Clinical Evaluation of BioFlx Crowns for the Restoration of Primary Teeth Ashwin Rao, Karuna Y Mahabala, Shweta Tiwari, Srikant Natarajan, M Swathi Renuka, P Sushmitha International Journal of Clinical Pediatric Dentistry, 2026 Original researchpreformed pediatric full-coverage restorations for primary teeth that offer the flexibility and snug fit of the preformed metal crowns, and the esthetics of preformed zirconia crowns. 8,9The clinical data in the literature for this crown are still nascent and evolving.The current paper studied the clinical performance of the BioFlx crown. IntroductIonThe demand for esthetics in primary teeth now encompasses not only anterior teeth but also posterior teeth.Unesthetic restorations are frequently refused by parents. 1 Preformed indirect zirconia fullcoverage restorations for primary teeth were introduced in the year 2010 to fulfill this clinical demand. 2 These full-coverage restorations offer natural esthetics along with long-term color stability, strength, biocompatibility, and durability. 3They are also autoclavable. 4 The yttrium-stabilized zirconium-based preformed zirconia crowns manufactured by the injection molding technique or milling technique have mechanical properties similar to a metal crown.Adjustment through trimming, crimping, or contouring is therefore not possible.This lack of flexibility, therefore, dictates greater tooth reduction for a passive fit. 5 The preformed zirconia crowns also require aggressive subgingival tooth preparation, which dissuades the clinician from placing them in young children.The ideal full-coverage restoration for primary teeth should retain the advantages of the preformed metal crown (stainless steel crowns).These include conservative tooth preparation and their ability to be trimmed, crimped, and contoured, resulting in a snap clinical fit.But an ideal full-coverage restoration should also be esthetic to fulfill the esthetic demands of the parent and child. 6 The indirect performed "BioFlx" full-coverage restorations (Kids-e-Dental, LLP, Mumbai, India) are a new generation of crowns fabricated from a biocompatible high-strength radiopaque polymerized resin already existing in the human healthcare field. 7hey are monochromatic, tooth-colored, and free from A-glycidyl methacrylate.flexible, long-lasting, self-adapting, and life-like
Effectiveness of a play-based distraction technique in reducing gag reflex during intraoral periapical radiography in children: a randomised crossover trial I. Singh, K. Sethia, Y. M. Karuna, N. Srikant, A. Rao, P. A. Nayak European Archives of Paediatric Dentistry, 2026 Purpose Excessive gagging in children can hinder the successful completion of intraoral radiographs, adversely impacting diagnosis and treatment. The literature on the use of active distraction during intraoral radiographic techniques in children is limited. The study examined the relationship between the gag reflex and dental anxiety in paediatric patients as well as effectiveness of using an acrylic thumb light in reducing gag severity during intraoral periapical radiography. Methods This in vivo comparative crossover study included 25 children aged 6–13 years with moderate to very severe gag reflex (classification of the gagging problem index). Each participant underwent intraoral periapical radiography twice: control (without distraction) and interventional (with play-based distraction using an acrylic thumb light), the order of which was randomised. Gag severity was assessed via the gagging severity (GS) criteria, and dental anxiety was measured via the Modified Child Dental Anxiety Scale–Faces version (MCDASf). The data were analysed via McNemar’s test and the Chi-square test. Results A significant reduction in severe/worst gagging was observed in the intervention group compared with the control group ( p = 0.001). Mild/moderate gag responses were noted in 84% of the children in the intervention group versus 40% in the control group. A significant association was found between higher MCDASf scores and increased gag severity in both the control ( p < 0.001) and intervention ( p = 0.019) conditions. Conclusion Play-based distraction using an acrylic thumb light significantly reduced gag reflex severity during intraoral periapical radiography, with dental anxiety influencing gag response.
