Cost-effectiveness of composite resins and amalgam in the replacement of amalgam Class II restorations. Intravenous sedation in pediatric dentistry using midazolam, nalbuphine and droperidol. Comparison of oral chloral hydrate with intramuscular ketamine, meperidine, and promethazine for pediatric sedation--preliminary report. A Comparative Evaluation of Marginal Leakage of Different Restorative Materials in Deciduous Molars: An in vitro Study A clinical study of the "open sandwich" technique in pediatric dental practice. Caries Management Strategies for Primary Molars General dental practitioners' views on the use of stainless steel crowns to restore primary molars Recommendations for conducting controlled clinical studies of dental restorative materials The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months Clinical evaluation of a chemomechanical method for caries removal in children and adolescents The atraumatic restorative treatment (ART) approach to restoring primary teeth in a standard dental clinic. Psychosocial benefits of insulin pump therapy in children with diabetes type 1 and their families: The pumpkin multicenter randomized controlled trial
OBJECTIVES The replacement of an old amalgam Class II restoration  is a common treatment and will remain so for decades . In addition to effectiveness , possible adverse health effects and esthetics , the costs of the treatment options will play a role in the choice of material . The aim of this study was to yield information on the relative cost-effectiveness of the use of composite resins and amalgam for the rerestoration of amalgam Class II restorations . METHODS As part of a larger r and omized clinical trial , treatment effectiveness and treatment costs were estimated in 73 composite and amalgam Class II posterior re-restorations .  The main treatment outcome was longevity . Secondary outcomes included need of repair and quality of the margin while in situ . Costs were analyzed from the perspective of dentistry , assuming a treatment strategy aim ed at offering ' value for money ' . From this perspective , differential costs were based on personnel costs as approximated by treatment time . RESULTS Replacing an amalgam Class II restoration with amalgam is associated with lower costs than replacing with a composite resin . A sensitivity analysis , considering type of composite , increasing proficiency with the material , and time needed for future removal of material , demonstrated that these differences are fairly robust . The material s performed equally well for the first 5 years after placement with respect to longevity . Differences in secondary outcomes were minor and not all in favor of the same material . CONCLUSIONS It is tentatively concluded that amalgams are more cost-effective than composites for replacing existing Class II amalgam restorations PURPOSE The purpose of this pilot investigation was to study the efficacy , physiologic responses , and safety of a multi-drug intravenous conscious sedation technique in an outpatient setting in children who demonstrated uncooperative behavior when comprehensive restorative dental treatment was attempted . METHODS Using a time-based sedation record , the physiologic responses of 153 healthy children , age range 23 months to 14.5 years , were measured after they had received midazolam ( Versed ) , nalbuphine ( Nubain ) , and droperidol ( Inapsine ) , each administered intravenously , and nitrous oxide and oxygen administered by nasal mask , while each child received comprehensive restorative or surgical dental care . Each patient was monitored according to the American Academy of Pediatrics Sedation Guidelines . Heart rate and rhythm , blood pressure , respiratory rate , hemoglobin oxygen saturation , end-tidal CO2 , level of sedation , and behavioral responses were recorded preoperatively , at 5 minute intervals during treatment and in recovery until discharge . Sedation was titrated to Level 2 or 3 during treatment as defined by the American Academy of Pediatric Dentistry Reference Manual . RESULTS For each child , the sedation level was judged to be either acceptable or optimal for the completion of all planned dental treatment . There were no sedation failures . Children under 20 kg required significantly higher dosages of each sedative medication than children more than 20 kg to achieve the same level of sedation ( P < 0.001 , ANOVA ) . There were no episodes of intraoperative vomiting , hypotension , cardiac arrhythmias , respiratory depression requiring respiratory support , or dysphoria during treatment , in the recovery period , or after discharge . CONCLUSION This multi-drug intravenous conscious sedation technique is a safe and effective method to control the behavior of uncooperative children who require comprehensive dental treatment Fifteen