-
Journal of Oral Biology and... 2024The inability in achieving complete pulpal anesthesia with standard buccal infiltration especially in cases with SIP used for maxillary teeth. The study aimed to compare...
BACKGROUND
The inability in achieving complete pulpal anesthesia with standard buccal infiltration especially in cases with SIP used for maxillary teeth. The study aimed to compare the anesthetic efficacy of buccal and buccal plus palatal infiltration technique using 2% lidocaine and 4% articaine in permanent maxillary first molars with the diagnosis of symptomatic irreversible pulpitis (SIP).
MATERIAL AND METHOD
One hundred and twenty-three patients with clinical diagnosis of SIP, aged 18-50 years were randomly allocated to three treatment groups (N = 41). Group 1(BIL): Buccal infiltration technique using 2% lidocaine with 1:80,000 adrenaline. Group 2(BPIL): combination of buccal plus palatal infiltration using 2% Lidocaine with 1:80,000 adrenaline. Group 3(BIA): Buccal infiltration using 4% articaine with 1:100,000 adrenaline. Pain intensity of patients were recorded before and after the administration of local anesthesia during endodontic procedure that is during caries removal, access preparation and pulp removal using Heft-Parker Visual Analog Scale (HP-VAS). Success was defined by "no pain (0 mm)" or "mild pain (0-54 mm)" during endodontic procedure. The anesthetic efficacy rates were analyzed using chi-square tests, age differences using one-way ANOVA.
RESULTS
The final analysis included total of 117 patients. Higher success was observed in group II (85%) in comparison to group I (69%) and group III (74%), but the difference was statistically nonsignificant (p > 0.05). Our results demonstrated a nonsignificant difference between genders in all three groups (p > 0.05).
CONCLUSION
The use of buccal plus palatal infiltration and 4% articaine can provide effective anesthesia as standard buccal infiltration and 2% lidocaine for patients with SIP in maxillary first molars.
PubMed: 38445050
DOI: 10.1016/j.jobcr.2024.02.004 -
Dental Research Journal 2024This review aims to perform a complete evaluation of the impact of photobiomodulation (PMB) on postoperative endodontic pain. (Review)
Review
BACKGROUND
This review aims to perform a complete evaluation of the impact of photobiomodulation (PMB) on postoperative endodontic pain.
MATERIALS AND METHODS
The PRISMA checklist was used to perform this systematic review. The electronic databases were searched, including Google Scholar, PubMed, and Embase. Sixty-three papers were obtained through a main electronic search and a hand search. Nine trials met the criteria after screening the titles, abstracts, and/or full texts.
RESULTS
Seven out of nine studies showed that PMB has a significant impact on relieving postoperative endodontic pain, with no statistically significant difference in the severity of pain between the laser and control groups in the two remaining studies. In addition, eight studies showed no adverse effects, indicating that we can remove the adverse effects of drugs such as nonsteroidal anti-inflammatory drugs. However, one study showed evidence of the consequences of PMB application on teeth with symptomatic irreversible pulpitis. Therefore, it can be concluded that PMB should not be used in teeth with pain because of irreversible pulpitis.
CONCLUSION
Although there is some understanding from a cellular viewpoint of the effects of PMB, there is still some uncertainty about whether these cell-level modifications impact reducing the postendodontic pain.
PubMed: 38425318
DOI: No ID Found -
BMC Oral Health Feb 2024Evidence-based dentistry suggests pulpotomy as a potential alternative to root canal treatment in mature permanent teeth with irreversible pulpitis. However, the...
INTRODUCTION
Evidence-based dentistry suggests pulpotomy as a potential alternative to root canal treatment in mature permanent teeth with irreversible pulpitis. However, the evidence surrounding the cost-valuation and cost-efficacy of this treatment modality is not yet established. In this context, we adopted an economic modeling approach to assess the cost-effectiveness of pulpotomy versus root canal treatment, as this could aid in effective clinical decision-making.
METHODS
A Markov model was constructed following a mature permanent tooth with irreversible pulpitis in an 18-year-old patient over a lifetime using TreeAge Pro Healthcare 2022. Transition probabilities were estimated based on existing literature. Costs were estimated based on the United States healthcare following a private-payer perspective and parameter uncertainties were addressed using Monte-Carlo simulations. The model was validated internally by sensitivity analyses, and face validation was performed by an experienced endodontist and health economist.
