Comparative Evaluation of Stress Distribution Against the Root Canal Wall at Three Different Levels by Using TruNatomy, XP-endo Shaper, F360, and 2Shape Files-A Finite Element Analysis.

OBJECTIVE: The aim of this in vitro study was to assess the stress distribution of novel endodontic rotary files of different cross sections and metallurgy against the root canal wall at three different levels by using finite element analysis. METHODS: A total of 60 novel NiTi rotary files were included in this study after being scanned for any surface deformities using a scanning electron microscope. The scanned files were assigned into 4 groups of 15 samples each based on their metallurgy and design: Group A-TruNatomy, Group B-XP-endo Shaper, Group C-F360, and Group D-2shape files. ANSYS® 15 Workbench finite element software (Canonsburg, Pennsylvania, United States) was used to numerically analyse the stress created by computer-aided models of these instruments on the dentinal wall of a simulated root canal to test the mechanical behaviour of these files. All data were analysed using one-way ANOVA with post hoc Tukey analysis, the Shapiro Wilk test, and Levene's test. The significance level was set at 5%. RESULTS: XP-endo Shaper files employed minimal stress on the surface of dentine during instrumentation, and F360 files exerted maximum stress on the dentinal wall. However, no statistically significant difference was found among the groups in relation to the amount of stress produced at the distinct levels of the root canal wall (p>0.05). CONCLUSION: There was no discernible difference in stress generation among the four groups in the current investigation. Therefore, it can be inferred that the upgrade in design and metallurgy of rotary files has the potential to downgrade the stress during the shaping of the canal and the menace of instrument breakage during their clinical usage.

Disrupted nuclear import of cell cycle proteins in Huntington's/PolyQ disease causes neurodevelopment defects in cellular and Drosophila model.

Huntington's disease is caused by an expansion of CAG repeats in exon 1 of the huntingtin gene encoding an extended PolyQ tract within the Huntingtin protein (mHtt). This expansion results in selective degeneration of striatal medium spiny projection neurons in the basal ganglia. The mutation causes abnormalities during neurodevelopment in human and mouse models. Here, we report that mHtt/PolyQ aggregates inhibit the cell cycle in the Drosophila brain during development. PolyQ aggregates disrupt the nuclear pore complexes of the cells preventing the translocation of cell cycle proteins such as Cyclin E, E2F and PCNA from cytoplasm to the nucleus, thus affecting cell cycle progression. PolyQ aggregates also disrupt the nuclear pore complex and nuclear import in mHtt expressing mammalian CAD neurons. PolyQ toxicity and cell cycle defects can be restored by enhancing RanGAP-mediated nuclear import, suggesting a potential therapeutic approach for this disease.

Comparative evaluation of stress distribution against the root canal wall at three different levels using novel NiTi rotary files - A finite element analysis.

Background: Recent innovations in the physical and mechanical features of endodontic file systems have diminished the prospect of stress generation and fracture risk in novel endodontic files. Aim: The purpose of this research was to comparatively evaluate the stress distribution of recently introduced endodontic rotary files with distinct features and metallurgy at three different levels of the root canal wall by finite element analysis. Materials and Methods: Forty endodontic files were used in this experiment after being inspected through a scanning electron microscope for any surface deformities. Based on their metallurgy and design, the scanned files were divided into four groups, each with 10 samples: Group A-2Shape files, Group B-F360, Group C-One Curve, and Group D-TruNatomy. To assess the mechanical behavior of these files, the stress produced by computer-aided models of these instruments on the dentinal wall of a simulated root canal was numerically analyzed using ANSYS® 15 Workbench finite element software. Results: A one-way ANOVA was used to assess all the raw data with post hoc Tukey analysis, the Shapiro-Wilk test, and Levene's test. F360 files exerted the maximum stress on the dentinal wall, while TruNatomy files exerted the least stress at all the distinct levels of dentinal walls. Conclusions: There was no statistically significant variation in the stress generated between the four groups. Therefore, it can be concluded that improvements in rotary file design and metallurgy have the potential to reduce the stress during canal shaping and the risk of instrument breakage during clinical use.

A Case of Vertigo with TORP in Inner Ear.

This is a case of a patient with history of ear surgery who visited ENT outdoor, for continuous vertigo which used to get aggravated with loud noise, associated with hearing loss, persistent sensations of right-sided aural fullness/pressure and otalgia for last 2 years. He had history of tympanoplasty with ossiculoplasty using a TORP. On exploration under local anesthesia there was a displaced prosthesis into inner ear, upon removal of which symptoms and severity subsided exponentially.

