Background
In children, dental caries is among the most prevalent chronic diseases worldwide. Pulp interventions are indicated for extensive tooth decay. Depending on the severity of the disease, three pulp treatment techniques are available: direct pulp capping, pulpotomy and pulpectomy. After treatment, the cavity is filled with a medicament.

This is an update of a Cochrane review first published in 2003. The previous review found insufficient evidence regarding the relative efficacy of these interventions, combining one pulp treatment technique and one medicament.

Objectives
To assess the effects of different pulp treatment techniques and associated medicaments for the treatment of extensive decay in primary teeth.

Search methods
We searched the Cochrane Oral Health Group's Trials Register (to 25 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 25 October 2013), EMBASE via OVID (1980 to 25 October 2013) and the Web of Science (1945 to 25 October 2013). We searched OpenGrey for grey literature and the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication when searching the electronic databases.

Selection criteria
Eligible studies were randomised controlled trials comparing different pulp interventions combining a pulp treatment technique and a medicament in children with extensive decay involving dental pulp in primary teeth.

Data collection and analysis
Two review authors independently carried out data extraction and risk of bias assessment in duplicate. We contacted authors of randomised controlled trials for additional information if necessary. The primary outcomes were clinical failure and radiological failure, as defined in trials, at six, 12 and 24 months. We performed data synthesis with pairwise meta-analyses using fixed-effect models. We assessed statistical heterogeneity using by I2 coefficients.

Main results
We included 47 trials (3910 randomised teeth) compared to three trials in the previous version of the review published in 2003. All trials were single centre and small sized (median number of randomised teeth 68). Overall, the risk of bias was low in only one trial with all other trials being at unclear or high risk of bias. The overall quality of the evidence was low. The 47 trials examined 53 different comparisons: 25 comparisons between different medicaments/techniques for pulpotomy, 13 comparisons between different medicaments for pulpectomy, 13 comparisons between different medicaments for direct pulp capping and two comparisons between pulpotomy and pulpectomy. Regarding pulpotomy, 14 trials compared mineral trioxide aggregate (MTA) with formocresol (FC). MTA reduced both clinical and radiological failures at six, 12 and 24 months, although the difference was not statistically significant. MTA also showed favourable results for all secondary outcomes measured, although again, differences between MTA and FC were not statistically significant (with the exception of pathological root resorption at 24 months and dentine bridge formation at six months). MTA showed favourable results compared with calcium hydroxide (CH) (two trials) for all outcomes measured, but the differences were not statistically significant (with the exception of radiological failure at 12 months). When comparing MTA with ferric sulphate (FS) (three trials), MTA had statistically significantly fewer clinical, radiological and overall failures at 24 months. This difference was not shown at six or 12 months.

FC was compared with CH in seven trials and with FS in seven trials. There was a statistically significant difference in favour of FC for clinical failure at six and 12 months, and radiological failure at six, 12 and 24 months. FC also showed favourable results for all secondary outcomes measured, although differences between FC and CH were not consistently statistically significant across time points. The comparisons between FC and FS showed no statistically significantly difference between the two medicaments for any outcome at any time point.

For all other comparisons of medicaments used during pulpotomies, pulpectomies or direct pulp capping, the small numbers of studies and the inconsistency in results limits any interpretation.

Authors' conclusions
We found no evidence to identify one superior pulpotomy medicament and technique clearly. Two medicaments may be preferable: MTA or FS. The cost of MTA may preclude its clinical use and therefore FS could be used in such situations. Regarding other comparisons for pulpectomies or direct pulp capping, the small numbers of studies undertaking the same comparison limits any interpretation.

Pulp treatment for extensive decay in primary teeth.

The world is seeing a quick segment move towards a more established populace, a pattern with significant clinical, social, monetary and political ramifications. Maturing is a multifaceted procedure, including various sub-atomic and cell components with regards to various organ frameworks. A urgent part of maturing is a lot of useful and auxiliary adjustments in the invulnerable framework that can show as a diminished capacity to battle contamination, lessened reaction to inoculation, increased incidence of cancer, higher prevalence of autoimmunity and constitutive lowgrade inflammation, among others. In addition to cell-intrinsic changes in both innate and adaptive immune cells, alteration in the stromal microenvironment in primary and secondary lymphoid organs plays an important role in age-associated immune dysfunction. This review will provide a broad overview of these phenomena and point out some of their clinical and therapeutic implications. This review study setting, discussing the gradual aging immune system. Data for this study is collected from different search engines like PubMed, Google Scholar, MeSH, Semantic scholar, Cochrane, NCBI, Medline, core science. A total of 53 articles were selected. The aging of the immune system is associated with dramatic changes in the distribution and competence of immune cells. Anti-Aging therapy should aim at prolonging T cells’ survival while weakening inflammation prone to innate immunity.

