Efficacy of Endo-Ice followed by intrapulpal ice application as an adjunct to inferior alveolar nerve block in patients with symptomatic irreversible pulpitis-a randomized controlled trial.

OBJECTIVE: The purpose of the present study was to evaluate the effect of Endo-Ice followed by intrapulpal ice application for reducing pain during pulp extirpation in mandibular molars with symptomatic irreversible pulpitis. MATERIALS AND METHODS: Sixty patients diagnosed with symptomatic irreversible pulpitis participated in the present study. Subjects were randomly allocated to any one of the following groups: control group-inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000), articaine group-inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000) + Buccal infiltration with articaine (4%) with adrenaline (1:100000); or cold group-inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000) + cold application. The outcome assessor measured the level of pain during access opening and pulp extirpation using the visual analogue scale. The anxiety level of the patient was also measured. RESULTS: During access opening, there was a significant difference in the pain reduction in the articaine group when compared to cold and control group (p value = 0.02). During pulp extirpation, cold group and articaine group showed a significant reduction in pain levels as compared to the control group (p value = 0.001). There was no difference in the pain level during pulp extirpation among the two test arms (articaine and cold) (p value = 0.99). Further, cold significantly reduced the level of anxiety when compared to the articaine or control group (p value = 0.001). CONCLUSION: Hence, cold is a simple, supplementary technique in reducing pain during pulp extirpation. CLINICAL RELEVANCE: Application of cold may help in minimizing the fear of additional injection in managing pain during endodontic treatment.

Needle Gauge Influences Pain Perception During Intrapulpal Anaesthesia - A Randomized Clinical Trial.

OBJECTIVE: The purpose of this randomized trial was to assess the pain perception during intrapulpal anesthesia (IP) using thinner gauge needles and syringes with or without topical anaesthesia as an adjunct. METHODS: One hundred patients, on whom the inferior alveolar nerve block and intraligamentary injections failed, were recruited for the trial. Block randomization was performed and the patients were allocated into 4 groups based on the needle gauge and topical application of anaesthesia prior to IP injection. In two groups (27GN, 31GN) the patients received IP injection with 27 gauge or 31 gauge needles. The patients of other two groups received topical lignocaine-prilocaine mixture prior to the IP injection with 27 or 31 gauge needles, respectively (27GT, 31GT). The visual analogue scale (VAS) was used to assess the pain immediately after IP injection and after cleaning and shaping by a blinded outcome assessor. The Kruskal-Wallis test for overall comparisons followed by the post-hoc analysis using the Conover's test (P<0.05) was done. Chi-square and Fischer exact test was used to assess the proportion of patients who were comfortable during IP anaesthesia. RESULTS: The intensity of pain during IP administration with 31GN and 31GT (3.7 and 2.3 respectively) was significantly less in comparison to 27GN and 27GT (5.6 and 5.7 respectively). The proportion of patients who were significantly comfortable with IP injections in the groups 31GN and 31GT (52% and 80% respectively) were more (VAS<4) when compared to 27GN and 27GT (12% and 8% respectively). Topical application of lignocaine-prilocaine reduced the pain on IP injection significantly when used as an adjunct with 31 gauge needles. The anaesthetic success of IP anaesthesia was comparable and 100% (VAS scoring <4) in all the groups. CONCLUSION: Thinner gauge needles (31 gauge) significantly reduce pain perceived during IP anaesthesia. Topical anaesthesia with lignocaine-prilocaine acts as an effective adjunct only with 31gauge needle.

Endodontic management of double dens invaginatus in maxillary central incisor.

This case report deals with the successful endodontic treatment of double dens invaginatus in maxillary left central incisor. Dens invaginatus is a rare developmental anomaly that is challenging to diagnose and treat. A patient reported with unesthetic appearance and previously attempted endodontic treatment of tooth #21. Cone beam computed tomography revealed the presence of a complex invagination communicating with the periodontium. A combination of techniques enhanced the debridement of the complex invagination. Obturation was performed using warm vertical compaction. The patient was asymptomatic during the follow-up period of 12 months.