tried to cover up most of the recent advancements in the field of pediatric dentistry in this presentation.

1. RECENT ADVANCEMENTS IN
PAEDIATRIC DENTISTRY
Dr. Aravindhan A,
JR-2,
Dept. of Paediatric and Preventive dentistry.

2. Contents
• Advancements in pain control
• Advancements in caries diagnosis
• Dental Implants
• Nano materials
• Silver diamine fluoride
• Advancements in Crowns for primary tooth
• Advancements in Naso Alveolar Moulding

3. Advancements in pain control
• Cook invented the modern dental syringe nearly
150 years ago.
• Here we see,
1.Vibrotactile devices,
2.Computer-controlled local anesthetic
delivery (CCLAD) systems,
3.Jet injectors,
4.Safety dental syringes and
5.devices for Intra-Osseous (IO) anesthesia.

4. Vibrotactile devices
• systems aimed at easing the fear of the
needle take advantage of the gate control
theory of pain management.
• GATE CONTROL THEORY?

5. VibraJect
• It is a small battery-operated attachment that
snaps on to the standard dental syringe.
• It delivers a high-frequency vibration to the
needle that is strong enough for the patient to
feel.
• Researches evaluating the effectiveness of
VibraJect, have shown mixed results.
• Nanitsos et al.,and Blair have recommended
the use of VibraJect for painless injection.

6. Dental vibe
• Its U-shaped vibrating tip attached to a
microprocessor-controlled Vibra-Pulse motor.
• It gently stimulates the sensory receptors at
the injection site, effectively closing the neural
pain gate, blocking the painful sensation of
injections.
• It also lights the injection area and has an
attachment to retract the lip or cheek.

7. Accupal
• Accupal provides pressure and vibrates the
injection site 360° proximal to the needle
penetration, which shuts the “pain gate” .
• After placing the device at the injection site
and applying moderate pressure, the unit light
up the area and begins to vibrate.
• The needle is placed through a hole in the
head of the disposable tip, which is attached
to the motor.

8. COMPUTER-CONTROLLED LOCAL ANESTHETIC DELIVERY SYSTEMS
• Incorporated computer technology to control the
rate of flow of the anesthetic solution through
the needle.
• Wand™ - first CCLAD- 1997 (U.S)
• Next generations:
1.Wand Plus
2. CompuDent
• Comfort Control Syringe -2001 (U.S)
• QuickSleeper and SleeperOne (France)
• Anaeject and Ora Star (Japan)

9. wand
• This system enabled operator to accurately
manipulate needle placement with fingertip
accuracy and deliver the LA with a foot-activated
control.
• The lightweight handpiece is held in a pen-like
grasp that provides the user with greater tactile
sensation and control.
• The greater control over the syringe and the fixed
flow rates of the LA drug are responsible for a
significantly improved injection experience.

10. Comfort control syringe
• No foot pedal.
• A base unit and a syringe
• Has five pre-programmed speeds for different
injection techniques.
• more perceptive than that of the CompuDent
system in the sense that the injection is
controlled by hand.
• syringe is bulky

11. Jet injectors
• Jet-injection technology is based on the principle
of using a mechanical energy source to create a
release of pressure sufficient to push a dose of
liquid medication through a very small orifice,
creating a thin column of fluid with enough force
that it can penetrate soft tissue into the
subcutaneous tissue without a needle.
• Syrijet
• MED-JET

12. Syrijet
• It accepts the standard 1.8 mL cartridges of LA
solution.
• permits the administration of a variable
volume of solution from 0 to 0.2 mL.
• and is completely autoclavable.

13. Med jet
• Directed through a small orifice 7 times
smaller than the smallest available needle in
the world.
• utilize low pressure delivery methods.

14. SAFETY DENTAL SYRINGES
• Use of a safety syringe minimizes the risk of
accidental needle-stick injury.
• These syringes possess a sheath that ‘locks’
over the needle when it is removed from the
patient's tissues preventing accidental needle
stick.

15. • Ultra Safety Plus XL syringe
Has a sterile disposable protective shield that
is fitted with a dental needle into which
anesthetic carpules are placed.
• UltraSafe Syringe
The entire assembly is disposable and is not
autoclavable..
Fully transparent.

16. • HypoSafety Syringe
The needle can be retracted into the barrel of
the syringe after the injection.
• RevVac safety syringe
When the plunger reaches the bottom, after
all medicine is administered, a further push on
the plunger breaks the seal, and the needle
retracts into the plunger.

