyme levels is linked to a considerable rise in caries severity. As a result, prevention may be possible with early detection.

Aims and background: Midazolam is commonly used as a preanesthetic medication for behavior management of children. The current study is conducted to find out the effect of midazolam through nasal and oral routes as a premedicament in pediatric patients treated under general anesthesia. The main aims of the study were: to compare the effect of oral syrup and intranasal spray as preanesthetic medication; to record the undesirable side effects of midazolam by both routes. Materials and methods: The patients aged 2–6 years of either sex were randomly divided into two equal groups of 30 each—group I: oral; group II: intranasal. Results: The oral and intranasal routes of midazolam were found to be equally effective and provided adequate sedation for easy separation from the parents and cooperation from children during the induction of anesthesia with minimal side effects. Conclusion: Based on the study results, we can conclude that both oral and intranasal midazolam can be used as preanesthetic medication for pediatric dental patients treated under general anesthesia. Clinical significance: In pediatric patients, the oral route should be preferred for midazolam premedication in comparison to the intranasal route.

Aim and background: The aim of this study was to determine the properties of a new luting cement, BioCem®, by evaluating shear bond strength (SBS) and flexural strength (FS). Materials and methods: A total of 60 extracted deciduous molars were included in this study. Samples were divided into two groups: Group I, Fuji I® (n = 30), and group II, BioCem® (n = 30). Each tooth was embedded in one acrylic block, such that the flattened enamel surface was exposed. Cylinders of 6 mm diameter and 8 mm height were prepared and evaluated for SBS using a universal testing machine. Ten rods of 25 × 2 × 2 mm of each material were prepared using a custom mold to evaluate the FS using a universal testing machine. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for statistical analyses. Intergroup analysis was performed using an independent sample t-test. Results: Upon comparing the SBS values of the luting agents and prepared enamel surfaces, glass ionomer cement (GIC) displayed the highest value, while BioCem® displayed the lowest. Upon comparing the FS values of the luting agents and prepared enamel surfaces, BioCem® performed better than GIC. Conclusion: BioCem® may be used as a luting agent for the cementation of stainless steel crowns (SSCs) on primary teeth. Clinical significance: BioCem®, a recently developed luting cement, may be used for cementing SSCs to the surfaces of prepared deciduous teeth; it exhibits significantly higher FS but lower SBS than that of GIC.

Introduction: Pediatric rotary systems have the advantage of improved canal centricity and conservative canal preparation with better obturation quality. Pro AF Baby Gold and Pedoflex files are two exclusive pediatric rotary file systems that were introduced in recent times. Aim and objective: The aim of the present study is to compare and evaluate the dentine thickness, centering ability, canal transportation, and instrumentation time of Pro AF Baby Gold and Pedoflex files using cone beam computed tomography (CBCT). Materials and methods: A total of 40 extracted human primary molar teeth with a minimum 7 mm root length were included in the study and randomly divided into two groups: group I, Pro AF Baby Gold; group II, Pedoflex files. Teeth were imaged preoperatively with CBCT, then root canal preparation was done in both groups with respective files, followed by postoperative CBCT imaging to evaluate the dentin thickness, centering ability, and canal transportation of both groups. Instrumentation time was noted using a stopwatch. Results: There is a statistically significant difference in the instrumentation time; Pedoflex took a shorter time when compared to Pro AF Baby Gold files. Regarding canal transportation, there was no significant difference between the two files, with Pedoflex showing a better value than the other files. Regarding centering ability, there was no significant difference between the two files, with Pro AF Baby Gold having a better value than the other files (p < 0.001). Conclusion: From the findings of our present study, it was found that both systems were able to effectively shape curved root canals in terms of canal transportation and centering ability.

