Challenges in orthodontic management for patients with cleft lip and palate (CLP) center on facial growth deficiencies and oral health. Patients with complete CLP exhibit maxillary arch constriction from an early age, typically more severe in the canine region than in the molar region. Transverse management centers on the maxillary arch and types of expansion. The ability to provide targeted anterior expansion while simultaneously addressing posterior crossbites is crucial for correcting arch constriction in patients with cleft lip and palate. Maxillary constrictions are usually addressed immediately prior to the secondary alveolar bone graft procedure. The instability of maxillary expansion in CLP patients is one reason why expansion is often performed early. Anteroposterior (sagittal) orthopedic management of maxillary deficiencies in patients with CLP still remains a challenge, with decisions on treatment based on timing, indications, and severity. A protocol is presented with favorable results for complicated cases. Early correction of the hypoplastic maxilla in patients with CLP is notoriously followed by substantial skeletal relapse; consequently, protraction undertaken in the deciduous or early-mixed dentition should be reserved for cases in which marked functional impairment, such as hipoacusia, is present. Conversely, when the same orthopedic stimulus is applied in proximity to the pubertal growth spurt, the skeletal correction tends to be considerably more stable. Challenges in pediatric dentistry persist with poor oral hygiene and caries. Without a foundation for stable dentition, the best of orthodontic treatment planning can be compromised. Despite awareness on importance of oral health as it relates to systemic conditions and the additional factors faced with CLP patients, more follow-up is needed. Prevention and frequent follow-up with the pediatric dentist are key.
Dental caries remains one of the most prevalent diseases in children, requiring early and accurate detection to prevent progression. Conventional visual examination, although widely used, is subjective and operator-dependent. With advancements in artificial intelligence (AI), image-based AI tools offer potential for more consistent caries detection. This study aimed to compare the validity and reliability of an AI tool (ScanO) with conventional visual examination in identifying dental caries in children. This observational study included 200 children attending the Department of Pediatric and Preventive Dentistry. Visual examination was performed independently by two trained examiners, and decayed, missing, and filled teeth (DMFT)/deft scores were recorded. Standardized intraoral photographs were captured and analyzed using the AI tool ScanO, which generated corresponding DMFT/deft scores. Data were analyzed using SPSS version 21. The AI tool successfully detected dental caries but consistently underestimated DMFT/deft scores compared to clinical examination (3.48 ± 2.94 vs. 4.70 ± 3.31; P < 0.001). Despite this, the intraclass correlation coefficient (ICC) analysis demonstrated excellent reliability for the AI tool (ICC = 0.968 single, 0.984 average) and near-perfect reliability for clinical examination (ICC = 0.999). The AI tool demonstrated good reliability in detecting dental caries but consistently underestimated DMFT/deft scores compared to clinical examination. The clinical method identified more carious lesions, reaffirming its role as the gold standard. Within the limitations of this study, the AI tool can be considered a supplementary screening aid in pediatric dentistry but cannot replace clinical judgment.
Molar-incisor hypomineralization (MIH) is associated with hypersensitivity and resistance to local anesthesia (LA), which complicates treatment in children. No nationwide study has examined the frequency of these anesthetic challenges among pediatric dentists or their association with clinician stress and burnout. The aim of the study was to assess the prevalence of LA inadequacy in MIH-affected teeth and its relationship with stress, burnout, and job satisfaction among pediatric dentists. A cross-sectional online survey was conducted among qualified pediatric dentists across India using a validated questionnaire. Convenience and snowball sampling yielded 100 complete responses after exclusion. The instrument covered sociodemographics, MIH clinical experience, anesthetic difficulties, escalation practices, and well-being (modified Mini Copenhagen Burnout Inventory). Data were analyzed using descriptive statistics, nonparametric tests, Chi-squared tests, Spearman correlations, and multivariable linear regression adjusted for confounders. Most respondents reported routine LA inadequacy in MIH cases, commonly with supplemental buccal infiltration and intraligamentary injections. Higher perceived LA failure was strongly associated with treatment postponement, extraction, and general anesthesia referral. MIH-related anesthetic stress was strongly correlated with higher burnout and lower job satisfaction. Multivariate analysis identified elevated MIH workload, corporate/private college settings, and longer experience as independent predictors of poorer well-being. LA challenges in MIH management are prevalent among Indian pediatric dentists and significantly contribute to occupational stress and burnout. Targeted training in adjunctive techniques and institutional wellness support are recommended to improve clinician resilience and patient care.