17. DEVICES FOR INTRA-OSSEOUS ANESTHESIA
• Aim to inject local anesthetic solution into the
cancellous bone adjacent to the apex of the
tooth.
• Stabident
• X-Tip
• IntraFlow

18. stabident
• A slow-speed hand piece with a latch contra-
angle for the perforator and a standard dental
anesthetic syringe for the needle.
• visible location in the attached gingiva distal
to the tooth to be anesthetized.

19. X tip
• the pilot drill itself a hollow tube through
which a 27-gauge needle can pass.
• more post-operative pain .

20. IntraFlow
• Essentially a dental handpiece equipped with an
injection system built into the body.
• single-step method
• High maintenance costs
• Study by Remmers et al.,(2008), found IntraFlow
to provide reliable anesthesia of posterior
mandibular teeth in 13 of 15 subjects, compared
to 9 of 15 with an inferior alveolar nerve block.
Remmers T et al.,-The efficacy of IntraFlow
intraosseous injection as a primary anesthesia
technique.,- J Endod. 2008 Mar; 34(3):280-3.

21. Single-tooth anesthesia
(STA)
• Developed by the manufacturers of WAND
(CCLAD).
• Dynamic Pressure Sensing (DPS) technology.
• Originally designed for use in medicine in
epidural regional anesthesia.
• Helpful in intraligamentary injection.

22. Reversing local anesthesia
• Oraverse ( phentolamine mesylate) (FDA-
2009)
• Prevents anesthetic lip bite injury.
• safe and effective in reducing soft tissue local
anesthetic recovery time in adults and
children as young as 6 years.
• dosage?
• Duration?

23. Future trends
• A nasal spray has shown to anesthetize
maxillary anterior six teeth is set to be tested
in an FDA Phase 3 trial, which will assess the
spray's effectiveness compared to the current
“gold standard” treatment - painful anesthesia
injections.
• Kovacaine Mist (3% tetracaine HCl with 0.05%
oxymetazoline HCl)
• Coronoid foramen and its block.

24. Advanced Methods of Caries Detection
• Digital radiographic methods
• Digital image enhancement
• Digital subtraction radiography
• Tuned-aperture computed tomography (TACT).
• Visible light
• Optical caries monitor
• Quantitative fiber-optic transillumination
• Digital Image fiber-optic transillumination
• Quantitative light/laser-induced fluorescence (QLF).
• Laser light
• DIAGNOdent – Laser autofluorescence.
• Electrical current
• Electrical conductance measurement
• Electrical impedance measurement.
• Ultrasound
• Ultrasonic caries detector.

25. Digital Radiographic Methods
Digital image enhancement
• Resolution of unenhanced digital image is lower than
radiographs
• Range of gray shades is limited to 256, whereas in a
radiographic film, over 1 million shades of gray appear
• Contrast can be digitally enhanced using a
mathematical rule often decided by the
algorithm/filter
• They are not practically used because they are very
time-consuming.
INDIRECTDIRECT

26. Digital subtraction radiography
• A digital bitewing radiograph is taken and later
a second radiograph of exactly the same region
is produced with identical exposure time, tube
current, and voltage.
• By subtracting gray values for each coordinate of
the first radiograph from equivalent coordinate
of second, a subtraction image is obtained.
• If no changes have occurred, the result of
subtraction is zero.

27. Tuned Aperture Computed Tomography
(TACT)
• This method constructs radiographic section
through teeth.
• The slices can be viewed for the presence of
radiolucency.
• Slices can be brought together in a three-
dimensional computer model called pseudo-
hologram.
• TACT slices and pseudo-hologram can adequately
detect small primary and secondary carious
lesions

28. Optical caries monitor
• Principle used is, scattering is stronger in
demineralised enamel than in sound enamel
surface
• Light is transported through a fiber bundle to
the tip of handpiece.

29. Digital imaging fiber-optic
transillumination (DIFOTI)
• Combining FOTI with a digital CCD camera.
• It uses a safe white light with which images taken
from all the tooth surfaces can be digitally
captured using a digital CCD and sent to a
computer for analysis.
• When the teeth are transilluminated, areas of
demineralized enamel or dentin scatter light and
incipient caries appear darker in the resultant
image.
• Images taken during different examinations can be
compared for clinical changes between several
images of the same tooth over time.

