Comparative Assessment of Pain during Infiltration by a Two-stage Infiltration Technique: A Double-blind Clinical Trial.

AIM: The aim of this study was to assess and compare the pain during infiltration by a modified two-stage local anesthetic infiltration technique under topical anesthesia (TA). MATERIALS AND METHODS: In this cross-over double-blind study, 30 volunteers participated, where two groups were given single-stage infiltration and the other two had two-stage infiltrations. Depending upon the infiltration technique (one- or two-stage) and the use of TA, the patients were randomly divided into four groups. Local anesthesia (LA) was administered by infiltration into the mucobuccal fold of the maxillary central incisor, and the pain perceived during the infiltration in each group was recorded. The volunteers were recalled after 24 hours to assess the tenderness at the injection site. The volunteers were recalled 2 weeks after infiltration for the subsequent groups to assess the pain for this cross-over study. RESULTS: A statistically significant difference was observed in the pain perceived when TA was used and when the infiltration was done in two stages. Regarding the pain at the site of injection after 24 hours, no significant difference was observed among the volunteers. CONCLUSION: Topical anesthesia was effective in reducing the pain of injection when compared to placebo. The pain of injection is further reduced with a two-stage infiltration technique after TA application. CLINICAL SIGNIFICANCE: Topical anesthesia can be used routinely before infiltration, and LA infiltration injections are less painful if administered in two stages.

Effect of Preoperative Pain on Inferior Alveolar Nerve Block.

The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1-54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55-114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis.

Evaluation of the effect of collagen stabilizing agents like chitosan and proanthocyanidin on the shear bond strength to dentin and microleakage of resin composite at enamel and cemental walls: An in vitro study.

OBJECTIVES: The objective is to evaluate the effect of collagen stabilizing agents-chitosan and proanthocyanidin (PA) on the shear bond strength to dentin and microleakage of resin composite at enamel and cemental walls. MATERIALS AND METHODS: Thirty premolars were decoronated 2 mm above cemento-enamel junction and restored with composite resin. Teeth were then randomly divided into three groups: Group I - Control, Group II - Pre-treatment with chitosan, and Group III - Pre-treatment with PA. Samples were then subjected to thermocycling for 500 cycles at 5°C and 55°C with the dwell time of 30 s and transfer time of 5-10 s. Then, the samples were subjected to shear bond strength evaluation on Universal testing machine. Shear load was applied until failure occurred. The load to failure was recorded individually and statistical analysis was done. Microleakage was determined by methylene blue dye penetration method and subjected to stereomicroscopic evaluation. Statistical analysis was carried out using Mann-Whitney test and Chi-square test. RESULTS: Group II specimens produced the highest median shear bond strength and group I showed the least. In addition, Group I, Group II, and Group III showed no statistically significant difference in microleakage. CONCLUSIONS: Application of Chitosan and PA improved the shear bond strength to dentin as compared to the control. However, no significant difference in shear bond strength and microleakage was found between them.

Evaluation of surface roughness of three different composite resins with three different polishing systems.

AIM: The aim of this study was to evaluate the surface roughness of three composites with three different polishing systems. MATERIALS AND METHODS: Composite specimens were made from the Teflon mold with a standardized cavity size (6 mm diameter and 3 mm height). Group I - Filtek Z350XT (Nano clusters), group II - T-Econom plus (Microhybrid), group III - G-aenial Flo (True Nano). The samples were cured for 30 s from both sides with the matrices in place. The 60 samples were divided into 3 groups (N = 20), which accounted for 40 surfaces, (n = 20 × 2 = 40) in each groups. Each group were subdivided into four subgroups based on the type polishing material, subgroup A - Control, subgroup B - Astrobrush, subgroup C - Astropol, and subgroup D - Soflex spiral wheel. The samples of all groups except group A (control) were finished and polished according to the manufacture's instruction. RESULTS: After polishing, the roughness (Ra) of the resin composite of all the specimens were measured using a profilometer. Soflex spiral wheel (group D) significantly had the least roughness (Ra) value as compared to the other groups. CONCLUSION: Among the three resin composites tested, G-aenial Flo exhibited least Ra value due to its reduced filler size and its uniform distribution.

Clinico-morphological profile and receptor status in breast cancer patients in a South Indian institution.

BACKGROUND: Breast cancer is the most common malignancy in women worldwide and the second most common cancer in females in India. Receptor status may be important for survival. OBJECTIVE: To analyse and correlate the clinical and morphological parameters with receptor status in breast carcinoma patients in a tertiary care institution in Southern India. MATERIALS AND METHODS: This retrospective study involved 320 patients of breast cancer diagnosed in an oncology hospital over a period of 31/2 years. Data was analysed using SPSS Version 21. RESULTS: Some 60.6% patients with breast carcinomas belonged to the age group of 40 to 60 years. The most common histological type was infiltrating ductal carcinoma, not otherwise specified, accounting for 84.4% of patients. On immunohistochemistry, estrogen receptor (ER) and progesterone receptor (PR) were expressed in 56.3% and 53.1% of cases, respectively. CONCLUSIONS: Breast cancers in India, a developing country, occur in younger women and tend to be more aggressive with lower rates of ER and PR expression and higher histological tumor grades. Both ER and PR status of the tumors had significant associations with the patient age, pathological TNM stage and histological tumor grade.

Management of mandibular first molar with four canals in mesial root.

Successful root canal treatment depends on adequate cleaning, shaping, and filling of the root canal system. The presence of middle mesial (MM) root canal of mandibular molars has been reported by various authors. But incidence of four canals in mesial root of mandibular molar is very rare. The aim of this case report is to present and describe the identification and management of a mandibular first molar with four canals in the mesial root and single canal in the distal root.

Management of an endodontic infection with an extra oral sinus tract in a single visit: a case report.

Chronic apical periodontitis can drain through a sinus tract, which may be intra-oral or extra-oral, though an intra-oral drainage is more common. Though such cases can be treated in a single visit, there is no report on a single visit endodontic treatment for a chronic apical periodontitis with a draining sinus. This case report demonstrates that the apical periodontitis with a cutaneous sinus tract can be successfully treated endodontically as a single visit procedure, if the patient is in good systemic health.