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European Endodontic Journal Aug 2023The objective of this study was to evaluate the effectiveness of preoperative analgesics on inferior alveolar nerve blocks (IANB) during root canal treatment in patients... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison of Preoperative Analgesics on the Efficacy of Inferior Alveolar Nerve Block with Patients Having Symptomatic Irreversible Pulpitis: A Double-Blinded, Randomized Controlled Trial.
OBJECTIVE
The objective of this study was to evaluate the effectiveness of preoperative analgesics on inferior alveolar nerve blocks (IANB) during root canal treatment in patients with symptomatic irreversible pulpitis of the mandibular molars.
METHODS
This study was a randomized, double-blinded, superiority trial with a parallel study design. A total of 120 subjects with symptomatic irreversible pulpitis were randomly assigned to one of four groups: group A (con- trol, Vitamin E, Evion 400 mg), group B (Diclofenac sodium, Voltral SR100 100 mg), group C (Piroxicam, Feldene 20 mg), and group D (Tramadol, Tramal 50 mg). The patients recorded preoperative pain levels, and after admin- istration of local anaesthesia intraoperative pain levels using the Heft-Parker visual analogue scale before and after the oral administration of the analgesics. Statistical analysis was performed using the Kruskal-Wallis test.
RESULTS
All the analgesic groups showed a significant effect on the efficacy of the inferior alveolar nerve block in contrast to the control group (p<0.05). However, no significant difference was found between the drug groups on the effectiveness of the inferior alveolar nerve block (p>0.05). No side effects were reported in the present study.
CONCLUSION
Preoperative analgesics significantly increase the effectiveness of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. Therefore, preoperative analgesics should be considered to increase the effectiveness of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis on the mandibular molars. (EEJ-2023-02-033).
Topics: Humans; Pulpitis; Nerve Block; Mandibular Nerve; Analgesics; Tramadol; Piroxicam; Pain
PubMed: 38219036
DOI: 10.14744/eej.2023.42650 -
European Endodontic Journal Aug 2023To investigate the concentration of Matrix metalloproteinases-9 (MMP-9) and Tumor necroses fac- tor-alpha (TNF- α) in pulpal blood at various stages of pulpal...
OBJECTIVE
To investigate the concentration of Matrix metalloproteinases-9 (MMP-9) and Tumor necroses fac- tor-alpha (TNF- α) in pulpal blood at various stages of pulpal inflammation in diabetics and to establish the relationship between these two biomarkers.
METHODS
77 patients, each having a tooth with pulpal exposure due to caries presenting with distinct stages of pulpitis were grouped into 2 main study groups as based on the HbA1c Levels-Group 1: Non-Diabetics (Control Group) (HbA1c < 5.6%) and Group 2: Type 2 Diabetics (Experimental Group) (HbA1c>6.5%; Random Plasma Glucose > 200) and diabetes mellitus with less than 10-year history. Depending on the radiological and clinical diagnosis, these two groups were again sub-divided into 2 subgroups: Sub-group A: Tooth with Symptomatic Irreversible Pulpitis. Sub Group B: Tooth with Reversible Pulpitis. Thus, for comparison purposes, a total of 4 sub-divisions were formed: Sub-group 1A- Non-Diabetic, Symtomatic Irreversible Pulpitis, Sub- group 1B: Non-Diabetic, Reversible Pulpitis, Sub-group 2A: Diabetic, Symptomatic Irreversible Pulpitis, Sub- group 2B: Diabetic, Reversible Pulpitis. Blood sample was collected from pulp chamber after partial pulpo- tomy was done. The total levels of MMP-9 and TNF-α were assessed by enzyme linked immunosorbent assays (ELISA). Inter-group comparison in levels of MMP-9 and TNF- α were conducted using the Kruskal Wallis test and pairwise comparison was done Mann-Whitney U test.
RESULTS
The inter-group comparison in levels of MMP-9 and TNF- α were conducted using the Kruskal Wallis test and pairwise comparison was done using Mann-Whitney U test. Pearson correlations were conducted in order to investigate correlations between the paired TNF-α and MMP-9 values and also their correlation with the blood sugar levels within the pulp diagnosis groups. MMP-9 and TNF-α levels were significantly higher (p<0.005) in irreversible pulpits than reversible pulpits and also in Type-2 diabetics than non-diabetics. High- est level of MMP-9 and TNF-α was found in Group 2A (Diabetic, symptomaticirreversible pulpitis) and lowest in Group 1B (Non-Diabetic, reversible pulpitis). There exists a very high significant positive correlation between MMP-9 and TNF-α (p<0.005).