30. Quantitative light/laser-induced fluorescence
• It provides a fluorescent image of a tooth surface within
yellow-green spectrum of visible light that quantifies mineral
loss and size of the lesion.
• Light source is a special arc lamp based on xenon technology.
• Recording of florescent image is done with a yellow
transmitting filter positioned in front of the color CCD sensor.
• Image is then digitized by the frame grabber and is available
for quantitative analysis.
• Tooth is seen on a computer monitor as fluorescent green and
dark areas indicate mineral loss or white spot lesions.
• At times, a red fluorescence appears that indicates leaking
around restorations and sealants
• SOPROLIFE (light-emitting diode fluorescence tool).

31. DIAGNOdent - laser autofluorescence
• It uses infrared laser fluorescence of 655 nm
for the detection of occlusal and smooth
surface caries.
• DIAGNOdent technology uses a simple laser
diode to compare the reflection wavelength
against a well-known healthy baseline to
uncover decay.
• Carious tooth structure exhibits fluorescence
proportionate to the degree of caries.
• DIAGNOdent pen- 2190.

32. Canary system
• The Canary System is a caries detection device, based on the
energy conversion technology photothermal radiometry
(PTR)–luminescence (LUM).
• When low- power laser light energy pulsed at 2 Hz is
absorbed by the tooth, two phenomena are observed:
1. the laser light is converted into LUM and
2. there is a release of heat (PTR).
• The output, called the Canary Number (CN)
• And is directly linked to the status of the tooth crystal
structure.
• CN increase as early mineral loss from the tooth (incipient
caries).
• In contrast, as remineralization of the lesion progresses, there
is a corresponding decrease in CN.

33. Electrical conductance measurement
• Demineralized tooth has more pores filled with water.
• Types. 1.site specific
2. surface specific
• 1.Vanguard electronic caries detector:
25 hz current.
0-9 reading
• 2. Caries meter:
400hz current.
Conductance will be converted into Coloured lights.
Green: No caries
Yellow: Enamel caries
Orange: Dentin caries
Red: Pulpal involvement.

34. Electrical impedance measurement
• Electrical impedance measurement is a
measure of degree at which an electric circuit
resists electric current flow when a voltage is
applied across two electrodes.
• Caries tissue has a lower impedance than
sound tooth.
• It is also known as electronic caries monitor.
• CARIES SCAN PRO

35. Ultrasound Caries Detector
• Demineralization of natural enamel is assessed by
ultrasound pulse-echo technique.
• Ultrasound interacts differently with different
tissues. They have a frequency of >20,000 Hz and
have all the properties of waves.
• An ultrasonic probe is used which sends and
receives longitudinal waves to and from the surface
of the tooth.
• Initial white spot lesions produce no or weak
surface echoes, whereas sites with visible
cavitation produce echoes with substantially higher
amplitude.
• Useful in diagnosis of proximal caries.

36. Newer technologies
• 1. Multiphoton imaging
• 2. Infrared fluorescence
• 3. Infrared thermography
• 4. Terahertz imaging
• 5. Optical coherence tomography
• 6. Polarized Raman spectroscopy
• 7. Modulated (frequency-domain) infrared
photothermal radiometry.
• 8. Magnetic Resonance Microimaging (mrm).
• 9. Near infrared light systems

37. Dental implants
• Definition: A prosthetic device made of
alloplastic material implanted into the oral
tissues beneath the mucosa and/or periosteal
layer, and on/within the bone to provide
retention or support to a prosthesis. The final
restoration looks, feels, & functions like a
natural tooth.
• Per ingvar branemark- swedish surgeon.

38. TILL DATE IT WAS BELIEVED THAT….
• The replacement of teeth by implants is restricted
to patients with completed craniofacial growth.
• There are two primary concerns:
(i) First, if implants are present during several
years of facial growth, there is a danger of them
becoming embedded, relocated, or displaced as
the jaw grows.
(ii) The second area of concern is the effect of
prosthesis on growth.

39. SCANDINAVIAN CONSENSUS CONFERENCE IN
SONKOPING, SWEDEN. 1996
• It was agreed that implants should not be
placed until growth and skeletal development
is completed or nearly completed.
• Exceptions:
1. severe oligodontia
2. ectodermal dysplasia
• But several authors found that alveolar ridge
loss is prevented in children with early loss of
permanent tooth who treated with implants.

40. Growth of craniofacial structures…

41. • Implants in the mandibular anterior region can
be placed to support an overdenture, from the
age of around 6 years, when the median sutures
of the mandible is closed.
-National Institute of Health consensus
Development Conference on Dental Implants at
Bethesda,1988.
• Whenever possible, implant placement must be
delayed until the age of 15 years for girls and 18
years for boys.
- Textbook of pediatric dentistry, Nikhil marwah.