Objective: Heated high flow nasal cannula (HHFNC) use in pediatric critical asthma is rising despite concerns regarding its ability to effectively deliver nebulized medications to the lower airway. We aim to measure the association of low versus high HHFNC flow rates for delivery of continuously inhaled short acting beta agonist (cSABA) on clinical outcomes in the Pediatric Intensive Care Unit (PICU).Methods: This is a retrospective cohort study investigating PICU patients admitted with critical asthma who were prescribed HHFNC for cSABA delivery. Patients were divided into two groups based on the average flow rate used to deliver cSABA: low flow (≤5 L/min) versus high flow (>5 L/min). Outcomes including total duration of cSABA, total duration of noninvasive respiratory support (HHFNC, continuous (CPAP) and bilevel (BPAP) positive airway pressure), PICU LOS, and hospital LOS were explored. Data were analyzed by Wilcoxon-Rank Sum, Chi-squared and Fisher's Exact tests.Results: 112 patients were included. Patients in the low flow group (n = 56) had a median HHFNC flow rate of 4.0 L/min (IQR 3.9-4.0) versus patients in the high flow group (n = 56) at 9.6 L/min (IQR 7.0-15.0; p < 0.001). Pediatric Asthma Severity Scores (PASS) were similar (p = 0.095). The low flow group had significantly shorter total duration of cSABA (p = 0.048), shorter duration of noninvasive respiratory support (p = 0.0234), and shorter PICU (p < 0.001) and hospital (p = 0.0063) LOS.Conclusions: Low HHFNC flow rates for cSABA delivery are associated with shorter durations of cSABA, noninvasive respiratory support, PICU and hospital LOS.
Oral health findings in pediatric chronic kidney disease (CKD) are heterogeneous, and CKD-related metabolic alterations may contribute to plaque mineralization and oral hygiene outcomes. Yet, the relationship between routinely measured serum biochemical parameters and standardized caries/oral hygiene indices in children with CKD is not well defined. This study aimed to evaluate the associations between serum biochemical parameters and oral health indices in pediatric CKD. This cross-sectional study included 34 children aged 6-14 years with diagnosed CKD. Demographic and available clinical data were recorded, and routinely measured serum biochemical parameters reflecting renal function, mineral metabolism, acid-base status, hematologic status, and nutritional/metabolic profile were obtained from routine laboratory records. Oral examination included caries assessment using Decayed, Missing, and Filled Teeth (dmft/DMFT) index for primary/permanent dentition and International Caries Detection and Assessment System (ICDAS) II indices, as well as oral hygiene evaluation using the Simplified Oral Hygiene Index (OHI-S), Debris Index (DI), and Calculus Index (CI). Developmental enamel defects were evaluated, and soft tissue lesions were examined. Pearson correlation analysis and Mann-Whitney U tests were performed. Statistical significance was set at p < 0.05. Most serum biochemical parameters were not significantly associated with caries experience or oral hygiene indices (p > 0.05). Serum magnesium showed weak-to-moderate negative correlations with CI (r = - 0.383, p = 0.026) and OHI-S (r = - 0.362, p = 0.035), indicating lower calculus accumulation and lower OHI-S scores with higher magnesium levels. In contrast, ALP demonstrated a weak-to-moderate positive correlation with CI (r = 0.386, p = 0.024). In this pediatric CKD cohort, routine serum biochemical parameters showed limited cross-sectional associations with caries experience and oral hygiene indices. However, the observed associations of serum magnesium and alkaline phosphatase with calculus accumulation suggest that mineral metabolism-related markers may be linked to plaque mineralization. These findings should be interpreted cautiously in view of the cross-sectional design, small sample size, and clinical heterogeneity of the study group.