CONCLUSION
These findings show that the inflammatory mediators MMP-9 and TNF-α are significantly in- creased in pulpal blood samples of diabetic patients. Also, in diabetic patients diagnosed with reversible pul- pitis, higher levels of inflammatory pulpal biomarkers were reported that could compromise the success of Vital Pulp Therapy (VPT) and may necessitate endodontic intervention. MMP-9 and TNF- α were reported to have a positive correlation. (EEJ-2023-01-04).
Topics: Humans; Biomarkers; Cross-Sectional Studies; Diabetes Mellitus; Glycated Hemoglobin; Inflammation; Matrix Metalloproteinase 9; Pulpitis; Tumor Necrosis Factor-alpha
PubMed: 38219033
DOI: 10.14744/eej.2023.41736 -
European Endodontic Journal Aug 2023The primary objective of this randomised clinical trial was to evaluate the efficacy of Calcium Enriched Mixture (CEM) cement compared to Mineral Trioxide Aggregate... (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy of Calcium Enriched Mixture Cement, Mineral Trioxide Aggregate and Calcium Hydroxide Used as Direct Pulp Capping Agents in Deep Carious Lesions - A Randomised Clinical Trial.
OBJECTIVE
The primary objective of this randomised clinical trial was to evaluate the efficacy of Calcium Enriched Mixture (CEM) cement compared to Mineral Trioxide Aggregate (MTA) and Calcium Hydroxide (CH) in maintaining pulp vitality when used for direct pulp capping (DPC) of deep carious lesions with reversible pulpitis and secondary objective was to assess the overall success of DPC in carious exposures.
METHODS
One hundred and fifty patients diagnosed with reversible pulpitis with deep carious lesions were included in this study. Patients were randomly allocated into three groups (n=50), Group C: CEM group, Group M: MTA group, and Group D: CH (Dycal) group. After caries removal by mechanical excavation except for one carious spot, the removal of which resulted in the exposure of the pulp, the final carious spot was removed with a sterile no.2 round carbide bur. After haemostasis, the pulpal wound was dressed by a capping agent, followed immediately by permanent restoration. Patients were assessed for successful outcomes based on positive vitality tests, absence of clinical signs and symptoms, and PAI scores after 1, 3, 6, 12, and 18-month follow-up periods. The ANOVA test was employed to analyse quantitative variables, and the Pearson Chi-square test was used for qualitative variables. A Bonferroni Test was employed as the post hoc test for intergroup comparison. The significance level was set at p≤0.05 within all tests.
RESULTS
The percentage of success in Group C was 86.7%, Group M was 77.3%, and Group D was 57.9%. This study's overall success rate after direct pulp capping of deep carious lesions was 74.8%. A statistically significant difference in PAI score was found between Groups C and D. Pain on percussion and response to vitality tests also showed significant differences among the three groups at the one-month follow-up.
CONCLUSION
CEM cement had comparable efficacy to MTA and was superior to CH in maintaining pulpal vitality following DPC in teeth with reversible pulpitis. An overall success rate of 74.8% indicated that DPC in deep carious lesions with reversible pulpitis could yield favourable clinical outcomes. (EEJ-2022-11-134).
Topics: Humans; Calcium Hydroxide; Pulp Capping and Pulpectomy Agents; Calcium; Pulpitis; Dental Pulp Capping; Dental Caries; Aluminum Compounds; Drug Combinations; Phosphorus Compounds; Calcium Compounds; Oxides; Silicates
PubMed: 38219032
DOI: 10.14744/eej.2023.83007 -
European Endodontic Journal Mar 2024Tramadol hydrochloride has shown local anesthetic properties similar to lidocaine, apart from a central analgesic effect. The present study evaluated the effect of the... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Tramadol hydrochloride has shown local anesthetic properties similar to lidocaine, apart from a central analgesic effect. The present study evaluated the effect of the administration of tramadol alone or in addition to 2% lidocaine, as supplementary intraligamentary injections.
