Inferior alveolar nerve block success of 2% mepivacaine versus 4% articaine in patients with symptomatic irreversible pulpitis in mandibular molars: A randomized double-blind single-centre clinical trial.

AIM: The aim of this study was to assess inferior alveolar nerve block (IANB) success of 2% mepivacaine (Scandonest 2%, Septodont, France) and 4% articaine (Septanest 4%, Septodont) in patients with symptomatic irreversible pulpitis (SIP) in mandibular molars during access cavity preparation and instrumentation. METHODOLOGY: Three hundred and thirty patients with moderate-to-severe pain in mandibular molars with SIP randomly received either 3.6 ml 2% mepivacaine hydrochloride with 1:100 000 adrenalin or 3.4 ml 4% articaine hydrochloride with 1:100 000 adrenalin (n = 165). Intraoperative pain (IOP) intensity was assessed during access cavity preparation and canal instrumentation using 11-point Numerical Rating Scale (NRS). Overall success was considered if the patient felt no-to-mild pain without the need for supplemental anaesthesia throughout treatment; the incidence of need for supplemental anaesthesia was also recorded. Data were statistically analysed using Mann-Whitney U- and Chi-squared (χ2 ) tests. Relative risk (RR) and 95% confidence interval (CI) of anaesthetic failure were calculated. The effect of pre-disposing factors on outcome variables was assessed using multivariable regression analyses. None of the participants reported any adverse effects. RESULTS: Baseline variables were balanced between groups (p > .05). The IOP intensity during access cavity preparation and canal instrumentation was similar for both groups (p > .05). IOP intensity was associated with preoperative pain intensity and tooth type (p < .05). Overall anaesthetic success rate was 35.8% for mepivacaine and 41.2% for articaine (p > .05) with a relative risk of failure [95% CI] 1.09 [0.92, 1.30]. The need for supplemental anaesthesia occurred 43.6% and 38.2% with mepivacaine and articaine respectively (p > .05; RR [95% CI]: 1.14 [0.88, 1.48]). Preoperative pain level and age were associated with the need for supplemental anaesthesia. CONCLUSIONS: 2% mepivacaine and 4% articaine demonstrate similar IANB success rates for mandibular molars with SIP. Intraoperative pain experience during endodontic treatment can be associated with preoperative pain, tooth type and age.

Association Between Keratoconus and Thyroid Gland Dysfunction: A Cross-Sectional Case-Control Study.

PURPOSE: To examine the clinical association between thyroid gland dysfunction and keratoconus. METHODS: This was a cross-sectional case-control study conducted between May 2018 and July 2019. After performing Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) examination, flat, steep, and maximum simulated keratometric readings were recorded for each patient. Serum concentrations of free triiodothyronine, free thyroxine, and thyroid-stimulating hormone were measured. Further examinations by an endocrinologist were indicated for patients with positive laboratory results to confirm thyroid gland dysfunction. RESULTS: One hundred eighty-seven patients with bilateral keratoconus and 187 sex- and age-matched healthy controls without keratoconus were analyzed. Mean age was 26.4 ± 8.2 years for the patients with keratoconus and 27.1 ± 9.4 years for the control patients, with no significant difference. The results showed that thyroid gland dysfunction prevalence was 10 of 187 patients with keratoconus (5.3%) and 2 of 187 control patients (1.1%), and the difference was statistically significant (P = .036). For the patients with keratoconus and thyroid gland dysfunction, 8 were women and 2 were men. Additionally, 6 patients (2 men and 4 women) had hyperthyrosis and 4 women had hypothyrosis. For controls, the two patients had hypothyrosis. CONCLUSIONS: This study showed that there is a possible association between keratoconus and thyroid gland dysfunction, but more studies are needed to build upon these results. [J Refract Surg. 2020;36(4):253-257.].

Analysis of the Outcomes of Combined Cross-Linking with Intracorneal Ring Segment Implantation for the Treatment of Pediatric Keratoconus.