Evaluation of the impact of acidic medications and fluoride-containing mouthwash on the enamel surface using quantitative light-induced fluorescence, microhardness, and scanning electron microscopy: an in vitro study Saanya Bhasin, Simran Singh, Manuel Sebastian Thomas, Karuna Yarmunja Mahabala, Ramya Shenoy BMC Oral Health, 2025 Background Due to their acidic nature, certain medications can have deleterious effects on tooth enamel. Fluoride is a popular method for reversing these effects. Therefore, this study aimed to assess the impact of acidic medications, specifically anti-asthmatic drugs and vitamin C tablets, on enamel surfaces and to investigate the effects of fluoride following drug exposure. Methods An in vitro experimental study was conducted on ninety-six healthy human posterior teeth. Forty-eight samples were tested for surface demineralization via quantitative laser fluorescence (QLF), and the other forty-eight samples were tested for enamel microhardness via a Vickers hardness tester. The samples were divided into six groups: (i) Group DW_NF- samples immersed in distilled water with no fluoride exposure; (ii) Group DW_F- samples immersed in distilled water with intermittent fluoride exposure; (iii) Group VC_NF- samples treated with vitamin C only; (iv) Group VC_F- samples treated with vitamin C and fluoride mouthwash; (v) Group SB_NF- samples exposed to salbutamol inhaler with no fluoride exposure; (vi) Group SB_NF- samples exposed to salbutamol inhaler followed by fluoride exposure. For the evaluation of surface morphology by scanning electron microscopy (SEM), two random samples used for QLF from each group were taken. The Wilcoxon signed-rank test, Kruskal‒Wallis test, and post hoc test were applied as appropriate. The p value was set at 0.05. Results Following exposure to medication, significantly higher QLF values were observed in Group VC_F and Group SB_F than in Group DW-NF (control group) (p = 0.15 and 0.004, respectively). The difference in the QLF values was significantly greater in Group VC_NF than in the control group DW-NF, indicating greater demineralization with acidic medications (p = 0.034). Significant changes in surface microhardness were detected in Group VC_F compared with the control group (p = 0.024). Qualitative analysis of SEM images revealed erosion at the enamel surface in all groups except the control group, with the most prominent erosion in the vitamin C- and fluoride-treated groups (VC_F group). Conclusion This study demonstrated the erosive potential of vitamin C tablets on enamel surfaces. Furthermore, the use of acidic fluoride mouthwash immediately after exposure to acidic medication exacerbates enamel demineralization.
Comparative evaluation on the masking ability of different tooth colored restoration over blackish discoloration caused by 38% silver diamine fluoride: an in -vitro study Prajval Mahajan, Anupama Nayak P, Srikant Natarajan, Karuna Yarmunje Mahabala, Kiran N Baliga, Ashwin Rao, Charisma Thimmaiah Bdj Open, 2025 Background The application of Silver diamine fluoride is an effective approach in controlling dental caries. But the black discoloration caused by its application is unaesthetic and is of greater concern to the parents. Aim To assess the potential color masking ability of tooth colored restorative material over discoloration caused by 38% SDF using a UV‒VIS-NIR spectrophotometer. Material and methods 20 extracted teeth were taken and randomly divided into 4 groups: Group A: 38% SDF + GIC; Group B: 38% SDF + RMGIC; Group C: 38% SDF+ Composite; Group D: 38% SDF+ Cention N. Two readings were recorded, one on application of 38% SDF and second after application of test materials using a UV‒VIS-NIR spectrophotometer. Result The intragroup comparison for color masking ability (ΔE) for all four restorative materials revealed no statistically significant differences, with a test value of 1.168 and a p value of 0.353, and the highest mean was observed in Group A, i.e., 38% SDF + GIC (9.171966) Significant differences in color were observed, with more shifts toward yellow in group A (2.488 ± 2.957) and group D (1.686 ± 0.559) and more shifts toward green in groups B (−0.088 ± 0.34) and C (−0.062 ± 0.5). The mean lightness was greatest for Group C, i.e., the composite group (86.396 ± 3.741), and least for Group A, i.e., the GIC group (76.664 ± 8.213). Conclusion All 4 restorative materials were equally effective in terms of color masking over 38% SDF discoloration.
Assessment of smartphone-based active distraction in association with audioanalgesia for overcoming airotor-related anxiety in children: a randomized controlled trial Kritika Bali, Radhika Ailawadi, Y. M. Karuna, N. Srikant, Ashwin Rao, P. Anupama Nayak, Charisma Thimmaiah BMC Research Notes, 2025 Background Most children experience distress while visiting a dentist, above which the sound of the airotor and suction machine results in fear and difficulty in performing further procedures. Methods This was a randomized controlled parallel-group study of 40 children aged 6–13 years who required cavity preparation via the airotor. The children were randomly allocated to either Group 1 (Piano music app; active distraction combined with audio analgesia) or Group 2 (basic behavioural guidance alone). Self-reported dental anxiety was measured via a modified child dental anxiety scale, and behavior was assessed via Venham’s and FLACC (Faces Legs Activity Cry and Consolability) scales. The data obtained were subjected to appropriate statistical analysis. Results Self-reported dental anxiety was significantly lower in group 1 (p < 0.005). No significant difference between the groups was observed for the Venham and FLACC scores. Conclusion Compared with basic behavioural guidance alone, the use of active distraction with audio analgesia in the form of the piano music app significantly decreased the degree of dental anxiety caused by the use of the airotor. This also resulted in clinically better cooperation by the child during cavity preparation. Trial Registration Registered in the Clinical Trials Registry India (CTRI/2024/07/070160) dated 08/07/2024.