Background: One of the major concerns of the current era is dental anxiety in Pediatric Dentistry. Kids are very well adapted to emojis or emoticons nowadays, and they represent emotions or moods better than a cartoon picture. Therefore, this study was conducted to evaluate a newly designed anxiety rating scale. The Jeet Wheel Scale (JWS) uses emoticons and colors to assess the anxiety or mood of the child during the first visit of the child. Aim: The aim was to establish the novel anxiety rating scale and compare it with the Venham Picture Test (VPT) and Facial Image Scale (FIS). Materials and methods: The study included 100 healthy children aged 4–8 years, and their dental anxiety was assessed using the JWS, VPT, and FIS at their first dental appointment, along with their scale preference. Results: The mean and standard deviation of anxiety scores measured using the FIS, VPT, and JWS were 1.67 ± 0.88, 1.99 ± 1.17, and 2.79 ± 1.35, respectively. Among the scales used, a significant difference was observed. A strong correlation was observed with the Pearson correlation test. The results indicated a strong correlation (0.863) between the JWS and VPT, and a strong correlation (0.802) between the JWS and the FIS. Based on the above observations, it could be confirmed that the JWS has high validity. Children preferred the JWS over the other two established scales. Conclusion: The JWS was found to be more efficient for assessing dental anxiety in children.

Objectives: Early childhood caries (ECC) continue to increase, especially among low socioeconomic communities. This study was conducted in an informal settlement comprising mostly foreigners who have settled in the area. Given the limited dental and medical services available to these communities, this study aimed to determine the dental and medical disease profile of these inhabitants. The objective was to determine the oral health status and the body mass index (BMI) of children attending crèches in an informal settlement. Materials and methods: Oral health data, including dental caries (DC), soft tissue lesions, fluorosis, erosion, and trauma, were recorded using the World Health Organization (WHO) recommended methods. The examiners were calibrated, and all examinations took place at the crèches under natural sunlight. The BMI was calculated by a team of dieticians who were blinded to the oral health status. The height and weight were measured by calibrated examiners under standardized conditions. Results: There were a total of 169 participants; the mean age was 4.02 years (±1.13; 1–7) and there was an equal distribution of males and females (49.7% females and 49.3% males). The prevalence of DC was 39.1%, with 19% having 4 or more carious teeth. The mean decayed, missing, and filled teeth (dmft) and plaque scores [Simplified Oral Hygiene Index (OHI-S)] were 1.58 (±2.70) and 0.65 (±0.43), respectively, and the mean dmft score increased with increasing age. The mean d component contributed 99% of the total mean dmft score (1.56). The mean BMI was 15.44, and this decreased significantly (p = 0.009) while the OHI increased significantly (p < 0.001) as the number of carious teeth increased. Conclusion: The prevalence of caries was relatively high, and those with caries had multiple decayed teeth. The d component contributed almost 100% to the mean score, indicating a lack of access to dental care. The mean BMI score was inversely proportional to the number of carious teeth, which could imply that those with caries had difficulty eating.

Aim and background: A child's temperament, influenced by inborn traits and emotional regulation, can impact their dental behavior and caries risk. Parenting styles, such as authoritative, authoritarian, permissive, or neglectful, also play a significant role. Authoritative parenting tends to yield more favorable dental outcomes, while permissive parenting can lead to a higher prevalence of caries. Studying these interactions can help tailor dental interventions and address potential risks associated with caries development. Thus, the study aims to correlate parental personality, the child's temperament to dental caries, and child's behavior in a dental setting. Materials and methods: A cross-sectional study was conducted on 160 children in the age-group of 6–9 years. The children were selected based on the selection criteria. The children were asked to fill out the parental perception questionnaire (PPQ), and the parents were asked to fill out the emotionality, activity, sociability (EAS) questionnaire to assess the parenting style and child's temperamental status. Later, the child's behavior pattern was assessed using the Frankl behavior rating scale. The children were intraorally examined for the presence of caries using the decayed, extracted, filled teeth (deft) and decayed, missing, filled teeth (DMFT) index. All the data were tabulated and statistically analyzed. Results: In this study, a total of 160 children were assessed, including 84 boys (52.3%) and 76 girls (47.5%), with an average age of 7.8 years. One-way analysis of variance (ANOVA) followed by Scheffe's post hoc test was performed to compare the temperamental status and parenting style with the behavior of the child in the dental office. The results were statistically significant with a p-value of 0.001. Pearson's correlation coefficient revealed a significant positive correlation between Temperament E scores and def scores in children with positive behavior (p-value = 0.004). Conclusion: This study's findings suggest that a child's behavior in a dental office is influenced by the parent's personality, the child's temperament, and the dentist. Clinical significance: A child's capacity to handle dental visits and their overall oral health can be notably affected by the child's temperament and parenting style.

