short attention span and multiple appointments makes it necessary to treat young child under general anesthesia. pediatric dentist would find it very helpful

1. Success rate of treatments provided for early
childhood caries under general anesthesia: A
Retrospective Cohort Study
Presented by:
Dr A.K.Zalan
PGR MDS
Pediatric Dentistry

2.  ABSTRACT:
 The purpose of this study was to assess the success rate of
various treatments provided under general anesthesia for early
childhood caries (ECC) over three-year follow-up period.
 METHODS:
ECC children no older than 72 months at the time of dental
surgery, who had completed a 3 year follow-up, were included.

3. RESULTS:
 A total of 818 children were included.
 Of these, 33 % had restored teeth that required further
treatment during the three-year follow-up.
 Amalgam restorations and stainless crowns showed
significantly longer survival than composite restorations in all
types of restorations.
 The survival rates of both indirect pulp capping and
pulpotomies were the same and significantly higher then
pulpectomies.

4.  RESULTS ( continued)
 The lower lingual holding arch had a significantly lower survival
rate than other space maintainers.
 CONCLUSIONS:
 SSCs and amalgam restorations were clinically more successful
and had better survival times than composite restorations.
 The survival rate for the LLHA was low compared to other space
maintainers.

6.  Plan for different types of space maintainers.
 Plan for prosthetic rehabilitations.
 Plan to attain the aesthetics and self esteem after
extractions.
 Plan for short and long term of oral rehabilitation before
undergoing procedures in GA.
 IF NOT???

9.  Early childhood caries is the most common chronic childhood
disease.
 Comprehensive full-mouth dental treatment under General
anesthesia is a common approach in ECC management that
aims to control the disease in a single visit.
 Restorative treatment options include fillings with various
dental materials, stainless steel crowns and different types of
space maintainers.

10.  New caries development after comprehensive dental
treatments under GA has been reported to affect
approximately 22 – 52 % of children after six months.
 The need for new restorations and extractions or even
another comprehensive treatment under GA was reported in
17 – 23 % of children within two years of initial treatment.
 Few reports evaluated the success rate of individual
procedures performed on patients under GA.
 A long-term comprehensive evaluation of treatments
commonly provided undergoing GA may help with decisions
concerning appropriate treatment modalities to improve
treatment outcomes and reduce relapse.

11.  METHODS:
 Data were collected from dental records of patients at two
private pediatric dental practices.
 Eligible participants were children no older than 72 months at
the time of GA.
 At each recall appointment, these patients received a dental
examination , dental prophylaxis, topical flouride and other
dental treatments as needed.
 Treatment completed at GA were considered to have failed if the
tooth received new treatment any time after the one month
postoperative visit.

12.  The success rate of every individual treatment, type of
retreatment rendered on failed cases, and time to failure were
evaluated.
RESULTS:
 All treatment was done in primary dentition
 LLHA was given only in patients with permanents centrals
erupted.
 33 % had restored teeth that required further treatment during
3-year follow-up period.

13.  Success and survival rates of individual treatments done at
General anesthesia:
PREVENTIVE TREATMENTS:
 The success rate for fissure sealant was 92.8 % over the 3
year period.
 No difference in the success rate between maxillary and
mandibular molars was noted.
 22 % of failed sealed primary molars were resealed and 24%
had occlusal composite restorations.
 More then half retreated received SSCs.

14.  PULPAL TREATMENTS ( indirect pulp cappings, pulpotomies
and pulpectomies )
 The success rates for indirect pulp capping, pulpotomies and
pulpectomies were 96 %, 93% and 75% respectively, over
three years follow up.
 Posterior teeth where pulpotomies and pulpectomies were
done were restored with SSCs, Class I and II restorations,
anterior teeth were restored with composite crowns.
 Pulpotomies restored with SSC were more successful then
with Class 1 or II restorations.
 Pulpotomies done in posterior teeth were more successful
then in the anterior teeth.
 Pulpectomies were significantly more successful in primary
second molar then in primary first molar.

15.  Pulpectomies done on primary first molars were seven times
more at risk to fail then pulpectomies performed on primary
second molars during three years follow up.
 The survival rates of IPC and pulpotomies were significantly
higher than for pulpectomies with no significant difference
between survival rates of pulpotomies and IPC.
 Pulpectomies were twice at risk to fail compare to IPCs and
eight times more than pulpotomies.

