Pediatric dentistry最新文献

Purpose: To investigate the color difference between groups and changes over time of resin-modified glass ionomer (RMGI) restorations placed immediately after silver diammine fluoride (SDF) treatment. Methods: Thirty-six specimens were prepared from extracted human third molars, had caries artificially induced, and were divided into three groups (N equals 12): (1) control group (CG): non-SDF-treated teeth restored with RMGI; (2) group one (G1): SDF-treated teeth restored immediately with RMGI; and (3) group two (G2): SDF-treated teeth stored in saliva sub- stitute for two weeks then restored with RMGI. A Vita Easyshade ® Advance 4.0 Spectrophotometer was used to determine CIE L*a*b* values of each specimen at three different time points: (1) demineralized dentin prior to SDF application (T0); (2) following restoration (T1); and (3) two weeks following restoration (T2). The color difference ( Δ E*) and color values (L*a*b*) were analyzed within and between groups. Significance was set to P<0.05. Results: There was no significant difference in the amount of discoloration from T1 to T2 between G1 and G2, but both were significantly different from the CG (P<0.001). At T2, however, G1 had a lower, darker, average L* value(L*equals 65.27+ 1.34), which was significantly different from G2 (L*equals 69.18 + 1.39) and CG (L*equals 79.85+ 0.99; P<0.001). Furthermore, the color difference between groups at T1 and T2 was clinically detectable ( Δ E* >2.7). Conclusions: A two-week delay in in-vitro resin-modified glass ionomer restoration placement over SDF arrested carious lesions resulted in a lighter restoration; however, it did not prevent or reduce color change over time.

Purpose: To determine factors affecting permanent tooth vital pulp therapy (VPT) success from a systematic review (SR) and metaanalyses. Methods: SRs of databases were completed through June 2024, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used for the certainty of evidence. Results: The 24-month indirect pulp treatment (IPT), direct pulp capping (DPC), partial pulpotomy (PP), and full pulpotomy (FP) successes (91 to 97 percent) were not statistically different (P=0.19) in teeth diagnosed with normal pulp/reversible pulpitis (NP/RP). IPT (94 percent) versus DPC (87 percent) success at 36 months was not significantly different when calcium silicate cement (CS) was used for DPC in teeth diagnosed with NP/RP (P=0.10). PP success versus DPC was equal (96 percent) after 24 months in teeth diagnosed with NP/RP if CS was used for DPC. Teeth exhibiting symptomatic irreversible pulpitis (SIP) were defined as exhibiting spontaneous unprovoked pain, lingering thermal pain, or referred pain, and may have periapical pathosis/involvement or not. One study's data on the five-year success rate for FP in teeth with SIP was 78 percent, and teeth without PPI showed significantly increased success (P=0.04). PP/FP success (90 percent) in teeth with SIP was not significantly different versus PP/FP success (97 percent) in NP/RP teeth (P=0.054). Selective caries removal minimized pulp exposures in teeth with deep caries diagnosed with NP/RP. For teeth diagnosed with SIP or extremely deep caries, complete caries removal is recommended to expose the pulp. If pulpal bleeding is controlled, it is recommended to perform a full pulpotomy. Hemo- stasis within six minutes likely improves pulpotomy success. Mineral trioxide aggregate was found to discolor teeth significantly more (83 percent) than Biodentine (zero percent) containing no bismuth oxide (P<0.001) PP/FP were significantly more successful for traumatic pulp exposures than DPC (P ≤ 0.001). Root maturity did not affect PP/FP success for NP/RP teeth. Conclusions: All vital pulp therapy methods are successful for teeth diagnosed with normal pulp/reversible pulpitis. Teeth diagnosed with symptomatic irreversible pulpitis can be treated successfully with a full pulpotomy.

Purpose: To identify the incidence of parental-reported post-discharge events (PDEs) following moderate sedation and determine the sedation regimen and patient-specific factors that contribute to PDEs. Methods: Two thousand patient charts of pediatric patients who underwent sedation were screened. Information gathered from the patient record included patient body mass index (BMI), airway assessment, history of sleep-disordered breathing (SDB) symptoms, sedation medications and dosages, and parentally reported post-operative information. Results: Parents provided post-discharge information for 1,079 records (54 percent response rate). PDEs were reported for 35.2 percent of patients, with behavior issues (19.5 percent) and dental complications (17.6 percent) reported the most. Overall, more PDEs occurred in American Society of Anesthesiologists (ASA) I patients compared to ASA II patients (P<0.001) and increased as BMI increased (P=0.003) and tonsillar obstruction decreased (P=0.02). Comparing sedation regimens showed no difference in the proportion of PDEs (overall or by category; P>0.05). Patient age, ASA classification, height, BMI, Brodsky score, and sedation route influenced PDEs based on different sedation regimens and specific PDEs. Conclusions: Behavioral and dental issues are the most commonly parental-reported post-discharge events, and the rate of occurrence did not depend on the sedation regimen. The incidence of PDEs increased as body mass index increased, reinforcing the recommendation that obese patients should not sedated in the dental office, even if dosed to their lean body weight.