42. • Ledermann et al in their 7-year follow-up reported
a 90% success rate on 42 endosseous dental
implants placed in 34 patients aged 9 to 18 years.
• There was a positive soft and osseous tissue
reaction to the implants, and most of the failures
occurred because of subsequent traumatic injuries
sustained during the healing phase after implant
placement.
• The major complication reported was the failure of
dental implants to respond to the vertical growth
of adjacent teeth and alveolus due to ankylosis.

43. • Prachar and Vaneek present the results of a
5-year study on the use cylindrical or screw
implants in adolescents of age 15-19 years.
Regardless of the criterion used, the rate of
success was always higher than 96% over the
5 years of study.

44. Implant procedure

45. Nano materials
• The American Physicist Richard Feynman through
his lecture titled “there is plenty room at the
bottom” delivered at Caltech in 1959 .
• Japanese scientist Norio Taniguchi of the Tokyo
University -1974- coined the term.
• Definition: Nanotechnology or nanoscience
refers to research and development of an applied
science at the atomic or molecular level.
• One nanometer is 1 billionth or 10−9 of a meter.

46. • The basic idea of nanotechnology is to employ
individual atoms and molecules to construct
functional structures.
• Nano materials synthesis
Bottom – up approach Top – down approach

47. Application of nanotechnology in
diagnosis and treatment
• Increase the efficiency and reliability of in
vitro diagnostics.
• The radiation dose obtained using digital
radiography with nanophosphor scintillators is
diminished and high quality images obtained.
• Optical nanobiosensor can also be used for
diagnosing oral cancer.
• Nanoshells have outer metallic layers that
selectively destroy cancer cells while leaving
normal cells intact.

48. Tissue engineering
• Bone augmentation, cartilage regeneration of
the temporomandibular joint, pulp repair,
periodontal ligament regeneration and implant
osseointegration.
• Bone grafts with better characteristics can be
developed with the use of nanocrystalline
hydroxyapatite. It was shown that nanocrystalline
hydroxyapatite stimulated the cell proliferation
required for periodontal tissue regeneration.
“Ability of nanocrystalline hydroxyapatite paste
to promote human periodontal ligament cell
proliferation” - Wilhausen et al., J Oral Health
Sciences 2008.

49. Bio-nano surface technology
• Roughening the implant surface at the
nanoscale level is important for the cellular
response that occur in the tissue.
• The nanoscale surface morphology augments
area and thus provides an increased implant
surface area that can react with the biologic
environment.

50. Nano anesthesia
• The gingiva of the patients is instilled with a colloidal
suspension containing millions of active, analgesic, micron-
sized dental robots that respond to input supplied by the
dentist.
• After contacting the surface of crown or mucosa, the
ambulating nanorobots reach the pulp via the gingiva sulcus,
lamina propia and dentinal tubules, guided by chemical
gradient, temperature differentials controlled by the dentist.
• Nerve-impulse traffic in tooth that requires treatment.
• After completion of treatment, they restore sensation
thereby providing patient with anxiety-free and needless
comfort. Anesthesia is fast acting, and reversible, with no
side effects or complications associated with its use.

51. • Sterilization: Nanoparticles have also been used
as sterilizing solution in the form of nanosized
emulsified oil droplets that bombard pathogens
- Eco-True which was reported to have 100%
destructive effect on HIV and germs. .
• Impression: Nanofillers are integrated into
vinypolysiloxanes, producing a unique siloxane
impression material that has a better flow,
improved hydrophilic properties and enhanced
precision detail.
• Nano needles and Nano tweezers.

52. Nano-robotic dentrifices
(dentifrobots)
• Dentifrobots in the form of mouthwash or
toothpaste left on the occlusal surface of teeth
can clean organic residues by moving throughout
the supragingival and subgingival surfaces.
• It metabolizes trapped organic matter into
harmless and odorless vapors and performing
continuous calculus debridement.
• These nanorobots can move as fast as 1-10 μ/s
and are safely self-deactivated when they are
swallowed.

53. Hypersensitivity care
• The dentinal tubules of a hypersensitive tooth
have twice the diameter and eight times the
surface density of those in nonsensitive teeth.
• Dental nanorobots could selectively and
precisely occlude selected tubules in minutes
using native logical materials, offering patients
a quick and permanent cure.