The objective of this study was to determine the effect of familiar or unfamiliar music with different rhythmic patterns on pediatric patients undergoing exodontia. Eighty-eighty children aged 5-9 years requiring dental extraction were divided into five groups based on the rhythmic pattern and familiarity of the musical interventions Group I (Control), Group II (Familiar-Synchronized), Group III (Familiar-Syncopated), Group IV (Unfamiliar-Synchronized), and Group V (Unfamiliar-Syncopated). During exodontia, a music therapist controlled the auditory input. Calibrated examiners assessed the patients' behavior, pain, and anxiety using the Houpt scale, the Face, Legs, Activity, Cry, and Consolability scale, and a pulse oximeter, respectively. The recorded data was tabulated and sent for statistical analysis using Python (v3.11) in the Julius Code Sandbox. Intergroup comparisons using the Kruskal-Wallis test did not reveal a significant reduction in anxiety ( P > 0.05) and showed a marginally nonsignificant difference in behavior ( P = 0.07). Intragroup comparisons using Wilcoxon signed-rank tests showed a significant decrease in anxiety scores in Groups III ( P = 0.04) and IV ( P = 0.04). Nonparametric testing revealed no significant differences in pain between groups ( P = 0.70). Regression analysis and a goodness-of-fit test revealed that neither age nor gender influenced the patient, regardless of the intervention. Pooled contrasts for a simple linear regression model showed that comparisons among the interventional musical pieces were not clinically significant. The rhythmic pattern or the patient's familiarity with the musical piece influenced the patient's behavior, anxiety, and pain assessment, but with no clinical significance.
The aim of this study was to evaluate the amount of dentin removed and the incidence of dentinal microcrack formation in the "danger zone" of the mesial and distal root canals of mandibular primary molars using three different root canal instrumentation systems. Mesial and distal root canals of mandibular primary molars (n = 66) were included in the study. The teeth were randomly assigned to three groups according to the instrumentation technique: conventional hand instrumentation, Kedo-SG, and Pro-Af Baby Gold rotary systems. Micro-Computed Tomography (Micro-CT) scans were obtained before and after root canal preparation. The amount of dentin removed from the danger zone and the presence of dentinal microcracks were evaluated using the reconstructed images. No statistically significant differences were observed among the groups in terms of the amount of dentin removed from the danger zone at either measurement level in both mesial and distal roots (p > 0.05). Similarly, no statistically significant differences were found among the groups regarding dentinal microcrack formation in either root. However, a lower incidence of microcrack formation was observed in the Kedo-SG rotary file system. When evaluated according to root regions, microcracks were most frequently detected in the coronal third, followed by the middle third, and least frequently in the apical third in both roots. No significant differences were observed among the instrumentation systems in terms of dentin removal from the danger zone or dentinal microcrack formation. Although the Kedo-SG group showed fewer microcracks numerically, no statistically significant difference was found. Further studies are needed to evaluate the potential clinical advantages of single-file rotary systems in primary teeth.
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Effective irrigation is essential for successful pulpectomy in primary teeth. Sodium hypochlorite (NaOCl), although widely used, has cytotoxic and demineralizing effects. Bioactive alternatives such as silver diamine fluoride (SDF) and fluoridated mouthwash require evaluation. This study aimed to compare the effects of NaOCl, SDF, and fluoridated mouthwash on dentinal surface morphology and elemental composition using scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) spectroscopy analysis. In vitro experimental study conducted in a tertiary dental institution. Materials and Methods: Thirty-six extracted primary maxillary incisors were randomly divided into three groups ( n = 12): 1% NaOCl, 3.8% SDF, and 0.05% fluoridated mouthwash. Standardized access preparation and irrigation were performed. SEM assessed smear layer removal, and EDX evaluated elemental composition (Ca, P, Ag, F). One-way ANOVA and Kruskal-Wallis tests were used with significance set at P < 0.05. NaOCl demonstrated complete smear layer removal (Score 0) across all root thirds with significantly reduced calcium and phosphorus content and no silver or fluoride deposition. SDF showed effective smear layer removal with dentinal tubule occlusion, significant silver (4.97%) and fluoride deposition, and preserved mineral content compared to NaOCl. Fluoridated mouthwash exhibited the highest calcium preservation with minimal residual smear layer and moderate fluoride uptake, with all intergroup differences being statistically significant ( P < 0.05). SDF and fluoridated mouthwash are effective bioactive alternatives to NaOCl, offering smear layer removal while preserving dentinal integrity and enhancing mineral deposition.
Vitamin C deficiency also known as scurvy, can present with musculoskeletal pain, gingival bleeding, oral discomfort, and impaired mobility. Children with Autism Spectrum Disorder (ASD) are at increased risk of vitamin C and other nutritional deficiencies due to sensory sensitivity and food selectivity. This report aims to describe two pediatric patients with nonverbal ASD who presented with oral and systemic symptoms. These cases highlight the importance of obtaining a detailed dietary history and complete examination when evaluating unexplained oral bleeding, gingival inflammation, and limb pain in children with ASD. Interdisciplinary collaboration among pediatric medicine, dentistry, and specialists is essential to ensure timely diagnosis and avoid unnecessary interventions. Increased clinical awareness of nutritional deficiencies and their oral manifestations can improve outcomes and reduce diagnostic delays in this vulnerable population.