Purpose: To evaluate changes in color stability and translucency for different zirconia crowns (ZRCs) following immersion in common childhood beverages. Methods: Twenty-four maxillary right central incisor ZRCs were obtained from NuSmile® Sprig, and Kinder Krowns® and randomly divided into four groups. Crowns were evaluated initially at baseline (control) with a spectrophotometer and immersed in Minute Maid® apple juice, Tum-E Yummies®, Gatorade®, and Kool-Aid® for 21 days to determine color and translucency. Mean and standard deviations were calculated for CIEDE2000 color differences (ΔE₀₀), translucency parameter (TP₀₀), and difference in translucency parameter (TP₀₀). Data were analyzed using two-way repeated measures analysis of variance and the Holm-Sidak post hoc test (P<0.05). Results were interpreted using visual color difference thresholds in dentistry (perceptibility threshold [PT] equals 0.8 for the 50:50, and acceptability threshold [AT] equals AT 1.8 50:50). Likewise, TP₀₀ values were interpreted using visual translucency difference thresholds (translucency perceptibility threshold TPT equals 0.6 for 50:50 and translucency acceptability threshold TAT equals 2.6 for 50:50). Results: Color changes for NuSmile® and Kinder Krowns® were seen at the initial time interval when exposed to Kool-Aid® or in apple juice. Sprig had its greatest change when exposed to Kool-Aid®. The greatest difference in translucency occurred with Sprig in Kool-Aid® and apple juice. All crowns experienced changes in color and translucency, exceeding the PT in at least one staining solution, but none exceeded the acceptability thresholds. Conclusion: Only slighty perceived differences in color and translucency after exposure to common childhood beverages may be observed in prefabricated pediatric zirconia crowns.

Purpose: To evaluate the relationship between administering medications used during delivery and molar hypomineralization (MH) development in rats. The hypothesis was that exposure to specific drugs used to induce childbirth could affect dental mineralization, potentially leading to MH. Methods: An experimental study was conducted using four pregnant Sprague Dawley (SD) albino rats. The rats were divided into four groups: one rat received 0.143 mg/Kg of dinoprostone, 0.714 mg/Kg of pethidine, and 0.036 mg/Kg of haloperidol; another rat received 0.143 mg/Kg of dinoprostone alone; a third rat was administered 0.714 mg/Kg of pethidine and 0.036 mg/Kg of haloperidol; the last rat served as a control group and received no treatment. On the 25th postpartum day, molar samples were extracted from the offspring's dental pulps, preserved in 0.1 percent thymol, and analyzed using scanning electron microscopy and energy-dispersive X-ray spectroscopy to evaluate their mineral content. Statistical analysis of magnesium, calcium, phosphorus, carbon, oxygen, and the calcium/phosphorus ratio was performed using one-way analysis of variance and Mann-Whitney U-tests at a 95 percent confidence level. Results: Significant differences (P<0.001) were found in magnesium and phosphorus levels in the group administered pethidine and haloperidol, indicating a significant impact on the mineral composition of teeth. Conclusion: The results suggest that medications administered during delivery could influence dental mineralization, potentially contributing to the development of molar hypomineralization.

Purpose: To assess the diagnostic and treatment decision-making accuracy of ChatGPT for various dental problems in pediatric patients compared to specialized pediatric dentists. Methods: This study included 12 cases, each with an average of three dental problems, resulting in a total of 36 dental problems. Successive prompts were given to ChatGPT (GPT-4), beginning with a comprehensive case presentation, followed by clinical and radiographic descriptions alongside clinical and radiographic images. Inputs for questions regarding the diagnosis and treatment were provided to the models. Accuracy was then scored based on the degree of alignment between the ChatGPT outputs and the pediatric dentistry committee decisions, which represented the control group based on their advanced training and clinical experience. Results: ChatGPT's diagnostic accuracy was 72.2 percent, with a kappa statistic of 0.69 (95 percent confidence interval [95% CI] equals 0.6 to 0.8). In detecting dental caries, ChatGPT achieved a sensitivity of 92.3 percent and a specificity of 100 percent, with positive and negative predictive values of 100 percent and 83.3 percent, respectively. ChatGPT's treatment decision accuracy was 47.2 percent with a kappa value of 0.43 (95% CI equals 0.4 to 0.6). The difference between the accuracy of ChatGPT in diagnosis and treatment decisions was statistically significant (P=0.01). Conclusions: ChatGPT achieved high diagnostic accuracy but had limited capability in making treatment decisions for pediatric dental problems. ChatGPT may serve as a secondary aid in diagnosis; however, it cannot be perceived as a reliable tool for therapeutic decision-making.