RESULTS
In the base case scenario, root canal treatment was associated with additional health benefit but at an increased cost (1.08 more years with an incremental cost of 311.20 USD) over a period of an individual's lifetime. The probabilistic sensitivity analysis revealed pulpotomy to be cost-effective at lower Willingness-To-Pay (WTP) values (99.9% acceptable at 50 USD) whereas increasing the values of WTP threshold root canal treatment was a cost-effective treatment (99.9% acceptable at 550 USD).
CONCLUSION
Based on current evidence, pulpotomy was a cost-effective treatment option at lower WTP values for the management of irreversible pulpitis in mature permanent teeth. However, by increasing the WTP threshold, root canal treatment became a more cost-effective treatment option over a period of lifetime of an individual.
Topics: Humans; Adolescent; Pulpotomy; Pulpitis; Cost-Effectiveness Analysis; Dental Pulp Cavity; Root Canal Therapy; Treatment Outcome
PubMed: 38418999
DOI: 10.1186/s12903-024-04052-9 -
Frontiers in Veterinary Science 2024Seven teeth extracted from two adult California sea lions () due to pulp exposure and/or to gain access to the mandibular canine teeth were histologically evaluated, and...
Seven teeth extracted from two adult California sea lions () due to pulp exposure and/or to gain access to the mandibular canine teeth were histologically evaluated, and the findings were compared with clinical and radiographic findings. Three teeth were diagnosed with pulp exposure, and two of these showed no radiographic signs of endodontic disease and were histologically vital with prominent coronal pulpitis and a pulp polyp. Another tooth with pulp exposure was showing clinical and radiographic signs of endodontic disease and was histologically confirmed with pulp necrosis. A discoloured incisor tooth was showing radiographic signs of endodontic disease and was also histologically non-vital. Two clinically and radiographically healthy mandibular first premolar teeth and one second incisor tooth had no evidence of pulpitis or pulp necrosis but had pulp canal obliteration. Regular clinical and radiographic follow-up for 5 months to 3 years after the procedures confirmed uneventful healing of the extraction sites, despite initial flap's dehiscence. Although extractions of affected teeth in California sea lions are considered the most practical and beneficial therapy, these are associated with the risks of extensive trauma and anaesthesia and the need to perform these surgical procedures on-site under variable conditions. As California sea lions can be trained to allow conscious dental radiographic re-checks, monitoring teeth with clinical signs of pulp polyp formation and without radiographic signs of endodontic disease warrant further evaluation/reconsideration from previous recommendations. Endodontic treatment of abscessed teeth in California sea lions is reportedly unsuccessful and is discouraged. However, vital pulpectomy could be an alternative treatment to extraction in teeth with pulp polyps as it was found to be highly successful in humans, but the possibility of endodontic failure and need for further treatments should be weighted in the treatment choice.
PubMed: 38414654
DOI: 10.3389/fvets.2024.1335960 -
Journal of Ayub Medical College,... 2023Preventing tooth loss is of utmost importance in maintaining optimal mastication, phonation, and aesthetics. Most commonly, pulpitis occurs as a result of caries, while... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Preventing tooth loss is of utmost importance in maintaining optimal mastication, phonation, and aesthetics. Most commonly, pulpitis occurs as a result of caries, while trauma less frequently causes it. In both cases, it can lead to unbearable pain. To alleviate this pain and preserve the tooth without resorting to extraction, root canal treatment is indicated. To compare the radiographic quality of root canal filling sealing achieved with the Obtura II system and the cold lateral condensation technique.
METHODS
This randomized clinical trial was conducted at the School of Dentistry with a total of 260 participants. The study focused on single-rooted teeth that required endodontic treatment. Group A was assigned the cold lateral condensation, while Group B received obturation using the Obtura II system. A radiographic assessment was performed to evaluate the presence of voids and the extent of extension at the apex in both groups. The chi-square test was utilized to compare the occurrence of voids and the extent of extension between the two groups.