Guidodontics: A global positioning system (GPS) to surgical Endodontics - A case series.

Endodontic treatment is associated with the risk of instrument separation due to multiple factors that create complications not only in further completion of the procedure but also on the final outcome and long-term prognosis of the treatment at times. Separated instrument retrieval is definitely challenging and technique sensitive, requiring a lot of clinical expertise for a successful therapy. All these hurdles make such cases a nightmare to the clinician. This case report presents two clinical cases in which cone-beam computed tomography (CBCT)-guided surgery was used for retrieval of separated instruments extending beyond the confines of root canals in a mandibular molar and maxillary premolar. This novel approach utilizes a customized 3D printed surgical guide fabricated with the help of CBCT, which is stabilized intraorally, helping in predefining the osteotomy site, angulation and depth required for retrieval of separated instruments without performing apicoectomy or root end filling. CBCT also plays an important role in these cases as the actual size, location, and depth of the separated instrument can be appreciated preoperatively. In the present cases, 3D surgical guides helped clinicians to selectively retrieve the separated instruments more conservatively and predictably. Furthermore, complete healing was seen within 3 months in both cases.

Guided autotransplantation of tooth: An innovative approach.

This case report describes a novel approach of guided autotransplantation of tooth so that we can assess its feasibility, accuracy, and stability. In the present case, autotransplantation of a third molar at the recipient site of mandibular first molar was done. Three-dimensional (3D) replica of donor tooth along with surgical guiding template was virtually designed and fabricated using 3D printing. The 3D replica and surgical template helped in the surgical modification of recipient site and placement of donor tooth in the exact position. Root canal treatment of the donor tooth was carried out after 2 weeks. At 6 months' follow-up, the transplanted tooth was functional with no evidence of mobility or periodontal inflammation. Radiographic evaluation showed the absence of widening of periodontal space and external root resorption. Hence, the transplantation of the third molar is an outstanding procedure for replacing a lost permanent molar tooth which in turn restores esthetics and function.

Nucleoporins are degraded via upregulation of ESCRT-III/Vps4 complex in Drosophila models of C9-ALS/FTD.

Disruption of the nuclear pore complex (NPC) and nucleocytoplasmic transport (NCT) have been implicated in the pathogenesis of neurodegenerative diseases. A GGGGCC hexanucleotide repeat expansion (HRE) in an intron of the C9orf72 gene is the most common genetic cause of amyotrophic lateral sclerosis and frontotemporal dementia, but the mechanism by which the HRE disrupts NCT is incompletely understood. We find that expression of GGGGCC repeats in Drosophila neurons induces proteasome-mediated degradation of select nucleoporins of the NPC. This process requires the Vps4 ATPase and the endosomal-sorting complex required for transport complex-III (ESCRT-III), as knockdown of ESCRT-III/Vps4 genes rescues nucleoporin levels, normalizes NCT, and suppresses GGGGCC-mediated neurodegeneration. GGGGCC expression upregulates nuclear ESCRT-III/Vps4 expression, and expansion microscopy demonstrates that the nucleoporins are translocated into the cytoplasm before undergoing proteasome-mediated degradation. These findings demonstrate a mechanism for nucleoporin degradation and NPC dysfunction in neurodegenerative disease.

Multi-omic analysis of selectively vulnerable motor neuron subtypes implicates altered lipid metabolism in ALS.

Amyotrophic lateral sclerosis (ALS) is a devastating disorder in which motor neurons degenerate, the causes of which remain unclear. In particular, the basis for selective vulnerability of spinal motor neurons (sMNs) and resistance of ocular motor neurons to degeneration in ALS has yet to be elucidated. Here, we applied comparative multi-omics analysis of human induced pluripotent stem cell-derived sMNs and ocular motor neurons to identify shared metabolic perturbations in inherited and sporadic ALS sMNs, revealing dysregulation in lipid metabolism and its related genes. Targeted metabolomics studies confirmed such findings in sMNs of 17 ALS (SOD1, C9ORF72, TDP43 (TARDBP) and sporadic) human induced pluripotent stem cell lines, identifying elevated levels of arachidonic acid. Pharmacological reduction of arachidonic acid levels was sufficient to reverse ALS-related phenotypes in both human sMNs and in vivo in Drosophila and SOD1G93A mouse models. Collectively, these findings pinpoint a catalytic step of lipid metabolism as a potential therapeutic target for ALS.