Background: Efforts have been made to minimize pain, prevent the development of needle fear, and promote positive experiences for children. The present study is designed to evaluate the effect of premedication with Ibugesic Plus before the administration of local anesthesia and extraction in children. Aim: The aim of the study is to assess the efficacy of preemptive analgesia on pain perception during local anesthesia administration and extraction in pediatric patients. Materials and methods: A total of 104 patients aged 7–10 years were selected who needed primary molar extraction. Group I—Ibugesic Plus syrup was given 30 minutes prior to extraction. Group II—Placebo solution (B-Folcin syrup) was given 30 minutes prior to extraction. Pain level, pulse rate, and SpO₂ were assessed using the Wong–Baker Faces Pain Rating Scale (WBFS) and pulse oximeter after injection, after extraction, and postoperatively. Results: The highest scores of pain were recorded after the time of injection and extraction. The patients who received preemptive analgesics (group I) reported significantly less pain than the placebo group (group II) at the time immediately after injection, after extraction, and 2 hours after extraction. Conclusion: The present study showed that preemptive analgesic administration may be considered a routine and rational pain management strategy in primary tooth extraction procedures in children. Clinical significance: Preemptive analgesia can be given to patients prior to dental procedures to reduce postoperative pain.

Background: Children are more prone to develop gingivitis as a result of deficient oral hygiene, morphological variance, and a diet that encourages the growth of pathogenic oral bacteria. Aim: The purpose of this randomized, double-blind clinical study is to compare the therapeutic effect of an herbal mouthwash made of decoction and ethanolic extract of Populus euphratica and Myrtus communis to that of chlorhexidine (CHX) mouthrinse. Materials and methods: In this study, 60 patients aged between 8 and 10 years were divided into four groups, each with 15 patients. The first group was treated with a mouthwash made of ethanolic herbal extract, the second group was treated with a mouthwash made of herbal decoction, the third group was treated with CHX mouthwash (0.12%) (positive control), and the fourth group was treated with a placebo made with colored distilled water (negative control). Clinical parameters gingival index (GI) and plaque index (PI) were evaluated at the start, 1, and 2 weeks from ensuing the treatment. Preoperative and postoperative photographs of the maxillary anterior sextant were recorded to evaluate CIELab coordinates to monitor color changes. Statistical analysis: One-way analysis of variance (ANOVA) with Tukey's honest significant difference (HSD) post hoc tests were used for data assessment. Results: Significant reductions in GI and PI were found among the tested groups (p < 0.05). A significant reduction in a* value was observed, while L* value showed a significant increase between baseline and posttreatment (p < 0.05). Conclusion: Herbal-based mouthwash of Populus euphratica and Myrtus communis, whether prepared by boiling or ethanolic extraction, reduced gingival inflammation significantly and has a lot of potential for treating and preventing periodontal disease in young children. Digital photography is a reliable supplementary approach for diagnosing and monitoring gingival inflammation in pediatric patients.