consecutive pediatric patients ranging from 3 to 5 years old were selected to receive one of three sedative/hypnotic techniques . Group 1 received oral chloral hydrate 50 mg/kg , and groups 2 and 3 received intramuscular ketamine 2 mg/kg and 3 mg/kg , respectively . In addition to ketamine , patients in groups 2 and 3 received transmucosal intramuscular injections of meperidine and promethazine into the masseter muscle . Sedation for the satisfactory completion of restorative dentistry was obtained for over 40 min on average in the chloral hydrate group , but completion of dental surgery longer than 40 min was achieved in groups 2 and 3 only by intravenous supplements of ketamine ABSTRACT Context : Microleakage around dental restorative material s is a major problem in clinical dentistry . Inspite of many new restorative material s available in the market very few actually bond to the tooth surface . Aims : The aims of this study were : ( 1 ) To evaluate and compare the marginal leakage of newer restorative material s viz colored compomer , ormocer , giomer and RMGIC in class I restoration of deciduous molars . ( 2 ) To compare the microleakage scores between the groups of : Colored compomer and ormocer , giomer and RMGIC , ormocer with giomer and RMGIC , giomer with RMGIC . Material s and methods : A total of 40 primary molars were r and omly divided into four groups of 10 each . Class I cavities were prepared and the cavities were restored with colored compomer ( Group A ) , Ormocer ( Group B ) , Giomer ( Group C ) and RMGIC ( Group D ) . The teeth were thermocycled and subjected to 0.5 % basic fuchsin dye penetration followed by sectioning . The cut sections were evaluated under a stereomicroscope and the data was subjected to statistical analysis . Statistical analysis used : Mann-Whitney U test and Student t-test . Results : No significant difference was observed when colored compomer was compared to ormocer , giomer and RMGIC . Ormocer showed significantly lower microleakage when compared to giomer . However , no significant difference was observed when ormocer was compared to RMGIC . No significant difference between giomer and RMGIC was found . Conclusion : Ormocer has proven to be an excellent restorative material as it showed least microleakage followed by colored compomer , giomer and RMGIC in increasing order . How to cite this article : Yadav G , Rehani U , Rana V. A Comparative Evaluation of Marginal Leakage of Different Restorative Material s in Deciduous Molars : An in vitro Study . Int J Clin Pediatr Dent 2012;5(2):101 - 107 PURPOSE This study evaluated the clinical efficacy of the " open s and wich " restoration for pediatric dental practice . METHODS Three pediatric dentists used a st and ardized preparation and restorative technique to place the restorations . The prepared tooth was etched with a phosphoric acid semigel and rinsed . A resin modified glass ionomer ( Fuji II LCor Photac-Fil ) was placed short of the margins and then light cured . The resin modified glass ionomer was covered with an occlusal layer of a microhybrid flowable composite ( Aeliteflo or Flow-it ) . The same preparation for the experimental restorations was used for the control conventional amalgam ( Tytin ) restorations . The restorations were evaluated at 6-month intervals and ranked with a modified United States Public Heath Survey ( USPHS ) scale as follows : Alfa : No discernible marginal opening or stain ; Beta : Slight opening of margin discernible with dental explorer , but without stain ; Charlie : Open margin and stain ; Delta : Recurrent caries or restoration failure . Restoration failures were categorized according to etiology , pulpal necrosis , bruxism , marginal leakage , isthmus fracture , or adhesive failure . RESULTS All recalled experimental restorations , except 8 , were rated as either Alpha or Beta . Six failed due to isthmus fracture and 2 due to pulpal necrosis . Fifteen restorations had delaminating of the flowable composite from the resin modified glass ionomer . The use of the " open s and wich " technique compared favorably with a similar study using adhesive amalgam restorations . CONCLUSIONS The " open s and wich " technique can be successfully used in a pediatric dental practice Minimal invasive approaches to managing caries , such as partial caries removal techniques , are showing increasing evidence of improved outcomes over the conventional complete caries removal . There is also increasing interest in techniques where no caries is removed . We present the 1-yr results of clinical efficacy for 3 caries management options for occlusoproximal cavitated lesions in primary molars :  conventional restorations ( CR ; complete caries removal and compomer restoration ) , Hall technique ( HT ; no caries removal , sealing in with stainless steel crowns ) , and nonrestorative caries treatment ( N RCT ; no caries removal , opening up the cavity , teaching brushing and fluoride application ) . In sum , 169 children ( 3 - 8 yr old ; mean , 5.56 ± 1.45 yr ) were enrolled in this secondary care – based , 3-arm , parallel-group , r and omized clinical trial . Treatments were carried out by specialist pediatric dentists or postgraduate trainees . One lesion per child received CR , HT , or N RCT . Outcome measures were clinical failure rates , grouped as minor failure ( restoration loss/need for replacement , reversible pulpitis , caries progression , etc . ) and major failure ( irreversible pulpitis , abscess , etc . ) . There were 148 children ( 87.6 % ) with a minimum follow-up of 11 mo ( mean , 12.23 ± 0.98 mo ) . Twenty teeth were recorded as having at least 1 minor failure : N RCT , n = 8 ( 5 % ) ; CR , n = 11 ( 7 % ) ; HT , n = 1 ( 1 % ) ( p = .002 , 95 % CI = 0.001 to 0.003 ) . Only the comparison between N RCT and CR showed no significant difference ( p = .79 , 95 % CI = 0.78 to 0.80 ) . Nine ( 6 % ) experienced at least 1 major failure : N RCT , n = 4 ( 2 % ) ; CR , n = 5 ( 3 % ) ; HT , n = 0 ( 0 % ) ( p = .002 , 95 % CI = 0.001 to 0.003 ) . Individual comparison of N RCT and CR showed no statistically significant difference in major failures ( p = .75 , 95 % CI = 0.73 to 0.76 ) . Success and failure rates were not significantly affected by pediatric dentists ’ level of experience ( p = .13 , 95 % CI = 0.12 to 0.14 ) . The HT was significantly more successful clinical ly than N RCT and CR after 1 yr , while pairwise analyses showed comparable results for treatment success between N RCT and CR ( Clinical Trials.gov NCT01797458 ) Aim To ascertain general dental practitioners ' views on the use of stainless steel ( pre-formed metal ) crowns to restore carious primary molars . Method Ninety-three general dental practitioners were selected at r and om from those practising in Lancashire , Cheshire and Greater Manchester in 2003 and interviewed separately about the clinical care they provide to the primary dentition . Before the interview participants recorded the care they would provide for a case scenario , describing a child with a carious lesion that the British Society of Paediatric Dentistry ( BSPD ) guidelines indicate should be treated with a stainless steel crown . Results In answering the case scenario only six ( 7 % ) of the dentists reported that they would fit a stainless steel crown .  Of the 93 dentists interviewed 71 % knew of the BSPD guidelines , but only 18 % had ever fitted a stainless steel crown  in general practice . Reasons given for not using stainless steel crowns were they are inappropriate for many children , time consuming to fit , difficult to manipulate , expensive , and ugly . Conclusion The BSPD guidelines on the use of stainless steel crowns do not reflect the views of the majority of general dental practitioners who consider these crowns unsuitable for most children and an impractical restorative technique in busy daily practice About 35 years ago , Ryge provided a practical approach to evaluation of clinical performance of restorative material s. This systematic approach was soon universally accepted . While that methodology has served us well , a large number of scientific method ologies and more detailed questions have arisen that require more rigor . Current restorative material s have vastly improved clinical performance and any changes over time are not easily detected by the limited sensitivity of the Ryge criteria in short term clinical investigations . However , the clinical evaluation of restorations not only involves the restorative material per se but also different operative techniques . For instance , a composite resin may show good longevity data when applied in conventional cavities but not in modified operative approaches . Insensitivity , combined with the continually evolving and non-st and ard investigator modifications of the categories , scales , and reporting methods , has created a body of literature that is extremely difficult to meaningfully interpret . In many cases , the insensitivity of the original Ryge methods is misinterpreted as good clinical performance . While there are many good features of the original system , it is now time to move to a more contemporary one . The current review approaches this challenge in two ways : ( 1 ) a proposal for a modern clinical testing protocol for controlled clinical trials , and ( 2 ) an in-depth discussion of relevant clinical evaluation parameters , providing 84 references that are primarily related to issues or problems for clinical research trials . Together , these two parts offer a st and ard for the clinical testing of restorative material s/ procedures and provide significant guidance for research teams in the