TFEB/Mitf links impaired nuclear import to autophagolysosomal dysfunction in C9-ALS.

Disrupted nucleocytoplasmic transport (NCT) has been implicated in neurodegenerative disease pathogenesis; however, the mechanisms by which disrupted NCT causes neurodegeneration remain unclear. In a Drosophila screen, we identified ref(2)P/p62, a key regulator of autophagy, as a potent suppressor of neurodegeneration caused by the GGGGCC hexanucleotide repeat expansion (G4C2 HRE) in C9orf72 that causes amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). We found that p62 is increased and forms ubiquitinated aggregates due to decreased autophagic cargo degradation. Immunofluorescence and electron microscopy of Drosophila tissues demonstrate an accumulation of lysosome-like organelles that precedes neurodegeneration. These phenotypes are partially caused by cytoplasmic mislocalization of Mitf/TFEB, a key transcriptional regulator of autophagolysosomal function. Additionally, TFEB is mislocalized and downregulated in human cells expressing GGGGCC repeats and in C9-ALS patient motor cortex. Our data suggest that the C9orf72-HRE impairs Mitf/TFEB nuclear import, thereby disrupting autophagy and exacerbating proteostasis defects in C9-ALS/FTD.

Experience of Perinatal and Neonatal Chikungunya Virus (CHIKV) Infection in a Tertiary Care Neonatal Centre during Outbreak in North India in 2016: A Case Series.

BACKGROUND: In 2016, there was a massive outbreak of chikungunya in North India. During the epidemic, we observed many neonatal and early infantile cases of chikungunya, with a probable perinatal transmission. METHODS: This retrospective study was carried out in a tertiary care neonatal centre between August 2016 and November 2016. Chikungunya virus (CHIKV) infection was detected and confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and/or serology (anti-CHIKV IgM) in mothers and infants. Clinical features and laboratory parameters were recorded. RESULTS: There were 16 cases of confirmed CHIKV infections during the study period. For babies presenting during the neonatal period (n = 13), the median age of presentation was 9.5 (range: 3-15) days, whereas for babies (three) presenting after the neonatal period, the median age was between 1 and 3 months. The most common presentation was fever (69%), followed by lethargy (56%) and seizures (50%). Skin manifestations were observed in 25% of the cases, which included maculopapular rashes, bullous lesions and hyperpigmentation over the axilla, perioral and genital areas. None of the cases had any feature of arthritis. Of all the cases included in the study (n = 16), RT-PCR for CHIKV was positive in 14 (87.5%), whereas the serum anti-CHIKV IgM antibody test was positive in two (12.5%) cases. Six (37.5%) cases were documented as perinatal CHIKV, as RT-PCR for CHIKV was positive in both mothers and babies. Fifteen babies survived and were discharged in a stable condition with no oxygen requirement and on full feeds. One baby died because of multi-organ failure and catecholamine refractory hypotension. CONCLUSION: In endemic areas, paediatricians should have a low threshold of suspicion for perinatal or neonatal chikungunya in any infant presenting with signs and symptoms mimicking sepsis, especially with skin manifestations, seizure and/or encephalopathy.

Yorkie Regulates Neurodegeneration Through Canonical Pathway and Innate Immune Response.

Expansion of CAG repeats in certain genes has long been known to be associated with neurodegenerastion, but the quest to identity the underlying mechanisms is still on. Here, we analyzed the role of Yorkie, the coactivator of the Hippo pathway, and provide evidence to state that it is a robust genetic modifier of polyglutamine (PolyQ)-mediated neurodegeneration. Yorkie reduces the pathogenicity of inclusion bodies in the cell by activating cyclin E and bantam, rather than by preventing apoptosis through DIAP1. PolyQ aggregates inhibit Yorkie functioning at the protein, rather than the transcript level, and this is probably accomplished by the interaction between PolyQ and Yorkie. We show that PolyQ aggregates upregulate expression of antimicrobial peptides (AMPs) and Yorkie negatively regulates immune deficiency (IMD) and Toll pathways through relish and cactus, respectively, thus reducing AMPs and mitigating PolyQ affects. These studies strongly suggest a novel mechanism of suppression of PolyQ-mediated neurotoxicity by Yorkie through multiple channels.