Aim and background: Sleep quality has a significant impact on children's overall health and is associated with oral diseases. This study aimed to investigate the relationship between dental caries, periodontal status, and sleep patterns in 8–12-year-old children. Materials and methods: This cross-sectional study was conducted on 120 children aged 8–12 years. The children's sleep habits questionnaire (CSHQ) was employed to evaluate sleep status. Another questionnaire was used to collect data on lifestyle habits. Dental caries status was evaluated using the decayed, missing, and filled teeth (DMFT) and International Caries Detection and Assessment System (ICDAS) indices. Periodontal status was assessed through the plaque index (PI), probing depth (PD), gingival index (GI), and periodontal screening and recording (PSR). The association between oral health and sleep patterns was evaluated using Spearman's coefficient correlation, independent t-test, and the Chi-squared test. Results: The ICDAS mean was significantly higher in children with improper sleep patterns (p = 0.032). However, there was no statistically significant relationship between DMFT and sleep patterns (p = 0.346). The GI, PD, and PSR mean were significantly higher in the inappropriate sleep pattern group. There was a significant relationship between children's sleep patterns and GI, PD, and PSR indices (p = 0.033, p = 0.020, p = 0.028, respectively). However, there was no significant association between PI and sleep patterns (p = 0.277). Conclusion: Children's sleep patterns were associated with dental caries and periodontal status. Adequate sleep is required to prevent oral diseases such as dental caries and periodontal diseases. Clinical significance: According to this study, it is recommended that children should be encouraged to get adequate sleep by their parents and dentists.

Introduction: Only a finite number of standard oral health-related quality of life (OHRQoL) measures are available for young children. However, instead of using parents as proxies to report a child's oral health status, children's self-reported oral health measures would be more accurate in providing their own perceptions of oral impacts. Aim: The study aimed to evaluate the psychometric properties of the Telugu version of the scale of oral health outcomes (SOHO-5T) for 5-year-old children in Telangana. Materials and methods: The forward-backward translated SOHO-5T was pilot-tested among thirty children. The tested questionnaire was administered to 419 children, followed by a clinical oral examination using dentition status to evaluate dental caries (DC). Children (n = 30) were readministered the same questionnaire after a 2-week interval to test reliability. Internal consistency and test-retest reliability were determined by Cronbach's α and intraclass correlation. Correlation with global ratings of oral health questions was done to assess construct validity. Discriminant validity was evaluated based on the presence or absence of DC. A p < 0.05 was considered statistically significant. Results: The mean SOHO-5T score was 4.70, and the mean decayed teeth score was 2.48, with 49.16% of children having DC. Cronbach's α scores and the intraclass correlation (ICC) coefficient for overall SOHO-5T were 0.90 and 0.91, respectively. SOHO-5T also demonstrated good construct validity with a significant positive correlation with global ratings of oral health. SOHO-5T showed good discrimination between the presence (9.43 ± 3.10), or absence (0.14 ± 1.01) of DC. Conclusion: This study shows good internal consistency and test-retest reliability. It also exhibited good construct and discriminant validity.

Aim: The aim of this study was to evaluate the antimicrobial efficacy and minimum inhibitory concentration (MIC) of commercially available pediatric dentifrices containing different compositions against Streptococcus mutans and Lactobacillus activity. Materials and methods: Four different commercially available brands of pediatric dentifrices, designated as sample I—fluoride, sample II—herbal, sample III—xylitol with nanosilver particles, and sample IV—xylitol with fluoride, along with two control groups (a positive control—ciprofloxacin and a negative control—distilled water), were tested for their antibacterial activity by measuring the zone of inhibition, followed by MIC against two dental bacterial pathogens, S. mutans strain and Lactobacillus acidophilus (LB) strain, at five different twofold dilutions of 100, 50, 25%, 12.5, and 6.25% concentrations. Result: All four dentifrices were found to have wide variations in their effectiveness against the two tested microorganisms at 100% (pure) and 50% concentrations, with sample I having the highest activity, followed by sample IV and sample II. At 25% concentration, only sample I and sample IV showed antibacterial activity, while at 12.5 and 6.25% concentrations, none of the tested toothpastes exhibited any antibacterial activity. Sample III failed to show antibacterial activity even in pure form against the two microorganisms. Conclusion: In our present study, the fluoride-containing pediatric dentifrice with a lower fluoride concentration (458 ppm) exhibited the highest zone of inhibition, followed by the xylitol with fluoride dentifrice and the herbal dentifrice. No zone of inhibition was observed in the nanosilver with xylitol dentifrice.