https://cibg.org.au/article_9867_6aed416d016740a2632725618ea66e22.pdf

Aging and Immune System: An Overview

Zinc oxide eugenol (ZOE) has traditionally been used as a root filling material in primary teeth pulpectomy. Calcium hydroxide and iodoform (Ca(OH)2/iodoform) may have advantages as a root canal filling material to evaluate treatment success of Ca(OH)2/iodoform pulpectomy in primary teeth compared with ZOE based on clinical and radiographical criteria. All human clinical studies reporting clinical and radiographical outcomes of Ca(OH)2/iodoform compared with ZOE in primary teeth pulpectomy were identified in digital bibliographic databases. Two authors independently selected studies and extracted relevant study characteristics. Success of treatment was based on an accomplishment of specific clinical and radiographical criteria. Meta-analyses were performed to appraise study heterogeneity and aggregated statistics. Out of 5,000 articles identified in initial search, 15 articles met all inclusion criteria, while 10 were included in the meta-analyses. At 6- and 12-month follow-up, there were no statistically significant differences in the clinical and radiographical success rates of Ca(OH)2/iodoform and ZOE. However, ZOE was shown to have statistically significant higher success rates at ≥18-month follow-up. On the basis of the findings of this systematic review, we recommend that Ca(OH)2/iodoform be utilized for pulpectomy in primary teeth nearing exfoliation; conversely, ZOE should be utilized when exfoliation is not expected to occur soon. Future randomized control clinical trials with a long-term follow-up are needed before a reliable conclusion can be drawn as to the best pulpectomy material. The success of pulpectomy in primary teeth depends on selecting the ideal root canal filling material. It is challenging to select the appropriate filling materials for primary teeth. ZOE or ZOE/iodoform combined with Ca(OH)2 appears to be the materials of choice if primary teeth are not nearing exfoliation. More high-quality randomized control clinical trials with a long-term follow-up period are needed before a reliable conclusion can be drawn as to the best pulpectomy material in primary teeth (systematic review registration number: CRD42016037563).

https://onlinelibrary.wiley.com/doi/pdf/10.1002/cre2.173

A comparison of calcium hydroxide/iodoform paste and zinc oxide eugenol as root filling materials for pulpectomy in primary teeth: A systematic review and meta-analysis.

Local anesthesia in dentistry

Although endodontic treatment is widely recommended for compromised dental pulp, there is no information regarding the factors associated with failures in primary teeth. The aim of this study was to evaluate the survival and factors associated with failure of pulpectomies performed in primary teeth by dental students. The sample comprised patients treated at a University Dental Service and required endodontic treatment in primary teeth. The study investigated treatment-related variables and patient factors potentially associated with treatment failure. Pulpectomy survival was analyzed by Kaplan-Meier estimator followed by log-rank test (p<0.05). The analysis included 81 pulpectomies performed in 62 children (5.6±1.5 years). The survival reached 62.9% up to 12 months follow-up. Most failures occurred in the first 3 months (p<0.001). Teeth with carious lesions at the start of treatment presented more failures than those with restorations or history of trauma (p=0.002). The survival of endodontically treated teeth restored with composite was higher than the ones filled with GIC (p=0.006). Pulpectomy performed in two or more sessions resulted in more failures (p=0.028). Patients presenting gingivitis had more failures in the endodontic treatment (p=0.022). The failures of root canal treatment in primary teeth were more prone to occur in a short time and when the treatment was performed in teeth presenting carious lesions. The use of composite instead of GIC increased the survival of pulpectomies. Repeated sessions for endodontic treatment and lack of oral hygiene habits had a negative effect on the results.

https://www.scielo.br/pdf/bdj/v28n1/1806-4760-bdj-0103-6440201601009.pdf

Survival and Factors Associated with Failure of Pulpectomies Performed in Primary Teeth by Dental Students.

The aim of this study was to compare the effectiveness of 2% articaine and 2% lignocaine in achieving adequate anesthesia in children between the age group of 6–13 years using inferior alveolar nerve block. A triple blinded randomized controlled trial was conducted in 180 participants (90 patients- 2% articaine, 90 patients-2% lignocaine). Effectiveness of the anesthetic agent was determined at 3 points determined by subjective evaluation of pain using pain scales (FPS-R). Paired sample t-test and chi square test were performed for statistical significance. Anesthetic success for 2% articaine were 64.4%, 42.2% and 81.8% respectively. The anesthetic success of 2% lignocaine was 66.7%, 48.9% and 85.7% at point one, point two and point three respectively (p > 0.05). This study concludes that 2% articaine in 1:2,00,000 did not demonstrate superior clinical effectiveness in comparison to 2% lignocaine. Lignocaine has always been considered the gold standard. With its unique chemical structure and increased potency, Articaine has been gaining popularity. Its efficacy in 2% concentration had not been compared to 2% lignocaine. 2% articaine did not show clinical superiority but its comparable effectiveness with lignocaine can encourage further research in using articaine in reduced concentrations to improve effectiveness.