Purpose: To evaluate the effectiveness of various remineralizing agents on artificially induced enamel lesions in primary teeth by a pH-cycled In Vitro model. Methods: Four remineralizing agents were tested on exfoliated/extracted primary human teeth in a pH-cycled model: fluoride varnish (FLV); casein phosphopeptide-amorphous calcium phosphate (CPP-ACP); self-assembling peptides-P11-4 (SAP); and poly(amidoamine) (PAMAM) dendrimers. Surface microhardness (SMH) improvement was quantitatively evaluated using Vickers hardness number testing, and surface morphology changes were qualitatively assessed with scanning electron microscopy. Results: Compared to SAP, PAMAM had a higher VHN value, and the difference was statistically significant (P<0.001). The comparison between the FLV and CPP-ACP groups showed a non-significant difference (P=0.56). FLV demonstrated a narrow interquartile range, underscoring its reliability. PAMAM and SAP resulted in a homogenous and smooth enamel surface, indicating successful mineral deposition. FLV and CPP-ACP showed more superficial mineral recovery. Conclusions: The In Vitro findings demonstrate each remineralizing agent's distinctive benefits and limitations in a controlled setting. Poly (amidoamine) dendrimers' standout performance suggests potential enamel repair strategies, potentially revolutionizing early carious lesion management. Fluoride varnish remains a dependable choice for clinicians, while casein phosphopeptide-amorphous calcium phosphate and self-assembling peptides-P11-4 contribute to biomimetic advancements in dentistry. Guided enamel regeneration through biomimetic approaches is aligned with minimum intervention dentistry principles and could substantially improve oral health outcomes.

Purpose: To determine the comparative accuracy of seven generative artificial intelligence (GenAI) platforms in answering multiple-choice questions on a predoctoral pediatric dentistry examination. This study evaluated the impact of question type and GenAI training on accuracy. Methods: In this study, 100 multiple-choice questions were answered by seven GenAIs using a standard prompt. The study included five untrained GenAIs (Llama, Gemini, Copilot, ChatGPT3.5, and ChatGPT4) and two trained GenAIs (ChatGPT3.5 and ChatGPT4). The training of GenAIs was performed using evidence-based data. The questions were categorized as knowledge-based versus critical thinking on 10 subspecialty domains. The GenAIs were asked to select one correct answer from four choices, and only the first generated response was recorded. Data were subjected to statistical analysis (alpha equals 0.05), with a passing score of 75 percent. Results: Trained ChatGPT4 had the highest accuracy score (90 percent), while untrained Copilot had the lowest accuracy score (57 percent). Only three GenAIs received a passing score (trained ChatGPT3.5, untrained and trained ChatGPT4). The average performance of these three GenAIs (87 percent) was comparable to that of dental students (89 percent). There was no difference in the accuracy of GenAI in answering knowledge-based or critical-thinking questions. Similarly, sub-specialty domain types did not impact the accuracy of GenAI. Conclusions: Newer or trained models of generative artificial intelligence have higher accuracy compared to older or untrained models of GenAI. In the future, due to high accuracy, newer or trained models of GenAI can be used as adjuncts in predoctoral pediatric dental education.

Purpose: The purpose of this study was to evaluate the influence of silver diammine fluoride (SDF) on shear bonding with total-etch adhesives. Methods: Thirty non-carious permanent human molars were collected and sectioned, exposing dentin that yielded two samples per tooth. Samples were mounted in resin, roughened, flattened to exposed dentine, and rehydrated (for 24 hours at 37 degrees Celsius). Fifteen samples were randomly allocated to each test group (n equals 15/gp): 3M™ Scotchbond™ Universal Plus Adhesive (SUPA), SDF+SUPA, Prime & Bond elect® Universal (PBE), and SDF+PBE. TPH Spectra® ST composite was utilized in all groups, light-cured, and rehydrated (for 24 hours at 37 degrees Celsius) before shear bond testing was performed. Maximum stress data were statistically analyzed using a two-way analysis of variance and Holm-Sidak post-hoc test (P<0.05). Results: Shear stress (MPa) were: SUPA (26.5±3.0), SDF+SUPA (25.6±7.2), PBE (21.1±5.7), and SDF+PBE (21.7±5.7). Statistically significant differences were only noted between SUPA and PBE (P=0.012). Conclusion: Within the limitations of this study, silver diammine fluoride did not affect the shear bonding of resin composite to dentin.