To assess whether personality styles vary across student and professional cohorts in dentistry, using psychology controls. A total of 249 dental students and 162 practicing dentists were compared with 160 psychology students and 430 psychotherapists. All participants completed the Personality-Styles-and-Disorders-Inventory (PSDI). Fourteen personality styles were analyzed across disciplines and career stages. MANOVA with post-hoc-tests showed significant differences among the four groups (dental and psychology students and professionals). Both student groups showed strong fluctuations around the normative mean, indicating higher emotional levels and peaks in stress-dependent styles. Dental students showed signs of severe stress and burnout tendencies. Their depression scores were highest, while optimism was lowest. Professionals generally showed lower values than students, often below the norm, indicating "functional adaptation" and professional stability. Psychotherapists showed the most balanced profile with the lowest values. Dentists remained moderately higher than psychotherapists, indicating higher stress. Their most distinctive characteristic was "compulsiveness", reflecting precision and perfectionism, already elevated during training and increasing in practice. While psychotherapists developed from higher stress levels during their studies to a balanced profile, dentists maintained higher stress and increased their perfectionism. Dentists demonstrate stronger tendencies towards precision and perfectionism than psychologists, who show greater flexibility and openness. Professionalization appears associated with adaptive personality style, although compulsive tendencies in dentistry remain elevated and may increase with clinical experience. These findings suggest an interplay between pre-existing dispositions and occupational socialization. Longitudinal studies are needed to clarify whether these differences are present before training or arise during professional practice. Insights into the differences in personality styles between dental students and dentists may inform dental education and prompt further research on dentist-patient relationships and treatment outcomes.
Effective moisture control is essential in pediatric dentistry. Cotton rolls provide limited isolation, while a rubber dam offers better control but may cause discomfort in children. Saliva absorbers have been introduced as an alternative. This study compares saliva absorbers with cotton rolls and a rubber dam for isolation in children. To evaluate and compare the effectiveness of cotton rolls, rubber dam, and parotid and sublingual saliva absorbers during class ii restorations in primary molars among children aged 4-9 years. This randomized clinical trial included 36 children aged 4-9 years requiring class ii restorations in primary molars. Participants were randomly allocated into three groups ( n = 12 each): cotton roll isolation, rubber dam isolation, and parotid and sublingual saliva absorbers. Standardized cavity preparation and restoration with high-strength glass ionomer cement were performed. Patient anxiety was assessed using pulse rate, face, legs, cry, consolability score scale, and animated emoji scale. Operator ease was evaluated using a questionnaire. Statistical significance was set at P < 0.05. Saliva absorbers showed better patient acceptance and satisfactory moisture control compared to cotton rolls and rubber dams. Rubber dam provided superior isolation but was associated with higher anxiety scores and longer placement time. Operator ease was the highest with saliva absorbers. Saliva absorbers were an effective isolation method, providing adequate moisture control with ease of handling.
First permanent molars (FPMs) erupt early and remain exposed to the oral environment for prolonged periods, making them particularly susceptible to dental caries, molar-incisor hypomineralization (MIH), restorative failure, and repeated restorative intervention. When long-term prognosis becomes unfavorable, extraction may represent a biologically appropriate treatment option. Favorable spontaneous eruptive adaptation of the second permanent molar (SPM) has been associated with several radiographic and developmental variables. This retrospective radiographic study evaluated demographic and panoramic radiographic parameters associated with favorable eruption potential of SPMs in children with indicated FPM extraction and investigated whether established radiographic conditions were present at the time extraction decisions were made. Following ethical approval, panoramic radiographs of 500 pediatric patients presenting with extraction-indicated FPMs (n = 712) were retrospectively evaluated. Demographic characteristics, dentition stage, number and location of affected FPMs, and extraction indications were recorded. Radiographic assessment included evaluation of SPM developmental stage according to Demirjian classification, SPM angulation, and presence of a third permanent molar (TPM) germ. Statistical analyses were performed using SPSS version 29.0. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were applied, with statistical significance established at p < 0.05. The mean age of the study population was 128.39 ± 22.11 months; 54.6% were girls and 45.4% boys. Extensive carious destruction (91.4%), repeated treatment interventions, severe structural breakdown, and MIH-related defects represented the principal indications for extraction. Radiographically, 17.6% of SPMs were classified as Demirjian stage E and 27.4% as stage F. Mesial angulation was observed in 55.2% of cases, while a TPM germ was present in 74.2%. However, only 12.8% of cases (62 patients, 91 teeth) fulfilled all predefined radiographic conditions associated with favorable eruption potential following FPM extraction. Radiographic conditions associated with favorable eruption potential of SPMs were present in only a limited proportion of cases at the time FPM extraction decisions were established. These findings highlight the discrepancy between theoretically favorable developmental timing conditions and the clinical realities of pediatric dental practice, where extraction is frequently necessitated by advanced structural disease. Systematic radiographic evaluation of SPM developmental stage, angulation, and TPM germ presence should therefore be incorporated into individualized treatment planning.