Models for acne: A comprehensive study.

Acne vulgaris (AV) is the familiar chronic skin ailment affecting most of the individuals. This multifarious, disease involves the bacterium gram-positive, anaerobic Propionibacterium acnes (P. acnes) which resides on skin microflora, and participated in acne inflammation and acne lesions. The object of this review is to discuss presently available in vitro, ex vivo, and in vivo models to evaluate the cosmetic formulations that are developed for dealing and prevention of acne formation. These various available models offer new chances for further research on biologically active materials, drugs & pharmaceutical as well as cosmetics for acne treatment.

A comparative evaluation of accuracy of three electronic apex locators using histological section as gold standard: An ex vivo study.

INTRODUCTION: The aim of the present study was to comparatively evaluate the accuracy of iRoot, iPex II, and Propex pixi apex locator using histological sections as the gold standard. MATERIALS AND METHODS: Thirty patients indicated for extraction of single-rooted permanent teeth with single canal system were selected. Working lengths (WLs) of teeth were determined using iRoot, iPex II, and Propex pixi. Teeth were then extracted, and the files were reintroduced to the anatomic apex to measure anatomic canal length (ACL) and fixed at the ACL using flowable composite. The apical 4 mm of the roots were longitudinally shaved away to visualize the canal under a stereomicroscope at ×24 magnification. Digital photographs were evaluated to measure the distance between the major diameter and minor diameter. Thus, the WL, that is, the minor diameter length (MDL) was ascertained. RESULTS: Measurements of mean WLs within ±0.5 mm of minor diameter were 90% acceptable for iRoot, 86.66% for iPex II, and 80% for Propex pixi when compared with mean MDL as obtained from the histological sections. CONCLUSIONS: All apex locators have been shown to produce acceptable level of accuracy which clearly indicates their reliability in determining the WL.

Effectiveness of Various Endodontic Irrigants on the Micro-Hardness of the Root Canal Dentin: An in vitro Study.

INTRODUCTION: Irrigating solutions used for the elimination of micro-organisms during root canal preparation may affect the chemical and the physical properties of dentin thereby rendering the tooth more susceptible to fracture. Therefore careful and judicious selection of irrigant is required which have maximum benefits with minimum undesirable properties. AIM: The aim of the present study was to evaluate the effect of various endodontic irrigants on the micro-hardness of the root canal dentin. MATERIALS AND METHODS: This in vitro study was carried out on eighty freshly extracted mandibular premolars with single canals. They were decoronated at the cemento-enamel junction. Roots were sectioned longitudinally into two halves. They were then polished and placed in autopolymerised resin moulds with the polished surface facing outside. The samples were divided into four groups based on the irrigants in which they were immersed i.e., 3% Sodium Hypochlorite (3% NaOCl), 17% Ethylene Dioxide Tetra Acetic Acid (17% EDTA), 0.2% Chitosan and 6% Morindacitrifolia Juice (MCJ) for 15 minutes each. All the specimens were then subjected to micro-hardness testing using a Vickers micro-hardness tester. Statistical analysis was done using one way Analysis of Variance (ANOVA), Post-Hoc Tukey test and Paired t-test to compare the pre and post immersion micro-hardness values of the selected samples. RESULTS: The results of the present study indicated that 17% EDTA and 0.2% Chitosan, significantly decreased the micro-hardness of root dentin whereas 6% MCJ and 3% NaOCl had no significant effect on the microhardness before and after immersing in the irrigants. CONCLUSION: A 6% MCJ and 3% NaOCl which have significant antibacterial, antifungal, anti-inflammatory and smear layer removing properties showed negligible effect on the micro-hardness of root canal dentin making them suitable endodontic irrigating solution.

Comparative antimicrobial efficacy of selected root canal irrigants on commonly isolated microorganisms in endodontic infection.