Effectiveness of 2% Articaine as an anesthetic agent in children: randomized controlled trial.

Aim
To evaluate the outcome of root canal treatment in primary teeth using three root canal filling materials – RC Fill, Vitapex and Pulpdent root canal sealer.

Methodology
The study was a single-centre, double-blind, randomized controlled trial carried out on 129 primary mandibular molars with necrotic pulps or irreversible pulpitis in 4- to 9-year-old children. Participants were selected based on specific inclusion and exclusion criteria and were randomly allocated into 3 groups: Group I – RC Fill [zinc oxide–eugenol (ZOE) with iodoform]; Group II – Vitapex (calcium hydroxide with iodoform); and Group III – Pulpdent root canal sealer (ZOE). The outcome measures were evaluated both clinically and radiographically at 6, 12 and 30 months according to modified American Association of Endodontists (AAE) criteria. The radiographic outcomes were assessed by two blinded and calibrated evaluators. Pearson's chi-square analysis was performed for both intention-to-treat (ITT) and per-protocol population.

Result
The success rates of RC Fill, Vitapex and Pulpdent were 94%, 90% and 97%, respectively, at 30 months and the differences were not significant (P = 0.137).

Conclusion
All three materials were found to be equally effective root filling materials for primary molars with necrotic pulps and irreversible pulpitis at 30 months. However, long-term follow-up until the eruption of the permanent successor teeth is needed for more definitive assessments.

Pulpectomies in primary mandibular molars: a comparison of outcomes using three root filling materials

Background: Contact areas in primary teeth are known to be broader, flatter and situated farther gingivally than permanent teeth The purpose of this study was to assess the prevalence of OXIS contact areas between primary molars using die models of children from two different ethnic populations The research question of the present study is “What is the prevalence OXIS contact areas of primary molars in the populations studied?” Methods: A cross-sectional study was planned in a representative sample of 200 caries-free contact areas among children aged 3-6 years in two centers, Ajman and Puducherry Data collection was performed from sectional or full-arch die stone models The contacts were assessed according to OXIS classification by a single calibrated examiner at Center 2 Prevalence was expressed as numbers and percentages The Chi-square test was applied to determine the association of OXIS contacts across genders and arches Results: The prevalence of O, X, I, and S contacts were 19%, 225%, 53%, and 55% in Center 1 and 6%, 15%, 755%, and 17% in Center 2, respectively Significant results (p=0005) were obtained in Center 1 when inter-arch comparison was performed and between the centers with respect to type of contact No significant difference was obtained with respect to gender and OXIS contact areas Conclusions: The present study confirmed OXIS contacts in both the centers The ‘O’ and ‘X’ types of contacts were observed more in Center 1, whereas ‘I’ and ‘S’ contacts were observed more in Center 2

/pdf/interproximal-contact-areas-of-primary-molars-based-on-oxis-17ghn673zx.pdf

Interproximal contact areas of primary molars based on OXIS classification - a two centre cross sectional study

Background: Contact areas in primary teeth are known to be broader, flatter and situated farther gingivally than permanent teeth. The purpose of this study was to assess the prevalence of OXIS contact areas between primary molars using die models of children from two different ethnic populations. The research question of the present study is “What is the prevalence OXIS contact areas of primary molars in the populations studied?”. Methods: A cross-sectional study was planned in a representative sample of 200 caries-free contact areas among children aged 3-6 years in two centers, Ajman and Puducherry. Data collection was performed from sectional or full-arch die stone models. The contacts were assessed according to OXIS classification by a single calibrated examiner at Center 2. Prevalence was expressed as numbers and percentages. The Chi-square test was applied to determine the association of OXIS contacts across genders and arches. Results: The prevalence of O, X, I, and S contacts were 19%, 22.5%, 53%, and 5.5% in Center 1 and 6%, 1.5%, 75.5%, and 17% in Center 2, respectively. Significant results (p=0.005) were obtained in Center 1 when inter-arch comparison was performed and between the centers with respect to type of contact. No significant difference was obtained with respect to gender and OXIS contact areas. Conclusions: The present study confirmed OXIS contacts in both the centers. The ‘O’ and ‘X’ types of contacts were observed more in Center 1, whereas ‘I’ and ‘S’ contacts were observed more in Center 2.

/pdf/oxis-contact-areas-of-primary-molars-a-two-center-cross-3kew3zy1uu.pdf

Steven J L Rodrigues

Papers

Effectiveness of 2% Articaine as an anesthetic agent in children: randomized controlled trial.

Pulpectomies in primary mandibular molars: a comparison of outcomes using three root filling materials

Interproximal contact areas of primary molars based on OXIS classification - a two centre cross sectional study

OXIS contact areas of primary molars - a two center cross-sectional study.