54. Nano orthodontics
• Reduction in the frictional force produced by
orthodontic movement by coating the
orthodontic wire with inorganic fullerene-like
tungsten disulfide nanoparticles (IF-WS2).
• Brackets coated with the nitrogen-doped
titanium oxide thin film prevents biofilm
accumulation over brackets.
• Orthodontic nanorobots could directly
manipulate the periodontal tissues, allowing
rapid and painless tooth straightening, rotating
and vertical repositioning as well as rapid tissue
repair within minutes to hours.

55. Nano composites
• High degree of strength
• Resistance to abrasion
• Superior esthetics
• Polishablity
• Increase in flow.
• Ex: Ceram-X Mono.

56. Silver diammine fluoride
• Ag(NH3)2F
• Ohaguro custom in japan.
• In which they used ohaguro dye made from
gall nut powder to stain the tooth.
• Yamaga et al., discovered SDF from ohaguro
dye.
• It has combined properties of silver nitrate
and sodium fluoride.
• It inhibits S. mutans microflora. Thus it is a
good antiplaque and anticariogenic agent.
Ammine-(NH3)
Amine-(NH2)

57. Mechanism of SDF
• 44,800 ppm of Fluoride.
• 2,54,709 ppm of Silver.
38% SDF
Ag ions F ions
Killing of microorganisms in
carious surface
ZOMBIE EFFECT
Remineralisation and
penetrates deeper into
dentin
Blocks the dentinal
tubules
Arrest of sensitivity
All of these lead to caries arrest.

58. Practical guidance by AAPD-2017
• 38% SDF
• Indications and usage :
• High caries-risk patients with anterior or posterior
active cavitated lesions.
• Cavitated caries lesions in individuals presenting
with behavioral or medical management challenges.
• Patients with multiple cavitated caries lesions that
may not all be treated in one visit.
• Difficult to treat cavitated dental caries lesions.
• Patients without access to or with difficulty
accessing dental care.
• Active cavitated caries lesions with no clinical signs
of pulp involvement.

59. Preparation of patients and practitioners:
• Universal precautions.
• No operative intervention (e.g., affected or
infected dentin removal) is necessary to achieve
caries arrest.
• Protect patient with plastic-lined bib and
glasses.
• Cotton roll or other isolation as appropriate.
• Use a plastic dappen dish as SDF corrodes
glass and metal. (pH- 10)
• Carefully dispose of gloves, cotton rolls, and
micro brush into plastic waste bag.

60. Procedure
• Remove gross debris from cavitation
• Minimize contact with gingiva and mucous membranes
• Dry with a gentle flow of compressed air (or use cotton
rolls/gauze to dry) affected tooth surfaces.
• Apply SDF directly to only the affected tooth surface.
• Dry with a gentle flow of compressed air for at least
one minute.
• Remove excess SDF with gauze, cotton roll, or cotton
pellet to minimize systemic absorption. Continue to
isolate site for up to three minutes when possible.

61. Post-operative instructions
• Eating and drinking immediately following
application is acceptable.
• Several SDF clinical trials recommended no
eating or drinking for 30 minutes – one hour.
Zhi QH et al., Randomized clinical trial on effectiveness of
silver diamine fluoride and glass ionomer in arresting dentine
caries in preschool children. -J Dent 2012.

62. Application frequency
• Monitor caries lesion arrest after 2-4 week period
and consider reapplication if necessary .
• Based on disease activity of individual.
• Biannual application is recommended.
• Fung M et al .,(2016) one-time SDF application in
arresting dental caries lesions ranges from 47
percent to 90 percent.
• Yee R et al.,(2011) After a single application of 38
percent SDF, 50 percent of the arrested surfaces at
six months had reverted to active lesions at 24
months.

63. • Esthetic consideration:
The hallmark of SDF is a visible dark staining that is a
sign of caries arrest on treated dentin lesions. This
dark discoloration is permanent unless restored.
“Pretreatment of dentin with SDF does not adversely
affect bond strength of resin composite to dentin.”
Selvaraj K, Sampath V, Sujatha V, Mahalaxmi S.
Evaluation of microshear bond strength and nanoleakage of
etch-andrinse and self-etch adhesives to dentin pretreated
with silver diamine fluoride/potassium iodide: An in vitro study.
Indian J Dent Res 2016.