RESULTS
In the Cold Lateral Compaction cold lateral condensation group, 113 cases (86.92%) achieved optimum extension, while in the Obtura II group, 114 cases (87.69%) achieved the same. A statistically significant difference was observed between the groups in terms of extension (p=0.033). Although the difference in extension quality was not statistically significant, it is worth noting that the Obtura II group had a higher incidence of overextension. The cold lateral condensation group had 104 cases (80.00%) with no voids, whereas the Obtura II group had 121 cases (93.08%) without voids. A statistically significant difference was observed between the groups regarding the presence of voids (p=0.004).
CONCLUSIONS
Obtura II exhibits a denser sealing and fewer voids compared to the cold lateral condensation technique. However, Obtura II showed a slightly higher tendency to extend beyond the apex compared to the CLC technique.
Topics: Humans; Pain; Root Canal Filling Materials; Root Canal Obturation
PubMed: 38406949
DOI: 10.55519/JAMC-04-12276 -
Journal of Conservative Dentistry and... Jan 2024Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used as a postoperative medication after endodontic treatment. The introduction of transdermal patches aided...
Comparative evaluation of efficacy of diclofenac and ketoprofen administered using transdermal drug delivery route in management of post endodontic pain: A randomized controlled clinical trial.
BACKGROUND
Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used as a postoperative medication after endodontic treatment. The introduction of transdermal patches aided in reducing the discomfort caused by medication prescribed through the oral route.
AIM
This study aims to compare the efficacy of transdermal patches of diclofenac and ketoprofen for postendodontic pain control.
MATERIALS AND METHODS
Thirty patients with symptomatic irreversible pulpitis in singlerooted teeth of either arch were endodontically treated by a single endodontist. Oral diclofenac for Group I and transdermal diclofenac patch for Group II and transdermal ketoprofen patch for Group III were administered as postendodontic analgesics. Visual Analog Scale chart was used to record pain intensity preoperatively and at intervals of 4, 8, and 24 h postoperatively. Paracetamol 500 mg tablets were provided as rescue medication.
STATISTICAL ANALYSIS
Repeated Measure ANOVA.
RESULTS
There was a significant decrease in the postoperative pain intensity scores for both transdermal groups. The postoperative scores gradually decreased from day 1 to day 2. Six out of ten patients who had received diclofenac tablets complained of gastric discomfort.
CONCLUSION
Both transdermal ketoprofen and diclofenac patches were effective than oral diclofenac tablet and can be used as an alternative and effective analgesic for postendodontic pain management, especially in patients with gastric discomfort.
PubMed: 38389736
DOI: 10.4103/JCDE.JCDE_160_23 -
Scientific Reports Feb 2024Direct pulp capping (DPC) is a conservative approach for preserving tooth vitality without requiring more invasive procedures by enhancing pulp healing and mineralized...
Direct pulp capping (DPC) is a conservative approach for preserving tooth vitality without requiring more invasive procedures by enhancing pulp healing and mineralized tissue barrier formation. We investigated the effectiveness of Platelet Rich Plasma (PRP) vs. Mineral Trioxide Aggregate (MTA) as a DPC agent. Forty-two teeth from three mongrel dogs were divided into two equal groups. After three months, the animals were sacrificed to evaluate teeth radiographically using cone-beam computerized tomography, histopathologically, and real-time PCR for dentin sialophosphoprotein (DSPP), matrix extracellular phosphoglycoprotein (MEPE), and nestin (NES) mRNA expression. Radiographically, hard tissue formation was evident in both groups without significant differences (p = 0.440). Histopathologic findings confirmed the dentin bridge formation in both groups; however, such mineralized tissues were homogenous without cellular inclusions in the PRP group, while was osteodentin type in the MTA group. There was no significant difference in dentin bridge thickness between the PRP-capped and MTA-capped teeth (p = 0.732). The PRP group had significantly higher DSPP, MEPE, and NES mRNA gene expression than the MTA group (p < 0.05). In conclusion, PRP enables mineralized tissue formation following DPC similar to MTA, and could generate better cellular dentinogenic responses and restore dentin with homogenous architecture than MTA, making PRP a promising alternative DPC agent.
Topics: Animals; Dogs; Calcium Compounds; Pulp Capping and Pulpectomy Agents; Root Canal Therapy; Platelet-Rich Plasma; Silicates; Oxides; Aluminum Compounds; Drug Combinations; RNA, Messenger; Dental Pulp
PubMed: 38355945
DOI: 10.1038/s41598-024-54162-1 -
Maedica Dec 2023Since pain control in dental treatments, including root canal treatment, is challenging, and no study has measured the appropriate pattern of Anaheal Plus drug...
