Thursday, March 30, 2017

A comparison of two different dosages of oral midazolam in the same pediatric dental patients

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Amir Yavari                                                                                   Date: 3/30/2017
Article Title:  
A comparison of two different dosages of oral midazolam in the same pediatric dental patients
Author(s):  Peretz B1, Kharouba J2, Somri M3.
Journal:  Pediatric Dentistry
Date: 2014
Major Topic: Oral conscious sedation with oral midazolam and comparing two different doeses
Type of Article: Cohort Study

Main Purpose: Compare the efficacy and safety of two different doses of oral midazolam

The purpose of this paper was to compare the efficacy and safety of two doses of oral midazolam (0.5 mg/kg and 0.75 mg/kg) on the same children when no cooperation could be achieved with the 0.5 mg/kg dose.



Twenty-three healthy 3 to 8-year-olds who were initially unable to tolerate dental treatment using non-pharmacologic behavioral management (sometimes in combination with nitrous oxide) participated in the study. Level of sedation, cooperation, parental satisfaction, parental prediction of child's future anxiety, and outcome of sedation with the two doses were evaluated. All treatments and behavioral evaluations were conducted by the same non-blinded dentist. Parental evaluations were non-blinded as well.

No respiratory events or other adverse effects were observed with either regimen. There was no gender difference in any parameter regarding the two doses of midazolam. No treatment was aborted with the 0.75 mg/kg dose. Sedation and cooperation were significantly higher at baseline and after 15, 30, and 45 minutes (P=.001) for the 0.75 mg/kg group. Parental satisfaction with the treatment was significantly greater with the higher dose.

Midazolam at 0.75 mg/kg with 100 percent oxygen can enhance outcomes for pediatric dental patients who did not cooperate satisfactorily with a dose of 0.5 mg/kg.
Assessment of Article:  Level of Evidence/Comments: II-2

Preformed metal crowns for primary and permanent teeth: Review of the literature.

Preformed metal crowns for primary and permanent teeth: Review of the literature.

Resident: Semantha Charles DDS
TitlePreformed metal crowns for primary and permanent teeth: Review of the literature. 
Authors: Randall, R., Vrijhoef, M. and Wilson, N. 
Journal: Pediatr Dent (2002) 24: 489-500.

Main Purpose: To carry out a review of the use and efficiency of preformed metal crowns (PMCs) for primary and permanent molar teeth.

Materials and Methods:
A literature search of English language journals was carried out using MEDI.lNE. Papers that addressed areas related to the use of PMCs regarding indications for use, placement techniques, risks, longevity, cost effectiveness and utilization were included in the review. Eighty-three papers were traced which fulfilled the above criteria, the majority addressing PMCs in primary molar teeth. Over half the papers were concerned with placement techniques and indications for use, with fewer papers reporting on clinical studies. The clinical data on PMCs spanned a considerable number of years and involved heterogeneous populations of patients, different makes and designs of crown, and differences among the operators and evaluators who were involved in the studies.

Key Points
- Indications for use of PMCs in primary molar teeth include after pulp therapy, for restorations of multisurface caries for patients at high caries risk, primary teeth with developmental defects, where an amalgam is likely to fail (eg: proximal box extended beyond the anatomic line angles), fractured teeth, teeth with extensive wear, and as an abutment for a space maintainer. 
- However, carrying out a crown prep of a tooth solely for use as an abutment is destructive and bands are preferable. 
- Indications for use in permanent molars include as an interim restoration of a broken-down or traumatized tooth until construction of a permanent restoration can be carried out or the eventual orthodontic status is established, when financial considerations are a concern, permanent PMCs are useful as a medium-term economical restoration in clinically suitable cases, teeth with developmental defects, and restoration of a permanent molar which requires full coverage but is only partially erupted. 
- Over the time-period of the literature surveyed, different authors have recommended various cements, for example, zinc phosphate, fast-setting zinc oxide, and polycarboxylate cement. The most recent publications (1997 and 1999) recommended RMGI cements.
- The preparation of a tooth for a permanent molar PMC is essentially the same as for a cast metal crown bur with a reduction in the amount of tooth tissue removed. It is important that the future preparation needs for a cast restoration are kept in mind when preparing the tooth for a PMC.
- It has been suggested that study models should routinely be taken for patients who are to receive a permanent molar PMC, as this allows better evaluation of the patient's occlusion and whether occlusal adjustment is needed prior to preparation.
- Unlike the primary molar crowns, those for permanent teeth cannot be left in hyperocclusion.
- The authors of these papers were in agreement in concluding that preformed crowns are superior to Class II amalgam restorations for multisurface cavities in primary molars.

This was a comprehensive article on preformed crowns that took into account many papers that have been written. Ultimately, the papers found that preformed crowns are better than Class II amalgams. This is an important finding for us, as these are the types of lesions we will be seeing for the rest of our careers. Hopefully, future articles will compare preformed crowns with newer Class II composites, and also studies need to be completed on the newer, more esthetic molar crowns. 

