Comparison of clinical efficacy of ropivacaine and lignocaine with adrenaline for implant surgery anesthesia: a split-mouth randomized controlled clinical trial.

BACKGROUND: The primary indication for using long-acting anesthetics in dentistry is extensive dental procedures that require pulpal anesthesia beyond 90 min and management of postoperative pain. Ropivacaine is an amide local anesthetic that is available at various concentrations with inherent vasoconstrictive properties at low concentrations. Ropivacaine has a 75% greater margin of safety than bupivacaine. Ropivacaine can be a good alternative to bupivacaine as a local anesthetic in dental implant surgery as it provides a longer duration of both pulpal and soft tissue anesthesia after mandibular nerve block and lowers CNS and cardiovascular toxicity. This study aimed to evaluate and compare the clinical efficacy of ropivacaine and lignocaine for implant surgery anesthesia. METHODS: Fifteen patients with bilateral edentulous sites indicated for implant placement were recruited for this study. Patients aged 20-60 years of both sexes were randomly recruited. Thirty implant placements were performed in the test and control groups using ropivacaine and lignocaine with adrenaline as local anesthetics, respectively. RESULTS: The results were analyzed statistically. The duration of anesthesia was significantly higher in the test group than in the control group. Ropivacaine was found to be superior to lignocaine in terms of the quality of anesthesia. The comparison of mean visual analog scale scores showed ropivacaine to have better anesthetic and analgesic effects than the control group. CONCLUSION: Ropivacaine 0.75% provides a significantly longer duration of anesthesia than lignocaine 2% with adrenaline. Ropivacaine 0.75% decreased intraoperative and postoperative analgesia compared to lignocaine 2% with adrenaline. Hence, ropivacaine 0.75% can be used as an alternative to lignocaine in implant surgeries and other intraoral surgical procedures that require a longer duration of anesthesia and analgesia.

An In-vitro Comparison of Nano Hydroxyapatite, Novamin and Proargin Desensitizing Toothpastes - A SEM Study.

INTRODUCTION: Dentinal Hypersensitivity (DH) is commonly encountered clinical condition in dental practice which affects 8-57% of the adult population presenting for dental treatment, but the treatment of the same remains doubtful. AIM: The purpose of this study was to evaluate and compare the effects of three different desensitizing agents (15% nano hydroxyapatite crystals; 5% novamin and 8% proargin) on dentinal permeability and tubule occlusion in-vitro. Scanning Electron Microscope (SEM) was used to evaluate the effect of these commercially available desensitizing toothpastes. MATERIALS AND METHODS: A total of 40 disc shaped dentin specimens were dissected from extracted premolars. Dentin discs of 1mm were obtained with the help of diamond discs. Ten specimens were randomly selected and allocated to the evaluation groups A (control group), B (Nano-hydroxyapatite), C (Novamin) and D (Proargin). Each treatment group dentine disc specimen was treated with the respective slurry for two minutes for a period of seven days. Each disc was subjected to a pre- and post-treatment SEM analysis to evaluate the changes occurring in the dentinal tubules. RESULTS: The qualitative analysis showed no occlusion of the dentinal tubules in Group A (control group) and Group B (nano-hydroxyapatite) showed 98.1% tubule occlusion. Group C (Novamin) and D (Proargin) showed 83.1% and 69.1% tubule occlusion respectively. Quantitative analysis showed a statistical significant difference between Group B and D (p< 0.005) and no statistical significant difference between group B and C (p= 0.235). Similarly, there was no significant difference between Group C and D as (p=0.235). CONCLUSION: It was concluded that all the three desensiting agents were effective in the dentine tubule occlusion. In addition efficacy of nano-hydroxyapatite toothpaste was greater compared to the other desensiting agents.

Comparative Evaluation of Bioactive Glass (Putty) and Platelet Rich Fibrin in Treating Furcation Defects.