PURPOSE: To analyze the visual and refractive outcomes of combined accelerated cross-linking with femtosecond laser intracorneal ring segment implantation for the treatment of pediatric keratoconus. MATERIALS AND METHODS: This retrospective multicenter noncomparative clinical study included 63 eyes of 37 patients (age, 9-17 years) who underwent between August and September 2016 combined cross-linking with intracorneal ring segment implantation for keratoconus. Preoperative and postoperative (6, 12, and 18 months) uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), subjective refractions, keratometry (K), and pachymetry measurements were compared. RESULTS: The postoperative spherical equivalent refraction was within ±1 D, ±2 D, and ±3 D in 19 (30.2%), 27 (42.9%), and 37 (58.8%) eyes, respectively. Only 27 eyes achieved the attempted preoperative spherical equivalent refraction. The mean spherical equivalent refraction significantly improved from -6.01 ± 2.97 to -3.13 ± 2.78 D postoperatively (P < 0.0001). The mean K average reading significantly decreased from 48.75 ± 4.25 to 46.65 ± 3.89 D postoperatively (P < 0.0001). The mean postoperative myopic, astigmatic, and spherical equivalent corrections were -2.17 ± 2.19, -1.52 ± 2.03, and -2.93 ± 2.35 D, respectively. The mean UDVA and CDVA showed significant improvements (0.89 ± 0.33 to 0.40 ± 0.28, P < 0.0001; 0.35 ± 0.31 to 0.25 ± 0.24, P = 0.004; respectively) at 18 months postoperatively. Keratoconus progression, segment migration, and segment extrusion were seen in four (6.4%), one (1.6%), and three (4.7%) eyes, respectively, probably contributing to the lower mean postoperative CDVA. CONCLUSION: Cross-linking plus is only partially effective for pediatric keratoconus. Despite some improvements in vision and keratometry measures, it resulted in complications such as keratoconus progression, segment extrusion, and segment migration that affected the vision in some patients. These findings suggest an assessment of standard epithelium-off collagen cross-linking as a sole procedure to treat pediatric keratoconus in future studies.

Standard cross-linking versus photorefractive keratectomy combined with accelerated cross-linking for keratoconus management: a comparative study.

PURPOSE: To compare the safety and efficacy of standard 30 min epithelium-off cross-linking (CXL) versus photorefractive keratectomy (PRK) combined with accelerated epithelium-off cross-linking (AXL) for the treatment of progressive keratoconus (CXL-Plus). METHODS: This study was a prospective multicentre comparative clinical study. A total of 125 eyes of 75 patients with grade 1 keratoconus and documented progression were divided into two groups. Group A included 58 eyes treated with standard CXL. Group B included 67 eyes treated with combined PRK and AXL. The recorded data included UDVA, CDVA, subjective and objective refraction, keratometry and pachymetry using corneal topographies preoperatively and postoperatively at 3, 6, 12 and 24 months of follow-up. RESULTS: In group A, at 24 months of UDVA and CDVA were improved from 1.12 ± 0.38 and 0.58 ± 0.42 to 0.66 ± 0.20 and 0.20 ± 0.12 (LogMAR±SD). The spherical equivalent was reduced from 4.03 ± 1.18 to 1.78 ± 1.04 D. The cylinder reduction was 0.32 ± 0.19 D. In group B, at 24 months of UDVA and CDVA were improved from 1.26 ± 0.52 and 0.68 ± 0.36 to 0.58 ± 0.28 and 0.20 ± 0.16 (LogMAR ± SD). The spherical equivalent was reduced from 4.23 ± 0.95 to 1.92 ± 0.74 D. The cylinder reduction was ±1.76 D. CONCLUSION: Surprisingly, standard CXL showed close results to CXL-Plus at the 24th follow-up month. Standard CXL acted as a stabilizing procedure associated with a late myopic component reduction. CXL-Plus acted as a refractive and stabilizing procedure with an early effect on both the myopic and the astigmatic component but no later improvements. Standard CXL seems to be more powerful than AXL in its long-term effect. Therefore, in the future, we want to test the combination of PRK with standard CXL.