16.  RESTORATIVE TREATMENTS:
( resin composite restorations, amalgam restorations, SSCs)
Anterior Restorations:
The succcess rate of buccal and lingual anterior resin composite
restorations was 92.4% .
Most of the failed anterior RCRs needed replacement.
Anterior two surface RCRs had a 90% success over three years
follow up.
Almost half of two surface failed RCRs were replaced while less
then quarter were extracted.
Multi-surface anterior RCRs and anterior resin composite crowns
were successful 91 and 88% of time respectively.
For anterior RCRs, no significant difference was found between
single-surface, two-surface, multi-surface or strip crowns over
three years of follow-up.

17.  Posterior restorations :
 The success rate of class 1 RCR was 93%.
 During recall visits, 18% of failed class I RCR required
replacement, while 68% were restored with SSCs.
 11% of failed Class I RCRs required pulp treatments.
 The success rate of Class II RCRs was 84%.
 Quarter of failed restorations were redone and 39% were
restored with SSCs

18.  Multi-surface RCRs were successful in 89% of cases.
 Half of failed RCRs were redone and 21% restored with SSCs.
 There was no significant difference between Class I, II or multi-
surface RCRs between maxillary and mandibular molars.
 The success rates of posterior amalgam restorations were 98.5%
for Class I, 98.8% for Class II and 100% for multi-surface amalgam
restorations.
 SSCs were successful in 97% of cases over three years.
 36% of failed SSCs were recemented, 20% redone, 43%
extracted.
 No significant difference was found between maxillary and
mandibular SSCs

19.  The survival of both Class II amalgam restoration and SSCs
was significantly higher than that of Class II RCRs.
 Class II RCRs were nine times more at risk to fail than class
II amalgam and 5 times more then SSC during the first three
years of follow up.

20.  SPACE MAINTAINERS:
 Chairside made and lab-fabricated band and loop SMs were
the most successful SMs with 93% and 85% success rates,
respectively.
 Less then two third of lab-fabricated distal shoe SMs failed
compared to only 23% chairside made distal shoes.
 61% LLHA failed over three years and two third of the failed
required re-fabrication.

21.  DISCUSSION:
 The purpose of the present study was to evaluate the success
rate of individual treatments provided to children undergoing
treatment under GA over a three-year follow up period.
 The success rates of most provided treatment was high- with
SSCs and amalgam being the most successful restorative
treatments.
 Despite the high success rate of composite restorations,
amalgam showed superiority over composite in all types of
posterior restorations.
 Previous reports on the success rate of SSCs were generally
high, ranging from 90% to 100% over an evaluation period up
to 10 years.

22.  Our results also confirmed the high success for SSCs
performed under GA.
 In this study, SSCs were more successful than Class II and
multi-surface composite restorations yet comparable to
amalgam restorations.
 As new carious lesions were one of the main reasons for most
failures, full coverage with SSCs may play a better protective
role.
 The extracted cases of SSCs can be due to the failure of
pulpal treatments rather than the failure of SSCs themselves.

23.  Fissure sealants showed a high success rate.
 Both IPCs and pulpotomies showed very high success rates in
the present study as well as many other studies.
 Despite the low success rate, the rationale behind
pulpectomies of primary teeth was to avoid extraction and
keep the tooth sypmtom-free until natural exfoliation.
 Most of the Space maintainers , with the exception of lab-
made distal shoes and LLHAs, had a half life of more than
three years.
 In this study , as well as in the previous reports, unilateral
appliances had greater survival times than bilateral ones.

24.  CONCLUSIONS:
 One third of patients who underwent comprehensive dental
treatment under general anesthesia had a treatment failure
within three years following GA.
 SSCs and amalgam restorations were clinically more successful
and had better survival times than resin composite restorations
in children treated under GA.
 Pulpotomies restored with SSCs were significantly more
successful than those restored with Class I or Class II
restorations.
 LLHA and lab-made distal shoe space maintainers showed
lower survival rates compared to other types of space
maintainers.

28. THANK YOU