OBJECTIVE: This study aims to evaluate and compare the antimicrobial efficacy of three selected root canal irrigants (BioPure MTAD, metronidazole, aztreonam) against microbes commonly isolated from polymicrobial microbiota of root canal infection. MATERIALS AND METHODS: This study was designed with four experimental groups (Group I - Bacteroides fragilis, Group II - Propionibacterium acnes, Group III - Enterococcus faecalis, Group IV - Candida albicans) based on the microbes selected for the study. Group I and Group II bacteria were used to compare and evaluate antimicrobial effect of BioPure MTAD, metronidazole, aztreonam, and normal saline. Group III and Group IV bacteria were used to compare and evaluate antimicrobial efficacy of BioPure MTAD, aztreonam, and normal saline. Normal saline was used as a control irrigant in this study. Agar disc diffusion method was applied to assess and compare the antimicrobial action of selected irrigants. RESULTS: Metronidazole was found to be the most effective root canal irrigant against B. fragilis and P. acnes among the tested irrigants. Mean zone of inhibition against E. faecalis has been shown to be maximum by BioPure MTAD, followed by aztreonam. Antifungal effect against C. albicans was only shown by BioPure MTAD. CONCLUSIONS: Overall, BioPure MTAD is the most effective root canal irrigant as it has shown an antibacterial effect against all the tested microorganisms. However, metronidazole showed maximum antibacterial effect against obligate anaerobes. Aztreonam also showed an antibacterial effect in the present study, raising its possibility to be used as a root canal irrigant in the future.

Perception of Acceptable Range of Smiles by Specialists, General Dentists and Lay Persons and Evaluation of Different Aesthetic Paradigms.

INTRODUCTION: One of the most important goals of restorative dentistry is to restore the patient's aesthetic. Smile analysis is subjective and it differs from person to person. An aesthetic smile involves a harmonious relationship between various parameters including the hard and soft tissues. AIM: The aim of the study was to identify the acceptable range of several smiles (alone and in conjunction with the face) by specialists, general dentists as well as lay persons; and to identify the values of different criteria i.e., the Golden Proportion (GP), the Recurrent Esthetic Dental proportion (RED), Width to Height ratio (W/H ratio), the Apparent Contact Dimension (ACD), and lateral incisor position in a smile. MATERIALS AND METHODS: Hundred photographs of 50 subjects were taken, 50 of the smile alone and 50 of the individual's frontal view of face. The photographs of the smiles and the faces were assessed for the aesthetic acceptability by 30 evaluators including 10 specialists with advanced training, 10 general dentists and 10 lay persons. Irreversible hydrocolloid impressions were made of the dentitions of all the individuals using stock trays and were poured in dental stone. Measurements were made on the facial surface of the teeth on the models and were recorded in millimeters using a sharp tipped digital vernier calliper. Data was analyzed to evaluate the presence of different parameters assessed in the smiles. Mean and standard deviation values for the percentage of only the agreeable smiles were calculated in both individual smile analysis and in conjunction with the face. The non agreeable smiles were excluded from further statistical analysis. Pearson Correlation Coefficient was calculated to compare the values obtained in all the three groups. RESULTS: More number of smiles were considered agreeable by the general dentists when compared to the specialists and the number even increased in case of evaluation by lay persons. Greater number of smiles was found to be agreeable when they were evaluated in conjunction with the face. CONCLUSION: Rather than assessment of individual numeric parameter that defines an ideal aesthetic smile, a smile to be aesthetic should harmonize with the composition of the face.

Evaluation of the incidence of microcracks caused by Mtwo and ProTaper Next rotary file systems versus the self-adjusting file: A scanning electron microscopic study.

INTRODUCTION: To evaluate the incidence of microcrack formation canal preparation with two rotary nickel-titanium systems Mtwo and ProTaper Next along with the self-adjusting file system. MATERIALS AND METHODS: One hundred and twenty mandibular premolar teeth were selected. Standardized access cavities were prepared and the canals were manually prepared up to size 20 after coronal preflaring. The teeth were divided into three experimental groups and one control group (n = 30). Group 1: The canals were prepared using Mtwo rotary files. Group 2: The canals were prepared with ProTaper Next files. Group 3: The canals were prepared with self-adjusting files. Group 4: The canals were unprepared and used as a control. The roots were sectioned horizontally 3, 6, and 9 mm from the apex and examined under a scanning electron microscope to check for the presence of microcracks. The Pearson's Chi-square test was applied. RESULTS: The highest incidence of microcracks were associated with the ProTaper Next group, 80% (P = 0.00), followed by the Mtwo group, 70% (P = 0.000), and the least number of microcracks was noted in the self-adjusting file group, 10% (P = 0.068). No significant difference was found between the ProTaper Next and Mtwo groups (P = 0.368) while a significant difference was observed between the ProTaper Next and self-adjusting file groups (P = 0.000) as well as the Mtwo and self-adjusting file groups (P = 0.000). CONCLUSION: All nickel-titanium rotary instrument systems were associated with microcracks. However, the self-adjusting file system had significantly fewer microcracks when compared with the Mtwo and ProTaper Next.