Since pain control in dental treatments, including root canal treatment, is challenging, and no study has measured the appropriate pattern of Anaheal Plus drug consumption in reducing pain after root canal treatment, in this study the appropriate pattern of taking Anaheal Plus drug in reducing pain after root canal treatment was evaluated. The present study examined maxillary and mandibular molar teeth with irreversible pulpitis. Patients were divided into three groups: A) Anaheal Plus capsule; B) control; and C) ibuprofen. Teeth were treated in two sessions, pulpectomy treatment was performed and drugs were used between sessions. A visual analog scale questionnaire was used to assess pain. Patients were asked to record the pain score before the root canal treatment as well as eight hours, 48 hours and five days after root canal treatment. All procedures were done in Amol's private clinic, where root canal treatment was administered by a dentist, and the teeth were obturated after a week. This study examined 90 patients with an average age of 33.94 years. Rescue doses were reported only in the control group, and there was a significant difference between groups (p-value < 0.001). In all groups, pain had decreased significantly (p-value<0.001), but the average pain in groups A and C was lower than that of group B at all times, and there was no difference between them. Anaheal Plus significantly reduced pain after root canal treatment compared to the control group.
PubMed: 38348069
DOI: 10.26574/maedica.2023.18.4.651 -
Journal of Dental Research Mar 2024
Topics: Humans; Toothache; Cannabidiol; Pulpitis
PubMed: 38347664
DOI: 10.1177/00220345231223691 -
Cureus Jan 2024A sessile multicellular organism that is immersed in a self-produced matrix of extracellular polymeric substances and has its cells firmly attached to a surface is...
BACKGROUND AND AIM
A sessile multicellular organism that is immersed in a self-produced matrix of extracellular polymeric substances and has its cells firmly attached to a surface is referred to as a microbial biofilm. When it comes to pulp and periradicular pathosis, biofilms are crucial. To reduce the number of microorganisms in the root canal and assist in treating periapical pathosis, endodontic therapy must include decontamination of the system of tooth root canals through biomechanical preparation and irrigation of the root canal. This study compares sodium hypochlorite (NaOCl), povidone-iodine, chlorhexidine, curcumin, and triphala as endodontic irrigating solutions regarding their capacity to eliminate biofilm from root canals.
MATERIALS AND METHODS
A total of 60 patients were included if they had pulpitis. Two specific samples (samples A and B) were chosen for analysis from a collection of samples so that their bacterial composition is most similar to that of acute pulpitis. The suspensions of bacterial cells from this polymicrobial culture have been collected from frozen stock and then regrown by inoculation on Columbia agar base (Basingstoke, UK) with the addition of vitamin K1, hemin, and 5% (v/v) calf blood. The pureness of the suspensions was assessed using colony morphology and Gram staining. Analytical profile index (API) 20A tests or automated test for bacteria (ATB) ID 32A tests were initially used to identify the isolates. These polymicrobial cultures' in vitro biofilms were developed using membrane filters made of cellulose nitrate. The tested irrigating solutions were as follows: 5.25% sodium hypochlorite, 10% triphala, 0.2% chlorhexidine gluconate, 10% povidone-iodine, and 5% curcumin (CUR). On the other hand, phosphate-buffered saline was taken as a control agent.
RESULTS
As the standard of excellence in endodontic irrigation, NaOCl has eliminated all germs in sample A following 15 minutes of culture and in both of the specimens after 40 minutes. Iodine also eliminated all germs after 40 minutes of administration, indicating that it would be worth exploring using iodine as a potential endodontic irrigant. Iodine achieved total bacterial elimination after 40 minutes in both samples; however, it was less effective after 15 minutes. Our findings indicate that iodine solution is the most suitable alternative after the supremely effective NaOCl, although it requires longer contact times to generate the necessary and recognized broad-spectrum antibacterial properties, including in the case of biofilms. Furthermore, curcumin also showed significant results after NaOCl and iodine.
CONCLUSION
The antibacterial potency of each studied irrigant was significant, supporting their usage in endodontics. It was observed that NaOCl has the maximum antibacterial activity.
PubMed: 38344514
DOI: 10.7759/cureus.52067