METHODS
One hundred and five patients, with a failed primary inferior alveolar nerve block (IANB), were randomly allocated to one of the three supplementary intraligamentary groups: 2% lidocaine with 1: 80,000 epinephrine; tramadol hydrochloride (50 mg/mL); and 2% lidocaine with 1: 80,000 epinephrine plus tramadol hydrochloride. Patients received 1.2 mL doses (0.6 mL of each root). Patients reporting pain ≤54 on Heft Parker visual analogue scale (Heft-Parker VAS), were categorized as successful anesthesia. A finger pulse oximeter was used to measure the heart rates. The anesthetic success rates, gender, and type of tooth were compared using the Pearson chi-square test. The heart rates and age were statistically evaluated using the one-way analysis of variance test. The level of significance was set at 0.05 (p=0.05).
RESULTS
The initial IANB was successful in 31% of cases. There were significant differences in the anesthetic success rates of different supplementary intraligamentary injections (χ2= 33.6, p<0.001, df=2). The 2% lidocaine-plus-tramadol resulted in significantly higher success rates than the two groups. There were no significant changes in the baseline heart rates of all groups (p>0.05).
CONCLUSION
The addition of tramadol to 2% lidocaine with 1: 80,000 epinephrine, given as supplementary intraligamentary injection, can help in achieving successful anesthesia during the endodontic management of mandibular molars with irreversible pulpitis resistant to IANB injections.
Topics: Humans; Anesthetics, Local; Epinephrine; Lidocaine; Molar; Nerve Block; Pulpitis; Tramadol; Male; Female
PubMed: 38219030
DOI: 10.14744/eej.2023.48343 -
Journal of Materials Science. Materials... Jan 2024This study aims to experimentally compare the efficacy of different endodontic materials (iRoot BP Plus, Biodentine, MTA, Rootdent, and Trioxide) in the treatment of...
This study aims to experimentally compare the efficacy of different endodontic materials (iRoot BP Plus, Biodentine, MTA, Rootdent, and Trioxide) in the treatment of pulpitis and perforations on extracted tooth specimens. Additionally, the study aims to investigate the influence of iRoot BP Plus endodontic material on the regenerative processes following pulp amputation in laboratory animals. The secondary goal is to evaluate the effect of iRoot BP Plus on the restoration process in laboratory animals after pulp removal. The study presents a micropermeability analysis of the selected biomaterials performed on a sample of 50 single-rooted apical teeth in 2022. All teeth underwent endodontic treatment. Changes in molar morphology were investigated with eight laboratory animals (rabbits, 3 months old, all males) after simulated pulp removal and subsequent treatment with the iRoot BP Plus biomaterials. iRoot BP Plus appeared to be more effective in retrograde apical root filling than other biomaterials, as evidenced by its higher sealing effect. An experiment involving animal participants revealed the presence of protective adaptive mechanisms, which manifested in the form of an inflammatory process within 6 weeks after the dental pulp was removed. The connective tissue replaced the necrosis, and new capillaries began to form intensively. These dental outcomes suggest that iRoot BP Plus enables hermetical sealing in tooth restoration with good adhesion. Thus, it may have the ability to promote more active tissue regeneration after pulp removal.
Topics: Animals; Male; Humans; Rabbits; Infant; Amputation, Surgical; Biocompatible Materials; Molar; Necrosis; Silicates
PubMed: 38206373
DOI: 10.1007/s10856-023-06770-y -
Archives of Oral Biology Mar 2024Hypoxia-inducible factor-1α (HIF-1α) and its downstream factor, 19 kDa BCL-2 interacting protein 3 (BNIP3), promote cellular autophagy under hypoxic conditions....
OBJECTIVE
Hypoxia-inducible factor-1α (HIF-1α) and its downstream factor, 19 kDa BCL-2 interacting protein 3 (BNIP3), promote cellular autophagy under hypoxic conditions. However, their roles in pulpitis are unclear. Therefore, the changes in inflammatory response and autophagy levels caused by hypoxia during pulpitis were evaluated. Additionally, the regulatory mechanism of HIF-1α/BNIP3 in cellular autophagy in pulpitis was explored.
DESIGN
Pulp from dental pulp tissues of healthy individuals and patients with pulpitis (n = 10) were exposed and combined with a low oxygen simulation chamber to construct pulpitis (n = 6), hypoxia (n = 6), and hypoxia+pulpitis (n = 6) rat models. Hematoxylin and eosin and immunohistochemical staining were used to detect the localization and expression levels of HIF-1α, BNIP3, and autophagy marker protein, LC3B. Transmission electron microscopy was used to confirm autophagosome formation. An in vitro hypoxic model of human dental pulp cells was established, and HIF-1α chemical inhibitor 3-(5'-hydroxymethyl-2'-furyl)- 1-benzylindazole (YC-1) was administered. Immunofluorescence and western blotting were used to detect the localization and protein levels of HIF-1α, BNIP3, and LC3B.