Apexification is a widely employed procedure for managing immature permanent teeth with necrotic pulps, utilizing calcium hydroxide (Ca(OH)₂) and iodoform combinations for canal disinfection and apical barrier formation. While these medicaments are effective, prolonged placement due to missed follow-up appointments may predispose to intracanal calcification, complicating subsequent canal negotiation and obturation. This case series reports three pediatric patients who presented with pain in mandibular permanent first molars exhibiting immature apices (Cvek's stage 4) and periapical radiolucencies. All patients had previously undergone apexification with a Ca(OH)₂-iodoform medicament (Metapex, Meta Biomed Co. Ltd., Cheongju, Korea) but missed scheduled follow-up appointments, reporting after six to 10 months. At recall, clinical symptoms had subsided, and radiographs showed healing of the periapical lesions. However, during re-instrumentation, extensive intracanal calcifications and calcific barriers were observed in the apical third, obstructing complete canal negotiation and interfering with working length determination. This case series emphasizes the importance of strict follow-up compliance and cautious monitoring when employing long-term intracanal medicaments in pediatric endodontics.
Intermittent hypoxia, which is a characteristic of obstructive sleep apnea can impair mandibular growth during early development, particularly in infants. This study aimed to investigate gene expression profiles associated with mandibular cartilage growth in infant male rats exposed to IH modeling pediatric OSA. Eight-day-old male Sprague-Dawley rats were subjected to either normoxic air or IH and sacrificed after 1 week. Mandibular growth was evaluated using micro-computed tomography and histomorphometry. RNA sequencing examined differential gene expression in bone and cartilage. IH caused mandibular growth deficits, including reduced total cartilage thickness in the mid- and posterior mandibular condylar regions. Comparative measurements between IH and normoxia showed thinning of all cartilage layers in these regions under IH. In contrast, the anterior region exhibited thicker proliferative and maturative layers but a thinner hypertrophic layer under IH. RNA sequencing identified 342 upregulated and 45 downregulated genes in the IH group, including key regulators of bone and cartilage metabolism, such as gremlin-2, fibroblast growth factor 2, insulin-like growth factor binding protein 2, interleukin-1B, bone gamma-carboxyglutamate protein, wingless-related integration site 2, and SRY-box transcription factor 11. These findings suggest that IH alters expression of critical genes in mandibular cartilage development, potentially contributing to growth deficits.
Children with molar incisor hypomineralization (MIH) frequently experience high caries burden. Although preventive interventions such as silver diamine fluoride (SDF) and other agents are increasingly used, the natural progression of untreated MIH-related caries remains poorly documented, limiting policy-relevant evaluation of proven benefits in the long term. To compare the 2-year caries progression in MIH-affected posterior teeth that were untreated versus those previously treated with SDF or universal bonding agents (UBAs). The retrospective cohort study was conducted among schoolchildren aged 6-16 years. Children diagnosed with MIH according to the European Academy of Paediatric Dentistry criteria and presenting with International Caries Detection and Assessment System (ICDAS) 1-4 lesions were included. Exposure was defined as prior treatment with SDF or UBA; comparator was untreated teeth from children who had previously declined treatment. Caries progression was assessed using the ICDAS criteria over a 2-year follow-up. Relative risk (RR), absolute risk reduction (ARR), and number needed to treat (NNT) were calculated. A total of 252 teeth had complete follow-up data: 142 untreated (56.3%) and 110 previously treated (43.7%). Caries progression occurred in 57.3% of treated teeth and 52.8% of untreated teeth. The unadjusted RR was 1.08 (95% confidence interval [CI]: 0.87-1.36). The ARR was - 4.5% (95% CI: -16.8% to 7.9%), indicating no statistically significant difference (χ 2 ; P = 0.48). The corresponding NNT suggested a number needed to harm of -23 (minus 23), though this estimate was unstable due to CIs crossing zero. Over 2 years, prior preventive treatment with SDF or UBA did not confer a measurable advantage over no treatment, highlighting the importance of long-term metrics to make inform decisions.
