Bioburden assessment of necrotic teeth disinfected with sodium hypochlorite, diode laser, and photodynamic therapy using flow cytometry-a randomized double-blinded clinical trial.

This study aimed to comparatively evaluate the disinfecting potential of sodium hypochlorite, diode laser, and photodynamic therapy in non-vital teeth with or without periapical rarefaction. Forty-five patients with the diagnosis of pulp necrosis with apical rarefaction were randomly assigned to three groups (n = 15) based on the disinfection protocol. Access cavities were prepared and pre-instrumentation microbial samples were taken using a paper point. Working length determination followed by cleaning and shaping with rotary files was performed. The canals were lubricated with ethylenediaminetetraacetic acid (EDTA) during instrumentation and finally rinsed with copious amounts of saline. Canals in group 1 were irrigated with 5 mL of 5.25% NaOCl, those in group 2 received irradiation with 808-nm diode laser (30 s, 7W), and those in group 3 were soaked with methylene blue photosensitizer (5 min) before irradiation with 660-nm diode laser (3 min). Post-disinfection microbial samples were collected using a paper point. Pre- and post-disinfection live bacterial counts were analyzed using a flow cytometer. The data were statistically analyzed using one-way ANOVA and Student's t-test. Comparison of pre-instrumentation mean live bacterial count showed no significant difference between the groups (p > 0.05). The mean live bacterial count post-disinfection was 41.07%, 46.99%, and 34.45% in groups 1-3 respectively. A significant reduction in the bacterial count was seen following disinfection in all the groups (p < 0.05). It can be concluded that both diode laser and photodynamic therapy were equally effective as 5.25% NaOCl in reducing the bioburden in root canals. TRIAL REGISTRATION: CTRI/2018/03/012667.

Post-operative analgesia of 2% lignocaine with or without magnesium sulfate for inferior alveolar nerve block in symptomatic mandibular molars - a randomized double blind controlled clinical trial

Background@#Single inferior alveolar nerve block is ineffective in achieving adequate pulpal anesthesia in 30-80% of patients due to anatomical variations, local tissue pH, central sensitization, and several factors. Various supplementary techniques and combination of adjuvants with lignocaine are used to overcome these failures. Magnesium sulfate (MgSO4), one such adjuvant, acts at the N-methyl-D-aspartate glutamate receptor resulting in effective anesthesia. The aim of this prospective, randomized, double-blind, clinical controlled trial was to evaluate the onset, anesthetic efficacy, duration and post-operative analgesia of 2% lignocaine with and without the addition of MgSO4 in patients with symptomatic irreversible pulpitis and apical periodontitis. @*Methods@#Fourty-two patients were randomly divided into three groups: 2% lignocaine (group 1) and 2% lignocaine with MgSO4 (75 mg) and (150 mg) in groups 2 and 3, respectively. Pre-operative vitals and Heft Parker–Visual Analogue Scale (HP-VAS) pain scores were recorded. The onset of anesthesia, anesthetic efficacy, and duration of anesthesia were evaluated post administration of the local anesthetic solution. The post-operative analgesia was examined at intervals of 2, 6, 12, 24, and 48 h. @*Results@#Administration of 150 mg MgSO4 hastens the onset of anesthesia (1.29 min) and produces better anesthetic efficacy (3.29 HP-VAS) compared to group 2 (2.07 min and 9.14 HP-VAS) and group 1 (3.29 min and 35.79 HP-VAS), respectively. The duration of anesthesia was significantly higher in group 3 (247.07 min) compared to that of groups 2 and 1 (190 min and 110.21 min) with P < 0.05. @*Conclusion@#Combining 75 mg or 150 mg of MgSO4 with lignocaine is more effective than 2% lignocaine and 75 mg of MgSO4 is adequate for endodontic procedures.

Calcium ion diffusion levels from MTA and ApexCal in simulated external root resorption at middle third of the root.

The purpose of this study was to investigate diffusion of calcium ions through exposed dentinal tubules following intracanal application of MTA and ApexCal. Thirty extracted anterior teeth were divided into three groups (n = 10): Group I: root canal prepared teeth with unfilled canals served as control; Group II: root canal space filled with MTA; Group III: root canal space filled with ApexCal. The teeth were decoronated, and root canal prepared to its working length and irrigated with EDTA and NaOCl. To simulate external root resorption, defects were created on the external surface of the root at the middle thirds. MTA/ApexCal was introduced into the canal and entrance sealed with IRM. The teeth were then coated with varnish except at the defect. Each tooth was immersed in a vial containing deionized water after which the release of Ca(2+)from the defects into the deionized water was measured at 1, 7, 12, 14, and 28 days. Ca(2+)concentrations of the immersion media were measured using a spectrometer. The post hoc-Bonferroni Alpha test (with mean difference significant at the 0.05 level) was done to statistically analyse the results using spss 11.5 software for Windows. The results showed greater calcium release by ApexCal than MTA with a significant increase with time. Within the experimental conditions of the present study APEX CAL may potentially be used in cases of root resorption.