Perforation Repair of a Primary Tooth: A 1-Year Follow-Up Case Report P. Sushmitha, A. P. Nayak, Y. M. Karuna, C. Thimmaiah Acta Medica Bulgarica, 2025 Aim and Background Primary teeth are more susceptible to perforation during endodontic treatment due to their anatomical features. Perforations, unintended communications between the root canal and external root surface, are a common procedural accident in endodontics, often leading to tooth loss. Managing these perforations in primary teeth is challenging, with prognosis dependent on factors such as location, size, and contamination. Traditional sealing materials have limitations like microleakage and toxicity. Mineral trioxide aggregate (MTA) is superior due to its sealing ability, biocompatibility, and promotion of hard tissue formation. Case Presentation This case report describes a furcal perforation repair in a primary molar using MTA in a 5-year-old child. Repulpectomy with calcium hydroxide based obturating material was performed. Follow up was done at 3, 6 months and 1 year. Conclusion With availability of bioactive materials like MTA, perforations in primary teeth can be repaired with good clinical and radiographic success. Clinical significance As stated the best space maintainer is the primary tooth by itself. Therefore, perforation repair with MTA can be a viable alternative to extraction in young children thus the tooth can be preserved and meet the functional demands.
Screening of toddlers at risk for autism spectrum disorder (ASD) in rural Dakshina Kannada, India, facilitated by accredited social health activists (ASHAs): a cross-sectional study Y.M. Karuna, Ramya Shenoy, Sham Bhat, B.S. Suprabha, Sharanya B. Shetty, Kiran Baliga Clinical Epidemiology and Global Health, 2025 <h2>ABSTRACT</h2><h3>Objective</h3> The purpose of screening for autism spectrum disorder (ASD) in the present study was to address delayed ASD diagnosis in developing countries. Using community healthcare workers, namely, accredited social health activists (ASHAs), this study targeted the early screening of kids who may have a risk of developing ASD. <h3>Materials and methods</h3> This analytical cross-sectional investigation was conducted among toddlers of randomly chosen primary health centers in Dakshina Kannada District, Karnataka, India. ASHA workers, trained in the use of the translated (to the Kannada language) Modified Checklist for Autism in Toddlers (M-CHAT), conducted screenings to detect toddlers at risk of ASD. During their regular home visits, the ASHA workers completed the M-CHAT questionnaire as per the input from the parents. The investigators collected the data collected by ASHA workers and further subjected the data to statistical analysis. <h3>Results</h3> Fifty-eight ASHA workers from 6 PHCs completed 906 M-CHATs. According to the data analysis, six toddlers (0.7%) were found to have a high risk for ASD, and nearly half of the sample population (42.23%) belonged to the necessary follow-up category. There was no statistically significant relationship between sex and the total score calculated per M-CHAT. <h3>Conclusion</h3> Within the limitations, the study reported that 0.7% of the toddlers had a high risk for ASD, and 42.3% required follow-up when evaluated using the M-CHAT with the assistance of ASHA workers. By the end of the training, ASHA workers were well-equipped to contribute effectively to early screening of ASD during home visits.
A scoping review on parental/caregiver challenges in maintaining oral hygiene among children with autism spectrum disorder Karuna Yarmunja Mahabala, Anuradha Dutt, Ramya Shenoy, YingMin Lee, Charisma Thimmaiah, Sham Bhat, Anupama Nayak, Ashwin Rao International Journal of Paediatric Dentistry, 2025 BackgroundDental practitioners must develop feasible and evidence‐based strategies to help parents/caregivers successfully implement daily oral hygiene measures among their children with autism spectrum disorder (ASD).AimThis scoping review aimed to explore challenges faced by parents/caregivers while performing routine oral hygiene care among their children with ASD.DesignA methodological framework recommended by Arksey and O'Malley and reporting guidelines prescribed by PRISMA‐ScR were adopted. A database search was conducted across PubMed, Scopus, Web of Science, EMBASE, and ClinicalKey, to identify articles that addressed challenges faced by parents/caregivers while performing routine oral hygiene care for their children with ASD.ResultsThe search yielded 4934 articles. Following the inclusion/exclusion criteria, nine articles were included in this scoping review. A qualitative analysis of included articles following the PICOS coding criteria revealed major themes. These consisted of various home oral hygiene practices followed by parents/caregivers, and challenges faced by them during home oral hygiene care owing to underlying sensory, behavioral, physical, and/or functional problems experienced by their children with ASD.ConclusionChallenges experienced by parents/caregivers of children with ASD were numerous, which resulted in deviations from routine oral hygiene practices from recommended guidelines for the prevention of dental caries.