Reverseal of soft-tissue local anesthesia with phentolamine mesylate in pediatric patients

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Nicholas Paquin                                                                           Date: 3/30/17

Article Title: Reverseal of soft-tissue local anesthesia with phentolamine mesylate in pediatric patients
Author(s): Taveres et al
Journal: JADA
Date: 8/2008
Major Topic: Phentolamine mesylate use in pediatric patients
Type of Article:
Main Purpose: To evaluate the safety and efficacy of a formulation of phentolamine mesylate (PM) as a local anesthesia reversal agent for pediatric patients.
Key Points/Summary:
- A total of 152 pediatric subjects received injections of local anesthetic with 2 percent lidocaine and 1:100,000 epinephrine before undergoing dental procedures. The subjects were randomized to receive a PM injection or a control injection (sham injection in which a needle does not penetrate the tissue) in the same sites as the local anesthetic was administered in a 1:1 cartridge ratio after the procedure was completed. Over a two- to-four-hour period, they measured the duration of soft-tissue anesthesia and evaluated vital signs, pain and adverse events.
- Results The median recovery time to normal lip sensation was 60 minutes for the subjects in the PM group versus 135 minutes for subjects in the control group. The authors noted no differences in adverse events, pain, analgesic use or vital signs, and no subjects failed to complete the study.
- Take away - PM was well-tolerated and safe in children 4 to 11 years of age, and it accelerated the reversal of soft-tissue local anesthesia after a dental procedure in children 6 to 11 years of age. Clinical Implications. PM can help dental clinicians shorten the posttreatment duration of soft-tissue anesthesia and can reduce the number of posttreatment lip and tongue injuries in children.

The longevity of amalgam versus compomer/composite restorations in posterior primary and permanent teeth: Findings From the New England Children’s Amalgam Trial

Department of Pediatric Dentistry

Lutheran Medical Center

Resident’s Name: John Diune                                                      Date: 3/29/2017

Article Title: The longevity of amalgam versus compomer/composite restorations in posterior primary and permanent teeth: Findings From the New England Children’s Amalgam Trial
Author(s): Soncini JA, Maserejian NN, Trachtenberg F, Tavares M, Haves C
Journal: JADA
Date: Jun 2007
Major Topic: Restorative dentistry
Type of Article: Randomized clinical trials
Main Purpose: Randomized clinical trial comparing replacement rates of restorative material in children’s posterior teeth.
Key Points: (2 lines Max): Compomer/composite restorations in pediatric patients may require more procedures than do amalgam restorations to maintain their integrity
The New England Children’s Amalgam Trial (NECAT) randomly assigned 6-10 yo children to groups receiving etiher amalgam or resin-based compomer/composite material and prospectively followed them for 5 years.
-          “often” used rubber dam and same technique for all restorations
-          Size of lesion categorized: small (1/4 of surface or less) / medium (14-1/2) / large (1/2 or more)
-          Requirement for replacement: new caries, recurrent caries, fracture, restoration loss or other
o   New caries – carious surface different from original
Compomers, introduced in mid-1990’s – polyacid-modified resin-based composites w/ 72% (by weight) strontium fluorosilicate glass (avg particle sice 2.5 micrometers)
-          Presence of both acid functional monomer and basic ionomer-type glass attracts moisture, can release fluoride and buffer acidic environments
Composites – 60%-65% filler of silica and glass (particle size 0.6-1 micrometer)
-          Small size of fillers particles allow greater polishability and finishing qualities than compomer
Survival time of restorations in primary teeth usually shorter than permanent and recurrent caries often cited as the most common reason for replacement.
During course of 5 year trial:
-          Compomer/composites consistently required more replacement or repair than amalgam restorations
-          Extracted primary teeth more likely to have been restored with compomer
-          Posterior permanent teeth had higher repair rates for resin-based composite restorations, yet not significantly greater replacement rates
DATA (only for reference):
Primary teeth:
-          47% of amalgam restorations replaced due to new caries VS 52% compomer restorations replaced due to recurrent caries
-          Subanalysis: 3% compomer restorations replaced due to recurrent caries VS 0.5% amalgam restorations (6x increase for compomer)
-          Size of restoration not a factor with need for replacement
o   Amalgam: 2.7% small restorations / 5.7% medium / 3.6% large
o   Compomer: 4.8% small restorations / 7.4% medium / 4.2% large
Primary teeth extractions: 10.7% compomer  vs 7.2% amalgam
-          Main difference due to mandibular 2nd molars (13.6% compomer vs 3.8% amalgam)
Permanent teeth:
-          Replacement within 2 years: 14.9% composites VS 10.8% amalgam
-          Replacement within 5 years: 21.9% composites VS 15.9% amalgam
-          Replacement increases with size of restoration:
o   Amalgam: 7.5% small restorations / 9.6% medium / 14.2% large
o   Composite: 10.1% small restorations / 11% medium / 19.8% large
-          Repair higher for composites
o   2.5 years: 2.8% composite vs 0.4% amalgam
o   5 years: 4% composite vs 0.5% amalgam