BackgroundDental anxiety is prevalent in children. This condition may cause uncooperative behavior and need a treatment under general anesthesia. The perioperative period, especially for children, is a stressing event. Premedication is commonly used to reduce perioperative anxiety and facilitate the induction of anesthesia.Methods132 children candidates for dental treatment under GA were enrolled in this study and randomly divided into 3 groups. Oral melatonin, midazolam, and normal saline were administered as premedication. Patient’s sedation score before GA, the ease of intravenous line establishment, patient’s need for painkillers, and duration of recovery were evaluated and compared.ResultsRegarding the sedation score and response to IV access establishment, comparisons showed statistically significant differences between melatonin and midazolam groups (P < 0.05) as well as between midazolam and placebo groups (P < 0.001). The difference between melatonin and placebo groups was not significant (P > 0.05). The need for painkiller administration was statistically different between midazolam and placebo, melatonin and placebo, and midazolam and melatonin groups (P < 0.05). A statistically significant difference was also found between melatonin and midazolam as well as between melatonin and placebo groups (P < 0.05) with regard to the recovery duration while no significant difference was observed between midazolam and placebo groups (P > 0.05).ConclusionMidazolam is superior to melatonin for premedication regarding the patients’ sedation score before anesthesia and the ease of IV access establishment. Premedication with midazolam decreases the need for painkillers and increases the rate of recovery in children undergoing GA for dental treatment.

Peripheral giant cell granuloma is a common benign and reactive gingival epulis in oral cavity. It is often difficult to make a clinical diagnosis; thereby definitive diagnosis depends on histopathologic features. We report a case of a 4-year-old Caucasian boy presenting with a five-month history a 20 × 15 × 12 mm pedunculated, lobular soft tissue mass of the left anterior maxilla gingiva which was misdiagnosed and maltreated before his referral. An excisional biopsy of the lesion followed by histopathologic examination of the biopsy specimen revealed distinctive features of peripheral giant cell granuloma. Early detection and excision of this hyperplastic nodule especially in children are important to minimize potential dentoalveolar complications.

Restoration of severely decayed primary anterior teeth is often considered as a special challenge by pedodontists. This case report presents a 5-year-old boy with severely damaged maxillary right canine. Subsequent to root canal treatment, a reversed (upside-down) metal post was put into the canal and composite build-up was performed. This new method offers a simple, practical and effective procedure for reconstruction of severely decayed primary anterior teeth, which re-establishes function and esthetics for time the tooth should be present and functional in the child's mouth.

Background:Proper analgesic agents should be used in combination with sedative agents. Remifentanil is a synthetic narcotic/analgesic agent with a short duration effect and decreases the risk of apnea during recovery. Bispectral index system (BIS) is a new noninvasive technique for the evaluation of the depth of sedation. The aim of present clinical trial was to evaluate and compare the efficacy of intravenous sedation with propofol/midazolam/remifentanil (PMR) in comparison to propofol/midazolam/ketamine (PMK) for dental procedures in children 3-7 years of age.Materials and Methods:In this clinical trial, 32 healthy uncooperative children who were candidates for dental treatments under sedation were randomly divided into two groups. Intravenous sedation was induced with PMR in one group and with PMK in the other group. After injection and during procedure BIS index, heart rate and respiratory rate, blood pressure, and oxygen saturation was evaluated every 5 min. After the procedure, recovery time was measured. Data were analyzed with ANOVA, Friedman, Wilcoxon, and t-test.Results:The BIS value was significantly low in ketamin group (P = 0.003) but respiratory rates and heart rates were same in both groups with no statistical difference (P = 0.884, P = 0.775). The recovery time was significantly shorter in remifentanil group (P = 0.008 and P = 0.003).Conclusion:It can be concluded that intravenous sedation technique with PMR combination induces effective and safe sedation, with less pain and more forgetfulness and a shorter recovery time for children 3-7 years of age during dental procedures.

Aim: Intranasal midazolam has been used to induce conscious sedation in children with negative and aggressive behavior. The main goal of this study was to determine the effectiveness of intranasal administration of midazolam (with a dose of 0.5 mg/kg) in behavior management of uncooperative children. Materials and methods: Thirty healthy, difficult children of 3-5 years were evaluated. At the beginning of each session, ordinary techniques of behavior management to treat patients were applied. In cases of unsatisfactory responses, intranasal midazolam was immediately employed. To determine the efficacy of the drug,child behavior was evaluated before and after administration of midazolam using Houpt rating scale of general behavior. Results: A statistically significant difference was demonstrated in the patients' behavior before and after administration of intranasal midazolam. Conclusions: this drug is effective in sedation and reduction of the anxiety of children under treatment.

Background:Prefabricated band and loops require only one appointment, are quickly placed in a session, and do not require laboratory work; thus, they need less time and cost. The aim of this study was to evaluate the survival rate of prefabricated band and loops in space maintenance of primary teeth and compare them with conventional band and loops.Materials and Methods:In this prospective clinical trial study 4–9-year-old patients, who met the requirements of the present study, were divided into two groups. The first group conventional band and loops and the second group prefabricated band and loops were placed. The patients were evaluated for cement dissolving. Failure of soldering (SF), breakdown, and deformation of each component of the band and loops, survival rate, and gingival health at the 1st, 3rd, 6th, and 9th-month Wilcoxon test, Fisher's exact test, Mann–Whitney test, Friedman test, and Kaplan–Meier test. Was used The level of statistical significance was set at P ≤ 0.05.Results:The two groups were not significantly different at the 1st, 3rd, 6th, and 9th-month recalls in cement solution, SF, breakdown, and deformation of each component of the band and loops. The survival rate of the conventional and prefabricated band and loops was 92% in the 9 months, and no significant difference was witnessed in survival rates between the two groups. The prevalence of gingivitis in prefabricated band and loops and conventional band and loops in the 9th month was statistically insignificant (P = 0.03).Conclusion:There is a similar success rate for the conventional and prefabricated band and loops.

Introduction. Among the new therapeutic materials, MTA and Biodentine are recommended for pulpotomy and sealing the pulp. Considering the similar characteristics of these two materials and considering that their effects on the treatment of primary second molars with irreversible pulpitis have not been compared properly, this study aimed to compare clinical and radiographic success between MTA and Biodentine in pulpotomy of primary mandibular second molars with irreversible pulpitis. Materials and Methods. This study was conducted as a randomized double-blind clinical trial. Participants were selected according to inclusion criteria and 52 samples were randomly selected using random numbers table in group A. Then, patients in the next group B were matched with the first group in terms of age range and sex. In group A, the remaining pulp was covered with 2 mm MTA+ and in group B with 3 mm Biodentine. Participants were called for clinical evaluation every three months for 12 months (long-term follow-up). Radiographic evaluations were in the sixth and twelfth months. Results. Fischer’s exact test showed that there was no significant difference between MTA and Biodentine in terms of clinical and radiographic success rates ( P value = 1). According to the results of the Kaplan–Meier test, the survival rate in both pulp treatment methods was similar in symptomatic teeth. Conclusions. The results of this study showed that Biodentine properties are similar to MTA, and both materials show high clinical and radiographic success rates in long-term follow-up.

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