Of the article: evaluation of the masticatory efficiency of children with stainless steel crowns: a pilot cross-sectional split-mouth study Madhura Sen, Karuna Yarmunja Mahabala, Srikant Natarajan, Deveshi Gupta, Shrehya Shekhar, Ashwin Rao, Anupama Nayak P BMC Oral Health, 2024 Background Stainless steel crowns (SSCs) are commonly employed to restore the posterior teeth of children and over the years, they are available with improved anatomical shapes. This study was conducted to evaluate and assess the effect of the placement of SSCs on the masticatory efficiency of children. Methods This pilot cross-sectional split-mouth study assessed masticatory efficiency in children aged 6–11 years. Fifteen participants, each with stainless-steel crowns placed unilaterally at least one month prior, were included. This study utilized two flavours of trident chewing gum (red and green) to measure masticatory efficiency. The child was asked to chew half a strip of red and green chewing gum placed one on top of the other using either the noncrown or crown side 15 times. Another set of chewing gum was given to the child to chew 20 times on the same side. The chewing exercise was repeated using teeth on the other side. Chewed gum samples were collected, photographed, and analysed via ImageJ software to determine the red and green areas. Masticatory efficiency was subsequently calculated with the help of a formula in which the red areas and green areas were calculated via ImageJ software. The data were analysed with paired t tests via SPSS (version 20.0). Results When the mean values of the crown side were compared with those of the noncrown side following 15 chewing cycles, the chewing efficiency on the noncrown side was greater, with a difference of 0.303, whereas the chewing efficiency following 20 chewing cycles was greater on the crown side, with a difference of 0.814. However, both differences were statistically nonsignificant, with t values of -0.07 and 0.26, respectively, and p values of 0.94 and 0.8, respectively. Conclusion The presence of SSCs on the molars of children did not affect masticatory efficiency.
Comparative evaluation of sealing ability and adaptation of gel form of MTA to dentinal walls: an in-vitro study Haritha Parthasarathy, Akshara Modak, Karuna Yarmunja Mahabala, Srikant Natarajan, Shrikala Baliga, Manuel Thomas, Ashwin Rao, Anupama Nayak Bdj Open, 2024 Context Mineral Trioxide Aggregate (MTA) is a calcium silicate-based cement that potentially exhibits improved washout resistance when carboxymethyl chitosan or gelatin is incorporated. Gel-form MTA is a novel mineral trioxide aggregate formulated using construction industry-based technology. The present study was conducted to comparatively evaluate the sealing ability and adaptation to dentinal walls of gel-form MTA. Materials and methods This in-vitro study consisted of two groups: gel-form MTA and the conventional powder-liquid MTA. 10 samples per group were used for each of the tested parameters. Adaptation of the MTA to the dentinal walls was tested under the light microscope and measured using Image J software. Sealing ability was evaluated using a single aerobic bacterial leakage model. Appropriate statistical analysis was done for the obtained data. Adaptation of the MTA was analyzed using independent t-test and Friedman test, whereas the bacterial leakage was analyzed using chi-square test. Results On comparison of the adaptation property at coronal and apical thirds, there was no statistically significant difference between the groups (p = 0.071 and p = 0.638, respectively). However, while comparing the same in the middle one-third of the root, lesser gaps were identified in the gel-form MTA group (p = 0.013). One sample belonging to the conventional powder-liquid MTA group showed significant turbidity during bacteria leakage evaluation (p = 0.001) with the presence of E. faecalis in the count of 103 colony forming units/milliliter. Conclusion The gel-form MTA shows a better adaptation to the dentinal walls at the middle third of the root and exhibits better sealing ability against bacterial leakage when tested for E. faecalis. The adaptation of gel-form MTA at coronal and apical third of the root was comparable to the conventional powder-liquid MTA.