design and conduct of contemporary clinical trials . Part 1 of the review considers the recruitment of subjects , restorations per subject , clinical events , validity versus bias , legal and regulatory aspects , rationale s for clinical trial design s , guidelines for design , r and omization , number of subjects , characteristics of participants , clinical assessment , st and ards and calibration , categories for assessment , criteria for evaluation , and supplemental documentation . Part 2 of the review considers categories of assessment for esthetic evaluation , functional assessment , biological responses to restorative material s , and statistical analysis of results . The overall review represents a considerable effort to include a range of clinical research interests over the past years . As part of the recognition of the importance of these suggestions , the review is being published simultaneously in identical form in both the “ Journal of Adhesive Dentistry ” and the “ Clinical Oral Investigations . ” Additionally an extended abstract will be published in the “ International Dental Journal ” giving a link to the web full version . This should help to introduce these considerations more quickly to the scientific community Background Scotl and has high levels of untreated dental caries in primary teeth . The Hall Technique is a simplified method of managing carious primary molars using preformed metal crowns ( PMCs ) cemented with no local anaesthesia , caries removal or tooth preparation . This study compared the acceptability of the  Hall Technique  for children , their carers , and dentists , and clinical outcomes for the technique , with conventional restorations . Methods General dental practice based , split mouth , r and omized controlled trial ( 132 children , aged 3–10 ) . General dental practitioners ( GDPs , n = 17 ) in Tayside , Scotl and ( dmft 2.7 ) placed conventional ( Control ) restorations in carious primary molars , and Hall Technique PMCs on the contralateral molar ( matched clinical ly and radiographically ) . Dentists ranked the degree of discomfort they felt the child experienced for each procedure ; then children , their carers and dentists stated which technique they preferred . The teeth were followed up clinical ly and radiographically . Results 128 conventional restorations were placed on 132 control teeth , and 128 PMCs on 132 intervention teeth . Using a 5 point scale , 118 Hall PMCs ( 89 % ) were rated as no apparent discomfort up to mild , not significant ; for Control restorations the figure was 103 ( 78 % ) . Significant , unacceptable discomfort was recorded for two Hall PMCs ( 1.5 % ) and six Control restorations ( 4.5 % ) . 77 % of children , 83 % of carers and 81 % of dentists who expressed a preference , preferred the Hall technique , and this was significant ( Chi square , p < 0.0001 ) . There were 124 children ( 94 % of the initial sample ) with a minimum follow-up of 23 months . The Hall PMCs outperformed the Control restorations  : a ) ' Major ' failures ( signs and symptoms of irreversible pulpal disease ) : 19 Control restorations ( 15 % ) ; three Hall PMCs ( 2 % ) ( P < 0.000);b ) ' Minor ' failures ( loss of restoration , caries progression ) : 57 Control restorations ( 46 % ) ; six Hall PMCs ( 5 % ) ( P < 0.000)c ) Pain : 13 Control restorations ( 11 % ) ; two Hall PMCs ( 2 % ) ( P = 0.003 ) . Conclusion The Hall Technique was preferred to conventional restorations by the majority of children , carers and GDPs . After two years , Hall PMCs showed more favourable outcomes for pulpal health and restoration longevity than conventional restorations . The Hall Technique appears to offer an effective treatment option for carious primary molar teeth . Trial registration numberCurrent Controlled Trials IS RCT N47267892 – A r and omized controlled trial in primary care of a novel method of using preformed metal crowns to manage decay in primary molar teeth : the Hall technique Objective . The purpose of this study was to make a clinical comparison of the chemomechanical method for caries removal and the conventional rotary instruments technique when used in children and adolescents . Material and Methods . The study comprised 120 patients aged 3–17 years r and omized into two groups : caries were removed chemomechanically in 60 patients and 60 patients received conventional treatment with rotary instruments . The outcome variables were : clinical ly complete caries removal , pain during caries removal , need for local anesthesia , treatment time , preferences of patients , and clinical success of the restorations during the 12-month evaluation period . Results . Complete caries removal was achieved in 92 % of chemomechanically treated teeth and in all teeth treated with rotary instruments ( p>0.05 ) . The chemomechanical