INTRODUCTION. Pharmacological sedation can support dental care in anxious or uncooperative children, but protocols and outcome measures vary. PURPOSE. To evaluate the effectiveness and safety of pediatric dental sedation, focusing on drug combinations and routes of administration. MATERIALS AND METHODS. The review followed PRISMA 2020 and was registered in PROSPERO (CRD420261366155). PubMed, the Cochrane Library and ScienceDirect were searched for randomized and cohort studies published from January 2021 to May 2026. JBI tools were used for critical appraisal; findings were synthesized qualitatively. RESULTS. Seven studies were included. Reported success rates ranged from 75% to 95%. Dexmedetomidine-based combinations generally showed favorable outcomes, while nitrous oxide / oxygen supported short procedures in cooperative children. Heterogeneity prevented meta-analysis. CONCLUSION. No single regimen could be considered universally superior. Larger randomized trials with standardized effectiveness and safety outcomes are needed.
INTRODUCTION. Nickel–titanium (NiTi) rotary instruments have been extensively employed in endodontics because of their flexibility and capability to preserve canal anatomy. However, unpredictable separation due to cyclic fatigue is still a major concern. As compared to traditional ground NiTi instruments, Twisted File (TF) instruments are produced using a thermomechanical twisting process that maintains the alloy grain structure and may improve fatigue resistance. PURPOSE. To evaluate the cyclic fatigue resistance (CFR) and fracture characteristics of conventional ground and twisted nickel-titanium rotary instruments using scanning electron microscopic (SEM) examination. MATERIALS AND METHODS. The study included thirty-two new NiTi rotary instruments, separated into four groups ( n = 8): Twisted File #25/.06, RaCe #25/.06, ProTaper Universal F1, and Helix #25/.06. Cyclic fatigue testing was conducted using an endodontic motor running at 300 rpm in a stainless-steel artificial canal with a 45° curvature and a 5 mm radius. The recorded time to fracture was used to calculate the number of cycles to failure (NCF). The lengths of fractured fragments were measured, and representative instruments were analyzed by SEM either before or after cyclic fatigue testing. A one-way analysis of variance (ANOVA) and Scheffé’s post hoc test were used to assess the data, and p < 0.05 was used to define statistical significance. RESULTS. The higher CFR was recorded for Twisted File instruments (690.00 ± 55.93 cycles), followed by RaCe (529.00 ± 45.23 cycles), ProTaper Universal (416.00 ± 29.64 cycles), and Helix (242.87 ± 21.63 cycles). A one-way ANOVA showed a statistically significant difference among groups. For every pairwise comparison, post hoc analysis demonstrates significant differences ( p < 0.001). The lengths of the broken fragments did not significantly differ among groups ( p = 0.06). SEM assessment indicated microcracks and crack propagation patterns generated by fatigue in all instrument systems. Twisted File instruments showed fewer surface flaws in comparison with the standard ground instruments, which had crack propagation linked with machining grooves. CONCLUSION. Twisted File instruments have better CFR than RaCe, ProTaper Universal, or Helix. SEM demonstrated characteristic fatigue failure patterns in all systems, but traditional ground instruments exhibited greater surface flaws. Twisted Files may have improved fatigue performance due to thermomechanical twisting.
INTRODUCTION. An immature permanent tooth with pulp necrosis, an open apex, and an acute apical abscess presents a treatment challenge. This case describes a regenerative approach combining canal disinfection, activated irrigation, and a blood-clot scaffold. PURPOSE. To describe the treatment and follow-up of an immature mandibular right second premolar with pulp necrosis and an acute apical abscess in a 10-year-old boy. CASE DESCRIPTION. The patient presented with pain, swelling, and purulent drainage associated with tooth 45. Periapical radiography and cone-beam computed tomography showed an open apex and extensive periapical radiolucency. Initial treatment comprised drainage, saline irrigation, light instrumentation with 2% chlorhexidine gel, and an intracanal dressing of calcium hydroxide with 2% chlorhexidine gel. At the second visit, 15 days later, the dressing was removed and 17% EDTA was activated with Easy Clean for three cycles of 60 seconds. Apical bleeding was induced, followed by placement of a collagen matrix, MTA HP Repair, and a composite restoration. RESULTS. Follow-up showed symptom resolution, periapical healing, increased root length, and dentinal wall thickening. The treatment timeline describes follow-up at 3, 6, and 10 months, and the case narrative reports maintained healing and tooth function at two years. CONCLUSION. This case was associated with symptom resolution, periapical healing, and continued root development after regenerative treatment. A single case cannot establish the independent contribution of irrigant activation or the predictability of the protocol.
INTRODUCTION. Chemical exposure and sterilization may influence the fatigue behavior of nickel-titanium endodontic instruments. AIM. To evaluate the effects of immersion in 2.5% sodium hypochlorite and autoclave sterilization on dynamic cyclic fatigue resistance of R-Motion files. MATERIALS AND METHODS. Eighty R25 instruments (25/.06) were allocated to four groups ( n = 20): untreated control, autoclave sterilization, immersion in 2.5 mL of 2.5% NaOCl for 3 minutes, and immersion followed by sterilization. Dynamic fatigue was tested in a metallic canal with a 45° curvature and a radius of 6.06 mm. Time to fracture and fragment length were recorded. RESULTS. No significant differences were found for time to fracture ( p = 0.149; effect size = 0.431; power = 0.899) or fragment length ( p = 0.655; effect size = 0.118; power = 0.120). CONCLUSION. Under the tested conditions, NaOCl exposure, sterilization and their combination did not significantly change cyclic fatigue resistance relative to untreated instruments.
INTRODUCTION. Surface treatment may influence bonding between acrylic custom trays and addition silicone impression materials. PURPOSE. To evaluate the effect of alumina particle size on shear bond strength and PMMA surface characteristics. MATERIALS AND METHODS. Thirty specimens were assigned to untreated control, 50 µm or 90 µm alumina sandblasting groups ( n = 10) for bond testing. Another 30 specimens were used for roughness testing. Three additional specimens underwent SEM and EDX analysis. Tray adhesive was applied before bonding to addition silicone. RESULTS. The 90 µm group had the highest shear bond strength (0.47 ± 0.25 MPa) and surface roughness (3.85 ± 0.79 µm). Bond strength differed across groups ( F = 9.41; p = 0.0015). The 50 µm group did not differ significantly from control. Aluminum weight fractions were 32.14% and 20.36% after 50 µm and 90 µm treatment, respectively. CONCLUSION. Under the tested laboratory conditions, 90 µm alumina sandblasting with adhesive produced higher bond strength than 50 µm treatment or the untreated control.