The aim of this study was to compare a second-generation bioactive glass putty biomaterial against platelet rich fibrin in treating grade II furcation defects. Subjects were 15 systemically healthy patients (10 males and 5 females, ages 20-50 with a mean age of 38.33) with 20 mandibular molar class II furcation defects according to Glickman's classification. The 20 mandibular molar furcation defects were randomly allocated as follows: Group I, 10 furcation defects were treated using bioactive glass (NovaBone) bone graft putty material; Group II, 10 furcation defects were treated using platelet rich fibrin (PRF). Customized acrylic stents were fabricated on study casts and trimmed to the height contour of the teeth to serve as a fixed reference point for measurements. The following measurements were collected: gingival index, plaque index, vertical probing depth (from gingival margin to base of the pocket), clinical attachment level (CEJ to the base of the pocket), and horizontal probing depth of furcation involvement (using stent). Results showed that both groups had improvement in gingival index (GI) and plaque index (PI) at the recall intervals. There was an overall reduction in both vertical and horizontal probing depth in both groups; however, the Putty group (Group I) showed consistently more vertical probing depth reduction than the PRF group (Group II) at the end of third month (P-value = 0.0004), sixth month (P-value = 0.00001), and ninth month (P-value = 0.0004). Our conclusion was that use of bioactive glass osteostimulative biomaterial yields superior clinical results, including increased pocket depth reduction of class II furcation defects as compared to an autologous platelet concentrate. The clinical significance of our findings include the ease of use and superior biologic performance of second-generation putty bioglass biomaterials in furcation defects.

Amnion and Chorion Allografts in Combination with Coronally Advanced Flap in the Treatment of Gingival Recession: A Clinical Study.

BACKGROUND: Guided tissue regeneration (GTR) based root coverage using different allograft membranes has been utilized to correct gingival recession defects with promising results. Amnion and chorion allograft membranes of alternative origin derived from human placental tissue has been advocated in the treatment of gingival recession. However, chorion membrane has been used in combination with amnion membrane no study has compared these allograft membranes in the treatment of gingival recession. Therefore, the purpose of this study was to clinically evaluate and compare the efficacy of amnion membrane and chorion membrane in combination with coronally advanced flap in the treatment of gingival recessions. MATERIALS AND METHODS: Twelve systemically healthy patients having at least 2 bilateral Miller's Class I or Class II gingival recession were recruited and coronally advanced flap was performed with amnion membrane or chorion membrane. Clinical parameters such as gingival Index, plaque index, length of the recession, width of the recession, width of keratinized gingiva, relative attachment level were evaluated at baseline, 3 and 6 months post-surgery. RESULTS: The mean decrease in length of recession (LR) for Chorion site was 2.00±1.54mm and amnion site was 1.58±1.14mm. The gain in attachment level for amnion site was 2.17±1.53mm and for chorion site was 1.58±1.22mm. The total mean percentage of root coverage was 34% for chorion site and 22% for amnion site. CONCLUSION: Both amnion membrane and chorion membrane has shown to be versatile allograft material to be used in the treatment of root coverage.

Enzymatic evaluation of gingival crevicular fluid in cleft palate patients during orthodontic treatment: A clinico-biochemical study.

BACKGROUND: Therapeutic goal in patients with cleft lip and palate is esthetics and long-term health of the stomatognathic system. Patients with cleft lip and palate routinely require extensive and prolonged orthodontic treatment. The osseous structures are absent or poorly developed in the osseous clefts and may be traumatized in the course of orthodontic therapy; hence require constant monitoring during orthodontic treatment. The aim of the study was to evaluate the tissue response of cleft palate patients by quantitative analysis of enzyme activity during orthodontic treatment and assess any difference in the tissue response with that of noncleft patients undergoing orthodontic treatment. MATERIALS AND METHODS: 20 patients requiring orthodontic treatment agedbetween 15 to 25 years were included to participate in the studyof which ten were cleft palate patients (group I) and ten noncleft patients (group II). The GCF samples were collected at incisor and molar sites during orthodontic treatment on days as per the study design in both the groups. The GCF enzymatic levels were estimated and compared. RESULTS: Both groups showed significant increased enzyme activity at the incisor site compared to molar site corresponding to the phases of tooth movement. CONCLUSION: There was significant difference in enzyme activity between the incisor adjacent to the cleft site and molar site. There was no difference in the tissue response between cleft palate patients and noncleft patients during orthodontic treatment.