Finite element analysis (FEA) is a widely used computational method for assessing stress distribution in dental structures. Understanding the mechanical behaviour of paediatric crowns under functional loads is essential for optimising restorative material selection. This study aims to evaluate the stress distribution in maxillary primary second molars restored with stainless steel, zirconia, and strip crowns under occlusal and lateral forces using FEA. Three-dimensional models of primary second molars with full coronal restorations were analysed. Vertical, horizontal and oblique force vectors were applied, and minimum and maximum principal stresses were calculated using finite element analysis software (Algor Fempro). Under vertical (axial) loading, the maximum principal stress values recorded on the root surface were 10.4 MPa (control), 7.8 MPa (stainless steel crown), 17 MPa (zirconia crown) and 10.3 MPa (strip crown). Stresses increased markedly under oblique and, in particular, horizontal forces in every model; the strip crown produced the highest root stresses (up to 505.7 MPa under horizontal loading), whereas the zirconia crown produced the highest stresses within the crown itself. All of the crown materials examined produced relatively low stresses under vertical (axial) loading, but their mechanical performance varied considerably with the direction of loading, with the highest stresses occurring under horizontal forces. Zirconia crowns concentrated the highest stresses within the crown, stainless steel crowns produced the most uniform stress distribution and the lowest root stresses, and strip crowns developed markedly elevated root stresses under non-axial loading. On the basis of stress distribution, the stainless steel and zirconia crowns performed more favourably than the strip crown under non-axial loading. These findings can inform material selection for full coronal restorations in paediatric dentistry.
The acidic nature of gastric refluxate and the aciduric properties of cariogenic microorganisms may influence the oral microbial environment in children with gastroesophageal reflux disease (GERD). Streptococcus mutans and Streptococcus sobrinus are among the primary bacteria associated with dental caries and may proliferate under acidic conditions. This study aimed to investigate the association between dental caries indices and oral levels of cariogenic microorganisms in children with GERD symptoms compared with healthy controls. This case-control study included 32 children with GERD symptoms and 37 healthy children aged 5-11 years. GERD symptoms were assessed using the Gastroesophageal Reflux Disease Assessment in Pediatrics Questionnaire (GASP-Q). Dental status was evaluated using the decayed, missing, and filled teeth (dmft/DMFT) index according to WHO criteria. Oral microbial samples were collected from the tongue and buccal mucosa using sterile cotton swabs, and the levels of S. mutans and S. sobrinus were quantified using culture-based methods. Statistical analyses were performed using chi-square tests, independent t-tests, Pearson correlation coefficients, and linear regression analysis at a significance level of P < 0.05. The mean age of participants was 8.22 ± 1.92 years. No significant differences were observed between the GERD and control groups regarding age (P = 0.379), sex distribution (P = 0.126), or dmft/DMFT scores (P = 0.410). However, the mean bacterial count was significantly higher in children with GERD symptoms compared with healthy controls (P < 0.001). After adjustment for age, sex, and dmft + DMFT, multivariable linear regression analysis indicated that children in the case group tended to have higher log10 bacterial counts than those in the control group, although the association was not statistically significant (β = 1.009, 95% CI: -0.192 to 2.209, P = 0.098). Athough children with GERD showed higher salivary counts of Streptococcus mutans and Streptococcus sobrinus, this association was not significant after adjustment for confounding factors. GERD was not independently associated with cariogenic bacterial counts or dental caries experience.
Intrusive luxation of a permanent maxillary central incisor is an uncommon yet highly challenging dental injury, often associated with extensive periodontal ligament (PDL) damage, pulpal necrosis, and an increased risk of root resorption. This case report details the comprehensive management of a severely intruded maxillary central incisor in a nine-year-old patient using controlled orthodontic extrusion. Clinical and radiographic evaluation confirmed significant apical displacement without evidence of crown or root fracture. Given the depth of intrusion and the stage of root development, orthodontic extrusion was chosen as a biologically conservative and predictable approach to reposition the tooth and support periodontal healing. Endodontic therapy was subsequently performed to prevent inflammatory root resorption. Over a five-year follow-up period, the tooth showed stable positioning, healthy periodontal support, and favourable aesthetic and functional outcomes. This case demonstrates the reliability of orthodontic extrusion as a minimally invasive and effective treatment modality for severe intrusive luxation injuries in permanent incisors.