Unmasking the Effect of Analgesics on Endodontic Diagnosis Using a Novel Bite Force Sensor Device: A Prospective, Randomized Clinical Trial.

INTRODUCTION: A definitive diagnosis is of primary importance before initiating any endodontic treatment; yet, there are occasions when the dental professional is unable to accurately reproduce the patient's chief complaint, as it can pose a dilemma and may require consideration of multiple variables in order to reach an accurate diagnosis. So to overcome this problem, a methodical approach in providing endodontic treatment should be implemented which includes diagnosis, definitive dental treatment and adjunctive drug therapy, known as the "3D" strategy. AIM: The purpose of this study was to evaluate the possible "masking" effect of these analgesics on endodontic diagnosis using a novel bite force sensor device. MATERIALS AND METHODS: A total of 90 patients with endodontic pain were selected and they were given either a placebo or 400 mg ibuprofen (brufen) or 50mg diclofenac sodium (voveron). Both patients and operators were completely blinded to the drugs administered. Bite force tolerance values were noted before and one hour after administration of medication using the self designed bite force sensor. RESULTS: The pre- and post-bite force tolerance values were tabulated for both contralateral and affected tooth. For the affected tooth, there was statistically significant difference between pre- and post-bite force tolerance values in Group I (i.e., ibuprofen) and Group II (i.e., diclofenac sodium) (p<0.05) with no significant difference observed in Group III (placebo). CONCLUSION: The easily available over the counter self administered analgesics in addition to providing symptomatic relief to patients suffering from symptomatic apical periodontitis may also cloud the definitive diagnosis of the clinician, thus jeopardising the treatment plan. The self designed bite force sensor was effective in arriving at a definitive diagnosis in teeth with chronic irreversible pulpitis with symptomatic apical periodontitis, where the allodynia has been camouflaged by the use of analgesics like ibuprofen and diclofenac sodium.

Effect of Oral Premedication on the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Double-Blind, Randomized Controlled Clinical Trial.

INTRODUCTION: It is generally accepted that achieving complete anaesthesia with an Inferior Alveolar Nerve Block (IANB) in mandibular molars with symptomatic irreversible pulpitis is more challenging than for other teeth. Therefore, administration of Non-Steroidal Anti-Inflammatory Agents (NSAIDs) 1 hour prior to anaesthetic administration has been proposed as a means to increase the efficacy of the IANB in such patients. AIM: The purpose of this prospective, double-blind, randomized clinical trial was to determine the effect of administration of oral premedication with ketorolac (KETO) and diclofenac potassium (DP) on the efficacy of IANB in patients with irreversible pulpitis. MATERIALS AND METHODS: One hundred and fifty patients with irreversible pulpitis were evaluated preoperatively for pain using Heft Parker visual analogue scale, after which they were randomly divided into three groups. The subjects received identical tablets of ketorolac, diclofenac pottasium or cellulose powder (placebo), 1 hour prior to administration of IANB with 2% lidocaine containing 1:200 000 epinephrine. Lip numbness as well as positive and negative responses to cold test were ascertained. Additionally pain score of each patient was recorded during cavity preparation and root canal instrumentation. Success was defined as the absence of pain or mild pain based on the visual analog scale readings. The data was analysed using One-Way Anova, Post-Hoc Tukey pair wise, Paired T - Test and chi-square test. Trial Registery Number is 4722/2015 for this clinical trial study. RESULTS: There were no significant differences with respect to age (p =0.098), gender (p = 0.801) and pre-VAS score (DP-KETO p=0.645, PLAC-KETO p =0.964, PLAC-DP p = 0.801) between the three groups. All patients had subjective lip anaesthesia with the IAN blocks. Patients of all the three groups reported a significant decrease in active pain after local anaesthesia (p< 0.05). The post injection VAS Score was least in group 1 (KETO) followed by group II (DP) & maximum in group III (PLACEBO). CONCLUSION: Oral pre-medication with 10 mg KETO resulted in significantly higher percentage of successful inferior alveolar block in patients with irreversible pulpitis than pre-medication with 50 mg DP & PLAC.