method significantly reduced the need for local anesthesia ( p<0.001 ) . Eighty-five percent of patients treated with Carisolv and 47 % treated with rotary instruments were satisfied with the treatment ( p<0.05 ) . The mean time for chemomechanical caries removal was 11.2±3.3 min and 5.2±2.8 min for caries removal with rotary instruments ( p<0.001 ) . At the end of the 12-month evaluation period , there was no observed influence of the caries removal method on the survival of the restorations . Conclusions . The chemomechanical caries removal technique is an adequate alternative to the conventional rotary instruments method and is advantageous in pediatric dentistry OBJECTIVES The aims of this study are to assess the feasibility of the  Atraumatic Restorative Treatment ( ART ) approach in primary teeth and to compare the ART approach with traditional amalgam restorations in primary molars . METHODS This study was conducted in a paediatric dentistry clinic in Kuwait between April 1999 and December 2001 . The ART and amalgam restorations were placed r and omly on comparable pairs of primary molars , if available . In addition , the ART approach was used for other primary teeth that had no pulpal involvement and no perceived pain before treatment . The restorations were assessed by both the ART evaluation criteria and USPHS criteria in August-September 2000 and in August-December 2001 . The mean follow-up period for the restorations was 8.3 months in the first assessment ( 2000 ) and 22 months in the second assessment ( 2001 ) . The assessment was possible for 35 children ( mean age = 5.7 years ) , 18 of whom had comparable pairs ( n = 35 pairs ) of restorations in their primary molars . In addition , 48 other ART restorations  were assessed in 2000 and 42 in 2001 . RESULTS In a 2-year follow-up , 89.6 % of all ART restorations were considered successful . The failure rate of the comparable pairs of ART and amalgam restorations was 5.7 % . There was no significant difference in success rate between ART and amalgam techniques . CONCLUSIONS Based on a 2-year follow-up evaluation , the class I ART restorations seemed to have a high success rate , indicating the appropriateness of the ART approach in primary teeth OBJECTIVE Continuous subcutaneous insulin infusion ( CSII ) is on the rise among pediatric patients with type 1 diabetes mellitus . Metabolic effects alone can not explain this rising popularity . From the patient 's perspective , the main benefits of CSII may be found in subjective psychosocial health outcomes ( patient-reported outcomes [ PRO ] ) . SUBJECTS AND METHODS In a multicenter open r and omized controlled trial , children and adolescents aged 6 to16 years currently treated with multiple daily injections ( MDI )  were r and omized 1:1 , stratified by center , to either starting with CSII immediately after the baseline interview or to continuing MDI while waiting 6 months for transmission to CSII . The primary outcomes were patient-reported diabetes-specific health-related quality of life ( DHRQOL ) and diabetes burden of the main caregiver . Secondary outcomes were caregiver stress , fear of hypoglycemia , satisfaction with treatment , and HbA1c . RESULTS Two-hundred and eleven patients were r and omized between February 2011 and October 2014 , and 186 caregivers and 170 patients were analyzed using the intention-to-treat principle for primary outcomes . Children 8 to 11 years in the CSII group reported improved DHRQOL at follow-up compared to MDI ( median difference [ MD ] 9.5 , 95 % confidence interval [ CI ] 3.6 - 16.7 , P = 0.004 ) . There were no treatment differences in the adolescent age-group 12 to 16 years ( MD 2.7 ; 95 % CI -3.2 - 9.5 ; P = 0.353 ) . The main caregivers of the CSII group reported a significant decline of overall diabetes burden at follow-up compared to the MDI group ( MD 0 ; 95 % CI -1 - 0 ; P = 0.029 ) . Secondary PROs also were in favor of CSII . CONCLUSIONS CSII has substantial psychosocial benefits . PROs demonstrate these benefits . Registered as NCT01338922 at clinical trials.gov
Regarding pain , there was a trend for treatments without rotary instruments and local anesthesia to be less frequently reported as painful .
No statistical difference was found intragroup nor among treatments for OHRQoL. CONCLUSIONS Anxiety and pain are directly related with more invasive restorative treatments .
On the other h and , quality of life is not improved regardless of the restorative technique used .
BACKGROUND Despite the increasing number of studies evaluating patient reported outcome measures ( PROs ) , there is no clearness regarding which restorative treatment offers major benefits based on the pediatric patient perspective .
AIM To compare different restorative techniques in pediatric dentistry regarding patient-reported outcomes .