RESULTS
Autophagy is significantly increased and HIF-1α and BNIP3 are elevated in inflamed dental pulp tissue. Both pulp exposure and hypoxia intervention cause inflammatory reactions in rat dental pulp tissue, accompanied by the autophagy activation. Hypoxia significantly enhances HIF-1α/BNIP3 and autophagy activation. BNIP3 downregulates and autophagy reduces after treatment with YC-1.
CONCLUSIONS
In pulpitis, activation of the HIF-1α/BNIP3 signaling pathway driven by hypoxia leads to increased autophagy. This provides a new molecular explanation for autophagy activation in apical periodontitis and new insights into the pathogenesis of the disease.
Topics: Animals; Humans; Rats; Autophagy; Cell Hypoxia; Hypoxia; Hypoxia-Inducible Factor 1, alpha Subunit; Membrane Proteins; Mitochondrial Proteins; Proto-Oncogene Proteins; Pulpitis
PubMed: 38199116
DOI: 10.1016/j.archoralbio.2024.105881 -
Journal of Clinical and Experimental... Dec 2023To compare the incidence of postoperative pain and analgesic intake on the administration of passive ultrasonic irrigation (PUI) using IrriSafeTM, laser-activated...
Comparison of postoperative pain reduction following laser, ultrasonic activation and conventional needle irrigation after root canal treatment - A randomized clinical trial.
BACKGROUND
To compare the incidence of postoperative pain and analgesic intake on the administration of passive ultrasonic irrigation (PUI) using IrriSafeTM, laser-activated irrigation (LAI) using Er:Cr: YSGG in comparison to conventional needle irrigation (CNI) in participants diagnosed with symptomatic irreversible pulpitis (SIP).
MATERIAL AND METHODS
In this randomised double-blinded parallel trial, 75 participants requiring root canal treatment in mandibular first molars diagnosed with SIP were enrolled. A 10 cm visual analogue scale (VAS) was used for pain assessment and patients presented with a preoperative pain score of 5 cm and above were only selected. After biomechanical preparation, the final irrigation protocols varied based on the irrigation protocol employed. In CNI, intracanal irrigation was conducted without agitation using a 31G side vented needle. In PUI, irrigant activation was conducted using IrriSafeTM and in LAI, irrigant activation was conducted using a pulsed Er:Cr: YSGG (2940 nm) laser with radial firing tip (RFT - 2). The pain scores and analgesic intake were assessed postoperatively after obturation at 6, 24 and 48 h.
RESULTS
A significant reduction in postoperative pain levels and analgesic intake was seen among all groups at assessed time intervals (<0.05). Overall, mean postoperative pain scores and analgesic intake were CNI>LAI>PUI (<0.05) respectively.
CONCLUSIONS
Participants diagnosed with SIP receiving PUI and LAI showed low and comparable levels of postoperative pain scores. Based on the analgesic intake, PUI showed the least analgesic intake when compared to LAI and CNI respectively. Endodontics, Root canal irrigants, Postoperative Pain, Passive ultrasonic activation, Laser ultrasonic activation.
PubMed: 38186915
DOI: 10.4317/jced.59898 -
Clinical Case Reports Jan 2024This case report focuses on the diagnosis and treatment of a maxillary lateral incisor affected by a talon cusp, a rare developmental dental anomaly. The case presented...
This case report focuses on the diagnosis and treatment of a maxillary lateral incisor affected by a talon cusp, a rare developmental dental anomaly. The case presented with irreversible pulpitis and an immature apex. The article discusses the prevalence, etiology, classification, and treatment options for talon cusps, highlighting their clinical significance and potential complications. Clinical and radiographic findings obtained from a periapical radiograph and a cone-beam computed tomography (CBCT) scan are outlined. The treatment approach involved the removal of the talon cusp, endodontic therapy including apexification with mineral trioxide aggregate, and aesthetic restoration of the tooth. The report underscores the value of precise diagnosis, careful treatment planning, and the utility of CBCT scans in effectively managing talon cusps.
PubMed: 38179468
DOI: 10.1002/ccr3.8404 -
SAGE Open Medicine 2024The present research evaluated and compared effectiveness between nitrofurantoin and double antibiotic paste in alleviating post-operative pain in patients suffering...