Odontomas have been described as a dental abnormality that develops due to the overgrowth of certain components of the dental lamina, which eventually leads to the formation of a poorly structured calcified mass. The occurrence has been attributed to local trauma, infection, congenital defects, odontoblastic hyperactivity, or changes in the genetic material. Clinically, odontomas are largely asymptomatic and are diagnosed during routine examinations and procedures. However, they might frequently be associated with delayed eruption, impacted teeth, or missing teeth, warranting early diagnosis and management. This current paper describes the localization and management of a compound odontoma associated with multiple odontogenic abnormalities diagnosed in a 10-year-old girl. Eventually, surgical excision was planned and performed, and the defect was packed with PRF to promote healing and regeneration of the large defect.

This case report describes the successful application of presurgical nasoalveolar molding (PNAM) in the treatment of a neonate with Veau's class III cleft lip and palate of the left side. PNAM, a noninvasive method, effectively reduced the cleft deformity (from 10 mm pretreatment to 1 mm post-NAM), improved nasal esthetics, and minimized the need for extensive surgical interventions and better surgical outcomes. The treatment involved precise impression procedures, custom-made appliances, and weekly modifications to achieve optimal results. The comprehensive approach resulted in favorable esthetic outcomes, reduced scar formation, and improved lip symmetry, demonstrating the potential of PNAM as a valuable adjunctive therapy in cleft lip and palate management.

Aim and background: In presurgical infant orthopedics, nasoalveolar molding (NAM) therapy has gained more popularity worldwide in treating patients with cleft lip and palate because of its soft tissue nasal corrections in addition to the alignment and close approximation of the cleft alveolar segments, which gives better postsurgical stability and esthetics with minimal tissue tension and scar formation to the patients. The clinical case report aims to show the better post-NAM results, which had helped to gain better postsurgical results in terms of stability and aesthetics in hard and soft tissues. Case description: This clinical report presents the case of a 9-day-old female patient reported in the Department of Orthodontics and Dentofacial Orthopedics at Sharad Pawar Dental College and Hospital with nonsyndromic complete left-sided unilateral cleft lip and palate with a defect size of 13 mm, which was treated with a presurgical nasoalveolar molding (PNAM) appliance. NAM therapy takes advantage of circulating maternal estrogen, bringing pliability to the cartilage cells for presurgical cartilage molding. This has resulted in the closure of the alveolar defect from 13 mm to <2 mm in the present case, with nasal symmetry restoration due to nasal stent within 12 weeks of active treatment; hence, the postsurgical esthetics are maintained. Conclusion: NAM therapy remained beneficial and had significant aesthetic results in reducing the cleft defect size. Because of this, it gained a big surgical advantage in reducing tissue tension, primary stability, and scar formation. Clinical significance: By reducing the cleft defect size of the dysplastic maxillae, which brings the lip segments and alveolar segments closer to each other, it thus reduces the defect size for primary lip and palate repair. This serves as the biggest advantage for maxillofacial and plastic surgeons to maintain the posttreatment results with redefined aesthetics and symmetry.

Aim: This systematic review and meta-analysis aimed to answer the following focused question: Are rotary file systems more effective than hand file systems in terms of the quality of obturation and instrumentation time among primary teeth? Study eligibility criteria, participants, and interventions: The inclusion criteria comprised studies that compared the effect on quality of obturation and instrumentation time among primary teeth after using rotary and hand file systems for biomechanical preparation of the root canals. Materials and methods: This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included Medline (via PubMed), EBSCO, and Google Scholar. Articles published from January 2000 to December 2021, but only in English, were included. Results: The search resulted in 8,003 published studies. After the removal of duplicate studies and full-text analysis, 9 studies were selected for systematic review, and 8 were selected for meta-analysis. Overall, the results demonstrated the promising effects of rotary file systems in reducing instrumentation time and improving obturation quality compared to hand files. Conclusion: Within the limitations of this review, it can be asserted that rotary file systems are superior to hand files in primary teeth for pulpectomy procedures. Clinical significance: Rotary files, a more recent technique, are more efficient than traditional hand files in lowering the time required for instrumentation. Additionally, they provide superior obturation quality in primary molars, making them particularly beneficial for pediatric patients.