64. Advancements in crowns
• Zirconia crowns
• Figaro crowns
• Biological crowns
• Luxa crowns

65. Zirconia crowns
• Zirconia crowns are very aesthetic and durable
crowns, and they can be used in most situations
where clinicians would place a stainless steel
crown, strip crown or preveneered crown.
• Also known as, Ceramic steel.
• Passive fit of crown is advised.
• Trade names:
1. Nu smile zr
2. Kinder crowns zr
3. EZ pedo crown
4. Kids e crown
5. Signature crown

66. Advantages:
• Strength
• Durability
• Esthetics
• Do not discolor
Disadvantages:
• More tooth reduction is required
• Brittle
• Cannot be crimped and trimmed.
• High cost
• Shade options are limited.

68. • Luting GIC is used to cement the zirconia crowns.
• Luthy et al., (2006), “Resin cement with MDP
monomer is the recommended cement for
monolithic zirconia crowns.”
• Sandblasting before cementation improves
bonding.
Immediate Post op 30 months follow up

69. Figaro crowns
• Reinforced fiber
glass crown.
• Tooth colored
• BPA free- non mutagenic
• Non metallic.
• High strength.
• Flex fit technology-
(crimpability)
• Thin margins- better marginal fit.

73. Luxa crowns
• Semipermanent composite crown .
• Technically simple
• Better durability
• Esthetics
• Patient compliance.

74. Procedure
• 1.5 mm tooth reduction is
needed in all aspects.
• Approx. 40 seconds after the
start of mixing, the filled
impression will be placed in the
patient's mouth and will stay
there for approx. 1:45 - 2:20
minutes, that is, till the material
is partially set.
• The impression will then be
taken out and the material will
be allowed to set outside
patient's mouth up to
approximately 5 minutes after
the start of mixing.

75. • Luxa video

76. Biological crowns
• Replacement of
decayed crown with
either autologous or
donated natural
crown.
• Donor crown should
be autoclaved and
sectioned acording to
the size of the
recipient tooth.
• Extracted tooth should
be stored in sterile
water.

77. Advancements in NAM
Modified muscle-activated maxillary orthopedic appliance
Suri and Tompson used a plate held in with
outriggers.
prevents cleft widening effect of tongue.
unilateral cleft lip and palate patients.
Suri S, Tompson BD. A modified muscle-activated
maxillary orthopedic appliance for presurgical
nasoalveolar moulding in infants with unilateral cleft lip
and palate. Cleft Palate-Craniofac J 2004;41:225-9.

78. Dynamic presurgical nasal remodeling
• Developed by Bennun and Figueroa.
• consists of two elements:
1. perfectly adapted conventional acrylic
intraoral plate.
2. dynamic nasal bumper attached to the
vestibular flange.
Bennun RD, Figueroa AA. Dynamic presurgical
nasal remodeling in patients with unilateral and
bilateral cleft lip and palate: Modification to the
original technique. Cleft Palate Craniofac J
2006;43:639-48

79. Active alveolar molding appliance
• Consists an alveolar molding plate
with an expansion screw (Jack
screw) fully opened.
• The appliance was activated by
closing the expansion screw and
by selective grinding and relining
with denture base material.
• The premaxilla was retracted and
the cleft gap was reduced within
3 months.
• Reducing tissue tension and scar
formation.

80. NAM with self retentive plate
• Ijaz et al.,2012.
• unilateral CLP cases
• Consists a custom-made orthopedic plate
incorporating nasal stent.
• The nasoalveolar orthopedic plate was made self-
retentive by adding soft acrylic on its palatal
surface in the defect part.
• There was no need of any extra oral attachment.
• Activation is done by adding soft liner in the
palatal portion.

81. • Thank you all.

82. References
• Text book of Pediatric dentistry- Nikhil
marwah
• Textbook of Pediatric dentistry- MS Muthu

83. QUESTIONS
• 1. which of the following advacement system in local
anesthesia delviery utilizes gate control theory?
• A. Wand
• B. Vibraject
• C. nano anesthesia
• D. Jet injectors
• 2. Zombie effect is associated with which of the following
• A. nano composite materials
• B. SDF
• C. monocortical implants
• D. figaro crown

84. • 3. Figaro crown utilizes which technology
• A. smooth fit technology
• B. crimp fit technology
• C. flex fit technology
• D. marginal fit technokogy
• 4. Implants can be placed in adolescent girls after
• A. 12 yrs
• B. 18 yrs
• C. 15 yrs
• D. 14 yrs

85. • 5. identify the given image
• A. Caries scan pro
• B. diagnodent
• C. soprolife
• D. canary system