The effectiveness of single antibiotic paste nitrofurantoin V/S double antibiotic paste in alleviation of post-operative pain of patients suffering from symptomatic irreversible pulpitis-A randomized controlled trial.
OBJECTIVE
The present research evaluated and compared effectiveness between nitrofurantoin and double antibiotic paste in alleviating post-operative pain in patients suffering from symptomatic irreversible pulpitis.
METHODS
There were 60 subjects enrolled who were allotted among three groups: Group 1 - Nitrofurantoin, Group 2 - double antibiotic paste, and Group 3 - Control. Succeeding access opening and chemo mechanical preparation, intracanal medicament was placed in the root canals. Using a numerical pain scale, pain scores were measured at the following time intervals: preoperative, 12, 24, 48, and 72 h. One-way ANOVA and post hoc statistical analysis were conducted, with a -value of ⩽ considered as statistically significant.
RESULTS
Preoperatively, most patients experienced moderate to severe pain. The patients in groups 1 and 2 reported considerable reduction in their pain scores ( ⩽ 0.001) on each time interval. However, patients in group 3 experienced a higher level of pain even at 72 h. No considerable distinction was found among participant's pain scores of groups 1 and 2 ( = 0.193).
CONCLUSION
For effective pain-relieving, both nitrofurantoin and double antibiotic paste can be successfully used in patients suffering from symptomatic irreversible pulpitis. However, when calcium hydroxide was used, patients experience high levels of pain.
PubMed: 38162909
DOI: 10.1177/20503121231220794 -
European Endodontic Journal Jan 2024To evaluate the effect of diode laser (GaAlAs-980 nm) for full coronal pulpotomy (FCP) compared to conventional crown pulpotomy (CCP) in mature teeth with symptomatic... (Randomized Controlled Trial)
Randomized Controlled Trial
The Outcome of GaAlAs Diode Laser (980 Nm) Pulpotomy in Patients with Symptomatic Irreversible Pulpitis Assessed Using CBCT - Randomised Controlled Trial with an 18-Month Follow-up.
OBJECTIVE
To evaluate the effect of diode laser (GaAlAs-980 nm) for full coronal pulpotomy (FCP) compared to conventional crown pulpotomy (CCP) in mature teeth with symptomatic irreversible pulpitis (SIP) and assess dentine bridge formation after FCP using CBCT.
METHODS
A total of 86 patients (43 per group) with SIP in permanent mandibular molars were included. Access opening and FCP were done, after which haemostasis was achieved with 2.5% NaOCl in the CCP group and a diode laser (GaAlAs-980 nm) in the laser crown pulpotomy group (LCP). Biodentine (Septodont, Saint-Maur-des-Fossés, France) was placed, and the cavity was sealed. Clinical and radiographic follow-ups were done at 6, 12, and 18 months, with additional CBCT evaluation at 18 months. Statistical analysis was performed using the Mann-Whitney U test, and survival rates were assessed using Kaplan-Meier analysis. The Cox proportional model was used to determine the effect of possible covariates on pulpotomy outcomes. P<0.05 was considered to be statistically significant.
RESULTS
The overall success rate for CCP and LCP at 18 months was 88.4% and 93% respectively. At the end of 18 months, 8 cases (5 in CCP, 3 in LCP) failed. The postoperative pain score at 48 hours was significantly higher for CCP (mean +- standard deviation: 1.7+-1.4; p<0.001). CBCT analysis at 18 months revealed thicker dentine bridge formation for LCP (Median & IQR: 0.89, 1.06) compared to CCP (p=0.0479). The Kaplan-Meier curve showed a more rapid decline in the survival rate of CCP (0.89) compared to that of LCP (0.93). Postoperative pain at 48 hours, PAI scores at 6, 12, 18 months, and age were found to affect the hazard ratio based on the Cox regression model.
CONCLUSION
Within the limitations of this trial, there was no significant difference in the outcome between diode laser and conventional pulpotomy. However, LCP resulted in lesser postoperative pain at 48 hours and thicker dentine bridge formation at 18 months, with a longer estimated survival rate. (EEJ-2023-01-011).
Topics: Humans; Pulpotomy; Pulpitis; Follow-Up Studies; Lasers, Semiconductor; Spiral Cone-Beam Computed Tomography; Pain, Postoperative
PubMed: 38157279
DOI: 10.14744/eej.2023.72687